Minimally invasive repair of pectus excavatum (MIRPE) in adults: is it a proper choice?

Introduction : The Nuss procedure is suitable for prepubertal and early pubertal patients but can also be used in adult patients. Aim : To determine whether the minimally invasive technique (MIRPE) can also be performed successfully in adults. Material and methods : Between July 2006 and January 2016, 836 patients (744 male, 92 female) underwent correction of pectus excavatum with the MIRPE technique at our institution. The mean age was 16.8 years (2–45 years). There were 236 adult patients (28.2%) (> 18 years) – 20 female, 216 male. The mean age among the adult patients was 23.2 years (18–45 years). The recorded data included length of hospital stay, postoperative complications, number of bars used, duration of the surgical procedure and signs of pneumothorax on the postoperative chest X-ray. Results: MIRPE was performed in 236 adult patients. The average operative time was 44.4 min (25–90 min). The median postoperative stay was 4.92 ±2.81 days (3–21 days) in adults and 4.64 ±1.58 (2–13) in younger patients. The difference was not statistically significant (p = 0.637). Two or more bars were used in 36 (15.8%) adult patients and in 44 (7.5%) younger patients. The difference was not statistically significant either (p = 0.068). Regarding the overall complications, complication rates among the adult patients and younger patients were 26.2% and 11.8% respectively. The difference was statistically significant (p = 0.007). Conclusions : MIRPE is a feasible procedure that produces good long-term results in the treatment of pectus excavatum in adults

Evaluation of clinical follow-up of patients with arteriovenous fistula

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Amaç: Hastaların çalışan arteriyovenöz fistül (AVF)’lerini böbrek nakli sonrası kapattırma veya kapattırmama istekleri, kararlarının nedenlerinin belirlenmesi, bu kararlarının diğer parametreler ile ilişkileri araştırıldı. Hastalar ve yöntemler: Araştırmanın örneklemini Ocak 2009 - Aralık 2015 tarihleri arasında İstanbul Şişli FNH’de böbrek nakli öncesi diyalize girmek için AVF açılan, nakil sonrası fistülleri çalışan 100 hasta (60 erkek, 40 kadın; ort. yaş 41.3±10.6 yıl; dağılım 22-65 yıl) oluşturdu. Hastaların sosyodemografik ve fistüle bağlı özellikleri, 25 maddelik Veri Toplama Formu ile sorgulandı.Objectives: This study aims to investigate the demands of the patients whether to close down or not to close down the working arteriovenous fistulas (AVF) subsequent to kidney transplantation, determining the reasons for decision, and relationships of these decision with other parameters. Patients and methods: The sampling of the study consists of 100 patients (60 males, 40 females; mean age 41.3±10.6 years; range 22 to 65 years), on whom AVF was opened before kidney transplantation and continued to work in the postoperative period in Istanbul Şişli FNH between January 2009 - December 2015. Sociodemographic and fistula-related characteristics of the patients were questioned using a 25-item Data Collection Form

The use of Jackson-Pratt silicone flat drains as prolonged pleural catheters for the management of pleural effusions

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Introduction: Imbalance between secretion and absorbtion of pleural fluid results in pleural effusion. Emergence of pleural effusion ipsilateral or contralateral to the side drained previously is named recurrent effusion. There is currently no standart approach for the management of recurrent pleural effusions. Materials and methods: Eighteen patients, treated between 2011 and 2012 for recurrent pleural effusions due to various etiologies, not considered for surgical or other treatments, and underwent placement of prolonged pleural catheters ( Jackson-Pratt drain ) were included in this study. Twenty two prolonged pleural catheters were inserted in 18 patients. There were 10 females and 8 males, with mean age 59 (35-77). In 20 patients the catheters were inserted by an anterior approach, and by a posterior approach in one patient. Daily drainage above 1,500 mL was not permitted in order to avoid pulmonary edema. Catheters were removed in patients who had lung expansion and drainage under 50 mL/day

Psychopathological and clinical features in patients with temporomandibular joint dysfunction syndrome

Amaç: Bu çalışmanın amacı, temporomandibuler eklem disfonksiyon sendromu (TMEDS) tanılı hastaları alt tanı gruplarına göre klinik ve psikopatolojik özellikler açısından karşılaştırmaktır. Gereç ve Yöntem: Multidisipliner Temporomandibuler Eklem (TME) Tanı ve Tedavi Ünitesi Polikliniği’ne başvuran ve TMEDS tanısı konan 200 hasta çalışmaya alındı. Hastalar yalnız miyofasiyal ağrısı olanlar (Grup-1), yalnız TME hastalığı olanlar (Grup-2) ve TME hastalığı ile birlikte miyofasiyal ağrısı olanlar (Grup-3) şeklinde üç alt gruba ayrıldı. Tüm hastalara standart TME muayenesi yapıldı. Hastalar psikopatolojik özellikler açısından Kısa Semptom Envanteri (KSE) ve Toronto Aleksitimi Ölçeği (TAÖ) ile değerlendirildi. Bulgular: Grup-2’de diğer iki gruba göre maksimal ağız açıklığı, Grup-1’e göre ise sağ ve sol maksimal lateral hareket anlamlı olarak daha azdı. Grup-3’te Grup-1’e göre maksimal protrüzyon anlamlı biçimde daha az bulundu. Grup-2’de diş sıkma/gıcırdatmanın ve stresin etkisi Grup-3’e göre anlamlı olarak daha azdı. Grup-2’ye göre, Grup-1’deki hastaların KSE somatizasyon puanları, Grup-3’deki hastaların depresyon, anksiyete ve belirti toplam indeks puanları anlamlı biçimde daha yüksek bulundu. Üç grup arasında aleksitimi düzeyi açısından fark saptanmadı. Sonuç: Yalnız miyofasial ağrılı olan ya da TME hastalığına eklenen miyofasiyal ağrısı olan hastaların psikopatolojik açıdan daha riskli olduğu görülmektedir. Klinisyenlerin bu hastalarda psikopatolojileri dikkate almaları gerekmektedir. Türk Fiz Tıp Re hab Derg 2012;58:9-15.Objective: The aim of this study was to compare the clinical and psychopathological variables among temporomandibular joint dysfunction syndrome (TMDS) subgroups. Metarials and Methods: In this study, we included two hundred individuals, who appealed to outpatient clinic of the Multidisciplinary Temporomandibular Joint (TMJ) Diagnosis and Management Unit and were diagnosed with TMDS. The subjects were divided into three subgroups: only myofascial pain group (Group-1), only TMJ disorder group (Group-2) and myofascial pain+TMJ disorder group (Group-3). All patients underwent standard TMJ examination. The patients were evaluated with the Brief Symptom Inventory (BSI) and the Toronto Alexithymia Scale (TAS) in terms of psychopathological features. Results: Maximum mouth opening was found significantly lesser in Group-2 than in the other two groups, right and left lateral movements were found significantly lesser in Group-2 than in Group-1. Maximum protrusion was found significantly lesser in Group-3 than in Group-1. In Group-2, teeth clenching/grinding and the effect of stress were significantly less. In comparison with Group-2, BSI somatization scores in Group-1 patients, depression, anxiety,and symptoms total index scores in Group-3 patients were found to besignificantly higher. No difference was found for the level of alexithymia between the groups. Conclusion: The patients with myofascial pain alone or myofascial pain and intercurrent TMJ disorder were found more likely to have a greater psychopathological risk. Clinicians should take into consideration the psychopathologies in these patients. Turk J Phys Med Rehab 2012;58:9-15

The Turkish version of the consensus auditory-perceptual evaluation of voice (CAPE-V): A reliability and validity study

Objective: The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) was developed to assess voice quality. The aim of this study was to develop a Turkish adaptation of CAPE-V and to evaluate the reliability and validity of the Turkish version. Methods: To adapt the CAPE-V protocol to Turkish, six sentences were constructed to meet the phonetic requirements. The validity of the Turkish version of the CAPE-V was tested with inter-rater reliability, intrarater reliability, and GRBAS versus the CAPE-V judgments. Ninety-nine dysphonic and 83 healthy subjects were enrolled. Results: High inter-rater and intrarater reliability (ICC > 0.88, r > 0.81, respectively) were obtained for all vocal parameters. The differences in the six CAPE-V parameters between healthy and dysphonic subjects were statistically significant (P < 0.0001). The correlations between CAPE-V and GRBAS scales were high in overall severity-grade and roughness parameters (r = 0.85, r = 0.82, respectively), the lowest correlation was the strain parameter (r = 0.66). Conclusion: The Turkish version of CAPE-V is a reliable and valid instrument for auditory-perceptual evaluation of the Turkish speaking population

Titanyum plaka ve mesh kullanılarak ateşli silah yaralanması sonrası gelişen sternal dehisensin onarımı

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Giriş ve Amaç: Toraksa yönelik ateşli silah yaralanması olan vakalarda ölüm ve sakatlık oranı oldukça yüksektir. Biz transmediastinal ateşli silah yaralanması sonrası sternum hasarı gelişen ve titanyum yama ile düzeltme uyguladığımız bir olguyu sunmayı amaçladık

Pneumomediastinum, Subcutaneous Emphysema, and Tracheal Tear in the Early Postoperative Period of Spinal Surgery in a Paraplegic Achondroplastic Dwarf

Achondroplasia was first described in 1878 and is the most common form of human skeletal dysplasia. Spinal manifestations include thoracolumbar kyphosis, foramen magnum, and spinal stenosis. Progressive kyphosis can result in spinal cord compression and paraplegia due to the reduced size of spinal canal. The deficits are typically progressive, presenting as an insidious onset of paresthesia, followed by the inability to walk and then by urinary incontinence. Paraplegia can be the result of direct pressure on the cord by bone or the injury to the anterior spinal vessels by a protruding bone. Surgical treatment consists of posterior instrumentation, fusion with total wide laminectomy at stenosis levels, and anterior interbody support. Pedicle screws are preferred for spinal instrumentation because wires and hooks may induce spinal cord injury due to the narrow spinal canal. Pedicle lengths are significantly shorter, and 20–25 mm long screws are appropriate for lower thoracic and lumbar pedicles in adult achondroplastic There is no information about the appropriate length of screws for the upper thoracic pedicles. Tracheal injury due to inappropriate pedicle screw length is a rare complication. We report an extremely rare case of tracheal tear due to posterior instrumentation and its management in the early postoperative period

Robotic lung segmentectomy for malignant and benign lesions

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Objective: Surgical use of robots has evolved over the last 10 years. However, the academic experience with robotic lung segmentectomy remains limited. We aimed to analyze our lung segmentectomy experience with robot-assisted thoracoscopic surgery. Methods: Prospectively recorded clinical data of 21 patients who underwent robotic lung anatomic segmentectomy with robot-assisted thoracoscopic surgery were retrospectively reviewed. All cases were done using the da Vinci System. A three incision portal technique with a 3 cm utility incision in the posterior 10th to 11th intercostal space was performed. Individual dissection, ligation and division of the hilar structures were performed. Systematic mediastinal lymph node dissection or sampling was performed in 15 patients either with primary or secondary metastatic cancers. Results: Fifteen patients (75%) were operated on for malignant lung diseases. Conversion to open surgery was not necessary. Postoperative complications occurred in four patients. Mean console robotic operating time was 84 +/- 26 (range, 40-150) minutes. Mean duration of chest tube drainage and mean postoperative hospital stay were 3 +/- 2.1 (range, 1-10) and 4 +/- 1.4 (range, 2-7) days respectively. The mean number of mediastinal stations and number of dissected lymph nodes were 4.2 and 14.3 (range, 2-21) from mediastinal and 8.1 (range, 2-19) nodes from hilar and interlobar stations respectively. Conclusions: Robot-assisted thoracoscopic segmentectomy for malignant and benign lesions appears to be practical, safe, and associated with few complications and short postoperative hospitalization. Lymph node removal also appears oncologically acceptable for early lung cancer patients. Benefits in terms of postoperative pain, respiratory function, and quality of life needs a comparative, prospective series particularly with video-assisted thoracoscopic surgery