Ali Yeginsu

Strength of esophageal closure techniques with and without tissue reinforcement.

ObjectivesThe purpose of this study was to investigate the effects of esophagotomy closure techniques on the esophageal bursting pressure.Materials and methodsAltogether, 122 freshly dead sheep esophagi received from the local slaughterhouse were prepared for manual closure. After esophagotomy, the specimens were divided into four groups. An interrupted mucosal suture pattern (n = 30), an interrupted mucosal-submucosal suture pattern (n = 30), an interrupted mucosal-submucosal + over-over continuous muscular suture pattern (n = 32), and an interrupted mucosal-submucosal + reinforcement with a diaphragmatic part with full-thickness interrupted U suture pattern (n = 30) were used for esophagotomy closure; 4-0 silk was used in all specimens. Bursting pressures were measured with a sphygmomanometer.ResultsWe found a statistically significant difference among the bursting pressures of all groups (p < 0.001). The bursting pressure values gradually increased from group 1 to group 4 (47.6 ± 22.7, 86.2 ± 49.5, 185.4 ± 53.5, and 226.8 ± 62.4 mmHg, respectively). Reinforcing the esophageal suture line with tissue significantly increased the bursting pressure compared to the other groups.ConclusionsEach layer of the esophagus significantly contributes to strengthening esophageal wall tension with primary esophageal closure, and reinforcement of the esophageal suture with tissue provides an additional significant increase in the bursting pressure of the esophagus.

Invasive Approaches to the Diagnosis of Pleural Effusion

This article reviews the surgical and other invasive procedures in the management of pleural effusions. Pleural effusion is frequent in clinical practice. Pleural procedures vary from aspiration to more challenging procedures such as thoracoscopy. However it is difficult to make diagnosis by thoracentesis or closed pleural biopsy. Thoracoscopy is gold standart in the investigation and management of pleural disease. Pleural biopsy by thoracoscopy should be actively carried out in patients with pleurisy, because the technique has a high diagnostic rate and can be easily and safely performed. Flexible or rigid thoracoscope, bronchoscope, endoscope and mediastinoscope can be used for operation.

Pseudochylothorax due to Rheumatoid Arthritis; A Very Rare Entity

DOI: 10.4328/JCAM.729 Received:16.06.2011 Accepted: 11.08.2011 Printed: 01.01.2014 J Clin Anal Med 2014;5(1): 62-4 Corresponding Author: Makbule Ergin, Gaziosmanpasa Üniversitesi Tip Fakültesi, Gogus Cerrahisi Anabilim Dalı., Cennet Mh. 60500, Tokat, Turkey. F.: +90 3562133179 E-Mail: makbuleergin@yahoo.com Özet Pseudoşilotoraks genellikle tüberküloz veya romatoid artrit [RA] gibi kronik inflamatuar hastalıklarla ilişkilidir. RA’e bağlı pseudoşilotoraks çok daha nadir olup 2009’a kadar İngiliz literatüründe sadece 21 vaka vardır. Uzun süreli plevral efüzyon [5 yılın üzerinde] ampiyem ve pseudoşilotoraks ile sonuçlanabilir, ancak bizim hastalarımızın hikayeleri 2 ve 3 yıllıktı. Bu yazıda pseudoşilotoraks ve ampiyemli 2 RA vakasını literatüre katkı sağlaması ve pseudoşilotoraks tanısında zamanın bir kriter olmadığını vurgulamak için bildirdik.

[A rare complication after Velpeau bandage: hemopneumothorax].

Velpeau bandage is a treatment method that fixes the arm to the body in cases of fractures and dislocations at the region of shoulder. Velpeau bandage very rarely leads to complications. This case report involves a 45-year-old male admitted to the emergency service after trauma. Glenoid and multiple rib fractures were detected in radiological examinations. A transient Velpeau bandage was performed before surgical correction. Patient had dyspnea and chest pain 24 hours after bandage application. An obvious displacement at the rib fracture sites and hemopneumothorax were seen in the chest X-ray. A chest tube was inserted into the patient. Glenoid fracture was corrected surgically. Patient was discharged on the sixth day. He has no problems at readmission after the first month.

Göğüs tüpü takılması

GIRIŞ Gogus tupu, kapali drenaj sistemleri yardimi ile plevral kavitenin tek yonlu drenajini saglar. Gogus tupu takilmasi (tup torakostomi) acil durumlarda potansiyel olarak hayat kurtarici bir girisimdir ve acil serviste calisan her hekim gerekli oldugunda uygulayabilecek duzeyde bilgi sahibi olmalidir. Gogus tupu takilmasinin esas amaci temelde plevral bosluktaki hava ya da sivinin (kan, lenf, pu ve diger) tahliyesini saglamaktir. Bununla birlikte tup icerisinden tedavi amacli degisik ilaclar plevral bosluga uygulanabilir (1,2).

OESOPHAGEAL BURST STRENGTH

At the early phase of primary oesophageal closure, the mechanical integrity of repaired oesophageal part is very important for maintaining an airtight, water-tight barrier against gastric contents that direct access to the mediastinum and pleural cavity, leading to severe mediastinitis, empyema and ultimately multiorgan failure. Our purpose was to investigate the influence of the length of repaired oesophageal part on the oesophageal bursting strength. Sixty fresh sheep oesophagi were received from the local slaughterhouse. The specimens were randomly divided into three groups (n = 20). Two-centimetre, 4-cm and 6-cm longitudinal oesophagotomy incisions were carried out in the 1/3 distal portion of the oesophagi in group 1, 2 and 3, respectively. Interrupted mucosal–submucosal suture plus over–over continuous muscular suture pattern with 4-0 silk was used in all groups. Specimens were mounted a sphygmomanometer (Riester, Jungingen, Germany), distal end of oesophagi were clamped and subsequently positioned under water. The bursting pressure level at which we detected air bubbles indicated the limits of the technique. One-way ANOVA was used for the comparison of parametric data. For post-hoc multiple comparison, the Scheffe’s test was used. A P-value of less than 0.05 was considered significant. Six-centimetre primary repair has significantly less bursting strength than the other groups (171 – 49mmHg, P= 0.011). Two-centimetre and 4-cm primary repairs had nearly equal bursting strengths (211 – 47mmHg and 214– 48mmHg, respectively. P= 0.989). Statistical evaluation of the bursting pressures was indicated in Table 1. Our study showed that the length of primary oesophageal closure affects the oesophageal bursting strength. In particular, primary repairs that are 6 cm or longer have less bursting strength than the shorter ones. The most vulnerable period of the healing anastomosis is between days 4 and 7.1 At this period of oesophageal healing, establishing the mechanical integrity is crucial for maintaining an airtight, water-tight barrier against the gastric contents. The leakage may occur through suture holes or between sutures in gastrointestinal repair and this might be due not only to the anastomotic technique, but also to the differences of elongation of intestine and suture material.2 It may be concluded that in a longer suture line, the likelihood of leakage rises because of more longitudinal elongation of the suture line. Bursting strength measurement is an acceptable method, which assesses longitudinal and circular forces in hollow organs.3 In this ex vivo study, we used a sheep oesophagus because of its similarities with that of humans regarding the thickness and histological structure.4