Thoracoscopic evacuation of retained post-traumatic hemothorax

Post-traumatic retained hemothorax is a major risk factor for empyema thoracis leading to prolonged hospitalization, entrapped lung and a need for decortication. VATS [Video Assisted Thoracoscopy] for retained hemothorax shortens the duration of chest tube drainage and length of stay. From December 2004 to July 2009, 110 consecutive patients underwent VATS for retained or clotted hemothoraces at the Department of Thoracic Surgery, Jinnah Postgraduate Medical Centre, Karachi. Majority of the patients were males [n = 91; 82.7%]. Sixty-five patients [59.1%] underwent VATS within 6 days and 45 patients [40.9%] between 7 - 14 days of injury. In 8 patients [7.3%] VATS was abandoned for thoracotomy. Post VATS full lung expansion was achieved in 87 patients [79.0] with complete evacuation of hemothorax. Chest tubes were removed within the first week in 100 patients [90.9%]. In hemodynamically stable patients, VATS is a safe, reliable and effective technique for the evacuation of retained hemothorax. Early intervention within 6 days of injury avoids the need for a thoracotomy and is associated with a better short and long-term outcome

Clinical profile and postoperative outcome in patients with simple and complex aspergilloma of lung

To compare the clinical presentation and results of pulmonary resection in simple and complex aspergilloma of the lung. Observational study. The Department of Thoracic Surgery, Jinnah Postgraduate Medical Centre, Karachi, from January 2003 to December 2008. Fifty-one adult patients with unilateral aspergilloma lung were included in this study. Patients were divided into two groups: A [simple aspergilloma-SA, n=14] and B [complex aspergilloma-CA, n=37], based on the radiological and operative characteristics of the cavitatory lesion and the presence or absence of extensive adhesions with the chest wall. Suitability for resection was assessed with arterial gases, pulmonary function tests and echocardiogram. Results were compared using Fishers exact test. Recurrent hemoptysis was the predominant symptom in both the groups. Exertional dyspnea [A=21.4%; B=56.8%; p=0.03], chest pain [A=21.4%; B=59.5%; p=0.027], cough [A=35.7%; B=70.3%; p <0.05] and postoperative complications like residual pleural space A=14.2%; B=54%; p=0.013] and pleural collection [A=7.1%; B=37.8%; p=0.041] were predominant in group B. Lobectomy was the most common procedure performed in group B [A=28.6%; B=59.5%], while wedge excision was performed in the majority of patients in group A [A=42.9%; B=29.7%]. Recurrence of aspergilloma was seen in 3 patients [8.1%] in group B only. Total number of early and late complications in SA and CA were 7, and 60, respectively. Early mortality was 8.1% and 0.0% in group A and group B, respectively [p=0.552]. The overall mortality was 5.4%. Symptoms were more frequently associated with CA as compared to SA. Surgery for CA was associated with low mortality but significant morbidity, whereas SA had low postoperative morbidity and no mortality

Role of urgent thoracotomy in improving the survival of patients with severe chest trauma

To determine the frequency of survival in patients with thoracic trauma, undergoing Urgent Thoracotomy [UT]. Quasi-experimental study. The study was carried out in the Department of Thoracic Surgery, JPMC, Karachi, from January 2005 to June 2007 [30 months]. Fifty two patients, who presented with chest trauma and underwent UT within 48 hours of sustaining thoracic trauma, were included in the study. All patients were assessed by history, physical examination and relevant investigations. A total of 475 patients with acute thoracic trauma needing admission during the study period presented to the Accidents and Emergency Department. Fifty-two [52/475; 10.9%] patients were indicated for UT. The most common indication for UT was massive hemothorax [43/52; 82.6%]. The mean age of the patients was 34.36 +/- 11.02 years. There were 22 [42.2%] blunt injuries and 30 [57.8%] penetrating injuries. Road Traffic Accidents [RTA] were the most frequent cause of blunt chest injuries [15 patients; 75%], while firearm injury was the commonest [21 patients; 70%] cause of penetrating chest trauma. Post thoracotomy mortality was 13.3% [4 out of 30] in patients with penetrating injuries and 18.2% [4 out of 22] in patients with blunt injuries [p < 0.01]. Mortality of UT was 15.3% with survival of 84.7%. Overall survival in 475 patients was 95.58%. Early recognition of treatable injuries and an aggressive approach in management with Urgent Thoracotomy can increase chances of survival of patients suffering from severe chest trauma