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Purpose: This study aims to investigate the effect of complications on survival after lung cancer surgery.Materials and Methods: This is a retrospective study of 802 patients who underwent surgical operations for lung cancer at two centers between January 2002 and December 2019. All patients were retrospectively evaluated according to age, gender, cancer stage, surgical technique, biochemical tests, pulmonary function tests, pulmonary risk index, length of the hospital stay, and the existing number of complications. Results: In total, 802 patients (%84 males, %16 females) with a mean age of 60 years (range 19-88 years) were included in the study. 5-year overall survival rate was 62.3%. 224 complications occurred in 180 patients (22.4%). The ten most common complications, respectively, were prolonged air leak (54), pneumonia (22), arrhythmia (19), respiratory failure (15), hemorrhage (17), atelectasis (10), pneumothorax-expansion defect (7), arrest (7) bronchopleural fistula (7), subileus-ileus (6). Cancer stage, the existing number of complications, advancing age, and tumor size are parameters that significantly affect survival. The occurs of one or more complications significantly adversely affects survival.Conclusion: Although the morbidity and mortality of lung cancer surgery have decreased in recent years, it is still high. Advanced stage lung cancer, advancing age, enlargement of tumor size and occurs of complications that negatively affect survival. Careful preoperative preparation may play a role in increasing long-term survival, as well as preventing complications, and decreasing early mortality., Amaç: Bu çalışma ile akciğer kanseri ameliyatı sonrası komplikasyon gelişiminin sağ kalıma etkisini araştırmayı amaçladık.Gereç ve Yöntem: Ocak 2002-Aralık 2019 tarihleri arasında iki merkezde operasyon uygulanan 802 akciğer kanserli olgular geriye dönük incelendi. Hastalarda, yaş, cinsiyet, kanser evresi, ameliyat tekniği, biyokimyasal değerleri, solunum fonksiyon testleri, pulmoner risk indeksi, postoperatif yatış süreleri ve gelişen komplikasyonlar analiz edildi. Bulgular: 802 hastanın %84 ü erkek, %16 sı kadındı. Ortalama yaş 60 (19-88yaş) idi. Genel sağkalım 5 yıllık % 62,3 idi. 180 hastada (%22.4) 224 komplikasyon gelişti. En sık görülen on komplikasyon uzamış hava kaçağı (54), pnömoni (22), aritmi (19), solunum yetmezliği (15), hemoraji (17), atelektazi (10), pnömotoraks-expansiyon kusuru (7), arrest (7), bronkoplevral fistül(7), subileus-ileus(6) olarak sıralandı. Kanser evresi, komplikasyon gelişimi, ileri yaş ve tümör çapı anlamlı olarak sağ kalımı etkileyen parametrelerdir. Bir ve/veya birden fazla komplikasyon gelişmesi sağ kalımı önemli derecede kötü etkilemektedir. Sonuç: Akciğer kanseri cerrahisinin morbidite ve mortalitesi son yıllarda azalmakla birlikte hala yüksektir. İleri akciğer kanseri evresi, yaşın ilerlemesi, tümör çapının büyümesi ve komplikasyon gelişmesi sağkalımı olumsuz etkilemektedir. Preoperatif dikkatli hazırlık, komplikasyon gelişmesini önlemek, erken dönem mortaliteyi azaltması yanında, uzun dönemde sağkalımı artırıcı rol oynayabilir.

Pulmonary aspergilloma is one of the clinical conditions with high mortality and morbidity in immunosuppressed patients. Surgical resection has been the leading treatment option; however, surgical treatment involves some risk of local and systemic dissemination and there are also patients who are functionally inappropriate to be treated surgically. In this paper, we present two patients with bilateral PA who underwent surgical and antifungal treatment. Antifungal therapy with voriconazole that was successful for both of our patients might be a promising approach to a group of PA patients who are not appropriate for surgery

Introduction Thymectomy is the preferred standard treatment in younger non-thymoma patients with myasthenia gravis as well as in patients with early stage thymoma. Total thymectomy by median sternotomy has been the surgical approach since resection of the thymus with video-assisted thoracoscopic surgery (VATS). Aim To compare the clinical outcomes of VATS thymectomy with conventional open thymectomy for neoplastic and non-neoplastic thymic diseases. Material and methods Forty patients underwent thymectomy between October 2012 and January 2016. Fifteen patients were male and 25 patients were female. The mean age was 40.3 ±17.7 years. Seventeen (55%) patients underwent VATS thymectomy and 23 (45%) patients underwent an open procedure. We retrospectively reviewed the data of the patients and compared these two techniques. Results The mean tumor size was 5.17 ±3.2 cm in the thymoma group (VATS 2.5 ±2.4 cm vs. open access 4.7 ±3.7 cm). None of the patients experienced a myasthenic crisis. Conversion to thoracotomy was required in 1 patient in the VATS group due to bleeding from the right internal mammary artery; therefore, the conversion rate was 2.5% among all the patients. No mortality occurred in either group. No significant difference was found in the perioperative blood loss, operative time or pain visual analogue scale scores. On the other hand, regarding postoperative drainage, duration of chest tube drainage and length of hospital stay, VATS thymectomy yielded better results and the differences were significant. Conclusions Video-assisted thoracoscopic surgery thymectomy can be performed for both neoplastic and non-neoplastic thymic diseases with minimal morbidity and mortality.

Introduction Video-assisted mediastinal lymphadenectomy (VAMLA) is a valuable tool for invasive staging of the mediastinum. Unilateral vocal cord paralysis (UVCP) may occur in patients following VAMLA and may result in secretion retention within the lungs, atelectasis and associated infectious situations such as pneumonia. Minimally invasive injection laryngoplasty (ILP) is the treatment of choice in UVCP. Aim To evaluate the efficacy and success of acute minimally invasive injection laryngoplasty for patients with UVCP following VAMLA. Material and methods Patients with the symptom of dysphonia following VAMLA were reviewed. All of the patients had UVCP according to the video laryngoscopy examination and had symptoms of aspiration and ineffective coughing. The Voice Handicap Index (VHI) questionnaire and maximum phonation time (MPT) were measured. Minimally invasive ILP was performed under general anesthesia with 1 cm of hyaluronic acid. Results There were 525 consecutive non-small cell lung cancer (NSCLC) patients who underwent VAMLA. Five (0.95%) of the patients had UVCP and were suffering from aspiration during oral intake and ineffective coughing reflex. Maximum phonation time (MFT) was measured before and after ILP, and the results were 7.1 ±1.6 and 11.1 ±2.3 s, respectively (p < 001). The Voice Handicap Index-10 (VHI-10) score was 30.4 ±4.7 and 13.4 ±3.5 (p < 0.01), respectively. Patients underwent surgical lung resection. There was no morbidity or mortality. Conclusions Unilateral vocal cord paralysis may occur as a complication of VAMLA. ILP may be an active tool for treating UVCP before anatomical lung resection to avoid potential morbidities. Successful management of this complication with multidisciplinary team work may encourage the use of VAMLA more frequently.

Objective The European Society of Thoracic Surgeons (ESTS) has proposed a revised preoperative lymph node staging guideline for patients with potentially resectable non–small cell lung cancer (NSCLC). We aimed to assess the validity of this revised ESTS guideline and survival results in our patient cohort. Methods A total of 571 patients with potentially resectable NSCLC seen between January 2004 and November 2013 were included in the study. The preoperative mediastinal staging was performed by video-assisted cervical mediastinoscopy or video-assisted mediastinoscopic lymphadenectomy in all patients except those with peripheral cT1N0 nonadenocarcinoma tumors. Resection via thoracotomy or video-assisted thoracoscopic surgery was done in patients with no mediastinal lymph node metastasis. Surgical pathological results were compared with the ESTS staging guideline, and the validity of the guideline was tested. Results In this series, mediastinal lymph node metastasis was revealed preoperatively in 266 patients (46.6%). A total of 305 patients underwent anatomic lung resection. The sensitivity, specificity, positive and negative predictive values, and accuracy of the guidelines were calculated as 95.0%, 100%, 100%, 94.6%, and 97.2%, respectively. Conclusions The ESTS revised preoperative lymph node staging guidelines for patients with NSCLC seem to be effective and valid, and may provide high survival following resectional surgery.

Gaucher disease (GD) is an autosomal recessive glycolipid storage disorder, due to deficiency of the lysosomal enzyme glucocerebrosidase, leading to accumulation of the substrate glucocerebroside in the cells of the macrophage-monocyte system. Patients with GD have alteration in their immune system and impaired microbicidal capacity of mononuclear phagocytes. It has also been demonstrated that monocyte dysfunction may correlate with the plasma glucocerebrosidase concentrations. Tuberculosis (TB) is a major public health problem in developing countries. Pleural TB is one of the most common forms of extra-pulmonary TB. Since immune system can be impaired due to the deficiency of glucocerebrosidase in various ways, TB can be observed in patients with GD especially when left untreated. Cytopenia(s) is also general finding in untreated Gaucher patients, and they may be observed most frequently due to the infiltration of the bone marrow with Gaucher cells together with the additional factor of splenomegaly. We herein present a case of an adult patient with heterozygous untreated GD1, who developed pleural TB complicated by ipsilateral pulmonary fibrosis. Before his admission to our clinic, pleurectomy operation was performed and 4-drug combination anti-TB therapy was initiated including isoniazid, rifampicin, ethambutol and pyrazinamide. Fever complaint was disappeared with anti-TB treatment but he also had fatigue and pain. After initiation of enzyme replacement therapy in addition to anti-TB treatment, clinical and hematological improvement was observed. To our knowledge, this is the first reported case of GD1 with pleural TB.

Bronchus Associated Lymphoid Tissue Lymphoma (BALTOMA) is a rare subgroup of pulmonary non-Hodgkin’s lymphomas (NHLs) comprising less than 1% of all cases. It constitutes 3.6% of all extranodal lymphomas and only 0.5–1% of primary pulmonary malignancies. They are usually low grade B-cell lymphomas and are considered to originate from the mucosa associated lymphoid tissue (MALT) of the bronchi. Here, we represent a rare case of BALTOMA presenting with immunodeficiency and multiple pulmonary nodules.

Amac: Pnomotoraks Trans Torasik Igne Aspirasyon Biopsisinin (TTIAB) en sik komplikasyonudur.Tedavisinde konservatif takip ve gogus tupu uygulamasinin yeri tartisilmakta ve tercihler farklilik gostermektedir.Bu calismanin amaci TTIAB sonrasi pnomotoraks tedavisini farkli yaklasimlarla degerlendirmektir. Hastalar ve Yontem: Calismamiz retrospektik kesitseldir. Ocak 2016 ve Aralik 2017 arasi TTIAB sonrasi gelisen pnomotoraks vakalari incelenmistir. Pnomotoraks tedavisi icin : yuksek ( 8-10 lt nazal oksijen ) ile konservatif ve gogus tupu yerlestirilmesini kullanarak olusturdugumuz 3 protokolu pnomotoraks yuzdesine gore uygulayip sonuclari degerlendirilmistir. Bulgular: Toplamda 187 hastaya akcigerdeki kitle lezyon tespiti ve malign hastalik ontanisiyla TTIAB islemi uygulandi. Hastalarin 24 unde (%12,8) islem sonrasi pnomotoraks tespit edildi. Tanimladigimiz protokoller kullanilarak toplamda 9 hastada (%37,5)gogus tupu yerlestirildi..On bes hasta (%62,5) konservatif ( yuksek akim nazal oksijen ile) tedavi edildi. Ortalama hastane kalis suresi tum calisma grubu icin 3,2 gun idi . Hastalarda mortalite yada morbidite izlenmedi Sonuc: TTIAB sonrasi iatrojenik pnomotoraks riski mevcuttur. Pnomotoraks yuzdesine gore olusturdugumuz 3 protoke dayali algoritmamiz basit olarak uygulanabilir ve sonuclari basarilidir. Bu hastalarin yakin takibi ve gerektiginde acil gogus tupu yerlestirilebilmesi icin multidisipliner takim calismasina ihtiyac vardir

Aim: We retrospectively reviewed the results of patients who underwent extended thymectomy for thymic malignancy and plannedto demonstrate the therapeutic effect of surgical treatment in patients with thymus tumors.Material and Method: The results of 29 patients with thymic malignancy who underwent consecutively expanded thymectomy between October 2012 and January 2018 in our clinic were examinedin detail. Preoperative, postoperative and postoperative follow-upparameters of the cases were recorded.Results: 13 of the patients were male and 16 were female. Themean age was calculated as 41.4±17.7 (range 9–75 years). Nineof the cases (31%) were accompanied by myasthenia graves(MG) disease. Mean FEV1 was 2678.17±954.5 ml and mean FEV1was calculated as 94±19.8 ml. Thymectomy was performed withsternotomy in 20 patients and thoracoscopic thymectomy wasperformed in 9 patients. The mean duration of operation was137.9±31.8 minutes (133.1±45.5 minutes in thoracoscopy group,134.1±26.5 minutes in sternotomy group), mean perioperativebleeding was 116.6±107 ml, postoperative drainage amount was417.3±339.9 ml and duration of drainage was 2.6±0.89 days.Complication rate was found to be 13.7% while mortality was notobserved. When the postoperative pain scores of the patientswere evaluated, the first 24 hour visual analogue pain score (VAS)averaged 3.4, 24–48 hours 2.71 and 48–72 hours 1.9. Mean hospital stay was 4.3±2.5 days and mean follow-up was 34.7 months(1.5–124 months). Recurrence was developed only in one patientwith type B2 thymoma and a myasthenic crisis was observed inone patient, on the 10th postoperative day. While no tumor metastasis was observed in any patient during the follow-up, the meandisease-free survival was 34.9 months.Conclusion: Extended thymectomy can be safely performed withlow morbidity and mortality using transsternal or thoracoscopicapproach in myasthenic and non-myasthenic thymus tumors., Amaç: Timik malignite nedeniyle genişletilmiş timektomi uyguladığımız hastaların sonuçlarını geriye dönük olarak inceleyerek,cerrahi tedavinin timus tümörü olan hastalarda terapotik etkileriniortaya koymayı planladık.Materyal ve Metot: Kliniğimizde Ekim 2012-Ocak 2018 tarihleri arasında ardışık olarak genişletilmiş timektomi uyguladığımıztimik maligniteli 29 hastanın sonuçları ayrıntılı olarak irdelendi.Olguların ameliyat öncesi, ameliyat sırası ve sonrasındaki takipdeğerleri kayıt edildi.Bulgular: Hastaların 13 tanesi erkek, 16 tanesi kadın idi. Ortalamayaş 41,4±17,7 olarak hesaplandı (9–75 yaş dağılımı). Olgularının9 tanesine (%31) myastenia graves (MG) hastalığı eşlik etmekteydi. Ortalama FEV1 2678,17±954,5 ml ve ortalama FEV1%94±19,8 ml olarak hesaplandı. Timektomi 20 hastada sternotomi ile uygulanırken, 9 hastada torakoskopik timektomi uygulandı.Ortalama operasyon süresi 137,9±31,8 dakika olarak hesaplanırken (Torakoskopi grubu 149,1±45,5 dakika, sternotomi grubu134,1±26,5 dakika), ortalama peroperatif kanama 116,6±107 ml,postoperatif drenaj miktarı ortalama 417,3±339,9 ml ve dren kalış süresi 2,6±0,89 gün idi. Mortalite izlenmezken, komplikasyonoranı %13,7 olarak saptandı. Hastaların postoperatif ağrı skorlarıdeğerlendirildiğinde, ilk 24 saat görsel analog ağrı skoru (VAS)ortalaması 3,4, 24–48 saat 2,71 ve 48–72 saat arası 1,9 değerleri bulundu. Ortalama hastanede kalış süresi 4,3±2,5 gün veortalama takip süresi 34,7 ay olarak hesaplandı (1,5–124 ay arası). Nüks, Tip B2 timoma olan bir olguda gelişirken, bir hastadapostoperatif 10. günde myastenik kriz gözlendi. Takip süresincehiçbir hastada tümör metastazı izlenmezken, hastalıksız sağkalımortalaması 34,9 ay olarak saptandı.Sonuç: Myasteninin eşlik ettiği veya eşlik etmediği timoma olgularında genişletilmiş timektomi videotorakoskopik girişim veya transsternal girişim kullanılarak düşük morbidite ve mortalite ile güvenleuygulanabilir.

Introduction: As the number of operations performed by videothoracoscopy is increasing, there is also a tendency to decrease the number of port incisions. Apart from the reduced number of surgical incisions, there are a few reports and systematic reviews that demonstrate some potential advantages of the uniportal video-assisted thoracoscopic surgery, but the impact of the reduced incisions in the clinical setting still remains uncertain. Aim: To compare uniportal video-assisted thoracoscopic surgery to multiport video-assisted thoracoscopic surgery for anatomical lung resections in patients with malignant and benign lung diseases. Material and methods: From August 2010 to April 2016, a total of 102 patients with malignant and benign lung diseases underwent videothoracoscopic lobar and sublobar lung resections in our department. Comorbidities, tumor stage, tumor localization, mortality, operative time, pain visual analogue scale, length of hospital stay, perioperative blood loss, duration and amount of postoperative drainage and air leak, number of harvested lymph nodes and complication rates were analyzed. Results: No significant difference was found in the duration of chest tube drainage, pain visual analogue scale score, length of hospital stay, perioperative blood loss, amount of postoperative drainage, number of harvested lymph nodes or complication rate. There was no surgical mortality in either of the two groups. However, operative time was shorter (189 min vs. 256 min, p < 0.005) in the multiport group than in the uniportal group. Conclusions: Compared with the uniportal approach, the multiport approach is associated with a significantly shorter operative time in our study.

Introduction: Chronic obstructive pulmonary disease (COPD) includes pulmonary emphysema (PE), chronic bronchitis, certain types of bronchiectasis, and sometimes asthma. Abnormal elastic fiber polymerization and degradation are from characteristic properties of PE. The copper-dependent lysyl oxidases play a role in the formation and accumulation of elastic fibers in the extracellular matrix. Aims and objectives: There are no data about the efficacy of lysyl oxidases in the development of PE in humans. We focused on the relationship between LOX, LOXL1, LOXL2 and PE pathogenesis in COPD patients. Methods: Alterations at the protein levels of LOX, LOXL1, LOXL2, COMMD1 (regulator protein of copper homeostasis) and hypoxia-inducible factor 1-alpha (HIF-1α, a transcription factor of LOX genes) were for the first time investigated to determine their effects on emphysema pathogenesis by Western blotting and immunohistochemical methods in lung of COPD patients (n=19) with lung cancer. Results: Enlargement alveoli, thinning and disruptions in alveolar wall, a lot of accumulated macrophages in alveolar lumen and increased HIF-1α immunoreactivity were observed in emphysematous areas. Furthermore, in these tissues, levels of elastin, LOX, LOXL1, LOXL2, HIF-1α and COMMD1 decreased when compared to non-emphysematous areas. Conclusions: We think that reductions of HIF-1α levels in PE led to decreases in protein levels of activated LOX, LOXL1 and LOXL2, and abnormalities in elastic fiber biology. In emphysematous areas, HIF-1α activation induced by decreased COMMD1 protein can contribute to the generation of disease pathogenesis. Approaches made to increase activated LOXs and COMMD1 can be effective for the regression of PE.

Background: Postoperative air leak is a common complication seen after pulmonary resection. It is a significant reason of morbidity and also leads to greater hospital cost owing to prolonged length of stay. The purpose of this study is to compare homologous sealant with autologous one to prevent air leak following pulmonary resection. Methods: A total of 57 patients aged between 20 and 79 (mean age: 54.36) who underwent pulmonary resection other than pneumonectomy (lobar or sublobar resections) were analyzed. There were 47 males (83%) and 10 females (17%). Patients who intraoperatively had air leaks were randomized to receive homologous (Tisseel; n=28) or autologous (Vivostat; n=29) fibrin sealant. Differences among groups in terms of air leak, prolonged air leak, hospital stay, amount of air leak were analyzed. Results: Indications for surgery were primary lung cancer in 42 patients (71.9%), secondary malignancy in 5 patients (8.8%), and benign disease in 10 patients (17.5%). Lobectomy was performed in 40 patients (70.2%), whereas 17 patients (29.8%) had wedge resection. Thirteen (46.4%) patients developed complications in patients receiving homologous sealant while 11 (38.0%) patients had complication in autologous sealant group (P=0.711). Median duration of air leak was 3 days in two groups. Time to intercostal drain removal was 3.39 and 3.38 days in homologous and autologous sealant group respectively (P=0.978). Mean hospital stay was 5.5 days in patients receiving homologous sealant whereas it was 5.0 days in patients who had autologous agent (P=0.140). There were no significant differences between groups in terms of measured maximum air leak (P=0.823) and mean air leak (P=0.186). There was no significant difference in the incidence of complications between two groups (P=0.711). Conclusions: Autologous and heterologous fibrin sealants are safe and acts similarly in terms of air leak and hospital stay in patients who had resectional surgery.

Abnormalities in the elastic fiber biology are seen in pulmonary emphysema (PE). The copper-dependent lysyl oxidases regulate the production and accumulation of elastic fibers in the connective tissue. This study focused on the relationship between lysyl oxidase (LOX), LOX-like protein 1 (LOXL1), and LOXL2 and PE pathogenesis. Lung samples with or without PE from patients with chronic obstructive lung disease (n=35) were used. Protein levels of elastin, LOX, LOXL1, LOXL2, hypoxia inducible factor 1-alpha (HIF-1α), copper metabolism domain containing-1 (COMMD1), and phosphatase and tensin homolog (PTEN) were assayed using microscopic and biochemical methods The emphysematous areas were characterized by enlargement of the alveoli, destruction of the alveolar structure, accumulation of macrophages in the alveolar lumens, and showed increased HIF-1α immunoreactivity. Additionally, the emphysematous areas had significantly lower elastin, LOX, LOXL1, LOXL2, HIF-1α, COMMD1, and PTEN protein levels than the non-emphysematous areas. We suppose that the reductions in the HIF-1α levels led to decreases in the protein levels of active LOX, LOXL1, and LOXL2. These decreases might cause abnormalities in the elastic fiber biology. HIF-1α activation induced by decreased COMMD1 and protease activation induced by decreased PTEN might contribute to the development of PE. Finally, methods aimed at increasing the protein levels of LOXs, COMMD1 and PTEN might be effective for treating PE.

Purpose We aimed to assess the role of computed tomography (CT) perfusion in differentiation of thymoma from thymic hyperplasia, lymphoma, thymic carcinoma, and lung cancer invading anterior mediastinum. Methods In this study, 25 patients with an anterior mediastinal lesion underwent CT perfusion imaging from January 2015 to February 2016. Diagnoses included thymoma (n=7), thymic hyperplasia (n=8), lymphoma (n=4), thymic carcinoma (n=3), and invasive lung cancer (n=3). Lymphoma, thymic carcinoma, and lung cancer were grouped as malignant tumors for statistical analysis. Values for blood flow, blood volume, and permeability surface were measured in CT perfusion. Results Blood flow and blood volume values were higher in thymoma in comparison to thymic hyperplasia; however, the difference was not statistically significant. Blood volume values were significantly higher in thymoma (mean, 11.4 mL/100 mL; range, 5.2-20.2 mL/100 mL) compared with lymphoma (mean, 5.3 mL/100 mL; range, 2.5-7.2 mL/100 mL) (P = 0.023). Blood flow and blood volume values were significantly higher in thymoma compared with non-thymoma malignant tumors (P = 0.025). Conclusion CT perfusion is helpful in differentiating thymoma from non-thymoma malignancies including lymphoma, thymic carcinoma, and invasive lung cancer involving the anterior mediastinum.

Introduction : The Nuss procedure is suitable for prepubertal and early pubertal patients but can also be used in adult patients. Aim : To determine whether the minimally invasive technique (MIRPE) can also be performed successfully in adults. Material and methods : Between July 2006 and January 2016, 836 patients (744 male, 92 female) underwent correction of pectus excavatum with the MIRPE technique at our institution. The mean age was 16.8 years (2–45 years). There were 236 adult patients (28.2%) (> 18 years) – 20 female, 216 male. The mean age among the adult patients was 23.2 years (18–45 years). The recorded data included length of hospital stay, postoperative complications, number of bars used, duration of the surgical procedure and signs of pneumothorax on the postoperative chest X-ray. Results: MIRPE was performed in 236 adult patients. The average operative time was 44.4 min (25–90 min). The median postoperative stay was 4.92 ±2.81 days (3–21 days) in adults and 4.64 ±1.58 (2–13) in younger patients. The difference was not statistically significant (p = 0.637). Two or more bars were used in 36 (15.8%) adult patients and in 44 (7.5%) younger patients. The difference was not statistically significant either (p = 0.068). Regarding the overall complications, complication rates among the adult patients and younger patients were 26.2% and 11.8% respectively. The difference was statistically significant (p = 0.007). Conclusions : MIRPE is a feasible procedure that produces good long-term results in the treatment of pectus excavatum in adults.

Introduction : The videothoracoscopic approach is minimally invasive with benefits that include less postoperative pain and shorter hospital stay. It is also a safe procedure which can be performed on an outpatient basis. Aim: To determine whether videothoracoscopic sympathicotomy can be performed safely in most patients as an outpatient procedure. Material and methods: Between July 2005 and October 2015, a total of 92 patients underwent bilateral and single port thoracoscopic sympathicotomy in our department on an outpatient basis. The level of sympathicotomy was T2 in 2 (2.2%) patients, T2 to T3 in 31 (33%) patients, T2 to T4 in 46 (50%) patients and T3 to T4 in 12 (13%) patients. Demographic data, length of postoperative stay, substitution index (SI), admission rate (AR) and readmission rate (RR), complications and patient satisfaction were reviewed retrospectively. Results: Two (2.2%) patients suffered from chest pain, while 4 (4.3%) patients complained about pain at the port site. Mean discharge time after surgery was 5.1 h (range: 4–6 h), mean duration of hospital stay was 0.15 days (0–3 days) postoperatively and the mean operation time was 43.6 min (15–130 min). In 8 (8.6%) patients, pneumothorax was detected on postoperative chest X-ray, while 5 (5.4%) patients required chest tube drainage. Mild or moderate compensatory sweating developed in 32 (34.7%) patients. No recurrence was observed, and the satisfaction rate was 96.7%. Substitution index and admission rate were 91.3% and 11% respectively, while RR was 0%. Conclusions : Bilateral video-assisted thoracoscopic sympathicotomy can be performed safely in most patients as an outpatient procedure.

Chylous leakage is a complication of thyroidectomy accompanied by bilateral neck dissection with incidence of 0.5–6.2%. A 51-year-old female patient underwent total thyroidectomy, bilateral and central neck dissection for papillary thyroid carcinoma. In post-operative 4 th day, left sided chylous leakage was observed as 1,500 cc/day through neck drain. Leakage did not cease after 1-month conservative treatment so single port thoracoscopic intervention was performed. Under general anesthesia, patient was placed in left lateral decubitus position. An Alexis ® retractor was placed through sixth intercostal space. Thoracic cavity was visualized with 30o scope. Posteroinferior edge of lower lobe was retracted superior posteriorly with a Foerster clamp to display inferior pulmonary ligament, which was then divided with electrocautery. Posterior mediastinal pleura between azygous vein and chest wall was incised to mobilize the vein. After that, mediastinal pleura between azygous vein and esophagus was cut longitudinally and esophagus was retracted anteriorly to dissect towards aorta. By dissection, thoracic duct was revealed as a thin tubular structure with occasional peristalsis. After isolation of the duct, it was clipped using Hem-o-lok ® . Finally, fibrin sealant was applied to decrease risk of recurrence. One chest tube was placed to ensure adequate drainage of thoracic cavity and complete re-expansion of lung. Neck drain and chest tube was extracted in postoperative second and fourth day respectively and patient was discharged at 8th day. Single port thoracoscopy is a safe choice for treatment of chylous leakages due to cervical ductus thoracicus injury with faster recovery.

Schwannoma is an easily identifiable and frequently diagnosed lesion of the spinal column. However, if the schwannoma contains a melanin component, the diagnosis is challenging. Our purpose in this case report is to discuss the imaging and histopathologic findings of a rarely seen psammomatous type of melanotic schwannoma diagnosed in a 31-year-old woman.

Gossypiboma is a rare surgical complication, with an estimated incidence of 1/1,000 to 1/10,000 per operation. Gossypiboma is an aseptic foreign body reaction with fibrosis and granuloma formation secondary to retained surgical sponges. The main sites of involvement are the abdomen, pelvis, and thorax. Intrathoracic gossypiboma poses diagnostic challenges because the surgical history may include extrathoracic operations and imaging findings can be atypical. We describe a patient with intrathoracic gossypiboma secondary to posterior vertebral body screw fixation after a traumatic injury. This case illustrates that thoracotomy history may not necessarily be found in intrathoracic gossypiboma.

In our research, we aimed to analyse the relationship between the lung cancer and the zinc (Zn) and the copper (Cu) which are important trace elements for the organisms in cases containing lung cancer. The research included 20 patients who have been operated as a result of primary lung cancer. In the research, the Zn and Cu and Cu/Zn levels in the patient's cancerous and normal lung tissues and serum (pre-operative, post-operative day first and day fifth) were measured (pre-operative, post-operative day first and post-operative day fifth serum albumin levels were also measured). It was found out that the Cu level in the tissue with tumour has been significantly higher than that of the normal tissue (p0.01); that the Zn level in the normal tissue has been significantly higher than the tissue with tumour (p0.001) and that the Cu/Zn rate in the tissue with tumour has been significantly higher than the normal tissue (p0.001). Regarding the serum values, in the post-operative day first, a significant decrease has been viewed in the levels of Cu, Zn and albumin compared to the pre-operative period (p0.001); in the post-operative day first serum Cu/Zn rate has significantly increased compared to the pre-operative period (p0.001); in the post-operative day fifth serum albumin levels have significantly decreased compared to the pre-operative period (p0.001); in the post-operative day fifth, serum Cu/Zn rate has significantly decreased compared to the post-operative day first (p0.01). As a result of the research we performed, we believe that the Cu/Zn level is a more significant data regarding the research of the cancer than the levels of Zn and Cu. We also believe that the Cu/Zn level in the patients with lung cancer should not be used as a diagnostic test, but rather as an indicator of the weakening of the antioxidant defence in patients.