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Öğe Benign intrapulmonary teratoma: Report of a case(Mosby, Inc, 2003) Eren, MN; Balci, AE; Eren, S[Abstract Not Available]Öğe Blunt thoracic trauma in children(Elsevier Science Bv, 2004) Balci, AE; Kazez, A; Eren, S; Ayan, E; Özalp, K; Eren, MNObjective: Thoracic injuries are uncommon in children and few report present on blunt ones. Methods: Between 1994 and 2003, 137 children with blunt thoracic injury were reviewed. Results: The mean age of children was 6.9 +/- 7.3 (1-16) years. Etiology was falls in 46.7%, traffical accidents in 51% and abuse in 2.2%. Average height in fallen-down cases was 6.4 +/- 2 (range: 3-11) m. Calculated mean kinetic energy transfer to body was 1923 +/- 1056 J. When first seen, 70% (82/117) of the patients had vital signs that were within normal limits. Forty-two (35.9%) children had isolated thoracic injury. Associated injuries were present in 75 (64.1%) children. Head injury was the most common associated injury present in 33 (28.2%). Pulmonary contusion was the most common thoracic injury with 68 (49.6%). Seventeen (12.4%) required surgery, 11 (8%) of them were thoracic (4 for diaphragmatic tear, 2 for flail chest, 2 for tracheobronchial injuries, 2 for laceration, 1 for esophageal rupture). Surgical group had higher ISS (26.8 vs 36.2, P = 0.001). Fifteen were lost (10.9%): There were lethal injuries in 7; chest tube treatment in 3; intensive care unit management in 2; mechanical support in 2 and observation in 1 patient. No death occurred for operations. Mortality rate was the lowest at injuries to chest alone and the highest for multi-system injuries (P < 0.05). The hospital length of stay for averaged 13.4 +/- 8.8 (range: 4-49) days. Conclusion: Associated injury is the most important mortality factor. Thoracic operations can be performed with minimal morbidity and without mortality in children with blunt thoracic trauma. (C) 2004 Elsevier B.V. All rights reserved.Öğe Comparison of the effectiveness of some pleural sclerosing agents used for control of effusions in malignant pleural mesothelioma(Karger, 2000) Senyigit, A; Bayram, H; Babayigit, C; Topçu, F; Balci, AE; Satici, ÖBackground and Objectives: Management of malignant pleural mesothelioma (MPM) has been an important clinical issue regardless of the treatment modality employed. We aimed to investigate the efficacy of oxytetracycline (OT), Corynebacterium parvum (CP), and nitrogen mustard (NM) in the management of pleural effusion associated with MPM. Methods: One hundred and seventeen patients who had stage-2 MPM or over according to the Butchart staging system and unilateral or bilateral pleural effusion took part in the study. The patients received either OT (35 mg/kg), CP (7 mg), or NM (0.4 mg/ kg) through a chest tube for pleurodesis. The association between several clinical parameters and patient survival was also investigated. Results: OT was applied to 59, CP to 29 and NM to 29 cases. A statistical analysis of the results obtained by these agents have demonstrated that OT (30 days, 81%; 90 days, 76.2%) and CP (30 days, 86.2%; 90 days, 79.3%) led to a significantly higher rate of successful pleurodesis as compared to NM (30 days, 48.2%; 90 days, 41.3%; p <0.05). Although the procedure was generally well tolerated by the patients, the NM-treated group experienced significantly more nausea-vomiting (46.1%) and hypotension (35.8%) compared to patients who received OT (nausea-vomiting and hypotension 4.3%; p < 0.001) and CP (nausea-vomiting and hypotension 5.1%; p < 0.001). Furthermore, we found that thrombocytosis, chest pain and weight loss were significantly associated with poor prognosis, whereas epithelial type had a positive effect on survival. Conclusion: These results suggest that OT and CP may be used as effective sclerosing agents for pleurodesis in the control of pleural effusions associated with MPM, without major side effects. Copyright (C) 2000 S. Karger AG, Basel.Öğe The effect of aprotinin on ischemia-reperfusion injury in an in situ normothermic ischemic lung model(Elsevier Science Bv, 2003) Eren, S; Esme, H; Balci, AE; Cakir, O; Buyukbayram, H; Eren, MN; Erdinc, LObjectives: In the context of the physiopathology of damage due to ischemic preservation and reperfusion injury following preservation, we aimed to demonstrate the positive effects of the addition of aprotinin, a serine protease inhibitor, to low potassium dextran (LPD), used as a single-flush solution in normothermic ischemic animal models, on lung protection and the prevention of reperfusion injury. Methods: In the study, 21 New Zealand white rabbits were used as experimental subjects. The subjects were ventilated with the assistance of a manual mechanical ventilator at 30 breaths/min and 10 ml/kg tidal volume. Lung protection solution was supplied to the pulmonary artery via a catheter. After applying the solution, ischemia was carried out for 120 min. At the end of this period, reperfusion was carried out for 90 min. The subjects were divided into three groups of seven subjects each. In the control group, pulmonary perfusion solution was not employed, whereas in the second group LPD was employed, and in the third group LPD and aprotinin (LPD + A) were perfused. Blood gas analysis, bronchoalveolar lavage (BAL) fluid examination, tissue malondialdehyde (MDA) level analysis and morphological examinations were performed. Results: The LPD + A group showed the significantly highest levels of oxygenation at the 15th and 60th minutes of reperfusion (297 +/- 76.7 and 327 +/- 97.4 mmHg) in comparison to the LPD (157 +/- 20.6 and 170 +/- 53.6 mmHg) and control (64 +/- 8.4 and 59 +/- 7.2 mmHg) groups (P < 0.001). The LPD + A group showed the significantly lowest levels of alveolar-arterial oxygen difference at the 60th minute of reperfusion (389 +/- 15 mmHg) in comparison to the LPD (478 +/- 19 mmHg) and control (542 + 23) groups (P < 0.001). The BAL fluid neutrophil percentage was significantly lower in the LPD + A group (22 +/- 2.4%) compared to the LPD (31 +/- 6.1%) and control (38 2.4%) groups. MDA levels were significantly lower in the LPD + A group (119.8 +/- 5.3 nmol MDA/g) when compared to the LPD (145.06 +/- 9.5 nmol MDA/g) and control (147.3 +/- 3.9 nmol MDA/g) groups (P < 0.05). Morphological examinations revealed pathological lesions and alveolar hemorrhaging in all samples, with the LPD + A group having statistically more significant levels than the LPD and control groups (P < 0.005). The LPD + A group had a significantly lower percentage of pathological lesions and alveolar hemorrhage grade values than the LPD and control groups (P < 0.005). Conclusions: It was observed that the addition of aprotinin to LPD solution as a pulmonary flush solution in an in situ normothermic ischemic lung model prevents reperfusion injury by means of various mechanisms and also protects the morphological, functional and biochemical integrity of the lung. In our view, therefore, the addition of aprotinin to lung protection solution will provide positive results in lung transplantation protocols. (C) 2002 Elsevier Science B.V. All rights reserved.Öğe Foreign body aspiration in children: experience of 1160 cases(Maney Publishing, 2003) Eren, S; Balci, AE; Dikici, Bünyamin; Doblan, M; Eren, MNHospital records of 1160 children less than or equal to 15 years old referred for suspected foreign body aspiration were reviewed. Bronchoscopy under general anaesthesia was performed on all patients. Foreign bodies were successfully removed in 1068 (92%) children. The majority, 885 (76.3%), presented with a definite history of foreign body aspiration. Bronchoscopy was negative in 85 (7.3%) children. Watermelon seeds, found in 414 (38.7%) children, were the most commonly aspirated foreign bodies. Open surgical procedures were required for 21 (1.8%) children. Bronchial rupture related to bronchoscopy occurred in four children, two of whom died post-operatively. The overall mortality rate was 0.8%.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 Pleural tenting in complicated primary spontaneous pneumothorax(Edizioni Minerva Medica, 2004) Eren, N; Balci, AE; Eren, SAim To assess the efficacy of pleural tenting in patients with complicated primary spontaneous pneumothorax (PSP) Methods. From 1988 through 2001, 43 patients underwent operations. Mean age was 30.4 years; the male/female ratio was 9.7. Twenty-one (48.8%) underwent pleural tenting in addition to bulla excision (experimental group, EG). Twenty-two (51.2%) underwent bulla excision plus pleural abrasion (11 patients), apical. partial pleurectomy (9 patients) and complete apical pleurectomy (2 patients) (control group, CG). The most frequent symptom was chest pain (37.2%). Surgical indications were recurrence in 21 (48.8%), prolonged air leak in 12 (27.9%), failure of expansion without air leak in 6 (13.9%), high risk occupancy in 2 (4.6%) and empyema due to air leak in 2 (4.6%). Results. Air leak time was decreased by tenting (1.9 days vs 3.7 days) as well as time of drainage (4.8 vs 6.9) and hospital stay (5.8 vs 7.9). Morbidity was 9.5% in EG and 9.1% in CG. Causes of morbidity were postoperative hematoma, prolonged air leak, expansion failure and blunt posterior sinus one of each. Re-operation needed for postoperative hematoma in CG. Mean follow-up was 5.1 years and 1 (4.5%) recurrence observed in CG. Conclusion. Tenting of the dependent lung from the apical pleura after bullectomy via axillary thoracotomy lessens air leak time without recurrence and low morbidity.Öğe Pneumonectomy in children for destroyed lung and the long-term consequences(Mosby, Inc, 2003) Eren, S; Eren, MN; Balci, AEObjectives: Destroyed lung introduces irreversible changes in lung parenchyma. This condition is uncommon in children. Operative intervention is essential for children in this state. We demonstrate our experience with this condition and report on the respective long-term results. Method: Seventeen children who underwent pneumonectomy for destroyed lung during a 15-year period Were retrospectively analyzed. Long-term results were detected in 13 patients. Results: Seventeen children underwent pneumonectomy. Five children were female (29.4%), and 12 children were male (70.5%). The median age of the study group children was 9.1 years (3-16 years). Sputum was the most common presenting symptom (n = 13, 76.4%). Bronchiectasis (n = 11), tuberculosis (n = 4), and necrotizing lung disease (n = 2) were the main underlying conditions. Destroyed lung was detected on the left side in 14 children (82.4%) and on the right side in 3 children (17.6%). Main bronchial stenosis was found in 4 children and mucosal thickening or congestion in 5 children. The median length of hospital stay was 15.5 days. The mortality rate was 11.7% (n = 2), and the morbidity rate was 23.5% (n = 4). Follow-up information was available for 13 patients, and this ranged from 1 year to 12 years (median 5.2 years). The respiratory capacity and scoliosis level of the patients were examined. Conclusions: Although pneumonectomy is considered a difficult procedure in children, its use for destroyed lung resolves complications and improves a patient's quality of life. In time, the remaining lung expands to compensate for the loss of the removed lung. Children grew and developed normally after pneumonectomy. Patients tend not to have major skeletal deformation as the result of pneumonectomy in the short term.Öğe Purulent pericarditis in childhood(W B Saunders Co, 2002) Cakir, Ö; Gurkan, F; Balci, AE; Eren, N; Dikici, BünyaminBackground/Purpose: Purulent pericarditis is a rapidly fatal disease if left untreated. This article describes our experience with diagnosis and management of 18 patients seen over a 10-year period. Methods: Eighteen children with purulent pericarditis were treated in our clinics between 1990 and 2000. Ten patients were boys and 8 were girls, and the mean age of all patients was 4 years (range, 8 months to 12 years). Results: Most common findings were fever and cardiac tamponade. Staphylococcus aureus was the most common causative agent, and the most common predisposing factor was respiratory tract infection. Chest radiography and echocardiography were the most important methods for diagnosis, and pericardiosynthesis was diagnostic in purulent pericarditis. The treatment methods performed in our patients were subxiphoidal pericardial tube (10 patients), pericardiectomy after subxiphoidal pericardial tube (2 patients), pericardiectomy (3 patients), and pericardiocentesis-intrapericardial thrombolytic treatment (3 patients). Only one patient (5.5%) died who was critically ill at the time of admission. Conclusions: Subxiphoidal tube drainage and pericardiectomy were performed with good results in these cases. Intrapericardial streptokinase and pericardial aspiration method also was thought to be beneficial. Copyright 2002, Elsevier Science (USA). All rights reserved.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 Spontaneous pneumothorax in children in the South-east of Turkey(Wiley, 2004) Eren, S; Gurkan, F; Balci, AE; Ulku, R; Onat, S; Eren, MNBackground: The purpose of the present study was to investigate the etiological factors, symptomatology, management and outcome of spontaneous pneumothorax in children aged <15 years. Methods: The authors' reviewed the records of 44 children with spontaneous pneumothorax between January 1990 and February 2002. Results: The median age was 4.6 years (range 2 months-14 years), and 51% were male. Breathlessness and coughing were the most common symptoms. All pneumothoraces were initially managed by closed tube drainage. Thirty-seven (84%) of the children responded well and were cured of pneumothorax with closed tube thoracostomy alone. Seven children (16%) underwent thoracotomy. The median hospital stay was 12.9 days. There were two deaths from respiratory failure. Six- to 96-month follow-up information was available for 32 patients, and only one recurrence was found. Conclusions: Lung infections were the most frequently observed underlying pathology in the patients studied. Closed tube thoracostomy alone was sufficient for the majority of patients.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 thoracic outlet syndrome(Elsevier Science Inc, 2003) Balci, AE; Balci, TA; Çakur, Ö; Eren, S; Eren, MNBackground. Because of the difficulty in diagnosis and different treatment options, debate on thoracic outlet syndrome (TOS) has continued. Our aim is to report our surgical experience. Methods. Forty-seven patients with thoracic outlet syndrome were operated on between 1985 and 2000. Mean age was 37.9 years (range, 17 to 58 years); female/male ratio was 41/6. The most frequent symptom was paresthesia (72.3%). Seventeen patients (36%) had bilateral symptoms. Of all, 89.3% (42 cases) were neurologic thoracic outlet syndrome, and 10.7% (five cases) were vascular. Lower plexus (C8-T1/ulnar nerve) compression was present in 36 patients and upper plexus (C5-C7/median nerve) compression in 6 patients. Doppler ultrasonography in 11 patients, angiography in 8, and lymph node scintigraphy in 1 patient were also performed. Main operative indications were persistence of symptoms after conservative therapy and reduced (< 60 m/s) ulnar nerve conduction velocity. Results. Fifty-five operations were performed on the 47 patients. First (59.6%) and cervical costae (21.3%) resections were the most frequent operations. Mean ulnar nerve conduction velocity was 54.8 m/s (range, 43 to 68 m/s) preoperatively and 69.4 m/s (range, 47 to 70 m/s) postoperatively (p < 0.05). The morbidity rate was 17% (8 of 47). No difference was observed between transaxillary and supraclavicular incisions. No brachial plexus injuries occurred. The most frequent cause of morbidity was incisional pain. Two reoperations were performed for recurrences. Follow-up was 4.6 years, and 75% of lower plexus and 50% of upper plexus compressions remained asymptomatic. Severe and long-term pain occurred in 1 patient. Conclusions. Surgical decompression for thoracic outlet syndrome is efficient and dependable, but results deteriorate over time. (C) 2003 by The Society of Thoracic Surgeons.Öğe Thoracic firearm injuries in children: management and analysis of prognostic factors(Oxford Univ Press Inc, 2003) Eren, S; Balci, AE; Ulku, R; Cakir, O; Eren, MNObjective: Thoracic firearm injuries (TFI) have become increasingly prevalent in children. Our purpose is to assess the injury pattern, Injury Severity Score (ISS), length of hospital stay (LOS), management and outcome of children with TFI with respect to the type of injury and to evaluate the value of ISS for predicting injury severity and the eventual need for thoracotomy, as well as the rate of morbidity and mortality. Methods: Between January 1987 and June 2002, 110 children (88 boys and 22 girls) less than or equal to 16 years of age with firearm injuries to the chest were evaluated. The children were divided in four groups according to cause of injury. An ISS was calculated for each child. Those children who died before admission were excluded from the study. The relationship between ISS and prognostic factors was analyzed in all four groups. Results: The mean age was 11.1 +/- 3.0 (range 3 - 16) years. Eighty-eight (80%) were male and 22 (20%) were female. The causes of firearm injuries were high-velocity gunshot wounds (HVGSW) in 52 (47.2%), low-velocity gunshot wounds (LVGSW) in 23 (20.9%), shotgun wounds (SGW) in 18 (16.3%), and explosives wounds (EW) in 17 (15.4%). Lung injury Occurred in 72 (65.5%) patients. Tube thoracostomy was sufficient in 76.3% (84 of 110) for thoracic injury. The morbidity rate was 16.3% (18/110) and the mortality rate was 4.5% (5/110). Mean ISS was 16.62 +/- 8.2 (range 4-48). Fifty-eight patients (52.7%) had an ISS : 16, while 31 (28.2%) had a score between 17 and 25, and 21 (19.1%) had a score greater than 25. The need for thoracotomy, as well as the rate of morbidity and mortality were significantly higher in children for those with an ISS >25. SGW and EW groups had a significantly higher ISS. The mean LOS was 10.84 +/- 4.7 days (range 4-42). The value of LOS was significantly higher in children with SGW and EW. Conclusion: The majority of TFI in children can be treated successfully by tube thoracostomy if there are no gross pulmonary lacerations and airway injuries. SGW and EW were commonly associated with higher ISS and LOS. The ISS was found to be an independent predictor of the need for thoracotomy, as well as for rates of morbidity and mortality. (C) 2003 Elsevier Science B.V. All rights reserved.Öğe Traumatic oesophageal perforation(Scandinavian University Press, 1997) Inci, I; Ozcelik, C; Nizam, O; Balci, AE; Eren, N; Ozgen, GSixteen patients were treated for traumatic oesophageal perforation (13 cervical, 3 thoracic) over a 16-year period. In 14 cases the trauma was penetrating. The median delay from injury to treatment was 32 hours and the mean period of hospitalization was 26 days. The treatment procedures were two-layer primary closure with or without drainage, drainage alone and near-total oesophageal exclusion with cervical T-tube oesophagostomy. Postoperative complications were cervical oesophageal leak in two patients and tracheo-oesophageal fistula and oesophageal stenosis, each in one case. Of the eight patients treated within 24 hours of perforation, two died, and of the eight treated later, four died (overall mortality 37.5%). The heightened mortality after delayed diagnosis illustrates the prognostic importance of a high index of suspicion. To prevent leakage, buttressing with viable tissue following primary closure can be useful, especially after delayed diagnosis. Because of the continuing controversy concerning management of late-diagnosed oesophageal perforation, individualized treatment is widely advocated.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.
