Five-year outcome of non-shunting and primary closure technique during carotid endarterectomy: a longitudinal cohort study.

OBJECTIVE: The long-term outcomes of primary carotid artery closure after carotid endarterectomy (CEA) have not been sufficiently studied. This prospective study was performed to analyze the 5-year outcomes of the non-shunting and primary arterial repair technique for CEA. METHODS: This study involved 150 patients who underwent CEA with the primary arterial closure technique without arterial shunting and completed 5 years of follow-up. RESULTS: The patients comprised 107 men and 43 women. The 30-day postoperative course was uneventful in 147 (98.0%) patients; however, cerebrovascular accidents occurred in 3 (2.0%) patients. With respect to the long-term results, most cases of restenosis at 5 years were <50%. Two patients developed asymptomatic total internal carotid artery occlusion. Eleven deaths occurred (mortality rate of 7.3%); one death (0.7%) occurred in the first 30 days. CONCLUSION: Primary arteriotomy closure provides very good long-term patency. Routine use of patch closure is unnecessary.

Metachronous recurrent pediatric primary spontaneous pneumothorax: A case presentation and literature review.

INTRODUCTION: Pediatric primary spontaneous pneumothorax (PSP) is defined as the presence of air in the pleural cavity without underlying lung disease or thoracic trauma. Metachronous recurrence of PSP whether ipsilateral or contralateral is rare. Apical bullae and sub-pleural blebs are found in the majority of PSP patients. As in adults, surgery is indicated in cases with prolonged air leak. Video-assisted thoracoscopic surgery (VATS) is increasingly performed in children and has been reported to be both safe and effective. PRESENTATION OF THE CASE: An 11-years-old girl had bilateral attacks of PSP, the second attack happened one after the first one and this later was associated with her menarche. Chest CT scan detected bilateral apical blebs. DISCUSSION: Contralateral recurrence in pediatric PSP is a low probability. The decision for surgery in the pediatric age group is a matter of controversy as there are no strict pediatric guidelines for management of PSP. Currently, VATS is superior to open surgery. Pediatric Catamenial pneumothorax is not well described in the literature. CONCLUSIONS: Contralateral recurrence of PSP in children is rarer. No guidelines exist for the management of these cases. The association of pediatric PSP with menarche is not well described in the current literature.