Kunter Balkanli

Surgical management of bronchiectasis: analysis and short-term results in 238 patients.

OBJECTIVE Bronchiectasis is defined permanent dilatations of bronchi with destruction of the bronchial wall. It is still a major cause of morbidity and mortality in developing countries. The aim of this retrospective study is to present our surgical experiences, the early and long-term results of 238 patients with bronchiectasis during a 10-year period. METHODS We reviewed the medical records of 238 patients who underwent surgical resection for bronchiectasis between January 1992 and December 2001, at Gülhane Military Medical Academy (GMMA) Thoracic Surgery Department. Variables of age, sex, symptoms, etiology, and type of operation, mortality, morbidity and the result of surgical therapy were analyzed. RESULTS There were 205 (86.13%) male and 33 (13.87%) female patients with an average age of 23.7 and a range of 15-48 years. The presenting symptoms were productive cough in 133 (55.88%), fetid sputum in 116 (48.73%), recurrent infections in 84 (35.29%), and hemoptysis in 39 (12.18%) patients. The disease was bilateral in 31 patients (13.02%) and mainly confined to the lower lobes in 162 (68.06%). The surgical treatment was as follows: pneumonectomy in 13 patients (5.46%), lobectomy in 189 (79.40%), lobectomy+segmentectomy in 31 (13.02%), and wedge resection or segmentectomy in five (2.1%). Staged bilateral thoracotomy was used in 14 patients. There was no operative mortality. Complications occurred in 21 patients and the morbidity rate was 8.82%. Complete resection was achieved in 154 (64.7%) patients. Follow-up data were obtained for 229 (96.21%) of the patients. Nine patients were lost to follow-up. The mean follow-up of these patients was 9 months (range, 3 months to 4 years). The symptoms disappeared in 189 patients (79.41%) and 29 patients (12.18%) had improved, whereas 11 patients (4.62%) had no improvement. Significantly better results were obtained in patients who had undergone a complete resection. CONCLUSIONS Surgical resection for bronchiectasis can be performed with acceptable morbidity and mortality at any age. The involved bronchiectatic sites should be resected completely for the optimum control of symptoms.

Cytologic diagnosis of complicated pulmonary unilocular cystic hydatidosis. A study of 131 cases.

OBJECTIVE To determine the value of cytochemical stains and microscopic techniques for the detection of true hydatid elements (primary cytologic criteria) and to evaluate the efficacy of granulomatous elements (secondary cytologic criteria) for the diagnosis of complicated pulmonary unilocular cystic hydatidosis (CPUCH). STUDY DESIGN Sputum, bronchial washing and bronchial brushing specimens obtained from 131 patients with a presumptive diagnosis of CPUCH were reviewed. RESULTS CPUCH was histopathologically proven in 111 of 131 patients. Scolices were found in 11 patients in Papanicolaou-EA65 (PAP-EA65)-stained slides. Special stains and dark field microscopy (DFM) did not make any additional contribution to specifying the nature of the scolexlike objects. Hooklets were found in 26 patients in PAP-EA65-stained slides. Massons trichrome stain and DFM revealed hooklets in 37 and 50 cases, respectively. Laminated membrane fragments were found in 14 patients in PAP-EA65-stained slides. Gomoris methenamine silver stain and DFM demonstrated laminated membrane fragments in 25 and 33 cases, respectively. Secondary cytologic criteria, such as multinucleated giant cells, degenerated squamous cells, dyskaryotic squamous cells, excessive amounts of eosinophils, plasma cells, lymphocytes, histiocytes, necrotic debris, fibrinoid material and erythrocytes, were considered to be suggestive of hydatid disease when there are more than three such factors in patients with a presumptive diagnosis of CPUCH. CONCLUSION Though DFM examination is superior to cytochemical stains used in this study, both cytochemical stains and DFM are useful in increasing the sensitivity of cytologic detection of true hydatid elements, especially hooklets and laminated membrane fragments. They should be used as auxiliary techniques. Secondary cytologic criteria are suggestive of the diagnosis of CPUCH, and special care should be taken when there are more than three such factors in cytologic specimens.

The use of absorbable material in correction of pectus deformities

Various techniques have been described for correction of the congenital anterior chest wall deformities. We described a new technique in which 33 patients were used in correction of those deformities. In this new technique we used the resorbable copolymer plaque and polymer screw for the fixation of the sternum. We have obtained excellent results in one-year follow up period. This technique was developed to avoid a second operation, which usually requires for removal of the metal support. Resorption of copolymer plaques and polymer screws are completed at the end of the first year.

Detection of thoracotomy-induced alterations in cell- and humoral-mediated immune response.

OBJECTIVE It is well known that thoracotomy leads to several complications. In this study, effects of thoracotomy on cellular and humoral immunities have been investigated. Leukocyte counts and lymphocyte counts of 100 patients operated by thoracotomy have been determined preoperatively and on the postoperative 3rd hour, and 1st, 2nd, 3rd, 5th days. Also lymphocyte surface markers (CD3, CD4, CD8, CD4/CD8, CD19, CD16/56) and immunoglobulin levels (IgG, IgA, IgM, IgE) in 40 out of 100 patients in the preoperative period and postoperatively twice on 7th day and then in the 3rd week have been detected. MATERIALS AND METHODS For the methodology hemocounter, flow cytometer, immunoprecipitation, and enzyme-linked immunosorbent assay were used. RESULTS A marked increase in leukocyte count while a marked decrease in lymphocyte count has been observed after thoracotomy (P<0.001). There was not any significant alteration in levels of lymphocyte surface markers and immunoglobulins in the postoperative period (P>0.2). CONCLUSION According to these results, leucocytosis occurred but lymphocyte count decreased in the early postoperative period. Immunoglobulin levels and subpopulation of lymphocytes were not affected from the operative stress.

Increased damage from rifle wounds of the chest caused by bullets striking commonly carried military equipment

BACKGROUND The purpose of this study was to investigate the fragmentation effect of the bullet that passes through the radio or ammunition magazine, which are essential pieces of equipment for a soldier, in thoracic gunshot injuries. METHODS Twelve adult pigs were used. The pigs were separated into three groups (each group contained four pigs). The first group was shot without any obstacle between muzzle and subject. The second group was shot through a cartridge magazine placed in front of the subjects thoracic cage. The third group was shot with a radio in front of the subjects thoracic cage. RESULTS It was observed that there was a large bullet entrance and fragmentation in the pigs that were shot with a radio or magazine placed over them, and there was no fragmentation in those that were shot without any obstacle. CONCLUSION Metal equipment that soldiers carry causes bullet fragmentation. Fragmented bullets may cause excessive tissue disruption of intrathoracic vital organs.

Chest Wall Tumors

We reviewed 94 consecutive patients who underwent resection of soft tissue or bone tumors of the chest wall between September 1989 and December 1996. There were 3 females and 91 males ranging in age from 12 to 69 years (median, 22.85 years); 16 had a primary malignant tumor, 11 had a metastatic tumor, and 67 had a benign tumor. Sixty-four patients underwent resection of the chest wall skeleton. Overlying soft tissue was resected en bloc in 15 patients. Chest wall defects were not reconstructed with prosthetic material or autogenous grafts because the defects were not large. Soft tissue reconstructive procedures were predominantly muscle transposition. There were no early postoperative complications and the median hospitalization was 14.2 days (range, 6 to 47 days). Follow-up was complete in all patients and ranged from 2 to 36 months (median, 24.5 months). All patients with benign tumors are currently alive. Recurrent chest wall tumors developed in 5 patients and they underwent a second operation. Nine patients died from distant metastases. There were no early or late deaths related to either resection or reconstruction of the chest wall. We conclude that wide or adequate chest wall resection, depending on histopathologic type of tumor, is the key to successful management of chest wall tumors. In general, this procedure can be performed in one operation with a short hospital stay and low operative mortality.