Early Autologous Blood-Patch Pleurodesis versus Conservative Management for Treatment of Secondary Spontaneous Pneumothorax.

BACKGROUND: Autologous blood-patch pleurodesis has been effectively utilized as a treatment option for the condition of secondary spontaneous pneumothorax (SSP). Moreover, it can be used with persistent air leak, with or without residual air space. However, there have been no robust reports for the optimal timing for autologous blood-patch pleurodesis. The aim of this study is to compare early autologous blood-patch pleurodesis with conservative management of SSP. METHODS: We conducted a randomized controlled study at the Menoufia University Hospital. A total of 47 patients with SSP were randomly allocated into two groups: group A (23 patients) received intrapleural instillation of 50 mL autologous blood 3 days after insertion of chest drain and group B (24 patients) managed conservatively. The duration required for air leak to seal, chest drainage duration, length of hospital stay, and the incidence of complications were compared and statistically analyzed. RESULTS: The duration of air leak, duration to drain removal, and length of hospital stay were all significantly shorter in group A than in group B. CONCLUSION: Early intrapleural instillation of autologous blood is successful in sealing air leak in patients with SSP with persistent air leak, who are not fit or not willing to undergo surgery. It is superior to conservative treatment or late instillation of autologous blood, even if their lungs are not fully expanded.

Double edge closure: a novel technique for reducing post-thoracotomy pain. A randomized control study.

OBJECTIVES: Thoracic surgeons being doctors, spend much effort not only to manage pathologies but also to make their procedures painless. Many surgical manoeuvres have been evolved to reduce post-thoracotomy pain with its associated morbidities. This trial aimed to study the impact of double edge closure technique on post-thoracotomy pain. METHODS: This was a prospective pre-muted block randomized study of 120 patients who had posterolateral thoracotomy. They were equally divided into two groups, the first in which double edge closure technique was used (DE group), and the other group in which the usual pericostal sutures were used (PC group). Outcomes assessed were operative time, time to ambulation, doses of analgesics injected in the epidural catheter, postoperative complications, chest tube drainage, hospital stay and pain score by the numeric rating scale from 0 to 10 and use of analgesics during the first postoperative year. RESULTS: Both groups had similar demographics, types of procedures, operative time and incisions length. Patients in DE group had significantly lower time to ambulation from 14.47 to 12.85 h, epidural doses from 3.65 to 1.87 and postoperative pain score throughout the first week. At 2 weeks, 1 and 3 months, there was significant reduction in pain and analgesics use in the DE group. At 6 months, analgesic use was not significantly different between both groups, but the pain score was significantly lower in the DE group (0.33 ± 0.51) than that in the PC group (0.63 ± 0.74). After 9 months, no significant difference was present between both groups with regard to pain score or the use of analgesics. CONCLUSIONS: Double edge technique for thoracotomy closure is easy, rapid, safe and effective in decreasing post-thoracotomy pain with subsequent earlier ambulation and lesser use of analgesics.

Fate of traumatic pulmonary pseudocyst: factors of resolution.

BACKGROUND: Traumatic pulmonary pseudocysts are rarely talked about, developing in less than 3% of patients with pulmonary parenchymal injuries. Resolution usually occurs within a few weeks to a few months. METHOD: A prospective study was undertaken in 21 cases treated in Menoufia University Hospital, Egypt from August 2011 through August 2013. RESULTS: The overall mean time for complete resolution was 61.1 days. The mean time for resolution of simple traumatic pulmonary pseudocysts was 21 days (n = 6), and the mean time for resolution of complicated (blood filled) traumatic pulmonary pseudocysts was 77.1 days (n = 15). Mean resolution time was 26.3 days for small pulmonary pseudocysts ≤22 mm (n = 11) and 99.4 days for those >22 mm (n = 10). The resolution time was 42.6 days in patients 17-years old or younger (n = 11) and 81.4 days in patients older than 17 years (n = 10). CONCLUSION: There was a highly significant difference in resolution time between simple and complicated pseudocysts. There was also a highly significant delay in the resolution time of pseudocysts larger than 22 mm and in patients older than 17 years.