The prevalence of chest trauma in children due to blunt injuries is high in Turkey. Extremity injury is thought to be the most commonly associated extra-thoracic injury. However, thoracic trauma in children can be managed conservatively in most of the cases.

Between 1976 and 1986 one hundred and ten children with pulmonary hydatid disease were treated surgically. Sixty five of the patients were males and 45 were females. We diagnosed hydatid cyst in 36 cases submitted in our clinic with hemoptysis. Thirty of the patients had cough, 16 had chest pain and dyspnea, 12 had purulent sputum and 8 cases had fever and anaphylactic phenomena. In most of the patients hydatid cysts were localised in the right lung. However, they had affinity for the lower lobes of both lungs, rather than the upper lobes. The radiological examination was found to be the most reliable diagnostic method. In the majority of our cases we performed thoracotomy + cystotomy + capitonnage, while in some cases we performed resection, like cystectomy, wedge resection and lobectomy. We did not encounter any serious operative and postoperative complications, except for one pleural empyema and a single case of mortality.

Objective: This study examined the correlation between tumour necrosis factor-alfa (TNF-α), interleukin (IL)-6 and IL-8, IL-10 and methylprednisolone pretreatment. Methods: This is a prospective, randomized and double-blinded study. Sixty patients undergoing coronary artery bypass grafting (CABG) were randomized to receive either intravenous methylprednisolone (n=30, Group M) or intravenous placebo (n=30, Group S). The patients received intravenously either 30 mg/kg methylprednisolone (Group M) or placebo (Group S) 10 min before and after cardiopulmonary bypass (CPB). In an intensive care unit (ICU), four additional doses were given at 6-hourly intervals. Blood samples for the measurements of TNF-α, IL-6, IL-8 and IL-10 were obtained before induction of anaesthesia (T0=control value), after induction (T1), before starting CPB (T2), after aortic declamping (T3), at the end of CPB (T4) and 6 hours (T5), 12 hours (T6) and 24 hours (T7) after skin closure. Creatine kinase (CK) and creatine kinase isoenzyme MB (CK-MB) were evaluated at the following intervals: T0, T5, T6 and T7. Results: When compared with the control value, TNF-α, IL-6 and IL-8 significantly increased in Group S and Group M (p B-0.05), but these values were significantly greater in Group S than in Group M (p B-0.05). In comparison with the control value, IL-10 increased in both groups (p B-0.05), but was significantly greater in Group M than in Group S (p B-0.05). CK and CK-MB were increased in both groups in postoperative values compared to control values. In Group S, CK and CK-MB levels were significantly lower than in Group M (p B-0.05). Conclusion: In this study, we have found that pre-operative administration of methylprednisolone has decreased TNF-α, IL-6 and IL-8 release, and increased the perfusing IL-10 levels after CPB. Thus, methylpredniso-lone may decrease the inflammatory response during the CPB procedure.

We report two cases of primary cardiac hydatid cyst in which hydatid materials caused recurrent embolizations in pulmonary arteries and pulmonary parenchyma. Cardiac hydatid cysts may stay asymptomatic for a long time, until they reveal themselves being perforated into cardiac chambers and/or pulmonary artery or systemic circulation. The role of imaging techniques in diagnosis is discussed and the importance of dynamic enhanced CT, MR imaging, and enhanced MR angiography (MRA) is reported. Imaging findings were confirmed by surgery and pathology. Early diagnosis is essential because delayed treatment increases the morbidity and mortality rates.

Right-sided cardiac echinococcosis shows special clinical and surgical features beyond the rareness of echinococcosis in this position, leading to serious and life-threatening complications. We examined our cardiac hydatid cyst patients, retrospectively, and report our experience of the surgical treatment of right-sided cardiac hydatid cysts. Between 1985 and 2000, seven patients were transferred to our department from the cardiology department with a diagnosis of cystic cardiac masses which were highly suspected of being hydatid cysts. Two were males and 5 were females. In 3 patients the hydatid cyst was located in the right ventricle, and one was in the right atrium. The mean age of the patients was 37 years (ranging from 12 to 60 years). One patient had preoperative pulmonary emboli. In all right-sided cardiac echinococcosis patients, cardiopulmonary bypass was used. All cysts were cleaned after quilting the cystic cavities, and daughter cysts were removed carefully. The cavities were closed with purse-string sutures. Postoperatively, one patient had pulmonary emboli. In all patients, mebendazole was administered postoperatively. When a right-sided cardiac hydatid cyst is diagnosed, early surgical treatment should be performed under open-heart surgery conditions. During the operation, a single cannula in the superior vena cava should be used until fibrillation, and after clamping, the cannula for the pulmonary artery inferior vena cava should be inserted.