***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Spontaneous pneumothorax ( SP ) is a disabling condition mostly affecting young , thin and otherwise healthy males . It is usually caused by ruptured pleural blebs . The first treatment is the insertion of a chest tube ( ICT ) but in a great number of patients there is recurrence of the disease . We believe that the video assisted thoracoscopy ( VATS ) is the best treatment possible because it allows us to treat the ruptured bleb radically avoiding any recurrence . In order to prove it , 40 patients admitted in a five-year period , with a SP , were r and omly assigned to be treated by ICT or VATS . The ICT patients were in the hospital a mean time of 7.5 ( 4 to 15 ) days and the VATS patients , 5.3 ( 2 to 7 ) days ( P < .05 ) . ICT patients required analgesic drugs during 76.8 + /- 31 hours and VATS patients 38.4 + /- 13 hours ( p < .05 ) . From the ICT group , 8 ( 53 % ) patients had recurrence of the disease and 6 ( 40 % ) had a prolonged air leak , while none of the patients of the VATS group had any complication ( < .001 ) . Cost of ICT and VATS  were $ 850 and $ 1730 , respectively . According to these results , VATS should be the treatment of choice in SP patients . It treats the cause of the disease . It also reduces the hospitalization time , the use of analgesic drugs post surgery , decreases recurrence of the disease and the cost of the treatment . Moreover , the patients were back to work in less than 10 days Simple thoracoscopic talcage ( TT ) is a safe and effective treatment of primary spontaneous pneumothorax ( PSP ) . However , its efficacy has not previously been estimated in comparison with st and ard conservative therapy ( pleural drainage ( PD ) ) . In this prospect i ve r and omised comparison of two well-established procedures of treating PSP requiring at least a chest tube , cost-effectiveness , safety and pain control was evaluated in 108 patients with PSP ( 61 TT and 47 PD ) . Patients in both groups had comparable clinical characteristics .  Drainage and hospitalisation duration were similar in TT and PD patients . There were no complications in either group . The immediate success rate was different : after prolonged drainage ( > 7 days ) , 10 out of 47 PD patients , but only 1 out of 61 TT patients required a TT as a second procedure . Total costs of hospitalisation including any treatment procedure were not significantly different between TT and PD patients . Pain , measured daily by visual analogue scales , was statistically higher during the first 3 days in TT patients but not in those patients receiving opiates . One month after leaving hospital , there was no significant difference in residual pain or full working ability : 20 out of 58 ( 34 % ) versus 10 out of 47 ( 21 % ) and 36 out of 61 ( 59 % ) versus 26 out of 39 ( 67 % ) in TT versus PD groups , respectively . After 5 yrs of follow-up , there had been only three out of 59 ( 5 % ) recurrences of pneumothorax after TT , but 16 out of 47 ( 34 % ) after conservative treatment by PD . Cost calculation favoured TT pleurodesis especially with regard to recurrences . In conclusion , thoracoscopic talc pleurodesis under local anaesthesia is superior to conservative treatment by chest tube drainage in cases of primary spontaneous pneumothorax that fail simple aspiration , provided there is efficient control of pain by opioids OBJECTIVES Major thoracic surgery is associated with trauma-related immunological changes . These may impair anti-tumour immunity . We hypothesize that the reduced operative trauma associated with a video-assisted thoracic surgery ( VATS ) approach may decrease acute phase responses and , consequently , lead to better preservation of immune function . This prospect i ve r and omized study compared the effects of conventional open thoracic surgery and VATS on acute phase responses in patients undergoing pulmonary lobectomy . METHODS Acute phase indicators were analyzed in patients undergoing lobectomy for suspected bronchogenic carcinoma . Surgery was prospect ively r and omized to pulmonary lobectomy by VATS or limited postero-lateral thoracotomy . Blood was taken pre-operatively and at 4 , 24 , 48 , 72 , 120 and 168 h post-operatively for analysis of C-reactive protein ( CRP ; 41 patients : open , n=22 ; VATS , n=19 ) interleukin (IL)-6 , tumour necrosis factor ( TNF ) receptors ( TNF-sR55 , TNF-sR75 ) and P-selectin ( 24 patients : open , n=12 ; VATS , n=12 ) . Sample s taken at 48 and 168 h were also analyzed for phagocyte reactive oxygen species ( ROS ) production ( 25 patients : open , n=16 ; VATS , n=19 ) . RESULTS Surgery increased acute phase responses .  VATS was associated with lower CRP and IL-6 levels . In the open surgery group , significant increases in ROS in neutrophils ( up to 36 % greater than before surgery , n=12 , P<0.02 - 0.05 ) were detected at 2 days after surgery , but in the VATS group , the increase after surgery ( of up to 17 % , n=18 ) did not reach significance . Similarly , monocyte ROS increases of up to 25 % in the mean ROS in the open surgery group and of up to 17 % in the VATS group were detected on days 2 and 7 after surgery . CONCLUSIONS VATS pulmonary lobectomy is associated with reduced peri-operative changes in acute phase responses . This finding may have implication s for peri-operative tumour immuno-surveillance in lung cancer patients OBJECTIVES Video-assisted thoracoscopic surgery ( VATS ) is generally recognized as a less invasive method than thoracotomy . However , the influence of VATS on postoperative pulmonary gas exchange has yet to be evaluated . METHODS Thirty eight patients with spontaneous pneumothorax were r and omized into bullectomy by VATS  ( n = 20 ) or axillary thoracotomy  ( n = 18 ) . Gas exchange was assessed by using hot wire mass spectrometer , and blood gas analysis preoperatively and postoperatively at 1 , 3 , 6 , 12 , 24 , and 48 h and on days 4 and 6 . Post operative pain control was managed by continuous epidural morphine injection and administration of diclofenac sodium orally or suppository .  Postoperative atelectasis was assessed by daily chest roentgenograms . RESULTS VATS patients had continuously higher PaO2 than axillary thoracotomy at 12 , 48 h and day 4 postoperatively ( P < 0.05 ) . Alveolar-arterial oxygen tension gradient in VATS patients was significantly less than that in patients with axillary thoracotomy from the 6th h throughout to the 4th day postoperatively ( P < 0.01 ) . Use of postoperative analgesics and the incidence of peripheral atelectasis were more frequent in patients with axillary thoracotomy . CONCLUSIONS Bullectomy via VATS was less deleterious to pulmonary gas exchange . Axillary thoracotomy caused worsening of gas exchange postoperatively due to incisional pain , chest wall deformity , and peripheral atelectasis BACKGROUND Few investigators have reported on results after video-assisted thoracoscopic surgery ( VATS ) for spontaneous pneumothorax ( SP ) with follow-up periods longer than 24 months . The aim of this study was to evaluate VATS for first-time and recurrent SP and to follow patients long-term . METHODS One hundred nine patients were followed long-term after treatment of SP by VATS . Ninety-five patients had primary SP and 14 had secondary SP . Sixty-two patients had a first episode and 47 had a recurrence . In 72 patients leaks or ruptured blebs were identified and excised without subsequent pleurodesis . In 37 patients showing no ruptured bullae or leaks only pleurodesis was applied . RESULTS Median follow-up was 53.2 months . Postoperative complications were rare . Three patients ( 2.7 % ) had a prolonged air leak . The long-term recurrence rate was 4.6 % . Only those patients who had not received pleurodesis at the time of first treatment by VATS experienced recurrence . CONCLUSIONS Immediate postoperative results show VATS to be a safe and reliable method in first-time and recurrent SP to obtain quick reexpansion of the lung . Long-term recurrence rates are acceptable and compare with results after open thoracotomy . Pleurodesis should be included in each procedure for adequate recurrence prevention The solitary pulmonary nodule often presents a diagnostic challenge to the specialist because the nature of the nodule is often indeterminate at the end of the usual diagnostic process , and operation frequently is required before a definite diagnosis can be made . We have conducted a r and omized , prospect i ve trial to evaluate the diagnostic efficacy of video-assisted thoracic surgery versus muscle-sparing lateral thoracotomy .  Between January 1991 and May 1994 , 44 patients suffering from solitary pulmonary nodule were divided at r and om into two groups : the nodule was removed in 22 cases by video-assisted thoracic surgery and in 22 cases by lateral thoracotomy . Nineteen wedge resections , 1 segmentectomy , and 2 lobectomies were performed in the first group and 13 wedge resections , 8 segmentectomies , and 1 lobectomy in the second group . An " access " thoracotomy had to be performed in 5 patients in the video-assisted thoracic surgery group . The operating room time was 97.2 + /- 32.9 minutes in the video-assisted thoracic surgery group and 130.5 + /- 14 minutes in the lateral thoracotomy group ( p > 0.05 ) . In both groups a final diagnosis was made in 100 % of cases . The postoperative hospital stay was 4.6 + /- 1.08 days in the video-assisted thoracic surgery group and 7.8 + /- 0.89 days in the lateral thoracotomy group ( p < 0.01 ) . Pain was evaluated on a visual analogue scale ; the scores were 26.5 + /- 11.6 in the video-assisted thoracic surgery group and 48.3 + /- 12.8 in the lateral thoracotomy group ( p < 0.05 ) . ( ABSTRACT TRUNCATED AT 250 WORDS OBJECTIVE To eluci date whether thoracoscopy for surgical therapy of pneumothorax leads to a reduction of inflammatory responses in comparison with st and ard thoracotomy . DESIGN A prospect i ve r and omized study PATIENTS Eleven patients ( 9 men and 2 women ; median age , 28 years ; range , 21 - 44 years ) were treated by thoracotomy ; 10 patients ( 9 men and 1 woman ; median age , 26 years ; range , 21 - 28 years ) were managed thoracoscopically .  The plasma concentrations of the following were determined : polymorphonuclear granulocyte elastase and C-reactive protein as inflammatory parameters and prostanoids ( prostacyclin , thromboxane A2 , prostagl and in F2 alpha , prostagl and in M , and prostagl and in E2 ) as vasoactive parameters . Blood sampling was performed perioperatively and on day 3 after surgery . RESULTS The thoracoscopy group revealed a shorter hospital stay ( 5 vs 7 days ; P < .05 ) and a significantly reduced need for intravenous pain medication within 48 hours ( 1 vs 3 requirements ; P < .01 ) vs the thoracotomy group . The release of inflammatory ( C-reactive protein , P < .01 ) and vasoactive ( prostacyclin and thromboxane A2 , P < .01 ) mediators was less during thoracoscopy compared with st and ard thoracotomy . CONCLUSIONS The thoracoscopic procedure is less invasive when performing wedge resection of apical blebs . With intracavitary management being equivalent to the conventional technique , the curtailed morbidity after thoracoscopic surgery is considered to be related to the minimal trauma associated with the access to lung tissue and the reduced h and ling of lung tissue BACKGROUND Lung biopsies are frequently needed to diagnose diffuse interstitial lung diseases . A prospect i ve r and omized , controlled trial comparing limited thoracotomy ( open lung biopsy ) and thoracoscopy for lung biopsy was done . METHODS Ambulatory patients with a clinical diagnosis of diffuse interstitial lung disease were r and omized to thoracoscopy or limited thoracotomy .  Data on postoperative pain , narcotic requirements , operating room time , adequacy of biopsy , duration of chest tube drainage , length of hospital stay , spirometry , and complications were collected . RESULTS A total of 42 r and omized patients underwent lung biopsy ( thoracoscopy 20 , thoracotomy 22 ) . The two study groups were comparable with respect to age , gender , corticosteroid use , and preoperative spirometry . Visual analog scale pain scores were nearly identical in the two groups ( p = 0.3 
    Output:
    
No substantial advantages were observed for video assisted thoracic surgery in lobectomies .
Video assisted thoracic surgery is associated with better outcomes and seems to have a complication profile comparable with that of thoracotomy for the treatment of pneumothorax and minor resections .