Pneumothorax contralateral to traumatic costal fractures.

In this case report, a 19-year-old woman suffered a high-energy trauma to her left side with multiple left-sided fractures, including ribs 8-12, with no pneumothorax on the left side, but a large right-sided pneumothorax. Contralateral pneumothorax is extremely rare in primarily unilateral trauma, especially when no contralateral rib fractures are present. A possible explanation is that of a barotrauma due to increased intrathoracic pressure with external compression. Careful examination of both sides of the body is necessary when evaluating patients with unilateral trauma, as serious organ injury may occur contralaterally.

Appropriate selection for omalizumab treatment in patients with severe asthma?

Background: Omalizumab improves asthma control in patients with uncontrolled severe allergic asthma; however, appropriate patient selection is crucial. Information in this field is sparse. Objective: We aimed to estimate whether potential omalizumab candidates were appropriately selected according to guidelines, and the clinical effect of omalizumab treatment over time. Design: We performed a retrospective observational study on adult patients with asthma treated with omalizumab during 2006-2015 at the Department of Respiratory Medicine at Odense University Hospital (OUH), Denmark. Data were obtained from the Electronic Patient Journal of OUH and Odense Pharmaco-Epidemiological Database. Guideline criteria for omalizumab treatment were used to evaluate the appropriateness of omalizumab candidate selection, and the Asthma Control Test (ACT) to assess the clinical effects of omalizumab at weeks 16 and 52 from treatment initiation. Results: During the observation period, 24 patients received omalizumab, but only 10 patients (42%) fulfilled criteria recommended by international guidelines. The main reasons for not fulfilling the criteria were inadequately reduced lung function, insufficient number of exacerbations, and asthma standard therapy below Global Initiative for Asthma (GINA) step 4-5. Seventeen and 11 patients completed treatment at weeks 16 and 52, with a statistically significant increase in ACT score of 5.1 points [95% confidence interval (CI) 3.1-7.2, p = 0.0001] and 7.7 points (95% CI 4.3-11.1, p = 0.0005), respectively. Conclusion: Only 42% of the omalizumab-treated patients were appropriately selected according to current guidelines. Still, as omalizumab showed significant improvement in asthma control over time, it is important to keep this drug in mind as an add-on to asthma therapy in well-selected patients.