Ekrem Senturk

PEComa (Clear Cell “Sugar” Tumor) of the Lung: A Benign Tumor That Presented With Trombocytosis

Perivascular epithelioid cell tumors of the lung are rare, benign neoplasms, usually presenting as a solitary pulmonary nodule on chest roentgenograms. Most lesions are solitary and asymptomatic, and are located within the peripheral lung. This is a case report of a 44-year-old woman who presented with thrombocytosis and solitary pulmonary nodule of the lung, which was removed by a thoracotomy.

Comparison of mitomycin-c and heparin affects in experimental corrosive esophagitis on rats

OBJECTIVE We comparative effects of mitomycin-c and heparin which have different mechanism of action in a minimal invasive corrosive esophagitis model which was formed by NaOH 40%. METHOD The study was performed on forty female Wistar albino rats; were divided into four equal groups each including ten animals. Group C (n=10); control, the group that esophagus was washed with normal saline, group I (n=10); injury group; alkali esophagus burn, not treated, group M (n=10); alkali esophagus burn, mitomycin-c treatment group, group H (n=10); alkali esophagus burn, heparin treatment group. The study was performed on a minimal invasive model which did not require general anesthesia and abdominal operation. In 28 day, all subjects were killed and their esophaguss were removed by thoraco-abdominal cut. Total esophagi from oropharynx to stomach were removed and they were examined macroscopically and microscopically and evaluated for esophageal tissue collagen deposition and histopathologic damage score. RESULTS When group C is compared with each of the other groups, statistically significant weight losses were detected; [(p<0.005, p<0.05, p<0.005), respectively]. Significant inflammation increase was detected in groups I, M and H in comparison to group C [(p<0.001, p<0, 0001, p<0.005)]. When granulation scores of groups were compared; statistically significant granulation increases were detected in groups I, M, and H [(p<0.05, p<0.05, p<0.05) compared to group C]. Significant collagen increase was detected in all 3 layers in groups; I, M and H according to group C [(p<0.05, p<0.05, p<0.05)]. Collagen increase in every 3 layers in groups M and H were significantly less according to group I [(p<0.05, p<0.05, p<0.05)]. Collagen increase in every 3 layers was less in group M than group H (p<0.05). CONCLUSION In corrosive esophagitis due to NaOH, heparin treatment is more effective in inflammation and granulation formation, mitomycin-c treatment is more effective in preventing the collagen accumulation step. Heparin decreases the tissue damage by preventing the inflammation and granulation formation; and prevents collagen accumulation and stricture development. As completing the effect of heparin; mitomycin prevents fibroblastic activity inhibition with direct collagen accumulation and stricture development strongly.

Mortalidade e fatores associados em uma UTI de cirurgia torácica

OBJECTIVE To assess mortality and identify mortality risk factors in patients admitted to a thoracic surgery ICU. METHODS We retrospectively evaluated 141 patients admitted to the thoracic surgery ICU of the Denizli State Hospital, located in the city of Denizli, Turkey, between January of 2006 and August of 2008. We collected data regarding gender, age, reason for admission, invasive interventions and operations, invasive mechanical ventilation, infections, and length of ICU stay. RESULTS Of the 141 patients, 103 (73.0%) were male, and 38 (23.0%) were female. The mean age was 52.1 years (range, 12-92 years), and the mortality rate was 16.3%. The most common reason for admission was trauma. Mortality was found to correlate with advanced age (p < 0.05), requiring invasive mechanical ventilation (OR = 42.375; p < 0.05), prolonged ICU stay (p < 0.05), and specific reasons for admission-trauma, gunshot wound, stab wound, and malignancy (p < 0.05 for all). CONCLUSIONS Among patients in a thoracic surgery ICU, the rates of morbidity and mortality are high. Increased awareness of mortality risk factors can improve the effectiveness of treatment, which should reduce the rates of morbidity and mortality, thereby providing time savings and minimizing costs.

Infecções relacionadas a cateteres torácicos

OBJECTIVE To determine the incidence of local and systemic infection in a sample of patients catheterized with thoracic catheters (TCs) and to identify the prognostic factors for catheter-related infection. METHODS A retrospective study involving 48 patients (17 females and 31 males) catheterized with TCs between December of 2008 and March of 2009 in the Thoracic Surgery Department of the Adnan Menderes University Hospital, located in Aydin, Turkey. Blood samples for culture were collected from the distal end of each TC and from each of the 48 patients. We looked for correlations between positive culture and possible prognostic factors for catheter-related infection. RESULTS Culture results were positive in TC samples only for 3 patients, in blood samples only for 2, and in both types of samples for another 2. Advanced age correlated significantly with positive culture in TC samples and in blood samples (r = 0.512 and r = 0.312, respectively; p < 0.05 for both), as did prolonged catheterization (r = 0.347 and r = 0.372, respectively; p < 0.05). There was a significant correlation between having undergone surgery and positive culture in TC samples only (p < 0.05). However, having an inoperable malignancy correlated with bacterial growth in blood and in TC samples alike (p < 0.05 for both). CONCLUSIONS Risk factors, such as advanced age, prolonged catheterization, comorbidities, and inoperable malignancy, increase the risk of catheter-related infection. It is imperative that prophylaxis with broad-spectrum antibiotics be administered to patients who present with these risk factors and might be catheterized with a TC.

A rare association; pulmonary blastoma developing on extrapulmonary sequestration basis

Pulmonary blastoma (PB) is a thoracopulmonary mesenchymal disembryogenic neoplasm which is rarely seen and generally in childhood. Pulmonary sequestration is one of the less observed congenital malformations. A 45-year-old female patient who was diagnosed with PB, histopathologically developed on atypically placed extrapulmonary sequestration in the left upper zone is presented in this study.

Diafragmoplastia con parche en el hidrotórax hepático debido a fístula pleuroperitoneal

Hepatic hydrothorax (HH) due to a pleuroperitoneal fistula (PPF) is a rare entity. Due to large amounts of pleural fluid, it frequently causes dyspnea and electrolytic imbalances. Its diagnosis is suspected in patients with confirmed cirrhosis and portal hypertension suffering from unilateral pleural effusion, in general found on the right side. We report the case of a patient with HH due to a PPF, which was detected as a transdiaphragmatic defect by scintigraphy using Tc99-labelled macroaggregated albumin. Repair surgery was performed through a right thoracotomy and a mesh was applied, which we called a diaphragmoplasty. The patient was referred to our clinic with dyspnea that had started 3 months earlier, opacity in the lower right lung, and the presence of pleural fluid, detected with a chest x-ray. The patient’s medical records revealed a 7-year history of cirrhosis. The patient had undergone insertion of a small-calibre catheter to drain the pleural cavity and an incomplete pleurodesis with talc. There was no vesicular respiration in the lower area of the right hemithorax. We also inserted a small-calibre catheter for drainage. After 12 h, 3500 ml of liquid had been drained. The suspected diagnosis was HH. Twenty milliliters of diluted methylene blue was administered in the peritoneal cavity. In the following 20 minutes the liquid flowed out of the chest catheters. The scan after the administration of Tc99labelled macroaggregated albumin showed the location and size of the transdiaphragmatic defect. After the 6th minute of the scan, the contrast medium moved to the right hemithorax from the hepatic area (Figure a, b). The defect was located in the posterolateral segment of the diaphragm. When the thoracotomy was performed, the diaphragm had stopped working. In the posterolateral area there was no muscle tissue in an area of 3×4 cm. This defective area had a fibrotic structure. The patient was treated with diaphragmoplasty through the right thoracotomy. The surgical treatment consisted of: 1) right thoracotomy, complete exploration of the right diaphragm; 2) marking the defective area; 3) placing a layer over the defective area; 4) suturing the layer; and 5) reconstruction of the whole area of the diaphragm with a mesh (Figure c). The defect in the diaphragm component was corrected with a wide 1.4 mm thick Gore-Tex patch (W. L. Gore & Associates, Flagstaff, AZ) using continuous suture (2-0 Prolene, Ethicon, Somerville, United States). The patch was trimmed to reduce the fold in the diaphragm. The diaphragmaplasty is shown in detail in the diagram (Figure d). The postoperative course was uneventful from a surgical viewpoint and the patient made a full recovery. HH can be defined as the pathological migration of large quantities of ascitic fluid through the diaphragm in patients without any other underlying disease apart from cirrhosis of the liver. However, it is usual to find proof of these effects with non-invasive imaging techniques. The rarity of detecting these defects of the diaphragm is explained below. Diaphragm defects can be divided into 4 types: Type 1: large; type 2: small; type 3 and 4: smaller. For diaphragm defect types 1-3, drainage and pleurodesis, or a peritoneovenous shunt can be performed. However, type-4 defects require surgical correction. A few case studies have described the satisfactory surgical correction of the defects of the diaphragm responsible for the fluid migration into the pleural cavity. The authors used video-assisted thoracoscopy to correct the defects in the diaphragm, as well as pleurodesis. Six of the cases made a complete recovery and there were no relapses. Furthermore, reinforcing the diaphragm with the pleura or a mesh seems to be a promising treatment for refractory HH. However, migration through the diaphragm may continue. Of course, the suggested treatment is a liver transplant. In conclusion, With COPD patients there is a series of circumstances which make this type of conversations easier, for example the patient’s trust in their doctor and the numerous opportunities offered by routine consultations during stable phases of the disease. It is important to take advantage of this to find a moment and pause, to talk about the future, about the patient’s personal wishes in the event of becoming seriously ill or at times of uncertainty, in order to plan the end of their life according to their values and preferences. Health care professionals need ongoing training in end-of-life problems and advance care planning. If the model of good practice is to become more deliberative and participative, it will be necessary to improve the patients’ involvement in decision-making, which nowadays rarely happens. Therefore, the first step is to improve the quality of the information process, a basic requirement to start making decisions.