Determination of the chest wall thicknesses and needle thoracostomy success rates at second and fifth intercostal spaces: a cadaver-based study.

INTRODUCTION: The purposes of this study were to measure the chest wall thicknesses (CWTs) at second intercostal space (ICS) mid-clavicular line (MCL) and fifth ICS MAL directly, and compare the actual success rates of needle thoracostomies (NTs) by inserting a 5-cm-long syringe needle. Predictive values of weight, body mass index (BMI) and CWT were also analyzed. MATERIALS AND METHODS: This study included 199 measurements of 50 adult fresh cadavers from both hemithoraces. Five-centimeter-long syringe needles were inserted and secured. Penetration into the pleural cavity was assessed, and CWTs at 4 locations were measured. Achieved power of this study for the primary aim of CWT comparison from 2nd and 5th ICSs was .94. RESULTS: Overall mean CWTs at 2nd ICS MCL and 5th ICS MAL were measured as 2.46 ± 0.78 and 2.89 ± 1.09, respectively, and 5th ICS MAL was found to be statistically thicker (P = .002). The success rate of NT at 2nd ICS MCL was 87% (95% CI, 80-94), and that at 5th ICS MAL was 78% (95% CI, 70-86; P = .3570). Only 6 (17.1%) of 35 failed NTs had a CWT greater than 5-cm. Needle thoracostomy has failed in 29 (14.9%) of 194 locations, despite a CWT less than 5-cm. Below a weight of 72 kg, BMI of 23 kg/m2, or CWT of 2.4 cm, all NTs were successful. DISCUSSION AND CONCLUSIONS: In this report, we present the largest cadaver-based cohort to date to the best of our knowledge, and we observed a statistically nonsignificant 9% more NT success rate at 2nd ICS at a power of 88% and statistically significant more success rate in males at 5th ICS was (47.7%). We also observed thinner CWTs and higher success rates than previous imaging-based studies. A BMI of 23 kg/m2 or less and weight of 72 kg or less seem to accurately rule-out NT failure in cadavers, and they seem to be better predictors at the bedside.

Incidentally Detected Lithopedion in an 87-Year-Old Lady: An Autopsy Case Report.

A lithopedion is a rare complication of pregnancy that occurs when a fetus in an intraabdominal location dies, and it is too large to be reabsorbed by the body. The case was an 87-year-old woman, and she was transferred to the morgue department in April 2014 to determine the cause of death. During autopsy, an intraabdominally located calcified dead fetus and a 12-cm diameter calcified cyst in the right ovary were incidentally detected. It was aged 25 to 29 weeks (according to femur and humerus measurements) with a size of 12.5 × 8 × 5 cm and a weight of 227 g. According to investigation reports, her husband died in 1990, and she had 3 deliveries, the most recent of which was in 1946. Because the menopause age of the case was not exactly known, the retention time of the lithopedion was supposed to be 24 to 68 years according to the date of the most recent pregnancy and the date of her spouse's death. It is the first case that has been incidentally detected and identified during an autopsy in Turkey and also one of the oldest cases in the literature.

[Widespread mesenteric venous thrombosis and cirrhosis diagnosed with autopsy]. / Otopsi ile tanisi konulan yaygin mezenter ven trombozu ve siroz.

Mesenteric venous thrombosis is a rare disorder with a high mortality rate. Since patients remain asymptomatic, diagnosis of the disease is difficult. Diagnosis can be mainly made with either laparotomy or autopsy. Many factors are considered in the etiology of mesenteric venous thrombosis. Liver cirrhosis and chronic pyelonephritis, which we detected in the autopsy and histologic examination of our case, are considered as two of the factors. In our study, it was aimed to present a case with near-total intestinal necrosis caused by portal vein thrombosis which spread to the lineal vein, pancreatic vein and to the branches of superior mesenteric veins.