Repair of complex left main bronchial rupture

Complex left main bronchial rupture at or near the carina is extremely rare. This injury is frequently missed. The treatment requires surgical and anesthetic teams highly experienced with such complex injuries. We report the case of a 49-year-old man involved in a motor vehicle accident with a complex left main bronchus injury. He was successfully managed with primary repair

Blunt and penetrating thoracic trauma: management strategy and short-term outcome

To review our experience with blunt and penetrating chest injuries that required surgical interventions. Retrospective case series. Six general hospitals in Kuwait. One hundred fifty nine patients who underwent emergency surgery for thoracic trauma. Urgent thoracic surgical procedures [thoracotomy or sternotomy]. Pattern of injuries, indications for surgery, surgical approaches, short-term morbidity and mortality. One hundred fifty-nine patients [68 with blunt and 91 with penetrating injuries] underwent thoracotomy or sternotomy between January 1995 and December 2006. The mean age was 27 years [range: 2-70 years]. The causes of penetrating injuries were stab wounds [n = 65], gunshot wounds [n = 19] and iatrogenic [n = 7]. The causes of blunt thoracic injuries were motor vehicle accidents [n = 63] and fall from height [n = 5]. The indications for thoracotomy were hemorrhage [n = 115], airway disruption [n = 14], pericardial tamponade [n = 5], clotted hemothorax [n = 8] and diaphragmatic rupture [n = 17]. Major lung resections were performed in four patients [2.5%]. The morbidity was 10 / 159 [6%] and the mortality was 7 / 159 [4.4%]. The majority of deaths were due to adult respiratory distress syndrome [ARDS]. Prompt thoracotomy can be performed with minimal morbidity and mortality in cases of blunt and penetrating thoracic injuries. The complex pattern of such injuries requires a detailed assessment and management by a thoracic surgeon

Right-sided pericardio-diaphragmatic rupture with complete liver and partial heart herniation after blunt trauma

Rupture of the diaphragm and pericardium is an uncommon injury, most frequently caused by high velocity trauma. We present a rare case of right-sided pericardio-diaphragmatic rupture [PDR] with complete herniation of the liver which prevented the complete herniation of the heart. Diagnostic pitfalls and possible mistakes in the treatment strategy are discussed

Effect of the developmental stage and thawing temperature on the survival and development of the vitrified embryos

The best developmental stage and the best thawing protocol suitable for cryopreservation of the early embryos are not well documented. The present study aimed at evaluating the effect of the ultra rapid cryopreservation [vitrification] technique, followed by slow or fast thawing protocol, on the fertilized ova, 4-cell embryos and morula. The vitrification method included equilibrating the ova in the vitrification solution [EFS40; consisted of 40% ethylene glycol, 30% Ficoll, 0.5 M sucrose in D-PBS] for 2 minutes before immersion in liquid nitrogen. Slow and fast thawing were done and the cryoprotectants were withdrawn by a hyperosmolar sucrose solution, which was then gradually diluted and replaced by culture medium. The best results were obtained with vitrification of the 4-cell embryos both with slow and fast thawing, which gave survival rate of 86% and 94%, and in vitro development rate of 74% and 80%, respectively. Fast thawing showed better survival rates [80%, 94%, 77%] and better in vitro development rates [60%, 80%, 63%] than those of slow thawing, following vitrification of the fertilized ova, 4-cell embryos and morula, respectively. These criteria of vitrification/ thawing could be inferred to the human 4-cell embryos in the IVF protocol

Subtotal versus total abdominal hysterectomy

To study subtotal compared to total hysterectomy. Retrospective, comparative analysis. King Abdulaziz University Hospital. Consecutive forty four patients undergoing subtotal and ninety patients undergoing total abdominal hysterectomy for benign indications were included in this study. Patients were subjected to either subtotal or total abdominal hysterectomy according to anticipated technical difficulty providing that all previous cervical smears had been normal. Main outcome measures: Various intra-operative and post-operative variables, hospital stay, urinary and sexual morbidity. A total of 134 patients were studied. Menorrhagia was the dominant indication for surgery in 89.5 percent, dysmenorrhoea was present in 38.7 percent followed by pelvic and back pain in 35.8 percent. Fibroids were present in 58.2 percent of patients. There was no statistically significant difference in the intra or post-operative complication rate except for wound bruising which was a more significant event in total than subtotal hysterectomy. There was no statistically significant change in urinary frequency and nocturia in both groups. A significant improvement in the symptoms of dyspareunia, coital desire and frequency was observed in the total, but not so in the subtotal hysterectomy group. This study demonstrated a better overall sexual outcome in total abdominal hysterectomy but no significant difference in urinary symptoms with both types. Large controlled prospective studies are awaited to identify the logical more subtle symptomatic advantages of subtotal over total abdominal hysterectomy

Video-assisted thoracoscopy versus thoracotomy for primary spontaneous pneumothorax: a Randomized controlled trial

Video-assisted thoracic surgery has been evaluated to replace thoracotomy for recurrent or persistent spontaneous pneumothorax. This study aimed to compare the clinical results and long-term follow-up of both procedures in treating primary spontaneous pneumothorax. In a prospective comparison, all 60 patients aged 14-57 years with recurrent or persistent primary spontaneous pneumothorax seen at the Chest Diseases Hospital in Kuwait were randomly allocated to treatment by video-assisted surgery or thoracotomy. Subsequently various factors were analysed and compared in both groups, and the follow-up of both procedures was 3 years. The mean and standard deviation [SD] operating time was longer in the thoracotomy group [95.3 +/- 16.4 min] than in those undergoing video-assisted thoracoscopy [77.5 +/- 13.7 min; p < 0.0001]. The mean +/- SD amount of analgesics [Demerol] used in the first 12 h postoperatively was 67.16 +/- 27.1 mg in the video-assisted thoracoscopy group and 148.3 +/- 24.5 mg in the thoracotomy group [p < 0.0001]. The mean 24-hour chest tube drainage was less in the video-assisted thoracoscopy group than in the thoracotomy group [82 vs. 347.1 ml; p < 0.0001]. The mean duration of intercostal chest tube was 4.1 days in the thoracoscopy group and 5 days in the thoracotomy group [p = 0.18]. The length of hospital stay was shorter in the thoracoscopy group than in the thoracotomy group [6.5 vs. 10.7 days; p < 0.0001]. After a follow-up of 3 years, the number of recurrences was 3 in the thoracoscopy group and none in the thoracotomy group. Video-assisted thoracoscopy has many clinical advantages over thoracotomy for recurrent or persistent primary spontaneous pneumothorax; but it results in a higher recurrence rate. The future role of video-assisted thoracoscopic surgery in this disease remains to be determined by a larger study