Atalay Sahin

Inhalation of foreign bodies in children: experience of 22 years.

BACKGROUND Foreign body (FB) inhalation into airways of the respiratory system is a life-threatening condition and can be fatal. The purpose of this survey was to evaluate the types and characteristics of inhaled foreign bodies, the age distribution of children, and the outcome. METHODS We outlined a retrospective review of hospital data of patients between 1990 and 2012. FB inhalation occurring in children 0 year to 16 years was considered for inclusion. During the study period, 1,660 patients undergoing bronchoscopy with the diagnosis of FB were included. Deaths on arrival were excluded. RESULTS Of the patients, 53% were male, and 47% were female (p > 0.05). The mean age was 6.2 years for girls and 4.7 years for boys. In 57% of all cases, the children were younger than 3 years. An FB was found within the respiratory tract of 1,565 patients. The FBs were always extracted by using rigid bronchoscopy. Hospitalization was always required owing to an institutional requirement. The origin of the FBs were within the two main groups of food and objects. Food FBs included seeds, nuts, beans, and fruit parts. FB objects included pins, toy parts, and metal pieces. FB and subsequent treatment revealed that morbidity was present; however, mortality was rare. CONCLUSION Most of the inhaled FBs were found in the bronchial tree. Children younger than 3 years are more vulnerable. There seemed to be an association between the aspirated FBs and season, geographic locality, and sociocultural environment. The removal of choice is rigid bronchoscopy under general anesthesia. That most cases of FB in children occurs under the supervision of adults indicates that the incidence and severity of airway FB inhalation can be reduced by parental education and public awareness. LEVEL OF EVIDENCE Epidemiologic study, level III.

Effects of Ecballium Elaterium on Proinflammatory Cytokines in a Rat Model of Sepsis.

ABSTRACT Objective: Ecballium elaterium (EE) is a plant from Cucurbitaceae family. Its anti-inflammatory role in sepsis is not well understood. We investigated the effects of EE on serum levels of proinflammatory cytokines and further explored the mechanisms underlying histological changes in liver and ileum following EE administration in a polymicrobial sepsis model. Methods: Thirty rats were divided into three groups of 10 rats each. Rats were subjected to sham laparotomy plus normal saline administration (control group, CG), laparotomy with cecal ligation and puncture (CLP) (sepsis group, SG), and laparotomy with CLP plus 2.5 mg/kg EE administration (experimental group, EG). Twenty-four hours after laparotomy, animals underwent cardiac puncture, and blood was collected for interleukin 1 (IL-1), interleukin 6 (IL-6), and tumor necrosis factor alpha (TNF-α) assessment. Whole sections of liver and ileum tissues were collected for histologic examination. Results: The serum level of IL-6 was significantly lower in EG as compared to SG. Although IL-6 levels were shown a statistically significant (p < 0.0001) decline to near control values, no significant changes were observed in serum levels of IL-1 and TNF-α after EE treatment. Histologic examination revealed statistically significant reduction in collagen formation (p = 0.001) on serosal surface of ileum and hepatic venous congestion (p = 0.040) in EG as compared to SG. Conclusion: EE might play a protective role in sepsis prevention and treatment by decreasing IL-6 production and reducing liver damage and may influence bacterial translocation by reinforcing intestinal barrier function.

Surgical Outcome of Bronchiectasis in Children: Long Term Results of 60 Cases

BACKGROUND Bronchiectasis is described as destruction and the irreversible dilatation of bronchial structure. We wanted to demonstrate our surgical practice and outcome of surgical treatment in bronchiectasis. METHODS We studied records of 60 pediatric patients who underwent surgical resection in our clinic between January 2000 and January 2013. The results were analyzed regarding factors influencing the outcome. RESULTS There were 32 boys and 28 girls with a mean age of 9.45 years (range 2-15). The most common cause was childhood infection in 25 (41.66%). The mean duration of the symptoms was 42.93 months. Patients underwent 64 operations including 2 staged thoracotomies and 2 re-thoracotomies. Atelectasis was the most frequent complication. Longer duration of symptoms related to postoperative complication. The morbidity and mortality rates were 20% and 3.33%, respectively. The outcome was optimal in 92%. Forced expiratory volume in 1 s less than 60% of the predicted value, hemoptysis and duration of symptoms were found prognostic variables for postoperative morbidity with high ratios of odds coefficients by using Binary Logistic Regression Method. CONCLUSIONS Complete and early resection of bronchiectasis provides a successful outcome. Duration of symptoms and timely intervention have a major impact on the management and prognosis.

Giant hydatid cysts of the lung: Analysis and surgical outcome of 67 cases

Aims: We aimed to evaluate the results of surgical treatment of huge hydatid cysts diagnosed at our clinic. Ruptured cysts have caused severe complications. Perforation of very large cysts is always possible. These can result in fatal complications. We present our surgical experience with large hydatid cysts in this paper. Materials and Methods : We retrospectively reviewed 191 patients diagnosed as hydatid cysts who were treated surgically. Among these, 67 cases were studied with a dimension of 10 cm or more. Age, gender, symptom, ruptured or intact, dimension, quantity and radiologic findings of the cases were determined. Incipiency of complaint, postoperative morbidity and length of hospital stay for all cases were assessed. Results: The cases comprised 41 females and 26 males. The mean age was 20.20 ± 16.13 (5-52) years. Hospital stay for the huge and ruptured cysts group was 11.21 ± 4.04 days. The huge but unruptured cysts group had a hospital stay of 8.40 ± 2.48 days. All patients underwent thoracotomy. Cystotomy plus capitonnage in 52 (77.61%), decortication in addition to cystotomy plus capitonage in seven (10.6%), cystotomy in six (8.6%), cystotomy plus enucleation in one and primer closure in one were carried out. Postoperative mortality was absent; however, 17 cases were complicated; atelectasis was found in five cases, prolonged air leakage in five cases, apical aseptic pleural space in three cases, empyema in two cases, hemopthisis in one case and diaphragmatic elevation in one. Conclusions: Immediate surgery is of choice in giant cysts. Possibility of complication and longer stay in the ruptured group is higher compared with simple cystic disease.

Evaluation of management of postpneumonic empyema thoracis in children

BackgroundEmpyema is a well-known sequelae of pneumonia, which is increasingly being reported in children despite strict management. The appropriate management remains controversial. The aim of this study was to evaluate different management options of postpneumonic empyema in children. Materials and methodsA total of 330 patients were reviewed between 2002 and 2012; their ages ranged from 1.25 to 15 years, with a median age of 4.3 years. The various management procedures included thoracentesis (n=11), chest tube drainage (n=229), chest tube drainage with intrapleural fibrinolytic therapy (n=117), video-assisted thoracoscopic surgery (VATS) (n=35), and thoracotomy because of a trapped lung noted on admissions and failed procedures (n=94). ResultsVariable success rates were noted as follows: tube thoracotomy (48.24%), fibrinolytic treatment (68.37%), and VATS (85.71%). Postoperative complications (11.14%) included wound infection (n=10), atelectasis (n=18), delayed expansion (n=7), and need for reoperation (n=2). Four patients died (1.21%), two of them following thoracotomy, one patient after fibrinolysis, and one patient following VATS. Patients treated with thoracotomy recovered completely. ConclusionNew therapeutic modalities had variable success rates in children with postpneumonic empyema. Thoracotomy is still needed as a last resort for cases unresponsive to chemical fibrinolysis and following failed thoracoscopy.