Omer Onal

Learning curve of conventional transbronchial needle aspiration

Intrathoracic lymphadenopathy usually occurs as a result of neoplasm, granulomatous diseases, infections or reactive hyperplasia. Conventional transbronchial needle aspiration (C‐TBNA) is a cheap and safe procedure for diagnosing intrathoracic lymphadenopathy. The aim of this study was to assess the learning curve and diagnostic accuracy of C‐TBNA after an observational education programme.

Is Anatomic Lung Resection Necessary in Surgical Treatment of Giant Lung Hydatid Cysts in Childhood

PURPOSEnThe aim of this study is to evaluate the results of parenchymal saving methods for giant lung hydatid cysts and to discuss the necessity of anatomic lung resection in childhood.nnnMETHODSnThe patients under the age of 16 years who were operated between January 2000 and January 2017 due to pulmonary hydatid cyst were evaluated retrospectively (n = 200). In all, 32 patients who had giant hydatid cyst were included in this study. Parenchymal saving methods (cystotomy-capitonnage) were preferred and decortication was also performed for pleural thickening if needed. No lung resections were applied.nnnRESULTSnMale patients were 53.1%. The mean age was 11.3 ± 3.2 years. The total number of giant cysts was 32. The average size of the cysts was 11 cm. Thirty seven point five percent of the cysts were perforated. Postoperative complication rate was 31.3%. No recurrence and mortality were seen during follow-up period.nnnCONCLUSIONnConsidering the high recovery capacity of lung tissue, a chance should be given to recover the existing infection, atelectasis, and parenchymal damage. Especially in areas where hydatid disease is endemic, children may be infected with the parasite again. For these reasons, we do not recommend resection with any indications.

Bilateral staged thoracotomy for multiple lung hydatidosis

BackgroundHydatid cyst disease is still a problem in many countries. Surgical removal is currently the generally accepted choice of treatment for lung hydatidosis. However, operating on bilateral widespread lung hydatidosis is still controversial. The aim of this retrospective study was to evaluate the results of surgical treatment in bilateral multiple hydatid disease of the lung.MethodsIn this study, we reviewed our experience in the surgical treatment of 17 (3.7%) patients with bilateral, and at least three, lung hydatid cysts. These 17 patients (8 male, 9 female), with an average age of 34.6xa0years (range 12–58xa0years), underwent bilateral staged thoracotomy.ResultsIn total 105 lung cysts were removed from 17 patients who underwent staged thoracotomies. The mean count of cysts was 6.7 (range 3–20 cysts). Most of the cysts (38.2%) were located in the right lower lobe. The mean interval between thoracotomies was 4.2 (range 3–5) days. Two patients (11.7%) had cysts associated with hepatic hydatidosis and one (5.8%) had cysts associated with the spleen; they were treated via phrenotomy during thoracotomies. All cysts were removed without lung resection. We observed some complications such as prolonged air leaks (nu2009=u20092), atelectasis (nu2009=u20093) and empyema (nu2009=u20092). No further surgery was required for management of complications. The mean hospital stay was 9.3xa0days. (range 7–23xa0days). Oral albendazole was started on the 2nd post operative day after the first thoracotomy in the dose of 10–20xa0mg/kg and was continued for 3xa0months with a gap of 1xa0week after each 21xa0days. No recurrences or deaths occured during the follow-up period.ConclusionsAlthough staged thoracotomy applied in 3–5xa0days after the initial thoracotomy increases the total hospital stay, it decreases the chance of possible complications can occur in cysts in the other lung when long intervals are preferred between the first and the second thoracotomy. In our experience, bilateral staged thoracotomy is an appropriate surgical option because morbidity rates are minimal and the hospital stay is acceptable for the treatment of bilateral widespread lung hydatidosis, even in patients who had a total of 20 hydatid cysts.

The role of endobronchial and endoscopic ultrasound guided fine needle aspiration for mediastinal nodal staging of non-small-cell lung cancer

IntroductionnMediastinal and hilar nodal staging is one of the key points for differentiating treatment modalities in patients with non-small-cell lung cancer (NSCLC). The aim of the present study was to determinate the diagnostic yields of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and combined EBUS-TBNA and EUS-FNA modalities for nodal staging in potentially operable NSCLC patients.nnnMaterials and MethodsnTwenty consecutive patients were prospectively enrolled in the study between March 2014 and November 2015. All patients had a potentially operable NSCLC diagnosis before endosonographic procedures.nnnResultnThirty lymph nodes were sampled by EBUS-TBNA and 17 lymph nodes were sampled by EUS-FNA in all 20 patients. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of F-18 fluorodeoxyglucose positron emission tomography with computed tomography (PET-CT), EBUS-TBNA, EUS-FNA and combined EBUS-TBNA and EUS-FNA were 100%, 33.3%, 64.7%, 100% and 70.0%; 81.8%, 100%, 100%, 81.8% and 90%; 81.8%, 100%, 100%, 75% and 88.2%; 90.9%, 100%, 100%, 90.0% and 95.0%, respectively.nnnConclusionsnThe combined EBUS-TBNA and EUS-FNA technique is a successful procedure for nodal staging in potentially operable NSCLC patients.

The relation between the location and the perforation rate of lung hydatid cysts in children

BACKGROUND/OBJECTIVEnThe pressure, size, and central or peripheral location of lung hydatid cysts are the most studied topics among the factors affecting perforation. The aim of this study is to investigate the relation between the location and the perforation rate of lung hydatid cysts in children.nnnMETHODSn197 patients under the age of 16 years, who were operated between January 2000 and December 2016 due to pulmonary hydatid cysts, were evaluated retrospectively. Patients who had giant hydatid cysts (nxa0=xa027), bilateral hydatid cysts (nxa0=xa024), and more than one cyst in one lung (nxa0=xa012) were excluded to create a more homogeneous group to enable investigation of the relation between the location and the perforation rates of hydatid cysts. Finally, 134 patients who had only one hydatid cyst were classified into two groups: Group 1 with perforated cysts and Group 2 with intact hydatid cysts.nnnRESULTSn70.9% of the patients were male. In total, 134 cysts were detected and 41% were perforated. The highest perforation rates were detected in the right middle lobe (70%) and the lingula (66.7%). There was a statistically significant difference between the location of the cysts and the perforation rates (pxa0=xa00.018). Also hydatid cysts located in the right middle lobe and the lingula had higher postoperative complication rates than hydatid cysts located in the upper and lower lobes (pxa0=xa00.018).nnnCONCLUSIONnWe recommend surgical treatment as soon as possible in children with hydatid cysts located in the right middle lobe and lingula to prevent the risk of perforation.

A Rare Cause of Spontaneous Pneumomediastinum: Ecstasy Ingestion

Ecstasy ingestion has life-threatening effects such as hyperpyrexia, rhabdomyolysis, disseminated intravascular coagulation, coma, and death. In the present report, we aimed to highlight ecstasy as a rare cause of spontaneous pneumomediastinum and its potential life-threatening effects. A 16-year-old female with dyspnea and chest pain presented to the emergency department. Chest computed tomography demonstrated pneumomediastinum at the level of the thoracic inlet and upper and posterior mediastinum. The patient was admitted to the thoracic surgery department with a preliminary diagnosis of spontaneous pneumomediastinum. She refused to answer any questions during the first visit, an a psychiatric consultation was requested. The most important finding of psychiatric consultation was ecstasy abuse, which could not be identified in the emergency department evaluation. Four days later, the symptoms resolved completely and control chest X-rays showed no complications; therefore, the patient was discharged. While investigating the etiology of spontaneous mediastinum, particularly in a young, healthy patient, ecstasy abuse should always be considered. Because the fatal complications that may develop due to ecstasy ingestion may be overlooked.