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Öğe Abdominothoracic Fistulas due to Complicated Echinococcosis(Georg Thieme Verlag Kg, 2012) Karamustafaoglu, Y. A.; Tarladacalisir, T.; Yoruk, Y.Purpose Abdominothoracic fistulas are severe complications of hydatid disease. We report here on the results of surgical treatment of hydatid abdominopleural fistulas in 6 patients. Material and Methods Between 2004 and 2010, 6 patients with abdominothoracic fistulas (ATF) were treated. The patients were 3 men and 3 women (age range: 4762 years; median age: 57.1 years). The main symptoms were dyspnea, chest pain, cough, purulent sputum, high fever in 4 patients and additionally bilioptysis in 2. Fistulas were left abdominopulmonary in 1, hepatopulmonary in 2 and hepatopleural in 3 patients. Results Five patients were operated for ATF and 1 patient was treated with tube thoracostomy. In 4 patients, liver dome hydatid cyst abscesses were exposed through a right thoracophrenotomy, a first left thoracophrenotomy was performed in 1 patient followed by a second left lower lobectomy due to a destroyed lobe. Tube thoracostomy and percutaneous transhepatic drainage was applied successfully in Patient #5. All patients were discharged from hospital in good health. Our strategy consisted of adequate evacuation of the intrahepatic cyst with dissection and closure of the fistula via thoracophrenotomy. Discussion ATF due to hydatid cyst is uncommon. In rare cases ATF may be present at the abdominal, thoracic or diaphragmatic level. Thoracophrenotomy is the best surgical treatment for all three levels.Öğe Does early use of bilevel positive airway pressure (bipap) in cardiothoracic intensive care unit prevent reintubation?(E-Century Publishing Corp, 2014) Sagiroglu, G.; Baysal, A.; Copuroglu, E.; Gul, Y. G.; Karamustafaoglu, Y. A.; Dogukan, M.Introduction: Non-invasive ventilation (NIV) is a preferred treatment in acute respiratory failure after operations. Our aim is to investigate the success of early use of bilevel positive airway pressure (BIPAP) after cardiac or thoracic surgeries to prevent reintubation. Methods: In a prospective randomized study, 254 patients were divided into two groups depending on the time period between extubation and the application of BIPAP. In Group 1 BIPAP was applied after extubation within 48 hours after surgery following fulfilling of acute respiratory failure criterias whereas, in Group 2, BIPAP was applied one hour after extubation for two episodes of 20 minute duration and 3 hours apart. Arterial blood gas values (pH, PaO2, PaCO2) at first and fourth hour after BIPAP were collected. Results: In comparison between groups, no significant differences were observed for arterial blood gas values of pH and PaCO2 at baseline, one and four hours after BIPAP (p > 0.05) however, the PaO2 values at one and four hours after BIPAP were significantly better in Group 1 in comparison to Group 2 (p < 0.001, p < 0.001; respectively). Reintubation rate was 14 patients (11%) in Group 1 and 7 patients (5.5%) in Group 2 (p = 0.103). Conclusions: The early and prophylactic use of BIPAP after cardiac or thoracic operations did not provide diminished rates in the postoperative complications such as reintubation.Öğe DOES EARLY USE OF BILEVEL POSITIVE AIRWAY PRESSURE (BIPAP) IN CARDIOTHORACIC INTENSIVE CARE UNIT PREVENT REINTUBATION?(Springer, 2014) Sagiroglu, G.; Baysal, A.; Capuroglu, E.; Gul, Y. G.; Karamustafaoglu, Y. A.; Dogukan, M.[Abstract Not Available]Öğe One-stage surgical management for lung and liver hydatid diseases Management of liver and lung cysts(Springer Wien, 2011) Karamustafaoglu, Y. A.; Reyhan, G.; Kuzucuoglu, M.; Yoruk, Y.Background: Hydatid disease remains a serious health problem in Mediterranean areas. We reviewed the efficacy of a single-stage operation in coexisting cysts of lung and liver in patients. Methods: Forty-one patients operated for the cysts located on the dome of the liver and right lung with one-stage surgical approach on between 1990 and 2010. There were 19 males (46%) and 22 females (54%) patients. The age range was 10-82 years, with a median age of 34 years. Results: All patients had simultaneous operations for both organs via right thoracotomy and phrenotomy except one patient. Surgical techniques used in the lung were cystotomy and capitonnage, with wedge resection of the destroyed lung parenchyma in three (7.3%) and additional decortication in three (7.3%). Cystotomy was applied with membrane removal in the liver cysts. Postoperative complications were prolonged biliary drainage, empyema, prolonged air leak, pleural effusion in one case (2.4%) each, respectively. All patients managed successfully and discharged. No hospital mortality occurred. Conclusions: We propose that concomitant right pulmonary and liver dome hydatid cysts can be treated effectively and safely in a one-stage operation through a right posterolateral thoracotomy and phrenotomy.Öğe Sublingual vs. intranasal dexmedetomidine sedation for flexible fiberoptic bronchoscopy procedure: a retrospective comparative study(Verduci Publisher, 2023) Yanik, F.; Sagiroglu, G.; Karamustafaoglu, Y. A.OBJECTIVE: Flexible fiberoptic bronchoscopy (FOB) is an often-employed invasive method in diagnosing, staging, and treating lung diseases. Conventional sedative agents facilitate this process. Dexmedetomidine (DM) has low side effects and is easy to administer for trans-mucosal absorption. This study aimed to investigate trans-mucosal DM used with local anesthesia during the FOB procedure. PATIENTS AND METHODS: Fifty-nine cases were retrospectively analyzed who had undergone diagnostic flexible fiberoptic bronchoscopy (FOB) in our clinic between September 2016 and September 2019. The two methods (Group 1: Sublingual, and Group 2: Intranasal) employed during the FOB procedure for the local anesthesia were compared. RESULTS: Fifty-nine patients were included in the study, wherein forty-six were males (77.9%), and thirteen (22.1%) females had a mean age of 58.02 +/- 8.7 years (range: 39-72 years). Thirty-three patients were in Group 1 (Sublingual) and 26 in Group 2 (Intranasal). No significant differences were there between groups regarding age, gender, body mass index, or ASA physical status. Modified Aldrete Score >9 was significant to reach with time as a correlation between operator and patient satisfaction. Sedation scores for groups at 1st, 9th, 12th, and 15th min were similar. Excessive coughing was observed in two (7.7%) patients of Group 2 but in none of Group 1 (p=0.105). Patients in both groups had no complaints of swallowing, excessive body movement, or lower oxygen saturation during examination (p>0.05). There were no complications (hypotension, bradycardia, respiratory depression, allergy, permanent amnesia, nausea, and vomiting) observed in patients. CONCLUSIONS: Our study results revealed that easily administered trans-mucosal dexmedetomidine sedation is safely applied during flexible fiberoptic bronchoscopy for adequate sedation, high satisfaction, and low complication rates with no significant difference in sublingual or intranasal administration.Öğe Surgical outcomes and clinical courses of solitary fibrous tumors of pleura(Wolters Kluwer Medknow Publications, 2019) Yanik, F.; Karamustafaoglu, Y. A.; Yoruk, Y.Aim: This study's aim is to define the clinicopathological and surgical outcomes, clinical courses, and results of long-term follow-up of cases that underwent surgical treatment for solitary fibrous tumors of the pleura (SFTp). Subjects and Methods: Clinical and long-term follow-up records of 16 consecutive patients who had surgery for SFTp between 2006 and 2016 were reviewed in the retrospective chart review. There were nine males (56%) and seven (44%) females with an average age of 60.5 +/- 17.1 (range 30-87 years). Etiological factors, diagnostic procedures, clinical and surgical outcomes, 5-year overall survival (OS), and disease-free survival (DFS) in these patients were researched. Results: There was no remarkable common etiological factor. Nine of the cases were asymptomatic. Other symptoms were chest pain, dyspnea, cough and hypertrophic osteoarthropathy, respectively. Thoracotomy for the removal of pleural mass was carried out in 15 (94%) cases. Additional resection procedures included the chest wall resection in two cases and lobectomy in two. Video-assisted thoracoscopic surgery (VATS) resection was performed in one (6%) case. Complete surgical excision was performed in 74% of cases. Nineteen percent of cases were malignant SFTp (mSFTp). One of the mSFTp cases died in the 19(th) month after the diagnosis. The mean follow-up time was 50.6 +/- 34.2 months (2--114 months). Mean survival of mSFTp patients was 40.6 +/- 19.08 months (19--55 months) and that for benign SFTp (bSFTp) was 52.9 +/- 37.05 months (2--114 months). Five-year OS--DFS were 93.5% and 74%, respectively. Conclusion: SFTp is an uncommon benign neoplasm but it can have malignant features. Even in the case of recurrence, the main treatment is total surgical excision. Oncologic treatments can be tried in unresectable and metastatic cases. VATS can be used in surgical total excision for small diameter and appropriate tumors. Understanding the nature of these tumors, immunohistochemical, and genetic studies may be a guide in future.Öğe Transaxillary Approach for Thoracic Outlet Syndrome: Results of Surgery(Georg Thieme Verlag Kg, 2011) Karamustafaoglu, Y. A.; Yoruk, Y.; Tarladacalisir, T.; Kuzucuoglu, M.Background: Thoracic outlet syndrome (TOS) is one of the most complicated diseases in thoracic surgery with regard to both diagnosis and treatment. Surgical removal of the first rib and cervical rib, if present, has been suggested as the treatment of choice in patients who do not benefit from physiotherapy. In this retrospective study, our surgical experience with TOS and the management of surgical complications are presented. Methods: A total of 109 cases with the diagnosis of TOS were operated on between January 1995 and April 2010. Ninety-five of the cases were females (87.2%) and 14 (12.8%) were males with a mean age of 35.7 (16-58). Results: A total of 131 operations were performed, of which 21 were bilateral and one was a recurrent operation. The diagnosis was neurogenic TOS in 107 (98.2%) and vascular TOS in two (1.8%) patients. All neurogenic TOS operations were performed via the transaxillary route. A posterior thoracoplasty approach was used for recurrent TOS in one case. A total of 23 (21.1%) cases had a cervical rib. Fibromuscular bands were observed in 68 (62.3%) cases. The rates for favorable and poor surgical outcome were 125 (95.4%) and 6 (4.6%), respectively. The most common complication was apical pneumothorax in 32 (24.6%) cases, followed by wound infection in four (3%), lymphatic leak, axillary hematoma and mild brachial plexus traction palsy in one (0.8%) case. Mortality was not observed. Conclusions: In our experience the exposure provided by the transaxillary approach is safe and superior to that offered by other approaches as it allows a wide range of surgical applications such as first rib resection, cervical rib resection and resection of fibrotic bands.