Recurrence after thoracoscopic surgery for primary spontaneous pneumothorax is a lingering problem, and many intraoperative methods to induce pleural symphysis have been introduced. We analyzed the effects of chemical pleurodesis during thoracoscopic procedures. Between August 2003 and July 2005, 141 patients among indicated surgical treatment for primary spontaneous pneumothorax in two hospitals of our institution allowed this prospective study. The patients were randomly assigned to 3 groups: thoracoscopic procedure only (group A, n=50), thoracoscopic procedure and pleurodesis with dextrose solution (group B, n=49), and thoracoscopic procedure and pleurodesis with talc-dextrose mixed solution (group C, n=42). There was no significant difference in demographic data among the three groups. The two groups that underwent intraoperative pleurodesis had significantly longer postoperative hospital stays (A/B/C: 2.50+/-1.85/4.49+/-2.10/6.00+/-2.58 days; p=0.001) and a higher incidence of postoperative fever (A/B/C: 10.0/22.45/52.38%; chi-square= 21.598, p=0.00). No significant differences were found for recurrence rates or the number of postoperative days until chest tube removal. Therefore, the results of our study indicate that intraoperative chemical pleurodesis gives no additional advantage to surgery alone in deterring recurrence for patients with primary spontaneous pneumothorax. Thus, the use of such scarifying agents in the operating room must be reconsidered.
Adolescent ; Adult ; Aged ; Female ; Glucose/*pharmacology ; Humans ; Male ; Middle Aged ; Oxygen/metabolism ; Pleurodesis/*methods ; Pneumothorax/*surgery/*therapy ; Prospective Studies ; Talc/*pharmacology ; Thoracic Surgery, Video-Assisted/*methods ; Treatment Outcome

Subclavian venous catheterization was once widely used for volume resuscitation, emergency venous access, chemotherapy, parenteral nutrition, and hemodialysis. However, its use has drastically reduced recently because of life-threatening complications such as hemothorax, pneumothorax. In this case, a patient admitted for a scheduled operation underwent right subclavian venous catheterization for preoperative, intraoperative, and postoperative volume resuscitation and parenteral nutrition. The procedure was performed by an experienced senior resident. Despite detecting slight resistance during the guidewire insertion, the resident continued the procedure to the point of being unable to advance or remove it, then attempted to forcefully remove the guidewire, but it broke and became entrapped within the thorax. We tried to remove the guidewire through infraclavicular skin incision but failed. So video-assisted thoracoscopic surgery was used to remove the broken guidewire. This incident demonstrates the risks of subclavian venous catheterization and the importance of using a proper and gentle technique.
Catheterization ; Catheterization, Central Venous ; Catheters ; Drug Therapy ; Emergencies ; Hemothorax ; Humans ; Parenteral Nutrition ; Pneumothorax ; Renal Dialysis ; Resuscitation ; Skin ; Thoracic Surgery, Video-Assisted* ; Thorax

No abstract available.
Adult ; Biopsy ; Disease Progression ; Fatal Outcome ; Humans ; Lung Neoplasms/*complications/diagnostic imaging/secondary/surgery ; Lymphatic Metastasis ; Male ; Pleural Effusion, Malignant/diagnostic imaging/*etiology/therapy ; Pneumothorax/diagnostic imaging/*etiology/therapy ; Sarcoma/*complications/diagnostic imaging/secondary/surgery ; Soft Tissue Neoplasms/*pathology ; Tomography, X-Ray Computed ; Treatment Outcome