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Öğe Bilateral subclavian arterial aneurysm and ruptured abdominal aorta pseudoaneurysm in Behcet's disease(Springer-Verlag, 2002) Çakir, Ö; Eren, N; Ülkü, R; Nazaroglu, HBehcet's disease is characterized by recurrent ulcers of the mouth and genitalia and relapsing iritis. It is recognized as a chronic multisystem disease affecting the skin, mucous membranes, eye, joints, central nervous system, and blood vessels. About 8% of the patients with Behcet's disease have severe vascular complications such as arterial aneurysm and occlusion. In our patient, there was a massive, painful, pulsatile mass on the clavicle on the right side of neck. A left subclavian artery aneurysm mass was observed on the left apex on a chest X-ray. Through angiography, a lobular giant saccular aneurysm on the proximal side of the right subclavian artery, giant aneurysm on the left subclavian artery, and occlusion on the left subclavian-axillary artery were observed. We treated first the right and then the left subclavian arterial aneurysm with a two-stage operation. The aneurysms were resected and polytetrafluoroethylene (PTFE) graft interposition was performed. Control angiography was performed 6 months postoperatively. Both grafts were open and there was no anastomotic aneurysm. The patient was reoperated on for a ruptured abdominal aorta pseudoaneurysm 13 months after the first operation. The aortic defect was repaired using a Dacron patch.Öğe Extrapulmonary intrathoracic hydatid cysts(Cma-Canadian Medical Assoc, 2004) Ülkü, R; Eren, N; Çakir, Ö; Balci, A; Onat, SIntroduction: Hydatid disease, a clinical entity endemic in many sheep- and cattle-raising areas, is still an important health problem in the world. Extrapulmonary location of cysts in the thorax is rare. We report our experience with intrathoracic but extrapulmonary hydatid cysts and discuss concepts of treatment. Method: In our Thoracic and Cardiovascular Surgery Department at the Dicle University School of Medicine, 133 patients with thoracic hydatid cysts were managed surgically between January 1990 and October 2002. In 14 (10.5%), the cysts were extrapulmonary but within the thorax, located in the pleural cavity, mediastinum, pericardium and diaphragm, or in pleural fissures. Cysts were intact in 12 patients and ruptured in 2. Radiographs of the chest were the main means of diagnosis; all patients with mediastinal and diaphragmatic cysts and some with pleural cysts were also scanned with computed tomography. All patients were managed surgically. Results: We operated on 3 mediastinal, 2 diapragmatic and 1 pericardial hydatid cyst, as well as 6 in pleural fissures and 2 in the pleural space. Lateral thoracotomy was chosen as the surgical incision in all patients except 1 (7% of the 14), who had median sternotomy lot a pericardial hydatid cyst. Empyema developed in 2 patients (morbidity, 14%). No patient died perioperatively. Conclusions: Hydatid cysts may be found in many different sites. Surgery to obtain a complete cure is the treatment of choice for most patients with intrathoracic but extrapulmonary cysts; excision must be done without delay to avoid or relieve compression of surrounding vital structures.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 Management of multiloculated empyema thoracis in children(Elsevier Science Bv, 2002) Balci, AE; Eren, S; Ülkü, R; Eren, MNObjective: Progression of empyema, with the development of fibrinous adhesions and loculations, makes simple drainage difficult or impossible. The appropriate management remains controversial. Intrapleural fibrinolytic treatment to facilitate drainage of loculated empyema instead of open thoracototny has been advocated recently. The aim of this study was to evaluate the effectiveness of the intrapleural fibrinolytic application. Methods: In our clinic we used urokinase in 28 patients and performed thoracotomy and decortication in another 43. The two groups of patients had similar characteristics. Mean age was 10.2 (range: 3-14 years). All had undergone medical treatment and tube thoracostomy. Empyema severity score (ESS) was measured in all. Results: Fibrinolytic treatment, and thoracototny and decortication had complete response rates of 67.8 and 100%, respectively. Treatment was ineffective in six (21.4%) out of 28 patients who underwent urokinase instillation; they recovered after thoracotomy. In three (10.7%) patients, partial resolution was observed. One patient died of sepsis and pleural hemorrhage. Mean hospital stay after urokinase was 10.7 (range: 6-17) days. In the thoracotomy group, all patients recovered completely. No deaths occurred. Postoperative complications were incisional infection in two patients, atelectasis in one and reoperation after hemorrhage in one. Mean hospital stay after surgery was 9.5 (5-19) days. The ESS of cases operated on was lower postoperatively (0.3 versus 0.8). Conclusion: Continued conservative therapy risks morbidity and mortality. Thoracotomy-decortication can be used successfully and must remain the preferred method in the treatment of multiloculated pediatric empyema. (C) 2002 Elsevier Science B.V. All rights reserved.Öğe Management of postpneumonic empyemas in children(Oxford Univ Press Inc, 2004) Ozcelik, C; Ülkü, R; Onat, S; Ozcelik, Z; Inci, I; Satici, OObjectives: Despite continued improvement in medical therapy, pediatric empyema remains a challenging problem for the surgeon. Multiple treatment options are available; however, the optimal therapeutic management has not been elucidated. The aim of this study is to assess different treatment options in the management of postpneumonic pediatric empyemas. Methods: A retrospective review was performed of pediatric patients admitted to Dicle University School of Medicine Thoracic and Cardiovascular Surgery Department between 1990 and 2002, with the diagnosis of empyema. Data tabulated included patient demographics, presentation, treatment and outcome. Results: There were 515 children (289 boys and 226 girls) with a mean age of 4.7 ranging from 18 days to 15 years. Empyema was secondary to pneumonia in all children. The most common radiologic finding was pleural effusion in 285 patients (55.32%). Staphylococcus aureus was the most frequently encountered organism and found in 105 patients (20.38%). Pleural fluid cultures were negative in 195 patients (37.86%). In addition to antibiotic therapy, initial treatment included serial thoracenthesis (n = 29), chest tube drainage alone (n = 214), chest tube drainage with intrapleural fibrinolytic therapy (n = 72), chest tube drainage with primary operation (n = 191), and primary operation without chest tube drainage (n = 9). Overall response rate with fibrinolytic treatment (complete and partial response) was obtained in 58 patients. In addition to decortication pulmonary resections were performed in 12 patients. Overall mortality rate was 1.55%. There was no operative mortality. Postoperative morbidity included wound infection in 21, delayed expansion in 8, and atelectasis in 35 patients. Conclusions: Multiple therapeutic options are available for the management of pediatric empyema. Depending on stages, every option has a role in the treatment of postpneumonic pediatric empyema. In the absence of bronchopleural fistula, intrapleural fibrinolytic treatment should be tried in all patients with multiloculations in stage II empyema. In the absence of pneumonia, decortication for empyema is a safe approach with low mortality and morbidity rates. (C) 2003 Elsevier B.V. All rights reserved.Öğe Open surgical approach for a tooth aspirated during dental extraction(Wiley, 2005) Ülkü, R; Baskan, Z; Yavuz, IForeign body aspiration is a common problem in children necessitating prompt recognition and early treatment to minimize the potentially serious and sometimes even fatal consequences. Most foreign bodies can usually be extracted by skilful application of endoscopic techniques. Nevertheless, spherical foreign bodies, such as pen caps and some teeth remain difficult to manage. In this case report clinical presentation and treatment options in the treatment of a patient who had a tooth lodged in the right lung are discussed. The complications of foreign body ingestion or aspiration associated with dental treatment is emphasized.Öğe Phrenic nerve injury after blunt trauma(Int College Of Surgeons, 2005) Ülkü, R; Onat, S; Balci, A; Eren, NPhrenic nerve injury resulting from blunt trauma is unusual and may closely mimic diaphragmatic rupture. Diagnosis remains difficult and is often delayed. A prompt diagnosis requires a high index of suspicion. We describe one patient with phrenic nerve injury in whom the diagnosis was made late at the time of injury. Radiograph, ultrasonography, and computed tomography were helpful in the diagnosis. Video-assisted thoracic surgery was performed on our patient for diagnostic purposes. Left phrenic nerve injury and pericardial injury were found. Diaphragmatic plication was performed through a miniature left posterolateral thoracotomy. This case was presented to show the unusual nature of phrenic nerve injury.Öğe Ruptured hydatid cysts of the lung in children(Elsevier Science Inc, 2002) Balci, AE; Eren, N; Eren, S; Ülkü, RBackground. Rupture of a hydatid cyst may cause some unique problems, especially in children. Methods. Sixty-three children with a total of 68 ruptured lung hydatid cysts were operated on between 1980 and 2000. Mean age was 12.3 years (range, 1 to 15 years). Radiographic findings were hydropneumothorax (20.6%) and air-fluid level (19%). Mean follow-up was 19.3 months. Results. Transthoracic needle aspiration was responsible for the rupture in 3 children. The interval between cyst rupture and operation was less than 24 hours in 10 patients (15.9%), 1 to 4 days in 36 (57.1%), and more than 4 days in 17 (27%). Resection rate was 22.1%. The most frequent operative method was cystotomy and capitonnage (38%). Morbidity was 25.4% (extended air leak 5, empyema 3, bronchopleural fistula 3, atelectasis 3, pneumonia 2). Mortality was 4.7% (hemoptysis 1, pneumonia and sepsis 1, aspiration of hydatid material 1). Morbidity and mortality seem to be more frequent in late cases. Conclusions. Early surgical intervention with single-lung ventilation and maximum parenchyma preservation are recommended. (C) 2002 by The Society of Thoracic Surgeons.Öğe Surgical treatment of post-traumatic tracheobronchial injuries(Elsevier Science Bv, 2002) Balci, AE; Eren, N; Eren, S; Ülkü, RObjective: Tracheobronchial injuries have different clinical pictures and high mortality unless aggressive treatment is used. We reviewed our surgical experience. Methods: The records of 32 patients from 1988 to 2002 were reviewed. Mean age was 22.3 years (range: 4-53). Three patients were female. Prominent symptoms were dyspnea, subcutaneous air and pneumothorax in chest X-rays. Associated injuries were seen in 22 patients (68.7%): most frequently in the lung parenchyma (11 patients) and esophagus (seven patients). Bronchoscopic detection of a rupture of the trachea or bronchus was the main indication for surgery. Results: Nineteen injuries (59%) were penetrating and 13 blunt (41%). The most common presenting sign of airway disruption was subcutaneous emphysema (25%) and stridor (22%). Of the 32 patients, 22 underwent bronchoscopic examination. Bronchography was used in three patients admitted during the late period. Surgical morbidity was 19.3%. Seven patients died (21.8%), of whom six had been operated on. In operations performed during the first 2 h of trauma, no mortality occurred. There were associated injuries in 100% of patients that died and in 60% of those that survived. The proportion (100 vs. 24%) and duration (2.8 vs. 11.6 days) of ventilatory support were lower in patients that survived than in those that died. Mean injury severity score of patients that died was 34.7 +/- 8.8 while it was 24.3 +/- 8.6 in those that survived. Tracheal stenosis developed in three patients (9.3%). Conclusion: In civilian life, tracheobronchial injuries occur relatively rarely. Early diagnosis and operative intervention save lives. Associated injury is an important mortality factor. (C) 2002 Elsevier Science B.V. All rights reserved.Öğe Surgical treatment of pulmonary hydatid cysts in children(Georg Thieme Verlag Kg, 2004) Ülkü, R; Onen, A; Onat, SAim of the Study: Hydatid disease is a parasitic infestation which is endemic in many sheep and cattle raising areas and is still an important health problem in the world. The aim of our study was to present our surgical experience and strategy in the management of pulmonary hydatid disease. Methods: Sixty-six patients with 83 pulmonary hydatid cysts underwent surgical treatment in our institution between January 1990 and March 2003. We used double-lumen endotracheal tubes in children older than 12 years who were operated on for hydatic cyst in the last 8 years. Results: There were 38 boys and 28 girls with a mean age of 9.6 +/- 7 years (range 5-15 years). Of the 83 cysts, 61 were intact and 22 were ruptured cysts. Isolated pulmonary hydatid cyst was seen in 61 patients (92.4%), while 5 patients (7.6%) had combined pulmonary and hepatic cysts. Lateral thoracotomy was performed in 54 patients (82%), thoracophrenotomy in 5, bilateral thoracotomy in 4, and median sternotomy in 3 patients. Cystotomy and capitonnage was performed in 58 cysts, cystotomy alone in 21, and resection techniques were used in 4. There were 8 postoperative complications in 7 patients. The most common complication was atelectasis. Conclusions: Surgery is the treatment of choice for most patients with pulmonary hydatid cysts. The usage of double-lumen tubes may decrease intra- and postoperative complications. Thoracophrenotomy can be chosen as the surgical procedure in the management of hepatic and pulmonary hydatid cysts.Öğe Unilateral post-traumatic pulmonary contusion(Springer, 2005) Balci, AE; Balci, TA; Eren, S; Ülkü, R; Çakir, Ö; Eren, NPurpose. There is still much controversy regarding the optimal treatment for pulmonary contusion. Therefore, we examined the variables affecting patient outcomes over a 10-year period. Methods. We retrospectively reviewed 107 consecutive patients with a mean age of 28 years, who were treated for pulmonary contusion during a 10-year period. Pulmonary perfusion scans were obtained for 11 patients. We used a pulmonary contusion score (PCS) of one-third of a lung=3 and the entire lung=9. Results. Overall mortality was 15%, which increased to 24.4% in patients with a PCS of 7-9. The time taken for contusions to resolve was longer based on scan results than chest X-rays (42.6 vs 15.5 days, respectively). Concomitant thoracic injures were present in 64.5% of patients, and 29% had a flail chest. The factors predictive of mortality were age >= 60 years, an injury severity score (ISS) >= 25, transfusion of >= 4 units of blood, a PaO2/FIO2 ratio of < 300, concomitant flail chest, and a PCS of 7-9. The predictors for mechanical ventilation were age >= 60 years, concomitant flail chest, a PCS of 7-9, and an ISS >= 25. Mortality and the need for mechanical ventilation were higher in patients with nonisolated contusions than in those with isolated contusions. Conclusions. Optimizing patient outcome requires prompt diagnosis, appropriate maintenance of fluid volume, and selective mechanical ventilation.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. All rights reserved.
