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[10] [11] [2]: 240 Patients with thoracic stab wounds and patients who arrive at the emergency department with signs of life are associated with the highest rates of survival. Patients with polytrauma and patients who present without signs of life are associated with the lowest rates of survival. [12]
In a study by Van Waes et al., (which included all thoracic-penetrating injuries, not just transmediastinal) survival after emergency department thoracotomy was 25%. [4] In other circumstances the unstable patient is immediately transferred to the operating room for exploration by thoracotomy or sternotomy.
A thoracotomy is a surgical procedure to gain access into the pleural space of the chest. [1] It is performed by surgeons (emergency physicians or paramedics under certain circumstances) to gain access to the thoracic organs, most commonly the heart, the lungs, or the esophagus, or for access to the thoracic aorta or the anterior spine (the latter may be necessary to access tumors in the spine).
Survival rates for gunshot wounds improved among US military personnel during the Korean and Vietnam Wars, due in part to helicopter evacuation, along with improvements in resuscitation and battlefield medicine. [60] [61] Similar improvements were seen in US trauma practices during the Iraq War. [62]
Even with prompt medical intervention, survival without neurological complications is rare. [2] In recent years, protocols have been proposed to improve survival rate in patients with traumatic cardiac arrest, though the variable causes of this condition as well as many coexisting injuries can make these protocols difficult to standardize. [3]
Confirmation done by tissue biopsy of accompanying nodes if any, mediastinoscopy, mediastinotomy, or thoracotomy. FNA biopsy is usually not adequate. Treatment of mediastinal Hodgkin's involves chemotherapy and/or radiation. 5 year survival is now around 75%. Large-cell type may have somewhat better prognosis.
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At the 2014 International Society for Minimally Invasive Cardiothoracic Surgery Annual Meeting in Boston, Dr. Joseph T McGinn presented a study titled "Minimally Invasive CABG is Safe and Reproducible: Report on the First Thousand Cases," which found a low rate of conversion to sternotomy and low rate of complications. Assessing survival and ...