Ahmet Sami Bayram

Preoperative maximal exercise oxygen consumption test predicts postoperative pulmonary morbidity following major lung resection

Background and objective:  Pulmonary resection carries a significant morbidity and mortality. The utility of maximal oxygen uptake test (VO2max) to predict cardiopulmonary complications following major pulmonary resection was evaluated.

Rib approximation without intercostal nerve compression reduces post-thoracotomy pain: a prospective randomized study

OBJECTIVE One of the most important considerations in the care of thoracic surgery patients is the control of pain, which leads to increased morbidity and relevant mortality. METHODS Between February and May 2009, 60 patients undergoing full muscle-sparing posterior minithoracotomy were prospectively randomized into two groups, according to the thoracotomy closure techniques. In the first group (group A), two holes were drilled into the sixth rib using a hand perforator, and sutures were passed through the holes in the sixth rib and were circled from the upper edge of the fifth rib, thereby compressing the intercostal nerve underneath the fifth rib. In the second group (group B), the intercostal muscle underneath the fifth rib was partially dissected along with the intercostal nerve, corresponding to the holes on the sixth rib. Two 1/0 polyglactin (Vicyrl) sutures were passed through the holes in the sixth rib and above the intercostal nerve. RESULTS There were 30 patients in each group. The visual analog score, observer verbal ranking scale (OVRS) scores for pain, and Ramsay sedation scores were used to follow-up on postoperative analgesia and sedation. The von Frey hair test was used to evaluate hyperalgesia of the patients. The patients in group B had lower visual analog scores at rest and during coughing. The patients in group B had lower OVRS scores than group A patients. The groups were not statistically different in terms of the Ramsay sedation scores and von Frey hair tests. CONCLUSIONS Thoracotomy closure by a technique that avoids intercostal nerve compression significantly decreases post-thoracotomy pain.

Pre- and post-operative cardiac evaluation of dogs undergoing lobectomy and pneumonectomy

This study aimed to assess the influence of lobectomy and pneumonectomy on cardiac rhythm and on the dimensions and function of the right-side of the heart. Twelve dogs undergoing lobectomy and eight dogs undergoing pneumonectomy were evaluated preoperatively and one month postoperatively with electrocardiography and Doppler echocardiography at rest. Pulmonary artery systolic pressure (PASP) was estimated by the tricuspid regurgitation jet (TRJ) via the pulse wave Doppler velocity method. Systemic inflammatory response syndrome criteria (SIRS) were also evaluated based on the clinical and hematological findings in response to lobectomy and pneumonectomy. Following lobectomy and pneumonectomy, we predominantly detected atrial fibrillation and varying degrees of atrioventricular block (AVB). Dogs that died within seven days of the lobectomy (n = 2) or pneumonectomy (n = 1) had complete AVB. Preoperative right atrial, right ventricular, and pulmonary artery dimensions increased gradually during the 30 days (p<0.05) following pneumonectomy, but did not undergo significant changes during that same period after lobectomy. Mean PASP was 56.0 ± 4.5 mmHg in dogs having significant TRJ after pneumonectomy. Pneumonectomy, but not lobectomy, could lead to increases (p<0.01) in the SIRS score within the first day post-surgery. In brief, it is important to conduct pre- and postoperative cardiac evaluation of dogs undergoing lung resections because cardiac problems are a common postoperative complication after such surgeries. In particular, complete AVB should be considered a life-threatening complication after pneumonectomy and lobectomy. In addition, pneumonectomy appears to increase the likelihood of pulmonary hypertension development in dogs.

Pleurovenous shunt for treating refractory benign pleural effusion

We report the case of a 63-year-old female with hepatic cirrhosis due to chronic hepatitis C, successfully treated for refractory nonmalignant hepatic hydrothorax by using a long-term pleurovenous shunt (PVS). After failure of conventional treatment by mechanical pleurodesis, a PVS was inserted to drain the pleural fluid into the right subclavian vein. After 8 months of follow-up, the effusion is well controlled, and the shunt remains patent.

Clinical outcomes of lung metastasectomy in patients with colorectal cancer

AIM To investigate prognostic factors of survival following curative, non-palliative surgical removal of lung metastases secondary to colorectal cancer (CRC). METHODS Between 1999 and 2009, a radical metastasectomy with curative intent was performed on lung metastases in 21 patients with CRC (15 male and 6 female; mean age: 57.4 ± 11.8 years; age range: 29-74 years) who had already undergone primary tumour resection. RESULTS The mean number of lung metastases ranged from one to five. The mean overall survival was 71 ± 35 mo (median: 25 mo). After adjusting for potential confounders, multivariable Cox regression analyses predicted only the number of lung metastases (1 vs ≥ 2; hazard ratio: 7.60, 95% confidence interval: 1.18-17.2, P = 0.03) as an independent predictor of poor survival following lung resection for metastatic CRC. CONCLUSION Resection of lung metastases is a safe and effective treatment in selected CRC patients with single lung metastases.

Pericardial cysts: an analysis of 12 cases.

BACKGROUND Pericardial cysts are usually asymtomatic, benign, congenital mediastinal lesions but may also be acquired after cardiothoracic surgery. The purpose of the study was to evaluate surgical approach and results of our experience with pericardial cysts. PATIENTS AND METHODS A total of 12 patients who had undergone surgical treatment for pericardial cyst between February 1999 and August 2010 were retrospectively evaluated. All patients were analyzed according to the symptoms, method for the diagnosis, cyst location, management, and outcomes. RESULTS The mean age was 50.4±17 years (range, 23-68 years) with a female-to-male ratio of 8:4. Pericardial cyst were located in the right hemithorax in 8 (67%) patients and left hemithorax in 4 (33%) patients. The cysts were resected by thoracotomy in 4 (33%) patients and by video-assisted thoracic surgery in 8 (67%) patients. There was an excellent long-term follow-up with no morbidity or mortality. CONCLUSION Videothoracoscopic surgical removal of pericardial cysts is an excellent surgical intervention without serious morbidity and mortality.

Case of solitary eosinophilic granuloma of the sternum.

We report a rare case of eosinophilic granuloma of the sternum in a 13-year-old male patient, who presented with anterior chest pain and a tender mass over the sternum.

Clinical significance of p53 gene mutation in T1-2N0 non-small cell lung cancer.

In the early stage, long-term survival with non-small cell lung carcinoma has never been ideal. The aim of this study was to compare pathologically proven N0 lymph nodes obtained during mediastinoscopy with p53 gene mutation, and to correlate these with postoperative recurrence. Thirty patients undergoing mediastinoscopy for staging of non-small cell lung carcinoma were studied prospectively. Standard cervical mediastinoscopy was performed in all cases, and the specimens were divided into two pieces for histopathological and genetic investigations. All but one of the patients were male, and the mean age was 61.2 years (range, 42–74 years). Although the histopathology was negative in all cases, p53 gene mutation was observed in 6 (20%) patients. Recurrence was detected in 3 patients who had negative histopathology but were positive for p53 mutation, and in one who had negative histopathology and no p53 mutation. Patients with pathologically N0 disease and p53 gene mutation must be carefully monitored for local recurrence or distant metastasis. Neoadjuvant and/or adjuvant therapies may be considered in this group of patients.

The success of surgery in the first 24 hours in patients with esophageal perforation.

OBJECTIVE Esophageal perforation (EP) is a critical and potentially life-threatening condition with considerable rates of morbidity and mortality. Despite many advances in thoracic surgery, the management of patients with EP is still controversial. MATERIALS AND METHODS We retrospectively reviewed 34 patients treated for EP, 62% male, mean age 53.9 years. Sixty-two percent of the EPs were iatrogenic. Spontaneous and traumatic EP rates were 26% and 6%, respectively. Three patients had EP in the cervical esophagus and 31 in the thoracic esophagus. RESULTS Mean time to initial treatment was 34.2 hours. Twenty patients comprised the early group <24 h) and 14 patients the late group (>24 h). Management of the EP included primary closure in 30 patients, non-surgical treatment in two, stent in one and resection in one. Mortality occurred in nine of the 34 patients (26%). Mortality was EP-related in four patients. Three of the nine patients that died were in the early group (p<0.05). Mean hospital stay was 13.4 days. CONCLUSION EP remains a potentially fatal condition and requires early diagnosis and accurate treatment to prevent the morbidity and mortality.

Can Thoracic Sympathetic Nerve Damage Be Reversed

BACKGROUND Function of the thoracic sympathetic chain (TSC) reportedly recovers after surgical clips are removed. Hence, this study was designed to study nerve regeneration after unclipping the TSC. METHODS The bilateral TSCs of six goats were studied; the goats were separated into three groups (groups I, II, and III) during excision, clipping, and unclipping. During surgery, the TSCs were excised with a scalpel in group I and clipped in groups II and III. In group III, the clips were removed 1 month postoperatively and observed for possible nerve healing for 1 month. All TSCs were examined histologically following en block resection at 1 month postoperatively in groups I and II and at 2 months postoperatively in group III. RESULTS Inflammation in nerve sections was noted following clip removal. Furthermore, there was significant degeneration and cell infiltration in the nerve fibers of the clipped regions. The Schwann cells around the peripheral nerve endings in the unclipped regions facilitated nerve transmission by reconstitution of myelin. CONCLUSION Clipping the TSC can cause histologic degeneration; however, histologic nerve regeneration occurs after unclipping.