Unusual Delayed Manifestation of a Penetrating Chest Trauma

Abstract Pericardial tamponade remains a diagnostic challenge to the clinician especially when the patient is well compensated hemodynamically. We report an unusual case who sought medical help 1 month after having been stabbed in his chest. An investigation revealed a perforation of the myocardium and a pericardial tamponade. The patient survived thanks to a large organized clot that plugged the perforation. The patient was exposed to increased risk due to delayed onset, recognition, and therapy of the tamponade. Most reports on this subject deal with acute pericardial tamponade. Only few cases of delayed pericardial tamponade have been reported. A review of the relevant literature and the therapeutic approaches are discussed.     

对儿童X线体检中减少照射剂量的探讨

目的:探讨儿童在X线体检中减少照射剂量的方法。方法:应用东芝500mA遥控X线机、FJ-427型热释光剂量仪等设备,对100名3~5岁儿童体检时,随机分成两个对照组、每组50名,分别接受胸透或平片检查,对检查测得数据均进行统计学处理。结果:胸透时胸部接受的照射剂量是平片的22倍多,其它部位接受的X线散射剂量平均值之比亦在20~30倍之间。结论:在儿童X线体检中应采用常规胸片替代胸透,可以有效地降低其辐射危害。     

应用ROC曲线评价DR后处理技术对胸部影像的影响

目的:运用ROC曲线,探讨DR胸部摄影最佳的影像后处理技术。方法:使用DR系统设置的正常胸部摄影条件,对胸部体模与专用于X线摄影的ROC曲线评价体模(TRG)进行组合并曝光。分析未使用后处理技术及使用不同后处理技术,对DR胸部摄影胸片影像的影响。结果:使用单纯噪声消除技术、噪声消除加图像反转及噪声消除加全屏放大三种后处理技术所得的ROC曲线下面积Az值依次为0.85、0.825及0.925,均明显大于未使用后处理技术的面积Az值0.6;单纯噪声消除技术获得的ROC曲线下面积略大于噪声消除加图像反转技术的面积;噪声消除加全屏放大技术获得的ROC曲线下面积Az值最大。结论:应对胸部原始影像实施后处理调节。单纯噪声消除技术可明显增加影像的信息量,若在噪声消除基础上实施全屏放大技术,可获得DR胸部摄影的最大影像信息量。     

老年人食道病变呈心绞痛样胸痛13例分析

13例有心绞痛样胸痛的住院病人入院均诊有冠心病心绞痛,后均经ECG、8例心脏“B”超、核素心肌灌注及24小时动态ECG各2例,确诊冠心病5例,不支持冠心病8例;后均行GI,并同时行胃镜、食管24小时pH测定及压力测定各2例,确诊有胃食管反流疾病(GERD),本组自胸痛症状出现至GERD确诊病程平均29.5个月(0.5～120个月),报告2例典型病例,讨论了误漏诊原因,探讨了老年人食管性胸痛的诊疗程序。     

Morphological changes in chest radiographs of patients with acute respiratory distress syndrome (ARDS)

Objective: To determine whether the quality of infiltrations in chest radiographs can accurately predict the histological extent of fibrotic change in patients with acute respiratory distress syndrome (ARDS). Design: Retrospective clinical investigation. Setting: Intensive care unit (ICU) of a university teaching hospital. Patients and methods: Of 47 patients treated with extracorporeal membrane oxygenation (ECMO) for severe ARDS over a 5-year period, 23 patients underwent open lung biopsy at thoracotomy for treatment, mostly of pneumothorax. Chest films obtained by portable chest roentgenography preceding the operation were reviewed retrospectively and compared to the histomorphological results of the lung specimen. Results: Chest radiographs displayed mixed alveolar-reticular opacification in 60.2 %, alveolar patterns in 22.9 % and reticular opacities in 10.5 %. In 0.4 % there were no infiltrates, 6 % could not be evaluated because of insufficient quality. There was no relevant difference between the right and left lungs. Subdividing patients into two groups according to the histological results of either absent or mild (1) or severe (2) lung fibrosis, we found an alveolar haziness in 12.3 % in group 1 compared with 28.2 % in group 2, while reticular characteristics were identified in 13 % and 11 %, respectively. Conclusions: The most common opacity in chest radiographs of patients with severe ARDS treated with ECMO is mixed alveolar-reticular opacification. Severe lung fibrosis is not positively correlated with a reticular radiographic pattern. ECMO does not lead to specific radiological changes in conventional radiograms, contrary to clinical findings that treatment with ECMO might induce pleural or pulmonic haemorrhage, especially in the earlier days when systemic heparinization had to be used instead of the heparin-coated tube-surfacing. Received: 24 November 1997 Accepted: 20 July 1998     

Chest Wall Implants: Their Use for Pectus Excavatum,Pectoralis Muscle Tears,Poland's Syndrome,and Muscular Insufficiency

Solid customized and prefabricated silicone implants have been used by the author for 15 years in a wide range of chest wall deformities. Chest wall implants are often used in males seeking to augment a muscularly deficient or underdeveloped chest; however, their greatest use has come in a variety of deformities both congenital and acquired, such as pectus excavatum, Poland's Syndrome, and pectoralis muscle tears. The implants can be either customized using a moulage technique or are prefabricated, manufactured implants which can be modified on the operating table to repair the contour deformity. The immediate postoperative problem of seroma and subcutaneous implant ``show' has been minimized by careful planning, gentle technique, deep insertion, improved patient positioning on the operating room table, and the use of oral anti-inflammatory medications. The long-term results of these implants seem very satisfactory. The patients are usualy physically active, and the implants show no long-term sequelae such as seroma, infection, displacement, or rupture.     

A new method of stabilizing the chest wall following major chest wall resection

Summary Prosthetic materials, such as metals, marlex mesh and methyl methacrylate have been used for stabilization of the chest wall after resection of large areas of rib cage. Such materials are contraindicated in an infected area. A new method of providing a stable chest wall using autogenous tissue is presented.     

廊坊市农村儿童1987～1993年头胸围及交叉月龄变化的分析

本文通过对我市农村1987、1990、19933个年份中10～24月龄男女儿童头围和胸围及头胸交叉所在月龄变化的分析。表明我市农村儿童随着家庭生活水平的不断提高,其生长发育正处在长期加速阶段。同时可以看到:由于基础较差,在科学育儿方面还有较大差距,尽快克服普遍存在的落后喂养习惯和断奶食品的缺乏已成为进一步提高我市农村儿童生长发育水平的关键.应予充分重视,加以解决。     

Rounded atelectasis: diagnosis by fine-needle aspiration cytology.

Rounded atelectasis, a rare, benign mass lesion, is most often seen in association with asbestos-related pleural changes. Often a presumptive diagnosis can be made on the basis of characteristic CT and chest radiographic findings. However, not infrequently radiographic imaging fails to differentiate rounded atelectasis from primary bronchogenic carcinoma, a disease which is seen with increased frequency in patients with asbestos exposure. We describe two cases where the diagnosis of rounded atelectasis was made by fine-needle aspiration (FNA) cytology. The cytologic features included abundant pulmonary parenchymal material with thickened alveolar walls containing pulmonary macrophages and connective tissue. It is important to realize that this is a useful positive finding indicating rounded atelectasis, rather than a negative finding suggesting the absence of neoplasm. Needles with a cutting action may be necessary to obtain sufficient material to make the diagnosis of rounded atelectasis.     

Reconstruction of complex and unusual defects of the thoracic wall

Summary From 1981 to. 1989, a total of 13 procedures were performed on 12 patients requiring complex reconstructions of the thoracic wall. The most common cause of these defects was cancer. Muscle flaps remain the treatment of choice for thoracic wall reconstruction and have been used in 10 cases. Microsurgical tissue transfer opens even larger therapeutic perspectives. A team approach is recommended.