Article Commentary: Contemporary Management of Flail Chest

2014 ◽  
Vol 80 (6) ◽  
pp. 527-535 ◽  
Author(s):  
P. Geoff Vana ◽  
Daniel C. Neubauer ◽  
Fred A. Luchette
Keyword(s):  
Surgical Management ◽  
High Mortality ◽  
Inflammatory Reaction ◽  
Flail Chest ◽  
Pulmonary Contusion ◽  
Thoracic Injury ◽  
Challenging Problem ◽  
History Of ◽  
Fractured Ribs ◽  
Contemporary Management

Thoracic injury is currently the second leading cause of trauma-related death and rib fractures are the most common of these injuries. Flail chest, as defined by fracture of three or more ribs in two or more places, continues to be a clinically challenging problem. The underlying pulmonary contusion with subsequent inflammatory reaction and right-to-left shunting leading to hypoxia continues to result in high mortality for these patients. Surgical stabilization of the fractured ribs remains controversial. We review the history of management for flail chest alone and when combined with pulmonary contusion. Finally, we propose an algorithm for nonoperative and surgical management.

Injuries to the Chest Part 1

2019 ◽  
Author(s):  
Erika B. Call ◽  
Amy N. Hildreth ◽  
J. Jason Hoth
Keyword(s):  
Emergency Department ◽  
Injury Severity ◽  
Flail Chest ◽  
Rib Fractures ◽  
Pulmonary Contusion ◽  
Thoracic Injury ◽  
Resuscitative Thoracotomy ◽  
Pulmonary Laceration ◽  
Tracheobronchial Injury ◽  
Early Trauma

Thoracic injury is common and is associated with significant morbidity and mortality. Injuries to the chest are responsible for 25% of blunt trauma fatalities and contribute to an additional 50% of deaths in this population.1 Fortunately, the majority of thoracic injuries can be treated effectively, and often definitively, by relatively simple maneuvers that can be learned and performed by most physicians involved in early trauma care. Only 5 to 10% will require operative intervention.2 These extremes in injury severity are unique to the chest and require treatment by a surgeon with a correspondingly broad range of knowledge and skills.  This article will address the following procedures and injuries:  tube thoracostomy, thoracotomy, emergency department resuscitative thoracotomy, video-assisted thoracoscopy, chest wall injuries including rib fractures and flail chest, pneumothorax, hemothorax, empyema, pulmonary contusion and laceration, and tracheobronchial injury. This review 6 figures, 1 table, and 49 references. Keywords: Tube thoracoscopy, emergency department resuscitative thoracotomy (EDRT), rib fractures, flail chest, pneumothorax, hemothorax, empyema, pulmonary contusion, pulmonary laceration, tracheobronchial injury

Injuries to the Chest Part 1

2019 ◽  
Author(s):  
Erika B. Call ◽  
Amy N. Hildreth ◽  
J. Jason Hoth
Keyword(s):  
Emergency Department ◽  
Injury Severity ◽  
Flail Chest ◽  
Rib Fractures ◽  
Pulmonary Contusion ◽  
Thoracic Injury ◽  
Resuscitative Thoracotomy ◽  
Pulmonary Laceration ◽  
Tracheobronchial Injury ◽  
Early Trauma

Thoracic injury is common and is associated with significant morbidity and mortality. Injuries to the chest are responsible for 25% of blunt trauma fatalities and contribute to an additional 50% of deaths in this population.1 Fortunately, the majority of thoracic injuries can be treated effectively, and often definitively, by relatively simple maneuvers that can be learned and performed by most physicians involved in early trauma care. Only 5 to 10% will require operative intervention.2 These extremes in injury severity are unique to the chest and require treatment by a surgeon with a correspondingly broad range of knowledge and skills.  This article will address the following procedures and injuries:  tube thoracostomy, thoracotomy, emergency department resuscitative thoracotomy, video-assisted thoracoscopy, chest wall injuries including rib fractures and flail chest, pneumothorax, hemothorax, empyema, pulmonary contusion and laceration, and tracheobronchial injury. This review 6 figures, 1 table, and 49 references. Keywords: Tube thoracoscopy, emergency department resuscitative thoracotomy (EDRT), rib fractures, flail chest, pneumothorax, hemothorax, empyema, pulmonary contusion, pulmonary laceration, tracheobronchial injury

Surgical management of choke through oesophagotomy in a buffalo: A case report

2017 ◽  
Vol 12 (3) ◽  
Author(s):  
Devasee Borakhatariya ◽  
A. B. Gadara
Keyword(s):  
Case Report ◽  
Surgical Management ◽  
Clinical Presentation ◽  
Clinical Signs ◽  
Thoracic Inlet ◽  
Cervical Oesophagus ◽  
Foreign Objects ◽  
History Of ◽  
Oesophageal Obstruction ◽  
Large Animals

Oesophageal disorders are relatively uncommon in large animals. Oesophageal obstruction is the most frequently encountered clinical presentation in bovine and it may be intraluminal or extra luminal (Haven, 1990). Intraluminal obstruction or “choke” is the most common abnormality that usually occurs when foreign objects, large feedstuff, medicated boluses, trichobezoars, or oesophageal granuloma lodge in the lumen of the oesophagus. Oesophageal obstructions in bovine commonly occur at the pharynx, the cranial aspect of the cervical oesophagus, the thoracic inlet, or the base of the heart (Choudhary et al., 2010). Diagnosis of such problem depends on the history of eating particular foodstuff and clinical signs as bloat, tenesmus, retching, and salivation

Occurrence of seromucinous borderline tumours in the peritoneal lesions after bilateral salpingo-oophorectomy

2020 ◽  
Vol 13 (12) ◽  
pp. e234692
Author(s):  
Taihei Yamada ◽  
Satoko Eguchi ◽  
Ikuko Yokoo ◽  
Takahide Arimoto
Keyword(s):  
Malignant Transformation ◽  
Surgical Management ◽  
Previous History ◽  
Cancer Antigen ◽  
History Of

A 65-year-old woman with a previous history of bilateral salpingo-oophorectomy had peritoneal cysts, increasing in size over 15 years and an increasing cancer antigen 19–9 (CA 19–9) level. The size of the cysts eventually reached 86 mm and 70 mm. As malignant transformation of endometriosis was suspected, we performed peritoneal cystectomy and hysterectomy. Histopathology revealed seromucinous borderline tumours (SMBTs) derived from endometriosis. One month after surgery, her CA 19-9 level had decreased. It is rare for SMBT to occur after bilateral salpingo-oophorectomy; surgical management is the best treatment at present.

The Hydrographic Collections of the British Museum

1956 ◽  
Vol 9 (3) ◽  
pp. 323-334 ◽  
Author(s):  
R. A. Skelton
Keyword(s):  
High Mortality ◽  
British Museum ◽  
Comparative History ◽  
History Of Cartography ◽  
History Of ◽  
History Of Navigation

The history of navigation and hydrography, as of other crafts or ‘mechanick arts’, has to be constructed from very imperfect materials. Instruments and charts, as the tools of practical men, were commonly discarded when they were worn out or superseded. The high mortality among original charts makes generalization in the comparative history of cartography hazardous. That no Portuguese charts before 1500 are now known does not allow us to conclude that none was made but only that none has survived. Many of the early charts that have been preserved are decorative examples drawn for royal or other patrons; those by which pilots conned their ships had a smaller expectation of life and are correspondingly rare.

scholarly journals Late stabilization surgery in flail chest and pulmonary contusion

2020 ◽  
Vol 14 (1) ◽  
pp. 9
Author(s):  
Andhika Citra Buana ◽  
Yopie Afriandi Habibie ◽  
Muyasir Muyasir
Keyword(s):  
Flail Chest ◽  
Pulmonary Contusion

Invasive pulmonary aspergillosis/pseudomonas

2021 ◽  
Vol 14 (7) ◽  
pp. e236887
Author(s):  
Menaka Mahendran ◽  
Daniel Urbine
Keyword(s):  
Antifungal Therapy ◽  
High Mortality ◽  
Surgical Intervention ◽  
Main Pulmonary Artery ◽  
Invasive Pulmonary Aspergillosis ◽  
Chest Discomfort ◽  
Pulmonary Aspergillosis ◽  
Extensive Disease ◽  
Massive Haemoptysis ◽  
History Of

A 47-year-old Caucasian man on long-standing antifungal therapy for chronic necrotising aspergillosis and a history of recurrent pseudomonas pneumonias presented to the outpatient pulmonary clinic with dyspnoea and chest discomfort for 3 days. A CT angiography of the chest demonstrated angioinvasion from the previously noted left upper lobe cavitary lesion into the left main pulmonary artery, along with new consolidating lesions. Due to the high risk for massive haemoptysis, he was evaluated by thoracic surgery and underwent a successful left pneumonectomy. As invasive pulmonary aspergillosis is associated with high mortality, surgical intervention should always be considered, especially in those who develop extensive disease, despite being on aggressive antifungal therapy. Though minimally described in literature, invasive pulmonary pseudomonas also carries a high mortality risk. In our patient, cultures from the resected lung only demonstrated Pseudomonas aeruginosa.

Conservative Surgical Management of Late Carotid Patch Infection in a Patient with Subsequent Stenting for Restenosis

2021 ◽  
pp. 153857442110433
Author(s):  
Álvaro Torres-Blanco ◽  
Mario Altable-García ◽  
Manuel Miralles-Hernández
Keyword(s):  
Surgical Management ◽  
Clinical Manifestations ◽  
Duplex Ultrasound ◽  
Carotid Stenting ◽  
Sinus Tract ◽  
Surrounding Tissue ◽  
Patch Removal ◽  
History Of ◽  
Dacron Patch

Carotid patch infection is a rare but dreaded complication after endarterectomy. About 160 cases can be found in literature, but presentation in a patient with post-endarterectomy stenting has not been reported. Most frequent clinical manifestations include the occurrence of a sinus, a pseudoaneurysm, or neck swelling, but in severe cases it may present anastomosis dehiscence with hematoma or hemorrhage. Usually, patch removal and reconstruction is recommended, but there is not a standard protocol for management. Conservative surgical management with patch preservation has only been reported in a minority of cases. We report a patient with a history of carotid endarterectomy and subsequent carotid stenting 21 months later because of >80% restenosis. He presented a sinus in the scar 81 months after the former intervention. The patient underwent surgery, and during the procedure, a detachment of a small segment of the Dacron patch from the surrounding tissue was found. The sinus tract was resected, and after verifying the integrity of the patch, it was irrigated with rifampicin and preserved in situ. S. epidermidis was isolated from tissue cultures. Twenty-four months later, the patient remains asymptomatic and duplex ultrasound shows no signs of infection. Conservative surgical approach can be a valid option for treatment and may be considered in selected patients with limited infection.

Acute mesenteric ischaemia due to superior mesenteric vein (SMV) thrombosis

2021 ◽  
Vol 14 (4) ◽  
pp. e239110
Author(s):  
Muhammad Salah Muhammad Ahmad ◽  
Muhammad Rafaih Iqbal ◽  
Jonathan Simon Refson
Keyword(s):  
Small Bowel ◽  
Surgical Management ◽  
Superior Mesenteric Vein ◽  
Anticoagulation Therapy ◽  
Emergency Laparotomy ◽  
Bowel Ischaemia ◽  
Thrombotic Occlusion ◽  
Mesenteric Vein ◽  
Coffee Ground ◽  
History Of

A 77-year-old male patient presented with a 5-day history of abdominal pain, coffee ground vomiting and blood-stained diarrhoea. CT scan of the abdomen and pelvis demonstrated a long segment thrombotic occlusion of the superior mesenteric vein (SMV) extending up to the proximal portion of the portal vein causing significant acute small bowel ischaemia. Patient’s deteriorating clinical condition warranted surgical management. Successful surgical management required multidisciplinary teamwork between emergency, vascular surgeons, anaesthetists and intensivists. Emergency laparotomy revealed gangrene of an estimated 120 cm of small bowel segment starting from duodenojejunal junction and a long segment thrombotic occlusion of the SMV extending up to the portal confluence. Resection of gangrenous small bowel without anastomosis and thrombo-embolectomy of SMV along with laparostomy was done at the initial operation. Patient was admitted in the intensive care unit on systemic heparinisation through intravenous administration of unfractionated heparin. Second relook exploration was done after 48 hours followed by anastomosis of the small bowel and closure of the abdomen. Patient made a good recovery following anticoagulation therapy and was discharged on postoperative day 10.

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