tetracycline and Pneumothorax

Pneumothorax is defined as the presence of air in the pleural cavity. Spontaneous pneumothorax, occurring without antecedent traumatic or iatrogenic cause, is sub-divided into primary and secondary. The severity of pneumothorax could be varied from asymptomatic to hemodynamically compromised. Optimal management of this benign disease has been a matter of debate. In addition to evacuating air from the pleural space by simple aspiration or chest tube drainage, the management of spontaneous pneumothorax also focused on ceasing air leakage and preventing recurrences by surgical intervention or chemical pleurodesis. Chemical pleurodesis is a procedure to achieve symphysis between the two layers of pleura by sclerosing agents. In the current practice guidelines, chemical pleurodesis is reserved for patients unable or unwilling to receive surgery. Recent researches have found that chemical pleurodesis is also safe and effective in preventing pneumothorax recurrence in patients with the first episode of spontaneous pneumothorax or after thoracoscopic surgery and treating persistent air leakage after thoracoscopic surgery. In this article we aimed at exploring the role of chemical pleurodesis for spontaneous pneumothorax, including ceasing air leakage and preventing recurrence. The indications, choice of sclerosants, safety, effects, and possible side effects or complications of chemical pleurodesis are also reviewed here.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Antibiotics, Antineoplastic; Antineoplastic Agents; Bleomycin; Humans; Minocycline; Picibanil; Pleurodesis; Pneumothorax; Povidone-Iodine; Secondary Prevention; Talc; Tetracycline

We report the case of a 60 year female patient suffering from rheumatoid arthritis for the last 25 years, under TNF-blocker and leflunomide, affected by a recurrent pneumothorax with several subpleural nodules, basal bronchiectasis and apical bullous emphysema. The patient was administered several treatments: aspiration, talc pleurodesis, surgical pleurodesis, pleurodesis induced by tetracycline and autologous blood. To allow the pleural inflammatory reaction necessary to the success of the pleurodesis, we had to interrupt the treatment by TNF-blocker and leflunomide. We then witnessed a partial pleurodesis with persistence of a pneumothorax. The medical situation is improving with disappearance of dyspnea.

Topics: Anti-Bacterial Agents; Antirheumatic Agents; Arthritis, Rheumatoid; Bronchiectasis; Dyspnea; Female; Humans; Immunosuppressive Agents; Isoxazoles; Leflunomide; Lung Diseases; Middle Aged; Pleural Diseases; Pleurodesis; Pneumothorax; Pulmonary Emphysema; Radiography, Thoracic; Recurrence; Tetracycline; Time Factors; Treatment Outcome; Tumor Necrosis Factor-alpha

Pneumothorax is defined as air in the pleural space, i.e. between the lung and the chest wall. Primary pneumothoraces (PSP) arise in otherwise healthy people without any lung disease. Secondary pneumothoraces (SSP) arise in subjects with underlying lung disease. Observation alone is recommended only in patients with small primary or secondary pneumothoraces of less than 1 cm depth or isolated apical pneumothoraces in asymptomatic patients. In symptomatic patients observation alone is inappropriate and active intervention is required. Although simple aspiration may be an option for first-line treatment in clinically stable patients with PSP, intercostal tube drainage is strongly recommended in all primary and secondary pneumothoraces requiring intervention. There are two objectives in the surgical management of pneumothorax. The first widely accepted objective is resection of blebs or the suture of apical perforations to treat the underlying defect. The second objective is to create a pleural symphysis to prevent recurrence. While video-assisted thoracic surgery may be the preferred surgical procedure for young, fit people with complicated or recurrent primary pneumothoraces, it is less reliable in cases of secondary pneumothorax. For the latter, open thoracotomy and repair is still the recommended approach.

Topics: Adult; Aged; Anti-Bacterial Agents; Biopsy, Fine-Needle; Diagnosis, Differential; Drainage; Female; Humans; Iatrogenic Disease; Male; Middle Aged; Pleurodesis; Pneumothorax; Radiography, Thoracic; Secondary Prevention; Talc; Tetracycline; Thoracic Surgery, Video-Assisted; Thoracotomy; Tomography, X-Ray Computed

Pneumothorax is a frequent affliction with the incidence peaks in youth and old age. The disease is more frequent in males and smokers. Most of the old patients have emphysema and/ or pulmonary fibrosis as the underlying disease. They often show low respiratory function and/ or heart failure. The first step in treatment is pleural drainage to achieve pulmonary re-expansion. If it is difficult to cure by pleural drainage, we try to perform pleurodesis using the chemicals such as OK-432 and tetracycline. As the next step, we try to perform video assisted thoracic surgery (VATS) or operation without video. To stop smoking is important before and after operation. We reviewed about pneumothorax in old patients.

Topics: Aged; Aged, 80 and over; Diagnosis, Differential; Fibrin Tissue Adhesive; Humans; Male; Picibanil; Pleurodesis; Pneumothorax; Smoking; Suction; Tetracycline; Thoracic Surgery, Video-Assisted; Tomography, X-Ray Computed

Primary and secondary pneumothoraces are relatively common problems in a busy chest physician's practice. Management options are often different when dealing with primary or secondary pneumothoraces because the underlying cause is different. Thoracoscopy will have a major impact on the surgical approach used in these patients, whereas the advent of lung transplantation has led to a more cautious approach toward the use of sclerosing agents in potential lung transplant recipients.

Topics: Barotrauma; Chest Tubes; Drainage, Postural; Humans; Pleura; Pneumothorax; Positive-Pressure Respiration; Pulmonary Edema; Talc; Tetracycline; Thoracotomy

Topics: Hemopneumothorax; Humans; Mediastinal Emphysema; Pneumothorax; Pulmonary Edema; Sclerosing Solutions; Suction; Tetracycline; Thoracostomy; Thoracotomy

The aim of this prospective study was to determine the rate of recurrence for spontaneous pneumothorax (SP) after tetracycline pleurodesis (TCP), using that of observation, tube thoracostomy alone, and thoracotomy as references. From 1985 to the end of 1991, 78 patients were treated with tetracycline pleurodesis and 135 patients served as control subjects. Pleurodesis was induced by instillation of tetracycline and ascorbic acid through the pleural drain. The indication was any SP treated with tube thoracostomy, without active pulmonary infection. Follow-up period was from 13 to 95 months (mean, 45 months); follow-up rate was 94 percent. Post-therapy surgery was necessary for eight patients in whom pleurodesis failed due to presence of a persistent air leak. The ipsilateral recurrence rate of patients treated with TCP was 9 percent (6/66) and recurrence time ranged from 2 days to 9 months. The recurrence rate for patients treated with observation was 36 percent, 35 percent for those having chest tube alone, and none for those undergoing surgery. No death occurred as a direct result of this procedure and all patients could be released from the hospital. Eleven subjects died during the follow-up period; the mean follow-up until death was 37 months (range, 2 to 87 months). Five deaths were due to respiratory causes and six were due to extrapulmonary causes. Tetracycline pleurodesis has been shown to be a good alternative for the prevention of recurrence of SP. Its recurrence rate is lower than that of tube drainage but higher than that of surgical treatment.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ascorbic Acid; Female; Humans; Male; Middle Aged; Pleurodesis; Pneumothorax; Prospective Studies; Recurrence; Tetracycline; Thoracostomy; Thoracotomy; Treatment Outcome

This prospective, multicenter, randomized, "unblinded," controlled clinical trial was designed to determine if the intrapleural instillation of 1500 mg of tetracycline hydrochloride would be effective in diminishing the ipsilateral rate of recurrence for spontaneous pneumothorax. During the 4-year enrollment period, 113 patients were assigned to the tetracycline group; 116 patients were assigned to the control group. During the 5-year study period, the recurrence rate in the tetracycline group (25%) was significantly less than that in the control group (41%). Use of tetracycline seemed to reduce the recurrence rates for patients with either primary or secondary spontaneous pneumothorax and for patients with either an initial or a recurrent pneumothorax. We conclude that the intrapleural administration of tetracycline in patients with spontaneous pneumothorax significantly reduces the rate of ipsilateral recurrence but is associated with intense chest pain. Intrapleural tetracycline therapy is indicated for patients with a spontaneous pneumothorax who are hospitalized and are treated with tube thoracostomy.

Topics: Adult; Aged; Humans; Injections; Male; Middle Aged; Pleura; Pneumothorax; Prospective Studies; Recurrence; Respiratory Function Tests; Tetracycline; Veterans

Spontaneous pneumothorax presents a high recurrence rate after conventional pleural drainage procedures. Different pleural scarifying agents are used in an attempt to prevent early and late recurrence. To investigate the effect of tetracycline and 30%-glucose, we conducted a randomized study on 20 patients with primary spontaneous pneumothorax: 10 patients were treated by pleural drainage combined with chemical pleurodesis; 10 patients were treated by pleural drainage alone. Chemical pleurodesis resulted in a statistically significant reduction (p less than 0.05) in early recurrence. The rate and magnitude of late recurrences however was unaffected by the pleurodesis treatment, although recurrence in the chemically treated group was later than in the conventional drainage group.

Topics: Adult; Aged; Drainage; Female; Follow-Up Studies; Glucose; Humans; Male; Middle Aged; Pleura; Pneumothorax; Recurrence; Tetracycline

From 1978 to 1985 96 patients with their first spontaneous pneumothorax were randomised into three groups, receiving either treatment with simple drainage (34 patients), drainage with tetracycline pleurodesis (33 patients), or drainage with talc pleurodesis (29 patients). There were 58 men and 38 women, aged 18-88 years. There was no significant difference between the three groups in the mean time in hospital or the period for which the drains were retained. The incidence of infection, persistent pneumothorax, and relapse while in hospital was also similar for the three groups. At follow-up in 1987-89 patients could be accounted for, with an average follow-up period of 4.6 years. The incidence of recurrence was 36% in the simple drainage group, 13% in the tetracycline pleurodesis group, and 8% in the talc pleurodesis group. The difference between the talc and simple drainage groups was significant. None of the methods caused severe short or long term side effects or changes in the follow-up chest radiograph. Thoracoscopy, performed on admission in 85 patients, showed normal appearances in 73 patients and small cysts in 12. The thoracoscopic findings were of no value in predicting recurrence. Talc pleurodesis resulted in a significantly lower recurrence rate than simple drainage, tetracycline pleurodesis having intermediate efficacy.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Drainage; Female; Humans; Length of Stay; Male; Middle Aged; Pleura; Pneumothorax; Prospective Studies; Random Allocation; Recurrence; Talc; Tetracycline; Thoracoscopy

Silver nitrate pleurodesis as prevention against recurrence in primary spontaneous pneumothorax was started in our department on an empiric basis. In a controlled trial in 1981 the method was found to be as good as earlier stated, but the method has a high number of side effects and has never been widely accepted. In a prospective, controlled trial comparing silver nitrate pleurodesis with tetracycline pleurodesis, we found no differences in recurrence frequency, but the time of hospitalization was significantly longer in the silver nitrate group (p less than 0.05). Furthermore, we found a decrease of exudation and a decreased use of analgetics in the tetracycline group. As a consequence of the investigation, we have abandoned the silver nitrate method and now recommend tetracycline pleurodesis as the treatment of choice in primary spontaneous pneumothorax in patients with only tiny blebs on the surface of the lung.

Topics: Adolescent; Adult; Clinical Trials as Topic; Female; Humans; Male; Methods; Middle Aged; Pleura; Pneumothorax; Prospective Studies; Random Allocation; Recurrence; Silver Nitrate; Tetracycline; Tissue Adhesions

Topics: Bronchoscopy; Catheterization; Dyspnea; Equipment Design; Humans; Lung; Male; Middle Aged; Pleurodesis; Pneumothorax; Prostheses and Implants; Tetracycline

The purpose of this retrospective study was to identify factors associated with recurrent spontaneous pneumothorax (SP) in southern China, and to compare the therapeutic effectiveness of different procedures.. A total of 182 consecutive patients (89.0% male; mean age, 38.9 years), admitted with their first episode of pneumothorax, were reviewed retrospectively. Follow up was available in 138 patients (75.8%), including 68 treated by chemical pleurodesis and 70 by chest tube drainage alone. The cumulative recurrence rates with different therapeutic procedures and different chemical sclerosing agents were compared, and the factors that influenced the recurrence rate were analysed using Cox's proportional hazard model.. The most common pre-existing lung disease responsible for pneumothorax was COPD (69.7%), followed by tuberculosis (16.5%). Recurrence was significantly more common in taller patients, patients with lower weight, and patients with secondary spontaneous pneumothorax. The cumulative recurrence rates in the pleurodesis therapy group after 6 months, 1 and 3 years were 13, 16 and 27%, respectively, whereas in the chest tube drainage group the recurrence rates were 26, 33 and 50%, respectively (P < 0.05). There was no significant difference in the recurrence rate for those receiving tetracycline compared with those who received gentamicin.. Spontaneous pneumothorax patients who are taller, weigh less or have secondary spontaneous pneumothorax are more likely to have recurrences. The risk of recurrence is reduced in patients who undergo chemical pleurodesis. Since there was no significant difference between intrapleural tetracycline and gentamicin, gentamicin should be considered as a potential chemical sclerosing agent.

Topics: Adult; Anti-Bacterial Agents; Body Height; Body Weight; China; Drainage; Female; Follow-Up Studies; Gentamicins; Humans; Incidence; Male; Pleurodesis; Pneumothorax; Proportional Hazards Models; Retrospective Studies; Risk Factors; Secondary Prevention; Tetracycline; Treatment Outcome

The introduction of video assisted thoracoscopic surgery (VATS) has led to the development of several endoscopic options for the management of spontaneous pneumothorax. We describe here our experience in the management of primary spontaneous pneumothorax (SP). We carried out 58 VATS procedures on 55 patients during the period 1993-95. There were six conversions to open thoracotomy because of dense adhesions in five patients and a large apical bulla of 20 cm in one. These patients were excluded from the study. The remaining 49 patients underwent 52 VATS procedures. There were 37 males and 12 females with a median age of 23 (range: 15-71) years. The indications for surgery were persistent SP for more than 5 days in 21 (40%), and recurrent SP in 31 (60%). Twenty-six procedures (25 patients) consisted of bullectomy alone (group 1; 1/1/93-30/9/94) and the next 26 procedures (24 patients) included chemical pleurodesis with 2 g of Acromycin (Lederle) in 10 ml of 0.9 normal saline (group 2; 1/10/94-31/12/95). Both groups had a mean follow up of 38 months (range: 36-40). Mean postoperative chest drainage in group 2 (3.1 +/- 1.09) was significantly shorter than in group 1 (4.7 +/- 1.0). Group 2 patients also had a shorter hospital stay (4.8 /- 1.08 vs. 6.76 +/- 1.09). There were five (20%) recurrences in group 1 while only one (4%) occurred in group 2. In view of these results we recommend the routine use of Acromycin pleurodesis in addition to thoracoscopic bullectomy.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Drainage; Female; Humans; Length of Stay; Male; Middle Aged; Pleurodesis; Pneumothorax; Secondary Prevention; Tetracycline; Thoracic Surgery, Video-Assisted

Chemical pleurodesis using tetracycline is an accepted and commonly employed treatment of pneumothorax and pleural effusions. We describe a case of chemical burn of the pleura in a ventilated 41-year-old who came to thoracotomy after 3 days of continuous intrapleural infusion of tetracycline at another hospital. To our knowledge this has not been previously reported although other adverse effects of this procedure are documented. We suggest that damage to the pleura and underlying lung may occur if excessive amounts of tetracycline are used in attempted pleurodesis.

Topics: Adult; Anti-Bacterial Agents; Biopsy; Burns, Chemical; Drug Overdose; Humans; Male; Pleura; Pleural Diseases; Pleurodesis; Pneumothorax; Respiratory Care Units; Suction; Tetracycline; Thoracotomy

3 groups of 37 patients were examined, in which for treatment of spontaneous pneumothorax drainage of pleural cavity and medicamentous pleurodesis with tetracycline hydrochloride and 4% solution of sodium bicarbonate were used. Interdependence of clinical criteria and level of protease inhibitors were evaluated, as well as the basic components of hemostasis. The best effectiveness of treatment in carrying out chemical pleurodesis was demonstrated, especially when 4% sodium bicarbonate solution was used. At the same time the application of this agent has evoked the most evident changes in values of hemostasis and protease inhibitors. The possibility of use of the above mentioned biochemical in dices together with clinical criteria for the evaluation of effectiveness of treatment of the unspecific spontaneous pneumothorax is stressed.

Topics: Adult; Biomarkers; Drainage; Female; Follow-Up Studies; Hemostasis; Humans; Male; Pleurodesis; Pneumothorax; Protease Inhibitors; Sodium Bicarbonate; Tetracycline; Treatment Outcome

Topics: Adult; Chest Pain; Diagnosis, Differential; Female; Humans; Marfan Syndrome; Pleurodesis; Pneumothorax; Tetracycline; Thoracoscopy

Persistent air leak and failure of the lung to expand completely after closed thoracostomy complicate the course of spontaneous pneumothorax in patients with AIDS. In such cases, attempts to discontinue chest tube drainage may fail. The following is a case of a patient with AIDS and spontaneous pneumothorax who responded to chemical pleurodesis with tetracycline.

Topics: Adult; AIDS-Related Opportunistic Infections; Anti-Bacterial Agents; Female; Humans; Pleurodesis; Pneumonia, Pneumocystis; Pneumothorax; Tetracycline; Treatment Outcome

Initial experience of thoracoscopic bullectomy and tetracycline pleurodesis for the treatment of spontaneous pneumothorax is reported. Thirty-three out of 49 patients admitted with spontaneous pneumothorax were suitable for treatment with this minimally invasive method. This series demonstrates that this surgical management offers early discharge and return to normal activities with excellent medium-term results, despite the three early failures. It is felt that with increased experience in thoracoscopy and improved selection of patients, thoracoscopic bullectomy and pleurodesis will become the treatment of choice for primary spontaneous pneumothorax.

Topics: Adolescent; Adult; Aged; Female; Humans; Male; Middle Aged; Pleurodesis; Pneumothorax; Surgical Procedures, Operative; Tetracycline; Thoracoscopy; Treatment Failure

Topics: Bleomycin; Costs and Cost Analysis; Doxycycline; Humans; Incidence; Minocycline; Pleurodesis; Pneumothorax; Recurrence; Talc; Tetracycline; Thoracoscopy; Thoracotomy

Results on treatment of 445 episodes of 420 patients suffering from spontaneous pneumothorax (sptx) are reported. The overall mortality was 1.4%. No death was encountered during the treatment of 246 primary sptx patients. Mortality of secondary ptx was 3.4%. Detailed data of the recent 92 patients are analysed. Recurrence rate of drainage (ICC) therapy of primary sptx was 8/33. Five out of eight patients were operated on. 16 thoracotomies were performed altogether in this group of patients. 3/18 patients were lost in the ICC treatment only subgroup of secondary sptx panel. 1/25 patient died in the ICC+pleurodesis subgroup of secondary sptx patients. Drainage and subsequent thoracotomy in case of failure of ICC treatment or of numerous recurrences is the choice to follow in primary sptx cases. Apart from exceptions there is no room for chemical pleurodesis in this form of ptx. On the other hand the ICC drainage with pleurodesis offers the best chances in the treatment of secondary sptx. Tetracycline and Vibramycin were proven as the best pleurodesis materials in first instances. Tissucol is recommended to use in case of failure of previous pleurodesis attempts.

Topics: Adult; Aged; Aged, 80 and over; Doxycycline; Drainage; Female; Fibrin Tissue Adhesive; Humans; Male; Middle Aged; Pleura; Pneumothorax; Recurrence; Tetracycline; Thoracoscopy; Thoracotomy

The results of treatment of 226 patients with unspecific spontaneous pneumothorax in 1980-1990 are discussed. Poor efficacy of punctures of the pleural cavity (32.4%) is noted. Pleural cavity drainage proved to be effective in 79.7% of cases, both in primary and in recurrent pneumothorax. Chemical pleurodesis with tetracycline and 4% sodium bicarbonate solution was conducted in patients with complicated forms of pneumothorax (bronchopleural fistulas, hydropneumothorax). The advantage of 4% sodium bicarbonate solution over the tetracycline solution was obvious. To prevent the development of encapsulated hydrothorax the authors improved the method of pleural cavity drainage. The described method of instrumental treatment of spontaneous pneumothorax allowed injurious surgical intervention and recurrent pneumothorax to be avoided in 100% of cases.

Topics: Adult; Animals; Bronchial Fistula; Combined Modality Therapy; Drainage; Female; Fistula; Humans; Hydropneumothorax; Male; Middle Aged; Pleural Diseases; Pneumothorax; Punctures; Rats; Recurrence; Sodium Bicarbonate; Tetracycline

Over a 20-year period, 83 patients underwent operative pleurodesis with resection of pulmonary blebs for spontaneous pneumothorax. Follow-up for all patients was between 5 and 25 years, with a mean of 9.1 years. There were five early (5.6 percent) and three late recurrences (3.6 percent). There were no deaths or need for blood transfusion in our series. There was a low incidence of postoperative fever (n = 8), minor wound infection (n = 6), air leak (n = 6), or pneumonia (n = 2). The low morbidity and recurrence rates compare favorably with published series of alternative treatment options for spontaneous pneumothorax.

Topics: Adolescent; Adult; Aged; Combined Modality Therapy; Humans; Middle Aged; Pleura; Pneumothorax; Recurrence; Tetracycline

From 1979 to 1988 483 patients were admitted with primary spontaneous pneumothorax. All patients underwent thoracoscopy to identify the cause of pneumothorax. Chemical pleurodesis with tetracycline was performed if cysts less than 2 cm in diameter were found. If larger cysts were found the patient underwent thoractomy. In 93 patients with cysts larger than 2 cm the recurrence rate after thoracotomy was 4%. In 390 patients treated with intrapleural instillation of tetracycline, the recurrence rate was 16% (61 patients). The cause of recurrence in 42 patients was cysts missed at the initial thoracoscopy. This study has demonstrated that thoracoscopy is a reliable and safe method for selection of patients for chemical pleurodesis.

Topics: Adolescent; Adult; Aged; Female; Humans; Instillation, Drug; Male; Middle Aged; Pleura; Pneumothorax; Recurrence; Retrospective Studies; Tetracycline; Thoracoscopy; Thoracotomy

Chemical pleurodesis is a frequently performed procedure for pneumothorax and effusion and significant adverse effects are unusual. We present a previously unreported case of acute renal failure associated with tetracycline pleurodesis. Recent studies have shown that intrapleural drug administration may lead to therapeutic serum levels. Systemic toxic drug effects may therefore be noted with chemical pleurodesants such as tetracycline. Alternative methods of pleurodesis should always be considered if a sensitivity or metabolic abnormality is suspected.

Topics: Acute Kidney Injury; Chest Tubes; Humans; Instillation, Drug; Male; Middle Aged; Pleura; Pneumothorax; Sclerotherapy; Tetracycline

With the resurgence of thoracoscopy, there is renewed interest in less invasive methods of pleurodesis. We wished to compare in an animal model a variety of methods suggested in reports. The purpose of the study was to rank the effectiveness of each procedure against the standard mechanical pleurodesis. Twenty-five mongrel dogs (weight, 25 to 35 kg) underwent bilateral thoracotomy. Each animal was randomly assigned to receive two of the following methods of pleurodesis: tetracycline, talc, mechanical abrasion, neodymium: yttrium-aluminum garnet (Nd:YAG) laser (Hereus Inc, E. Rutherford, NJ) photocoagulation, and argon beam coagulator (ABC) (Beacon Lab, Bloomfield, CO) electrocoagulation of the parietal pleura. At evaluation at 30 +/- 2 days, the efficacy of pleurodesis was graded on a scale of 0 to 4, with 0 representing a complete absence of pleural symphysis and 4 the adhesion of more than one lobe to both the chest wall and mediastinum. Mean grade and standard deviation of each method were: talc, 3.0 +/- 0.67; mechanical, 3.0 +/- 0.82; tetracycline, 2.3 +/- 1.4; ABC, 1.5 +/- 0.97; and Nd:YAG laser, 0.7 +/- 0.95. Both the talc and mechanical methods were superior to either the Nd:YAG laser or the ABC (p < 0.01). In this study, neither the Nd:YAG laser nor the ABC proved efficacious in producing pleurodesis. Talc poudrage is the only method of pleural symphysis comparable with mechanical abrasion.

Topics: Animals; Dogs; Laser Therapy; Pleura; Pneumothorax; Talc; Tetracycline; Tissue Adhesions

Spontaneous pneumothorax has a high incidence of recurrence if treated only with intercostal drainage. A series of 404 patients in a special treatment program is presented. Early thoracoscopy was performed in 97%. The 86 patients (21%) then found to have true cyst (> 2 cm) were subjected to thoracotomy with removal of cyst and mechanical pleurodesis, and in the others a dilute tetracycline solution was instilled intrapleurally, followed by intercostal tube drainage. There was no recurrence of pneumothorax in the group treated with thoracotomy, but 8% recurrence in the tetracycline-treated group. Repeated thoracoscopy was performed in 21 of the 25 patients with recurrent pneumothorax, and thoracotomy with resection of large cyst in four. The probable cause of recurrence was identified in 21 cases, making the true recurrence rate 1% (4 patients). The mean hospital stay was 7.6 days for the patients with thoracotomy and 4.3 days for the tetracycline-treated group.

Topics: Adult; Chest Tubes; Drainage; Female; Follow-Up Studies; Humans; Incidence; Instillation, Drug; Male; Pneumothorax; Recurrence; Tetracycline; Thoracoscopy; Thoracotomy; Tissue Adhesions

The epidemiology and etiology of spontaneous pneumothorax (SP) are shifting away from the predominance of subpleural bleb disease as emphasized by most reports since that of Kjaergaard (Sweden, 1932). We conducted a retrospective review of all patients admitted to a large urban hospital with the diagnosis of SP over the past 8 years. Of 120 patients, 32 had the acquired immunodeficiency syndrome (AIDS) (group 1, 26.6%), 43 patients had classic subpleural bleb disease or chronic obstructive pulmonary disease with blebs (group 2, 35.8%), and 45 patients had nonbleb disease exclusive of AIDS (group 3, 37.5%). These three groups were studied with respect to primary success rates with differing modalities of therapy. Bilateral SP occurred in 34% of group 1 patients, 2% of group 2 patients, and 11% of group 3 patients. The in-hospital mortality was 34% in group 1 compared with 2% in group 2 and 4% in group 3. Thirty-four percent of group 1 patients had recurrent SP compared with 16% of group 2 patients and 8% of group 3 patients. This report describes the changing etiology and epidemiology of SP in a large urban hospital from 1983 to 1991 and represents the largest single-institution report of AIDS-related pneumothorax. Standardized therapy was shown to have predictably favorable results in patients with bleb disease and nonbleb disease exclusive of AIDS. SP in patients with AIDS was associated with a high mortality rate and primary treatment failure; small-bore catheters and nondrainage therapies have a very limited role in these patients.

Topics: Acquired Immunodeficiency Syndrome; Catheterization; Chest Tubes; Humans; Lung Diseases; Lung Diseases, Obstructive; Oxygen Inhalation Therapy; Pleural Diseases; Pneumothorax; Punctures; Retrospective Studies; Suction; Tetracycline; Texas; Time Factors; Tissue Adhesions

The purpose of this study was to delineate the etiological factors for iatrogenic pneumothorax in the era of increased use of invasive procedures and to determine its impact on morbidity. Between 1983 and 1987 the Department of Veterans Affairs conducted a cooperative study at 13 medical centers to assess the utility of the intrapleural instillation of tetracycline for the prevention of recurrent pneumothorax. Since all patients with any type of pneumothorax were screened at each medical center, it was decided to collect data on all the iatrogenic pneumothoraces during that period. During the study period, the number of reported iatrogenic pneumothoraces were 538. Because of incomplete data, 3 iatrogenic pneumothoraces reported from one center were excluded. The leading causes of iatrogenic pneumothorax were transthoracic needle aspiration (128), subclavicular needle stick (119), thoracentesis (106), transbronchial biopsy (54), pleural biopsy (45) and positive pressure ventilation (38). Most patients required treatment for 4-7 days; however, hospitalization was prolonged due to this treatment in only 8% of patients, presumably because of their underlying disease which required long hospitalization. Patients with underlying chronic obstructive pulmonary disease required significantly longer duration of treatment than those without. We conclude that in our patient population, the three leading causes of iatrogenic pneumothorax are transthoracic needle aspiration, subclavicular needle stick and thoracentesis. Hospitalization is prolonged in only a small percentage of the patients who required treatment for the iatrogenic pneumothorax.

Topics: Adult; Aged; Aged, 80 and over; Biopsy, Needle; Humans; Iatrogenic Disease; Incidence; Intermittent Positive-Pressure Ventilation; Length of Stay; Middle Aged; Needlestick Injuries; Pneumothorax; Radiography; Recurrence; Tetracycline; United States; United States Department of Veterans Affairs

From 1979 to 1988 483 patients were admitted with primary spontaneous pneumothorax. All patients underwent thoracoscopy to identify the cause of pneumothorax. Chemical pleurodesis with instillation of tetracycline was performed if cysts less than 2 cm in diameter were found. If larger cysts were identified the patient underwent thoracotomy. In 93 patients with cysts larger than 2 cm the recurrence rate after thoracotomy was 4%. In 390 patients treated with intrapleural instillation of tetracycline, the recurrence rate was 16%. Fifty percent of the recurrences occurred within 30 days. The cause of recurrence in 42 patients (69%) was cysts missed at the initial thoracoscopy. This study has demonstrated that thoracoscopy is a reliable and safe method for selection of patients for chemical pleurodesis. It is, however, necessary that the thoracoscopy is meticulous to avoid recurrence from missed cysts.

Topics: Adolescent; Adult; Aged; Female; Humans; Instillation, Drug; Male; Middle Aged; Pleura; Pneumothorax; Recurrence; Tetracycline; Thoracotomy

Topics: Combined Modality Therapy; Humans; Immunocompromised Host; Methods; Pleura; Pneumothorax; Suction; Tetracycline

Topics: Humans; Pleura; Pleural Effusion, Malignant; Pneumothorax; Tetracycline; Tissue Adhesions

The article describes the method of drug pleurodesis and determines the indications for its application. Study of the late-term results and the drawn conclusions provide evidence that the method of drug pleurodesis may de an alternative to operative treatment of spontaneous pneumothorax.

Topics: Drainage; Humans; Injections; Middle Aged; Pleura; Pneumothorax; Tetracycline; Tetracyclines

Topics: Humans; Male; Pneumothorax; Recurrence; Tetracycline; Thoracostomy

Spontaneous pneumothorax is occurring in patients with the acquired immunodeficiency syndrome and Pneumocystis carinii infection with increasing frequency. These patients are typically poor surgical candidates. Conservative management using tetracycline sclerosis was performed with good results in a patient with acquired immunodeficiency syndrome and recurrent pneumothorax.

Topics: Acquired Immunodeficiency Syndrome; Adult; Chest Tubes; Humans; Instillation, Drug; Male; Pleura; Pneumonia, Pneumocystis; Pneumothorax; Sclerotherapy; Tetracycline

Topics: Acquired Immunodeficiency Syndrome; Adult; Bleomycin; Female; Humans; Intubation; Pneumonia, Pneumocystis; Pneumothorax; Sclerotherapy; Tetracycline

The aim of this study was to assess the value of peridural thoracic analgesia (ATP) to prevent pain observed during pleural symphysis with tetracycline (STP) for pneumothorax (PNO). 12 patients (age 27 +/- 6 years) having a spontaneous PNO benefited from 13 SPT (1 gm, tetracycline diluted in 60 cc of normal saline) under cover of an APT (at the D5-D6 level) with Fentanyl (0.1 mg) and Bupivacaine 0.5% adrenalin (1 mg/kg). The protocol was used on three successive days. Repeated determinations of blood bupivacaine levels were performed in 9 patients on the first day. No patient had an intolerable pain which required injection of parenteral morphine and/or an interruption of the protocol. For two patients (one of them having a right symphysis and then a left symphysis one month later) the treatment sessions to achieve a symphysis were totally painless. 10 patients experienced moderate pain, mainly on the first day, which was relieved by reinjection of peridural bupivacaine (25 mg) (n = 9) or by the parenteral injection of non morphine analgesia (n = 1). No patient had a respiratory depression, collapse or bradycardia. The blood bupivacaine levels were always significantly less than the toxic levels (1.6 mg). The results observed suggest that APT, (Fentanyl and Bupivacaine) is an effective method, non toxic and well tolerated for the prevention of intolerable pain which is seen in SPT for PNO.

Topics: Adult; Analgesia, Epidural; Blood Pressure; Bupivacaine; Female; Fentanyl; Humans; Injections; Male; Pleura; Pleural Diseases; Pneumothorax; Recurrence; Respiration; Tetracycline; Tissue Adhesions

Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Pleural Diseases; Pneumothorax; Tetracycline; Tissue Adhesions

Treatment of spontaneous pneumothorax aims at avoiding relapses besides achieving immediate reexpansion of the lung. Thoracoscopy should definitely occupy a well-established position in the diagnostic and therapeutic step-by-step schedule. On the one hand, it enables local treatment methods, and on the other it helps in arriving at a decision with regard to the operation. If conditions permit, pleurodesis should be effected via the intrapleural rubber-tube drain, tetracycline hydrochloride having proved very suitable for this purpose. A retrospective review is given on the experiences with thoracoscopy and pleurodesis on the basis of own cases.

Topics: Adult; Drainage; Female; Humans; Male; Pneumothorax; Recurrence; Tetracycline; Thoracoscopy

Persistent air leak makes chemical pleurodesis difficult because the chest tube cannot be clamped after drug instillation. A technique is described that obviates the need for clamping the chest tube in this setting.

Topics: Humans; Methods; Pleura; Pneumothorax; Tetracycline

We reviewed the records of all patients with cystic fibrosis and radiologically demonstrated pneumothorax at Rainbow Babies and Childrens Hospital between 1959 and 1987. There occurred 144 pneumothoraces, 71 right and 73 left, in 99 patients, 48 female and 51 male. The median survival from the date of the first pneumothorax was 29.9 months. Primary therapy included the following: observation; tube thoracostomy; tube thoracostomy with instillation of quinacrine hydrochloride, tetracycline, silver nitrate, or talc; or partial pleurectomy. Complications were minimal in each group. The surgical group did significantly better than all other groups except the group given talc. We conclude that pneumothorax is a late and ominous complication of cystic fibrosis. The primary treatment of pneumothorax should be partial pleurectomy. Talc instillation should be reserved for patients in respiratory failure who are too ill to undergo operation and for the occasional patient in whom surgical intervention fails.

Topics: Adolescent; Adult; Child; Cystic Fibrosis; Female; Humans; Male; Pleura; Pneumothorax; Quinacrine; Silver Nitrate; Talc; Tetracycline; Thoracostomy; Tissue Adhesions

Seven patients with symptomatic pleural effusions (six) and recurrent pneumothorax (one) underwent attempted pleurodesis using tetracycline. Lidocaine (150 mg), followed immediately by tetracycline (20 mg/kg), was instilled into the pleural space through a chest tube. Venous blood was obtained at 0, 15, 30, 60, and 120 minutes following instillation in order to determine concentrations of lidocaine and tetracycline. The mean peak serum concentration of lidocaine was 1.3 mu/ml +/- 0.4 microgram/ml (mean +/- SE) (range, 0.3 microgram/ml to 3.2 microgram/ml), and the mean time to peak serum concentration of lidocaine was 86 +/- 13 minutes. The mean peak serum concentration of tetracycline was 3.6 microgram/ml +/- 0.9 microgram/ml (range, 1.0 microgram/ml to 5.0 micrograms/ml), and the mean time to peak serum concentration of tetracycline was 96 +/- 16 minutes. Therapeutic serum concentrations of lidocaine were found in four of the seven patients and therapeutic serum levels of tetracycline in four of five patients. With systemic absorption of lidocaine and tetracycline following intrapleural instillation, patients are at risk for potential toxic effects. If lidocaine is used in a dosage of less than 3 mg/kg, toxic levels of the drug are unlikely to occur. Furthermore, use of tetracycline or lidocaine in pleurodesis is contraindicated in patients with known sensitivity to the drugs.

Topics: Female; Humans; Instillation, Drug; Lidocaine; Male; Pleura; Pleural Effusion; Pneumothorax; Recurrence; Tetracycline

Topics: Adult; Aged; Humans; Injections; Male; Middle Aged; Pleura; Pneumothorax; Tetracycline

The validity of previous recommendation of early thoracoscopy and tetracycline pleurodesis in the management of spontaneous pneumothorax without thoracoscopically visualized true cyst was assessed under non-trial, normal hospital conditions. Among 46 patients treated during a year, seven underwent immediate thoracotomy following finding of large cysts. Of the remaining 39 patients, 11 had recurrence of pneumothorax after a median of 11 (range 2-64) weeks. Repeat thoracoscopy then showed large cyst or bullous emphysema in seven cases. Tetracycline pleurodesis was again performed in the others. In continued observation for at least 2 years there were no further recurrences. The importance of meticulous thoracoscopy is stressed. The demonstrated diagnostic errors do not detract from the value of tetracycline pleurodesis when spontaneous pneumothorax is caused by rupture of only tiny blebs on the surface of an otherwise healthy lung. The procedure is fast, simple and efficacious.

Topics: Adolescent; Adult; Combined Modality Therapy; Humans; Middle Aged; Pneumothorax; Recurrence; Tetracycline; Thoracic Surgery; Thoracoscopy

A 57-year-old woman with bilateral pneumothoraces secondary to pulmonary metastases from leiomyosarcoma of the uterus was treated successfully by intrapleural instillation of tetracycline.

Topics: Female; Humans; Leiomyosarcoma; Lung Neoplasms; Middle Aged; Pleura; Pneumothorax; Tetracycline

Topics: Adult; Female; Humans; Menstruation; Pleural Diseases; Pneumothorax; Recurrence; Tetracycline; Tissue Adhesions

Topics: Female; Humans; Injections; Ketamine; Male; Pleura; Pneumothorax; Sclerosing Solutions; Tetracycline

A retrospective analysis was made of all spontaneous pneumothoraces admitted to a Respiratory Unit between 1976 and 1981. There were 117 individuals responsible for 148 admissions, with a male to female ratio of 2: 1, giving a higher incidence amongst females than has been previously reported. Significantly fewer admissions were noted during May, June and July. Of the total survey population 89 per cent had smoked and in 40 per cent there was pre-existing lung disease. There was a history of two or more pneumothoraces in 36 per cent. Tetracycline pleurodesis, while attempted in 19 patients, was successful in only ten. Twelve patients underwent thoracotomy with a preponderance following right sided lesions. The duration of admission was more than 20 days for 17 per cent of the population. The aetiology, pathogenesis and management of pneumothorax is discussed.

Topics: Adolescent; Adult; Age Factors; Aged; Female; Humans; Intubation; Lung Diseases; Male; Middle Aged; Pneumothorax; Recurrence; Retrospective Studies; Scotland; Seasons; Sex Factors; Smoking; Suction; Tetracycline

The treatment of 15 patients with neoplastic pleurisy and 25 with spontaneous pneumothorax occurring for the second time is described. All were given endopleural tetracycline therapy for symphyseal purposes. In the neoplastic pleurisy cases, the treatment reduced the number of thoracenteses required. In only 1 case did spontaneous pneumothorax recur a short time after treatment.

Topics: Adolescent; Adult; Aged; Breast Neoplasms; Central Nervous System Diseases; Female; Humans; Injections; Lung Neoplasms; Male; Middle Aged; Neoplasms; Pleura; Pleurisy; Pneumothorax; Rectal Neoplasms; Skin Neoplasms; Tetracycline

Topics: Humans; Pneumothorax; Tetracycline

Pleurodesis with a sclerosing agent was attempted in an animal model in which a pneumothorax with an active air leak was created. Adult rabbits had a small left thoracotomy and then a 1-cm controlled cut in the lung surface. Animals served as control, or tetracycline was administered. The chest tube was removed after the air leak stopped. Animals were sacrificed after 20 days. Group A was control rabbits (6); group B had powdered tetracycline placed at thoracotomy; group C, tetracycline solution, 2 ml/kg, 25 mg/ml (4); and group D, tetracycline solution, 1 ml/kg, 50 mg/ml (10). Control rabbits showed few adhesions, and the pleura appeared to be normal by histologic examination. There was a spectrum of results with tetracycline, but with the concentrated tetracycline solution (group D) histologic examination showed uniform pleurodesis and thickening of the pleura. In group D it took no longer for the pulmonary air leak to seal than with the group A (control) rabbits. We conclude that concentrated tetracycline solution is effective in causing pleurodesis even when an active air leak is present. The lung, however, must be kept expanded so that symphysis can occur between the visceral and parietal pleura.

Topics: Animals; Lung; Pleura; Pneumothorax; Rabbits; Tetracycline

We reviewed our experience over the past 12 years to determine the best method of management, to determine the morbidity and the physiologic outcome of medical vs surgical treatment of pneumothorax complicating CF, and to assess the influence of age, sex, and Shwachman scores on survival. Sixty-five patients, ages ranging from 5 to 32 years (mean 18 years). Shwachman scores ranging from 25 to 87 (mean 57), and a male-female ratio of 1:1, experienced 170 pneumothoraces, 93 first episodes, and 77 recurrences, requiring 211 trials of management. All methods of management except needle aspiration resulted in a fair rate of resolution (70 to 100%), but recurrence rates were high for observation (60%), needle aspiration (79%), trocar thoracotomy (63%), tetracycline sclerosis (86%), and silver nitrate sclerosis (43%). The recurrence rates were 12.5% for quinacrine sclerosis and 0% for parietal pleurectomy. Quinacrine sclerosis and parietal pleurectomy were the most effective methods of management. There was no significant difference in pulmonary function before pneumothorax and after pleural sclerosis or parietal pleurectomy. Age, sex, and severity of pulmonary disease were all independent variables influencing prognosis. Severity of disease, rather than the occurrence of a pneumothorax, appears to be the major cause of death. We recommend that quinacrine sclerosis should be considered for management of the first pneumothorax, and parietal pleurectomy if it fails.

Topics: Adolescent; Adult; Child; Child, Preschool; Cystic Fibrosis; Female; Humans; Intubation; Male; Pleura; Pneumothorax; Quinacrine; Respiratory Function Tests; Retrospective Studies; Sclerosing Solutions; Silver Nitrate; Suction; Tetracycline

Topics: Aged; Humans; Male; Pleura; Pneumothorax; Recurrence; Tetracycline; Tissue Adhesions

Topics: Animals; Humans; Pleura; Pneumothorax; Rabbits; Rats; Tetracycline

Topics: Adult; Humans; Male; Pleura; Pneumothorax; Recurrence; Tetracycline

Topics: Adolescent; Bronchial Neoplasms; Bronchiectasis; Cysts; Diagnosis, Differential; Fluorescence; Fluoroscopy; Gastric Lavage; Humans; Lung Abscess; Lung Diseases; Male; Mediastinal Neoplasms; Pneumothorax; Sputum; Tetracycline; Tuberculosis, Pulmonary

Topics: Catheterization; Child; Child, Preschool; Chloramphenicol; Empyema; Erythromycin; Humans; Infant; Infant, Newborn; Kanamycin; Mortality; Novobiocin; Penicillin Resistance; Penicillins; Pneumonia; Pneumothorax; Radiography, Thoracic; Staphylococcal Infections; Streptomycin; Tetracycline

Topics: Drainage; Empyema; Female; Humans; Infant; Lung Abscess; Male; Penicillins; Pleuropneumonia; Pneumonia, Staphylococcal; Pneumothorax; Tetracycline

Topics: Anti-Bacterial Agents; Bacitracin; Child; Chloramphenicol; Chlortetracycline; Drainage; Empyema; Erythromycin; Escherichia coli Infections; Haemophilus influenzae; Humans; Infant; Infant, Newborn; Kanamycin; Novobiocin; Oleandomycin; Pediatrics; Penicillins; Pneumococcal Infections; Pneumothorax; Staphylococcal Infections; Streptococcal Infections; Sulfonamides; Surgical Procedures, Operative; Tetracycline; Vancomycin

Topics: Abscess; Anti-Bacterial Agents; Bacitracin; Bronchial Fistula; Chloramphenicol; Empyema; Erythromycin; Humans; Kanamycin; Novobiocin; Penicillins; Pleural Effusion; Pneumonia; Pneumonia, Staphylococcal; Pneumothorax; Sepsis; Staphylococcal Infections; Tetracycline; Vancomycin

Topics: Antibiotic Prophylaxis; Humans; Injections, Intravenous; Pneumonectomy; Pneumothorax; Pneumothorax, Artificial; Postoperative Care; Pulmonary Surgical Procedures; Pyrrolidines; Rolitetracycline; Tetracycline; Thoracoplasty; Tuberculosis; Tuberculosis, Pulmonary