Concomitant Occurrence of Hepatopulmonary hydatid Cysts in Turkey.

BACKGROUND: We aimed to report the demographic characteristics with diagnosis and treatment methods in patients with concomitant hepatopulmonary hydatid cysts. METHODS: Over a ten-year period (from 2002-2020) in Konya, Turkey, surgery was performed on 52 patients with hepatopulmonary hydatid cyst. Main outcome measure(s) were 52 hydatid cysts patients, which had cysts both in the liver and lungs, were investigated regarding their age, gender, cyst localization, suppuration, symptoms, and treatment methods. RESULTS: Seventeen of the patients were males. Their mean age was 39.7±18.8 years. The most common occupation was housewifery. The most common symptom was coughing and none of the patients with concomitant hepatopulmonary hydatid cysts was asymptomatic. The pulmonary hydatid cysts were mostly encountered in the right lung and the majority of the hepatic hydatid cysts were observed in the right lobe. The mean hospitalization time of the operated patients was 17.12±6.7 days. CONCLUSION: In patients with hydatid cysts localized concomitantly in the right lung and subdiaphragmatic area, right thoracotomy for the pulmonary cyst and a transdiaphragmatic approach for the hepatic cyst is a safe, effective, and comfortable method.

The analysis of pleural complications of COVID-19 pneumonia

Background/aim: As the number of case reports related to the new type of coronavirus (COVID-19) increases, knowledge of and experience with the virus and its complications also increase. Pleural complications are one relevant issue. We aimed in this study to analyze pleural complications, such as pneumothorax, pneumomediastinum, and empyema, in patients hospitalized with the diagnosis of COVID-19 pneumonia. Materials and methods: The files of patients who have pleural complications of COVID-19 pneumonia and were consulted about thoracic surgery between March 2020 and December 2020 were retrospectively reviewed. The data of the patients were analyzed according to age, sex, length of stay, treatment method for pleural complications, mortality, severity of COVID-19 pneumonia, tube thoracostomy duration, and presence of a mechanical ventilator. Results: A total of 31 patients fulfilling the inclusion criteria were included in the study. There were 11 female (35.5%) and 20 male (65.5%) patients. The most common complication was pneumothorax in 20 patients (65%). The median duration of hospitalization was 22 days and the mortality rate was 71%. Mortality was significantly higher in patients on mechanical ventilation (p = 0.04). Conclusion: The mortality rate is very high in patients with pleural complications of COVID-19 pneumonia. Pneumothorax is a fatal complication in critically ill patients with COVID-19 pneumonia.

Prognostic factors for sarcomatoid carcinomas of lung: A single-centre experience.

BACKGROUND: Although lung sarcomatoid carcinomas (LSCa) arised from the epithelial tissue, they have very distinctive features than other non-small cell lung carcinomas in terms of histopathology and survival. It constitutes 0.1%-0.4% of all lung cancers. The aim of our study is to evaluate the survival analysis of LSCa in a single thoracic surgery clinic and to determine the prognostic factors. MATERIALS AND METHODS: It was a retrospective cohort study. After the approval of the local ethics committee, a total of 34 patients who were operated in our department between January 2010 and December 2018, whose pathologies were reported as sarcomatoid carcinoma was included in the study. The patients were analyzed by age, gender, presence of necrosis in the histopathological examination, tumor stage, tumor diameter, and tumor location. RESULTS: There were 28 males and 6 females. The median age was 60 years (range: 36-80 years). The median survival was 42 months (32.6-52.2 months), and the 5-year overall survival was 33.6%. Significantly negative prognostic factors were tumor diameter and tumor stage (P = 0.003 and 0.001, respectively). Median disease-free interval (DFI) was 38 months (27.3-49.1 months), and 5-year DFI was 32.6%. CONCLUSION: LSCa are highly heterogeneous epithelial malignancies, and it has worse survival than other epithelial cancers. Relatively, satisfactory results can be obtained in these tumors with surgical treatment.

Determination of prognostic factors of surgically treated pathological Stage IIIA non-small cell lung cancer.

BACKGROUND: This study aims to identify the prognostic factors in Stage IIIA non-small cell lung cancer and to investigate whether there was a significant difference in terms of overall survival and diseasefree survival among the subgroups belonging to this disease stage. METHODS: Between January 2010 and December 2018, a total of 144 patients (125 males, 19 females; median age 60 years; range, 41 to 80 years) who were operated for non-small cell lung cancer in our clinic and whose pathological stage was reported as IIIA were retrospectively analyzed. Data including demographic and clinical characteristics of the patients, histopathological diagnosis, the standardized uptake value of the mass on positron emission tomography-computed tomography, tumor diameter, type of surgery, lymph node metastasis status, visceral pleural invasion, and overall and disease-free survival rates were recorded. RESULTS: The median survival was 39 (range, 27.8 to 46.1) months and the five-year overall survival rate was 28%. The mean tumor diameter was 4.3±2.7 cm. The median disease-free survival was 37 (range, 28.1 to 48.6) months and the five-year disease-free survival rate was 26.9%. In the multivariate analysis, overall survival and disease-free survival in T2N2M0 subgroup were significantly worse than the other subgroups. The other poor prognostic factors of survival were the standardized uptake value of the tumor, pneumonectomy, and histopathological subtypes other than squamous cell carcinoma and adenocarcinoma. Parietal pleural invasion was significantly associated with worse disease-free survival rates. CONCLUSION: Our results showed that there may be significant survival differences between subgroups created by tumor histopathology, lymph node invasion and the type of surgery in a heterogeneous lung cancer stage.

Effects of topical mitomycin-C on the tracheal epithelia of rabbits following tracheostomy

Background/aim: We aimed to investigate the topical application of mitomycin-C (MMC) after the conventional tracheostomy in a rabbit model. Materials and methods: Twenty-four male New Zealand White rabbits were randomly divided among 3 equal groups (n: 8). Trache- ostomies were performed on 16 subjects. Group 1 which served as a control for all tracheal measurements. After tracheostomy, we applied sterile saline (group 2) or MMC at 0.8 mg/mL (group 3) around the tracheotomy site for 5 min. At the 3rd week after surgery, all tracheas were subjected to morphometric and histopathological examinations, including tracheal lumen diameter (LD), number of capillary vessels (CV), subepithelial tissue thickness (SETT), fibroblasts, and inflammatory cells (IC). Results: There was a statistically significant difference between the two tracheostomy groups themselves and the control group for LD (p = 0.035), CV (p = 0.006), SETT, fibroblasts, and IC (p < 0.001). Histopathological analysis showed the decreased LD, CV, SETT, IC, and fibroblasts compared to MMC with tracheostomy groups. MMC was more effective than saline for LD, CV, SETT, IC, and fibroblasts. Conclusion: Wound healing modulation may prevent scar formation. Fibrosis decreased following tracheostomy in the group treated with MMC. Fibroblasts appear to be key cells mediating these effects.

8-year old patient with giant hydatid cyst consulted with chest wall asymmetry.

Cystic echinococcosis, a zoonotic disease, is common in Turkey and is caused by the Echinococcus granulosus tapeworm. We describe the case of an 8-year-old girl who was admitted to hospital with chest wall asymmetry after a fall from height, without any other symptoms. Cystic lesion was identified on radiology, and serology supported the diagnosis of hydatid cyst. The patient underwent thorax surgery. Postoperatively, she was treated with benzimidazoles for 2 months. Rarely, hydatid cysts can reach a size sufficiently large to cause chest deformity.

The effect of costal cartilage resection on the chest wall development: a morphometric evaluation.

OBJECTIVE: In repair of thoracic wall deformities, there is a debate in the literature regarding the optimal age and the type and number of costal cartilage resections. We evaluated the effect of costal cartilage resections on the chest wall development in young rabbits. METHODS: Fifty apparently healthy, 6 weeks of age, male New Zealand white rabbits were evaluated in five groups, each including 10 subjects. Group 1 served as control for the observation of normal thoracic development. Rabbits in group 2 underwent partial and rabbits in group 3 underwent total resections of the right third and fourth costal cartilages; those in group 4 underwent partial and rabbits in group 5 underwent total resections of the right third to sixth costal cartilages. Anteroposterior, horizontal and vertical diameters of the chest were measured before operation and repeated at 24 weeks of age. RESULTS: Upper and lower anteroposterior diameters of the thoracic wall and horizontal diameters of the left hemithorax differed significantly among groups (p=0.011, p=0.004, and p=0.002, respectively). Upper anteroposterior diameter was 49 mm in group 1 and 44 mm in group 3 (p=0.009). Lower anteroposterior diameter in group 5 (66 mm) was significantly less than that in group 1 (70 mm) (p=0.039) and there was also a statistically significant difference between group 4 (71 mm) and group 5 (66 mm) (p=0.002). Horizontal diameters of the left hemithorax in group 3 (32 mm; p=0.005) and 5 (32 mm; p=0.008) were significantly different when compared to group 1 (26 mm). Growth in right hemithorax was statistically less than that in left side in all operated groups except in group 2. CONCLUSIONS: Thoracic resections in young rabbits have demonstrated that the costal cartilage resection is not an innocent procedure as it severely affects the chest wall development especially in anteroposterior direction and the thoracic growth is markedly retarded when growth centers of the ribs are not preserved and/or four or more ribs are resected.

Pleomorphic adenoma of the trachea mimicking bronchial asthma: report of a case.

Benign tracheal tumors are rare and difficult to diagnose. A delay in diagnosis is common because the symptoms mimic those of bronchial asthma. We report the case of a 42-year-old woman who was treated for asthma for 2 years before a diagnosis of pleomorphic adenoma of the trachea was made. To our knowledge, only 33 patients with pleomorphic adenoma of the trachea have been reported. We treated our patient by performing circumferential segmental tracheal resection and end-to-end anastomosis. A dynamic Y-stent was implanted for tracheal stenosis soon after the operation and it was removed 2 years later. The patient is now asymptomatic and no recurrence has been detected in the 5 years since diagnosis.

Comparison of pulmonary hydatid cysts in children and adults.

BACKGROUND: The purpose of the present study was to compare the clinical features and the surgical approaches of the pulmonary hydatid cysts in children and adults. METHODS: One hundred and thirty-four patients, operated on for pulmonary hydatid cysts over the last 10 years were retrospectively evaluated in two groups: 39 children who were younger than 18 years old (29%) and 95 adults (71%). The patients in each group were analysed according to their clinical, radiological and surgical findings. RESULTS: The frequency of pulmonary hydatid cysts in children was significantly higher in boys (74%) than in girls (26%). However, there was no sex tendency in adults (52% in male vs 48% in women). The sex difference in hydatid cyst frequencies between adults and children was significant (P < 0.05). Among preoperative pleural complications, pneumothorax (15.5%) in children and empyema (11%) in adults were more frequent. The frequency of concomitant hepatic cysts was less in children than in adults (33%vs 79%). Huge pulmonary cysts (=10 cm) were more common in children (31%) than in adults (22%). Cystotomy with capitonnage was the most frequently preferred method in both groups. Postoperative complications developed in six children (16%) and 19 adults (19%), and were more frequent in patients with huge cysts (27%vs 16%). No recurrence was observed in both groups. CONCLUSIONS: Isolated pulmonary cysts are more common in children than adults. The cysts also tend to be bigger in children than adults. The frequency of concomitant hepatic cysts is less in children. Because of higher lung expansion ability and improvement capacity in children, resection should be avoided and lung saving surgical procedures should be performed. In spite of differences observed in the clinical features it does not change the treatment of pulmonary hydatid cysts in children.

Inferior laryngeal paraganglioma presenting as plunging goiter.

Paragangliomas are uncommon slow-growing neuroendocrine tumors that may arise from the extra-adrenal paraganglia. Paragangliomas of the inferior and superior laryngeal paraganglia are known as laryngeal paraganglioma. Inferior laryngeal paraganglioma, which is also called subglottic paraganglioma, is very seldomly observed. To our knowledge only 24 patients with subglottic paraganglioma have been found. We present a 77-year-old male patient who has been previously followed-up for cervical goiter, which has a progressive enlargement into the mediastinum, causing severe tracheal obstruction. The tumor was completely and easily resected via median sternotomy with collar incision and finally diagnosed as inferior laryngeal paraganglioma. The present case is the first subglottic laryngeal paraganglioma descending into the visceral compartment of the mediastinum in the literature.

Benign mature cystic teratoma of the anterior mediastinum leading to heart failure: report of a case.

A 12-year-old male child was referred to our clinic for the surgical treatment of an anterior mediastinal mass, suspected to be a thymic cyst, which was considered to potentially lead to cardiac failure. The mass was resected completely with a median sternotomy. The postoperative course was uneventful. A pathological examination revealed a mature cystic teratoma of anterior mediastinum which is a very rare cystic tumor at this location. The incidence, diagnostic procedures, complications, and treatment of mediastinal teratomas are discussed along with a review of the literature.

Giant localized solitary fibrous tumors of the diaphragmatic pleura: report of two cases.

We report two cases, of 48- and 53-year-old women, with huge intrathoracic extrapulmonary tumors which originated from the diaphragm. In these cases the totally resected tumors were examined histologically and immunohistochemically, and based on these studies benign localized solitary fibrous tumors originating from the diaphragmatic pleura were diagnosed. We observed no recurrence in the long-term follow-up, which was necessary for these cases due to the tumors' unpredictable clinical behavior even when they were thought to be benign histologically. Because of the huge sizes of these tumors, originating from the diaphragmatic pleura with pedicles, and benign clinical outcome correlating with the histological examination, these cases are thought to be worthy of interest.

Comparison between pulmonary and hepatopulmonary hydatidosis.

OBJECTIVES: To compare the clinical features and the surgical approaches between single pulmonary (SPH) and hepatopulmonary hydatidosis (HPH). METHODS: The hospital and follow-up records of 141 patients who had undergone surgery for pulmonary hydatidosis in our clinic between January 1991 and January 2001 were reviewed. Forty-nine patients (34.8%) had concomitant liver cysts in addition to the pulmonary cysts and they were regarded as HPH (Group I). The remaining 92 (65.2%) patients had SPH (Group II). Both groups were compared according to their clinical, radiological and surgical features. RESULTS: Seventeen (34.7%) male and 32 (65.3%) female patients had HPH. The mean age of the patients with HPH was significantly higher than the age of those with SPH (P<0.05) and the frequency of hepatopulmonary localization, which is contrary to single pulmonary cyst, was significantly higher in females (P<0.05). The majority (67.3%) of the cysts located in the liver were solitary. Multiple pulmonary cysts were in higher ratio in Group II, compared to Group I (45.7 vs. 22.8%) and bilateral pulmonary cyst ratio was higher in Group II, as well (26.5 vs. 13%) (P<0.05). In 14 patients (28.6%), the concomitant cysts localized in the dome of liver were extirpated via right thoracophrenotomy, and in one of them sternophrenotomy was performed. There was no statistically significant difference associated with the postoperative complications and hospital stay between groups. No recurrence and mortality were recorded in Group II. CONCLUSIONS: Multi-organ localizations (especially liver) should be examined in all patients with pulmonary hydatid cysts. HPH is more frequent in female patients over 40 years of age. The pulmonary cysts in HPH show a tendency to be bilateral and multiple. HPH should be regarded as a different entity since it can cause either economic or labour loss due to the multi-operations and prolonged postoperative care. The operative strategy and approach should be different in hepatopulmonary cysts especially if they locate in the right or bilateral lung. One-session operation with the improvements of its techniques and methods should be considered in selected cases.

Pleural complications of hydatid disease.

OBJECTIVE: The aim of this retrospective study was to review pleural and pericardial complications of patients with hydatid cysts and to analyze the management of therapy for these patients. METHODS: Between 1991 and 2001, 43 (29.7%) of 145 patients presented with pleural and pericardial complications. These patients had spontaneous pneumothorax (6.2%), empyema (7.6%), pleural thickening (10.3%), hepatopleural fistula (2.8%), pericarditis (2.1%), and hepatobronchial fistula (0.7%). There were 22 male and 21 female patients, with a mean age of 30 years. RESULTS: The most common symptom was chest pain (79.1%). In 37 (86.1%) of 43 patients, the cysts were unilateral. The ratio of ruptured cysts was 88.4%. In most of the patients, hydatid cysts developed in the right lung (62.9%) and the lower lobes of the lung (70.4%). Multiple cysts were found in 8 (18.6%) patients. The most common surgical techniques were cystotomy with capitonnage (55.7%) and decortication (69.8%). Radical lung resection was used in 14% of the patients. The morbidity rate was 16.3%, and the mortality rate was 2.3%. The mean follow-up was 19 months with no recurrence. CONCLUSIONS: Although lung-preserving surgical interventions should be preferred, radical surgical procedures have been used more commonly in patients with pleural complications of hydatid cysts, and the postoperative morbidity rate was higher in these patients. Because of this, the surgical treatment should be carried out before the development of pleural complications. In addition, echinococcosis should be considered and included in the differential diagnosis of spontaneous pneumothorax and empyema.

Cold abscess of the chest wall as an unusual complication of BCG vaccination.

Bacillus-Calmette-Guérin (BCG) vaccination often results in local adverse effects; however, serious or long-term complications are rare. The involvement of sternum among skeletal BCG osteomyelitis is a rarely seen complication of BCG vaccination. Such a complication may confuse with a chest wall tumor and a surgical intervention may be needed for the definite diagnosis. A 9-month-old infant who had a parasternal cold abscess in the anterior chest wall and sternal osteomyelitis of tuberculosis in the late period of BCG vaccination of whom the etiological diagnosis was histopathologically confirmed after surgery is presented and the preoperative diagnostic problems are discussed.

Chest trauma in children.

OBJECTIVES: Chest trauma in childhood is uncommon in clinical practice. The management and treatment principles of children with thoracic trauma were discussed with the data reported in the literature. METHODS: Of the chest injury diagnosed in 1653 patients, 225 were children in the last 17-year period. There were 199 boys (88.44%) and 26 girls (11.55%). The most common causes were blunt injuries in 135 cases (60%), stab wounds in 67 cases (29.77%) and gunshot wounds in 22 cases (9.77%). RESULTS: Out of 225, 217 patients were treated conservatively and eight patients were treated surgically. There was no mortality and morbidity. CONCLUSIONS: The prevalence of chest trauma in children due to blunt injuries is high in Turkey. Extremity injury is thought to be the most commonly associated extra-thoracic injury. However, thoracic trauma in children can be managed conservatively in most of the cases.