[Predictive factors of recurrence in spontaneous pneumothorax]. / Facteurs prédictifs de récidive dans le pneumothorax spontané.

BACKGROUND: Spontaneous pneumothorax is usually a benign condition that most often affects young patients. Its most common complication is recurrence. This complication appears to be increased by some factors. AIM: To identify predictors of recurrence in spontaneous pneumothorax through a series of 204 cases. METHODS: A retrospective study of 204 cases of patients hospitalized for spontaneous pneumothorax. 50 patients experienced at least one recurrence. The study of predictors of recurrence is based on the X2 test for the univariate analysis and logistic regression for the multivariate analysis. RESULTS: The average age of our patients was 37 ± 7.6 years. A male predominance was noted (97.6 %). 80.4% of patients were smokers. Pneumothorax is considered primary in 65.2 % of cases. Fifty patients had at least one recurrence of their pneumothorax. Smoking and the pursuit of tobacco intoxication were the two risk factors for recurrence in our patients. Gender, age, side, importance of pneumothorax and therapeutic means of the first episode as well as the primary or secondary pneumothorax did not influence recurrence. In the multivariate analysis the pursuit of tobacco intoxication was the only predictor factor of recurrence. CONCLUSION: The recurrence is the most common complication of spontaneous pneumothorax. This risk appears to be increased by smoking and the pursuit of tobacco intoxication. Thus smoking cessation could be a simple and effective means to prevent recurrence.

Impact of previous cardiovascular disease on the outcome of lung transplantation.

BACKGROUND: The impact of previous cardiovascular disease on the outcome of lung transplantation may be important but remains unstudied. METHODS: Cardiovascular risk factors, echocardiography, right heart catheterization, isotopic ventriculography and vascular ultrasonography data were obtained from 258 adults who underwent lung transplantation at our center between 1988 and 2007. The effect of these parameters on survival and cardiovascular disease after transplantation was determined using the Cox model. RESULTS: By multivariate analysis, diabetes (hazard ratio [HR]: 2.4), atrial fibrillation (HR: 3.51), elevated systolic pulmonary artery pressure (HR: 1.23 per 10 mm Hg) and low cardiac index (HR: 1.47 per-liters/min/m(2)) before transplantation were associated with a higher risk of death after transplantation. Heart failure (2.08 cases per 100 patient-years) and atherothrombosis (2.5 cases per 100 patient-years) were frequent after lung transplantation. A history of atherothrombosis (HR: 12.98) and diabetes (HR: 5.8) before transplantation were associated with a higher risk of atherothrombosis after transplantation. Major cardiovascular events led to death in 11 patients. Diabetes (HR: 62.5) and a low cardiac index (HR: 6.8 per-liters/min/m(2)) were associated with a higher risk of death from cardiovascular causes. CONCLUSIONS: Diabetes and a history of atrial fibrillation before lung transplantation were associated with excess mortality after transplantation. Diabetes was also associated with a major increase in the risk of atherothrombosis and death from cardiovascular causes. Lung transplant recipients may be considered at high risk for cardiovascular disease.