trelstar and Pneumothorax

This study aims to propose a therapeutic approach for catamenial pneumothorax based on outcomes reported in 18 cases. We conducted a retrospective study of 18 female elderly patients with an average age of 32.2 years who had undergone surgery for right (16 cases) and bilateral catamenial pneumothorax (2 cases) from January 1994 to December 2016. The patients were divided into 3 groups on the basis of the evolution of our surgical capability over time: group 1(G1) from January 1994 to June 2006, group 2 (G2) from July 2006 to February 2008, group 3(G3) from March 2008 to December 2016, these groups were composed of 5, 2 and 11 patients respectively. All these patients were nulliparous who had suffered from dysmenorrhoea associated, in 11 cases, to catamenial chest pain since puberty. Standard radiographic evaluation of the chest was sistematically performed and complemented, in 8 cases, by chest CT scan that showed apical bubbles in addition to pneumothorax (5 cases). Exploration through posterolateral mini-thoracotomy (16 cases) and through videothoracoscopy (2 case of G3) showed diaphragmatic fenestrations (18 cases) and bubbles (5 cases). Biopsy of lesions as well as resection of the bubbles were sistematically performed . Surgical treatment of diaphragmatic fenestrations was based, in group 1, on resection-suture with pleural abrasion, in group 2, on Gore-tex patches coverage with pleural abrasion and, in group 3, on patch coverage with pleural talcage. Each patient underwent hormone therapy (triptoreline) for 6 months during postoperative period, in order to suspend menstruations. Surgical outcomes were evaluated on the basis of the recurrence or non-recurrence of a pneumothorax after resumption of menstruations. Mortality was zero. Postoperative hospital length of stay was 9.32 days. Anatomo-pathological examinations confirmed thoracic endometriosis in 9 cases. After a mean follow-up period of 5.3 years, outcomes were good in 12 patients (3/5 in G1, 1/2 in G2 and 8/11 in G3); 3 patients in G3 continued to have minimal episodes of dyspnoea at the beginning of some menstrual cycles without radiological evidence of recidivism, 3 patients (2 in G1 and 1 in G2) had recurrences requiring reoperation. We recommend phrenoplasty using patches associated with pleural talcage and complementary concomitant hormone therapy for 6 months in patients suffering from catamenial pneumothorax with diaphragmatic fenestrations.

Topics: Adult; Dysmenorrhea; Endometriosis; Female; Follow-Up Studies; Humans; Luteolytic Agents; Menstruation; Middle Aged; Pneumothorax; Recurrence; Reoperation; Retrospective Studies; Thoracic Surgery, Video-Assisted; Thoracotomy; Treatment Outcome; Triptorelin Pamoate; Young Adult

Topics: Adult; Antineoplastic Agents, Hormonal; Desogestrel; Endometriosis; Female; Humans; Pneumothorax; Progestins; Triptorelin Pamoate

Topics: Adult; Female; Gonadotropin-Releasing Hormone; Humans; Menstruation; Pneumothorax; Recurrence; Triptorelin Pamoate

Catamenial pneumothorax is a rarely encountered entity characterized by recurrent pneumothorax concurrent with menstruation. Numerous mechanisms have been postulated in the etiology of catamenial pneumothorax and treatment is still controversial. We report a case of a catamenial pneumothorax successfully treated with a Gn-RH analogue supporting the efficacy of this regimen and the endometriosis theory as an underlying cause of the disease.

Topics: Adult; Endometriosis; Female; Humans; Luteolytic Agents; Menstruation; Pneumothorax; Recurrence; Triptorelin Pamoate

A thirty four year old woman with recurrent catamenial pneumothorax is described. Pleural endometriosis was suspected and cytologic examination of fluid drained from the right pleural cavity showed glandular cell clusters of probable endometrial origin. The patient received a long-acting GnRH agonist (Triptorelin-Arvekap-Ipsen) 3.75 mg/month I.M. for nine months and remains asymptomatic with regular periods 12 months after discontinuing the treatment.

Topics: Adult; Endometriosis; Female; Humans; Luteolytic Agents; Pleural Diseases; Pneumothorax; Recurrence; Triptorelin Pamoate

The lung is an infrequent location of extragenital endometriosis, an exceptional cause of hemoptysis or pneumothorax. Adequate management has not yet been well established. We present two cases of pulmonary endometriosis, parenchymal and pleural. The presenting symptoms were catamenial hemoptysis and pneumothorax, respectively, which were treated with GnRH analogues. The first patient received Buserelin (900 micrograms/day intranasally) for 6 months. After 15 months of normal menstrual activity, the symptoms reappeared. The patient was then treated with Triptorelin (3.75 mg/month intramuscularly) for 6 months and remains asymptomatic and menstruating 14 months after discontinuing treatment. The patient presenting with pneumothorax was treated with leuprolide (1 mg/day subcutaneously) for 6 months and is asymptomatic 1 year after stopping treatment. These results suggest that GnRH analogues may be an acceptable alternative to danazol in the medical management of pulmonary endometriosis.

Topics: Administration, Intranasal; Adult; Antineoplastic Agents; Buserelin; Endometriosis; Female; Gonadotropin-Releasing Hormone; Hemoptysis; Hormones; Humans; Leuprolide; Lung Neoplasms; Pneumothorax; Triptorelin Pamoate

Pulmonary endometriosis has been described as occurring in two forms: --bronchopulmonary with haemoptysis at the periods, --pleuropulmonary with pneumothorax at the periods. In 30-40% of cases it is associated with pelvic endometriosis. The pathways along which it can be disseminated are: --transdiaphragmatic peritoneal migration, --or metastatic migration through the veins and lymphatics. The treatment at present consists of hormone therapy together with surgery.

Topics: Adult; Chest Tubes; Endometriosis; Female; Gonadotropin-Releasing Hormone; Humans; Lung Neoplasms; Luteolytic Agents; Menstruation; Pneumothorax; Recurrence; Thoracostomy; Triptorelin Pamoate