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Surgical Treatment for Thoracic Injuries - One Clinic's Experience

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Pogorzelski R., Szostek M., Wołoszko T., Jakuczun W., Toutounchi S., Macioch W., Szostek M., Skórski M.
Polish Journal of Surgery
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2007
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vol. 79
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issue 10
643-648
EN
The aim of the study was to present one clinic's experience in the treatment of thoracic injuries. Particular attention was paid to the methods for treatment of patients after thoracic injuries.Material and methods. During the years 1996-2006, 273 patients with thoracic injuries were hospitalized in the clinic; 0.9% of all patients treated during this time. There were 66 women (24.2%) and 207 men (75.8%), aged 17 to 85 years (average: 34.9).Results. Among all of the thoracic injuries analyzed, the most common was traffic accidents, which made up 111 (40.7%) cases. Next, accidents of violence made up 87 (31.9%) cases, and accidental falls and falls from heights 62 (22.7%) cases. Rare were self-mutilations, crash traumas and gunshot traumas. Isolated injury was observed in 107 cases, and 166 (60.8%) patients had multifocal trauma and multi-organ injuries. 50 patients (18.3%) had acute, penetrating injuries, and 223 patients (81.7%) had blunt thoracic injuries. During hospitalization, other traumas were diagnosed: rib fractures in 107 cases (39.2%), pleurohematoma in 37 cases (13.6%), pneumothorax in 36 cases (13.2%), pneumohemothorax in 26 cases (9.5%), lung contusion in 43 cases (15.8%), posttraumatic aorta aneurysm in 31 cases (11.4%), and contusion of the heart or great vessels in 8 cases (2.9%).The applied treatment was: pleural cavity drainage in 86 cases (27.8%), immediate thoracotomy in 24 cases (8.8%), laparotomy in 23 cases (8.4%), stent-graft implantation in posttraumatic aneurysms in 30 cases (11%), and other specialized operations in 46 cases (16.9%). Qualified surgical treatment was performed in 176 cases (64.5%) out of 273. Multispecialized treatment was used in 46 cases (16.8%). 16 patients died (5.9%), most directly after admission to the hospital.Conclusions. 1. Over 30% of patients need no surgical treatment after thoracic trauma. 2. The most common coexisting injuries with thoracic trauma are cranio-cerebral injuries and bone fractures. 3. The main cause of death is oligovolemic shock due to heart and great vessels contusion.
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One-Centre Study Investigating a need for an immediate vascular surgery in patients over 80 years of age - comparison analysis of the results

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Pogorzelski R., Wołoszko T., Małek A., Szostek M., Jakuczun W., Toutounchi S., Macioch W., Leszczyński J., Skórski M.
Polish Journal of Surgery
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2010
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vol. 82
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issue 5
267-271
EN
According to the observation made by the study authors, every year there is an increasing number of patients advanced in years who require surgical management of their vascular disease. They constitute more than 4% of all patients. The similar situation is our medical centre, where the number of the hospitalisations of octogenarians increases with every subsequent year. In spite of many concomitant diseases we propose them immediate operation. Then it seems to be important a comparison two ways of treatment: immediate and elective ones.The aim of the study was evaluation of the results obtained in the treatment of vascular diseases requiring an immediate surgical intervention.Material and methods. In the years 2005-2007, there were 150 patients treated for arterial diseases. The group consisted of 87 men (58%) and 63 women (42%), with a mean age of 83.6. All the patients were divided into two groups: patients undergoing an elective surgery (n = 113), and those operated on immediately (n = 37). For both these groups was performed the comparison analysis, concerning the most important concomitant disorders, having an unquestionable influence on the final results of the operative treatmentResults. The comparison analysis of deaths, amputations, and hospitalisation period in the elective and immediate surgeries revealed the following: 5.3% vs 21.6% (p = 0.006), 7.9% vs 13.5% (p = 0.33), and 15.8 vs 9.8, respectively.Conclusions. Immediate vascular surgery is especially needed by older women. Culture and customs are the reasons for treatment delay in Poland, with its direct effects on the treatment results.
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Anastomotic Aneurysms in the Groin - Results of Surgical Treatment

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Pogorzelski R., Wołoszko T., Szostek M., Macioch W., Leszczyński J., Jakuczun W., Małek A., Skórski M., Szostek M.
Polish Journal of Surgery
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2007
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vol. 79
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issue 10
635-642
EN
The aim of the study. The authors introduce single-center results of surgical treatment of 84 aneurysms in 79 patients. Anastomotic aneurysms belong to group of pseudoaneurysms which appear in places after vascular anastomosis.The most common location of this kind of pseudoaneurysm is the groin (85%). The next most common location is the proximal anastomotic place with the aorta or iliac common artery (12%), which constitutes from 1 to 5% of all vascular abnormalities. Usually, these need to be surgically treated.Material and methods. The authors present surgical treatment results of 79 patients with 84 pseudoaneurysms: 10 women (12.7%) and 69 men (87.3%) ranging in age from 44 to 81 years old, with an average age of 64.7 years old.The frequency of this pathology in all patients with vascular diseases treated in our Department was 1.6% and 7.7% in patients after surgical anastomosis in the groin. Eleven patients (13.9%) with aneurysm rupture and four (5.1%) with thrombosis and acute ischemia of the lower limb needed an emergency operation. The remaining 64 patients (81%) were operated on according to the plan.The most common operations were: vascular by - pass, secondary suture of anastomosis, and covering the lost part of the anastomosis with a patch. This treatment was used in 66 cases (84.5%), and 18 patients (22.8%) needed early secondary operation. 18 patients (22.8%) had a vascular prosthesis infection.Results. A good treatment result of anastomotic aneurysms was observed in 64 patients (81%).In 10 cases (12.7%), amputation was needed due to lack of blood recirculation in the limbs.Five patients died because of MODS due to vascular prosthesis infection.Conclusions. 1. The most important complication resulting in surgical treatment failure is vascular prosthesis infection and the progress of peripheral arteriosclerosis. 2. Distant vascular anastomosis dehiscence may show that the anastomosis was done using too much tension or that there were dakron physicochemical changes due to the aging process.
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