الفهرس 
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Abstract
Primary spontaneous pneumothorax (PSP) affects young, healthy people without a known eliciting event. Patients with PSP possess a unique thoracic configuration, which is characterized by anteroposteriorly flatter, laterally narrower, and craniocaudally taller dimensions of the thorax in age and gender matched subjects. This leads to the fact that in lungs with relatively great height, the gravitational alveolar stretch and pleural negative pressure can increase simultaneously. Flat chests with narrow anteroposterior diameters have a sharper apical configuration, which leads to the increase in apical stress. This leads to rupture of small bullae or subpleural blebs on the pleural surface, which allows egress of air from the lung into the pleural space.
The aim of the present study was to evaluate the efficiency, safety and advantages, disadvantages of one-way Heimlich flutter valve (HV) drainage system in comparison to the traditional under water seal device (UWSD).
This a prospective randomized controlled study included 40 consecutive patients with a first episode and unilateral of PSP, with at least 2-cm rim of air and no or minimal associated pleural collection were included.
group A included 20 patients with ICT connected to HV while group B included 20 patients with ICT connected to UWSD.
A total of 40 eligible patients with a mean age 31.63±8.69 years, 92.5% were males and 75% had right sided pneumothorax. Male smokers were 70% of patients. No female smokers were recorded. Cannabis smokers were 47.5%.
The HV was significantly superior to the UWSD in early patient recovery by significant reduction in ambulation time 3.15±1.93 versus 14.7±7.41 hours (P<0.001), less hospital stay of 1.3±1.342 versus 9.5±4.62 days (P<0.001) and earlier ICT removal 4.25±2.97 versus 11.5±6.78 days (P<0.001).
After the first 24 hours a follow up chest radiography was done. HV was significantly superior to the UWSD in earlier drainage of pneumothorax with strong statistical significance (P=0.002) by complete drainage of 85% of pneumothoraces, while in the UWSD group only one patient (5%).
We showed that a HV was safe and had high success rates as compared to the UWSD. It also preserved patients’ comfort and mobility, allowing early discharge and decreasing in hospital costs and stay.