Acta Chir Belg
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A case of late diagnosis of right diaphragmatic rupture due to blunt trauma is presented. Traumatic diaphragmatic rupture is an uncommon but severe problem in a patient with multiple injuries. ⋯ Imaging studies like computed tomography, scan and magnetic resonance imaging can be helpful for differential diagnosis. Right-sided injuries occur more commonly than previously thought and often require thoracotomy.
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A 68-year old man suffered severe respiratory distress, secondary to massive pleural effusion on the right side several hours after removing the nephrostomy tube from both right and left kidneys. A chest tube was placed and a yellowish fluid was evacuated. This was found to be urine from a fistula between the right pelvis and the chest cavity. Diagnosis and management of urinothorax are discussed.
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Hypothermia has some protective effect against ischemia of the spinal cord in thoracoabdominal aneurysm repair. Its method is divided into systemic or regional cooling. Several experimental studies of the regional cooling of the spinal cord have been performed, however, clinical reports are few. The purpose of this study is to evaluate the effect and safety of perfusion cooling of the epidural space during thoracic or thoracoabdominal aortic replacement. ⋯ Perfusion cooling of the epidural space during most or all of the descending thoracic or thoracoabdominal aneurysm repair was effective in reducing postoperative spinal cord injury and a safe method in clinical situations.
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Transverse fracture-dislocations of the sacrum are rare. Associated lesions of the lumbosacral spine as well as neurological injuries are common. Conventional radiographs of the pelvis often fail to clearly visualize the fracture. ⋯ Both lesions in this patient were successfully stabilized using an internal fixator system. The other patient presented with a bilateral transforaminal sacral fracture. The transverse component was not recognized on the initial radiographs, which resulted in loss of reduction and progressive neurological disfunction after sacroiliac screw fixation.
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A retrospective analysis of 187 cases of thoracic trauma seen between January 1, 1994 and June 30, 1999 is presented. The majority of the patients were male (male-female ratio 2.9:1) and the average age at admission was 41.1 years. Blunt trauma, especially motor vehicle accidents (72.2%) and falls (17.1%), were the most frequent causes of chest injury (95.8%). ⋯ In a survival analysis the ISS was found to be the most significant determining survival (p < 0.0001), followed by neurotrauma (p = 0.05). Mortality after thoracic trauma remains relatively high, especially in case of associated neurotrauma. The ISS is a valuable score for assessing the severity of trauma and predicting outcome.