Aberrant right bronchial artery originating from right coronary artery - MDCT angiography findings.

Aberrant bronchial arteries are rarely seen and may originate from various vascular structures. In our case, a 48-year-old man with recurrent chest pain underwent multidetector CT (MDCT) coronary angiography. MDCT images demonstrated an aberrant right bronchial artery originating from the right coronary artery. To our knowledge, this is the first case report of an aberrant right bronchial artery originating from the right coronary artery.

A 6.2-cm tracheal segment resection for tracheal post-intubation stenosis.

Post-intubation tracheal stenosis is a clinical problem caused by regional ischemic necrosis of the airway. The outcome of a long tracheal segment resection (6.2 cm) in a patient with post-intubation stenosis is presented.

Parenchyma-saving surgical treatment of giant pulmonary hydatid cysts.

OBJECTIVE: The purpose of this study was to review 97 patients with giant pulmonary hydatid cysts and assess the clinical features and results of different operative techniques over a 27-year period. MATERIAL AND METHODS: Between January 1981 and December 2007, 590 patients were operated on for pulmonary hydatidosis and 97 (17 %) of these patients had giant pulmonary hydatid cyst. We retrospectively reviewed the medical records of these 97 patients. The diameter of the hydatid cysts were measured using radiological methods and intraoperatively. RESULTS: Seventy-eight patients were male (80 %) and 19 were female (20 %). The median age was 23.4 years (range: 15-63 years). The most common symptoms were chest pain (54 %), cough (43 %) and dyspnea (41 %). Fourteen patients were asymptomatic (14 %). The diameters of the cyst ranged between 10 and 25 cm (mean 13.8 cm). The cysts were located in the right hemithorax in 52 (54 %) patients, in the left hemithorax in 44 (45 %) patients and bilaterally in one patient (1 %). Five patients had more than one cyst. The procedures consisted of cystotomy and capitonnage in 53 patients, enucleation and capitonnage in 27 patients and simple cystotomy or enucleation in 8 patients. Anatomical resection was performed in 9 patients. Prolonged air leakage of more than 7 days occurred in five patients; one patient underwent an operation and a Heimlich valve was placed in two patients. There was no postoperative mortality. Recurrence was not detected at follow-up after 6 months and 27 months. CONCLUSION: The higher lung tissue elasticity and delayed symptoms due to localizations of the cyst are the reasons for the occurrence of giant hydatid cysts in the lung. A parenchyma-saving operation should be performed instead of anatomical resection because of the low complication rates and because most complications can be treated conservatively.

Diagnosis and surgical treatment of pulmonary sequestration.

BACKGROUND: Pulmonary sequestration is the term used to describe a rare embryonic mass of lung tissue which has no bronchial communication with the normal tracheobronchial tree. METHODS: In this study, we reviewed the medical records of 14 patients who underwent surgical resection for pulmonary sequestration between January 1992 and December 2006. RESULTS: Nine patients were symptomatic with recurrent respiratory tract infections and five patients were asymptomatic with a suspected lesion revealed incidentally during imaging investigations for other indications. Pulmonary sequestration was diagnosed with preoperative diagnostic procedures in eight patients and the other six cases were diagnosed after histopathological examination of the resected specimen. All patients were treated surgically. No postoperative complications were observed. CONCLUSIONS: We conclude that the optimal treatment of pulmonary sequestration is surgical resection to avoid infection and destruction of the normal pulmonary parenchyma, even in asymptomatic cases. Moreover, in the case of pulmonary infection and the destruction of normal tissue, major resection such as lobectomy or pneumonectomy may be considered, instead of limited resection.

Surgical repair of congenital sternal cleft in an adult to prevent traumatic pericardial rupture.

INTRODUCTION: Isolated congenital sternal cleft in an adult is a very rare anomaly and few cases have been reported so far. Here we report on a successful repair of a sternal cleft associated with an anterior pericardial defect in an adult. MATERIAL AND METHOD: A 20-year-old man presented with a bony defect in the inferior part of his sternum. Physical examination revealed an ovoid gap with a diameter of 5 cm in the distal part of the sternum. Pulsations of the heart could be easily seen through the defect. There were no associated anomalies. The patient underwent surgery for repair of the sternal cleft. RESULTS: A computed tomography scan of the chest confirmed the physical findings of an inferior sternal cleft involving approximately 50 % of the sternum. The result of echocardiography was normal. The postoperative period was uneventful. Direct complete closure without compromising cardiac function was achieved in this patient. At one-year follow-up, his sternal appearance was normal. DISCUSSION: According to the literature, the use of autogenous tissue is better than prosthetic material for reconstruction, with respect to both the risk of infection and the inability of prosthetic material to grow with the patient.

Surgical treatment for pulmonary hydatidosis (a review of 422 cases).

OBJECTIVE: Hydatidosis in man is frequently encountered in sheep and cattle raising regions of the world. We reviewed 422 patients, treated surgically for pulmonary hydatid disease in our clinic between January 1980 and January 1998, assessing the clinical features and results of results of operative treatment management in our centre. PATIENTS AND METHODS: 52 of the patients were female and 370 were male. The median age of the patients was 33 years (range, 11 to 66 years). The cysts were located in the right lung in 214 (50.7%) patients, the left lung in 156 (37%) and bilaterally in 17 (4%) cases. We found an intrathoracic extrapulmonary cyst in 35 (8.3%) patients. We performed enucleation and capitonnage in 202 cases, wedge resection in 40, cystotomy and capitonnage in 171, and lobectomy in 9 patients. The high-risk patients were treated with Albendazol (10 mg/kg/day), for a period of 3 months postoperatively. RESULTS: Preoperative diagnosis was based primarily on chest roentgenograms and led to correct diagnosis in 347 cases (82.2%). An additional computerised tomography (CT) scan in 56 cases and magnetic resonavive imaging (MRI) were required in 15 cases. The diagnosis is established intraoperatively in 4 cases. Most (296) patients presented with a solitary lung cyst. The rest were found to have multiple cysts in one or more lobes. 87 of 422 also had cysts in the liver, 19 in the spleen, and 1 in the pancreas. The follow-up data was completed in 392 of 422 (92.8%) patients. The mean follow-up period was 4.3 years (2 to 19 years). We detected recurrence in 3 patients (0.71%). CONCLUSION: The effective treatment of hydatid cyst(s) in the lung is complete excision of the cyst(s) with maximum preservation of the lung parenchyma. Additional medical treatment with Albendazole should be carried out for high-risk group patients.

The use of absorbable material in correction of pectus deformities.

Various techniques have been described for correction of the congenital anterior chest wall deformities. We described a new technique in which 33 patients were used in correction of those deformities. In this new technique we used the resorbable copolymer plaque and polymer screw for the fixation of the sternum. We have obtained excellent results in one-year follow up period. This technique was developed to avoid a second operation, which usually requires for removal of the metal support. Resorption of copolymer plaques and polymer screws are completed at the end of the first year.