Massive hemothorax is an indication for thoracotomy. We report a case of an 85-year-old debilitated patient, in whom massive hemorrhage from an actively bleeding intercostal artery was controlled by angiographic embolization. Angiographic embolization proved to be an effective alternative to thoracotomy in this patient, thus avoiding numerous postoperative complications and high mortality. Massive bleeding from an intercostal artery should be considered an indication for angiographic embolization in selected patients.

Hypothesis: Routine repeat head Computed Tomography (CT) for patients with traumatic head injury, initially presenting with GCS of 14-15, does not change therapeutic policy in these trauma patients. Methods: This was a retrospective cohort study of trauma patients with Glasgow Coma Scale (GCS) of 14-15 on admission, suffering from different types of intracranial bleeding who were admitted for observation in a level II trauma center. The size of hematoma on initial head CT was measured and compared to findings of repeat CT performed following 12hours. Patients were evaluated as to changes in neurologic status and treatment. Results: 68 patients treated over a period of 5 years were evaluated. Forty two (61.8%) were male and 24 (38.2%) were female. Mean age was 56.2 years and mean ISS score was 12 ± 5.1. Initial GCS was 15 in 51 patients and 14 in 15 other patients. CT scan revealed 7 epidural hematomas, 20 subdural hematomas, twenty eight intraparenchymal bleeding, and 13 subarchnoid hemorrhages. Repeat CT revealed an increase in size of the hematoma in 8 eight patients. None of these patients suffered from clinical deterioration. Repeat CT in 12 patients who's GCS deteriorated, did not show any significant changes on the repeat CT scan. None of the patients underwent intervention after a routine repeat CT. Conclusions: Routine repeat CT scan of head, performed 12 hours after the initial scan did not change the therapeutic policy in GCS 14-15 head trauma patients. The need for mandatory CT of head in mild traumatic brain injury should be questioned.

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A novel technique for the damage control of big diaphragmatic injuriesPurpose: To evaluate and describe a novel technique for the temporary closure ofmajor diaphragmatic defects not suitable for primary suture in damage control setting.Background: It is an acceptable opinion that all left sided diaphragmatic injuriesshould be repaired, as opposed to right sided where the liver may safely protect thedefect. In most cases the repair of the diaphragm is simple, using non-absorbablesutures. Closure of defects not suitable for primary suture, remains a reallychallenging problem. Up today, there is no adequate solution for prevention of re-protrusion of abdominal contents in a damage control setting.Methods: We report a novel technique suitable for treating diaphragmatic injuries indamage control setting. This method allows a rapid temporary closure of, non-suitablefor primary closure, large diaphragmatic defects and part of the damage controlconcept.Results: Two anesthetized pigs were used in an animal trial to evaluate the feasibilityof the technique. Same size defects were created in both subjects. In the first subject,the defect was closed with a plastic (Bogota) bag. In the second subject, thediaphragmatic defect was covered using a large abdominal pad. In both cases, nochest protrusion was observed after completion of the experiment.Conclusion: We describe a simple new technique for temporary diaphragmatic closurethat might be done as part of damage control. Further investigation will help toinclude it to routine surgical arsenal.