Diagnosis of Pulmonary Artery Sarcoma with Multi-modality Imaging.

Pulmonary artery sarcoma is an extremely uncommon malignancy with a poor prognosis. It is often difficult to distinguish it from pulmonary thromboembolic disease because of nonspe cific signs and symptoms as well as similar imaging findings. We present a 46-year-old man who had initially been diagnosed with presumed asthma that later proved to be pulmonary artery sarcoma. The patient was evaluated with multi-modality imaging studies which showed a mass in the pulmonary artery, its extension, mobility and invasion, and attachment to the artery wall. Pulmonary artery mass was excised and pulmonary artery endarterectomy was performed. The histopathological diagnosis was undifferentiated sarcoma with pleomorphic morphology.

Delayed chest closure for oversized lung allograft in lung transplantation: a retrospective analysis from turkey

Abstract Introduction: The aim of this study was to evaluate the delayed chest closure (DCC) results in patients who underwent lung transplantation. Methods: Sixty patients were evaluated retrospectively. Only bilateral lung transplantations and DCC for oversized lung allograft (OLA) were included in the study. Six patients who underwent single lung transplantation, four patients who underwent lobar transplantation, two patients who underwent retransplantation, and four patients who underwent DCC due to bleeding risk were excluded from the study. Forty-four patients were divided into groups as primary chest closure (PCC) (n=28) and DCC (n=16). Demographics, donor characteristics, and operative features and outcomes of the patients were compared. Results: The mean age was 44.5 years. There was no significant difference between the demographics of the groups (P>0.05). The donor/recipient predicted total lung capacity ratio was significantly higher in the DCC group than in the PCC group (1.06 vs. 0.96, P=0.008). Extubation time (4.3 vs. 3.1 days, P=0.002) and intensive care unit length of stay (7.6 vs. 5.2 days, P=0.016) were significantly higher in the DCC group than in the PCC group. In the DCC group, postoperative wound infection was significantly higher than in the PCC group (18.6% vs. 0%, P=0.19). Median survival was 14 months in all patients and there was no significant difference in survival between the groups (16 vs. 13 months, P=0.300). Conclusion: DCC is a safe and effective method for the management of OLA in lung transplantation.

Donor selection for lung transplant in Turkey: Is it necessary to wait for an ideal donor?

BACKGROUND: The aim of this study was to evaluate the donor criteria used in lung transplantation in our clinic. METHODS: A total of 55 cadaveric donors who were accepted for lung transplantation in our clinic between December 2016 and January 2019 were retrospectively analyzed according to ideal donor criteria. The donors were divided into two groups as ideal and non-ideal ones according to their age, partial pressure of oxygen in arterial blood, history of smoking, and ventilation day. Donor data, recipient characteristics and survival outcomes were evaluated. RESULTS: Of 55 donors accepted for lung transplantation, 24 (43.7%) were ideal and 31 (56.3%) were non-ideal donors. The 90-day mortality and one-year survival rates were not significantly different between the two groups. The 90-day mortality was 25% in the ideal group and 22.6% in the non-ideal group (p=0.834). The one-year survival rates after lung transplantation were 64.5% versus 70.6% in the ideal and non-ideal groups, respectively (p=0.444). CONCLUSION: The whole clinical picture should be evaluated before accepting or rejecting donors for lung transplantation. The use of lung donors that do not meet the ideal criteria does not impair short- and mid-term results, compared to ideal lung donors. Strict implementation of donor criteria may prevent using suitable donors for lung transplantation. Use of non-ideal donors can reduce waiting list mortality.

Effect of long noncoding RNAs on epithelial-mesenchymal transition in A549 cells and fibrotic human lungs.

Long noncoding RNAs (LncRNAs) regulate epithelial-mesenchymal transition (EMT). EMT involves myofibroblast differentiation and pulmonary fibrosis (PF). We aimed to determine the expression profiles of HOTAIR, CARLo-5, and CD99P1 LncRNAs in EMT-mediated myofibroblast differentiation in A549 cells and fibrotic human lungs and to explain their roles. A group of A549s was stimulated with transforming growth factor ß (TGF-ß; 5 ng/ml) to induce EMT. The remaining A549s were incubated with 20 µM FH535 after 24 h of TGF-ß treatment to inhibit EMT. A549s were collected at 0, 24, 36, and 48 h. Expressions of three LncRNAs and protein/genes related to EMT, myofibroblast differentiation, and PF were assayed by quantitative reverse-transcription polymerase chain reaction and Western blot analysis in A549s and fibrotic human lungs. The targets of three LncRNAs were investigated by bioinformatics methods. TGF-ß stimulation resulted in increased expressions of three LncRNAs, ACTA2, COL1A1, SNAI1, CTNNB1, TCF4, LEF1, α-SMA, and active-ß-catenin, and decreased E-cadherin at 24, 36, and 48 h in A549s. FH535 treatment regressed these alterations. But it increased HOTAIR expression at 36 h and did not increase E-cadherin at 48 h. Fibrotic human lungs were characterized by increased expressions of HOTAIR, CARLo-5, CD99P1, and miR-214, decreased expressions of miR-148b, miR-218-1, miR-7-1, and the presence of CARLo-5 and CD99P1 in HDAC1-LncRNAs coprecipitation products, but not HOTAIR. Bioinformatic analysis showed the interactions of three LncRNAs with both proteins and at least 13 microRNAs related to EMT and PF. In conclusion, HOTAIR, CARLo-5, and CD99P1 can regulate EMT-mediated myofibroblast differentiation through interacting with proteins and miRNAs associated with EMT and PF. These LncRNAs can be considered as potential targets to decrease EMT for treating PF.

Delayed Chest Closure for Oversized Lung Allograft in Lung Transplantation: a Retrospective Analysis from Turkey.

INTRODUCTION: The aim of this study was to evaluate the delayed chest closure (DCC) results in patients who underwent lung transplantation. METHODS: Sixty patients were evaluated retrospectively. Only bilateral lung transplantations and DCC for oversized lung allograft (OLA) were included in the study. Six patients who underwent single lung transplantation, four patients who underwent lobar transplantation, two patients who underwent retransplantation, and four patients who underwent DCC due to bleeding risk were excluded from the study. Forty-four patients were divided into groups as primary chest closure (PCC) (n=28) and DCC (n=16). Demographics, donor characteristics, and operative features and outcomes of the patients were compared. RESULTS: The mean age was 44.5 years. There was no significant difference between the demographics of the groups (P>0.05). The donor/recipient predicted total lung capacity ratio was significantly higher in the DCC group than in the PCC group (1.06 vs. 0.96, P=0.008). Extubation time (4.3 vs. 3.1 days, P=0.002) and intensive care unit length of stay (7.6 vs. 5.2 days, P=0.016) were significantly higher in the DCC group than in the PCC group. In the DCC group, postoperative wound infection was significantly higher than in the PCC group (18.6% vs. 0%, P=0.19). Median survival was 14 months in all patients and there was no significant difference in survival between the groups (16 vs. 13 months, P=0.300). CONCLUSION: DCC is a safe and effective method for the management of OLA in lung transplantation.

Lung transplantation for graft-versus-host disease after allogeneic stem cell transplantation: A report of two cases.

Allogeneic peripheral stem cell transplantation is an effective treatment of malignant and non-malignant hematological diseases. However, it is associated with several complications, such as graft-versus-host disease, and also various complications involving different organ systems. Late-onset non-infectious lung complication is one of them. This pathology may also affect the different anatomical regions in the lung as parenchymas, bronchi, or vessels and may manifest with different clinical presentations. Lung transplantation can be an effective treatment in patients with pulmonary complications after allogeneic stem cell transplantation and also in patients who do not respond to treatment adequately and with a limited life expectancy. Herein, we report two rare cases who underwent lung transplantation after allogeneic stem cell transplantation.

Vitamin D modulates E-cadherin turnover by regulating TGF-ß and Wnt signalings during EMT-mediated myofibroblast differentiation in A459 cells.

Vitamin D (VitD) has an anti-fibrotic effect on fibrotic lungs. It reduces epithelial-mesenchymal transition (EMT) on tumors. We aimed to investigate target proteins of VitD for the regression of EMT-mediated myofibroblast differentiation. A group of A549 cells were treated with 5 % cigarette smoke extract (CSE) and 5 %CSE + TGF-ß (5 ng/ml) to induce EMT. The others were treated with 50 nM VitD 30 min before %5CSE and TGF-ß treatments. All cells were collected at 24, 48 and 72 h following 5 %CSE and TGF-ß administrations. The expression of p120ctn and NEDD9 proteins acted on E-cadherin turnover in addition to activations of TGF-ß and Wnt pathways were examined in these cells and fibrotic human lungs. CSE and TGF-ß induced EMT by reducing E-cadherin, p-VDR, SMAD7 and DKK1, increasing α-SMA, p120ctn, Kaiso, NEDD9 and stimulating TGF-ß and Wnt/ß-catenin signalings in A549 cells. VitD administration reversed these alterations and regressed EMT. Co-immunoprecipitation analysis revealed p-VDR interaction with ß-catenin and Kaiso in fibrotic and non-fibrotic human lungs. VitD pre-treatments reduced TGF-ß and Wnt/ß-catenin signalings by increasing p-VDR, protected from E-cadherin degradation and led to the regression of EMT in A549 cells treated with CSE and TGF-ß. Finally, VitD supplementation combined with anti-fibrotic therapeutics can be suggested for treatment of pulmonary fibrosis, which may be developed by smoking, in cases of VitD deficiency.

Combined Off-Pump Coronary Artery Bypass Grafting and Lung Resection in Patients with Lung Cancer Accompanied by Coronary Artery Disease.

INTRODUCTION: Optimal surgical approach for the treatment of resectable lung cancer accompanied by coronary artery disease (CAD) remains a contentious issue. In this study, we present our cases that were operated simultaneously for concurrent lung cancer and CAD. METHODS: Simultaneous off-pump coronary artery bypass surgery (OPCABG) and lung resection were performed on 10 patients in our clinic due to lung cancer accompanied by CAD. Demographic features of patients, operation data and postoperative results were evaluated retrospectively. RESULTS: Mean patient age was 63.3 years (range 55-74). All patients were male. Six cases of squamous cell carcinoma, three of adenocarcinoma and one case of large cell carcinoma were diagnosed. Six patients had single-vessel CAD and 4 had two-vessel CAD. Three patients underwent OPCABG at first and then lung resection. The types of resections were one right pneumonectomy, three right upper lobectomies, one right lower lobectomy, three left upper lobectomies, and two left lower lobectomies. Reoperation was performed in one patient due to hemorrhage. One patient developed intraoperative contralateral tension pneumothorax. One patient died due to acute respiratory distress syndrome at the early postoperative period. CONCLUSION: Simultaneous surgery is a safe and reliable option in the treatment of selected patients with concurrent CAD and operable lung cancer.

Combined off-pump coronary artery bypass grafting and lung resection in patients with lung cancer accompanied by coronary artery disease

Abstract Introduction: Optimal surgical approach for the treatment of resectable lung cancer accompanied by coronary artery disease (CAD) remains a contentious issue. In this study, we present our cases that were operated simultaneously for concurrent lung cancer and CAD. Methods: Simultaneous off-pump coronary artery bypass surgery (OPCABG) and lung resection were performed on 10 patients in our clinic due to lung cancer accompanied by CAD. Demographic features of patients, operation data and postoperative results were evaluated retrospectively. Results: Mean patient age was 63.3 years (range 55-74). All patients were male. Six cases of squamous cell carcinoma, three of adenocarcinoma and one case of large cell carcinoma were diagnosed. Six patients had single-vessel CAD and 4 had two-vessel CAD. Three patients underwent OPCABG at first and then lung resection. The types of resections were one right pneumonectomy, three right upper lobectomies, one right lower lobectomy, three left upper lobectomies, and two left lower lobectomies. Reoperation was performed in one patient due to hemorrhage. One patient developed intraoperative contralateral tension pneumothorax. One patient died due to acute respiratory distress syndrome at the early postoperative period. Conclusion: Simultaneous surgery is a safe and reliable option in the treatment of selected patients with concurrent CAD and operable lung cancer.

The bronchial obstruction as a complication of endovascular repair of aortic pseudoaneurysm in Behçet's disease.

Behçet's disease (BD) is an autoimmune disorder affecting multiple organs. Aortic pseudoaneurysm is the most catastrophic lesion in BD. This lesion type is considered as a complicated and challenging pathology by surgeons because of the technical operative difficulties and frequent recurrence. So, the endovascular repair of inflammatory aortic pseudoaneurysm has been used as an alternative to open surgical repair. It is particularly important in patients who are high-risk surgical candidates because of comorbidities. In this report, we present a case and treatment of bronchial obstruction, which caused progressive dyspnea after endovascular repair of aortic rupture, in patient with known history of BD.

Video-assisted thoracoscopy for spontaneous pneumothorax after pneumonectomy.

In this paper, we present 3 patients who had previously undergone pneumonectomy and then presented with a spontaneous pneumothorax. The indication for pneumonectomy was tuberculosis and NSCLC in 2 and 1 patient, respectively. The interval between the surgery and development of pneumothorax was 2, 4, and 11 years. On admission, 2 of the 3 patients were in extreme respiratory distress requiring urgent chest tube insertion. In all patients we undertook elective video-assisted thoracoscopy with complete preparation for cardiopulmonary support on the side. Bullectomy and/or diathermy ablation for apical bullae and blebs were performed concomitantly with total parietal pleurectomy. The postoperative course was uneventful in the patients, and they remain on routine follow-up for up to 6-12 months without any complaints. Our experience suggests that emphysematous changes in the remaining lung should be carefully inspected during long-term follow-up after pneumonectomy. Video-assisted thoracoscopic (VAT) pleurectomy appears to be a good option for the management of spontaneous pneumothorax only if it is performed by a dedicated multidisciplinary team with various cardiopulmonary support facilities on the side.

Squamous cell carcinoma in a postpneumonectomy cavity.

A 55-year-old woman was referred to our department with the diagnosis of a bronchopleural fistula and empyema. Her medical history revealed that she had undergone a left pneumonectomy 25 years prior due to a destroyed lung associated with tuberculosis. Open drainage and a biopsy was performed because of the large mass detected on thoracic computed tomography. Postoperative pathology revealed squamous cell carcinoma.