From April 1993 to March 1998 patients with chest injuries were retrospectively assessed for the incidence, presentation, and outcome of thoracic trauma. The majority (55.6%) were less than 40 years of age and 83 (92%) were male. The mode and extent of injury, specific intrathoracic organ injuries, associated injuries, flail chest, ventilatory requirements, management, morbidity, and mortality were analyzed. Blunt injuries were seen in 56 (62.2%) and penetrating injuries in 34 (37.7%). Multiple rib fractures with hemopneumothorax was the most frequent presentation with orthopedic and head injuries being most commonly associated. Patients with tachypnea, cyanosis, lung contusion, partial pressure of aterial oxygen less than 60 mm Hg, and those with more than 6 rib fractures most often required ventilation but the majority (54.4%) were treated with a chest drain only. Emergency or delayed thoracotomy was required in 24.4%. The mortality rate was 6.7%, mainly due to respiratory insufficiency. Subcutaneous emphysema requiring releasing incisions accounted for most of the morbidity. Mean hospital stay was 9.5 days. Chest injuries were of major concern in multisystem trauma patients and early planned management is recommended in a mostly vulnerable section of our population in an age of violence and vehicular accidents.
Between 1965 and 1995, 552 patients underwent closure of isolated secundum atrial septal defect, of whom 24 (4.3%) were infants with a mean age of 238.5 ± 13.8 days (range, 90 to 348 days). Mean weight was 6 ± 0.3 kg (range, 3.5 to 9 kg). Twenty-two had noted failure to thrive and 13 had chest infections. Direct closure was carried out in 20 and 4 underwent patch closure. There were 3 (12.5%) early deaths (intraoperatively, 5 hours, and 2 days postoperatively). Three patients had pulmonary hypertension with pulmonary arterial to systemic arterial pressure ratios of 0.74 to 0.83 preoperatively. Of 21 survivors, 13 were extubated within 24 hours and 8 within 72 hours of surgery. Mean hospital stay was 16.2 ± 8.2 days. There were 2 late deaths; one from pneumonia at 177 days postoperatively and another patient with a severe neuromuscular disorder who could not be extubated, died 328 days postoperatively. We concluded that some infants require early surgery and an atrial septal defect can be closed safely in infancy but the risk increases in patients with pulmonary vascular disease. The etiology of pulmonary vascular disease in such patients remains unclear.
From January 1995 to December 1996 patients with mitral stenosis underwent surgical valvotomy and another 50 had balloon mitral valvuloplasty. Balloon valvuloplasty was performed by the Inoue technique and surgical closed mitral valvotomy was carried out through a standard anterolateral thoracotomy with transventricular repeated Tubbs or finger dilatation. Functional status, left atrial mean transmitral gradient, mitral valve area, and left atrial size were recorded. No significant difference was found between the values of these parameters in the 2 groups of patients at the end of the study. consecutive patients with mitral stenosis who were suitable for either CMV or BMV were alternately assigned to one or other procedure. Echocardiography and cardiac Doppler studies were performed with a Sonos 1500 system (HewlettPackard, Rockville, MD, USA). The mitral valve orifice area was determined by the pressure half-time method on Doppler echocardiography. Fifty patients underwent CMV by standard transventricular Tubbs dilatation with or without finger dilatation and 50 had BMV by the Inoue balloon (Toray Medical, Tokyo, Japan) technique.Patients undergoing BMV were managed by cardiologists in the cardiac care unit and those undergoing CMV were managed in the postoperative intensive care unit. Postoperative echocardiography was performed on the 3rd post-procedure day, with follow-up echocardiography after 6 months and one year. On follow-up, the patients were also assessed for cardiac rhythm, New York Heart Association functional class, medication, and the presence or progression of the same or other valvular lesions. Results were compared by the Student t test.
A 35-year-old tiiale iuiclenveiit eniergeticy pericardiectoniy for repeated tanipoiincle. A conipirted toniograpliy scan of the thorax showed a consolidated luiig lesiori with pleural effirsioii. Emergency aspiration renioiied heniorrhagic pericardial fliiid arid straw colortd pleirral effirsioii. Botli fluids tested negative for nialignant cells. He later ioidenvent ci pneirnionectoniy after. a biopsy reilealed car-ciiionia of the lirtig. The case is reported to illirstrate this rare presentation of bronchoalt*eolnr carcitionia.
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