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Video-assisted thoracoscopic surgery can be beneficial for patients with penetrating and blunt thoracic trauma. It has utility in the initial assessment as well as the management of sequelae of traumatic injuries, especially retained hemothorax, and should be part of any trauma surgeon’s skill set. This review intends to emphasize the best-supported indications and timing for the use of this surgical approach in the injured patient.

Background The immunologic relationship between T H 1-type autoimmune disorders and T H 2-type allergic disorders and the role of T-cell regulation in humans is as yet unclear. The regulatory cytokine production capacity of individuals with concomitant allergy and T H 1-type autoimmunity may provide insight into the role of T-cell regulation in both disorders. Objectives To examine the production capacity of interleukin 10 (IL-10) and transforming growth factor β (TGF-β), 2 regulatory cytokines, in individuals with concomitant allergic rhinitis and T H 1-type autoimmune diagnoses and to compare that capacity with that in individuals with allergic rhinitis only and individuals with neither diagnosis. Methods Seventeen case subjects and 17 age-, sex-, and ethnicity-matched controls with allergic rhinitis only were recruited from an allergy clinic. Fourteen matched controls with neither diagnosis were recruited from the general population. Peripheral blood mononuclear cells were obtained and cultured with and without mitogen stimulation (lipopolysaccharide and phytohemagglutinin). Cytokine levels from culture supernatants were measured by enzyme-linked immunosorbent assay. Results Cases with allergic rhinitis and autoimmune diseases had significantly lower unstimulated day 3 IL-10 levels compared with controls with allergic rhinitis only ( P = .05) and significantly lower stimulated day 5 TGF-β levels compared with controls with neither diagnosis ( P = .02). Cases had consistently lower regulatory capacity compared with both control groups, as measured by an additive index using IL-10 and TGF-β levels. Conclusion Individuals with concomitant allergic rhinitis and T H 1-type autoimmune disorders have a lower regulatory cytokine production capacity than individuals with allergic rhinitis only and those with neither diagnosis.