Hermes
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HERMES Hermes # Springer-Verlag Berlin Heidelberg 2013 Upper thoracic shape in children with pectus excavatum: impact on lung function Redding GJ, Kuo W, Swanson JO et al Pediatr Pulmonol (2013) 48 :817–823 Pectus excavatum (PE) is often repaired for cosmetic reasons, but not infrequently for a variety of clinical issues. The pectus severity index (PSI) or Haller index only modestly correlates with lung function measurements. The authors hypothesized that assessment of an additional (upper) thoracic feature, the slender chest or pectus gracilis (PG), may also impact lung function. They developed a CT-based PG index (PGI) based on a chest width-to-depth ratio at the manubrial/sternal body junction level and measured PGI in 316 control children 10– 20 years of age. They defined PG as >2 z-scores greater than the normal value. They then investigated the prevalence of PG in 97 patients with PE and correlated PSI and PGI with vital capacity (VC) in the 86 patients that performed spirometric testing. They determined that the mean and upper limit of normal for PGI averaged 2.73 and 3.55, respectively for control children. Importantly, the prevalence of PG among control and PG children was 3.2% and 59.0% respectively (OR=45, P <0.00001). There was good correlation (r =0.77, P <0.001) of PGI and PSI in children with PE. Both PGI and PSI correlated inversely with VC, and PGI correlated with VC after adjusting for PSI among patients with PE. The authors conclude that the upper thoracic feature of PG is common in patients with PE and contributes to reduction in VC. The authors conclude that the addition of the PGI to the PSI may improve structure/function correlation in patients with PE. Sparing-lung surgery for the treatment of congenital lung malformation Fascetti-Leon F, Gobbi D, Pavia SV et al J Pediatr Surg (2013) 48 :1476–1480 The management of asymptomatic infants with congenital lung malformations (CLM) varies significantly in pediatric centers worldwide. The authors describe an alternative to lobectomy, lung-sparing surgery (LS), that preserves lung tissue by performing wedge resection or segmentectomy by videothoracoscopy (VT) or open thoracotomy. They retro- spectively reviewed their surgical experience in 81 patients from 2001 to 2010. Fifty-four patients had LS at a mean age of 8.6 months. Forty-seven patients (92%) had prenatal diagnosis of CLM between 20 and 32 weeks’ gestation. In infancy, nine infants were symptomatic prior to surgery—six with respira- tory distress and three with bacterial pneumonia. Twenty-eight patients had an initial open thoracotomy, 26 had initial VT, with subsequent conversion to open in 18, and 8 were com- pleted by VT alone. Complications included one tension pneumothorax requiring drainage catheter and three patients had intraoperative bleeding requiring transfusion. Mean dura- tion of follow-up was 65 months. One patient had a cystic lung lesion on follow-up CT requiring second surgery and two patients experienced pneumonia. Histologic review of lesions classified 23 as congenital cystic adenomatoid malformations, 17 as hybrid lesions, 10 as sequestrations, 1 as a bronchogenic cyst and 3 as ‘others’. The authors conclude that LS is a safe and effective method of lung parenchymal preservation. It is most appropriate in those patients with small asymptomatic lesions. Childhood interstitial lung diseases: an 18-year retrospective analysis Soares JJ, Deutsch GH, Moore PE et al Pediatrics (2013) 132 :684–691 Over this last decade, multi-institutional and international collaborative studies at specialized pediatric lung centers have significantly improved our knowledge and classification of childhood interstitial lung diseases (ChILD), rare infant and childhood diffuse lung problems with high morbidity and mortality. The authors used the classification system of Deutsch et al. (Am J Resp Crit Care Med (2007) 176:1120– 1128) and retrospectively reviewed and classified all ChILD cases seen from 1994 to 2011 to determine the historical occurrence of ChILD in a general, non-specialties pediatric pulmonary practice. They identified 93 cases, of which 91.4% were classifiable. Sixty-four (68.8%) had lung biopsy Pediatr Radiol (2014) 44:241–242 DOI 10.1007/s00247-013-2842-7
Transcript of Hermes
HERMES
Hermes
# Springer-Verlag Berlin Heidelberg 2013
Upper thoracic shape in children with pectus excavatum:impact on lung functionRedding GJ, Kuo W, Swanson JO et alPediatr Pulmonol (2013) 48:817–823
Pectus excavatum (PE) is often repaired for cosmetic reasons,but not infrequently for a variety of clinical issues. The pectusseverity index (PSI) or Haller index only modestly correlateswith lung function measurements. The authors hypothesizedthat assessment of an additional (upper) thoracic feature, theslender chest or pectus gracilis (PG), may also impact lungfunction. They developed a CT-based PG index (PGI) basedon a chest width-to-depth ratio at the manubrial/sternal bodyjunction level and measured PGI in 316 control children 10–20 years of age. They defined PG as >2 z-scores greater thanthe normal value. They then investigated the prevalence of PGin 97 patients with PE and correlated PSI and PGI with vitalcapacity (VC) in the 86 patients that performed spirometrictesting. They determined that the mean and upper limit ofnormal for PGI averaged 2.73 and 3.55, respectively forcontrol children. Importantly, the prevalence of PG amongcontrol and PG children was 3.2% and 59.0% respectively(OR=45, P <0.00001). There was good correlation (r =0.77,P <0.001) of PGI and PSI in children with PE. Both PGI andPSI correlated inversely with VC, and PGI correlated with VCafter adjusting for PSI among patients with PE. The authorsconclude that the upper thoracic feature of PG is common inpatients with PE and contributes to reduction in VC. Theauthors conclude that the addition of the PGI to the PSI mayimprove structure/function correlation in patients with PE.
Sparing-lung surgery for the treatment of congenital lungmalformationFascetti-Leon F, Gobbi D, Pavia SV et alJ Pediatr Surg (2013) 48:1476–1480
The management of asymptomatic infants with congenitallung malformations (CLM) varies significantly in pediatriccenters worldwide. The authors describe an alternative tolobectomy, lung-sparing surgery (LS), that preserves lung
tissue by performing wedge resection or segmentectomy byvideothoracoscopy (VT) or open thoracotomy. They retro-spectively reviewed their surgical experience in 81 patientsfrom 2001 to 2010. Fifty-four patients had LS at a mean age of8.6months. Forty-seven patients (92%) had prenatal diagnosisof CLM between 20 and 32 weeks’ gestation. In infancy, nineinfants were symptomatic prior to surgery—six with respira-tory distress and three with bacterial pneumonia. Twenty-eightpatients had an initial open thoracotomy, 26 had initial VT,with subsequent conversion to open in 18, and 8 were com-pleted by VT alone. Complications included one tensionpneumothorax requiring drainage catheter and three patientshad intraoperative bleeding requiring transfusion. Mean dura-tion of follow-up was 65 months. One patient had a cysticlung lesion on follow-up CT requiring second surgery and twopatients experienced pneumonia. Histologic review of lesionsclassified 23 as congenital cystic adenomatoid malformations,17 as hybrid lesions, 10 as sequestrations, 1 as a bronchogeniccyst and 3 as ‘others’. The authors conclude that LS is a safeand effective method of lung parenchymal preservation. It ismost appropriate in those patients with small asymptomaticlesions.
Childhood interstitial lung diseases: an 18-year retrospectiveanalysisSoares JJ, Deutsch GH, Moore PE et alPediatrics (2013) 132 :684–691
Over this last decade, multi-institutional and internationalcollaborative studies at specialized pediatric lung centers havesignificantly improved our knowledge and classification ofchildhood interstitial lung diseases (ChILD), rare infant andchildhood diffuse lung problems with high morbidity andmortality. The authors used the classification system ofDeutsch et al. (Am J Resp Crit Care Med (2007) 176:1120–1128) and retrospectively reviewed and classified all ChILDcases seen from 1994 to 2011 to determine the historicaloccurrence of ChILD in a general, non-specialties pediatricpulmonary practice. They identified 93 cases, of which 91.4%were classifiable. Sixty-four (68.8%) had lung biopsy
Pediatr Radiol (2014) 44:241–242DOI 10.1007/s00247-013-2842-7
performed. The majority of interstitial lung diseases related tosystemic disease processes (25%), immunocompromised hosts(25%) and a variety of diseases more prevalent in infancy(23%). There were eight cases of neuroendocrine cell hyper-plasia of infancy (NEHI), five of which were previously unrec-ognized. Although 83 patients (89%) had chest CT, the authorsdid not detail the findings other than to note that five patientshad typical findings for NEHI. Duration of patient follow-upwas highly variable, however 75 (81%) of patients were alivewithout transplant at the time of follow-up. The authors stressedthat with increasing clinical, genetic and imaging knowledge ofChILD, the need for lung biopsy may decline.
Lung ultrasound characteristics of community-acquiredpneumonia in hospitalized childrenCaiulo VA, Gargani L, Caiulo S et alPediatr Pulmonol (2013) 48:280–287
This article challenges us to think about the use of lung US(LUS) as an alternative to chest radiography in communityand potentially hospital practice as clinicians seek alternativesto the use of ionizing radiation. It was the aim of this study todescribe the US features of community-acquired pneumonia(CAP) in a group of 102 patients with signs and symptoms of
pneumonia and compare the results to same-day one-view(frontal) chest radiography (CXR). The authors had an expe-rienced pediatric sonographer perform a standard protocol ofthe anterior, axillary and posterior approach US images intransverse and longitudinal planes. LUS signs of pneumoniaincluded subpleural lung consolidation, presence of ‘b-lines’noted perpendicular to the pleural surface, pleural line abnor-malities, and presence of pleural effusions. The gold standardfor pneumonia was follow-up review of all accumulated dataafter the clinical episode by two experienced pediatricians. Bythese criteria, 89 of 102 patients had pneumonia, 88 of whomwere diagnosed by LUS and 81 by CXR. Eight patients withnormal CXR had abnormal LUS and one patient with anabnormal CXR had normal LUS. LUS detected 16 pleuraleffusions whereas CXR detected three. Of note, the authorsprovided no data regarding length of exam (other than to say itwas rapid), sonographer training required to achieve proficien-cy, or cost data and benefit analysis. The authors concluded thatLUS is a simple and reliable imaging tool that is not inferior toCXR in the diagnosis of pneumonia and it is free of radiation.
Abstracted by: Eric L. EffmannE-mail: [email protected]
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