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Kazbekov A, Bekarisov O, Tazhin K. Surgical Treatment of Chest Deformity in a Patient with Poland Syndrome. Clinical Case Report. Int Med Case Rep J 2024; 17:247-252. [PMID: 38562434 PMCID: PMC10982578 DOI: 10.2147/imcrj.s441944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 03/07/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Poland syndrome is a rare congenital syndrome that is characterized by partial or complete unilateral absence of the pectoralis major muscle, congenital malformation of the hand and deformation of the chest. Often the patients has abnormalities of the nipple-areolar complex. Here, we present a case of surgical treatment of local chest deformity with patient with Poland syndrome. Case Presentation We observed a patient, an 18-year-old man. The parents noticed the deformation of the chest from birth. The patient did not receive any treatment until adulthood. The patient contacted our clinical research center to correct chest deformity. After clinical and diagnostic procedures, the patient underwent surgical operation: open thoracoplasty with installation of a wire-frame construction. The early postoperative period was uneventful. Early postoperative outcome was assessed 6 months after surgery. Conclusion Our experience shows that thoracoplasty using a wire-frame construction is a good method for correcting local chest deformities in patients with Poland syndrome.
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Affiliation(s)
- Ablaikhan Kazbekov
- National Scientific Center for Traumatology and Orthopedics Named After Academician N.D. Batpenov, Ministry of Health of the Republic of Kazakhstan, Astana, Kazakhstan
- Astana Medical University, Astana, Kazakhstan
| | - Olzhas Bekarisov
- National Scientific Center for Traumatology and Orthopedics Named After Academician N.D. Batpenov, Ministry of Health of the Republic of Kazakhstan, Astana, Kazakhstan
| | - Kairat Tazhin
- National Scientific Center for Traumatology and Orthopedics Named After Academician N.D. Batpenov, Ministry of Health of the Republic of Kazakhstan, Astana, Kazakhstan
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Owen GS, Harmon KA, Sullivan GA, Petit HJ, Westrick J, Cameron JR, Gulack BC, Shah AN. Methods of measurement for pneumothorax in pediatric patients: a systematic review. Pediatr Surg Int 2024; 40:77. [PMID: 38472473 DOI: 10.1007/s00383-024-05640-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2024] [Indexed: 03/14/2024]
Abstract
Accurate measurement of pneumothorax (PTX) size is necessary to guide clinical decision making; however, there is no consensus as to which method should be used in pediatric patients. This systematic review seeks to identify and evaluate the methods used to measure PTX size with CXR in pediatric patients. A systematic review of the literature through 2021 following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was conducted using the following databases: Ovid/MEDLINE, Scopus, Cochrane Database of Controlled Trials, Cochrane Database of Systematic Reviews, and Google Scholar. Original research articles that included pediatric patients (< 18 years old) and outlined the PTX measurement method were included. 45 studies were identified and grouped by method (Kircher and Swartzel, Rhea, Light, Collins, Other) and societal guideline used. The most used method was Collins (n = 16; 35.6%). Only four (8.9%) studies compared validated methods. All found the Collins method to be accurate. Seven (15.6%) studies used a standard classification guideline and 3 (6.7%) compared guidelines and found significant disagreement between them. Pediatric-specific measurement guidelines for PTX are needed to establish consistency and uniformity in both research and clinical practice. Until there is a better method, the Collins method is preferred.
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Affiliation(s)
- Grant S Owen
- Rush Medical College, Rush University Medical Center, Chicago, IL, USA
| | - Kelly A Harmon
- Rush Medical College, Rush University Medical Center, Chicago, IL, USA
| | - Gwyneth A Sullivan
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, 1653 W. Congress Parkway, Suite 794, Chicago, IL, 60612, USA
| | - Hayley J Petit
- Rush Medical College, Rush University Medical Center, Chicago, IL, USA
| | - Jennifer Westrick
- Library of Rush Medical Center, Rush University Medical Center, Chicago, IL, USA
| | - James R Cameron
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Brian C Gulack
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, 1653 W. Congress Parkway, Suite 794, Chicago, IL, 60612, USA
| | - Ami N Shah
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, 1653 W. Congress Parkway, Suite 794, Chicago, IL, 60612, USA.
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Mazenq J, Dubus JC. [Diagnosis and management of idiopathic spontaneous pneumothorax in adolescents]. Rev Mal Respir 2024; 41:139-144. [PMID: 38326190 DOI: 10.1016/j.rmr.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 11/11/2023] [Indexed: 02/09/2024]
Abstract
INTRODUCTION Due to the absence of consensual definition and agreed-upon pediatric treatment, pneumothorax (PNO) in children and adolescents often remains difficult to properly apprehend. STATE OF THE ART While initial diagnostic suspicion is clinical, confirmation necessitates chest imaging, and lung ultrasound has become increasingly prevalent, often at the expense of chest radiography. The goal of treatment is twofold, on the one hand to a fully re-expand the lungs, and on the other hand to forestall PNO recurrence. Depending on PNO severity and clinical tolerance, it may be advisable to envision conservative management, oxygen supplementation, needle exsufflation, or chest tube drainage. PERSPECTIVES In order to harmonize clinical practices, guidelines for the precise definition and graduated management of PNO in children and adolescents are highly advisable. CONCLUSIONS Idiopathic spontaneous PNO frequently occurs in teenage populations, and its likewise frequent recurrence is not satisfactorily predicted by chest CT findings. It is of paramount importance that patients be fully informed of the risk of recurrence.
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Affiliation(s)
- J Mazenq
- Service de pneumologie et allergologie pédiatrique, CHU Timone enfants - Assistance Publique des Hôpitaux de Marseille, Marseille, France; Aix-Marseille Université, Inserm, INRA, C2VN, Marseille, France.
| | - J-C Dubus
- Service de pneumologie et allergologie pédiatrique, CHU Timone enfants - Assistance Publique des Hôpitaux de Marseille, Marseille, France; RD, Aix Marseille Université, MEPHI, IHU Méditerranée Infection, Marseille, France
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Aker C, Selin Onay M, Cansever L. Pneumothorax and pneumomediastinum in children. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2024; 32:S37-S42. [PMID: 38584791 PMCID: PMC10995689 DOI: 10.5606/tgkdc.dergisi.2024.25755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 12/21/2023] [Indexed: 04/09/2024]
Abstract
Pneumothorax is a condition that describes the presence of air between the visceral and parietal pleura sheets and the consequent collapse of the lungs. The collapse of the lungs can be partial or total and can present in different clinical stages, such as a high-pressure pneumothorax that can cause a mediastinal shift. Pneumomediastinum is the presence of free air between the mediastinal tissues due to various causes. It can manifest spontaneously and be minimally symptomatic but can also develop due to severe complications. Its etiology includes numerous iatrogenic and traumatic factors. Although spontaneous pneumothorax and pneumomediastinum that develop in childhood are similar to adult patients, it is important to determine the appropriate treatment strategy in addition to the age group, the effectiveness of the treatment, the role of the applied treatment in reducing recurrence, and the etiologyoriented treatments if there is an underlying pathology.
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Affiliation(s)
- Cemal Aker
- Department of Thoracic Surgery, Health Sciences University, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Türkiye
| | - Mahmuti Selin Onay
- Department of Thoracic Surgery, Health Sciences University, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Türkiye
| | - Levent Cansever
- Department of Thoracic Surgery, Health Sciences University, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Türkiye
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Sag S, Elemen L. Management of primary spontaneous pneumothorax in children: Current practices among Turkish pediatric surgeons. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2023; 31:222-228. [PMID: 37484636 PMCID: PMC10357861 DOI: 10.5606/tgkdc.dergisi.2023.23244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 04/15/2022] [Indexed: 07/25/2023]
Abstract
Background This study aims to evaluate current practices in the management of primary spontaneous pneumothorax among Turkish pediatric surgeons. Methods Between October 2021 and November 2021, an online survey comprising 19 questions was delivered to all members of the Turkish Association of Pediatric Surgeons (TAPS). A total of 74 respondents (42 males, 32 females; mean age: 42.3±7.9 years; range, 29 to 61 years) were included. Results The response rate was 17.1% among all society members. The rate of utilization of computed tomography in the initial admission was 27.4%, and the rate of use in cases requiring surgical treatment was 78.4%. A total of 81% of surgeons reported that the size of the pneumothorax influenced management. For the first episode of primary spontaneous pneumothorax, 75.7% of surgeons opted for chest tube drainage, 14.9% for only oxygen administration, 4.1% for needle aspiration, and none of the surgeons preferred video-assisted thoracoscopic surgery. For patients with a persistent air leak after chest tube placement, there was a wide variation in the duration of observation before performing surgery. Video-assisted thoracoscopic surgery was the most preferred surgical intervention (75.3%) and the most preferred surgical method was stapled bullectomy (43.8%). Conclusion There are practice variations in the management of pediatric primary spontaneous pneumothorax among the society members. However, the majority of members seem to agree on the use of computed tomography, initial treatment, and surgical interventions.
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Affiliation(s)
- Sefa Sag
- Department of Pediatric Surgery, University of Health Sciences, Sancaktepe Şehit Prof. Dr. Ilhan Varank Training and Research Hospital, Istanbul, Türkiye
| | - Levent Elemen
- Department of Pediatric Surgery, University of Health Sciences, Sancaktepe Şehit Prof. Dr. Ilhan Varank Training and Research Hospital, Istanbul, Türkiye
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Miscia ME, Castellano M, Chiarini S, Lauriti G, Casaccia M, Lelli Chiesa P, Lisi G. Pediatric primary spontaneous pneumothorax: a comparison of treatment at pediatric surgery vs. thoracic surgery departments. LA PEDIATRIA MEDICA E CHIRURGICA 2023; 45. [PMID: 36920181 DOI: 10.4081/pmc.2023.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 02/13/2023] [Indexed: 03/16/2023] Open
Abstract
Management of pediatric Primary Spontaneous Pneumothorax (PSP) is controversial and based on guidelines on adults. Therapeutic strategies include: observation, needle aspiration, chest drain, or surgery. We aimed to assess: i) differences in the management of PSP in pediatric vs. adult departments; ii) risk of recurrence associated to each therapeutic choice; iii) management of "large" pneumothorax (i.e. >3cm at the apex on chest X-Ray); iv) role of CT scan in addressing the treatment. We reviewed all PSP treated at Pediatric Surgery Unit (PSU) and Thoracic Surgery Unit for adults (TSU) in a 10-year period (2011 to 2020). We included a total of 42 PSP: 30/42 1st episodes and 12/42 recurrences. Among the 30/42 1st episodes, 15/30 were managed in the PSU and 15/30 in the TSU. Observation was significantly most common among PSU patients (9/15, 60%) vs. TSU cases (1/15, 6.7%; p=0.005]. Chest drain placement was reduced in PSU (3/15, 20%) vs. TSU (12/15, 80%; p=0.002). Observational was associated with a reduced risk of recurrence (0/10, 0%) compared to chest drain (7/15, 46.7%; p=0.01). Management of 20/42 "large" pneumothorax was: 4/20 (20%) observation, 10/20 (50%) chest drain, 2/20 (10%) needle aspiration, 4/20 (20%) surgery. Twentythree/ 29 PSP (79.3%) underwent CT-scan after the first episode. Bullae were detected in 17/23 patients and 5/17 (29.4%) had seven episodes of recurrence. PSP patients treated by PSU were more likely to receive clinical observation. Those managed by TSU were mostly treated by chest drain. Observation seems an effective choice for clinically stable PSP, with low risk of recurrence at a mid-term follow-up. CT-scan seems not to detect those patients at higher risk of recurrence.
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Affiliation(s)
- Maria Enrica Miscia
- Department of Medicine and Aging Science, "G. d'Annunzio" University of Chieti-Pescara, Italy; Pediatric Surgery Unit, "Spirito Santo" Hospital of Pescara.
| | - Maria Castellano
- Department of Medicine and Aging Science, "G. d'Annunzio" University of Chieti-Pescara, Italy; Pediatric Surgery Unit, "Spirito Santo" Hospital of Pescara.
| | | | - Giuseppe Lauriti
- Department of Medicine and Aging Science, "G. d'Annunzio" University of Chieti-Pescara, Italy; Pediatric Surgery Unit, "Spirito Santo" Hospital of Pescara.
| | - Marco Casaccia
- Thoracic Surgery Unit, "Santo Spirito" Hospital of Pescara.
| | - Pierluigi Lelli Chiesa
- Department of Medicine and Aging Science, "G. d'Annunzio" University of Chieti-Pescara, Italy; Pediatric Surgery Unit, "Spirito Santo" Hospital of Pescara.
| | - Gabriele Lisi
- Department of Medicine and Aging Science, "G. d'Annunzio" University of Chieti-Pescara, Italy; 2 Pediatric Surgery Unit, "Santo Spirito" Hospital of Pescara.
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Stewart S, Fraser JA, Rentea RM, Aguayo P, Juang D, Fraser JD, Snyder CL, Hendrickson RJ, Oyetunji TA, St Peter SD. Management of primary spontaneous pneumothorax in children: A single institution protocol analysis. J Pediatr Surg 2023:S0022-3468(23)00075-1. [PMID: 36803908 DOI: 10.1016/j.jpedsurg.2022.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 12/13/2022] [Accepted: 12/31/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Midwest Pediatric Surgery Consortium (MWPSC) suggested a simple aspiration of primary spontaneous pneumothorax (PSP) protocol, failing which, Video-Assisted Thoracoscopic Surgery (VATS) should be considered. We describe our outcomes using this suggested protocol. METHODS A single institution retrospective analysis was conducted on patients between 12 and 18 years who were diagnosed with PSP from 2016 to 2021. Initial management involved aspiration alone with a ≤12 F percutaneous thoracostomy tube followed by clamping of the tube and chest radiograph at 6 h. Success was defined as ≤2 cm distance between chest wall and lung at the apex and no air leak when the clamp was released. VATS followed if aspiration failed. RESULTS Fifty-nine patients were included. Median age was 16.8 years (IQR 15.9, 17.3). Aspiration was successful in 33% (20), while 66% (39) required VATS. The median LOS with successful aspiration was 20.4 h (IQR 16.8, 34.8), while median LOS after VATS was 3.1 days (IQR 2.6, 4). In comparison, in the MWPSC study, the mean LOS for those managed with a chest tube after failed aspiration was 6.0 days (±5.5). Recurrence after successful aspiration was 45% (n = 9), while recurrence after VATS was 25% (n = 10). Median time to recurrence after successful aspiration was sooner than that of the VATS group [16.6 days (IQR 5.4, 19.2) vs. 389.5 days (IQR 94.1, 907.0) p = 0.01]. CONCLUSION Simple aspiration is safe and effective initial management for children with PSP, although most will require VATS. However, early VATS reduces length of stay and morbidity. LEVEL OF EVIDENCE IV. Retrospective study.
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Affiliation(s)
- Shai Stewart
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - James A Fraser
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Rebecca M Rentea
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Pablo Aguayo
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - David Juang
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Jason D Fraser
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Charles L Snyder
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Richard J Hendrickson
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Tolulope A Oyetunji
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Shawn D St Peter
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
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Engwall-Gill AJ, Weller JH, Rahal S, Etchill E, Kunisaki SM, Nasr IW. Early risk factors of operative management for hospitalization children with spontaneous pneumothorax. J Pediatr Surg 2022; 57:994-999. [PMID: 35649747 DOI: 10.1016/j.jpedsurg.2022.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/22/2022] [Accepted: 05/03/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The optimal timing of operative management in children with primary spontaneous pneumothorax (PSP) remains controversial. This study sought to determine early risk factors for failure of chest tube nonoperative management during the initial hospitalization in adolescents with PSP. METHODS A retrospective review was conducted for children (aged ≤18 years) admitted to a single tertiary care referral center for their first presentation of a PSP managed with at least 48 h of chest tube decompression (CTD) alone. Patient outcomes and early risk factors for operative management were analyzed by multivariate regression. RESULTS Of the 39 patients who met inclusion criteria, 15 (38.5%) patients failed nonoperative treatment while 24 (61.5%) patients were managed with CTD therapy alone. Progression to thoracoscopic surgery was associated with longer CTD of 8 vs 3 days and hospital length of stay of 9 vs 4 days when compared to nonoperative management (p < 0.001, both). Air leak and increase in pneumothorax size at 24 h after CTD were independently associated with progression to surgery (p = 0.007, p = 0.002). Combined, these risk factors were associated with a significant increase in recurrence (OR 6.00, 95% CI 1.11-41.11, p = 0.048). There were no significant differences between PSP management strategies regarding cumulative radiation exposure or 2 year recurrence. CONCLUSIONS Air leak or increasing pneumothorax size within 24 h of CTD are highly correlated with failed nonoperative management during the initial hospitalization in pediatric patients with PSP. This data may be useful in the development of pediatric-specific treatment algorithms to optimally manage these patients. LEVEL OF EVIDENCE Treatment study, Level III.
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Affiliation(s)
- Abigail J Engwall-Gill
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins Children's Center, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287-1005, USA.
| | - Jennine H Weller
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins Children's Center, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287-1005, USA
| | - Simon Rahal
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins Children's Center, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287-1005, USA
| | - Eric Etchill
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins Children's Center, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287-1005, USA
| | - Shaun M Kunisaki
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins Children's Center, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287-1005, USA
| | - Isam W Nasr
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins Children's Center, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287-1005, USA
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Owen GS, Sullivan GA, Skertich NJ, Pillai S, Madonna MB, Shah AN, Gulack BC. Long-Term Recurrence Risk Following Pleurectomy or Pleurodesis for Primary Spontaneous Pneumothorax. J Surg Res 2022; 278:132-139. [DOI: 10.1016/j.jss.2022.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/18/2022] [Accepted: 03/29/2022] [Indexed: 11/26/2022]
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Contemporary Role of Computed Tomography in Managing Pediatric Primary Spontaneous Pneumothorax. J Surg Res 2022; 276:256-260. [PMID: 35398629 DOI: 10.1016/j.jss.2022.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/23/2022] [Accepted: 03/11/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The value of chest computed tomography (CT) in pediatric primary spontaneous pneumothorax (PSP) remains controversial. This study sought to evaluate the utility of CT scans in a contemporary cohort of children with PSP. MATERIALS AND METHODS An institutional review board approval was obtained for a retrospective review of all children (aged ≤18 y) who underwent video-assisted thoracoscopic surgery (VATS) for PSP between 2009 and 2019 at a university-affiliated pediatric hospital. Preoperative CT scans were evaluated for diagnostic accuracy of the CT of bleb disease. RESULTS Thirty nine patients underwent VATS procedures for PSP, 34 (87%) of the patients were noted to have blebs. Twenty eight (72%) patients received preoperative CT scans with a 5.5:1 male to female ratio. On CT, 17 (61%) were diagnosed with blebs and all had blebs intraoperatively. CT did not identify disease in 11 patients, but seven had blebs intraoperatively. The positive and negative predictive values of preoperative CT for detecting ipsilateral bleb disease were 100% and 36%, respectively, with a sensitivity of 71%. Eleven patients had a contralateral disease on CT (39%). Five received elective contralateral VATS and three developed spontaneous PSP, with intraoperative blebs in all eight patients. Three never developed contralateral PSP. Six (21%) patients with no contralateral disease on CT developed spontaneous PSP with intraoperative blebs. CONCLUSIONS The decision to operate for PSP should be made based on clinical findings rather than on the presence or absence of blebs identified by CT.
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Benhaïm E, Roth B, Michel F, Merrot T, Dubus J. Management of primary spontaneous pneumothorax in teenagers: An 11-year study. Acta Paediatr 2022; 111:845-849. [PMID: 34923666 DOI: 10.1111/apa.16223] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/29/2021] [Accepted: 12/16/2021] [Indexed: 10/19/2022]
Abstract
AIM Management of teenagers with primary spontaneous pneumothorax (PSP) is not consensual. We report our experience over an 11-year period. METHODS For each patient under 20 years hospitalised with PSP from 2008 to 2018, demographic data, smoking habits, clinical presentation, hospitalisation unit, radiological management and its results, therapeutic management (observation, needle aspiration, chest tube drainage and surgery), complications, length of stay, given advice at discharge and recurrence were collected. RESULTS Seventy patients were included in different paediatric or adult surgery or pulmonology wards (82.9% boys; 16.8 ± 1.7 years; one severe presentation; 18/58 smokers). Chest CT-scan (n = 42/70, 60%) revealed blebs/bullae in 18/39 examinations (46.2%). Treatment consisted of observation (14/70, 20%), needle aspiration (2/70, 2.9%), chest tube (53/70, 75.7%) and video-assisted thoracoscopy surgery (27/70, 38.6%). Half patients with interventional procedure presented complications. A median of 10 chest X-rays was noted during a median stay of 8 days. Advice concerning sport practice, flying, smoking, etc., was variably delivered. PSP recurrence concerned 35/70 patients (50%) without identified predictive factors. CONCLUSION Compared to recent recommendations of a more conservative approach, chest CT-scan and interventional strategy are overused in our teenagers with PSP. Observation, more or less needle aspiration, should be clearly the first-line treatments.
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Affiliation(s)
- Eve Benhaïm
- Unité de Pneumologie Pédiatrique Centre Hospitalo‐Universitaire (CHU) Timone‐Enfants Marseille France
| | - Brimbelle Roth
- Département de Santé Publique Centre Hospitalo‐Universitaire (CHU) de la Conception Marseille France
| | - Fabrice Michel
- Unité d’Anesthésie‐Réanimation Pédiatrique Centre Hospitalo‐Universitaire (CHU) Timone‐Enfants Marseille France
| | - Thierry Merrot
- Département de Chirurgie Viscérale Pédiatrique Centre Hospitalo‐Universitaire (CHU) Timone‐Enfants Marseille France
| | - Jean‐Christophe Dubus
- Unité de Pneumologie Pédiatrique Centre Hospitalo‐Universitaire (CHU) Timone‐Enfants Marseille France
- Aix Marseille Université IRD AP‐HM MEPHI IHU‐Méditerranée Infection Marseille France
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Lieu N, Ngo P, Chennapragada SM, Fitzgerald DA, Karpelowsky J, Pandit C, Selvadurai H, Robinson PD. Update in management of paediatric primary spontaneous pneumothorax. Paediatr Respir Rev 2022; 41:73-79. [PMID: 34511373 DOI: 10.1016/j.prrv.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/03/2021] [Indexed: 11/26/2022]
Abstract
Paediatric spontaneous pneumothorax (PSP) management continues to lack paediatric-specific guideline recommendations. There have been increasing reports of paediatric retrospective case studies supplemented by important well designed RCT (predominantly) adult studies. Taken together, these suggest that conservative management may have an increasing role to play in the management of PSP and that aspiration may have limited utility as a first line intervention. Our local experience, as part of a multicentre retrospective analysis and subsequent audit of management since, corroborates recent published data: it highlights an increasing trend towards conservative management in spontaneous pneumothorax with similar rates of recurrence, compared to intervention, and low use of aspiration with similarly low success rates. We have therefore updated our local practice guidelines and share these with readers. Specifically, we have removed aspiration in the management of primary spontaneous pneumothorax and reserved intervention for children who are clinically unstable or show evidence of increasing air leak irrespective of pneumothorax size. Whilst the success of this change in clinical practice will need to be reviewed in the next 5-10 years, the overall low incidence of the condition, demands a multicentre, and probably multinational, collaborative approach to allow the best chance of obtaining definitive evidence to guide clinical paediatric management.
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Affiliation(s)
- Nathan Lieu
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, Australia; Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia
| | - Peter Ngo
- Emergency Department, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - S Murthy Chennapragada
- Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia; Department of Interventional Radiology, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Dominic A Fitzgerald
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, Australia; Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia
| | - Jonathan Karpelowsky
- Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia; Department of Paediatric Surgery, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Chetan Pandit
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Hiran Selvadurai
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, Australia; Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia
| | - Paul D Robinson
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, Australia; Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia.
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13
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Yousuf S, Cardenas S, Rezaee F. Pediatric pneumothorax: Case studies and review of current literature. Respir Med Case Rep 2021; 34:101548. [PMID: 34820257 PMCID: PMC8602041 DOI: 10.1016/j.rmcr.2021.101548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/01/2021] [Accepted: 11/08/2021] [Indexed: 11/24/2022] Open
Abstract
Pneumothorax is an abnormal collection of air between the lung and chest wall. Pneumothorax management guidelines put forth by the American College of Chest Physicians, European Respiratory Society, and British Thoracic Society are specific to adult patients. These guidelines' utility has not been addressed in pediatric populations, which causes significant management variation in younger patients. Additionally, pneumothorax management ranges from conservative to surgical treatment, but these approaches, timelines, and effectiveness have not been validated in significant numbers of pediatric patients. Here, we present three cases of pediatric pneumothorax with variable clinical courses—one with persistent air leak despite chest tube presence who underwent VATS and surgical resection of apical blebs. In contrast, the other two cases were managed more conservatively. We reviewed the current literature for diagnostic and management of pediatric patients with pneumothorax, which underscores the need for guidelines specific to this population.
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Affiliation(s)
- Shahwar Yousuf
- Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Silvia Cardenas
- Center for Pediatric Pulmonary Medicine, Cleveland Clinic Children's, Cleveland, OH, USA
| | - Fariba Rezaee
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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14
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Kao CN, Chou SH, Tsai MJ, Chang PC, Liu YW. Male adolescents with contralateral blebs undergoing surgery for primary spontaneous pneumothorax may benefit from simultaneous contralateral blebectomies. BMC Pulm Med 2021; 21:210. [PMID: 34217255 PMCID: PMC8255021 DOI: 10.1186/s12890-021-01577-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 06/29/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND In adults with primary spontaneous pneumothorax (PSP), contralateral recurrence occurs in about 25-28% when there are asymptomatic blebs. How to treat contralateral recurrence of PSP in pediatric populations remains controversial. This study evaluated the outcomes of excising contralateral blebs to prevent recurrence in adolescents being operated on for PSP under the same anesthesia. METHODS One hundred thirty-two male PSP patients under age 19 were surgically treated in a single institution between January 2008 and December 2016. Thoracoscopic blebectomies with pleurodesis were performed in all patients. The patients were categorized into those with contralateral blebs receiving one-stage bilateral surgeries (32 patients), those with contralateral blebs only receiving unilateral surgeries (40 patients), and those without contralateral blebs only receiving unilateral surgeries (60 patients). Perioperative details and outcomes were retrospectively analyzed. RESULTS Significant differences in contralateral recurrence rate were found among the three groups (0%, 30%, and 1%, respectively; P < 0.001). Multivariate analysis showed that being under 16.5 years old was a risk factor for overall recurrence (Hazard ratio [HR] 2.81, 95% confidence interval [CI] 1.08-7.30, P = 0.034). Moreover, patients who had contralateral blebs and only received unilateral surgery were at greater risk of overall recurrence (HR 6.06, 95% CI 1.77-20.75, P = 0.004). Kaplan-Meier analysis showed that contralateral and overall recurrence-free survival differed among the three groups (P < 0.0001, P = 0.0002). CONCLUSIONS Although younger male PSP adolescents treated with surgery were more likely to have postoperative recurrences, the performance of simultaneous contralateral blebectomies in those receiving one-stage bilateral surgeries significantly reduced future contralateral recurrence without compromising patient safety.
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Affiliation(s)
- Chieh-Ni Kao
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung, 80756, Taiwan
| | - Shah-Hwa Chou
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung, 80756, Taiwan
- Department of Surgery, Pingtung Hospital, Ministry of Health and Welfare, Pingtung, Taiwan
| | - Ming-Ju Tsai
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Po-Chih Chang
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung, 80756, Taiwan
| | - Yu-Wei Liu
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung, 80756, Taiwan.
- PhD Program in Environmental and Occupational Medicine, College of Medicine, Kaohsiung Medical University, National Health Research Institutes, Kaohsiung, Taiwan.
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15
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Wilson PM, Rymeski B, Xu X, Hardie W. An evidence-based review of primary spontaneous pneumothorax in the adolescent population. J Am Coll Emerg Physicians Open 2021; 2:e12449. [PMID: 34179877 PMCID: PMC8212556 DOI: 10.1002/emp2.12449] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/16/2021] [Accepted: 04/20/2021] [Indexed: 02/03/2023] Open
Abstract
Primary spontaneous pneumothorax (PSP) is a relatively common problem in emergency medicine. The incidence of PSP peaks in adolescence and is most common in tall, thin males. Recent advances in the care of patients with PSP have called into question traditional approaches to management. This clinical review highlights the changing management strategies for PSP and concludes with a proposed evidence-based pathway to guide the care of adolescents with PSP.
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Affiliation(s)
- Paria M. Wilson
- Department of PediatricsUniversity of CincinnatiCollege of MedicineCincinnatiOhioUSA
- Division of Emergency MedicineCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Beth Rymeski
- Division of Pediatric SurgeryCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Xuefeng Xu
- Department of RheumatologyImmunology & AllergyRespiratory MedicineThe Children's HospitalZhejiang University School of MedicineNational Clinical Research Center for Child HealthHangzhouChina
| | - William Hardie
- Department of PediatricsUniversity of CincinnatiCollege of MedicineCincinnatiOhioUSA
- Division of Pulmonary MedicineCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
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16
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Stanko S, Oesterle C, Lowe MC. High-Resolution CT Following Primary Spontaneous Pneumothorax in Adolescents: Useful Tool or Wasted Radiation? Cureus 2021; 13:e14936. [PMID: 34123633 PMCID: PMC8191423 DOI: 10.7759/cureus.14936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background The current trend in management of first-time primary spontaneous pneumothorax (PSP) in children is to obtain a high-resolution chest computerized tomography (HRCT) scan to look for bleb/bullae disease or other forms of structural lung disease. We aimed to evaluate the significance of HRCT findings in relation to initial management strategies, and we hypothesized that these findings do not guide management. Methods We evaluated patients with first-time PSP in a single-institution, retrospective, longitudinal study. Data were obtained through direct chart review. The primary endpoint was the percentage of patients who underwent surgical intervention after HRCT. Results We identified 10 children from 10 to 17 years old from January 2013 to November 2019 who met criteria for the study. Seven out of 10 patients (70%) had HRCT after the first-time PSP during the same hospital stay. Blebs/bullae were discovered in five out of seven (71%) of those patients. Two of those five patients had subsequent surgical intervention (40%) before a recurrence. Of the three patients with blebs/bullae identified on HRCT treated without initial surgery, two had a recurrence of PSP and subsequently underwent VATS with blebectomy and pleurodesis. Among the patients without initial HRCT, there were no recurrent cases of PSP noted. Conclusions Our study suggests there is value in obtaining HRCT after the first time PSP, as these results can be used to guide management strategies. Further studies in pediatric PSP are needed to validate the sensitivity of HRCT in bleb detection, the predictive value of bleb disease and recurrence, and the benefits and risks of early surgical intervention.
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Affiliation(s)
- Sarah Stanko
- Pediatrics, The University of Arizona, Banner-Diamond Children's Medical Center, Tucson, USA
| | | | - Merlin C Lowe
- Pediatrics/Hospitalist Medicine, The University of Arizona, Banner-Diamond Children's Medical Center, Tucson, USA
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17
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Hung CS, Chen YC, Yang TF, Huang FH. Systematic review and meta-analysis on juvenile primary spontaneous pneumothorax: Conservative or surgical approach first? PLoS One 2021; 16:e0250929. [PMID: 33930078 PMCID: PMC8087103 DOI: 10.1371/journal.pone.0250929] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 04/18/2021] [Indexed: 11/18/2022] Open
Abstract
Background Primary spontaneous pneumothorax (PSP) prevalence is typically higher in juvenile patients than in adults. We aimed to evaluate the optimal treatment for primary spontaneous pneumothorax and its efficacy and safety in juveniles. Materials and methods We searched PubMed, Embase, and Cochrane databases for eligible studies published from database inception to October 10, 2020, and conducted a systematic review and meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The primary and secondary outcomes were recurrence rate and hospital stay length, respectively. Odds ratios (OR) and mean differences were used for quantitatively analyzing binary and continuous outcomes, respectively. In total, nine retrospective studies with 1,452 juvenile patients (aged <21) were included for the quantitative analysis. The surgical approach led to a lower recurrence rate than did conservative approaches (OR: 1.95, 95% confidence interval: 1.15–3.32). Moreover, the recurrence rate was low in patients who underwent conservative treatment first and received surgery later. Conclusions Surgical approach for first-line management might have a greater effect on recurrence prevention than do conservative approaches. An upfront surgery might be an optimal choice for juvenile primary spontaneous pneumothorax.
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Affiliation(s)
- Chun-Shan Hung
- Department of Medical Education, Changhua Christian Hospital, Changhua City, Taiwan
| | - Yang-Ching Chen
- Department of Family Medicine, Taipei Medical University Hospital, Taipei City, Taiwan
- Department of Family Medicine, School of medicine, College of medicine, Taipei Medical University, Taipei City, Taiwan
| | - Ten-Fang Yang
- Department of Biological Science and Technology, National Chiao-Tung University, Hsinchu City, Taiwan
- Graduate Institute of Biomedical Informatics, Taipei Medical University and Hospital, Taipei City, Taiwan
| | - Fu-Huan Huang
- Department of Biological Science and Technology, National Chiao-Tung University, Hsinchu City, Taiwan
- Division of Pediatric Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei City, Taiwan
- * E-mail:
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18
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Primary spontaneous pneumothorax in children: A single institutional experience. Asian J Surg 2021; 44:969-973. [PMID: 33581946 DOI: 10.1016/j.asjsur.2021.01.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/18/2021] [Accepted: 01/21/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The treatment of primary spontaneous pneumothorax (PSP) remains controversial. We aimed to examine the role of chest computed tomography (CT), the advantages of pigtail catheter versus chest tube regarding duration of drainage or hospitalization period, and the impact of small PSP and surgical treatment on recurrence rate. METHODS We retrospectively reviewed the medical records of 109 children with PSP (20 years' period). Patients with recurrent and those with non-recurrent PSP were compared. RESULTS We recorded 183 episodes of PSP (45% recurrences), 89 patients (97%) were male, and the median age at presentation was 16 years. There were no significant differences between recurrence and non-recurrence PSP regarding age, gender, medical background, presentation symptoms, type of chest drain, median hospitalization length and median follow-up period. Recurrences were less frequent among patients who presented with small PSP and were treated conservatively (P = 0.029). PSP was almost always unilateral and the recurrence was observed ipsilateral in almost 80% of the cases. CT was more frequently used and blebs/bullae were more frequently found among patients with recurrent PSP. Pigtail use had no advantage in reducing hospitalization period and surgical procedures prevented recurrences. CONCLUSION The size of pneumothorax at presentation helps to predict recurrences. There are no differences regarding duration of drainage or hospitalization period in the use of pigtail compared to chest tube. CT helps evaluate findings in the lungs in recurrent cases of PSP and surgery prevents recurrences effectively.
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19
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Cerchia E, Conighi ML, Bleve C, Chiarenza SF, Sgrò A, Pini Prato A, Rotundi F, Parolini F, Bulotta AL, Alberti D, Rena O, Rapuzzi G, Rossi F, La Canna F, Cheli M. Feasibility of a Standardized Management for Primary Spontaneous Pneumothorax in Children and Adolescents: A Retrospective Multicenter Study and Review of the Literature. J Laparoendosc Adv Surg Tech A 2020; 30:841-846. [DOI: 10.1089/lap.2019.0493] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Elisa Cerchia
- Department of Pediatric Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Cosimo Bleve
- Department of Pediatric Surgery, S. Bortolo Hospital, Vicenza, Italy
| | | | - Alberto Sgrò
- Department of Pediatric Surgey, Alessandria Children Hospital, Alessandria, Italy
| | - Alessio Pini Prato
- Department of Pediatric Surgey, Alessandria Children Hospital, Alessandria, Italy
| | - Franco Rotundi
- Department of Pediatric Surgey, Alessandria Children Hospital, Alessandria, Italy
| | - Filippo Parolini
- Department of Pediatric Surgery, “Spedali Civili” Children's Hospital, Brescia, Italy
| | - Anna Lavinia Bulotta
- Department of Pediatric Surgery, “Spedali Civili” Children's Hospital, Brescia, Italy
| | - Daniele Alberti
- Department of Pediatric Surgery, “Spedali Civili” Children's Hospital, Brescia, Italy
| | - Ottavio Rena
- Department of Pediatric Surgery Unit, AOU “Maggiore della Carità,” Novara, Italy
| | - Giovanni Rapuzzi
- Department of Pediatric Surgery Unit, AOU “Maggiore della Carità,” Novara, Italy
| | - Fabio Rossi
- Department of Pediatric Surgery Unit, AOU “Maggiore della Carità,” Novara, Italy
| | - Francesco La Canna
- Department of Pediatric Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Maurizio Cheli
- Department of Pediatric Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
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20
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Ng GYH, Nah SA, Teoh OH, Ong LY. Primary spontaneous pneumothorax in children: factors predicting recurrence and contralateral occurrence. Pediatr Surg Int 2020; 36:383-389. [PMID: 31993738 DOI: 10.1007/s00383-020-04619-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/11/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND The risk factors for recurrence in primary spontaneous pneumothorax (PSP) in children are not well known. We aimed to identify possible risk factors, and to evaluate the utility of computerised tomography (CT) scans in predicting future episodes. METHODS We reviewed children aged < 18 years admitted to our institution for PSP from 2008 to 2017, excluding those with malignancies. Basic demographic data were extracted. Clinical data collected include pneumothorax laterality, CT results, treatment protocols and recurrences. RESULTS 63 patients were included, 19 (30.2%) of whom had CT scans. A total of 41 surgeries were performed. The median (interquartile range) age was 15.4 years (14.9-15.9), and body-mass index was 17.9 kg/m2 (15.8-19.3). 56 (88.9%) patients were male. Median follow-up duration was 19.8 months (11.6-35.9). Multivariate logistic regression analyses identified surgery in the first episode as a predictor for a subsequent contralateral occurrence (odds ratio [95% confidence interval] 32.026 [1.685-608.518], p = 0.021). No predictors for ipsilateral recurrence were found. CT scans were 76.5% sensitive for bleb detection, and predicted poorly for occurrence (positive predictive value 14.3%, likelihood ratio 1.1). CONCLUSION This is the first study demonstrating that surgery at first presentation appears to predict for occurrence of PSP on the contralateral lung. CT appears to be ineffective in detecting blebs and predicting PSP occurrence.
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Affiliation(s)
- Glenn Yang Han Ng
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,General Paediatrics Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Shireen Anne Nah
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore, Singapore.,Paediatric Surgery Unit, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Oon Hoe Teoh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Respiratory Medicine Service, KK Women's and Children's Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Lin Yin Ong
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore. .,Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore, Singapore. .,Duke-NUS Medical School, Singapore, Singapore.
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21
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Changing the Paradigm for Management of Pediatric Primary Spontaneous Pneumothorax: A Simple Aspiration Test Predicts Need for Operation. J Pediatr Surg 2020; 55:169-175. [PMID: 31706614 DOI: 10.1016/j.jpedsurg.2019.09.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 09/29/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE Chest tube (CT) management for pediatric primary spontaneous pneumothorax (PSP) is associated with long hospital stays and high recurrence rates. To streamline management, we explored simple aspiration as a test to predict need for surgery. METHODS A multi-institution, prospective pilot study of patients with first presentation for PSP at 9 children's hospitals was performed. Aspiration was performed through a pigtail catheter, followed by 6 h observation with CT clamped. If pneumothorax recurred during observation, the aspiration test failed and subsequent management was per surgeon discretion. RESULTS Thirty-three patients were managed with simple aspiration. Aspiration was successful in 16 of 33 (48%), while 17 (52%) failed the aspiration test and required hospitalization. Twelve who failed aspiration underwent CT management, of which 10 (83%) failed CT management owing to either persistent air leak requiring VATS or subsequent PSP recurrence. Recurrence rate was significantly greater in the group that failed aspiration compared to the group that passed aspiration [10/12 (83%) vs 7/16 (44%), respectively, P=0.028]. CONCLUSION Simple aspiration test upon presentation with PSP predicts chest tube failure with 83% positive predictive value. We recommend changing the PSP management algorithm to include an initial simple aspiration test, and if that fails, proceed directly to VATS. TYPE OF STUDY Prospective pilot study LEVEL OF EVIDENCE: Level III.
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22
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The accuracy of computed tomography in detecting surgically resectable blebs or bullae in primary spontaneous pneumothorax. Radiol Med 2019; 124:833-837. [PMID: 31134432 DOI: 10.1007/s11547-019-01044-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 05/13/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Chest computed tomography is commonly used in patients with primary spontaneous pneumothorax to detect the presence of pulmonary blebs or bullae. The aim of this study is to calculate the accuracy of chest computed tomography to detect surgically resectable blebs or bullae in patients with primary spontaneous pneumothorax. METHODS This is a retrospective study includes all patients with primary spontaneous pneumothorax who underwent chest computed tomography evaluation for their disease over the period from January 2005 to December 2015. Patients who underwent surgical exploration were sub-grouped to calculate the sensitivity and the specificity of the chest computed tomography to detect surgically resectable pulmonary blebs or bullae. RESULTS A total of 143 patients were included in the study. Among them, 120 patients underwent surgical exploration with the finding of 95.7% sensitivity and 42.3% specificity for the chest computed tomography in detection of surgically resectable pulmonary blebs or bullae. CONCLUSION The sensitivity of the chest computed tomography scan is high in detecting surgically resectable pulmonary blebs or bullae. However, the specificity is low. This may lead to overdiagnosis of the patients to have pulmonary blebs and bullae. Therefore, the routine use of chest computed tomography scan before the surgical exploration in patients with primary spontaneous pneumothorax should depend on the clinical judgment.
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23
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Yamanaka S, Kurihara M, Watanabe K. A novel dual-covering method in video-assisted thoracic surgery for pediatric primary spontaneous pneumothorax. Surg Today 2019; 49:587-592. [PMID: 30955098 DOI: 10.1007/s00595-019-01785-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 01/12/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Primary spontaneous pneumothorax (PSP) generally occurs in young adults, whereas pediatric PSP is uncommon. It is difficult to source reliable data on pediatric PSP, the management of which is based on guidelines for adult PSP; however, the rate of recurrence after video-assisted thoracoscopic surgery (VATS) for pediatric PSP is reported to be higher. METHODS We reviewed retrospectively a collective total of 66 surgical cases of a first pneumothorax episode in 46 children under 16 years of age, who were treated at our hospital between February, 2005 and November, 2017. RESULTS The surgical cases were divided into two groups, depending on how the treated lesions were covered. In the dual-covering (DC) group, the PSP was covered by oxidized regenerated cellulose and polyglycolic acid (8 patients; 13 cases) and in the single-covering (SC) group, the PSP was covered by oxidized regenerated cellulose (38 patients; 53 cases). There was no incidence of recurrence after surgery in the DC group, but 17 cases (32.1%) of recurrence after surgery in the SC group. This difference was significant. CONCLUSION The DC method prevented the recurrence of PSP more effectively than the SC method after VATS in pediatric patients. Long-term follow-up after VATS for pediatric PSP is also important because of the risk of delayed recurrence.
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Affiliation(s)
- Sumitaka Yamanaka
- Department of Thoracic Surgery, Ebara Hospital, 4-5-10 Higashi-yukigaya, Ota-ku, Tokyo, 145-0065, Japan.,Pneumothorax Research Center, Nissan Tamagawa Hospital, 4-8-1, Seta, Setagaya-ku, Tokyo, 158-0095, Japan
| | - Masatoshi Kurihara
- Pneumothorax Research Center, Nissan Tamagawa Hospital, 4-8-1, Seta, Setagaya-ku, Tokyo, 158-0095, Japan.
| | - Kenichi Watanabe
- Pneumothorax Research Center, Nissan Tamagawa Hospital, 4-8-1, Seta, Setagaya-ku, Tokyo, 158-0095, Japan
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24
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Huang R, Lin W, Fan H, Lu G, Yang D, Ma L, Lin J. Bronchoalveolar lavage with pediatric flexible fibreoptic bronchoscope in pediatric haematopoietic stem cell transplant patients: Nursing considerations for operative complications. J SPEC PEDIATR NURS 2019; 24:e12236. [PMID: 30821121 DOI: 10.1111/jspn.12236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 02/11/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Bronchoalveolar lavage (BAL) with pediatric flexible fibreoptic bronchoscopy (FB) is used for diagnostic and therapeutic purposes in pediatric haematopoietic stem cell transplant (HSCT) patients with pulmonary complications. The aim of our study was to evaluate complications in pediatric HSCT patients undergoing BAL/FB and to explore the nursing emphases on complications. DESIGN AND METHODS We performed a retrospective, case-controlled study to evaluate perioperative complications of HSCT children. BAL/FB was conducted for 42 children with HSCT who experienced pulmonary complications between January 2017 and January 2018 within a tertiary hospital. Forty patients diagnosed with general pneumonia were randomly selected during the same period and served as the control group. We analyzed the signs and symptoms of all patients and compared the operative complications between the two groups. Furthermore, we presented the methods used to manage complications. RESULTS The presence of cough, lung rales, and imaging findings in the HSCT patients was significantly different from that of the control group (p < 0.0001). The complication rate was 66.67% (28/42) in the HSCT group and 22.5% (9/40) in the control group, and the difference was significant (p < 0.0001). Twelve out of 42 HSCT patients experienced airway mucosal bleeding (28.57%), and six had transient fever (14.29%). The topical use of epinephrine diluted saline (1:10,000) was highly effective for controlling airway mucosal bleeding without causing fluctuations in blood pressure. PRACTICE IMPLICATIONS There were more perioperative complications in the HSCT patients than in the general pneumonia patients who underwent BAL/FB. Airway mucosal bleeding was a key focus of perioperative nursing in HSCT patients undergoing bronchoscopy as main complication. BAL with the use of epinephrine diluted saline (1:10,000) effectively decreased airway mucosal bleeding.
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Affiliation(s)
- Rulin Huang
- Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
| | - Wenchun Lin
- Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
| | - Huifeng Fan
- Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
| | - Gen Lu
- Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
| | - Diyuan Yang
- Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
| | - Lan Ma
- Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
| | - Jiamian Lin
- Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
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25
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Gariépy M, Beaunoyer M, Miron MC, Gravel J. Management and recurrence of spontaneous pneumothorax in children. Paediatr Child Health 2019; 25:86-92. [PMID: 33390745 DOI: 10.1093/pch/pxz032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 02/17/2019] [Indexed: 11/12/2022] Open
Abstract
Objective No guideline clearly prescribes an approach to management of spontaneous pneumothorax in children. The objectives of this study were to evaluate practice variation in the management of spontaneous pneumothorax in children and its probability of recurrence. Methods This study was a retrospective chart review followed by a phone follow-up that included all children who had visited a tertiary care paediatric hospital for a first episode of spontaneous pneumothorax between 2008 and 2017. The primary outcomes were the management of pneumothorax (observation, oxygen, needle aspiration, intercostal chest tube, surgery) and the probability of recurrence. All charts were evaluated by a rater using a standardized report form and 10% of the charts were evaluated in duplicate. All children/families were contacted by phone to assess recurrence. The primary analyses were the proportions of each treatment modalities and recurrence, respectively. Results During the study period, 76 children were deemed eligible for the study. Among them, 59 had a primary spontaneous pneumothorax while 17 were secondary. The most common first therapeutic approaches were chest tube insertion (31), oxygen alone (27), and observation (14). A total of 54 patients were available for follow-up among whom a recurrence was observed in 28 (37% of the total cohort or 52% of available children). Conclusion Chest tube insertion was the first line of treatment in about 40% of children with a first spontaneous pneumothorax. In this population, the recurrence probability is established between 37 and 52% and the majority occurs in the following months.
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Affiliation(s)
- Martin Gariépy
- Faculty of Medicine, Université Laval, Quebec City, Quebec
| | - Mona Beaunoyer
- Department of Surgery, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec
| | - Marie-Claude Miron
- Department of Radiology, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec
| | - Jocelyn Gravel
- Department of Pediatrics Emergency Medicine, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec
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Simultaneous Bilateral Primary Spontaneous Pneumothorax: A Case Report and a Review of the Literature. Case Rep Pulmonol 2019; 2019:6583842. [PMID: 30809412 PMCID: PMC6369490 DOI: 10.1155/2019/6583842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 12/25/2018] [Indexed: 11/22/2022] Open
Abstract
Background Simultaneous bilateral primary spontaneous pneumothorax (SBPSP) is an extremely rare and potentially fatal condition. Patients usually have no relevant medical conditions. Some cases, however, may have certain risk factors such as smoking, being young, and male gender. We reported a case of a healthy young male who presented with BPSP. Case Presentation A 21-year-old man with a past medical history of well-controlled intermittent asthma presented with acute worsening shortness of breath overnight. Chest X-ray performed showed bilateral large pneumothorax with significantly compressed mediastinum. Chest tubes were placed bilaterally with immediate clinical improvement. However, the chest tubes continued to have an air leak without full lungs expansion. Computed tomography scan without contrast of the chest revealed subpleural blebs in both upper lobes. The patient underwent bilateral video-assisted thoracoscopic surgery (VATS) with apical bleb resection, bilateral pleurectomy, and bilateral doxycycline pleurodesis. Biopsy of the apical blebs and parietal pleura of both lungs were negative for any atypical cells suspicious for malignancy or Langerhans cell histiocytosis. The patient had been doing well six months following surgery with no recurrence of pneumothorax. Conclusion SBPSP is a rare and urgent condition that requires prompt intervention. In a young patient without any underlying disease, surgical intervention, such as VATS, is relatively safe and can be considered early.
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Williams K, Baumann L, Grabowski J, Lautz TB. Current Practice in the Management of Spontaneous Pneumothorax in Children. J Laparoendosc Adv Surg Tech A 2018; 29:551-556. [PMID: 30592692 DOI: 10.1089/lap.2018.0629] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION There is a lack of pediatric-specific guidelines for the workup and management of primary spontaneous pneumothorax (PSP) in children. The aim of this study was to describe current practices among North American pediatric surgeons. MATERIALS AND METHODS An online survey comprising 18 questions was sent out through the American Pediatric Surgical Association Outcomes and Clinical Trials Committee to all members. Bivariate analysis was performed using Chi-square analysis. RESULTS A total of 287 surveys were completed (33% response rate). For a first episode of PSP, 57% of surgeons opt for chest tube drainage, 4% for upfront video-assisted thoracoscopic surgery (VATS), 3% for needle aspiration, and 29% for only oxygen administration. Eighty-one percent of surgeons report that the size of the pneumothorax influences management. However, neither practice setting (P = .87) nor years in practice (P = .11) correlated with initial management strategy. For patients with a persistent air leak after chest tube placement, there is wide variation in duration of observation before performing VATS, with 40% operating after 3 days, but 21% waiting at least 5 days. The use of chest computed tomography (CT) is also highly variable. Eighty-two percent of respondents perform surgery only after the second episode of PSP. Most perform a stapled apical blebectomy and mechanical pleurodesis for both initial and recurrent PSP. CONCLUSION There is significant variation among pediatric surgeons in the management of spontaneous pneumothorax, including the use of CT, timing of operation, and duration of observation for air leak before performing surgery. Prospective data are needed to better inform guidelines and standardize practice.
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Affiliation(s)
- Kibileri Williams
- 1 Department of Surgery, Howard University Hospital, Washington, District of Columbia.,2 Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Lauren Baumann
- 2 Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,3 Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Julia Grabowski
- 2 Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,4 Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Timothy B Lautz
- 2 Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,4 Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Kaslow J, Bickel S, Wiesenauer C, Eid N, Morton R. Pediatric Spontaneous Pneumothorax: Our Experience and a Review of the Literature. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2018. [DOI: 10.1089/ped.2018.0931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Jacob Kaslow
- Division of Allergy, Immunology, and Pulmonary Medicine, Vanderbilt University, Nashville, Tennessee
| | - Scott Bickel
- Division of Pediatric Pulmonology, University of Louisville, Louisville, Kentucky
| | - Chad Wiesenauer
- Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Nemr Eid
- Division of Pediatric Pulmonology, University of Louisville, Louisville, Kentucky
| | - Ronald Morton
- Division of Pediatric Pulmonology, University of Louisville, Louisville, Kentucky
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Soler LM, Raymond SL, Larson SD, Taylor JA, Islam S. Initial primary spontaneous pneumothorax in children and adolescents: Operate or wait? J Pediatr Surg 2018; 53:1960-1963. [PMID: 29361279 DOI: 10.1016/j.jpedsurg.2017.12.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 11/14/2017] [Accepted: 12/01/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE The management of primary spontaneous pneumothorax (PSP) in the pediatric population is not standardized. The purpose of this study was to understand the management options for a first episode of PSP in children and adolescents, and their associated outcomes. METHODS A retrospective study was conducted for patients 5-20 years old with a diagnosis of PSP at a large academic children's hospital between 2002 and 2014. Patient data were reviewed for each case. Management and outcomes were analyzed and compared between groups. RESULTS Eighty patients met all inclusion criteria. Overall recurrence rate was 40% with 86% occurring within 12 months of the initial PSP. Patients with recurrent PSP were significantly taller. Size of pneumothorax based on initial chest x-ray was comparable between recurrent and nonrecurrent groups. A negative CT scan for subpleural blebs did not predict recurrence. Patients undergoing thoracoscopic blebectomy and mechanical pleurodesis at initial presentation had significantly lower recurrence rate compared to patients who underwent nonoperative management (operative group 14%, nonoperative group 45%; p=0.0373). CONCLUSIONS Recurrence following nonoperative management was high with the majority occurring within a year and requiring readmission. These findings support offering surgery to families as a potential initial management option. LEVEL OF EVIDENCE 3b/4 - retrospective series or case control study, single institution, very limited population.
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Affiliation(s)
- Lisa M Soler
- Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Steven L Raymond
- Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Shawn D Larson
- Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Janice A Taylor
- Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Saleem Islam
- Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA.
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Nong BR, Kuo PY, Huang YF, Chiou YH. Primary spontaneous pneumothorax in children: A literature review. ACTA ACUST UNITED AC 2018. [DOI: 10.4103/prcm.prcm_3_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Williams K, Oyetunji TA, Hsuing G, Hendrickson RJ, Lautz TB. Spontaneous Pneumothorax in Children: National Management Strategies and Outcomes. J Laparoendosc Adv Surg Tech A 2017; 28:218-222. [PMID: 29237135 DOI: 10.1089/lap.2017.0467] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The timing of surgical intervention in the management of spontaneous pneumothorax remains controversial. The aim of this multicenter review was to compare management strategies and outcomes in children with spontaneous pneumothorax. METHODS We retrospectively reviewed patients 10-19 years old in the Pediatric Health Information System admitted for spontaneous pneumothorax from 2010 to 2014. Three treatment groups were identified based on initial hospital management-no intervention, initial chest tube placement, and operation; and outcomes were compared. RESULTS A total of 1040 patients were included. The majority were male (82.1%) and White (71.1%). The mean age at first encounter was 15.7 ± 1.7 years. Initial treatment included no intervention in 336 (32.3%), chest tube in 497 (47.8%), and video-assisted thoracoscopic surgery (VATS) in 207 (19.9%). Ultimately, 417 (40.1%) patients underwent VATS during the initial admission and 559 (53.8%) during the initial admission or a subsequent encounter. Aggregate length of stay (LOS) was highest for those treated initially with chest tube alone (P < .001). For patients managed initially with chest tube, the probability of requiring surgery increased with each day of hospitalization. Initial operation was associated with a decreased risk of readmission (OR 0.67, 95% CI 0.50-0.90). Estimated adjusted hospital costs, aggregated across all encounters, were highest for chest tube alone (P < .001). CONCLUSION Early VATS is associated with decreased hospital LOS, charges, and readmissions. For those managed initially with chest tube alone, the likelihood of requiring operation increases with each day hospitalized, and early conversion to operative management should be considered in patients with persistent pneumothorax or air leak.
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Affiliation(s)
- Kibileri Williams
- 1 Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois.,2 Department of Surgery, Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | - Tolulope A Oyetunji
- 3 Department of Surgery, Children's Mercy Kansas City , Kansas City, Missouri
| | - Grace Hsuing
- 1 Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois.,2 Department of Surgery, Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | | | - Timothy B Lautz
- 1 Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois.,2 Department of Surgery, Northwestern University Feinberg School of Medicine , Chicago, Illinois
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Yeung F, Chung PHY, Hung ELY, Yuen CS, Tam PKH, Wong KKY. Surgical Intervention for Primary Spontaneous Pneumothorax in Pediatric Population: When and Why? J Laparoendosc Adv Surg Tech A 2017; 27:841-844. [PMID: 28099064 DOI: 10.1089/lap.2016.0163] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Spontaneous pneumothorax in pediatric patients is relatively uncommon. The management strategy varies in different centers due to dearth of evidence-based pediatric guidelines. In this study, we reviewed our experience of thoracoscopic management of primary spontaneous pneumothorax (PSP) in children and identified risk factors associated with postoperative air leakage and recurrence. MATERIALS AND METHODS We performed a retrospective analysis of pediatric patients who had PSP and underwent surgical management in our institution between April 2008 and March 2015. Demographic data, radiological findings, interventions, and surgical outcomes were analyzed. RESULTS A total of 92 patients with 110 thoracoscopic surgery for PSP were identified. The indications for surgery were failed nonoperative management with persistent air leakage in 32.7%, recurrent ipsilateral pneumothorax in 36.4%, first contralateral pneumothorax in 14.5%, bilateral pneumothorax in 10%, and significant hemopneumothorax in 5.5%. Bulla was identified in 101 thoracoscopy (91.8%) with stapled bullectomy performed. 14.5% patients had persistent postoperative air leakage and treated with reinsertion of thoracostomy tube and chemical pleurodesis. 17.3% patients had postoperative recurrence occurred at mean time of 11 months. Operation within 7 days of symptoms onset was associated with less postoperative air leakage (P = .04). Bilateral pneumothorax and those with abnormal radiographic features had significantly more postoperative air leakage (P = .002, P < .01 respectively) and recurrence (P < .01, P = .007). CONCLUSION Early thoracoscopic mechanical pleurodesis and stapled bullectomy after thoracostomy tube insertion could be offered as a primary option for management of large PSP in pediatric population, since most of these patients had bulla identified as the culprit of the disease.
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Affiliation(s)
- Fanny Yeung
- Division of Paediatric Surgery, Department of Surgery, University of Hong Kong Medical Center , Queen Mary Hospital, Hong Kong, China
| | - Patrick H Y Chung
- Division of Paediatric Surgery, Department of Surgery, University of Hong Kong Medical Center , Queen Mary Hospital, Hong Kong, China
| | - Esther L Y Hung
- Division of Paediatric Surgery, Department of Surgery, University of Hong Kong Medical Center , Queen Mary Hospital, Hong Kong, China
| | - Chi Sum Yuen
- Division of Paediatric Surgery, Department of Surgery, University of Hong Kong Medical Center , Queen Mary Hospital, Hong Kong, China
| | - Paul K H Tam
- Division of Paediatric Surgery, Department of Surgery, University of Hong Kong Medical Center , Queen Mary Hospital, Hong Kong, China
| | - Kenneth K Y Wong
- Division of Paediatric Surgery, Department of Surgery, University of Hong Kong Medical Center , Queen Mary Hospital, Hong Kong, China
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