Search

Pulmonary hydatid cyst (PHC) can imitate many diseases. Sometimes, positron emission tomography/computed tomography (PET/CT) is performed in terms of malignancy exclusion for complicated cysts. Although some specific findings (doughnut sign) have been identified in hydatid cyst of the liver, there is no specific sign described for PHC. The aim of this study is to investigate the presence of a common finding in PHC patients scanned with PET/CT inadvertently.From January 2015 to 2020, patients proven to have PHC were analyzed retrospectively. From all the patients, only 17, having a previous PET/CT, were included the study. Lesions were evaluated in three groups according to FDG uptake: A, negative; B, focal; C, doughnut sign.The total number of patients was 17. Nine of the patients were male and the median age was 41.94 + 14.68 (16-65) years. SUV max of the lesions ranged from 0.5 to 15.8 (mean ± SE: 4.68). According to the FDG uptake of the lesions, five were in Group A, two in Group B, and the remaining ten (58.8%) in Group C with doughnut sign. To correlate the CT findings with PET/CT findings, doughnut sign, which is a typical finding of hydatid cysts of liver, is seen in only four patients in Group 1-classified cysts which are non-complicated. But in Group 2 (n = 3) and 3(n = 4), the finding of doughnut sign is three in both groups.PET/CT is not a recommended imaging technique for PHC, but in cases where a definitive diagnosis is difficult, interpreting PET/CT findings is significant. This study demonstrates that previously described doughnut sign for liver hydatid cysts is also common for perforated pulmonary cysts. According to our knowledge, this is the first largest series of determining PET/CT findings of PHC. Further larger series will contribute to the literature.

Giriş: Bireylerin ihtiyaçlarını, isteklerini, dürtülerini kısacası çeşitli insan ihtiyaçlarını gidermeye yönelik bir süreç olan motivasyonun hastanelerde tedavi ve bakımın amacına ulaşılmasını sağlamada önemi büyüktür.Amaç: Bu araştırmanın amacı dışsal motivasyonun cerrahi sonrası dönemdeki hastaların mobilizasyon ve oral sıvı alım miktarlarına olan etkisini değerlendirmektir.Yöntem: Araştırma prospektif, yarı deneysel tiptedir. Örneklemi toraks cerrahisi geçiren 104 hasta oluşturdu. Araştırmaya alınan hastalara, kriterlere uyan davranışlarında, bunu kanıtlayan farklı renklerde “motivasyon bilekliği” olarak tanımladığımız bileklikler takıldı. Hastalar bileklik verilmeyen kontrol grubu (n=54) ve bileklik verilerek motive edilen (n=50) olmak üzere iki gruba ayrıldı. Araştırmada her iki grubun verileri karşılaştırıldı.Bulgular: Motive edilmeyen grubun sıvı alım ortalamasının 2,03 litre, motive edilen grubun sıvı alım ortalamasının 2,95 litre olduğu belirlendi (p < 0,001). Motive edilmeyen grubun yürüme ortalaması -bileklik sayısı esas alınarak- 1,52 iken motive edilen grubun yürüme ortalamasının 2,66 olduğu belirlendi (p < 0,001). Araştırmadaki iki grup arasında puan ortalamaları açısından istatistiksel olarak anlamlı fark bulundu (p < 0,001).Sonuç: Hastaların dışsal motivasyonu sağlanarak tedaviye katılımının artırıldığı, cerrahi sonrası süreçte mobilizasyon ve oral sıvı alımına yönelik kanıta dayalı somut verilere ulaşıldığı görüldü.

Objectives: Lung cancer is the leading cancer type among cancer deaths in the world and our country. There are some controversial issues that specialists dealing with oncology have difficulty in decision making. The aim of this study is to determine the approach of physicians of different specialties to the management of lung cancer.Methods: In this study, an on line questionnaire was applied to specialists of lung cancer. In this questionnaire there were some lung cancer scenarios created on controversial issues, each including different stages of the disease. The scenarios were based on the hypothesis that “the participating physicians had lung cancer themselves”, and expected to answer the treatment scenarios in this wise. The participants are pulmonologists, thoracic surgeons, radiation oncologists and medical oncologists. Results: Of the participating 170 physicians 45% were radiation oncologists, 24% pulmonologists, 23% thoracic surgeons and 8% medical oncologists. In the scenario, created to determine the approach to surgery in N2 disease, 45% of cases preferred surgery. It was also remarkable that surgery was preferred 16% in N3 diasease. In stage 1A2 disease, when pulmonary functions were insufficient for surgery, radiotherapy was preferred by 64% of cases. In the scenario questioning the decision about chemotherapy in T3N2 disease, cisplatin-etoposide vs paclitaxel-carboplatin options were preferred 32%, 26% respectively. The approach to solitary brain metastasis was 64% in favor of stereotactic radiotherapy after brain surgery. Immunotherapy was the preferred treatment when multipl brain metastasis occured in case with negative driver mutations and PDL1>1%. In oligometastatic disease, 97% of cases preferred surgery for both lung and metastatic side. Conclusions: Although there are guidelines in the management of lung cancer, there are still controversial issues with renewed treatment protocols in some special conditions. We believe that the results of this study will highlight these issues.

Degerli Meslektaslarimiz, Plevra hastaliklari, gunumuzde insidansi giderek artan ve hem gogus hastaliklari hem de gogus cerrahisi kliniklerinin pratiginde yaygin bir is yuku olusturan sorun halinde karsimiza cikmaktadir. Cok genis sebeplere dayali bir dagilim gosteren plevra patolojilerinin tani ve tedavi yontemi multidisipliner yaklasim gerekmektedir. Bu konuyla ilgili cikarilan eserler oldukca degerli teorik bilgiler icermekle birlikte pratik ve vaka noktasinda bilgi birikimini gerektigi olcude yansitmadigi gozlenmektedir. Bu dusunceden yola cikarak, plevral hastaliklari ve cerrahi tedavi yaklasimini olgu sunumlari esliginde ozetleyen alaninda bu yonuyle ilk eser olan bu kitabi degerli okuyucularimiza sunmaktan gurur duyuyoruz. Bu eserde gunumuzdeki plevra patolojilerine yaklasim, guncel tani rehberleri ve cerrahi tedavideki yenilikler, gogus hastaliklari ve gogus cerrahisi alanlarinda kursu sahibi olan degerli hocalarimiz tarafindan olgular esliginde islenmistir. Klinik tecrubelerin kanita dayali yontemlerle aktarildigi, vakalarin guncel pratigimizde rehberlik edecegi bir kaynak olarak titizlikle hazirlanmistir. Eserin tum bolumlerinin hazirlik asamasinda emegi gecen kiymetli hocalarimiza ayri ayri sukranlarimizi sunariz. Kiymetli meslektaslarimiza faydali olmasi temennisiyle…. Kizlarimiz Zulal, Elif, Defne, Gokcen ve tum saglik calisanlarinin cocuklarina armagan olmasi dilegiyle

Heimlich valve (HV) drainage system, described at 1965 from Henry Heimlich, is a oneway valve system used by thoracic surgeons in various conditions. So many studies have been described in the literature to demonstrate the effectiveness and usefulness of the method. Differently, our study was planned to evaluate HV system from the view of the patients. This prospective study included 50 patients who underwent tube thoracostomy with different indications since August 2016. All the patients were discharged from the hospital with HV system. Patients demographic data, primary disease, indication for drainage, operative history, date of connection of the drain to HV system and the duration of the system were recorded. After the discharge a “satisfaction questionnaire” was applied to determine possible questions and problems. The patients age ranged from 18 to 87. Most frequent indications were, postoperative expansion problems, prolonged air leakage due to surgery (n=13). The duration with HV at home was 2-102 days. Some of the patients had anxiety because of discharging with a chest drain (n=21), but only 5 of them had problems with the system and wound care. Eigthy percent of the patients thought that the aim of the system is “to make them more comfortable at their home and shorten the lenght of hospital stay”. Nearly half of the patients (48%) said; “even if the drain in my chest, going home was good”. Only 20% prefered to stay at the hospital instead of discharging with a drain. HV system has many advantages. Even though the 48% of patients satisfied seems to be small when other benefits are also taken into account we believe that it would be wise for the practice to be included in the daily practice of thoracic surgery.

Endometriosis is characterized by the growth of endometrium outside the uterine cavity or myometrium. There is no specific radiologic finding that defines endometriosis. Parenchymal lesions, nodules or blebs are reported in the literature, although this clinical entity is rare. Definitive diagnosis and treatment are often possible with surgery. We report here two cases: a forty-two-year-old female patient with a 2-year history of intermittent hemoptysis associated with her menstrual cycle was diagnosed as having endometriosis and treated via thoracotomy; another 30-year-old female referred to our department due to recurrent pneumothorax caused by underlying endometriosis underwent surgical treatment which revealed endometrial foci on the diaphragm.

Resumen La endometriosis se caracteriza por el crecimiento del endometrio fuera de la cavidad uterina o el miometrio. No hay signos radiologicos especificos que indiquen una endometriosis. En la literatura se describen lesiones parenquimatosas, nodulos o bullas. El diagnostico de certeza y el tratamiento son posibles a menudo con la cirugia. A una mujer de 42 anos de edad con hemoptisis intermitente (asociada al ciclo menstrual) desde hacia 2 anos se le diagnostico una endometriosis y fue tratada mediante una toracotomia. Otra mujer de 30 anos fue remitida a nuestro departamento a causa de un neumotorax recurrente causado por una endometriosis subyacente, y se le aplico un tratamiento quirurgico que puso de manifiesto la presencia de focos de endometrio en el diafragma.

Giriş: Spontan pnömotoraks tedavisinde cerrahi önemli bir yer tutmakla beraber, cerrahi adayı olamayan hastalarda plörodez gündeme gelmektedir. “Otolog blood patch” ile plörodez yapılırken tüp torakostominin klampe edilmesi cilt altı amfizemine neden olabilmektedir. Bu çalışmada, plörodez sırasında göğüs tüpünün klampe edilmesinin sakınca yaratacağı uzamış hava kaçağı olan olgularımızda uyguladığımız basit bir teknik tanımlanmıştır. Gereç ve Yöntem: Eylül 2001-Aralık 2006 tarihleri arasında operasyonu kabul etmeyen 2'si primer, ciddi amfizem nedeniyle genel anestezi alamayacak durumda olan 9'u sekonder spontan pnömotorakslı toplam 11 olguya yapılan klampajsız “otolog blood patch” uygulamasının sonuçları retrospektif olarak incelendi. Uygulama yatak başında 50 ml otolog kanın göğüs tüpünden verilmesi şeklinde yapıldı. Hastaya 2 saat süre ile 4 ayrı pozisyon verildi ve tüp klampe edilmeksizin, tüpün giriş yerinden daha yüksekte bir askı üzerinden geçirilerek kanın drenaj şişesine akması önlendi. Hava kaçağının uygulama sonrası ilk 72 saatte kaybolması tam yanıt, belirgin derecede azalması ise kısmi yanıt olarak değerlendirildi. Bulgular: Onu erkek, 1'i kadın olan hastaların yaş ortalaması ve yaş aralığı sırasıyla 55.6+15.7 ve 29-75' ti. Altı olguda tam yanıt (%54.5), 4 olguda kısmi yanıt (%36.4) alındı. Bir olguda hava drenajı değişiklik olmaksızın devam etti. Komplikasyon olarak, olguların 1'inde ampiyem, 1'inde intratorasik koagulum gelişti. Sonuç: “Otolog blood patch” ile plörodez diğer yöntemlere göre maliyetsiz, ağrısız ve kolay temin edilebilir olması nedeniyle tercih edilen bir yöntemdir. Hava kaçağı devam eden olgularda klampaj sonrası gelişebilecek cilt altı amfizeminin önüne geçebilmek amacıyla önerdiğimiz klampajsız askı yöntemi, bu komplikasyon nedeniyle işlemin sonlandırılmasını önlemektedir. Yöntemin, cerrahi adayı olmayan seçilmiş olgularda güvenilir bir teknik olduğu kanısındayız., Introduction: In some cases, spontaneous pneumothorax may require surgery, but in poor risk patients, pleurodesis may be a reasonable choice. Pleurodedis with autologous blood necessitates the clampage of the chest tube for a period. Excess air leakage from the chest tube may avoid the clampage. A simple technique without clamping the chest tube during pleurodesis is described which we used in patients with persistent air leak. Material and Method: The study comprised 11 patients diagnosed with spontaneous pneumothorax who were treated by autologous blood patch pleurodesis without clamping the chest tube. Pleurodesis was performed at the bedside by giving 50 ml autologous blood into the pleural cavity. The tube was lifted up to form a loop, in order to prevent the blood from draining into the bottle. Cessation of air leak at the end of 72 hours was accepted as complete response, whereas a marked decrease in air leakage was accepted as partial response to the procedure. Results: The mean age and age range of 10 male and 1 female patients were 55.6+15.7 and 29-75, consecutively. Complete response was obtained in 6 patients (%54.5), partial in 4 (%36.4). Air drainage continued without any change in 1 patient. Complications were empyema (1 patient) and intrathoracic coagulum (1 patient). Conclusion: The aforementioned loop technique facilitates the execution of autologous blood patch pleurodesis, particularly in patients with an excessive air leak. In our opinion, it is a reliable technique both for preventing air leakage and achieving pleurodesis in selective patients unsuitable for surgery.