Tevfik Ilker Akcam

[A life-saving approach after thoracic trauma: emergency room thoracotomy].

BACKGROUND In this article, the outcomes, indications and methods of emergency department service resuscitative thoracotomy in cardiac and/or respiratory arrest patients after thoracic trauma are discussed. METHODS Between January 2004 and December 2010, nine resuscitative thoracotomies were performed after thoracic trauma in the emergency department of our hospital. The records of the patients were evaluated retrospectively. RESULTS A total of nine patients underwent resuscitative thoracotomy: five stab wounds, two traffic accidents, one fall from height, and one gunshot wound. Anterolateral thoracotomy in supine position was performed in all. Three patients had lung parenchymal laceration, three patients had cardiac laceration, two patients had intercostal vessel injury, and one patient had descending aorta injury. None of the four patients with blunt trauma recovered. Three of five patients with penetrating trauma were discharged after an average of eight days of follow-up, whereas two of them were lost perioperatively. CONCLUSION Emergency room thoracotomy can be performed in thoracic trauma cases who are in shock and have unresponsive hypotension despite large volume fluid and blood replacement and no time for transportation to the operating room. The results are better in penetrating trauma patients than in blunt trauma.

Bilateral Familial Elastofibroma Dorsi: Is Genetic Abnormality Essential?

Elastofibroma dorsi is a rare, slowly growing, benign soft tissue tumor located in the periscapular region on the chest wall. Although it is generally unilateral, it may be bilateral in 10% of cases. The tumor is located between the costa and the chest wall muscles. The patients generally describe back and shoulder pain that increases with movement. Three sisters, aged 58, 61, and 63 years, who were admitted to our clinic with of bilateral swelling and pain in the infrascapular region, received diagnoses of elastofibroma dorsi after radiologic examination. Bilateral elastofibroma dorsi resection was performed on the three sisters. Inasmuch as cases of elstofibroma dorsi demonstrate familial features, a genetic examination was conducted; however, prominent chromosomal instability was not detected. It is emphasized that the disease might be familial; however, chromosomal changes may not be present.

Diagnostic value of 18 F-FDG-PET/CT in benign lung diseases

Introduction There are many diseases which, despite not being malignant, show high metabolic activity and cause false-positive results. Aim To evaluate the results of positron emission tomography (PET) in patients who underwent resection after preliminary diagnosis of malignancy based on fluorodeoxyglucose (FDG) uptake value, in whom the lesions were later classified as pathologically benign. Material and methods The analysis included the records of 106 (12.3%) patients out of 862 patients who underwent surgery between January 2012 and December 2015 after being initially diagnosed with malignant lung lesions based on PETCT results, in whom the lesions were later classified as pathologically benign. Diagnoses, PET findings, types of surgery, and demographic data of the patients were recorded. Results The mean age of the patients was 55.5 (26–79) years. The mean diameter and SUVmax of the lesions were 2 ±2.14 (0.5–13) and 3.55 ±4.35 (0–22.2) cm, respectively. The pathology results were analyzed in five different groups. The SUVmax in the hamartoma group was significantly lower than in the other groups (p < 0.001), while the SUVmax in the granulomatous disease group was significantly higher than in the other groups (p < 0.001). Conclusions The possibility of false positive PET results must be kept in mind when diagnosing and treating lung cancer. In particular, in the case of suspected granulomatous disease, all available pre- and intraoperative diagnostic procedures must be used.

Prediction of postoperative pulmonary complications in lung cancer surgery: Is proportion of emphysema important?

OBJECTIVE: Preoperative evaluation in thoracic surgery is highly important to determine surgical suitability, estimate postoperative pulmonary complications, and for patient follow-up. However, there is neither a definite explanation about the possible complications nor a gold standard method. MATERIALS AND METHODS: In this study, 297 patients undergoing anatomic lung resection for primary lung carcinoma were retrospectively evaluated. To form a homogeneous group, all factors that increase the rate of pulmonary complication were excluded except emphysema. Patients who did not meet these criteria were removed from the study. The study continued with 104 other patients. This patient subgroup was divided into groups according to Goddard Classification– Score (GdCS). The correlation between GdCS and other variables was statistically investigated. RESULTS: According to the GdCS of 104 patients, the patient distribution was as follows: 10 patients (9.6%) were G0, 28 patients (26.9%) were G1, 42 patients (40.4%) were G2, 22 patients (21.2%) were G3, and 2 patients (1.9%) were G4. Thirty-five (33.6%) of 104 patients had a pulmonary complication during the postoperative follow-up. The average drainage time was longer for higher GdCS scores, and the rate of exposition to a pulmonary complication was higher in the patients with increased GdCS. CONCLUSION: In view of these findings, Goddards scoring for chronic obstructive pulmonary disease-emphysema patients was considered likely to be an indicative parameter in the preoperative evaluation and postoperative follow-up of thoracic surgery patients.

İdiyopatik mediastinal fibrozis

Halsizlik ve kilo kaybi sikayetleri ile tetkik edilen 66 yasindaki erkek hastanin gogus bilgisayarli tomografisinde, anterior mediastende, 10 cm boyutlu kitlesel lezyon saptandi. Tanisal amacli operasyona alinan hastaya, sol hemitorakstan videotorakoskopik biyopsi uygulandi. Histopatolojik inceleme sonucunda kesin bir taniya varilamamasi uzerine ayni islem ikinci bir operasyon ile sag hemitoraksa yonelik uygulandi. Yine tani elde edilememesi uzerine hasta tekrar operasyona alinarak mediastinotomi uygulandi. Tum histopatolojik inceleme sonuclari ve klinik bulgulari ile birlikte degerlendirilen olguda idiyopatik mediastinal fibrozis tanisina ulasildi. (MF) olgulari radyolojik olarak malign mediasten tumorleri ile benzerlik gosterebilir ve ayirici tani yapilmasi buyuk onem arz etmektedir.

The Efficacy of VATS and Intrapleural Fibrinolytic Therapy in Parapneumonic Empyema Treatment

BACKGROUND Development of multiloculation-septation is a challenging entity in empyema patients. In this study, it is aimed to investigate the success rates of videothoracoscopic deloculation (VATS-D) and intrapleural fibrinolytic (IPFib) application after tube thoracostomy. METHODS The study retrospectively examined the patients diagnosed with empyema with multiloculation and septation between January 2005 and December 2014. Among these patients, the study included those who received VATS-D or IPFib therapy. RESULTS VATS-D (Group 1) was applied to 54 patients and IPFib (Group 2) was applied to 24 patients. The success of both procedures was evaluated considering the need of decortication in the following periods. In the VATS-D group, 4 (7.4%) patients required decortication via thoracotomy where it was 1 (4.1%) patient (p = 0.577) in the IPFib group. The length of hospital stay was 6.81 ± 2.55 (4-15) days in Group 1 compared to 14.25 ± 6.44 (7-27) days in Group 2 (p <0.001). CONCLUSIONS It was demonstrated that both of the methods applied in the study have high efficacy and are preferable methods based on the general conditions of patients. Additionally, the shorter length of hospital stays in patients received VATS-D was established as a significant parameter.

Spontaneous Splenic Rupture in the Early Postoperative Period to After Lobectomy

Spontaneous splenic rupture is a quite rare entity that may develop secondary to some special situations (lymphoma, post-abdominal surgey etc). In the literature, the case of a patient has been reported following thoracic surgery. In a patient who had undergone right upper lobectomy for pulmonary carcinoma, signs of acute abdomen and low levels in the hemogram were detected on the fifth postoperative day; therefore, the patient underwent further investigations. A radiological evaluation revealed splenic rupture, and the patient was operated on. A case is presented that may be fatal and requires emergency response and that has to be kept in mind, although it is extremely rare. A case of spontaneous splenic rupture has been presented that may be fatal and requires emergency response; this should be kept in mind, although it is extremely rare.

The prognostic value of carcinoembryonic antigen levels in blood and intraoperative pleural lavage fluid in non-small-cell lung cancer

Introduction There is no specific marker for lung cancer, but, in some lung cancer types, carcinoembryonic antigen (CEA) can reach high levels in the blood and pleural fluid. Aim This study investigated the relationship of CEA levels in blood (CEAB) and intraoperative pleural lavage fluid (CEAP) in non-small-cell lung cancer (NSCLC) with the type, stage, and extent of lung cancer. Material and methods A total of 50 patients, who underwent surgery at our clinic due to NSCLC (group I) or benign lung pathology (group II), were assessed. For this prospectively designed study, 25 consecutive patients were included in each group, and their CEAB and CEAP levels were investigated. Results When the levels of CEAP were compared, the average value of group I (1.35 ng/ml) was significantly higher than the average value of group II (0.04 ng/ml) (p = 0.027). When CEA levels were examined separately, and average values were taken according to surgical pathology results, both CEAB and CEAP levels of adenocarcinoma patients were found to be higher than those of the other groups. This difference was only significant for the level of CEAP (p = 0.026). Conclusions Although the average CEAB levels of patients with adenocarcinoma were higher than those of patients with other histopathological types, this difference was not statistically significant. However, we found that CEAP levels were significantly higher in patients with adenocarcinoma. These results have led us to consider that CEAP elevation is a more sensitive marker than the elevation of CEAB.

Is the Risk of Postoperative Atrial Fibrillation Predictable in Patients Undergoing Surgery Due to Primary Lung Cancer

BACKGROUND Atrial fibrillation (AF) is a type of cardiac arrhythmia which is commonly seen following lung resection. There is currently no algorithm which can predict which patients will develop postoperative AF (PAF). The present study aims to identify the risk factors for the development of PAF and high-risk patients with PAF along with multiple risk factors. MATERIALS AND METHODS A total of 887 patients, who underwent lung resection due to primary lung malignancy at our clinic between January 2000 and December 2016, were retrospectively analysed. Group 1 (n=44) consisted of the patients who developed PAF and Group 2 (n=843) consisted of the patients without PAF. Age and sex of the patients, comorbidities, previous diagnosis of malignancy, and surgery-related variables were evaluated using statistical methods for their effects on the development of AF. A score was assigned to each identified risk factor and scores of the patients were calculated. The risk of developing PAF was evaluated based on this scoring system. RESULTS We found that ≥60 years of age and the diagnosis of chronic obstructive pulmonary disease (COPD) were significant risk factors for the development of PAF (p<0.05). The risk of developing PAF was not associated with male sex, previous history of malignancy, presence of comorbidities, and the type of surgery applied. There was an increased risk of AF with increasing scores in the risk calculation system. CONCLUSION Advanced age and the presence of COPD were found to be associated with an increased risk of developing PAF. In addition we found a significant increase in the risk of developing PAF in the presence of multiple factors, although they did not reach statistical significance alone.

Prolonged Air Leakage in Secondary Spontaneous Pneumothorax: Is Proportion of Emphysema Important?

Prolonged air leakage is the most common complication that can cause severe problems in cases of secondary spontaneous pneumothorax (SSP). The purpose of this study was to explore whether Goddard Classification Score (GCS) can be a marker of prolonged air leakage, particularly during the post‐operative period, for patients with emphysema.