Irfan Tastepe

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.

Pleurectomy:decortication for palliation in malignant pleural mesothelioma: results of surgery

OBJECTIVE Surgery can only offer palliation in an attempt to slow the progression of malignant pleural mesothelioma (MPM). We want to assess the effectiveness and safety of pleurectomy/decortication in establishing a tissue diagnosis, and controlling pleural fluid accumulation and symptoms in patients with MPM. METHODS We reviewed our pleurectomy results in 100 patients with MPM over a 19 year period. Major symptoms were chest pain, cough and dyspnea, and radiographic findings included pleural mass, pleural fluid and constriction of involved hemithorax. RESULTS Approximately two thirds of the patients underwent surgery prior to tissue diagnosis. Eighty-nine patients had stage I and stage II disease, 8 and 81%, respectively. The patients underwent subtotal (44%) or total pleurectomy (56%). The surgical mortality rate was 1% (1/100) and the morbidity rate was 22%. Morbidity included prolonged air leak (n = 12), empyema (n = 6), reaccumulation of pleural fluid (n = 2) and wound infection (n = 2). Palliative results included dyspnea and cough relief in all patients, chest relief in 60 (85%) and pleural fluid control in 52 (96%) patients. Median survival was 17 months in MPM patients. CONCLUSIONS We conclude that pleurectomy/decortication safely provides both tissue diagnosis and effective of pleural effusion and symptoms and therefore excellent palliation in patients with MPM.

Surgery in bronchial carcinoids: experience with 83 patients

OBJECTIVE With the changing clinical presentation and histopathological pattern, carcinoids are now considered as a distinct and well-defined group in the neuroendocrine tumour scale. Surgery, especially parenchyma-sparing operations, are the treatment of choice for carcinoids. METHODS Over a 25-year period, 83 patients with typical carcinoid tumour underwent thoracotomy on in our institution. The records of the patients were reviewed and the results were evaluated. RESULTS The diagnosis was made with radiological methods and bronchoscopy. Cough and recurrent pneumonia were the most common symptoms. A variety of surgical procedures were performed. Thirty of the 83 patients underwent tissue-saving operations. Twenty patients underwent bronchotomy excision, eight were managed with sleeve or partial sleeve resective procedures, and two underwent segmentectomy. CONCLUSIONS Conservative surgery is the treatment of choice of carcinoids, which were histologically typical and anatomically endobronchial. Especially for polypoid type carcinoids and for selected cases with sessile type, bronchotomy with simple excision and sleeve resections is a simple and effective method. As these types of operations produce a better functional result, they should be encouraged in these patients.

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.

Neurogenic Tumors of the Mediastinum: A Report of 60 Cases

OBJECTIVES To analyze retrospectively 60 patients (13 infants and children, 47 adults--21 men and 39 women) with mediastinal neurogenic tumours admitted to Atatürk Centre for Chest Disease and Chest Surgery, Ankara, Turkey between 1988 and 1999. This comprised 21.2% of 283 patients who had surgical operations for all mediastinal masses during the same period. PATIENTS AND METHODS The patients ranged from four to 67 years of age. Thirteen patients were younger than 15 years and 47 were 15 years of age or older. Medical records were reviewed for demographic data, clinical presentation, diagnostic investigations, operative procedures, and tumour location and invasion. Postoperative morbidity and mortality were noted as well as long term follow-up. The clinical investigations included chest x-ray and computed tomography of the thorax in all patients, and spinal magnetic resonance imaging and bronchoscopical examination in some. Clinical variables were compared. RESULTS The tumours had the following characteristics: 42 (70%) were nerve sheath tumours; 15 (25%) were autonomic ganglion tumours; two (3.6%) were paragangliomas; and one (1.4%) was a malignant peripheral neuroectodermal tumour (Askins tumour). Nerve cell tumours comprised the majority of tumours in infants and children (nine of 13, 69%), whereas the nerve sheath tumours were most frequent in adults (39 of 47, 83%). There were 48 benign and 12 (20%) malignant tumours when all age groups were considered; the malignancy rate was 61.5% (eight of 13) in children and 8.5% (four of 47, P<0.05) in adults. All patients were operated via a posterolateral thoracotomy. Surgical resection of the tumour was complete in 56 of 60 patients (93.3%). Resection of malignant tumours was grossly incomplete in four cases (four of 12, 33.3%). All benign tumours were totally excised. There were two major complications (respiratory failure and pulmonary emboli) and 14 minor complications in the perioperative period. The mean follow-up period was five years and seven months. Tumours recurred in 5.3% (three of 56) of patients who had a complete resection initially. There were no late deaths related to benign tumours. CONCLUSIONS Complete resection of tumours can be performed safely by a thoracotomy approach and is important for achieving satisfactory long term survival in most mediastinal neurogenic tumours.

A case of multiple synchronous localized fibrous tumor of the pleura

We report a patient with two synchronous distinct masses in the same hemithorax both of which got the diagnosis of benign localized fibrous tumor of the pleura. The plain chest X-ray was rather obscured due to a large left-sided pleural effusion, but her subsequent computerized chest tomography revealed a heterogeneous hypodense soft tissue mass, which was pleural in origin, sitting on the diaphragm bathed in fluid. At thoracotomy, we detected two distinct masses in the left hemithorax, both arising from the visceral pleura via their vascular pedicles.

Management of intrathoracic goitre

A retrospective review is presented of 20 cases with resection of intrathoracic goitre between 1975 and 1993. The mean age of the 11 men and nine women was 53 years. The intrathoracic goitre was primary in seven cases and secondary in 13. The presenting clinical features and the pathology, surgical risks and optimal approaches are discussed. Primary intrathoracic goitre should be approached via a thoracotomy, because of the independent vascular supply. As secondary intrathoracic goitres are supplied by vascular pedicles arising from the inferior thyroid artery, a cervical collar incision is preferable. In the event of significant mediastinal bleeding, which is difficult to control from a cervical incision, a T-shaped incision for partial or full sternotomy can be performed, or even thoracotomy.

Bronchoscopic Diagnosis of Ruptured Pulmonary Hydatid Cyst Presenting As Nonresolving Pneumonia: Report of Two Patients

The diagnosis and management of pulmonary hydatid disease represents an important clinical problem in areas of the world endemic to echinococcal infection. We report two patients, ages 14 and 34, respectively, who were admitted to our clinic for investigation of nonresolving pneumonia. Neither had responded to antibiotics prior to admission. Chest x-rays demonstrated lobar collapse and consolidation in both patients. Fiberoptic bronchoscopy revealed laminated membrane of hydatid cyst occluding the bronchus of apicoposterior and anterior segmental bronchi of the left upper lobe in the first patient and the anterior segment of the right upper lobe in the second patient. The diagnoses were confirmed at the time of surgery.

The effect of CYP1A1, GSTT1 and GSTM1 polymorphisms on the risk of lung cancer A case–control study

Lung cancer, which is mainly affected by environmental factors, is a lethal malignancy. It is also important to investigate the effect of genetic factors on lung cancer aetiology. In this study, we aimed to investigate the distribution of CYP1A1*2C, GSTT1 and GSTM1 polymorphisms in Turkish lung cancer patients to determine whether any promoting effect of polymorphisms could cause development of lung cancer. For this purpose, genomic DNA samples obtained from peripheral blood of 128 patients with lung cancer and 122 healthy subjects were analyzed. Genotyping of polymorphic enzymes were carried out by polymerase chain reaction–restriction fragment length polymorphism methods. Although there were no significant differences between groups in terms of CYP1A1 polymorphism, the carriers of CYP1A1 Ile/Val genotype (odds ratio [OR] = 1.224, 95% confidence interval [CI]: 0.585–2.564) or CYP1A1 Val/Val genotype (OR = 3.058, 95% CI: 0.312–30.303) had an increased risk of lung cancer development. There was no statistical difference between groups in terms of both GSTT1 null genotype (OR = 1.114, 95% CI: 0.590–2.105) and GSTM1 null genotype (OR = 0.776, 95% CI: 0.466–1.290). This is the first case–control study investigating CYP1A1 Ile/Val, GSTT1 and GSTM1 polymorphisms in Turkish lung cancer patients. Although we suggest that other genes in addition to the proposed genes could play a role in lung cancer development, the results of our study will contribute to the possible associations between CYP1A1 Ile/Val, GSTT1 and GSTM1 gene polymorphism on the risk of lung cancer.

Synchronous Bilateral Multiple Typical Pulmonary Carcinoid Tumors

Synchronous bilateral multiple carcinoid tumors of the lung are uncommon. We report an unusual case of synchronous, bilateral, and multiple typical pulmonary carcinoids. A 58-year-old woman with cough and chest pain was admitted to our clinic. A thoracic computed tomographic scan showed multiple bilateral nodular lesions. Bronchoscopic evaluation was normal. We performed sequential bilateral thoracotomies, frozen section examination, wedge resection, and lymphadenectomy. Histopathologic examinations revealed typical carcinoid tumor in both lungs. No pathologic lesions were observed in 18-month postoperative follow-up. We discuss treatment of synchronous bilateral multiple carcinoid tumors.