Surgical treatment in malignant pleural effusion.

Malignant pleural effusion can be described as the presence of exudate in the pleural space, accompanied by the detection of cancer cells in pleural fluid or tissue, which is the indicator of the disease in its advance stages, and survival time of these patients ranges between 3 and 12 months. Treatment options for malignant pleural effusion vary from observation in asymptomatic patients to pleurectomies or even extrapleural pneumonectomies in severe cases.

Factors determining the complications in Nuss procedure.

BACKGROUND: This study aims to share our experiences in complications developing in patients who underwent Nuss procedure and the management of these complications. METHODS: In the study, files of 59 patients (50 males, 9 females; mean age 17.6±5.1 years; range, 2.5 to 33 years) who were applied Nuss procedure for pectus excavatum in our clinic between July 2007 and May 2016 were retrospectively assessed. Patients" age, gender, surgical method-complications and hospitalization durations were recorded. Fisher"s chisquare test and logistic regression analysis were used for data evaluation. RESULTS: Nuss procedure was performed in all patients without severe complications such as death, organ injury or massive hemorrhage. The most frequently observed postoperative earlyperiod complication was minimal pneumothorax (n=16, 27.1%), while bar dislocation was most frequently observed in the lateperiod (n=5, 8.3%). CONCLUSION: Being male and/or over 23 years of age were determined as risk factors for complication development after Nuss procedure. Still, being a minimally invasive and manageable approach with its success in correcting the deformity, short operation duration, and low complication rates, Nuss procedure can be safely performed in selected patients.

Tracheobronchial foreign bodies have never been so strange!

BACKGROUND: In the present study, we aimed to present our experience about retrieval of foreign bodies over a 28-year period. METHODS: We retrospectively analyzed the files of 22 patients (18 males, 4 females; mean age 34.9 years; range, 9 months to 80 years) who required removal of a foreign body from the tracheobronchial tree between April 1987 and December 2015. RESULTS: A total of 72.7% of the study group were 10 years old or older. There was no history of aspiration in 37% of cases, most often in older patients. Of the 22 unusual foreign bodies, seven (31.8%) were aspirated through permanent tracheostomy. The strangest foreign bodies were grass inflorescences, an acacia thorn, and construction nail. The foreign bodies were removed by rigid bronchoscopy in 18 patients, while thoracotomy was performed in two patients, and pericardiotomy in one patient. No intervention was required in one patient. CONCLUSION: The elderly and patients with tracheostomies may aspirate unusual foreign bodies. Even if there is no history of aspiration, the differential diagnosis of c ough or dyspnea should include foreign body aspiration.

Is the Abramson technique effective in pectus carinatum repair?

BACKGROUND: The minimally invasive pectus carinatum (PC) surgery described by Abramson has been performed in many centers. We have been using this technique since 2011. This article describes our experience with PC correction. METHODS: Between 2011 and 2016, 32 patients at our institution underwent minimally invasive repair of a PC deformity. All patients presented with cosmetic complaints. The deformity involved the lower sternum (all had chondrogladiolar type PC), and three patients had asymmetrical deformities. All operations followed the principles defined by Abramson. RESULTS: Satisfactory esthetic results were achieved in our patients. The hospital stay averaged 5.3 days (range 4-7 days). The most common early complication was pneumothorax, and the most common late complication was wire suture breakage. CONCLUSION: The Abramson technique is an effective, minimally invasive procedure for PC with shorter operating and hospitalization times and low morbidity rates.

Comparison of trauma scores for predicting mortality and morbidity on trauma patients.

BACKGROUND: In this study, we compared the anatomical, and physiological scoring systems trauma revised injury severity score (TRISS), revised trauma score (RTS), injury severity score (ISS), new injury severity score (NISS) to each other, to find out the most accurate and reliable trauma score for the risk classification of morbidity and mortality among the trauma patients. METHODS: This is a cross-sectional study, which included 633 patients who admitted to our University Hospital Emergency Department during an 8-month period due to trauma. All blunt and penetrating traumas (traffic accident, assault, etc.) patients above 16 years were included. RESULTS: Arrival time trauma scores (ISS, NISS, RTS, and TRISS) of the patients was calculated. Mean trauma score for the mortality prediction was calculated, and the p value was equal for all (p=0.001). Trauma scores were also analyzed for the hospitalization time in intensive care unit (ICU). While NISS, RTS, and TRISS values were significant (p=0.048, p=0.048, and p=0.017, respectively), ISS value was not significant (p=0.257) for predicting the ICU hospitalization time. Only TRISS was a good predictor for the mechanically ventilation time in ICU patients (p=0.01). CONCLUSION: In conclusion, we determined that the anatomical trauma scores (NISS, ISS) predicted the hospitalization and ICU necessities better, whereas TRISS, an anatomo-physiological trauma score, defined the ICU hospitalization and mechanically ventilation time better.

Textiloma mimicking superior sulcus tumor: positron emission tomography/computed tomography findings of a pseudotumor.

We present an interesting case report of a 52-year-old man with a superior sulcus tumor. To evaluate the suspicious left lung tumor, 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) was used. Increased FDG level was indicative of a malignant tumor. Left thoracotomy revealed a textiloma retained during cardiac surgery.

Does hydatid disease have protective effects against lung cancer?

We hypothesized that solid tumors rarely occur in patients with hydatid disease. We obtained the serum of 14 patients diagnosed with hydatid disease, the serum of 10 patients who did not have a history of hydatid disease, and the hydatid cyst fluid from six patients. These sera and fluid samples were added at different concentrations to NCI-H209/An1 human lung small cell carcinoma cells and L929 mouse fibroblasts as a control group. Sera of patients with hydatid diseases had cytotoxic effects on NCI-H209/An1 cells, but they did not have cytotoxic effects on fibroblast cells. Sera from healthy subjects did not have a cytotoxic effect on the tumor cell line or control fibroblasts. Cyst fluid, also, did not have toxic effects on the NCI-H209/An1 cell line, but was toxic to fibroblasts up to a 1:32 dilution. Sera from patients with hydatid disease had cytotoxic effects on human small cell lung cancer cells in vitro.

A thoracic surgeon's perspective on the elastofibroma dorsi: A benign tumor of the deep infrascapular region.

BACKGROUND: An elastofibroma is a benign, soft-tissue tumor and is important in the differential diagnosis of thoracic wall masses. Here, patients with elastofibromas who underwent thoracic surgery were retrospectively reviewed to elucidate elastofibroma formation and to facilitate the differential diagnosis. METHODS: This is a retrospective and descriptive study of a series of 30 patients with elastofibroma dorsi. The data was obtained by review of the hospital records. RESULTS: There were 27 female and three male patients (mean age, 55.13 ± 8.7 years) with a total of 42 elastofibroma dorsi tumors (12 bilateral cases, 18 unilateral cases) diagnosed between January 2004 and October 2011. Twenty patients (67%) underwent surgery as a result of subscapular swelling and pain. In 10 (33%) asymptomatic patients, elastofibromas were found incidentally during a thoracotomy. Imaging methods in symptomatic patients included computerized tomography (15 cases), magnetic resonance (three), and ultrasonography (two). For five patients, fluorodeoxyglucose uptake values were available and revealed mild metabolic activity in the elastofibromas. Elastofibromas were significantly larger in symptomatic patients (8.15 ± 1.9 vs. 6.2 ± 2.3; P= 0.02). Exposure to long-term repetitive micro-trauma was a precipitating factor in 23 (77%) patients. Seroma formation, the most common surgical complication, was observed in 40% of patients. CONCLUSION: The differential diagnosis of elastofibroma dorsi is straightforward, and preoperative histology is unnecessary when the clinical, radiological, and metabolic characteristics are known. Repetitive micro-trauma may predispose to hyperproliferation of fibroelastic tissue, and genetics may also play a role. Surgical treatment can be reserved for cases with severe symptoms.

Antitumoral effects of Allium sivasicum on breast cancer in vitro and in vivo.

This work aims to investigate the antiproliferative properties of Allium sivasicum (AS) on breast cancer. AS extracts were studied for cytotoxicity against the breast cancer cell lines. In vitro apoptosis studies of breast cancer cells were performed by annexin V staining in flow cytometry analyses. AS showed cytotoxicity to three cancer cell lines. Annexin-positive cells level in AS treated cell lines were higher than the untreated control cells. The expressions of caspase-7 protein and TUNEL positive cells were much higher for the rats treated by AS, compared with the untreated control group. The expressions of the Ki-67 decreased in treatment groups compared with the control group. In vivo studies showed that mean tumor volume inhibition ratio in AS treated group was 38 % compared with the untreated rats. These results indicate that A. sivasicum has antitumoral potential against breast cancer.

Video-assisted thoracoscopic surgery to treat hydatid disease of the thorax in adults: is it feasible?

BACKGROUND: Optimal treatment of intrathoracic hydatid diseases in adults involves complete removal of the cyst with parenchyma-preserving surgery. In current practice, thoracotomy remains the standard surgical approach for pulmonary hydatid cysts, so surgical experience is limited, particularly with regard to video-assisted thoracoscopic surgery (VATS). SUBJECTS AND METHODS: Between June 2007 and May 2011, a selected series of 12 adult patients presenting with intrathoracic hydatid cysts underwent VATS. The cysts were completely removed using a three-trocar technique. RESULTS: Complete removal of the cysts was successful in all patients. All cysts were diagnosed by computerized tomography, and 6 (50%) patients had a history of hydatid disease in the liver or lung. No serious postoperative complications were observed. Patients with thoracoscopic excision were discharged after a median of 2.9 days (range, 2-6 days). No recurrences or complications were observed during a mean follow-up of 29 months. CONCLUSIONS: Considering the conversion and complication rates in our series, VATS should be the primary therapeutic choice for adults with thoracic hydatid cysts. Open surgical interventions in patients with large and uncomplicated cysts appear optional.

Antitumoral effects of Melissa officinalis on breast cancer in vitro and in vivo.

BACKGROUND: There is a long standing interest in the identification of medicinal plants and derived natural products for developing cancer therapeutics. Here we investigated the antiproliferative properties of Melissa officinalis (MO) from Turkey on breast cancer. METHODS: MO extracts were studied for cytotoxicity against breast cancer cell lines (MCF-7, MDA-MB-468 and MDA-MB-231). In vitro apoptosis studies were performed by annexin V staining and flow cytometry analyses. Immunohistochemistry for Ki-67 and caspase 7 in the tumoral tissue sections of DMBA-induced mammary tumors in rats was also performed, along with TUNEL assays to detect apoptotic cells. In vivo anticancer activity testing was carried out with reference to inhibition of growth of DMBA induced mammary tumors in rats. RESULTS: MO showed cytotoxicity against three cancer cell lines, inducing increase in Annexin-positive cells. Expression of caspase-7 protein and TUNEL positive cells were much higher in rats treated by MO, compared with the untreated control group, while expression of Ki-67 was decreased. Furthermore, in vivo studies showed that mean tumor volume inhibition ratio in MO treated group was 40% compared with the untreated rats. CONCLUSION: These results indicated that MO extrcts have antitumoral potential against breast cancer.

Investigation of wound healing in rat lung tissues in the postpartum period.

To assess the wound healing capabilities of damaged lung tissue in the postpartum period, we investigated the parameters related to wound healing in a rat model of lung damage. Rats were divided into six groups: IA, IB, II, IIIA, IIIB and IV (n=7 in each group). Group IA included rats not in the postpartum period that were sacrificed on the third day after lung injury, group IB included rats not in the postpartum period that were sacrificed on the tenth day after lung injury, group II included rats not in the postpartum period that did not receive lung injury, group IIIA included rats in the postpartum period that were sacrificed on the third day after lung injury, group IIIB included rats in the postpartum period that were sacrificed on the tenth day after lung injury and group IV included rats in the postpartum period without lung injury. Wound healing was evaluated histopathologically and measurements of hydroxyproline levels, serum alanine and glutamine were taken. A significant difference in serum alanine levels was evident between groups IA and IIIA. Significant differences were also observed between serum alanine and glutamine levels in groups IB and IIIB. In conclusion, we demonstrated that serum alanine levels were reduced in the postpartum period following lung injury, which may be expected to negatively impact wound healing in this period. The administration of exogenous alanine for traumatic events occurring during the postpartum period may thus contribute positively to wound healing capabilities during this period.

An analysis of 214 cases of rib fractures.

INTRODUCTION: Rib fractures are the most common type of injury associated with trauma to the thorax. In this study, we investigated whether morbidity and mortality rates increased in correlation with the number of fractured ribs. MATERIALS AND METHODS: Data from 214 patients with rib fractures who applied or were referred to our clinic between January 2007 and December 2008 were retrospectively evaluated. The patients were allocated into three groups according to the number of fractures: 1) patients with an isolated rib fracture (RF1) (n = 50, 23.4%), 2) patients with two rib fractures (RF2) (n = 53, 24.8%), and 3) patients with more than two rib fractures (RF3) (n = 111, 51.9%). The patients were evaluated and compared according to the number of rib fractures, mean age, associated chest injuries (hemothorax, pneumothorax, and/or pulmonary contusion), and co-existing injuries to other systems. FINDINGS: The mean age of the patients was 51.5 years. The distribution of associated chest injuries was 30% in group RF1, 24.6% in group RF2, and 75.6% in group RF3 (p<0.05). Co-existing injuries to other systems were 24% in group RF1, 23.2% in group RF2, and 52.6% in group RF3 (p<0.05). Two patients (4%) in group RF1, 2 patients (3.8%) in group RF2, and 5 patients (4.5%) in group RF3 (total n = 9; 4.2%) died. CONCLUSION: Patients with any number of rib fractures should be carefully screened for co-existing injuries in other body systems and hospitalized to receive proper treatment.

The association between methylene-tetrahydrofolate reductase gene polymorphism and lung cancer risk.

This study aimed to determine the relation between methylene-tetrahydrofolate reductase (MTHFR) gene polymorphism and lung cancer risk and the frequency of this polymorphism. The study involved 64 lung cancer patients (the study group) with definitive diagnosis and 61 noncancerous subjects (the control group). MTHFR C677T and A1298C mutation analysis was made using DNA isolated from peripheric blood and multiplex PCR and reverse hybridization strip test. Eighty-four percent of the patients were male. The age, gender, and history of alcohol use of the patients and control group were statistically similar. While MTHFR 677T and 677C allele frequency was 0.33 and 0.67 in the patients respectively, it was 0.29 and 0.71 in the control group. The frequencies of MTHFR 1298C and 1298A were 0.33 and 0.67 in the patients, and it was 0.31 and 0.69 in the control group respectively. When MTHFR 677TT and 677CT genotypes were compared with 677CC genotype, lung cancer risk was 2.4 times higher in the 677TT genotype. When MTHFR 1298AC and 1298CC genotypes were compared with 1298AA genotype, lung cancer risk was 1.5 times higher in 1298CC genotype. According to the results, allele frequency of homozygote T and C was high in lung cancer patients. It was 3.05 and 1.29 times higher in smokers than in non-smokers, and 3.05 and 1.64 times higher in males than in females; 3.0 and 2.44 times higher in those with non-small cell lung cancer than in those with small-cell lung cancer.

An analysis of 214 cases of rib fractures

INTRODUCTION: Rib fractures are the most common type of injury associated with trauma to the thorax. In this study, we investigated whether morbidity and mortality rates increased in correlation with the number of fractured ribs. MATERIALS AND METHODS: Data from 214 patients with rib fractures who applied or were referred to our clinic between January 2007 and December 2008 were retrospectively evaluated. The patients were allocated into three groups according to the number of fractures: 1) patients with an isolated rib fracture (RF1) (n = 50, 23.4 percent), 2) patients with two rib fractures (RF2) (n = 53, 24.8 percent), and 3) patients with more than two rib fractures (RF3) (n = 111, 51.9 percent). The patients were evaluated and compared according to the number of rib fractures, mean age, associated chest injuries (hemothorax, pneumothorax, and/or pulmonary contusion), and co-existing injuries to other systems. FINDINGS: The mean age of the patients was 51.5 years. The distribution of associated chest injuries was 30 percent in group RF1, 24.6 percent in group RF2, and 75.6 percent in group RF3 (p<0.05). Co-existing injuries to other systems were 24 percent in group RF1, 23.2 percent in group RF2, and 52.6 percent in group RF3 (p<0.05). Two patients (4 percent) in group RF1, 2 patients (3.8 percent) in group RF2, and 5 patients (4.5 percent) in group RF3 (total n = 9; 4.2 percent) died. CONCLUSION: Patients with any number of rib fractures should be carefully screened for co-existing injuries in other body systems and hospitalized to receive proper treatment.

[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.