[Triple filling plasty in Clagett thoracostomy]. / Triple plastie de comblement d'une thoracostomie de Clagett.

Clagett's thoracostomy is a widely used procedure in the initial treatment of postpneumonectomy empyema. We describe in this paper an original one-step operation of thoracic filling after empyema sterilization. The triple plasty includes an apical thoracoplasty limited to the first 3 ribs, a pedicle flap of the latissimus dorsi transferred inside the thoracic cavity, and an upper translation of the diaphragm to the 4th rib in order to reduce residual pleural space. Three patients were operated and followed up clinically (for 20, 29, and 30 months), and radiologically with a MRI on the 12th month. Complete tissue healing and loss of all residual space was observed in all patients. We therefore recommend the use of this technique rather than thoracic wall coverage procedures.

Traumatic rupture of the thoracic aorta--case report.

Acute traumatic rupture of the thoracic aorta due to blunt trauma is a relatively common injury after deceleration accidents. However, only one fifth of these patients survive to reach medical facilities. The limiting factor to successful management is early diagnosis and prompt treatment. A case of acute traumatic rupture of the descending aorta due to blunt trauma is presented. Diagnostic and management modalities are discussed.

Penetrating carotid injuries--a wartime experience.

Thirty-nine patients with penetrating carotid injuries were treated between 1975 and 1987. All were war victims. On admission 27 (69%) had no neurologic deficit (group I), 8 (20.5%) had a mild neurologic deficit (group II), and 4 (10.5%) had a severe deficit (group III). Repair was undertaken in 38 of 39 (97.5%) patients, and carotid ligation was performed in 1 case (2.5%). Associated injuries were found in 25 (65%) patients. All patients survived. At the time of discharge all group I and II patients had a normal neurologic examination. One patient in group III recovered completely, whereas two had significant improvement. One patient remained unchanged. We conclude that repair should be attempted in all patients with carotid injuries who are seen early (less than 120 minutes) after the accident.

Emergency arteriography in the assessment of penetrating trauma to the lower limbs.

One hundred emergency arteriographies (EA) were performed in 87 patients with lower limb trauma due to high-velocity missiles. Thirteen patients had bilateral injuries. In 79 cases, EA findings were positive and led to emergency surgery. In 76 cases an arterial injury was found and treated, a positive predictive value of 96% (76/79). In the other 3 cases, no arterial lesion was found (3 false positives). Among the 21 patients with normal findings from angiography, 10 had surgical exploration because of high clinical suspicion of vascular injury. Arterial injury was found in 2 cases (2 false negatives). In 8 patients, arteriography modified the surgical procedure. In the 11 remaining patients, clinical and echo Doppler follow-up results were normal, a negative predictive value of 90% (19/21). Sensitivity was 97%, specificity 86%, and accuracy 95%. These data show that arteriography in stable patients is a safe and accurate procedure. It permits avoidance of unnecessary surgical exploration in selected patients and helps modify the surgical procedure.

[Indications for arteriography in penetrating wounds of the lower limbs]. / Indication de l'artériographie dans les plaies pénétrantes des membres inférieurs.

One hundred arteriographies were performed in emergency in 87 patients with penetrating trauma of the lower limbs caused by high- or medium-velocity projectiles (bullet or shell fragment). Thirteen patients had bilateral wounds. In 79 cases, the arteriogram was abnormal and led to surgical exploration. In 76 cases, an arterial lesion was found and treated (positive predictive value = 76/79 = 96%). In three cases, no arterial lesion was detected (3 false-positive findings). Among the 21 patients with normal arteriograms, 10 had surgical exploration because of clinical suspicion. An arterial lesion was found in 2 cases (2 false-negative findings). In the other 11 cases, the clinical and Doppler sonographic observations were normal (negative predictive value = 19/21 = 90%). The sensitivity rate was 97%, specificity 86% and accuracy 95%. In 8 cases, arteriography led to modifying the surgical procedure. These results show that preoperative arteriography, performed as an emergent examination in hemodynamically stable patients, allows avoiding surgery in some cases, and modifying the procedure in others.

Thoracic splenosis. Case report and literature review.

Thoracic splenosis is the autotransplantation of splenic tissue into the thoracic cavity after thoracoabdominal trauma. We report a case of thoracic splenosis in a 35-year-old woman who had had a thoracoabdominal gunshot wound 12 years earlier. A review of the literature revealed 15 cases already reported. All patients had an asymptomatic thoracic lesion discovered on a plain chest film 9 to 32 years (mean 16) after the initial accident. In 13 cases an operation was necessary to establish the diagnosis. In two cases technetium 99m and indium 111 scans established the diagnosis.

Penetrating wounds to the heart: a wartime experience.

Forty-nine war casualties with penetrating cardiac wounds were treated at the Hôtel-Dieu de France University Hospital between April 1975 and December 1987. All the wounds were caused by high-velocity missiles. An aggressive approach was utilized. Emergency room thoracotomy was performed in 17 "lifeless" patients, 4 of whom survived. Twenty-seven of the 32 patients who were in stable enough condition to undergo initial repair in the operating room survived. Overall survival was 63% (31/49). No intracardiac injuries were diagnosed in survivors, and no cardiac reoperations were required. Careful analysis of the trajectory of the missile or missiles and a portable chest roentgenogram were the most important factors for diagnosing a penetrating wound to the heart and for predicting potential associated injuries.

[Thoracic splenosis. Review of the literature apropos of a case]. / Splénose thoracique. Revue de la littérature à propos d'un cas.

Thoracic splenosis consists of autotransplantation of splenic tissue in the thorax following thoraco-abdominal trauma. The authors report a case of thoracic splenosis in a 35 year old woman who suffered a thoraco-abdominal gunshot wound 12 years previously. Sixteen cases of thoracic splenosis have been reported in the literature. Always asymptomatic, the thoracic lesions were discovered by chance on chest x-rays performed for various reasons 9 to 32 years after the initial trauma. Surgery was required in 13 patients in order to establish the diagnosis. In 2 cases Tc99 and Indium 111 isotope scans revealed the diagnosis, avoiding the need for surgery.

[Cardiac wounds. Experience from 10 years of war. Apropos of 32 cases treated surgically]. / Plaie cardiaque. Une expérience de dix ans de guerre. A propos de trente-deux cas opérés.

Thirty-two patients with cardiac wounds from high velocity firearms (bullets or shrapnel) were operated. Seven of these patients who had no cardiac activity on arrival underwent emergency thoracotomy with a mortality of 85%. The other twenty-five patients underwent planned sternotomy with a mortality of 12%. The authors analyse these case with emphasis on the diagnostic and therapeutic management.

Causalgia: a wartime experience--report of twenty treated cases.

During the 10-year period from 1975 to 1985 20 patients suffering from causalgia were treated. There were 15 men and five women. Ages ranged from 17 to 45 years (mean, 23). All were war casualties injured by high-velocity missiles. The median nerve was involved in eight cases, ulnar nerve in six, brachial plexus in four, sciatic nerve in four, radial nerve in three, and there were multiple nerve injuries in five cases. The diagnosis of causalgia was based on the characteristic clinical picture and was confirmed by sympathetic blocks. All patients were treated by sympathectomy and all had complete dramatic relief in the immediate postoperative period. Followup ranged from 4 months to 10 years (mean, 5.3 yr).

Simple electrodiagnostic test for Bell's palsy.

Experience with the use of a simple and practical nerve-excitability test in 56 cases of Bell's palsy has demonstrated its value in estimating prognosis and progress at an early stage of the disease.