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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 Cold abscess of tuberculosis on Thoracic wall: three case report(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2014) Meteroglu, Fatih; Arikanoglu, Zulfu; Eren, SevvalNearly 15 to 20% of tuberculosis cases are extrapulmonary and can be rarely seen as isolated in the thoracic wall. Three consecutive patients who were admitted to our clinic with complaint of painful swelling on chest were examined with a preliminary diagnosis of a mass on the thoracic wall. The common complaint of the patients, including two women and one man of 60, 35 and 30 years of age, respectively, was a palpable mass. A soft mass in the right eight rib on physical examination was palpable in our second case. In the other two cases, the masses which were fluctuating and presented with soft characteristics in their natures (on manibrium sterni in the first case and in the third left rib in the third case) were evaluated with a preliminary diagnosis of a tumor by using computed tomography. The lesions were completely removed by excisional biopsy in all cases. Histopathological examination was reported as the tissue showing caseose necrosis. Acid resistant bacteria studies were negative. Anti-tuberculosis therapy with four-drug combination was started for the cases. An isolated tuberculosis-related cold abscess in three cases, which is a rarely seen in the thoracic wall, was discussed in regard to clinical characteristics, diagnostic and treatment methods.Öğe Comparison of preoperative and postoperative arterial blood gas analysis, respiratory function test and lung perfusion scintigraphy of adult patients undergoing lung decortication surgery(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2012) Oruc, Menduh; Cakmak, Muharrem; Eren, SevvalBackground: In this study, we aimed to determine the effect of lung decortication surgery on the postoperative respiratory function, comparing pre- and postoperative findings of arterial blood gas analysis, respiratory function test and lung perfusion scintigraphy of the adult patients. Methods: Between January 2000 and November 2008, the clinical data of 37 patients over 15 years of age (25 males, 12 females; mean age 37.3 years; range 15 to 73 years) were retrospectively analyzed, who underwent lung decortication surgery due to chronic empyema in Thoracic Surgery Department of the Faculty of Medicine of Dicle University, Diyarbakir. Pre- and postoperative findings of arterial blood gas analysis, respiratory function test and lung perfusion scintigraphy were analyzed statistically. Results: Sixteen (43.24%) of the patients underwent right thoracotomy, while 21 (56.75%) underwent left thoracotomy. Histopathologic examination revealed chronic fibrinous pleuritis in 28 patients (75.6%) and tuberculous pleuritis in nine patients (24.3%). Statistical significance was found in PO2, SO2 (p<0.05), FEV1 and FVC and perfusion scintigram (p<0.001), whereas no statistical significance was observed in PCO2 (p>0.05). Conclusion: Our study results suggest that decortation surgery eliminates the compression on the lungs, allowing re-ventilation and leads to improvement of the respiratory function over time. These findings were also consistent with the previous study results.Öğe Evaluation of management of postpneumonic empyema thoracis in children(Lippincott Williams & Wilkins, 2013) Sahin, Atalay; Meteroglu, Fatih; Eren, Sevval; Eren, Canan; Celik, YusufBackground Empyema is a well-known sequelae of pneumonia, which is increasingly being reported in children despite strict management. The appropriate management remains controversial. The aim of this study was to evaluate different management options of postpneumonic empyema in children. Materials and methods A total of 330 patients were reviewed between 2002 and 2012; their ages ranged from 1.25 to 15 years, with a median age of 4.3 years. The various management procedures included thoracentesis (n=11), chest tube drainage (n=229), chest tube drainage with intrapleural fibrinolytic therapy (n=117), video-assisted thoracoscopic surgery (VATS) (n=35), and thoracotomy because of a trapped lung noted on admissions and failed procedures (n=94). Results Variable success rates were noted as follows: tube thoracotomy (48.24%), fibrinolytic treatment (68.37%), and VATS (85.71%). Postoperative complications (11.14%) included wound infection (n=10), atelectasis (n=18), delayed expansion (n=7), and need for reoperation (n=2). Four patients died (1.21%), two of them following thoracotomy, one patient after fibrinolysis, and one patient following VATS. Patients treated with thoracotomy recovered completely. Conclusion New therapeutic modalities had variable success rates in children with postpneumonic empyema. Thoracotomy is still needed as a last resort for cases unresponsive to chemical fibrinolysis and following failed thoracoscopy. (C) 2013 Annals of Pediatric Surgery.Öğe The factors affecting persistent pneumothorax and mortality in neonatal pneumothorax(Turkish J Pediatrics, 2008) Esme, Hidir; Dogru, Oemer; Eren, Sevval; Korkmaz, Mevluet; Solak, OkanThe aim of this study was to present our experience in management of neonatal pneumothorax and factors contributing to persistent pneumothorax and mortality. Forty-two newborns were analyzed according to gestational age, birth weight, Apgar score, age of admittance, type of delivery, mother's age, side of pneumothorax, causes of pneumothorax, accompanying disorders, tube thoracostomy and mechanical ventilation durations, mean hospital stay, and deaths. Sixteen patients (38%) weighed less than 2500 g and 28 (66%) were preterm. The mean Apgar score at 5(th) minute was 6.2 (2-10). The pneumothorax was bilateral in 9 patients (21%). There was a defined underlying lung pathology in 26 (61%) patients and accompanying disorder in 14 (33%). Mean tube thoracostomy duration was 5 days (2-12). Twenty-five patients (59%) needed mechanical ventilation. Overall 10 babies died. Our findings indicated that underlying primary lung pathology, need for mechanical ventilation, and bilateral pneumothorax were major determinants of persistent pneumothorax and mortality in newborns.Öğe Giant hydatid cysts of the lung: Analysis and surgical outcome of 67 cases(Medknow Publications & Media Pvt Ltd, 2013) Meteroglu, Fatih; Sahin, Atalay; Eren, Sevval; Eren, CananAims: We aimed to evaluate the results of surgical treatment of huge hydatid cysts diagnosed at our clinic. Ruptured cysts have caused severe complications. Perforation of very large cysts is always possible. These can result in fatal complications. We present our surgical experience with large hydatid cysts in this paper. Materials and Methods: We retrospectively reviewed 191 patients diagnosed as hydatid cysts who were treated surgically. Among these, 67 cases were studied with a dimension of 10 cm or more. Age, gender, symptom, ruptured or intact, dimension, quantity and radiologic findings of the cases were determined. Incipiency of complaint, postoperative morbidity and length of hospital stay for all cases were assessed. Results: The cases comprised 41 females and 26 males. The mean age was 20.20 +/- 16.13 (5-52) years. Hospital stay for the huge and ruptured cysts group was 11.21 +/- 4.04 days. The huge but unruptured cysts group had a hospital stay of 8.40 +/- 2.48 days. All patients underwent thoracotomy. Cystotomy plus capitonnage in 52 (77.61%), decortication in addition to cystotomy plus capitonage in seven (10.6%), cystotomy in six (8.6%), cystotomy plus enucleation in one and primer closure in one were carried out. Postoperative mortality was absent; however, 17 cases were complicated; atelectasis was found in five cases, prolonged air leakage in five cases, apical aseptic pleural space in three cases, empyema in two cases, hemopthisis in one case and diaphragmatic elevation in one. Conclusions: Immediate surgery is of choice in giant cysts. Possibility of complication and longer stay in the ruptured group is higher compared with simple cystic disease.Öğe Inhalation of foreign bodies in children: Experience of 22 years(Lippincott Williams & Wilkins, 2013) Sahin, Atalay; Meteroglu, Fatih; Eren, Sevval; Celik, YusufBACKGROUND: Foreign body (FB) inhalation into airways of the respiratory system is a life-threatening condition and can be fatal. The purpose of this survey was to evaluate the types and characteristics of inhaled foreign bodies, the age distribution of children, and the outcome. METHODS: We outlined a retrospective review of hospital data of patients between 1990 and 2012. FB inhalation occurring in children 0 year to 16 years was considered for inclusion. During the study period, 1,660 patients undergoing bronchoscopy with the diagnosis of FB were included. Deaths on arrival were excluded. RESULTS: Of the patients, 53% were male, and 47% were female (p > 0.05). The mean age was 6.2 years for girls and 4.7 years for boys. In 57% of all cases, the children were younger than 3 years. An FB was found within the respiratory tract of 1,565 patients. The FBs were always extracted by using rigid bronchoscopy. Hospitalization was always required owing to an institutional requirement. The origin of the FBs were within the two main groups of food and objects. Food FBs included seeds, nuts, beans, and fruit parts. FB objects included pins, toy parts, and metal pieces. FB and subsequent treatment revealed that morbidity was present; however, mortality was rare. CONCLUSION: Most of the inhaled FBs were found in the bronchial tree. Children younger than 3 years are more vulnerable. There seemed to be an association between the aspirated FBs and season, geographic locality, and sociocultural environment. The removal of choice is rigid bronchoscopy under general anesthesia. That most cases of FB in children occurs under the supervision of adults indicates that the incidence and severity of airway FB inhalation can be reduced by parental education and public awareness. (J Trauma Acute Care Surg. 2013; 74: 658-663. Copyright (C) 2013 by Lippincott Williams & Wilkins)Öğe Isolated thoracic duct injury in penetrating neck trauma(Turkish Assoc Trauma Emergency Surgery, 2007) Eren, Sevval; Cakir, Oemer; Gueloglu, Cahfer; Eren, M. NesimiA 39-year-old man was admitted with a stab wound to left lower neck. Chest X-ray revealed a left hydropneumothorax. Thoracentesis was performed and analysis of the fluid revealed chyle. Patient was treated conservatively by closed chest drainage and total parenteral nutrition. On the basis of this clinical report and review of the literature, it is concluded that thoracic duct injury should be kept in mind in penetrating neck trauma and conservative treatment should be the first line therapy.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 Mediastinal Cysts Clinical Evaluation and Surgical Results of 32 Cases(Texas Heart Inst, 2011) Esme, Hidir; Eren, Sevval; Sezer, Murat; Solak, OkanThe purpose of this retrospective study was to analyze our experience with mediastinal cysts, emphasizing the clinical presentations and results of surgery Thirty-two patients with mediastinal cysts underwent surgery from January 2000 through June 2005. The records of these patients were reviewed for age at presentation, sex, signs and symptoms at presentation, results of the imaging techniques, types of mediastinal cysts, location and size of cysts, types of surgical procedure, length of hospital stay early postoperative complications, death, and other follow-up information. The 32 mediastinal cysts comprised 12 bronchogenic, 9 pericardial, 7 thymic, and 2 enteric cysts, together with 2 cystic teratomas. Overall, 14 of the 32 patients with mediastinal cysts were asymptomatic. The surgical approach was thoracotomy in 30 patients and median sternotomy in 2 patients. The mean length of hospital stay was 77 +/- 2.6 days. All patients were free from recurrence during the mean follow-up period of 4.4 +/- 3.3 years. Surgery for mediastinal cysts is associated with low morbidity and mortality rates and a very low recurrence rate. It offers a definitive diagnosis and cure, avoiding the higher morbidity and mortality risks associated with conservative observation. (Tex Heart Inst J 2011;38(4):371-4)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 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 The risk factors and management of posttraumatic empyema in trauma patients(Elsevier Sci Ltd, 2008) Eren, Sevval; Esme, Hidir; Sehitogullaric, Abidin; Durkan, AtillaBackground: Posttraumatic empyema increases patient morbidity, mortality and length of hospital stay, and the cost of treatment. The aim of this study was to identify the risk factors for posttraumatic empyema and to review our treatment outcomes in patients with this condition. Methods: A total of 2261 patients who were admitted with thoracic traumas and underwent tube thoracostomy between January 1989 and January 2006 were investigated retrospectively. Posttraumatic empyema developed in 71 patients. Logistic regression was used to assess the association between potential risk factors for posttraumatic empyema. All values were expressed as the mean +/- S.D. Results: Eight hundred and thirty-six (37%) of the patients had penetrating type trauma, white 1425 (63%) had blunt type trauma. The rate of posttraumatic empyema development was 3.1% for all patients. Pulmonary contusion was seen in 221 (9.8%) patients and fractures of more than two ribs were seen in 191 (8.4%) patients. Tube thoracostomy placement was performed in the emergency room in 1728 (76.4%) patients, in the hospital ward in 197 (8.7%), in the intensive care unit in 182 (8.0%), and in the operating room in 154 (6.8%). The duration of tube thoracostomy was 6.11 +/- 2.99 (1-21) days. Retained haemothorax was seen in 175 (7.7%) patients. The mean lengths of hospital and intensive care unit stay were 6.42 +/- 3.45 and 2.36 +/- 2.66 days, respectively. The analysis showed that duration of tube thoracostomy (OR, 2.49, p < 0.001), length of intensive care unit stay (OR, 4.21, p < 0.001), and presence of contusion (OR, 3.06, p < 0.001), retained haemothorax (OR, 5.55, p < 0.001), and exploratory laparotomy (OR, 2.46, p < 0.001) were independent predictors of posttraumatic empyema. The relative risk of posttraumatic empyema was higher than 1 for each of the following risk factors: penetrating trauma (OR, 1.59, p = 0.055), associated injuries (OR, 1.12, p = 0.628) and fractures of more than two ribs (OR, 1.60, p = 0.197). Conclusion: Prolonged duration of tube thoracostomy and length of intensive care unit stay, and the presence of contusion, laparotomy and retained haemothorax are independent predictors of posttraumatic empyema. Use of prophylactic antibiotics may be recommended in patients with these risk factors. (c) 2007 Elsevier Ltd. All rights reserved.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.
