Trauma cerrado de aorta torácica, desde el servicio de urgencias hasta el quirófano: revisión narrativa / Blunt trauma of the thoracic aorta, from the emergency department to the operating room: narrative review / Trauma contuso da aorta torácica: do pronto-socorro ao centro cirúrgico, uma revisão narrativa

El trauma es la principal causa de muerte de la población en edad productiva. El abordaje del trauma torácico cerrado todavía es un desafío para el médico de urgencias. Aunque no es una entidad frecuente, se asocia con una alta mortalidad y resultados adversos. El diagnóstico del trauma cerrado de aorta torácica (LCAT) requiere un alto índice de sospecha, dado que los signos y síntomas no son específicos de esta enfermedad (dolor torácico, dolor interescapular, disnea, disfagia, estridor, disfonía). Es importante resaltar que la ausencia de inestabilidad hemodinámica no debe descartar una lesión aórtica. Para su diagnóstico imagenológico se debe tener en cuenta que los rayos X de tórax no tienen el rendimiento adecuado, el patrón de referencia es la angiotomografía y el ecocardiograma transesofágico (ETE) constituye una opción diagnóstica. El manejo incluye líquidos endovenosos y antihipertensivos como medida transitoria, manejo quirúrgico definitivo y, en algunos casos, manejo expectante o diferido. Los pacientes inestables o con signos de ruptura inminente deben ser llevados de manera inmediata a cirugía. El manejo quirúrgico temprano ha impactado en la mortalidad. A pesar de los avances en las técnicas quirúrgicas, la técnica quirúrgica abierta documenta mayor tasa de mortalidad que el manejo endovascular, el cual tiene numerosas ventajas al ser poco invasivo. Esta es una revisión narrativa que destaca algunos aspectos clave sobre los mecanismos de lesión, diagnóstico y manejo inicial del trauma cerrado aorta torácica. Por último, se propone un algoritmo de abordaje de trauma de aorta.

Trauma is the leading cause of death in the productive-age population. Addressing blunt chest trauma is still a challenge for the emergency physician. Although it is not a common entity, it is associated with high mortality and adverse outcomes. The diagnosis of blunt thoracic aortic trauma (LCAT) requires a high index of suspicion, given that the signs and symptoms are not specific to this disease (chest pain, interscapular pain, dyspnea, dysphagia, stridor, dysphonia). It is important to highlight that the absence of hemodynamic instability should not rule out aortic injury. For its imaging diagnosis, it must be taken into account that chest X-rays do not have adequate performance; the reference standard is angiotomography and transesophageal echocardiography (TEE) is a diagnostic option. Management includes intravenous fluids and antihypertensives as a temporary measure, definitive surgical management and, in some cases, expectant or deferred management. Unstable patients or patients with signs of imminent ruptura should be taken immediately to surgery. Early surgical management has impacted mortality. Despite advances in surgical techniques, the open surgical technique documents a higher mortality rate than endovascular management, which has numerous advantages as it is minimally invasive. This is a narrative review that highlights some key aspects about the mechanisms of injury, diagnosis and initial management of blunt thoracic aortic trauma. Finally, an algorithm for addressing aortic trauma is proposed.

O trauma é a principal causa de morte na população em idade produtiva. Abordar o trauma torácico contuso ainda é um desafio para o médico emergencista. Embora não seja uma entidade comum, está associada a alta mortalidade e resultados adversos. O diagnóstico de trauma fechado de aorta torácica (TACE) requer alto índice de suspeição, visto que os sinais e sintomas não são específicos desta doença (dor torácica, dor interescapular, dispneia, disfagia, estridor, disfonia). É importante ressaltar que a ausência de instabilidade hemodinâmica não deve descartar lesão aórtica. Para seu diagnóstico por imagem deve-se levar em consideração que a radiografia de tórax não apresenta desempenho adequado; o padrão de referência é a angiotomografia e a ecocardiografia transesofágica (ETE) é uma opção diagnóstica. O manejo inclui fluidos intravenosos e anti-hipertensivos como medida temporária, manejo cirúrgico definitivo e, em alguns casos, manejo expectante ou diferido. Pacientes instáveis ou com sinais de ruptura iminente devem ser encaminhados imediatamente para cirurgia. O manejo cirúrgico precoce impactou a mortalidade. Apesar dos avanços nas técnicas cirúrgicas, a técnica cirúrgica aberta documenta maior taxa de mortalidade do que o manejo endovascular, que apresenta inúmeras vantagens por ser minimamente invasivo. Esta é uma revisão narrativa que destaca alguns aspectos-chave sobre os mecanismos de lesão, diagnóstico e manejo inicial do trauma contuso da aorta torácica. Finalmente, é proposto um algoritmo para tratar o trauma aórtico.

CT as a first-line modality in elderly patients with stable blunt chest trauma / 中华创伤杂志(英文版)

PURPOSE@#Blunt thoracic injuries are common among elderly patients and may be a common cause of morbidity and death from blunt trauma injuries. We aimed to examine the impact of chest CT on the diagnosis and change of management plan in elderly patients with stable blunt chest trauma. We hypothesized that chest CT may play an important role in providing optimal management to this subgroup of trauma patients.@*METHODS@#A retrospective analysis was performed on all the admitted adult blunt trauma patients between January 2014 and December 2018. Stable blunt chest trauma patients with abbreviated injury severity (AIS) < 3 for extra-thoracic injuries confirmed with chest X-ray (CXR) and chest CT on admission or during hospitalization were included in the study. The AIS is an international scale for grading the severity of anatomic injury following blunt trauma. Primary outcome variables were occult injuries, change in management, need for surgical procedures, missed injuries, readmission rate, intensive care unit (ICU) and length of hospital stay.@*RESULTS@#There are 473 patients with blunt chest trauma included in the study. The study patients were divided into two groups according to the age range: group 1: 289 patients were included and aged 18-64 years; group 2: 184 patients were included and aged 65-99 years . Elderly patients in group 2 more often required ICU admission (11.4% vs. 5.2%), had a longer length of ICU stay (days) (median 11 vs. 6, p = 0.01), and the length of hospital stay (days) (median 14 vs. 6, p = 0.04). Injuries identified on chest CT has led to a change of management in 4.4% of young patients in group 1 and in 10.9% of elderly patients in group 2 with initially normal CXR. Chest CT resulted in a change of management in 12.8% of young patients in group 1 and in 25.7% of elderly patients in group 2 with initially abnormal CXR.@*CONCLUSION@#Chest CT led to a change of management in a substantial proportion of elderly patients. Therefore, we recommend chest CT as a first-line imaging modality in patients aged over 65 years with isolated blunt chest trauma.

Blunt trauma related chest wall and pulmonary injuries: An overview / 中华创伤杂志(英文版)

Physical traumas are tragic and multifaceted injuries that suddenly threaten life. Although it is the third most common cause of death in all age groups, one out of four trauma patients die due to thoracic injury or its complications. Blunt injuries constitute the majority of chest trauma. This indicates the importance of chest trauma among all traumas. Blunt chest trauma is usually caused by motor vehicle accident, falling from height, blunt instrument injury and physical assault. As a result of chest trauma, many injuries may occur, such as pulmonary injuries, and these require urgent intervention. Chest wall and pulmonary injuries range from rib fractures to flail chest, pneumothorax to hemothorax and pulmonary contusion to tracheobronchial injuries. Following these injuries, patients may present with a simple dyspnea or even respiratory arrest. For such patient, it is important to understand the treatment logic and to take a multidisciplinary approach to treat the pulmonary and chest wall injuries. This is because only 10% of thoracic trauma patients require surgical operation and the remaining 90% can be treated with simple methods such as appropriate airway, oxygen support, maneuvers, volume support and tube thoracostomy. Adequate pain control in chest trauma is sometimes the most basic and best treatment. With definite diagnosis, the morbidity and mortality can be significantly reduced by simple treatment methods.

Successful Repair of Traumatic Tricuspid Regurgitation / 日本心臓血管外科学会雑誌

A 62-year-old man was referred to our hospital because of dyspnea. Electrocardiogram showed chronic atrial fibrillation and echocardiogram revealed severe tricuspid regurgitation. His history included a motorbike accident at age 17, and a heart murmur was pointed out in the following year. He developed paroxysmal atrial fibrillation when he was 45 years old. Heart failure was not controlled by medication and tricuspid valve repair was indicated. At surgery, the anterior leaflet of tricuspid valve was widely prolapsed due to chordal rupture. We performed chordal reconstruction with 4 expanded polytetrafluoroethylene (CV-5®) sutures, and ring annuloplasty. Furthermore, a small fenestration at the tricuspid annulus was noticed and was closed with a direct suture. The biatrial modified Maze procedure was performed subsequently. The patient is doing well without TR recurrence, and restored sinus rhythm is maintained. We report successful repair of traumatic tricuspid regurgitation.

Aortic Valve Repair of Traumatic Aortic Regurgitation to a Young Woman / 日本心臓血管外科学会雑誌

<p>A 28-year-old woman with no underlying health issues was injured in a motorcycle accident and taken to our hospital by ambulance when she was 26 years old. Though she was diagnosed with multiple trauma, upon arrival at the hospital neither cardiac murmurs nor cardiac abnormalities on transthoracic echocardiography were detected. She was managed conservatively, and discharged on hospital day 16. She experienced dyspnea upon mild effort, and an early diastolic murmur appeared. She was again referred to our hospital, and diagnosed with severe aortic regurgitation. We scheduled an aortic valve replacement using an bioprosthetic valve because she intended to give birth. We also considered simultaneous aortic root enlargement as her aortic annulus was small. We performed the surgery 2 years after the initial motorcycle accident. Perioperatively, we noticed that her non-coronary cusp was torn. We converted the procedure to an aortic valve repair using an autologous pericardial patch. Her aortic regurgitation disappeared after the operation, and she was discharged on postoperative day 14. We successfully preserved the aortic valve cusps and avoided the need for anticoagulant therapy.</p>

A Case Report of Cardiac Tamponade Caused by Anterior Mediastinal Bleeding after Blunt Chest Trauma / 日本心臓血管外科学会雑誌

A 37-year-old man who fell from a truck had chest pain and we diagnosed blunt chest trauma. A chest computed-tomography displayed a traumatic cardiac tamponade. The patient was transported to our hospital for emergency surgery. After median sternotomy, there was no injury of heart and great vessels in the pericardial sac but a rupture of the pericardium. Bleeding and hematoma were found in the anterior mediastinal space. The cardiac tamponade was caused by the bleeding from anterior mediastinal space. Usually, blunt cardiac tamponade was caused by the bleeding from cardiovascular organs, however, we encountered a very rare cardiac tamponade due to the bleeding from the anterior mediastinal space.

A combination of methylprednisolone and quercetin is effective for the treatment of cardiac contusion following blunt chest trauma in rats

Cardiac contusion is a potentially fatal complication of blunt chest trauma. The effects of a combination of quercetin and methylprednisolone against trauma-induced cardiac contusion were studied. Thirty-five female Sprague-Dawley rats were divided into five groups (n=7) as follows: sham, cardiac contusion with no therapy, treated with methylprednisolone (30 mg/kg on the first day, and 3 mg/kg on the following days), treated with quercetin (50 mg·kg−1·day−1), and treated with a combination of methylprednisolone and quercetin. Serum troponin I (Tn-I) and tumor necrosis factor-alpha (TNF-α) levels and cardiac histopathological findings were evaluated. Tn-I and TNF-α levels were elevated after contusion (P=0.001 and P=0.001). Seven days later, Tn-I and TNF-α levels decreased in the rats treated with methylprednisolone, quercetin, and the combination of methylprednisolone and quercetin compared to the rats without therapy, but a statistical significance was found only with the combination therapy (P=0.001 and P=0.011, respectively). Histopathological degeneration and necrosis scores were statistically lower in the methylprednisolone and quercetin combination group compared to the group treated only with methylprednisolone (P=0.017 and P=0.007, respectively). However, only degeneration scores were lower in the combination therapy group compared to the group treated only with quercetin (P=0.017). Inducible nitric oxide synthase positivity scores were decreased in all treatment groups compared to the untreated groups (P=0.097, P=0.026, and P=0.004, respectively). We conclude that a combination of quercetin and methylprednisolone can be used for the specific treatment of cardiac contusion.

Clinical analysis of 18 patients with blunt bronchial injuries / 重庆医学

Objective To sum up the experience on diagnosis and treatment of blunt bronchial injuries .Methods From January 2002 to December 2009 ,18 patients with blunt broncheal injuries were admitted .The definitive diagnosis was confirmed by fibro-bronchoscopy .Twelve patients suffered from main bronchial injuries and the remaining 6 patients from lobe bronchial injuries .All patients managed with surgical therapies .Emergent operation was performed in 15 patients and elective operation in 3 patients .End to end bronchial anastomosis was performed in 15 patients and primary repair in 3 patients .Results There was no death in this group .One patient after emergent primary repair developed ischic necrosis in the repair site on 3 the postoperative day and under-went resection of the necrotic tissue followed by end to end anastomsis .Thirteen patients had no complications and were able to take part in normal activities .Anastomotic stricture occurred in 5 patients and managed with granulation tissue resection and cryothera-py .Four patients were healed but one patient underwent lobectomy 6 months later as a result of recurrent stricture and severe dysp-nea .Conclusion Fibrobronchoscopy is able to define the blunt bronchial injuries immediately .Early surgery after trauma can im-prove the successful rate of treatment .

Spontaneous Obliteration of Right Ventricular Pseudoaneurysm after Blunt Chest Trauma: Diagnosis and Follow-Up with Multidetector CT

Right ventricular (RV) pseudoaneurysm caused by trauma is very rare. We report a case of RV pseudoaneurysm which resolved without surgical treatment in a patient who survived a falling accident. Echocardiography failed to identify the pseudoaneurysm. Electrocardiography-gated CT showed a 17-mm-sized saccular pseusoaneurysm arsing from the RV outflow tract with a narrow neck. Follow-up CT after two months showed spontaneous obliteration of the lesion.

Right Coronary Artery Fistula and Occlusion Causing Myocardial Infarction after Blunt Chest Trauma

Myocardial infarction (MI) secondary to coronary artery fistula and the subsequent occlusion of the distal right coronary artery (RCA) after blunt chest trauma is a rare entity. Here, we describe a case of coronary artery fistula and occlusion with an inferior MI that occurred following blunt chest trauma. At the initial visit to the emergency room after a car accident, this patient had been undiagnosed with acute myocardial infarction, readmitted five months after ischemic insult, and revealed to have experienced MI due to RCA-right atrial fistula and occlusion of the distal RCA. He underwent coronary surgery and recovered without complications.

Tricuspid Valve Repair for Traumatic Tricuspid Valve Regurgitation over 30 Years after Causative Trauma / 日本心臓血管外科学会雑誌

A 28-year-old man was involved in a traffic accident that sandwiched his chest between a wall and a truck. Shortness of breath and other symptoms started to appear several years later. Echocardiography at that time showed severe tricuspid regurgitation due to a failed valve and ruptured chordae in the anterior leaflet. He was followed up with medication. Leg edema developed at the age of 62 years and worsening symptoms of heart failure over a period of 6 months indicated a need for surgery. Intraoperative findings revealed the ruptured chordae attached to the anterior leaflet and a scarred myocardium at the septomarginal trabeculation. The tricuspid valve was surgically repaired, the anterior leaflet chordae were surgically reconstructed, an annuloplasty ring was implanted to address the tricuspid regurgitation and atrial fibrillation was treated using the Maze procedure. Surgery 34 years after trauma has improved hemodynamic cardiac function and normalized the cardiac rhythm in this patient.

Stanford Type A Acute Aortic Dissection Case Caused by Blunt Chest Trauma / 日本心臓血管外科学会雑誌

A 31-year-old man fell into syncope caused by compression by a machine in his factory. He was taken to the nearest hospital at once for treatment. His chest X-ray seemed normal and his general condition improved. He received no medical treatment and was allowed to return home. Two days later, he went to the hospital for further investigation, and contrast-enhanced chest computed tomography (CT) was performed. Chest CT showed aortic dissection from the ascending aorta to the aortic arch. Therefore, he was admitted for bed rest with antihypertensive therapy. He was discharged on the 35th day after the accident. However, the diameter of the ascending aorta was found to have become dilated, and so he underwent ascending aorta and hemiarch replacement at our hospital. His postoperative course was uneventful, and he was discharged on the 16th postoperative day. We report a rare case of an acute aortic dissection caused by blunt chest trauma.

Role of routine chest radiographs in the evaluation of patients with stable blunt chest trauma: a prospective analysis / Papelde las radiografías de tórax rutinarias en la evaluación de pacientes contraumas contundentes estables del tórax: análisis prospectivo

OBJECTIVE: The study sought to assess the test performance characteristics of clinical judgement in the evaluation of stable blunt chest trauma patients compared with chest radiography (CXR) in the determination of significant intra-thoracic injury. METHODS: We prospectively enrolled all adult patients (older than 16 years) who were considered to have stable blunt chest trauma over a six-month period (May 1-October 31, 2009). We defined the latter as patients who were unintubated, normotensive (systolic blood pressure > 90 mm Hg) and without hypoxia (oxygen saturation > 95% at room air). Patients eligible for the study were sent for anteroposterior (AP) CXRs which were then interpreted by the same consultant radiologist throughout the study period. Both test (clinical judgement) and disease status (CXR) were assigned and correlated as binary measures. We compared the test performance characteristics such as sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic likelihood ratios of clinical judgement to CXR findings in the determination of significant intra-thoracic injury. RESULTS: During the six-month period, data were collected from 77 eligible stable blunt chest trauma patients (age over 16 years). Fifty-nine patients (76.6%) were male. Nine patients (11.7%) were radiologically confirmed to have significant blunt chest injuries including rib fractures, pneumothorax and an isolated case of pulmonary contusion. All nine (11.7%) patients had a positive (abnormal) radiograph for rib fractures. In addition, three (3.9%) of them also had both rib fracture and pneumothoraces and one (1.3%) had both a rib fracture and pulmonary contusion. Clinical judgement for the diagnosis of significant blunt chest injuries matched with the CXR finding with 95%confidence intervals (CIs): sensitivity 100% (95% CI 66.4, 100), specificity 32.4% (95% CI 21.5, 44.8), prevalence 11.7%, PPV 16.4% (95% CI 7.77, 28.8), NPV 100% (95% CI 84.6, 100), DLR+ 1. 48 (95% CI 1. 25, 1. 74). CONCLUSION: The majority of patients who sustained blunt chest injuries and were assessed as stable patients do not require CXR routinely. This study revealed that physicians in the local Emergency Department may be over-utilizing CXR for patients who have stable blunt chest trauma.

OBJETIVO: Este estudio se propuso evaluar las características de rendimiento de test del juicio clínico, a la hora de evaluar pacientes con traumatismos contundentes torácicos estables, en comparación con la radiografía de tórax al determinar lesiones intra-torácicas significativas. MÉTODOS: De forma prospectiva, fueron enrolados todos los pacientes adultos (mayores de 16 años) de quiénes se consideraba que habían tenido un trauma contundente torácico estable por un período de más de seis meses (1ero de mayo al 31 de octubre, 2009). Definimos a estos últimos como pacientes no entubados, normotensos (tensión arterial sistólica > 90 mm Hg) y sin hipoxia (saturación de oxígeno > 95% en el aire de la habitación). Los pacientes elegibles para el estudio fueron enviados a hacerse una radiografía torácica anteroposterior (AP), la cual fue entonces interpretada por el mismo radiólogo consultante a cargo de ese análisis durante todo el periodo de estudio. Tanto el test (juicio clínico) como el estatus de la enfermedad (rayos X del tórax) fueron asignados y correlacionados como medidas binarias. Se compararon las características de rendimiento del test, tales como la sensibilidad, la especificidad, el valor predictivo positivo, el valor predictivo negativo, las tasas de probabilidad diagnóstica del juicio clínico, con los hallazgos de los rayos X de tórax para la determinación de la lesión intra-torácica significativa. RESULTADOS: Durante el periodo de seis meses, se recogieron datos de 77 pacientes elegibles con traumatismos contundentes estables de tórax (mayores de 16 años). Cincuenta y nueve pacientes (76.6%) eran varones. En nueve pacientes (11.7%) se habían confirmado radiológicamente lesiones de tórax significativas, incluyendo fracturas de las costillas, pneumotórax, y un caso aislado de contusión pulmonar. Los nueve (11.7%) pacientes todos tenían una radiografía positiva (anormal) de las fracturas de las costillas. Además, tres de ellos (3.9%) tenían fractura de la costilla y además pneumotórax, en tanto que uno (1.3%) presentaba fractura de las costillas y contusión pulmonar también. El juicio clínico para el diagnóstico de lesiones contundentes estables de tórax significativas se correspondía con los hallazgos de las radiografías torácicas, como lo muestran los siguientes resultados de la prueba, con intervalos de confianza (ICs) de 95%: sensibilidad 100% (95% IC 66.4, 100), especificidad 32.4% (95% IC 21.5, 44.8), prevalencia, 11.7%, PPV 16.4% (95% IC 7.77, 28.8), NPV 100% (95% IC 84.6, 100), DLR+ 1.48 (95% IC 1.25, 1.74). CONCLUSIÓN: La mayoría de los pacientes que han sufrido traumatismos contundentes de tórax, y fueron evaluados como pacientes estables no requieren rayos C de tórax rutinariamente. Este estudio reveló que los médicos en el Departamento de Emergencias local pueden estar haciendo un uso excesivo de las radiografías torácicas en el caso de pacientes con traumas torácicos contundentes estables.

Experience in the surgical treatment of 16 cases of cardiac rupture caused by blunt chest trauma / 中国综合临床

ObjectiveTo retrospectively analyze the experience in the treatment of cardiac rupture caused by blunt chest trauma and to explore the approaches and methods to improve patient survival.Methods From 2004 to 2010,16 cases of closed chest trauma caused by cardiac rupture,who were treated in our hospital,were treated by heart repair using median sternotomy incision approach.Results Except for 1 patient occurred cardiac arrest before the establishment of CPB,who was failed for cardiopulmonary resuscitation after surgical repair,the remaining 15 patients were all successfully treated.Conclusion The diagnosis of cardiac rupture should be made as soon as possible once it occurs.Timely and decisive rescue and emergency surgery should be given.Heart repair can greatly improve the patient's survival.

Spontaneously Resolved Purtscher's Retinopathy within 24 Hours: Case Report and OCT Review

PURPOSE: To report a case of unilateral Purtscher's retinopathy that spontaneously resolved within 24 hours. CASE SUMMARY: A 54-year-old man presented with decreased visual acuity in his left eye after a vehicle accident. When the accident occurred, his chest region was compressed by the safety belt. The case was diagnosed with Purtscher's retinopathy based on fundus examination, flourescein angiography (FAG) and optical coherent tomography (OCT). At presentation, the best corrected visual acuity (BCVA) was 0.3 in the affected eye. Tiny Purtscher-flecken and macular edema were observed but there was no sign of retinal hemorrhage. Immediately after the trauma, OCT detected abnormally increased hyperreflectivity in the nerve fiber layer and ganglion cell layer, severe cystoid edema and serous foveal detachment. Without any treatment, BCVA was improved to 1.0 within 12 hours. Recovery of visual acuity was followed by improvement of abnormal hyperreflectivity in the nerve fiber layer, cystoid macular edema and serous foveal detachment. CONCLUSIONS: The authors of the present study report a dramatically resolved unilateral Purtscher's retinopathy after blunt chest trauma.

Bronchial Ruptures after Blunt Trauma in Two Patients: Different Time of Diagnosis and Different Prognosis

Bronchial injury due to blunt trauma is often associated with other significant injuries; as a result, making a rapid diagnosis can be difficult. Delay of early diagnosis and surgical treatment can result in a fatal course, including persistent pneumothorax, soft tissue emphysema, lung collapse, recurrent infection, or death. Bronchoscopy remains a reliable diagnostic method; however, it is difficult to perform in the emergency department. In some cases, suspicion of emergency physicians, depending on findings observed on computed tomography scan, can be more helpful than bronchoscopy. In this article, we present two cases of bronchial injury after blunt chest trauma; differences in prognosis were dependent on the time taken to make a decision.

Delayed Hemothorax After Conservative Treatment of Sternal Fracture / General Medicine

Delayed hemothorax following blunt chest trauma is classified as a late presentation of hemothorax after a nearly normal chest X-ray on admission. Here, we present a case of delayed hemothorax 5 days after blunt chest trauma with ribs and sternal fracture.

Effect of dexmedetomidine on serum concentrations of TNF-α and IL-1β in acute lung injury following blunt chest trauma in rats / 中华急诊医学杂志

Objective To investigate the effect of dexmedetomidine on the outcome of rats with acute lung injury following blunt chest trauma.Method Forty male SD rats weighing 250～300 g were randomly (random number)divided into 5 groups(n=8 each),namely,group C(normal),group D(normal plus dexmedetomidine),group T(trauma),group TD(trauma plus dexmedetomidine),group TDY(trauma plus dexmedetomidine plus yohimbine).Au rats were sacrificed by using exsanguination from arteria femoralis 6 hours later.The TNF-α and IL-1β levels in plasma were examined by using ELISA.Lung wet/dry(W/D)weight and the percentage of neutrophil in leucocytes in bronehoalveolar lavage fluid(BALF)of rats were detected.HE staining was performed to observe the injury of lung tissue under microscope.Results There was significant lung injury after blunt chest trauma.The serum concentrations of TNF-α and IL-1β,PMN%and lung wet/dry(W/D)weight were significantly higher in traumatic group(P<0.05,P<0.01).chest trauma,but this protective effect of dexmedetomidine could be blocked by yohimbine,at least in part,via the inhibition of α2-adrenergie receptor.Conclusions Dexmedetomidine has a certain protective effect on acute traumatic acute lung injury in rats.

Papillary Muscle Rupture of the Mitral Valve Caused by Traffic Accident / 日本心臓血管外科学会雑誌

A 59-year-old man was admitted to our hospital because of multiple traumas in a motorcycle accident. On admission, his vital signs were stable, however, 4 h later his respiratory condition suddenly worsened and be needed ventilatory support. Cardiogenic shock was suspected, however, the conventional echocardiograph findings were indistinct because of the presence of subcutaneous air. On the third day of hospitalization day, the Swan-Ganz catheter revealed high pulmonary arterial pressure. The subsequently performed trans-esophageal echocardiography showed severe mitral regurgitation. Therefore, semi-emergency mitral valve replacement was planned on the 5th hospital day. Operative findings showed that the anterolateral papillary muscle had torn off from the left ventricular wall and the associated strut chordae was also torn from the anterior leaflet. The post-operative course was uneventful, and the patient was discharged on the 40th postoperative day.

Successful Repair in Two Cases of Traumatic Tricuspid Regurgitation / 日本心臓血管外科学会雑誌

Traumatic tricuspid regurgitation is a rare cardiovascular event that can follow blunt chest trauma. We report 2 cases of successful repair of traumatic tricuspid regurgitation. Case 1 : a 22-year-old man. At 18 years of age, he was involved in a falling accident. At the age of 19, he had an abnormal electrocardiogram and a cardiac murmur pointed out on a medical examination in his university. Echocardiography revealed severe tricuspid regurgitation, and he was referred to our institution for surgery. The operative findings showed some fenestrations in the anterior leaflet of the tricuspid valve. The fenestrations were sutured directly and ring annuloplasty was performed. Case 2 : a 54-year-old man. At age 18, he was involved in a falling accident. At age 31, he complained of fatigue and dyspnea. Echocardiography revealed severe tricuspid regurgitation. At age 54, liver dysfunction was discovered. He was referred to our institution for surgical treatment. In the operative findings, the chordae tendineae of the anterior and septal leaflets of the tricuspid valve were ruptured. Tricuspid valvuloplasty was performed using chordal replacement with 2 expanded polytetrafluoroethylene (CV-52^®) sutures, edge-to-edge sutures and ring annuloplasty.