Clinical Approach for the Pneumomediastinum after Blunt Chest Trauma

Objective: Pneumomediastinum (PM) can be observed after blunt and penetrating chest trauma. Most of the patients with PM due to trauma can be managed conservatively. This study aimed to evaluate the cases with PM on thorax computed tomography (CT) after blunt chest trauma (BCT). Methods: Medical records of patients with PM due to BCT between January 2000 and December 2014 were reviewed retrospectively. Thorax CT was used to verify pneumomediastinum in all patients. Twenty-four patients which had different causes of PM (penetrating trauma, iatrogenic, spontaneous) were excluded from the study. Data of sixty-nine patients with the diagnosis of PM secondary to BCT and who were observed without any further procedure for the cause of PM, were evaluated retrospectively. Results: There were 59 male and 10 female patients with the mean age of 47.60 ± 17.47 years (range, 16 to 80 years). The most common cause of PM etiology was traffic accident with a rate of 38 (55.06%) patients, followed by fall from height in 25 (36.24%), compression in 3 (4.35%) and drubbing in 3 (4.35%) patients. There was a 12.46 ± 6.42 days (range, 6 to 28 days) mean duration of chest tube drainage which was performed for accompanying pathologies like pneumothorax and hemothorax. No complication was determined for short and long term follow-up of patients when all hospital records were analyzed in terms of complication. Conclusions: PM after BCT may be a marker of esophageal and tracheobronchial injury and invasive procedures like bronchoscopy and endoscopy can be needed for differential diagnosis. We evaluated 69 patients in good general status and no need for intensive care management with PM in this study and observed them without any further procedure. As a result of these findings we concluded that for the PM patients after BCT with uneventful clinical course, conservative treatment without any further procedure is a safe and sufficient method.

The Effect of Preoperative AchR-Ab Level to the Prognosis in Operated Myasthenia Gravis Patients

Objective: Seropositive myasthenia gravis (MG) depends on the presence of acetylcholine receptor antibodies (AchR-Ab) against nicotinic acetylcholine receptors at the postsynaptic neuromuscular junction. In this study, we investigated the effect of AchR-Ab levels to symptoms and treatment in the MG patients underwent surgery for thymic pathology. Materilas and Methods: The records including level of preoperative AchR-Ab, type of thymic pathology, the changes of symptoms and treatment after surgery for thymic pathology of 37 MG patients between January 2007 and December 2015 have been viewed retrospectively. Results: The mean age of 37 patients (21 females, 16 males) was 40.2 ± 14.9 years (range, 18 to 75 years). The mean of the level of AchR-Ab was 144.7 ± 427.6 nmol/L (range, 0.1 to 1806 nmol/L). In the patient group including the reduced use of anticholinesterase after surgery the mean of level of AchR-Ab was 241.3 nmol/L while it was 10.8 nmol/L in the patient group including the non-reduced use of anticholinesterase (p = 0.082) after a mean follow-up period of 23 months postoperatively. The mean levels were 246.7 nmol/L and 8.5 nmol/L for the reduced and non-reduced use of corticosteroid patient groups, respectively (p = 0.001). In the 25 patients with fewer symptom after surgery the mean of the AchR-Ab level was 205.3 nmol/L while it was 18.3 nmol/L in the patients without any changes (p = 0.071). Conclusion: We concluded that the preoperative level of AchR-Ab was associated with postoperative dosage of anticholinesterase and corticosteroids and severity of symptoms postoperatively. We think that the levels of AchR-Ab titers can be a marker for the efficacy of thymic surgery.

Rebar Impalement Injury Throughout Bilateral Hemithorax and Pericardium

Thoracic traumas have an important place among all injuries as they can cause significant mortality and morbidity. The thoracic injuries are the large part of trauma with head and extremity injuries. Thoracic traumas are divided into two groups, including penetrating and blunt. The primary causes for penetrating traumas are wounds caused by gunshot and sharp objects. The lungs are the most injured organ in penetrating thoracic traumas with many organ injuries accompanied. This case report is about a rebar impalement into bilateral hemitoraces and pericardium after falling down in spite of any injury is not occurred in heart, lung and great vessels. The fact that an injury to such an extent does not cause any intrathoracic catastrophic event is something that has not been reported in the past.