Blunt and penetrating trauma of the thoracic aorta and aortic arch branches: an autopsy study.

BACKGROUND: Due to the highly lethal nature of trauma of the thoracic aorta and aortic arch branches (TA-AAB), autopsy studies are essential for the investigation of its epidemiologic characteristics. METHODS: The reports of 11,446 consecutive medicolegal autopsies were reviewed. Among 1,980 injury-related fatalities, 251 victims (12.7%) with 302 TA-AAB injuries were found. Several trauma variables were recorded and their relations were examined. RESULTS: Blunt TA-AAB injuries were recorded in 86.4% of the victims. They were located mainly at the aortic isthmus and distal descending thoracic aorta and were accompanied to a great extent by extrathoracic trauma. The vast majority of penetrating lacerations were located at the ascending aorta, arch, and arch branches and were mostly associated with other lethal intrathoracic injuries. All penetrating trauma victims died before reaching the hospital, whereas 5.5% of the blunt trauma victims were admitted to the hospital alive. CONCLUSION: Major differences between blunt and penetrating TA-AAB injuries were revealed, regarding their location, patterns of concomitant injuries, and victims' survival time. Patients injured in motor vehicle crashes, as opposed to various other causes of trauma, were found to have the best chances of reaching the hospital alive.

Primary desmoid tumor of the posterior mediastinum.

We describe a unique case of a de novo desmoid tumor of the posterior mediastinum in a 21-year-old nulligravida. The tumor recurred twice despite its histologically confirmed radical extirpations. Because of the aggressive local behavior of desmoid tumors and their unusual locations, which prevent wide excision margins, we favor the early consideration of adjuvant therapy.

Cardiac tamponade complicating percutaneous catheterization of subclavian vein.

Cardiac tamponade has not been reported previously as a complication of central venous pressure (CVP) monitoring catheters inserted via the percutaneous subclavian vein approach. In one patient perforation of the vein by the catheter resulted in the catheter lying free in the mediastinum. Deterioration of the patient prompeted increasing infusion of fluids through this catheter with incresing cardiac compression. Relief was obtained after a thoracotomy. Ti is suggested that this complication may be recognized in the future and corrected without thoracotomy if radiopaque dye is infused through the CVP catheter.

Direct selective myocardial revascularization by internal mammary artery-coronary vein anastomosis.

In this report, we shall describe our work with retrograde coronary perfusion, first in mongrel dogs and then in 6 patients. The left internal mammary artery (LIMA) is anastomosed to the left anterior descending coronary vein (LADV) to provide myocardial perfusion. This procedure may be of great value in the treatment of patients who are not suitable candidates for direct coronary bypass grafting, i.e., those who have diffuse atherosclerosis, with poor or no runoff of the left anterior descending coronary artery (LADA),but who have satisfactory left ventricular contraction.