Isolated pneumomediastinum following laparoscopic cholecystectomy: an unpredictable situation

Pneumomediastinum is a clinical event characterized by the presence of air in the mediastinum. Often a result of physical trauma, this condition results from air escaping from the respiratory airway and moving into the mediastinal cavity. Although rare, it can also develop following abdominal laparoscopic surgical procedures. Diagnosis is commonly made by visualizing a radiolucent airline in the mediastinum and/or surrounding the heart following a chest X-ray radiography or a thoracic CT scan. This case study describes the diagnosis, treatment and follow-up of a 51 years old female patient who developed pneumomediastinum following a laparoscopic cholecystectomy

Ischaemic mitral regurgitation: the effects of ring annuloplasty and suture annuloplasty repair techniques on left ventricular re-remodeling

To examine the mid-term results of patients on whom a coronary revascularization as well as a mitral ring and suture annuloplasty have been performed due to coronary artery disease [CAD] and ischaemic mitral regurgitation [IMR]. Totally 73 patients on whom a revascularization and a mitral valve repair due to CAD and IMR had been performed in our clinic between 2000-2008 were included in the study. Patients were divided into two groups one of which included 38 patients [52.05%] on whom a coronary artery bypass graft [CABG] and a ring annuloplasty on the mitral valve had been performed [Group 1] and the other one 35 patients [47.95%] on whom only suture annuloplasty as well as a CABG had been performed [Group 2]. The study was planned retrospectively and study data have been obtained by screening the hospital registries retrospectively. In the mid-term, patients were invited for a check and their intragroup and intergroup echocardiographic parameters and functional capacities were assessed statistically. In pre-operational and post-operational intragroup assessment in terms of echocardiographic findings; although LVEDD, LVESD, EDV, PAP and the degree of recurrent MR have been decreased in both groups, the decrease in LVESD and PAP and the low degree of recurrent MR were statistically significant in Group 1 patients [p=0.047, p=0.023, p=0.01, respectively]. When the mid-term intergroup echocardiograpic findings were assessed; PAP and recurrent MR have been determined statistically lower in Group 1 patients [p=0.005, p=0.08, respectively]. The length of intensive care unit stay, length of hospitalization and length of detachment from respiratory support were statistically significantly longer in ring annuloplasty performed group [p=0.012, p=0.033, p=0.029, respectively]. In moderate to severe IMR patients, a positive contribution can be provided to ventricular remodeling by a ring annuloplasty through a significant decrease in left ventricular diameter and a low recurrent MR and PAP

Surgical management of liver traumas in a liver transplantion center analysis of 2 years experience

Despite advances in diagnostic techniques, liver trauma management remains a challenging issue. To audit the 2 years resutls of liver traumas treated surgically. Retrospective analysis of patients who underwent surgery for liver injury were reviewed. Age, gender, type of trauma, haemodynamic parameters, preoperateive hemoglobin, number of injuries to the liver, coexisting organ injuries, type of surgery, duration of hospitalisation, health status on discharge were evaluated. A total of 30 patients underwent surgery for liver trauma, their median age was 35 +/- 17.14 [23 male, 7 female]. Blunt liver trauma was seen in 50% of the cases [n=15], while, remaining had penetrating trauma. Nine patients [30%] were haemodynamically unstable. Number of injuries to the liver were 1 in 13 patients [43.3%] 2 in 7 patients [23.33%] 3 in 4 patients [13.33%] and more than 3 in 6 patients [20%] Twenty two patients [73.3%] had co-existing injuries to other organs too. Among the surgical procedures used, 9 were damage controlling procedures and 9 were definitive repair, and one patient underwent living donor liver transplantion. Mortality was 10% [n=3]. Coexisting organ injuries and hemodynamically unstable status contributed to mortality

Surgical management of atrial septal defect in patients over 40 years of age

Atrial septal defect [ASD] makes up about 10% of all congenital heart diseases diagnosed after delivery and up to 30-40% of heart defects diagnosed in patients aged over 40 years. The objective of this study was to evaluate the effects of surgical ASD repair on functional status, right ventricular size, cardiothoracic ratio and pulmonary hypertension in patients over 40 years of age. Between the period of August 2001 and August 2010, 20 of the patients who had undergone surgical repair of a secundum ASD when they were aged >40 years at our institution were included in this study. To evaluate the effects of surgery on clinical outcome, we compared functional status, echocardiographic and radiographic findings of the patients before and after surgery. The defect was closed with either a running nonabsorbable suture or an autologous pericardial patch. Postoperatively, clinical status of the patients improved significantly. The mean NYHA functional class decreased from 2.8 +/- 0.4 to 1.5 +/- 1.1 [P < 0.001]. Postoperatively, mean right ventricle diameter was found regressed from 38.2 +/- 9.3 mm to 34.8 +/- 6.2 mm [P < 0.002] at a median interval of four months. The pulmonary artery pressures were also significantly decreased [p < 0.002]. The data provided by this study suggest that surgical repair of ASD improves functional status and relieves symptoms. Therefore, we suggest that ASDs that are unsuitable for transcatheter closure or requiring additional surgical intervention should undergo surgical repair to reduce subsequent morbidity and mortality, in patients including over 40 years of age

Our experience of infrapopliteal revascularization of lower extremity in ten years

In this study the long term results of infrapopliteal arterial revascularization procedure was evaluated. The efficiency of distal revascularization was also searched for the treatment of critical limb ischemia. From 1999 to 2009 32 patients underwent infrapopliteal revascularization procedure in our hospital for the treatment of critical limb ischemia. Demographic data of patients are: 23 male, 9 female and mean age was 60.5. Hypertension [n:15, 46.3%], diabetes mellitus [n:16, 50%], smoking [n:29, 90.6%] were the risk factors. The patients were classified in Fontaine III [n:25] and Fontaine IV [n:7]. Extremity viability and long term patency was detected with limb examination, Doppler Ultrasonography and angiography. The cases were evaluated for post operative mortality, morbidity and primary graft patency for one year. Mean follow up period was 21.3-/+15.9 monthes [12-60 monthes]. Two patients died in early post operative period. Eight patients underwent re-operation. Re-operations were performed on six patients for the treatment of acute graft thrombosis and two patients for the control of surgical bleeding. The long term graft patency was 38% and extremity recovery rate was 46%. In post operative early period two minor and one major amputation was performed. Infrapopliteal arterial revascularization procedure is an efficient method for the treatment of critical limb ischemia and high rate of long term patency is the main advantage of this procedure

Management of giant venous aneurysms secondary to arteriovenous fistula in hemodialysis patients

An aneurysmal fistula can continue to provide hemodialysis access for along time, but giant aneurysms should be operated on to prevent complication. The purpose of this study was to describe our experience of the surgical management of giant venous aneurysms that have developed as a complication of dialysis access. Twenty patients with giant venous aneurysms of the AVF underwent surgical procedures at our hospital from December 2003 to December 2010. The diagnoses were made by physical examination and Color Doppler Ultrasonography. There were 12 male and 8 female patients ranging in age from 29 to 68 years with a mean age of 44.6 +/- 12.3 years. Plication of the aneurysmal dilatations was performed in 17 patients. In two patients, aneurysmal dilatations were excised with restoration of the artery. The remaining one patient who received a successful renal transplantation was also associated with brachial artery aneurysm. Venous aneurysmal dilatations were excised and arterial aneurysms were repaired. All patients experienced a marked decrease in the size of venous dilatations. There were no vascular complications during the follow-up period. We suggest that plication is safe and effective in controlling venous dilatation and achieving patency. Reinforcing the suture line using an external mesh may not be required. However, prospective randomized studies will be required to assess the long-term outcomes

Penetrating cardiac injuries 10 year experience

To evaluate clinical findings and surgical interventions and their results in the patients referred to our hospital with cardiac injuries. Penetrating heart injury is potentially a life-threatening condition due to cardiac tamponade or exsanguinating hemorrhage. The data of 20 patients undergoing surgical intervention due to penetrating cardiac injury between 2001 and 2010 were retrospectively evaluated. In this series of 20 patients all were male between the ages of 14-65 years, with a mean age of 33.2 +/- 14.15 years. Age interval of the participating patients was between 14 - 65. Eighteen of these patients were diagnosed with right ventricular injuries while two were diagnosed with left ventricular injuries. All the diagnoses were established with clinical examination, direct radiograph, CT, echocardiography and ECG. Four of the patients admitted in emergency service were in agony, four were in shock, and six presented with hypotensive hemodynamic, and four with stable hemodynamic. Right anterior thoracotomy was applied to four patients in agony in the emergency service. Two of these patients died. None of other patients died. All the postoperative patients were followed with echocardiography. Post - pericardiotomy syndrome was detected in one of the patients. Our experience shows that early diagnosis and immediate surgical intervention are the main factors affecting patient survival after penetrating heart injuries. Penetrating cardiac injuries have high mortality. This rate may be 80% in those patients in agony. Emergent intervention in emergency services for the patients under emergent conditions may be life- saving

Diagnosis and treatment of carotid body tumors

Carotid body tumors [CBTs], especially familial paragangliomas, are rare benign neoplasm, accounting for < 0.5% of all tumors; and they are the most common extra-adrenal paraganglioma. Because of peripheral vascular and neural invasion or compression of tumors, early diagnosis and treatments are very important, whereas this kind of tumors have got slow progression and low malignity potential. The aim of this study was to review an institutional experience in the management of paragangliomas. In this study, CBTs were clinically suspected in 33 patients but diagnosed by histopathology in between 1999 and 2011 at our department. Three of these patients presented with bilateral tumors. All but one was operated upon. The ages of the 48.3 surgically treated patients ranged 32-58 years. A mass in the neck was the common symptom in all patients. The patients were classified according to the Shamblin classification. There were 17 patients [11 women 6 men] in the first group, 13 patients [9 women, 4 men] in the second group, and 3 patients [2 women 1 man] in the third group. All of these 33 surgically treated patients had confirmed CBT by histopathology. CBTs were resected without a shunt procedure. No mortality occurred, however one patient experienced Horner syndrome post operatively. In the follow up period, no recurrences were observed. Three of the patients was had hoarseness, but improved after six months. No stroke occurred in the patients. CBTs are infrequent neoplasm; their surgical treatment is highly dependent on the ability and experience of the surgeon. The diagnostic and therapeutic relevance reside in making a timely diagnosis to propose a surgical treatment aimed at preventing complications and neurological damage. Surgical resection is usually definitive therapy for these lesions

Preoperative progressive pneumoperitoneum for giant inguinal hernias

Reduction of giant hernia contents into the abdominal cavity may cause intraoperative and postoperative problems such as abdominal compartment syndrome. Preoperative progressive pneumoperitoneum expands the abdominal cavity, increases the patient's tolerability to operation, and can diminish intraoperative and postoperative complications. Preoperative progressive pneumoperitoneum is recommended for giant ventral hernias, but rarely for giant inguinal hernias. We present two giant inguinal hernia patients who were prepared for hernia repair with preoperative progressive pneumoperitoneum and then treated successfully by graft hernioplasty. We observed that abdominal expansion correlated with the inflated volume and pressure during the first four days of pneumperitoneum. Although insufflated gas volume can be different among patients, we observed that the duration of insufflation may be the same for similar patients

Investigation of a one-time phenol application for pilonidal disease

To investigate wound healing rates and postoperative recovery of patients after a one-time phenol application for pilonidal disease. A total 30 consecutive patients with chronic pilonidal disease ranging from midline to complex sinuses were enrolled in the study. No preoperative laboratory examinations or bowel preparation were required. No antibiotic prophylaxis or sedation was used. A small incision was made on the midline and hair/ debris in the sinuses was removed. A cotton swab with saturated phenol was moved into the cavity and the phenol was left for 2 min. No special dressing was necessary and patients left the hospital immediately afterwards. Patients filled out a daily questionnaire for 7 days. We did not intervene in the wounds with a second phenol application or curettage during the observation period. Wounds were inspected at weekly intervals for 2 months. At the end of the third day, 97% of the patients were pain-free and 100% of the patients were free from analgesics. Time off work was 2 days for most patients [93.3%]. Twenty-eight [93.3%] patients were satisfied with the procedure, they found it easy and painless and suggested the procedure to other patients. Twenty-five [83%] patients were asymptomatic at the end of 2 months' observation and the remaining 5 patients had un-healed sinuses. Mean time for wound healing was 25 days [range 10-63 days]. There were 4 recurrences after a mean of 14 months' follow-up and the overall success rate was 70%. A one-time phenol application was an effective treatment for pilonidal disease with acceptable wound healing rates, less postoperative pain and less time off work. Hence it can be an alternative treatment modality