The Annals of thoracic surgery
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The use of talc in the infected pleural space has not been reported previously. Five patients who had empyema of the pleura in the fibrinopurulent stage and did not respond to treatment with tube drainage and antibiotics were treated by talc insufflation to stimulate pleural adhesions. ⋯ No untoward effects were observed. These results suggest that talc pleurodesis may be an acceptable solution to the problem of empyema resistant to other methods of treatment.
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Case Reports
Combined tracheal transection and innominate artery disruption from blunt chest trauma.
Both transection of the trachea and injury of the aorta and its arch vessels can occur after blunt chest trauma; however, the combination of these injuries in 1 patient is exceedingly rare. This report of a patient with distal trachea transection and proximal innominate artery disruption from blunt chest trauma reviews some of the important factors to be considered in managing these injuries. ⋯ The use of prosthetic materials should be avoided in vascular injury repair due to contamination of the field from the associated airway disruption. Attention to postoperative bronchial hygiene is mandatory for successful outcome after tracheal anastomosis.
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Comparative Study
A comparison of pulmonary function tests for postthoracotomy pain using cryoanalgesia and transcutaneous nerve stimulation.
The beneficial effects of transcutaneous nerve stimulation (TNS) and cryoanalgesia for post-thoracotomy pain were compared against each other and against a control group through pulmonary function testing in the immediate and delayed postoperative period. Patients receiving cryoanalgesia did not perform well in the first 24 hours after operation. However, by the fifth postoperative day, they did as well as or even better than the TNS patients. Both cryoanalgesia and TNS were significantly effective in the management of postoperative pain as compared with controls.
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Doppler echocardiography was used to determine the site and size of a ventricular septal defect in a patient with a penetrating wound of the heart. Additional physiological measurements by Doppler study, including pulmonary artery pressure and degree of left-to-right shunting, were helpful in deciding on surgical closure of the defect as the definitive therapy in this patient. Associated intracardiac defects (e.g., mitral or tricuspid regurgitation) can be excluded by Doppler echocardiography.
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One hundred six consecutive patients with injuries to the tracheobronchial tree who were admitted to the emergency room of the Tulane Medical Center Hospital or the Charity Hospital of Louisiana at New Orleans over a period of almost 20 years were analyzed retrospectively. Penetrating trauma of the neck or chest was reported in 100 of the patients, and only 6 had blunt trauma to the neck or thorax as the cause of injury. There were 18 deaths among the 106 patients (16.98%), including 11 (13.75%) of 80 with injuries of the cervical trachea. ⋯ Hemoptysis was an unreliable signal of serious injury, being present in only 28 of the patients. Patients who had major vascular injuries combined with trachea involvement were generally not salvageable. In regard to morbidity and mortality, the most common preventable errors were delay in diagnosis and treatment of tracheobronchial injuries, missed esophageal injuries, massive aspiration of blood, and abdominal vascular injuries.(ABSTRACT TRUNCATED AT 250 WORDS)