Orhan Yücel

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.

Is there any cardioprotective role of Taurine during cold ischemic period following global myocardial ischemia

BackgroundThe aim of the present study was to investigate the cardioprotective effect of Taurine on the donor hearts during cold ischemic period.Methods32 rats were divided into four groups (sham, taurine, ischemia, treatment group, 8 rats in each). All rats were fed with rat food for three weeks. Taurine and treatment groups were given a 200 mg/kg/day dose of Taurine by oral gavage besides rat feed. Cardiectomy was performed in all rats after three weeks. In ischemia and treatment groups, harvested hearts were kept in 0.9% sodium chloride at +4 degrees C for 5 hours. Tissue samples were taken from left ventricle in all groups. These samples were evaluated by histopathologic and biochemical examination.ResultsIn the present study results of the biochemical and histopathological examination reveals the protective effects of Taurine. As a marker of lipid peroxidation, Malondialdehyde (MDA) levels in ischemia group were significantly higher than both Sham and Taurine groups. MDA values were recorded; 3.62 ± 0.197 in the sham group, 2.07 ± 0.751 in the Taurine group, 9.71 ± 1.439 in the ischemia group and 7.68 ± 1.365 in the treatment group. MDA levels decreased in treatment group. (p < 0.05) In accordance with MDA findings, while superoxide dismutase and glutathione peroxidase levels decreased in ischemia group, they increased in treatment group. (p < 0.05) There was no differences in Catalase (CAT) enzyme level between treatment and ischemia group (p = 1.000). CAT level results were recorded; 7.08 ± 0.609 in the sham group, 6.15 ± 0.119 in the Taurine group, 5.02 ± 0.62 in the ischemia group, and 5.36 ± 0.384 in the treatment group. Less intracellular edema and inflammatory cell reaction were observed in histologic examination in favor of treatment group. (p < 0.01)ConclusionTaurine decreased myocardial damage during cold ischemic period following global myocardial ischemia.

Proanthocyanidin to prevent formation of the reexpansion pulmonary edema

BackgroundWe aimed to investigate the preventive effect of Proanthocyanidine (PC) in the prevention of RPE formation.MethodsSubjects were divided into four groups each containing 10 rats. In the Control Group (CG): RPE wasnt performed. Then subjects were followed up for three days and they were sacrificed after the follow up period. Samplings were made from tissues for measurement of biochemical and histopathologic parameters. In the Second Group (PCG): The same protocol as CG was applied, except the administration of PC to the subjects. In the third RPE Group (RPEG): Again the same protocol as CG was applied, but as a difference, RPE was performed. In the Treatment Group (TG): The same protocol as RPEG was applied except the administration of PC to the subjects.ResultsIn RPEG group, the most important histopathological finding was severe pulmonary edema with alveolar damage and acute inflammatory cells. These findings were less in the TG group. RPE caused increased MDA levels, and decreased GPx, SOD and CAT activity significantly in lung tissue.ConclusionPC decreased MDA levels. Oxidative stress plays an important role in pathophysiology of RPE and PC treatment was shown to be useful to prevent formation of RPE.

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.

Protective efficiacy of taurine against pulmonary edema progression: experimental study.

Re-expansion pulmonary edema (RPE) is an acute, rare and potentially lethal complication [1,2]. Its beginning is sudden and dramatic. The mechanism is not yet fully understood [1]. Some authors suggest that it may occur after rapid re-inflation of a collapsed lung [1]. It was reported by other authors that it may relate to surfactant depletion or may result from hypoxic capillary damage, leading to increased capillary permeability [1,3]. In RPE, unilateral lung injury is initiated by cytotoxic oxygen metabolites and temporally associated with an influx of polymorphonuclear neutrophils [1]. These toxic oxygen products are the results of re-oxygenation of a collapsed lung. Treatment of re-expansion pulmonary edema is basically preventive [4].

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.

Comparison of side effects of oxytetracycline and talc pleurodesis: an experimental study

BackgroundChemical pleurodesis is widely recommended in the treatment of refractory pleural effusion or pulmonary air leak of different etiologies. Although several agents have been used, many questions have remained unanswered about their toxicity. Talc is the most commonly used agent for the treatment, with rare, serious complications reported. Oxytetracycline pleurodesis in clinical practice has been described in a few studies, but literature reveals no experimental studies using this agent. We performed a prospective, randomized, observer-blinded, controlled study to evaluate the changes in lung histology and systemic response to pleurodesis with oxytetracycline and talc in acute and subacute phases in a rat model.MethodsForty-two male albino Wistar rats were divided into three groups and 3 subgroups with 7 animals in each. Group 1 was given oxytetracycline, 35 mg/kg; Group 2 was given talc slurry, 60 mg/kg in 0.5 mL saline solution, and Group 3 was given only 0.5 mL saline intrapleurally. In subgroups a the nimls were sacrificed at the postoperative 72nd hour and, in subgroups b, on the postoperative day 7. The surfaces were graded by microscopic examination.ResultsOxytetracycline produced alveolar collapse, hemorrhage, edema, inflammation at the postoperative 72nd hour and hemorrhage on the postoperative day 7, while talc produced significant edema, inflammation, proliferation, fibrosis at the postoperative 72nd hour and hemorrhage, edema, inflammation, proliferation, and fibrosis on the postoperative day 7 (p < 0,0042). Talc produced significant edema compared to oxytetracycline on the postoperative day 7. On contralateral side, oxytetracycline and talc produced significant hemorrhage on the postoperative day 7 (p < 0.0042).ConclusionsBoth agents were shown to produce pulmonary lesions. In acute phase, the pulmonary side effects of oxytetracycline were more pronounced, whereas the side effects of talc were prolonged to subacute phase. We propose that the occasional side effects in humans may be related to these changes as were observed in our rat model, and like talc, oxytetracycline must be used cautiously in patients with limited respiratory function.

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.