Leyla Hasdiraz

Complications of bronchoscopy for foreign body removal: experience in 1035 cases

BACKGROUND Tracheobronchial foreign body aspirations, which threaten lives in childhood, also carry potential risks during and after bronchoscopy. The aim of this study is to review complications and precautions that need to be taken against possible risks. METHODS From 1987 to 2005, bronchoscopy was done in 1035 children in our department on suspicion of foreign body aspiration. The average age of these patients, mostly male (55%), was 4.1 years. Medical history, physical examination, radiological methods and bronchoscopy were used in the diagnosis. Bronchoscopy was applied under general anaesthesia, and the respiratory and cardiac systems were closely observed for 4 hours after the process. RESULTS Nine hundred eleven of 1035 patients (88%) had a foreign body in the tracheobronchial system. In 42 of the patients, infection required aggressive medication; in 30, hypoxia and bradycardia occurred as a result of obstruction during bronchoscopy; in 37, laryngeal edema, laryngeal spasm and/or bronchospasm required ventilation support; in 6 patients, tracheobronchial system bleeding occurred; in 2 patients pneumothorax occurred, in 1 patient pneumomediastinum was observed and 6 patients needed thoracotomies because of foreign body aspiration. In this series there were 8 deaths. CONCLUSION Bronchoscopy, performed for tracheobronchial foreign body aspiration, carries a potential life-threatening risk during and after the process. The clinician needs to be aware of these risks, take proper precautions, and perform bronchoscopy by taking the medical condition of the patient and characteristics of the inspired foreign body into consideration.

IS LOBECTOMY NECESSARY IN THE TREATMENT OF PULMONARY HYDATID CYSTS

Background:  Hydatidosis is endemic in Turkey and many other areas of the world. The definitive treatment for pulmonary hydatidosis is surgical. The purpose of this study was the review of surgical therapy of our patients with pulmonary hydatid disease and the necessity of lobectomy.

Evaluation of peripheral blood CD34+ cell count in the acute phase of traumatic brain injury and chest trauma

Abstract Aim: To determine the impact of traumatic brain injury (TBI) and chest trauma (CT) on the number of peripheral blood (PB) stem cells in affected patients in comparison to normal controls. Additionally, the aim was to determine the relationship between CD34+ cell counts and TBI-induced hypothalamus-pituitary-adrenal axis dysfunction in the acute phase of trauma. Patients and method: Thirty patients with TBI, 12 patients with CT and 53 healthy subjects were included in the study. Results: CD34+ cell counts within the first 24–48 hours of TBI were found to be lower than those obtained on the 7th day of TBI and those in the healthy controls. CD34+ cell counts obtained on the 2nd day of CT were lower than those in the healthy group, but did not differ from those measured on the 7th day of CT. There was no correlation between CD34+ cell counts and serum total cortisol (STC) levels on the 2nd and 7th days in the TBI or CT groups. Conclusion: An increase in CD34+ cell counts as observed on the 7th day in both TBI and CT groups suggested that CD34 changes were not specific to TBI. Moreover, this study showed for the first time that CD34 response was not affected by changes in cortisol levels induced by TBI and severity of TBI.

CAN SERUM INFLAMMATORY PARAMETERS ESTIMATE OUTCOME OF PLEURODESIS IN MESOTHELIOMA

Background:  As pleurodesis causes systemic inflammation and is associated with considerable cost and morbidity during long‐term follow up, the identification of patients who will experience an unsuccessful pleurodesis would be desirable. This study was aimed to investigate whether systemic inflammatory reaction induced by insuflation of talc into the pleura can predict the outcome of pleurodesis.

A Rare Cause of Spontaneous Pneumomediastinum: Ecstasy Ingestion

Ecstasy ingestion has life-threatening effects such as hyperpyrexia, rhabdomyolysis, disseminated intravascular coagulation, coma, and death. In the present report, we aimed to highlight ecstasy as a rare cause of spontaneous pneumomediastinum and its potential life-threatening effects. A 16-year-old female with dyspnea and chest pain presented to the emergency department. Chest computed tomography demonstrated pneumomediastinum at the level of the thoracic inlet and upper and posterior mediastinum. The patient was admitted to the thoracic surgery department with a preliminary diagnosis of spontaneous pneumomediastinum. She refused to answer any questions during the first visit, an a psychiatric consultation was requested. The most important finding of psychiatric consultation was ecstasy abuse, which could not be identified in the emergency department evaluation. Four days later, the symptoms resolved completely and control chest X-rays showed no complications; therefore, the patient was discharged. While investigating the etiology of spontaneous mediastinum, particularly in a young, healthy patient, ecstasy abuse should always be considered. Because the fatal complications that may develop due to ecstasy ingestion may be overlooked.

Tracheal Adenoid Cystic Carcinoma Mimicking Bronchial Asthma

Adenoid cystic carcinomas are rare tracheal tumors that can mimic bronchial asthma. We describe the characteristics of 2 patients with adenoid cystic carcinoma who presented with symptoms suggestive of bronchial asthma of 2 years duration. Biopsy specimens revealed that the lesions were adenoid cystic carcinoma of the trachea. Both patients underwent collar incision and median sternotomy, the tumors were resected, and the tracheas were reconstructed primarily. Postoperative radiotherapy was given. Their postoperative clinical courses were uneventful and no local recurrences were seen at the 1-year follow-up.