The value of surgical resection in patients with multidrug resistant tuberculosis.

BACKGROUND: Multidrug resistant tuberculosis (MDR-TB) still continues to be a serious health problem throughout the world. Although main treatment of MDR-TB is medical, surgical resection with adjuvant medical therapy may increase the chance of cure in selected patients. METHODS: We performed surgical resections in 55 patients between 1997 and 2005; 36 were male and 19 were female with a median age of 34 years (range 13 to 66 years). Sputum was negative for 49 patients and positive for 6 patients in the preoperative period. Patients were treated according to a new therapy protocol for a mean of 3.7 months before the operation. RESULTS: Lobectomy was performed in 37 patients, pneumonectomy in 17 patients and lobectomy + segmentectomy in 1 patient. One patient with positive sputum preoperatively died in the early postoperative period (mortality: 1.81 %). Various complications occurred in 16 (29.09 %) patients. Prolonged air leak was the most common complication (n = 8). Bronchopleural fistula (BPF) + empyema occurred in 2 (3.63 %) patients. In the postoperative period, sputum negativity was achieved in all patients except three cases throughout the 57 months of follow-up (cure rate 94.5 %). Patients received drug therapy for 24 months postoperatively. CONCLUSIONS: Surgical resection with adjuvant drug therapy increases the chance of cure in patients with localized disease if they have an adequate cardiopulmonary reserve, favorable nutritional status and are treated with a new therapy protocol for at least 3 months.

Management of postpneumonic empyemas in children.

OBJECTIVE: The optimal treatment of children with empyema remains controversial. The purpose of this clinical retrospective study was to assess different treatment options in the management of postpneumonic pediatric empyemas. METHODS: From April 1997 to October 2005, 111 consecutive children (57 boys and 54 girls) were managed for pleural empyema. The mean age was 7.07 years (range: 18 months-14 years). Patients were divided into 3 groups depending on the treatment received: group I, chest tube alone (n = 89); group II, chest tube with fibrinolytics (n = 22); group III, thoracotomy with decortication (n = 19, consisting of 9 patients of group I and 10 of group II with unsuccessful treatment results). RESULTS: Chest tube alone, chest tube with fibrinolytics, and thoracotomy with decortication had complete response rates of 89.9%, 54.5%, and 100%, respectively. The hospital stay was 11.46 +/- 3.79 days for group I, 9.08 +/- 2.07 days for group II, and 6.32 +/- 2.54 days for group III. There was no statistically significant difference between group I and group II with regard to hospital stay (P = 0.040). Mild pain occurred in 4 children of group II after streptokinase instillation. Only one atelectasis appeared in group III during the postoperative period. CONCLUSION: Chest tube drainage is a safe, effective primary treatment of postpneumonic pediatric empyema. In cases where it is insufficient, thoracotomy with decortication can be used successfully with low morbidity and mortality rates.

Bullet embolism of the right external iliac artery following cardiac gunshot wound (a case report).

Penetrating cardiac injury (PCI) frequently cause hemorrhage and cardiac tamponade. However peripheral embolization is very rare. In this manuscript one of the rare case of bullet embolism in the right external iliac artery, which occurred after cardiac gunshot wound is reported under the light of literature.

[Evaluation of 572 cases of blunt and penetrating thoracic trauma]. / Künt ve penetre toraks travmali 572 olgunun degerlendirilmesi.

We retrospectively evaluated 572 patients with thoracic trauma from total of 2163 trauma patients who admitted to 2nd General Surgery Emergency Service of Kartal Education and Research Hospital from January 1997 to February 2000. 501 of the patients (87.5%) were male and 71 (12.5%) were female. The range of ages 2-84 and mean age was 32.2. 337 (59%) patients had blunt and 235 (41%) had penetrating thoracic trauma. While traffic accidents (72%) were determined as the most common ethiological factor for blunt thoracic trauma, penetrating and cutting instruments injuries (82%) were the most common factor for penetrating thoracic trauma. Accompanying trauma were observed in 37.5% of cases. 332 (58%) tube thoracostomy, 185 (32.5%) conservative treatment, 41 (7.1%) thoracotomy 14 (2.4%) mechanical ventilation were carried out. The rates of mortality were 6.8% and of morbidity 3.3%. Early diagnosis and immediate appropriate treatment in thoracic trauma increases the survival.

[Evaluation of patients wounded in the 17 August 1999 Marmara earthquake]. / Depremde yaralanan hastalara yaklasim: 17 Agustos 1999 Marmara depremi deneyimimiz.

This study describes the experience of Kartal Research and Training Hospital in the Marmara Earthquake. We reviewed medical records of 698 patients admitted to our hospital in a 30 days' period after the earthquake and analysed the types of injuries, treatment, morbidity and mortality rates. The hospitalized 273 patients were grouped according to the major injury; patients with crush syndrome were analysed separately. The most frequent injuries were crush injury (23.1%), extremity fractures (16.8%) and pelvis and spine injuries (16.1%). More than two system injuries were seen most frequently in the abdominal injury (45.5%), crush injury (24.4%), and pelvis and spine injury (27.3%) groups (p < 0.05). Overall mortality rate was 7.3%. The highest mortality rates were seen in the abdominal injury (27.3%) and crush injury (20%) groups (p < 0.05). 61.9% of the patients with crush syndrome underwent fasciotomy due to the compartment syndrome; hemodialysis was performed in 31 patients. The most serious problem with earthquake is organization in the earthquake area, between hospitals and in hospitals. Crush injury is the major injury seen earthquakes. Early diagnosis and proper treatment should be done to improve survival.