Pneumothorax associated with pulmonary tuberculosis
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Aim To explore the etiopathogenesis,prevention,diagnosis and treatment of newborn pneumothorax.Methods The data of 15 cases of newborn pneumothorax admitted in our newborn ward in the last 3 years were analyzed for etiology,clinical manifestation,diagnosis and management.Results In the 15 cases of newborn pneumothorax,there were spontaneous pneumothorax 3 cases,pathologic pneumothorax 9 cases,iatrogenic pneumothorax 3 cases.The clinical symptom of pathologic and iatrogenic pneumothorax was more serious than that of spontaneous pneumothorax.According to the state of the disease,the 15 cases of newborn pneumothorax were treated with expectant treatment,thoracic puncture or drainage respectively.pneumothorax of 14 cases vanished.Conclusion the pathogeny of Newborn Pneumothorax was different,some of which could be prevented.Early diagnosis was very important in newborn pneumothorax.Selection of clinical management for newborn pneumothorax based on different degrees and types would result in favorable treatment outcomes.
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Objective:To investigate the effect of using normal saline (NS) injection to prevent pneumothorax in percutaneous needle biopsy of lung.Methods:136 patients (55 years of age,n=36;55 years of age,n=100) having percutaneous needle biopsy were divided into two groups (group A,Group B),with 50 patients in each group.NS was injected via the needle during the percutancous needle biopsy operation in Group B.Results:Of the 136 patients,percutaneous needle biopsy of lung were successfully performed.2 cases in patients with the age 55 years of age had complicated pneumothorax,with the volume of gas 10%.Of the patients with the age 55 years,pneumothorax were seen more commonly.14 cases in Group A were complicated with pneumothorax,12 patients had the volume 10% and 2 patients 30%,subcutaneous emphysema was seen in 1 patient.Of the Group B,only 4 patients had pneumothorax with the volume 10%,the incidence rate of pneumothorax was obviously lower than that of Group A,morbidity including cough or expectoration was not occurred due to injection of NS.Conclusion:Injection of NS during percutaneous needle biopsy of lung can block the puncture pathway of visceral pleura in certain degree,and reduce the incidence rate of pneumothorax.
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Lung biopsy
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BACKGROUND: Spontaneous pneumothorax have been managed with a variety of methods. The technique most frequently used is chest tube drainage. Small caliber catheters were first used in the management of pneumothorax complicating the percutaneous needle aspiration lung biopsy, and the try to treat spontaneous pneumothorax also has been reported. However, the value of small caliber catheters in spontaneous pneumothorax has not been fully evaluated. So, we tried to elucidate the efficacy of 8 French catheter in the management of spontaneous pneumothorax. METHOD: From January, 1990, to April, 1994, 44 patients with spontaneous pneumothorax treated at Chung-Ang university hospital were reviewed. The patients were sub-divide into 8 French catheter insertion group (n=21) and chest tube insertion group (n=23). We compared the presence of underlying lung disease, the extent of the collapse, the duration of indwelling catheter and complication between two groups. RESULTS: 1) The duration of indwelling showed no significant difference between 8 French catheter group and chest tube. But, complication after insertion as subcutaneous emphysema was developed in only chest tube group. (p<0.05) 2) In the primary spontaneous pneumothorax, all case of the pneumothorax of which size was less than 50% showed complete healing with 8 French catheter insertion. Whereas the success rate in patients with large pneumothorax (more than 50%) was tended to be dependent on the age. 3) In the patients with secondary spontaneous pneumothorax who were managed with 8 French catheter, the success rate was trended to be high if the underlying disease of pneumothorax was not COPD and if the patient was young. CONCLUSION: These results show that 8 French catheter insertion probably was effective in the pneumothorax less than 50%, the primary spontaneous pneumothorax, young age or secondary pneumothorax not associated with COPD.
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Observation alone is advised only for primary spontaneous pneumothoraces with less than 20 percent of the lungs collapsed. In such cases, it is the resorption capabilities of the visceral pleura that are solely relied upon. The AIM of the present experimental study was to demonstrate the capabilities of the pleura for pneumothorax resolution by room air.The study was conducted with six laboratory animals (New Zealand white rabbits, weighing 2.5-3.5 kg), in which right total pneumothorax was induced. Conventional chest X-rays at intervals of 2 days were used to monitor the changes in the size of the pneumothorax until its final resolution. The size of the pneumothorax was estimated by the Light index.Total resolution of the pneumothorax occurred within 12 days after it was induced. The average rate of pneumothorax resolution was 6.63% (SEM +/- 0.20)/daily.The study imitates initial clinical observation in pneumothorax. Despite the fact that the study demonstrates resolution of total pneumothorax (100%), observation only is inappropriate as a treatment modality in patients with more than 20% collapse of the lung.
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Purpose To assess the influence of various patient-, lesion-, and procedure-related variables on the occurrence of pneumothorax as a complication of CT-guided percutaneous transthoracic needle biopsy. Material and methods In a total of 208 patients, 215 lung/mediastinal lesions (seven patients were biopsied twice) were sampled under CT guidance using coaxial biopsy set via percutaneous transthoracic approach. Incidence of post procedure pneumothorax was seen and the influence of various patient-, lesion-, and procedure-related variables on the frequency of pneumothorax with special emphasis on procedural factors like dwell time and needle-pleural angle was analysed. Results Pneumothorax occurred in 25.12% (54/215) of patients. Increased incidence of pneumothorax had a statistically significant correlation with age of the patient (p = 0.0020), size (p = 0.0044) and depth (p = 0.0001) of the lesion, and needle-pleural angle (p = 0.0200). Gender of the patient (p = 0.7761), emphysema (p = 0.2724), site of the lesion (p = 0.9320), needle gauge (p = 0.7250), patient position (p = 0.9839), and dwell time (p = 0.9330) had no significant impact on the pneumothorax rate. Conclusions This study demonstrated a significant effect of the age of the patient, size and depth of the lesion, and needle-pleural angle on the incidence of post-procedural pneumothorax. Emphysema as such had no effect on pneumothorax rate, but once pneumothorax occurred, emphysematous patients were more likely to be symptomatic, necessitating chest tube placement. Gender of the patient, site of the lesion, patient position during the procedure, and dwell time had no statistically significant relation with the frequency of post-procedural pneumothorax. Surprisingly, needle gauge had no significant effect on pneumothorax frequency, but due to the small sample size, non-randomisation, and bias in needle size selection as per lesion size, further studies are required to fully elucidate the causal relationship between needle size and post-procedural pneumothorax rate. The needle should be as perpendicular as possible to the pleura (needle-pleural angle close to 90°), to minimise the possibility of pneumothorax after percutaneous transthoracic needle biopsy.
Percutaneous biopsy
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Objective To study the relationship between the factors of pneumothorax on CT-guided percutaneous needle biopsy. Methods 283 patients with lung lesions were compeleted on CT-guided percutaneous needle biopsy,analysis of factor pneumothorax oc- curred and relationship between different the factors.Promoting the corresponding methods of prevention and treatment.Results 283 pa- tients with lung biopsy were successful,pneumothorax occurred in 32 cases,with the exception of 3 cases of marked pneumothorax,the oth- ers were little pneumothorax.Pneumothorax occurred is related to operated technique,the conditions of patients themselves,lesions factors, the size of puncture needle and anesthesia factor.A little pneumothorax was not treatment and a large of pneumothorax required drainage pipe.Conclusion There were correlation impact factors about pneumothorax formation on CT-guided percutaneous needle biopsy,the technique of operator is important factor of pneumothorax formed.The condition of patients themselves,lesions position,anesthesia and the size of needle are secondary factors.
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Percutaneous biopsy
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Objective To determine the risk factors for the rate of pneumothorax associated with TNAB of the lung. Methods This study involved 424 consecutive patients who underwent TNAB in our hospital under consistent methods. Patient age,sex,needle size,lesion size,distance of lesion from the pleura and results of pulmonary function tests were analyzed as single variables for pneumothorax. Results Forty-three patients had pneumothorax (10.1%) after TNAB. Age associated with higher rate of pneumothorax ( P 0.01). Increased lesion depth was a significant predictor of pneumothorax ( P 0.01). Smaller lesion size was correlated with increased risk of pneumothorax ( P 0.01). The FEV 1%、FEV 1/FVC ratio were lower in patients with pneumothorax ( P 0.01). Needle size was also correlated with increased risk of pneumothorax (P=0.0397).Conclusion Age,increased lesion depth and smaller lesion size,needle size and PFTs are correlated strongly with the development of pneumothorax. Our findings suggest that PFTs is necessary to perform in all patients prior to biopsy.
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BACKGROUNDThis study was performed to evaluate the incidence and clinical characteristics of symptomatic pneumothorax in the full-term neonate. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 32 symptomatic pneumothorax patients in the full term neonates who admitted to the neonatal intensive care unit in Ulsan Dong Kang General Hospital from January, 2000 to December, 2004. The subjects were divided into two groups according to underlying causes; spontaneous pneumothorax group and secondary pneumothorax group, then each clinical characteristics were assessed. RESULTS: Spontaneous pneumothorax patients were 10 (31%) and secondary pneumothorax patients were 22 (69%). Overall incidence of spontaneous pneumothorax was 0.4%. Most common cause of secondary pneumothorax was pneumonia. Twelve cases (54.5%) among secondary pneumothorax patients were associated with mechanical ventilator care. Clinical characteristics, courses and managements were similar between two groups, but more shorter duration of admission and chest-tube insertion in spontaneous pneumothorax group CONCLUSION: The patient with symptomatic pneumothorax needs careful observation and proper management with or without underlying respiratory diseases
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