Today, in spite of the developments in imaging methods and antibiotherapy, childhood pleural empyema is a prominent cause of morbidity and mortality. In recent years, it has been shown that there has been an increase in the frequency of pleural empyema in children, and antibiotic resistance in microorganisms causing pleural empyema has made treatment difficult. Despite the many studies investigating thoracoscopic debridement and fibrinolytic treatment separately in the management of this disease, there is are not enough studies comparing these two treatments. The aim of this study was to prospectively compare the efficacy of two different treatment methods in stage II and III empyema cases and to present a perspective for treatment options.We excluded from the study cases with: i) thoracoscopic intervention and fibrinolytic agent were contraindicated; ii) immunosuppression or additional infection focus; iii) concomitant diseases, those with bronchopleural fistula diagnosed radiologically, and Stage I cases. This gave a total of 54 cases: 23 (42.6%) in stage II, and 31 (57.4%) cases in stage III. These patients were randomized into two groups of 27 cases each for debridement or fibrinolytic agent application by video-assisted thoracoscopic decortication (VATS). The continuity of symptoms after the operation, duration of thoracic tube in situ, and the length of hospital stay in the VATS group were of significantly shorter duration than in the streptokinase applications (P=0.0001). In 19 of 27 cases (70.37%) in which fibrinolytic treatment was applied and in 21 cases of 27 (77.77%) in which VATS was applied, the lung was fully expanded and the procedure was considered successful. There was no significant difference with respect to success rates between the two groups (P=0.533). The complication rate in our cases was 12.96% and no mortality was observed. Similar success rates in thoracoscopic drainage and enzymatic debridement, and the low cost of enzymatic drainage both served to highlight intrapleural streptokinase treatment as a reliable method in reducing the need for surgery in complicated empyema.

AIM:The study compares the efficiency, side effects and complications of autologous blood pleurodesis with talcum powder and tetracycline.MATERIALS AND METHODS:This prospective study evaluated 50 patients with persistent air leak resulting from primary and secssondary spontaneous pneumothorax between February 2004 and March 2009. The patients inclussded 32 (64.0%) males and 18 (36.0%) females with a median age of 39 years (range 14-69 years). All cases had persistent air leak of more than seven days. Pleurodesis was performed using autologous blood in 20 (40.0%) patients, talc powder in 19 (38.0%) patients and tetracycline in 11 (22.0%) patients through a chest tube. Air leak cessation times after pleurodesis, side effects and pulmonary function tests (PFT) in the first and third months were measured.RESULTS:Recurrent primary spontaneous pneumothorax was the cause of persistent air leak in all cases. Air leaks were expiratory only in 54.0% of cases. We obtained a success rate of 75.0% using autologous blood, 84.2% using talc powder and 63.6% using tetracycline. Mean air leak termination interval was significantly (P < 0.001) shorter in patients treated with autologous blood in comparison to talc powder and tetracycline. We observed a significant (P < 0.05) decline in PFT in patients treated with talc powder compared with tetracycline and autologous blood. Vital capacity, FVC and FEV1 were significantly lower in patients treated with tetracycline compared with autologous blood.CONCLUSION:This study shows that autologous blood pleurodesis compared to talc powder and tetracycline is related with shorter leak cessation time and less pulmonary function decline in patients with persistent air leak. We think further randomized clinical trials of pleurodesis as treatment could increase its use in thorax surgery by demonstrating the safety and the efficacy of this procedure.

No abstract

Objective: Hydatid cyst disease, endemic in Eastern region of Turkey, is a significant parasitic public health problem. In this study, pleural complications of hydatid cysts were presented in 76 cases. Materials and Methods:In our study, of the 412 pulmonary hydatid cyst cases operated on between 2003 and 2011, 76 cases had ruptured into the pleura for various reasons, and the different clinicoradiological presentations were evaluated retrospectively. The age distribution of the cases was between 7 and 56 years, and the mean age was 26.20±13.04. Results:The most frequent symptom due to pleural rupture in patients was dyspnea (44 cases, 57.8%). Etiologically, iatrogenic perforation was detected in four cases and thoracic trauma in nine cases (six car accidents and three falls from a height). An anthelmintic drug use history was found in three cases of ruptured pleura. Spontaneous perforation was detected in the other 60 (78.9%) cases. Two cases that were admitted to the emergency unit and were immediately administered a tube thoracostomy developed tension pneumothorax. In addition, 21 cases had hydropneumothorax, 17 had pneumothorax, and 36 had pleurisy. Morbidity was observed in 30 cases (39.4%). Atelectasis was the most frequent cause of morbidity in these patients (10 cases). The mean duration of hospitalization was determined to be 12.26±2.90 days. Conclusion:This disease can progress asymptomatically for a long time and can sometimes lead to life-threatening emergency situations, such as tension pneumothorax. The delayed admission of a patient to a physician causes the disease to become more complicated and to increase the morbidity and mortality rates. Treatment of the disease is in the form of surgery. Possible parenchymal protection should be applied in surgical treatment, and anatomic resection should not be performed unless necessary.Key Words: Empyema, Capitonnage, Pleura, Rupture Özet Amaç: Kist hidatik hastalığı, yöremizin ve ülkemizin endemik olarak görülen önemli bir paraziter-halk sağlığı sorunudur. Kist hidatik hastalığı, asemptomatik olarak seyredebildiği gibi, tansiyon pnömo-toraks gibi hayatiyet arzeden önemli komplikasyonlarla da kendini gösterebilir. Çalışmamızda kist hidatiğin plevral komplikasyonları 76 olgu temelinde sunulmuştur. Gereç ve Yöntem:2003-2011 yılları arasında opere edilen 412 akciğer kist hidatikli olgudan, plevraya çeşitli nedenlerle ve değişik klinikradyolojik presentasyonlarla rüptüre olan 76 olgu retrospektif olarak değerlendirildi. Olguların 42'si erkek, 34'ü kadındı. Olguların yaş dağılımı 7-56 arasında ve ortalama yaş 26.20±13.04 olarak belirlendi. Bulgular:Plevral rüptür nedeniyle olgularda en sık gözlenen semptom dispne oldu (44 olgu, %57.8). Etyolojide 4 olguda iatrojenik perforasyon, 9 olguda toraks travması (6 olgu araç içi trafik kazası, 3 olguda yüksekten düşme) tesbit edildi. Plevraya rüptüre 3 olguda daha önceden antihelmintik ilaç alımı söz konusuydu. Diğer 60 (%78.9) olguda spontan perforasyon tesbit edildi. Acil ünitesine başvuran ve derhal tüp tora...

Abstract:Helicobacter pylori causes various diseases such as chronic gastritis, peptic ulcer and gastric cancer. While majority of the people infected with H. pylori is asymptomatic, 15-20 % of them develop such diseases. The main factors, which determine the development of H. pylori related diseases might be bacterial virulence, host genetic and environmental factors. The aim of this study was to reveal the factors that play a role in the disease development in patients with refl ux esophagitis and peptic ulcer, infected with Helicobacter pylori. Environmental factors such as medical agents, smoking and body mass index were evaluated. The factors specifi c to bacteria such as vacA, CagA, babA and iceA virulence genotypes and the host factors such as IL-1, IL-2, IL-4, IL-6, IL-10, IL-12, interferon-γ, TNF-α, ve TGF-β 1 gene polymorphisms were compared between the two groups. H. pylori infected twenty fi ve patients with refl ux esophagitis and peptic ulcer were enrolled in the study. There was no statistical difference between the two groups regarding environmental factors. IL-2 -330T +166T (p=0.037) and IL10 -1082A; -819C (p=0.049) gene polymorphisms were signifi cantly more common in the group of patients with peptic ulcer compared to the group with refl ux esophagitis. In both groups of patients, either with refl ux esophagitis or peptic ulcer, multiple H. pylori virulence genotypes (cagA, vacA, babA) (mean values 74 %, 78 %, 54 % respectively) were observed. In this study, we revealed that cytokine gene polymorphisms may play a role in the development peptic ulcer while H. pylori virulence genotypes seem to be crucial for the development of associated diseases (Tab. 4, Ref. 51). Text in PDF www.elis.sk.

BACKGROUND:Although the incidence has declined over the past years in societies with high socioeconomic status, bronchiectasis is still an important health problem in our country.AIM:To review and present our cases undergoing surgery for bronchiectasis in the past 12 years and their early and late term postoperative outcomes and our experience in bronchiectasis surgery and the effect of morphological type on the prognosis.METHODS:The medical records of 62 cases undergoing surgical resection for bronchiectasis in the Clinics of Thoracic and Pediatric Surgery were evaluated retrospectively. The disease was on the left in 33 cases, on the right in 26 and bilateral in three cases. The most common surgical procedure was lobectomy. Forty one patients underwent pneumonectomy, lobectomy and complete resection including bilobectomy. Twenty-one (33.87%) cases underwent incomplete resection, of whom 11 (17.74%) underwent segmentectomy and 10 (16.13%) underwent lobectomy + segmentectomy.RESULTS:It was found that the rate of being asymptomatic was significantly higher in patients undergoing complete resection compared to those undergoing incomplete resection. Spirometric respiratory function tests were performed to assess the relationship between morphological type and the severity of disease. All parameters of respiratory function were worse in the saccular type and FEV1/FVC showed a worse obstructive deterioration in the saccular type compared to the tubular type.CONCLUSION:The success rate of the procedure increases with complete resection of the involved region. The morphological type is more important than the number and extension of the involved segments in showing the disease severity.

No abstract

BackgroundAlthough the prevalence of bronchiectasis decreased significantly in developed countries, in less developed and in developing countries, it still represents a significant cause of morbidity and mortality. The aim of this retrospective study is to present our surgical experiences, the morbidity and mortality rates and outcome of surgical treatment for bronchiectasis.MethodsWe reviewed the medical records of 129 patients who underwent surgical resection for bronchiectasis between April 2002 and April 2010, at Van Training and Research Hospital, Thoracic Surgery Department. Variables of age, sex, symptoms, etiology, and surgical procedures, mortality, morbidity and the result of surgical therapy were analyzed retrospectively.ResultsMean age was 21.8 year (the eldest was 67 year, the youngest was 4 years-old). Male/female ratio was 1.86 and 75% of all patients were young population under the age of 40. Bilateral involvement was 14.7%, left/right side ratio according to localization was 2.1/1. The most common reason for bronchiectasis was recurrent infection. Surgical indications were as follows: recurrent infection (54%), hemoptysis (35%), empyema (6%), and lung abscess (5%). There was no operative mortality. Complications occurred in 29 patients and the morbidity rate was 22.4%. Complete resection was achieved in 110 (85.2%) patients. Follow-up data were obtained for 123 (95%) of the patients. One patient died during follow-up. The mean follow-up of this patient was 9 months. Mean postoperative hospitalization time was 9.15 ± 6.25 days. Significantly better results were obtained in patients who had undergone a complete resection.ConclusionsSurgical treatment of bronchiectasis can be performed with acceptable morbidity and mortality at any age. The involved bronchiectatic sites should be resected completely for the optimum control of symptoms.