2 Civetta JM . After quibbles and rontrasts. conc:epts and caveats (editorial). Chest 1988:93:897-98 3 Kanarak DJ. Shannon DC. Adverse effect of positive end· expiratory pres.s ure on pulmonary perfusion and arterial oxy· ~:enation. Am Rev Respir Dis 1975; 112:457-59 4 Bae-u OR. Wagner RB, l...owe ry BD, Colt VL. Pulmonary hyperinOation: a fi>rm of bamtrauma d uring mechanical ven li· lation. JThorac Cardiovasc Surf.: 1985: 70:790-803 5 Jardin F. Desfimd P. Bazi n M , Sportiche M, MargairdZ A. Controlled ventilation with best positive e nd-expiratory pressure (PEEP) and hi~o:h level PEEP in acute respiratory failure (ARF): a comparative study on patients with bilateral and unilateral lung d isease. Inte nsive Care Med 1981: 7:171-76 6 Goodwin CA. Epstein DH. Lun~: perfusion scanning: the case of"reverse mismatch.'' Clio Nucl Med 1984: 9:519-22 7 Rosen JM , Romney BM. Pulmonary atelectasis associated with relative hyperperfusion. Eur J Nucl Med 1988; 14:629-31 8 Kvetan V. Graziano GC, Howland WS. Acute pulmonary failure in asymmetric lung disease: approach to management. Crit Care Med 1982: 10:114·18 9 Seeker-Walke r RH. Siegal BA. The use of nuclear medicine in the diagnosis of lung disease. Radio! Clio North Am 1973; 11: 215-4 1 10 BenumofJL, RoJ;tersSN , Moyek EA, Saidman LJ. Hypoxic pulmonary vasoconstriction and r~onal and whole-lung PEEP in the d~. Anesthesiology 1979; 51:503-Q7 11 West JB. Blood How to the lung and Jt3S exchange. Anesthesiology 1975; 41:124·38 12 Qvist JH , Pontoppidan H . Wilson RS, Laver MB. Haemody· namic response to mechanical ventilation with PEEP: the effect of hypervolemia. Anesthesiolo!tr 1975; 42:45-55 13 Johnston WE , Vinton-Johansen J, Tommasi E. Sodium nitro· prusside and positive e nd-expiratory pressure are not detrimen· tal in canine asymmetric pulmonary edema. Crit Care Med 1989; 17:241-40 14 Mink SN, Light RB , Colligan T, Wood LDH . Effect of PEEP on gas exchange and pulmonary perfusion in canine lobar pneumonia. J Appl Physioll981; 50:517·23

Intrapleural Tetracycline for Spontaneous Pneumothorax in Acquired Immunodeficiency Syndrome*

tissue destruction caused by P carinii infection, namely: the formation of pneumatoceles and cavitary bullous lesions.l Not only does this place patients at risk for spontaneous pneumothorax. but also it increases the risk of recurrence. In our experience these occurrences of pneumothorax tend to be more problematic in that prolonged air leaks from chest tubes are quite common and surgical risk is generally considered to be high in this group of patients. We therefore ore conservative approach in the treatment of propose a m this condition and present a case managed successfully using tetracycline pleurodesis. CASE REPORT

A 40-year-