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Zsolt Sziklavari, Michael Ried, Florian Zeman, Christian Grosser, Tamas Szöke, Reiner Neu, Rudolf Schemm, Hans-Stefan Hofmann
BACKGROUND: This retrospective study analyzed the effectiveness of intrathoracic negative pressure therapy for debilitated patients with empyema and compared the short-term and long-term outcomes of three different intrapleural vacuum-assisted closure (VAC) techniques. METHODS: We investigated 43 consecutive (pre)septic patients with poor general condition (Karnofsky index ≤ 50 %) and multimorbidity (≥ 3 organ diseases) or immunosuppression, who had been treated for primary, postoperative, or recurrent pleural empyema with VAC in combination with open window thoracostomy (OWT-VAC) with minimally invasive technique (Mini-VAC), and instillation (Mini-VAC-Instill)...
October 21, 2016: Journal of Cardiothoracic Surgery
Tae Nyoung Chung, Sun Wook Kim, Je Sung You, Hyun Soo Chung
OBJECTIVE: Tube thoracostomy (TT) is a commonly performed intensive care procedure. Simulator training may be a good alternative method for TT training, compared with conventional methods such as apprenticeship and animal skills laboratory. However, there is insufficient evidence supporting use of a simulator. The aim of this study is to determine whether training with medical simulator is associated with faster TT process, compared to conventional training without simulator. METHODS: This is a simulation study...
March 2016: Clin Exp Emerg Med
Christopher Bell, Fernando Domingo, Ashley D Miller, Jeremiah S Smith, James R Headrick
We report a case of a posterior mediastinal mature cystic teratoma with rupture secondary to blunt chest trauma in a 20-year-old male involved in a motor-vehicle accident. Initial treatment was guided by Advanced Trauma Life Support and a tube thoracostomy was performed for presumed hemothorax. The heterogeneous collection within the thoracic cavity was discovered to be the result of a ruptured cystic mass. Pathologic findings confirmed the mass consistent with a mature cystic teratoma. As mediastinal teratomas are most commonly described arising from the anterior mediastinum, the posterior location of the teratoma described in this report is exceedingly rare...
2016: Case Reports in Surgery
Charles Bakhos, Peter Doelken, Stevan Pupovac, Ashar Ata, Tom Fabian
BACKGROUND: Prolonged pulmonary air leaks (PALs) are associated with increased morbidity and extended hospital stay. We sought to investigate the role of bronchoscopic placement of 1-way valves in treating this condition. METHODS: We queried a prospectively maintained database of patients with PAL lasting more than 7 days at a tertiary medical center. Main outcome measures included duration of chest tube placement and hospital stay before and after valve deployment...
July 2016: JSLS: Journal of the Society of Laparoendoscopic Surgeons
Sidharth Navin Jogani, Ramesh Subedi, Amit Chopra, Marc A Judson
We describe a man who developed pleural effusion with Pasteurella multocida, and review the reported literature concerning this entity. We identified 21 such cases, including our own. Most patients with P. multocida pleural effusions are immunocompromised and/or have significant co-morbidities. These effusions are typically complicated parapneumonic effusions that are grossly purulent (87%) with a low pleural fluid pH (mean 6.8), high protein (mean 4.8 g/dl) and high LDH (mean 1911 U/L) and low glucose (28...
2016: Respiratory Medicine Case Reports
H Drinhaus, T Annecke, J Hinkelbein
Decompression of the chest is a life-saving invasive procedure for tension pneumothorax, trauma-associated cardiopulmonary resuscitation or massive haematopneumothorax that every emergency physician or intensivist must master. Particularly in the preclinical setting, indication must be restricted to urgent cases, but in these cases chest decompression must be executed without delay, even in subpar circumstances. The methods available are needle decompression or thoracentesis via mini-thoracotomy with or without insertion of a chest tube in the midclavicular line of the 2nd/3rd intercostal space (Monaldi-position) or in the anterior to mid-axillary line of the 4th/5th intercostal space (Bülau-position)...
October 2016: Der Anaesthesist
Can Ozen, Haldun Akoglu, Rifat Ozgur Ozdemirel, Elif Omeroglu, Cigdem Ulubay Ozpolat, Ozge Onur, Yalcin Buyuk, Arzu Denizbasi
INTRODUCTION: The purposes of this study were to measure the chest wall thicknesses (CWTs) at second intercostal space (ICS) mid-clavicular line (MCL) and fifth ICS MAL directly, and compare the actual success rates of needle thoracostomies (NTs) by inserting a 5-cm-long syringe needle. Predictive values of weight, body mass index (BMI) and CWT were also analyzed. MATERIALS AND METHODS: This study included 199 measurements of 50 adult fresh cadavers from both hemithoraces...
August 20, 2016: American Journal of Emergency Medicine
Asthildur Arnadottir, Saddiq Mohammad Qazi, Thomas Høi-Hansen
A 29-year-old pregnant woman was admitted to hospital with chest pain and dyspnoea. A thoracal computed tomography (CT) was performed to rule out pulmonary embolism, and it revealed a left-sided pneumothorax, which was treated with tube thoracostomy. Three days after discharge she was readmitted with spontaneous pressure pneumothorax. Her clinical condition did not improve, and a pulmonary scintigraphy and a new thoracal CT showed unilateral right pulmonary agenesis. Pulmonary agenesis is very rare in adulthood, and in this case it was complicated with spontaneous pneumothorax...
August 22, 2016: Ugeskrift for Laeger
Chen-Hao Hsiao, Ke-Cheng Chen, Jin-Shing Chen
BACKGROUND: Parapneumonic empyema patients with coronary artery disease and reduced left ventricular ejection fraction are risky to receive surgical decortication under general anesthesia. Non-intubated video-assisted thoracoscopy surgery is successfully performed to avoid complications of general anesthesia. We performed single-port non-intubated video-assisted flexible thoracoscopy surgery in an endoscopic center. In this study, the possible role of our modified surgery to treat fibrinopurulent stage of parapneumonic empyema with high operative risks is investigated...
August 12, 2016: Surgical Endoscopy
Mahmut Tokur, Mehmet Ergin, Mehmet Okumuş, Zerrin Defne Dündar
BACKGROUND/AIM: The collection of fluids, blood, pus, or air in the pleural cavity is a pathological condition requiring pleural drainage. A newly designed thorax drainage catheter in the prototype phase was used in this experimental study to test its efficacy. MATERIALS AND METHODS: A hemopneumothorax was first caused by a penetrating injury on the frontal axis of the sixth intercostal space on the right hemithorax with a scalpel on 6 female Sus domesticus swine subjects...
2016: Turkish Journal of Medical Sciences
Allie Daugherty
No abstract text is available yet for this article.
June 2016: JEMS: a Journal of Emergency Medical Services
Pier Luigi Filosso, Alberto Sandri, Francesco Guerrera, Andrea Ferraris, Filippo Marchisio, Giulia Bora, Lorena Costardi, Paolo Solidoro, Enrico Ruffini, Alberto Oliaro
Tube thoracostomy is usually the first step to treat several thoracic/pleural conditions such as pneumothorax, pleural effusions, haemothorax, haemo-pneumothorax and empyema. Today, a wide range of drains is available, ranging from small to large bore ones. Indications for an appropriate selection remains yet matter of debate, especially regarding the use of small bore catheters. Through this paper, we aimed to retrace the improvements of drains through the years and to review the current clinical indications for chest drain placement in pleural/thoracic diseases, comparing the effectiveness of small-bore drains vs...
July 2016: Journal of Thoracic Disease
Marco Chiarelli, Martino Gerosa, Angelo Guttadauro, Francesco Gabrielli, Giuseppe Vertemati, Massimo Cazzaniga, Luca Fumagalli, Matilde De Simone, Ugo Cioffi
BACKGROUND: The majority of patients with severe blunt chest trauma is successfully treated with supportive measures and thoracostomy tube; only few cases need urgent thoracotomy. Lung-sparing techniques are treatments of choice but major pulmonary resections are necessary in case of injuries involving hilar vessels or bronchi. Currently the mortality associated with pulmonary lobectomy performed for chest trauma is 40%. METHODS: Over a 2-year period [2013-2014], 210 patients with chest trauma were hospitalized at our Institution...
July 2016: Journal of Thoracic Disease
Zeeshan Ahmed, Pinakin Patel, Suresh Singh, Raj Govind Sharma, Pankaj Somani, Abdul Rauf Gouri, Shiv Singh
INTRODUCTION: Subcutaneous emphysema is a common complication of tube thoracostomy. Though self-limiting, it should be treated when it causes palpebral closure, dyspnea, dysphagia or undue disfigurement resulting in anxiety and distress to the patient. PRESENTATION OF CASE: A 72year old man who was a known case of COPD on bronchodilators developed a large pneumothorax and respiratory distress after a CT guided transthoracic lung biopsy done for a lung opacity (approx...
2016: International Journal of Surgery Case Reports
Nobuyuki Ashizawa, Shigeki Nakamura, Shotaro Ide, Masato Tashiro, Takahiro Takazono, Yoshifumi Imamura, Taiga Miyazaki, Koichi Izumikawa, Yoshihiro Yamamoto, Katsunori Yanagihara, Yoshitsugu Miyazaki, Shigeru Kohno
A 76-year-old woman received long-term immunosuppressive treatment for collagen vascular disease-associated interstitial pneumonia. The patient developed a cavitary mass lesion in the right lower lung field, and both nontuberculous mycobacteria and Aspergillus spp. were isolated after bronchial washing. The patient underwent a right lower lobectomy but developed Aspergillus empyema. Empyema due to Aspergillus spp. is a rare and life-threatening condition; however, the standard therapeutic strategies for treating Aspergillus empyema are not clear...
2016: Internal Medicine
Ting-Min Hsieh, Tsung-Cheng Tsai, Yueh-Wei Liu, Ching-Hua Hsieh
BACKGROUND: High-grade blunt hepatic and/or splenic injuries (BHSI) remain a great challenge for trauma surgeons. The main aim of this study was to investigate the characteristics, mortality rates, and outcomes of high-grade BHSI in motorcyclists and car occupants hospitalized for treatment of traumatic injuries in a Level I trauma center in southern Taiwan. METHODS: High-grade BHSI are defined as grade III-VI blunt hepatic injuries and grade III-V blunt splenic injuries...
2016: International Journal of Environmental Research and Public Health
Mohsen Sokouti, Mohammad Reza Ghaffari, Masoud Sokouti, Mohammad-Hossein Rahimi-Rad
A 53-year-old woman with foreign body esophageal perforation, was first misdiagnosed as pulmonary thromboembolism. In referral hospital her chest computed tomography was reported as giant hiatal hernia or giant pulmonary abscess. She was treated for abscess, after several days, right hemithorax tube thoracostomy was performed. After that, she developed necrotizing fasciitis on the chest wall. After a 19-day delay, we found a 5-cm mid-thoracic esophageal tearing during thoracotomy and repaired it. After 2 years follow up the patient condition is good...
May 2016: Chirurgia
Danielle Hart, Mary Ann McNeil, Cullen Hegarty, Robert Rush, Jeffery Chipman, Joseph Clinton, Troy Reihsen, Robert Sweet
There are many models currently used for teaching and assessing performance of trauma-related airway, breathing, and hemorrhage procedures. Although many programs use live animal (live tissue [LT]) models, there is a congressional effort to transition to the use of nonanimal- based methods (i.e., simulators, cadavers) for military trainees. We examined the existing literature and compared the efficacy, acceptability, and validity of available models with a focus on comparing LT models with synthetic systems...
2016: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
Kevin High, Jeremy Brywczynski, Oscar Guillamondegui
OBJECTIVE: The use of thoracostomy to treat tension pneumothorax is a core skill for prehospital providers. Tension pneumothoraces are potentially lethal and are often encountered in the prehospital environment. METHODS: The authors reviewed the prehospital electronic medical records of patients who had undergone finger thoracostomy (FT) or tube thoracostomy (TT) while under the care of air medical crewmembers. Demographic data were obtained along with survival and complications...
July 2016: Air Medical Journal
Leonardo Duranti, Luca Tavecchio, Giovanni Leuzzi, Ugo Pastorino
We herein report a case of a 56-year old man who underwent an intrapericardial right pneumonectomy plus partial left atrial resection for a lung sarcomatoid carcinoma. One month after surgery, the patient developed a broncho-pleural fistula in the right main bronchus. After the failure of several consecutive conservative and surgical treatments (bronchoscopic submucosa injection of fibrin glue, thoracostomy, Amplatzer device placement, omentoplasty, VAC therapy), the patient developed a pleural empyema. So, we decided to fill the pleural space with granulated sugar (changing thoracostomy dressing daily) with subsequent clinical improvement, allowing a definitive surgical closure through a thoracoplasty...
July 1, 2016: European Journal of Cardio-thoracic Surgery
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