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Öğe Bilateral Giant Morgagni Hernia Causing Cardiac Shifting(Ekin Tibbi Yayincilik Ltd Sti-Ekin Medical Publ, 2009) Avci, Alper; Girgin, Sadullah; Gedik, Ercan; Onat, SerdarA 76-year-old woman weighing 114 kg presented with shortness of breath and worsening chest pain for 2-year duration. There was no history of trauma. Plain and cross-sectional imaging identified a giant anterior diaphragmatic hernia which caused cardiac posterior shifting. She was transferred to general surgery department for further investigations and treatment. Reduction of herniated contents and repairing of bilaterally diaphragmatic defect were performed via laparotomy. Bilateral, giant Morgagni hernia which causes cardiac shifting to the backward is extremely rare.Öğe Bilateral Spontaneous Pneumothorax due to Pulmonary Metastasis of Synovial Sarcoma: A Case Report(Bilimsel Tip Publishing House, 2011) Avci, Alper; Eren, SevvalSpontaneous pneumothorax is a rarely seen complication in metastatic pulmonary diseases. It could be the first symptom and might be seen in the post chemotherapy period. We here report a 20-year-old male with surgically treated-bilaterally spontaneous pneumothorax who had hypopharyngeal synovial sarcoma initially and had been treated with surgery and chemotherapy. We emphasised that spontaneous pneumothorax could be caused by pulmonary mature metastais of synovial sarcoma, as a result of air leakage. Surgical treatment such as metastasectomy and pulmonary paranchimal repair and intraoperatively chemical pleurodesis would be requiredÖğe Factors affecting the outcome of surgically treated non-iatrogenic traumatic cervical esophageal perforation: 28 years experience at a single center(Biomed Central Ltd, 2010) Onat, Serdar; Ulku, Refik; Cigdem, Kemal M.; Avci, Alper; Ozcelik, CemalBackground: We reviewed our experience with non-iatrogenic traumatic cervical esophageal perforations, paying particular attention to factors affecting the outcome of such cases. Methods: In total, 30 patients treated surgically between 1980 and 2008 for non-iatrogenic traumatic cervical esophageal perforation in our clinic were reviewed. Results: There were 25 male and 5 female patients with a median age of 27.5 years. The type of injury was external trauma in 21 (70%) patients and endoluminal injury in the remaining 9 (30%) patients. The mechanism of injury was gunshot in 16 patients, stabbing in 4, falling in 1 (extraluminal injury), and foreign body in 9 (endoluminal injuries). The overall mortality rate was 16.6% (5/30). The mortality rate for extraluminal injuries was 19%, and for endoluminal injuries was 11.1%. Mortality in patients treated within 24 h of sustaining injury was substantially less than in those for whom diagnosis and treatment were delayed (12.5 and 21.4%, respectively). The mortality rate was 33.3% (3/9) for patients with tracheal injuries and 9.5% (2/21) for those without tracheal injuries. Conclusions: A treatment delay greater than 24 h, the presence of tracheal injury, or extraluminal perforation significantly affected the outcome of surgically treated non iatrogenic traumatic cervical esophageal perforation.Öğe Hemangioma of the Sternum(Elsevier Science Inc, 2008) Onat, Serdar; Ulku, Refik; Avci, Alper; Mizrak, Bulent; Ozcelik, CemalPrimary tumors of the sternum are rare and most of them are malignant. Benign lesions are typically chondromas, bone cysts, or hemangiomas. Among these tumors, hemangiomas are extremely rare. We report a rare case of hemangioma of the sternum. The patient was successfully treated with complete resection of the tumor and sternum stability was obtained by polypropylene mesh and methylmethacrylate.Öğe Hydatid cysts in muscles: clinical manifestations, diagnosis, and management of this atypical presentation(Soc Brasileira Medicina Tropical, 2015) Tekin, Recep; Avci, Alper; Tekin, Rojbin Ceylan; Gem, Mehmet; Cevik, RemziIntroduction: Hydatid cysts are rarely detected in muscle tissue (0.7-0.9%), even in endemic countries. The aim of this study was to present information regarding the clinical manifestations, diagnosis, and management of muscle echinococcosis. Methods: Twenty-two patients with hydatid cysts in the muscle were followed from January 2006 through December 2014. Results: Twenty-four sites of muscle involvement were observed in the 22 patients. Fifteen (68%) of our patients were women, while seven (32%) were men. The mean age was 28.1 +/- 15.4 (6-61) years. The most frequent locations were the thigh (27.2%) and the paravertebral region (13.6%). Most patients reported a painless slow-growing mass with normal overlying skin. Most (90.2%) cases were treated by surgical excision and fine-needle aspiration. Conclusions: Primary muscle hydatid cyst should be considered in the differential diagnosis in cystic masses of the muscular system without pain and localized enlargement of soft tissue, especially in endemic areas. Hydatid cyst should be investigated using serological tests and imaging modalities. If possible, total surgical excision of hydatid cyst in the muscle should be performed.Öğe Life-threatening giant mediastinal cystic teratoma in a 4-month-old male baby(Springer Japan Kk, 2009) Avci, Alper; Eren, SevvalCystic teratomas of the mediastinum are rare and present with severe respiratory distress during childhood. Aspiration of the cyst is indicated to reduce the cyst volume, alleviate the patient's symptoms, and secure an operative field. This report describes a 4-month-old male baby with a large anterior mediastinal teratoma presenting with severe respiratory distress. The cystic teratoma was large enough to cause pectus carinatum. Respiratory distress secondary to airway obstruction was markedly reduced by percutaneous aspiration of the cyst. Surgical excision is indicated for a malignant or benign well-demarcated mass in any part of the mediastinum. In our patient, total surgical excision was performed. Preoperatively, percutaneous aspiration was performed twice, with the symptoms being reduced after each aspiration. Surgical excision is the best means of diagnosing and treating a benign teratoma. Percutaneous cyst aspiration not only improved ventilation but also facilitated easy excision of the cyst during surgical management.Öğe Posterior Mediastinal Bronchogenic Cyst: Case Report(Ortadogu Ad Pres & Publ Co, 2010) Eren, Sevval; Avci, AlperBronchogenic cysts are usually located in the mediastinum and pulmonary parenchyema, however they may occasionally be subdiaphragmatic or subcutaneous. Although seen in all age groups, symptomatic ones can be diagnosed in the newborn period whereas the asymptomatic ones are detected incidentally on chest X-ray in advenced ages. We present a 21-year-old man with a bronchogenic cyst in the posterior mediastinum that led to complaints of fatigue and back pain. A posteroanterior chest plain radiography showed enlargement of the mediastinum. Computerized thorax tomography showed a 4x3 cm cystic lesion in the left posterior mediastinum, in paravertebral location. The cyst was exised via a thoracotomy. The histopathological diagnosis was bronchogenic cyst. The patient was asymtomatic and without any radiological recurrence in the sixth-month follow up visit.Öğe Primary sternal tuberculosis: a case report(Ekin Tibbi Yayincilik Ltd Sti-Ekin Medical Publ, 2010) Eren, Sevval; Avci, AlperTuberculosis of bone-joint systems is considerably rare. Pulmonary tuberculosis is primary source in most patients. There are few cases in the literature in which tuberculosis targets the sternum primarily. In this article, we present a case of a primary sternal tuberculosis in a 64-year-old woman who was admitted to our clinic with chest pain and a chest wall mass. The patient was treated with sternal resection and chest wall reconstruction.Öğe Resection of Intercostal Hemangioma with Involved Chest Wall and Ribs in an 11-Year-Old Girl(Texas Heart Inst, 2010) Ulku, Refik; Onat, Serdar; Avci, Alper; Ozmen, Cihan AkgulWe report a case of an 11-year-old girl who presented with a slowly enlarging mass in the right posterolateral chest wall. Computed tomography showed a soft-tissue mass 8.5 x 7.5 x 5.5 cm in size, arising from the right posterolateral 9th, 10th, and 11th intercostal spaces. Magnetic resonance imaging confirmed a vascular mass. The patient underwent complete resection of the tumor, together with the right 8th, 9th, 10th, 11th, and 12th ribs and their intercostal muscles. Reconstruction of the chest wall was performed with methyl methacrylate and Mar lex mesh. Histopathologic examination of the tumor confirmed an intercostal cavernous hemangioma. At last examination, 6 months after the operation, the child was doing well, with no evidence of recurrence. (Tex Heart Inst J 2010;37(4):486-9)Öğe Right-sided Bochdalek hernia in an adult: a case report(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2011) Ulku, Refik; Avci, Alper; Onat, Serdar; Ozcelik, CemalCongenital right diaphragmatic hernia of Bochdalek rarely occurs in adults. Most of them are asymptomatic. In this article, we report a case of a 21-year-old male with right-sided Bochdalek diaphragmatic hernia who presented with abdominal pain and dyspnea. The chest radiography showed features suggestive of right-sided diaphragmatic hernia. This was confirmed on a computed tomography. The patient underwent right posterolateral thoracotomy whereby a 10 cm posterolateral diaphragmatic defect with herniation of the colon and kidney through the opening was found. During surgery the colon and right kidney were reduced into peritoneal cavity, and the diaphragmatic defect was repaired with non-absorbable sutures. The patient's recovery was uneventful. He remained well at six-month follow-up.Öğe Risk factors affecting outcome and morbidity in the surgical management of bronchiectasis(Mosby-Elsevier, 2007) Eren, Sevval; Esme, Hidir; Avci, AlperObjective: Bronchiectasis continues to be a major cause of morbidity and mortality in developing countries. The purpose of this study was to present the results of our 14 years of surgical experience to re-evaluate our indications for using surgical therapy and to analyze several factors that might affect the outcome and postoperative complications of this disease. Method: Age, sex, etiologic factors, symptoms, the duration of symptoms, radiologic and radionuclide examinations, preoperative evaluation, surgical procedures, postoperative morbidity and mortality, and the follow-up results from 143 patients operated on for bronchiectasis between January 1992 and January 2006, were reviewed retrospectively. Results: One hundred forty-three patients underwent 148 operations for bronchiectasis. The mean age was 23.4 years. Complete resection was achieved in 118 patients. The morbidity rate was 23.0% and the mortality rate was 1.3%. Postoperatively, 75.9% of the patients were free of symptoms, 15.7% were improved, and 8.2% showed no improvement or were worse. The logistic regression analysis showed that a history of tuberculosis and incomplete resection were independent predictors of the operative result. Moreover, the lack of a preoperative bronchoscopic examination, a forced expiratory volume in 1 second of less than 60% of the predicted value, a history of tuberculosis, and incomplete resection were independent predictors of postoperative complications. Conclusions: A history of tuberculosis and incomplete resection were risk factors both for postoperative complications and for a worse operative result. The lack of a preoperative bronchoscopic examination and a low forced expiratory volume in 1 second were risk factors for postoperative complications. Surgery for multiple segments on different lobes should be performed whenever possible.Öğe Risk factors affecting post-traumatic acute respiratory distress syndrome development in thoracic trauma patients(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2019) Avci, Alper; Sarac, Ezgi Ozyilmaz; Eren, Tahir Sevval; Onat, Serdar; Ulku, Refik; Ozcelik, CemalBackground: This study aims to investigate the risk factors affecting post-traumatic acute respiratory distress syndrome development in thoracic trauma patients. Methods: This two-centered, retrospective study included 3,080 thoracic trauma patients (2,562 males, 518 females; mean age 33.9 +/- 19.4 years; range, 2 months to 91 years) treated between January 2005 and January 2019. Demographic characteristics, mechanisms of injury, traumatic injuries, injury severity score and new injury severity score results, treatments, comorbidities, complications, morbidity and mortality rates, and durations of hospital stay were collected. Data were used to predict the risk factors for development of post-traumatic acute respiratory distress syndrome by univariate and multivariate statistical analysis. Results: Acute respiratory distress syndrome was detected in 81 patients. In multivariate logistic regression analysis; age, pulmonary contusion, intracranial hemorrhage, rib fracture (unilateral and four-five pieces), femur and tibia fracture, diabetes mellitus, chronic obstructive pulmonary disease, blood transfusion (>= 3 units), high white blood cell count at admission, sepsis, and hepatic injury were detected as independent risk factors (p<0.05). Optimal cutoff points (sensitivity/specificity ratios) for acute respiratory distress syndrome development risk were >= 16 (79%/68%) for injury severity score, >= 27 (90%/68.7%) for new injury severity score, and >= 16,000 (75.3%/71.6%) for admission white blood cell count. New injury severity score was superior than injury severity score to predict the development of acute respiratory distress syndrome. Conclusion: Acute respiratory distress syndrome causes significant mortality and morbidity in trauma patients. In addition to the well-known risk factors, diabetes mellitus and chronic obstructive pulmonary disease were independent risk factors. We defined a cutoff value for new injury severity score to predict post-traumatic acute respiratory distress syndrome.Öğe The role of mediastinoscopy in the diagnosis of non-lung cancer diseases(Dove Medical Press Ltd, 2017) Onat, Serdar; Ates, Gungor; Avci, Alper; Yildiz, Tekin; Birak, Ali; Ozmen, Cihan Akgul; Ulku, RefikBackground: Mediastinoscopy is a good method to evaluate mediastinal lesions. We sought to determine the current role of mediastinoscopy in the investigation of non-lung cancer patients with mediastinal lymphadenopathy. Materials and methods: We retrospectively reviewed clinical parameters (age, gender, histological diagnosis, morbidity, mortality) of all patients without lung cancer who consecutively underwent mediastinoscopy in Hospital of Faculty of Medicine of Dicle University between June 2003 and December 2016. Results: Two-hundred twenty nine patients without lung cancer who underwent mediastinoscopy for the pathological evaluation of mediastinum during the study period were included. There were 156 female (68%) and 73 male (32%) patients. Mean age was 52.6 years (range, 16 to 85 years). Mean operative time was 41 minutes (range, 25 to 90 minutes). Mean number of biopsies was 9.3 (range, 5 to 24). Totally, 45 patients (19.6%) had previously undergone a nondiagnostic bronchoscopic biopsy such as transbronchial needle aspiration or endobronchial ultrasound-guided transbronchial needle aspiration. Mediastinoscopy was diagnostic for all patients. Diagnosis included sarcoidosis (n=100), tuberculous lymphadenitis (n=66), anthracosis lymphadenitis (n=44), lymphoma (n=11) metastatic carcinoma (n=5), and Castleman's disease (n=1); there was a diagnosis of silicosis in one patient and tymoma in one patient. Neither operative mortality nor major complication developed. The only minor complication was wound infection which was detected in three patients. Conclusion: Although newer diagnostic modalities are being increasingly used to diagnose mediastinal diseases, mediastinoscopy continues to be a reliable method for the investigation of mediastinal lesions.Öğe Severe Tracheal Compression due to Mediastinal Tuberculous Lymphadenitis(Bilimsel Tip Publishing House, 2009) Eren, Sevval; Avci, Alper; Fuat, Gurkan; Capan, KoncaWe report a case of an 18 months old boy admitted for respiratory distress and wheezing who did not respond to nebulized salbutamol and budesonid. On chest X ray and computed tomographic investigation, a right paratracheal regular mass was seen. During hospitalization the clinical status of the child deteriorated. An enlarged inflammatory lymph node was excised from its location after thoracotomy, and mediastinal tuberculous lymphadenitis was diagnosed histopathologically. It is important to take a chest radiograph in an infant suffering a first wheezing episode in a tuberculous prevalent area.Öğe Thoracic Esophageal Perforation After Blunt Trauma in a Child: A Delayed Diagnosis and Surgical Management(Derman Medical Publ, 2010) Avci, Alper; Eren, Sevval; Ozturk, BulentEsophageal rupture due to external blunt trauma is extremely rare in children. A-13-year old boy was admitted to emergency room with shortness of breath and abdominal pain. His history revealed fall down from 3 metres height, falling of a wooden block over chest, 4 hours before at home. Thoracic esophageal perforation was diagnosed at the 6th day of hospital stay. Surgical management was planned and right-sided thoracotomy was performed at the 7th day after admission. The esophageal layers were closed primarily and separately after muscular and mucosal debridement. Reinforcement of the primary repair was done with pleural and intercostal muscle flaps. The esophagus was tied with absorbable sutures at proximal and distal parts of the perforation to block the esophageal passage. Gastrostomy and jejunostomy were performed for nutrition. We report here a successful management with primary repair of this esophageal perforation of late diagnosis.Öğe Thoracic Wall Necrotizing Fascitis in a Neonate: a Case Report(Derman Medical Publ, 2010) Onat, Serdar; Avci, Alper; Ulku, Refik; Oruc, Menduh; Ozcelik, CemalNecrotizing fasciitis (NF) is a rapidly progressive and potentially life-threatening infection of superficial fascia and subcutaneous tissue. Thoracic wall is one of the rarest locations for NF. Broad-spectrum antibiotics receiving, early surgical debridement, and skin grafting are life saving in NF. We report a 7-day-old female neonate who had left sided thoracic wall NF. She had undergone extensive surgical debridement within 4 hours of hospital admission, and reconstruction of skin defect by split-thickness skin grafting later. Early diagnosis is important, as prompt surgical debridement offers the best chance for survival. Early and extensive surgical debridement is a widely accepted clinical approach and the mainstay of effective treatment. The goals of surgical intervention are to remove all necrotic tissues, and to help control the progression of NF. Reconstruction of skin defects should be performed by early split-thickness skin grafting like our patient or primary closure. Because early wound resurfacing prevents fluid, electrolyte, and protein loss from the wound site, and decreases secondary infection. Although chest wall NF is rare in neonates, it is a rapidly spreading, highly lethal infection. A high index of suspicion, early diagnosis, and aggressive approach are essential to its successful treatment.Öğe Urgent thoracotomy for penetrating chest trauma: Analysis of 158 patients of a single center(Elsevier Sci Ltd, 2011) Onat, Serdar; Ulku, Refik; Avci, Alper; Ates, Gungor; Ozcelik, CemalBackground: Penetrating injuries to the chest present a frequent and challenging problem, but the majority of these injuries can be managed non-\operatively. The aim of this study was to describe the incidence of penetrating chest trauma and the ultimate techniques used for operative management, as well as the diagnosis, complications, morbidity and mortality. Methods: A retrospective 9-year review of patients who underwent an operative procedure following penetrating chest trauma was performed. The mechanism of injury, gender, age, physiological and outcome parameters, including injury severity score (ISS), chest abbreviated injury scale (AIS) score, lung injury scale score, concomitant injuries, time from admission to operating room, transfusion requirement, indications for thoracotomy, intra-operative findings, operative procedures, length of hospital stay (LOS) and rate of mortality were recorded. Results: A total of 1123 patients who were admitted with penetrating thoracic trauma were investigated. Of these, 158 patients (93 stabbings, 65 gunshots) underwent a thoracotomy within 24 h after the penetrating trauma. There were 146 (92.4%) male and 12 (7.6%) female patients, and their mean age was 25.72 +/- 9.33 (range, 15-54) years. The mean LOS was 10.65 +/- 8.30 (range, 5-65) days. Patients admitted after a gunshot had a significantly longer LOS than those admitted with a stab wound (gunshot, 13.53 +/- 9.92 days; stab wound, 8.76 +/- 6.42 days, p < 0.001). Patients who died had a significantly lower systolic blood pressure (SBP) on presentation in the emergency room (42.94 +/- 36.702 mm Hg) compared with those who survived (83.96 +/- 27.842 mm Hg, p = 0.001). The overall mortality rate was 10.8% (n = 17). Mortality for patients with stab wounds was 8/93 (8.6%) compared with 9/65 (13.8%) for patients with gunshot wounds (p = 0.29). Concomitant abdominal injuries (p = 0.01), diaphragmatic injury (p = 0.01), ISS (p = 0.001), chest AIS score (p < 0.05), ongoing output (p = 0.001), blood transfusion volume (p < 0.01) and SBP (p = 0.001) were associated with mortality. Conclusion: Penetrating injuries to the chest requiring a thoracotomy are uncommon, and lung-sparing techniques have become the most frequently used procedures for lung injuries. The presence of associated abdominal injuries increased the mortality five-fold. Factors that affected mortality were ISS, chest AIS score, SBP, ongoing chest output, blood transfusion volume, diaphragmatic injury and associated abdominal injury. (C) 2010 Elsevier Ltd. All rights reserved.Öğe Vascular Tumors of the Sternum Reply(Elsevier Science Inc, 2009) Onat, Serdar; Ulku, Refik; Avci, Alper; Ozcelik, Cemal; Mizrak, Bulent[Abstract Not Available]
