Case Report of Efficacy of Skin Perfusion After Hyperbaric Oxygen Therapy Following Peripheral Tissue Injury due to Usage of Inotropes and Vasopressors.

Hyperbaric Oxygen Therapy (HBOT) has garnered significant attention as a therapeutic principle with potential benefits across a variety spectrum of medical conditions, ranging from wound healing and ischemic conditions to neurologic disorders and radiation-induced tissue damage. HBOT involves the administration of 100% oxygen at higher atmospheric pressures, leading to increased oxygen dissolved in bodily fluids and tissues. The elevated oxygen levels are proposed to facilitate tissue repair, reduce inflammation, and promote angiogenesis. This case report presents a compelling instance of the usefulness of HBOT in promoting skin perfusion and healing following peripheral tissue injury resulting from the administration of inotropic and vasopressor agents in septic shock patients.

Treatment of pneumothorax following acupuncture: is a closed thoracostomy necessary for a first choice of treatment modality?

BACKGROUND: Acupuncture is currently the most popular of all forms of complementary and alternative medicine, and acupuncture is not dangerous in the hands of a trained practitioner. However, complications of acupuncture including pneumothorax have been reported. OBJECTIVES: Despite the use of fine needles in acupuncture, the lung-collapsed degree of acupuncture pneumothorax is relatively high. In general, the treatment modality of acupuncture pneumothorax is closed thoracostomy with a chest tube of larger diameter. However, the treatment of acupuncture pneumothorax frequently faces controversy concerning the necessity of a standard chest drain insertion. DESIGN: This was a retrospective study from March 1994 to February 2004. SUBJECTS: Nine (9) patients were admitted due to pneumothorax following acupuncture from March 1994 to February 2004 in Hanil General Hospital, KEPCO Medical Foundation (Seoul, Republic of Korea). RESULTS: Five (5) patients had a moderate degree of pneumothoraces, while 4 patients had a severe degree of pneumothoraces. Four (4) patients were treated by closed thoracostomy with a standard chest drain and the other four patients were treated by the percutaneous chest drainage with a narrow-bore central venous catheter. One (1) patient with a mild degree of pneumothorax was treated only by nasal oxygen inhalation. One (1) patient was treated by video-assisted thoracic surgery after the closed thoracostomy due to continuous air leak. CONCLUSIONS: We treated the acupuncture pneumothorax by making a choice between the closed thoracostomy and the percutaneous chest drainage based on a smoking history and chest radiographic findings. In the absence of smoking history and pulmonary emphysema or bullae, we got favorable results, not by the closed thoracostomy but only by the percutaneous chest drainage with a narrow-bore central venous catheter.

12-year experience of spontaneous hemopneumothorax.

OBJECTIVES: Spontaneous hemopneumothorax is a rare clinical disorder that results from a torn small vessel located in adhesions between the visceral and parietal pleurae resulting from the progress of lung collapse. A large spontaneous hemopneumothorax is often life threatening, so the late recognition and delayed intervention can increase mortality rate. PATIENTS AND METHODS: From March 1994 to February 2006, a total of 983 patients were treated with spontaneous pneumothorax. Seventeen (1.7%) developed spontaneous hemopneumothorax. We analyzed many factors such as sex and age distribution, affected site, clinical symptoms, bleeding volume, causes, treatments, complications, and others. RESULTS: All 17 patients were males between the ages of 16 and 33 with the average being 19.5 years, except for 1 patient who was 60 years old. In all patients, it was the first occurrence of pneumothorax. Thirteen patients had a history of smoking (76.5%, average 8.6 pack-years). The amount of bleeding ranged from 450 to 2,900 mL (average 1,308.8 mL). Eight patients were given a homologous blood transfusion. In all patients, the cause of hemopneumothorax was a torn pleural adhesion band. All patients were treated with the closed thoracostomy; five were treated with only the closed thoracostomy, and the other 12 were treated by the thoracostomy combined with video-assisted thoracic surgery (VATS) or thoracotomy. One patient, who had had a thoracotomy, needed an exploratory thoracotomy because of a trapped lung after 1 week. CONCLUSIONS: We are reporting 17 patients with spontaneous hemopneumothorax to emphasize the following: (i) the mechanism of spontaneous hemopneumothorax, which was caused by a torn pleural adhesion band resulting from the lung collapse. The collapse was developed mainly by an air leak from ruptured bullae, and rarely by additional pressure from the outside during a drainage procedure. (ii) The importance of early recognition and prompt surgical intervention by VATS or thoracotomy. We preferred VATS to thoracotomy because it is easier to access the bleeding point near the Sibson's fascia by VATS, and it can reduce the loss of blood by relatively shorter operating time.

A Morgagni diaphragmatic hernia found after removal of mediastinal tumor.

Morgagni hernia is a disease in which the abdominal contents herniate into the thoracic cavity through a congenital parasternal defect of the diaphragm resulting from an increased intra-abdominal pressure. Obesity, pregnancy, and a history of trauma are considered predisposing factors of Morgagni hernia. However, there is slight evidence that trauma has been the factor. Moreover, Morgagni hernia related to an operation has been rarely reported. We report a case of a female patient, whose mediastinal tumor had been removed 6 months prior to her being diagnosed with postoperative Morgagni hernia. There was a satisfactory result after the repair by an upper abdominal incision.