Diagnostic Dilemma In Discrimination Between Hydatid Cyst and Tumor, For Two Cases

Although cystic lung lesions appear benign on radiological examination; it is known that they interfere with some lung and pleural tumors. Especially in countries like our country where the cyst hydatid disease is endemic and so, they can be confused with lung tumors, as seen in our cases. The radiological lesions which have well-circumscribed are known to may not be a part of cyst hydatid. Surgical operation appears to be a good option for both treatment and definitive diagnosis in suspected cases. In our study, we presented two cases who we can’t distinguish between tumor and cyst with the conventional methods and we decided to perform exploration

Congenital Superior Sternal Cleft Repair Using Primary Closure

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Tiroid Kanserinin Göğüs Duvarına Uzak Metastazları

Amaç: Tiroid bezi kanseri endokrin sistem kanserleri içinde en sık görülen maligniteler olmasına rağmen, tiroid kanserinin yıllık sıklığı bölgeden bölgeye önemli ölçüde, 100 000'de 2-4 arasında değişmektedir. Bu çalışmanın amacı, tiroid bezin kanserinden kaynaklanan göğüs duvarı metastazı olan hastaların klinik karekteristiklerini incelemektir. Hastalar ve Yöntemler: Aralık 2000 - Kasım 2007 tarihleri arasında, dört hastaya tiroid kanserinin göğüs duvarına metastazı tanısı konuldu. Olguların biri erkek (%25), üçü kadın (%75), ortalama yaşları 58 (dağılım 47-70) idi. Tüm hastalar göğüs duvarında ağrı ve şişlik ile başvurdular. Tüm hastalarda tümör ile birlikte göğüs duvarı rezeksiyonu uygulandı. Olguların klinik özellikleri retrospektif olarak analiz edildi. Göğüs duvarına metastaz bir olguda medüller tiroid karsinomu ve üç olguda ise papiller tiroid karsinomu nedeniyleydi. Göğüs duvarı metastazları iki olguda senkron iken iki olguda metakron metastazdı. Göğüs duvarı rezeksiyonundan sonra oluşan geniş defektler iki olguda çevre dokuların yardımı ile kapatılırken iki olguda politetrafloretilen (PTFE) greft ile kapatıldı. Medüller tiroid kanserli olgu hariç, diğer üç olguda cerrahi tedavinin devamında radyoiyot ablasyon tedavisi uygulandı. Bulgular: İki papiller tiroid kanseri olgusu beşinci ve 36. aylarda, medüller tiroid kanseri olan bir hasta 24. ayda tiroid kanserinin uzak metastazı nedeni ile öldü. Bir hasta ise cerrahiden sonra beşinci yılında halen sağ ve sağlıklıdır. Sonuç: Differansiye tiroid kanserlerinde (papiller ve foliküler) uzak metastazların kaldırılması sağkalımın uzaması ve hayat kalitesinin artırılması nedeniyle önerilmektedir.Objectives: Carcinoma of the thyroid gland is the most common malignancy of the endocrine system although the annual incidence of thyroid cancer varies considerably in different registries, ranging from 2-4 per 100,000 individuals. The purpose of this study was to review clinical characteristics of the patients with chest wall metastasis originating from thyroid cancer. Patients and Methods: Between December 2000 and November 2007, four patients with thyroid cancer were diagnosed with chest wall mass at our hospital. There were one male (25%) and three females (75%) with a mean age of 58 years (range 47-70 years). All patients were admitted with chest pain and swelling in invading chest wall. Their clinical characteristics were analyzed retrospectively. The tumor was resected together with chest wall in all patients. Incidence of chest wall metastasis from papillary thyroid cancer was three patients and one patient from medullary thyroid cancer. The chest wall distant metastasis was synchronous in two patients and metachronous in two patients. Large defects were reconstructed with appropriate tissues, the material used was polytetrafluoroethylene (PTFE) mesh in two patients. Radioiodine ablation therapy was carried out in three patients, except for one medullary carcinoma patient. Results: Two papillary carcinoma patients died in five and 36 months, medullary carcinoma patient died in 24 months due to distant metastasis resulting from thyroid cancer. One patient is alive and well after five years following surgery. Conclusion: The surgical removal of distant metastases from differentiated thyroid carcinoma (papillary and follicular) offers the best chance for prolonged survival and improved quality of life

İntratorasik ekstra abdominal agresif fibromatozis

Fibröz doku kaynaklı tümörler toraksta ve mediastinumda nadir olarak görülmekte ve rapor edilmektedirler. Biz burada, agresif fibromatozisin, toraks içi dokulardan kaynaklanan nadir bir formunu bildirmek istedik. Otuz altı yaşında bayan hasta hastanemize sol göğüs ağrısı ve sıkışma hissi ile başvurdu. Çekilen PA grafi ve toraks bilgisayarlı tomografisinde, sol toraks alt kısmını üçte iki oranında dolduran dev kitle görüldü. Bunun üzerine hastaya sol yedinci interkostal aralıktan yapılan torakotomi ile geniş rezeksiyon uygulandı. Tümör patolojisi 20x15x15 cm çapında agresif fibromatozis olarak geldi. Hasta 15 aydır takip altında ve kontrollerinde yineleme görülmedi.Tumors of fibrous tissue origin (fibromatosis) in chest and mediastinum have been rarely reported in the literature. Herein, we report a rare case of aggressive fibromatosis presenting as an intrathoracic tumor. A 36-year-old woman admitted to our hospital due to a feeling of oppression and pain in the left chest. A chest X-ray, thorax computed tomography revealed a large mass filling two thirds of lower left thorax. Widely surgical resection of the tumor was performed thoracotomy via seventh intercostal space. The tumor was 20x15x15 mm in size and diagnosed pathologically as aggressive fibromatosis. The patient has been well without recurrence for 15 months after surgery

13-year experience with penetrating trauma patients

Amaç: Toraks travmalarının tüm travmalar içindeki oranı %25-30'dur. Bunun %70'i künt, %30'u penetran travmalardır. Bu çalışmada son 13 yıldaki penetran toraks travmalı olgularımızı, klinik deneyimlerimizi sunduk ve literatür eşliğinde irdeledik. Hastalar ve Yöntemler: Kliniğimizde, Ocak 1995 - Haziran 2008 tarihleri arasında penetran toraks travması tanısı ile yatırılarak tedavi edilen 200 hasta (184 erkek (%92), 16 kadın (%8); ort. yaş 27.4; dağılım 11-80) retrospektif olarak değerlendirildi. Bulgular: Penetran travmaların en sık nedeni kesici delici alet yaralanması 153 (%76.5) ve ateşli silah yaralanması 47 (%23.5) idi. 174 hastada (%87) intraplevral patoloji, dokuz hastada ekstratorasik organ yaralanması mevcuttu. Hastaların 173'ü (%86.5) tüp torakostomi, 27'si (%13.5) diğer konservatif yöntemlerle tedavi edildi. Otuz dokuz (%19.5) hastaya torakotomi uygulandı. Morbidite %7.5 (15 olgu) mortalite, %0.5 (bir olgu) olarak gerçekleşti. Sonuç: Penetran toraks travmalarının acil torakotomi gerektirenleri hariç, büyük çoğunluğu tüp torakostomi veya konservatif yöntemlerle tedavi edilebilir. Eşlik eden intratorasik organ yaralanmaları mortalite ve mobiditeyi artıran nedenlerdir; multidisipliner hızlı ve iyi değerlendirme gerektirir.Objectives: Thoracic injuries occur in approximately 25-30% of all trauma cases. Among these, 70% is blunt trauma and 30% is penetrating trauma. We presented our clinical experience with penetrating thoracic trauma patients in the last 13 years. Patients and Methods: We retrospectively assessed 200 cases of penetrating thoracic trauma (184 males (%92), 16 females (%8); mean age 27.4 years; range 11 to 80 years) urgently hospitalized at our clinic between 1995-2008. Results: In 153 (76.5%) cases sharp penetrating trauma and in 47 (23.5%) patients gunshot wounds were seen. Intrapleural pathology was found in 174 (87%) cases and extrathoracic organ injury was found in nine cases. Surgical treatment included chest tube thoracostomy in 173 (86.5%) cases and other conservative treatment methods were applied in 27 (13.5%) cases. Thoracotomy was required in 39 (19.5%) of the cases. The morbidity rate was 7.5% and mortality rate was 0.5%. Conclusion: In penetrating thoracic trauma cases, except emergency thoracotomy patients, conservative treatment methods are applied in most of the patients. Trauma with intrathoracic organ injury increases the mortality and morbidity, and requires fast and well-organized multidisciplinary approach

Evaluation of the Possible Risk Factors on Bronchial Closure Techniques for Bronchopleural Fistula after Lung Resection

Background: Broncho-pleural fistula (BPF) can occur after pulmonary resections as a complication with high morbidity and mortality rates.  Aim: In the present study, we analyzed the relation between the possible risk factors and the two major bronchial closure techniques for BPF after lung resections, and the management methods of BPF.  Materials and methods: A total of 26 cases detected and managed with BPF diagnosis in our clinic between September 2005 and September 2017 were evaluated retrospectively. The cases were divided into two groups: Group 1 (n=14); bronchial closure performed manually and Group 2 (n=12) bronchial closure with stapler. We analyzed cases for age, gender, body mass index, pulmonary function tests, time to fistula, total protein/albumin level, length of hospital stay, bronchial stump distance, presence of bronchial stump coverage, and the mean survivals. Results: Twenty-three of the cases were males (88.5%) with a mean age of 60.03±8.7 years (range 38-73). While BPF was detected in twenty-three (88.5%) of the cases after pneumonectomy, three (11.5%) of them were after lobectomy. There was no statistically significant correlation between the two groups in gender, age, BMI, preoperative FEV1, time to fistula, total protein/albumin level, length of hospital stay, bronchial stump distance, and presence of bronchial stump coverage (chi-square test, p>0.05). As a result of the applied Kaplan-Meier analysis, we found no statistically significant difference in the mean survival rates between the two groups (p>0.05). Conclusions: Broncho-pleural fistulas still remains a major challenge. Although there is no statistical relationship between bronchial closure techniques and possible risk factors in our study, patients should be assessed in terms of possible risk factors. The management strategy for BPF varies according to individual patients’ clinical condition, the size of the fistula, and development time

Evaluation of the Possible Risk Factors on Bronchial Closure Techniques for Bronchopleural Fistula after Lung Resection

Background: Broncho-pleural fistula (BPF) can occur after pulmonary resections as a complication with high morbidity and mortality rates.  Aim: In the present study, we analyzed the relation between the possible risk factors and the two major bronchial closure techniques for BPF after lung resections, and the management methods of BPF.  Materials and methods: A total of 26 cases detected and managed with BPF diagnosis in our clinic between September 2005 and September 2017 were evaluated retrospectively. The cases were divided into two groups: Group 1 (n=14); bronchial closure performed manually and Group 2 (n=12) bronchial closure with stapler. We analyzed cases for age, gender, body mass index, pulmonary function tests, time to fistula, total protein/albumin level, length of hospital stay, bronchial stump distance, presence of bronchial stump coverage, and the mean survivals. Results: Twenty-three of the cases were males (88.5%) with a mean age of 60.03±8.7 years (range 38-73). While BPF was detected in twenty-three (88.5%) of the cases after pneumonectomy, three (11.5%) of them were after lobectomy. There was no statistically significant correlation between the two groups in gender, age, BMI, preoperative FEV1, time to fistula, total protein/albumin level, length of hospital stay, bronchial stump distance, and presence of bronchial stump coverage (chi-square test, p>0.05). As a result of the applied Kaplan-Meier analysis, we found no statistically significant difference in the mean survival rates between the two groups (p>0.05). Conclusions: Broncho-pleural fistulas still remains a major challenge. Although there is no statistical relationship between bronchial closure techniques and possible risk factors in our study, patients should be assessed in terms of possible risk factors. The management strategy for BPF varies according to individual patients’ clinical condition, the size of the fistula, and development time

DIAGNOSTIC DILEMMA IN DISCRIMINATION BETWEEN HYDATID CYST AND TUMOR, FOR TWO CASES

Kistik görünümlü akciğer lezyonlarının radyolojik olarak benign karakterli olmasına karşın; bazı akciğer ve plevra tümörleri ile karışabildiği bilinmektedir. Özellikle ülkemiz gibi kist hidatik hastalığının endemik olduğu ülkelerde,bizim olgularımızda olduğu gibi akciğer tümörleri ile karışabilmektedir. Radyolojik olarak düzgün sınırlı kistik lezyonların bir kısmının kist hidatik olmayabileceği bilinmektedir. Tanıda şüphe olan durumlarda, cerrahi eksplorasyon hem kesin tanı, hem de tedavi için iyi bir seçenek olarak karşımıza çıkmaktadır. Çalışmamızda konvansiyonel yöntemlerle tümör-kist ayrımını yapamadığımız ve eksplorasyon kararı aldığımız iki olgumuzu sunduk.Although cystic lung lesions appear benign on radiological examination; it is known that they interfere with some lung and pleural tumors. Especially in countries like our country where the cyst hydatid disease is endemic and so, they can be confused with lung tumors, as seen in our cases. The radiological lesions which have well-circumscribed are known to may not be a part of cyst hydatid. Surgical operation appears to be a good option for both treatment and definitive diagnosis in suspected cases. In our study, we presented two cases who we can’t distinguish between tumor and cyst with the conventional methods and we decided to perform exploration