Positron emission tomography/computed tomography findings of lung invasive adenocarcinoma subgroups and comparison of their short-term survivals.

BACKGROUND: The aim of this study was to compare the maximum standardized uptake values on positron emission tomography/ computed tomography and survival of lung invasive adenocarcinoma subgroups. METHODS: Between January 2010 and January 2016, a total of 152 patients (112 males, 40 females; mean age: 64.2±8.6 years; range, 41 to 88 years) who underwent lung resection for an invasive adenocarcinoma were retrospectively analyzed. The patients were divided into subgroups as follows: acinar, lepidic, micropapillary, papillary, and solid. The maximum standardized uptake values in the imaging study and their relationship with survival were examined. RESULTS: There were 84 acinar (55%), 31 solid (20%), 23 lepidic (15%), nine papillary (5%), and five micropapillary (3%) cases. The positron emission tomography/computed tomography enhancement showed a statistically significant difference among the subgroups (p=0.004). The solid subgroup was the most involved (9.76), followed by micropapillary (8.98), acinar (8.06), papillary (5.82), and lepidic (4.23) subgroups, respectively. According to Tumor, Node, Metastasis staging, Stage I was present in 48.68% (n=74) of the cases, Stage II in 25.0% (n=38), Stage III in 25.0% (n=38), and Stage IV in 1.31% (n=2). The one-year, three-year, and five-year survival rates were significantly different among the disease stages (p=0.01). The longest survival duration was in the lepidic subgroup, although it did not reach statistical significance among the subgroups (p=0.587). CONCLUSION: The evaluation of invasive adenocarcinomas based on maximum standardized uptake values provides valuable information and may guide neoadjuvant and adjuvant therapies in the future.

Medicolegal Evaluation of Long-Term Respiratory Functions in Patients Injured Due to Traffic Accidents.

Aim Blunt chest trauma is a frequent injury in developing countries, with motor vehicle accidents being the most common cause. Most studies about the effects of post-traumatic injuries on pulmonary functions are related to the acute phase. The aim of this study is to compare the effect of injury type on pulmonary function tests as a long-term disability in patients with severe chest trauma due to traffic accidents. Methods In our study, 53 patients were admitted to the Forensic Expert Council with the aim of determining the disability ratio at least six months after the traffic accident. All patients who had a respiratory function test because of respiratory symptoms and whose reporting period was completed were appreciated. A retrospective examination of the forensic committee reports, types of injuries, and current pulmonary function test results were analyzed and the data were evaluated by using the Statistical Package for the Social Sciences (SPSS) 22.0 program (IBM Corp, Armonk, NY). Results Thirty-two (32) of the patients were male while 21 were female. Their average age was 39.88 ± 15.29. Sixty-six percent (66%; n: 35) of the cases were injured due to in-vehicle traffic accidents, 18.9% (n: 10) due to motorcycle accidents, 15.1% (n: 8) due to non-vehicle traffic accidents. The number of cases with costa fractures was 47 and 74.4% of these cases had three or more rib fractures. The mean forced expiratory volume in 1 second/forced vital capacity ratio (FEV1/FVC-Tiffeneau-Pinelli index) was calculated as 85.3% ± 9.45, and the average FVC was 84.3 ± 14.98%. The average number of rib fractures in all patients was 3.41 ± 2.24. It was observed that tube thoracostomy was performed in seven of 12 cases with FEV1/FVC below 80%, and the average number of rib fractures was 3.75. In 20 cases where the FVC average was below 80%, the mean number of rib fractures was 3.8, and tube thoracostomy was performed in 10 of these cases. The highest FEV1 value was 116%, and the lowest FEV1 value was 35%. The FEV1 value of 23 cases was between 75% and 95%. The highest FEV1/FVC value was 113% and the lowest FEV1/FVC value was 50%. The FEV1/FVC values of 38 cases were between 80% and 100%.  Conclusions In our study, most patients achieve near-complete recovery in pulmonary function tests; the impact of pre-existing pulmonary compromise on recovery is less known. The number of rib fractures can reflect the severity of the blunt trauma but it would not necessarily predict the resulting pulmonary function. These results are consistent with the previous studies. Further larger prospective studies are required to investigate different factors affecting prognosis.

Measurement validation of treatment planning for a MR-Linac.

PURPOSE: The magnetic field can cause a nonnegligible dosimetric effect in an MR-Linac system. This effect should be accurately accounted for by the beam models in treatment planning systems (TPS). The purpose of the study was to verify the beam model and the entire treatment planning and delivery process for a 1.5 T MR-Linac based on comprehensive dosimetric measurements and end-to-end tests. MATERIAL AND METHODS: Dosimetry measurements and end-to-end tests were performed on a preclinical MR-Linac (Elekta AB) using a multitude of detectors and were compared to the corresponding beam model calculations from the TPS for the MR-Linac. Measurement devices included ion chambers (IC), diamond detector, radiochromic film, and MR-compatible ion chamber array and diode array. The dose in inhomogeneous phantom was also verified. The end-to-end tests include the generation, delivery, and comparison of 3D and IMRT plan with measurement. RESULTS: For the depth dose measurements with Farmer IC, micro IC and diamond detector, the absolute difference between most measurement points and beam model calculation beyond the buildup region were <1%, at most 2% for a few measurement points. For the beam profile measurements, the absolute differences were no more than 1% outside the penumbra region and no more than 2.5% inside the penumbra region. Results of end-to-end tests demonstrated that three 3D static plans with single 5 × 10 cm2 fields (at gantry angle 0°, 90° and 270°) and two IMRT plans successfully passed gamma analysis with clinical criteria. The dose difference in the inhomogeneous phantom between the calculation and measurement was within 1.0%. CONCLUSIONS: Both relative and absolute dosimetry measurements agreed well with the TPS calculation, indicating that the beam model for MR-Linac properly accounts for the magnetic field effect. The end-to-end tests verified the entire treatment planning process.

A practical technique in laparoscopic diaphragm pacing surgery: Retrospective analyse of 43 patients.

INTRODUCTION: Diaphragm pacing stimulation (DPS) is a treatment method used in respiratory failure occurs in diseases such as high-level cervical spinal cord injury, central hypoventilation syndrome and amyotrophic lateral sclerosis. MATERIALS AND METHODS: A total of 43 patients, who had undergone DPS implantation surgery were evaluated retrospectively. The patients were divided into two groups according to the surgical technique (Group 1: classical surgical technic and Group 2: modified surgical technic) applied. The patients with previous abdominal surgery or percutaneous endoscopic gastrostomy were excluded from the study. RESULTS: The mean operation duration was significantly shorter in modified DPS implantation technic (105.1 min in Group 1 and 87.4 min in Group 2) (P < 0.001). Capnothorax is seen 11% of the cases in classical surgery procedure. In the modified group, capnothorax was not observed. Pneumothorax rate was found similar in both groups. Post-operative atelectasis was determined 16% of the cases in classical surgery procedure and also in the modified group atelectasis was not observed. The complications were higher in classical surgery procedure group but not differed statistically in this study. Total hospitalisation duration was significantly shorter in the modified surgical technique group compared to the other group (8.0 days in Group 1 and 6.0 days in Group 2) (P = 0.03). CONCLUSION: With modification in DPS implantation surgery, shorter operation and hospitalisation durations, and less complications may be achieved.

Determination of severity of deformity with rib length to costal cartilage length ratio in thorax deformities.

BACKGROUND: This study aims to investigate whether rib length to costal cartilage length ratio is effective in determining the severity of chest wall deformity. METHODS: The study included 72 patients (64 males, 8 females; mean age 18.5±6 years; range, 6 to 40 years) who were operated because of chest wall deformity and 38 control subjects (22 males, 16 females; mean age 14.6±4.2 years; range, 6 to 25 years). Of the patients, pectus excavatum was detected in 69 and pectus carinatum in three. All participants' rib length-costal cartilage length ratio index, Haller index, correction index and computed tomography depression index were measured and compared. RESULTS: In patient group, there was a mild-level significant negative relationship between computed tomography depression index and rib length-costal cartilage length ratio index (p<0.05). Except for the computed tomography depression index, there was no significant relationship between rib length-costal cartilage length ratio index and other indexes and control group indexes in patient group. Rib length was higher than costal cartilage length in patient group compared to control group. There was no statistically significant difference between patient and control groups in terms of costal cartilage length (p>0.05). CONCLUSION: Contrary to what would be expected, there was no significant difference between patient and control groups in terms of costal cartilage length. Therefore, studies with larger series are required to demonstrate if costal cartilage length is effective in determining the severity of chest wall deformities.

Measurement of the Na2 51Σg+→A1Σu+ and 61Σg+→A1Σu+ transition dipole moments using optical-optical double resonance and Autler-Townes spectroscopy.

Accurate knowledge of transition dipole moment matrix elements is crucial since important parameters associated with the interaction of light with matter, such as emission and absorption line intensities, lifetimes, and Einstein coefficients, depend on these matrix elements. We report here an experimental study of the Na2 51Σg+↔A1Σu+ and 61Σg+↔A1Σu+ electronic transition dipole moments and their dependence on internuclear distance. We have measured absolute transition dipole matrix elements for ro-vibrational transitions of the Na2 51Σg+↔A1Σu+ and 61Σg+↔A1Σu+ electronic transitions using Autler-Townes and optical-optical double resonance spectroscopy, and we compare the results to ab initio theoretical values [A. Sanli et al., J. Chem. Phys. 143, 104304 (2015)].

Preoperative parameters and their prognostic value in amyotrophic lateral sclerosis patients undergoing implantation of a diaphragm pacing stimulation system.

INTRODUCTION: Amyotrophic lateral sclerosis (ALS) is a progressive neuromuscular disease with devastating and fatal respiratory complications. Diaphragm pacing stimulation (DPS) is a treatment option in diaphragm insufficient ALS patients. Ventilatory insufficiency depending on diaphragmatic failure is treated by the present study aimed to investigate prognostic value of preoperative clinical and functional characteristics of ALS patients undergoing implantation of a DPS system and to determine appropriate indications for the DPS system. METHODS: The study included 34 ALS patients implanted with DPS system. All patients underwent multidisciplinary and laboratory evaluations before the surgery. The laboratory examinations included pulmonary function tests and arterial blood gas analysis. Survival rates were recorded in a 2-year follow-up after the surgery. RESULTS: Twenty-eight of 34 patients with ALS survived after a 2-year follow-up. These patients were younger than those who died and had the disease for a longer time; however, the differences were not significant. Both right and left hemidiaghragms were thicker in the survived patients (P < 0.0001 for each). Pulmonary function tests revealed no significant differences between the patients who survived. Arterial blood gas analysis demonstrated lower partial pressure of carbon dioxide in the survived patients (P = 0.025). CONCLUSIONS: DPS implantation was more efficacious in ALS patients with mild respiratory failure and thicker diaphragm. Predictors of long-term effectiveness of DPS system are needed to be addressed by large-scale studies.

Importance of diaphragm thickness in amyotrophic lateral sclerosis patients with diaphragm pacing system implantation.

INTRODUCTION: Severe respiratory failure develops as a result of the involvement of the respiratory muscles in patients with amyotrophic lateral sclerosis (ALS). Implantation of diaphragm pacing system (DPS) has been carried out on ALS patients since 2005 to avoid these situations, but the importance of diaphragm thickness has not yet been established clearly. MATERIAL AND METHOD: We retrospectively evaluated 34 ALS patients who had previously implanted DPS to detect the importance of diaphragm thickness. We investigated the effect of diaphragm thickness, which was measured by preoperative thorax computerized tomography on preoperative respiratory function tests (RFT), arterial blood gas (ABG) analysis, postoperative 3- and 6-month oxygen saturations and mortality. RESULTS: The right diaphragm thickness was calculated as 4.60 (2.95-6.00) mm, while the left diaphragm thickness was 4.10 (2.77-6.00) mm. Six patients died during the follow-up period. We did not detect a significant relationship between ABG parameters, RFT and diaphragm thickness. However, according to our observations, the diaphragm thickness was significantly related to mortality. The right diaphragm was significantly thinner in cases that required preoperative respiratory support and had percutaneous endoscopic gastrostomy. When the cut-off values for the diaphragm thickness were accepted as 3.50 mm, significantly higher mortality among patients below this was observed. CONCLUSION: Diaphragm thickness is an important criterion in cases for which DPS implantation is planned. We consider that avoidance of DPS implantation is more suitable for cases with a diaphragm thickness below 3.50 mm because of mortality.

Electronic transition dipole moment and radiative lifetime calculations of sodium dimer ion-pair states.

We report here ab initio calculated electronic transition dipole moments for the sodium dimer ion pair states of (1)Σg (+) symmetry. They vary strongly as a function of internuclear distance because of the effect of the Na(+) + Na(-) ion pair potential, which also causes the formation of additional wells and shoulders in the molecular potential energy curves. We also present a computational study of the transition dipole moment matrix elements and lifetimes for these ion-pair states.

[Aspergillus colonization of an echinococcal cyst cavity: case report]. / Ekinokok Kisti Kavitesinde Aspergillus Kolonizasyonu: Olgu Sunumu.

Although lungs are common sites for the occurrence of saprophytic or invasive mycosis as well as hydatid cyst, aspergilloma within a hydatid cyst is a rare occurrence. A 36-year-old immunocompetent male presented with hemoptysis episodes of about 1 year duration. Chest X-ray revealed a smooth countered mass lesion located in the upper part of lower lobe of left lung. Surgical enucleation of the cyst wall was performed. Microscopic examination showed that the laminated membranes of hydatid cyst were invaded by septated fungal hyphea oriented with acute angles consistent with aspergillus. Herein, we report such a unique coexistence of hydatid cyst and aspergilloma, and emphasize possible complications depending on the immunostatus of the patient, if the aspergillus colonization is unnoticed in resected cystectomy material.

Prevention of pleural adhesions using a membrane containing polyethylene glycol in rats.

BACKGROUND: Recurrent thoracotomies regardless of the cause are not a rare occurrence. However, each thoracotomy results in adhesion to some extent. This adhesions increase morbidity and mortality presents a significant inconvenience for surgeons and prolongs the length of operations. OBJECTIVE: We investigated the efficacy of Prevadh®, an anti-adhesion agent to prevent intrapleural adesions following thoracotomy in a rat model. METHODS: Twenty male adult Wistar Albino rats were divided into a sham group (Group A, n = 4), a control group (Group B, n = 8), and a study group (Group C, n = 8). Only left thoracotomy was performed in Group A. Group B underwent left thoracotomy, induction of adhesion, and 1 ml saline solution was administered to the thoracic cavity. However, in Group C underwent left thoracotomy, induction of adhesion, and Prevadh® was placed between the pleura and the lung. The rats were sacrificed on day 21, and adhesions were analyzed using both macroscopic and histopathological methods. The results were statistically analyzed. A value of P<0.05 was considered statistically significant. RESULTS: Mean lengths of adhesion differed statistically significantly among all three groups, while mean intensity of adhesion differed between Group A and Group B, and between Group B and Group C (P>0.05). There was also a statistically significant difference between Group A and Group C in mesothelium proliferation score (P>0.05). No statistically significant differences were found among the groups in terms of pleural thickness, macrophage and mononuclear cell infiltration (P>0.05). CONCLUSIONS: Prevadh® was shown in a rat model to effectively prevent post-thoracotomy adhesions.

Primary pulmonary extranodal marginal zone lymphoma/low grade B-cell lymphoma of MALT type combined with well-differentiated adenocarcinoma.

We describe a rare case of extranodal marginal zone/low-grade B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) combined with areas of well-differentiated adenocarcinoma. In addition, the MALT lymphoma was synchronously systemic, with involvement of the lung, stomach and duodenum.

Nodular lymphoid hyperplasia of the lung: the role of positron emission tomography in diagnosis.

Pulmonary nodular lymphoid hyperplasia (NLH) is defined as reactive lymphoid proliferation forming solitary or multiple nodules or localized infiltrates localized in the lungs. Radiological presentations are generally solitary or multiple nodules, but air bronchograms and ground glass attenuation may be present. Patients mostly asymptomatic and the lesions were detected coincidentally on routine chest X-rays. We present a case of NLH with cavitary lesion arising in the lung of a 61 year-old man who admitted with cough and massive hemoptysis. The lesion had positive fluorodeoxyglucose (FDG) uptake. To our knowledge, this is the only patient reported in the literature presenting with massive hemoptysis and a cavitary lesion with positive FDG uptake.

Chylothorax due to tuberculosis lymphadenopathy: report of a case.

While pulmonary tuberculosis is a very frequent infection, chylothorax is an unusual manifestation of tuberculous disease. A 71-year-old woman with chylothorax is herein presented. The ductus thoracicus was ligated and lymphadenomegaly, which was adjacent to diaphragm, was resected. Based on the findings of various tests, a diagnosis of tuberculosis lymphadenitis was made. The patient was administered antituberculosis chemotherapy and has since remained asymptomatic for 1 year after the operation. In conclusion, tuberculosis lymphadenomegaly may lead to the development of chylothorax. The combination of appropriate surgical and medical treatment is an effective therapeutic strategy for this pathology.

Effects of retinoic acid on compensatory lung growth.

BACKGROUND: We investigated the effect of Retinoic acid in the growth of contralateral lung after pneumonectomy. METHODS: Twenty one adult male Wistar albino rats from the same colony were used. They were divided into three groups (Group A, B and C). Group A undergone only left posterolateral thoracotomy. In Group B and C, the rats were subjected to left posterolateral thoracotomy and left pneumonectomy. In Group C, rats were given intraperitoneal Retinoic acid during the operation and continued to be given everyday postoperatively. Rats were sacrificed on the 10th day and their total body, right lung weights and right lung volumes were measured. RESULTS: The volume and weight indices of the lung were found to be higher in Group C. In histopathological examination, there was a reduction in the mean number of alveoli in Group B and C. A significant rise in the mean dimension and average wall thickness of the alveolar structure were determined in Group C. CONCLUSION: Retinoic acid contributes to the compensatory growth of the residual lung tissue.

Cervical mediastinoscopy versus computed tomography for detecting enlarged mediastinal lymph nodes in non-cancerous lung diseases.

Cervical mediastinoscopy (CM) is considered to be the gold standard for evaluating mediastinal lymph nodes. The aim of this study was to determine the diagnostic yield of computed tomography (CT) and CM for detecting enlarged mediastinal lymph nodes in non-malignant pulmonary diseases. We retrospectively investigated the correlation and differentiation between chest CT and CM findings in terms of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), in 30 patients with granulomatous lung disease diagnosed by CM and isolated enlarged lymph nodes seen on CT scans. Biopsy tissues from the lymph nodes in stations right, 1, 2, 3, 4, and 7, were obtained for pathological examination. The 30 patients comprised 11 men (mean age 47.1 +/- 18.4 years) and 19 women (mean age 44.2 +/- 14.0 years). Radiological examination showed that the diagnostic value of stations 2 and 4 was particularly high. Thus, when CM is used for diagnostic purposes, the small lymph nodes in station 1, obtained by careful dissection of the higher mediastinal region, can be helpful. Generally, there is no absolute consistency between the findings of CM and CT. For this reason, obtaining samples from each station regardless of CT findings is recommended.

Chest-wall metastasis in a patient who underwent liver transplantation due to hepatocellular carcinoma.

Hepatocellular carcinoma is a common malignancy. It may cause extrahepatic metastases through haematogenous or lymphatic dissemination or direct invasion. Furthermore, methods such as fine-needle aspiration biopsies performed to obtain a diagnosis or percutaneous ethanol injection and radiofrequency hyperthermia performed for treatment may also cause tumour dissemination. We present a 52-year-old male patient whose isolated right chest wall metastasis developed after liver transplantation due to hepatocellular carcinoma. We performed chest wall reconstruction after the mass was removed.

Survivin expression in non-small-cell lung carcinomas: correlation with apoptosis and other apoptosis-related proteins, clinicopathologic prognostic factors and prognosis.

The role of survivin that regulates the biological behavior of non-small-cell lung carcinoma (NSCLC) is still controversial. We aimed to investigate survivin expression in NSCLC and to define any correlation with expressions of p53, bcl-2, bax, apoptotic index (AI), tumor cell proliferation, clinicopathologic variables, and overall survival. Tumors of 63 patients with NSCLC were examined for expressions of survivin, p53, bcl-2, bax, and Ki-67 by immunohistochemistry. AI was also evaluated. Results for each antibody were correlated with each other, and with clinicopathologic variables including age, sex, histologic subtype, TNM (T: primary tumor, N: regional lymph node metastasis, M: distant metastasis) stage, lymph node status, smoking history, and prognosis. Nuclear survivin expression was inversely correlated with p53 expression (P = 0.04, r = - 0.367), and tumor stage (P = 0.03, r = - 0.273), and positively correlated with tumor cell proliferation (P = 0.009, r = 0.329). Cytoplasmic survivin expression positively correlated with smoking history (P = 0.02, r = 0.282). Survivin/bax ratio was inversely correlated with AI (r: - 0.004). By Kaplan-Meier analysis, TNM stage (P < or = 0.001), lymph node metastasis (P = 0.04), and Ki-67 index (P < or = 0.001) were associated with survival, whereas survivin was not. In multivariate analysis, only TNM stage was an independent predictor. Although survivin and other apoptosis-related protein expressions fail to predict the clinical outcome, the present findings suggest that survivin is involved in tumor cell apoptosis and proliferation and may play a role in critical steps of cancer progression in NSCLC.