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Fractures of the first and second ribs had a very low association with ruptured bronchus (2%) and ruptured aorta or brachiocephalic vessel (8%) in a series of 50 patients. Radiographic abnormalities indicative of ruptured bronchus include massive pneumothorax, pneumomediastinum, subcutaneous emphysema, and lobar or whole lung collapse which may fall to the dependent part of the thorax on erect views. Abnormalities pointing to a laceration of the aorta or one of the brachiocephalic vessels include widening of the superior mediastinum, shift of the trachea or nasogastric tube to the right, enlargement or indistinctness of the aortic knob, and widening of the right paraspinal line. One or more of these abnormalities indicates the need for thoracic aortography. In the absence of these abnormalities, aortography is not indicated solely by the presence of a first or second rib fracture on the chest radiograph.
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PMID:Fractures of first and second ribs: predictive value for arterial and bronchial injury. 697 21

James Carson, a Scot, graduated from Edinburgh in 1799. He settled in Liverpool where he became a successful and respected physician and where he also found time to pursue a longstanding interest in physiology and to conduct certain important experiments. He read a series of papers on these experiments and their import before the Literary and Philosophical Society of Liverpool of which the two most important were On the elasticity of the lungs and On lesions of the lungs. In the first he clarified the mechanics of respiration while in the second he suggested that this knowledge might be employed to produce temporary collapse of the lung as a therapeutic measure. Two attempts at a clinical trial were defeated by widespread pleural adhesions but the first recorded attempts at artificial pneumothorax had been made. George Bodington, a Warwickshire man, after serving a surgical apprenticeship studied at St Bartholomew's Hospital and obtained the licence of the Society of Apothecaries in 1825. He later practised near Sutton Coldfield where he was known as an acute observer and a thoughtful and fluent speaker. In 1840 he published an essay on the treatment and cure of pulmonary consumption in which he roundly condemned the current therapy and advocated instead fresh air in abundance, gentle exercise in the open, an adequate and varied diet, and a minimum of medicaments. Violently attacked by the reviewers he became discouraged about tuberculosis and devoted the remainder of his professional life to the care of the mentally ill.
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PMID:Two forgotten pioneers. James Carson and George Bodington. 700 66

In patients with pneumothorax, the normal lung tends to maintain its original shape because its retractility is more or less uniform. Lobar collapse leads to a localized increase in the force of retraction and a greater tendency of air to collect in the overlying pleural space, sometimes leading to an unusual distribution of pleural air. Four cases of pneumothorax in supine patients with lobar collapse are presented. Knowledge of the factors governing the distribution of free pleural air is of value in the early detection of pneumothorax. In the presence of lobar collapse, and probably any degree of atelectasis secondary to airway obstruction, an unusual distribution of air should be expected.
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PMID:The effect of lobar collapse on the distribution of free intrapleural air. 705 19

Twenty-three patients with primary spontaneous pneumothorax and 30 patients with secondary spontaneous pneumothorax treated by intercostal catheter drainage with underwater seal were divided randomly into two groups, one receiving suction drainage (up to 20 cm H2O pressure) and the other no suction. The success rate was 57% for the former and 50% for the latter. The suction group spent an average of five days in hospital, whereas the non-suction group averaged four days. Suction drainage therefore did not have any advantage. To determine how soon the catheter could be removed without complication, patients were also divided randomly into two subgroups--one had the catheter removed, without previous clamping, as soon as the lung was expanded; the other had the catheters left in situ for a further three days. The success rate was 52% for the former, and 53% for the latter. But most of the failure in the early removal group was caused by re-collapse of the lung rather than persistent air leakage; hence removal of the catheter too early was not recommended.
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PMID:Catheter drainage of spontaneous pneumothorax: suction or no suction, early or late removal? 707 93

Round (helical) atelectasis is a little-known form of pulmonary collapse. It is thought to occur secondary to lung compression from pleural effusion or following therapeutic pneumothorax. Its occurrence is favoured in patients with exudative pleural effusions and extensive pleural thickening. It presents radiographically as a pulmonary pseudotumour, and experience with this entity and its pathogenesis are discussed.
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PMID:Round (helical) atelectasis. 726 May 20

In 24 anesthetized and vagotomized cats, activity on high-threshold as well as 45% of low threshold and intermediate receptors during collapse of lungs either decreased essentially or stopped altogether. In other 55% of low-threshold and intermediate receptors the decrease of firing rate during expiration was either weak or absent, although a decrease in respiratory modulations of firing rate did occur. In great pneumothorax (100--120 ml) these receptors discharged evenly with the frequency 4 to 40/sec. The data obtained corroborate the hypothesis suggesting that the low-frequency impulse activity of the lung stretch receptors induces stimulation of inspiration and shortens the expiration.
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PMID:[Spike activity of the pulmonary stretch receptors of cats with pneumothorax]. 728 20

Pneumothorax is an uncommon complication of bronchiolitis. The case illustrates an unusual pattern of atelectasis of the right lung with pleural air surrounding the right upper lobe and the remainder of the lung expanded. It is thought that the hyperinflated lung is unable to collapse as a result of the 'ball valve' effect of air trapping.
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PMID:Pneumothorax complicating bronchiolitis in an infant. 740 51

Localized pneumothorax adjacent to a collapsed lobe has been reported in children with bronchial obstruction. We present our findings in seven children with a similar phenomenon occurring in association with diffuse obstructive airway disease. The children, aged from 3 weeks to 17 years, were admitted for diffuse obstructive airway disease and, subsequently, developed lobar collapse with adjacent localized pneumothorax. In five of the seven patients there was a paradoxical shift of the mediastinum toward the side of the pneumothorax. In six cases, the pneumothorax resolved spontaneously with lobar reexpansion. A conservative treatment approach to patients with this constellation of radiographic findings appears justified.
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PMID:Localized pneumothorax with lobar collapse and diffuse obstructive airway disease. 749 Nov 98

470 patients underwent either lobectomy, bilobectomy or decortication at our institution between 1980 and 1991. A residual postoperative pneumothorax was observed in 20.7% of the patients at discharge after removal of the chest tubes. There was no significant correlation between the development of a residual postoperative pneumothorax and the patient's age and gender, the type of operation (lobectomy vs bilobectomy vs decortication) and the date of operation (as related to the introduction of stapling devices). This residual postoperative pneumothorax at discharge resolved without any further treatment in 95% of the patients during follow-up. Complete regression was observed in 91% of the patients within one year after the operation and the duration of regression did not correlate with the size of the pneumothorax at discharge. No empyema was observed in any patient with residual pneumothorax during follow-up, which also holds true for patients who underwent resection or decortication for inflammatory disease. We conclude that there is no need for treatment of residual postoperative pneumothorax, either with space-filling maneuvers at the initial operation or repeat chest tube insertions during follow-up, provided there is no evidence of lung collapse.
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PMID:[Residual postoperative pneumothorax: harmless radiological finding or complication-prone diagnosis?]. 767 28

When using endobronchial anaesthesia for the management of transthoracic endoscopic sympathectomy (TES), excessive insufflation of carbon dioxide into the pleural space may cause haemodynamic instability, hypoxaemia and tension pneumothorax. We prospectively studied an alternative technique using a tracheal tube, i.v. fentanyl, propofol, atracurium and nitrous oxide in 82 consecutive healthy patients (31 male, 51 female; mean age 26.48 (range 14-50) yr, weight 61.26 (33-100)kg.) They were suffering from severe palmar hyperhidrosis and they underwent bilateral TES (mean duration of operation 34.57 (15-90) min). After being placed in a 30-40 degree head-up position, three patients required ephedrine to treat arterial hypotension. A capnograph was used to confirm correct placement of the Verres needle in the pleural space. In two groups of 13 patients undergoing ventilation with an FlO2 of either 0.3 or 0.4, during partial collapse of the operative lung, PaO2 and the PaO2:FlO2 ratio decreased significantly (P < 0.001). TES was unsuccessful in three patients because of pleural adhesions. After operation five patients required chest drains; two for haemothorax and three for pneumothorax. Seventy-seven patients without complications were discharged from hospital within 24 h.
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PMID:Tracheal anaesthesia for transthoracic endoscopic sympathectomy: an alternative to endobronchial anaesthesia. 769 60


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