Langenbecks Archiv für Chirurgie
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Langenbecks Arch Chir · Jan 1986
Case Reports[Stab injuries of the heart--an indication for thoracotomy].
The indication for thoracotomy is undisputed with gaping wounds and massive hemorrhage. Pericardial tamponade, however, can develop with discrete stab wounds. Since valuable time is lost during management of superficial wounds, the success of cardiac wound revision, which is usually possible without a pump-oxygenator, is limited due to the tamponade-related reduction of cerebral perfusion and subsequent ischemic brain damage. Exploratory thoracotomy, the risks from which are small compared to those from pericardial tamponade, is generally indicated for stab wounds of the heart.
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The posttraumatic pneumatocele is a rare intrapulmonary lesion following blunt thoracic injury. By means of a well documented case report this rare form of lung contusion is demonstrated and the clinically important differential diagnosis is discussed.
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In 10 to 66% blunt chest traumata lead to cardiac traumata. As it is shown in our special collective (n = 12) injuries of the pericardial sac of the myocardium, of the myocardial septum, of the coronary arteries and of the cardiac valves have occurred. ⋯ Bleedings and/or pericardial tamponade caused by rupture of the atrial or ventricular wall, injury of main coronary vessels or cardiac dislocation after pericardial rupture urgently require a surgical intervention. Aneurysms caused by blunt trauma, ventricular septal defects, valve insufficiencies may be mostly treated in the interval.
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Cardiac injuries were present in 16% of our patients suffering from blunt chest trauma. 25% of these cases had no concomitant rib fractures. Sonography is extremely important for evaluation. In myocardial contusion the electrocardiogram reveals mainly disturbances in repolarisation (66 out of 108 patients) and rhythm disturbances (59 patients). ⋯ Prognosis is mainly based on additional injuries. Heart wall rupture and luxation of the heart require operative treatment. Lesions of the aortic valves are the most frequent valve injuries.
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Langenbecks Arch Chir · Jan 1986
[Functional results following conservative and surgical therapy of pathologic fractures in malignant diseases].
From 1972-1982 149 pathological fractures in 91 patients were treated. 134 of these were caused by malignant disease. With 78% metastases were the most common cause for fractures. 59% of the patients were women. The most frequent fracture localisation was the femur followed by ribs and humerus. 62% of the fractures but 100% of the leg fractures were treated operatively. ⋯ The one year survival rate was 24.6% and the two year survival rate was 9.2%. The best survival rates were observed in women, patients with breast cancer metastases, femur shaft- or subtrochanteric fractures. The lowest survival rate was found in male patients, patients with unknown primary tumour and femur neck fractures.