Early evacuation of posttraumatic clotted hemothorax or retained pleural fluid: result of vats versus conventional thoracotomy

To compare the outcome of VATS versus conventional thoracotomy in the early evacuation of posttraumatic clotted hemaothorax or retained pleural fluid in patients with chest trauma after failure of the initial management with tube thoracostomy. Between January 2001 and December 2005, fifty-four patients with posttraumatic clotted hemothorax or retained pleural fluid were included in this study. They were claimed to have clotted hemothorax or retained pleural fluid after 3 to 5 days posttruama by chest roentgenogram and chest CT. The patients were divided into 2 groups, group I [VATS group] and group II [thoracotomy group]. Group I patients [VATS group] included 23 patients, VATS was performed for evacuation of posttraumatic clotted hemaothorax or retained pleural fluid. Group II patients [thoracotomy group] included 31 patients; conventional thoracotomy was performed for management of posttraumatic clotted hemothorax. There was no statistical significant difference between the mean ages of both groups, as the mean age of the VATS group patients was 33 +/- 8 years, while it was 32.7 +/- 7 years for the thoracotomy group patients. The mean preoperative ICT period was [6 +/- 1.5 days VS 7 +/- 2 days respectively]. It was statistically non-significant There was statistical significant difference [P-value

Early and mid term results of surgical repair of coarctation of the aorta: experience of Benha in 19 patients with simple coarctation of the aorta

To evaluate early and mid-term results of surgical repair of coarctation of the aorta in patients with isolated [simple] coarctation of the aorta. Between March 2000 and February 2005, nineteen patients diagnosed as cases of isolated coarctation of the aorta [with or without PDA] using Echocardiography .They underwent resection of the coarctated segment with end-to-end anastomosis. The patients were followed up for a mean period 23.8 +/- 7.4 months. In each visit, the patient was clinically evaluated for blood pressure, gradient [by echocardiography], neurological and recoarctation symptoms. The age ranged from 6 months to 9 years [mean of 4.4 +/- 2.8 gears] and 12 patients of them [63%] were males. The patients presented with different symptoms in the form of claudications in 12 patients [63%], headache in 10 patients [54%], chest pain in 3 patients [16%], and repeated chest infections in 7 patients [36%]. On examination, 14 patients [73%] had weak femoral pulse, and 11 patients [58%] had systolic continuous murmur conducted to the back. All the patients had hypertension which was defined as blood pressure greater than that of the 90th percentile for age, On measuring blood pressure, the mean upper limb blood pressure was 129/83 +/- 6.7/5.7 mm Hg, and the mean gradient was 35.4 +/- 6.8mm Hg. Operatively, the mean operative time was 149.2 +/- 14.6 minutes, the mean cross clamp time was 25.7 +/- 2.4 minutes, the mean intercostal tube [ICT] period was 2.7 +/- 0.8 days, the mean ICU stay was 1.6 + 0.6 days and the mean hospital stay was 9.9 +/- 1.6 days. There was no operative or hospital mortality. There was immediate postoperative increase in mean blood pressure which was 131/82 +/- 6/3 mm Hg, this increase was controlled with infusion of antihypertensive drugs. However, all the patients had dramatic improvement in blood pressure before discharge as the mean blood pressure on discharge was 114/67 +/- 6/4 mm Hg and the mean gradient on discharge was 13.3 +/- 5.1mm Hg. On follow up, the signs of hypertension occurred in total of 4 patients [21%], unfortunately, 2 of them died due to heart failure [11 and 15 months postoperatively]. The other 2 patients with postoperative hypertension were on one antihypertensive medication to control blood pressure. There was significance difference [P Value less than 0.05] between both mean blood pressure as well as mean gradient on admission and both on discharge, also, there was significant difference between both mean blood pressure and mean gradient on admission and both on 30 months after surgery. Surgical repair of isolated coarctation of the aorta by the technique of excision of the coarctated part with end-to-end anastomosis is essential in young patients to avoid subsequent morbidity and premature mortality. The short-term and mid-term results were satisfactory and encouraging

Comparative study between autologous blood patch pleurodesis versus talc slurry pleurodesis in persistent air leak

The aim of this work is to compare the outcome and results of pleurodesis with injection of talc slurry versus pleurodesis with injection of autologous blood patch in management of persistent air leak complicating lung resection, decortication or spontaneous pneumothorax. This study was carried out from January 2003 till December 2006. The persistent air leak was a postoperative complication of lung resection or/and decortication or due to spontaneous pneumothorax. All the patients were considered to have persistent air leak if the air leak persisted for 7 days or more. The patients were divided into 2 groups, group I [autologous blood patch pleurodesis group] and group II [talc slurry pleurodesis group]. The Group I patients included 13 patients; 50 mL of autologous patch blood were injected intrapleurally for pleurodesis. Group II patients included 16 patients; 5 gm of asbestos-free talc slurry was injected intrapleurally for pleurodesis. There was no statistical significant difference between the mean ages of both groups, as the mean age of the blood group patients was 31 +/- 10 years, while it was 30 +/- 8 years for the talc slurry group patients. The mean prepleurodesis air leak period was [6.8 +/- 1 days VS 7.1 +/- 1 days respectively]. It was statistically non-significant There was no statistical significant difference in the mean post pleurodesis air leak period between the blood pleurodesis group patients and the talc slurry pleurodesis group patients [2.9 +/- 1.7 days VS 3.9 +/- 1.8 days respectively]. There was statistical significant difference in the mean dose of analgesics given postpleurodesis [139 +/- 60 mg VS 231 +/- 14 mg respectively], and in the mean postpleurodesis analgesic period [1.7 +/- 1 days VS 3.5 +/- 0.5 days respectively].There was no statistical significant difference between the 2 groups of patients in mean ICT period postpleurodesis [4.7 +/- 3.1 days VS 6.6 +/- 4 days respectively] and the mean hospital stay [7.5 +/- 3.7 days VS 9 +/- 4 days respectively]. Minor adverse effects occurred in blood plearodesis group of patients and talc slurry pleurodesis group of patients. Fever [23% VS 50%, respectively], empyema [8% VS 6%, respectively], chest pain [15% VS 56%, respectively], and recurrence [8% VS 13%, respectively]. Persistent air leak occurred in [8% VS 13%, respectively], and second dose pleurodesis in 1 patient of each group [8% VS 6%, respectively]. We concluded that in persistent air leak, pleurodesis with one of the 2 methods of pleurodesis [Autologous Blood Patch or Talc Slurry] is easy to perform, safe, available, and effective and does not add more costs. Acceptable minor adverse effects may occur more with talc slurry pleurodesis, but, it still effective and could be tolerated by the majority of patients

Comparative study of left anterior thoracotomy versus vats in management of pericardial effusions

The aim of this study is to compare the outcome and results of VATS versus left anterior conventional thoracotomy in the management of pericardial effusions and creation of pericardial window. Between March 2002 and February 2006, nineteen patients with proved pericardial effusions were included in this study. They were claimed to have pericardial effusions by chest roentgenogram, echocardiography and chest CT. The patients were divided into 2 groups, group I [Thoracotomy group] and group II [VATS group]. Group I patients [thoracotomy group] included 11 patients, and Group II patients [VATS group] included 8 patients. Thoracotomy or VATS was performed for evacuation of pericardial effusions, creation of pericardial window and sending the taken biopsies of both the pericardium and fluid for cytological pathological and histological examinations. There was no statistical significant difference between the man ages of both groups, as the mean age of the thoracotomy group patients was 47 +/- 7 years, while it was 45.5 +/- 7 years for the VATS group patients. Eight patients [73%] of group I and 6 patients [75%] of group II had symptoms [chest pain or/and dyspnea]. Preoperative pericardiocentesis was done in 6 patients [55%] in thoracotomy group and another 6 patients [75%] in VATS group. There was statistical significant difference [P-value 0.05] between the thoracotomy group patients and the VATS group patients in the mean operative time [52 + 6 minutes VS 44 +/- 3 minutes respectively], and, mean volume of analgesics given in the first 24 hours postoperatively [227 +/- 15 mg VS 206 +/- 14 mg respectively], in the mean ICU stay [5.7 +/- 1 days VS 4 +/- 1 days, respectively], and in the mean hospital stay [10 +/- 1 day VS 6 +/- 1 days, respectively] postoperatively. There were no statistical significant difference between the 2 groups of patients in the mean ICT drainage postoperatively [737 +/- 170 mL VS 673 +/- 110 mL respectively], and, mean ICT period postoperatively [3.7 +/- 1 days VS 3.75 +/- 1.5 days respectively]. Biopsies proved malignancies in 5 patients [45%] in group I, and in 4 patients [50%] in group II. Complications occurred more in thoracotomy group of patients than that of VATS group of patients. Mortality [9% VS 0%, respectively], wound infection [9% VS 0%, respectively], and recurrence [18% VS 25%, respectively]. Although VATS with the creation of pericardial window requires general anesthesia and single lung ventilation, it is a safe, minimally invasive technique that allows for effective pericardial drainage as well as diagnostic tools. It carries less morbidity and mortality than that of conventional left anterior thoracotomy. We suggest that it should be used in carefully selected patients with proper indications