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Yayın Accelerated treatment of concomitant empyema and lung cancer by video-assisted thoracoscopic surgery(ELSEVIER DOYMA SL, 2016) Eryigit, Hatice; Orki, Alpay; Unaldi, Mehmet; Ozdemir, Attila; Orki, Tulay; Kosar, Altug; Demirhan, Recep; Arman, BulentBackground: The most common cause of pleural empyema are parapneumonic effusions, and lung cancer is a rare cause of empyema. The aim of the present study is to analyse the results of the thoracoscopic treatment of empyema before definitive oncological treatment. Methods: Retrospective descriptive study of 332 patients including different clinical variables between 2002 and 2010. Results: Among 332 patients with empyema, the etiology of this disease was lung cancer in 11 patients. Ten of these patients were male and one was female (median age, 57.9 years; range, 46-76). The initial treatment was tube thoracostomy in 8 patients and video-assisted thoracoscopic surgery in 3 patients. Thoracoscopic debridement was performed in 4 patients whose tube thoracostomy underperformed because of insufficient drainage. The methods used for diagnosis of lung cancer were fiberoptic bronchoscopy and video-assisted thoracoscopic surgery. Surgical resection was performed on 7 suitable patients following infection control. Postoperative bronchopleural fistula and empyema occurred after pneumonectomy in one case. No operative mortality was observed. The mean survival time was 32.8 months for patients undergoing resection. Conclusions: Empyema could be a rare presentation of lung cancer and those suitable for surgical treatment should undergo standard treatment with reasonable results. (C) 2014 AEC. Published by Elsevier Espana, S.L.U. All rights reserved.Yayın BÖLGE YANIK MERKEZİ YOĞUN BAKIM ÜNİTESİ’NDE TOKSİK EPİDERMAL NEKROLİZİS’Lİ HASTALAR(2014) Kuzucuoğlu, Tamer; Saraçoğlu, Ayten; Demirhan, Recep; Erhan, Tuncay; Yakupoğlu, Sezer; Ersoy, BurakAmaç: Toksik epidermal nekrolizis (TEN) sepsis ve ölümle sonuçlanan potansiyel hayatı tehdit edici, ender görülen bir hastalıktır. Bu çalışmanın amacı hastanemiz yanık ünitesine kabul edilen 12 TEN hastasına ait mortalite oranı, ilişkili komorbiditeler, klinik ve epidemiyolojik karakteristiklerini belirlemektir. Yöntem: Yanık yoğun bakım ünitesine kabul edilen TEN tanısı konulmuş 12 hasta çalışmaya dahil edildi. Hastaların yaş, cinsiyet, ilaç kullanımı, cilt yanık hasarının derinliği ve yüzdesi, APACHE II skorları, cerrahi girişimler, hastanede kalış süresi, mekanik ventilasyon süresi, komplikasyonlar, mortalite ve morbidite oranları retrospektif olarak dökümante edildi. Hastaların mortalite oranlarının belirlenmesinde Scorten Skalası kullanıldı. Bulgular: Ortalama yaş 35±5,7 yıldı. Erkek hastaların kadınlara oranı 5:7 idi ve ortalama APACHE II skoru 15,4±3,2 idi. Epidermal ayrılma vücut yüzey alanının %75’inden fazla, median hasta yatış süresi 17±1,2 gündü. Bir hastada parasetamol ve etodolak, 3 hastada fenitoin alım öyküsü bulunmaktaydı. TEN semptomları bir başka hastada antitüberküloz tedavisi sonucunda, 4 hastada da sultamisilin tedavisini takiben ortaya çıktı. Diğer hastaların etyolojisi bilinmiyordu. Median mekanik ventilasyon destek süresi 3,2±0,7 gündü. Mortalite oranı %16,6 (2/12) idi. Sonuç: TEN hastaları yüksek mortalite riskinden dolayı değişik yaklaşımlar ve tedavi stratejileri gerektirirler. Sorumlu ilacın erken dönemde belirlenerek kesilmesinin ve bir yanık merkezinde özel destekleyici tedavi ortamının oluşturulmasının toksik epidermal nekroliziste mortalite oranını düşüreceği kanısına varılmıştır.Yayın The experimental use of N-Butyl cyanoacrylate tissue adhesive in pulmonary wedge resections(Elsevier, 2012) Koşar, Altuğ; Kapıcıbaşı, Oğuz; Alpay, Levent; Mısırlıoğlu, Aysun K.; Sönmez, Hakan; İskender, İlker; Demirhan, RecepBackground: In this experimental study, the effectiveness of N-butyl cyanoacrylate tissue adhesive on preventing air leakage after pulmonary wedge resection was observed. Methods: Twenty pairs of sheep lungs were used. Before initiating the study, the sheep lungs were ventilated to identify any air leakage from the parenchyma. On positive results, those sheep lungs were then excluded from the study. Wedge resection was performed on the right and left lower lobes of sheep lungs by clamping the edges forming a triangle of 5 cm × 5 cm × 5 cm. One side of parenchyma was sutured by 3/0 vicryl (Group A) while the other side of parenchyma was sealed by N-butyl cyanoacrylate (Group B). After waiting for 5 min for N-butyl cyanoacrylate to dry, the sheep lungs were intubated by 6 F endotracheal tubes. The lungs were soaked in a bath tub filled with 10 cm deep water and inflated by 40 mmHg pressure to record any air leakage from the parenchyma partially sutured by vicryl and sealed by N-butyl cyanoacrylate. Results: Air leakages were observed on the parenchyma surfaces of group of lungs (100%) sutured by vicryl (minimal 30%, mild 50% or massive 20% levels), while only on four of (20%) the other group of lungs sealed by N-butyl cyanoacrylate,minimal airleakage was observedontheparenchymal surface.There was anextremely significantdifferencebetween Group A and Group B in terms of the development of air leakage (p = 000). Conclusion: We consider that, N-butyl cyanoacrylate could be used effectively and safely to prevent air leakage from the pulmonary wedge resection surface.Yayın Management of postpneumonic empyemas in children(National Center for Biotechnology Information, 2008) Demirhan, Recep; Koşar, Altuğ; Sancaklı, İrfan; Kiral, Hakan; Orki, Alpay; Arman, BülentObjective: The optimal treatment of children with empyema remains controversial. The purpose of this clinical retrospective study was to assess different treatment options in the management of postpneumonic pediatric empyemas. Methods: From April 1997 to October 2005, 111 consecutive children (57 boys and 54 girls) were managed for pleural empyema. The mean age was 7.07 years (range: 18 months-14 years). Patients were divided into 3 groups depending on the treatment received: group I, chest tube alone (n = 89); group II, chest tube with fibrinolytics (n = 22); group III, thoracotomy with decortication (n = 19, consisting of 9 patients of group I and 10 of group II with unsuccessful treatment results). Results: Chest tube alone, chest tube with fibrinolytics, and thoracotomy with decortication had complete response rates of 89.9%, 54.5%, and 100%, respectively. The hospital stay was 11.46 +/- 3.79 days for group I, 9.08 +/- 2.07 days for group II, and 6.32 +/- 2.54 days for group III. There was no statistically significant difference between group I and group II with regard to hospital stay (P = 0.040). Mild pain occurred in 4 children of group II after streptokinase instillation. Only one atelectasis appeared in group III during the postoperative period. Conclusion: Chest tube drainage is a safe, effective primary treatment of postpneumonic pediatric empyema. In cases where it is insufficient, thoracotomy with decortication can be used successfully with low morbidity and mortality rates.Yayın Pneumonectomy in children for destroyed lung: evaluation of 18 cases(Elsevier, 2010) Koşar, Altuğ; Orki, Alpay; Kiral, Hakan; Demirhan, Recep; Arman, BülentBackground. Destroyed lung is an uncommon condition; it describes a nonfunctional lung and is most often caused by inflammatory diseases. Surgical resection is used to resolve or prevent complications and improve quality of life. We reviewed our experience in surgery for destroyed lung in children. Methods. The records of 18 children aged 16 years and younger who had undergone pneumonectomy for destroyed lung between 1991 and 2007 were analyzed retrospectively. Results. Eighteen children, 10 males (55.5%) and 8 females, aged 5 to 16 years, with a mean age of 12.3 underwent pneumonectomy. Cough was the major presenting symptom (n 18, 100%). The median preoperative period for symptoms was 6 years. Radiologic diagnostic methods included chest radiograph, computed tomography, bronchoscopy, and bronchography. Bronchiectasis (n 13), tuberculosis (n 4), and aspergillosis (n 1) were the main pathologies. Five patients had tuberculosis history, and tuberculosis culture was positive in 2 patients. Pneumonectomy was applied to the left side in 14 and right side in 4 patients. There was no mortality. Complication occurred in 3 patients (atelectasis [n 1], fistula and empyema [n 1], and wound infection [n 1]). Atelectasis was treated with bronchoscopy and stoma was needed for another patient for empyema. The mean follow-up was 64.9 months (range, 19 to 164 months). In their follow-up period, scoliosis was found in 1 patient. Conclusions. The morbidity and mortality rates of pneumonectomy are acceptable for selected and well prepared children. Antibiotics and antituberculosis treatment in certain cases and good timing in pneumonectomy are essential. Children grew and developed normally after pneumonectomy.Yayın Spontan pnömotoraks: 348 olgunun geriye dönük olarak değerlendirilmesi(Ulusal Travma ve Acil Cerrahi Dernegi, 2009) Demirhan, Recep; Koşar, Altuğ; Eryiğit, Hatice; Kiral, Hakan; Yıldırım, Mehmet; Arman, BülentAMAÇ Spontan pnömotoraks’lı (SP) hastalar iki gruba ayrılarak yaş, cinsiyet, tanı yöntemleri, uygulanan tedavi şekli ve sonuçları açısından geriye dönük olarak değerlendirildi. GEREÇ VE YÖNTEM Haziran 1997 ile Mayıs 2005 tarihleri arasında SP nedeniyle tedavi edilen 348 hasta (320 erkek, 28 kadın; ort. yaş 34,5; dağılım 14-80) çalışmaya alındı. Hastaların 274’ü (%78,7) primer SP’li, 74’ü (%21,3) sekonder SP’li idi. Sekonder SP’li hastalarda tüberküloz en sık sebepti. Hastaların %10’una ilk tedavi olarak nazal oksijen ve aspirasyon, %90’ına tüp torakostomi uygulandı. BULGULAR Nazal oksijen ve aspirasyon ile başarı oranı primer SP’li hastalarda %85,7, sekonder SP’li hastalarda %66,7 olarak bulundu. Tüp torakostomi ile başarı oranı primer SP ve sekonder SP’li hastalarında benzerdi (%88,4 ve %85,7). Tüp torakostominin başarısız olduğu primer SP’li 29 (%11,6) hastanın 15’ine aksiller torakotomi, 14’üne video yardımlı torakoskopik cerrahi (VATS) yapıldı. VATS ile cerrahi uygulanan bir (%7,1) hastada nüks meydana geldi. SONUÇ Tüp torakostominin başarı oranı hem primer SP’li, hem de sekonder SP’li hastalarda yüksektir. Bununla beraber tüp torakostominin başarısız olduğu hastalarda cerrahi yöntemler güvenle ve düşük nüks oranları ile uygulanabilir.Yayın Spontaneous pneumothorax: retrospective analysis of 348 cases(TURKISH ASSOC TRAUMA EMERGENCY SURGERY, 2009) Demirhan, Recep; Kosar, Altug; Eryigit, Hatice; Kiral, Hakan; Yildirim, Mehmet; Arman, BuelentBACKGROUND In this study, spontaneous pneumothorax (SP) cases were divided into two groups and retrospectively evaluated according to age, sex, diagnostic methods, treatments, and results. METHODS Between June 1997 and May 2005, 348 patients (320 males, 28 females; mean age 34.5; range 14 to 80 years) with SP were enrolled into our study. There were 274 (78.7%) primary SP and 74 (21.3%) secondary SP patients. Tuberculosis was the most common cause in secondary SP patients. Nasal oxygen and aspiration was the first-line therapeutic option in 10% of patients and tube thoracostomy was performed in 90%. RESULTS Nasal oxygen and aspiration success ratio wits 85.7% in primary SP patients and 66.7% in secondary SP patients. Tube thoracostomy Success ratio was nearly the same in patients with primary and secondary SP (88.4% and 85.7%). Of the 29 patients (11.6%) with primary SP with unsuccessful result of tube thoracotomy, 15 underwent axillary thoracotomy and 14 underwent video-assisted thoracoscopic surgery (VATS). One patient among these 14 who underwent VATS (7.1%) had recurrence. CONCLUSION Tube thoracostomy success ratio was high in both primary and secondary SP patients. Surgical procedures can be applied safely, with low recurrence rate, when the tube thoracostomy remains unsuccessful.Yayın The value of surgical resection in patients with multidrug resistant tuberculosis(Georg Thieme Verlag KG, 2009) Orki, Alpay; Koşar, Altuğ; Demirhan, Recep; Saygı, A.; Arman, BülentBackground: Multidrug resistant tuberculosis (MDR-TB) still continues to be a serious health problem throughout the world. Although main treatment of MDR-TB is medical, surgical resection with adjuvant medical therapy may increase the chance of cure in selected patients. Methods: We performed surgical resections in 55 patients between 1997 and 2005; 36 were male and 19 were female with a median age of 34 years (range 13 to 66 years). Sputum was negative for 49 patients and positive for 6 patients in the preoperative period. Patients were treated according to a new therapy protocol for a mean of 3.7 months before the operation. Results: Lobectomy was performed in 37 patients, pneumonectomy in 17 patients and lobectomy + segmentectomy in 1 patient. One patient with positive sputum preoperatively died in the early postoperative period (mortality: 1.81 %). Various complications occurred in 16 (29.09 %) patients. Prolonged air leak was the most common complication (n = 8). Bronchopleural fistula (BPF) + empyema occurred in 2 (3.63 %) patients. In the postoperative period, sputum negativity was achieved in all patients except three cases throughout the 57 months of follow-up (cure rate 94.5 %). Patients received drug therapy for 24 months postoperatively. Conclusions: Surgical resection with adjuvant drug therapy increases the chance of cure in patients with localized disease if they have an adequate cardiopulmonary reserve, favorable nutritional status and are treated with a new therapy protocol for at least 3 months.
