Physical traumas are tragic and multifaceted injuries that suddenly threaten life. Although it is the third most common cause of death in all age groups, one out of four trauma patients die due to thoracic injury or its complications. Blunt injuries constitute the majority of chest trauma. This indicates the importance of chest trauma among all traumas. Blunt chest trauma is usually caused by motor vehicle accident, falling from height, blunt instrument injury and physical assault. As a result of chest trauma, many injuries may occur, such as pulmonary injuries, and these require urgent intervention. Chest wall and pulmonary injuries range from rib fractures to flail chest, pneumothorax to hemothorax and pulmonary contusion to tracheobronchial injuries. Following these injuries, patients may present with a simple dyspnea or even respiratory arrest. For such patient, it is important to understand the treatment logic and to take a multidisciplinary approach to treat the pulmonary and chest wall injuries. This is because only 10% of thoracic trauma patients require surgical operation and the remaining 90% can be treated with simple methods such as appropriate airway, oxygen support, maneuvers, volume support and tube thoracostomy. Adequate pain control in chest trauma is sometimes the most basic and best treatment. With definite diagnosis, the morbidity and mortality can be significantly reduced by simple treatment methods.
Flail Chest ; therapy ; Hemothorax ; therapy ; Humans ; Lung Injury ; therapy ; Pain Management ; Pneumothorax ; therapy ; Rib Fractures ; therapy ; Thoracic Injuries ; therapy ; Thoracic Wall ; injuries ; Wounds, Nonpenetrating ; therapy

OBJECTIVETo study the clinical effect and safety of bubble nasal continuous positive airway pressure (BNCPAP) versus conventional nasal continuous positive airway pressure (nCPAP) in respiratory support for preterm infants with neonatal respiratory distress syndrome (NRDS).

METHODSA retrospective analysis was performed for the clinical data of 130 preterm infants with NRDS. Among them, 69 underwent BNCPAP and 61 underwent nCPAP. The two groups were compared in terms of mortality rate, duration of respiratory support, use of pulmonary surfactant (PS), and treatment failure rate, and the incidence rates of bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP), as well as the changes in blood gas pH, partial pressure of oxygen, and partial pressure of carbon dioxide. The safety was evaluated for both groups.

RESULTSThere were no significant differences between the BNCPAP group and the nCPAP group in sex distribution, gestational age, birth weight, Apgar score at 1 and 5 minutes after birth, delivery mode, and the severity of NRDS (P>0.05). No infants in the BNCPAP group died, and one infant in the nCPAP group died; there was no significant difference in the mortality rate between the two groups (P>0.05). There were also no significant differences between the two groups in the duration of noninvasive ventilation, treatment failure rate, the incidence rates of BPD and ROP, and the percentage of infants with a need for use or reuse of PS (P>0.05). After 8-12 hours of ventilation, there were no significant differences between the two groups in the changes in blood gas pH and oxygenation index (P>0.05), while the BNCPAP group had a significantly greater reduction in partial pressure of carbon dioxide than the nCPAP group (P<0.05). There were no significant differences between the two groups in the incidence rates of pneumothorax, nasal septal injury, and nasal mucosal injury (P>0.05).

CONCLUSIONSBNCPAP and nCPAP have similar clinical effect and safety in respiratory support for preterm infants with NRDS.

Blood Gas Analysis ; Carbon Dioxide ; analysis ; blood ; Continuous Positive Airway Pressure ; methods ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Infant, Premature ; blood ; Male ; Oxygen ; analysis ; blood ; Pneumothorax ; therapy ; Respiratory Distress Syndrome, Newborn ; blood ; therapy ; Retrospective Studies ; Treatment Failure

No abstract available.
Adult ; Biopsy ; Disease Progression ; Fatal Outcome ; Humans ; Lung Neoplasms/*complications/diagnostic imaging/secondary/surgery ; Lymphatic Metastasis ; Male ; Pleural Effusion, Malignant/diagnostic imaging/*etiology/therapy ; Pneumothorax/diagnostic imaging/*etiology/therapy ; Sarcoma/*complications/diagnostic imaging/secondary/surgery ; Soft Tissue Neoplasms/*pathology ; Tomography, X-Ray Computed ; Treatment Outcome

Humans ; Pneumothorax ; therapy ; Silicosis ; therapy

For the German speaking countries, Tscherne's definition of "polytrauma" which represents an injury of at least two body regions with one or a combination being life-threatening is still valid. The timely and adequate management including quick referral of the trauma patient into a designated trauma center may limit secondary injury and may thus improve outcomes already during the prehospital phase of care. The professional treatment of multiple injured trauma patients begins at the scene in the context of a well structured prehospital emergency medical system. The "Primary Survey" is performed by the emergency physician at the scene according to the Prehospital Trauma Life Support (PHTLS)-concept. The overall aim is to rapidly assess and treat life-threatening conditions even in the absence of patient history and diagnosis ("treat-first-what-kills-first"). If no immediate treatment is necessary, a "Secondary Sur- vey" follows with careful and structured body examination and detailed assessment of the trauma mechanism. Massive and life-threatening states of hemorrhage should be addressed immediately even disregarding the ABCDE-scheme. Critical trauma patients should be referred without any delay ("work and go")toTR-DGU® certified trauma centers of the local trauma networks. Due to the difficult pre- hospital environment the number of quality studies in the field is low and, as consequence, the level of evidence for most recommendations is also low. Much information has been obtained from different care systems and the interchangeability of results is limited. The present article provides a synopsis of rec- ommendations for early prehospital care for the severely injured based upon the 2011 updated multi- disciplinary S3-Guideline "Polytrauma/Schwerstverletzten Behandlung", the most recently updated European Trauma guideline and the current PHTLS-algorithms including grades of recommendation whenever possible.
Airway Management ; Emergency Medical Services ; Fluid Therapy ; Fractures, Bone ; therapy ; Germany ; Hemostatics ; therapeutic use ; Humans ; Multiple Trauma ; therapy ; Pneumothorax ; therapy

OBJECTIVETo observe the clinical effect of central venous catheter in the treatment of refractory pleural effusion and pneumothorax.

METHODSPatients with coal workers' pneumoconiosis-tuberculosis complicated by pleural effusion or pneumothorax were randomly divided into central venous catheter group (48 cases, treated by chest drainage using a peripherally inserted central catheter) and conventional puncture group (56 cases, treated by conventional pleural puncture). Chemotherapy (DOTS strategy) was fully supervised, and both groups used 3HRZE/6HR (H, isoniazid; R, rifampicin; Z, pyrazinamide; E, ethambutol).

RESULTSIn the central venous catheter group, catheterization in the thoracic cavity was performed once in all cases, without fall-off; the mean total volume of pumped effusion was 3932±4430 ml; the time to disappearance of pleural effusion and pneumatosis was 10±2 d; 40 (83.33%) of the 48 cases were cured. In the conventional puncture group, the volume of pumped effusion was 2753±315 ml; the time to disappearance of pleural effusion and pneumatosis was 18±6 d; pleural puncture was performed twice in 4 cases, 3-4 times in 38 cases, and over 5 times in 10 cases, with an average of 3.8 times; 26 (46.43%) of the 56 cases were cured. The cure rate was significantly higher in the central venous catheter group than in the conventional puncture group (χ(2) = 7.59, P < 0.01).

CONCLUSIONFor pleural effusion and pneumothorax, PICC can be used instead of closed thoracic drainage and pleural puncture, and it has good clinical effect, causes little pain, and is easy to operate.

Anthracosis ; Catheterization ; Central Venous Catheters ; Drainage ; Humans ; Pleural Effusion ; complications ; therapy ; Pneumothorax ; complications ; therapy

Gestational trophoblastic disease (GTD) is a condition of uncertain etiology, choriocarcioma, or placental-site hydatidiform moles, invasive moles, choriocarcinoma, and placental-site trophoblastic tumors. It arises from the abnormal proliferation of trophoblastic tissue and spreads beyond the uterus hematogenously. The early diagnosis of GTD is important to ensure timely and successful management and the preservation of fertility. We report the unusual case of a metastatic choriocarcinoma that formed bullae on the lung surface and presented as recurrent pneumothorax in a 38-year-old woman with elevated beta-human chorionic gonadotropin (hCG) levels. She underwent thoracoscopic wedge resection of the involved lung and four subsequent cycles of consolidation chemotherapy. No other evidence of metastatic disease or recurrent pneumothorax was noted during 22 months of follow-up. GTD should be considered in the differential diagnosis of spontaneous pneumothorax in reproductive-age women with an antecedent pregnancy and abnormal beta-hCG levels.
Adult ; Choriocarcinoma* ; Chorionic Gonadotropin ; Consolidation Chemotherapy ; Diagnosis, Differential ; Drug Therapy ; Early Diagnosis ; Female ; Fertility ; Follow-Up Studies ; Gestational Trophoblastic Disease ; Humans ; Hydatidiform Mole, Invasive ; Lung ; Neoplasm Metastasis* ; Pneumothorax* ; Pregnancy ; Trophoblastic Tumor, Placental Site ; Trophoblasts ; Uterus

Pneumothorax is a complication that rarely occurs after chemotherapy for lung cancer. We report the chest computed tomography findings of a case of spontaneous pneumothorax complicating docetaxel (Taxotere®) treatment for pulmonary metastasis in a 70-year-old woman with pulmonary adenocarcinoma. The patient developed bilateral pneumothoraces, which was induced by changes in the cavitary pulmonary metastatic lesions, after systemic chemotherapy with docetaxel. The chest computed tomography findings and possible mechanisms of this unusual complication are discussed in this report.
Adenocarcinoma ; complications ; diagnostic imaging ; drug therapy ; Aged ; Antineoplastic Agents ; adverse effects ; therapeutic use ; Female ; Humans ; Lung Neoplasms ; complications ; diagnostic imaging ; drug therapy ; Neoplasm Metastasis ; Pneumothorax ; complications ; diagnostic imaging ; drug therapy ; Taxoids ; adverse effects ; therapeutic use ; Tomography, X-Ray Computed

OBJECTIVETo investigate the risk factors and preventative measures for neonatal pneumothorax.

METHODSRetrospective analysis was performed on the clinical data of 2286 neonates who were hospitalized in the neonatal intensive care unit between October 2010 and November 2011, and a case-control study was conducted to analyze the risk factors and preventative measures for neonatal pneumothorax.

RESULTSThe incidence of pneumothorax among the neonates was 1.57% (36/2286), and it was significantly higher in full-term infants than in preterm infants (23/1033 vs 13/1253, P=0.023). Logistic regression analysis indicated that cesarean section, neonatal respiratory distress syndrome (NRDS), wet lung, pneumonia and mechanical ventilation were the independent risk factors for neonatal pneumothorax (odds ratios=7.951, 6.090, 7.898, 6.272 and 4.389; P<0.05 for all). The higher the peak inspiratory pressure (PIP) during mechanical ventilation, the higher the incidence of neonatal pneumothorax (P<0.001). Pulmonary surfactant reduced the incidence of pneumothorax among neonates with NRDS (2.9% vs 10.1%; P=0.006).

CONCLUSIONSNeonatal pneumothorax occurs mostly in full-term infants. Cesarean section, NRDS, wet lung, pneumonia and mechanical ventilation are closely associated with neonatal pneumothorax. Strict management of indications for cesarean section, keeping PIP at a low level during mechanical ventilation, and use of pulmonary surfactant are helpful in preventing neonatal pneumothorax.

Case-Control Studies ; Cesarean Section ; adverse effects ; Female ; Humans ; Infant, Newborn ; Logistic Models ; Male ; Pneumothorax ; etiology ; prevention & control ; therapy ; Respiration, Artificial ; adverse effects ; Respiratory Distress Syndrome, Newborn ; complications ; Retrospective Studies

Subclavian venous catheterization was once widely used for volume resuscitation, emergency venous access, chemotherapy, parenteral nutrition, and hemodialysis. However, its use has drastically reduced recently because of life-threatening complications such as hemothorax, pneumothorax. In this case, a patient admitted for a scheduled operation underwent right subclavian venous catheterization for preoperative, intraoperative, and postoperative volume resuscitation and parenteral nutrition. The procedure was performed by an experienced senior resident. Despite detecting slight resistance during the guidewire insertion, the resident continued the procedure to the point of being unable to advance or remove it, then attempted to forcefully remove the guidewire, but it broke and became entrapped within the thorax. We tried to remove the guidewire through infraclavicular skin incision but failed. So video-assisted thoracoscopic surgery was used to remove the broken guidewire. This incident demonstrates the risks of subclavian venous catheterization and the importance of using a proper and gentle technique.
Catheterization ; Catheterization, Central Venous ; Catheters ; Drug Therapy ; Emergencies ; Hemothorax ; Humans ; Parenteral Nutrition ; Pneumothorax ; Renal Dialysis ; Resuscitation ; Skin ; Thoracic Surgery, Video-Assisted* ; Thorax