Clamping of chest drain before removal in spontaneous pneumothorax

Abstract Background In spontaneous pneumothorax, clamping the chest drain before its removal may avoid reinsertion in case of early recurrence, but may be unsafe and may prolong hospital stay. The objective of this study was to examine the incidence of early recurrence in both clamped and unclamped pneumothorax episodes, and factors associated with it. Methods Retrospective chart review of primary and secondary spontaneous pneumothorax episodes in which chest drain was inserted during the period April 2012 to March 2014. Results Data of 122 episodes were analysed. There were 36 primary pneumothorax and 86 secondary pneumothorax episodes. Mean age was 59 years with 92% males. Clamping of the chest drain was done in 68 episodes (55.7%), and not done in 54. The clamping group was significantly younger, had more primary pneumothorax, and had shorter time from cessation of air leak to clamp/removal. Recurrence within 24 h were seen in 12 (17.6%) clamped episodes and 4 (7.4%) non-clamped episodes, although in only eight episodes were reinsertion of chest drain saved. Significantly more previous pneumothorax episodes were seen in the early recurrence group. We observed no new onset of tension pneumothorax or subcutaneous emphysema associated with clamping. Conclusion The practice of clamping the chest drain before removal in spontaneous pneumothorax appear safe. Clamping saved chest drain reinsertion in 11.8% of cases, and has the potential to save more if clamped for up to 24 h. However, clamping may result in more early recurrences. Prospective randomised studies are needed.

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Tuberous sclerosis complex: Clinical spectrum and epilepsy: A retrospective chart review study

Translational Neuroscience ◽

10.1515/tnsci-2018-0023 ◽

2018 ◽

Vol 9 (1) ◽

pp. 154-160

Author(s):

Sulaiman Almobarak ◽

Mohammad Almuhaizea ◽

Musaad Abukhaled ◽

Suad Alyamani ◽

Omar Dabbagh ◽

...

Keyword(s):

Tuberous Sclerosis ◽

Gene Mutation ◽

Tuberous Sclerosis Complex ◽

Chart Review ◽

Clinical Presentation ◽

Retrospective Chart Review ◽

Neurocutaneous Disorder ◽

Development Delay ◽

Review Study ◽

New Onset

Abstract Tuberous sclerosis complex (TSC) is an autosomal dominant genetic neurocutaneous disorder, with heterogeneous manifestations. We aimed to review the clinical presentation of TSC and its association with epilepsy among Saudi population. This was a retrospective chart review study of 88 patients diagnosed with TSC with or without epilepsy. In 38.6% of patients, symptoms began before 1 year of age. The most frequent initial manifestations of TSC were new onset of seizures (68.2%), skin manifestations (46.6%) and development delay (23.9%). During the evolution of the disease 65.9% had epilepsy, 17% facial angiofibromas, 13.6% Shagreen patch, 18.2% heart rhabdomyomas and 12.5% retinal hamartomas. The genetic study for TSC diagnosis was done for 44 patients, 42 (95,4%) of them were genetically confirmed, for whom 13 patients had TSC1 mutation (29.5%), 29 patients were carrying TSC2 gene mutation (65.9%), Genetic test for TSC 1 and TSC 2 were negative for 2 patients (4.5%) despite positive gene mutation in their relative with TSC. The most common manifestations were central nervous system (predominantly epilepsy) and dermatological manifestations. Most of the patients develop epilepsy with multiple seizure types. TSC 2 mutation is more common than TSC 1 mutation.

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Analysis of pneumothorax recurrence risk factors in 843 patients who underwent videothoracoscopy for primary spontaneous pneumothorax: results of a multicentric study

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivaa064 ◽

2020 ◽

Vol 31 (1) ◽

pp. 78-84

Author(s):

Maria Cattoni ◽

Nicola Rotolo ◽

Maria Giovanna Mastromarino ◽

Giuseppe Cardillo ◽

Mario Nosotti ◽

...

Keyword(s):

Risk Factors ◽

Spontaneous Pneumothorax ◽

Primary Spontaneous Pneumothorax ◽

Chest Drain ◽

Air Leak ◽

Old Patients ◽

Multicentric Study ◽

Prolonged Air Leak ◽

Pleural Abrasion

Abstract OBJECTIVES Risk factors for pneumothorax recurrence after videothoracoscopy for primary spontaneous pneumothorax are still being debated. The goal of this study was to assess whether the pleurodesis technique and other variables are possibly associated with the postoperative ipsilateral recurrence of pneumothorax. METHODS We retrospectively collected data of 1178 consecutive ≤40-year-old patients who underwent videothoracoscopy for primary spontaneous pneumothorax in 9 centres between 2007 and 2017. We excluded patients with hybrid pleurodesis and/or incomplete follow-up, leaving for analysis 843 cases [80% men; median age (interquartile range) 22 (18–28) years]. Univariable and multivariable analyses were performed by logistic regression and tested by Cox regression model to assess factors related to ipsilateral pneumothorax recurrence including age, gender, body mass index, smoking habit, cannabis smoking, respiratory comorbidity, dystrophic severity score, surgical indication, videothoracoscopy port number and side, lung resection, pleurodesis technique and postoperative prolonged air leak (>5 days). RESULTS Blebs/bullae resection was performed in 664 (79%) patients. Pleurodesis was achieved by partial pleurectomy in 228 (27%) cases; by pleural electrocauterization in 176 (21%); by pleural abrasion in 121 (14%); and by talc poudrage in 318 (38%). During a median follow-up period of 70.0 months (95% confidence interval 66.6–73.4), pneumothorax recurred in 79 patients (9.4%); among these, 29 underwent redo surgery; 34, chest drain/talc slurry; and 16, clinicoradiological observation. The only independent risk factor for recurrence was postoperative prolonged air leak (P < 0.001) that was significantly related to blebs/bullae resection (P = 0.03). CONCLUSIONS In this multicentric series, postoperative ipsilateral pneumothorax recurrence was remarkable and independently related to prolonged postoperative air leak; besides the retrospective study setting, the pleurodesis method did not have an impact on recurrence. To prevent prolonged air leak, blebs/bullae treatment should be accurate and performed only if indicated.

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402. Spontaneous pneumothorax in COVID-19

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.597 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S269-S269

Author(s):

Zain Tariq ◽

Diana Doeing ◽

Varidhi Nauriyal ◽

Zohra Sarfraz Chaudhry ◽

Anita Shallal ◽

...

Keyword(s):

Spontaneous Pneumothorax ◽

Late Complication ◽

Tension Pneumothorax ◽

Case Series ◽

Retrospective Chart Review ◽

Hospitalized Patients ◽

Tube Placement ◽

Positive Pressure ◽

Chest Imaging ◽

Bilateral Pneumothorax

Abstract Background Pneumothorax has been reported with the use of positive pressure ventilation in COVID-19 pneumonia. Literature on spontaneous pneumothorax (PTX) in COVID-19 patients is scant. We present a case series of 7 patients with COVID-19 pneumonia, who developed spontaneous pneumothorax without prior mechanical ventilation. Methods A retrospective chart review of 7 cases was performed from two different hospitals in the US between 4/6/2020–5/15/2020. Hospitalized patients with confirmed COVID-19 by nasopharyngeal RT-PCR who developed spontaneous pneumothorax were included. Collected data included demographics, co-morbidities, inflammatory biomarkers, chest imaging and management strategies. Length of stay, transfer to intensive care unit and death were the assessed outcomes. A descriptive analysis was done. Results There were 3 patients from Henry Ford Health System, Michigan and 4 patients from Silver Cross Hospital, Illinois. Median age was 75 years and 6 out of 7 (85.7%) were males (Table 1). There were no co-morbidities associated with spontaneous pneumothorax except for one patient with COPD. None of the patients’ imaging prior to diagnosis of pneumothorax revealed any underlying blebs. Median time from symptom onset to diagnosis of pneumothorax was 17 days. One of the patients had tension pneumothorax, two had bilateral pneumothorax and three had pneumomediastinum (Figure 1). Four patients required chest tube placement, three required escalation to ICU, of which two died. Table 1. Demographics and Clinical Characteristics of Patients with Spontaneous Pneumothorax Figure 1. CT imaging before (left) and after (right) Spontaneous Pneumothorax Conclusion Spontaneous pneumothorax may be an unrecognized late complication of COVID-19 pneumonia. In hospitalized patients with acute respiratory decompensation, spontaneous pneumothorax should be considered as part of the differential diagnosis. Repeat chest imaging should be considered in these cases. Disclosures All Authors: No reported disclosures

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Post COVID-19 large pneumatocele: clinical and pathological perspectives

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivab072 ◽

2021 ◽

Author(s):

Abdel-Mohsen Mahmoud Hamad ◽

Hala Ahmed El-Saka

Keyword(s):

Male Patient ◽

Histopathological Examination ◽

Thoracoscopic Surgery ◽

Lower Lobe ◽

Alveolar Haemorrhage ◽

Chest Drain ◽

Air Leak ◽

Air Space ◽

Radiological Studies ◽

New Onset

Abstract A middle aged COVID-19 male patient presented 2 weeks after discharge with new onset of dyspnoea and desaturation. Radiological studies revealed right side pneumothorax and lower lobe cystic air space. Chest drain was inserted and on a later date the patient underwent thoracoscopic surgery where a large pneumatocele was identified. Deroofing and closure of sources of air leak were done. Histopathological examination demonstrated extensive fibrosis, intra-alveolar Haemorrhage and pneumocytes hyperplasia.

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Development of Postoperative Diabetes Mellitus in Patients Undergoing Distal Pancreatectomy versus Whipple Procedure

The American Surgeon ◽

10.1177/000313481708301007 ◽

2017 ◽

Vol 83 (10) ◽

pp. 1050-1053 ◽

Cited By ~ 1

Author(s):

Adrienne Nguyen ◽

Aram Demirjian ◽

Maki Yamamoto ◽

Kathryn Hollenbach ◽

David K. Imagawa

Keyword(s):

Diabetes Mellitus ◽

Distal Pancreatectomy ◽

Chart Review ◽

Retrospective Chart Review ◽

Whipple Procedure ◽

The Body ◽

Diabetic Status ◽

Underlying Pathology ◽

New Onset Diabetes Mellitus ◽

New Onset

Because the islets of Langerhans are more prevalent in the body and tail of the pancreas, distal pancreatectomy (DP) is believed to increase the likelihood of developing new onset diabetes mellitus (NODM). To determine whether the development of postoperative diabetes was more prevalent in patients undergoing DP or Whipple procedure, 472 patients undergoing either a DP (n = 122) or Whipple (n = 350), regardless of underlying pathology, were analyzed at one month postoperatively. Insulin or oral hypoglycemic requirements were assessed and patients were stratified into preoperative diabetic status: NODM or preexisting diabetes. A retrospective chart review of the 472 patients between 1996 and 2014 showed that the total rate of NODM after Whipple procedure was 43 per cent, which was not different from patients undergoing DP (45%). The incidence of preoperative diabetes was 12 per cent in patients undergoing the Whipple procedure and 17 per cent in the DP cohort. Thus, the overall incidence of diabetes after Whipple procedure was 54 and 49 per cent in the DP group. The development of diabetes was unrelated to the type of resection performed. Age more than 65 and Caucasian ethnicity were associated with postoperative diabetes regardless of the type of resection performed.

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Analysis of Incident DKA in the Indiana New Onset T1D Patient Population

Proceedings of IMPRS ◽

10.18060/24524 ◽

2020 ◽

Vol 3 ◽

Author(s):

Brianna Beer ◽

Kelly Moors ◽

Carmella Evans-Molina ◽

Emily Sims

Keyword(s):

Chart Review ◽

Pediatric Patients ◽

Retrospective Chart Review ◽

Inclusion Criteria ◽

Significant Difference ◽

Life Threatening ◽

Life Threatening Complication ◽

Body Production ◽

New Onset

Background/Objective: Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes (T1D) resulting from ketone body production and metabolic acidosis occurring due to insulin deficiency. We sought to define the occurrence of DKA amongst pediatric patients presenting with new-onset T1D in Indiana and to determine whether patterns of DKA were affected by the COVID-19 pandemic. Methods: This was a retrospective chart review for patients <18 years admitted to Riley Children’s Hospital with a clinical diagnosis of new onset T1D who had available chemistry values. Patients diagnosed from March 23- June 30, 2020 and over the same period in 2019 were included. DKA was classified as mild (bicarbonate 10-15 mmol/L) or severe (bicarbonate <10 mmol/L). Results: Ninety-four patients met inclusion criteria. The total number of incident T1D cases in 2019 and 2020 were similar (48 vs. 46, respectively). Similarly, there was no significant difference in rates of DKA (21 in 2019 vs. 25 in 2020; p>0.05). Of the 94 patients, 49% met criteria for DKA; 79% of cases were classified as severe and 21% as mild. More males were diagnosed with DKA in both 2019 and 2020 (61% of DKA cases). Non-Hispanic whites comprised 75% of all new onset T1D patients and no differences in race or ethnicity were present amongst those presenting in DKA. Conclusion: DKA was present in nearly half of all new onset pediatric T1D cases in Indiana in 2019 and 2020. There was no observed impact of the COVID-19 pandemic on T1D or DKA. Impact and Implications: DKA is common amongst pediatric patients with new onset T1D in Indiana. Prompt recognition of symptoms is needed to prevent this life-threatening complication of T1D.

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