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PubMed2002

[Pulmonary sequestration].

UNLABELLED: Pulmonary sequestration is rare and serious dysplasia, which has clinical signs of pneumonia and respiratory distress syndrome and radiological signs of polymorphic shadows. Pulmonary sequestration masses have autonomic blood supply. For confirmation of the diagnosis we use ultrasound examination, CT scan, MRI, angiopulmography and aortography. AIM OF THE STUDY: To present pathogenesis, diagnostic features and surgical treatment tactics of rare and serious pulmonary dysplasia. MATERIAL AND METHODS: During the period of 1979-2002, we have examined and treated 9 patients because of pulmonary sequestration. We analyzed clinical signs, results of the examination before operation, indications for operation and results of surgical treatment. RESULTS: Seven patients after the operation recovered, 1 patient died due to infection and cardiovascular complications. One patient is supposed to be operated on in the near future. CONCLUSIONS: 1. Pulmonary sequestration is rare and serious bronchial - pulmonary dysplasia, which has clinical signs of pneumonia and respiratory distress syndrome and radiological signs of polymorphic shadows. 2. Pulmonary sequestrations are classified as intralobar, extralobar and extrapulmonary sequestration. 3. Pulmonary sequestration is often associated with cardiovascular dysplasias and diaphragmatic malformations. 4. Methods of examination: X-ray examination, CT scan, MRI, ultrasound examination, aortography. 5. Complications of pulmonary sequestration: pneumonia, pleuritis, necrosis of the sequestration, chylothorax, respiratory distress syndrome, hemothorax, cystic transformation, and pneumothorax. 6. Treatment - surgery or embolisation of abnormal supply vessels.

Angiography↗
PubMed2002

[A case of pulmonary arteriovenous malformation treated by transcatheter embolization using coils].

The patient was a 21-year-old woman who, at 16 years old, had had no subjective symptoms. She was referred to our hospital because of abnormal shadows in the middle of the left lung that were seen on a chest radiograph during a school medical screening. In her first examination at our hospital, CT revealed tumor-like shadows with diameters of 2.0 cm in Lt-S6 and 0.5 cm in Rt-S5, together with arteries and veins. Lung ventilation and blood flow scintigraphy was used to obtain images of both kidneys and the head, and as a result, a pulmonary arteriovenous malformation (PAVM) was diagnosed. Because of a low shunt fraction of 10.8%, the patient was only kept under observation. However, at 21 years of age, she complained of dyspnea with exercise and was admitted to the hospital for further examination. Chest CT showed an increase in the diameter of the arteriovenous malformation (AVM) to 2.7 cm, and 3-D image reconstruction clearly revealed the position of the tumor in relation to the pulmonary artery and vein. The shunt fraction had increased to 18.3%. Coil embolization was therefore performed to A6b, the artery feeding the AVM (using interlocking detachable coils of 6 mm-10 cm and 8 mm-20 cm, and Trufill coils of two 7 mm-6 cm and 5 mm-4 cm). The patient had no serious postoperative complications. A decreased AVM diameter of 1.7 cm and an improved shunt fraction of 11% were observed, and she was discharged from the hospital. Since then, she has been well, without dyspnea, and her chest films show only coils and no aggravation of other AVMs. AVMs generally have no symptoms, but they can cause severe complications such as hypoxia from a right-to-left shunt, hemoptysis, hemothorax, and brain abscesses. Coil embolization should be considered more often for the treatment of AVM because it is safer, more effective and less invasive than traditional operations.

Adult↗
PubMed2001

Pitfalls and complication avoidance associated with transthoracic endoscopic sympathectomy for primary hyperhidrosis (analysis of 2200 cases).

BACKGROUND: Transthoracic endoscopic sympathectomy (TES) has been already a standard method for the treatment of primary hyperhidrosis. There are rare reports about possibly encountered problems during TES. Therefore, we present our experience in treating palmar and axillary hyperhidrosis and discuss the resoluble methods of potential problems during and after TES. PATIENTS AND METHODS: From June 1994 to October 1999, there were 2200 patients with palmar or axillary hyperhidrosis underwent TES. There are 926 males and 1274 females. Their mean age was 23.4 years old (range: 5-65). All except 12 patients were placed in half-sitting position under single or double-lumen intubation anesthesia. Either a 6-mm or 8-mm, 0degrees thoracoscope, (Karl Storz, Germany) was used to perform sympathectomy thru 0.8 cm incisions below each axilla. Ablation of T2 ganglion was performed in treating patients with palmar hyperhidrosis. Ablation of T3 and T4 ganglia was performed for patients with axillary hyperhidrosis. All except 22 patients were discharged 4 hours after TES, and returned to their activities within one week. RESULT: Successful sympathectomy were achieved up to 2178 patients (99%), but the rates of incidental unusual findings and possibly encountered problems during TES were 5.6% and 7.1% alternatively. Surgical complications included pneumothorax (10 patients, 0.45%), Hemothorax (2 patients, 0.09%) segmental atelectasis (12 patients, 0.55%), mild wound infection (3 patients, 0.14%) and compensatory sweating (1936 patients, 88%). There was no surgical mortality case. But pleural adhesion (54 patients, 2.45%), repeat sympathectomy (27 patients, 1.23%), obscured upper sympathetic trunk by adipose tissue (22 patients, 1%), medially located sympathetic trunk (18 patients, 0.81%), great vessels overriding or close to the sympathetic trunk (15 patients, 0.68%), aberrant vessels (3 patients, 0.14%), transient bradycardia (3 patients, 0.14%) and re-expansion pulmonary edema (1 patient, 0.05%) might occur during TES. CONCLUSION: Potential complications may happen during and after TES. But nearly all endoscopic sympathectomy could be achieved if surgeons acknowledge possible anatomic variation and has ability to overcome pleural adhesions.

Adolescent↗
PubMed1992

[Diagnosis and treatment of complex closed chest injuries].

The results of treatment of 256 patients with complicated closed chest injury are discussed. Multiple fractures of the ribs were found in 178, closed pneumothorax in 127, pneumohemothorax in 71, isolated hemothorax in 55, and rupture of the diaphragm in 3 patients. Most patients received nonoperative treatment, 5 patients (6.1%) needed emergency thoracotomy. Early drainage of the pleural cavity, endoscopic (thoracoscopy, bronchoscopy) methods of treatment, mechanical stabilization of floating rib fractures made it possible to improve the results and reduce the terms of treatment. Two (0.8%) persons died from shock and cardiopulmonary insufficiency.

Adolescent↗
PubMed2003

Inflammatory responses and CNS injury: implications, prophylaxis, and treatment.

EXCERPT: Early detection of perioperative stroke is essential if there is to be any opportunity to improve outcome. If there is suspicion of cerebral embolic stroke, scanning with computerized tomography can rule out acute hemorrhage and demonstrate diagnostic changes in a majority of patients within 5 hours of onset of symptoms. Strategies for reperfusion of ischemic tissue may include intraarterial thrombolysis in select patients with acute ischemic stroke even after recent cardiac operation. In one series, 13 patients with acute ischemic stroke within 12 days of cardiac operation underwent intraarterial thrombolysis within 6 hours of stroke symptom onset. Recanalization was complete in 1 patient and partial in 5, and 7 patients had low flow. Neurologic improvement occurred in 5 patients (38%). One patient needed a chest tube for hemothorax; 2 others received transfusions for low hemoglobin. No operative intervention for bleeding was necessary. In addition to thrombolysis, mechanical clot removal may be attempted. Thromboaspiration requires favorable anatomy and a fresh nonadhesive clot. It reduces the time for recanalization, has no hemorrhagic risk, and may prevent distal clot migration. Thromboaspiration may be attempted as an adjunct or alternative to intraarterial fibrinolysis for basilar artery recanalization. If massive cerebral gas embolism is suspected and hyperbaric facilities are available, confirmation can be obtained by early single-photon emission tomography (SPET) and hyperbaric oxygen therapy instituted. This process was successfully undertaken in a case of paradoxical air embolism in a patient undergoing percutaneous nephrolithotripsy in the prone position and presenting with blindness and neurological deficits 8 hours later. Treatment with hyperbaric oxygen therapy was successful in this case.

Animals↗
PubMed2003

[Ruptured bronchial artery aneurysm; report of a case].

A 74-year-old man who went into shock following an acute hemomediastinum and left hemothorax was operated on. Postoperative angiographies revealed a saccular aneurysm of the left bronchial artery of 2.0 cm in diameter. Sixty days after the initial operation, the aneurysm was resected under F-F bypass. A saccular aneurysm was found at the root of the left bronchial artery, which had a very short segment between the aneurysm and the aorta. Pathological study of aneurysm revealed thinning of the wall and lack of tunica media.

Aged↗
PubMed2003

Delayed treatment of contained blunt traumatic aortic rupture: a case of rupture treated by endoprosthesis.

A 45-year-old man sustained an intracerebral frontal hematoma and a contained aortic isthmic rupture in a head-on automobile collision. Due to the intracerebral hemorrhage, open repair was contraindicated. Treatment with a stent graft was selected but delayed until the next morning, because the correct stent size was unavailable. Two hours before the time scheduled for surgery, the patient experienced oxygenation problems and became hypotensive. Chest radiography revealed a new, severe left hemothorax. Fortunately, the stent graft had just arrived from the manufacturer, and it was deployed to seal the ruptured aorta. Immediate angiography showed good stent-graft position without any endoleak as did a computed tomographic scan 2 days after the procedure. The patient was transferred to a rehabilitation unit to recover from his neurologic trauma. A 3-month follow-up computed tomographic scan showed the patient's condition to be unchanged.

Aortic Rupture↗
PubMed1992

[Endovenous thrombolysis in acute myocardial infarct. The experience in a community hospital. An analysis of 120 patients].

PURPOSE: To demonstrate the experience with thrombolytic therapy in a community hospital without a cardiac catheterization laboratory. METHODS: One hundred and twenty patients with EKG evidence of acute myocardial infarction with less than 6 hours of pain entered the study. They were retrospectively subdivided into two groups: group 1 (n = 96) received streptokinase and group 2 (n = 24) received rt-PA. RESULTS: One hundred and twenty patients were analysed. Ninety six (80%) received SK and 24 (20%) received intravenous rt-PA. Infarct side was anterior in 57 cases (47.5%) and inferior and/or lateral in 63 (52.5%). Coronary-angiography performed prior the discharge in reference hospital demonstrated patency of culprit vessel in 69 patients (80%) treated with SK and in 22 (91%) treated with rt-PA. According to clinical and angiographic data 60 patients (50%) were managed with medical treatment, 31 (25.8%) were submitted to angioplasty of the culprit artery and 29 (24.1%) underwent coronary bypass surgery. The complications were intracranial hemorrhage in 2 cases (1.6%), 1 post SK (1.0%) and 1 post rt-PA (4%); both of these patients died; reinfarction occurred in 4 patients and in 3 of them SK infusion was repeated successfully. There were no reinfarction in patients receiving rt-PA; major bleeding requiring blood transfusion occurred in 2 patients (1.6%); 1 patient developed hemothorax post SK and another one treated with rt-PA developed hematoma of left inferior limb. Eleven patients (9.1%) died during the hospital stay; 2 patients died of intracranial hemorrhage, 7 of cardiogenic shock and 2 had sudden death. The mortality rate in patient with anterior wall infarction was 15.7%, whereas it was significantly lower in the remaining patients (3.1%, p < 0.05). Only 4 patients over the age 75 received thrombolysis and 2 of them (50%) died. CONCLUSION: Intravenous thrombolytic therapy was safe and feasible in a community hospital without cardiac catheterization facilities. We observed only 2 fatal complications (1.6%) directly related to drug management (intracranial hemorrhage). The hospital mortality was 9.1%, including patient undergoing angioplasty of surgery following thrombolytic therapy.

Adult↗
PubMedDate not supplied

[A subcutaneous thoracic abscess due to the aspiration of an ear of grain].

The paper deals with a child aged 9 years, with spastic then productive cough and moderate haemoptysis. X-ray picture shows a condensation process at the bottom of the right hemothorax. A subcutaneous abscess is registered 10 days after hospitalization. At the abscess incision, a wheatear inhaled previously by the child is found out.

Abscess↗
PubMed1992

Managing complications of posterior spinal instrumentation and fusion.

Complications of posterior spinal instrumentation for adolescent idiopathic scoliosis are often preventable. Preoperative planning helps to minimize intraoperative and postoperative problems. Late recurrence of rotational deformity (crankshaft) in skeletally immature patients can be prevented by adding anterior surgery. Intraoperative complications are minimized by controlled hypotensive anesthesia and sequencing of surgical steps to allow for autocoagulation, reducing blood loss. Use of spinal cord monitoring, Stagnara wakeup test, and careful distraction decreases the risk of neurologic deficit. Good hook-site preparation helps avoid dural tears. The incidence of postoperative pneumothorax and hemothorax is decreased by careful hook attachment, avoiding pleural penetration, judicious use of rib excision thoracoplasty, and roentgenographic verification of central venous pressure line position. Postoperative recommendations include bed position at 30 degrees, frequent log rolling, incentive spirometry, early sitting and standing, early Foley catheter and nasogastric tube removal, prophylactic antibiotics, and prompt attention to wound infections. Postoperative orthotic wear, prescribed exercise, and activity restriction decrease the risk of early instrumentation failure and help correct early postoperative trunk imbalance. The late complications include suspected pseudarthrosis; this should be surgically treated again if there is persistent pain or marked loss of curve correction.

Adolescent↗
PubMedDate not supplied

Factors affecting postoperative mortality in abdominal trauma.

Records of 345 patients in whom laparatomies were performed because of blunt and penetrating abdominal trauma were reviewed retrospectively with respect to factors affecting mortality. One hundred and twenty-eight patients had blunt abdominal trauma (Group I), 114 patients had gunshot wounds of the abdomen (Group II), and 103 patients had stab wounds of the abdomen (Group III). Mortality rates were 14.8%, 12.3% and 1.9% in groups I, II and III respectively. The presence of head trauma especially if accompanied by hypotension in group I, and the presence of chest trauma (hemothorax and/or pneumothorax) and hypotension (less than 90 mmHg) in group II were associated with a high mortality rate (p less than 0.05). Of the two patients who died in group III, one had septic shock due to massive intestinal necrosis and the other had hemorrhagic shock due to multiple organ injury and bleeding from an injured internal thoracic artery as the cause of death.

Abdominal Injuries↗
PubMed1992

[A case of pulmonary rupture with primary pulmonary leiomyosarcoma--management by emergency surgical intervention].

We report a case of 18-year-old boy who was admitted to our hospital for hemoptysis and hemothorax caused by rupture in the pulmonary tissue. A tumoral mass was found protruding from the inferior aspect of the left lower lobe towards the diaphragma. A large hematoma was seen in the vicinity of the tumoral mass. An emergency left lower lobectomy was performed and the hematoma was removed. The tumor was yellow in color, soft and 7 cm in diameter. The histological diagnosis was that of primary pulmonary leiomyosarcoma. The resected lobe had a liver-like hard consistency due to extended infiltration of blood resulting from hemorrhages within the tissue located in and around the tumoral mass. Microscopically, the tumor was composed of the spindle-shaped cells with multinucleation along with some clear cell patterns. Recurrence of the tumor appeared six months after the operation, and a second resection of the recurrent leiomyosarcomatous tissue was performed. The patient is still alive for 1 year and 6 months after the first operation.

Adolescent↗
PubMed1992

[Extrapleural hematoma].

The authors report a case of a voluminous extra-pleural hematoma in relation to a fracture of the body of the eleventh thoracic vertebra on a 74 year-old man after craniothoracic injury. Thoracic CT Scan showed a homogeneous posterior parietal mass of tissue density (40 HU) outlined by a fatty lining associated with a fracture of the eleventh thoracic vertebra. This allowed a modification in the diagnosis of a hemothorax established previously on conventional radiography. The authors insist on the gravity of this affection when the volume of the hematoma is important. But this is very rare (6 cases out of which 5 were autopsic findings). If present it requise an urgent surgical treatment without forgetting the fiability of CT Scan which relies on putting into evidence the pleural lining sign.

Aged↗
PubMed2003

[Chest trauma: analysis of 592 cases].

INTRODUCTION: Thoracic traumas constitute an important part of the patients who are being admitted to the emergency units and deaths due to trauma. The aim of this study was to compare our clinical experience and results of the literature. METHODS: 592 patients with thoracic trauma who were admitted to our clinic between 1996 and 2000 were evaluated retrospectively. RESULTS: 449 patients (75.8%) had blunt and 43 patients (24.2%) had penetrating thorax trauma. There was rib fracture in 448 patients (75.7%), clavicula fracture in 55 (9.2%), scapula fracture in 31 (5.2%) and sternal fracture in 20 (3.4%). In addition, flail chest was detected in 79 cases (13.3%). The most frequent complications were pneumothorax (n: 158; 26.7%), and hemothorax ( n: 119; 20.1% ). Three hundred and thirty - nine patients (57.2%) were treated by tube thoracostomy and 190 by conservative management (32.1%). Surgical treatment was performed in 99 (16.7%) patients. Morbidity was 18.4% ( n: 109 ) and mortality, 6.4% ( n: 38 ). Mean hospital stay time was 13.4 days (2 - 93 days). CONCLUSION: Thoracic traumas can cause vital organ injuries and impaired cardio-respiratory hemodynamics should be treated immediately.

Adolescent↗
PubMedDate not supplied

[Lung resection in the elderly: some limits].

INTRODUCTION: A progressive and constant increase of mean life duration in the last century has determined the challenge of the treatment of lung cancer even in the elderly with good functional status. The aim of the present study is to evaluate the results obtained in the elderly, over seventy years old, who underwent pulmonary resection at our Division of Thoracic Surgery of Polyclinic of Bari from 1985 to 1995. PATIENTS AND METHODS: 938 patients with NSCLC have been operated on, from January 1985 to December 1995. 189 were over seventy and 19 were over eighty years old. We have performed the following surgical procedures: 21 pneumonectomies, 108 lobectomies/bi-lobectomies, 44 wedge resections, 16 staging thoracotomies. RESULTS: Post-operative complications were as follows: atelectasis 57, air leak 37, empyema 9, broncho-pleural fistula 3, arrhythmia 103, pulmonary edema 8, cardiac ischemia 3, pulmonary embolisms 1, delirium 2, hemothorax 3, exitus 5. There were 3 deaths caused by acute myocardial ischemia, one by pulmonary embolism, one by main right bronchus broncho-pleural fistula. Two and five-year overall survival were 67.1 and 37.8, respectively. CONCLUSION: Diagnostic and therapeutical procedures for lung cancer should be different in the elderly. In our experience, main post-operative complications were cardiovascular, consequent to the entity and duration of surgical operation and intra-operative blood leaks. The elderly require a more careful post-operative monitoring to prevent this kind of complications.

Aged↗
PubMed1992

Percutaneous internal jugular vein catheterization with double lumen for temporary hemodialysis: experience of 100 cases.

We studied a total of 100 patients (46 men, 54 women) with renal failure requiring hemodialysis therapy by using double lumen catheter for temporary vascular access through the internal jugular vein. Fifteen patients had acute renal failure and 85 patients had end stage renal disease (including 27 cases of DM nephropathy). The mean length of time the catheter was in situ was 18.7 +/- 11.1 days (2-67 days); the mean frequency of the hemodialysis performed through this access was 7.8 +/- 4.6 (1-27). Recirculation rate was 7.19 +/- 2.68% (3.2-10.7%). The blood flow during hemodialysis was 180-200 ml/min. There was no catheter related mortality. The most common complication was catheter related septicemia (4%). Local infection of the catheter entry site occurred in 3 cases. Inadequate blood flow was detected in 3 cases. Two episodes of arrhythmia (atrial premature contractions, short runs of ventricular tachycardia) developed during the first hemodialysis procedure. Hematoma due to accidental puncture of the carotid artery was noted in one case. Neither pneumothorax nor hemothorax was detected. Our experiences revealed that the percutaneous internal jugular vein catheterization with a double lumen catheter is a safe and efficient temporary vascular access for hemodialysis.

Adolescent↗
PubMedDate not supplied

[The complications of puncture catheterization of the subclavian vein and their diagnosis].

The authors describe 21 complications which occurred in puncture catheterization of the subclavian vein in 1,276 (1.65%) patients. They varied widely in character--hemothorax, pneumothorax, thrombosis of the subclavian vein, etc. The case record of one patient with traumatic pneumothorax after puncture catheterization of the subclavian vein is discussed in detail.

Acute Disease↗
PubMed2003

Improved results using ultrasound guidance for central venous access.

Central venous cannulation is an essential part of patient management in a variety of clinical settings. The complications of cannulation may be as high as 10 per cent and include arterial puncture, pneumothorax, hemothorax, cardiac tamponade, hematoma, malposition of catheter, nerve injury, and death. Standard technique for placement of central venous catheters is by use of a blinded, external landmark-guided technique. Success rates and complication rates vary according to the technique employed. Ultrasound use in general surgery has gained popularity and is now readily available in most operating suites. A prospective study was conducted to evaluate the feasibility of ultrasound-guided placement of central venous access devices. Ultrasound guidance was used to place central venous ports for chemotherapy in 29 patients. Catheters were placed using a handheld ultrasound (7.5 MHz, linear probe, Aloka, Wallingford, CT) with the Seldinger technique. The internal jugular vein was used as the primary site. Accurate placement within the superior vena cava was confirmed with fluoroscopy. All procedures were performed under local anesthesia with intravenous sedation. The data analyzed included length of procedure, complications, and success rates. The right internal jugular vein was used in all but 4 of our patients. In 2 of those patients, the left internal jugular was chosen initially. In the other 2, anatomical variants were discovered requiring a modification of technique to cannulate the right internal jugular vein. Overall, ultrasound led to a change in management in 14 per cent of patients. The average time for placement was 30 minutes (range, 22-42 minutes). There were no failures in placement or misplacement of the catheters. Detection of anatomy prior to venipuncture and direct real-time visualization are the keys to success with ultrasound guidance. This study shows that placement of central venous catheters, using ultrasound guidance, may be done in a timely manner while minimizing risks and maximizing success.

Adult↗