Accidental Use of Sodium Hypochlorite Instead of Haemodialysis Solution: A Case Report

Haemodialysis that involves diffusion of solutes across a semi-permeable membrane allows excretion of harmful solutes and excess fluids. All dialysis machines are disinfected by chemical agents (e.g. sodium hypochlorite, formaldehyde, glutaraldehyde, peroxyacetic acid). Sodium hypochlorite (NaOCl), which is known as household bleach, is a whitening agent and used in medical treatment and disinfection of tap water. Herein, we present a 66-year-old female patient who was inadvertently connected to NaOCl solution infusion in a routine haemodialysis session. By the time the accident was noticed, approximately 200 ml of undiluted NaOCl cleaning solution (concentration 1.21-1.23 g/ml) had been added to the dialysis bath, soaking the membrane fibres. The patient was admitted to the hospital about 30 minutes after the exposure, and her Glasgow Coma Scale score was recorded as 5/15 (E1, V1, M3). In conclusion, more stringent standards should be enforced in the sterilization of haemodialysis machines and related equipments. Accidental contacts with disinfectants should be prevented in dialysis units.

Atmospheric concentrations, distributions and air-soil exchange tendencies of PAHs and PCBs in a heavily industrialized area in Kocaeli, Turkey

Dilovasi is one of the heavily industrialized areas in Turkey with serious environmental problems. In this study, the atmospheric concentration of PAHs and PCBs were measured for a whole year at 23 sites. The average ambient air Σ₁₅PAH and Σ₄₁PCB concentrations were found as 285 ± 431 ng m^-3 and 4152 ± 6072 pg m^-3, respectively. PAH concentrations increased with decreasing temperature especially in urban areas, indicating the impact of residential heating. However, PCB concentrations mostly increased with temperature probably due to enhanced volatilization from their sources. The gradient obtained for PCBs, rural < suburban < urban < industrial/urban, is more clear than those obtained for PAHs. The average Σ₁₅PAH and Σ₄₁PCB soil concentrations were found as 992 ± 1323 and 18.8 ± 32.0 μg kg^-1, respectively. PCB soil concentrations did not show significant temporal variations while PAH concentrations were variable especially for urban areas. The volatilization tendencies of low and medium molecular weight PAHs from soil to air were higher in industrial-urban areas than rural sites, showing that soil was a secondary source for PAHs. Fugacity ratios of PCBs were mostly <1.0 for the whole sampling period. Although the source/sink tendency of soil for some PCBs depends on their volatility, considering the whole data, PCBs were generally deposited to soil.

Size segregated PM and its chemical composition emitted from heated corn oil

Characterization of the airborne particulate matter (PM) emitted from cooking components including cooking oil, and additives like salt has not been carefully investigated. This study provides new data on the concentration, composition, and emission rates/fluxes of PM (less than 3.3µm) generated during heating corn oil and corn oil with added table salt. The concept of emission flux was employed to estimate the emission rates in this study. A statistically significant reduction of 47.6% (P<0.05) in the total PM emission rate and emission flux were observed when salt was added to the heated corn oil (5.15×10¹mgmin^-1) compared to the pure oil (9.83×10¹mgmin^-1). The OC emission rate decreased 61.3% (P<0.05) when salt was added to the corn oil (2.35×10¹mgmin^-1) compared to the pure corn oil (5.83×10¹mgmin^-1). With the salt, the total EC emission rate was 6.99×10^-1mgmin^-1, a 62.7% reduction in EC emission compared to pure corn oil (1.88mgmin^-1). These results suggest that table salt can be added to the corn oil prior to frying to reduce exposure to cooking generated PM.

PAHs and PCBs in an Eastern Mediterranean megacity, Istanbul: Their spatial and temporal distributions, air-soil exchange and toxicological effects

Istanbul, one of the mega cities in the world located between Asia and Europe, has suffered from severe air pollution problems due to rapid population growth, traffic and industry. Atmospheric levels of PAHs and PCBs were investigated in Istanbul at 22 sampling sites during four different sampling periods using PUF disk passive air samplers and spatial and temporal variations of these chemicals were determined. Soil samples were also taken at the air sampling sites. At all sites, the average ambient air Σ₁₅PAH and Σ₄₁PCB concentrations were found as 85.6 ± 68.3 ng m^-3 and 246 ± 122 pg m^-3, respectively. Phenanthrene and anthracene were the predominant PAHs and low molecular weight congeners dominated the PCBs. The PAH concentrations were higher especially at urban sites close to highways. However, the PCBs showed moderately uniform spatial variations. Except four sites, the PAH concentrations were increased with decreasing temperatures during the sampling period, indicating the contributions of combustion sources for residential heating, while PCB concentrations were mostly increased with the temperature, probably due to enhanced volatilization at higher temperatures from their sources. The results of the Factor Analysis represented the impact of traffic, petroleum, coal/biomass and natural gas combustion and medical waste incineration plants on ambient air concentrations. A similar spatial distribution trend was observed in the soil samples. Fugacity ratio results indicated that the source/sink tendency of soil for PAHs and PCBs depends on their volatility and temperature; soil generally acts as a source for lighter PAHs and PCBs particularly in higher temperatures while atmospheric deposition is a main source for higher molecular weight compounds in local soils. Toxicological effect studies also revealed the severity of air and soil pollution especially in terms of PAHs in Istanbul.

Oxidase Activity of Ceruloplasmin and Some Acute Phase Reactant and Trace Element Concentrations in Serum of Patients with Chronic Lymphocytic Leukemia

In the present study, we aimed to investigate the parameters in serum of patients with chronic lymphocytic leukaemia (CLL) and correlate with the cancer stage. The serum concentrations of ceruloplasmin, a-1-acid glycoprotein, albuminumin, transferrin, copper, zinc, manganese, and ceruloplasmin oxidase activity were measured, and compared with those from a healthy control group. The serum from 34 patients with CLL were extracted before chemotherapy. Serum transferrin, albuminumin and Zinc concentrations were lower in patients with CLL while serum a-1-acid glycoprotein, ceruloplasmin, copper concentrations, and ceruloplasmin oxidase activity were higher in CLL patients when compared with the control group. Although serum manganese concentration was lower in CLL groups than in the control group, the difference was not statistically significant. Serum transferrin concentration was lower in the early stage group compared with the advanced stage. Serum ceruloplasmin level positively correlated with serum ceruloplasmin oxidase activity in patients from the early stage group. Serum ceruloplasmin level positively correlated with serum ceruloplasmin oxidase activity in patients with advanced stage. In conclusion, increased serum ceruloplasmin oxidase activity, ceruloplasmin, a-1-acid glycoprotein, copper levels and decreased transferrin and albuminumin, unchanged manganese levels are associated with CLL and appear to be a consequence of the disease itself.

Neutrophil-Lymphocyte Ratio Is Significantly Decreased in Preemptive Renal Transplant Patients

AIM

Cardiovascular diseases and infections are the leading two causes of morbidity and mortality in end-stage renal disease (ESRD) patients. Kidney transplantation is the preferred method for renal replacement owing to better survival. There are reports of irreversibly damaged immune system in dialysis patients, which did not return to normal even after kidney transplantation. The neutrophil-lymphocyte ratio (NLR) is an easily applicable method for evaluation of inflammation. We hypothesized that preemptive kidney transplantation can improve inflammatory state compared with nonpreemptive recipients. To test our hypothesis, we retrospectively investigated pretransplant and posttransplant NLR and C-reactive protein (CRP) levels of ESRD patients and compared them with values in healthy controls.

MATERIALS AND METHODS

We retrospectively analyzed NLR, CRP, and other hematologic parameters of ESRD patients who were transplanted between January 2005 and January 2014 on the day of transplantation and at the end of first year. We grouped the patients as preemptive and nonpreemptive ones. We excluded patients with coronary artery disease, obesity, hypotension, hyperthyroidism, uncontrolled diabetes mellitus, hematologic or solid organ cancers, and active documented infection at any evaluation period.

RESULTS

We included 137 ESRD patient and 34 healthy control individual in our study. Of the 137 ESRD patients, 52 (38%) were transplanted preemptively. Of the patients, 85 were already on either hemodialysis or peritoneal dialysis therapy at the time of transplantation. The white blood cell count value of the patient and control group (7246.72 ± 1460.26 and 76661.76 ± 1286.29, respectively; P = .43), NLR of the control group was significantly lower than patient group (1.98 ± 0.94 and 3.47 ± 2.33, respectively; P = .007). The NLR of the preemptive group was decreased substantially at the end of first year posttransplantation, the NLR of the preemptive group was significantly lower than the nonpreemptive group (3.08 ± 1.32 and 3.71 ± 2.33; P = .01).

CONCLUSIONS

We showed that all ESRD patients had an increased inflammation rate according to CRP and NLR when compared with healthy controls. We also found that improvement of inflammatory state in preemptive patients is significantly better than nonpreemptive patients at the end of first year evaluation.

Caregiver Burden, Anxiety, Depression, and Sleep Quality Differences in Caregivers of Hemodialysis Patients Compared With Renal Transplant Patients

BACKGROUND

We compared the caregivers of hemodialysis (HD) patients and caregivers of patients with renal transplantation (Tx) in terms of anxiety, depression, sleep quality, and caregiver burden. We believe that caregivers of HD have more difficult conditions than caregivers of the patients with Tx.

METHODS

This cross-sectional study analyzed the psychological status of caregivers of Tx patients compared with those of HD patients with using the Hospital Anxiety and Depression Scale, Zarit Burden Interview, and Pittsburg Sleep Quality Indexes. We recruited 133 caregivers-65 caregivers in the Tx group and 68 in the HD group.

RESULTS

Mean age was 43.1 ± 8.5 years. The age, sex, income level, and education level were similar between the 2 groups. Caregivers in the HD group had significantly higher rates of anxiety and depression compared with the Tx group (P = .007 and P < .001, respectively). Good sleep quality rates for caregivers in the Tx group and caregivers in the HD group were 92% (n = 60) and 63% (n = 43), respectively. Poor sleep quality was significantly higher in caregivers in the HD group compared with caregivers in the Tx group (P < .001). Caregiver burden scores were significantly higher for caregivers in the HD group compared with caregivers in the Tx group (P < .001).

CONCLUSIONS

We suggest that Tx is the more appropriate renal replacement therapy for caregivers who undertake the care of patients with end-stage renal disease and chronic kidney disease.

Changes in Exfoliative Cell of Oral Mucosa in Kidney Transplant Patients

OBJECTIVES

The aim of this study was to investigate quantitative cytologic changes in oral mucosal smears collected from kidney transplant patients by modern stereologic methods.

METHODS

We enrolled 32 kidney transplant patients. Smears were obtained from the buccal mucosa transplant patients before and 12 months after kidney transplantation. Smears from each individual were stained using the Papanicolaou method and were analyzed using a stereological method.

RESULTS

Statistically, the nuclear volumes and cytoplasmic volumes in the cells of buccal mucosa were markedly higher after kidney transplantation (P < .05). There was a decreased positive cell density in the oral epithelial cells after kidney transplantation compared with before renal transplantation (P < .05).

CONCLUSIONS

These findings suggest that there are alterations in the oral epithelial cells after kidney transplantation, which are detectable by microscopy and cytomorphometry.

[Capsule endoscopy in a supra-regional network corporation: experience in more than 1000 cases]

INTRODUCTION

Capsule endoscopy (CE) is firmly established as a standard procedure in the diagnostic algorithm of mid gastrointestinal (GI) bleeding. Despite its excellent diagnostic yield, missing expertise, reading time and financial expenditure limit an area-wide availability. A multicentric cooperation might compensate these disadvantages.

METHODS

The CE device was bought by a centrally located hospital (CH). CE-equipment is transported to the network partner (NP) on request and the procedure performed at the spot. Video reading is exclusively done in the CH.

RESULTS

Between January 2002 and July 2013, 1026 CE (548 m, 478f; 64 ± 16, 13 - 93 yrs.) were performed within the network. 744/1026 (73 %) CE were done at 17 NP, 282/1026 (27 %) in the CH. Between 2002 (n = 39) and 2012 (n = 136) the annual number of CE increased threefold. Leading indication for CE was suspected mid GI-bleeding (80 %). Mean latencies between requested date and actual examination were less than 24 h and 2 days between CE performance and report. 95 % of the capital investment in each cooperating hospital could be avoided by sharing one workstation within the network.

CONCLUSION

The experience from more than 1000 CE show that long-term multicentric utilization of CE equipment is feasible. Such a network runs at stable procedural quality levels similar to an in-house supply, allows an economic as well as area-wide availability of CE and improves reading expertise by centralized video evaluation.

Psychological and emotional status, and caregiver burden in caregivers of patients with peritoneal dialysis compared with caregivers of patients with renal transplantation

OBJECTIVES

We sought to examine the relationship between caregivers of continuous ambulatory peritoneal dialysis (CAPD) and of renal transplant (Tx) patients with regard to sleep quality, anxiety, depression, and overall burden.

METHODS

This cross-sectional study of prevalent caregivers of CAPD patients and of renal Tx patients used a multidimensional instrument to assess the association of sleep quality, depression and anxiety symptoms, as well as burden using a Zarit Burden Interview. Among the 113 caregivers who participated in this study, 53 were in the Tx and 60 in the CAPD group.

RESULTS

The overall mean age was 40.7 ± 13.6 years. The proportions of age, gender, income, and education level were similar between the 2 groups. Caregivers of peritoneal dialysis patients had significantly higher rates of anxiety and depression compared with the Tx group (P = .039 and P = .003, respectively). Good sleep quality rates for caregivers of Tx versus CAPD patients were 88.7% (n = 47) and 61.7% (n = 37), respectively. Poor sleep quality was significantly higher among caregivers of CAPD compared with those for Tx patients (P = .001). Caregiver burden scores were significantly higher in caregivers of CAPD patients compared with Tx patients (P < .001). Upon logistic regression analysis, caregivers of CAPD patients were 2.61 times (95% confidence interval, 1.03-6.59; P = .043) higher than the caregiver burden risk than those for Tx patients.

CONCLUSIONS

This study indirectly indicated that renal Tx improves the life quality and decreases psychiatric symptoms among caregivers of ESRD patients.

Does a predialysis education program increase the number of pre-emptive renal transplantations?

OBJECTIVES

Renal transplantation (RT) is the most appropriate form of treatment for end-stage renal disease (ESRD). Pre-emptive RT decreases the rates of delayed graft function and acute rejection episodes, increasing patient and graft survival, while reducing costs and complications associated with dialysis. In this study, we investigated the relationship between a predialysis education program (PDEP) for patients and their relatives and pre-emptive RT.

METHODS

We divided 88 live donor kidney transplant recipients into 2 groups: transplantation without education (non-PDEP group; n = 27), and enrollment in an education program before RT (PDEP group n = 61).

RESULTS

Five patients in the non-PDEP group underwent pre-emptive transplantation, versus 26 of the PDEP group. The rate of pre-emptive transplantations was significantly higher among the educated (42.62%) versus the noneducated group (18.51%; P < .001).

CONCLUSION

PDEP increased the number of pre-emptive kidney transplantations among ESRD patients.

Cu/Zn-superoxide dismutase, paraoxonase and arylesterase activities and malondialdehyde levels in patients with familial mediterranean fever

OBJECTIVES

In this study, alterations in antioxidant enzyme activities and malondialdehyde (MDA) levels in the serum samples of patients with familial Mediterranean fever (FMF), an autosomal recessive disease characterized by recurrent episodes of peritonitis, pleuritis, arthritis and fever, were investigated and compared with those of age- and sex-matched healthy controls.

METHODS

Twenty-five patients with FMF undergoing colchicine therapy at doses of 1-1.5 mg and 25 age- and sex-matched healthy controls were included in the study. In the patients with FMF and control subjects, the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level were measured. Cu/Zn-superoxide dismutase (Cu/Zn-SOD), paraoxonase-1 (PON-1) and arylesterase (ARE) enzyme activities and MDA levels as a production of lipid peroxidation were evaluated using the appropriate methods.

RESULTS

No statistically significant differences in the serum levels of ESR, CRP, Cu/Zn-SOD, MDA and PON-1 between the groups were observed (p>0.05). Serum ARE activity was significantly decreased in the patients with FMF compared with the control subjects (p<0.01).

CONCLUSION

In conclusion, some abnormalities in the antioxidant defense system and lipid peroxidation may be observed in FMF patients during attack-free periods. However, further long-term studies on the subject are needed to explore altered lipid peroxidation and antioxidant defense mechanisms in patients with FMF (Tab. 1, Fig. 1, Ref. 35).

Comparison of the oxidant-antioxidant parameters and sialic acid levels in renal transplant patients and peritoneal dialysis patients

OBJECTIVE

Several studies have shown that in end-stage renal failure, increased oxidative stress and reduced antioxidant system functions may play an important role in inflammation, atherosclerosis, and many other complications. Paraoxonase (PON) and arylesterase (ARE) are antioxidant and malondialdehyde (MDA) an oxidant agent. Increased sialic acid (SyA) levels in uremic patients is an acute-phase response showing tissue and organ damage. The aim of this study was to compare PON, ARE, MDA, and SyA among continuous ambulatory peritoneal dialysis (CAPD) and renal transplant patients.

METHODS

Twenty-six CAPD patients including 7 women and 19 men of overall mean age 40.5 ± 10.66 years were included in this study. There were 28 preemptive transplant patients, namely 6 women and 22 men of overall mean age 36.5 ± 10.97 years. CAPD was the initial sole replacement therapy. Serum PON, ATE, MDA, and SyA levels were measured at 13-15 months of treatment.

RESULTS

Higher PON (P = .015) and ARE (P = .002) and lower MDA (P = .002) and SyA (P = .000) values were determined among transplanted compared with CAPD patients.

CONCLUSIONS

In the transplant group, antioxidant parameters were higher and oxidant parameters lower with less activation of SyA than in the CAPD group. We observed that renal transplantation had a constructive effect on the oxidant-antioxidant system and consequent tissue destruction, which were impaired in uremic subjects. This study showed that renal transplantation is a more appropriate replacement treatment than CAPD.

Central retinal vein thrombosis and hyperhomocysteinemia in a young patient with renal transplantation

A 28-year-old woman was admitted with a sudden loss of vision in the right eye. She underwent renal transplantation in June 1999 for chronic renal failure secondary to amyloidosis. Upon ophthalmologic examination, the patient was diagnosed with central retinal vein occlusion. Physical and laboratory examinations failed to disclose any remarkable pathology except for high homocysteine levels. Hyperhomocysteinemia has been reported as a potential risk factor requiring treatment and a significant association has been found between this condition and central retinal vein thrombosis.

Detecting the limits of bronchial closure methods in an animal model

BACKGROUND

Bronchopleural fistula is a serious complication of major lung resections that may lead to mortality. An experimental animal model was designed to find out the safest bronchial closure method by comparing leakage rates under pressure.

METHODS

The tracheobronchial trees of 50 freshly dead sheep were prepared for either manual closure or closure with a stapler. After left pneumonectomy, the specimens were divided into five groups (n = 10); 3/0 Premilene suture was used with two "u" sutures + interrupted sutures in Group I; in Group II, 3/0 Premilene sutures with continuous horizontal mattress + over-over continuous sutures were used. In Group III and IV the same techniques were used with 3/0 Vicryl. A stapler was used in Group V. Specimens were intubated with an endotracheal tube, connected to a sphygmomanometer, and subsequently positioned under water. The pressure level at which we detected air bubbles indicated the limits of the technique.

RESULTS

The median leakage pressure resistance was significantly lower in Group III (135 mm Hg) ( P = 0.001). The best results were achieved by using the continuous horizontal mattress + over-over continuous suture technique. No statistical significance difference was found between the stapler group, Groups I, II, and IV in terms of median leakage pressures.

CONCLUSIONS

This trial suggests that manual suture closure using an appropriate technique and monofilament materials is as safe as the stapler.

The Impact of Immunohistochemical Detection of Positive Lymph Nodes in Early Stage Lung Cancer

BACKGROUND

Detection of micrometastatic disease is an interesting area in non-small cell lung cancer (NSCLC). We conducted a study to determine whether the detection of mediastinal lymph node spread by immunohistochemical (IHC) analysis offers some prognosis with respect to patients' disease-free survival or not.

METHODS

Between 1997 and 2003, twenty-one early stage lung cancer patients underwent complete resection with mediastinoscopy and systemic nodal dissection. Four hundred and twenty-six paraffin-embedded lymph node sections from 21 patients were analyzed. Epithelial specific-antigen Ab-9 and Keratin-Pan Ab-1 were used as IHC marker.

RESULTS

Based on nodal spread four of the 21 patients (19.04%) were up-staged after IHC analysis. Two patients with stage IB (T2N0) up-staged to stage IIIA (T2N2); two patients staged as IIB (T2N1) up-staged to IIIA (T2N2). Statistical analysis showed that the lymphatic dissemination detected with IHC analysis was associated with reduced disease-free survival (DFS) (p = 0.002).

CONCLUSIONS

Our study provides some indication that patients with lymphatic micrometastasis have a reduced DFS. Before creating a new TNM staging system, more information is needed to understand the prognostic impact of micrometastatic dissemination.

Surgical treatment of pulmonary hydatid disease in children: report of 122 cases

BACKGROUND/PURPOSE

The aim of this study was to review the authors' surgical experience in pediatric pulmonary hydatid disease focusing on clinical presentation, parenchyma saving operations, and long-term results.

METHODS

One hundred twenty-two children with pulmonary hydatid cyst were treated surgically over the last 2 decades and were reviewed retrospectively. There were 66 boys and 56 girls with a mean age of 9 years.

RESULTS

Pulmonary hydatid cyst was seen in 111 (91%) patients and pulmonary and hepatic cysts in 11 (9%). Lateral thoracotomy was performed in 106 (87%) patients, thoracotomy and laparotomy in 6 (5%), median sternotomy in 5 (4%), lateral thoracotomy with phrenotomy in 4 (3%), and median sternotomy with phrenotomy in 1 (0.8%). Parenchyma-saving procedures were performed in 114 patients (93%) and lung resection in 8 (7%). There was no mortality. Postoperative complication was seen in 5 patients (4%).

CONCLUSIONS

Parenchyma-saving procedures without capitonnage are preferable. In patients with right or bilateral lung and coexisting cysts in the upper part of the liver, thoracotomy or median sternotomy and transdiaphragmatic approach allows the surgeon to remove the lung and liver cysts in a single operation. Median sternotomy is an alternative method for the bilateral lung hydatidosis compared with sequential thoracotomy.

Video-assisted thoracoscopic surgery: experience with 341 cases

OBJECTIVE

Until recently, thoracoscopy had been used primarily for diagnostic purposes for more than 80 years in thoracic diseases. In this report we reviewed our video-assisted thoracoscopic surgery experience with 341 cases focusing on indications, operative procedures, complications or failure rates.

PATIENTS AND METHODS

Over the last 3 years, we performed 459 video-assisted thoracoscopic procedures. There were 206 male and 135 female patients.

RESULTS

The indications were diagnostic in 171 cases, and therapeutic in 170 cases. There were no operative mortality. Non-fatal complications were seen in 15 cases (4.4%). The mean postoperative stay was 5 days. The specific procedures performed were operations on the pleura (237 cases), lung (158 cases), mediastinum (56 cases) and pericardium (four cases). Conversion to thoracotomy was needed in 43 cases (12.6%). Definitive diagnosis was obtained in 100% of patients with pulmonary nodule/mass or diffuse lung disease, and 95.2% of patients with undiagnosed pleural effusions. The success rate of thoracoscopic approach in non-tuberculous thoracic empyema was 87.3%.

CONCLUSIONS

Video-assisted thoracoscopic surgery is an ideal procedure in the following situations: (1) undiagnosed pleural effusion, (2) recurrent pneumothorax or bullous lung disease, (3) stage II thoracic empyema, (4) lung cancer staging, (5) peripheral pulmonary nodule, and (6) wedge biopsy for diffuse lung disease.

Factors affecting postoperative morbidity and mortality in destroyed lung

BACKGROUND

The presence of specific risk factors can increase the postoperative complication rate of pneumonectomy for destroyed lung.

METHODS

Our experience in 118 consecutive patients who underwent pneumonectomy for destroyed lung over a 10-year period was retrospectively analyzed to evaluate the effect of specific risk factors on postoperative complications. The significance of tuberculosis, right pneumonectomy, preoperative empyema, and duration of illness longer than 36 months was examined by univariate analyses.

RESULTS

The most common underlying diseases were nonspecific bronchiectasis (n = 52) and tuberculosis (n = 43). Sixty-day or in-hospital morbidity and mortality rates were 11.9% and 5.9%, respectively. The combined morbidity and mortality rate was significantly higher in patients with preoperative empyema (p < 0.003), tuberculosis (p < 0.03), and right pneumonectomy (p < 0.03). The prevalence of bronchopleural fistula was higher in patients with preoperative empyema (p < 0.02) and patients with tuberculosis (p < 0.03).

CONCLUSIONS

The postoperative complication rate of pneumonectomy for destroyed lung is acceptably low. However, it is increased by preoperative empyema, tuberculosis, and right-sided resection.

Giant hydatid cysts of the lung

BACKGROUND

Hydatid disease is a parasitic infection caused by Echinococcus granulosus, characterized by cystic lesions in the liver, lungs, and, rarely, in other parts of the body. The large cysts in the lung are a special clinical entity called giant hydatid cysts. Characteristics on presentation, operative techniques, and postoperative morbidity and mortality rates in 47 patients with 50 giant pulmonary hydatid cysts 10 cm in diameter or larger were reported in this study.

METHODS

Cystotomy plus the obliteration of the residual cavity by imbricating sutures from within (capitonnage) was the most frequently used operative technique (n = 31), followed by pericystectomy plus capitonnage (n = 6), closure of bronchial openings plus pericystectomy (n = 6), and lobectomy (n = 3).

RESULTS

The mean age of patients with giant hydatid cyst of the lung was lower than the age of those with usual-sized cysts (p = 0.04). Five patients had prolonged air leaks (more than 10 days), three had empyema, and one had pneumonia in the opposite lung after the operation. One patient died of cardiorespiratory collapse during the operation. There was one recurrence during follow-up.

CONCLUSIONS

The increase in the diameter of the cyst in younger ages was correlated with higher lung tissue elasticity and the delay in diagnosis because of delayed symptoms in these patients. Although postoperative complications occurred in 19.1% of patients, all were managed by conservative measures, and there were no indications that the affected lung should have been treated with resection instead of a parenchyma-saving operation.

Transhiatal versus transthoracic esophagectomy for esophageal cancer

We retrospectively analyzed 238 patients with esophageal carcinoma treated between 1983 and 1991; 120 underwent transthoracic esophagectomy, and 118 underwent transhiatal esophagectomy. The two groups were statistically similar in preoperative characteristics, except that upper esophageal cancer was more frequent in the transhiatal esophagectomy group than in the transthoracic esophagectomy group (p < 0.01). The rate of postoperative complications differed significantly in wound infection (21% in patients who underwent transthoracic esophagectomy, 10% in those who underwent transhiatal esophagectomy; p < 0.05) and empyema (11% with transthoracic esophagectomy, 1% with transhiatal esophagectomy; p < 0.01). Pneumothorax was detected in 24% of the transhiatal esophagectomy cases. Intraoperative blood loss was 1340 +/- 490 ml in the transthoracic esophagectomy group and 930 +/- 340 ml in the transhiatal esophagectomy group (p < 0.001). Hospital mortality was 11% in the transthoracic esophagectomy group and 6.7% in the transhiatal esophagectomy group. Late complication rate was lower with transhiatal esophagectomy than with transthoracic esophagectomy (11% and 51%, respectively). There was no significant difference in actuarial survival of patients in both groups. Transhiatal esophagectomy, which can be performed in almost all levels of the esophagus, is the safer of the two operations.