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Annual Congress of Malaysian Thoracic Society PP 27 Surgery for Primary Spontaneous Pneumothorax: Results from Hospital Serdang Sachithanandan A, Ali A M, Ismail F, Badmanaban B, Jasid M, Nor A M Department of Cardiothoracic Surgery, Hospital Serdang, Ministry of Health, Malaysia Introduction Surgical indications for primary spontaneous pneumothorax (PSP) include prolonged air leak, failure of the lung to re-expand and recurrent SP. We describe our initial experience and technique at a regional cardiothoracic unit. Methods We conducted a retrospective review of consecutive PSP cases operated at our institution. From November 2009- April 2010 (18 months), 46 operative procedures were performed in 44 SP patients. Mean patient age was 27 years and a majority were male (n=38) (86%). Twenty-three (52%) patients were active smokers and 9 had no drain prior to surgery. In the remaining 35 (79.5%) patients mean duration of the pre-operative drain (ie. persistent air leak) was 12.1 days. Indications for surgery included a 1st episode SP with a persistent air leak in 29 (66%) patients. Two patients presented with simultaneous bilateral SP. Operative procedures involved a minimally invasive video assisted thoracoscopic (VATS) approach in 39 (88.7%) (including 2 simultaneous bilateral VATS procedures) and 5 open thoracotomies. Results There was no operative or in-hospital mortality in this series. Mean duration of post-operative drain was 6.7 days and mean hospital stay was 8.15 days. There was no intra-operative conversion of any VATS procedures and no patient developed any infective complications (eg. port site infection or empyema). Three (6.5%) patients were re-explored for haemothorax (n=2) and recurrent pneumothorax (n=1). Four patients had a residual air space which resolved with prolonged suction. Conclusion Our initial experience suggests most PSP patients can be treated successfully with a minimally invasive VATS approach with low morbidity. An increased awareness is required to promote smoking cessation and ensure early referral to the chest physician/ thoracic surgeon for specialist treatment. We advocate a standard 3 port VATS approach with an apical pleurectomy, bullectomy and basal pleural abrasion in such patients. 89
Annual Congress of Malaysian Thoracic Society PP 28 Clinical Presentation of Obstructive Sleep Apnea Syndrome Referred to Sleep Clinic in Institut Perubatan Respiratori Dora A A 1 , Shaharudin A 2 , Ashari Y 1 ,Aziah A M 1 , Rosmahani A 1 , Aishah Z 1 , Fauziah L 1 , Norzira A R 1 , Zuriyana M 1 , Razak M 1 1 Institut Perubatan Respiratori, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia 2 Pusat Pengajian Sains Perubatan, Universiti Sains Malaysia, Kampus Kesihatan, Kelantan, Malaysia This report is part of the Sleep Registry in Institut Perubatan Respiratori (IPR). The objective was to review the clinical features of suspected obstructive sleep apnoea syndrome (OSAS) patients at presentation when referred to IPR. Questionnaires and retrospective case-notes of 110 patients referred to IPR from 2008- 2009 with suspected OSAS were reviewed. 84% of patients referred to IPR were diagnosed with significant OSAS. Mean age at presentation was 47 years and both genders had equal percentages. 60% of the patients were Malays and worked in the government sector. Most patients presented with snoring (92%), hypersomnolence (84%) and nocturnal choking (53%). The symptoms were noticed by partners since 40% of the total study population were married. 87% of patients had symptoms noticed years prior to initial presentation to doctors. The majority of patients were referred from Ear, Nose and Throat (ENT) Department and government hospitals. The presence of co-morbidities did not influence the diagnosis of OSAS. The majority of patients had a Mallampati score of 3 or 4 at 56% and were obese (Body Mass Index [BMI] >30). We noted that 66% of the study population were diagnosed as significant OSAS (moderate and severe category). Multivariate analysis showed that age, presence of hypersomnolence and BMI were predictors of OSAS diagnosis. However, snoring was not a predictor of OSAS. Age, hypersomnolence, witnessed apnoea and Mallampati score were predictors for OSAS severity. Surprisingly BMI was not a predictor for OSAS severity. Conclusion Majority of patients referred were young. Late presentation to health services resulted in significant OSAS at the time of diagnosis. BMI was not a predictor of OSAS severity. Snoring was not a significant predictor for OSAS diagnosis. 90
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