Lung resection and application of latissimus dorsi muscle flap for pulmonary aspergilloma: Case report

Aspergilloma, is the most common form of aspergillus infectionthat presents as parenchymal cavitary lesion withsaprophytic colonization. This disease is associated withvariety of lung diseases such as tuberculosis, sarcoidosisand bronchiectasis. The patient in this study with tuberculosiswas diagnosed 12 years ago and treated for sixmonths. Most frequently referred symptom is hemoptysis.Aspergilloma get a diagnosis with chest x-ray and thoraxcomputerized tomoghraphy. In treatment usually anatomicresection is performed, bronchial stump is supportedand the remaining space is filled with a flap. The pateintwas admitted to our hospital with hemoptysis and left upperlobectomy was performed due to cavitary lesion andbronchial stump was supported with latissimus dorsi muscleflap. The postoperative period was uneventful with noreccurrence so far.Key words: Bronchopulmonary aspergillosis, thoracicsurgery, tuberculosi

When conservative treatment in trachea laserations?

Introduction: The tracheobronchial injuries are usually fatal and some of the lucky people can reach emergency services without dying in the place of trauma. They can cause severe symptoms which can be lifetreathing. This type of injuries must been taken carefully and need to decide fast what treatment you going to give. Case report: We present a 53 years old patient who has been stabbed during a fight and got his trachea ruptured. His complaints shortness of breath and neck swelling. He can be treated conservatively with bronchoscopic and clinical evaluation. Discussion: Tracheobronchial injuries are life-threatening and the airway must be secured first. They can be treated conservatively in some cases. CT can be useful but fiberoptic bronchoscopy is the key in diagnosis. Conclusion: Although early treatment of tracheal lacerations is urgent surgery, it is reported that these injuries can be treated with conservative methods under appropriate conditions

Effect of diclofenac on experimental pleurodesis induced by tetracycline in rabbits.

BACKGROUND AND OBJECTIVE: Pleurodesis is a frequently preferred procedure in thoracic surgery, and many factors may affect the process. We aimed to determine whether the administration of systemic diclofenac sodium diminishes the effectiveness of the pleurodesis induced by intrapleural tetracycline in rabbits. METHODS: Twelve male New Zealand rabbits that received tetracycline 35 mg/kg intrapleurally were allocated into two groups. The first group (diclofenac group, n = 6) received 2 mg/kg diclofenac sodium intramuscularly for 10 days, and the second group (control group, n = 6) received acetaminophen 30 mg/kg orally for 10 days after the pleurodesis procedure. The rabbits were sacrificed after 28 days, and the pleural spaces were assessed grossly for evidence of pleurodesis and microscopically for evidence of fibrosis, inflammation, and collagenization. RESULTS: The mean macroscopic pleurodesis score of the diclofenac group was 2.16 +/- 0.40 compared with 2.83 +/- 0.40 in the control group (p = .027). The mean microscopic pleurodesis score of the diclofenac group was 2. 3 +/- 1.03, whereas it was 3.5 +/- 0.54 in the control group (p = .045). CONCLUSION: The administration of diclofenac sodium for 10 days following tetracycline pleurodesis reduces the effectiveness of pleurodesis in rabbits

Does tumor volume affect survival in patients with operated early-stage non-small-cell lung cancer?

Amaç: Bu çalışmada erken evre ameliyat edilen küçük hücreli dışı akciğer kanserli hastalarda tümör hacminin sağkalımı etkileyip etkilemediği araştırıldı. Çalış­ma­ planı:­ Eylül 2009 - Haziran 2013 tarihleri arasında anatomik rezeksiyon ve mediastinal lenf bezi diseksiyonu yapılan küçük hücreli dışı akciğer kanserli 156 hasta (146 erkek, 10 kadın; ort. yaş 62.3±8.0 yıl; dağılım 38-79 yıl) retrospektif olarak incelendi. Tümör hacimleri histopatolojik veriler kullanılarak hesaplandı. Tümör hacminin prognoz ve sağkalım üzerindeki etkisi araştırıldı. Bulgu­lar:­ Hastaların 116’sında Evre I ve 40’ında Evre II hastalık var idi. Ortalama tümör hacmi 38.2±54.6 (dağılım; 356.15- 0.01) cm3 iken, ortalama en büyük çap 4.2±2.0 (dağılım; 10-0.3) cm idi. Cox- regresyon analizinde eşik değerin altında tümör hacmi (29.69 cm3) 2 olasılık oranı (OR) ile sağkalımı artırmakla birlikte, bu değer istatistiksel olarak anlamlı idi (p=0.022). T faktörüne göre eşik değer 4.5 cm olup, OR=1.7 idi; ancak, sağkalım ile arasında anlamlı bir ilişki gözlenmedi (p=0.058). Sonuç:­ Bu çalışmada en büyük tümör çapı ve sağkalım arasındaki bilinen ilişkinin aksine, tümör hacmi ile sağkalım arasında daha yakın bir ilişki saptandı. Çalışma bulgularımıza göre, akciğer kanseri evrelemesinde tümör çapı ile beraber tümör hacminin hesaplanması ve göz önünde bulundurulması önerilmektedir.Background: This study aims to investigate whether tumor volume affects survival in patients with operated early-stage non-small-cell lung cancer. Methods: A retrospective analysis of 156 patients (146 males, 10 females; mean age 62.3±8.0 years; range 38 to 79 years) with non -small-cell lung cancer who underwent anatomical resection and mediastinal lymph node dissection between September 2009 and June 2013 was performed. the tumor volumes were calculated using histopathological data. the effect of tumor volume on prognosis and survival was investigated. Results: of the patients, 116 had Stage I disease and 40 patients had Stage II disease. the mean tumor volume was 38.2±54.6 (range, 356.15 to 0.01) cm3, and the mean largest diameter was 4.2±2.0 (range, 10 to 0.3) cm. in the Cox regression analysis, the tumor volume below the cut- off value (29.69 cm3) increased survival with an odds ratio (OR) of 2, and this value was statistically significant (p=0.022). the cut- off value per T factor was 4.5 cm and the OR was 1.7; however, no significant correlation with the survival was observed (p=0.058). Conclusion: the present study found a closer correlation between the tumor volume and survival in contrast to the known correlation between the tumor’s largest diameter and survival. Based on our study results, it is recommended to calculate and consider the tumor volume along with the tumor diameter in the staging of lung cancer

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, Goddard’s 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

Skip metastasis in non-small cell lung cancer: does it affect the prognosis?

Amaç: Bu çalışmada küçük hücreli dışı akciğer kanseri nedeni ile rezeksiyon yapılan hastalarda skip metastazları incelendi.Ça lış ma pla nı: Kliniğimizde Ocak 2005 - Aralık 2011 tarihleri arasında küçük hücreli dışı akciğer kanseri tanısı konan ve R0 akciğer rezeksiyonu örneklerinin patolojik incelemesi sonucunda aynı taraf mediastinal lenf nodu metastazı saptanan toplam 111 hasta (94 erkek, 17 kadın; ort. yaş: 58.9±10.2 yıl; dağılım 35-82 yıl) retrospektif olarak incelendi. Hastalar skip metastazlı grup (sN2) (grup 1, n=55) [N1(-), N2(+)] ve skip metastazı olmayan aynı taraf mediastinal lenf nodu metastazlı grup (nsN2) (grup 2, n=56) [N1(+), N2(+)] olmak üzere iki gruba ayrıldı.Bul gu lar: Her iki çalışma grubunda medyan sağkalım 25 ay olup, beş yıllık genel sağkalım oranı %13 idi. Beş yıllık genel sağkalım oranı grup 2'ye kıyasla grup 1'de daha yüksek olmakla birlikte (sırasıyla %7.4'e karşın %20), fark istatistiksel olarak anlamlı değildi (p=0.084).So nuç: Çalışma sonuçlarımız istatistiksel olarak anlamlı bir fark olmasa da skip metastazı olmayan hastalara kıyasla, skip metastazlı ameliyat edilebilir hastalarda beş yıllık genel sağkalım oranının daha yüksek olduğunu göstermektedir.Background: This study aims to examine skip metastases in patients who had resection due to non-small cell lung cancer.Methods: A total of 111 patients (94 males, 17 females; mean age: 58.9±10.2 years; range 35 to 82 years) who were diagnosed with non-small cell lung cancer and in whom an ipsilateral mediastinal lymph node metastasis was detected based on the pathological examination of the R0 pulmonary resection samples between January 2005 and December 2011 in our clinic were retrospectively analyzed. The patients were divided into two groups: the skip metastasis group (sN2) (group 1, n=55) [N1(-), N2(+)] and non-skip ipsilateral mediastinal lymph node metastasis group (nsN2) (group 2, n=56) [N1(+), N2(+)].Results: The median survival was 25 months and fiveyear overall survival rate was 13% for both study groups. Five-year overall survival rate was higher in group 1, compared to group 2 (20% vs. 7.4%, respectively), although the difference was not statistically significant (p=0.084).Conclusion: Our study results show that five-year overall survival rates of operable patients with skip metastases are higher than those without skip metastases, although the difference is not statistically significant

Primer spontan pnömotoraksta elektrokardiyografik değişiklikler

Background: This study aims to evaluate the electrocardiographic (ECG) changes in patients with primary spontaneous pneumothorax. Methods: A total of 48 patients (42 males, 6 females; mean age 29.7;plusmn;12.5 years, range 15 to 58 years) with PSP were prospectively analyzed between November 2010 and November 2011. Pneumothorax size was calculated using the Rhea method. At least two standard 12-lead ECG were obtained for each patient (after the diagnosis of pneumothorax and prior to drain placement - ECGpneumothorax, and after a complete re-expansion of the lung was achieved and confirmed radiologically - ECGre-expanded). P wave measurement, PR distance, QRS distance, QT interval and QT interval corrected for heart rate (QTc) were calculated. Heart rate (bpm), axis deviation measurement and the QRS amplitudes in precordial leads were calculated. Results: There were 29 cases (60.4%) of left-sided and 19 cases (39.6%) of right-sided pneumothorax. The mean relative volume of pneumothorax was 43.0;plusmn;21.5%. The most common symptoms included chest pain in 34 patients (70.8%) and dyspnea in 14 patients (29.2%). The pneumothorax duration was ;lt;=24 hours in 30 patients (62.5%) and ;gt;24 hours in 18 patients (37.5%). There was a statistically significant difference between before and after the treatment for QT duration, axis deviation, heart rate, QRSV1, QRSV4, QRSV5 and QRSV6 (respectively; p=0.001, p=0.023, p=0.001, p=0.010, p=0.046, p=0.000, p=0.008). A total of seven patients had relevant QRS abnormalities including incomplete right bundle branch block in three patients, ST elevation in two patients and T-wave pointedness in one patient. Conclusion: Our study results suggest that left and right lung pneumothorax may cause axis variation, which is more pronounced in women, and that voltage increases after drainage in QRSV 4, 5 and 6 leads. In addition, pneumothorax may lead to specific ECG variations such as right bundle branch block and ST variations.Amaç: Bu çalışmada primer spontan pnömotoraks olgularındaki elektrokardiyografik (EKG) değişiklikler değerlendirildi.Ça­lış­ma­pla­nı:­Primer spontan pnömotorakslı toplam 48 hasta (42 erkek, 6 kadın; ort. yaş: 29.7±12.5 yıl; dağılım 15-58 yıl) Kasım 2010 - Kasım 2011 tarihleri arasında prospektif olarak incelendi. Pnömotoraks alanı Rhea metodu ile hesaplandı. Her hastaya en az iki kere standart 12 derivasyonlu EKG çekildi (pnömotoraks tanısından sonra ve göğüs tüpü uygulamasından önce - EKGpnömotoraks ve akciğerin yeniden ekspanse olması ve radyolojik olarak doğrulanmasından sonra - EKGre-ekspanse). P dalgası ölçümü, PR mesafesi, QRS mesafesi, QT intervali ve kalp hızı için düzeltilmiş QT aralığı (QTc) hesaplandı. Ayrıca kalp hızı (dakikada nabız sayısı), aks deviasyonu ölçümleri ve prekordial derivasyonlarda QRS amplitüdleri hesaplandı.Bul gu lar: Pnömotoraks hastaların 29'unda (%60.4) sol, 19'unda (%39.6) sağ hemitoraksta idi. Pnömotoraks alanının ortalaması %43.0±21.5 idi. En sık görülen semptomlar, 34 hastada (%70.8) göğüs ağrısı, 14 hastada (%29.2) nefes darlığı idi. Pnömotoraks süresi 30 hastada (%62.5) =24 saat iken, 18 hastada (%37.5) >24 saat idi. Tedavi öncesi ve tedavi sonrası QT süresi, aks deviasyonu, kalp hızı, QRSV1, QRSV4, QRSV5 ve QRSV6 değerleri arasında istatistiksel olarak anlamlı bir fark saptandı (sırası ile p=0.001, p=0.023, p=0.001, p=0.010, p=0.046, p=0.000, p=0.008). Üç hastada sağ dal bloku, iki hastada ST yükselmesi ve bir hastada T dalgası sivriliği olmak üzere toplam yedi hastada ilişkili QRS anormallikleri saptandı.So nuç: Çalışma bulgularımız hem sağ hem de sol pnömotoraksın kadınlarda daha belirgin olmak üzere, aks değişikliğine neden olabileceğini ve QRSV 4, 5 ve 6 derivasyonlarında voltajın drenaj sonu arttığını göstermektedir. Ayrıca pnömotoraks sağ dal bloku ve ST değişikliği gibi özellikli EKG değişikliklerine de yol açabilir