Serdar Sen

Topical Heparin: A Promising Agent for the Prevention of Tracheal Stenosis in Airway Surgery

BACKGROUND The protective effects of topical mitomycin-C (MMC) have been well documented for tracheal stenosis; however, to the best of our knowledge, the use of heparin as an anti-inflammatory agent to support wound healing in upper airway surgery was not studied before. The aim of this study was to investigate the efficacy of topical heparin for healing of tracheal re-implants in a rabbits model and its resultant histological changes compared with that of MMC. METHODS In a rabbit model (n = 21), an elliptically shaped portion of the anterior tracheal wall was excised (3-4 tracheal cartilages) under anesthesia and immersed in an isotonic saline solution containing 0.4 mg/mL (0.04%) MMC (n = 7), heparin (liquemine) 5000 U/mL (n = 7), or none (n = 7) for 2 min and then re-implanted. The follow-up period was 2 wk for all animals and then both the larynx and the trachea were excised for histological evaluation. Hematoxylin-eosin (H and E) staining was applied to the excised tissues for microscopic evaluation. RESULTS Compared with controls, the granulation tissue formation score in MMC group (P = 0.03), and epithelial regeneration and inflammation scores in heparin group (P = 0.032 and P = 0.022, respectively) were more favorable. The fibrosis index and tracheal lumen ratio values were also more favorable in both MMC (P = 0.019 and P = 0.0028, respectively) and heparin (P = 0.023 and P = 0.0021, respectively) groups compared with controls on the 15th d. CONCLUSIONS Topical heparin application may have favorable effects on healing of tracheal autografts in a rabbit model. We suggest that heparin therapy should be further researched for the prevention of tracheal stenosis in airway surgery.

PEComa (Clear Cell “Sugar” Tumor) of the Lung: A Benign Tumor That Presented With Trombocytosis

Perivascular epithelioid cell tumors of the lung are rare, benign neoplasms, usually presenting as a solitary pulmonary nodule on chest roentgenograms. Most lesions are solitary and asymptomatic, and are located within the peripheral lung. This is a case report of a 44-year-old woman who presented with thrombocytosis and solitary pulmonary nodule of the lung, which was removed by a thoracotomy.

Primary neuroendocrine carcinoma of the mediastinum

A mediastinal mass was found in a 37 year old male who presented with fever, weight loss and fatigue. The chest CT revealed a 9×6×4 cm well circumscribed mass located paratracheally in the upper mid-mediastinum. The mass was removed by right thoracotomy. Macroscopically the tumor weighed 195 g and measured 9×6×4 cm. Microscopically the tumor consisted of small blue cells in solid and trabeculer patern. Immunohistochemical studies performed for differential diagnosis of small blue cell tumors. The tumor was diagnosed as primary neuroendocrine carcinoma of the mediastinum. This case is presented for its rare recurrence in that particular location.

Comparison of mitomycin-c and heparin affects in experimental corrosive esophagitis on rats

OBJECTIVE We comparative effects of mitomycin-c and heparin which have different mechanism of action in a minimal invasive corrosive esophagitis model which was formed by NaOH 40%. METHOD The study was performed on forty female Wistar albino rats; were divided into four equal groups each including ten animals. Group C (n=10); control, the group that esophagus was washed with normal saline, group I (n=10); injury group; alkali esophagus burn, not treated, group M (n=10); alkali esophagus burn, mitomycin-c treatment group, group H (n=10); alkali esophagus burn, heparin treatment group. The study was performed on a minimal invasive model which did not require general anesthesia and abdominal operation. In 28 day, all subjects were killed and their esophaguss were removed by thoraco-abdominal cut. Total esophagi from oropharynx to stomach were removed and they were examined macroscopically and microscopically and evaluated for esophageal tissue collagen deposition and histopathologic damage score. RESULTS When group C is compared with each of the other groups, statistically significant weight losses were detected; [(p<0.005, p<0.05, p<0.005), respectively]. Significant inflammation increase was detected in groups I, M and H in comparison to group C [(p<0.001, p<0, 0001, p<0.005)]. When granulation scores of groups were compared; statistically significant granulation increases were detected in groups I, M, and H [(p<0.05, p<0.05, p<0.05) compared to group C]. Significant collagen increase was detected in all 3 layers in groups; I, M and H according to group C [(p<0.05, p<0.05, p<0.05)]. Collagen increase in every 3 layers in groups M and H were significantly less according to group I [(p<0.05, p<0.05, p<0.05)]. Collagen increase in every 3 layers was less in group M than group H (p<0.05). CONCLUSION In corrosive esophagitis due to NaOH, heparin treatment is more effective in inflammation and granulation formation, mitomycin-c treatment is more effective in preventing the collagen accumulation step. Heparin decreases the tissue damage by preventing the inflammation and granulation formation; and prevents collagen accumulation and stricture development. As completing the effect of heparin; mitomycin prevents fibroblastic activity inhibition with direct collagen accumulation and stricture development strongly.

Pulmonary lymphomatoid granulomatosis evolving to large cell lymphoma in the skin.

Lymphomatoid granulomatosis is an angiodestructive, angioinvasive lymphoproliferative disorder. It involves most frequently lungs, central nervous system and skin. Recent studies indicate that lymphomatoid granulomatosis is an Epstein-Barr virus associated B cell disorder with a background of reactive T lymphocytes. In a 49 year old woman presenting with fever, malaise and pulmonary masses the diagnosis of lymphomatoid granulomatosis was established histologically by open lung biopsy. Following the initial diagnosis the patient was found to have gastric and skin involvement. The skin lesion was diagnosed as diffuse large B-cell lymphoma.

Transthoracic echocardiographic documentation of disappearance of massive pulmonary artery thromboemboli after fibrinolytic therapy.

In this paper, we report two cases of acute massive pulmonary thromboemboli with pulmonary artery thrombus, in which disappearance of thrombus followed fibrinolytic therapy were documented at transthoracic echocardiographic follow-up. Data from these limited experiences suggest that, transthoracic echocardiography might be useful as a first diagnostic screening in cases of suspect pulmonary thromboembolism and thrombolytic therapy might be considered in patients with pulmonary artery thrombus with pulmonary embolism.

Mortalidade e fatores associados em uma UTI de cirurgia torácica

OBJECTIVE To assess mortality and identify mortality risk factors in patients admitted to a thoracic surgery ICU. METHODS We retrospectively evaluated 141 patients admitted to the thoracic surgery ICU of the Denizli State Hospital, located in the city of Denizli, Turkey, between January of 2006 and August of 2008. We collected data regarding gender, age, reason for admission, invasive interventions and operations, invasive mechanical ventilation, infections, and length of ICU stay. RESULTS Of the 141 patients, 103 (73.0%) were male, and 38 (23.0%) were female. The mean age was 52.1 years (range, 12-92 years), and the mortality rate was 16.3%. The most common reason for admission was trauma. Mortality was found to correlate with advanced age (p < 0.05), requiring invasive mechanical ventilation (OR = 42.375; p < 0.05), prolonged ICU stay (p < 0.05), and specific reasons for admission-trauma, gunshot wound, stab wound, and malignancy (p < 0.05 for all). CONCLUSIONS Among patients in a thoracic surgery ICU, the rates of morbidity and mortality are high. Increased awareness of mortality risk factors can improve the effectiveness of treatment, which should reduce the rates of morbidity and mortality, thereby providing time savings and minimizing costs.

Infecções relacionadas a cateteres torácicos

OBJECTIVE To determine the incidence of local and systemic infection in a sample of patients catheterized with thoracic catheters (TCs) and to identify the prognostic factors for catheter-related infection. METHODS A retrospective study involving 48 patients (17 females and 31 males) catheterized with TCs between December of 2008 and March of 2009 in the Thoracic Surgery Department of the Adnan Menderes University Hospital, located in Aydin, Turkey. Blood samples for culture were collected from the distal end of each TC and from each of the 48 patients. We looked for correlations between positive culture and possible prognostic factors for catheter-related infection. RESULTS Culture results were positive in TC samples only for 3 patients, in blood samples only for 2, and in both types of samples for another 2. Advanced age correlated significantly with positive culture in TC samples and in blood samples (r = 0.512 and r = 0.312, respectively; p < 0.05 for both), as did prolonged catheterization (r = 0.347 and r = 0.372, respectively; p < 0.05). There was a significant correlation between having undergone surgery and positive culture in TC samples only (p < 0.05). However, having an inoperable malignancy correlated with bacterial growth in blood and in TC samples alike (p < 0.05 for both). CONCLUSIONS Risk factors, such as advanced age, prolonged catheterization, comorbidities, and inoperable malignancy, increase the risk of catheter-related infection. It is imperative that prophylaxis with broad-spectrum antibiotics be administered to patients who present with these risk factors and might be catheterized with a TC.

A rare association; pulmonary blastoma developing on extrapulmonary sequestration basis

Pulmonary blastoma (PB) is a thoracopulmonary mesenchymal disembryogenic neoplasm which is rarely seen and generally in childhood. Pulmonary sequestration is one of the less observed congenital malformations. A 45-year-old female patient who was diagnosed with PB, histopathologically developed on atypically placed extrapulmonary sequestration in the left upper zone is presented in this study.

The Efficacy of Tramadol Combined with A Donor of NO, Glyceryl Trinitrate (GTN) Mixture on Cytokines, NF-KB Expression and Oxidative Stress Marker in the Rat Model of Formalin Induced Inflammation

In addition to well-known analgesic action of tramadol, its potential antinflammatory effects have not been thoroughly evaluated. On the other hand, effectiveness of antioxidants is also reported against inflammation. It is known that glyceryl trinitrate, as a Research Article British Journal of Medicine & Medical Research, 3(4): 1988-1998, 2013 1989 nitric oxide donor, enhance the antioxidative and anti-inflammatory effects. In the present study, the efficacy of the tramadol mixtue with glyceryl trinitrate on cytokines, NF-kappa B expression and oxidative stress marker was examined on the formalin-induced inflammation in rats (Tramadol 5, 10 and 30 mg/kg + nitroglycerine 1 mg/kg). Cytokines (TNF-, IL-6 and IL-10) and oxidative/anti-oxidative stress markers (MDA, GSH) were measured in blood samples. NF-kappa B expression was assessed immunohistochemically in spleen and thymus. The results show that tramadol 30 mg/kg has both anti-inflammatory and anti-oxidative effects. Additionally, it was evidenced that glyceryl trinitrate improves the antiinflammatory and anti-oxidative effects of Tramadol (30 mg/kg) on the formalin-induced inflammation in rats. In this framework, the present study provides a unique approach for the analysis of the efficacy of tramadol and additive effects of glyceryl trinitrate on the acute inflammations in rats.