An unusual pulmonary perforation case after chest tube placement

Pulmonary laceration is an uncommon complication of tube thoracostomy technique that is expected vigorous clinically and may be fatal. In this study, we report a case of pulmonary laceration owing to a tube thoracostomy, with no clinical signs, and detected incidentally on thorax computed tomography.     

The nonoperative approach to esophageal perforation due to celestin tube placement.

Perforation of the esophagus during placement of esophageal tubes for palliation of obstructing inoperable cancer is a well-known complication that may preclude satisfactory amelioration of symptoms. Experience with two such patients suggests that the complication can best be treated by proper placement of the tube so that it seals the leak and bypasses the obstruction. Judicious use of antibiotics is beneficial. Drainage of the mediastinum may also be necessary. Resectional or extensive operative therapy is probably not wise in these ill and debilitated patients, particularly if the cancer is incurable.     

Hemifacial spasm due to cerebellopontine angle meningiomas--two case reports

A 54-year-old female and a 49-year-old female presented with complaints of hemifacial spasm. Both patients underwent surgery to remove cerebellopontine angle meningiomas. In one case, no vascular compression was observed at the root exit zone. The tumor was removed subtotally leaving residual tumor adhered to the lower cranial nerves. The hemifacial spasm disappeared immediately after the operation. The residual tumor was treated using gamma knife radiosurgery. In the other case, the root exit zone of the facial nerve was compressed by both the tumor and anterior inferior cerebellar artery and the tumor was removed totally. Postoperatively, the hemifacial spasm disappeared, but the patient suffered facial nerve paresis and deafness that was probably due to intraoperative manipulation. However, the facial nerve paresis gradually improved. Cerebellopontine angle meningioma with hemifacial spasm must be treated by surgical resection limited to preserve cranial nerve function. Subtotal removal with subsequent radiosurgery to treat the remaining tumor tissue is one option for the treatment of cerebellopontine angle meningioma.     

Avoiding chest tube placement after video-assisted thoracoscopic wedge resection of the lung.

OBJECTIVE: A chest tube is usually placed in the pleural cavity after wedge resection of the lung, even after thoracoscopic procedures. The aim of this study was to determine the validity and safety of postoperative management without chest tube placement for patients undergoing thoracoscopic wedge resection of the lung. METHODS: Between 1998 and 2002, 93 patients underwent thoracoscopic wedge resection of the lung. In January 2000, we established the following criteria for avoiding chest tube placement: (1) absence of air leaks during intraoperative alternative sealing test, (2) absence of bullous or emphysematous changes on inspection, (3) absence of severe pleural adhesions, and (4) absence of prolonged pleural effusion requiring chest drainage preoperatively. Seventeen of 93 patients did not satisfy the criteria. The other 76 patients were divided into two groups: group 1 consisted of 34 patients who underwent thoracoscopic resection before 1999 and in whom a chest tube was routinely placed in spite of retrospectively meeting the criteria, group 2 consisted of 42 patients who underwent thoracoscopic resection after 2000 and in whom chest tube was not placed. The clinical data were evaluated and analyzed between the two groups. RESULTS: Two patients in group 1 required new intervention after removal of a chest tube that had been inserted during the operation due to recurrence of a pneumothorax, so did two patients in group 2 after the operation. The rate of late pneumothorax requiring intervention is similar in groups 1 and 2. No differences were found between the two groups with regard to postoperative chest pain and hospital stay. No patients experienced a significant adverse outcome. CONCLUSIONS: Avoiding the chest tube placement did not increase postoperative morbidity if carefully selected criteria are met.     

Difficulty in placement of a left-sided double-lumen tube due to aberrant tracheobronchial anatomy

A rare case of a tracheal bronchus coexisting with a left-shifted carina and an acute angle of left main bronchus is presented. A 66 year old man with a history of colon cancer was scheduled for right thoracoscopic pericardial window due to recurrent pericardial effusion. After induction of anesthesia, the trachea was intubated using a 39-French, left-sided double lumen tube (DLT); the DLT was positioned with fiberoptic bronchoscopic guidance. Significantly high airway pressure was noticed as we initiated one-lung ventilation after the patient was positioned in the left lateral decubitus position. While repositioning the DLT, we found an aberrant tracheal bronchus. Although multiple attempts were made to adjust the DLT so as to achieve lung isolation, we could not place the DLT in the appropriate position due to abnormal and distorted anatomy. Lung isolation was unsuccessful; both lungs were carefully ventilated with small tidal volumes.     

Management of close-range shotgun injuries to the chest by diaphragmatic transposition: case reports

A method of reconstructing the chest wall following close-range shotgun injuries is described. This technique requires detaching the diaphragm peripherally and suturing it above the chest wall defect, resulting in an intact chest cavity and an abdominal wall defect. This latter problem can then be addressed by a variety of standard methods. Two patients are presented with excellent long-term results of diaphragmatic transposition, which should be in the armamentarium of all surgeons who deal with trunk trauma.     

Migration of the shunt tube after lumboperitoneal shunt--two case reports

A 60-year-old male and a 36-year-old female suffered shunt migration after lumboperitoneal shunt procedures, upward into the spinal subarachnoid space and downward into the abdominal cavity, respectively. Defects of the fixation devices in the shunt system are considered the main cause in both cases. Upward migration of the lumbar tube in the subarachnoid space is extremely rare. We suppose that raised abdominal pressure is related to this unusual complication.     

Chest wall arteriovenous fistula: an unusual complication after chest tube placement

Posttraumatic arteriovenous fistulas can form between vessels of the thorax that have sustained loss of integrity to the vessel wall. Although most are caused by injuries as a consequence of missile penetration or stab wounds, iatrogenic damage is a potential cause. Herein we present a case of a systemic arteriovenous fistula involving an intercostal artery and subcutaneous vein after chest tube placement.     

Neurogenic arthropathy of the knee due to chronic alcoholism: two case reports

The authors report two cases of neurogenic arthropathy of the knee in patients affected by chronic alcoholism. The aim of the authors is to discuss the etiopathogenic theory (neurotraumatic or/and neurovascular) as well as the mechanism by which alcohol damages joints.     

Perforation of the stomach due to chest tube complication in a patient with iatrogenic diaphragmatic rupture

Diagnosis of diaphragmatic injury is difficult. A case of iatrogenic diaphragmatic rupture is reported in which perforation of a herniated stomach occurred following left lobectomy and partial resection of the diaphragm for lung cancer. On the second postoperative day, bile-stained fluid coming out from the chest tube revealed gastrointestinal leakage. This rare complication of chest tube insertion, early diagnosis and treatment are emphasized.     

Subarachnoid-pleural fistula due to blunt chest trauma. A case report

Subarachnoid pleural fistula (SPF) due to blunt chest trauma is rare. When SPF isn't associated with any neurological deficits, its clinical diagnosis is possible only with high degree of suspicion. Presentation symptoms include dyspnea and respiratory distress caused by the collection of cerebral-spinal fluid in the pleural cavity. Computed tomography scan after myelography is helpful in confirming the site of the fistula. Possible dangerous complications are infections or pneumoencephalus. Some cases resolved spontaneously after bed rest or pleural drainage alone, while others required surgical repair. We report a case of spontaneous closure after pleural drainage and a brief period of mechanical ventilation.     

Recurrent inguinal hernia due to mesh dissolution: two case reports

The recurrence of inguinal or other abdominal hernia due to Prolene polypropylene mesh dissolution has never been reported in the literature. This is a report of two cases of recurrent inguinal hernias after mesh hernioplasty, but, on exploration, no mesh was found.     

Neurogenic bladder due to the anterior spinal artery syndrome: 2 case reports

A 43-year-old woman with anterior spinal artery syndrome was admitted with complaints of tetraplegia and urinary retention. Her bladder had capacity of more than 500 ml and was inactive, with low voltage of external urethral sphincter. She was treated with distigmine bromide and intermittent catheterization. 50 days later, urodynamic study showed normal bladder and incomplete coordination of external sphincter. A 78-year-old man had chief complaints of urinary retention and paraplegia. A catheter was left indwell for 6 months. Then he was treated with intermittent catheterization, but urgency incontinence was still observed. We discussed the therapy of neurogenic bladder due to the anterior spinal artery syndrome.     

A case of left main bronchial rupture due to bronchocath tube

A 68-year-old woman underwent a right upper lobectomy for lung cancer. After resection, we noticed the left main bronchial rupture due to bronchocath tube (polyvinyl chloride double lumen tube). The lesion of the rupture was repaired by interrupted sutures with 4-0 prolene. Subsequent course of the patient was uneventful. Tracheobronchial rupture is rare complication of intubation with polyvinyl chloride double lumen tube. There are 6 cases of this complication last five years in Japan. The cause and prevention of this complications are described. It is important to use an adequate tube size, to prevent malposition of the tube and overinflation of the bronchial balloon.     

Aortic regurgitation due to nonpenetrating trauma of the chest; report of a case

A 64-year-old man was admitted to our hospital with multiple traumas, caused by motorcycle accident. Six months later, he revisited our hospital, because he was found to have aortic regurgitation and subsequent congestive heart failure. Therefore, the aortic valve was excised and replaced with 23 mm CarboMedics prosthesis. His postoperative course was uneventful. Aortic regurgitation due to nonpenetrating trauma of the chest is rare.     

A case of complete circumferential aortic rupture due to blunt chest trauma

A case of complete circumferential rupture of the thoracic aorta due to blunt chest trauma is presented. A 30-year-old man was admitted after a traffic accident. The admission chest X-ray film demonstrated mediastinal widening. About 6 hours after the traffic accident, chest CT scanning demonstrated mediastinal hematoma, left pleural effusion and partial aortic dissection. Diagnoses of aortic rupture and liver injury were made, and surgery for the thoracic aorta was performed immediately. The aorta was found to be completely disrupted for the length of 2 cm, and a vascular prosthesis was interposed between the two ends of the aorta under pairtial cardiopulmanary bypass. We conclude that the enhanced chest CT scanning is helpful for diagnosis, and that if other organ injuries are not severe, the emergency operation should be performed.