Chest
Clinical Investigations: HIV/InfectionsTreatment of AIDS-Related Spontaneous Pneumothorax: A Decade of Experience
Section snippets
Materials and Methods
A retrospective review of the medical and radiographic records of all patients admitted to Parkland Memorial Hospital, Dallas, between 1983 and 1994 with the diagnosis of AIDS and spontaneous pneumothorax was conducted. A total of 50 patients were identified over this 11-year period. Patients who had a history of trauma (traumatic injuries or iatrogenic pneumothorax due to thoracentesis or bronchoscopy) were excluded from this review; likewise, patients with barotrauma from ventilator support
Results
A total of 46 patients, all male, were identified. The mean age was 36 years (range, 20 to 57 years). The absolute lymphocyte count was obtained in 21 patients, with a mean of 474/mm3 (range, 25 to 2,460/mm3); the CD4 (helper T cell) count was obtained in 17 patients, with a mean of 52/mm3 (range, 2 to 123/mm3; normal CD4 count=494 to 1,362/mm3). Eighteen of 46 patients had a positive smoking history, yet none carried a diagnosis of chronic obstructive bronchopulmonary disease (emphysema,
Discussion
Due to the retrospective nature of this review, statistically conclusive data are difficult to extract and strong recommendations cannot be made with authority. Nevertheless, meaningful clinical insights from this report update our previous study from November 1992 and represent the largest single-institution experience with AIDS-related SP reported in the English literature (to our knowledge). Our results show that the success rate for standard therapy is poor (26 percent) for
Addendum
Since the submission of this article, four consecutive additional patients were subsequently admitted to the hospital with large, symptomatic AIDS-related SP. These four patients were successfully treated with VATS-talc poudrage as initial therapy (following emergency department placement of large-bore pleural chest tubes). After adding these patients to the present cohort of study patients, Table 3 illustrates our entire experience.
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