Cemal Asim Kutlu

A novel technique for bronchopleural fistula closure: an hourglass-shaped stent.

complex forms of long-segment congenital tracheal stenosis. Ann Thorac Surg. 2006;82:1540-2. 3. Kim SM, Han SJ, Choi HS, Nam YT, Oh JT, Choi SH. Slide thyrocricotracheoplasty: a novel technique for congenital laryngeal atresia. Pediatr Surg Int. 2008; 24:383-6. Epub 2007 May 24. 4. Kutlu CA, Yeginsu A, Ozalp T, Baran R. Modified slide tracheoplasty for the management of tracheobronchopathia osteochondroplastica. Eur J Cardiothorac Surg. 2002;21:140-2. 5. Kutlu CA, Goldstraw P. Slide tracheoplasty for congenital funnel shaped tracheal stenosis (a 9-year follow-up of the first case). Eur J Cardiothorac Surg. 1999;16: 98-9. Brief Communications

Malignant Invasive Thymoma in the Posterior Mediastinum

We present a rare case of malignant invasive thymoma (type A) arising from the posterior mediastinum. A 17-year-old girl was referred to our clinic after detection of a mass on a chest roentgenogram. Thoracoscopy showed a lobulated, pale yellowish mass located in the posterior compartment together with several foci in the lung parenchyma. The tumor and parenchymal foci were totally resected through a left minithoracotomy. Postoperative pathology revealed malignant invasive thymoma type A.

Video-assisted thoracoscopy for spontaneous pneumothorax after pneumonectomy.

In this paper, we present 3 patients who had previously undergone pneumonectomy and then presented with a spontaneous pneumothorax. The indication for pneumonectomy was tuberculosis and NSCLC in 2 and 1 patient, respectively. The interval between the surgery and development of pneumothorax was 2, 4, and 11 years. On admission, 2 of the 3 patients were in extreme respiratory distress requiring urgent chest tube insertion. In all patients we undertook elective video-assisted thoracoscopy with complete preparation for cardiopulmonary support on the side. Bullectomy and/or diathermy ablation for apical bullae and blebs were performed concomitantly with total parietal pleurectomy. The postoperative course was uneventful in the patients, and they remain on routine follow-up for up to 6-12 months without any complaints. Our experience suggests that emphysematous changes in the remaining lung should be carefully inspected during long-term follow-up after pneumonectomy. Video-assisted thoracoscopic (VAT) pleurectomy appears to be a good option for the management of spontaneous pneumothorax only if it is performed by a dedicated multidisciplinary team with various cardiopulmonary support facilities on the side.

A Schwannoma in the Middle Mediastinum Originated from the Phrenic Nerve

Neurogenic tumors are one of the major causes of mediastinal masses. Most of those detected in adulthood are benign and diagnosed incidentally [1]. Schwannomas may arise from various neural structures such as sympathetic or parasympathetic chain, intercostal nerves or spinal ganglia. Schwannomas are usually located in the posterior mediastinum. It is very rare for them to be localized in middle mediastinum or arise from the phrenic nerve [1, 2]. We present a case of Schwannoma that originated from the phrenic nerve and treated by videothoracoscopic resection.

End-to-side bronchial anastomosis using the continuous suture technique

S leeve resection with bronchial anastomosis has become a routine procedure in most thoracic units. Several studies have reported satisfactory outcomes after this surgery; however, they all used the traditional interrupted suture technique. Experience with the continuous suture technique for tracheal and bronchial anastomosis was first reported in 1999. This technique is rapid and easy to perform, and the results are comparable to those obtained using the interrupted suture technique. Kutlu and Goldstraw report 100 consecutive cases of various anastomoses; however, they were all performed end to end. Therefore, the reliability of the continuous suture technique for end-to-side bronchial anastomosis remains unconfirmed.

Latero-lateral slide tracheoplasty for upper airway stenosis: An 8-year follow-up

Although several surgical options have been widely established in the treatment of renal cell carcinoma extending into the IVC, whenever a potential involvement of the right atrium is suspected, the use of cardiopulmonary bypass with hypothermic arrest is usually adopted, albeit such technique yields potential risks, mainly in terms of coagulopathy. Because the huge dimensions and extension close to the right atrium of the neoplastic thrombus could have made its removal potentially cumbersome and therefore significantly prolonged the duration of hypothermic circulatory arrest, a novel perfusion strategy was adopted to allow continuous perfusion of the supra-aortic vessels during systemic circulatory arrest. Therefore, as described in the present report, the cardiopulmonary bypass temperature can be maintained at a greater degree than conventional hypothermic circulatory arrest ( 18 C). Moreover, the described modification is cost-effective, without consistent modifications to the cardiopulmonary bypass circuit.