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Öğe Disappointing results of staged arteriovenous reversal (AVR) in severely ischemic extremity(Westminster Publ Inc, 1998) Ozcelik, C; Inci, I; Nizam, O; Ozgen, GBetween 1991 and 1995 the authors performed the arteriovenous fistula (AVF) procedure, which forms the first stage of staged arteriovenous reversal (AVR), in 6 patients (4 with Buerger's disease, 2 with atherosclerosis obliterans) with lower extremity arterial occlusive disease. The patients were all men with a mean age of forty-one years. The clinical indications for revascularization included rest pain and nonhealing ischemic ulcer. The results were disappointing: 4 patients with patent fistulas underwent major amputation, and 2 with occluded fistulas underwent toe amputation.Öğe Intrapleural fibrinolytic treatment of multiloculated postpneumonic pediatric empyemass(Elsevier Science Inc, 2003) Ozcelik, C; Inci, I; Nizam, O; Onat, SBackground. 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 thoracotomy has been advocated since the 1950s. The aim of this study was to assess the effectiveness of intrapleural fibrinolytic treatment in postpneumonic pediatric empyemas. Methods. In our clinic, we used intrapleural fibrinolytic agents in 72 pediatric patients with multiloculated empyema between 1994 and 2002. Streptokinase, 250,000 U in 100 mL of 0.9% saline solution (59 patients), and urokinase, 100,000 U in 100 mL of 0.9% saline solution (13 patients), were instilled daily into the chest tube, and the tube was clamped for 4 hours followed by suction. This treatment was continued daily for 2 to 10 days until resolution was demonstrated by chest radiograms or computed chest tomography. Results. The rate of drainage after fibrinolytic treatment was increased 73.77%. Treatment was ineffective in 14 (19.44%) of 72 patients who underwent fibrinolytic instillation. Treatment was discontinued because of allergic reaction and pleural hemorrhage in 1 patient, and because of development of bronchopleural fistula in another one. The regimen was completely successful in 43 (59.72%) patients, and partially successful in another 15 (20.83%). Twelve of those patients who had failure eventually required decortication and recovered completely. One patient died of sepsis and pleural hemorrhage; another patient died because of food aspiration. Conclusions. In all patients with loculations except those with a bronchopleural fistula, intrapleural fibrinolytic treatment should be tried. Thus, the majority of children with loculated empyemas can be treated successfully without invasive interventions, such as thoracoscopic debridements or open surgery. (Ann Thorac Surg 2003;76:1849-53) (C) 2003 by The Society of Thoracic Surgeons.Öğe Intrapleural fibrinolytic treatment of traumatic clotted hemothorax(Amer Coll Chest Physicians, 1998) Inci, I; Özçelik, C; Ülkü, R; Tuna, A; Eren, NStudy objective: To evaluate the role of intrapleural fibrinolytic treatment (IPFT) in traumatic clotted hemothorax. Design and patients: Between August 1995 and February 1997, 24 patients with traumatic clotted hemothorax were included. Streptokinase (SK), 250,000 IU, or urokinase (UK), 100,000 IU, diluted in 100 mt of saline solution was givers daily. We administered 5.0+/-1.8 (range, 2 to 9) doses of SK or 6.25+/-5,97 (range, 2 to 15) doses of UK, Setting: Dicle University School of Medicine, Thoracic and Cardiovascular Surgery Department. Results: Complete response, which was defined as resolution of symptoms with complete drainage of fluid and no residual space radiographically, occurred in 15 (62.5%) patients, Partial response, which was defined as resolution of symptoms with a small pleural cavity, occurred in severs (29.2%) patients, Two patients (8.3%) required decortication; they were defined as nonresponders, The mean period of time between the diagnosis and fibrinolytic treatment (FT) was 11.65+/-6.38 (range, 4 to 25) days, There were no complications related to IPFT, There was no mortality during the course of IPFT. Conclusion: The use of intrapleural fibrinolytic agents has resulted in resolution of clotted hemothorax with an overall success rate of 91.7%. We recommend that IPFT should be added to the algorithm for management of clotted hemothorax before proceeding with minithoracotomy or pleural decortication.Öğe Management of postpneumonic empyemas in children(Oxford Univ Press Inc, 2004) Ozcelik, C; Ülkü, R; Onat, S; Ozcelik, Z; Inci, I; Satici, OObjectives: Despite continued improvement in medical therapy, pediatric empyema remains a challenging problem for the surgeon. Multiple treatment options are available; however, the optimal therapeutic management has not been elucidated. The aim of this study is to assess different treatment options in the management of postpneumonic pediatric empyemas. Methods: A retrospective review was performed of pediatric patients admitted to Dicle University School of Medicine Thoracic and Cardiovascular Surgery Department between 1990 and 2002, with the diagnosis of empyema. Data tabulated included patient demographics, presentation, treatment and outcome. Results: There were 515 children (289 boys and 226 girls) with a mean age of 4.7 ranging from 18 days to 15 years. Empyema was secondary to pneumonia in all children. The most common radiologic finding was pleural effusion in 285 patients (55.32%). Staphylococcus aureus was the most frequently encountered organism and found in 105 patients (20.38%). Pleural fluid cultures were negative in 195 patients (37.86%). In addition to antibiotic therapy, initial treatment included serial thoracenthesis (n = 29), chest tube drainage alone (n = 214), chest tube drainage with intrapleural fibrinolytic therapy (n = 72), chest tube drainage with primary operation (n = 191), and primary operation without chest tube drainage (n = 9). Overall response rate with fibrinolytic treatment (complete and partial response) was obtained in 58 patients. In addition to decortication pulmonary resections were performed in 12 patients. Overall mortality rate was 1.55%. There was no operative mortality. Postoperative morbidity included wound infection in 21, delayed expansion in 8, and atelectasis in 35 patients. Conclusions: Multiple therapeutic options are available for the management of pediatric empyema. Depending on stages, every option has a role in the treatment of postpneumonic pediatric empyema. In the absence of bronchopleural fistula, intrapleural fibrinolytic treatment should be tried in all patients with multiloculations in stage II empyema. In the absence of pneumonia, decortication for empyema is a safe approach with low mortality and morbidity rates. (C) 2003 Elsevier B.V. All rights reserved.Öğe A new treatment for clot retention: Intravesical streptokinase instillation(Williams & Wilkins, 1996) Korkmaz, K; Sahin, H; Islim, F; Bircan, Z; Inci, I[Abstract Not Available]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 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.
