The Annals of thoracic surgery
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Blunt chest trauma can result in cardiac injury with consequent dysrhythmias, valve malfunction, or frank rupture. Typically, patients with blunt chest trauma and suspected cardiac injury have required cardiac monitoring for 48 to 72 hours. Predicting which patients with blunt chest trauma are not at risk for cardiac complications would obviate many patient-hours of monitoring in the intensive care unit. ⋯ Eighty-four patients (73%) had normal two-dimensional echocardiograms, and a cardiac complication requiring treatment developed in only 1 (1.2%) of them. Of the 9 patients who required treatment of cardiac complications, 3 had normal admission electrocardiograms and only 1 had elevated levels of the myocardial-specific isoenzymes of creatine kinase. We believe two-dimensional echocardiography is a sensitive test for evaluating cardiac injury resulting from blunt chest trauma and is helpful in selecting those patients who require monitoring in the intensive care unit.
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Review Case Reports
Swan-Ganz catheter-induced massive hemoptysis and pulmonary artery false aneurysm.
Swan-Ganz catheter-induced massive hemoptysis and later pulmonary artery false aneurysm occurred in a patient with prosthetic mitral regurgitation. This patient was successfully managed by double-lumen endotracheal intubation, control of pulmonary hypertension, reversal of anticoagulation, mitral valve re-replacement, and transcatheter embolization. The pertinent literature is reviewed.
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Case Reports
Tracheal and main bronchial disruptions after blunt chest trauma: presentation and management.
Tracheobronchial disruption is one of the less common injuries associated with blunt thoracic trauma. This injury can be life threatening, however, and failure to diagnose it early can lead to disastrous acute or delayed complications. Nine cases of tracheobronchial disruption in the setting of nonpenetrating thoracic trauma were seen at four Los Angeles trauma centers between 1980 and 1987. ⋯ Radiographic findings were most commonly pneumothorax, pneumomediastinum, and clavicle or rib fractures. Rigid bronchoscopy and fiberoptic bronchoscopy were both highly accurate methods for diagnosis but only in the hands of trained cardiothoracic surgeons. Delay in diagnosis increased the likelihood of postoperative complications.
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Review Case Reports
Pharyngoesophageal perforation after blunt neck trauma.
Pharyngoesophageal perforation secondary to blunt neck trauma is an uncommon injury that can cause serious morbidity and mortality if not recognized and treated. Pharyngeal perforation secondary to blunt trauma sustained while boxing is reported. ⋯ Analysis of these cases indicates that perforations less than 2 cm and limited to the pharynx may be treated medically with close observation. Large perforations and those perforations that extend to the esophageal inlet or involve the esophagus exclusively are best treated surgically.
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Ischemic spinal cord injury after aortic cross-clamping may be produced by a steal phenomenon. The present study investigates this possibility by directly measuring the oxygen tension on the spinal cord surface in pigs. After simple clamping of the aorta, oxygen tension decreased significantly distal to the clamping site both after occlusion of the thoracic aorta at T3-4 (group 1) and after occlusion of the abdominal aorta at L-1 (group 2). ⋯ We conclude that after aortic cross-clamping, blood tends to drain away from the spinal cord rather than supplying it longitudinally. Without knowledge of the position of the Adamkiewicz artery in humans as well as of the competence of the collateral circulation in the excluded segment, it is necessary to develop a new strategy for repair of the aorta. We describe and discuss two surgical techniques for the prevention of paraplegia after aortic cross-clamping: the counterocclusion technique and the bypass fractionated technique.