Surgical outcomes and clinical courses of solitary fibrous tumors of pleura.

AIM: This study's aim is to define the clinicopathological and surgical outcomes, clinical courses, and results of long-term follow-up of cases that underwent surgical treatment for solitary fibrous tumors of the pleura (SFTp). SUBJECTS AND METHODS: Clinical and long-term follow-up records of 16 consecutive patients who had surgery for SFTp between 2006 and 2016 were reviewed in the retrospective chart review. There were nine males (56%) and seven (44%) females with an average age of 60.5 ± 17.1 (range 30-87 years). Etiological factors, diagnostic procedures, clinical and surgical outcomes, 5-year overall survival (OS), and disease-free survival (DFS) in these patients were researched. RESULTS: There was no remarkable common etiological factor. Nine of the cases were asymptomatic. Other symptoms were chest pain, dyspnea, cough and hypertrophic osteoarthropathy, respectively. Thoracotomy for the removal of pleural mass was carried out in 15 (94%) cases. Additional resection procedures included the chest wall resection in two cases and lobectomy in two. Video-assisted thoracoscopic surgery (VATS) resection was performed in one (6%) case. Complete surgical excision was performed in 74% of cases. Nineteen percent of cases were malignant SFTp (mSFTp). One of the mSFTp cases died in the 19th month after the diagnosis. The mean follow-up time was 50.6 ± 34.2 months (2--114 months). Mean survival of mSFTp patients was 40.6 ± 19.08 months (19--55 months) and that for benign SFTp (bSFTp) was 52.9 ± 37.05 months (2--114 months). Five-year OS--DFS were 93.5% and 74%, respectively. CONCLUSION: SFTp is an uncommon benign neoplasm but it can have malignant features. Even in the case of recurrence, the main treatment is total surgical excision. Oncologic treatments can be tried in unresectable and metastatic cases. VATS can be used in surgical total excision for small diameter and appropriate tumors. Understanding the nature of these tumors, immunohistochemical, and genetic studies may be a guide in future.

Abdominothoracic fistulas due to complicated echinococcosis.

PURPOSE: Abdominothoracic fistulas are severe complications of hydatid disease. We report here on the results of surgical treatment of hydatid abdominopleural fistulas in 6 patients. MATERIAL AND METHODS: Between 2004 and 2010, 6 patients with abdominothoracic fistulas (ATF) were treated. The patients were 3 men and 3 women (age range: 47-62 years; median age: 57.1 years). The main symptoms were dyspnea, chest pain, cough, purulent sputum, high fever in 4 patients and additionally bilioptysis in 2. Fistulas were left abdominopulmonary in 1, hepatopulmonary in 2 and hepatopleural in 3 patients. RESULTS: Five patients were operated for ATF and 1 patient was treated with tube thoracostomy. In 4 patients, liver dome hydatid cyst abscesses were exposed through a right thoracophrenotomy, a first left thoracophrenotomy was performed in 1 patient followed by a second left lower lobectomy due to a destroyed lobe. Tube thoracostomy and percutaneous transhepatic drainage was applied successfully in Patient #5. All patients were discharged from hospital in good health. Our strategy consisted of adequate evacuation of the intrahepatic cyst with dissection and closure of the fistula via thoracophrenotomy. DISCUSSION: ATF due to hydatid cyst is uncommon. In rare cases ATF may be present at the abdominal, thoracic or diaphragmatic level. Thoracophrenotomy is the best surgical treatment for all three levels.

Transaxillary approach for thoracic outlet syndrome: results of surgery.

BACKGROUND: Thoracic outlet syndrome (TOS) is one of the most complicated diseases in thoracic surgery with regard to both diagnosis and treatment. Surgical removal of the first rib and cervical rib, if present, has been suggested as the treatment of choice in patients who do not benefit from physiotherapy. In this retrospective study, our surgical experience with TOS and the management of surgical complications are presented. METHODS: A total of 109 cases with the diagnosis of TOS were operated on between January 1995 and April 2010. Ninety-five of the cases were females (87.2 %) and 14 (12.8 %) were males with a mean age of 35.7 (16-58). RESULTS: A total of 131 operations were performed, of which 21 were bilateral and one was a recurrent operation. The diagnosis was neurogenic TOS in 107 (98.2 %) and vascular TOS in two (1.8 %) patients. All neurogenic TOS operations were performed via the transaxillary route. A posterior thoracoplasty approach was used for recurrent TOS in one case. A total of 23 (21.1 %) cases had a cervical rib. Fibromuscular bands were observed in 68 (62.3 %) cases. The rates for favorable and poor surgical outcome were 125 (95.4 %) and 6 (4.6 %), respectively. The most common complication was apical pneumothorax in 32 (24.6 %) cases, followed by wound infection in four (3 %), lymphatic leak, axillary hematoma and mild brachial plexus traction palsy in one (0.8 %) case. Mortality was not observed. CONCLUSIONS: In our experience the exposure provided by the transaxillary approach is safe and superior to that offered by other approaches as it allows a wide range of surgical applications such as first rib resection, cervical rib resection and resection of fibrotic bands.

Self-expandable esophageal stents placement for the palliation of dysphagia as a result of lung cancer.

We report our experience with self-expandable metallic stents for the palliation of malignant dysphagia and tracheoesophageal fistulae caused by lung cancer. Esophageal self-expandable metallic stents were deployed in 28 patients with malignant dysphagia as a result of lung cancer between August 2002 and January 2009. Mean age was 62.1 (42-77) with 26 male patients. Twenty-three patients received previous chemo-radiotherapy and two had pneumonectomy. Tracheoesophageal fistulae were coexisting in eight patients. Stents were inserted under fluoroscopic control over guide-wire with the patient under conscious sedation. One stent was used in all patients except one fistula patient with two stents. Immediate improvement after stent insertion was seen in all patients. Fistulae were sealed off in all. No complication was seen except transitional pain in 12 patients (42%). During the follow-up, all patients remained asymptomatic with no clinical appearance of dysphagia symptoms except one patient whom gastrostomy was applied. All patients with fistulae died with a mean survival of 15.4 weeks. Dysphagia patients without fistulae died with mean survival of 6 months except one patient with 1 month follow-up. Self-expandable esophageal metallic stent insertion can manage malignant dysphagia in lung cancer patients with significant survival period via nonsurgical approach.

Surgical therapy of pulmonary arterial aneurysms in Behçet's syndrome.

Two patients with Behçet's syndrome were operated for exsanguinating pulmonary artery aneurysm into a bronchus. Lower lobectomy was performed in the first patient. He died of hypoxia and sepsis on the 8th postoperative day. Pneumonectomy was undertaken in the second patient, who is well 30 months after the operation.

The rupture of hepatic hydatid disease into the right hepatic vein and bile ducts: a case report.

Echinococcus granulosus and Echinococcus multilocularis cause liver hydatid disease. One of its most common complications is rupture into the bile ducts; however, penetration of a cyst into a vessel is a very rare complication. We detected a defect (2 x 1 cm) on the wall of the right hepatic vein, in addition to three distinctive ruptures into the bile ducts, in our case. For systemic hypotension due to a bleeding during operation and to repair the vessel wall defect, an urgent right thoracotomy followed by a radial phrenotomy was needed. We were able to reach the operation site easily and repaired the vessel wall with polypropylene suture. Because of the occurrence of these two complications together and the difficulties of the operation, we decided to report this case.

Laparoscopic versus open cholecystectomy: effect on pulmonary function tests.

BACKGROUND/AIMS: Operations often cause impairment in respiration due to pain. This study was designed to compare the changes in pulmonary function tests after open and laparoscopic cholecystectomy. METHODOLOGY: Two groups of 35 patients were randomly set up. Each patient had 3 pulmonary function tests performed and 2 postero-anterior grid chest roentgenograms taken. All of these data were evaluated by the same group of investigators. RESULTS: After taking into consideration the difference between pulmonary function tests, values were not significant (P < or = 0.05). All pulmonary function test values decreased significantly on the 1st postoperative day (P < or = 0.05). When postero-anterior chest roentgenograms were compared no clinically evident atelectasis except 3 lineary was seen in the laparoscopic cholecystectomy group, whereas 5 lineary, 7 focal, and 3 segmentary atelectasia were encountered in the open cholecystectomy group (P < or = 0.05). CONCLUSIONS: We believe that laparoscopic cholecystectomy has more advantages when speaking of postoperative pulmonary function tests and atelectasia.

Simultaneous operation for coexisting lung and liver hydatid cysts: a treatment modality.

BACKGROUND/AIMS: Hydatid disease is very common in our region. Whether or not coexisting cysts of lung and liver should be operated on simultaneously is a challenging question. METHODOLOGY: Of 127 patients operated on for hydatid cysts of the lung between 1990 and 1995, 23 (18%) had coexisting hydatid cysts of the right lung and liver. There were 12 male and 11 female patients with an average age of 34 years. RESULTS: All patients had simultaneous operations for both organs via right thoracotomy with an incision in the diaphragm (phrenotomy). In the lung, cystotomy and capitonnage were performed in 21 patients and wedge resection in 2; in the liver, cystotomy and capitonnage were performed in all 23 patients. No hospital mortality occurred. CONCLUSION: Coexisting hydatid cysts of the right lung and liver should be surgically treated simultaneously.

Videothoracoscopy in the treatment of spontaneous pneumothorax: an initial experience.

We report an initial experience with the new and potentially advantageous technique of videothoracoscopy in the treatment of pneumothorax. A series of 18 consecutive patients (14 male, 4 female) presenting with spontaneous pneumothorax over a 4-month period underwent surgical treatment by this method. The indication for surgery was recurrent pneumothorax in nine patients and persistent air leak in the remainder (median duration 15 days, range 5-28 days). Stapled apical bullectomy with apical parietal pleurectomy was performed in 14 patients, bullectomy alone was performed in one patient and pleurectomy alone in three patients. Additional talc pleurodesis was carried out in three of these patients. Median duration of operation was 53.5 min (range 35-120 min). The median postoperative drainage was 300 ml in 24 h (range 50-580 ml). The median duration of intercostal drainage was 48 h (range 24-384 h) and of postoperative hospital stay 4 days (range 3-18 days). The mean postoperative analgesic requirement was 1.3 mg morphine/h. Three complications required reoperation. In two patients a large air leak persisted after operation; one proceeded to thoracotomy for suturing of the air leak and in the other this was accomplished by videothoracoscopy. A further patient re-presented at 2 weeks with recurrent pneumothorax which was treated at thoracotomy. At a median follow-up of 68.5 days (range 10-124 days) this is the only recurrence. These complications were caused by errors in surgical technique early in our series. This initial experience of videothoracoscopic pleurectomy suggests it is an effective, well-tolerated treatment of spontaneous pneumothorax.

Esophageal stent placement for the palliation of dysphagia in lung cancer.

BACKGROUND: The aim of this study was to evaluate the experience with expandable metal stents for the palliation of malignant dysphagia caused by lung cancer. METHODS: Between August 2002 and April 2006, we deployed esophageal metal stents in 14 patients with esophageal involvement from lung cancer. The mean age of the patients was 61.4 years, and 12 were male patients. Expandable metal stents were inserted under fluoroscopic control over a guide-wire with the patient under conscious sedation. RESULTS: Four patients had concomitant tracheoesophageal fistula. Eleven patients had received previous chemotherapy or radiotherapy and two had had a pneumonectomy. Immediate improvement after esophageal stent replacement was seen in all patients. The fistula was sealed off in all. All the patients remained asymptomatic during follow-up. All patients died, with mean survival of 10 weeks for patients with fistula and 8.3 months in the patients without fistula. CONCLUSION: The poor quality of life associated with malignant dysphagia and tracheoesophageal fistula in lung cancer patients can be significantly improved by a non-surgical intervention such as the deployment of expandable metal stents.

Pleurosubcutaneous fistula presenting as lateral thoracic lump in an oncologic patient.

We describe a case of pleurosubcutaneous fistula of the left thoracic wall in an oncologic female patient. She presented with left-sided pain and a chest wall mass bulge suspicious for breast neoplasm metastasis.

Arginase and ornithine, as markers in human non-small cell lung carcinoma.

The arginase activity and ornithine level were determined in tissue obtained from patients with non-small cell lung carcinoma (NSLC). The arginase activity and ornithine level in tumor tissues were 1.89 +/- 1.28 U/mg protein and 42.32 +/- 25.82 nmol/mg protein, respectively versus 0.67 +/- 0.19 U/mg protein and 10.12 +/- 3.69 nmol/mg protein for normal tissues (p < 0.01).