RESUMO
PURPOSE: Recurrence is the most common complication after an initial episode of primary spontaneous pneumothorax (PSP). However, preventive surgery in children remains a controversial issue. The purpose of this study was to determine predictive factors of recurrence to better inform early surgical referrals. METHODS: We retrospectively reviewed all consecutive patients under 18 years of age who conservatively treated for an initial episode of PSP between March 2005 and September 2011. RESULTS: One hundred fourteen patients were included in this study. The mean follow-up period was 43.1 months. Ipsilateral and contralateral recurrence developed in 47.3% and 14.0% of patients. The risk of ipsilateral recurrence for patients with or without air-containing lesions according to high-resolution computed tomography (HRCT) was 60.3% and 31.4%. In the multivariate analysis, the presence of air-containing lesions on HRCT scans and bullae on chest X-rays were independent risk factors for ipsilateral recurrence. CONCLUSION: The presence of bleb or bullae on HRCT scans or chest X-rays after an initial episode of PSP was significantly related to the ipsilateral recurrence in children. If the risk factors are clarified in further studies, hospital stays and the recurrence of PSP after the first episode could be reduced with early video-assisted thoracoscopic surgery.
Assuntos
Pneumotórax/terapia , Prevenção Secundária/métodos , Adolescente , Fatores Etários , Distribuição de Qui-Quadrado , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Tomografia Computadorizada Multidetectores , Análise Multivariada , Pneumotórax/diagnóstico , Pneumotórax/cirurgia , Modelos de Riscos Proporcionais , Recidiva , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Cirurgia Torácica Vídeoassistida , Fatores de Tempo , Resultado do TratamentoRESUMO
A 76-year-old man presented with chest discomfort. On coronary angiography, subtotal occlusion in the mid-right coronary artery (RCA) and 60 % tubular stenosis in the distal RCA were revealed. Two intracoronary stents could be placed in the RCA without any difficulty. However, the guidewire could not be removed. The intraoperative finding showed that the guidewire had become entrapped in the coronary stent. The guidewire was successfully removed and emergency coronary bypass grafting was performed.