Management of primary spontaneous pneumothorax in Chinese children

OBJECTIVES

To (1) determine the demographics of Chinese children admitted with primary spontaneous pneumothorax, (2) suggest how they may be quantified radiologically, (3) compare the difference in outcomes after their primary management by thoracentesis and chest tube insertion, and (4) review the local experience with surgical intervention for such children.

DESIGN

Retrospective, descriptive study.

SETTING

Acute tertiary public hospital, Hong Kong.

PATIENTS

Consecutive patients younger than 18 years and admitted with primary spontaneous pneumothorax between 1 January 1999 and 30 September 2007.

MAIN OUTCOME MEASURES

Hospital stay and risk of recurrence after thoracentesis versus chest tube insertion. RESULTS. Seventy-seven patients with 114 episodes of primary spontaneous pneumothorax were reviewed. They were significantly taller (P<0.001) and thinner (P<0.001) than the population mean percentile. Both the Light index and Collins formula were accurate in quantifying pneumothorax volume, but as the former was simpler and more user-friendly, this was more applicable in children. Thoracentesis resulted in shorter hospital stays (mean, 4.6; standard deviation, 1.9 days) than chest tube insertion (6.9; 3.0 days), but there was no significant difference in the recurrence rates within 6 months (P=1.0), 1 year (P=0.9), and 2 years (P=0.1). Insignificant pneumothorax was treated with observation alone in 16% of the patients. For patients with a clinically significant pneumothorax, thoracentesis and chest tube insertion were successful in 78% and 67%, respectively (P=0.34). The success rate of video-assisted thoracoscopic surgery was 89%, and postoperative recurrence occurred more commonly in patients without a lung bleb.

CONCLUSION

Chinese children with primary spontaneous pneumothorax exhibited similar demographic characteristics to Caucasian children. Light index is simple and accurate for quantifying pneumothorax volume in children. Conservative treatment including observation, thoracentesis, and chest tube insertion should suffice for most patients with first episode of primary spontaneous pneumothorax. Early surgery is warranted for any patient who fails conservative treatment, for which video-assisted thoracoscopic surgery is safe and effective.

Mammary angiosarcoma in two patients at either end of the age spectrum

Angiosarcoma of the breast is rare and has a poor prognosis due to its aggressive nature. This is a report of two patients with mammary angiosarcomas, each with different clinical presentations, and at either end of the age spectrum. One is an 18-year-old woman who presented with a rapidly enlarging breast mass, and the other a 72-year-old woman whose breast mass was found during screening mammography. The radiological features of mammary angiosarcoma are summarised in this report.

Predicting bone scan findings using sPSA in patients newly diagnosed of prostate cancer: feasibility in Asian population

OBJECTIVE

A number of large-scaled studies done in Western countries have proven a positive relationship between serum prostate-specific antigen (PSA) level and prevalence of positive bone scan findings in newly diagnosed prostate cancer (CaP) patients. The objective of this study is to verify that the tendency occurs as well in Asian population, as well as to establish a possible correlation between PSA level, bone scan result, and Gleason score.

METHOD

Records of 116 patients diagnosed to have CaP were reviewed retrospectively for bone scan results, PSA levels, and Gleason score.

RESULT

Thirty-four patients were proven to have bone metastases based on positive bone scintigraphy result. None of these patients had a PSA level of less than 10 ng/ml. Two patients had PSA level between 11 and 20, and 15 patients had PSA level between 21 and 200. For patients with PSA level over 201, 17 had bone metastases on bone scintigraphy.

CONCLUSION

Based on the PSA level, the likelihood of positive bone scintigraphy result can be postulated. According to PSA levels, staging investigations can be more selective for patients with confirmed CaP. The risk of having positive bone scan is so low that it is not required for patients with PSA level less than 10 ng/ml. On the other hand, on studying the correlation between Gleason score and PSA level or bone scan results, no statistically significant relationship was established.

Hepatic portal venous gas complicating septic thrombophlebitis of the superior mesenteric vein

Hepatic portal venous gas is a rare radiological finding with a wide spectrum of underlying pathologies. We describe a case of hepatic portal venous gas due to septic thrombophlebitis of the superior mesenteric vein. The clinical management of portomesenteric venous gas and the importance of computed tomography in delineating its underlying causes are discussed.