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Öğe Congenital lobar emphysema(Wiley-Blackwell, 2008) Ulku, Refik; Onat, Serdar; Ozcelik, CemalBackground: 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.Öğe 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, CemalBackground: 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.Öğe Hemangioma of the Sternum(Elsevier Science Inc, 2008) Onat, Serdar; Ulku, Refik; Avci, Alper; Mizrak, Bulent; Ozcelik, CemalPrimary tumors of the sternum are rare and most of them are malignant. Benign lesions are typically chondromas, bone cysts, or hemangiomas. Among these tumors, hemangiomas are extremely rare. We report a rare case of hemangioma of the sternum. The patient was successfully treated with complete resection of the tumor and sternum stability was obtained by polypropylene mesh and methylmethacrylate.Öğe Right-sided Bochdalek hernia in an adult: a case report(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2011) Ulku, Refik; Avci, Alper; Onat, Serdar; Ozcelik, CemalCongenital right diaphragmatic hernia of Bochdalek rarely occurs in adults. Most of them are asymptomatic. In this article, we report a case of a 21-year-old male with right-sided Bochdalek diaphragmatic hernia who presented with abdominal pain and dyspnea. The chest radiography showed features suggestive of right-sided diaphragmatic hernia. This was confirmed on a computed tomography. The patient underwent right posterolateral thoracotomy whereby a 10 cm posterolateral diaphragmatic defect with herniation of the colon and kidney through the opening was found. During surgery the colon and right kidney were reduced into peritoneal cavity, and the diaphragmatic defect was repaired with non-absorbable sutures. The patient's recovery was uneventful. He remained well at six-month follow-up.Öğe Risk factors affecting post-traumatic acute respiratory distress syndrome development in thoracic trauma patients(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2019) Avci, Alper; Sarac, Ezgi Ozyilmaz; Eren, Tahir Sevval; Onat, Serdar; Ulku, Refik; Ozcelik, CemalBackground: This study aims to investigate the risk factors affecting post-traumatic acute respiratory distress syndrome development in thoracic trauma patients. Methods: This two-centered, retrospective study included 3,080 thoracic trauma patients (2,562 males, 518 females; mean age 33.9 +/- 19.4 years; range, 2 months to 91 years) treated between January 2005 and January 2019. Demographic characteristics, mechanisms of injury, traumatic injuries, injury severity score and new injury severity score results, treatments, comorbidities, complications, morbidity and mortality rates, and durations of hospital stay were collected. Data were used to predict the risk factors for development of post-traumatic acute respiratory distress syndrome by univariate and multivariate statistical analysis. Results: Acute respiratory distress syndrome was detected in 81 patients. In multivariate logistic regression analysis; age, pulmonary contusion, intracranial hemorrhage, rib fracture (unilateral and four-five pieces), femur and tibia fracture, diabetes mellitus, chronic obstructive pulmonary disease, blood transfusion (>= 3 units), high white blood cell count at admission, sepsis, and hepatic injury were detected as independent risk factors (p<0.05). Optimal cutoff points (sensitivity/specificity ratios) for acute respiratory distress syndrome development risk were >= 16 (79%/68%) for injury severity score, >= 27 (90%/68.7%) for new injury severity score, and >= 16,000 (75.3%/71.6%) for admission white blood cell count. New injury severity score was superior than injury severity score to predict the development of acute respiratory distress syndrome. Conclusion: Acute respiratory distress syndrome causes significant mortality and morbidity in trauma patients. In addition to the well-known risk factors, diabetes mellitus and chronic obstructive pulmonary disease were independent risk factors. We defined a cutoff value for new injury severity score to predict post-traumatic acute respiratory distress syndrome.Öğe Spontaneous cyst-cutaneous fistula caused by pulmonary hydatid cyst: An extremely rare case(Dicle Üniversitesi Tıp Fakültesi, 2008) Onat, Serdar; Avcı, Alper; Ulku, Refik; Ozcelik, Cemal[Özet Yok]Öğe Thoracic Wall Necrotizing Fascitis in a Neonate: a Case Report(Derman Medical Publ, 2010) Onat, Serdar; Avci, Alper; Ulku, Refik; Oruc, Menduh; Ozcelik, CemalNecrotizing fasciitis (NF) is a rapidly progressive and potentially life-threatening infection of superficial fascia and subcutaneous tissue. Thoracic wall is one of the rarest locations for NF. Broad-spectrum antibiotics receiving, early surgical debridement, and skin grafting are life saving in NF. We report a 7-day-old female neonate who had left sided thoracic wall NF. She had undergone extensive surgical debridement within 4 hours of hospital admission, and reconstruction of skin defect by split-thickness skin grafting later. Early diagnosis is important, as prompt surgical debridement offers the best chance for survival. Early and extensive surgical debridement is a widely accepted clinical approach and the mainstay of effective treatment. The goals of surgical intervention are to remove all necrotic tissues, and to help control the progression of NF. Reconstruction of skin defects should be performed by early split-thickness skin grafting like our patient or primary closure. Because early wound resurfacing prevents fluid, electrolyte, and protein loss from the wound site, and decreases secondary infection. Although chest wall NF is rare in neonates, it is a rapidly spreading, highly lethal infection. A high index of suspicion, early diagnosis, and aggressive approach are essential to its successful treatment.Öğe Treatment of pediatric parapneumonic empyemas with pulmonary cavitary lesions(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2013) Alar, Timucin; Ozcelik, Cemal; Onat, Serdar; Ozcelik, Zerrin; Bayar, Emin SirriBackground: This study aims to evaluate the treatment approach and timing of surgical intervention in pediatric parapneumonic empyema cases with cavitary lesions. Methods: Between January 1990 and December 2006, 38 patients (21 boys, 17 girls; mean age 4.1+2 years; range 1 to 15 years) from the pediatric age group treated for parapneumonic empyema with cavitary lung lesions at the Dicle University Faculty of Medicine Department of Thoracic Surgery were retrospectively analyzed. The demographic characteristics, symptom duration, radiological examinations, treatment methods, and time to recovery of cavitary lesions during the hospitalization and follow-up were evaluated. Results: A total of 13 patients (34%) were given medical treatment, while 25 (66%) underwent surgical treatment. The medical treatment group had a statistically significantly shorter inpatient duration than the surgical treatment group (p=0.010). Analysis of the postoperative inpatient duration revealed that the surgically treated patients stayed statistically significantly shorter in the hospital than the medical treatment group (p<0.001). A bronchopleural fistula (BPF) was found in eight (21%) patients and all were in the surgical treatment group. The mean time to recovery of cavitary lesions during follow-up was 48.7 +/- 8 days (range, 22-106 days). Conclusion: Treatment of parapneumonic pediatric empyema cases with cavitary lesions should include controlling the pleural process with standard empyema treatment, considering pneumonia treatment as an integral part of the disorder, performing surgical treatment if a bronchopleural fistula is present or otherwise waiting patiently for the cavitary lesions to regress and postponing open surgical treatment until the recovery period is completed.Öğe Urgent thoracotomy for penetrating chest trauma: Analysis of 158 patients of a single center(Elsevier Sci Ltd, 2011) Onat, Serdar; Ulku, Refik; Avci, Alper; Ates, Gungor; Ozcelik, CemalBackground: Penetrating injuries to the chest present a frequent and challenging problem, but the majority of these injuries can be managed non-\operatively. The aim of this study was to describe the incidence of penetrating chest trauma and the ultimate techniques used for operative management, as well as the diagnosis, complications, morbidity and mortality. Methods: A retrospective 9-year review of patients who underwent an operative procedure following penetrating chest trauma was performed. The mechanism of injury, gender, age, physiological and outcome parameters, including injury severity score (ISS), chest abbreviated injury scale (AIS) score, lung injury scale score, concomitant injuries, time from admission to operating room, transfusion requirement, indications for thoracotomy, intra-operative findings, operative procedures, length of hospital stay (LOS) and rate of mortality were recorded. Results: A total of 1123 patients who were admitted with penetrating thoracic trauma were investigated. Of these, 158 patients (93 stabbings, 65 gunshots) underwent a thoracotomy within 24 h after the penetrating trauma. There were 146 (92.4%) male and 12 (7.6%) female patients, and their mean age was 25.72 +/- 9.33 (range, 15-54) years. The mean LOS was 10.65 +/- 8.30 (range, 5-65) days. Patients admitted after a gunshot had a significantly longer LOS than those admitted with a stab wound (gunshot, 13.53 +/- 9.92 days; stab wound, 8.76 +/- 6.42 days, p < 0.001). Patients who died had a significantly lower systolic blood pressure (SBP) on presentation in the emergency room (42.94 +/- 36.702 mm Hg) compared with those who survived (83.96 +/- 27.842 mm Hg, p = 0.001). The overall mortality rate was 10.8% (n = 17). Mortality for patients with stab wounds was 8/93 (8.6%) compared with 9/65 (13.8%) for patients with gunshot wounds (p = 0.29). Concomitant abdominal injuries (p = 0.01), diaphragmatic injury (p = 0.01), ISS (p = 0.001), chest AIS score (p < 0.05), ongoing output (p = 0.001), blood transfusion volume (p < 0.01) and SBP (p = 0.001) were associated with mortality. Conclusion: Penetrating injuries to the chest requiring a thoracotomy are uncommon, and lung-sparing techniques have become the most frequently used procedures for lung injuries. The presence of associated abdominal injuries increased the mortality five-fold. Factors that affected mortality were ISS, chest AIS score, SBP, ongoing chest output, blood transfusion volume, diaphragmatic injury and associated abdominal injury. (C) 2010 Elsevier Ltd. All rights reserved.Öğe Vascular Tumors of the Sternum Reply(Elsevier Science Inc, 2009) Onat, Serdar; Ulku, Refik; Avci, Alper; Ozcelik, Cemal; Mizrak, Bulent[Abstract Not Available]
