Diagnosis and treatment of open thoraco-abdominal injuries

From January 1954 to December 1987, 42 cases with open thoracoabdominal injuries were surgically treated. The causes of trauma were gun shot in 11, stabbing in 28, and buffalo horn injury in 3 cases. 24 cases were complicated with shock and 29 cases had more than two thoracoabdominal organs injured. 3 patients died postoperatively, an operative mortality rate of 7.1%. The authors discussed the problems of nomenclature, diagnosis and treatment and emphasized that: (1) open wound with thoracic and abdominal cavities and diaphragm involved simultaneously should be called open thoraco-abdominal injury; (2) surgical treatment is often delayed if diagnosis depends solely on X-ray examination; (3) operative approach should be carefully selected according to circumstances.     

Penetrating thoraco-abdominal gunshot wounds procedure.

Gunshot injuries of the trunk in the peace time are rare, but always represent great therapeutic and organisational problems. It concern especially thoraco-abdominal injury. Aim of this report is to present our treatment experiences with 19 wounded patients. Different procedure was applied. In 16 cases wounded laparotomy was done, in 4 cases following pleura cavity drainage. After that in 4 wounded thoracotomy was performed. In the 3 rest wounded thoraco-phrenolaparotomy was done. All of them had lung injury and a few of them have had great vessel and heart lesions. In the abdomen we found 1-4 organs injury. 7 (37%) wounded died, among these 6 after abdominal complications. Injuries mentioned above are severe, complicated and required individual and differentiated procedure. Above all severity of abdominal organs injury determined prognosis. Not enough experienced thoracic surgeon can cooperate with abdominal specialist surgeon during treatment procedure such a patients.     

Diagnosis and treatment of uncommon wounds

Uncommon wounds present unique challenges to plastic surgeons and other wound care providers in regard to their presentation, recognition, and ultimate treatment. This article presents an overview of diagnosis and actual case treatment of unusual wounds, a review of the literature, and case studies of interest. A systematic approach to diagnosis; careful review of history; and full understanding of topical, systemic, and surgical therapies is paramount to proper treatment recommendations, appropriate patient management, and successful wound-healing outcomes. The ability to identify and treat wounds caused by an unusual etiology or presentation is an important skill.     

65例胸腹联合伤的诊断与手术治疗

目的：总结胸腹联合伤的早期诊断与手术治疗经验。方法：对1990－1998年收治的65例胸腹联合伤病例进行回顾性分析。结果：开胸手术15例,胸腔闭式引流加开腹手术50例。治愈62例,死亡3例（5％）,死亡病例均因心血损伤严重失血性休克,结论：胸腹联合伤病情重,临床表现复杂,早期正确诊断,及时和合理的手术治疗是减少死亡率提高救治水平的关键。积极抗体克,实行重症监护的防治并发症等非常重要。     

Injuries of the heart and pericardium in thoraco-abdominal wounds

Forty observations of damaged hearts and pericardium in thoracoabdominal wounds were studied. All the patients were operated on. Causes of diagnostic errors and erroneous choice of surgical methods are analyzed. It is found that 61% of patients with heart damage in thoracoabdominal wounds are admitted to hospitals and given urgent surgical aid. Fifteen patients were examined in the long-term postoperative period.     

Diagnosis and treatment of penetrating anorectal wounds

Penetratingwoundofanalcanalisrelativelyrareinclinic.Concomitantinjuriesofrectum,urinarybladderorposteriorurethraareoftenpresent.Misseddiagnosisorimpropertreatmentcancause complicationssuchaspelvicabscess,analstenosis,fecalincontinenceandrecto vesicalfistula.Sixteen casesofpenetratinganotectalwoundsweretreatedin ourhospitalfrom1985to2004.Goodresultswere obtained.Thedetailsaredescribedinthisarticle.METHODS GeneraldataTherewere16malepatientsof penetratinganorectalwounds,aged1852years(average3…     

Diagnosis and treatment heart and pericardium wounds

The experience of diagnosis and treatment of heart and pericardium wounds in 152 patients are presented. In obecure diagnosis the authors prefer X-ray examination and echocardiography. Total lethality was 23.6%. Its high level is due to injury of coronary arteries and intracardiac structures, other thoracic and abdominal organs. The left anterolaferal thoracotomy is the optimum approach in wounds of the heart and pericardium. The most frequent complication of postoperative period is pericarditis, its echographic symptoms were revealed in 91% examinys. Non-steroid and steroid antiinflammatory drugs are effective for prophylaxis and treatment of pericarditis.     

Diagnosis and treatment of wounds of the gluteal area

The authors present results of surgical treatment of 98 patients with gluteal wounds. In 93.9% of cases the wounds were not penetrating and in 6.1% there were penetrating wounds. All the patients admitted to hospitals in state of shock as well as suspected to the penetrating character of the wound underwent general laparoscopy. In 2 patients with penetrating wounds of the abdominal cavity and in 7 patients with non-penetrating wounds ligation of the internal iliac artery was necessary because of huge bleeding. Two patients (2%) with penetrating wounds of the abdominal cavity died.     

Diagnosis and treatment of gunshot wounds to the chest

Experience of treatment of 86 patients with chest wounds are summarized. Diagnostic and curative algorithm of these patients are presented. Fenestration of the pericardium is proposed for diagnosis of heart wounds. This algorithm permitted to reduce early pleural complications rate from 55.1 to 22.1% and diagnostic mistakes--from 34.2 to 11.2%.     

Surgical treatment of thoraco-abdominal and suprarenal aortic aneurysm

Ninety-nine patients underwent surgery for thoraco-abdominal (n = 73) or suprarenal (n = 26) aortic aneurysm, between January 1, 1981 and May 10, 1988. The in-graft technique was combined with re-implantation of renal, visceral, and segmental arteries, using the method proposed by Crawford. Ischaemic tolerance of kidneys was extended by means of flush cooling and was more recently manipulated by means of prostaglandin E1. Spinal cord function had been monitored since 1985 by means of the authors' method of spino-electrogram reading, with intercostal arteries being re-implanted in cases of need. The intervention was survived by 79 patients, with ruptures in 69 per cent of all cases and no ruptures in 82 per cent. The rate of paraplegia amounted to seven per cent (with 2.5 per cent of survivors. 25 per cent of deaths, 18 per cent with dissecting aneurysm, and five per cent without dissection), and it depended on the extent of aortic replacement (Types I, II, and III for 773 patients and Types IV and V for 0/26). While the incidence of postoperative disorders of renal function, including temporary dialysis, was also somewhat related to the extent of aortic replacement (Types I, II, and III 22 per cent and Types IV and V eight per cent), it was clearly affected to a greater extent by the general condition of patients (ruptures in 50 per cent, intact and without dissection in nine per cent). Spinal monitoring and protection against ischaemia have substantially contributed to much better surgical results, in recent years. Surgical treatment, therefore, is recommended for patients with aneurysmol symptoms as well as for advanced cases of aneurysm, the more as rupture-related mortality has proved to be extremely high in spontaneous courses without surgical action.     

Diagnosis and the treatment procedure in wounds of the heart and pericardium

An analysis of 136 clinical observations has shown that clinical symptoms and additional methods of examination (X-ray analysis of the chest, ECG, puncture of the pleura and pericardium) are sufficient for timely diagnosis of wounds of the heart and pericardium. The necessity of urgent operation prevents using complex diagnostic methods. Outcomes of the treatment are dependent on the time of admission of the patient to the hospital and timely operative interventions.     

Clinical course, diagnosis and treatment of thoraco-abdominal injuries

High incidence of diagnostic errors in thoracoabdominal wounds is due to the critical state of the patients, insufficient clinical examination and underestimation of localization of the wound hole. Errors in diagnosis result in the incorrect sequence of surgical procedures, time loss during the arrest of bleeding, use of traumatic operative accesses.