Aydin Sanli

Bax, bcl-2 and c-kit expression in non-small-cell lung cancer and their effects on prognosis

In non‐small‐cell lung cancer (NSCLC), stage of the disease is still the most important prognostic factor. Other than stage, many biological markers and many other prognostic factors are studied to define their effects on prognosis of lung cancer. In this study, we aimed to evaluate the expressions of Bax and bcl‐2 genes which are important in apoptosis and c‐kit, which is a tyrosine kinase transmembrane receptor, as well as searched their response to treatment modalities and effects on survival.

Chylothorax due to tuberculosis lymphadenopathy: Report of a case

While pulmonary tuberculosis is a very frequent infection, chylothorax is an unusual manifestation of tuberculous disease. A 71-year-old woman with chylothorax is herein presented. The ductus thoracicus was ligated and lymphadenomegaly, which was adjacent to diaphragm, was resected. Based on the findings of various tests, a diagnosis of tuberculosis lymphadenitis was made. The patient was administered antituberculosis chemotherapy and has since remained asymptomatic for 1 year after the operation. In conclusion, tuberculosis lymphadenomegaly may lead to the development of chylothorax. The combination of appropriate surgical and medical treatment is an effective therapeutic strategy for this pathology.

Intrathoracic migration of ventriculoperitoneal shunt: a case report

IntroductionIntrathoracic migration of ventriculoperitoneal shunt can be transdiaphragmatic or supradiaphragmatic. This complication causes important respiratory symptoms.Case presentationA 7 year-old Caucasian female, hospitalized with the prediagnosis of pneumonia, was determined to have ventriculoperitoneal shunt migration at left hemithorax. A left thoracotomy was performed and the shunt was successfully removed transdiaphragmatically.ConclusionThe patients with intrathoracic migration of ventriculoperitoneal shunt must be treated surgically as soon as possible. Transdiaphragmatic surgical approach would be more suitable from the point of surgical easiness.

Primary pulmonary extranodal marginal zone lymphoma/low grade B-cell lymphoma of MALT type combined with well-differentiated adenocarcinoma

We describe a rare case of extranodal marginal zone/low-grade B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) combined with areas of well-differentiated adenocarcinoma. In addition, the MALT lymphoma was synchronously systemic, with involvement of the lung, stomach and duodenum.

Giant Solitary Fibrous Tumor of the Pleura

A 74-year-old male presented with dyspnea, cough, and chest pain. On physical examination, breath sounds were diminished over the posterior inferior part of the right hemithorax. A chest roentgenogram revealed elevation of the right hemidiaphragm (Fig. 1). Computed tomography (CT) of the chest revealed a homogeneous mass with welldefined borders filling a large part of the right hemithorax. The mass had scattered necrotic areas causing compression of adjacent vascular structures and bronchi (Fig. 2). Positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) revealed a supradiaphragmatic mass with a standardized uptake value of 2.0 (Fig. 3). A transthoracic fineneedle aspiration biopsy was nondiagnostic. A right thoracotomy revealed a brown, lobulated, encapsulated mass that was pedunculated with increased vascularity. The mass occupied most of the right hemithorax and originated from diaphragmatic parietal pleura. The resected mass was 2,700 g and measured 25 9 15 9 11 cm. Histopathologic examination of the mass was consistent with a solitary fibrous tumor of the pleura. There were large necrotic areas within the tumor separated from each other by collagenous bands. In other locations there was a myxoid appearance. Spindle-shaped neoplastic cells that contained nuclear atypical and pleomorphism were noted. These cells were positive with CD34, vimentin, and BCL-2. The number of mytoses was 3 per 10 9 high-powered field (Fig. 4). The patient was discharged from the hospital 6 days after surgery. The patient received radiotherapy (10 9 300 cGy) 1 month following surgery. No recurrence was observed 1 year following discharge. Solitary fibrous tumor of the pleura is a relatively rare tumor originating from the mesenchymal cells of the submesothelial tissue of the pleura. It has unusual histologic and clinical features. The majority of these tumors are benign, but about 20% fulfill criteria for malignancy [1]. Individuals may present with symptoms of dyspnea, cough, chest pain, or hemoptysis. Postobstructive pneumonia may occur. The tumors can become locally aggressive and lifethreatening. The larger the tumor, the more likely that symptoms will be present. In giant solitary fibrous pleural tumors, pulmonary atelectasis or complete lung collapse and contralateral mediastinal shift may occur [2]. Radiologic imagining plays an important role in the diagnosis. However, in our individual, PET scanning was not very helpful other than to show no extrathoracic metastasis. Fine-needle aspiration biopsies rarely provide S. Karapolat (&) A. Onen A. Sanli M. Eyuboglu Department of Chest Surgery, Dokuz Eylul Medical School, Izmir, Turkey e-mail: samikarapolat@yahoo.com Fig. 1 Chest roentgenogram showing elevation of the right hemidiaphragm

Primer hydatid cyst of thymus: report of a case.

Cystic lesions in the mediastinum constitute one-fourth of all mediastinal masses and are usually identified incidentally. However, hydatid cysts very rarely present in the mediastinum. A 13-year-old male patient was admitted to our hospital because of chest pain and cough. A chest roentgenogram and computed tomography examination found a homogeneous cystic lesion with a size of 7.5 x 7 cm in the anterior mediastinum. Thymectomy was performed following a left thoracotomy in order to complete the pericystectomy. The histological diagnosis was hydatid cyst. No recurrence was observed during 1 year of follow-up.

Cervical Mediastinoscopy Versus Computed Tomography for Detecting Enlarged Mediastinal Lymph Nodes in Non-Cancerous Lung Diseases

Cervical mediastinoscopy (CM) is considered to be the gold standard for evaluating mediastinal lymph nodes. The aim of this study was to determine the diagnostic yield of computed tomography (CT) and CM for detecting enlarged mediastinal lymph nodes in non-malignant pulmonary diseases. We retrospectively investigated the correlation and differentiation between chest CT and CM findings in terms of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), in 30 patients with granulomatous lung disease diagnosed by CM and isolated enlarged lymph nodes seen on CT scans. Biopsy tissues from the lymph nodes in stations right, 1, 2, 3, 4, and 7, were obtained for pathological examination. The 30 patients comprised 11 men (mean age 47.1 ± 18.4 years) and 19 women (mean age 44.2 ± 14.0 years). Radiological examination showed that the diagnostic value of stations 2 and 4 was particularly high. Thus, when CM is used for diagnostic purposes, the small lymph nodes in station 1, obtained by careful dissection of the higher mediastinal region, can be helpful. Generally, there is no absolute consistency between the findings of CM and CT. For this reason, obtaining samples from each station regardless of CT findings is recommended.

Congenital Cystic Adenomatoid Malformation Type 4 and Aneurysm of the Vein of Galen: A Rare Coincidence or Possibly Related Association

As far as the prognosis is concerned, it is important to diagnose the exact type of congenital cystic adenomatoid malformation (CCAM) in order to exclude associated anomalies, as well as the risk of development of malignancies in later life. The frequency of associated malformations of CCAM type 4 is unknown. We report a 4-month-old boy with CCAM type 4 and aneurysmal malformation of the vein of Galen (AVG). Although AVG is the most frequent arteriovenous malformation during childhood, this is the first case report, to our knowledge, of CCAM type 4 in association with an anomaly. In addition, we speculate that the relation between CCAM type 4 and AVG appears to be more likely a possibly related association rather than a rare coincidence, as both malformations develop at the same stages of embryonic life, and pathogenetically, apoptosis play a significant role in both entities. However, further studies are needed to validate this speculation placing emphasis on the association of the two anomalies, otherwise a rare coincidence cannot be excluded.

A practical technique in laparoscopic diaphragm pacing surgery: Retrospective analyse of 43 patients

Introduction: Diaphragm pacing stimulation (DPS) is a treatment method used in respiratory failure occurs in diseases such as high-level cervical spinal cord injury, central hypoventilation syndrome and amyotrophic lateral sclerosis. Materials and Methods: A total of 43 patients, who had undergone DPS implantation surgery were evaluated retrospectively. The patients were divided into two groups according to the surgical technique (Group 1: classical surgical technic and Group 2: modified surgical technic) applied. The patients with previous abdominal surgery or percutaneous endoscopic gastrostomy were excluded from the study. Results: The mean operation duration was significantly shorter in modified DPS implantation technic (105.1 min in Group 1 and 87.4 min in Group 2) (P < 0.001). Capnothorax is seen 11% of the cases in classical surgery procedure. In the modified group, capnothorax was not observed. Pneumothorax rate was found similar in both groups. Post-operative atelectasis was determined 16% of the cases in classical surgery procedure and also in the modified group atelectasis was not observed. The complications were higher in classical surgery procedure group but not differed statistically in this study. Total hospitalisation duration was significantly shorter in the modified surgical technique group compared to the other group (8.0 days in Group 1 and 6.0 days in Group 2) (P = 0.03). Conclusion: With modification in DPS implantation surgery, shorter operation and hospitalisation durations, and less complications may be achieved.

Preoperative parameters and their prognostic value in amyotrophic lateral sclerosis patients undergoing implantation of a diaphragm pacing stimulation system

Introduction: Amyotrophic lateral sclerosis (ALS) is a progressive neuromuscular disease with devastating and fatal respiratory complications. Diaphragm pacing stimulation (DPS) is a treatment option in diaphragm insufficient ALS patients. Ventilatory insufficiency depending on diaphragmatic failure is treated by the present study aimed to investigate prognostic value of preoperative clinical and functional characteristics of ALS patients undergoing implantation of a DPS system and to determine appropriate indications for the DPS system. Methods: The study included 34 ALS patients implanted with DPS system. All patients underwent multidisciplinary and laboratory evaluations before the surgery. The laboratory examinations included pulmonary function tests and arterial blood gas analysis. Survival rates were recorded in a 2-year follow-up after the surgery. Results: Twenty-eight of 34 patients with ALS survived after a 2-year follow-up. These patients were younger than those who died and had the disease for a longer time; however, the differences were not significant. Both right and left hemidiaghragms were thicker in the survived patients (P < 0.0001 for each). Pulmonary function tests revealed no significant differences between the patients who survived. Arterial blood gas analysis demonstrated lower partial pressure of carbon dioxide in the survived patients (P = 0.025). Conclusions: DPS implantation was more efficacious in ALS patients with mild respiratory failure and thicker diaphragm. Predictors of long-term effectiveness of DPS system are needed to be addressed by large-scale studies.