ABSTRACT
BACKGROUND: The effects of neoadjuvant therapy on perioperative and postoperative outcomes of patients with stage IIIA non-small cell lung cancer remain controversial. We investigated histopathological changes possibly caused by neoadjuvant chemotherapy and their effect on the tensile forces of pulmonary structures. METHODS: A prospective study of 30 patients who had undergone lung resection was performed. The patients were divided into two groups. Group 1 included those who received neoadjuvant chemotherapy, and Group 2 included those who underwent surgery alone. Tensile stress tests were performed on freshly excised vascular and bronchial strips after lung resection. The pulmonary artery, veins, and bronchi that had not been invaded by the tumor were histopathologically examined in both groups. Intraoperative and postoperative complications were recorded. RESULTS: This study showed that the tensile strength of pulmonary vessels and bronchi was less in the neoadjuvant group than in the control group. There were statistically significant differences in the tissue strips obtained from arteries, veins, and bronchi between the two groups. In the chemotherapy group, most cases exhibited extensive fibrosis. There was no statistically significant difference in complications between the groups. CONCLUSIONS: Neoadjuvant chemotherapy did not increase postoperative morbidity or mortality. The decreased tensile strength of pulmonary vessels and bronchi after neoadjuvant therapy should alert thoracic surgeons to possible surgical complications.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/adverse effects , Carcinoma, Non-Small-Cell Lung/drug therapy , Lung Neoplasms/drug therapy , Lung/drug effects , Biomechanical Phenomena , Bronchi/drug effects , Bronchi/pathology , Carcinoma, Non-Small-Cell Lung/pathology , Carcinoma, Non-Small-Cell Lung/surgery , Chemotherapy, Adjuvant , Female , Humans , Lung/blood supply , Lung/pathology , Lung/surgery , Lung Neoplasms/pathology , Lung Neoplasms/surgery , Male , Middle Aged , Neoadjuvant Therapy , Neoplasm Staging , Pneumonectomy/adverse effects , Prospective Studies , Pulmonary Artery/drug effects , Pulmonary Artery/pathology , Pulmonary Veins/drug effects , Pulmonary Veins/pathology , Tensile Strength , Treatment Outcome , TurkeyABSTRACT
BACKGROUND: The prevalence of bronchiectasis has decreased significantly over recent decades in developed countries. However, resection for bronchiectasis still plays an important part in thoracic surgery practice in developing countries such as Turkey. This study was designed to evaluate the outcomes of surgical treatment for bronchiectasis, particularly in aspects related to the effects on functional well-being. PATIENTS AND METHOD: From January 1995 through December 2003, operations for bronchiectasis were performed in 81 patients. Demographic features, type of resection, and operative morbidity and mortality were evaluated. The outcomes related to overall "social" or nonpulmonary functional status were classified and compared according to a scale constructed to assess patients' well-being preoperatively and at the 6th postoperative month. RESULTS: The mean age was 24.4 years and 47 patients (58%) were male. Surgical treatment was lobectomy in 37 (45%), pneumonectomy in 10 (12%), segmentectomy in 13 (16%), and lobectomy plus segmentectomy in 22 (27%) of the operations. Complete resection of disease was achieved in 69 patients (85%). There was no operative mortality. The rate of morbidity was 18.3%. Improvement to a functional status of excellent was observed in 81.7% and improvement to a status of good was seen in 12.7% of patients; 5.6% experienced no change. The results of complete resection were significantly better than those of incomplete resection (P=.0015). CONCLUSION: Functional results of surgical treatment for bronchiectasis in this series suggest that the outcomes are favorable and promising, particularly in selected patients with sufficient pulmonary reserves and localized disease who are suitable for complete resection.
Subject(s)
Bronchiectasis/physiopathology , Bronchiectasis/surgery , Adolescent , Adult , Child , Developing Countries , Female , Humans , Male , Middle Aged , Respiratory Function Tests , Retrospective Studies , Treatment Outcome , TurkeyABSTRACT
Pericardial cysts are generally recognized when they present in a cardiophrenic angle, but may not be suspected when they occur elsewhere in the thorax. To highlight the unusual localisations of pericardial cysts, we represent two patients with cysts of which one was adjacent to the left pulmonary hilum and the other was located in the subpulmonary region. The clinicians should take into consideration this entity in the differential diagnosis of cystic lesions of the mediastinum.
Subject(s)
Mediastinal Cyst/diagnostic imaging , Adult , Aged , Female , Humans , Male , Mediastinal Cyst/surgery , Tomography, X-Ray ComputedABSTRACT
The tracheobronchial injuries are seldom, but life threatening. Their successful diagnosis and treatment require a high level of suspicion. In this report, we reviewed our experience with seven patients with tracheobronchial injuries due to blunt thoracic trauma, treated over the past 10 years. Definitive diagnosis was recognized with bronchoscopy after clinical suspicion. Most injuries were located in the right bronchial tree (five patients), whereas only one patient had an injury located in the left bronchial tree and one in trachea. The majority of the injuries were repaired primarily (five patients) and two required lobectomy. There were no postoperative mortality; but three postoperative complications were noted; one empyema and two partial stenoses on the repair line.
Subject(s)
Bronchi/injuries , Emergency Treatment , Trachea/injuries , Wounds, Nonpenetrating/diagnosis , Wounds, Nonpenetrating/therapy , Adolescent , Adult , Bronchoscopy , Diagnosis, Differential , Female , Humans , Male , TurkeyABSTRACT
In Izmir Chest Diseases and Thoracic Surgery Training Hospital, Department of 1st Thoracic Surgery, between 1988 and 1998, 987 patients who were treated for their chest trauma were retrospectively reviewed in regard to their age, sex, cause of trauma, associated organ injuries, treatment modality, complication rate and mortality. In 710 (72%) cases of chest injuries were related to blunt trauma and 277 (28%) patients sustained penetrating trauma. 402 (41%) patients underwent tube thoracostomy only. While majority of patients (553 pts, 56%) were managed conservatively, only 32 (3%) underwent thoracotomy. Complication rate in our series was 4.6% and the most frequently atelectasis was seen. 13 patients died due to trauma related causes (mortality: 1.3%). There was no difference between blunt and penetrating trauma patients in view of morbidity and mortality rates (p = 0.29 and p = 0.10, respectively). Mean hospital stay among all patients was 9.6 +/- 8.6 days. This period was 10.0 +/- 8.5 days in blunt trauma group, and 8.4 +/- 8.6 days in penetrating trauma group. However this difference has reached statistical significance at a p value of 0.0068.
Subject(s)
Emergency Treatment/statistics & numerical data , Thoracic Injuries/epidemiology , Wounds, Nonpenetrating/epidemiology , Wounds, Penetrating/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Child , Decision Trees , Female , Humans , Male , Middle Aged , Retrospective Studies , Thoracic Injuries/etiology , Thoracic Injuries/mortality , Thoracic Injuries/therapy , Turkey/epidemiology , Wounds, Nonpenetrating/etiology , Wounds, Nonpenetrating/mortality , Wounds, Nonpenetrating/therapy , Wounds, Penetrating/etiology , Wounds, Penetrating/mortality , Wounds, Penetrating/therapyABSTRACT
Objetivo: La prevalencia de las bronquiectasias ha disminuido significativamente durante los últimos decenios en los países desarrollados. Sin embargo, la resección quirúrgica de las bronquiectasias desempeña todavía un papel importante en la práctica de la cirugía torácica en los países en vías de desarrollo como Turquía. El presente estudio se ha diseñado para evaluar los resultados obtenidos con el tratamiento quirúrgico de las bronquiectasias, especialmente en lo que se refiere a sus efectos sobre el bienestar funcional de los pacientes. Pacientes y método: Entre enero de 1995 y diciembre de 2003 recibieron tratamiento quirúrgico debido a bronquiectasias 81 pacientes. Se evaluaron las características demográficas, el tipo de resección quirúrgica y la morbilidad y mortalidad operatorias. Los resultados relativos al nivel funcional global "social" o extrapulmonar se clasificaron y compararon con una escala creada para determinar el grado de bienestar de los pacientes antes de la intervención y a los 6 meses. Resultados: La edad media de los pacientes era de 24,4 años y 47 (58%) eran de sexo masculino. El tratamiento quirúrgico consistió en lobectomía en 37 (45%), neumonectomía en 10 (12%), segmentectomía en 13 (16%) y la combinación de lobectomía y segmentectomía en 22 (27%) de las intervenciones quirúrgicas. La resección completa se llevó a cabo en 69 pacientes (85%). No se produjo ningún fallecimiento a consecuencia de la cirugía. La tasa de morbilidad fue del 18,3%. Se observó mejoría hasta un estado funcional excelente en el 81,7% de los pacientes, así como mejoría hasta un estado funcional bueno en el 12,7%; en el 5,6% no se observaron cambios. Los resultados obtenidos con la resección completa fueron significativamente mejores que los conseguidos con la resección incompleta (p = 0,0015). Conclusión: Los resultados funcionales del tratamiento quirúrgico de las bronquiectasias obtenidos en esta serie de pacientes son favorables y prometedores, especialmente en pacientes seleccionados con una reserva pulmonar suficiente y con un proceso patológico localizado en quienes es posible la resección completa
Background: The prevalence of bronchiectasis has decreased significantly over recent decades in developed countries. However, resection for bronchiectasis still plays an important part in thoracic surgery practice in developing countries such as Turkey. This study was designed to evaluate the outcomes of surgical treatment for bronchiectasis, particularly in aspects related to the effects on functional well-being. Patients and method: From January 1995 through December 2003, operations for bronchiectasis were performed in 81 patients. Demographic features, type of resection, and operative morbidity and mortality were evaluated. The outcomes related to overall "social" or nonpulmonary functional status were classified and compared according to a scale constructed to assess patients' well-being preoperatively and at the 6th postoperative month. Results: The mean age was 24.4 years and 47 patients (58%) were male. Surgical treatment was lobectomy in 37 (45%), pneumonectomy in 10 (12%), segmentectomy in 13 (16%), and lobectomy plus segmentectomy in 22 (27%) of the operations. Complete resection of disease was achieved in 69 patients (85%). There was no operative mortality. The rate of morbidity was 18.3%. Improvement to a functional status of excellent was observed in 81.7% and improvement to a status of good was seen in 12.7% of patients; 5.6% experienced no change. The results of complete resection were significantly better than those of incomplete resection (P=.0015). Conclusion: Functional results of surgical treatment for bronchiectasis in this series suggest that the outcomes are favorable and promising, particularly in selected patients with sufficient pulmonary reserves and localized disease who are suitable for complete resection