Spontaneous pneumothorax in cocaine sniffers

PURPOSE: To evaluate intraobserver and interobserver reproducibility of measurements in images obtained by the 50 MHz Humphrey Ultrasound Biomicroscope. METHODS: The first stored image of central cornea, central anterior chamber, and angle structures obtained at 50 examinations were measured twice by three observers. Nine different parameters were measured in angle images and two in images of central cornea and anterior chamber. Intraobserver reproducibility was assessed by calculating the coefficient of variation and interobserver reproducibility by a two-ways ANOVA. RESULTS: Intraobserver reproducibility was high for all measurements of central cornea thickness and anterior chamber depth with a coefficient of variation (%) < or = 3.8%. In angle images the intraobserver reproducibility of measurements was often lower (coefficient of variation (%) 1.3-52.6%). The lower reproducibility was most noticeable in measurements involving the less defined structures. Interobserver reproducibility was poor. CONCLUSIONS: Comparison of measurements are best done of well defined structures and by only one observer.     

Spontaneous pneumothorax in a patient with an azygos lobe

The association between a spontaneous pneumothorax and an azygos lobe is surprisingly rare. A case is reported in which surgical management was difficult; it is suggested that thoracotomy is preferable to video-assisted thoracoscopic surgery in this situation. It is possible that the presence of an azygos lobe might protect against the subsequent development of a spontaneous pneumothorax, and the possible mechanism of this is discussed.     

自发性气胸90例治疗临床观察

目的:探讨自发性气胸的临床病因、诊断与治疗.方法:收集2007年9月至2009年9月收治的自发性病例90例完整资料进行分析.结果:患者所有症状完全缓解,肺脏完全复张68例,胸片提示肺大部复张20例,无效2例.结论:自发性气胸多为原发性气胸,胸腔闭式引流是治疗自发性气胸常而有效的治疗方法.     

自发性气胸182例临床疗效分析

目的:探讨自发性气胸患者的治疗方法,观察疗效.方法:回顾性分析2007年2月～2010年2月我院住院诊治的182例自发性气胸患者的临床资料,根据不同的病情采取胸膜腔穿刺抽气、单纯胸腔闭式引流、胸腔闭式引流加用药物胸膜固定术、腋下小切口手术和胸腔镜手术等方法治疗.结果:本组182例自发性气胸患者均治愈出院,单纯采用胸膜腔穿刺抽气治疗者和胸腔闭式引流术治疗者复发率较高,腋下小切口手术以及胸腔镜手术者未有复发.结论:对气胸长期不愈又不适宜手术治疗者可用药物胸膜固定术;腋下小切口手术对自发性气胸是一种经济、实用、安全和有效的治疗方法.     

Spontaneous pneumothorax complicating lung metastasis from lingual carcinoma

Cervical cancer is the fourth cancer in women. It is the first malignancy for which mass population screening has been demonstrated to significantly reduce the mortality due to this disease. In Belgium, the mortality associated to cervical cancer decreased from 6 to 4 per 100,000 women-years from 1955-1959 to 1985-1989. European recommendations regarding cervical cancer screening are to perform a cervical smear each three years in women aged 25 to 65 years. In Belgium, while the Flemish region has decided to organize the cervical cancer screening according to the European recommendations, the screening in the French part of the country is essentially opportunistic. In this short review, the cost/benefit of the organized screening versus the opportunistic screening is discussed.     

Spontaneous arterial thrombosis in association with pancreatic carcinoma: diagnosis and interventional management

BACKGROUND: Soft tissue sarcomas of the hands and feet present a challenge for limb-preserving resections. METHODS: A retrospective review of 19 patients with sarcomas of the hand or foot was done. Wide or local excision was performed in 14 patients (74%), and amputation in 5 patients (26%). Of the latter group, three amputations involved a digit or toe, and two (10%) were major amputations (one Syme amputation and one below-knee amputation). When the minimum surgical margin was narrow (1 to 2 mm), adjuvant radiation was given postoperatively (n = 4). RESULTS: Local recurrence was observed in four patients (21%). Two of these required an amputation for local control. Local recurrence was observed in one of four patients (25%) treated with marginal resection and radiation and three of 15 (20%) of those with resection alone. CONCLUSIONS: A sizable percentage (37%) of patients with soft tissue sarcomas of the hand and foot ultimately required an amputation, although often the amputation was a minor one involving only a toe or a digit. Limb preservation was successful in the majority of patients (63%). The local recurrence rate was 21%, which may be improved with more frequent use of adjuvant therapy. The 5-year survival rate was 82%, which is better than that usually quoted for overall extremity soft tissue sarcomas.     

Evidence for McKusick''s hypothesis of deficient collagen cross-linking in patients with homocystinuria

Fractionation of the venom of the spider Phoneutria nigriventer revealed that it was a mixture of several neurotoxic peptides. The peptides so far characterized either inhibited or induced neurotransmitter release. These effects were mediated by Ca2+ channels or increasing Na+ permeability through voltage sensitive Na(+)-channels, respectively. The pooled toxic components (fraction P4) showed stimulatory effects on acetylcholine release from brain cortical slices. In addition, a component of the observed effects resembling that of alpha-latrotoxin was identified, which was characterized by the ability to provoke release of acetylcholine (ACh) at low temperature and in a manner independent of extracellular Ca2+ and of voltage sensitive Na(+)-channels.     

Video-assisted thoracic surgery in patients with spontaneous pneumothorax

Following the development of video-assisted technologies and the principle of minimally-invasive surgery thoracoscopy has finally established itself as an integral part of the surgeon's armamentarium in the treatment of spontaneous pneumothorax. This procedure was performed on 18 patients at the Department of Cardio-Thoracic Surgery of the Medical University in Vienna from October 1995 to April 1996 and on 5 patients at the Department of Thoraco-Abdominal Surgery of the Medical University in Plovdiv from October 1996 to January 1997, all of which had been diagnosed as having complicated spontaneous pneumothorax. The main indications were: recurrent spontaneous pneumothorax or persistent pneumothorax following a five-day unsuccessful drainage of the pleural cavity. All our patients underwent partial parietal pleurectomy down to the level of the third intercostal space. Apical blebs were found in 14 patients and atypical wedge resection was performed. The authors used three trocars 5-12 mm in diameter. The thoracoscope was inserted in the fifth intercostal space in the midaxillary line. The other two operative trocars were inserted in the anterior and posterior axillary lines, respectively. The mean postoperative stay was 6 days. Our results support the view that video-assisted thoracic surgery is technically feasible and safe, associated with decreased perioperative pain and opiate requirements, shorter hospital stay, excellent cosmetic results, low recurrence rate, early return to routine activity and minimal morbidity and is therefore superior to conventional thoracotomy.     

A study of cardiovascular risk in heterozygotes for homocystinuria

Early atherosclerotic-like lesions and thromboemobolic problems are prominent in homocystinuric patients. Recent evidence suggested that mild homocyst(e)inemia, such as is present in heterozygotes for homocystinuria due to cystathionine synthase deficiency, may cause a marked excess in early ischemic heart disease. To evaluate the risk due to mild homocyst(e)inemia, the frequencies of heart attacks and strokes in parents and grandparents of homocystinuric children were assessed in the present study. No statistically significant increases in the incidence of heart attacks or strokes were consistently detected. The data available are sufficient to virtually exclude an increase in the cardiovascular risk for homocystinuria heterozygotes of as much as fivefold compared to controls, and to make very improbable a relative risk of as much as threefold. Less than 5% of homocystinuria heterozygotes are likely to have a fatal or nonfatal heart attack by age 50. These results fail to suggest that mild homecyst(e)inemia is an important contributory factor in the overall incidence of cardiovascular disease.     

Acute life-threatening event with rhabdomyolysis after starting on high-dose pyridoxine therapy in an infant with homocystinuria

A case of posttraumatic ischaemic stenosis is presented. The patient, a five year-old girl, was admitted to hospital with physical and radiological signs of small bowel obstruction about two weeks after sustaining blunt abdominal trauma in a car accident. At laparotomy two lesions of the distal jejunum were found. Proximal to this the small intestine was dilated. A segment of 25 cms. of small bowel including the two lesions was resected. Microscopic examination showed two ulcers with adjacent fibrosis consistent with ischaemic stenosis. The patient recovered completely after the operation. The entity of "seat belt syndrome" is presented.     

ECG changes associated with spontaneous left-sided pneumothorax

A patient with chronic obstructive pulmonary disease had a 100% pneumothorax on the left side associated with marked ECG changes. The changes occurring in this situation can be confusing. Because of the high prevalence of coronary heart disease in patients presenting with left-sided chest pain, an ECG usually is obtained to rule out acute myocardial infarction, in many instances even before history taking, physical examination, or chest x-ray study is done. Therefore, familiarity with the ECG manifestations of left-sided penumothorax is necessary to avoid delay in establishing the diagnosis and in beginning therapy.