Goksel Kalayci

Mesoatrial shunt in Budd-Chiari syndrome

BACKGROUND The operations with proven effects on survival in Budd-Chiari syndrome are shunt operations and liver transplantation. PATIENTS AND METHODS Between 1993 and 1999 (June), 13 cases of Budd-Chiari syndrome have been treated surgically. Four cases had concomitant thrombosis of the inferior vena cava; the others had marked narrowing of the lumen due to the enlarged caudate lobe. Mesoatrial (n = 12) or mesosuperior vena caval (n = 1) shunts were constructed with ringed polytetrafluoroethylene grafts. RESULTS The median portal pressure fell from 45 (range 32 to 55) to 20 (range 11 to 27) cm H(2)O (P <0.001). Two patients died in the early postoperative period. One patient who did not comply with anticoagulant treatment had a shunt thrombosis in the second postoperative year. The other 10 patients are alive without problems during a median 42 (range 1 to 76) months of follow-up. CONCLUSION Mesoatrial shunt with a ringed polytetrafluoroethylene graft is effective in Budd-Chiari syndrome cases with thrombosis or significant stenosis in the inferior vena cava.

Oxygen uptake kinetics during cardiopulmonary exercise testing and postoperative complications in patients with lung cancer.

It is accepted that cardiopulmonary exercise testing is one of the most valuable parameters, especially peak oxygen uptake (VO(2)), for the evaluation of risk assessment in lung cancer surgery. It therefore represents an attractive way of identifying a patient at high risk for postoperative complications. However, many patients do not achieve the maximal or predictive level during an incremental exercise testing. The purpose of the current investigation was to study the value of the oxygen uptake efficiency slope (OUES), which shows exercise capacity during submaximal testing, in predicting postoperative mortality in patients with bronchogenic carcinoma scheduled for lung resection. Forty-nine patients with bronchogenic carcinoma participated in studies with exercise tests as a preoperative evaluation. The peak VO(2) was calculated for each subject by averaging values obtained during the final 10s of exercise. The following equation was used to determine OUES: VO(2)/log(10)VE. Peak VO(2) without postoperative complication was 22.8+/-3.3 ml/(kg min), however, peak VO(2) in patients with present complications was 19.1+/-4.2 ml/(kg min) (p=0.001). In addition, although the mean OUES in patients with present complications was 11.1+/-1.2, the mean OUES in the absent group was 13.3+/-2.1 (p<0.001). Although peak VO(2) is useful in evaluating selected patients with bronchogenic carcinoma, OUES is also a beneficial parameter and should be calculated and recorded with peak VO(2), a better predictor of poor surgical outcome than absolute values, and should be integrated into preoperative decision making.

Clinical significance of P16INK4A and retinoblastoma proteins in non-small-cell lung carcinoma

This study was performed to determine the frequency of expression loss of p16 and pRb; their relations with each other, tumour histology, tumour stage, nodal status, and survival in formalin fixed, paraffin embedded tumour tissues of patients with non-small-cell lung carcinoma (NSCLC). P16 and/or pRb expression loss is observed in 72 (75.8%) out of 95 patients, and 70 (73.7%) of them showed inverse correlation (P<0.05). Thirty-six (37.9%) of the p16 positive cases usually showed weak or moderate immunohistochemical staining. Loss of p16 expression was found to be significantly greater in squamous cell carcinoma than in adenocarcinoma cases, whilst no relation was observed with other clinical parameters. Immunohistochemical reactivity for pRb was generally moderate or strong. PRb expression loss was observed in 15.8% of the cases, and no relation was found between pRb loss and age, sex, tumour histology, tumour stage, or nodal status. PRb negative squamous cell carcinoma cases had significantly shorter survival independent of nodal status. These results suggest that disruption of p16/pRb pathway is frequently involved in NSCLC, and pRb expression loss in cases with squamous cell carcinoma may predict clinical outcome.

The diagnostic value of image guided percutaneous fine needle aspiration biopsy in equivocal mediastinal masses

Background and aimsThe aim of this study was to assess the diagnostic value of image guided percutaneous fine needle aspiration (FNA) biopsy in equivocal mediastinal masses.PatientsSixty-six patients with an equivocal mediastinal mass who underwent FNA biopsy between 1993 and 2003 were eligible for final analysis. The cytological and definitive diagnosis of masses were grouped as primary 22 (33%)−30 (46%) and secondary (metastatic) neoplasms 18 (27%)−18 (27%) and nonneoplastic lesions 20 (30%)−18 (%27) respectively.ResultsThe diagnostic accuracy (%95 C.I.) of FNA biopsy for primary mediastinal neoplasms, secondary neoplasms and nonneoplastic lesions were found to be 93.3 (83.8–98.2)%, 100 (95.1–100)%, 93.3 (83.8–98.2)%, respectively.ConclusionImage guided percutaneous FNA biopsy is a safe and highly accurate diagnostic method for equivocal mediastinal masses.

Hydatid Cystic Disease of the Soft Tissues with Pulmonary and Hepatic Involvement: Report of a Case

Abstract.Hydatid disease, which is caused by the Echinococcus granulosis parasite, is endemic in certain parts of the world where close contact between humans and sheep exists. The disease most commonly involves the liver and other solid organs. This report describes the case of a teenage girl with hydatid disease involving the right axilla and various other sites concomitantly. The patient was admitted to hospital with a mass in the right axillary region, and further examinations revealed that the liver and right lung were also involved. We report this case to emphasize that hydatid disease should be considered in the differential diagnosis of patients from endemic areas who present with soft tissue masses.

An unusual intrapleural foreign body: ignored aspiration

A 54-year-old male patient was admitted to our department with fever, dyspnea and chest pain. Left pleural effusion and destroyed left lower lobe was noticed in his computerized chest tomography. After chest tube drainage, massive hemoptysis developed. An emergency thoracotomy was performed. A bronchopleural fistula, destroyed left lower lobe and the head of an oat were detected in the pleural space. Left lower lobectomy and perioperative pneumoperitoneum were performed. The patient had an uneventful postoperative (p.o.) course and was discharged on p.o. day 6. We present this case because of the rarity and to emphasize the clinical presentation. The physicians should be aware of life threatening complications of oat head aspiration.

Sleeve resection of the right main bronchus for postlobectomy broncho-pleural fistula

In this case report we present a novel treatment for bronchial fistula after lobectomy. The patient had right upper lobectomy for T1 N0 M0 peripheral adenocarcinoma and he had been reexplored 4 days later for massive air leak in another chest surgery department. After the reoperation the bronchial fistula persisted and the patient was admitted to our department. Nineteen days after the reoperation, bronchoscopy confirmed that the bronchial stump was totally opened. A sleeve resection to the right main broncus including the fistulous stump of right upper lobe was performed.

Life-threatening hemoptysis in a child: the only symptom.

An 8-year-old girl was evaluated for hemoptysis, 50 mL/day, which lasted for 3 days. Computed thoracic tomography detected a mass lesion in the right lower lobe. During rigid bronchoscopic examination, exanguinating hemoptysis occurred, and a Fogarty balloon catheter was placed in the right intermediate bronchus. Thoracotomy revealed a 2 x 2-cm mass in the right lower lobe. Common basal segmentectomy was performed. Pathological frozen-section analysis confirmed the diagnosis of perforated hydatid cyst.

Chest wall invasion in lung cancer patients.

Abstract This study was performed to assess the prognosis in patients with non-small cell lung cancer invading the chest wall. In this study, the data from 43 patients who were operated on between January 1990-January 1998, for non-small cell lung cancer with pathologically verified parietal pleural and chest wall invasion were retrospectively reviewed. The median and 3-year survival of the population was calculated to be 16.8 months and 34%. The pathologic stages were T3N0 in 31 (72.09%) patients, T3N1 in 5 (11.62%) and T3N2 in 7 (16.27%). The median survival of the T3N0M0 patients was 24 months but in the same T3 population with pathologically verified N1 and N2, the median survival was 7.4 months (p < 0.01). A complete resection was achieved in 37 (86.84%) patients. The median and 3-year survival of the patients with complete resection were 20.60 months and 41% respectively. In six patients, who had incomplete resection, median survival was noted to be 7.4 months. Patients who received adjuvant radiotherapy in the N2 positive group and the incomplete resection group, did not benefit (p > 0.05). The results of this study confirmed that the lung cancer patients with chest wall invasion had different survival curves. The survival of patients changed according to the completeness of the resection and lymphatic metastases of either N1 or N2.

An unusual localization of thymoma.

Abstract A 41-year-old man with myasthenia gravis was referred to our clinic to undergo a thymectomy by videoassisted thoracic surgery. After physical examination of the thorax and evaluation by computed tomography, a mass lesion was noticed in the neck and thymectomy was performed by partial sternotomy combined with a cervical incision. The cervical thymoma was discontinuous with the thymus. Thymoma in the neck has rarely been reported. In this case report we emphasize the possible presence of thymoma in the neck and the importance of neck evaluation in patients with myasthenia gravis.