Spontaneous pneumothorax: are we missing something?

Most thoracic surgeons overlook the fact that spontaneous pneumothorax is one of the pulmonary complications of connective tissue disorders such as Marfan or Ehlers-Danlos syndromes, and they consider it as primary. In the following report we describe a unique case of spontaneous rupture of the sigmoid secondary to a spontaneous recurrent contralateral pneumothorax in a young patient with undiagnosed Marfan syndrome. The aim of this presentation is to raise a high index of suspicion of every thoracic surgeon to include in his differential diagnosis the connective tissue disorders in any case of spontaneous pneumothorax and if so, to follow further diagnostic procedures to anticipate any other visceral complications.

Preservation of compromised intestine after ischemic injury.

It is possible to preserve ischemic intestinal segments, which currently are routinely resected, following superior mesenteric artery occlusion by exteriorizing them through the abdominal wall with De Martell clamps and observing them carefully. If the functional demands of an anastomosis are not imposed, the circulation of such segments will often be restored, and they will withstand successful anastomosis a few days later. If circulation fails to improve or deteriorates, prompt resection and possibly reexteriorization can be done without delay. Intestinal absorptive surface, crucial to subsequent survival may thus be saved.

Catheter separation during cardiac catheterization and coronary angiography. A report of four incidents and review of the literature.

Four incidents of catheter separation in three patients during left heart catheterization and coronary angiography are presented. In two cases the catheters had been used before. After the second incident, we decided to use angiography catheters once only. All catheter fragments were removed under local anesthesia, and no further complications arose. In all incidents the point of catheter fracture was near the bond between the body of the catheter and its tip. We believe that catheter separation is related to polymer aging. The catheters in the third and fourth incidents were unused, but there was no expiration date on their packages. We recommend that expiration dates be clearly stated on every catheter package, catheter manufactures issue warnings not to use catheters after expiration date, and unused angiography catheters with no expiration date not be used. We also suggest that consideration be given to using catheters once only.