[Clinical Assessment of Spontaneous Hemopneumothorax].

We experienced 25 cases of spontaneous hemopneumothorax, in which 9 were defined as occult cases on chest X-ray at the time of visit. All 9 cases visited our hospital within 12 hours after the onset. Of these, 5 were done chest computed tomography (CT) and 3 could be diagnosed as hemopneumothorax. Emergency surgery were necessary in 4 of 9. Chest CT and careful observation is thought to be essential in case of suspiciously combined hemothorax in pneumothorax cases.

Evaluating patient self-assessment of health as a predictor of hospital admission in emergency practice: a diagnostic validity study.

BACKGROUND: Emergency departments deal with large patient loads on a day-to-day basis. The importance of patient self-assessment in the triage process has not been fully considered when determining the need for hospital admission. OBJECTIVE: To determine the validity of a series of self-administered triage questions in determining the need for hospitalisation in the emergency setting. DESIGN: Prospective cohort study. SETTING: Emergency department in a tertiary-care, municipal hospital in Japan. PARTICIPANTS: 5380 consecutive walk-in patients visiting the emergency department of Okazaki City Hospital were asked to self-evaluate the urgency and severity of their condition and their perceived need for hospital admission. These patients were then assessed by emergency physicians blinded to the results from each patient's self-assessment. MAIN OUTCOME MEASURES: Sensitivity, specificity and likelihood ratios were calculated for each self-assessment by comparing these with findings from assessments made by emergency physicians. RESULTS: Patient-perceived need for hospitalisation had a sensitivity of 0.79 (95% CI 0.76 to 0.82) and a specificity of 0.93 (95% CI 0.92 to 0.93) in determining hospital admission. The positive and negative likelihood ratios for self-assessments were 10.68 (95% CI 9.59 to 11.90) and 0.22 (95% CI 0.19 to 0.26), respectively, in the diagnosis of hospital admission (p<0.01). CONCLUSIONS: The patient self-triage questions concerning condition with five categories (medication only to life threatening) seem to supplement the triage process for hospital admission in emergency departments.

[Pyothorax due to ruptured lung abscess successfully treaed by video-assisted thoracic surgery; report of a case].

A 30-year-old female was admitted to our hospital for chest pain and dyspnea We diagnosed lung abscess of the left lung. On day 2, the patient required mechanical ventilation for pneumopyothorax due to ruptured lung abscess with acute respiratory distress syndrome. We managed this patient antibiotics, sivelestat sodium hydrate and steroid pulse therapy. Curettage and decortication for empyema cavity and closure of bronchopleural fistula was done under video-assisted thoracic surgery with minithoracotomy on day 17. Postoperative course was uneventful.

[Pleomorphic carcinoma; report of a case].

We experienced a case of pulmonary pleomorphic carcinoma. This patient was a 67-year-old male and was admitted because of an abnormal lung shadow on chest X-ray. Transbronchial biopsy was performed to the polypoid lesion of the left B10, however dignosis was not confirmed. For the shadow was strongly suspisious for lung carcinoma left lower lobectomy was performed. The resected tumor was composed of spindle cell component and basaloid squamous cell carcinoma component indicating unusual pulmonary pleomorphic carcinoma. Seventeen months after operation the patient is alive without any sign of recurrence.

Combined coronary artery re-operation and pulmonary resection for hemoptysis.

We present a 59-year-old woman who underwent combined pulmonary resection for bronchiectasis with massive, recurrent hemoptysis and redo coronary artery bypass. She had previously been hospitalized four times for massive hemoptysis. She had also undergone coronary artery bypass and had symptomatic severe graft disease. We performed simultaneous right middle lobectomy and redo triple bypass. At surgery, lobectomy was performed before heparinization, then redo bypass was performed using on-pump cardiopulmonary bypass. The postoperative course was uneventful.

Upper thoracic extralobar pulmonary sequestration with anomalous blood supply from the subclavian artery.

The authors report on a newborn boy with extralobar pulmonary sequestration in the right upper thoracic region. Preoperative angiography showed an anomalous large vessel from the right subclavian artery, supplying the sequestrated lobe. Right thoracotomy was performed to resect the sequestrated lobe, which was diagnosed as extralobar form. This is an extremely rare case of extralobar pulmonary sequestration in which anomalous blood supply from the subclavian artery was seen preoperatively on radiographs. The authors recommend angiographic examination, particularly in case of diagnostic difficulty.