Evaluation of the relationship between primary spontaneous pneumothorax and exercise and patient return to previous activities in patients after treatment

Introduction: The most common cause of primary spontaneous pneumothorax (PSP) is sub pleural bleb apical rupture. Little is known about the relationship between PSP and exercise and return to exercise time. In this study, wee tend to investigate the relationship between exercise and PSP and time of return to exercise and previous activities. Method: This study was designed as a case series and the sample size included all patients diagnosed with PSP in Razi and Poursina and Aria hospitals of Rasht during 2015-2019 based on inclusion criteria. Variables were analyzed using Fisher's exact test, Chi square, Mann Whitney U and t-test (p<0.05). Results: The most common type of treatment in patients was transaxillary thoracotomy with pleurodesis with iodine (TTP) in 58.2% and tube thoracostomy and pleurodesis in 41.7%, which was not statistically significant between athletes and non-athletes (p=0.806). Athletes who underwent TTP after 4 weeks and those treated with tube thoracostomy and pleurodesis after 8-12 weeks were advised to return to their previous activity. Of athletes, 9.5% had recurrence; of non-athletes, 9.8% had recurrence. Of athletes, 4.8% did not tolerate a return to their previous activity; of non-athletes, 7.3% did not tolerate returning to their previous activity regardless of treatment, and this difference was not significant. Conclusion: Our study showed no significant difference between clinical manifestations and image findings as well as frequency of treatment and complications in both athlete and non-athlete patients. There is no increase in recurrence and intolerance at the time recommended for return to previous activity.

A Case Report of Delayed Hemothorax Complicated by Fibrothorax

Delayed hemothorax is a potentially life-threatening complication of thoracic trauma that should be carefully considered in all patients presenting with thoracic injury. We report a case of delayed hemothorax in a 77-year-old male presenting eleven days’ status post multiple right mid- to high-rib fractures. His case was complicated by retained hemothorax after CT-guided chest-tube with subsequent video-assisted tube thoracostomy (VATS) revealing fibrothorax necessitating conversion to open thoracotomy. Known risk factors for development of delayed hemothorax include older patient age, three or more rib fractures, and presence of mid- to high-rib fractures, and should be used in risk stratification of thoracic trauma. Tube thoracostomy is often sufficient in management of delayed hemothorax. In rare cases, hemothoraces can be complicated by retained hemothorax or fibrothorax, which require more invasive therapy and carry greater morbidity and mortality.

To Observe the Treatment Outcomes of Duodenal Injury in Penetrating and Blunt Trauma Patients

Aim: To study about the management of duodenal injury in two clinical aspects, blunt and penetrating injury, along with its complications. Study design: Observational case series. Place and duration of study: Accident & Emergency and General Surgery Departments at M. Islam Teaching Hospital, Gujranwala from March 2019 to March 2020. Methodology: One hundred patients presenting in Accident & Emergency and General Surgical Department of with penetrating chest trauma as diagnosed clinically were included. Routine investigations like complete blood tests, X-rays and special investigations i.e. ultrasound, CT scan were done only in cases where patients were stable. Each hemithorax was divided into medial and lateral hemithorax by an imaginary line drawn longitudinally from clavicle down to the costal margin passing through the nipple. All patients were observed for the type of treatment they were getting i.e. thoracotomy or tube thoracostomy. Patients who were initially treated with tube thoracostomy were cautiously observed for any developing indications for thoracotomy. If such indications arose thoracotomy would be arranged at the earliest possible. Results: A total of 100 patients, 85 (85%) were males and 15 (15%) were females. Male to female ratio was 5.66:1. The mean age of patient was 35.65±9.75 years. There were 38 (38%) had road traffic accidents, 10 (10%) were fall, 7 (7%) injured with fight, 41 (41%) victims of firearm injury and only 4 (4%) victims of stab. The mean blood pressure was 82.15±7.97mmHg. Eighty five (85%) patients were stay in the hospital for 2 weeks and while 15 (15%) were hospital stay >2 weeks. The mean values of hospital stay was 12.45±4.16 days. Conclusion: It is concluded that penetrating thoracic trauma is a major cause of morbidity and mortality. The overall complications rate for blunt trauma injuries after adequate treatment is 18% and mortality rate is 8%. Keywords: Blunt trauma, Thorocotomy, Tube thoracostomy, Pneumothorax

Recurrent spontaneous pneumothorax in pregnancy-a case report

Spontaneous pneumothorax during pregnancy is a rare but a serious condition. The typical symptoms of spontaneous pneumothorax include pleuritic chest pain and shortness of breath. Diagnosis is usually made on chest X-ray with abdominal shielding. Management differs according to severity and no specific guidelines are described for management of spontaneous pneumothorax in pregnancy. We report a case of a 27-year-old multigravida, with insignificant past medical history for any respiratory illness, presenting with recurrent, left sided spontaneous pneumothorax during a single pregnancy. It was managed by chest tube thoracostomy each time and patient was discharged with tube till the delivery of the fetus.

Conservative management of Occult Hemothorax in trauma patients requiring assisted ventilation: An observational descriptive study

Background: Traumatic hemothorax is a common consequence of blunt chest trauma. A hemothorax that is missed by initial chest X-ray, but diagnosed by computed tomography (CT), is known as an occult hemothorax. The present study aims at investigating the clinical outcomes of conservative management of occult hemothorax in mechanically ventilated trauma patients. Methods: A retrospective study of all adult blunt chest trauma patients with occult hemothorax requiring mechanical ventilation in a level 1 trauma center was conducted (2010- 2017). Data were obtained from the trauma registry and electronic medical records. Patients were categorized into (a) successful conservative treatment group, and (b) tube thoracostomy group. Results: During the study period, 78 blunt chest trauma patients who had occult hemothorax required mechanical ventilation. Occult hemothorax was managed conservatively in 69% of the patients, while 31% underwent tube thoracostomy. The main indication for tube thoracostomy was the progression of hemothorax on follow-up chest radiographs. Comparison between groups showed that pulmonary contusions (59% vs. 83%), bilateral hemothorax (26% vs. 58%) and chest infections (9% vs. 29%) were lower in conservatively treated group (p < 0.05). Length of stays in ICU and hospital were also lower (p < 0.05). Longer duration of mechanical ventilation and maximum PEEP were significantly associated with tube thoracostomy. Overall mortality was 12% and was comparable between groups. Conclusion: Mechanically ventilated patients with occult hemothorax following blunt chest trauma can be managed conservatively without tube thoracostomy. Tube thoracostomy can be restricted to patients who had evidence of progression of hemothorax on follow-up or developed respiratory compromise.

Spontaneous pneumothorax associated with COVID-19 pneumonia: a single-centre retrospective study

Spontaneous pneumothorax (SP) is a rare complication of COVID-19 pneumonia; it affects both intubated and non-intubated patients. The pathogenesis includes barotrauma and pneumatocele formation. In the following article, we present case series of 18 patients with COVID-19 associated pneumothorax - a detailed demographic and clinical analysis were performed. The study revealed that men were more affected than women, especially above the age of 55 years; whilst, the distribution of intubated patients and those with spontaneous breathing were equal. Importantly, tube thoracostomy was the preferred method of treatment. The lethal outcome was observed in all patients on mechanical ventilation, due to the severe course of the underlying disease. The occurrence of pneumothorax in patients with COVID-19 is associated with poorer outcome of the disease, especially in those placed on mechanical ventilation.

Risk factors and outcomes of unrecognised endobronchial intubation in major trauma patients

BackgroundEmergency tracheal intubation during major trauma resuscitation may be associated with unrecognised endobronchial intubation. The risk factors and outcomes associated with this issue have not previously been fully defined.MethodsWe retrospectively analysed adult patients admitted directly from the scene to the ED of a single level 1 trauma centre, who received either prehospital or ED tracheal intubation prior to initial whole-body CT from January 2008 to December 2019. Our objectives were to describe tube-to-carina distances (TCDs) via CT and to assess the risk factors and outcomes (mortality, length of intensive care unit stay and mechanical ventilation) of patients with endobronchial intubation (TCD <0 cm) using a multivariable model.ResultsWe included 616 patients and discovered 26 (4.2%) cases of endobronchial intubation identified on CT. Factors associated with an increased risk of endobronchial intubations were short body height (OR per 1 cm increase 0.89; 95% CI 0.84 to 0.94; p≤0.001), a high body mass index (OR 1.14; 95% CI 1.04 to 1.25; p=0.005) and ED intubation (OR 3.62; 95% CI 1.39 to 8.90; p=0.006). Eight of 26 cases underwent tube thoracostomy, four of whom had no evidence of underlying chest injury on CT. There was no statistically significant difference in mortality or length of stay although the absolute number of endobronchial intubations was small.ConclusionsShort body height and high body mass index were associated with endobronchial intubation. Before considering tube thoracostomy in intubated major trauma patients suspected of pneumothorax, the possibility of unrecognised endobronchial intubation should be considered.