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Postextubation swallowing dysfunction is a common phenomenon within the pharyngo-esophago-gastric dysmotility disorders. It is commonly seen after major surgery which requires endotracheal intubation for mechanical ventilation and associated with pulmonary complications which may lead to increased morbidity and mortality, prolonged hospital stay and increased cost. Thus, understanding the underlying mechanism of this phenomenon is crucial for early recognition and diagnosis of this entity, and to take preventive measures to minimize associated complications and morbidity. Literature search of the Medline database was performed to obtain related studies discussing pharyngo-esophago-gastric dysmotility. We focused on studies including PSD following major surgery and extracted data from the relevant studies, compared results, and summarized the related information. We reviewed the underlying mechanism, available diagnostic tools, risk factors, major pulmonary complications and their consequences, basic preventive measures and potential solutions related to this entity and aimed to guide physicians through decision-making process for their individual patients.

Bone cement implantation syndrome is a rare and potentially fatal complication which may occur following cemented bone surgery. Herein, we present a case of delayed and fatal presentation of bone cement implantation syndrome following cemented spinal surgery, despite mechanical support with extracorporeal mechanical oxygenation.

Purpose: The anterior mediastinal masses are composed of neoplasms from many different groups, thymic epithelial tumors (TET) being the most common type. Histologic subtype, tumor stage and completeness of resection are considered to be the most important prognostic factors in thymic malignancies. The aim of this study is to evaluate the association between the preoperative CT characteristics and the histological types, mostly focusing on thymic neoplasms. Methods: Preoperative CT features and pathologic data of 40 patients who underwent surgery due to an anterior mediastinal mass were retrospectively analyzed. Patients are grouped as thymomas, thymic carcinomas and others. Results: CT characteristics such as shape, contour, necrosis, lymph node enlargement, surrounding organization, pathologic invasion pattern, internal density, presence of cystic component, pleural/pericardial effusion and calcification were compared with histologic subtypes. Among these parameters solely pathologic invasion and surrounding organization were statistically different between the groups (p0,05). Conclusion: According to the results of our study, CT imaging has a limited role in predicting stage and malignant potential particularly for thymic neoplasms and anterior mediastinal masses.

Objective: Extracorporeal membrane oxygenation (ECMO) is a temporary life-support modality offered for stabilizing neonates with congenital diaphragmatic hernia (CDH) who are in a critical condition and unresponsive to optimal medical therapy. The aim of this study was to examine our institutional outcomes of early CDH repair on ECMO. Materials and Methods: A total of 17 ECMO-supported patients with CDH were evaluated and the demographic, diagnostic, laboratory, clinical data, complications and outcome of the patients were reported. Results: The study consisted of 7 females and 10 males. Mean birth weight (BW) was 3107 g (range, 2360–3840 g). Median age of ECMO initiation was 2.1 days. In total four patients received VV ECMO. Other patients received VA ECMO via aortic and right atrial cannulation. The mean duration of ECMO was 25 days (range: 1-140 days). Six patients (35.2%) could be weaned from ECMO. The most common ECMO related complications were hemorrhage, disseminated intravascular coagulation (DIC) and limb ischemia (64.7%, 41.1% and 29.4%, respectively). Diaphragmatic defect was repaired via a subcostal incision in 12 of 13 patients. In 88.2% of patients diaphragmatic repair was performed with polytetrafluoroethylene patch. In 77% of patients early CDH repair was performed concomitantly with ECMO insertion. The survival rate was 17.6%. Conclusion: Early repair of CDH in neonates on ECMO can be associated with high rates of morbidity and mortality. However, ECMO may be considered a life-saving measure for patients with CDH who would have otherwise not been salvageable.

Sternal cleft is a unique congenital chest wall malformation that results from failure of sternal fusion early in the embryological development. Surgical correction is advised both to protect mediastinal structures and to restore respiratory dynamics. Early surgical correction, preferably in the neonatal period, is recommended in order to benefit from the elasticity of the thoracic cage. In this article, we present a two-month-old female patient with a superior V-shaped sternal cleft, which was successfully corrected with posterior periosteal flap, sliding chondroplasty and cartilage graft interposition techniques.

Objectives:In this study, we examined our 38 years of institutional experience with 81 patients operated for primary cardiac tumor.Materials and Methods:Among the 81 patients included, 95% (n=77) had benign tumors and 5% (n=4) had malignant tumors. Benign tumors were myxomas (n=66, 81.5%), rhabdomyomas (n=9, 11.1%) and papillary fibroelastomas (n=2, 2.5). Malignant tumors included angiosarcomas (n=2, 2.5%) and rhabdomyosarcomas (n=2, 2.5%). Common symptoms of admission were dyspnea (49.4%), palpitation (30.9%) and systemic embolization (14.8%). Tumors originated from the left atrium in 61 cases (75.3%), right atrium in 12 cases (14.8%), right ventricle in 5 cases (6.2%) and left ventricle in 3 cases (3.7%). The surgical method was uniatrial in 47 patients (58%). Bilateral atriotomy was performed in 26 patients (32%). The incidence of postoperative complication was 14.8% (n=12).Results:In-hospital (30 day) mortality was 4.9% (n=4). The survival of other benign tumors and malignant tumors were poorer than the patients with myxomas.Conclusion:Surgical resection of primary cardiac tumors with negative margins have excellent long-term survival which are similar to general population.

Introduction Postoperative complications following thoracic procedures are a major cause of morbidity and mortality. Alveolar air leaks and/or bronchopleural fistulas are associated with increased risk of infection, prolonged chest tube, and hospital stay duration and therefore generate economical concern for health care providers. A variety of surgical sealants or adhesives have been introduced to overcome this complication. Since intraoperative BioGlue® application can also cause an inflammatory reaction and mimic tumor recurrence on FDG PET-CT, in the present study we aimed to investigate its potential role in false-positive PET-CT results in patients operated for NSCLC. Materials and methods Data of six patients who underwent resection for primary NSCLC at our institution (Department of Thoracic Surgery, Hacettepe University Medical Faculty) between January 2015 and December 2018 and had false positivity, due to BioGlue® application, at the bronchial stump in follow-up FDG PET-CT were retrospectively analyzed from a prospectively collected database. Result One of the 6 patients was female and 5 were male. The mean age was 68 years (range, 56-79 years). The average time interval between operation and postoperative FDG-PET imaging was 4.3 months (range, 4-6 months). Follow-up FDG-PET imaging SUVmax values ranged between 3.0 and 9.0 (median: 5.33). All patients have been evaluated by FDG-PET scan following the detection of soft tissue densities at the surgical site suspicious for recurrence at their follow-up chest CT scans. Four patients underwent a bronchoscopic examination, bronchial stumps were examined and multiple biopsies were taken from suspicious nodules or tissues and sent for pathologic examination. Histopathological results revealed inflammation which is compatible with foreign body granuloma, without any suspicion for malignancy, in all cases. Two patients were solely followed-up and subsequent FDG-PET imaging after 3 months revealed complete resolution of FDG uptake. Conclusions To avoid unnecessary biopsies or surgical procedures, the possibility of false-positive results due to surgical adhesive product use should be taken into account while interpreting follow-up FDG-PET imaging results and the operative reports should be written in detail, describing which surgical materials used and their exact application sites.

Tracheoesophageal fistulas (TEFs) are abnormal connections between the esophagus and tra-chea and are associated with atresia of the esophagus in most cases. Herein, we present a case of H-type TEF in a young woman which is successfully treated with slide tracheoplasty technique.

Thymic carcinoid tumors are rare tumors which may be associated with multiple endocrine neoplasia type 1. Bronchial carcinoids are also rare tumors and associated with multiple endocrine neoplasia type 1. Coexisting of thymic and bronchial carcinoid tumors in this case is extremely rare. Herein, we report a unique case of coexistence of thymic and bronchial carcinoid tumors which were simultaneously resected via thoracotomy.

Cardiac resynchronization therapy is a promising therapeutic option for patients with end-stage heart failure. The preferred method for left ventricular lead implantation is the percutaneous access through the coronary sinus. However, this technique may impose certain technical difficulties due to suboptimal lead positioning. In such cases, a video-assisted thoracoscopic epicardial approach may be a good alternative. To date, video-assisted left ventricular epicardial lead implantation from two or three port incisions have been described. Herein, we present the first successful left ventricular epicardial lead implantation through a simplified single-port video-assisted thoracoscopy technique in Turkey.

Kumbasar U, Aypar E, Karagoz T, Demircin M, Dogan R. Pulmonary thromboendarterectomy in pediatric patients: Report of three cases. Turk J Pediatr 2018; 60: 604-607. Chronic thromboembolic pulmonary hypertension (CTEPH), which occurs due to impartial resolution of the pulmonary thrombus, is a rare type of pulmonary hypertension. However, most patients have an excellent long-term survival following pulmonary thromboendarterectomy (PTE). Pulmonary emboli and associated CTEPH is unusual in the pediatric population and is mostly reveals an underlying thrombophilic state. PTE is also recognized as the best therapeutic option in this subgroup of patients. In this case series, we report three young patients who had successfully undergone PTE due to pulmonary emboli and associated CTEPH.

OBJECTIVES In this study, we aimed to evaluate the early and mid-term outcomes of surgery for renovascular hypertension (RVH) at our institution, within the last 13 years. METHODS We retrospectively reviewed 19 patients who underwent surgery for RVH, between 2005 and 2017. The age at operation, clinical characteristics, cause of arterial stenosis, diagnostic workup, surgical management and outcomes during the follow-up were analysed. The continuous variables were expressed as mean ± standard deviation. RESULTS Twelve female and 7 male patients underwent surgery for RVH. Their mean age was 17.07 ± 11.9 years (range 4–42 years). Nine patients had renal arterial stenosis, and 10 patients had midaortic syndrome (MAS). Aortorenal bypass with the saphenous vein was performed in 6 patients with renal arterial stenosis and 1 patient with MAS. An isolated thoracic aorta-abdominal aortic bypass was performed in 1 patient with MAS, and thoracic aorta-abdominal aortic bypass combined with unilateral aortarenal bypass was performed in 9 patients with MAS. The other surgical procedures performed were 2 autotransplantations and 2 unilateral nephrectomies. Among the patients with MAS, 4 underwent reoperation. The mean follow-up duration was 45.58 ± 32.7 months. Hypertension was cured in 3 patients and improved in 14 patients. The postoperative follow-up creatinine levels were similar to preoperative creatinine levels. All bypasses were patent on mid-term follow-up. One patient who underwent aortorenal bypass died 14 months postoperatively. CONCLUSIONS Surgical management is a suitable option for patients with RVH, who were unresponsive to medical and/or endovascular management. Surgical methods are safe and effective in children and young adults with RVH.

Gestasyonel Trofoblastik Neoplaziler (GTN) plasenta dokusundan köken alırlar ve erken vasküler invazyon yaptıklarından sıklıkla metastaz yaparlar. Beyin metastazı nadir görülür. Metastatik GTN'nin taranmasında 18-florodeoksiglukoz pozitron emisyon tomografisinin (FDG-PET) etkinliği konusunda veriler yetersizdir. Bu olgu sunumunda, eş zamanlı akciğer ve beyin metastazı olan ve beyin metastazının FDG-PET ile saptanama- dığı bir GTN olgusunu sunuyoruz., Gestational trophoblastic neoplasms (GTN) originate from placental tissue and usually metastasizes because of its propensity for early vascular invasion. Intracranial metastases are relatively uncommon. There are limited data on the efficacy of 18-fluorodeoxyglucose positron emission tomography (FDG-PET) in the eva- luation of metastatic GTN. We present a case of GTN with simultaneous pulmonary and cranial metastases in which the cranial metasteses were undetectable with positron emission tomography (PET) scan.

Background & objectives: Oxidative stress can cause many diseases and increases the risk of post-operative complications in children with congenital heart disease. For these reasons, this study was aimed to investigate the differences between cyanotic and acyanotic paediatric patients who underwent heart surgery with markers of oxidative stress. Methods: Eighty five patients were included in the study. The samples taken before the surgery and within the first 24 h after the surgery were evaluated for haemoglobin (Hb), leukocytes, uric acid, glutathione (GSH), malondialdehyde and total antioxidant capacity. Cyanotic, acyanotic, hyperoxygenated, normo-oxygenated, cardiac surgery with or without cardiopulmonary bypass (CPB) comparisons were made. Results: Positive correlation was found between age and pre-operative total antioxidant status values. Cyanotic and acyanotic patients did not have different antioxidant reserve capacities preoperatively. Although pre-operative thiobarbituric acid reactive substances (TBARS) levels were significantly lower in cyanotic patients, post-operative levels were higher. TBARS levels increased and GSH levels reduced postoperatively. The level of oxygenation did not cause a significant difference on markers of oxidative stress. The duration of CPB did not have negative effects on oxidative stress. Interpretation & conclusions: Cyanotic and younger patients were found to be more vulnerable to oxidative stress. The increased levels of TBARS and the decreased levels of GSH could be the indicators of oxidative damage depending on many factors such as surgery, CPB, ischaemia/reperfusion, inflammation, iron overload and oxygenation. The level of oxygenation does not cause a noticeable difference in oxidative stress. CPB causes oxidative stress, but if it is conducted appropriately, the duration of CPB does not cause a significant negative impact on oxidative stress.

Background This study aims to investigate whether preconditioning with alpha-lipoic acid has any protective effect in neuronal damage in an experimental spinal cord ischemia-reperfusion injury model. Methods Eighteen adult male New Zealand rabbits (2.4-3.5 kg) were equally divided into sham, control and treatment groups. The abdominal aorta was occluded for 30 min proximally 1 cm below the renal artery and distally 1 cm above the bifurcation using aneurysm clips in control and treatment groups. Treatment group received intraperitoneal 100 mg/kg lipoic acid 20 min before aortic cross-clamping. The animals were sacrificed 48 hours after the operation and spinal cord segments between L2 and L5 were removed for biochemical and histopathological analysis. Levels of glutathione, malondialdehyde, total nitrate/nitrite, advanced oxidation protein products, catalase, superoxide dismutase, and glutathione peroxidase were examined in spinal cord. Results Preconditioning with alpha-lipoic acid demonstrated significantly favorable effects in all measured parameters of oxidative stress. Histopathological evaluation of the tissues also demonstrated significantly decreased neuronal degeneration, axonal damage, and microglial and astrocytic infiltration in the treatment group compared to the control group. Conclusion The results of this study indicate that alpha-lipoic acid administration before aortic cross-clamping has significant neuroprotective effect on spinal cord injury in rabbits.

Iatrojenik trakeobronşiyal yaralanmaları, endotrakealentübasyon gibi hava yolu erişimi tekniklerinin ciddi komplikasyonlarındandır.Orotrakeal entübasyon sonrası görülme sıklığı yaklaşık % 0.005’dir. Zaman zamankoruyucu methodlarla tedavi edilseler de çoğu vaka cerrahi yöntemlerle tedaviedilir. Bu olgu sunumunda, 78 yaşındaki bir hastada, entübasyon sonrası meydanagelen geniş membranöz trakea rüptürünün kardiyopulmoner bypass yardımı ilecerrahi tedavisini sunuyoruz., Iatrogenic tracheobronchial injuries are severecomplications of airway access techniques such as endotracheal intubation. Thereported incidence is approximately 0.005% for orotracheal intubations.Although conservative methods may also be used, surgical intervention is thetreatment of choice for most cases. Herein, we present a 78-year old patientwith a post-intubation huge membranous tracheal rupture, which was eventuallyrepaired surgically with cardiopulmonary bypass support.

Doğumsal diyafragmatik herni (CDH), en sıkkarşılaşılan konjenital anomalilerden biri olup abdominal organların göğsüne herniyasyonunaneden olan diyafram kusurunun varlığı olarak tanımlanmaktadır. Son yıllardaileri tedavi stratejileri getirilmesine rağmen hayatta kalma oran, % 70civarında kalmışve geliştirilememiştir. KKH'de kötü sonuçların başlıcabelirleyicileri pulmoner hipoplazi ve pulmoner hipertansiyondur. Akciğerfonksiyonlarını ve sağkalımı geliştirmek için çeşitli cerrahi müdahaleler veyeni tıbbi tedaviler denmektedir, ancak istenilen seviyeden daha az orandadır.Protez materyali ile diyafragma defektinin onarımının, takip sırasında yüksekkomplikasyonlar ve rekürrens oranları ile ilişkili olduğu tespit edilmiştir. Bunedenle, rejeneratif ilaç hem hipoplazi akciğerlerde hücresel fonksiyonuindükleyerek (kök hücre tedavisi) hem de işlevsel bir miyojenik yama (dokumühendisliği) geliştirerek, CDH'de alternatif bir tedavi stratejisi olarakdüşünülmektedir.Solunum yetmezliğine sebep olan ciddi pulmoner hipoplazi vehipertansiyon ile doğan CDH'li yenidoğanların yaklaşık % 30'unun hayattakalması pulmoner hipoplazi derecesi ile ilişkili olduğundan, bu dereceyiprenatal olarak değerlendirmek büyük önem taşır. Prenatal ultrasonografi (US)ve manyetik rezonans görüntüleme (MRI) iki ana tanı aracıdır. CDH'de pulmonerhipoplazi ve hipertansiyonu iyileştirmek için çeşitli doğum öncesi tedavistratejileri denendi. Vitamin A, kortikosteroidler, C vitamini, E,N-asetilsistein, fosfodiesteraz inhibitörleri, glukagon benzeri peptit 1agonistleri ve tirozin kinaz inhibitörleri gibi antioksidanlar hayvançalışmalarında analiz edildi ve değişken sonuçlar gösterdi. İnsanlar üzerindeçok az çalışma olduğu için, bu terapilerin klinik yararlarını teyit edebilmekiçin ileri aşama araştırmalar insanlar üzerinde olmalıdır. Doğumdan sonrabebeğe destekleyici tedavisinin yanı sıra solunum yetmezliği durumunda tercihenyüksek frekanslı salınımlı ventilasyon ile solunum desteği de uygulanmalıdır.Eksojen kök hücreler, özellikle AFS hücreleri akciğer gelişimini hem çeşitlipulmoner hücre tiplerine entegre ederek, hem de anti-inflamatuvar veimmünomodülatör etkiler yoluyla parakrin modele göre veya doğal progenitörhücreleri aktive ederek geliştirebilir. Ancak, akciğer hasarının altında yatanmekanizmayı ve kök hücrelerin moleküler tepkisini anlamak için, özellikle deinsanlarda yapılacak daha ileri araştırmalara ihtiyaç vardır. Doğum öncesitarama yöntemlerindeki ilerlemeler sayesinde, artık gebelikteki en büyükgenetik bozuklukların çoğunu tespit etme ve postnatal dönemde optimal tedavistratejisi sunma olanaği bulunmaktadır. CDH'li çocukların tedavisinderejeneratif tıbbın uygulanmasına ilişkin hayvan çalışmalarının sonuçlarıgelecek vadetmektedir. Yakın gelecekte özellikle güvenlik ve etik konularçerçevesinde yoğunlaşan daha ileri çalışmaların desteğiyle, klinik olarak uygulanması için gerekli kanıtlar buçalışmalar ile sağlanacaktır., Congenitaldiaphragmatic hernia (CDH) is one of the most common major congenital anomaliesand is described as the presence of a diaphragmatic defect that leads theherniation of abdominal organs into the chest. Although advanced treatment strategies are introduced over the recent years, they have not reallyimproved the survival rate which stayed at around 70%. Major determinants ofpoor outcome in CHD are pulmonary hypoplasia and pulmonary hypertension.Various surgical interventions and novel medical therapiesare attempted to improve lung function and survival but remains less thandesired. Repair of the diaphragmatic defect with prosthetic materials was foundto be associated with high rates of complications and recurrences duringfollow-up. Therefore, regenerative medicine should beconsidered as an alternative treatment strategy in CDH both by inducingcellular function in the hypoplastic lungs (stem cell therapy) and bydeveloping a functional myogenic patch (tissue engineering). Nearly 30% ofinfants who have CDH born with severe pulmonaryhypoplasia and hypertension which may lead to respiratory failure and promptmechanical support, since the survival of these newborns relate to the degreeof pulmonary hypoplasia, accurate prenatal evaluation of this degree is of paramount importance. The two maindiagnostic tools which could be used for this purpose are prenatal ultrasound(US) and magnetic resonance imaging (MRI). Various prenatal treatmentstrategies have been tried to cure pulmonary hypoplasia and hypertension in CDH. Vitamin A,corticosteroids, antioxidants such as vitamin C, E,N-acetylcystein, phosphodiesterase inhibitors, glucagon-like peptide 1 agonistsand tyrosine kinase inhibitors have all been analyzed in animal studies anddemonstrated variable results. Since there are veryfew human studies, further researches should be performed in humans confirmingthe clinical benefit of these therapies. Due to the advancements in prenatalscreening methods, we, now have the ability to detect most of the major genetic disorders in gestation and have chance toprovide optimal treatment strategy in the postnatal period. Results of theanimal studies regarding the application of regenerative medicine for treatmentof children with CDH are encouraging. Hopefully, withthe support of further studies focusing especially on safety and ethicalissues, the near future will provide us the evidence necessary for theirapplication in our clinical practice.

Hidatidoz, hayvancilikla ugrasilan ulkelerde endemik parazitik bir hastaliktir. Perikardiyal hidatik hastaliga bagli gelisen konstriktif perikardit, oldukca nadir gorulen bir rahatsizliktir. Bizim olgumuzda kist, primer kardiyak kist hidatik degil idi. Bu yazida, 72 yasindaki erkek hastada hepatik bir kist hidatigin perikarda fistulizasyonuna bagli gelisen konstriktif perikardit olgusu sunuldu. Parsiyel perikardiyektomi ve hepatik kistin drenaji basari ile uygulandi ve takiben medikal tedavi verildi. Anah tar soz cuk ler: Fistul; hidatik kist; perikard. Hydatidosis is a parasitic infestation which is endemic to sheepherding regions of the world. Constrictive pericarditis secondary to pericardial hydatid disease is a very rare entity. In our case, the cyst was not a primary cardiac hydatid cyst. In this article, we report a 72-year-old male case of constrictive pericarditis due to fistulization of a hepatic hydatic cyst to the pericardium. Partial pericardiectomy and drainage of the hepatic cyst were performed successfully, followed by medical treatment.

To analyze the consequences of major pulmonary resections on right ventricle (RV) function by using the tissue Doppler imaging (TDI) technique. Materials and methods: Twenty patients (16 males and 4 females) who received pulmonary resection for primary non-small cell lung cancer underwent echocardiographic examinations before surgery on the 2nd and 7th postoperative days. Results: Tricuspid E wave significantly decreased from the postoperative 2nd day to the 7th day (45.93 ± 8.0 to 35.77 ± 7.4 cm/s; P = 0.02). On the postoperative 2nd and 7th days, tricuspid A wave values (58.27 ± 9.6 and 58.94 ± 8.4 cm/s) were significantly higher compared to preoperative values (45.71 ± 12.2 cm/s; P = 0.02 for both). The S' wave measured at the basal segment of the right ventricle markedly decreased on the postoperative 2nd day (12.35 ± 2.2 to 10.15 ± 3.2 cm/s; P = 0.03). Tricuspid annular S’ wave velocity of patients who underwent pneumonectomy was lower than in patients who underwent lobectomy (10.65 ± 2.4 versus 14.42 ± 3.3 cm/s; P = 0.04). Conclusion: In the early postoperative period, significant dilatation and dysfunction of the RV is caused by pulmonary resection. Early detection of this deterioration by means of this noninvasive technique could make swift interventional therapy possible, which is an important step towards avoiding future right heart failure.

Primary neoplasms of the diaphragm are rare. Neurogenic tumors of the diaphragm, particularly those showing malignant degeneration are quite rare. We report herein a case of a 48-year-old woman, who was found to have a malignant schwannoma of the diaphragm.

Transmediastinal approach for resection of bilaterally metastatic lung tumors, bullectomy and apical pleurectomy is a technically feasible and safe method. We report herein a 40-year-old male with a 20-year history of progressive dyspnea who underwent bilateral bullae excision through a left posterolateral thoracotomy. We tried to emphasize that a transmediastinal contralateral approach may prevent a secondary operation in patients with bilateral bullous lesions.