Spontaneous hemopneumothorax in children: case report and review of literature

Spontaneous hemopneumothorax is rare, occurs in young adolescents, and can be life threatening secondary to massive bleeding. An adolescent with spontaneous hemopneumothorax and shock managed by tube thorascostomy is described here. We compared our case with published data of spontaneous hemopneumothorax in the pediatric age group. Spontaneous hemopneumothorax involves the accumulation of air and blood in the pleural space in the absence of trauma or other obvious causes. Spontaneous hemopneumothorax is usually seen in adolescents, more common in males than females. The common clinical features of spontaneous hemopneumothorax include dyspnoea and chest pain, and 30% present with hypovolemic shock. The bleeding can result from a torn adhesion between the parietal and visceral pleurae, from a rupture of vascularized bullae, or from torn congenital aberrant vessels. Over the last 6 decades, the treatment has progressed from the thoracotomy to minimally invasive techniques such as video assisted thoracoscopic surgery, with great reduction in mortality and recurrence rates. Although a rare entity, diagnosis of spontaneous hemopneumothorax must be considered in young adolescents presenting with spontaneous onset of chest pain and dyspnoea with radiograph findings of hydropneumothorax and/or signs of shock.     

Serious air gun injuries in children: update of injury statistics and presentation of five cases

There were over 70,000 injuries to children caused by air guns reported from 1981 to 1984. The majority of these injuries were minor; however, serious injury resulted in eight deaths. Reported injuries include corneal perforation, liver laceration, stomach and intestinal perforation, intracranial bleeding, cardiac perforation, and hemopneumothorax. Primary care physicians must be aware of the potentially serious or lethal nature of air gun injury and educate their patients accordingly. Legislation is also needed to restrict the sale of these guns, or increase the safety of air gun use. We report five cases of potentially life-threatening injury caused by air guns, three of which required emergency laparotomy.     

Pediatric bilateral spontaneous pneumothoraces in monozygotic twins

Primary spontaneous pneumothorax from subpleural bleb disease is an uncommon occurrence in pediatric patients. This is a rare case of monozygotic twins presenting at alternating intervals with a single-sided spontaneous pneumothorax, only to have it surgically corrected, and to present later with a subsequent contralateral pneumothorax. A review of familial spontaneous pneumothoraces occurring in children was queried for congenital or genetic syndromes. We concluded that a vast majority of pneumothoraces in children, like adults, are not spontaneous and not familial linked. While they are rare, some congenital syndromes have been identified. The HLA haplotype A2 B40, the gene encoding folliculin, Alph-1-antitrypsin, Marfan's syndrome, Ehlers-Danlos syndrome and Birt-Hogg-Dube syndrome have all been associated with familial spontaneous pneumothoraces. Physicians need to counsel family members to ensure appropriate observation and expedited treatment is not delayed.     

Spontaneous Resolution of the Septal Defects in Atrioventricular Septal Defect

It is known that atrial septal defects of the secundum type and ventricular septal defects may undergo spontaneous closure. However, it is not well recognized that atrioventricular septal defects may infrequently also undergo spontaneous resolution. We report one case of complete atrioventricular septal defect that underwent spontaneous closure of the ventricular component. We also describe one case of partial atrioventricular septal defect with almost complete spontaneous resolution of the interatrial communication. Presence of shunting across the defects is demonstrated by color Doppler echocardiography, along with later absence of shunting. The rate of spontaneous resolution is estimated.     

Spontaneous resolution of optic nerve coloboma-associated retinal detachment

We report a congenital neurosensory retinal detachment associated with an optic nerve coloboma with subsequent spontaneous reattachment. This represents the earliest reported case of such a clinical situation. An observation period is recommended for infants with this clinical course to allow for the opportunity of spontaneous reattachment.     

Spontaneous remission of acute lymphoblastic leukemia with mediastinal mass

Spontaneous remission/regression of cancer is defined as partial or complete disappearance of malignant disease temporarily or permanently in the absence of medical treatment. This event is named as spontaneous regression for solid tumors and spontaneous remission for leukemia. The authors report the case of a girl aged 4 years and 3 months, who presented with mediastinal mass and leukemic findings in the bone marrow both of which reappeared after spontaneous regression and remission, respectively.     

Spontaneous bladder rupture secondary to posterior urethral valves in a neonate

Bladder rupture is a rare cause of ascites in neonates. A review of literature revealed about 32 cases including both iatrogenic and spontaneous rupture. This case report describes a successfully treated case of spontaneous rupture of bladder with ascites in a neonate with posterior urethral valves.     

Spontaneous biliary perforation and necrotizing enterocolitis

A case of spontaneous bile-duct perforation in a 5-month-old boy with a history of necrotizing enterocolitis in his 1st week of life is reported. To our knowledge, this is the second case reported with such an antecedent, supporting a vascular etiology for some cases of spontaneous biliary perforation. Accepted: 7 July 1998     

Efficacy of synchronized IMV on weaning neonates from the ventilator

This study evaluated the efficacy of a new patient-triggered ventilator that triggered the patient's inspiratory effort by detecting the change in airflow by means of a ‘hot wire’ anemometer. This ventilator was used in both the conventional and the synchronzied intermittent mandatory ventilation (SIMV) modes in seven neonates. Values for blood gas, spontaneous breathing rate, tidal volume of spontaneous breaths and minute volume were compared in all seven neonates. The resistive work of spontaneous breathing in five neonates, obtained with synchronized intermittent mandatory ventilation was compared with the values obtained using conventional mechanical ventilation on the previous day of weaning from the ventilator. At each the inflation time studied (0.4, 0.3, 0.24 s), all mechanical breath occurred synchronously with infants' inspiratory efforts. The median trigger delay was 80 ms. Oxygenation was improved on the new system compared with the conventional system. Tidal volume of spontaneous breathing and minute volume were increased with SIMV compared with conventional mechanical ventilation, although the resistive work of spontaneous breathing was decreased with SIMV. The tidal volume of spontaneous breaths was more constant with SIMV versus conventional mechanical ventilation. Thus, the airway flow-triggered SIMV may lessen inspiratory muscle fatigue during weaning process. We conclude that the SIMV is useful in weaning neonates from the ventilator. oxygenation resistive work of spontaneous breathing synchronized intermittent mandatory ventilation wearing process.     

Bilateral internal carotid artery occlusions in a pediatric patient with refractory acute myeloid leukemia

Thromboembolism is a well‐known complication of cancer including acute myeloid leukemia (AML) especially in patients with high myeloblast counts. However, spontaneous vaso‐occlusion in the main arteries is very rare especially in patients with low blast counts and no pre existing vasculopathy. We report the case of a 3‐year‐old male with refractory AML who developed spontaneous bilateral internal carotid artery occlusion with diffuse cerebral infarcts. Strokes are rarely secondary to spontaneous carotid artery thrombosis and few cases have been reported in the literature. Pediatr Blood Cancer 2010;54:770–772. © 2010 Wiley‐Liss, Inc.     

婴幼儿自发性症状性癎性发作5年复发率的影响因素

目的调查婴幼儿自发性症状性癎性发作首次发作后的复发率及其复发的危险因素。方法收集苏州儿童医院2009年4月至2011年4月首次自发性症状性癎性发作婴幼儿的临床资料。每1~3个月随访一次,随访时间1~60个月。采用Kaplan-Meier乘积限法及Cox比例风险模型计算自发性症状性癎性发作复发率并分析复发危险因素。结果符合入选标准的首次自发性症状性癎性发作患儿共63例,首次发作5年后累积复发43例,5年累积复发率为69.4%。复发大多在首次发作后1年内,占总复发数的86%。多因素Cox比例风险模型分析提示,脑电图癎样放电是自发性症状性癎性发作复发的独立危险因素,风险函数比为5.349,95%可信区间为2.375~12.048。结论婴幼儿自发性症状性癎性发作首次发作后的复发率高;脑电图癎样放电为其复发的独立的高危因素,建议此类患儿进行抗癫癎治疗。     

Endogenous growth hormone secretion does not correlate with growth in patients with Turner's syndrome. Italian Study Group for Turner Syndrome

We investigated in Turner's syndrome patients whether the decrease in growth hormone (GH) secretion is frequent or sporadic, whether or not reduced GH secretion contributes to insufficient growth, and whether age, spontaneous presence of telarche and/or pubarche, karyotype and weight influence GH secretion decrease. We evaluated GH reserve in 301 patients by classical stimulation tests and in 68 of these patients mean nocturnal spontaneous secretion was also measured. Spontaneous telarche and/or pubarche were present in 33% of girls aged > 9 years. In 11% of patients, weight was more than 20% above levels appropriate for height. In 36.2% of patients (low-responders), we observed a reduction of the GH reserve (peak < or = 10 micrograms/l during two stimulation tests). Moreover, we noted reduced mean nocturnal spontaneous secretion (< or = 3.3 micrograms/l) in 61.8% of patients. Karyotype and the presence/absence of spontaneous telarche and/or pubarche did not influence either GH reserve or mean nocturnal spontaneous secretion. GH secretion (both GH reserve and mean nocturnal spontaneous secretion) did not influence height, yet low-responders had a significantly higher chronological age than normal-responders. Obese Turner's girls were low-responders and showed reduced mean nocturnal spontaneous secretion more frequently than normal weight girls; body mass index was significantly higher in patients with reduced GH secretion when compared to patients with normal GH secretion. We conclude that impairment of GH secretion is frequent in Turner's syndrome patients, especially if obese; that GH secretion impairment is not related to karyotype or spontaneous telarche and/or pubarche; that GH secretion is irrelevant to growth in these, patients and, therefore, its evaluation is unnecessary.     

婴儿自发性脑室出血诊治

目的探讨婴儿自发性脑室出血的病因和治疗方法。方法总结分析62例婴儿自发性脑室出血病例的临床资料。结果45例该症患儿行脑室外引流术等微创手术治疗,效果良好。结论婴儿自发性脑室出血病因以晚发性维生素K缺乏症为主,早期外科手术是该症有效的治疗方法。     

Pediatric spontaneous pneumothorax

The aim of this study was to review pediatric spontaneous pneumothorax and describe diagnostic and therapeutic approaches and to review our institutional experience with spontaneous pneumothorax. A medline search using keywords pneumothorax and pediatric in both French and English from 1988 through May 2002 was performed, and pertinent papers regarding the natural history, diagnosis, imaging, and therapy were reviewed. A 10-year chart review of spontaneous pneumothorax recording data on demographics, diagnostic imaging, therapeutic approach, and outcomes was performed. Only 4 case series and one review article were produced by the medline search involving exclusively pediatric spontaneous pneumothrax. One hundred ninety-six other articles involved adult series with a minority of patients under 18 years of age. A subset of articles from this adult-based group were examined to assist in formulating recommendations for diagnosis, imaging, treatment, and surgical management of pediatric spontaneous pneumothorax. Few articles on this topic report randomized studies in the adult literature and none in the pediatric literature. The chart review yielded 53 cases of spontaneous pneumothorax in 40 patients with important data presented in the current review. Although few articles are able to provide best-evidence information, the diagnosis, imaging, treatment, and surgical management of patients with primary spontaneous pneumothorax is achieved with good results. Stronger data specific to pediatric patients are needed.     

Spontaneous abortion rates, gravidity and neural tube defects.

Kline and her co-workers [20, 21] suggest that spontaneous abortions show no overall gravidity effect. However, spontaneous abortions seem to show a negative gravidity effect in some sibships (those containing an infant affected by anencephaly or spina bifida) [22]. It is inferred that there is a heterogeneity among spontaneous abortion sibships, and that there are other sibships in which spontaneous abortions show a positive gravidity effect (perhaps as a result of e.g. iso-immunization).     

Mitral Valve Chordal Rupture Masquerades as Endocarditis

Mitral valve chordal rupture is often associated with an inciting event. There are very few reported pediatric cases of spontaneous mitral valve chordal rupture. We describe a 9-year-old boy with a history of mitral valve prolapse who developed spontaneous mitral valve chordal rupture without evidence of endocarditis or trauma.     

极低出生体重儿动脉导管未闭转归的影响因素分析

目的分析极低出生体重儿动脉导管未闭(PDA)转归的影响因素。方法以2012年1月至2014年12月收治的194例极低出生体重儿为研究对象,根据心脏超声检查及治疗转归情况分为无PDA组,PDA自然关闭组、药物关闭组、手术关闭组,分析其临床及超声心动图特征。结果 PDA自然关闭率58.7%。自然关闭组的出生胎龄、出生体重、小于胎龄儿比例均大于药物和手术关闭组,药物及手术关闭组的新生儿呼吸窘迫综合征发生率及肺表面活性物质(PS)应用比例高于自然关闭组(P0.05)。不同时间段自然关闭组的动脉导管直径均明显小于药物和手术关闭组(P0.05)。多因素logistic回归分析示出生胎龄、PS应用及48 h动脉导管直径与PDA转归显著相关。自然关闭组PDA分流类型均以关闭型为主,而药物及手术关闭组在48 h以肺高压型及进展型为主,在4 d、7 d时均以进展型为主。结论极低出生体重儿PDA自然关闭率较高,出生胎龄越小以及应用PS的患儿自然关闭率越低;动脉导管直径越大且分流类型为进展型或脉冲型的PDA不易自然关闭。     

Familial spontaneous pneumothorax.

A family is described in which four persons in three generations suffered spontaneous pneumothoraces: a newborn, an infant, an adolescent, and an adult. Review of the literature reveals 61 reports of familial spontaneous pneumothorax in 22 families. The ratio of male to female cases is approximately 1.8. Affected parents and affected children (including affected fathers and sons) are seen in ten families, while affected siblings with unaffected parents are noted in 13 families. Consanguinity has not been reported. Although autosomal dominant inheritance has been suggested as an explanation of familial spontaneous pneumothorax, available pedigree data are not adequate for statistical analysis. Physicians should be aware of the familial occurrence of spontaneous pneumothorax so that members of such families may be appropriately managed when problems arise.     

Pneumomediastinum: a rare complication of anorexia nervosa in children and adolescents. A case study and review of the literature

Spontaneous pneumomediastinum is uncommon in paediatric practice. We describe two cases of spontaneous pneumomediastinum in a child and an adolescent with anorexia nervosa. Thorough investigation failed to reveal any underlying cause for secondary pneumomediastinum. Pneumomediastinum in anorexia nervosa can be caused by not only elevated intrathoracic pressures, but also by the poor quality of the alveolar walls due to malnutrition. The incidence of spontaneous pneumomediastinum in anorexia nervosa is probably higher than that recorded, since it resolves spontaneously and, therefore, it can remain undetected. We conclude that it is our considered opinion that malnutrition associated with anorexia nervosa predisposes for spontaneous pneumomediastinum due to weakness of the alveolar wall and the loss of connective tissue.     

Hyperthyroidism accelerates growth in Turner''s syndrome

Graves' disease in a girl with Turner's syndrome (karyotype 46,Xdel(Xp)) is described. Hyperthyroidism led to a pronounced acceleration of height velocity. During treatment with methimazole and L-thyroxine, height velocity normalized. The patient also developed spontaneous puberty with a clear-cut pubertal growth spurt. Final height, however, did not appear to be influenced either by Graves' disease or by spontaneous puberty.