Intrapleural tetracycline for the prevention of recurrent spontaneous pneumothorax: results of a Department of Veterans Affairs cooperative study

Article Abstract:

Spontaneous pneumothorax, in which air enters the pleural cavity, causing collapse of a lung without apparent cause, occurs in about 17,000 people annually in the United States, sometimes in those with no history of lung disease, although it is often associated with chronic obstructive pulmonary disease. Thoracotomy, surgical opening of the chest cavity, tends to prevent recurrences, but this is a major operation. The authors investigated whether injecting tetracycline into the chest cavity would prevent recurrence of the condition. Tetracycline therapy seemed to decrease the recurrence rate for all types of pneumothorax, although it was not necessarily effective in closing bronchial fistulas (openings). The primary side effect of the injection was intense chest pain, which was not considered in the protocol. After the first 16 patients, the protocol was modified, and lidocaine hydrochloride was given for the pain. It did not reduce the pain significantly, but the authors conjecture that a larger dose might have helped. The informed consent form was modified to say, "The pain could be the severest you have ever experienced." Tetracycline therapy seemed to be more effective when pain was moderate to severe, indicating that the addition of lidocaine hydrochloride may have diluted the tetracycline. It was most effective in the group of patients with recurrent pneumothorax. There is a possibility of long term complications resulting from this therapy, but these would probably occur rarely if at all. There were nine pneumothoraces on the opposite side of the chest from the original pneumothorax, as opposed to two in the control group, for no known reason. Other studies have found that recurrences occurred at a constant rate, but in this study only 14 percent occurred more than six months later. Although there were 70 recurrences, only one patient died from recurrent pneumothorax. The authors conclude that tetracycline therapy significantly lowers the rate of recurrence of pneumothorax on the same side. There are no adverse effects on lung function tests or chest X-rays. However, the treatment does cause intense pain, and it does not help the closing of the hole which caused the condition. The authors recommend tetracycline therapy for patients who have been given a tube thoracostomy, and liberal doses analgesics or amnesics (drugs to alleviate the pain or to make the patient forget that it occurred), or both, should be given. (Consumer Summary produced by Reliance Medical Information, Inc.)

Reports, Pneumothorax

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The Department of Veterans Affairs smoke-free policy

Article Abstract:

As of January 7, 1991, the Department of Veterans Affairs required all 172 acute-care VA hospitals to be smoke-free. At this point, long-term, chronic-care facilities, psychiatry services or chemical-dependency services are not affected. The policy, which will affect 4,500,000 VA patients, also applies to visitors and employees. Both the American Medical Association and the American College of Physicians have endorsed smoke-free hospitals, and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requires accredited hospitals to be smoke-free. Labor unions objected to certain aspects of the ban, but most of their concerns were met by guarantees to build outdoor shelters for smokers. Smoking breaks and reimbursement for attendance at smoking-cessation programs are being negotiated. Some VA hospitals have had smoke-free environments for several years and have proved the effectiveness of the policy.

Laws, regulations and rules, Nonsmoking areas, Hospitals, Veterans', Veterans hospitals

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Human ehrlichiosis - Maryland, 1994

Article Abstract:

Human monocytic ehrlichiois (HME) should be considered in patients with generalized illness and fever who have likely been exposed to ticks. HME is transmitted by a tick found in the eastern and south-central states. Five case histories of Maryland patients illustrate that typical symptoms include fever, muscle ache, weakness, nausea, vomiting, and neurologic symptoms. Laboratory results may include elevated hepatic enzymes, cells in cerebral spinal fluid, and abnormal blood cell counts. Testing for antibodies to the organism is generally negative early on. Treatment with a tetracycline antibiotic or chloramphenicol usually takes effect within a day or two.

Ehrlichiosis

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