RESUMEN
Seven cases of injury to the tracheobronchial tree in closed trauma of the thorax, treated by the surgical emergency service of the Hospital das Clínicas, University of São Paulo School of Medicine, during the period 1980-2 are described and compared with previously published cases. The diagnosis of the seven cases presented in this series was clinically suspected and endoscopically confirmed within 24 hours of injury, all patients being immediately submitted to reconstructive surgery; and except for one who failed to respond to initial resuscitation and died during surgery all the patients had a satisfactory postoperative course. Many previously reported cases of tracheobronchial injury by contrast have taken more than a month to be diagnosed; but for the best results such injuries must be repaired immediately. Awareness of the possibility of tracheobronchial injury in cases of violent chest trauma is important for early diagnosis; emphysema, dyspnoea, and pneumothorax are not always present, and absence of radiological and clinical signs of tracheobronchial injury does not exclude such injury. Bronchoscopy is the most important investigation for clinical diagnosis. Once the diagnosis has been made thoracotomy is nearly always required. Throughout the surgical procedure expert cooperation between anaesthetist and surgeon is essential. After operation prevention of further damage to the trachea depends on careful respiratory management.
Asunto(s)
Bronquios/lesiones , Tráquea/lesiones , Adulto , Bronquios/cirugía , Preescolar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Rotura , Tráquea/cirugíaRESUMEN
Os autores apresentam sete casos de lesoes da arvore traqueo-bronquica por traumatismo toracico fechado atendidos no Servico de Cirurgia de Emergencia do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo no periodo de 1980 a 1982. Compararam sua experiencia com aquela da literatura chamado a atencao para as dificuldades que podem ser encontradas no diagnostico precoce deste tipo de lesao Os sete casos motivo desta publicacao tiveram seu diagnostico suspeitado clinicamente e confirmado endoscopicamente e todos foram submetidos, de imediato, a cirurgia reparadora. Com excecao de um doente que nao respondeu satisfatoriamente a ressuscitacao inicial e faleceu no intra-operatorio, os demais tiveram evolucao satisfatoria. Finalmente sao comentados os mecanismos etiopatologicos destas lesoes, suas caracteristicas anatomo-patologicas, as bases do diagnostico e do tratamento cirurgico
Asunto(s)
Preescolar , Adulto , Persona de Mediana Edad , Humanos , Masculino , Femenino , Bronquios , Traumatismos Torácicos , TráqueaRESUMEN
Neste trabalho, realizado em 20 pacientes portadores de hemotorax traumatico, os autores estudaram as caracteristicas do sangue contido na cavidade pleural, em vistas ao seu aproveitamento para reinfusao. Concluem que este sangue tem caracteristicas muito semelhantes as do sangue circulante, exceto pela reducao dos fatores de coagulacao. Em decorrencia nao e necessario anticoagula-lo para reinfundi-lo
Asunto(s)
Adolescente , Adulto , Persona de Mediana Edad , Humanos , Masculino , Femenino , Transfusión de Sangre Autóloga , HemotóraxAsunto(s)
Intubación Gastrointestinal/efectos adversos , Neumonía por Aspiración/etiología , Traqueotomía/efectos adversos , Adolescente , Adulto , Niño , Preescolar , Estado de Conciencia , Azul de Evans , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Neumonía por Aspiración/diagnóstico , InconscienciaRESUMEN
Os autores fazem um estudo da incidencia de aspiracao de conteudo da orofaringe para a traqueia em 42 pacientes (sendo 26 deles intubados e 16 traqueostomizados), utilizando o corante azul de Evans a 1% para detectar a presenca de aspiracao. Os resultados obtidos mostram indices elevados de aspiracao (da ordem de 50%), nao havendo diferenca significativa, esteja o paciente intubado ou traqueostomizado, em coma ou consciente, com sonda nasogastrica ou nao. E analisada tambem a fisiopatologia, e sao feitos comentarios de ordem pratica, principalmente sob o ponto de vista de prevencao de aspiracao
Asunto(s)
Humanos , Masculino , Femenino , Intubación Gastrointestinal , Neumonía por Aspiración , TraqueotomíaRESUMEN
We studied the reaction in rats to implants of heterotopic bone in the paravertebral region, using three types of material: bone preserved in alcohol, homologous bone preserved in alcohol associated with autogenous cancellous bone obtained from the iliac crest of the same animal, and isolated autogenous cancellous bone. Thirty rats were operated on, ten in each group. Some were sacrificed after 6, 14 and 21 days. The excised grafts were histologically studied. Animals in the third group showed new bone formation even in the first days, those in the second group presented less intense bone formation and those in the first group showed only traces of new bone tissue in the third week.