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1
Iacobellis, Francesca, Isabella Iadevito, Anna Ierardi, Gianpaolo Carrafiello, Federica Perillo, Refky Nicola, and Mariano Scaglione. "Imaging Assessment of Thoracic Cage Injuries." Seminars in Musculoskeletal Radiology 21, no. 03 (June 1, 2017): 303–14. http://dx.doi.org/10.1055/s-0037-1602413.
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Thoracic injuries are the third most common traumatic injury. Approximately two thirds of thoracic injuries are due to motor vehicle collisions. They are associated with up to a 20% mortality rate. This is primarily due to the presence of several complex anatomical structures within the thoracic cage such as the heart, great vessels, esophagus, airways, lungs, mediastinum, bones, muscles, diaphragm, and pleura. A chest radiograph is the initial imaging modality in the evaluation of the chest. However, multidetector computer tomography (MDCT) with intravenous contrast is the imaging modality of choice in the assessment of acute thoracic injuries.Endovascular repair is less invasive and has a better outcome than traditional surgical repair. This review article discusses the indications, benefits, and findings of radiographs and MDCT in patients with thoracic injuries, especially with regard to the thoracic aorta.
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Zheng, Yifan, Aidan F. Pierce, Willi L. Wagner, Hassan A. Khalil, Zi Chen, Andrew B. Servais, Maximilian Ackermann, and Steven J. Mentzer. "Functional Adhesion of Pectin Biopolymers to the Lung Visceral Pleura." Polymers 13, no. 17 (September 2, 2021): 2976. http://dx.doi.org/10.3390/polym13172976.
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Pleural injuries and the associated “air leak” are the most common complications after pulmonary surgery. Air leaks are the primary reason for prolonged chest tube use and increased hospital length of stay. Pectin, a plant-derived heteropolysaccharide, has been shown to be an air-tight sealant of pulmonary air leaks. Here, we investigate the morphologic and mechanical properties of pectin adhesion to the visceral pleural surface of the lung. After the application of high-methoxyl citrus pectin films to the murine lung, we used scanning electron microscopy to demonstrate intimate binding to the lung surface. To quantitatively assess pectin adhesion to the pleural surface, we used a custom adhesion test with force, distance, and time recordings. These assays demonstrated that pectin–glycocalyceal tensile adhesive strength was greater than nanocellulose fiber films or pressure-sensitive adhesives (p < 0.001). Simultaneous videomicroscopy recordings demonstrated that pectin–glycocalyceal adhesion was also stronger than the submesothelial connective tissue as avulsed surface remnants were visualized on the separated pectin films. Finally, pleural abrasion and hyaluronidase enzyme digestion confirmed that pectin binding was dependent on the pleural glycocalyx (p < 0.001). The results indicate that high methoxyl citrus pectin is a promising sealant for the treatment of pleural lung injuries.
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Kotiv, B. N., I. M. Samokhvalov, V. Yu Markevich, A. P. Chuprina, I. I. Dzidzava, O. V. Barinov, V. V. Suvorov, A. V. Goncharov, A. A. Rud, and K. V. Petukhov. "Prevention and treatment of infectious complications of penetrating thoracic injuries." Bulletin of the Russian Military Medical Academy 20, no. 4 (December 15, 2018): 22–25. http://dx.doi.org/10.17816/brmma12240.
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Results of treatment of 325 wounded are analyzed with penetrating wounds of the chest and identify risk factors for the development of infectious complications. Found that infectious complications of the chest organs developed in 49 (15,1%) cases. It has been established that the most frequent infectious complications of penetrating wounds of the chest are post-traumatic pneumonia (67,3% of cases) and acute empyema of the pleura (26,5% of cases). The most prognostic significant risk factors for the development of infectious complications were identified: the type of injury (odds ratio - 2,48;95% confidence interval - 1,34-3,76), the severity of injuries (odds ratio - 7,88; 95% confidence interval - 3,9-15,92), blood loss (odds ratio - 3,09; 95% confidence interval - 1,6-5,94), duration of stay in the intensive care unit (odds ratio - 9,25;95% confidence interval - 4,57-18, 74), the intersection of chest wall structures (odds ratio - 2,84; 95% confidence interval- 1,24-6,47). Measures aimed at the prevention of infectious complications should be started from the moment the woundedperson enters the hospital. The priority tasks are to maintain the patency of the tracheobronchial tree, expanding the lung,adequate drainage and debridement of the pleural cavity. A high risk of developing infectious complications in penetratingwounds of the chest is expected in the wounded in a severe and extremely serious condition (according to the scale of fieldsurgery - condition at admission more than 31 points). The duration of stay in the intensive care unit for more than 4 daysincreases the probability of infectious complications 9 times.
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Pegu, Niju, Joydeep Purkayastha, Abhijit Talukdar, Bibhuti Borthakur, Dipjyoti Kalita, Gaurav Das, Srinivas Bannoth, Jitin Yadav, Dwipen Kalita, and Pritesh Singh. "Managing iatrogenic tracheal injury during esophagectomy." International Surgery Journal 6, no. 7 (June 29, 2019): 2652. http://dx.doi.org/10.18203/2349-2902.isj20193014.
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Iatrogenic tracheal injuries are uncommon, but potentially lethal and associated with significant morbidity. During esophagectomy the proximity of the trachea to esophagus makes it vulnerable to injury. The reported incidence of tracheal injury during esophagectomy ranges between 1-5%. Various methods for repairing tracheal injuries have been described in the literature. Most preferred mode of repair described is the reinforcement of the primary repair with flap cover. Most common autologous flaps used are pericardium, pleura, extra thoracic muscle flaps and intercostal muscle flaps. Other described methods for repairing tracheal injuries are primary repair without buttressing, and buttressing with gatric conduit serosal patch, graft and glue. In this study we reviewed different methods and outcome of repair described in the literature and our experienced of managing three cases.
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Vesovic, Natasa, Aleksandar Ristanovic, Vlado Cvijanovic, Dejan Stojkovic, Nebojsa Maric, Vanja Kostovski, Ljubinko Djenic, and Aleksandar Nikolic. "Penetrating neck injury with consequential thoracic complications managed with use of video-assisted thoracoscopic surgery: A case report." Vojnosanitetski pregled 77, no. 3 (2020): 330–34. http://dx.doi.org/10.2298/vsp170904053v.
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Introduction. Penetrating injuries of the neck are potentially life-threatening conditions. They can cause injuries of larynx, trachea, esophagus and major blood vessels in this area. Case report. The patient was a 28-year-old male who was stabbed with broken glass penetrating the front side of the base of his neck. The patient had dyspnea and the wound was inflicted the night before admission to hospital. An otorhinolaryngologist found a stab wound in the region of the left basis of the neck. The wound was 2 cm long with no signs of bleeding and deep injuries of the anatomical structures of the neck. However, since left hemopneumothorax was clinically and radiologically apparent, drainage of the thorax was performed upon admission to the intensive care unit. Initially, 400 mL of hemorrhagic effusion was evacuated. However, 24 hours later the patient became hemodynamically unstable. It was an indication for videoassisted thoracoscopy (VATS). Therefore, VATS was used as a diagnostic method in order to determine the nature of the injury. Intraoperatively, we treated a laceration of pleuropulmonary adhesion which was continuously bleeding from the apex of the thoracic cavity. As a result, adequate surgical hemostasis was achieved. Furthermore, during the three-week postoperative period, thoracic tubes were placed due to the prolonged air leakage. A thoracic tube was placed laterally along with another one which was placed in intercostal space higher. After total reexpansion of the left lung, thoracic tubes were extracted, and the patient was discharged. Conclusion. Nowadays, VATS has become a highly important ultimate treatment of thoracic trauma. This minimally invasive method allows us to verify injury type and localization, to resolve it and further to follow-up evaluation of pathological changes in the lungs, pericardium, mediastinum, pleura and thoracic wall. In the case of stab wounds in the cervical region, any injuries of the lungs and pleura must be taken into consideration.
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Pal, Naresh, Vineet Mishra, Udit Jain, and Poonam . "Pattern and management of penetrating and nonpenetrating thoracic injuries." International Journal of Research in Medical Sciences 7, no. 8 (July 25, 2019): 3133. http://dx.doi.org/10.18203/2320-6012.ijrms20193407.
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Background: Chest trauma constitutes a major public health problem which includes the injuries to chest wall, pleura, tracheobronchial tree, lungs, diaphragm, oesophagus, heart and great vessels. It consist of more than ten percent of all traumas and twenty five percent of death due to trauma occurs because of chest injury. Chest trauma is increasing in frequency in urban hospitals. Penetrating and nonpenetrating thoracic injuries the most serious injuries leading to significant morbidity and mortality.Methods: This study was prospective observational study of 220 patients of thoracic trauma both penetrating and non-penetrating. These patients admitted in general surgical units from August 2017 to May 2018 of Pandit Bhagwat Dayal Sharma, PGIMS Rohtak Haryana India. The study was pertaining to both penetrating and non-penetrating chest trauma.Results: Out of 220 chest injury patients who were studied during the said period, Males were 203 and females 17 by a ratio of 12:1 and age ranged from lowest 18 years to 85 years of age. Majority of the patients (90.45%) sustained blunt injuries. RTA was the common mechanism of blunt injury affecting (50.45%) of patients. Multiple Rib fractures was the commonest type of chest injury (21.36%) followed by head injury (17.27%). Head injury was the commonest associated injury seen in our patients. Conclusions: Chest trauma resulting from road traffic accident remains a major mechanism of chest injury. The measures to decrease the trauma are, educating people about traffic rules and regulations and strictly implementing them is necessary to reduce incidence of chest injuries.
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Nikolic, Slobodan, and Vladimir Zivkovic. "Subendocardial hemorrhages in a case of extrapercardial cardiac tamponade: A possible mechanism of appearance." Srpski arhiv za celokupno lekarstvo 144, no. 7-8 (2016): 440–42. http://dx.doi.org/10.2298/sarh1608440n.
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Introduction. Subendocardial hemorrhages are grossly visible bleedings in the inner surface of the left ventricle, the interventricular septum, and the opposing papillary muscles and adjacent columnae carneae of the free wall of the ventricle. These are commonly seen in sudden profound hypotension either from severe blood loss from ?shock? in the widest sense and, even more often, in combination with brain injuries. Case Outline. We present a case of a 38-year-old man, injured as a car driver in a frontal collision, who died c. 45 minutes after the accident. The autopsy revealed severe chest trauma, including multiple right-sided direct rib fractures with the torn parietal pleura and right-sided pneumothorax, several right lung ruptures, and a rupture of one of the lobar bronchi with pneumomediastinum, and prominent subcutaneous emphysema of the trunk, shoulders, neck and face. The patchy subendocardial hemorrhage of the left ventricle was observed. The cause of death is attributed to severe blunt force chest trauma. Conclusion. We postulate pneumomediastinum leading to extrapericardial tamponade as the underlying mechanism of this subendocardial hemorrhage.
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Cressoni, Massimo, Chiara Chiurazzi, Miriam Gotti, Martina Amini, Matteo Brioni, Ilaria Algieri, Antonio Cammaroto, et al. "Lung Inhomogeneities and Time Course of Ventilator-induced Mechanical Injuries." Anesthesiology 123, no. 3 (September 1, 2015): 618–27. http://dx.doi.org/10.1097/aln.0000000000000727.
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Abstract Background: During mechanical ventilation, stress and strain may be locally multiplied in an inhomogeneous lung. The authors investigated whether, in healthy lungs, during high pressure/volume ventilation, injury begins at the interface of naturally inhomogeneous structures as visceral pleura, bronchi, vessels, and alveoli. The authors wished also to characterize the nature of the lesions (collapse vs. consolidation). Methods: Twelve piglets were ventilated with strain greater than 2.5 (tidal volume/end-expiratory lung volume) until whole lung edema developed. At least every 3 h, the authors acquired end-expiratory/end-inspiratory computed tomography scans to identify the site and the number of new lesions. Lung inhomogeneities and recruitability were quantified. Results: The first new densities developed after 8.4 ± 6.3 h (mean ± SD), and their number increased exponentially up to 15 ± 12 h. Afterward, they merged into full lung edema. A median of 61% (interquartile range, 57 to 76) of the lesions appeared in subpleural regions, 19% (interquartile range, 11 to 23) were peribronchial, and 19% (interquartile range, 6 to 25) were parenchymal (P < 0.0001). All the new densities were fully recruitable. Lung elastance and gas exchange deteriorated significantly after 18 ± 11 h, whereas lung edema developed after 20 ± 11 h. Conclusions: Most of the computed tomography scan new densities developed in nonhomogeneous lung regions. The damage in this model was primarily located in the interstitial space, causing alveolar collapse and consequent high recruitability.
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Sangster, Guillermo P., Aldo González-Beicos, Alberto I. Carbo, Maureen G. Heldmann, Hassan Ibrahim, Patricia Carrascosa, Miguel Nazar, and Horacio B. D’Agostino. "Blunt traumatic injuries of the lung parenchyma, pleura, thoracic wall, and intrathoracic airways: multidetector computer tomography imaging findings." Emergency Radiology 14, no. 5 (July 11, 2007): 297–310. http://dx.doi.org/10.1007/s10140-007-0651-8.
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Davydkin, V. I. "PROFESSOR IVAN NIKIFOROVICH PIKSIN (to the 85th anniversary of the birth)." Grekov's Bulletin of Surgery 178, no. 6 (March 18, 2020): 80–82. http://dx.doi.org/10.24884/0042-4625-2019-178-6-80-82.
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The article is dedicated to the 85th birthday of the famous scientist, honored worker of science of the Russian Federation, honored worker of science of the Republic of Mordovia, honored doctor of the Republic of Mordovia, laureate of State prize, head of the scientific-pedagogical surgical school, doctor of medical Sciences professor Piksin Ivan Nikiforovich. I. N. Piksin is the author of fundamental studies of the biomedical effects of quantum radiation at the molecular, cellular and organismal levels in patients with acute destructive diseases of the lungs, purulent-septic diseases, lactational mastitis and other pathologies. The team of the scientific-pedagogical school led by I. N. Piksin explores the problems of diagnosis and treatment of gastroduodenal bleeding, mechanical jaundice, pancreatitis, suppurative diseases of the lung and pleura, surgical diseases of the heart, blood vessels, prevention of complications of limb injuries, diabetes and diabetic foot care, pediatric orthopedics. Under the leadership of I. N. Piksin, new minimally invasive technologies have introduced: transthoracic drainage and rehabilitation therapy of purulent cavities of the lung and pleura, percutaneous and transhepatic cholecystocholangiography, diagnostic and treatment interventions in space-occupying lesions of the abdomen and thyroid gland, ultrasound techniques of diabetes in acute destructive pancreatitis and others. He is considered as one of organizers of higher medical education system in the region. The professor is actively working on improvement in training of medical and scientific personnel for various regions of the Russian Federation.
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Zong, Ruiwen. "Injuries and molting interference in a trilobite from the Cambrian (Furongian) of South China." PeerJ 9 (April 7, 2021): e11201. http://dx.doi.org/10.7717/peerj.11201.
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An injured Shergoldia laevigata Zhu, Hughes & Peng, 2007 (Trilobita, Asaphida) was collected from the Furongian of Guangxi, South China. The injuries occurred in the left thoracic pleurae possessing two marked V-shaped gaps. It led to substantial transverse shortening of the left pleural segments, with barely perceptible traces of healing. This malformation is interpreted as a sub-lethal attack from an unknown predator. The morphology of injuries and the spatial and temporal distribution of predators indicated that the predatory structure might have been the spines on the ganathobase or ganathobase-like structure of a larger arthropod. There were overlapped segments located in the front of the injuries, and slightly dislocated thoracic segments on the left part of the thorax, suggesting that the trilobite had experienced difficulties during molting. The freshly molted trilobite had dragged forward the old exuvia causing the irregular arrangement of segments. This unusual trilobite specimen indicates that the injuries interfered with molting.
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Cvijanovic, Vlado, Vojkan Stanic, Aleksandar Ristanovic, Bojan Gulic, and Snezana Kovacevic. "Surgical treatment of war posttraumatic pleural empyemas." Vojnosanitetski pregled 64, no. 12 (2007): 813–18. http://dx.doi.org/10.2298/vsp0712813c.
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Background/Aim. Posttraumatic pleural empyema is the most frequent septic complication of the thoracic penetrating war injuries. Surgical treatment used to be based on the experience gained in the treatment of parapneumonic empyema, the most frequent empyema, and used to be favored the pleural drainage until the nineties of the last century. Thoracotomy and decortication was performed in case of drainage failure, in early chronic phase, 4-6 weeks after injury. The aim of this study was to emphasize the necessity of different surgical approaches in the treatment of this disease which is based on the different pathophisyology of posttraumatic and other sorts of empyema. Also, to recommend on the basis of the surgical treatment results, early decortication as better method in the treatment of this septic complication. Methods. In the period between September 1991-June 1999. 1 303 thoracic injures were surgically treated. There were 1 117 penetrating injures with 675 dominant thoracic injures, and 442 thoracic injures as the following ones. In 59 (5.3%) injured people raised posttraumatic empyema (PET). The patients were divided into the groups with early and late decortications regarding the interval between the injury and the surgical treatment. Almost all the patients sustained this complication in various periods before the admittance to the hospital. Surgical treatment efficiency of early and late decortication was analyzed on the basis of perioperative and postoperative study parameters and analyzing postoperative complications. Results. Thoracotomy and decortication were performed in 46 (78%) injured patients with post traumatic pleural empyema while only 13 (22%) injured patients were successfully treated for this septic complication with drainage procedures. This study proved that there were in the group with early decortications lesser intra and postoperative blood loss, duration of operation was shorter as well as febrile postoperative period. In this group, also, hospitalization was shorter and with lesser complications. Conclusion. The obtained results showed that thoracotomy and decortication should be done as early as possible in patients, not later than two weeks after the injury.
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Dahran, Naief, and Roger Soames. "INTERVERTEBRAL VEINS DIRECTLY CONNECTING THE VERTEBRAL VENOUS SYSTEM TO THE AZYGOS VENOUS SYSTEM RATHER THAN THE PROXIMAL END OF THE POSTERIOR INTERCOSTAL VEINS. Venas intervertebrales conectando directamente el sistema venoso vertebral al sistema venoso." Revista Argentina de Anatomía Clínica 7, no. 2 (March 28, 2016): 88–92. http://dx.doi.org/10.31051/1852.8023.v7.n2.14171.
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La estructura de las venas de la cavidad torácica varía significativamente en función de sus conexiones. Treinta cadáveres embalsamados con la técnica de Thiel fueron disecados (18 mujeres, 12 hombres), con edades comprendidas entre 48 y 98 años (media 81.3±12.40). Los pulmones, el corazón, la aorta torácica, el esófago y la pleura parietal fueron cuidadosamente retirados para permitir la visualización de las venas ácigos, hemiácigos y hemiácigos accesoria así como el conducto torácico. En la mayoría de los especímenes (21) se encontró que las venas intervertebrales estaban directamente conectadas con el sistema venoso ácigos en vez de con la parte terminal proximal de las venas intercostales posteriores. Se observó también que dicha distribución es más común en el lado derecho, pero no en todos los niveles vertebrales. Estas conexiones podrían jugar un rol en la regulación del volúmen de sangre entre los sistemas venosos ácigos y vertebral: también podrían actuar como vías metastásicas entre las regiones torácica y abdominal. Dado que su aspecto es bastante similar al de los vasos intercostales posteriores, es importante que los cirujanos sean conscientes de esta variación para evitar lesiones que induzcan hematomas postoperatorios. Veins in the thoracic cavity are highly variable in terms of their communications. Thirty Thiel-embalmed cadavers were dissected (18 females and 12 males), ranging in age from 48 to 98 years old (mean 81.3±12.40). The lungs, heart, thoracic aorta, oesophagus and parietal pleura were removed carefully to expose the azygos, hemiazygos, accessory hemiazygos veins and thoracic duct. In most specimens (21) intervertebral veins were connected directly to the azygos venous systems rather than the proximal end of the posterior intercostal veins. This presentation was observed to be more common on the right side, but not at all vertebral levels. These communications could play a role in regulating blood volume between the azygos and vertebral venous systems; they may also act as metastatic pathways between the thoracic and abdominal regions. As they mimic posterior intercostal vessels, it is important for surgeons to be aware of this variation to avoid injuries leading to postoperative hematomas.
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ABREU, EMANUELLE MARIA SÁVIO DE, CARLA JORGE MACHADO, MARIO PASTORE NETO, JOÃO BAPTISTA DE REZENDE NETO, and MARCELO DIAS SANCHES. "The impact of a chest tube management protocol on the outcome of trauma patients with tube thoracostomy." Revista do Colégio Brasileiro de Cirurgiões 42, no. 4 (August 2015): 231–37. http://dx.doi.org/10.1590/0100-69912015004007.
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ABSTRACTObjective:to investigate the effect of standardized interventions in the management of tube thoracostomy patients and to assess the independent effect of each intervention.Methods:A chest tube management protocol was assessed in a retrospective cohort study. The tube thoracostomy protocol (TTP) was implemented in August 2012, and consisted of: antimicrobial prophylaxis, chest tube insertion in the operating room (OR), admission post chest tube thoracostomy (CTT) in a hospital floor separate from the emergency department (ED), and daily respiratory therapy (RT) sessions post-CTT. The inclusion criteria were, hemodynamic stability, patients between the ages of 15 and 59 years, and injury severity score (ISS) < 17. All patients had isolated injuries to the chest wall, lung, and pleura. During the study period 92 patients were managed according to the standardized protocol. The outcomes of those patients were compared to 99 patients treated before the TTP. Multivariate logistic regression analysis was performed to assess the independent effect of each variable of the protocol on selected outcomes.Results:Demographics, injury severity, and trauma mechanisms were similar among the groups. As expected, protocol compliance increased after the implementation of the TTP. There was a significant reduction (p<0.05) in the incidence of retained hemothoraces, empyemas, pneumonias, surgical site infections, post-procedural complications, hospital length of stay, and number of chest tube days. Respiratory therapy was independently linked to significant reduction (p<0.05) in the incidence of seven out of eight undesired outcomes after CTT. Antimicrobial prophylaxis was linked to a significant decrease (p<0.05) in retained hemothoraces, despite no significant (p<0.10) reductions in empyema and surgical site infections. Conversely, OR chest tube insertion was associated with significant (p<0.05) reduction of both complications, and also significantly decreased the incidence of pneumonias.Conclusion:Implementation of a TTP effectively reduced complications after CTT in trauma patients.
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Lee, Y. C. G., C. J. Devin, L. R. Teixeira, J. T. Rogers, P. J. Thompson, K. B. Lane, and R. W. Light. "Transforming growth factor β2 induced pleurodesis is not inhibited by corticosteroids." Thorax 56, no. 8 (August 1, 2001): 643–48. http://dx.doi.org/10.1136/thx.56.8.643.
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BACKGROUNDTalc and tetracyclines induce pleurodesis by directly injuring the pleura. The injury results in intense inflammation which subsequently leads to fibrosis. Corticosteroids can inhibit talc pleurodesis by reducing the inflammatory process. We hypothesised that transforming growth factor β2 (TGFβ2), a fibrogenic cytokine with immunomodulatory functions, could induce effective pleurodesis without generating significant pleural inflammation and therefore remain effective despite co-administration of corticosteroids.METHODSThirty rabbits were divided into two groups. Rabbits in the steroid group received weekly intramuscular injections of triamcinolone diacetate (0.8 mg/kg). Ten rabbits in each group were given 5.0 μg TGFβ2 intrapleurally via a chest tube while the remaining five received 1.7 μg TGFβ2. Pleurodesis was graded macroscopically after 14 days from 1 (none) to 8 (>50% symphysis).RESULTSTGFβ2produced excellent pleurodesis at both 5.0 μg and 1.7 μg doses. The pleural effusions produced after the injection were low in all inflammatory markers. No significant differences were seen between the steroid group and controls in macroscopic pleurodesis scores (7.2 (1.3)v 7.1 (1.2)), levels of inflammatory markers in the pleural fluids (leucocyte 1107 (387)/mm3v 1376 (581)/mm3; protein 3.1 (0.3) mg/dl v 2.9 (0.3) mg/dl, and LDH 478 (232) IU/l v 502 (123) IU/l), and the degree of microscopic pleural fibrosis and pleural inflammation.CONCLUSIONSTGFβ2can induce effective pleurodesis and remains effective in the presence of high dose parenteral corticosteroids.
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Khomenko, I. P., K. P. Gerzhyk, and B. M. Kucher. "The place and role of videothoracoscopic surgical interventions in war wounds and injuries of the chest organs." Reports of Vinnytsia National Medical University 22, no. 3 (September 28, 2018): 522–24. http://dx.doi.org/10.31393/reports-vnmedical-2018-22(3)-26.
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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.
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Atmaca, Ali Fuat, Abdullah Erdem Canda, Ege Can Serefoglu, Serkan Altinova, Ahmet Tunc Ozdemir, and M. Derya Balbay. "The Incidence and Management of Pleural Injuries Occurring during Open Nephrectomy." Advances in Urology 2009 (2009): 1–4. http://dx.doi.org/10.1155/2009/948906.
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Objective. To evaluate the incidence, management, and risk factors of pleural injuries occurring during open nephrectomy.Methods. Between June 2004/and June 2008, 165 patients (167 renal units) underwent open simple (n=37,22.2%), partial (n=39,23.4%) or radical (n=91,54.5%) nephrectomy in our institution.Results. Flank, Chevron, and abdominal midline incisions were used in 148(88.6%), 17(10.2%), and in 2(1.2%) surgical procedures, respectively. Ribs were excised in 109(65.3%) procedures (11th rib, 10th-11th ribs, and 11th-12th ribs). Intraoperative pleural injuries were detected in 20(12%) procedures, 16(80%) were treated successfully with simple evacuation technique, and 4 required chest tube insertion. Age, sex, surgery type, incision type, and surgery site were not associated with pleural injury occurrence (P>.05). Rib resection was the only parameter associated with pleural injury occurrence.Conclusion. Pleural injuries occur in 12% of open nephrectomy procedures, and 80% can be repaired successfully. Few of them (2.4%) need chest tube insertion. Performing rib resection is a significant risk factor for pleural injury occurrence during nephrectomies.
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Golovko, K. P., V. Yu Markevich, T. Yu Suprun, A. B. Vertiy, S. E. Komyagin, N. A. Zhirnova, and I. M. Samokhvalov. "Prospects for improving pre-hospital care for wounded with gunshot penetrating wounds to the chest." Bulletin of the Russian Military Medical Academy 22, no. 3 (December 15, 2020): 140–47. http://dx.doi.org/10.17816/brmma50550.
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Abstract. The analysis of injuries, life-threatening consequences and outcomes of treatment of wounded with penetrating chest wounds and the results of approbation of a prototype (medical) disposable set UD-02v for the elimination of strained and open pneumothorax, hemothorax, pleural drainage and collection of spilled blood with the possibility of subsequent reinfusion at the pre-hospital stage is presented. The prototype of the UD-02v set was created as part of the implementation of the state defense order in 2018. Its creation is due to the fact that despite the improvement of medical care at the stages of medical evacuation and the widespread use of individual armor protection, chest injuries currently remain a frequent type of combat surgical injury, accounting for 6 to 12% of all injuries. The main cause of death of injured and injured with chest injuries remains blood loss caused by continuing intrapleural bleeding and concomitant damage to other anatomical areas. Stressful pneumothorax, together with intrapleural bleeding, account for 93% of preventable causes of fatal chest injuries at the pre-hospital stage. Untimely elimination of the consequences of severe breast injuries should be considered as a negative factor affecting the outcome of treatment, and significant improvement in treatment results should be expected only in the case of early elimination of the most severe consequences of breast injuries. The developed set of UD-02v exceeds foreign medical devices in its medical and technical characteristics, and is the most promising for acceptance for the supply of the Armed forces of the Russian Federation as part of the samples of complete and service equipment.
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Gallagher, John J. "Management of Blunt Pulmonary Injury." AACN Advanced Critical Care 25, no. 4 (October 1, 2014): 375–86. http://dx.doi.org/10.4037/nci.0000000000000059.
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Thoracic injuries account for 25% of all civilian deaths. Blunt force injuries are a subset of thoracic injuries and include injuries of the tracheobronchial tree, pleural space, and lung parenchyma. Early identification of these injuries during initial assessment and resuscitation is essential to reduce associated morbidity and mortality rates. Management of airway injuries includes definitive airway control with identification and repair of tracheobronchial injuries. Management of pneumothorax and hemothorax includes pleural space drainage and control of ongoing hemorrhage, along with monitoring for complications such as empyema and chylothorax. Injuries of the lung parenchyma, such as pulmonary contusion, may require support of oxygenation and ventilation through both conventional and nonconventional mechanical ventilation strategies. General strategies to improve pulmonary function and gas exchange include balanced fluid resuscitation to targeted volume-based resuscitation end points, positioning therapy, and pain management.
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Samiatina, Diana, and Romaldas Rubikas. "Vaizdo torakoskopija – pirmo pasirinkimo atvirų krūtinės traumų diagnostikos ir gydymo metodas urgentinėje torakalinėje chirurgijoje." Lietuvos chirurgija 2, no. 1 (January 1, 2004): 0. http://dx.doi.org/10.15388/lietchirur.2004.1.2378.
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Diana Samiatina, Romaldas RubikasKauno medicinos universiteto klinikųTorakalinės chirurgijos klinikaEivenių g. 2, KaunasEl paštas: dsamatina@yahoo.de Tikslas Įrodyti, kad vaizdo torakoskopija yra pirmo pasirinkimo atvirų krūtinės traumų diagnostikos ir gydymo metodas, jei ligonio būklė stabili. Ligoniai ir metodai Retrospektyviai išanalizuotos ligonių, 1997–2003 m. operuotų nuo atviros krūtinės traumos, ligos istorijos. Tarpusavyje palyginti du chirurginio gydymo metodai: urgentinė torakotomija ir vaizdo torakoskopija. Vertinta dreno buvimo pleuros ertmėje, gydymo po operacijos trukmė, ankstyvos pooperacinės komplikacijos, skausmo intensyvumas pooperaciniu laikotarpiu, kosmetinis efektas, vaizdo torakoskopijos, kaip minimaliai invazinės chirurgijos metodo, jautrumas, specifiškumas, teigiama ir neigiama prognostinės vertės. Duomenų analizei naudota SPSS statistinė programa. Grupių skirtumai statistiškai vertinti taikant Mann-Whitney U testą. Grupių skirtumai laikyti statistiškai reikšmingais, kai paklaidos tikimybė p < 0,05. Rezultatai 1997–2003 m. nuo atviros krūtinės traumos operuoti 146 ligoniai. Keturiasdešimt septyniems ligoniams atlikta urgentinė vaizdo torakoskopija, iš jų 9 vėliau operuoti per torakotomijos pjūvį. Devyniasdešimt aštuoniems atlikta urgentinė torakotomija: 79 operuoti nuo izoliuotos atviros krūtinės traumos, 17 – nuo torakoabdominalinio ir 2 – nuo abdominotorakalinio sužalojimo. 12,3% ligonių po urgentinės torakotomijos dėl pilvaplėvės organų pažeidimo atlikta urgentinė laparotomija. Dreno buvimo pleuros ertmėje trukmė po vaizdo torakoskopijos – 4,57 dienos, po urgentinės torakotomijos – 6,88 dienos (p < 0,05). Gydymo po vaizdo torakoskopijos trukmė – 8,21 dienos, po urgentinės torakotomijos – 14,89 dienos (p < 0,05). Suvartotų nenarkotinių analgetikų kiekis po vaizdo torakoskopijos – 1056,98 mg, po urgentinės torakotomijos – 1966,70 mg (p < 0,05). Vaizdo torakoskopijos diagnostinė vertė, t. y. jautrumas ir specifiškumas, yra atitinkamai 0,67 ir 0,86, teigiama ir neigiama prognostinė vertė – atitinkamai 0,95 ir 0,375. Išvados Vaizdo torakoskopija – tai minimaliai invazinės chirurgijos metodas, leidžiantis įvertinti patologinius plaučio, perikardo, diafragmos, tarpuplaučio, krūtinės sienos, pleuros pokyčius, nustatyti tikslią jų lokalizaciją, sužalojimo pobūdį ir sunkumą. Palyginti su operacijomis per torakotomijos pjūvį, po vaizdo torakoskopijos buvo mažiau ankstyvų poopercinių komplikacijų, sutrumpėjo dreno buvimo pleuros ertmėje ir gydymo stacionare trukmė. Vaizdo torakoskopija turėtų būti atliekama visiems pacientams, patyrusiems atvirą krūtinės traumą, jei hemodinamika ir kvėpavimo funkcija stabili. Vaizdo torakoskopija – informatyvus diagnostikos ir gydymo metodas, leidžiantis atrinkti ligonius urgentinei torakotomijai. Prasminiai žodžiai: urgentinė torakalinė chirurgija, vaizdo torakoskopija, atvira krūtinės trauma, urgentinė torakotomija Video-assisted thoracoscopic surgery as a first choice method in the diagnostics and management of penetrating chest injuries Diana Samiatina, Romaldas Rubikas Objective To prove that video-assisted thoracoscopic surgery is a first choice method in the diagnostics and management of penetrating chest injuries. Patients and methods A retrospective analysis was made of case reports of patients operated on for open chest trauma during 1997–2003. Two methods of surgical treatment (urgent video-assisted thoracoscopy and urgent thoracotomy) were compared. The duration of drain presence in the pleural cavity, the duration of postoperative treatment, pain intensity and cosmetic effect were assessed. Data analysis was performed using the SPSS statistical software. Statistical evaluation of differences among the groups was performed using the Mann–Whitney U test. The differences among the groups were considered statistically significant at the probability of deviation p < 0.05. The sensitivity, specificity, positive and negative prognostic values of video-assisted thoracoscopy were evaluated. Results During 1997–2003, 146 patients with open chest trauma were operated on. Fourty seven patients underwent urgent video-assisted thoracoscopy, 98 patients were operated on through thoracotomy incision: 79 due to isolated open chest trauma, 17 due to thoracoabdominal injury, and 2 due to abdominothoracic injury. For 12.3% of patients, after urgent thoracotomy we made urgent laparatomy due to a the damaged diaphragm or other organs of the peritoneal cavity. Conversion of video-assisted thoracoscopy to operation through thoracotomy incision was employer in 9 cases. The duration of drain presence in the pleural cavity after video-assisted thoracoscopy was 4.57 days and after urgent thoracotomy 6.88 days (p < 0.05). The duration of post-operative treatment after video-assisted thoracoscopy was 8.21 days and after urgent thoracotomy 14.89 days (p < 0.05). The consumed non-narcotic analgesics after video-assisted thoracoscopy amounted to 1056.98 mg and after urgent thoracotomy to 1966.70 mg (p < 0.05). The sensitivity, specificity, positive and negative prognostic values of video-assisted thoracoscopy were 0.67; 0.86; 0.95; 0.375. Conclusions Video-assisted thoracoscopy is a minimal invasive method of thoracic surgery, allowing evaluation of the pathological changes in the lung, pericardium, diaphragm, mediastinum, thoracic wall and pleura, including the localization of these changes and the type and severity of the injury. The number of early post-operative complications following video-assisted thoracoscopy is lower. In comparison with operations through thoracotomy incision, video-assisted thoracoscopies entail the shortening of the duration of drain presence in the pleural cavity and the duration of post-operative treatment. Video-assisted thoracoscopy should be performed on all patients with open chest trauma, showing a stable hemodynamics and respiratory function. Video-assisted thoracoscopy is an informative diagnostic and treatment method allowing for the selection of patients for urgent thoracotomy. Keywords: urgent thoracic surgery, video-assisted thoracoscopy, open chest trauma, urgent thoracotomy
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Turkalj, Ivan, Kosta Petrovic, Sanja Stojanovic, Djordje Petrovic, Alma Brakus, and Jelena Ristic. "Blunt chest trauma: An audit of injuries diagnosed by the MDCT examination." Vojnosanitetski pregled 71, no. 2 (2014): 161–66. http://dx.doi.org/10.2298/vsp1402161t.
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Background/Aim. Multidetector computed tomography (MDCT) characterized by speed and precision is increasingly accessible in emergency wards. The aim of our study was to determine the most common injuries to the chest region, as well as type associated extrathoracic injuries, and the treatment outcome. Methods. This prospective study included 61 patients with blunt trauma who were submitted to computed tomography (CT) of the thorax. The number of injuries was evaluated by organs and organ systems of the chest. The cause of the injury, the length and the outcome of the treatment, and the presence of injuries in other regions were assessed. Results. Chest injuries were associated with injuries to other regions in 80.3% cases, predominantly injuries to extremities or pelvic bones in 54.1% cases, followed by head injuries in 39.3% patients. Associated thoracic injuries were present in 90.9% of patients with lethal outcome. Lung parenchymal lesions, pleural effusions and rib fractures were the most common injuries affecting 77.1%, 65.6% and 63.9% of the cases, respectively. Conclusion. Blunt chest trauma is a significant problem affecting predominantly males in their forties and it is usually caused by a motor vehicle accident. In case of pneumomediastinum or mediastinal haematoma, the use of 3D reconstructions is advised for diagnosing possible tracheobronchial ruptures and thoracic aorta injuries. Increased resolution of CT scanners yielded a large number of findings that are occult on radiography, especially in the event of lung parenchymal and pleural injuries. However, none imaging modality can replace surgical judgement.
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Rutledge, Michael, David Aronoff, Werner de Riese, and Bernhard Mittemeyer. "Management of pleural injuries during retroperitoneal surgical procedures." International Urology and Nephrology 39, no. 3 (December 5, 2006): 717–22. http://dx.doi.org/10.1007/s11255-006-9117-2.
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Duzhyi, І. D., O. M. Lytvynenko, S. О. Holubnichyi, О. L. Sytnik, V. Ya Pak, and І. А. Symonenko. "Injuries of ductus thoracicus." Klinicheskaia khirurgiia 87, no. 7-8 (September 30, 2020): 20–24. http://dx.doi.org/10.26779/2522-1396.2020.7-8.20.
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Objective. To study peculiarities of course and diagnosis of traumatic and spontaneous injuries of ductus thoracicus.
Маterials and methods. Ten patients, suffering chylothorax, were observed and examined, using thoracoscopy, аnd exudate - using test with sudan ІІІ.
Results. In 6 patients the injuries of ductus thoracicus were revealed: in 1 patient - direct, in 1 - iatrogenic, and in 4 - spontaneous. In 4 patients chylothorax presented a symptom of other diseases.
Conclusion. Diagnostic-treatment tactics, if the ductus thoracic injury and presence of chylothorax are suspected, ought to be following: analysis of anamnesis - pleural puncture - exudate aspiration - investigation, directed on identification of the malignant tumor cells and mycobacteria of tuberculosis - test with sudan ІІІ - thoracoscopy - pleurobiopsy - histological investigation - final diagnosis - specialized treatment (оperative-conservative).
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Alexander, Quevedo-Florez Leonardo, Montenegro-Apraez Alvaro Andrés, Aguiar-Martinez Leonar Giovanni, Hernández Juan Carlos, and Cortés-Tascón Juan David. "Contralateral Traumatic Hemopneumothorax." Case Reports in Emergency Medicine 2018 (December 19, 2018): 1–4. http://dx.doi.org/10.1155/2018/4328704.
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Pneumothorax is the entry of air into the virtual space between the visceral and the parietal pleurae, which can occur spontaneously or to a greater extent in a traumatic way. In daily clinical practice it is frequent to find injuries that generate traumatic pneumothorax that is ipsilateral to the lesion. However, there are case reports of contralateral pneumothorax that occurred in procedures such as insertion of pacemakers, or in cases of pneumonectomy. The following is the case report of a 37-year-old man who was admitted with a sharp wound to the right paravertebral region who developed a left haemopneumothorax due to a tangential course of the injuring agent. Adequate clinical judgment was followed, and several imaging studies were carried out, leading to the diagnosis of traumatic pneumothorax that was contralateral to the described injury.
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Pollack, Ian I. F., Dachling Pang, and Walter A. Hall. "Subarachnoid-Pleural and Subarachnoid-Mediastinal Fistulae." Neurosurgery 26, no. 3 (March 1, 1990): 519–25. http://dx.doi.org/10.1227/00006123-199003000-00023.
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Abstract Subarachnoid-pleural fistula and subarachnoid-mediastinal fistula are rare complications of chest trauma. One case each of subarachnoid-mediastinal fistula and subarachnoid-pleural fistula is described. Both patients were young children who suffered severe longitudinal distraction injuries to their thoracic spine and exhibited complete cord transection without radiographic evidence of vertebral column injury. Progressive mediastinal widening and enlarging pleural effusion in the absence of angiographic evidence of aortic injury suggested the diagnosis of an intrathoracic cerebrospinal fluid fistula. Myelograms identified the site of spinal cord rupture and cerebrospinal fluid leakage. The diagnosis. management, and outcome of these rare fistulae are discussed.
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Kanzaki, Masato, Ryo Takagi, Tamami Isaka, and Masayuki Yamato. "Off-the-Shelf Cell Sheets as a Pleural Substitute for Closing Visceral Pleural Injuries." Biopreservation and Biobanking 17, no. 2 (April 2019): 163–70. http://dx.doi.org/10.1089/bio.2018.0105.
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Moscote-Salazar, Luis Rafael, Osvaldo Koller, Sergio Valenzuela, Claudia Cataldo, Juan Jose Marengo, Gabriel Campos, Jose Joaquin Muller, and Cristobal Vergara. "Traumatic subarachnoid pleural fistula in children: case report, algorithm and classification proposal." Romanian Neurosurgery 30, no. 2 (June 1, 2016): 277–83. http://dx.doi.org/10.1515/romneu-2016-0043.
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Abstract Subarachnoid pleural fistulas are rare. They have been described as complications of thoracic surgery, penetrating injuries and spinal surgery, among others. We present the case of a 3-year-old female child, who suffer spinal cord trauma secondary to a car accident, developing a posterior subarachnoid pleural fistula. To our knowledge this is the first reported case of a pediatric patient with subarachnoid pleural fistula resulting from closed trauma, requiring intensive multimodal management. We also present a management algorithm and a proposed classification. The diagnosis of this pathology is difficult when not associated with neurological deficit. A high degree of suspicion, multidisciplinary management and timely surgical intervention allow optimal management.
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Krylov, Vladimir Viktorovich, Anatoly Andreyevich Grin, Yury Solomonovich Ioffe, Viktor Mikhailovich Kaznacheev, Nikolay Nikolayevich Nikolaev, and Mikhail Alekseyevich Nekrasov. "TREATMENT FOR COMPLICATED AND UNCOMPLICATED SPINE INJURIES IN MULTITRAUMA PATIENTS." Hirurgiâ pozvonočnika, no. 4 (December 15, 2005): 008–14. http://dx.doi.org/10.14531/ss2005.4.8-14.
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Objective. To determine treatment tactics for spine and spinal cord injuries in multitrauma patients. Material and Methods. 184 patients with spine and spinal cord injuries combined with multiple traumas were treated at Sklifosovsky Clinical and Research Institute for Emergency Medicine in 2000–2003, out of them 141 patients underwent surgical treatment. Diagnostic algorithm included general and neurologic examinations, ultrasound studies of the abdominal and pleural cavities, radiography of the skull, pelvic, ribs, injured extremities and all spine levels, and spine myelography and CT. Patients were examined by resuscitator, neurosurgeon, traumatologist and surgeon. Hemodynamic and arterial blood characteristics were monitored in critically ill patients. To assess the severity of multiple trauma the ISS scoring system was used. Results. Single-stage operation in the spine and bones of the skeleton was performed in 13 patients, first-stage spine surgery (preceding another intervention) – in 39 patients, second-stage spine surgery – in 24 patients, and 65 patients underwent a spine surgery alone. Neurologic status improved in 60 patients. Total lethality was 22 % and postoperative one – 14 %. Conclusion. Direct relation between surgery outcome and severity of multiple trauma was reveled. Application of upto- date transpedicular and laminar fixation techniques, and halo-apparatus provides the possibility to perform twostage surgery for complicated unstable vertebral fractures in patients with severe trauma.
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Kalashnikov, Anton V., Alexander A. Vorobiev, Svetlana A. Kalashnikova, and Dmitry Sh Salimov. "COMPLEX BIOSTIMULATION OF INTRAPLEURAL ADHESIOGENESIS IN THORACAL SURGERY." Pharmacy & Pharmacology 8, no. 2 (October 14, 2020): 86–99. http://dx.doi.org/10.19163/2307-9266-2020-8-2-86-99.
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The aim of the study is to determine the effectiveness of the use of platelet enriched plasma in the complex treatment of chest trauma and chronic pleural empyema.Materials and methods. The work was performed on 450 male rats, simulated with chest trauma (n=180) and chronic pleural empyema (n=270). In the experimental groups, biostimulation of adhesiogenesis as an intrapleural injection of 1 ml of platelet-enriched plasma was carried out; in the comparison group; the animals with pleural empyema were injected with 1 ml of doxycycline solution; in the negative control groups, the treatment was not carried out at all. Withdrawal from the experiment took place on the 10th, 20th, 30th days. The samples of intrapleural adhesions were fixed in 10% formalin, followed by histological tracing and preparation of micropreparations, staining with hematoxylin and eosin. The morphometric study included determination of the volume fraction (VF) of collagen and reticular fibers; fibrin; inflammatory cells; blood-stream (%).Results. An intrapleural administration of platelet-rich plasma is an effective way to stabilize the rib cage in chest injuries, and to eliminate residual cavities in chronic pleural empyema. When assessing the severity of the adhesions in chest trauma, it was found out that adhesions are most often visualized at the sites of rib fractures (from 13.3 to 40%). In pleural empyema, during the entire process of observation, the VF of collagen fibers forming adhesions was higher in the group with biological stimulation of adhesiogenesis than in the NCpe group and in the CG. In the PRP group, already at the initial stages of the experiment, this indicator was significantly lower than in the NC and CG (p<0.05).Conclusion. Based on the data obtained, the effectiveness of the use of platelet-enriched plasma in thoracic surgery for the biological potentiation of adhesiogenesis has been proved in experimental chest injuries and chronic pleural empyema.
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Atyasov, N. I. "Emergency breast and abdominal surgery." Kazan medical journal 67, no. 3 (May 15, 1986): 228–29. http://dx.doi.org/10.17816/kazmj70104.
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The monograph consists of a preface, two large sections with 12 chapters, and a list of references. The first section "Emergency surgery of acute diseases and injuries of the chest" consists of 4 chapters. Chapter I analyzes errors in the diagnosis and treatment of diseases and injuries of the chest and their prevention. Chapter II characterizes acute diseases of the chest, airway obstruction, foreign bodies of the trachea and bronchi. Briefly, but quite fully outlined modern methods of treatment of asphyxia, burns of airways, spontaneous pneumothorax, empyema of pleural cavity, abscesses and gangrene of lung, acute purulent pericarditis, mediastinitis, esophageal injuries, aneurysms of heart and chest aorta, pulmonary embolism and pulmonary bleeding.
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Hadžismajlović, Ademir, and Alen Pilav. "Pleural Drainage and its Role in Management of the Isolated Penetrating Chest Injuries During the War Time in Sarajevo, 1992.-1995." Bosnian Journal of Basic Medical Sciences 7, no. 2 (May 20, 2007): 152–56. http://dx.doi.org/10.17305/bjbms.2007.3071.
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Penetrating chest injuries are the most frequent causes of serious demage and death in wounded indivisuals. In reports from the last wars where wounds caused by high velocity projectiles predominated, thoracotomies were perfomed in about 15% of the wounded individuals, mostly encompassing injuries of the heart and great vessels, accomanied by massive bleeding that could not be resolved by chest tube insertion. This retrospective analysis was performed on the medical records of 477 patients tretaed for isolated penetrating chest injuries in Department of Thoracic Surgery Clinical Center of the University in Sarajevo between april 1992 - june 1995. We analised the ways of their menagement with special view on pleural drainage, indication for this method and results of treatment. 398 (83,4%) wounded individuals have been treated with pleural tube inserting as definitive mesaure and for the urgent thoracotomy there were 79 (16,6%) patients left. Average hospital treatment in wounded drained patients was 7,68 days. With shrapnels there were 357 (74,84%) wounded individuals, and with bullet 120 (25,16%) wounded individuals. The complications of plaural tube inserting were - empyema in 34 (7,13%) patients and there were no other complications. Chest tube inserting as definitive mesaure was used in 398 (83,44%) patients. Chest tube inserting as preoperative measure (urgent thoracotomy) was used in 79 (16,56%) patients. There were 460 (96,44%) healed patients. Death occurred in 17 (3,56%) patients.
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Bunin, Yu V., P. M. Zamyatin, R. M. Mihаylusov, V. V. Negoduyko, S. O. Beresnyev, and L. V. Provar. "EVOLUTION OF VIEWS ON THE DEVELOPMENT AND IMPLEMENTATION OF MODERN SURGICAL MAGNETIC INSTRUMENTS ON THE CASE OF INFLAMMATORY PENETRATING INJURIES OF THE BREAST." Kharkiv Surgical School, no. 2 (April 20, 2020): 113–18. http://dx.doi.org/10.37699/2308-7005.2.2020.23.
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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.
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Palas, João, António P. Matos, Vasco Mascarenhas, Vasco Herédia, and Miguel Ramalho. "Multidetector Computer Tomography: Evaluation of Blunt Chest Trauma in Adults." Radiology Research and Practice 2014 (2014): 1–12. http://dx.doi.org/10.1155/2014/864369.
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Imaging plays an essential part of chest trauma care. By definition, the employed imaging technique in the emergency setting should reach the correct diagnosis as fast as possible. In severe chest blunt trauma, multidetector computer tomography (MDCT) has become part of the initial workup, mainly due to its high sensitivity and diagnostic accuracy of the technique for the detection and characterization of thoracic injuries and also due to its wide availability in tertiary care centers. The aim of this paper is to review and illustrate a spectrum of characteristic MDCT findings of blunt traumatic injuries of the chest including the lungs, mediastinum, pleural space, and chest wall.
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Abdurakhmanov, Sh, Zh Chyngysheva, B. Musaliev, and E. Tilekov. "Results of the Controlled Clinical Test of Intraoperative Blood Reinfusion Hardware, Assembled From the Abdominal Cavity in Conditions of Slow and Fast Modes." Bulletin of Science and Practice 6, no. 2 (February 15, 2020): 111–17. http://dx.doi.org/10.33619/2414-2948/51/08.
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Conducting parallel clinical and experimental control on the basis of controlled clinical trials was necessitated by, on the whole, a more thorough assessment of the effectiveness of intraoperative blood reinfusion hardware with the establishment of the possibility of ‘transfer’ of experimental data on modeling cavity blood loss to a clinical platform. Objective: a comparative description of the results of the following studies performed in the context of controlled clinical trials: 1) experimental control — a study of blood collected from the pleural and abdominal cavities before and after intraoperative blood reinfusion hardware under simulation conditions in animal injuries of the abdomen and chest with the formation, respectively, of hemothorax and hemoperitoneum; 2) clinical control — a study of blood collected from the abdominal and thoracic cavities before and after intraoperative blood reinfusion hardware in patients with injuries and injuries of the chest and abdomen with the corresponding formation of hemothorax and hemoperitoneum.
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Tseimakh, Ye A., A. V. Levin, I. N. Gontarev, P. E. Zimonin, and T. A. Tolstihina. "Low Invasive Approaches at Treatment of Patients with Severe Concomitant Injury and Dominant Chest Injury." N.N. Priorov Journal of Traumatology and Orthopedics 19, no. 4 (December 15, 2012): 62–67. http://dx.doi.org/10.17816/vto20120462-67.
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For the purpose of increasing the efficacy of complex treatment of 72 patients (main group) with severe concomitant injury and dominant chest injury low invasive treatment, i.e. local differential fibrinolytic therapy, valvural bronchoblocking, videothoracoscopy was applied. One hundred twelve patients (comparative group) were under traditional treatment (blind drainage of pleural cavities, thoracotomy, etc). Unilateral thoracic injuries were detected in 165 (89.7%) patients, bilateral — in 19 (10.3%). In 141 (76.6%) patient chest injuries were accompanied by subcutaneous and intercondylar emphysema. Elaborated treatment and diagnostic tactics as well as differentiated approach to the use of low invasive techniques enabled to increase the number of recovered patients — 61 versus 54 patients from comparative group (p
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Tsang, John, and Frank Ryan. "Delayed Diaphragmatic Herniation Masquerading as a Complicated Parapneumonic Effusion." Canadian Respiratory Journal 6, no. 4 (1999): 361–66. http://dx.doi.org/10.1155/1999/357295.
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Injury to the diaphragm following blunt or penetrating thoraco-abdominal trauma is not uncommon. Recognition of this important complication of trauma continues to be a challenge because of the lack of specific clinical and plain radiographic features, the frequent presence of other serious injuries and the potential for delayed presentation. Delayed diaphragmatic herniation often presents with catastrophic bowel obstruction or strangulation. Early recognition of diaphragmatic injury is required to avoid this potentially lethal complication. The case of a 35-year-old man with a history of a knife wound to the left flank 15 years previously, who presented with unexplained acute hypoxemic respiratory failure and a unilateral exudative pleural effusion that was refractory to tube thoracostomy drainage, is reported. After admission to hospital, he developed gross dilation of his colon; emergency laparotomy revealed an incarcerated colonic herniation into the left hemithorax. Interesting clinical features of this patient's case included the patient's hobby of weightlifting, a persistently deviated mediastinum despite drainage of the pleural effusion and deceptive pleural fluid biochemical indices.
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Rezaei Mehr, B., M. Etemadian, P. Shadpour, R. Maghsoudi, M. Mokhtary, J. Samady, and H. Akhiary. "MP-10.17 Evaluation of Pleural Injuries after Intercostal Access in Percutaneous Nephrostolithotomy." Urology 78, no. 3 (September 2011): S108. http://dx.doi.org/10.1016/j.urology.2011.07.244.
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Barmina, T. G., S. N. Danielyan, L. S. Kokov, F. A. K. Sharifullin, O. A. Zabavskaya, I. E. Popova, K. M. Rabadanov, and M. A. Gasanov. "Computed tomography as a method of substantiating a minimally invasive approach in the treatment of esophageal injuries and their complications." Medical Visualization 25, no. 2 (May 18, 2021): 63–73. http://dx.doi.org/10.24835/1607-0763-997.
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The purpose of the study. To analyze possibilities of computed tomography (CT) for esophageal injuries and their complications as part of a differentiated approach to the choice of a minimally invasive treatment method.Materials and methods. The results of CT scans were analyzed in 25 patients with esophageal injuries of various etiologies who were treated at the N.V. Sklifosovsky Research Institute of SP in the period 2019–2020. CT was performed with oral and intravenous bolus contrast, primarily at admission and in dynamics, a total of 77 studies.Results. In all cases, direct and indirect CT signs of esophageal damage were detected, and the degree of involvement of surrounding organs and tissues in the pathological process was assessed. Based on the data obtained, the following variants of esophageal damage and its complications were identified: intramural esophageal hematoma (2); rupture of the thoracic esophagus without the development of purulent complications (2); rupture of the thoracic esophagus complicated by the development of mediastinitis (4); rupture of the thoracic esophagus with the development of mediastinitis and pleural empyema (13); rupture of the cervical calving of the esophagus, complicated by phlegmon of the neck and descending mediastinitis (4). Different patient management tactics were used for each variant. Thus, the selection and sequence of minimally invasive interventions, such as thoracoscopic sanitation mediastinal and pleural cavity, esophageal stenting, percutaneous endoscopic gastrostomy (CEG) and endoscopic vacuum aspiration system (E-VAS), were carried out taking into account CT data, including observations in dynamics.Conclusion. CT scan for esophageal injuries allows you to get complete information about both the nature of esophageal damage and its complications, to determine their type, localization and volume. CT data allow us to justify a minimally invasive approach in the treatment of esophageal injuries, to determine the order of interventions. CT studies performed in dynamics allow us to evaluate the effectiveness of treatment and to carry out timely correction of tactics.
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Sokolov, V. V. "Pleural empyema from the point of view of a thoracic surgeon." Infusion & Chemotherapy, no. 3.2 (December 15, 2020): 267–68. http://dx.doi.org/10.32902/2663-0338-2020-3.2-267-268.
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Background. Pleural empyema (PE) is the presence of pus in the pleural cavity. The causes of PE include the diseases of adjacent organs (75 %), direct contamination of the pleural cavity during injuries or operations (20 %), and hematogenous dissemination of infection (5 %).
Objective. To describe the modern views on the treatment of EP.
Materials and methods. Analysis of literature sources on this topic.
Results and discussion. Radiography, computed tomography, and ultrasound can be used to diagnose PE. To detect PE, radiography should always be performed in two projections, paying special attention to the posterior sinus and the space above the diaphragm. Computed tomography shows pleural layers’ separation and a “pregnant woman” symptom. Ultrasound can distinguish fluid, pleural thickening and pulmonary infiltration, as well as determine the optimal point for puncture. The ultimate goals of PE treatment include the obliteration of the pleural cavity or creating conditions for the formation of a sterile residual cavity. In case of acute PE, drainage, washing, and antibiotic therapy are applied; correction of concomitant diseases is carried out. Drainage of the pleural cavity should be preceded by a puncture of the pleural cavity to obtain pathological contents. The appearance and odor of the fluid obtained by puncture are the most important indicators of the pathology. Drainage can be performed at the point where the pus was obtained, or in the VII-VIII hypochondrium along the posterior axillary line. Drains from polyvinylchloride with a diameter of 6-8 mm are applied. The length depends on the task. Videothoracoscopy is a modern method of treating PE. This method is minimally invasive, removes fibrin and pus, destroys adhesions, connects cavities and provides drainage at the optimal point. To wash the pleural cavity, it is advisable to use decamethoxine or povidone-iodine. With regard to antibiotic therapy, levofloxacin or third-generation cephalosporins are used in combination with an antianaerobic drug, or carbapenems or glycopeptides.
Conclusions. 1. PE is often a secondary infectious process caused by adjacent structures’ infection. 2. Pleural cavity sanitation during videothoracoscopy and drainage are the main methods of PE treatment. 3. Antibiotic therapy and pleural lavage are integral components of PE treatment.
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Amarantov, D. G., M. F. Zarivchatskii, A. A. Kholodar, O. S. Gudkov, and E. V. Kolyshova. "Modern approaches to surgical treatment of thoraco-abdominal wounds." VESTNIK KHIRURGII IMENI I.I.GREKOVA 177, no. 5 (November 23, 2018): 100–104. http://dx.doi.org/10.24884/0042-4625-2018-177-5-100-104.
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Thoraco-abdominal wounds are the most severe injuries of the chest and abdomen, with mortality reaching 13–20 %. The main focus of treatment of such patients is surgical correction of the injuries. Wide range of classical and minimally invasive interventions is used for treatment of victims . The paper presents the range of views of modern researchers on the indications for laparocentesis, drainage of the pleural cavity, thoracoscopy and laparoscopy, thoracotomy and laparotomy in this pathology. The opinions of various researchers on the optimal combination of interventions and tactics of surgical treatment of victims with thoraco-abdominal wounds are presented. It is necessary to continue the search for optimal combinations of classical and minimally invasive interventions in relation to a variety of clinic situations that arise in the treatment of patients with thoraco-abdominal wounds.
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Kesieme, Emeka B., Andrew Dongo, Ndubueze Ezemba, Eshiobo Irekpita, Nze Jebbin, and Chinenye Kesieme. "Tube Thoracostomy: Complications and Its Management." Pulmonary Medicine 2012 (2012): 1–10. http://dx.doi.org/10.1155/2012/256878.
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Background. Tube thoracostomy is widely used throughout the medical, surgical, and critical care specialities. It is generally used to drain pleural collections either as elective or emergency. Complications resulting from tube thoracostomy can occasionally be life threatening.Aim. To present an update on the complications and management of complications of tube thoracostomy.Methods. A review of the publications obtained from Medline search, medical libraries, and Google on tube thoracostomy and its complications was done.Results. Tube thoracostomy is a common surgical procedure which can be performed by either the blunt dissection technique or the trocar technique. Complication rates are increased by the trocar technique. These complications have been broadly classified as either technical or infective. Technical causes include tube malposition, blocked drain, chest drain dislodgement, reexpansion pulmonary edema, subcutaneous emphysema, nerve injuries, cardiac and vascular injuries, oesophageal injuries, residual/postextubation pneumothorax, fistulae, tumor recurrence at insertion site, herniation through the site of thoracostomy, chylothorax, and cardiac dysrhythmias. Infective complications include empyema and surgical site infection.Conclusion. Tube thoracostomy, though commonly performed is not without risk. Blunt dissection technique has lower risk of complications and is hence recommended.
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Zarutskyi, Ya L., S. A. Aslanyan, O. V. Borzykh, V. G. Hetman, V. E. Saphonov, K. V. Kravchenko, A. E. Tkachenko, M. S. Vovk, V. S. Honcharuk, and O. A. Lavrenchuk. "Surgical treatment of wounded persons with complicated thoracic damages." Klinicheskaia khirurgiia 87, no. 11-12 (December 28, 2020): 3–9. http://dx.doi.org/10.26779/2522-1396.2020.11-12.03.
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Objective. To improve the results of complex surgical treatment of wounded and injured persons with thoracic trauma, complicated by bronchopleural fistulas, pleural empyema and defects in the thoracic wall soft tissues, basing on introduction of the proposed procedure of vacuum therapy in combination with bronchoscopic obturation of certain bronchus.
Materials and methods. Analysis of results of the complex surgical help delivery for 54 wounded persons with defects of the thoracic wall soft tissues, broncho-pleural fistulas and pleural empyema, caused by the combat thoracic trauma, on ІІІ and ІV levels of medical support while conduction of the Antiterrorist operation/Operation of the Joined Forces (the main group) and 73 injured persons with thoracic trauma of the peace period (the comparison group) in the 2014 - 2019 yrs period was conducted.
Results. Improvement of complex surgical treatment of the wounded and damaged persons with thoracic trauma and defects of the thoracic wall soft tissues have permitted to reduce the complications frequency by 6.7%, and lethality - by 9.2% in the main group.
Conclusion. There was proposed a procedure of vacuum therapy, ultrasound cavitation together with bronchoscopic bronchial obturation for its fistula, which have proved its efficacy in complex surgical treatment of severely wounded persons with the gun-shot thoracic damages and presence of combination of pleural empyema, bronchial fistula and defects of soft tissues.
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Gales, Hannah, and Michael Perry. "Is there a Role for Planned Serial Chest Radiographs and Abdominal Ultrasound Scans in the Resuscitation Room Following Trauma?" Annals of The Royal College of Surgeons of England 88, no. 6 (October 2006): 535–39. http://dx.doi.org/10.1308/003588406x116918.
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INTRODUCTION Despite advances in trauma care, significant morbidity and mortality exists which could be reduced if all injuries were immediately identified. Two treatable factors are hypoxia and hypovolaemia which may occur secondary to haemorrhage into the chest and abdomen. Pneumothorax is also a frequent cause of preventable trauma death. Clinical examination is limited and we often rely on imaging. Anecdotally, it seemed some patients were investigated too quickly because their injuries had not evolved sufficiently enough to become detectable. In these patients, repeated assessments and imaging would, therefore, be necessary. PATIENTS AND METHODS This was a retrospective study looking at all patients over a 15-month period with significant chest and abdominal injuries. Patients with a chest or abdominal Abbreviated Injury Score (AIS) of 3 or above were identified. As a cross reference, those patients who required at least one chest drain, or a laparotomy within 24 h of admission were also identified. Case notes and films were reviewed with particular attention to the presence of initial ‘normal’ imaging. RESULTS A total of 1036 patients were eligible for entry into the trauma database; of these, 170 patients had chest and/or abdominal injuries coded as AIS 3 or more. We were able to identify 7 cases (4%) where initial clinical examination and imaging failed to detect either bleeding (pleural space or abdomen) or a pneumothorax. A further 5 cases were potential missed injuries, but the data were incomplete making confident inclusion in this group impossible. CONCLUSIONS Occult injuries are reported to have an incidence of around 2–5%. Serial imaging in the resuscitation room may enable early identification of chest and abdominal injuries. However, only 12 cases were identified making interpretation of suitable candidates for repeat imaging difficult. The question is which group of patients would benefit from planned repeat imaging before leaving the resuscitation room.
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Al-Sadek, Tabet A., Desislav Niklev, Ahmed Al-Sadek, and Lina Al-Sadek. "Scapular Fractures in Blunt Chest Trauma – Self-Experience Study." Open Access Macedonian Journal of Medical Sciences 4, no. 4 (November 16, 2016): 688–91. http://dx.doi.org/10.3889/oamjms.2016.135.
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AIM: The aim of this retrospective study was to report the scapular fractures in patients with blunt chest trauma and to present the type and the frequency of associated thoracic injuries.MATERIAL AND METHODS: Nine patients with fractures of the scapula were included in the study. The mechanisms of the injury, the type of scapular fractures and associated thoracic injuries were analysed.RESULTS: Scapular fractures were caused by high-energy blunt chest trauma. The body of the scapula was fractured in all scapular fractures. In all cases, scapular fractures were associated with other thoracic injuries (average 3.25/per case). Rib fractures were present in eight patients, fractured clavicula - in four cases, the affection of pleural cavity - in eight of the patients and pulmonary contusion in all nine cases. Eight patients were discharged from the hospital up to the 15th day. One patient had died on the 3rd day because of postconcussional lung oedema.CONCLUSIONS:The study confirms the role of scapular fractures as a marker for the severity of the chest trauma (based on the number of associated thoracic injuries), but doesn’t present scapular fractures as an indicator for high mortality in blunt chest trauma patients.
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Neeki, Michael M., Christina Cheung, Fanglong Dong, Nam Pham, Dylan Shafer, Arianna Neeki, Keeyon Hajjafar, Rodney Borger, Brandon Woodward, and Louis Tran. "Emergent needle thoracostomy in prehospital trauma patients: a review of procedural execution through computed tomography scans." Trauma Surgery & Acute Care Open 6, no. 1 (August 2021): e000752. http://dx.doi.org/10.1136/tsaco-2021-000752.
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BackgroundTraumatic tension pneumothoraces (TPT) are among the most serious causes of death in traumatic injuries, requiring immediate treatment with a needle thoracostomy (NT). Improperly placed NT insertion into the pleural cavity may fail to treat a life-threatening TPT. This study aimed to assess the accuracy of prehospital NT placements by paramedics in adult trauma patients.MethodsA retrospective chart review was performed on 84 consecutive trauma patients who had received NT by prehospital personnel. The primary outcome was the accuracy of NT placement by prehospital personnel. Comparisons of various variables were conducted between those who survived and those who died, and proper versus improper needle insertion separately.ResultsProper NT placement into the pleural cavity was noted in 27.4% of adult trauma patients. In addition, more than 19% of the procedures performed by the prehospital providers appeared to have not been medically indicated.DiscussionLong-term strategies may be needed to improve the capabilities and performance of prehospital providers’ capabilities in this delicate life-saving procedure.Level of evidenceIV.
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Sameh, Wael M., and Ahmed Fouad Kotb. "Open adrenalectomy for medium sized adrenocortical tumour: How I do it?" Canadian Urological Association Journal 9, no. 5-6 (May 13, 2015): 291. http://dx.doi.org/10.5489/cuaj.2572.
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Introduction: The aim of our work was to report our experience in managing cases with medium-sized adrenocortical carcinoma by the high retroperitoneal extra pleural approach.Methods: During the past 2 years, 10 patients with suspected adrenocortical carcinoma were managed by our technique: the high supra 10th rib, retroperitoneal extra pleural approach. We included cases with 5 to 10 cm adrenal masses, suspected as adrenocortical carcinoma.Results: The mean patient age was 38 years (range: 26–44), the median tumour volume was 7 cm (range: 5–8). Of the 10 patients, 7 were female. Of the patients, 6 had right- and 4 had left-sided tumours. Intraoperatively, all cases had proper surgical removal, with no apparent residual tumour tissue. No single patient required a chest tube or developed respiratory problems. There were no major vascular injuries during surgery. We did not compare our findings to the standard lateral or subcostal approaches, as in our institution we adopt this high lateral approach for medium-sized tumours, while managing larger tumours with transperitoneal subcostal approach and smaller tumours laparoscopically.Conclusion: The high supra 10th lateral retroperitoneal, extra pleural approach is a safe, doable technique, allowing easy access to medium-sized suprarenal tumours and its vasculature, for cases suspected to be adrenocortical carcinoma.
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Kostov, Konstantin. "DIAGNOSIS AND TREATMENT OF THORACIC INJURIES AND TRAUMATIC HEMOPNEUMOTHORAX." Journal of IMAB - Annual Proceeding (Scientific Papers) 27, no. 1 (March 17, 2021): 3611–14. http://dx.doi.org/10.5272/jimab.2021271.3611.
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Purpose: The purpose of the study is to analyze the diagnosis and treatment of patients with traumatic chest injuries and traumatic hemopneumothorax in UMHATEM "N. I. Pirogov ". Material and Methods: Data on 113 patients with thoracic trauma were processed within a retrospective clinical analysis for the period of 1.1. 2016 to 1.1. 2018 in the General, Visceral and Emergency Surgery Section of the UMHATEM "Pirogov. Of the hospitalized women are 38 (33.63%), men 75 (66.37%). The age in this retrospective analysis varied from 18 to 83 years (average 57.4 years). Results: In our study, among 113 patients, 43 patients had a pneumothorax, 29 patients were with hemothorax, 18 patients with hemopneumothorax, 2 patients had tension pneumothorax and others 21 had only rib fractures. Associated injuries were confirmed in 43 patients (38.05%). From all patients group, 21 patients were managed conservatively, 89 patients with chest tube insertion and only 3 with thoracotomy. Conclusions: The majority of the patients with a thoracic injury can be performed in emergency surgery by conservative management or by mini-intervention- thoracic chest tube. Tube thoracostomy was evaluated to be important for pleural collections from blunt or penetrating trauma. Therefore it was recommended as a first-line therapeutic approach.
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Khomenko, I. P., S. O. Korol, S. V. Khalik, V. Yu Shapovalov, R. V. Yenin, O. S. Нerasimenko, and S. V. Tertyshnyі. "Clinical and Epidemiological analysis of the structure of combat surgical injury during Antiterrorist operation / Joint Forces Operation." Ukrainian Journal of Military Medicine 2, no. 2 (June 30, 2021): 5–13. http://dx.doi.org/10.46847/ujmm.2021.2(2)-005.
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I
Introduction. In generalizing the experience of providing medical care to the wounded in armed conflicts, a special place belongs to the analysis of the magnitude and structure of casualties, which depend on the conditions, forms and methods of hostilities.
The purpose. Conduct a clinical and epidemiological analysis of the proportion of gunshot and mine injuries in the structure of combat surgical trauma during the Anti-terrorist operation / Joint Forces operation.
Materials and methods. The total number of wounded as a result of the armed conflict in eastern Ukraine in the period from 2014 to 2019 was more than 41 thousand people, from them killed among the civilian population – 3350 people and 4100 – servicemen.
Results. It was proved that the wounded with non-severe combat surgical trauma are 36.5%, severe – 48.9%, extremely severe – 14.6%. Shrapnel wounds were received by 35.3%, bullet wounds – 48.3%, mine injuries – 16.6%. Isolated combat surgical trauma was found in 16.8%, multiple – in 34.3%, combined – in 48.9% of the wounded. Impenetrable combat surgical trauma was diagnosed in 63.7% of the wounded, penetrating into the pleural cavity – in 17.2%, in the abdominal cavity – in 16.0%, in the pelvic cavity – in 3.1%.
Conclusions. In the structure of sanitary losses of the surgical profile during the ATO / OOS, the wounded with injuries of the extremities are 56.7%, with injuries of the chest – 10.1%, abdomen – 5.1%, pelvis – 3.0%.
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Rudkin, David M. "Exoskeletal abnormalities in four trilobites." Canadian Journal of Earth Sciences 22, no. 3 (March 1, 1985): 479–83. http://dx.doi.org/10.1139/e85-047.
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Four trilobite specimens, two of Ordovician, one of Silurian, and one of Devonian age, display abnormal exoskeletal features ranging in expression from superficial to severe. Traumatic injury and developmental malfunction are considered the most probable causative mechanisms, each accounting for two of the abnormalities. Evidence of external healing of a marginal pygidial wound is apparent in one of the injured trilobites; the other may have succumbed to more extensive posterolateral pleural trauma. The two examples of developmental malfunction both involve disruption of axial and pleural regions of the pygidia. One was of limited effect, the second more severe and possibly fatal.
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Wiener-Kronish, J. P., T. Sakuma, I. Kudoh, J. F. Pittet, D. Frank, L. Dobbs, M. L. Vasil, and M. A. Matthay. "Alveolar epithelial injury and pleural empyema in acute P. aeruginosa pneumonia in anesthetized rabbits." Journal of Applied Physiology 75, no. 4 (October 1, 1993): 1661–69. http://dx.doi.org/10.1152/jappl.1993.75.4.1661.
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We developed an experimental model of acute Pseudomonas aeruginosa pneumonia in anesthetized ventilated rabbits to determine whether bacterial-induced injury to the alveolar epithelium would occur and the effect of the injury on the pleural space. Dose-response studies established that 10(9) colony-forming units of P. aeruginosa (wild-type strain, PAO-1) were required to injure the epithelial barrier and to cause pleural empyema with exudative pleural effusions that contained both the instilled alveolar protein tracer and P. aeruginosa. We explored the mechanisms of P. aeruginosa-induced lung and pleural injury by using three isogenic bacterial strains to compare several extracellular virulence products. PAO-S21, which carries an insertion mutation in a regulatory gene that prevents the production of exoenzyme S, resulted in no lung or pleural injury. PAO-R1, which carries a deletion in a regulatory gene that controls the production of elastase and alkaline protease, caused the same degree of lung and pleural injury as PAO-1 did. Instillation of PLC-SRN, which has both structural genes encoding phospholipase C activity deleted, resulted in a moderate reduction in alveolar epithelial injury. Although other products may be involved, exoenzyme S and phospholipase C are important in mediating injury to the alveolar epithelial barrier in acute P. aeruginosa pneumonia in rabbits.