RESUMO
Abstract Introduction: In high-volume trauma centers, especially in developing countries, penetrating cardiac box injuries are frequent. Although many aspects of penetrating chest injuries have been well established, video-assisted thoracoscopy is still finding its place in cardiac box trauma and algorithmic approaches are still lacking. The purpose of this manuscript is to provide a streamlined recommendation for penetrating cardiac box injury in stable patients. Methods: Literature review was carried out using PubMed/MEDLINE and Google Scholar databases to identify articles describing the characteristics and concepts of penetrating cardiac box trauma, including the characteristics of tamponade, cardiac ultrasound, indications and techniques of pericardial windows and, especially, the role of video-assisted thoracoscopy in stable patients. Results: Penetrating cardiac box injuries, whether by stab or gunshot wounds, require rapid surgical consultation. Unstable patients require immediate open surgery, however, determining which stable patients should be taken to thoracoscopic surgery is still controversial. Here, the classification of penetrating cardiac box injury used in Colombia is detailed, as well as the algorithmic approach to these types of trauma. Conclusion: Although open surgery is mandatory in unstable patients with penetrating cardiac box injuries, a more conservative and minimally invasive approach may be undertaken in stable patients. As rapid decision-making is critical in the trauma bay, surgeons working in high-volume trauma centers should expose themselves to thoracoscopy and always consider this possibility in the setting of penetrating cardiac box injuries in stable patients, always in the context of an experienced trauma team.
Assuntos
Humanos , Traumatismos Torácicos , Ferimentos por Arma de Fogo , Ferimentos Penetrantes , Traumatismos Cardíacos/cirurgia , Traumatismos Cardíacos/diagnóstico por imagem , Toracoscopia , Cirurgia Torácica VídeoassistidaRESUMO
INTRODUCTION: In high-volume trauma centers, especially in developing countries, penetrating cardiac box injuries are frequent. Although many aspects of penetrating chest injuries have been well established, video-assisted thoracoscopy is still finding its place in cardiac box trauma and algorithmic approaches are still lacking. The purpose of this manuscript is to provide a streamlined recommendation for penetrating cardiac box injury in stable patients. METHODS: Literature review was carried out using PubMed/ MEDLINE and Google Scholar databases to identify articles describing the characteristics and concepts of penetrating cardiac box trauma, including the characteristics of tamponade, cardiac ultrasound, indications and techniques of pericardial windows and, especially, the role of video-assisted thoracoscopy in stable patients. RESULTS: Penetrating cardiac box injuries, whether by stab or gunshot wounds, require rapid surgical consultation. Unstable patients require immediate open surgery, however, determining which stable patients should be taken to thoracoscopic surgery is still controversial. Here, the classification of penetrating cardiac box injury used in Colombia is detailed, as well as the algorithmic approach to these types of trauma. CONCLUSION: Although open surgery is mandatory in unstable patients with penetrating cardiac box injuries, a more conservative and minimally invasive approach may be undertaken in stable patients. As rapid decision-making is critical in the trauma bay, surgeons working in high-volume trauma centers should expose themselves to thoracoscopy and always consider this possibility in the setting of penetrating cardiac box injuries in stable patients, always in the context of an experienced trauma team.
Assuntos
Traumatismos Cardíacos , Traumatismos Torácicos , Ferimentos por Arma de Fogo , Ferimentos Penetrantes , Traumatismos Cardíacos/diagnóstico por imagem , Traumatismos Cardíacos/cirurgia , Humanos , Cirurgia Torácica Vídeoassistida , ToracoscopiaRESUMO
Congenital lobar overinflation is characterized by disruption of bronchopulmonary development which produces lobar or segmental bronchial abnormalities and overinflation of normal lung tissue. This is a 44-year old man, never smoker, who presents dyspnea every time he arrived in highlands, marked decreased breathing sounds and hyperresonance in the left hemithorax. Imaging studies suggested left upper lobe overinflation. The affected area was resected resulting in symptoms improvement. Accepted treatment is resection, however conservative management has been proposed for asymptomatic patients because cases of spontaneous improvement have been described. We recommend close monitoring and resection if symptoms or overinflation progress.
Assuntos
Enfisema Pulmonar , Adulto , Brônquios , Dispneia , Humanos , Pulmão/diagnóstico por imagem , Pulmão/cirurgia , MasculinoRESUMO
In Colombia, the number of younger female surgeons is increasing along with a growing interest in thoracic and cardiac surgery. It is our duty to motivate young female surgeons in pursuing a career in chest surgery to answer the already growing deficit of cardio-thoracic surgeons.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Cirurgia Torácica , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Colômbia , Feminino , Humanos , Inquéritos e QuestionáriosAssuntos
Países em Desenvolvimento , Acessibilidade aos Serviços de Saúde , Pneumotórax/terapia , Padrões de Prática Médica , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Colômbia , Fidelidade a Diretrizes , Acessibilidade aos Serviços de Saúde/normas , Disparidades em Assistência à Saúde , Humanos , Pneumotórax/diagnóstico , Pneumotórax/etiologia , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Resultado do TratamentoAssuntos
Humanos , Feminino , Gravidez , Aborto Legal , Aborto Legal/legislação & jurisprudência , Aborto , ArgentinaRESUMO
BACKGROUND: eSS is a rat model of type 2 diabetes characterized by fasting hyperglycemia, glucose intolerance, hyperinsulinemia and early hypertriglyceridemia. Diabetic symptoms worsen during the second year of life as insulin release decreases. In 12-month-old males a diffuse hepatic steatosis was detected. We report the disturbances of lipid metabolism of the model with regard to the diabetic syndrome. METHODS: The study was conducted in eight 12-month-old eSS male rats and seven age/weight matched eumetabolic Wistar rats fed with a complete commercial diet al libitum. Fasting plasmatic glucose, insulin, triglycerides, total cholesterol, low-density and high-density lipoprotein, and nonesterified fatty acids levels were measured. Very low density and intermediate-density lipoproteins were analyzed and hepatic lipase activity was determined. RESULTS: eSS rats developed hyperglycemia and hyperinsulinemia, indicating insulin resistance. Compared with controls, diabetic rats exhibited high plasmatic levels of NEFA, triglycerides (TG), total cholesterol (Chol) and LDL-Chol while high-density lipoprotein (HDL) cholesterol values were reduced. eSS rats also displayed TG-rich VLDL and IDL particles without changes in hepatic lipase activity. CONCLUSION: The nonobese eSS rats develop a syndrome characterized by glucose and lipid disorders and hepatic steatosis that may provide new opportunities for studying the pathogenesis of human type 2 diabetes.