Hasan Türüt

A comprehensive analysis of traumatic rib fractures: morbidity, mortality and management

OBJECTIVE A rib fracture secondary to blunt thoracic trauma is an important indicator of the severity of the trauma. In the present study we explored the morbidity and mortality rates and the management following rib fractures. METHODS Between May 1999 and May 2001, 1417 cases who presented to our clinic for thoracic trauma were reviewed retrospectively. Five hundred and forty-eight (38.7%) of the cases had rib fracture. There were 331 males and 217 females, with an overall mean age of 43 years (range: 5-78 years). These patients were allocated into groups according to their ages, the number of fractured ribs and status, i.e. whether they were stable or unstable (flail chest). RESULTS The etiology of the trauma included road traffic accidents in 330 cases, falls in 122, assault in 54, and industrial accidents in 42 cases. Pulmonary complications such as pneumothorax (37.2%), hemothorax (26.8%), hemo-pneumothorax (15.3%), pulmonary contusion (17.2%), flail chest (5.8%) and isolated subcutaneous emphysema (2.2%) were noted. 40.1% of the cases with rib fracture were treated in intensive care units. The mean duration of their stay in the intensive care unit was 11.8+/-6.2 days. 42.8% of the cases were treated in the wards whereby their mean duration of hospital stay was 4.5+/-3.4 days, while 17.1% of the cases were followed up in the outpatient clinic. Twenty-seven patients required surgery. Mortality rate was calculated as 5.7% (n=31). CONCLUSIONS Rib fractures can be interpreted as signs of significant trauma. The greater the number of fractured ribs, the higher the mortality and morbidity rates. Patients with isolated rib fractures should be hospitalized if the number of fractured ribs is three or more. We also advocate that elderly patients with six or more fractured ribs should be treated in intensive care units due to high morbidity and mortality.

Effects of early administration of dexamethasone, N-acetylcysteine and aprotinin on inflammatory and oxidant–antioxidant status after lung contusion in rats

INTRODUCTION This experimental setting was undertaken to elucidate and confirm the role of inflammatory and oxidant-antioxidant mechanisms on blunt injury induced moderate pulmonary contusion (PC). We intended to determine the effects of dexamethasone (DXM), N-acetylcysteine (NAC) and aprotinin (APR) in terms of their ability to diminish the consequences of acute lung injury due to PC. METHODS Rats were allocated to five subgroups. Except for the control, all subgroups had a moderate pulmonary contusion. Following 45 min of observation, animals in groups I and II received intraperitoneal saline, group III 10 mg/kg DXM, group IV 500 mg/kg NAC and group V 30,000 kIU/ml APR. After the procedure, 6 h after contusion, blood gas analysis, lung tissue nitric oxide (NO) and malondialdehyde (MDA) levels, superoxide dismutase (SOD) and catalase (CAT) activity, bronchoalveolar lavage (BAL) fluid and histopathological examination were performed. RESULTS All PaO(2) values decreased significantly in contused rats as compared with the control group (p<0.05). DXM, NAC and APR resulted in a slight increase in PaO(2) values compared with group II (p<0.05). Lung tissue levels of MDA and NO were higher in the contusion group than in the control (p<0.05). DXM, NAC and APR all decreased the levels of MDA and NO (p<0.05), however the decrease in NO was not found to be significant with APR (p>0.05). SOD and CAT activities increased significantly after contusion compared to control group (p<0.05). There was no significant difference even though SOD levels were elevated in groups III, IV and V compared with contused animals (p>0.05). Neutrophils in BAL fluid significantly increased in contused animals (p<0.05). Only DXM significantly decreased neutrophil population in BAL fluid (p<0.05). Scores for alveolar haemorrhage/oedema were higher in all contusion-performed rats than those in the control (p<0.05). Compared with the other drugs, only APR significantly improved the haemorrhage/oedema scores compared to sham animals (p=0.024). CONCLUSIONS Our findings demonstrate that moderate bilateral PC induced by blunt chest trauma leads to an early inflammatory process which is clearly associated with activation of the oxidant-antioxidant cascade. On this basis, early supportive treatment with DXM, NAC and APR may yield favourable results on pulmonary pathophysiological parameters which are adversely affected due to PC.

The relationship between time of admittance and complications in paediatric tracheobronchial foreign body aspiration.

Abstract Purpose : Majority of tracheobronchial foreign body aspirations occur in paediatric age group and may constitute a life hazard. We examined the relationship between the time of admittance and complications in children with tracheobronchial foreign body aspiration. Material and methods : Sex, age, time of admittance, presenting symptoms, radiological findings, and the nature of the foreign body were reviewed retrospectively in patients aged 16 and under follow-up for tracheobronchial foreign body aspiration between January 1990 and January 2005. Cases were randomly assigned into 6 groups based on admittance times. Results : Within 15-year period, 263 children under the age of 16 were followed-up for tracheobronchial aspiration of foreign body. The most commonly aspirated foreign bodies included sunflower seed, peanut, hazelnut, walnut. While the pathology could be detected radiographically in 80.3% (n: 211) of the cases, in 19.7% (n: 52) radiology was normal. All cases had rigid bronchoscopy under general anaesthesia. In 220 cases foreign body was detected and could successfully be removed in 209 cases. The remaining 11 cases required bronchotomy or pneumotomy to remove the foreign body. Among 679 cases operated for bronchiectasis during the same period, 22 cases (3.2%) had foreign body as the aetiology. No complications were observed when the patients presented to the hospital within the first 24 hours after the aspiration while fever, purulent sputum, haemoptysis and bronchiectasis were noted in those presented later. Most of the complications were medically treated. Conclusion : Paying medical attention within the first 24 hours after the aspiration of foreign bodies is critical in order to accomplish a complication-free course. Organic foreign bodies and retention period of 30 days and over, constitute major risk factors in the development of bronchiectasis. It is advisable to perform bronchoscopy in the early stages of all suspected cases to avoid serious complications such as bronchiectasis.

Zinc Aspartate Alleviates Lung Injury Induced by Intestinal Ischemia-Reperfusion in Rats

BACKGROUND Intestinal ischemia-reperfusion (II/R) induced acute lung injury is mediated by activated neutrophils and formation of free radicals. Several antioxidants have been shown to attenuate such remote organ injury. We studied the effects of zinc aspartate on lung injury induced by II/R in rats. MATERIALS AND METHODS Twenty-four Sprague-Dawley rats were randomized into three groups. Group I was the control. Animals in Groups II and III (II/R + zinc aspartate [ZA]) underwent 60 min of ischemia and 60 min of reperfusion, respectively. Rats in Group III also received 50 mg/kg zinc aspartate before 15 min of reperfusion. Lung tissue samples and bronchoalveolar lavage fluid were obtained to assess lung tissue myeloperoxidase (MPO), adenosine deaminase (ADA), xanthine oxidase (XO), glutathione peroxidase (GPx) activities, and nitric oxide (NO), malondialdehyde (MDA) levels. Also, the levels of MDA, NO, and MPO activity were determined in bronchoalveolar lavage fluid. RESULTS Compared with the control, lung tissue MDA, NO levels, and MPO, ADA, XO activities were markedly increased (P < 0.05), whereas GPx activity significantly decreased in the II/R group (P < 0.05). However, administration of ZA significantly reversed these effects by reducing the levels of MDA, NO, and decreasing MPO, ADA, XO activities (P < 0.05). In addition, ZA significantly increased GPx activity (P < 0.05). The activity of MPO and the levels of NO and MDA were found to be higher in bronchoalveolar lavage fluid in II/R group than the control (P < 0.05). Zinc aspartate significantly diminished MPO activity and the levels of NO and MDA compared with that of control rats (P < 0.05). CONCLUSION Our results indicate that zinc aspartate alleviates lung injury induced by II/R attributable to its antioxidant and antiinflammatory effects.

Clinical and Radiologic Evaluation of Foramen of Morgagni Hernias and the Transthoracic Approach

The limited number of publications on repair of the foramen of Morgagni hernia concentrates mainly on the laparotomy approach. We present our experience with the transthoracic approach. Patients who were diagnosed as having a foramen of Morgagni hernia and were operated on via the transthoracic approach between December 1991 and June 2004 are reviewed retrospectively for their age, sex, presenting symptoms, and diagnostic and surgical procedures. Surgical repair was carried out via the transthoracic approach in all cases. Of the 24 patients who underwent transthoracic diaphragmatic repair of the defect, 16 were women and 8 were men, with an overall mean age of 55.1 years (range 42–69 years). In most cases the defect was on the right side; there was only one case of a left-sided defect. The most common presenting symptoms were dyspnea and gastrointestinal discomfort; five (20.8%) patients were asymptomatic. In 21 cases (87.5%) the diagnoses were established radiologically. The defect was accessed surgically via a posterolateral thoracotomy. No postoperative morbidity or mortality was observed. The mean follow-up was 8.3 years (14 months to 14 years), and no recurrence was noted. As important as the surgical repair of the foramen of Morgagni hernia itself is selection of the surgical approach so adhesions of the hernial sac from the surrounding tissues in the thoracic cavity are easily released. The transthoracic approach is amenable to safe primary repair of the defect and the release of adhesions, even in elderly and obese patients, in whom adhesions may be excessive.

Completion pneumonectomy for bronchiectasis: morbidity, mortality and management.

BACKGROUND Completion pneumonectomy performed for benign causes is associated with a high morbidity and mortality. We analyzed the patients who underwent completion pneumonectomy procedure for bronchiectasis, which constitutes a specific benign condition, together with the indications for surgery, the difficulties encountered during operations and the postoperative results. METHODS Records of all patients who underwent completion pneumonectomy for the diagnosis of brochiectasis between January 1991 and April 2006 at the thoracic surgery clinic of a training and research hospital specializing in chest diseases and chest surgery were retrospectively evaluated. The age and the gender of the patients, etiologic factors, symptoms, characteristics of the first operation, the time between the first operation and completion pneumonectomy, and postoperative follow-up are examined. RESULTS During the evaluation period of more than 15 years, 23 patients underwent completion pneumonectomy. The median age of these 23 patients was 28 (range: 9 - 53); 17 of the patients were male and 6 were female. The most common indication for surgery was recurrent lung infections (n = 15). The most common symptoms were cough (n = 21), expectoration (n = 19), and hemoptysis (n = 15). The mean time between the first operation and the completion pneumonectomy was 4.9 years (range: 5 months - 11 years). Left completion pneumonectomy was performed in 14 and right completion pneumonectomy was performed in 9 cases. The mean duration of hospital stay was 16.7 days (range: 12 - 42 days). The course after surgery was uneventful in all patients. The mortality rate was 0 % and morbidity was 43.5 %. CONCLUSION Although completion pneumonectomy for benign causes is a high risk procedure, it can be performed in selected patients with an acceptable morbidity and mortality after an effective preoperative medical therapy for inflammation of the lungs and with careful dissection at the operation.

Effects of hyperbaric oxygen therapy on wound healing after tracheal resection and end-to-end anastomoses in rats: results of early observations.

BACKGROUND Proliferating scar tissue is an important problem after tracheal surgery. Hyperbaric oxygen (HBO) provides good support to the poorly perfused tissues. We aimed to evaluate the early effects of HBO therapy on tracheal healing after tracheal resection. METHODS A total of 15 Wistar rats were divided into two groups and two tracheal rings of each rat were resected. A control group received no therapy while the other group was treated with HBO. At the end of the study or when a rat died, a histopathological examination was performed to assess neovascularization, necrosis and epithelization. RESULTS HBO treatment caused better epithelization and inflammation scores compared to the control group. In the HBO group the intraluminal purulent exudates were limited (P=0.001). Healing of the damaged mucosal epithelium was better in the HBO group (P=0.031). In the HBO-treated group, neovascularization also started earlier than in the group without HBO. CONCLUSION Our short-term observation results demonstrate that HBO treatment increases tracheal healing and decreases the complication ratios. HBO may be preferred as a supportive treatment modality during the healing period after tracheal surgery.

Propofol with N-Acetylcysteine Reduces Global Myocardial Ischemic Reperfusion Injury More than Ketamine in a Rat Model

Objective: We examined the cardioprotective effects of propofol and ketamine with and without N-acetylcysteine (NAC). Methods: 60 rats were divided into six groups of 10 rats each. Anesthesia induction was produced with an intraperitonal injection of ketamine in Groups 1–3 and propofol in Groups 4–6. NAC (200 mg kg− 1) was given intraperitonally during anesthesia induction in Groups 3 and 6. Groups 2, 3, 5, and 6 were subjected to 90 s of myocardial ischemia by clamping the ascending aorta, and then reperfusion was begun by unclamping the ascending aorta. After 60 min of reperfusion, blood samples were taken from the ascending aorta for biochemical analyses, and heart tissue samples were taken for biochemical and histopathological analyses. Results: Creatine kinase (CK), myocardial band of creatine kinase (CK-MB), and troponin-I (Tn-I) levels were significantly higher in the ischemia–reperfusion groups (2, 3, 5, 6) compared to the nonischemic groups (1, 4). CK, CK-MB, and Tn-I levels did not differ significantly between the ketamine groups (1–3) and the propofol groups (4–6) p >. 05). Malondialdehyde levels were significantly higher in Groups 2 and 3 than in Group 1 and were significantly lower in Groups 4 and 6 than in Group 5 (p <. 05). Malondialdehyde levels in the propofol groups (4–6) were significantly lower than in the ketamine groups (1–3; p <. 05). Catalase levels in propofol groups were higher than ketamine groups. Superoxide dismutase levels were significantly higher in Group 6 than in Group 3 (p <. 05). Conclusions: In this rat model of global cardiac ischemia, propofol with NAC attenuates myocardial injury more than ketamine (with or without NAC).

Surgical results and prognosis of patients with primary bronchogenic carcinoma aged less than 36 years.

Background and objective:  This study reports on the demographic features, clinico‐pathological results and prognoses of patients aged less than 36 years diagnosed with non‐small cell lung cancer (NSCLC).

The influence of specific factors on postoperative morbidity in young adults with bronchiectasis.

BACKGROUND Surgical treatment of bronchiectasis is associated with acceptable mortality and morbidity rates. To date, few reports on the prediction of postoperative morbidity using some preoperative measures have been presented. We present our results regarding the influence of some specific factors on postoperative morbidity on young adult patients who were treated surgically for bronchiectasis. METHODS Between January 2000 and July 2007, 122 patients were operated upon. Female gender, increased number of resected segments, presence of haemoptysis and bilateral disease, compromised pulmonary function test (FEV1/VC<60%) and absence of preoperative fiberoptic bronchoscopy (FOB) were examined as the potential risk factors for postoperative complications such as persistent air leak (PAL), atelectasis, residual air space (RAS), bronchopleural fistula (BPF) and empyaema. RESULTS There was no operative mortality. Morbidity was observed in a total of 16 patients with an overall morbidity rate of 13.1%. Complete resection was achieved in 88 patients (72.1%). The number of resected segments was not found to be significantly associated with increased morbidity. Presence of preoperative haemoptysis did not correlate with postoperative complications significantly. Absence of preoperative FOB was not found to be associated with post-operative complications (p<0.05). Compromised PFT was significantly associated with RAS (p=0.028), however it was not associated with increased risk of PAL, atelectasis or empyaema significantly. CONCLUSION Multi-segmental resectable bronchiectasis should not be considered an occult risk factor for morbidity after resection. Associated non-severe haemoptysis and absence of preoperative bronchoscopy are not associated with significant increased risk of postoperative morbidity.