RESUMO
BACKGROUND: Pulmonary resection is rarely required for trauma, and its mortality is reportedly high. METHODS: A 10-year retrospective review of pulmonary resections for trauma was done. RESULTS: Of 2,455 patients with chest trauma, 183 (7.4%) underwent thoracotomy and 32 (1.3%) required pulmonary resection. Mean age was 28.4 years and mean injury severity score was 24.5. Mechanism of injury was stab wound in 14 patients, gunshot wound in 6, and blunt trauma in 12. Blunt trauma patients had a higher injury severity score (29.6) than penetrating trauma patients (21.4), but this was not significant (p < 0.07). Indications for thoracotomy were hemorrhage in 24 patients, airway disruption in 4, and other indications in 4. Operations consisted of wedge resection (19 patients), lobectomy (9), and pneumonectomy (4). Four (12.5%) patients (pneumonectomy, 2; lobectomy, 1; wedge, 1) died. Mortality for pneumonectomy was 50%, but this was not significantly higher than for lesser resections. Blunt trauma had a higher mortality (33%) than penetrating trauma (0%) (p < 0.02). Nonsurvivors had higher injury severity scores (44.2) than survivors (21.6) (p < 0.001). CONCLUSIONS: Pulmonary resection is infrequently required for lung injury. Overall mortality is lower than previously reported, but pneumonectomy has a high mortality. Blunt trauma has a higher mortality than penetrating trauma. Injury severity scores are higher for nonsurvivors than survivors; this shows the importance of associated injuries on outcome.
Assuntos
Lesão Pulmonar , Ferimentos não Penetrantes/cirurgia , Ferimentos Penetrantes/cirurgia , Adulto , Feminino , Humanos , Escala de Gravidade do Ferimento , Pulmão/cirurgia , Masculino , Pneumonectomia/mortalidade , Estudos Retrospectivos , Taxa de Sobrevida , Toracotomia , Ferimentos não Penetrantes/mortalidade , Ferimentos Penetrantes/mortalidadeRESUMO
The safety and efficacy of staging cervical mediastinoscopy is well established. Extended cervical mediastinoscopy has been proposed as a safe and effective method of staging left upper lobe lung cancers. We report a case of cerebrovascular accident complicating extended cervical mediastinoscopy.
Assuntos
Transtornos Cerebrovasculares/etiologia , Mediastinoscopia/efeitos adversos , Idoso , Carcinoma Broncogênico/patologia , Feminino , Humanos , Neoplasias Pulmonares/patologia , Linfonodos/patologia , Mediastinoscopia/métodos , Estadiamento de Neoplasias/métodos , Estudos RetrospectivosRESUMO
OBJECTIVE: To determine the optimal treatment of sylvatic cystic hydatid lung disease. DESIGN: Retrospective case study. SETTING: Five Edmonton hospitals serving northern Alberta and parts of the Northwest Territories. PATIENTS: Fourteen patients with cystic (Echinococcus granulosus) hydatid lung disease. INTERVENTIONS: Cyst enucleation, wedge resection and pulmonary lobectomy. MAIN OUTCOME MEASURES: Eradication of pulmonary hydatid disease and complications of treatment. RESULTS: Mean patient age was 32 years. Eight patients were symptomatic. Liver cysts were present in three patients. One of the three patients managed by observation required surgery for an expanding cyst. Surgery (13 procedures in 12 patients) was successful in eradicating pulmonary hydatid disease: 8 cyst enucleations, 3 wedge resections and 2 lobectomies were done. There was only one major postoperative complication (pneumatocele requiring repeat surgery). Intraoperative cyst rupture occurred in five cases, but anaphylaxis or seeding did not result. There were no bronchopleural fistulae. CONCLUSIONS: Sylvatic cystic hydatid lung disease is more benign than pastoral hydatid disease. Patients with asymptomatic cysts should be managed by observation. Surgery, consisting of endocyst enucleation or wedge resection, is indicated for symptomatic, enlarging or infected cysts.
