Validation of the tablet-based Turkish-PAINReportIt® for lung cancer patients after thoracotomy in Turkey.

BACKGROUND: Digital pain assessment is advantageous and timely for healthcare priorities in Turkey. However, a multi-dimensional, tablet-based pain assessment tool is not available in the Turkish language. PURPOSE: To validate the Turkish-PAINReportIt® as a multi-dimensional measure of post-thoracotomy pain. METHODS: In the first of a two-phased study, 32 Turkish patients (mean age 47.8 ± 15.6 years, 72 % male) participated in individual cognitive interviews as they completed the tablet-based Turkish-PAINReportIt® once during the first four days post-thoracotomy, and 8 clinicians participated in a focus group discussion of implementation barriers. In the second phase, 80 Turkish patients (mean age 59.0 ± 12.7 years, 80 % male) completed the Turkish-PAINReportIt® preoperatively, on postoperative days 1-4, and at the two-week post-operative follow-up visit. RESULTS: Patients generally interpreted accurately the Turkish-PAINReportIt® instructions and items. We eliminated some items unnecessary for daily assessment based on focus-group suggestions. In the second study phase, pain scores (intensity, quality, pattern) were low pre-thoracotomy for lung cancer and high postoperatively high on day 1, decreasing on days 2, 3 and 4, and back down to pre-surgical levels at 2-weeks. Over time, pain intensity decreased from post-operative day 1 to post-operative day 4 (p < .001) and from post-operative day 1 to post-operative week 2 (p < .001). CONCLUSIONS: The formative research supported proof of concept and informed the longitudinal study. Findings showed strong validity of the Turkish-PAINReportIt® to detect reduced pain over time as healing occurs after thoracotomy.

Coadministration of intravenous remifentanil and morphine for post-thoracotomy pain: comparison with intravenous morphine alone.

OBJECTIVES: In this double-blind, randomized study, the authors compared the effects of a patient-controlled remifentanil and morphine combination with morphine alone on post-thoracotomy pain, analgesic consumption, and side effects. DESIGN: A prospective, randomized, double-blind clinical study. SETTING: University hospital. PARTICIPANTS: Volunteer patients at a university hospital undergoing elective thoracotomy surgery. INTERVENTIONS: Patients were allocated randomly into 2 groups to receive patient-controlled analgesia: the morphine (M) group or the morphine plus remifentanil (MR) group. Pain, discomfort, sedation scores, cumulative patient-controlled morphine consumption, rescue analgesic (meperidine) requirement and side effects were recorded for 24 hours. MEASUREMENTS AND MAIN RESULTS: Sixty patients were allocated randomly to receive intravenous patient-controlled analgesia with morphine alone (M) or morphine plus remifentanil (MR) in a double-blind manner. Patients were allowed to use bolus doses of morphine (0.02 mg/kg) or the same dose of a morphine plus remifentanil (0.2 µg/kg) mixture every 10 minutes without a background infusion. VAS scores were lower in the MR group than in the M group at 30 minutes (p = 0.04), 1 hour (p = 0.03), and 2 hours (p = 0.04). Mean cumulative doses of morphine were not significantly different at 27.8±15 mg for the M group and 21.9±10.5 mg for the MR group. Significantly more patients needed meperidine in the M group (p = 0.039); these also experienced more nausea (p = 0.01). CONCLUSIONS: Coadministration of PCA remifentanil with morphine for the treatment of post-thoracotomy pain did not reduce morphine consumption but provided superior analgesia, less use of rescue analgesics, and fewer side effects compared to morphine alone.

Simultaneous heart and bilateral lung hydatid cyst operated in a single session.

A 48 year-old man was admitted to our hospital because of coughing with dispnoea and chest pain. On physical examination he showed marked respiratory difficulty, with a respiratory rate of 25 breaths per minute, and his jugular veins were mildly distended. Transthoracic echocardiography showed a cystic mass located in the diaphragmatic surface of the right ventricular wall without any protrusion into the ventricular cavity. These cardiac and also bilateral pulmonary hydatic cysts were demonstrated by thoracic CT imaging. There were three hydatic cysts which were located in the right middle lobe medial segment (20 mm × 20 mm) and two of them were located in the left lower lobe laterobazal segment (15 mm × 15 mm and 17 mm × 14 mm). Extracorporeal bypass via median sternotomy was used and all components of hydatid cysts in heart and lungs were removed in same session. Patient recovered well. So one-stage surgery by median sternotomy is an excellent approach for cardiac and lung cyst hydatid.

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.

Sleeve resections for squamous cell carcinoma of the lung.

BACKGROUND: Sleeve resection is an advanced technique that was developed as an alternative to pneumonectomy. This study evaluated our cases of sleeve resection for squamous cell carcinoma of the lung and compared the outcomes with the literature reports. METHODS: In total, 26 bronchial, 5 bronchovascular, and 3 vascular sleeve lobectomies were performed between January 2000 and July 2005 in our clinic. Age, gender, operations, postoperative diagnosis and staging, and postoperative morbidity and mortality were evaluated. RESULTS: Sleeve resections were performed in 34 patients. All patients were male, with a mean age of 59.4 years. The operations consisted of 16 right upper, 14 left upper, and 1 left lower sleeve lobectomies and 3 superior sleeve bilobectomies. The most common postoperative pathological staging group was stage IIb (32.3%). Operative mortality was 5.9% (n=2). Postoperative morbidity was 20.5% (n=7), including 4 prolonged air leaks plus empyema, 1 prolonged air leak, 1 postoperative bleeding needing revision, and 1 severe bronchostenosis; of these, 6 had persistent atelectasis. The local tumour recurrence rate was 11.7% (n=4). The median survival time and 5-year survival were 36 months and 42%, respectively. CONCLUSIONS: Sleeve resection proved to be good therapy for lung cancer and has a lower morbidity and mortality than standard pneumonectomies and results in better lung function and quality of life. The anastomosis-related complications are experience-related technical complications and training thoracic surgeons to perform SRs at experienced centres will reduce the morbidity associated with SRs.

Diffuse cystic disease of the lung associated with simultaneous bilateral spontaneous pneumothorax: an unknown component of Caroli disease?

Simultaneous bilateral spontaneous pneumothorax is an uncommon and serious medical problem frequently related to an underlying lung disease such as parenchymal lung disease, inflammatory events or neoplasms. Recurrent pneumothorax associated with persistent air leakage may pose a therapeutic dilemma in patients with underlying lung diseases. Caroli disease (CD) is a very rare congenital disorder characterised by intrahepatic biliary cystic dilatations and frequently associated with polycystic kidney and hepatic fibrosis. To date, no relation between CD and the bilateral diffuse cystic structure of pulmonary parenchyma has been described. In this paper we present a patient with the diagnosis of CD in whom simultaneous bilateral spontaneous pneumothorax was the initial finding due to severe underlying pulmonary disease. Our patient's demographic and clinical characteristics, laboratory findings and course made us exclude the other aetiologies leading to such diffuse multi-bullous pulmonary involvement. The coincidence of recurrent pneumothorax and severe pulmonary disease has led to a big therapeutic dilemma. Open or minimally invasive surgery could be morbid or even mortal because of the nature of the parenchyma and the operative risk due to CD. Therefore, we suggest a unique conservative management including tube thoracostomy by locating the correct air spaces with the aid of high-resolution computed tomography followed by talc pleurodesis in patients with severe multi-bullous lung disease associated with potential risks due to co-morbidities.

Surgical management of bronchiectasis in childhood.

OBJECTIVE: Though there is a gradual decrease in the prevalence of bronchiectasis, it is still a cause of mortality and morbidity among children in developing countries such as Turkey. We reviewed the morbidity and mortality rates and the outcome of surgical treatment for childhood bronchiectasis. PATIENTS AND METHODS: Age, sex, etiological factors, symptoms, radiological examinations, surgical procedures, postoperative morbidity and mortality in patients aged 16 years and younger, operated for bronchiectasis between January 1991 and April 2006 in the Thoracic Surgery Clinic of Atatürk Training and Research Hospital for Chest Disease and Chest Surgery were reviewed retrospectively. RESULTS: Between January 1991 and April 2006, 176 cases aged 16 and younger were operated for bronchiectasis. There were 95 females (54%) and 81 males (46%), with a mean age of 12.3 years (range: 3.4-16 years). The most common cause of bronchiectasis was lung infection (n: 87, 49.4%). Main symptoms were coughing (n: 167, 94.9%), sputum (n: 139, 79%), hemoptysis (n: 78, 44.3%), and fever (n: 77, 43.7%). Mean duration of the symptoms in patients who were operated was 3.8 years (range: 0-7.6 years). Cases underwent a total of 201 operations: 19 cases had bilateral surgical resection and 6 cases had completion pneumonectomy. Majority of cases had complete resection (n: 165, 93.75%) while only 11 cases (6.25%) had incomplete resection. Mean duration of hospitalization was 8.9 days (range: 5-39 days). The outcome, based on the responses of patients postoperatively, was 'perfect' in 129 cases (73.3%), 'improved' in 41 cases (23.3%), and 'no changes' in 6 cases (3.4%). The mean follow-up after surgery was 4.3 years (range: 14 months to 7.2 years), mortality was 0% and morbidity was 13% (n: 23). CONCLUSION: With acceptable mortality and morbidity rates and high chance of cure after complete resection, surgical treatment is a successful and reliable method of treatment in childhood bronchiectasis that yields marked improvement in the quality of life.

Rare cause of pleural nodularity: Splenosis.

Splenosis is a rare condition described as ectopic splenic tissue implantation generally after a splenic rupture. A 35-year-old male patient who had a history of splenectomy operation due to gunshot wound seven years ago was referred to our hospital with complaints, including exhaustion, sweating and shortness of breath. Thoracic computed tomography of the patient showed nodular pleural thickenings at the level of the left lower lobe, which proved to be unrelated with the presenting symptoms. The patient underwent a minithoracotomy for diagnosis and treatment. During the intraoperative observation, dark-colored, soft, multiple nodular lesions with a biggest size of 2 cm inside the visceral pleura over an area of 5 x 10 cm in dimension were observed. Also, a few tiny nodules in the lung parenchyma approximately 1-cm deep to the pleural nodules were palpated. The lesions were excised. The histopathological examination of the specimen showed splenic tissue in the lung parenchyma and pleura, so the lesions were accepted as splenosis. Pleuropulmonary splenosis, which develops generally after simultaneous rupture of the diaphragma and spleen, is a very rare condition. Most of the patients are asymptomatic and the lesions are detected accidentally. If the diagnosis can be made preoperatively, surgical excision is not needed.

Cusum analysis for learning curve of videothoracoscopic lobectomy.

BACKGROUND: Video assisted thoracoscopic (VATS) lobectomy has a demanding learning curve due to its technical complexity and risk of uncontrollable bleeding. We investigated the case number required for gaining technical proficiency by applying cumulative sum analysis on initial VATS lobectomy operations of a single surgeon. METHODS: CALGB definition was used for the definition of VATS lobectomy. The data of the initial cases evaluated and cumulative sum (CUSUM) analysis was applied to duration of the operations and length of hospital stay. RESULTS: Fifty-eight patients underwent VATS lobectomy. Of those 51 were malignant and 7 were benign. Fifty-five of the procedures were lobectomy, 2 were inferior bi-lobectomy and 1 was left upper lobectomy with chest wall resection. CUSUM analysis reached to proficiency at 27 cases for duration of the operations. CONCLUSIONS: The length of learning curve depends on previous experience of the surgeon on open lobectomy and simpler VATS operations, potential number of VATS lobectomy cases and VATS capability of the surgeon. Depending on these factors, it is possible to obtain technical proficiency with an inferior number of procedures compared with existing literature (50-200).

The importance of administration of early surfactant and nasal continuous positive airway pressure in newborns with respiratory distress syndrome.

AIM: Mechanical ventilation is an invasive method and causes to important problems in the respiratory tract and lung parenchyma. The objective of our study was to investigate if administration of early surfactant and nasal continuous positive airway pressure (nCPAP) was superior to delayed surfactant administration and mechanical ventilation. MATERIAL AND METHODS: The study was conducted in the Van 100th Year University, Medical Faculty Hospital, Neonatal Intensive Care Unit. One hundred and nine infants with respiratory distrss syndrome (RDS) with a gestational age of 32 weeks and/or below were included in the study. Surfactant was given to 61 infants in the delivery room or intensive care unit and subsequently nCPAP was administered. Surfactant was administered in 48 infants in the control group and mechanical ventilation was inititated subsequently. Informed consent was obtained from the relatives of all patients and ethics committee approval was also obtained (Approval number: 03.02.2011/15). RESULTS: There was no statistically significant difference between the two groups in terms of gestational age, birth weight, gender, height and head circumference measurements (p>0.05). The mean hospitalization time in the patients in the study group was 24.4±17.8 days, whereas the mean time of nCPAP was 28.4 (4-120) hours. In the study group, intracranial hemorrhage was found with a rate of 27.85%, bronchopulmonary dysplasia was found with a rate of 4.91%, pneumothorax was found with a rate of 3.27%, necrotizing enterocolitis was found with a rate of 3.27%, patent ductus arteriosus was found with a rate of 16.39, sepsis was found with a rate of 22.95% and retinopathy of prematurity was found with a rate of 1.63%. No statistically significant difference was found between the study and control groups in terms of the rates of complications. During the follow-up period, 17 (27.86%) patients were lost. The length of stay on mechanical ventilation in the study group was found to be statistically significantly shorter compared to the control group (p<0.05). CONCLUSIONS: In our study, it was observed that administration of early surfactant and nCPAP in treatment of preterm newborns with a diagnosis of RDS markedly decreased the lenght of stay on mechanical ventilation, but had no significant impact on morbidity and mortality.

[Traumatic pulmonary pseudocyst: 2 case reports]. / Travmatik pulmoner psödokist: Iki olgu sunumu.

Traumatic pulmonary pseudocysts (TPP) are cavitary lesions that are rarely seen after blunt thoracic traumas. Two male patients who were diagnosed with cystic lesions in the left lung after trauma were followed in our clinic with the diagnosis of TPP. Due to increase in cyst dimensions and wall tension, which were seen on the follow-up thorax tomography, surgical intervention was decided for both cases. The first case underwent cystotomy and capitonnage via thoracotomy, and was discharged without any complication. However, the second case was lost due to cardiac arrest during the operative preparations. Thorax tomography is an important method in the diagnosis and radiological follow-up of TPP. The surgery option should always be remembered for patients who show progression during the follow-up.

Kergin pneumonectomy: a rare procedure.

We have evaluated our cases of "Kergin" pneumonectomy in which a bronchial flap of the medial part of the right main stem bronchus was created during right pneumonectomy and was turned upward to cover the lateral airway defect at the level of the carina. Five male patients with a mean age of 53.6 underwent "Kergin" pneumonectomy due to nonsmall cell carcinoma arising from right upper lobe entrance, which does not allow a classical pneumonectomy. Postoperative pathology stagings were stage IIB in 1 patient and stage IIIA in 4 patients. Any operative mortality or short-term complication was not observed. Two of the patients died in the second year of follow-up. "Kergin" pneumonectomy is a rarely performed procedure with acceptable morbidity and mortality and good lung cancer resection. Actually, our current report of five cases will be one of the largest series of "Kergin" pneumonectomy.

Comparison of the effects of N-acetyl cysteine and erdosteine in rats with renal injury caused by paracetamol intoxication.

AIM: The aim of the present study was to investigate the therapeutic and preventive effects of N-acetyl cysteine and erdosteine on renal injury associated with paracetamol (acetaminophen) intoxication. MATERIALS AND METHODS: Female albino Wistar rats were divided into six groups: control; paracetamol (1 g/kg, oral); paracetamol (1 g/kg, oral) + erdosteine (150 mg/kg/day, oral); paracetamol (1 g/kg, oral) + N-acetyl cysteine (140 mg/kg bolus, followed by 70 mg/kg, oral); N-acetyl cysteine control (140 mg/kg bolus, followed by 70 mg/kg, oral); and erdosteine control (150 mg/kg/day, oral). Potential renal injury was assessed using biochemical analyses, radionuclide imaging, and histopathological parameters. RESULTS: In the paracetamol group, blood urea nitrogen and creatinine levels were significantly increased compared with controls. Histopathological examination showed tubular vacuolization, tubular necrosis, and remarkable interstitial inflammation. The excretion function was observed to be insufficient on radionuclide imaging. However, in the groups treated with erdosteine or N-acetyl cysteine after paracetamol, biochemical analyses, radionuclide imaging, and histopathological parameters showed significantly less evidence of renal toxicity than that observed in the group receiving paracetamol alone. Less renal toxicity was detected in rats receiving N-acetyl cysteine than in those receiving erdosteine. CONCLUSION: Renal injury may develop after paracetamol overdose. Erdosteine and N-acetyl cysteine are both effective in the prevention of renal injury when given in the early phase of paracetamol nephrotoxicity. N-acetyl cysteine is more protective than erdosteine.

Prevention of pulmonary complications of pneumoperitoneum in rats.

BACKGROUND: Carbon dioxide (CO2) pneumoperitoneum facilitates the visualization of abdominal organs during laparoscopic surgery. However, the associated increase in intra-abdominal pressure causes oxidative stress, which contributes to tissue injury. OBJECTIVE: We investigated the ability of the antioxidant and anti-inflammatory drug Erdosteine to prevent CO2 pneumoperitoneum-induced oxidative stress and inflammatory reactions in a rat model. METHODS: Fourteen female adult Wistar albino rats were divided into a control group (Group A, n = 7) and an Erdosteine group (Group B, n = 7). Group A received 0.5 cc/day 0.9% NaCl, and Group B received 10 mg/kg/day Erdosteine was administered by gavage, and maintained for 7 days prior to the operation. During the surgical procedure, the rats were exposed to CO2 pneumoperitoneum with an intra-abdominal pressure of 15 mmHg for 30 min. The peritoneal gas was then desufflated. The rats were sacrificed following 3 h of insufflation. Their lungs were removed, histologically evaluated, and scored for intra-alveolar hemorrhage, alveolar edema, congestion, and leukocyte infiltration. The results were statistically analyzed. A value of P < 0.05 was considered statistically significant. RESULTS: Significant differences were detected in intra-alveolar hemorrhage (P < 0.05), congestion (P < 0.001), and leukocyte infiltration (P < 0.001) in Group A compared with Group B. However, the differences in alveolar edema were not statistically significant (P = 0.698). CONCLUSIONS: CO2 pneumoperitoneum results in oxidative injury to lung tissue, and administration of Erdosteine reduces the severity of pathological changes. Therefore, Erdosteine may be a useful preventive and therapeutic agent for CO2 pneumoperitoneum-induced oxidative stress in laparoscopic surgery.

The evaluation of Pat-Pat related injuries in the Western Black Sea region of Turkey.

BACKGROUND: Accidents caused by motorized vehicle in the agricultural sector are frequently observed. In Turkey; accidents arising from motorized vehicles, named Pat-Pat, which are used by farmers in the Western Black Sea region is not unusual. METHODS: One hundred five patients who were brought into the Emergency Department of Duzce University, Medical Faculty Hospital between September 2009 and August 2010 due to Pat-Pat related accidents were evaluated. RESULTS: The cases consisted of 73 (69.5%) males and 32 (30.5%) females, ranging from 2 to 73 years of age. In the 10-39 age group, a total of 63 (60.0%) cases were determined. The months when the greatest rate of cases applied to the hospital consisted of July, August, September and the season is summer. The cases were exposed to trauma in roads in 54 (51.4%), and 51 (48.6%) occurred in agricultural area without roads. Eighty seven (82.9%) cases were injured due to the overturning of vehicle. The patients were brought to the hospital using a private vehicle in 54 (51.4%) of the cases and in 51 (48.6%) cases, 112 ambulance system was used. The cases were determined to apply to the hospital most frequently between 6 pm-12 am. The injuries frequently consisted of head-neck and spine traumas, thorax traumas and upper extremity traumas. In 55 (52.4%) cases, open wound-laceration was determined. Seventy five (71.4%) cases were treated in the Emergency Department, and 28 (26.7%) were hospitalized. Three (2.9%) cases were deceased. CONCLUSIONS: Serious injuries can occur in Pat-Pat related accidents, and careful systematic physical examination should be conducted. In order to prevent these accidents, education of farm operators and engineering studies on the mechanics and safety of these vehicles should be taken and legal regulations should be created.

Effects of Urtica dioica on hepatic ischemia-reperfusion injury in rats.

OBJECTIVES: To evaluate the effects of Urtica dioica on hepatic ischemia-reperfusion injury. METHODS: Thirty adult male Wistar albino rats were divided into three groups: sham group (group 1), control group (group 2), and Urtica dioica group (group 3). All the rats were exposed to hepatic ischemia for 60 min, followed by 60 min of reperfusion. In group 2, a total of 2 ml/kg 0.9% saline solution was given intraperitoneally. In group 3, a total of 2 ml/kg Urtica dioica was given intraperitoneally. At the end of the procedure, liver tissue and blood samples were taken from all rats. Serum aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, ceruloplasmin, catalase, paraoxonase, arylesterase, and lipid hydroperoxide levels were measured. Liver tissue histopathologies were also evaluated by light microscopy. RESULTS: Serum aspartate aminotransferase, alanine aminotransferase and lactate dehydrogenase levels were significantly higher in group 2 than in group 1, and significantly lower in group 3 than in group 2. Also, group 2 had higher serum lipid hydroperoxides and ceruloplasmin levels but lower catalase, paraoxonase, and arylesterase levels than group 1. In group 3, serum lipid hydroperoxides and ceruloplasmin levels were significantly lower, and catalase, paraoxonase, and arylesterase levels were higher than those in group 2. Histopathological examination showed that liver tissue damage was significantly decreased in group 3 compared with group 2. CONCLUSIONS: Urtica dioica has a protective effect on the liver in hepatic ischemia-reperfusion-injured rats.

Thoracotomies in children.

Thoracotomies in children have been less extensively studied, as the incidence of diseases necessitating thoracotomies is low in the pediatric age group. This study reviews childhood thoracic diseases, thoracotomy approaches, indications, and complications. Surgical procedures and complications of a total of 196 children below 16 years of age who underwent thoracotomy for various reasons at the Department of Thoracic Surgery, Ataturk Chest Diseases and Chest Surgery Training and Research Hospital, between January 2000 and December 2004, were reviewed in this study. Out of the 196 patients, 77 were female (39%) and 119 (61%) were male. The most commonly encountered indications for surgery were hydatid cyst (35%), bronchiectasis (25%), chronic nonspecific pleuritis (13%), chest wall deformities (10%), and mediastinal cystic formations and masses (10%). The other indications included tuberculosis (3%), aspergilloma (0.5%), fibrohyalinized cyst (0.5%), resection of trachea (0.5%), bronchogenic cyst (0.5%), inflammatory pseudo-tumor (0.5%), sequestration (1%), lipoblastoma (0.5%), and eosinophilic granuloma (1%). Out of the 196 patients, 176 underwent lateral thoracotomy and 20 patients with a chest wall deformity underwent midsternal incision. Complications were seen in 35 patients (18%): atelectasia and secretory retention (54%), wound infection (17%), hemorrhage (3%), chylothorax (3%), intrathoracic space (3%), and postoperative extended air leakage (20%). The mean hospital stay was 15 days and we did not encounter any mortality. The physiology and anatomy of the respiratory system and especially the respiratory control mechanism in pediatric patients vary from those of the adults, resulting in a more morbid course after thoracic surgery in children. Despite severe postoperative pain, posterolateral thoracotomy is the preferred approach in adults because of an advanced intrathoracic exposure and easy manipulation. On the other hand, lower pain threshold and the different types of diseases seen in children make lateral thoracotomy a more appropriate choice for thoracotomy, which, at the same time, spares the serratus anterior muscle decreasing its negative impact on postoperative respiratory function.

Hydatid disease of the first rib causing thoracic outlet syndrome.

OBJECTIVE: To present a case of hydatid disease of the first rib as a rare cause of thoracic outlet syndrome. CLINICAL PRESENTATION: A 57-year-old female patient who had suffered from pain on the left shoulder radiating to the arm and numbness and weakness on the left arm for 3 months was admitted to our hospital. She had undergone an operation due to a mass lesion of the first rib compressing the thoracic outlet which was detected in the preoperative examinations. During the intraoperative examination it was decided that the lesion was a hydatid cyst and the first rib was totally resected. CONCLUSION: This report shows that hydatid disease should be taken into consideration amongst the tumoral diseases of the first rib as a very rare cause of thoracic outlet syndrome.