Hemothorax as the Clinical Presentation of a Pancreaticopleural Fistula: Report of a Case

Pancreaticopleural fistula is a rare complication of acute pancreatitis with pancreatic pseudocyst. We report the case of a 39-year-old man admitted for respiratory distress. Chest X-ray showed a pleural effusion, and thoracentesis yielded bloody fluid. Computed tomography (CT) scan showed a multiloculated pleural effusion and sagittal reconstruction revealed a fistulous tract between the pleura and a pancreatic pseudocyst. We treated the acute hemothorax complicating the pancreaticopleural fistula by performing urgent thoracotomy with the evacuation of blood and clots and lung decortication. We also gave the patient somatostatin and performed endoscopic retrograde cholangiopancreatography with sphincterotomy, and placed a pancreatic stent. The patient recovered well.     

Unanticipated hemothorax during general anesthesia

We experienced a case of uncommon spontaneous hemothorax during general anesthesia. A 72-year-old woman underwent emergency repair of damaged ascending colon. Her chest roentgenogram before surgery revealed no abnormalities. After the uneventful surgery, the trachea was extubated and the patient breathed without difficulty with stable vital signs. However, the S_{p O 2} varied around 95% with a 100% oxygen mask. Chest roentgenogram obtained after extubation showed a massive amount of fluid in the pleural cavity. A chest drainage tube was inserted, and approximately 1000ml of frank blood was drawn without air leakage. Thereafter, her oxygenation remarkably improved. We could not determine the etiology of the hemothorax.     

Late-onset hemothorax after the Nuss procedure for funnel chest

A 4-year-and-3-month-old boy with funnel chest underwent the Nuss procedure. He had an uneventful intraoperative and postoperative course, and was discharged on the tenth day of hospitalization. He developed chest pain while playing on the 29th day after surgery, and was diagnosed with right hemothorax. He was followed conservatively and the hemothorax disappeared.     

胸外伤230例报告

本文报告1976～1987年收治的胸外伤230例,以男性、农民、21～50岁的青壮年受伤最多。在致伤原因中,车祸占第一位,而斗欧也不容忽视。在诊疗过程中,本文强调:一抓“早”,二要“全”(即全面检查、全面分析),三是“定”(即定部位、定程度、定方案),四“注意”(即注意轻重缓急、注意动态观查、注意中西医结合、注意基本理论的学习和基本技能的锻炼)。     

Right hemothorax after a Nissen fundoplication

Nissen fundoplication is one of the most popular techniques for treatment of patients with gastroesophageal reflux. There may be several complications, some common to any laparotomy and others specific to the fundoplication. We have recently observed an unusual complication: a right hemothorax from a perforated fundoplication that had not herniated into the thorax. The absence of abdominal symptoms made the diagnosis difficult and delayed surgical therapy.     

Hemothorax in the newborn

Twenty cases of hemothorax in newborns, including 4 of our own patients, are reviewed in detail. This unusual cause of acute respiratory distress within the neonatal period was observed in 14 males and 6 females. Most of the patients were full-term newborns. As causal factors hemorrhagic disease of the newborn (vitamin K deficiency), disseminated intravascular coagulation, arteriovenous malformations and pleura/vvascular rupture are considered. The time of occurence of bleeding symptoms ranged from 1 to 28 days of life. Sixteen out of 20 patients survived without sequelae, but in 4 cases the outcome was lethal.Dedicated to Prof. Dr. H. Plückthum on occasion of his 60th birthday     

脊柱骨折合并多发肋骨骨折的麻醉处理

目的：探讨脊柱骨折合并多发肋骨骨折的麻醉管理方法。方法：对56例需要在伤后24h内行后路手术的脊柱骨折合并多发肋骨骨折的病人进行前瞻性研究。根据具体情况予以分组，施行不同的麻醉，A组：胸，腰椎脊柱骨折伴截瘫合并多发肋骨骨折，无血气胸，局麻加强化麻醉。B,组：胸，腰椎脊柱骨折伴截瘫合并多发肋骨骨折，有血气胸，静脉全麻。结果：52例顺利完成手术，术中以脉搏氧饱和度各组之间有差异，但不影响手术。结论：脊柱骨折合并多发肋骨骨折的麻醉方法应根据具体情况加以选择，重点是呼吸保障。     

创伤性血胸观察治疗失败的危险因素分析

目的分析探讨创伤性血胸观察治疗失败的危险因素。方法收集2012年1月至2018年12月期间胸腔外科收治的54例次行观察治疗的创伤性血胸患者临床资料,分析其治疗效果。通过多因素分析观察治疗失败的危险因素。结果观察治疗总失败率为59.26%(32/54)。观察治疗失败组在血胸量、住院时间、合并气胸、大于3根肋骨骨折患者比例等方面均明显高于治疗成功组(P<0.05)。观察治疗失败的独立危险因素是合并气胸(OR=9.529,95%CI:1.988~45.580,P=0.005)和肋骨骨折大于3根(OR=5.535,95%CI:1.065~28.754,P=0.042)。结论合并气胸和肋骨骨折大于3根是创伤性血胸观察治疗失败的危险因素,应将合并气胸和肋骨骨折情况纳入创伤性血胸的观察治疗决策中。     

A comparative study of pericostal and submuscular bar fixation technique in the Nuss procedure

We evaluated the safety and stability of the less-invasive submuscular bar fixation method in the Nuss procedure. One hundred and thirteen patients undergoing the Nuss procedure were divided into three groups according to the bar fixation technique employed. Group 1 consisted of 25 patients who had undergone bilateral pericostal bar fixation, group 2 consisted of 39 patients with unilateral pericostal one, and group 3 included 49 patients with bilateral submuscular one. The patients' age ranged from 2 to 25 yr, with an average of 7.2+/-5.67 yr. Bar dislocation occurred in 1 patient (4%) in Group 1, 2 patients (5.1%) in Group 2, and 1 patient (2.0%) in Group 3 (p=0.46). Hemothorax was noted in 2 patients (8%) in Group 1, 2 (5.1%) in Group 2, and none (0%) in Group 3 (Group 1 vs. Group 3, p=0.028). The mean operation time was shorter in Group 3 than Group 1 (50.1+/-21.00 in Group 3 vs. 67.2+/-33.07 min in Group 1, p=0.041). The submuscular bar fixation results in a decrease in technique-related complications and operation time and is associated with favorable results with regard to the prevention of bar dislodgement.