RESUMO
INTRODUCTION: Determining the risk of recurrence of primary spontaneous pneumothorax is challenging. The objective of this study was to develop a risk assessment model to predict the probability of recurrence in patients with spontaneous pneumothorax. METHODS: A retrospective study was performed of all episodes of pneumothorax diagnosed in the last 12 years in a hospital, in patients not initially submitted to surgery. Logistic regression was used to estimate the probability of recurrence. Based on a set of variables, a predictive model was built with its corresponding ROC curve to determine its discrimination power and diagnostic precision. RESULTS: Of the 253 patients included, 128 (50.6%) experienced recurrence (37% within the first year). Recurrence was detected within 110 days in 25% of patients. The median of time to recurrence for the whole population was 1120 days. The presence of blebs/bullae was found to be a risk factor of recurrence (OR: 5.34; 95% CI: 2.81-10.23; p=0.000), whereas chest drainage exerted protective effect (OR: 0.19; 95% CI: 0.08-0.40; p=0.000). The variables included in the regression model constructed were hemoglobin and leukocyte count in blood, treatment received, and presence of blebs/bullae, with a fair discriminative power to predict recurrence [AUC=0.778 (95% CI: 0.721-0.835)]. CONCLUSION: The overall recurrence rate was high and was associated with the presence of blebs/bullae, failure to perform an active intervention (chest drainage) and low levels of hemoglobin and leukocytes in blood. Recurrence rarely occurs later than three years after the first episode. Once validated, this precision model could be useful to guide therapeutic decisions.
Assuntos
Pneumotórax , Humanos , Pneumopatias , Pneumotórax/diagnóstico , Pneumotórax/terapia , Recidiva , Estudos Retrospectivos , Tomografia Computadorizada por Raios XRESUMO
Pericarditis is the most frequent cardiac manifestation of systemic lupus erythematosus (SLE), but pericardial effusion rarely occurs as the only first clinical manifestation of SLE. We report the case of a male patient whose initial manifestation of lupus was a pericardial effusion. We comment on its clinical course and we reviewed in the medical literature different presenting features in SLE.
Assuntos
Lúpus Eritematoso Sistêmico/diagnóstico , Derrame Pericárdico/etiologia , Idoso , Humanos , MasculinoAssuntos
Resfriado Comum/diagnóstico , Infecções por Mycobacterium/microbiologia , Mycobacterium tuberculosis/isolamento & purificação , Complicações Pós-Operatórias , Parede Torácica/diagnóstico por imagem , Parede Torácica/microbiologia , Toracoplastia , Abscesso , Idoso , Idoso de 80 Anos ou mais , Anti-Infecciosos/uso terapêutico , Resfriado Comum/tratamento farmacológico , Humanos , Masculino , Infecções por Mycobacterium/tratamento farmacológico , Fatores de Tempo , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVES: To analyze the impact on the outcome of video-assisted thoracoscopic surgery (VATS) of delaying surgery in patients with previous episodes of pneumothorax. MATERIAL AND METHODS: We studied 57 surgical procedures for recurrent primary spontaneous pneumothorax. The cases were grouped according to the medical history. One group comprised patients treated surgically at the first episode of contralateral pneumothorax or the second episode of ipsilateral pneumothorax. The second group comprised patients treated surgically at the third or successive episode. We compared the 2 groups as to number of thoracotomies, number of conversions from VATS to thoracotomy, presence of adhesions, and length of postoperative hospital stay. RESULTS: Of the total number of procedures, 13.9% were performed during the third or successive episode. In this group the number of pleuropulmonary adhesions and the percentage of thoracotomies (whether initially indicated or conversions from VATS) was significantly higher (P<.05). However, there was no difference between the 2 groups in length of postoperative stay. CONCLUSIONS: VATS is the technique of choice for the surgical treatment of recurrent primary spontaneous pneumothorax. Such treatment should be performed at the first episode of contralateral pneumothorax or the second episode of ipsilateral pneumothorax since delayed surgery gives rise to a higher incidence of technical difficulties that entail thoracotomies.