Cemal Kahraman

Tracheobronchial foreign body aspirations in childhood: a 10-year experience

OBJECTIVE Tracheobronchial foreign body aspirations comprise the majority of accidental deaths in childhood. Diagnostic delay may cause an increase in mortality and morbidity in cases without acute respiratory failure. We report our diagnostic and therapeutic modalities. METHODS In our department, bronchoscopy was performed on 548 patients with the diagnosis of tracheobronchial foreign body aspirations (from 1987 to 1997). Of these cases, 55.6% were male and 44.4% female. Their ages ranged from 2 months to 16 years (average 5.5 years). Diagnosis was made on history, physical examination, radiological methods and bronchoscopy. RESULTS Foreign bodies were localized in the right bronchial tree in 312 cases (56.9%), the left in 126 cases (23.0%) and in the trachea in 62 cases ( 1.3%). Foreign body was not found during bronchoscopy in 48 cases (8.7%). The majority of the foreign bodies were vegetable matters. Foreign bodies were removed with bronchoscopy in all but two cases which underwent limited thoracotomy. In the late period, pulmonary resection was performed in five cases because of irreversible complications. After bronchoscopy, hypoxia developed in four patients, requiring mechanical ventilation. Pneumothorax developed in two cases and mediastinal emphysema in two. Four patients (0.7%) died because of respiratory failure. CONCLUSION Proper use of diagnostic techniques provides a high degree of success, and the treatment modality to be used depending on the type of the foreign body is mostly satisfactory.

Unusually located hydatid cysts: Intrathoracic but extrapulmonary

BACKGROUND Hydatid cyst disease is still a problem in Turkey, as well as in many other places in the world. Extrapulmonary location of the disease in the thorax is very rare, and surgical procedures can be considered that differ from those used for pulmonary hydatid cysts. METHODS We reviewed retrospectively our experience in the surgical treatment of 22 patients with intrathoracic, extrapulmonary hydatid cysts. In our department, 297 patients with thoracic hydatid cysts were managed surgically in the last 14 years, in 22 (7.4%) of whom the cysts were localized extrapulmonarily in the thorax. The locations of these hydatid cysts were a fissure, the pleural cavity, chest wall, mediastinum, myocardium, and diaphragm. RESULTS Total resection was chosen as the surgical procedure in all patients except 4 (18.2%), 1 of whom had cystectomy and capitonnage for cardiac hydatid cyst and 3 of whom had cystectomy and local curettage for cysts located in the chest wall. Empyema developed postoperatively in 1 case (4.5%) with a cyst in the fissure. The follow-up period was 1 year, and there were no deaths. CONCLUSIONS Hydatid cyst may be found in many different sites, including extrapulmonarily in the thorax, and bearing this in mind will facilitate planning of the operation.

Surgical treatment of vasculo-Behçet's disease. A review of patients with concomitant multiple aneurysms and venous lesions.

Background: Vascular complications can be seen in patients with Behcet’s disease. Arterial and venous complications may be found separately or concomitantly in patients. Patients and methods: Out of 29 patients with vasculo-Behcet’s disease 7 patients with multiple aneurysms and venous lesions were documented over a period of 20 years. All patients were male, ranging in age from 24 to 52 years. The mean duration of the disease was 6 ± 2 years. The aneurysms were found in the following locations: one pulmonary artery, two abdominal aorta, four iliac, five femoral, and two popliteal artery. Both aneurysmal and occlusive lesions were present in three patients. In the venous lesions associated with the aneurysms there were three deep and three superficial venous thrombosis. Two patients had caval involvement-superior and inferior vena caval syndromes. Results: We performed seven interposition grafting by polytetrafloroethylene, one Y-grafting, one aneurysmorrhaphy, one lobectomy. Re-anastomosis was performed ...BACKGROUND Vascular complications can be seen in patients with Behçets disease. Arterial and venous complications may be found separately or concomitantly in patients. PATIENTS AND METHODS Out of 29 patients with vasculo-Behçets disease 7 patients with multiple aneurysms and venous lesions were documented over a period of 20 years. All patients were male, ranging in age from 24 to 52 years. The mean duration of the disease was 6 +/- 2 years. The aneurysms were found in the following locations: one pulmonary artery, two abdominal aorta, four iliac, five femoral, and two popliteal artery. Both aneurysmal and occlusive lesions were present in three patients. In the venous lesions associated with the aneurysms there were three deep and three superficial venous thrombosis. Two patients had caval involvement-superior and inferior vena caval syndromes. RESULTS We performed seven interposition grafting by polytetrafloroethylene, one Y-grafting, one aneurysmorrhaphy, one lobectomy. Re-anastomosis was performed in two patients who had anastomotic aneurysms and graft occlusion without disabling ischemia. Venous pathologies were treated by medical therapy. The patients were followed up between 1 to 8 years. One of the patients with iliac artery aneurysm died due to gastrointestinal bleeding 15 months after the operation. CONCLUSIONS In conclusion, when an aneurysm has been found in a patient with Behçets disease, the patient should be scanned for possible multiple aneurysms and venous lesions since they might be found together. Surgical treatment, when feasible, should be performed in cases with Behçet aneurysms because of a high risk of rupture. However, the possibility of an anastomotic aneurysm developing after surgery should also be kept in mind.

Intrathoracic Migration of a Kirschner Wire

Intrathoracic migration of a Kirschner wire is a serious complication and immediate removal of the wire is mandatory. We describe a case of Kirschner wire migration from the left shoulder to the thorax. The wire was successfully retrieved from the intrapleural cavity.

Blunt Thoracic Trauma: Analysis of 1730 Patients

Between 1978 and 1997, 1730 patients with blunt thoracic trauma were treated in our department. There were 450 females and 1280 males. The mean age was 34.3 years ranging from 2 months to 80 years. The most frequent causes of trauma were motor vehicle accidents in 1438 patients and occupational accidents in 232. Injury to multiple intrathoracic structures was noted in 986 (57%) cases. There were associated injuries to the abdomen (13.76%), the head (23.35%), and the skeletal system (22.6%). Eighty-nine percent of the blunt thoracic traumas did not require open thoracotomy but immediate use of lifesaving measures such as closed tube thoracostomy for hemothorax or pneumothorax was necessary in 1543 cases. A laparotomy was carried out in 238 patients. The most common blunt thoracic traumas requiring immediate thoracotomy were massive hemothorax (33 cases), cardiac tamponade (2 cases), and massive tracheobronchial air leak (24 cases). Surgical intervention was necessary in 22 patients with diaphragmatic rupture and in 5 patients with isolated sternal fractures. During the posttraumatic period, adult respiratory distress syndrome occurred in 71 patients, pleural thickening in 29, and pleural empyema in 21 patients. The most common causes of morbidity were atelectasis (10.06%) and pneumonia (5.32%). The mean hospital time for all patients was 15 days and the mortality rate was 5.61%.

A Fibromatosis Case Mimicking Abdominal Aorta Aneurysm

Retroperitoneal fibrosis is a rare fibrosing reactive process that may be confused with mesenteric fibromatosis. Abdominal aorta aneurysm is rare too and mostly develops secondary to Behcets disease, trauma, and infection or connective tissue diseases. Incidence of aneurysms occurring as a result of atherosclerotic changes increases in postmenopausal period. Diagnosis can be established with arteriography, tomography, or magnetic resonance imaging associated with clinical findings. Tumors and cysts should be considered in differential diagnosis. Abdominal ultrasound and contrast-enhanced computerized tomography revealed an infrarenal abdominal aorta aneurysm in a 41-year-old woman, but, on surgery, retroperitoneal fibrosis surrounding the aorta was detected. We present this interesting case because retroperitoneal fibrosis encircling the abdominal aorta can mimic abdominal aorta aneurysm radiologically.

A giant aneurysm of a branch of axillary artery

A 61-year-old man presented with a painful mass in the right axilla that had been present for several months. Over the past few weeks, it had grown in size and his level of discomfort had increased dramatically. The patient denied fevers, redness, recent travel, insect bites, or similar symptoms in the past. He denied any history of recent or remote trauma to the right axilla, recent use of crutches, or other possible injury. He had no history of ischemic arm symptoms. On examination, a large pulsatile and tender mass was appreciated without surrounding erythema or induration (A). All extremity pulses were palpable, and there were no ischemic, neurologic, or edematous signs in the arm. An axillary duplex scan demonstrated a mass of 15 cm in its widest diameter and turbulent pulsatile flow within the mass. Arteriography confirmed the presence of a giant aneurysm of right lateral thoracic artery (Cover). Surgical treatment was recommended. The origin of the aneurysmal branch was ligated at its junction with the axillary artery through a deltopectoral-subclavicular approach, and then the aneurysm was excised (B). No sign of infection was encountered during exploration and histopathology of the aneurysmal mural specimen revealed only atherosclerosis (C). The patient was discharged without complication after postoperative 5 days. He remained problem-free at the 1-year follow-up. Degenerative, sometimes termed atherosclerotic, aneurysms of the axillary artery and its branches are rare. Pseudoaneurysms represent the majority of the reported aneurysms in this location, and they almost always occur as a result of trauma or instrumentation. 1,2 True aneurysm of the axillary artery or its branches can cause vascular or neurologic compression complications, thromboembolic events, or rupture, so they should be treated. Although endovascular options could be considered, in this case the large size and associated symptoms required decompression and open surgical treatment was effective.

Lung Infections Due to Aspirated Foreign Bodies: Analysis of 84 Cases

Tracheobronchial foreign body aspiration is a significant cause of morbidity and mortality in the pediatric population because of serious early and late complications. In our department, 84 patients with pneumonia (75), bronchiectasis (7), or lung abscess (2) due to aspirated foreign bodies were managed between 1978 and 1997. Neither the patients nor their parents reported aspiration of an object. Foreign bodies were verified during diagnostic bronchoscopies. One patient with an abscess and 74 of the patients with pneumonia were managed by medical therapy after removal of the foreign body. All patients with bronchiectasis underwent surgical treatment with lobectomy (6) or segmentectomy (1). The patients were discharged from hospital after a mean of 10 days. The mortality was 2.4% (2 patients). An aspirated foreign body should be suspected in cases of persistent or recurrent lung infection in the same location and bronchoscopy should be performed for diagnosis and management.

Tracheal Adenoid Cystic Carcinoma Mimicking Bronchial Asthma

Adenoid cystic carcinomas are rare tracheal tumors that can mimic bronchial asthma. We describe the characteristics of 2 patients with adenoid cystic carcinoma who presented with symptoms suggestive of bronchial asthma of 2 years duration. Biopsy specimens revealed that the lesions were adenoid cystic carcinoma of the trachea. Both patients underwent collar incision and median sternotomy, the tumors were resected, and the tracheas were reconstructed primarily. Postoperative radiotherapy was given. Their postoperative clinical courses were uneventful and no local recurrences were seen at the 1-year follow-up.