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PubMed1984

[Right-sided traumatic diaphragmatic hernia following blunt trauma].

The mechanism of right-sided traumatic diaphragmatic hernia following blunt trauma was examined. In 13 cases of Traumatic diaphragmatic hernia admitted to the Department of Traumatology Osaka University Hospital, 3 cases were on the right. All cases were associated with severe injuries in the chest, abdomen and pelvis. Rib fractures, hemothorax, and liver injury were seen in the same site of the ruptured diaphragm. So it seemed that there were some differences in the force itself caused diaphragmatic rupture between right-sided and left. We reviewed 40 cases of right-sided traumatic diaphragmatic hernia reported in Japan. The following results were obtained. Main force which caused right-sided diaphragmatic rupture was the blunt impact to the right thoracic wall. In the right-sided diaphragmatic hernia, the most frequently herniated organ was the right lobe of the liver and there was high-frequency of G-I tract herniation in delayed types. Herniation of the abdominal organs seemed to be varied as the time passed.

Abdominal Injuries↗
PubMed1980

[Traumatic bilateral chylothorax (author's transl)].

A case is presented of a bilateral chylothorax caused by rupture of the thoracic duct, secondary to a closed traumatism of the thorax in a polytraumatized patient, and produced by a mechanism of hyperextension of the dorsal segment of the vertebral column. Considerations are made with reference to the anatomy of the thoracic duct, the rupture mechanism, diagnosis, complications and treatment. The chylothorax could not be distinguished clinically and by simple radiology from the traumatic hemothorax. The preliminary diagnosis will be made according to the macroscopic appearance of the drained fluid, and the definite diagnosis by the analytical and histopathologic characteristics of the same fluid. The lymphographic examination reveals the exact point of the lesion. The immediate complications are related to the respiratory insufficiency due to the occupation of the pleural space, and under a long period of time undernutrition provoked by the loss of fats and proteins. The treatment of choice is based upon the early drainage of the chylothorax and on the absolute suppression of the oral intake, establishing a complete parenteral feeding during at least 15 days. Afterwards oral diet can be initiated with a gradual increase in its quantity and always without fat content, while at the same time the parenteral nutrition is reduced. Following this protocol a great number of ruptures of the thoracic duct can be corrected, achieving a spontaneous closure of the duct. In the cases in which this not occur, at the end of 15 days it would be advisable to perform a surgical operation according to the Lampson's ligature technique.

Accidents, Traffic↗
PubMed1982

[Right atrial rupture caused by closed chest injury].

A case of right atrial laceration secondary to closed chest trauma is reported. Thirteen cases treated surgically with success have previously been reported. Rupture of a cardiac chamber represents 64 p. 100 of cardiac events after closed chest trauma; the right atrium is involved in 61 p. 100 of atrial lesions, either at the auricle or at the veno-atrial junction. The diagnosis is often difficult due to the gravity of associated lesions but it should be suspected systematically. In the absence of a pericardial laceration tamponade may develop; when associated wih pericardial rupture, a recurrent hemothorax may be observed. The emergency surgery should be performed through a median sternotomy or an anterior thoracotomy. Although repair may be possible on the beating heart, cardiopulmonary bypass is extremely useful for repair and exploration of the coronary vessels in the atrioventricular groove. The prognosis depends on the rapidity of patient transport and the speed of diagnosis.

Adolescent↗
PubMed1983

Adenocarcinoma in Barrett's esophagus.

The association of adenocarcinoma with Barrett's esophagus stimulated a review of our experience to study the clinical presentation, pathology, and results of management. Nineteen patients (15 men and four women) satisfied the criteria of primary adenocarcinoma arising in columnar epithelium in the esophagus. The majority had dysphagia (95%) and weight loss (63%). Nearly three fourths of the patients also had a history of hiatus hernia or esophagitis. Diagnosis was confirmed preoperatively in all by endoscopic biopsy and/or cytologic study. Potentially curative resection was performed in 15 patients and palliative procedures in four. Fourteen patients had advanced (Stage III) disease and only five had Stage I or II disease. Multicentric disease within the esophagus was found in seven patients. Postoperative complications included empyema, hemothorax, and pneumonia (one case each). The only postoperative death resulted from complications of previously undetected brain metastases. The median survival of the 15 patients having resection for cure is 12 months. Four are alive, one with disease at 46 months and three free of disease at 19, 87, and 93 months. All four patients undergoing palliative procedures died within 8 months. The study demonstrates that multifocal presentation of the tumor is common in this group of patients and that long-term survival is possible when early tumors are managed aggressively.

Actuarial Analysis↗
PubMed1983

[Traumatic bladder perforation in pelvic ring fracture. Case report with differential diagnostic aspects].

In the context to multiple traumata, a 19-year-old man suffered an extraperitoneal bladder rupture due to perforation by a fractured pubic ramus. Because of a rapid shock-induced decrease of hematuria and the misinterpretation of a bruise on the right flank as a renal contusion, the clinical diagnosis was not established. The patient died of head injuries and ruptures of the liver and diaphragm with hemothorax and intra-abdominal bleeding. The impressive bladder perforation was first documented at the postmortem examination. The diagnosis and differential diagnosis of hematuria are discussed.

Adult↗
PubMed1978

Surgical correction of chronic postembolic obstructions of the pulmonary arteries.

Following episodes of pulmonary embolism, the presence of thrombi in the pulmonary arteries leads to severe respiratory insufficiency and chronic right heart failure. We have operated upon 16 such patients, nine men and seven women from 23 to 68 years of age. All had severe dyspnea, 14 had chronic cor pulmonale, six had mental disturbances with syncope, and four had severe cardiac failure. The presence of clots was demonstrated by pulmonary angiography, and the permeability of the distal arterial bed was ascertained by selective injection of the bronchial arteries. In all cases but two a lateral thoracotomy was used so that the obstructed arterial branches could be approached distally. The inferior vena cava was always ligated to prevent recurrences. There were six operative deaths, three from cardiac failure, one from acute pulmonary edema, one from hemothorax, and one following a pyothorax. Ten patients are surviving after 6 months to 10 years. One is still limited because of significant pleuropulmonary sequelae. Six are enjoying good results with marked improvement in their functional limitations, a significant drop in the pulmonary artery pressure, and radiological permeability of previously obstructed arteries. Three are excellent condition--completely asymptomatic.

Adult↗
PubMedDate not supplied

[Closed abdominal injuries: the diagnostic reliability of ultrasonics].

47 consecutive patients underwent a ultrasound examination: they had suspect clinical-laboratorial picture caused from traumatic lesions of the abdominal viscera. We considered two kinds of visceral lesions: alterations of the parenchimal organs and of the empty ones. In the first group we analyzed direct signs of the lesion; in the second group we considered the indirect signs (hemothorax, hemoperitoneum and so on). Sometimes meteorism and the patient's conditions limited the reliability of the examination. We registered three false negative in volumetrically regular spleens, the seat hampering the complete exploration of the organ; on the contrary the lack of experience may cause interpretative mistakes (false positive). The obtained results induce to consider the employment of the ultrasound diagnostic imaging in abdominal traumas as a first approach, efficient test because, very often, it can condition surgical decisions, avoiding more aggressive diagnostic investigations.

Abdominal Injuries↗
PubMed1982

[Ultrasonic diagnosis of chest injuries].

Ultrasonic diagnostic examinations were used in 365 patients with closed injuries (150), wounds (181) and consequences of traumas (34). The ultrasonic method allows to rapidly and exactly determine the presence and limits of the exudate, blood, coagulated hemothorax, residual cavity, thickness of the parietal and visceral layers of the pleura, the state of the pulmonary tissue (inflammation, blood inhibition, atelectasis). The ultrasonic method is simple, harmless and applicable under conditions of any surgical hospital.

Adult↗
PubMed1982

Experimental copper deficiency in laboratory mice.

Copper deficiency was produced in weanling C57BL/6J and Hap:(ICR) mice that were fed a milk-sucrose based diet supplemented with appropriate vitamins, minerals, and amino acids. Growth retardation, decreased hematocrit, lethargy, dyspnea, achromotrichia, and high mortality (in ICR mice) were apparent in copper-deficient mice. Cardiac enlargement, hemopericardium, hemothorax, and pleural effusion were observed at necropsy. Thrombosis of the atria, myocardial degeneration and necrosis, and sites of myocardial rupture were observed at histopathologic examination.

Animals↗
PubMed1980

[Intrathoracic splenosis. Apropos of a case].

The authors report an exceptional case of intrathoracic splenosis in a 34 year old woman suffering from a circulation injury with rupture of the spleen and left diaphragm and hemothorax. She had been splenectomized. Eleven years later, a systematic thoracic X-ray examination revealed a rounded opacity of the left extremity. Exeresis of a lump the size of a nut located in the pleural space without individualized vascular pedicle was performed. The lesion showed macroscopic and microscopic characteristics of splenic tissue. If peritoneal splenosis is more frequent, intrathoracic splenosis is exceptional (only 7 observations known). Every time, a traumatic splenic antecedent has been noted. The etiopathogeny consists of an autograft of splenic tissue most often in the pleural cavity, when a diaphragmatic lesion has been associated to the injury. The lesion is asymptomatic and does not provoke complication in that area. Histologically, the splenic parenchyma can be normal or limited to the red pulp with a more or less important degree of white pulp. The histological differences with the normal or accessory spleen are the non contractile collagenous texture of the capsular and the septa and the absence of hila. One should consider this etiology when antecedents of splenic and diaphragmatic traumatism are noted. Hepato-splenic scintigraphy can be useful in the diagnosis and help to avoid thoracotomy.

Adult↗
PubMedDate not supplied

Hemopneumothorax in systemic lupus erythematosus.

Neither hemothorax nor pneumothorax are well recognized manifestations of systemic lupus erythematosus (SLE). Two patients with SLE who developed hemopneumothorax during the course of their illness are described. The clinical, laboratory, roentgenographic, and pathological findings are presented. Both patients were treated with chest tube suction, but 1 required surgical decortication of fibrinous pleural adhesions.

Adult↗
PubMed1978

[Isolated rupture of the pericardium after closed trauma of the thorax (author's transl)].

Rupture of the pericardium after closed trauma of the thorax is rare. There are two main clinical presentations: one of severe thoracic trauma with hemothorax requiring an operation which permits the diagnosis, the other of pain and pericardial signs on auscultation which should attract attention. The treatment requires closure of the pericardial tear as a routine owing to the risk of fatal complications due to dislocation of the heart.

Adult↗
PubMed1980

[Panlobular emphysema. Value of radiology to assess the need for surgery (author's transl)].

Surgical decompression in 12 patients with panlobular emphysema and severe respiratory insufficiency, over the last 5 years, gave encouraging postoperative results. Preoperative radiological examination results were well correlated with findings during operation. Signs of thoracic distention and diffuse peripheral hypovascularization were noted in all cases. Furthermore, at least on the affected side, all patients showed avascular zones presenting as large bullae or as bullous zones extending over at least half of the hemothorax region, and compression signs affecting the lung parenchyma, the mediastinum, and the diaphragm. Radiological investigation is essential for assessing the need for operation, as it remains the only method which can demonstrate the part played by the bullae and the rest of the parenchyma in the alteration of respiratory function. Data can be obtained by standard radiological examinations with dynamic films on forced inspiration and expiration, and by computed tomography. However, pulmonary angiography gives a more precise evaluation of the vascularization of the remaining parenchyma, which is important when choosing the side to be operated upon, or that which should be operated upon first in cases of bilateral symmetrical lesions.

Adult↗
PubMed1995

[Left diaphragmatic hernia due to blunt chest trauma complicated with intrapleural gastric perforation].

A 17-year-old male was injured by traffic accidents. Multiple left rib fractures, radiopacity of left hemithorax and rightward mediastinal shift lead us to the diagnosis of traumatic hemothorax. But left tube thoracostomy could not obtain any fluid. After this finding we suspected diaphragmatic hernia. Neither inserted nasogastric tube nor abdominal echogram could not lead to definitive diagnosis. Chest CT could identify stomach and spleen in the thoracic cavity. Insufflation of 300 ml air through nasogastric tube could not expand the stomach. By insertion of another thoracic tube some coffee-ground like materials could be obtained. Laparotomy disclosed rupture of left hemidiaphragm and intrathoracic displacement of the stomach and spleen. After reposition of stomach, we discovered 5 cm fissure of the stomach and left thoracic cavity filled with leaked gastric contents. Though reports of combined diaphragmatic hernia and gastric rupture are rare, these combination could occur if a patient with diaphragmatic hernia encounters blunt chest trauma on a full stomach.

Accidents, Traffic↗
PubMed1995

[Thoracic trauma in childhood. Radiologic findings].

In childhood blunt trauma to the chest wall is more frequent than penetrating injuries. Most of these are the result of traffic accidents. Solitary or serial rib fractures are seen more often than fractures of the sternum. Complications of thoracic injuries are pulmonary contusion, hemothorax and, less frequently, pneumothorax. Pulmonary contusion can result in post-traumatic pneumatocele or chronic pulmonary hematoma. Injuries of the heart, the great vessels and bronchotracheal rupture, presenting initially with pneumothorax, followed by atelectasis, rarely occur. Blunt thoracic trauma is frequently associated with further injuries (head and/or blunt abdominal trauma). The prognosis also depends on the concurrent injuries. The initial evaluation of an injured child is based on the chest X-ray and abdominal ultrasound examination. Additional information can be obtained by a CT scan in mediastinal injuries.

Child↗
PubMed1995

[A case of tuberculosis in which hemoptysis was caused by bleeding from intercostal arteries].

A 60-year-old man was referred to our hospital because of persistent hemoptysis. Chest roentgenogram and computed tomogram revealed that the right hemithorax was almost completely occupied by solid material with scattered calcifications. Mycobacteria were detected in the sputum culture. Administration of antituberculosis agents began after admission. Four months after admission, massive hemoptysis occurred. Topical treatment via fiberoptic bronchoscopy resulted in no improvement. Surgical resection of the right lung would probably have been difficult because of the almost complete collapse of the right lung and the extensive calcifications within the right hemithorax. Angiographic examination revealed extravasation of contrast medium from the right 7th, 8th, 9th, 10th, and 12th intercostal arteries. After transcatheter embolization of each of these intercostal arteries, hemoptysis stopped. It is unclear how bleeding from intercostal arteries caused massive hemoptysis, but the bleeding may have caused a right hemothorax that drained into an airway.

Embolization, Therapeutic↗
PubMed1995

[Usefulness of urokinase in multilocular pleural effusion].

Recognizing the confirmed efficacy of urokinase as a thrombolytic and proteolytic agent, we assess its usefulness in the treatment of multiloculated pleural effusion, empyema and hematoma as a substitute of other more invasive procedures. Treatment with urokinase was applied in 18 consecutive cases. Inclusion criteria were a well-placed thoracic probe that did not drain and a radiological image showing occupation. Patients were excluded if they had bronchial fistulas or hemothorax of less than 7 days duration. Effusion in the included cases had developed after pneumonia, after surgery or after trauma. Treatment lasted 3 to 4 days ant was considered effective or not based on the volume of liquid drained and on radiological evidence of change. The amount of liquid drained was highly variable (mean 1,282 and S.D. 1,224; range 100-3,975). Radiological change was considered completely satisfactory in 10 cases, with 6 patients continuing to show occupation of the costophrenic sinus with no clinical repercussions. Two patients died of causes unrelated to administration of the drug. There were two mild relapses that did not require a second round of treatment with urokinase. Patients were followed for a least 30 days after discharge and no new recurrences were detected. We have found urokinase to be a useful fibrinolytic agent for treating multiloculated effusion. Contraindications are few and therefore urokinase should be considered the first-choice treatment to be applied before other more invasive measures are taken.

Drainage↗
PubMed1995

[Two cases of empyema treated with rectus abdominis myocutaneous flap and muscle flap].

A rectus abdominis myocutaneous flap (RAM flap) has often been useful in breast reconstructions after the surgical therapy for breast cancer, or in other plastic surgeries. However, there have been few reports concerning about its applications for intrathoracic diseases. In this paper, we report two cases of recurrent empyema treated with RAM flap and muscle flap from rectus abdominis. One case is 75-year-old male with right-empyema and bronchial fistula after the thoracoplasty due to lung tuberculosis. The bronchial fistula was successfully closed with muscle flap from the right rectus abdominis. The other is 33-year-old male with left empyema and cutaneous fistula after the hemothorax due to traffic accident. He contracted with MRSA in his thoracic cavity. We resected the fistula and reconstructed his left chest wall with left RAM flap. The muscle flap from rectus abdominis or RAM flap has been very effective for the therapy of bronchial fistula after lung tuberculosis, and for the reconstruction of chest wall.

Adult↗