İsa Döngel

High Risk of Malignant Mesothelioma and Pleural Plaques in Subjects Born Close to Ophiolites

BACKGROUND Ophiolites, a special sequence of geologic rock units, are known sources of naturally occurring asbestos. The aim of this study was to test whether the occurrence of malignant mesothelioma (MM) or pleural plaques (PPs) in the province of Sivas, Turkey, is determined by the proximity of the patients birthplace to ophiolites and, if so, to establish the magnitude of the risk. METHODS The birthplaces of patients with MM or PPs (cases) and patients with prostate or breast cancer (control subjects), diagnosed between 2000 and 2010 and identified through a mandatory cancer registry or from hospital records (PPs), were located on a geologic map, and the nearest distance to ophiolites was measured. The relation of MM or PPs with distance to ophiolites was analyzed by logistic regression. Samples of soil and house plaster were determined by x-ray diffraction. RESULTS Patients with MM (n = 100) or PPs (n = 133) were born significantly nearer to ophiolites (median distance, 4.5 km for men, 0 km for women) than were patients with prostate cancer (n = 161) or breast cancer (n = 139) (median distance, 20 km for both). ORs were 1.6 (men) ( P < .001) and 2.0 (women) ( P < .001) for every 5-km decrease in the distance of birthplace to ophiolites for MM, compared with prostate and breast cancer, respectively. CONCLUSION In this area without substantial industrial asbestos use, there is an association between the occurrence of mesothelioma (and of PPs) and the proximity of the subjects birthplace to ophiolites.

Management of thoracic trauma in emergency service: Analysis of 1139 cases.

Objective: Thoracic trauma is a common cause of significant morbidity and mortality. This study presents a series of thoracic trauma with the aim to assess epidemiologic features, distribution of pathologies, additional systemic injuries, diagnosis, management and outcome. Methodology: Between January 2007 and December 2011, all patients with thorax trauma admitted to the emergency service of our hospital were retrospectively reviewed with respect to age, gender, etiological factors, distribution of pathologies, additional systemic injuries, diagnosis, treatment modalities, referral and outcome. Results: A total of 1139 patients with thorax trauma were included in the study. Of these, 698 (61.3%) were male and 441 (38.7%) were female, and the average age was 54.17±17.39 years. 1090 (95.7%) of the patients had blunt trauma, whereas 49 (4.3%) had penetrating trauma. Etiological factors were falls in 792 (69.5%), motor vehicle accidents in 259 (22.8%), animal related accidents in 39 (3.4%) and penetrating injuries in 49 (4.2%) patients. It was found that 229 (20%) patients had single, 101 (8.9%) had double, 5 (3%) had three or more, 10 (0.9%) had bilateral rib fractures and 19 (1.7%) had sternal fracture. Pneumothorax was diagnosed in 58 (5.1%) patients, whereas hemothorax, hemopneuomothorax and other system injuries were diagnosed in 36 (3.2%), 38(3.3%) and 292 (25.6%) respectively. In our series, thirteen patients (mortality rate 1.1%) died as result of hemorrhagic shock (n=8), respiratory distress (n=3) and severe multiple trauma (n=2). Conclusion: Although majority of the patients with thorax trauma receive treatment as outpatients; thoracic traumas may be a life threatening condition, and should be identified and treated immediately. Mortality varies based on etiological factors, additional systemic pathologies, capabilities of the hospital especially diagnostic and treatment facilities in emergency services. We believe that a multidisciplinary approach to the patients with severe thorax trauma, and the opportunities of emergency bedside thoracotomy in emergency services will significantly reduce the morbidity and mortality.

Subcutaneous emphysema and pneumomediastinum complicating a dental procedure.

Cervicofacial emphysema and pneumomediastinum are rarely observed complications of dental interventions. The complications are associated with the use of a high-speed air-turbine dental drill. It is a potentially life-threatening condition, but the majority of cases are self-limiting and benign. We describe a patient with remarkable subcutaneous emphysema, pneumomediastinum, and partial pneumothorax after right second mandibular molar extraction. Dentists and physicians more often attribute the rapid onset of dyspnea in patients after a dental procedure to an allergic reaction to the anesthesia used during the procedure. Dentists and physicians should be aware that soft tissue emphysema can cause acute swelling of the cervicofacial region after dental procedures, which may mimic an allergic reaction.

Hypertrophic epicardial adipose tissue mimicking a thoracic mass.

A 25-year-old man presented with a complaint of left chest pain. Radiological images of the thorax showed a mass located in the left lower hemithorax (Figure 1a, 1b, 1c). A left thoracotomy revealed hypertrophic epicardial adipose tissue concomitant with a 2 3-cm brown mass suggesting hibernoma, which is an uncommon benign soft tissue tumor derived from remnants of fetal brown adipose tissue (Figure 1d). However, histopathologic examination showed only white adipose tissue (Figure 1e).

Scimitar syndrome: A rare cause of dyspnea and chest pain.

Corresponding author: Isa Döngel, MD, Department of Thoracic Surgery, Süleyman Demirel University Medical Faculty, Isparta, Turkey. Email: drdongel@hotmail.com Figure 1. Axial computed tomography at the level of the right lower lobe, showing (a) drainage of the right main pulmonary vein into the inferior vena cava (short arrow), and (b) the small (hypoplastic) lower lobe of the right lung. (c, d) Coronal maximum intensity projection images clearly show a dilated anomalous vein (right main pulmonary vein) that drains into the inferior vena cava at the level of the lung bases (arrow).

Cardiac rupture due to blunt chest trauma: postmortem findings in two cases.

Blunt traumatic cardiac rupture is associated with high mortality and usually identified at autopsy. Two women aged 47 and 86 years-old died immediately after motor vehicle accidents. In the first case, autopsy revealed fractures of the bilateral clavicula, multiple bilateral ribs, and the body of the sternum. Massive hemothorax was present in the pleural cavity. An oblique transmural laceration measuring 6 cm in length was observed in the left ventricle 1.5 cm above the cardiac apex (Figure 1). In the other case, autopsy showed massive hemothorax in both pleural cavities and fractures in multiple bilateral ribs, the body of the sternum, and the manubrium sterni. A transmural laceration in the back of the right atrium, measuring 1.8 0.8 cm, was also observed (Figure 2). Cardiovascular injuries represent the second most common cause of traumatic death, after central nervous system injuries. Few patients survive to reach hospital. One should keep in mind blunt cardiac rupture in a patient with severe chest trauma.