Vacuum Assisted Closure (V.A.C.) Therapy has previously been shown to facilitate healing of wounds. However, the physiological mechanism(s) of this treatment modality and its systemic effects require further investigations. The goal of this porcine study was to investigate the effect of V.A.C. Therapy on the systemic distribution of the inflammatory cytokines interleukin (IL)-6, IL-8, IL-10, and transforming growth factor-beta1. Twelve pigs were each given one full-thickness excisional wound, using electrocautery. Six of the pigs were treated with V.A.C. Therapy and six with saline-moistened gauze. Serum samples were collected immediately after wound creation, and hourly for 4 hours. Samples were analyzed using commercially available enzyme-linked immunosorbent assay kits. During the initial 4 hours of treatment, V.A.C. Therapy resulted in earlier and greater peaking of IL-10 and maintenance of IL-6 levels compared with saline-moistened gauze controls, which showed decreased IL-6 values over the first hour (both at p<0.05). No other treatment-based differences were detected.

P ulmonary artery pseudoaneurysms after traumatic injury are a very rare occurrence; only 14 cases have been reported in the literature. Blunt traumatic pulmonary artery pseudoaneurysms constitute a small number of these cases; only three cases have been reported to date. In every reported case of traumatic pulmonary artery pseudoaneurysm since 1920, the pseudoaneurysm was repaired operatively using local resection (aneurysectomy), ligation of vessels, lobectomy, or embolization. 1,2 We report a case of blunt traumatic main pulmonary artery pseudoaneurysm detected on initial computed tomography (CT) that was treated nonoperatively. To our knowledge, this is the first reported pulmonary artery pseudoaneurysm detected immediately on trauma assessment and also the first reported patient with traumatic pulmonary artery pseudoaneurysm treated nonoperatively that survived. CASE REPORTA 57-year-old man who was involved in a head-on motor vehicle collision as the unrestrained passenger presented awake and alert with multiple facial lacerations and unknown loss of consciousness. The patient denied any known drug allergies and took no medications. Medical history was significant for hypertension and diabetes mellitus and there was no surgical history. The patient did admit to regular alcohol and marijuana use but denied any significant family medical history. The primary survey was unremarkable. The airway was patent, Glasgow Coma Scale score was 15, and the patient seemed in no apparent distress. No additional injuries were noted and motor and sensory exams were normal. The usual resuscitation maneuvers were employed.Routine pelvis and chest x-rays were obtained. The chest film revealed minimal widening of the superior mediastinum (measured as 10 cm of 38.5 cm chest width) and tortuosity of the thoracic aorta. The pelvic film was negative. The patient had helical multidetector CT imaging without contrast of the head, face, and c-spine. The head CT was negative for intracranial injury, whereas the CT scan of the face showed minimal medial displacement of the left zygoma. In addition, helical multidetector CT imaging of the chest with intravenous contrast was obtained in addition to the usual abdomen/ pelvis CT with oral and intravenous contrast. The chest CT was added because of widened mediastinum and loss of aortic knob. The chest CT revealed a lobulated contour of the main pulmonary artery with an 18-mm probable pseudoaneurysm along the left superior margin of the main pulmonary artery (Fig. 1). A small amount of mediastinal hematoma was seen although the aorta and great vessels of the arch were intact. There was no evidence of pericardial effusion, pleural effusion, or pneumothorax. The abdomen/pelvis CT scan revealed minimal free fluid in the left upper quadrant inferior to the spleen and in the left paracolic gutter with the absence of identifiable solid organ injury.The patient was then taken for pulmonary angiography, which also revealed a lobulated appearance with a focal contour abnormality along the left anterio...

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