POSTTRAUMATIC HEMOTHORAX, DIAGNOSIS AND TREATMENT

P.P. LUKYANCHENKO

National Scientific Center of Surgery named after A.N.Sizganov, Almaty, KAZAKHSTAN

Hemothorax is a terrible complication of blunt chest injury. According to the literature, the frequency of hemothorax in closed chest injuriesranges between 25-39%. For the last 10 decade, in theNSCS named after A.N.Syzganov,there were observed52 patientswith post-traumatic hemothorax. The pathology occurs mainly in severe chest injuries, but there are cases of lung laceration with bleeding and chest contusion without fracture of ribs. Hemothoraxwas combined with other complications in 24 patients (subcutaneous emphysema - 10, pneumothorax - 13, hemoptysis - 1). The clinical picture depends on the severity of the injury and the intensity of bleeding. The main significance in the diagnosis of hemothorax is paid to radiologic examination, which allows to determine the presence or absence of pneumothorax, its size and prevalence, the presence of hemothorax, hemopericardium, the degree of lung collapse. 38 patients had a circumscribed hemothorax, 9 –subtotal and 5 patients - total. Hemopneumothorax(13 patients) involves subcutaneous emphysema which is formed as a result of rupture of the lung, pleura, visceral and parietal layers. Subcutaneous emphysema is usually located on the side of injury, more often - on the side of the chest. Subject to the extent of hemothorax, and availability of other consequences of the trauma of the chest, following treatment optionsare used.On the first stage of treatment, puncture the pleural cavity with the evacuation of blood from the pleural cavity with furhter control P-graphy of the chest is used. In case of repeated hemothorax it is recommended to perform diagnostic thoracoscopyfor the identification of the reason of bleeding, as well as its elimination.Videothoracoscopic operations for post-traumatic diseases of the thoracic cavity wereperformed in 27 patients, thoracotomy was performed in 3 patients, 18 patients were treated by puncture method. 2 patients were performed angiopulmonography. 4 patients were treated by drainage. During videothoracoscopy, lung suturing was performed in four patients, 3 patients were performed suturing of intercostal artery. 3 patients were performed thoracotomy, suturing of the lung. No complications and fatal outcomes were observed in the postoperative period.

Conclusion Wideuse of videothoracoscopic operationallows timely recognition of the nature of the injury and avoidance of unnecessary thoracotomies.

CLINICAL AND LABORATORY FEATURES OF CHRONIC HEPATITIS C in different functional states of THYROID

I. LUPASCO

State University of Medicine and Pharmacy "N. Testemitanu" Chisinau, MOLDOVA

Introduction: Moldova is the world leader in mortality and morbidity from cirrhosis of the liver, where special place is occupied by HCV infection that often presents with extrahepatic manifestations.

Materials and methods: It has been done a comprehensive clinical and laboratory examination of 127 patients with chronic hepatitis HCV with a detailed assessment of the functional state of the thyroid gland. 30 healthy persons served as a control group. In order to characterize the phase of viral infection and functional state of liver it was determined the concentration of virus in serum (PCR) and a set of specific biochemical tests, reflecting well-known symptoms of cytolysis, cholestasis, immune inflammation.

Results: Thyroid dysfunction was found in 41,73% (53), including its hyperfunction – 22,83% (29), and hypothyroidism in 18,90 (24). Presence of antibodies to thyroid peroxidase (TPO) was detected in 40,15% (51) and to thyroglobulin (TG) - in 18,89% (24) cases, indicating the presence of autoimmune changes in thyroid gland. There was established an increase of IgG in hyperthyroidism and the presence of antibodies to TPO, while increased IgA and cryoglobulins in the case of hypothyroidism. It was determined the influence of the replication phase of viral C infection on increased levels of T₃, T₄ and more frequent detection of antibodies to thyroid peroxidase. It was found the dependence of the main clinical symptoms characteristic for chronic hepatitis with the functional state of thyroid gland and an increase in antibody titers to thyroid peroxidase and thyroglobulin.

Discussion: These facts indicate a close relationship between the functional states of the liver and thyroid in chronic hepatitis HCV, which may further aggravate the already existing morphological changes in the liver, contributing to the emergence of centrilobular focal necrosis, cholestasis and venous stasis.

Conclusions: Our evidence on the incidence of thyroid dysfunction in patients with chronic HCV hepatitis strongly dictates the necessity for a comprehensive examination of thyroid gland with a simultaneous study of functional state of liver.

Date: 2014-12-28; view: 883