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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 Intrapleural fibrinolytic treatment of multiloculated pediatric empyemas(Springer, 2004) Ülkü, R; Önen, A; Onat, S; Kilinç, N; Özçelik, COur objective was to compare the efficacy of adjunctive intrapleural fibrinolytic agents (IPFA) (streptokinase, urokinase) on fibrinopurulent stage empyema and chronic stage empyema in children. IPFA were used in 78 pediatric patients with empyema (36 fibrinopurulent stage empyemas, 42 chronic stage empyemas) between December 1994 and September 2002. Pleural biopsy was done for staging in all cases. Streptokinase 250,000 units in 100 ml normal saline (62 patients) or 100,000 units urokinase in 100 ml normal saline (16 patients) was instilled daily into the patient's chest tube, and the tube was clamped for 4 h, followed by suction. This treatment was continued daily for 2-8 days until resolution was demonstrated by chest radiographs and/or computed chest tomography. Success of treatment was 97.2% (complete response 24/36, partial response 11/36) in the fibrinopurulent stage and 9.4% (complete response 2/42, partial response 2/42) in chronic empyema cases. In one patient with fibrinopurulent empyema, the treatment was stopped due to allergic reaction and pleural hemorrhage; this patient died 1 day later in a septic condition. Although an invasive method, the pleural biopsy technique may be an alternative way of more properly staging thoracic empyema in selected children in whom staging based on radiographic and biochemical findings is doubtful. Intrapleural fibrinolytic treatment is an effective and safe therapy of choice and may have significant benefit in most children with fibrinopurulent phase empyema, except for those with bronchopleural fistula. IPFA do not seem to be effective in children with chronic phase empyema.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 Lymphoepithelial cyst of the mediastinum(Texas Heart Inst, 2005) Ulku, R; Yilmaz, F; Eren, S; Onat, SWe report a rare case of lymphoepithelial cyst of the mediastinum. A 38-year-old woman was found to have a right paratracheal mediastinal mass on chest radiograph. Computed tomographic scanning showed a cystic mass on the right side of the trachea. The encapsulated mass was situated in the upper mediastinum and was adherent to the trachea. The lesion was resected via a right thoracotomy Histopathologic examination showed that the cystic mass was lined with 1 layer of ciliate columnar epithelium. There were no malignant foci. These findings were consistent with a diagnosis of multicystic lymphoepithelial cyst. The postoperative course was uneventful, and the patient was discharged from the hospital on the 7th postoperative day.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 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 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 pulmonary hydatid cysts in children(Georg Thieme Verlag Kg, 2004) Ülkü, R; Onen, A; Onat, SAim of the Study: Hydatid disease is a parasitic infestation which is endemic in many sheep and cattle raising areas and is still an important health problem in the world. The aim of our study was to present our surgical experience and strategy in the management of pulmonary hydatid disease. Methods: Sixty-six patients with 83 pulmonary hydatid cysts underwent surgical treatment in our institution between January 1990 and March 2003. We used double-lumen endotracheal tubes in children older than 12 years who were operated on for hydatic cyst in the last 8 years. Results: There were 38 boys and 28 girls with a mean age of 9.6 +/- 7 years (range 5-15 years). Of the 83 cysts, 61 were intact and 22 were ruptured cysts. Isolated pulmonary hydatid cyst was seen in 61 patients (92.4%), while 5 patients (7.6%) had combined pulmonary and hepatic cysts. Lateral thoracotomy was performed in 54 patients (82%), thoracophrenotomy in 5, bilateral thoracotomy in 4, and median sternotomy in 3 patients. Cystotomy and capitonnage was performed in 58 cysts, cystotomy alone in 21, and resection techniques were used in 4. There were 8 postoperative complications in 7 patients. The most common complication was atelectasis. Conclusions: Surgery is the treatment of choice for most patients with pulmonary hydatid cysts. The usage of double-lumen tubes may decrease intra- and postoperative complications. Thoracophrenotomy can be chosen as the surgical procedure in the management of hepatic and pulmonary hydatid cysts.Öğe The value of open surgical approaches for aspirated pen caps(W B Saunders Co-Elsevier Inc, 2005) Ülkü, R; Onen, A; Onat, S; Özçelik, CPurpose: The aim of this study was to present the therapeutic approach of aspirated pen cap foreign bodies, with emphasis on the importance of open surgical intervention. Methods: The records of patients who underwent bronchoscopy and bronchoscopy and surgical therapy for pen cap foreign bodies between January 1997 and June 2003 were reviewed retrospectively. Diagnosis was made based on history, physical examination, radiological methods, and bronchoscopy. Age, sex, symptoms, radiological methods, surgical procedure, complications, and outcomes were recorded. Results: A total of 24 bronchoscopies were performed on 19 patients (10 boys, 9 girls) with a median age of 11 years (range, 8 - 15 years). Pen caps were localized in the right bronchial tree in 14 cases (74%). Pen caps were extracted successfully by forceps during bronchoscopy in 9 patients. Of the remaining 10 patients, 5 underwent bronchoscopy and tracheostomy and 5 patients underwent thoracotomy and bronchotomy. Significant complications were observed in 2 patients (10.53%) (severe bronchospasm in one and pneumothorax and subglottic edema in another). Conclusions: Pen caps aspiration is a challenging problem because of the difficulties during extraction and higher morbidity compared with other foreign body aspirations. In such cases in which classic bronchoscopy failed and/or pen caps could not be removed via vocal cords, open surgical approaches, either bronchoscopy and tracheostomy or thoracotomy and bronchotomy, may be an alternative procedure of choice. (c) 2005 Elsevier Inc. All rights reserved.
