Celal Tekinbas

The management of esophagogastric anastomotic leak after esophagectomy for esophageal carcinoma

Esophagogastric anastomotic leaks are the most feared surgical complications following resection of esophageal cancers. We aimed to develop a therapeutic algorithm for this complication characterized by high morbidity and mortality using our 20 years of experience and the published literature. A total of 354 patients who had undergone an esophagectomy and esophagogastric anastomosis due to esophageal carcinoma were evaluated retrospectively. The incidence for anastomotic leak was 15.5% (n = 90) in the cervical region and 4.2% (n = 264) in the thoracic region (mean: 7.1%). Cervical anastomotic leaks were detected after a mean period of 7.2 days following the procedure. Fourteen patients with cervical leaks were treated conservatively. Four out of 14 patients (28.6%) died due to sepsis and multi-organ failure related to fistula. Thoracic anastomotic leaks were detected after a mean period of 4.7 days following the procedure. Emergency reoperation, resection and reconstruction procedures were performed in one patient. Self-expanding metallic coated stents were placed at the anastomosis region in two patients. A more conservative approach was employed in other patients with thoracic anastomotic leaks. Six of them (46.2%) died due to fistula. General mortality rate was 37.0%, and the duration of hospitalization was 40.0 days for patients with anastomotic leaks. Cervical anastomotic leaks are more common than thoracic anastomotic leaks, but most of them are successfully treated with conservative approaches. Thoracic anastomotic leaks that in the past were related to high mortality rates despite conservative or surgical procedures might be successfully treated nowadays with the use of self-expanding metallic coated stents.

Mediastinal lymph nodes: Assessment with diffusion-weighted MR imaging

To prospectively determine whether the diffusion‐weighted magnetic resonance imaging is useful to distinguish between malignant and benign mediastinal lymph nodes.

Ischemia-modified albumin in the diagnosis of pulmonary embolism: an experimental study

STUDY OBJECTIVE We designed this experimental study to determine the value of ischemia-modified albumin in the diagnosis of pulmonary embolism. METHODS Twenty-four mature female New Zealand rabbits were divided into 4 groups, each consisting of 6 animals. These were classified into group 1 ,the control group; group 2, the deep venous thrombosis group; group 3, the deep venous thrombosis with pulmonary embolism group; and group 4, the pulmonary embolism-alone group. Deep venous thrombosis was produced by ligation of the iliac vein. To establish pulmonary embolism, 2 clots were administered from the iliac vein. Blood samples were taken from all the groups at hours 0, 1, 3, and 6 for ischemia-modified albumin measurement. RESULTS Pulmonary embolism was established in all the rabbits in groups 3 and 4, and this was confirmed by tomographic and histologic findings. Measurement of mean ischemia-modified albumin levels for all rabbits at hours 0, 1, 3, and 6 revealed that mean ischemia-modified albumin levels in groups 3 and 4 were statistically significantly higher than those in groups 1 and 2. There was no difference between the mean ischemia-modified albumin levels in groups 1 and 2 nor between groups 3 and 4. The alteration in ischemia-modified albumin levels over time was statistically significant. CONCLUSIONS The results of our experimental study demonstrate that ischemia-modified albumin levels may be useful in the diagnosis of pulmonary embolism.

Hydatid cyst disease of the lung as an unusual cause of massive hemoptysis: a case report

IntroductionEchinococcosis and/or hydatidosis is one of the most important zoonotic diseases in the world. In Turkey, echinococcosis is an endemic disease, however, hydatid disease of the lung is uncommon and usually caused by Echinococcus granulosus.Case presentationIn this report we describe a 17-year-old male patient who presented with massive hemoptysis due to hydatid disease of the lung.ConclusionAlthough it is one of the less common causes of massive hemoptysis, hydatid disease of the lung requires greater attention in countries, such as Turkey, in which hydatid cyst disease is common.

Adult Inflammatory Myofibroblastic Tumor of the Trachea: Case Report and Literature Review

Inflammatory myofibroblastic tumor of the trachea is a rare benign tumor in adults. It is mostly seen before the age of 16. We describe a 20-year-old female patient who presented with stridor. She had a fixed obstruction on spirometry, and computed tomography and bronchoscopy confirmed tracheal thickening and stenosis below the vocal cords and bronchial wall thickening at the level of the carina. Bronchoscopic biopsy confirmed an inflammatory myofibroblastic tumor. She recovered after mechanical dilatation and resection via rigid bronchoscopy, followed by corticosteroid therapy.

A Case of Intratracheal Schwannoma Presenting at the Emergency Department with a Diagnosis of Asthmatic Attack

Primary tumors of the tracheobronchial tree are rare, and benign tumors are even rarer. Patients with tracheobronchial tumors are at times wrongly diagnosed with asthma. A 77-year-old woman presented to our Emergency Department with increasing dyspnea and stridor. She had been treated for bronchial asthma for the last 7 years. Due to the presence of the stridor, a cervical soft tissue computed tomography scan was performed. It revealed a tracheal polyp at the level of the thyroidal isthmus. Polyp excision with rigid bronchoscopy was performed by a thoracic surgeon. This case demonstrates that intratracheal masses should be considered in patients with dyspnea and stridor or in patients with asthma refractory to usual treatment.

Giant Fibrous Tumor Misdiagnosed as Traumatic Hemothorax

Abstract Solitary fibrous tumors of the pleura are neoplasms of the mesenchymal tissue of the pleural mesothelium. The most frequent symptoms are dyspnea, coughing and chest pain. A 45-year-old female patient presented after a thoracic contusion. A radio-opaque image was evidenced on chest X-ray. At the initial hospital, a hemorrhagic fluid was aspirated at thoracocentesis and the patient was transferred to our hospital with diagnosis of traumatic hemothorax. A thoracic CT showed a tumoral formation filling two-thirds of the left hemithorax. The transthoracic biopsy finding was compatible with a fibrous tumor. The patient was taken for surgery and the large pleural tumor was excised. In conclusion, a large pleural fibrous tumor was initially mistaken for hemothorax. A CT-scan revealed the tumoral nature of the thoracic opacity.

The Perforation of the Superior Vena Cava Secondary to the Left Subclavian Dialysis Catheter

Introduction: The perforation of the superior vena cava during the placement of dialysis catheter and consequent hemothorax is a rare serious complication. Case Report: Dialysis catheter was placed in the left subclavian vein in a 69-year-old male patient with chronic renal insufficiency who was hospitalized for intracerebral hematoma. During hemodialysis a day after the procedure, the patient was noted having right-sided hemothorax, causing lethargy, dyspnea, hypotension, and bradycardia. Right tube thoracostomy was performed and 1500 cc of hemorrhagic fluid was drained. Under general anesthesia, the right posterolateral thoracotomy was performed and the tip of the dialysis catheter was found in the pleural space, penetrating the anteromedial side of the superior vena cava. The perforation area was repaired by suturing with 3-0 prolene, and the dialysis catheter was removed externally. Postoperative period was uneventful, and tube thoracostomy was terminated on day 4. Conclusion: Establishing the diagnosis early and accurately and performing appropriate surgery would be lifesaving in superior vena cava perforation due to dialysis catheter.

Comparison of T2 and T3 sympathectomy for compensatory sweating on palmar hyperhidrosis

Background: An otherwise successfully performed endoscopic thoracic sympathectomy (ETS) to treat palmar hyperhidrosis (PH) often has a serious side effect: compensatory sweating (CS). This side effect occurs in other parts of the body to a disturbing extent. The objective of this study is to determine whether there is a relationship between the level of ETS performed on patients with PH, and the occurrence and severity of postoperational CS. Methods: Between January 2014 and January 2015, ETS procedures were performed on 25 randomly selected consecutive subjects (group A) at T2 level, and on another 25 subjects (group B) at T3 level, who all felt severely handicapped due to PH. All subjects were assessed in terms of their demographic characteristics including gender and age, as well as postoperative complications, short-term results, side effects, recurrence of symptoms, and long-term results. Results: The symptoms disappeared in all subjects in short-term, and no recurrence was seen in their short or long-term follow-ups. At the end of year one, CS developed at a rate of 12% in group A and 8% in group B, particularly in their back and abdominal regions. The overall satisfaction with the procedure in year one was 96% in group A and 100% in group B. Conclusion: When an ETS performed at T2 or T3 level for PH involves only the interruption of the sympathetic chain, with a limitation on the range of dissection and avoidance of any damage to ganglia, sweating is stopped completely. No recurrence of PH is encountered, and CS develops only at low rates and severities.

Primitive Transport Vehicle (Varangele) Accidents

ural settlements in the Eastern Black Sea region of urkey are built on the steep slopes of hills and mounains. To solve difficult transportation problems, the peole in the agricultural areas of the Black Sea have deeloped a simply designed cable car (varangele). The arangele is widely used, despite its deficiencies, due to ts utility. A characteristic pattern of injuries from cable ar accidents is discussed.