Mehmet Oğuzhan Özyurtkan

Predictors of mortality within three months in the patients with malignant pleural effusion

BACKGROUND Malignant pleural effusion (MPE) has a limited life expectancy (3-12 months). We investigated the predictors of the early mortality (EM) within three months. METHODS The patients were retrospectively grouped according to the death within three months (Group I) and survival more than three months (Group II). Demographical, clinical, and biochemical parameters in the fluid were analysed to determine their effects on the EM. The 30-day response rate of talc pleurodesis was investigated. RESULTS The study included 85 patients (Group I/Group II=40/45). The patients in Group I died within a median of 28 days. Twenty-six patients in Group II died in a median of 205, but 19 were still alive (median 200 days). The median survival was longer in renal cell, colorectal, breast, liver, ovarian and oropharynx carcinoma, and mesothelioma. Sixty-two patients (63%) underwent talc pleurodesis, which prevented the fluid reaccumulation (p=0.04). The significant factors of the EM in the univariate analysis were the presence of high-risk tumors (lung, stomach, soft tissue, bladder, esophagus, prostate, cervix, and lymphoma), the low Karnofsky performance score (KPS) (p<0.0001), the low pH value of the fluid (p=0.05), and the low concentration of glucose (p=0.01), total protein (p<0.0001), and albumin (p<0.0001) in the fluid. According to the multivariate analysis high-risk tumors (p=0.03), a lower KPS (p<0.001), and glucose value (p=0.04) were the predictors of the EM. CONCLUSION Talc pleurodesis prevents the fluid reaccumulation. High-risk tumors, a poor performance status, and lower pleural fluid glucose concentration are predictors of the EM within three months in the patients with a MPE.

Surgical treatment of intrathoracic hydatid disease: A 5-year experience in an endemic region

PurposeTo present our recent surgical experience in treating patients with intrathoracic hydatidosis.MethodsThis study reviewed the files of patients with pulmonary/intrathoracic extrapulmonary hydatid cysts treated surgically between 2003 and 2009. Demographic, laboratory and radiological data, clinical manifestations, site of the cyst, surgical approaches, and final outcome were noted and analyzed.ResultsForty patients underwent 42 operations (21 females, 19 males, mean age 36 years). Thirty-six patients (90%) had pulmonary (56.7% were intact/uncomplicated), three (7.5%) had intrathoracic extrapulmonary, and one (2.5%) had both pulmonary/intrathoracic extrapulmonary hydatid cysts. The right lung was involved in 64.9%. Larger pulmonary cysts ruptured more commonly (P = 0.007). Most patients (95%) were symptomatic, mostly dyspneic (72.5%). The mean forced expiratory volume in 1 s value was significantly reduced in cases with a large (P < 0.0001), or ruptured cyst (P = 0.05). The erythrocyte sedimentation rate was elevated in case of rupture (P = 0.05). A thoracotomy was performed for all patients. A cystotomy and capitonnage was performed more commonly than cystotomy without capitonnage for the pulmonary, and total excision was performed for the intrathoracic extrapulmonary hydatid cysts. The mortality was 0% and the morbidity was 17.5%. All patients received antihelminthic therapy postoperatively. There was no recurrence.ConclusionSurgery is considered to be the optimal treatment for intrathoracic hydatid disease. In addition, recurrence is very low when all such patients receive postoperative antihelminthic therapy.

Postoperative psychiatric disorders in general thoracic surgery: incidence, risk factors and outcomes

OBJECTIVE Postoperative psychiatric disorders (PPDs) may complicate the post-surgical outcome. We analysed the types, incidences, risk factors and outcomes of the PPDs in non-cardiac thoracic surgery patients. METHODS All patients (n=100) undergoing major non-cardiac thoracic surgery from January 2004 to March 2005 were investigated prospectively. The diagnosis of PPD was made based on the Diagnosis and Statistical Manual of Mental Disorders. The patients were grouped into two according to the presence (group I) or absence (group II) of PPD. Data on pre-, per- and postoperative factors, and the adverse outcomes were analysed. RESULTS Eighteen patients (18%) developed PPD, including delirium in 44%, adjustment disorders in 22%, panic attack in 17%, minor depression in 11% and psychosis in 6%. The patients who developed PPD were older (58+/-17 vs 50+/-15 years, p=0.05), had a longer operation time (6+/-1 vs 5+/-2h, p=0.015) and hospital stay (13+/-9 vs 8+/-5 days, p=0.019). The morbidity and mortality rates were not significantly different between the groups (67% vs 46%; 11% vs 1%, respectively). The causative factors in the development of PPD were older age, longer operation time, abnormal serum chemistry values of sodium, potassium, calcium and glucose, hypoalbuminaemia, the presence of the postoperative respiratory distress and infection and blood transfusion (p<0.05). CONCLUSIONS PPDs are associated with adverse outcomes including a longer hospital stay, and increased morbidity and mortality rates. The identification, detection and elimination of these risk factors are recommended.

Clinical and surgical specifications of adult unilateral diaphragmatic eventration according to their aetiology in 28 patients. Importance of using diaphragmatic patch and minimal thoracotomy incision

OBJECTIVE This study aims to determine the differences among various diaphragmatic eventration (DE) aetiologies and to compare the outcomes of the operation relative to the use of a diaphragmatic patch. METHODS Between 2003 and 2009, 28 patients with a DE who underwent surgery were classified according to the following aetiology: (a) previous operation or disease, (b) congenital/idiopathic and (c) trauma. Patients who received diaphragmatic patches during their operations (plication+patch, P/P, 19 cases) were compared with the patients receiving sole plication during the operation (P, 9 cases). The operations had been performed through a minimal length lateral thoracotomy incision (12-14 cm). RESULTS The mean age of the patients was 53.3+/-9.8 years. A high hemi-diaphragm (alone or associated with a blunt sinus or a wide mediastinum) was the most prominent chest X-ray (CXR) finding in 19 patients (68%). The postoperative mean forced expiratory volume in 1s (FEV(1)) value (2.1+/-0.7) and the dyspnoea score (1.8+/-0.7) were better than the preoperative values (1.7+/-0.6; 3.4+/-0.9, respectively). The average height of the diaphragm (7.8+/-3.1cm) was not correlated with the dyspnoea score and the FEV(1) value. Postoperative complications (4/28 or 14.3%) were minimal, excluding one respiratory insufficiency. The mean follow-up time was 23.4+/-17.8 months. Patients with congenital aetiology were younger, had higher diaphragms, had earlier operations after symptoms started and had better preoperative FEV(1) values. P/P operations were done later than P operations. The P/P method patients had shorter postoperative hospital stays than the P method patients. Two diaphragmatic events (recurrence and herniation) occurred after the operations were performed with the P method. CONCLUSIONS Buttressing the diaphragm by patch after the plication can protect from recurrence of a DE or any diaphragmatic insufficiency. Previous abdominal interventions may increase the complication rate after a DE operation.

Multiple cystic pulmonary chondroid hamartomas colonized by Aspergillus species: report of a case.

Pulmonary hamartoma is the most common benign neoplasm of the lung, but the cystic form is very rare. This report presents the case of a 31-year-old woman with two cystic pulmonary lesions. She was radiologically and clinically diagnosed to have multiple ruptured hydatid cysts, and underwent a thoracotomy. The pathological investigation revealed that these lesions were cystic chondroid hamartomas, and one of the cysts was colonized by Aspergillus. Multilocular pulmonary cystic hamartomas are exceptionally rare and should be differentiated from other cystic pulmonary lesions. This is the first case of cystic pulmonary hamartomas colonized by Aspergillus species.

Lung Cancer: Clinical and Surgical Specifications

Description: Lung cancer diagnosis worldwide has advanced considerably. Progress in diagnostic techniques and therapeutic methods has greatly improved life expectancy in lung cancer patients. Information on lung cancer diagnosis and treatment is therefore useful for all medical professionals especially those who work outside the realm of pulmonology or oncology. This book answers the needs of medical professionals seeking this information and includes both internal and surgical aspects of lung cancer as well as developments in molecular research on pulmonary oncology.

Symmetrical excessive pectus excavatum in children

Objectives The indications for repair of pectus excavatum are controversial. We present our surgical results in children with severe pectus excavatum. Methods 27 children aged 6–15-years were included in the study. Pulmonary function tests and chest measurements were performed pre- and postoperatively. Deformed cartilages were resected subperichondrially, and a Kirchner wire was used to support the chest cage; it was removed 5 days after the operation. Fourteen children with restricted pulmonary function were considered to have excessive pectus excavatum. Results 3 patients had asthma-like symptoms that resolved postoperatively. None suffered chest pain postoperatively. Postoperative hospital stay was 7.1 days. Only minor complications occurred postoperatively. The mean pectus severity index was 0.27 ± 0.2 preoperatively and 0.41 ± 0.1 postoperatively (p < 0.05). For children with restricted pulmonary function, it was 0.17 ± 0.3 preoperatively and 0.38 ± 0.2 postoperatively (p < 0.05). Mean percentage of predicted forced expiratory volume in 1 s changed significantly from 79.2% ± 17.8% preoperatively to 83.6% ± 12.2% by the 3rd postoperative month. For children with a pectus severity index <0.2, it changed from 68.5% ± 13.2% preoperatively to 82.3% ± 13.4%. Pulmonary restriction correlated with a worse pectus severity index (r = 0.8). After 6 and 13 months, a minor decrease in pulmonary function was noted. Significant increases in right and left ventricular function occurred in cases of severe deformity. Conclusions Surgery is recommended not only for cosmetic reasons but also to increase cardiorespiratory functional capacity and alleviate symptoms. Kirchner wires can be used safely.