[The features of diagnosis and treatment of traumatic and non-traumatic pulmonary bleeding]. / Osobennosti diagnostiki i lecheniia legochnogo krovotecheniia travmaticheskoi i netravmaticheskoi étiologii.

AIM: To analyze an efficacy of differentiated approach for pulmonary bleeding of different etiology and severity. MATERIAL AND METHODS: The study included 134 cases of pulmonary bleeding for the period 2006-2015 including 53 patients with traumatic and 81 with non-traumatic etiology. Men/women ratio was 2.7:1, mean age was 43 years. Comparative retrospective analysis of X-ray and CT data in diagnosis of bleeding source was performed. Bronchoscopy was used to confirm these data. There were 43 endovascular examinations including 40 cases of bronchial arteriography (BAG). RESULTS AND DISCUSSION: X-ray and CT-signs of bleeding source were detected more often in case of traumatic pulmonary bleeding (62.3% and 93%) compared with non-traumatic (27.2 and 54%; p<0.05). Bronchoscopy revealed ongoing pulmonary bleeding in 40 (30%) patients, completed - in 94 (70%) patients. Indirect angiographic signs were the most frequent for pulmonary bleeding origin: hypervascularization (32.6%), bronchial-pulmonary shunts (23.2%) and bronchial artery dilatation (20.9%). 17 patients with ongoing bleeding underwent bronchial obstruction with adequate hemostasis in all cases. Endovascular interventions included bronchial arteries embolization (EBA) (33), occlusion of intercostal arteries (3) and segmental branches of low-lobar pulmonary artery (1), aortic stenting (1). Early efficacy of EBA was 97% with 2 month recurrence of pulmonary bleeding near 12.5%. Ongoing traumatic pulmonary bleeding was an indication for emergency thoracotomy in 18.9% compared with 12.3% for non-traumatic bleeding when surgery was made after endoscopic and endovascular hemostasis. CONCLUSION: Differentiated approach depending on etiology and severity of pulmonary bleeding improves outcomes and reduces the number of operations for ongoing severe bleeding.

[Risk factors of suppurative complications in case of thoracic injury].

It was performed retrospective analysis of 463 cases of suppurative thoracic complications after injury (232) and closed thoracic trauma (231) for 20-year period. Incidence of purulent complications was 3.2% and 1.6% in case of injury and closed thoracic trauma respectively including pleural empyema in 1.5 and 1.3%, pulmonary abscess in 0.3 and 0.4%, mediastinitis in 0.35 and 0.12%, pericarditis in 1.5 and 0.26%, osteomyelitis in 0.4 and 0.18% respectively. Factors preceding suppurative complications in case of injuries and closed trauma have been considered as predictors. Multivariant regression analysis established significant risk factors of suppurative thoracic complications. Clotted hemothorax, mediastinal hemorrhage, heart injury, late appeal for medical assistance and mechanical ventilation over 5 days were identified irrespective of character of trauma. In case of thoracic injury there were damage of osteochondrous frame, hollow thoracic and abdominal organs, gunshot wound of lung, delirium and injuries severity over 20 scores according to ISS scale. Pulmonary bleeding, sternal fracture and Glasgow Coma Scale rate<12 scores were identified as risk factors in case of closed trauma.

[Medico-social characteristics of patients with septic complications after penetrating thoracic wounds].

232 cases of septic complications after penetrating thoracic injury were analyzed. All patients were divided into groups according to the injury mechanism and inhabitancy. Patients with medico-social deviations, as well as patients with hemocontact infections, mental insanity and social deviations were marked out. 75% of patients were reported to have any medico-social deviations. Among them the distributing was as follows: persons with no fixed abode (100%), women (91%), patients over 50 years (86.2%) and patients after knife thoracic injury (77.4%). Among patients with hemocontact infection the majority were incomers from the near-abroad countries (37%), victims of assault (20%) and patients aged 31-40 years (18.4%).

[Treatment of septic complications of thoracic injuries].

Treatment results of 77 patients with suppurative lung complications after injuries (n=22) and closed thoracic trauma (n=55) were analyzed. It was registered, that purulent process in lung was typical for the cases with direct primary lung tissue injury: 72.7% of patients with penetrating thoracic injuries and 83.6% of patients with closed chest trauma. Complex conservative treatment with adequate bronchial and transthoracic drainage proved to be the most effective modalities during the acute suppurative phase. Gram-negative flora proved to be the cause of chronic forms of suppuration. The overall chronisation rate of the lung abscess was 4.5% after penetrating thoracic injuries and 10.9% of patients with closed chest trauma.

[Medical and social characteristics of patients with septic complications of the closed thoracic injury].

231 cases of septic complications after the closed thoracic injury were analyzed. All patients were divided into groups according to the injury mechanism and inhabitancy. Patients with medico-social deviations, as well as patients with hemocontact infections, mental insanity and social deviations were marked out. The leading mechanisms of the closed thoracic injury were: fall from a height (34.2%), assault and battery (24.7%) and automobile accident (16.4%). 51.1% of patients were reported to have any medico-social deviations. Among the patients with socially important infections, the distribution was as follows: persons with no fixed abode (50%), incomers from the near-abroad countries (36.4%), victims of assault (28.1%) and pedestrians (21.4%).

[The treatment of pulmonary bleedings and its' complicsations by the blunt thoracic trauma].

The experience of treatment of 224 patients with pulmonary bleeding after the blunt thoracic trauma were analyzed. All patients were diagnosed with lung contusion, of them 134 had traumatic cavities (hematomas) in the lung. The complete regression of contusion foci was observed within 13.7±4.2 days, whereas only 65.4% of patients demonstrated the regression of lung hematomas after 3 months of follow-up. 5.36% of pulmonary bleeding required the urgent thoracotomy on the reason of the continuous bleeding. The thorough analysis of etiology of posttraumatic infectious pulmonary complications after the blunt thoracic trauma is submitted. The drainage of septic foci allowed the fast recovery of the majority of patients. 7,4% of lung abscesses and pleural empyem required thoracotomy.

[Diagnostics and treatment of pulmonary hemorrhage by the closed thoracic trauma].

Results of diagnostic and treatment of 156 patients with pulmonary hemorrhage, caused by the closed thoracic trauma, were analyzed. All patients had lung bruise, 101 of them had lung rupture. 115 (73.7%) patients demonstrated hemopneumothorax, bleeding was diagnosed in 86 (55.1%) cases and mediastinal emphysema was diagnosed in 52 (33.3%). Pulmonary hemorrhage developed more often by polytrauma of the chest, rather then by solitary lesions. Spiral computed tomography proved to be the best diagnostic means of thoracic trauma. Surgical tactics was defined mainly by the severity of intrapleural or pulmonary bleeding. Conservative treatment allowed successful recovery in the majority of patients. Only 5.1% of patients required surgery. High level of septic complications of pulmonary hemorrhage was registered/ Pneumonia developed in 28.8% and lung abscess was diagnosed in 14.1% of patients. The lethality rate was 9.6%.