Surgical management of costal margin rupture associated with intercostal hernia: Evolution of techniques.

Introduction: Costal margin rupture (CMR) injuries in association with intercostal hernia (IH) are rare and symptomatic and provide a significant surgical challenge. Surgical failure rates up to 60% are reported, and optimal techniques are unclear. We have characterized these injuries and describe the evolution of our surgical management techniques.

Costal margin injuries and trans-diaphragmatic intercostal hernia: Presentation, management and outcomes according to the Sheffield classification.

Background: Costal margin rupture (CMR) injuries are under-diagnosed and inconsistently managed, while carrying significant symptomatic burden. We hypothesized that the Sheffield Classification system of CMR injuries would relate to injury patterns and management options.

Methods: Data were collected prospectively between 2006 and 2023 at a major trauma center in the United Kingdom.

Unifying classification for transdiaphragmatic intercostal hernia and other costal margin injuries.

Objectives: Taxonomy of injuries involving the costal margin is poorly described and surgical management varies. These injuries, though commonly caused by trauma, may also occur spontaneously, in association with coughing or sneezing, and can be severe. Our goal was to describe our experience using sequential segmental analysis of computed tomographic (CT) scans to perform accurate assessment of injuries around the costal margin.

Uniportal thoracoscopic management of middle lobe torsion after upper lobectomy.

Lobar torsion is a rare but potentially life-threatening complication following pulmonary resection. Surgical management usually entails an exploratory thoracotomy and resection of the involved lobe if nonviable. We present the case of a 67-year-old woman diagnosed with right middle lobe torsion 5 days after thoracotomy and right upper lobectomy for squamous carcinoma of the lung.

Diaphragmatic and intercostal muscle tear after an episode of violent sneezing: spontaneous diaphragmatic injury.

Spontaneous diaphragmatic injuries are rare, accounting for approximately 1% of all diaphragmatic injuries. We report a case of a 69-year-old male with a concurrent lower respiratory tract infection who sustained diaphragmatic and intercostal muscle injuries after an episode of violent sneezing. To our knowledge, this is the first reported case of spontaneous diaphragmatic injury after sneezing.

The successful use of octreotide in the treatment of traumatic chylothorax.

Chylothorax is a well-documented complication of thoracic trauma and is associated with mortality rates of up to 75%. The conservative treatment of chylothorax includes pleural drainage and a low-fat diet rich in medium-chain fatty acids, followed by total parenteral nutrition and nothing by mouth. If these measures fail and drainage continues to exceed 1 L/d, surgical thoracic duct ligation is usually recommended.

Inhaled nitric oxide for modulation of ischemia-reperfusion injury in lung transplantation.

Background: The prophylactic administration of inhaled nitric oxide (NO) during reperfusion after lung transplantation has been shown to reduce neutrophil-induced injury in animal models. There remain questions regarding efficacy in the clinical setting and concerns regarding increased free radical injury. We sought to assess the efficacy of NO in reducing neutrophil infiltration and associated injury if administered from the very onset of reperfusion in clinical lung transplantation.

Abo-incompatible heart transplantation in infants: the Freeman Hospital experience.

Background: Incompatibility of the major blood groups A, B, and O has been an absolute contraindication for heart transplantation. However, because of immunologic immaturity, infants may have relative protection from hyperacute rejection and thus could undergo transplantation with ABO-mismatched organs.

Methods: Since January 2000, the authors have adopted a policy of considering infants for ABO-incompatible heart transplantation.

Pentoxifylline is as effective as leukocyte depletion for modulating pulmonary reperfusion injury.

Objective: Previous studies have suggested the amelioration of lung reperfusion injury when initial reperfusion is undertaken with leukocyte-depleted blood. Pharmacologic agents, such as pentoxifylline, are also effective, but no previous studies have demonstrated which is superior. We investigated these agents in a porcine model of left single-lung transplantation.

Improvements in lung compliance after pulmonary transplantation: correlation with interleukin 8 expression.

Objective: Previous studies have suggested reductions in lung reperfusion injury when initial reperfusion is undertaken with the addition of pharmacological modulators. We investigated three pharmacological agents in a porcine model of left single lung transplantation to determine the effect on lung compliance and its relationship with the expression of the cytokine, interleukin-8 (IL-8).

Methods: Donor lungs were preserved with modified Euro-Collins for a mean ischaemic time of 18.