Evaluation of peripheral blood CD34+ cell count in the acute phase of traumatic brain injury and chest trauma

AIM

To determine the impact of traumatic brain injury (TBI) and chest trauma (CT) on the number of peripheral blood (PB) stem cells in affected patients in comparison to normal controls. Additionally, the aim was to determine the relationship between CD34+ cell counts and TBI-induced hypothalamus-pituitary-adrenal axis dysfunction in the acute phase of trauma.

PATIENTS AND METHOD

Thirty patients with TBI, 12 patients with CT and 53 healthy subjects were included in the study.

RESULTS

CD34+ cell counts within the first 24-48 hours of TBI were found to be lower than those obtained on the 7(th) day of TBI and those in the healthy controls. CD34+ cell counts obtained on the 2(nd) day of CT were lower than those in the healthy group, but did not differ from those measured on the 7(th) day of CT. There was no correlation between CD34+ cell counts and serum total cortisol (STC) levels on the 2(nd) and 7(th) days in the TBI or CT groups.

CONCLUSION

An increase in CD34+ cell counts as observed on the 7(th) day in both TBI and CT groups suggested that CD34 changes were not specific to TBI. Moreover, this study showed for the first time that CD34 response was not affected by changes in cortisol levels induced by TBI and severity of TBI.

CAN SERUM INFLAMMATORY PARAMETERS ESTIMATE OUTCOME OF PLEURODESIS IN MESOTHELIOMA?

BACKGROUND

As pleurodesis causes systemic inflammation and is associated with considerable cost and morbidity during long-term follow up, the identification of patients who will experience an unsuccessful pleurodesis would be desirable. This study was aimed to investigate whether systemic inflammatory reaction induced by insuflation of talc into the pleura can predict the outcome of pleurodesis.

METHODS

A total of 58 consecutive patients (26 men, 32 women) with malignant pleural mesothelioma underwent video-assisted thoracoscopy under general anaesthesia with monopulmonary ventilation between the years 2003 and 2006. Four grammes of asbestos-free and sterile talc were insuflated into the pleural space under direct vision. To assess the success of pleurodesis, chest radiographs were obtained at the 8th and 30th postoperative days. Venous blood samples were drawn both on admission and at the 24th hour after pleurodesis for the analysis of white blood cells, erythrocyte sedimentation rate and C-reactive protein.

RESULTS

The mean age (standard deviation) of patients was 59.0 +/- 12.0 years. Pleurodesis was achieved (no effusion on chest radiograph) in 43 of 58 patients (74.1%)(group I), whereas it was unsuccessful in the remaining 15 patients (25.9%)(group II). There was a significant difference between two groups for basal and postpleurodesis levels of measured inflammatory parameters, C-reactive protein and erythrocyte sedimentation rate (for each, P < 0.05). However, the difference was not significant for white blood cells between the groups.

CONCLUSION

Serum levels of inflammatory parameters (C-reactive protein and erythrocyte sedimentation rate) may be used to predict the success of pleurodesis in patients with malign mesothelioma who underwent thoracoscopic talc poudrage.

Is lobectomy necessary in the treatment of pulmonary hydatid cysts?

BACKGROUND

Hydatidosis is endemic in Turkey and many other areas of the world. The definitive treatment for pulmonary hydatidosis is surgical. The purpose of this study was the review of surgical therapy of our patients with pulmonary hydatid disease and the necessity of lobectomy.

METHODS

We reviewed 107 patients: 26 of whom were women and 81 were men. The median age was 30 years (range, 7-57 years). Chest roentgenogram, abdominal ultrasound and computed tomography of the chest and upper abdomen were carried out as diagnostic study. All patients underwent thoracotomy and cystotomy with or without capitonnage.

RESULTS

Four patients had two cysts in the same lobe and one patient had three cysts (one perforated and two intact) in the left lower lobe (4.6%). In nine patients, the cysts were >10 cm in diameter (8.4%). In 18 patients, the cysts were suppurative (16.8%). None of the patients required lobectomy. Of the 107 patients, prolonged air leaks (n = 8), atelectasis (n = 3) and empyema (n = 3; two had empyema preoperatively because of pleural perforation of cysts and the other had prolonged air leak) were observed in the postoperative period. There was no death.

CONCLUSION

The effective treatment of hydatid cysts in the lung is the complete excision of the cyst with maximum preservation of lung parenchyma. We believe that the decision of lobectomy must be taken very carefully, even in the case of infected hydatid cysts, atelectasis, giant cysts and multiple cysts in the same lobe.

Complications of bronchoscopy for foreign body removal: experience in 1,035 cases

BACKGROUND

Tracheobronchial foreign body aspirations, which threaten lives in childhood, also carry potential risks during and after bronchoscopy. The aim of this study is to review complications and precautions that need to be taken against possible risks.

METHODS

From 1987 to 2005, bronchoscopy was done in 1,035 children in our department on suspicion of foreign body aspiration. The average age of these patients, mostly male (55%), was 4.1 years. Medical history, physical examination, radiological methods and bronchoscopy were used in the diagnosis. Bronchoscopy was applied under general anaesthesia, and the respiratory and cardiac systems were closely observed for 4 hours after the process.

RESULTS

Nine hundred eleven of 1,035 patients (88%) had a foreign body in the tracheobronchial system. In 42 of the patients, infection required aggressive medication; in 30, hypoxia and bradycardia occurred as a result of obstruction during bronchoscopy; in 37, laryngeal edema, laryngeal spasm and/or bronchospasm required ventilation support; in 6 patients, tracheobronchial system bleeding occurred; in 2 patients pneumothorax occurred, in 1 patient pneumomediastinum was observed and 6 patients needed thoracotomies because of foreign body aspiration. In this series there were 8 deaths.

CONCLUSION

Bronchoscopy, performed for tracheobronchial foreign body aspiration, carries a potential life-threatening risk during and after the process. The clinician needs to be aware of these risks, take proper precautions, and perform bronchoscopy by taking the medical condition of the patient and characteristics of the inspired foreign body into consideration.

Turban Pin Aspiration: Non-Asphyxiating Tracheobronchial Foreign Body in Young Islamic Women

BACKGROUND

Foreign body aspiration is rare in adults. However, in recent years, the aspiration of pins which are used for securing turbans (headscarves) is seen frequently in young women. The aim of this article was to review 105 patients who were admitted to our hospital for turban pin aspiration.

METHODS

Chest X-rays were used for diagnosis. Various methods of treatment were performed: laryngoscopy in 6 patients, flexible fiberoptic bronchoscopy in 16, rigid bronchoscopy in 93, and thoracotomy in one patient, while in the other patient the turban pin was spontaneously expectorated.

RESULTS

Localization of the pin in the right bronchial system was common (52%). In 6 patients, turban pins located in the larynx were extracted successfully by direct laryngoscopy. Turban pins were successfully removed with a flexible fiberoptic bronchoscope in 4 patients of the 16 (25%) and by rigid bronchoscope in 93 patients of 94 (99%). The average time until discharge was 18 hours and there was no mortality.

CONCLUSIONS

Turban pin aspiration is common in Islamic populations and treatment usually requires bronchoscopic procedures. In order to minimize turban pin aspiration frequency, we recommend that turbans should be secured by traditional fastening methods or with an apparatus which cannot be aspirated.

Chest wall deformities

BACKGROUND

Pectus deformities and atypical costal anomalies are congenital thoracic wall defects that can cause a marked cosmetic defect with attendant psychological trauma and limited physical performance.

PATIENTS AND METHODS

We reviewed 43 patients with chest wall deformities, 24 (55.8%) were pectus excavatum, 13 (30.2%) pectus carinatum and 6 (14%) atypical costal anomalies, in the last sixteen years. There were nine female and 34 (79.1%) male patients. The mean age of the patients was 14.4 years (range, 5 to 23). Scoliosis (13.5%), Poland's syndrome (5.4%), Marfan's syndrome (5.4%), neurofibromatosis (2.7%), atrial septal defect (2.7%) and mitral valve prolapse (13.5%) were associated with pectus deformities. The modified Ravitch's technique was used in pectus cases. Concomitant surgery was performed in two patients with pectus carinatum.

RESULTS

The complications of pectus deformity repair were pneumothorax (24.3%), wound infection (8.1%), and local tissue necrosis (2.7%). There was no major recurrence, while minor recurrence rate was 10.8%. There was no mortality.

CONCLUSION

Timely surgical procedures for the treatment of pectus deformities result in an excellent cosmetic outcome and improve cardiorespiratory function, providing both physical and psychological benefits.