Figen Türk

A case of leiomyosarcoma originating from pulmonary vein, occluding mitral inflow

Cardiac leiomyosarcoma is a very rare entity that is found in less than 0.2% of all cardiac tumors. Because of its rarity and classification problem, there are few prospective studies about therapy and outcomes. Generally, diagnosis is delayed because of the nonspecific nature of the symptoms and by the time of diagnosis, most cases present with large tumors. Primary treatment of these tumors is still complete surgical resection. In this study we present a myxoid leiomyosarcoma originating from a pulmonary vein and extending into the left atrium, occluding mitral inflow in a woman 49 years of age. The tumor was totally removed. Open heart surgery is the acceptable approach for the management of intracardiac tumors, which may cause obstruction of blood flow through the heart.

Patient and physician delay in the diagnosis and treatment of non-small cell lung cancer in Turkey.

AIM The early diagnosis and treatment of lung cancer are important for the prognosis of patients with lung cancer. This study was undertaken to investigate patient and doctor delays in the diagnosis and treatment of NSCLC and the factors affecting these delays. MATERIALS AND METHODS A total of 1016 patients, including 926 (91.1%) males and 90 (8.9%) females with a mean age of 61.5±10.1 years, were enrolled prospectively in this study between May 2010 and May 2011 from 17 sites in various Turkish provinces. RESULTS The patient delay was found to be 49.9±96.9 days, doctor delay was found to be 87.7±99.6 days, and total delay was found to be 131.3±135.2 days. The referral delay was found to be 61.6±127.2 days, diagnostic delay was found to be 20.4±44.5 days, and treatment delay was found to be 24.4±54.9 days. When the major factors responsible for these delays were examined, patient delay was found to be more frequent in workers, while referral delay was found to be more frequent in patients living in villages (p<0.05). We determined that referral delay, doctor delay, and total delay increased as the number of doctors who were consulted by patients increased (p<0.05). Additionally, we determined that diagnostic and treatment delays were more frequent at the early tumour stages in NSCLC patients (p<0.05). DISCUSSION The extended length of patient delay underscores the necessity of educating people about lung cancer. To decrease doctor delay, education is a crucial first step. Additionally, to further reduce the diagnostic and treatment delays of chest specialists, multidisciplinary management and algorithms must be used regularly.

Effectiveness of Palatal Mucosa Graft in Surgical Treatment of Sub-Glottic Stenosis

Objectives Mucosal free grafts may be successfully applied in many surgical interventions. This study aims at investigating the feasibility of palatal mucosa graft in sub-glottic field in an animal model. Methods This randomized prospective controlled study was conducted with an animal model. Sub-glottic inflammation was created in 15 adult rabbits in each group and sub-glottic stenosis surgery was applied thereafter. The rabbits in group 1 (control group) underwent segmental resection, partial cricoidectomy, and trachea-thyroid cartilage anastomosis; the rabbits in group 2 underwent segmental resection, cricoplasty, and crico-tracheal anastomosis using free buccal mucosa graft; and the rabbits in group 3 underwent segmental resection, cricoplasty, and crico-tracheal anastomosis using free palatal mucosa graft. Re-stenosis was evaluated after 42 days. Results The percentages of stenosis were 27%±20%, 40%±20%, and 34%±23% for group 1, 2, and 3, respectively and the difference was not statistically significant (P=0.29). Intensive and tight fibrosis was observed in 2 rabbits (13%) in group 1, in 5 rabbits (33%) in group 2, and in 3 rabbits (20%) in group 3. There was not a statistically significant difference between groups (P=0.41). Excessive inflammation was observed in 3 rabbits (20%) in group 1, in 7 rabbits (47%) in group 2, and 3 rabbits (20%) in group 3. There was no a statistically significant difference between groups although inflammation rate was higher in the rabbits which underwent buccal mucosa graft (P=0.18). Conclusion The surgical treatments applied with free mucosa graft reduced anastomosis tension through enabling anastomosis to the distal of cricoid instead of thyroid cartilage. Free palatal mucosa grafts may be used in sub-glottic field, one of the most challenging fields of trachea surgery, due to ease of application and rapid vascularization.

Reflex Sympathetic Dystrophy in Children

DOI: 10.4328/JCAM.838 Received: 21.10.2011 Accepted: 13.12.2011 Printed: 01.11.2014 J Clin Anal Med 2014;5(6): 521-3 Corresponding Author: Adnan Ayvaz, Cumhuriyet Universitesi Tip Fakultesi, Cocuk Norolojisi Bilim Dali, 58040 Sivas, Turkiye. T.: 0 346 2581179, Gsm: 0 533 9218131, E-mail: aayvaz@ttmail.com Ozet Refleks sempatetik distrofi (kronik bolgesel agri sendromu) cocukluk caginda ve pediatri pratiginde sik karsilasilan bir durum degildir (1). Refleks sempatetik distrofi (RSD) lokalize yaygin agri, siklikla sislik, renk degisikligi, trofik degisiklikler ve vasomotor bozukluklar gibi otonomik anormalliklerle karakterize bir hastaliktir. Etiyolojisi tam olarak aydinlatilamamistir. Hastalik kismi olarak hasara ugrayan sinir tarafindan innerve edilen bir alanda gelisir. Bu yazida, cocukluk caginda nadir gorulen refleks sempatetik distrofili iki kiz hasta klinik ve laboratuar bulgulariyla literatur esliginde tartisilmistir.

Hydatid cyst, an unusual cause of spontaneous hemothorax and diagnostic thoracoscopy: Case report

Hydatid disease is a common parasitic disease in areas where sheep and cattle are raised and is currently endemic in the eastern and southwestern parts of Turkey. Patients with hydatid cysts typically present with cough, chest pain, dyspnea, hemoptysis, or allergic reactions. When ruptured, these cysts may cause hemoptysis, dyspnea, and hydatid thorax. Previously published series of cyst hydatid have reported cyst hydatid rupture and hemothorax secondary to trauma, but nontraumatic hemothorax due to spontaneous rupture of hydatid cyst has not been defined. We discuss the clinical features of a patient with no history of trauma who presented to the emergency department with hemoptysis and dyspnea and was found to have hemothorax due to spontaneous rupture of the hydatid cyst on videothoracoscopic investigation and underwent thoracotomy for hydatid disease treatment.

Lung Resection in an Elderly Patient with Limited Pulmonary Function; Case Report

Corresponding Author: Figen Türk, Erenler Mah. 211 Sk, No: 4/4, Yenişehir, Denizli, Türkiye. Phone: +90-258-373 98 34 · E-mail: figenturk@pau.edu.tr Özet Akciğer kanserinde anatomik rezeksiyon (lobektomi) en uygun cerrahi seçimdir. Kronik obstrüktif akciğer hastalığı akciğer kanserlerinde yaygın bir etiyolojik faktördür. Genellikle ileri yaştaki akciğer kanserli hastalarda kronik obstrüktif akciğer hastalığına bağlı solunum yetersizliği nedeniyle cerrahi rezeksiyondan kaçınılmakta ve özellikle FEV1 değeri 1 lt’nin altında olanlarda lobektomiden daha kısıtlı rezeksiyonlar önerilmektedir. Biz bu çalışmada akciğer kanserli ve FEV1 değeri 1 lt’nin altında olan ileri yaştaki bir hastaya yaptığımız lobektomi ameliyatı ile hastanın postoperatif sonuçlarını ilgili literatür eşliğinde tartıştık. Anahtar Kelimeler Akciğer Kanseri, Yaşlı, FEV1, Kronik Akciğer Hastalığı. Abstract Anatomical resection (lobectomy) is the best surgical choice for lung cancer.1 Chronic obstructive pulmonary disease is a common etiological factor for these cancers. Surgical resection is usually avoided in lung cancer patients at an advanced age because of respiratory insufficiency due to chronic obstructive pulmonary disease and resections that are more limited than lobectomy are recommended especially when the FEV1 value is below 1 L. We discuss the postoperative results of a lung cancer patient who underwent lobectomy despite being of advanced age and having an FEV1 value below 1 L.

The Right Inferior Pulmonary Vein Related Inflammatory Myofibroblastic Tumor in an Adult Case

Inflammatory myofibroblastic tumor (IMT) is a rare neoplasm, which is derived of mesenchymal origin. Here we present an adult case with IMT, the origin of which was considered to be right inferior pulmonary vein. A male patient who was 52 years old, admitted to our outpatient clinic with the complaint of shortness of breath. He had cigarette smoking history for 30 years. On direct posterior - anterior X-Ray of the chest, a well-circumscribed mass with calcification in right hilum of the lung was observed. There was a mass which was extending to the inferior inferior pulmonary vein from right hilum of the lung, was measured 70 × 60 mm on computed tomography of the chest. Hamartoma, teratoma and Castleman Disease were among the possible diagnoses. On diagnostic bronchoscopy, signs of pressure from outside to the bronchi of the right middle and lower lobe was observed. Surgical excision is decided and the mass was totally excised through a muscle-sparing thoracotomy. The mass thought to arise from the inferior pulmonary vein on intraoperative inspection and right inferior lobe excision is undertaken by intrapericardial approach. No postoperative complication is encountered. Histological examination of the mass indicated inflammatory myofibroblastic tumor. Main treatment of IMT is surgical excision with negative surgical margin. Here in we present an IMT which is encountered at an unexpected location is excised completely with right lower lobe excision by an intrapericardial approach.

Total Situs Inversus Found Coincidentally Following a Firearm Injury

Situs inversus totalis is very rare and usually diagnosed coincidentally as it does not affect the patients life. Being unaware of the patients condition can lead to undesirable results from the surgeon and patients point of view when an emergency and forensic surgical intervention is required. We present a case who was operated on urgently for a firearm injury after receiving a preoperative diagnosis of situs inversus totalis. In conclusion, situs inversus totalis can cause difficulties for surgeons in case of emergency surgery and is usually diagnosed coincidentally. There are a few cases of situs inversus with lung cancer in the literature but this is the first time a case with a firearm injury has been reported.

Uzun süre KOAH tedavisi alan skuamoz hücreli endotrakeal karsinom olgusu

Primary tracheal tumors are rare, and composed of various benign and malignant pathologies. They often can simulate obstructive pulmonary diseases, such as asthma and chronic obstructive pulmonary disease, and patients with malign tracheal tumors sometimes undergo long-term treatment for such diseases, without any improvement. Therefore, these tumors should be included in the differential diagnosis in patients presenting tracheobronchial tree obstruction. We present a squamous cell endotracheal carcinoma case that had received treatment with a diagnosis of chronic obstructive pulmonary disease for a long time. The recent increase in symptoms had been thought to be due to an exacerbation of the disorder but the bronchoscopy performed after 3 months of no improvement revealed an endotracheal mass lesion. Full recovery was obtained with bronchoscopic resection of the tumor.

The choice of invasive diagnostic techniques in advanced lung cancer.

BACKGROUND We retrospectively evaluated the invasive diagnostic techniques that were not suitable for transthoracic biopsy or bronchoscopy and the results of these techniques for advanced lung cancer cases. METHODS The files of patients operated at the Department of Thoracic Surgery, Faculty of Medicine, Pamukkale University for advanced lung cancer (stages III and IV) between 2006 and 2010 were retrospectively reviewed for the analysis of definite diagnostic methods. RESULTS The mean age of 59 patients who underwent invasive diagnostic techniques was 56.55 ± 9.42 years (32 to 75) and the female to male ratio was 1:4 (11 female:48 male). Mediastinoscopy was the most commonly used invasive technique with 20 patients (34%) while the second most common technique was video-assisted thoracoscopic surgery with 10 patients (17%). Thoracotomy was the most invasive diagnostic technique with four patients (6.5%). CONCLUSIONS Although it would be desirable to use noninvasive and minimally invasive diagnostic techniques in the diagnosis of lung cancers, we should not try to avoid using invasive diagnostic techniques in surgical practice in advanced lung cancers where other techniques may be inadequate.