Alper Gözübüyük

Surgical management of bronchiectasis: analysis and short-term results in 238 patients.

OBJECTIVE Bronchiectasis is defined permanent dilatations of bronchi with destruction of the bronchial wall. It is still a major cause of morbidity and mortality in developing countries. The aim of this retrospective study is to present our surgical experiences, the early and long-term results of 238 patients with bronchiectasis during a 10-year period. METHODS We reviewed the medical records of 238 patients who underwent surgical resection for bronchiectasis between January 1992 and December 2001, at Gülhane Military Medical Academy (GMMA) Thoracic Surgery Department. Variables of age, sex, symptoms, etiology, and type of operation, mortality, morbidity and the result of surgical therapy were analyzed. RESULTS There were 205 (86.13%) male and 33 (13.87%) female patients with an average age of 23.7 and a range of 15-48 years. The presenting symptoms were productive cough in 133 (55.88%), fetid sputum in 116 (48.73%), recurrent infections in 84 (35.29%), and hemoptysis in 39 (12.18%) patients. The disease was bilateral in 31 patients (13.02%) and mainly confined to the lower lobes in 162 (68.06%). The surgical treatment was as follows: pneumonectomy in 13 patients (5.46%), lobectomy in 189 (79.40%), lobectomy+segmentectomy in 31 (13.02%), and wedge resection or segmentectomy in five (2.1%). Staged bilateral thoracotomy was used in 14 patients. There was no operative mortality. Complications occurred in 21 patients and the morbidity rate was 8.82%. Complete resection was achieved in 154 (64.7%) patients. Follow-up data were obtained for 229 (96.21%) of the patients. Nine patients were lost to follow-up. The mean follow-up of these patients was 9 months (range, 3 months to 4 years). The symptoms disappeared in 189 patients (79.41%) and 29 patients (12.18%) had improved, whereas 11 patients (4.62%) had no improvement. Significantly better results were obtained in patients who had undergone a complete resection. CONCLUSIONS Surgical resection for bronchiectasis can be performed with acceptable morbidity and mortality at any age. The involved bronchiectatic sites should be resected completely for the optimum control of symptoms.

Autologous blood pleurodesis in rats to elucidate the amounts of blood required for reliable and reproducible results.

BACKGROUND Pleurodesis is used in the treatment of spontaneous pneumothorax or refractory pleural effusions of different etiologies. Several agents have been employed, but many questions remain unanswered about their effectiveness and toxicity. Use of autologous blood pleurodesis in clinical practice has been described in the literature without any clear consensus regarding its efficacy. Experimental studies using this technique are limited to a single study in rabbits. We performed a prospective, randomized, observer-blinded, controlled study to evaluate the safety and efficacy of increasing doses of autologous blood pleurodesis in a novel rat model. MATERIALS AND METHODS Twenty-eight albino Wistar rats were divided into four groups. Groups 1, 2, and 3 were the study groups and group 4 was the control group, with seven animals in each group. Groups 1, 2, and 3 were given autologous blood, 1 mL/kg, 2 mL/kg, 3 mL/kg, respectively, and group 4 (control) was given only 2 mL/kg saline intrapleurally. The rats were sacrificed on postoperative day 30. The surfaces were graded by macroscopic (visible adhesion formation) and microscopic (inflammation and fibrosis) examination. RESULTS Macroscopically, group 2 and group 3 developed significantly more adhesions; 3 mL/kg autologous blood produced the most significant pleurodesis with generalized adhesions seen between visceral, parietal, and mediastinal pleura. Microscopic examination showed that all study groups developed an inflammatory response at the site of blood injection. There were no pathologic changes in ipsilateral and contralateral lung parenchyma. CONCLUSIONS Autologous blood at doses 2-3 mL/kg were shown to be effective to produce adhesions in 30 d, and the results were highly reproducible in all rats. We propose that the occasional negative results obtained in humans may be related to an insufficient amount of injected blood, as observed in our rat model.

Protective efficiacy of taurine against pulmonary edema progression: experimental study.

Re-expansion pulmonary edema (RPE) is an acute, rare and potentially lethal complication [1,2]. Its beginning is sudden and dramatic. The mechanism is not yet fully understood [1]. Some authors suggest that it may occur after rapid re-inflation of a collapsed lung [1]. It was reported by other authors that it may relate to surfactant depletion or may result from hypoxic capillary damage, leading to increased capillary permeability [1,3]. In RPE, unilateral lung injury is initiated by cytotoxic oxygen metabolites and temporally associated with an influx of polymorphonuclear neutrophils [1]. These toxic oxygen products are the results of re-oxygenation of a collapsed lung. Treatment of re-expansion pulmonary edema is basically preventive [4].

Repair of pectus deformities: experience and outcome in 317 cases.

BACKGROUND The most common congenital chest wall deformities are pectus excavatum and pectus carinatum. Various techniques have been described for correction of pectus deformities. We describe our experience with surgical repair of pectus deformity (PD) in adults, including our new technique, which uses a resorbable plaque for fixation of the sternum. METHODS We reviewed the records of 317 patients who underwent surgical correction of PD between October 1997 and December 2005. RESULTS All of the patients were male and the median age was 21.3 years (range, 16–32 years). Of 317 patients, the type of deformity was a pectus excavatum in 230 patients and a pectus carinatum in 87 of the patients. Four different operative techniques were used. There were no intraoperative deaths or major perioperative morbidity. The complications rate was 17%. Overall mean hospital stay was 14.25 days. In 208 patients who underwent a mid-term outpatient follow up (mean, 8 months), there was no recurrence. Patient satisfaction was excellent in 234 patients, good in 79 patients and fair in 4 patients. CONCLUSION The majority of patients with pectus deformity had been operated on during childhood; therefore there is limited published information about the correction of pectus excavatum and pectus carinatum deformities in adults. The most important point in pectus correction is to achieve proper and long-term stability of the sternum following osteotomy. Various techniques can be used for this purpose.

Pulmonary Sequestration and Surgical Treatment

Pulmonary sequestration is nonfunctioning, abnormal pulmonary tissue existing inside or outside the visceral pleura. It is not connected to the tracheobronchial tree. In this study, the results of 8 patients, who were diagnosed with pulmonary sequestration and treated during hospitalization in Gülhane Military Medical Academy between 1996 and 2003, were reported. Sex, age, symptoms, diagnostic approach, operative findings, procedures and postoperative outcomes were reviewed. No postoperative complications were seen. In the long-term follow-up all patients were seen to be asymptomatic. We believe surgical resection is mandatory in order to avoid infection and destruction of the normal pulmonary parenchyma even in asymptomatic cases. Furthermore, when infection occurs, major resection such as lobectomy may be necessary rather than segmentectomy or wedge resection, which involves removal of minimal pulmonary parenchyma.

Surgical Management of Chest Wall Tuberculosis

Objective: Tuberculosis remains one of the most fatal diseases in the world. Extrapulmonary tuberculosis increases in parallel fashion with the rise of incidence of pulmonary tuberculosis. Tuberculosis of the chest wall is rare. Methods: Our study retrospectively evaluated 10 patients with tuberculosis of the chest wall who were treated with surgery in addition to antituberculous chemotherapy in the last 8 years. Seven of the lesions were located on the anterior chest wall, and three of the lesions were on the lateral chest wall. Results: Surgical therapy consisted of evacuation of the cold abscess material from the cavities and wide débridement of the soft tissue planes in all patients. Partial rib resections were performed in six patients owing to costal or chondral involvement. Conclusions: Chest wall tuberculosis must be considered in the differential diagnosis of chest wall lesions, especially in endemic areas.

Unusually located thoracic hydatid cysts.

Human hydatid disease caused by the larval form of Echinococcus granulosus has a worldwide distribution and is endemic in many countries. The disease, known since the time of Hippocrates, is primarily an illness of residents in rural areas who frequently come into contact with sheep, cows and carnivores.1-4 The estimated surgical case rate of cystic echinococcus is 0.87-6.6 per 100 000 in Turkey.2 The prevalence of Echinococcus granulosus infestation in dogs in Turkey is between 0.32% and 40% and the reported prevalence of cystic echinococcus in domestic animals has ranged from 11.3 to 50.7% and varies widely by geography.5,6 Echinococcal cysts may develop in almost any part of the body. The liver and the lungs are the most commonly affected areas in adults. Within the thorax most of the cysts settle in the lung parenchyma. In this situation surgical treatment is usually easy and quick. Sometimes the cyst grows as an extrapulmonary lesion or passes over the lung parenchyma to other structures. Location of the disease outside the lung parenchyma in the thorax is rare and surgical procedures can be considered that may differ from those used for pulmonary cysts.7 The aim of this study was to review surgical techniques and possible perioperative complications. We present our experience, documenting the clinical features and the treatment employed for unusually located thoracic hydatid cysts.

Unexpected difficult intubation due to lingual tonsillar hyperplasia in a thoracotomy patient: intubation with the double-lumen tube using stylet and fiberoptic bronchoscopy.

Lingual tonsillar hyperplasia is rare, and it may cause difficulty with tracheal intubation during induction of general anesthesia. A different orotracheal intubation technique was performed using a double-lumen endotracheal tube, flexible fiberoptic bronchoscope, and a stylet, in an unexpected difficult endobronchial intubation case due to massive lingual tonsillar hyperplasia.

BRAF Inhibitors for BRAF V600E Mutant Colorectal Cancers: Literature Survey and Case Report

The main method of fighting against colon cancer is targeted treatment. BRAF inhibitors, which are accepted as standard treatment for V600E mutant malign melanomas, are the newest approach for targeted treatment of V600E mutant colorectal cancers. In this case report, we share our experience about the use of BRAF inhibitor vemurafenib on a V600E mutant metastatic right colon adenocarcinoma patient. A 59-year-old male with only lung multiple metastatic V600E mutant right colon cancer presented to our clinic. The patient was evaluated and FOLFOX + bevacizumab treatment was initiated, which was then continued with vemurafenib. A remarkable response was achieved with vemurafenib treatment in which the drug resistance occurred approximately in the sixth month. Even though the patient benefited majorly from vemurafenib, he died on the 20th month of the diagnosis. The expected overall survival for metastatic V600E mutant colon adenocarcinoma patients is 4.7 months. BRAF inhibitors provide new treatment alternatives for V600E mutant colorectal cancers, with prolonged overall survival. BRAF inhibitors in combination with MEK inhibitors are reported as feasible treatment to overcome BRAF inhibitor drug resistance on which phase studies are still in progress. To conclude, BRAF inhibitors alone or in combination with other drugs provide a chance for curing BRAF V600E mutant colorectal cancer patients.

Left-sided pleural effusion in a 47-year-old female

A 47-year-old female patient was admitted to the Dept of Thoracic Surgery, Gulhane Military Medical Academy (Ankara, Turkey) with right thoraco-abdominal pain, which had been aggravated by cough and deep breathing. Despite being treated with several courses of antibiotics for these symptoms during the previous 2 years, her non-productive cough had worsened. She had been operated on 4 years previously for a hepatic cyst. Laboratory tests were normal. On physical examination, submatite was established on the right lateral thoracic wall along the anterior and posterior axillary lines.