Rasih Yazkan

Transaxillary approach in thoracic outlet syndrome: the importance of resection of the first-rib

OBJECTIVE The aim of this study was to analyze the transaxillary surgical approach and results of thoracic outlet cases in our clinic in the light of the recent literature data. METHODS Between 1996 and 2002 a series of 35 cases diagnosed as thoracic outlet syndrome (TOS) hospitalized and surgically treated in our clinic have been studied retrospectively. RESULTS Twenty-six of our cases were females (75%) and the mean age was 25+/-1 (17-40 years). The most important symptom was localized pain in the arm. In 90% of the cases the Adson, hyperabduction and abduction external rotation (AER) tests were positive. There was paresthesia in 30 cases (85%), atrophy in 3 cases (10%), and cyanosis in 6 cases (20%). Preoperative electromyogram (EMG) was demonstrated as 56.7 m/s (50-65) and postoperative EMG was demonstrated as 65.1 m/s (60-71). Postoperative EMG values were significantly higher than the preoperative EMG values (p<0.001). All patients were operated using the transaxillary approach. A total number of 40 operations were performed. Upon radiological investigation (n=17) 50% of the patients were found to have cervical ribs. In 30 cases (85%) the results were very good and in four cases (12%) good, and in one case (3%) the results were bad. There was no recurrence and reoperation in the long term follow-up. CONCLUSION Careful patient history and physical examination should be done by a team, which consists of thoracic surgeon, physical therapy specialist, and a neurologist. Total resection of the first-rib with periosteally should be preferred in all of these cases with accompanying pathologies such as cervical rib, fibrous ligaments, and scalenius muscles. The transaxillary approach has provided a good exposure for the resection of cervical ribs, the first-rib and excision of fibrous ligaments and scalenius muscle by a perfect cosmetic result. All the patients should be encouraged for 2 months of physical exercises starting from early postoperative period.

The relation of radiation-induced pulmonary fibrosis with stress and the efficiency of antioxidant treatment: an experimental study.

Background Radiation-Induced Lung Injury has 2 components: radiation pneumonitis and radiation fibrosis. The pulmonary fibrosis has no known efficient treatment. The purpose of this study was to study the relationship between the oxidant/antioxidant status and pulmonary fibrosis in rats having radiation induced pulmonary fibrosis and to study the antioxidant effects of pentoxifylline, vitamin E, and vitamin C in the treatment of pulmonary fibrosis. Material/Methods The study rats were divided into 5 groups: Thoracic RT + vitamin E+ Pentoxifylline for group 1, Thoracic RT + vitamin C + Pentoxifylline for group 2, Thoracic RT + vitamin C + vitamin E + Pentoxifylline for group 3, and Thoracic RT + Pentoxifylline for group 4, and group 5 was the control group. Results When groups are evaluated in pairs, significant differences between group 1 and 2, group 1 and 4, and group 1 and 5 were determined (p: 0.002, p: 0.002, p<0.001, respectively). No significant difference was determined between group 1 and 3 (p: 0.161). No significant difference was determined between group 2 and group 3, 4, and 5 (p: 0.105, p: 0.645, p: 0.234, respectively). There was no significant difference between group 4 and 5 (p: 0.645). Conclusions The combination of vitamin E and pentoxifylline is efficient in preventing radiation-induced lung fibrosis. The additional benefit of vitamin C, which is added to this combination to increase the antioxidant activity, cannot be shown. It would be useful to investigate the combination of vitamin E, pentoxifylline, and other non-enzymatic antioxidants.

The relationship between aluminum and spontaneous pneumothorax; treatment, prognosis, follow-up?

Aluminum is known as a toxic metal today. Aluminum has already been determined to cause asthma bronchial and chronic obstructive pulmonary disease. It was also reported that Shaver disease undergoing fibrosis with large bubbles and the symptoms of potroom asthma had developed in the workers working in the manufacture of aluminum. The aim of the study was to analyze the relationship between aluminum and spontaneous pneumothorax in the patients not working in the industry and also to evaluate its results. Two groups were studied: the patient group and control group. The first group consisted of 30 cases who were admitted to hospital and treated in the clinic. The other group (control group) was composed of 30 healthy individuals who had no complaints. The aluminum level in blood plasma in spontaneous pneumothorax was found significantly higher than that in the control group (P<0.001). In the spontaneous pneumothorax cases, the specificity of the aluminum was determined to be 100% and its sensitivity was determined to be 90%. The aluminum risk level in spontaneous pneumothorax group was determined to be ten times as high as that in the control group. We believe that this study will be helpful for thoracic surgeons in the treatment and follow up of spontaneous pneumothorax.

Transthoracic biopsy of lung masses: Non technical factors affecting complication occurrence.

To investigate the transthoracic computed tomography (CT)‐guided lung nodule biopsy complications and risk factors associated with the development of these complications.

Elastofibroma dorsi: report of a case with diagnostic features.

Elastofibroma dorsi, named for its characteristic location, is a rarely seen benign soft tissue tumor mostly detected at the infrascapular region between the thoracic wall, the serratus anterior muscle, and the latissimus dorsi muscle. 1,2 The other locations of elastofibroma are the greater trochanter, deltoid muscle, ischial tuberosity, breast, foot, stomach, mediastinum, orbita, cornea, and oral mucosa. 3 The anatomic location, clinical symptoms, and typical radiologic features of elastofibroma dorsi may not easily distinguish this rare benign tumor from malignant soft tissue tumors. 4-6 Here we report preoperative diagnostic methods and surgical treatment of elastofibroma dorsi presenting with severe thoracic pain.

The Cause of Unexpected Acute Abdomen and Intra-Abdominal Hemorrhage in 24-Week Pregnant Woman: Bochdalek Hernia

Bochdalek hernia (BH) is the most common type of congenital diaphragm hernia and is rarely seen in adults. In adult patients, BH often remains asymptomatic or presents with nondiagnostic symptoms and may lead to complications, though rarely. The necrosis and perforations occurring in the hernia may lead to mortality. In this report, we present a 34-year-old pregnant woman at 24 gestational weeks who presented with Bochdalek hernia causing gastric volvulus associated with perforation and intra-abdominal hemorrhage associated with splenic rupture.

Could Recurrent Anxiety be a New Surgical Indication for Patients with Spontaneous Pneumothorax

DOI: 10.4328/JCAM.2074 Received: 30.09.2013 Accepted: 01.10.2013 Printed: 01.01.2015 Corresponding Author: İsa Döngel, Süleyman Demirel Üniversitesi Tıp Fakültesi Göğüs Cerrahisi Anabilim Dalı, Isparta, Türkiye. T.: +902462119251 GSM: +905052228388 F.: +902462112830 E-Mail: drdongel@hotmail.com Editör için: Yazkan R. ve ark. tarafından yapılan “Tekrarlama Anksiyetesi Spontan Pnömotorakslı Hastalar için Yeni Bir Cerrahi Endikasyon Olabilir mi?” başlıklı çalışmayı spontan pnömotoraks klinik tablosuna farklı bir bakış açısı ortaya koyması nedeniyle ilgiyle okudum. Spontan pnömotoraks plevra yaprakları arasında hava birikmesi ve buna sekonder gelişen akciğer kollapsı olarak tanımlanmaktadır ve göğüs cerrahisi kliniklerinde sık karşılaşılan hastalıklardan birisidir [1,2]. Anksiyete ise hoş olmayan özellikleri ile diğer duygulanım şekillerinden ayrılan korku ve endişe duygusudur. Anksiyeteli hasta fizyolojik ve psikolojik olarak çarpıntı, nefes almada zorluk, hızlı hızlı nefes alma, ellerde ve ayaklarda titreme, aşırı terleme, sıkıntı, heyecan, aniden çok kötü bir şey olacakmış hissi ve korkusunu taşır [3]. Yayınladığınız çalışma spontan pnömotorakslı hastalarda tekrarlama anksiyetesinin yeni bir cerrahi endikasyon oluşturup oluşturmadığını irdelemekte ve bu konuda yapılmış nadir çalışmalardan biri olma özelliğini taşımaktadır. Spontan pnömotoraks tedavisinde amaç, kliniğin düzeltilmesi, pnömotoraksın boşaltılarak akciğerin tekrar ekspansiyonunun sağlanması ve pnömotoraksın tekrarının önlenmesidir [1,2]. Anksiyete ve spontan pnömotoraksın klinik bulgularında benzer özellikler mevcut olup, spontan pnömotorakslı hastaların hastalıkları konusunda tatmin edici düzeyde bilgilendirilmesi hastaları tekrarlama anksiyetesinden korur. Dolayısıyla bu yazının yeni bir cerrahi endikasyondan çok, tekrarlama anksiyetesi yönünden hastaların ve doktorların uyanık olması ve bu konuda hastaların detaylı bilgilendirilmesini hatırlatması yönüyle daha anlamlı olduğunu düşünüyorum. Primer spontan pnömotoraks gelişen hastaların %25-30 oranında konservatif tedavi yöntemlerine cevap vermemekte ve cerrahi tedavi gerekebilmektedir [2,4]. Bu nedenle hastalara ilk atakta cerrahi yapmanın uygun olmadığını, mutlaka konservatif yöntemler denendikten sonra, başarılı olunamıyorsa cerrahinin daha uygun olduğunu düşünüyorum. Ayrıca nonkardiyak göğüs ağrısı nedeniyle acil servise başvuran hastalarda Hastane Anksiyete ve Depresyon Skalası (HADS) kullanılarak yapılan çalışmalarda, HADS skoru yüksek saptanan hastalarda anksiyete ve/veya depresyon tanısı alma oranı %73,3 bulunmuştur [5]. Yani bu tür hastaların bir kısmının anksiyete ve/veya depresyona yatkın oldukları anlamını taşımaktadır. Dolayısıyla tekrarlama anksiyetesi nedeniyle yapılan cerrahi sonrası, hastaların bir kısmının yine anksiyete ve/veya depresyon geçirme riski taşıyacağı aşikârdır. Bu nedenle spontan pnömotoraks geçiren hastaların ilk atakta konservatif tedavi edilmesi şayet hasta tekrarlama anksiyetesi riski taşıyorsa psikiyatri ile konsülte edilerek yakın takip edilmesinin daha uygun bir yaklaşım olduğu kanaatindeyim.

Deadly portal was caught red-handed: the computed tomographic images of the source of pulmonary air embolism.

FIGURE 2. Air in right ventricle and pulmonary artery. A and B, Computed tomography scan images were rendered in minimum intensity projection method, and air was localized in right ventricle outlet (black arrow) and main, right, and left pulmonary artery (white arrow). C andD, Air located in right ventricle (black arrow) and right pulmonary artery (white arrow). Deadly Portal Was Caught Red-Handed The Computed Tomographic Images of the Source of Pulmonary Air Embolism

Is Total Collapse a Good Sign for Treatment Process of Spontaneous Pneumothorax

1 Rasih Yazkan1, Serdar Han2, Ünal Sakıncı3 1Afyonkarahisar State Hospital, Department of Thoracic Surgery, Afyonkarahisar, 2Ankara Ufuk University, Department of Thoracic Surgery, Ankara, 3Ankara Numune Education and Research Hospital, Department of Thoracic Surgery, Ankara, Turkey Spontaneous Pneumothorax and Total Collapse / Spontan Pnömotoraks ve Total Kollaps Is Total Collapse a Good Sign for Treatment Process of Spontaneous Pneumothorax?

KÜNT TORAKS TRAVMASI

Travma 40 yas altinda gorulen olumlerin en sik nedenidir. Vakalarin hemen hemen dortte biri toraks travmasidir ve bunlarin da onemli bir yuzdesini kunt travmalar olusturur. Yaralanma izgesi minor vakalardan ciddi, hayati tehdit edenlere kadar cesitlilik gosterebilir. Kunt toraks travmasi hakkinda yeterli bilgi sahibi olunmasi ve travmanin meydana geldigi yerden baslayan uygun bakim morbidite ve mortalitenin azaltilmasinda son derece onemlidir.