Hakki Ulutas

Tracheobronchial foreign body aspiration: a continuing challenge.

Objective The aim was to present the features and outcomes for 140 cases of foreign body aspiration and to discuss specific problems and new management recommendations. Study Design and Setting Records were retrospectively reviewed and the following data were recorded for each patient: age, sex, symptoms, duration of symptoms, findings on physical examination and chest radiography, location and type of foreign body, complications related to aspiration itself or to extraction, and outcome. Results Seventy-eight patients presented within 24 hours of aspiration. The most common symptoms and findings were cough, dyspnea-stridor, decreased breath sounds, radiopaque foreign body, air trapping, and atelectasis. All 140 patients underwent rigid bronchoscopy, and 110 had the foreign material extracted via the scope. No foreign body was detected bronchoscopically in 25 cases. In the other 5 cases, the material was visualized but could not be removed via the scope, and 3 of these patients required thoracotomy for removal. Eleven patients developed morbidity after bronchoscopy. Conclusion History suggestive of foreign body aspiration is a definite indication for bronchoscopy, and bronchoscopic extraction should only be performed by experts. Each case tends to present different challenges, and endotracheal intubation and tracheotomy may be required.

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.

Optimal Timing for Surgical Treatment to Prevent Recurrence of Spontaneous Pneumothorax

PurposePersistent air leakage and recurrence are the most common indications for the surgical treatment of spontaneous pneumothorax; however, the optimal timing for surgery is still unclear.MethodsThe subjects of this study were 90 patients treated for either primary spontaneous pneumothorax (PSP; n = 58) or secondary spontaneous pneumothorax (SSP; n = 32). We compared the incidence of prolonged air leak, the rate of recurrence of pneumothorax, the time from the first episode of pneumothorax to recurrence, and the postoperative complications in the two groups. We also analyzed the recurrence rate after treatment with observation and tube drainage versus surgery.ResultsSeventy-three patients were treated with tube thoracostomy or oxygen therapy for the first episode of pneumothorax. Surgery was performed in 32 patients; for the first episode of pneumothorax in 17 and for the second or third episode in 15. Postoperative complications developed in six (18.7%) patients and 24 of 73 patients who did not undergo thoracotomy suffered recurrence. The incidence of a second episode was 32.9% and the incidence of a third episode in the 18 patients who suffered recurrence after conservative treatment was 61.1%. None of the patients who underwent surgery suffered recurrence.ConclusionsTube thoracostomy is still the treatment of choice for first-time spontaneous pneumothorax. However, because the incidence of a third episode of pneumothorax after conservative treatment is high, surgical treatment should always be considered for patients with recurrence. In short, surgical intervention is safe and effective and minimizes the chance of recurrence of both PSP and SSP.

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.

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-

Surgical management of upper- and lower-lobe bronchiectasis without middle lobe involvement: is middle lobectomy necessary?

Postoperative quality of life is a crucial factor in decisions regarding surgical management of bronchiectasis. The goal of surgical treatment in such cases is to eradicate diseased portions of lung while preserving as much healthy lung parenchyma as possible. The volume of remaining lung must be sufficient to fill the pleural space. In patients with bronchiectasis, it is extremely unusual to have upper- and lower-lobe involvement without middle lobe involvement. A normal-sized middle lobe alone is usually not adequate to fill the right hemithorax. When the disease involves both the upper and lower lung lobes, surgeons must assess whether pneumonectomy is required. Herein, we describe the case of a patient with bronchiectasis who was successfully treated with upper and lower lobectomy and preservation of the middle lobe.

A Giant Primary Liposarcoma of the Anterior Mediastinum

DOI: 10.4328/JCAM.939 Received: 27.02.2012 Accepted: 09.03.2012 Printed: 01.03.2015 J Clin Anal Med 2015;6(2): 239-41 Corresponding Author: Erdal Yekeler, Osmangazi Mah. 230 Sok. Taner Apt. B-Blok No: 4 Yildizkent, Palandoken 25070 Erzurum, Turkey. GSM: +905326761759 F.: +90 3123552135 E-Mail: drerdalyekeler@hotmail.com Ozet Liposarkomlar; primitive mezensimal hucrelerden kaynaklanan nadir tumorlerdir. Mediastinal yerlesim cok nadirdir ve tum mediastinal tumorlerin %1’den azini olusturur. Bu tumorler akcigerin elastikiyeti ve plevral bosluk nedeniyle buyuk boyutlara ulasincaya kadar asemptomatik kalabilirler. Mediastinal hayati organlari invaze etmis kotu diferansiye tiplerde tam rezeksiyon her zaman mumkun olmayabilir. Biz bu makalemizde; son 3 aya kadar hic bir sikâyeti olmayan, on mediasten yerlesimli, dev boyutlara ulasmis, 34 yasinda erkek hastamizi ve onun basarili cerrahi tedavisini sunduk.