Microsievert Wide-Volume Versus Spiral Computed Tomography Using an Automatic Exposure Control System in the Diagnosis of Foreign Body Aspiration in Children.

BACKGROUND: Foreign body aspiration (FBA) in childhood is a life-threatening condition that necessitates prompt management to prevent devastating complications. Different imaging methods are used in the diagnosis of FBA. OBJECTIVE: The aim of this study was to compare the diagnostic value and dose of microsievert wide-volume computed tomography (µSv-WV-CT) with multidetector computed tomography using an automatic exposure control system (MDCT-AEC) in children with FBA. MATERIAL AND METHODS: In this single-center cross-sectional study, 102 cases diagnosed with FBA between September 2013 and September 2021 were retrospectively evaluated. The patients were divided into 2 groups according to the diagnostic modality used: group A, µSv-WV-CT (2016-2021) and group B, MDCT-AEC (2013-2021). The diagnostic performance and radiation dose of the 2 groups were statistically compared. RESULTS: The diagnostic performance (sensitivity, specificity, positive predictive value, negative predictive value, and accuracy) of the 2 groups was similar. The mean effective radiation dose of group A was 34.89 ± 0.01 µSv, which was significantly lower than that of group B (179.75 ± 114.88 µSv) ( P < 0.001). CONCLUSION: In children with suspected FBA, µSv-WV-CT at a lower radiation dose had similar diagnostic performance to MDCT-AEC.

The effect of meteorological variables on spontaneous pneumothorax in two regions with different altitudes.

Spontaneous pneumothorax (SP) is defined as the presence of free air inside the pleural space. Many studies have reported that meteorological variables may trigger SP, but the mechanism is unknown. The aim of this study was to compare the effects of meteorological variables on the development of SP in two regions with different altitudes. The study was conducted in the Çanakkale (2 m above sea level) and the Erzurum region (1758 m). A total of 494 patients with SP who presented to the hospitals of the two regions between January 2011 and December 2016 were included in the study. The meteorological variables used included ambient temperature, atmospheric pressure, relative humidity, precipitation amount, wind speed, and wind direction (as north and south). The total 2192 days were divided into two as days with and without an SP case presentation. A 4-day period prior to the day a case presented was compared with the other days without any cases to investigate the presence of any lagged effect. Statistical significance was accepted at p < 0.05. Comparison of these two regions showed a significant difference between them. The meteorological variables of the regions that affect SP development were found to be low mean minimum temperature, high daily temperature change, low precipitation, low wind speed and north winds for Erzurum, and only rainy days for Çanakkale. The results have demonstrated that cold weather, sudden temperature changes, north winds, and low wind speed are risk factors for the development of SP at high altitudes.

An alternative plane block for multiple rib fractures: Rhomboid Intercostal and Sub-Serratus block (RISS).

Rib fractures are a common injury, which occur after severe blunt chest trauma. Sufficient and early pain control is essential to avoid respiratory complications. In recent years, the serratus plane and the erector spinae plane blocks have been used in ED for pain related to rib fractures. The Rhomboid Intercostal and Sub-Serratus (RISS) block can be utilized for pain control in patients with multiple rib fractures. We report two cases of patients with multiple rib fractures in which pain reduction was achieved with application of the RISS block.

An important finding for differential diagnosis in thymic cyst mimicking pericardial cyst: punctate calcification.

Mediastinal cysts are usually congenital but present in adulthood. A pericardial cyst is usually localized in the right cardiophrenic region. Thymic cysts are less common and are located in the cervical region or anterior mediastinal region. While thoracoscopic excision or aspiration can be applied in pericardial cysts, excision is recommended in thymic cysts. We present a case of a thymic cyst located in the localization of the pericardial cyst and radiologically containing wall punctate calcification.

Comparing Capitonnage and Uncapitonnage Techniques for Pulmonary Hydatid Cysts: A Systematic Review and Meta-analysis.

Surgery is the primary treatment for pulmonary hydatid cysts. This systematic review and meta-analysis aimed to compare the results of capitonnage and uncapitonnage techniques for the surgery of pulmonary hydatid cysts. Descriptive Boolean queries were used to search PubMed, Scopus, and Web of Science for articles published up to June 2022 to evaluate the outcomes of pulmonary hydatid cysts in terms of mortality, postoperative complications, and hospital stay. A total of 12 studies were included. An analysis of the total side effects revealed that there was a statistically significant difference between the capitonnage and uncapitonnage groups (odds ratio=3.81, 95% confidence interval=[1.75-8.31], P < .001). The results showed that more side effects were observed in the uncapitonnage group than in the capitonnage group. The risk of side effects in the uncapitonnage group is 3.81 times higher than in the capitonnage group. The results showed that more prolonged air leak was seen in uncapitonnage group than in the capitonnage group (odds ratio=4.18, 95% confidence interval=[1.64-10.64], P=.003). The results show that more empyema was observed in uncapitonnage group than in the capitonnage group (odds ratio=4.76, 95% confidence interval=[1.29-17.57], P =0.020). An analysis of atelectasis and mean hospital stay revealed that there was no statistically significant difference between the capitonnage and uncapitonnage groups. The results reveal the advantages of capitonnage in the treatment of pulmonary hydatid cysts and that the capitonnage method is quite effective in reducing complications compared to the uncapitonnage method.

Pulmonary Hamartomas: A Single-Center Analysis of 59 Cases.

OBJECTIVE: This study investigated the clinical, radiological, and surgical treatment results of patients who underwent surgical treatment for pulmonary hamartomas. MATERIALS AND METHODS: Fifty-nine consecutive patients who underwent surgical treatment for pulmonary hamartomas in our clinic between January 2001 and February 2021 were analyzed retrospectively. RESULTS: Forty-three out of 59 (72.9%) of the cases were male and 16 (27.1%) were female. The average age was 52.0 ± 15.0 (between 5 years and 80 years). While pulmonary hamartoma was in the form of a solitary pulmonary nodule in 55 (93.2%) of the cases, there were multiple lesions in 4 (6.8%) cases. Simultaneous gastric adenocarcinoma was detected in 1 patient. One case had been operated on for Wilms tumor. Twenty-two (37.3%) of the cases were asymptomatic and were detected incidentally. Locations of pulmonary hamartomas were 18 (29.0%) in the left lower lobe, 16 (25.8%) in the right upper lobe, 12 (19.4%) in the right lower lobe, 9 (14.5%) in the left upper lobe, and 7 (11.3%) in the right middle lobe. The mean lesion diameter was 22.0 ± 9.5 mm (between 10 mm and 56 mm). Mild to moderate fluorodeoxyglucose (FDG) uptake was observed in 11 of 15 cases that were evaluated with positron emission tomography/computed tomography. Surgically, 44 (74.6%) patients underwent wedge resection, 13 (22.0%) patients underwent enucleation and two (3.4%) patients underwent lobectomy. Perioperative morbidity and mortality were not observed in any of the cases. The cases were followed up for an average of 40.6 ± 38.7 months (between 1 month and 151 months). No recurrence was observed in any of the cases during follow-up. CONCLUSION: Pulmonary hamartomas are usually detected incidentally and as a solitary pulmonary nodule. Although radiological findings provide important information, a definitive diagnosis is usually made during surgery. Parenchyma-sparing surgery should be preferred in these cases whenever possible.

Foreign body aspirations in children and adults.

OBJECTIVE: Foreign body aspiration (FBA) can be encountered in all age groups, especially in children under 3 years of age. In this study, we aimed to evaluate our results in children and adults who underwent rigid bronchoscopy due to a history of foreign body aspiration. MATERIALS AND METHODS: In a single-center study, 822 consecutive patients with suspected foreign body aspiration and undergoing rigid bronchoscopy between January 2000 and August 2021 in our clinic were retrospectively evaluated. RESULTS: There were 451 (54.9%) male and 371 (45.1%) female patients. The mean age was 8.1 ± 14.0 (range 1 month-84 years). 525 (63.9%) of the cases consisted of cases under 3 years old, including 3 years old. There were 726 (88.3%) pediatric patients (≤18 years old), and 96 (11.7%) adult patients. The most important symptoms were cough in 690 (83.9%) cases and wheezing in 492 (59.9%) cases. The most frequently aspirated foreign bodies in children were sunflower seeds (14.2%, n = 71), food particles (11.4%, n = 57) and needles (52%, n = 10.4). The most frequently aspirated foreign bodies in adults were needles (39.5%, n = 28), non-needle metallic objects (21.1%, n = 15) and food particles (11.3%, n = 8). No mortality was observed in any of the patients who underwent rigid bronchoscopy. CONCLUSION: FBA is higher in children and direct radiological findings are less than in adults. Current findings show that FBAs in children are more difficult to diagnose and more dangerous clinically.

Detection of SARS-CoV-2 RNA in the Pleural Swab of a COVID-19 Patient with a Pneumothorax.

Coronavirus disease 2019 (COVID-19) is a viral disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). While evaluating nasopharyngeal swabs by real-time reverse transcriptase-polymerase chain reaction (rRT-PCR) is diagnostic, thorax computed tomography (CT) findings are also guiding in diagnosis. The association of pneumothorax and pleural effusion is not common in coronavirus disease. We presented the nucleic acid detection by a pleural swab sample in a COVID-19 patient with ground-glass opacity appearance and spontaneous pneumothorax.

Minimally Invasive and Endoscopic Approach to Esophageal Perforation.

Although esophageal perforation is rare, it is a life-threatening condition. The esophagus is very sensitive to rupture and perforation due to the absence of a serosal layer. More than half of the esophageal perforations are iatrogenic and most occur during endoscopy. Around 55% of esophageal injuries occur in the intrathoracic region, 25% in the cervical region, and 20% in the abdominal region. Clinical manifestations and mortality are related to various components such as the etiology, localization, type of injury, severity of contamination, injury to adjacent mediastinal structures, and time from perforation to treatment. When perforation occurs in the esophagus, saliva, stomach contents, bile fluid, and other secretions may pass into the mediastinum causing mediastinal emphysema, inflammation followed by mediastinal necrosis, and chemical mediastinitis. Early clinical suspicion and imaging are essential for successful treatment. Despite advances in technology and treatment, the morbidity and mortality rate due to esophageal perforation is still higher than 20% according to the reported studies. Until now, the main treatment of esophageal perforation was the surgical approach. Nowadays, endoluminal procedures such as endoscopic vacuum therapy, endoscopic stent placement, endoscopic clip closure, endoscopic suturing, and tissue adhesives have started to be applied more. In this review, the minimally invasive and endoscopic approach methods suitable for esophageal perforation according to the characteristics of the patients and the structure of the perforation were examined.

Is thoracic esophagostomy an option in esophageal perforation in pediatric patients?

Esophagostomy and subsequent esophagectomy are extremely rare operations in the management of benign esophageal perforations in children. In this report, we present a 20-month-old female in whom we performed thoracic esophagostomy and subsequent intrathoracic esophagogastric anastomosis due to esophageal perforation caused by a chronic foreign body. The patient was discharged on the 10th postoperative day, and no complications were observed in the patient, who was followed for four years. The thoracic esophagostomy procedure helps preserve the esophageal length and easy execution of the esophagogastric anastomosis in the thorax. We believe it can be a safe and useful technique in carefully selected cases.

Pulmonary Hydatid Cyst in Children and Adults: Diagnosis and Management.

Hydatid cyst disease induced by Echinococcus granulosus is a parasitic disease known since ancient times. Today, it continues to be seen in many countries and creates serious problems. The lung is the second most frequently affected organ by hydatid cysts after the liver. Lung involvement is more prevalent in children than adults, and the growth of the cyst is faster in children. Hydatid cysts are mostly seen in the right lower lobe of the lung. Common symptoms are chest pain, cough, and shortness of breath, with the most diagnostic symptom being the expectoration of cyst fluid or membranes. In endemic areas, the diagnosis of hydatid cysts can usually be made easily by clinical findings, serology tests, and radiological findings. When the hydatid cyst ruptures and becomes complicated, it is clinically and radiologically confused with many diseases, especially lung cancer. Surgery is accepted as primary treatment of lung hydatid cysts all over the world. The surgical approach is related to several factors such as the size of the cyst, whether it is intact or complicated, unilateral or bilateral, solitary or multiple, and the presence of destruction of the lung parenchyma. Although it is stated by some surgeons that capitonnage is not required, the most frequently applied surgical technique is cystotomy and capitonnage. Pulmonary resection should be avoided as much as possible, particularly in children. Albendazole or mebendazole treatment in pulmonary hydatid cyst is generally used after surgery and to prevent recurrences.

Evaluation of albendazole efficiency and complications in patients with pulmonary hydatid cyst.

OBJECTIVES: This study investigated the efficacy and complications of albendazole use after surgery in patients with pulmonary hydatid cysts. METHODS: One hundred fifty-three consecutive patients who met the study criteria out of 215 patients who received prophylaxis with albendazole after surgery for isolated pulmonary hydatid cysts in our clinic between January 2011 and December 2020 were analysed retrospectively. RESULTS: Eighty-six out of 153 (56.2%) of cases were male and 67 (43.8%) were female. The average age was 24.6 ± 17.4 (between 3 and 71 years), 76 of them (49.7%) were 18 years old and younger, while 77 (50.3%) were adults. All cases were approached transthoracically and a total of 170 operations were performed on the 153 cases. Fever, weakness and dizziness were reported in only one patient who was given albendazole treatment. A partial increase in liver enzymes was observed in 16 cases (10.5%) after albendazole treatment. Mild leukopoenia and neutropenia were observed in only one of the cases. In 1 case, a second operation was performed 30 months later due to recurrence. Albendazole treatment was not required to be discontinued in any of the cases. Mortality was not observed in any of the cases. Factors such as mean age, cyst size and hospitalization period did not have a statistically significant effect on any changes in liver enzymes tests following albendazole therapy (P > 0.05). CONCLUSIONS: Albendazole treatment can safely be used for postoperative prophylaxis in patients with pulmonary hydatid cysts in a controlled manner without causing serious complications. SUBJ COLLECTION: 152.

Comparison of VATS and Thoracotomy Results in Mediastinal Neurogenic Tumors.

OBJECTIVE: In this study, we aimed to compare the results of patients who underwent surgery by thoracotomy and Video-assisted thoracoscopic surgery (VATS) in mediastinal neurogenic tumors. MATERIALS AND METHODS: Twenty-six consecutive cases (12 males and 14 females; mean age 39.4 ± 22.3 years; range 1-72 years) who were histopathologically diagnosed as having mediastinal neurogenic tumors between January 2000 and August 2020 were included in a single-center, retrospective study. RESULTS: There were 5 (19.2%) children and 21 (80.8%) adults. Lesions in all cases were located in the posterior mediastinum. Schwannoma was detected histopathologically in 18 cases (69.2%), and all of these cases were adult patients. Resection was performed by thoracotomy in 14 cases (7 right and 7 left) and 12 cases by thoracoscopy (7 right and 5 left). The mean tumor size was 7.4 ± 1.9 cm (range 5-12 cm) in the thoracotomy group and 4.3 ± 1.9 cm (range 2-7 cm) in the VATS group (P = .001). Mean operative time was 101.7 ± 27.8 min (range 70-150 min) in the thoracotomy group and 77.9 ± 24.3 min (range 60-150 min) in the VATS group (P = .014). Mean postoperative hospital stay was 7.4 ± 4.0 days (range 3-20 days) in the thoracotomy group and 4.7 ± 1.7 days (range 2-7 days) in the VATS group (P = .040). CONCLUSION: Most of the mediastinal neurogenic tumors are benign and surgical resection is required in their treatment. With increasing experience, resection can be performed thoracoscopically in most cases.

Modified capitonnage technique for giant pulmonary hydatid cyst surgery.

OBJECTIVES: This study investigated the effectiveness of the modified technique (Aydin Technique), which was applied for capitonnage in the surgical treatment of giant pulmonary hydatid cysts. METHODS: Twenty-two cases were operated on for giant hydatid cysts with a total of 23 modified techniques for capitonnage (bilateral giant hydatid cyst in 1 case) in our clinic between January 2018 and December 2020. The demographic data were recorded. RESULTS: Thirteen out of 22 (59.1%) of cases were male and 9 (40.9%) were female. The mean age was 22.0 ± 15.8 and 14 cases (63.6%) were children. Hydatid cysts were intact in 13 (56.5%) cases and ruptured in 10 (43.5%) cases. Hydatid cyst diameters were on average 123 ± 21 mm. A modified method was performed for capitonnage in all cases while decortication was performed in 2 (8.7%) cases due to pleural thickening. Radiological atelectasis was observed in 6 cases (27.3%) postoperatively. The patients with atelectasis recovered without any clinical problem and no intervention was needed. In 1 case, an infection developed at the incision site. Postoperative prolonged air leak, empyema and mortality were not observed in any of the cases. The postoperative mean length of hospital stay was 7.18 ± 2.15 days. The mean follow-up period was 19.5 ± 11.5 months. No recurrence was encountered in the follow-up of the patients. CONCLUSIONS: The results of this study may suggest to perform this new-described modified Aydin technique to avoid major capitonnage complications of the giant pulmonary hydatid cyst surgery.

The Epidemiology, Clinical Manifestations, Radiology, Microbiology, Treatment, and Prognosis of Echinococcosis: Results of NENEHATUN Study.

Aim: Echinococcosis, caused by Echinococcus species, is an important zoonotic disease causing major health problems in humans and animals. Herein, we aimed to evaluate the epidemiology, clinical and laboratory parameters, radiological, serological, pathological, and treatment protocols of followed-up cases of hydatidosis. Methods: A total of 550 patients diagnosed with hydatid cyst disease were included in this study. Patients who were positive for one or more of the enzyme-linked immunosorbent assay or indirect hemagglutination test, pathological results, or radiological findings were examined. The data analyzed were collected from nine centers between 2008 and 2020. Records were examined retrospectively. Results: Among the patients, 292 (53.1%) were women and 258 (46.9%) were men. The patients' mean age was 44.4 ± 17.4 years. A history of living in rural areas was recorded in 57.4% of the patients. A total of 435 (79.1%) patients were symptomatic. The most common symptoms were abdominal pain in 277 (50.4%), listlessness in 244 (44.4%), and cough in 140 (25.5%) patients. Hepatomegaly was found in 147 (26.7%), and decreased breath sounds were observed in 124 (22.5%) patients. Radiological examination was performed in all cases and serological methods were also applied to 428 (77.8%) patients. The most frequently applied serological test was IHA (37.8%). A single cyst has been found in 66% patients. Hepatic involvement occurred in 327 (59.4%), pulmonary involvement was found in 128 (23.3%), whereas both of them were recorded in 43 (7.8%) patients. Splenic involvement was only detected in nine (1.6%) patients. Echinococcus granulosus (72.5%) was most frequently detected. Cyst diameters of 56.9% of the patients were in the range of 5-10 cm. A total of 414 (75.2%) patients received albendazole as an antiparasitic. Mortality was noted in nine (1.6%) patients. Conclusion: Echinococcosis is an important public health problem in Turkey. It can affect the social, economic, and political structures of the community. Public education and awareness are extremely important.

Laparoscopic approach in the treatment of Morgagni hernia.

BACKGROUND: In this study, we aimed to evaluate the efficacy and safety of primary laparoscopic repair of Morgagni hernia. METHODS: In this retrospective study, a total of 12 patients (4 males, 8 females; mean age 56.5±14.9 years; range, 32 to 80 years) who underwent primary laparoscopic repair for Morgagni hernia between January 2014 and December 2019 were included. In all cases, the hernia sac was excised and the defect was repaired primarily with non-absorbable sutures. RESULTS: All patients had excellent outcomes and were uneventfully discharged from the hospital after a mean length of hospital stay of 4.6±1.3 days (range, 3 to 7 days). No mortality, morbidity or recurrence were observed in any of the patients. CONCLUSION: The primary laparoscopic repair is an effective and safe approach to surgical repair for Morgagni hernia in experienced hands.

An Unusual Cause of Pulmonary Arterial Hypertension: Hydatid Cyst.

Hydatid cyst is an important health problem throughout the world, and it is caused by the larval form of Echinococcus granulosus. Although it is most commonly located in the liver and lungs, hydatid cyst can also affect other organs because the oncospheres spread through the bloodstream. The disease may have many different clinical presentations. Although it is a benign disease, sometimes it can cause serious morbidity and even mortality. Here, the case of a 33-year-old male patient who underwent surgery for a right ventricle and bilateral lung hydatid cyst 9 years ago and had pulmonary hypertension is presented.

Relevance of Pulmonary Alveolar Echinococcosis.

BACKGROUND: Pulmonary alveolar echinococcosis (PAE) is a chronic disease caused by Echinococcus multilocularis with very low incidence in developed countries. METHODS: This single-center, retrospective study included 34 patients who were diagnosed with PAE between January 2001 and February 2019 (15 males, 19 females, mean age: 52.4±15.8 years, age range: 28-78 years) in Ataturk University Medical School, Erzurum, Turkey. RESULTS: The liver was the primary involved organ in all cases. Pulmonary involvement was detected in 13.0% (34/261) of all cases with hepatic alveolar echinococcosis (AE), and three patients (8.8%) had both pulmonary metastasis and brain metastasis. The route of spread to the lungs based on radiological data was hematogeneous in 25 patients (73.5%), transdiaphragmatic in three patients (8.8%) and both hematogeneous and transdiaphragmatic in six patients (17.7%). AE showed bilateral involvement in 19 patients (55.9%), whereas only the right lung was involved in 12 patients (35.3%) and the left lung in three patients (8.8%). Of the patients, five underwent surgery due to PAE and 29 patients received medical therapy with albendazole. A total of three patients died during the follow-up period (2, 5 and 10 years after the diagnosis of PAE), while 31 patients continued with follow-up and treatment for a mean duration of 5.4±3.8 years (1-14 years). CONCLUSIONS: Patients with hepatic AE must, as a matter of course, be screened for possible lung involvement. Albendazole therapy may slow down disease progression in patients with widespread pulmonary involvement who are not eligible for surgery.