M. Muharrem Erol

The management of esophagogastric anastomotic leak after esophagectomy for esophageal carcinoma

Esophagogastric anastomotic leaks are the most feared surgical complications following resection of esophageal cancers. We aimed to develop a therapeutic algorithm for this complication characterized by high morbidity and mortality using our 20 years of experience and the published literature. A total of 354 patients who had undergone an esophagectomy and esophagogastric anastomosis due to esophageal carcinoma were evaluated retrospectively. The incidence for anastomotic leak was 15.5% (n = 90) in the cervical region and 4.2% (n = 264) in the thoracic region (mean: 7.1%). Cervical anastomotic leaks were detected after a mean period of 7.2 days following the procedure. Fourteen patients with cervical leaks were treated conservatively. Four out of 14 patients (28.6%) died due to sepsis and multi-organ failure related to fistula. Thoracic anastomotic leaks were detected after a mean period of 4.7 days following the procedure. Emergency reoperation, resection and reconstruction procedures were performed in one patient. Self-expanding metallic coated stents were placed at the anastomosis region in two patients. A more conservative approach was employed in other patients with thoracic anastomotic leaks. Six of them (46.2%) died due to fistula. General mortality rate was 37.0%, and the duration of hospitalization was 40.0 days for patients with anastomotic leaks. Cervical anastomotic leaks are more common than thoracic anastomotic leaks, but most of them are successfully treated with conservative approaches. Thoracic anastomotic leaks that in the past were related to high mortality rates despite conservative or surgical procedures might be successfully treated nowadays with the use of self-expanding metallic coated stents.

Mediastinal lymph nodes: Assessment with diffusion-weighted MR imaging

To prospectively determine whether the diffusion‐weighted magnetic resonance imaging is useful to distinguish between malignant and benign mediastinal lymph nodes.

Hydatid cyst disease of the lung as an unusual cause of massive hemoptysis: a case report

IntroductionEchinococcosis and/or hydatidosis is one of the most important zoonotic diseases in the world. In Turkey, echinococcosis is an endemic disease, however, hydatid disease of the lung is uncommon and usually caused by Echinococcus granulosus.Case presentationIn this report we describe a 17-year-old male patient who presented with massive hemoptysis due to hydatid disease of the lung.ConclusionAlthough it is one of the less common causes of massive hemoptysis, hydatid disease of the lung requires greater attention in countries, such as Turkey, in which hydatid cyst disease is common.

Endobronchial Metastasis from Testicular Seminoma

Objective: To present a case of endobronchial metastasis from a seminoma mimicking a primary pulmonary mass on X-ray radiograph. Clinical Presentation and Intervention: A 27-year-old man presented with a 1-month history of hemoptysis. Thorax computerized tomography of the patient obtained at the level of the main right bronchi demonstrated a mass with a size of 7 × 6 cm and a peripheral lobulated nodule. Bronchoscopic examination showed narrowing and multiple nodules in the right upper and right intermediary lobar bronchi. Histopathological examination of bronchial biopsies and brushing confirmed endobronchial metastasis of the testicular seminoma. Conclusion: This case shows the prognostic significance of distinguishing endobronchial metastasis from primary lung carcinoma.

Giant Fibrous Tumor Misdiagnosed as Traumatic Hemothorax

Abstract Solitary fibrous tumors of the pleura are neoplasms of the mesenchymal tissue of the pleural mesothelium. The most frequent symptoms are dyspnea, coughing and chest pain. A 45-year-old female patient presented after a thoracic contusion. A radio-opaque image was evidenced on chest X-ray. At the initial hospital, a hemorrhagic fluid was aspirated at thoracocentesis and the patient was transferred to our hospital with diagnosis of traumatic hemothorax. A thoracic CT showed a tumoral formation filling two-thirds of the left hemithorax. The transthoracic biopsy finding was compatible with a fibrous tumor. The patient was taken for surgery and the large pleural tumor was excised. In conclusion, a large pleural fibrous tumor was initially mistaken for hemothorax. A CT-scan revealed the tumoral nature of the thoracic opacity.

An unusual tracheobronchial foreign body

A 66-year-old man, who underwent total laryngectomy for a laryngeal tumour 5 years previously, was admitted because he had aspirated a large nail. He was admitted to the emergency department with mild respiratory …

Cisplatin Plus Etoposide in the Adjuvant Treatment of Patients with Non-Small Cell Lung Cancer

Aim: In this study, the efficacy and safety of cisplatin and etoposide (PE) combination in the adjuvant treatment of patients with resected non-small cell lung cancer (NSCLC) was investigated. Material and Method: We retrospectively evaluated the medical charts of patients receiving adjuvant treatment for NSCLC at our center. Results: Forty-five patients were evaluated. The disease-free survival was 10 (1-114) months and the median overall survival was 18 (3-114) months. Discussion: Based on our limited experience, we concluded that PE regimen is safe and effective as adjuvant therapy for patients with NSCLC.

Diffuse Increased FDG Uptake in the Bone Marrow due to Leukemoid Reaction

Bone marrow accumulation of 18F-FDG is generally faint diffuse low-grade activity, less than liver activity and mostly seen in vertebral bodies. Metastases can be distinguished by the higher intensity of diffuse FDG uptake. Granulocyte colony stimulation factor treatment and chemotherapy can lead to a diffusely increased FDG uptake [1]. Granulocyte colony stimulating factor (G-CSF)-producing tumors usually show peripheral granulophilia or leukemoid reactions and lead to diffusely increased bone marrow FDG uptake. A 43-year-old man with pulmonary malignant fibrous histiocytoma was referred to our unit for preoperative staging with PET/ CT imaging. After six hours of fasting and having serum glucose 78 mg/dl, the patient was injected with 555 MBq (15 mCi) of F-18 FDG intravenously. After 60 minutes of waiting, the patient was imaged from vertex to middle of the thigh using an integrated PET/CT scanner which consisted of a full-ring high resolution (HI-REZ) PET with lutetium oxy-orthosilicate (LSO) crystal and a 6-slice CT (Siemens Biograph 6, Chicago, USA). PET/CT image showed intense hipermetabolic mass lesion in the right lung and also showed diffuse FDG uptake throughout the bone marrow suspected for bone marrow metastases (Figure 1 A, B and C1,C2,C3,C4). Recent chemotheraphy treatment, haemotologic disorders, granulocyte colony-stimulating factor using was not there on patient medical history. Complete blood count was checked. Total leukocyte count was 51800/μL, with 92.1 % neutrophils, 0.7 % eosinophils, 4.3 % lymphocytes, and 2.8 % monocytes. Bone marrow biopsy was done and revealed a hypercellular marrow with no evidence of malignancy. It was diagnosed that diffuse bone marrow FDG uptake in our patient was due to leukemoid reaction. Leukocytosis in excess of 50000/mL not related to bone marrow involvement, termed leukemoid reaction. It is usually seen in response to infection, inflammation, or therapeutic agents such as growth factors and is less commonly caused by malignancy. Reports of granulocyte colony stimulating factor (G-CSF)-producing tumors usually show peripheral granulophilia or leukemoid reactions, suggesting that tumor-derived G-CSF acts on bone-marrow cell proliferation and differentiation to granulocytes. Different histological types of G-CSF-producing lung cancers such as large cell carcinoma, squamous cell carcinoma, small cell carcinoma, adenocarcinoma, sarcoma and were reported [2]. In literature, four cases of G-CSF-producing tumors originating from the lung were reported, three of which were pleomorphic carcinoma and the other was a spindle cell carcinoma [3-4] Our case is the first case of pulmonary malignant fibrous histiocytoma lead to diffuse FDG uptake in the bone marrow on PET-CT due to leukemoid reaction. Nuclear physician should be aware of to leukemoid reaction in whom diffuse increased FDG uptake in the bone marrow was seen.

A Case of Descending Necrotizing Mediastinitis Following Tooth Cleaning With a Crochet Hook

Acute mediastinitis is a potentially fatal condition that caused by oropharyngeal infections, esophageal perforations or after cardio-thoracic surgery . Early diag - nosis, aggressive surgical debridement and drainage are important for succesful treatment. Here we present a case of DNM that caused by tooth cleaning with a crochet hook. There is no case of DNM in the literature developed after teeth cleaning.

Contents Vol. 17, 2008

507 Abstracts of Award-Winning Posters, 13th Annual Health Sciences Poster Conference, Faculty of Medicine, Health Sciences Centre, Kuwait University, Kuwait, April 22–24, 2008 512 Abstracts of Theses Approved for the MSc and PhD Degrees at the Faculty of Medicine, Health Sciences Centre, Kuwait University, Kuwait 515 List of Reviewers Vol. 17, 2008 517 Author Index Vol. 17, 2008 519 Subject Index Vol. 17, 2008