Objective: A rib fracture secondary to blunt thoracic trauma is an important indicator of the severity of the trauma. In the present study we explored the morbidity and mortality rates and the management following rib fractures. Methods: Between May 1999 and May 2001, 1417 cases who presented to our clinic for thoracic trauma were reviewed retrospectively. Five hundred and forty-eight (38.7%) of the cases had rib fracture. There were 331 males and 217 females, with an overall mean age of 43 years (range: 5‐ 78 years). These patients were allocated into groups according to their ages, the number of fractured ribs and status, i.e. whether they were stable or unstable (flail chest). Results: The etiology of the trauma included road traffic accidents in 330 cases, falls in 122, assault in 54, and industrial accidents in 42 cases. Pulmonary complications such as pneumothorax (37.2%), hemothorax (26.8%), hemo-pneumothorax (15.3%), pulmonary contusion (17.2%), flail chest (5.8%) and isolated subcutaneous emphysema (2.2%) were noted. 40.1% of the cases with rib fracture were treated in intensive care units. The mean duration of their stay in the intensive care unit was 11.8 ^ 6.2 days. 42.8% of the cases were treated in the wards whereby their mean duration of hospital stay was 4.5 ^ 3.4 days, while 17.1% of the cases were followed up in the outpatient clinic. Twenty-seven patients required surgery. Mortality rate was calculated as 5.7% (n ¼ 31). Conclusions: Rib fractures can be interpreted as signs of significant trauma. The greater the number of fractured ribs, the higher the mortality and morbidity rates. Patients with isolated rib fractures should be hospitalized if the number of fractured ribs is three or more. We also advocate that elderly patients with six or more fractured ribs should be treated in intensive care units due to high morbidity and mortality. q 2003 Elsevier Science B.V. All rights reserved.

/pdf/a-comprehensive-analysis-of-traumatic-rib-fractures-4u771s32ka.pdf

A comprehensive analysis of traumatic rib fractures: morbidity, mortality and management

Cystic echinococcosis is endemic in certain parts of the world The growth of the cyst is often slow, and the liver and lungs are the most frequently involved organs Diagnosis is based on clinical signs and symptoms and epidemiological data, while ultrasonography is important for the classification of hydatid cysts Although certain types of hydatid cysts are successfully treated by percutaneous aspiration, injection, and reaspiration, surgery remains the treatment of choice We reviewed the current trends in the diagnosis and management of cystic echinococcosis, with special emphasis on hepatic and pulmonary involvement

Cystic hydatid disease: current trends in diagnosis and management.

Background— Cardiopulmonary bypass and cardiac surgery are associated with a significant systemic inflammatory response that may increase postoperative complications. This meta-analysis assessed whether the benefits and risks of corticosteroid use were dose dependent in adult cardiac surgery. Methods and Results— Randomized controlled trials of the use of corticosteroid prophylaxis in adult cardiac surgery (>18 years of age) requiring cardiopulmonary bypass were selected from MEDLINE (1966 to August 1, 2008), EMBASE (1988 to August 1, 2008), and the Cochrane controlled trials register without any language restrictions. A total of 3323 patients from 50 randomized controlled trials were identified and subject to meta-analysis. Corticosteroid prophylaxis reduced the risk of atrial fibrillation (25.1% versus 35.1%; number needed to treat, 10; relative risk, 0.74; 95% confidence interval [CI], 0.63 to 0.86; P<0.01) and length of stay in the intensive care unit (weighted mean difference, −0.37 days; 95% CI, −0....

https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.108.848218

Benefits and Risks of Corticosteroid Prophylaxis in Adult Cardiac Surgery A Dose-Response Meta-Analysis

We sought to establish the efficacy and safety of prophylactic steroids in adult patients undergoing cardiopulmonary bypass (CPB). We performed a meta-analysis of randomized trials reporting the effects of prophylactic steroids on clinical outcomes after CPB. Outcomes examined were mortality, myocardial infarction, neurological events, new onset atrial fibrillation, transfusion requirements, postoperative bleeding, duration of ventilation, intensive care unit (ICU) stay, hospital stay, wound complications, gastrointestinal complications, and infectious complications. We included 44 trials randomizing 3205 patients. Steroids reduced new onset atrial fibrillation [relative risk (RR) 0.71, 95% confidence interval (CI) 0.59 to 0.87], postoperative bleeding [weighted mean difference (WMD) −99.6 mL, 95% CI −149.8 to −49.3], and duration of ICU stay (WMD −0.23 days, 95% CI −0.40 to −0.07). Length of hospital stay was also reduced (WMD −0.59 days, 95% CI −1.17 to −0.02), but this result was less robust. A trend towards reduction in mortality was observed (RR 0.73, 95% CI 0.45 to 1.18). Randomized trials suggest that perioperative steroids have significant clinical benefit in CPB patients by decreasing the risk of new onset atrial fibrillation, while results are encouraging for reducing bleeding, length of stay, and mortality. These data do not raise major safety concerns, however, a sufficiently powered trial is warranted to confirm or refute these findings.

/pdf/clinical-benefit-of-steroid-use-in-patients-undergoing-1sc78cz1pn.pdf

Clinical benefit of steroid use in patients undergoing cardiopulmonary bypass: a meta-analysis of randomized trials

Cystic echinococcosis (CE) is a zoonotic parasitic disease caused by the larval stages of the cestode Echinococcus granulosus. Worldwide, pulmonary hydatid cyst is a significant problem medically, socially, and economically. Surgery is the definitive therapy of pulmonary hydatidosis. Benzimidazoles may be considered in patients with a surgical contraindication. This review will focus on pathogenesis, lifecycle, clinical features, and management of pulmonary hydatid disease.

Cystic pulmonary hydatidosis.

OBJECTIVE This study examined the correlation between tumour necrosis factor-alpha (TNF-alpha), interleukin (IL)-6 and IL-8, IL-10 and methylprednisolone pretreatment. METHODS This is a prospective, randomized and double-blinded study. Sixty patients undergoing coronary artery bypass grafting (CABG) were randomized to receive either intravenous methylprednisolone (n = 30, Group M) or intravenous placebo (n = 30, Group S). The patients received intravenously either 30 mg/kg methylprednisolone (Group M) or placebo (Group S) 10 min before and after cardiopulmonary bypass (CPB). In an intensive care unit (ICU), four additional doses were given at 6-hourly intervals. Blood samples for the measurements of TNF-alpha, IL-6, IL-8 and IL-10 were obtained before induction of anaesthesia (T0 = control value), after induction (T1), before starting CPB (T2), after aortic declamping (T3), at the end of CPB (T4) and 6 hours (T5), 12 hours (T6) and 24 hours (T7) after skin closure. Creatine kinase (CK) and creatine kinase isoenzyme MB (CK-MB) were evaluated at the following intervals: T0, T5, T6 and T7. RESULTS When compared with the control value, TNF-alpha, IL-6 and IL-8 significantly increased in Group S and Group M (p < 0.05), but these values were significantly greater in Group S than in Group M (p < 0.05). In comparison with the control value, IL-10 increased in both groups (p < 0.05), but was significantly greater in Group M than in Group S (p < 0.05). CK and CK-MB were increased in both groups in postoperative values compared to control values. In Group S, CK and CK-MB levels were significantly lower than in Group M (p < 0.05). CONCLUSION In this study, we have found that preoperative administration of methylprednisolone has decreased TNF-alpha, IL-6 and IL-8 release, and increased the perfusing IL-10 levels after CPB. Thus, methylprednisolone may decrease the inflammatory response during the CPB procedure.

Methylprednisolone prevents inflammatory reaction occurring during cardiopulmonary bypass: effects on TNF-α, IL-6, IL-8, IL-10

Between 1976 and 1986 one hundred and ten children with pulmonary hydatid disease were treated surgically. Sixty five of the patients were males and 45 were females. We diagnosed hydatid cyst in 36 cases submitted in our clinic with hemoptysis. Thirty of the patients had cough, 16 had chest pain and dyspnea, 12 had purulent sputum and 8 cases had fever and anaphylactic phenomena. In most of the patients hydatid cysts were localised in the right lung. However, they had affinity for the lower lobes of both lungs, rather than the upper lobes. The radiological examination was found to be the most reliable diagnostic method. In the majority of our cases we performed thoracotomy + cystotomy + capitonnage, while in some cases we performed resection, like cystectomy, wedge resection and lobectomy. We did not encounter any serious operative and postoperative complications, except for one pleural empyema and a single case of mortality.

The hydatid cyst of the lung in children and results of surgical treatment.

Purpose
To retrospectively investigate the effectiveness of tube drainage in the treatment of bilateral pneumothorax.

Bilateral pneumothorax: a retrospective analysis of 40 patients.

A series of 460 surgically treated cases of hydatid cyst of the lung is presented. Radiologic preoperative diagnosis was made in 90% of the patients. Cystotomy with subsequent capitonnage was performed in 395 cases, wedge resection in 27, lobectomy in 15 and segmental resection in 23 cases. After careful hemostasis, two drains were placed in the thorax and the thoracic cavity was closed. There were three postoperative deaths (0.6%) and two recurrences of cyst (0.4%) during follow-up investigation for periods up to 10 years.

Surgery in hydatid cyst of the lung. A report of 460 cases.

Acute Thrombosis of Inferior Vena Cava in a Pregnant Woman Presenting with Sciatica: A Case Report

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