Biphasic clinical characteristics of mild to moderate chest trauma according to age.

PURPOSE: Mild to moderate chest trauma is a common disease, although its clinical characteristics are not well known. We investigated the clinical profiles and the early and long-term outcome of hospitalized patients with chest trauma, focusing particularly on elderly patients. METHODS: The clinical records of patients who were hospitalized in Higashisumiyoshi Morimoto Hospital for chest trauma between January 2001 and December 2004 were retrospectively reviewed. The clinical profiles, treatment methods, and outcomes were investigated. The primary endpoint was a repeat visit to the hospital for another traumatic condition after discharge, and the secondary endpoint was death. The patients were divided into two groups with respect to the age of 60 years, and differences were compared statistically. RESULTS: In all, 53 patients (34 men) were hospitalized for chest trauma in our hospital between January 2001 and December 2004. The mean age was 54.9 years (17-85 years). The distribution of age showed biphasic peaks-in the tens to twenties, and sixties to seventies. Injuries were significantly more likely to be caused by a fall in elderly patients than in younger patients (P < 0.05). The elderly patients revisited our hospital with another trauma more frequently than did the younger patients (P < 0.05). CONCLUSION: Elderly patients were likely to suffer both falls and a further traumatic condition. This probably reflects the general deterioration of physical abilities, such as lowered cognitive and somatic performances.

Comparison of the outcomes between anatomical resection and limited resection for single hepatocellular carcinomas no larger than 5 cm in diameter: a single-center study.

BACKGROUND/PURPOSE: Liver resection is a widely preferred treatment modality for hepatocellular carcinomas (HCCs). This study aimed to compare the survival impact of anatomical resection with that of limited resection, in patients with single HCCs no larger than 5 cm in diameter. METHODS: A cohort study was carried out on 209 consecutive patients who underwent hepatic resection for a single HCC no larger than 5 cm in diameter between January 1994 and March 2007 at Osaka City General Hospital. RESULTS: The cumulative 5-year overall survival and disease-free survival rates in the anatomical resection group (n = 111) were 71 and 40%, respectively, both of which were significantly better than the 48 and 25% seen in the limited resection group (n = 98) (P = 0.0043 and P = 0.0232, respectively). Better effects of the anatomical resection on both overall and disease-free survival were seen in patients having HCC larger than 2 cm in diameter and in patients with moderately or poorly differentiated HCC. But no significant difference in either overall or disease-free survival was seen between the groups in patients with a HCC 2 cm or less in diameter or in the patients with well-differentiated HCC. Using Cox's regression model, anatomical resection was confirmed to be an independent favorable factor for both overall and disease-free survival. CONCLUSIONS: Anatomical resection is therefore recommended for histologically advanced single HCCs ranging from 2 to 5 cm in diameter.

Acute respiratory failure caused by an incarcerated right-sided adult bochdalek hernia: report of a case.

We herein report the case of a 63-year-old woman with a right-sided Bochdalek hernia. She was admitted to our hospital as an emergency patient with dyspnea and abdominal pain. A blood gas analysis showed hypoxia. A chest X-ray and computed tomography revealed a remarkable right diaphragm elevation caused by a herniation of the colon and right kidney. Under a thoracolaparotomy, a herniation of the strangulated colon and right kidney was recognized in the site of the foramen of Bochdalek, and a direct closure of the hernia opening was thus performed after repairing the location of the colon and right kidney. A right-sided Bochdalek hernia in adults is a rare clinical entity and there have been fewer than ten such cases so far reported in the world literature. This case highlights the need for a prompt diagnosis and appropriate surgical intervention.