Management of a patient with primary mucinous testicular adenocarcinoma as a rare case with adjuvant and metastatic sequential treatments.

INTRODUCTION: Mucinous adenocarcinomas of the testicular surface epithelial tumors are very rare and are similar to malignant ovarian-type surface epithelial tumors. Although only 32 cases have been reported to date, there are only five cases of primary testicular mucinous carcinoma with access to literature in English. So there is still limited information about clinical, etiopathogenesis and treatment options. CASE REPORT: In this article, we discuss a 56-year-old male patient diagnosed with testicular mucinous adenocarcinoma due to its rarity in the light of literature review.Management and outcome: We preferred cisplatin-paclitaxel regimen for adjuvant treatment. We then used sequential treatments including oxaliplatin, 5-fluorourasil, etoposide, gemcitabine, and docetaxel to treat metastatic disease. The patient underwent lung metastasectomy for the first relapse. The patient was diagnosed in November 2013 and the response to treatment was evaluated in December 2019 and stable disease was detected. The patient, who has a total survival of 73 months, is still under treatment. DISCUSSION: Excluding malign transformation and borderline mucinous testicular tumors from mucinous cystadenomas of the testis, the knowledge on carcinogenesis, clinical course, and treatment of primary testicular mucinous adenocarcinomas is very limited.

Gastric involvement of sarcoidosis in a patient with multiple lung nodules.

Sarcoidosis is a granulomatous disorder mostly could involve intrathoracic structures. The gastric involvement is rare and the symptoms may be non-specific. We herein report a case of a 56-year-old female patient who was admitted due to chest tightness and discomfort. Computed tomography (CT) of the thorax revealed bilaterally nodular lesions in the lower lobes of the lung and pleural effusion on the left side. Positron emission tomography/CT showed lung nodules and gastric involvement with mesenteric lymphadenomegalies with pathological uptake of 18F-fluoro-2-deoxy-d-glucose. Pathological examination of the lung biopsy taken by thoracotomy demonstrated non-caseating granulomas. The gastric biopsies taken by endoscopy also showed non-caseating granulomas consistent with a diagnosis of sarcoidosis.

Pleural multicystic mesothelial proliferation that presented with hemothorax.

Pleural multicystic mesothelial proliferation is a very rare serosal pathology. In this paper, we share a pleural multicystic mesothelial proliferation case arrives the emergency service with sudden chest pain and dyspnea complaint that presented with hemothorax complication. In the literature, there is only one pleural multicystic mesothelial proliferation issue that is determined by coincidence. Even though being a rare benign pathology; pleural multicystic mesothelial proliferation can cause some vital complications as a hemothorax.

An unusual case of foreign body aspiration and review of the literature.

Tracheobronchial foreign body aspiration is a health problem that can be seen in all age groups, and it requires urgent diagnosis and intervention. We report a case of an unusual foreign body aspiration in a laryngectomized patient and we aim to discuss this situation according to the literature. A 72-year-old man, who underwent total laryngectomy 7 years ago for a squamous cell carcinoma of the larynx, was reported with complaint of aspiration of a silicone tracheostomy canula. Foreign body aspiration can present with a wide variety of symptoms. Although it is sometimes asymptomatic, mostly there exists cough, dispnea, hemoptisis and even respiratory arrest. Clinical history and radiological examinations are enough for the diagnose but in some cases, it is difficult to diagnose even by bronchoscopy. In this report, ethiology, pathogenesis, clinical presentation, diagnose and treatment of foreign body aspirations are discussed under the light of the literature. Ethiology and pathogenesis are beneficial for the assessment of treatment time and method. Appropriate and ontime clinical intervention makes the diagnosis to be easier. Treatment timing and methods are important to prevent the complications. Flexible bronchoscopy can be used for the diagnose and is preferential to remove small and fit foreign bodies. For children, for complicated cases and in order to remove penetrating or amorph-shaped bodies rigit bronchoscopy should be preferred.

New experimental corrosive esophagitis model in rats.

PURPOSE: Caustic esophagitis is a serious clinical problem and many agents are currently tried out in many experimental models. The model of Gehanno is the most commonly used invasive model, which is required general anesthesia and laparotomy. We aimed to form a new pratic and non-invasive model. METHODS: Twenty rats were studied. The stomachs of the rats were reached through guidance catheter with ether anesthesia, Fogarty catheter was send in through, it was filled with pressure in the stomach. Then, Fogarty was pulled back and stomach entrance was closed. Control group was given; n = 10; 0.25 cc isotonic, injury group was given; n = 10; 0.25 cc, %40 NaOH and it was waited for 60 s. Their esophagi were examined after 28 days. RESULTS: In the histopathologic evaluation of the control group, no pathology was discovered. Sub-mucosal collagen increase, muscularis mucosa and tunica muscularis damage have all been detected in the injury group p < 0.005; p < 0.003; p < 0.005). CONCLUSIONS: Corrosive esophagitis was formed without general anesthesia and laparotomy. Burn was formed in the total esophagus, unlike other models in which the burn is just formed at the below end. With our less invasive, more easily applied model; treatment agents can be given just as the corrosive esophagitis can be formed.

[Minimally invasive approach in the pleural fluids]. / Plevral efüzyonlarda minimal invaziv yaklasim.

The excess production or depleted absorbtion of pleural fluid is the major mechanism of pleural effusion formation. Primary lung pathologies or pathologies that originated from the other organs can be cause of pleural effusion. The search for suitable, practical and ideal treatment is continued at the present day. We have reviewed 94 patients with pleural effusion that have been treated by 10F catheter with local anesthesia in 2007-2008. The patient with dispenea, massive effusion or reoccurrent pleural effusion have been administrated pleural catheter through 7th or 8th intercostal interspace with local anesthesia. The mean age of patients (58 male, 36 female) was 57.2 (26-94). The most common etiologic causes were primary broncho carcinoma (34 cases 36.1%), cardiac failure (11 cases 11.1%) and empyema (eight cases 9.5%). Fifty three (56.3%) have been administrated pleurodesis because of treatment failure or reoccurrence. In 19 of these cases (20.2%), pleurodesis was successful. Pleurodesis agent was talc or tetracycline according to patients pain threshold. The treatment methods of pleural effusion include thoracentesis, thoracoscopy, tube thoracostomy and catheters with permanent tunnel. The simple and small-diameter catheters are administrated easily with minimal morbidity and no mortality. It's not only used in malign effusion but also used in benign effusion. Finally, simple catheter can be first treatment choice in short-term therapy and alternative choice in long-term therapy because of it's administrating facility, effectiveness in pleurodesis and cost-effectiveness.

Topical heparin: a promising agent for the prevention of tracheal stenosis in airway surgery.

BACKGROUND: The protective effects of topical mitomycin-C (MMC) have been well documented for tracheal stenosis; however, to the best of our knowledge, the use of heparin as an anti-inflammatory agent to support wound healing in upper airway surgery was not studied before. The aim of this study was to investigate the efficacy of topical heparin for healing of tracheal re-implants in a rabbit's model and its resultant histological changes compared with that of MMC. METHODS: In a rabbit model (n = 21), an elliptically shaped portion of the anterior tracheal wall was excised (3-4 tracheal cartilages) under anesthesia and immersed in an isotonic saline solution containing 0.4 mg/mL (0.04%) MMC (n = 7), heparin (liquemine) 5000 U/mL (n = 7), or none (n = 7) for 2 min and then re-implanted. The follow-up period was 2 wk for all animals and then both the larynx and the trachea were excised for histological evaluation. Hematoxylin-eosin (H and E) staining was applied to the excised tissues for microscopic evaluation. RESULTS: Compared with controls, the granulation tissue formation score in MMC group (P = 0.03), and epithelial regeneration and inflammation scores in heparin group (P = 0.032 and P = 0.022, respectively) were more favorable. The fibrosis index and tracheal lumen ratio values were also more favorable in both MMC (P = 0.019 and P = 0.0028, respectively) and heparin (P = 0.023 and P = 0.0021, respectively) groups compared with controls on the 15th d. CONCLUSIONS: Topical heparin application may have favorable effects on healing of tracheal autografts in a rabbit model. We suggest that heparin therapy should be further researched for the prevention of tracheal stenosis in airway surgery.

[Operative stabilization of traumatic flail chest using a reconstruction plaque]. / Travmatik yelken gögsün rekonstrüksiyon plagi ile cerrahi stabilizasyonu.

Flail chest is the most serious form of blunt thoracic trauma that occurs as a result of fracture of three or more ribs from at least two places or sternal fractures and/or separation of costochondral junctions. Existence of life-threatening physiopathological changes almost always affects the clinical status of the patients. Typically the fractured segment moves in the interior and exterior directions during inspirations and expirations, respectively and this paradoxical motion is called as flail chest. Non-operative treatment approaches are usually preferred for the flail chest cases. However, surgery constitutes the unavoidable treatment procedure in the existence of severe chest wall deformities, unstable ventilation dynamics, lung and diaphragmatic injuries and prolonged mechanical ventilation. Here we present a case of traumatic flail chest in a patient with traumatic severe chest wall deformity treated by chest wall reconstruction with AO-ASIF [Arbeitsgemeindschaft fur Osteosynthesefragen (Association for the Study of Internal Fixation)] osteosynthesis plaque.

[Atypically located pulmonary adenoid cystic carcinoma: case report]. / Atipik yerlesimli pulmoner adenoid kistik karsinom: Olgu sunumu.

Pulmonary adenoid cystic carcinomas typically arise from central extra-pulmonary airways and lung involvement is rare. On the other hand, this entity should be kept in mind because it has a more favorable clinical course compared to the primary lung adenocarcinoma. In this paper; the clinical, radiological and pathological aspects of a 47 years old man with a complaint of chronic cough, who was found to have a mass lesion at upper lobe of right lung and a final diagnosis of primary pulmonary adenoid cystic carcinoma according to transbronchial needle biopsy and pneumonectomy, was presented.

The protective effect of nitroglycerin on gastrointestinal and renal side effects of lornoxicam in rats.

UNLABELLED: The aim of this study is firstly, to determine the preventive effect of chronic usage of combination of nitroglycerin and lornoxicam on gastrointestinal and renal side effects and secondly, to investigate the oxidative and antioxidative effects of this combination in rats. METHODS: Thirty-seven Wistar male rats were divided into five groups for 15 days; isotonic group (n = 8, sodium chloride 0.09, Group ISO), lornoxicam group (n = 8, lornoxicam 1.3 mg/kg, Group L), nitroglycerin group (n = 6, nitroglycerin 1 mg/kg, Group NTG), lornoxicam-nitroglycerin combination group (n = 8, 1.3 mg/kg lornoxicam + 1 mg/kg nitroglycerin, Group L-NTG), and control group (n = 7, no drug was administered, Group C). Nitric oxide, malondialdehyde, reduced glutathione (GSH), catalase, interleukin (IL)-6 and tumor necrosis factor (TNF)-alpha concentrations were measured before drug injection and on fifteenth day in all blood samples. Gastrointestinal and renal biopsies were performed on fifteenth day. RESULTS: Two rats died on tenth and twelfth days in Group L. There were significant differences in Group L compared to the other groups for the lesions of stomach and kidney (p = 0.01, p = 0.028 respectively). Gastric ulceration was occurred in a rat in Group L. Malondialdehyde, TNF-alpha, and IL-6 levels decreased in NTG and L-NTG groups, whereas catalase and glutathion levels increased in NTG, L and L-NTG groups compared to control group (p < 0.05). CONCLUSION: Lornoxicam may cause gastrointestinal and renal side effects without oxidative stress. Adding nitroglycerin to lornoxicam for chronic treatment may prevent these side effects and enhance antioxidative effect compared to the use of lornoxicam alone in rats.

Primary neuroendocrine carcinoma of the mediastinum.

A mediastinal mass was found in a 37 year old male who presented with fever, weight loss and fatigue. The chest CT revealed a 9x6x4 cm well circumscribed mass located paratrachaelly in the upper mid-mediastinum. The mass was removed by right thoracotomy. Macroscopically the tumor weighed 195 g and measured 9x6x4 cm. Microscopically the tumor consisted of small blue cells in solid and trabecular pattern. Immunohistochemical studies performed for differential diagnosis of small blue cell tumors. The tumor was diagnosed as primary neuroendocrine carcinoma of the mediastinum. This case is presented for its rare recurrence in that particular location.

Pulmonary lymphomatoid granulomatosis evolving to large cell lymphoma in the skin.

Lymphomatoid granulomatosis is an angiodestructive, angioinvasive lymphoproliferative disorder. It involves most frequently lungs, central nervous system and skin. Recent studies indicate that lymphomatoid granulomatosis is an Epstein-Barr virus associated B cell disorder with a background of reactive T lymphocytes. In a 49 year old woman presenting with fever, malaise and pulmonary masses the diagnosis of lymphomatoid granulomatosis was established histologically by open lung biopsy. Following the initial diagnosis the patient was found to have gastric and skin involvement. The skin lesion was diagnosed as diffuse large B-cell lymphoma.

[Bronchiolitis obliterans organizing pneumonia presenting with solitary pulmonary nodule and spontan pneumothorax]. / Soliter pulmoner nodül ve spontan pnömotoraks nedeniyle basvuran bir bronsiyolitis obliterans organize pnömoni olgusu.

Chronic obstructive pulmonary disease (COPD) is characterized with progressive airflow limitation as a result of abnormal inflammation due to inhalation of various noxious gases and particulate dusts. COPD is an increasing important health problem that is parallel to the increasing habit of tobacco smoke. Tracheobronchial infections seem to be the most important cause of exacerbation in COPD, however pneumothorax and pulmonary thromboembolism are also important determinant factors in the attack's severity. Since the tobacco smoking is the common risk factor in both COPD and lung cancer, solitary pulmonary nodules especially in smokers should be carefully examined. Bronchiolitis obliterans organizing pneumonia (BOOP) is an uncommon pulmonary disorder, the clinical spectrum of which is variable. In this case report, a COPD patient manifesting spontaneous pneumothorax and solitary pulmonary nodule has been discussed who was diagnosed as BOOP after surgical procedure.

Esophageal Leiomyoma in Patients with Megaloblastic Anemia.

Esophageal leiomyoma is the most common benign intramural tumor of esophagus. Although its incidence is not exactly known, it is very rare (0.006%-0.1% in autopsy series). It is generally asymptomatic and detected incidentally. Here, we present a rare case report describing coexistence of megaloblastic anemia and esophageal leiomyoma. How to cite this article: Coskun A, Unubol M, Yukselen O, Yukselen V, Aydin A, Sen S, Karaoglu AO. Esophageal Leiomyoma in Patients with Megaloblastic Anemia. Euroasian J Hepato-Gastroenterol 2014;4(2):98-100.

Pulmonary Sequestration with Renal Aplasia and Elevated SUV Level in PET/CT.

Extralobar sequestration with other bronchopulmonary malformations is commonly seen; however, the association of extralobar sequestration with renal aplasia is very rare. A 75-year-old female patient was admitted with back pain. Ultrasonography revealed aplasia of the left kidney and tomography showed 6 × 4.5 cm sized tumor in the left hemithorax at the posterobasal area. The lesion has focally increased glycolytic activity (SUVmax: 3.2) at the left upper pole on positron emission tomography scan (PET/CT). Sequestrectomy was performed after the confirmation by frozen section that the lesion was benign and of extrapulmonary sequestration. No complication occurred during postoperative and 50-month follow-up period.

A hemiclamshell incision for a giant solitary fibrous tumor of the right hemithorax.

A 41-year-old female was admitted with respiratory distress. Chest radiographs showed opacity in the right hemithorax with mediastinal shift. Computed tomography (CT) scan showed a pleural mass with a 22 cm diameter occupying the whole right hemithorax and causing atelectasis. Magnetic resonance imaging (MRI) showed lower position of the right hemidiaphragm and the liver. Superior vena cava and heart were shifted to left. Presence of infiltration to the adjacent tissues could not be clearly evaluated because of pressure effect. Transthoracic needle biopsy specimen was reported to be benign. Because of the size and location of the mass, a hemiclamshell incision was chosen, which allowed excellent visualization and complete dissection of the giant tumor. The histopathology of the resected specimen confirmed solitary fibrous tumor. The patient was stabilized by careful observation and treatment. No complication except pneumonia in the postoperative first month occurred during the 22-month follow-up period.

Comparison of mitomycin-c and heparin affects in experimental corrosive esophagitis on rats.

OBJECTIVE: We comparative effects of mitomycin-c and heparin which have different mechanism of action in a minimal invasive corrosive esophagitis model which was formed by NaOH 40%. METHOD: The study was performed on forty female Wistar albino rats; were divided into four equal groups each including ten animals. Group C (n=10); control, the group that esophagus was washed with normal saline, group I (n=10); injury group; alkali esophagus burn, not treated, group M (n=10); alkali esophagus burn, mitomycin-c treatment group, group H (n=10); alkali esophagus burn, heparin treatment group. The study was performed on a minimal invasive model which did not require general anesthesia and abdominal operation. In 28 day, all subjects were killed and their esophagus's were removed by thoraco-abdominal cut. Total esophagi from oropharynx to stomach were removed and they were examined macroscopically and microscopically and evaluated for esophageal tissue collagen deposition and histopathologic damage score. RESULTS: When group C is compared with each of the other groups, statistically significant weight losses were detected; [(p<0.005, p<0.05, p<0.005), respectively]. Significant inflammation increase was detected in groups I, M and H in comparison to group C [(p<0.001, p<0, 0001, p<0.005)]. When granulation scores of groups were compared; statistically significant granulation increases were detected in groups I, M, and H [(p<0.05, p<0.05, p<0.05) compared to group C]. Significant collagen increase was detected in all 3 layers in groups; I, M and H according to group C [(p<0.05, p<0.05, p<0.05)]. Collagen increase in every 3 layers in groups M and H were significantly less according to group I [(p<0.05, p<0.05, p<0.05)]. Collagen increase in every 3 layers was less in group M than group H (p<0.05). CONCLUSION: In corrosive esophagitis due to NaOH, heparin treatment is more effective in inflammation and granulation formation, mitomycin-c treatment is more effective in preventing the collagen accumulation step. Heparin decreases the tissue damage by preventing the inflammation and granulation formation; and prevents collagen accumulation and stricture development. As completing the effect of heparin; mitomycin prevents fibroblastic activity inhibition with direct collagen accumulation and stricture development strongly.

Mortality and associated factors in a thoracic surgery ICU.

OBJECTIVE: To assess mortality and identify mortality risk factors in patients admitted to a thoracic surgery ICU. METHODS: We retrospectively evaluated 141 patients admitted to the thoracic surgery ICU of the Denizli State Hospital, located in the city of Denizli, Turkey, between January of 2006 and August of 2008. We collected data regarding gender, age, reason for admission, invasive interventions and operations, invasive mechanical ventilation, infections, and length of ICU stay. RESULTS: Of the 141 patients, 103 (73.0%) were male, and 38 (23.0%) were female. The mean age was 52.1 years (range, 12-92 years), and the mortality rate was 16.3%. The most common reason for admission was trauma. Mortality was found to correlate with advanced age (p < 0.05), requiring invasive mechanical ventilation (OR = 42.375; p < 0.05), prolonged ICU stay (p < 0.05), and specific reasons for admission-trauma, gunshot wound, stab wound, and malignancy (p < 0.05 for all). CONCLUSIONS: Among patients in a thoracic surgery ICU, the rates of morbidity and mortality are high. Increased awareness of mortality risk factors can improve the effectiveness of treatment, which should reduce the rates of morbidity and mortality, thereby providing time savings and minimizing costs.

Thoracic catheter-related infections.

OBJECTIVE: To determine the incidence of local and systemic infection in a sample of patients catheterized with thoracic catheters (TCs) and to identify the prognostic factors for catheter-related infection. METHODS: A retrospective study involving 48 patients (17 females and 31 males) catheterized with TCs between December of 2008 and March of 2009 in the Thoracic Surgery Department of the Adnan Menderes University Hospital, located in Aydin, Turkey. Blood samples for culture were collected from the distal end of each TC and from each of the 48 patients. We looked for correlations between positive culture and possible prognostic factors for catheter-related infection. RESULTS: Culture results were positive in TC samples only for 3 patients, in blood samples only for 2, and in both types of samples for another 2. Advanced age correlated significantly with positive culture in TC samples and in blood samples (r = 0.512 and r = 0.312, respectively; p < 0.05 for both), as did prolonged catheterization (r = 0.347 and r = 0.372, respectively; p < 0.05). There was a significant correlation between having undergone surgery and positive culture in TC samples only (p < 0.05). However, having an inoperable malignancy correlated with bacterial growth in blood and in TC samples alike (p < 0.05 for both). CONCLUSIONS: Risk factors, such as advanced age, prolonged catheterization, comorbidities, and inoperable malignancy, increase the risk of catheter-related infection. It is imperative that prophylaxis with broad-spectrum antibiotics be administered to patients who present with these risk factors and might be catheterized with a TC.