Özkan Saydam

Accuracy of positron emission tomography in mediastinal node assessment in coal workers with lung cancer.

The purpose of this study was to explore the accuracy of 18F-fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography (PET/CT) in the assessment of mediastinal lymph node in coal workers who had non-small cell lung cancer. We retrospectively reviewed 42 retired coal workers who had lung cancer without distant metastasis, between May 2007 and May 2010. Regarding the mediastinal lymph nodes, when the standard uptake value was greater than 2.5, it was considered “malignancy positive.” After histological examination of the mediastinal lymph nodes, anthracotic and metastatic ones were detected. The results of PET/CT were analyzed to determine its accuracy. Of these 42 patients, PET/CT detected 47 positive mediastinal lymph nodes in 24 patients with a mean SUV maximum of 6.2 (2.6–13.8). One hundred and thirty-one mediastinal lymph node foci were dissected. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FDG-PET/CT in detecting nodal metastases were 84% (16/19), 65% (15/23), 66% (16/24), 83% (15/18), and 74% (31/42) on a per-patient basis, respectively. Mediastinal node staging with FDG-PET/CT in coal workers is insufficient due to the high false-positive rates due to the presence of pneumoconiosis. In these patients, an invasive technique such as mediastinoscopy seems mandatory for confirmation of ipsilateral or contralateral mediastinal lymph node metastasis.

Antioxidant vitamins C, E and coenzyme Q10 vs Dexamethasone: comparisons of their effects in pulmonary contusion model

BackgroundThe goal of our study is to evaluate the effects of antioxidant vitamins (vitamin C and E), Coenzyme Q10 (CoQ10) and dexamethasone (Dxm) in experimental rat models with pulmonary contusion (PC).MethodsRats were randomly divided into six groups. Except for the control, all subgroups had a moderate pulmonary contusion. Animals in the group I and group II received intraperitoneal saline, group III received 10mg.kg-1 CoQ10 group IV received 100mg.kg-1 vitamin C, group V received 150mg.kg-1 vitamin E, and group VI received 10mg.kg-1 Dxm. Blood gas analysis, serum nitric oxide (NO) and malondialdehyde (MDA) levels as well as superoxide dismutase (SOD) activity assays, bronchoalveolar lavage (BAL) fluid and histopathological examination were performed.ResultsAdministration of CoQ10 resulted in a significant increase in PaO2 values compared with the group I (p = 0.004). Levels of plasma MDA in group II were significantly higher than those in the group I (p = 0.01). Early administration of vitamin C, CoQ10, and Dxm significantly decreased the levels of MDA (p = 0.01). Lung contusion due to blunt trauma significantly decreased SOD activities in rat lung tissue compared with group I (p = 0.01). SOD levels were significantly elevated in animals treated with CoQ10, Vitamin E, or Dxm compared with group II (p = 0.01).ConclusionsIn our study, CoQ10, vitamin C, vitamin E and Dxm had a protective effect on the biochemical and histopathological outcome of PC after experimental blunt thorax trauma.

Effect of ghrelin on inflammatory response in lung contusion.

The purpose of this study was to investigate the effects of ghrelin on inflammatory response and tissue damage following trauma‐induced acute lung injury. Thirty male wistar albino rats (300–400 g) were randomly assigned into three groups: control group (n = 6), lung contusion plus saline (saline‐treated, n = 12), and lung contusion plus ghrelin (ghrelin‐treated, n = 12). Saline‐ or ghrelin‐treated traumatic rats were sacrificed at two time points (24 and 72 hours) after lung contusion. Blood was collected for the analysis of serum adenosine deaminase (ADA). Tissue transforming growth factor‐beta 1 (TGF‐β1) and matrix metalloproteinase‐2 (MMP‐2) levels were measured by enzyme‐linked immunosorbent assay and histopathological examination was performed on the lung tissue samples. Our results indicated that ghrelin significantly reduced morphologic damages. Serum ADA activities were significantly decreased after lung contusion and this decline started early with ghrelin treatment. TGF‐β1 and MMP‐2 levels in lung tissue were elevated at 72 hours after lung contusion and treatment with ghrelin significantly increased TGF‐β1 level and reduced MMP‐2 level. In conclusion, our study demonstrates that acute lung injury initiated proinflammatory responses and ghrelin administration showed an anti‐inflammatory effect in lung contusion.

Ratio of neutrophil to lymphocyte counts in Crimean Congo Hemorrhagic Fever

1 Kenan Ahmet Turkdogan1, Sevki Hakan Eren2, Abuzer Coskun2, Aynur Engın3, Ertan Sonmez1, Cemil Cıvelek1 1Bezmialem Vakif University, Department of Emergency, Istanbul, 2Department of Emergency, Cumhuriyet University,Sivas, 3Infectious Diseases and Clinical Microbiology, Cumhuriyet University, Sivas, Turkey NLR in CCHF Patients Ratio of neutrophil to lymphocyte Counts in Crimean Congo Hemorrhagic Fever

Experience with Vacuum-Assisted Closure in the Management of Postpneumonectomy Empyema: An Analysis of Eight Cases.

BACKGROUND The treatment of postpneumonectomic empyema is challenging. The aim of this study was to test the efficacy of vacuum-assisted closure (VAC) in the treatment of patients with open window thoracostomy (OWT). METHODS Between January 2010 and April 2014, eight patients developed empyema following pneumonectomy for malignant diseases in our department and then underwent an OWT with subsequent VAC therapy; their cases were retrospectively studied. Each session of VAC therapy lasted 72 hours, and therapy was completed after approximately 6 sessions. RESULTS  OWT in six patients resulted in either decreased size or complete closure after VAC treatment. Five patients had a bronchopleural fistula (BPF), which was closed either with a tracheal stent (three patients), primary suture, or omentoplasty. The BPF in one of these patients closed during VAC therapy. The treatment failed in two patients due to the microfistula becoming obvious in one and persistence of the fistula in the other. CONCLUSION  We believe that the use of VAC in the treatment of postpneumonectomy empyema is effective, except for patients with BPF.

Mediastinal Masses; the Analysis of 28 Cases in the Western Black Sea Region

DOI: 10.4328/JCAM.910 Received: 31.01.2012 Accepted: 29.02.2012 Printed: 01.03.2013 J Clin Anal Med 2013;4(2): 93-5 Corresponding Author: Mertol Gökçe, Karaelmas Üniversitesi Tıp Fakültesi; Göğüs Cerrahisi Anabilim Dalı. 67400 Zonguldak, Türkiye. T.: +905324070788 E-Mail: dr.mertol@gmail.com Özet Amaç: Mediastinal kitleler hayati organlara yakın olması ve çeşitli histopatolojik tipler içermesinden dolayı çok önemlidir. Bu çalışmanın amacı, cerrahi olarak tanı konulan ve rezeksiyon yapılan mediastinal kitleli olguları retrospektif olarak analiz etmektir. Gereç ve Yöntem: Mayıs 2008-Aralık 2011 tarihleri arasında, Batı Karadeniz bölgesinde ki üniversite hastaneleri göğüs cerrahisi kliniklerimizde mediastinal kitle nedeniyle operasyon uygulanan 28 hasta retrospektif olarak incelendi. Olgular yaş, cinsiyet, şikâyet, klinik ve radyolojik bulgular, cerrahi yaklaşım, histopatolojik tanı, postoperatif komplikasyon ve mortalite açısından incelendi. Olguların yaş aralığı 31-76 arasında (ortalama: 52,07) ve 19’u kadın, 9’u erkek toplam 28 hastadan oluşuyordu. Başvuru şikâyetleri öksürük, göğüs ağrısı, kas güçsüzlüğü ve dispne idi. Bir olguda vena kava süperior sendromu vardı. Olguların %21,4’ü asemptomatikti. Olguların %85,72’sine komplet rezeksiyon yapılırken, %14,28’ine ise yalnızca biyopsi yapılabildi. Postoperatif komplikasyon bir olguda görüldü ve mortalite izlenmedi. Sonuç: Cerrahi tedavi, mediastinal kitlelerin kesin tanı ve tedavisinde düşük mortalite ve morbidite oranı ile güvenilir bir yöntemdir.

Surgical approach to posterior mediastinal lesions and long-term outcomes

Background Posterior mediastinal lesions are classified as solid lesions and cysts. The treatment for both types is surgery. We evaluated the surgical outcomes and recurrence rates after video-assisted thoracic surgery and thoracotomy for posterior mediastinal lesions. Methods Data of 66 resections for posterior mediastinal masses between 2000 and 2014 were reviewed retrospectively. Twenty-two patients were treated by video-assisted thoracic surgery (group V) and 44 underwent thoracotomy (group T); 29 (43.9%) were female and 37 (56.1%) were male, the mean age was 45.9 ± 14.7 years. Results Bronchogenic cyst was the most common cystic lesion (10/12, 83.3%), and benign schwannoma was the most common solid lesion (32/54, 59.2%). The mean diameter of solid lesions was 5.19 ± 2.4 cm (group V 3.98 ± 1.8 vs. group T 5.78 ± 2.5 cm, p = 0.006). The tumor diameter was 4.06 ± 1.9 cm in asymptomatic patients and 6.93 ± 2.2 cm (p < 0.001) in symptomatic patients. In group V, hospital stay and duration of drainage were significantly shorter than in group T (p = 0.02, p = 0.01). Local recurrence was detected in 4 (6.1%) patients. Cystic lesions had a higher recurrence rate than solid lesions (p = 0.01). There was no significant difference in recurrence rates in groups V and T (p = 0.59). Conclusion Video-assisted thoracic surgery is a safe method for surgical treatment of posterior mediastinal lesions, with a shorter drainage time and postoperative hospitalization and similar recurrence rates. More recurrences are seen in patients with cystic lesions.

Which is the Best Minimal Invasive Approach for the Treatment of Spontaneous Pneumothorax? Uniport, Two, or Three Ports: A Prospective Randomized Trail

Objective Video‐assisted thoracoscopic surgery (VATS) has become the standard treatment method for primary spontaneous pneumothorax. Concerns about lesser pain and better cosmesis led to the evolution of uniportal access. This study prospectively compared the results of the uniportal, two‐port, and three‐port thoracoscopic surgery. Material and Methods One hundred and thirty‐five patients were randomized into three groups according to the port numbers. The groups were compared regarding the operation time, hospital stay, amount of drainage, area of pleurectomy, complications, recurrences, and pain scores. Results Except for the amount of drainage (p = 0.03), no factors were found to be statistically significant. The overall recurrence rate was 5%. Although the first and second week pain scores were not statistically significant, the single‐incision group patients had significantly less pain at 4, 24, and 72 hours (p < 0.05). Conclusion The study indicated that uniportal VATS approach is less painful and has better cosmetic results, besides it is as efficient as two‐ or three‐port VATS approach.

Is Right Sleeve Lower Lobectomy Necessary? Is It Safe?

OBJECTIVES  The right sleeve lower lobectomy is the least used of the bronchial sleeve operations. There are only case-based studies in the literature. In this study, we compared this technique to those used in patients who underwent a right lower bilobectomy. METHODS  We retrospectively reviewed the data of patients who had been operated on due to non-small cell lung cancer (NSCLC) from January 2005 to December 2015 from a dataset that was formed prospectively. Of the 4,166 patients who underwent resections due to NSCLC, the files of those who had a right sleeve lower lobectomy (group S) and those who had a right lower bilobectomy (group B) were evaluated. The remaining 25 patients in group B and 18 patients in group S were compared in terms of demographic data, morbidity, hospitalization time, mortality, histopathology, recurrence, and total survival. RESULTS  No significant differences in the demographic or clinical characteristics were observed between the two groups, except that group S had more female patients. Postoperative complications developed in 52% of the patients in group B and 11.1% of the patients in group S (p = 0.006). Mean hospitalization time was 9.6 ± 3.6 (range, 6-19) days in group B and 6.72 ± 1.5 (range, 4-9) days in group S (p = 0.001). All patients received complete resections. The mean patient follow-up time was 42.9 months. No significant difference was found between local and distant recurrences (p = 1, p = 0.432). Mean survival time was 89.6 months (5-year rate = 73%), which was 90.6 months (5-year rate = 75.3%) in group B and 63.1 months (5-year rate = 69.3%) in group S (p = 0.82). CONCLUSION  This technique allows for reduced filling of the thoracic cavity by a prolonged air leak and a reduced prevalence of complications. Additionally, the hospitalization time is shortened. It does not produce any additional mortality burden, and total survival and oncological outcomes are reliable. This technique can be used in selected patients at experienced centers.

Pulmonary sequestration: is it fraught to operate without the diagnosis?

Background: Pulmonary sequestration is defined as nonfunctional lung tissue without a normal tracheobronchial tree that is supplied by an aberrant systemic artery. The awareness of the preoperative diagnosis could be very crucial for the safety of the operation. Materials and Methods: We retrospectively reviewed the records of 16 patients who underwent resection for pulmonary sequestration between 2006-2016. Nine of 16 cases (56%) were female, and the mean age of the patients was 38.5 ± 9.9 years. Fiberoptic bronchoscopy and standard computed thorax tomography were performed for diagnostic work-up in all cases. The patients were divided into 2 groups based on the presence (Group A) or abscence (Group B) of the preoperative diagnosis. Results: The most common presenting symptoms were cough and expectoration. Preoperative diagnosis of the sequestration was obtained in only 5 patients (31%). Bronchiectasis was the most common cause of false diagnosis, followed by hydatid disease, malignancy, and aspergillosis. Left-sided and intrapulmonary locations were dominant with 12 (75%) and 13 (81%) cases, respectively. Lobectomy was the most common type of surgical resection (75%) and thoracic aorta was the source of aberrant artery in 87% of the patients. Patients in group A were younger. Though intralobar and extralobar types were equally distributed in both groups, all cases in group B had intralobar type. The mean operation time, blood loss, the amount of drainage, and the hospital stay were all insignificantly longer in group B patients. Five of the 6 morbidities occured in group B patients, but the difference was not statistically significant. No mortality occured. Conclusions: Surgical resection provides definitive management, and is usually reserved for the patients with symptoms. Facilities for a definitive diagnosis should be performed in every case, because, although insignificant, the rate of morbidity is higher in the patients without a definitive diagnosis. Further studies concerning of more patients are required to obtain more comprehensive results.