Retrospective analysis of pneumothorax after repair of esophageal atresia/tracheoesophageal fistula

Background To analyze the possible causes, treatment and outcomes of postoperative pneumothorax in patients with Gross type C esophageal atresia/tracheoesophageal fistula (EA/TEF). Methods Medical records of patients with Gross type C EA/TEF who were diagnosed and treated in Beijing Children’s Hospital from January 2007 to January 2020 were retrospectively collected. They were divided into 2 groups according to whether postoperative pneumothorax occurred. Univariate and multivariate logistic regression analysis were performed to identify risk factors for pneumothorax. Results A total of 188 patients were included, including 85 (45 %) in the pneumothorax group and 103 (55 %) in the non-pneumothorax group. Multivariate logistic regression analysis showed that postoperative anastomotic leakage [P < 0.001, OR 3.516 (1.859, 6.648)] and mechanical ventilation [P = 0.012, OR 2.399 (1.210, 4.758)] were independent risk factors for pneumothorax after EA/TEF repair. Further analysis of main parameters of mechanical ventilation after surgery showed that none of them were clearly related to the occurrence of pneumothorax. Among the 85 patients with pneumothorax, 33 gave up after surgery and 52 received further treatment [conservative observation (n = 20), pleural puncture (n = 11), pleural closed drainage (n = 9), both pleural puncture and closed drainage (n = 12)]. All of the 52 patients were cured of pneumothorax at discharge. Conclusions Anastomotic leakage and postoperative mechanical ventilation were risk factors for pneumothorax after repair of Gross type C EA/TEF, but the main parameters of mechanical ventilation had no clear correlation with pneumothorax. After symptomatic treatment, the prognosis of pneumothorax was good.

Retrospective Analysis of Pneumothorax After Repair of Esophageal Atresia/Tracheoesophageal Fistula: A Case Control Study

Background To analyze the possible causes, treatment and outcomes of postoperative pneumothorax in patients with Gross type C esophageal atresia/tracheoesophageal fistula (EA/TEF).Methods Medical records of patients with Gross type C EA/TEF who were diagnosed and treated in Beijing Children’s Hospital from January 2007 to January 2020 were retrospectively collected. They were divided into 2 groups according to whether postoperative pneumothorax was occurred. Univariate and multivariate logistic regression analysis were performed to identify risk factors for pneumothorax.Results A total of 188 patients were included, including 85 (45%) in the pneumothorax group and 103 (55%) in the non-pneumothorax group. Multivariate logistic regression analysis showed that postoperative anastomotic leakage [P < 0.001, OR 3.516 (1.859, 6.648)] and mechanical ventilation [P = 0.012, OR 2.399 (1.210, 4.758)] were independent risk factors for pneumothorax after EA/TEF repair. The further analysis of main parameters of mechanical ventilation after surgery showed that none of them were clearly related to the occurrence of pneumothorax. Among the 85 patients with pneumothorax, 33 gave up after surgery and 52 received further treatment [conservative observation (n = 20), pleural puncture (n = 11), pleural closed drainage (n = 9), both pleural puncture and closed drainage (n = 12)]. All of the 52 patients were cured of pneumothorax at discharge.Conclusions Anastomotic leakage and postoperative mechanical ventilation were risk factors for pneumothorax after repair of Gross type C EA/TEF, but the main parameters of mechanical ventilation had no clear correlation with pneumothorax. After symptomatic treatment, the prognosis of pneumothorax was good.

Treatment of Chylothorax complicating pulmonary resection with hypertonic glucose Pleurodesis

Background To retrospectively assess the efficacy of hypertonic glucose pleurodesis for treatment of chylothorax after pulmonary resection. Methods Out of a total of 8252 patients who underwent pulmonary resection (at least lobectomy) at department of thoracic surgery, between June 2008 and December 2015, 58 patients (0.7%) developed postoperative chylothorax. All patients received conservative treatment, including thoracic closed drainage, oral fasting, and total parenteral nutrition. Results Conservative treatment was successful in 50 (86.2%) patients, while eight patients [mean age: 58.0 years (range, 45–75)] were treated with hypertonic glucose pleurodesis. All eight patients had undergone operation for lung cancer (four squamous cell carcinomas and four adenocarcinomas). The bronchial stump was covered by pleural flap in three patients. After pleurodesis, three patients developed fever but without empyema; thoracentesis was performed in two patients. The mean time interval between pleurodesis and operation was 4.3 days (range,3–5) days. The average length of stay was 23.1 days (range, 18–31). No recurrent pleural effusion was observed over a mean follow-up duration of 28 months. Conclusion Hypertonic glucose pleurodesis performed via the chest drainage tube is a viable treatment option for chylothorax after lung resection, prior to resorting to a thoracoscopic or thoracotomic ductus thoracicus ligation of the thoracic duct leak. It is a simple, safe and efficient modality associated with rapid recovery and less pain.

Association of gravity drainage and complications following Whipple: an analysis of the ACS-NSQIP targeted database

Background The optimal type of operative drainage following pancreaticoduodenectomy (PD) remains unclear. Our objective is to investigate risk associated with closed drainage techniques (passive [gravity] vs. suction) after PD. Methods We assessed operative drainage techniques utilized in patients undergoing PD in the ACS-NSQIP pancreas-targeted database from 2016 to 2018. Using multivariable logistic regression to adjust for characteristics of the patient, procedure, and pancreas, we examined the association between use of gravity drainage and postoperative outcomes. Results We identified 9665 patients with drains following PD from 2016 to 2018, of which 12.7% received gravity drainage. 61.0% had a diagnosis of adenocarcinoma or pancreatitis, 26.5% had a duct <3 mm, and 43.5% had a soft or intermediate gland. After multivariable adjustment, gravity drainage was associated with decreased rates of postoperative pancreatic fistula (odds ratio [OR] 0.779, 95% confidence interval [CI] 0.653–0.930, p=0.006), delayed gastric emptying (OR 0.830, 95% CI 0.693–0.988, p=0.036), superficial SSI (OR 0.741, 95% CI 0.572–0.959, p=0.023), organ space SSI (OR 0.791, 95% CI 0.658–0.951, p=0.012), and readmission (OR 0.807, 95% CI 0.679–0.958, p=0.014) following PD. Conclusions Gravity drainage is independently associated with decreased rates of CR-POPF, DGE, SSI, and readmission following PD. Additional prospective research is necessary to better understand the preferred drainage technique following PD.

Spontaneous pneumothorax as a complication of lung injury due to COVID-19

The objective of the study: to study the course and clinical outcomes of spontaneous pneumothorax (SP) in patients with lung injury due to COVID-19.Subjects and methods. Clinical and radiation data of 11 patients (above 18 years old) with SP due to COVID-19 were retrospectively analyzed, they all were treated in the thoracic surgery department. COVID-19 was confirmed in all patients by laboratory tests. According to the chest computed tomography, the patients had signs typical of viral pneumonia and SP.Results. The surgical treatment of SP that included thoracocentesis on the pneumothorax side and closed drainage of the pleural cavity allowed resolving the pneumothorax and inflating the lung fully in 10/11 patients within 4 days on average (max = 7 days) from the moment when the surgery was done. The lethal outcome was in 1/11 (9.1%) patient which occurred 1 day after the diagnosis and successful drainage of the bilateral SP, the patient had symptoms of acute cardiovascular failure.

Hyperperfusion and intracranial hemorrhage after burr hole surgery of chronic subdural hematoma

Background: Chronic subdural hematomas (CSDHs) mainly occur in elderly people and usually develop after minor head injuries. CSDH can be cured by a relatively simple burr hole surgery. Rarely reported, hemorrhagic postsurgical complications include subarachnoid, intracerebral, intraventricular, and remote cerebellar hemorrhages. The causes of such uncommon complications are difficult to explain and remain poorly understood. Case Description: We report the case study of an 89-year-old man with CSDH who presented with the right hemiparesis. He underwent burr hole surgery with a closed-drainage system. A computed tomography (CT) scan conducted the following day demonstrated an acute intraventricular hemorrhage and hyperperfusion of the ipsilateral hemisphere. Conclusion: This is a rare case of an acute hematoma in the ventricle following drainage of a CSDH. The likely mechanism of this intraventricular hemorrhage could be that the drainage of the hematoma produced a movement of the ventricle and hemisphere accompanied by hyperperfusion.

Influence of territory slope and drainage systems on the value of fire risk during transportation of flammable liquids by road transport

В работе осуществлена оценка величины потенциального риска при перевозке пожароопасных грузов автомобильным транспортом с учетом возможного стекания горючей жидкости по уклонам. Проведено сравнение величины пожарного риска для случаев открытых и закрытых дренажных канав. It is not possible to calculate the fire risk that takes into account slopes on roads within the existing methodology for determining the calculated fire risk values at production facilities. The article suggests the elaboration of methodology considering the above-mentioned factors. The paper provides comparative assessment of the fire risk when transporting gasoline by automobile tanks with a capacity of 28 m, both considering one of the factors (road slope, the presence of drainage ditches) and without it. It is shown that these factors can have a significant impact on the fire risk value for objects near which there is an accident with a fire of vehicles with significant amount of flammable liquid. The potential risk increases approaching the lowest point of the road section. At the same time, depending on the total length of the section with a slope, this value may be an order higher than the fire risk in the areas located above. Technical measures such as drainage ditches can significantly affect the fire risk value. When open drainage ditches are installed, the risk of fire escalation increases when the burning liquid flows down. When installing closed drainage ditches, the risk of escalation due to the spread of fire is minimized and is possible mainly in the locations of drainage ditch hatches. At the same time, such technical solution increases the potential risk in the area of liquid discharge to the terrain.

Ozonated water lavage and physiological saline irrigation combined with vacuum-sealed drainage in the treatment of 18 cases of chronic osteomyelitis

Objective Ozone is a colorless gas used as a disinfectant and to treat diseases by limiting the effects of bacteria, viruses, fungi, yeast, and protozoa. In this study, we investigated the clinical efficacy of ozonated water lavage and physiological saline irrigation combined with vacuum-sealed drainage (VSD) in the treatment of chronic osteomyelitis. Methods Eighteen patients (14 men and 4 women) with chronic osteomyelitis in the limbs (tibia: 13 cases; femur: 4 cases; humerus: 1 case) admitted to our hospital between April 2012 and October 2018 were selected. The patients were aged 9 to 52 years, with a mean age of 31 years. All patients underwent ozonated water lavage and physiological saline irrigation combined with VSD negative pressure closed drainage during hospitalization. The patients were followed up for 18 to 84 months, with a mean of 31 months. Results Osteomyelitis recurred in only one case of nonunion. The length of hospitalization was 18 to 29 days, with a mean of 21 days. Conclusions A combination of ozonated water lavage, physiological saline irrigation, and VSD provided good clinical effects in the treatment of chronic osteomyelitis, and thus, is recommended for such treatment.

A six-year old boy with refractory mycoplasmal pneumonia combined with recurrent pneumothorax

A six-year old boy presented with mycoplasmal pneumonia combined with recurrent pneumothorax. The patient had been treated with azithromycin and methylprednisolone for mycoplasmal pneumonia after admission, however his condition deteriorated. We increased the dosage of methylprednisolone and changed to erythromycin from azithromycin, his condition improved progressively. He presented pneumothorax twice during recovery phase. He was put on thoracic closed drainage and was cured. Pneumothorax is rare complication of mycoplasmal pneumonia. Here we reported the case to raise awareness of this condition.

ADVANCED METHOD FOR CLEANING HORIZONTAL CLOSED DRAIN

The article discusses an advanced method for cleaning closed horizontal drainage systems in the irrigation zone. The technological process of cleaning from sediment is carried out by dragging winches of a special cable with a ruff, previously laid inside the horizontal closed drainage during primary cleaning with the help of the PDT-200 machine, through adjustable and fixed blocks. While the ruff has the ability to deviate and rotate along the longitudinal axis of the drainage pipe, and the mounting frames are installed in the inspection wells, fixed with bolts and sequentially re-installed from one well to another. The use of this method allows you to reduce the labor intensity, reduce the number of expensive reclamation machines used, special hoses and pumping equipment, as well as the use of manual labor and the consumption of a large amount of water. The improved method will significantly increase the productivity, quality and reliability of the technological process by eliminating the shortcomings in the spring and autumn cleaning of closed horizontal drainage. The effectiveness of the improved method is to increase the productivity and quality of cleaning the closed horizontal drainage from sediments, as well as to a sharp decrease in the level of mineralized groundwater.