Can scoring systems be used for the triage of COVID-19 patients?

Background and Aim: Whether to send COVID-19 patients home with quarantine measures or to hospitalize and treat them on an inpatient basis is a very important decision in the treatment of COVID-19 patients. This study aimed to introduce a scoring system that will enable making decisions on inpatient or outpatient treatment of patients by scoring their symptoms, clinical, radiological, and laboratory results during the initial assessment. Materials and Methods: Data of patients over 18 years of age, examined for COVID-19 between March 11, 2020, and May 31, 2020, and who had a positive PCR result, and their radiological (computed tomography reports) and blood test (complete blood count, blood gas and laboratory results) results were recorded to develop our scoring system. Results: A comparison of COVID-19 patients, who received outpatient and inpatient treatments by age variable, revealed a significant result (P < 0.001). The comparison of laboratory results showed a significant difference between both groups (P < 0.001). The comparison of the groups by the presence of comorbidity also revealed a significant result (P < 0.001). According to the scoring system that we developed (Cebeci score), a score of 5 points and above had a specificity of 81% and a sensitivity of 88% for indicating the probability of receiving inpatient treatment. Conclusion: We believe that the scoring system we developed will be a simple, practical, and leading guide for physicians to avoid dilemmas regarding the issue of whether to quarantine patients at home or to hospitalize them in order to use medical resources effectively.

Prevalence study for postoperative nausea vomiting: A training hospital example.

BACKGROUND: Simplified risk models, such as the Apfel score, have been developed to calculate the risk of postoperative nausea-vomiting (PONV) for adult patients. In the absence of any risk factors, PONV risk is assumed to be 10%. While the presence of one of the four risk factors determined as female gender, non-smoking, PONV/car sickness history, and postoperative opioid use is associated with 20% risk for PONV, the risk increases by 20% with the addition of each risk factor, and reaches to 80% if four factors are present. AIM: : Our aim in this study is to investigate the prevalence of PONV, and whether the scoring systems used for nausea-vomiting in the literature are still valid. PATIENTS AND METHODS: Five groups of patients were included in the study with an Apfel score of 0, 1, 2, 3, 4. Each case was taken to the recovery room at the end of the operation. They were observed whether had nausea-vomiting was recorded according to the Abramowitz emesis score. RESULTS: While the PONV risk for women is 24.637 times higher than men, the PONV risk of those who had gynecological surgery is 6.27 times higher than that of the other type of surgery. Those who had urological surgery are 0.345 times less than the other type of surgery. Those who had lower abdominal surgery had a risk of PONV of 4.56 times higher than the others. As the duration of the case increases, the risk of PONV increases 1.01 times (P values P < 0.001, P < 0.001, P < 0.001, P = 0.048, P < 0.001, respectively). CONCLUSION: As a result, our PONV prevalence is considerably lower than the frequency rates mentioned in the literature. PONV scoring systems need long-term studies with larger populations to be updated.

A comparison of the relationship between the golden ratio and anatomical characteristics of the supraorbital foramen in bare skulls belonging to the Byzantine era and modern era / Comparación de la relación entre la proporción áurea y las características anatómicas del foramen supraorbitario en cráneos de la época bizantina y la edad moderna

The aim of the present study is to determine the frequency of the occurrence of supraorbital foramen/notch (SOF/N) in the skulls of the people who lived in the modern era and the late Byzantine era, to determine the symmetry and the asymmetry between the two halves of the skulls by measuring the linear distance to various landmarks, to check the consistency between the location of the SOF/N and the golden ratio by calculating the ratio between linear distances and to evaluate the differences between the skulls from both historical periods. In the study, the frequency of the occurrence of the supraorbital notch in the skulls from the Byzantine era was found to be 26.60 % on the right and 13.30 % on the left while it was 14.30 % on the right and 9.52 % on the left in the skulls belonging to modern humans. In the skulls belonging to the Byzantine era, the average distance between SOF/N and the sagittal axis passing along the lateral orbital wall was found to be 34.81±2.51 mm and 32.99±2.81 mm respectively on the right and the left while it was 33.14±2.19 mm and 33.39±2.06 mm in the skulls belonging to modern era. The average distance between the SOF/N and the sagittal plane passing along the midline of the skull was found to be 24.55±2.79 mm and 21.57±2.44 mm on the right and the left respectively in the skulls belonging to the Byzantine era while it was 0.04±3.30 mm and 20.96±2.37 mm in the skulls belonging to the modern era. The average distance between the SOF/N and sagittal plane passing along the medial orbital wall was found to be 23.78±3.60 mm and 23.81±3.20 mm on the right and the left respectively in the skulls belonging to the Byzantine era while it was found to be 22.23±3.29 mm and 23.97±1.93 mm in the skulls belonging to the modern era. The average value of the distance between the sagittal planes passing along the lateral and medial sides of the orbit and the ratios between the distance from SOF/N to the sagittal plane passing along the lateral side of the orbit was found to be 1.47±0.21 mm and 1.60±0.08 mm respectively in the skulls belonging to the Byzantine era and the modern era. No significant difference was found between this ratio and the golden ratio; the average value of the ratios between the distance from the SOF/N to the sagittal plane passing along the midline of the skull and the distance from the SOF/N to the sagittal plane passing along the lateral side of the orbit was found to be 0.98±0.26 mm and 1.04±0.36 mm respectively in the skulls belonging to the Byzantine era and the modern era. A significant difference was found between this ratio and the golden ratio for both historical periods (modern society and late Byzantine period) (p <0.005). The comparison of the relevant anatomic characteristics of the SOF/N is very important for anthropologists while a broad knowledge on proportional calculations regarding morphometric values and the location are important for reconstructive surgeons and the experts in forensics and pain control.

El objetivo fue determinar la frecuencia del foramen y incisura supraorbitaria (FSO/E) en cráneos de individuos de la era moderna y aquellos de la era bizantina, para determinar la simetría y asimetría entre las dos mitades de cráneos, mediante la medición de la distancia lineal a varios puntos de referencia, para comprobar la coherencia entre la ubicación del FSO/ y la proporción áurea, a través del cálculo de la relación entre las distancias lineales. Además, se evaluaron las diferencias entre los cráneos de periodos históricos. En el estudio, se determinó que la frecuencia registrada de la incisura supraorbitaria en los cráneos de la época bizantina fue del 26,60% en el lado derecho y 13,30 % en el izquierdo; mientras que en cráneos humanos modernos fue de 14,30% en el lado derecho y 9,52 % en el izquierdo. En los cráneos pertenecientes a la época bizantina, la distancia media entre FSO/E y el eje sagital a lo largo de la pared lateral de la órbita fue de 34,81±2,51 mm y 32,99±2,81 mm, a la derecha e izquierda, respectivamente; mientras que en cráneos de la era moderna fue de 33,14±2,19 mm y 33,39±2,06 mm, a la derecha e izquierda, respectivamente. La distancia media entre la FSO/E y el plano sagital que pasa a lo largo de la línea mediana del cráneo, en los cráneos de la época bizantina, fue de 24,55±2,79 mm y 21,57±2,44 mm a la derecha e izquierda, respectivamente; mientras que fue de 0,04±3,30 mm y 20,96±2,37 mm en los cráneos de la era moderna. La distancia media entre la FSO/E y el plano sagital que pasa a lo largo de la pared medial de la órbita, en los cráneos pertenecientes a la época bizantina fue de 23,78±3,60 mm y 23,81±3,20 mm, a la derecha e izquierda, respectivamente; mientras que en los cráneos pertenecientes a la era moderna fue de 22,23±3,29 mm y 23,97±1,93 mm, a la derecha e izquierda, respectivamente. Se determinó que el valor medio de la distancia entre los planos sagitales a lo largo de los márgenes lateral y medial de la órbita y las proporciones entre la distancia desde FSO/E al plano sagital a lo largo del lado lateral de la órbita fueron de 1,47±0,21 mm y 1,60±0,08, respectivamente, en los cráneos pertenecientes a la época bizantina y la era moderna. No encontramos diferencias significativas entre esta relación y la proporción áurea. El valor medio de las relaciones entre la distancia de la FSO/E al plano a lo largo de la línea mediana del cráneo y la distancia de la FSO/E al plano sagital a lo largo de la pared lateral de la órbita fueron de 0,98±0,26 mm y 1,04±0,36 mm, respectivamente, en los cráneos pertenecientes a la era bizantina y la era moderna. No se encontró una diferencia significativa entre esta relación y la proporción áurea en ambos períodos históricos (la sociedad moderna y el periodo bizantino tardío) (p <0,005). La comparación de características anatómicas relevantes para el FSO/E son importantes para los antropólogos, donde un conocimiento integro de cálculos proporcionales con respecto a los valores morfométricos, mientras que para los cirujanos reconstructivos y los expertos en medicina forense es importante su ubicación.

A comparison of anatomical measurements of the infraorbital foramen of skulls of the modern and late Byzantine periods and the golden ratio / Comparación de las medidas anatómicas del foramen infraorbitario en cráneos de la época bizantina tardía, edad moderna y la proporción áurea

The aim of this study was to examine the morphometric characteristics of the infraorbital foramen of skulls of people living in modern society and in the late Byzantine period, to ascertain the symmetry or asymmetry of the two halves of the skulls by measuring the linear distance between various landmarks, to evaluate at the conformity between the infraorbital foramen and the golden ratio by calculating the ratios between these linear distances, and to set out the differences or similarities between the skulls of these different periods. It was found in the study that the morphometric characteristics of the infraorbital foramen in skulls of the modern period were 47.05 % circular, 41.17 % oval and 11.76 % atypical (semilunar and triangular) on the right, and 70.58 % circular and 29.41 % oval on the left, while those of the Byzantine period were 46.06 % circular and 53.3% oval on the right, and 50% circular and 50 % oval on the left. It was found that the measurements across the infraorbital foramen of the Byzantine skulls averaged 2.93±1.05 mm and 3.15±1.03 mm on the right side and 2.62±0.97 mm and 3.16±0.68 mm on the left vertically and horizontally respectively, and those of the modern period measured 2.32±0.50 mm and 3.00±0.92 mm on the right and 2.48±0.45 mm and 2.76±0.65 mm on the left vertically and horizontally respectively. The ratio between the distances from the outer orbital wall of the IOF to the sagittal plane and the piriform aperture were 1.46±0.25 mm and 1.40±0.21 mm for left and right respectively for the Byzantine skulls, and 1.24±0.24 mm and 1.29±0.42 mm for the modern skulls. A significant difference was found between the ratio obtained and the golden ratio for each of the periods (modern and Byzantine) (p<0.005). A comparison of anatomical characteristics of the infraorbital foramen of people living at different historical periods is important for anthropologists and knowing morphological types and amassing knowledge on the proportional calculation of location is important for dentistry, maxillofacial surgery and algology.

El objetivo fue examinar las características morfométricas de los forámenes infraorbitarios en cráneos de personas que viven en la sociedad moderna y aquellas que vivieron en el periodo bizantino tardío, para determinar la simetría o asimetría de las dos mitades de los cráneos. Se realizó la medición de la distancia lineal entre varios puntos de referencia, para evaluar la conformidad entre el foramen infraorbitario (FO) y la proporción áurea, mediante el cálculo de la relación entre esas distancias lineales, así como las diferencias y similitudes entre los cráneos de estos períodos. En relación a las características morfométricas, se encontraron en cráneos de la época moderna FO circulares (47,05%), ovalados (41,17 %) y atípicos (semilunar y triangular) en un 11,76 %, del lado derecha, y en el lado izquierdo estos porcentajes correspondieron a circulares (70,58 %) y ovalados (29,41%). Por su parte, los cráneos del período bizantino presentaron FO circulares (46,06 %) y ovalados (53,3 %) del lado derecho, mientras que del lado izquierdo fueron circulares (50 %) y ovalados (50 %). Se encontró que las medidas del FO de los cráneos bizantino tuvo un promedio de 2,93±1,05 mm y 3,15±1,03 mm en el lado derecho, y 2,62±0,97 mm y 3,16±0,68 mm a la izquierda, vertical y horizontal, respectivamente; y en el período moderno midieron 2,32±0,50 mm y 3,00±0,92 mm a la derecha y 2,48±0,45 mm y 2,76±0,65 mm a la izquierda, en medidas verticales y horizontales respectivamente. La relación entre las distancias de la pared orbitaria exterior del FO al plano sagital y la apertura piriforme fue de 1,46±0,25 mm y 1,40±0,21 mm, a izquierda y derecha respectivamente, para los cráneos bizantinos; y 1,24±0,24 mm y 1,29±0,42 mm para los cráneos modernos. Se encontró una diferencia significativa entre la proporción obtenida y la proporción áurea para cada uno de los períodos (moderno y bizantino) (p <0,005). La comparación de las características anatómicas del FO de individuos que vivieron en diferentes períodos históricos es valioso para los antropólogos y los conocimientos sobre el cálculo proporcional de la ubicación del FO son importantes en la odontología, cirugía maxilofacial y el estudio del dolor.

Performance, meat quality, meat mineral contents and caecal microbial population responses to humic substances administered in drinking water in broilers.

This study was conducted to examine the effect of different levels of humic substances (HS) administered in drinking water on caecal microflora and mineral composition and colour characteristics of breast and thigh meats and the growth performance, carcass and gastrointestinal tract (GIT) traits of broiler chicks. A total of 480 3-d-old broiler chickens were randomly allocated to 4 treatments with 4 cages per treatment and 30 bird (15 males and 15 females) chicks per cage. All birds were fed on commercial basal diet. The control birds (HS0) received drinking water with no additions, whereas birds in the other treatment groups received a drinking water with 7.5 (HS7.5), 15.0 (HS15.0) and 22.5 (HS22.5) g/kg HS. Mush feed were provided on an ad libitum basis. Body weight and feed intake of broilers were determined at d 0, 21, and 42, and feed conversion ratio was calculated. On d 42, 4 broilers (2 males and 2 females) from each cage were slaughtered and the breast and thigh meats were collected for mineral composition and quality measurements. Performance, carcass and GIT traits and caecal microbial population of broiler chicks at d 42 were not affected by the dietary treatments. The lightness (L*) of breast and thigh meat decreased in broilers supplemented with 15 and 22.5 g/kg HS in drinking water. Although the redness (a*) of breast meat increased, yellowness of thigh meat decreased in broilers supplemented with 15 and 22.5 g/kg HS in drinking water (P < 0.05). In conclusion, the 15 and 22.5 g/kg HS administration in drinking water can be applied for broiler chicks to maintain growth performance and improve meat quality without changing caecal microflora.

Novel non-synonymous polymorphisms in the COX-1 gene in Turkish pediatric patients with cardiovascular anomalies.

Variation in the gene encoding cyclooxygenase-1 (COX-1) is involved in the process of aspirin resistance. This study investigated the genetic variations in the COX-1 gene. The 4 coding regions of the human COX-1 gene in 90 pediatric patients (median age of 6.5 months, 55% males) with cardiovascular anomalies were screened using DNA sequencing. Twenty coding-region variants causing amino acid substitutions as well as 2 new non-synonymous polymorphisms were identified. All variants were compared with an independent Caucasian population (N = 24 unrelated individuals). Most of the discovered polymorphisms were rare, although some variants resulted in amino acid changes occurring at a frequency >5% (W8R, P17L, Q41Q, Q240Q, D189E, and P188P). In addition, 2 new non-synonymous polymorphisms (F200L and D189E) were identified. These findings demonstrated novel genetic variants of the human COX- 1 gene. Future studies characterizing the functional impact of these variants are warranted.

Postoperative repeated respiratory insufficiency and thyrotoxicosis in molar pregnancy.

Following the removal of a hydatiform mole in a 34-year-old, 14-week pregnant patient, thyrotoxicosis and respiratory insufficiency attacks were twice unexpectedly repeated. The symptoms were resolved with the administration of plasmapheresis, antithyroid and ß-blocker drugs and non-invasive mechanical ventilation; however, she was again operated due to prolonged elevated ß-hCG.

Effects of humic substances supplementation provided through drinking water on performance, carcass traits and meat quality of broilers.

The present study aimed at evaluating the effects of different doses of humic substances (HS) in waterer pan on broiler performances and meat quality. For the trial, 480 chicks (ROSS 308) were allocated into four groups (HS0, HS150, HS300 and HS450) of 120 equally mixed-sex birds, each receiving a drinking water supplemented with 0, 150, 300 and 450 ppm of a humic acid (provided by 0.0%, 0.5%, 1.0% and 1.5% of HS, v/v) respectively. At the age of 21 and 42 days, feed consumption and live weight were taken. At the age of 42 days, 16 birds per treatment were slaughtered, dressing percentages, digestive tract traits were evaluated and samples of breast (pectoralis major) and thigh (iliotibialis) meat were taken to evaluate the changes in colour characteristics (CIE L*, a* and b*) and chemical composition. The body weight gain increased by the HS300 in relation to the HS0 and HS450, and decreased by the HS450 in relation to the HS0. The feed consumption of birds in the HS450 and feed efficiency of birds in the HS300 were lower and higher than those in the other treatments respectively. The carcass weight of broilers in the HS150 and HS300 were higher than those of in the HS0 and HS450. The carcass weight decreased by the HS450 in relation to the other treatments. The dressing percentage increased by the HS150 in relation to the HS450. The HS450 resulted in breast and thigh meat colour that were lighter than those found in the HS0 birds. The HS450 increased fat content of thigh meat in relation to the HS0. It was concluded that the humic acid supplementation at 300 ppm and 450 ppm appears to have a measurable impact on live performance improving feed efficiency and lightness of breast and thigh meat colours in broilers respectively.

Retroperitoneal localization of hydatid cyst disease.

In this study we discuss a rare case; hydatid cyst disease that is located in the retroperitoneum. Two cases were treated in our department with hydatid cyst disease located in the retroperitoneum; one of the cysts was in the minor pelvis and the other was on the left psoas muscle. Diagnosis was confirmed with blood tests, and radiological examinations. The cyst wall was excised partially and was oversewn. Following the operation both of the patients were given albendasole tablets for 10 weeks with blood count and liver enzyme monitorization. Hydatic cysts located in retroperitoneum were treated successfully. Especially in the endemic areas hydatid cyst should be remembered when evaluating cystic masses in the retroperitoneum. It can be treated successfully with surgery.

The comparison of electron microscopy and scintigraphy in determining the protective effect of dimethylsulphoxide (DMSO) on ischemia/reperfusion injury through Pringle maneuver.

BACKGROUND/AIMS: We investigated the role of the electron microscopy and hepatobiliary scintigraphy in determining the effect of DMSO (dimethysulphoxide) and ischemia/reperfusion injury in the liver after the Pringle maneuver. METHODOLOGY: Twenty-four rabbits were divided into the following groups; A: Control group, B: Pringle, C: 10 mg/kg DMSO, D: 1 g/kg DMSO + Pringle. Group A was considered as a control group and only laparotomy was applied. Group B was exposed to Pringle maneuver only. Group C was given 10 mg/kg of DMSO via the vena cava inferior. Group D was given 1 g/kg of DMSO. A clamp was fastened for the groups of B, C and D in the 30th minute of the Pringle maneuver and a biopsy was applied five minutes later. Fifteen minutes later a dynamic hepatobiliary scintigraphy was applied. From dynamic images, liver peak time and activity half time of the liver were obtained. RESULTS: It was found that liver peak time and liver activity half time values of the group B, C and D were significantly longer than group A. Liver peak time and liver activity half time values of group B was not different from group C. However, some values of group D were found to be significantly shorter than groups B and C. In the electron microscopy examination, only in group B were some specific degenerative changes observed in the sinusoids. We observed less irreversible changes in group C than in group B. On the other hand, the least irreversible changes were in group D. CONCLUSIONS: As a conclusion, while electron microscopy is regarded as the "gold standard", hepatobiliary scintigraphy may be thought of as an easily applicable method in determining the ischemic reperfusion injury in the clinical comparison of the protective agents.

The importance of intraoperative cholangiography during laparoscopic cholecystectomy.

Laparoscopic cholecystectomy (LC) using an electrosurgery energy source was successfully performed in 59 (95%) out of 62 selected patients. The procedures were performed by different surgical teams at Trakya University, Medical Fakulty, in the department of General Surgery and the Karl-Franzens-University School of Medicine, in the department of General Surgery. Cholangiography was routine at Karl Franzens University and selective at Trakya University. Laparoscopic intraoperative cholangiography (IOC) was performed in 48 (81.3%) patients, and open IOC was performed in 3 patients. Two patients had common duct stones; one of which was unsuspected preoperatively. These cases underwent endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic papillotomy (EP). One patient had a choledocal tumor, unsuspected preoperatively. Anatomical anomalies were not identified. Cholangiography could not be performed in one case in which there was no suspected pathology. ERCP was performed on one patient 30 days after being discharged because of acute cholangitis. In this case, residual stones were identified in the choledocus. Four patients underwent open cholecystectomy because of tumor, unidentified cystic duct or common bile duct pathology that could not be visualized on the cholangiogram. Our study suggests that cholangiography performed via the cystic duct before any structures are divided can prevent the most serious complication of laparoscopic cholecystectomy--common duct injury. We recommend that cholangiography be attempted on all patients undergoing LC.

Laparoscopic versus open cholecystectomy: effect on pulmonary function tests.

BACKGROUND/AIMS: Operations often cause impairment in respiration due to pain. This study was designed to compare the changes in pulmonary function tests after open and laparoscopic cholecystectomy. METHODOLOGY: Two groups of 35 patients were randomly set up. Each patient had 3 pulmonary function tests performed and 2 postero-anterior grid chest roentgenograms taken. All of these data were evaluated by the same group of investigators. RESULTS: After taking into consideration the difference between pulmonary function tests, values were not significant (P < or = 0.05). All pulmonary function test values decreased significantly on the 1st postoperative day (P < or = 0.05). When postero-anterior chest roentgenograms were compared no clinically evident atelectasis except 3 lineary was seen in the laparoscopic cholecystectomy group, whereas 5 lineary, 7 focal, and 3 segmentary atelectasia were encountered in the open cholecystectomy group (P < or = 0.05). CONCLUSIONS: We believe that laparoscopic cholecystectomy has more advantages when speaking of postoperative pulmonary function tests and atelectasia.

Erythrocyte superoxide dismutase and glutathione peroxidase activities, and malondialdehyde and reduced glutathione levels in schizophrenic patients.

There is abundant evidence that free radicals are involved in membrane pathology in the central nervous system and that they may play a role in neuropsychiatric disorders, including schizophrenia. In this study, we investigated erythrocyte superoxide dismutase and glutathione peroxidase activities as antioxidant enzymes, malondialdehydes as a sign of lipid peroxidation, and reduced glutathione levels in schizophrenic patients. Activities of superoxide dismutase and levels of malondialdehyde in erythrocytes were greater in all patients (n=48) and in patients with acute (n=16) and chronic schizophrenia (n=32) (p<0.001 for all patients and chronic patient group; p<0.05 for acute patient group). The activities of glutathione peroxidase were lower in patients (p<0.05 for all patients and acute patient group; p=0.051 for chronic patient group) compared with the control group. Mean erythrocyte reduced glutathione was lower in patients than in controls (p<0.05). In the patient group, erythrocyte superoxide dismutase activity was positively correlated with scales and duration of disease and erythrocyte malondialdehyde concentration. These data reveal that antioxidative defense mechanisms might be impaired in schizophrenic patients.

First-case postpartum psychoses in Eastern Turkey: a clinical case and follow-up study.

OBJECTIVE: The aim of this study was to investigate the clinicodemographic features and long-term course of postpartum psychosis (PPP). METHOD: A total of 64 in-patients with psychotic postpartum disorder, who were admitted for the first time to a psychiatry clinic, were reexamined retrospectively and then compared with 64 control patients. Follow-up investigation was carried out either by interviewing the patients personally or with the help of general practitioners (GPs). All patients were rediagnosed according to DSM-IV. RESULTS: The majority of PPP patients were young, married, primiparae, had a low educational level and were living in rural areas. The mean onset time of PPP after delivery was 3.62 weeks. More than 75% of the patients with PPP had further psychotic episodes during the follow-up period of 11 years; 42% of the puerperal cases were diagnosed as schizophrenia at the follow-up investigation, and 59.3% of the patients had confuso-oneiroid syndrome. CONCLUSION: These findings, unlike those of the Western studies, demonstrate that PPP is not uniform in different populations.

Simultaneous operation for coexisting lung and liver hydatid cysts: a treatment modality.

BACKGROUND/AIMS: Hydatid disease is very common in our region. Whether or not coexisting cysts of lung and liver should be operated on simultaneously is a challenging question. METHODOLOGY: Of 127 patients operated on for hydatid cysts of the lung between 1990 and 1995, 23 (18%) had coexisting hydatid cysts of the right lung and liver. There were 12 male and 11 female patients with an average age of 34 years. RESULTS: All patients had simultaneous operations for both organs via right thoracotomy with an incision in the diaphragm (phrenotomy). In the lung, cystotomy and capitonnage were performed in 21 patients and wedge resection in 2; in the liver, cystotomy and capitonnage were performed in all 23 patients. No hospital mortality occurred. CONCLUSION: Coexisting hydatid cysts of the right lung and liver should be surgically treated simultaneously.

Coronary artery aneurysm development after successful primary stent implantation.

This case report describes a patient who developed an aneurysmatic dilation of a coronary artery 6 months after successful primary stent implantatIon. The dilation occurred within the stented segment of the artery. To our knowledge, this is the first report of the development of an aneurysm, in the absence of angiographically visible dissection or other possible causative factors.

The rupture of hepatic hydatid disease into the right hepatic vein and bile ducts: a case report.

Echinococcus granulosus and Echinococcus multilocularis cause liver hydatid disease. One of its most common complications is rupture into the bile ducts; however, penetration of a cyst into a vessel is a very rare complication. We detected a defect (2 x 1 cm) on the wall of the right hepatic vein, in addition to three distinctive ruptures into the bile ducts, in our case. For systemic hypotension due to a bleeding during operation and to repair the vessel wall defect, an urgent right thoracotomy followed by a radial phrenotomy was needed. We were able to reach the operation site easily and repaired the vessel wall with polypropylene suture. Because of the occurrence of these two complications together and the difficulties of the operation, we decided to report this case.