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Treatment of Recurrent Primary Spontaneous Pneumothorax – Own Experience

100%
Tomczyk G., Pawełczyk K., Marciniak M., Rzechonek A., Kołodziej J.
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vol. 85
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issue 1
12-19
EN
Primary spontaneous pneumothorax could be a serious therapeutic problem in case of recurrence. Lack of therapeutic standards sometimes leads to delay in definitive surgical treatment and could cause respiratory complications. The aim of the studywas the evaluation of treatment results in patients with recurrence of primary spontaneous pneumothorax and looking for optimal therapeutic method after first recurrence (surgical treatment vs. pleural drainage). Material and methods.Between 01.01.2009 and 31.07.2010 fifty four patients with recurrent primary spontaneous pneumothorax was hospitalized in Wrocław Thoracic Surgery Centre (24.3% of all patients with pneumothorax). The recurrence was treated surgically in 24 cases, in 30 pleural drainage was performed: simple drainage (n=14) or drainage with chemical pleurodesis (n=16). Mean age of patients treated without surgery was higher than surgically treated (p=0,012). Results.In surgery group no recurrence was found, in drainage group 11 recurrences occurred (p=0.0009). In group of 11 patients with second recurrence, pleurodesis was performed four times (36%) vs. 12 times (63%) in 19 patients without a recurrence of the disease. 70% of non-surgically treated patients vs. 50% of surgically treated were afraid of recurrence (p=0.01). Among 11 patients in drainage group, nine underwent surgery at the second episode of recurrence. Conclusions.The optimal treatment method in case of first recurrence of primary spontaneous pneumothorax is surgical treatment. When it is not possible chemical pleurodesis should be performed during pleural drainage. Most of the patients after second recurrence are treated surgically anyway. The surgical treatment significantly reduces patient’s fears for future recurrence of the disease. Younger patients are most often surgically treated.
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Diagnostic and Therapeutic Thoracoscopy (Videothoracoscopy) in Malignant Pleural Effusion - Our Experience

100%
Kacprzak G., Kołodziej J., Pawełczyk K., Marciniak M., Rzechonek A.
Polish Journal of Surgery
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2008
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vol. 80
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issue 1
35-41
EN
Diagnosis and treatment of patients with malignant pleural effusion (MPE) is a serious problem for clinicians.The aim of the study were: to evaluate the diagnostic and therapeutic value of thoracoscopy and videothoracoscopy (VTS) and to determine the efficiency of using talc for the management of MPE.Material and methods. Between January 1996 and December 2006, thoracoscopy (VTS) was performed in 95 patients. A 4 g dose of talc was used for pleurodesis. Out of the 95 diagnostic procedures, malignancy was diagnosed in 94 (98.9%) patients. Patients were divided into two subgroups: subgroup A, patients (n=4) who died within first month, and subgroup B, patients (n=91) who lived more than one month. In subgroup A, complete remission (CR) was achieved in four (100%) patients until they died. In subgroup B, CR was achieved in 90 (98.9%) patients after one month, with relapse (R) occurring in 1 (1.1%) patient. After three months, CR was achieved in 86 (94.5%), partial remission (PR) in three (3.3%), and R in two (2.2%) patients. After six and nine months, CR was achieved in 85 (93.4%), PR in three (3.3%), and R in three (3.3%) patients. Postoperative complications, side effects after applying talc, and general performance were assessed. Difficulties in lung expansion requiring redrainage occurred in four (4.2%) patients. Fever appeared in 79 (83.2%) patients, while pain appeared in 90 (94.7%) patients. After treatment, the number of patients classified as I on the WHO scale increased from 36.8% to 74.7%, while the number of patients classified as III on the WHO scale decreased from 10.5% to 2.1%.Conclusions. Thoracoscopy (VTS) significantly improves diagnostic effectiveness in cases without cytological and histological diagnosis and is a method of treatment for MPE. Very good results were achieved after intrapleural administration of talc (CR occurred in 93.4% patients). The most common side effect of administering talc was pain.
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