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

results of thoracoscopic surgery for secondary spontaneous pneumothorax

To review our experience of video-assisted thoracoscopic surgery for the treatment of secondary spontaneous pneumothorax caused by bullous emphysema. Prospective study. Chest Diseases Hospital, Kuwait. Forty-six consecutive patients who under went thoracoscopy for secondary spontaneous pneumothorax by a single surgeon during a fiveyearperiod. Video-assisted thoracoscopic bullectomy and pleural symphysis procedure. Resolution of pneumothorax. Mean age of patients was 49.3 years [range: 38 - 70 years], and 44 were men [96%]. All patients had bullous emphysema; their mean preoperative forced expiratory volume in one second [FEV1] was 54.4% of predicted and mean forced vital capacity [FVC], 66.9% of predicted. Persistent pneumothorax was the most frequent indication for surgery, occurring in 35 patients [76%]. The most common method of management was stapling of an identifiedbulla, which was done in all patients. Pleurodesis was achieved by gauze abrasion [n = 23] and apical pleurectomy [n = 23]. Postoperative prolonged air leak occurred in seven patients [15%], six in the pleural abrasion group and one in the apical pleurectomy group [p = 0.04]. The mean [ +/- SD] postoperative hospital stay was 5.7 +/- 4.5 days. Mean follow-up is 42 months [range = 36 - 54 months] for all patients. Pneumothorax recurred in three patients [6.5%] in whom pleural abrasion was done. The recurrences occurred in the first six months of follow-up. Video-assisted thoracoscopic surgery is a safe procedure in the treatment of select secondary spontaneous pneumothorax caused by bullous emphysema. Apical pleurectomy is a more effective way of producing pleural symphysis