Onur Genç

Surgical management of bronchiectasis: analysis and short-term results in 238 patients.

OBJECTIVE Bronchiectasis is defined permanent dilatations of bronchi with destruction of the bronchial wall. It is still a major cause of morbidity and mortality in developing countries. The aim of this retrospective study is to present our surgical experiences, the early and long-term results of 238 patients with bronchiectasis during a 10-year period. METHODS We reviewed the medical records of 238 patients who underwent surgical resection for bronchiectasis between January 1992 and December 2001, at Gülhane Military Medical Academy (GMMA) Thoracic Surgery Department. Variables of age, sex, symptoms, etiology, and type of operation, mortality, morbidity and the result of surgical therapy were analyzed. RESULTS There were 205 (86.13%) male and 33 (13.87%) female patients with an average age of 23.7 and a range of 15-48 years. The presenting symptoms were productive cough in 133 (55.88%), fetid sputum in 116 (48.73%), recurrent infections in 84 (35.29%), and hemoptysis in 39 (12.18%) patients. The disease was bilateral in 31 patients (13.02%) and mainly confined to the lower lobes in 162 (68.06%). The surgical treatment was as follows: pneumonectomy in 13 patients (5.46%), lobectomy in 189 (79.40%), lobectomy+segmentectomy in 31 (13.02%), and wedge resection or segmentectomy in five (2.1%). Staged bilateral thoracotomy was used in 14 patients. There was no operative mortality. Complications occurred in 21 patients and the morbidity rate was 8.82%. Complete resection was achieved in 154 (64.7%) patients. Follow-up data were obtained for 229 (96.21%) of the patients. Nine patients were lost to follow-up. The mean follow-up of these patients was 9 months (range, 3 months to 4 years). The symptoms disappeared in 189 patients (79.41%) and 29 patients (12.18%) had improved, whereas 11 patients (4.62%) had no improvement. Significantly better results were obtained in patients who had undergone a complete resection. CONCLUSIONS Surgical resection for bronchiectasis can be performed with acceptable morbidity and mortality at any age. The involved bronchiectatic sites should be resected completely for the optimum control of symptoms.

The use of absorbable material in correction of pectus deformities

Various techniques have been described for correction of the congenital anterior chest wall deformities. We described a new technique in which 33 patients were used in correction of those deformities. In this new technique we used the resorbable copolymer plaque and polymer screw for the fixation of the sternum. We have obtained excellent results in one-year follow up period. This technique was developed to avoid a second operation, which usually requires for removal of the metal support. Resorption of copolymer plaques and polymer screws are completed at the end of the first year.

Protective efficiacy of taurine against pulmonary edema progression: experimental study.

Re-expansion pulmonary edema (RPE) is an acute, rare and potentially lethal complication [1,2]. Its beginning is sudden and dramatic. The mechanism is not yet fully understood [1]. Some authors suggest that it may occur after rapid re-inflation of a collapsed lung [1]. It was reported by other authors that it may relate to surfactant depletion or may result from hypoxic capillary damage, leading to increased capillary permeability [1,3]. In RPE, unilateral lung injury is initiated by cytotoxic oxygen metabolites and temporally associated with an influx of polymorphonuclear neutrophils [1]. These toxic oxygen products are the results of re-oxygenation of a collapsed lung. Treatment of re-expansion pulmonary edema is basically preventive [4].

Repair of pectus deformities: experience and outcome in 317 cases.

BACKGROUND The most common congenital chest wall deformities are pectus excavatum and pectus carinatum. Various techniques have been described for correction of pectus deformities. We describe our experience with surgical repair of pectus deformity (PD) in adults, including our new technique, which uses a resorbable plaque for fixation of the sternum. METHODS We reviewed the records of 317 patients who underwent surgical correction of PD between October 1997 and December 2005. RESULTS All of the patients were male and the median age was 21.3 years (range, 16–32 years). Of 317 patients, the type of deformity was a pectus excavatum in 230 patients and a pectus carinatum in 87 of the patients. Four different operative techniques were used. There were no intraoperative deaths or major perioperative morbidity. The complications rate was 17%. Overall mean hospital stay was 14.25 days. In 208 patients who underwent a mid-term outpatient follow up (mean, 8 months), there was no recurrence. Patient satisfaction was excellent in 234 patients, good in 79 patients and fair in 4 patients. CONCLUSION The majority of patients with pectus deformity had been operated on during childhood; therefore there is limited published information about the correction of pectus excavatum and pectus carinatum deformities in adults. The most important point in pectus correction is to achieve proper and long-term stability of the sternum following osteotomy. Various techniques can be used for this purpose.

The role of oxidative stress and effect of alpha-lipoic acid in reexpansion pulmonary edema - an experimental study.

Introduction We investigated the role of oxidative stress in the pathogenesis of reexpansion pulmonary edema (RPE) and effect of alpha-lipoic acid (ALA) in the prevention of RPE. Material and methods There were 4 groups consisting of 10 rats in each group; control group (CG), α-lipoic acid group (ALAG), reexpansion pulmonary edema group (RPEG), reexpansion pulmonary edema plus α-lipoic acid group (RPE + ALAG). In all the groups, all rats were sacrificed 2 hours after the reexpansion of lungs. To indicate oxidative stress malondialdehyde (MDA), and to indicate antioxidant status superoxide dismutase (SOD), catalase (CAT) and glutathione peroxides (GPx) were measured in the lungs of rats. Results Mean MDA value was lower in CG (7.02 ±0.14) and in ALAG (6.95 ±0.11) than the other groups (p = 0.001). It was highest in RPEG (8.89 ±0.21) (p = 0.001). It was lower in RPE + ALA G (7.21 ±0.32) than RPEG (p = 0.001). Antioxidant levels: GPx (37.21 ±3.01), CAT (2.87 ±0.14) and SOD (100.12 ±12.39) were lowest in RPEG among all groups (p = 0.001). These values were GPx (45.21 ±3.54), CAT (3.24 ±0.21) and SOD (172.36 ±15.48) in RPE + ALA G and were greater than those of RPEG (p = 0.001). While normal pulmonary parenchyma was seen in 2 rats in RPE + ALAG, it was not seen in RPEG. Pulmonary edema was seen in 1 rat in RPE + ALAG; however, it was seen in 3 in RPEG. Conclusions Oxidative stress might have an important role in the pathogenesis of RPE. In addition, ALA treatment might contribute in preventing RPE.

Pulmonary Sequestration and Surgical Treatment

Pulmonary sequestration is nonfunctioning, abnormal pulmonary tissue existing inside or outside the visceral pleura. It is not connected to the tracheobronchial tree. In this study, the results of 8 patients, who were diagnosed with pulmonary sequestration and treated during hospitalization in Gülhane Military Medical Academy between 1996 and 2003, were reported. Sex, age, symptoms, diagnostic approach, operative findings, procedures and postoperative outcomes were reviewed. No postoperative complications were seen. In the long-term follow-up all patients were seen to be asymptomatic. We believe surgical resection is mandatory in order to avoid infection and destruction of the normal pulmonary parenchyma even in asymptomatic cases. Furthermore, when infection occurs, major resection such as lobectomy may be necessary rather than segmentectomy or wedge resection, which involves removal of minimal pulmonary parenchyma.

Adenocarcinoma arising in a retained esophageal remnant

Fistulation between the trachea and an infected mucocele arising from an excluded retained esophageal segment is an interesting and unusual complication of esophageal bypass surgery. We present such a case in which there was also malignant transformation in the cyst wall, manifested by invasive adenocarcinoma and widespread high-grade glandular dysplasia.

Surgical Management of Chest Wall Tuberculosis

Objective: Tuberculosis remains one of the most fatal diseases in the world. Extrapulmonary tuberculosis increases in parallel fashion with the rise of incidence of pulmonary tuberculosis. Tuberculosis of the chest wall is rare. Methods: Our study retrospectively evaluated 10 patients with tuberculosis of the chest wall who were treated with surgery in addition to antituberculous chemotherapy in the last 8 years. Seven of the lesions were located on the anterior chest wall, and three of the lesions were on the lateral chest wall. Results: Surgical therapy consisted of evacuation of the cold abscess material from the cavities and wide débridement of the soft tissue planes in all patients. Partial rib resections were performed in six patients owing to costal or chondral involvement. Conclusions: Chest wall tuberculosis must be considered in the differential diagnosis of chest wall lesions, especially in endemic areas.

Unusually located thoracic hydatid cysts.

Human hydatid disease caused by the larval form of Echinococcus granulosus has a worldwide distribution and is endemic in many countries. The disease, known since the time of Hippocrates, is primarily an illness of residents in rural areas who frequently come into contact with sheep, cows and carnivores.1-4 The estimated surgical case rate of cystic echinococcus is 0.87-6.6 per 100 000 in Turkey.2 The prevalence of Echinococcus granulosus infestation in dogs in Turkey is between 0.32% and 40% and the reported prevalence of cystic echinococcus in domestic animals has ranged from 11.3 to 50.7% and varies widely by geography.5,6 Echinococcal cysts may develop in almost any part of the body. The liver and the lungs are the most commonly affected areas in adults. Within the thorax most of the cysts settle in the lung parenchyma. In this situation surgical treatment is usually easy and quick. Sometimes the cyst grows as an extrapulmonary lesion or passes over the lung parenchyma to other structures. Location of the disease outside the lung parenchyma in the thorax is rare and surgical procedures can be considered that may differ from those used for pulmonary cysts.7 The aim of this study was to review surgical techniques and possible perioperative complications. We present our experience, documenting the clinical features and the treatment employed for unusually located thoracic hydatid cysts.

Chest Wall Tumors

We reviewed 94 consecutive patients who underwent resection of soft tissue or bone tumors of the chest wall between September 1989 and December 1996. There were 3 females and 91 males ranging in age from 12 to 69 years (median, 22.85 years); 16 had a primary malignant tumor, 11 had a metastatic tumor, and 67 had a benign tumor. Sixty-four patients underwent resection of the chest wall skeleton. Overlying soft tissue was resected en bloc in 15 patients. Chest wall defects were not reconstructed with prosthetic material or autogenous grafts because the defects were not large. Soft tissue reconstructive procedures were predominantly muscle transposition. There were no early postoperative complications and the median hospitalization was 14.2 days (range, 6 to 47 days). Follow-up was complete in all patients and ranged from 2 to 36 months (median, 24.5 months). All patients with benign tumors are currently alive. Recurrent chest wall tumors developed in 5 patients and they underwent a second operation. Nine patients died from distant metastases. There were no early or late deaths related to either resection or reconstruction of the chest wall. We conclude that wide or adequate chest wall resection, depending on histopathologic type of tumor, is the key to successful management of chest wall tumors. In general, this procedure can be performed in one operation with a short hospital stay and low operative mortality.