The Role of Duration of Hyperbaric Oxygen Therapy on Lung Injury: An Experimental Study Lung Injury and Hyperbaric Oxygen Therapy.

OBJECTIVES: We aim to histopathologically analyze the effect of hyperbaric oxygen (HBO) therapy in the lung tissue. MATERIAL AND METHODS: A total of 21 rabbits were divided into three groups, with each containing seven rabbits. Group 1 was the control group. Group 2 underwent HBO of 3 atmosphere absolute (ATA) for 90 min/day for 7 days. In group 3, HBO at 3 ATA was administered 90 min/day for 28 days. Oxygen saturation (SpO2) was determined by pulse oximetry before and after administration of HBO. Rabbits were sacrificed, and the apex of the right lung was excised. RESULTS: SpO2 was 98-100% in all rabbits before HBO administration. After the procedure, the mean SpO2 was 92% and 83% in groups 2 and 3, respectively. As expected, histopathologic examination in group 1 was normal. In group 2, congestion in the lung vessels, mononuclear cell infiltration in the bronchial mucosa, interstitial edema, and alveolar dilation were evident. Histopathologic examination in group 3 indicated diffuse alveolar edema, peribronchial mononuclear cell infiltration, thickening of the alveolar and vessel wall, and intraalveolar hemorrhage. CONCLUSION: There is a strict relationship between duration of HBO administration and severity of lung injury.

Evaluation of factors affecting prognosis in penetrating thoracic injuries.

BACKGROUND: This study aims to investigate the prognostic factors affecting survival and clinical outcomes in patients exposed to pediatric penetrating thoracic injury. METHODS: A t otal o f 2 67 p ediatric p enetrating t horacic injury patients (217 males, 50 females; mean age 10.8 years; range, 3 to 17 years) who were treated at our hospital during the recent 20 years were analyzed retrospectively. Penetrating thoracic injuries were divided into three groups: incisive/stabbing injuries, gunshot injuries, explosive injuries. Patients" age, gender, New Injury Severity Score, injury type, injuries accompanying thoracic trauma, types of treatment applied, length of hospital stay, and morbidity and mortality outcomes were examined. Their prognostic characteristics were compared to their injury types, New Injury Severity Scores, lengths of hospital stay and complications. RESULTS: Of the patients, 103 were exposed to gunshot injuries, 128 to incisive/stabbing injuries, and 36 to explosive injuries. Of the penetrating thoracic injuries, while 211 (79%) were isolated injuries, 56 (21%) were accompanying non-thoracic injuries. Mean New Injury Severity Score was 13±10. Of the patients, 50 (18.6%) were treated with medical therapy alone, 199 (74.5%) with tube thoracostomy, and 18 (6.7%) with thoracotomy. Fiftyone patients (19%) developed complications. Length of hospital was 9±2.7 days. Twenty-one patients (7.9%) died. New Injury Severity Scores, rates of combined injuries, complications, length of hospital stay, and mortality were higher in explosive injuries (p<0.05). CONCLUSION: Pediatric penetrating thoracic injuries may be observed in all age groups in children, the most severe type being explosive injuries. Prognostic factors may vary according to injury type, complications, treatment approach, and presence of accompanying non-thoracic injuries.

Effect of human development index parameters on tuberculosis incidence in Turkish provinces.

INTRODUCTION: A country's development level is measured with a quantitative parameter called the human development index (HDI). The present study researched the effects of HDI parameters (such as healthcare standards, income, and education level) on the incidence of tuberculosis. METHODOLOGY: HDI data of 36 provinces of Turkey and the tuberculosis surveillance data were obtained from the Ministry of Development and the Ministry of Health, respectively. The associations between the incidence of tuberculosis and other HDI parameters were analyzed. RESULTS: Higher population density (n/km2) (CI = 0.05 to 0.40) and higher relapse rate of tuberculosis (CI = 0.36 to 1.48) were identified to be independent predicting factors that increased the incidence of tuberculosis, whereas higher gross national product (CI = -0.06 to 0.00), the population that holds a green Medicare card (CI=-0.58 to -0.04), increased general practitioners per 100,000 people (CI=-0.66 to -0.01), female population (CI = -0.70 to -0.06), married population (CI = -1.34 to -0.03), were found to be significant negative predicting factors that were relevant to the incidence (protective against tuberculosis). CONCLUSIONS: Tuberculosis is a disease that is affected by multiple factors, including the components of HDI. Improvement of income level, facilitation of access to health services via health insurance, urbanization with lower population density strategy, and provision of enough general practitioners may be useful in reducing the incidence of TB' in provinces of developing countries such as Turkey.

Unexpected complication of oesophagoscopy: iatrogenic aortic injury in a child.

INTRODUCTION: Oesophagoscopy is usually a safe procedure to localise and remove ingested foreign bodies, however, unexpected complications may develop during this procedure. In this case report we discuss iatrogenic aortic injury, which developed during oesophagoscopy, and its immediate treatment. CASE REPORT: A six-year-old male patient was admitted to hospital with symptoms of having ingested a foreign body. Oesophagoscopy was carried out and the foreign body was visualised at the second constriction of the oesophagus. During this procedure, profuse bleeding occurred. Subsequently, a balloon dilator was placed to control bleeding in the oesophagus. Thoracic contrast tomography revealed thoracic aortic injury. Open surgical aortic repair was immediately carried out on the patient and the oesophageal hole was primarily repaired. The patient was discharged on postoperative day 15 with a total cure. CONCLUSION: Although oesophagoscopy is a safe, easily applied method, it should be kept in mind that fatal complications may occur during the procedure. This procedure should be done in high-level medical centres, which have extra facilities for managing complications.

Do Meteorological Changes Have an Effect on The Occurence of Spontaneous Pneumothorax?

OBJECTIVES: Spontaneous pneumothorax refers to the leakage of air into the space between the parietal and the visceral layers of the pleura. It occurs with or without a known lung disease. We aimed to investigate the effects of atmospheric pressure, humidity, and temperature changes on the incidence of spontaneous pneumothorax (SP). MATERIAL AND METHODS: This study included 551 patients with spontaneous pneumothorax retrospectively screened between January 2009 and December 2013. The medical data of the patients were accessed via their medical records on the hospital automation system. The atmospheric pressure, temperature, humidity rate, amount of precipitation, and wind velocity on the day of spontaneous pneumothorax were obtained from the data provided by the general directorate of meteorology. The three consecutive days on which at least 2 cases of SP presented were collectively considered as a cluster. The study data were analyzed with the SPSS version 15 software package, using the Chi-square and the Student's t tests. A p value less than 0.05 was considered statistically significant. RESULTS: Of the 552 patients included in the study, 89.3% had primary spontaneous pneumothorax and 10.7% had secondary spontaneous pneumothorax. Ninety-two percent of the patients were male and 8% were female. The mean age was 24 years. Clustering was observed in 71.7% of the study population. No significant differences were observed between yearly and monthly SP incidences. There were, however, differences between the days with SP and the days without SP with respect to atmospheric pressure, ambient temperature, wind velocity, and humidity rate. The differences between the atmospheric pressures were not statistically significant, although the differences between the ambient temperature and the humidity rate were statistically significant (p≤ 0.05). CONCLUSION: We determined that the changes in the ambient temperature and the humidity rate affected the rate of spontaneous pneumothorax by altering the meteorological conditions.

[Diaphragmatic injury: condition be noticed in the management of thoracic trauma]. / Toraks travmasi takibinde dikkat edilmesi gereken durum: Diyafragma yaralanmalari.

BACKGROUND: The aim of the present study was to emphasize diaphragmatic injuries that can be overlooked in chest traumas. METHODS: Between January 2000 and June 2013, fifty-three patients with traumatic diaphragmatic laceration were evaluted among 1349 patients who had chest injuries. Patients were examined regarding age, gender, associated injuries, surgical interventions, postoperative morbidity, mortality and length of hospital stays. RESULTS: Of them, fifty-three cases had diaphragmatic lacerations. There were forty-eight male and five female patients, with a mean age of 31.06 (4-60) years and 35.80 (18-50) years. Thoracotomy in 66%, laparotomy in 20.75% and laparotomy+thoracotomy in 13.20% of the cases were performed. Video-assisted thoracoscopy was carried out in 15.09% of the patients. Diaphragm was repaired on the left in thirty-one cases and in the right in twenty-two cases. Pulmonary complications like morbidity was mostly seen in 37.73% of blunt trauma. Mortality was seen in three cases of penetrating trauma. Mean hospital duration was 8.75 days (range, 4-15 days). Patients were followed for a mean duration of 28.13 months (range, 3-60 months). There was no significant statistical difference between types of injury, ages and gender of cases (p=0.05); whereas, morbidity rate was important in patients with blunt trauma. DISCUSSION: Diaphragmatic lacerations should be kept in mind when penetrating and blunt injuries to the thorax are evaluated.