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At least 1,549 records · Page 86Linked to original sources
PubMed2005

[Emergency management of thoracic trauma].

Thoracic injuries are a major cause of mortality during the "golden hour" of trauma. Many patients with chest trauma die after reaching the hospital. Less than 10% of all blunt thoracic injuries require a thoracotomy, and many potentially life-threatening conditions can be relieved by simple procedures, such as chest tube insertion.Thus, many cases of traumatic deaths due to chest injury may be prevented by prompt diagnosis and a standardized therapeutic approach in the emergency room. A high index of suspicion for lethal injury patterns, based on the mechanism of trauma and the clinical presentation, is a crucial prerequisite for an adequate initial assessment and management of patients with chest trauma. The worldwide implementation of standardized diagnostic and therapeutic guidelines, such as the "Advanced Trauma Life Support" (ATLS) protocol, has led to a significant reduction of early deaths attributed to thoracic injuries.

Adult↗
PubMed2001

Independent lung ventilation in patients with unilateral pulmonary contusion. Monitoring with compliance and EtCO(2).

OBJECTIVE: a) to describe a non-barotraumatic ventilatory setting for independent lung ventilation (ILV); b) to determine the utility of single lung end-tidal CO(2) (EtCO(2)) monitoring to evaluate the ventilation to perfusion (V/Q) matching in each lung during ILV and for ILV weaning. DESIGN: prospective study. SETTING: general intensive care unit in a university teaching hospital. PATIENTS: twelve patients with unilateral thoracic trauma needing ILV. INTERVENTIONS AND RESULTS: ILV was started with each lung ventilated with the same tidal volume (Vt): plateau airway pressure (Pplat) was 34.2+/-3.2 cmH2O in diseased lungs (DL) and 18.1+/-1.9 cmH2O in normal lungs (NL) ( P<0.01). Static compliance (Cst) was 9.9+/-1.1 ml/cmH(2)O in DL and 19.3+/-1.7 ml/cmH(2)O in NL ( P<0.01). EtCO2 was 22.5+/-2.2 mmHg in DL and 36.6+/-1.9 mmHg in NL ( P<0.01). PaO(2)/FiO(2) was at 151+/-20. PEEP was applied on the DL and each lung was ventilated with a Vt that developed Pplat < or =26 cmH2O. With this setting, Vt given to the NL was unchanged, whereas it was reduced in the DL (238+/-30 ml vs 350+/-31 ml; P<0.01). Cst and EtCO2 were still significantly lower in the DL ( P<0.01, respectively), while the PaO(2)/FiO(2) ratio remained unchanged. Vt was then progressively increased in the DL as Pplat decreased, but remained unchanged in the NL. ILV was discontinued when Vt, Cst and EtCO(2) were the same in each lung. PaO(2)/FiO(2) ratio had then increased to 295+/-18. CONCLUSIONS: a) during ILV, adequate oxygenation and a reduction in V/Q mismatch can be obtained by setting Vt and PEEP to keep Pplat below a safe threshold for barotrauma; b) measurement of single lung EtCO2 can be useful to evaluate progressive V/Q matching.

Adult↗
PubMed2005

Costal osteochondroma presenting as haemothorax and diaphragmatic laceration.

We report the unusual case of an 11-year-old girl who suffered a large haemothorax and lacerated left hemidiaphragm because of a costal osteochondroma arising from the left sixth rib near the costochondral junction. Surgical excision of the osteochondroma was performed and the lacerated diaphragm was repaired.

Bone Neoplasms↗
PubMed1999

CT-guided 14-G cutting needle lung biopsy in children: safe and effective.

CT-guided percutaneous lung biopsy was performed in children with chronic respiratory disease to obtain samples for histological examination. An automatic cutting device with a 14-G needle was used with one or two cores obtained in each procedure. Seven procedures were performed in six children, mostly with local anaesthesia. Adequate tissue was obtained in all cases. Although a small pneumothorax and/or haemothorax occurred in most procedures, these were usually visible only on CT and did not require active management. A larger pneumothorax in one child also resolved with conservative management. Percutaneous CT-guided 14-G automatic cutting-needle biopsy of lung parenchyma in children is a minimally invasive alternative to open-lung biopsy with no complications in our series.

Adolescent↗
PubMed1997

Gorham syndrome of the thorax and cervical spine: CT and MRI findings.

Gorham syndrome is a rare disorder that is characterized by local osseous invasion and surrounding soft tissues by an angiomatous mass, eventually causing lysis of the affected bone. To date, only four cases have reported the MR imaging appearance of this disease and the findings have been variable. We present a case involving the cervical and thoracic spine and part of the osseous hemithorax with attention to the MR findings.

Angiomatosis↗
PubMedDate not supplied

Pseudoaneurysm of the internal mammary artery as an unusual cause of post-sternotomy hemorrhage: the role of multislice computed tomography in the diagnosis and treatment planning.

Pseudoaneurysm of the internal mammary artery (IMA) following median sternotomy is extremely rare. To date, the reported cases are only in single figures. The majority of these pseudoaneurysms were suspected from the clinical presentation, echocardiography or computed tomography (CT) but were only confirmed on contrast angiography. This case report demonstrates the current ability to carry out detailed vascular imaging on a 16-slice CT scanner. This accurate delineation of the pseudoaneurysm allowed targeted therapeutic embolization to be performed without unnecessary angiographic imaging.

Aneurysm, False↗
PubMed2001

A 73-year-old man with chronic lymphocytic leukaemia and a haemorrhagic pleural effusion.

A 73-year-old man presented with haemorrhagic pleural effusion, having been diagnosed with chronic lymphocytic leukaemia (CLL). The differential diagnosis of haemorrhagic pleural effusion is considered. Tuberculosis and pleural infiltration of CLL are considered most likely. Pleural biopsy confirms the diagnosis of pleural involvement of CLL in this case. Although pleural involvement of CLL has been reported several times the presentation of pleural effusion as the first symptom of CLL has not previously been described.

Aged↗
PubMed2003

[Catheter-based rescue of a split pacemaker lead in the pulmonary artery].

This case report describes a successful catheter-based rescue of a split pacemaker lead in the pulmonary artery-as an unusual reason for pleural effusion. Hemorrhagic pleural effusion was diagnosed 7 months after pacemaker exchange due to battery depletion and lead replacement due to an increase of the stimulation threshold. The reason for the pleural effusion was a splitting of the inactive electrode lead into shaft and inner fragment which was dislocated into the pulmonary artery and micro-perforated. The dislocated lead was retrieved using biopsy forceps and a gooseneck snare. Finally it was capped and fixed. Even in an anatomically difficult position, catheter-based rescue is feasible. Not in all pacemaker lead types is cutting the adapter of the inactive pacemaker leads recommendable.

Aged↗
PubMed1997

[Traumatic aortic rupture--diagnosis with transesophageal echocardiography].

A quick and exact diagnosis of a ruptured aorta can be achieved by different imaging methods (CT, TEE, NMR). In this case report, we describe a 36-year-old patient, who suffered rupture of the thoracic aorta in the isthmus region during a car accident. CT was suspicious of aortic rupture and the exact localization of the rupture site was visualized by TEE. It was confirmed during the operation when an aortic prosthesis was implanted. The high mortality of aortic rupture could possibly be lowered by early application of TEE. Preoperative angiography seems not to be necessary.

Adult↗
PubMed2003

Surfactant therapy in neonates with respiratory failure due to haemorrhagic pulmonary oedema.

UNLABELLED: We studied the clinical and biochemical factors associated with surfactant dysfunction and factors affecting the responsiveness to exogenous surfactant among 27 neonates with haemorrhagic pulmonary oedema (HPE). HPE was defined as the presence of a large amount of blood-stained lung effluent and respiratory failure which was difficult to differentiate from respiratory distress syndrome. Among the neonates, 33% had very low birth weight, 96% were preterm, 70% were delivered by caesarean section, and 44% had delivery room intubation. The onset of HPE was at 1.5+/-0.1 h (mean +/- SEM) after birth. In 26 cases, surfactant was administered at 3.0+/-1.3 h after the onset of HPE. The concentrations of surfactant protein A (SP-A), disaturated phosphatidylcholine (DSPC), and albumin in the epithelial lining fluid were determined using the first lung effluent from the patients. The level of inhibitory activity against pulmonary surfactant in the effluent was determined in vitro. Surfactant inhibitory activity was associated with lower birth weight, earlier gestational age, delivery room intubation, earlier onset of HPE, and lower SP-A or DSPC concentration. A good response to exogenous surfactant, which was defined as ventilatory index <0.047 at 1 h after surfactant administration, was seen in 82% of cases, and was associated with lower serum albumin, lower birth weight, and earlier gestational age. Cases with higher DSPC concentration prior to surfactant administration and shorter interval between the onset of HPE and surfactant administration showed an immediate response to surfactant, followed by no increase in ventilatory index for 24 h after surfactant administration. CONCLUSION: exogenous surfactant appeared to be a useful adjunctive therapy for overcoming surfactant inhibition and normalising the respiratory status of infants with haemorraghic pulmonary oedema. Surfactant treatment for this indication awaits further investigations including a randomised controlled study.

Albumins↗
PubMed1997

Complications associated with central venous catheters used for the collection of peripheral blood progenitor cells to support high-dose chemotherapy and autologous stem cell rescue.

The purpose of this study was to review the incidence and type of complications associated with the insertion and use of central venous catheters for leukapheresis and high-dose chemotherapy with stem cell rescue. One hundred sixty-seven central venous catheters placed either at the transplant center or by various community surgeons were studied for insertion complications, inability to perform leukapheresis and incidence of infection. The overall incidence of hemo- or pneumothorax was 3.6%. Inability to pherese occurred in 13% of catheters placed by outside surgeons and 6.5% of catheters inserted at the transplant institution. Most often, these were due to malposition of the catheter too high in the superior vena cava or in other veins. Deep venous thrombosis was often related to this malposition and occurred in 4.8% of all patients. Pulmonary embolism was not seen in these patients despite the fact the catheters were often left in place during the thrombotic episode. Early or late-onset infections occurred in 6.5% of patients and were most often exit site infections. The incidence of complications of pheresis catheters is high but might be reduced by more attention to proper placement of the catheter closer to the right atrial/superior vena cava junction, and limiting insertion to a cadre of surgeons familiar with leukapheresis requirements.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2005

Successful treatment of massive bleeding into the open thoracotomy space by pulmonary artery occlusion: report of a case.

A 69-year-old man underwent decortication and latissimus dorsi muscle transposition for the treatment of chronic empyema in January 2001. The empyema recurred in March 2002, and open drainage was thus started in July 2002. In February 2003, massive hemorrhaging from the thoracic cavity occurred. Tamponade and hemostasis were performed immediately, and angiography revealed bleeding from the pulmonary artery (PA). After identification of the bleeding point, surgical hemostasis was successfully achieved following PA occlusion with a Swan-Ganz thermodilution catheter.

Aged↗
PubMed2006

Aortic rupture: comparison of three imaging modalities.

We report a case of a 56-year-old man with traumatic aortic rupture (TAR) sustained in a motor vehicle accident diagnosed by helical computed tomography, aortography, and transesophageal echocardiography. A large majority of patients with TAR never make it to the hospital, and for those who do, a timely diagnosis is critical for survival. We discuss the merits and pitfalls of the three imaging modalities.

Accidents, Traffic↗