Atila Turkyilmaz

A new risk factor in oesophageal cancer aetiology: hyperthyroidism.

Abstract Purpose: In individuals with malignant disease, many qualitative and quantitative hormonal changes have been detected. Although there are many studies showing that there is a relationship between thyroid hormone disorders and certain tumours, no study investigating the association between oesophageal cancer and thyroid diseases has been reported. The present study was designed to evaluate whether there is a relationship between oesophageal cancer and thyroid hormones. Methods: In a prospective study conducted between December 2006 and February 2008, thyroid functions were studied in a group of 102 sequential patients with oesophageal cancer and a control group of 160 sequential patients without oesophageal cancer, presenting to the Thoracic Surgery Department of Ataturk University. Age, gender, tumour location and histological type in patients with oesophageal cancer were recorded. Results: Of 102 patients with oesophageal cancer, 21 (20.58%) had hyperthyroidism, 2 (1.96%) had hypothyroidism and 6 (5.88%) exhibited nodular/multinodular goitre on ultrasonography and computed tomography. In the control group, 8 patients (5.0%) had hyperthyroidism, 4 (2.5%) had hypothyroidism and 7 (4.38%) showed nodular/multinodu-lar goitre. In patients with oesophageal cancer, the incidence of hyperthyroidism was found to be significantly higher compared to the control group (p < 0.001). Conclusion: Data show that there may be an important relationship between oesophageal cancer and hyperthyroidism. We believe that thyroid hormone levels should be measured in all cases of oesophageal cancer. In further prospective and experimental studies, the physiopathology of this relationship can be fully explained.

Total occlusion of the superior vena cava due to bronchogenic cyst.

Abstract Bronchogenic cysts are the most common form of congenital cystic lesions in the mediastinum. Of all cases with bronchogenic cysts, 1/3 are symptomatic. The symptoms vary depending on the location and compression of the adjacent structures of the cyst. Some mediastinal bronchogenic cysts can cause severe respiratory distress due to airway and vascular compression. We herein present a case with a bronchogenic cyst that required venoplasty to the superior vena cava (SVC) due to total occlusion of the SVC.

Surgical treatment of mediastinal cysts: report on 29 cases.

Abstract Aim : Mediastinal cysts are rare, forming 12–18% of all primary mediastinal tumors. The purpose of this study is to evaluate type, clinical properties, treatment modalities, and results of mediastinal cystic neoplasm in the light of available literature. Patients and methods : We retrospectively investigated 29 patients who were diagnosed and surgically treated for mediastinal cysts in our clinic between January 1996 and May 2011. Results : Sixteen (55.2%) patients were male and 13 (44.8%) were female. The average age of the patients was 36.5 ± 22.1 (17–77 years old). The mediastinal cysts comprised 11 (37.9%) bronchogenic cysts; seven (24.1%) hydatid cysts; four (13.8%) benign cystic teratomas; three (10.3%) pericardial cysts; one (5.3%) thymic cyst; one (5.3%) cyst of the thoracic duct; one (5.3%) enteric cyst; and one (5.3%) lymphangioma. Approach methods were thoracotomy in 18 (62.1%) cases; video-assisted thoracoscopicsurgery (VATS) in seven (24.1%) cases; median sternotomy in three (10.3%) cases; and anterior mediastinotomy in one case. Postoperative observations during the follow-up period showed chylothorax in one patient; pleural effusion in one patient; and the recurrence of a bronchogenic cyst in one patient five years after the operation. Postoperative mortality did not occur in any case. The average postoperative hospitalization period was 7.3 days (2–14 days). Conclusion : A surgical approach to mediastinal cysts offers histological analysis, pathological diagnosis, curative treatment, and prevention from complications.

Lung Hydatid Cyst Treatment With Laparotomy: A New and Different Technique

This report presents the case of a patient with a pulmonary hydatid cyst. The patient underwent laparotomy for hepatic and splenic cysts, and cystotomy and capitonnage were perfomed using a transdiaphragmatic intervention. The pulmonary hydatid cyst was located at the base of the lung and near the diaphragm. The diaphragm was cut about 5 cm at the front, and the thorax was entered.The pulmonary cyst was treated intraabdominally. This technique is effective and safe, and it prevents the patient from undergoing a second operation. The suggestion is that this technique, which has not been defined before, can be applied safely in carefully selected patients.

Lung Image: Doege–Potter Syndrome

A 37-year-old male patient presented to an external clinic reporting dyspnea, fatigue, dizziness, and intermittent episodes of syncope. Upon blood testing, he was found to have hypoglycemia. His anamnesis revealed a surgical procedure and radiotherapy was performed 6 years prior due to a solitary fibrous tumor in his right hemithorax. He had no history of diabetes or medication at all. The patient was somnolent and his blood pressure was 125/80 mmHg, pulse was 95 bpm, and breathing rate was 19 breaths/min. Upon auscultation, no respiratory sounds were heard in the right hemithorax. His blood glucose level was approximately 50 mg/dL and his serum insulin level was 3.4 μU/mL. An intravenous infusion of 50% glucose was performed in an attempt to keep the patient’s blood glucose level within normal limits. Upon chest X-ray, opacity was observed in his right hemithorax. During thoracic tomography, a giant heterogeneous mass was seen in his right hemithorax (Fig. 1). No FDG uptake was observed in PET–CT scans (Fig. 2). The patient was reported to have a solitary fibrous tumor following a transthoracic fine-needle aspiration biopsy. A total excision of the mass and pleura with right redo posterolateral thoracotomy was performed next (Fig. 3). The patient’s blood glucose level remained within normal limits in the postoperative period. He was discharged on postoperative

How to treat right post‐pneumonectomy fistula with carinal sleeve resection

Despite the presence of some treatment methods for the closure of a right post-pneumonectomy bronchopleural fistula (BPF), unsuccessful outcomes still pose a major risk. Three male patients aged 32, 33 and 59 had undergone right pneumonectomy with posterolateral thoracotomy (two bronchial carcinoma and one destroyed lung caused by bronchiectasis). In all cases, bronchial closure was done with stapler and reinforcement of the bronchial stump was not performed. The patients presented to our department at postoperative day 11, 26 and 57 complaining about shortness of breath, cough, purulent phlegm, abundant serohaemorrhagic expectoration and fever. Chest X-rays showed decreased fluid levels in right hemithorax and thorax tomographies revealed fistula. The purulent fluid was aspirated with thoracentesis, the patients underwent tube thoracostomy and broad-spectrum antibiotic therapy was started. All patients underwent fiberoptic bronchoscopy to calculate the length of the main bronchus and determine the width of fistula. A pleural lavage was performed with isotonic solution through tube thoracostomy (average 2 weeks, once a day) until the direct microscopic examination and culture became negative. Then, patients were operated rethoracotomy. After removal of all debris, the lower end of the trachea and the left main bronchus were freed with dissection and extending up to 2 cm away from carina. The carinal region and the bronchial stump where the fistula was located were resected. At the same time, ventilation was continued by way of left main bronchus intubation from sterile area. Then, end-to-end anastomoses were performed at distal trachea and proximal left main bronchus with the continuous suture technique using 3.0 polyglactin (Vicryl; Ethicon, Somerville, NJ, USA) (Fig. 1). The patients were discharged within 6–9 days without complications and they were still asymptomatic at the end of their follow-up periods of 20 months on the average. Occurring mostly after lung surgery, BPF is a frightening complication and is among the most common causes of morbidity and mortality. A post-pneumonectomy BPF is seen more often after right pneumonectomy, and a clinically more severe form than that seen after a lobectomy with a mortality rate ranging from 25 to 71%. The widely used treatment methods include tube thoracostomy, open window thoracostomy, thoracomyoplasty, closure of the fistula with rethoracotomy and reinforcing the stump with live autologous flaps, and transpericardial closure of the fistula with sternotomy. The incidence of BPF in carinal sleeve resections is generally within the range of 3.8–21.6% in the literature. The carinal sleeve resection performed through rethoracotomy has lower probability of fistula recurrence as compared to other interventions. Since the bronchial system tends, by its nature, to remain open, the outward force along the suture line in the closed bronchi increases the probability of fistula formation. In fact, all sleeve resections have less BPF rates as they eliminate this tendency in the bronchi. We think here that since it has to be performed much closer to the carina region, a direct primary repair of the stump will increase the probability of fistula recurrence by causing greater tensile strength as compared to the initial operation. Conversely, the distal trachea and the left main bronchial lumens are brought facing each other and the cylindrical aspect of the bronchial structure is

Bilateral open pneumothorax resulting in a sucking chest wound

A 17-year-old male was brought to the emergency department after a sawmill injury. The patient’s general condition was poor, he was disoriented, his level of consciousness was somnolent, and he had difficulty cooperating with medical staff. His arterial blood pressure was 80–55mmHg, his pulse was 94/min, and his respiration was shallow (30/ min). A physical examination revealed an actively bleeding cut on the patient’s back extending transversely below both scapulae. The cut was up to 20 cm wide and so deep that it had severed the spinal erector muscles and the posterior thoracic wall muscles, resulting in a bilateral open pneumothorax (Figure 1). The patient was urgently intubated. The defect area was closed with occlusive dressing and a bilateral thoracostomy tube was immediately administered. Thoracic computed tomography revealed the bilateral pneumothorax as well as a laceration in the lower lobes of both lungs, segmental fractures in the posterior regions of right ribs 6–9 and left ribs 7–9, and fractures in the inferior right scapula and the right lamina of the sixth thoracic vertebra (Figure 2). The patient was operated on while in the prone position under general anesthesia. A thoracotomy was performed on the right side and then on the left to access the defect areas on the thoracic wall. The lacerated areas on the posterior basal segments of the lower lobes of both lungs were primarily sutured before the thoracotomies were closed. The vertebral defect area was then explored and bone fragments were removed. It was seen that, the dura mater was absent in the cut area, leaving the lacerated spinal cord uncovered. Finally, the muscle, fascia, and the subcutaneous and skin tissues of the posterior thoracic wall were primarily sutured. The patient was discharged on day seven with paraplegia due to the injury. At a six-month follow-up, he was still receiving physiotherapy for the paraplegia. In many countries, including Turkey, lumbering is a major economic activity and a significant source of labor employment. Due to the nature of the working conditions in this trade, cutting tools and sawmill machines are frequently used. Sawmill workers are at high-risk for work-related injuries and other health problems. A report by Alamgir et al. found the most common sawmill injuries to be open wounds, dislocations, sprains-strains, and fractures of the upper limbs, skull, intracranium, spine-trunk, and lower limbs [1]. Sawmill injuries generally involve the upper extremities, particularly the hands. A thorax-related injury is rarely encountered. Open pneumothorax is a rarely seen subgroup of traumatic pneumothorax that primarily occurs due to penetrating injuries. It typically involves a chest wall defect that directly communicates with the parietal pleura. In these sucking chest wounds, even after the atmospheric and intra-pleural pressures have equalized, air will continue to flow Figure 1. The defect area on the posterior chest wall after the sawmill injury.

A Comfortable Solution To Tracheal Anastomosis Protection: Tracheal Retention Sutures

Fixation of the chin to the anterior chest wall is the most commonly used method of reducing anastomotic tension following a segmental resection of the trachea and reconstruction with primary anastomosis. However, the sutures required for this method may lead to various organic and psychological problems. In five patients who underwent tracheal resection and primary anastomosis, retention sutures were placed on the proximal and distal-lateral edges of the anastomotic line rather than placing a Guardian chin stitch. All patients were mobilised in the early postoperative period and were able to perform their routine daily activities without restrictions. During their average 14.4 months of follow-up, no complications were found in their anastomotic lines during their clinical, radiological, and bronchoscopic assessments. The placement of tracheal retention sutures proved an inexpensive and reliable method to reduce anastomotic tension without additional surgical burden, and was effective in terms of patient comfort.

Do the nodules detected in chest X‐rays always indicate a disease of lung parenchyma?

A fracture in the radial/ulnar shaft of the left forearm, bilateral multiple rib fractures and a left haemopneumothorax were found in a 61-year-old male patient at an external clinic due to falling from height. After having been administered a left tube thoracostomy, he was referred to our clinic for further treatment. In the patient’s posteroanterior chest X-ray, which was sent to our clinic digitally before his transportation, bilateral multiple well-circumscribed nodules of various sizes were observed, suggesting the presence of different additional pathologies such as metastatic lung tumours, granulomatous diseases or infections (Fig. 1). During the physical examination after being admitted into the clinic, widespread skin nodules of various sizes were found all over his body (Fig. 2). The recollection heard from the patient and his family revealed that the patient and his brother were being treated for neurofibromatosis type 1. In thoracic tomography, no pathology was observed in the lungs and it was concluded that his skin nodules caused the pathological appearance in chest X-ray (Fig. 3). Affecting approximately 1 in 3500 live births, neurofibromatosis type 1 is an autosomal dominant, multisystem disorder with variable expressions. This disease is characterized by von Recklinghausen with multiple café-au-lait spots, axillary or inguinal freckling, cutaneous neurofibromas, plexiform neurofibromas, iris Lisch nodules, optic glioma and bony abnormalities. Neurofibromas are tumours of the nerve sheath comprised of Schwann cells, fibroblasts, perineural cells, mast cells, axons and blood vessels. They can occur in any part of the body in various shapes and sizes. In general, cutaneous neurofibromas are dome-shaped, soft, fleshy, skin coloured to slightly hyperpigmented lesions developing more commonly in teenagers and adults. As in this case, neurofibromas that can be in large numbers and great sizes covering the thoracic