J Thorac Cardiovasc Surg 2005;129:1199-1200
© 2005 The American Association for Thoracic Surgery
Reply to the Editor
Walter Weder, MD
Division of Thoracic Surgery, University Hospital of Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland
My colleagues and I thank Dr Alifano for his interest in our work and would like to respond to the comments brought forward concerning our recently published review on catamenial pneumothorax (CPT).1 First, they debate the classic description of CPT. As a time-honored working definition, this phenomenon has been described on the basis of its temporal relationship with the menstrual cycle. In the majority of published cases, CPT has been reported to reach clinical significance (culminating in the diagnosis of spontaneous pneumothorax) within 72 hours of the beginning of the menstrual flow. Yet as Dr Alifano has pointed out, there are some reports on CPT being diagnosed beyond this strict timeframe.2 Because we believed the same, we have refrained from quoting this arbitrary 72-hour definition but rather stated that each episode of CPT is associated with the menstrual flow. Being aware of the pathophysiologic background, it is obvious that the individual relevance of a developing pneumothorax might be subject to a wider chronologic margin.
Second, Dr Alifano criticizes our therapeutic approach in CPT. He suggests "excision of all visible lesions (when technically feasible)." Similarly, we stated the following: "All accessible lesions should be excised, and plication is recommended to seal and strengthen this area." In contrast to our approach, Dr Alifano adds a 6-month course of hormonal therapy to his surgical therapy in all cases. Describing this therapeutic regimen in a recent publication, Alifano and associates3 cite only one (early) recurrence out of 8 treated patients; however, in this study the mean follow-up time is 6.6 months, with a range from 2 to 15 months. In contrast, on the basis of our experience and the world literature, abrogating the ovarian steroid genesis in mature women with CPT constitutes a significant alteration of the hormonal equilibrium in these patients. Without data on the long-term follow-up with these courses, we believe that abrogating the ovarian steroid genesis in a young woman is not a justifiable first-line approach for this clinical picture because excision and plication of the diaphragm might prevent recurrence of pneumothorax, as reported in several cases.
References
- Korom S, Canyurt H, Missbach A, Schneiter D, Kurrer MO, Haller U, et al. Catamenial pneumothorax revisited. clinical approach and systematic review of the literature. J Thorac Cardiovasc Surg. 2004;128:502-508.[Abstract/Free Full Text]
- Alifano M, Cancellieri A, Fornelli A, Trisolini R, Boaron M. Endometriosis-related pneumothorax. clinicopathological observations from a newly diagnosed case. J Thorac Cardiovasc Surg. 2004;127:1219-1221.[Free Full Text]
- Alifano M, Roth Th, Camilleri-Broet S, Schussler O, Magdeleinat P, Regnard J-F. Catamenial pneumothorax. A prospective study. Chest. 2003;124:1004-1008.[Abstract/Free Full Text]
