Traumatic diaphragmatic rupture with combined thoracoabdominal injuries: Difference between penetrating and blunt injuries / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>Traumatic diaphragmatic rupture (TDR) needs early diagnosis and operation. However, the early diagnosis is usually difficult, especially in the patients without diaphragmatic hernia. The objective of this study was to explore the early diagnosis and treatment of TDR.</p><p><b>METHODS</b>Data of 256 patients with TDR treated in our department between 1994 and 2013 were analyzed retrospectively regarding to the diagnostic methods, percentage of preoperative judgment, incidence of diaphragmatic hernia, surgical procedures and outcome, etc. Two groups were set up according to the mechanism of injury (blunt or penetrating).</p><p><b>RESULTS</b>Of 256 patients with a mean age of 32.4 years (9-84), 218 were male. The average ISS was 26.9 (13-66); and shock rate was 62.9%. There were 104 blunt injuries and 152 penetrating injuries. Preoperatively diagnostic rate was 90.4% in blunt injuries and 80.3% in penetrating, respectively, P < 0.05. The incidence of diaphragmatic hernia was 94.2% in blunt and 15.1% in penetrating respectively, P < 0.005. Thoracotomy was performed in 62 cases, laparotomy in 153, thoracotomy plus laparotomy in 29, and combined thoraco-laparotomy in 12. Overall mortality rate was 12.5% with the average ISS of 41.8; and it was 21.2% in blunt injuries and 6.6% in penetrating, respectively, P < 0.005. The main causes of death were hemorrhage and sepsis.</p><p><b>CONCLUSIONS</b>Diagnosis of blunt TDR can be easily obtained by radiograph or helical CT scan signs of diaphragmatic hernia. For penetrating TDR without hernia, "offside sign" is helpful as initial assessment. CT scan with coronal/sagittal reconstruction is an accurate technique for diagnosis. All TDR require operation. Penetrating injury has a relatively better prognosis.</p>

Use of bronchofiberscopy in management of severe thoracic trauma / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the diagnostic and therapeutic effect of bronchofiberscopy in the management of severe thoracic trauma.</p><p><b>METHODS</b>A retrospective study was conducted on 207 consecutive patients with severe thoracic trauma enrolled in our hospital between January 2008 and June 2012. During the period, 488 bronchofiberscopies and lavages were done. The bronchofiberscope was inserted through tracheal incision (282), nasal cavity (149) and oral cavity (57). Intensive SaO2 monitoring as well as blood gas analysis were performed pre-, intra- and postoperatively. Simultaneously oxygen therapy or ventilatory support was given. Sputum culture was done intraoperatively.</p><p><b>RESULTS</b>Diagnosis in 207 cases was confirmed by bronchofiberscopy. The result of sputum culture was positive in 78 cases. Lavage was performed on 156 cases. SaO2 significantly increased after bronchofiberscopies as well as lavages and PaO2 obviously improved 2 h after surgery (both P less than 0.05). Heart rate and respiratory rate decreased. There was no bronchofiberscopy-related death.</p><p><b>CONCLUSION</b>Bronchofiberscopy plays an important role in the diagnosis and treatment of severe thoracic trauma, which can not only timely diagnose bronchial injury and collect deep tracheal sputum for bacterial culture but also effectively remove foreign body, secretion, blood and sputum crust in the airway, manage obstructive atelectasis and pneumonia, and significantly improve respiratory function and treatment outcome.</p>