Spontaneous pneumothorax and tuberculosis: long-term follow-up.

Though spontaneous pneumothorax (SP) is a well-known complication of pulmonary tuberculosis (TB), there are very few reports addressing this topic. For this reason, we retrospectively analysed the experience of SP in patients diagnosed with TB in our hospital between 1989 and 2010. Out of 872 patients treated for SP during this period, 47 (5.4%) had TB antecedents, 21 with active TB (0.95% of the 2,089 TB cases diagnosed during this period) and 26 with residual inactive TB. 46 cases were treated with pleural drainage (PD): 40 (85%) with only one PD, two with two, and four with three. The mean ± SD length of PD treatment was 12.9 ± 11.3 days. In 11 (23%) cases, a relapse of SP occurred, with no statistical relationship between the different studied variables. In 13 (28%) cases, it became necessary to carry out a resection (atypical segmentectomy in all cases) for persistent air leaks with PD. Survival statistics were unfavourable only in elderly patients and those infected with HIV. We conclude that the treatment of SP secondary to TB with PD is usually a sound response, with a good general prognosis and a low percentage of cases that require another PD and surgical treatment.

Hepaticothoracic transdiaphragmatic echinococcosis.

Between 1970 and 1985, seven patients were referred to us for surgical treatment of simultaneous hydatid cysts in the liver and the chest. Their mean age was 45.4 years (age range, 23-73 years), and they represented 46% of patients with hydatid cysts in the liver and thorax. Three patients had hepaticopleural involvement, and 3 patients had symptoms of pulmonary origin. In a single patient, only the diaphragm was involved along with the liver. Liver scintigraphy and ultrasonography were equally helpful in delineating the extent of the disease, but computed tomographic scanning is now the method of choice. The operations were through a thoracolaparotomy in 3 patients and a thoracotomy alone in 3 patients. A single patient had a thoracotomy with a transdiaphragmatic laparotomy. Complete drainage or excision of hydatid cavities was accomplished in all patients. Hydrogen peroxide instilled into the cysts was satisfactory for control of spread potentially secondary to possible intraoperative spillage. There have been no postoperative deaths. Follow-up has ranged from 6 months to 8 years, and 2 patients had relapsing hydatid disease 3 years postoperatively. These results suggest that, when hydatid disease of the liver is complicated by transdiaphragmatic extension and simultaneous pleural or pulmonary cysts, early surgical repair is indicated. Complete drainage and cyst excision are recommended.

Traumatic injuries of the diaphragm. Experience in 33 cases.

Between 1978 and 1985, 33 patients were treated because of a traumatic injury of the diaphragm. There were 28 males and 5 females, ages ranging from 19 to 54 years, with a mean of 34.5. There were 19 cases of open trauma and 14 were closed injuries. In 3 cases, the diagnosis was established on a delayed basis. Treatment was always surgical, with the following procedures: Laparotomy and chest drainage tube in 7 cases (21%), thoracotomy in 12 cases (36%) and a combined thoracoabdominal approach in 14 (43%). Surgical findings were 19 perforations, 10 tears and 4 crushes. In 11 cases there was gastric intrathoracic migration, in 9 cases pulmonary lesions and in 4 cases liver injuries. There were 4 cases of hospital mortality (12%) and overall 6 cases (18%). It is concluded that the early establishment of the diagnosis and the prompt initiation of therapeutic measures is a fundamental factor in the outcome of diaphragmatic injuries. The surgical approach must be individualized in every case, however we prefer the abdominal approach in acute and left diaphragmatic injuries and the thoracic approach in the case of chronic and right lesions.