Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “RIB FRACTURES”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,261 records · Page 70Linked to original sources
PubMed1989

Clinical use of differential lung ventilation in the treatment of asymmetric lung injury: report of a case.

Successful treatment of a 26-year-old male with asymmetric lung injury following a traffic accident is described. The patient was admitted with head injuries, right lung contusion, right pneumothorax, and multiple rib fractures (right 1-9). He developed a left pneumohemothorax and complete atelectasis of the lower lobe of the left lung two days later. Conventional mechanical ventilation with and without positive end-expiratory pressure (PEEP), supplemented by repeated therapeutic bronchoscopy, failed to reexpand the left lung. After 16 days of atelectasis, synchronized differential lung ventilation using a double lumen endobronchial tube connected to two ventilators (Siemens 900C) was instituted. Measurement of the tidal volume and static compliance of each lung showed marked inequality and 9 cm H2O of PEEP was applied selectively to the left lung (zero PEEP to the right) in an attempt to equalize tidal volumes. Evident improvement in blood gases and chest radiograph was obtained within 30 min but weaning back to a single lumen tube required 6 days, and was complicated by further episodes of atelectasis. Complete pulmonary and neurological recovery was obtained, and a normal chest radiograph was documented 3 months later. Differential ventilation proved simple to use, and highly effective in the management of this combination of lung problems.

Adult↗
PubMedDate not supplied

Cardiac damage in nonpenetrating chest injuries. Report of 5 cases.

The Authors report 5 cases of cardiac injury after blunt chest trauma: (a) one right atrial disruption with acute tamponade treated successfully; (b) two left ventricular perforations with rib fractures: one patient was exsanguinated and died, the other one presented a late subacute cardiac tamponade with successful operative repair; (c) one isolated traumatic tricuspid insufficiency which was well tolerated; (d) one atrio-inferior caval disruption with acute tamponade. Cardiac damage secondary to nonpenetrating chest trauma is uncommon but with the present modes of high speed transportation they are occurring with increasing frequency; correct management of cardiac ruptures depends upon rapid recognition of the injury and expeditious surgical repair. The occurrence of tricuspid valvular lesions alone as a result of nonpenetrating trauma is not common. Echocardiographic examination after blunt chest trauma is a useful diagnosis procedure.

Accidents, Traffic↗
PubMed1985

[Analysis of the effectiveness of repeated radiation treatment of lung cancer].

In spite of a direct effect obtained in radiotherapy of lung cancer, tumor growth often resumes afterwards, metastases appear, all these causing death of most patients within the first 1-2 yrs. It is worth nothing that a considerable number of patients die from tumor recurrences in the absence of generalization. Therefore a question arises as to the therapeutic tactics for such patients, including the potentialities and appropriateness of repeated irradiation. The efficacy of repeated radiation therapy of 100 patients with lung cancer was analysed. Direct improvement was noted in 44% of x-ray findings and in 77% of clinical findings. The patients' mean survival rates were 29.7-2.6 mos. after the 1st course of treatment and 17.2 +/- 2.5 mos. after repeated irradiation. Short- and longterm results showed correlation, i.e. in x-ray improvement the mean survival after the 2nd course was 23.5 +/- 4 mos. whereas in its absence it was 13.5 +/- 4 mos. It was established that the longer the interval between the therapeutic courses the more probable an increase in a survival period after repeated radiation exposure. After 2 radiotherapy courses all the patients developed radiation pneumosclerosis of varying degree pathological rib fractures were marked in 4 patients and tumor regression in 5 patients. A conclusion has been made that repeated radiation therapy of lung cancer patients is of palliative nature.

Adenocarcinoma↗
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↗
PubMed1988

Traumatic manubriosternal joint subluxations in two basketball players.

Two cases of traumatic manubriosternal joint subluxation without rib fractures in basketball players are illustrated. The incidence of this sport injury is rare. Accidental or intentional violent blows of the elbow to the body of the sternum is the mechanism of this injury. Radiographic analysis of the manubriosternal joint is discussed. Radiographically, the body of the sternum in each case has subluxated posteriorly. The athletes present pain directly at the manubriosternal joint; this may be aggravated by active thoracic hyperflexion or hyperextension. Ordinary or deep breathing does not cause discomfort. Palpation may reveal local tenderness that will be accentuated by ballottement against the manubrium. Conservative treatment consists of manipulative hyperflexion reduction supplemented with antiinflammatory or analgesic cream, cryotherapy, taping or with pad, strapping and rest.

Adult↗
PubMed1988

Pulmonary artery disruption from blunt thoracic trauma.

Blunt chest trauma occurs in up to 50 per cent of all fatal motor vehicle accidents and is the primary cause of death in 12-25 per cent; yet only 15 per cent of patients with chest trauma arriving alive to the emergency department require early thoracotomy. Pulmonary artery disruption from blunt trauma is extremely rare. Two patients both women, older and obese with multiple rib fractures and little pulmonary parenchymal damage are reported. Neither had injury to the aorta, heart or intra-abdominal organs. One patient survived after lateral repair of the left main pulmonary artery and the other exsanguinated from a laceration of the right main pulmonary artery. Intrapericardial exposure of the proximal pulmonary arteries may be necessary for control of hemorrhage. Trauma surgeons should be familiar with this technique. Indications for immediate thoracotomy should include: massive hemothorax (greater than 1000 ml), continued bleeding greater than 300 ml in the first hour, bleeding greater than 200 ml/hr for 5 hours, or increasing hemothorax in spite of tube thoracostomy. Close adherence to these guidelines would have allowed both patients to be explored earlier.

Accidents, Traffic↗
PubMed1987

[Value of imaging procedures in the diagnosis and therapy of severe thoracic injuries].

Plain chest radiographs allow the diagnosis of most intrathoracic injuries. However, they are only momentary pictures and give no information on the respiratory function. A tension pneumothorax, rib fractures and subcutaneous emphysema should be diagnosed clinically before radiographs are taken. Computed tomography is helpful in evaluation of intrapulmonary lesions, hemothorax, rupture of the diaphragm and dislocation of the heart. Further diagnostic tools include aortography in suspected aortic rupture, sonography in cardiac injuries and hemopericardium, bronchoscopy in suspected bronchial or tracheal rupture, ECG and enzyme determinations in cardiac contusion, and eventually pneumoperitoneum in suspected rupture of the diaphragm.

Diagnosis, Differential↗
PubMed1987

Major mediastinal vessel injury: an underestimated lesion.

Of patients who sustain traumatic rupture of the aorta, 15% to 20% will reach the hospital alive. Without associated major brain trauma or irreversible abdominal injury, survival depends on early diagnosis and prompt surgical repair by an experienced surgeon. Regardless of whether there is radiologic evidence of rupture or rib fractures, a constant awareness of aortic rupture should be maintained, based on the history of the accident. Among 50 patients in whom a rupture of the thoracic aorta was diagnosed, 47 with traumatic rupture of the descending thoracic aorta were treated by the author. Of 34 involved in motor vehicle accidents and in whom a history of the accident was obtained, 30 (88%) were not wearing seat belts and 11 (33%) were involved in a lateral collision. Six percent of the 50 patients sustained a vertical fall of more than 10 m.

Accidents, Traffic↗
PubMed1985

[A case of renal cell carcinoma found in traumatic ruptured kidney].

A case of traumatic kidney rupture with pre-existing renal cell carcinoma in a 38-year-old male is reported. Macrohematuria appeared 48 hours after left precordial trauma in a traffic accident. Initial diagnosis at the emergency clinic was 9th rib fracture of his left chest alone and no other injury was recorded. A large mass in left abdomen was palpable at urologic OPD, however, and X-ray examination revealed a non-visualizing left kidney in IVP. After the ECHO, CT and arteriography findings gave an impression of left kidney rupture. Left nephrectomy accompanied by partial colectomy of descending colon by transperitoneal approach was performed 25 days after initial trauma. This delay was mainly due to disagreement of patient for surgical treatment because there were no subjective symptom except microhematuria and subsiding fever after transfer to the urologic section. En bloc removed specimen showed ruptured kidney with adhesiveness laterally to descending colon and harder core portion was found in midst of renal mass. Coronal slice of the specimen exhibited a renal parenchymal tumor with necrotic spots. Pathologic findings were complete kidney rupture in upper pole and clear cell type renal cell tumor was found in mid and lower pole. Also lymph nodes which obtained from left renal pedicle and para aortic margin proved no metastasis of tumor cell. Post operative clinical course was favourable without any recurrence for 15 months after surgery. Clinical incidence of type I and type II kidney trauma with pre-existing neoplastic change is considerably high, but the kidney ruptured case bearing renal cell carcinoma as a core shape is very rare.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

[An analysis of 103 patients with renal injuries].

Between 1971 and 1983, 103 patients with renal injury were admitted to the Department of Urology, Tatebayashi Kosei Hospital. There were 87 males and 16 females. The most frequent age group seen (27.2% of patients) was the 10 to 19 year group. The various causes included traffic accidents (55 patients), falls (16 patients), athletic injuries (8 patients), labor accidents (7 patients), blows (6 patients) and others (11 patients). Associated injuries were present in 52.4% of the patients, including thoracic injuries such as rib fracture (20 patients), lumbar vertebra and transverse process fractures (18 patients), and head injuries (12 patients). Evaluation of the renal injuries was made by excretory urogram (IVP) and conservative management was for most, contusion and rupture, and operation for laceration as a principle: 95 patients (97 renal injuries) were treated by conservative management and 7 patients were treated surgically, 5 patients by nephrectomy and 2 patients by perirenal drainage. Nine patients who had associated injuries were treated surgically. In the follow-up study of 41 patients who had received conservative management and operation (perirenal drainage), followed for more than 6 months and had IVP, urinalysis and blood pressure measurement, representative changes were calyceal deformity (3 patients), renal calculus formation (2 patients) and non-functioning kidney (2 patients) in urograms.

Accidents, Occupational↗
PubMed1985

A study of the techniques of cardiac massage with the abdomen open.

The present study compares the hemodynamic effectiveness of closed-chest cardiac massage (CCCM) with closed subdiaphragmatic massage (CSDM) and four open transdiaphragmatic cardiac massage techniques during cardiac arrest with an open abdomen. In 10 dogs CCCM resulted in the lowest cardiac index (CI), mean arterial pressure (MBP), and carotid blood flow (CBF) of all cardiac massage techniques tested. CSDM was not statistically superior to CCCM in the dog (p greater than 0.05) but did result in a 23% increase in CI and a 54% increase in CBF. Transdiaphragmatic retrocardiac massage through an incision in the diaphragm resulted in the highest CI, MBP, and CBF of all the four open transdiaphragmatic techniques and had significantly higher values than those for CCCM in the dog (p less than 0.05). In three cadaveric renal donors, all four open transdiaphragmatic techniques and CSDM were noted to be equal to or superior to CCCM. Three patients have been successfully resuscitated with diaphragmatic cardiac massage techniques for cardiac arrest while undergoing abdominal operations. These studies reveal that all subdiaphragmatic or transdiaphragmatic techniques for cardiac massage are hemodynamically equivalent to or superior to the standard CCCM without such complications as fractured ribs and should be considered the treatment of choice for cardiac arrest in the patient with an open abdomen.

Abdomen↗
PubMed1979

[Diagnostic problems in chest injuries (angiography) (author's transl)].

Roentgenography is the simplest and most reliable means to arrive at the diagnosis of chest injury. General roentgenograms are difficult to interpret as they tend to be technically imperfect. Fractures, emphysema, pneumothorax, accumulation of fluid can usually be ascertained directly; but the traumatic origin of changes in the pulmonary parenchyma or of an enlarged heart shadow cannot be reliably deduced from the X-ray appearance. It may provide some differential-diagnostic information but the correct interpretation of the findings depends on further observation. In 6-7% of severe chest trauma with vascular injuries and rupture of the diaphragm angiography is indicated. The evidence to be obtained from chest radiography should not be overestimated: fractures of ribs are sometimes overlocked, even by the expert; parenchymatous lesions may manifest themselves as shadows but their nature remains obscure until they have been related to the clinical and subsequent radiological findings. The same applies to rupture of the diaphragm, bronchi or vessels, if only the immediate posttraumatic roentgenographs are examined. A tent-shaped heart shadow is considered characteristic of the presence of fluid in the pericardium; this is valid only for chronic hydropericardium, but not for the potentially fatal cardiac tamponade; if the pericardium has lost its elasticity a haemorrhage of not more than 150 ml may prove fatal. Nor does the roentgenogram provide information about pulmonary function. Especially in cases of pulmonary shock minor changes in the chest roentgenogram may give a false sense of security when, in fact, blood gas analyses show that a life-endangering situation has developed. The radiologist who is aware of the limititations of the method will derive maximum diagnostic benefit from a chest angiography. No other method is capable of supplying information of such great importance in such a short time.

Angiography↗