Kutsal Turhan

Traumatic diaphragmatic rupture: look to see

OBJECTIVE Traumatic diaphragmatic rupture (TDR) is a rare but potentially life threatening clinical entity with a high incidence of associated injuries. In this article, our experience with this challenging diagnosis is presented. METHODS In this study, a total of 68 patients with TDR, were operated in our center between July 1994 and September 2005. Study group was analyzed retrospectively. The etiological factors, management and outcomes were discussed. RESULTS The mean age was 32.9 years with a female to male ratio of 9/59. TDR was right-sided in 16.2% (n=11) and left-sided in 83.8% (n=57). The cause of the rupture was penetrating trauma in 51 (75%), and blunt trauma in 17 (25%). Only three patients (4.4%) had late diagnosis. Associated injuries were seen in 91% (n=62) of the patients. The most common used incision was a laparotomy incision (89.6%). Morbidity and mortality were encountered in 13.1% (n=9) and 16.2% (n=11) patients, respectively. CONCLUSIONS Although rare, diaphragmatic rupture must be suspected in any patient with thoracoabdominal injury. Early diagnosis of TDR is sometimes difficult and depends on a high index of suspicion. Surgical repair is necessary even for small tears. The most common approach is the transabdominal approach, which allows a complete exploration of the abdominal organs for associated injuries. The transthoracic approach might be used in most cases with latent diaphragmatic rupture.

Prognostic factors for survival in patients with thymic epithelial tumors.

BACKGROUND Aim of the study was to identify and evaluate the prognostic efficacy of standard clinicopathological factors of thymic epithelial tumors (TETs) for treatment-related outcomes. MATERIALS AND METHODS All patients treated between 1993-2008 at Ege University Faculty of Medicine Departments of Radiation Oncology and Thoracic Surgery were reviewed retrospectively. RESULTS Forty-seven patients with a median age of 51 (range: 24-72) were identified. Complete resection was performed in 23 (51.1%), incomplete resection with microscopic residues in 17 (37.8%), subtotal resection with gross residues in 2 (4.4%) and biopsy in 5 (11.1%) patients. Radiotherapy was administered to 39 (83%) patients. Median follow-up duration was 51 months (range: 3-168 months). Five-year local recurrence-free survival (LRFS), disease-free survival (DFS), and overall survival (OS) rates were 93%, 90% and 85% for thymoma and 80%, 66% and 72% for thymic carcinoma patients, respectively. In multivariate analysis, the extent of resection was the only significant prognostic factor for OS (P = 0.001). CONCLUSIONS The most important prognostic factor for overall survival was the extent of resection. Further studies with larger numbers of patients are required to confirm the prognostic factors and to obtain a better understanding of the biological behavior of TETs.

Ligasure Vessel Sealing System versus Harmonic Scalpel for Sutureless Nonanatomical Pulmonary Resections in a Rabbit Model

Background: The safety and efficacy of the ligasure vessel sealing system (LVSS) and harmonic scalpel (HS) in sutureless nonanatomical lung resections were evaluated. Methods: On twenty adult rabbit lungs, 1 × 1 cm wedge resections were performed under one-lung ventilation with both LVSS and HS. The air tightness and tissue damage caused by these different techniques were measured and compared. Results: No statistically significant differences were found when the air tightness for both devices was compared after resection (p = 0.37). Tissue damage was obtained for LVSS, and the difference was statistically significant (p < 0.001). Discussion: LVSS and HS can both be used for peripheral lung resections without any need of further intervention for securing the air tightness. LVSS was found safer by means of tissue damage when compared with HS in this experimental study.

The Effect of Blood Vessel Invasion on Prognosis of Operated Stage I Non-small Cell Lung Cancer Patients

OBJECTIVE A retrospective study was conducted to identify the effect of blood vessel invasion on prognosis in surgically treated stage I non-small cell lung cancer patients. METHODS A total of 71 consecutive patients who had undergone complete resection for stage I primary non-small cell lung cancer (NSCLC) between 1998 and 2007 were evaluated. All pathological specimens were examined for evidence of blood vessel invasion. The follow-up period was 5-118 months. Survival data were analyzed for all patients using the Kaplan-Meier test. RESULTS There were 63 men and 8 women (mean age 59.2, age range 35-86). The most common tumor types were adenocarcinoma (35 patients, 49 %) and squamous cell carcinoma (26 patients, 37 %). Twenty-five patients (35 %) had stage IA disease, and 46 had (65 %) stage IB disease. In 13 cases (18 %) blood vessel invasion was demonstrated, whereas in the remaining 58 cases there was no evidence of vascular invasion. Minimum and maximum follow-up periods were 5 and 118 months respectively, with a mean of 41.76 +/- 27 months (median 33.5 months). Overall disease-free survival was 79.6 +/- 6.4 months: 38.3 +/- 12.0 months for the group with blood vessel invasion and 87.5 +/- 6.7 months for the remaining group. The difference between the two groups was statistically significant ( P < 0.003). Overall survival rate was 86.7 +/- 6.7 months: 44.5 +/- 11.3 months for blood vessel invasion group and 98.2 +/- 6.2 months for the remaining group. The difference between the two groups was statistically significant ( P < 0.001). CONCLUSION Vascular invasion can be an important factor for predicting unfavorable prognosis in stage I NSCLC patients.

Preserving T2 in thoracic sympathicotomy for palmar hyperhidrosis: less tissue trauma, same effectiveness.

BACKGROUND The aim of this study was to compare two different sympathicotomy procedures for primary hyperhidrosis in terms of compensatory sweating, complications, safety and effectiveness. METHODS The data of 78 consecutive patients who underwent bilateral endoscopic thoracic sympathicotomy (156 laterals) for palmar hyperhidrosis between January 2005 and September 2009 were studied retrospectively. The first 29 consecutive patients were treated with a T2-3 sympathicotomy (Group A). After November 2007, all patients (49 patients) were treated with a T3 sympathicotomy alone (Group B). The chest tubes were always removed after checking for pneumothorax with roentgenography. All patients were followed up and evaluated for results, side effects, complications, and satisfaction levels. The differences between the two groups were analyzed. RESULTS The mean age of the 47 (60.2 %) female and 31 (39.8 %) male patients was 25.2 years. Horners syndrome and pneumothorax was not detected in either group. The mean follow-up time was 20.82 months (6-52 months). Effectiveness of the procedure at the time of discharge and at follow-up was 100 % and 97.5 %, respectively. There was no significant difference between groups with regard to any analyzed parameter. CONCLUSION This study demonstrates that preserving the T2 ganglion is safe, and does not compromise the effectiveness of the procedure. Sympathicotomy has the same success rate as sympathectomy, but requires significantly less dissection and results in less tissue trauma.

[A life-saving approach after thoracic trauma: emergency room thoracotomy].

BACKGROUND In this article, the outcomes, indications and methods of emergency department service resuscitative thoracotomy in cardiac and/or respiratory arrest patients after thoracic trauma are discussed. METHODS Between January 2004 and December 2010, nine resuscitative thoracotomies were performed after thoracic trauma in the emergency department of our hospital. The records of the patients were evaluated retrospectively. RESULTS A total of nine patients underwent resuscitative thoracotomy: five stab wounds, two traffic accidents, one fall from height, and one gunshot wound. Anterolateral thoracotomy in supine position was performed in all. Three patients had lung parenchymal laceration, three patients had cardiac laceration, two patients had intercostal vessel injury, and one patient had descending aorta injury. None of the four patients with blunt trauma recovered. Three of five patients with penetrating trauma were discharged after an average of eight days of follow-up, whereas two of them were lost perioperatively. CONCLUSION Emergency room thoracotomy can be performed in thoracic trauma cases who are in shock and have unresponsive hypotension despite large volume fluid and blood replacement and no time for transportation to the operating room. The results are better in penetrating trauma patients than in blunt trauma.

Myasthenia Gravis with Thymoma: Histopathologic Examination and Rate of Complication After Surgery

Aim It is known that thymus and thymoma have a role in the etiopathogenesis of myasthenia gravis (MG). These associations and their effects on the survival have investigated in several studies since 17th century. The incidence of MG in patients with thymoma was reported to be 20-50% in different studies. The aim of this study is to investigate the relationship between thymoma and MG and to evaluate the rates of postoperative complications. Material and Methods The study included 25 patients (13 female and 12 male) and the mean age of patients was 42.3 years (range 24 to 70 years). 11 (44%) of patients had been treated with the diagnosis of MG. Eight (57%) of 14 (56%) patients without the diagnosis of MG had no symptoms and thymoma was detected accidentaly. The common symptom of the other 6 (43%) patients was cough. 9 (36%) patients were staged according to WHO classification. The other patients could not be staged according to WHO classification; because they were operated before the year of 2001. Four of patients were stage B1, 2 were stage B2, 2 were stage B3 and 1 was stage AB. Postoperative complication occured in 4 (16%) patients. Results MG was seen with a higher rate in cortical thymoma when compared with medullary thymoma, in immunohistochemical investigations. MG had been thought as a negative prognostic factor for thymoma but in the last years it had been reported as a positive prognostic factor due to the development of postoperative intensive care conditions, medical therapy and follow up.

Diagnostic value of 18 F-FDG-PET/CT in benign lung diseases

Introduction There are many diseases which, despite not being malignant, show high metabolic activity and cause false-positive results. Aim To evaluate the results of positron emission tomography (PET) in patients who underwent resection after preliminary diagnosis of malignancy based on fluorodeoxyglucose (FDG) uptake value, in whom the lesions were later classified as pathologically benign. Material and methods The analysis included the records of 106 (12.3%) patients out of 862 patients who underwent surgery between January 2012 and December 2015 after being initially diagnosed with malignant lung lesions based on PETCT results, in whom the lesions were later classified as pathologically benign. Diagnoses, PET findings, types of surgery, and demographic data of the patients were recorded. Results The mean age of the patients was 55.5 (26–79) years. The mean diameter and SUVmax of the lesions were 2 ±2.14 (0.5–13) and 3.55 ±4.35 (0–22.2) cm, respectively. The pathology results were analyzed in five different groups. The SUVmax in the hamartoma group was significantly lower than in the other groups (p < 0.001), while the SUVmax in the granulomatous disease group was significantly higher than in the other groups (p < 0.001). Conclusions The possibility of false positive PET results must be kept in mind when diagnosing and treating lung cancer. In particular, in the case of suspected granulomatous disease, all available pre- and intraoperative diagnostic procedures must be used.

Assessment of Cardiac Complications in Patients Undergoing Pulmonary Resection

BACKGROUND Patients who underwent lung resection in our clinic were retrospectively investigated in terms of development of postoperative cardiac complications. METHODS The file records of 207 patients who underwent lung resection between the years 2010 and 2014 were reviewed. One hundred and eighteeen (118) (57%) of the patients were evaluated by the preoperative cardiologist and the risk level of the patients was determined according to the Lee index. Postoperative cardiac complication relation was compared with each parameter. RESULTS The difference between the mean age of the patients with and without complication was statistically significant (p=0.024). When the patients were grouped as over and under 65 years old, the risk of developing postoperative complications was higher and statistically significant (p=0.015) in patients over 65 years of age. When the patients were evaluated in line with the presence of additional disease, smoking and electrocardiogram (ECG) findings, patients with hypertension developed more complications than those without hypertension (p=0.002). When the logistic regression was adjusted according to age and sex, the development of cardiac complications in patients with hypertension was 3.25 times greater. CONCLUSIONS It should be kept in mind that the presence of hypertension in patients who will undergo lung resection and advanced age increases the risk of cardiac complications and that preoperative cardiology care may be appropriate for these patients.

İdiyopatik mediastinal fibrozis

Halsizlik ve kilo kaybi sikayetleri ile tetkik edilen 66 yasindaki erkek hastanin gogus bilgisayarli tomografisinde, anterior mediastende, 10 cm boyutlu kitlesel lezyon saptandi. Tanisal amacli operasyona alinan hastaya, sol hemitorakstan videotorakoskopik biyopsi uygulandi. Histopatolojik inceleme sonucunda kesin bir taniya varilamamasi uzerine ayni islem ikinci bir operasyon ile sag hemitoraksa yonelik uygulandi. Yine tani elde edilememesi uzerine hasta tekrar operasyona alinarak mediastinotomi uygulandi. Tum histopatolojik inceleme sonuclari ve klinik bulgulari ile birlikte degerlendirilen olguda idiyopatik mediastinal fibrozis tanisina ulasildi. (MF) olgulari radyolojik olarak malign mediasten tumorleri ile benzerlik gosterebilir ve ayirici tani yapilmasi buyuk onem arz etmektedir.