Kuthan Kavakli

Reconstruction with a patient-specific titanium implant after a wide anterior chest wall resection

The reconstruction of full-thickness chest wall defects is a challenging problem for thoracic surgeons, particularly after a wide resection of the chest wall that includes the sternum. The location and the size of the defect play a major role when selecting the method of reconstruction, while acceptable cosmetic and functional results remain the primary goal. Improvements in preoperative imaging techniques and reconstruction materials have an important role when planning and performing a wide chest wall resection with a low morbidity rate. In this report, we describe the reconstruction of a wide anterior chest wall defect with a patient-specific custom-made titanium implant. An infected mammary tumour recurrence in a 62-year old female, located at the anterior chest wall including the sternum, was resected, followed by a large custom-made titanium implant. Latissimus dorsi flap and split-thickness graft were also used for covering the implant successfully. A titanium custom-made chest wall implant could be a viable alternative for patients who had large chest wall tumours.

Surgical Management of Chest Wall Tuberculosis

Objective: Tuberculosis remains one of the most fatal diseases in the world. Extrapulmonary tuberculosis increases in parallel fashion with the rise of incidence of pulmonary tuberculosis. Tuberculosis of the chest wall is rare. Methods: Our study retrospectively evaluated 10 patients with tuberculosis of the chest wall who were treated with surgery in addition to antituberculous chemotherapy in the last 8 years. Seven of the lesions were located on the anterior chest wall, and three of the lesions were on the lateral chest wall. Results: Surgical therapy consisted of evacuation of the cold abscess material from the cavities and wide débridement of the soft tissue planes in all patients. Partial rib resections were performed in six patients owing to costal or chondral involvement. Conclusions: Chest wall tuberculosis must be considered in the differential diagnosis of chest wall lesions, especially in endemic areas.

[Traumatic pulmonary pseudocyst: two case reports].

Traumatic pulmonary pseudocysts (TPPs) are rare sequelae of blunt chest trauma. Young adults and adolescents are predominantly affected. In this study, two cases of TPPs in young patients are presented. Chest radiographs are usually insufficient for the diagnosis, and the imaging modality of choice is computed tomography (CT). TPPs are self-limiting, benign lesions that usually require no specific therapy. Surgical treatment is indicated in rare instances and only when complications occur.

Is there any superiority among diagnostic methods in organizing pneumonia in terms of clinical features of the patients

Background Organizing pneumonia (OP) can be idiopathic or secondary to some clinical situations. If an etiological cause is not present, this phenomenon is called cryptogenic OP. Secondary OP is associated with various diseases that are known to induce the OP. Objectives The aim of this study was to evaluate the clinical features of the cases with OP and compare the patients diagnosed by bronchoscopic transbronchial biopsy with patients diagnosed by surgical lung biopsy. Patients and methods Medical records of 41 patients diagnosed with OP between 2004 and 2014 were reviewed retrospectively. Results Totally, 41 patients with OP were identified. In all, 39.02% of the cases were diagnosed by bronchoscopic methods, and 60.97% of the cases were diagnosed by surgical procedures. Although the frequency of ground glass opacities, consolidations, and micronodules was higher in the group diagnosed by bronchoscopy, mass-like lesions were more common in the cases diagnosed by surgery. Bronchoscopy, performed in 30 patients totally, had a diagnostic efficacy of 53.33%. Diagnostic value of bronchoscopy was significantly higher in cryptogenic OPs. Although diffuse radiological pattern was more common in “successful bronchoscopy” group, frequency of focal pattern was higher in “failed bronchoscopy” group. Ground glass opacity in successful bronchoscopy group and mass-like lesions in failed bronchoscopy group reached significant differences. Conclusion There were significant differences between the diagnostic procedures in terms of radiological patterns. This is the first study about the relationship between the diagnostic methods and the characteristics of OP.

Is Multiple Bilateral Thoracic Anomaly Different From Poland’s Syndrome?

After reading the inspirational presidential address by Douglas E. Wood [1], I feel obliged to contribute. Although The Annals of Thoracic Surgery publishes topics in cardiovascular and thoracic surgery, I, as a cardiac surgeon and member of the Society of Thoracic Surgeons, would like to bring to your attention my thesis, entitled (translated) “A Narrative Reflection on Negative Coronary Artery Bypass Graft Surgery Outcomes: The Spiritual Experience of a Surgeon.” Reflection on one’s clinical practice asks for introspection about professional as well as personal life [2]. Furthermore, narrative knowledge contributes to an individual’s insight into specific experiences [3]. The practical theologian is interested in the integration of the individual person’s story with the story of God and considers it as epistemologically important [4]. With this thesis I took the reader on a personal, spiritual journey by means of an auto ethnographical study design. Henri Nouwen points out that for a person to grow spiritually, three movements of the spirit need to be completed [5]. These three movements were applied to construct the thesis. The inner struggle that a surgeon experiences when a patient dies or experiences complications requires movement from loneliness to solitude. My individual series of patients who underwent coronary artery bypass grafting (CABG) was presented for a hermeneutical investigation with the view to spiritual transformation. A physician should furthermore provide hospitality instead of hostility towards the patient. Nouwen indicates that the last spiritual movement should be from illusion to prayer. I addressed this by asking an evocative question about how God acts in cardiac operations. Amy Ai has done much work over many years on prayer and the outcomes after cardiac surgical procedures [6]. God is neither questioned nor proved, but God was drawn into my time-space to make sense of the negative outcomes after CABG. In a shared Christian spirituality, using the Delphi survey, fellow surgeons were invited to elucidate on spiritual issues. This interdisciplinary research confirms that the sciences need not to function in isolation, but that medical science and theology can join in the establishment of a meaningful existential existence. Mentors with brilliant minds trained me. I watched colleagues with skillful hands. I would like to emphasize the spiritual side of the cardiac surgeon’s make-up.

Solitary Supraclavicular Fossa Masses.

Objective:The aim of this study is to present the diagnostic spectrum of solitary supraclavicular fossa (SCF) masses in a Turkish context. The demographic data of the patients and the effectivity of the diagnostic tools are also discussed to improve current diagnostic strategies. Patients and Methods:The charts of patients who underwent surgical intervention for solitary SCF mass of an unknown etiology between January 2005 and January 2015 were reviewed. Patients presenting evidences of synchronous cancers and patients with a history of previous cancers were excluded. The data encompassing the demographics of the patients, the discriminative specifications, the histopathological diagnosis of the masses, and the diagnostic tools used in the workup period were noted. The descriptive data are presented and statistical analyses were performed using the Mann-Whitney test, Fisher exact test, and Chi-squared tests. Results:In total, 44 male (76%) and 14 (24%) female patients were enrolled in the study. Thirty-five masses (60%) were located in the left SCF and 23 masses (40%) in the right. The masses were categorized as neoplastic (n = 31, 53%), inflammatory (n = 18, 31%), and congenital (n = 9, 16%). The 44 (76%) masses in our series were lymph nodes (LNs), and 25 (57%) of them were malign, whereas 19 (43%) were either inflammatory or benign. Male sex (P = 0.027) and the size of the mass (P = 0.017) were significantly related to malign LNs. The patients’ ages and sides of the masses were not significantly different between the malign and benign LN groups. Conclusions:Lymph nodes constitute the majority of solitary SCF masses. Although imaging techniques and fine needle aspirations are routinely applied, excisional biopsies are necessary in most cases to reach an exact diagnosis and to plan a definitive treatment regime in this presented series.

Paraganglioma Necessitating Aggressive Surgical Staging After Primary Staging of Malignant Melanoma by FDG-PET/CT: Case Report

Malignant melanoma (MM) is a dermal cancer originating from melanocytes locating in epidermis. Its mortality is high and treatment option is determined by the stage of the disease. Therefore all patients with MM should be staged properly even if it requires aggressive surgical staging. Herein we presented a patient with MM who was staged with aggressive surgical approach that includes left axillary lymph node biopsy, video assisted thoracic surgery (VATS) thymectomy and resection of intrapericardial lesion via median sternotomy. This aggressive surgical approach avoided upstaging of the patient and unnecessary treatment.

Treatment of compensatory hyperhidrosis of the trunk with radiofrequency ablation

OBJECTIVES Although Endoscopic Thoracic Sympathectomy is a widely accepted treatment method for patients with palmar hyperhidrosis, compensatory hyperhidrosis of the trunk remains a challenging side effect of the procedure. No satisfactory treatment options for this side effect were available until now. In this study, we aimed to define a new procedure for the treatment of compensatory hyperhidrosis of the trunk. METHODS A total of 10 patients admitted our institution for the treatment of compensatory hyperhidrosis of the trunk were enrolled in the study between November 2010 and January 2012 in a prospective manner. Sympathetic blockage was achieved via radiofrequency thermo-ablation technique. The results of treatment were evaluated via telephone calls. RESULTS Ten patients (2 females, 8 males) underwent radiofrequency thermo-ablation of T6 sympathetic ganglion for compensatory hyperhidrosis of the trunk. The mean age was 29.2 years and the median duration of symptom was 10.5 months. The median follow-up period was 14 months. Six of ten patients (60%) were treated successfully. There was no procedure related complication. CONCLUSION The radiofrequency treatment for patients with compensatory hyperhidrosis of the trunk is an alternative option with promising results.

Parathyroid adenoma upstaging the lung cancer

Mediastinal staging of NSCLC with noninvasive methods such as PET/CT can be misleading when a mediastinal disease accompany. Histopathologic confirmation should be made before any treatment plan. Herein, we presented a case of parathyroid adenoma upstaging the lung cancer.

Left-sided pleural effusion in a 47-year-old female

A 47-year-old female patient was admitted to the Dept of Thoracic Surgery, Gulhane Military Medical Academy (Ankara, Turkey) with right thoraco-abdominal pain, which had been aggravated by cough and deep breathing. Despite being treated with several courses of antibiotics for these symptoms during the previous 2 years, her non-productive cough had worsened. She had been operated on 4 years previously for a hepatic cyst. Laboratory tests were normal. On physical examination, submatite was established on the right lateral thoracic wall along the anterior and posterior axillary lines.