[Pneumonia complicated with empyema in children, to operate or not? Risk factors for surgery and review of the literature]. / Neumonía complicada con empiema en niños, operar o no operar? Factores de riesgo para cirugía y revisión de la literatura.

The precise indication for surgery for pleural empyema is still a controversy. With the aim of identifying the risk factors associated with surgery in pediatric patients with empyema post-pneumonia, a retrospective case control study was performed. From 1992 to 1996, 18 children underwent surgery (cases) and 12 did not (controls). The analyzed variables were those mentioned in the literature as risk factors. More than 25 days of evolution, more than three antibiotic schemes, fever, empyema organizing phase, two or more chest tubes lasting more than nine days, multiple loculations, trapped lung and paquipleura were associated with thoracostomy and decortication (p < 0.05). We conclude that a pediatric patient with a late referral to the hospital, empyema organizing phase, and multiple loculations with large purulent collections no longer susceptible to drainage and complications that impair lung expansion will probably require major surgery.

[Severe respiratory failure secondary to vascular ring. Report of 2 cases]. / Insuficiencia respiratoria grave secundaria a anillo vascular. Informe de dos casos.

Vascular compression of the airways is an infrequent situation that can be masked by inespecific respiratory symptoms. We present two cases with severe respiratory distress, that needed assisted mechanical ventilation in patients with overdistended lungs which improved when the endotracheal cannula was shifted near the carina. The chest radiograph showed hyperinflation of the lungs; an identation was demonstrated in the esophagogram and the endoscopy demostrated extrinsic esophagical compression. The angiogram documented double aortic arch in the first case and aberrant subclavia artery in the second. Vascular section and liberation of trachea and esophagus were performed with good outcome. The decrease of thoracic overdistention when the cannula was placed in the lower part of the trachea gave the clue to the diagnosis of vascular ring. A high index of suspicion is necessary for an early diagnosis.