Search

Background: In this study, we aimed to evaluate the success of surgery and a complete resection for bronchiectasis treatment and to present our 23 years of surgical experience. Methods: Between January 1991 and December 2013, a total of 1,357 patients (667 males, 690 females; mean age 30.5±14.3 years; range, 3 to 73 years) with the diagnosis of bronchiectasis who underwent pulmonary resection in our clinic were retrospectively analyzed. Demographic and clinical characteristics of the patients, etiologies, symptoms, localizations, surgical procedures, and long-term follow-up results were evaluated. Results: There were 1,394 surgeries, as 37 (2.7%) patients had bilateral disease. The surgical procedures included lobectomy (n=702, 50.3%), pneumonectomy (n=183, 13.1%), segmental resections (n=114, 8.2%), bilobectomy (n=83, 6.0%), and lobectomy + segmentectomy (n=312, 22.4%). During the postoperative period, 1,269 (93.5%) patients were followed at a mean duration of 51.6 (range, 1 to 120) months. After surgery, 774 (61%) patients were asymptomatic, 456 (35.9%) showed an improvement, and 39 (3.1%) had no response or deterioration. Conclusion: The surgical treatment plays an important role in the clinical and symptomatic improvement of patients with bronchiectasis. Surgery reduces the morbidity and mortality rates with careful preoperative preparation and appropriately selected cases.

OBJECTIVES The objective was to describe changing patterns of etiological factors and treatment modalities for massive hemoptysis. MATERIAL AND METHODS From January 2008-December 2012, the medical records of 58 massive hemoptysis patients were reviewed. RESULTS Fifty-eight patients, 44 were men (75.9%) and 14 were women (24.1%), with a mean age of 51.4 years (range= 19-84 years), were divided into three groups; surgical management (n= 37, 63.8%), conservative management (n= 14, 24.1%) and bronchial artery embolization (n= 6, 10.4%). One case (1.7%) had combined treatment modality; bronchial artery embolization was followed by surgical resection. Anatomical lung resections were the most preferred resection type in the surgical management group (n= 34, 91.9%). The most common etiological factor was bronchiectasis (n= 19, 32.8%); followed by bronchial cancer (n= 14, 24.1%). The duration of hospitalization in the surgical management group was 11.4 days (range= 4-24); whereas in the bronchial artery embolization group, hospitalization was only four days (range= 2-7) (p< 0.01). Prolonged air leak (n= 7; 18.9%) was the most common complication in the surgical management group. CONCLUSION We emphasize that bronchiectasis was leading cause of massive hemoptysis. Surgical treatment remains the definitive therapy in the management of massive hemoptysis with decreased mortality rates over decades; whereas bronchial artery embolization is an effective therapeutic tool.

Summary Background Diaphragm plication surgery is conducted to remove dyspnea, which results from mediastinal shift, atelectasia, and ventilation/perfusion dyssynchrony in lungs that occur because of an eventrated diaphragm. This study aims to determine whether diaphragm plication has any effect on respiration by analyzing the patients' changing values in the respiratory function test (RFT) after plication surgery. Methods Sixteen patients who underwent diaphragm plication surgery in our clinic because of plication eventration or paralysis were examined prospectively. Diaphragm eventration values were assessed using a calculation method that uses posteroanterior pulmonary radiographies taken during patient admission and control; then, these data were recorded. The amount of changes in the eventration levels and in restrictive respiratory failure parameters—forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC) of RFTs—conducted in pre- and postoperative control periods were compared using statistical analysis methods. The compatibility between the amounts of RFT changes was examined through a satisfaction survey—using a questionnaire that consisted of multiple choice questions with answer options such as "better," "the same," and "worse"—to understand preoperative and postoperative symptom levels in the 12 th month of postoperative control. Results According to postoperative levels, a decrease between 19% and 23% was observed in eventration amounts within the 1 st postoperative month, 6 th postoperative month, and 12 th postoperative month. In addition, the highest average increase in FEV1 liter (lt) values was 0.2 lt and 0.25 in FVC (lt) values. Conclusion Researchers of this study believe that more distinctive decisions need to be taken while identifying patients for surgery in unilateral diaphragm eventrations, especially in the adult patient group; surgical option should be used for cases in which the eventrated diaphragm results in mediastinal shift and respiratory failure.

Aim: There are many reports on the ingestion of foreign bodies in the esophagus; however, little is known about complete dentures as a risk factor. Material and Methods: We conducted a retrospective analyses of 11 adult patients treated for suspected esophageal foreign body between March 2008 to December 2012. Results: Out of 11 patients, 45.5% (n=5) were male and 54.5% (n=6) were female, and with the mean age of 47. Esophageal foreign bodies were found and retrieved or pushed into the stomach in all cases. Bones (n=9, 81.8%) were the most common ingested foreign body. Four patients (36.4%) had a history of using complete dentures and two patients (18.2%) had a single-tooth replacement. Of these patients, the most common location of the foreign body was in the first narrowing (n=7, 63.6%), followed by the mid-third (n=3, 27.3%). The duration of hospitalization ranged between 1 to 37 days (median: 3 days; mean: 6.3 days), one patient (9.1%) had a complication, an esophageal perforation. Conclusion: Edentulism is the result of repeated tooth extractions. It is estimated that 17% of the adult population has one-arc or two-arch edentulism and are candidates for complete dentures. Therefore, the fact that a finding of 36.4% of patients who were using complete dentures in esophageal foreign body patients greatly exceeds the general average. Thus, using complete dentures increases the frequency of esophageal foreign bodies and is one of the risk factors for such an occurrence.

Small cell osteosarcomas are very rare tumors which are classified as the component of Ewing's sarcoma family. Although the tumor generally is seen on long bones, short bone involvement is rare. Moreover, rib localization is quite uncommon and to the best of our knowledge, only one case has been reported so far. Herein, we described a case of rib-localized small cell osteosarcomas which was only presented with localized left sided pain. Resection surgery followed by adjuvant chemotherapy was performed. Clinico-pathological features and therapeutic approach are discussed in the light of the relevant literature.

Aim: In this study we aim to present differences of etiological factors and treatment procedures between primary and secondary spontaneous pneumothorax patients who were treated in our hospital. Material and Method: Pneumothorax patients who were hospitalized and treated in Ministry of Health Ankara Training and Research Hospital between January 2005 and December 2010 were retrospectively evaluated. Age, sex, etiological factor, treatment procedure, treatment duration and treatment results were detected. Results: Totally 260 pneumothorax patients were treated. 227 (87.3%) of patients were male while 33 (12.7%) were female. Average age was 27.038.65. 238 patients (91.5%) were treated with the diagnosis of primary spontaneous pneumothorax while 22 patients had (8.5%) secondary spontaneous pneumothorax. In the comparison of these two groups, significant differences were found in age, sex, cigarette smoking, complaint duration, treatment duration and recurrence ratios (p

Pneumothorax is the accumulation of air in the pleural space. Pneumothorax may occur spontaneously (primary spontaneous pneumothorax, PSP). Chest tube drainage (CTD) is the most common choice for treatment of PSP. This study aimed to evaluate patients treated with CTD, regarding demographic and diagnostic characteristics, and to compare the effectiveness of apical and axillary approaches. We retrospectively analyzed a total of 217 patients with PSP regarding symptoms, duration of complaints, and treatment procedures. There were 196 (90.3%) male patients and mean age was 25.22 ± 5.37 years. The approach of CTD was determined randomly; being performed with the apical approach on 93 (42.9%) and axillary on 124 patients (57.1%). There were no statistically significant differences between the two groups in terms of age, sex, BMI, collapse size, and complaint duration. However, a statistically significant relationship was determined between collapse size and leading symptoms where the significance was related to dyspnea (p0.001). This led to the thought that dyspnea increases with the increase of collapse size. The patients who were admitted to hospital in the later term when compared with others, had a larger collapse size (p0.001). This also led to the thought that collapse increases in relation to time due to late admission of patients. Hospitalization time was significantly shorter in patients who had apical CTD (p0.001). In conclusion, inserting the tube from the apex could shorten the treatment period.

Amac: Calismada, cerrahi yaklasimin kucuk hucreli akciger kanseri (KHAK) tedavisindeki onemi arastirildi ve cerrahi yaklasimla diger tedavi yontemlerinin bir araya getirilmesinin sagkalim uzerindeki muhtemel etkileri degerlendirildi. Ca­lis­ma­pla­ni:­Ocak 1998 Ocak 2008 tarihleri arasinda klinik ve radyolojik olarak malignite suphesi tasiyan, tanisal yontemler etkin olmadigi icin eksplorasyon amaci ile torakotomi uygulanan ve patoloji sonucu kucuk hucreli akciger kanseri olarak bildirilen 20 hasta (16 erkek, 4 kadin; ort. yas 58.3 yil; dagilim 41-76 yil) retrospektif olarak incelendi. Olgulara radikal lenf nodu diseksiyonu ile beraber, 10 ust lobektomi, iki alt lobektomi, alti pnomonektomi ve iki inferiyor bilobektomi yapildi. Tum olgular yas, cinsiyet, tani yontemleri, uygulanan ameliyatlar, ameliyat sonrasi takip ve sagkalim sonuclari ile degerlendirildi. Bul gu lar: Ameliyat sonrasi histopatolojik degerlendirme sonuclari kucuk hucreli akciger kanseri olarak bildirildi, 11 olguda miks tip tumor izlendi. Olgulardan besi evre 1, altisi evre 2, dokuzu evre 3 idi. Ameliyat sonrasi donemde tum olgulara kemoterapi ve nodal tutulumu olan olgulara radyoterapi uygulandi. Bes yilik sagkalim evre 1 ve 2 icin %76, evre 3 icin %13; N0 ve N1-2 olgular icin ise sirasiyla %86 ve %15 olarak hesaplandi. So­nuc:­Kucuk hucreli akciger kanseri de cerrahi tedavi erken evre (T1-2 N0) olgularda dusunulebilir. N2 varliginda cerrahi yaklasimdan kacinilmasi gerekmektedir. Cerrahi rezeksiyonun ardindan ameliyat sonrasi kemoterapi uygulanmalidir ve nodal metastazli olgularda mediastinal radyoterapi ilave edilmelidir. Anah tar soz cuk ler: Akciger kanseri; lenf nodu diseksiyonu; kucuk hucreli akciger kanseri; cerrahi. Background:­ This study aims to investigate the role of a surgical approach in the treatment of small-cell lung cancer (SCLC), and evaluate the possible effects of combining the surgical approach with other treatment modalities for survival. Methods: Twenty patients (16 males, 4 females; mean age 58.3 years; range 41 to 76 years) who had a clinical and radiological suspicion of malignancy, who underwent an exploratory thoracotomy since diagnostic methods proved ineffective, and whose pathological results were reported as SCLC between January 1998 and January 2008 were reviewed retrospectively. Ten upper lobectomies, two lower lobectomies, six pneumonectomies and two inferior bilobectomies were performed along with radical lymph node dissection. All cases were evaluated according to age, gender, diagnostic methods, the operations performed, postoperative follow-up and survival results. Results:­The results of the postoperative histopathological assessments were reported as small-cell lung cancer and mixed type tumors were observed in 11 cases. Five of the cases were stage 1, six were stage 2, and nine were stage 3. During the postoperative period all cases received chemotherapy, and radiotherapy was applied to the cases with nodal metastases. The five-year survival rate was calculated as 76% for stage 1 and 2 cases, 13% for stage 3 cases and 86% and 15% for N0 and N1-2 cases, respectively. Conclusion:­ Surgical treatment for SCLC can be considered in early stage (T1-2 N0) cases. In the presence of N2, a surgical approach should be avoided. Postoperative chemotherapy should be applied after surgical resection, and mediastinal radiotherapy should be added in cases with nodal metastasis.

Objective:Pulmonarycarcinoidtumors arerare low-grade malignant neoplasms andconstitute2—5% of all lung tumors. In this study, we aimed to determine the clinical presentations, types of surgery, long-term treatment outcomes and survival rates of patients diagnosed with carcinoid tumor treated surgically in our clinic. Methods: Patients operated in our clinic between 1992 and 2008 with confirmed or suspected diagnoses of carcinoid tumorswere includedin our study. Patients’ hospital records were retrospectively analyzed.Results:A total of 104 patients (age 19—71 years, mean 44 13 years, 2 SD) with pathologically confirmed carcinoid tumor were analyzed. A total of 84 patients (81%) were diagnosed as typical and the remaining 20 (19%) being atypical carcinoid tumor. As many as 24 patients (23%) were asymptomatic. The most frequent symptom was recurrent respiratory infection (35%). The most used surgical procedures were lobectomy (47%) and bilobectomy (16%). Mean postoperative follow-upperiodwas72months(6—190months).No surgeryrelatedmortalitywasnoticed.Asmanyas 15(14%)patientsdied duringthefollow-up period. Overall 5- and 10-year survival rates were 89% and 72%, respectively. For typical carcinoid tumors, the 5- and 10-year survival rates were 92% and 83%, and for atypical carcinoids 73% and 46%, respectively (p < 0.001). Conclusions: In our study, we noticed histological subtype, stage of the disease and the type of surgery performed to be prognostic factors of carcinoid tumors. Atypical carcinoid tumors tend to be more metastatic and had worse prognosis when compared with typical carcinoid tumors. We conclude that surgery is the best treatment of choice for carcinoid tumors, especially parenchyma-sparing procedures, because of their good mid- and long-term survival rates. # 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

Chyloptysis and chylomediastinum are uncommon complications of various kinds of thoracic operations, malign and nonmalign diseases. In the English language medical literature, there were no cases of both chylomediastinum and chyloptysis following trauma. We discuss a case of chylomediastinum and chyloptysis after penetrating trauma. The patient sustained a bullet wound that caused chylomediastinum and chyloptysis without damaging major structures apart from the thoracic duct in the mediastinum. Following surgical intervention, the patient has remained problem-free for 5 months.

Descending necrotizing mediastinitis (DNM) is a rare clinical condition associated with high risk morbidity and mortality rate. Early diagnosis, effective antibiotherapy, and surgical drainage constitute the main principle of management. We present our treatment strategy of two cases of DNM and compare our results with previous studies. We believe the treatment of this high mortality rate condition should include both mediastinal and pleural irrigation together with complete surgical drainage and debridement

Ectopic thyroid tumours arising in the mediastinum without connection to the cervical thyroid gland are very rare. Follicular adenoma, papillary carcinoma and follicular carcinoma in the mediastinum has been reported, but primary ectopic thyroid B cell lymphoma has riot been reported previously. We report mediastinal primary ectopic thyroid large B cell lymphoma in an 80-year-old man. Differential diagnosis from primary mediastinal large B cell lymphoma and clinicopathologic features are discussed

To the Editor, Diaphragm plication surgery is conducted to remove dyspnea, which results from mediastinal shift, atelectasia and ventilation/perfusion dyssynchrony in lungs that occur due to an eventrated diaphragm. A total of 16 cases that underwent diaphragm plication surgery in our clinic due to eventration or paralysis were examined prospectively. Diaphragm eventration values were calculated by means of a new calculation method through PA pulmonary radiographies taken during patient admission and control. Using PA pulmonary radiography, the distance between the peak of the intactus hemidiaphragm and apex point of the ipsilateral hemithorax was measured with this new method. Similarly, the distance between the peak of the eventrated hemidiaphragm and the apex point of ipsilateral hemithorax was measured. The ratio of distances and eventration level were calculated by percentage. Compared to preoperative values, a decrease was found in FEV1 (lt) values of three cases in the first month, four cases in the sixth month and six cases in the twelfth month of postoperative control. Compared to preoperative values, no change was found in FEV1 (lt) values of two cases in the first month, two cases in the sixth month and one case in the twelfth month of postoperative control. Compared to preoperative values, a decrease was found in FVC (lt) values of three cases in the first month, five cases in the sixth month and seven cases in the twelfth month of postoperative control. Compared to preoperative values, no change was found in FVC (lt) values of two cases in first month, one case in the sixth month and one case in the twelfth month of postoperative control (Table 1). TABLE 1. Comparing values of preoperative and postoperative respiratory function tests and symptomatology at postoperative twelfth month With regard to the plication operation in general, the first investigation for the indication of an operation was made by Svanberg in 1956. Since then, it has been argued whether repair of the diaphragm at the lower levels with plication is functional or not (1). Mulvey et al. (2) followed 12 cases for two to four years and no clear change was found in the spirometric measurements of pulmonary volumes. According to research investigating 17 diaphragm plication cases in a wide and long follow-up period, which was reported at the 2006 EACTS/ESTS congress, it was found that the postoperative mean FEV1 value was 71%, which was an increase from 64% in the preoperative period (3). In the present study, an increase was found in RFT values in nine (56.2%) cases compared to the preoperative values. However, considering that the mean increase was 0.09 lt for FEV1 and 0.13 lt for FVC, it is evident that discussions on the indication of diaphragm plication operation are justified. We believe that more selective decisions should be taken when determining whether patients are appropriate for surgery in unilateral diaphragm eventrations and especially in the adult patient group; plication operations should not be used for low-level diaphragm eventrations which do not result in mediastinal shift.

As the liver and the lungs are the most common sites for hydatid cysts, a primary mediastinal involvement is quite rare. The symptoms related to primary mediastinal hydatid cysts usually depend on the size, location and com- pression to nearby structures. Presenting a 51-year-old male patient with the symptoms of Horner's Syndrome, we draw attention to a rare complication of a giant primary mediastinal hydatid cyst and its challenging management.

Background Conventional treatment methods in postpneumonectomy empyemas (PPE) are associated with long stay in hospital, poor patient comfort, and high rate of postoperative mortality. Vacuum-assisted management (VAM) may be helpful in solving these problems. Methods VAM was performed on nine patients with PPE in our clinic between July 2010 and September 2011 to provide continuous drainage of empyema in the pouch and to improve empyema with obliteration of the pouch by accelerating tissue granulation. Results All nine patients were men (mean age: 54.5 years; range: 18–68 years). Empyema resolution and obliteration of the pouch were achieved with VAM in the cases with empyema without fistula (n = 7) after the pneumonectomy. In the patients with fistula (n = 2), VAM was performed after closure of the fistula. Mean duration of hospital stay was 36.5 (12–57) days. The treatment was successful in eight of nine patients (88.9%). Mean duration of follow-up in the successfully treated patients was 10.9 (3–17) months. Conclusion Intrathoracic VAM was effective and safe in the treatment of PPE.

Background Hemangiopericytoma, an uncommon hypervascular tumor, occurs anywhere in the body with capillary vessels originating from the pericyte. These tumors most frequently occur in the musculature of the lower extremities and retroperitoneum, but are rarely seen in the thoracic cavity. The objective of this study is to present primary classical hemangiopericytomas of the thorax together with a literature review. Methods The postoperative pathologic records of 17,165 operations that were performed between January 1990 and December 2010 in the clinic were retrospectively searched, and the files of 6 cases with the diagnosis of primary classical hemangiopericytoma were analyzed for clinical characteristics of patients, surgical procedures, histopathologic features, treatments after surgery, and morbidity and mortality results. Results There were 4 female and 2 male patients with an average age of 30.3 years (range, 15 to 60 years). Three patients had thoracic wall lesions, 2 patients had intrathoracic extrapulmonary lesions, and 1 patient had mediastinal lesion. Four left and two right posterolateral thoracotomies were performed. Chest wall resection was performed in 3 patients, intrathoracic extrapulmonary mass excision in 2 patients, and mediastinal mass excision and left lower lobectomy in 1 patient. Postoperative histopathologic diagnoses were primary classical hemangiopericytomas in 4 patients and primary classical malignant hemangiopericytomas in 2 patients. Four patients underwent reoperation for recurrence. In the follow-up period, 2 patients are still alive at 30 months and 14 years postoperatively; 3 patients died at 7, 8, and 16 years postoperatively. One patient was lost to follow-up. All 3 mortalities were related to the recurrence or distant metastasis of the tumor. Conclusions Although hemangiopericytomas are benign or malignant tumors, they generally display malignant behaviors. The risk of recurrence and distant metastasis occurs even many years after resection, suggesting that the prognosis becomes worse after each recurrence.

Objectives: This study is conducted to show the relationship between visceral pleural, lymphovascular, and perineural invasion, and other clinicopathologic characteristics and their significance as prognostic factors. Methods: The clinicopathologic characteristics of 289 patients who underwent a potentially curative surgical resection between 2000 and 2009 in our clinic were reviewed retrospectively. The prognostic factors were then evaluated by univariate and multivariate analysis. The patients who were given neoadjuvant-adjuvant chemotherapy and/or radiotherapy and who died due to postoperative mortality were excluded. Data from 188 patients were analyzed. Results: Out of the 188 patients (108 diagnosed as adenocarcinoma and 80 squamous cell carcinoma), 66 patients had lymphovascular invasion, 53 patients had perineural invasion, and 92 patients had visceral pleural invasion. Visceral pleural invasion was related with T factor, tumor histology, dimension, stage, and differentiation. Lymphovascular invasion was related with N status and stage. Perineural invasion was observed more frequently in tumors with moderate/poor differentiation. Visceral pleural and lymphovascular invasion were found to be poor prognostic factors but we could not show statistically meaningful effect of perineural invasion on survival. Conclusion: The presence of visceral pleural or lymphovascular invasion can show higher risk of mortality whereas perineural invasion has no effect on prognosis. (C) 2011 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

WOS: 000293479500035 …

Fig. 1. (A) The posteroanterior chest X-ray demonstrating a homogenous mass residing in the middle and inferior zones of the right hemithorax. (B) Thoracoabdominal magnetic resonance scan (T2 weighted coronal view) depicting a hyperintense lobulated paravertebral mass lesion in the right hemithorax, infiltrating both the thoracal and the abdominal cavities, and extending laterally along the diaphragm.

* Corresponding author. Address: Kardelen mahallesi Mobilyacilar sitesi, 482/19 Batikent, Ankara, Turkey. Tel.: C90-312-3801031; fax: C90-3122568136. E-mail address: mehmetsirmali@yahoo.com (M. Sirmali). the thorax depicted the mass lesion 5!6!7.5 cm in dimensions, including multiple septal formations in the location of left first rib (Fig. 1B). The left first rib was resected en bloc with the adjacent soft tissues via left posterior thoracotomy. Postoperative pathological evaluation was consistent with aneurysmal bone cyst (Fig. 2). European Journal of Cardio-thoracic Surgery 26 (2004) 826–827 www.elsevier.com/locate/ejcts

A 54-year-old man was seen with massive hemoptysis. A posteroanterior chest radiograph revealed increased bronchovascular branching in the left hemithorax. Thoracic computed tomography showed a well-demarcated mass with uniform density confined to the apicoposterior and anterior segments of the left upper lobe. Fiberoptic bronchoscopy revealed a locus of bleeding in the apicoposterior segment of that lobe. Exploratory left thoracotomy confirmed the presence of a mass. The results of frozen section examination of a biopsy specimen were benign. The mass was resected by upper lobectomy. The definitive result of histopathological study of the mass was cavernous hemangioma. Very few cases of pulmonary hemangioma have been reported in the literature.