Use of ultrasonography for differentiation between bullae and pneumothorax.

PURPOSE: Modern lung ultrasound (US) is mainly applied not only in critical care, emergency medicine, and trauma surgery, but also in pulmonary and internal medicine. In some cases, pneumothorax (PTX) distinguishes with bullous diseases. In this study, we aimed to discuss the success of US on detecting PTX versus bullae. METHODS: We performed a prospective blinded study. Patients underwent thorax computed tomography (CT) if bullae or pneumothorax could not be differentiated from the chest radiography. An emergency medicine specialist trained in lung US and unaware of x-ray and CT findings performed US. All patients US performed from anterior and lateral wall. RESULTS: Final study population included 81 patients. The sensitivity of the presence of pleural sliding in the diagnosis of bullae was 97.50% (86.84-99.94%), and specificity was 100.0% (91.4-100.0%). CONCLUSION: In conclusion, direct visualisation of ultrasonographic pleural sliding can be a good tool for differentiating bullae and pneumothorax.

Catamenial hemoptysis: a case report.

Herein we present a 25-year-old female patient who was admitted with recurrent hemoptysis in menstrual period. At the thorax computed tomography taken during menstruation of patient, diffuse ground glass density and acinar nodules at superior segment of lower lobe at left lung were detected. There was no this findings at the thorax tomography taken in non-menstruation period. Therefore, patient was considered catamenial hemoptysis with clinical and radiological findings. Pulmonary endometriosis is rarely seen disease of the lung, so we are presenting it in the light of the literature knowledge.

Comparison of the effects of alpha lipoic acid and dexpanthenol in an experimental tracheal reconstruction animal model.

OBJECTIVES: To investigate the positive effects of intraperitoneal administration of alpha-lipolic acid (ALA) and dexpanthenol (DXP) on wound healing after tracheal surgery in rats. METHODS: The study was carried out at Necmettin Erbakan University, Konya, Turkey, from January 2014-2019. A total of 30 healthy and adult Sprague-Dawley type female rats were included in the study. For the experiment, rats were randomly divided into 3 groups: ALA group (n=10), DXP group (n=10), and control group (n=10). After trachea surgery, 100 mg/kg/day ALA was given to group ALA and 100 mg/kg/day intraperitoneal DXP to group DXP for 15 days, and the rats were sacrificed on the 21st day. The excised tracheal sections were evaluated and graded for inflammatory cell infiltration, angiogenesis, fibroblast proliferation, collagen deposition, and epithelial regeneration to evaluate wound healing. RESULTS: Inflammation was found to be less in both the ALA and DXP groups. With the Mann-Whitney test, it was determined that inflammation was less in the ALA group than in the DXP group (C-D [p=0.097] and C-A [p=0.024]). On the other hand, no statistically significant difference was found in epithelial regeneration (p=0.574; >0.05), angiogenesis (p=0.174; >0.05), fibroblast proliferation, and collagen deposition (p=0.102; >0.05). CONCLUSION: Alpha-lipolic acid injected intravenously after tracheal reconstruction in patients can prevent restenosis by reducing inflammation without adversely affecting wound healing.

Concomitant Occurrence of Hepatopulmonary hydatid Cysts in Turkey.

BACKGROUND: We aimed to report the demographic characteristics with diagnosis and treatment methods in patients with concomitant hepatopulmonary hydatid cysts. METHODS: Over a ten-year period (from 2002-2020) in Konya, Turkey, surgery was performed on 52 patients with hepatopulmonary hydatid cyst. Main outcome measure(s) were 52 hydatid cysts patients, which had cysts both in the liver and lungs, were investigated regarding their age, gender, cyst localization, suppuration, symptoms, and treatment methods. RESULTS: Seventeen of the patients were males. Their mean age was 39.7±18.8 years. The most common occupation was housewifery. The most common symptom was coughing and none of the patients with concomitant hepatopulmonary hydatid cysts was asymptomatic. The pulmonary hydatid cysts were mostly encountered in the right lung and the majority of the hepatic hydatid cysts were observed in the right lobe. The mean hospitalization time of the operated patients was 17.12±6.7 days. CONCLUSION: In patients with hydatid cysts localized concomitantly in the right lung and subdiaphragmatic area, right thoracotomy for the pulmonary cyst and a transdiaphragmatic approach for the hepatic cyst is a safe, effective, and comfortable method.

Endobronchial valve vs coil for lung volume reduction in emphysema: results from a tertiary care centre in Turkey.

BACKGROUND: Bronchoscopic lung volume reduction (BLVR) by either the endobronchial valve (EBV) or coil (EBC) procedure is recommended for severe emphysematous patients. BLVR applications generally help healthy lung areas ventilate more comfortably by reducing the hyperinflation and improving the contraction capacity of diaphragm. OBJECTIVES: Compare our experience with valve and coil BLVR devices. DESIGN: Retrospective. SETTING: Single tertiary care centre. PATIENTS AND METHODS: Demographic data, vital signs, pulmonary function tests (PFTs), the six-minute walking test (6MWT), vital signs, arterial blood gases and complications were recorded. MAIN OUTCOME MEASURES: Change in PFTs and completion of the 6MWT. SAMPLE SIZE: 60 Turkish men with a diagnosis of chronic pulmonary lung disease. RESULTS: Clinical and demographic characteristics were similar in patients who underwent EBV and EBC. Thirty (96.8%) EBV patients and 27 (93.1%) of the EBC patients were able to properly complete the PFT before the procedures, but all complied after the procedures. Significant improvement in PFTs were achieved after the procedure and there were no statistically significant differences in post-procedure performance. For the 6MWT, the completion rate improved from 15 (48.4%) to 19 (61.3%) patients in the EBV patients (P=.125) and from 19 (65.5%) to 21 (72.4%) patients in the EBC patients (P=.500). There was no significant difference in completion rates for the walking test for either group (median 32 meters in EBV patients and 37 meters in EBC patients; P=.652). Vital signs and arterial blood gases were similar in the two groups. The rates of complications were similar in both groups. CONCLUSION: Endobronchial valves and coils are safe and effective methods for BLVR for patients with severe emphysema. LIMITATIONS: Relatively small sample, retrospective design, single-centre retrospective study. CONFLICT OF INTEREST: None.

A simultaneous coronary artery bypass grafting on beating heart and right upper lobectomy in a patient with a lung adenocarcinoma.

A coexisting coronary heart disease may increase the operative mortality and morbidity rates of lung resection. A simultaneous or a two-stage procedure using myocardial revascularization prior to the pulmonary resection may reduce the postoperative morbidity and mortality. Herein, we present a 65-year-old male case of a lung adenocarcinoma in whom a simultaneous coronary artery bypass grafting on a beating heart and right upper lobectomy was performed.

Adult foreign body aspirations treated for many years with the diagnosis of asthma: report of two cases.

While foreign body aspirations are mostly seen in children, they are also observed in adulthood, but in a rare frequency. As it can be asymptomatic for a long time, it can also be confused with many clinical conditions, such as asthma, which can cause chronic cough. Various complications, such as bronchiectasis and pneumonia, can develop in the presence of long-standing aspirated foreign body. In this study, we present two cases one of whom diagnosed with asthma and treated for 30 years, and the other diagnosed with asthma and treated for 10 years. Although no pulmonary complications developed in our first case, bronchiectasis in the right middle lobe developed in our second case.

Our transthoracic biopsy practices accompanied by the imaging process: The contribution of positron emission tomography usage to accurate diagnosis.

OBJECTIVES: The objective of this study was to compare the results of transthoracic biopsies performed through the use of FDG PET/CT imaging with the results of transthoracic needle biopsy performed without using the FDG PET/CT imaging. METHODS: The medical files of a total of 58 patients with pulmonary and mediastinal masses. A total of 20 patients, who were suspected of malignancy with the SUVmax value of over 2.5 in FDG PET/CT, underwent a biopsy process. Twelve patients with no suspicion of malignancy in accordance with CT images and with the SUVmax value below 2.5 underwent no biopsy procedure, and hence, they were excluded from the study. On the other hand, 26 patients directly went through a biopsy process with the suspicion of malignancy according to CT imaging, regardless of performing any FDG PET/CT imaging. RESULTS: According to the biopsy results, the number of the patients diagnosed with cancer was 20 (43.5%), while the number of non-cancerous patients was 26 (56.5%). When these findings were considered, it was determined that the sensitivity of the whole TTNB (transthoracic needle biopsy) was 80.8%, and the specificity was found as 100%. The positive predictive value of the whole TTNB was 100%, while its negative predictive value was found to be 80%. The sensitivity in TTNB performed together with FDG PET/CT was 90.9%, whereas the specificity was 100%. The positive predictive value of TTNB with FDG PET/CT was 100%, while its negative predictive value was found to be 81.8%. The sensitivity in TTNB performed without the use of FDG PET/CT was 73.3%, whereas the specificity was determined as 100%. CONCLUSIONS: Performing FDG PET/CT imaging process prior to a transthoracic biopsy as well as preferring FDG PET/CT for the spot on which the biopsy will be performed during the transthoracic biopsy procedure increases the rate of receiving accurate diagnosis.

Cardiac and arterial elastance and myocardial wall stress in children with pectus excavatum.

OBJECTIVES: Pectus excavatum (PE) is one of the most common skeletal deformities of childhood. The study was undertaken to assess cardiac functions in children with PE. METHODS: Echocardiography was performed on 32 children with PE and 40 age-matched healthy controls. The following parameters were monitored: meridional left ventricular (LV) wall stress (WSM), arterial elastance (Ea), LV elastance at end-systole derived by single beat (Ees(sb)), LV circumferential end-systolic wall stress (ESWSc), midwall shortening fraction (SFmid), predicted midwall fiber shortening for a measured fiber stress (midwall VCFc), myocardial fiber stress (MFS), LV end-systolic dimension (LVES), LV end-diastolic dimension (LVED) and end-systolic blood pressure (Pes), LV wall thickness at end-systole (hes). To assess the severity of PE, Haller index (HI) was calculated by computed tomography of the thorax. RESULTS: SFmid, ESWSc, midwall VCFc and MFS were lower in PE children than in controls. The degree to which the parameters SFmid, ESWSc, midwall VCFc and MFS were altered in PE children was 14.9, 27.5, 20.3 and 20.3%, respectively. The minimum HI value of children with PE was 2.00, the maximum value was 4.93 and the arithmetic mean was 2.62 ± 0.56. Of the 32 children, 14 (43.75%) demonstrated mild deformity, 15 (46.88%) showed moderate and only 3 (9.37%) had severe deformity. In children with PE, there was no statistically significant correlation between the cardiac data (ESWSc, midwall VCFc, MFS, Ea, Ees(sb), LVES, LVED, Pes, hes) and HI. CONCLUSION: We found ESWSc, MFS, midwall VCFc and SFmid to be lower in children with PE than in controls. We concluded that the myocardial contractility and afterload is affected in children with PE.

In Vitro Efficacy of the Ankaferd Galenic Hemostatic Extract as a Germicidal Agent.

BACKGROUND: Hydatid cysts are encountered frequently in regions endemic with livestock. The basic treatment for a hydatid cyst is total surgical removal of the cyst and its inner contents. Hypertonic NaCl or diluted betadine solution are used as germicidal agents for most hydatid surgeries. However, the germicidal efficacy of the Ankaferd Blood Stopper® (ABS) has not been investigated. Thus, we compared the efficacy of ABS for hydatid cysts with that of other germicidal agents. METHODS: Lung and liver tissues containing hydatid cyst liquid were collected from slaughterhouses. Six samples of each cyst were randomly allocated into different groups as follows: 20% hypertonic NaCl, betadine solution, ABS, 20% liquefied Andazole solution, 0.1% eosin, and distilled water. All groups were examined microscopically at 5, 10, and 15 min after treatment began to determine protoscolece viability rates. RESULTS: The most efficacious germicidal agent at 5 min was ABS, and betadine and hypertonic NaCl had similar efficacies. Betadine, ABS, and hypertonic NaCl showed similar efficacies at 15 min. CONCLUSION: ABS was an effective germicidal agent to treat hydatid cysts.

Effect of the Human Amniotic Membrane on Liver Regeneration in Rats.

Introduction. Operations are performed for broader liver surgery indications for a better understanding of hepatic anatomy/physiology and developments in operation technology. Surgery can cure some patients with liver metastasis of some tumors. Nevertheless, postoperative liver failure is the most feared complication causing mortality in patients who have undergone excision of a large liver mass. The human amniotic membrane has regenerative effects. Thus, we investigated the effects of the human amniotic membrane on regeneration of the resected liver. Methods. Twenty female Wistar albino rats were divided into control and experimental groups and underwent a 70% hepatectomy. The human amniotic membrane was placed over the residual liver in the experimental group. Relative liver weight, histopathological features, and biochemical parameters were assessed on postoperative day 3. Results. Total protein and albumin levels were significantly lower in the experimental group than in the control group. No difference in relative liver weight was observed between the groups. Hepatocyte mitotic count was significantly higher in the experimental group than in the control group. Hepatic steatosis was detected in the experimental group. Conclusion. Applying the amniotic membrane to residual liver adversely affected liver regeneration. However, mesenchymal stem cell research has the potential to accelerate liver regeneration investigations.

[Removal of mediastinal foreign body (steel shot) using mediastinoscopy: case report]. / Mediastinoskopi ile çikarilan mediastinal yabanci cisim (saçma çekirdegi): Olgu sunumu.

Morbidity and mortality is high in patients with gunshot wounds to the chest. Only in rare cases do foreign bodies persist in the thorax without significant pathology. At this study, we present a case in which steel shot was removed through the mediastinum using mediastinoscopy due to the risk of tracheal fistula.

Endovascular angioplasty-stenting as a definitive treatment for isolated spontaneous common carotid artery dissection. A case report.

Isolated spontaneous common carotid artery (CCA) dissection is rare. So far, surgical or medical treatment have only been reported in a few cases in the literature. We report a 39-year-old man, diagnosed as isolated spontaneous CCA dissection one year ago, who experienced a new minor stroke despite medical treatment. Because of the presence of new ischemic lesions on new magnetic resonance imaging despite medical treatment, and critical narrowing of internal carotid artery (ICA) orifice with jet and turbulence flow pattern at the bulbar portion of the ICA, endovascular management was performed with carotid stent deployment. To the best of our knowledge, this is the first case of spontaneous isolated CCA dissection treated with stenting of the carotid artery reported in literature. - ÖZET - Izole spontan common carotid arter (CCA) diseksiyonu nadirdir. Literatürde sadece birkaç adet, medikal veya cerrahi tedavi uygulanan, CCA diseksiyonu olgusu bildirilmistir. Bildirimizde, bir yil önce izole spontan CCA diseksiyonu tanisi almis ve medikal tedavi altinda iken yeni minor strok geçiren 39 yasinda erkek olguyu sunuyoruz. Olgunun yeni magnetik rezonans görüntülemesinde (MRG), sol posterior frontal ve pariyetal loblarda yeni iskemik lezyonlarin ortaya çiktigi görüldü. Renkli Doppler ultrasonografi (RDUS) incelemesinde eski incelemesine gore darligin arttigi izlendi. Karotis anjiografide de internal karotis arter baslangicinda jet ve türbülans akima neden olan kritik darlik saptanmasi üzerine endovasküler tedavi planlandi. Femoral girisimle koruyucu filtre kullanilarak self ekspandibl stent yerlestirildi ve postdilatasyon balon uygulandi. Islemden 24 saat sonra alinan difüzyon MRG incelemesinde yeni iskemik alan görülmedi. Birinci ve 3. ay kontrollerinde, nörolojik muayenesinde yeni bulgu saptanmadi. RDUS incelemelerinde stentin açik oldugu görüldü. Karotis artere stent yerlestirimesi cerrahiye alternatif bir tedavi olup daha az invazivdir. Stent uygulamasi, spontan ve travmatik internal karotis arter darliklarinda kullanilmis, ancak izole spontan CCA diseksiyonunda kullanilmamistir. Olgumuz nadir görülen izole spontan CCA diseksiyonu olgularindan biri olup stent yerlestirilerek tedavi edilmistir. Sonuç olarak, medikal tedaviye ragmen tekrarlayan semptomlari olan izole spontan CCA diseksiyonu olgularda tromboemboli kaynaginin kontrol altina alinmasi ve yeterli karotis akiminin saglanmasi için stent yerlestirilmesi gerekebilir.