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Öğe Intrapleural fibrinolytic treatment of multiloculated pediatric empyemas(Springer, 2004) Ülkü, R; Önen, A; Onat, S; Kilinç, N; Özçelik, COur objective was to compare the efficacy of adjunctive intrapleural fibrinolytic agents (IPFA) (streptokinase, urokinase) on fibrinopurulent stage empyema and chronic stage empyema in children. IPFA were used in 78 pediatric patients with empyema (36 fibrinopurulent stage empyemas, 42 chronic stage empyemas) between December 1994 and September 2002. Pleural biopsy was done for staging in all cases. Streptokinase 250,000 units in 100 ml normal saline (62 patients) or 100,000 units urokinase in 100 ml normal saline (16 patients) was instilled daily into the patient's chest tube, and the tube was clamped for 4 h, followed by suction. This treatment was continued daily for 2-8 days until resolution was demonstrated by chest radiographs and/or computed chest tomography. Success of treatment was 97.2% (complete response 24/36, partial response 11/36) in the fibrinopurulent stage and 9.4% (complete response 2/42, partial response 2/42) in chronic empyema cases. In one patient with fibrinopurulent empyema, the treatment was stopped due to allergic reaction and pleural hemorrhage; this patient died 1 day later in a septic condition. Although an invasive method, the pleural biopsy technique may be an alternative way of more properly staging thoracic empyema in selected children in whom staging based on radiographic and biochemical findings is doubtful. Intrapleural fibrinolytic treatment is an effective and safe therapy of choice and may have significant benefit in most children with fibrinopurulent phase empyema, except for those with bronchopleural fistula. IPFA do not seem to be effective in children with chronic phase empyema.Öğe Intrapleural fibrinolytic treatment of traumatic clotted hemothorax(Amer Coll Chest Physicians, 1998) Inci, I; Özçelik, C; Ülkü, R; Tuna, A; Eren, NStudy objective: To evaluate the role of intrapleural fibrinolytic treatment (IPFT) in traumatic clotted hemothorax. Design and patients: Between August 1995 and February 1997, 24 patients with traumatic clotted hemothorax were included. Streptokinase (SK), 250,000 IU, or urokinase (UK), 100,000 IU, diluted in 100 mt of saline solution was givers daily. We administered 5.0+/-1.8 (range, 2 to 9) doses of SK or 6.25+/-5,97 (range, 2 to 15) doses of UK, Setting: Dicle University School of Medicine, Thoracic and Cardiovascular Surgery Department. Results: Complete response, which was defined as resolution of symptoms with complete drainage of fluid and no residual space radiographically, occurred in 15 (62.5%) patients, Partial response, which was defined as resolution of symptoms with a small pleural cavity, occurred in severs (29.2%) patients, Two patients (8.3%) required decortication; they were defined as nonresponders, The mean period of time between the diagnosis and fibrinolytic treatment (FT) was 11.65+/-6.38 (range, 4 to 25) days, There were no complications related to IPFT, There was no mortality during the course of IPFT. Conclusion: The use of intrapleural fibrinolytic agents has resulted in resolution of clotted hemothorax with an overall success rate of 91.7%. We recommend that IPFT should be added to the algorithm for management of clotted hemothorax before proceeding with minithoracotomy or pleural decortication.Öğe Penetrating chest injuries(Springer Verlag, 1998) Inci, I; Özçelik, C; Taçyildiz, I; Nizam, Ö; Eren, N; Özgen, GPenetrating chest injuries are a challenge to the thoracic or trauma surgeon, Penetrating thoracic trauma, especially that due to high-velocity gunshot wounds, is increasing at an alarming rate in our region, We report our experience with penetrating chest injuries mainly due to high-velocity gunshot wounds. During a period of 6 years we retrospectively reviewed the hospital records of 755 patients admitted to the Department of Thoracic and Cardiovascular Surgery, Dicle University School of Medicine, with the diagnosis of penetrating thoracic trauma. The mean age was 27.48 years, and 89.8% were male. The causes of penetrating injury were stab wounds in 45.3% and gunshot wounds in 54.7%. About 30% of the wounds were due to high-velocity gunshots; and among the gunshot wounds 56.2% were due to high-velocity shots, The most common thoracic injury was hemothorax (n = 190) followed by hemopneumothorax (n = 184), Isolated thoracic injuries were found in 53% of the patients. Nonoperative management was sufficient in 92% of the patients. Thoracotomy was performed in 8.1%, The mean duration of hospitalization was 11.2 days, The mean injury severity score (ISS) was 20.17 +/- 13.87. The morbidity was 23.3% and the mortality 5.6%. Fifty percent of all deaths were due to adult respiratory distress syndrome, Altogether 17% of patients with an ISS >25 died, whereas only 0.9% of those with a score <16 died. The mortality due to firearms was 8.95%. We concluded that in civilian practice chest tube thoracostomy remains by far the most common method of treating penetrating injury to the chest, The easy availability of high-velocity guns will continue to increase the number of civilians injured by these weapons.Öğe The value of open surgical approaches for aspirated pen caps(W B Saunders Co-Elsevier Inc, 2005) Ülkü, R; Onen, A; Onat, S; Özçelik, CPurpose: The aim of this study was to present the therapeutic approach of aspirated pen cap foreign bodies, with emphasis on the importance of open surgical intervention. Methods: The records of patients who underwent bronchoscopy and bronchoscopy and surgical therapy for pen cap foreign bodies between January 1997 and June 2003 were reviewed retrospectively. Diagnosis was made based on history, physical examination, radiological methods, and bronchoscopy. Age, sex, symptoms, radiological methods, surgical procedure, complications, and outcomes were recorded. Results: A total of 24 bronchoscopies were performed on 19 patients (10 boys, 9 girls) with a median age of 11 years (range, 8 - 15 years). Pen caps were localized in the right bronchial tree in 14 cases (74%). Pen caps were extracted successfully by forceps during bronchoscopy in 9 patients. Of the remaining 10 patients, 5 underwent bronchoscopy and tracheostomy and 5 patients underwent thoracotomy and bronchotomy. Significant complications were observed in 2 patients (10.53%) (severe bronchospasm in one and pneumothorax and subglottic edema in another). Conclusions: Pen caps aspiration is a challenging problem because of the difficulties during extraction and higher morbidity compared with other foreign body aspirations. In such cases in which classic bronchoscopy failed and/or pen caps could not be removed via vocal cords, open surgical approaches, either bronchoscopy and tracheostomy or thoracotomy and bronchotomy, may be an alternative procedure of choice. (c) 2005 Elsevier Inc. 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