Clinical Outcomes of Minimally Invasive Surgical Stabilization of Rib Fractures Using Video-Assisted Thoracoscopic Surgery.

Background: Multiple rib fractures are common in blunt chest trauma. Until recently, most surgical rib fixations for multiple rib fractures were performed via open thoracotomy. However, due to the invasive nature of tissue dissection and the resulting large wound, an alternative endoscopic approach has emerged that minimizes the postoperative complications caused by the manipulation of injured tissue and lung during an open thoracotomy. Methods: Our study concentrated on patients with multiple rib fractures who underwent surgical stabilization of rib fractures (SSRF) between June 2018 and May 2020. We found 27 patients who underwent SSRF using video-assisted thoracoscopic surgery. The study design was a retrospective review of the patients' charts and surgical records. Results: No intraoperative events or procedure-related deaths occurred. Implant-related irritation occurred in 4 patients, and 1 death resulted from concomitant trauma. The average hospital stay was 30.2±20.1 days, and ventilators were used for 12 of the 22 patients admitted to the intensive care unit. None of the patients experienced major pulmonary complications such as pneumonia or acute respiratory distress syndrome. Conclusion: Minimally invasive rib stabilization surgery with the assistance of a thoracoscope is expected to become more widely used in patients with multiple rib fractures. This method will also assist patients in a quick recovery.

Traumatic coronary artery dissection misdiagnosed as stress-induced cardiomyopathy in a patient with multiple trauma.

Traumatic coronary artery dissection resulting from blunt trauma, is a relatively rare and life-threatening event. We present a case report of a 42-year-old male who presented with electrocardiogram abnormality and cardiac enzyme elevation following a fall from a height of 3 m. The patient was misdiagnosed with stress-induced cardiomyopathy because of the absence of clinical signs of acute coronary syndrome. The patient was subsequently diagnosed with traumatic coronary artery dissection using coronary angiography, and the relevance of the trauma was confirmed using intravascular ultrasonography (IVUS). Herein, we highlight that trauma team should maintain a high suspicion of traumatic coronary artery dissection, although the early recognition of traumatic coronary artery dissection can be difficult. Additionally, the importance of coronary angiography with IVUS modalities for the evaluation of traumatic coronary artery dissection is highlighted.

Successful management of traumatic giant pulmonary hematoma in poly-trauma patient.

Traumatic pulmonary giant hematoma, resulting from blunt trauma, is a relatively rare event. Here, we report the rare case of a patient with a giant traumatic pulmonary hematoma that was associated with blunt trauma. A 50-year-old man was admitted to our medical center after a fall from a height of 5 m. He was diagnosed with pulmonary contusion, and tests showed a huge pulmonary hematoma of approximately 8.2 × 5.3 × 13.2 cm in the left lung field along with other significant injuries. Treatment comprised of aggressive coagulation management, broad-spectrum antibiotics, and pulmonary hygiene. The patient's symptoms gradually improved and magnetic resonance scan revealed that he did not develop an abscess formation. No complications were seen at the 6 months follow-up visit. If the above mentioned measures would have failed to control the bleeding or secondary infection, then emergency surgery would have been warranted. Awareness of this kind of injury and efforts to reduce infection are important to guide the giant traumatic pulmonary hematoma to the benign course.

Acute Type A Aortic Dissection in a Patient with Situs Inversus Totalis.

We describe the occurrence of acute type A aortic dissection in a patient with situs inversus totalis. A 37-year-old man presented to the emergency department with acute chest pain. Initial chest X-ray findings showed a right-sided heart and a left-sided liver. Contrast- enhanced computed tomography revealed a Stanford type A acute aortic dissection, aortic root dilatation, and situs inversus totalis. All of the thoracic structures were mirror-image reversed and an abnormal coronary artery was observed. The Bentall operation was performed. This report demonstrates that computed tomography and echocardiography were useful for understanding the anatomy and the presence or absence of concurrent anomalies in a patient with situs inversus totalis. The patient's postoperative course was uneventful.

A 31-year-old pericardial textiloma.

Gossypibomas are uncommon but important complications of surgery. This case report is of a gossypiboma found accidentally 31 years after heart surgery. A 41-year-old man had lost 5 kg in the previous three months and suffered from intermittent epigastric discomfort. A computed tomography scan incidentally revealed a well-defined mass in the right lower anterior mediastinum. Given his history of previous cardiac surgery to repair a ventricular septal defect, the possibility of gossypiboma could not be excluded. Elective excision of the mass was performed through a median sternotomy, and a 5-cm ovoid mass consisting of a thrombus and gauze was removed. The postoperative course was uneventful. The patient's clinical findings were normal, with no abnormal findings on transthoracic echocardiogram performed one year later.

Extracorporeal Cardiopulmonary Resuscitation with Therapeutic Hypothermia for Prolonged Refractory In-hospital Cardiac Arrest.

BACKGROUND AND OBJECTIVES: We identified the impact of extracorporeal cardiopulmonary resuscitation (ECPR) followed by therapeutic hypothermia on survival and neurologic outcome in patients with prolonged refractory in-hospital cardiac arrest (IHCA). METHODS: We enrolled 16 adult patients who underwent ECPR followed by therapeutic hypothermia between July 2011 and December 2015, for IHCA. Survival at discharge and cerebral performance category (CPC) scale were evaluated. RESULTS: All patients received bystander cardiopulmonary resuscitation (CPR); the mean CPR time was 66.5±29.9 minutes, and the minimum value was 39 minutes. Eight patients (50%) were discharged alive with favorable neurologic outcomes (CPC 1-2). The mean follow-up duration was 20.1±24.3 months, and most deaths occurred within 21 days after ECPR; thereafter, no deaths occurred within one year after the procedure. CONCLUSION: ECPR followed by therapeutic hypothermia could be considered in prolonged refractory IHCA if bystander-initiated conventional CPR is performed.

Influence of old pulmonary tuberculosis on the management of secondary spontaneous pneumothorax in patients over the age of 70 years.

BACKGROUND: This study aimed to investigate the treatment outcomes and influence of old pulmonary tuberculosis (TB) in elderly patients (over 70 years) with secondary spontaneous pneumothorax (SSP). METHODS: A retrospective analysis was performed on patients with SSP between January 2002 and December 2014. Treatment outcomes including chest tube duration (CTD), type and complication of surgery, recurrence and survival rate were obtained from the review of medical records and analyzed statistically. RESULTS: Two hundred and sixteen consecutive cases were recruited. Of these, 134 (62.0%) did not have old pulmonary TB [non-tuberculosis (NTB) group], and the other 82 (38.0%) had experienced pulmonary TB (TB group). More thoracoscopic surgeries had been performed in the NTB group (P=0.038). More postoperative complications developed in the TB group (P=0.038). Total CTD and postoperative CTD in the TB group were significantly longer (P=0.015 and 0.030, respectively). However, recurrence-free survival and overall survival rate were not significantly different between the TB and NTB groups. CONCLUSIONS: Old pulmonary TB in elderly patients with SSP made their treatment more complicated. However, surgery might be considered in highly selected patients regardless of old pulmonary TB, and could be conducted with acceptable morbidity and mortality.

Staged Management of a Ruptured Internal Mammary Artery Aneurysm.

The rupture of an internal mammary artery (IMA) aneurysm in a patient with type 1 neurofibromatosis (NF-1) is a rare but life-threatening complication requiring emergency management. A 50-year-old man with NF-1 was transferred to the emergency department of Kyungpook National University Hospital, where an IMA aneurysmal rupture and hemothorax were diagnosed and drained. The IMA aneurysmal rupture and hemothorax were successfully repaired by staged management combining endovascular treatment and subsequent video-assisted thoracoscopic surgery (VATS). The patient required cardiopulmonary cerebral resuscitation, the staged management of coil embolization, and a subsequent VATS procedure. This staged approach may be an effective therapeutic strategy in cases of IMA aneurysmal rupture.

Surgical treatment of extensive tumoral calcinosis associated with systemic sclerosis.

Extensive tumoral calcinosis affecting a large joint is uncommon in patients with systemic sclerosis. We report the case of a 52-year-old female patient referred for a growing calcified mass in the shoulder. She was diagnosed with interstitial lung disease and progressive systemic sclerosis. Although the pain and disability associated with the affected joint was not severe, the patient underwent surgical excision because the mass continued to grow and was likely to produce shoulder dysfunction and skin ulceration. The patient appeared well 10 months after surgery with no signs of recurrence. This report highlights the timing and indication of surgical excision in similar cases.

Is primary spontaneous pneumomediastinum a truly benign entity?

OBJECTIVE: This study aimed to investigate the benignancy of primary spontaneous pneumomediastinum (PSP), and to establish an appropriate management strategy. METHODS: Patients diagnosed with PSP between January 2003 and December 2013 were analysed retrospectively. From January 2013 onwards, a simplified protocol, with consensus for the management of PSP, was applied in our hospital. RESULTS: In total, 37 patients were identified as having PSP during the study period. Among them, 27 were enrolled prior to applying the new protocol. Among these patients, extra diagnostic tests, in addition to chest radiography (CXR) and chest computed tomography (CT), were performed in 15 patients (55.5%). In the pre-protocol decade, a total of 15 patients (55.5%) were initially fasted and 16 (59.3%) were administered antibiotics. Mean hospital stay was 2.9 days (range, 0-5 days). No patient developed complications during the hospital stay and outpatient follow up. Since the revised protocol was in practical use, 10 consecutive patients with PSP were enrolled and reviewed. No additional diagnostic imaging studies or procedures (except for CXR and chest CT) were performed in these patients; furthermore, diet was not restricted and prophylactic antibiotics were not prescribed. Mean hospital stay was 14.5 h (range, 1-34 h). No complications were observed in any of the patients. CONCLUSIONS: Our management protocol (i.e. routine check of chest CT without any additional diagnostic tests, no special treatment, and early discharge with short-term follow up) may be safe and feasible for the treatment of PSP.

Recurrent pneumomediastinum in two young adults.

Spontaneous pneumomediastinum (SPM) is an uncommonly encountered entity. In addition, due to its rarity, little is known about recurrent SPM. We report on two exceptional cases of recurrent pneumomediastinum. One was a 16-year-old male whose first episode was accompanied by blunt chest trauma followed by a spontaneous second episode with a free interval of 17 months. The other case was a 17-year-old male whose presenting symptom was right and left pleuritic chest pain, respectively, without any predisposing or precipitating factors. We diagnosed these patients without performing invasive procedures and administered conservative management with success.

Spontaneous pneumomediastinum with concurrent pneumorrhachis.

Spontaneous pneumomediastinum is a very uncommon entity that is defined as the presence of free air in the mediastinum without an obvious etiology. The presence of air in the spinal canal, known as concurrent pneumorrhachis, is an extremely rare epiphenomenon of spontaneous pneumomediastinum. We report a rare case of spontaneous pneumomediastinum with pneumorrhachis associated with influenza. The patient was diagnosed without invasive procedures, was managed with supportive treatment, and recovered without any complications.

Operative management in a patient with scapulothoracic bursitis.

Scapulothoracic bursitis, an uncommon lesion, has been reported to be a painful disorder of scapulothoracic articulation. The articulation may become inflamed secondary to trauma when overused because of sports or work that requires repetitive or constant movement of the scapula against the posterior chest wall. The bursitis usually appears as a growing mass at the scapulothoracic interface and is often confused with a soft tissue tumor. We report on a patient with scapulothoracic bursitis who underwent surgical excision.