RESUMEN
BACKGROUND: Penetrating thoracic injuries have a significant risk of morbi-mortality. Despite the advancements in damage control methods, a subset of patients with severe pulmonary vascular lesions and bronchial injuries persists. In some of these cases, post-traumatic pneumonectomy is required, and perioperative extracorporeal membrane oxygenation (ECMO) support may be required due to right ventricular failure and respiratory failure. CASE DESCRIPTION: A male was brought to the emergency department (ED) with a penetrating thoracic injury, presenting with massive right hemothorax and active bleeding that required ligation of the right pulmonary hilum to control the bleeding. Subsequently, he developed right ventricular dysfunction and ARDS, necessitating a dynamic hybrid ECMO configuration to support his condition and facilitate recovery. CONCLUSIONS: Penetrating thoracic injuries with severe pulmonary vascular lesions may need pneumonectomy to control bleeding. ECMO support reduces the associated mortality by decreasing the complications rate. A multidisciplinary team is essential to achieve good outcomes in severe compromised patients.
Asunto(s)
Oxigenación por Membrana Extracorpórea , Neumonectomía , Humanos , Oxigenación por Membrana Extracorpórea/métodos , Masculino , Lesión Pulmonar/cirugía , Lesión Pulmonar/etiología , Adulto , Traumatismos Torácicos/cirugía , Traumatismos Torácicos/complicaciones , Heridas Penetrantes/cirugía , Hemotórax/etiología , Hemotórax/cirugía , Cuidados Posoperatorios/métodosRESUMEN
INTRODUCTION: Traumatic pulmonary injuries are common in chest trauma. Persistent air leaks occur in up to 46% of patients depending on injury severity. Prolonged leaks are associated with increased morbidity and cost. Prior work from our first-generation pectin patches successfully sealed pulmonary leaks in a cadaveric swine model. We now test the next-generation pectin patch against wedge resection in the management of air leaks in anesthetized swine. METHODS: A continuous air leak of 10% to 20% percent was created to the anterior surface of the lung in intubated and sedated swine. Animals were treated with a two-ply pectin patch or stapled wedge resection (SW). Tidal volumes (TVs) were recorded preinjury and postinjury. Following repair, TVs were recorded, a chest tube was placed, and animals were observed for presence air leak at closure and for an additional 90 minutes while on positive pressure ventilation. Mann-Whitney U test and Fisher's exact test used to compare continuous and categorical data between groups. RESULTS: Thirty-one animals underwent either SW (15) or pectin patch repair (PPR, 16). Baseline characteristics were similar between animals excepting baseline TV (SW, 10.3 mL/kg vs. PPR, 10.9 mL/kg; p = 0.03). There was no difference between groups for severity of injury based on percent of TV loss (SW, 15% vs. PPR, 14%; p = 0.5). There was no difference in TV between groups following repair (SW, 10.2 mL/kg vs. PPR, 10.2 mL/kg; p = 1) or at the end of observation (SW, 9.8 mL/kg vs. PPR, 10.2 mL/kg; p = 0.4). One-chamber intermittent air leaks were observed in three of the PPR animals, versus one in the SW group ( p = 0.6). CONCLUSION: Pectin patches effectively sealed the lung following injury and were noninferior when compared with wedge resection for the management of acute traumatic air leaks. Pectin patches may offer a parenchymal sparing option for managing such injuries, although studies evaluating biodurability are needed.
Asunto(s)
Lesión Pulmonar , Neumonectomía , Humanos , Animales , Porcinos , Pulmón/cirugía , Lesión Pulmonar/cirugía , Tubos Torácicos , Pectinas , Complicaciones Posoperatorias/cirugíaRESUMEN
A 84-year-old man was diagnosed with complete atrioventricular block and underwent pacemaker implantation( PMI). Two days after the PMI, chest X-ray revealed left pneumothorax, and a chest tube was inserted. The pneumothorax did not improve, and computed tomography revealed left lung injury by the right ventricular lead. Surgical procedure through median sternotomy was performed, and the penetrated lead was removed. The injured right ventricle and left lung were repaired. Ten days after the surgical procedure, intravenous implantation of new right ventricular lead was performed. He was discharged 38 days after the surgical procedure.
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Lesiones Cardíacas , Lesión Pulmonar , Marcapaso Artificial , Neumotórax , Anciano de 80 o más Años , Lesiones Cardíacas/diagnóstico por imagen , Lesiones Cardíacas/etiología , Lesiones Cardíacas/cirugía , Humanos , Pulmón , Lesión Pulmonar/diagnóstico por imagen , Lesión Pulmonar/etiología , Lesión Pulmonar/cirugía , MasculinoRESUMEN
We report the case of a patient with injuries to multiple organs as a result of attempted suicide with a nail gun. The patient shot 12 nails into his chest, causing damage to multiple organs, including the heart, lungs, and stomach. With timely emergency surgery, we successfully removed all the nails, and the patient was discharged from the hospital two weeks after surgery.
Asunto(s)
Traumatismo Múltiple/etiología , Traumatismo Múltiple/cirugía , Intento de Suicidio , Heridas Penetrantes/etiología , Heridas Penetrantes/cirugía , Materiales de Construcción , Ecocardiografía , Cuerpos Extraños/diagnóstico por imagen , Cuerpos Extraños/etiología , Cuerpos Extraños/cirugía , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/lesiones , Ventrículos Cardíacos/cirugía , Humanos , Lesión Pulmonar/diagnóstico por imagen , Lesión Pulmonar/etiología , Lesión Pulmonar/cirugía , Masculino , Traumatismo Múltiple/diagnóstico por imagen , Estómago/diagnóstico por imagen , Estómago/lesiones , Estómago/cirugía , Traumatismos Torácicos/etiología , Traumatismos Torácicos/cirugía , Tomografía Computarizada por Rayos X , Heridas Penetrantes/diagnóstico por imagen , Adulto JovenAsunto(s)
Fijación de Fractura/métodos , Lesión Pulmonar/cirugía , Tratamientos Conservadores del Órgano/métodos , Fracturas de las Costillas/terapia , Rotura/cirugía , Accidentes de Tránsito , Humanos , Pulmón/diagnóstico por imagen , Pulmón/cirugía , Lesión Pulmonar/diagnóstico , Lesión Pulmonar/etiología , Masculino , Persona de Mediana Edad , Fracturas de las Costillas/complicaciones , Rotura/diagnóstico , Rotura/etiología , Resultado del TratamientoRESUMEN
Damage control techniques applied to the management of thoracic injuries have evolved over the last 15 years. Despite the limited number of publications, information is sufficient to scatter some fears and establish management principles. The severity of the anatomical injury justifies the procedure of damage control in only few selected cases. In most cases, the magnitude of the physiological derangement and the presence of other sources of bleeding within the thoracic cavity or in other body compartments constitutes the indication for the abbreviated procedure. The classification of lung injuries as peripheral, transfixing, and central or multiple, provides a guideline for the transient bleeding control and for the definitive management of the injury: pneumorraphy, wedge resection, tractotomy or anatomical resection, respectively. Identification of specific patterns such as the need for resuscitative thoracotomy, or aortic occlusion, the existence of massive hemothorax, a central lung injury, a tracheobronchial injury, a major vascular injury, multiple bleeding sites as well as the recognition of hypothermia, acidosis or coagulopathy, constitute the indication for a damage control thoracotomy. In these cases, the surgeon executes an abbreviated procedure with packing of the bleeding surfaces, primary management with packing of some selected peripheral or transfixing lung injuries, and the postponement of lung resection, clamping of the pulmonary hilum in the most selective way possible. The abbreviation of the thoracotomy closure is achieved by suturing the skin over the wound packed, or by installing a vacuum system. The management of the patient in the intensive care unit will allow identification of those who require urgent reintervention and the correction of the physiological derangement in the remaining patients for their scheduled reintervention and definitive management.
Las técnicas de control de daños aplicadas al manejo de lesiones torácicas han evolucionado en los últimos 15 años. A pesar de que el número de publicaciones es limitado, la información es suficiente para desvirtuar algunos temores y establecer los principios de manejo. La severidad del compromiso anatómico justifica el procedimiento de control de daños solamente en algunos casos. En la mayoría, la magnitud del deterioro fisiológico y la presencia de otras fuentes de sangrado dentro del tórax o en otros compartimientos corporales constituyen la indicación del procedimiento abreviado. La clasificación de la lesión pulmonar como periférica, transfixiante y central o múltiple, proporciona una pauta para el control transitorio del sangrado y para el manejo definitivo de la lesión: neumorrafía, resección en cuña, tractotomía o resecciones anatómicas, respectivamente. La identificación de ciertos patrones como la necesidad de toracotomía de reanimación o de oclusión aórtica, la existencia de un hemotórax masivo, de una lesión pulmonar central, una lesión traqueobronquial o una lesión vascular mayor, así como el reconocimiento de hipotermia, acidosis o coagulopatía, constituyen la indicación de una toracotomía de control de daños. En estos casos, el cirujano concluye de manera abreviada los procedimientos con empaquetamiento de las superficies sangrantes, el manejo primario con empaquetamiento de algunas lesiones pulmonares periféricas o transfixiante seleccionadas y el aplazamiento de la resección pulmonar, pinzando el hilio de la manera más selectiva posible. La abreviación del cierre de la toracotomía se logra con la sutura de la piel sobre el empaquetamiento de la herida, o mediante la instalación de un sistema de presión negativa. El manejo del paciente en cuidados intensivos permitirá identificar aquellos que requieren reintervención urgente y corregir la alteración fisiológica de los restantes para su reoperación programada y manejo definitivo.
Asunto(s)
Hemorragia/terapia , Técnicas Hemostáticas , Lesión Pulmonar/cirugía , Toracotomía/métodos , Acidosis/diagnóstico , Aorta , Trastornos de la Coagulación Sanguínea/diagnóstico , Hemorragia/etiología , Humanos , Hipotermia/diagnóstico , Lesión Pulmonar/clasificación , Lesión Pulmonar/complicaciones , Lesión Pulmonar/epidemiología , Ilustración Médica , Fotograbar , Oclusión Terapéutica , Técnicas de Cierre de HeridasRESUMEN
Recently, there has been a rise in the incidence of E-cigarette/Vaping-Associated Lung Injury (EVALI) in the United States, mostly involving tetrahydrocannabinol. Current treatment strategies for EVALI are aimed at controlling the inflammatory and infectious causes, in addition to supportive care. Although most patients improve with supportive measures, the long-term pulmonary effects of this illness are still not well defined. This report describes a case of EVALI resulting in progressive, irreversible destruction of the lung parenchyma that was treated with double lung transplantation.
Asunto(s)
Sistemas Electrónicos de Liberación de Nicotina , Lesión Pulmonar/cirugía , Trasplante de Pulmón/métodos , Vapeo/efectos adversos , Adolescente , Humanos , Lesión Pulmonar/diagnóstico , Lesión Pulmonar/etiología , Masculino , Radiografía TorácicaAsunto(s)
Cementos para Huesos/efectos adversos , Lesiones Cardíacas/inducido químicamente , Lesiones Cardíacas/cirugía , Lesión Pulmonar/inducido químicamente , Lesión Pulmonar/cirugía , Neumotórax/etiología , Vertebroplastia/efectos adversos , Femenino , Lesiones Cardíacas/diagnóstico por imagen , Humanos , Persona de Mediana Edad , Resultado del TratamientoAsunto(s)
Contusiones/terapia , Oxigenación por Membrana Extracorpórea , Lesión Pulmonar/terapia , Traumatismo Múltiple/terapia , Tráquea/lesiones , Contusiones/complicaciones , Contusiones/cirugía , Oxigenación por Membrana Extracorpórea/métodos , Humanos , Laceraciones/diagnóstico por imagen , Laceraciones/terapia , Lesión Pulmonar/complicaciones , Lesión Pulmonar/cirugía , Masculino , Toracotomía , Tomografía Computarizada por Rayos X , Tráquea/diagnóstico por imagen , Tráquea/cirugía , Adulto JovenRESUMEN
OBJECTIVE: To establish the indications for optimal open lung surgery in patients with severe blunt chest injury. MATERIAL AND METHODS: Hematomas, lung wounds and purulent pulmonary complications were studied in four groups of victims. Causes of injuries included road accidents (n=426), falling and beating (n=387), catatrauma (n=217), squeezing the body with a massive weight (n=46). Majority of victims (n=731, 67.9%) were transferred to the hospital within 1-5 hours after injury; 345 (32.1%) patients were transferred from other hospitals to treat combined injuries of head, chest, abdomen and complications within 1-49 days after injury. RESULTS: Lung surgery was applied in 48 patients. Typical resections and pneumonectomies made up 77.1%. Indications for surgery included lung wounds complicated by pulmonary hemorrhage grade IIa and severe hemothorax, intrapulmonary hematoma ≥6 cm with high risk of bleeding and suppuration, gangrene, gangrenous and purulent abscesses of aspiration genesis, lung cancer first diagnosed in victims. Postoperative mortality was 14.6%. Twelve victims with unrecognized deep lung wounds and pulmonary root rupture were not operated. Thus, 5.6% of victims with severe blunt chest trauma need for open lung surgery.
Asunto(s)
Lesión Pulmonar , Traumatismos Torácicos , Heridas no Penetrantes , Hemotórax/etiología , Hemotórax/cirugía , Humanos , Pulmón/cirugía , Enfermedades Pulmonares/diagnóstico , Enfermedades Pulmonares/etiología , Enfermedades Pulmonares/cirugía , Lesión Pulmonar/etiología , Lesión Pulmonar/cirugía , Estudios Retrospectivos , Traumatismos Torácicos/complicaciones , Traumatismos Torácicos/cirugía , Heridas no Penetrantes/complicaciones , Heridas no Penetrantes/cirugíaRESUMEN
Left atrial perforation is a known complication following pulmonary vein catheter ablation. Our case of a 62-year-old female underwent urgent surgery for repair of left atrium perforation with left pleural effusion as a late complication after multiple transcatheter radiofrequency pulmonary vein ablations for persistent atrial fibrillation.
Asunto(s)
Fibrilación Atrial/cirugía , Ablación por Catéter/efectos adversos , Ablación por Catéter/métodos , Lesiones Cardíacas/etiología , Lesiones Cardíacas/cirugía , Lesión Pulmonar/etiología , Venas Pulmonares , Procedimientos Quirúrgicos Cardíacos/métodos , Urgencias Médicas , Femenino , Atrios Cardíacos/lesiones , Atrios Cardíacos/cirugía , Humanos , Lesión Pulmonar/cirugía , Persona de Mediana Edad , Derrame Pleural/etiología , Derrame Pleural/cirugía , Resultado del TratamientoRESUMEN
The resection of lung parenchyma for thoracic trauma is uncommon. Different surgical procedures with a wide range of complexities have been described depending on the severity of trauma and the presence of associated injuries. The aim of this study was to analyze outcomes of wedge resection, lobectomy, and pneumonectomy. Data for this study were obtained from an eight-year retrospective National Trauma Data Bank study (2007-2015). Adult patients who sustained severe chest trauma (Abbreviated Injury Scale > 3) that required any type of lung resection were included. Propensity score (PS) analysis was adopted. Overall, 3107 patients were included. Wedge resection was performed in 54.3 per cent, lobectomy in 38.2 per cent, and pneumonectomy in 7.5 per cent of patients. Longer in-hospital length of stay (P = 0.01), ICU length of stay (P = 0.002), and mechanical ventilation days (P = 0.038) were found in case of major resections. The overall morbidity and mortality were 32 per cent and 27.5 per cent, respectively. A stepwise increase in mortality occurred when comparing wedge (20.3%), lobectomy (30.8%), and pneumonectomy (63.4%) (P < 0.001). After PS analysis, lobectomy and pneumonectomy were associated with higher mortality compared with wedge resection (odds ratio [OR] 1.42; 95% confidence interval 1.26-1.71 and OR 4.16; 95% confidence interval 2.84-6.07, respectively). Similarly, after PS analysis, lobectomy and pneumonectomy were associated with higher overall complications compared with wedge resection (OR 1.21 and OR 1.56, respectively). Comparable results were found in the subgroup analysis of patients with isolated lung injury. After PS matching, lobectomy and pneumonectomy were associated with significantly higher morbidity and mortality compared with nonanatomical wedge resection.
Asunto(s)
Causas de Muerte , Tiempo de Internación , Lesión Pulmonar/mortalidad , Lesión Pulmonar/cirugía , Neumonectomía/métodos , Adulto , Anciano , Intervalos de Confianza , Bases de Datos Factuales , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Lesión Pulmonar/diagnóstico , Masculino , Persona de Mediana Edad , Tempo Operativo , Neumonectomía/mortalidad , Pronóstico , Puntaje de Propensión , Procedimientos Quirúrgicos Pulmonares/métodos , Procedimientos Quirúrgicos Pulmonares/mortalidad , Estudios Retrospectivos , Medición de Riesgo , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
Pneumonectomy after traumatic lung injury (TLI) is associated with shock, increased pulmonary vascular resistance, and eventual right ventricular failure. Historically, trauma pneumonectomy (TP) mortality rates ranged between 53 and 100%. It is unclear if contemporary mortality rates have improved. Therefore, we evaluated outcomes associated with TP and limited lung resections (LLR) (i.e., lobectomy and segmentectomy) and aimed to identify predictors of mortality, hypothesizing that TP is associated with greater mortality versus LLR. We queried the Trauma Quality Improvement Program (2010-2016) and performed a multivariable logistic regression to determine the independent predictors of mortality in TLI patients undergoing TP versus LLR. TLI occurred in 287,276 patients. Of these, 889 required lung resection with 758 (85.3%) undergoing LLR and 131 (14.7%) undergoing TP. Patients undergoing TP had a higher median injury severity score (26.0 vs. 24.5, p = 0.03) but no difference in initial median systolic blood pressure (109 vs. 107 mmHg, p = 0.92) compared to LLR. Mortality was significantly higher for TP compared to LLR (64.9% vs 27.2%, p < 0.001). The strongest independent predictor for mortality was undergoing TP versus LLR (OR 4.89, CI 3.18-7.54, p < 0.001). TP continues to be associated with a higher mortality compared to LLR. Furthermore, TP is independently associated with a fivefold increased risk of mortality compared to LLR. Future investigations should focus on identifying parameters or treatment modalities that improve survivability after TP. We recommend that surgeons reserve TP as a last-resort management given the continued high morbidity and mortality associated with this procedure.
Asunto(s)
Lesión Pulmonar/cirugía , Pulmón/cirugía , Neumonectomía/mortalidad , Neumonectomía/métodos , Adolescente , Adulto , Niño , Femenino , Humanos , Lesión Pulmonar/mortalidad , Masculino , Persona de Mediana Edad , Riesgo , Índices de Gravedad del Trauma , Resultado del Tratamiento , Adulto JovenRESUMEN
Chest trauma, penetrating or blunt is common in this era of motor vehicle accidents, violence and terrorism in South Asia. Islamabad is the capital of Pakistan but there is no dedicated chest surgery unit in any government sector hospitals. Gunshot chest, is therefore managed by general surgery team in our tertiary care setting i.e. Federal Government Polyclinic Hospital and Post Graduate Medical Institute, Islamabad. We report a case of gunshot chest with lung contusion and open pneumothorax with a chest wall defect of 10 x 15 cm. in March 2015, this young man presented in emergency department of Federal Government Polyclinic Hospital (FGPC), Post Graduate Medical Institute (PGMI) Islamabad in shock after self-inflicted point blank suicidal gunshot to his left anterolateral chest. After primary resuscitation, the patient was shifted to OR, and a left anterolateral thoracotomy performed. Lung contusion was repaired and chest drain placed. The challenging task of closing the huge chest wall defect was performed by rotating the left latissimus dorsi muscle flap. The patient was shifted to ICU and remained stable postoperatively.
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Lesión Pulmonar/cirugía , Procedimientos de Cirugía Plástica/métodos , Neumotórax/cirugía , Músculos Superficiales de la Espalda/trasplante , Traumatismos Torácicos/cirugía , Pared Torácica/cirugía , Heridas por Arma de Fuego/cirugía , Humanos , Masculino , Colgajos Quirúrgicos , Adulto JovenRESUMEN
It has been previously suggested that lung tissue remains viable without blood supply from the pulmonary artery (PA). However, our experience demonstrates otherwise. We present 2 cases of accidental left lower lobe PA occlusion during upper lobectomy causing ischaemic changes to the remaining lung tissue. Both patients became septic secondary to necrosis of infarcted lung and required completion pneumonectomy. Development of collateral circulation to bypass the occluded PA may occur but is often insufficient to support the affected lung tissue. Unless the patient is medically unfit, resection of the ischaemic lung should be undertaken.
Asunto(s)
Infarto/diagnóstico , Lesión Pulmonar/cirugía , Neoplasias Pulmonares/cirugía , Pulmón/irrigación sanguínea , Neumonectomía/efectos adversos , Arteria Pulmonar/diagnóstico por imagen , Estenosis de Arteria Pulmonar/diagnóstico , Anciano , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/cirugía , Angiografía por Tomografía Computarizada , Humanos , Infarto/etiología , Infarto/cirugía , Pulmón/diagnóstico por imagen , Pulmón/cirugía , Lesión Pulmonar/diagnóstico , Neoplasias Pulmonares/diagnóstico , Masculino , Complicaciones Posoperatorias , Reoperación , Estenosis de Arteria Pulmonar/complicaciones , Heridas por Arma de Fuego/diagnóstico , Heridas por Arma de Fuego/cirugía , Adulto JovenRESUMEN
BACKGROUND: Serious chronic medical conditions occur in childhood cancer survivors. We aimed to investigate incidence of and risk factors for end-organ damage resulting in registration on a waiting list for or receiving a solid organ transplantation and 5-year survival following these procedures. METHODS: The Childhood Cancer Survivor Study (CCSS) is a retrospective cohort of individuals who survived at least 5 years after childhood cancer diagnosed at younger than 21 years of age, between Jan 1, 1970, and Dec 31, 1986, at one of 25 institutions in the USA. We linked data from CCSS participants treated in the USA diagnosed between Jan 1, 1970, and Dec 31, 1986 (without solid organ transplantation before cohort entry) to the Organ Procurement and Transplantation Network-a database of all US organ transplants. Eligible participants had been diagnosed with leukaemia, lymphoma, malignant CNS tumours, neuroblastoma, Wilms' tumours, and bone and soft tissue sarcomas. The two primary endpoints for each type of organ transplant were date of first registration of a transplant candidate on the waiting list for an organ and the date of the first transplant received. We also calculated the cumulative incidence of being placed on a waiting list or receiving a solid organ transplantation, hazard ratios (HRs) for identified risk factors, and 5-year survival following transplantation. FINDINGS: Of 13â318 eligible survivors, 100 had 103 solid organ transplantations (50 kidney, 37 heart, nine liver, seven lung) and 67 were registered on a waiting list without receiving a transplant (21 kidney, 25 heart, 15 liver, six lung). At 35 years after cancer diagnosis, the cumulative incidence of transplantation or being on a waiting list was 0·54% (95% CI 0·40-0·67) for kidney transplantation, 0·49% (0·36-0·62) for heart, 0·19% (0·10-0·27) for liver, and 0·10% (0·04-0·16) for lung. Risk factors for kidney transplantation were unilateral nephrectomy (HR 4·2, 95% CI 2·3-7·7), ifosfamide (24·9, 7·4-83·5), total body irradiation (6·9, 2·3-21·1), and mean kidney radiation of greater than 15 Gy (>15-20 Gy, 3·6 [1·5-8·5]; >20 Gy 4·6 [1·1-19·6]); for heart transplantation, anthracycline and mean heart radiation of greater than 20 Gy (dose-dependent, both p<0·0001); for liver transplantation, dactinomycin (3·8, 1·3-11·3) and methotrexate (3·3, 1·0-10·2); for lung transplantation, carmustine (12·3, 3·1-48·9) and mean lung radiation of greater than 10 Gy (15·6, 2·6-92·7). 5-year overall survival after solid organ transplantation was 93·5% (95% CI 81·0-97·9) for kidney transplantation, 80·6% (63·6-90·3) for heart, 27·8% (4·4-59·1) for liver, and 34·3% (4·8-68·6) for lung. INTERPRETATION: Solid organ transplantation is uncommon in ageing childhood cancer survivors. Organ-specific exposures were associated with increased solid organ transplantation incidence. Survival outcomes showed that solid organ transplantation should be considered for 5-year childhood cancer survivors with severe end-organ failure. FUNDING: US National Institute of Health, American Lebanese Syrian Associated Charities, US Health Resources and Services Administration.
Asunto(s)
Supervivientes de Cáncer/estadística & datos numéricos , Neoplasias/terapia , Trasplante de Órganos/estadística & datos numéricos , Adolescente , Adulto , Niño , Preescolar , Enfermedad Hepática en Estado Terminal/cirugía , Femenino , Insuficiencia Cardíaca/cirugía , Trasplante de Corazón/estadística & datos numéricos , Humanos , Incidencia , Lactante , Recién Nacido , Fallo Renal Crónico/cirugía , Trasplante de Riñón/estadística & datos numéricos , Trasplante de Hígado/estadística & datos numéricos , Lesión Pulmonar/cirugía , Trasplante de Pulmón/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Neoplasias/diagnóstico , Factores de Riesgo , Tasa de Supervivencia , Factores de Tiempo , Listas de Espera , Adulto JovenRESUMEN
BACKGROUND/AIM: Video-assisted thoracic surgery (VATS) for ipsilateral reoperations is challenging because of the potential for pleural adhesions. Insertion of the initial port can lead to lung injury because of the blinded intrathoracic area. We assessed the usefulness of ultrasonography before VATS to reduce the incidence of lung injury at the time of the initial port insertion during secondary ipsilateral VATS. PATIENTS AND METHODS: Thirty-three patients who underwent repeat VATS for ipsilateral pulmonary lesions were included. All patients underwent preoperative ultrasonography to assess the possible presence of pleural adhesions using the lung sliding sign. RESULTS: Seven adhesions were found at the VATS ports. Two of these adhesions were not evaluated as pleural adhesions using ultrasonography; however, they were loose. All initial ports were inserted without lung injury. There were no major complications. CONCLUSION: Preoperative detection of pleural adhesions using ultrasonography can determine the best initial port for secondary ipsilateral VATS.
Asunto(s)
Enfermedades Pleurales/cirugía , Cirugía Torácica Asistida por Video , Cirugía Torácica/métodos , Ultrasonografía , Adulto , Anciano , Femenino , Humanos , Pulmón/fisiopatología , Pulmón/cirugía , Lesión Pulmonar/fisiopatología , Lesión Pulmonar/cirugía , Masculino , Persona de Mediana Edad , Enfermedades Pleurales/fisiopatología , Cuidados Preoperatorios , Toracotomía , Adherencias Tisulares/fisiopatologíaRESUMEN
BACKGROUND: Penetrating neck and chest trauma is a very common entity in emergency medicine that usually requires surgical treatment. Our case report illustrates the case of a 27-year-old Arabian man with hemopneumothorax associated with pneumomediastinum due to an unusual occupational injury. CASE PRESENTATION: A metal sliver, coming from an axe using for wood chopping, penetrated the neck of a 27-year-old Arabian man in the left supraclavicular region mimicking a gun bullet; the entrance hole was at the left pleural dome where the sliver had just penetrated the apex of the lung passing through the upper lobe of his left lung creating an exit wound in the dorsal segment of the same lobe arriving in the posterior thoracic wall. Biportal video-assisted thoracic surgery was performed to remove blood clots and the unusual foreign body. CONCLUSION: In the literature, there are several case series about this topic, with some of them reporting unusual foreign bodies that lead to penetrating trauma. However, to the best of our knowledge, no cases like the one we have reported are described in the current literature.
Asunto(s)
Cuerpos Extraños/cirugía , Lesión Pulmonar/cirugía , Traumatismos del Cuello/cirugía , Cirugía Torácica Asistida por Video/métodos , Heridas Penetrantes/cirugía , Adulto , Cuerpos Extraños/diagnóstico por imagen , Hemoneumotórax/etiología , Humanos , Masculino , Metales/efectos adversos , Traumatismos Ocupacionales/cirugía , Heridas Penetrantes/diagnóstico por imagenRESUMEN
BACKGROUND: Previous studies suggest that transbronchial lung biopsy using a cryoprobe is superior to transbronchial lung biopsy using forceps for evaluating lung grafts, although the technique can be associated an increase in complications. Because cryoprobe experience is limited, assessment of a greater number of cases is warranted. This prospective study evaluates the diagnostic yield, complications, and risk factors associated with the cryoprobe technique. METHODS: From April 2013 to April 2016, 321 consecutive cryoprobe transbronchial biopsies were indicated in single or bilateral lung transplant patients with acute or chronic clinical lung injury or in asymptomatic patients before hospital discharge after lung transplantation. RESULTS: With a mean of 4.32 lung parenchyma specimens per procedure, adequate alveolar lung parenchyma was obtained in 96.6% (84.27 ± 44.14 mm2) of cases. Obtaining at least 4 samples increased the histological diagnostic certainty (P < .001). Moderate to severe bleeding was observed in 7.48% of patients and was significantly more frequent in patients with unilateral transplantation (odds ratio, 0.10; 95% confidence interval, 0.02-0.30; P < .001) and in those with high blood pressure during scanning (odds ratio, 0.31; 95% confidence interval, 0.12-0.86; P = .019). Pneumothorax was observed in 7.7% of the patients, but only 3.7% of these patients required pleural drainage. CONCLUSIONS: Obtaining 4 or more cryobiopsy samples is valuable and safe for lung allograft monitoring. Being a recipient of a unilateral lung transplant or having arterial hypertension during bronchoscopy seem to be risk factors associated with increased bleeding.