Akin Yildizhan

The Evaluation of 13 Patients with Intrathoracic Extrapulmonary Hydatidosis

Cases of intrathoracic extrapulmonary hydatid cysts are very rare. We identified 13 patients with intrathoracic extra-pulmonary hydatid cysts in our clinic over 12 years. Four patients had extra-pulmonary cysts only; nine patients had both intrapulmonary and extrapulmonary cysts. Cysts were identified in the pleural space, extrapleural region, diaphragm and chest wall. Thoracotomy was used in all patients, and extrapulmonary lesions were removed by cyst extirpation from surrounding tissue or by pericystectomy. In one patient with chest wall involvement, partial rib resections were performed because of rib destruction. In two patients with liver cysts passing through the diaphragm to the thorax, the diaphragm was cut, cysts on the liver roof were removed and then the diaphragm was repaired. There was no mortality, morbidity, or disease recurrence during the post-operative period in any of the 13 patients. We conclude that these rare cases give a new insight into hydatid cyst pathophysiology.

The influence of specific factors on postoperative morbidity in young adults with bronchiectasis.

BACKGROUND Surgical treatment of bronchiectasis is associated with acceptable mortality and morbidity rates. To date, few reports on the prediction of postoperative morbidity using some preoperative measures have been presented. We present our results regarding the influence of some specific factors on postoperative morbidity on young adult patients who were treated surgically for bronchiectasis. METHODS Between January 2000 and July 2007, 122 patients were operated upon. Female gender, increased number of resected segments, presence of haemoptysis and bilateral disease, compromised pulmonary function test (FEV1/VC<60%) and absence of preoperative fiberoptic bronchoscopy (FOB) were examined as the potential risk factors for postoperative complications such as persistent air leak (PAL), atelectasis, residual air space (RAS), bronchopleural fistula (BPF) and empyaema. RESULTS There was no operative mortality. Morbidity was observed in a total of 16 patients with an overall morbidity rate of 13.1%. Complete resection was achieved in 88 patients (72.1%). The number of resected segments was not found to be significantly associated with increased morbidity. Presence of preoperative haemoptysis did not correlate with postoperative complications significantly. Absence of preoperative FOB was not found to be associated with post-operative complications (p<0.05). Compromised PFT was significantly associated with RAS (p=0.028), however it was not associated with increased risk of PAL, atelectasis or empyaema significantly. CONCLUSION Multi-segmental resectable bronchiectasis should not be considered an occult risk factor for morbidity after resection. Associated non-severe haemoptysis and absence of preoperative bronchoscopy are not associated with significant increased risk of postoperative morbidity.

SPIROMETRIC CHANGES AFTER PLEURAL DECORTICATION IN YOUNG ADULTS

Background:  The collection of pleural fluid and thickened pleura restrict the movement and expansion of lung. The main treatment strategy is lung decortication for the thickened pleura. The aim of this study was to investigate lung functions before and after pleural decortication in young adults.

Is bilateral chylothorax possible after simple cough? Yes

Chylothorax is accumulation of chylous fluid in the pleural space due to impaired integrity of the thoracic duct or its branches. In childhood, the causes differ from those in adults because children less frequently develop malignancies and are more resistant to trauma. Commonly, chylothorax occurs as a complication of tumoral invasion or cardiopulmonary surgery. Treatment of chylothorax is essentially medical. In the event of medical treatment failure or a massive effusion, surgery is needed. We describe the case of a 65-year-old woman who developed bilateral chylothorax after a simple cough. She was treated with a medium-chain triglyceride diet and thoracentesis.

Anterior Mediastinal Angiomyolipoma

Angiomyolipomas are benign, solitary, noninvasive mesenchymal tumors. They most often arise in the kidney. Extrarenal presentations of these tumors are in skin, orophaynx, abdominal wall, gastrointestinal tract, heart, lung, liver, uterus, penis, and spinal cord. Angiomyolipoma of the mediastinum is extremely rare and is composed of an admixture of fat, smooth muscle cells, and tortuous, thick-walled, small to medium sized blood vessels. We present a surgically confirmed case of anterior mediastinal angiomyolipoma incidentally diagnosed in an asymptomatic patient.

Is T3 and T6 Sympathetic Clipping More Effective in Primary Palmoplantar Hyperhydrosis

OBJECTIVE Our aim was to establish a standardized approach for patients with palmoplantar and axillary hyperhidrosis and to compare patient satisfaction and complication rates for two different operations. MATERIALS AND METHODS Between 2008 and 2010, 30 patients underwent conventional T3/4 clipping (group A), and 30 underwent only T3 and T6 clipping (group B). Both groups were compared with regard to compensatory sweating (CS), complications, patient satisfaction and recovery of plantar hyperhidrosis. RESULTS The CS rate was 60 % in group A and 47 % in group B. CS was significantly less in group B compared to group A ( P ≤ 0.001). The plantar hyperhidrosis recovery rate was higher in group B (n = 19) compared to group A (n = 13), but the difference was not statistically significant ( P ≥ 0.299). Patient satisfaction rate was 93.3 % in group A and 96.6 % in group B. CONCLUSIONS Our study showed that T3/6 clipping was as effective as T3/4 clipping for palmar and axillary hyperhidrosis. Our results revealed that this technique is more effective than T3/4 sympathectomy to treat plantar hyperhidrosis.

Does endoscopic thoracic sympathectomy through clipping procedure have early effects on electrocardiographic parameters

Background & objectives: Hyperhidrosis is a pathologic condition of excessive sweating in amounts greater than physiologic needs. Endoscopic thoracic sympathectomy (ETS) is a globally accepted treatment modality for primary palmar and axillary hyperhidrosis. ETS also has distinctive effects on the heart, circulatory and respiratory systems. In this study early effects of ETS on electrocardiographic (ECG) parameters of hyperhidrosis patients were evaluated. Methods: Twelve-lead ECGs were performed on 72 patients who were free from cardiovascular, metabolic, neurological and pulmonary diseases and underwent planned ETS because of hyperhidrosis, before and after the procedure within the first 24 h. Heart rate (HR), PR, QT, corrected QT (QTc), QTc/Tpeak-Tend (TpTe) intervals, P-wave and QTc/TpTe dispersions were compared by ECG. Results: A total of 72 patients (24.1±6.0 yr, 17 female) were included in the study. The pre-operative HR of patients was significantly higher than post-operative HR of patients (73.8±12.8 vs. 68.1±12.6 beats/ min; P<0.001). The QTc dispersion (QTcd) durations of pre-operative patients were significantly longer than those of post-operative patients (51.5±6.3 vs. 44.9±5.6 msec; P<0.01). The TpTe dispersion value of pre-operative patients was significantly (P<0.001) higher than that of post-operative patients. Interpretation & conclusions: Our study showed that ETS through clipping procedure had positive effects on the mechanisms of arrhythmia by reducing HR, QTcd, TpTe and TpTe dispersion parameters of ECG in early periods in hyperhidrosis patients.

Is Tracheal Transplantation Possible With Cryopreserved Tracheal Allograft and Hyperbaric Oxygen Therapy? An Experimental Study.

BACKGROUND Allografts have achieved prominence for tracheal reconstruction because of their natural physiologic and anatomic structure, which preserves respiratory tract flexibility and lumen patency. The immunomodulatory effects of cryopreservation prevent tracheal allograft rejection. In addition, hyperbaric oxygen therapy (HBOT) accelerates wound healing by promoting epithelization and neovascularization. This experimental study investigated the early and late effects of HBOT on cryopreserved tracheal allografts (CTAs). METHODS The study used 33 outbred Wistar rats weighing 300 to 350 g as allograft transplantation donors and recipients. Among these, 22 recipient rats were randomly assigned to the HBOT (n = 11) and control (n = 11) groups. Rats in the HBOT group were treated with 100% oxygen for 60 minutes at 2.5 atmospheres of absolute pressure for 7 days. Recipient rats in both groups were euthanized at 1 week (n = 5) and 4 weeks (n = 6) after transplantation, defined as the early and late periods, respectively. RESULTS In the early period, no significant histopathologic differences were observed between groups (p > 0.05). However, microscopic evaluation of the control group during the late period showed low epithelization of the CTA. In contrast, microscopic evaluation of the HBOT group during this same period revealed epithelium covering the transplanted CTA lumen. Significant epithelization and vascularization and significantly reduced inflammation and fibrosis were found in the HBOT group compared with the control group (p < 0.05). CONCLUSIONS HBOT may be effective in tracheal reconstruction by increasing epithelization and neovascularization after extended tracheal resection. HBOT, therefore, should be considered in CTA transplantation.

The Jeune syndrome in an adult: A case report

Jeune syndrome or asphyxiating thoracic dystrophy characterized by narrow rib cage and respiratory distress, accompanied by a multi-organ anomaly is a rare disease. Patients usually die due to complications of respiratory distress and in their first year. 25-year-old man was admitted to our clinic with the diagnosis of Jeune syndrome. We detected radiologically that patients rib cage was small and narrow and transverse and sagittal diameter of the rib cage was short . It has been reported in a small number of adult patients with Jeune syndrome. The respiratory distress determines the prognosis of patients. The respiratory problems decrease with age. Over time, kidney and liver damage may occur. For this reason, intensive respiratory support for these patients from birth and the follow-up of liver and renal functions are important.

Detecting the efficacy of cyanoacrylate onto bronchial closure on an animal model

Bronchopleural fistula is a serius complication that may lead to mortality following pulmonary resection. In our study, it was aimed to investigate the efficacy of tissue adhesive cyanoacrylate onto bronchial closure methods. During this experimental study totally 40 sheep lung and trachea were removed together for either manuel closure, stapler or cyanoacrylate. After left pneumonectomy, four groups was formed; in group I, 4/0 Premilene® suture was used with continuous horizontal matrix + over and over sutures. Bronchial stapler was used in group II. In group III, same techniques were used with group I and cyanoacrylate was applied. In group IV, bronchial suturing was achieved using 4/0 Premilene® in a continuous horizontal suture and then cyanoacrylate was applied. Each specimen was intubated with an endotracheal tube which was connected to a sphgmomanometer. The pressure level causing air bubbles was recorded inside the water. The median leakage pressure (300 mmHg) was significantly higher in group III (p0.05). Tissue adhesive cyanoacrylate was successful in preventing the leakage of bronch. We suggest that more expanded studies will provide cyanoacrylate to be used in bronchial closure after the pneumonectomy.