scholarly journals The place and role of videothoracoscopic surgical interventions in war wounds and injuries of the chest organs

2018 ◽  
Vol 22 (3) ◽  
pp. 522-524
Author(s):  
I.P. Khomenko ◽  
K.P. Gerzhyk ◽  
B.M. Kucher
Keyword(s):  
Wounds And Injuries ◽  
General Structure ◽  
Traumatic Injury ◽  
Gunshot Wounds ◽  
Severe Injuries ◽  
Surgical Interventions ◽  
War Wounds ◽  
Medical Evacuation ◽  
Video Assisted ◽  
Surgical Tactics

Thoracic injuries are considered to be one of the most severe injuries of human systems and organs, which are characterized by a large number of complications and high mortality. According to the ATO data in eastern Ukraine, the frequency of chest injuries in the general structure of combat surgical injuries is 11.7%, the overwhelming majority of which were non-penetrating injuries (83.6%). The overall mortality rate for penetrating wounds of the breast is 5–10%. Surgical tactics for injuries and injuries of the chest is diverse and depends on the type of traumatic injury, the time of first medical and specialized care, the severity of the condition of the victims, the presence of complications, the technical capabilities of the hospital. Objective: optimization of surgical tactics for wounds and injuries of the chest through the use of video-assisted thoracoscopic techniques. A retrospective analysis of the surgical treatment of 103 thoracic wounded and injured, which were located in the Military Medical Clinical Center of the Southern Region in Odessa and the area of responsibility (level II–IV medical care) from June 2014 to July 2017, was carried out. At the stages of medical evacuation of all 103 thoracic wounded and injured in most cases (41 people (39.8%)), drainage of the pleural cavity was sufficient to eliminate hemo- and pneumothorax — 25 (24.3%) underwent various surgical interventions from thoracotomic approaches, 16 (15.5%) had various video-assisted thoracoscopic surgeries, 16 (15.5%) had only surgical treatments for gunshot wounds, and 5 (4.9%) wounded and injured had only conservative therapy. Conclusions: Promising, in our opinion, can be the widespread introduction of video-assisted thoracoscopic interventions into the practice of surgeons who are involved in the ATO, followed by a multicenter assessment of the results.

scholarly journals Multidetector computed tomography in the diagnosis of lesions of the main vessels for gunshot injury of the chest

2019 ◽  
Vol 18 (1) ◽  
pp. 31-38
Author(s):  
A. Yu. Vasil’ev ◽  
I. S. Obelchak
Keyword(s):  
Traumatic Injury ◽  
Surgical Care ◽  
Gunshot Wounds ◽  
Main Method ◽  
Gunshot Injuries ◽  
Chest Injuries ◽  
Vascular Bed ◽  
Great Vessels ◽  
Vascular Structures ◽  
Surgical Tactics

Purpose – examine the possibilities of multislice computed tomangiography (MSCTA) in case of suspected damage to the great vessels in a chest gunshot fghting injury.Material and methods. A radiation survey of 130 wounded with gunshot injuries of the chest to assess the nature, diagnosis of gunshot injuries of the vascular bed.Results. Of the 130 wounded with gunshot wounds to the chest, 41 (31.5 %) of the injured had gunshot wounds to the chest were non­penetrating, and 89 (68.5 %) had penetrating injuries. In 76 (58.4 %) patients with gunshot chest injuries, the nature of the wound was fragmentation, in 54 (41.6 %), wounds were bullet wounds. In the algorithm of radiation examination of patients with gunshot wounds of the chest to identify the nature of damage to the organs of the mediastinum and vascular structures, the main method of visualization was MSCT with contrast enhancement. Damage to the bone skeleton of the chest (ribs, collarbone, sternum, scapula) by MSCT was observed in 23 (17.6 %) patients. Almost half – 66 (50.1 %) of the wounded with gunshot injuries during MSCT examination, traumatic injury (pulmonitis) of the lung was observed. In 2 (1.5 %) cases, damage to the heart was detected that was not recognized at the stage of skilled surgical care. False post­traumatic aneurysm of the thoracic aorta was diagnosed in two wounded. Accuracy, sensitivity, specifcity of MSCT angiography in imaging of the vascular bed and diagnosis of damage to the great vessels of the chest cavity was 98, 97 and 97 %, respectively.Conclusions. MSCT made it possible to reliably assess the nature of the gunshot injuries of the chest, identify timely damage to the great vessels of the mediastinum, determine the localization of the foreign injuring bodies near the vascular structures, and determine the surgical tactics.

Fall, Crush, Kick: Mechanisms and Outcomes in a Cohort of Equine-Related Injuries

2021 ◽  
pp. 000313482110488
Author(s):  
Pratik Bhade ◽  
Amelia Parsons ◽  
Abbey Smiley ◽  
Jacob Shreffler ◽  
Nick Nash ◽  
...  
Keyword(s):  
Traumatic Injury ◽  
The United States ◽  
Rib Fractures ◽  
High Rate ◽  
Protective Equipment ◽  
Solid Organ ◽  
Mechanism Of Injury ◽  
Severe Injuries ◽  
Protective Devices ◽  
Animal Size

Introduction The potential for significant traumatic injury to individuals who interact with horses remains high due to animal size, forces applied, and unpredictability. Despite an estimated 30 million riders in the United States annually, few recent publications have addressed this patient population. Objectives This study describes characteristics of patients injured in interactions with horses, focusing on mechanism of injury and use of protective equipment. Methods We queried our institution’s trauma registry for all patients admitted for equine-related injuries (ERI) between January 1, 2013 and December 31, 2017. We categorized by specific mechanism of injury (fall, crush, kick, fall + crush, and fall + kick) and presence or absence of protective devices. Results We discovered 143 patients admitted for injuries in equine-related accidents. Patients averaged 49.2 years old, and 62.2% were female. Crush injuries resulted in a high rate of rib fractures. Riders who were kicked had an increased chance of solid organ and facial injuries and falls most commonly led to rib fractures and extremity trauma. Despite lack of documentation on most subjects, protective devices were associated with less severe injuries in those with data (n = 36). Conclusions In this relatively large series of patients with ERI, we found mechanism differences within injury groups. Providers should more carefully document specific circumstances of ERIs. All individuals working with or around horses should exercise prudence and consider using protective equipment.

Trampoliny – czy są bezpieczne? Skoki na batucie jako przyczyna urazów narządu ruchu w materiale dziecięcego oddziału urazowo-ortopedycznego

2019 ◽  
Vol 22 (1) ◽  
Author(s):  
Piotr Zając
Keyword(s):  
Distal Tibia ◽  
Severe Injuries ◽  
Locomotor System ◽  
Surgical Interventions ◽  
Number Of Children ◽  
Risk Of Injury ◽  
Limb Injuries ◽  
Supracondylar Humerus Fractures ◽  
Forearm Bones ◽  
Humerus Fractures

Introduction. Skilful marketing and accessible prices are main causes of popularity of garden trampolines. Increasingly often the improper and unwise use of them leads to severe injuries of the locomotor system. Aim. An analysis of the above-mentioned injuries in children using materials of the Orthopaedics and Trauma Unit. Material and methods. Using the hospital IT system emergency admittances were analysed for the years 2016-2017. A selected group of patients was evaluated in terms of epidemiology and treatment methods. Results. Treatment was provided to 41 patients (21 boys, 20 girls), aged 2 to 16 years (mean age: 7.3 years). 85.4% of the admitted patients used the trampoline together with other children, 70.7% children bounced on the trampoline unsupervised by adults. Upper limb injuries represented 82.9% (34 children) of all cases, the majority of injuries involved the elbow joint and the forearm. Supracondylar humerus fractures and fractures of the shaft of both forearm bones were most frequently diagnosed. Lower limb injuries represented 17.1% (7 children) of all cases, related to the knee joint and ankle area, the most frequently diagnosed injuries were distal tibia and fibula fractures. Twenty eight (68.3%) children required surgical treatment, and 13 (31.7%) patients received conservative treatment. Conclusions. There are a growing number of children with locomotor system injuries related to playing on a trampoline and requiring hospitalisation and surgical interventions. Own experience and quoted references allow formulating principles reducing the risk of injury, including prohibiting the youngest children to play, reduction of the simultaneous use of a trampoline by more than one child, and a requirement of a constant supervision.

scholarly journals Radiation diagnostics of thoracic gunshot wounds

2020 ◽  
pp. 70-80
Author(s):  
Iryna Dykan
Keyword(s):  
Soft Tissues ◽  
General Structure ◽  
Ground Glass Opacity ◽  
Gunshot Wounds ◽  
Lung Parenchyma ◽  
Combat Trauma ◽  
Side Impact ◽  
Pulmonary Contusion ◽  
Projectile Energy ◽  
Surgical Trauma

The frequency of thoracic injuries in the general structure of combat surgical trauma remains at the level of 7-12 % and unchanged from the time of the Second World War to the current armed conflicts. The overwhelming majority of them (up to 72 %) are shrapnel gunshot wounds. The formation of a gunshot wound occurs due to the action of a shock wave; a wounding projectile; energy of side impact and vortex wake. The shape, size, features of the wound canal are determined by the kinetic energy of the wounding agent and the physical properties of the damaged tissues. The lung parenchyma is loose and elastic, so small-caliber bullets with low energy cause minimal damage. The wound canal is well differentiated on CT-slices. Its cavity is filled with blood, fragments of destroyed tissue, air bubbles. On the periphery, the contusion zone is determined (area of increased attenuation in the lung-ground-glass opacity). Shrapnel wounds can be accompanied by ruptures of the pulmonary parenchyma with hemorrhages, bilateral pulmonary contusion, damage to the bone frame and soft tissues of the chest. Vascular injury with massive hemorrhage into the pleural cavity and tense hemopneumothorax are one of the main causes of mortality in penetrating wounds. Transmediastinal gunshot wounds, armor trauma and bullet embolism require special attention during radiation examination of victims. The purpose of radiation diagnostics of modern combat trauma is to identify and fully characterize injuries and their complications. The amount of diagnostic information is determined by the level of medical care. Key words: gunshot wounds, chest cavity organs, radiation diagnostics.

scholarly journals EVOLUTION OF VIEWS ON THE DEVELOPMENT AND IMPLEMENTATION OF MODERN SURGICAL MAGNETIC INSTRUMENTS ON THE CASE OF INFLAMMATORY PENETRATING INJURIES OF THE BREAST

2020 ◽  
pp. 113-118
Author(s):  
Yu. V. Bunin ◽  
P. M. Zamyatin ◽  
R. M. Mihаylusov ◽  
V. V. Negoduyko ◽  
S. O. Beresnyev ◽  
...  
Keyword(s):  
Foreign Bodies ◽  
Pleural Cavity ◽  
Gunshot Wounds ◽  
Surgical Instruments ◽  
Internal Organs ◽  
Surgical Interventions ◽  
Magnetic Nozzle ◽  
Endoscopic Laser ◽  
Laser Visualization ◽  
Magnetic Instrument

Summary. The arms — to analyze the evolution of the development of modern surgical instruments in gunshot wounds chest. Materials and methods. 80 cases of using a modern magnetic surgical instrument for penetrating gunshot wounds of the chest were analyzed. Intraoperatively used: a magnetic multifunctional tool for the diagnosis and removal of metallic ferromagnetic foreign bodies, a flexible device for removing ferromagnetic foreign bodies, a magnetic tool for endovideoscopic diagnosis and removal of metallic ferromagnetic foreign bodies from the abdominal and pleural cavities, a magnetic nozzle for video endoscopic surgical interventions. When removing metal foreign bodies, the following methods were used: a method for preliminary determination of the material and properties of a foreign body, a method for video endoscopic laser visualization of the internal organs of the abdominal and pleural cavities. Results. Foreign bodies of the pleural cavity were diagnosed in 80 (100 %) wounded according to СT. Ferromagnetic metal foreign bodies of a gunshot origin of the pleural cavity were removed both during thoracotomy or minithoracotomy, and during thoracoscopic surgical interventions using the method of video endoscopic laser visualization of the internal organs of the abdominal and pleural cavities. The most convenient tool was the endoscopic magnetic tool for removing foreign bodies from the pleural or abdominal cavities. A magnetic nozzle for video endoscopic surgical interventions allows navigation both in the pleural cavity and along the wound channel. Conclusions. 1. The development of a surgical magnetic instrument was phased and began with the improvement of a surgical magnetic instrument to remove ferromagnetic foreign bodies of soft tissues. 2. The improvement of the tool took place as the restrictions on the use of the existing tool were established, which was a prerequisite for the development of a new tool. 3. It is advisable to create a special set of surgical magnetic instruments for video endoscopic surgery.

scholarly journals SURGICAL ASPECTS OF DIAGNOSIS AND TREATMENT OF CHEST PATHOLOGY CAUSED BY CORONAVIRUS DISEASE COVID-19, ANALYSIS OF CLINICAL CASE

2020 ◽  
Vol 19 (4) ◽  
pp. 25-31
Author(s):  
V. Yatskyv ◽  
B. Maksymyuk ◽  
S. Frimet ◽  
Ya. Hyrla ◽  
S. Mereuca
Keyword(s):  
Personal Experience ◽  
Viral Infections ◽  
Specific Treatment ◽  
Lung Parenchyma ◽  
Surgical Interventions ◽  
Medical Institutions ◽  
Surgical Tactics ◽  
Bilateral Lung ◽  
Surgical Aspects ◽  
Basic Medical

The COVID-19 pandemic has generated many challenges both for humanity in general, and for the systems of organizing medical care and many areas of specialized treatment, in particular surgical. The very dynamics of the pandemic, the lack of available specific treatment, various approaches to assessing statistical and clinical data in various countries today do not allow generally accepted conclusions to be drawn. Numerous publications on this topic, as a rule, contain information about personal experience of research, diagnosis, treatment and a review of the current literature. We analyzed 68 cases of chest diseases caused by COVID-19 in patients who received consultative, specialized surgical thoracic care in basic medical institutions of Chernivtsi region for the period January-September 2020. Bilateral lung lesions predominated – 70.6 % in older patients 42 years (66.2 %). Surgical interventions were performed in 65 (95.6 %) patients. The most common complication in the acute period was pneumothorax on the background of active viral pneumonia – 40 (58.8 %) patients, 6 (8.8 %) – patients with heart and pericardial lesions, 7 (10.3 %) – hemorrhagic, serous-fibrinous pleurisy. Based on own data in comparison with the histological and pathophysiological researches resulted in the available literature, surgical tactics, separate surgical receptions at patients with virus-induced complications, in particular: drainage of a pleural cavity, pericardium, videothoracoscopic techniques are proved. The algorithm of examinations and treatment tactics in the formation of intrapulmonary pseudocysts after coronavirus disease are presented. We analyzed 5 (7.4 %) cases in which there were complications of major diseases (cancer, nonspecific purulent-septic diseases) caused by COVID-19. Study of the effectiveness of the use of videothoracoscopic electric welding technologies in the destruction of the lung parenchyma caused by viral infections.

scholarly journals FEATURES OF EMERGENCY SURGERY IN PATIENTS WITH LOCALLY ADVANCED GASTRIC CANCER

2020 ◽  
pp. 108-112
Author(s):  
V. V. Boyko ◽  
I. V. Krivorotko ◽  
V. A. Lazirsky
Keyword(s):  
Gastric Cancer ◽  
Advanced Gastric Cancer ◽  
Surgical Intervention ◽  
Locally Advanced ◽  
Postoperative Mortality ◽  
Surgical Interventions ◽  
Second Stage ◽  
Locally Advanced Gastric Cancer ◽  
Surgical Tactics ◽  
Gastric Cancer Patients

Summary. Materials and methods. The work is based on an analysis of the results of surgical treatment of 418 patients with complicated locally advanced gastric cancer. Patients are divided into two groups: comparisons — 212, and the main — 206 patients who were treated from 2006 to 2010. and from 2011 to 2015 respectively. The complications rating was: bleeding in 252 (60.3 %) patients, stenosis in 89 (21.3 %), perforation in 15 (3.5 %), and their combination in 62 (14.8 %). Results and discussion. Radical operations were performed in 212 (50.7 %) patients, in 145 (34.6 %) — palliative and symptomatic. Postoperative complications occurred in 82 patients (19.6 %), postoperative mortality was 7.2 % (30 patients). A two-stage surgical tactics has been developed, which involves the implementation of minimally invasive endoscopic and endovascular surgical interventions at the first stage with the implementation of a delayed or planned surgical intervention at the second stage. Conclusions. Urgent operations decreased from 21.7 to 6.3 %, which reduced the number of palliative and symptomatic operations from 50.4 to 18.4 %.

War Wounds and Injuries

BMJ ◽  
1940 ◽  
Vol 2 (4171) ◽  
pp. 832-832
Keyword(s):  
Wounds And Injuries ◽  
War Wounds
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