İsmail Cüneyt Kurul

Surgery in bronchial carcinoids: experience with 83 patients

OBJECTIVE With the changing clinical presentation and histopathological pattern, carcinoids are now considered as a distinct and well-defined group in the neuroendocrine tumour scale. Surgery, especially parenchyma-sparing operations, are the treatment of choice for carcinoids. METHODS Over a 25-year period, 83 patients with typical carcinoid tumour underwent thoracotomy on in our institution. The records of the patients were reviewed and the results were evaluated. RESULTS The diagnosis was made with radiological methods and bronchoscopy. Cough and recurrent pneumonia were the most common symptoms. A variety of surgical procedures were performed. Thirty of the 83 patients underwent tissue-saving operations. Twenty patients underwent bronchotomy excision, eight were managed with sleeve or partial sleeve resective procedures, and two underwent segmentectomy. CONCLUSIONS Conservative surgery is the treatment of choice of carcinoids, which were histologically typical and anatomically endobronchial. Especially for polypoid type carcinoids and for selected cases with sessile type, bronchotomy with simple excision and sleeve resections is a simple and effective method. As these types of operations produce a better functional result, they should be encouraged in these patients.

Long-term survival following bronchotomy for polypoid bronchial carcinoid tumours

OBJECTIVE Typical bronchial carcinoids are very low grade neuroendocrine neoplasm of the tracheobronchial tree and have very good results in surgical treatment. Surgical treatment varies from bronchotomy-excision to major resective procedures. We presented our results of bronchotomy, simple excision and long-term follow-up. METHODS In Atatürk Centre for Chest Disease and Chest Surgery, 16 patients with bronchial carcinoid tumour underwent bronchotomy-excision over a 23-year-period. In all of the cases tumours were in polypoid type. Except these 16 cases 51 patients with bronchial carcinoids underwent operations in the same period. Presenting symptoms were haemoptysis, cough, recurrent pulmonary infection, dyspnea and chest pain. Rigid bronchoscopies were performed on all of the patients preoperatively for diagnosis of the tumour and to determine the surgical procedure and we performed control bronchoscopies on all of the patients in their follow-up period. RESULTS Patients were checked for periods ranging from 2 to 23 years both radiologically and bronchoscopically. We did not find any recurrences and death related to surgery and morbidity rate were minimal. CONCLUSION We think that bronchotomy and simple excision are effective and safe procedures for the treatment of bronchial carcinoid tumours with low morbidity in selected cases like polypoid type lesions and have as good a long-term survival rate as the other surgical treatment methods have.

Surgical Management of Pulmonary Aspergilloma

Records of 59 patients (41 males and 18 females) who underwent 70 operations for pulmonary aspergilloma in a 23-year period were examined retrospectively. Sixty-three operations were for primary treatment of pulmonary aspergilloma, and 7 were for complications of surgery. Twenty-six postoperative complications occurred in 19 patients. Three lobectomies that resulted in bronchopleural fistula were managed by intercostal muscle-flap closure and partial thoracomyoplasty. Two patients died within the first week of surgery. Surgery is the treatment of choice for most patients with pulmonary aspergilloma. Selective bronchial artery embolization is helpful only in combating hemoptysis, and this has been considered a temporary measure in most reports. Thus, open thoracotomy and anatomical resection are recommended as early as possible after the diagnosis is established.

Endobronchial Lipomatous Hamartoma

Pulmonary hamartomas are the most common benign neoplasm of the lung, occurring in the parenchyma or sometimes within the bronchi. Reported is a case of a 64-year-old male patient with an endobronchial tumor. Sleeve left upper lobectomy was performed and histhopathological examination revealed multiple growths of endobronchial hamartomatous foci. This report demonstrates that endobronchial hamartomas may develop from multiple foci.

Primary pulmonary adenoid cystic carcinoma: report of two cases

A 51-year-old man with adenoid cystic carcinoma in the main stem bronchus was treated by a left lower lobectomy. A 44-year-old man with adenoid cystic carcinoma in the peripheral small bronchi underwent a right sleeve upper lobectomy with tracheobronchoplasty and neo-carina reconstruction; because of positive tumor margins, radiotherapy was administered postoperatively. Both patients were alive without any signs of tumor after 30 and 24 months of follow-up, respectively.

EF24 and RAD001 potentiates the anticancer effect of platinum-based agents in human malignant pleural mesothelioma (MSTO-211H) cells and protects nonmalignant mesothelial (MET-5A) cells:

The most widespread neoplasm of the pleura is malignant pleural mesothelioma (MPM) with low prevalence rate. The mechanistic target of rapamycin signaling pathway, inhibited by RAD001, was shown to be deregulated in MPM development and considered a novel target for the MPM therapy. The EF24, a curcumin analog, also affects several signaling pathways and kills cancer cells as a single agent or in combination with classical drugs. We aimed to evaluate possible effects of RAD001, EF24, cisplatin, and oxaliplatin treatments on both malignant pleural mesothelioma (MSTO-211H) and nonmalignant mesothelial (Met-5A) cell lines. The effects of the agents on MSTO-211H and Met-5A cells were evaluated in terms of cell viability, cytotoxicity, DNA synthesis rate, quantitation of apoptotic DNA fragmentation, and cleaved caspase 3 levels. Moreover, quantitative messenger RNA (mRNA) analysis of apoptotic (CASP9) and antiapoptotic (BCL2L1 and BCL2) genes were also performed. We found that both EF24 and RAD001 alone treatments decreased only MSTO-211H cell viability, but cisplatin and oxaliplatin affected both cell lines. Pretreatment with EF24 or RAD001 followed by cisplatin increased the effects of cisplatin alone application. EF24 and RAD001 pretreatment decreased DNA fragmentation rate when compared with cisplatin alone treatment in Met-5A cells. Sequential treatments resulted in a significant increase of CASP9 mRNA expression in MSTO-211H cells but not in Met-5A cells. Our preliminary results suggest that pretreatment with EF24 or RAD001 may reduce cytotoxic effect of cisplatin on nonmalignant mesothelial cells and increase cell death response of MPM cells. Further analyses using animal models are needed to confirm these findings in vivo.

Upregulated mrna expression of mtor in surgically resected early stage non-small cell lung carcinoma: a potential molecular targeted therapy

Background: Non-small cell lung cancer (NSCLC) comprises about 85% of all lung cancers. Although many attempts for early detection and treatment, prognosis of NSCLC is still poor. In recent years the pathways and the genes that play role in lung cancer development were researched widely. PI3K/AKT/MTOR which is thought to be efficacious in the development of many cancer which controls the expression of many genes playing an important role in cell proliferation, metastasis, resistance to apoptosis and angiogenesis. Also the increase in CCND1 expression was shown in several cancer types. The aim of this study is to search the mRNA expression profile of AKT, MTOR and CCND1 genes which has been thought to play role in NSCLC development, and their expression in different pathological stages and histological types of the disease. Materials and Methods: Forty-four NSCLC patients who didn’t get neoadjuvant therapy were included in this study. The samples from tumor and matched normal lung tissue were obtained from resection specimens (lobectomy or pneumonectomy). Total cellular RNA was isolated from the samples. The mRNA expression levels of AKT1, mTOR and CCND1 genes were measured by quantitative real-time polymerase chain reaction (qPCR). Results: Our findings revealed a statistically significant increase of mTOR expression on mRNA levels (P < 0.05). Although AKT and CCND1 expression slightly increased in malign tissues, these changes in the expression were not significant (P > 0.05). The mRNA expression of mTOR was also upregulated and it was statistically significant for early stage disease and adenocarcinoma subtype (P < 0.05). Conclusions: Inhibition of mTOR gene expression at mRNA level might be potential target for future treatment strategies of NSCLC.

One-Stage Operation for Hydatid Disease of Right Lung and Liver; Analysis of the 21 Patients

1 İlknur Aytekin1, Kerim Tülüce2, Şevki Mustafa Demiröz3, Muhammet Sayan4, İsmail Cüneyt Kurul5, Sedat Demircan5 1Ordu Devlet Hastanesi, Göğüs Cerrahisi Bölümü, Ordu, 2Rize Devlet Hastanesi Göğüs Cerrahisi Bölümü, Rize, 3Malatya Devlet Hastanesi, Göğüs Cerrahisi Bölümü, Malatya, 4Aksaray Devlet Hastanesi, Göğüs Cerrahisi Bölümü, Aksaray, 5Gazi Üniversitesi Tıp Fakültesi, Göğüs Cerrahisi Bölümü, Ankara, Türkiye Eş Zamanlı Akciğer ve Karaciğer Hidatik Kist Cerrahisi / Simultaneous Lung and Liver Hydatid Cysts Surgery One-Stage Operation for Hydatid Disease of Right Lung and Liver; Analysis of the 21 Patients

Surgical Treatment of the Lung Hydatid Cysts; Analysis of the 73 Patients

1 Ilknur Aytekin1, Kerim Tuluce2, Mustafa Demiroz3, Muhammet Sayan4, Ismail Cuneyt Kurul5, Sedat Demircan5, Abdullah Irfan Tastepe5 1Ordu Devlet Hastanesi, Gogus Cerrahisi Bolumu, Ordu, 2Rize Devlet Hastanesi Gogus Cerrahisi Bolumu, Rize, 3Malatya Devlet Hastanesi, Gogus Cerrahisi Bolumu, Malatya, 4Aksaray Devlet Hastanesi, Gogus Cerrahisi Bolumu, Aksaray, 5Gazi Universitesi Tip Fakultesi, Gogus Cerrahisi Bolumu, Ankara, Turkiye Akciger Kist Hidatik Cerrahisi / Surgery of the Lung Hydatic Cysts Surgical Treatment of the Lung Hydatid Cysts; Analysis of the 73 Patients

Spontaneous extrathoracic hematoma related to anticoagulant treatment.

Extrathoracic hematoma is a very rare condition that generally occurs after trauma. A 59-year-old man was admitted with acute onset of chest pain and shoulder swelling on the left hemithorax (Figure 1). He was on oral warfarin 5mg per day for ischemic heart disease, chronic atrial fibrillation, and a cerebrovascular event 3 years earlier. There was no trauma history. Computed tomography showed an extrathoracic subpectoral mass on the left chest (Figure 2). After plasma and vitamin K replacement, the hematoma was removed through a submammary incision.