Bowel obstruction due to diaphragmatic injury after penetrating thoracic trauma.

Diaphragmatic injuries due to penetrating traumas to the thorax progress insidiously. Proper diagnosis might only be performed after months. Delayed diagnosis increases morbidity and mortality. Herein, we present a case of diaphragm injury due to penetrating thoracic trauma that was diagnosed 2 years later. The case was referred to emergency service with bowel obstruction symptoms and after the examinations, first laparotomy and then thoracotomy were performed. The trace of the injury tract should be evaluated in all penetrating thoracic traumas and diaphragmatic injury should be taken into consideration. It is important to keep in mind that thoracic symptoms could be obscured and, if needed, further evaluation and surgical exploration should be performed. In the absence of early symptoms, failure to recognize diaphragmatic injuries can result in mortality.

Thoracic empyema due to bacterial translocation in acute appendicitis.

Appendicitis and thoracic empyema are rarely presented together. Herein, we present a thoracic empyema due to bacterial translocation in a patient, after she underwent appendicectomy for nonperforated acute appendicitis. Postoperative third day, thoracic empyema was revealed clinically and radiologically. Tube thoracostomy and antibiotherapy were performed. Despite all these therapy, her symptoms went on, and abdominal ultrasonography revealed multilocular collections and formations of abscess in the abdomen. All abscesses were drained by nonvascular interventional radiologic methods. We believe that simultaneous occurence of thoracic empyema and formations of abscess were occured due to bacterial translocation.

Benefits from apical chest tube drainage in pneumothorax.

Pneumothorax is the accumulation of air in the pleural space. Pneumothorax may occur spontaneously (primary spontaneous pneumothorax, PSP). Chest tube drainage (CTD) is the most common choice for treatment of PSP. This study aimed to evaluate patients treated with CTD, regarding demographic and diagnostic characteristics, and to compare the effectiveness of apical and axillary approaches. We retrospectively analyzed a total of 217 patients with PSP regarding symptoms, duration of complaints, and treatment procedures. There were 196 (90.3%) male patients and mean age was 25.22 ± 5.37 years. The approach of CTD was determined randomly; being performed with the apical approach on 93 (42.9%) and axillary on 124 patients (57.1%). There were no statistically significant differences between the two groups in terms of age, sex, BMI, collapse size, and complaint duration. However, a statistically significant relationship was determined between collapse size and leading symptoms where the significance was related to dyspnea (p < 0.001). This led to the thought that dyspnea increases with the increase of collapse size. The patients who were admitted to hospital in the later term when compared with others, had a larger collapse size (p < 0.001). This also led to the thought that collapse increases in relation to time due to late admission of patients. Hospitalization time was significantly shorter in patients who had apical CTD (p < 0.001). In conclusion, inserting the tube from the apex could shorten the treatment period.

Giant mediastinal parathyroid adenoma.

Primary hyperparathyroidism is most commonly caused by either a parathyroid adenoma or parathyroid hyperplasia. Parathyroid adenomas also rarely attain huge proportions. We present a case of a 63-year-old female patient causing hypercalcemia and the mass which is located in the mediastinum. High intact parathormone level secondary to an ectopic hypersecretory parathyroid adenoma were detected (642 pg/mL). It was removed via a right thoracic approach. In this case parathyroid adenoma measuring 7 x 5 x 4 cm and weighing 145 g; to our knowledge the greatest mass reported in the literature. Despite its huge size it did not cause many of the hypercalcemic symptoms.

Is open surgery necessary for metastatic pulmonary tumors evaluated with thorax tomography?

BACKGROUND: This study aims to compare the tomographic evaluations and intraoperative findings of patients treated surgically for primary tumors and who had pulmonary metastasis. METHODS: The study included 160 patients (102 males, 58 females; mean age 34.6±14.3 years; range, 11 to 64 years) who underwent pulmonary metastasectomy. The primary focus was surgically excised and no metastases other than pulmonary were detected on scans. Preoperative tomographic images together with the findings of the open surgical intervention were evaluated and compared. RESULTS: A total of 296 surgical resection were performed and 345 metastatic lesions were excised in 166 open surgical procedures. In 35 patients (21.9%), 71 (20.6%) metastatic lesions were detected in tomographic evaluations although no lesions had been detected on direct radiographs. In 29 patients (18.1%), 33 (9.6%) metastatic lesions, which had not been detected radiologically, were found intraoperatively. CONCLUSION: Tomographic evaluation is used in the follow-up of patients with malignancy but as for pulmonary metastasis it is not efficient and adequate. Therefore, open surgery should be the preferred approach for intraoperative detection of metastases that cannot be detected radiologically. Open surgical resection for pulmonary metastasis can be performed safely with low rates of perioperative morbidity and mortality.

A rare localization of an extrapleural solitary fibrous tumor.

Solitary fibrous tumor (SFT) is a rare neoplasm that generally originates in the pleura. Extrapleural locations are rare. In such cases, a definitive preoperative diagnosis is often difficult, because neither radiological nor cytological examinations are exhaustive. Therefore, surgical excision is frequently the only way to reach the correct diagnosis and to provide definitive treatment. The case is here described of a solitary fibrous tumor of the soft tissue in the subscapular area in a 50-year-old male.

Montelukast attenuates radioactive I131-induced pulmonary damage on rats.

PURPOSE: Radioactive I131 (RAI) therapy is a standard method to ablate the remnant thyroidal tissue after total thyroidectomy and its metastases in differentiated thyroid carcinomas; however, I131 also accumulates in nonthyroidal tissue, which may cause adverse effects and limit the I131 dose required for treatment. We hypothesized that montelukast, a known agent with anti-inflammatory and anti-oxidant properties, would ameliorate the radiation-induced histopathological characteristics such as pneumonitis and fibrosis in rat lungs after RAI. METHODS: Fifty female Wistar albino rats were randomly separated into five groups of 10. Group 1 was the control group; Group 2 was administered RAI only; Group 3 was administered RAI and montelukast, Group 4 was administered RAI after total thyroidectomy and Group 5 was administered RAI and montelukast after total thyroidectomy. All rats were sacrificed after 12 weeks and the lungs were evaluated in the histological examination to determine the degree of inflammation and fibrosis and for immunohistochemical (IHC) staining for tissue expression of IL-1, IL-6 and TNF-alpha and TGF-beta. RESULTS: The RAI-administered groups, Group 2 and Group 4, were significantly different from the control group, however, the groups medicated with both RAI and montelukast, Group 3 and Group 5, were not significantly different from the control group. All histopathological and IHC parameters were significantly less in the groups administered with montelukast compared to the groups not administered with montelukast. CONCLUSIONS: The results of this study demonstrated the radioprotective effect of montelukast in the pulmonary system through histopathological and IHC examination.

Parenchyma-preserving surgery in the management of pulmonary hydatid cysts.

Pulmonary hydatid cysts remain a significant health problem in endemic regions like Turkey. Here, we present our surgical experience in patients with pulmonary hydatid cysts. Between January 1985 and January 2001, 1118 operations were performed in 1032 patients (528 males, 504 females; mean age 32.7 years; range 1-87 years) with pulmonary hydatid cysts in our department. Posterolateral thoracotomy was performed in 1015 (98.3%), two-stage thoracotomy in 34 (3.3%), and median sternotomy in 17 (1.7%) patients. We preferred conservative surgical procedures. As a surgical procedure, cystotomy and capitonnage was performed in 626 (56%), cystotomy alone in 368 (33%), wedge resection in 81 (7%), enucleation in 29 (3%), and decortication in 11 (1%) patients. None of our patients were treated with anatomic resection. During surgery, 949 patients (92%) had unruptured and 83 patients (8%) had ruptured hydatid cyst. The morbidity ratio was 6.7%. Major complications were wound infection (2.3%), prolonged air leak (1.9%), atelectasis (1.2%), pleural effusion (0.8%), postoperative hemothorax (0.6%), and empyema (0.3%). Two patients (0.2%) died within the first month postoperatively. Mean follow-up was 31.2 months. Recurrence was detected in only 35 patients (3.3%). Treatment of pulmonary hydatid cyst is primarily surgical. Medical treatment is indicated for recurrent and multiple hydatid cysts postoperatively. Cystotomy alone, or cystotomy and capitonnage, as parenchyma-preserving surgery, is preferred. Radical surgery including pneumonectomy, lobectomy, and segmentectomy should be avoided.

[The superiorities of invasive procedures in nodal staging of non-small cell lung cancers]. / Küçük hücreli disi akciger kanserinde nodal evrelemede invaziv prosedürlerin üstünlükleri.

The staging of non-small cell lung cancer is the most important factor that affects the treatment form and prognosis. The management strategy includes serious variations according to clinical condition of the patient, preoperative, intraoperative and postoperative pathologic staging outcomes. Today, obtaining the histopathological diagnosis preoperatively became mandatory. Reaching the definite tissue diagnosis requires the using of invasive technics. Nowadays; there is a widespread use of invasive staging and diagnostic procedures in order to show the evidence of disease presence and determine the probability of contralateral metastasis in a patient who will undergo a possible thoracotomy. In the preoperative period, benefiting from the invasive staging methods that will reveal occult N2 disease totally, would be more useful for the patients.

[Association of combined small cell and large cell lung cancer with Lambert-Eaton myasthenic syndrome: case report]. / Kombine küçük hücreli ve büyük hücreli akciger kanseri ile Lambert-Eaton miyastenik sendromu birlikteligi: Olgu sunumu.

Lambert-Eaton myasthenic syndrome (LEMS) is a rare type of neuromusculer conduction disorder. This disease can be seen with lung cancer and, it is associated with otoimmunity. Among the symptoms of lung cancer LEMS can be seen, but it is very rare. In this case, LEMS symptoms were analyzed before lung cancer symptoms. The localization of the tumor was near the pulmonary artery. By the early diagnose, the patient had the chance of cure.

[Development and treatment approaches of bronchopleural fistula after pulmonary resection]. / Rezeksiyon sonrasi bronkoplevral fistül gelisimi ve tedavi yaklasimlari.

Pulmonary resections comprise most of the operations performed in thoracic surgery departments. Diseases like pulmonary cancers, bronchiectasis, pulmonary abscess, tuberculosis and fungal infections are treated surgically by pulmonary resections. One of the important steps of the pulmonary resection is to suture the bronchi through which the air is supplied to the resected pulmonary tissue. Bronchopleural fistula developed in the bronchial stump is encompassed as one of the most important factors affecting mortality and morbidity regarding postoperative complications.

[Gene therapy in malignant mesothelioma]. / Malign mezotelyomada gen tedavisi.

Malignant mesothelioma which arises from pleural mesothelial cells is a rare and deadly disease. Environmental factors, especially the exposure of asbestos, are accepted as etiological factors. There is not any accepted treatment of malignant mesothelioma. Nowadays four main forms of therapy and the combination of these forms are put in the practise for the treatment of malignant mesothelioma. These are surgical therapy, chemotherapy protocols, radiotherapy protocols and recently immunologic therapy which is based on direct antiproliferative effect of interferon. Gene therapy has been studying experimentally for recent years. The main principles of the gene therapy is sensitizing to antiviral drugs by infecting and changing the gene structure of the malign cells. The most used gene is herpes simplex virus (HSV) tk gene. In malignant mesothelioma, there is no standard treatment protocol and the main cause of death is local spread of tumor and the pathological effects of its mass rather than metastasis and the diagnosis and treatment results are evaluated from the same localization (pleural space). According of these factors, gene therapy could be an appropriate treatment for malignant mesothelioma.

[Synchronous lung carcinoma: a case report]. / Pulmoner Senkron Kanser: Olgu Sunumu.

Synchronous tumor is defined as presenting two different tumors at the same time in an organ. Finding more than one primary pulmonary tumors at lung in different lobes or in different sides at the same time mean pulmonary synchronous tumor. In cases who have more than one mass, synchronous tumors should be appeared that; surgical treatment chance can be given and a long survival can be achieved than medical treatment protocol.

Rapid enlargement of elastofibroma dorsi after physical therapy.

Elastofibroma dorsi is an uncommon, slow-growing, ill-defined soft tissue tumor. Its most prominent symptom is back and shoulder pain. Elastofibroma dorsi is usually located beneath the scapula and bilateral involvement occurs in only 10% of patients. We report herein a case of bilateral elastofibroma dorsi who underwent physical therapy for treatment of shoulder pain. Elastofibroma was misdiagnosed and rapidly progressed after physical therapy. We conclude that elastofibroma should be kept in mind for patients with shoulder or back pain, and the patient should be evaluated carefully before initiating physical therapy.