Chest
Clinical Investigations; Articles; Thoracic SurgeryVideothoracoscopic Appearance of First and Recurrent Pneumothorax
Section snippets
Materials and Methods
All patients presenting with SP between December 1991 and December 1993 were included in the study except patients with known underlying pulmonary disease at presentation. An SP was defined as recurrent if radiologic proof of a previous ipsilateral episode was available.
All patients underwent videothoracoscopy under general anesthesia with double-lumen intubation. The lung surface and the pleural cavity were thoroughly inspected. During the procedure, the lung was reinflated in order to detect
Age
A comparison of clinical results of patients with first and recurrent pneumothorax is summarized in Table 1. There were 82 patients included in the study. Of these, 61 presented with their first pneumothorax (74%) and 21 (26%) had suffered from recurrent pneumothorax. There were 64 men (mean [±SD] age, 32.7± 15.1 years) and 18 women (mean age, 31.6±13.7 years) included in the study. Mean age of all patients was 32.4±14.7 years. There was no significant difference in age between patients with
Discussion
The cause of SP is unknown. Mostly, SP is attributed to rupture of a subpleural bleb or bulla. The etiology of bulla and bleb formation is obscure. The high incidence of adhesions, in 25% (15 of 61) of patients with first SP, suggests that an inflammatory reaction has preceded the event of SP. Maybe in these patients a previous episode of SP has passed unnoticed.2 These adhesions were found significantly more frequently in patients with blebs or bullae (33%) than in patients with a
Conclusions
Smoking and bullous lesions are probably independent risk factors for developing an SP. There are no differences between the thoracoscopic findings in patients with first time and recurrent SP. Apparently, patients without macroscopic abnormalities are not less prone to recurrence of pneumothorax than patients with blebs and bullae. This implicates that thoracoscopy for diagnostic purposes is not necessary in patients with first time SP.
ACKNOWLEDGMENT
The authors would like to thank Wytze P. Oosterhuis, MD, PhD for his assistance with stastistical analyses.
References (27)
- et al.
Videothoracoscopic ligation of bulla and pleurectomy for spontaneous pneumothorax
Ann Thorac Surg
(1991) - et al.
Nd:YAG laser pleurodesis through thoracoscopy: new curative therapy in spontaneous pneumothorax
Ann Thorac Surg
(1989) - et al.
Thoracoscopic stapled resection for spontaneous pneumothorax
J Thorac Cardiovasc Surg
(1993) - et al.
Spontaneous pneumothorax: suggested etiology and comparison of treatment methods
Am J Surg
(1964) - et al.
Regional lung function of non-smokers with healed spontaneous pneumothorax
Chest
(1986) Pneumothorax
Clin Chest Med
(1985)- et al.
Smoking and the increased risk of contracting spontaneous pneumothorax
Chest
(1987) - et al.
Nonsmoking, non-alpha1-antitrypsin deficiency-induced emphysema in nonsmokers with healed spontaneous pneumothorax, identified by computed tomography of the lungs
Chest
(1993) - et al.
Long-term results after tetracyclin pleurodesis in spontaneous pneumothorax
Ann Thorac Surg
(1992) - et al.
Three years experience in video-assisted thoracic surgery (VATS) for spontaneous pneumothorax
J Thorac Cardiovasc Surg
(1994)
Bilateral therapy for unilateral spontaneous pneumothorax
J Thorac Cardiovasc Surg
Bilateral bleb excision through median sternotomy
Am J Surg
Spontaneous pneumothorax
Am J Surg
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2015, The Lancet Respiratory MedicineCitation Excerpt :Other studies have shown no difference in recurrence rates, irrespective of presence or absence of blebs or bullae.4,60,61 There were no differences in the thoracoscopic features of blebs and bullae between patients with first and recurrent pneumothoraces in a study of 82 patients, suggesting that recurrence of pneumothorax cannot be predicted by thoracoscopic features.62 Ouanes-Besbes and colleagues63 assessed a bullae scoring system in a prospective cohort of 80 patients and recorded no difference in recurrence rates between patients with and without dystrophic lesions seen on CT.
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