Flow chart of the diagnosis and treatment of a case of catamenial pneumothorax]

A 44-year-old female had sudden cough during menstruation. She visited a clinic and mild right pneumothorax was pointed out on chest X-ray. She was admitted to our hospital for continuous pneumothorax and tube drainage was performed. Although pneumothorax improved within a week after drainage, catamenial pneumothorax was suspected because her serum CA 125 showed a high value of 109 U/ml. Therefore diagnostic pneumoperitoneum was performed during the next menstruation, and right pneumothorax occurred. Laparoscopy revealed pelvic endometriosis and thoracoscopy revealed a few small holes in the right diaphragm. The case was diagnosed as catamenial pneumothorax and hormonal treatment was given. She had been well for one year without recurrence of pneumothorax. The authors made a flow chart for diagnosis and treatment based on this case and discussed its value in relation to cases described in the literature.     

Nonsurgical treatment of a catamenial pneumothorax with a Gn-RH analogue

Catamenial pneumothorax is a rarely encountered entity characterized by recurrent pneumothorax concurrent with menstruation. Numerous mechanisms have been postulated in the etiology of catamenial pneumothorax and treatment is still controversial. We report a case of a catamenial pneumothorax successfully treated with a Gn-RH analogue supporting the efficacy of this regimen and the endometriosis theory as an underlying cause of the disease.     

Recurrence rate after surgical treatment of Crohn's disease

In an unselected series of 207 consecutive patients with Crohn's disease diagnosed between 1958 and 1974, 170 underwent a resection of all the macroscopically involved bowel ('radically' resected). Two patients died during the first postoperative month. The crude recurrence rate for the surviving 168 patients was 49%. The cumulative recurrence rate, calculated by the actuarial method, was 53% at 15 years. Age, sex, length of preoperative disease history, localization of the lesions in the bowel, and primary surgical procedures performed had no influence on the recurrence rate. However, the histopathological appearance of the resection margins seemed to influence the prognosis, since the presence of ulcers and/or granulomas was correlated with a significantly increased recurrence rate.     

A very rare entity: catamenial pneumothorax

Catamenial pneumothorax, a variant of spontaneous pneumothorax occurs exclusively in women of menstrual age. Catamenial pneumothorax is associated with a high rate of recurrence. The etiology and pathogenesis is enigmatic. We describe the case of a 42-year-old woman with right-sided catamenial pneumothorax recurring four times, caused by ectopic endometriosis in the pleural layers which was confirmed histopathologically. Surgical treatment should be accomplished during menstruation for optimal visualization of pleurodiaphragmatic endometriosis.     

A case of catamenial pneumothorax due to diaphragmatic endometriosis confirmed by video-assisted thoracoscopic surgery]

We describe a case of catamenial pneumothorax caused by diaphragmatic endometriosis and histologically confirmed thoracoscopically. The patient was a 33-year-old woman who had had recurrent right chest pain starting on the day preceding each menstruation since she was 26 years of age. In June 2001, at the age of 33, she felt right chest pain and developed dyspnea, and so came to our hospital. Chest radiography showed bilateral pneumothorax. Timely thoracoscopy revealed the characteristic appearances of catamenial pneumothorax such as a blueberry spot on the central tendon of the right diaphragm and a purplish-red locus in the right apex. Histopathological examination further confirmed the presence of endometrial tissue on the diaphragm as well as in the lesion of the right lung. Despite resection of the endometrial tissues from the right hemidiaphragm and the lung under thoracoscopy, right pneumothorax recurred after one month. Since then, the patient's condition has been well controlled by therapy with gonadotropin releasing hormone, with no recurrence of catamenial pneumothorax.     

4例月经性气胸临床分析

目的分析月经性气胸(Catamenial Pneumothorax,CPTX)的临床特点、处理及其预后。以提高临床医生对该疾病认识,减少误诊误治。方法分析4例CPTX患者的临床表现、处理和转归。结果 CPTX发病率较低,4例月经性气胸经内外科及妇产科联合治疗,未见复发。结论 CPTX是女性自发性气胸的一种特殊类型,当女性出现气胸时要考虑本病可能,应多科合作,联合治疗。     

Recurrence of colorectal liver metastases after surgical treatment: multifactorial study

BACKGROUND/AIMS: The authors evaluated the significance of various factors regarding the recurrence of colorectal liver metastases (CLM) after liver resection or radiofrequency ablation. METHODOLOGY: 82 patients were operated on for CLM at our department between 1998 and 2003. Radical surgery was performed in 58 patients (74.4%), an palliative surgery in 20 (25.6%). Recurrence of the disease was recorded in 53 patients (71.6%), 21 (28.4%) were without any sign of recurrence. The factors examined in the multifactorial analysis were: age and sex, localization of the primary carcinoma, Dukes classification, grading, histology, microscopically free resection line, chemotherapy and radiotherapy after colorectal or liver surgery, different types of liver resection, radical versus palliative liver surgery, complication after liver surgery, laterality of metastatic process, number of metastases, blood transfusion, staging, repeated liver surgery. Long-rank and Wilcoxon test were used for the statistical evaluation. RESULTS: The factors statistically significant for disease-free interval after liver surgery were: unilaterality of metastatic process, microscopically free resection line, radical versus palliative surgical treatment. The survival rates after liver surgery and after the primary operation were dependent on grading, age, radical versus palliative resection, Dukes classification and staging. CONCLUSIONS: These factors could play an important role as predictors of colorectal cancer recurrence in patients' follow-up period after liver surgery for CLM.     

Diaphragmatic laceration, partial liver herniation and catamenial pneumothorax

Catamenial pneumothorax is a recurrent pneumothorax temporally associated with menstruation. Pathogenesis remains debated however pleural endometriosis or diaphragmatic abnormalities are almost always present. We report the case of a 35-year-old woman with recurrent right catamenial pneumothorax. At thoracoscopy a large laceration of the diaphragm with partial intrathoracic liver herniation was seen. Treatment involved repair of the diaphragmatic lacerations, and pleurodesis. This report shows that large diaphragmatic defects may be observed in patients with catamenial pneumothorax.     

Spiral computerized tomography and video thoracoscopy in catamenial pneumothorax

Catamenial pneumothorax is a rare disease that is usually diagnosed on clinical grounds. Delay in diagnosis can lead to considerable morbidity. We describe a case in which spiral CT scan and videothoracoscopy led to early objective diagnosis and management.     

Recurrence after surgical resection of intrahepatic cholangiocarcinoma

We aimed to assess the patterns of recurrence after surgery for intrahepatic cholangiocarcinoma (ICC) and the outcomes of treatment in patients with recurrence. From 1981 to 1999, 123 patients with ICC underwent hepatectomy. The 3-year and 5-year survival rates were significantly higher in patients after curative resection (n = 56; 53%, 50%) than in patients after noncurative resection (n = 67; 7%, 2%; P < 0.0001). In 54 patients followed-up after curative resection, the rate of recurrence after surgery was 46%. The recurrences were in the liver (56%), abdomen (disseminated; 24%), and lymph nodes (20%). The rates of recurrence were significantly higher in patients with various classifications of mass-forming ICC tumors (P = 0.039) than in those with other types of tumors, and in patients with tumors over 3 cm in greatest diameter than in those with tumors 3 cm or less (P = 0.006). Hepatic recurrence, abdominal dissemination, and intraductal recurrence were significantly related to tumors that included mass-forming ICC (P = 0.002), tumors that included periductal infiltrating ICC (P = 0.009), and tumors that included intraductal growth ICC (P = 0.038), respectively. Seven patients with recurrence underwent radiation, chemotherapy, immunotherapy, or surgical resection. Only 2 patients, with intrahepatic metastasis and intraductal recurrence, respectively, had good outcomes after surgery. The effectiveness of other treatments has not been established.     

The surgical treatment of spontaneous pneumothorax by video-thoracoscopy.

Since March 1991, 66 patients with spontaneous pneumothorax were treated thoracoscopically employing the principles of minimally invasive surgery. Of these cases, 14 involved a first occurrence, 18 had a pneumothorax longer than 7 days, and 34 were recurrences; causative lung disease was determined in 25 patients. The blebs and bullae were ligated with chromic catgut Roeder loop or resected with the Endo-GIA stapler. If pathological changes to the lung consistent with Vanderschueren's stage IV were found (n = 36), the treatment was extended to include a parietal pleurectomy. No complications requiring therapy were encountered, the average postoperative hospital stay was 3.2 days. During an average observation period of 10 months (1-27) the recurrence rate was 4.5%. Thoracoscopic therapy proved to be a simple and safe method for all forms of spontaneous pneumothorax.     

Recurrence of intrahepatic cholangiocarcinoma nine years after surgical resection

This paper reports a rare case of intrahepatic cholangiocarcinoma (ICC) which recurred nine years after surgical resection. The patient underwent right hepatic trisegmentectomy with lymph node dissection and biliary tract reconstruction for a tumor in the right lobe of the liver. The patient was diagnosed with ICC, intraductal growth (IG) type. Nine years after the operation a rise of tumor markers and a recurrent lesion in the remnant liver were recognized and the patient underwent S2 subsegmentectomy with tumor thrombectomy and biliary tract reconstruction. The resected specimen showed well differentiated adenocarcinoma, which consisted of chiefly intraductal growth component. The patient is still alive 26 months after the second operation without recurrence. It is important to observe the patient carefully cosidering that it is possible for an IG type cholangiocarcinoma to recur a long time after surgical treatment, and surgical treatment for the recurrent tumor should be tried for long survival.     

Expression of CA125 in thoracic endometriosis in a patient with catamenial pneumothorax.

A 40-year-old woman had experienced monthly right thoracic pain and productive cough occurring at the beginning of her menstrual period. X-ray findings indicated a diagnosis of catamenial pneumothorax. The serum CA125 level was very high at 159.6 U/ml. Thoracoscopy showed multiple dark cherry-colored nodules with neovascularization on the diaphragm. Following partial resection of the diaphragm thoracic endometriosis was diagnosed. Immunohistochemical staining of these endometrial cells showed antibodies to CA125. She has been well without recurrence for 15 months, and her serum CA125 level was within the normal range after operation.