Şevval Eren

Foreign body aspiration in children: experience of 1160 cases.

Abstract Hospital records of 1160 children ≤15 years old referred for suspected foreign body aspiration were reviewed. Bronchoscopy under general anaesthesia was performed on all patients. Foreign bodies were successfully removed in 1068 (92%) children. The majority, 885 (76.3%), presented with a definite history of foreign body aspiration. Bronchoscopy was negative in 85 (7.3%) children. Watermelon seeds, found in 414 (38.7%) children, were the most commonly aspirated foreign bodies. Open surgical procedures were required for 21 (1.8%) children. Bronchial rupture related to bronchoscopy occurred in four children, two of whom died post-operatively. The overall mortality rate was 0.8%.

Surgical treatment of post-traumatic tracheobronchial injuries: 14-year experience

OBJECTIVE Tracheobronchial injuries have different clinical pictures and high mortality unless aggressive treatment is used. We reviewed our surgical experience. METHODS The records of 32 patients from 1988 to 2002 were reviewed. Mean age was 22.3 years (range: 4-53). Three patients were female. Prominent symptoms were dyspnea, subcutaneous air and pneumothorax in chest X-rays. Associated injuries were seen in 22 patients (68.7%): most frequently in the lung parenchyma (11 patients) and esophagus (seven patients). Bronchoscopic detection of a rupture of the trachea or bronchus was the main indication for surgery. RESULTS Nineteen injuries (59%) were penetrating and 13 blunt (41%). The most common presenting sign of airway disruption was subcutaneous emphysema (25%) and stridor (22%). Of the 32 patients, 22 underwent bronchoscopic examination. Bronchography was used in three patients admitted during the late period. Surgical morbidity was 19.3%. Seven patients died (21.8%), of whom six had been operated on. In operations performed during the first 2 h of trauma, no mortality occurred. There were associated injuries in 100% of patients that died and in 60% of those that survived. The proportion (100 vs. 24%) and duration (2.8 vs. 11.6 days) of ventilatory support were lower in patients that survived than in those that died. Mean injury severity score of patients that died was 34.7+/-8.8 while it was 24.3+/-8.6 in those that survived. Tracheal stenosis developed in three patients (9.3%). CONCLUSION In civilian life, tracheobronchial injuries occur relatively rarely. Early diagnosis and operative intervention save lives. Associated injury is an important mortality factor.

Open Fixation in Flail Chest: Review of 64 Patients

The strategy for treatment of flail chest remains controversial. Various alternatives were assessed by reviewing the records of 64 patients treated from 1991 through 2000. Patients were classified according to therapeutic approach: group 1 was 27 patients who underwent open fixation of the fractured ribs, group 2 was 19 patients managed by intermittent positive-pressure ventilation, and group 3 was 18 patients managed mainly by synchronized intermittent mandatory ventilation. Two patients initially treated by ventilation underwent successful open fixation. In group 1, ventilatory support was required in 21 (77.8%) patients postoperatively, the mean duration of ventilation was 3.1 days, mean hospital stay was 18.3 days, morbidity was 11.1% (3/27), and mortality was 11.1%. In groups 2 and 3, the mean time for stabilization of paradoxical chest wall movement was 6.6 days, and mean duration of ventilation was 7.2 days. Mortality was 27.0% (10/37) in patients treated nonsurgically; 21.0% (4/19) in group 2, and 33.3% (6/18) in group 3. In groups 2 and 3, pain control required epidural analgesia in 13 (35.1%) cases, intercostal nerve blockade in 16 (43.2%), and narcotic or nonnarcotic parenteral analgesia in 8 (21.6%). Open fixation is a successful treatment modality for traumatic flail chest.

Pneumonectomy in children for destroyed lung and the long-term consequences

OBJECTIVES Destroyed lung introduces irreversible changes in lung parenchyma. This condition is uncommon in children. Operative intervention is essential for children in this state. We demonstrate our experience with this condition and report on the respective long-term results. METHOD Seventeen children who underwent pneumonectomy for destroyed lung during a 15-year period were retrospectively analyzed. Long-term results were detected in 13 patients. RESULTS Seventeen children underwent pneumonectomy. Five children were female (29.4%), and 12 children were male (70.5%). The median age of the study group children was 9.1 years (3-16 years). Sputum was the most common presenting symptom (n = 13, 76.4%). Bronchiectasis (n = 11), tuberculosis (n = 4), and necrotizing lung disease (n = 2) were the main underlying conditions. Destroyed lung was detected on the left side in 14 children (82.4%) and on the right side in 3 children (17.6%). Main bronchial stenosis was found in 4 children and mucosal thickening or congestion in 5 children. The median length of hospital stay was 15.5 days. The mortality rate was 11.7% (n = 2), and the morbidity rate was 23.5% (n = 4). Follow-up information was available for 13 patients, and this ranged from 1 year to 12 years (median 5.2 years). The respiratory capacity and scoliosis level of the patients were examined. CONCLUSIONS Although pneumonectomy is considered a difficult procedure in children, its use for destroyed lung resolves complications and improves a patients quality of life. In time, the remaining lung expands to compensate for the loss of the removed lung. Children grew and developed normally after pneumonectomy. Patients tend not to have major skeletal deformation as the result of pneumonectomy in the short term.

Surgical treatment of thoracic outlet syndrome: effect and results of surgery

BACKGROUND Because of the difficulty in diagnosis and different treatment options, debate on thoracic outlet syndrome (TOS) has continued. Our aim is to report our surgical experience. METHODS Forty-seven patients with thoracic outlet syndrome were operated on between 1985 and 2000. Mean age was 37.9 years (range, 17 to 58 years); female/male ratio was 41/6. The most frequent symptom was paresthesia (72.3%). Seventeen patients (36%) had bilateral symptoms. Of all, 89.3% (42 cases) were neurologic thoracic outlet syndrome, and 10.7% (five cases) were vascular. Lower plexus (C8-T1/ulnar nerve) compression was present in 36 patients and upper plexus (C5-C7/median nerve) compression in 6 patients. Doppler ultrasonography in 11 patients, angiography in 8, and lymph node scintigraphy in 1 patient were also performed. Main operative indications were persistence of symptoms after conservative therapy and reduced (< 60 m/s) ulnar nerve conduction velocity. RESULTS Fifty-five operations were performed on the 47 patients. First (59.6%) and cervical costae (21.3%) resections were the most frequent operations. Mean ulnar nerve conduction velocity was 54.8 m/s (range, 43 to 68 m/s) preoperatively and 69.4 m/s (range, 47 to 70 m/s) postoperatively (p < 0.05). The morbidity rate was 17% (8 of 47). No difference was observed between transaxillary and supraclavicular incisions. No brachial plexus injuries occurred. The most frequent cause of morbidity was incisional pain. Two reoperations were performed for recurrences. Follow-up was 4.6 years, and 75% of lower plexus and 50% of upper plexus compressions remained asymptomatic. Severe and long-term pain occurred in 1 patient. CONCLUSIONS Surgical decompression for thoracic outlet syndrome is efficient and dependable, but results deteriorate over time.

Esophageal foreign bodies under cricopharyngeal level in children: an analysis of 1116 cases

Esophageal foreign bodies (FBs) in children are a commonly seen complaint that can cause severe morbidity. Different methods are used for their extraction. We reviewed our cases and described direct extraction technique. The specifications of 1116 children with esophageal FBs between 1990 and 2000 were evaluated. All FB cases were considered emergencies and intervention was performed in the operating theater. Patients with coins were only sedated and relaxed while the FB was removed under direct vision by McGill forceps. Other FBs were removed under general anesthesia by rigid esophagoscope. There were 1035 coins in 1007 patients and 112 other FBs in 109 children. Mean age was 4.2 years, ranging from 1 month to 15 years. Immediate interventions were performed in 16 (1.4%) patients. Reasons included respiratory distress from pressure in eight (five coins, three toy pieces), increased rupture risk after 4 days in three (all coins) and esophageal rupture in five patients. Four (0.3%) perforations occurred during intervention; two (0.02%, 2/1116) arose from coin extraction, and another two (1.8%, 2/109) were caused by esophagoscopic removal. The success rate for esophagoscopic removal was 95.4% (105/109). Three (0.2%) of 1116 patients underwent surgery to remove FBs. All were esophagoscopy patients, thus the surgery ratio for esophagoscopic removal was 2.7% (3/109). If an FB is diagnosed quickly and removed few problems arise. Esophageal coins can be successfully extracted under direct vision.

Non-capitonnage method for surgical treatment of lung hydatid cysts.

Capitonnage is usually advocated for obliteration of the residual cavity after removal of a hydatid cyst. To assess a non-capitonnage method, results in 33 patients were compared with those of 80 patients who had capitonnage. The non-capitonnage patients had a shorter mean hospital stay and earlier radiologic improvement but higher morbidity than the capitonnage patients. Extended air leak caused significant morbidity in each group. Bronchoscopic intervention was needed for atelectasis in 1 patient. There was no mortality in either group. In the follow-up period, no late complication or recurrence was observed in non-capitonnage patients. Among the capitonnage patients, 2 had bronchiectasis, and suture material expectoration occurred in one. The non-capitonnage method may be a good alternative to the capitonnage procedure for lung hydatid cyst. Better management of bronchial openings should improve the results of the non-capitonnage method.

Benign intrapulmonary teratoma: report of a case

Although intrathoracic teratomas are frequent, benign intrapulmonary teratomas seldomly occur. Only 37 cases have been reported so far. It is known that these tumors originate from the third pharyngeal sac. Teratomas occur with the same incidence in men and women. These tumors generally become manifest with their complications such as lung abscess, bronchiectasis, empyema, and hemoptysis. Preoperative diagnoses are usually inaccurate. We review the literature and report a case.

Transtorasik Dikiş İğnesi'ne Bağli Diafragma Rüptürü

Ectopic neurohypophysis is an anomaly of the Pituitary gland which may be associated with short stature due to Growth hormone deficiency. MRI is the modality of choice in diagnosing this condition. We present a case of pituitary dwarfism and ectopic neurohypophysis with clinical and radiological findings. 21 year-old male admitted with short stature. All hormones, except prolactin, of anterior hypophysis were low. Bright spot was ectopically located at level of median eminence on enhanced MRI of hypophysis and stalk of hypophysis was not observed. Ectopic neurohypophysis may be present with pituitary dwarfism. Cranial MRI may be useful to investigate related pathologies in such cases.