This randomised study was designed to compare clinical outcomes for simple aspiration versus tube thoracostomy, in the treatment of the first primary spontaneous pneumothorax (PSP) attack. A randomised trial, comparing simple aspiration with tube thoracostomy, in 137 patients with a first episode of PSP was carried out.Immediate success was obtained in 40 out of the 65 patients (62%) randomly assigned to undergo simple aspiration and in 49 out of the 72 patients (68%) who had been randomly assigned to undergo tube thoracostomy. The 1-week success rates were: 58 (89%) patients in the intentionto-treat simple aspiration group and 63 (88%) patients in the tube thoracostomy group. In the aspiration group, there were more recurrences during the 3-month follow-up period (15 versus 8%), though the difference was not significant. Recurrence rates at 1 and 2 yrs were 16 (22%) and 20 (31%) for patients who had undergone simple aspiration, respectively, and 17 (24%) and 18 (25%) for patients who had undergone tube thoracostomies, respectively. Complications occurred in 5 (7%) patients who had undergone a tube thoracostomy and 1 (2%) patient who had undergone simple aspiration. Analgesia was required in 22 (34%) patients of the simple aspiration group versus 40 (56%) patients of the tube thoracostomy group.These findings suggest that simple aspiration could be an acceptable alternative to tube thoracostomy in the treatment of primary spontaneous pneumothorax.
A total of 235 children, aged between 7 months and 15 years had bronchoscopy on suspicion of foreign body aspiration. The histories of these patients were studied to examine the diagnostic value of symptoms, signs, and chest x-rays, and rate of negative bronchoscopy. The sensitivity of choking and coughing was high (82% and 80%), but the specificity was poor (37% and 34%). The sensitivity of a chest radiograph was 66%, the specificity was 51%. The sensitivity of asymmetric auscultation was 80% and specificity was 72%. The sensitivity and specificity of combination of symptoms, signs and abnormal chest radiograph was 61% and 83%, respectively. In 206 (87.7%) children a foreign body was identified and extracted. The remaining 29 patients (12.3%) had negative bronchoscopy. A wide variety of objects was recovered, the most common being seeds and peanuts. Foreign bodies were in the right and left main bronchus in 72 (35%), 50 (24.3%) cases, respectively, while in the remaining 84 cases, the foreign bodies were in other parts of the respiratory tree. In 204 (99%) patients with foreign body aspiration, the foreign bodies were removed successfully using a rigid bronchoscopy. Minor complications like subglottic edema and bronchospasm occurred in 4 children. In conclusion, rigid bronchoscopy is a safe procedure and the only tool that will give certainty about the correct diagnosis of foreign body aspiration in children. Asymmetric auscultation is more specific than history and chest radiograph. The combination of history, clinical signs and radiological signs are more specific than each one separately.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.