Hanife Karakaya Kabukcu

One-stage transthoracic operation for the treatment of right lung and liver hydatid cysts.

In this study we reviewed our experience of hydatid disease of the lung and the liver and discussed the safety and the follow-up results of the one-stage operation. Between 1990 and 2004, 142 patients with pulmonary hydatid disease underwent operation in our clinic. Of these, 27 (19%) patients had cysts located on the dome of the liver, treated with phrenotomy through a right thoracotomy. Hydatid cysts located in the lungs were managed by means of cystotomy. For liver cysts, cystotomy and the inversion of the cavity with sutures was the surgical method of choice, and a drain was left in place. The pulmonary cysts of 12 (8.4%) patients were bilateral and 5 (3.5%) patients had prior surgical treatment of hepatic (n = 1) or pulmonary (n = 4) hydatid cysts. The liver cysts were approached transdiaphragmatically after the lung cysts were excised in 27 (19%) patients. In patients with pulmonary cysts, cystotomy, with or without capitonnage was performed on 123 (86.6%) patients, and wedge resection was performed on 11 (7.7%), segmentectomy was performed on 6 patients (4.2%), and lobectomy was performed on 2 (1.4%) patients. There was no mortality, and only a small number of complications were encountered: empyema in 3, excessive biliary drainage in 2, and bronchopleural fistula in only 1. We suggest that the extraction of pulmonary and hepatic cysts simultaneously through the transthoracic route is a useful and safe surgical technique. This technique also prevents the need for a second operation.

The effect of pentoxifylline on haemolysis during cardiopulmonary bypass in open-heart surgery.

Objective — Haemolysis has long been recognized as one of the responses to cardiopulmonary bypass (CPB). Pentoxifylline (PTX), a methylxanthine derivative, has been known for many years for its haemorrheological properties. In this prospective, randomized study, we investigated whether a PTX treatment would reduce the haemolysis during CPB. Methods — The effect of PTX treatment on haemolysis during CPB was studied in 25 patients (PTX group). Oral PTX (1200 mg/day in 3 divided doses) treatment for 3 days was followed by 300 mg i.v. PTX administration after anaesthesia induction.The control group consisted of 25 patients with equivalent surgery but no PTX treatment. Blood samples were collected at seven time points: prior to CPB, at 5 and 10 min of CPB and 5, 10 and 15 min after removal of cross clamping and 10 min after weaning from bypass in order to measure the haemolysis parameters, which included free haemoglobin and haptoglobin. Results — PTX-treatment caused statistically significant decrements in plasma free haemoglobin levels during CPB. On the other hand, plasma haptoglobin levels stayed higher in PTX-medicated patients during the CPB as compared to control subjects. Conclusions — These findings suggested that PTX may be an effective agent in reducing the haemolysis during CPB.

Comparison of pressure and volume-controlled ventilation in laparoscopic cholecystectomy operations.

Laparoscopic cholecystectomy has many advantages such as shorter hospital stay of patients, minimal postoperative pain, rapid recovery after the operation; however, systemic disadvantages because intra‐abdominal pressure, position and general anaesthesia may also appear. In this study, pressure‐controlled ventilation (PCV) and volume‐controlled ventilation (VCV) modes during laparoscopic cholecystectomy operations were compared in terms of their effects on haemodynamic, respiratory and blood gas parameters.

Sublingual heterotopic large cyst in a newborn: anesthetic management

A one-month-old 3,950-g male infant was hospitalized with a sublingual cystic lesion that caused feeding difficulty and respiratory distress. The cyst was first diagnosed in the fourth month of pregnancy during a routine prenatal ultrasound examination. Shortly after delivery, the cyst was reduced in size by needle aspiration. It rapidly re-grew, however, and on return to hospital, a cystic lesion (4 9 4 cm) on the ventral surface of the infant’s tongue extended outside the oral cavity (Figure, panel A). In the accompanying magnetic resonance

In reply: Using a Mcintosh blade for retromolar intubation: a comment

To the Editor, We read Drs Veyckemans’ and Fayoux’s valuable comments on our report outlining the airway management of a one-month-old infant who presented with an obstructive sublingual cyst. They recommended cyst aspiration to allow easier direct laryngoscopy. Certainly, in the presence of airway obstruction, intubation after cyst drainage and/or urgent tracheostomy can be options to secure an airway. However, after respiratory tract obstruction is evaluated with preoperative magnetic resonance imaging (MRI) and no respiratory tract compression is observed, we believe that opting for tracheal intubation without cyst aspiration is a reasonable choice. Nevertheless, we ensured that a surgical team was immediately available to perform urgent cyst aspiration and tracheostomy if needed. In our case, intubation was performed successfully using a curved blade, and urgent cyst aspiration and tracheostomy were not required. Veyckeman and Fayoux also recommended nasal flexible bronchoscopic (FB) intubation as an alternative technique. Indeed, intubation using a FB permits direct visualization of the glottis to facilitate passage of an endotracheal tube into the trachea and clearly would provide a reliable alternative method in cases of difficult intubation. This application, however, requires extensive experience and knowledge of complicated pediatric airway management. In addition, only very small diameter FBs can be placed through a 3-mm endotracheal tube, which was not available in our centre. Veyckemans and Fayoux also referred to muscle relaxant use in cases of difficult intubation, which carries a risk of increased oropharyngeal obstruction due to loss of muscle tone. This risk must be balanced against the potential benefit of preventing laryngospasm. If intubation could not be performed successfully, we had planned for cyst aspiration and direct intubation. Lastly, their recommendation for using a straight (i.e., Miller) blade for intubation must be balanced against the difficulty of the advancing the straight blade toward the vallecula during intubation when the cyst may be blocking that route. Indeed, during our first intubation attempt, the tongue could not be moved laterally with a straight blade, and the vocal cords could not be seen. On our second intubation attempt, the laryngoscope was successfully advanced through the right molar gap, and the epiglottis was easily visualized with use of the curved blade. Successful intubation ensued. Accordingly, we believe both straight and curved blades should be kept available prior to intubation and alternative options be considered and made available.

Right atrial thrombus associated with subclavian catheter developed due to total parenteral nutrition application

Central venous catheterization as a frequent routine clinical procedure may have significant complications. Mechanical complications may occur during catheter placement, whereas thromboembolic and infectious complications can be seen during follow-up. Total parenteral nutrition (TPN) associated central venous catheterizations may result in early mechanical complications and thrombotic and infectious complications in the long term. This paper describes a patient diagnosed as mitochondrial neurogastrointestinal encephalomyopathy requiring long-term central venous catheterization for TPN implementation, who had an infected thrombus on the catheter tip resected by cardiac surgery.

Negative Pressure Pulmonary Edema Developed After Endoscopic Sinus Surgery

Objective: Negative pressure pulmonary edema (NPPE) is an uncommon complication of anesthesia, usually resulting from post-extubation laryngospasm. The most common risk factors are young age, male sex, and head or neck surgery. In this case report, the diagnostic and therapeutic approaches to a patient with NPPE due to severe laryngospasm that developed in the early postoperative period of functional endoscopic sinus surgery performed under general anesthesia is presented. Case: Antrochoanal polyp excision under general anesthesia was performed in a 51-year-old male patient. After extubation, severe laryngospasm developed and positive pressure ventilation was provided with a mask. Despite the application of positive pressure ventilation with a mask, adequate oxygenation was not obtained, the respiratory distress was aggravated, respiratory crackles were heard and the patient was intubated again. Pink frothy liquid coming from the lungs was seen in the endotracheal tube. The patient was transferred to intensive care after IV furosemide application. Pulmonary edema findings were detected on PA chest X-ray. PEEP was administered. The patient was discharged three days later without any complications.. Conclusion: NPPE resolves generally within 24 hours with prompt diagnosis and therapeutic action. When recognition is delayed, patients with NPPE have mortality rates ranging from 11% to 40%. If hypoxia continues despite PEEP with a mask, re-intubation and invasive mechanical ventilation may be necessary..