Bibliometric analysis of qualitative research on patients' experiences of intestinal stoma published between 2002 - 2018.

AIMS: The purpose of this paper was to perform a bibliometric analysis of the production of qualitative research in scientific journals through aggregation by levels and to identify factors of diversity, such as types of designs, in qualitative research on the experience of having an intestinal stoma between 2002 and 2018. DESIGN: Descriptive bibliometric study focused on the production of qualitative research on the subject of study, on three levels: micro, meso and macro. METHODS: Databases such as PubMed, CINAHL, Web of Knowledge, Scopus, SciELO, CUIDEN, Lilacs and Google Scholar were used to collect the data, between August - November 2018. RESULTS: Nursing was the main area of knowledge. Brazil was the predominant country of origin. The most productive journal was the Journal of Wound, Ostomy & Continence Nursing. English and Portuguese were the main languages of scientific communication. The number of authors was typically between 2 and 6. Authors conducted descriptive and phenomenological studies. CONCLUSION: The present bibliometric study helps us to map the qualitative research on the experiences of individuals with an intestinal stoma and to understand patterns in the designs, methods, disciplines and journals involved in this area of research. This will allow nurses to have a leading contribution to stoma care at their disposal.

Health Utility, Social Interactivity, and Peristomal Skin Status: A Cross-Sectional Study.

PURPOSE: The objective of this study was to examine relationships among social interaction, health utility, and peristomal skin status in adults with ostomies. DESIGN: Cross-sectional, descriptive. SUBJECTS AND SETTING: 15,591 persons residing in the United States were randomly selected from 3 multinational proprietary databases of individuals who had undergone surgery. METHODS: The study was a cross-sectional assessment utilizing the SF36v2 survey instrument. Potential subjects were sent an e-mail letter of invitation that included instructions for completing the questionnaire, an informed consent form, and nontransferable link to an electronic survey. Health utility was derived from the SF6D, and the Hawthorne Friendship Scale was used to measure social connectivity. Social functioning was derived from the SF36v2. A minimally important social value of health (MISVH) is reported as the minimum quality-adjusted life-days to be of benefit (influence) within indices of social connectivity and function. A self-reported determinant of peristomal skin health was included. RESULTS: Increased social interactivity, defined as social functioning and social connectivity, was associated with increased health utility. In addition, health utility decreased as peristomal skin integrity worsened. A MISVH can be demonstrated. CONCLUSION: Findings indicate that peristomal skin complications are more than dermatologic issues. They negatively affect the well-being of those who must cope and adapt to their impact and the community at large. Social interaction is also negatively influenced.

A Quasi-experimental Study to Explore the Effect of Barrier Cream on the Peristomal Skin of Patients With a Tracheostomy.

Peristomal skin problems represent one of the most common complications of a tracheostomy. A quasi-experimental study was conducted among patients ages 18 to 65 years hospitalized in a Turkish university hospital ear-nose-throat clinic between August 15, 2013, and December 15, 2013, to compare the effect of using or not using a barrier cream on the peristomal skin with regard to pH, moisture, temperature, color, odor, turgor, infections, and lesions after tracheostomy surgery. Patients were selected using a purposeful sampling method and included if they had not undergone another operation for a complication (eg, pneumothorax, tube misplacement, hemorrhage) within 24 hours following the tracheostomy operation. In phase 1 of the study, 9 registered nurses were observed 3 times each by the researcher, who completed an observation form. From these observations and related nursing textbooks, the researcher developed a protocol entitled "Nursing Care Steps for Patients with a Tracheostomy." This protocol was followed during phase 2 of the study during which participants were alternately assigned to either the intervention (a barrier cream containing dimethicone, acrylate terpolymer, oils, paraffin, water, dicapryladipate, isopropyl palmitate, and PPG-15 stearyl ether followed by gauze) or control (gauze only) group (n = 30 each) and observed for 7 days. Demographic characteristics were gathered for each patient upon admission to the study. Peristomal skin was assessed in terms of pH, temperature, and moisture (relative humidity [RH]) using a surface pH meter, surface thermometer, and digital skin moisture tester, as well as for lesions, infection, and maceration. Findings were documented on a skin condition assessment form. Twenty-four (24) hours post surgery, the barrier cream plus gauze was applied over peristomal area in the study group and gauze dressing only in the control group. Peristomal skin pH, moisture, and temperature were within the normal range for both groups during all observations throughout the study but closer to normal ranges in the intervention group. Mean peristomal skin pH in the intervention group was significantly higher (5.452 ± 0.043) than in the control group (5.123 ± 0.057; P &.001), mean peristomal skin moisture in the control group (46.90 ± 0.132 RH) was significantly greater than in the intervention group (41.71 ± 0.774 RH; P &.001), and mean peristomal skin temperature in the control group (33.59 ± 1.3˚ C) was significantly higher than in the intervention group (31.64 ± 0.607˚ C; P &.001). In both groups, Staphylococcus epidermidis was the most commonly cultured microorganism, and S aureus was the most cultured pathological microorganism in addition to the normal skin flora. Peristomal skin condition was maintained for both the intervention and control groups. Use of a barrier cream to protect tracheostomy peristomal skin beneath absorbent dressings (eg, gauze) is recommended, but additional short-term and long-term studies are needed.

Institutional Experience with Ostomies Created During Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemoperfusion.

BACKGROUND: Cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion (CRS-HIPEC) is a complex procedure that often requires ostomy creation to protect high-risk anastomoses. This study aimed to evaluate the authors' institutional experience with CRS-HIPEC-associated ostomies, determine predictors of ostomy creation and reversal, and assess their impact on survival. METHODS: The study analyzed clinicopathologic, perioperative, and oncologic data from a prospective database of 1435 CRS-HIPEC procedures for peritoneal metastases. The Kaplan-Meier method was used to estimate survival. Multivariate analyses identified associations with ostomy creation/reversal and survival. RESULTS: Ostomies were created in 34% of the patients, most commonly loop ileostomies (82%). Loop ileostomies were reversed in the majority of patients (83%), whereas non-loop ileostomies were infrequently reversed (< 10% reversal rate). In a multivariate logistic regression model, intermediate or high tumor grade, colectomy/proctectomy, longer operative time, and lower Charlson comorbidity index were associated with loop ileostomy creation, whereas incomplete macroscopic resection, colorectal histology, and major postoperative complications were associated with non-reversal of loop ileostomy. In a multivariate Cox proportional hazards model, intermediate or high tumor grade and non-reversal of loop ileostomy were associated with worse overall survival. CONCLUSIONS: Loop ileostomies were almost always reversed, whereas non-loop ileostomies were almost always permanent. Hospital readmissions for loop ileostomy-related complications were common. Therefore, formal outpatient protocols for prevention and management should be implemented. Non-reversal of loop ileostomy was associated with very poor survival.

Stoma Creation and Reversal After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy.

INTRODUCTION: Cytoreductive surgery with heated intraperitoneal chemotherapy (CRS/HIPEC) often includes stoma creation. We evaluated the indications, morbidity, and mortality associated with stoma creation and reversal after CRS/HIPEC. METHODS: Retrospective analysis of a prospective database of 1149 CRS-HIPEC procedures was performed. Patient demographics, type of malignancy, comorbidities, Clavien-graded morbidity, mortality, indications for stoma creation, and outcomes of subsequent reversal were abstracted. RESULTS: Sixteen percent (186/1149) of CRS/HIPEC procedures included stoma creation, whereas 1.1 % (11/963) of patients without initial stoma creation developed anastomotic leaks requiring stoma. Patients who required a stoma had worse preoperative performance status (ECOG 0/1: 77.2 vs. 86.1 %, p = 0.002), greater burden of disease (PCI 17.6 vs. 12.9, p < 0.0001), and were more likely to have R2 resections (74.5 vs. 48.8 %, p < 0.0001) than those without stoma creation. Stomas were intended to be permanent in 17.5 % (35/199). Of 164 patients with potentially reversible ostomies, only 26.2 % (43/164) underwent reversal. Disease progression (43/164, 26.2 %) and death (40/164, 24.3 %) most commonly precluded reversal. After reversal, 27.9 % (12/43) suffered a Clavien I/II morbidity, 27.9 % (12/43) suffered Clavien III/IV morbidity, and 30-day mortality was 4.7 % (2/43). Anastomotic leak occurred after 9 % (3/33) of ileostomy and 10 % (1/10) of colostomy reversals. CONCLUSIONS: Stomas are more common among CRS/HIPEC patients with a high burden of disease and poor functional status. Reversal is uncommon and is associated with significant major morbidity. Preoperative counseling for those with high disease burden and poor functional status should include the risk of permanent stoma.

The discovery of the synovial lymphatic stomata and lymphatic reabsorption in knee effusion.

To illustrate the mechanism of lymphatic reabsorption in knee joint effusion. The current investigation employed transmission electron microscopy (TEM) and scanning electron microscopy (SEM) techniques to reveal the ultrastructure of the knee synovial membrane in New Zealand rabbits and human. Ultrastructural changes of the synovial lymphatic stomata were observed by using trypan blue absorption and sodium hydroxide (NaOH) digestion methods, and the animal models of synovitis. New Zealand rabbits and human synovial membranes were composed of two types of synovial cells: type A and type B. No lymphatic stomata were found among type A synovial cells, whereas lymphatic stomata with the diameters ranging 0.74-3.26 µm were found in type B synovial cells, and some stomata were closed. After the NaOH digestion, a number of sieve pores, similar to lymphatic stomata in size and shape, were observed in the dense fibrous connective tissue underneath the type B synovial cells. After injecting trypan blue into the rabbit knee joint cavity, absorption of trypan blue through the lymphatic stomata was observed, suggesting the absorption function of the synovial lymphatic stomata. In the rabbit knee joint synovitis models, the synovial lymphatic stomata diameter enlarged. Some macrophages migrated from the lymphatic stomata, indicating that the synovial lymphatic stomata were involved in the joint effusion absorption and inflammatory response. Our study is the first to report the existence of synovial lymphatic stomata in the New Zealand rabbits and human knee joints. Lymphatic stomata may have an important role in the reabsorption of joint effusion.

Lymphatic Stomata in the Adult Human Pulmonary Ligament.

BACKGROUND: Lymphatic stomata are small lymphatic openings in the serosal membrane that communicate with the serosal cavity. Although these stomata have primarily been studied in experimental mammals, little is known concerning the presence and properties of lymphatic stomata in the adult human pleura. Thus, adult human pleurae were examined for the presence or absence of lymphatic stomata. METHODS AND RESULTS: A total of 26 pulmonary ligaments (13 left and 13 right) were obtained from 15 adult human autopsy cases and examined using electron and light microscopy. The microscopic studies revealed the presence of apertures fringed with D2-40-positive, CD31-positive, and cytokeratin-negative endothelial cells directly communicating with submesothelial lymphatics in all of the pulmonary ligaments. The apertures' sizes and densities varied from case to case according to the serial tissue section. The medians of these aperture sizes ranged from 2.25 to 8.75 µm in the left pulmonary ligaments and from 2.50 to 12.50 µm in the right pulmonary ligaments. The densities of the apertures ranged from 2 to 9 per mm(2) in the left pulmonary ligaments and from 2 to 18 per mm(2) in the right pulmonary ligaments. However, no significant differences were found regarding the aperture size (p=0.359) and density (p=0.438) between the left and the right pulmonary ligaments. CONCLUSIONS: Our study revealed that apertures exhibit structural adequacy as lymphatic stomata on the surface of the pulmonary ligament, thereby providing evidence that lymphatic stomata are present in the adult human pleura.

Ultrastructure of lymphatic stomata in the tunica vaginalis of humans.

Lymphatic stomata are small openings of lymphatic capillaries on the surface of the mesothelium that lines the serous cavity and have the function of active absorption. They play an important role in physiological and pathological conditions. The cavity of the tunica vaginalis is a typical serous cavity of the testis, but the lymphatic stomata of the tunica vaginalis of humans have never been reported. Here, we studied their ultrastructure by scanning and transmission electron microscopy. The submesothelial connective tissue with foramina was investigated after the mesothelial cells were digested using NaOH solution. We found the lymphatic stomata in cuboidal mesothelial cell regions of the parietal layer of the tunica vaginalis of humans with a diameter of about 1-2 µm. Sometimes, closed lymphatic stomata could be observed. Our study is the first to report the existence of lymphatic stomata of the tunica vaginalis of humans. We found that the tunica vaginalis cavity is connected with the lymphatic system through the stomata, which might provide a morphological basis for the drainage of hydrocele and tumor metastasis of the tunica vaginalis of humans.

Problema de pele em paciente estomizada: relato de caso / Skin problems in a stomized patient: a case report

Objetivo: Relatar o caso vivenciado na prática de enfermagem, no manejo de complicações de pele periestoma,e avaliar as mudanças clínicas obtidas após a utilização de protetores cutâneos. Relato de caso: O estudo foi desenvolvido em uma paciente estomizada de 57 anos, cuja pele periestoma apresentava extensa dermatite periestomal com aspecto brilhante, altamente exsudativa, irritativa e dolorosa, em que o dispositivo para estomia mantinha-se adaptado por menos de 24 horas. Conclusão: Após o manejo dos protetores cutâneos, houve evolução satisfatória em relação à lesão periestomal e no emocional, o que resultou no fechamento da ileostomia.

Objective: To report a case experienced in nursing practice regarding the management of peristomal skin complications, as well as to evaluate the clinical changes obtained after the use of skin protectors. Case report: this study was developed in a patient with stoma 57, whose skin had extensive peristomal dermatitis, glossy, highly exudative, irritating and painful, who had a device installed for ostomy adapted forless than 24 hours. Conclusion: After the management of skin protectors, there was satisfactory progress in relation to peristomal and emotional injury, which resulted in the closure of the ileostomy.

Recent advances in the research of lymphatic stomata.

Lymphatic stomata are small openings of lymphatic capillaries on the free surface of the mesothelium. The peritoneal cavity, pleural cavity, and pericardial cavity are connected with lymphatic system via these small openings, which have the function of active absorption. The ultrastructure of the lymphatic stomata and their absorption from the body cavities are important clinically, such as ascites elimination, neoplasm metastasis, and inflammatory reaction. The lymphatic stomata play an important role in the physiological and pathological conditions. Our previous study indicated for the first time that nitric oxide (NO) could regulate the opening and absorption of the lymphatic stomata. It could decrease the level of free intracellular calcium [Ca(2+)] through increasing the cyclic guanosine monophosphate (cGMP) level in the rat peritoneal mesothelial cells, thus regulating the lymphatic stomata. This process is related with the NO-cGMP-[Ca(2+)] signal pathway. In this review, we summarize the recent advances in understanding the development and the function of the lymphatic stomata. The ultrastructure and regulations of the lymphatic stomata are also discussed in this review.

Cell signal transduction mechanism for nitric oxide regulating lymphatic stomata and its draining capability.

We have previously demonstrated that nitric oxide (NO) is involved in the regulation of the lymphatic stomata. However, the related mechanisms are still unknown. The present study was designed to test the hypothesis that NO-cyclic guanosine monophosphate (cGMP) -mediated cytosolic Ca(2+) concentration ([Ca(2+)]i) signaling may contribute to the regulation of the lymphatic stomata and lymph drainage. Using trypan blue as a tracer, the effects of NO-cGMP-Ca(2+) signal cascade on the lymphatic stomata and lymph absorption were examined by means of scanning electron microscopy. Then, the role of NO in cGMP and [Ca(2+)]i of rat peritoneal mesothelial cells (RPMCs) was measured by radioimmunoassay and a confocal laser scanning microscope. Our results showed that NO-donor spermine/nitric oxide complex (Sper/NO) could broaden the opening area of the lymphatic stomata and enhance lymph absorption in a dose-dependent manner. These NO-mediated changes could be blocked by 1H-[1,2,4] oxadiazolo [4,3-a] quinoxalin-1-one (ODQ), a specific inhibitor of soluble guanylyl cyclase, and mimicked by calcium channel blocker nifedipine. Furthermore, Sper/NO enhanced the cGMP level and lessened [Ca(2+)](i) in RPMCs, which was completely abrogated at the presence of ODQ. Nifedipine induced an immediate and marked decrease of [Ca(2+)](i) in the RPMCs, which was not attenuated by addition of Sper/NO, indicating that the Sper/NO-cGMP signaling system induced [Ca(2+)](i) change was related to the L-type voltage-gated calcium channel in the RPMCs. Our results suggest that NO enlarges the opening area of the lymphatic stomata to strengthen the lymph drainage of tracer by means of NO-cGMP-[Ca(2+)]i signal transduction pathway in the RPMCs.

[Effects of nitric oxide on peritoneal lymphatic stomata and lymph drainage via NO-cGMP-Ca2+ pathway].

To study the cell signal transduction mechanism of nitric oxide (NO) on the peritoneal lymphatic stomata and lymph drainage in the rat, cGMP content were measured by a commercially available radioimmunoassay kit, and the [Ca(2+)](i) were observed by a confocal laser scanning microscope in the cultured peritoneal mesothelial cell. Animal experiment was practiced to study the effect of NO-cGMP-Ca(2+) pathway on the lymphatic stomata and lymph absorption. The results showed that: (1) Sper/NO increased cGMP of the rat peritoneal mesothelial cell (RPMC) in a dose-dependent manner (P<0.01) compared to the control group. This effect was blocked by 1H-[1,2,4] oxadiazolo [4,3-a] quinoxalin-1-one (ODQ) (P<0.05), a specific inhibitor of soluble guanylyl cyclase (sGC). The level of [Ca(2+)](i) in single RPMC decreased by adding Sper/NO (P<0.05). Pretreatment with ODQ for 10 min blocked the Sper/NO-induced decrease in [Ca(2+)](i). L-typed calcium channel blocker nifedipine induced an immediate and marked decrease in [Ca(2+)](i) (P<0.05).. After [Ca(2+)](i) reached a balance again, adding Sper/NO could not change [Ca(2+)](i) (P>0.05). (2) Sper/NO increased the area of the stomata (P<0.01) and the quantity of the tracer in a dose-dependent manner (P<0.05) compared to the control group. Pretreatment with ODQ significantly inhibited Sper/NO-induced change of lymphatic stomata and lymph drainage (P<0.01). Nifedipine increased the opening area of the lymphatic stomata (P< 0.01) and the concentration of absorbed trypan blue of the diaphragm (P<0.05). Sper/NO could not make a further change in the samples pretreated by nifedipine (P> 0.05). The results indicate that NO can decrease [Ca(2+)](i) in the RPMC through the NO-cGMP pathway. This procession is related with the L- type voltage-gated Ca(2+) channel. NO enlarges the opening area of the lymphatic stomata and enhances the lymph drainage of tracer by NO-cGMP-[Ca(2+)](i) pathway.

Contribution of lymphatic drainage through stomata to albumin removal from pleural space.

The contribution of lymphatic drainage through the stomata of parietal mesothelium to the overall removal of labeled albumin from the pleural space was found 89% in sheep with very large hydrothoraces (10 ml/kg), a condition involving a approximately 20 times increase in lymphatic drainage [Broaddus et al., J. Appl. Physiol. 64 (1988) 384]. We determined this contribution in anesthetized rabbits with small (0.12 ml/kg) and large (2.4 ml/kg) hydrothoraces of Ringer-albumin with labeled albumin and labeled dextran-2000 kDa. This dextran was used as marker of liquid removal through the stomata because it should essentially leave the pleural space through the stomata only, owing to its size. The removal of labeled albumin by lymphatic drainage through the stomata was 39% of the overall removal in the small hydrothoraces, and 64% in the large ones. Hence, lymphatic drainage through the stomata does not contribute most of protein and liquid removal from the pleural space under physiological conditions, as it has been maintained. It markedly increases with the increase in pleural liquid volume.

[Effects of nitric oxide on pleural lymphatic stomata and lymphatic drainage in the rat].

To investigate the effects of nitric oxide (NO) on the pleural lymphatic stomata and lymph absorption from the pleural cavity, the NOS (nitric oxide synthase) inhibitor N(omega)-nitro-L-arginine-methyl-ester (L-NAME) and the NO donor isosorbide dinitrate (ISDN) were injected into the peritoneal cavity of the rats respectively. Trypan blue was used as a tracer. Then the concentrations of NO and trypan blue in the blood serum were measured, and the ultrastructural changes in pleural lymphatic stomata were observed under a scanning electron microscope (SEM) and studied by a computer image processing system attached to SEM. It turned out that the concentration of NO in the serum was 49.34+/-18.47 micromol/L, and the area and density of the pleural lymphatic stomata were 6.80+/-1.13 microm(2) and 170.24+/-66.60 /0.1 mm(2) respectively in the NO donor group. The concentration of NO reduced to 17.72+/-6.58 micromol/L, and the area and density of the pleural lymphatic stomata were 5.72+/-1.54 microm(2) and 61.71+/-12.73/0.1 mm(2) in the NOS inhibitor group. We found that the area and density of the pleural lymphatic stomata were positively correlated with the NO quantity. After the tracer was injected into the pleural cavity, the NO donor group exhibited a higher trypan blue concentration than the control group. The ability of the pleura to absorb trypan blue was enhanced because of the large opening of the stomata. It is suggested that NO can increase lymph absorption of the pleura by relaxing pleural lymphatic stomata.

Postinflammatory changes of the diaphragmatic stomata.

Numerous investigations concerning the fine morphology of diaphragmatic stomata have been performed, but its ultrastructural changes in experimental conditions remain unclear. The present study demonstrates the peritoneal side of the diaphragm in adult Wistar rats by transmission electron microscopy. Ten experimental animals were observed 5 and 8 days after Pseudomonas aeuriginosa instillation (PI) into the peritoneal cavity. A control group of 6 rats showed flat mesothelial covering on basal lamina (BL) and connective tissue layer, as well as cubic mesothelial cells, single stomata over underlying lymphatic lacunae (LL). Five days after PI the mesothelial cells had more numerous microvilli, microvesicles, vacuoles, lysosomes and a lesser number of specialized contacts. The multiplication of the extravasal cells and larger intercellular spaces lead to thickenings of the connective tissue around LL. LL were larger and located in close proximity of the mesothelium. Intercellular spaces in the mesothelial layer and different types of contacts between mesothelial cells and endothelial protrusions of LL (with common BL or without BL) were encountered. Eight days after PI the mesothelium, endothelium of LL, their BL and surrounding connective tissue were interrupted and structurally modified to form typical new channels--stomata. The larger portion of the channels were formed of mesothelial cells, while the endothelial cells participated in the submesothelial part. LL were more numerous than in the previous period, and were arranged in groups. LL increased their vertical (50.59 microm) and horizontal (155.57 microm) diameter, as compared with control animals (respectively 12.37 microm and 74.08 microm). Neighbouring LL were separated by thin or thick septae. Peristomatal mesothelial cells or more rarely endothelium formed valve- or bridge-like structures. Valves on the opposite side of LL were observed. Groups of electron-dense bodies characterized some tall endothelial cells of LL. Cubic mesothelium, endothelium of the LL, both BL, the cell connections that formed new stomata, LL and surrounding connective tissue underwent rapid and parallel changes after PI. Among these elements of the lymphatic regions mentioned above, the mesothelium and endothelium of LL had a main role in experimental conditions.

Pneumotórax catamenial: uma revisão da literatura a respeito da etiologia, patogênese, terapêutica e relato de um caso / Catamenial pneumothorax: a literature rewiew of etiology, pathogenesis, managmenty and a case report

Introdução: O pneumotórax espontâneo catamenial é uma entidade clínica definida com a presença de ar no espaço pleural, durante as primeiras 48 a 72 horas após o início do fluxo menstrual. Ocorre, preferencialmente, no hemitórax direito, com maior incidência nas terceiras e quartas décadas de vida. Apesar de constituir uma entidade pouco conhecida pela literatura mundial, dada a raridade do quadro, acredita-se que possa estar relacionado à existência de pertuitos diafragmáticos associado ou não à presença de implantes de células endometriais na cavidade torácica. Objetivos: Fazer a revisão da literatura e relatar um caso de pneumotórax catamenial. Material e métodos: Apresentamos um caso de paciente de 28 anos, sexo feminino, admitida no Hospital Monte Sinai com quadro de dispnéia de instalação súbita, tosse persistente e dor no hemitórax direito do tipo pleurítica, irradiada para a região escapular homolateral. Era a quinta vez que apresentava essa sintomatologia. A radiografia do tórax foi realizada com objetivo de se confirmar a presença de pneumotórax. Posteriormente, a paciente foi submetida a videopleuroscopia, com inventário minuncioso do espaço pleural, incluindo a visualização do diafragma e de toda a pleura. Resultados: À videopleuroscopia detectaram-se vários pertuitos diafragmáticos. Enviado material para estudo anatomopatológico, pudemos descartar endometriose pleural. A terapêutica consistiu em pleurectomia, com o objetivo de prevenir novos episódios. Conclusão: Em função da raridade do caso, o pneumotórax catamenial tem seu diagnóstico após vários episódios. Nesse caso específico, o achado de orifícios diafragmáticos permitiu optar pelo tratamento cirúrgico. A paciente encontra-se assintomática.

Introduction: Catamenial pneumothorax is characterized by recurrent accumulation of air in the thoracic space appeared within 48 to 72 hours from the menstrual flow. In most cases, catamenial pneumothorax is right-sided, and most of the affected women are in the third to fourth decades of life. Although it is a rare entity of unknown etiology, there are some possible cause for pnemothorax catamenial have been proposed: 1) rupture of pulmonary bleb; 2) diaphragmatic fenestration; 3) thoracic endometriosis. Objectives: 1) To make a review of the literature about pneumothorax catamenial. 2) To present a case of pneumothorax catamenial caused by diaphragmatic fenestration. Methods: A 28-year-old woman suffered 5 episodes of right-sided pneumothorax, which appeared during menstruation. She had undergone thoracic radiography to confirm the diagnosis. Then she had undergone video-assisted thoracoscopy, with histological examination of diaphragm specimen. Results: We identified diaphragm defects of different extension. Endometriosis could not be found. The patient undergone pleurectomy to prevent further occurrences. Conclusion: Because of its rarity, the diagnosis of catamenial pneumothorax could be difficult. In this present case the patient is assymptomatic before thoracocirurgical intervention, without using anovulatory therapy.