Murat Öncel

Tracheobronchial aspiration of foreign bodies and rigid bronchoscopy in children

Background:  A significant proportion of cases of tracheobronchial foreign body aspiration due to life‐threatening condition is observed during childhood. The aim of the present study was to describe our experience with the diagnosis and treatment of foreign body aspirations during childhood and review published literature.

Clinical experience of repair of pectus excavatum and carinatum deformities

Background We present the results of surgical correction of pectus excavatum (PE) and pectus carinatum (PC) deformities in adults, and also report a new method of sternal support used in surgery for PE deformities. Methods We present the results of 77 patients between the ages of 10 and 29 years (mean 17) with PE (n = 46) or PC (n = 31) deformities undergoing corrective surgery from 2004 to 2011, using the Ravitch repair method. Symptoms of the patients included chest pain (15%) and tachycardia (8%). Three patients underwent repair of recurrent surgical conditions. Results All of the patients with dyspnoea with exercise experienced marked improvement at five months post operation. Complications included pneumothorax in 5.1% (n = 4), haemothorax in 2.6% (n = 2), chest discomfort in 57% (n = 44), pleural effusion in 2.6% (n = 2), and sternal hypertrophic scar in 27% (n = 21) of patients. Mean hospitalisation was eight days. Pain was mild and intravenous analgesics were used for a mean of four days. There were no deaths. Results after surgical correction were very good or excellent in 62 patients (80%) at a mean follow up of three years. Three patients had recurrent PE and were repaired with the Nuss procedure. In three patients who underwent the Ravitch procedure, a stainless steel bar was used for sternal support instead of Kirschner wire. Conclusions Pectus deformities may be repaired with no mortality, low morbidity, very good cosmetic results and improvement in cardiological and respiratory symptoms.

Assistant Training Using Videothoracoscopy

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Training for Thoracoscopic Lobectomy

1. Riquet M, Arame A, Pricopi C. Is survival affected by nodal upstaging after lung cancer resection or surgical approach? (letter). Ann Thorac Surg 2016;102:1031. 2. Martin JT, Durbin EB, Chen L, et al. Nodal upstaging during lung cancer resection is associated with surgical approach. Ann Thorac Surg 2016;101:238–45. 3. Licht PB, Jørgensen OD, Ladegaard L, Jakobsen E. A national study of nodal upstaging after thoracoscopic versus open lobectomy for clinical stage I lung cancer. Ann Thorac Surg 2013;96:943–9; discussion 949–50. 4. Thoracoscopic lung cancer staging with the use of intraoperative ultrasound. Available at: https://clinicaltrials.gov/ ct2/show/NCT02218242. Accessed April 11, 2016. 5. CoC Quality of Care Measures. American College of Surgeons. Available at: https://www.facs.org/quality-programs/ cancer/ncdb/qualitymeasures. Accessed April 11, 2016.

Congenital cyst in a rare localisation

A 19-year-old female patient was admitted to our hospital with right-sided chest pain and shortness of breath. Physical examination was unremarkable the results of all laboratory studies were within normal limits. Chest computed tomography (CT) revealed an 8×4 cm homogeneous oval mass in the range of water attenuation (12 HU) in the upper dome area of the liver adjacent to the diaphragm. Magnetic resonance imaging (MRI) was performed in order to evaluate the extent of the lesion and details of the internal structure. The lesion showed low signal intensity on T1-weighted MRI and homogeneous high signal intensity on T2-weighted images, without septation or any mural nodule …

Penetrating cardiac injuries: assessment of 21 patients

BACKGROUND Penetrating cardiac injuries carry high mortality rates due to serious clinical outcomes. This study was planned to investigate patients treated surgically in our hospital for penetrating cardiac injury. METHODS In this article, we reviewed retrospectively 21 patients (18 male, 3 female) suffering from penetrating heart injuries who admitted to our hospital between February 2006 and January 2011. Patients were evaluated with respect to clinical findings, treatment methods and clinical outcomes. RESULTS Among the patients, 19 cases were due to stab injury and 2 cases to gunshot injury. Emergent surgical interventions were performed in all patients. Cardiac injuries involved the right ventricle in 13 patients, left ventricle in 5 patients and right atrium in 3 patients. There was no left atrial injury. Cardiac injuries were repaired by primary suturing method. Mortality was determined in 6 patients (28.6%). CONCLUSION Penetrating cardiac injuries are seen generally in young people. Early transport, proper resuscitation and emergent surgery treatment improved survival in patients who sustained penetrating cardiac injuries.

Lung herniation or subcutaneous emphysema after cardiopulmonary resuscitation

Pneumothorax and subcutaneous emphysema are thoracic complications of cardiopulmonary resuscitation, especially in older patients or those whose cartilage development is incomplete. Fractures of the anterior ribs are commonly seen. A 73-year-old woman with hepatic cirrhosis suddenly developed cardiac arrest while eating at home. The emergency medical team performed intubation and started cardiac massage. At the 5th minute of heart massage, the emergency team noticed subcutaneous emphysema in the left hemithorax; they continued cardiopulmonary resuscitation. When the patient was transferred to hospital, her heart started to beat. Positive inotropic agents were administered and arterial blood pressure could be measured. A left pneumothorax was seen on computed tomography (Figure 1), and a chest tube was inserted into the left hemithorax. The patient underwent urgent dialysis because of hyperpotassemia. The lung expanded after tube thoracostomy and the subcutaneous emphysema decreased (Figure 2). This case is very interesting because of the computed tomography image which Asian Cardiovascular & Thoracic Annals 2018, Vol. 26(3) 245–246 The Author(s) 2018 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0218492318760877 journals.sagepub.com/home/aan

Video-Assisted Thoracoscopic Lobectomy for Lung Cancer

要 旨:原 発 性 肺 癌 に 対 す る胸 腔 鏡 補 助 下 肺 葉 切 除 術(以 下VATS葉 切)の 意 義 につ い て 検 討 し た.当 施 設 で は1995 年4月 か ら2000年12月 ま で に98例 の 肺 癌 症 例 にVATS葉 切 を 施 行 し た.対 象 例 の 臨 床 病 期 はIA 80例,IB 13例,IIA 2例,IIIA 2例,IIIB 1例 で,病 理 病 期 はIA 65例,IB 18例,IIA 4例,IIB 3例,IIIA 7例,IIIB 1 例 で あ っ た.VATS葉 切 に 要 し た 手 術 時 間 は183.7±52.5分(95~330分),術 中 出 血 量 は203.9±230.0ml (15~1345ml)で あ っ た.cIA期VATS葉 切 施 行 例 を 同 時 期 に 開胸 に よ っ て 葉 切 を施 行 したcIA 57例 と比 較 す る と,3年 生 存 率 は 開 胸 症 例 が73.0%,VATS葉 切 が91.7%で 有 意 にVATS葉 切 が 予 後 良 好 で あ っ た(p =0.02).無 再 発3年 生 存 率 お よび 腫 瘍 径2cm以 上 の 症 例 の 無 再 発3年 生 存 率 は 差 が な か っ た.術 後 在 院 日 数

Pain Control With Bupivacaine After Lung Resections

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Use of Magill Forceps to Remove Foreign Bodies in Children

Introduction  Esophageal foreign body (FB) in all age groups can cause serious morbidity or mortality. The study aims to report our experience retrieving FBs from the upper esophagus in children using Magill forceps. Materials and Methods  In this study, 88 patients (45 males [51.1%] and 43 females [48.9%]) were presented with suspected FB ingestion. FB ingestion was determined via endoscopic analysis, or lateral and posterior-anterior radiographies, including oropharynx, neck, chest, and abdomen. Cases were classified into seven groups, according to history, diagnostic method, and postintervention findings, as follows: (1) coins, (2) toys, (3) metals, (4) bones, (5) battery, (6) glass, and (7) food. A laryngoscope was used to elevate the larynx and expose the esophageal entrance. Magill forceps were advanced into the esophagus and opened to observe and extract the FB. Results  All 88 patients who underwent endoscopic examination due to suspected FB ingestion were confirmed to have ingested a FB. Median age was 12 years; 15 patients were aged < 5 years; 63 (71.5%) were diagnosed based on routine radiographic findings, and others were diagnosed based on physical findings and history. The most common type of FB was coins ( n  = 51 [57.9%]). Mean surgical duration was 20 minutes. Conclusion  FBs located at cervical esophageal level are usually the most difficult to remove. Magill forceps should be used before other methods.