Serdar Han

THE ASSOCIATION OF OGG1 Ser326Cys POLYMORPHISM AND URINARY 8-OHdG LEVELS WITH LUNG CANCER SUSCEPTIBILITY: A HOSPITAL- BASED CASE-CONTROL STUDY IN TURKEY

The Association of OGG1 Ser326Cys Polymorphism and Urinary 8-OHdG Levels With Lung Cancer Susceptibility: A Hospital-Based Case-Control Study in Turkey High incidence and poor prognosis of lung cancer make it a major health problem worldwide. Although smoking is a major cause of lung cancer, only some smokers develop lung cancer, which suggests that there is a genetic predisposition in some individuals. 8-OHG is an important oxidative base lesion and may elevate due to cancer and smoking. It is repaired by 8-hydroxyguanine DNA glycosylase 1 (OGG1), which has several polymorphisms. Although the Ser326Cys polymorphism is consistently associated with a range of cancers, findings about this polymorphism and lung cancer risk are contradictory. To date, no study has examined this association in the Turkish population. We conducted a case-control study to investigate the association between OGG1 Ser326Cys polymorphism and the risk of lung cancer using PCR-RFLP. We also evaluated gene-smoking interaction and excretion of urinary 8-OHdG. Our results suggest that the OGG1 Ser326Cys polymorphism is not a genetic risk factor for lung cancer, and that the heterozygous genotype is associated with a significantly reduced risk for lung cancer. The levels of 8-OHdG did not correlate with the polymorphism and smoking. Larger association studies are needed to validate our findings, and mechanistic studies are needed to elucidate the underlying molecular mechanisms of this association. Povezanost OGG1 Ser326Cys polimorfizma i razina 8-OHdG u mokraći sa sklonosti obolijevanju od karcinoma pluća: rezultati ispitivanja na bolesnicima i kontrolnoj populaciji u Turskoj Karcinom pluća velik je javnozdravstveni problem u čitavom svijetu zbog svoje visoke učestalosti i loše prognoze. Premda je navika pušenja jedan od glavnih uzročnika karcinoma pluća, od ove bolesti oboli samo dio populacije pušača, što govori u prilog postojanju genetske predispozicije za njezin nastanak. 8-OHG je oksidativno oštećenje baze u molekuli DNA čija se učestalost može povećati zbog zloćudnih tumora i pušenja. U popravku tog oštećenja sudjeluje enzim 8-hidroksigvanin DNA-glikozilaza (OGG1) za koji je dokazano postojanje polimorfizma. Iako se polimorfizam Ser326Cys često dovodi u vezu s različitim vrstama zloćudnih bolesti, dosadašnji su rezultati o vezi između polimorfizma tog enzima i rizika od pojave karcinoma pluća kontradiktorni. Do danas na turskoj populaciji nisu provedena istraživanja koja bi dala jasne odgovore o toj povezanosti. Ovo je istraživanje usporedo provedeno u bolesnika i u zdravoj populaciji primjenom metode PCR-RFLP s ciljem utvrđivanja moguće povezanosti polimorfizma OGG1 Ser326Cys i rizika od karcinoma pluća. Nadalje, istražena je interakcija gena i navike pušenja te ekskrecija 8-OHdG u mokraći. Dobiveni rezultati pokazuju da polimorfizam OGG1 Ser326Cys nije genetski čimbenik rizika od pojave karcinoma pluća, a pokazalo se da je heterozigotni genotip povezan sa značajno nižim rizikom od karcinoma pluća. Razine 8-OHdG izmjerene u mokraći nisu bile u korelaciji ni s polimorfizmom ni s navikom pušenja. Zaključujemo da su za vrednovanje dobivenih rezultata potrebna istraživanja na još većem broju ispitanika te mehanistička istraživanja koja bi mogla razjasniti molekularne mehanizme koji su u pozadini ove povezanosti.

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.

An Unexpected Complication of Titanium Rib Clips

Surgical stabilization of the rib fractures has been successfully performed for the management of pain in multiple rib fractures, fixation of chronically painful nonunion, reduction of overriding ribs, and flail chest cases. Herein we report a patient who was treated with titanium rib clips after a motor vehicle accident leading to pulmonary parenchymal laceration and multiple painful rib fractures. Three of the rib clips were broken 4 months after the operation. The patient underwent the second operation for restabilization of the broken ribs. We review the relevant literature, with particular emphasis on the management of this complication.

Thymoma type B1 arising in a giant supradiaphragmatic thymolipoma.

Thymolipomas are uncommon tumors of the anterior mediastinum. They may extend into, but rarely stem from, the chest cavity. Furthermore, thymoma arising in a thymolipoma is extremely rare. We report a unique case of thymoma type B1 that originated form a giant thymolipoma located in the chest cavity, which was resected by a lateral thoracotomy in a 23-year-old woman. To our knowledge, this is the first reported case of thymoma type B1 arising within a giant thymolipoma.

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.

The importance of costoclavicular space on possible compression of the subclavian artery in the thoracic outlet region: a radio-anatomical study

OBJECTIVES The purposes of this study were to identify possible compression points along the transit route of the subclavian artery and to provide a detailed anatomical analysis of areas that are involved in the surgical management of the thoracic outlet syndrome (TOS). The results of the current study are based on measurements from cadavers, computed tomography (CT) scans and dry adult first ribs. METHODS The width and length of the interscalene space and the width of the costoclavicular passage were measured on 18 cervical dissections in 9 cadavers, on 50 dry first ribs and on CT angiography sections from 15 patients whose conditions were not related to TOS. RESULTS The average width and length of the interscalene space in cadavers were 15.28 ± 1.94 mm and 15.98 ± 2.13 mm, respectively. The widths of the costoclavicular passage (12.42 ± 1.43 mm) were significantly narrower than the widths and lengths of the interscalene space in cadavers (P < 0.05). The average width and length of the interscalene space (groove for the subclavian artery) in 50 dry ribs were 15.53 ± 2.12 mm and 16.12 ± 1.95 mm, respectively. In CT images, the widths of the costoclavicular passage were also significantly narrower than those of the interscalene space (P < 0.05). The measurements from cadavers, dry first ribs and CT images were not significantly different (P > 0.05). CONCLUSIONS Our results showed that the costoclavicular width was the narrowest space along the passage route of the subclavian artery. When considering the surgical decompression of the subclavian artery for TOS, this narrowest area should always be kept in mind. Since measurements from CT images and cadavers were significantly similar, CT measurements may be used to evaluate the thoracic outlet region in patients with TOS.

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.

Use of previously divided latissimus dorsi muscle for bronchopleural fistula.

Management of postpneumonectomy bronchopleural fistula remains a major challenge for thoracic surgeons. Successful closure of a postpneumonectomy bronchopleural fistula was performed in a 60-year-old man, using a flap made by a combination of serratus anterior and latissimus dorsi muscle which had been divided during the pneumonectomy operation. The flap was prepared on the presence of a dependable collateral serratus anterior branch to the lateral thoracic artery, which provides retrograde flow to the latissimus dorsi muscle.

Endobronchial intubation in thoracic surgery: Which side should be preferred?

Aim This study was undertaken to compare the clinical performance of right versus left double-lumen endotracheal tubes placed without using fiberoptic bronchoscopy in thoracic surgery operations. Methods This was a retrospective review of patients who were operated on in our institution between January 2013 and February 2014. We analyzed clinical performance in terms of hypoxia, hypercapnia, and adequate deflation of the lungs with both left- and right-sided double-lumen endotracheal tubes. Results There were 80 patients with a mean age of 53.74 ± 15.59 years. Right-sided double-lumen tubes were used in 33 patients, and left-sided double-lumen tubes were used in 47. Perioperative hypoxi (p < 0.05), hypercapnia (p < 0.01), and inadequate deflation of the lung (p < 0.001) were found more frequently with the use of right-sided double-lumen endotracheal tubes. Arterial blood gas analyses in the post-anesthesia care unit showed that high pCO2 (>45 mm Hg), low pH (<7.36), and high lactate levels (>4 mmol L−1) were more frequent with right-sided double-lumen endotracheal tubes (p < 0.001). The incidence of atelectasis was greater (p < 0.001) and the duration of hospital stay was longer (p = 0.02) with the use of right-sided double-lumen endotracheal tubes. Conclusion Right-sided double-lumen endotracheal tubes resulted in poorer clinical performance. Therefore, a left-sided double-lumen endotracheal tube should be preferred in thoracic surgery operations when an appropriate size of fiberoptic bronchoscope is not available.

Surgical correction of a fistula between left pulmonary artery and innominate vein.

A 48-year-old woman with chronic dyspnea complaints was referred to the thoracic surgery clinic for a surgical lung biopsy to make a definitive diagnosis of interstitial lung disease. Thoracic computed tomography imaging revealed a vascular structure located anterior to the aorta, between the left innominate vein and the pulmonary artery. Magnetic resonance angiography showed the abnormal vessel connection in detail. Pulmonary perfusion scintigraphy showed decreased perfusion of the left upper lobe and the superior lingular segment. A fistulectomy was performed through a mini thoracotomy. The patient no longer had any dyspnea symptoms after the operation.