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Amaç: Sedoanaljezi eşliğinde entübasyon olmadan video yardımlı torakoskopik cerrahi (VATS) son on yılda minimal invaziv prosedürler için giderek daha popüler bir cerrahi teknik haline gelmiştir. Bu çalışmada ise, sedasyon veya torasik epidural anestezi kullanılamayan hastalarda sadece lokal anestezi ile uygulanan video yardımlı torakoskopi tekniğinin sunulması amaçlanmıştır. Gereç ve Yöntemler: 2009-2019 yılları arasında, genel anestezi riski yüksek olarak sınıflandırılarak uyanık halde video yardımlı torakoskopik cerrahi yapılan 43 hasta retrospektif olarak incelendi. 10 ml izotonik ile sulandırılan 10 ml %0,5 bupivakain, cilt altına ve kas içine uygulandı. 15 dakika sonra 10 mm 0 derece videotorakoskop için toraksa tek bir port insizyonunu takiben VATS uygulandı. Yaş, cinsiyet, başvuru yakınmaları, lateralite, efüzyon tipi, sitoloji sonuçları, hastaların komorbiditeleri, hastanede kalış süresi, efüzyon miktarı, ameliyat süresi ve patoloji sonuçları retrospektif olarak değerlendirildi. Bulgular: Yaş ortalaması 67,32 (45-85) olan kırk üç hastanın 23’ü erkek, 20’si kadındı. En sık yakınma (n = 40) dispne idi. 22 sol ve 21 sağ hemitoraksa VATS uygulandı. 39 hidrotoraks, 4 pnömotoraks olgusu vardı. Hidrotoraks tanılı olgulardan drene edilen ortalama sıvı miktarı 1311 ml (400-4000 ml) idi. Bül nedeniyle pnömotoraks gelişen 2 olguya wedge rezeksiyon yapıldı. Hiçbir hastaya kas gevşetici veya sedasyon verilmedi. Sonuç: Uyanık VATS seçilmiş hastalarda, kas gevşetici ve sedoanaljezi gerektirmediğinden güvenli bir tekniktir.

Aim: Nuss procedure for pectus excavatum and Abramson procedure for pectus carinatum are used as minimally invasive methods for surgical treatment of chest wall defomities. The aim of this study is to investigate the causes of bar-related complications, and to present technical details of their management. Materials and Methods: Patients who underwent minimally invasive correction surgery with the diagnosis of pectus excavatum and pectus carinatum between 2011-2020 in our clinic were included in this study. The surgical treatments, bar related complications, and follow-up records of patients were recorded and analyzed retrospectively. Results: 141 patients with a mean age of 16.08 ± 4.38 were included in the study. Postoperative bar-related complications were encountered in 28 (19.8%) of all patients. There were no life-threatening early or late complications. The most common complication was skin reaction in 7 (4.9%) cases. Conclusion: Bar-related complications are problems that can cause morbidity and disrupt patient comfort, thus management of complications should be focused on.

Background: In this study, we aimed to examine the development of knowledge on pectus deformities through a meticulous analysis of the 100 most-cited articles published on this topic. Methods: Publications related to pectus deformities from January 1975 to April 2020 were scanned using the Web of Science Core Collection database. The publications were ranked from maximum to minimum according to the number of citations and were examined in detail. Results: The 100 articles were published in 27 different journals and received a total of 8,290 citations. The average of the impact factors of journals in 2018 was 4.441. The mean citation density of all articles was 5.1±3.8. In the past years, a surgical technique definition and experience transfer were more frequently used, while complications and technical details were started to be presented in recent years. Conclusion: Our study results suggest that the studies of pectus deformities would continue and, from now on, issues such as complications and technical details would come to the forefront in the articles.

Most of the previous studies evaluating lung volume of pectus excavatum (PE) patients were based on spirometric measurements. We aimed to calculate lung volume of patients with PE and compare them with lung volume of patients without chest wall deformity using CT volumetry. After institutional review board approval, preoperative chest CT of PE patients who underwent minimal invasive procedure between January 2012 and February 2018, were evaluated retrospectively. As a control group, age and sex matched patients who underwent chest CT scan in the same period were enrolled. Total, right and left lung volumes were calculated using an automated software. Haller indexes were measured for both groups. Lung volumes and Haller indexes compared between the two groups. We also compared left and right lung volumes in both groups. We evaluated whether there is a correlation across the Haller index and total lung volume. Total, right and left lung volumes were not statistically different between the two groups. While left lung volumes were significantly smaller in PE group (p = 0.041), there was no significant difference between the left and right lung volume in the control group (p = 0.12). Haller index and total lung volume showed no significant correlation between patients with the same age and gender (p = 0.14, R = −0.3). PE deformity does not reduce lung volume when compared to age and sex matched control group. Quantitative CT volumetric evaluation of lung gives valuable data about lung volume.

WOS: 000448749100002, PubMed: 30377655, Cyst hydatid in the lung is still a health problem for many countries. It develops in the lung and can grow into the lung parenchyma. When it is diagnosed as a giant cyst, surgery should be performed. In the surgery, capitonnage is necessary to protect the lung parenchyma.

Aim: Computed tomography (CT) and magnetic resonance imaging (MRI) are diagnostic modalities in pulmonary hydatid disease. We aimed to present CT and MRI findings in pulmonary hydatid disease. Material and Methods: CT and MRI findings of pulmonary hydatid cysts from January 2011 through June 2018 were evaluated retrospectively. CT images of 112 patients and MRI images of 27 patients were evaluated. Patients’ gender and ages, lesion number and distribution, concomitant organ involvement, complications, HU density of lesions on CT and signal characteristics of lesions on MRI were analyzed. T2 hypointense rim, T1 and T2 signal intensity, daughter vesicle and detached membranes were the evaluated parameters on MRI.Results: 147 hydatid cyst lesions of 119 (66 female, 53 male) patients with a mean age of 39.4±19.6 years were included in the study 62 (52.1%) of patients had isolated lung involvement. 79 of 119 patients (66.4%) had solitary lung lesion. Mean CT density of cysts were 16 HU. 25 of 32 cysts showed T2 hypointense rim on MRI. Conclusion: Imaging plays important role in diagnosis and presurgical evaluation of pulmonary hydatid disease. CT is mostly used in diagnosis; MRI should be a choice particularly in pediatric population.Keywords: Computed tomography; pulmonary; hydatid cyst; magnetic resonance.

Antik schwannomlar nadiren görülen tümörlerdir. Genellikle retroperiton yerleşimlidirler. Asemptomatik olarak büyük boyutlara ulaşabilmektedir. Radyolojik tetkikler tümörün yerleşimi ve karakteri hakkında yardımcı olmaktadır. Tedavisi cerrahi olarak rezeksiyondur. Tanısı patolojik olarak konur., Ancient schwannomas are rarely seen tumors. Generally they are located in retroperitoneum. They can arrive larger diameters without clinical symptoms. Radiological imaging is beneficial for location and morphology of tumor. The treatment is surgical resection of tumor. It is diagnosed by pathology specimen.

Gastroözefageal reflü için uygulanan cerrahi tedavilerden biri olan Nissen fundoplikasyonu, minimal invaziv olması, hastada daha az ağrıya yol açması ve daha kısa süreli hospitalizasyon gerektirmesi nedeniyle yaygınca uygulanmaktadır. Ancak komplikasyon oranı oldukça düşük olmasına rağmen ölüme neden olabilecek tansiyon pnömotoraks gibi bir klinik durum ortaya çıkabilmektedir. Hastamızda reflü cerrahisi (Nissen fundoplikasyonu) sonrası tansiyon pnömotoraks ve sonrasında hidrotoraks gelişmiştir. Bu gibi komplikasyonlar hastanede kalış süresini uzatmakta, morbiditeyi artırmaktadır. Laparoskopik cerrahi işlemler kolay ve yaygın uygulamalardır; intraoperatif ve postoperatif komplikasyonlar açısından erken tanı önemlidir, Nissen fundoplication, one of the surgical procedures applied to treat gastroesophageal reflux, is performed commonly because it is minimally invasive, causes the patient less pain, and requires shorter hospitalization. However, despite the low complication rate some patients may develop tension pneumothorax, a clinical condition that can be fatal. After reflux surgery (Nissen fundoplication), our patient develop tension pneumothorax and then hydrothorax. Such complications lead to prolonged hospitalization and increased morbidity. Laparoscopic surgical procedures are practical and common interventions; and early diagnosis is important for intraoperative and postoperative complications.

Objective : The goal of this retrospective study was to evaluate the outcomes of bilateral video-assisted thoracoscopic sympathectomy for primary hyperhydrosis. Methods : Between January 2007 and December 2011, a total of 335 patients (192 male, 143 female, mean age 28.3 years) who underwent bilateral thoracoscopic sympathectomy for primary hyperhydrosis were reviewed retrospectively. Results : Hyperhydrosis occurred in the palmar and axillary region in 175 (52.23%) patients, in only the palmar region in 52 (15.52%), in the craniofacial region in 44 (13.13%), in only the axillary region in 42 (12.53%), and in the palmar and pedal regions in 22 (6.56%) patients. Bilateral thoracoscopic sympathectomy was performed in all patients. The mean follow-up period was 24 (6-48) months. The initial cure rate was 95% and the initial satisfaction rate was 93%. There was no mortality in this study. The complication rate was 15.82% in 53 patients. Conclusion : Video-assisted thoracoscopic sympathectomy for the treatment of primary hyperhydrosis was effective, with low rates of morbidity and mortality. Despite the appearance of postoperative complications, such as compensatory sweating, patient satisfaction with the procedure was high and their quality of life improved.

WOS: 000328933900006, PubMed: 24240383, Background: We present the results of surgical correction of pectus excavatum (PE) and pectus carinatum (PC) deformities in adults, and also report a new method of sternal support used in surgery for PE deformities. Methods: We present the results of 77 patients between the ages of 10 and 29 years (mean 17) with PE (n = 46) or PC (n = 31) deformities undergoing corrective surgery from 2004 to 2011, using the Ravitch repair method. Symptoms of the patients included chest pain (15%) and tachycardia (8%). Three patients underwent repair of recurrent surgical conditions. Results: All of the patients with dyspnoea with exercise experienced marked improvement at five months post operation. Complications included pneumothorax in 5.1% (n = 4), haemothorax in 2.6% (n = 2), chest discomfort in 57% (n = 44), pleural effusion in 2.6% (n = 2), and sternal hypertrophic scar in 27% (n = 21) of patients. Mean hospitalisation was eight days. Pain was mild and intravenous analgesics were used for a mean of four days. There were no deaths. Results after surgical correction were very good or excellent in 62 patients (80%) at a mean follow up of three years. Three patients had recurrent PE and were repaired with the Nuss procedure. In three patients who underwent the Ravitch procedure, a stainless steel bar was used for sternal support instead of Kirschner wire. Conclusions: Pectus deformities may be repaired with no mortality, low morbidity, very good cosmetic results and improvement in cardiological and respiratory symptoms.

WOS: 000408345600004, PubMed: 28825029, Introduction Esophageal foreign body (FB) in all age groups can cause serious morbidity or mortality. The study aims to report our experience retrieving FBs from the upper esophagus in children using Magill forceps. Materials and Methods In this study, 88 patients (45 males [51.1%] and 43 females [48.9%]) were presented with suspected FB ingestion. FB ingestion was determined via endoscopic analysis, or lateral and posterior-anterior radiographies, including oropharynx, neck, chest, and abdomen. Cases were classified into seven groups, according to history, diagnostic method, and postintervention findings, as follows: (1) coins, (2) toys, (3) metals, (4) bones, (5) battery, (6) glass, and (7) food. A laryngoscope was used to elevate the larynx and expose the esophageal entrance. Magill forceps were advanced into the esophagus and opened to observe and extract the FB. Results All 88 patients who underwent endoscopic examination due to suspected FB ingestion were confirmed to have ingested a FB. Median age was 12 years; 15 patients were aged < 5 years; 63 (71.5%) were diagnosed based on routine radiographic findings, and others were diagnosed based on physical findings and history. The most common type of FB was coins (n = 51 [57.9%]). Mean surgical duration was 20 minutes. Conclusion FBs located at cervical esophageal level are usually the most difficult to remove. Magill forceps should be used before other methods.

WOS: 000387037900004, PubMed: 28824977, Transient vision loss after major surgical procedures is a rare clinical complication. The most common etiologies are cardiac, spinal, head, and neck surgeries. There has been no report on vision loss after lung resection. A 65-year-old man was admitted to our clinic with lung cancer. Resection was performed using right upper lobectomy with no complications. Cortical blindness developed 12 hours later in the postoperative period. Results from magnetic resonance imaging and diffusion-weighted investigations were normal. The neurologic examination was normal. The blood glucose level was 92 mg/dL and blood gas analysis showed a PO2 of 82 mmHg. After 24 hours, the patient began to see and could count fingers, and his vision was fully restored within 72 hours after this point. Autonomic dysfunction due to impaired microvascular structures in diabetes mellitus may induce posterior circulation dysfunction, even when the hemodynamic state is normal in the perioperative period. The physician must keep in mind that vision loss may occur after lung resection due to autonomic dysfunction, especially in older patients with diabetes mellitus.

Bilgisayarli tomografi anamnezi supheli gecmeyen pnomonisi olan hastalarda endobronsial bir obstruksiyonu gosterme acisindan onemlidir. Ozellikle organik maddelerin siserek zaman icerisinde obstruksiyon olusturmasinda yardimci olabilmektedir ayrica atelektazileri gostermede mukemmeldir. Tespit edilen yabanci cismi cikarmada rijid bronkoskop kullanilmaktadir. Ana bronsa ve trakeaya yerlesen yabanci cisimler de hizli ve dogru bir bicimde forseps yardimi ile cikartilmaktadir

Background: A significant proportion of cases of tracheobronchial foreign body aspiration due to life-threatening condition is observed during childhood. The aim of the present study was to describe our experience with the diagnosis and treatment of foreign body aspirations during childhood and review published literature. Methods: One hundred and eighty-four patients under 16 years of age with a tentative diagnosis of foreign body aspiration were retrospectively evaluated according to age, sex, patient delay symptoms at presentation, foreign body type, localization and the diagnostic and therapeutic methods used. Results: The most frequently aspirated objects were shelled nuts and seeds such as sunflower seeds, pistachio and hazelnuts. The chief symptom was cough. On physical examination, the most frequent findings were unilateral decrease of respiratory sound on the affected side with coarsening and bronchi. While 51% of cases presented a radiological finding, chest X-ray was normal in the other. All patients underwent rigid bronchoscopy under general anesthesia and a foreign body was identified in 137 (74.3%). The rigid bronchoscopy intervention was used in some cases, especially in the presence of tracheal foreign bodies of organic origin. Conclusions: Tracheobronchial foreign body aspiration is a significant cause of childhood morbidity and mortality. Early diagnosis and treatment is of utmost importance. Rigid bronchoscopy under general anesthesia should be performed in all patients suspected of foreign body aspiration, which could minimize mortality and morbidity if performed by experienced personnel with safe methods.

WOS: 000448027400013, PubMed: 29752918, …

Farm tractors are the major cause of occupational fatalities in agricultural regions. Fatalities typically result from being run over or crushed by the tractor, becoming entangled in the moving parts of the tractor, accidents on roadways, and tractor rollovers, which involve the tractor tipping sideways or backwards and crushing the operator. In this study, tractor-related fatalities in the Konya province of Turkey are retrospectively evaluated. Out of the 3940 cases on which a death examination and/or autopsy was performed between the years 2000 and 2007 at The Konya Branch of Forensic Medicine Council, 86 (2.2%) of the death cases were caused by tractor accidents and are included in this study. The ages of the victims varied between 3 and 80 years old with a mean age of 31.7 + or - 22.3. Sixty-eight (79.1%) of the cases involved males, while 18 (20.9%) of the cases involved females. In 32 (37.2%) of the cases, the deaths due to tractor accidents occurred when the tractor overturned. In 37 (43.0%) of the cases, the tractor-related fatalities involved the passengers and the drivers were involved in 34 (39.5%) of the cases. In conclusion, tractor accidents are preventable and deaths from tractor accidents can be significantly reduced if drivers are required to wear safety belts and helmets and frequent checks are implemented to enforce the ban on carrying passengers.

Persons whose occupations are in animal husbandry may be seriously injured or killed while tending to animals. Bulls are among the most dangerous of these animals. In this study, seven deaths and 23 traumatic injury cases caused by bull attacks and treated in the General Surgery and Chest Surgery Department of Selcuk University Meram Medical Faculty Hospital are presented. Of the 30 total cases, 24 were male and 6 were female. The ages of the cases ranged from 33 to 86 years and the average age was 60.3 +/- 12.4 (mean +/- standard deviation). All of the death and injury cases occurred while engaged in the care of bulls. It was also determined that the injuries were in the chest region of five (71.4%) and in the head of two (18.6%) out of seven death cases; and in the abdominal region of 14 (60.9%) and in the chest region of nine (39.1%) out of 23 traumatic injury cases. Of the 14 cases that were in the abdominal region and treated surgically, 11 were perforation of small/large intestines, whereas hemorrhages involving the intestinal mesentery, intraabdominal hemorrhage due to perforation of the abdominal wall, and splenic laceration were determined in one case each. There were one or multiple costal fractures in all nine chest injury cases, flail chest in five cases, and hemothorax, pneumothorax, or hemopneumothorax were determined in six cases. Of the chest injury cases, tube thoracostomy was performed in six whereas the other three cases were discharged from the hospital after supportive care. It was concluded that animals such as bulls might be the cause of serious trauma ending with death for those working in the animal husbandry. For this reason, caution is required while feeding and working with bulls. Risk can be reduced by chutes, gates, restraints, special housing, and confinement facilities. Also, wearing protective helmets would be useful especially for preventing head injuries.

PubMed: 26625768, Background: In this study, we aimed to determine platelet indices such as platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), Plateletcrit (PCT) platelet count (PLT) in lung cancer cases, and evaluate any relationships between these parameters and stage or histologic types. Materials and Methods: This retrospective study covered 44 lung cancer patients and 47 healthy subjects. Platelet indices including PLT, PCT, MPV, PDW were estimated and compared with normal subjects. The results were evaluated statistically. Results: The PDW value was significantly higher in the cancer group compared to the control group; however, the values for PCT and MPV were lower. Conclusions: We suggest potential use of platelet indices in diagnosis of lung cancer.

Simultaneous bilateral pneumothorax is a very rarely condition that is mainly seen in patients with underlying metastatic disease or lung cancer. It is estimated that < 1% of all cases of spontaneous pneumothorax are tumor-associated and most commonly due to the metastatic osteogenic or soft tissue sarcomas .