Altug Kosar

Bronchogenic Cysts of the Lung: Report of 29 Cases

BACKGROUND Intrapulmonary bronchogenic cysts are congenital anomalies of the tracheobronchial tree and foregut. The aim of this retrospective study was to review the diagnosis, clinical and histological features, operative techniques, outcomes and follow-up of intrapulmonary bronchogenic cysts treated in a single institute. METHODS Twenty-nine patients with intrapulmonary bronchogenic cysts were treated surgically between 1990 and 2005. There were 17 female and 12 male patients and their ages ranged from 7 to 68 years. Patients were divided into two groups according to surgical procedure. Resection (lobectomy or wedge resection) was performed on Group I (n=18), and partial excision with de-epithelisation was performed on Group II (n=11). RESULTS Twenty-five patients (86.2%) were symptomatic. Cough and sputum were the most common symptoms. Twenty-four of the 29 BCs were simple cysts (82.7%) whereas 5 (17.3%) were complicated cysts. Postoperative hospital stay was 4.55+/-0.86 days in group I and 6.54+/-3.34 days in group II (P=0.172). Complications in Group I were pneumonia in one case and wound infection in two cases; prolonged air leakage were observed in two cases of Group II. No statistical difference was determined between the complication rates of the two groups (P=0.91). However a significant difference was determined between the complication rates of simple and complicated cysts (P=0.026). Two cases in Group II showed recurrence, whereas no recurrence occurred in Group I. (P=0.065) No postoperative mortality was observed in any of the groups. CONCLUSIONS All bronchogenic cysts should be treated surgically. We believe that partial excision with de-epithelisation may be an alternative to resection in symptomatic patients with limited respiratory capacity.

Pneumonectomy in Children for Destroyed Lung: Evaluation of 18 Cases

BACKGROUND Destroyed lung is an uncommon condition; it describes a nonfunctional lung and is most often caused by inflammatory diseases. Surgical resection is used to resolve or prevent complications and improve quality of life. We reviewed our experience in surgery for destroyed lung in children. METHODS The records of 18 children aged 16 years and younger who had undergone pneumonectomy for destroyed lung between 1991 and 2007 were analyzed retrospectively. RESULTS Eighteen children, 10 males (55.5%) and 8 females, aged 5 to 16 years, with a mean age of 12.3 underwent pneumonectomy. Cough was the major presenting symptom (n = 18, 100%). The median preoperative period for symptoms was 6 years. Radiologic diagnostic methods included chest radiograph, computed tomography, bronchoscopy, and bronchography. Bronchiectasis (n = 13), tuberculosis (n = 4), and aspergillosis (n = 1) were the main pathologies. Five patients had tuberculosis history, and tuberculosis culture was positive in 2 patients. Pneumonectomy was applied to the left side in 14 and right side in 4 patients. There was no mortality. Complication occurred in 3 patients (atelectasis [n = 1], fistula and empyema [n = 1], and wound infection [n = 1]). Atelectasis was treated with bronchoscopy and stoma was needed for another patient for empyema. The mean follow-up was 64.9 months (range, 19 to 164 months). In their follow-up period, scoliosis was found in 1 patient. CONCLUSIONS The morbidity and mortality rates of pneumonectomy are acceptable for selected and well prepared children. Antibiotics and antituberculosis treatment in certain cases and good timing in pneumonectomy are essential. Children grew and developed normally after pneumonectomy.

Clinicopathologic demonstration of complex bronchopulmonary foregut malformation.

Bronchopulmonary foregut malformations are rare and often prove to be extremely difficult to diagnose. The presented case is a 44-year-old man complaining about cough and hemoptysis. These symptoms continued despite medical treatment. A computed thorax tomographic scan depicted a paravertebral cystic lesion. The patient underwent surgical exploration, and communication between the cyst and the esophagus was found. A left lower lobectomy was performed. The pathologic result confirmed a duplication cyst of mixed bronchogenic and esophageal type with bronchiectasis of the lower lobe. We present this unusual malformation complex especially in an adult with the review of the literature.

A survey analysis of thoracic surgeons in Turkey on mediastinal investigation of lung cancer.

A total of 59 general thoracic surgeons of 21 academically based thoracic surgery centres in Turkey were surveyed to identify the attitudes toward mediastinal investigations in patients with lung cancer. The surgeons were asked 16 questions in five separate groups by survey questionnaire. Analyses of the replies were as follows: Group I: 37 (62.7%) of the respondents were working in 11 centres where > 100 patients are admitted or referred for lung cancer annually. More than 50 thoracotomies are performed for lung cancer annually in one third of the centres in which 28 (47.5%) respondents work. Group II: Among the diagnostic methods for evaluating mediastinum, surgeons most commonly used the computed tomography, mediastinoscopy, mediastinotomy and scalene lymph node biopsy. Invasive staging was done routinely by ten (16.9%) and selectively by 44 (74.6%). Group III: In patients with preoperatively histologically proven ipsilateral mediastinal lymph node involvement, 39 (66.1%) were advocates of operating. When the lymph node(s) was found to be positive at operation, 33 of them (55.9%) gave the decision with respect to the number, size and presence of pericapsular invasion of the node(s), while 24 (40.7%) decided to perform lung resection in every situation. Group IV: All accessible mediastinal nodes were said to be removed at thoracotomy by 37 (62.7%). Group V: Currently available methods for mediastinal investigation were found to be partially sufficient by 37 (62.7%). The most important factor in predicting postoperative survival was selected as nodal status by 27 (45.8%). It is noticed that nearly all thoracic surgeons in Turkey perform mediastinal investigation preoperatively in patients with lung cancer, however, the impact of lymph node status needs to be more commonly appreciated.

A rare cause of intercostal neuralgia: Ancient schwannoma of the chest wall

Intercostal neuralgia is a rare condition that causes pain along the intercostal nerves. Neural tumors of the chest mostly arise from mediastinum and only less than 5-10% of primary tumors originate from intercostal nerves. These patients are usually asymptomatic. Herein, we report a 42-year-old male patient with severe intercostal neuralgia due to the schwannoma of the chest wall. The patient underwent surgical resection and his histopathological diagnosis was a very rare type of schwannoma: ancient schwannoma. Resecting the tumor relieved his pain

Lung Cancer: Clinical and Surgical Specifications

Description: Lung cancer diagnosis worldwide has advanced considerably. Progress in diagnostic techniques and therapeutic methods has greatly improved life expectancy in lung cancer patients. Information on lung cancer diagnosis and treatment is therefore useful for all medical professionals especially those who work outside the realm of pulmonology or oncology. This book answers the needs of medical professionals seeking this information and includes both internal and surgical aspects of lung cancer as well as developments in molecular research on pulmonary oncology.

The Experimental Use of N-Butyl Cyanoacrylate Tissue Adhesive in Pulmonary Wedge Resections

BACKGROUND In this experimental study, the effectiveness of N-butyl cyanoacrylate tissue adhesive on preventing air leakage after pulmonary wedge resection was observed. METHODS Twenty pairs of sheep lungs were used. Before initiating the study, the sheep lungs were ventilated to identify any air leakage from the parenchyma. On positive results, those sheep lungs were then excluded from the study. Wedge resection was performed on the right and left lower lobes of sheep lungs by clamping the edges forming a triangle of 5 cm × 5 cm × 5 cm. One side of parenchyma was sutured by 3/0 vicryl (Group A) while the other side of parenchyma was sealed by N-butyl cyanoacrylate (Group B). After waiting for 5 min for N-butyl cyanoacrylate to dry, the sheep lungs were intubated by 6F endotracheal tubes. The lungs were soaked in a bath tub filled with 10 cm deep water and inflated by 40 mmHg pressure to record any air leakage from the parenchyma partially sutured by vicryl and sealed by N-butyl cyanoacrylate. RESULTS Air leakages were observed on the parenchyma surfaces of group of lungs (100%) sutured by vicryl (minimal 30%, mild 50% or massive 20% levels), while only on four of (20%) the other group of lungs sealed by N-butyl cyanoacrylate, minimal air leakage was observed on the parenchymal surface. There was an extremely significant difference between Group A and Group B in terms of the development of air leakage (p=000). CONCLUSION We consider that, N-butyl cyanoacrylate could be used effectively and safely to prevent air leakage from the pulmonary wedge resection surface.