Minerva chirurgica
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The authors report 5 cases that presented to the emergency department of the Athens Naval and Veterans Hospital (Athens, Greece) with spontaneous pneumomediastinum. The clinical picture was not diagnostic in most of the cases, with symptoms of acute retrosternal pain and severe dyspnea in just one case. Diagnostic work disclosed the presence of mediastinal air, and after the exclusion of other diagnoses, spontaneous pneumomediastinum was treated conservatively in all cases. In this case series the authors discuss the main aspects of treatment of these patients, the value of antibiotics during the recovery period and the air distribution in the thoracic tissues.
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While the number of the patients suffering from end-stage pulmonary disease has been increasing, the most common treatment for this entity remains mechanical ventilation that entails the risks of lung damage by itself. Although the lung protective strategy for the prevention of further damage to the lung tissue has been elucidated and performed, mechanical ventilation alone as the management tactic coping with the patients of acute respiratory distress syndrome, chronic respiratory failure and lung transplantations has been a frustrated scenario. Extracorporeal membrane oxygenation or extracorporeal lung assist have been applied to these patients with occasional success, but it always accompanies difficulties such as multiple blood transfusion, labor intensity, technically complexity and tendency to infection. ⋯ It has been mostly due to the lack of the capable technologies. Entering 21st century with advent of new technology especially invention of the low resistance oxygenator, the developments of artificial lungs have entered the new stage. In this report current status of the artificial lungs will be reviewed.
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Diaphragmatic injuries are quite rare and result from either blunt or penetrating trauma. They are not always recognized at the time of injury and there is often a delay between the trauma and the diagnosis The diagnosis is confirmed by chest X-ray, USG, CT Scan and barium studies This case report discusses the delayed presentation of diaphragmatic rupture as an intrathoracic gastric volvulus observed in a 36-year-old man.
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Comparative Study
[New intraoperative therapeutic approach to control post-thoracotomy pain in patients who underwent main resection due to lung neoplasm].
The aim of this study was to determine the effectiveness of an incisional infusion of local anesthetics through a continuous-infusion elastomeric pump for the management of postoperative pain after thoracotomy. ⋯ A continuous infusion of ropivacaine at 4 mL/h through the ON-Q elastomeric infusion pump is a safe and effective adjunct in postoperative pain management after thoracotomy. The use of the ON-Q Pain Relief System results in decreased narcotic use and lower pain scores.
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The beneficial effects of minilaparotomy approach in patients undergoing abdominal aortic aneurysm (AAA) repair have been defined. In this respect, the authors compared treatment outcome and procedure-related mortality rates of minilaparotomy technique with those of open standard repair in patients with ischemic heart disease. ⋯ The minilaparotomy technique has advantages that include less postoperative morbidity and mortality rates, early resumption of intestinal functions, reduced cost, decreased length of stay in the ICU and hospital. There-fore, the authors believe that this approach is still a valid alternative approach in the treatment of patients with AAA having ischemic heart disease as a risk factor.