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PubMed1997

[Urgent thoracotomy for injuries to the tracheobronchial tree due to blunt trauma--a seven cases report and a literature review of 32 cases in Japan].

Surgery for injuries to the tracheobronchial tree due to blunt trauma occurs over three periods: an emergency period requiring emergency room thoracotomy, an urgent period, and a late period. We observed seven cases in which thoracotomy (tracheobronchial plasty and pneumonectomy/lobectomy) was carried out during the urgent period. Thirty-two similar cases reported in Japan possessed features with the same patterns. It has been considered that lesions were frequently injured near the carina and that the bronchus would be injured symmetrically. However, both our experience and a literature review shows that only 59% of the cases (23/39) were injured near the carina and that 88% of bronchial injuries (14/16) occurred on the right side. This report also reviews the following clinical symptoms and roentogenological signs that contributed to the diagnosis: 1) dyspnea or respiratory distress, 2) subcutaneous and/or mediastinal emphysema, 3) fallen lung sign, and 4) upper rib fractures. Although a flexible bronchofiberscope was performed only in 24 cases (75%) out of the 32 reviewed patients and only 20 (83%) out of the 24 was diagnosed, the examination should be performed for all the patients even with minor or possible injury of the tracheobronchial tree. The results also suggested that an immediate and accurate diagnosis and subsequent emergency thoracotomy may improve the prognosis of the injury for patients during emergency period.

Adolescent↗
PubMed1997

[Computed tomography in injuries to the respiratory system in children. The correlation with adults].

INTRODUCTION: Diagnostic imaging in emergency rooms may be inadequate and delayed, which makes chest traumas in children more severe and difficult to treat. We carried out a retrospective study on adults and children who had survived major chest traumas involving the respiratory tract to assess the differences between the two age groups and the role of emergency CT. MATERIAL AND METHODS: Our series consisted of fourteen children admitted to the emergency department for various accidents. Home accidents prevailed (9/14 = 64.3%). On admission, chest radiography was performed in most cases (11/14 = 78.6%); CT was carried out in 21.4% (3/14 patients). RESULTS: Trauma involved more organs in pediatric patients (11/14 = 78.6%) and lung involvement was always associated with other types of injury, namely contusion (14/14 = 100%), pneumothorax (11/14 = 78.6%), hemothorax (10/14 = 71.4%), tear (4/14 = 28.6%). CT corrected or integrated the radiographic findings of contusion focus in 67% (8/14) and that of pneumothorax in 63.6%; both patterns cannot be demonstrated otherwise. DISCUSSION: Mixed and multiple posterior parenchymal injuries with no rib fractures prevail in young subjects because their bones and ligaments are more elastic, which may lead to trauma underestimation. Tracheobronchial ruptures and pneumomediastinum are much more severe in children than in adults. Chest plain film is often the only diagnostic tool used, despite its major technical and interpretative limitations, also because skull and abdomen are the most investigated regions. Executive limitations are stronger in childhood, increasing the margin of error and the risk of delayed treatment. CT is as cost-effective as radiography and shows even the injuries missed or poorly depicted on conventional images; CT also gives accurate information on damage severity and nature. CONCLUSIONS: Traumatic injuries are more severe in pediatric patients due to their build and to biomechanical, clinical and management factors. Spiral CT should be considered the examination of choice to be performed in the emergency department equipped also for pediatric re-animation.

Accidents, Home↗
PubMed1998

[Epidural abscess secondary to the implantation of a thoracic catheter].

Spinal compression related to the formation of an epidural abscess after epidural blockade is a rare but serious complication. We report the case of a male patient in whom a thoracic epidural catheter was implanted to provide analgesia after trauma involving fracture ribs. The patient developed an epidural abscess within one week of implantation. Delay in diagnosis led to persistent neurogenic bladder symptoms in spite of aggressive treatment. We review causal factors, mechanisms of formation, pathogenesis, diagnosis and management, as well as possible relation between injury and abscess formation. We also emphasize the importance of adequate vigilance as well as rapid diagnosis and adoption of therapeutic measures in order to avoid permanent sequelae such as paresis, sensory deficits or mechanical sphincter dysfunction.

Abscess↗
PubMed1998

[The traumatic amputation of the forearm complicated by pneumocephalus].

The case of 37-year old man is reported who had traumatic amputation of the right forearm together with brachial plexus and cervical roots and third right rib fracture without pneumothorax. Due to a large damage of the limb replantation was dropped and only surgical elaboration of the wound was made. A few hours after the operation, dyspnoe and headache appeared. New x-ray picture showed right pneumothorax and pneumocephalus with continuing air shadow in cervical vertebral canal. In our opinion the air from pleura might go through cervical intramuscular space to the holes in dura after avulsed roots causing pneumocephalus.

Adult↗
PubMed1998

Role of electron beam treatment in postoperative management of carcinoma of the breast.

The aim of post operative radiotherapy to chest wall and drainage areas in advanced breast cancer is to sterilize the possible microscopic disease. Fifty cases of post surgical breast cancers were evaluated in a prospective study of chest wall radiation therapy by electrons. Fifty women of histologically proved post operative invasive breast cancers underwent simple mastectomy with axillary dissection followed by post-operative radiotherapy (Electron) to chest wall +/- drainage area. The chest wall and IMC was treated by a direct electron beam (9/12 MeV and 12 MeV) at fixed angle. 6 MV X-ray beam was used to treat axillary apex and supraclavicular area. In some cases, supplement RT was given by 6 MV X-rays through small posterior axillary portal. The energy of electron beam was 9 MeV or 12 MeV depending on the thickness of treated area. The supraclavicular and axillary lymphatic regions were treated, by direct custom shaped anterior portal. The dose delivered was 50 Gy over 5 weeks at 2 Gy per fraction. Adjuvant chemotherapy was given to patients who were pre-menopausal with histologically proved axillary node involvement as Cyclophosphamide, Methotrexate and 5-Fluorouracil (CMF) after radiotherapy. Post menopausal patients received adjuvant tamoxifen 10 mg.bid. The overall time varied from 26 to 87 days with a median of 41.5 days (SD 11.7). The followup period varied from 4-32 months with a mean of 22 months (SD 6.4). All the fifty patients developed dense pigmentation towards the end of radiation therapy, along with patchy dry desquamation. Moist desquamation occurred in 6 patients. The median OTT in the patients who developed moist desquamation was 34.5 days. The moist reaction healed over 10-15 days after completion of radiotherapy. Lung Fibrosis (Apical lobe) occurred in four patients. The fibrosis was evident at a median of 12 months of follow up. Lymphoedema of the ipsilateral arm occurred in six patients. None of 50 patients developed late sequalae like Cardiac effects, Rib fracture, Brachial Plexopathy, Shoulder joint impairement and Soft tissue effects. Local control in this study was 96% (48 patients). The two year actuarial overall survival was 80%. In early stages survival was significantly better compared to late stages. The actuarial two year DFS was 72%. In early stages DFS was significantly better compared to late stages.

Adult↗
PubMed1996

An unusual cause of stress fracture of the first rib.

An unusual case of stress fracture of the first rib that occurred in a young male as a result of the constant loading due to carrying a heavy schoolbag is reported. This case demonstrates the difficulty in diagnosis and highlights the need for awareness of this condition, thus avoiding invasive investigation.

Adolescent↗
PubMed1982

Isolated fracture of a cervical rib: a case report.

A case of isolated fracture of a cervical rib in a young woman is presented. The mechanism of injury was direct blunt trauma. Histological examination showed changes compatible with a previous fracture of the cervical rib. Literature concerning the incidence, complications and removal of these ribs is reviewed. Closely associated with this anomaly is the thoracic outlet syndrome, a differential diagnosis of which is given.

Adult↗
PubMed1990

Stress fracture of the first rib from serratus anterior tension: an unusual mechanism of injury.

Fracture of the first rib usually results from high-impact, direct trauma. Stress fractures are less common and are associated with minimal morbidity. The case of a patient with a stress fracture resulting from the use of an exercise machine is reported. Previous reports have attributed stress and fatigue fractures of the first rib to the forces exerted by the scalene muscles. A new pathophysiologic mechanism involving the serratus anterior muscle is introduced and is supported by T2 relaxation times from magnetic resonance imaging. Stress and fatigue fractures of the first rib have minimal complications. An aggressive diagnostic evaluation of first rib fractures occurring by this mechanism is not warranted.

Adult↗
PubMed1978

[Therapy of the unstable thorax in serial fractures of the ribs].

The histories of patients with flail chest and respiratory insufficiency caused by blunt chest injury have been analyzed. The first group represented patients with surgical stabilization of 3-4 ribs by introduction of "Rehbein plates" into the medullary cavity (10 patients 1972-1975). The patients of the second group have been supported by controlled mechanical respiration (11 patients 1972-1975). Patients with chest and further injuries (polyblessés) of comparable degree have been selected for both groups. The two groups were compared with regard to duration of intubation and artificial ventilation (average of 8.8 days for the operated and 21.4 days for the mechanically ventilated patients), stay in the intensive care unit (15.2 days after operation and 28.3 days for treatment by respirator) and average total hospitalization time (33.5 days after surgical management and 54.2 days after nonsurgical treatment). Severe bronchial infections caused by hospital germs have occurred more frequently in patients on long-term intubation and mechanical respiration. The average age of patients was almost the same in both groups. The technique of surgical stabilization of the ribs is described, and the advantages and limits of surgical and conservative management of respiratory insufficiency caused by flail chest are discussed.

Adult↗