Pneumothorax in AIDS patients: operative management.
Acquired immunodeficiency syndrome (AIDS) is a devastating disease. Pneumocystis carinii pneumonia (PCP) is a major clinical manifestation of AIDS. A 2-year experience with eight operations for PCP-associated pneumothorax in seven AIDS patients was reviewed. Initial treatment was tube thoracostomy in all cases. Operation was performed because of inability to expand the lung and/or persistent air-leak. Time from insertion of the initial chest tube to operation was 9-66 days (mean, 33 days). Pulmonary air leaks were closed with surgical staples and/or sutures. Chest tubes were removed 3-16 days after surgery (mean, 8.5 days). There were no cases of postoperative respiratory insufficiency and there were no deaths. Patients were discharged from the hospital 6-18 days after surgery (mean, 13 days). The postoperative hospital stay was substantially shorter than the preoperative period of nonoperative therapy (13 vs. 33 days). Follow-up is complete in six of the seven patients. Three patients died of AIDS 4-8 months after surgery (mean, 6 months). Three patients are alive 7-14 months after operation (mean, 11 months). Operative management of PCP-associated pneumothorax is effective and can be performed with low morbidity and mortality. We conclude that surgery should be considered as an early option in AIDS patients with PCP-associated pneumothorax.
Horowitz
M D
MD
Division of Thoracic and Cardiovascular Surgery, University of Miami/Jackson Memorial Medical Center, Florida.
Oliva
H
H
D017088:AIDS-Related Opportunistic Infections / Q000150:complications*; D000328:Adult; D015505:Chest Tubes; D005260:Female; D006801:Humans; D008168:Lung / Q000601:surgery*; D008297:Male; D011020:Pneumonia, Pneumocystis / Q000150:complications*; D011030:Pneumothorax / Q000209:etiology* / Q000601:surgery*; D013528:Surgical Staplers; D013536:Suture Techniques; D013908:Thoracotomy; D013997:Time Factors