Ömer Soysal

Tracheobronchial foreign body aspiration: a continuing challenge.

Objective The aim was to present the features and outcomes for 140 cases of foreign body aspiration and to discuss specific problems and new management recommendations. Study Design and Setting Records were retrospectively reviewed and the following data were recorded for each patient: age, sex, symptoms, duration of symptoms, findings on physical examination and chest radiography, location and type of foreign body, complications related to aspiration itself or to extraction, and outcome. Results Seventy-eight patients presented within 24 hours of aspiration. The most common symptoms and findings were cough, dyspnea-stridor, decreased breath sounds, radiopaque foreign body, air trapping, and atelectasis. All 140 patients underwent rigid bronchoscopy, and 110 had the foreign material extracted via the scope. No foreign body was detected bronchoscopically in 25 cases. In the other 5 cases, the material was visualized but could not be removed via the scope, and 3 of these patients required thoracotomy for removal. Eleven patients developed morbidity after bronchoscopy. Conclusion History suggestive of foreign body aspiration is a definite indication for bronchoscopy, and bronchoscopic extraction should only be performed by experts. Each case tends to present different challenges, and endotracheal intubation and tracheotomy may be required.

The role of surgery in chest wall tuberculosis

Chest wall tuberculosis is a rare entity and its clinical presentation may resemble a pyogenic abscess or chest wall tumor. The role of surgery in the diagnosis and treatment of chest wall tuberculosis is still controversial. During a 6-year period (1997-2002), six cases with cold abscesses of chest wall were managed in our clinic. Clinical presentation, diagnostic workup, treatment strategies, and results of medical and surgical treatment were retrospectively reviewed. There were four male and two female patients. All but one had a fluctuating and abscess-like chest wall mass. Pleura and mediastinal or chest wall lymph nodes were also involved in three patients. Before the debridement and abscess drainage, the diagnosis was not confirmed in any of our patients except one. All received a four-drug antituberculous regimen for 6-12 months postoperatively and improved clinically and radiologically. Surgical intervention and histological examination are usually necessary for the treatment and to confirm the diagnosis in chest wall tuberculosis. Antituberculous medical treatment and adjunctive surgery are quite effective in this process.

Pleuropulmonary blastoma: report of a case presenting with spontaneous pneumothorax

Akin Kuzucu*, Omer Soysal, Cengiz Yakinci, N. Engin Aydin Department of Thoracic and Cardiovascular Surgery, Inonu University Faculty of Medicine, Turgut Ozal Medical Center, Malatya, Turkey Department of Pediatrics, Inonu University Faculty of Medicine, Turgut Ozal Medical Center, Malatya, Turkey Department of Pathology, Inonu University Faculty of Medicine, Turgut Ozal Medical Center, Malatya, Turkey

Optimal Timing for Surgical Treatment to Prevent Recurrence of Spontaneous Pneumothorax

PurposePersistent air leakage and recurrence are the most common indications for the surgical treatment of spontaneous pneumothorax; however, the optimal timing for surgery is still unclear.MethodsThe subjects of this study were 90 patients treated for either primary spontaneous pneumothorax (PSP; n = 58) or secondary spontaneous pneumothorax (SSP; n = 32). We compared the incidence of prolonged air leak, the rate of recurrence of pneumothorax, the time from the first episode of pneumothorax to recurrence, and the postoperative complications in the two groups. We also analyzed the recurrence rate after treatment with observation and tube drainage versus surgery.ResultsSeventy-three patients were treated with tube thoracostomy or oxygen therapy for the first episode of pneumothorax. Surgery was performed in 32 patients; for the first episode of pneumothorax in 17 and for the second or third episode in 15. Postoperative complications developed in six (18.7%) patients and 24 of 73 patients who did not undergo thoracotomy suffered recurrence. The incidence of a second episode was 32.9% and the incidence of a third episode in the 18 patients who suffered recurrence after conservative treatment was 61.1%. None of the patients who underwent surgery suffered recurrence.ConclusionsTube thoracostomy is still the treatment of choice for first-time spontaneous pneumothorax. However, because the incidence of a third episode of pneumothorax after conservative treatment is high, surgical treatment should always be considered for patients with recurrence. In short, surgical intervention is safe and effective and minimizes the chance of recurrence of both PSP and SSP.

Teratoma Presenting As a Cystic Lesion on the Chest Wall: Case Report

A 28-year-old woman presented with a rare case of chest-wall teratoma. Computed tomography of a cystic lesion located in the anterior chest wall revealed a hyperdense object with the appearance of a tooth. The cystic mass was totally excised via a chest-wall incision without thoracotomy. Pathologic examination showed a benign teratoma containing an immature tooth.A 28-year-old woman presented with a rare case of chest-wall teratoma. Computed tomography of a cystic lesion located in the anterior chest wall revealed a hyperdense object with the appearance of a tooth. The cystic mass was totally excised via a chest-wall incision without thoracotomy. Pathologic examination showed a benign teratoma containing an immature tooth.

Postintubation Tracheal Rupture

Tracheal rupture following endotracheal intubation is an extremely rare emergency that needs expedient diagnosis and treatment. The clinical and radiological features of postintubation tracheal rupture in a 45-year-old woman who underwent vertebral stabilization are described. Primary suture closure was performed successfully via a cervical approach.

Pathologic hepatic Tc-99m-MDP uptake in polyostotic fibrous dysplasia

Fibrous dysplasia of bone is a congenital, sporadic developmental disorder characterized by immature fibrous connective tissue and bone deformities. Hepatic Tc-99m-MDP uptake is a rare, serendipitous finding during bone scanning studies. The present patient was a 25-year-old male who had severe polyostotic fibrous dysplasia. On Tc-99m-MDP (methylene diphosphonate) bone scintigraphy, increased activity accumulations were seen on multiple ribs, vertebrae and base of the cranium. In addition, diffuse increased pathologic uptake of Tc-99m-MDP in the liver was shown. Intravenous pamidronate was administered monthly for two months. In the third week of the last administration Tc-99m-MDP bone scintigraphy was performed again, but despite sustained bone involvement, pathologic hepatic uptake was not seen on the scan. We thought that pathologic hepatic Tc-99m-MDP accumulation, may be related to the formation and aggregation of calcium oxalate and phosphate crystals which improved with pamidromat treatment.