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1.
Rev. colomb. cir ; 36(3): 540-544, 20210000. fig
Article in English | LILACS | ID: biblio-1254390

ABSTRACT

Introduction. Chest trauma is one of the most common causes of death corresponding to 20 to 25 % of cases. The majority of the patients (85%), can be managed with only a tube thoracostomy. Our objective by presenting this case report is to provide an example of how to manage a challenging chest tube thoracostomy in a patient with cardiac hernia diagnosed in the preoperative phase, based on signs of computed tomography. Case report. A 45-year-old male presented to our emergency department who fell from a light pole 7 meters high. He fell to the ground on his back. Physical examination revealed a huge subcutaneous emphysema on his entire anterior chest wall and presented no sensitivity or movements below the navel line. After the initial assessment and management care, the patient improved. As the patient stabilized we decided to go to CT. The scan revealed pericardial rupture with only the right pericardial circumference intact, the heart herniated into the left pleural space, bilateral pneumothorax, small right hemothorax and a relevant subcutaneous emphysema surrounding the chest. We decided to perform the blunt dissection technique to insert chest tubes bilaterally because of safety. After performed it the patient was transferred to cardiothoracic department. Discussion. There is a variety of techniques to perform tube thoracostomy but the blunt dissection remain the safer, especially when we are facing an anatomic distortion of the heart. Conclusion. We present a case report of a challenging thoracic drainage performed in a patient with traumatic cardiac hernia, which procedure was successful


Introducción. El traumatismo torácico es una de las causas más comunes de muerte y corresponde al 20 a 25 % de los casos. La mayoría de los pacientes (85 %) pueden tratarse solo con toracostomía. Nuestro objetivo al presentar este informe de caso es proporcionar un ejemplo de cómo manejar una toracostomía desafiante en un paciente con hernia cardíaca, diagnosticada en la fase preoperatoria, basada en signos de tomografía computarizada. Presentación del caso. Paciente masculino de 45 años que ingresa a nuestro departamento de emergencias luego de caída de 7 metros de altura (poste de luz), cayendo de espaldas al suelo. El examen físico reveló un enfisema subcutáneo importante en todo el tórax anterior y sin sensibilidad ni movimientos debajo de la línea del ombligo. Después de la evaluación y atención inicial el paciente mejoró y se decidió realizar una tomografía computarizada que reveló la rotura pericárdica, con solo la circunferencia pericárdica derecha intacta, el corazón herniado en el espacio pleural izquierdo, neumotórax bilateral, pequeño hemotórax en el lado derecho y enfisema subcutáneo rodeando completamente el tórax. Se escogió una técnica de disección roma para insertar el tubo torácico en ambos hemitórax, debido a su mayor seguridad. Posteriormente, el paciente fue trasladado al departamento de cirugía cardiotorácica. Discusión. Existe una variedad de técnicas para realizar una toracostomía con sonda, pero la disección roma sigue siendo la más segura, especialmente cuando enfrentamos una distorsión anatómica del corazón. Conclusión. Presentamos el caso de un drenaje torácico desafiante practicado a un paciente con hernia cardíaca traumática, con éxito.


Subject(s)
Humans , Thoracic Injuries , Heart Injuries , Wounds, Nonpenetrating , Thoracostomy , Chest Tubes , Myocardial Contusions
2.
Rev. colomb. anestesiol ; 48(4): e401, Oct.-Dec. 2020. tab, graf
Article in English | LILACS, COLNAL | ID: biblio-1144319

ABSTRACT

Abstract Introduction The use of extracorporeal membrane oxygenation (ECMO) has increased exponentially in recent years and has shown to be effective in treating adult respiratory distress syndrome (ARDS) secondary to HiNi-related pneumonia. However, evidence remains controversial. This study describes a case series of ECMO in ARDS secondary to viral pneumonia. Methods A search was conducted in the ECMO database of Fundación Cardiovascular de Colombia for the 20132017 period. A case series report was written of patients diagnosed with ARDS secondary to confirmed or suspected viral pneumonia. Results Nineteen patients with ECMO support and ARDS due to viral pneumonia were included in the study. The survival rate upon discharge was 11 patients (58%) and weaning from ECMO support was successful in 13 patients (68%). Hemorrhagic complications were the most frequent: gastrointestinal bleeding, 10 patients (53%); intracranial bleeding, 2 (10%); alveolar hemorrhage, 2 (10%);' hemothorax requiring thoracostomy with chest tube drainage, 2 (10%); cannulation site bleeding, 9 patients (47%); and surgical site bleeding in 3 patients (25%) who required tracheostomy. Other complications were: pneumothorax, 1 patient (5%); sepsis, 6 patients (32%); and growth of microorganisms in bronchial lavage, 6 patients (32%). Conclusions This study supports the use of veno-venous ECMO to achieve a higher survival rate than expected in patients with severe ARDS and refractory hypoxemia secondary to viral pneumonia. Early initiation of the therapy should improve overall results.


Resumen Introducción El uso de la oxigenación por membrana extracorpórea (ECMO) ha tenido un incremento exponencial en los últimos años y ha demostrado ser efectivo en el manejo del síndrome de dificultad respiratoria del adulto (SDRA) secundario a neumonía por H1N1, si bien la evidencia sigue siendo controvertida. En este estudio describimos una serie de casos de ECMO por SDRA secundario a neumonía viral. Métodos Se realizó una búsqueda en la base de datos de ECMO de la Fundación Cardiovascular desde el año 20132017. Reportamos una serie de casos donde se incluyeron pacientes diagnosticados con SDRA secundario a neumonía viral sospechosa o confirmada. Resultados Se incluyeron en el estudio 19 pacientes con soporte de ECMO y SDRA por neumonía viral. La sobrevida al alta fue 11 pacientes (58%) y el destete del ECMO fue exitoso en 13 pacientes (68%). Las complicaciones hemorrágicas presentadas fueron: sangrado digestivo, 10 pacientes (53%), sangrado cerebral, 2 (10%), hemorragia alveolar, 2 (10%), hemotórax con requerimiento de toracostomía a drenaje cerrado, 2 (10%), sangrado activo por sitio de canulación, 9 pacientes (53%), y 3 pacientes traqueostomizados (25%) que sangraron por el sitio quirúrgico. Otras complicaciones presentadas fueron: neumotórax, 1 paciente (5%), septicemia, 6 (32%) y crecimiento de microorganismos en lavados bronquiales 6 (32%). Conclusion El presente estudio permite indicar que el uso de la ECMO VV viabiliza una sobrevida mayor a la esperada en pacientes con SDRA severo e hipoxemia refractaria secundario a neumonía viral. Su inicio tempranamente debe mejorar los resultados globales.


Subject(s)
Humans , Male , Female , Middle Aged , Pneumonia, Viral , Poisons , Respiratory Distress Syndrome, Newborn , Extracorporeal Membrane Oxygenation , Chest Tubes , Hemothorax , Pneumothorax , Thoracostomy , Tracheostomy , Catheterization , Survival Rate , Sepsis , Bronchoalveolar Lavage , Influenza A Virus, H1N1 Subtype
3.
Rev Assoc Med Bras (1992) ; 66(Suppl 2): 102-105, 2020. graf
Article in English | LILACS, SES-SP | ID: biblio-1136401

ABSTRACT

SUMMARY INTRODUCTION What has been published so far regarding safe methods to deal with chest tube insertion during COVID-19. METHODS A descriptive study of the literature available in the Medline/PubMed, Lilacs, Scopus databases and specialized books. The search was carried out using the terms "infectious diseases"; "COVID-19"; "Chest tubes". RESULTS This paper aggregates and consolidates some old concepts to new tactics to minimize the contamination of teams who deal with chest tubes, before, during, and after the procedure. CONCLUSIONS Health officials are under increasing pressure to control the spread of COVID-19, which is a very virulent disease. Our analysis brought together old rules against contamination along with new tactics for professionals who deal with chest drains in order to minimize the contamination of teams during the Pandemic.


Subject(s)
Humans , Pneumonia, Viral/prevention & control , Chest Tubes/adverse effects , Infectious Disease Transmission, Professional-to-Patient/prevention & control , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Coronavirus Infections/prevention & control , Personal Protective Equipment , Pneumonia, Viral/epidemiology , Coronavirus Infections , Coronavirus Infections/epidemiology , Pandemics , Betacoronavirus
4.
Einstein (Säo Paulo) ; 18: eAO4409, 2020. tab, graf
Article in English | LILACS | ID: biblio-1039728

ABSTRACT

ABSTRACT Objective To compare the chest tube drainage by the same thoracotomy intercostal space with the traditional approach in patients undergoing muscle-sparing thoracotomy. Methods We evaluated 40 patients aged ≥18 years who underwent elective muscle sparing thoracotomies. Patients were divided into two groups of 20 patients. One group underwent thoracic drainage by the same intercostal space of thoracotomy and the other by traditional chest drainage approach. Results The mean length of hospital stay for the intercostal drainage group in the intensive care unit was 1.5 day (1.0 to 2.0 days) and 2.0 days (25.1 to 3.0 days) for the traditional chest drainage group (p=0.060). The intercostal drainage group had mean length of hospital stay (p=0.527) and drainage (p=0.547) of 4 days, and the traditional chest drainage group and 2 and 5.5 days, respectively. Dipirona and tramadol doses did not differ between groups (p=0.201 and p=0.341). The mean pain scale values on first postoperative was 4.24 in the drainage by the same intercostal group and 3.95 in the traditional chest drainage (p=0.733). In third postoperative day, mean was 3.18 for the first group and 3.11 for the traditional group (p=0.937). In the 15th day after surgery, drainage by the incision was 1.53 and the traditional chest drainage was 2.11 (p=0.440), 30th days after drainage by incision was 0.71 and traditional chest drainage was 0.84 (p=0.787). Complications, for both groups were similar with 30% in proposed drainage and 25% in traditional approach (p=0.723). Conclusion Drainage by the same thoracotomy intercostal space was feasible and results 30 days after surgery were not inferior to those of the traditional chest drainage approach.


RESUMO Objetivo Comparar a drenagem torácica pela mesma intercostotomia à drenagem tradicional em pacientes submetidos à toracotomia poupadora lateral. Métodos Foram avaliados 40 pacientes maiores de 18 anos submetidos a toracotomias poupadoras laterais eletivas. Eles foram separados em dois grupos de 20 pacientes cada, sendo um submetido à drenagem torácica pelo mesmo espaço intercostal da toracotomia e o outro à drenagem tradicional. Resultados No grupo da drenagem pela mesma intercostotomia, a mediana de tempo de internação em unidade de terapia intensiva foi de 1,5 dia (1,0 a 2,0 dias) e de 2,0 dias (1,25 a 3,0 dias) na drenagem tradicional (p=0,060). As medianas do tempo de internação (p=0,527) e de drenagem (p=0,547) foram ambas de 4 dias, no primeiro grupo, e de 2 e 5,5 dias, no grupo com drenagem tradicional. As doses utilizadas de dipirona e de tramadol não apresentaram diferenças estatísticas entre os grupos (p=0,201 e p=0,341). As médias da escala de dor foram 4,24 no primeiro dia pós-operatório do grupo com a drenagem proposta e 3,95 nos drenados da forma tradicional (p=0,733); no terceiro pós-operatório, foi de 3,18 para o grupo drenado pela incisão e de 3,11 nos drenados da forma tradicional (p=0,937). No 15º dia após a cirurgia, a drenagem pela incisão foi de 1,53 e a tradicional de 2,11 (p=0,440); no 30º pós-operatório, foi de 0,71 e 0,84, respectivamente, para a incisão e a forma tradicional (p=0,787). Em relação às complicações, os grupos foram semelhantes, com 30% na drenagem proposta e 25% na drenagem tradicional (p=0,723). Conclusão A drenagem pelo mesmo espaço intercostal foi exequível e não apresentou inferioridade à técnica tradicional no período pós-operatório estudado de 30 dias.


Subject(s)
Humans , Thoracotomy/methods , Chest Tubes , Drainage/methods , Pain, Postoperative/drug therapy , Postoperative Period , Atrial Fibrillation/etiology , Tramadol/therapeutic use , Pain Measurement , Thoracotomy/adverse effects , Analgesia, Epidural , Drainage/statistics & numerical data , Dipyrone/therapeutic use , Prospective Studies , Dyspnea/etiology , Analgesics/therapeutic use , Length of Stay
5.
Rev. gastroenterol. Perú ; 39(1): 64-69, ene.-mar. 2019. ilus
Article in Spanish | LILACS | ID: biblio-1014127

ABSTRACT

El hidrotórax hepático (HH) se define como un derrame pleural mayor de 500 ml en pacientes con cirrosis e hipertensión portal. Representa una complicación infrecuente por lo general asociada con ascitis y su origen se relaciona con el paso de líquido ascítico a través de pequeños defectos en el diafragma de predominio en el hemitórax derecho. Una vez establecido el diagnóstico por imágenes, la toracentesis diagnostica permite confirmar un trasudado. La terapia inicial está basada en la restricción de sodio y el uso combinado de diuréticos. El 20-25% de los pacientes desarrolla un HH refractario, el cual requiere intervenciones invasivas tales como la derivación percutánea portosistémica intrahepática (DPPI), la reparación de los defectos diafragmáticos por videotoracoscopia asistida asociada a pleurodésis química y el uso de un catéter pleural tunelizado. No se recomienda la inserción de un tubo de tórax por su elevada morbilidad y mortalidad. El tratamiento definitivo del HH es el trasplante hepático el cual alcanza una excelente sobrevida. Presentamos tres casos de hidrotórax hepático con diferentes enfoques terapéuticos que incluyeron el manejo conservador con dieta y diuréticos, la inserción fallida de un tubo de tórax con pleurodesis y una DPPI.


Hepatic hydrothorax is uncommon transudative pleural effusion greater than 500 ml in association with cirrhosis and portal hypertension. Ascites is also present in most of the patients and the pathophysiology include the passage of ascites fluid through small diaphragmatic defects. After diagnostic thoracentesis studies, the first line management is restricting sodium intake and diuretics combination including stepwise dose of spironolactone plus furosemide. Therapeutic thoracentesis is a simple and effective procedure to relief dyspnea. Hepatic hydrothorax is refractory in approximately 20-25% and treatments options include repeated thoracentesis, transjugular intrahepatic portosystemic shunts (TIPS) placement, chemical pleurodesis with repair diaphragmatic defects using video-assisted thoracoscopy surgery (VATS), and insertion of an indwelling pleural catheter. Chest tube insertion carries significant morbidity and mortality with questionable benefit. Hepatic transplantation remains the best treatment option with long term survival. We present three cases of hepatic hydrothorax with different therapeutic approach including first line management, failed chest tube insertion and TIPS placement.


Subject(s)
Aged , Female , Humans , Middle Aged , Hydrothorax/therapy , Pleural Effusion/therapy , Ascites/therapy , Chest Tubes , Liver Transplantation , Hepatitis C/complications , Combined Modality Therapy , Pleurodesis , Portasystemic Shunt, Transjugular Intrahepatic , Metabolic Syndrome/complications , Diuretics/therapeutic use , Thoracentesis , Conservative Treatment , Hydrothorax/surgery , Hydrothorax/etiology , Hypertension, Portal/complications , Liver Cirrhosis/complications
6.
Article in English | WPRIM | ID: wpr-741394

ABSTRACT

OBJECTIVE: To analyze the complications of percutaneous transthoracic needle biopsy using CT-based imaging modalities for needle guidance in comparison with fluoroscopy in a large retrospective cohort. MATERIALS AND METHODS: This study was approved by multiple Institutional Review Boards and the requirement for informed consent was waived. We retrospectively included 10568 biopsies from eight referral hospitals from 2010 through 2014. In univariate and multivariate logistic analyses, 3 CT-based guidance modalities (CT, CT fluoroscopy, and cone-beam CT) were compared with fluoroscopy in terms of the risk of pneumothorax, pneumothorax requiring chest tube insertion, and hemoptysis, with adjustment for other risk factors. RESULTS: Pneumothorax occurred in 2298 of the 10568 biopsies (21.7%). Tube insertion was required after 316 biopsies (3.0%), and hemoptysis occurred in 550 cases (5.2%). In the multivariate analysis, pneumothorax was more frequently detected with CT {odds ratio (OR), 2.752 (95% confidence interval [CI], 2.325–3.258), p < 0.001}, CT fluoroscopy (OR, 1.440 [95% CI, 1.176–1.762], p < 0.001), and cone-beam CT (OR, 2.906 [95% CI, 2.235–3.779], p < 0.001), but no significant relationship was found for pneumothorax requiring chest tube insertion (p = 0.497, p = 0.222, and p = 0.216, respectively). The incidence of hemoptysis was significantly lower under CT (OR, 0.348 [95% CI, 0.247–0.491], p < 0.001), CT fluoroscopy (OR, 0.594 [95% CI, 0.419–0.843], p = 0.004), and cone-beam CT (OR, 0.479 [95% CI, 0.317–0.724], p < 0.001) guidance. CONCLUSION: Hemoptysis occurred less frequently with CT-based guidance modalities in comparison with fluoroscopy. Although pneumothorax requiring chest tube insertion showed a similar incidence, pneumothorax was more frequently detected using CT-based guidance modalities.


Subject(s)
Biopsy , Biopsy, Needle , Chest Tubes , Cohort Studies , Cone-Beam Computed Tomography , Ethics Committees, Research , Fluoroscopy , Hemoptysis , Image-Guided Biopsy , Incidence , Informed Consent , Lung Neoplasms , Multivariate Analysis , Needles , Pneumothorax , Referral and Consultation , Retrospective Studies , Risk Factors
7.
Article in Korean | WPRIM | ID: wpr-719520

ABSTRACT

PURPOSE: Noninvasive positive pressure ventilation (NIPPV) is one of the ventilation-supporting methods by providing adequate exogenous pressure without intubation or tracheostomy. We aimed to assess the frequency and clinical factors for pneumothorax occurring during NIPPV application in a tertiary children's hospital. METHODS: We selected cases of pneumothorax related to NIPPV by keyword searching in our institution's clinical data warehouse, and their medical records were retrospectively reviewed. RESULTS: During a period of 17 years, 15 cases undergoing NIPPV developed pneumothorax, which was an incidence of 0.64% (15 of 2,343). There were 9 neonates and 6 adolescents. In 9 neonates, pneumothorax was caused by the continuous positive airway pressure (CPAP) ventilator, and occurred on 2 days after birth (median, range 1–3 days). In neonates, pneumothorax developed within 36 hours after CPAP application. One neonate underwent tracheal intubation and 3 neonates underwent chest tube insertion. In the postteenager group, pneumothorax developed 23 months (median, range 5 days to 47 months) after NIPPV application with a mask. All of the 6 patients had underlying neuromuscular disorders and one had superimposed interstitial lung disease. One of the 7 cases underwent surgical treatment and 4 cases were intubated. One case died from the deterioration of underlying interstitial lung disease. CONCLUSION: Although it rarely happens, the NIPPV can result in pneumothorax. In most cases, it can be resolved by supportive cares with oxygen or chest tube with or without tracheostomy. The prognosis is related to the type of underlying disease and its progression.


Subject(s)
Adolescent , Chest Tubes , Continuous Positive Airway Pressure , Humans , Incidence , Infant, Newborn , Intubation , Lung Diseases, Interstitial , Masks , Medical Records , Noninvasive Ventilation , Oxygen , Parturition , Pneumothorax , Positive-Pressure Respiration , Prognosis , Respiratory Insufficiency , Retrospective Studies , Tracheostomy , Ventilators, Mechanical
8.
Korean Circulation Journal ; : 498-510, 2019.
Article in English | WPRIM | ID: wpr-759439

ABSTRACT

BACKGROUND AND OBJECTIVES: Aspirin plays an important role in the maintenance of graft patency and the prevention of thrombotic event after coronary artery bypass graft surgery (CABG). However, the use of preoperative aspirin is still under debate due to the risk of bleeding. METHODS: From PubMed, EMBASE, and Cochrane Central Register of Controlled Trials, data were extracted by 2 independent reviewers. Meta-analysis using random effect model was performed. RESULTS: We performed a systemic meta-analysis of 17 studies (12 randomized controlled studies and 5 non-randomized registries) which compared clinical outcomes of 9,101 patients who underwent CABG with or without preoperative aspirin administration. Preoperative aspirin increased chest tube drainage (weighted mean difference 177.4 mL, 95% confidence interval [CI], 41.3–313.4; p=0.011). However, the risk of re-operation for bleeding was not different between the preoperative aspirin group and the control group (3.2% vs. 2.4%; odds ratio [OR], 1.23; 95% CI, 0.94–1.60; p=0.102). There was no difference in the rates of all-cause mortality (1.6% vs. 1.5%; OR, 0.98; 95% CI, 0.64–1.49; p=0.920) and myocardial infarction (MI) (8.7% vs. 10.4%; OR, 0.83; 95% CI, 0.66–1.04; p=0.102) between patients with and without preoperative aspirin administration. CONCLUSIONS: Although aspirin increased the amount of chest tube drainage, it was not associated with increased risk of re-operation for bleeding. In addition, the risks of early postoperative all-cause mortality and MI were not reduced by using preoperative aspirin.


Subject(s)
Aspirin , Chest Tubes , Coronary Artery Bypass , Coronary Vessels , Drainage , Hemorrhage , Humans , Mortality , Myocardial Infarction , Odds Ratio , Transplants
9.
Article in English | WPRIM | ID: wpr-765319

ABSTRACT

OBJECTIVE: Corpectomy of the first lumbar vertebra (L1) for the management of different L1 pathologies can be performed using either an anterior or posterior approach. The aim of this study was to evaluate the usefulness of a retroperitoneal extrapleural approach through the twelfth rib for performing L1 corpectomy. METHODS: Thirty consecutive patients underwent L1 corpectomy between 2010 and 2016. The retroperitoneal extrapleural approach through the 12th rib was used in all cases to perform single-stage anterior L1 corpectomy, reconstruction and anterior instrumentation, except for in two recurrent cases in which posterior fixation was added. Visual analogue scale (VAS) was used for pain intensity measurement and ASIA impairment scale for neurological assessment. The mean follow-up period was 14.5 months. RESULTS: The sample included 18 males and 12 females, and the mean age was 40.3 years. Twenty patients (67%) had sensory or motor deficits before the surgery. The pathologies encountered included traumatic fracture in 12 cases, osteoporotic fracture in four cases, tumor in eight cases and spinal infection in the remaining six cases. The surgeries were performed from the left side, except in two cases. There was significant improvement of back pain and radicular pain as recorded by VAS. One patient exhibited postoperative neurological deterioration due to bone graft dislodgement. All patients with deficits at least partially improved after the surgery. During the follow-up, no hardware failures or losses of correction were detected. CONCLUSION: The retroperitoneal extrapleural approach through the 12th rib is a feasible approach for L1 corpectomy that can combine adequate decompression of the dural sac with effective biomechanical restoration of the compromised anterior load-bearing column. It is associated with less pulmonary complication, no need for chest tube, no abdominal distention and rapid recovery compared with other approaches.


Subject(s)
Asia , Back Pain , Chest Tubes , Decompression , Female , Follow-Up Studies , Humans , Lumbar Vertebrae , Male , Osteoporotic Fractures , Pathology , Ribs , Spinal Fusion , Spine , Transplants , Weight-Bearing
10.
Article in English | WPRIM | ID: wpr-761855

ABSTRACT

BACKGROUND: Uniportal video-assisted thoracoscopic surgery (VATS) has proven safe and effective for pulmonary wedge resection and lobectomy. The objective of this study was to evaluate the safety and feasibility of uniportal VATS segmentectomy by comparing its outcomes with those of the multiportal approach at a single center. METHODS: The records of 84 patients who underwent VATS segmentectomy from August 2010 to August 2018, including 33 in the uniportal group and 51 in the multiportal group, were retrospectively reviewed and analyzed. RESULTS: Anesthesia and operative times were similar in the uniportal and multiportal groups (215 minutes vs. 220 minutes, respectively; p=0.276 and 180 minutes vs. 198 minutes, respectively; p=0.396). Blood loss was significantly lower in the uniportal group (50 mL vs. 100 mL, p=0.013) and chest tube duration and hospital stay were significantly shorter in the uniportal group (2 days vs. 3 days, p=0.003 and 4 days [range, 1–14 days] vs. 4 days [range, 1–62 days], p=0.011). The number of dissected lymph nodes tended to be lower in the uniportal group (5 vs. 8, p=0.056). CONCLUSION: Our preliminary experience indicates that uniportal VATS segmentectomy is safe and feasible in well-selected patients. A randomized, prospective study with a large group of patients and long-term follow-up is necessary to confirm these results.


Subject(s)
Anesthesia , Chest Tubes , Follow-Up Studies , Humans , Ion Transport , Length of Stay , Lymph Nodes , Mastectomy, Segmental , Operative Time , Prospective Studies , Retrospective Studies , Thoracic Surgery, Video-Assisted
11.
Article in English | WPRIM | ID: wpr-788748

ABSTRACT

OBJECTIVE: Corpectomy of the first lumbar vertebra (L1) for the management of different L1 pathologies can be performed using either an anterior or posterior approach. The aim of this study was to evaluate the usefulness of a retroperitoneal extrapleural approach through the twelfth rib for performing L1 corpectomy.METHODS: Thirty consecutive patients underwent L1 corpectomy between 2010 and 2016. The retroperitoneal extrapleural approach through the 12th rib was used in all cases to perform single-stage anterior L1 corpectomy, reconstruction and anterior instrumentation, except for in two recurrent cases in which posterior fixation was added. Visual analogue scale (VAS) was used for pain intensity measurement and ASIA impairment scale for neurological assessment. The mean follow-up period was 14.5 months.RESULTS: The sample included 18 males and 12 females, and the mean age was 40.3 years. Twenty patients (67%) had sensory or motor deficits before the surgery. The pathologies encountered included traumatic fracture in 12 cases, osteoporotic fracture in four cases, tumor in eight cases and spinal infection in the remaining six cases. The surgeries were performed from the left side, except in two cases. There was significant improvement of back pain and radicular pain as recorded by VAS. One patient exhibited postoperative neurological deterioration due to bone graft dislodgement. All patients with deficits at least partially improved after the surgery. During the follow-up, no hardware failures or losses of correction were detected.CONCLUSION: The retroperitoneal extrapleural approach through the 12th rib is a feasible approach for L1 corpectomy that can combine adequate decompression of the dural sac with effective biomechanical restoration of the compromised anterior load-bearing column. It is associated with less pulmonary complication, no need for chest tube, no abdominal distention and rapid recovery compared with other approaches.


Subject(s)
Asia , Back Pain , Chest Tubes , Decompression , Female , Follow-Up Studies , Humans , Lumbar Vertebrae , Male , Osteoporotic Fractures , Pathology , Ribs , Spinal Fusion , Spine , Transplants , Weight-Bearing
12.
Rev. Col. Bras. Cir ; 46(1): e2011, 2019. tab, graf
Article in Portuguese | LILACS | ID: biblio-976949

ABSTRACT

RESUMO Objetivo: criar, em impressora 3D, um simulador de baixo custo de caixa torácica humana que permita a reprodução da técnica de drenagem fechada de tórax (DFT) comparando sua eficácia com a do modelo animal. Métodos: foi realizada impressão 3D do arcabouço ósseo de um tórax humano a partir de uma tomografia de tórax. Após a impressão das costelas, foram realizados testes com diversos materiais que contribuíram para formar a simulação da caixa torácica e da pleura. Foi, então, realizado um estudo experimental, randomizado e controlado comparando sua eficácia ao modelo animal no ensino da DFT para estudantes de medicina, que foram divididos em dois grupos: Grupo Modelo Animal e Grupo Modelo Simulador, que treinaram DFT em animais e no modelo simulador, respectivamente. Resultados: a reconstrução do tórax exigiu o conhecimento anatômico para análise da tomografia e para edição fiel da superfície 3D. Não houve diferença significativa quanto à segurança de realizar o procedimento entre os grupos (7,61 vs. 7,73; p=0,398). Foi observada maior pontuação no grupo modelo simulador para uso como material didático e aprendizado da técnica de drenagem torácica quando comparado ao grupo modelo animal (p<0,05). Conclusão: o custo final para a confecção do modelo foi inferior ao de um simulador comercial, o que demonstra a viabilidade do uso da impressão 3D para esse fim. Além disso, o simulador desenvolvido se mostrou equivalente ao modelo animal quanto à simulação da técnica de drenagem para aprendizado prático e houve preferência pelo modelo simulador como material didático.


ABSTRACT Objective: by using a 3D printer, to create a low-cost human chest cavity simulator that allows the reproduction of the closed chest drainage technique (CCD), comparing its effectiveness with that of the animal model. Methods: it was made a 3D printing of the bony framework of a human thorax from a chest computerized tomography scan. After printing the ribs, we performed tests with several materials that contributed to form the simulation of the thoracic cavity and pleura. An experimental, randomized, and controlled study, comparing the efficacy of the simulator to the efficacy of the animal model, was then carried out in the teaching of CCD technique for medical students, who were divided into two groups: animal model group and simulator model group, that trained CCD technique in animals and in the simulator model, respectively. Results: the chest reconstruction required anatomical knowledge for tomography analysis and for faithful 3D surface editing. There was no significant difference in the safety of performing the procedure in both groups (7.61 vs. 7.73; p=0.398). A higher score was observed in the simulator model group for "use as didactic material" and "learning of the chest drainage technique", when compared to the animal model group (p<0.05). Conclusion: the final cost for producing the model was lower than that of a commercial simulator, what demonstrates the feasibility of using 3D printing for this purpose. In addition, the developed simulator was shown to be equivalent to the animal model in relation to the simulation of the drainage technique for practical learning, and there was preference for the simulator model as didactic material.


Subject(s)
Humans , Male , Female , Adult , Young Adult , Chest Tubes , Computer-Aided Design/instrumentation , Neurosurgical Procedures/education , Neurosurgical Procedures/instrumentation , Education, Medical/methods , Equipment Design/instrumentation , Simulation Training/methods , Models, Anatomic , Physicians , Students, Medical , Computer Simulation , Clinical Competence , Computer-Aided Design/economics , Neurosurgical Procedures/economics , Costs and Cost Analysis , Education, Medical/economics , Equipment Design/economics , Simulation Training/economics
13.
Rev. méd. Chile ; 146(11): 1343-1346, nov. 2018. graf
Article in Spanish | LILACS | ID: biblio-985708

ABSTRACT

Pulmonary expansion edema is a rare complication of the management of primary spontaneous pneumothorax. We report a 20 year old male admitted with a right primary spontaneous pneumothorax. A chest tube connected to a water seal was placed, achieving lung expansion. Immediately, the patient presented hypotension and a reduction in arterial oxygen saturation to 78%. Non-invasive ventilation was started. A chest X ray showed extensive right lung edema. The patient was managed with noradrenaline and albumin infusion with good response. Pulmonary edema resolved on day 3 but air leak was persistant so, the patient required surgery to excise apical bullae in the right lung. He was discharged during the following days in good condition.


Subject(s)
Humans , Male , Young Adult , Pneumothorax/complications , Pneumothorax/therapy , Pulmonary Edema/etiology , Pulmonary Edema/therapy , Drainage/adverse effects , Pulmonary Edema/diagnostic imaging , Radiography, Thoracic , Chest Tubes/adverse effects , Risk Factors , Treatment Outcome
14.
J. pediatr. (Rio J.) ; 94(2): 140-145, Mar.-Apr. 2018. tab, graf
Article in English | LILACS | ID: biblio-894112

ABSTRACT

Abstract Objectives To evaluate the effectiveness of videothoracoscopic surgery in the treatment of complicated parapneumonic pleural effusion and to determine whether there is a difference in the videothoracoscopic surgery outcome before or after the chest tube drainage. Methods The medical records of 79 children (mean age 35 months) undergoing videothoracoscopic surgery from January 2000 to December 2011 were retrospectively reviewed. The same treatment algorithm was used in the management of all patients. Patients were divided into two groups: in group 1, videothoracoscopic surgery was performed as the initial procedure; in group 2, videothoracoscopic surgery was performed after previous chest tube drainage. Results Videothoracoscopic surgery was effective in 73 children (92.4%); the other six (7.6%) needed another procedure. Sixty patients (75.9%) were submitted directly to videothoracoscopic surgery (group 1) and 19 (24%) primarily underwent chest tube drainage (group 2). Primary videothoracoscopic surgery was associated with a decrease of hospital stay (p = 0.05), time to resolution (p = 0.024), and time with a chest tube (p < 0.001). However, there was no difference between the groups regarding the time until fever resolution, time with a chest tube, and the hospital stay after videothoracoscopic surgery. No differences were observed between groups regarding the need for further surgery and the presence of complications. Conclusions Videothoracoscopic surgery is a highly effective procedure for treating children with complicated parapneumonic pleural effusion. When videothoracoscopic surgery is indicated in the presence of loculations (stage II or fibrinopurulent), no difference were observed in time of clinical improvement and hospital stay among the patients with or without chest tube drainage before videothoracoscopic surgery.


Resumo Objetivos Avaliar a eficácia da cirurgia torácica videoassistida no tratamento de derrame pleural parapneumônico complicado e determinar se há diferença no resultado da cirurgia torácica videoassistida realizada antes ou depois da drenagem torácica. Métodos Analisamos retrospectivamente prontuários médicos de 79 crianças (idade média de 35 meses) submetidas a cirurgia torácica videoassistida de janeiro de 2000 a dezembro de 2011. O mesmo algoritmo de tratamento foi utilizado no manejo de todos os pacientes. Os pacientes foram divididos em dois grupos: o Grupo 1 foi submetido a cirurgia torácica videoassistida como procedimento inicial; o Grupo 2 foi submetido a cirurgia torácica videoassistida após drenagem torácica prévia. Resultados A cirurgia torácica videoassistida foi eficaz em 73 crianças (92,4%); as outras seis (7,6%) necessitaram outro procedimento. Sessenta pacientes (75,9%) foram diretamente submetidos a cirurgia torácica videoassistida (Grupo 1) e 19 (24%) foram primeiramente submetidos a drenagem torácica (Grupo 2). A cirurgia torácica videoassistida primária foi associada à redução do tempo de internação (p = 0,05), do tempo para resolução (p = 0,024) e do tempo com o tubo torácico (p < 0,001). Contudo, não houve diferença entre os grupos a respeito do tempo até que não tivessem mais febre, do tempo com o tubo torácico e do tempo de internação após a cirurgia torácica videoassistida. Não foram observadas diferenças entre os grupos com relação à necessidade de cirurgia adicional e à presença de complicações. Conclusões A cirurgia torácica videoassistida é um procedimento altamente eficaz para tratar crianças com derrame pleural parapneumônico complicado. Quando a cirurgia torácica vídeoassistida é indicada na presença de loculações (fase II ou fibrinopurulenta) não há diferença no tempo de melhora clínica e no tempo de internação entre os pacientes com ou sem drenagem torácica antes da cirurgia torácica videoassistida.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Pleural Effusion/surgery , Pneumonia/surgery , Chest Tubes , Drainage/methods , Thoracic Surgery, Video-Assisted , Pleural Effusion/etiology , Pneumonia/complications , Time Factors , Retrospective Studies , Treatment Outcome
15.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 28(1): 66-70, jan.-mar. 2018. ilus
Article in English, Portuguese | LILACS | ID: biblio-906763

ABSTRACT

Os autores realizam uma revisão, de característica didática, das aortopatias, focalizando o histórico, o desenvolvimento do tratamento e os aspectos atuais de abordagem, utilizando a alta tecnologia das salas híbridas. Nos últimos anos, graças ao desenvolvimento das técnicas endovasculares, ocorreu uma verdadeira revolução no tratamento, especialmente para as patologias da aorta descendente, em que procedimentos eficientes foram aplicados com acentuada redução da morbimortalidade. A utilização de salas híbridas e tecnologia de moldes 3D, permitindo endoprótese customizadas, constituem-se em avanços significativos a serem utilizados nos próximos anos e que mudarão os paradigmas de uma subespecialidade


The authors performed a didactic review of aortic diseases, focusing on the historical aspects, the development of treatment, and aspects of the current approach using the latest technology of hybrid surgical rooms. In recent years, thanks to the development of endovascular techniques, there has been a real treatment revolution, especially for diseases of the descending aorta, with the application of efficient procedures, resulting in a significant reduction in morbidity and mortality. The use of hybrid technology rooms and computer 3-D reconstruction technology, enabling customized endoprostheses, are significant advances to be used in the coming years, and that will change the paradigms of a sub-specialty.


Subject(s)
Humans , Male , Female , Aorta, Thoracic/surgery , Aortic Aneurysm, Thoracic/therapy , Diagnosis , Endovascular Procedures/methods , Aorta/surgery , Prostheses and Implants , Transplantation , Aged , Tomography/methods , Chest Tubes , Stents , Treatment Outcome , Aneurysm, Dissecting , Aneurysm, Dissecting/complications
16.
Article in English | WPRIM | ID: wpr-742324

ABSTRACT

BACKGROUND: We evaluated the feasibility and outcomes of pulmonary resection and mediastinal node dissection (MND) by video-assisted thoracoscopic surgery (VATS) following neoadjuvant therapy for stage IIIA N2 non-small cell lung cancer (NSCLC). METHODS: From November 2009 to December 2013, a total of 35 consecutive patients with pathologically or radiologically confirmed stage IIIA N2 lung cancer underwent pulmonary resection and MND, performed by a single surgeon, following neoadjuvant chemoradiation. Preoperative patient characteristics, surgical outcomes, postoperative drainage, postoperative complications, and mortality were retrospectively analyzed. RESULTS: VATS was completed in 17 patients. Thoracotomy was performed in 18 patients, with 13 planned thoracotomies and 5 conversions from the VATS approach. The median age was 62.7±7.9 years in the VATS group and 60±8.7 years in the thoracotomy group. The patients in the VATS group tended to have a lower diffusing capacity for carbon monoxide (p=0.077). There were no differences between the 2 groups in the method of diagnosing the N stage, tumor response and size after induction, tumor location, or histologic type. Complete resection was achieved in all patients. More total and mediastinal nodes were dissected in the VATS group than in the thoracotomy group (p < 0.05). The median chest tube duration was 5.3 days (range, 1 to 33 days) for the VATS group and 7.2 days (range, 2 to 28 days) for the thoracotomy group. The median follow-up duration was 36.3 months. The 5-year survival rates were 76% in the VATS group and 57.8% in the thoracotomy group (p=0.39). The 5-year disease-free survival rates were 40.3% and 38.9% in the VATS and thoracotomy groups, respectively (p=0.8). CONCLUSION: The VATS approach following neoadjuvant treatment was safe and feasible in selected patients for the treatment of stage IIIA N2 NSCLC, with no compromise of oncologic efficacy.


Subject(s)
Carbon Monoxide , Carcinoma, Non-Small-Cell Lung , Chest Tubes , Disease-Free Survival , Drainage , Follow-Up Studies , Humans , Lung Neoplasms , Methods , Mortality , Neoadjuvant Therapy , Postoperative Complications , Retrospective Studies , Survival Rate , Thoracic Surgery, Video-Assisted , Thoracotomy
17.
Article in English | WPRIM | ID: wpr-713772

ABSTRACT

Chest tube insertion is a common procedure usually done for the purpose of draining accumulated air or fluid in the pleural cavity. Small-bore chest tubes (≤14F) are generally recommended as the first-line therapy for spontaneous pneumothorax in non-ventilated patients and pleural effusions in general, with the possible exception of hemothoraces and malignant effusions (for which an immediate pleurodesis is planned). Large-bore chest drains may be useful for very large air leaks, as well as post-ineffective trial with small-bore drains. Chest tube insertion should be guided by imaging, either bedside ultrasonography or, less commonly, computed tomography. The so-called trocar technique must be avoided. Instead, blunt dissection (for tubes >24F) or the Seldinger technique should be used. All chest tubes are connected to a drainage system device: flutter valve, underwater seal, electronic systems or, for indwelling pleural catheters (IPC), vacuum bottles. The classic, three-bottle drainage system requires either (external) wall suction or gravity (“water seal”) drainage (the former not being routinely recommended unless the latter is not effective). The optimal timing for tube removal is still a matter of controversy; however, the use of digital drainage systems facilitates informed and prudent decision-making in that area. A drain-clamping test before tube withdrawal is generally not advocated. Pain, drain blockage and accidental dislodgment are common complications of small-bore drains; the most dreaded complications include organ injury, hemothorax, infections, and re-expansion pulmonary edema. IPC represent a first-line palliative therapy of malignant pleural effusions in many centers. The optimal frequency of drainage, for IPC, has not been formally agreed upon or otherwise officially established.


Subject(s)
Catheters , Chest Tubes , Drainage , Gravitation , Hemothorax , Humans , Palliative Care , Pleura , Pleural Cavity , Pleural Effusion , Pleural Effusion, Malignant , Pleurodesis , Pneumothorax , Pulmonary Edema , Suction , Surgical Instruments , Thorax , Ultrasonography , Vacuum
18.
Article in English | WPRIM | ID: wpr-713075

ABSTRACT

Delayed massive hemothorax requiring surgery is relatively uncommon and can potentially be life-threatening. Here, we aimed to describe the nature and cause of delayed massive hemothorax requiring immediate surgery. Over 5 years, 1,278 consecutive patients were admitted after blunt trauma. Delayed hemothorax is defined as presenting with a follow-up chest radiograph and computed tomography showing blunting or effusion. A massive hemothorax is defined as blood drainage >1,500 mL after closed thoracostomy and continuous bleeding at 200 mL/hr for at least four hours. Five patients were identified all requiring emergency surgery. Delayed massive hemothorax presented 63.6±21.3 hours after blunt chest trauma. All patients had superficial diaphragmatic lacerations caused by the sharp edge of a broken rib. The mean preoperative chest tube drainage was 3,126±463 mL. We emphasize the high-risk of massive hemothorax in patients who have a broken rib with sharp edges.


Subject(s)
Chest Tubes , Diaphragm , Drainage , Emergencies , Follow-Up Studies , Hemorrhage , Hemothorax , Humans , Lacerations , Radiography, Thoracic , Rib Fractures , Ribs , Thoracic Injuries , Thoracostomy , Thorax
19.
Article in English | WPRIM | ID: wpr-719094

ABSTRACT

OBJECTIVE: The shock index (SI), as a trauma triage tool, is a capable clinical indicator of hemodynamic instability and hypovolemic shock, but the conception of SI is contradictory to shock. The reverse shock index (RSI) was introduced recently, but its utility has not been sufficiently proven. METHODS: This study examined the RSI utility by evaluating the procedures performed at an emergency department (ED) and the associated outcomes when the RSI is used alone or in combination with the Korean Triage and Acuity Scale (KTAS). This was a retrospective study conducted by including data of 4,789 adult trauma patients for a year. The clinical variables, procedures performed on patients, and outcomes were investigated. The median RSI was 0.9 in the RSI < 1 group. RESULTS: Patients in the RSI < 1 group had a higher odds of requiring procedures at the ED and for experiencing worse outcomes: intubation (odds ratio [OR], 5.4; 95% confidence interval [CI], 2.3–13.1; P < 0.001), chest tube insertion (OR, 6.5; 95% CI, 0.4–111.84; P < 0.001), use of emergency drugs (OR, 3.6; 95% CI, 1.5–8.5; P < 0.001), circulatory support (OR, 5.4; 95% CI, 2.3–12.9; P < 0.001), intensive care unit admission (OR, 3.5; 95% CI, 1.8–6.8; P < 0.001), and mortality during the ED stay (OR, 20.4; 95% CI, 5.5–75.7; P < 0.001). In the group with KTAS 1–3, trends similar to those in the RSI < 1 group were observed. Patients with RSI < 1 had more severe injuries and poorer outcomes than those with RSI≥1, regardless of whether the RSI was used alone or in combination with KTAS. CONCLUSION: RSI can provide an appropriate triage with concurrent KTAS use.


Subject(s)
Adult , Chest Tubes , Emergencies , Emergency Service, Hospital , Fertilization , Hemodynamics , Humans , Intensive Care Units , Intubation , Mortality , Retrospective Studies , Shock , Triage
20.
Article in Korean | WPRIM | ID: wpr-718694

ABSTRACT

A 35-year-old female complaining of a painful huge right posterior chest wall mass was admitted. Chest computed tomography showed the pleural invasion of mass and deformed ribs. Suspected diagnosis was hemangioma. Entire mass was removed carefully and pleural biopsy was performed. The operation was finished after bleeding control and chest tube insertion. The mass was diagnosed as a cavernous hemangioma histopathologically. Cavernous hemangioma of chest wall is a rare benign vascular tumor. Surgical operation of hemangioma demands meticulous bleeding control because of risk of hemorrhage.


Subject(s)
Adult , Biopsy , Chest Tubes , Diagnosis , Female , Hemangioma , Hemangioma, Cavernous , Hemorrhage , Humans , Ribs , Thoracic Wall , Thorax
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