Kyobu geka. The Japanese journal of thoracic surgery
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A 60-year-old man was admitted to our hospital because of impalement injury due to traffic accident. Chest X-ray on admission revealed normal lung field. CT scans of the chest and abdomen revealed slight pneumothorax and intra-abdominal organ protruding from abdominal cavity. ⋯ Impalement injuries which have aspects of both blunt and penetrating trauma are uncommon. Accordingly, wound exploration and debridement of fistulous tract are necessary. In the case of thoraco-abdominal injuries by impalement, one should bear in mind the existence of diaphragmatic injury even with normal diaphragmatic shadow on chest X-ray.
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A 41-year-old man, who had undergone descending aortic repair following rupture of the DeBakey type III aortic dissection, underwent thoracoabdominal aneurysm repair 1 year after the first surgery. The operation was performed by partial-clamping and single crossclamping without using assisted bypass or shunt, in order to minimize bleeding ensuing the re-thoracotomy and dissection between lung and the graft.
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Case Reports
[Ruptured dissecting aneurysm of the transverse arch after replacement of the descending and ascending aorta].
A 28-year-old Marfan's syndrome woman was referred to our hospital because of sudden chest and back pain. She had received replacement of the descending and ascending aorta for acute aortic dissection previously in other two institutions. ⋯ She recovered uneventfully although she had residual thoracoabdominal dissecting aneurysm. It was suggested that total arch replacement should be performed for Stanford A type dissection in Marfan's syndrome.
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Laryngeal mask which is widely used in clinical anesthesiology permits establishment of airway without tracheal intubation. Flexible bronchoscopy or bronchoscopic treatment using the laryngeal mask was evaluated to determine its safety, less invasiveness, and usefulness. Fifty-two patients underwent flexible bronchoscopy or bronchoscopic treatment using laryngeal mask 54 times. ⋯ There were three patients with sore throat and one with an unpleasant feeling in the pharynx following the examination, however, all of these complaints resolved within three days after the examination. Laryngeal masks are less invasive and have very little effect on either the respiratory system or the circulatory system. They may be used safely even in aged patients and appears to be highly effective for diagnostic and therapeutic bronchoscopy.
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A 21-year-old man; complaining of left chest pain and dyspnea, was admitted to our hospital with a diagnosis of spontaneous pneumothorax. Though chest X-ray on admission did not show hemothorax, chest drainage revealed intrapleural bleeding. As chest X-ray on the following day showed evident fluid level, emergency operation was carried out with a diagnosis of spontaneous hemopneumothorax. ⋯ The bulla was resected following hemostasis. After improvement of complicating postoperative re-expansive pulmonary edema, the patient was discharged on the 18th postoperative day. On treatment of spontaneous hemopneumothorax, existence of such a case as ours should be taken into account.