Erkan Ceylan

Extraction of pins from the airway with flexible bronchoscopy

Background: Tracheobronchial foreign body aspiration is a worldwide health problem which often results in life threatening complications. Standard flexible bronchoscopy (FB) is used increasingly in the treatment of tracheobronchial foreign body aspiration in adults and older children, especially in the removal of aspirated foreign bodies which have entered into the peripheral bronchi. Objectives: In the present study, we discuss how to minimize complications and increase the success rate of FB in the aspiration of pins, and recommend techniques to facilitate the application. Methods: The study was performed at a community hospital in Van, the Harran University Hospital in Sanliurfa and the Sutcuimam University Hospital in Kahramanmaras, Turkey. Between 2000 and 2005, 23 female patients between the ages of 12 and 23, who were admitted to the clinics and diagnosed as having tracheobronchial headscarf pin aspirations were included in our study to evaluate the efficiency of FB. Diagnosis of the patients was established by history, FB and radiological methods. All patients received transoral FB under local anesthesia. Results: FB was successfully applied in all cases. During removal, the pins in 2 patients dropped at the proximal trachea and subglottic zone, and were ingested into the gastrointestinal track. In both cases, the pins were spontaneously excreted from the body in the stool within one day. No other complication was detected in the other patients during or following bronchoscopy. Conclusions: Our study suggests that FB is a safe, easy and successful method used in the removal of foreign bodies, such as pins, from the tracheobronchial trees. By employing FB, indications of thoracotomy and other invasive methods can be reduced especially in the cases of pins localized in distal airways and in the evaluation of suspected foreign bodies.

Clinical presentation of abdominal tuberculosis in HIV seronegative adults.

BackgroundThe accurate diagnosis of abdominal tuberculosis usually takes a long time and requires a high index of suspicion in clinic practice. Eighty-eight immune-competent patients with abdominal tuberculosis were grouped according to symptoms at presentation and followed prospectively in order to investigate the effect of symptomatic presentation on clinical diagnosis and prognosis.MethodsBased upon the clinical presentation, the patients were divided into groups such as non-specific abdominal pain & less prominent in bowel habit, ascites, alteration in bowel habit, acute abdomen and others. Demographic, clinical and laboratory features, coexistence of pulmonary tuberculosis, diagnostic procedures, definitive diagnostic tests, need for surgical therapy, and response to treatment were assessed in each group.ResultsAccording to clinical presentation, five groups were constituted as non-specific abdominal pain (n = 24), ascites (n = 24), bowel habit alteration (n = 22), acute abdomen (n = 9) and others (n = 9). Patients presenting with acute abdomen had significantly higher white blood cell counts (p = 0.002) and abnormalities in abdominal plain radiographs (p = 0.014). Patients presenting with alteration in bowel habit were younger (p = 0.048). The frequency of colonoscopic abnormalities (7.5%), and need for therapeutic surgery (12.5%) were lower in patients with ascites, (p = 0.04) and (p = 0.001), respectively. There was no difference in gender, disease duration, diagnostic modalities, response to treatment, period to initial response, and mortality between groups (p > 0.05). Gastrointestinal tract alone was the most frequently involved part (38.5%), and this was associated with acid-fast bacteria in the sputum (p = 0.003).ConclusionGastrointestinal tract involvement is frequent in patients with active pulmonary tuberculosis. Although different clinical presentations of patients with abdominal tuberculosis determine diagnostic work up and need for therapeutic surgery, evidence based diagnosis and consequences of the disease does not change.

Pulmonary echinococcosis with multiple nodules mimicking metastatic lung tumor in chest radiography.

A 27-year-old man presented with a 2-year history of fatigue, cough with clear sputum, chest pain, and dyspnea. He had a history of a right lung operation and a cardiac echinococcus operation because of Echinococcus granulosus 10 and 3 years earlier, respectively. Laboratory investigations including tuberculin skin test, Creactive protein, rheumatoid factor, antinuclear antibody, and ANCA were all normal. Urinalysis was normal. Echocardiography showed severe tricuspid failure and pulmonary hypertension (pulmonary artery tension was 65 mm Hg). Right heart chambers were enormously enlarged. No endobronchial lesion was observed in fl exible bronchoscopy. The chest radiography showed multiple nodules and masses involving both lungs ( fi g. 1 ). A chest CT scan showed multiple nodular patterns with fl uid density. Some of these ruptured spontaneously. Some of the lesions were beside the pleura, whereas others were localized in the mediastinum ( fi g. 2 a). It was observed that the patient expectorated clear salty water including material resembling onion membranes in shape while coughing ( fi g. 2 b). E. granulosus is one of the most important helminthic pulmonary diseases. It is distributed worldwide and occurs most commonly in sheep and cattle-raising areas, particularly in Australia, South America, the Mediterranean, and some parts of Africa. Pulmonary cysts are seen on imaging as solitary or multiple circumscribed or oval masses. However, they are usually solitary, in 72% of cases affecting one lobe. Unruptured cysts are often indistinguishable from a variety of other pulmonary lesions [1, 2] . We present a case resembling metastasis on the chest radiography. There are interesting radiographic fi ndings, and it may be diffi cult to make a differential diagnosis. There is a wide differential diagnosis for multiple nodules and masses with extensive pulmonary involvement on radiography, which includes pulmonary echinococcosis. The presence of pulmonary echinococcosis is often not apparent on the radiograph but can usually be distinguished on CT scanning. CT may be useful in improving the characterization of the lesions. Published online: January 23, 2006