Chest drain and thoracotomy for chest trauma

Traumas are the leading cause of death in the first four decades of life. Nevertheless, thoracic traumas only seldom require invasive procedures. In particular, chest drain placement is required in case of pleural disruption causing haemothorax, pneumothorax or haemopneumothorax. Although large-bore chest drains have been traditionally used in case of haemothorax, recent evidences seem to question this routine, showing good performances of small-bore and pig tail drains. Although it is a common procedures, experience and training is needed to avoid complications which might be even lethal. Surgical exploration after thoracic trauma is rare, accounting for less than 3% of traumas. Penetrating traumas more likely require surgical exploration compared to blunt trauma. Anterolateral thoracotomy is usually performed in this setting, but also clamshell or hemi-clamshell approach can be used. In selected patients, minimally invasive techniques can be performed. Large randomized trials are still needed to assess and standardized the role of new tools and procedures in the thoracic trauma setting

Surgical management of chronic diaphragmatic hernias

Chronic diaphragmatic hernia (CDH) is an uncommon disease which may be associated with significant morbidity and mortality. Antecedent (even many months or years before CDH development) blunt or penetrating thoracic/ thoraco-abdominal trauma is generally recognized. A wide spectrum of different mechanisms of injury, timing in presentation, size of the diaphragmatic defect, types and amount of abdominal viscera herniated into the chest cavity, clinical symptoms are observed in CDHs. Thoracic and abdominal CT scan (with coronal, axial and sagittal reconstructions) is the best diagnostic tool; sometimes thoracic MRI is needed to better define the extent of the diaphragmatic defect and the number of abdominal organs displaced into the chest cavity. Surgery (sometimes urgent) represents the treatment of choice for CDH; diaphragmatic hernia direct repair with a tension-free suture is generally attempted; in case of very large defects or when a tension-free suture is deemed unfeasible, the use of prosthesis is recommended. This review article will discuss about CDH aetiology, clinical presentation diagnosis and surgical treatment

LHCb tracker upgrade technical design report

The upgrade of the LHCb detector will extend the physics reach of the experiment by allowing it to run at higher luminosity, Linst = 2 x 1033 cm\uf02d2 s\uf02d1, with increased trigger e_ciency for a wide range of decay channels. This is facilitated by the implementation of new front-end electronics, designed such that complete events can be read out and sent to the LHCb data acquisition farm for selection by a full software trigger, every 25 ns. The upgraded LHCb detector is conceived to take physics data for an integrated luminosity of at least 50 fb bc0 c001. This Technical Design Report describes in detail the upgrade of the two tracking subsystems, located just before and just after the LHCb dipole magnet. The tracking detector before the magnet (the Upstream Tracker) will be composed of new, high-granularity silicon micro-strip planes with an improved coverage of the LHCb acceptance. Behind the magnet, a Scintillating Fibre Tracker will be built, which is composed of 2.5m long _bres read out by silicon photomultipliers at the edge of the acceptance. The performance of the two tracking detectors and of the LHCb tracking software are presented, as well as the cost, schedule and task sharing

LHCb particle identification upgrade technical design report

The LHCb upgrade will take place in the second long shutdown of the LHC, currently scheduled to begin in 2018. The upgrade will enable the experiment to run at luminosities of 2 x 10^33cm^-2s^-1 and will read out data at a rate of 40MHz into a flexible software-based trigger. All sub-detectors of LHCb will be re-designed to comply with these new operating conditions. This Technical Design Report presents the upgrade plans of the Ring Imaging Cherenkov (RICH) system, the calorimeter system and the muon system, which together provide the particle identification capabilities of the experiment

LHCb VELO upgrade technical design report

The upgraded LHCb VELO silicon vertex detector is a lightweight hybrid pixel detector capable of 40 MHz readout at a luminosity of 2 x 10^33 cm^-2 s^-1. The track reconstruction speed and precision is enhanced relative to the current VELO detector even at the high occupancy conditions of the upgrade, due to the pixel geometry and a closest distance of approach to the LHC beams of just 5.1 mm for the first sensitive pixel. Cooling is provided by evaporative CO2 circulating in microchannel cooling substrates. The detector contains 41 million 55 um x 55 um pixels, read out by the custom developed VeloPix front end ASIC. The detector will start operation together with the rest of the upgraded LHCb experiment after the LHC LS2 shutdown, currently scheduled to end in 2019. This Technical Design Report describes the upgraded VELO system, planned construction and installation, and gives an overview of the expected detector performance