Does endoscopic thoracic sympathectomy through clipping procedure have early effects on electrocardiographic parameters?

BACKGROUND & OBJECTIVES: Hyperhidrosis is a pathologic condition of excessive sweating in amounts greater than physiologic needs. Endoscopic thoracic sympathectomy (ETS) is a globally accepted treatment modality for primary palmar and axillary hyperhidrosis. ETS also has distinctive effects on the heart, circulatory and respiratory systems. In this study early effects of ETS on electrocardiographic (ECG) parameters of hyperhidrosis patients were evaluated. METHODS: Twelve-lead ECGs were performed on 72 patients who were free from cardiovascular, metabolic, neurological and pulmonary diseases and underwent planned ETS because of hyperhidrosis, before and after the procedure within the first 24 h. Heart rate (HR), PR, QT, corrected QT (QTc), QTc/Tpeak-Tend (TpTe) intervals, P-wave and QTc/TpTe dispersions were compared by ECG. RESULTS: A total of 72 patients (24.1±6.0 yr, 17 female) were included in the study. The pre-operative HR of patients was significantly higher than post-operative HR of patients (73.8±12.8 vs. 68.1±12.6 beats/ min; P<0.001). The QTc dispersion (QTcd) durations of pre-operative patients were significantly longer than those of post-operative patients (51.5±6.3 vs. 44.9±5.6 msec; P<0.01). The TpTe dispersion value of pre-operative patients was significantly (P<0.001) higher than that of post-operative patients. INTERPRETATION & CONCLUSIONS: Our study showed that ETS through clipping procedure had positive effects on the mechanisms of arrhythmia by reducing HR, QTcd, TpTe and TpTe dispersion parameters of ECG in early periods in hyperhidrosis patients.

Is Tracheal Transplantation Possible With Cryopreserved Tracheal Allograft and Hyperbaric Oxygen Therapy? An Experimental Study.

BACKGROUND: Allografts have achieved prominence for tracheal reconstruction because of their natural physiologic and anatomic structure, which preserves respiratory tract flexibility and lumen patency. The immunomodulatory effects of cryopreservation prevent tracheal allograft rejection. In addition, hyperbaric oxygen therapy (HBOT) accelerates wound healing by promoting epithelization and neovascularization. This experimental study investigated the early and late effects of HBOT on cryopreserved tracheal allografts (CTAs). METHODS: The study used 33 outbred Wistar rats weighing 300 to 350 g as allograft transplantation donors and recipients. Among these, 22 recipient rats were randomly assigned to the HBOT (n = 11) and control (n = 11) groups. Rats in the HBOT group were treated with 100% oxygen for 60 minutes at 2.5 atmospheres of absolute pressure for 7 days. Recipient rats in both groups were euthanized at 1 week (n = 5) and 4 weeks (n = 6) after transplantation, defined as the early and late periods, respectively. RESULTS: In the early period, no significant histopathologic differences were observed between groups (p > 0.05). However, microscopic evaluation of the control group during the late period showed low epithelization of the CTA. In contrast, microscopic evaluation of the HBOT group during this same period revealed epithelium covering the transplanted CTA lumen. Significant epithelization and vascularization and significantly reduced inflammation and fibrosis were found in the HBOT group compared with the control group (p < 0.05). CONCLUSIONS: HBOT may be effective in tracheal reconstruction by increasing epithelization and neovascularization after extended tracheal resection. HBOT, therefore, should be considered in CTA transplantation.

Is bilateral chylothorax possible after simple cough? Yes.

Chylothorax is accumulation of chylous fluid in the pleural space due to impaired integrity of the thoracic duct or its branches. In childhood, the causes differ from those in adults because children less frequently develop malignancies and are more resistant to trauma. Commonly, chylothorax occurs as a complication of tumoral invasion or cardiopulmonary surgery. Treatment of chylothorax is essentially medical. In the event of medical treatment failure or a massive effusion, surgery is needed. We describe the case of a 65-year-old woman who developed bilateral chylothorax after a simple cough. She was treated with a medium-chain triglyceride diet and thoracentesis.

Anterior mediastinal angiomyolipoma.

Angiomyolipomas are benign, solitary, noninvasive mesenchymal tumors. They most often arise in the kidney. Extrarenal presentations of these tumors are in skin, orophaynx, abdominal wall, gastrointestinal tract, heart, lung, liver, uterus, penis, and spinal cord. Angiomyolipoma of the mediastinum is extremely rare and is composed of an admixture of fat, smooth muscle cells, and tortuous, thick-walled, small to medium sized blood vessels. We present a surgically confirmed case of anterior mediastinal angiomyolipoma incidentally diagnosed in an asymptomatic patient.

The effects of clipping on thoracic sympathetic nerve in rabbits: early and late histopathological findings.

BACKGROUND: The clipping of the thoracic sympathetic nerve, which has been a technique used for approximately the past 10 years, has rapidly become popular because of its "bring-back" claim. However, the information regarding the mechanism behind this claim is based on investigator's comments and has not been proven by objective research, such as the histopathological examination of the clipped nerve and/or ganglion. We aimed to evaluate sympathetic regeneration and degeneration after clip removal. METHODS: The rabbits were divided into two groups with six rabbits per group. For the first group (group A), the sympathetic chain was clipped using two titanium clips, and a right thoracotomy was made at the T4 and T5 levels. For the second group (group B), the animals were also operated on, which was similar to the rabbits in group A. At the end of a 48-hour follow-up period, the clips were removed after a second operation. The rabbits in group B were followed for 45 days and sympathetic nerves were also examined histopathologically. RESULTS: In group A, hemorrhage, fibrinous material, polymorphonuclear leukocyte infiltration, and acute inflammation with fat necrosis were observed in and around the sympathetic ganglia and trunk. Loss of nuclei and vacuolization in some sympathetic ganglia cells were also observed. These findings demonstrated severe degeneration of the sympathetic ganglia and trunk. For group B, microscopic examination revealed a loss of sympathetic ganglion cells as well as fibrosis within and around the ganglia. No signs of regeneration were detected and the progression of nerve degeneration was observed. CONCLUSIONS: The clips used in our study were shown to cause the degeneration of neural structures within 2 days. At the end of the 45 days following the removal of the clips, progressive, degenerative changes radiating along the axons of the sympathetic cells were seen.

[Hydatid cyst disease mimicking metastatic lung disease: a case report]. / Metastatik Akciger Hastaligini Taklit Eden Hidatik Kist Hastaligi Olgusu.

Pulmonary hydatid cysts usually present as a single lesion, whereas multiple cases are rare. It is not easy to distinguish hydatid cyst and nodular lesions radiologically. Chest radiograph of a 22 years-old male patient who was admitted due to right sided chest pain, revealed bilateral pulmonary nodules. His computerized tomography (CT) showed 34 nodular densities in the right lung and 21 nodular densities in the left lung. At that time, metastatic lung disease was suggested . Tru-cut lung biopsy was non-diagnostic. Anti-E. granulosus IgG (ELISA) was positive and hydatid cyst disease (HCD) was set as a prediagnosis. A right thoracotomy was performed and more cysts in number than those in tomography were observed intraoperatively. Postoperatively, 800 mg per day albendazole treatment was started. CT at the second month of medical therapy revealed that the lesions were stable in number but their sizes were smaller. CT of the fourth month showed that some of the lesions became cavitary. HCD should be kept in to mind in case of doubtful radiological findings. Although main treatment modality is surgery for HCD, when all cysts can not remove with the surgical treatment in patient with multiple cysts, medical treatment can be administered.

The influence of specific factors on postoperative morbidity in young adults with bronchiectasis.

BACKGROUND: Surgical treatment of bronchiectasis is associated with acceptable mortality and morbidity rates. To date, few reports on the prediction of postoperative morbidity using some preoperative measures have been presented. We present our results regarding the influence of some specific factors on postoperative morbidity on young adult patients who were treated surgically for bronchiectasis. METHODS: Between January 2000 and July 2007, 122 patients were operated upon. Female gender, increased number of resected segments, presence of haemoptysis and bilateral disease, compromised pulmonary function test (FEV1/VC<60%) and absence of preoperative fiberoptic bronchoscopy (FOB) were examined as the potential risk factors for postoperative complications such as persistent air leak (PAL), atelectasis, residual air space (RAS), bronchopleural fistula (BPF) and empyaema. RESULTS: There was no operative mortality. Morbidity was observed in a total of 16 patients with an overall morbidity rate of 13.1%. Complete resection was achieved in 88 patients (72.1%). The number of resected segments was not found to be significantly associated with increased morbidity. Presence of preoperative haemoptysis did not correlate with postoperative complications significantly. Absence of preoperative FOB was not found to be associated with post-operative complications (p<0.05). Compromised PFT was significantly associated with RAS (p=0.028), however it was not associated with increased risk of PAL, atelectasis or empyaema significantly. CONCLUSION: Multi-segmental resectable bronchiectasis should not be considered an occult risk factor for morbidity after resection. Associated non-severe haemoptysis and absence of preoperative bronchoscopy are not associated with significant increased risk of postoperative morbidity.

A sledgehammer on the brachial plexus: thoracic outlet syndrome, subclavius posticus muscle, and traction in aggregate.

Reported here is a 30-year-old man who was seen because of pain and weakness in the upper extremities after a tractional injury. Physical examination revealed significant atrophy in the left deltoid and right intrinsic hand muscles, generalized hypoesthesia, decreased deep tendon reflexes bilaterally, and decreased strength in various muscle groups. Roos (right) and hyperabduction (bilateral) tests were positive. Electrodiagnostic studies were consistent with bilateral brachial plexopathy. Cervical radiographs showed long transverse process of C7 on the right side and a small rudimentary rib articulating with C7 on the left side. Brachial plexus magnetic resonance imaging demonstrated an aberrant muscle and compressive brachial plexus injury on the left side. Surgery via transaxillary approach was performed on the left side. The occurrence of traumatic brachial plexopathy in the presence of underlying thoracic outlet syndrome and subclavius posticus muscle is discussed for the first time in the literature.

Hyperbaric oxygen as adjunctive therapy in experimental mediastinitis.

BACKGROUND: Mediastinitis is a dreaded complication of cardiac surgical procedures. The purpose of our study was to research the role of hyperbaric oxygen therapy (HBO) in the treatment of experimental mediastinitis and to investigate whether it potentiates the antibiotic effects of linezolid, teicoplanin, and vancomycin. METHODS: The study included nine groups; an uncontaminated and a contaminated untreated control groups, and seven contaminated groups that received HBO or systemic antibiotics with linezolid, vancomycin, or teicoplanin, or a combination therapy consisting of one of these antibiotics and HBO. There were six adult male Wistar rats in each group. Contaminated groups were inoculated with 0.5 mL 10(8) CFU/mL methicillin resistant Staphylococcus aureus in the mediastinal and in the sternal layers. The antibiotic treatment continued 7 d. Twelve hours later at the end of the treatment, the rats were sacrificed, a sternotomy was performed for each rat and tissue samples from the upper ends of the sternum were aseptically obtained and evaluated microbiologically. RESULTS: There was no difference between the therapeutic efficacy of linezolid, teicoplanin, or vancomycin (P>0.05). When the groups were analyzed separately, treatment with a combination of HBO and antibiotic therapy reduced the bacterial count in comparison with HBO or antibiotic treatment alone (P<0.05). The combination of teicoplanin or vancomycin and HBO, respectively, was not more effective in reducing the bacterial count in comparison with the combination of linezolid and HBO (P>0.05). CONCLUSIONS: Linezolid and teicoplanin therapy was found as effective as standard vancomycin therapy for methicillin resistant Staphylococcus aureus (MRSA) mediastinitis. Adjunctive HBO offered additional benefit to the antibiotic treatment of mediastinitis.

Spirometric changes after pleural decortication in young adults.

BACKGROUND: The collection of pleural fluid and thickened pleura restrict the movement and expansion of lung. The main treatment strategy is lung decortication for the thickened pleura. The aim of this study was to investigate lung functions before and after pleural decortication in young adults. METHODS: A total of 63 patients with thickened pleura were retrospectively evaluated. Before the operation, patients with tuberculosis (n = 36) were treated with anti-tuberculosis therapy for 3-6 months. Patients with non-tuberculosis causes (n = 27) had been treated with broad-spectrum antibiotics. Forced expiratory volume in 1 s (FEV1, %), forced vital capacity (%) and vital capacity (litre) were measured before and after decortication. RESULTS: Spirometric parameters FEV1 (68.1 +/- 16.7 vs 71.01 +/- 14.4), forced vital capacity (67.6 +/- 16.4 vs 71.3 +/- 14.4) and vital capacity (2.6 +/- 0.6 vs 2.8 +/- 0.7) significantly improved after the operation (P +/- 0.01). Spirometric changes were not significantly different between tuberculosis and non-tuberculosis groups. CONCLUSION: Pleural decortication may improve the lung restoration in patients with thickened pleura and also improve lung functions significantly in young adults.

A novel terminology and dissemination theory for a subgroup of intrathoracic extrapulmonary hydatid cysts.

Chest wall, mediastinal, pericardial, myocardial, lobar fissure and pleural locations of the hydatid cysts are referred to be intrathoracic extrapulmonary cysts. In this report a 20-year-old male patient had a liver dome cyst, which was opened into the diaphragm and caused diaphragmatic hydatid cysts. The scoleces have probably been transported by diaphragmatic lymphatics into the subpleural location and then hydatid disease has been disseminated via parasternal lymph nodes anteriorly and intercostal lymph nodes posteriorly towards cupola of the thorax. With regard to this localization, we propose a novel terminology as 'intrathoracic extrapleural hydatid cyst' and we hypothesize a novel dissemination theory for the hydatid cysts via diaphragmatic lymphatic drainage.