BENEFITS OF EARLY AGGRESSIVE MANAGEMENT OF EMPYEMA THORACIS

BACKGROUND

The end-target of the management of thoracic empyema is to obtain early rehabilitation by re-expansion of the trapped lung resulting from intrapleural infected material. Our aim was to shorten the hospitalization time and to prevent a possible thoracotomy by using video-assisted thoracoscopy initially.

METHODS

Seventy patients with parapneumonic empyema were prospectively studied between January 1997 and June 2004. The patients were randomly divided into two groups. In group I (n = 35 patients), a chest tube was inserted into the patients after pleural content was evacuated and fibrins were debrided using video-assisted thoracoscopy. In group II (n = 35 patients), tube thoracostomy was carried out without using a video-assisted thoracoscope. Both groups were compared in terms of hospitalization time, open surgery for decortication and complications.

RESULTS

There was no statistically significant difference between the groups from the point of view of age and sex (P > 0.05). In group I, 17.1% of the patients underwent open decortication, whereas in group II, 37.1% of the patients underwent the same procedure (P < 0.05). Whereas average hospital stay in group I was 8.3 days (range, 7-11 days), it was 12.8 days in group II (range, 10-18 days; P < 0.05). There was one bronchopleural fistula in group I, and there was one bronchopleural fistula and one death in group II.

CONCLUSION

Video-assisted thoracoscopic evacuation and chest tube insertion in situ is a new therapeutic approach for pleural empyema that shortens hospital stay and reduces the necessity of open decortication.

Endovascular treatment of lower limb penetrating arterial traumas

PURPOSE

The purpose of this study was to evaluate the effectiveness of percutaneous arterial embolization in patients with penetrating peripheral arterial trauma.

MATERIALS AND METHODS

Twelve patients with penetrating peripheral arterial trauma were treated with percutaneous arterial embolization between 2002 and 2007. All injuries were secondary to penetrating stab wounds. Active bleeding (eight patients), recurrent bleeding episodes (one patient), persistent pain and mass (one patient), leg edema, claudication, swelling (one patient), local hyperemia, and pain (one patient) were the presenting symptoms. Microcatheter systems were used for catheterization. We used n-butyl cyanoacrylate mixture as the embolizing agent in all patients.

RESULTS

On angiograms the inferior gluteal artery (one patient), internal pudendal artery (one patient), perforating branch of the profundal femoral artery (six patients), superficial femoral artery (one patient), peroneal artery (two patients), and anterior tibial artery (one patient) were found to be injured. In all patients, the source of arterial bleeding could be reached, and a safe embolization was achieved. Nontarget embolization due to backflow of n-butyl cyanoacrylate mixture was detected in two patients and inguinal hematoma at the puncture site occurred in one patient.

CONCLUSIONS

We conclude that embolization-particularly n-butyl cyanoacrylate embolization-is technically feasible in patients with penetrating peripheral arterial trauma.

The effect of high dose melatonin on cardiac ischemia- reperfusion Injury

PURPOSE

Melatonin, the most potent scavenger of toxic free radicals, has been found to be effective in protecting against pathological states due to the release of reactive oxygen species. This study was performed to establish the effect of high dose melatonin on protection against ischemia- reperfusion (I/R) injury in rat hearts.

MATERIALS AND METHODS

Forty male Sprague-Dawley rats were used in this study. They were separated into four groups of ten rats each. A left coronary artery occlusion was induced in the rats by ligating the artery for 20 minutes and then releasing the ligation (reperfusion) afterwards. The control group was Group A. Group B was subjected to myocardial ischemia-reperfusion without any treatment, while Group C underwent myocardial ischemia-reperfusion with a melatonin treatment before the ischemia. Group D was subjected to myocardial ischemia-reperfusion with a melatonin treatment before the reperfusion. After 20 minutes of reperfusion, blood samples were obtained from each group for biochemical studies, and the animals were sacrificed for histological and, immunohistochemical examinations of the myocardial tissue.

RESULTS

We found that the cardiac troponin T(cTn-T) levels were significantly increased in Group B when all groups were compared. In the Group C rats treated with melatonin, the cTn-T values were significantly lower than those in Groups B and D. In addition, malondialdehyde (MDA) and antioxidant enzymes including, superoxide dismutase (SOD) and myeloperoxidase (MPO) were lower than those in Group B in the melatonin treated groups. The differences were statistically significant (p < 0.05). Histopathologic and immunohistopathologic studies also supported the effectiveness of melatonin.

CONCLUSION

Our study suggests that high dose melatonin, appears to offer protection against cardiac ischemia-reperfusion injuries in rats by scavenging the free radicals and could have a potential clinical use in the management of myocardial ischemia.

Surgical approach to the management of cardiovascular echinococcosis

OBJECTIVE

Echinococcosis is a serious health problem in some regions of the world. Although cardiovascular hydatid cyst is rare, its early diagnosis and surgical management is important.

METHODS

We reviewed 10 patients with cardiovascular hydatid cyst who underwent surgery in our department between January 1982 and 2007. Standard cardiopulmonary bypass and antegrade cardioplegia with aortic cross-clamping were used in all but one patient. After the cysts were removed, the cavity was cleaned and then obliterated with purse-string sutures. Albendazole was used in all patients. The mean follow-up was 4.5 years.

RESULTS

The mean age was 27 years (range 12 to 76 years). Eight patients were men. The hydatid cysts were located on left ventricle (five patients), left atrium (two patients), right ventricle (three patients), right atrium (one patient), pericardium (one patient), and aorta (one patient). Except for two patients who died, all were discharged without postoperative complications. There was no late cardiac mortality or recurrence.

CONCLUSIONS

Cardiac hydatid cyst should be treated surgically without delay. Although its surgical treatment carries a high complication rate, gentle handling of the heart during cardiopulmonary bypass minimizes operative risk.

Extrapleural regional versus systemic analgesia for relieving postthoracotomy pain: a clinical study of bupivacaine compared with metamizol

BACKGROUND

The effects of a local anesthetic delivered through a catheter inserted in the extrapleural region by a surgeon and an analgesic agent given systemically on pain after thoracotomy were assessed.

METHODS

The patients in group I (n = 25) had a catheter inserted between the parietal pleura and the endothoracic fascia by a surgeon, and 0.5% bupivacaine was given through this catheter. Another 25 patients (group II) had metamizol given intravenously. Respiratory function tests, arterial blood gases, range of shoulder motion, and postoperative pain were evaluated for each group. Bupivacaine and metamizol were given just before finishing the thoracotomy and then repeated every 4 hours for 3 days.

RESULTS

There was no statistical difference in arterial blood gases between the groups (P >.05). There were statistically significant differences in the respiratory function tests, range of shoulder motion, and visual analogue scale (P <.05) between the groups. Group I had fewer complications than group II. There was no mortality in either group.

CONCLUSIONS

Bupivacaine given through a catheter to the extrapleural region before finishing thoracotomy is substantially beneficial for the prevention of postoperative pain and reduction of postoperative complications.

Modified pudendal thigh flap for perineoscrotal reconstruction: A case of Leriche syndrome with rapidly progressing Fournier’s gangrene

We present the first report of Leriche syndrome associated with Fournier's gangrene. We used a modified pudendal thigh flap in the treatment of an extensive perineoscrotal soft-tissue defect successfully. We propose this new robust flap as an addition to the existing reconstructive armamentarium and draw attention to the coexistence of Leriche syndrome and Fournier's gangrene.

Angiomyolipoma with Cavoatrial Extension

In this paper, we report a case of angiomyolipoma with cavoatrial extension in a 55-yr-old woman. Multislice computed tomography revealed a hypodense mass extending into the right atrium through the right renal vein and inferior vena cava without a renal mass. The patient underwent surgery, and right atrial mass was resected. Pathologic evaluation revealed a tumor consisting of mature adipose tissue, smooth muscle and vessels consistent with angiomyolipoma. Our case reminds us of the rare possibility that angiomyolipoma, which is classified as a benign tumor, may invade the inferior vena cava or right atrium.

Unfavorable results following surgical, endovascular and dermal treatments of vascular anomalies

AIM

The aim of this paper to summarize the clinical characteristics of unfavorable results occurred following an unsuitable surgical, endovascular or dermal treatment for vascular anomalies.

METHODS

Seventeen patients with vascular anomalies who had unintentional results following an intervention that was not consistent with the one suggested by a local academic multidisciplinary team were enrolled. The medical records of all patients were retrospectively examined.

RESULTS

Venous malformation was the most frequent lesion in the patients (41.2%). More than half of the patients (52.9%) had an inadequate treatment as a concomitant of lack of a correct diagnosis. The most frequently occurred unfavorable result was the progression of the disease, the recurrence of the lesions, and clinical deterioration (64.7%).

CONCLUSION

The physicians who participating in the management of vascular anomalies should have a higher order of qualification than an average degree. Also, a multidisciplinary approach for the management of these anomalies is recommended.