Management of traumatic pneumothorax in isolated blunt chest trauma

Objectives: Pneumothorax is an important complication of blunt chest trauma. The aim of this study was toreport our experience in treatment strategy and outcomes of traumatic pneumothorax.Methods: A total of 78 patients who developed pneumothorax due to isolated blunt chest trauma were evaluatedin terms of age, gender, size of pneumothorax, treatment methods, complications and length of hospital stay.The size of pneumothorax was calculated with computer-aided volumetry.Results: Tube thoracostomy was performed for 48 patients while observation was undertaken for 30 cases.Chest tubes were inserted in 6 patients after 24 hours following the traumatic event. A total of 8 patients whodeveloped prolonged air leakage and hemothorax as complications underwent video-assisted thoracoscopicsurgery. None of the patients developed any mortality or morbidity.Conclusions: Traumatic pneumothorax demands prompt diagnosis and treatment. Monitoring all patients evenwith small sizes of traumatic pneumothorax for at least 24 hours onset of their initial assessment and applyingchest tubes for cases who have pneumothorax larger than 50% at first examination should be an appropriatemodality for treatment. Moreover, the minimally invasive approach of video-assisted thoracoscopic surgerybenefits to overcome the complications of thoracic trauma

Reentrant Phase Transitions of the Blume-Emery-Griffiths Model for a Simple Cubic Lattice on the Cellular Automaton

The spin-1 Ising (BEG) model with the nearest-neighbour bilinear and biquadratic interactions and single-ion anisotropy is simulated on a cellular automaton which improved from the Creutz cellular automaton(CCA) for a simple cubic lattice. The simulations have been made for several sets of parameters $K/J$ and $D/J$ in the $-3<D/J\leq 0$ and $-1\leq K/J\leq 0$ parameter regions. The re-entrant and double re-entrant phase transitions of the BEG model are determined from the temperature variations of the thermodynamic quantities ($M$, $Q$ and $\chi$). The phase diagrams characterizing phase transitions are compared with those obtained from other methods.Comment: 12 pages 7 figure

CD4(+) T cells of myasthenia gravis patients are characterized by ıncreased IL-21, IL-4, and IL-17A productions and higher presence of PD-1 and ICOS

Myasthenia gravis (MG) is an autoimmune disease mediated by autoantibodies predominantly against the acetylcholine receptor (AChR). Specific T cell subsets are required for long-term antibody responses, and cytokines secreted mainly from CD4(+) T cells regulate B cell antibody production. The aim of this study was to assess the differences in the cytokine expressions of CD4(+) T cells in MG patients with AChR antibodies (AChR-MG) and the effect of immunosuppressive (IS) therapy on cytokine activity and to test these findings also in MG patients without detectable antibodies (SN-MG). Clinically diagnosed AChR-MG and SN-MG patients were included. The AChR-MG patients were grouped as IS-positive and -negative and compared with age- and sex-matched healthy controls. Peripheral blood mononuclear cells were used for ex vivo intracellular cytokine production, and subsets of CD4(+) T cells and circulating follicular helper T (cTfh) cells were detected phenotypically by the expression of the chemokine and the costimulatory receptors. Thymocytes obtained from patients who had thymectomy were also analyzed. IL-21, IL-4, IL-10, and IL-17A productions in CD4(+) T cells were increased in AChR-MG compared to those in healthy controls. IS treatment enhanced IL-10 and reduced IFN-gamma production in AChR-MG patients compared to those in IS-negative patients. Increased IL-21 and IL-4 productions were also demonstrated in SN-MG patients. Among CD4(+) T cells, Th17 cells were increased in both disease subgroups. Treatment induced higher proportions of Th2 cells in AChR-MG patients. Both CXCR5(+) and CXCR5(-) CD4(+) T cells expressed higher programmed cell death protein 1 (PD-1) and inducible costimulatory (ICOS) in AChR-MG and SN-MG groups, mostly irrespective of the treatment. Based on chemokine receptors on CXCR5(+)PD-1(+) in CD4(+) T (cTfh) cells, in AChR-MG patients without treatment, the proportions of Tfh17 cells were higher than those in the treated group, whereas the Tfh1 cells were decreased compared with those in the controls. The relevance of CXCR5 and PD-1 in the pathogenesis of AChR-MG was also suggested by the increased presence of these molecules on mature CD4 single-positive thymocytes from the thymic samples. The study provides further evidence for the importance of IL-21, IL-17A, IL-4, and IL-10 in AChR-MG. Disease-related CD4(+)T cells are identified mainly as PD-1(+) or ICOS+ with or without CXCR5, resembling cTfh cells in the circulation or probably in the thymus. AChR-MG and SN-MG seem to have some similar characteristics. IS treatment has distinctive effects on cytokine expression.Istanbul Universit

Preventing the Development of Recurrence and Postoperative Seroma of Elastofibroma Dorsi

Objectives: Elastofibroma dorsi is a benign and infrequent tumor of uncertain etiology usually located at the subscapular region. We present our experience in the treatment of elastofibroma dorsi. Methods: We conducted a retrospective study of 20 marginal excisions in 14 patients with the diagnosis of elastofibroma dorsi during a period of seven years. All patients underwent a marginal excision and also had flat silicone suction drains in the surgery site with pressure wound dressing to avoid seroma. Clinical parameters including age, gender, body mass index, type and duration of symptoms, radiological method of diagnosis, side and size of tumor, extent of surgical margin, complications and recurrence were examined. Results: The patients are 4 male and 10 female with a median age of 54.2 years. Six patients presented with bilateral lesions. Symptoms are pain during movement and snapping scapula lasting for approximately nine months. The overall mean of tumor volume is 332.2 cm'. Overall free surgical margin has an average of 1.14 cm. The only postoperative complication is a seroma in one (5%) patient. No patient had recurrence. Conclusion: Current treatment modality of elastofibroma dorsi is a marginal excision. Flat suction drains in the surgery site and pressure wound dressing is of particular importance to prevent the most common postoperative complication

Bronş ve aortun müşterek yaralanmasının başarılı tedavisi]

Tracheobronchial injury is an uncommon but severe complication of blunt thoracic trauma. In this study, we present a patient who developed complete avulsion of the left main bronchus with a vertical rupture toward the carina accompanying a contained rupture of the descending aorta after being run over by a van.We performed a left upper lobectomy and reimplantation of the lower lobe to the left main bronchus. Subsequently, an endovascular stent was placed to cover the pseudoaneurysm.The patient was discharged on day nine after an uneventful postoperative course. Tracheobronchial trauma complicated with concomitant major injuries apparently requires a rapid and challenging multidisciplinary approach in a well-developed and experienced trauma centre for a successful treatment