Search

BackgroundAlthough they constitute a small portion of thoracictrauma, sternal fractures require attention as they may be indicators of majorcardiac injuries. The aim of this study is to review the diagnosis, treatment,and outcome of such patients administered to our emergency department.Material and MethodsThe archive files of the patients administered to theemergency department due to thoracic trauma and diagnosed to have sternalfractures between January 2015 and December 2017 were reviewed for age, gender,type of trauma, type of injury, associated injuries, and clinical outcome.ResultsThere were 27 male, and 6 female patients. The meanage was 48.9 ± 16.50 years (20-79). The most frequent cause was vehicleaccident. The sternal fracture was isolated in 13, and associated with otherinjuries in 20 patients. Eight of the isolated fracture patients and all of thelatter were hospitalized. Six of the patients underwent tube thoracostomy, onebilateral. When the length of hospital stay is compared between the two groups,sternal fracture with associated injury patients stayed in the hospital forsignificantly longer periods. ConclusionAlthough isolated sternal fracture is benign in natureand may be treated with basic measures, when associated with other injuries, itbecomes more complicated to treat, and the length of hospital stay increasessignificantly., Amaç;Sternum fraktürleri,göğüs travması sonrası acil serviste görülen patolojilerden küçük bir yüzdesinioluşturmasına rağmen, kardiyak yaralanmaların habercisi olabilmeleri nedeni iletanı ve izlemleri önem taşımaktadır. Amaç bu hastaların tanı izlem vetedavisindeki yaklaşımları tartışmaktır. Yöntem;Çalışma Ocak 2015 –Aralık 2017 tarihleri arasında göğüs travması sebebi ile acil servise başvuruyapan ve sternum fraktürü tanısı alan 33 hastanın demografik özellikleri veklinik özellikleri retrospektif olarak değerlendirildi. Bulgular;Hastaların 27’si erkek,6’sı kadındı. Yaş ortalaması 48.9 ± 16.50 (20-79) olarak tespit edildi. En sıkgörülen etiyolojik neden trafik kazası olarak bulundu. Hastaların 13’ünde izolesternum fraktürü tespit edilirken 20’sinde komplike fraktür görüldü. Eşlik edenen sık travmatik patoloji kot fraktürü olarak tespit edildi. İzole fraktürlerin8’i hastaneye yatırılırken komplike fraktürlerin tamamının izlemi hastaneyeyatırılarak tedeavisi yapıldı. Olguların 6 sına tüp torakostomi uygulandı.Hastanede yatış süreleri açısından değerlendirildiğinde komplile sternumfraktürü mevcut olan hastaların izole fraktürlere göre istatistiksel olarakanlamlı bir şekilde uzun olduğu tespit edildi .Sonuç;İzole sternum fraktürlerimedikal yöntemlerle güvenle yönetilerek hastanede kalış süresi kısa, iyiprognozlu travmalar olarak değerlendirebilir. Eşlik eden yaralanma tespitedilen hastalarda meydana gelen patolojiler nedeniyle hem hastanede kalışsüresi hem de morbiditenin arttığı kanısındayız.

Background This study aims to perform autologous blood pleurodesis in an animal model and investigate the effects of paracetamol and diclofenac on autologous blood pleurodesis. Methods We divided 42 female Wistar albino rats (aged three months; average weight 275±25 g) into three major groups of 14. Each major group was further divided into two subgroups of seven rats to be sacrificed at seven days for early changes and 21 days for late changes. We performed autologous blood pleurodesis in all rats at a dose of 3 mL/kg. Group C (control group) was administered saline, group P was administered paracetamol, and group D was administered diclofenac for the postoperative five consecutive days as a single dose intraperitoneally. We sacrificed the rats at the designated dates and removed the thoracic cages en bloc. Results According to macroscopical and microscopical evaluation of the specimens, paracetamol led to a similar degree of adhesions with saline, whereas diclofenac significantly reduced the intensity of the desired adhesions between the two pleural sheets (p=0.05). Conclusion Using anti-inflammatory analgesics following autologous blood pleurodesis may lead to unsuccessful outcome of the procedure.

Tup torakostomisi, kardiyovaskuler cerrahi kliniklerinde rutin olarak kullanilan bir girisimdir. Tup torakostomisi bircok durumda hayat kurtarici bir islem olmakla birlikte, mortaliteye neden olabilecek ciddi komplikasyonlari vardir. Klinigimizde koroner arter baypas greft (KABG) ameliyati yapilmis 71 yasinda erkek bir hastada, ameliyat sonrasi apikal gogus tupu yerlestirilmesinin alisilmadik bir komplikasyonu olarak cikan aort perforasyonu gelisti. Bu komplikasyon basarili bir sekilde tedavi edilerek, hasta tam sifa ile taburcu edildi. Ozellikle torakarli tup torakostomisi uygulanan hastalarda bu nadir ancak olumcul komplikasyonun gelisebilecegi akilda tutulmalidir. Keza, ameliyat sonrasi donemde bu hastalarda mediastinal yer degisikligi olup olmadigina dikkat edilmelidir. Anah tar soz cuk ler: Aort rupturu; gogus tupu; torakostomi. Tube thoracostomy is a routine intervention which is used in cardiovascular surgery clinics. Although it is a life-saving intervention in most cases, it has serious complications leading to mortality. We encountered an ascending aortic perforation, an unusual complication following apical chest tube insertion, in a 71-year-old male patient who underwent coronary artery bypass graft (CABG) surgery in our clinic. This complication was managed successfully and the patient was discharged with a complete recovery. This rare but fatal complication should be considered for the patients undergoing tube thoracostomy, particularly with a toracar. It should also be noticed whether the patients have mediastinal shift in postoperative period.

Background: Pulmonary hypertension development in pure severe aortic stenosis is a situation that affects mortality and morbidity. Material and Methods: Data from files of 31 patients with systolic pulmonary artery pressure over 50 mm Hg and with pure severe aortic stenosis, and underwent aortic valve replacement in our clinic were examined retrospectively. Results: Preoperative effort capacities of the patients were evaluated as follows according to NYHA; 4 patients class 1-2, 16 patients class 3, and 11 patients class 4. Twenty-five metal, and 6 biologic aortic valves were used. Postoperative hospital mortality was recorded as 12% with 4 patients. Patients were reevaluated on the postoperative 2nd and 12th months. Pulmonary arterial pressure of the patients was measured using echocardiography. Preoperative average pulmonary artery systolic pressure was measured as 55 ± 3 mmHg. The average pressure was measured as 41 ± 3 mmHg on the 2nd, and as 37.8 ± 4 mmHg on the 12th month. The effort capacity evaluation in the postoperative 2nd month was as follows: 11 patients class 1-2, 12 patients class 3, and 4 patients class 4. The effort capacity evaluation conducted in the 12th month was: 14 patients were class 1-2, 10 patients were class 3, and 2 patients were class 4. During the follow-up 1 year, survival rate of the patients was determined as 83.8% average, 5 year survival rate was determined as 61.5%. Conclusion: We believe that AVR may be performed in severe aortic stenosis cases with high pulmonary pressure with acceptable ortality, leading to a better quality and longer life.

Background. Thoracic outlet syndrome may be due to various reasons and be classified as neurogenic, arterial, and venous thoracic outlet syndrome. The surgical treatment of neurogenic thoracic outlet syndrome can be performed using either a trans-axillary or a supraclavicular approach. The aim of this study is to report on such patients operated in a single institution by a single thoracic surgeon using trans-axillary approach. Methods. The patient files were screened for patients operated due to neurogenic thoracic outlet syndrome related symptoms between September 1, 2002 and April 1, 2015 in the Department of Thoracic Surgery of Bursa Yuksek Ihtisas Training and Research Hospital. Results. There were 22 female and five male patients with an average age of 31.9±11.7 years. The most common symptom was pain in the affected limb and shoulder (n=29). Of the diagnostic maneuvers abduction external rotation (Roos) test was the most frequently found positive test (n=27). Nerve conduction velocity studies revealed an average ulnar nerve conduction velocity of 62.7±6.6 m/s. Limited pneumothorax uneventfully resolved in 2 days was seen following 12 operations. Conclusion. We conclude that trans-axillary approach may provide good exposure with favorable opportunity to excise the 1 st and the cervical rib, and neurolysis with a low rate of complication.

Background. When a sternotomy cannot be performed at the midline and/or there is infection at the operation site, sternotomy revision can cause problems that increase the mortality and morbidity of the patients. There is no agreement on the best treatment method. In this paper we present a modified wiring technique. Methods. This technique consisted of wrapping wires twice around each rib head and placing standard circumferential wire sutures, thus providing full stability by decreasing the load on the sternum using only steel wires. The study group included 23 patients with sternal dehiscence because of inappropriate sternotomy (n = 10) and/or mediastinitis (n = 13). Two mediastinal tubes were placed for irrigation in 13 patients with mediastinitis and/or wound infection, and mobilization and interposition of omentum as an axial graft was performed in 2 patients. Irrigation and antibiotherapy were continued for 4 to 6 weeks. Results. Complete wound healing was obtained in all patients. Twenty-two patients treated with this technique survived. One patient died on postoperative 42nd day because of renal insufficiency and multi-organ failure. Conclusion. Early and aggressive debridement of infected and necrotic tissue, irrigation, and antibiotics are necessary for successful treatment, but we believe that the most important factor is full stabilization of the sternal tissue with minimal use of foreign stabilization material. Despite the limited number of cases, we suggest that our stabilization technique seems to be successful in achieving full stabilization even in infected and fragile sternal bony tissue in patients with sternal dehiscence and/or inappropriate sternotomy

Hypothermic total circulatory arrest and open proximal anastomosis techniques are not commonly used in abdominal or juxtarenal abdominal aortic aneurysm repair. Proximal aortic clamping is usually adequate for surgical repair of abdominal aortic pathologies. We present two cases of giant-sized abdominal aortic aneurysms, one was juxtarenal and one was a Crawford type IV thoracoabdominal aneurysm, that were repaired by using open proximal anastomosis under hypothermic total circulatory arrest and a transabdominal approach. This technique may be useful for both thoracoabdominal and large abdominal aortic aneurysms because it offers the opportunity to not clamp the aorta and operate in bloodless surgical field.

Objective. Acute mesenteric ischemia (AMI) is a rare but serious complication after cardiac surgery. The aim of this retrospective study was to evaluate the incidence, outcome, and perioperative risk factors of AMI in the patients undergoing elective cardiac surgery. Methods. From January 2005 to May 2013, all patients who underwent cardiac surgery were screened for participation, and patients with registered gastrointestinal complications were retrospectively reviewed. Univariate analyses were performed. Results. The study included 6013 patients, of which 52 (0.86%) patients suffered from AMI, 35 (67%) of whom died. The control group (150 patients) was randomly chosen from among cases undergoing cardiopulmonary bypass (CPB). Preoperative parameters including age (), renal insufficiency (), peripheral vascular disease (), preoperative inotropic support (), poor left ventricular ejection fraction (), cardiogenic shock (), and preoperative intra-aortic balloon pump (IABP) support () revealed significantly higher levels in the AMI group. Among intra- and postoperative parameters, CPB time (), dialysis (), inotropic support (), prolonged ventilator time (), and IABP support () appeared significantly higher in the AMI group than the control group. Conclusions. Prompt diagnosis and early treatment should be initiated as early as possible in any patient suspected of AMI, leading to dramatic reduction in the mortality rate.

Tears of inferior vena cava (IVC) leading to retroperitoneal hemorrhage, generally occur due to blunt or penetrating trauma. Spontaneous rupture of IVC without any trauma history, however, is an extremely rare clinical entity with high mortality. A 75-year-old female patient receiving low molecular weight heparin for the last 5 days due to atrial fibrillation and peripheral artery disease referred to our Emergency Service with hypovolemic shock. Abdominal computed tomography revealed diffuse retroperitoneal hematoma. The patient required cardiopulmonary resuscitation upon development of cardiac arrest. Following resuscitation, she underwent emergency laparotomy, and the hematoma in the right retroperitoneal region was evacuated. During exploration, a 1-cm smooth edged tear located in the anterior aspect of IVC was found, and was repaired. Unfortunately, the patient failed to recover, and passed away within 72 hours due to multiple organ failure. The postmortem examination of vein specimens obtained from the patient revealed no histopathological abnormality. To our knowledge, the patient we are presenting here is the 3rd case in the English literature. Spontaneous rupture of the IVC is a clinical entity that should be kept in mind among other etiologies in cases presenting with acute abdominal symptoms.

Bronchogenic cysts are usually discovered only incidentally in the adult. A giant bronchogenic cyst in a 19-year-old woman presenting with pain and shortness of breath was mistaken for tension pneumothorax and initially treated with tube thoracostomy. Giant bullae were diagnosed by computed tomography. Bullae resection was undertaken, but the remaining lung tissue required pneumonectomy. Pathologic examination of the specimen confirmed bronchogenic cyst.

Metabolic syndrome is a well-known cardiovascular risk factor closely related to increased insulin resistance. This study assessed the effects of metabolic syndrome on early post-operative mortality and morbidity in 100 coronary artery bypass graft (CABG) patients: 50 patients with and 50 without metabolic syndrome. A total of 17 patients were excluded from the analysis as they did not attend follow-up, leaving 51 males (61.4%) and 32 (38.6%) females of mean ± SD age 60.02 ± 9.76 years for analysis. Diabetes, hypertension and a high body mass index were significantly more common in patients with metabolic syndrome. A statistically significant relationship was found between metabolic syndrome and surgical wound infection. Non-significant positive correlations were found between metabolic syndrome and post-operative atrial fibrillation, surgical revision due to haemorrhage, ventricular tachycardia and ventricular fibrillation, and prolonged intubation. In conclusion, metabolic syndrome did not affect mortality, but did increase the risk of postoperative surgical wound infection.

OBJECTIVE The purpose of this study was to compare the effects of ticlopidine and clopidogrel on the development of neointimal hyperplasia after experimental arterial injury. METHODS This experimental, prospective, randomized controlled study was performed on twenty-seven rabbits, which were divided into three groups, each of which contained nine subjects. Following the development of a balloon catheter injury in the iliac artery, no drugs were administered to Group 1 (control). Group 2 was given ticlopidine, while Group 3 was given clopidogrel. At the end of the 21-day experimental period, arterial sections were evaluated histomorphologically and immunohistochemically with staining using antibodies against platelet derived growth factor beta and basic fibroblast growth factor. Statistical analyses were performed using Chi-Square, Mann Whitney U and one-way ANOVA tests. RESULTS At the end of study period, ticlopidine and clopidogrel strongly reduced the development of intimal hyperplasia after arterial injury (54.1%, p

To compare the histological changes occurring after three different treatment modalities for telangiectasias.Thirty 16-week-old New Zealand white rabbits weighing 2.4-3.1 kg were enrolled in the study. The rabbits were divided into three groups. The group 1 received sclerotherapy, he group 2 received phototherapy, and group 3 received high-power diode laser treatments. All animals were treated on the right dorsal marginal ear vein. Biopsies were taken on days 1, 2, 7, and 30 post-treatment, and histopathogical evaluation was performed.Clinical and histological thrombosis occurred between days 1 and 7 in all groups. Superficial necrosis, neutrophil infiltration, and recanalization were mostly seen in group 3, whereas thrombosis was prominent in groups 1 and 2.All of the methods tested appear to have similar mechanisms of action, but had differing clinical and histological results. Phototherapy and laser treatment are non-invasive and do not require an exact, pinpoint technique, in contrast to sclerotherapy. However, sclerotherapy and phototherapy showed better results, especially with regard to recanalization.

Background. The aim of this study was to compare the results of percutaneous septal myocardial ablation (PSMA) and surgical myectomy (SM) for decreasing the left ventricular outflow tract (LVOT) gradient, septal thickness, ventricular dimensions, and mitral regurgitation (MR) in patients with symptomatic hypertrophic obstructive cardiomyopathy.Methods: We treated 40 patients (mean age, 24.4 ± 6.8 years; 34 male and 6 female patients) between June 2002 and April 2006. Twenty-four patients underwent SM, and 16 patients underwent PSMA. All patients were symptomatic despite maximal medical treatment and had an LVOT gradient higher than 65 mm Hg. Their echocardiographic data were recorded before and after the procedure and then compared. The patients were followed up postoperatively for a mean of 13 months.Results: There was no mortality in either group. One year after the procedure, the LVOT gradients for the 2 groups were not statistically different. During the follow-up, moderate MR was found in 4 patients (25%) in the ablation group and in 2 patients (8.3%) in the myectomy group. Exercise capacity and New York Heart Association class improved after PSMA, whereas postoperative MR severity and effort capacity were better in the surgical group.Conclusion: The 2 approaches yielded similar results with regard to reducing the LVOT gradient. We conclude that SM is preferable to PSMA in cases with MR.

Background. During off-pump coronary bypass grafting, local vascular control of the target vessel and a bloodless field are crucial. The aim of this study is to asses the histopathological outcomes of intracoronary shunts and bulldog clamping on the beating heart in a canine model. Methods. Twelve healthy adult mongrel dogs weighing between 15 to 25 kg were included in the study. Following left thoracotomy, proximal left anterior descending artery segment 1 cm to distal of diagonal branch was marked. Arteriotomy at this site was performed and a shunt was inserted for 10 min in the shunt group. The bulldog clamp was applied 3 cm distal to the mark for 10 min after heparinization in the bulldog group. Thirty days after the procedure, the specimens of left anterior descending artery from both regions were collected and were examined. Vascular damage, presence of intimal hyperplasia, and denudation were noted. Results. Only intimal denudation was found significantly higher in the shunt group (P < 0.05). In this group, only one case had grade 0 endothelial damage. In the bulldog group, all cases had endothelial damage of various grades. Conclusion. The proven advantages of temporary intracoronary shunts are well-known, e.g., preserving the ventricular functions. Despite these advantages, our study revealed an ultimate bad result for an off-pump coronary by pass patient: intimal denudation. We conclude that further studies with a larger number of subjects are needed to decide whether routine shunt insertion into coronary arteries during off-pump coronary bypass surgery is appropriate or not.

Bronchocutaneous fistula is an extremely rare complication of lung cancer and is frequently seen following biopsy or radiotherapy. A 67-year old male patient was administered to our hospital due to sudden onset of shortness of breath and subcutaneous emphysema on the right side. Chest computed tomography revealed a cavitary lesion in the left upper lobe in connection with the subcutaneous emphysema on the right side through sternum and anterior chest wall. The pathological examination of the biopsy performed during tube insertion revealed a well-differentiated squamous cell carcinoma of the lung. The patient was referred for adjuvant therapy to local oncology hospital. He passed away 9 months following diagnosis.