Subscribe
56
Zhang Zhi Gong
Cardiothoracic Surgery
About me
Zhang Zhigong, male, associate chief physician, with a postgraduate degree. He is the vice chairman of the Youth Academic Committee of Hunan Provincial People's Hospital and the secretary of the Thoracic Surgery Department. He has been engaged in thoracic surgery for over ten years and has visited Shanghai Pulmonary Hospital, Chest Hospital, and Henan Zhengzhou First Hospital for learning. In 2015, he was selected by the hospital to study abroad at the teaching hospital of University of Göttingen, Germany.
Proficient in diseases
Proficient in minimally invasive single-port thoracoscopy, lung bullae, pneumothorax, advanced lung cancer, thermal ablation, radioactive seed implantation, minimally invasive NUSS funnel chest surgery, and other minimally invasive surgeries. Also, was the first in the world to apply 3D printing to the treatment of rib fractures in cardiothoracic surgery. Has extensive clinical experience in congenital and acquired heart diseases.
Voices
How many days after pneumothorax can one smoke?
For patients with pneumothorax, it is advised to strictly quit smoking, as smoking greatly increases the recurrence of pneumothorax. Smoking leads to airway inflammation and respiratory bronchitis. Among male patients with pneumothorax, compared to non-smokers, smokers have a significantly higher incidence of pneumothorax, which is related to the degree of smoking. If the patient smokes less than half a pack, the recurrence rate of his pneumothorax is about 7 times higher. For moderate smokers, those who smoke between half a pack and one pack, the recurrence rate increases to 21 times. If one smokes a pack a day, the recurrence rate rises to 102 times, this is in males. In females, for those smoking less than half a pack, between half a pack and one pack, and more than one pack, the recurrence rates of pneumothorax become 4 times, 14 times, and 68 times respectively. Therefore, for both male and female patients with pneumothorax, smoking significantly increases the probability of recurrence. So, once pneumothorax is resolved, quit smoking as well, to prevent any future recurrences.
Causes of pneumothorax
The causes of pneumothorax vary with age. In young people, the condition often occurs in tall, thin individuals, somewhat akin to a balloon. We can liken the lung to a balloon: for shorter, heavier individuals, the balloon is rounder and experiences more uniform stress, whereas for tall, thin individuals, it's as if the balloon is being stretched vertically. Therefore, the tips of the balloon (or the lung) in tall, thin individuals are more prone to rupture. Additionally, for tall, thin individuals, the blood supply to the apical alveoli may not be as robust, making them more susceptible to micro-ruptures. Microscopic anatomical structures have also proven that there are tiny pores in the apical bubble tissues in these individuals. In older adults, the causes of pneumothorax are usually underlying lung diseases, such as chronic smoking, chronic obstructive pulmonary disease (COPD), chronic bronchitis, and other conditions like tuberculosis or HIV infections can also lead to pneumothorax. Some cases are due to traumatic causes like physical injuries or stab wounds, which can lead to secondary or iatrogenic pneumothorax. In summary, while the causes of pneumothorax vary by age, in young people, it more commonly stems from being tall and thin. In older individuals, smoking, tobacco use, chronic bronchitis, and infections are more common causes.
Pectus excavatum should go to which department?
Regarding the registration of patients or children with pectus excavatum, if it is for children and the consultation is only about the hereditary aspect of pectus excavatum or its etiology, consider registering at the pediatrics or child health department. It is also feasible to consult the genetics department. If the consultation is about treatment options for pectus excavatum, including methods of treatment, consider registering at the thoracic surgery department. Thoracic surgery can provide advice and methods for the treatment of pectus excavatum, including both surgical and non-surgical options. Of course, not all hospitals have a thoracic surgery department; generally, municipal third-level, first-class hospitals are equipped with thoracic surgery departments. If there is no thoracic surgery available, consider registering under the general surgery department.
Foods to avoid with pneumothorax
We know that the lung tissue of a normal person is like a balloon. When breathing, this balloon expands and contracts, and there are about hundreds of millions of small structures in the lungs like balloons, which we call alveolar tissue. This structure also continuously expands and contracts, expelling carbon dioxide and inhaling oxygen. For certain reasons, such as infection or due to the body shape of tall, thin young people, or chronic obstructive pulmonary disease (COPD) and bronchitis in elderly people, this alveolar structure can rupture, causing some alveoli to merge into a large bulla. Of course, if the large bulla eventually ruptures, the break in this balloon-like surface will leak air into the pleural cavity, causing a pneumothorax. As for the nutrition from food, we believe that patients should not refrain from certain foods, but should instead increase their intake of protein, such as eating three to four egg whites daily. If worried about high cholesterol, discard the yolk, consuming only one yolk per day, but ensuring adequate protein intake. Therefore, for patients with pneumothorax, it is not about avoiding certain foods, but about eating more of those foods to which they are not allergic, such as shrimp and beef, rather than restricting their diet.
Is pectus excavatum hereditary?
In current medical technology, although no genes exclusively associated with pectus excavatum have been identified, there is evidence suggesting genetic predisposition when pectus excavatum coincides with other conditions. For instance, the incidence of pectus excavatum is significantly higher in patients with congenital connective tissue disorders, such as Marfan Syndrome, and is linked to certain genes within this syndrome. Additionally, patients with congenital diaphragmatic hernia also show an increased incidence of pectus excavatum. Moreover, the condition is more prevalent in patients, or children, who have subglottic airway stenosis or congenital bronchopulmonary dysplasia. Thus, these evidences confirm that pectus excavatum, as a disease in itself, is directly or indirectly related to congenital genetic factors, indicating a certain hereditary nature.
Why can't people with funnel chest gain weight?
In clinical observations, we have found that children with pectus excavatum generally do not have as good nutrition as normal children, and are not as plump. This may be related to the deformity of the chest indentation. We know that the normal cross-section of the thorax on a CT scan is oval-shaped, with the heart and lungs located behind the sternum. In children with pectus excavatum, the sternum is compressed backward toward the spine, which deforms and even pushes the heart completely to one side. This compression of the heart limits the blood's ability to fully return to the heart, and may even prevent the valves from closing completely, leading to valve insufficiency. As a result, both cardiac and pulmonary functions are somewhat impaired. Therefore, 80% of children with pectus excavatum experience exercise intolerance, meaning they cannot run as well as normal children, which also indicates poorer physical fitness and, comparatively, a lesser appetite. Recent studies have found that children with pectus excavatum also have slightly weaker immune functions, and their digestive and absorption capabilities are not as good as those of typical children. Poor exercise capacity and digestive function ultimately lead to poorer nutrition in children with pectus excavatum, making them less plump than normal children.
How many days does it take for a pneumothorax to heal?
The healing time for a patient with pneumothorax, or how many days it takes to heal, mainly depends on when the rupture on the lung heals. In younger patients who have good elasticity and strong healing capabilities, and whose nutrition keeps up, pneumothorax tends to heal relatively easily. Especially in younger patients experiencing pneumothorax for the first time, 70-80% may heal within two to three days because the gas escapes very quickly. Once the surface rupture on the lung heals, it can be cleared within a day, leading to healing. However, if the patient is older and also has conditions like tuberculosis or chronic bronchitis, the elasticity of the lungs is poorer, making healing difficult. Like a balloon without elasticity, if it gets a rupture, it may continue to expand, complicating the prediction of healing time. Regardless of age, whether the patient is young or old, if pneumothorax recurs a second time, it is advisable to seek aggressive treatment. Patients who have experienced pneumothorax twice are at more than a 70% to 80% risk of a third occurrence. This indicates a weak spot on the lung surface, similar to a wound on the hand. If a hand wound does not heal in a few days, it can be sutured. The same applies to lung surface wounds; as it is located inside the chest cavity, a thoracoscope is needed for suturing. Thus, in normal circumstances, pneumothorax could heal in a few days, but if repeatedly delayed, aggressive treatment might be necessary.
Can funnel chest heal itself?
Actually, a portion of children with pectus excavatum can heal on their own, especially those who are newly born and discovered to have pectus excavatum. This is because children are curled up while in the mother's womb. In some cases, their hands and feet might be placed in front of the sternum, pressing it backward and inward, causing a deformity. However, once the mother gives birth and the child's limbs unfold, the pressure on the sternum is relieved. As the chest grows, it gradually returns to its normal shape, and these children with pectus excavatum can be cured. On the other hand, another group of patients do not have pectus excavatum at birth, but develop a noticeable chest indentation as they grow older. These patients, when they are young, can also be treated with conservative methods, such as using a vacuum bell for pectus excavatum to gradually draw the indentation outward. With its stabilizing effect, as the child grows, the deformity can be slowly corrected. Of course, there are also children who might have a more rapid skeletal development, and essentially become "set" in their ways. At this stage, they may require surgical intervention to treat the condition. In summary, a portion of pectus excavatum patients can be healed, while another portion requires active intervention and treatment.
Does pectus excavatum hurt?
The sternum of pectus excavatum caves inward and backward, directly compressing the patient's heart or lungs, causing a certain degree of chest pain. This chest pain is not caused by pectus excavatum itself, but by the compression of the heart or lungs due to pectus excavatum. Imagine a normal ribcage as an oval shape; its cross-section is also oval and is a ratio of the patient's left-right diameter, transverse diameter, and anterior-posterior diameter. In normal individuals, this ratio is less than 2.5. In pectus excavatum, since the anterior-posterior diameter is significantly reduced and the sternum is markedly pressed towards the spine, the patient's heart is entirely compressed and deformed. Therefore, the patient's coronary arteries or valves may be squeezed and deformed, resulting in about 60% of pectus excavatum patients experiencing chest pain.
Pneumothorax CT manifestations
Pneumothorax CT manifestations, we know that there is a potential gap between the lungs and the chest wall in normal individuals, but normally, this gap or cavity is under negative pressure. This negative pressure ensures that the lungs are pressed tightly against the chest wall and the pleura, also containing a certain amount of lubricating fluid which allows for movement during inhalation without excessive friction causing pain. However, if due to some reason, such as a burst large or small pulmonary bullae, air enters this potential cavity or the pleural space, it is referred to as pneumothorax. Moreover, on a CT scan, it is distinctly visible that part of the chest cavity shows an area devoid of air-containing lung structures, indicating the absence of normal lung in this region. Normally on CT, a healthy lung appears like a sponge, so this phenomenon reveals sponge-like tissue, referred to as lung texture. But when air enters, the pressure from the air can compress the lung, causing it to collapse, similar to a deflating balloon. In addition, part of the CT imaging presents as dark areas around the periphery where lung textures are absent or cavities appear, referred to as pneumothorax.