Squamotous-type sarcomatoid carcinoma of the lung with rhabdomyosarcomatous components

Lung carcinosarcoma is an infrequently biphasic tumor composed of carcinomatous and sarcomatous components. It is divided into endobronchial (squamous-type) and peripheral (glandular type) categories. The carcinomatous component is usually a squamous carcinoma, and the sarcomatous component usually resembles a fibrosarcoma or a malignant fibrous histiocytoma. The presence of rhabdomyoblastic differentiation in such neoplasms is exceedingly rare. There are strong associations with smoking and asbestosis. In this study, we describe a unique case of a 43-year-old man with a 75 packet/year smoking history in whom a rare mixed malignant tumor of the lung was diagnosed and treated by left pneumonectomy. Histological examination of the resected specimen showed squamous cell carcinoma and rhabdomyosarcoma components. Although rare, the association of a sarcomatoid carcinoma of the lung with squamous cell carcinoma and rhabdomyosarcomatous component is possible and should be kept in mind when dealing with these unusual tumors

Thoracoscopy under local anesthesia for patients with a high cardiopulmonary risk index

Background: In this study, we aimed to investigate the efficacy of thoracoscopy performed under local anesthesia and sedation for the diagnosis and treatment of patients with a high cardiopulmonary risk index. Methods: Between January 2007 and October 2010, 32 patients (22 males, 10 females; mean age 63.6 years; range 36 to 89 years) with a high cardiopulmonary risk index who underwent thoracoscopy under local anesthesia and sedation at Pamukkale University, School of Medicine, Department of Thoracic Surgery were included. Risk assessment was performed using the cardiopulmonary risk index. All procedures were performed in the operating room. Results: The cardiopulmonary risk index points of the patients ranged from 7 to 37 (mean 13.6). None of the patients underwent general anesthesia, indotracheal intubation, or epidural or intercostal blockage. Pleural biopsy/effusion drainage, either with or without talc pleurodesis, was performed in fifteen patients, six had drainage and debridement of empyema, and four had a biopsy of a mediastinal lymph node. In addition, three patients had a partial pleurectomy for secondary pneumothorax, one underwent a biopsy of a mediastinal mass, and one had a hematoma removed. Furthermore, a foreign body was extracted from one patient, and a wedge resection for the diagnosis of multiple lung nodules was performed on another. None of the patients required a thoracotomy. Morbidity was observed in three patients (9%), but no mortality was seen. Conclusion: Thoracoscopy performed under local anesthesia and sedation is a safe and effective, even for patients in poor general condition

Diafragma laserasyonu ve bronşektaziye yol açan bronşial web ile birlikteki kostal ekzositoz

Thoracic complications belong to exostosis with the other abnormality are extremely rare. A 40 year-old man presented with right-sided pleuritic chest pain. Computed tomographic scan of the chest revealed exostosis length 2.5 cm pushing pleura and diaphragm and compressing adjacent to lung and liver. Middle and lower lobe bronchiectasis was also identified. There were a web lesion in bronchial lumen at the level of middle lobe at bronchoscopy. In operation, diaphragm laceration was repaired with sutures. Bilobectomy inferior was performed and 10th costa was partially resected together with exostosis. Exostosis cases which lead to diaphragm laceration and bronchiectasis in addition with bronchial web as we present in this case are quite rare

Archaeogenetic analysis of Neolithic sheep from Anatolia suggests a complex demographic history since domestication

Yurtman, ozer, Yuncu et al. provide an ancient DNA data set to demonstrate the impact of human activity on the demographic history of domestic sheep. The authors demonstrate that there may have been multiple domestication events with notable changes to the gene pool of European and Anatolian sheep since the Neolithic. Sheep were among the first domesticated animals, but their demographic history is little understood. Here we analyzed nuclear polymorphism and mitochondrial data (mtDNA) from ancient central and west Anatolian sheep dating from Epipaleolithic to late Neolithic, comparatively with modern-day breeds and central Asian Neolithic/Bronze Age sheep (OBI). Analyzing ancient nuclear data, we found that Anatolian Neolithic sheep (ANS) are genetically closest to present-day European breeds relative to Asian breeds, a conclusion supported by mtDNA haplogroup frequencies. In contrast, OBI showed higher genetic affinity to present-day Asian breeds. These results suggest that the east-west genetic structure observed in present-day breeds had already emerged by 6000 BCE, hinting at multiple sheep domestication episodes or early wild introgression in southwest Asia. Furthermore, we found that ANS are genetically distinct from all modern breeds. Our results suggest that European and Anatolian domestic sheep gene pools have been strongly remolded since the Neolithic

Inhalation Injury

Inhalation injury is defined as airway or pulmonary parenchymal injury caused by inhalation of smoke, toxin and chemical gases. Frequently, it results from inhalation of smoke and incomplete products of combustion. The mortality and morbidity of burn patients increase with the damaging effect of inhalation injury. Lung injury from smoke inhalation can be caused by chemical and thermal insults. In the early period, the upper airway obstruction may develop due to chemical or direct thermal injury. Pathophysiological changes in the lung associated with inhalation injury result from inhalation of incomplete products of combustion. Pulmonary oedema, hypoxia, ventilation-perfusion mismatching, increased airway resistance, decreased pulmonary compliance, increased pulmonary vascular resistance, and atelectasis occur due to inhalation injury. The risk of infection (pneumonia) is increased and consequently, acute respiratory disease syndrome (ARDS) may occur. Some clinical symptoms and signs are suggestive and fiberoptic bronchoscopy may be diagnostic. For treatment, sufficient oxygenation and patency of airway must be provided. Therapeutic coughing, chest physiotherapy, airway suctioning with nasotracheal aspiration or bronchoscopy have been effective in the removal of retained secretions. Medical treatment includes administration of bronchodilators, racemic epinephrine, mucolytics and analgesic drugs. Another important issue is sufficient fluid resuscitation. In conclusion, the objective of the management is maintaining the respiratory care and thus the morbidity and mortality associated with inhalation injury can be reduced

Inhalation Injury

Inhalation injury is defined as airway or pulmonary parenchymal injury caused by inhalation of smoke, toxin and chemical gases. Frequently, it results from inhalation of smoke and incomplete products of combustion. The mortality and morbidity of burn patients increase with the damaging effect of inhalation injury. Lung injury from smoke inhalation can be caused by chemical and thermal insults. In the early period, the upper airway obstruction may develop due to chemical or direct thermal injury. Pathophysiological changes in the lung associated with inhalation injury result from inhalation of incomplete products of combustion. Pulmonary oedema, hypoxia, ventilation-perfusion mismatching, increased airway resistance, decreased pulmonary compliance, increased pulmonary vascular resistance, and atelectasis occur due to inhalation injury. The risk of infection (pneumonia) is increased and consequently, acute respiratory disease syndrome (ARDS) may occur. Some clinical symptoms and signs are suggestive and fiberoptic bronchoscopy may be diagnostic. For treatment, sufficient oxygenation and patency of airway must be provided. Therapeutic coughing, chest physiotherapy, airway suctioning with nasotracheal aspiration or bronchoscopy have been effective in the removal of retained secretions. Medical treatment includes administration of bronchodilators, racemic epinephrine, mucolytics and analgesic drugs. Another important issue is sufficient fluid resuscitation. In conclusion, the objective of the management is maintaining the respiratory care and thus the morbidity and mortality associated with inhalation injury can be reduced

Effects of non-dependent lung oxygen insuffation on oxygenation and respiratory mechanics during one-lung ventilation in patients with stage II COPD

Introduction: The aim of this study was to investigate the changes on oxygenation, shunt ratio and respiratory mechanics of 6 L/min oxygen insuffation to the non-dependent lung, while extrinsic PEEP (PEEPe, equivalent to the patient's PEEPi) was being applied to the dependent lung in patients undergoing lung surgery. Material and Methods: Patients with stage II COPD undergoing elective lung surgery (n=22) were intubated with a doublelumen endobronchial tube and performed a PA catheterization. One lung ventilation settings were: tidal volume 6 ml/kg, 12 breaths/min, and I: E ratio 1: 2. Procedure was performed in four sequential periods (each period continued for 15 minutes): After frst stabilization period (PEEP0-1), PEEPe (at the level of intrinsic PEEP, PEEPi) was applied in the dependent lung while the non-dependent lung was exposed to air. After second stabilization period (PEEP0-2), the non-dependent lung received 6 L/min oxygen (O2) through a catheter placed into the tube while PEEPe (at the level of PEEPi) was applied in the dependent lung (PEEPe+O2). At the end of each 15 minute period, haemodynamic data, lung compliance (C), airway resistance (R), and PEEPi were recorded and blood gas samples were obtained. Results: PaO2 was signifcantly higher during the PEEPe+O2 period (p2 period when compared with the PEEPe period (p<0.0001). Compliance increased signifcantly during PEEPe compared to PEEP0-1 (p<0.05). Discussion and Conclusion: The insuffation of oxygen to the non-dependent lung with application of PEEPe-equivalent to the patient's PEEPi - to the dependent lung increased oxygenation and decreased Qs/Qt in patients with moderate COPD. We recommend this simple and useful method which does not need extra equipment

Postoperative respiratory muscle training in addition to chest physiotherapy after pulmonary resection: a randomized controlled study

Purpose: The effects of preoperative respiratory muscle training (RMT) on postoperative complications in patients with pulmonary resection have recently attracted the attention of researchers. More studies are obviously needed to clarify the effects of RMT after pulmonary resection. The aim of this study was to evaluate the effectiveness of intense RMT in addition to chest physiotherapy after pulmonary resection in terms of respiratory muscle strength, exercise capacity, and length of hospital stay rather than postoperative complications. Methods: Forty subjects undergoing pulmonary resection were included in the study. Subjects were divided into two groups using a simple randomization method. The subjects in the study group (SG; n = 20) received RMT in addition to regular chest physiotherapy in the postoperative period. The subjects in the control group (CG; n = 20) received only regular chest physiotherapy. Respiratory muscle strength (maximal inspiratory and expiratory pressure [PImax and PEmax]) was measured pre-postoperatively and before discharge, and exercise capacity, which was measured by the 6-min walk test (6MWT), was assessed preoperatively and before discharge. The length of hospital stay was also recorded. Results: There were no differences between groups in terms of demographic and surgical characteristics. The nonsignificant change of PImax from the preoperative to the discharge value was 65.1 ± 15.5 to 68.2 ± 19.2 cmH2O in SG and 59.2 ± 13.7 to 44.3 ± 14.8 cmH2O in CG (p &gt; 0.05, p &gt; 0.05, respectively). The change of PEmax from the preoperative to the discharge value was 80.4 ± 24.9 to 81.5 ± 24.9 cmH2O in SG (nonsignificant) and 85.4 ± 38.2 to 61.3 ± 25.4 cmH2O in CG (p &gt; 0.05, p = 0.002, respectively). There was a significant difference between SG and CG in terms of RMT effect (PImax: 11.05 [21.84; 0.25] cmH2O p = 0.045; PEmax: 25.23 [42.83; 7.62] cmH2O p = 0.006). A significant difference was found in the 6MWT when the mean differences were compared between the groups (85.72 [166.15; 5.28] m p = 0.037). The length of hospital stay was significantly shorter in the SG (number of days for SG 9.1 ± 3 and for CG 12.9 ± 4.2 [p = 0.002]). Conclusion: The addition of RMT to chest physiotherapy after pulmonary resection can have positive effects on respiratory muscle strength, exercise capacity, and length of hospital stay. © 2018 Taylor & Franci

A single-center large-volume experience in the surgical management of hydatid disease of the lung with and without extrapulmonary involvement

Background: We compared the number of incisions, surgical procedures, hospital duration, and complications in hydatid cyst patients with unilateral or bilateral thoracic involvement and concomitant involvement of the extrathoracic organs. Methods: A total of 76 hydatid cyst cases surgically treated between the years 2007 and 2012 were divided into three groups according to radiological evidence of other organ involvement and surgical procedures: group 1 had only unilateral thoracic involvement and a single incision; group 2 had additional involvement of the contralateral thoracic side or extrathoracic organs and at most two incisions were performed at the same session; and group 3 had two or more incisions performed at separate sessions in addition to the involvement features of group 2. Results: We had 46 (60.5 %) cases with only thoracic involvement and 30 others (39.5 %) with extrathoracic organ involvement. Complications were seen in only one patient each in the first and second groups, and in 6 patients in the third group. Duration of hospital stay was 7.04 ± 0.86 (5-9) days in group 1.8.33 ± 1.87 (7-13) days in group 2, and 13.95 ± 2.03 (9-18) days in group 3. Conclusions: Although multiple session surgery is used to decrease the risk of complications, contamination, and infection in multiple or bilateral pulmonary hydatid cyst cases, or in patients with other organ involvement, single-session surgery can be used in selected cases taking into account the operative trauma, financial consequences, and psychological profile. © 2013 Société Internationale de Chirurgie

KAHVE Laboratory RF circulator and transmission line project

Turkish Physical Society 33rd International Physics Congress, TPS 2017; Bodrum Municipality - Herodot Culture Center; Bodrum; Turkey; 6 September 2017 through 10 September 2017An 800 MHz RF circulator and transmission line project has recently started at the newly commissioned Kandilli Detector, Accelerator and Instrumentation (KAHVE) Laboratory at the Boǧaziçi University. The aims are to design, build and construct an RF circulator and transmission line in Turkey for high power and high frequency applications. The project consists of 8 transmission line elements: 800 MHz RF generator with 60 kW power (klystron), klystron to waveguide converter, waveguides, E and H bends, 3-port circulator and waveguide to coaxial converter to transmit RF power to a pillbox RF cavity. Design studies and details of the ongoing project will be presented.Scientific and Technological Research Council of Turkey (TUBITAK 116E221); Bogazici BAP grant 16B03S1