Polymyositis and dermatomyositis.

Several techniques have been developed to accomplish these objectives. Open thoracotomy allows for the resection or stapling of apical blebs followed by a mechanical pleu-ral abrasion or parietal pleurectomy to create a pleural symphysis and prevent pneumothorax recurrence. Pneumothorax recurrence rates are less than 1%. However, with the significant postoperative morbidity associated with an open thoracotomy, less invasive techniques have been developed. The application of video-assisted thoracic surgery (VATS) allows for an endoscopic approach in the management of pneumothorax. This technique allows for the endoscopic stapling of apical blebs and partial pleurectomy. Pleurodesis can be accomplished by either pleural abrasion or insufflation of talc. VATS is an acceptable technique in preventing pneumothorax recurrence for patients with PSP and SSP. Currently, VATS is the surgical procedure of choice in the management of SSP. Although there is no current data to indicate that bullectomy must be performed when talc is administered by poudrage, less successful procedures may be performed in patients at prohibitive risk for general anesthesia. The timing for VATS in the management of pneumothorax remains a matter of debate. Most authors agree that pneumothorax prevention is cost justified in SSP after the first pneumo-thorax occurrence. However, patient preferences and underlying lung diseases will influence this recommendation. In the management of PSP, most experts recommend VATS only after ipsilateral recurrence. Pleurodesis should not be withheld in patients who might need lung transplantation. Although surgery is technically more difficult after pleurodesis, the consequences of pneumothorax in this fragile subset of patients can be catastrophic. The time that is required from the pleurodesis procedure until an effective pleural symphysis has occurred remains unknown but is estimated at approximately 2 weeks. Therefore, the time from pneumothorax occurrence to safe resumption of air travel remains controversial and depends on whether pleurodesis was performed and type of lung disease. In general, individuals with previous pneumothoraces should be discouraged from diving. Cost-effectiveness of video-assisted thoraco-scopic surgery versus conservative treatment for first time of recurrent spontaneous pneumothorax. Abstract Polymyositis (PM) and dermatomyositis (DM) are idiopathic inflammatory myopathies of autoimmune origin involving the skeletal muscles. Pulmonary involvement occurs and is a source of morbidity and mortality. The main forms of pulmonary involvement include interstitial lung disease, respiratory muscle weakness, and aspiration pneumonia. Non-specific interstitial pneumonia, organizing pneumonia, usual interstitial pneumonia , diffuse alveolar damage, and lymphocytic interstitial pneumonia are the main histologic patterns found. Anti-Jo-1 antibody (anti-histidyl-tRNA synthetase) is …