Diagnosis, treatment, and management of esophageal foreign bodies in patients with mental retardation: A retrospective study from three centers.

Background: This study aims to assess the outcomes and prognosis of surgical interventions aimed at removing esophageal foreign bodies in patients with mental retardation. Methods: Between January 2010 and January 2021, a total of 30 consecutive patients (20 males, 10 females; median age: 29.5 years; range, 2 to 57 years) with mental retardation who were diagnosed with esophageal foreign bodies and underwent surgical treatment were retrospectively analyzed. Age and sex of the patients, symptoms, type of the foreign body, esophageal stricture level, methods used for preoperative diagnosis, type of surgical procedure, postoperative complications, and length of hospital stay were recorded. Results: Seventeen (56.6%) patients had a foreign body in the first narrowing, 12 (40%) in the second narrowing, and one (3.3%) in the third narrowing. A rigid esophagoscopy was performed in all cases. However, successful removal was not achieved in two (6.6%) cases, and foreign bodies were removed through cervical esophagotomy in one (3.3%) patient and through esophagotomy with right thoracotomy in one (3.3%) patient. Postoperative complications included esophagitis in seven patients (23.3%) and wound infection and pneumonia in two patients (6.6%). The median length of hospital stay after treatment was 1.09 days in patients without complications and 3.3 days in patients with complications. There was a significant correlation between the occurrence of complications and the length of hospital stay (p=0.002). The foreign body was successfully removed in all patients, and no mortality was observed. Conclusion: Early diagnosis and emergency intervention can reduce complications, particularly considering the possibility of non-food and sharp-edged foreign bodies that pose a higher risk of damaging the digestive system, in patients with mental retardation than those without such conditions.

Effect of preoperative three-dimensional modeling on uniportal video-assisted thoracoscopic bronchial sleeve resection and early postoperative outcomes.

Background: The aim of this study was to evaluate the effects of preoperative three-dimensional (3D) modeling on the performance of uniportal video-assisted thoracoscopic bronchial sleeve resection and early postoperative outcomes. Methods: A total of 10 patients (5 males, 5 females; mean age: 53.8±16.9 years; range, 18 to 75 years) who underwent uniportal video-assisted thoracoscopic bronchial sleeve resection with preoperative 3D modeling between April 2021 and November 2023 were retrospectively analyzed. Preoperative 3D modeling was prepared using computed tomography with an open-source 3D software program. Demographic, clinical, intraoperative, and postoperative data of the patients were recorded. Anatomical landmarks identified by preoperative 3D modeling were compared with intraoperative findings. Results: The anatomical landmarks created with the 3D model were in 100% agreement with the intraoperative findings. The procedures performed were three left lower lobes, three right upper lobes, one middle lobe, one right lower lobe, and one parenchyma-sparing intermediate bronchial sleeve resection. Bronchial sleeve resection was completed using uniportal video-assisted thoracoscopic technique in 90% of patients, with only one patient requiring conversion to open thoracotomy. The mean resection time was 264.2±40.5 min, and the mean anastomosis time was 86.0±20.3 min. Anastomosis times decreased with increasing experience (p=0.008). Postoperative atelectasis was observed in two patients, and there was no mortality. The mean follow-up duration was 12.2±11.8 months. Conclusion: Preoperative 3D modeling significantly contributed to the successful implementation of uniportal video-assisted thoracoscopic bronchial sleeve resection surgery. In the future, with advancements in simulation programs, patient-specific 3D modeling is expected to benefit the identification of anatomical landmarks for bronchial sleeve resections.

Awake sternal fixation; comparison of technical details and early results with sternal fixation methods performed via general anaesthesia.

OBJECTIVES: Isolated sternal fractures are rare pathologies that rarely require surgical fixation. Although different fixation techniques are used, it is routinely performed under general anaesthesia. In our study, we aimed to share the details of the awake sternal fixation technique performed in our clinic and to compare the early results with sternal fixation methods performed under general anaesthesia. METHODS: Between January 2009 and January 2023, 129 patients who were diagnosed with sternal fracture and who underwent investigations and follow-up in our clinic were evaluated retrospectively. Thirteen patients who underwent surgical fixation for isolated sternal fracture were included in the study. Patients were categorized according to fixation and anaesthetic technique; group 1: fixation with steel wire under general anaesthesia (n = 4), group 2: fixation with titanium plate-screw under general anaesthesia (n = 4) and group 3: fixation with awake titanium plate-screw with parasternal intercostal plane block (n = 5). Demographics, surgical indication, radiological findings, surgical incision, surgical time and hospital stay were statistically compared. RESULTS: The mean age of the patients included in the study was 55.15 ± 15.01 years and 84.6% (n = 11) were male. The most common reason for fixation was displaced fracture (53.8%). Fixation surgery was performed due to pain in 30.8% (n = 4) and non-union in 15.4% (n = 2) of the fractures. The mean duration of surgery were 98.75 ± 16.52, 77.5 ± 35 and 41 ± 14.74 min, respectively. Duration of surgery was significantly lower in group 3 compared to the other groups (P = 0.012). The hospital stay duration for group 1 was 6 days, group 2 was 4 days and group 3 was 1 day. A notable difference was observed among all groups (P = 0.019). CONCLUSIONS: Awake sternal fixation technique with titanium plate-screw system under superficial parasternal intercostal plane block is an easy and effective method for surgical treatment of isolated sternal fractures. This technique showed a direct positive effect on the duration of surgery and hospital stay.

COVID-19 and pneumothorax, pneumomediastinum, subcutaneous emphysema: Analysis of risk factors.

Background: In this study, we aimed to analyze the risk factors of barotrauma in patients who were followed in the intensive care unit due to novel coronavirus disease 2019 (COVID-19) pneumonia. Methods: Between March 2020 and January 2021, a total of 261 patients (155 males, 106 females; mean age: 63.3±15.3 years; range, 11 to 91 years) who were followed in the intensive care unit due to COVID-19 pneumonia and were diagnosed with pneumothorax, pneumomediastinum, and subcutaneous emphysema were retrospectively analyzed. Demographics data of the patients, past and current medical history, clinical management, patient progress, and survival data were obtained from medical records of our hospital. Results: Twenty-seven of the patients were diagnosed with barotrauma. A total of 88.8% of the patients were followed with intubation. The development of pneumothorax, pneumomediastinum, and subcutaneous emphysema due to barotrauma was not dependent on sex, smoking/non-smoking status, using/not using corticosteroids, or comorbid diseases. There was a significant correlation between pneumothorax, pneumomediastinum, and subcutaneous emphysema development in intubated patients with different ventilator modes. Changing the ventilator mode from synchronized intermittent mandatory ventilation to airway pressure release ventilation increased the possibility of barotrauma by 15 times. Conclusion: Despite all lung-protective applications, barotrauma is a common complication, particularly in mechanically ventilated patients who have COVID-19 pneumonia with severe acute respiratory distress syndrome. Mechanical ventilator pressure modes should be patientspecific and followed carefully and frequently for the risk of barotrauma.

The effects of the degree of pleural invasion on survival in patients with non-small cell lung cancer undergoing surgical resection.

Background: The aim of this study was to evaluate the degree and size of pleural invasion in non-small cell lung cancer patients and to compare its relationship with the survival time. Methods: Between January 2008 and June 2019, a total of 164 patients (143 males, 21 females; median age: 64.65 years; range 39 to 92 years) who underwent surgical resection with a diagnosis of non-small cell lung cancer and who were found to have pleural invasion histopathologically were retrospectively analyzed. The control group consisted of 105 patients (95 males, 10 females; median age: 61.7 years; range, 32 to 82 years) who underwent surgical resection but who were not found to have pleural invasion histopathologically during the same time period. Survival time was compared between the groups. Results: Median survival was 52 months in the group with pleural invasion, while it was 70.6 months in the group without pleural invasion. In the pleural invasion group, the patients who underwent sublobar resection had shorter survival. The degree of pleural invasion (p=0.028), advanced age (p=0.022), and lymph node involvement (p=0.011) were found to be poor prognostic factors for survival. Conclusion: In non-small cell lung cancer patients, the increase in the degree and size of pleural invasion is negatively correlated with the survival time and this is thought to be associated with advanced disease stage.

Effects of platelet-rich plasma on cartilage regeneration after costal cartilage resection: a stereological and histopathological study.

BACKGROUND: In cases of congenital chest wall deformities, it is important to maintain the flexibility of the chest wall after rib cartilage resection. In this study, we aimed to determine the regeneration capability of cartilage and the effects of platelet-rich plasma (PRP) on the regeneration process. METHODS: A total of 16 four-week-old New Zealand rabbits were used in this study. In the 4th-5th right costal cartilages, the perichondrial sheaths were dissected and costal cartilages were excised. Then, the perichondrial sheaths were closed with absorbable material in the sham group (n = 8), and this was done after replacing PRP in the PRP group (n = 8). The left costal cartilages of the animals were used as controls. The volumes of the costal cartilages and their perichondrial sheaths were estimated using Cavalieri's principle. In addition, the mean numerical densities of the chondroblasts and chondrocytes per square millimetre were estimated using unbiased counting frames. RESULTS: In the PRP and sham groups, the volumes of the cartilages and perichondrial sheaths were higher than those of the control group (p < 0.05). The numerical densities of the chondroblasts and chondrocytes increased more in the PRP group than in the sham group (p < 0.05). CONCLUSIONS: Applying PRP after resection may provide better healing and faster regeneration of cartilage.

Recurrent dilatation in resistant benign esophageal strictures: timing is significant.

BACKGROUND/AIM: Benign esophageal strictures are frequently encountered pathologies occurring due to various reasons. Repeated dilatations may be needed, particularly in resistant strictures. This study aimed to evaluate patients who underwent repeated dilatations in our clinic due to resistant esophageal strictures. MATERIALS AND METHODS: Sixteen patients who underwent multiple dilatations in our clinic with the diagnosis of resistant benign esophageal stricture between 2007 and 2014 were studied for age, sex, etiology, symptoms, complications, number of dilatations, and intervals between dilatations. Under general anesthesia, all patients underwent dilatation with Savary-Gilliard bougie dilators with the help of rigid esophagoscopy. RESULTS: In 10 of the patients, stenosis was cervical, and in others it was in the thoracic esophagus. The mean dilatation performance was 4.4 (range: 3-12). In 9 patients, dilatations were performed when the patients presented with the complaint of dysphagia. Following the initial dilatation performed for dysphagia, 7 patients underwent endoscopy and dilatation 3-5 times with 1-week intervals without waiting for the development of dysphagia symptoms. These patients developed no complications, and no stenting was needed. In 5 patients, restenosis developed despite multiple dilatations, and esophageal stent placement was performed. CONCLUSION: Dilatations performed at frequent intervals without waiting for the symptoms of dysphagia can contribute to safer and more effective results in resistant benign esophageal strictures.

The risk of tumor cell dissemination in mediastinoscopy: a cytological study.

BACKGROUND/AIM: Mediastinoscopy is an invasive procedure that is used in the diagnosis of mediastinal diseases and in staging lung cancer. Tumor cell seeding during mediastinoscopy along the mediastinum and the incision line is a very rare complication. This study aimed to test the safety of mediastinoscopy in terms of tumor seeding by cytological evaluation of mediastinal lavage samples taken before and after biopsy. MATERIALS AND METHODS: The patients who underwent mediastinoscopy in our hospital between 2011 and 2014 were studied prospectively. Seventy-three patients with a diagnosis of lung or mediastinal malignancy were included in the study. All patients underwent classical cervical mediastinoscopy and mediastinal lavages were taken before and after the biopsy. Both lavage samples were sent to the pathology department in syringes for malignant cell cytology screening. RESULTS: The results of the histopathological examinations of lymph node biopsies were reactive in 25 patients and positive for malignancy in 48 patients. In 2 of 48 patients whose lymph nodes were reported to be positive for malignancy, the mediastinal lavage sample was reported to be positive for malignancy after biopsy, although it was negative preoperatively. In two patients, both the pre- and postbiopsy lavage samples were reported to be positive for malignancy. CONCLUSION: While performing dissection and biopsy during mediastinoscopy, tumor seeding into the mediastinum may occur. Long follow-up periods and large patient series are needed to determine how cytopathological examination of both fluids would affect the prognosis.

The effect of minimally invasive surgical repair on the lung volumes of patients with pectus excavatum.

OBJECTIVES: To assess the increase in lung volume after Nuss surgery in patients with pectus excavatum (PE) by using stereological methods and to evaluate the correlation between the lung volume and spirometry findings. METHODS: Twenty patients, treated for PE between 2008 and 2010, were evaluated prospectively. They underwent preoperative chest radiography, computed thorax tomography (CTT), and spirometry. Thereafter, the Haller index was calculated for each patient. In the third postoperative month, CTT and spirometry were repeated.Lung volumes and volume fractions were evaluated using CTT images, applying the Cavalieri principle for stereological methods. Then the correlation between the pre- and postoperative values of the lung volumes with spirometry findings was determined. RESULTS: Volumes of the right and left lungs were calculated stereologically, using CTT images. Postoperative volume increase of ∼417.6 ± 747.6 mL was detected. The maximum volume increase was observed in the left lung. In the postoperative period, the total volume increase and the volume increase detected in the left lung were found to be statistically significant (p < 0.05).The preoperative correlation coefficients (r) for forced vital capacity, forced expiratory volume in 1 second, and forced expiratory flow 25 to 75% were 0.67, 0.68, and 0.61, respectively; the postoperative r figures were 0.43, 0.42, and 0.35, respectively. Although there was a strong correlation between the preoperative lung volume and spirometry findings (p < 0.05), no correlation was observed between the postoperative lung volume and spirometry findings (p > 0.05). CONCLUSIONS: Postoperative pulmonary volume increase occurs in patients with PE after Nuss surgery. However, postoperative spirometry findings may not reflect morphological improvement because pain restricts thoracic movements. Therefore, in patients with PE, quantitative evaluation of the results of surgical repair is possible using the CTT images through a combination of stereological methods.

Postoperative lung volume change depending on the resected lobe.

OBJECTIVES: The aim of this study was to evaluate the lung volume changes depending on the resected lobes. The changes were quantitatively evaluated using stereological methods on computed tomography images and by pulmonary function tests (PFTs). METHODS: The study subjects included 30 patients who underwent lung resection. Of these, 26 patients underwent lung resection due to non-small cell lung cancer and 4 patients for benign reasons. Patients were classified into the following six groups according to the resected lobes and lungs: right lower lobectomy, right upper lobectomy, left lower lobectomy, left upper lobectomy, right pneumonectomy, and left pneumonectomy cases. All patients were evaluated with the PFT and computed thorax tomography (CTT), preoperatively and in the postoperative 3rd month. Volume changes due to resection were estimated on CTT scans using the Cavalieri principle of the stereological methods, and their relationships to the PFTs were evaluated. RESULTS: Stereologically estimated data showed that the volume loss was 19.01% in upper lobectomy and 5.57% in lower lobectomy (p < 0.05). The highest volumetric increase of the contralateral lung and minor volume loss of the ipsilateral lung was observed in lower lobectomy. After right lower lobectomy, the highest postoperative volume increase was observed at the contralateral lung and the least volume loss in the remaining ipsilateral lung. In PFT, forced vital capacity (FVC) decreased to 3.07% after lower lobectomy whereas it decreased to 11.94% after upper lobectomy. FVC revealed that no significant change occurred after right lower lobectomy (p < 0.05). CONCLUSIONS: Although the parenchyma resected in lower lobectomy is larger, the postoperative total lung volume reduction is less than that of upper lobectomy. After lower lobectomy, postoperative compensation is achieved specifically by the expansion of contralateral lung, together with the remaining ipsilateral lung.

Endobronchial hypertrophic seromucous salivary gland: a rare bronchial occlusion.

A 41-year-old woman came to our clinics describing increased cough and shortness of breath. A chest roentgenogram revealed a loss of volume in her right lung. Computed tomography revealed a lesion at the level of the main carina, clogging the right main bronchus almost totally. The lesion underwent biopsy by use of flexible bronchoscopy. Histopathologic evaluation showed that the specimen was a hypertrophic seromucous salivary-type gland. Total excision of the mass was performed by bronchotomy through a right thoracotomy. We describe this case of a hypertrophic seromucous salivary gland in the tracheabronchial system.

Pure yolk-sac tumor of the lung.

Primary germ cell tumors of the chest often localize in the anterior mediastinal compartment. Such tumors originating from lungs and pleura are rare. Chest tomography revealed a mass in the middle lobe of the right lung in a 25-year-old man. A middle lobe medial segmentectomy was performed, and chemotherapy was applied postoperatively.

Endobronchial lipoma: a rare cause of bronchial occlusion.

Benign neoplasms of the endobronchial tree are uncommon, and among them lipomas are the most uncommon. Endobronchial lipoma is histologically benign in character but may cause bronchial obstruction. We describe a 47-year-old woman with an endobronchial lipoma arising from the right main bronchus which was treated as asthma for 4 years.