The prevalence of chest wall deformity in Turkish children

Background/aim: This study aimed to identify children who have chest wall deformity, the prevalence of deformity, and the factors affecting the psychological and physical disorders caused by the deformity. Materials and methods: The study was conducted among 14,108 girls and boys aged 11­14 years, who were 5th­8th grade secondary school students in Ankara Province between October 2014 and March 2015. Results: Of the 14,108 students in our study, the mean age of the children was 12.53 ± 1.11 years (median 12.54, 11­14 years) and chest wall deformity was detected in 199 (1.41%) students. Male/female and pectus carinatum/pectus excavatum ratios were 2.16 and 1.59, respectively. According to multivariate logistic regression analysis, physical disturbance was found to be statistically significantly higher among children in age group 11 [adjusted OR (95% CI) =16.01 (1.89­135.61), P < 0.011] and in children who were aware of the deformity [adjusted OR (95% CI) = 0.31 (0.13­0.71), P < 0.006], and psychological disturbance was found to be statistically significantly higher in girls [adjusted OR (95% CI) = 15.44 (1.68­141.59), P < 0.015] and in those with a presence of family history [adjusted OR (95% CI) = 18.66 (1.92­181.60), P < 0.012]. Conclusion: In this study conducted in a large population, chest wall deformities were found to be more prevalent in boys (0.96%) and pectus carinatum was found as the most common deformity type in our country, contrary to the literature.

Unilateral anhidrosis: A rare complication of thoracic epidural analgesia.

Management of pain following thoracotomy is an important issue for the control of early morbidity. We herein present the case of a patient who was referred to our hospital after a fall from a height. Right-sided multiple rib fractures, hemopneumothorax, and diaphragmatic rupture were detected. Thoracic epidural catheterization was performed for pain management just before thoracotomy. The patient developed unilateral anhidrosis postoperatively. We discuss this rare complication of thoracic epidural analgesia with a review of relevant literature.

Painful Chest Wall Swellings: Tietze Syndrome or Chest Wall Tumor?

BACKGROUND: Tietze syndrome (TS) is an inflammatory condition characterized by chest pain and swelling of costochondral junction. Primary chest wall tumors may mimic TS. In this article, we report our experience of approximately 121 patients initially diagnosed as TS and determined chest wall tumor in some cases at the follow-up. METHODS: This is a retrospective review of patients diagnosed as TS by clinical examination, chest X-ray, electrocardiogram, routine laboratory tests, and computed tomography (CT) of chest: all treated and followed up between March 2001 and July 2012. There were 121 cases (41 males and 80 females; mean age, 39.6 ± 3.2 years) of TS. RESULTS: In 27 patients with initial normal radiological findings, the size of swellings had doubled during the follow-up period (mean, 8.51 ± 2.15 months). These patients were reevaluated with chest CT and bone scintigraphy and then early diagnostic biopsy was performed. Pathologic examination revealed primary chest wall tumor in 13 patients (5 malignant, 8 benign). CT had a sensitivity of 92.3% and a specificity of 64.2% in detection of tumors (kappa: 0.56, p = 0.002), whereas the sensitivity and the specificity of bone scan were 84.6 and 35.7%, respectively (kappa: 0.199, p = 0.385). CONCLUSION: Primary chest wall tumors could mimic TS. Bone scintigraphy or CT is not specific enough to determine malignant and other benign disorders of costochondral junction. Therefore, clinicians should follow TS patients more closely, and in case of increasing size of swelling, early diagnostic biopsy should be considered.

Traumatic pulmonary pseudocyst due to thoracic trauma.

Traumatic pulmonary pseudocyst is uncommon and usually regresses spontaneously with conservative treatment. In rare cases, surgical intervention may be necessary. A pseudocyst may be treated surgically to prevent potential complications if the patient undergoes a thoracotomy for another reason. We present a patient with hemopneumothorax and traumatic pulmonary pseudocyst after a motor vehicle accident, who was operated on electively due to massive air leak.

A Rare Entity: Bilateral First Rib Fractures Accompanying Bilateral Scapular Fractures.

First rib fractures are scarce due to their well-protected anatomic locations. Bilateral first rib fractures accompanying bilateral scapular fractures are very rare, although they may be together with scapular and clavicular fractures. According to our knowledge, no case of bilateral first rib fractures accompanying bilateral scapular fractures has been reported, so we herein discussed the diagnosis, treatment, and complications of bone fractures due to thoracic trauma in bias of this rare entity.

A Rare and Serious Syndrome That Requires Attention in Emergency Service: Traumatic Asphyxia.

Traumatic asphyxia is a rare syndrome caused by blunt thoracoabdominal trauma and characterized by cyanosis, edema, and subconjunctival and petechial hemorrhage on the face, neck, upper extremities, and the upper parts of the thorax. Traumatic asphyxia is usually diagnosed by history and inspection; however, the patient should be monitored more closely due to probable complications of thoracoabdominal injuries. Treatment is conservative, but the prognosis depends on the severity of the associated injuries. Herein we present a traumatic asphyxia due to an elevator accident in a 32-year-old male patient and discuss the diagnosis, treatment, and prognosis by reviewing the relevant literature.

An unexpected complication of titanium rib clips.

Surgical stabilization of the rib fractures has been successfully performed for the management of pain in multiple rib fractures, fixation of chronically painful nonunion, reduction of overriding ribs, and flail chest cases. Herein we report a patient who was treated with titanium rib clips after a motor vehicle accident leading to pulmonary parenchymal laceration and multiple painful rib fractures. Three of the rib clips were broken 4 months after the operation. The patient underwent the second operation for restabilization of the broken ribs. We review the relevant literature, with particular emphasis on the management of this complication.

Elastofibroma dorsi management and outcomes: review of 16 cases.

OBJECTIVES: Elastofibroma dorsi (ED) is a rare, benign lesion arising from connective tissue, usually found at the inferior pole of the scapula. To date, only a few small series have been reported in the English literature and there are few data about the long-term outcomes after surgery. Our goal is to contribute a better understanding of this tumour and to determine the long-term outcomes after surgery. METHODS: Sixteen patients with a diagnosis of ED were identified from the unit's database. The clinical presentation, diagnosis, pathological evidences and long-term outcomes were evaluated. RESULTS: There were 11 females and 5 males with a mean age of 61.1 years (range 38-78 years). The tumour was located on the right in 5 (31.2%) patients, on the left in 6 (37.5%) patients and bilaterally in 5 (31.2%). Six patients had painful scapular swelling resulting in restriction of movement of the shoulder whereas 10 reported only painful scapular mass. All 16 patients underwent complete resections. The tumour size ranged from 3 to 15 cm. The mean hospital stay was 3.1 ± 1.4 days with a morbidity of 18.75% (seroma observed in 3 patients). The mean follow-up was 58.4 ± 29.5 months (range 11-92 months). In 2 patients (12.5%) a new occurrence on the contralateral side was observed at the follow-up. CONCLUSIONS: Elastofibroma dorsi is a rare, ill-defined, pseudotumoural lesion of the soft tissues. Surgical treatment can be proposed if the lesion is symptomatic. Furthermore, at the follow-up, the possibility of new occurrences on the contralateral side should be kept in mind.

A novel and safe technique in closed tube thoracostomy.

BACKGROUND: Tube thoracostomy (TT) is the most commonly performed surgical procedure in thoracic surgery clinics. The procedure might have to be repeated due to ineffective drainage in patients with tube malposition (TM), in whom the drain is not directed to the apex or located in the fissure. Trocar technique, which is used to prevent TM, is not recommended because of its potential for severe complications. METHODS: The study involved 180 patients who required TT application for any etiology within one year. The patients were divided into two groups as Group A, who had undergone classical surgical technique (n = 90) and Group B, who had undergone a combination of surgery and trocar techniques (n = 90). The groups were compared for TM, the effect of TM on the drain removal, and other insertion related complications. RESULTS: In Group A, 23 patients had TM, 4 of whom developed associated ineffective drainage, while the patients in Group B had no insertion related complications (p = 0.001). The mean drain removal time of the patients with TM was 5 +/- 2.25 days. In the patients who did not develop TM, it was 3.39 +/- 1.18 days (p = 0.001). CONCLUSIONS: The modified combination technique is a reliable method in preventing TM and its potential complications.

A comparison of epidural and paravertebral catheterisation techniques in post-thoracotomy pain management.

BACKGROUND: Thoracotomy is a surgical procedure associated with severe pain. Operative morbidity rates reduce by effective postoperative pain control. The aim of this study is to compare the effectiveness of the thoracic epidural blockade (TEB) and the paravertebral blockade (PVB) methods in relieving the pain caused by a thoracotomy incision. MATERIALS AND METHODS: We studied 44 consecutive patients who underwent elective posterolateral thoracotomy. The patients were classed into two groups: TEB (n=19) and PVB (n=25). Patients in both the groups could self-control the infusion of bupivacaine infusion and diclofenac sodium. The groups were compared according to the parameters such as analgesic efficacy (VAS), respiratory function tests (forced expiratory volume in 1s (FEV(1)), peak expiratory flow rate (PEFR) and arterial blood gases), stress response (serum cortisol and glucose levels), adverse effects, necessity for additional analgesia, duration of catheter application procedure, mean hospital stay and postoperative follow-up. Results are analysed statistically by Mann-Whitney U, Wilcoxon, chi-square and Fisher's exact tests, and a p-value of <0.05 was accepted to be statistically significant. RESULTS: There was no significant difference between the two groups with regard to age, gender, VAS, FEV(1), PEFR, serum cortisol and glucose levels, necessity for additional analgesia and hospital staying days. In contrast, adverse effects and duration of catheterisation were statistically significantly lower in group PVB (p=0.001 and p<0.001, respectively). CONCLUSION: PVB catheterisation can be easily performed and placed in a short span perioperatively. Therefore, it might be the preferred method over TEB which has a high incidence of adverse effects and complication rates.

An analysis of clinical features of pulmonary giant hydatid cyst in adult population.

BACKGROUND: We performed an analysis of giant hydatid cysts (GCHs) detected in the adult population by comparison with the features of other simple hydatid cysts (CHs) in the light of the relevant literature. METHODS: The records of 74 adult patients who were operated on in our clinic for pulmonary CHs between 2001 and 2005 were retrospectively evaluated. Cysts that were 10 cm or larger in diameter on any plane were considered GCHs. The cysts were classified into 2 groups as GCHs (group A) and other (group B). The groups were then compared for age, sex, symptom, cyst location, preoperative complications, surgical procedure performed, operative morbidity, and mortality. RESULTS: Of 74 patients, 10 (13.5%) were in group A and 64 were in group B. No differences were detected between the clinical presentation, gender distribution, surgical procedure performed, and postoperative morbidity and mortality rates of GCHs and other cysts in adults. In both groups, there were no significant differences between the rates of involvement of 2 lungs (P = .527). However, both groups had lower lobe involvement, more markedly in group A (81.8% and 45.5% respectively; P = .023). Two patients in group A (20%) and 18 patients in group B (28.1%) had complicated cysts. CONCLUSIONS: The tendency of GCH to involve the lower lobe of the lung compared to smaller cysts suggests underlying mechanisms other than lung elasticity in the late onset of the symptoms parallel to cyst growth.

A case of radiation-induced sternal malignant fibrous histiocytoma treated with neoadjuvant chemotherapy and surgical resection.

BACKGROUND: Primary sternal malignant fibrous histiyocytoma (MFH) is highly rare. Effective treatment modality is surgical resection with wide margins. However, to date, the effects of radiotherapy or chemotherapy has not been clearly defined. CASE PRESENTATION: Herein, we aimed to present a 50-year old female patient with MFH occurred in the radiotherapy field who had had surgical procedure for breast cancer 19 years ago and had followed by radiotherapy. Neoadjuvant chemotherapy was applied for MFH due to cardiac and mediastinal vascular invasion. Wide resection was carried out for the mass after having been decreased in size following neoadjuvant chemotherapy. CONCLUSION: Neoadjuvant chemotherapy was an effective method. In planning the surgical resection, the size of the tumor before chemotherapy should be considered as the initial size and surgical margins should be determined accordingly.

Chylothorax Resulting from a Penetrating Injury of the Neck: a Case Report.

Chylothorax is characterized by an accumulation of lymphatic fluid in the pleural cavity due to compression or loss of integrity of the thoracic duct for any reason. It is frequently secondary to intrathoracic malignancies and iatrogenic trauma. Thoracic duct injury and resulting chylothorax, due to penetrating injuries of the neck, are very rare. This report presents a patient with chylothorax associated with penetrating neck trauma, who was successfully treated, and provides discussion on this very rare case in the light of the available literature.

Traumatic pulmonary pseuodocysts: two case reports.

Traumatic pulmonary pseudocyst (TPP) is a rare complication, sometimes encountered after blunt thoracic trauma and even more rarely following penetrating injuries. It is more common among pediatric and young adult patients. Although TPP is usually benign in nature, complications associated with hemoptysis and secondary infection may develop. The treatment is conservative. In this report, we present two rare cases of TPP occuring after a high-speed accident and a stab wound injury, where conservative treatment provided good outcomes.

Intrathoracic humeral head fracture-dislocation: is removal of the humeral head necessary?

Intrathoracic fracture dislocation of the humeral head due to a blunt trauma is very rare. It may be accompanied by local and systemic injuries associated with high-energy trauma. Because a limited number of cases were reported, appropriate treatment modality remains unclear. A case of intrathoracic humeral head fracture-dislocation caused by a high-speed motor vehicle accident is presented herewith, along with the treatment methods used within the scope of the current literature.