单孔胸腔镜与单操作孔胸腔镜治疗自发性气胸疗效对比研究

[目的]比较单孔胸腔镜与单操作孔胸腔镜下行肺大疱切除加胸膜固定术的临床治疗效果.[方法]回顾性分析2016年1月至2019年12月本院收治的84例自发性气胸患者,根据手术方法的不同将其分为观察组(单孔胸腔镜手术治疗,n=43)和对照组(单操作孔胸腔镜手术治疗,n=41).记录并比较两组患者切口长度、出血量、手术时间、术...     

Spontaneous Pneumothorax and Lung Carcinoma: Should One Consider Synchronous Malignant Pleural Mesothelioma?

We describe the clinical and pathologic findings of a 68-year-old smoker with previous asbestos exposure who presented with spontaneous hydropneumothorax and was diagnosed with synchronous undifferentiated lung carcinoma and incidental malignant pleural mesothelioma. The synchronous occurrence of these two neoplasms is an extremely rare event with fewer than 20 reported cases in the English literature. The accurate diagnosis of synchronous tumors can be extremely challenging and the identification of a concomitant mesothelioma in our case was not made until an extensive immunohistochemical analysis was done on the resection specimen. Spontaneous pneumothorax occurs much more commonly in patients with malignant mesothelioma than with primary lung carcinomas. Consequently, although synchronous pleural mesotheliomas and lung carcinomas are infrequent, this diagnosis should be considered when a patient with a lung mass and a history of asbestos exposure presents with spontaneous pneumothorax and pleural thickening on imaging. Identification of synchronous tumors is of critical importance for determining the patient's stage and management and can have significant medicolegal implications should the patient seek compensation.     

针刺及穴位注射致气胸38例临床分析

目的:探讨针刺或穴位注射疗法继发气胸的发病机制及其预防方法.方法:回顾性分析38例针刺或穴位注射疗法继发气胸的初起临床征象并将其分为4型:呼吸困难型、休克型、胸痛型和迟发型.阐明各临床型与气胸严重程度的关系以及气胸造成患者死亡的机制.结果:本组报告针刺和穴位注射后发生气胸38例,其中有呼吸困难型4例、休克型16例、胸痛型14例、迟发型4例.经适当处理治疗,38例中痊愈37例,1例呼吸困难型患者死于张力性气胸.结论:针刺或穴位注射疗法继发气胸的发病机制是施针或穴位注射时将毫针或注射针头刺入肺组织内,又由于患者的呼吸动作,毫针或注射针头就像刀尖一样将肺割开,肺泡内的气体漏入胸膜腔而形成气胸.施针或穴位注射时不要将毫针或注射针头刺入肺组织内是预防继发气胸的可靠方法.     

食管异物并发气胸经胸腔闭式引流及食管镜下异物取出1例

食管异物如未及时就诊,继续进食或因处理不当,可引起严重并发症,甚至导致死亡。损伤性食管炎、食管周围炎、食管穿孔、颈间隙感染、纵隔感染或大血管破溃等并发症文献报道较多,气管食管瘘、颈部皮下气肿或纵隔气肿等并发症较少见,而并发气胸者国内外文献罕见报道。2014年5月,我们收治食管异物并发气胸患者1例,报道如下。     

Acute airway distress secondary to iatrogenic injury during Tracheostomy

Laceration and perforation of the membranous trachea are uncommon. We present a case of bilateral Pneumothorax, which developed subsequent to iatrogenic injury during tracheostomy.     

高压氧治疗昏迷合并开放性气胸患者的护理

总结了1例交通意外导致昏迷合并开放性气胸患者高压氧治疗成功的护理体会.护理要点包括:成立急救小组与制订治疗护理方案,做好进舱前的准备,高压氧舱治疗中加压期、稳压期、减压期观察和护理.     

Costal osteochondroma causing pneumothorax in an adolescent: a case report and review of the literature

Costal osteochondroma is a rare but important condition to recognize because of the possibility of serious consequences if not diagnosed and treated promptly. Patients can present with numerous complications, including hemothorax, pneumothorax, nervous or vascular impingement, and fracture. We report the case of a 17-year-old adolescent boy who presented to the pediatrician with intermittent shortness of breath and pleuritic chest pain. A chest x-ray demonstrated a left-sided pneumothorax and triangular opacity in the left chest. A computed tomographic scan of the chest revealed the cause to be a costal exostosis of the anterior fifth rib. The lesion was excised using video-assisted thoracoscopic surgery, which has become an increasingly popular method for treating these lesions, causing significantly less morbidity and allowing for a faster recovery than a major thoracotomy.     

Takao Hiraki's work on interventional radiology

Dr. Takao Hiraki is a scientist carrying out interventional radiology research in the Department of Radiology at Okayama University Medical School, Japan. He has conducted animal and human clinical studies on interventional radiology for various conditions. For example, he clarified the hepatic hemodynamic changes caused by hepatic venous occlusion. He also developed new devices, such as hydrogel coils for the occlusion of the aneurismal sac after an endovascular stent-graft of an aortic aneurysm to prevent endoleakage and small intestinal submucosa-covered stents for transjugular intrahepatic portosystemic shunts. Further, he performed a number of studies on the radiofrequency ablation of lung cancer, mediastinal lymph node metastasis, and computed tomography-fluoroscopy-guided lung biopsies. He intends to continue to dedicate his academic career to expand the role of interventional radiology in clinical medicine.     

Usefulness and Limitation of Manual Aspiration Immediately After Pneumothorax Complicating Interventional Radiological Procedures with the Transthoracic Approach

The goal of this study was to evaluate the efficacy of simple aspiration of air from the pleural space to prevent increased pneumothorax and avoid chest tube placement in cases of pneumothorax following interventional radiological procedures performed under computed tomography fluoroscopic guidance with the transthoracic percutaneous approach. While still on the scanner table, 102 cases underwent percutaneous manual aspiration of a moderate or large pneumothorax that had developed during mediastinal, lung, and transthoracic liver biopsies and ablations of lung and hepatic tumors (independent of symptoms). Air was aspirated from the pleural space by an 18- or 20-gauge intravenous catheter attached to a three-way stopcock and 20- or 50-mL syringe. We evaluated the management of each such case during and after manual aspiration. In 87 of the 102 patients (85.3%), the pneumothorax had resolved completely on follow-up chest radiographs without chest tube placement, but chest tube placement was required in 15 patients. Requirement of chest tube insertion significantly increased in parallel with the increased volume of aspirated air. When receiver-operating characteristic curves were applied retrospectively, the optimal cutoff level of aspirated air on which to base a decision to abandon manual aspiration alone and resort to chest tube placement was 670 mL. Percutaneous manual aspiration of the pneumothorax performed immediately after the procedure might prevent progressive pneumothorax and eliminate the need for chest tube placement. However, when the amount of aspirated air is large (such as more than 670 mL), chest tube placement should be considered.     

Is Pneumothorax Size on Chest X-Ray a Predictor of Neonatal Mortality?

Objective

Pneumothorax in newborns may result in a significant mortality and morbidity. To predict who will survive or die is of great importance in the clinical management. The aim of this study is to address whether assessment of pneumothorax size on chest X-ray may be a predictor of prognosis in newborns presenting with pneumothorax.

Methods

Of 5929 infants admitted to our neonatal intensive care unit (NICU) from January 2007 to April 2011, 60 (1.0%) newborns presenting with pneumothorax were included in the present study. Pneumothorax size was calculated by measuring the widest transverse diameter of pneumothorax area in the posteroanterior view and dividing it by the widest transverse diameter of thoracic cavity above the diaphragm. Clinical data were collected from the patients’ records.

Findings

Overall mortality rate was 30% (18 patients). Pneumothorax size was significantly higher in nonsurvivors (31.1±2.8 vs 16.4±1.4, P < 0.001). The cut-off point of pneumothorax size for predicting survival was determined as 20%. The sensitivity was 72% whereas the specificity 83%. Preterm birth, low birth weight, resuscitation at birth, need for mechanical ventilation and chest tube insertion were of great significance in predicting mortality. However, of overall significant parameters, only pneumothorax size was the independent prognostic factor by regression analysis (P = 0.02)

Conclusion

We conclude that the calculation of pneumothorax size in the newborns is a predictor of prognosis with high sensitivity and specificity. Furthermore newborns with pneumothorax size greater than 20% are likely to have worse prognosis.