Bochdalek hernia masquerading as a tension pneumothorax

A rare case of congenital diaphragmatic defect presenting with clinical signs of an acute tension pneumothorax is described. The clinical findings were eventually attributable to a herniation of abdominal contents into the chest (Bochdalek hernia). Attempted decompression of the chest by needle thoracocentesis and subsequent introduction of a chest drain caused gastric perforation, requiring repair at laparotomy. It is suggested that if needle thoracocentesis does not result in immediate clinical improvement, or if there is abdominal pain, a portable chest radiograph should be performed before tube thoracostomy to exclude Bochdalek hernia. All emergency department staff should be taught to recognise the radiological appearance of a Bochdalek hernia.     

疝环充填式无张力疝修补术的探讨

采用疝环充填物及网状补片对60例各类腹股沟疝病人进行无张力疝修补,对手术方法及时间、术后病人自主能力的恢复、术后伤口疼痛、并发症、住院时间和复发率等进行观察。结果60例手术顺利,术后并发症尿潴留2例,阴囊积液2例,伤口持续疼痛1例,切口感染1例,异物感3例,随访2个月～4年,无复发。疝环充填式无张力疝修补符合生理解剖,且具有手术操作简单、创伤小、无张力、省时、近期疗效满意及复发率低等优点,尤其适合老年病人。     

成人腹腔镜疝修补术与无张力疝修补术疝复发的回顾性分析

目的探讨成人腹腔镜疝修补术与无张力疝修补术疝复发的回顾性分析。方法回顾性分析2009年1月²013年12月入住我院普外科的115例腹股沟疝患者的临床资料,根据不同的手术方法分组,观察组为48例腹腔镜疝修补术,对照组为67例无张力疝修补术,比较两组患者的治疗效果、术中术后各项指标、并发症及复发情况等。结果两组均全部手术成功,差异无统计学意义(P>0.05);观察组手术时间、住院时间、疼痛持续时间、下床活动时间分别为56.5±15.5min、3.0±0.5d、8.5±2.5h、10.5±2.5h,对照组为47.5±10.5min、4.5±1.5d、25.5±5.5h、6.5±2.5h,差异有统计学意义(P<0.05);观察组并发症明显低于对照组,差异有统计学意义(P<0.05);观察组复发3例,对照组无复发,差异有统计学意义(P<0.05)。结论腹腔镜与无张力疝修补术对于腹股沟疝均有较好疗效,但腹腔镜远期易复发,适用于发病初期,临床应根据病情需要选择适合的术式。     

疝气无张力修补术在老年腹股沟疝气治疗中的应用效果分析

目的分析疝气无张力修补术在老年腹股沟疝气治疗中的应用效果。方法选取2014年4月22日~2016年4月22日我院收治的100例老年腹股沟疝气患者,将其抽签化分组,各50例,对照组和观察组分别采用传统疝修补术治疗和疝气无张力修补术治疗。结果观察组患者的术中出血量(56.89±5.28)ml、手术时间(42.62±6.38)min、下床活动时间(20.85±3.95)h、住院时间(4.69±1.85)d、治疗后一天VAS评分(2.11±0.65)分、治疗后三天VAS评分(0.38±0.41)分、不良事件发生率(2.00%)、ALT(48.43±29.73)μ/L、AST(95.51±6.98)IU/L-1、ALB(36.73±5.28)g/L-1、血尿素(5.53±1.99)mmol/L、腹内压(6.42±1.47)mm Hg、膀胱压(6.85±2.58)cm H2O、6个月后的复发率(0.00%)、12个月后的复发率(2.00%)均优于对照组(P0.05)。结论对老年腹股沟疝气患者实施疝气无张力修补术,能够提高整体疗效。     

Gastrointestinal Bleeding as a Complication of Varicella

In patients with chronic bronchitis and emphysema who have evidence of respiratory decompensation, often even a pneumothorax displacing 10% or less of the hemithorax may require catheter drainage as an adjunct to therapy. Three illustrative cases are presented.     

Pneumothorax as a Complication After TASER Activation

Use of the TASER electronic control device by law enforcement and civilians is increasing. Advocates for the use of the device believe that it has reduced the number of officer and suspect injuries. However, the use of the device is not without complications. Many of these injuries to superficial body structures or those sustained in the postactivation fall have been described in the literature. Injury to deep structures of the abdomen and chest were previously thought to be unlikely given the length of the TASER barb. This case report of a 16-year-old male patient who suffered a pneumothorax after TASER activation is thought to be the first reported in the literature.     

Bochdalek diaphragmatic hernia masquerading as pneumonia - a rare cause of Non-Traumatic Hemothorax

Hemothorax is defined as collection of blood in the pleural cavity. Massive hemothorax may result in severe respiratory distress. We present an extremely rare cause of non-traumatic hemothorax in a 3 1/2-year-old girl by Bochdalek diaphragmatic hernia (BDH), and that was initially misdiagnosed as pneumonia with massive pleural effusion. Hemothorax masks the clinical and X-ray findings of BDH that makes the diagnosis even more difficult. Delayed or incorrect diagnosis of BDH complicated with respiratory distress leads to the wrong decision-making and the subsequent management, which may result in significant morbidity and mortality. Accordingly, emergency physicians need to be aware of this extremely rare etiology when evaluating pediatric hemothorax in a busy emergency department.     

疝环充填式无张力疝修补术并发症的原因及对策

目的：探讨疝环充填式无张力疝修补术并发症的发生原因和对策。方法：总结分析326例患者的临床资料。结果：术后出现局部硬块和异物感6例(1．8％)，切口及阴囊血肿或水肿7例(2．1％)，切口感染4例(1．2％)，复发3例(0．9％)．顽固性疼痛9例(2．8％)。结论：手术规范操作和正确治疗是预防并发症发生的要点。     

MycroMesh无张力腹股沟疝修补120例临床观察

【目的】总结使用MycroMesh无张力疝修补术治疗腹股沟疝 120 例的临床经验。【方法】使用美国Gore公司生产的MycroMesh人体软组织补片,对120例各类腹股沟疝患者进行无张力修补治疗。对手术方法及时间,手术指征,术后患者自主能力的恢复,术后切口疼痛,并发症,住院时间和复发率进行观察。【结果】与传统疝修补术相比,无张力疝修补术具有术后疼痛轻,恢复快,住院时间短,并发症少和复发率低的优点。【结论】MycroMesh人体软组织补片无张力腹股沟疝修补术安全、简单、有效,值得推广应用。     

外伤性截瘫合并耳聋11例临床分析

初步分析了11例外伤性截瘫合并耳聋患者,指出外伤性截瘫多有慢性肾功能不全、肾性贫血等并发症。这些并发症对耳聋的发生有一定的影响,但长时间或反复使用耳毒性药物是一个不可忽视的重要因素。作者对此提出了预防耳聋的一些具体措施,可供临床参考或借鉴。     

MycroMesh低张力修补法治疗腹股沟斜疝87例

腹股沟斜疝的治疗历史悠久,然而其传统的手术方法存在各种缺点,不尽如人意.随着医疗技术的进步,以及对疝认识的深入了解,人造补片广泛应用于临床,逐步替代传统的Bassini和Shouldice等手术.……     

Bilateral Bochdalek hernias presenting as respiratory failure in an elderly patient

Bochdalek hernia occurs from a congenital defect of the diaphragm, allowing the passage of abdominal structures into the thoracic cavity, limiting lung expansion and ventilatory function. Bochdalek hernia is common in neonates but rarely occur in adults; there are only 4 documented cases in the elderly population. We present a case of an 88-year-old woman with severe hypoxia and respiratory failure that required ventilatory support, in whom bilateral Bochdalek hernias progressed over the years and severely invaded the thoracic cavity, causing acute decompensation. This is a rare condition in adults but can cause substantial morbidity when the involvement of the thoracic cavity is severe.     

Delayed-onset Bochdalek hernia in a 3-year-old child

A 3-year-old child presented to the emergency department (ED) with the sudden onset of shortness of breath and wheezing. The child had previously been in good health and had no problems during the neonatal period. Chest x-ray performed in the ED was consistent with a Bochdalek diaphragmatic hernia. Subsequently, the child had surgery. The diagnosis was confirmed, and recovery was uneventful. The differential diagnosis of late onset congenital diaphragmatic hernia is discussed with an emphasis on both early recognition and differential diagnosis of this rare but correctable entity.     

Early-Onset Chronic Renal Failure as a Complication of Acute Intermittent Porphyria

In a retrospective survey of patients who have had a provenattack of acute intermittent porphyria (AIP) in the West ofScotland a highly significant association (p < 0·001)was observed between AIP and the development of early-onsetchronic renal failure. Six patients with AIP and chronic renalfailure arising in early middle-age are described. As no othercause could be attributed to the renal failure three possiblecausal links between these two conditions were considered, namely,enhanced susceptibility to analgesic nephropathy, porphyria-inducedhypertension, and nephrotoxic effects of porphyrins and theirprecursors. We suggest that porphyria-induced hypertension isthe most important factor in causing early-onset chronic renalfailure in acute intermittent porphyria