Preface

Having spent nearly 25 years in the specialty of Cardiothoracic Surgery in the UK, one would have thought that managing pneumothorax should come as a second nature. It doesn't. Humans collapse their lungs frequently, and the different ways we deal with this complication matches its frequency. There are bound to be differences in opinion, and the multicentre randomized controlled trials have not come up with a solid protocol to guide management. During my years of training as a cardiothoracic surgeon, I worked for several consultants, without any two of them agreeing on the management of this condition. Jean-Marc Gaspard Itard, a student of René Laennec's, first recognized the entity of the pneumothorax in 1803, but it was Laennec who described the full clinical picture of the condition in 1819 [1]. There was no general agreement on therapy when Ruckley and McCormac of the Royal Infirmary, Edinburgh described the management of pneumothorax in 1966 [2]. There is no agreement at our present time either. Robert Cerfolio summarized the conflict in few words; "although thoracic surgeons are the best trained physicians to manage chest tubes and pleural problems, they often do not speak the same language or recommend similar treatment algorithms even to each other" [3]. This sentiment inspired the collation of all information about "pneumothorax" under one roof. We aimed it at clinicians who encounter pneumothorax in their practice; pulmonologists, thoracic surgeons, pediatricians, obstetricians, and intensivists looking after sick ventilated patients in the Intensive Care Units amongst other clinicians. Based on published evidence, the book describes evidence and contemporary management of primary and secondary pneumothorax, when to adopt conservative management for first time primary pneumothorax and when to abandon it for surgical solutions. The evidence is discussed for and against key hole and open operations. Strategies for special circumstances are discussed, such as pneumothorax around menstrual cycles, during pregnancy, and before general anesthesia for other reasons, air travel, and scuba diving. A separate chapter highlights the current controversies about the different modalities of treatment. This is a book for every clinician struggling to find evidence on the best practice, and lost among the different contradicting rules and taboos of current practice. Further research remains the only way forward to narrow down our choices for what to do in the different scenarios of "pneumothorax".

**Mr. Khalid M A Amer** FRCS (C Th) [Fellow of the Four Royal Colleges of Surgery Cardio Thoracic] FRCS (en) [Fellow of the Royal College of Surgeons – England] MD Clinical Surgery – University of Khartoum, Sudan

Consultant Thoracic Surgeon The University Hospital Southampton NHS Foundation Trust The Wessex Cardiovascular and Thoracic Centre Southampton General Hospital, Southampton, United Kingdom

**V**

**References**

Chaudé; 1819;(4)

1966;**21**:139-144

[1] Laennec RTH. Traité du diagnostic des maladies des poumons et du coeur. Tome Second. Paris: Brosson and

[2] Ruckley CV, McCormack RJM. The management of spontaneous

pneumothorax. Thorax.

[3] Cerfolio RJ, Bryant AS. The management of chest tubes after pulmonary resection. Thoracic Surgery

Clinics. 2010;**20**(3):399-405
