Interference by carbohydrate substrates, flavonoids, and monosaccharide derivatives on bacterial beta-D-glucuronidase assays

PURPOSE: To determine if suprarenal placement of inferior vena cava (IVC) filters is associated with renal dysfunction or other complications. MATERIALS AND METHODS: Case files of all patients with suprarenal vena caval filter placement since 1985 were reviewed for clinical and biochemical evidence of renal dysfunction and renal vein thrombosis. The occurrence of associated complications, including IVC occlusion, filter fracture, device migration, and recurrence of pulmonary embolism was also recorded. RESULTS: Twenty-two (2.9%) of 764 IVC filters were implanted above the renal veins: titanium Greenfield filter modified hook (TGF-MH) (n = 16), LGM type I (n = 2), LGM type II (n = 2), and Bird's Nest (BN) type I (n = 2). Reasons for suprarenal filter placement included thrombus to the level of the renal veins (n = 9), failure or poor position of the infrarenal filter (n = 6), pregnancy or intent of pregnancy (n = 4), and the malpositioning of BN filters above the renal veins (n = 2). A single patient demonstrated evidence of transient renal dysfunction. Pulmonary embolus was found at autopsy in one patient. Abdominal radiographs were obtained at follow-up of 18 patients and demonstrated a 2 cm or more migration of the filter in five patients (27.7%). This rate of migration was significantly different from the 3% migration rate reported by the authors' institution in the follow-up of 320 infrarenal IVC filters. There was one filter fracture (5.5%.) and penetration of the IVC occurred in one patient (5.5%). CONCLUSION: Follow-up indicates suprarenal IVC filter placement is safe, and no evidence of permanent renal dysfunction after placement was found. Filter migration was the most frequent complication, but no clinical sequelae were noted with these patients.     

Vena cava duplex imaging before caval interruption

PURPOSE: Venacavograms are routinely obtained before vena cava filter placement to evaluate cava size, patency, and the presence of thrombus or venous anomalies. The objective of this study was to determine the ability of duplex ultrasonography to adequately evaluate the inferior vena cava (IVC) for size, patency, and the presence of thrombus before Greenfield filter (GF) insertion. METHODS: Duplex ultrasonographic scans were performed in 40 patients who had documented lower-extremity deep venous thrombosis diagnosed by duplex scan before GF placement. The infrarenal transverse and anteroposterior diameters of the IVC were measured, and the entire IVC was imaged for patency and the presence of thrombus or anomalies. Preoperative venacavograms were not obtained in any patients who had GFs placed in the operating room, but was performed during surgery during filter insertion. An additional 26 patients who had deep venous thrombosis and did not have caval interruption underwent IVC duplex to determine the patency and proximal extent of venous thrombosis. RESULTS: The indications for GF placement were contraindication to anticoagulation in 72.5% (29 patients); five filters were placed prophylactically; three for failure of anticoagulation; two after a complication of anticoagulation; and one before pulmonary embolectomy. The filters were placed in the operating room by surgeons in 82.5% of patients, with the remainder inserted in an angiography suite by an interventional radiologist. The ability of duplex to measure a transverse diameter of 26 mm or less had a sensitivity of 97.5%, positive predictive value of 100%, and overall accuracy of 97.5% using venacavography as the standard. Measurements of IVC diameter by duplex correlated with those based on venacavograms (r = 0.766; p < 0.001). Of the entire group of 66 IVC duplex examinations, one (1.5%) was incomplete because of technical limitations. IVC thrombus was noted by duplex in two patients who underwent GF insertion, which was confirmed with venacavography. No IVC anomalies were noted by duplex scans or venacavograms. CONCLUSION: Duplex ultrasonography is a useful and accurate method for assessment of the IVC before vena cava filter placement.     

In vitro and in vivo experimental evaluation of a new vena caval filter

PURPOSE: A new stainless steel (MP35N alloy) vena cava filter without a central stasis point was evaluated in vitro and in vivo. MATERIALS AND METHODS: The clot-trapping efficiency and hemodynamic flow pattern of the filter were assessed in a flow model and were compared with those of currently available commercial filters including the Vena Tech-LGM, Simon nitinol, Greenfield, and Bird's Nest filters. The new filter was placed in the inferior vena cava (IVC) of 31 dogs; 21 of the 31 dogs were followed up with cavography for up to 3 months. At the termination of the study, the filters and IVCs were examined grossly and histologically. An in vivo clot-trapping test was carried out in five dogs. RESULTS: The least turbulence was noted with the new filter and the titanium Greenfield filter. The stainless steel Greenfield and Simon nitinol filters caused major flow disturbances. Migration within 5 cm of initial placement occurred in two animals (9.5%). There were no IVC thromboses, perforations, or filter embolizations. An in vivo clot-trapping study showed an 80% efficiency for small thrombi (3 x 20 mm) and 100% efficiency for large thrombi (6 x 20 mm) with the new filter. The Simon and the new filter had the best clot-trapping capabilities. The Vena Tech-LGM and Bird's Nest filters were slightly inferior and the Greenfield filter demonstrated by far the lowest trapping capacity. CONCLUSION: The new vena cava filter is easily introduced percutaneously through a 12-F sheath and appears to be very promising due to its high filtering capability, low turbulence, nonmagnetic properties, good mechanical stability, and hypothrombogenicity. Clinical trials are warranted.     

Arterial disease and thrombosis in the antiphospholipid syndrome: a pathogenic role for endothelin 1

PURPOSE: It has been proposed that inferior vena cava filter placement should be the initial treatment of deep venous thrombosis (DVT) or pulmonary embolus (PE) in patients with coexisting malignant disease. We have chosen instead to selectively place filters only in patients with either a contraindication to anticoagulation therapy or a subsequent complication from anticoagulation therapy. The treatment efficacy and mortality rates in patients with concomitant malignant disease and venous thromboembolism using this approach was determined. METHODS: We retrospectively reviewed all patients at our institution with malignant disease in whom venous thromboembolism developed between August 1991 through August 1996 and identified 166 patients with PE (n = 8), DVT (n = 147), and DVT/PE (n = 11). Of these patients, 138 (83.1%) were initially treated with anticoagulation therapy, and 28 (16.9%) had primary filter placement because of contraindications to anticoagulation therapy (10 for intracranial tumors, 11 for recent or upcoming operations, 6 for recent hemorrhage, and 1 for a malignant bloody pericardial effusion). RESULTS: Thirty-two (23%) of the 138 patients who initially underwent anticoagulation therapy subsequently required a filter for the following reasons: bleeding (n = 15, 10.9%); recurrent thromboembolism (n = 6, 4.3%); heparin-induced thrombocytopenia (n = 1, 0.7%); and perceived high risk for bleeding with continued anticoagulation therapy (n = 11, 8%). Both bleeding and recurrent thromboembolism developed in 1 patient. Sixty patients (36%) received filters. No major technical complications occurred from filter placement. Major recurrent thromboembolic complications developed in 10 patients: DVT (n = 6, 10%), PE (n = 2, 3.3%), inferior vena cava thrombosis and phlegmasia cerulea dolens (n = 1, 1.7%), superior vena cava thrombosis (n = 1, 1.7%). Venous gangrene developed in 1 patient with DVT. The 1-year actuarial survival rates for patients treated with filter and anticoagulation therapy were 35% and 38%, respectively (P = NS). CONCLUSION: In summary, our experience suggests that 64% of patients with malignant disease and venous thromboembolism are effectively treated with anticoagulation alone; 17% require primary filter placement for standard indications, and an additional 19% require subsequent filter placement because of complications (primarily bleeding) or failure of anticoagulation therapy. Although technical complications of filter placement are low, serious life-threatening or limb-threatening thromboembolic complications developed in 17% of patients. Survival was poor in all patients, regardless of treatment. These data support a conservative approach of routine anticoagulation therapy with selective filter placement.     

Selection-dependent trends of autogeny and blood feeding in an autogenous strain of Culex tarsalis (Diptera:Culicidae)

The purpose of this report is to examine the outcomes for patients with an underlying diagnosis of malignancy who have had Greenfield vena caval filters placed for protection from pulmonary embolism, and to identify areas requiring further study. This was a retrospective review of data obtained from the Greenfield filter registry and the University of Michigan Tumor Registry for 166 patients treated at the University of Michigan Medical Center between January 1988 and June 1994. The 84 men and 82 women (mean age 57.8 years) had a mean survival time of 10 (range 1-68) months. This differs significantly from patients in the filter registry who do not have malignancy (P<0.0001). Some 51% experienced recurrence of their malignancy at a mean of 20 months; this timing corresponds to development of new or recurrent thrombembolism and filter placement. Distant metastases were present in 72% of patients at the time of filter placement. In conclusion, as anticipated, filter patients with malignancy have a significantly shorter survival time than those with other concurrent diseases. A temporal association between the progression of the malignancy and the occurrence of thromboembolism is observed in this population and requires further study. Future studies regarding the use of vena caval filters in these patients and the role of diagnostic screening for deep venous thrombosis and occult recurrence of malignancy should focus on efficacy, safety, cost and patient quality of life rather than on survival.     

Urinary excretion of proteolyzed alpha1-antitrypsin: specificity, quantitation, and relation to therapy response in patients with acute myeloid leukemia

The purpose of this study was to characterize the long-term safety and efficacy of the stainless-steel Greenfield filter. All patients who underwent Greenfield filter placement at three institutions during tenure of the senior author (L.J.G.) were entered prospectively into a filter registry and followed on an annual basis. Follow-up consisted of clinical examination to evaluate the status of venous disease or recurrence of pulmonary embolism, abdominal radiographs to determine the stability of the filter and an evaluation of the patency of the inferior vena cava and lower extremities. This report summarizes the 20-year experience. The rate of recurrent pulmonary embolism was 4% and the caval patency rate was 96%. Some filter movement of no clinical significance was seen in 8% of cases. There was no procedural mortality and morbidity was minimal. Greenfield filter insertion provides long-term protection from pulmonary embolism while preserving caval patency.     

Prosthetic replacement of the inferior vena cava for malignancy

PURPOSE: Invasion of the inferior vena cava (IVC) by tumor is generally considered a criterion of unresectability. This study was designed to review the outcomes of a strategy of aggressive resection of the vena cava to achieve complete tumor resection coupled with prosthetic graft placement to re-establish caval flow. METHODS: Retrospective review of patients treated at a university referral center. Ten patients (mean age 54; eight females, two males) underwent tumor resection that involved circumferential resection of the IVC and immediate prosthetic replacement with ringed polytetrafluoroethylene (PTFE) grafts ranging in diameter from 12 to 16 mm. RESULTS: Seven patients had replacement of the infrarenal IVC, two of their suprarenal IVC, and one had reconstruction of the IVC bifurcation. Four of the 10 patients received preoperative chemotherapy, and none received radiotherapy. The most common (7/10) pathologic diagnosis was leiomyosarcoma arising from the IVC or retroperitoneum. Additional diagnoses included teratoma (one), renal cell carcinoma (one), and adrenal lymphoma (one). There were no perioperative deaths, and one complication (prolonged ileus) occurred. Mean length of stay was 8.1 days. Anticoagulation was not routinely used intraoperatively or postoperatively. Follow-up (mean duration = 19 months) demonstrated that survival was 80% (8/10) and 88% (7/8) of patients were free of venous obstructive symptoms. CONCLUSION: Resection of the IVC with prosthetic reconstruction allows for complete tumor resection and provides durable relief from symptoms of venous obstruction.     

Vitreous changes and retinal detachment in highly myopic eyes

Although the impressive increase in the number of filters placed since 1988 is not surprising, it is appropriate to continue to review the indications for placement to determine whether abuse of these devices is occurring. Initially, there were very stringent requirements that were appropriate because there were few data to evaluate the efficacy and safety of the device. Now, data have been accumulated indicating the Greenfield filter has a high degree of efficacy (95%) and comparable caval patency (96%)32 for 20 years.1 Knowing that the filter is safe and effective, physicians are electing to place it in patients with greater comorbidity factors or with longer life-expectancy. In addition, advances in the treatment of patients with multiple trauma and malignancy have resulted in improved survival, leaving more patients at risk of DVT and PE. Finally, the number of patients older than age 60 is increasing rapidly, and the number of elective and emergent orthopaedic procedures is growing. All of these factors have led to an increased number of filter placements that should be considered appropriate. Although there are certainly cases in which the filter was placed without sufficient justification, the explosion in use can more accurately be correlated with changes in medical care, the established efficacy and safety of the device, the growing numbers of patients diagnosed with thromboembolism, and the increased awareness of the risk of complications from anticoagulation. When filter placement is preceded by a careful assessment of the patient to determine the risks and benefits of alternative treatments, there is little danger of abuse. However, more clinical investigation will be necessary to determine the optimal, cost-effective approach in situations in which controversy currently exists.     

IVC filter tilt and asymmetry: comparison of the over-the-wire stainless-steel and titanium Greenfield IVC filters

PURPOSE: A comparison of tilting, caval coverage, asymmetry, and insertion problems with the over-the-wire stainless-steel and titanium versions of the Greenfield filter. MATERIALS AND METHODS: The study compared 104 stainless-steel and 141 titanium Greenfield inferior vena cava (IVC) filter insertions. The angle the sheath and deployed filter made relative to the cava, as well as filter strut distribution, were determined from spot films. The proportionate caval coverage was computed from the cavogram (anteroposterior projection). Mean filter tilts, subgrouped by insertion site, and caval coverage were compared with the Student t test, whereas strut patterns were analyzed with a contingency table. RESULTS: The filter caval and sheath caval angles correlated. The filter caval angles varied with insertion site, but were lowest with a right jugular approach. Caval coverage was identical with both designs. The stainless-steel version resulted in a more uniform distribution of struts in comparison with the titanium version. The incidence of insertion problems was not significantly different between the filter types. CONCLUSIONS: While IVC filter tilting was not improved with the newer design, the pattern of struts was more uniformly symmetric with the stainless-steel device. The right jugular insertion site was associated with the lowest filter caval angles and the most symmetric pattern of struts.     

Vena cava filter ensnarement and delayed migration: an unusual series of cases

PURPOSE: To review delayed and guidewire-induced morbidity associated with vena cava filters. METHODS: The records from the Johns Hopkins Hospital, a tertiary care referral center, of all patients who had vena cava filter complications from August 1993 through July 1996 were retrospectively reviewed. RESULTS: Five patients had filter migration or ensnarement with a guidewire. One patient had delayed extrusion of a filter strut into the duodenum. Four patients had filters ensnared by guidewires, including one during initial filter placement and one several years after placement. CONCLUSIONS: Delayed complications of vena cava filters should be considered whenever unusual patient signs or symptoms cannot be easily explained, even in the absence of a history of filter placement. To prevent guidewire ensnarement of filters, simple techniques should modify endovascular procedures when vena cava filters are present.     

Bird's nest inferior vena caval filter migration into the duodenum: a rare cause of upper gastrointestinal bleeding

PURPOSE: To report the first case of a potentially catastrophic complication of vena caval interruption with a bird's nest filter. METHODS AND RESULTS: A 55-year-old Saudi patient presented with hypovolemic shock from massive upper gastrointestinal hemorrhage. Endoscopy identified a metallic object penetrating the duodenum. Five years earlier, the patient had a bird's nest vena caval filter inserted for recurrent pulmonary embolism. During emergent laparotomy, a broken filter wire was found projecting into the duodenum, where it had induced three profusely bleeding ulcers. The wire was transected and the ulcers oversewn. A hook projecting from the inferior vena cava (IVC) was also cut flush with the vessel wall, but the IVC was not opened nor the filter replaced. The patient's postoperative course was complicated by deep venous thrombosis, but he recovered and is asymptomatic on warfarin anticoagulation after 1 year. Computed tomography (CT) at 1-year follow-up confirmed no further migration of the filter. CONCLUSION: This event reinforces the need to monitor patients with IVC filters over the long term, preferably using CT scanning, and to consider filter migration as a possible cause of upper gastrointestinal bleeding.     

Single muscle fibre analyses in 2 brothers with succinate dehydrogenase deficiency

Thrombosis of the access site and occlusion of the inferior vena cava after placement of an inferior vena caval filter are known complications of caval interruption. 30 patients were evaluated with colour-coded Doppler sonography 4 to 66 months (average 2.5 years) after percutaneous placement of either a Günther filter, a Bird's Nest filter or a Simon-Nitinol filter. One right internal jugular vein had post-thrombotic alterations. One inferior vena cava was found to be occluded 15 months after Simon-Nitinol filter placement. The long-term occlusion rates of access site and inferior vena cava after percutaneous filter introduction are low. These two factors need not be considered if implantation of a caval filter is contemplated.     

Management of deep vein thrombosis of the lower extremity in pregnancy: a challenging dilemma

This study reviews our experience in the management of deep vein thrombosis (DVT) of the lower extremity during pregnancy and analyzes the outcome of various treatment alternatives, including conventional full-dose heparin therapy and Greenfield filter insertion. Twenty-four patients treated over an 8-year period were reviewed. Fifteen patients were treated with conventional full-dose intravenous heparin therapy for 5 to 10 days, followed by subcutaneous low-dose heparin until labor, and continued for 6 weeks postpartum (Group A); Eleven patients had Greenfield filters inserted, followed by the same low-dose subcutaneous heparin regimen (Group B). There were 18 femoral or iliofemoral, 5 femoropopliteal, and 1 popliteal and below-knee DVT. The indications for Greenfield filter insertion included two patients in Group A (one with pulmonary embolism, despite adequate heparin therapy, and one with significant bleeding). Nine other patients had prophylactic indications: two for free-floating iliofemoral DVT, three with iliofemoral DVT (occurring just 1-2 weeks before labor), and four with femoropopliteal DVT. There were three immediate major complications (pulmonary embolism, bleeding, or death) in Group A; two with pulmonary embolism, one of which was fatal, and one with significant bleeding (3 of 15 patients; 20%). No major complications occurred in Group B. On long-term follow-up (mean, 61 months), 4 of 12 patients (33%) in Group A had significant leg swelling, with partial resolution of DVT in 2 patients and venous occlusion in 2 patients by duplex ultrasound. This is in contrast to 3 of 11 patients (27%) in Group B with significant leg swelling. There was no fetal morbidity or mortality in either group. Conventional full-dose heparin therapy for DVT of the lower extremity in pregnancy can carry significant morbidity and mortality. Greenfield filters may be used safely in some of these patients.     

Malnutrition in geriatric patients: a neglected problem?

PURPOSE: The authors report their experience with the translumbar inferior vena cava (IVC) approach for central venous access during a 6-year period at three teaching hospital sites. PATIENTS AND METHODS: Twenty-nine percutaneous IVC central venous access catheters were inserted in 22 patients during a 6-year period in the radiology departments of three teaching hospital sites. All patients had undergone unsuccessful attempts at conventional central venous access. Information was gathered by retrospective radiologic and hospital chart review. RESULTS: All attempted placements were successful. Catheters were in place for a total of 3,510 catheter days. The average length of catheter placement was 121 days (range, 14-536 days). Life-table analysis predicted catheter function rates of 55% and 29% at 6 and 12 months, respectively. Three procedure-related complications occurred. A lower pole branch of the right renal artery was inadvertently entered with a 22-gauge needle during attempted IVC puncture in one patient without clinical sequelae. A second patient developed a small groin hematoma at the femoral venous puncture site, which resolved spontaneously. A third patient developed a moderate retroperitoneal hematoma, which resolved without specific intervention. The sepsis rate was 2.8 infections per 1,000 catheter days with an average time to infection of 127 days (range, 10-536 days). CONCLUSION: In the authors' experience of 29 translumbar central venous catheter insertions, all attempts were successful. Percutaneous central venous access via the IVC is a safe and effective option for patients in whom more conventional access is not possible.     

An unusual cause of low back pain? A case report

STUDY DESIGN: Case report. OBJECTIVE: To highlight the evaluation of a patient with low back pain after an incidental radiographic finding clouded routine management. SUMMARY OF BACKGROUND DATA: Greenfield filters have been used for 20 years with good results. Complications have been seen and documented, but the natural history of filter placement in young patients is not fully appreciated. A prong from a Greenfield filter embedded within a vertebral body has been reported once as an incidental finding in a patient undergoing prophylactic monitoring for recurrence of tumor. METHODS: A 31-year-old woman had a pulmonary embolus after surgery for a benign adnexal mass. A bleeding complication occurred after systemic anticoagulation, and a vena caval filter was placed to limit the possibility of further emboli. The patient was referred to the orthopedic clinic 5 years later with low back pain and an unusual finding on computer tomographic scan: One prong of the filter was embedded within a vertebral body. RESULTS: A bone scan was obtained to evaluate the status of bone activity around the prong. Bone reaction was not evident. Conservative management of her low back pain was instituted, and after 2 years, the patient remains asymptomatic. CONCLUSION: The overall use of vena caval filters has produced favorable results, although numerous complications have been reported. All long-term sequelae have not been completely identified.     

Histo-blood group p: biosynthesis of globoseries glycolipids in EBV-transformed B cell lines

PURPOSE: In vitro and in vivo investigations were performed to evaluate the Irie retrievable inferior vena caval (IVC) filter. MATERIALS AND METHODS: The clot capturing performance of the Irie and five other IVC filters were assessed in both horizontal and vertical orientations within a pulsed-flow circuit with 240 clot challenges for each filter. Subjective comparisons of the flow disturbance characteristics of the Irie and three other filters were also performed. In vivo studies consisted of 13 Irie filter insertions and eight attempted retrievals in 11 pigs. Histologic evaluation of the IVC was performed with the Irie filter in situ and following retrieval. RESULTS: In vitro testing demonstrated the clot capturing capability and flow disturbance characteristics of the Irie filter to be similar to those of other IVC filters. Filter deployment problems occurred during three of the 13 insertions. Six of the eight retrieval procedures were successful; four filters were retrieved 1 month after insertion. Follow-up cavography demonstrated two tilted filters and three caval perforations. CONCLUSION: The performance of the Irie filter is similar to that of other currently available IVC filters. The filter can be retrieved after neointimal incorporation of the struts into the IVC wall.     

Vena cava filter. Indications, complications, clinical evaluation

INTRODUCTION: Pulmonary embolism is the third leading cause of death in the western countries. If anticoagulation fails or is contra-indicated, or if the risk for pulmonary embolism is increased for other reasons, the percutaneous implantation of a vena cava filter should be considered. METHODS: The available filters can be differentiated by the design (cone, basket, net-types), by the material, and by their removability. The rate of complications (caval thrombosis, fracture of filter) and the in vitro efficacy in trapping thrombotic clots is dependent on the specific filter type. RESULTS: In clinical practice there is no evidence for significant differences in trapping efficacy among the different filters. About 4% of all patients treated by caval filters still can have pulmonary embolism, and 1% will have a fatal outcome. Dependent on the filter type, the most common complication is caval thrombosis, in up to 25% of cases. CONCLUSION: The percutaneous implantation of caval filters can readily be performed by interventional radiologists. However, randomized clinical studies failed to clearly document efficacy of caval filters. Therefore, indication has to be considered carefully.     

Thrombolysis and endovascular stent placement for inferior vena caval thrombosis in a liver transplant recipient

BACKGROUND: Vascular complications remain an important cause of postoperative morbidity in liver transplant patients. Herein, we present an unusual case of nonanastomotic inferior vena cava (IVC) stenosis in a patient with a "piggyback" caval anastomosis. METHODS: A 59-year-old woman underwent liver transplantation using a piggyback IVC anastomosis. Her postoperative course was complicated by IVC thrombosis. Catheter-directed thrombolysis, followed by balloon angioplasty and intravascular stent placement, was used to recanalize the IVC and treat a severe retrohepatic IVC stenosis. RESULTS: After 46 hr of catheter-directed urokinase infusion, there was clot lysis and identification of a severe stenosis in the retrohepatic IVC. The lesion was extremely resistant to balloon dilatation alone and a 22-mm-diameter intravascular stent was placed. Simultaneous dilatation of three high-pressure balloons was necessary for maximal stent expansion. The patient remains asymptomatic with no evidence of IVC compromise through 20 months of follow-up. CONCLUSIONS: IVC stenosis and thrombosis after liver transplantation may be treated favorably in some patients using catheter-directed thrombolytic therapy followed by balloon dilatation and/or stent placement.     

Analysis of tube thoracostomy performed by pulmonologists at a teaching hospital

STUDY OBJECTIVE: To evaluate all tube thoracostomies (TTs) done by pulmonary/critical care fellows and attending physicians in the Medical University of South Carolina's health-care system documenting patient demographics, indication for placement, size and characteristics of the tube, and associated problems. DESIGN: Prospective. SETTING: University health-care system, including a university hospital, a Veterans Affairs hospital, and a county hospital. PATIENTS: All adult patients requiring consultation by a member of the pulmonary/critical care staff for a tube thoracostomy. RESULTS: One hundred twenty-six tube thoracostomies were performed over a 24-month period in 91 patients. The most common initial indication for a TT was pneumothorax (69/103, 67%). Overall mortality in the patient population was 35% (32/91). Early problems (< 24 hours following placement) occurred in 3% (4/126); late problems (> 24 h after placement) occurred in 8% (10/126). Problems occurred in 36% (4/11) of small-bore tube placements vs 9% (10/115) of standard TT placements (p=0.02). CONCLUSIONS: Tube thoracostomy can be safely performed by pulmonologists with relatively few associated problems.