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PubMed1990

Emergency autotransfusion in hypovolemia.

Autotransfusion as a technique in managing hypovolemia has been enjoying renewed popularity. Autotransfusion from hemothorax is the most common application of the procedure; this consists of collection, anticoagulation, and retransfusion. The advantages include compatibility, no time delay required in laboratory type and crossmatch, and no transmission of disease. The use of autologous blood in managing hypovolemia in chest trauma has proven to be a practical and beneficial adjunct to traditional fluid and homologous blood therapy and should be considered by every emergency department.

Blood Transfusion, Autologous↗
PubMed1987

Inhibitory effects of heparin plus cortisone acetate on endothelial cell growth both in cultures and in tumor masses.

A combination of heparin and cortisone acetate significantly inhibited both embryonic angiogenesis and the tumor growth of Lewis lung carcinoma (3LL) transplanted into C57BL/6 mice, although each of these agents used alone affected neither angiogenesis nor tumor growth. On the other hand, this combination neither decreased the number of metastatic foci in the lung nor prolonged the survival time of mice with 3LL. All tumor-bearing mice died of hemothorax due to pulmonary metastases. Cortisone acetate by itself increased metastasis, and addition of heparin did not affect accelerated metastasis. Because an antiangiogenic activity appears independent of metastasis acceleration by cortisone acetate, the use of steroids other than cortisone acetate having no metastasis-promotion effect should be required for an antiangiogenic tumor therapy in the presence of heparin. Heparin plus cortisone acetate prevented the DNA synthesis of cultured vascular endothelial cells but not that of cultured 3LL cells. Additionally, oral administration of this combination decreased the [3H]thymidine labeling of endothelial cells of tumor blood vessels prior to the suppression of tumor growth. The specific inhibition of the growth of endothelial cells by heparin plus cortisone acetate was revealed in both the in vitro and the in vivo tests.

Animals↗
PubMed1989

Isolated pulmonary blast injury in rats--a new model using the extracorporeal shock-wave lithotriptor.

Blast injury to the lungs is one of the most overwhelming threats to survival following exposure to powerful explosions. The pathophysiology of blast injuries differs significantly from other forms of trauma. Using the extracorporeal shock-wave lithotriptor, originally designed for the noninvasive treatment of nephrolithiasis, we were able to produce isolated, typical pulmonary blast effects in rats. The immediate mortality was associated with bilateral pneumothorax and hemothorax. A nonlethal dose of shock waves caused intra-alveolar and intrabronchial hemorrhages and an immediate 2- to 3-fold increase in the lung weight. Additional marked increase in lung weight started 12 to 24 hours later, consistent with the clinical picture of delayed respiratory insufficiency which occurs after a latent period of 12 to 48 hours in many blast casualties. The use of air-containing vest as a protective measure completely prevented blast injury to the lungs.

Animals↗
PubMed1989

[The management of chest injuries].

The mortality from chest injuries is so high due to severe physiologic imbalance that an immediate and accurate diagnosis of the injured organ and prompt treatment can salvage the patient from the strategy. This study comprises 1329 injured cases including 145 patients with crushed chests. The cause of injury was traffic accident in 537 cases (40.5%), fall or degradation in 332 cases (25%). There was a correlation between the cause of injury and age, as that traffic accident was a major one in young aged and fall in elders. Treatment against crushed patients included 150 surgical operations, 206 plaster bandages, 56 drainage of thoracic, peritoneal and cranial cavities. Thoracotomies performed in patients with flail chest (2), lung contusion (4), rupture of the bronchi and diaphragm (each 1) and for evacuation of clotted hemothorax in 3 patients. The prognosis of all these patients was good. Lastly we conclude that since the prognosis of injured patients depends on how fast the patient can be carried to the hospital and how quickly the physician or surgeon can evaluate the trauma and institute a prompt treatment, the education of the primary staff is the most important.

Accidents, Traffic↗
PubMed1989

[Split rib cranioplasty].

Presented are an operative technique and clinical indications for split rib cranioplasty, and the results of its practical application. This technique was applied to 6 patients, in five of whom infection after previous cranioplasty had been noted before split rib cranioplasty. Two patients out of the 5 had been suffering from inveterate and repetitive postoperative infections; one patient had been operated on twice and the other three times, respectively. Operative results were excellent without serious and/or infectious complications, except initially in one patient who presented hemothorax after rib harvest. This method can be applied for those who have extensive defect of the skull or who need additional reconstruction using split rib graft because of infectious complications after previously performed cranioplasty. This technique also has the following advantage; cranial contour is easy to reconstruct and good cosmetic results can be expected.

Adult↗
PubMed1989

[Fractures of the thoracic spine (T1-T10). Apropos of 105 cases].

Thoracic spine (T1-T10) fractures can be considered a specific entity owing to the anatomic features of the rib cage and the spinal canal. During a nine year period, the authors treated 105 such fractures. The thoracic spine fractures included 57 (54.2 per cent) compression fractures, 21 (20 per cent) comminuted (burst) fractures, 3 (2.8 per cent) flexion-distraction fractures, and 24 (23 per cent) fracture-dislocations. Five lesions, termed "fracture-dislocations by an oblique shearing force", were characterized by considerable displacement and the absence of neurologic injury. 35.2 per cent of the patients had injuries at multiple levels. The frequency of associated thoracic (26.5 per cent) and scapular injuries (20 per cent) reflected involvement of the entire thoracic cage. The frequency of neurologic impairment (30.4 per cent including 20 per cent complete paraplegia) reflects the particular vulnerability of the dorsal spinal cord. 32 per cent of the patients presented one or more thoracic effusions (hemomediastinum, hemothorax) related to parietal hematoma and/or hematoma at the fracture site. Functional management of 47 patients led to recovery of a painless spine without kyphotic deformity. Conservative treatment was often difficult because of associated parietal lesions; the 10 patients treated in this manner had only moderate reductions that maintained poorly in time, but had no major painful sequellae. A posterior approach was used for 42 patients with unstable or neurotoxic fractures because this permitted a complete decompression down to the posterior wall, when necessary by a "wide laminectomy". The anterior approach was reserved for purely anterior compression (3 cases) or residual compression after an initial posterior procedure (2 cases). Cotrel-Dubousset instrumentation (used in 7 cases) was particularly indicated because it offers the advantages of Harrington rods (31 cases) while providing better stabilization. This prevented later loss of reduction and obviated the need for a postoperative brace.

Adolescent↗
PubMed1989

Asymptomatic intrathoracic extramedullary hematopoiesis: a report of three cases.

Extramedullary hematopoiesis (EMH) is observed in people suffering from severe anemia of prolonged duration and appears to be a compensatory mechanism for disturbed medullary hematopoiesis. The hemoglobinopathies (such as thalassemia, spherocytosis, and sickle cell disease), neoplastic diseases such as leukemia and lymphoma, and others, including myelofibrosis and osteitis fibrosa cystica, are associated with EMH. These diseases and their resultant anemia have in common the ability to stimulate erythropoietin production, which in turn may stimulate hematopoiesis in organs of mesenchymal origin. The liver and spleen are the most common sites of EMH; however, other sites, including the falx cerebri, thoracic cavity, retroperitoneal area and pelvis have been reported. When present, intrathoracic EMH is most frequently associated with thalassemia. Spinal cord compression and hemothorax have also been reported as complications of intrathoracic EMH.

Adult↗
PubMed1989

[A case of spontaneous esophageal rupture treated with esophagectomy].

Although the rupture of the esophagus is frequently a catastrophic event leading to lethal consequences, the mortality and morbidity rate can be significantly lessened by early diagnosis and nutritional management. Early recognition and intensive treatment of this condition are essential and life saving. Multiple techniques, often complex, are necessary to treat the disease, especially when the diagnosis is delayed. A 52-year-old women suffered from severe back pain after vomiting during breakfast, and was admitted to our hospital. Next morning bilateral massive pleural effusion was recognized, and chest drainage tubes were inserted into the bilateral pleural cavity. Three days after admission, drainage fluid changed to be mucous and dark green. Esophagography with Gastrografin demonstrated leakage from right wall of the lower esophagus. A right thoracotomy was performed 83 hours after the onset. In the lower esophagus, there was a longitudinal tear 3 cm in length and the mediastinum was significantly inflamed. So we decided to perform esophagectomy and esophagogastrostomy through ante-thoracic wall route. The right pleural cavity was debrided and thoroughly irrigated with saline. After chest drain removal, right hemothorax occurred in the postoperative period, but she had good recovery and was discharged from our hospital 2 months after the esophagectomy.

Esophageal Diseases↗
PubMed1989

[Percutaneous biopsy of paracardiac masses].

Computed tomography was used to guide 55 biopsies on paracardiac masses. The authors' experience, gained with over 800 thoracic biopsies, points to CT as the method of choice for paracardiac masses, especially in those cases where the masses are located close to mediastinal and cardiovascular structures, which are not easily evaluated with fluoroscopy and, therefore, imply a greater bioptic risk. Furthermore, CT allows a more accurate needle trajectory to be selected than fluoroscopic guidance does. A diagnosis was reached in 47 of 55 cases, with 85% diagnostic accuracy. No complications such as hemoptysis, hemothorax, pericarditis and hemopericardium were observed. Only one patient required drainage after pneumothorax.

Biopsy, Needle↗
PubMed1989

[Recurrent dissection of aortic aneurysm with pulmonary complications].

The authors demonstrate a case of aorta aneurysm. The patient had survived despite the relatively rare and unfavourable complications presented in the observed consecutive aortic dissections. Both dissections had led to severe complications of the respiratory tract, to hemothorax and to hemoptysis.

Aged↗
PubMed1989

[Epidemiologic study of pleural effusion in a district].

The pleural exudate complicates many different diseases. With the aim of facilitating differential diagnosis, the authors conducted a prospective epidemiological study of individual types of exudates. In a catchment area of 44,000 inhabitants, the authors, in cooperation with general practitioners and other physicians from the local hospital found clinical and roentgenological signs of effusion in 0.32% of the total population in one-year period. The exudate was diagnosed in 93 living and 49 dead patients, where it was undiagnosed during lifetime. The highest frequency was noted in the cardiac effusion (46%), malignant effusion (22%) and pneumonic exudate (17%). The next most frequent effusions were found in cases of embolism, hemothorax, inductive effusion in abdominal affections, effusion due to uremia, myxedema and rheumatoid exudates. These findings are comparable only with the estimated incidence of pleural effusion made in the USA accompanying the underlying condition and occurring in approximately 0.5% of the population. Accurate data drawn from an epidemiological field study have not been found either in Czechoslovak or world literature.

Aged↗
PubMed1989

[A case report of ruptured thymic carcinoid].

A scarce case of a rupture of thymic carcinoid followed by hemothorax and mediastinal enlargement was reported. And the mechanism of rupture of thymic carcinoid was discussed comparing to 38 thymic carcinoid cases reported in Japan. A 61-year-old male who had been pointed out mediastinal tumor by chance in a chest X-ray developed a sudden onset of chest pain and dyspnea during an aortography in a hospital transferred to our center because the rupture of the tumor was suspected. Emergency median sternotomy revealed a rupture of a solid tumor with a lot of clot which originally located in the anterior mediastinum but perforated into the right pleural space. This may be the first report of the ruptured thymic carcinoid, so far as we know in Japan. Reviewing the reported cases, the tumor of carcinoid is generally large in size and poorly differentiated in histological study. In more than half of the cases, it is reported that intraparenchymal necrosis or hemorrhage is found. Therefore, it is considered that a thymic carcinoid is a tumor which may result in the rupture, and it should be emphasized that the rupture of the thymic carcinoid which require an emergency treatment is one of the severe complications of the tumor.

Carcinoid Tumor↗
PubMed1989

[A study of 22 cases of renal injury].

Between June, 1984 and May, 1988, 22 cases of renal injury were treated. There were 13 males and 9 females. The most frequent causes were traffic accidents (13 cases) and the next were falls (7 cases). Associated injuries were seen in 9 cases, including bone fractures, head injuries, liver lacerations, hemothorax and splenic laceration. Out of the 22 patients, there were 13 cases of renal contusion, 6 cases of renal laceration, 1 case of renal rupture and 2 cases of pedicle injury. Evaluation was made by IVP, CT, arteriography and so on. Arteriography was the most useful method whether immediate surgery should be done or not. Three cases were treated surgically (2 nephrectomies for rupture and pedicle injury, 1 drainage for laceration). The other cases were treated conservatively and no complications have been seen.

Accidental Falls↗
PubMed1989

Traumatic pulmonary pseudocyst. Report of twelve cases.

Twelve cases of traumatic pulmonary pseudocyst were seen between January 1966 and July 1987 at Saiseikai Kanagawaken Hospital. The cause of the traumatic pulmonary pseudocyst was closed blunt chest trauma in all patients. For the first few days after the injury, computed tomographic scan was more useful in diagnosis than chest roentogenogram. Tube drainage of the pleural cavity was performed in 10 patients who had hemothorax or hemopneumothorax, and antibiotics were administered to all patients. No patient underwent a surgical procedure, and all traumatic pulmonary pseudocysts eventually resolved, without any specific treatment, within 1 to 4 months (average 1.8 month) after the trauma. We conclude that pulmonary resection is not indicated except in the rare instance in which the traumatic pulmonary pseudocyst becomes infected.

Adolescent↗
PubMedDate not supplied

Chest radiography after minor chest trauma.

The results of chest radiography in 581 patients with blunt minor thoracic trauma were reviewed. Frontal and lateral views of the chest indicated pathology in 72 patients (12.4%). Pneumothorax was present in 16 patients; 4 had hemothorax. The physical examination and the results of chest radiography were not in accordance because in 6 (30%) of the 20 patients with hemo/pneumothorax the physical examination was normal. Consequently there is wide indication for chest radiography after minor blunt chest trauma.

Adolescent↗
PubMedDate not supplied

Extended donor criteria for heart transplantation.

The shortage of ideal donor hearts had led to an increasing number of would-be heart transplant recipients who die while on the waiting list. Therefore analogous to kidney and liver transplantation, an extension of the classical donor criteria became necessary, especially for high-urgency recipients. In a series of 121 orthotopic heart transplantations in 117 patients with a 1-year survival of 77%, the criteria for the selection of donor hearts have been gradually extended. Hearts from donors over 40 years of age but not exceeding 50 years were accepted without coronary angiography for 25 patients. There was no immediate graft failure, and the mean postoperative left ventricular ejection fraction, as assessed by radionuclide ventriculography, was normal. The incidence of late postoperative graft atherosclerosis was slightly but not significantly higher. Donor hearts with severe chest trauma, including bilateral hemothorax, rib fractures, and aortic hematoma were accepted for 11 patients. Immediate graft function was normal in all organs. In seven donors the body weight difference was more than 20%. Three patients with smaller grafts with more than 30% body weight difference had a highly complicated postoperative condition. In one patient acute graft failure was reversible with the administration of high dosages of catecholamines. In the other two patients, however, retransplantation was required because of irreversible failure. Episodes of hypotension that did not exceed 30 minutes had no substantial influence on postoperative graft function. The 1-year survival of recipients with donor grafts not complying with standard criteria was not significantly worse than the survival of patients whose grafts were selected according to the standard (76% versus 79%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

[Traumatic aorto-right ventricular fistula. Apropos of a case].

The authors report the case of a 19 year old young man with an aorto-right ventricular fistula caused by a stab wound. The diagnosis was not made initially during surgery to control haemorrhage (left hemothorax due to a damaged internal mammary artery). However, three weeks later, a continuous murmur was detected and the diagnosis established by echocardiography and cardiac catheterisation. The lesions were repaired by open heart surgery under cardiopulmonary bypass. The authors describe the main features of this condition based on their own experience and a review of the literature.

Adult↗
PubMed1988

Maintaining chest tube patency.

This method of maintaining patency of the chest tube has been found to be safe and efficient with little discomfort to the patient. It is especially helpful when dealing with hemothorax and with subsequent formation of clots in the pleural space.

Humans↗