Title
Catamenial pneumothorax in a young patient
diagnosed by thoracoscopic surgery; report of a case. [Japanese]
Authors
Ishikawa
N. Takizawa
M. Yachi
T. Hiranuma
C. Sato
H.
Institution
Department of Thoracic Surgery, Ishikawa Prefectural
Source
Kyobu Geka - Japanese Journal of Thoracic Surgery. 56(4):336-9,
2003 Apr.
Abstract
A 16-year-old woman presented with chest pain on 2 days before the onset
of menstruation and was referred to our hospital because of a pneumothorax. She was diagnosed as spontaneous penumothorax and surgical treatment was performed. Thoracoscopy revealed the presence of multiple blueberry
spots near central tendon of the diaphragm and little pleural effusion. No
other abnormal lesions were found in the left pleural cavity and left lung. Thoracoscopic biopsy and coagulation of the lesions were
successfully performed. Histological findings of biopsied
specimen did not contradict as an endometoriosis and catamenial pneumothorax
was diagnosed. CA 125 level of the pleural effusion had increased to 99.2 U/ml.
Because she was young, she did not receive a systemic hormonal therapy.
Authors
Chen
JS. Hsu
HH. Kuo
SW. Tsai
PR. Chen
RJ. Lee
JM. Lee
YC.
Institution
Division of Thoracic Surgery, Department of Surgery, National Taiwan
University Hospital and National Taiwan University College of Medicine, Taipei,
Taiwan.
Title
Needlescopic versus conventional video-assisted thoracic surgery for
primary spontaneous pneumothorax:
a comparative study.
Source
Annals of Thoracic Surgery. 75(4):1080-5, 2003 Apr.
Abstract
BACKGROUND: Management of primary spontaneous pneumothorax by needlescopic
video-assisted thoracic surgery (VATS) has rarely been attempted and no
comparison study with conventional VATS is available. In this study, we
compared the clinical outcomes of needlescopic VATS
with conventional VATS in treating primary spontaneous pneumothorax.
The technique and our experience with needlescopic
VATS are reported. METHODS: Between April 2001 and April 2002, a total
of 63 patients with recurrent, persistent, or contralateral
primary spontaneous pneumothorax were
recruited for this study. Operative procedures included needlescopic
VATS in 28 patients and conventional VATS in 35 patients. We used a modified
operative technique to improve the poor and narrower vision of the needle-videothoracoscope. RESULTS: There was no mortality
or major complications in either of the two groups. Needlescopic
and conventional VATS groups had comparable operation times, postoperative
pain, requested doses of meperidine hydrochloride,
durations of postoperative chest drainage, and length of hospital stay. After a
mean follow-up of 8 months, the needlescopic VATS
group had less residual neuralgia (p = 0.021) and better wound satisfaction (p
= 0.043) than the conventional VATS group. Ipsilateral
recurrence of pneumothorax occurred in 1
patient (3.6%) in the needlescopic VATS group but not
in any patients in the conventional VATS group. CONCLUSIONS: Our
experience showed that needlescopic VATS is
technically feasible and can be a satisfactory alternative to conventional VATS
in treating primary spontaneous pneumothorax.
Limited vision of needlescopic VATS can be improved
by the modified technique we used. However, conversion to conventional VATS or minithoracotomy is suggested in selected patients to
prevent early recurrence
Title
Catamenial pneumothorax:
retrospective study of surgical treatment.
Authors
Bagan
P. Le
Pimpec Barthes F. Assouad
J. Souilamas
R. Riquet
M.
Institution
Service de Chirurgie Thoracique, Hopital Europeen Georges Pompidou,
Source
Annals of Thoracic Surgery. 75(2):378-81; discusssion 381, 2003 Feb.
Abstract
BACKGROUND: Catamenial pneumothorax is a rare entity characterized by
recurrent accumulation of air in the thoracic space during menstruation. Catamenial pneumothorax is
also associated with a high rate of postoperative recurrence. The aim of this
study was to discuss the etiology and to determine the optimal surgical
treatment of this entity. METHODS: From December 1991 to September 2000,
10 patients with catamenial pneumothorax
were treated at our institution. Median age at time of operation was 37 years
(range, 21 to 44 years). We retrospectively evaluated the pathologic findings,
the operation performed, and the results in all patients. The mean follow-up
was 55.7 months. RESULTS: Pleurodesis alone
was performed in 5 patients and an associated diaphragmatic procedure was
performed in 5 patients. In 5 patients, no diaphragmatic anomaly was
discovered: 3 experienced one or more recurrences and all still suffer from
chronic catamenial chest pain. Hormonal therapy
temporarily improved outcome for 6 months in 2 patients. On the contrary, in 5
patients surgical pleurodesis was associated with the
repair of diaphragmatic defects (simple closure or coverage by a polyglactin mesh): these patients experienced no recurrence
(n = 0/5, p = 0.0016) and no subsequent catamenial
chest pain. CONCLUSIONS: The postoperative outcome is influenced by the
diagnosis of diaphragmatic defects with or without endometriosis. Surgical
treatment should be accomplished during menstruation for an optimal
visualization of pleurodiaphragmatic endometriosis.
Because diaphragmatic lesion is frequent and may be occult, we propose the
systematic coverage of the diaphragmatic surface by a polyglactin
mesh to prevent catamenial pneumothorax
recurrence even when the diaphragm appears normal.