Penetrating chest injuries are a challenge to the thoracic or trauma surgeon. Penetrating thoracic trauma, especially that due to high-velocity gunshot wounds, is increasing at an alarming rate in our region. We report our experience with penetrating chest injuries mainly due to high-velocity gunshot wounds. During a period of 6 years we retrospectively reviewed the hospital records of 755 patients admitted to the Department of Thoracic and Cardiovascular Surgery, Dicle University School of Medicine, with the diagnosis of penetrating thoracic trauma. The mean age was 27.48 years, and 89-8% were male. The causes of penetrating injury were stab wounds in 45.3% and gunshot wounds in 54.7%. About 30% of the wounds were due to high-velocity gunshots; and among the gunshot wounds 56.2% were due to high-velocity shots. The most common thoracic injury was hemothorax (n = 190) followed by hemopneumothorax (n = 184). Isolated thoracic injuries were found in 53% of the patients. Nonoperative management was sufficient in 92% of the patients. Thoracotomy was performed in 8.1%. The mean duration of hospitalization was 11.2 days. The mean injury severity score (ISS) was 20.17 +/- 13.87. The morbidity was 23.3% and the mortality 5.6%. Fifty percent of all deaths were due to adult respiratory distress syndrome. Altogether 17% of patients with an ISS > 25 died, whereas only 0.9% of those with a score < 16 died. The mortality due to firearms was 8.95%. We concluded that in civilian practice chest tube thoracostomy remains by far the most common method of treating penetrating injury to the chest. The easy availability of high-velocity guns will continue to increase the number of civilians injured by these weapons.

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Sixteen patients were treated for traumatic oesophageal perforation (13 cervical, 3 thoracic) over a 16-year period. In 14 cases the trauma was penetrating. The median delay from injury to treatment was 32 hours and the mean period of hospitalization was 26 days. The treatment procedures were two-layer primary closure with or without drainage, drainage alone and near-total oesophageal exclusion with cervical T-tube oesophagostomy. Postoperative complications were cervical oesophageal leak in two patients and tracheo-oesophageal fistula and oesophageal stenosis, each in one case. Of the eight patients treated within 24 hours of perforation, two died, and of the eight treated later, four died (overall mortality 37.5%). The heightened mortality after delayed diagnosis illustrates the prognostic importance of a high index of suspicion. To prevent leakage, buttressing with viable tissue following primary closure can be useful, especially after delayed diagnosis. Because of the continuing controversy concerning management of late-diagnosed oesophageal perforation, individualized treatment is widely advocated.

Background:Pneumothorax is common and life-threatening clinical condition which may require emergency treatment in Emergency Medicine Departments.Objectives:We aimed to reveal the epidemiological analysis of the patients admitted to the Emergency Department with pneumothorax.Material and Methods:This case-control and multi-center study was conducted in the patients treated with the diagnosis of pneumothorax between 01.01.2010-31.12.2010. Patient data were collected from hospital automation system. According to the etiology of the pneumothorax, study groups were arranged like spontaneous pneumothorax and traumatic pneumothorax.Results:82.2% (n = 106) of patients were male and 17.8% (n = 23) of patients were female and mean age were 31.3 ± 20,2 (Minimum: 1, Maximum: 87). 68.2% (n = 88) of patients were spontaneous pneumothorax (61.36%, n=79 were primary spontaneous pneumothorax) and 31.8% (n = 41) of patients were traumatic pneumothorax (21.95% were iatrogenic pneumothorax). Main complaint is shortness of breath (52.3%, n=67) and 38% (n=49) of patients were smokers. Posteroanterior (PA) Chest X-Ray has been enough for 64.3% (n = 83) of the patients' diagnosis. Tube thoracostomy is applied to 84.5% (n = 109) of patients and surgery is applied to 9.3% (n = 12) of patients and 6.2% (n = 8) of patients were discharged with conservative treatment. Spontaneous pneumothorax showed statistically significant high recurrence compared with traumatic pneumothorax (P = 0.007). 4.65% of (n = 6) patients died. The average age of those who died (9.3 ± 19.9), statistically were significantly lower the mean age of living patients (32.4 ± 19.7) (t test, P = 0,006). 83.33% of the patients who died were neonatals and in the 0-1 years age group, and five of these patients were secondary spontaneous pneumothorax, and one of these patients were iatrogenic pneumothorax due to mechanical ventilation.Conclusions:Pneumothorax in adults can be treated by tube thoracostomy or surgically. Despite treatment, mortality of secondary and iatrogenic pneumothorax in newborns and 0-1 years age group is high.