Video-Assisted Thoracoscopic Surgery Is a Safe and Feasible Technique for Mediastinal Parathyroid Lesions.

Introduction: Hyperfunctional ectopic parathyroid glands in the mediastinum pose a challenge to diagnosis and require optimal surgical management. Video-assisted thoracoscopic surgery (VATS) has emerged as a promising minimally invasive approach, offering potential benefits in terms of both patient comfort and oncological principles. This study aimed to evaluate the effectiveness and safety of VATS for the treatment of hyperfunctional ectopic parathyroid glands in the mediastinum. Methods: Among the 538 patients with mediastinal tumors who underwent thoracoscopic surgery at Istanbul University (2008-2021), 11 exhibited hyperfunctional ectopic parathyroid glands. The localization of the glands was performed using various diagnostic techniques, including neck ultrasound, sestamibi scan, CT (computerized tomography), and SPECT (Single-photon emission computed tomography). VATS (Video-assisted thoracoscopic surgery) was used to remove ectopic parathyroid glands in all 11 patients, with no need for conversion to open surgery. Results: The pathological results showed that VATS successfully removed the ectopic glands in all 11 patients. Serum parathyroid hormone (PTH) levels were monitored intraoperatively, and frozen sections were used to confirm the presence of parathyroid adenomas in all cases. Postoperative analysis showed that PTH levels dropped by at least 50% within 10-15 minutes after adenoma removal. Conclusion: VATS is a safe and effective method for the treatment of hyperfunctional ectopic parathyroid glands in the mediastinum with a low risk of complications.

Bronchial Stump Recurrence after Complete Resection of Lung Cancer: Effect of the Distance between the Tumor and Bronchial Resection Margin.

PURPOSE: The purpose of this study was to evaluate the following parameters after complete resection in established lung cancer patients: the frequency of bronchial stump recurrence (BSR), the effect of the distance between the tumor and bronchial resection margin (DBTM) on BSR, the survival of patients with BSR, and the effect of the DBTM on survival. PATIENTS AND METHODS: We retrospectively evaluated 553 consecutive lung cancer patients who underwent complete lung resection. The patients were classified as DBTM: ≤ 10 mm (group 1), 11 to 20 mm (group 2), and > 20 mm (group 3). RESULTS: We found BSR in eight (1.5%) patients. Six patients were in group 1, and two were in group 2. The difference was found to be statistically significant (p = 0004; groups 1 vs. 3). In multivariable analysis, we observed a trend toward significance for the effect of a DBTM on BSR development (p = 0.1). The DBTM did not significantly affect survival (p = 0.61). The survival of patients who developed BSR was significantly poor compared with those who did not develop BSR (p = 0.001). CONCLUSION: BSR can develop even after complete resection of lung cancer. The DBTM is associated with BSR risk, and the survival of patients who develop BSR is poor.

Concomitant etoposide and cisplatin provided improved survival compared with docetaxel and cisplatin in patients with locally advanced non-small cell lung cancer treated with chemoradiotherapy.

Presently, there is no consensus regarding which chemotherapy regimen is best to administer with radiotherapy in patients with locally advanced non-small-cell lung cancer (LA-NSCLC). Herein, our aim was to compare the outcome of patients treated with either etoposide-cisplatin (EP) or docetaxel-cisplatin (DP) in this curative setting.Patients treated with either EP or DP and concurrent radiotherapy from 2004 to2012 were identified and their detailed medical records and follow-up information were obtained for analysis in this retrospective study. Survival rates were compared using Cox proportional hazards regression models with adjustments for confounding parameters provided by propensity score methods.A total of 105 patients were treated with concurrent chemoradiotherapy for LA-NSCLC (stage IIB-IIIA-IIIB). The median ages were 54 years (range, 32-70 years) and 55 years (range, 37-73 years) in the EP (n = 50) and DP (n = 55) groups, respectively. The median follow-up time was 27 months (range, 1-132 months) in the EP group and 19 months (range, 1-96 months) in DP group. There was no significant difference in baseline clinicopathologic features including age, sex, performance status, histologic subtype, and clinical TNM stages between groups. In the univariate analysis, the median overall survival of patients treated with EP was higher than that of patients treated with DP (41 vs. 20 months, P = 0.003). Multivariate analysis further revealed a survival advantage with EP compared with DP (hazard ratio [HR], 0.46; 95% confidence interval: 0.25-0.83; P = 0.009). The toxicity profile of the 2treatment groups was similar except that pulmonary toxicity was higher in the DP group (grade 3-4: 0% vs. 6%, P = 0.024).Concurrent chemoradiotherapy with EP may provide more favorable outcomes than DP and with an acceptable safety profile.

Results of videothoracoscopic thymectomy in children: an analysis of 40 patients†.

OBJECTIVES: Experience in video-assisted thoracoscopic (VATS) thymectomy is limited in paediatric patients with non-thymomatous myasthenia gravis (MG). The aim of this study is to evaluate the medical status and surgical results of paediatric patients who underwent a VATS thymectomy. METHODS: Of the 367 VATS thymectomies performed for MG patients in our Department of Thoracic Surgery between June 2002 and April 2013, 40 patients were in the paediatric age group. The data were evaluated retrospectively. Age, sex, duration of disease, body mass index, prescribed medication, duration of the operation, complications, chest tube duration, length of postoperative hospital stay and pain score using a visual analogue scale were analysed. RESULTS: The average age was 14.8 ± 2.2 years (range, 8-18 years), and 27 (68%) patients were female. The electromyography and acetylcholine receptor antibody tests were positive in 30 (75%) and 27 (67%) patients, respectively. The mean quantitative MG score was 11.5 ± 5.3. The mean prescribed preoperative pyridostigmine bromide dosage was 209 ± 112 mg. Eleven (27.5%) patients were on corticosteroid treatment and 22 (55%) received intravenous immunoglobulin treatment preoperatively. There were no open conversions or mortalities. The average duration of the operation was 48.9 ± 31.3 min. All patients were extubated on the table and only one (2.5%) required mechanic ventilation for 18 h postoperatively. Three (7.5%) patients experienced complications. The average duration of chest drainage and postoperative stay were 20.5 ± 12.1 h and 1.8 ± 1.0 days, respectively. The average pain score using a visual analogue scale was 2.3 ± 1.2. CONCLUSIONS: A right-sided VATS thymectomy is a safe procedure in paediatric patients with MG.

Robotic and video-assisted thoracic surgery lung segmentectomy for malignant and benign lesions.

OBJECTIVES: The experience with robotic techniques (RATS) and video-assisted thoracic surgery (VATS) in pulmonary segmentectomy is still limited. We evaluated our prospectively recorded database to compare two different minimally invasive techniques. METHODS: Between May 2007 and July 2014, a total of 99 patients underwent RATS (n = 34) and VATS (n = 65) pulmonary segmentectomies at two institutions. The median age of patients was 59 ± 15 (16-84) years, and 61% were male. Seventy-six patients were operated on for malignancy and 23 for benign diseases. RESULTS: The major morbidity and mortality rates were 24-23% and 0-1.5% for RATS and VATS (P = 0.57) and (P = 0.66), respectively. The mean console time for RATS was longer than the mean operation time for VATS [76 ± 23 (40-150) vs 65 ± 22 (30-120) min (P = 0.018)]. The mean duration of drainage was similar for RATS and VATS [3.53 ± 2.3 (1-10) days vs 3.98 ± 3.6 (1-21) (P = 0.90)], respectively. The duration of postoperative stay for RATS was 4.65 ± 1.94 (2-10) days and for VATS was 6.16 ± 4.7 (2-24) days (P = 0.39). CONCLUSIONS: Both RATS and VATS pulmonary segmentectomy operations are performed with similar morbidity and mortality rates. Although the duration of operation is longer in RATS when compared with an established VATS programme, there is a tendency towards a shorter postoperative stay.

Donor-recipient matching in lung transplantation: which variables are important?†.

OBJECTIVES: Donor to recipient (D/R) matching in lung transplantation (LTx) is usually directed by blood group (identity or compatibility) and predicted total lung capacity (pTLC) based on height and age. Other donor (D) and recipient (R) characteristics such as cytomegalovirus (CMV) serology (±), gender [male (M)/ female (F)] and age are often ignored, but the impact of D/R mismatch for these variables and their combinations on outcome is less investigated. METHODS: The early and late outcomes in 461 lung recipients (149 single-lung and 312 double-lung) transplanted between July 1991 and December 2009 were explored, comparing different D/R combinations for gender (M/F), age (<20/21 to 45/≥ 45 years), CMV (±), blood group (identical/compatible) and pTLC (-9%Δ, +11%Δ). RESULTS: Overall 5-, 10-, 15- and 20-year survival rates were 69, 50, 37 and 37%, respectively, and were significantly better in females {HR [95% confidence interval (CI)]: 0.5 (0.3-0.9); P = 0.023} and worse in older recipients [HR (95% CI): 1.6 (1.2-2.2); P = 0.003]. On univariate analysis, survival was significantly worse in recipients with gender opposite to that of the donor (39% for mismatch vs 51% for match at 10 years; P = 0.04), but not for other D/R matching variables: age (P = 0.89), pTLC (P = 0.14), CMV (P = 0.15), blood group (P = 0.82) and their combinations. The best survival at 5 years was seen in female donor (DF)/female recipient (RF) (80%), the worst in DF/male recipient (RM) (47%), and intermediate in male donor (DM)/RF (72%) and DM/RM (63%); P = 0.0001. On multivariate analysis, D/R gender mismatch was found to be the sole negative predictive factor for survival with an 80% increased risk of mortality [HR (95% CI): 1.8 (1.1-2.8); P = 0.01]. CONCLUSIONS: In our patient cohort, survival after LTx was superior in female and younger recipients. D/R gender mismatch may be an important prognostic factor for long-term outcome. A gender combination of DF/RM should be avoided. The exact reasons for these differences remain speculative.

Squamous cell carcinomas confined to the bronchial wall: the effect of growth patterns.

BACKGROUND: Squamous cell carcinomas confined to the bronchial wall (SCC-CBW) exhibit two distinct patterns of growth: superficially spreading and endobronchial mass lesions. We examined whether differences exist in the histopathological features and prognosis of SCC-CBW exhibiting different growth patterns. MATERIALS AND METHODS: In this study, 37 cases with SCC-CBW were included. Tumors were classified into two groups: superficially spreading squamous cell carcinoma (s-SCC) and nodular squamous cell carcinoma (n-SCC). For each case, the growth pattern, T and N status, lymphovascular and perineural invasions, immunohistochemical expressions of p53 and Ki-67, and survival rates were analyzed. RESULTS: Twenty cases were classified as s-SCC, and 17 cases were classified as n-SCC. There was a significant relationship and correlation between the length of s-SCC in the longitudinal axis and the depth of invasion (p = 0.01, R = 0.557). There was a statistically significant positive relationship between the depth of invasion and the nodal status (N1 involvement) (p < 0.0001, R = 0.71). CONCLUSIONS: SCC-CBW exhibits variable growth patterns. However, despite this variability, there are no biological or histological differences between tumors of different growth patterns, and this variability has very little, if any, effect on survival.

Which type of surgery should become the preferred procedure for malignant pleural mesothelioma: extrapleural pneumonectomy or extended pleurectomy?

PURPOSES: Since radiation and chemotherapy have limitations as therapies for malignant pleural mesothelioma (MPM). The type of surgery [extrapleural pneumonectomy (EPP), extended pleurectomy (E/P), and pleurectomy/decortication (P/D)] remains controversial. METHODS: This study involves 76 consecutive patients. 58 of the cases were males (76%) with a median age of 53.17±10.93 years. EPP, E/P, and P/D were performed in 31, 20, and 25 cases, respectively. RESULTS: The median survival time was 20 months in all patients. Overall, five-year survival rate was 14.3%. The survival rate was significantly better in epithelioid mesothelioma (P=0.049). For EPP cases, the median survival rate was 17 months, and the three-to-five year survival rates were 21% and 17%, respectively. For E/P cases, the median survival rate was 27 months and the three-year and four-year survival rates were 34% and 30%, respectively. For P/D cases, the median survival rate was 15 months and the three-to-five year survival rate was 13% and 0%. There were no statistically significant differences between the three surgical techniques (P=0.088). A comparative analysis indicates only a statistically significant difference in the E/P and P/D comparison (P=0.032). Hospital mortality showed a higher trend in EPP group (EPP: 12.9%, E/P: 0% and P/D: 4%, P=0.145). N2 cases, there were no cases of two-year survival. The survival rate in N2 was comparatively much lower, which was statistically significant (P=0.005). In multivariate analysis, only P/D (OR 0.3, 95% CI: 0.1-0.9, P=0.049) and N2 (OR 1.6, 95% CI: 0.9-2.6, P=0.090) were found to be poor prognostic factors. CONCLUSIONS: E/P could be encouraged to EPP with lower mortality rate and better survival trend in MPM. N2 diseases were negative prognostic factors in MPM.

Extent of lung resection in non-small lung cancer with interlobar lymph node involvement.

BACKGROUND: Optimal resection type for non-small cell lung cancer (NSCLC) with interlobar lymph node involvement (ILNI) has seldom been reported. To completely resect a NSCLC with ILNI, some surgeons believe that a pneumonectomy is needed. METHODS: We retrospectively studied 151 patients (147 men, 4 women; mean age 58 ± 8 years, range 34-79) with non-small lung cancer without mediastinal or hilar lymph node metastasis who underwent an anatomic lung resection with systematic lymph node dissection between January 1995 and November 2006. All patients had involvement of the surgical-pathologic interlobar (#11) lymph node: 8 patients had a T1 tumor; 95, T2; 39, T3; and 9, T4. We evaluated the effect of resection type (pneumonectomy in 90 patients versus lobectomy in 61) on their prognosis by univariate and multivariate analyses. RESULTS: The 5-year survival rate of patients was 61% for the lobectomy and 35% for the pneumonectomy (p = 0.04). We did not find statistically significant differences in sex, median age, distributions of tumor site, histology and differentiation, complete resection rate, N1 involvement status, morbidity and mortality. Patients who underwent the pneumonectomy had larger tumors and more T3 tumors. The T status, multiple levels N1 involvement and histology did not affect survival in the univariate analysis. Multivariate analysis revealed resection type as a significant prognostic factor. CONCLUSIONS: Pneumonectomy was not necessary in patients with NSCLC and interlobar lymph node involvement that we had discovered intraoperatively.

The validity of preoperative lymph node staging guidelines of European Society of Thoracic Surgeons in non-small-cell lung cancer patients.

OBJECTIVE: The European Society of Thoracic Surgeons (ESTS) has proposed preoperative lymph-node staging guidelines (LNSGs) for non-small-cell lung cancer (NSCLC) based on the introduction of new staging modalities into clinical practice. The validity of these guidelines was assessed. METHODS: Among the patients (n=185) with histologically confirmed NSCLC diagnosed between 2007 and 2009, who were suitable for thoracotomy, the 168 who underwent computed tomography (CT) of the chest and CT-integrated positron emission tomography (PET-CT) were included in the study. The preoperative mediastinal stage was confirmed by mediastinoscopy in all patients. A thoracotomy was done for mediastinoscopy-negative patients. The mediastinal staging results were adapted to the ESTS-LNSG (direct thoracotomy for T1-2 N0 tumour according to CT and PET-CT and invasive staging for others) and the validity of the guidelines was tested. RESULTS: In this series, the overall mediastinal lymph-node metastasis (MLNM) prevalence was 29.2%. If the guidelines had been applied, thoracotomy without invasive mediastinal staging would have been done in only 11 (6.5%) patients, and no MLNM would have been detected. Mediastinoscopy would have been performed in 157 patients and MLNM would have been found in 41 (26%). In the 116 mediastinoscopy-negative patients, MLNM would have been detected after thoracotomy in an additional eight patients. Thus, the sensitivity, specificity, and positive and negative predictive values of the guidelines were calculated as 84%, 100%, 100% and 94%, respectively. CONCLUSIONS: The preoperative LNSGs for NSCLC proposed by the ESTS are effective.

Survival and prognostic factors in surgically resected synchronous multiple primary lung cancers.

OBJECTIVE: The presence of synchronous multiple primary non-small-cell lung cancers (SMPLC) is a rare condition and the optimal treatment remains unclear. In this study, the survival of surgically treated SMPLC patients and the factors affecting survival were analyzed. METHODS: Between 2001 and 2008, 26 consecutive patients diagnosed with SMPLC, who had all of their tumors resected, were retrospectively evaluated. Patients, who had bronchoalveolar carcinoma or carcinoid tumors and satellite nodules, were excluded. Prognostic factors were analyzed using univariate and multivariate analyses. RESULTS: The tumors were unilateral in 14 and bilateral in 12 patients. In total, 38 procedures were performed. A complete resection was achieved in 35 (92.1%) procedures. The in-hospital mortality rate was 7.6% (two patients). The overall 5-year survival rate was 49.7%, and the median survival time was 40 months. The 5-year survival rate was 40.6% for unilateral and 62.8% for bilateral SMPLC patients (p = 0.47). Histopathologic tumor type, N1 nodal disease, tumor (T) status, and older age did not influence survival. There was no survival disadvantage for patients, upon whom a sublobar resection had been performed. There was a trend toward poorer survival in patients upon whom a pneumonectomy had been performed (p = 0.12). The 3-year survival rate for patients, who received adjuvant chemotherapy and/or radiotherapy (66.7%), was better than other patients (56.3%). In the multivariate analysis, we found a trend toward poor survival in patients, who received a pneumonectomy, and a trend toward better survival in patients, who received adjuvant therapy (p = 0.05 and p = 0.06). CONCLUSIONS: The survival of SMPLC patients, who were treated surgically, was satisfactory. Pneumonectomy was a poor prognostic factor, whereas adjuvant therapy was a good prognostic factor.

Tumor angiogenesis in predicting the survival of patients with stage I lung cancer.

OBJECTIVE: The effects of angiogenesis on survival were assessed by measuring the tumor microvessel density and vascular endothelial growth factor expression in patients with resected stage I non-small cell lung carcinoma. METHODS: The study population included 141 patients who underwent complete resection for stage pT1 and T2 N0 M0 tumors between 1999 and 2007. Lobectomy and pneumonectomy were performed in 131 and 10 patients, respectively. Tumor specimens were analyzed immunohistochemically for staining with anti-CD105 antibody to determine tumor microvessel density and anti-vascular endothelial growth factor antibody to determine the vascular endothelial growth factor expression level. Univariate and multivariate analyses were performed for factors influencing patients' survival. RESULTS: The overall 5-year survival was calculated as 68%, with rates of 76.9% for patients with T1 disease and 66.2% for patients with T2 disease (P = .4). The vascular endothelial growth factor expression rate was 94.3% for patients with stage I non-small cell lung carcinoma. Vascular endothelial growth factor expression did not influence survival (P = .9). The median microvessel density of the tumors measured based on the level of CD105 expression was 19.8. The effect of microvessel density on survival was significant (P = .02). The 5-year survivals of patients with tumors with 20 or more microvessels and less than 20 microvessels were 76.8% and 56.1%, respectively; this difference was highly significant (P = .004). The microvessel density was determined as an independent factor influencing survival on multivariate analysis (P = .03). CONCLUSIONS: The level of vascular endothelial growth factor expression in tumors was not a successful predictor of survival in patients with resected stage I non-small cell lung carcinoma. A high microvessel density based on CD105 is a strong predictor of prognosis in these patients.

Enigmatic contralateral hemothorax after left thoracotomy.

Intrathoracic hemorrhage following surgical intervention that needs rethoracotomy has a low rate in the daily practice of thoracic surgery. Hemothorax in the contralateral site is definitely unexpected after thoracotomy. We present a case of contralateral hematoma after left posterolateral thoracotomy as a rare and enigmatic complication.

The importance of pleural fluid and serum NT-proBNP levels in differentiating pleural effusion due to heart failure from other causes of effusion.

BACKGROUND AND OBJECTIVE: Pleural effusion due to congestive heart failure (CHF) typically are transudates. Light's criteria may be insufficient in determining if the pleural effusion is transudative or exudative in patients with CHF. The aim of our study was to assess the diagnostic performance of the amino-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) in pleural fluid and serum for the identification of pleural effusion owing to heart failure. METHODS: The study prospectively evaluated NT-proBNP in serum and pleural fluid from patients with effusion owing to heart failure (n=51) and other causes (n=64). Measurements were made of levels of NT-proBNP by an electrochemiluminiscence immunoassay. The discriminative properties of NT-proBNP levels in identifying pleural effusion due to heart failure were determined by receiver operating characteristic curve (ROC) analysis and compared to the diagnostic value of finding a transudate by Light's criteria and serum-pleural fluid albumin gradients. RESULTS: Serum and pleural fluid NT-proBNP levels were significantly elevated in patients with pleural effusion owing to heart failure. The area under ROC for the diagnosis of pleural effusion from heart failure was similar for pleural fluid (0.973, 95% CI: 0.914-0.995) and serum (0.968, 95% CI: 0.890-0.989) NT-proBNP. CONCLUSION: NT-proBNP levels in either pleural fluid or serum have high diagnostic values and they are easily useable parameters in the diagnosis of heart failure-related pleural effusion.

Prognostic significance of surgical-pathologic N1 lymph node involvement in non-small cell lung cancer.

BACKGROUND: Patients with N1 non-small cell lung cancer represent a heterogeneous population with varying long-term survival. To better define the importance of N1 disease and its subgroups in non-small cell lung cancer staging, we analyzed patients with N1 disease using the sixth edition and proposed seventh edition TNM classifications. METHODS: From January 1995 to November 2006, 540 patients with N1 non-small cell lung cancer who had at least lobectomy with systematic mediastinal lymphadenectomy were analyzed retrospectively. RESULTS: For completely resected patients, the median survival rate and 5-year survival rate were 63 months and 50.3%, respectively. The 5-year survival rates for patients with hilar N1 (station 10), interlobar (station 11), and peripheral N1 (stations 12 to 14) involvement were 39%, 51%, and 53%, respectively. Patients with hilar lymph node metastasis showed a shorter survival period than patients with peripheral lymph node involvement (p = 0.02). Patients with hilar zone N1 (stations 10 and 11) involvement tended to show poorer survival than patients with peripheral zone N1 (12 to 14) metastasis (p = 0.08). Multiple-station lymph node metastasis indicated a poorer prognosis than single-station involvement (5-year survival 39% versus 51%, respectively, p = 0.01). Patients with multiple-zone N1 involvement showed poorer survival than patients with single-zone N1 metastasis (p = 0.04). A significant survival difference was observed between N1 patients with T1a versus T1b tumors (p = 0.02). Multivariate analysis revealed that only multiple-station lymph node metastasis was predictive of poor prognosis (p = 0.05). CONCLUSIONS: Multiple-station versus single-station N1 disease and multiple-zone versus single-zone N1 involvement indicate poorer survival rate. Patients with hilar lymph node involvement had lower survival rates than patients with peripheral N1. The impact of T factor seemed to be veiled by the heterogenous nature of N1 disease. Further studies of adjusted postoperative strategies for different N1 subgroups are warranted.

Surgical treatment and prognosis of primitive neuroectodermal tumors of the thorax.

INTRODUCTION: Primitive neuroectodermal tumors (PNETs) are rare, rapidly progressive, small- round cell tumors with a poor prognosis despite multimodal therapy, including surgery and chemoradiotherapy. The treatment of choice was unknown since no clinical series with surgical therapy had been reported. We evaluated the impact of multimodal treatment in patients with PNETs located in the thoracic region. METHODS: Between 1998 and 2006, 25 patients with PNETs in the thoracic region were treated in 3 tertiary-care hospitals. The patients consisted of 15 males and 10 females with a mean age of 27.2 years (range, 6-60). The tumor was in the chest wall in 20 (involving the costovertebral junction in 9), the lung in four, and the heart in one patient. Twelve patients received neoadjuvant chemotherapy (54.5%), and 22 of 25 patients underwent surgery. RESULTS: In patients who received neoadjuvant treatment, the mean regression rate was 65.4% (range, 30-100%). Eighteen (82%) patients underwent chest wall resection, while 7 (32%) had vertebral resections, and the remaining 4 (16%) had pulmonary resections. A complete resection was possible in 18 of 22 patients (82%). Patients with incomplete and complete resections had 25% and 56% 5-year survival rates, respectively (p = 0.13). The progression-free 3-year survival rate was 36% and the median survival time was 13 months. The complete resection rate was significantly higher in patients receiving neoadjuvant therapy (p = 0.027). The 5-year survival rate of the patients with or without neoadjuvant therapy was 77% and 37%, respectively (p = 0.22) although it prolonged the disease-free survival (p = 0.01). The 5-year survival rate of patients without costovertebral junction involvement was 66%, whereas patients with PNETs involving the costovertebral junction had a 21% 3-year survival. The difference was statistically significant (p = 0.01). The 5-year progression-free survival rate of patients without costovertebral junction involvement was 58%, whereas patients with PNETs involving the costovertebral junction had a 14% 1-year progression-free survival (p = 0.004). CONCLUSIONS: PNET is an aggressive malignancy that often requires multimodal therapy. Induction chemotherapy leads to a greater complete resection rate and better disease-free survival, while involvement of the costovertebral junction indicates a poorer survival.

Thoracoscopic removal of a maternal mediastinal ectopic parathyroid adenoma causing neonatal hypocalcemia: a case report.

Most parathyroid glands in hyperparathyroidism can be resected through a cervical approach. In approximately 2% of cases, the ectopic gland is in the mediastinum in a location that requires a thoracic approach. Advancement in video-assisted thoracoscopic surgical (VATS) techniques has decreased the need for sternotomy to successfully remove these ectopic glands. We describe a case involving a 29-year-old woman with hyperparathyroidism resulting from an ectopic mediastinal parathyroid adenoma that caused neonatal hypocalcemia, which was removed through VATS.

Tumor necrosis factor gene polymorphisms in Turkish patients with sarcoidosis.

BACKGROUND: As reported recently, some gene polymorphisms are suspected to determine susceptibility to sarcoidosis and are held responsible for the extent and progression of the disease. Polymorphism at -857 locus of tumor necrosis factor (TNF)-alpha gene is considered to be a predisposition factor in sarcoidosis and held responsible for pathogenesis of the disease. We compared these polymorphisms in healthy Turkish control subjects and Turkish patients with sarcoidosis. METHODS: We examined gene polymorphisms in 90 cases which were histopathologically diagnosed as sarcoidosis and 110 healthy subjects without any history of a chronic disease. TNF-alpha-857 gene polymorphisms were determined using a polymerase chain reaction (PCR)-based method after DNA isolation. Genotype distributions of the groups were evaluated by the Hardy-Weinberg equilibrium test. RESULTS: Genotype distributions were in agreement with the Hardy-Weinberg equilibrium both in sarcoidosis patients and healthy subjects. TNF-alpha gene (C/T) polymorphism, at position -857, revealed no differences in genotype and allele frequency between patients and control subjects but more relapses and more frequently involvement of three or more organs were found in sarcoidosis patients who have this polymorphism (p<0.05, p<0.01 respectively). CONCLUSION: T allele at -857 locus of TNF gene is a marker for more extensive disease in Turkish sarcoidosis patients.

[The role of positron emission tomography (PET) in mediastinal staging of non-small cell lung cancer]. / Küçük hücreli disi akciger kanserinin mediastinal evrelemesinde pozitron emisyon tomografisi (PET)'nin rolü.

Mediastinal lymph node metastasis (MLNM) is the most important prognostic factor and guide to the treatment in non-small cell lung cancer (NSCLC) patients with no distant metastasis. As a non invasive method, using of positron emission tomography (PET) to evaluate NSCLC is increasing. We aimed to compare results of PET and mediastinoscopy to reveal effectiveness of PET in the mediastinal staging of NSCLC patients. PET was performed to 100 operable NSCLC patients between 2004 and 2006. Later, standard cervical mediastinoscopy was performed to all of the patients. Twenty-six patients who detected MLNM at mediastinoscopy were referred to oncology clinic for neoadjuvant or definitive chemo-radiotherapy. Other 74 patients underwent thoracotomy and performed lung resection and mediastinal lymphatic dissection. Sensitivity and specificity rates for detecting mediastinal lymphatic metastasis of PET and mediastinoscopy were compared. There were 89 male and 11 female with mean age of 59 years. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy rates were calculated as 74%, 76%, 59%, 86% and 76% respectively for PET and 83%, 100%, 100%, 93% and 95% respectively for mediastinoscopy. Accuracy rate of PET is not sufficient and mediastinoscopy is still the gold standard to evaluate mediastinal staging of NSCLC, at present.

Nutritional and prognostic significance of sick euthyroid syndrome in non-small cell lung cancer patients.

OBJECTIVES: Our study aimed to determine the frequency of sick euthyroid syndrome (SES) among patients diagnosed as non-small cell lung cancer (NSCLC) and its association with the stage of the disease, Karnofsky index (KI), and nutritional parameters. METHODS: We enrolled 80 consecutive patients with newly diagnosed NSCLC. Cases with NSCLC were staged by using the TNM system. The cases were examined for thyroid function tests, KI and nutritional evaluation before treatment. Moreover, cases were investigated for their overall survival ratio. RESULTS: Out of 80 patients, SES was identified in 28 (35%). SES was more frequent among stage III (26%) and stage IV (62%) cases. The body mass index (BMI), KI and serum albumin level were found to be significantly low in cases with SES when compared to cases without SES. SES was found to be negatively correlated with BMI, KI and serum albumin level, and it was positively correlated with disease stage and weight loss. Additionally, the presence of SES was found as a prognostic factor at survival analysis (p=0.0002). CONCLUSION: SES was frequently seen in cases with NSCLC. SES can be used as a predictor of poor prognosis in NSCLC patients.