Recurrent secondary spontaneous pneumothorax in silicosis: a case report.

Silicosis is an occupational lung disease which is caused by inhalation and accumulation of crystalline silica particles in the lung. It commonly occurs in workers involved in quarrying, mining, sandblasting, tunneling, foundry work, and ceramics. Pneumothorax is one of the complications of silicosis with pleural involvement. The occurrence of pneumothorax in a patient with silicosis is a rare event, but it may be fatal. The rate of pneumothorax recurrence in silicosis is usually low. We report a case of recurrent secondary spontaneous pneumothorax in silicosis.

Neumotórax postoperatorio espontáneo contralateral / No disponible

No disponible

Prevalencia de lesiones asociadas a lesionados medulares simultáneas al evento traumático / Prevalence of associated lesions in patients with acute traumatic spinal cord injury

Introducción. Los traumatismos suelen ocasionar otras lesiones más allá de la lesión medular (LM) que pueden pasar desapercibidas en los primeros momentos, acarreando riesgo vital, retrasos en la recuperación funcional o aumento de la discapacidad. Los objetivos de este trabajo son determinar la prevalencia de las lesiones asociadas entre los pacientes que sufrieron una lesión traumática aguda, conocer su tipo y la relación con las variables epidemiológicas y con las complicaciones concurrentes durante el ingreso. Material y método. Se realizó un estudio transversal en los pacientes ingresados en el Hospital Nacional de Parapléjicos, que presentasen LM traumática aguda, edad igual o superior a 18 años, haber sufrido al menos una lesión asociada simultánea a la LM y que no fueran dados de alta en la semana del estudio. De los 196 pacientes ingresados, se seleccionaron por lesión traumática 90, de los que 62 tenían lesiones asociadas agudas. Se evaluaron edad, género, etiología, prevalencia de lesiones óseas y viscerales, traumatismo craneoencefálico, hemotórax, neumotórax, lesiones de plexo y factores psicosociales. Resultados. La prevalencia de lesiones asociadas fue 68,9 %. La edad media de estos pacientes fue significativamente menor. El género no se asoció a mayor vulnerabilidad para lesiones asociadas. Etiologicamente los tráficos doblaron a las caídas.Aquellos que sufrieron fractura o LM dorsal presentaron un número mayor de lesiones asociadas con significación estadística. Conclusión. Las lesiones agudas asociadas deben ser siempre tenidas en cuenta en la valoración inicial por su prevalencia alta, especialmente si hay fractura o LM dorsal (AU)

Introduction. Traumatic patients afflicted with spinal cord injury (SCI) could have lesions in other anatomical regions.These lesions frequently receive delayed diagnosis and may increase the mortality risk, modify the course of recovery and produce worse functional outcomes.The aims of the present work is to determine the prevalence, etiology, epidemiology and complications of associated lesions in patients with acute traumatic SCI. Material and methods. We perfomed a cross-sectional study of associated lesions in acute traumatic SCI patients admitted to the National Paraplegic Hospital of Toledo.The selection criteria were to suffer an acute traumatic SCI, to be older than eighteen years, to have at least one associated lesion concomitant with the SCI and not to be discharged during the time of acquisition data (one week). 90 out of 196 admitted patients had an acute traumatic SCI, 62 of them showing associated lesions.We obtained data regarding age, gender, etiology, prevalence of simultaneous visceral or bone lesions, traumatic brain injury, pneumothorax, hemothorax, braquial plexus injury and psychosocial profile. Results. The prevalence of associated lesions in acute traumatic SCI patients was 68.9 % with a mean age lower than the reported in other series and without gender differences. Traffic accidents doubled in frequency to falls as cause of the SCI. Statistical test showed that the frequency of associated lesions was significantly in patients with thoracic SCI or thoracic vertebrae fractures, compared to patients with injuries at other spinal or vertebrae levels. Conclusions. Taking into consideration the high prevalence of associated lesions in patients with acute traumatic SCI, it is of major importance to suspect them in the initial clinical assessment, particularly in patients with thoracic SCI or vertebral trauma (AU)

Physical fitness after apical resection for the treatment of primary spontaneous pneumothorax.

The objective of the present study was to assess the physical fitness of patients after apical resection and partial apical pleurectomy for the treatment of primary spontaneous pneumothorax (PSP). Between 1982 and 1999, 58 patients received surgical treatment for PSP in our department. Twelve patients needed bilateral surgical intervention. At an average of 121 months after surgery (range, 16-231 months), the patients underwent follow-up assessments. Information was obtained on the basis of a questionnaire and from clinical examinations, including spirometry/body plethysmography and exercise testing with a bicycle ergometer. High-resolution computed tomography was used to identify postoperative changes of the lung apex. Forty-eight of 58 patients took part in the study, and all were found to be fully fit. High-resolution computed tomography gave evidence of new postoperative fibrocystic processes in 26 of the 31 affected apexes. One recurrence was observed (3.2%). Because apical resection cannot counteract pathogenetic mechanisms underlying parenchymal destruction and the formation of postoperative bullae among patients with a history of PSP, additional treatment of the apical pleura is necessary to prevent recurrences. Our results suggest that the physical fitness of patients with PSP can be completely restored postoperatively.

[Clinical pathway for the treatment of primary spontaneous pneumothorax in a general surgery department]. / Vía clínica para el tratamiento del neumotórax espontáneo primario en un servicio de cirugía general.

INTRODUCTION: Primary spontaneous pneumothorax (PSP) is a common entity. Treatment varies widely across different health systems and even among doctors in the same department. In our general surgery department 30 to 40 patients with PSP are treated each year and there is significant variability in care delivery. This prompted the development of a clinical pathway (CP) based on analysis of the process, a search for studies with the greatest scientific evidence and professional consensus. The aim of this study was to present the results after 1 year's evaluation of the CP. PATIENTS AND METHOD: A series of 34 patients treated in the year prior to the design of the pathway was analyzed to identify weak points and areas for improvement. To address these weak points the CP included associated protocols and principal documents. Thirty-one patients included in the CP were treated over 1 year and the results were compared with those of the pre-pathway series. RESULTS: The mean length of stay in the pre-pathway patients was 7.3 days compared with 5.0 days in the pathway patients. The number of radiographs also fell from 4.3 to 3.2. The rate of complications and re-admissions was similar in both groups. The mean cost per process decreased from 1863 Euro to 1168 Euro. CONCLUSION: The CP for pneumothorax reduced both variability in professional care patterns and hospital costs, justifying the work involved in its development and implementation.

Complicaçao relacionada ao uso da respiraçao com pressao positiva intemotente / The intermittent positive pressure breathing complication

O uso do recurso terapeutico com pressao positiva intermitente (RPPI), para expansao pulmonar, tem sido intenso dentro do tratamento de pacientes em uma Unidade de Terapia Intensiva. As suas indicaçoes sao basicamente a prevençao de atelectasias, aumento das capacidades pulmonares e recrutamento de areas pulmonares hipoventiladas ou colapsadas. Embora a contra indicaçao absoluta seja o pneumotorax, a avaliaçao clinica se faz necessaria previamente ao uso da tecnica (RPPI), com o intuito de evitarem-se complicaçoes associadas á indicaçao inadequada ou ate mesmo ao seu uso indiscriminado, como foi reportado nesse estudo de caso.

[Evaluation of surgical treatment of spontaneous pneumothorax--assessment of postoperative recurrence and quality of life].

To assess the effect of surgical treatment for spontaneous pneumothorax, including the evaluation of the quality of postoperative life by a questionnaire method, we examined 139 patients with spontaneous pneumothorax who underwent the surgical treatment. The operation was performed 149 times and 154 sides for these patients. Of these, 95 cases (65.2%) were the first episode of the disease, since we often chose surgical treatment even for the first attack of the disease. Postoperative recurrence was seen in only one case (0.6%). Operative complications included 4 cases of empyema (in two of them requiring reoperation) and 18 cases of wound infection. The most common postoperative complaints were post-thoracotomy pain in 12 cases (12.6%), disturbance of sensation in the scar in 9 (9.5%), and limitation of exercise in 9 (9.5%). Four patients (4.2%) suffered from these symptoms and had difficulty in daily life. Forty-seven patients (49.5%) had a fear of recurrence. Quality of postoperative life was almost satisfactory. From the viewpoints of both prevention of the recurrence and postoperative quality of life, the surgical treatment is effective and safe method. We advocate the surgical treatment as the first choice of the treatment even in case of the first episode of the disease, especially in patients with high activities in social life.

[Treatment of spontaneous pneumothorax]. / Lechenie spontannogo pnevmotoraksa.

The results of treatment of 418 patients with spontaneous pneumothorax are discussed. A total of 167 operations were carried out; they consisted in direct removal of the cause of the pneumothorax and operative pleurodesis. The complex of surgical measures included drainage of the pleural cavity, costal or apical pleurectomy, laser pleurodesis, and one-stage operation on both lungs by means of median sternotomy. Precise indications for applying each of the methods described were defined. Recurrent pneumothorax after the operative interventions was not encountered.

Immediate physiotherapy in perforating wounds of the pleural cavity and underlying lung.

Patients suffering from uncomplicated pneumothorax, haemothorax or haemopneumothorax of clinical significance are treated with fluid replacement, intercostal under-water drainage, antibiotics and routine physiotherapy. The commencement of routine physiotherapy may be delayed 8-60 hrs depending on the time the patient is admitted and arrangement of 'out-of-hours' physiotherapy services, but immediate physiotherapy produces superior results from every point of view.