Effect of meteorological factors on first episode and recurrence of primary spontaneous pneumothorax

SUMMARY OBJECTIVE: In this study, we evaluated the clinical characteristics and seasonal distribution of patients with primary spontaneous pneumothorax and examined the relationships between meteorological factors and pneumothorax development overall and in terms of first episode and recurrence. METHODS: The hospital records of 168 pneumothorax patients treated in our clinic between January 2016 and December 2020 were reviewed retrospectively. A cluster was defined as two or more patients with pneumothorax presenting within three consecutive days. Meteorological factors were compared between days with and without pneumothorax patients. This comparison was based on meteorological data from the day of symptom onset (D), the day before symptom onset (D1), and the difference between those days (D-D1). Meteorological data from the index day (D) were also compared between patients with first episode and recurrence of pneumothorax. RESULTS: The study included 149 (88.7%) men and 19 (11.3%) women. The mean age was 25.02±6.97 (range, 17-35; median, 26) years. Of note, 73 (43.4%) patients underwent surgery. The highest number of patients presented in November (n=19, 11.3%). In terms of season, most presentations occurred in autumn. Humidity was significantly lower on recurrence days compared with first episode (p=0.041). CONCLUSION: Our results indicated that meteorological factors (i.e., atmospheric pressure, humidity, wind speed, temperature, and precipitation) were not associated with pneumothorax development. By comparing the patients with first episode and recurrence, the humidity was significantly lower in the recurrence group.

Association between ventilatory settings and pneumothorax in extremely preterm neonates

OBJECTIVES: Pneumothorax is a catastrophic event associated with high morbidity and mortality, and it is relatively common in neonates. This study aimed to investigate the association between ventilatory parameters and the risk of developing pneumothorax in extremely low birth weight neonates. METHODS: This single-center retrospective cohort study analyzed 257 extremely low birth weight neonates admitted to a neonatal intensive care unit between January 2012 and December 2017. A comparison was carried out to evaluate the highest value of positive end-expiratory pressure (PEEP), peak inspiratory pressure (PIP), and driving pressure (DP) in the first 7 days of life between neonates who developed pneumothorax and those who did not. The primary outcome was pneumothorax with chest drainage necessity in the first 7 days of life. A matched control group was created in order to adjust for cofounders associated with pneumothorax (CRIB II score, birth weight, and gestational age). RESULTS: There was no statistically significant difference in PEEP, PIP, and DP values in the first 7 days of life between extremely low birth weight neonates who had pneumothorax with chest drainage necessity and those who did not have pneumothorax, even after adjusting for potential cofounders. CONCLUSIONS: Pressure-related ventilatory settings in mechanically ventilated extremely low birth weight neonates are not associated with a higher risk of pneumothorax in the first 7 days of life.

Deficiencia de alfa-1 antitripsina y neumotórax espontáneo. ¿Solo una coincidencia? / Alpha-1 antitrypsin deficiency and spontaneous pneumothorax. Just a coincidence?

Resumen La deficiencia de alfa-1 antitripsina (AAT) es uno de los trastornos hereditarios más frecuentes y con mayor incidencia en pacientes con enfermedad pulmonar obstructiva crónica (EPOC). Se desconoce su prevalencia en aquellos con neumotórax espontáneo. El objetivo fue estimar la prevalencia de deficiencia de AAT en sujetos con neumotórax espontáneo. El estudio fue prospectivo y de corte transversal en pacientes con neumotórax espontáneo primario. Se excluyeron aquellos con neumotórax secundario. Se realizó cuantificación de AAT en suero por nefelometría y posterior genotipificación rápida (PCR en tiempo real) para detectar los alelos de deficiencia más prevalentes (Z y S) en aquellos con concentraciones séricas ≤ 120 mg/dl. Se incluyeron 58 pacientes con neumotórax espontáneo primario. La edad promedio fue de 34 ± 13 años con predominio de sexo masculino (72%) y alta prevalencia de tabaquismo actual y pasado (60%). Del total, el 26% (IC95%: 15-39) presentó concentraciones de AAT ≤ 120mg/dl. Encontramos 7 formas deficitarias (12%; IC 95%: 5-23%). Un paciente presentó una forma grave Pi*ZZ (1.7%), 3 fueron heterocigotos Z (5.2%) y 3 heterocigotos S (5.2%). La prevalencia de variantes deficitarias de AAT fue alta en este grupo con neumotórax espontáneo.

Abstract Alpha-1 antitrypsin (AAT) deficiency is one of the most common inherited disorders with a higher incidence in patients with chronic obstructive pulmonary disease (COPD). Its prevalence in patients with spontaneous pneumothorax is unknown. The objective was to estimate the prevalence of AAT deficiency in patients with spontaneous pneumothorax. This was a prospective cross-sectional study, in patients with spontaneous pneumothorax, where those with secondary pneumothorax were excluded. Quantification of serum AAT by nephelometry and subsequent rapid genotyping (real time PCR) was performed, in order to detect the most prevalent deficiency alleles (Z and S) in those subjects with serum AAT concentrations ≤ 120 mg/dl. Fifty-eight patients with primary spontaneous pneumothorax were included. The average age was 34 ± 13 years with male predominance (72%) and high prevalence of current and past smoking (60%). Twenty six percent of them (95% CI: 15-39) presented AAT serum concentrations ≤ 120mg/dl. We found 7 deficiency variants (12%; IC 95%: 5-23%). One patient presented a severe Pi*ZZ form (1.7%), 3 were heterozygotes Z (5.2%) and 3 heterozygotes S (5.2%). The prevalence of AAT deficient variants was high in patients with spontaneous pneumothorax.

Prevalencias de complicaciones asociadas a la instalación de catéter venoso central para hemodiálisis / Prevalence of complications associated with central venous catheter instalation for hemodyalisis

Background: Placing central venous lines under ultrasonographic guidance reduces the complications of the procedure. Aim: To compare prevalences of complications of central venous line placements with or without ultrasonographic guidance. Material and Methods: Descriptive study that contemplated the comparison of two groups of patients subjected to a central venous line placement at a nephrology service for renal replacement therapy. In one group of 100 patients, the line was placed without ultrasonographic guidance between 2008 and 2012. Between 2015 and 2017 the line was placed in 138 patients using ultrasonographic guidance. The prevalences of complications with both types of procedures were recorded. Results: The frequency of complications of procedures with and without ultrasonographic guidance was 0.7 and 18% respectively (prevalence ratio 0.04, 95% confidence interval 0-0.3). Ninety five percent of recorded complications were arterial puncture, followed by hematomas in 10% and pneumothorax in 5%. The higher prevalence of complications was observed in emergency line placement without ultrasonographic guidance. There was a direct association between the number of line placement attempts in a single procedure and the prevalence of complications. Conclusions: Ultrasonographic guidance is associated with a reduction in the prevalence of central venous line complications.

Presión positiva continua en la vía aérea comparada con la respiración mecánica asistida en prematuros de 28 a 32 semanas de gestación con administración precoz de surfactante pulmonar / Nasal CPAP versus mechanical ventilation in 28 to 32-week preterm infants with early surfactant administration

Introducción. La presión positiva continua en la vía aérea ( Continuous Positive Airway Pressure , CPAP) es útil en prematuros de 28 a 32 semanas de gestación con síndrome de dificultad respiratoria, pero no se ha precisado si es mejor que la respiración mecánica asistida después de la administración precoz de surfactante pulmonar. Objetivo. Comparar la incidencia de eventos adversos en prematuros de 28 a 32 semanas de gestación con síndrome de dificultad respiratoria atendidos con surfactante y respiración mecánica asistida o CPAP de burbuja. Materiales y métodos. Se atendieron 147 neonatos con respiración mecánica asistida y 176 con CPAP, ninguno de los cuales presentaba asfixia perinatal o apnea. Resultados. La incidencia de fracaso de la CPAP fue de 6,5 % (IC 95% 11,3-22,8 %). Fallecieron 29 pacientes, 7 de los cuales habían recibido CPAP (4,0 %) y, 22, respiración mecánica asistida (15,0 %; p<0,001). El riesgo relativo (RR) de morir de quienes recibieron CPAP, comparado con el de quienes recibieron respiración mecánica asistida, fue de 0,27 (IC 95% 0,12-0,61), pero, al ajustar por los factores de confusión, el uso de CPAP no implicó mayor riesgo de morir (RR=0,60; IC 95% 0,29-1,24). La letalidad con respiración mecánica asistida fue de 5,70 (IC 95% 3,75-8,66) muertes por 1.000 días-paciente, mientras que con CPAP fue de 1,37 (IC 95% 0,65-2,88; p<0,001). La incidencia de neumopatía crónica fue menor con CPAP (RR=0,71, IC 95% 0,54-0,96), al igual que la de hemorragia cerebral (RR=0,28; IC 95% 0,09-0,84) y la de sepsis (RR=0,67; IC 95% 0,52-0,86), pero fue similar en cuanto a escapes de aire (RR=2,51; IC 95% 0,83-7,61) y enterocolitis necrosante (RR=1,68; IC 95% 0,59-4,81). Conclusión. La incidencia de neumopatía crónica, hemorragia ventricular y sepsis es menor con el uso de CPAP.

Introduction: Continuous positive airway pressure (CPAP) is useful in low birth weight infants with respiratory distress, but it is not known if it is a better alternative to mechanical ventilation after early pulmonary surfactant administration. Objective: To compare the incidence of adverse events in 28 to 32-week newborns with respiratory distress managed with mechanical ventilation or CPAP after early surfactant administration. Materials and methods: In total, 176 newborns were treated with CPAP and 147 with mechanical ventilation, all with Apgar scores >3 at five minutes and without apnea. Results: The incidence of CPAP failure was 6.5% (95% CI: 11.3-22.8%); 29 patients died: 7 with CPAP (4.0%) and 22 with mechanical ventilation (15.0%, p<0.001). The relative risk of dying with CPAP versus mechanical ventilation was 0.27 (95% CI: 0.12-0.61), but after adjusting for confounding factors, CPAP use did not imply a higher risk of dying (RR=0.60; 95% CI: 0.29-1.24). Mechanical ventilation fatality rate was 5.70 (95% CI: 3.75-8.66) deaths/1,000 days-patient, while with CPAP it was 1.37 (95% CI: 0.65-2.88, p<0.001). Chronic lung disease incidence was lower with CPAP than with mechanical ventilation (RR=0.71; 95% CI: 0.54-0.96), as were intracranial hemorrhage (RR=0.28, 95% CI: 0.09-0.84) and sepsis (RR=0.67; 95%CI: 0.52-0.86), and it was similar for air leaks (RR=2.51; 95% CI: 0.83-7.61) and necrotizing enterocolitis (RR=1.68, 95% CI: 0.59-4.81). Conclusion: CPAP exposure of premature infants with respiratory distress syndrome is protective against chronic lung disease, intraventricular hemorrhage and sepsis compared to mechanical ventilation. No differences were observed regarding air leak syndrome or death.

Incidencia del neumotórax en el Hospital Julio Trigo López / Incidence of pneumothorax in Julio Trigo Hospita

Objetivos: determinar el comportamiento del neumotórax como urgencia en el Hospital Julio Trigo López, en el período comprendido entre 1995-2004. Métodos: se realizó un estudio descriptivo, retrospectivo de corte transversal. Se analizaron las historias clínicas de los 555 pacientes con neumotórax en el Hospital Julio Trigo López en el período comprendido entre 1995 a 2004. El universo estuvo constituido por los 555 pacientes con diagnóstico de neumotórax, que fueron atendidos en nuestro hospital durante el período señalado. Resultados: el neumotórax es más frecuente en el sexo masculino (75,1 por ciento), y los grupos de edades afectados con más frecuencia se encontraron entre 21 y 40 años (52 por ciento). El 78 por ciento de los pacientes con neumotórax espontáneo son fumadores, y de los 43 pacientes que no tienen hábito de fumar, 37 de ellos tienen antecedentes de afecciones respiratorias, con predominio del enfisema, el asma bronquial y la bronquiectasia. Los neumotórax espontáneos fueron menos frecuentes en 195 pacientes (35,1 por ciento) en relación con los neumotórax traumáticos, que se presentaron en 360 pacientes (64,9 por ciento), y de ellos, 127 presentaron hemoneumotórax. Hubo 62 pacientes (11 por ciento) con complicaciones, y fueron las más frecuentes: la persistencia del cuadro (4,7 por ciento) y el shock hipovolémico (3,4 por ciento). Conclusiones: existe una relación directa entre las enfermedades crónicas respiratorias y los neumotórax espontáneos. Los neumotórax espontáneos recidivantes están relacionados con el hábito de fumar, la edad avanzada y con las afecciones respiratorias crónicas(AU)

Objectives: to determine the behavior of pneumothorax as emergency in Julio trigo Hospital from 1995 to 2004. Methods: a cross-sectional, retrospective and descriptive study was conducted. The medical records from 555 patients with pneumothorax admitted in above mentioned hospital between 1995-2004. Universe included 555 patients diagnosed with pneumothorax, seen in our hospital during the above period. Results: the pneumothorax is more frequent in male sex (75.1 percent ) and in age groups between 21 and 40 years old (52 percent). The 78 percent of patients presenting with spontaneous pneumothorax are smokers and from the 43 non-smokers patients 37 of them have backgrounds of respiratory affections with predominance of emphysema, the bronchial asthma and bronchiectasis. The spontaneous pneumothorax were less frequent in 195 patients (35.1 percent) related to those traumatic pneumothorax ones present in 360 patients (64.9 percent) and from them, 127 had hemo-pneumothorax. There were 62 patients (11 percent) with complications and the more frequent ones included: the persistence of this situation (4.7 percent) and hypovolemic shock (3.4 percent). Conclusions: the is a close relationship among the respiratory chronic diseases and the spontaneous pneumothorax. The relapsing spontaneous types are related to smoking, old age and chronic respiratory affections(AU)

Climatic conditions and the onset of primary spontaneous pneumothorax: an investigation of the influence of solar terms

To study the correlation between climatic changes and the development of primary spontaneous pneumothorax [PSP]. We retrospectively studied the relationship between 337 patients with conservatively treated PSP and meteorological conditions during a 3-year period in the urban area of Xi'an, China. The comparison was made depending on solar terms and on different aspects of atmospheric pressure, outdoor temperature, relative humidity, and wind speed. Significant differences were found between PSP and non-PSP days depending on daily mean values of outdoor temperature and atmospheric pressure [p = 0.001 and p < 0.001, respectively]. However, no obvious differences of meteorological factor variations between the 'PSP day' and the 'pre-PSP day' on days with and without PSP were found. The occurrence of PSP was associated with the solar terms Spring Equinox [p < 0.05] and End of Heat [p < 0.01]. Among the factors examined in our study, daily mean outdoor temperature and atmospheric pressure showed a strong correlation with the occurrence of PSP. The solar terms Spring Equinox and End of Heat were found to be closely related with PSP development, which shed light on a new way for PSP incidence evaluation

Factores asociados a la recidiva de un neumotórax espontáneo primer episodio: estudio de casos y controles / Factors associated with recurrence of spontaneous pneumothorax first episode: case - control study

INTRODUCCIÓN: El neumotórax espontáneo (NEP) es la presencia de aire en la pleura sin etiología identificable. Después de un primer episodio 30 por ciento recidiva, aún sin consenso del manejo de ambos. Postulamos relación entre datos del paciente consultante por NEP con la recidiva de un neumotórax espontáneo primario primer episodio (NEPPE). OBJETIVO: Identificar características del paciente recidivado del NEPPE (RNEP) versus el paciente sin recidiva. MATERIAL Y MÉTODO: Estudio de casos y controles. Se analizaron datos de pacientes atendidos en el Servicio de Cirugía del Hospital Gustavo Fricke entre Enero de 2006 y Junio de 2010. Nuestro n=41 con 17 casos (16 hombres, mediana edad 21 años) de RNEP y 24 controles (23 hombres, mediana edad 20,5 años) para NEPPE no recidivados. Se describieron datos y se analizó asociación entre variables en función de los casos y controles a través de Odds Ratio. RESULTADOS: Se encontró que los pacientes que debutaron su NEPPE en la temporada de otoño tenían mayor recidiva que las otras temporadas con OR de 7,8 (IC 95 por ciento: 1,40-53,85). El tabaco no muestra asociación con OR de 0,297 (IC 95 por ciento:0,062-1,315). DISCUSIÓN: No se encontró significancia estadística entre otras variables y la recidiva o no del NEPPE. Concluimos que debutar un NEPPE en otoño predispone a RNEP, aunque faltarían estudios con una muestra mayor para establecer conductas. A pesar de que algunos estudios dan importancia al tabaco en la recidiva del NEPPE, no encontramos igual asociación que puede explicarse por la poca gente de nuestro grupo que fumaba.

INTRODUCTION: Spontaneous pneumotorax (SP) is defined as the presence of air into the pleura without recognizable cause. After a first episode of SP, 30 percent of them recur, without consensus about their management. We postulated a relationship between anamnesis and recurrence of a first episode of SP. OBJETIVE: Our aim was to identify characteristics of patients who recurred compared with patients without recurrence. MATERIAL AND METHOD: We analyzed information of patients attended treated in Surgery Service of Gustavo Fricke Hospital between January of 2006 and Juny of 2010. Our patients were 41, with17 patients (16 male, average age of 21) with recurred SP and 24 controls (23 male, average age of 20.5) with non recurred SP. Data were described and relationship between variables in cases and control patients using Odds Ratio was analyzed. RESULTS: Patients with their first episode of SP occurred in autumn were more likely to recur with an OR of 7,8 (CI 95 percent: 1.40-53.85). Smoking did not show relationship with recurrence (OR of 0.297, CI 95 percent 0.062-1.315). Other variables were not statistically significant for recurrence or not of first episode of SP. DISCUSSION: Although more studies with a larger amount of patients are needed to define a proper management, we concluded that a first episode of SP occurred in autumn predisposes a recurrence of this disease. In addition, we did not found relationship between smoking and SP recurrence, maybe because the low prevalence of smoking in our sample, in contrast with some studies which postulate it as a risk factor.

CT guided transthoracic Needle Aspiration biopsy; effect of size of the lesion on the rate of pneumothorax

To analyze the rate of Pneumothorax after CT guided TNAB of lung masses, and correlating it with the size of the lesion. Descriptive study. Department of Radiology Mayo Hospital, Lahore. From June 2002 to April 2003, Seventy patients underwent CT guided FNA of the chest masses. Out of Seventy, 18 patients i.e.; 26% developed Pneumothorax. Lesion less than 1 cm, out of 6 patients 3 developed pneumothorax [50%], lesions 1-2 cm 5 out of 11 developed pneumothorax [45%], lesions with size of 2-3 cm 5 out of 14 patients developed pneumothorax [35%], lesions between 3-4 cm 2 out of 8 developed pneumothorax [25%], lesion sized 4-5 cm 1 out of 15 developed pneumothorax [6%], and lesion with more than 5 cm size 1 out of 16 developed pneumothorax [6%]. The study shows that the rate of Pneumothorax after CT guided TNAB of Lung Masses increases as the size of the lesion decreases

Chest Computed Tomography (CT) Immediately after CT-Guided Transthoracic Needle Aspiration Biopsy as a Predictor of Overt Pneumothorax

BACKGROUND/AIMS: This study examined the correlation between pneumothorax detected by immediate post-transthoracic needle aspiration-biopsy (TTNB) chest computed tomography (CT) and overt pneumothorax detected by chest PA, and investigated factors that might influence the correlation. METHODS: Adult patients who had undergone CT-guided TTNB for lung lesions from May 2003 to June 2007 at Seoul National University Bundang Hospital were included. Immediate post-TTNB CT and chest PA follow-up at 4 and 16 hours after CT-guided TTNB were performed in 934 patients. RESULTS: Pneumothorax detected by immediate chest CT (CT-pneumothorax) was found in 237 (25%) and overt pneumothorax was detected by chest PA follow-up in 92 (38.8%) of the 237 patients. However, overt pneumothorax was found in 18 (2.6%) of the 697 patients without CT-pneumothorax. The width and depth of CT-pneumothorax were predictive risk factors for overt pneumothorax. CONCLUSIONS: CT-pneumothorax is very sensitive for predicting overt pneumothorax, and the width and depth on CT-pneumothorax are reliable risk factors for predicting overt pneumothorax.

Incidência de pneumotórax residual após simpatectomia torácica videotoracoscópica com e sem drenagem pleural e sua possível influência na dor pós-operatória / The incidence of residual pneumothorax after video-assisted sympathectomy with and without pleural drainage and its effect on postoperative pain

OBJETIVO: Avaliar se o pneumotórax residual após simpatectomia torácica videotoracoscópica tem incidência diferente quando utilizada a drenagem pleural pós-operatória ou não e se este pneumotórax residual, quando presente, pode influenciar a dor pós-operatória até o 28º dia. MÉTODOS: Foram incluídos todos os pacientes com queixa de hiperidrose palmoplantar primária atendidos no Ambulatório de Cirurgia Torácica do Hospital Estadual Sumaré, de julho a dezembro de 2006. Todos foram submetidos à simpatectomia do terceiro gânglio torácico por videotoracoscopia e aleatorizados para receber ou não drenagem pleural pós-operatória por 3 h. Todos foram avaliados no pós-operatório imediato com radiogramas de tórax e tomografia computadorizada de tórax de baixa emissão de energia para detecção de pneumotórax residual. Foram avaliados quanto à dor pós-operatória em diferentes momentos até o 28º dia de pós-operatório, por meio de escala numérica visual e dosagem requerida de analgésicos opióides. RESULTADOS: Foram incluídos 56 pacientes neste estudo, 27 com drenagem pleural bilateral e 29 sem drenagem pleural. Não houve diferença estatística entre a incidência de pneumotórax residual após simpatectomia com e sem drenagem pleural. O pneumotórax residual, quando presente e diagnosticado por qualquer um dos métodos, não influenciou a dor pós-operatória até o 28º dia. CONCLUSÃO: Concluiu-se que a drenagem pleural tubular fechada, por um período de 3 h, no pós-operatório imediato de simpatectomia torácica videotoracoscópica, foi tão eficiente quanto a não drenagem, em relação à reexpansão pulmonar e à presença de pneumotórax residual. O pneumotórax residual, quando presente, não interferiu na dor pós-operatória até o 28º dia.

OBJECTIVE: To determine the incidence of residual pneumothorax after video-assisted thoracic sympathectomy, with and without postoperative pleural drainage, and to evaluate the possible influence of this type of pneumothorax on postoperative pain within the first 28 postoperative days. METHODS: All patients presenting symptoms consistent with primary palmoplantar hyperhidrosis and treated at the Thoracic Surgery Outpatient Clinic of the State Hospital of Sumaré between July and December of 2006 were included. All were submitted to sympathectomy up to the third ganglion using video-assisted thoracoscopy and were randomized to receive or not receive postoperative pleural drainage for 3 h. Chest X-rays and low-dose computed tomography scans of the chest were performed on the first postoperative day in order to determine the incidence of residual pneumothorax. At different time points up to postoperative day 28, patient pain was assessed using a visual numeric scale and by measuring the quantity of opioid analgesics required. RESULTS: This study comprised 56 patients, 27 submitted to bilateral pleural drainage and 29 not submitted to drainage. There was no statistical difference between the two groups in terms of the incidence of post-sympathectomy residual pneumothorax. Residual pneumothorax diagnosed through any of the methods did not influence pain within the first 28 postoperative days. CONCLUSION: Performing closed pleural drainage for 3 h immediately after video-assisted thoracic sympathectomy did not affect lung re-expansion or the incidence of residual pneumothorax. When residual pneumothorax was present, it did not affect pain within the first 28 postoperative days.

El aumento de la frecuencia del neumotórax iatrogénico en un hospital universitario / The increase of the frequency of the iatrogenic chokes in a university hospital

Antecedentes: En los últimos años se ha observado un aumento en la incidencia de neumotórax iatrogénicos en el Hospital de Clínicas. Objetivo: Analizar las causas relacionadas con este medio. Material y método: Se analizaron en forma retrospectiva las historias clínicas de 73 enfermos con neumotórax iatrogénico tratados entre julio de 2002 y abril de 2004 en la División de Cirugía Torácica. Resultados: Sobre un total de 105 neumotórax, 73 (70%) fueron secundarios a procedimientos diagnóstico o terapéuticos. El promedio de edad fue de 72 años (16 a 98). Sus causas fueron: acceso venenoso central 35, barotrauma 16, toracocentesis 16, colocación de sonda nasogástrica tipo K 108 2, colocación de marcapasos 1, postoperatorio de Nissen laparoscópico 1, lesión de vía aérea por intubación 1 y traqueostomía 1. Se encontraban internados en UTI 55 enfermos y, de ellos, 50 bajo ARM. El tratamiento utilizado fue avenamiento pleural; 55 casos se lo llevó a cabo en la Unidad de cuidados intensivos. Hubo 8 (11%) complicaciones vinculadas con el procedimiento: 4 pérdidas aéreas prolongadas que cedieron espontáneamente, 3 fallas de reexpansión (1 requirío nuevo drenaje pleural) y 1 desplazamiento del drenaje (re-colocación). Murieron 41 enfermos por la evolución de su enfermedad de base. Conclusiones: La alta incidencia actual del neumotórax iatrogénico en el Hospital Universitario, superior a la comunicada en otros ambientes, debe ser un signo de alarma que obligue a revisar las prácticas y conductas terapéuticas que pueden desencadenar tal complicación.

Aetiology and clinical profile of spontaneous pneumothorax in adults.

BACKGROUND: Limited information is available on epidemiology of spontaneous pneumothorax (SP) from India. The present study was aimed at studying aetiology and clinical profile of patients with SP. METHODS: All patients admitted at a tertiary care hospital with the diagnosis of SP between January 2001 and March 2002 were prospectively studied. Detailed demographic and clinical data were recorded. Patients were divided into two groups-primary spontaneous pneumothorax (PSP), if no underlying aetiology for pneumothorax was found, and secondary spontaneous pneumothorax (SSP), when an underlying respiratory disorder could be identified. The clinical features were compared between the two groups. RESULTS: Sixty patients (12 with PSP and 48 with SSP) were included in the study. Annual incidence of SP was calculated as 99.9 per 100,000 hospital admissions. Annual incidence figures for PSP and SSP were 20.0 and 80.0 per 100,000 hospital admissions respectively. Age distribution showed a biphasic pattern and the overall male to female ratio was 5 : 1. The most common cause of SSP was found to be pulmonary tuberculosis (41.7%). CONCLUSIONS: Pneumothorax is more common among men. In India, SSP is far more common than PSP, and the predominant underlying cause is pulmonary tuberculosis.

Epidemiología quirúrgica del neumotórax, experiencias y resultados en el Hospital Manuel Fajardo (1988-2003) / Surgical epidemiology of pneumothorax, experiences and results in Manuel Fajardo Hospital (1988-2003)

Se realizó un estudio descriptivo, prospectivo, de corte transversal, en 154 pacientes con diagnóstico clínico-radiológico de neumotórax, que fueron atendidos en el Hospital Universitario Manuel Fajardo en el período comprendido entre 1988 y 2003. En todos los casos se siguió un algoritmo de trabajo confeccionado por el Grupo de Cirugía Torácica del centro hospitalario. El objetivo fue estudiar el tratamiento del neumotórax en el hospital a partir de un algoritmo de trabajo y de determinar conductas, complicaciones y mortalidad. Predominaron el sexo masculino, los pacientes con hábito de fumar y el tipo de neumotórax espontáneo. Más de la mitad de los pacientes necesitó solamente la pleurotomía mínima, el 24,7 por ciento requirió una toracotomía y el 3,9 por ciento resolvió con tratamiento médico. Las principales indicaciones de la toracotomía fueron el neumotórax persistente y el recidivante. La complicación más frecuente después de la pleurotomía fue la obstrucción de la sonda pleural y la fuga de aire posterior a la toracotomía. La resección y pleurectomía parietal ofrecieron el 100 por ciento de efectividad. La mortalidad quirúrgica fue nula. El algoritmo de trabajo del Grupo de Cirugía Torácica permitió estandarizar el tratamiento del neumotórax en el centro y proporcionar criterios sobre la efectividad de la atención médica con disminución de las complicaciones y eliminación de la mortalidad por esta enfermedad(AU)

e/she was carried out a descriptive, prospective study, of traverse court, in 154 patients with clinical-radiological diagnosis of neumotórax that were assisted in the University Hospital Manuel Fajardo in the period understood between 1988 and 2003. In all the cases a work algorithm was continued made by the Group of Thoracic Surgery of the hospital center. The objective was to study the treatment of the neumotórax in the hospital starting from a work algorithm and of determining behaviors, complications and mortality. They prevailed the masculine sex, the patients with habit of smoking and the type of spontaneous neumotórax. More than half of the patients he/she needed only the minimum pleurotomía, 24,7 percent it required a toracotomía and 3,9 percent it solved with medical treatment. The main indications of the toracotomía were the persistent neumotórax and the recidivante. The most frequent complication after the pleurotomía was the obstruction of the probe pleural and the flight of later air to the toracotomía. The resection and parietal pleurectomía offered 100 percent of effectiveness. The surgical mortality was null. The algorithm of work of the Group of Thoracic Surgery allowed to standardize the treatment of the neumotórax in the center and to provide approaches about the effectiveness of the medical attention with decrease of the complications and elimination of the mortality for this illness(AU)

Non-biliary mishaps during laparoscopic cholecystectomy.

BACKGROUND: The most important complications of laparoscopic cholecystectomy (LC) are biliary tract injuries. Non-biliary complications can be equally devastating, but have received less attention in literature. METHODS: The case files of 1748 patients who underwent LC over a period of seven years (1997-2003) in our department were retrospectively reviewed to identify non-biliary complications and their management. RESULTS: Nine patients (0.5%) sustained significant non-biliary injury while undergoing LC. The commonest was duodenal perforation during dissection of the Calot's triangle (3 cases). Other complications included diaphragmatic injury (2 cases), and small bowel injury while inserting the umbilical port, right external iliac artery injury during insertion of Veress needle, portal vein injury during dissection, and liver laceration while using a delivery system to extract the gall bladder (1 each). All these complications were detected and managed intra-operatively. During the same period, 10 patients sustained biliary injury. CONCLUSION: Intra-operative non-biliary injuries during LC occur as frequently as biliary injuries, and can be life-threatening and difficult to manage.

Which patients are at risk? Evaluation of the morbility and mortality in newborn pneumothorax.

This study was conducted to evaluate the morbidity and mortality among the newborns hospitalized for pneumothorax. The data of 83 cases were analysed retrospectively according to gestational age, weight, underlying primary lung pathology, age of admittance, side of pneumothorax, drainage time, need for mechanical ventilation and mortality. Male: Female ratio was 1.6:1. Mean duration of admission was 63.8 hours (2 hours-20 days). 51 patients (61.4%) weighed les than 2500g and 41 patients (49.4%) were preterms. The mean weight was 2280 g (640-5170). Fifty one patients (61.4%) needed mechanical ventilation. The pnemothorax was on the right in 44 (53%), left in 21 (25.7%) and bilateral in 18 patients (21.7%). Overall 32 babies died. Among the non-survivors, 22 (68%) were preterm and there was a defined underlying lung pathology in 24 (75%). Twenty nine (90.6%) of them needed mechanical ventilation. The difference in mortality was significant in the presence of primary lung disease, low birth weight, prematurity and use of mechanical ventilation (P <005).

Neumotorax (D) en RN / Neumotorax (D) in RN

Presenta Proceso de enfermería basado en un estudio realizado a un bebé ingresado en la sala de Neonatología en la Unidad de Cuidados Intensivos, del Hospital San Juan de Dios, durante el período de mayo a junio del 2001, con frecuencia cardíaca, sianótico. El objetivo del proceso es aplicar las etapas del proceso de enfermería en la elaboración de acciones que ayuden a mejorar las condiciones del paciente con Neumotorax

Neumotórax catamenial / Catamenial pneumothorax

El neumotorax catamenial es uno de los tipos de neumotorax secundario menos frecuentes; no alcanzan a 100 los casos informados en la literatura inglesa. Se presenta de manera caracteristica en mujeres en su tercera y cuarta decadas, durante las primeras 48 a 72 horas del inicio de la menstruacion. Su etiologia, aunque no claramente establecida, parece estar relacionada con los niveles elevados de prostaglandina F y trometamina durante la primera etapa de la menstruacion que ocasionarian la constriccion arterial y de los bronquiolos terminales, con isquemia e hiperinsuflacion distal con ruptura de unidades terminales y escape aereo a la cavidad pleural. Se revisa 1 caso tratado en el Hospital Universitario de San Ignacio. Se describe el tratamiento actual, el cual es medico y quirurgico. El primero incluye terapias hormonales que lleven a la amenorrea, y el segundo se fundamenta en la fusion pleural. Se propone un flujograma de variables.

Morbimortalidad neonatal en pacientes de muy bajo peso sometidos a ventilación mecánica / Neonatal morbidity and mortality in very low birthweight infants, who were under mechanical ventilation

El análisis de la morbimortalidad neonatal, en forma periódica, es uno de los mejores indicadores para evaluar la calidad asistencial, no solo en una unidad de cuidados intensivos neonatales, sino a nivel institucional. En un período de un año de estudió en forma prospectiva a todos los recién nacidos de muy bajo peso, es decir, neonatos con peso ó a 1,500 g, que ameritaron ventilación mecánica. Se dividieron en cuatro grupos de acuerdo al peso al nacimiento; grupo I con peso de 501 a 750 g; grupo II, 751 a 1000 g; grupo III, 1001 a 1250 g y grupo IV 1251 a 1500 g. Se analizó peso, edad gestacional, sexo, indicación inicial de ventilación mecánica, persistencia del conducto arterioso, displasia broncopulmonar, hemorragia intraventricular y mortalidad. Durante el período de estudio el 57.1 por ciento de pacientes con peso ó a 1,500 g, ameritaron ventilación mecánica (120/210). En el 70 por ciento de los casos la ventilación mecánica (VM) fue síndrome de dificultad respiratoria. La incidencia de volutrauma fue del 37.5 por ciento y de displasia broncopulmonar de 43.3 por ciento. El 25 por ciento (30/120) presentaron conducto arterioso sintomático. La incidencia de hemorragia intraventricular (HIV) fue del 53.3 por ciento. La mortalidad general para los pacientes con peso ó a 1,500 g fue del 24.3 por ciento y los que ameritaron VM fue del 42.5 por ciento. Estos resultados muestran una disminución en la mortalidad con respecto a años anteriores, con aumento en la morbilidad, principalmente displasia broncopulmonar y hemorragia subependimaria-intraventricular

Tratamiento quirúrgico de la enfermedad vesiculosa del pulmón / Surgical treatment of vesiculose lung disease

Se consideran 22 enfermos con neumotórax secundarios a vesículas y 4 pacientes con enfermedad vesiculosa del pulmón sin neumotórax. El primer grupo eran hombres con una edad media de 45,5 años, y un 73// fumadores importantes. Once enfermos (50//) presentaron neumotórax previos, 11 (50//) EPOC y cuatro (18//) presentaban insuficiencia ventilatoria. En 12 (54//) se debió recurrir a la toracotomía pero en los enfermos con enfisema esta cifra fue inferior (4,36//), pues en ellos predominó el tratamiento con drenaje y pleurodesis con tetraciclina. Según las alteraciones anatopatológicas se diferenciaron cuatro grupos: 1) vesículas en uno o más lóbulos sin enfisema difuso (9,41//); 2) vesiculas asociadas a enfisema difuso (1,50//); 3) distrofia lobal vesiculosa (1,4//); 4) quistes aéreos (1,4//). En los grupos 1,3 y 4 la toracotomía es la terapéutica de elección, mientras que en el grupo a debe favorecerse el drenaje, la toracoscopía o los métodos complementarios. Un paciente falleció en insuficiencia cardiorrespiratoria y neumotórax bilateral con graves alteraciones enfisematosas y múltiples drenajes. Los 4 enfermos con enfermedad vesiculosa del pulmón sin neumotórax consultaron por disnea progresiva y eran severos fumadores. La TAC fue el método más importante en el diagnóstico y la evaluación preoperatoria, junto con la angiografía pulmonar. Se constataron vesículas gigantes bilaterales en 3 pacientes y unilaterales en otro. La cirugía se indicó ante la buena calidad de los vasos del pulmón comprimido. Se propone agrupar a los enfermos en: Grupo 1 o EVP sin enfisema difuso u obstrucción de la vía aérea, y Grupo 2 o EVP con enfisema u obstrucción de la vía aérea. Se favorece el abordaje bilateral de las lesiones, considerándose a la esternotomía como la vía de elección. Los cuatro pacientes mejoraron su calidad de vida, realizan actividades de esfuerzo y dos usan drogas broncodilatadoras después de un año de operados