Correlation of myeloid-derived suppressor cells with C-reactive protein, ferritin and lactate dehydrogenase levels in patients with severe COVID-19

The novel coronavirus disease 2019 (COVID‐19) remains a global health emergency, and understanding the interactions between the virus and host immune responses is crucial to preventing its lethal effects. The expansion of myeloid‐derived suppressor cells (MDSCs) in COVID‐19, thereby suppressing immune responses, has been described as responsible for the severity of the disease, but the correlation between MDSC subsets and COVID‐19 severity remains elusive. Therefore, we classified patients according to clinical and laboratory findings—aiming to investigate the relationship between MDSC subsets and laboratory findings such as high C‐reactive protein, ferritin and lactate dehydrogenase levels, which indicate the severity of the disease. Forty‐one patients with COVID‐19 (26 mild and 15 severe; mean age of 49.7 ± 15 years) and 26 healthy controls were included in this study. MDSCs were grouped into two major subsets—polymorphonuclear MDSCs (PMN‐MDSCs) and monocytic MDSCs—by flow cytometric immunophenotyping, and PMN‐MDSCs were defined as mature and immature, according to CD16 expressions, for the first time in COVID‐19. Total MDSCs, PMN‐MDSCs, mature PMN‐MDSCs and monocytic MDSCs were significantly higher in patients with COVID‐19 compared with the healthy controls (P < .05). Only PMN‐MDSCs and their immature PMN‐MDSC subsets were higher in the severe subgroup than in the mild subgroup. In addition, a significant correlation was found between C‐reactive protein, ferritin and lactate dehydrogenase levels and MDSCs in patients with COVID‐19. These findings suggest that MDSCs play a role in the pathogenesis of COVID‐19, while PMN‐MDSCs, especially immature PMN‐MDSCs, are associated with the severity of the disease.

Evaluation of the relationship between perceived social support, coping strategies, anxiety, and depression symptoms among hospitalized COVID-19 patients

OBJECTIVE

We aimed to evaluate the relationship between perceived social support, coping strategies, anxiety, and depression symptoms among hospitalized COVID-19 patients by comparing them with a matched control group in terms of age, gender, and education level.

METHOD

The patient group (n = 84) and the healthy controls (HCs, n = 92) filled in the questionnaire including the socio-demographic form, Hospital Anxiety Depression Scale, Multidimensional Perceived Social Support Scale, and Brief Coping Orientation to Problems Experienced through the online survey link.

RESULTS

The COVID-19 patients had higher perceived social support and coping strategies scores than the HCs. However, anxiety and depression scores did not differ significantly between the two groups. In logistic regression analysis performed in COVID-19 patients, the presence of chest CT finding (OR = 4.31; 95% CI = 1.04-17.95) was a risk factor for anxiety and the use of adaptive coping strategies (OR = 0.86; 95% CI = 0.73-0.99) had a negative association with anxiety. In addition, the use of adaptive coping strategies (OR = 0.89; 95% CI = 0.79-0.98) and high perceived social support (OR = 0.97; 95% CI = 0.93- 0,99) had a negative association with depression symptoms.

CONCLUSIONS

Longitudinal studies involving the return to normality phase of the COVID-19 pandemic are needed to investigate the effects of factors such as coping strategies and perceived social support that could increase the psychological adjustment and resilience of individuals on anxiety and depression.

The Relationship between COVID-19 Severity and Bacillus Calmette-Guérin (BCG)/ Mycobacterium tuberculosis exposure history in healthcare workers: a multi-center study

The COVID-19 pandemic has brought countries’ health services into sharp focus. It was drawn to our group’s attention that healthcare workers (HCWs) had a lower mortality rate against higher COVID-19 incidence compared to the general population in Turkey. Since risk of exposure to tuberculosis bacillus among healthcare workers are higher than the population, we aimed to investigate if there is a relationship between BCG and Mycobacterium tuberculosis exposure history with COVID-19 severity in infected HCWs. This study was conducted with 465 infected HCWs from thirty-three hospitals to assess the relationship between COVID-19 severity (according to their hospitalization status and the presence of radiological pneumonia) and BCG and Mycobacterium tuberculosis exposure history. HCWs who required hospital admission had significantly higher rates of chronic diseases, radiological pneumonia, and longer working hours in the clinics. Higher rates of history of contact and care to tuberculosis patients, history of tuberculosis, and BCG vaccine were observed in hospitalized HCWs. HCWs who had radiological pneumonia had a significantly increased ratio of history of care to tuberculosis patients and a higher family history of tuberculosis. The findings from our study suggest that the lower mortality rate despite the more severe disease course seen in infected HCWs might be due to frequent exposure to tuberculosis bacillus and the mortality-reducing effects of the BCG vaccine.

The evaluation of prognostic value of acute phase reactants in the COVID-19

AIMS

The aim of this study was to explain the demographic data, comorbidity and laboratory findings of our first cases in COVID-19 pneumonia in our country.

METHODS

We gathered the data of COVID-19 pneumonia participants from our electronic medical system, including daily medical knowledge and laboratory, radiological, and microbiological results between March 10 to April 7, 2020.

RESULTS

Totally, 125 patients, whose findings were compatible with COVID-19, were included in the study, 42 patients were excluded from the study. The distribution of genders was, 39 females (46.9 %), 44 males (53.01 %), the average age was 56.36 ± 16.25 (19-85). Hypertension above 60 years of age and diabetes mellitus under 60 years of age were the most common comorbidities. Neutrophils/ Lymphocyte percent(% NLR) was noted in 44 (53.01 %) patients, average: 3 (range 1.78-4.63). There was a statistically significant and positive relationship between D-dimer and C Reactive Protein (CRP) and ferritin.

CONCLUSION

We detected that comorbidities, which were seen at COVID-19 disease differ according to the patients age. Besides that D-dimer, ferritin and CRP outcomes were particularly high and had a significant correlation with COVID-19 severity (Tab. 3, Fig. 2, Ref. 25). Text in PDF www.elis.sk Keywords: COVID-19, prognosis, acute phase reactan.

Case Series: Pericardial gossypibomas detected after cardiovascular surgery: Imaging findings

We present the chest radiograph, computed tomography (CT), and magnetic resonance imaging (MRI) findings of three pericardial gossypibomas, which are rarely reported and an exceptional complication of cardiovascular surgery. The diagnosis is usually possible with surgical history, high clinical suspicion, and awareness of variable imaging findings. Usage of sponges with radiopaque markers facilitates early detection by chest radiographs and CT. In case of radiolucent gossypibomas, specific MRI features help to differentiate this pathology from other masses and diffusion-weighted images can be used to distinguish it from an abscess.

Flexible bronchoscopy may decrease respiratory muscle strength: premedicational midazolam in focus

Background: Flexible bronchoscopy (FB) is a procedure accepted to be safe in general, with low complication rates reported. On the other hand, it is known that patients with pre-existing respiratory failure have developed hypoventilation following FB. In this study the effects of FB on respiratory muscle strength were investigated by measuring maximum respiratory pressures. Methods: One hundred and forty patients, aged between 25 and 90 years, who had undergone diagnostic bronchoscopy between February 2012 and May 2012, were recruited to the study. Pre- and post-procedure maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were measured. A correlation between the MIP and MEP changes and patient characteristics and FB variables were investigated. Results: Significant decreases in both MIP and MEP values were observed following FB (p < 0.001 for both). Decreases were attributed to the midazolam used for sedation. Significant decreases in respiratory muscle strengths were observed especially in the high-dose midazolam group, compared to both low-dose and non-midazolam groups. Conclusions: It was determined that respiratory muscle weakness may arise post-procedure in patients who have undergone FB, and this is constitutively related to midazolam premedication. Respiratory muscle weakness might play a role in potential hypoventilation in critical patients who undergo FB.

Flexible bronchoscopy may decrease respiratory muscle strength: premedicational midazolam in focus

BACKGROUND

Flexible bronchoscopy (FB) is a procedure accepted to be safe in general, with low complication rates reported. On the other hand, it is known that patients with pre-existing respiratory failure have developed hypoventilation following FB. In this study the effects of FB on respiratory muscle strength were investigated by measuring maximum respiratory pressures.

METHODS

One hundred and forty patients, aged between 25 and 90 years, who had undergone diagnostic bronchoscopy between February 2012 and May 2012, were recruited to the study. Pre- and post-procedure maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were measured. A correlation between the MIP and MEP changes and patient characteristics and FB variables were investigated.

RESULTS

Significant decreases in both MIP and MEP values were observed following FB (p < 0.001 for both). Decreases were attributed to the midazolam used for sedation. Significant decreases in respiratory muscle strengths were observed especially in the high-dose midazolam group, compared to both low-dose and non-midazolam groups.

CONCLUSIONS

It was determined that respiratory muscle weakness may arise post-procedure in patients who have undergone FB, and this is constitutively related to midazolam premedication. Respiratory muscle weakness might play a role in potential hypoventilation in critical patients who undergo FB.

Pneumothorax as an initial manifestation of obstructive sleep apnea syndrome

CASE REPORT

A sixty-five-year-old man with bullous lung disease was admitted to emergency service with chest pain and dyspnea that developed during sleep. Pneumothorax was diagnosed both clinically and radiologically. After the chest drainage, the patient presented with a prolonged air leak that required thoracotomy. Further history and occurrence of pneumothorax during sleep suggested that obstructive sleep apnea might play a role in the development of pneumothorax. Nocturnal polysomnography later confirmed the diagnosis of severe obstructive sleep apnea syndrome.

DISCUSSION

We hypothesized that obstructive sleep apnea may be a risk factor for pneumothorax especially in patients with bullous lung disease, and pneumothorax may be listed in the complications of obstructive sleep apnea syndrome.

Radiological and functional assessment of pulmonary involvement in the rheumatoid arthritis patients

The aim was to evaluate the findings of high resolution computed tomography (HRCT) and pulmonary function tests (PFT) in the rheumatoid arthritis (RA) patients with and without pulmonary symptoms and to determine their role in prediction of respiratory system involvement. Among 54 consecutive RA patients, 22 (41%) were symptomatic and 32 (59%) were asymptomatic after detailed respiratory examination. Abnormal findings in PFTs were present in 10 (45%) symptomatic and 15 (47%) asymptomatic patients. PFT results were similar in both groups. A total of 18 (82%) symptomatic and 16 (50%) asymptomatic patients had abnormalities in HRCT scans. About 16 (80%) of 20 patients with normal HRCT scans had no pulmonary symptoms at all and we noted a significant correlation (P < 0.05). HRCT was more useful mean than PFTs in evaluation of pulmonary involvement in the RA patients; however, no correlation was present between various respiratory symptoms and abnormal findings both in PFTs and HRCT scans.

The effect of costal cartilage resection on the chest wall development: a morphometric evaluation

OBJECTIVE

In repair of thoracic wall deformities, there is a debate in the literature regarding the optimal age and the type and number of costal cartilage resections. We evaluated the effect of costal cartilage resections on the chest wall development in young rabbits.

METHODS

Fifty apparently healthy, 6 weeks of age, male New Zealand white rabbits were evaluated in five groups, each including 10 subjects. Group 1 served as control for the observation of normal thoracic development. Rabbits in group 2 underwent partial and rabbits in group 3 underwent total resections of the right third and fourth costal cartilages; those in group 4 underwent partial and rabbits in group 5 underwent total resections of the right third to sixth costal cartilages. Anteroposterior, horizontal and vertical diameters of the chest were measured before operation and repeated at 24 weeks of age.

RESULTS

Upper and lower anteroposterior diameters of the thoracic wall and horizontal diameters of the left hemithorax differed significantly among groups (p=0.011, p=0.004, and p=0.002, respectively). Upper anteroposterior diameter was 49 mm in group 1 and 44 mm in group 3 (p=0.009). Lower anteroposterior diameter in group 5 (66 mm) was significantly less than that in group 1 (70 mm) (p=0.039) and there was also a statistically significant difference between group 4 (71 mm) and group 5 (66 mm) (p=0.002). Horizontal diameters of the left hemithorax in group 3 (32 mm; p=0.005) and 5 (32 mm; p=0.008) were significantly different when compared to group 1 (26 mm). Growth in right hemithorax was statistically less than that in left side in all operated groups except in group 2.

CONCLUSIONS

Thoracic resections in young rabbits have demonstrated that the costal cartilage resection is not an innocent procedure as it severely affects the chest wall development especially in anteroposterior direction and the thoracic growth is markedly retarded when growth centers of the ribs are not preserved and/or four or more ribs are resected.

Diuretics, plasma brain natriuretic peptide and chronic obstructive pulmonary disease

BACKGROUND

Brain natriuretic peptide (BNP) is associated with increased myocardial stretching. This study aims to assess the effect of mild diuretics on plasma BNP levels in patients with an acute exacerbation of chronic obstructive pulmonary disease (COPD) who have high plasma concentrations of BNP.

METHODS

Thirty consecutive patients with an acute exacerbation of COPD without any clinical evidence of cor pulmonale who had elevated plasma BNP concentrations (group 1) and 15 patients with stable COPD as controls (group 2) participated in this study. A mild diuretic treatment in addition to the standard treatment for an acute attack of COPD was randomised to 15 patients in group 1 (group 1A). The remaining patients in group 1 only took standard treatment for acute COPD exacerbation (group 1B). Plasma BNP concentrations were measured on admission and repeated on the 5th and 10th days.

RESULTS

There was a significant decrease in plasma BNP concentrations, more striking in group 1A than 1B. Both in group 1A and 1B, the fall in plasma BNP concentrations was independent of either presence or absence of right ventricular dysfunction on echo evaluation.

CONCLUSION

Adding mild diuretics to the standard treatment for an acute attack of COPD may rapidly reduce plasma BNP levels in COPD patients with acute exacerbations who have high plasma BNP levels without any clinical evidence of cor pulmonale.

Pleomorphic adenoma of the trachea mimicking bronchial asthma: report of a case

Benign tracheal tumors are rare and difficult to diagnose. A delay in diagnosis is common because the symptoms mimic those of bronchial asthma. We report the case of a 42-year-old woman who was treated for asthma for 2 years before a diagnosis of pleomorphic adenoma of the trachea was made. To our knowledge, only 33 patients with pleomorphic adenoma of the trachea have been reported. We treated our patient by performing circumferential segmental tracheal resection and end-to-end anastomosis. A dynamic Y-stent was implanted for tracheal stenosis soon after the operation and it was removed 2 years later. The patient is now asymptomatic and no recurrence has been detected in the 5 years since diagnosis.

Risk factors for postoperative pulmonary complications in upper abdominal surgery

BACKGROUND

Pulmonary complications are the most frequent cause of postoperative morbidity and mortality in upper abdominal surgery (UAS). We aimed to examine the influence of possible preoperative, operative and postoperative risk factors on the development of early postoperative pulmonary complications (POPC) after UAS.

METHODS

A prospective study of 60 consecutive patients was conducted who underwent elective UAS in general surgical unit. Each patient's preoperative respiratory status was assessed by an experienced chest physician using clinical examination, chest radiographs, spirometry and blood gas analysis . Anaesthetical risks, surgical indications, operation time, incision type, duration of nasogastric catheter and mobilization time were noted. Forty-eight hours after the operation, pulmonary examinations of the patients were repeated.

RESULTS

Postoperative pulmonary complications were observed in 35 patients (58.3%). The most common complication was pneumonia, followed by pneumonitis, atelectasis, bronchitis, pulmonary emboli and acute respiratory failure. The presence of preoperative respiratory symptoms and the spirometric parameter of forced expiratory volume in 1 s/forced vital capacity were the most valuable risk factors for early prediction of POPC. The sensitivity, specificity and diagnostic efficiency of the presence of preoperative respiratory symptoms in the POPC prediction were 70, 61 and 66%, respectively.

CONCLUSION

We recommend a detailed pulmonary examination and spirometry in patients who will undergo UAS by chest physicians to identify the patients at high risk for POPC, to manage respiratory problems of the patients before surgery and also to help surgeons to take early measures in such patients before a most likely POPC occurrence. Improvement of lung function in those patients at risk for POPC before operation may decrease morbidity in surgical patients.

Embolisation of hydatid cysts in the pulmonary artery presenting with haemoptysis

A 49-year-old female patient who had undergone surgery for hepatic echinococcosis five years previously was admitted with haemoptysis. MRI angiography showed total occlusion of the left inferior pulmonary artery. Echocardiography showed no pulmonary hypertension. The patient underwent pneumonectomy and cysts in the left pulmonary artery were observed. Pulmonary artery involvement should be considered in patients who have undergone hepatic cyst surgery if haemoptysis is the first presenting symptom, especially in endemic regions for hydatidosis.

Tracheopathia osteoplastica associated with iron deficiency anemia

Tracheopathia osteoplastica (TPO) is a benign disease of trachea characterised by numerous cartilaginous or bony structures protruding into tracheobronchial lumen. We report a case of a 85-year-old male patient in whom tracheopathia osteoplastica was diagnosed incidentally during bronchoscopy which was missed on chest computed tomography examination. The patient also had iron deficiency anemia, the cause of which was not identified. We review TPO and discuss the associated abnormalities reported in the literature.

Comparison of pulmonary hydatid cysts in children and adults

BACKGROUND

The purpose of the present study was to compare the clinical features and the surgical approaches of the pulmonary hydatid cysts in children and adults.

METHODS

One hundred and thirty-four patients, operated on for pulmonary hydatid cysts over the last 10 years were retrospectively evaluated in two groups: 39 children who were younger than 18 years old (29%) and 95 adults (71%). The patients in each group were analysed according to their clinical, radiological and surgical findings.

RESULTS

The frequency of pulmonary hydatid cysts in children was significantly higher in boys (74%) than in girls (26%). However, there was no sex tendency in adults (52% in male vs 48% in women). The sex difference in hydatid cyst frequencies between adults and children was significant (P < 0.05). Among preoperative pleural complications, pneumothorax (15.5%) in children and empyema (11%) in adults were more frequent. The frequency of concomitant hepatic cysts was less in children than in adults (33%vs 79%). Huge pulmonary cysts (=10 cm) were more common in children (31%) than in adults (22%). Cystotomy with capitonnage was the most frequently preferred method in both groups. Postoperative complications developed in six children (16%) and 19 adults (19%), and were more frequent in patients with huge cysts (27%vs 16%). No recurrence was observed in both groups.

CONCLUSIONS

Isolated pulmonary cysts are more common in children than adults. The cysts also tend to be bigger in children than adults. The frequency of concomitant hepatic cysts is less in children. Because of higher lung expansion ability and improvement capacity in children, resection should be avoided and lung saving surgical procedures should be performed. In spite of differences observed in the clinical features it does not change the treatment of pulmonary hydatid cysts in children.

Inferior laryngeal paraganglioma presenting as plunging goiter

Paragangliomas are uncommon slow-growing neuroendocrine tumors that may arise from the extra-adrenal paraganglia. Paragangliomas of the inferior and superior laryngeal paraganglia are known as laryngeal paraganglioma. Inferior laryngeal paraganglioma, which is also called subglottic paraganglioma, is very seldomly observed. To our knowledge only 24 patients with subglottic paraganglioma have been found. We present a 77-year-old male patient who has been previously followed-up for cervical goiter, which has a progressive enlargement into the mediastinum, causing severe tracheal obstruction. The tumor was completely and easily resected via median sternotomy with collar incision and finally diagnosed as inferior laryngeal paraganglioma. The present case is the first subglottic laryngeal paraganglioma descending into the visceral compartment of the mediastinum in the literature.

[Diagnostic efficiency of serum lipid-bound sialic acid level in malignant pleural effusions]

In this study, pleural fluid and serum lipid-bound sialic acid (LBSA) levels of 68 cases with pleural effusion hospitalised at the department of Chest Diseases in the Medical School of Selçuk University, and serum LBSA levels of 30 healthy individuals as control group were studied. Pleural effusions of 32 cases were due to malignancy of which considerably lung cancer. In the other 36 cases the causes were nonmalignant in origin. Levels of mean serum LBSA in malignant and benign groups were significantly higher than control group (p< 0.001). However, difference of the mean serum LBSA levels of malignant and benign groups was not statistically significant. We found the mean pleural fluid LBSA level of 23.34 mg/dL in malignant group and it was significantly higher than benign group (17.97 mg/dL) (p< 0.05). It was observed that there was no significant statistical difference between the pleural fluid to serum LBSA ratios of malignant and benign groups. In differential diagnosis of malignant pleural effusions, sensitivity and specificity of pleural fluid LBSA were 91%, and 51%, respectively. In conclusion, for the differentiation of malignant pleural effusions LBSA is not believed to be a reliable tumor marker since it may also increase in various chronic and inflammatory diseases. Despite of that, in cases with a suspicion of malignancy, the increased level of pleural fluid LBSA may be useful as a supportive parameter.

[Diagnostic efficiency of pseudocholinesterase level in discrimination of transudates-exudates]

In this study, 80 cases with pleural effusion hospitalized at the departments of Chest Diseases and Internal Medicine in the Medical School of Selcuk University, and 30 healthy people as control group were studied. Regarding to the diagnosis, pleural fluids were classified into two groups as follows; transudates and exudates. Difference between the mean pleural pseudocholinesterase levels of transudates and exudates was statistically significant (p< 0.001). Similar significance was also obtained in the mean pleural fluid/serum pseudocholinesterase ratios of the groups (p< 0.001). In determination of exudative fluids both sensitivity and specificity of the pleural fluid pseudocholinesterase level was 100%. Sensitivity and specificity of the pleural fluid/serum pseudocholinesterase ratio were 90 and 87%, respectively. We have concluded that pleural pseudocholinesterase level and pleural fluid/serum pseudocholinesterase ratio can be used as a parameter with high diagnostic efficiency in discrimination of pleural effusions as exudates and transudates.

Giant localized solitary fibrous tumors of the diaphragmatic pleura: report of two cases

We report two cases, of 48- and 53-year-old women, with huge intrathoracic extrapulmonary tumors which originated from the diaphragm. In these cases the totally resected tumors were examined histologically and immunohistochemically, and based on these studies benign localized solitary fibrous tumors originating from the diaphragmatic pleura were diagnosed. We observed no recurrence in the long-term follow-up, which was necessary for these cases due to the tumors' unpredictable clinical behavior even when they were thought to be benign histologically. Because of the huge sizes of these tumors, originating from the diaphragmatic pleura with pedicles, and benign clinical outcome correlating with the histological examination, these cases are thought to be worthy of interest.

Pleural complications of hydatid disease

OBJECTIVE

The aim of this retrospective study was to review pleural and pericardial complications of patients with hydatid cysts and to analyze the management of therapy for these patients.

METHODS

Between 1991 and 2001, 43 (29.7%) of 145 patients presented with pleural and pericardial complications. These patients had spontaneous pneumothorax (6.2%), empyema (7.6%), pleural thickening (10.3%), hepatopleural fistula (2.8%), pericarditis (2.1%), and hepatobronchial fistula (0.7%). There were 22 male and 21 female patients, with a mean age of 30 years.

RESULTS

The most common symptom was chest pain (79.1%). In 37 (86.1%) of 43 patients, the cysts were unilateral. The ratio of ruptured cysts was 88.4%. In most of the patients, hydatid cysts developed in the right lung (62.9%) and the lower lobes of the lung (70.4%). Multiple cysts were found in 8 (18.6%) patients. The most common surgical techniques were cystotomy with capitonnage (55.7%) and decortication (69.8%). Radical lung resection was used in 14% of the patients. The morbidity rate was 16.3%, and the mortality rate was 2.3%. The mean follow-up was 19 months with no recurrence.

CONCLUSIONS

Although lung-preserving surgical interventions should be preferred, radical surgical procedures have been used more commonly in patients with pleural complications of hydatid cysts, and the postoperative morbidity rate was higher in these patients. Because of this, the surgical treatment should be carried out before the development of pleural complications. In addition, echinococcosis should be considered and included in the differential diagnosis of spontaneous pneumothorax and empyema.

Comparison between pulmonary and hepatopulmonary hydatidosis

OBJECTIVES

To compare the clinical features and the surgical approaches between single pulmonary (SPH) and hepatopulmonary hydatidosis (HPH).

METHODS

The hospital and follow-up records of 141 patients who had undergone surgery for pulmonary hydatidosis in our clinic between January 1991 and January 2001 were reviewed. Forty-nine patients (34.8%) had concomitant liver cysts in addition to the pulmonary cysts and they were regarded as HPH (Group I). The remaining 92 (65.2%) patients had SPH (Group II). Both groups were compared according to their clinical, radiological and surgical features.

RESULTS

Seventeen (34.7%) male and 32 (65.3%) female patients had HPH. The mean age of the patients with HPH was significantly higher than the age of those with SPH (P<0.05) and the frequency of hepatopulmonary localization, which is contrary to single pulmonary cyst, was significantly higher in females (P<0.05). The majority (67.3%) of the cysts located in the liver were solitary. Multiple pulmonary cysts were in higher ratio in Group II, compared to Group I (45.7 vs. 22.8%) and bilateral pulmonary cyst ratio was higher in Group II, as well (26.5 vs. 13%) (P<0.05). In 14 patients (28.6%), the concomitant cysts localized in the dome of liver were extirpated via right thoracophrenotomy, and in one of them sternophrenotomy was performed. There was no statistically significant difference associated with the postoperative complications and hospital stay between groups. No recurrence and mortality were recorded in Group II.

CONCLUSIONS

Multi-organ localizations (especially liver) should be examined in all patients with pulmonary hydatid cysts. HPH is more frequent in female patients over 40 years of age. The pulmonary cysts in HPH show a tendency to be bilateral and multiple. HPH should be regarded as a different entity since it can cause either economic or labour loss due to the multi-operations and prolonged postoperative care. The operative strategy and approach should be different in hepatopulmonary cysts especially if they locate in the right or bilateral lung. One-session operation with the improvements of its techniques and methods should be considered in selected cases.

Cold abscess of the chest wall as an unusual complication of BCG vaccination

Bacillus-Calmette-Guérin (BCG) vaccination often results in local adverse effects; however, serious or long-term complications are rare. The involvement of sternum among skeletal BCG osteomyelitis is a rarely seen complication of BCG vaccination. Such a complication may confuse with a chest wall tumor and a surgical intervention may be needed for the definite diagnosis. A 9-month-old infant who had a parasternal cold abscess in the anterior chest wall and sternal osteomyelitis of tuberculosis in the late period of BCG vaccination of whom the etiological diagnosis was histopathologically confirmed after surgery is presented and the preoperative diagnostic problems are discussed.