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        "resumen" => "<span class="elsevierStyleSectionTitle">OBJECTIVE</span><p class="elsevierStyleSimplePara elsevierViewall">The main cause of primary spontaneous pneumothorax is the rupture of subpleural blebs or bullae&#46; The presence of bullae may also lead to an increased risk of recurrence&#46; The best way to detect them is by means of computed tomography &#40;CT&#41;&#46; Our objective in the present study was to determine whether bullae detected by CT represent an increased risk of recurrence after a first episode of primary spontaneous pneumothorax&#46; We also evaluated therapeutic implications&#46;</p> <span class="elsevierStyleSectionTitle">PATIENTS AND METHODS</span><p class="elsevierStyleSimplePara elsevierViewall">We carried out a prospective study that included 55 patients &#40;41 men and 14 women&#41; with primary spontaneous pneumothorax&#46; For all patients&#44; the therapeutic recommendations of the Spanish Society of Pulmonology and Thoracic Surgery &#40;SEPAR&#41; were followed&#46; After resolution of the episode&#44; a chest CT was performed and the presence&#44; location&#44; number&#44; and size of bullae were evaluated&#46; Subsequently&#44; the number of recurrences in each group was evaluated&#46;</p> <span class="elsevierStyleSectionTitle">RESULTS</span><p class="elsevierStyleSimplePara elsevierViewall">The mean follow-up period was 30&#46;7 months &#40;95&#37; confidence interval&#44; 24-37 months&#41;&#46; Twenty-six patients presented bullae&#44; and 6 of these experienced recurrence&#46; Of the 29 patients without bullae&#44; 7 experienced recurrence&#46; No association was found between the presence or absence of bullae and recurrence &#40;<span class="elsevierStyleItalic">P</span> &#61; &#46;92&#41;&#46; Bullae in the right lung led to more frequent recurrence of pneumothorax &#40;<span class="elsevierStyleItalic">P</span> &#61; &#46;03&#41;&#46; The number and size of the bullae had no significant influence on recurrence &#40;<span class="elsevierStyleItalic">P</span> &#61; &#46;51&#41;&#46;</p> <span class="elsevierStyleSectionTitle">CONCLUSIONS</span><p class="elsevierStyleSimplePara elsevierViewall">The present study could not demonstrate that the presence&#44; size&#44; or number of bullae on CT scans has any influence on recurrence rate&#46; We cannot recommend surgery after a first episode of primary spontaneous pneumothorax based on the presence of bullae on the CT scan&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">OBJETIVO</span><p class="elsevierStyleSimplePara elsevierViewall">La causa fundamental del neumot&#243;rax espont&#225;neo primario es la rotura de bullas o <span class="elsevierStyleItalic">blebs</span> subpleurales&#46; Estas bullas podr&#237;an tambi&#233;n condicionar un mayor riesgo de recidiva&#46; La mejor forma de detectarlas es mediante tomograf&#237;a axial computarizada &#40;TAC&#41;&#46; Nos planteamos aqu&#237; si las bullas en la TAC suponen un riesgo mayor de recidivas tras un primer episodio de neumot&#243;rax espont&#225;neo primario&#46; Asimismo&#44; se valoran las implicaciones terap&#233;uticas&#46;</p> <span class="elsevierStyleSectionTitle">PACIENTES Y M&#201;TODOS</span><p class="elsevierStyleSimplePara elsevierViewall">Se trata de un estudio prospectivo en el que se incluy&#243; a 55 pacientes &#40;41 varones y 14 mujeres&#41; con neumot&#243;rax espont&#225;neo primario&#46; En todos ellos se siguieron las recomendaciones terap&#233;uticas de la Sociedad Espa&#241;ola de Neumolog&#237;a y Cirug&#237;a Tor&#225;cica &#40;SEPAR&#41;&#46; Tras la resoluci&#243;n del episodio se efectu&#243; una TAC de t&#243;rax y se valoraron la presencia&#44; la localizaci&#243;n&#44; el n&#250;mero y el tama&#241;o de bullas&#46; Posteriormente&#44; se evalu&#243; el n&#250;mero de recidivas en cada grupo&#46;</p> <span class="elsevierStyleSectionTitle">RESULTADOS</span><p class="elsevierStyleSimplePara elsevierViewall">El tiempo medio de seguimiento fue de 30&#44;7 meses &#40;intervalo de confianza del 95&#37;&#44; 24-37 meses&#41;&#46; Presentaron bullas 26 pacientes&#44; de los que en 6 hubo recidiva&#46; De los 29 pacientes sin bullas&#44; 7 presentaron recidiva&#46; No se encontraron diferencias entre la presencia o ausencia de bullas y la recidiva &#40;p &#61; 0&#44;92&#41;&#46; Las bullas derechas recidivaron con mayor frecuencia &#40;p &#61; 0&#44;03&#41;&#46; El n&#250;mero y el tama&#241;o de las bullas no tuvieron influencia significativa &#40;p &#61; 0&#44;51&#41;&#46;</p> <span class="elsevierStyleSectionTitle">CONCLUSIONES</span><p class="elsevierStyleSimplePara elsevierViewall">El estudio no ha podido demostrar que la presencia de bullas en la TAC&#44; su tama&#241;o o su n&#250;mero influyan en el &#237;ndice de recidivas&#46; No se puede recomendar la cirug&#237;a tras un primer episodio de neumot&#243;rax espont&#225;neo primario por presentar bullas en la TAC&#46;</p>"
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Vol. 43. Issue 6.
Pages 304-308 (January 2007)
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Vol. 43. Issue 6.
Pages 304-308 (January 2007)
Original Articles
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Usefulness of Computed Tomography in Determining Risk of Recurrence After a First Episode of Primary Spontaneous Pneumothorax: Therapeutic Implications
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David Martínez-Ramos
Corresponding author
davidmartinez@comcas.es

Correspondence: Dr. D. Martínez-Ramos. Servicio de Cirugía General y del Aparato Digestivo. Hospital General de Castellón. Avda. Benicàssim, s/n. 12004 Castellón. España
, Vicente Ángel-Yepes, Javier Escrig-Sos, Juan Manuel Miralles-Tena, José Luis Salvador-Sanchís
Sección de Cirugía Torácica, Servicio de Cirugía General y del Aparato Digestivo, Hospital General de Castellón, Castellón, Spain
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OBJECTIVE

The main cause of primary spontaneous pneumothorax is the rupture of subpleural blebs or bullae. The presence of bullae may also lead to an increased risk of recurrence. The best way to detect them is by means of computed tomography (CT). Our objective in the present study was to determine whether bullae detected by CT represent an increased risk of recurrence after a first episode of primary spontaneous pneumothorax. We also evaluated therapeutic implications.

PATIENTS AND METHODS

We carried out a prospective study that included 55 patients (41 men and 14 women) with primary spontaneous pneumothorax. For all patients, the therapeutic recommendations of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) were followed. After resolution of the episode, a chest CT was performed and the presence, location, number, and size of bullae were evaluated. Subsequently, the number of recurrences in each group was evaluated.

RESULTS

The mean follow-up period was 30.7 months (95% confidence interval, 24-37 months). Twenty-six patients presented bullae, and 6 of these experienced recurrence. Of the 29 patients without bullae, 7 experienced recurrence. No association was found between the presence or absence of bullae and recurrence (P = .92). Bullae in the right lung led to more frequent recurrence of pneumothorax (P = .03). The number and size of the bullae had no significant influence on recurrence (P = .51).

CONCLUSIONS

The present study could not demonstrate that the presence, size, or number of bullae on CT scans has any influence on recurrence rate. We cannot recommend surgery after a first episode of primary spontaneous pneumothorax based on the presence of bullae on the CT scan.

Key words:
Pneumothorax
Recurrence
Bullae
Blebs
Computed tomography
OBJETIVO

La causa fundamental del neumotórax espontáneo primario es la rotura de bullas o blebs subpleurales. Estas bullas podrían también condicionar un mayor riesgo de recidiva. La mejor forma de detectarlas es mediante tomografía axial computarizada (TAC). Nos planteamos aquí si las bullas en la TAC suponen un riesgo mayor de recidivas tras un primer episodio de neumotórax espontáneo primario. Asimismo, se valoran las implicaciones terapéuticas.

PACIENTES Y MÉTODOS

Se trata de un estudio prospectivo en el que se incluyó a 55 pacientes (41 varones y 14 mujeres) con neumotórax espontáneo primario. En todos ellos se siguieron las recomendaciones terapéuticas de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR). Tras la resolución del episodio se efectuó una TAC de tórax y se valoraron la presencia, la localización, el número y el tamaño de bullas. Posteriormente, se evaluó el número de recidivas en cada grupo.

RESULTADOS

El tiempo medio de seguimiento fue de 30,7 meses (intervalo de confianza del 95%, 24-37 meses). Presentaron bullas 26 pacientes, de los que en 6 hubo recidiva. De los 29 pacientes sin bullas, 7 presentaron recidiva. No se encontraron diferencias entre la presencia o ausencia de bullas y la recidiva (p = 0,92). Las bullas derechas recidivaron con mayor frecuencia (p = 0,03). El número y el tamaño de las bullas no tuvieron influencia significativa (p = 0,51).

CONCLUSIONES

El estudio no ha podido demostrar que la presencia de bullas en la TAC, su tamaño o su número influyan en el índice de recidivas. No se puede recomendar la cirugía tras un primer episodio de neumotórax espontáneo primario por presentar bullas en la TAC.

Palabras clave:
Neumotórax
Recidiva
Bullas
Blebs
Tomografía computarizada
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