Spontaneous pneumothorax; a multicentre retrospective analysis of emergency treatment, complications and outcomes.

BACKGROUND: Spontaneous pneumothorax can be managed initially by observation, aspiration or chest drain insertion. AIMS: To determine the clinical features of spontaneous pneumothorax in patients presenting to the emergency department (ED), interventions, outcomes and potential risk factors for poor outcomes after treatment. METHODS: Retrospective chart review from ED of three major referral and two general hospitals in Australia of presentations with primary spontaneous pneumothorax (PSP) or secondary spontaneous pneumothorax (SSP). Main outcomes were prolonged air leak (>5 days) and pneumothorax recurrence within 1 year. RESULTS: We identified 225 people with PSP and 98 with SSP. There were no clinical tension pneumothoraces with hypotension. Hypoxaemia (haemoglobin oxygen saturation measured by pulse oximetry ≤92%) occurred only in SSP and in older patients (age >50 years) with PSP. Drainage was performed in 150 (67%) PSP and 82 (84%) SSP. Prolonged air leak occurred in 16% (95% confidence interval 10-23%) of PSP and 31% (21-42%) of SSP. Independent risk factors for prolonged drainage were non-asthma SSP and pneumothorax size >50%. Complications were recorded in 11% (7.5-16%) of those having drains inserted. Recurrences occurred in 5/91 (5%, 1.8-12%) of those treated without drainage versus 40/232 (17%, 13-23%) of those treated by drainage, of which half occurred in the first month after drainage. CONCLUSION: Pneumothorax drainage is associated with substantial morbidity including prolonged air leak. As PSP appears to be well tolerated in younger people even with large pneumothoraces, conservative treatment in this subgroup may be a viable option to improve patient outcomes, but this needs to be confirmed in a clinical trial.

Were pneumothorax and its management known in 15th-century anatolia?

Jean-Marc Gaspard Itard, a student of René Laennec's, first recognized pneumothorax in 1803, and Laennec himself described the full clinical picture of the condition in 1819. Treatment of pneumothorax was not begun as a standard procedure until World War II, but we think that Serefeddin Sabuncuoglu recognized the condition and applied treatment in the 15th century.Sabuncuoglu (1385-1470) was a surgeon who lived in Amasya (in Anatolia). In 1465, he completed Cerrahiyyetül Haniyye (Imperial Surgery), the 1st illustrated surgical textbook in the Turkish-Islamic medical literature. We describe the highlights of the book's recommendations concerning treatment of thoracic trauma, particularly of pneumothorax. We reproduce 2 of the colored miniature illustrations and add our comments regarding the advice of Sabuncuoglu. Most notably, he advocated "mihceme," a cupping therapy, as a simple technique of thoracic aspiration.