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Objective: During the pandemic, elective cases other than those requiring emergency thoracic surgery were postponed. Depending on the magnitude of the impact the pandemic posed on hospitals and clinics, there have been changes in the number and variety of cases of thoracic surgery. The intention behind conducting this study was to share the experiences gained by a thoracic surgery clinic during the pandemic period.Methods: Altogether, 214 patients were included in the study. Patient data that were recorded included those on age, gender, lung pathology, duration of hospital stay, positivity for COVID-19, survival, and causes of death.Results: Of the 214 patients operated on, 12 died during the postoperative period. Eight of these patients died due to their primary disease and one died due to gastrointestinal bleeding, whereas the remaining three patients died due to COVID-19 infection.Conclusions: If opportunities and facilities favorable for the administration of surgical treatment are made available, surgical treatment services can be offered safely to all patients

Objective:Lung cancer remains the leading cause of cancer deaths worldwide. The surgical approach to locally advanced non-small cell lung cancer (NSCLC) goes beyond the classical approach and requires a multidisciplinary approach both preoperatively and postoperatively. In addition to the tumor size, the location of T3 tumors affects the extent of the surgery.Materials and Methods:Patients who underwent lung resection for cancer between March 2019 and October 2022 were retrospectively reviewed. Patients who underwent chest wall resection were evaluated in terms of age, gender, pathology, type of operation, survival, recurrence, complications, receipt of preoperative chemotherapy, tumor node metastasis (TNM) stage, whether or not mediastinoscopy was performed, STAS (The spread through air spaces) positivity, visceral pleural invasion, parietal pleural invasion, lymphovascular invasion, perineural invasion, and alveolar/bronchial wall invasion.Results:Thoracic wall resection was performed in nine patients with locally advanced NSCLC. The use of prolene mesh was required in eight patients. All patients complained of pain in the thoracic wall in the preoperative period. Postoperative pathology results showed STAS positivity in four patients; alveolar/bronchial wall invasion in four; and visceral, parietal, pleural, and lymphovascular invasion in seven. The mean survival of the patients was 24.20 months (0.63–39). No patient developed recurrence during the follow-up period.Conclusion:Chest wall resection and reconstruction for lung cancer is a surgical treatment method that should be performed without violating respiratory physiology and by using a small amount/number of synthetic materials., Amaç: Akciğer Kanseri dünya çapında kanser ölümlerinin önde gelen nedeni olmaya devam etmektedir. Lokal ileri küçük hücreli dışı akciğer kanserinde (khdak) cerrahi yaklaşım klasik yaklaşımın ötesine geçerek hem preoperatif hem de post operatif multidisipliner yaklaşım ihtiyacını doğurur. Tümörün boyutunun büyüklüğüne ek olarak boyuttan bağımsız T3 tümörlerin yerleşim yeri uygulanacak cerrahinin büyüklüğünü etkiler.Gereç ve Yöntem: Patients who underwent lung resection for malignancy between March 2019 and October 2022 were retrospectively examined. Göğü duvarı rezeksiyonu uygulanan hastalar yaş, cinsiyet, patoloji, operasyon şekli, sağkalım, nüks, komplikasyonlar, preoperatif kemoterapi alıp-almadığı, TNM evresi, mediastinoskopi yapılıp-yapılmadığı, STAS ( The spread through air spaces) pozitifliği, visseral plevra invazyonu, paryetal plevra invazyonu, lenfovasküler invazyon, perinöral invazyon ve alveol/bronş duvarı invazyonu açısından değerlendirildi.Bulgular: Lokal ileri küçük hücreli dışı akciğer kanseri nedeniyle 9 hastaya toraks duvarı rezeksiyonu uygulanmıştır. Hastaların 8’indee prolen mesh kullanma ihtiyacı doğmuştur. Tüm hastalarda preoperatif dönemde toraks duvarında ağrı şikayeti mevcuttu. Postoperatif patoloji sonuçlarında hastaların 4’ünde STAS pozitifliği, 4’ünde alveol/bronş duvarı invazyonu, 7’sinde visseral, paryetal plevra ve lenfovasküler invazyon tespit edilmiştir. Hastaların ortalam sağ kalım süresi 24,20 ay (0,63-39) olarak tespit edilmiştir. Takip süresi içerisinde nüks gelişen hasta olmamıştır.Sonuç: Akciğer kanseri nedeniyle gerçekleştirilen göğüs duvarı rezeksiyonu ve rekonstrüksiyonu solunum fizyolojisine aykırı davralınmadan ve az miktarda/sayıda sentetik materyal tercih edilerek gerçekleştirilmesi gereken bir cerrahi tedavi yöntemidir.

Aim: The COVID-19 patients with pulmonary involvement frequently develop pneumothorax, pneumomediastinum and subcutaneous emphysema due to barotrauma. Reviewing the literature, pneumothorax, pneumomediastinum and subcutaneous emphysema it can be observed among ICU patients due to the pulmonary involvement of the COVID-19 disease, and therefore, can cause mortality and morbidity. This study aims to analyse the factors that affect mortality in COVID-19 patients in ICUs who develop subcutaneous emphysema. Material and Method: A total of 854 COVID-19 patients who were consulted from all branches in the Chest Surgery Clinic of Ankara City Hospital between September 1, 2020 - March 1, 2021 were retrospectively analyzed. Demographic characteristics, comorbid diseases and COVID-related tests (LDH, D-dimer, procalcitonin, ferritin, CRP, IL-6, lymphocyte percentage and neutrophil and lymphocyte ratio) imaging results and survival of 66 patients with subcutaneous emphysema were analyzed. Results: Of the patients, 41 (62%) were male and 25 (38%) were female. The mean age was 63 years. 55 (83%) of these patients were followed up with invasive ventilation support due to general health impairment, increased oxygen demand and heart problems. Age, intubation and NLR were found to be statistically significant in terms of survival and death, on survival. It was discovered that age and intubation variables could be risk factors. The mortality rates were 1.01 times higher for the elderly compared to the younger patients and 13.8 times higher for the intubated compared to the non-intubated patients. Conclusion: Age of patient and intubation can be regarded as risk factors for mortality in COVID-19 patients with subcutaneous emphysema, monitored in ICUs. Furthermore, comorbid diseases increase mortality rates.

Congenital bronchoesophageal fistulas are extremely rare. Symptoms may not be detected before treatment or may be seen intermittently until advanced ages. Treatment is surgical closure of the fistula.A 20-year-old female patient with presented complaints of sputum production and cough. A fistula was confirmed between the middle esophagus and the left main bronchus by bronchoscopy. Management is by surgical closure of the fistula via right thoracotomy. The patient had an uneventful recovery.Congenital bronchoesophageal fistula malformation can cause long-term respiratory symptoms associated with the fistula and loss of lung parenchyma if left untreated.

Background: The aim of this study is to evaluate the surgical perspective on the coexistence of chronic obstructive pulmonary disease (COPD) and lung cancer. Methods: Lung cancer and COPD are two diseases with high morbidity and mortality rates worldwide. In the present study, we present our experience with a total of 21 patients with both COPD and lung cancer who underwent surgical treatment in our center. This retrospective study included 21 patients with COPD and lung cancer who underwent preoperative pulmonary rehabilitation between 2019 and 2020 in our center. Statistical analyses were performed with SPSS version 15 package program. Results: This study included a total of 21 patients. The disease duration for patients diagnosed with COPD was 2–9 years. Positive correlations were noted between time since COPD diagnosis and intensive and nonintensive care hospitalization durations (p

Background A pneumothorax is common in patients admitted to the intensive care unit (ICU) with coronavirus disease (COVID-19) when non-invasive or invasive mechanical ventilation is performed to maintain adequate oxygenation. The aim of the present study was to investigate the effects of elevated inflammatory markers and an elevated systemic immune inflammatory index (SII) on mortality in this patient population. Materials and methods Between March 2020 and May 2021, 124 patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reacion positviity who were admitted to the ICU in our hospital and diagnosed with and treated for a pneumothorax were evaluated retrospectively. Interleukin-6 (IL-6), C-reactive protein, neutrophil, lymphocyte, platelet and white blood cell levels were measured. These parameters were used to calculate the neutrophil–lymphocyte ratio (NLR) and SII, and the association of these parameters with pneumothorax-related mortality was examined. Results This study included 39 female (31.5%) and 85 male (68.5%) patients. The mean age was 65.3 ± 12.6 years. Non-invasive mechanical ventilation was performed in 13 (10.5%) patients, and 111 (89.5%) patients received invasive mechanical ventilation. Tube thoracostomy was performed in 113 patients (91.1%), and 11 patients (8.9%) were treated with oxygen therapy. The factors affecting mortality in the pneumothorax patients were the Charlson Comorbidity Index (four or higher), IL-6 level and NLR. The IL-6 level was 53.4 in those who died versus 24.6 in those who survived (p = 0.017). The NLR in the patients who died was 16.9 as compared to 12.5 in those who survived (p = 0.011). Conclusion Elevated markers of infection were associated with an increased risk of mortality in pneumothorax patients with COVID-19 who received invasive or non-invasive mechanical ventilation in the ICU. In this patient population, high levels of positive end-expiratory pressure should be avoided, and inflammatory marker levels and the SII should be closely monitored.

Background: In this study, we present our experiences with local injections of triamcinolone and prilocaine in patients diagnosed with Tietze syndrome. Methods: Between January 2016 and January 2019, a total of 28 patients (12 males, 16 females; median age: 33 years; range, 21 to 51 years) who were diagnosed with TS in our clinic were retrospectively analyzed. Triamcinolone hexacetonide and prilocaine hydrochloride were injected into painful joints. At first week, pain sensation of the patients was recorded using the Pain Rating Scale developed by the British Pain Society. Pain was also assessed at one, two, and three weeks after injections qualitatively and based on physical examination. Results: At one week, the pain severity before the local injection treatment was above average the pain-related discomfort rates, and the response was quite favorable after the treatment (p=0.005 and p=0.001, respectively). A statistically significant rating was observed for treatment response and success (p=0.003). Totally 75% of the patients experienced more than 70% reduction in pain level after the injection. Conclusion: Our treatment approach involving injection of a mixture of steroid and a local anesthetic provides a rapid relief from pain, irrespective of age, sex, or employment status in patients diagnosed with Tietze syndrome.

Amaç: Plevral aralıkta serbest hava görülmesi olarak tanımlanan pnömotoraksın sekonder sebepleri arasında en sık görülen patoloji Kronik obstruktif akciğer hastalığı (KOAH)’dır. KOAH’lı hastalarda sınırlı pulmoner rezerv nedeniyle pnömotoraks tedavisinin hızlı ve etkin olması önemlidir. Bu çalışmanın amacı, KOAH hastalarında gelişen pnömotoraksta otolog kan ile yapılan plörödezis işleminin sonuçlarını incelemektir. Gereç ve Yöntem: Kliniğimizde şubat 2017-şubat 2020 yılları arasında KOAH hastalığı olan ve pnömotoraks sebebiyle tüp torakostomi uygulanan ve otolog kan ile plöredezis işlemi yapılan olgular incelendi. Yaş, cinsiyet, sigara öyküsü, plöredezis sonrası semptomlar, nüks oranları, komplikasyon ve hastanede yatış süreleri açısından retrospektif olarak değerlendirildi. Bulgular: Yaş ortalaması 65,5 (54-76) olan 27 olgunun tamamı sigara içen erkek hastalardan oluşmaktaydı. Olguların hava kaçağı ortalama süresi 9 (5-16) gün, ortalama yatış süresi 12 gün (8-19), 3 aylık takiplerindeki nüks oranı ise %11.1 olarak (3 olgu) bulundu. Olguların hiçbirinde plöredezis sonrası allerjik reaksiyon, enfeksiyon ve ağrı gözlenmedi. 1 olguda (%3,7) işlem sonrası cilt altı amfizemi, 5 olguda (%18,5) dispne gelişti. Olgularda yaş arttıkça işlem sonrası saturasyon düşüklüğünün anlamlı olarak arttığı izlendi. Saturasyon değerinin artmasının dispne şikayetini anlamlı şekilde azalttığı, yüksek saturasyon değerlerinin 3 aylık periyotta nüks oranını anlamlı şekilde azalttığı gözlenmektedir (p

Burkitt lymphoma manifesting as an intracardiac mass is a rare entity. This report describes the case of a 10-year-old boy who presented with an intracardiac mass and tumor thrombosis in the anterior mediastinum that proved to be Burkitt lymphoma. The LMB-96 chemotherapy protocol was given and at the end of the treatment there was still residual mass. A biopsy was performed and the pathology revealed thymus tissue. The patient has been in complete remission for 3 months. Burkitt lymphoma has a short doubling time and an intracardiac lesion can become life threatening. Early recognition and prompt treatment are crucial in achieving optimal outcomes.

Aim: Future projections suggest that more older people will be affected by non-small cell lung cancer (NSCLC) over the next years due to longer life expectancy and aging global population. Chronological age is used to define elderly. 70 years of age is the most commonly accepted lower limit of senescence since the majority of physiological changes occur after this age. The aim of the current study was to review demographic, epidemiological and clinical characteristics of patients over the age of 70 diagnosed with NSCLC who underwent pneumonectomy at our clinic in a retrospective manner. Methods: This cross-sectional study involved a retrospective assessment of 21 patients over 70 years of age who were diagnosed with NSCLC and underwent pneumonectomy between January 2010 and January 2020. Demographic data, symptoms, tumor types, localization of tumors, postoperative complications and stages of cancer were recorded in the database and statistically analyzed.Results: All 21 patients were male and had a mean age of 72.5 years. The presenting symptom was dyspnea in 23.8% of the patients, cough in 28.6%, hemoptysis in 19%, chest pain in 14.3% and weight loss in 4.8% of the patients and 9.5% of the cases were detected incidentally. The tumor types included squamous cell carcinoma (57.1%), adenocarcinoma (23.8%), adenosquamous carcinoma (14.3%) and large cell carcinoma (4.8%). Tumor site was the left lung in 81% and right lung in 19% of the patients. Early postoperative complications occurred in 5 (23.8%) patients. Three of these patients developed atrial fibrillation and two patients suffered hemorrhage. Postoperative tumor stages of the patients were stage 3a (47.6%), stage 2b (19%), stage 2a (14.3%), stage 1b (9.5%) and stage 1a2 (9.5%). Multidimensional scaling analysis showed an association between the type of tumor and smoking but no association was found between tumor type and family history (P=0.024, P=0.586, respectively).Conclusion: It should be kept in mind that surgical resection and even pneumonectomy which is associated with high mortality and morbidity can be successfully performed in older cancer patients through a good preoperative workup, tumor staging, assessment of the risk of mortality and the effects of comorbid conditions., Amaç: Uzayan yaşam süresi ve yaşlanan dünya nüfusu ilerleyen yıllarda daha fazla sayıda yaşlı küçük hücreli dışı akciğer kanserli (KHDAK) hastanın ortaya çıkacağını göstermektedir. Yaşlılık tanımlaması için kronolojik yaş kullanılmaktadır. 70 yaş fizyolojik değişikliklerin giderek artmaya başladığı dönem olması nedeniyle en çok kabul gören sınır olmuştur. Çalışmamızda; kliniğimizde KHDAK tanısı nedeniyle pnömonektomi uygulanmış 70 yaş üstü hastaların demografik, epidemiyolojik ve klinik özelliklerinin geriye dönük olarak incelenmesi amaçlanmıştır. Yöntemler: Kesitsel tipteki bu çalışmada, Ocak 2010 ile Ocak 2020 arasında KHDAK tanısı alan ve pnömonektomi yapılan 70 yaş üstü 21 hastanın retrospektif olarak değerlendirilmesi yapıldı. Demografik veriler, semptomlar, tümör tipleri, tümörlerin lokalizasyonu, postoperatif komplikasyonlar ve kanser evreleri veri tabanına kaydedildi ve istatistiksel olarak analiz edildi.Bulgular: Çalışmamızda yer alan 21 hastanın tamamı erkek ve ortalama yaş 72,5 idi. Hastaların %23, 8’i dispne, %28,6’ı öksürük, %19’u hemoptizi, %14,3’ü göğüs ağrısı, %4,8’i kilo kaybı şikayeti ile başvururken %9,5’i insidental olarak saptanmıştır. Tümör tipi %57,1 squamöz hücreli karsinom, %23,8 adenokarsinom, %14,3 adenosquamöz karsinom ve %4,8 large cell karsinom olarak tespit edilmiştir. Tümör %81 sol, %19 sağ akciğer yerleşimliydi. Postoperatif erken dönemde olguların 5’inde (%23,8) komplikasyon görülmüştür. Erken dönem komplikasyon görülen olguların 3’ünde atrial fibrilasyon, 2’sinde kanama olduğu görüldü. Hastaların postoperatif evreleri; %47,6’ı evre 3a, %19’u evre 2b, %14,3’ü evre 2a, %9,5’i evre 1b ve %9,5’i evre 1a2 idi. Çok boyutlu ölçekleme analizinde tümör tipi ile sigara kullanımının ilişkisi saptanmış ancak aile öyküsü ile tümör tipi arasında ilişki kurulamamıştır (sırasıyla P=0.024, P=0.586).Sonuç: Cerrahi rezeksiyon olarak morbidite ve mortalitesi yüksek olan pnömonektominin bile yaşlı hastalarda iyi bir preoperatif değerlendirme, evreleme, eşlik eden hastalıkların etkileri ve mortalite tayini ile başarılı bir şekilde uygulanabileceği bilinmelidir.

Lymph node involvement is an important prognostic factor for non-small cell lung cancer. This study aims to investigate the relationship between lymph node involvement and the depth of chest wall invasion. Thirty-three patients who were operated on between 2015 and 2019 for radiologically and pathologically diagnosed chest wall invasion were retrospectively reviewed. Thirtytwo of the patients were male (97.3%) and 1 was female (2.7%) with an average age of 59.4 years. The tumor had a mean diameter of 5.81cm. The invasion was in the posterior part of the chest wall in 17 patients (51.5%), lateral in 11 (33.3%) and anterior chest wall in 5 patients (15.2%). Pleural, soft tissue and costal involvement was present in 32, 19 and 9 cases, respectively. A statistically negative correlation was observed between the depth of chest wall invasion and metastasis of lymph nodes no. 2, 4, 7, 10 and 11 (p:0.041, p:0.006, p:0.011, p:0.025, and p:0.009, respectively). As the invasion progresses towards the periphery, the result of the histopathological evaluation of the lymph nodes number 2, 4, 7, 10 and 11 was found to be benign in 73.1%, 64.6%, 91.4%, 87.5% and 64.9%, respectively. The correlation between the depth of invasion and lymph node metastasis, a subject of negligence up to now was evaluated. The findings presented herein have shown that in chest wall resections, the possibility of complete resection and the presence of lymphatic involvement which is an important prognostic marker are more important in terms of survival compared to the depth of invasion. [Med-Science 2021; 10(3.000): 934-8]

Background This study aims to report the difficulties and complications we experienced in video-assisted thoracoscopic surgery lobectomies performed at our thoracic surgery center. Methods A total of 76 patients (54 males, 22 females; mean age 48.3 years; range 9 to 83 years) who underwent video-assisted thoracoscopic surgery lobectomy between January 2012 and June 2016 were retrospectively reviewed. Preoperative patient characteristics such as additional diseases or tuberculosis history, stage for malignant diseases, surgical characteristics such as port properties and amount of bleeding, postoperative characteristics such as amount, time and duration of drainage, air leakage, and discharge time, morbidity and mortality rates, and their causes were evaluated. Results Of the patients, 35 were evaluated due to benign pulmonary diseases and 41 due to malignant pulmonary diseases. Postoperative prolonged air leakage developed in 14 patients. Of these patients, one was administered thoracotomy and primary repair, three were administered pleurodesis, and three were administered secondary pleurocan catheter, while the air leakage ended spontaneously in seven patients. Due to bleeding, one patient was treated with revision video-assisted thoracoscopic surgery on the same day postoperatively. One patient developed chylothorax and one patient developed pneumonia, which caused respiratory failure. Conclusion Video-assisted thoracoscopic surgery lobectomy is a safe thoracic procedure, which is used for both oncologic and non-oncologic diseases of the lung. Video-assisted thoracoscopic surgery may be performed by all thoracic surgeons experienced in open thoracic surgery. Thanks to the gained experiences, the rates of video-assisted thoracoscopic surgery lobectomy may improve in all centers.