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Nonanatomic prognostic factors in resected nonsmall cell lung carcinoma: The importance of perineural invasion as a new prognostic marker

BACKGROUND A number of prognostic factors have been reported for resected nonsmall cell lung carcinoma. Although none of them reported to have greater prognostic impact than the TNM staging system, which is based on anatomical descriptions of tumors, the prognoses of a significant number of patients are not in agreement with real survival of the patients. Moreover, certain histopathologic properties of the tumor (such as lymphatic and vascular invasion) could help to predict the survival of the patients. METHODS A retrospective study was conducted on 82 surgically resected nonsmall cell lung carcinomas, and the following prognostic factors were evaluated in univariate analysis: age, gender, clinical and surgical-pathologic T and N status, histologic type of tumor, grade of differentiation, lymphatic invasion, vascular invasion, and perineural invasion. RESULTS Lymphatic invasion and perineural invasion of the tumor were found to be significant prognostic factors (p = 0.02 and p = 0004). Blood vessel invasion (venous or arterial involvement) had no prognostic impact (p > 0.05). According to multivariate analyses, three factors were selected as prognostic indicators: (1) clinical N status (p = 0.027), (2) lymphatic invasion (p = 0.027) and (3) perineural invasion (p = 0.0148). By combining these factors we identified a poor prognostic subgroup of patients with stage I disease. CONCLUSIONS Our study showed that lymphatic vessel and perineural invasion of the tumor could be prognostic factors, along with anatomical determinants such as cN and surgical-pathologic stage of the pulmonary carcinoma.

Accuracy of positron emission tomography in mediastinal node assessment in coal workers with lung cancer.

The purpose of this study was to explore the accuracy of 18F-fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography (PET/CT) in the assessment of mediastinal lymph node in coal workers who had non-small cell lung cancer. We retrospectively reviewed 42 retired coal workers who had lung cancer without distant metastasis, between May 2007 and May 2010. Regarding the mediastinal lymph nodes, when the standard uptake value was greater than 2.5, it was considered “malignancy positive.” After histological examination of the mediastinal lymph nodes, anthracotic and metastatic ones were detected. The results of PET/CT were analyzed to determine its accuracy. Of these 42 patients, PET/CT detected 47 positive mediastinal lymph nodes in 24 patients with a mean SUV maximum of 6.2 (2.6–13.8). One hundred and thirty-one mediastinal lymph node foci were dissected. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FDG-PET/CT in detecting nodal metastases were 84% (16/19), 65% (15/23), 66% (16/24), 83% (15/18), and 74% (31/42) on a per-patient basis, respectively. Mediastinal node staging with FDG-PET/CT in coal workers is insufficient due to the high false-positive rates due to the presence of pneumoconiosis. In these patients, an invasive technique such as mediastinoscopy seems mandatory for confirmation of ipsilateral or contralateral mediastinal lymph node metastasis.

Effect of Ankaferd Blood Stopper on air leakage in the lung and prevention of bleeding: an experimental study

BackgroundAir leakage and hemorrhage are important causes of morbidity and mortality in operations and traumas of the lung. Ankaferd Blood Stopper is a herbal product used for stopping hemorrhage. In our study, we investigated the efficacy of Ankaferd Blood Stopper in the prevention of air leakage in the lung and bleeding.MethodsA total of twenty-one Wistar-Albino rats weighing 240 ± 20 grams were used in our study. An equal amount of injury was created in all groups by performing left thoracotomies. No interventions were made on tissue injury in the first group, and suturing was performed in the second group, and Ankaferd was applied in the third group. Air leakage and duration of bleeding were recorded in all groups.ResultsA statistically significant difference was found between the three groups in terms of air leakage time (p = 0,0001) and bleeding time (p = 0,0001). While a significant effect of Ankaferd was detected in terms of air leakage compared to standard surgery (p = 0,017), no difference was found in terms of bleeding time.ConclusionsAnkaferd Blood Stopper ceases the air leakage in the lung parenchyma significantly and effectively. No significant difference is seen compared to the standard surgery group, although it ceases bleeding significantly.

A unique case of right-sided Poland syndrome with true dextrocardia and total situs inversus

Poland syndrome has been reported to be associated with true dextrocardia, but not with true situs inversus. In this report, we describe the first patient with total situs inversus in medical literature and try to highlight the syndromes probable etiology and pathogenetic mechanisms in utero.

The effect of erythropoietin to pulmonary injury and mast cells secondary to acute pancreatitis

BackgroundAcute pancreatitis is a life-threatening necroinflammatory disease that is characterized by systemic inflammatory response syndrome and acute lung injury even in its very first days. Erythropoietin (EPO) is a hormone considered as an antiapoptotic and cytoprotective with observed receptors of anti-inflammatory effect on organs apart from the liver and the kidneys. In this study, the effects of EPO on pulmonary mast cells and on secondary injury caused by acute pancreatitis are investigated.MethodsTwenty one Wistar Albino rats were divided into three groups—sham, control, and EPO groups—with 7 rats per group. Pancreatitis was induced by administering 4.5% sodium taurocholate into the pancreatic duct. A 1000 U/kg/day dosage (three times) of EPO was administered to the EPO group. Blood urea nitrogen (BUN), creatinine, amylase, and troponin I in the serum were studied; and lung, kidney, brain, and heart tissues were examined histopathologically.ResultsThere were no histopathological changes in the other organ tissues except for the lung tissue. Compared to the control group, the EPO group showed significantly reduced alveolar hemorrhage, septal neutrophil infiltration, lung wall thickness score, and mast cell count in the lung tissue.ConclusionsAdministration of EPO reduces the mast cell count and lung wall thickness, and it reduces the alveolar hemorrhage and septal infiltration induced by acute pancreatitis.

Mediastinal Masses; the Analysis of 28 Cases in the Western Black Sea Region

DOI: 10.4328/JCAM.910 Received: 31.01.2012 Accepted: 29.02.2012 Printed: 01.03.2013 J Clin Anal Med 2013;4(2): 93-5 Corresponding Author: Mertol Gökçe, Karaelmas Üniversitesi Tıp Fakültesi; Göğüs Cerrahisi Anabilim Dalı. 67400 Zonguldak, Türkiye. T.: +905324070788 E-Mail: dr.mertol@gmail.com Özet Amaç: Mediastinal kitleler hayati organlara yakın olması ve çeşitli histopatolojik tipler içermesinden dolayı çok önemlidir. Bu çalışmanın amacı, cerrahi olarak tanı konulan ve rezeksiyon yapılan mediastinal kitleli olguları retrospektif olarak analiz etmektir. Gereç ve Yöntem: Mayıs 2008-Aralık 2011 tarihleri arasında, Batı Karadeniz bölgesinde ki üniversite hastaneleri göğüs cerrahisi kliniklerimizde mediastinal kitle nedeniyle operasyon uygulanan 28 hasta retrospektif olarak incelendi. Olgular yaş, cinsiyet, şikâyet, klinik ve radyolojik bulgular, cerrahi yaklaşım, histopatolojik tanı, postoperatif komplikasyon ve mortalite açısından incelendi. Olguların yaş aralığı 31-76 arasında (ortalama: 52,07) ve 19’u kadın, 9’u erkek toplam 28 hastadan oluşuyordu. Başvuru şikâyetleri öksürük, göğüs ağrısı, kas güçsüzlüğü ve dispne idi. Bir olguda vena kava süperior sendromu vardı. Olguların %21,4’ü asemptomatikti. Olguların %85,72’sine komplet rezeksiyon yapılırken, %14,28’ine ise yalnızca biyopsi yapılabildi. Postoperatif komplikasyon bir olguda görüldü ve mortalite izlenmedi. Sonuç: Cerrahi tedavi, mediastinal kitlelerin kesin tanı ve tedavisinde düşük mortalite ve morbidite oranı ile güvenilir bir yöntemdir.

The Effects of Ankaferd Blood Stopper on the Recovery Process in an Experimental Oesophageal Perforation Model

BACKGROUND Oesophageal perforation is a life-threatening pathology that is generally treated conservatively; however, surgical procedures are frequently performed. A topical haemostatic agent, Ankaferd Blood Stopper (ABS), also has beneficial wound-healing effects. AIMS This study aimed to determine the effects of ABS following experimental oesophageal perforations. STUDY DESIGN Animal experiment. METHODS The experimental rats were classified into 6 groups (with 7 rats in each group). Pairs of groups (primary repair alone and primary repair + ABS) were terminated in the 1(st), 2(nd), and 3(rd) weeks following injury. The oesophageal perforations, which were 8-10 mm in length, were created using a nasogastric tube. The perforation sites were repaired with a 6-0 polyglactine thread in the primary repair groups. Additionally, ABS was sprayed over the perforation site in the treatment groups. Each oesophagus was evaluated histopathologically. RESULTS There were fewer microabscesses and areas of necrosis in the ABS groups compared with the primary repair groups. The histopathological evaluation revealed that the ABS groups had less inflammation and more re-epithelisation compared to the primary repair groups (p=0.002 and p=0.003, respectively). Fibrosis in the ABS groups was moderate in the 2(nd) week and mild in the 3(rd) week. Comparing the groups with respect to the time intervals, only the 1(st) week groups showed a significant difference in terms of re-epithelialisation (p=0.044). CONCLUSION Topical ABS application on the repaired experimental oesophageal perforation regions led to positive wound-healing effects compared with the rats that were administered the primary repair alone.

An adenocarcinoma developed in tuberculosis cavity

A 71-year-old female patient with a history of tuberculosis was explored via thoracotomy due to a lesion mimicking an intra-cavitary fungus ball (Fig. 1). Intra-operatively, a benign cavity encapsulating a tumoural mass was observed and the frozen section of the mass displayed an adenocarcinoma (Fig. 2). Upper lobectomy and lymph node dissection were performed. Fig. 2. Histopathology displayed an adenocarcinoma developed in a sterile tuberculosis cavity (a): Photomicrograph of the tumoural tissue (HEX40). Adenocarcinoma (b): Photomicrograph of the paratracheal lymph node. Case-ified granulomatous lymphadenitis (HEX40). Fig. 1. (a) Posteroanterior chest radiograph. A cavity containing a mass like formation in the middle zone of right lung. (b) Thoracic computed tomography. A cavity 4 cm in diameter containing a formation 1.5 cm in diameter.

İlginç Bir İnhaler Cihaz Kazasi; Çivi Aspirasyonu Olgusu

Sonucta bu olgu bildirimi, KOAH tanisiyla bron- kodilatator ilac kullanimi sirasinda inhaler cihaz icinde biraktigi civiyi aspire etmis olan yasli bir hastada oldugu gibi, ender olarak olusabilecek as- pirasyonlari onleyebilme adina, riskli hasta grup- larinda tibbi cihaz ve ilaclarin kullanimi hakkin- da daha iyi bilgilendirmenin onemini vurgulamak amaciyla sunulmustur

Bronchocentric granulomatosis in a patient with rheumatoid arthritis

Bronchocentric granulomatosis is an uncommon entity which has no specific clinical, radiological and immunological features. It is usually diagnosed at morphological examination of biopsy or resected lung material. Aetiology of bronchocentric granulomatosis is unclear. A 49–year-old female patient, who was followed up with diagnosis rheumatoid arthritis in our outpatient clinic, presented with right lobe nodular lesion in chest radiography. Right thoracotomy and wedge resection was performed. Pathological examination revealed bronchocentric granulomatosis. Bronchocentric granulomatosis has been rarely reported in rheumatoid arthritis. This case might be a proof that bronchocentric granulomatosis may be one of the respiratory manifestations of rheumatoid arthritis.