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.
Article: Pediatric spontaneous pneumothorax.[Show abstract] [Hide abstract]
ABSTRACT: Spontaneous pneumothorax (SP) occurs when air enters the pleural space in the absence of a traumatic or iatrogenic etiology and is an uncommon phenomenon in the pediatric population. Although the typical presentation has been well described in the literature, much debate still surrounds the epidemiology, pathophysiology, diagnosis, and management of this condition in the pediatric population. To date, much of the emphasis in the pediatric literature has been on surgical options. Questions still remain regarding the true incidence of this disease in children, appropriate diagnostic imaging, and treatment recommendations for practitioners in the emergency department setting. This review of the evidence seeks to elaborate on current knowledge and clinical practice, as well as the applicability of adult recommendations to the pediatric population.Pediatric emergency care 07/2012; 28(7):715-20; quiz 721-3. · 0.92 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Spontaneous pneumothorax, a prevalent medical challenge in most trauma cases, is a form of sudden lung collapse closely associated with risk factors such as lung cancer and emphysema. Our work seeks to explore and quantify the currently unknown pathological factors underlying lesion rupture in pneumothorax through biomechanical modeling. We hypothesized that lesion instability is closely associated with elastodynamic strain of the pleural membrane from pulsatile air flow and collagen-elastin dynamics. Based on the principles of continuum mechanics and fluid-structure interaction, our proposed model coupled isotropic tissue deformation with pressure from pulsatile air motion and the pleural fluid. Next, we derived mathematical instability criteria for our ordinary differential equation system and then translated these mathematical instabilities to physically relevant structural instabilities via the incorporation of a finite energy limiter. The introduction of novel biomechanical descriptions for collagen-elastin dynamics allowed us to demonstrate that changes in the protein structure can lead to a transition from stable to unstable domains in the material parameter space for a general lesion. This result allowed us to create a novel streamlined algorithm for detecting material instabilities in transient lung CT scan data via analyzing deformations in a local tissue boundary.Computational and Mathematical Methods in Medicine 01/2013; 2013:679308. · 0.79 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: The role computed tomography (CT) performed prior to thoracoscopic surgery for primary spontaneous pneumothorax (PSP) remains unclear. We retrospectively reviewed medical records of all patients who underwent thoracoscopic surgery for PSP during 2008-2012. Patients were stratified into two groups: CT group (patients who received preoperative CT scanning) and control group (patients who did not receive preoperative scanning). Short-term postoperative results and long-term pneumothorax recurrence rates were compared. A total of 298 patients were studied. Preoperative CT scanning was performed in 140 of them. The duration of operation, incidence of bullae formation, number of excised specimens, rate of complications, and postoperative hospital stay were similar between the two groups. After a mean follow-up of 20 months, the recurrence rates were 8.6% (12/140) in the CT group and 5.7% (9/158) in the control group (p = 0.371). In the CT group, five patients had unexpected pulmonary findings and three of them (60%) developed pneumothorax recurrence, the rate of which was significantly higher than that in patients without unexpected pulmonary findings (9/135, 6.7%, p = 0.004). Unexpected pulmonary lesions were more commonly noted in females (4/19, 21.1%) than in males (1/121, 0.8%; p < 0.001). Preoperative CT scanning was not associated with better results after thoracoscopic surgery for PSP and is, therefore, not justified as a routine examination prior to the operation. In female patients, however, preoperative CT scanning might be needed because these patients tended to have a higher incidence of unexpected pulmonary lesions, which were associated with a higher rate of recurrence.Journal of the Formosan Medical Association 04/2014; · 1.00 Impact Factor