[Management of spontaneous pneumothorax: nationwide fact-finding survey among Italian thoracic surgery units]. / Trattamento dello pneumotorace spontaneo. Indagine conoscitiva nazionale nelle strutture di Chirurgia Toracica.

Spontaneous pneumothorax, in both the primary and secondary variants, is a relatively frequent disease, occurring at all ages. Management of spontaneous pneumothorax is not standardised. Furthermore, few attempts have been made in the literature to codify the diagnostic workup and treatment. The aim of the present study is to report the results of a nationwide fact-finding survey, focused on current practice in the management of spontaneous pneumothorax by thoracic surgeons. A questionnaire, consisting of items in 6 major areas, was prepared and e-mailed to 49 thoracic surgery units in Italy. Thirty-five centres responded. The results (collected in a database presented at the XXX Congress of the Italian Society of Thoracic Surgeons in October 2006) show agreement on some questions (surgical indications, thoracoscopy as the first-choice surgical technique, use of mechanical staplers...) and a great variability of ideas and attitudes on others (CT scanning in primary spontaneous pneumothorax, definition of persistent air-leak, clamping of the chest tube before removal, pleurodesis techniques, postoperative chest X-ray schedule...). It is the authors' opinion that further work is needed in order to achieve a greater measure of agreement in the management of primary and secondary pneumothorax.

Chylothorax after abdominal surgery.

Chylothorax is usually a complication of thoracic surgery procedures. Over a 5-year period we encountered three cases of chylothorax following abdominal surgery performed in general surgery units. The initial effusions, not lactescent, were ascribed to a pleural reaction that sometimes is observed during the postoperative period after abdominal surgery. Once the diagnosis was established, the initial conservative treatment failed, and surgery was necessary. In our patients, their debilitated physical condition precluded a thoracotomy approach. A video-assisted thoracoscopy procedure was undertaken, but the extensive pleural effusions, caused in part by the delay in the diagnosis, prevented the exact localization of the duct and its closure. Talc pleurodesis was successfully employed in all patients. Even after abdominal surgery, a persistent pleural effusion should always induce us to suspect a chylothorax.

CT guided percutaneous fine needle biopsy of small lung lesions in outpatients. Safety and efficacy of the procedure compared to inpatients.

PURPOSE: To compare the safety and efficacy of CT-guided fine needle biopsy (FNAB) of small (<15 mm) lung lesions in inpatients and outpatients. MATERIALS AND METHODS: 108 consecutive inpatients (69 M, 39 F, mean age 56) and 121 consecutive outpatients (90 M, 31 F, mean age 50) who underwent CT-guided FNAB of small lung lesions were included. Lesion size, depth, number of needle passes, presence of emphysema were recorded. 22 G Chiba needles and the roll-over technique were used for all patients; if no significant pneumothorax was detected after FNAB, outpatients were allowed to go home and instructed to return in case of complications. The incidence of pneumothorax and other complications, sensitivity, specificity, diagnostic accuracy were calculated. RESULTS: 12 inpatients and 33 outpatients were lost to follow-up. No statistical differences were observed in lesion size, depth, needle passes, presence of emphysema between the groups. We had 15 pneumothoraces in inpatients, 4 requiring a chest tube, 12 in outpatients, 2 requiring a tube. Diagnostic accuracy was 92.7% in inpatients and 90.9% in outpatients. There were 7 false negatives in inpatients and 8 in outpatients, with negative predictive value of 79% and 78%, respectively. There were no false positives. All differences are nonsignificant. CONCLUSIONS: CT-guided FNAB of small lung lesions is an equally safe and effective procedure in inpatients and outpatients; outpatient performance of FNAB can decrease costs.