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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 Cardiac hydatic cyst causing cerebral emboli in a child(Springer, 2002) Cakir, O; Eren, N; Kilinc, NCardiac hydatic cyst is rarely encountered. In this article, a case of hydatid cyst localized in the left ventricle causing cerebral emboli is reported.Öğe Does sodium nitroprusside reduce lung injury under cardiopulmonary bypass?(Elsevier Science Bv, 2003) Cakir, O; Oruc, A; Eren, S; Buyukbayram, H; Erdinc, L; Eren, NObjective: We hypothesized that direct pulmonary arterial infusion of sodium nitroprusside (SNP) would ameliorate lung injury under cardiopulmonary bypass. Methods: Experiments were performed on 12 adult mongrel dogs of both sexes weighing 20-28 kg. The animals were randomly divided into two groups of six animals each. All animals were subjected to total cardiopulmonary bypass (CPB) and moderate hypothermia (28degreesC core temperature). During total CPB, the aorta was clamped together with the pulmonary artery to prevent any antegrade flow to the lungs. After cardioplegic arrest for 120 min, the animals were rewarmed, weaned from CPB, and their condition stabilized for another 90 min. After the release of the aortic cross-clamp, the dogs received either a 5% glucose solution as a placebo (group I) or SNP (0.5 mug/kg per min) (group II), both infused into the pulmonary arterial line. The infusion was stopped after 60 min. To measure lung tissue malondialdehyde (MDA), water content and polymorphonuclear leukocytes count, lung tissue samples were taken before CPB and after weaning from CPB. In addition, alveolar-arterial oxygen difference (AaDO(2)) for tissue oxygenation was calculated by obtaining arterial blood gas samples. Results: Values of MDA before CPB of 42.0 +/- 5.3 nmol/g of tissue rose to 67.6 +/- 5.7 nmol/g of tissue after weaning from CPB in group I (P = 0.028). In group II MDA values also increased from 43.1 +/- 4.3 to 52.4 +/- 5.7 nmol MDA/g of tissue after weaning from CPB (P = 0.046). The MDA increase in group II after CPB was found to be significantly lower than that for group I (P = 0.004). The wet-to-dry lung weight ratio in the sodium nitroprusside group was 5.1 +/- 0.2, significantly lower than in the control group (6.8 +/- 0.4), (P = 0.01). AaDO(2) increased significantly in group I (P = 0.028). There was no statistically significant difference (P = 0.065) between groups I and II. During histopathological examination it was observed that neutrophil counts in the lung parenchyma rose significantly after CPB in both groups. The increase in group I was significantly larger than that in group II (P < 0.001). Conclusions: The results represented in our study indicate that pulmonary arterial infusion of sodium nitroprusside during reperfusion can reduce lung injury under cardiopulmonary bypass. (C) 2003 Elsevier Science B.V. All rights reserved.Öğe Effects of N-acetylcysteine on pulmonary function in patients undergoing coronary artery bypass surgery with cardiopulmonary bypass(Sage Publications Ltd, 2003) Eren, N; Çakir, Ö; Oruc, A; Kaya, Z; Erdinc, LCardiopulmonary bypass (CPB) has been implicated in causing poor pulmonary gas exchange postoperatively in patients undergoing coronary artery bypass grafting (CABG) procedures. In this prospective, randomized, double-blind, placebo-controlled study, we examined the pulmonary effects of N-acetylcysteine (NAC) in patients undergoing CABG. Twenty patients undergoing elective CABG and early tracheal extubation were randomized into two groups. Group I (ten patients) received a physiologic salt solution as a placebo in a continuous intravenous infusion for one hour before CPB and 24 hours after CPB; Group II (ten patients) received 100 mg/ kg NAC intravenously for one hour before CPB and 40 mg/kg/day at 24 hours after CPB. Perioperative hemodynamic and pulmonary data were recorded. Postoperative tracheal extubation was accomplished at the earliest appropriate time. The postoperative clinical course was similar in the two groups. Both groups exhibited significant postoperative increases in A-a oxygen gradient (p < 0.01), but patients in Group II exhibited significantly lower increases in postoperative A-a oxygen gradient (p < 0.006). Other hemodynamic and pulmonary data (pulmonary capillary wedge pressure, pulmonary vascular resistance (PVR), cardiac index (CI), shunt flow, dynamic lung compliance and static lung compliance) exhibited no differences between the groups. There was no significant difference in terms of intubation time. The malondialdehyde (MDA) increase in Group II following CPB was found to be significantly lower than in Group I (p = 0.043). This clinical study reveals that administration of NAC to patients undergoing elective CABG with CPB improves systemic oxygenation. There was no effect in other pulmonary parameters and in terms of intubation time.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 Free-floating ball thrombus in the left atrium(Springer, 2002) Cakir, O; Eren, N; Oruç, A; Buyukbayram, HFree-floating ball thrombi in the left atrium are rarely seen. They can cause sudden death by occluding the mitral valve. A 47-year-old female patient who showed signs of mitral stenosis during it physical examination and atrial fibrillation by electrocardiography was not administered anticoagulant therapy. On the transthoracic echocardiogram, a stenotic mitral valve and a floating mobile mass were seen inside the large left atrium. This mass was rounded (ball-like), had smooth contours, and occasionally occluded the stenotic mitral valve. The patient underwent emergency surgery to remove the mass, which was later proven to be a thrombus pathologically. Additionally, mitral valve replacement was performed. The importance of anticoagulant therapy for patients with rheumatic mitral stenosis has been emphasized by this case.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 N-acetylcysteine reduces lung reperfusion injury after deep hypothermia and total circulatory arrest(Wiley, 2004) Çakir, Ö; Oruc, A; Kaya, S; Eren, N; Yildiz, F; Erdinc, LObjective: We hypothesized that the use of N-acetylcysteine would ameliorate the lung reper-fusion injury observed after deep hypothermia and total circulatory arrest (DHTSA). Methods: Experiments were carried out on 12 adult mongrel dogs of either sex weighing 25 to 30 kg. The animals were randomly divided into two groups of six animals each. All animals were cooled to an esophageal temperature of 15 degreesC during 30 minutes and underwent 60 minutes of DHTSA, followed by the reinstitution of cardiopulmonary bypass (CPB) and rewarming. Before rewarming, while 100 mL physiologic saline solution was added into the pump in group 1, 50 mg/kg N-acetylcysteine(NAC) was given in group II. Heart rate, mean arterial pressure, pulmonar arterial pressure, left atrial pressure, central venous pressure, and cardiac output were recorded. To measure lung tissue malondialdehyde (MDA), water content and polymorphonuclear leukocytes (PMNs) count, lung tissue samples were taken before CPB and after weaning CPB. In addition, alveolar-arterial oxygen difference (AaDO(2))for tissue oxygenation was calculated by obtaining arterial blood gas samples. Dynamic lung compliance (DLC) was measured before CPB and after CPB. Results: MDA levels before CPB of 44.2 +/- 3.9 nmol/g tissue rose to 76.6 +/- 5.6 nmol/g tissue after weaning CPB in group I (p = 0.004). In group II also, the MDA levels increased from 43.5 +/- 4.2 to 57.4 +/- 5.6 nmol MDA/g tissue after weaning CPB (p = 0.006). The MDA increase in group 11 after CPB was found to be significantly lower than in group I (p = 0.006). The wet-to-dry lung weight ratio in the NAC group was 5.1 +/- 0.2, significantly less than in the control group (5.9 +/- 0.3), (p = 0.004). AaDO(2) significantly increased in the group I and II (p = 0.002 and p = 0.002, respectively); this elevation in group I was significant than in group II (p = 0.044). In histopathological examination, it was observed that neutrophil counts in the lung parenchyma rose significantly after CPB in both groups (p < 0.001). The increase in group I was significantly larger than group II (p < 0.001). Conclusions: Results represented in our study indicate that addition of NAC into the pump after DHTSA can reduce lung reperfusion injury.Öğe Neuroprotective effect of N-acetylcysteine and hypothermia on the spinal cord ischemia-reperfusion injury(Elsevier Sci Ltd, 2003) Cakir, O; Erdem, K; Oruc, A; Kilinc, N; Eren, NThe purpose of this study was to investigate the effect of N-acetylcysteine (NAC) on spinal cord ischemia-reperfusion (I-R) in rabbits. Thirty rabbits were divided into five equal groups, group I (sham-operated, no I-R), group II (control, only I-R), group III (I-R + NAC), group IV (I-R + hypothermia), group V (I-R + NAC + hypothermia). Spinal cord ischemia was induced by clamping the aorta both below the left renal artery and above the aortic bifurcation. Forty-eight hours postoperatively, the motor function of the lower limbs was evaluated in each animal according to Tarlov Score. Spinal cord samples were taken to evaluate the histopathological changes. The sham-operated rabbits (group I) showed no neurologic deficit (Score = 4). Paraplegia (Score = 0) developed in all rabbits in the control group (group II). Administration of 50 mg/kg of NAC (group III) resulted in significant reduction of motor dysfunction (Score = 3.1 +/- 1.3, p = 0.002). Application of hypothermia alone (group IV) showed significant recovery of motor functions (Score = 3.0 +/- 1.1, p = 0.002), and combination of hypothermia and 50 mg/kg of NAC (group V) showed complete recovery of lower limb motor function (Score = 4, p = 0.001). Histologic examination of the spinal cord in rabbits with paraplegia revealed several injured neurons. The cords of animals with no motor function deficits showed only minimal cellular infiltrates in the gray matter, and there was good preservation of nerve cells. NAC showed protective effects of the spinal cord. Moderate hypothermia alone also showed protective effects. Combined use of NAC and hypothermia resulted in highly significant recovery of spinal cord function. (C) 2003 The International Society for Cardiovascular Surgery. Published by Elsevier Ltd. All rights reserved.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 Penetrating chest injuries in children: A review of 94 cases(W B Saunders Co, 1996) Inci, I; Ozcelik, C; Nizam, O; Eren, N; Ozgen, GNinety-four children with penetrating chest injuries were treated at Dicle University School of Medicine during a 6-year period. The mean age was 11.51 +/- 3.31 years, and the male:female ratio was 5.25:1. Forty-five had stab wounds, 27 had high-velocity gunshot wounds, 13 had low-velocity gunshot wounds, seven had a bomb (shrapnel) injury, one had a shotgun wound, and one had a horse bite. Sixty patients had isolated thoracic injuries, and 34 had associated injuries, The most common thoracic injury was hemothorax (28), followed by hemopneumothorax (25). Tube thoracostomy alone was sufficient in 79.8% of the patients (75 of 94). Thoracotomy was performed in 4.25% (4 of 94). In two of the five observed patients, delayed hemothorax developed, The mean duration of hospitalization was 5.13 +/- 1.93 days. The mean Injury Severity Score was 14.71 +/- 8.62. Prophylactic antibiotics were used in all patients. The morbidity rate was 8.51% (8 of 94). Only one death occurred after cervical tracheal repair. The study suggests that the majority of penetrating chest injuries in children can be treated successfully by tube thoracostomy alone or in conjunction with expectant observation. (C) 1996 by W.B. Saunders CompanyÖğe 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 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 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 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 Thoracic outlet vascular injuries(Westminster Publ Inc, 1998) Ozcelik, C; Inci, I; Nizam, O; Eren, N; Ozgen, GManagement of vascular injuries at the thoracic outlet and neck continues to be a major problem to the trauma surgeon. Of 47 patients treated over an eighteen-year period, 45 were due to penetrating injuries (41 gunshot [87.2%], 4 stab wounds [8.5%]). In 16 patients shock was present at the time of admission. Five patients were operated on in comatose condition. In 37 patients immediate, and in 10 cases delayed, operation was performed. In 13 patients with arterial injuries, end-to-end anastomosis; in 24, saphenous vein graft; in 6, synthetic graft; in 2, lateral suture; and in 2, ligation were performed. Three subclavian arterial injuries repaired by saphenous vein graft occluded owing to thrombosis, requiring synthetic graft replacement. In 3 axillary arterial injuries, ligation was performed following the operation because of infection. One of these patients underwent amputation. Only 3 of 14 brachial plexus injuries (BPI) were primarily repaired. In only 1 of 3 repaired patients did complete function return. Overall mortality was 5 including 3 comatose patients with carotid injuries and 2 with axillary arterial injuries. In conclusion: (1) Subclavian and axillary artrial injuries may be overlooked by physical examination in the absence of critical ischemia. (2) We recommend ligation instead of revascularization in comatose carotid injury cases. (3) Synthetic grafts may be used, in cases of size discordance or in unstable patients, to end the operation as soon as possible. (4) In associated venous injuries, repair should be preferred to ligation. (5) In the presence of BPI due to gunshot wounds the results are not good in spite of nerve repair, and serious sequelae may remain.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 Treatment of vascular injuries associated with limb fractures(Royal Coll Surgeons England, 2005) Cakir, O; Subasi, M; Erdem, K; Eren, NINTRODUCTION The goal of therapy in all patients with combined orthopaedic and vascular injuries of the extremities is salvage of a functional limb. In this study, we have evaluated our experience with a subset of patients who had a combination of vascular injury and limb fracture. PATIENTS AND METHODS The records of 192 patients with vascular injuries of the lower and upper limbs associated with bone fractures were reviewed. Of these, 168 were males and 24 were females; the mean age was 26 years. RESULTS The mechanism of injury was a penetrating wound in 97 (51%) patients and blunt trauma in 95 (49%) patients. Injured vessels included 6 subclavian/axillary, 39 brachial, 14 radial/ulnar, 11 radial, 8 ulnar, 36 femoral, 43 popliteal, 35 tibial arteries. Saphenous vein graft was the most common conduit of choice in arterial repair (55%). Amputations were needed for 20 patients. The limb salvage rate was 88%. Three patients died. CONCLUSIONS This study established that delay in surgery, blunt trauma and extensive soft tissue defect in combined orthopaedic and vascular injuries are associated with increased risk of amputation.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.
