Cardiac-specific troponins (Tns) are sensitive and specific markers of myocardial injury that have been shown to be predictive of outcomes in many cardiac and noncardiac conditions. We sought to determine whether normal cardiac Tn concentrations obtained during the first 24 hours following blunt chest trauma would predict good cardiac outcomes. A PubMed/MEDLINE search was performed to identify prospective studies in patients with blunt chest trauma in which serial cardiac TnT or TnI values were measured within 24 hours of admission and clinical outcomes assessed. Ten studies qualified for review. Studies that used the lower reference limit of Tn as the cutoff for cardiac injury showed 100% negative predictive value (NPV) for developing cardiac complications, whereas studies using higher Tn cutoffs showed wider variation in NPV (50%-98%). Cardiac Tn measured within 24 hours using the lower reference limit (LRL) as the cutoff appears to have excellent NPV for clinically significant adverse cardiac events. This could allow for early discharge after a 24-hour observation period in otherwise uncomplicated blunt chest trauma patients and avoid the need for more expensive cardiac imaging and additional resource utilization.

1. INTRODUCTION Spontaneous pneumothorax is one of the most common types of aeropathic syndrome, caused by chronic obstructive pulmonary diseases, tuberculosis and complicated lung cancer. Nearly two hundred years have passed since the first description of the first cases of pneumothorax. Although during this period the scientist´s view of the etiology, pathogenesis, diagnostics and treatment methods has changed, a number of issues related to the diagnostics and treatment of this complication of pulmonary diseases remain unsolved. The aim of the treatment of spontaneous pneumothorax is to remove the cause of this condition, to perform the decompression of the pleural cavity, to induce the obliteration of the pleural cavity and to prevent the recurrence of the disease. Pleural puncture and drainage of the pleural cavity are not sufficiently effective – the incidence of incomplete lung expansion and rapid recurrence of the disease (relapse) reaches 25% [Mova VA, 1999]. Urgent thoracotomy is performed in cases when the drainage of the pleural cavity fails to reduce the symptoms of the aeropathic syndrome and breathing and blood circulation insufficiency caused by the spontaneous pneumothorax. Frequently thoracotomy is performed after pleural drainage in cases of exudative pleuritis or starting pleural empyema. The postoperative period is marked by a large number of complications and prolongation of hospital stay, and post-operative mortality in the group of geriatric... [to full text]

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