Mehmet Dakak

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

OBJECTIVEnBronchiectasis 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.nnnMETHODSnWe 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.nnnRESULTSnThere 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.nnnCONCLUSIONSnSurgical 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.

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.

Taurine attenuates lung ischemia–reperfusion injury after lung transplantation in rats

PurposeTaurine, the major intracellular free amino acid found in high concentrations in mammalian cells, is known to be an endogenous antioxidant and a membrane-stabilizing agent. It was hypothesized that taurine may be effective in reducing ischemia–reperfusion injury after lung transplantation and an experimental study was conducted in a rat model.MethodsThe number of Sprague–Dawley rats used in the study was 35. Animals were randomized into five groups of 7 rats each, including control, donor I, donor II, ischemia–reperfusion injury, and treatment groups. All animals were exposed to the same experimental conditions in the preoperative period. Rats were fixed in a supine position after the induction. After the rats were shaved, a left pneumonectomy was performed following sternotomy in control, donor I, and donor II groups. The harvested grafts in donor I and donor II groups were transplanted to the rats of the ischemia–reperfusion group and treatment group, respectively. However, taurine was administered intraperitoneally for 3xa0days before the harvesting procedure in donor II. All harvested lungs were kept in a Euro-Collins solution at +4xa0°C for 24xa0h in a half-inflated manner. After harvesting and transplantation, lungs were sampled for histopathological and biochemical analysis.ResultsMalondialdehyde and superoxide dismutase, glutathione peroxidase, and catalase levels were lower in the treatment group than the other groups (pxa0<xa00.05). Histopathological findings were better in treatment group than the ischemia–reperfusion group (pxa0<xa00.05).ConclusionIt was demonstrated that donor treatment with taurine resulted in preservation of transplanted lung tissue in respect to histopathological and biochemical findings.

Repair of pectus deformities: experience and outcome in 317 cases.

BACKGROUND The most common congenital chest wall deformities are pectus excavatum and pectus carinatum. Various techniques have been described for correction of pectus deformities. We describe our experience with surgical repair of pectus deformity (PD) in adults, including our new technique, which uses a resorbable plaque for fixation of the sternum. METHODS We reviewed the records of 317 patients who underwent surgical correction of PD between October 1997 and December 2005. RESULTS All of the patients were male and the median age was 21.3 years (range, 16–32 years). Of 317 patients, the type of deformity was a pectus excavatum in 230 patients and a pectus carinatum in 87 of the patients. Four different operative techniques were used. There were no intraoperative deaths or major perioperative morbidity. The complications rate was 17%. Overall mean hospital stay was 14.25 days. In 208 patients who underwent a mid-term outpatient follow up (mean, 8 months), there was no recurrence. Patient satisfaction was excellent in 234 patients, good in 79 patients and fair in 4 patients. CONCLUSION The majority of patients with pectus deformity had been operated on during childhood; therefore there is limited published information about the correction of pectus excavatum and pectus carinatum deformities in adults. The most important point in pectus correction is to achieve proper and long-term stability of the sternum following osteotomy. Various techniques can be used for this purpose.

Pulmonary Sequestration and Surgical Treatment

Pulmonary sequestration is nonfunctioning, abnormal pulmonary tissue existing inside or outside the visceral pleura. It is not connected to the tracheobronchial tree. In this study, the results of 8 patients, who were diagnosed with pulmonary sequestration and treated during hospitalization in Gülhane Military Medical Academy between 1996 and 2003, were reported. Sex, age, symptoms, diagnostic approach, operative findings, procedures and postoperative outcomes were reviewed. No postoperative complications were seen. In the long-term follow-up all patients were seen to be asymptomatic. We believe surgical resection is mandatory in order to avoid infection and destruction of the normal pulmonary parenchyma even in asymptomatic cases. Furthermore, when infection occurs, major resection such as lobectomy may be necessary rather than segmentectomy or wedge resection, which involves removal of minimal pulmonary parenchyma.

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

BACKGROUNDnThe 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.nnnMETHODSnTwelve 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.nnnRESULTSnIt 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.nnnCONCLUSIONnMetal equipment that soldiers carry causes bullet fragmentation. Fragmented bullets may cause excessive tissue disruption of intrathoracic vital organs.

Surgical Management of Chest Wall Tuberculosis

Objective: Tuberculosis remains one of the most fatal diseases in the world. Extrapulmonary tuberculosis increases in parallel fashion with the rise of incidence of pulmonary tuberculosis. Tuberculosis of the chest wall is rare. Methods: Our study retrospectively evaluated 10 patients with tuberculosis of the chest wall who were treated with surgery in addition to antituberculous chemotherapy in the last 8 years. Seven of the lesions were located on the anterior chest wall, and three of the lesions were on the lateral chest wall. Results: Surgical therapy consisted of evacuation of the cold abscess material from the cavities and wide débridement of the soft tissue planes in all patients. Partial rib resections were performed in six patients owing to costal or chondral involvement. Conclusions: Chest wall tuberculosis must be considered in the differential diagnosis of chest wall lesions, especially in endemic areas.

Unusually located thoracic hydatid cysts.

Human hydatid disease caused by the larval form of Echinococcus granulosus has a worldwide distribution and is endemic in many countries. The disease, known since the time of Hippocrates, is primarily an illness of residents in rural areas who frequently come into contact with sheep, cows and carnivores.1-4 The estimated surgical case rate of cystic echinococcus is 0.87-6.6 per 100 000 in Turkey.2 The prevalence of Echinococcus granulosus infestation in dogs in Turkey is between 0.32% and 40% and the reported prevalence of cystic echinococcus in domestic animals has ranged from 11.3 to 50.7% and varies widely by geography.5,6 Echinococcal cysts may develop in almost any part of the body. The liver and the lungs are the most commonly affected areas in adults. Within the thorax most of the cysts settle in the lung parenchyma. In this situation surgical treatment is usually easy and quick. Sometimes the cyst grows as an extrapulmonary lesion or passes over the lung parenchyma to other structures. Location of the disease outside the lung parenchyma in the thorax is rare and surgical procedures can be considered that may differ from those used for pulmonary cysts.7 The aim of this study was to review surgical techniques and possible perioperative complications. We present our experience, documenting the clinical features and the treatment employed for unusually located thoracic hydatid cysts.

Left-sided pleural effusion in a 47-year-old female

A 47-year-old female patient was admitted to the Dept of Thoracic Surgery, Gulhane Military Medical Academy (Ankara, Turkey) with right thoraco-abdominal pain, which had been aggravated by cough and deep breathing. Despite being treated with several courses of antibiotics for these symptoms during the previous 2 years, her non-productive cough had worsened. She had been operated on 4 years previously for a hepatic cyst. Laboratory tests were normal. On physical examination, submatite was established on the right lateral thoracic wall along the anterior and posterior axillary lines.