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Marc Noppen - One of the best experts on this subject based on the ideXlab platform.

  • Spontaneous Pneumothorax epidemiology pathophysiology and cause
    European Respiratory Review, 2010
    Co-Authors: Marc Noppen
    Abstract:

    Spontaneous Pneumothorax represents a common clinical problem. An overview of relevant and updated information on epidemiology, pathophysiology and cause(s) of Spontaneous (primary and secondary) Pneumothorax is described.

  • management of Spontaneous Pneumothorax state of the art
    European Respiratory Journal, 2006
    Co-Authors: Jm Tschopp, Marc Noppen, Ramon Ramiporta, P Astoul
    Abstract:

    Spontaneous Pneumothorax remains a significant health problem. However, with time, there have been improvements in pathogenesis, diagnostic procedures and both medical and surgical approaches to treatment. Owing to better imaging techniques, it is now clear that there is almost no normal visceral pleura in the case of Spontaneous Pneumothorax, and that blebs and bullae are not always the cause of Pneumothorax. In first episodes of primary Spontaneous Pneumothorax, observation and simple aspiration are established first-line therapies, as proven by randomised controlled trials. Aspiration should be better promoted in daily medical practice. In the case of recurrent or persistent Pneumothorax, simple talc poudrage under thoracoscopy has been shown to be safe, cost-effective and no more painful than a conservative treatment using a chest tube. There are also new experimental data showing that talc poudrage, as used in Europe, does not lead to serious side-effects and is currently the best available pleural sclerosing agent. Alternatively, surgical techniques have considerably improved, and are now less invasive, especially due to the development of video-assisted thoracoscopic surgery. Studies suggest that video-assisted thoracoscopic surgery may be more cost-effective than chest tube drainage in Spontaneous Pneumothorax requiring chest tube drainage, although it is more expensive than simple thoracoscopy and requires general anaesthesia, double-lumen tube intubation and ventilation. Recommendations are made regarding the treatment of Pneumothorax. In secondary or complicated primary Pneumothorax, i.e. recurrent or persistent Pneumothorax, some diffuse treatment of the visceral pleura should be offered, either by talc poudrage under thoracoscopy or by video-assisted thoracoscopic surgery. Moreover, all of these new techniques should be better standardised to permit comparison in randomised controlled studies.

  • fluorescein enhanced autofluorescence thoracoscopy in patients with primary Spontaneous Pneumothorax and normal subjects
    American Journal of Respiratory and Critical Care Medicine, 2006
    Co-Authors: Marc Noppen, Jan Dhaese, Grigoris Stratakos, Marc Meysman, Tom Dekeukeleire, Shane Hanon, Kayvan Amjadi, Priscilla Madsen, Walter Vincken
    Abstract:

    Rationale: The exact site(s) and pathophysiology of air leakage in patients with primary Spontaneous Pneumothorax (PSP) are unknown. In one patient with PSP, fluorescein-enhanced autofluorescence thoracoscopy (FEAT) has shown areas of parenchymal abnormality unnoticed during white light thoracoscopy (WLT).Objectives: To prospectively perform and compare WLT and FEAT in patients with Spontaneous Pneumothorax and in normal subjects.Methods: One-time FEAT and WLT inspection with systematic mapping of semiquantified lesions in 12 consecutive patients with PSP was compared with one-time FEAT and WLT during sequential bilateral thoracoscopy in 17 control subjects.Results: WLT abnormalities (anthracosis, cobblestone malformation, and blebs/bullae) were more prevalent in PSP. FEAT, however, showed high-grade lesions in PSP only, which often were present at areas that were normal, or that only showed anthracosis at WLT. When blebs/bullae were present, bleb-associated FEAT abnormalities were only present in two. Ac...

  • belgian society of pneumology guidelines on the management of Spontaneous Pneumothorax
    Acta Chirurgica Belgica, 2005
    Co-Authors: P De Leyn, Marc Noppen, M Lismonde, V Ninane, H Slabbynck, A Van Meerhaeghe, P Van Schil, F Vermassen
    Abstract:

    (2005). Belgian Society of Pneumology. Guidelines on the management of Spontaneous Pneumothorax. Acta Chirurgica Belgica: Vol. 105, No. 3, pp. 265-267.

  • fluorescein enhanced autofluorescence thoracoscopy in primary Spontaneous Pneumothorax
    American Journal of Respiratory and Critical Care Medicine, 2004
    Co-Authors: Marc Noppen, Sylvia Verbanck, Jan Dhaese, Grigoris Stratakos, Marc Meysman, Walter Vincken
    Abstract:

    The exact site of air leakage in a patient with primary Spontaneous Pneumothorax is difficult to determine and locate. In particular, the role of rupture of emphysema-like changes (blebs and bullae) versus that of enhanced porosity of lung parenchyma in the pathophysiology of primary Spontaneous Pneumothorax remains unclear. This is the first description of a patient with recurrent primary Spontaneous Pneumothorax in whom inhalation of aerosolized fluorescein followed by autofluorescence thoracoscopy allowed in vivo localization of various lung areas of extensive subpleural fluorescein accumulation which were not, or only partly, visibly abnormal during normal white light thoracoscopy. No air leak was present at the time of thoracoscopy. No emphysema-like changes were seen. Our findings suggest substantial areas of parenchymal abnormality that remain unnoticed by white light thoracoscopic inspection of the parenchymal surface. In this respect, fluorescein-enhanced autofluorescence thoracoscopy may become ...

Walter Vincken - One of the best experts on this subject based on the ideXlab platform.

  • fluorescein enhanced autofluorescence thoracoscopy in patients with primary Spontaneous Pneumothorax and normal subjects
    American Journal of Respiratory and Critical Care Medicine, 2006
    Co-Authors: Marc Noppen, Jan Dhaese, Grigoris Stratakos, Marc Meysman, Tom Dekeukeleire, Shane Hanon, Kayvan Amjadi, Priscilla Madsen, Walter Vincken
    Abstract:

    Rationale: The exact site(s) and pathophysiology of air leakage in patients with primary Spontaneous Pneumothorax (PSP) are unknown. In one patient with PSP, fluorescein-enhanced autofluorescence thoracoscopy (FEAT) has shown areas of parenchymal abnormality unnoticed during white light thoracoscopy (WLT).Objectives: To prospectively perform and compare WLT and FEAT in patients with Spontaneous Pneumothorax and in normal subjects.Methods: One-time FEAT and WLT inspection with systematic mapping of semiquantified lesions in 12 consecutive patients with PSP was compared with one-time FEAT and WLT during sequential bilateral thoracoscopy in 17 control subjects.Results: WLT abnormalities (anthracosis, cobblestone malformation, and blebs/bullae) were more prevalent in PSP. FEAT, however, showed high-grade lesions in PSP only, which often were present at areas that were normal, or that only showed anthracosis at WLT. When blebs/bullae were present, bleb-associated FEAT abnormalities were only present in two. Ac...

  • fluorescein enhanced autofluorescence thoracoscopy in primary Spontaneous Pneumothorax
    American Journal of Respiratory and Critical Care Medicine, 2004
    Co-Authors: Marc Noppen, Sylvia Verbanck, Jan Dhaese, Grigoris Stratakos, Marc Meysman, Walter Vincken
    Abstract:

    The exact site of air leakage in a patient with primary Spontaneous Pneumothorax is difficult to determine and locate. In particular, the role of rupture of emphysema-like changes (blebs and bullae) versus that of enhanced porosity of lung parenchyma in the pathophysiology of primary Spontaneous Pneumothorax remains unclear. This is the first description of a patient with recurrent primary Spontaneous Pneumothorax in whom inhalation of aerosolized fluorescein followed by autofluorescence thoracoscopy allowed in vivo localization of various lung areas of extensive subpleural fluorescein accumulation which were not, or only partly, visibly abnormal during normal white light thoracoscopy. No air leak was present at the time of thoracoscopy. No emphysema-like changes were seen. Our findings suggest substantial areas of parenchymal abnormality that remain unnoticed by white light thoracoscopic inspection of the parenchymal surface. In this respect, fluorescein-enhanced autofluorescence thoracoscopy may become ...

  • music a new cause of primary Spontaneous Pneumothorax
    Thorax, 2004
    Co-Authors: Marc Noppen, Sylvia Verbanck, Marc Meysman, Walter Vincken, Jeffrey Harvey, R Van Herreweghe, Manuel Paiva
    Abstract:

    Most cases of primary Spontaneous Pneumothorax are thought to be caused by air leaks at so-called "emphysema-like changes" or in areas of pleural porosity at the surface of the lung. Environmental pressure swings may cause air leaks as a result of transpulmonary pressure changes across areas of trapped gas in the distal lung. This is the first report of music as a specific form of air pressure change causing Pneumothorax (five episodes in four patients). While rupture of the interface between the alveolar space and pleural cavity in these patients may be linked to the mechanical effects of acute transpulmonary pressure differences caused by exposure to sound energy in association with some form of distal air trapping, we speculate that repetitive pressure changes in the high energy-low frequency range of the sound exposures is more likely to be responsible. Exposure to loud music should be included as a precipitating factor in the history of patients with Spontaneous Pneumothorax.

Ben C H Kwan - One of the best experts on this subject based on the ideXlab platform.

  • conservative versus interventional treatment for Spontaneous Pneumothorax
    The New England Journal of Medicine, 2020
    Co-Authors: Simon G A Brown, Emma L Ball, Kyle Perrin, Stephen Edward Asha, Irene Braithwaite, Diana Egertonwarburton, Peter A Jones, Gerben Keijzers, Frances B Kinnear, Ben C H Kwan
    Abstract:

    Abstract Background Whether conservative management is an acceptable alternative to interventional management for uncomplicated, moderate-to-large primary Spontaneous Pneumothorax is unknown. Metho...

  • conservative versus interventional treatment for Spontaneous Pneumothorax
    The New England Journal of Medicine, 2020
    Co-Authors: Simon G A Brown, Emma L Ball, Kyle Perrin, Stephen Edward Asha, Irene Braithwaite, Diana Egertonwarburton, Gerben Keijzers, Frances B Kinnear, Peter Jones, Ben C H Kwan
    Abstract:

    BACKGROUND: Whether conservative management is an acceptable alternative to interventional management for uncomplicated, moderate-to-large primary Spontaneous Pneumothorax is unknown. METHODS: In this open-label, multicenter, noninferiority trial, we recruited patients 14 to 50 years of age with a first-known, unilateral, moderate-to-large primary Spontaneous Pneumothorax. Patients were randomly assigned to immediate interventional management of the Pneumothorax (intervention group) or a conservative observational approach (conservative-management group) and were followed for 12 months. The primary outcome was lung reexpansion within 8 weeks. RESULTS: A total of 316 patients underwent randomization (154 patients to the intervention group and 162 to the conservative-management group). In the conservative-management group, 25 patients (15.4%) underwent interventions to manage the Pneumothorax, for reasons prespecified in the protocol, and 137 (84.6%) did not undergo interventions. In a complete-case analysis in which data were not available for 23 patients in the intervention group and 37 in the conservative-management group, reexpansion within 8 weeks occurred in 129 of 131 patients (98.5%) with interventional management and in 118 of 125 (94.4%) with conservative management (risk difference, -4.1 percentage points; 95% confidence interval [CI], -8.6 to 0.5; P = 0.02 for noninferiority); the lower boundary of the 95% confidence interval was within the prespecified noninferiority margin of -9 percentage points. In a sensitivity analysis in which all missing data after 56 days were imputed as treatment failure (with reexpansion in 129 of 138 patients [93.5%] in the intervention group and in 118 of 143 [82.5%] in the conservative-management group), the risk difference of -11.0 percentage points (95% CI, -18.4 to -3.5) was outside the prespecified noninferiority margin. Conservative management resulted in a lower risk of serious adverse events or Pneumothorax recurrence than interventional management. CONCLUSIONS: Although the primary outcome was not statistically robust to conservative assumptions about missing data, the trial provides modest evidence that conservative management of primary Spontaneous Pneumothorax was noninferior to interventional management, with a lower risk of serious adverse events. (Funded by the Emergency Medicine Foundation and others; PSP Australian New Zealand Clinical Trials Registry number, ACTRN12611000184976.).

Marc Meysman - One of the best experts on this subject based on the ideXlab platform.

  • fluorescein enhanced autofluorescence thoracoscopy in patients with primary Spontaneous Pneumothorax and normal subjects
    American Journal of Respiratory and Critical Care Medicine, 2006
    Co-Authors: Marc Noppen, Jan Dhaese, Grigoris Stratakos, Marc Meysman, Tom Dekeukeleire, Shane Hanon, Kayvan Amjadi, Priscilla Madsen, Walter Vincken
    Abstract:

    Rationale: The exact site(s) and pathophysiology of air leakage in patients with primary Spontaneous Pneumothorax (PSP) are unknown. In one patient with PSP, fluorescein-enhanced autofluorescence thoracoscopy (FEAT) has shown areas of parenchymal abnormality unnoticed during white light thoracoscopy (WLT).Objectives: To prospectively perform and compare WLT and FEAT in patients with Spontaneous Pneumothorax and in normal subjects.Methods: One-time FEAT and WLT inspection with systematic mapping of semiquantified lesions in 12 consecutive patients with PSP was compared with one-time FEAT and WLT during sequential bilateral thoracoscopy in 17 control subjects.Results: WLT abnormalities (anthracosis, cobblestone malformation, and blebs/bullae) were more prevalent in PSP. FEAT, however, showed high-grade lesions in PSP only, which often were present at areas that were normal, or that only showed anthracosis at WLT. When blebs/bullae were present, bleb-associated FEAT abnormalities were only present in two. Ac...

  • fluorescein enhanced autofluorescence thoracoscopy in primary Spontaneous Pneumothorax
    American Journal of Respiratory and Critical Care Medicine, 2004
    Co-Authors: Marc Noppen, Sylvia Verbanck, Jan Dhaese, Grigoris Stratakos, Marc Meysman, Walter Vincken
    Abstract:

    The exact site of air leakage in a patient with primary Spontaneous Pneumothorax is difficult to determine and locate. In particular, the role of rupture of emphysema-like changes (blebs and bullae) versus that of enhanced porosity of lung parenchyma in the pathophysiology of primary Spontaneous Pneumothorax remains unclear. This is the first description of a patient with recurrent primary Spontaneous Pneumothorax in whom inhalation of aerosolized fluorescein followed by autofluorescence thoracoscopy allowed in vivo localization of various lung areas of extensive subpleural fluorescein accumulation which were not, or only partly, visibly abnormal during normal white light thoracoscopy. No air leak was present at the time of thoracoscopy. No emphysema-like changes were seen. Our findings suggest substantial areas of parenchymal abnormality that remain unnoticed by white light thoracoscopic inspection of the parenchymal surface. In this respect, fluorescein-enhanced autofluorescence thoracoscopy may become ...

  • music a new cause of primary Spontaneous Pneumothorax
    Thorax, 2004
    Co-Authors: Marc Noppen, Sylvia Verbanck, Marc Meysman, Walter Vincken, Jeffrey Harvey, R Van Herreweghe, Manuel Paiva
    Abstract:

    Most cases of primary Spontaneous Pneumothorax are thought to be caused by air leaks at so-called "emphysema-like changes" or in areas of pleural porosity at the surface of the lung. Environmental pressure swings may cause air leaks as a result of transpulmonary pressure changes across areas of trapped gas in the distal lung. This is the first report of music as a specific form of air pressure change causing Pneumothorax (five episodes in four patients). While rupture of the interface between the alveolar space and pleural cavity in these patients may be linked to the mechanical effects of acute transpulmonary pressure differences caused by exposure to sound energy in association with some form of distal air trapping, we speculate that repetitive pressure changes in the high energy-low frequency range of the sound exposures is more likely to be responsible. Exposure to loud music should be included as a precipitating factor in the history of patients with Spontaneous Pneumothorax.

Pieter E Postmus - One of the best experts on this subject based on the ideXlab platform.

  • prevalence of birt hogg dube syndrome in patients with apparently primary Spontaneous Pneumothorax
    European Respiratory Journal, 2015
    Co-Authors: P C Johannesma, Rinze Reinhard, Y Kon, J D Sriram, Henk Smit, R J A Van Moorselaar, Fred H Menko, Pieter E Postmus
    Abstract:

    Birt–Hogg–Dube syndrome is probably the cause of Pneumothorax in 5–10% of primary Spontaneous Pneumothorax patients http://ow.ly/FiIGS

  • current aspects of Spontaneous Pneumothorax
    European Respiratory Journal, 1997
    Co-Authors: F M N H Schramel, Pieter E Postmus, R G J R A Vanderschueren
    Abstract:

    Although Spontaneous pneumothoraces have been recognized and treated for almost 180 yrs, new aspects have emerged concerning pathogenesis, diagnostic procedures and treatment modalities. In spite of the fact that blebs and bullae are frequently found in patients with primary Spontaneous Pneumothorax, they seldom seem to be the actual cause of the Pneumothorax. Inflammatory changes in the distal airways play an important role in the occurrence of the Pneumothorax during transpulmonary pressure changes. The value of the routine use of additional expiratory chest radiographs in diagnosing pneumothoraces has been doubted in previous studies. In this review, the diagnostic yield from additional expiratory chest radiographs is analysed. The role of previous pneumothoraces at presentation and the presence of blebs and bullae are discussed in predicting future recurrences and choosing appropriate treatment for optimal cost-effectiveness. Recommendations are made regarding treatment of primary and secondary Spontaneous Pneumothorax.