Pneumothorax and AP - the real risk is very low if AP is used properly

[Guest guest]

Hi Holmes & All,

 

Holmes wrote:

> Two acupuncturists were sued for malpractice under allegations that

> somehow they were responsible for causing a Pneumothorax in their

> clients. More reports are surfacing around the world alleging needle

> fragments found on a tomogram months after the acupuncture treatment,

> and an odd case of a ruptured mediastinum because of a congenital hole

> in the underdeveloped sternum. To what extent are acupuncturists

> knowledgeable about these reports? Are other professionals who practice

> acupuncture more cited than orthodox acupuncturists? How well informed

> are practitioners about the man with a tendency to spontaneous

> Pneumothorax? Am I paranoid, or are these legitimate concerns? Please

> participate. Dr. Holmes

 

I urge you all to read the article: " Preventing Pneumothorax " by Holmes

Keikobad, MBBS, DPH (Ret.), Dipl.Ac., LAc

http://www.acupuncturetoday.com/archives2004/jun/06keikobad.html

 

Well done, Holmes! It is a great article.

 

IMO, serious adverse effects of AP are very rare if the AP is given by

properly trained therapists who use single-use needles and best practice

techniques.

 

Most of the adverse effects (including pneumothorax) arise when AP is

given by badly trained therapists who use unsafe techniques and

disregard simple anatomical considerations.

 

Standard WM investigations, such as needle biopsy, subclavian venous

access ports, placement of pacemaker leads, pulmonary artery

catheterization, etc., cause far more pneumothorax than AP with 30-38-

gauge needles. And, as Holmes quotes in his article, 8000-9000 people

develop spontaneous pneumothorax in USA each year.

 

For example Medline has:

 

73 hits for the profile:

pneumothorax AND (acupuncture OR acup*);

http://tinyurl.com/4zzwj

 

but has 1067 hits for the profile:

pneumothorax AND (puncture OR punctur*);

http://tinyurl.com/4hltk

 

and 1134 hits for the profile:

pneumothorax AND (puncture OR punctur* OR acupuncture OR acup*);

http://tinyurl.com/54nsv

 

Below is an abstract by Dr. Adrian White <adrian.white

that puts adverse effects of AP in perspective (Well done, Adrian!):

 

White A. (2004) A cumulative review of the range and incidence of

significant adverse events associated with AP. Acupunct Med.

Sep;22(3):122-33. Peninsula Medical School, Plymouth, UK.

OBJECTIVE: To summarise the range and frequency of significant

adverse events associated with AP in order to provide evidence on

which to base continuing efforts to improve the safety of AP practice.

METHODS: Searches were conducted of computerised databases,

previous reviews of case reports, population surveys, prospective

surveys of AP practice and relevant sections of textbooks for primary

and secondary reports to indicate the range of significant adverse

events associated with AP. Data from prospective surveys of AP were

combined to estimate the incidence of serious adverse events.

RESULTS: A total of 715 adverse events was included. There were 90

primary reports of trauma, and 186 secondary reports; the most

common were pneumothorax and injury to the central nervous system.

Infection accounted for 204 primary reports and 91 secondary reports.

Over 60% of these cases were hepatitis B. The next most common

infection was of the external ear, as a complication of auricular AP. The

144 miscellaneous events mainly comprised seizures and drowsiness

judged severe enough to cause a traffic hazard. There were 12 primary

reports of deaths. According to the evidence from 12 prospective

studies which surveyed >1 million treatments, the risk of a serious

adverse event with AP is estimated to be 0.0005/100 treatments, and

0.0055/100 individual patients. CONCLUSIONS: The risk of serious

events occurring in association with AP is very low, below that of many

common medical treatments. The range of adverse events reported is

wide and some events, specifically trauma and some episodes of

infection, are likely to be avoidable. Publication Types: Review Review,

Tutorial PMID: 15551936 [PubMed - indexed for MEDLINE]

 

Here is another one: Peuker E. (2004) Case report of tension

pneumothorax related to AP. Acupunct Med. Mar;22(1):40-3. Comment

in: Acupunct Med. 2004 Jun;22(2):101; author reply 101-2. Department

of Anatomy, University of Muenster, Germany. e-peuker

Although recent prospective studies came to the conclusion that the

incidence of adverse events following AP can be classified as minimal,

many cases of acupuncture-related pneumothorax have been published

over the years, among them some cases of tension pneumothorax. In

this case, a slender woman received acupuncture from a fully trained

medical acupuncturist including needling of the points LU1 in the

subacromial region and BL13, which is a paravertebral point at the level

of the spinous process of the third thoracic vertebra. During the final

treatment, she experienced difficulties in breathing and pain in the left

chest. On x ray examination a tension pneumothorax was diagnosed.

Even though pneumothorax is the most frequently reported serious

complication related to acupuncture, it is not an inevitable complication

of AP, and in most cases involves negligence from inadequate

consideration of basic anatomy. Publication Types: Case Reports

PMID: 15077937 [PubMed - indexed for MEDLINE]

 

Finally, here is one that may bring a smile to the faces of inveterate

smokers (like myself):

 

Crestanello JA, Allen MS, Jett JR, Cassivi SD, Nichols FC 3rd, Swensen

SJ, Deschamps C, Pairolero PC. (2004) Thoracic surgical operations in

patients enrolled in a computed tomographic screening trial. J Thorac

Cardiovasc Surg. Aug;128(2):254-9. Div of General Thoracic Surgery,

Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.

OBJECTIVE: Screening for lung cancer with computed tomography may

detect cancers at an earlier stage but may also result in overdiagnosis.

We reviewed the thoracic surgical operations performed on patients

enrolled in our computed tomographic screening program. METHODS:

From January 1999 through December 2002, screening computed

tomography for lung cancer was performed annually on 1520

participants. All participants were at least 50 years old and smoked

more than 20 pack/y. We found 3130 indeterminate pulmonary nodules

in 1112 participants (73%). Fifty-five participants (3.6%) underwent 60

thoracic operations for a variety of indications. The medical records of

these 55 patients were reviewed. RESULTS: Indications for operation

included suspicious pulmonary nodules, mediastinal adenopathy, and a

spontaneous pneumothorax. Operations performed included a

lobectomy in 37 cases, wedge resection in 11, segmentectomy in 6,

video-assisted thoracoscopic surgical talc pleurodesis in 1, bilobectomy

in 2, mediastinoscopy in 2, and anterior mediastinotomy in 1. Benign

disease was found in 10 patients (18.1%), and lung cancer was found in

45 (81.9%), 2 of whom had metachronous lung cancers. Cell types were

adenocarcinoma in 15 cancers, bronchioloalveolar cell carcinoma in 13,

squamous cell in 13, carcinoid in 2, small cell in 2, and large cell and

undifferentiated non-small cell in 1 case each. Twenty-eight cancers

were classified as stage IA, 4 as IB, 4 as IIA, 1 as IIB, 4 as IIIA, 3 as

IIIB, 1 as IV, and 2 as limited small cell carcinoma. Complications

occurred in 27% of patients. Operative mortality was 1.7%.

CONCLUSION: Computed tomographic screening finds a large number

of indeterminate pulmonary nodules in smokers 50 years old or older,

most of which are observed and not operated on. Although 47 cancers

were detected thus far in this highly selected group of patients, this

represents only 1.5% of the pulmonary nodules identified. PMID:

15282462 [PubMed - indexed for MEDLINE]

 

I have just lit my pipe again!

 

 

Best regards,

 

 

Tel: (H): +353-(0) or (M): +353-(0)

 

 

 

 

Ireland.

Tel: (W): +353-(0) or (M): +353-(0)

 

 

 

" Man who says it can't be done should not interrupt man doing it " -

Chinese Proverb