A new technique for neonatal Jeune syndrome: External thoracic expansion.

Jeune syndrome is a rare form of skeletal dysplasia characterized by a narrow, bell-shaped chest (thoracic cage), and typical phalangeal and pelvic bone deformities. Chest expansion is impaired by the short, horizontally positioned ribs, resulting in alveolar hypoventilation and eventually neonatal-infantile death in most cases. External distraction with sternoplasty is a new technique for the treatment of Jeune syndrome, which was firstly used by our team on a newborn by placing a sliding finger fixator which was designed for ulnar lengthening. We believe that this approach can be life-saving in neonates with improved and widespread usage.

Bronchial Artery Embolization, an Increasingly Used Method for Hemoptysis; Treatment and Avoidance.

OBJECTIVES: Hemoptysis is an alarming symptom. It may cause some severe life-threatening complications. Hypertrophic and fragile bronchial artery causes hemoptysis and occurs mostly in bronchiectasis, sarcoidosis, active or sequelae tuberculosis, aspergilloma, lung cancer or cystic fibrosis. Bronchial artery embolization is one of the angiographic methods used in diagnosis and treatment for years performed by radiologists. Hemoptysis is used mostly in patients with hemoptysis. Using this method, surgical management with high mortality and morbidity rates can be avoided or better conditions for surgery can be provided via stopping hemorrhage before surgery. We aim to share the experiences of our hospital about patients who underwent bronchial artery embolization and compare our results with the literature. METHODS: Thirty-nine patients (29 male, 10 female) underwent angiography-aiming embolization. Pathologies were hemoptysis in 37 patients, Castleman disease in two patients. Embolization was performed in 33 patients; 31 for hemoptysis, two for Castleman disease. Bilateral embolization was performed in six patients. RESULTS: Computed tomography (CT) was helpful in diagnosing the side of bleeding in 91.8% of the patients with hemoptysis. Bronchoscopy was diagnostic in 53% of patients. Polyvinyl alcohol (n=27) was mostly used for embolization. Hemoptysis recurred in six patients (19.3%). All were managed successfully, of four with re-embolization. One major complication, transient blindness, was observed. CONCLUSION: Bronchial artery embolization is minimally invasive, more tolerable compared to surgery can be managed with high success and lower complication rates, especially hemoptysis and in some other situations. It provides time for evaluating the underlying disease and delaying surgery for elective conditions. That is why this method has been used increasingly.

Diffusion MR: A New Diagnostic Tool for Elastofibroma Dorsi.

Elastofibroma dorsi is a benign lesion commonly presents as a palpable enlarging mass at the inferior pole of the scapula. Clinical presentation and radiological characteristics are often enough to suggest an accurate diagnosis. Increased awareness of the characteristic appearance and location of these benign lesions will increase radiologic diagnosis and decrease the need for biopsy. Ten patients were admitted with a complaint of asymptomatic or painful subcutaneous masses localized at subscapulary region. Thorax computed tomography, magnetic resonance imaging (MRI) and a new feasible technique in differential diagnosis with malignancy and probable diagnosis of elastofibroma dorsi and diffusion-weighted MRI were used for diagnosis. Surgery was applied to all patients, frozen-section biopsies of the lesions at the preoperative period, and final pathologies were all benign. Totally resection of whole lesions as en-bloc excision without any rest was performed at all patients. Postoperative and follow-up periods were uneventful. Diffusion MRI can play an important role in the future and save the patients, especially medically poor ones, from the potential risks of surgery. Necessary further examinations for probable bilaterally lesions will save the patient from the risk of a second operation.

Antiproliferative Activity of Chemically Characterized Propolis from Turkey and Its Mechanisms of Action.

The aim of this study was to evaluate the ethanolic extract of propolis originated from northern Turkey for its antiproliferative, apoptotic and cell cycle arrest promoting effects on MCF7, HGC27, A549 cancer cell lines and a healthy cell line (HUVEC) in terms of DNA content, morphological features, expression of cell cycle checkpoint proteins p21, p53, Cyclin D1 and immune checkpoint protein PD-L1. The extract showed moderate antiproliferative activity against all tested cancer cell lines with IC50 values in the range of 58.6-90.7 µg/mL in MTS assay. Further studies indicated that propolis extract exerted apoptotic effect on cancer cell lines, promoted cell cycle arrest through activation of p21 and resulted in accumulation at G0/G1 phase of cancer cells. Propolis treatment caused increased cell size, according to fluorescent imaging except for MCF7. HPTLC analysis revealed that 3-O-methylquercetin, chrysin, caffeic acid, CAPE, galangin and pinocembrin were the main components of the extract. The amounts of caffeic acid and CAPE in the extract were found to be 5.5 and 11.1 mg/g, respectively, by a validated HPLC method. Our study is the first one, revealing effect of propolis on PD-L1 expression on certain cancer cell lines.

Effect of nitric oxide synthase inhibitors in acute lung injury due to blunt lung trauma in rats.

BACKGROUND: This study aims to investigate the effects of blunt lung trauma performed in experimental rat model on lung tissue and blood as well as proinflammatory cytokines, oxidant-antioxidant enzymes and histopathological parameters after Ngamma-nitro-L-arginine methyl ester and N-iminoethyl-L-ornithine administration. METHODS: The study included 50 adult male Wistar albino rats (weighing 350 to 400 g). Rats were randomly allocated into four groups. Except in the control, moderate-level pulmonary contusion was created in all other groups. Intraperitoneal saline solution was performed in groups 1 and 2, 25 mg.kg-1 Ngamma-nitro-L-arginine methyl ester in group 3, and 20 mg.kg-1 N-iminoethyl-L-ornithine in group 4. Blood and lung tissues were studied biochemically and histopathologically. RESULTS: Best outcomes were recorded statistically significantly in groups with administration of Ngamma-nitro-L-arginine methyl ester and N-iminoethyl-L-ornithine when malondialdehyde response, mucous and histopathological values were examined. Significant improvement was detected in superoxide dismutase values in the group with administration of competitive nitric oxide synthase inhibitor Ngamma-nitro-L-arginine methyl ester. Nitric oxide values were substantially decreased in N-iminoethyl-L-ornithine group, while no significance was detected. CONCLUSION: Free oxygen radicals and lipid peroxidation played a role in pulmonary contusion after blunt lung trauma. According to biochemical and histopathological outcomes, effects of inflammation were decreased and protective effects were formed with administration of both Ngammanitro- L-arginine methyl ester and N-iminoethyl-L-ornithine.

Management of Post-Intubation Tracheal Membrane Ruptures.

BACKGROUND: Iatrogenic tracheal rupture is a rare complication after intubation. Overinflation of the tracheal cuff was speculated to be a frequent cause of tracheal rupture. The surgical approach is a widespread treatment for tracheal ruptures. The aim of this study is to evaluate the results of conservative and surgical therapy approaches in tracheal rupture cases inflicted by tracheal intubation. METHODS: Data on 12 patients who experienced tracheal ruptures secondary to intubation were reviewed. The average age of the patients was 58 years (range of 38 to 81 years). Six patients were men and 6 patients were women. Four of the patients were performed thoracotomy for primary surgery and underwent surgical therapy. 8 patients were treated conservatively. The results of both approaches were evaluated. RESULTS: Patients, who underwent both conservative and surgical therapy, were completely recovered. There was no rupture originated complication or death. CONCLUSIONS: Both conservative and surgical therapies are appropriate for treatment of membranous tracheal rupture.

[Our ultrasound-guided paravertebral block experiences in thoracic surgery]. / Torasik cerrahide ultrason rehberliginde paravertebral blok deneyimlerimiz.

OBJECTIVES: Ultrasound-guided thoracic paravertebral block (TPVB) may be employed for postoperative analgesia in thoracic surgery. In application of TPVB, single injections, multiple injections or catheter techniques may be used. In this paper we present our experiences with ultrasound-guided TPVB in thoracic surgery patients for postoperative analgesia. METHODS: Patients undergoing thoracic surgery and on whom ultrasound-guided TPVB was performed for postoperative analgesia from January 2012 to March 2013 in our clinic were analyzed retrospectively. Demographic data, block technique, complications and 1st, 6th, 12th and 24th hour VAS scores were recorded. RESULTS: A total of 18 patients had TPVB. Single injection was administered to 9 patients, multiple injections to 5, and catheters to 4. While statistically insignificant, 1st hour VAS scores were found to be greater than 3 in the single injection and catheter groups. CONCLUSION: Similarly to multiple injection and continuous TPVB administration, ultrasound-guided single injection TPVB provides effective 24-hour postoperative analgesia.

Transthoracic fine-needle aspiration cytology of non-invasive, low-grade urothelial carcinoma with lung metastasis: A case report with review of the literature.

Radiological analyses in a 61-year-old patient being followed since 2005 for low-grade, non-invasive urothelial carcinoma (UC) (Ta) revealed a 5-cm pleural-based mass in the lower lobe of the right lung for which a subsequent transthoracic fine-needle aspiration cytology was performed. Upon observing the carcinoma cells consistent with UC metastasis, systemic chemotherapy was commenced. The patient underwent a metastatectomy based on the thoracic computerized tomography scan performed on the 4(th) month of treatment, which revealed notable regression. The resected tumor was morphologically similar to cells seen in the transthoracic fine-needle aspiration and was immunohistochemically positive for p63, uroplakin, thrombomodulin, CK7 and CK20 at varying degrees but was negative for TTF-1. We report a case of metastatic UC of the lung in a patient who had had a low-grade superficial UC of the urinary bladder and we discuss the cytopathological features of this rare entity in light of the literature.

False positive PET scan deserves attention.

PURPOSE: Pulmonary focal lesions are frequently identified incidentally. Furthermore, a final diagnosis is really a considerable problem for patients having risk factors for malignancy or particularly for a newly detected nodule during the postoperative period after any kind of lung surgery. For treatment decisions, the nature of the lesions needs to be clarified. Relatively recently positron emission tomography (PET) scan has been introduced as a non-invasive imaging method for the diagnosis of lesions on the basis of metabolic activity. METHODS: In this study 19 cases with false-positive nodules on PET scan are presented. Chest x-rays and thoracic computed tomographies (CT) were performed to all patients. Due to abnormal/suspicious lesions on radiologic imagies, PET scan was performed to these patients and high standard uptake values (SUV) above the cut-off value of 2.5 were suggestive of malignancy. Invasive procedures were performed to the patients with high suspicion of malignancy. RESULTS: Histology of the resected lesions showed that all of them were benign and therefore the PET results were false-positive. The final diagnoses were tuberculosis, aspergilloma, bronchiolitis obliterans organizing pneumonia (BOOP), sarcoidosis, sequestration, anthracosis and hamartoma. CONCLUSION: Patients living especially in countries with a high incidence of granulomatous diseases like tuberculosis, or patients in postoperative periods with high SUV should be studied thoroughly for false-positive PET results.

Primary synovial sarcoma of lung.

Synovial sarcoma (SS) is a highly malignant tumor that accounts for 10% of all soft-tissue sarcomas. Primary SS arising from the lung is extremely rare, and the prognosis is poor. We report a case of pulmonary SS presenting with a mass lesion invading the right upper and middle lobes, extending to the mediastinum and the chest wall. After tru-cut biopsy, surgical resection was performed. The final diagnosis was SS (biphasic type) based on histological and immunohistochemical findings. There are no guidelines for optimal treatment due to the rarity of these tumors. Current treatment includes surgery and adjuvant chemotherapy and/or radiotherapy.

Thymic epithelial tumors: analysis of prognostic factors with emphasis on the role of adjuvant radiation therapy.

BACKGROUND: The prognostic impacts of histopathological classification, Masaoka staging system, extent of surgery, and adjuvant treatment approaches in thymic epithelial tumors (TETs) were investigated. MATERIAL AND METHODS: Records of 22 patients were retrospectively reviewed. Total thymectomy was performed on 5 patients and thymectomy on 17. Complete resection was achieved for 14 patients. Radiation therapy (RT) was considered for all patients with stage III or IV disease and all patients undergoing incomplete resections. RESULTS: Local control had been achieved in all patients and all were alive with no evidence of disease (ANED) at 0.2-7.8 years (median, 2.3 years). Of 4 patients with stage II disease, 2 (favorable group) had undergone complete resections and 2 (intermediate group) had undergone incomplete resections. Those undergoing incomplete resections had received RT. Of these 4 patients, all were ANED. All 4 patients with Masaoka stage III disease that were involved in the study had undergone incomplete resections and had received RT. Also, these patients were ANED. CONCLUSIONS: Patients with TETs undergoing less than complete resections might be referred for RT in the postoperative setting, while the role of RT in patients undergoing complete resections remains unclear.

Is a small-bore catheter efficient for most pleural pathologies?

PURPOSE: Chest tubes are used for drainage of the pleural cavity. Traditionally, large-bore catheters are inserted for all indications, but there has been a recent tendency to use small-bore catheters. We share the results of our experience of using small-bore catheters for almost all indications routinely in our clinic. METHODS: A collective total of 309 small-bore chest catheters (10 F) were inserted via the Seldinger technique in 287 patients during a 5-year-period. Malignant pleural effusion and pneumothorax were the most common indications for chest tube insertion. RESULTS: The mean catheter duration was 5.6 days, being 5 days for pneumothorax and 6 days for malignant pleural effusion. Pleurodesis was performed effectively for malignant pleural effusions. In this series, the failure rate of small-bore catheters was 7.2 %. CONCLUSION: Based on our clinical experience of using small-bore catheters, we believe that they are potentially effective for almost all pleural pathologies. Our results concur with those in the literature, but this series also includes different pleural diseases requiring chest tube insertion.

Excision of ectopic mediastinal parathyroid adenoma via parasternal videomediastinoscopy.

Mediastinum is one of the place in which ectopic parathyroid adenomas can be located.Here, an ectopic mediastinal parathyroid adenoma, which was excised via parasternal videomediastinoscopy was presented. The patient with chronic renal insufficiency had increased calcium levels persistence after the surgery for cervical parathyroid adenoma.Radiologic and scintigraphic examinations revealed a focal intense nodule in anterior mediastinum. Parasternal videomediastinoscopy was performed via parasternal incision through the second intercostal space. Ex-vivo specimen radioactivity measurements and frozen examination confirmed parathyroid adenoma. Calcium levels were decreased dramatically after the operation. Parasternal videomediastinoscopy could be an alternative surgical way in anterior mediastinal small masses such as ectopic parathyroid adenoma. It is the first case in which parasternal videomediastinoscopy was used for excision of mediastinal parathyroid adenoma.

A comparison of the EZ-Blocker with a Cohen Flex-Tip blocker for one-lung ventilation.

OBJECTIVES: The EZ-Blocker (IQ Medical Ventures BV, Rotterdam, Netherlands) is a newly designed device for one-lung ventilation. The aim of this study was to compare the effectiveness of the Cohen Flex-Tip bronchial blocker (Cook, Bloomington, IN) and the EZ-Blocker for one-lung ventilation during thoracic surgery. DESIGN: Randomized and prospective. SETTING: A university hospital. PARTICIPANTS: This study included 40 patients undergoing thoracic surgical procedures. INTERVENTIONS: Patients were assigned to 2 study groups: Patients who received the Cohen Flex-Tip blocker were assigned to the Cohen group, and patients who received the EZ-Blocker were assigned to the EZ group. In both groups, fiberoptic guidance was used during placement of the bronchial blockers. Comparisons between the groups included the time to correct placement, the incidence of malpositioning, and the satisfaction level of the surgeon (good, fair, poor). MEASUREMENTS AND MAIN RESULTS: One-lung ventilation was achieved successfully for all patients. The time to correct placement (mean±SD) was significantly shorter in the EZ group (146±56 seconds) compared with the Cohen group (241±51 seconds; p=0.01). The incidence of malpositioning was significantly lower in the EZ group compared with the Cohen group (p=0.018). Surgeon satisfaction was similar in both groups. CONCLUSIONS: In this study, both bronchial blockers provided similar surgical exposure during thoracic procedures. The EZ-Blocker had a shorter time to correct positioning and less frequent intraoperative malpositioning.

Effect of locally applied transforming growth factor Beta3 on wound healing and stenosis development in tracheal surgery.

BACKGROUND: Tracheal stenosis constitutes one of the most frequently seen problems in thoracic surgery. Although many treatment modalities to prevent fibroblast proliferation, angiogenesis, or inflammation that causes tracheal stenosis have been attempted, an effective method has not yet been found. In this study, a transforming growth factor beta3 (TGF-ß3)/chitosan combination was used for this purpose. METHODS: A slow-release preparation containing a thin layer of TGF-ß3 with a chitosan base was made. Thirty albino Wistar rats were divided into 3 groups. A full-layer vertical incision was made in the anterior side of the trachea of each rat between the second and fifth tracheal rings. The tracheal incision was sutured. Group A was evaluated as the control group. In Group B, a chitosan-based film was placed on the incision line. In Group C, a slow-release TGF-ß3/chitosan-coated substance was placed on the incision line. The rats were killed on day 30, and their tracheas were excised by cutting between the lower edge of the thyroid cartilage and the upper edge of the sixth tracheal ring together with the esophagus. Epithelialization, fibroblast proliferation, angiogenesis, inflammation, and collagen levels were evaluated histopathologically by the same histopathologist. RESULTS: Statistically significant differences were not found among the 3 groups. Cold abscesses were observed at the incision sites in both the TGF-ß/chitosan and chitosan groups. These were thought to have formed due to the chitosan. CONCLUSIONS: As this was the first experiment in the literature to use this type of TGF-ß3 formulation, we intend to change the formulation and perform this study again with a different TGF-ß3/chitosan preparation.

A minimal invasive surgical alternative to aberrant systemic arterial supply: Coil embolization.

We present the case of a 20-year-old man with hemoptysis for 3 years. Chest radiography revealed increased pulmonary vascular opacities in the left lower lung field. Computed tomography showed an anomalous systemic artery arising from descending aorta supplying the basal segments of the left lower lobe. Bronchial tree was normal. Pulmonary artery angiogram revealed a hypoplastic inferior lobar branch of the left pulmonary artery. There was no direct communication between anomalous artery and pulmonary veins. We diagnosed our case as aortopulmonary collateral with normal lung parenchyma. Coil embolization of the anomalous systemic artery was performed. The patient survived well without evidence of hemoptysis for 18 months after coil embolization.

Simple and economical management of a prolonged air leak.

Prolonged air leak has been described in many pulmonary diseases but remains one of the common complications of pulmonary resections. Although, the management of prolonged air leaks related to broncho-pleural or alveolo-pleural fistulae traditionally requires surgical repair. In recent years, bronchoscopic approaches have drawn attention because of their conservative nature. We report a case of prolonged air leak after a pulmonary wedge resection that was treated with a simple and economical endobronchial method.

Characterization of malignant thrombus in an invasive thymoma with intravascular growth.

We report an unusual case of an invasive thymoma with a thrombus in the right atrium and describe the radiological findings consistent with the malignant nature of the thrombus. The thrombus showed significant enhancement on computerized tomography images similar to the tumoral mass. On magnetic resonance imaging, both the tumor and the thrombus have heterogeneously high signal intensities on T2-weighted images. On diffusion-weighted images they both exhibit high signal intensity and low apparent diffusion coefficient (ADC) values which support the malignant nature of the thrombus and the mass.