Demographic characteristics of pectus deformities across Turkey.

BACKGROUND: This study aims to investigate the demographic characteristics and familial inheritance of pectus deformities across Turkey. METHODS: Demographic characteristics of a total of 5,098 patients (5,028 males, 70 females, mean age 23.6 years; range, 1 to 56 years) with pectus excavatum and pectus carinatum admitted to our outpatient clinic between January 1996 and December 2018 were retrospectively analyzed. The distribution of the patients across the country was made according to seven regions and 81 provinces. Familial inheritance was investigated using patients" data obtained from the clinical records and telephone calls. RESULTS: Of all patients, 3,330 (65.3%) had pectus excavatum and 1,768 (34.7%) had pectus carinatum deformity with a pectus excavatum-to-pectus carinatum ratio of 1/1.9. In the Southeast Anatolia region, the rate of pectus excavatum was lower than the overall average and higher in the Marmara region (p=0.009 and p=0.037, respectively). In the Southeast Anatolia region, the rate of pectus carinatum was higher than the general average and lower in the Marmara region (p=0.001 and p=0.003, respectively). Kastamonu, Çankiri, Karabük, and Sinop were the most common provinces for pectus deformity cases. Family history was positive in 39% of pectus excavatum and 43% of pectus carinatum patients. All regions showed a similar distribution in terms of the presence of family history. CONCLUSION: This is the first study to report the distribution of pectus deformities in Turkey and the high frequency of pectus deformities in certain regions and provinces of Turkey indicates familial inheritance.

BRAF Inhibitors for BRAF V600E Mutant Colorectal Cancers: Literature Survey and Case Report.

The main method of fighting against colon cancer is targeted treatment. BRAF inhibitors, which are accepted as standard treatment for V600E mutant malign melanomas, are the newest approach for targeted treatment of V600E mutant colorectal cancers. In this case report, we share our experience about the use of BRAF inhibitor vemurafenib on a V600E mutant metastatic right colon adenocarcinoma patient. A 59-year-old male with only lung multiple metastatic V600E mutant right colon cancer presented to our clinic. The patient was evaluated and FOLFOX + bevacizumab treatment was initiated, which was then continued with vemurafenib. A remarkable response was achieved with vemurafenib treatment in which the drug resistance occurred approximately in the sixth month. Even though the patient benefited majorly from vemurafenib, he died on the 20th month of the diagnosis. The expected overall survival for metastatic V600E mutant colon adenocarcinoma patients is 4.7 months. BRAF inhibitors provide new treatment alternatives for V600E mutant colorectal cancers, with prolonged overall survival. BRAF inhibitors in combination with MEK inhibitors are reported as feasible treatment to overcome BRAF inhibitor drug resistance on which phase studies are still in progress. To conclude, BRAF inhibitors alone or in combination with other drugs provide a chance for curing BRAF V600E mutant colorectal cancer patients.

Comparison of side effects of oxytetracycline and talc pleurodesis: an experimental study.

BACKGROUND: Chemical pleurodesis is widely recommended in the treatment of refractory pleural effusion or pulmonary air leak of different etiologies. Although several agents have been used, many questions have remained unanswered about their toxicity. Talc is the most commonly used agent for the treatment, with rare, serious complications reported. Oxytetracycline pleurodesis in clinical practice has been described in a few studies, but literature reveals no experimental studies using this agent. We performed a prospective, randomized, observer-blinded, controlled study to evaluate the changes in lung histology and systemic response to pleurodesis with oxytetracycline and talc in acute and subacute phases in a rat model. METHODS: Forty-two male albino Wistar rats were divided into three groups and 3 subgroups with 7 animals in each. Group 1 was given oxytetracycline, 35 mg/kg; Group 2 was given talc slurry, 60 mg/kg in 0.5 mL saline solution, and Group 3 was given only 0.5 mL saline intrapleurally. In subgroups "a" the nimls were sacrificed at the postoperative 72nd hour and, in subgroups "b", on the postoperative day 7. The surfaces were graded by microscopic examination. RESULTS: Oxytetracycline produced alveolar collapse, hemorrhage, edema, inflammation at the postoperative 72nd hour and hemorrhage on the postoperative day 7, while talc produced significant edema, inflammation, proliferation, fibrosis at the postoperative 72nd hour and hemorrhage, edema, inflammation, proliferation, and fibrosis on the postoperative day 7 (p < 0.0042). Talc produced significant edema compared to oxytetracycline on the postoperative day 7. On contralateral side, oxytetracycline and talc produced significant hemorrhage on the postoperative day 7 (p < 0.0042). CONCLUSIONS: Both agents were shown to produce pulmonary lesions. In acute phase, the pulmonary side effects of oxytetracycline were more pronounced, whereas the side effects of talc were prolonged to subacute phase. We propose that the occasional side effects in humans may be related to these changes as were observed in our rat model, and like talc, oxytetracycline must be used cautiously in patients with limited respiratory function.

Autologous blood pleurodesis in rats to elucidate the amounts of blood required for reliable and reproducible results.

BACKGROUND: Pleurodesis is used in the treatment of spontaneous pneumothorax or refractory pleural effusions of different etiologies. Several agents have been employed, but many questions remain unanswered about their effectiveness and toxicity. Use of autologous blood pleurodesis in clinical practice has been described in the literature without any clear consensus regarding its efficacy. Experimental studies using this technique are limited to a single study in rabbits. We performed a prospective, randomized, observer-blinded, controlled study to evaluate the safety and efficacy of increasing doses of autologous blood pleurodesis in a novel rat model. MATERIALS AND METHODS: Twenty-eight albino Wistar rats were divided into four groups. Groups 1, 2, and 3 were the study groups and group 4 was the control group, with seven animals in each group. Groups 1, 2, and 3 were given autologous blood, 1 mL/kg, 2 mL/kg, 3 mL/kg, respectively, and group 4 (control) was given only 2 mL/kg saline intrapleurally. The rats were sacrificed on postoperative day 30. The surfaces were graded by macroscopic (visible adhesion formation) and microscopic (inflammation and fibrosis) examination. RESULTS: Macroscopically, group 2 and group 3 developed significantly more adhesions; 3 mL/kg autologous blood produced the most significant pleurodesis with generalized adhesions seen between visceral, parietal, and mediastinal pleura. Microscopic examination showed that all study groups developed an inflammatory response at the site of blood injection. There were no pathologic changes in ipsilateral and contralateral lung parenchyma. CONCLUSIONS: Autologous blood at doses 2-3 mL/kg were shown to be effective to produce adhesions in 30 d, and the results were highly reproducible in all rats. We propose that the occasional negative results obtained in humans may be related to an insufficient amount of injected blood, as observed in our rat model.

Unexpected difficult intubation due to lingual tonsillar hyperplasia in a thoracotomy patient: intubation with the double-lumen tube using stylet and fiberoptic bronchoscopy.

Lingual tonsillar hyperplasia is rare, and it may cause difficulty with tracheal intubation during induction of general anesthesia. A different orotracheal intubation technique was performed using a double-lumen endotracheal tube, flexible fiberoptic bronchoscope, and a stylet, in an unexpected difficult endobronchial intubation case due to massive lingual tonsillar hyperplasia.

Meteorological conditions related to the onset of spontaneous pneumothorax.

Spontaneous pneumothorax is defined as the rupture of bleb or emphysematous bullae that develop just beneath the pulmonary pleura. Weather changes may influence the incidence of spontaneous pneumothorax. The aim of this study was to examine the influence of rainfall, temperature and atmospheric pressure changes on the onset of spontaneous pneumothorax. The study involved 669 spontaneous pneumothorax admissions to three reference hospitals in Ankara, Turkey between 1996 and 2006 (612 males and 57 females with the mean age of 34.0 +/- 15.5 years). The meteorological data were obtained from Turkish State Meteorological Services for temperature, atmospheric pressure, and rainfall. The correlation between these values and spontaneous pneumothorax clusters, which was defined as the admission of at least two patients with pneumothorax within three days of each other, was evaluated. Among 669 episodes of spontaneous pneumothorax, 472 (70.5%) occurred in 188 clusters. When compared to days without spontaneous pneumothorax, the amount of average rainfall on the day of admission with spontaneous pneumothorax, one day before and two days before the admission was significantly high. Similarly, the atmospheric pressure on one day and two days before the admission of spontaneous pneumothorax patients was significantly low. In addition, maximum temperature level was significantly lower on admission day of spontaneous pneumothorax patients compared to those on the days without spontaneous pneumothorax. This largest series of the literature shows that spontaneous pneumothorax occurs in clusters and suggests that rainfall, temperature and falls in atmospheric pressure might play a role in the pathophysiology of spontaneous pneumothorax.

Surgical management of chest wall tuberculosis.

OBJECTIVE: Tuberculosis remains one of the most fatal diseases in the world. Extrapulmonary tuberculosis increases in parallel fashion with the rise of incidence of pulmonary tuberculosis. Tuberculosis of the chest wall is rare. METHODS: Our study retrospectively evaluated 10 patients with tuberculosis of the chest wall who were treated with surgery in addition to antituberculous chemotherapy in the last 8 years. Seven of the lesions were located on the anterior chest wall, and three of the lesions were on the lateral chest wall. RESULTS: Surgical therapy consisted of evacuation of the cold abscess material from the cavities and wide débridement of the soft tissue planes in all patients. Partial rib resections were performed in six patients owing to costal or chondral involvement. CONCLUSIONS: Chest wall tuberculosis must be considered in the differential diagnosis of chest wall lesions, especially in endemic areas.

Protective efficiacy of taurine against pulmonary edema progression: experimental study.

Re-expansion pulmonary edema (RPE) is an acute, rare and potentially lethal complication. Its beginning is sudden and dramatic. The mechanism is not yet fully understood. Some authors suggest that it may occur after rapid re-inflation of a collapsed lung. It was reported by other authors that it may relate to surfactant depletion or may result from hypoxic capillary damage, leading to increased capillary permeability. In RPE, unilateral lung injury is initiated by cytotoxic oxygen metabolites and temporally associated with an influx of polymorphonuclear neutrophils. These toxic oxygen products are the results of re-oxygenation of a collapsed lung. Treatment of re-expansion pulmonary edema is basically preventive.

Appropriate approach to bronchobiliary fistulas: a case series with hydatid disease and algorithm of case-based management.

Bronchobiliary fistula caused by liver echinococcosis is a relatively unusual but severe complication of hydatid disease. Optimal management of cases is crucially important in establishing rapid recovery and avoiding additional complications. The use of an algorithmic guide is essential because of an ongoing dilemma that involves a large variety of therapeutic options. We present four patients with bronchobiliary fistulas caused by liver hydatid disease to discuss the management of therapeutic options through a case-based approach and an extent review to finally generate an algorithm. In this series, two patients were treated surgically, and the remaining were treated with conservative methods. To date, they have developed neither recurrence nor need for additional intervention. Although treatment of bronchobiliary fistulas is traditionally thought to be surgical, most of the less severe cases can be treated nonoperatively. Making an accurate selection among less invasive methods and/or open surgical interventions seems to be a key component of management.

Repair of pectus deformities: experience and outcome in 317 cases.

BACKGROUND: The most common congenital chest wall deformities are pectus excavatum and pectus carinatum. Various techniques have been described for correction of pectus deformities. We describe our experience with surgical repair of pectus deformity (PD) in adults, including our new technique, which uses a resorbable plaque for fixation of the sternum. METHODS: We reviewed the records of 317 patients who underwent surgical correction of PD between October 1997 and December 2005. RESULTS: All of the patients were male and the median age was 21.3 years (range, 16-32 years). Of 317 patients, the type of deformity was a pectus excavatum in 230 patients and a pectus carinatum in 87 of the patients. Four different operative techniques were used. There were no intraoperative deaths or major perioperative morbidity. The complications rate was 17%. Overall mean hospital stay was 14.25 days. In 208 patients who underwent a mid-term outpatient follow up (mean, 8 months), there was no recurrence. Patient satisfaction was excellent in 234 patients, good in 79 patients and fair in 4 patients. CONCLUSION: The majority of patients with pectus deformity had been operated on during childhood; therefore there is limited published information about the correction of pectus excavatum and pectus carinatum deformities in adults. The most important point in pectus correction is to achieve proper and long-term stability of the sternum following osteotomy. Various techniques can be used for this purpose.

Pulmonary sequestration and surgical treatment.

Pulmonary sequestration is nonfunctioning, abnormal pulmonary tissue existing inside or outside the visceral pleura. It is not connected to the tracheobronchial tree. In this study, the results of 8 patients, who were diagnosed with pulmonary sequestration and treated during hospitalization in Gülhane Military Medical Academy between 1996 and 2003, were reported. Sex, age, symptoms, diagnostic approach, operative findings, procedures and postoperative outcomes were reviewed. No postoperative complications were seen. In the long-term follow-up all patients were seen to be asymptomatic. We believe surgical resection is mandatory in order to avoid infection and destruction of the normal pulmonary parenchyma even in asymptomatic cases. Furthermore, when infection occurs, major resection such as lobectomy may be necessary rather than segmentectomy or wedge resection, which involves removal of minimal pulmonary parenchyma.

Surgical management of bronchiectasis: analysis and short-term results in 238 patients.

OBJECTIVE: Bronchiectasis is defined permanent dilatations of bronchi with destruction of the bronchial wall. It is still a major cause of morbidity and mortality in developing countries. The aim of this retrospective study is to present our surgical experiences, the early and long-term results of 238 patients with bronchiectasis during a 10-year period. METHODS: We reviewed the medical records of 238 patients who underwent surgical resection for bronchiectasis between January 1992 and December 2001, at Gülhane Military Medical Academy (GMMA) Thoracic Surgery Department. Variables of age, sex, symptoms, etiology, and type of operation, mortality, morbidity and the result of surgical therapy were analyzed. RESULTS: There were 205 (86.13%) male and 33 (13.87%) female patients with an average age of 23.7 and a range of 15-48 years. The presenting symptoms were productive cough in 133 (55.88%), fetid sputum in 116 (48.73%), recurrent infections in 84 (35.29%), and hemoptysis in 39 (12.18%) patients. The disease was bilateral in 31 patients (13.02%) and mainly confined to the lower lobes in 162 (68.06%). The surgical treatment was as follows: pneumonectomy in 13 patients (5.46%), lobectomy in 189 (79.40%), lobectomy+segmentectomy in 31 (13.02%), and wedge resection or segmentectomy in five (2.1%). Staged bilateral thoracotomy was used in 14 patients. There was no operative mortality. Complications occurred in 21 patients and the morbidity rate was 8.82%. Complete resection was achieved in 154 (64.7%) patients. Follow-up data were obtained for 229 (96.21%) of the patients. Nine patients were lost to follow-up. The mean follow-up of these patients was 9 months (range, 3 months to 4 years). The symptoms disappeared in 189 patients (79.41%) and 29 patients (12.18%) had improved, whereas 11 patients (4.62%) had no improvement. Significantly better results were obtained in patients who had undergone a complete resection. CONCLUSIONS: Surgical resection for bronchiectasis can be performed with acceptable morbidity and mortality at any age. The involved bronchiectatic sites should be resected completely for the optimum control of symptoms.