Chest ultrasound in the assessment of patients in ICU: How can it help?

Background: Different imaging techniques can be used for assessment of chest problems in ICU patients, however ultrasound is a good diagnostic tool giving more information and at the same time without exposure to radiation and without risk of critical patient transfer.Aim of the work: The aim of this work was to study the role of thoracic ultrasound in assessment of ICU patients.Materials and methods: The study was carried out on 30 patients admitted to the ICU.B and M modes chest ultrasound was done for all patients using EsaoteMyLab?Alpha with eHD Technology.Results: The study included 19 males and 11 females with mean age of 42.6 ± 21.4 years. In this study ultrasound was able to diagnose Pneumothorax: 3 cases (10%). Pleural effusion: 20 cases (66.6%). Alveolar interstitial syndrome: 7 cases (23.3%). Lung consolidation: 20 cases (66.6%). Pulmonary infarcts: 1 case (3.3%). Neoplastic disease: 1 case (3.3%). Chest wall pathology: 1 case (3.3%).Conclusion: Ultrasound examination of the chest is a non- invasive, and promising bed side tool for examination of ICU patients.     

食管异物并发气胸经胸腔闭式引流及食管镜下异物取出1例

食管异物如未及时就诊,继续进食或因处理不当,可引起严重并发症,甚至导致死亡。损伤性食管炎、食管周围炎、食管穿孔、颈间隙感染、纵隔感染或大血管破溃等并发症文献报道较多,气管食管瘘、颈部皮下气肿或纵隔气肿等并发症较少见,而并发气胸者国内外文献罕见报道。2014年5月,我们收治食管异物并发气胸患者1例,报道如下。     

Acute airway distress secondary to iatrogenic injury during Tracheostomy

Laceration and perforation of the membranous trachea are uncommon. We present a case of bilateral Pneumothorax, which developed subsequent to iatrogenic injury during tracheostomy.     

高压氧治疗昏迷合并开放性气胸患者的护理

总结了1例交通意外导致昏迷合并开放性气胸患者高压氧治疗成功的护理体会.护理要点包括:成立急救小组与制订治疗护理方案,做好进舱前的准备,高压氧舱治疗中加压期、稳压期、减压期观察和护理.     

Costal osteochondroma causing pneumothorax in an adolescent: a case report and review of the literature

Costal osteochondroma is a rare but important condition to recognize because of the possibility of serious consequences if not diagnosed and treated promptly. Patients can present with numerous complications, including hemothorax, pneumothorax, nervous or vascular impingement, and fracture. We report the case of a 17-year-old adolescent boy who presented to the pediatrician with intermittent shortness of breath and pleuritic chest pain. A chest x-ray demonstrated a left-sided pneumothorax and triangular opacity in the left chest. A computed tomographic scan of the chest revealed the cause to be a costal exostosis of the anterior fifth rib. The lesion was excised using video-assisted thoracoscopic surgery, which has become an increasingly popular method for treating these lesions, causing significantly less morbidity and allowing for a faster recovery than a major thoracotomy.     

CT引导下经皮穿刺肺活检术中影响针胸膜夹角的因素

目的探讨CT引导下经皮肺穿刺活检术中影响针胸膜夹角的因素。方法 828例肺内孤立性病变患者接受CT引导下经皮穿刺肺活检,分别记录病变大小、病变部位、穿刺点位置及进针深度等。将以上变量与针胸膜夹角进行统计学分析。结果位于双肺上叶的病变与小的针胸膜夹角有关;不同病变大小、不同进针深度的针胸膜夹角病例数分布不一致;不同穿刺点位置的针胸膜夹角病例数分布一致。病变在20～29mm时,针胸膜夹角与穿刺例数无相关关系。结论病变部位可能影响针胸膜夹角,尤其是双肺上叶的病变与针胸膜夹角大小有密切关系。     

人工气胸在CT引导下纵隔病灶穿刺中的应用

目的探讨人工气胸在CT引导下纵隔病灶穿刺中的应用。方法对22例纵隔占位患者行CT引导下经胸膜腔路径纵隔病灶穿刺,其中19例接受CT引导下经皮穿刺组织(芯)活检,2例接受125I粒子植入,1例接受纵隔脓肿抽吸。采用22G小儿腰穿针制造人工气胸,调整患者体位,使穿刺针道尽可能位于胸腔内相对高位。注入足量气体,压缩穿刺路径上的肺组织,再行CT引导下病灶穿刺。活检或治疗完成后,抽出等量气体。结果所有病例均成功制造人工气胸,顺利完成活检及治疗。术中1例患者发现胸膜粘连,但仍完成活检。术后未发现大出血、需引流的气胸等严重并发症。结论人工气胸为CT引导下纵隔病灶穿刺提供了经胸膜腔路径,是一种安全的方法。     

胸部外伤的临床诊治

目的总结胸部外伤的诊治经验。方法回顾分析581例胸部外伤的临床资料,其中肋骨骨折、肺挫伤、血气胸常见,伴有颅脑损伤和腹部闭合伤。结果全组治愈569例,治愈率97．4％,死亡12例,死亡原因包括伤及心脏及大血管2例,胸腹联合伤2例,ARDS2例,胸外伤合并重度颅脑损伤6例,死亡率2．6％。结论创伤所致胸外伤病情危急,具体分析致伤原因及根据临床体征检查,迅速作出诊断和快速救治是关键,合并颅脑损伤、腹部脏器损伤、急性呼吸窘迫综合征（ARDs）和失血性休克是其主要死亡原因。     

Takao Hiraki's work on interventional radiology

Dr. Takao Hiraki is a scientist carrying out interventional radiology research in the Department of Radiology at Okayama University Medical School, Japan. He has conducted animal and human clinical studies on interventional radiology for various conditions. For example, he clarified the hepatic hemodynamic changes caused by hepatic venous occlusion. He also developed new devices, such as hydrogel coils for the occlusion of the aneurismal sac after an endovascular stent-graft of an aortic aneurysm to prevent endoleakage and small intestinal submucosa-covered stents for transjugular intrahepatic portosystemic shunts. Further, he performed a number of studies on the radiofrequency ablation of lung cancer, mediastinal lymph node metastasis, and computed tomography-fluoroscopy-guided lung biopsies. He intends to continue to dedicate his academic career to expand the role of interventional radiology in clinical medicine.     

Chemical pleurodesis with autologous blood and freeze-dried concentrated human thrombin improved spontaneous pneumothorax and thoracic endometriosis: The first case involving a pregnant woman

Objective

Spontaneous pneumothorax combined with thoracic endometriosis is a rare condition during pregnancy. We present a case of chemical pleurodesis with autologous blood and freeze-dried concentrated human thrombin during pregnancy.