Hasan Solak

Chest trauma in children

OBJECTIVES Chest trauma in childhood is uncommon in clinical practice. The management and treatment principles of children with thoracic trauma were discussed with the data reported in the literature. METHODS Of the chest injury diagnosed in 1653 patients, 225 were children in the last 17-year period. There were 199 boys (88.44%) and 26 girls (11.55%). The most common causes were blunt injuries in 135 cases (60%), stab wounds in 67 cases (29.77%) and gunshot wounds in 22 cases (9.77%). RESULTS Out of 225, 217 patients were treated conservatively and eight patients were treated surgically. There was no mortality and morbidity. CONCLUSIONS The prevalence of chest trauma in children due to blunt injuries is high in Turkey. Extremity injury is thought to be the most commonly associated extra-thoracic injury. However, thoracic trauma in children can be managed conservatively in most of the cases.

Methylprednisolone prevents inflammatory reaction occurring during cardiopulmonary bypass: effects on TNF-α, IL-6, IL-8, IL-10:

Objective: This study examined the correlation between tumour necrosis factor-alfa (TNF-α), interleukin (IL)-6 and IL-8, IL-10 and methylprednisolone pretreatment. Methods: This is a prospective, randomized and double-blinded study. Sixty patients undergoing coronary artery bypass grafting (CABG) were randomized to receive either intravenous methylprednisolone (n=30, Group M) or intravenous placebo (n=30, Group S). The patients received intravenously either 30 mg/kg methylprednisolone (Group M) or placebo (Group S) 10 min before and after cardiopulmonary bypass (CPB). In an intensive care unit (ICU), four additional doses were given at 6-hourly intervals. Blood samples for the measurements of TNF-α, IL-6, IL-8 and IL-10 were obtained before induction of anaesthesia (T0=control value), after induction (T1), before starting CPB (T2), after aortic declamping (T3), at the end of CPB (T4) and 6 hours (T5), 12 hours (T6) and 24 hours (T7) after skin closure. Creatine kinase (CK) and creatine kinase isoenzyme MB (CK-MB) were evaluated at the following intervals: T0, T5, T6 and T7. Results: When compared with the control value, TNF-α, IL-6 and IL-8 significantly increased in Group S and Group M (p B-0.05), but these values were significantly greater in Group S than in Group M (p B-0.05). In comparison with the control value, IL-10 increased in both groups (p B-0.05), but was significantly greater in Group M than in Group S (p B-0.05). CK and CK-MB were increased in both groups in postoperative values compared to control values. In Group S, CK and CK-MB levels were significantly lower than in Group M (p B-0.05). Conclusion: In this study, we have found that pre-operative administration of methylprednisolone has decreased TNF-α, IL-6 and IL-8 release, and increased the perfusing IL-10 levels after CPB. Thus, methylpredniso-lone may decrease the inflammatory response during the CPB procedure.

The clinical and surgical features of right-sided intracardiac masses due to echinococcosis.

Right-sided cardiac echinococcosis shows special clinical and surgical features beyond the rareness of echinococcosis in this position, leading to serious and life-threatening complications. We examined our cardiac hydatid cyst patients, retrospectively, and report our experience of the surgical treatment of right-sided cardiac hydatid cysts. Between 1985 and 2000, seven patients were transferred to our department from the cardiology department with a diagnosis of cystic cardiac masses which were highly suspected of being hydatid cysts. Two were males and 5 were females. In 3 patients the hydatid cyst was located in the right ventricle, and one was in the right atrium. The mean age of the patients was 37 years (ranging from 12 to 60 years). One patient had preoperative pulmonary emboli. In all right-sided cardiac echinococcosis patients, cardiopulmonary bypass was used. All cysts were cleaned after quilting the cystic cavities, and daughter cysts were removed carefully. The cavities were closed with purse-string sutures. Postoperatively, one patient had pulmonary emboli. In all patients, mebendazole was administered postoperatively. When a right-sided cardiac hydatid cyst is diagnosed, early surgical treatment should be performed under open-heart surgery conditions. During the operation, a single cannula in the superior vena cava should be used until fibrillation, and after clamping, the cannula for the pulmonary artery inferior vena cava should be inserted.

Pulmonary embolism due to cardiac hydatid disease: imaging findings of unusual complication of hydatid cyst

Abstract. We report two cases of primary cardiac hydatid cyst in which hydatid materials caused recurrent embolizations in pulmonary arteries and pulmonary parenchyma. Cardiac hydatid cysts may stay asymptomatic for a long time, until they reveal themselves being perforated into cardiac chambers and/or pulmonary artery or systemic circulation. The role of imaging techniques in diagnosis is discussed and the importance of dynamic enhanced CT, MR imaging, and enhanced MR angiography (MRA) is reported. Imaging findings were confirmed by surgery and pathology. Early diagnosis is essential because delayed treatment increases the morbidity and mortality rates.

Bilateral pneumothorax: a retrospective analysis of 40 patients.

PurposeTo retrospectively investigate the effectiveness of tube drainage in the treatment of bilateral pneumothorax.MethodsWe retrospectively examined 40 patients with bilateral pneumothorax treated at the Thoracic and Cardiovascular Surgery Departments of Selcuk University between January 1994 and December 2000. There were 37 male and 3 female patients, aged 5–80 years (mean age, 42 years). The definite diagnosis of pneumothorax was made by radiological evaluation. In total, 38 tube drainage, 2 thoracentesis, and observation procedures were done, and some patients also required thoracotomy or median sternotomy.ResultsThe types of pneumothorax were spontaneous in 9 patients, traumatic in 30, and iatrogenic in 1. We treated simultaneous bilateral pneumothorax in 34 patients and nonsimultaneous bilateral pneumothorax in 6 patients by tube drainage or additional surgical treatment. Two patients died.ConclusionsBilateral pneumothorax may require extended hospital stay and could result in death. We think that tube drainage is appropriate and effective for most cases of bilateral pneumothorax.

Effect of off-pump and on-pump coronary artery bypass grafting on renal function.

Background. Coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) has the risk of renal dysfunction. The cause of renal dysfunction after CPB is multifactorial, such as nonpulsatile flow, renal hypoperfusion, hypothermia, and duration of CPB. This study compared off-pump technique with on-pump technique on renal function in patients who underwent CABG. Methods. Sixty patients with normal preoperative renal functions undergoing CABG were randomly assigned to conventional revascularization with CPB (on-pump) or beating heart revascularization (off-pump). Renal functions were assessed up to 10 days postoperatively. Results. Creatinine clearance was found to be significantly higher in the off-pump group than in the on-pump group (p < .05). The off-pump group had significantly less increase in creatinine levels when compared with the on-pump group (p < .05). The free water clearance values decreased similarly in both groups; however, the recovery was more prompt in the off-pump group (p < .05). No significant differences were found in the prevalence of postoperative hemodialysis. Conclusion. The off-pump technique may provide a positive contribution and sufficient protection on postoperative renal functions in patients undergoing CABG.

Cost-effective and time-saving surgical treatment of pulmonary hydatid cysts with multiple localization.

Abstract.Abstract.Purpose: The most frequent anatomic locations of hydatid cysts are the liver and lungs. Because there is no effective medical therapy against this parasitic disease, surgery is the treatment of choice. The aim of this retrospective study was to compare the cost and effect of a one-stage operation with those of two- or three-stage operations in the treatment of lung hydatid cysts with multiple localizations.Methods: We evaluated 364 patients who underwent surgical treatment for hydatid cysts, all of whom had multiple localizations. To avoid two- or three-staged operations, we performed median sternotomy, simultaneous bilateral thoracotomy and unilateral thoracotomy with a transdiaphragmatic approach.Results: For the treatment of 460 hydatid cyst localizations in 364 patients, a collective 381 operations were performed. The number of operations and periods of hospitalization were reduced.Conclusion: A one-stage surgical procedure for bilateral lung and liver hydatid cysts is superior to the traditional two- and three-stage operations because it reduces morbidity, hospital stay, and cost.

A recurrent right atrial thrombus: a suggestive sign for Behçet's disease? A case report

Abstract A 29-year-old woman with Behçets disease was admitted to our cardiology department with a history of cough, dyspnea, and palpitation. Transthoracic and transesophageal echocardiography revealed a right atrial mass. She was operated on to remove the mass, which was shown by histopathological examination to be a thrombus. Three months later, echocardiography was repeated and recurrent right atrial thrombus was observed. Warfarin was given to the patient. One month later, the mass was not observed on echocardiographic examination. We report recurrent right atrial thrombus in a patient with Behçets disease.

Hydatid Cyst on Right Ventricular Posterior Wall

A 14-year-old boy was investigated for unexplained tachycardia and multiple pulmonary emboli demonstrated by computed tomography. A right ventricular hydatid cyst was diagnosed by echocardiography and successfully excised under cardiopulmonary bypass.

The cerebroprotective effects of pentoxifylline and aprotinin during cardiopulmonary bypass in dogs

Objective: The purpose of this study was to investigate the cerebroprotective effects of pentoxifylline (PNX) and aprotinin in dogs using cardiopulmonary bypass (CPB). Materials and methods: Eighteen clinically healthy dogs were divided into three groups: Group 1 (control, n = 6), Group 2 (PNX, n = 6), and Group 3 (aprotinin, n = 6). PNX was administered at a dose of 300 mg/day in Group 2 three days before the operation and during the operation. Half a million IU aprotinin were added to the prime solution and 500 000 IU were transfused via a central venous jugular catheter preoperatively in Group 3. Blood samples were taken from the central jugular vein before and after CPB and interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and S100β protein were measured. Gliosis was investigated histopathologically in cerebral cortex biopsy samples under light microscopy. Results: The preoperative results of IL-6, TNF-α, and S100β protein values were found to be significantly higher (p < 0.001) when compared with postoperative values. This significant difference was observed in the same parameters between Groups 1 and 2, and 1 and 3 (p < 0.001). There was no significant difference between Groups 2 and 3. Comparison between pre- and postoperative levels of IL-6 and TNF-α for Group 2 and Group 3 revealed statistically significant differences (p < 0.001), whereas S100β protein levels did not. Histopathological examinations showed significant differences between the control group and PNX and aprotinin, and between aprotinin and PNX groups (p < 0.001). Conclusion: PNX and aprotinin might be useful in order to reduce postoperative cerebral damage in patients undergoing cardiac surgery with CPB.