Efficacy of Blebs Detection for Preventive Surgery in Children’s Idiopathic Spontaneous Pneumothorax
ABSTRACT BackgroundThis retrospective, single-center study was designed to assess our management strategy based on blebs detection on the initial
MethodsChildren younger than aged 18years presenting with a primary spontaneous pneumothorax (PSP) between 2000 and 2007 in a University
Children’s Hospital (hospital Armand Trousseau, Paris, France) were included in this study.
ResultsTwenty-five children who presented with PSP were included. The mean age was 14.2±1.9years, and the sex ratio was 2.1. There
was no significant difference between patients with or without blebs with regard to the anthropomorphic data or the side of
the pneumothorax. Six patients had recurrence, which, in most cases, was a grade 1 pneumothorax. Fourteen (56%) children showed
blebs on CT scan, which was ipsilateral or bilateral in 13 cases and contralateral in 1 case. Eleven of these children had
surgery, and all the remaining patients (n=3) had recurrence. All the patients, except one, presenting blebs on the preoperating CT scan, showed blebs on the subsequent
surgery (predictive positive value=92%), and the CT-scan sensibility for blebs was 75%.
ConclusionsIn children, blebs detection on CT scan has a good sensitivity and may be a useful tool to determine the indication of lung
surgery to prevent PSP recurrence.
- SourceAvailable from: Shawn D St. Peter
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- "This makes a strong argument for not using CT in the management of these patients because the blebs not only are apparently difficult to find on CT but also don't necessarily predict outcome when found. In a recent small series of 14 children who underwent CT for bleb detection, the authors felt CT was useful because most of the patients with blebs identified on CT were found to have bullous disease during thoracoscopy . This corroborated the result of a previous series of 43 children in which there were no false positives . "
ABSTRACT: Spontaneous pneumothorax may result from rupture of subpleural blebs. Computed tomography (CT) has been used to identify blebs to serve as an indication for thoracoscopy. We reviewed our experience with spontaneous pneumothorax to assess the utility of CT in these patients. A retrospective review was conducted of all patients who underwent an operation for spontaneous pneumothorax from January 1999 to October 2009. All procedures were performed thoracoscopically. We identified 39 pneumothoraces in 34 patients who underwent evaluation and a procedure for spontaneous pneumothorax. Mean age was 16.1 years (range, 10-23 years), with an average of 1.7 spontaneous pneumothoraces before operation (range, 1-4). Preoperative chest CT scans were obtained in 26 cases. Blebs were demonstrated on 8 CT scans. The presence of blebs was confirmed at operation in all 8 patients. Of the 18 negative scans, 14 (77.8%) were found to have blebs intraoperatively, 7 of these patients were initially managed nonoperatively and developed recurrence. The sensitivity of CT for identifying blebs was 36%. Chest CT does not appear to be precise in the identification of pleural blebs and a negative examination does not predict freedom from recurrence. Operative decisions should be based on clinical judgment without the use of preoperative CT.Journal of Pediatric Surgery 08/2011; 46(8):1523-5. DOI:10.1016/j.jpedsurg.2011.01.002 · 1.31 Impact Factor
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ABSTRACT: To examine the role of CT scans and early surgical intervention in the management of pediatric patients with primary spontaneous pneumothorax (PSP). Retrospective cohort study. The authors identified 46 cases with 70 episodes of pneumothorax. The recurrence rate among conservatively treated patients was 50% both after the first and the subsequent episode. Recurrence rate in cases with and without blebs on CT was comparable. Initial episodes were treated with supplemental oxygen (n = 18) and chest tube drainage (n = 18), and 10 patients underwent video-assisted thoracoscopic surgery (VATS). The recurrence rate was significantly lower following surgical intervention compared with other therapy, and morbidity was comparable with that in patients who needed chest tube drainage. Recurrence after the first episode of PSP in children is frequent and is difficult to predict by CT findings. VATS is safe and effective in preventing recurrences. Surgical intervention may be an attractive alternative in patients who require chest tube drainage for the first episode of PSP.Clinical Pediatrics 04/2011; 50(9):797-802. DOI:10.1177/0009922811404699 · 1.26 Impact Factor
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ABSTRACT: We sought to compare hematologic recovery between patients who did or did not receive granulocyte-colony-stimulating factor (G-CSF)-stimulated bone marrow (rich bone marrow [RBM]). The study subjects were 20 patients whose bone marrow was taken without prior stimulation with G-CSF and 15 patients in whom bone marrow was taken after previous G-CSF mobilization. The bone marrow harvest took place on the fifth day after G-CSF initiation. The bone marrow aliquot was 20 mL/kg. The median value of nucleated cells obtained from patients without G-CSF preparation was 3.65×10(8)/kg. The median value of nucleated cells from RBM patients was 4.83×10(8)/kg. The median value of stem cells obtained from patients without G-CSF preparation was 0.96×10(6)/kg versus 1.9×10(6)/kg from RBM patients. The median time to recovery of the hematopoietic system based on an increase in PLT value>20 g/L was 12.6 days for RBM versus 18.8 days without G-CSF preparation. The median time to recovery of the hematopoietic system based on assessment of growth ANC>0.5 g/L was 13.0 days for RBM versus 17.8 days without G-CSF stimulation. Significantly higher values of nucleated cells and increased stem cells were observed among RBM patients compared with those whose bone marrow was harvested without any stimulation (P=.01). There was faster recovery of the hematopoietic system in cases where bone marrow was collected after G-CSF: PLT>20 g/L (P=.015) and ANC>0.5 g/L (P=.01). We also observed that the use of stimulated bone marrow shortened hospital stay after the administration of hematopoietic cells to 17.3 days compared with 23.1 days among patients receiving hematopoietic cells from nonstimulated bone marrow. The number of complications during transplantation was comparable in both cases, the most frequent ones being febrile neutropenia and grade III and IV mucositis. RBM is a better method to obtain stem cells from bone marrow. Stimulated bone marrow shows faster engraftment compared with nonstimulated bone marrow helping patients who fail to generate are adequate number of stem cells from peripheral blood.Transplantation Proceedings 10/2011; 43(8):3114-5. DOI:10.1016/j.transproceed.2011.08.006 · 0.95 Impact Factor