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Thoracic emergency

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https://www.readbyqxmd.com/read/29342420/-use-of-bronchial-blocker-in-emergent-thoracotomy-in-presence-of-upper-airway-hemorrhage-and-cervical-spine-fracture-a-difficult-decision
#1
Carlos Almeida, Maria João Freitas, Diogo Brandão, José Pedro Assunção
Female, 85 y.o., weighting 60kg, multiple trauma patient. After an initial laparotomy, an emergent thoracotomy was performed using a bronchial blocker for lung isolation (initial active suction was applied). During surgery, bronchial cuff was deflated, causing a self-limited tracheal blood flooding. A second lung isolation was attempted but it was not as effective as initially. Probably, a lung collapse with the same bronchial blocker was impaired in the second attempt because of the obstruction of bronchial blocker lumen by intraoperative endobronchial hemorrhage...
January 13, 2018: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/29339085/wnt5a-mediates-chronic-post-thoracotomy-pain-by-regulating-non-canonical-pathways-nerve-regeneration-and-inflammation-in-rats
#2
Afang Zhu, Le Shen, Li Xu, Weiyun Chen, Yuguang Huang
As well-characterized ligands involved in neurogenesis, Wnts are emerging as promising targets in pain pathogenesis. Our previous pilot study showed that intrathecal inhibition of Wnt5a, but not Wnts, relieves chronic post-thoracotomy pain (CPTP) in rats. In the present study, we aimed to further explore the regulatory mechanism of Wnt5a in CPTP development. Increased protein levels of Wnt5a, transmembrane receptor Ror2, and activated non-canonical Wnt pathway members were found in the thoracic dorsal root ganglions from postoperative day (POD) 7 to POD 21...
January 12, 2018: Cellular Signalling
https://www.readbyqxmd.com/read/29337450/-emergency-medicine-update-2017
#3
Frédéric Rouyer, Fabrice Dami, Olivier Grosgurin, Valériane Rossier, Majd Ramlawi, Mathieu Pasquier, Olivier T Rutschmann
Emergency medicine is part of the current stream of efficient and qualitative medicine : 1) the modified Valsava maneuver results in the resolution of almost 50% of supra-ventricular tachycardia without any drug; 2) lung echography performed by emergency physicians is a very sensitive and specific diagnostic tool for most thoracic emergencies; 3) cardiopulmonary resuscitation initiated by lay-rescuers improves short and long-term outcome; 4) no anticoagulant treatment is warranted in distal deep vein thrombosis and 5) systematic unenhanced abdominal CT might improve evaluation of elderly patients with acute abdominal pain...
January 10, 2018: Revue Médicale Suisse
https://www.readbyqxmd.com/read/29336762/r-a-cowley-the-golden-hour-the-momentary-pause-and-the-third-space
#4
David E Clark
R Adams Cowley (1917-1991), the Baltimore thoracic and trauma surgeon, was an outstanding politician and promoter of emergency medical services. His skills included the effective use of language, for example, identifying the critical time immediately after injury as a "golden hour," and describing shock as a "momentary pause in the act of death." Conversely, Cowley avoided the tendency of some contemporaries to justify massive crystalloid infusion by invoking a "third space." Cowley is often assumed to have originated the first two phrases, but, in fact, their histories go back at least to the 19th century and illustrate the development of surgical science...
December 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/29332327/stage-ii-thymoma-and-emergency-coronary-artery-bypass-to-irradiate-or-not-to-irradiate-to-avoid-radiation-induced-vascular-injury-case-report-and-literature-review
#5
Ilias A Kouerinis, Maria Tolia, Flora Zagouri, Michail Nikolaou, Nikolaos Tsoukalas, George Kyrgias, Meletios A Dimopoulos, Charalambos Vlachopoulos, Ioannis Karathanassis, Christina K Zoubouli, Ioannis Kokakis, Vasileios Kouloulias, Konstantinos Triantafillou
PURPOSE: The purpose of this study was to present the controversial role of adjuvant radiotherapy to a 72-year-old male patient with Masaoka stage II thymoma and coronary artery bypass and to review the relevant literature. METHODS: The data were collected by relevant studies on PubMed and EMBASE. Articles up to March 2017 were included. RESULTS: Although the radiation-induced vascular injury to the internal thoracic artery and its suitability for grafting in a patient who is candidate for coronary artery bypass is documented, the possible catastrophic effect of adjuvant radiotherapy to existing grafts in a patient with prior bypass surgery has not been fully investigated...
November 2017: Journal of B.U.ON.: Official Journal of the Balkan Union of Oncology
https://www.readbyqxmd.com/read/29327341/combined-thoracic-paravertebral-and-pectoral-nerve-blocks-for-breast-surgery-under-sedation-a-prospective-observational-case-series
#6
A Pawa, J Wight, D N Onwochei, R Vargulescu, I Reed, L Chrisman, E Pushpanathan, A Kothari, K El-Boghdadly
Avoidance of general anaesthesia for breast surgery may be because of clinical reasons or patient choice. There is emerging evidence that the use of regional anaesthesia and the avoidance of volatile anaesthetics and opioid analgesia may have beneficial effects on oncological outcomes. We conducted a prospective observational case series of 16 breast cancer surgeries performed under thoracic paravertebral plus pectoral nerve block with propofol sedation to demonstrate feasibility of technique, patient acceptability and surgeon satisfaction...
January 12, 2018: Anaesthesia
https://www.readbyqxmd.com/read/29325526/aortoesophageal-fistula-and-arch-pseudoaneurysm-after-removing-of-a-swallowed-chicken-bone-a-case-report-of-one-stage-hybrid-treatment
#7
Jia-Yu Shen, Hong-Wei Zhang, Kang-Jun Fan, Hu Liao, Er-Yong Zhang, Jia Hu
BACKGROUND: Aortoesophageal fistula (AEF) and arch pseudoaneurysm are rare complications induced by a foreign body, and considerable controversy remains regarding the appropriate management strategies. We herein report a successful one-stage hybrid treatment in a patient with AEF and arch pseudoaneurysm. CASE PRESENTATION: The patient, a 40-year-old man, presented to the emergency room because of intense retrosternal discomfort for 3 days and hematemesis for 3 h...
January 11, 2018: BMC Surgery
https://www.readbyqxmd.com/read/29321106/segway%C3%A2-personal-transporter-related-injuries-a-systematic-literature-review-and-implications-for-acute-and-emergency-care
#8
Ali Pourmand, Jen Liao, Jesse M Pines, Maryann Mazer-Amirshahi
BACKGROUND: The Segway® Personal Transporter™ (SPT) is used widely as a means of transport for city sightseeing tours, law enforcement, and professionals working in large facilities and factories. METHODS: We conducted a systematic review of the literature to assess SPT-related injuries. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines, we queried PubMed from 1990 to 2017. The search terms Segway, personal transporter, and injury were used...
January 8, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29310701/severe-thoracic-trauma-still-an-independent-predictor-for-death-in-multiple-injured-patients
#9
Michael Grubmüller, Maximilian Kerschbaum, Eva Diepold, Katharina Angerpointner, Michael Nerlich, Antonio Ernstberger
BACKGROUND: Over the past, the severe thoracic trauma has had decisive influence on the outcome of multiple injured patients. Today, new therapies (e.g. extracorporeal membrane oxygenation (ECMO), protective ventilation methods and new forms of patient positioning) are available and applied regularly. What impact on the patient's outcome does the thoracic trauma have today? METHODS: Prospective data collection of multiple injured patients in a level-I trauma center was performed between 2008 and 2014...
January 8, 2018: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/29310091/measurement-of-respiratory-rate-by-multiple-raters-in-a-clinical-setting-is-unreliable-a-cross-sectional-simulation-study
#10
Mikkel Brabrand, Peter Hallas, Lars Folkestad, Cecilie Hovitz Lautrup-Larsen, Jacob Broder Brodersen
OBJECTIVE: To evaluate the inter-observer reliability of nurses assessing respiratory rate. METHODS: We presented seven minimum 60-seconds long videos of thoraces of non-identifiable patients breathing to experienced nurses from several Danish emergency departments. Two videos were assessed by 50 raters while five were reviewed by eight. The videos were shown using an online system that also recorded the counted respiratory rate. RESULTS: A total of 140 nurses participated with a median of 15years' experience...
December 28, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/29290895/falls-from-height-a-retrospective-analysis
#11
Kasim Turgut, Mehmet Ediz Sarihan, Cemil Colak, Taner Güven, Ali Gür, Sükrü Gürbüz
BACKGROUND: Emergency services manage trauma patients frequently and falls from height comprise the main cause of emergency service admissions. In this study, we aimed to analyse the demographic characteristics of falls from height and their relationship to the mortality. METHODS: A total of 460 patients, who admitted to the Emergency Department of Inonu University between November 2011 and November 2014 with a history of fall from height, were examined retrospectively...
2018: World Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29289988/rerouting-the-internal-thoracic-pedicle-a-novel-solution-for-maxillofacial-reconstruction-in-vessel-depleted-situations-a-preliminary-anatomic-study
#12
François Morel, Frédéric Crampon, Jérôme Adnot, Pierre-Yves Litzler, Fabrice Duparc, Olivier Trost
PURPOSE: Microsurgical reconstruction in a vessel-depleted neck is a challenge due to the lack of reliable vessels in or nearby the host site. The use of the internal thoracic pedicle (ITP) by rib section or sparring is a limited option due to the small length of the pedicle of some flaps. However, in cardiac surgery, the internal thoracic artery (ITA) is widely used for myocardial revascularization, providing a long and versatile pedicle. We aimed at determining precise anatomical bases for the use of the ITP, approached by sternotomy and rerouted in the neck, as recipient vessels for free-flap facial reconstructions...
December 30, 2017: Surgical and Radiologic Anatomy: SRA
https://www.readbyqxmd.com/read/29279461/immunoglobulin-g-subclass-4-related-lymphoplasmacytic-thoracic-aortitis-in-a-patient-with-acute-type-a-aortic-dissection
#13
Tetsuro Uchida, Azumi Hamasaki, Yoshinori Kuroda, Mitsuaki Sadahiro, Nobuyuki Tamazawa, Rintaro Ohe, Mitsunori Yamakawa
Immunoglobulin G subclass 4-related disease (IgG4-RD) is a recently recognized systemic inflammatory disease characterized by an elevated serum IgG4 level and an IgG4-positive lymphocyte infiltrate mainly in exocrine tissues. Previous reports documented IgG4-RD in several cardiovascular disorders. We present a case of type A aortic dissection associated with IgG4-RD. A 52-year-old man diagnosed with a type A aortic dissection was referred for surgical treatment. He underwent emergency hemiarch reconstruction with a prosthetic graft...
December 27, 2017: Annals of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29276439/endovascular-treatment-of-distal-aortic-arch-aneurysm-associated-with-coarctation-of-aorta-in-a-jehovah-s-witness
#14
Luigi Di Tommaso, Vito A Mannacio, Ettorino Di Tommaso, Giovanni B Pinna, Immacolata Fontana, Gabriele Iannelli
Late aneurysm formation in the proximal aorta or distal aortic arch is a recognized sequela of untreated stenosis of the aortic isthmus and is associated with substantial risk of aortic rupture. We describe the case of a 44-year-old man with untreated coarctation of the aorta who presented with a prestenotic dissecting thoracic aortic aneurysm. He declined surgery because he was a Jehovah's Witness. Instead, we performed emergency endovascular aortic repair in which 2 stent-grafts were placed in the descending aorta...
December 2017: Texas Heart Institute Journal
https://www.readbyqxmd.com/read/29275829/risk-modeling-to-optimize-patient-selection-for-management-of-the-descending-thoracic-aortic-aneurysm
#15
Akiko Tanaka, Harleen K Sandhu, Wande B Pratt, Rana Afifi, Charles C Miller, Kristofer Charlton-Ouw, Maria E Codreanu, Naveed U Saqib, Ali Azizzadeh, Hazim J Safi, Anthony L Estrera
BACKGROUND: A single-institutional study comparing early and long-term outcomes of thoracic endovascular aortic repair (TEVAR) and open surgical repair (OSR) was performed to determine the appropriate treatment option for descending thoracic aortic aneurysm (DTAA). METHODS: Between 2005 and 2014, 438 DTAA patients were treated (TEVAR, 88; OSR, 350). Acute dissection and traumatic injury were excluded. Perioperative and follow-up data were reviewed. Stratified analyses were conducted to identify patients most likely to benefit from TEVAR...
December 21, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29274600/evidence-of-intimal-tear-in-type-a-intramural-hematoma-of-the-aorta-a-case-series
#16
Gianfranco Filippone, Giovanni Caruana, Claudia Calia, Violetta Moscaritolo, Vincenzo Argano
INTRODUCTION: Aortic intramural hematoma (IMH) is described as "dissection without intimal tear" due to rupture of vasa vasorum, which results in bleeding within the tunica media in the absence of intimal disruption or blood flow communication. The aim of our study is to validate perioperative evidence of intimal entry tear in patients with IMH and to suggest that this entity may represent a part of a disease and not a separate disease. PRESENTATION OF CASES: We report two patients admitted to our institution with sudden onset thoracic pain...
December 12, 2017: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/29273422/med-score-24-a-multivariable-prediction-model-for-poststernotomy-mediastinitis-24%C3%A2-hours-after-admission-to-the-intensive-care-unit
#17
Mercedes Nieto-Cabrera, Cristina Fernández-Pérez, Inés García-González, Juan Carlos Martin-Benítez, Justo Ferrero, María Bringas, Manuel Carnero, Luis Maroto, Miguel Sánchez-García
OBJECTIVES: Mediastinitis is a serious complication of heart surgery. In this study, we developed a bedside risk score for poststernotomy mediastinitis. METHODS: Data were prospectively collected from 4625 patients admitted to our intensive care unit after heart surgery (January 2005-June 2011). Mediastinitis was defined according to Centers for Disease Control and Prevention criteria. A logistic model was constructed in a randomly selected subgroup of 2618 patients and validated in a second cohort of 1352, as well as in a prospective cohort of 2615 (June 2011-December 2015)...
November 22, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29259148/successful-recovery-from-spontaneous-spinal-epidural-hematoma-in-a-patient-undergoing-hemodialysis
#18
Arata Hibi, Takahisa Kasugai, Keisuke Kamiya, Keisuke Kamiya, Satoru Kominato, Chiharu Ito, Toshiyuki Miura, Katsushi Koyama
BACKGROUND Spontaneous spinal epidural hematoma (SSEH) occurs in the spinal epidural space in the absence of traumatic or iatrogenic causes, and is considered to be a neurological emergency, as spinal cord compression may lead to neurological deficit. Prompt diagnosis of SSEH can be difficult due to the variety of presenting symptoms, which may resemble those of stroke. Patients who undergo hemodialysis (HD) are at risk of bleeding due to anticoagulation during dialysis and uremia. However, SSEH in HD patients undergoing HD has rarely been reported...
December 20, 2017: American Journal of Case Reports
https://www.readbyqxmd.com/read/29250478/an-unusual-complication-of-congenital-diaphragmatic-hernia
#19
E Tian Tan, Keren Sloan, Kokila Lakhoo
A term newborn was referred to our unit with a postnatal diagnosis of a right-sided congenital diaphragmatic hernia (CDH). She was managed with high-frequency oscillatory ventilation, inotropic support, and nitric oxide, with planned surgical repair when she was medically optimized. On day 6 of life, there was an acute deterioration causing difficulty maintaining adequate ventilation and the infant requiring increasing analgesia and paralysis, especially during abdominal examination. A repeat X-ray showed distended bowel loops in the right hemithorax when compared with previous films raising suspicion of bowel obstruction...
January 2017: European Journal of Pediatric Surgery Reports
https://www.readbyqxmd.com/read/29249769/open-conversion-for-type-a-ascending-aortic-dissection-after-thoracic-endovascular-aortic-repair-by-the-chimney-graft-technique
#20
Hirofumi Kasahara, Yoshito Inoue, Takashi Hachiya
An 83-year-old man with aortic arch aneurysm underwent zone 0 thoracic endovascular aortic repair (TEVAR) by the chimney graft technique with two supra-aortic arch debranching grafts and developed subacute type A ascending aortic dissection. We performed emergency open conversion with circulatory arrest under deep hypothermia. The tip of the chimney graft (around the sino-tubular junction in the ascending aorta) was stiff, making it difficult to inspect the lumen and perform anastomosis. Deep hypothermic circulatory arrest and cutting the endograft stents to mobilize the graft were necessary for secure anastomosis...
December 18, 2017: Annals of Thoracic and Cardiovascular Surgery
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