Patients with pectus excavatum have lower cardiac index at submaximal exercise when compared with healthy age-matched controls. Their cardiac index and FEV(1) are increased one year after the modified Nuss operation.
Patients with pectus excavatum complain about fatigue, tachypnea, discomfort and dyspnea, but the existence of an equivalent underlying pathophysiology has been questioned. We investigated 75 teenagers (49 pectus excavatum patients and 26 age matched controls) at rest and during bicycle exercise at submaximal exercise levels. At rest cardiac function was determined using echocardiography. During rest and exercise, cardiac output, heart rate and aerobic exercise capacity were measured using photo-acoustic gas-rebreathing technique for non-invasive determination of the cardiopulmonary function. At rest, no cardiac differences were found between control subjects and patients with pectus excavatum. During submaximal exercise, cardiac index was lower 6.6(6.3-7.0) l/min/m(2) among the pectus patients as compared to the control subjects 8.0(7.3-8.8) l/min/m(2), P=0.0001. The lower cardiac output among the pectus patients was due to a lower stroke index 42(39-45) ml/beat/m(2) as compared to controls 54(44-64) ml/beat/m(2), P=0.0022, whereas heart rate was unchanged. Cardiac function is significantly impaired at submaximal exercise level compared to healthy age matched controls.
Trauma-induced coagulopathy (TIC) is a risk factor for death and is associated with deviations in thrombin generation. TIC prevalence and thrombin levels increase with age. We assayed in vivo and ex vivo thrombin generation in injured patients (n = 418) to specifically investigate how age impacts thrombin generation in trauma and to address the prognostic ability of thrombin generation. Biomarkers of thrombin generation were elevated in young (< 40 years) and older (≥ 40 years) trauma patients. In vivo thrombin generation was associated with Injury Severity Score (ISS) and this association was stronger in young than older patients. In vivo thrombin generation decreased faster after trauma in the young than the older patients. Across age groups, in vivo thrombin generation separated patients dying/surviving within 30 days at a level comparable to the ISS score (AUC 0.80 vs. 0.82, p > 0.76). In vivo and ex vivo thrombin generation also predicted development of thromboembolic events within the first 30 days after the trauma (AUC 0.70–0.84). In conclusion, younger trauma patients mount a stronger and more dynamic in vivo thrombin response than older patients. Across age groups, in vivo thrombin generation has a strong ability to predict death and/or thromboembolic events 30 days after injury.
We report an unusual case of traumatic aortic rupture and lesion of the left main bronchus after blunt chest trauma in an 8-year-old otherwise healthy boy. The trauma mechanism was severe compression of the thoracic cavity underneath a heavy object without a deceleration component. The visceral lesions were disproportionally severe compared with the surface injury. This case shows the possibility of an osseous pinch after severe compression of the chest and the importance of meticulous examination and monitoring of the patient for complications afterwards.An 8-year-old boy was transferred to our institution with an aortic rupture after being caught under a tilting soccer goal frame during a match. He had been unconscious for a few moments, but on arrival at the local hospital the boy scored the full 15 points on the Glasgow Coma Scale. A left-sided tension pneumothorax was treated with a chest tube. A computerized tomographic (CT) scan showed bilateral contusions of the lungs, a small residual pneumothorax, a pneumomediastinum and a left-sided mediastinal hematoma with a possible aortic lesion at the level of the aortic isthmus, just distal to the origin of the left subclavian artery in the CT slices (Fig. 1a,b) and in a full reconstruction of the thoracic aorta (Fig. 2). The boy was transferred to our institution for surgery, awake and in a circulatory and respiratory stable condition. Because of the pneumomediastinum and the CT findings, we suspected an oesophageal or bronchial lesion This paper is available online at http://www.grandrounds-e-med.com. In the event of a change in the URL address, please use the DOI provided to locate the paper.
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