MULTIDETECTOR COMPUTED TOMOGRAPHY IN BLUNT CHEST TRAUMA SINGLE TERTIARY CARE TRAUMA CENTRE EXPERIENCE.

Thoracic injuries are significant causes of morbidity and mortality in trauma patients, second only to head injuries. In addition to conventional radiography, multidetector computed tomography (CT) is increasingly being used, since it can quickly and accurately help diagnose a wide variety of injuries in trauma patients. Furthermore, multiplanar and MiNIP, volumetric reformatted CT images provide improved visualization of injuries, increased understanding of trauma-related diseases, and enhanced communication between the radiologist and the referring clinician. To identify and accurately a Aims: ssess variety of injuries in blunt thoracic trauma with multidetector Computed Tomography (MDCT). To find commonest pattern of intrathoracic injury related to blunt chest trauma. This Method: retrospective observational study included 50 patients who underwent Multidetector CT examination during the period from November 2020 to April 2021 at tertiary care trauma centre, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai. Blunt chest Conclusion: trauma injuries were classified into pleural injury, lung parenchymal injury, bony thorax, tracheobronchial and vascular injuries. The commonest injury detected was pleural (70%) followed by lung parenchymal injury (52%) and bony thorax injury in 50% cases. 50% of the pleural injury cases were associated with rib fractures. Multiple injuries were seen in the 47 patients, stating the importance of a detail evaluation of all chest components. No oesophageal and cardiac injury was detected in our CT studies' with its multiplanar, MinIP and volume reconstruction images increases the confidence in imaging diagnosis and play a critical role in understanding thoracic trauma related complications.

Hallazgos tomográficos posoperatorios en pacientes con traumatismos torácicos / Tomographic postoperative findings in patients with thoracic trauma

Introducción: El trauma torácico se encuentra entre las primeras causas de muerte, fundamentalmente en personas jóvenes. Objetivos: Caracterizar a una población operada por traumatismos torácicos según variables clinicoepidemiológicas y describir los hallazgos tomográficos posquirúrgicos. Métodos: Se llevó a cabo un estudio observacional y descriptivo de 48 pacientes atendidos en el Servicio de Radiología del Provincial Clínico-Quirúrgico Docente Saturnino Lora de Santiago de Cuba, de enero del 2016 a diciembre del 2018, a los cuales se les realizó tomografía computarizada multidetector. Resultados: Los traumas torácicos predominaron en personas jóvenes del sexo masculino, asociadas fundamentalmente a acciones violentas que provocaron traumas abiertos. La contusión pulmonar resultó ser el hallazgo tomográfico inicial más frecuente, en tanto, el neumotórax persistente y el hemotórax coagulado constituyeron los hallazgos tomográficos más influyentes en la decisión de una reintervención quirúrgica. Conclusiones: La tomografía es un medio diagnóstico que permite una descripción detallada del estado posoperatorio de los órganos afectados, con un alto valor orientativo para decidir procedimientos quirúrgicos posteriores.

Introduction: The thoracic trauma is among the first causes of death, fundamentally in young people. Objectives: To characterize a population operated due to thoracic trauma according to clinical epidemiological variables and describe the postsurgical tomographic findings. Methods: An observational and descriptive study of 48 patients assisted in the Radiology Service of Saturnino Lora Teaching Clinical Surgical Provincial Hospital was carried out in Santiago de Cuba, from January, 2016 to December, 2018, to whom a multidetector computed tomography was carried out. Results: The thoracic traumas prevailed in young male people, fundamentally associated with violent actions that caused open traumas. The lung contusion was the most frequent initial tomographic finding, as long as, the persistent pneumothorax and the coagulated hemothorax constituted the most influential tomographic findings in the decision of a surgical reintervention. Conclusions: Tomography is a diagnostic means that allows a detailed description of the postoperative state in the affected organs, with a high orientative value to decide later surgical procedures.

Thoracolumbar burst fracture: From injury causes to clinical symptoms / 第二军医大学学报

ObjectiveTo analyze the relationship between the factors causing thoracolumbar burst fracture and the corresponding clinical manifestations, so as to improve the early warning and diagnosis of thoracolumbar burst fracture, reduce the misdiagnosis and missed diagnosis, and improve the success rate of first aid. MethodsThe clinical data of thoracolumbar burst fractures treated in the Intensive Care Unit of Depretment of Emergency of our hospital from Jan. 2009 to Dec. 2018 were retrospectively analyzed. The clinical data, including age, sex, hospital duration, causes, complications, discharge, and prognosis, were analyzed retrospectively. Results A total of 83 patients with thoracolumbar burst fracture, including 69 males (83.13%) and 14 females (16.87%), were selected for this study. The average age was (44.64±15.26) years. The causes of the injury included: High falling injury (53 cases, 63.86%), traffic accident injury (17 cases, 20.48%), and heavy object injury (12 cases, 14.46%). There were 31 cases (37.35%) of craniocerebral injury, 53 cases (63.86%) of chest injury, 37 cases (44.58%) of abdominal injury, 44 cases (53.01%) of other fracture. Among the 53 cases of chest injury, there were 19 cases (35.85%) with hemopneumothorax, 13 cases (13.21%) with simple hemothorax, 7 cases (24.53%) with simple pneumothorax, 8 cases (15.09%) with mediastinal hemorrhage, 7 cases (13.21%) with mediastinal emphysema, 11 cases (20.75%) with flail chest, and 5 cases (9.43%) with diaphragmatic hernia. Among 37 cases of abdominal injuries, there were 8 cases (21.62%) with rupture of spleen, 3 cases (8.11%) with subcapsule hematomas, and 4 cases (10.81%) with simultaneous injury of liver and spleen. The missed diagnoses at the initial diagnosis included: 5 cases (100.00%) of diaphragmatic hernia, 5 cases (62.50%) of mediastinal hemorrhage, 4 cases (57.14%) of mediastinal emphysema, 2 cases (18.18%) of flail chest, and 2 cases (15.38%) of simple hemothorax. Missed diagnosis rate of the other complications were all under 10.00%. The main complications were bronchopneumonia (37 cases, 44.58%) and traumatic hemorrhagic shock (17 cases, 20.48%). There were 8 cases (9.64%) complicated with multiple organ dysfunction syndrome (MODS), with more than 3 systems involved. There were 39 patients (46.99%) had paraplegia and 3 cases (3.61%) died at discharge. ConclusionThoracolumbar burst fractures are more common in young and middle-aged men, with high falling being the primary cause and hemopneumothorax being the main clinical manifestation. Diaphragmatic hernia, mediastinal hemorrhage and mediastinal emphysema are easy to have missed diagnosis. Nearly 50% patients have traumatic paraplegia, which is worthy of attention and in-depth study.

Clinical Observation of Posterior Pituitary Injection Combined with Ulinastatin for Injection in the Treat-ment of Severe Lung Contusion / 中国药房

OBJECTIVE:To investigate the therapeutic efficacy and safety of Posterior pituitary injection combined with Ulina-station for injection in the treatment of severe lung contusion. METHODS:In retrospective study,60 patients with severe lung con-tusion in our hospital from Jan. 2015 to May 2016 were divided into control group and observation group according to therapy plan,with 30 cases in each group. Control group was given Ulinastation for injection 100 thousand U+0.9% Sodium chloride injec-tion 100 mL,ivgtt,bid. Observation group was additionally given Posterior pituitary injection 6 U+0.9% Sodium chloride injection 49 mL,intravenous pumping (initial rate was 0.008 U/min,adjusted to ≤0.04 U/min),bid,on the basis of control group. Both groups were treated for 1 week. The respiratory frequency,simple score of pulmonary contusion,chest X-ray score,the levels of arterial blood gas indexes(PaO2,PaCO2,SaO2,PO2/FiO2)and inflammation indexes(IL-2,IL-6,IL-10,hs-CRP,TNF-α)before and after treatment as well as clinical efficacy were observed in 2 groups. The occurrence of ADR was recorded. RESULTS:Before treatment,there was no statistical significance in respiratory frequency,simple score of pulmonary contusion,chest X-ray score, the levels of arterial blood gas index or inflammation indexes between 2 groups(P>0.05). After treatment,respiratory frequency, simple score of pulmonary contusion,chest X-ray score,and the levels of IL-6,hs-CRP,TNF-αin 2 groups were decreased signif-icantly,and the observation group was significantly lower than the control group,with statistical significance(P<0.05). The lev-els of PaO2,PaCO2,SaO2,PO2/FiO2,IL-2 and IL-10 in 2 groups were increased significantly,and the observation group was sig-nificantly higher than the control group,with statistical significance (P<0.05). Total response rate of observation group (100%) was significantly higher than that of control group(86.67%),with statistical significance(P<0.05). The incidence of ADR in con-trol group(13.33%)was significantly higher than observation group(6.67%),with statistical significance(P<0.05). CONCLU-SIONS:Posterior pituitary injection combined with Ulinastatin for injection show good therapeutic efficacy for severe lung contu-sion and effectively inhibit inflammatory reaction with good safety.