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%; χ2=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.

No abstract

The progress in anti-platelet therapy and percutaneous coronary intervention led to reconfigure indications of hybrid re-vascularisation. However, there are still some controversies over indication, timing and patient management during the procedure. The case discussed here is a patient who was diagnosed with myocardial infarction and treated with hybrid re-vascularisation. The patient underwent stent insertion followed by bypass surgery. After the hybrid procedure, the patient was stable but eventually died on the 12th day after the surgery owing to unexpected stent thrombosis. We discuss the current controversy over hybrid re-vascularisation, variables that can affect the outcome and the requirement for establishing accurate logistics based on our case.

No abstract

No abstract