Ozgur Samancilar

Traumatic diaphragmatic rupture: look to see

OBJECTIVE Traumatic diaphragmatic rupture (TDR) is a rare but potentially life threatening clinical entity with a high incidence of associated injuries. In this article, our experience with this challenging diagnosis is presented. METHODS In this study, a total of 68 patients with TDR, were operated in our center between July 1994 and September 2005. Study group was analyzed retrospectively. The etiological factors, management and outcomes were discussed. RESULTS The mean age was 32.9 years with a female to male ratio of 9/59. TDR was right-sided in 16.2% (n=11) and left-sided in 83.8% (n=57). The cause of the rupture was penetrating trauma in 51 (75%), and blunt trauma in 17 (25%). Only three patients (4.4%) had late diagnosis. Associated injuries were seen in 91% (n=62) of the patients. The most common used incision was a laparotomy incision (89.6%). Morbidity and mortality were encountered in 13.1% (n=9) and 16.2% (n=11) patients, respectively. CONCLUSIONS Although rare, diaphragmatic rupture must be suspected in any patient with thoracoabdominal injury. Early diagnosis of TDR is sometimes difficult and depends on a high index of suspicion. Surgical repair is necessary even for small tears. The most common approach is the transabdominal approach, which allows a complete exploration of the abdominal organs for associated injuries. The transthoracic approach might be used in most cases with latent diaphragmatic rupture.

Reducing cardiac injury during minimally invasive repair of pectus excavatum

Minimally invasive repair of pectus excavatum (MIRPE) provides a minimal access approach to correct pectus excavatum deformities. Cardiovascular complications represent a rare but catastrophic complication of this cosmetic operation. We describe a modification to the technique following a case of cardiac puncture.

Ligasure Vessel Sealing System versus Harmonic Scalpel for Sutureless Nonanatomical Pulmonary Resections in a Rabbit Model

Background: The safety and efficacy of the ligasure vessel sealing system (LVSS) and harmonic scalpel (HS) in sutureless nonanatomical lung resections were evaluated. Methods: On twenty adult rabbit lungs, 1 × 1 cm wedge resections were performed under one-lung ventilation with both LVSS and HS. The air tightness and tissue damage caused by these different techniques were measured and compared. Results: No statistically significant differences were found when the air tightness for both devices was compared after resection (p = 0.37). Tissue damage was obtained for LVSS, and the difference was statistically significant (p < 0.001). Discussion: LVSS and HS can both be used for peripheral lung resections without any need of further intervention for securing the air tightness. LVSS was found safer by means of tissue damage when compared with HS in this experimental study.

The Effect of Blood Vessel Invasion on Prognosis of Operated Stage I Non-small Cell Lung Cancer Patients

OBJECTIVE A retrospective study was conducted to identify the effect of blood vessel invasion on prognosis in surgically treated stage I non-small cell lung cancer patients. METHODS A total of 71 consecutive patients who had undergone complete resection for stage I primary non-small cell lung cancer (NSCLC) between 1998 and 2007 were evaluated. All pathological specimens were examined for evidence of blood vessel invasion. The follow-up period was 5-118 months. Survival data were analyzed for all patients using the Kaplan-Meier test. RESULTS There were 63 men and 8 women (mean age 59.2, age range 35-86). The most common tumor types were adenocarcinoma (35 patients, 49 %) and squamous cell carcinoma (26 patients, 37 %). Twenty-five patients (35 %) had stage IA disease, and 46 had (65 %) stage IB disease. In 13 cases (18 %) blood vessel invasion was demonstrated, whereas in the remaining 58 cases there was no evidence of vascular invasion. Minimum and maximum follow-up periods were 5 and 118 months respectively, with a mean of 41.76 +/- 27 months (median 33.5 months). Overall disease-free survival was 79.6 +/- 6.4 months: 38.3 +/- 12.0 months for the group with blood vessel invasion and 87.5 +/- 6.7 months for the remaining group. The difference between the two groups was statistically significant ( P < 0.003). Overall survival rate was 86.7 +/- 6.7 months: 44.5 +/- 11.3 months for blood vessel invasion group and 98.2 +/- 6.2 months for the remaining group. The difference between the two groups was statistically significant ( P < 0.001). CONCLUSION Vascular invasion can be an important factor for predicting unfavorable prognosis in stage I NSCLC patients.

Alveolar adenoma: an unusual lung tumor

A 34-year-old woman presented with chest pain and a solitary pulmonary nodule on chest roentgenogram. She was diagnosed with a rare benign lung tumor, alveolar adenoma of the lung, through pathological examination of the surgical specimen resected from the left upper lobe. Clinicians should also keep this entity in mind when making the differential diagnosis of a solitary pulmonary nodule.

REZEKSİYON UYGULANMIŞ BÜYÜK BOYUTLU PRİMER MEDİASTİNAL KİTLELİ YEDİ OLGUNUN ANALİZİ

Surgical resection which is usually adequate in the treatment of most cases with primary mediastinal masses, should also be considered primarily in the patients with huge mediastinal masses that compress the vascular structures, major airways and that threat their lives. Between 1997-2004, among 35 cases of surgically resected primary mediastinal masses and cysts, seven patients with a tumor size of 12-25 cm are evaluated retrospectively. Tumors are localized in the anterior and the middle mediastinum and causing symptoms for 2-12 months. In addition to the excision of the primary tumor, four of the cases had underwent pericardial, three had pulmonary and two had partial vena cava superior resection. Histopathological types consisted of malignant thymoma, thymic carcinoma, thymic teratoma, non-Hodgkin lymphoma, immature teratoma, indifferent malignant epithelial tumor and lipoma. Surgical resection should be considered promptly for relieving the symptoms and verifying exact histopathological diagnosis for the patients who had severe cardiac and respiratory symptoms due to huge mediastinal masses, with acceptable morbidity and no mortality.