Ayşe Gül Ergönül

[A life-saving approach after thoracic trauma: emergency room thoracotomy].

BACKGROUND In this article, the outcomes, indications and methods of emergency department service resuscitative thoracotomy in cardiac and/or respiratory arrest patients after thoracic trauma are discussed. METHODS Between January 2004 and December 2010, nine resuscitative thoracotomies were performed after thoracic trauma in the emergency department of our hospital. The records of the patients were evaluated retrospectively. RESULTS A total of nine patients underwent resuscitative thoracotomy: five stab wounds, two traffic accidents, one fall from height, and one gunshot wound. Anterolateral thoracotomy in supine position was performed in all. Three patients had lung parenchymal laceration, three patients had cardiac laceration, two patients had intercostal vessel injury, and one patient had descending aorta injury. None of the four patients with blunt trauma recovered. Three of five patients with penetrating trauma were discharged after an average of eight days of follow-up, whereas two of them were lost perioperatively. CONCLUSION Emergency room thoracotomy can be performed in thoracic trauma cases who are in shock and have unresponsive hypotension despite large volume fluid and blood replacement and no time for transportation to the operating room. The results are better in penetrating trauma patients than in blunt trauma.

Successful Colchicine Therapy in a Patient With Follicular Bronchiolitis Presumed to Be Asthma

Follicular bronchiolitis (FB) is a rare small-airway pathology that is associated mainly with connective tissue diseases. This case report presents a new, diagnosed, different airway disease in a non-smoker with rheumatoid arthritis in remission who was treated for presumed asthma, but was not controlled. She was ultimately diagnosed with FB after video-assisted thoracoscopic surgery. The clinical findings of FB were controlled successfully by colchicine after she did not respond to systemic steroid therapy. This is the first case report of FB associated with rheumatoid arthritis that responded to colchicine.

Diagnostic value of 18 F-FDG-PET/CT in benign lung diseases

Introduction There are many diseases which, despite not being malignant, show high metabolic activity and cause false-positive results. Aim To evaluate the results of positron emission tomography (PET) in patients who underwent resection after preliminary diagnosis of malignancy based on fluorodeoxyglucose (FDG) uptake value, in whom the lesions were later classified as pathologically benign. Material and methods The analysis included the records of 106 (12.3%) patients out of 862 patients who underwent surgery between January 2012 and December 2015 after being initially diagnosed with malignant lung lesions based on PETCT results, in whom the lesions were later classified as pathologically benign. Diagnoses, PET findings, types of surgery, and demographic data of the patients were recorded. Results The mean age of the patients was 55.5 (26–79) years. The mean diameter and SUVmax of the lesions were 2 ±2.14 (0.5–13) and 3.55 ±4.35 (0–22.2) cm, respectively. The pathology results were analyzed in five different groups. The SUVmax in the hamartoma group was significantly lower than in the other groups (p < 0.001), while the SUVmax in the granulomatous disease group was significantly higher than in the other groups (p < 0.001). Conclusions The possibility of false positive PET results must be kept in mind when diagnosing and treating lung cancer. In particular, in the case of suspected granulomatous disease, all available pre- and intraoperative diagnostic procedures must be used.

Assessment of Cardiac Complications in Patients Undergoing Pulmonary Resection

BACKGROUND Patients who underwent lung resection in our clinic were retrospectively investigated in terms of development of postoperative cardiac complications. METHODS The file records of 207 patients who underwent lung resection between the years 2010 and 2014 were reviewed. One hundred and eighteeen (118) (57%) of the patients were evaluated by the preoperative cardiologist and the risk level of the patients was determined according to the Lee index. Postoperative cardiac complication relation was compared with each parameter. RESULTS The difference between the mean age of the patients with and without complication was statistically significant (p=0.024). When the patients were grouped as over and under 65 years old, the risk of developing postoperative complications was higher and statistically significant (p=0.015) in patients over 65 years of age. When the patients were evaluated in line with the presence of additional disease, smoking and electrocardiogram (ECG) findings, patients with hypertension developed more complications than those without hypertension (p=0.002). When the logistic regression was adjusted according to age and sex, the development of cardiac complications in patients with hypertension was 3.25 times greater. CONCLUSIONS It should be kept in mind that the presence of hypertension in patients who will undergo lung resection and advanced age increases the risk of cardiac complications and that preoperative cardiology care may be appropriate for these patients.

İdiyopatik mediastinal fibrozis

Halsizlik ve kilo kaybi sikayetleri ile tetkik edilen 66 yasindaki erkek hastanin gogus bilgisayarli tomografisinde, anterior mediastende, 10 cm boyutlu kitlesel lezyon saptandi. Tanisal amacli operasyona alinan hastaya, sol hemitorakstan videotorakoskopik biyopsi uygulandi. Histopatolojik inceleme sonucunda kesin bir taniya varilamamasi uzerine ayni islem ikinci bir operasyon ile sag hemitoraksa yonelik uygulandi. Yine tani elde edilememesi uzerine hasta tekrar operasyona alinarak mediastinotomi uygulandi. Tum histopatolojik inceleme sonuclari ve klinik bulgulari ile birlikte degerlendirilen olguda idiyopatik mediastinal fibrozis tanisina ulasildi. (MF) olgulari radyolojik olarak malign mediasten tumorleri ile benzerlik gosterebilir ve ayirici tani yapilmasi buyuk onem arz etmektedir.

Spontaneous Splenic Rupture in the Early Postoperative Period to After Lobectomy

Spontaneous splenic rupture is a quite rare entity that may develop secondary to some special situations (lymphoma, post-abdominal surgey etc). In the literature, the case of a patient has been reported following thoracic surgery. In a patient who had undergone right upper lobectomy for pulmonary carcinoma, signs of acute abdomen and low levels in the hemogram were detected on the fifth postoperative day; therefore, the patient underwent further investigations. A radiological evaluation revealed splenic rupture, and the patient was operated on. A case is presented that may be fatal and requires emergency response and that has to be kept in mind, although it is extremely rare. A case of spontaneous splenic rupture has been presented that may be fatal and requires emergency response; this should be kept in mind, although it is extremely rare.

The prognostic value of carcinoembryonic antigen levels in blood and intraoperative pleural lavage fluid in non-small-cell lung cancer

Introduction There is no specific marker for lung cancer, but, in some lung cancer types, carcinoembryonic antigen (CEA) can reach high levels in the blood and pleural fluid. Aim This study investigated the relationship of CEA levels in blood (CEAB) and intraoperative pleural lavage fluid (CEAP) in non-small-cell lung cancer (NSCLC) with the type, stage, and extent of lung cancer. Material and methods A total of 50 patients, who underwent surgery at our clinic due to NSCLC (group I) or benign lung pathology (group II), were assessed. For this prospectively designed study, 25 consecutive patients were included in each group, and their CEAB and CEAP levels were investigated. Results When the levels of CEAP were compared, the average value of group I (1.35 ng/ml) was significantly higher than the average value of group II (0.04 ng/ml) (p = 0.027). When CEA levels were examined separately, and average values were taken according to surgical pathology results, both CEAB and CEAP levels of adenocarcinoma patients were found to be higher than those of the other groups. This difference was only significant for the level of CEAP (p = 0.026). Conclusions Although the average CEAB levels of patients with adenocarcinoma were higher than those of patients with other histopathological types, this difference was not statistically significant. However, we found that CEAP levels were significantly higher in patients with adenocarcinoma. These results have led us to consider that CEAP elevation is a more sensitive marker than the elevation of CEAB.

Is the Risk of Postoperative Atrial Fibrillation Predictable in Patients Undergoing Surgery Due to Primary Lung Cancer

BACKGROUND Atrial fibrillation (AF) is a type of cardiac arrhythmia which is commonly seen following lung resection. There is currently no algorithm which can predict which patients will develop postoperative AF (PAF). The present study aims to identify the risk factors for the development of PAF and high-risk patients with PAF along with multiple risk factors. MATERIALS AND METHODS A total of 887 patients, who underwent lung resection due to primary lung malignancy at our clinic between January 2000 and December 2016, were retrospectively analysed. Group 1 (n=44) consisted of the patients who developed PAF and Group 2 (n=843) consisted of the patients without PAF. Age and sex of the patients, comorbidities, previous diagnosis of malignancy, and surgery-related variables were evaluated using statistical methods for their effects on the development of AF. A score was assigned to each identified risk factor and scores of the patients were calculated. The risk of developing PAF was evaluated based on this scoring system. RESULTS We found that ≥60 years of age and the diagnosis of chronic obstructive pulmonary disease (COPD) were significant risk factors for the development of PAF (p<0.05). The risk of developing PAF was not associated with male sex, previous history of malignancy, presence of comorbidities, and the type of surgery applied. There was an increased risk of AF with increasing scores in the risk calculation system. CONCLUSION Advanced age and the presence of COPD were found to be associated with an increased risk of developing PAF. In addition we found a significant increase in the risk of developing PAF in the presence of multiple factors, although they did not reach statistical significance alone.

Psychiatric assessments in patients operated on due to lung cancer

Background This study was undertaken to determine the relationship between preoperative and postoperative psychiatric status and postoperative complications in patients operated on due to lung cancer. Methods We prospectively enrolled 25 patients undergoing surgery with a diagnosis of lung cancer. There were 17 (68%) males, 8 (32%) females, and the mean age was 61 ± 8.9 years (range 38–81 years). Their psychiatric status was assessed using the Experiences in Close Relationships Scale II, European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire C30, Perceived Family Support Scale, the combined Stress Thermometer and Hospital Anxiety Depression Scale, in the preoperative period, and the Perceived Family Support, Stress Thermometer, and European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire C30 at 1 month postoperatively. Results We found that 44% of patients had depression and 28% had anxiety. There was no difference between sexes in terms of anxiety (p = 0.088), but more women had depression (p = 0.03). Postoperative complications occurred in 5 of 18 patients with negligible anxiety scores (27.8%) and 3 (42.9%) of 7 patients with high scores, as well as 3 (21.4%) patients with negligible depression scores and 5 (45.5%) of 11 patients with high scores. Conclusions Patients selected for lung cancer surgery should be assessed preoperatively using the Hospital Anxiety-Depression Scale and Stress Thermometer. Psychosocial support is recommended to improve their quality of life and reduce postoperative complications.

An unusual pathology with an undefined etiology:solitary fibrous tumors of the pleura.

BACKGROUND/AIM The aim of the present study was to evaluate the etiology and clinical and pathological behavior of solitary fibrous tumors of the pleura (SFTPs), as well as the most appropriate surgical approach and the results of long-term follow-up of this condition. MATERIALS AND METHODS Clinical and long-term follow-up records of 14 patients who had surgery for SFTP between 2001 and 2014 were reviewed retrospectively. Etiological factors, diagnostic procedures, and clinical courses and outcomes for these patients were studied. RESULTS Of the 14 patients, 8 were male (57%) and 6 were female (43%) patients. The mean age was 54.14 ± 10.35 (41-75) years. There was no remarkable common etiological factor. Preoperative diagnosis was achieved only in 2 patients. Predominant symptoms were cough and chest pain. Complete resection was achieved in all patients. Video-assisted thoracic surgery (VATS) was performed in 8 patients. All but one patient were classified as having benign SFTP. The mean follow-up was 58.5 ± 41.4 (10-132) months and no recurrence was noted in the follow-up. CONCLUSION These rarely seen tumors of the pleura are usually benign and asymptomatic and their preoperative diagnosis is difficult. Clinical and pathological behavior is still unpredictable and the treatment consists of complete resection. Minimally invasive techniques such as VATS are recommended for surgery if the tumor size is appropriate.