Hormonal therapy after the operation for catamenial pneumothorax - is it always necessary?

BACKGROUND: Our recent clinical observations put into question the routine hormonal therapy for pneumothorax recurrence prevention, in patients operated for catamenial pneumothorax (CP). METHODS: Retrospective review of the treatment of four women operated for CP in a recent 32-months period. RESULTS: The four presented patients with CP represent 4.8 % of the overall number of patients operated for spontaneous pneumothorax and 19 % of women operated for pneumothorax in the same period. In all patients, typical multiple diaphragm holes existed. The involved part of the diaphragm was removed with diaphragm suture in three patients, whilst in one patient, a diaphragm placation was done. Endometriosis was histologically confirmed in two patients. During the follow-up period of 6-43 months, none of the patients underwent a postoperative hormonal therapy for different reasons, and in none of them the pneumothorax recurrence occurred. CONCLUSION: The clinical course of these patients, with the absence of the pneumothorax recurrence despite the omission of the hormonal treatment, suggests that the appropriateness of the routine hormonal treatment with gonadotrophin-releasing hormone analogues for 6-12 months, should be reconsidered and re-evaluated in further studies.

[Transthoracic ultrasonography in diagnosis and treatment of acute pleural empyema].

The aim of this study was to estimate validity of transthoracic ultrasonography in diagnosis and evaluation of the results of initial surgical therapy of acute pleural empyema. The study included 49 patients with II stage acute pleural empyema. Initial surgical tretament was indicated according to CT and transthoracic ultrasonography findings. Evaluation of initial therapy results has been made by transthoracic ultrasonography (TUS). Clinical significance of standard x-ray, CT and TUS in different stages of diagnostic and therapeutic procedure has been analyzed. Chest drainage was initial treatment in 10 (20.4%) patients, thoracentesis in 39 (79.6%). Complete cure with this two methods was achieved in 22 (44.9%) patients. In 27 (55.1%) patients initial treatment failed. TUS was sufficient for adequate estimate of initial treatment results in 41 (83.6%). Additional CT was indicated in 8 (16.3%) patients. Transthoracic ultrasonography has impotrant role in choice of initial surgical therapy of acute pleural empyema. If initial estimate of therapy results is made by TUS, CT is rarely necessary.

[Miliary tuberculosis of the lungs]. / Milijarna tuberkuloza pluca.

The study concerned 37 adults patients with miliary tuberculosis, who were treated at the Institute for Lung Diseases and Tuberculosis in Belgrade, over the period from 1987 to 1990. This number of patients is 1.37% of the total number of hospitalized patients with TB. The average age was 51 yrs (21-78). The sex distribution was equal. Associated diseases and predisposing conditions existed in 28 (76%) patients, most often haematologic diseases, systemic diseases of the connective tissue, and alcoholism. Classical X-ray finding of the lungs was present in 89% of the patients, and poor and atypical in 11%. The accompanying pleural exudation was observed in 13.5% of the patients, smaller cavernae in 5.4%, and enlarged mediastinal lymph nodes in one patient. The diagnosis of miliary TB was bacteriologically or pathohistologically confirmed in 31 (84%) patients, on autopsy in 2 cases and by antituberculotic test in 4 cases. Positive Loewenstein culture media were obtained in 62% of patients, from sputum in 64% of cases, in the liquor in 5.4%, and from the pleural fluid in 2.7% of patients. (BK was found by direct sputum microscopy in 6 pts - 16%). Positive pathohistological findings was obtained in 18 (49%) patients: by pleural biopsy in 2 cases, lung biopsy in 8 (bronchoscopy in 5 pts, aspiration needle biopsy in 2 pts), and by biopsy of extrathoracic tissues and organs in 8 pts. Early diagnosis was established in 62% patients.