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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 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.