Saban Sebit

Analysis of Chest Injuries Sustained During the 1999 Marmara Earthquake

Abstract.Purpose: The chest injury pattern after a major earthquake is not well understood because data on the type of trauma and surgical intervention are limited. This study was conducted to analyze patients who sustained chest injury during the Marmara earthquake that struck Turkey on August 17, 1999 registering 7.4 on the Richter scale.Methods: The medical reports of 528 patients transported to a military hospital in the first 48 h after the earthquake were reviewed. Two chest surgeons examined these 528 patients, 19 of whom (4%) had suffered a major chest injury. We retrospectively evaluated the injury pattern, Abbreviated Injury Score (AIS), and Injury Severity Score (ISS) in these 19 patients.Results: Eight patients (42%) had isolated chest injuries and 11 (58%) had suffered injury to more than one organ system, including chest trauma. The mean AIS and ISS were assigned as 2.9 (SD: 1) and 22 (SD: 7), respectively. Three (16%) of the 19 patients died, all of whom had suffered multiple injuries. The mean ISS of these three patients was 28.7 (range 25–34). Chest injury after a major earthquake was associated with an overall mortality rate of 16%, but chest injury with multiple injuries and an ISS over 25 was associated with a mortality rate of 60%. All patients with isolated chest injuries survived.Conclusion: Coexistent trauma with chest injury and an ISS over 25 were defined as poor prognostic factors for patients rescued after a major earthquake.

The Evaluation of 13 Patients with Intrathoracic Extrapulmonary Hydatidosis

Cases of intrathoracic extrapulmonary hydatid cysts are very rare. We identified 13 patients with intrathoracic extra-pulmonary hydatid cysts in our clinic over 12 years. Four patients had extra-pulmonary cysts only; nine patients had both intrapulmonary and extrapulmonary cysts. Cysts were identified in the pleural space, extrapleural region, diaphragm and chest wall. Thoracotomy was used in all patients, and extrapulmonary lesions were removed by cyst extirpation from surrounding tissue or by pericystectomy. In one patient with chest wall involvement, partial rib resections were performed because of rib destruction. In two patients with liver cysts passing through the diaphragm to the thorax, the diaphragm was cut, cysts on the liver roof were removed and then the diaphragm was repaired. There was no mortality, morbidity, or disease recurrence during the post-operative period in any of the 13 patients. We conclude that these rare cases give a new insight into hydatid cyst pathophysiology.

A novel dissemination pathway of hydatid cyst

Cushing’s syndrome (EAS). Moreover, they suggest that a positive image at Octreoscan is predictive of a successful treatment with somatostatin analogues. We completely agree with the authors about the usefulness of functional images in the follow-up of those patients whose tumour has shown a positive tracer uptake preoperatively. In our experience, among nine patients with EAS, CT helped to localize the lesion in 5/9 cases; Octreoscan was false negative in three, false positive in two, while it early identified two relapses, F-deoxyglucose positron emisson tomography (PET) was false negative in two, false positive in one and positive in one. Furthermore, we also observed that one patient with negative Octreoscan imaging transiently improved his clinical condition when treated with somatostatin analogues. Thus, we believe that every patient with EAS should preoperatively undergo Octreoscan, and probably also PET, but CT or MRI seem to be the best techniques to localize ectopic ACTH tumors. In addition, owing to the relative rarity of this severe condition, it would be hoped and advisable to share experiences and efforts from different Centers.