Muharrem Çakmak

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.

Thoracotomy in Thoracic Injuries: Results from a Tertiary Referral Hospital

Introduction:Critically injured patients may require thoracotomy after a thoracic injury. This study is a retrospective analysis of the results of thoracotomy in patients with thoracic injury.Materials and Methods:Injured patients with detectable signs of life on arrival at the hospital and who underwent thoracotomy within 4 h of the injury were investigated. Demographic data and medical records were reviewed for associated injuries, indications, intraoperative findings, and outcomes. The factors affecting the mortality were analyzed.Results:Between April 2003 and January 2009, 488 patients with thoracic injury (blunt/penetrating = 73.7%/26.3%) were treated, and 20 (4.1%) underwent thoracotomy (male/female = 17/3, mean age = 27 ± 9 years). The injury was penetrating in 15 (11.7%) and blunt in five (1.4%). None of them required an endotracheal intubation at the scene or in transit. The mean transport time was 58 min. Severe and continuous hemothorax (80%), massive air leak, major vessel injury, and trauma causing an open chest wall defect with bleeding were indications of the thoracotomy. Eighty-five percent survived after the surgery (penetrating/ blunt = 86.6%/80%). The mean injury severity score (ISS) of the survivors was lower (21 ± 9 vs. 39 ± 10, p = 0.05). Mortality was associated with a lower Glasgow coma scale (GCS) (p = 0.03), a higher ISS (p = 0.05), and a longer transport time (p = 0.05).Conclusions:Thoracotomy after thoracic injury is a life-saving procedure in selected cases. Lower GCS and higher ISS are associated with increased mortality. Early transport and quick attempts to diagnose the indications necessitating thoracotomy play a significant role in improving the outcome.

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.

A case of Non-Hodgkin's Lymphoma on Chest Wall Location

Thoracic involvement in non-Hodgkins lymphoma is generally seen as mediastinal-hilar lymphadenopathy or with pulmonary parenchymal involvement. Isolated chest wall involvement in non-Hodgkins lymphoma is rare. Described here is the case of a patient with nonHodgkins lymphoma who had undergone excision and reconstruction and presented at the clinic with an infected mass lesion with a left anterosuperior location.

Analysis of pulmonary hydatid cysts underwent surgery

Introduction: Hydatid cyst is a parasitic disease caused by Echinococcus granulosus. The liver and lungs are the most frequently involved organs. The treatment of lung hydatid disease is surgery. We aimed to discuss the results of surgically treated patients with pulmonary hydatid cysts in light of the related literature. Materials and Method: 85 patients were divided into two groups as complicated and non-complicated. Patients who had more than one cyst in the same lobe or patients with multiple lung cysts in different locations were excluded in the study. The significance of the results was assessed by Fishers exact test. P values<0.05 were considered as significant. Findings: While the number of non-complicated patients was 58 (68%), it was 27 (32%) for complicated patients. In the statistical analysis, gender difference was not significant for both groups (p>0.05). Additionally, the disease was not significant in terms of right or left lung location (p>0.05). For both groups, the disease was not significant in terms of the location of lobe. Statistically, gender was found to be not significant on bronchus or pleural expanding (for male p>0.05, for female p>0.05). But, the right lung lesions were found to be significant in terms of the expansion in both bronchus and pleura (p<0.05). Centrally located lesions were found to be statistically significant in terms of bronchial expansion (p<0.05). Discussion: Hydatid disease is particularly common in places where farming is still widespread. We believe that the only treatment method is peoples awareness and surgical procedures.