Aykut Elicora

Effect of Locally Applied Transforming Growth Factor Beta3 on Wound Healing and Stenosis Development in Tracheal Surgery

BACKGROUND: Tracheal stenosis constitutes one of the most frequently seen problems in thoracic surgery. Although many treatment modalities to prevent fibroblast proliferation, angiogenesis, or inflammation that causes tracheal stenosis have been attempted, an effective method has not yet been found. In this study, a transforming growth factor beta3 (TGF-β3)/chitosan combination was used for this purpose. METHODS: A slow-release preparation containing a thin layer of TGF-β3 with a chitosan base was made. Thirty albino Wistar rats were divided into 3 groups. A full-layer vertical incision was made in the anterior side of the trachea of each rat between the second and fifth tracheal rings. The tracheal incision was sutured. Group A was evaluated as the control group. In Group B, a chitosan-based film was placed on the incision line. In Group C, a slow-release TGF-β3/chitosan-coated substance was placed on the incision line. The rats were killed on day 30, and their tracheas were excised by cutting between the lower edge of the thyroid cartilage and the upper edge of the sixth tracheal ring together with the esophagus. Epithelialization, fibroblast proliferation, angiogenesis, inflammation, and collagen levels were evaluated histopathologically by the same histopathologist. RESULTS: Statistically significant differences were not found among the 3 groups. Cold abscesses were observed at the incision sites in both the TGF-β/chitosan and chitosan groups. These were thought to have formed due to the chitosan. CONCLUSIONS: As this was the first experiment in the literature to use this type of TGF-β3 formulation, we intend to change the formulation and perform this study again with a different TGF-β3/chitosan preparation.

Aspiration of a Cigarette Filter From a Bronchodilator Inhaler

The majority of foreign-body aspirations are seen in children. In adults, neurological dysfunction, trauma, alcohol abuse, or psychological disorders can lead to aspiration, but normal adults can also suffer foreign body aspiration. The symptoms include acute asphyxiation, with or without complete airway obstruction, cough, dyspnea, choking, and fever, which also occur in many other medical conditions. Bronchoscopic removal of the foreign body is necessary, and flexible bronchoscopy is effective in the diagnosis and removal. We saw a patient with COPD who aspirated a plastic cigarette filter while using his bronchodilator inhaler.

Congenital tracheal diverticulum seen in adult age

Figure 1: 65-year old male patient with right-sided tracheal diverticulum. (a) Diverticulum opening in posterolateral tracheal wall, virtual bronchoscopic view, (b) axial and (c) coronal section of thorax CT. Arrow: the hole in the postero-lateral wall of trachea, *main carina. Figure 2: 51-year old male patient. (a) Axial, (b) coronal section of thorax CT showing air-filled bilobed tracheal diverticulum. (c) Bronchoscopic appearance of the opening of diverticulum, (d) 3D reconstruction of air way demonstrating posteriorly located diverticulum. Arrow: the diverticulum, *main carina.

A difficult case: ectopic thyroid, bronchial anomalies, and incidentaloma in a patient with lung carcinoma.

CLINICAL SUMMARY Mediastinal enlargement and a solitary pulmonary nodule were detected on a 68-year-old male patient’s chest radiograph during routine annual examination. Computed tomography and magnetic resonance imaging revealed a lobulated, solid, and well-demarcated right paratracheal mass 6 3 4 3 4 cm in dimension (Figure 1). The solitary, heterogeneous parenchymal mass located in the right upper lobe was 4 3 3 3 3 cm in dimension. Results of thyroid function tests were within reference range. Right tracheal bronchus (bronchus suis) was observed on bronchoscopy. Results of bronchoscopy and bronchial lavage cytologic examination were not diagnostic. Positron emission tomography (PET)–computed tomography revealed metabolic activity both in the parenchymal mass (standard uptake values 8.3 early and 9.6 late) and in the nodule of left thyroid lobe (standard uptake values 4.1 early and 5.1 late; Figure 1). There was no metabolic activity in the mediastinal mass or mediastinal lymph node stations. Computed tomographically guided transthoracic fine-needle aspiration of the parenchymal mass revealed non–small cell lung carcinoma. Thyroid ultrasonography and scintigraphy with sodium pertechnetate Tc 99m showed mixed hypoechoic and hypoactive nodules in both thyroid lobes. Because of the suspicion of retrosternal goiter, scintigraphy with iodine 131 was performed, revealing that the mass took up radioiodine. The diagnosis was expected to be thyroid malignancy with lung metastasis. Ultrasonographically guided fine-needle aspiration biopsy of the nodule in left thyroid gland with positive results on positron emission tomography was performed for definitive diagnosis. Pathologic examination

Radio Antenna Aspiration

W e have had much experience with foreign body aspiration, but children still continue to surprise us with strange aspirated materials. A telescopic radio antenna was observed on the chest roentgeno-gram of a 2-year-old girl (Fig 1A and 1B), located just below the vocal cords and extending to the main carina. It was removed without any complications by rigid bronchoscopy (Fig 1C).

Partial Anomalous Venous Return of Left Superior Pulmonary Vein in Adult

Drainage of one or more pulmonary veins into rightsided circulation instead of the left atrium is a rarely seen anomaly in adults [1–4]. In the preoperative evaluation of a female patient with esophageal carcinoma, axial (Fig 1A), coronal section (Fig 1B), and three-dimensional reconstruction (Fig 1C) of thorax computed tomography demonstrated abnormal drainage of the left superior pulmonary vein to the left brachiocephalic vein. Because pulmonaryto-systemic shunt size was not large and the patient was asymptomatic, surgical correction was not performed. She underwent esophageal carcinoma surgery.