A 55-year-old male patient suffered from severe high-voltage electric burn with an area of 20%TBSA full-thickness injury. The injury involved the distal end of left upper limb, right trunk, and whole abdominal wall. Fracture of the 7th-10th ribs was found in the right side of chest, with perforation of abdominal cavity, and bilateral pleural effusion was found. Part of the small intestine was necrotic and exposed. At the early stage, xeno-acellular dermal matrix was grafted after debridement of abdominal wound; peritoneal lavage was performed; negative pressure drainage was performed in orificium fistula of intestine for promoting the adhesion between perforated intestine and abdominal scar. Two orificium fistulas formed after closure of abdominal granulation wound by autologous skin grafting. Eschar of chest wall and denatured ribs were retained. The risk of infection of thoracic cavity was decreased by promoting the adhesion between lung tissue and chest wall. During the treatment, the patient was diagnosed with Henoch-Schonlein purpura nephritis by renal biopsy, with the symptoms of purpura in the lower limbs, heavy proteinuria, severe hypoalbuminemia, edema, etc. After control of kidney damage by immunosuppressive treatment instead of glucocorticoid, alleviation of the levels of proteinuria and blood albumin, free latissimus dorsi myocutaneous flap was excised to repair chest wall, and free skin graft was excised to repair intestinal fistula. After all the wounds were successfully covered, the patient was treated with glucocorticoid combined with immunosuppressants for more than 1 year. The patient was followed up for 3 years, and his renal function was completely recovered with satisfactory clinical outcome.
Abdominal Cavity ; Abdominal Injuries ; complications ; surgery ; Burns, Electric ; complications ; surgery ; Humans ; Male ; Middle Aged ; Nephritis ; complications ; surgery ; Purpura, Schoenlein-Henoch ; complications ; surgery ; Thoracic Cavity ; Thoracic Injuries ; complications ; surgery

Extrapleural hematoma results from blood accumulating between the parietal pleura and the endothoracic fascia, whereas hemothorax shows pooling in the pleural space. Extrapleural hematoma results from an intact parietal pleura that blocks blood from escaping the pleural cavity. Extrapleural fat, a fat layer outside the pleura in the chest wall between the parietal pleura and the endothoracic fascia, is pathognomonic on computed tomography. We diagnosed traumatic extrapleural hematoma and treated it with video-assisted thoracic surgery. We report here on this case along with a review of the literature.
Fascia ; Hematoma ; Hemothorax ; Pleura ; Pleural Cavity ; Thoracic Surgery, Video-Assisted ; Thoracic Wall ; Thoracoscopy ; United Nations

Catheterization ; methods ; Humans ; Needles ; Pneumothorax ; nursing ; surgery ; Silicosis ; nursing ; surgery ; Thoracic Cavity

BACKGROUND: Pleural drainage following video-assisted thoracic surgery has traditionally been achieved with large- bore, semi-rigid chest tubes. Recent trends in thoracic surgery have been toward less invasive approaches for a variety of diseases. The purpose of this study was to evaluate the safety and efficacy of drainage by means of small, soft, and flexible 14Fr Blake drains. MATERIAL AND METHOD: Between December 2007 and March 2008, 14Fr silastic Blake drains were used for drainage of the pleural cavity in 37 patients who underwent a variety of video- assisted thoracic surgical procedures at our institution. RESULT: The average postoperative length of hospital stay was 3.26 days (range, 2~12 days), Blake drains were left in the pleural space for an average of 3.15 days (range, 1~7 days), and the average amount of drainage was 43.8 ml/day. The maximal amount of blood removed daily by a Brake drain was as much as 290 mL. There were no drain-related complications. Blake drains seemed to cause less pain while in place, and particularly at the time of removal. CONCLUSION: The use of a Blake drain following minor thoracic surgery appeared to be safe and effective in drainage of fluid or air in the pleural space, and were associated with minimal discomfort.
Catheters ; Chest Tubes ; Dimethylpolysiloxanes ; Drainage ; Humans ; Hypogonadism ; Length of Stay ; Mitochondrial Diseases ; Ophthalmoplegia ; Pleural Cavity ; Thoracic Surgery ; Thoracic Surgery, Video-Assisted ; Thoracic Surgical Procedures

A 66-year-old patient undergoing regular follow-up at Samsung Medical Center after left lower lobectomy visited the emergency department around 9 months postoperatively because of nausea and vomiting after routine esophagogastroduodenoscopy at a local clinic. Abdominal computed tomography showed the stomach herniating into the left thoracic cavity. We explored the pleural cavity via video-assisted thoracic surgery (VATS). Adhesiolysis around the herniated stomach and laparotomic reduction under video assistance were successfully performed. The diaphragmatic defect was repaired via VATS. The postoperative course was uneventful, and he was discharged with resolved digestive tract symptoms.
Aged ; Diaphragm ; Emergency Service, Hospital ; Endoscopy, Digestive System ; Follow-Up Studies ; Gastrointestinal Tract ; Hernia ; Hernia, Diaphragmatic* ; Humans ; Nausea ; Pleural Cavity ; Stomach ; Thoracic Cavity ; Thoracic Surgery, Video-Assisted ; Vomiting

Subclavian catheters were used in the treatment of chronic renal failure patients waiting for the maturation of AV fistula. But, it sometimes causes fatal complications. Of these, massive bleeding into pleural cavity after subclavian vein cannulation is a rather rare but causes very serious complication. Most of patients with hemothorax are successfully treated with conservative treatment(i.e. pleural drainage, maintaining the circulatory volume, treatment of possible coagulopathy) but it sometimes needs surgery. We recently experienced a case of ARDS complicated by hemothorax which was successfully treated with thracooscopic drainage. We reviewed the pathogenesis of ARDS by hemothorax and suggested the guidlines for the treatment of massive hemothorax using video-assisted thoracoscopic surgery.
Catheterization ; Catheters* ; Drainage ; Fistula ; Hemorrhage ; Hemothorax* ; Humans ; Kidney Failure, Chronic ; Pleural Cavity ; Subclavian Vein ; Thoracic Surgery, Video-Assisted

Mesothelial cyst is a rare mediastinal tumor and usually presents in the right cardiophrenic angle. However, it sometimes occurs in atypical locations and it's locating in the posterior mediastinum, especially, is very rare. A large cystic mass of the posterior mediastinum between pericardium and vertebral body was incidentally recognized in a patient of a 30-year-old woman admitted due to traffic accident. Even though it was very large in size measuring 18 cm at longest diameter and is extending mainly to the left pleural cavity, she had no symptomatic complaints. Complete excision was performed through video-assisted thoracoscopic surgery with a additional small working window, which was necessary for dissecting the deepest point to the right pleural cavity. She is in good condition without recurrence on long-term follow-up.
Accidents, Traffic ; Adult ; Female ; Follow-Up Studies ; Humans ; Mediastinal Neoplasms ; Mediastinum* ; Pericardium ; Pleural Cavity ; Recurrence ; Thoracic Surgery, Video-Assisted ; Thoracoscopy

Mesothelial cyst is a rare mediastinal tumor and usually presents in the right cardiophrenic angle. However, it sometimes occurs in atypical locations and it's locating in the posterior mediastinum, especially, is very rare. A large cystic mass of the posterior mediastinum between pericardium and vertebral body was incidentally recognized in a patient of a 30-year-old woman admitted due to traffic accident. Even though it was very large in size measuring 18 cm at longest diameter and is extending mainly to the left pleural cavity, she had no symptomatic complaints. Complete excision was performed through video-assisted thoracoscopic surgery with a additional small working window, which was necessary for dissecting the deepest point to the right pleural cavity. She is in good condition without recurrence on long-term follow-up.
Accidents, Traffic ; Adult ; Female ; Follow-Up Studies ; Humans ; Mediastinal Neoplasms ; Mediastinum* ; Pericardium ; Pleural Cavity ; Recurrence ; Thoracic Surgery, Video-Assisted ; Thoracoscopy

A 43-year-old man underwent lipoma excision operation with video-assisted thoracoscopic surgery (VATS). Upon completion of the surgery, 20degrees C cold saline irrigation was performed to clean the surgical field. During this procedure, a sudden sinus bradycardia (33 beats/min) occurred. After interruption of the irrigation, the normal sinus rhythm returned spontaneously. With the suspicion that the cold saline could have induced the bradycardia, 40degrees C warm saline irrigation was performed; however, the repeat sinus bradycardia occurred again. The saline irrigation was stopped and the heart rate returned to normal. We conclude that although warm saline irrigation is a common practice after surgical procedures to ensure hemostasis and to clean the surgical field, it may induce profound sinus bradycardia.
Adult ; Bradycardia ; Cold Temperature ; Dietary Sucrose ; Heart Rate ; Hemostasis ; Humans ; Lipoma ; Pleural Cavity ; Thoracic Surgery, Video-Assisted

The aim of this study was to introduce the experience of diagnosis and treatment for patients with migrated acupuncture needle to pleural cavity and or lung parenchyma. We had treated 5 patients who had acupuncture needles in their thoracic cavity from January 2000 to September 2009. The mean age was 55.8 yr old. All patients suffered from the sequelae of the cerebrovascular accident and had been treated with acupuncture. They had drowsiness and hemiplegic or quadriplegic motor activity. Fever and dyspnea were main symptoms when referred to us. Diagnosis was made by the chest radiography and chest computed tomography which revealed straight metallic materials in their thoracic cavity. The needles were removed via thoracotomy or thoracoscopic procedures. Pleural decortications were also needed in four patients. Thoracoscopic surgery was successfully performed in two patients. After the removal all patients became symptomless. Although we experienced only five patients who have migrated acupuncture needles in thoracic cavity, we suggest that thoracoscopic removal of the needle with or without pleural decortication is the most optimal modality of treatment in those patients.
Acupuncture Therapy/*adverse effects/instrumentation ; Adult ; Aged ; Female ; Foreign-Body Migration/diagnosis/*etiology/*surgery ; Humans ; Male ; Middle Aged ; Needles/*adverse effects ; Pleural Cavity/radiography/surgery ; Radiography, Thoracic ; Retrospective Studies ; Stroke/therapy ; Thoracic Cavity/surgery ; Thoracic Surgery, Video-Assisted ; Thoracotomy ; Tomography, X-Ray Computed