Seven years experience of bronchogenic cysts.

OBJECTIVE: To reveal the clinical, radiological, and surgical results of bronchogenic cysts. METHODS: Patients that underwent surgical procedure between January 2000 and June 2007, at Izmir Dr. Suat Seren Chest Disease and Thoracic Surgery Training Hospital, Izmir, Turkey with a radiological diagnosis of bronchogenic cyst were assessed retrospectively. Patients with confirmed histopathologically bronchogenic cyst (n=28) were evaluated for age, gender, symptoms, clinical and radiological signs, procedure of surgical treatment, and post-operative complications. RESULTS: There were 12 females, 16 males, and the mean age was 45.3 (25-73) years. Cysts were located at the pulmonary parenchyma in 53.5%, at the mediastinum in 43%, and at the intrathoracic extrapulmonary in 3.5%. There was no relation between localization and gender (p=0.276), and localization and the presence of symptoms (p=0.409). Frequently seen symptoms were dyspnea and chest pain. Cysts were infected in 11%, and intact in 89%. The average diameter of the cysts was 6.18 cm (2-12). Surgical complete resection was performed via thoracotomy in all patients. Mean follow-up time was 36 months, and there was no death. Minor postoperative complications occurred in 3 patients. CONCLUSION: Radiology alone may not be enough for diagnosis of bronchogenic cysts in all patients. Early surgical intervention is suggested for the exact diagnosis and prevention of operative difficulties and complications.

MUC4 expression and its relation to ErbB2 expression, apoptosis, proliferation, differentiation, and tumor stage in non-small cell lung cancer (NSCLC).

There is a peptide sequence homology between the gene product of human MUC4 and rat Muc4/sialomucin complex (SMC). Each contains a transmembrane subunit with two epidermal growth factor (EGF)-like domains that act as ligand for ErbB2. MUC4 and ErbB2 mediate intracellular signaling pathways that are linked to repression of apoptosis and either to proliferation or to differentiation of tumor cells. This study investigates the expression of human MUC4 in neoplastic and corresponding non-neoplastic tissues, and the relation of MUC4 expression in neoplastic tissues to ErbB2 expression, apoptosis, proliferation, differentiation, and tumor stage in a series of 100 non-small cell lung carcinomas (NSCLCs). MUC4 and ErbB2 expressions and cell proliferation (PCNA) were shown using immunohistochemistry. Apoptotic index (AI) and tumor differentiation were determined by morphologic criteria. All the non-neoplastic bronchial tissues and 85% of NSCLCs showed MUC4 expression. MUC4 expression was found to be higher in neoplastic than in non-neoplastic tissues (Yates correction p: 0.0006). MUC4 expression was inversely correlated with AI (p=0.0002) and was correlated with ErbB2 expression (p=0.022), but not with PCNA counts and tumor stage. Our results indirectly suggest that MUC4, in association with ErbB-2, might be involved in the repression of apoptosis and differentiation rather than proliferation in tumor cells of NSCLCs.

Is Acrylate Co-monomer (Glubran-2) Useful in the Prevention of Prolonged Air Leaks After Pulmonary Lobectomy?

Many synthetic materials are being used in order to reduce the frequency of prolonged air leak (PAL) in thoracic surgical practice. This study presents our experience with the topical application of acrylate co-monomer (Glubran-2) as a synthetic tissue adhesive in an attempt to decrease troublesome postoperative air leaks in patients undergoing resection for non-small cell lung carcinoma. Of the 112 patients who had undergone resection for lung carcinoma, 69 patients having lobectomy or bilobectomy were included in this study. The application group (group A) consisted of 33 patients where a synthetic tissue adhesive (Glubran-2) was used and compared with the control group (group C, n = 36) retrospectively. There was no difference between the groups regarding demographic details and operative variables. Both groups were compared in view to PAL, chest tube duration, in-hospital stay and hospital costs. There was no significant difference between group A (n = 11, 33 %) and group C (n = 6, 17 %) for the development of PAL (P = 0.11). Hospital stay was 16.1 ± 6.7 days in group A and 15.3 ± 5.8 days in group C (P = 0.66). The surgical cost was significantly higher in group A (€806 ± 127) than the group C (€624 ± 94) (P < 0.001). There was no significant difference between the groups regarding overall hospital costs (P = 0.41). In this study, the use of Glubran-2 following lung resection for non-small cell lung carcinoma did not decrease the incidence of PAL. Neither did it have a favorable effect concerning in-hospital stay nor did it decrease overall hospital costs while increasing surgical costs as expected.

Primary intrathoracic extrapulmonary hydatid cysts: analysis of 14 patients with a rare clinical entity.

Primary hydatid cysts very rarely form in intrathoracic yet extrapulmonary sites. Accurate preoperative diagnosis in such cases is difficult, and corrective surgical procedures necessarily differ from those that are used to treat the far more typical pulmonary or hepatic hydatid cysts. We retrospectively evaluated the diagnostic and operative characteristics of intrathoracic extrapulmonary hydatid cysts, and we examined the outcome of aggressive surgical interventions that went beyond conventional parenchymal-sparing procedures.From 2003 through 2007, 14 patients (mean age, 39.14 +/- 16.8 yr) underwent surgical treatment in our hospital for primary intrathoracic extrapulmonary hydatid cysts. These cysts were variously in the diaphragm, chest wall, mediastinum, pleura, and pericardial cavity. All patients underwent cystectomy, decortication, resection, and repair of the adjacent structure. No complication, recurrence, or death occurred in the follow-up period of 15 +/- 18.1 months (range, 2-52 mo).In order to achieve complete resection and to avoid recurrence of disease from intrathoracic extrapulmonary hydatid cysts, the thoracic surgeon should forgo cystotomy and capitonnage in favor of cystectomy with a wide resection and reconstruction of surrounding tissues. Postoperatively, patients should adhere to a regimen of anthelmintic therapy.

Fibrin glue administration to support bronchial stump line.

Bronchopleural fistula is an important cause of mortality and morbidity after pulmonary resection. The use of fibrin glue to reduce the tension and number of sutures in the bronchial stump was assessed in this prospective study of 20 patients between June 2002 and May 2003. They all had a high risk of bronchopleural fistula development because of bronchiectasis, tuberculosis, lung abscess, diabetes mellitus, preoperative neoadjuvant radiotherapy, or residual tumor at the surgical margin. After pulmonary resection, the bronchial stump was closed with separate nonabsorbable sutures supported with fibrin glue. Bronchopleural fistula was observed in only 1 (5%) patient during 6.45 +/- 3.09 months of follow-up. There was no postoperative mortality. Closing the bronchial stump with an appropriate technique and supporting it with fibrin glue were considered effective in preventing bronchopleural fistula development after pulmonary resection in high-risk patients.

Outcome of surgery for lung cancer in young and elderly patients.

PURPOSE: It has been suggested that lung cancer follows a more aggressive course and has a poorer prognosis in young patients than in elderly patients. We conducted this study to determine whether the basal characteristics and survival of young patients undergoing surgical resection of lung cancer differ from those of elderly patients. METHODS: Eighty patients who underwent surgery for lung cancer at our hospital between 1989 and 2004 were divided into two groups according to age. Group 1 comprised 50 patients aged 45 years or younger and group 2 comprised 30 patients aged 70 years or older. The patients' medical records were reviewed with respect to age, gender, histological diagnosis, coexisting diseases, smoking history, postoperative staging, type of operation, and postoperative morbidity, mortality, and survival results. RESULTS: The average ages were 40.2 +/- 3.77 years (range, 29-45 years) in group 1 and 72.2 +/- 2.53 years (range, 70-80 years) in group 2. The incidence of postoperative complications was significantly higher in group 2 (P = 0.02). However, the 5-year survival rates for patients who underwent surgery for non-small cell lung cancer did not differ between groups 1 and 2, at 33.3% versus 21.3%, respectively (P = 0.09). CONCLUSIONS: The incidence of adenocarcinoma was higher in the young patients, whose prognosis was slightly better than that of the elderly patients. Coexisting diseases and postoperative complications were the major factors that adversely affected the prognosis of the elderly patients.