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PubMed1983

Radionuclide diagnosis of diaphragmatic rupture with hepatic herniation.

Seven surgically proven cases of a traumatic rupture of the right hemidiaphragm with a hepatic herniation were preoperatively diagnosed by radionuclide liver-spleen imagings, and they were retrospectively analyzed. All injuries resulted from blunt traumatic injury including automobile accidents, and there were associated pelvic and rib fractures in five cases. All patients developed some degree of dyspnea in the relatively immediate phase. All chest radiographs showed an apparent elevation of right hemidiaphragm. Radionuclide liver-spleen imaging with 99mTc sulfur colloid characteristically demonstrated a distortion of liver configuration with superior and posterior displacement of the right lobe. Four patients had a large tear in the central tendon of the right hemidiaphragm, and none had a tear in the anterior part or in left lobe of the liver. The differential diagnosis of elevated right hemidiaphragm is briefly discussed. It is concluded that the correct preoperative diagnosis of the diaphragmatic rupture with liver hernia could be made with an awareness of this condition following trauma and radionuclide liver-spleen imaging.

Accidents, Traffic↗
PubMed1982

Cervicomediastinal injuries following blunt trauma.

Blunt injuries to aortic arch branches are encountered with increasing frequency. From 1976 to 1980 20 patients with 26 cervicomediastinal arterial injuries were treated. Physical findings varied depending on the vessel injured: all subclavian artery injuries had positive signs, one carotid artery injury had a bruit as the only finding, and injuries to the innominate artery had no positive physical findings. Angiographic examination was performed in all patients when findings suggested vascular injury or there was a high index of suspicion based on patient history, widened mediastinum, or first rib fracture. Vessels injured included the subclavian (13 instances), carotid (five instances), innominate (five instances) and vertebral (three instances). In injured vertebral arteries were ligated. Innominate artery wounds were reconstructed using Dacron grafts; the remainder were excised in the area of intimal damage with primary anastomosis or interposition of a saphenous vein graft. There were no deaths or major vascular complications. Three patients, each, have major upper extremity neurologic deficits due to brachial plexus stretch injuries.

Adolescent↗
PubMed1982

Environmental zinc and cadmium pollution associated with generalized osteochondrosis, osteoporosis, and nephrocalcinosis in horses.

Several suspect causes of chronic zinc/cadmium toxicosis in horses near a zinc smelter were investigated following observations of lameness, swollen joints, and unthriftiness, particularly in foals. Two foals born and raised near the smelter were lame and had joint swellings that were attributable to severe generalized osteochondrosis. Zinc and cadmium concentrations were markedly increased in the pancreas, liver, and kidney. The serum of 1 foal, zinc and potassium concentrations were high, whereas calcium and magnesium concentrations were low. Marked nephrocalcinosis and osteoporosis were observed in this foal. Nephrocalcinosis also was observed in his dam, who died of a punctured lung following rib fractures, though there was no history of trauma. The joint cartilage lesions were similar to those induced experimentally in animals fed high-zinc diets and may have been the result of zin-induced abnormality of copper metabolism. The osteoporosis and nephrocalcinosis were consistent with chronic cadmium toxicosis.

Animals↗
PubMed1981

Chest trauma in a developing country.

In a developing country with inadequate clinical facilities a conservative method of management of a major clinical problem is often the only rational approach. This policy was adopted in the management of 145 patients with chest trauma in a teaching hospital in Nigeria. Automobile accidents were the cause of the thoracic injuries in 73.1% of the patients; 71.7% of the patients were managed as in-patients. The management of the patients was essentially aimed at correction of hypovolaemia, tube drainage of pleural collections, and relief of pain by intercostal nerve block. Major operative procedures were adopted in 11 cases (7.6%) for persistent haemothorax or for pyothorax, ruptured diaphragm, ruptured abdominal viscus, and subdural haematona. No operative reduction of rib fractures was performed and only 1 of the 12 patients with flail chest was mechanically ventilated. The hospital mortality was 9.7% and, despite a high rate of default at follow-up attendances, no late death or serious complication was recorded. Th aspects peculiar to chest trauma in Nigeria are discussed.

Accidents, Traffic↗
PubMed1980

[State of the respiratory function in closed thoracic trauma].

The article deals with the function of external ventilation and respiration mechanisms in patients with closed traumas of the chest accompanied by fractures of ribs. The data were taken at the moment of admission and following the conservative treatment. The respiration biomechanics and functional indices of lungs in all the patients on admission were considerably disturbed. After treatment they were found to improve, still remaining considerably decreased. After discharge the patients need dispensary follow-up and therapy aimed at the repair of the respiratory function.

Adult↗
PubMed1980

Symposium on trauma. 2. Chest trauma: current concepts.

Blunt chest trauma continues to be an important cause of death following motor vehicle accidents in Canada. Current methods of diagnosis are presented emphasizing a physiologic approach. The most important physiologic consequence of trauma associated with chest wall instability or ruptured diaphragm is pulmonary contusion. Current therapy therefore stresses the treatment of pulmonary contusion (Trinkle's regimen) rather than the associated chest wall instability. A widened mediastinum or a fractured first rib on the chest film, or upper limb hypertension should suggest possible rupture of the aorta, which can be confirmed by aortography. Early surgical repair is recommended. Current techniques for repair are detalied. Cardiac tamponade and exsanguinating hemorrhage are the common causes of death following cardiac trauma. Methods for recognizing and treating cardiac tamponade are outlined. The indications for early thoracotomy following cardiac trauma are listed; thoracotomy should be done in a fully equipped operating room rather than the emergency room. Successful management of major chest injuries requires an aggressive physiologic approach to diagnosis and emphasis on maintaining effective ventilation and adequate cardiac output.

Aortic Rupture↗
PubMed1980

[The diagnosis of traumatic rupture of the aorta. 36 cases (author's transl)].

Thirty six cases of traumatic rupture of the thoracic aorta (TRA) were diagnosed during the hours following the accident responsible. Rupture was situated at the aortic isthmus in 32 cases, the ascending aortic in 2 cases, the arch of the aorta in 1 case and the descending sub-isthmic aorta in 1 case. Ten patients had no rib fractures. In 16 patients not undergoing surgery before 20th hour after the trauma, 10 died of secondary rupture. The course of a TRA is thus unpredictable and it is of fundamental importance to make the diagnosis and undertake appropriate surgical treatment immediately. The essential clinical sign is a difference in blood pressure between the upper and lower limbs (6 6%). Radiological signs suggestive of TRA are, in a plain PA chest film : widening of the mediastinum (92 %), poor visibility of the knuckle of the aorta (89 %), left haemothorax (67 %), deviation of the trachea to the right (55 %) and lowering of the left main bronchus (47 %). The slightest suspicion of a TRA should lead to aortic angiography preferably via an arterial approach (humeral or femoral), or intravenously. Surgical treatment should not be delayed.

Aorta, Thoracic↗
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

[Respiratory disorders among fishermen].

BACKGROUND: Information concerning to the habits and diseases of sea fishermen is scarce. The respiratory disorders and the risk groups in fishermen from the province of Guipúzcoa, Spain were evaluated in this study. METHODS: A descriptive transversal study (questionnaire and spirometry) and retrospective review of the data on laboral disability and mortality were carried out. RESULTS: The prevalences of chronic bronchitis, asthma and smokers were found to be 18.3%, 9.8% and 47.5% respectively; with a history of pneumonia being 8.9%, tuberculosis 7.3%, pleural disease 5.5%, rib fracture 10.6%, and obstructive disorder 8.9%. Smoking, followed by the presence of previous infectious, were the factors most associated to the presence of respiratory disease. The most prevalent smoking habit observed among the high sea fishermen did not completely explain the greater prevalence of chronic bronchitis found among these subjects. The number of years working at sea was not related to any disorder. Tumors represented the first cause of mortality (34.9%) with those of the trachea, bronchials and lung heading the list (13.3%). Laboral disability due to respiratory causes occupied the third place in the global population (13.0%) and the first place in high sea fishermen (22.2%). In relation with coastal fishermen, the high sea fishermen presented a lower Tiffeneau index and a greater prevalence of smoking, chronic bronchitis, history of tuberculosis and laboral disability, number of medical consultations and admissions due to respiratory problems. CONCLUSIONS: Sea fishermen present a high prevalence of respiratory disease. Differences were observed between high sea and coastal fishermen with the former demonstrating a lower Tiffeneau index and a greater frequency of smoking, chronic bronchitis, tuberculosis history and laboral disabilities, number of medical consultations and admissions for respiratory causes.

Adult↗
PubMed1995

[Tracheal rupture in a patient with head and thoracic injuries].

A 49-year-old patient presented with cranioencephalic injuries including subdural hematoma and severe mass effect, facial and thoracic injuries with bilateral rib fractures but no parenchymatous lesions or extrapulmonary air. After surgical evacuation of the subdural hematoma, the patient entered the intensive care unit. Twenty-four hours later the patient pulled out the tubes, which were reinserted after signs of respiratory failure appeared. A series of clinical and radiological signs then followed, namely subcutaneous cervicothoracic emphysema, mediastinitis accompanied by hyperinsufflated balloon tamponade (pressures < 28 cmH2O). Tracheal rupture was suspected, but fibrebronchoscopy through the trachea revealed no damage. Surgical exploration 72 hours after admission confirmed high tracheal rupture near the pars membranacea. The damage was sutured, but sepsis with severe respiratory distress and mediastinitis led to death.

Brain Injuries↗
PubMed1994

[Multiple trauma in children younger than 16 years; a retrospective study over the 1984-1991 period].

OBJECTIVE: Evaluation of incidence, treatment and outcome of multiple injuries in children and adults. METHOD: All patients aged 16 years or under with an Injury Severity Score of 18 or more admitted to the Intensive Care Unit between 1984 and 1991, were retrospectively studied. Type and severity of injuries, treatment, complications and outcome were noted. The severity of injuries was scored using both the Injury Severity Score and the Paediatric Trauma Score. RESULTS: Children are more likely to be run over by motor vehicles. Rib fractures are rare in childhood. Compared with adults, children stay relatively shortly in the Intensive Care Unit. None of the children studied developed a Respiratory Distress Syndrome (RDS) or Multi-Organ Failure (MOF). External fixation of fractures is a common treatment in children. CONCLUSIONS: I. Outcome of multiple injuries in children is relatively good. This can partly be attributed to the low incidence of RDS and MOF, but also to the more common diffuse brain injury in children compared with adults, with better outcome and lower mortality. 2. External fixation of fractures appears to be a first rate treatment in children. 3. Scoring of multiple injuries in children with the Paediatric Trauma Score instead of the Injury Severity Score offers no advantages.

Adolescent↗
PubMed1994

[Two cases of pericardial rupture due to blunt chest trauma].

We treated two cases of pericardial rupture from blunt chest trauma. Case 1: A 55-year-old male was injured in an automobile accident. He recovered from the left hemothorax by tube drainage. One year and two months after the trauma, a left pericardial rupture was found during an operation for a left diaphragmatic hernia. As the epicardium adhered firmly to the pericardium, the ruptured pericardium was not sutured. Case 2: A 46-year-old man fell from a tree five meters in height. Chest radiography showed multiple right rib fractures, a pelvic fracture, pneumopericardium, and right hemopneumothorax. After four days, we performed a thoracoscopic examination under local anesthesia. The thoracoscopy revealed a rupture as large as an egg in the right pericardium anterior to the phrenic nerve. Judging from the size of the rupture, cardiac luxation was suspected not to have occurred. So the defect was not repaired. These two patients were discharged uneventfully without cardiac luxation. In the future, the accumulation of thoracoscopic findings may provide adequate information for judging the indication of operative repair in pericardial ruptures.

Humans↗
PubMed1994

[A case of bronchial rupture and pulmonary laceration caused by blunt chest trauma].

A 37-year-old female was crushed by a traffic accident. She was in severe respiratory distress. A chest X-ray revealed right pneumothorax and multiple rib fractures. Shortly after the initiation of the positive pressure ventilation, severe subcutaneous emphysema developed and she became shock. The bronchoscopy showed the rupture of the right main bronchus which was repaired through a right posterolateral thoracotomy using interrupted monofilament PPP sutures. Pulmonary lacerations were also repaired by the same sutures. Postoperative bronchoscopic examination showed good healing without any stricture. It cannot be overemphasized that accurate diagnosis and urgent surgical management is mandatory in patients with bronchial rupture.

Accidents, Traffic↗