Traumatismo torácico: análisis de hospitalizaciones según grupo etario / Thoracic trauma: analysis of hospitalizations among different age-groups

Resumen Introducción: El traumatismo es la primera causa de muerte en adolescentes y la quinta en el adulto mayor. El traumatismo torácico (TT) posee características particulares en diferentes grupos de edad. Objetivos: Analizar características clínicas, índice de gravedad de traumatismo (IGT) y mortalidad en hospitalizados por TT según grupo etario. Materiales y Método: Estudio descriptivo de hospitalizaciones por TT, período enero de 1981 a diciembre de 2018. Revisión de protocolos prospectivos de TT y base de datos. Se definió grupo etario según Organización Mundial de la Salud (Adolescente: 10-19 años; Adulto Joven: 20-44 años; Adulto Maduro 45-59 años; Adulto Mayor: ≥ 60 años). Se comparó clasificación, mecanismo, agente, tratamiento, IGT, Trauma Injury Severity Score (TRISS) y mortalidad del TT según grupo etario. Se utilizó SPSS25® con pruebas chi-cuadrado y ANOVA, considerando significativo p < 0,05. Resultados: Total 4.297 TT. Grupo etario Adolescente: 608 (14,1%); Adulto Joven: 2.544 (59,2%); Adulto Maduro: 601 (14,0%); Adulto Mayor: 544 (12,7%). Se observó disminución progresiva y significativa en TT penetrante, por agresión y del TT por arma blanca desde grupo etario Adolescente hasta Adulto Mayor. En Adulto Joven predominó tratamiento invasivo: cirugía 541 (21,2%) y en Adulto Maduro el TT con lesiones asociadas 215 (35,8%), p < 0,05. Según grupo etario, se observaron diferencias significativas en TRISS y en mortalidad. La mortalidad fue 1,6%; 2,5%; 3,3%; 5,0%, según grupo etario respectivamente (p < 0,05). Conclusiones: Existen diferencias estadísticamente significativas en las características clínicas, IGT y mortalidad del TT al comparar distintos grupos etarios. La edad es uno de los factores que determina el pronóstico de pacientes hospitalizados por TT.

Background: Trauma is the leading death cause among adolescents and the fifth in the elderly. Thoracic trauma (TT) has particular characteristics in different age-groups. Aim: To analyze clinical characteristics, trauma severity indices (TSI) and mortality in patients hospitalized for TT among different age-groups. Materials and Method: Descriptive study of patients hospitalized for TT between January-1981 and December-2018. Prospective TT surgical operation notes and data base were reviewed. Age-groups were determined according to the World Health Organization (Adolescent: 10-19 years; Young Adult: 20-44 years; Mature Adult: 45-59 years; Elderly > 60 years). TT classification, mechanism, agent, treatment, TSI, Trauma Injury Severity Score (TRISS) and mortality were compared among age-groups. SPSS25® with chi-square test and ANOVA were used, considering p < 0.05 significant. Results: Total 4.297 TT. Adolescent age-group: 608 (14.1%); Young Adult: 2,544 (59.2%); Mature Adult: 601 (14.0%); Elderly: 544 (12.7%). Was observed a progressive and significant decrease of penetrating TT, aggression-caused and bladed weapon-caused TT from Adolescent to Elderly. In Young Adult the invasive treatment predominant: surgery 541 (21.2%), whereas in Mature Adult TT with associated injuries 215 (35.8%), p < 0.05. Differences in TRISS and mortality 1.6%; 2.5%; 3.4%; 5.0% (p < 0.05) were observed among age-groups, respectively. Conclusions: There are statistical significant differences in clinical characteristics, TSI and mortality when comparing TT by age group. Age is an important factor determining the outcome in TT hospitalized patients.

Traumatismo torácico por arma de fuego / Thoracic trauma by firearms

Resumen Introducción: Los traumatismos torácicos por armas de fuego (TTAF) son cada vez más frecuentes. Objetivos: Describir características clínicas, morbilidad, mortalidad y la evolución a través del tiempo de hospitalizados por TTAF. Materiales y Método: Estudio analítico longitudinal. Período enero de 1981-diciembre de 2018. Revisión base de datos, protocolos prospectivos y fichas clínicas. Se utilizó planilla Microsoft Excel® y programa SPSS24® con chi cuadrado y de Mann-Whitney. Descripción de características de TTAF en pacientes hospitalizados y comparación por períodos. Se calcularon índices de gravedad del traumatismo (IGT): Injury Severity Score (ISS), Revised Trauma Score (RTS-T), Trauma Injury Severity Score (TRISS). Resultados: Total 4.306 pacientes hospitalizados por traumatismo torácico (TT), 205 (4,8%) hospitalizados por TTAF. Hombres: 188 (91,7%), edad promedio 28,8 ± 11,2 años, TTAF aislado 115 (56,1%), asociado a lesiones extratorácicas 90 (43,9%), de estos 55 (26,8%) se consideraron politraumatismos. Mecanismo: Agresión 193 (94,1%), autoagresión 11 (5,4%) y accidental 1 (0,5%). Lesiones y/o hallazgos torácicos más frecuentes: Hemotórax 127 (62,0%), neumotórax 96 (46,8%) y contusión pulmonar 51 (24,9%). Tratamiento definitivo: Pleurotomía 88 (42,9%), cirugía 71 (34,6%) y tratamiento médico 46 (22,4%). Mediana de hospitalización 7 días. Según IGT: ISS promedio 16,7 ± 11,7, RTS-T promedio 11,1 ± 2,1, TRISS promedio 9,6. Morbilidad: 44 (21,5%). Mortalidad: 14 (6,8%). En los diferentes períodos, se observó aumento de politraumatismos y TRISS, sin cambios en mortalidad. Discusión: La mayoría de los TTAF fueron aislados. Aproximadamente un tercio de los pacientes requirió cirugía. La mortalidad observada es menor a la esperada. Se observan cambios en los TTAF a través del tiempo.

Background: Thoracic trauma by firearms (TTF) are increasingly frequent. Aim: To describe clinical characteristics, morbidity and mortality and the evolution over time of patients hospitalized due TTF. Materials and Method: Longitudinal analytical study. Period January 1981 - December 2018. Database review, prospective protocols and clinical files. Microsoft Excel® spreadsheet and SPSS24® program with chi square and Mann-Whitney tests were used. Description of characteristics of TTF in hospitalized patients and comparison of TTF by periods. Trauma severity indexes (TSI) were calculated: Injury Severity Score (ISS), Revised Trauma Score (RTS-T), Trauma Injury Severity Score (TRISS). Results: Total: 4306 hospitalized patients due thoracic trauma (TT), 205 (4.8%) hospitalized due TTF. Men: 188 (91.7%), average age 28.8 ± 11.2 years, isolated TTF 115 (56.1%), associated with extrathoracic lesions 90 (43.9%), and of these 55 (26.8%) were considered polytraumatism. Mechanisms: aggression 193 (94.1%), self-harm 11 (5.4%) and accidental 1 (0.5%). Frequent thoracic injuries and/or findings: hemothorax 127 (62.0%), pneumothorax 96 (46.8%) and pulmonary contusion 51 (24.9%). Definitive treatment: Pleurotomy 88 (42.9%), surgery 71 (34.6%) and medical treatment 46 (22.4%). Median hospitalization 7 days. According TSI: Average ISS 16.7 ± 11.7, average RTS-T 11.1 ± 2.1, average TRISS 9.6. Morbidity: 44 (21.5%). Mortality: 14 (6.8%). There is an increase in polytraumatism and average TRISS, without changes in mortality. Discussion: The majority of TTF were isolated TT. Approximately one third of patients required surgery. The observed mortality is lower than expected. Changes in TTF were observed over time.

Traumatismo torácico en el adulto mayor / Thoracic trauma in the elderly

Resumen Introducción: Los traumatismos constituyen la quinta causa de muerte en el adulto mayor (60 años o más), siendo los traumatismos contusos los más frecuentes. Objetivo: Describir características, índices de gravedad de traumatismo (IGT), morbilidad y mortalidad en adultos mayores (AM) hospitalizados con traumatismo torácico (TT). Materiales y Método: Estudio descriptivo transversal. Período desde enero de 1981 a diciembre de 2017. Revisión de base de datos, protocolos quirúrgicos y fichas clínicas. Descripción de características de TT en AM hospitalizados. Se calculó IGT: Injury Severity Score (ISS), Revised Trauma Score (RTS-T), Trauma Injury Severity Score (TRISS). Resultados: Total 4.163 TT, AM 513 (12,3%). Hombres: 350 (68,2%), edad promedio 71,2 ± 8,4 años, mediana 70 (rango: 60-103), TT aislado 350 (68,2%), asociado a lesiones extratorácicas 163 (31,8%) y de estos 96 (18,7%) se consideraron politraumatismos. Traumatismo contuso 456 (88,9%) y penetrante 57 (11,1%). La causa más frecuente fueron las caídas en 252 (49,1%). Lesiones y/o hallazgos torácicos más frecuentes: fracturas costales 409 (79,7%), hemotórax 186 (36,3%) y neumotórax 185 (36,1%). Tratamiento definitivo: médico 287 (55,9%), pleurotomía 193 (37,6%) y cirugía 40 (7,8%). Cirugía extratorácica 33 (6,4%). Hospitalización promedio 9,0 ± 8,8 días. Según IGT: ISS promedio 12,1 ± 9,6, RTS-T promedio 11,6 ± 1,3, TRISS promedio 8,1. Morbilidad 76 (14,8%) y mortalidad 26 (5,1%). Discusión: La mayoría de los TT en AM son contusos, causados por accidentes domésticos. Las lesiones y hallazgos más frecuentes fueron fracturas costales y hemotórax. La mortalidad fue menor a la esperada según IGT.

Introduction: Trauma is the fifth leading cause of death in the elderly (60 or older), with blunt trauma being the most frequent. Objective: To describe characteristics, Trauma Severity Indices (TSI) and morbidity and mortality in hospitalized elderly for Thoracic Trauma (TT). Materials and Method: Crosssectional descriptive study was carried out. Term: from January 1981 to December 2017. Database review, surgical protocols and medical records were performed. TT description of characteristics was conducted in hospitalized elderly. TSI was calculated: Injury Severity Score (ISS), Revised Trauma Score (RTS-T), Trauma Injury Severity Score (TRISS). Results: Total 4.163 TT, 513 elderly (12.3%). Men: 350 (68.2%), average age 71.2 ± 8.4 years, 70 median (range 60-103). Isolated TT: 350 (68.2%), 163 associated with extrathoracic trauma (31.8%) and of these 96 (18.7%) were considered polytraumatism. Blunt trauma 456 (88.9%) and penetrating 57 (11.1%). Most frequent domestic accident mechanism was 196 (38.2%) and 158 traffic accidents (30.8%). Frequently thoracic injuries or findings: 409 rib fractures (79.7%), 186 hemothorax (36.3%), and 185 pneumothorax (36.1%). Final treatment: 287 Medical treatment (55.9%), 193 pleurotomy (37.6%), and 40 thoracic surgery (7.8%). Extrathoracic surgery 33 (6.4%). Average hospitalization: 9.0 ± 8.8 days. According IGT: ISS 12.1 ± 9.6, RTS-T 11.6 ± 1.3, TRISS 8.1. Morbidity: 76 (14.8%) and mortality: 26 (5.1%). Discussion: Most TT in elderly are blunt, caused by domestic accidents. Injuries and most frequent findings were rib fractures and hemothorax. Mortality was lower than expected according to TSI.

Traumatismo torácico contuso / Blunt Thoracic Trauma

INTRODUCCIÓN: El traumatismo torácico (TT) es una causa importante de morbilidad y mortalidad, presente en el 25-50% de la mortalidad por traumatismo. El TT contuso (TTC) es el tipo más frecuente de TT según las diferentes publicaciones internacionales. OBJETIVO: Nuestros objetivos son describir las características, tratamientos, morbilidad y mortalidad en pacientes hospitalizados por TTC en nuestra institución. MATERIAL Y MÉTODOS: Estudio descriptivo transversal desde enero-1981 a diciembre-2017. Revisión de una base de datos prospectiva, protocolos quirúrgicos y fichas clínicas. Se describen y comparan las características de los TTC. Se calcularon índices de gravedad de traumatismo (IGT): Injury Severity Score (ISS), Revised Trauma Score (RTS-T), Trauma Injury Severity Score (TRISS). RESULTADOS: Total 4.163 pacientes hospitalizados por TT, 1.719 (41,3%) TTC. Hombres 1.327 (77,2%), edad promedio 46,7±18,8 años. Se consideró TT aislado 966 (56,2%), asociado a lesiones extratorácicas 753 (43,8%) y de estos 508 (29,6%) eran politraumatizados. Mecanismo: Accidente de tránsito 838 (48,7%), caída de altura 279 (16,2%). Lesiones y hallazgos torácicos: fractura costal 1.294 (75,3%), neumotórax 752 (43,1%). Tratamiento: médico 874 (50,8%), pleurotomía 704 (41%) y cirugía torácica 141 (8,2%). Período de hospitalización 9,2 ± 9,5 días. Según IGT: ISS promedio 14,1 ± 11,1, RTS-Tpromedio 11,5 ± 1,5, TRISS promedio 6,6. Morbilidad en 297 (17,3%), mortalidad en 68 (4%). DISCUSIÓN: La causa principal de los TTC fue el accidente de tránsito. La fractura costal correspondió a la lesión torácica más frecuente. La mayoría requirió solo tratamiento médico. La mortalidad fue menor a la esperada según IGT.

BACKGROUND: Thoracic trauma (TT) is a major cause of morbimortality, involved in 25-50% of trauma deaths. Internationally, blunt thoracic trauma (BTT) is the most frequent type of TT. OBJECTIVE: Our objectives are to describe the clinical characteristics, treatments, morbidity and mortality in patients hospitalized by blunt thoracic trauma (BTT) in our institution. MATERIAL AND METHODS: Cross-sectional descriptive study from january-1981 to december-2017. Prospective database review, surgical protocols and clinical files. The characteristics of the BTT are described and compared. The following trauma severity indices (TSI) were calculated: Injury Severity Score (ISS), Revised Trauma Score (RTS-T) and Trauma Injury Severity Score (TRISS). RESULTS: 4,163 patients were hospitalized because of TT, 1.719 (41.3%) of them with BTT. 1,327 (77.2%)patients were men, average age 46.7 ± 18.8 years-old. We considered isolated TT 966 (56.2%), associated with extrathoracic lesions 753 (43,8%) and 508 (29.6%)with polytraumatism. Mechanism: Traffic accident 838 (48.7%), fall down from a height 279 (16.2%). Lesions and intrathoracic findings: rib fracture 1.294 (75.3%), pneumothorax 752 (43.7%). Treatment: Medical 876 (50.8%), pleurotomy 704 (41%) and thoracic surgery 141 (8.2%). Average hospitalized period 9.2 ± 9.5 days. According to TSI: ISS average 14.1 ± 11.1, RTS-T average 11.5 ± 1.5, TRISS average 6.6. Morbidity in 297 (17.3%), mortality in 68 (4%). DISCUSSION: The TTC was mainly attributed to the traffic accident. Rib fracture was the most common chest injury. The majority of patients required only medical treatment. Mortality was lower than expected according to TSI.

Perfil epidemiológico do trauma torácico em um hospital referência da Foz do Rio Itajaí / Epidemiological profile of thoracic trauma in a reference hospital of Foz do Rio Itajai

RESUMO Objetivo: descrever o perfil epidemiológico do trauma torácico na região da Foz do Rio Itajaí, no Estado de Santa Catarina, Brasil. Métodos: estudo observacional, descritivo e prospectivo, realizado através de coleta de dados a partir de formulário pré-elaborado pelos pesquisadores e preenchido pela equipe responsável pelo atendimento em hospital de referência, entre junho de 2017 e maio de 2018. Resultados: foram analisados 119 formulários de pacientes vítimas de trauma torácico, dos quais 70,5% eram homens e 29,4% mulheres, com média de idade de 39,8 anos. Os atendimentos ocorreram geralmente no período diurno (67,9%), 30,2% dos pacientes chegaram ao serviço através de meios próprios e 52,9% após uma hora do trauma. Quanto aos exames admissionais, a maior parte das vítimas foi submetida exclusivamente à radiografia de tórax (67,2%). Houve prevalência de trauma torácico fechado (89%), tendo como principal mecanismo os acidentes com motocicleta (35,2%) e a lesão predominante foi a fratura de costela (42%). A maioria dos pacientes (53,8%) foi submetida a tratamento conservador. O tempo médio de internação foi de 2,6 dias e a taxa de óbito de 5%. Conclusão: o perfil dos pacientes com trauma torácico em Itajaí é de homens jovens, atendidos durante o dia, a maioria com fratura de costela, acometidos por trauma torácico fechado em decorrência de acidente de trânsito envolvendo motocicleta. A radiografia de tórax foi utilizada para a confirmação de grande parte dos diagnósticos e houve prevalência de tratamento conservador. O tempo de internação e taxa de óbito foram menores do que na literatura, o que pode ser explicado pelo alto índice de lesão muscular exclusiva.

ABSTRACT Objective: to describe the epidemiological profile of thoracic trauma in the region of Foz do Rio Itajai, in the state of Santa Catarina, Brazil. Methods: observational, descriptive and prospective study performed through the collection of data starting with a form elaborated by researchers and filled in by the team in charge of a reference hospital between June 2017 and May 2018. Results: one hundred and nineteen forms from victims of thoracic trauma were analyzed, constituted of 70.5% male patients and 29.4% female patients, with an average of 39.8 years of age. Medical care happened mainly in daytime (67.9%), 30.2% of patients arriving by their own means, and 52.9% of patients one hour after suffering trauma. As to admission exams, most victims only went through chest X-ray (67.2%). There was a prevalence of closed thoracic trauma (89%), whose main cause was motorcycle accidents (35.2%) and the predominant lesion was rib fracture (42%). Most patients (53.8%) went through a conservative treatment. The average admission time was 2.6 days and the death rate was 5%. Conclusion: the profile of patients with thoracic trauma in Itajai comprises young men, admitted during the day, most of them presenting rib fracture, with closed thoracic trauma due to a road traffic accident involving a motorcycle. Chest X-ray were used to confirm most of the diagnoses, and there was a prevalence for conservative treatment. The admission time and the death rate were smaller than those cited in medical literature, which can be explained by the high index of exclusive muscular lesions.

Trauma cardíaco fatal na cidade de Manaus/AM, Brasil / Fatal cardiac trauma in the city of Manaus, Amazonas state, Brazil

RESUMO Objetivo: determinar o índice de trauma cardíaco fatal na cidade de Manaus e esclarecer os mecanismos de trauma e de morte, o tratamento hospitalar prévio, assim como as lesões associadas ao trauma cardíaco. Métodos: estudo retrospectivo, observacional, transversal, que revisou os laudos de necropsias do Instituto Médico Legal de Manaus entre novembro de 2015 e outubro de 2016, cuja causa mortis foi lesão cardíaca. Resultados: o índice de trauma cardíaco foi de 5,98% (138 casos) dentre 2306 necropsias realizadas no período do estudo. Homens foram afetados em 92%. A mediana de idade foi de 27 anos (14 a 83). A arma de fogo foi o mecanismo de trauma em 62,3% e a arma branca em 29,7%. A exsanguinação foi responsável pela maioria das mortes e o tamponamento cardíaco esteve presente em segundo lugar. Óbito no local ocorreu em 86,2%. Os ventrículos foram as câmaras mais lesionadas. O hemotórax foi descrito em 90,6%. Apenas 23 (16,7%) doentes foram removidos até o pronto socorro, porém seis deles (26,2%) não foram submetidos à toracotomia, apenas à drenagem de tórax. O pulmão foi acometido em 57% unilateralmente e 43% bilateralmente. Conclusão: o trauma cardíaco fatal representou um índice de 5,98% na cidade de Manaus. A maioria dos doentes morre na cena do trauma, geralmente devido à exsanguinação causada por ferimento de arma de fogo. Cerca de um quarto dos pacientes que chegaram ao pronto socorro e morreram, não foram diagnosticados com trauma cardíaco em tempo hábil.

ABSTRACT Objective: to determine the frequency of fatal cardiac trauma in the city of Manaus, Brazil, between November 2015 and October 2016, and to clarify the mechanisms of trauma and death, previous hospital treatment, as well as the injuries associated with cardiac trauma. Methods: retrospective, observational, and cross-sectional study, which reviewed the necropsy reports of individuals whose cause of death was cardiac injury. Results: the cardiac trauma rate was of 5.98% (138 cases) out of 2,306 necropsies performed in the study period by Instituto Médico Legal (IML) de Manaus (IML is a Brazilian institute responsible for necropsies and cadaveric reports). Males accounted for 92% of the cases. The median age was 27 years (14-83). Gunshot wounds (GSW) was the trauma mechanism in 62.3% and stab wound (SW) in 29.7%. Exsanguination was responsible for most of the deaths and cardiac tamponade was present in second place. On-site death occurred in 86.2% of the cases. The ventricles were the most common site of cardiac injury. Hemothorax was identified in 90.6% of the individuals. Only 23 patients (16.7%) were taken to the hospital (Emergency Room), but six (26.2%) were submitted only to chest drainage, not to thoracotomy. The lung was unilaterally affected in 57% of the cases and bilaterally in 43%. Conclusion: fatal cardiac trauma represented an index of 5.98% in the city of Manaus. Most patients die at the scene of the trauma, usually due to exsanguination caused by gunshot wound. About a quarter of patients who reached the hospital and died were not diagnosed with cardiac trauma in time.

Traumatic Diaphragmatic Hernia.

Blunt traumatic diaphragmatic ruptures are uncommon yet associated with high mortality. They occur due to blunt or penetrating thoraco-abdominal injury. Diagnosis is often missed, and a high index of suspicion is vital. They may present acutely or delayed as respiratory distress or obstruction. They can be managed through a laparotomy or a thoracotomy and in the present day with minimal access surgery. We report an interesting case of blunt traumatic diaphragmatic hernia in a 48-year-old man presenting after abdomino-thoracic injury due to fall from height. He had herniation of the colon and stomach. Through a left subcostal incision, the herniated organs were reduced, and the diaphragmatic defect closed with prolene suture.

Quilotórax bilateral posterior a trauma de tórax cerrado / Bilateral chylothorax after a blunt chest trauma

El término quilotórax se refiere a la presencia de quilo en el espacio pleural, es usualmente secundario a la ruptura del conducto torácico, a una se sus ramas o debido a alguna alteración del flujo del quilo. Algunas de sus causas: son trauma, neoplasias, misceláneas e idiopáticas. Está asociado a una alta morbilidad y mortalidad. Su manejo puede ser conservador o quirúrgico...

Trauma penetrante mediástinico por bala / Transmediastinal gunshot wound treated conservatively

Los pacientes con heridas de mediastino son sometidos en un alto porcentaje a intervenciones quirúrgicas con una alta mortalidad. Pueden agruparse en aquellos que requieren cirugía o en aquellos que serán evaluados y mantenidos en observación. El 50 por ciento de los heridos por bala en el mediastino sufrirá intervención de emergencia. La selección se efectúa según la condición hemodinámica de ingreso. Menos de un 10 por ciento de los pacientes estables requerirá una operación. Caso clínico: Presentamos el caso de un paciente varón de 22 años sin antecedentes mórbidos tratado en el Hospital Barros Luco Trudeau, herido por arma de fuego, hemodinámicamente estable cuyo proyectil ingresó por vía medioesternal, atravesando el esternón y alojándose en mediastino anterior, por delante del corazón y los grandes vasos, cuya evolución y estudio descartó lesiones viscerales. Se estudió con radiografía de tórax, ecocardiografía, tomografía computarizada (TC) de tórax con contraste y laboratorio de rutina. Se realizó monitorización, se inició tratamiento antibiótico de amplio espectro y analgesia. Su evolución fue satisfactoria. A 2 años de seguimiento se encuentra clínicamente normal. Los heridos en el mediastino, hemodinámicamente estables, pueden ser evaluados y seleccionados en forma segura con TC de tórax. Hay un grupo de pacientes sin lesión mayor, que evolucionan satisfactoriamente y que no requieren cirugía.

Patients with mediastinal trauma are subjected to numerous surgical procedures and have a high mortality. Fifty percent of patients will require emergency surgery and its indication depends on their hemodynamic condition on admission. Less than 10% of hemodynamically stable patients will require surgery. Case report: A 22 years old male with a transmediastinal gunshot wound. The bullet crossed the sternum and lodged in the anterior mediastinum in front of the heart and great vessels, without causing visceral lesions. A chest X ray, echocardiography, CT scan and routine laboratory were performed. The patient was treated with antimicrobials and analgesics with a satisfactory evolution. After two years of follow up, he is in good conditions.

Thoracoscopic and endovascular management of retained haemothoarx associated with an intercostal artery pseudoaneurysm.

Intercostal artery pseudoaneurysm (IAP) is a rare entity and may complicate a percutaneous intervention through an intercostal space or follow thoracic trauma. Its rupture into the pleural space can give rise to haemothorax, which if untreated may lead to a retained haemothorax (RH). Traditionally both the IAP and the RH are managed by a thoracotomy. We report a patient who developed an IAP with haemothorax following a trauma. The diagnosis was established by computed tomography. The patient was treated by endovascular embolisation of the IAP followed by thoracoscopic decortications of the RH.

Fractura de esternón por cornada de Buey / Sternal fracture caused by ox horns

Introducción: las fracturas de esternón son infrecuentes, por cuanto se reportan muy pocos casos en la bibliografía médica, lo que despierta gran interés conocer la conducta correcta que se debe seguir con estos enfermos. Objetivo: presentar un caso tratado y revisar la bibliografía acerca de la enfermedad. Métodos: se realizó una amplia revisión del tema y se presenta la descripción del diagnóstico y tratamiento del enfermo con una fractura esternal. Presentación del caso: paciente con fractura de esternón secundario a trauma torácico cerrado causado por cornada de buey. Luego de determinado el diagnóstico en un lapso de 4 horas se decidió la intervención quirúrgica de urgencia para realizar reducción de la fractura y osteosíntesis con alambre No 5 y lámina tubular de mediano fragmento No 20 con 6 tornillos. La ventilación mecánica como terapéutica complementaria se mantuvo durante el postoperatorio. La evolución fue satisfactoria hasta el egreso hospitalario y el enfermo permanece asintomático durante su seguimiento. Conclusiones: es factible la osteosíntesis en el esternón utilizando lámina y clavos, dando una estabilidad y consolidación del foco de fractura adecuado y sin secuelas(AU)

Introduction: sternal fractures are infrequent because they are reported in very few cases in medical literature, which arouses great interest of knowing the correct behavior to be adopted with these patients. Objective: to present a treated case and to review literature about this type of disease. Methods: an extensive literature review was made and the description of diagnosis and treatment of a patient with sternal fracture was presented. Case presentation: a patient with sternal fracture secondary to close chest trauma after the patient being gored in the thorax by an ox. After 4 hours of diagnosing process, it was decided to operate him to reduce fracture and to apply osteosynthesis with no 5 wire and no 20 medium fragment tubular plate with 6 screws. The mechanical ventilation was the supplementary therapy during the postoperative phase. The progression was satisfactory till the hospital discharge and the patient remained asymptomatic during the follow-up period. Conclusions: it is feasible to use osteosynthesis in the sternum by using plate and screws to give stability and consolidation of the fracture focus adequately without any sequelae(AU)

Landslide fatalities: A study of six cases.

A mountain collapsed on National Highway-53(NH-53) on 6th July 2011 around 2:30 p.m. A minibus which was carrying Security Personnel of Manipur Rifles (MR) and Indian Reserved Battalion (IRB) was hit by the landslide. Six occupants died on the spot and seven were injured. The cases were registered under U.D. Case no. 5/2011/G-SPM-PS and were brought to the RIMS Morgue the next day for Post Mortem Examination (PME). On PME, the victims showed general features of blunt force injuries with gross deformation and one case showed clogging of the whole respiratory tract with soil debris of the landslide. The victims died almost immediately on the spot due to vital organs injuries except in one case where it was due to traumatic asphyxia. Landslides occur frequently in these National Highways due to the hilly terrain and the perpetual rains, such major fatalities have never occurred before. Therefore the cases are reported here to analyze the types of injuries sustained, the causes of death and to discuss precautionary measures for prevention of further mishaps. This will also serve as an eye-opener to the magnitude of severity such a natural disaster.

Blunt injuries of chest: A medicolegal analysis.

Chest injuries are always a great challenge for medical professionals as two of the vital organs, which are present there, very often involved & damaged causing excessive bleeding and death. These injuries are usually caused by blunt forces or sharp penetrating weapons. Here in this paper 60 cases of chest injuries by blunt forces are studied for their epidemiological, medicolegal and clinico-pathological aspects. Most of them are adult/ middle aged male between 20-50years of age, hit or run over by heavy vehicles in road traffic accidents. Lungs are lacerated in almost all the cases and internal haemorrhage & shock is the prime cause of death. Heart, aorta & other organs were also involved in substantial number of cases. Though majority of them died within two hours, either on the spot or in the way to the hospital, an attempt is also made to correlate the prognosis & the nature of injuries.

Victim profile and pattern of thoraco-abdominal injuries sustained in fatal road traffic accidents.

The present research aims to highlight the pattern of thoraco-abdominal injuries sustained by the victims of fatal road traffic accidents (RTA) in Manipal, South India. The study is an autopsy based observation of thoraco-abdominal injuries in victims of fatal road traffic accidents during 1999 – 2003. Road traffic accidents accounted for most of the injury related deaths (77%) during the study period. A male preponderance (86%) was observed with a male-female ratio of 6:1. Individuals in the age group of 21 to 50 years formed the most vulnerable (83%) group. External thoracic injuries were more common than internal thoracic injuries in the thoracic region. In the abdominal region, internal injuries were more common than external injuries. Lungs (61%) and kidneys (23%) were the most commonly involved organs in the thoracic and abdominal regions respectively. Majority of the victims were two wheeler occupants (35%) followed by pedestrians (23%). The study indicates the pattern of thoraco-abdominal injuries sustained along with the trend of road traffic accidents in the region.

Late Simultaneous Presentation of Left Ventricular Pseudoaneurysm and Tricuspid Regurgitation after Blunt Chest Trauma

A 32-yr-old man developed progressive exertional dyspnea 4 yr after blunt chest trauma due to an automobile accident. Two-dimensional echocardiography and computed-tomographic coronary angiography demonstrated a large pseudoaneurysm of the left ventricle and severe tricuspid regurgitation. The patient underwent successful surgical exclusion of the pseudoaneurysm by endoaneurysmal patch closure and repair of the tricuspid valve regurgitation. To the best of our knowledge, this is the first case of these 2 different pathologies presenting late simultaneously after blunt chest trauma and successful surgical repairs in the published literature.

Trauma torácico severo (TTS): experiencia en el Hospital Domingo Luciani: Caracas / Severe thoracic trauma (TTS): experience in the Hospital Domingo Luciani: Caracas

Describir la incidencia y manejo del trauma torácico severo en los Servicios de Cirugía del Hospital "Dr. Domingo Luciani" durante el período 2008-2009. Estudio retrospectivo, descriptivo, transversal. Se seleccionaron pacientes diagnósticados como traumatismo torácico en el centro, que presentaron fracturas del primer, segundo o tercer arco costal, fractura escapular, fractura esternal, ó la combinación de cualquiera de estas, desde enero de 2008 hasta diciembre 2009. Se evaluo edad, sexo, evento traumático, radiología, días hospitalización, toracotomía mínima, valores de laboratorio e ingreso a UTI. El grupo mayormente afectado fue 41 a 50 años con 31,1% y el sexo masculino (68,8%) 44% Accidentes en vehículos 50,9% de los casos evidenciaron fracturas del 2do-3er arco costal, 86,6% de los casos ameritaron drenaje torácico y 11% requirieron manejo en UTI. El TTS es una entidad seria, comprende fracturas de los 3 primeros arcos costales y/o fracturas de esternón y/o fracturas de escapula. Englobamos todas estas como TTS pues hay relación probada entre estas fracturas y traumas de alto impacto, causando lesiones potencialmente fatales. Consideramos la necesidad de redefinir el término de TTS, crear un protocolo de atención y estandarización para optimizar la atención del paciente lesionado.

To describe the incidence and management of severe thoracic trauma (STT) in General Surgery Service of Hospital "Dr. Domingo Luciani" during 2008-2009 period. A retrospective study descriptive, trasnversal. Patients diagnosed with severe thoracic trauma, (first, second or third rib fracture, sternal or scapular fracture or a combination of any), during January 2008 to December 2009. We reviewed, age, sex, traumatic event, radiologic images, hospitalization time, chest tube drainage, laboratory values and ICU admission. Group most affected was 41 to 50 years (31,1%) and males (68,8%). Traffic accidents caused 44% of trauma. In 50,9%, 2nd and 3rd rib fractures was present. 86,6% Needed chest tube dranage and 11% required ICU admission. The STT is a serious entity. It is defined by fracture of any of the 3 first ribs and/or sternal or scapular fracture. We included all these injuries as STT because there is a relationship between these fractures and high energy trauma, leading to potentially fatal consequences. We consider the need of redefining the STT term, creating an approach protocol and setting it up for optimizing the injured patient attention.

Cistosarcoma phyllodes bilateral: un raro caso / Bilateral cystosarcoma phyllodes: a rare case

El cistosarcoma phyllodes es un tumor mixto poco frecuente de la mama, que contiene elementos de tejido epitelial y conectivo. Los cistosarcomas phyllodes bilaterales son raros y solo existen 7 casos publicados en la literatura. A continuación se reporta el caso de una paciente de 48 años con cistosarcoma phyllodes bilateral.

The cystosarcoma phyllodes is a less frequent breast mixed tumor, that containing both: the epithelial and the connective tissue elements. The bilateral cystosarcoma phyllodes tumors are rare and only 7 cases are recorded in the literature. We report a case of a 48 years old female patient with bilateral cystosarcoma phyllodes.

Diagnóstico de asma en el niño: [revisión] / Diagnosis of asthma in children: [review]

El asma es una enfermedad crónica inflamatoria de las vías aéreas, caracterizado por obstrucción aérea, la cual puede ser total o parcialmente reversible con o sin terapia específica. La inflamación de la vía aérea es el resultado de la interacción entre varias células, elementos celulares y citocinas. En individuos susceptibles, la inflamación aérea puede causar broncoespasmo recurrente o persistente, lo cual genera síntomas como dificultad respiratoria, falta de aliento, sensación de opresión torácica y tos. El asma infantil cuenta con varios fenotipos clínicos y diferentes estrategias terapéuticas. El diagnóstico de asma en niños necesita de un examen físico y una revisión adecuada de la historia médica actual y pasada. El diagnóstico del asma requiere de estudios especializados y descartar otras posibles causas.

Asthma is a chronic inflammatory disorder of the airway pathways characterized by an obstruction of airflow, which may be completely or partially reversed with or without specific therapy. Airway inflammation is the result of interactions between various cells, cellular elements and cytokines. In susceptible individuals, airway inflammation may cause recurrent or persistent broncho spasm, which causes symptoms including wheezing, breathlessness, chest tightness, and cough. Childhood asthma includes several different clinical phenotypes with different management strategies.The diagnosis of asthma in children requires a careful review of the child's current and past medical history, family history and a physical examination. Specialized testing is sometimes needed to diagnose asthma and to rule out other possible causes.

Penetrating chest injuries: a medicolegal analysis.

Penetrating injuries are one of the commonest methods of committing murder, of which penetrating injuries of the chest/heart are very serious and prove fatal in most of the cases (1). In a post mortem study of penetrating chest injuries at Lucknow, majority of the victims were adult male between 20-50 years of age. In majority of the cases injuries were caused by firearms usually a shot gun. Injuries by knives and daggers were also seen in few cases. Injuries were seen on the front of chest, predominantly on the left side, in majority of the cases. Lungs were damaged in all the cases. Heart; aorta & other thoracic organs were also injured in substantial number of cases. In the cases where heart was found damaged, the right ventricle was injured in majority of the cases. Two-third of the victims died within three hours after getting injuries, either on the spot or in the way to the hospital. All the cases of penetrating chest injuries were homicidal & personal rivalry was the single most common reason behind these deaths.

Evaluation of thoracic trauma in dogs and cats: a review of seventeen cases

The objective of this study was to assess the etiology, diagnosis, treatment methods, surgical findings, postoperative results and necropsy findings of seventeen cases of thoracic trauma by evaluating medical records. A car accident, falling down, stabbing and bites were identified as the causes of trauma. Diagnosed pathologies in the cases included pneumothorax, hemothorax, pulmonary contusion, lung lobe collapse or eventration, rib fractures, etc. The treatment methods employed in these cases were medical therapy, thoracocentesis, tube thoracostomy, lateral intercostal thoracotomy, median sternotomy and thoracic wall revisions. Atelectasis, rupture, laceration or contusion of the lung lobes, pulmonary artery rupture, rib fracture and etc. were the surgical findings. Overall, seven dogs and four cats recovered completely. Two dogs were euthanized due to other pathologies including multisegmental lumbar fracture, paraplegia and postpneumonectomy syndrome. Three dogs and a cat died during treatment management. The necropsies revealed that the animals had pulmonary artery and tracheobronchial ruptures. The cat also had sudden onset cardiac arrest during surgery. In conclusion, cases with thoracic trauma should be assessed closely and managed with the necessary emergency and surgical procedures