Sublobar resections in early-stage non-small cell lung cancer.

BACKGROUND: This study aims to evaluate the outcomes of sublobar resections in patients with early-stage non-small cell lung cancer and to investigate the factors affecting survival. METHODS: Medical files of a total of 63 patients (52 males, 11 females; mean age 64 years; range, 39 to 81 years) who underwent sublobar resection for suspected or known early-stage non-small cell lung cancer between January 2001 and August 2013 were retrospectively reviewed. Data including demographic characteristics of the patients, comorbid conditions, smoking status, surgical margin, visceral pleura invasion, distance from surgical margin to tumor, tumor size, pathological N status, cell type, tumor localization, and recurrences were recorded. RESULTS: Survival was significantly longer in the patients with negative surgical margin for tumor (R0) than in those with positive margin (R1) (94.1 months vs. 32.2 months, p<0.01). Survival was also significantly longer in the patients without lymphatic invasion (p<0.01). CONCLUSION: In early-stage lung tumors, sublobar resection can be performed, if complete resection is performed. Lymphatic invasion is a negative prognostic factor for survival following sublobar resection.

[The prognostic effect of natural killer cell infiltration to tumoral tissues in stage I non-small cell lung cancer]. / Evre I küçük hücreli disi akciger kanserinde tümör dokusuna natural killer hücre infiltrasyonunun prognoza etkisi.

Lung cancer is the most common type of cancer among males and females in developed countries. Currently, the five-year survival rate of lung cancer patients is 14%. Immune system has been considered to play an important role in the development and metastasis of lung cancer. In this study, natural killer (NK) cell infiltration was evaluated in the tumor tissues of 40 patients with stage I non-small cell lung cancer (NSCLC) to evaluate its effect on the prognosis. The evaluation included the tissue samples of 40 patients who underwent resection due to NSCLC between 1994 and 1998 in Ankara University Medical School, Chest Surgery Department. All the patients had stage I squamous cell carcinoma. The patients were followed-up for 4-8 years postoperatively. NK cell counts varied between 1 and 86 (mean: 13.63 +/- 11.86). The patients were divided into two groups according to their cell counts as low (n= 24) and high (n= 16). The mean survival time of the group with low NK cell count was 52 +/- 6 months and the mean five-year survival rate was 51%. The mean survival time of the group with high NK cell count was 58 +/- 4 months and the mean five-year survival rate was 68%. No statistically significant difference was detected between the two groups for five-year survival time (p= 0.15). As a result, in our study we did not find any significant effect of natural killer infiltration on tumoral tissue in prognosis of stage I NSCLC.

Comparison of mersilene mesh-methyl metacrylate sandwich and polytetrafluoroethylene grafts for chest wall reconstruction.

We report the outcomes of patients who underwent reconstruction with Mersilene mesh-methyl methacrylate (MM-MM) sandwich and polytetrafluoroethylene (PTFE) grafts after a large chest wall resection. Between June 1990 and September 2001, 59 consecutive patients (37 men, 22 women; mean age, 48.1 +/- 11.8 years; range 22-74 years) underwent large chest wall resection (greater than 5 cm diameter) and reconstruction with prosthetic material in our department. Twenty-one patients (33%) underwent reconstruction with a PTFE graft (group 2) between 1990 and 1994, and 38 patients (67%) underwent reconstruction with an MM-MM sandwich graft (group 1) between 1994 and 2001. Operative morbidity ratios were 5.2% (2/38) in group 1 and 24% (5/21) in group 2 (p = .036). The paradoxical respiration ratio was significantly higher (p = .018) in group 2 (5/21: 24%) than it was in group 1 (1/38: 2.6%). The operative mortality ratio was 4.5% (1/21) in group 2 and 0% in group 1. Mean hospital stay was 10.6 days (range 5-21 days) in group 1 and 13.3 days (range 7-36 days) in group 2 (p = .015). The MM-MM graft is inexpensive and easy to apply, provides better cosmetic options, and offers minimal morbidity. We therefore recommend that the MM-MM sandwich graft be used rather than the PTFE graft for large defects of the anterolateral chest wall and sternum where successful prevention of paradoxical respiration is required.

Thoracic outlet syndrome, Paget-Schroetter syndrome and aberrant subclavian artery in a young man.

Reported here is a 22-year-old young man with the diagnosis of thoracic outlet syndrome, Paget-Schroetter syndrome (effort-related thrombosis of the subclavian vein) and an aberrant right subclavian artery. The symptomatology and the diagnosis pertaining to these pathologies are discussed in light of the relevant literature.

Parenchyma-preserving surgery in the management of pulmonary hydatid cysts.

Pulmonary hydatid cysts remain a significant health problem in endemic regions like Turkey. Here, we present our surgical experience in patients with pulmonary hydatid cysts. Between January 1985 and January 2001, 1118 operations were performed in 1032 patients (528 males, 504 females; mean age 32.7 years; range 1-87 years) with pulmonary hydatid cysts in our department. Posterolateral thoracotomy was performed in 1015 (98.3%), two-stage thoracotomy in 34 (3.3%), and median sternotomy in 17 (1.7%) patients. We preferred conservative surgical procedures. As a surgical procedure, cystotomy and capitonnage was performed in 626 (56%), cystotomy alone in 368 (33%), wedge resection in 81 (7%), enucleation in 29 (3%), and decortication in 11 (1%) patients. None of our patients were treated with anatomic resection. During surgery, 949 patients (92%) had unruptured and 83 patients (8%) had ruptured hydatid cyst. The morbidity ratio was 6.7%. Major complications were wound infection (2.3%), prolonged air leak (1.9%), atelectasis (1.2%), pleural effusion (0.8%), postoperative hemothorax (0.6%), and empyema (0.3%). Two patients (0.2%) died within the first month postoperatively. Mean follow-up was 31.2 months. Recurrence was detected in only 35 patients (3.3%). Treatment of pulmonary hydatid cyst is primarily surgical. Medical treatment is indicated for recurrent and multiple hydatid cysts postoperatively. Cystotomy alone, or cystotomy and capitonnage, as parenchyma-preserving surgery, is preferred. Radical surgery including pneumonectomy, lobectomy, and segmentectomy should be avoided.

Thoracic splenosis.

Intrathoracic splenosis is a rare condition that results after rupture of the spleen or diaphragmatic injury. We present herein a case of intrathoracic splenosis of a 48-years-old woman whom splenectomy had been performed 5 years ago after a traffic accident. The patient was operated on with suspicion of malignancy and total resection of the lesion was performed with video-assisted thoracic surgery (VATS). Histopathologic examination confirmed the splenosis diagnosis. Thoracic splenosis should be suspected for the patients with thoracic lesions whom had medical history of thoracoabdominal injury including splenectomy or diaphragmatic injury.

Prognostic value of tumor size in non-small cell lung cancer larger than five centimeters in diameter.

OBJECTIVES: The tumor size is an important prognostic factor in non-small cell lung cancer (NSCLC). However, a criterion for tumor size has remained unchanged for the last 25 years in TNM classification. The purpose of this study was to determine the relationship between tumor size and survival in patients with non-small cell lung cancer. METHOD: Of 550 consecutive patients who underwent operation for NSCLC between 1994 and 1998, we reviewed the medical record of 509 patients. There were 470 men and 39 women. Survivals were compared according to groups of tumor size (Group I: < or = 3 cm, Group II: 3.1-4 cm, Group III: 4.1-5 cm, Group IV: >5 cm, Group A (II + III): 3.1-5 cm, and Group B (IV): >5 cm). The Cox proportional hazard model was used with same variables. RESULTS: The univariate analysis showed that poor pulmonary function test (P < 0.05), pneumonectomy (P < 0.05), limited resection (P < 0.001), tumor size larger than 5 cm (P = 0.006), T factor (P < 0.05), N status (P < 0.001), and advanced staged of disease (P < 0.001) were all significant prognostic factors. Further comparison of survival between tumor size groups demonstrated a significantly poor prognosis for larger tumors. There was a statistically significant difference between Group A (3.1-5 cm) and Group B (> 5 cm), with 5 years survivals of 45.9% and 31.4%, respectively (P = 0.005). CONCLUSION: We emphasize that tumor size is an important prognostic factor in NSCLC. The 5 years survival with tumors larger than 5 cm (31.4%), is significantly less than the tumors 3.1-5 cm (45.9%) (P = 0.005). These initial results should strongly encourage additional studies in different countries on the interaction between tumor size and lung cancer characteristics to better clarity. In future revisions of the TNM classification, 5 cm may be a new threshold.

Predictors of clinical outcome following extended thymectomy in myasthenia gravis.

OBJECTIVE: Thymectomy remains as the optimal treatment of choice in patients with myasthenia gravis (MG), however, the selection criteria for surgery remains controversial. METHODS: We examined the data charts of patients with MG underwent extended thymectomy. We investigated the possible correlations between the clinicopathologic features and clinical outcomes, and analyzed the data to clarify the effect of prognostic factors on clinical outcome. RESULTS: A total of 61 patients with a mean age of 35.8 +/- 12.2 years (range, 13-66 years) were analyzed. The overall improvement/remission and clinical worsening rates were 81.9 and 18.1%, respectively. Ossermann stage (P = 0.011) and presence of mediastinal ectopic thymic tissue (P = 0.007) showed a significant correlation with the clinical outcome. Multivariate analysis confirmed Ossermann stage (P = 0.0158), and presence of mediastinal ectopic thymic tissue (P = 0.0100) as independent predictors on clinical outcome. CONCLUSION: Ossermann stage and the presence of mediastinal ectopic thymic tissue are potential predictors on clinical outcome in patients with MG undergoing extended thymectomy.

Nonsurgical treatment of a catamenial pneumothorax with a Gn-RH analogue.

Catamenial pneumothorax is a rarely encountered entity characterized by recurrent pneumothorax concurrent with menstruation. Numerous mechanisms have been postulated in the etiology of catamenial pneumothorax and treatment is still controversial. We report a case of a catamenial pneumothorax successfully treated with a Gn-RH analogue supporting the efficacy of this regimen and the endometriosis theory as an underlying cause of the disease.

Surgical treatment in bronchiectasis: analysis of 166 patients.

BACKGROUND: Bronchiectasis is usually caused by pulmonary infections and bronchial obstruction. It is still a serious problem in developing countries as our country. We reviewed the morbidity and mortality rates and outcome of surgical treatment for bronchiectasis. PATIENTS AND METHODS: Between 1990 and 2000, 166 patients (92 female and 74 male patients) underwent pulmonary resection for bronchiectasis. The mean age was 34.1 years (range, 7-70 years). Mean duration of symptoms was 5.7 years. RESULTS: Symptoms were copious amount of purulent sputum in 135 patients, expectoration of foul-smelling sputum in 109, hemoptysis in 35 and cough in all patients. The indication for pulmonary resection was failure of medical therapy in 158 patients, massive hemoptysis in five and lung abscess in three. The disease was bilateral in six patients and mainly confined to the lower lobe in 127. One hundred and twenty patients had a lobectomy, 13 had a pneumonectomy, 21 had a segmentectomy and a combination of these approaches in 18. Operative morbidity and mortality were seen in 18 (10.5%) and in three (1.7%) patients, respectively. Follow-up was complete in 148 patients with a mean of 4.2 years. Overall, 111 patients were asymptomatic after surgical treatment, symptoms were improved in 31, and unchanged or worse in six. CONCLUSIONS: Surgical treatment of bronchiectasis is more effective in patient with localized disease. It is satisfactory with acceptable ratio of morbidity and mortality.

Three-dimensional CT of thoracic outlet syndrome: report of three cases.

Recently, three-dimensional (3-D) imaging has become useful for the diagnosis and treatment of several diseases as computed tomography (CT) imaging technology has advanced. We used three dimensional CT for determination of the narrowing of the thoracic outlet (TO) in three patients with thoracic outlet syndrome (TOS). 3D-CT images are effective for visually identifying the relationships of the structures and planning the operation in TOS.

Primary hydatid cyst of the posterior cervical triangle.

Hydatid cysts in the cervical region are extremely rare. We report herein a case with a hydatid cyst that was primarily located in the posterior cervical triangle without any pulmonary or hepatic involvement. A hydatid cyst of the neck should be considered in the differential diagnosis of lesions in the cervical region, in endemic areas, so as to avoid any dangerous complications such as contamination and a fatal anaphylactic reaction.

Giant dumbbell-shaped gastroenteric cyst presenting with total situs inversus.

We present a case of an 8-month-old boy with total situs inversus, who had a giant dumbbell-shaped gastroenteric cyst. The concurrence of these entities has never been reported previously. The cyst occupied a large space in the mediastinum and involved both hemithoraces.

The use of a homologous preserved costal cartilage in an infant with Poland's syndrome.

Poland's syndrome is a rarely encountered congenital deficiency involving chest wall and breast deformity associated with hand anomalies. Chest wall reconstruction is necessary if the bony thorax is involved. We present the use of a homologous preserved costal cartilage for reconstruction of the chest wall in an infant with Poland's syndrome, the use of which provided optimal chest wall stability with a favourable outcome.