Thoracic Mass Lesions on Imaging: Beware of Tuberculosis Cases.

Tuberculosis (TB) and thoracic malignancy mimic each other clinically, and pose diagnostic challenges. Both diseases are characterised by similar symptoms. We aimed to emphasise that some forms of TB are associated with misleading clinical and radiological manifestations. We present a retrospective study of clinical and pathological results of 10 cases with a preliminary presumptive diagnosis of thoracic malignancy. All patients were found to have TB without evidence of malignancy and were successfully treated with standard antibiotherapy after completion of diagnostic procedures. TB should be considered as a noteworthy differential diagnosis in patients living in TB-endemic countries, and biopsy plays a vital role in correctly diagnosing TB. Key Words: Mass, Neoplasm, Pulmonary, Tuberculosis.

The Role of Duration of Hyperbaric Oxygen Therapy on Lung Injury: An Experimental Study Lung Injury and Hyperbaric Oxygen Therapy.

OBJECTIVES: We aim to histopathologically analyze the effect of hyperbaric oxygen (HBO) therapy in the lung tissue. MATERIAL AND METHODS: A total of 21 rabbits were divided into three groups, with each containing seven rabbits. Group 1 was the control group. Group 2 underwent HBO of 3 atmosphere absolute (ATA) for 90 min/day for 7 days. In group 3, HBO at 3 ATA was administered 90 min/day for 28 days. Oxygen saturation (SpO2) was determined by pulse oximetry before and after administration of HBO. Rabbits were sacrificed, and the apex of the right lung was excised. RESULTS: SpO2 was 98-100% in all rabbits before HBO administration. After the procedure, the mean SpO2 was 92% and 83% in groups 2 and 3, respectively. As expected, histopathologic examination in group 1 was normal. In group 2, congestion in the lung vessels, mononuclear cell infiltration in the bronchial mucosa, interstitial edema, and alveolar dilation were evident. Histopathologic examination in group 3 indicated diffuse alveolar edema, peribronchial mononuclear cell infiltration, thickening of the alveolar and vessel wall, and intraalveolar hemorrhage. CONCLUSION: There is a strict relationship between duration of HBO administration and severity of lung injury.

Effects of Ecballium Elaterium on Proinflammatory Cytokines in a Rat Model of Sepsis.

OBJECTIVE: Ecballium elaterium (EE) is a plant from Cucurbitaceae family. Its anti-inflammatory role in sepsis is not well understood. We investigated the effects of EE on serum levels of proinflammatory cytokines and further explored the mechanisms underlying histological changes in liver and ileum following EE administration in a polymicrobial sepsis model. METHODS: Thirty rats were divided into three groups of 10 rats each. Rats were subjected to sham laparotomy plus normal saline administration (control group, CG), laparotomy with cecal ligation and puncture (CLP) (sepsis group, SG), and laparotomy with CLP plus 2.5 mg/kg EE administration (experimental group, EG). Twenty-four hours after laparotomy, animals underwent cardiac puncture, and blood was collected for interleukin 1 (IL-1), interleukin 6 (IL-6), and tumor necrosis factor alpha (TNF-α) assessment. Whole sections of liver and ileum tissues were collected for histologic examination. RESULTS: The serum level of IL-6 was significantly lower in EG as compared to SG. Although IL-6 levels were shown a statistically significant (p < 0.0001) decline to near control values, no significant changes were observed in serum levels of IL-1 and TNF-α after EE treatment. Histologic examination revealed statistically significant reduction in collagen formation (p = 0.001) on serosal surface of ileum and hepatic venous congestion (p = 0.040) in EG as compared to SG. CONCLUSION: EE might play a protective role in sepsis prevention and treatment by decreasing IL-6 production and reducing liver damage and may influence bacterial translocation by reinforcing intestinal barrier function.

Do Meteorological Changes Have an Effect on The Occurence of Spontaneous Pneumothorax?

OBJECTIVES: Spontaneous pneumothorax refers to the leakage of air into the space between the parietal and the visceral layers of the pleura. It occurs with or without a known lung disease. We aimed to investigate the effects of atmospheric pressure, humidity, and temperature changes on the incidence of spontaneous pneumothorax (SP). MATERIAL AND METHODS: This study included 551 patients with spontaneous pneumothorax retrospectively screened between January 2009 and December 2013. The medical data of the patients were accessed via their medical records on the hospital automation system. The atmospheric pressure, temperature, humidity rate, amount of precipitation, and wind velocity on the day of spontaneous pneumothorax were obtained from the data provided by the general directorate of meteorology. The three consecutive days on which at least 2 cases of SP presented were collectively considered as a cluster. The study data were analyzed with the SPSS version 15 software package, using the Chi-square and the Student's t tests. A p value less than 0.05 was considered statistically significant. RESULTS: Of the 552 patients included in the study, 89.3% had primary spontaneous pneumothorax and 10.7% had secondary spontaneous pneumothorax. Ninety-two percent of the patients were male and 8% were female. The mean age was 24 years. Clustering was observed in 71.7% of the study population. No significant differences were observed between yearly and monthly SP incidences. There were, however, differences between the days with SP and the days without SP with respect to atmospheric pressure, ambient temperature, wind velocity, and humidity rate. The differences between the atmospheric pressures were not statistically significant, although the differences between the ambient temperature and the humidity rate were statistically significant (p≤ 0.05). CONCLUSION: We determined that the changes in the ambient temperature and the humidity rate affected the rate of spontaneous pneumothorax by altering the meteorological conditions.

[Diaphragmatic injury: condition be noticed in the management of thoracic trauma]. / Toraks travmasi takibinde dikkat edilmesi gereken durum: Diyafragma yaralanmalari.

BACKGROUND: The aim of the present study was to emphasize diaphragmatic injuries that can be overlooked in chest traumas. METHODS: Between January 2000 and June 2013, fifty-three patients with traumatic diaphragmatic laceration were evaluted among 1349 patients who had chest injuries. Patients were examined regarding age, gender, associated injuries, surgical interventions, postoperative morbidity, mortality and length of hospital stays. RESULTS: Of them, fifty-three cases had diaphragmatic lacerations. There were forty-eight male and five female patients, with a mean age of 31.06 (4-60) years and 35.80 (18-50) years. Thoracotomy in 66%, laparotomy in 20.75% and laparotomy+thoracotomy in 13.20% of the cases were performed. Video-assisted thoracoscopy was carried out in 15.09% of the patients. Diaphragm was repaired on the left in thirty-one cases and in the right in twenty-two cases. Pulmonary complications like morbidity was mostly seen in 37.73% of blunt trauma. Mortality was seen in three cases of penetrating trauma. Mean hospital duration was 8.75 days (range, 4-15 days). Patients were followed for a mean duration of 28.13 months (range, 3-60 months). There was no significant statistical difference between types of injury, ages and gender of cases (p=0.05); whereas, morbidity rate was important in patients with blunt trauma. DISCUSSION: Diaphragmatic lacerations should be kept in mind when penetrating and blunt injuries to the thorax are evaluated.

Intra-peritoneal administration of Ecballium elaterium diminishes postoperative adhesions.

PURPOSE: To evaluate the effects of Ecballium elaterium (EE), Elaterium officinarum, in postoperative intraperitoneal adhesions in rats. METHODS: Thirty rats were divided into three groups and underwent midline laparotomy under 35 mg/kg ketamine and 5 mg/kg xylazine anaesthesia. In group 1 (n=10), the sham operation group, the abdominal walls were closed without any process. In group 2 (n=10), the control group, the antimesenteric border of the ceacum and the corresponding parietal peritoneum were abraded with dry sterile gauze. In group 3 (n=10), the EE group, 2.5 mg/kg dose of EE was administered as intraperitoneally to the rats after abrasion. All rats were sacrificed on postoperative day 15. Samples were obtained RESULTS: The adhesion score was significantly decreased in the EE group (p=0.001) in comparison with the control group. Microscopically, the EE and sham groups were significantly lower than that of the control group (p<0.001 and p=0.000, respectively). Furthermore, the measurement of tissue levels of hydroxyproline was significantly lower in the sham and EE groups compared to the control group (sham group: 47.6 ± 10.6, EE group: 62.9 ± 9.7, CONTROL GROUP: 84.2 ± 22.1 mg /L/g-tissue). CONCLUSION: The grade and severity of abdominal adhesion could be significantly reduced through administered Ecballium elaterium and therefore be a suitable anti-inflammatory agent for the prevention of postoperative peritoneal adhesion in the future.

A case of lymphoma simulating primary sternal tumour.

Any mass on the chest wall may not always be the primary local pathology. A case of lymphoma with an aggressive course may involve the sternum through local invasion and can mimic a chest wall tumour. A 15-year-old boy with mediastinal lymphoma presented with a sternal mass. Partial sternectomy with replacement by methyl methacrylate prosthesis was performed.

Inhalation of foreign bodies in children: experience of 22 years.

BACKGROUND: Foreign body (FB) inhalation into airways of the respiratory system is a life-threatening condition and can be fatal. The purpose of this survey was to evaluate the types and characteristics of inhaled foreign bodies, the age distribution of children, and the outcome. METHODS: We outlined a retrospective review of hospital data of patients between 1990 and 2012. FB inhalation occurring in children 0 year to 16 years was considered for inclusion. During the study period, 1,660 patients undergoing bronchoscopy with the diagnosis of FB were included. Deaths on arrival were excluded. RESULTS: Of the patients, 53% were male, and 47% were female (p > 0.05). The mean age was 6.2 years for girls and 4.7 years for boys. In 57% of all cases, the children were younger than 3 years. An FB was found within the respiratory tract of 1,565 patients. The FBs were always extracted by using rigid bronchoscopy. Hospitalization was always required owing to an institutional requirement. The origin of the FBs were within the two main groups of food and objects. Food FBs included seeds, nuts, beans, and fruit parts. FB objects included pins, toy parts, and metal pieces. FB and subsequent treatment revealed that morbidity was present; however, mortality was rare. CONCLUSION: Most of the inhaled FBs were found in the bronchial tree. Children younger than 3 years are more vulnerable. There seemed to be an association between the aspirated FBs and season, geographic locality, and sociocultural environment. The removal of choice is rigid bronchoscopy under general anesthesia. That most cases of FB in children occurs under the supervision of adults indicates that the incidence and severity of airway FB inhalation can be reduced by parental education and public awareness. LEVEL OF EVIDENCE: Epidemiologic study, level III.

Laparoscopic cholecystectomy in patients with situs inversus totalis: literature review of two patients.

Situs inversus totalis is a rare condition, which presents difficulties in diagnosis and treatment of gallstones due to the reversal location of abdominal organs. In this article we present 2 cases of women in age of 51 and 55 years with situs inversus totalis and gallstones. There are described the clinical and imaging features, also the laparoscopic surgery with the difficulties encountered by right handed surgeon. In patients with situs inversus totalis, laparoscopic surgery may be performed safely by a surgeon with experience.