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Spontaneous Pneumothorax*

Spontaneous Pneumothorax*


Vol. lXXVIIT SPONTANEOUS PNEIJMOTHORAXTABLE 3 - ADMISSION DIAGNOSISNumbersPneuinothorax 35Lobar Pneumonia 1Broncho Pneumonia 1Pleural Effusion 1Myositls 1pneumothoraces as was one with a moderate effusion. The small effusionswere those showing radiographic evidence of obliteration of the costophrenicangle on the involved side.Table 5 consists of essential data derived from this series. The caserequiring 279 days for re-expansion demands special comment and isdetailed separately in brackets. This was in essence a patient withchronic pneumothorax who refused treatment. Repeat examination eightmonths later revealed complete re-expansion. It can therefore be seenthat the time element here may be inaccurate.Three cases of hemopneumothorax were encountered in the 18-40 agegroup; none of these required thoracotomy either for control of haemorrhageor decortication.All cases requiring aspiration of air, which as previously stated wasdone because of respiratory embarrassment, had over 50 per cent lungcollapse. The lungs re-expanded fully in all cases. No residual atelectasisor evidence of sepsis was demonstrated in any case.The extent of collapse was estimated from the first radiographic examinationof the chest. Fifty-six per cent of all patients, and 45 per centof the patients treated by bed rest demonstrated more than 50 per centcollapse of their lungs.The re-expansion time was computed from the date of onset of symptomsto the date of radiographic confirmation of complete re-expansion.The 29 patients treated by bed rest showed an average re-expansion timeof 29 days.The recurrence rate at Westminster Hospital has been approximately10 per cent.DiscussionThe introduction of a catheter with active suction is considered the method of treatmentgiving the most rapid re-expansion of the lung; from immediate re-expansion3to 3.5 days.4Increased morbidity and the possible developemnt of chronic pneumothorax arethe arguments advanced against conservative therapy.The points against more aggressive treatment are the possible development ofbroncho-pleural fistula and permanent anatomical damage resulting from varioustypes of operative interference.In recent articles, the majority of author&’2’3”3 advocate an aggressive approachin the treatment of spontaneous pneumothorax. Active therapy recommended variesfrom the use of catheter suction in all cases8 to thoracotomy if the lung fails to reexpandafter five to seven days of suction and if bronchoscopy is negative.’’ Reportedresults are difficult to interpret especially as regards morbidity in patients submittedTABLE 4 - PRESENCE OF EFFUSIONNone 24Effusion: SlightModerateMarked1032Downloaded From: on 05/02/2014

514 VAIL, ALWAY AND ENGLAND November, 1960TABLE 5 - SUMMATION OF DATABed Rest:-Numbers:Re-expansionTime:Days - RangeAverageAir Aspiration: - Numbers:Re-expansion Time:Days - RangeAverageBlood Aspiration: - Numbers:Re-expansion Time:Days - RangeAverageCatheter Plus Water Seal:Re-expansionTime:Days - RangeAverage218-702513131323-9352223-493611081080 1622-5841423-60(229)36(97)298-7029623-108(279)49(88)0 0 3723-9350 17to thoracotomy. It would seem reasonable to assume that duration of hospitalizationwould be considerably prolonged if cases subjected to thoracotomy were included.Wynn Williams10 and Cliff’1 discussing a conservative regime report good results,similar to our own.To date the results on the medical service at Westminster Hospital compare favorablywith the results reported elsewhere. We feel that th continuation of conservativemanagement in the treatment of spontaneous pneumothorax is warrantd.SUMMARYThirty-nine consecutive cases of spontaneous pneumothorax treated with a conservativeapproach at Westminster DVA Hospital are analyzed.1. No previous pulmonary history was given in 27 patients; the remainder gave ahistory in keeping with chronic bronchitis and/or emphysema.2. Pain and/or dyspnea were initial symptoms in all.3. Four were misdiagnosed on initial clinical examination prior to chest radiography.4. Fifteen demonstrated an effusion on radiographic examination, three of whichwere obvious on clinical examination.5. The average re-expansion time for 35 patients treated by needle aspiration and/orbed rest was 32 days.6. The recurrence rate was 10.2 per cent.7. No immediate or remote complication was encountered in this series.8. We disagree with the early thoracotomy recommended by some authors.RESUMENSe analizan treinta y nueve casos consecutivos de neumotOrax espont#{225}neo, tratadosde manera conservadora en el Hospital DVA de Westminster.1. En 27 enfermos no habla antecedente alguno de enfermedad pulmonar, el restodi#{243} una historia ya sea de bronquitis y/o enfisema.2. Los sintomas iniciaies fueron dolor y disnea o ambos.3. Cuatro fueron errOneamente diagnosticados antes de la radiografia de tOrox.4. En quince habia derrame al examen radiogr#{225}fico, de los que evidentemente tresexistian ya cuando se hizo el estudio clinico.5. El t#{233}rmino medio de tiempo que requiriO la expansiOn para 35 enfermos tratadoscon aspiraciOn por aguja y reposo en cama o sin #{233}ste, fu#{233} de 32 dIas.6. La recurrencia fu#{233} de 10.2 porciento.7. No hubo complicaciones inmediatas 0 tardias en esta serie.8. No estamos de acuerdo con la recomendaciOn de algunos autorees que haven Iatoracotomia temprana.RESUMELes auteurs analysent 39 cas de pneumothorax spontan#{233}s trait#{233}s par des proc#{233}d#{233}sconservateurs a l’Hospital DVA de Westminster.1. Il n’y avait aucun antecedent chez 27 malades; les autres avaient une histoire debronchite chronique associ#{233}e ou non a de l’emphys#{232}me.Downloaded From: on 05/02/2014

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