الفهرس 
1. IntroductionOnly 14 pages are availabe for public view
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Abstract
Pneumothorax is defined as the presence of air in the pleural space. Pneumothoraces can be divided into spontaneous (SP) or traumatic, and SP are further classified clinically as primary (PSP) or secondary (SSP). PSP occurs in otherwise healthy individuals, whereas SSP occurs as a complication of underlying lung disease.
Spontaneous pmeumothorax is thought to result from the rupture of pulmonary bullae or subpleural blebs. SP is a relatively common respiratory disease. One unfortunate characteristic of SP is its tendency to recur and without treatment, recurrence rates range from 30% to 60%.
Complications of spontaneous pneumothorax may be persistent air leak, pneumomediastinum, hemopneumothorax, tension pneumothorax and recurrence.
Recurrence is the most frequent complication of PSP. Recurrence is defined as a pneumothorax that appears in the ipsilateral side >7 days after a pneumothorax has resolved. Most recurrences occur within 2 years after the first episode (5,12).
After a first recurrence, the incidence of subsequent recurrence increases progressively, up to 62% for a second recurrence and 83% for a third.
Debate continues regarding the best management of primary spontaneous pneumothorax. Therefore, the goals of treatment of SP are to remove air from the pleural space and to decrease the likelihood of a recurrent attack.
Procedures to prevent recurrence of SP usually preserved for the second attack. However some procedures to prevent recurrence after the first attack specially thoracoscopy or pleurodesis could be offered for some patients.
One way to prevent the recurrence of a SP is to create a pleurodesis where the visceral and parietal pleura are fused such that a pneumothorax cannot develop. This is most commonly done by the intrapleural instillation of a sclerosing agent through a chest tube, in an attempt to create an intense inflammatory reaction that will cause pleural symphesis . The most popular are doxycycline, tetracycline and talc. The recurrence rates in patients who received pleurodesis was significantly lower than in the patients who had chest tube drainage alone.
Since the removal of tetracycline from the market, doxycycline has been used to treat nonmalignant recurrent pleural effusions and pneumothoraces .
The study was carried on twenty patients who had primary spontaneous pneumothorax. The patients’ age ranged from 18 to 62 years old. The study group included 19 males and one female.
There were 18 smoker patients and only one non-smoker; the female patient, while another male patient was ex-smoker. Out of the 20 patients there was 6 addict patients all were smokers, 5 of them were drivers and one manual worker.
The presenting symptoms varied between dyspnea, pain and cough. Dyspnea was the leading symptom noticed in 18 cases, chest pain and dry cough were equal as 5 cases each.
All the patients had free past medical history regarding similar attacks or chronic diseases e.g. hypertension, diabetes mellitus and COPD.
Radiological examination on admission revealed that right sided pneumothorax was common in 14 cases while only 6 patients had left sided pneumothorax.
Patients were subjected to three successive morning sputum sample test to exclude tuberculosis and all patients were negative.
After air leak cessation and lung inflation was obtained by chest X-ray, the patients were examined by CT chest. All patients had normal study showing no
underlying lung pathology confirming primary spontaneous pneumothorax diagnosis.
Complications related to pleurodesis were mainly pain, fever and anaphylactic reaction. Pain was the main complication as all patient had pain but with varying grade. Pain was tolerated in 11 cases but severe in 9 cases.
There was anaphylactic reaction in only one case in form low grade fever and chills resolved with intravenous antihistaminic.
Lastly it was noticed that six month follow up showed recurrence in only one case (5%) while follow up of the rest of the group was uneventful.
The patient who had recurrent spontaneous pneumothorax was noticed after three months of the first attack. The patient had open pleurectomy through posterolateral muscle sparing thoracotomy where few pleural adhesions were noticed.
So we conclude that doxycycline pleurodesis is safe and effective way for prevention of recurrence of primary spontaneous pneumothorax after first attack on short term follow up of six months.