Yiğit Akçali

Tracheobronchial foreign body aspirations in childhood: a 10-year experience

OBJECTIVE Tracheobronchial foreign body aspirations comprise the majority of accidental deaths in childhood. Diagnostic delay may cause an increase in mortality and morbidity in cases without acute respiratory failure. We report our diagnostic and therapeutic modalities. METHODS In our department, bronchoscopy was performed on 548 patients with the diagnosis of tracheobronchial foreign body aspirations (from 1987 to 1997). Of these cases, 55.6% were male and 44.4% female. Their ages ranged from 2 months to 16 years (average 5.5 years). Diagnosis was made on history, physical examination, radiological methods and bronchoscopy. RESULTS Foreign bodies were localized in the right bronchial tree in 312 cases (56.9%), the left in 126 cases (23.0%) and in the trachea in 62 cases ( 1.3%). Foreign body was not found during bronchoscopy in 48 cases (8.7%). The majority of the foreign bodies were vegetable matters. Foreign bodies were removed with bronchoscopy in all but two cases which underwent limited thoracotomy. In the late period, pulmonary resection was performed in five cases because of irreversible complications. After bronchoscopy, hypoxia developed in four patients, requiring mechanical ventilation. Pneumothorax developed in two cases and mediastinal emphysema in two. Four patients (0.7%) died because of respiratory failure. CONCLUSION Proper use of diagnostic techniques provides a high degree of success, and the treatment modality to be used depending on the type of the foreign body is mostly satisfactory.

Unusually located hydatid cysts: Intrathoracic but extrapulmonary

BACKGROUND Hydatid cyst disease is still a problem in Turkey, as well as in many other places in the world. Extrapulmonary location of the disease in the thorax is very rare, and surgical procedures can be considered that differ from those used for pulmonary hydatid cysts. METHODS We reviewed retrospectively our experience in the surgical treatment of 22 patients with intrathoracic, extrapulmonary hydatid cysts. In our department, 297 patients with thoracic hydatid cysts were managed surgically in the last 14 years, in 22 (7.4%) of whom the cysts were localized extrapulmonarily in the thorax. The locations of these hydatid cysts were a fissure, the pleural cavity, chest wall, mediastinum, myocardium, and diaphragm. RESULTS Total resection was chosen as the surgical procedure in all patients except 4 (18.2%), 1 of whom had cystectomy and capitonnage for cardiac hydatid cyst and 3 of whom had cystectomy and local curettage for cysts located in the chest wall. Empyema developed postoperatively in 1 case (4.5%) with a cyst in the fissure. The follow-up period was 1 year, and there were no deaths. CONCLUSIONS Hydatid cyst may be found in many different sites, including extrapulmonarily in the thorax, and bearing this in mind will facilitate planning of the operation.

BENEFITS OF EARLY AGGRESSIVE MANAGEMENT OF EMPYEMA THORACIS

Background:  The end‐target of the management of thoracic empyema is to obtain early rehabilitation by re‐expansion of the trapped lung resulting from intrapleural infected material. Our aim was to shorten the hospitalization time and to prevent a possible thoracotomy by using video‐assisted thoracoscopy initially.

The effect of standard posterolateral versus Muscle-Sparing thoracotomy on multiple parameters

BACKGROUND Different alternative approaches to thoracotomy have been developed because of the considerable morbidity associated with the standard posterolateral incision. METHODS We studied a prospective, randomized, blinded study of 60 consecutive patients to compare surgical approach time, postoperative pain (quantitated by narcotic requirements and the visual analogue scale), pulmonary function, shoulder strength, and range of motion between standard posterolateral (group I) and muscle-sparing (group II) thoracotomy techniques. RESULTS There were no differences in postoperative surgical time, pulmonary function, shoulder range of motion, mortality, or hospitalization time. There was significantly less postoperative pain in group II. In this group, narcotic requirement was less in the first 24 hours, and visual analogue scale scores were significantly lower (p < 0.05) throughout the first postoperative week. Muscle strength had returned to preoperative levels by 1 month in both groups. Morbidity was identical in the two groups with the exception of postoperative seromas. The prevalence of seroma was 16.6% in the muscle-sparing group. CONCLUSIONS We conclude that the muscle-sparing incision may be a sensible alternative to a standard posterolateral thoracotomy.

Surgical treatment of vasculo-Behçet's disease. A review of patients with concomitant multiple aneurysms and venous lesions.

Background: Vascular complications can be seen in patients with Behcet’s disease. Arterial and venous complications may be found separately or concomitantly in patients. Patients and methods: Out of 29 patients with vasculo-Behcet’s disease 7 patients with multiple aneurysms and venous lesions were documented over a period of 20 years. All patients were male, ranging in age from 24 to 52 years. The mean duration of the disease was 6 ± 2 years. The aneurysms were found in the following locations: one pulmonary artery, two abdominal aorta, four iliac, five femoral, and two popliteal artery. Both aneurysmal and occlusive lesions were present in three patients. In the venous lesions associated with the aneurysms there were three deep and three superficial venous thrombosis. Two patients had caval involvement-superior and inferior vena caval syndromes. Results: We performed seven interposition grafting by polytetrafloroethylene, one Y-grafting, one aneurysmorrhaphy, one lobectomy. Re-anastomosis was performed ...BACKGROUND Vascular complications can be seen in patients with Behçets disease. Arterial and venous complications may be found separately or concomitantly in patients. PATIENTS AND METHODS Out of 29 patients with vasculo-Behçets disease 7 patients with multiple aneurysms and venous lesions were documented over a period of 20 years. All patients were male, ranging in age from 24 to 52 years. The mean duration of the disease was 6 +/- 2 years. The aneurysms were found in the following locations: one pulmonary artery, two abdominal aorta, four iliac, five femoral, and two popliteal artery. Both aneurysmal and occlusive lesions were present in three patients. In the venous lesions associated with the aneurysms there were three deep and three superficial venous thrombosis. Two patients had caval involvement-superior and inferior vena caval syndromes. RESULTS We performed seven interposition grafting by polytetrafloroethylene, one Y-grafting, one aneurysmorrhaphy, one lobectomy. Re-anastomosis was performed in two patients who had anastomotic aneurysms and graft occlusion without disabling ischemia. Venous pathologies were treated by medical therapy. The patients were followed up between 1 to 8 years. One of the patients with iliac artery aneurysm died due to gastrointestinal bleeding 15 months after the operation. CONCLUSIONS In conclusion, when an aneurysm has been found in a patient with Behçets disease, the patient should be scanned for possible multiple aneurysms and venous lesions since they might be found together. Surgical treatment, when feasible, should be performed in cases with Behçet aneurysms because of a high risk of rupture. However, the possibility of an anastomotic aneurysm developing after surgery should also be kept in mind.

Endovascular Treatment of Lower Limb Penetrating Arterial Traumas

Purpose:The purpose of this study was to evaluate the effectiveness of percutaneous arterial embolization in patients with penetrating peripheral arterial trauma.Materials and Methods:Twelve patients with penetrating peripheral arterial trauma were treated with percutaneous arterial embolization between 2002 and 2007. All injuries were secondary to penetrating stab wounds. Active bleeding (eight patients), recurrent bleeding episodes (one patient), persistent pain and mass (one patient), leg edema, claudication, swelling (one patient), local hyperemia, and pain (one patient) were the presenting symptoms. Microcatheter systems were used for catheterization. We used n-butyl cyanoacrylate mixture as the embolizing agent in all patients.Results:On angiograms the inferior gluteal artery (one patient), internal pudendal artery (one patient), perforating branch of the profundal femoral artery (six patients), superficial femoral artery (one patient), peroneal artery (two patients), and anterior tibial artery (one patient) were found to be injured. In all patients, the source of arterial bleeding could be reached, and a safe embolization was achieved. Nontarget embolization due to backflow of n-butyl cyanoacrylate mixture was detected in two patients and inguinal hematoma at the puncture site occurred in one patient.Conclusions:We conclude that embolization—particularly n-butyl cyanoacrylate embolization—is technically feasible in patients with penetrating peripheral arterial trauma.

Is capitonnage unnecessary in the surgery of intact pulmonary hydatic cyst

Background:  Hydatid disease, a parasitosis, is still an important health problem in Turkey. Surgery is the choice of treatment for pulmonary hydatid cyst. In this study, cystotomy and capitonnage were compared to cystotomy.

Direct CT Venography for Evaluation of the Lower Extremity Venous Anomalies of Klippel-Trénaunay Syndrome

OBJECTIVE Our aim was to describe the technique of direct CT venography and to describe various forms of venous anomalies detected with CT venography in patients with Klippel-Trénaunay syndrome. CONCLUSION MDCT is helpful for visualizing the full length of extremities and for evaluating length and thickness on one image.

Extrapleural regional versus systemic analgesia for relieving postthoracotomy pain: a clinical study of bupivacaine compared with metamizol.

BACKGROUND The effects of a local anesthetic delivered through a catheter inserted in the extrapleural region by a surgeon and an analgesic agent given systemically on pain after thoracotomy were assessed. METHODS The patients in group I (n = 25) had a catheter inserted between the parietal pleura and the endothoracic fascia by a surgeon, and 0.5% bupivacaine was given through this catheter. Another 25 patients (group II) had metamizol given intravenously. Respiratory function tests, arterial blood gases, range of shoulder motion, and postoperative pain were evaluated for each group. Bupivacaine and metamizol were given just before finishing the thoracotomy and then repeated every 4 hours for 3 days. RESULTS There was no statistical difference in arterial blood gases between the groups (P >.05). There were statistically significant differences in the respiratory function tests, range of shoulder motion, and visual analogue scale (P <.05) between the groups. Group I had fewer complications than group II. There was no mortality in either group. CONCLUSIONS Bupivacaine given through a catheter to the extrapleural region before finishing thoracotomy is substantially beneficial for the prevention of postoperative pain and reduction of postoperative complications.

The Effect of High Dose Melatonin on Cardiac Ischemia-reperfusion Injury.

Purpose Melatonin, the most potent scavenger of toxic free radicals, has been found to be effective in protecting against pathological states due to the release of reactive oxygen species. This study was performed to establish the effect of high dose melatonin on protection against ischemia-reperfusion (I/R) injury in rat hearts. Materials and Methods Forty male Sprague-Dawley rats were used in this study. They were separated into four groups of ten rats each. A left coronary artery occlusion was induced in the rats by ligating the artery for 20 minutes and then releasing the ligation (reperfusion) afterwards. The control group was Group A. Group B was subjected to myocardial ischemia-reperfusion without any treatment, while Group C underwent myocardial ischemia-reperfusion with a melatonin treatment before the ischemia. Group D was subjected to myocardial ischemia-reperfusion with a melatonin treatment before the reperfusion. After 20 minutes of reperfusion, blood samples were obtained from each group for biochemical studies, and the animals were sacrificed for histological and, immunohistochemical examinations of the myocardial tissue. Results We found that the cardiac troponin T(cTn-T) levels were significantly increased in Group B when all groups were compared. In the Group C rats treated with melatonin, the cTn-T values were significantly lower than those in Groups B and D. In addition, malondialdehyde (MDA) and antioxidant enzymes including, superoxide dismutase (SOD) and myeloperoxidase (MPO) were lower than those in Group B in the melatonin treated groups. The differences were statistically significant (p < 0.05). Histopathologic and immunohistopathologic studies also supported the effectiveness of melatonin. Conclusion Our study suggests that high dose melatonin, appears to offer protection against cardiac ischemia-reperfusion injuries in rats by scavenging the free radicals and could have a potential clinical use in the management of myocardial ischemia.