RESUMEN
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 = 0.05] between the VATS group patients and the thoracotomy group patients in the mean operative time [70 +/- 4 minutes VS 77 +/- 6 minutes respectively], and, mean volume of analgesics given in the first 24 hours postoperatively [201 +/- 17 mg VS 239 +/- 18 mg respectively], in the mean ICT drainage in the first 24 hours post-operatively [219 +/- 22 ml VS 230 +/- 18 ml respectively], and, mean ICT period postoperatively [4 +/- 1 days VS 6.5 +/- 1 days respectively].There was also statistical significant difference between the 2 groups of patients in the mean hospital stay postoperatively [6 +/- 3 days VS 10 +/- 2.5 days respectively], and, the mean period to return to more or less normal activity [15 +/- 1.8 days VS 23 +/- 3.5 days respectively]. Complications occurred less in VATS group of patients than that of thoracotomy group of patients. Prolonged air leak [13% VS 20%, respectively], postoperative empyema [4% VS 10%, respectively] and wound infection [0% VS 10%, respectively]. Reoperationfor management of postoperative empyema performed in one patient [4%] of the VATS group of patients and 2 patients [6%] of the thoracotomy group of patients. We concluded that early thoracoscopic intervention should be considered for management of posttraumatic clotted hemothorax or retained pleural fluid. Benefits include abbreviated thoracostomy tube drainage, shorter hospital stay after procedure, shorter overall hospitalization, as well as early return to normal activity. Moreover, early evacuation usually decrease the complications associated with retained hemothoraces, such as empyema and fibrothorax. Also, thoracoscopic surgery has fewer complications than the conventional thoracotomy
Asunto(s)
Humanos , Masculino , Femenino , Derrame Pleural/terapia , Heridas y Lesiones , Toracotomía , Toracoscopía , Cirugía Torácica Asistida por VideoRESUMEN
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
Asunto(s)
Humanos , Masculino , Femenino , Ecocardiografía , Estudios de Seguimiento , Signos y Síntomas , Hipertensión , Presión Sanguínea , Tiempo de InternaciónRESUMEN
To assess the influence of off-pump coronary artery surgery on early and midterm clinical results in elderly patients. Coronary artery bypass grafting [CABG] in elderly patients is associated with perioperative mortality and morbidity rates higher than those observed in young aged patients. The avoidance of cardiopulmonary by pass [CPB] in this population is potentially beneficial. This a retrospective study consisted of 1007 CABG patients. Of these 583 patients underwent CABG without CPB [group A] and 424 patients underwent CABG with CPB [group B]. Patients that converted from off-pump to CPB ere included in group A. Most of the preoperative variables ere comparable between the two groups. Group A patients had more preoperative cerebrovascular accident [p=0.044], carotid artery disease [p=0.025] and renal impairment [p=0.03]. Group B had more female patients [p=0.045], more patients with low EF [p=0.007] and more patients with multivessel disease [P=0.031]. 33[5.7%] patients were converted to CPB. Early mortality was 3.7% [group A, 2.6%, Group B, 5.2%; p=0.045, acute myocardial infarction incidence was 2.38% [group A, 1.5%; group B, 35%; p=0.041], cerebrovascular accident incidence was 0.99% [group A, 0.34%; group B, 1.88%; p=0.0.34], and early major events incidence was 9.9% [group A, 7.9%; group B, 13.2%; p=0.006]. Group A had a short ICU and hospital stay than group B, Stepwise logistic regression analysis showed that CPB was an independent risk factor for higher mortality [Odds Ratio "OR", 2.2; p=0.021 7], higher incidence of acute myocardial infarction [Odds Ratio, 2.5; p=0.0185], and higher incidence of early major events [Odd Ratio, 1.8, p=0.0034]. Mid-term mortality or cardiac-related events were similar in the two groups. In elderly patients, off-pump CABG is safe-procedure that facilitates early recovery and reduces the incidence of postoperative mortality and morbidity. At mid-term follow up, the incidence of mortality and cardiac-related events were low in both group supporting a more aggressive policy of coronary revascularization in elderly patients