We thank Drs Apostolakis and Baikoussis for their comments and suggestions [1]. After pulmonary lobectomies, we recommend using two tubes only in patients in whom a higher incidence of haemorrhage is expected, as we implied in the conclusion section of our article [2]. Patients having dense pleural adhesions (who needed extrapleural dissection or not) or having bleeding diathesis or have underg...

Small-bore flexible feeding tubes decrease the risk of ulceration of the nose, pharynx, and stomach compared with large-bore and more rigid tubes. However, small-bore feeding tubes have more respiratory system complications, such as pneumothorax, hydropneumothorax, bronchopleural fistula, and pneumonia, which are associated with significant morbidity and mortality. Thus, it is important to conf...

OBJECTIVE We sought to determine the current practice habits among clinicians treating spontaneous pneumothorax and bronchopleural fistula. METHODS Practice habits were determined by a randomized postal survey of 3,000 American College of Chest Physicians members. Group comparisons are performed by chi2 analysis with p<0.05 being significant. RESULTS Four hundred nine respondents (13.6%) in...

OBJECTIVES Owing to the great absorption capability of the pleura for transudates, the protein content of draining pleural fluid may be considered as a more adequate determinant than its daily draining amount in the decision-making for earlier chest tube removal. In an a priori pilot study, we observed that the initially draining protein-rich exudate converts to a transudate quickly in most pat...

Introduction: Transhiatal esophagectomy is a widely accepted approach for palliative resection of subcarinal esophageal cancers. This study was designed to evaluate the necessity of routine thoracostomy tube insertion in this technique.  Methods: This descriptive study was conducted on 123 consecutive patients with esophageal cancers undergoing transhiatal esophagectomy from March 2001 to Fe...

A 40 year old asthmatic presented with acute respiratory distress. Chest radiograph appeared to show loops of bowel within the thorax and a diagnosis of spontaneous/effort rupture of the diaphragm was made. Emergency laparotomy revealed an intact diaphragm and chest drain was inserted relieving a tension pneumothorax.