The Evaluation of 13 Patients with Intrathoracic Extrapulmonary Hydatidosis

Cases of intrathoracic extrapulmonary hydatid cysts are very rare. We identified 13 patients with intrathoracic extra-pulmonary hydatid cysts in our clinic over 12 years. Four patients had extra-pulmonary cysts only; nine patients had both intrapulmonary and extrapulmonary cysts. Cysts were identified in the pleural space, extrapleural region, diaphragm and chest wall. Thoracotomy was used in all patients, and extrapulmonary lesions were removed by cyst extirpation from surrounding tissue or by pericystectomy. In one patient with chest wall involvement, partial rib resections were performed because of rib destruction. In two patients with liver cysts passing through the diaphragm to the thorax, the diaphragm was cut, cysts on the liver roof were removed and then the diaphragm was repaired. There was no mortality, morbidity, or disease recurrence during the post-operative period in any of the 13 patients. We conclude that these rare cases give a new insight into hydatid cyst pathophysiology.

Is T3 and T6 sympathetic clipping more effective in primary palmoplantar hyperhydrosis?

OBJECTIVE

Our aim was to establish a standardized approach for patients with palmoplantar and axillary hyperhidrosis and to compare patient satisfaction and complication rates for two different operations.

MATERIALS AND METHODS

Between 2008 and 2010, 30 patients underwent conventional T3/4 clipping (group A), and 30 underwent only T3 and T6 clipping (group B). Both groups were compared with regard to compensatory sweating (CS), complications, patient satisfaction and recovery of plantar hyperhidrosis.

RESULTS

The CS rate was 60 % in group A and 47 % in group B. CS was significantly less in group B compared to group A ( P ≤ 0.001). The plantar hyperhidrosis recovery rate was higher in group B (n = 19) compared to group A (n = 13), but the difference was not statistically significant ( P ≥ 0.299). Patient satisfaction rate was 93.3 % in group A and 96.6 % in group B.

CONCLUSIONS

Our study showed that T3/6 clipping was as effective as T3/4 clipping for palmar and axillary hyperhidrosis. Our results revealed that this technique is more effective than T3/4 sympathectomy to treat plantar hyperhidrosis.

Does atopy affect the radiological extent of pulmonary tuberculosis?

BACKGROUND

Th1 cytokines, IL-2 and IFN-gamma , have critical importance in the CD4 cell driven antimycobacterial activity. Th2 type immune response is a characteristic feature of atopic disorders. Th1 and Th2 cells have been reported to negatively cross-regulate each other in vitro and in experimental animals. Our aim in the present study is to determine whether the atopy affects radiological extent of pulmonary tuberculosis (TB) and disease severity.

MATERIALS AND METHODS

A total of 82 male patients with pulmonary TB were prospectively enrolled in the study between March 2005 and March 2006. All patients were evaluated for atopic symptoms and TB related systemic symptoms. Radiological dissemination was scored and cavitation was noted. The skin prick test (SPT) was performed and serum total IgE level was measured.

RESULTS

The SPTs were positive in 28 of 82 (34.1 %) patients. There was no distinction between SPT-positive and negative patients in terms of pulmonary cavitation and radiological dissemination. The median IgE level of moderate-severe radiologically disseminated TB patients was significantly higher than that of mild radiologically disseminated TB patients (130 IU/ml vs. 58 IU/ml). Cavitary TB patients had also significantly higher median IgE levels (78 IU/ml vs. 46 IU/ml) (p < 0.05)

CONCLUSION

This study suggests that SPT-positivity and atopic respiratory phenotype do not affect the formation of cavitation, radiological dissemination and systemic symptoms of pulmonary TB. The high level of IgE in patients with cavitary and radiologically disseminated TB may be a consequence of a dysregulated immune response to infection or reflect disease activity.

Does the Atopic Phenotype Prevent Development of Active Tuberculosis Infection?

This study investigated the relationship between the atopic phenotype and the development of active tuberculosis. A total of 82 human immunodeficiency virus-negative males with active pulmonary tuberculosis and 88 healthy controls were enrolled into this prospective study. Serum immunoglobulin E (IgE) levels were measured and skin prick tests performed before initiation of treatment. Skin prick tests were positive in 34.1% of the tuberculosis patients and 39.8% of the controls. Allergic respiratory symptoms were significantly less frequent in skin prick test positive tuberculosis patients (21.4%) compared with skin prick test positive controls (62.9%). Median IgE levels in atopic tuberculosis patients were significantly higher than in atopic controls. The low rate of atopic respiratory complaints seen in the tuberculosis patients, despite having similar allergic skin prick test sensitivities to the controls, could be attributed to a weak T-helper (Th) 2 immune reaction and its effects on Th1–Th2 interaction.

Effect of active tuberculosis on skin prick allergy tests and serum IgE levels

OBJECTIVE

Mycobacterium tuberculosis has been shown to suppress allergic airway disease driven by type 2 helper T cells in animal models. In this study, we investigated the effect of active tuberculosis on skin prick test (SPT) positivity and serum immunoglobulin (Ig) E levels of atopic patients with and without tuberculosis infection.

MATERIALS AND METHODS

Seventeen atopic HIV-negative men with pulmonary tuberculosis and 18 atopic healthy male controls at our military hospital were studied prospectively between March 2005 and March 2006. The sums of all SPT positive tests and positivity to house dust mite alone were calculated before initiation of treatment and after 6 months. Measurement of total serum IgE levels was also performed at the same moments.

RESULTS

The mean (SD) initial serum total IgE concentrations were significantly higher in the tuberculosis patients than in the healthy controls (324.1 [317.67] U/mL vs. 146.7 [75.29] U/mL, respectively; P < .05), The total serum IgE concentrations after 6 months of treatment were also higher in the patients than in the controls. The mean sum of SPT positivity was higher in the tuberculosis patients than in the controls at both testing times.

CONCLUSION

Our study does not support the hypothesis that M tuberculosis suppresses atopy and atopic disorders, but large, prospective experimental studies are needed before excluding the possibility of a relationship.

Clinical experience of surgical therapy in 207 patients with thoracic hydatidosis over a 12-year-period

PRINCIPLES

Hydatid disease is the most severe helminthic zoonosis, with a major medical, social, and economic impact in Turkey. The aim of this study was to evaluate retrospectively 207 patients diagnosed with hydatid cyst and treated surgically in our department between January 1990 and December 2001.

METHODS

Hundred and ninety three patients were male and 14 female. They ranged in age from 19 to 72 years (mean 25.3 years). The most common presenting symptoms were cough, expectoration and chest pain. The surgical approach was thoracotomy in 198 patients, bilateral staged thoracotomies in 5 patients, median sternotomy in one patient and video-assisted thoracic surgery in 3 patients.

RESULTS

Hundred and thirty eight of the 265 intrapulmonary cystic lesions were found in the right lung and 127 in the left lung. Intrathoracic extrapulmonary cystic lesions were detected in 13 patients. 38 patients also had cystic lesions in the liver. Conservative surgical procedures were adopted except for small wedge resections in 8 patients, segmentectomy in 4 patients and lobectomy in one. Operative and postoperative mortality was nil. Albendazole treatment was given to patients who had multiple intrathoracic cysts or additional hepatic cysts after 1994.

CONCLUSIONS

Our preferred surgical techniques for removal of cysts were conservative surgical procedures such as enucleation of cysts or removal by cystotomy. Radical procedures such as pneumonectomy, lobectomy and segmentectomy should be avoided as far as possible.

Clinical experience of surgical therapy in 207 patients with thoracic hydatidosis over a 12-year-period

PRINCIPLES

Hydatid disease is the most severe helminthic zoonosis, with a major medical, social, and economic impact in Turkey. The aim of this study was to evaluate retrospectively 207 patients diagnosed with hydatid cyst and treated surgically in our department between January 1990 and December 2001.

METHODS

Hundred and ninety three patients were male and 14 female. They ranged in age from 19 to 72 years (mean 25.3 years). The most common presenting symptoms were cough, expectoration and chest pain. The surgical approach was thoracotomy in 198 patients, bilateral staged thoracotomies in 5 patients, median sternotomy in one patient and video-assisted thoracic surgery in 3 patients.

RESULTS

Hundred and thirty eight of the 265 intrapulmonary cystic lesions were found in the right lung and 127 in the left lung. Intrathoracic extrapulmonary cystic lesions were detected in 13 patients. 38 patients also had cystic lesions in the liver. Conservative surgical procedures were adopted except for small wedge resections in 8 patients, segmentectomy in 4 patients and lobectomy in one. Operative and postoperative mortality was nil. Albendazole treatment was given to patients who had multiple intrathoracic cysts or additional hepatic cysts after 1994.

CONCLUSIONS

Our preferred surgical techniques for removal of cysts were conservative surgical procedures such as enucleation of cysts or removal by cystotomy. Radical procedures such as pneumonectomy, lobectomy and segmentectomy should be avoided as far as possible.