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    74 Year-old-man with pneumopericardium due to blunt chest trauma: Case report
    (Dicle Üniversitesi Tıp Fakültesi, 2008) Orak, Murat; Üstündağ, Mehmet; Onat, Serdar; Doğan, Halil; Avcı, Alper
    Pneumopericardium is the presence of air in the pericardial space. It may be seen in the context with severe blunt chest trauma. Usually, pneumopericardium is self-limiting and requiring no specific therapy. However, a continuous monitoring of the electrocardiography and the blood pressure is necessary at an intermediate care unit. We report a 74 year-old-man had been presented with Pneumopericardium, after a car striking. He had bilateral pneumohematothoraces, pneumomediastinum and bilateral multiple rib fractures. Pneumopericardium was diasappeared without surgical management like written in english literature. Frequent cardiac and vital signs monitoring and general support treatment were successful in our treatment.
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    Adult Bochdalek hernia: an analysis of eight patients
    (Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2015) Meteroglu, Fatih; Sahin, Atalay; Oruc, Menduh; Onat, Serdar
    Background: This study aims to analyze congenital diaphragmatic hernias in adult age groups. Methods: We retrospectively studied files of eight patients (3 males, 5 females; mean age 31.4 years; range 18 to 53 years) of Bochdalek hernias of advanced age who were operated in our clinic between January 2005 and June 2013. Patients' age, sex, associated diseases, symptoms, surgical access, abdominal organs in the thorax, postoperative morbidity and mortality rates, and duration of hospital stay were evaluated. Results: Cough, chest pain, and dyspnea were the most common symptoms. Intestinal sounds in the thorax were present in six patients on auscultation. Pulmonary function tests, biplane chest X-rays, and thoracic computed tomography were performed. Bochdalek hernia was located on the left side in seven patients and on the right side in one patient. Posterolateral thoracotomy + laparotomy were performed in one patient, while posterolateral thoracotomy was performed in the other seven patients. No postoperative morbidity or mortality was observed. The mean duration of hospital stay was 8.75 days (range 4-25 days). Patients were followed up for a mean of 28.13 months (range 3-60 months). Conclusion: Although rarely, congenital diaphragmatic hernias may be seen in the older age groups. Life-threatening complications may develop in asymptomatic patients over time. Surgical treatment is essential upon diagnosis.
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    Akut akciğer hasarı oluşturulan tavşanlarda pentoksifilin ve metilprednizolonun koruyucu etkisi
    (2003) Ülkü, Refik; Eren, M. Nesimi; Balcı, Akın E.; Şehitoğulları, Abidin; Büyükbayram, Hüseyin; Onat, Serdar
    Çalışmamızın amacı; akut akciğer hasarı oluşturulan tavşanlarda pentoksifilin ve metilprednizolonun koruyucu etkisini araştırmaktır. Çalışmamızda 28 adet tavşanı dört grup halinde kullandık. Grup 1 kontrol grubu (n= 7), grup 2 oleik asit grubu (n= 7), grup 3 pentoksifilin grubu (n= 7), grup 4 metilprednizolon grubu (n= 7). Kontrol grubu dışındaki diğer üç gruba da akut akciğer hasarı oluşumu için oleik asit verildi (oleik asit, endotoksin gibi hayvanlarda pulmoner vasküler permeabilite artışına, pulmoner ödem ve hipoksiye yol açarak akut akciğer hasarını oluşturur). Tüm denekler monitörize edildi. Kan gazları ölçümü, periferik lökosit sayımları, ortalama arteryel basınçların seri ölçümleri, bronkoalveoler lavaj sıvısında lökosit miktarı, yaş/kuru akciğer ağırlık oranları, patolojik değişikliklerin değerlendirilmesi yapıldı. Deneyin üçüncü saati sonunda tavşanlar sakrifiye edildi. Göğüs kafesi açıldı ve her bir pulmoner hilus çiftli olarak klemplendi ve transeksiyon yapıldı. Ortalama arteryel kan basıncı; oleik asit alan gruplarda düşük kaydedildi, ancak kontrol grubuna göre anlamlı düşüş sadece oleik asit grubunda saptandı (p< 0.01). Ortalama kalp atım hızında kontrol grubu dışındaki diğer üç grupta da düşüş kaydedildi. Ancak istatistiksel olarak anlamlı düşüş sadece oleik asit grubunda tespit edildi (p< 0.01). Deney boyunca periferik lökosit sayıları incelendiğinde oleik asit alan her üç grupta da düşüş anlamlı idi (p< 0.01). Ancak bu düşüş sadece oleik asit alan grupta daha derindi. Sonuç olarak; tavşanlarda oluşturulan akut akciğer hasarı modelinde pentoksifilin ve metilprednizolon tedavisinin akciğerlerde nötrofil toplanmasını ve akciğer hasarını engellediği saptandı.
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    Bilateral giant morgagni hernia causing cardiac shifting
    (2009) Girgin, Sadullah; Gedik, Ercan; Onat, Serdar; Avcı, Alper
    Yetmiş altı yaşında, 114 kg ağırlığında bayan hasta iki yıldır kötüleşen göğüs ağrısı ve efor ile nefes darlığı şikayetleri ile başvurdu. Öyküsünde travma yoktu. Düz ve kesitsel görüntülemede kardiyak posterior itilmeye neden olan dev anterior diyafragmatik herni saptandı. İleri tetkik ve tedavi için genel cerrahi bölümüne sevk edildi. Herniye bölümlerin redüksiyonu ve bilateral diyafragmatik defektin onarımı laparotomi kullanılarak yapıldı. Posterior kardiyak itilmeye neden olan bilateral dev Morgagni hernisi çok nadir bir olgudur.
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    Bilateral Giant Morgagni Hernia Causing Cardiac Shifting
    (Ekin Tibbi Yayincilik Ltd Sti-Ekin Medical Publ, 2009) Avci, Alper; Girgin, Sadullah; Gedik, Ercan; Onat, Serdar
    A 76-year-old woman weighing 114 kg presented with shortness of breath and worsening chest pain for 2-year duration. There was no history of trauma. Plain and cross-sectional imaging identified a giant anterior diaphragmatic hernia which caused cardiac posterior shifting. She was transferred to general surgery department for further investigations and treatment. Reduction of herniated contents and repairing of bilaterally diaphragmatic defect were performed via laparotomy. Bilateral, giant Morgagni hernia which causes cardiac shifting to the backward is extremely rare.
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    Cilt Biyopsisi ile Tanısı Konulan Malign Mezotelyoma Olgusu
    (2016) Çakmak, Muharrem; Ülkü, Refik; Onat, Serdar; Durkan, Atilla; Öztürk, Bülent
    Malign plevral mezotelyoma plevranın kötü huylu tümörüdür. Tanı plevra biyopsi ile konur. Cilt metastazı ile klinik bulgu veren ve cilt biyopsisi ile tanısı konulan mezotelyoma olgusu çok nadirdir. Burada, cilt metastazı ile gelen ve ciltteki lezyondan alınan biyopsi ile mikst tip mezotelyoma tanısı konulan olguyu sunduk.
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    Çocuk ampiyemlerinde tedavi: Kapalı su altı drenajı ve dekortikasyon
    (2002) Eren, Tahir Şevval; Balcı, Akın Eraslan; Ülkü, Refik; Onat, Serdar; Eren, M. Nesimi
    Başlangıç tedavisi olarak, kapalı toraks drenajı (KTD) uygulanan 497 postpnömonik ampiyemli çocuk değerlendirildi. Aynı anda birden fazla dren taşıyan hastalar %3.6; tedavi sürecinde birden fazla dren uygulananlar %7.8 oranındaydı. Drenajın başarısız olduğu 106 hastada dekortikasyon yapıldı (%21.3). En sık operasyon endikasyonları tuzaklanmış akciğer ve persistan-multipl pleural postu (%91.5). Operasyon öncesi KTD süresi T 1.6 gündü. Üç çocukta rezeksiyon gerekti (%2.8). Postoperatif hastane süresi 7.4 gündü. Dekortikasyon grubunda mortalite yoktu, diğer grupta %1.5 oldu. Bir yıllık izlem periyodunda, tam akciğer ekspansiyonu, KTD ile tedavi edilenlerde %78; dekortikasyon geçirenlerde %90.5 olarak bulundu. Her iki gruptaki hastaların büyük kısmı 17-20 gün içinde taburcu edildi.
  • Küçük Resim
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    Combined late diagnosed right main bronchial disruption and chylothorax from blunt chest trauma
    (2004) Özçelik, Cemal; Onat, Serdar; Bayar, Emin Sırrı; 0000-0001-7654-5523
    Both main bronchial disruption and chylothorax are uncommon injuries associated with blunt thoracic trauma. We report the case of a patient who presented late after traumatic rupture of the right main bronchus who also had a traumatic chylothorax.
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    Comparison of awake and intubated video-assisted thoracoscopic surgery in the diagnosis of pleural diseases: A prospective multicenter randomized trial
    (Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2019) Kocaturk, Celalettin; Kutluk, Ali Cevat; Usluer, Ozan; Onat, Serdar; Cinar, Huseyin Ulas; Yanik, Fazli; Cesur, Ezgi
    Background: This study aims to compare the safety and diagnostic accuracy of awake and intubated video-assisted thoracoscopic surgery in the diagnosis of pleural diseases. Methods: This prospective randomized study was conducted between October 2016 and April 2018 and included 293 patients (201 males, 92 females; mean age 53.59 years; range, 18 to 90 years) from five medical centers experienced in video-assisted thoracoscopic surgery. The patients were randomized into two groups as awake video-assisted thoracoscopic surgery with sedoanalgesia (non-intubated) and video-assisted thoracoscopic surgery with general anesthesia (intubated). Patients with undiagnosed pleural effusions and pleural pathologies such as nodules and masses were included. Conditions such as pain, agitation, and hypoxia were indications for intubation. The groups were compared in terms of demographic data, postoperative pain, operative time, complications, diagnostic accuracy of the procedures, and cost. All patients completed a follow-up period of at least 12 months for samples that were non-specific, suspicious for malignancy or inadequate. Results: Awake video-assisted thoracoscopic surgery was performed in 145 and intubated video-assisted thoracoscopic surgery was performed in 148 patients. Pleural disease was unilateral in 83% (243/293) and bilateral in 17% (50/293) of the patients. There was no difference between the groups in terms of presence of comorbidity (p=0.149). One patient in the awake video-assisted thoracoscopic surgery group (0.6%) was converted to general anesthesia due to refractory pain and agitation. As postoperative complications, fluid drainage and pneumonia were observed in one patient in the awake video-assisted thoracoscopic surgery group (0.6%) and fluid drainage was detected in one patient in the video-assisted thoracoscopic surgery group (0.6%). There were no differences in pain intensity measured with visual analog scale at postoperative 4, 8, 12, or 24 hours (p>0.05). Distribution and rates of postoperative pathological diagnoses were also similar (p=0.171). Both operative cost and total hospital cost were lower in the awake video-assisted thoracoscopic surgery group (p<0. 001, p=0.001). Conclusion: Our study showed that awake video-assisted thoracoscopic surgery is safe, has similar reliability and diagnostic accuracy compared to video-assisted thoracoscopic surgery performed under general anesthesia, and is less costly. Awake video-assisted thoracoscopic surgery can be the first method of choice in all patients, not only in those with comorbidities.
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    Comparison of demographical characteristics, prognostic factors, and surgical outcomes in children and adult patients with pulmonary hydatid cyst
    (Turkish Respiratory Society, 2017) Oruç, Menduh; Şahin, Atalay; Meteroğlu, Fatih; Onat, Serdar; Durkan, Atilla; Ülkü, Refik; Taylan, Maşuk
    Objective: Pulmonary involvement of hydatid cyst disease (HCD) may cause rupture, anaphylaxis, pneumothorax, and pulmonary hypertension. Our aim was to analyze demographical and clinical characteristics of pulmonary HCD. Methods: Demographical characteristics, laboratory parameters, and clinical features of 171 children and adult patients with pulmonary HCD were analyzed. Age, gender, ELISA test results, duration of hospitalization, surgical method of cyst excision and number, diameter, localization, and perforation status of cysts were recorded. Physical examination, ultrasonography, computed tomography, and serologic tests were used to confirm diagnosis of hydatid cysts. Results: Perforated cysts were observed in 26 children and 22 adults. Twenty-three children and 12 adults had a giant cyst. Extrapulmonary hydatid cysts were observed in 10 children and 21 adults. ELISA IgG positivity was determined in 30 children and 34 adults. Twelve children experienced long-lasting air leakage and responded to drainage. In the adult group, 14 patients had long-lasting air leakage and 3 had empyema and expansion defect. The mean duration of hospitalization for children and adults was 8.9 and 10.45 days, respectively. Conclusion: A better understanding of demographic features, clinical characteristics, complications of disease, and surgical procedures helps to determine optimal follow-up and the therapeutic choice.
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    Computed Tomography (CT) findings of pulmonary hydatid cysts in children and the factors related to cyst rupture
    (International Scientific Information, Inc., 2017) Özmen, Cihan Akgül; Onat, Serdar
    Background: The lungs are the most common site of hydatid cysts in children. Rupture is the main complication of cysts causing morbidity and mortality. In this study we aimed to comprehensively describe the CT signs for cysts and analyze the relationship of cyst ruptures to the diameter and location of cyst. Material/Methods: A total of 145 cysts from 102 patients, aged 17 years or younger, who underwent a multi-detector computed tomography (MDCT) evaluation and had surgically proven pulmonary hydatid disease were included retrospectively. The CT images were analyzed for radiologic findings and signs of cyst rupture. Results: The cysts had a mean diameter of 5.45±3.03 cm. Most of the patients had a solitary cyst (70.6%). The most common lobes involved were the lower lobes (58.6%). Peripherally located cysts were more common than central cysts. The overall number of ruptured cysts was 69 (47.5%). The most common sign was the waterlily sign with a prevalence of 24.6%. After exclusion of cysts of 1 cm, the mean cyst diameter was 6.23±2.83 cm in the unruptured group and 5.02±2.80 cm in the complete ruptured group (p=0.020). The mean cyst diameter was 6.38±3.11 cm for centrally located cysts, and 4.31±2.37 cm for peripherally located cysts (p<0.0001). Conclusions: Pulmonary hydatid cysts commonly presents as solitary cysts with a predilection for lower lobes and the peripheral regions of the lung. Peripherally located cysts are more common but smaller than centrally located cysts. Radiologists should also be aware of atypical imaging findings of cyst rupture, and radiologic signs should be explored during radiologic evaluation.
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    Congenital lobar emphysema
    (Wiley-Blackwell, 2008) Ulku, Refik; Onat, Serdar; Ozcelik, Cemal
    Background: Congenital lobar emphysema (CLE) is a rare anomaly of lung development that usually presents in the neonatal period with respirator distress and pulmonary lobar hyperinflation. It is commonly confused with pneumothorax. The aim of the present paper was to review the authors' experience in order to emphasize the importance of differential diagnosis with pneumothorax. Methods: Children with CLE treatment at Department of Thoracic Surgery, Dicle University School of Medicine, Turkey, between January 1993 and June 2004, were reviewed. Results: Ten children consisting of six boys and four girls (age range, 6 h-12 months) had CLE. Major presenting symptoms were tachypnea(n = 100%) and respiratory distress in (n = 80%). On chest radiograph, emphysema was seen in all patients, and shift-herniation to the opposite lung, atelectasis were observed. Computed tomography was performed in all patients, which indicated emphysema in the affected lobes in all cases. Pulmonary perfusion scan was performed in two patients, showing loss of perfusion in the affected lobe. The most common affected lobe was the left upper lobe (50%). In the present series, three patients were mistakenly diagnosed as pneumothorax and intercostal drains were inserted in the emergency department. Eight patients underwent lobectomy, and postoperative course was uneventful. Two patients were followed conservatively. Emphysema was detected in all pathological specimens. One patient was lost to follow up. Mean follow-up duration of all patients was 26.8 +/- 29.24 months (range, 1-89 months). Conclusions: CLE is established on combined clinical, radiological and scintigraphic imaging. Surgical excision of the affected lobe is the appropriate treatment. Particularly, differential diagnosis should be made between CLE and pneumothorax.
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    Erişkinlerde özofagus yabancı cisimleri
    (2004) Eren, Tahir Şevval; Eren, M. Nesimi; Ülkü, Refik; Bayar, Emin Sırrı; Onat, Serdar
    Amaç: Özofagus yabancı cismi nedeniyle tedavi edilen 98 erişkin hastada yabancı cisimlerin özellikleri, tedavi yöntemleri ve komplikasyonlarını değerlendirmek amacıyla retrospektif bir çalışma yürütüldü. Gereç ve Yöntemler: Ocak 1990 ile Haziran 2002 yılları arasında 98 erişkin hasta özofagus yabancı cismi nedeniyle tedavi edildi. Dicle Üniversitesi Tıp fakültesi Göğüs Kalp Damar Cerrahisi kliniğinde yatan hastaların hastane kayıtları retrospektif olarak gözden geçirildi. Bütün hastalarda rigid özofagoskopi genel anestezi altında yapıldı. Bulgular: Atmışiki kadın (%63.3), 36 erkek (%36.7) hasta mevcuttu. Ortalama yaş 52.8 idi (17-80). Hastaların şikayet ettiği başlıca semptomlar odinofaji ve takılma hissi idi. Yabancı cisim, olguların %82.7 de servikal, %11.2 de torasik ve %3.1 de de distal özofagus yerleşimliydi. En sık bulunan yabancı cisimler kemik, etli kemik ve etti (%67.3). Özofagus yabancı cisimleri genel anestezi altında direk görüş altında laringoskop veya rijid özofagoskopi ile çıkarıldı. Cerrahi ile çıkarma 2 hastada yapıldı. Özofagoskopiye bağlı 3 perforasyon ve geç başvurmaya bağlı da 1 perforasyon mevcuttu. Mortalite görülmedi. Sonuç: Hastaların klinik anamnezi ve semptomları bir hastaya özofagoskopi yapılıp yapılmayacağı kararında en önemli elemanlardır. Özofagus yabancı cisimleri için erken tanı ve tedavi hayatı tehdit edici komplikasyonları nedeniyle esastır. Biz, rijid özofagoskopiyi yabancı cisimlerin çıkarılmasında emniyetli ve güvenilir bir teknik olarak görüyoruz.
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    Esophageal Injury with Unusual Trauma
    (Springer Heidelberg, 2009) Ulku, Refik; Onat, Serdar; Yilmaz, Guelsen; Akay, Hatice
    Esophageal foreign bodies are frequently encountered in the pediatric population and specific high-risk groups of adults. Foreign bodies in the esophagus can result in serious complications, depending on the size and the shape of the ingested object. We report the case of a four-year-old boy with an esophageal injury after the accidental ingestion of an umbrella wire.
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    The evaluation of 250 patients with thoracoabdominal injuries
    (Turkish Assoc Trauma Emergency Surgery, 2008) Ciftci, Fatih; Girgin, Sadullah; Gedik, Ercan; Onat, Serdar; Tacyildiz, Ibrahim Halil; Keles, Celalettin
    BACKGROUND Prognostic factors affecting mortality and morbidity in thoracoabdominal injuries were evaluated. METHODS Two hundred and fifty patients (227 males, 23 females; mean age 30.1 +/- 5.11; range 15 to 71 years) who had been exposed to thoracoabdominal injuries and underwent laparotomy between June 1996 and November 2005 were investigated retrospectively. Patients were assessed according to age, sex, trauma-operation interval, shock, hospitalization period, number of injured organs, blood transfusion, timing of closed thorax drainage, thoracotomy, Abdominal Trauma Index, Injury Severity Score, Abbreviated Injury Score, Revised Trauma Score, and complications. RESULTS Mortality and morbidity ratios were 15.6% and 53.5%, respectively. The factors effective on mortality were trauma-operation interval >= 3 hours (p=0.03), presence of shock (p=0.03), increase in the rate of blood transfusion (p=0.001), injured organ number >= 3 (p=0.001), and not performing early-term closed thorax drainage (p=0.005). Trauma-operation interval <3 (p=0.02), increase in the rate of blood transfusion (p=0.02), injured organ number >= 3 (p=0.001), and not performing early-term closed thorax drainage (p=0.005) were the factors effective on morbidity. CONCLUSION It was determined that trauma-operation period >= 3 hours, number of injured organs >= 3, and increased number of blood transfusions increased both mortality and morbidity. However, presence of shock increased only mortality. On the other hand, application of closed thorax drainage within a reasonable time period was determined to decrease mortality and morbidity.
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    Evaluation of patients diagnosed with spontaneous hemopneumothorax
    (Marmara Üniversitesi, 2017) Oruç, Menduh; Monis, Serdar; Şahin, Atalay; Erbey, Ahmet; Meteroğlu, Fatih; Onat, Serdar
    Objective: Spontaneous hemopneumothorax (SHP) may threaten life unless timely diagnosed and appropriately treated. The aim of this study was to review our institutional experience in the management of patients with SHP. Patients and Methods: We retrospectively analyzed age, gender, the affected side, the amount of drainage, clinical findings, and treatment outcomes of 610 patients with diagnosis of spontaneous pneumothorax at emergency department. Later, they were admitted to the Department of Thoracic Surgery, Dicle University Hospital. Results: Posteroanterior chest radiographs, thoracic computed tomography (CT) scans, biochemistry and coagulation test results of all patients were evaluated. All patients underwent closed chest drainage. Seven (1.14%) of 610 patients were diagnosed with SHP. These patients underwent operation after thoracic drainage. Three of them were operated by video-assisted thoracoscopic surgery (VATS) and the others by thoracotomy. No postoperative complication was observed. Conclusion: SHP should be considered in patients presenting with sudden chest pain and dyspnea when there is air-fluid level in addition to pneumothorax on radiography. The first treatment approach should be the application of tube thoracostomy. Next step should include close clinical and hemodynamic control and be followed primarily by VATS or urgent thoracotomy in case of continued bleeding. An early diagnosis and appropriate surgical approach can prevent fatal complications.
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    Factors affecting the outcome of surgically treated non-iatrogenic traumatic cervical esophageal perforation: 28 years experience at a single center
    (Biomed Central Ltd, 2010) Onat, Serdar; Ulku, Refik; Cigdem, Kemal M.; Avci, Alper; Ozcelik, Cemal
    Background: We reviewed our experience with non-iatrogenic traumatic cervical esophageal perforations, paying particular attention to factors affecting the outcome of such cases. Methods: In total, 30 patients treated surgically between 1980 and 2008 for non-iatrogenic traumatic cervical esophageal perforation in our clinic were reviewed. Results: There were 25 male and 5 female patients with a median age of 27.5 years. The type of injury was external trauma in 21 (70%) patients and endoluminal injury in the remaining 9 (30%) patients. The mechanism of injury was gunshot in 16 patients, stabbing in 4, falling in 1 (extraluminal injury), and foreign body in 9 (endoluminal injuries). The overall mortality rate was 16.6% (5/30). The mortality rate for extraluminal injuries was 19%, and for endoluminal injuries was 11.1%. Mortality in patients treated within 24 h of sustaining injury was substantially less than in those for whom diagnosis and treatment were delayed (12.5 and 21.4%, respectively). The mortality rate was 33.3% (3/9) for patients with tracheal injuries and 9.5% (2/21) for those without tracheal injuries. Conclusions: A treatment delay greater than 24 h, the presence of tracheal injury, or extraluminal perforation significantly affected the outcome of surgically treated non iatrogenic traumatic cervical esophageal perforation.
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    Fibrovascular polyp of the esophagus: Diagnostic dilemma
    (2004) Özçelik, Cemal; Onat, Serdar; Dursun, Mehmet; Arslan, Adem
    A 51-year-old female patient was admitted to our department. She had symptoms of dysphagia, regurgitation of a fleshy mass into the mouth, and attacks of dyspnea. Every effort was made for diagnosis. At cervical exploration, upper esophageal polyp was discovered incidentally, and removed. We present this case because of rarity and emphasize the clinical presentation. The physician should be aware of the presence of this rare esophageal tumor. © 2003 Elsevier B.V. All rights reserved.
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    Göğüs Duvarında Osteokondrom; 11 Olgu
    (2015) Şahin, Atalay; Oruç, Menduh; Ülkü, Refik; Onat, Serdar; Meretoğlu, Fatih; Erbey, Ahmet
    Amaç: Cerrahi olarak tedavi ettiğimiz göğüs duvarında osteokondromlu vakaların değerlendirilmesini amaçladık. Gereç ve Yöntem: 2010-2014 yılları arasında göğüs duvarı kitlesi olup osteokondrom tanısı alan hastaların cinsiyet, yaş, klinik muayene, radyolojik grafikleri ve cerrahi sonuçlarını retrospektif olarak inceledik. Total eksizyon sonrası oluşan boşluğu primer olarak kapatmak için prostetik materyal kullanıldı. Bulgular: Sekizi erkek, üçü kadın olan 11 hastanın yaş ortalaması 27.4 idi. Ameliyat sonrası takip süremiz ortalama 3 yıl idi. Olguların yakınma süresi ortalama 3 ay idi. Hastaların çoğunluğunda yavaş ve ağrısız şişkinlik şikâyeti vardı. Dört hastada basmakla hassasiyet mevcuttu. On hastanın lezyonu kaburgalarla sınırlıyken bir hastamızın lezyonu skapulada yerleşmişti. Dört hastanın lezyonu ikiden fazla kaburgayı tutmuştu. Sonuç: Osteokondromların maligniteye dönüşme potansiyelleri vardır. Bunları kondro sarkomdan ayırmak bazen zor olabilir. Bu yüzden kostakartilajından kaynaklanan tümörler erkenden cerrahi olarak çıkarılmalıdır.
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    Gözden kaçan bir komplikasyon, ampiyema nesessitatis: 766 ampiyemli olgunun değerlendirilmesi
    (Bilimsel Tıp Yayınevi, 2019) Avcı, Alper; Kuşçu, Ferit; Ulu, Aslıhan Candevir; Onat, Serdar
    Giriş: Plevral ampiyem (PA), plevra yaprakları arasında infekte mayi bulunmasıdır. Ampiyema nesessitatis (AN) ise PA’nın pariyetal plevrave endotorasik fasiayı geçerek çevre yumuşak dokular içinde yayılması ve cilt altı yayılımı ile bazen cilde fistülize olmasıyla karakterize,nadir bir komplikasyonudur. Ayırıcı tanıda karmaşıklığa neden olur. Bu çalışmada, AN risk faktörlerinin tespit edilmesi, tanı ve tedavisindetecrübelerimizin paylaşımı amaçlanmıştır.Materyal ve Metod: Yatarak takip ve tedavi edilen 766 PA hastası retrospektif olarak değerlendirildi. Hastaların demografik özellikleri(yaş, cinsiyet), yandaş hastalık, PA lokasyonu, lokülasyon varlığı, uygulanan medikal ve cerrahi tedaviler, ampiyemin nüksü, postoperatifveya posttravmatik olma durumu, kültür sonuçları, AN varlığı, morbidite ve mortalite oranları not edildi. İstatistiksel analiz için SPSS v20.0programı kullanıldı.Bulgular: Ampiyema nesessitatis 11 (%1.4) hastada görüldü. İleri yaş ve Mycobacterium tuberculosis PA, AN gelişmesi için risk faktörleriolarak saptandı. Ampiyema nesessitatis grubunda etken mikroorganizmalar anlamlı olarak daha fazla tespit edildi ve majör cerrahioperasyon daha geç yapıldı. Bununla beraber cinsiyet, mevcut sağlık sorunları, PA tarafı, lokülasyon varlığı, göğüs tüpü uygulanması, M.tuberculosis dışı etken mikroorganizma, ampiyemin etyolojik sebebi ve majör cerrahi uygulanmış olması risk faktörü olarak saptanmadı.Sonuç: Ampiyema nesessitatis PA’nın nadir bir komplikasyonudur ve en önemli nokta gelişmesinin önlenmesidir. İleri yaşlarda daha sıkgörülür ve M. tuberculosis en sık etkendir. Medikal ve cerrahi tedavi prensipleri PA ile aynıdır. Hastalığın göğüs duvarı yumuşak dokuinfeksiyonu veya apsesi olarak tanı alması tedavide gecikmeye neden olur.