The knockdown of stathmin with si-RNA inhibits invasion of mesothelioma.

BACKGROUND: To investigate the mechanism of action of stathmin1 (STMN1) in mesothelioma (MSM) and whether it has any role in its treatment. METHODS: STMN1 expression was examined using immunohistochemistry in biopsy tissues taken from MSM patients. The relationships between the levels of STMN1 expression in the pathology preparations of MSM patients, and the clinicopathological characteristics of these patients, and their survival times were investigated. Transfection of STMN1-specific siRNA into SPC212 cells was compared to negative control siRNAs. The mRNA levels of genes that may play a role in invasion, apoptosis, and autophagy were evaluated by RT-PCR. RESULTS: The expression of STMN1 was shown to be high in MSM tissues (p < 0.05). It was found that the only independent predictor factor affecting the survival time of MSM patients was the disease stage (p < 0.05). STMN1 was significantly reduced after siRNA intervention (81.5%). STMN1 with specific siRNA has been shown to suppress invasion by reducing the mRNA levels of cadherin-6 (CDH6), fibroblast growth factor-8 (FGF8), hypoxia-inducible factor 1 (HIF1A), matrix metallopeptidase 1-2 (gelatinase A) (MMP1-2), and TIMP metallopeptidase inhibitor 2 (TIMP2), which are important markers for invasion. Although the expression of apoptosis and autophagy-related genes, caspase-2 (Casp2) and LC-3, was reduced by silencing STMN1 with specific siRNA in western blot analysis, this effect was not observed in PCR results. CONCLUSIONS: Immunohistochemical analysis of STMN1 may contribute to the differential diagnosis of MSM, and STMN1 may also be considered as a potential therapeutic target in the early invasive stage of MSM therapy.

How can we use positron emission tomography/computed tomography more accurately for characterization of asbestos-related pleural thickening?

Introduction: There is no consensus about the standardized uptake value maximum (SUVmax) cut-off value to characterize pleural thickening worldwide. Sometimes, this causes unnecessary invasive diagnostic procedures. Our first aim is to determine a cut-off value for SUVmax. Secondly, we try to answer the following question: If we use this cut-off value together with morphological parameters, can we differentiate benign thickening from malignant pleural mesothelioma (MPM) more accurately? Material and methods: Thirty-seven patients who underwent 2-deoxy-2-fluoro-D-glucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) before pleural biopsy were included the study. All of patients had histopathologically proven primary pleural disease. Their [18F]FDG-PET/CT imaging reports were re-assessed. If a patient's SUVmax or size of the thickening was not mentioned in the report, we calculated it with their [18F]FDG-PET/CT. Results: Age, pleural effusion, size, and SUVmax were found to have a relationship with MPM. We found the size > 14 mm, and SUVmax > 4.0 as cut-off values for MPM. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for size > 14 mm were found to be 86.4%, 85.2%, 82.6%, 88.5%, respectively. For SUVmax > 4.0, sensitivity, specificity, PPV, NPV were 90.9%, 87.0%, 85.1%, 92.2%, respectively. Conclusions: If a patient has SUVmax > 4.0 and/or size > 14 mm, the risk of MPM is high. These patients should undergo biopsy. If a patient's SUVmax < 4.0, size < 14 mm and does not have pleural effusion, he/she has low risk for MPM. These patients can undergo the follow-up. If a patient's SUVmax < 4, size < 14, and has pleural effusion the MPM risk is approximately 4%. These patients can undergo biopsy/cytology/follow-up. Novel studies are needed for these patients.

Characteristics of the patients undergoing surgical treatment for pneumothorax: A descriptive study.

OBJECTIVE: To identify the characteristic features of pneumothorax patients treated surgically. METHODS: The retrospective study was conducted at Gazi Yasargil Education and Research Hospital Thoracic Surgery Clinic, Diyarbakir, Turkey and comprised records of pneumothorax patients from January 2004 to December 2014. They were divided into two groups as spontaneous and traumatic. Patients who had not undergone any surgical intervention were excluded. Mean age, gender distribution, location of the disease, type of pneumothorax, and treatment method were noted. Among patients with spontaneous pneumothorax, age and months distribution, smoking habits, pneumothorax size, and treatment method were assessed. The effect of gender, location, comorbid disease, smoking, subgroup of disease, and pneumothorax size on surgical procedures were also investigated. RESULTS: The mean age of the 672 patients in the study was 34.5±6.17 years. There were 611(91%) men and 61(9%) women. Disease was on the right side in 360(53.6%) patients, on the left side in 308(45.8%), and bilateral in 4(0.59%). Besides, 523(77.8%) patients had spontaneous, and 149(22.7%) had traumatic pneumothorax. Overall, 561(83.5%) patients had been treated with tube thoracostomy, whereas 111(16.5%) were treated with thoracotomy/thoracoscopic surgery. The presence of comorbid diseases, being primary, and being total or subtotal according to partial were found to create predisposition to thoracotomy/ thoracoscopic surgery (p<0.05 each). CONCLUSIONS: In the case of pneumothorax being total, the presence of comorbid diseases, and the increase in pneumothorax size, thoracotomy or thoracoscopic surgery is preferred.

Analysis of Patients with Spontaneous Pneumomediastinum.

OBJECTIVES: Spontaneous pneumomediastinum is characterized by the presence of air in the mediastinum without any reason. The objective of this study is to report our experience in the diagnosis and treatment of this clinical condition. MATERIAL AND METHODS: 21 patients with spontaneous pneumomediastinum who were referred to our clinic between January 2010 and May 2015 were evaluated retrospectively. The presence of radiological pneumomediastinum and the absence a traumatic cause were taken as the basic criterion. RESULTS: The mean age of the patients was 24.78 ± 4.37 years. Thirteen patients were male, eight patients were female. The main complaints of the patients were chest pain, dyspnea, neck pain, sore throat and cough. Thirteen patients were smokers. Seven patients had a prior history of asthma, five patient had chronic bronchitis and one patient had cronic obstructive lung diseases. No precipitating factor was identified in 9 patients. While initial complaints was associated with physical effort in 7 patients, three patients cough and two patients had a history of severe crying. Pneumomediastinum was diagnosed by chest radiography in 8 patients, and with chest CT in 13 patients. All the patients were performed bronchoscopy and radiograph of esophagus. Electrocardiogram was taken for all patients. Arrhythmia was detected in 4 of the patients. Treatment included analgesia, rest and oxygen therapy. Mortalitiy and morbidity were not seen. The mean length of hospital stay was 4.4 ± 2.17 days. CONCLUSION: Spontaneous pneumomediastinum is a benign process. Despite its low incidence, it should be considered in the differential diagnosis of acute chest pain.

Study of 433 Operated Cases of Thoracic Trauma.

Patients with thoracic trauma constitute one third of all the trauma cases. Of traumatic patients, 20-25 % die because of thoracic trauma. Our aim was to compare our clinical experience and the results with the related literature. Four hundred thirty-three patients, who underwent surgical interventions due to thoracic trauma, were evaluated. The latest form of treatment applied were taken as the criteria for the quantitative detection of patients. Continuous variables were expressed as mean ± standard deviation, while categorical variables were explained as number and percentage. The significance of the analysis results was evaluated using Fisher's exact test. p values <0.05 were considered as significant. Penetrating injuries were found in 258 (59 %) of the patients, and blunt trauma was identified in 175 (41 %). Depending on the trauma, pneumothorax was discovered in 130 patients (30.02 %), hemothorax in 117 (27.02 %), hemopneumothorax in 61 (14.08 %), pulmonary contusion in 110 (45 %), pneumomediastinum in 14 (3.23 %), and pericardial tamponade in 1 patient (0.23 %). It was demonstrated that 385 of 433 patients examined in the study underwent tube thoracostomy, 41 were treated with thoracotomy, while 6 of them underwent video-assisted thoracoscopic surgery (VATS), and 1 underwent sternotomy. No correlation was observed between mortality, morbidity, and gender and type of trauma and location of trauma (p > 0.05). However, statistically significant correlation was found between mortaxlity, morbidity, and the presence of concomitant injuries, the duration between injury and admission being more than 1 h (p < 0.05). Urgent intervention, early diagnosis, and fast transport are vital for patients with thoracic injuries.

Multiple cystic pulmonary chondroid hamartomas colonized by Aspergillus species: report of a case.

Pulmonary hamartoma is the most common benign neoplasm of the lung, but the cystic form is very rare. This report presents the case of a 31-year-old woman with two cystic pulmonary lesions. She was radiologically and clinically diagnosed to have multiple ruptured hydatid cysts, and underwent a thoracotomy. The pathological investigation revealed that these lesions were cystic chondroid hamartomas, and one of the cysts was colonized by Aspergillus. Multilocular pulmonary cystic hamartomas are exceptionally rare and should be differentiated from other cystic pulmonary lesions. This is the first case of cystic pulmonary hamartomas colonized by Aspergillus species.

Predictors of mortality within three months in the patients with malignant pleural effusion.

BACKGROUND: Malignant pleural effusion (MPE) has a limited life expectancy (3-12 months). We investigated the predictors of the early mortality (EM) within three months. METHODS: The patients were retrospectively grouped according to the death within three months (Group I) and survival more than three months (Group II). Demographical, clinical, and biochemical parameters in the fluid were analysed to determine their effects on the EM. The 30-day response rate of talc pleurodesis was investigated. RESULTS: The study included 85 patients (Group I/Group II=40/45). The patients in Group I died within a median of 28 days. Twenty-six patients in Group II died in a median of 205, but 19 were still alive (median 200 days). The median survival was longer in renal cell, colorectal, breast, liver, ovarian and oropharynx carcinoma, and mesothelioma. Sixty-two patients (63%) underwent talc pleurodesis, which prevented the fluid reaccumulation (p=0.04). The significant factors of the EM in the univariate analysis were the presence of high-risk tumors (lung, stomach, soft tissue, bladder, esophagus, prostate, cervix, and lymphoma), the low Karnofsky performance score (KPS) (p<0.0001), the low pH value of the fluid (p=0.05), and the low concentration of glucose (p=0.01), total protein (p<0.0001), and albumin (p<0.0001) in the fluid. According to the multivariate analysis high-risk tumors (p=0.03), a lower KPS (p<0.001), and glucose value (p=0.04) were the predictors of the EM. CONCLUSION: Talc pleurodesis prevents the fluid reaccumulation. High-risk tumors, a poor performance status, and lower pleural fluid glucose concentration are predictors of the EM within three months in the patients with a MPE.

Thoracotomy in Thoracic Injuries: Results from a Tertiary Referral Hospital.

INTRODUCTION: Critically injured patients may require thoracotomy after a thoracic injury. This study is a retrospective analysis of the results of thoracotomy in patients with thoracic injury. MATERIALS AND METHODS: Injured patients with detectable signs of life on arrival at the hospital and who underwent thoracotomy within 4 h of the injury were investigated. Demographic data and medical records were reviewed for associated injuries, indications, intraoperative findings, and outcomes. The factors affecting the mortality were analyzed. RESULTS: Between April 2003 and January 2009, 488 patients with thoracic injury (blunt/penetrating = 73.7%/26.3%) were treated, and 20 (4.1%) underwent thoracotomy (male/female = 17/3, mean age = 27 ± 9 years). The injury was penetrating in 15 (11.7%) and blunt in five (1.4%). None of them required an endotracheal intubation at the scene or in transit. The mean transport time was 58 min. Severe and continuous hemothorax (80%), massive air leak, major vessel injury, and trauma causing an open chest wall defect with bleeding were indications of the thoracotomy. Eighty-five percent survived after the surgery (penetrating/ blunt = 86.6%/80%). The mean injury severity score (ISS) of the survivors was lower (21 ± 9 vs. 39 ± 10, p = 0.05). Mortality was associated with a lower Glasgow coma scale (GCS) (p = 0.03), a higher ISS (p = 0.05), and a longer transport time (p = 0.05). CONCLUSIONS: Thoracotomy after thoracic injury is a life-saving procedure in selected cases. Lower GCS and higher ISS are associated with increased mortality. Early transport and quick attempts to diagnose the indications necessitating thoracotomy play a significant role in improving the outcome.

[Case report: secondary pleural hydatidosis].

Hydatid cyst has a predilection to locate in liver, lungs, and brain. Intrathoracic extrapulmonary locations are generally the mediastinum, pleura, pericardium and chest wall. Pleural involvement usually follows the rupture of a pulmonary or hepatic cyst inside the pleural space causing secondary pleural hydatidosis. Radiological investigations of a patient suffering from cough and dyspnea revealed multiple cysts located in the posterior lower right hemithorax, and implanted in the diaphragmatic pleura and parietal pleura lining the chest wall. He had undergone two hepatic hydatid cystectomy operations. These multiple cysts were removed by thoracotomy. The possibility of secondary pleural dissemination should be considered in patients with lobulated cystic masses as well as a previous hepatic cystic hydatid disease.

Case report: mediastinal hydatid cysts.

Although the intrathoracic location is common for hydatid cyst, chest-wall, mediastinal, pericardial, myocardial, fissural and pleural-space locations have been reported. The incidence of mediastinal involvement is 0.1-0.5%. Here in this paper, two cases of mediastinal hydatid cysts are reported. Both of them had anterior mediastinal hydatidosis, while one of the patients had also additional three pericardial hydatid cysts. They have undergone thoracotomy for the removal of cystic lesions. Hydatid cysts should be considered in the differential diagnosis of mediastinal cystic lesions especially in the endemic regions. Surgical removal is the treatment of choice for mediastinal hydatid cysts, and additional medical therapy may avoid recurrence.