PURPOSE: Safe and effective surgical treatment of peptic ulcer perforations is fundamental to achieve favorable outcomes. We present laparoscopic single figure of eight suturing omentopexy for perforated duodenal ulcer and review associated clinical outcomes. This is a new formulaic surgical technique for laparoscopic omentopexy. METHODS: Laparoscopic single figure of eight suturing omentopexies for perforated duodenal ulcer were completed in 15 consecutive patients between April 2008 and November 2017 at Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea. Using prospectively collected data, we performed an observational study on an intention-to-treat basis. RESULTS: The mean age of the 15 patients who underwent laparoscopic repair was 41.7±13.9 years. The perforation site was the anterior duodenal bulb in all patients. The median perforation size was 5 mm (range: 3~8 mm). The mean operation time was 66.7±19.6 minutes. There was no evidence of leakage from the omentopexy site clinically or in the postoperative upper gastrointestinal series. One patient (6.7%) experienced the postoperative complication of pneumothorax. There were no cases of postoperative mortality or reoperation within 30 days after surgery. The median time to tolerance of regular diet was 6 (range: 4~9) days. The median postoperative hospital stay was 7 days (range: 5~11 days). CONCLUSION: Laparoscopic single figure of eight suturing omentopexy can be a viable option in the surgical management of perforated duodenal ulcer in selected patients without surgical risk factors. Laparoscopic single figure of eight suturing omentopexy is safe and easy to perform, and may therefore reduce operation time.
Diet ; Duodenal Ulcer ; Humans ; Korea ; Laparoscopy ; Length of Stay ; Mortality ; Observational Study ; Peptic Ulcer Perforation ; Pneumothorax ; Postoperative Complications ; Prospective Studies ; Reoperation ; Risk Factors ; Seoul

BACKGROUND: Ventilator-associated pneumonia (VAP) is a common disease that may contribute to morbidity and mortality among trauma patients in the intensive care unit (ICU). This study evaluated the associations between trauma factors and the development of VAP in ventilated patients with multiple rib fractures. METHODS: We retrospectively and consecutively evaluated 101 patients with multiple rib fractures who were ventilated and managed at our hospital between January 2010 and December 2015, analyzing the associations between VAP and trauma factors in these patients. Trauma factors included sternal fracture, flail chest, diaphragm injury, traumatic aortic dissection, combined cardiac injury, pulmonary contusion, pneumothorax, hemothorax, hemopneumothorax, abbreviated injury scale score, thoracic trauma severity score, and injury severity score. RESULTS: Forty-six patients (45.5%) had at least 1 episode of VAP, 10 (21.7%) of whom died in the ICU. Of the 55 (54.5%) patients who did not have pneumonia, 9 (16.4%) died in the ICU. Using logistic regression analysis, we found that VAP was associated with severe lung contusion (odds ratio, 3.07; 95% confidence interval, 1.12 to 8.39; p=0.029). CONCLUSION: Severe pulmonary contusion (pulmonary lung contusion score 6–12) is an independent risk factor for VAP in ventilated trauma patients with multiple rib fractures.
Abbreviated Injury Scale ; Contusions ; Diaphragm ; Flail Chest ; Hemopneumothorax ; Hemothorax ; Humans ; Injury Severity Score ; Intensive Care Units ; Logistic Models ; Lung ; Lung Injury ; Mortality ; Pneumonia* ; Pneumonia, Ventilator-Associated ; Pneumothorax ; Retrospective Studies ; Rib Fractures* ; Ribs* ; Risk Factors* ; Thoracic Injuries ; Wounds and Injuries

Percutaneous transthoracic needle biopsy (PTNB) is an important procedure for diagnosis of pulmonary lesions. PTNB is minimally invasive procedure but sometimes complications can occur. The most common complications include pneumothorax, hemorrhage, and hemoptysis. Air embolism is very rare complication, but it can be a life-threatening if not managed appropriately. So knowledge of air embolism entity may minimize morbidity and mortality after PTNB.
Biopsy, Needle* ; Diagnosis ; Embolism, Air ; Hemoptysis ; Hemorrhage ; Image-Guided Biopsy ; Mortality ; Needles* ; Pneumothorax

Tracheal foreign body aspiration, which most commonly occurs in the pediatric population, can lead to a life-threatening event. In many pediatric cases it is difficult to confirm a history of foreign body aspiration, with frequent misdiagnoses of asthma, croup or pneumonia, leading to increased complications and mortality. When a tracheal foreign body is suspected, the treatment principle is to do bronchoscopy under the cooperation of otolaryngologists, pediatricians and cardiothoracic surgeons; the choice between procedures should be made with consideration of factors such as the size, location of foreign body and the condition of the patient. Subcutaneous emphysema and pneumothorax are rarely reported complications of tracheal foreign body, and are known to usually occur after removal of the foreign body. The authors hereby report, with a review of the literature, 2 cases of subcutaneous emphysema and pneumothorax occurring after foreign body removal through bronchoscopy and tracheotomy in pediatric tracheal aspiration patients.
Asthma ; Bronchoscopy ; Croup ; Diagnostic Errors ; Foreign Bodies* ; Humans ; Mortality ; Pneumonia ; Pneumothorax* ; Subcutaneous Emphysema* ; Tracheotomy

Small-bore flexible feeding tubes decrease the risk of ulceration of the nose, pharynx, and stomach compared with large-bore and more rigid tubes. However, small-bore feeding tubes have more respiratory system complications, such as pneumothorax, hydropneumothorax, bronchopleural fistula, and pneumonia, which are associated with significant morbidity and mortality. Thus, it is important to confirm the correct position of feeding tubes. Chest X-ray is the gold standard to detect tracheal malpositioning of the feeding tube. We present three cases in which intubated patients exhibited an altered mental state. An assistant guide wire was used at the insertion of small-bore feeding tubes. These conditions are thought to be potential risk factors for tracheobronchial malpositioning of feeding tubes.
Critical Care ; Critical Illness* ; Enteral Nutrition ; Fistula ; Humans ; Hydropneumothorax ; Mortality ; Nose ; Pharynx ; Pneumonia ; Pneumothorax ; Respiratory System ; Risk Factors ; Stomach ; Thorax ; Ulcer

Toxic epidermal necrolysis (TEN) is the most severe form of skin reactions caused by drugs or infection. Acute pulmonary complications in TEN are often observed. The mortality is especially high in those who suffer chronic pulmonary complications of TEN such as bronchiolitis obliterance, which occur as a consequence of bronchial epithelial injury. We report a case of a 16-year-old male who had required mechanical ventilation due to acute respiratory distress syndrome caused by TEN at 8 years of age. Although the patient initially recovered from acute respiratory distress syndrome, he required mechanical ventilation again due to severe chronic pulmonary complications of bronchiolitis obliterance and bronchiectasis caused by respiratory epithelial detachment. Thereafter, chronic bronchitis and chronic sinusitis has persisted due to mucosal ciliary dysfunction and several episodes of spontaneous pneumothorax has occurred. However, despite these persisting and serious sequelae of TEN, the patient has survived for 8 years. We report a rare case of a patient with long-term chronic pulmonary complications who had previously suffered TEN 8 years ago.
Adolescent ; Bronchiectasis ; Bronchiolitis ; Bronchitis, Chronic ; Epidermal Necrolysis, Toxic* ; Humans ; Male ; Mortality ; Pneumothorax ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult ; Sinusitis ; Skin

BACKGROUND: Rib fractures are the most common type of thoracic trauma and cause other complications. We explored the risk factors for pneumonia in patients with multiple rib fractures. MATERIALS AND METHODS: Four hundred and eighteen patients who visited our hospital with multiple rib fractures between January 2002 and December 2008 were retrospectively reviewed. Chest X-rays and chest computed tomography were used to identify injury severity. Patients with only a single rib fracture or who were transferred to another hospital within 2 days were excluded. RESULTS: There were 327 male patients (78%), and the median age was 53 years. The etiologies of the patients' trauma included traffic accidents in 164 cases (39%), falls in 78 cases (19%), slipping and falling in 90 (22%), pedestrian accidents in 30 (7%), industrial accidents in 41 (10%), and assault in 15 (4%). The median number of rib fractures was 4.8. Pulmonary complications including flail chest (2.3%), lung contusion (22%), hemothorax (62%), pneumothorax (31%), and hemopneumothorax (20%) occurred. Chest tubes were inserted into the thoracic cavity in 216 cases (52%), and the median duration of chest tube insertion was 10.26 days. The Injury Severity Score (ISS) and rib score had a median of 15.27 and 6.9, respectively. Pneumonia occurred in 18 cases (4.3%). Of the total cases, 33% of the cases were managed in the intensive care unit (ICU), and the median duration of stay in the ICU was 7.74 days. Antibiotics were administered in 399 patients (95%) for a median of 10.53 days. Antibiotics were used for more than 6 days in 284 patients (68%). The factors affecting pneumonia in patients with multiple rib fractures in multivariate analysis included age (p=0.004), ISS (p<0.001), and rib score (p=0.038). The use of antibiotics was not associated with the occurrence of pneumonia (p=0.28). In-hospital mortality was 5.3% (n=22). CONCLUSION: The factors affecting risk of pneumonia in patients with multiple rib fractures included age (p=0.004), ISS (p<0.001), and rib score (p=0.038). Elderly patients with multiple traumas have a high risk of pneumonia and should be treated accordingly.
Accidents, Occupational ; Accidents, Traffic ; Aged ; Anti-Bacterial Agents ; Chest Tubes ; Contusions ; Flail Chest ; Hemopneumothorax ; Hemothorax ; Hospital Mortality ; Humans ; Injury Severity Score ; Intensive Care Units ; Lung ; Male ; Multiple Trauma ; Multivariate Analysis ; Pneumonia ; Pneumothorax ; Retrospective Studies ; Rib Fractures ; Ribs ; Risk Factors ; Thoracic Cavity ; Thorax

OBJECTIVETo assess the predisposing factors, frequency and mortality of pneumothorax (PTX) among the newborns hospitalized in a neonatal intensive care unit (NICU) in Isfahan, Iran.

METHODSThe data of 43 cases of PTX among the 738 neonates hospitalized in the NICU were analyzed retrospectively according to gestational age, birth weight, Apgar score, type of delivery, age of mother, parity, perinatal asphyxia, resuscitation at birth, side of PTX, mechanical ventilation, surfactant therapy, and underlying lung disorders.

RESULTSMean gestational age was 31 weeks and birth weight was 1 596 g in the PTX cases. The gestational age of 12 (28%) neonates was less than 28 weeks. Twenty-eight (65%) neonates were below 1,500 g. In total, PTX occurred in 43 (5.8%) neonates. Sixty-three episodes of PTX (97%) were unilateral and 2 (3%) were bilateral. Respiratory distress syndrome (RDS) (40/43, 93%) and mechanical ventilation (37/43, 86%) were common predisposing factors of PTX. Overall, 28 (65%) neonates with PTX died. Birth weight, gestational age and chest tube duration were significantly different between dead and surviving infants. The mortality rate was significantly higher in neonates who required surfactant therapy than that in those who did not require it.

CONCLUSIONSThe incidence and mortality of PTX in this study were higher than some other reports and this might be attributed to lower birth weight and gestational age. RDS and mechanical ventilation were the most common predisposing factors for the development of neonatal PTX, and mortality increased with lower birth weight, lower gestational age and more severe underlying primary lung disease.

Humans ; Incidence ; Infant, Newborn ; Intensive Care Units, Neonatal ; Iran ; epidemiology ; Pneumothorax ; epidemiology ; etiology ; mortality ; Retrospective Studies

Bronchiolitis obliterans (BO) or bronchiolitis obliterans organizing pneumonia (BOOP) is one of manifestations of graft-versus-host disease (GVHD), a complication of hematopoietic stem cell transplantation (HSCT). Recently there are reports about thoracic air-leakage syndrome (TALS), but real incidence, clinical course, and implications of TALS remain unclear. Retrospective review of 18 TALS patients among 2,177 patients who received allogeneic HSCT between January 2000 to July 2007 was done. Clinical manifestations, treatments, and outcomes of TALS were reviewed. The incidence of TALS was 0.83% (18/2,177). The onset of TALS was mean 425.9+/-417.8 days (60-1,825 days) after HSCT, and the duration was mean 16.3+/-21 days (2-90 days). The most common types of TALS were spontaneous pneumothroax (n=14), followed by subcutaneous emphysema (n=6), pneumomediastinum (n=5), interstitial emphysema (n=2), and pneumopericardium (n=1). TALS persisted in six patients, who died during the same hospitalization. The 12 patients recovered from TALS, but only 2 survived, while others died due to aggravation of GVHD. TALS may complicate BO/BOOP and be an initial manifestation of BO/BOOP. TALS is hard to be resolved, and even after the recovery, patients die because of aggravation of GVHD. We suggest specifically in HSCT patients, when once developed, TALS seems hard to be cured, and as a result, be related to high fatality.
Adolescent ; Adult ; Comorbidity ; Female ; Graft vs Host Disease/*mortality/*surgery ; Hematopoietic Stem Cell Transplantation/*mortality ; Hemothorax/*mortality ; Humans ; Incidence ; Korea ; Male ; Middle Aged ; Pneumothorax/*mortality ; Prognosis ; Risk Assessment ; Risk Factors ; Survival Analysis ; Survival Rate ; Syndrome ; Treatment Outcome ; Young Adult

OBJECTIVETo probe into the mechanism of pneumothorax caused by acupuncture or acupoint injection and the preventive methods.

METHODSRetrospectively analyze the clinical original symptoms of 38 cases with pneumothorax caused by acupuncture and acupoint injection, which were divided into four clinical types: dyspnea type, shock type, thoracalgia type and tardy type. Illustrate the relation of the clinical types with severe degrees of pneumothorax, and the mechanism of pneumothorax inducing death of the patient.

RESULTSIn the series there were 38 cases with pneumothorax induced by acupuncture or acupoint injection, including 4 cases of dyspnea type, 16 cases of shock type, 14 cases of thoracalgia type, 4 cases of tardy type. After proper treatment, 37 cases were cured and one case of dyspnea type died of tension pneumothorax.

CONCLUSIONThe mechanism of pneumothorax caused by acupuncture or acupoint injection is that due to the filiform needle tip or the syringe's needle tip inserting into the lung tissue at the patient's respiration in acupuncture or acupoint injection, the filiform needle tip or the syringe's needle tip lacerates the lung tissue. Air in alveolus goes into the thorax pleura cavity to form pneumothorax. In acupuncture or acupoint injection, the needle tip must not insert into the lung tissue, which is a key for prevention of pneumothorax.

Acupuncture Points ; Acupuncture Therapy ; adverse effects ; Adult ; Aged ; Drug-Related Side Effects and Adverse Reactions ; Female ; Humans ; Injections ; adverse effects ; Male ; Middle Aged ; Pneumothorax ; diagnosis ; etiology ; mortality ; therapy ; Retrospective Studies ; Young Adult