The Diagnostic Value of Pericardial Fluid and Pericardial Biopsy: Single Center Experiences.

BACKGROUND: Patients with recurrent pericardial effusion and pericardial tamponade are usually treated in thoracic surgery clinics by VATS (video-assisted thoracoscopic surgery) or open pericardial window operation. The diagnostic importance of pathological evaluation of the pericardial fluid and tissue in the same patients has been reported in few studies. We reviewed pathological examination of the pericardial tissue and fluid specimens and the effect on the clinical treatment in our clinic, and compared the results with the literature. METHODS: We retrospectively analyzed 174 patients who underwent pericardial window operation due to pericardial tamponade or recurrent pericardial effusion. For all patients both the results of the pericardial fluid and pericardial biopsy specimen were evaluated. Clinicopathological factors were analyzed by using descriptive analysis. RESULTS: Median age was 61 (range, 20-94 years). The most common benign diagnosis was chronic inflammation (94 patients) by pericardial biopsy. History of malignancy was present in 28 patients (16.1%) and the most common disease was lung cancer (14 patients). A total of 24 patients (13.8%) could be diagnosed as having malignancy by pericardial fluid or pericardial biopsy examination. The malignancy was recognized for 12 patients who had a history of cancer; 9 of 12 with pericardial biopsy, 7 diagnosed by pericardial fluid. Twelve of 156 patients were recognized as having underlying malignancy by pericardial biopsy (n = 9) or fluid examination (n = 10), without known malignancy previously. CONCLUSION: Recurrent pericardial effusion/pericardial tamponade are entities frequently diagnosed, and surgical interventions may be needed either for diagnosis and/or treatment, but specific etiology can rarely be obtained in spite of pathological examination of either pericardial tissue or fluid. For increasing the probability of a specific diagnosis both the pericardial fluid and the pericardial tissues have to be sent for pathologic examination.

Thoracic Traumas: A Single-Center Experience.

OBJECTIVES: Trauma is currently among the most important health problems resulting in mortality. Approximately 25% of trauma-related deaths are associated with thoracic trauma. In the present study, morbidity and mortality rates and interventions performed in patients who had been treated as inpatients in Dr. Siyami Ersek Thoracic and Cardiovascular Surgery hospital after trauma were aimed to be evaluated. MATERIAL AND METHODS: In our study, 404 patients who were treated as inpatients because of thoracic trauma between January 2005 and December 2008 were retrospectively evaluated. RESULTS: The rates of blunt and penetrating trauma were 39.6% and 60.4%, respectively. In the study, 115 (28.4%) patients were noted to have pneumothorax, 99 (24.5%) had hemothorax, and 57 (14.1%) had hemopneumothorax. While tube thoracostomy was sufficient for treatment in approximately 80% of the patients, major surgical interventions were performed in 12.6% of the patients. Mortality rate was found to be 2.2%. CONCLUSION: In patients with chest trauma, necessary interventions should be started at the time of the event, and the time from trauma to arriving at the emergency department should be made the best of. Mortality and morbidity rates in thoracic trauma cases may be reduced by timely interventions and effective intensive care monitoring.

Aneurysmal bone cyst of the rib: a case report.

INTRODUCTION: An aneurysmal bone cyst is a benign, but expansile tumor like lesion that generally occurs in the long bones including the vertebral column. An aneurysmal bone cyst arising from the rib, especially in the elderly, is extremely rare. CASE PRESENTATION: We report a 58-year-old Turkish woman with an aneurysmal bone cyst of the right 3rd rib treated with chest wall resection. The pathologic findings confirmed the diagnosis of aneurysmal bone cyst. The patient has been followed up for 5 years with no evidence of recurrence. CONCLUSION: En bloc resection can be curative and provide good results for this rare type of chest wall tumor.

A new approach to pectus deformity in females.

One of the most preferred procedures for correction of pectus deformities is the modified Ravitch procedure. The main aim is cosmetic for many patients, especially in females. Two types of skin incisions have been described for this operation in the literature: midsternal and transversal. Both incisions leave a skin scar on the sternum and result in unacceptable cosmetic results. As a way of concealing the ugly skin incision scar under the breasts after puberty, we describe and discuss the use of bilateral inframammarian separated skin incisions. We have used our method for correction of pectus deformity in 12 female cases in our clinic since 1991. Two 4-5 cm incisions were localized as 1/3 medially and 2/3 laterally below both breasts. With this incision we performed the modified Ravitch technique. In spite of technical difficulties of exposure, correction of the deformity was satisfactory in all patients. Only one patient had seroma and one had perioperative pneumothorax. The patients were followed up for from 3 months to 9 years. No recurrence was observed. Breast development and sensitivity was found to benormal at follow-up. The new approach was found to be effective and more cosmetically acceptable than the other approaches for correction of pectus excavatum in female patients.