Diagnosis, treatment, and management of esophageal foreign bodies in patients with mental retardation: A retrospective study from three centers.

Background: This study aims to assess the outcomes and prognosis of surgical interventions aimed at removing esophageal foreign bodies in patients with mental retardation. Methods: Between January 2010 and January 2021, a total of 30 consecutive patients (20 males, 10 females; median age: 29.5 years; range, 2 to 57 years) with mental retardation who were diagnosed with esophageal foreign bodies and underwent surgical treatment were retrospectively analyzed. Age and sex of the patients, symptoms, type of the foreign body, esophageal stricture level, methods used for preoperative diagnosis, type of surgical procedure, postoperative complications, and length of hospital stay were recorded. Results: Seventeen (56.6%) patients had a foreign body in the first narrowing, 12 (40%) in the second narrowing, and one (3.3%) in the third narrowing. A rigid esophagoscopy was performed in all cases. However, successful removal was not achieved in two (6.6%) cases, and foreign bodies were removed through cervical esophagotomy in one (3.3%) patient and through esophagotomy with right thoracotomy in one (3.3%) patient. Postoperative complications included esophagitis in seven patients (23.3%) and wound infection and pneumonia in two patients (6.6%). The median length of hospital stay after treatment was 1.09 days in patients without complications and 3.3 days in patients with complications. There was a significant correlation between the occurrence of complications and the length of hospital stay (p=0.002). The foreign body was successfully removed in all patients, and no mortality was observed. Conclusion: Early diagnosis and emergency intervention can reduce complications, particularly considering the possibility of non-food and sharp-edged foreign bodies that pose a higher risk of damaging the digestive system, in patients with mental retardation than those without such conditions.

Extended resections in the treatment of locally advanced lung cancer.

Background: This study aims to evaluate surgical outcomes and prognosis in patients who underwent extended lung resection for locally advanced lung cancer. Methods: Between January 2015 and December 2019, a total of 61 patients (60 males, 1 female; mean age: 61.7±12.2 years; range, 32 to 90 years) with locally advanced non-small-cell lung cancer who underwent extended lung resection were retrospectively analyzed. Data including age, sex, comorbid diseases, symptoms, smoking status, pulmonary function test results, tumor location, methods used for preoperative tissue diagnosis, histopathological cell type, type of surgical resection, pathological stage, nodal involvement, postoperative complications, types of adjuvant therapy, and mortality rate were recorded. Survival and the factors affecting survival were examined. Results: Seven (11.4%) patients had Stage IIIB, 40 (65.5%) patients had Stage IIIA, and 14 (22.9%) patients had Stage IB disease. Intrapericardial pneumonectomy accounted for 30 (49.1%) of all extended lung resections. Chemotherapy was administered to 31 (50.8%) patients and chemoradiotherapy to 24 (39.3%) patients in the postoperative period. In the survival analysis, 70-month survival rate was calculated as 63.9% and the median survival was 48 months. There was a statistically significant association between survival with adjuvant chemotherapy and chemoradiotherapy (p=0.003). The mortality rate at 70 months of follow-up was 36.1%. Conclusion: Extended lung resection contributes significantly to the improvement of survival rates in carefully selected locally advanced cases. Particularly with adjuvant chemotherapy, local recurrences can be prevented, and survival rates can be improved.

A case of pulmonary alveolar proteinosis misdiagnosed as COVID-19 pneumonia.

A 48-year-old female patient with complaints of shortness of breath and coughing had bilateral diffuse infiltration in her chest X-ray and diffuse ground-glass opacities in her chest computed tomography. Despite her polymerase chain reaction test being negative, she was treated 10 days for coronavirus disease 2019 (COVID-19) pneumonia due to her radiological images and clinical hypoxia. As there was no improvement in her symptoms, she was administered fiberoptic bronchoscopy and she was diagnosed with pulmonary alveolar proteinosis (PAP). PAP can be confused with COVID-19 pneumonia due to their similar clinical and radiological appearances.

Una paciente de 48 años con quejas de disnea y tos tenía infiltración difusa bilateral en la radiografía de tórax y opacidades difusas en vidrio deslustrado en la tomografía computarizada de tórax. A pesar de que su prueba de PCR fue negativa, fue tratada durante 10 días por neumonía COVID-19 debido a sus imágenes radiológicas e hipoxia clínica. Como no hubo mejoría en sus síntomas, se le administró fibrobroncoscopia y se le diagnosticó proteinosis alveolar pulmonar. La proteinosis alveolar pulmonar se puede confundir con la neumonía COVID-19 debido a su apariencia clínica y radiológica similar.

The Effects of Nitrofurazone on Wound Healing in Thoracoabdominal Full-thickness Skin Defects.

INTRODUCTION: The use of topical antibiotics on wound healing has been a matter of debate for many years because of the effectiveness. OBJECTIVE: The aim of this study is to investigate the potential effects of topical nitrofurazone, an antibacterial agent, on the healing of full-thickness skin defects created in a laboratory setting. MATERIALS AND METHODS: A total of 42 adult male Sprague Dawley rats were divided into 2 groups: group A (control group; n = 21) and group B (nitrofurazone group; n = 21). Circular full-thickness skin defects about 1 cm x 1 cm in size were formed in the left thoracoabdominal regions of all rats. Local physiological saline was applied to the wound once daily in the control group, and a thin layer of nitrofurazone cream was applied to the wound topically once daily in the nitrofurazone group. The defect sizes of all rats were photographed at baseline and days 3, 7, and 10 of the experiment, and wound size reduction was measured macroscopically on the computer to calculate the healing rates. A total of 7 rats from each group were euthanized on days 3, 7, and 10, and their defected regions were resected. The removed specimens were evaluated histopathologically and scored for inflammatory cells, collagen accumulation, granulation tissue formation, reepithelization, and features of the skin defect (eg, layers of the skin affected, size, whether it involves any abscess-necrosis). Statistical significance was set at P ⟨ .05. RESULTS: The healing rate had higher values in group B at days 7 and 10 of the experiment (P ⟨ .001). A comparison of the group scores showed that there were statistically significant differences in favor of group B. No statistically significant difference was found between the 2 groups with respect to granulation tissue formation. CONCLUSIONS: Topically applied nitrofurazone produced positive effects accelerating the wound healing process.

[Causes of mediastinal/hilar granulomatous lymphadenitis]. / Mediastinal/hiler granülomatöz lenfadenit etyolojisi.

INTRODUCTION: Granulomatous lung disease (GLD) is caused by a wide range of conditions and it is challenge for pulmonologist. A detailed history of exposures is fundamental in GDL and has been found pivotal to reach a precise diagnosis. MATERIALS AND METHODS: Between September 2014 and December 2016, the distribution of patients diagnosed with granulomatous lymphadenitis in the mediastinal/hilar lymph nodes by endobronchial ultrasound (EBUS) or mediastinoscopy was analyzed. To be listed as 'confident', a diagnosis of sarcoidosis required compatible histological, radiological and clinical findings in conjunction with negative cultures. Infectious entities listed as 'confident' had either microorganisms in tissue section, positive culture, positive serology or positive antigen detection in a consistent clinical pathological setting. RESULT: Granulomatous lymphadenitis was detected in 110 patients. The included 110 cases consisted of 70.9% women and median age of 53 (range 44-61) years. The final diagnosis of the patients was accepted to be sarcoidosis in 79 (71.8%), sarcoid like granulomas in 7 (6.4%), tuberculosis in 4 (3.6%), silicosis in 4 (3.6%), drug-associated granuloma in 2 (1.8%), hypersensitivity pneumonitis in 1 (0.9%), Chron disease in 1 (0.9%), unspecified in 12 (10.9%). Three patients were classified as tuberculosis based on culture. CONCLUSIONS: In this study, we found that the most common cause of granulomatous lymphadenitis was sarcoidosis. Contrary to expectations, the number of patients diagnosed with tuberculosis was very low.

Lung Hydatid Cyst Treatment With Laparotomy: A New and Different Technique.

This report presents the case of a patient with a pulmonary hydatid cyst. The patient underwent laparotomy for hepatic and splenic cysts, and cystotomy and capitonnage were perfomed using a transdiaphragmatic intervention. The pulmonary hydatid cyst was located at the base of the lung and near the diaphragm. The diaphragm was cut about 5 cm at the front, and the thorax was entered.The pulmonary cyst was treated intraabdominally. This technique is effective and safe, and it prevents the patient from undergoing a second operation. The suggestion is that this technique, which has not been defined before, can be applied safely in carefully selected patients.

Effects of Endoscopic Thoracic Sympathectomy on Raynaud's Disease.

INTRODUCTION: Raynaud's disease is a disorder that is characterized by attacks of pain, cyanosis, redness, and numbness in the upper extremities caused by vasospasm of digital arteries due to cold or emotional stress. We aimed at demonstrating our experiences with endoscopic thoracic sympathectomy (ETS) in the treatment of Raynaud's disease. METHODS: From 48 patients who underwent ETS for various reasons at our department between January 2014 and January 2015, we reviewed 9 patients with Raynaud's disease (18.7%) with respect to their demographic characteristics such as gender and age, postoperative complications, short-term results, side effects, recurrence of symptoms, and long-terms results. RESULTS: The symptoms and findings reappeared and the number and dosage of the drugs used returned to their preoperative levels in 66.6% of the patients at month 6, and in all patients except 1 at the end of the 1st year. CONCLUSION: ETS should be considered an ultimate choice for patients with Raynaud's disease who have treatment-resistant severe symptoms and serious complications, disturbed social and daily lives, and impaired quality of life, and all patients should be properly informed before the surgery about the possibility of a high rate of recurrence.

A Comfortable Solution To Tracheal Anastomosis Protection: Tracheal Retention Sutures.

Fixation of the chin to the anterior chest wall is the most commonly used method of reducing anastomotic tension following a segmental resection of the trachea and reconstruction with primary anastomosis. However, the sutures required for this method may lead to various organic and psychological problems. In five patients who underwent tracheal resection and primary anastomosis, retention sutures were placed on the proximal and distal-lateral edges of the anastomotic line rather than placing a Guardian chin stitch. All patients were mobilised in the early postoperative period and were able to perform their routine daily activities without restrictions. During their average 14.4 months of follow-up, no complications were found in their anastomotic lines during their clinical, radiological, and bronchoscopic assessments. The placement of tracheal retention sutures proved an inexpensive and reliable method to reduce anastomotic tension without additional surgical burden, and was effective in terms of patient comfort.

Comparison of T2 and T3 sympathectomy for compensatory sweating on palmar hyperhidrosis.

BACKGROUND: An otherwise successfully performed endoscopic thoracic sympathectomy (ETS) to treat palmar hyperhidrosis (PH) often has a serious side effect: compensatory sweating (CS). This side effect occurs in other parts of the body to a disturbing extent. The objective of this study is to determine whether there is a relationship between the level of ETS performed on patients with PH, and the occurrence and severity of postoperational CS. METHODS: Between January 2014 and January 2015, ETS procedures were performed on 25 randomly selected consecutive subjects (group A) at T2 level, and on another 25 subjects (group B) at T3 level, who all felt severely handicapped due to PH. All subjects were assessed in terms of their demographic characteristics including gender and age, as well as postoperative complications, short-term results, side effects, recurrence of symptoms, and long-term results. RESULTS: The symptoms disappeared in all subjects in short-term, and no recurrence was seen in their short or long-term follow-ups. At the end of year one, CS developed at a rate of 12% in group A and 8% in group B, particularly in their back and abdominal regions. The overall satisfaction with the procedure in year one was 96% in group A and 100% in group B. CONCLUSION: When an ETS performed at T2 or T3 level for PH involves only the interruption of the sympathetic chain, with a limitation on the range of dissection and avoidance of any damage to ganglia, sweating is stopped completely. No recurrence of PH is encountered, and CS develops only at low rates and severities.

Relationship of spontaneous pneumothorax cases seen in Eastern Black Sea region with meteorological changes.

The relationship of climate changes or weather conditions with the incidence of pneumothorax has been explored for many years. We aimed at revealing the effects of meteorological changes on the incidence of pneumothorax in the Eastern Black Sea region where spontaneous pneumothorax cases are seen relatively more frequently. The records of 195 subjects (179 males and 16 females) who had been monitored and treated due to spontaneous pneumothorax between January 2006 and December 2012 at our clinic were reviewed retrospectively, and their relationship was investigated with the meteorological data obtained by going through the database archive records of the 11th Regional Meteorology Directorate for the years between 2006 and 2012. Wind velocity was observed to be less in the days of having spontaneous pneumothorax than in the days of having no spontaneous pneumothorax, and the difference was found statistically significant (P = 0.026). The people of our region whose active lifestyle is reflected in their working life, social life, and even in their folk dances usually take a rest in the days of slower wind speed. We think that this state of resting leads to an increase in the frequency of spontaneous pneumothorax.

The Perforation of the Superior Vena Cava Secondary to the Left Subclavian Dialysis Catheter.

INTRODUCTION: The perforation of the superior vena cava during the placement of dialysis catheter and consequent hemothorax is a rare serious complication. CASE REPORT: Dialysis catheter was placed in the left subclavian vein in a 69-year-old male patient with chronic renal insufficiency who was hospitalized for intracerebral hematoma. During hemodialysis a day after the procedure, the patient was noted having right-sided hemothorax, causing lethargy, dyspnea, hypotension, and bradycardia. Right tube thoracostomy was performed and 1500 cc of hemorrhagic fluid was drained. Under general anesthesia, the right posterolateral thoracotomy was performed and the tip of the dialysis catheter was found in the pleural space, penetrating the anteromedial side of the superior vena cava. The perforation area was repaired by suturing with 3-0 prolene, and the dialysis catheter was removed externally. Postoperative period was uneventful, and tube thoracostomy was terminated on day 4. CONCLUSION: Establishing the diagnosis early and accurately and performing appropriate surgery would be lifesaving in superior vena cava perforation due to dialysis catheter.

Misdiagnosed Chest Pain: Spontaneous Esophageal Rupture.

UNLABELLED: Chest pain is one of themost common complaints expressed by patients presenting to the emergency department, and any initial evaluation should always consider life-threatening causes. Esophageal rupture is a serious condition with a highmortality rate. If diagnosed, successful therapy depends on the size of the rupture and the time elapsed between rupture and diagnosis.We report on a 41-year-old woman who presented to the emergency department complaining of left-sided chest pain for two hours. KEY WORDS: Chest pain; Coronary artery disease; Esophageal rupture; Misdiagnosis.

Effectiveness of the STIR turbo spin-echo sequence MR imaging in evaluation of lymphadenopathy in esophageal cancer.

PURPOSE: We have investigated the utility of the STIR TSE sequence in the differentiation of benign from malignant mediastinal lymph nodes in patients with esophageal cancer. PATIENTS AND METHODS: This study included 35 consecutive patients who were diagnosed as esophageal cancer and were undergone surgery. STIR TSE sequences were obtained as the ECG trigger. The signal intensity of the benign and malign lymph nodes, normal esophagus, and pathologic esophagus can be calculated on STIR sequence. RESULTS: Pathologically, the number of total lymph nodes in 35 operated cases was 482. Approximately 152 lymph nodes were detected with MR imaging. Of these, 28 were thought to be malignant, and 124 were thought to be benign, although 32 were malignant and 120 were benign according pathological results. The ratio of benign lymph node intensity value to normal esophagus intensity value was 0.73±0.3. The ratio of malignant lymph node intensity value to normal esophagus intensity value ratio was 2.03±0.4. According to these results, the sensitivity of MR was 81.3%, the specificity was 98.3%. CONCLUSION: We think that if motionless images can be obtained with MRI, we may be able to differentiate benign lymph nodes from malignant ones.

Complications of metallic stent placement in malignant esophageal stricture and their management.

OBJECTIVE: At the present time, covered self-expandable metallic stent placement is the palliative treatment method for inoperable esophageal cancer. However, life-threatening early and late complications are seen related to esophageal stent placement. In this study, we discuss complications of esophageal stent placement with their management and present our own experience. METHODS: Between January 2000 and February 2009, 215 covered esophageal stent placements were performed in 174 inoperable esophageal cancer and/or esophagorespiratory fistula patients in the Department of Thoracic Surgery at the Ataturk University Hospital. RESULTS: Major complications related to stent placement developed in 24 patients (11 bleeding, 6 aspiration pneumonia, 3 tracheal compressions, 2 perforations, and 2 esophagorespiratory fistulas). Two hundred and thirty minor complications were observed among 174 patients (165 chest pain, 29 tumoral overgrowth, 17 stent migration, 6 gastroesophageal reflux, 3 failure in stent placement, 3 hiccup, 2 foreign body sensation, 2 failure in stent expansion, 1 tumor ingrowth, 1 granulation tissue formation, and 1 food bolus obstruction). Reintervention was required in 56 (32.2%) patients who experienced complications. Stent-related mortality was seen in 4 (2.3%) patients (2 aspiration pneumonia, 1 tracheal compression, and 1 esophagorespiratory fistula). One hundred sixty-two of 174 patients died during follow up. The mean survival time was 177.3+/-59.3 days (range: 2 to 993 d). CONCLUSIONS: The complication rate of self-expandable metallic stent placement is high in inoperable esophageal cancer patients. Although some of these complications are life threatening, many of them can be managed successfully with endoscopic reintervention.