Esophageal foreign bodies: 177 cases

The aim of this study is to assess patients treated for esophageal foreign bodies. The charts of patients (n=177), between January 1994 and April 2009, were investigated retrospectively. Patients' age and gender, locations and types of foreign bodies (FBs) and interventions were taken into consideration. Fifty-seven percent of the patients were male. The youngest patient was 6 months, whereas the oldest was 83 years old. The median age was 9 years. Half of the patients were in their first decade. Treatment took place 11 h (ranging from 1 to 120 h) after impaction of the FB. One hundred fifty-two FBs were removed in 177 patients. Our negative esophagoscopy (n=25) rate was 14%. The FBs were radiopaque in 75% (n=114) and were commonly (71%; n=109) located in the cervical esophagus. Metallic coins (n=81-53%) were the most commonly observed inorganic FB while bones and/or meat impaction (n=54-35%) were the most frequent organic FB. A total of 182 endoscopic interventions were performed on these patients. One hundred eleven of them were esophagoscopy and the remaining 71 were direct laryngoscopy. The FB was pushed into the stomach in 11 patients. Our morbidity rate was 1.6% (n=3). Iatrogenic perforation occurred in two patients. There was no mortality. Esophageal FBs may vary in type: sharp or round objects, metallic, plastic or organic material. FBs are commonly found at pharyngoesophageal junction and usually removed by McGill forceps. Rigid esophagoscopy is used for children and adults because of its large working channel. Rigid instruments are considered reliable and safe for extracting foreign bodies.

Sternum fractures and effects of associated injuries

BACKGROUND

Aim of this study was to determine the clinical characteristics, morbidity and mortality in patients with a sternum fracture (SF).

METHODS

From October 1998 to December 2008, 80 patients with sternal fractures were admitted to the Thoracic Surgery Department of the University Hospital. The records of all patients were reviewed retrospectively. Patients' age and gender, extent of sternal and thoracic injury, types of associated injuries, treatment and outcome, the length of hospital stay, morbidity and mortality were collected. We divided our patients into two groups: Group I with an isolated sternum fracture and Group II with a sternum fracture and additional injury.

RESULTS

Patients' ages ranged from 18 to 83 years with an average age of 48.7 +/- 15.4 years. There were 67 male (84 %) and 13 female (16 %) patients. Thirty-five patients (44 %) sustained an isolated SF and the remaining 45 (56 %) had a SF in combination with associated injuries. The commonest etiology of the SF was a motor vehicle accident (77 %). Most of the fractures were located at the sternal body (76 %). The most common associated injuries were rib fractures (30 %), followed by extremity injuries (18 %). The great majority of patients (81 %) was treated with conservative measures such as bed rest, analgesia, etc. The remainder was treated either by tube thoracostomy (15 %), thoracotomy (1.25 %) or sternal fixation (2.5 %). There was no mortality and morbidity in Group I, but the morbidity and mortality rates of Group II were 15 % and 1 %, respectively. Mean length of hospital stay for all the patients was 5.7 days.

CONCLUSION

Isolated SFs are benign entities that can be safely managed with rest and analgesia. Associated injuries in patients with SF determine the morbidity and length of hospital stay.

Iatrogenic pneumothorax: etiology, incidence and risk factors

BACKGROUND

We discuss the etiology and incidence of iatrogenic pneumothorax (IPnx) which can develop after invasive procedures performed for diagnostic and/or therapeutic purposes, and the efforts to prevent this complication and its consequences.

METHODS

The records of patients who were treated for the diagnosis of IPnx between December 1998 and December 2006 were retrospectively reviewed. The patients were evaluated according to their age, gender, the procedure which caused IPnx, the department which performed the procedure, the treatment and its consequences.

RESULTS

12 010 invasive procedures were performed in our hospital during the period and 164 patients (1.36 %) developed IPnx. Their mean age was 49.27 (range: 8 months-93 years). Of the patients, 101 (61 %) were male and 63 (39 %) were female. The 56.7 % of the invasive procedures which caused IPnx were performed under emergency conditions and 43.3 % were performed under elective conditions. In 69 patients (42 %) the procedures were performed due to underlying lung diseases and in 95 patients (58 %) for diseases other than lung diseases. The most frequent procedure type causing IPnx was central venous catheterization, with 72 patients (43.8 %). The other frequent causes were thoracentesis with 33 patients (20.1 %) and barotrauma due to mechanical ventilation with 15 patients (9.1 %).

CONCLUSION

At training hospitals the incidence of IPnx will increase in parallel to the increase in invasive procedures. Invasive procedures should be performed by experienced personnel or under their supervision when risk factors are involved.

Empyema in adults and children: difference in surgical approaches, report of 139 cases

AIM

We investigated specific aetiology and different therapeutic approaches in patients with empyema in a General Thoracic Surgery Clinic.

MATERIAL AND METHODS

Charts of 139 patients admitted with empyema, between January 1998 and March 2005 were retrospectively reviewed. Although not completely comparable, patients were divided into two groups; Paediatric (n = 71) and adult (n = 68) cases. In addition to demographic characteristics, treatment options, complications and clinical outcomes were investigated according to the specific group.

RESULTS

The mean age was 5.6 years (4 mo - 17 y) for paediatric patients and 49.6 years (20-81 y) for adult patients. Overall, 65% of the patients (n = 91) were male. All paediatric cases had parapneumonic empyema, while 63% of the adult cases had parapneumonic and 23.5% had postoperative empyema. Of the paediatric cases, 50% received fibrinolytic treatment in addition to tube thoracostomy and 35% had decortication. In adults, 42% had tube thoracostomy and fibrinolytic treatment, and decortication was required in 9% only. Thoracomyoplasty was performed in 12% of the patients (n = 8). We had no mortality in paediatric patients, however mortality rate was 8% in the adult group. Morbidity, consisted mostly of prolonged air leakage and impaired lung expansion.

CONCLUSION

Early decortication and fibrinolytic treatment are sufficient for paediatric patients, while a variety of techniques including open drainage, rib resection and thoracomyoplasty are required in adult patients with empyema.

Atypical presentation of an unusual lung tumor

We describe a case of a rare bronchial epithelial- myoepithelial carcinoma of the lung in a 36-year-old man. Tumor enucleation was carried out and the patient was put on long-term follow up. Tumor categorisation was difficult. The patient is disease-free on the 30th postoper- ative month. The clinicopathological uniqueness of this neoplasm is reviewed.

Bilateral chylothorax caused by pleuropulmonary lymphangiomyomatosis: a challenging problem in thoracic surgery

Massive left-sided pleural effusion in a 35-year-old man was initially diagnosed as idiopathic spontaneous chylothorax and treated with serial thoracenteses and left thoracotomy. Six weeks later, a right thoracotomy was performed for contralateral chylothorax, and histologic examination revealed lymphangiomyomatosis. The patient survived this rare and potentially fatal disease. We have found no previously published case of bilateral lymphangiomyomatosis treated with separate thoracotomies because of bilateral chylothorax.

Unusual sites of uncommon endobronchial foreign bodies. Reports of four cases

Foreign body aspiration occurs most commonly in children and can have serious consequences. In adults, it is associated with surgery, trauma and accidents. We report four unusual cases of foreign body inhalation. In one case a spike of wild barley entered the trachea through a tracheostomy cannula and migrated from the chest wall. In the second case a piece of coarse cloth which was introduced through a tracheostomy stoma aided by a wood sliver was retained in the trachea. In another patient an inhaled sewing needle migrated to the pericardium, and in the fourth case the head of a metal stud penetrated the trachea percutaneously through the neck and lodged in the right main bronchus. The incidence, causes, complications and management of such cases are discussed and the literature is briefly reviewed.

Turban pin aspiration; a potential risk for young Islamic girls

A turban is a kind of headcover, worn for religious intentions. In Islamic countries, girls start to wear a turban with the onset of puberty. Turban pins (headscarf needles) are used for attaching the layers of turban to each other in order to keep it in a steady position around the head. Aspiration of these pins is investigated in accordance with age groups, pin characteristics and treatment. From 1987 through 1998, 63 girls were admitted to our department with turban pin aspiration. All patients were healthy prior to aspiration. The median age was 14 years. Foreign bodies were removed, either by rigid bronchoscopy (n = 57), flexible bronchoscopy (n = 2), laryngoscopy (n = 3) or thoracotomy (n = 1). Repeated bronchoscopy rate was 8% (n = 5) and we had no mortality. This recently recognized aspiration hazard can be minimized by using adhesive bands or snap fasteners, instead of pins, when wearing a turban.

Lung mass due to amniotic fluid embolism--an intrathoracic complication of pregnancy

A 29-year-old woman with right chest pain was admitted for radiographic investigation and found to have a round mass in the right lower zone. This was initially suspected to be a hydatid lung cyst but was confirmed as a cystic mass by computed tomography and duly excised. Histologic examination revealed an amniotic fluid embolism. The patient had had a stillbirth three months earlier.

Right-sided hiatal hernia of the oesophagus

At chest radiography performed for recurrent pneumonia in a 3-month-old boy, an air-fluid level in the right cardiophrenic angle was found and initially perceived as a lung abscess. Upper gastrointestinal tract radiographs, however, revealed a congenital diaphragmatic hernia, which was successfully repaired.

Management of intrathoracic goitre

A retrospective review is presented of 20 cases with resection of intrathoracic goitre between 1975 and 1993. The mean age of the 11 men and nine women was 53 years. The intrathoracic goitre was primary in seven cases and secondary in 13. The presenting clinical features and the pathology, surgical risks and optimal approaches are discussed. Primary intrathoracic goitre should be approached via a thoracotomy, because of the independent vascular supply. As secondary intrathoracic goitres are supplied by vascular pedicles arising from the inferior thyroid artery, a cervical collar incision is preferable. In the event of significant mediastinal bleeding, which is difficult to control from a cervical incision, a T-shaped incision for partial or full sternotomy can be performed, or even thoracotomy.

Effect of allopurinol on myocardial recovery during reperfusion

A comparative study on isolated guinea pig hearts was carried out to determine the effect of allopurinol added to reperfusion solution on myocardial recovery after global ischaemia. After 20 min of normothermic ischaemia two groups of solutions (1-Krebs Solution 2-Krebs Solution + Allopurinol 1 mmol l-1) were used for reperfusion (10 animals in each group). Post-ischaemic myocardial functions (ventricular contractile force and heart work) and enzyme activities (CK-MB, LD) were compared with their preischemic values. Addition of allopurinol 1 mmol l-1 to reperfusion solution improved post-ischaemic myocardial functions and decreased myocardial injury.

Dipyridamole induced myocardial recovery after global ischemia

1. An experimental comparative study on isolated guinea pig hearts was carried out to determine the effect of dipyridamole added to the reperfusion solution on myocardial recovery after global ischemia. 2. After 20 min of normothermic ischemia two groups of solutions: (1) Krebs solution; (2) Krebs + dipyridamole 20 micrograms/l (10 experiments in each group) were used for reperfusion. 3. Postischemic myocardial functions (heart rate, ventricular contractility, heart work) and tissue enzymes (CPK-MB, LDH) were compared with their preischemic values. 4. Addition of dipyridamole 20 micrograms/l to reperfusion solution improved postischemic myocardial functions and decreased myocardial injury.