Nesimi Günal

Elastofibroma dorsi management and outcomes: review of 16 cases

OBJECTIVES Elastofibroma dorsi (ED) is a rare, benign lesion arising from connective tissue, usually found at the inferior pole of the scapula. To date, only a few small series have been reported in the English literature and there are few data about the long-term outcomes after surgery. Our goal is to contribute a better understanding of this tumour and to determine the long-term outcomes after surgery. METHODS Sixteen patients with a diagnosis of ED were identified from the units database. The clinical presentation, diagnosis, pathological evidences and long-term outcomes were evaluated. RESULTS There were 11 females and 5 males with a mean age of 61.1 years (range 38-78 years). The tumour was located on the right in 5 (31.2%) patients, on the left in 6 (37.5%) patients and bilaterally in 5 (31.2%). Six patients had painful scapular swelling resulting in restriction of movement of the shoulder whereas 10 reported only painful scapular mass. All 16 patients underwent complete resections. The tumour size ranged from 3 to 15 cm. The mean hospital stay was 3.1 ± 1.4 days with a morbidity of 18.75% (seroma observed in 3 patients). The mean follow-up was 58.4 ± 29.5 months (range 11-92 months). In 2 patients (12.5%) a new occurrence on the contralateral side was observed at the follow-up. CONCLUSIONS Elastofibroma dorsi is a rare, ill-defined, pseudotumoural lesion of the soft tissues. Surgical treatment can be proposed if the lesion is symptomatic. Furthermore, at the follow-up, the possibility of new occurrences on the contralateral side should be kept in mind.

Traumatic pulmonary pseuodocysts: two case reports

Traumatic pulmonary pseudocyst (TPP) is a rare complication, sometimes encountered after blunt thoracic trauma and even more rarely following penetrating injuries. It is more common among pediatric and young adult patients. Although TPP is usually benign in nature, complications associated with hemoptysis and secondary infection may develop. The treatment is conservative. In this report, we present two rare cases of TPP occuring after a high-speed accident and a stab wound injury, where conservative treatment provided good outcomes.

Quantative computerized tomography assessment of lung density as a predictor of postoperative pulmonary morbidity in patients with lung cancer

BACKGROUND The aim of this study was to evaluate the pulmonary reserve of the patients via preoperative quantitative computerized tomography (CT) and to determine if these preoperative quantitative measurements could predict the postoperative pulmonary morbidity. METHODS Fifty patients with lung cancer who underwent lobectomy/segmentectomy were included in the study. Preoperative quantitative CT scans and pulmonary function tests data were evaluated retrospectively. We compare these measurements with postoperative morbidity. RESULTS There were 32 males and 18 females with a mean age of 54.4±13.9 years. Mean total density was -790.6±73.4 HU. The volume of emphysematous lung was (<-900 HU) 885.2±1,378.4 cm(3). Forced expiratory volume in one second (FEV1) (r=-0.494, P=0.02) and diffusion capacity of carbon monoxide (DLCO) (r=-0.643, P<0.001) were found to be correlate with the volume of emphysematous lung. Furthermore FEV1 (r=0.59, P<0.001) and DLCO (r=0.48, P<0.001) were also found to be correlate with mean lung density. Postoperative pulmonary morbidity was significantly higher in patients with lower lung density (P<0.001), larger volume of emphysema (P<0.001) and lower DLCO (P=0.039). A cut-off point of -787.5 HU for lung density showed 86.96% sensitivity and 81.48% specificity for predicting the pulmonary morbidity (kappa =-0.68, P<0.001). Additionally a cut-off point of 5.41% for emphysematous volume showed 84.00% sensitivity and 80.00% specificity for predicting the pulmonary morbidity (kappa =0.64, P<0.001). According to logistic regression analyses emphysematous volume >5.41% (P=0.014) and lung density <-787.5 HU (P=0.009) were independent prognostic factors associated with postoperative pulmonary morbidity. CONCLUSIONS In this study, the patients with a lower lung density than -787.5 HU and a higher volume of emphysema than 5.41% were found to be at increased risk for developing postoperative pulmonary morbidity. More stringent precautions should be taken in those patients that were found to be at high risk to avoid pulmonary complications.

Painful Chest Wall Swellings: Tietze Syndrome or Chest Wall Tumor?

BACKGROUND  Tietze syndrome (TS) is an inflammatory condition characterized by chest pain and swelling of costochondral junction. Primary chest wall tumors may mimic TS. In this article, we report our experience of approximately 121 patients initially diagnosed as TS and determined chest wall tumor in some cases at the follow-up. METHODS  This is a retrospective review of patients diagnosed as TS by clinical examination, chest X-ray, electrocardiogram, routine laboratory tests, and computed tomography (CT) of chest: all treated and followed up between March 2001 and July 2012. There were 121 cases (41 males and 80 females; mean age, 39.6 ± 3.2 years) of TS. RESULTS In 27 patients with initial normal radiological findings, the size of swellings had doubled during the follow-up period (mean, 8.51 ± 2.15 months). These patients were reevaluated with chest CT and bone scintigraphy and then early diagnostic biopsy was performed. Pathologic examination revealed primary chest wall tumor in 13 patients (5 malignant, 8 benign). CT had a sensitivity of 92.3% and a specificity of 64.2% in detection of tumors (kappa: 0.56, p = 0.002), whereas the sensitivity and the specificity of bone scan were 84.6 and 35.7%, respectively (kappa: 0.199, p = 0.385). CONCLUSION  Primary chest wall tumors could mimic TS. Bone scintigraphy or CT is not specific enough to determine malignant and other benign disorders of costochondral junction. Therefore, clinicians should follow TS patients more closely, and in case of increasing size of swelling, early diagnostic biopsy should be considered.

Endoskopik Torakal Sempatektomide Prilokaine Bağlı Methemoglobinemi

Prilokain cok sik kullanilan bir lokal anestezik olup methemoglobinemiye neden olmaktadir. 22 yasinda palmar hiperhidrozis tanisi ile sedoanaljezi esliginde bilateral endoskopik torakal sempatektomi (ETS) yapilan kadin hastada prilokainin infiltrasyon anestezisi sonrasi 5. dakikada perioral ve tirnak yataklarinda siyanoz gelisti. 6 lt/dk maske O2 destegine ragmen direncli hipoksemi (SpO2: %80 ve PO2: 93 mmhg) gelisen hastada methemoglobinemi dusunulerek yogun bakim unitesine alindi. Kantitatif Glukoz-6-fosfat-dehidrogenaz (G6PD) enzim duzeyi, labaratuar degerleri ve akciger grafisi normal olan hastanin hidrasyonu %5 dekstroz ile saglandi. 4 lt/dk maske O2 ile oksijenizasyonu saglanan hastaya intravenoz (iv) kullanima uygun metilen mavisi bulunmadigindan iv askorbik asit infuzyonu baslandi. Takiplerinde arteryal kan gazlarinda pO2 ve methemoglobin (MetHb) duzeylerinde duzelme gorulen hastanin postoperatif 8. saatinde periferik ve perioral siyanozu yok oldu. MetHb duzeyi %4,5 ve pO2: 169 mmhg idi. Lokal anestezik kullanimi sonrasi aciklanamayan siyanoz ve hipoksemi gelismesine ragmen, farmakolojik antagonizma ve destekleyici medikal tedavilerin erken donemde uygulanmasi ile hastanin tedavisi saglandi.

Lung cancer and warthin"s tumor: a case report and review of the literature

Warthin’s tumor (WT) is a salivary gland neoplasm, which is also called as papillary cyst adenoma lymphomatosis. Herein, we present an uncommon coexistence of WT in an 80-year-old patient with PET/CT positive cervical lymph nodes, during the diagnostic workup of a pulmonary mass lesion. Histopathologic diagnosis of the lymph node was reported as Warthin tumor and transthoracic biopsy of the mass as non-small cell lung carcinoma. We want to emphasize that it would be essential to identify patients with WT as an association with lung cancer was suggested in the recent literature.

Long-term survival after R0 resection of thymoma:

Background The aim of this study was to evaluate the results of R0 resection of thymoma to identify prognostic factors for long-term outcomes. Methods Data of 62 patients (28 male, 34 female) with a mean age of 47.26 ± 14.42 years, who underwent R0 resection for thymoma and were followed-up between February 2004 and March 2016, were analyzed retrospectively. Results Eight patients had a video-assisted thoracoscopic thymectomy and 54 had a transsternal extended thymectomy. During a mean follow-up of 128.67 ± 7.95 months, regional recurrence of thymoma was observed in 9 (14.5%) patients. Overall 5- and 10-year survival rates were 85.36% and 78.20%, respectively. The 5- and 10-year survival rates in patients aged < 50 years were significantly better than in those aged ≥ 50 years (92% and 72% vs. 88% and 39%, p < 0.0001). The 10-year overall survival of patients in Masaoka stage I and II was better than those in stage III (88.9%, 78.4%, 69.8%, respectively, log-rank p < 0.001). The 10-year survival of patients with World Health Organization histological type A, AB, and B1 thymomas was better than those with type B2 and B3 (log-rank test p < 0.001). In multivariate analysis, age < 50 years (p = 0.001), Masaoka stage (p = 0.006), histological type (p = 0.001), and recurrence (p = 0.04) were independent prognostic factors for survival. Conclusion Our study indicates that age < 50 years, Masaoka stage, histological type, and recurrence are the determinants of survival in surgically resected cases of thymoma.

Cerrahi olarak tedavi edilen dev ve daha küçük boyuttaki akciğer kist hidatiklerinin karşılaştırmalı analizi

Amac: Bu calismanin amaci akcigerin dev kist hidatiklerinin daha kucuk boydaki hidatik kistlerle karsilastirilmasidir. Gerec ve Yontemler: Akciger kist hidatigi nedeniyle ameliyat edilen 62 hasta geriye dunuk olarak degerlendirildi. Hastalar dev kist hidatik (Grup A, n=23) ve daha kucuk capta olanlar (Grup B, n=39) olmak uzere iki gruba ayrildi. Gruplar yas, cinsiyet, semptomlar, kist yerlesimi ve sayisi, preoperative komplikasyonlar, uygulanan cerrahi girisim sekli, postoperative uzamis hava kacagi, gogus tupu alinma gunu, postoperative komplikasyonlar, hastanede kalis suresi, morbidite ve mortalite acisindan karsilastirildi. Bulgular : Yas, cinsiyet, kist yerlesim yeri acisindan anlamli fark saptanmadi ((P = 0.925, P = 0.293, P = 0.179). Grup A’da 21 (%91) vakada kistler tek , Grup B’de vakalarin yaklasik 1/3’unde birden fazla kist saptandi. Kistleri tek olmasi anlamli bulundu (P = 0.005). Grup A’da 13 (%56) vakada kistotomi + kapitonaj yapilirken, Grup B’de 8 (%20) vakada yapilmisti. Kistotomi + kapitonaj yontemi Grup B’de Grup A’ya gore anlamli olarak yuksekti. Uzamis hava kacagi Grup A’da 8 (%20), Grup B’de 2 (%5) vakada gozlendi. Ortalama gogus tupu cekilme gunu Grup A’da 4.57 ± 2.48 gun, Grup B’de 2.49 ± 1.63 gun ve hastanede kalis suresi Grup A’da 8.48 ± 3.39 gun ve Grup B’de 5.69 ± 1.80 gun olup her iki parametre istatistiksel olarak anlamliydi (P < 0.001 ve P < 0.001). Postoperatif komplikasyonlar Grup A’da iki, Grup B’de uc vakada gozlendi. Her iki grupta da mortalite yoktu. Sonuclar : Dev akciger kistlerinin soliter gorulme ihtimali fazla, ortalama gogus tupu cekilme ve hastanede kalis suresi uygulanan operasyondan bagimsiz olarak uzamistir. Kapitonajli veya kapitonajsiz yontemlerin uygulandigi her iki grupta kuratif cerrahi girisimlerin sonuclari mukemmeldir.

Nuss procedure and Factor VII deficiency: a case report.

A 19 year-old boy admitted with pain and discoloration on his chest wall 18 months after a Nuss procedure performed for pectus excavatum deformity. His physical examination revealed that this skin lesion was an ecchymosis. We diagnosed a very rare bleeding disorder due to Factor VII deficiency which is a recessively inherited coagulation disorder where even spontaneous bleedings may be seen. We aimed to discuss the management of the patient, if it had been diagnosed preoperatively and the preoperative preparation before the bar removal.