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At least 307 records · Page 17Linked to original sources
PubMed2004

Changing dogmas: history of development in treatment modalities of traumatic pneumothorax, hemothorax, and posttraumatic empyema thoracis.

Development of treatment modalities for chest wounds and traumatic empyema thoracis is reviewed in the light of war experience. Mortality from thoracic injury was more than 50% before World War I and was about 25% during World War I. It came down to 10% in World War II and was about 5% during the Korean War. It improved further during the Vietnam War, until it ranged at 2% to 4%, where no further improvement could be imagined. Thoracic surgery was born in the field hospitals of World War I. Established drainage methods and standardized anesthesia made thoracotomy a standard procedure in World War II. As experience increased in chest trauma, surgical aggression diminished. Drainage ruled primary chest trauma treatment algorithms during the Vietnam War and coexisted with the full arsenal of cardiothoracic surgery when it was needed. Optimization of thoracic surgical aggression includes a case-tailored approach when major chest surgery with or without interventions on the central cardiovascular system is needed. This is where we are now, provided a proper logistic, Medevac system exists. If we let the past fade away, the danger of committing the mistakes of our predecessors increases without having their excuses. Our present is only the past of the future.

Empyema, Pleural↗
PubMed1986

[Hemothorax disclosing hemorrhagic necrosis of a pheochromocytoma: circumstance for detection of multiple endocrine neoplasia type IIa. Detection of 5 familial cases].

Whilst investigating 26 members of the same family, we discovered 5 cases of multiple endocrine neoplasia type II a. The present report demonstrates the diagnostic value of basal plasma thyrocalcitonin (TCT) assays, before and after stimulation with pentagastrin, and of plasma carcinoembryonic antigen (CEA) assays. Some of the clinical features encountered were novel--e.g. in one patient the phaeochromocytoma was revealed by a haemothorax with cardiovascular collapse--and others were peculiar; thus, in 4 cases the medullary thyroid carcinoma (MTC) was less than 2 cm in diameter and without lymph node or visceral metastases, even in patients aged 87, 59 and 56. More classically, MTC, always multifocal, was clinically silent, as were the two cases of phaeochromocytoma and hyperparathyroidism. Phaeochromocytomas were difficult to diagnose. Ultrasonic tomography did not prove very helpful and the disease was transmitted as an autosomal dominant trait. Finally, MTC secreted a variety of substances (TCT, CEA, beta-endorphin, somatostatin), and HLA A2-B15 antigens were found in 3 patients.

Adrenal Gland Neoplasms↗
PubMed1991

[Fibrinolytic activity in traumatic hemothorax fluids].

Twenty-nine patients, 15 to 85-year-old (mean: 50 years) who presented with a pleural effusion after trauma were studied. The blood content of pleural fluid was confirmed by thoracocentesis. None of the patients had been taking anticoagulant drugs during the fortnight preceding the trauma. Thoracocentesis was always carried out less than 90 min after the trauma. The following parameters were measured in the haemothorax liquid samples: clotting fibrinogen fraction (Fg C), fibrin degradation D-dimers, functional plasminogen, alpha 2-antiplasmin, alpha 2-macroglobulin, plasminogen tissue activator (tPA Ag), type 1 tPA plasma inhibitor (PAI), and haematocrit. Haemothorax liquid haematocrit values ranged from 13 to 35% (25 +/- 7%, with a mean peripheral venous haematocrit of 34 +/- 6%). Only three patients had some Fg C (0.05-0.13 g.l-1). The D-dimer level was very high (0.23 +/- 0.22 g.l-1). The other factors involved in fibrinolysis were also present. Moreover, there was a statistically significant inverse correlation between D-dimer and alpha 2-macroglobulin levels (r = -0.64, p less than 0.0025). These data suggest two possible mechanisms to explain the fibrinogen levels: coagulation is activated, followed by an important fibrinolytic reaction elicited by the large amounts of plasminogen and tPA present in the haemothorax liquid.

Adolescent↗
PubMed1994

[Autotransfusion, with blood drained from a hemothorax, using the ConstaVac device].

The technique of autotransfusion with blood drained from a haemothorax has been described nearly 80 years ago. The shed blood is easy to collect and is incoagulable. This technique as two indications: lifesaving autotransfusion in the prehospital phase and blood saving and/or transfusional safety at hospital arrival. This prospective study assessed its value as well as the advantages and disadvantages of the ConstaVac system in 30 patients suffering from haemothorax. This apparatus consists of a 800 mL collecting reservoir on a support equipped with an electric aspirator and a battery. The collected blood is transferred into a reinfusion bag while remaining in a closed circuit. The retransfused volume was 685 +/- 430 mL, representing 80% of the collected volume. The retransfusion took place in less than four hours. The patients with an isolated haemothorax did not receive any homologous blood. Only one technical problem occurred, related to the excessive volume of the haemothorax. The shed blood has decreased content of platelets, fibrinogen, and is incoagulable. Moreover, it is hemolyzed. Its hematocrit is lower than the patient's one. On the other hand, the concentration of 2,3 DPG remains normal. These modifications have no detrimental consequences on the patients as long as the autotransfused volume does not exceed two litres. Infectious problems are rare. Handling requires strict asepsis. The ConstaVac system is marketed for postoperative autotransfusion. It is compact, self-contained and very easy to use. It is the only system able of ensuring blood drainage and retransfusion simultaneously, without requiring any opening of the circuit.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1998

[Rupture of the intra-abdominal spleen as a cause of hemothorax].

We report a case of a 17-year-old patient with an haemothorax related to an intra-abdominal spleen rupture. The nature of this haemothorax is unusual and the problem is how to obtain the etiology in this case. The spleen was in intra-abdominal position on all radiological examinations and was the source of bleeding. Therefore, laparotomy is the only convenient therapy.

Accidents, Traffic↗
PubMed2006

[Spontaneous hemothorax: a rare but serious complication of intralobular pulmonary sequestration].

Pulmonary sequestration is a rare congenital malformation characterized by a non-functional portion of pulmonary parenchyma devoid of any connection with the bronchial tree and pulmonary artery. If not identified antenatally or at birth, the sequestration may not be discovered until complications, mainly repeated infections, arise. Hemorrhage is another but much rarer complication which is generally severe. We report a new case of intralobular pulmonary sequestration revealed by hemoptysis then massive hemothroax with shock requiring emergency thoracotomy for hemostasis.

Adult↗