Indications and findings of flexible bronchoscopy in trauma field in Korea: a case series.

Purpose: Since its implementation, flexible fiberoptic bronchoscopy (FBS) has played an important role in the diagnosis and treatment of tracheobronchial tree and pulmonary disease. Although FBS is often performed by endoscopists, it has also been performed by surgeons, albeit rarely. This study investigated FBS from the surgeon's perspective. Methods: This retrospective study included patients who underwent FBS performed by a single thoracic surgeon between March 2017 and December 2021. Accordingly, the epidemiology, purpose, results, and complications of FBS were analyzed. Results: A total of 47 patients received FBS, whereas 13 patients underwent repeat FBS. Their mean age was 60.7 years. The main organs injured involved the chest (n=22), brain (n=9), abdominal organ (n=7), cervical spine (n=4), extremities (n=4), and face (n=1). The average Injury Severity Score was 22.5. Indications for FBS included atelectasis or haziness on chest x-ray (n=34), pneumonia (n=17), difficult ventilator management (n=7), percutaneous dilatory tracheostomy (n=3), blood aspiration (n=2), foreign body removal (n=2), and intubation due to a difficult airway (n=1). The findings of FBS were mucous plugs (n=36), blood and blood clots (n=16), percutaneous dilatory tracheostomy (n=3), foreign bodies (n=2), granulation tissue at the tracheostomy site (n=2), tracheostomy tube malposition (n=1), bronchus spasm (n=1), difficult airway intubation (n=1), and negative findings (n=5). None of the patients developed complications. Conclusions: FBS is an important modality in the trauma field that allows for the possibility of diagnosis and therapy. With sufficient practice, surgeons may safely perform FBS at the bedside with relative ease.

Outcomes of open neck injuries.

Purpose: The neck is a particularly critical region for penetrating injuries due to the close proximity of the trachea, esophagus, blood vessels, and the spinal cord. An open neck injury has the potential for serious morbidity and mortality. The purpose of this study is to evaluate the assessment and management of open neck injuries. Methods: In this retrospective study, open neck injury patients who were admitted to the Trauma Center of Daejeon Eulji Medical Center, Eulji University between December 2015 and December 2017 were analyzed for epidemiology, the mechanism of trauma, the injured organ, complications, and mortality. Results: Thirty-two patients presented with open neck injuries. All patients underwent computed tomographic angiography to evaluate their injuries once their vital signs stabilized. Among these patients, 27 required surgical treatment. The most commonly injured organ was the airway. There were five deaths, and the main cause of death was bleeding. Mortality was associated with the initial systolic blood pressure at the hospital and Glasgow Coma Scale. Conclusions: Mortality from open neck injuries was associated with initial systolic blood pressure at the hospital and Glasgow Coma Scale.

Direct cardiac rupture associated with sternal fracture following blunt trauma: A report of two case.

Traumatic cardiac injury is not rare. Especially cardiac contusion with sternal fracture due to blunt trauma in common. But cardiac rupture due to direct injury from fractured sternum in very rare. There were two case of cardiac injury supposed to be due to direct injury from fractured sternum. We operated immediately, so we could save these patients. Our cases show that it's rare but blunt trauma could make sternum fracture with direct injury to right side heart.

Acute mediastinitis after gastric rupture due to blunt trauma: A case report.

Acute mediastinitis after gastric rupture due to blunt trauma is very rare. In such cases, the esophageal hiatus widens due to elevated intra-abdominal pressure, and spillage of gastric contents causes acute posterior mediastinitis. The present report describes the case of a 30-year-old man who injured his left flank, which resulted in gastric rupture. During emergency laparotomy, a ruptured stomach was observed and the abdominal cavity and posterior mediastinum were found to be filled with gastric contents. Following partial gastrectomy, multiple loculated fluids were detected around the esophagus. Irrigation and drainage around the esophagus were performed via video-assisted thoracic surgery. After surgery, the patient recovered from acute mediastinitis and was discharged without any significant complications. In patients with upper gastric rupture, acute mediastinitis should be suspected, and video-assisted thoracic surgery may be an appropriate treatment strategy in such patients.

Impacts of Social Distancing During the COVID-19 Outbreaks in Korea: Level 1 Trauma Center Data of Domestic Incidents and Intentional Injury.

OBJECTIVES: As a protective measure to slow down the transmission of coronavirus disease 2019 in Korea, social distancing was implemented from February 29th, 2020. This study aimed to evaluate the prevalence of domestic incidents and intentional injury during March 2020 when social distancing was in effect. METHODS: There were 12,638 patients who visited the Level 1 trauma center of Chungnam province with injuries from domestic incidents, familial discord, and intentional injury. The prevalence of injuries during March 2020 was compared with the average of the previous 5 years, and the average for every March between 2015 and 2019. RESULTS: The prevalence of domestic incidents in March 2020 was significantly higher than the 5-year average, and the average for every March from 2015 to 2019 (p < 0.001). Familial discord (p = 0.002) and intentional injury (p = 0.031) were more frequently observed in March 2020. Adolescents showed a markedly higher level of intentional injury in March 2020 than in both the 5-year average (p = 0.031), and average for every March over the previous 5 years (p = 0.037). CONCLUSION: The prevalence of domestic incidents and intentional injury were significantly higher during the period of social distancing in Korea. There is a need for social consensus, better policies, and psychological support services, especially if faced with a second or third wave of coronavirus disease.

Post-traumatic pseudoaneurysms of the left gastric artery: A case report.

Post-traumatic pseudoaneurysm of the gastric artery is very rare. Prompt diagnosis and management are necessary because mortality is high due to massive intra-abdominal hemorrhage. A 79-year-old man complained of abdominal pain after slipping down 2 days prior to admission. Abdominal computed tomography showed some hemoperitoneum with suspicious contrast leakage and aneurysmal change of the left gastric artery. Pseudoaneurysm of the left gastric artery was treated by angioembolization. After the angioembolization, he recovered without any problems. Delayed pseudoaneurysm of the gastric circulation should always be kept in mind as a possible cause of delayed hemoperitoneum.

Concomitant Avulsion Injury of the Subclavian Vessels and the Main Bronchus Caused by Blunt Trauma.

Concomitant rupture of the subclavian vessels and the left main bronchus caused by blunt trauma is a serious condition. Moreover, the diagnosis of a tracheobronchial injury with rupture of the subclavian vessels can be difficult. This report describes the case of a 33-year-old man who suffered from blunt trauma that resulted in the rupture of the left subclavian artery and vein. The patient underwent an operation for vascular control. On postoperative day 3, the left main bronchus was found to be transected on a computed tomography scan and bronchoscopy. The transected bronchus was anastomosed in an end-to-end fashion. He recovered without any notable problems. Although the bronchial injury was not detected early, this case of concomitant rupture of the great vessels and the airway was successfully treated after applying extracorporeal membrane oxygenation.

Acute Respiratory Distress Syndrome after Viscum album Pleurodesis for Primary Spontaneous Pneumothorax.

A 52-year-old male patient who underwent multiple wedge resections experienced postoperative acute respiratory distress syndrome in both lungs after Viscum album pleurodesis. Despite initial rapid deterioration in clinical condition and rapid progression of bilateral lung infiltration, he exhibited a relatively smooth clinical recovery with marked response to glucocorticoid treatment. Our case report suggests that care must be taken to guard against the development of acute respiratory complications in the use of Viscum album for pleurodesis. However, in view of the clinically benign course, initial aggressive management of complications can prevent suffering and sequelae.

Thyrohyoid membrane transection caused by a stab injury.

BACKGROUND: The thyrohyoid membrane is located between the hyoid bone and thyroid cartilage. Transection of the thyrohyoid membrane can be fatal. CASE PRESENTATION: A 54-year-old man presented to the emergency room after attempting to commit suicide by cutting his neck. An endotracheal tube was inserted through the thyrohyoid membrane, which had been cut almost completely. After a tracheostomy, temporary wound closure was performed due to coagulopathy caused by hemorrhagic shock. Several hours later, a hyoidothyroidopexy was performed. Damage control surgery was applied to this patient's neck injury. The tracheostomy tube was removed postoperatively and he was discharged without complications. CONCLUSION: Damage control surgery could be an option for airway injury with blood clotting problems due to massive bleeding after securing a patent airway.

The Management of Delayed Post-Pneumonectomy Broncho-Pleural Fistula and Esophago-Pleural Fistula.

Broncho-pleural fistula (BPF) and esophago-pleural fistula (EPF) after pulmonary resection are challenging to manage. BPF is controlled by irrigation and sterilization, but such therapy is not sufficient to promote closure of EPF, which usually requires surgical management. However, it is generally difficult to select an appropriate surgical method for closure of BPF and EPF. Here, we report a case of concomitant BPF and EPF after left completion pneumonectomy, in which both fistulas were closed through a right thoracotomy.

Single incision thoracoscopic lobectomy through a 2.5 cm skin incision.

Single incision thoracoscopic surgery (SITS) involves only one intercostal space with minimal skin incision, which means it can be the most minimally invasive technique up to date. We minimized the skin incision to a length of 2.5 cm to achieve the less chest wall trauma and the more cosmesis during SITS lobectomy for benign pulmonary disease. Four patients who had bronchiectasis [left lower lobe (LLL)], congenital lobar emphysema [left upper lobe (LUL)], aspergilloma [right upper lobe (RUL)], and hamartoma (RUL) were planned to undergo 2.5 cm SITS lobectomy. There were no conversion cases to multi-port video-assisted thoracic surgery (VATS) or thoracotomy. The mean operation time was 182±25 minutes. Chest drains were removed on postoperative day (POD) 2 in all patients. Three patients discharged on POD 3. One patient who discharged on POD 5 readmitted for delayed pleural effusion and treated with mini-tube insertion. There were no late complications or symptom relapses during the median follow-up of 13.5 months. A 2.5 cm SITS lobectomy can be alternative option for relatively young patients with benign lung disease.

Outcomes of Contralateral Bullae in Primary Spontaneous Pneumothorax.

BACKGROUND: The management of contralateral bullae incidentally found in radiological studies is controversial, largely due to the unpredictability of the natural course of incidentally found contralateral bullae. This study aimed to identify the factors associated with the contralateral occurrence of primary spontaneous pneumothorax (PSP), and to characterize the outcomes of contralateral bullae incidentally found in radiological studies. METHODS: From January 2005 to December 2008, 285 patients were admitted to our institution for PSP, and the patients underwent follow-up until August 2012. The relationships between the following variables and contralateral pneumothorax occurrence were evaluated: age, sex, smoking history, body mass index, ipsilateral recurrence, ipsilateral bullae size, the number of ipsilateral bullae, contralateral bullae size, and the number of contralateral bullae. RESULTS: The study group consisted of 233 males and 29 females. The mean age and mean body index of the patients were 23.85±9.50 years and 19.63±2.50 kg/m(2). Contralateral PSP occurred in 26 patients. The five-year contralateral PSP occurrence- free survival rate was 64.3% in patients in whom contralateral bullae were found. CONCLUSION: The occurrence of contralateral PSP was associated with younger age, ipsilateral recurrence, and the presence of contralateral bullae. Contralateral PSP occurrence was more common in young patients and patients with recurrent PSP. Single-stage bilateral surgery should be considered if an operation is needed in young patients, patients with recurrent pneumothorax, and patients with contralateral bullae.

A successfully treated case of gorham-stout syndrome with sternal involvement.

Gorham-Stout Syndrome (GSS) is a rare disease characterized by localized bone resorption. Any part of the skeleton may be affected; therefore, symptoms can vary depending on the site involved. Pathological analysis reveals lymphovascular proliferation and osteolysis in the affected lesion, but the etiology of the disease is poorly understood. When GSS occurs in the chest, chylothorax or respiratory failure may occur. Thus far, a standard treatment for GSS has not been established, and the prognosis remains unknown. The following case report describes a successfully treated case of GSS in a 16-year-old boy with an affected sternum and ribs.

Recurrence of primary spontaneous pneumothorax in young adults and children.

OBJECTIVES: Although better nutritional support has improved the growth rates in children, the occurrence of primary spontaneous pneumothorax has also been increasing in children. The current study attempts to investigate the occurrence and recurrence of primary spontaneous pneumothorax and the efficacy of surgery for primary spontaneous pneumothorax in young adults and children. METHODS: A total of 840 patients were treated for pneumothorax at our hospital from January 2006 to December 2010. Exclusion criteria for this study were age >25 or secondary, traumatic or iatrogenic pneumothorax, and a total of 517 patients were included. Patients were classified into three groups according to age at the first episode of primary spontaneous pneumothorax: Group A: ≤16 years; Group B: 17-18 years and Group C: ≥19 years. RESULTS: The study group was composed of 470 male and 47 female patients. There were 234 right-sided, 279 left-sided and 4 bilateral primary spontaneous pneumothoraces. Wedge resection by video-assisted thoracic surgery was performed in 285 patients, while 232 were managed by observation or closed thoracostomy. In the wedge resection group, 51 patients experienced recurrence. The recurrence rates after wedge resection were 27.9% in Group A, 16.5% in Group B and 13.2% in Group C (P = 0.038). The recurrence rates after observation or closed thoracostomy were 45.7% in Group A, 51.9% in Group B and 47.7% in Group C (P = 0.764). CONCLUSIONS: In the present study, postoperative recurrence rates were higher than those in the literature. Intense and long-term follow-up was probably one reason for the relatively high recurrence rate. The recurrence rate after wedge resection in patients aged ≤16 years was higher than that in older patients. There was no difference between the recurrence rates after observation or closed thoracostomy, regardless of age. These results suggest that wedge resection might be delayed in children.

Immunoglobulin G4-related sclerosing disease invading the trachea and superior vena cava in mediastinum.

It is well known that immunoglobulin G4 (IgG4)-related sclerosing disease usually occurs in the pancreas, bile duct and gall bladder, but not in the mediastinum, trachea or superior vena cava (SVC). In this case, a patient underwent mediastinal mass excision and trachea resection and repair for a mediastinal and intratracheal mass 15 years ago. This mass was diagnosed postoperatively as an inflammatory pseudotumour (plasma cell granuloma). Subsequently, a mass was found to have recurred in the SVC. We performed a mass excision and innominate vein to the right atrium auricle bypass operation. The mass was diagnosed as IgG4-related sclerosing disease. This patient is now disease and recurrence free.