1/30. Left upper lobe bronchus reimplantation for nonpenetrating thoracic trauma.Trauma to the tracheobronchial tree has been diagnosed and treated with increasing frequency over the last several decades. However, most reports have dealt with management of injuries to the trachea and main stem bronchi, as approximately 80% of blunt tracheobronchial injuries occur within this area. With few exceptions, injury to the lobar bronchi has resulted in thoracotomy and lobectomy. We describe a patient with an injury to the left upper lobe bronchus who presented with delayed obstruction of the airway by fibrogranulation tissue. A successful segmental resection of the bronchial occlusion with reimplantation was performed, thereby preserving the patient's otherwise normal left upper lobe. This case demonstrates that resection and reimplantation of an injured lobar bronchus are feasible, even in a delayed setting.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
2/30. Ultrasound of epigastric injuries after blunt trauma.Blunt trauma to the epigastrum may result in a retroperitoneal hematoma involving the head of the pancreas and descending duodenum. Secondary effects include obstruction of the gastric outlet, obstruction of the biliary tree, and extrinsic compression of the inferior vena cava. Four patients with epigastric trauma were reviewed who had been examined by ultrasound of the abdomen. Ultrasound showed the extent of the retroperitoneal hematoma, its effect on contiguous organs, and was helpful in clinical management.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
3/30. Planned complex suicide: report of three cases.Three cases of planned complex suicide in a 3-year period are reported. A 40-year-old man was found dead, in his garage, hanging by his neck, with a gunshot in the head from a pen gun. A 50-year-old man was found dead in the sea with a gunshot to his head. A third man was found in a field hanging by a tree and burned. The investigation of the scenes and the methods used pointed toward a suicidal etiology. The main difference between planned complex suicide and those cases defined in medicolegal literature as combined suicides lies in the complex mechanism used by the victim as a protection against the failure of one of the mechanisms.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
4/30. gallbladder injury in blunt abdominal trauma.A 36-year-old woman was admitted to the hospital for an abdominal blunt trauma. At ultrasound (US) and computed tomography (CT), a gallbladder lesion was suspected, along with a tear of the liver. The patient was submitted to a diagnostic laparoscopy. The gallbladder was partially avulsed and bile was infiltrated in the hepatoduodenal ligament. Intraoperative cholangiography and Kocher's maneuver excluded other lesions. Laparoscopic cholecystectomy was performed, but due to severe hemorrhage from the liver tear, the operation was converted to an open procedure. gallbladder lesions in blunt trauma are rare occurrences, but they are often associated with other organ injuries. US and CT scan are valuable for their diagnosis, but if a lesion is suspected, diagnostic laparoscopy is advisable in stable patients. It should be accompanied by a cystic duct cholangiography and a Kocher's maneuver to evaluate the integrity of the biliary tree. Laparoscopic cholecystectomy is generally feasible. Associated lesions require laparotomy when they are not amenable to laparoscopic treatment.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
5/30. Fatal head trauma from tree related injuries.Two cases of death following tree related injuries are presented. Two females, an elderly woman and a child, suffered severe head trauma from falling objects from trees--a falling coconut and a falling branch respectively. Although this mode of injury has been previously documented, there have been no prior reports of in-hospital deaths in such patients. This uncommon cause of death is reviewed and recommendations made concerning its prevention.- - - - - - - - - - ranking = 6keywords = tree (Clic here for more details about this article) |
6/30. Membranous tracheal rupture in children following minor blunt cervical trauma.Injuries to the tracheobronchial tree are well-recognized sequelae of massive blunt or penetrating injuries of the neck or chest. They may also occur as a rare complication of endotracheal intubation. We present 2 cases of a less well-recognized clinical entity, rupture of the membranous trachea following minimal blunt trauma to the neck in children. The case histories and management of this disorder are discussed. Recognition and treatment of this problem requires a high index of suspicion for the lesion and timely investigations. Open repair of the trachea to secure a stable airway is recommended for this injury, unless the wound is small and the wound edges are well approximated.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
7/30. A minimally invasive approach to bile duct injury after blunt liver trauma in pediatric patients.A 12-year-old boy presented with a large liver laceration after blunt abdominal trauma. He was treated nonoperatively and subsequently had bile peritonitis from a bile leak. Endoscopic retrograde cholangiopancreatography (ERCP) visualized the bile duct injury and allowed decompression of the biliary tree with an endoscopically placed biliary stent. A drain also was placed over the laceration through a small subcostal incision. The patient recovered rapidly after this minimally invasive procedure and went home 9 days later.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
8/30. Tracheobronchial rupture due to blunt trauma in children: report of two cases.Tracheobronchial tree injuries occur in a small number of patients after blunt chest trauma, and their occurrence is uncommon in the pediatric trauma population. The authors report two male children, one with a tracheal rupture, and the other with disruption of the main right bronchus. Mediastinal and subcutaneous emphysema resulting in airway obstruction were noted in Case 1 and soft-tissue emphysema, pneumomediastinum and tension pneumothorax were evident in Case 2 at the time of presentation. In the child with bronchial disruption, a major airway injury was suspected early on, because of a massive air leak despite two properly placed chest tubes. The definitive diagnosis was established bronchoscopically, and thoracotomy and primary repair were performed. The child with rupture of the posterior tracheal wall was diagnosed at an early stage by bronchoscopy and he was successfully managed without surgery.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
9/30. Anaesthetic management of tracheobronchial rupture following blunt chest trauma.Injuries to the tracheobronchial tree are a well-recognized sequel of massive blunt trauma to the chest, and although unusual, are life threatening. We report a 16-year-old-boy who developed complete disruption of both bronchi after a motor vehicle accident. After induction of general anaesthesia and oral intubation, ventilation could not be maintained, and oxygenation worsened abruptly with peripheral oxygen saturation values less than 60%. Jet ventilation through two intrabronchial catheters, inserted via emergency thoracotomy, raised the saturation from 60% to 100%, and surgery thereafter was straightforward. The anaesthetic management of tracheobronchial repair is discussed.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
10/30. rupture of the descending thoracic aorta caused by blunt chest trauma: report of a case.A 66-year-old man fell from a tree and was diagnosed to have multiple fractured ribs and hemopneumothorax based upon the chest roentgenogram findings. He underwent chest tube drainage and evacuation using video-assisted thoracic surgery. One week after the operation, he exhibited recurrent hemothorax. He underwent a thoracotomy, and the hemothorax was found to be due to a penetration of the lower descending thoracic aorta by a fractured rib. We performed a direct closure of the penetrated portion of the descending thoracic aorta. The patient has remained well for 1 year following the second operation.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
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