Background Damage Control (DC) has improved survival from severe abdominal and extremities injuries. The data on the surgical strategies and outcomes in patients managed with DC for severe thoracic injuries is scarce. Methods Retrospective review of the patients treated with DC for thoracic/pulmonary complex trauma at two level I trauma centers from 2006 to 2010. Subjects 14 and older, were included. Demographics, trauma characteristics, surgical techniques, and resuscitation strategies were reviewed. Results A total of 840 trauma thoracotomies were performed. Damage control thoracotomy (DCT) was done in 31 (3.7%). Pulmonary trauma was found in 25 of them. The median age was 28 (IQR 20–34) years, Revised Trauma Score was 7.11, (IQR 5.44–7.55), and Injury Severity Score was 26 (IQR 25–41). Nineteen patients had gunshot-wounds, four stab-wounds and two blunt trauma. Pulmonary trauma was managed by pneumorrhaphy in three cases, tractotomy in 12, wedge resection in one and packing as primary treatment in 8. Clamping of the pulmonary hilum was used as a last resource in 7 cases. Five patients returned to the ICU with the pulmonary hilum occluded by a vascular clamp or an en masse ligature. These patients underwent a deferred resection within 16 to 90 hours after the initial DCT. Four of them survived. Bleeding from other intra-thoracic sources was found in 20 cases: major vessels in nine, heart in three, and thoracic wall in nine. DCT mortality in pulmonary trauma was 6/25, (24%) due to coagulopathy or persistent bleeding in five cases and to multiorgan failure in one. Conclusion This series describes our experience with DCT in severe lung trauma. We describe pulmonary hilum clamping and deferred lung resection as a viable surgical alternative for major pulmonary injuries, and the use of packing as a definitive method for hemorrhage control.

ResumenEl carcinoma renal suele manifestarse clínica-mente de forma tardía, por lo que aproximadamente un tercio de los pacientes presentan metástasis a distancia en el momento del diagnóstico. En estos casos, la supervivencia disminuye drásticamente, situándose en una media de 12 meses. Se han descrito algunos casos de regresión espontánea (RE) en este tumor, que varían desde regresiones completas y duraderas hasta parciales y temporales. La RE se presenta entre el 0,4 y el 4% de los pacientes con carcinoma renal mestastásico (CRM). A pesar de estar descritos muchos factores relacionados con este raro y favorable suceso, no se conoce su verdadero origen y no es, por tanto, un evento predecible. Presentamos un caso de RE tras nefrectomía en un paciente con carcinoma renal, que presentaba metástasis pulmonares confirmadas histológicamente y recidiva local.Palabras clave: Carcinoma Renal. Regresión Espontánea. Nefrectomía. Oncología, 2006; 29 (6):263-273 SummaryThe clinical manifestations of renal cell carcinoma are often late, so that approximately one third of the patients have metastatic disease at the time of diagnosis. In this case, the survival rate diminishes dramatically, with an average survival time of 12 months. However, some cases of spontaneous regression have been reported for this kind of tumor, either complete and permanent or partial and temporary. Spontaneous regression occurs in 0.4-4.0% of the patients with metastatic renal cell carcinoma. Many factors have been proposed as related with this rare but favorable event, but until now the origin remains unknown and no prediction can be made. We present a case of renal cell carcinoma with histologic confirmation of lung metastases and local relapse showing a spontaneous regression after nephrectomy.