Erdal Yekeler

A Rare Case of Swyer-James Macleod Syndrome and a New Clinical Presentation, Acquired Lobar Emphysema

Swyer-James Macleod syndrome is a radiologic entity characterized by hyperlucency of one or more lobes or of the entire lung, decreased number and diameter of ipsilateral peripheral pulmonary vessels, and difficult visibility of the arterial network and unobstructed bronchial system. A 21-year-old male was admitted to our clinic on the observation of left hemithoracic hyperinflation on chest radiography. Preoperative evaluation revealed an increase of ventilation to the left lower lobe and the deletion of peripheral vascular structures. Scintigraphy revealed a perfusion defect in the left lower lobe. In this patient with congenital left upper lobe hypoplasia and Swyer-James Macleod syndrome in the lower half of the lower lobe, I present the coexistence of these two rare clinical entities and acquired lobar emphysema.

Bilateral Chylothorax After Severe Vomiting in a Child

In the etiology of chylothorax, traumas and malignancies are the first two leading causes. Today in pediatric patients, the most common cause of chylothorax includes the complications secondary to cardiothoracic operations. Bilateral chylothorax is rarely observed after severe vomiting leading to increase in intrathoracic pressure. In idiopathic chylothorax, bilateral localization is dominant. A 9-year-old girl who presented to our emergency department with the complaints of dyspnea and back pain following severe vomiting received a diagnosis of bilateral chylothorax. The patient was treated with the insertion of a bilateral chest tube, and pleurodesis was performed in left hemithorax. Examination did not reveal a pathology to this condition, except the vomiting observed 2 days previously after the meal.

The use of the LigaSure™ in esophagectomy

This study aimed to evaluate the efficacy of the LigaSure vessel sealing system (LVSS) when used for esophagectomy. We compared 56 consecutive patients (32 male and 24 female, mean age: 56.64+/-12.61 years), who had undergone Ivor-Lewis esophagectomy for esophageal carcinoma between January 2005 and May 2009. Among them, from January 2005 to April 2007, 27 patients (group 1) were operated on with the conventional clamp-and-tie technique, whereas from April 2007 to May 2009, 29 patients (group 2) underwent total esophagectomy for esophageal cancer with the LVSS. Both groups were compared for operation duration, amount of intraoperative bleeding, postoperative hospitalization time, and intraoperative complications. In the evaluation of the patients, the two groups had similar distributions of age and gender. The duration of operation (349.44+/-46.82 min vs. 288.27+/-60.09 min, P<0.05) and the amount of intraoperative bleeding (414.82+/-137.04 ml vs. 217.41+/-111.78 ml, P<0.05) were significantly lower in LVSS group than in the conventional method group. There were no differences for hospitalization time and intraoperative complications between the groups. LVSS significantly shortens operation duration and decreases the amount of intraoperative bleeding compared with the conventional methods, but does not provide advantages for hospitalization time and/or intraoperative complications. We believe LVSS is an effective and reliable method for esophagus surgery.

Hydatid cysts of the lung: lesion size in relation to clinical presentation and therapeutic approach

PurposesThe aim of this study was to assess the relationship between the pulmonary hydatid cyst size and the clinical presentation, surgical approach, and postoperative outcome. We review the problems encountered in treating large pulmonary hydatid cysts and highlight the risks associated with the rupture of the cyst and a delay of the surgical treatment.MethodsThe medical records of 169 patients surgically treated for lung hydatid cysts were reviewed. Patients were divided into two groups based on cyst size: group 1 (nxa0=xa0128) with small (<10xa0cm) cysts and group 2 (nxa0=xa041) with giant (≥10xa0cm) cysts. Data related to symptoms, preoperative complications, surgical procedures performed and postoperative morbidity were analyzed and compared.ResultsIn both groups, the most common symptom was chest pain, followed by dyspnea and cough, respectively. There were no differences between the two groups with respect to cyst-associated parenchymal or pleural complications before surgery (pxa0=xa00.80). In the large majority of cases, the surgical treatment was cystotomy, removal of the cystic membrane and capitonnage. Wedge resection was performed in nine patients in total (seven in group 1, two in group 2) and one patient in group 2 required a lobectomy. Decortication was required significantly more frequently in group 2 than in group 1 (pxa0=xa00.001). Sixteen patients in group 1 and 10 patients in group 2 developed postoperative complications (pxa0=xa00.19). There was no peri or postoperative mortality. There was no difference between the groups with respect to the duration of hospitalization (pxa0=xa00.17). Two patients with complicated hydatid cysts in group 1 had recurrent lesions during follow-up, whereas there was no recurrence in group 2.ConclusionAll pulmonary hydatid cysts should be surgically treated as soon as possible after their diagnosis in order to avoid complications. Most of these lesions, regardless of size, can be surgically managed with procedures that preserve the maximal lung parenchyma and yield excellent outcomes.

Fibrinolytic therapy for parapneumonic empyema during pregnancy

Pneumonia and parapneumonic complicated effusion during pregnancy is uncommon but poses potentially serious risks to both mother and fetus. Enzymatic debridement of the pleural cavity with fibrinolytic agents is a noninvasive option that can facilitate drainage and prevent the need for surgery. Herein, we describe the cases of two pregnant women with parapneumonic empyema who were successfully treated with intrapleural fibrinolytic therapy.

A GIANT RUPTURED HYDATID CYST CAUSING TENSION PNEUMOTHORAX AND HEMOTHORAX IN A PATIENT WITH BLUNT THORACIC TRAUMA: A RARE CASE ENCOUNTERED IN THE EMERGENCY CLINIC

A 26-year-old male farmer presented to the Emergency Department (ED) complaining of left-sided chest pain and increasing dyspnea after blunt trauma involving cattle 6 h prior. He had a productive cough and expectorated slightly salty fluid. On the physical examination, the blood pressure was 90/60 mm Hg, pulse rate was 129 beats/min, and the respiration rate was 27 breaths/min. The left side of the chest did not fully expand with inspiration. Breath sounds were diminished on the left side. The laboratory results were non-specific. A posterioranterior view of the chest (Figure 1) revealed a 10 8-cm air cyst located on the diaphragm in the left hemithorax, a pleural effusion in the left costophrenic angle, deviation of the heart to the right, and a parenchymal consolidation. The initial diagnosis of the patient, who had a history of trauma, was traumatic hydropneumothorax based on the findings revealed by the pulmonary graph. However, the findings were not typical for a traumatic hydropneumothorax, and salty fluid expectoration as described by the patient was suggestive of other possible diagnoses. The computed tomography (CT) scan of the chest revealed a ruptured cyst measuring 16 12 11 cm in the left hemithorax, in the base of which a germinative

Role of Prolene Mesh in Late Postpneumonectomy Empyema: Esophageal Pleural Fistula

Apatient, who had undergone left pneumonectomy for bronchial carcinoma 6 years previously, presented to our clinic with halitosis, fever, loss of appetite, and weight loss that had occurred within the last 3 months. A chest roentgenogram showed air-fluid level in the pneumonectomy space (Fig 1). Thoracic computed tomography revealed fluid in the pneumonectomy space and a mass on the lateral thoracic wall. The patient underwent chest puncture, through which a purulent fluid sample was obtained. A chest tube was then placed and purulent fluid was drained. A chest roentgenogram obtained after the drainage clearly showed the presence of a mass on the left chest wall. These findings suggested the presence of bronchopleural fistula in the pneumonectomy pouch and tumor recurrence. On bronchoscopy, the bronchial stump had a normal appearance and there was no tumor recurrence and fistula. After confirmation of the absence of bronchopleural fistula, empyema was treated using daily active irrigation by chest tube. After the regression of infectious signs, a single-port videoassisted thoracoscopic surgical procedure was performed and examination of the pneumonectomy space, debride-