We recommend the transabdominal subcostal approach in patients with Morgagni hernia for surgical exposure, easy repair of the hernia sac, and low morbidity.

In our experience the exposure provided by the transaxillary approach is safe and superior to that offered by other approaches as it allows a wide range of surgical applications such as first rib resection, cervical rib resection and resection of fibrotic bands.

Amaç: Bu çalışmada diyafram rüptürü nedeni ile cerrahi uygulanan hastalarda mortaliteyi ekileyen olası faktörler araştırıldı. Ça lış mapla nı:Mayıs 1997 -Mayıs 2009 tarihleri arasında toplam 30 hasta (27 erkek, 3 kadın; ort. yaş 42.6 yıl; dağı-lım 16-88 yıl) diyafram rüptürü nedeni ile kliniğimizde ameliyat edildi. Hastalar mortaliteyi etkileyen olası faktör-ler açısından retrospektif olarak değerlendirildi. Yirmi iki hastaya acil cerrahi girişim ilk yedi günde uygulandı. Diğer altı hasta latent fazda ve iki hasta obstrüktif fazda ameliyat edildi. Bul gu lar: Dokuz hastaya torakotomi, dokuz hastaya laparotomi ve 12 hastaya torakotomi ve laparotomi yapıldı. Sekiz hastaya eksploratif laparotomi ile tanı konuldu. Hastanede kalış süresi ortalama 12 gün (1-50 gün) idi. Sekiz hastada morbidite (%27) görülür iken, yedi hastada (%23) mortalite görüldü. Beş hastada eşlik eden yaralanma bulunamaz iken, 25 hastada eşlik eden yaralanmalar vardı. Bu hastaların 16'sında (%53) eşlik eden yaralanmalar için ek cerrahi girişimler gerekti. İleri yaş (p= 0.020) ve daha uzun süre yoğun bakım ihtiyacı olması (p= 0.020) mortaliteyi negatif yönde etkileyen faktörler olarak bulundu. So nuç:Eşlik eden organ yaralanmaları morbidite ve mortaliteyi etkileyen ana prognostik faktördür. İleri yaş ve travmatik diyafram rüptürüne eşlik eden organ yaralanması olan hastaların mekanik ventilatörden erken ayrılması, agresif tedavi ve yakın takibi, morbidite ve mortaliteyi azaltabilir.Anah tar söz cük ler: Diyafram; mortalite; rüptür; travma.Background:This study aims to investigate possible factors affecting mortality in patients with traumatic diaphragmatic ruptures. Methods: Between May 1997 and May 2009 a total of 30 patients (27 males, 3 females; mean age 42.6 years; range 16 to 88 years) were operated in our clinic with a diagnosis of traumatic diaphragmatic rupture. The patients were evaluated retrospectively in terms of possible factors affecting mortality. Emergency surgery was performed 22 patients within the first seven days. Other two patients were operated in the latent phase and six patients were operated in the obstructive phase. Results: Thoracotomy was performed in nine patients, laparotomy in nine patients and thoracotomy + laparotomy in 12 patients. Eight patients were diagnosed by explorative laparotomy. The mean duration of hospitalization was 12 days (range, 1-50 days). Morbidity was observed in eight patients (27%), while mortality was seen in seven patients (23%). Five patients had no associated pathology, while various associated pathologies were observed in 25 patients. Additional surgical interventions were required for associated pathologies in 16 of these patients (53%). Older age (p=0.020) and need for longer length of stay in the intensive care unit (p=0.020) were found to be negative prognostic factors affecting mortality. Conclusion: Associated organ injuries are the main prognostic factors which affect morbidity and mortality. Early weaning from mechanical ventilation, aggressive treatment and close follow-up of pati...

The aim of this study was to investigate the protective effects of N-acetylcysteine (NAC) on peroxidative and apoptotic changes in the contused lungs of rats following blunt chest trauma. The rats were randomly divided into three groups: control, contusion, and contusion + NAC. All the rats, apart from those in the control group, performed moderate lung contusion. A daily intramuscular NAC injection (150 mg/kg) was given immediately following the blunt chest trauma and was continued for two additional days following cessation of the trauma. Samples of lung tissue were taken in order to evaluate the tissue malondialdehyde (MDA) level, histopathology, and epithelial cell apoptosis using terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) assay and active caspase-3 immunostaining. In addition, we immunohistochemically evaluated the expression of surfactant protein D (SP-D) in the lung tissue. The blunt chest trauma-induced lung contusion resulted in severe histopathological injury, as well as an increase in the MDA level and in the number of cells identified on TUNEL assay together with active caspase-3 positive epithelial cells, but a decrease in the number of SP-D positive alveolar type 2 (AT-2) cells. NAC treatment effectively attenuated histopathologic, peroxidative, and apoptotic changes, as well as reducing alterations in SP-D expression in the lung tissue. These findings indicate that the beneficial effects of NAC administrated following blunt chest trauma is related to the regulation of oxidative stress and apoptosis.

A 53-year old man was admitted to hospital with chest pain because of thoracic blunt trauma. Lateral chest-X ray showed bone expansion in the inferior sternum. Computerized thorax tomography and 3D reconstruction showed a sternal foramen with a typical bow tie appearance on the inferior sternal body and a bifid xiphoid process (Fig. 1A and B).