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At least 1,279 records · Page 71Linked to original sources
PubMed1988

[Biopsy of lung tissue in the diagnosis of disseminated transformations].

The results of complex studies in 440 patients with disseminated processes are presented. In 135 of them the diagnosis was confirmed by clinical, roentgenologic and laboratory data and by biopsies of skin, muscles and subcutaneous lymph nodes. Transbronchial lung biopsy was performed in 218 patients. It gave positive results in 65% of the cases. Open biopsy of lung was performed in 134 cases. Hemodynamic and gas exchange studies during the operation indicated its insignificant traumatism. Complications (limited hemothorax, partial pneumothorax, subcutaneous emphysema, wound suppuration) were noted in 10 (7.5%) cases in the postoperative period. Pulmonary tests performed three weeks after the operation did not reveal significant changes in the subjects, even those with considerable initial disorders. Open biopsy permitted to verify the diagnosis in 131 (98%) patients. In 52% of these cases the diagnosis did not correspond to the presumed one and considerably influenced the subsequent treatment.

Adolescent↗
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↗
PubMedDate not supplied

[Clinical study and development of a revealing case of phlebitis].

This article deals with a case of pleural metastases of an adenocarcinoma starting at an unknown point in a 59-year-old patient without notable circulatory antecedents, shown by a recurrent phlebitis having several sites over two months and a hemothorax.

Adenocarcinoma↗
PubMed1988

[Complications of closed chest injuries].

The role of predisposing factors in the development of complications in 1533 patients with closed traumas of the chest was studied as well as the dynamics of the state of the system of humoral regulation of microcirculation. The factors predisposing to the development of complications are the age older than 40, hospitalization later than 1 day from the trauma, double fractures of the ribs, injuries of lungs, hemothorax, concomitant diseases. In all the patients there was a subacute syndrome of disseminated intravascular coagulation, activation of the Kallikrein-Kinin system and inhibition of the complement system.

Adolescent↗
PubMed1988

Chest injuries: a clinical and autopsy profile.

The clinical profiles and management of 236 consecutive chest injury patients treated and followed up at All India Institute of Medical Sciences between January 1983 and July 1985 were analyzed prospectively. There were 149 blunt and 87 penetrating injuries; 21 patients (9%) required thoracotomy. Single- or multiple-tube thoracostomy was performed in 141 patients (60%). The remaining 74 patients (31%) required only observation for a period of 24-48 hours. Fifteen patients (6.3%) died, the mortality being related to head injury in four, irreversible hypovolemic shock in four, pulmonary embolism in three, septicemia in two, and respiratory failure in two. Nonfatal complications included residual hemothorax in 18 cases, persistent air leak in 13, pulmonary infection in eight, pulmonary embolism in one, and empyema in one. The average hospital stay was 6.9 days. Evidence of chest injury of various magnitudes was found in 756 of 2,286 autopsies conducted for trauma-deaths during the same study period analyzed retrospectively; however, it was the major cause of death in only 147 (19%). Cardiac injuries accounted for 41% of the deaths resulting primarily from chest trauma. Only 10% of the patients who sustained cardiac injury reached hospital alive.

Adolescent↗
PubMed1987

[Prevention of complications during the surgical treatment of myasthenia gravis].

The authors observed 298 patients with myasthenia who had been subjected to thymectomy. Complications during operation were as follows: injuries of the mediastinal pleura, pericardium, humerocephalic vein and hemothorax. The improvement of preoperative preparation, methods of thymectomy have decreased complications from 19% to 7%.

Adolescent↗
PubMed1978

Pulmonary sequestration.

Pulmonary sequestration is an uncommon congenital abnormality in which nonfunctioning lung tissue is supplied by an anomalous systemic artery. Both the extralobar and intralobar forms probably develop from an accessory lung bud from the primitive foregut. Both forms are situated on the left side in about two-thirds of patients. The anomalous arterial supply usually originates from the descending thoracic aorta, and there may be a large left-to-left or left-to-right shunt through the sequestration. The sequestration may have a fistulous communication with the upper gastrointestinal tract. Congenital anomalies, particularly diaphragmatic hernia, are frequently associated with the extralobar form. Intralobar sequestration occasionally is an incidental finding on roentgenograms of the chest in an asymptomatic patient; however, the disorder is usually symptomatic and the most common presentation is recurrent pulmonary infection. Presentation may be characterized by gastrointestinal symptoms, congestive heart failure, hemoptysis or hemothorax. Extralobar sequestration is usually an incidental finding on routine roentgenograms of the chest or during the management of some other congenital anomaly. Infrequently, extralobar sequestration presents with symptoms similar to those seen with the intralobar form. Roentgenograms of the chest, upper gastrointestinal series and arteriography are the most helpful diagnostic aids. The usual treatment is resection of the sequestration by removal of only the sequestration in patients with the extralobar form and by lobectomy or segmental resection in patients with the intralobar form. The reported results of operation have generally been excellent.

Abnormalities, Multiple↗
PubMedDate not supplied

Percutaneous transhepatic biliary drainage for acute cholangitis.

Percutaneous Transhepatic Biliary Drainage (PTHBD) was performed in 56 consecutive patients with severe acute cholangitis, during a period of one year. An immediate decompression effect with a "good" response was achieved in 46 (82.2%), who usually became afebrile within 18 to 24 hours, and "poor" response in 10 (17.8%). Five died (8.93%) in a subsequent operation. No mortality was associated with the use of PTHBD. Complications related to the procedure occurred in 12 of the 56 patients (21.4%). Hemobilia was the major complication. The other complications were intraabdominal hemorrhage, bleeding from the puncture site, transient hypotension, catheter occlusion and/or dislodgement, bile leak, pneumothorax and hemothorax. Two with hemobilia, one with intraabdominal hemorrhage and the other with bile leak required an emergency operation. PTHBD procedures can be lifesaving in biliary sepsis. Once infection and hyperbilirubinemia are controlled, rational subsequent therapy can be formulated for the underlying disease.

Acute Disease↗
PubMed1986

Thoracostomy.

Tube thoracostomy in the Emergency Department is an integral part of trauma and care and treatment of nontraumatic intrapleural collections. An understanding of pleuropulmonary anatomy, physiology, and pathophysiology forms the basis for appropriate and safe application of this procedure. Rapid diagnosis and treatment of intrapleural collections in the trauma patient is essential when one considers the grave prognosis of untreated tension pneumothorax or massive hemothorax. Prior knowledge of possible procedural complications with particular attention to thoracostomy site, sterile technique, and careful blunt dissection makes chest tube placement straightforward and safe. Most post-procedural complications can be avoided through a thorough understanding of the collection system and careful monitoring of the patient.

Drainage↗
PubMedDate not supplied

Total esophagectomy without thoracotomy: results of a European questionnaire (GEEMO).

The results of a questionnaire answered by the European Members of the GEEMO concerning esophagectomy without thoracotomy are reported and discussed. 172 cases of esophagectomy without thoracotomy following benign lesions and 666 cases following various levels of esophageal neoplasia were grouped in the 26 Centers that have answered the questionnaire amounting to a total of 838 cases. The most frequent indications for benign lesions were as follows: decompensated or relapsed megaesophagus (83 cases), acute or stabilized lesions caused by caustic agents (59 cases), stenoses from gastroesophageal reflux (17 cases), scleroderma (7 cases) and spontaneous or iatrogenic perforation (6 cases). Concerning the esophageal site where the technique was employed with esophageal carcinoma, the most frequent was the cervical (201 cases), then the lower (150 cases), the middle (91 cases) and upper thirds of the esophagus (48 cases). Adenocarcinoma of the cardia seems to be an additional indication for many Surgeons to use esophagectomy without thoracotomy (142 cases). In general, the most frequent intra-surgical complications (from benign and malignant lesions) were as follows: pleural lesions (34.4%), lesions of the left recurrent nerve (7.8%), severe endo-mediastinic hemorrhages (8.5%), tracheo-bronchial (1.5%) and thoracic duct (0.5%) lesions. The intra-operative mortality was 0.36%. The post-operative complications were as follows: pleural effusion (17.8%), anastomotic fistulas (15.2%), hemothorax (5%) and post-operative mortality (10.3%). Cancer of the cervical esophagus and adenocarcinoma of the cardia were considered sensitive to this radical treatment whereas in intra-thoracic cancer it can have only a palliative effect.

Esophageal Diseases↗
PubMed1985

[Surgical procedure in the treatment of post-traumatic pleural empyema].

Questions of pathogenesis and tactics of treatment of 62 patients with empyema of the pleura after a closed trauma and penetrating wounds of the chest are discussed. The development of empyema was dependent on the character and degree of the injury as well as on surgical errors in diagnosis and treatment of the trauma. Coagulated hemothorax was the most frequent cause of empyema. Operation was the main method of treatment, the operation of choice being pleurectomy and decortication of the lung.

Adolescent↗
PubMed1985

[Causes of complications in penetrating chest wounds].

The authors have analyzed 110 patients and describe most frequent errors in diagnosis and treatment. They are: not complete examination of the victims, non-radical primary surgical treatment of the wounds, irrational and late drainage of the pleural cavity in hemothorax and pneumothorax.

Adult↗
PubMed1979

[Myocardial infarction due to buckshot lodged in the right coronary artery (author's transl)].

A rare case of myocardial infarction produced by a buckshot lodged in the right coronary artery is presented. It resulted from a shotgun blast aimed at the right side of the chest. The patient was admitted to an Intensive Care Unit in a state of shock 1 hour after the accident. The diagnosis was suspected from the first moment because of ECG disturbances and it was later confirmed by coronary angiography. Hemodynamic studies were carried out simultaneously. The patient also presented hemothorax requiring pleural drainage. X-rays revealed a lung contusion with an intraparenchymatous hematoma the whole length of the projectile pathway. During the clinical course a slight hemopericardium was demonstrated by echocardiography; it was originally suspected on the basis of the X-rays. Drainage was not necessary. The patient left the Intensive Care Unit 7 days after entry and was discharged from the Hospital 5 days later. His clinical and hemodynamic condition was good and ECG indicate cicatrization of the myocardial infarction of the diaphragmatic face. The diagnosis and treatment of open or closed traumas of the thorax with similar cardiac involvement in emergency conditions are discussed. The authors prefer not to operate immediately in these cases.

Adult↗
PubMed1979

[Transvenous retrieval of central embolized fragments of venous catheters (author's transl)].

The industrial supply with complete venous catheter sets facilitated central venous techniques via various peripheral venous entries. The complication rate by pneumothorax, hemothorax, hemopericardium after perforation of a cardiac cavity and central embolism of catheter fragments are rather rare. Nevertheless the indication for central venous catheterization procedures should be calculated critically in every case because of the hazard of venous thrombosis and embolism or sepsis, which occurs more often. Perforation of a cardiac cavity by venous catheters leads to lethal sequelae in more than 60%. Central embolism of venous catheter fragments without perforation is followed by serious complications in most cases. Therefore the retrieval of the embolized fragment should be attempted by trasvenous technique or by thoracotomy. For the transvenous retrieval a special forceps or the transvenous Dotter retrieval set were very useful in our experience. Centrally embolized catheter fragments were drawn back in three patients after transcutaneous puncture via the femoral vein with two-plane X-ray control.

Adult↗
PubMed1983

Resuscitation of the multiply injured patient.

The resuscitation of the traumatized patient with multisystem injuries begins on the scene of the incident, continues into the emergency department, and finally includes the surgeon and the operating room. Treatment of the traumatized patient requires a systematic approach to best utilize all facilities and personnel while limiting duplication of service. The patient must go to the facility that best meets his or her needs. Stabilization in the emergency department should proceed in an orderly and organized fashion. Care must be taken when establishing the airway to protect the cervical spine. Massive hemothorax, tension pneumothorax, cardiac tamponade, intraabdominal bleeding, and retroperitoneal bleeding, as well as flail chest, must be remedied before stabilization and resuscitation can come to a successful outcome. Internal cardiac massage may need to be done for cardiac tamponade or when resuscitation has failed. Fluid repletion must be vigorous and aggressive. Albumin is probably of no benefit to the patient and, in fact, may be deleterious. Hetastarch may turn out to be a valuable addition to the fluid management of these patients. The patient is entitled to one physician who can call the consultants together. In addition, there should be a single physician for the patient who can control the timing of operative intervention as well as coordinate the overall management by the consultants.

Blood Transfusion, Autologous↗
PubMed1984

[A child with successfully treated posterior mediastinal endodermal sinus tumor].

A 15-month-old boy with posterior mediastinal endodermal sinus tumor is reported. The patient was admitted with recurrent hemothorax, and his serum alpha-fetoprotein level was 29,520 ng/ml. After removal of the posterior mediastinal tumor, VAC therapy (vincristine, actinomycin D, cyclophosphamide) was started. The chemotherapy was continued 18 months. The patient continues to do well with no sign of tumor and a normal alpha-fetoprotein level 53 months after the operation and 35 months after the completion of therapy. He is the youngest patient documented in the literature and successfully treated for mediastinal endodermal sinus tumor.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1983

[Autotransfusion with the Sörensen apparatus].

Since 1980 in Würzburg the Sorensen autotransfusion unit has been clinically used in 47 patients (35 vascular, 11 trauma patients, one with arterial bleeding after BII, one with aneurysm of the a. pericallosa) and tested to study its practicability, its advantages and disadvantages. Within the laboratory data there was a small decrease of hemoglobin, hematocrit and blood platelets, as well as of the "Quick" and AT-3. PTT and thrombin-time persisted unchanged, as did the results of electrolytes, parameters of renal and liver function, and the status of blood gas analysis. Free hemoglobin i.s. or i.u. was found in three patients with extremely high volume autotransfusions. The autotransfusion unit is convenient, easy to use and reliable. However, it is only suitable for the reinfusion of blood when hemorrhage is moderate and not severe. Hemothorax blood can be used only when adequate anti-fibrinolytic therapy is guaranteed. Nevertheless, the use of the Sorensen autotransfusion unit within the named diagnoses can achieve a precious contribution for saving homologous blood.

Adult↗
PubMed1984

Resection of cancer of the thoracic esophagus without thoracotomy.

We developed a new surgical technique to manually resect the thoracic esophagus without thoracotomy and employed it in 31 patients with cancer of the esophagus who were considered poor risks for resection by traditional thoracotomy. Postoperative complications consisted of left hemothorax in seven patients, hoarseness in five, sternal osteomyelitis in three, a perforated trachea in one, and cardiorenal failure in three patients. No severe pulmonary complications occurred, and there were no hospital deaths. The long-term results of this surgical treatment have not been assessed.

Aged↗