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Sol üst lobda yer alan küçük hücreli dışı akciğer kanseri (KHDAK) için sol üst lobektomi ve segmentektomi sonuçlarını karşılaştırmayı amaçladık. Kliniğimizde 1999-2016 yılları arasında sol üst lob yerleşimli KHDAK nedeniyle segmentektomi veya lobektomi uygulanan hastaların verilerini retrospektif olarak inceledik. Segmentektomi; lobektomi için uygun evre I hastalar ve sınırlı kardiyopulmoner rezervi nedeniyle lobektomi için uygun olmayan hastalarda uygulandı. Toplamda 127 hasta optimal veri eşleştirme algoritması kullanılarak propensity skoru analizine dahil edildi. 1: 2 eşleştirme algoritmasından sonra 90 hasta iki gruba ayrıldı; grup 1 segmentektomi (n=30) ve grup 2 lobektomi (n=60). Morbidite, mortalite, uzun dönem sağkalım oranları ve prognostik faktörler analiz edildi. Histopatolojik incelemede 57 hasta evre I [grup 1 (n = 18), grup 2 (n = 39)], 33 hasta evre II-IV [grup 1 (n = 12), grup 2 (n = 21 )] tespit edildi. Morbidite oranı % 37.78 (37/90) [grup 1: n = 11 (% 36.67), grup 2: n = 23 (% 38.33), p = 1.000] ve mortalite oranı % 1.11 [grup 1: n = 1 (% 3.33), grup 2: n = 0 (% 0), p = 0.333] idi. Evre I hastalarda ortalama Kaplan-Meier sağkalım süresi grup 1 için 146.09 (% 95 CI: 111.70-180.49) ve grup 2 için 106.99 (% 95 CI: 77.68-136.30) idi (p = 0.185) olarak sonuçlandı. Bu çalışmada sol üst lobda segmentektomi veya lobektomi uygulanan erken evre KHDAK'li hastalar için benzer sonuçlar elde edildi. Özellikle lingulektomi veya trisegmentektomi, evre I KHDAK için lobektomiye kıyasla standart bir prosedür olarak önerilmektedir. We aim to compare the outcomes of left upper lobectomy and segmentectomy for non-small cell lung cancer (NSCLC) located at the left upper lobe. We retrospectively reviewed the medical data of patients with NSCLC located in the left upper lobe who underwent segmentectomy or lobectomy between 1999 and 2016. Segmentectomy was preferred for patients with stage I who were also eligible for lobectomy and for patients who were not eligible for lobectomy due to limited cardiopulmonary reserve. In total, 127 patients were included into the propensity score analysis by using optimal data matching algorithm. After the 1:2 matching algorithm, 90 patients were divided into two groups; group 1 segmentectomy (n=30), and group 2 lobectomy (n=60). The morbidity, mortality, long-term survival rates and prognostic factors were analyzed. Histopathological investigation revealed 57 patients as stage I [group 1 (n=18), group 2 (n= 39)], 33 patients as stage II-IV [group 1 (n=12), group 2 (n= 21)]. Morbidity rate was 37.78% (37/90) [group 1: n=11 (36.67%), group 2: n=23 (38.33%), p=1.000] along with mortality rate of 1.11% [group 1: n=1 (3.33%), group 2: n=0 (0%), p=0.333]. In stage I patients, mean Kaplan-Meier survival time was 146.09 (95%CI: 111.70-180.49) for group I and 106.99 (95%CI: 77.68-136.30) for group 2 (p=0.185). This study revealed similar outcomes for patients with early stage NSCLC located at the left upper lobe undergoing either segmentectomy or lobectomy. In particular, lingulectomy or trisegmentectomy is recommended as a standard procedure for Stage I NSCLC compared to lobectomy.

Hidrosefali, beyin omurilik sıvısında artış ile seyreden, serebral ventriküllerde genişlemeye ve serebral kortekste incelmeye neden olan artmış intrakraniyal basınç ile karakterize yaygın bir nöroşirurjikal hastalıktır. Hidrosefalinin yönetiminde en sık kullanılan tedavi yöntemi ventriküloperitoneal şanttır. Şant işlemi sonrası daha çok mekanik obstrüksiyonlar ve enfeksiyonlar görülmektedir. Torasik migrasyon oldukça nadir görülür fakat görüldüğü zaman ivedilikle müdahale edilmesi gereken bir tablodur. Hydrocephalus is a common neurosurgical pathology characterized by increased production of cerebrospinal fluid, causing high intracranial pressure, which results with dilatation of cerebral ventricles and thinned cerebral cortex. The most common treatment of hydrocephalus is ventricoloperitoneal shunt. Mechanic obstruction and infection are seen frequently after shunt procedures. Thoracic migration of distal shunt catheter is rare complication, but when present it must be carried out immediately.

Küçük hücreli dışı akciğer kanseri (KHDAK)’nin en sık metastaz yaptığı organlardan biri beyindir. Beyin metastazı olan hastalar tedavi edilmediğinde ortalama yaşam süresi aylarla sınırlıdır. Bu çalışmanın amacı beyin metastazı yapmış evre 4 KHDAK hastalarda beyin metastazı için cerrahi tedavi uygulamasının onkolojik sonuçlarını göstermektir. Kliniğimizde 2004-2012 yılları arasında KHDAK tanısı konan ve BM nedeniyle cerrahi tedavi uygulanan 59 hastanın verileri prospektif olarak kaydedildi ve retrospektif olarak incelendi. Hastaların cerrahi ve onkolojik sonuçları irdelendi. Sağ kalım süresi beyin metastazı tanısı konulduğu tarih ile ölüm tarihi veya mevcut en son takip arasındaki zaman olarak hesaplandı. Hastaların 51’i erkek, 8’i kadın, ortalama yaş 56.92 (37-81) yıl idi. Cerrahi olarak 55 hastaya total eksizyon, 4 hastaya subtotal eksizyon yapıldı. Ameliyat sonrası mortalite saptanmadı. Patolojik inceleme sonucunda 55 hastada cerrahi sınırlar tümörsüz, 4 hastada ise cerrahi sınır mikroskobik pozitif olarak bildirildi. Ameliyat sonrasında tüm hastalara palyatif kranial radyoterapi ve sistemik kemoterapi verildi. 11 hastaya(%18,6) akciğerdeki primer kitleye kemoradyoterapi verildi. 8 hastaya akciğere yönelik cerrahi lobektomi, 7 hastaya pnömonektomi uygulandı. Medyan genel sağkalım süresi 12,00 (1,0-159,0) aydı. Hastaların 12, 24 ve 60 aylık sağkalım oranları sırasıyla %47.5, %28.8 ve %13.5 olarak bulundu. Üç olguda ise 10 yılın üzerinde genel sağ kalım elde edildi. Beyin metastazı yapmış KHDAK’lu hastalarda kranial metastazektomi hastaların sağkalımına olumlu katkı sağlayabilir. The brain is one of the organs that non-small cell lung cancer (NSCLC) metastasizes most frequently. The life expectancy is limited to months in patients with brain metastasis (BM), which is not treated. This study aims to show the oncological outcomes of surgical treatment of cranial lesion in patients with stage 4 NSCLC. The data of 59 patients who were diagnosed with NSCLC and underwent surgical treatment of BM between 2004 and 2012 in our clinic were prospectively recorded and analyzed retrospectively. The surgical and oncological outcomes of the patients were studied. Survival was calculated as the time between the diagnosis of BM and the date of death or the last followup. Fifty-one of the patients were male, and eight were female, and the median age was 56.9 (37-81) years. Fifty-five patients underwent total excision, and four patients underwent subtotal excision. No postoperative mortality was detected. As a result of the pathological examination, the surgical margins were reported as tumor-free in 55 patients, and microscopically positive in 4 patients. Palliative cranial radiotherapy and systemic chemotherapy were given to all patients after surgery. Eleven patients (18.6%) underwent chemoradiotherapy to the primary mass in the lung. Lobectomy and pneumonectomy were performed in 8 and 7 patients. The median overall survival was 12.00 (1.0159.0) months. The 12, 24, and 60-month survival rates of the patients were 47.5%, 28.8%, and 13.5%, respectively. In three cases, overall survival over ten years was obtained. Cranial metastasectomy may contribute positively to the survival of patients with NSCLC.

There is a dilemma about usage and selection of the antibiotics following pulmonary contusion. Thus, this study aimed to evaluate pulmonary infection risk in dogs with pulmonary contusion. In total, eleven dogs with pulmonary contusion included in the study. Diagnosis of the pulmonary contusion and its degrees were determined based on the clinical and radiological findings. Under general anesthesia, bronchoscopy and bronchoalveolar lavage (BAL) was applied on 0, 24 and 48(th) h and BAL samples were collected. Cytological examination, culture and antibiotic susceptibility analysis of the BAL samples were performed. Clinically, mild, moderate and severe degree pulmonary contusions were diagnosed, but radiological results pointed out severe degree of pulmonary contusion in all dogs. Bronchoscopy showed the hemoptysis in all dogs except one. Cytologically, all preparations had the inflammatory results at 0(th) hour and these were increased at 24 and 48(th) hours. Additionally, evidence of infection was determined in the cytological preparations of four dogs (case 1, 2, 5 and 8) taken at 0, 24 and 48(th) hours. These cytological results were compatible with microbiological results of case 1, 2, 5 and 8. Pasteurella multocida in case 1 and 2, and Escherichia coli in case 5 and 8 was cultured microorganism from the BAL samples, separately. While P. multocida was resistant to gentamicin, erythromycin and oxytetracycline; E. coli was resistant only sulfamethoxazole/trimethoprim. In conclusion, it may be stated that pulmonary contusion triggers inflammation process, and if there is a pathogenic opportunistic flora in the lower respiratory tracts, the pulmonary infections might accompany with inflammation process. Thus, if it is able, antibiotic usage must be planned considering to the results of BAL culture and antibiogram tests. Pulmoner kontüzyon sonrası antibiyotik kullanımı ve seçimi hakkında bir çelişki vardır. Bu nedenle bu çalışma pulmoner kontüzyonlu köpeklerde pulmoner enfeksiyon riskinin değerlendirmesini amaçladı. Çalışmaya pulmoner kontüzyonlu 11 köpek dahil edildi. Pulmoner kontüzyon tanısı ve derecelendirilmesi klinik ve radyolojik bulgular temelinde belirlendi. Genel anestezi altında, 0, 24 ve 48. saatlerde köpeklerde bronkoskopi ve bronkoalveolar lavaj (BAL) uygulandı ve BAL numunesi alındı. BAL numunelerin sitolojik muayenesi, kültür ve antibiyotik duyarlılık analizleri yapıldı. Klinik olarak hafif, orta ve şiddetli derece pulmoner kontüzyon tanıları konuldu, ancak radyolojik bulgular tüm köpeklerde şiddetli derecede pulmoner kontüzyonu belirtti. Bronkoskopi, biri hariç tüm köpeklerde hemoptiziyi gösterdi. Sitolojik olarak, tüm preparatlar 0. saatte enflamasyon bulgularına sahipti ve bu bulgular 24 ve 48. saatlerde artıyordu. Ek olarak, enfeksiyon varlığı, dört köpeğin (olgu 1, 2, 5 ve 8) 0, 24 ve 48. saatlerde alınan sitoloji preparatlarında belirlendi. Bu sitolojik bulgular olgu 1, 2, 5 ve 8’in mikrobiyolojik bulguları ile uyumluydu. Sırasıyla, Pasteurella multocida olgu 1 ve 2’de, Escherichia coli olgu 5 ve 8’de BAL numunelerinden kültüre edilen mikroorganizmalardı. P. multocida gentamisin, eritromisin ve oksitetrasiklin’e dirençli iken, E. coli sadece sulfametoksazol/ trimetoprim’e dirençliydi. Sonuç olarak, pulmoner kontüzyononun yangısal süreci tetikleyebildiği ve eğer alt solunum yollarında patojenik fırsatçı bir flora var ise akciğerdeki yangısal sürece enfeksiyonun da eşlik edebileceği söylenebilir. Bu yüzden, antibiyotik kullanımı olanaklar elveriyor ise BAL kültür ve antibiyogram sonuçları göz önüne alınarak kurgulanmalıdır.

Pulmoner hamartomlar, akciğerin en sık görülen benign tümörleridir. Genellikle soliter olup akciğerin periferinde yerleşirler. Mezenşimal hücrelerden köken alan bu tümörler matür kıkırdak, yağ, osteoid ve düz kas dokularının değişen miktarlarda birleşiminden oluşurlar. Çalışmamızda 2005 ile 2014 yılları arasında Patoloji Anabilim Dalı’nda pulmoner hamartom tanısı almış 30 olgu dahil edilmiştir. Hastalar, yaş, cinsiyet, hastanın başvuru sırasındaki şikayeti, klinik ve/veya radyolojik ön tanı, tümör yerleşim yeri, ameliyat prosedürü, tümör boyutu ve histopatolojik bulgular açısından retrospektif olarak değerlendirilmiştir. Olguların 20’si erkek, 10’u kadın olup erkek/kadın oranı 2’dir. Yaş ortalaması 54.5 yaş (aralık 27–75 yaş) olarak bulunmuştur. En sık görülen yakınma öksürük olup semptomatik olan 18 hastanın 14’ünde (%78) mevcuttur. Hastaların 16’sında (%53) tümör sağ akciğer yerleşimlidir. Hastaların biri hariç hepsine wedge rezeksiyon uygulanmıştır. Makroskopik incelemede ortalama tümör çapı 2.1 cm (aralık 0.3–9 cm) olarak tespit edilmiştir. Olguların tamamı soliter olup, bir olguda hamartom ile aynı lobda yerleşmiş akciğer kökenli adenokarsinom saptanmıştır. Makroskopik incelemede, pulmoner hamartomlara nadir de olsa malignitenin eşlik edebileceği akılda tutulmalı ve lezyon dışı akciğer parankimi dikkatlice incelenmeli ve örneklenmelidir. Pulmonary hamartomas are the most common benign tumors of lung. They are mostly solitary, and are located peripherally. These tumors are composed of varying amounts of cartilage, fatty, smooth muscle and fibrous tissue as they originate from mesenchymal cells. Thirty cases, which were diagnosed as pulmonary hamartoma at the Department of Pathology between 2005 and 2014, were examined retrospectively in this study. Patients’ data including age, sex, complaint, clinical and/or radiological diagnosis, tumor localization, surgical procedure, tumor size, and histopathological findings were recorded. Of the 30 cases, 20 were male and 10 were female, with a male-to-female ratio of 2. The age range of the study population was between 25 and 75 years, and the mean age was 54.5 years. The most common complaint was cough, which was present in 78% symptomatic patients (14 out of 18). In 16 (53%) patients, tumor was localized in the right lung. Wedge resection was performed in all patients except one. In macroscopic examination, tumor size ranged between 0.3 cm and 9 cm, with a mean size of 2.1 cm. One patient was detected to have an adenocarcinoma of lung originating from the same lobe as hamartoma. It should always be kept in mind that a malignancy may accompany a pulmonary hamartoma. Therefore, the nontumoral parenchyma should be carefully examined and sampled during the macroscopic dissection.

Objective: One of the most important considerations in the care of thoracic surgery patients is the control of pain, which leads to increased morbidity and relevant mortality. Methods: Between February and May 2009, 60 patients undergoing full muscle-sparing posterior minithoracotomy were prospectivelyrandomized into two groups, according to the thoracotomy closure techniques. In the first group(group A), two holes were drilled into the sixth rib using a hand perforator, and sutures were passed through the holes in the sixth rib and were circled from the upper edge of the fifth rib, thereby compressing the intercostal nerve underneath the fifth rib. In the second group (group B), the intercostal muscle underneath the fifth rib was partially dissected along with the intercostal nerve, corresponding to the holes on the sixth rib. Two 1/0 polyglactin (Vicyrl) sutures were passed through the holes in the sixth rib and above the intercostal nerve.Results:There were 30 patients in each group. The visual analog score, observer verbal ranking scale (OVRS) scores for pain, and Ramsay sedation scores were used to follow-up on postoperative analgesia and sedation. The von Frey hair test was used to evaluate hyperalgesia of the patients. The patients in group B had lower visual analog scores at rest and during coughing. The patients in group B had lower OVRS scores than group A patients. The groups were not statistically differentin terms of the Ramsaysedation scores and von Frey hair tests.Conclusions:Thoracotomy closure bya techniquethat avoids intercostal nerve compression significantly decreases post-thoracotomy pain. # 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

Although it is well known that numerical and structural chromosomal aberrations are common in leukemic cells, tetraploidy and near-tetraploidy is a rare entity in acute myeloid leukemia (AML) [1-4]. We describe a rare case of AML-M0 with near-tetraploidy and superior vena cava syndrome (SVCS) due to a large mediastinal granulocytic sarcoma (GS). A 25-year-old male was admitted to our hospital with a progressive non-productive cough, dyspnea, pain on the left upper extremity and weight loss. One month ago, he was treated with a diagnosis of venous thrombosis because of the pain and swelling on his left upper extremity. At the time of admittance, physical examination revealed dyspnea, facial edema, swelling of the neck and upper extremities and dilated jugular and superficial veins of the chest. Peripheral lymph node or organomegaly was absent. His hematological findings were: hemoglobin, 14.1 g dl−1; hematocrit, 41.6%; MCV, 87.5 fl; WBC, 15.3 × 109 l−1 with 15% polymorphonuclear cells; 22% bands; 37% lymphocytes; 26% resembling blastic cells; and platelets 284 × 109 l−1. The chest X-ray showed enlarged mediastinum and thorax computed tomography (CT) demonstrated a multi-lobar mass with a diameter of 9 × 5 cm in the anterior mediastinum which also compressed the superior vena cava (Figure 1A). Abdominopelvic CT scan was normal. Mediastinoscopy was performed for definite diagnosis. The biopsy specimens from mediastinal mass revealed diffuse malignant infiltration in lipomatous tissue, which consisted of round, large sized cells. Nuclei were large, vesicular and contained two or three nucleolus. Cytoplasm was moderate in amount and clear. The specimens showed negativity for all of the antibodies and staining except for myeloperoxidase (MPO), CD34 and TdT (Figure 1B). Bone marrow aspirate revealed the presence of large blasts with a relatively low nuclear-cytoplasmic ratio, moderate chromatin pattern, two-to-three prominent nucleoli, no cytoplasmic granules and few cytoplasmic vacuolization. Most of the cells had heterogeneous shaped nuclei. No Auer rod was seen (Figure 1C). Cytochemistry revealed negativity for MPO, Sudan black B, periodic acid Schiff, combined esterase and acid phosphatase. Flow cytometric studies of the bone marrow cells revealed positivity for CD13, CD33, CD34, CD45, CD7 and HLA-DR. Cytogenetic analysis showed near tetraploidy (Figure 1D). Results of cytogenetic analysis of 20 metaphases of the bone marrow cells were as follows; 102, XXYY, +13, +14, +14, +15, +16, +18, +19, +21, +21, +22 [6] / 104, XXYY, +X, +Y, +3, +4, −7, −8, +10, +11, +13, +13, −14, +15, +15, +19, +21, +21, +22, +22 [9] / 98, XXYY, +3, +4, −6, +8, −11, +13, +14, −16, +19, +20, +21, +21 [5]. Neither apparent structural rearrangement nor normal clone was identified. Upon establishing the diagnosis (AML-M0/near tetraploidy+/mediastinal GS+) [5], he was given an induction chemotherapy consisting of daunorubicin (45 mg m−2 per day, days 1–3) and cytarabine (100 mg m−2 per day continuous infusion, days 1–7) and bone marrow remission was achieved. Then, he received the first consolidation chemotherapy consisting of idarubicin (10 mg m−2 per day, days 1–3) and cytarabine (1000 mg m−2 per day, days 1–6), followed by second consolidation chemotherapy consisting of cytarabine (6 gr m−2 per day, days 1–3) and 1800 cGy radiotherapy on mediastinum. The symptoms of SVCS improved gradually after the 5th day of induction chemotherapy. Likewise, the mediastinal mass decreased in size by 30% after induction chemotherapy, 70% after consolidation chemotherapies and disappeared completely after the completion of radiotherapy (Figures 1E and F). Presently, he is in the 10th month of his complete remission without any recurrence in the disease or GS.

Objective: Complex pulmonary aspergilloma (CPA) following pulmonary tuberculosis may lead to massive and fatal hemoptysis. Pulmonary resection, as initial therapy, carries high morbidity and mortality. Resection is contraindicated in patients with compromised lung function (FEV1!40%) and in those with bilateral disease. We reviewed the results of patients undergoing single stage cavernostomy and myoplasty as an alternative therapy in patients with normal and compromised lung function. Methods: Patients suffering from recurrent massive hemoptysis (600 ml/24 h or O150 ml/h) due to CPA were selected for single stage cavernostomy and myoplasty. We performed rib resection, cavernostomy, closure of the bronchial openings and total/partial obliteration of the cavity with a muscle flap as a single stage technique in patients with CPA regardless of pulmonary function or bilateral disease. Patients began oral Itracanozole two weeks prior to surgery and continued for 3 months post-operatively. Results: Three women and four men (median age 38 years; range 24‐59 years) with CPA were evaluated. Four patients had either bilateral disease or compromised lung function. Pectoralis major muscle was used for the myoplasty in five and trapezius or latissimus dorsi in the other two patients. The median number of bronchial fistulae closed during the surgery was six (range 2‐12). Blood loss was minimal (median 227 ml). Two patients underwent successful re-exploration for significant air leak. The median hospital stay was 9 days (6‐27days). Six patients are alive and hemoptysis free (median follow-up 57.2 months). Conclusions: Cavernostomy and myoplasty as a single stage technique is safe and reliable in the management of patients with complex pulmonary aspergilloma. Morbidity is low even in patients with compromised lung function or bilateral disease. Q 2005 Published by Elsevier B.V.

Our aim was to show the effect of one-lung ventilation (OLV) on cerebral blood flow (CBF) by measuring carotid blood flow. This technique has been the subject of experimental and clinical studies. Materials and methods: Carotid doppler flows were measured at 4 different times. Peak systolic velocity (PSV) and end diastolic velocity (EDV) were measured and pulsatility index (PI) and resistive index (RI) calculated. Results: There were no significant changes in PSV, PI, RI, or flow volume in the normal or diseased sides at repeated measures (P > 0.05).There was no significant difference between the flow velocities, PIs, RIs, or flow volumes measured in the supine and decubitus positions during OLV. In addition, there was no significant difference between the flow parameters of the upper and lower carotids measured in the lateral decubitus position before and after OLV. There was no correlation between any of the flow parameters and duration of OLV. Conclusion: OLV poses no additional risk in terms of CBF. However, further studies, supported by biochemical parameters and involving wider patient groups, are now needed.

Objective: Sleeve resection with or without lung resection is a valid conservative operation for patients with benign or malignant tumors; it enables the preservation of lung parenchyma. The aim of this prospective randomized study was to compare complications, operating time, and bronchial healing between the techniques of interrupted and continuous suturing for bronchial anastomosis in dogs. Methods: Twenty adult mongrel dogs each weighing 18-22 kg (average: 20 kg) were divided into two groups according to the anastomosis technique performed: group A, interrupted suturing and group B, continuous suturing. Each group comprised of 10 dogs. Following right thoracotomy, sleeve resection of the right cranial lobe was performed in all dogs. Basic interrupted sutures using 4/0 Vicryl (Ethicon, USA) were used in group A, and continuous sutures were used in group B. Results: The median anastomosis time was 15.2 min (range: 13-21 min) in group A and 9.6 min (range: 8-13 min) in group B. In all dogs, the anastomosis line was resected via right pneumonectomy for histopathological investigation 1 month after sleeve resection. Histopathological examination revealed that the healing of the anastomosis was not affected by the suturing technique applied. One dog from each group died on the fourth postoperative day; Fisher's exact test, p = 0.763. Conclusions: Our research revealed that the healing of the anastomosis was not affected by the suturing technique performed.

Malignant pericardial effusions (MPE) account for approximately 21% of all patients with advanced malignancies. The standard approach to management of MPE has remained controversial. In this article, we present the case of an 18-year-old female who was admitted to our clinic with pericardial tamponade. A cytological examination of the pericardial effusion revealed malignant cells, and the biopsy confirmed the diagnosis of Hodgkin's lymphoma of the nodular sclerosing type.

Amac: Bu calismada, doku biyopsileri ile ince igne aspirasyonu (IIA) karsilastirildi ve bu kombinasyonun mediastinoskopideki yanlis negatiflik oranini azaltip azaltmayacagi arastirildi. Ca­lis­ma­ pla­ni:­Ocak 2004 ve Ekim 2005 tarihleri arasinda servikal video mediastinoskopi uygulanan kucuk hucreli disi akciger kanserli (KHDAK) 92 hasta bu prospektif calismaya dahil edildi. Ayni lenf nodundan hem doku biyopsisi hem de IIA yapildi ve patolojik incelemeye gonderildi. Doku ornekleri ve IIA’lar Hematoksilen-Eosin ile boyandi. Tum ornekler iki histopatolog tarafindan incelendi. Bul gu lar: Doku biyopsisi ornekleri ile 54 hastada metastaza rastlanmaz iken, 38 hastada metastaz saptandi. IIA’da ise 48 hastada metastaza rastlanmaz iken, 44 hastada metastaz saptandi. Farklilik istatistiksel olarak anlamli degil idi (p>0.05). Yanlis negatiflik oranlari, IIA ve doku biyopsisi sonrasi sirasiyla %5.4 ve %12 idi. Negatif IIA ve doku biyopsili 43 hastaya takiben torakotomi ile akciger rezeksiyonu ve total sistematik lenf nodu diseksiyonu yapildi. Mediastinal lenf nodu diseksiyonu sonrasi iki olguda (%4.6) lenf nodu metastazi saptandi. Buna bagli olarak iki yontem kombine edildiginde mediastinoskopinin yanlis negatifligi %4.6’ya indi. Teknige bagli herhangi bir komplikasyon ile karsilasilmadi. So­nuc:­Mediastinal lenf nodlarinin IIA’si doku biyopsisi ile karsilastirildiginda guvenli ve etkili bir yontem olup, doku biyopsisi ile kombine edildiginde mediastinoskopinin yanlis negatiflik oranini azaltabilir. Anah tar soz cuk ler: Biyopsi; ince igne aspirasyonu; akciger kanseri; lenf nodu; mediastinoskopi. Background:­This study aims to compare tissue biopsy with fine needle aspiration (FNA) and investigate whether the combination reduces false negativity of mediastinoscopy. Methods: Between January 2004 and October 2005, 92 patients with non-small cell lung cancer (NSCLC) who underwent cervical video mediastinoscopy were included in this prospective study. Tissue biopsy samples and FNAs were obtained from the same lymph node and were sent for a pathologic examination. Tissue samples and FNAs were stained with Hematoxilene-Eosine. All specimens were evaluated by two histopathologists. Results:­ Using tissue biopsy samples, no metastasis was found in 54 patients, while 38 patients were metastatic. Forty-eight patients had no metastasis, while 44 patients were metastatic using FNA samples. The difference was statistically non-significant (p>0.05). The false negativity of the FNA and tissue biopsy were 5.4% and 12%, respectively. Subsequently, 43 patients with negative FNA and tissue biopsy underwent lung resection with thoracotomy and sistematic lymph node dissection. Following lymph node dissection, lymph node metastases were found in two cases (4.6%). As a result, false negativity of mediastinoscopy was reduced to 4.6% when two techniques were combined. There was no complication related to the technique. Conclusion:­ The FNA of mediastinal lymph nodes is a safe and effective method, compared to tissue biopsy and reduces the false negativity of mediastinoscopy when combined with tissue biopsy.

Aim: To describe the clinical features of descending necrotizing mediastinitis (DNM) and to outline the diagnostic and therapeutic measures to be taken in its management. Materials and methods: We retrospectively analyzed the data from 13 patients with DNM treated between 2001 and 2012 in 2 tertiary care centers, together with their demographics, diagnostic methods, therapeutic interventions, and clinical outcomes. Results: The patients consisted of 10 males and 3 females, aged from 16 to 72 years (mean age: 44). Odontogenic and tonsillar infections were the probable sources of infection in the majority of cases. Computerized tomography is a crucial imaging modality in the diagnosis and follow-up of patients with DNM. All patients underwent surgical treatment in addition to intravenous broad-spectrum antibiotics. Tube thoracostomy, mediastinal drainage, cervical drainage, and thoracotomy were the therapeutic measures utilized in these patients. Five patients were lost (38%) and 8 survived. Conclusion: DNM is a life-threatening condition that may originate from oropharyngeal infections. Emergency surgical intervention is mandatory in the management of DNM. The 2 most important survival factors are early surgical intervention and adequate drainage.

Background: Pericardial cysts are usually asymtomatic, benign, congenital mediastinal lesions but may also be acquired after cardiothoracic surgery. The purpose of the study was to evaluate surgical approach and results of our experience with pericardial cysts. Patients and Methods: A total of 12 patients who had undergone surgical treatment for pericardial cyst between February 1999 and August 2010 were retrospectively evaluated. All patients were analyzed according to the symptoms, method for the diagnosis, cyst location, management, and outcomes. Results: The mean age was 50.4 +/- 17 years (range, 23-68 years) with a female-to-male ratio of 8:4. Pericardial cyst were located in the right hemithorax in 8 (67%) patients and left hemithorax in 4 (33%) patients. The cysts were resected by thoracotomy in 4 (33%) patients and by video-assisted thoracic surgery in 8 (67%) patients. There was an excellent long-term follow-up with no morbidity or mortality. Conclusion: Videothoracoscopic surgical removal of pericardial cysts is an excellent surgical intervention without serious morbidity and mortality.

Tracheobronchial resection in humans is a still problem in lung cancer invading the carina, because there is not a standard surgical procedure. This study aimed to compare postoperative complications and histopathological results of simple continuous and simple interrupted suturing techniques in tracheobronchial anastomosis following the wedge carinal resection in dogs. Twelve mongrel dogs were divided into A and B groups. Right pneumonectomy with wedge carinal resection technique was performed under general anesthesia, and then tracheobronchial resection line was sutured simple continuously in group A and simple interruptedly in group B. The dogs were checked during two months in terms of postoperative complications, and euthanized at the end of two months to evaluate tracheobronchial anastomosis lines histopathologically. No postoperative complication was encountered in group A; but, 2 dogs in group B died due to respiratory failure on postoperative 4(th) and 12(th) days. Autopsy of the dogs revealed tracheobronchial dehiscence and opening of the simple interrupted suturing line, which was considered operative technique failure of suturing. Histopathologically, the sections taken from tracheobronchial anastomosis line had similar microscopic results in both group. Statistically, Fisher's exact test was applied between groups to determine the differences with regard to postoperative complications and histopathological results. There was no statistically significant differences between the groups in postoperative complications and histopathological results. In conclusion, operative technique failure of suturing is still common in tracheobronchial anastomosis; however, taking the histopathological results of the study into consideration, it has been implied that both suturing technique can be performed in tracheobronchial anastomosis following the wedge carinal resection. Standart bir cerrahi prosedür olmadığından dolayı insanlarda karinaya yayılmış akciğer kanserlerinde trakeobronşiyal rezeksiyon hala problemdir. Bu çalışma köpeklerde kama karinal rezeksiyon sonrası trakeobronşiyal anastomozda basit sürekli ve basit ayrı dikiş tekniklerinin postoperatif komplikasyon ve histopatolojik bulgularını karşılaştırmayı amaçlamaktadır. Oniki melez köpek A ve B gruplarına ayrıldı. Kama karinal rezeksiyon tekniği ile genel anestezi altında sağ pnömonektomi yapıldı ve sonrasında trakeobronşiyal rezeksiyon hattı grup A’da basit sürekli ve grup B’de basit ayrı olarak dikildi. Köpekler postoperatif komplikasyonlar bakımından iki ay boyunca kontrol edildi ve ikinci ayın sonunda trakeobronşiyal anastomoz hattını histopatolojik olarak değerlendirmek için ötenazi edildi. Grup A’da postoperatif komplikasyon görülmedi ancak grup B’de 2 köpek postoperatif 4 ve 12. günlerde solunum yetmezliğinden dolayı öldü. Köpeklerin otopsisi trakeobronşiyal dikiş hattında bozulma ve dikiş uygulamasının operatif teknik başarısızlığı olarak düşünülen basit ayrı dikiş uygulanan hattın açıklığını ortaya çıkardı. Histopatolojik olarak, trakeobronşiyal anastomoz hattından alınan kesitler her iki grupta benzer mikroskopik bulguları gösterdi. İstatistik olarak, postoperatif komplikasyon ve histopatolojik bulgular yönünden gruplar arasındaki farklılıkları belirlemek için Fisher’in kesin testi uygulandı. Postoperatif komplikasyon ve histopatolojik bulgularda gruplar arasında istatistik olarak önemli farklılık bulunmadı. Sonuç olarak dikiş uygulamasının operatif teknik başarısızlığı trakeobronşiyal anastomozda hala yaygındır. Ancak, çalışmanın histopatolojik bulguları göz önüne alındığında kama karinal rezeksiyon sonrası trakeobronşiyal anastomozda her iki dikiş tekniğin kullanılabileceği kanısına varıldı.

There are four matters of uncertainty considered in this working group report, which are distilled into four clinical questions: (1) What is the evidence for the need for palpation of the lung in modern era of imaging? (2) Is there evidence of a difference in outcome for an open versus a closed approach? (3) Is there evidence of a difference in outcome for an initial policy of bilateral versus unilateral exploration? (4) In patients with known bilateral disease, is there a difference in outcome with a simultaneous versus a staged approach?We searched the literature formally and supplemented this with knowledge from all other sources. We provide evidence tables on the first two questions by relying on a group consensus and frame recommendations for the other two.There are no randomized trials to guide us but there are comparative studies addressing the need for palpation and the need to and open operation in all cases. The evidence is equivocal, and opinions are divided in the literature.Palpation of the lung is still seen as necessary in a therapeutic metastasectomy as opposed to a diagnostic procedure when videothoracoscopy is adequate. However, the importance of palpation becomes less clear with advances in imaging. Routine bilateral exploration for unilateral disease was not favored. For bilateral disease, an initial median sternotomy has a place for some cases but sequenced thoracotomy was preferred.

Çalışmamızda, torakoskopik cerrahi sonrası intravenöz parasetamol uygulamasının postoperatif analjezi üzerine etkinliğini değerlendirmeyi amaçladık. ASA I-II grubu 40 hasta, anestezi indüksiyonundan önce ve postoperatif 24 saat içinde her 6 saatte bir intravenöz 1 gr parasetamol veya 100 ml serum fizyolojik verilmek üzere randomize olarak ayrıldı. Dinlenme ve hareket sırasındaki ağrı skorları, sedasyon skorları, hemodinamik parametreler, morfin kullanımı, hasta/hemşire memnuniyeti ve yan etkiler değerlendirildi. İlk analjezik gereksinim zamanı, ilk mobilizasyon ve hastaneden çıkış zamanları kaydedildi. Parasetamol grubunda; morfin tüketimi postoperatif 2., 4., 8., 12. ve 24. saatlerde daha düşük (p=0.017, p=0.021, p

The objective of this study was to assess the etiology, diagnosis, treatment methods, surgical findings, postoperative results and necropsy findings of seventeen cases of thoracic trauma by evaluating medical records. A car accident, falling down, stabbing and bites were identified as the causes of trauma. Diagnosed pathologies in the cases included pneumothorax, hemothorax, pulmonary contusion, lung lobe collapse or eventration, rib fractures, etc. The treatment methods employed in these cases were medical therapy, thoracocentesis, tube thoracostomy, lateral intercostal thoracotomy, median sternotomy and thoracic wall revisions. Atelectasis, rupture, laceration or contusion of the lung lobes, pulmonary artery rupture, rib fracture and etc. were the surgical findings. Overall, seven dogs and four cats recovered completely. Two dogs were euthanized due to other pathologies including multisegmental lumbar fracture, paraplegia and postpneumonectomy syndrome. Three dogs and a cat died during treatment management. The necropsies revealed that the animals had pulmonary artery and tracheobronchial ruptures. The cat also had sudden onset cardiac arrest during surgery. In conclusion, cases with thoracic trauma should be assessed closely and managed with the necessary emergency and surgical procedures.

Mediastinal hemangiomas are rare neoplasms among mediastinal tumors. We report a rare case of hemangioma of the vena cava that was detected incidentally in a 30-year-old female patient.

Objective and design Retrospective study of the outcomes of Heimlich valve drainage in dogs. Procedure Medical records of the past 3 years were retrospectively reviewed. Heimlich valve drainage was used in 34 dogs ( median body weight 30 +/- 5 kg): lobectomy ( n = 15), pneumonectomy ( n = 9), intrathoracic oesophageal surgery ( n = 2), diaphragmatic hernia repair ( n = 1), traumatic open pneumothorax ( n = 2), bilobectomy ( n = 2), ligation of the thoracic duct ( n = 1), and chylothorax and pneumothorax ( n = 1 each). Evacuation of air and/or fluid from the pleural cavity was performed with the Heimlich valve following thoracostomy tube insertion. During drainage, the dogs were closely monitored for possible respiratory failure. Termination of Heimlich valve drainage was controlled with underwater seal drainage and assessed with thoracic radiography. Results Negative intrathoracic pressure was provided in 29 dogs without any complications. Post pneumonectomy respiratory syncope and post lobectomy massive hemothorax, which did not originate from the Heimlich valve, were the only postoperative complications. Dysfunction of the valve diaphragm, open pneumothorax and intrathoracic localisation of an acute gastric dilatation-volvulus syndrome caused by a left-sided diaphragmatic hernia following pneumonectomy were the Heimlich valve drainage complications. Conclusions The Heimlich valve can be used as a continuous drainage device in dogs, but the complications reported here should be considered by veterinary practitioners. Australian Government Department of Industry, Innovation and Science Cooperative Research Centres (CRC) Programme

Transmediastinal ateşli silah yaralanmaları hasta hayatını tehdit eden kalp, büyük damar, özofagus ve/veya akciğer gibi organların yaralanması ile sonlanabilir. Hemodinamik açıdan stabil olan hastalarda, tanıya yönelik incelemeler ve seçilecek tedavi yöntemleri tartışmalı noktalar içermektedir. Bu yazıda, hemodinamik açıdan stabil, transmediastinal ateşli silah yaralanması bulunan ve tanısal testler sonucunda üçü ameliyata alınan beş olgudaki deneyimlerimizi sunduk. Ameliyata karar vermeden önce hemodinamik açıdan stabil transmediastinal ateşli silah yaralanması olan olgularda tanısal testler sistematik olarak yapılmalıdır. Transmediastinal gunshot wounds may result in damage to the heart, large blood vessels, esophagus or lung. In hemodynamically stable patients, diagnostic examinations have critical importance and the preferred therapies still have unresolved points. In this paper, we present our experience with five patients, three of whom were operated for transmediastinal gunshot wounds after diagnostic tests; all were hemodynamically stable. Before deciding on operation, diagnostic tests should be performed in hemodynamically stable patients with transmediastinal gunshot wounds.

The comparison of the histologic healing and bronchopleural fistula (BPF) complications encountered with three different BS closure techniques (manual suture, stapler, and manual suture plus tissue flab) after pneumonectomy in dogs was investigated for a one-month period. The dogs were separated into two groups: group I (GI) (n = 9) and group II (GII) (n = 9). Right and left pneumonectomies were performed on the animals in GI and GII, respectively. Each group was further divided into three subgroups according to BS closure technique: subgroup I (SGI) (n = 3), manual suture; subgroup II (SGII) (n = 3), stapler; and subgroup III (SGIII) (n = 3), manual suture plus tissue flab. The dogs were sacrificed after one month of observation, and the bronchial stumps were removed for histological examination. The complications observed during a one-month period following pneumonectomy in nine dogs (n = 9) were: BPF (n = 5), peri-operative cardiac arrest (n = 1), post-operative respiratory arrest (n = 1), post-operative cardiac failure (n = 1) and cardio-pulmonary failure (n = 1). Histological healing was classified as complete or incomplete healing. Histological healing and BPF complications in the subgroups were analyzed statistically. There was no significant difference in histological healing between SGI and SGIII (p = 1.00; p > 0.05), nor between SGII and SGIII (p = 1.00; p > 0.05). Similarly, no significant difference was observed between the subgroups in terms of BPF (p = 0.945; p > 0.05). The results of the statistical analysis indicated that manual suture, stapler or manual suture plus tissue flab could be alternative methods for BS closure following pneumonectomy in dogs.

Backgrounds: Pulmonary resection carries a significant morbidity and mortality. The utility of maximal oxygen uptake test (VO(2)max) to predict cardiopulmonary complications following major pulmonary resection was evaluated. Methods: Following standard preoperative work-up and VO(2)max testing, 55 patients (49 male; mean age 59 years, range 20-74) underwent major pulmonary surgery: lobectomy (n = 31), bilobectomy (n = 6) and pneumonectomy (n = 18). An investigator blinded to the preoperative assessment prospectively collected data on postoperative cardiopulmonary complications. Patients were divided into two groups according to preoperative VO(2)max and also according to FEV1. The frequency of postoperative complications in the groups was compared. Results: Complications were observed in 19 (34.5%) patients, 11 of which were pulmonary (20%). There were two deaths (3.6%), both due to respiratory failure. Preoperative FEV1 failed to predict postoperative respiratory complications. Five of 36 patients with a preoperative FEV1 > 2 L suffered pulmonary complications, compared with six of 19 patients with FEV1 < 2 L. Cardiopulmonary complications were not observed in patients with VO(2)max > 15 mL/kg/min (n = 27); however, 11 patients with VO(2)max < 15 mL/kg/min (n = 28) suffered cardiopulmonary complications (P < 0.05). Conclusions: VO(2)max predicts postoperative pulmonary complications following major lung resection, and the risk of complications increases significantly when the preoperative VO(2)max is less than 15 mL/kg/min.

Aims and Background Lung cancer is one of the most common cancers and has became a predominant cause of cancer-related death throughout the world. The k-ras codon 12 mutation, which is the most common lung cancer mutation, is found in 15 to 30% of all lung cancers. Furthermore, the p53 gene has a very important role in the biological properties of tumor cells, and it is mutated in about 50% of non-small cell lung cancers. Residual tumor cells remain in surgical margins diagnosed as tumor free by histopathological techniques, and they can play a role in forming any local recurrence. Molecular methods may be exploited that are sensitive enough to detect small numbers of tumor cells. Methods In the present study, we examined p53 gene mutations and k-ras codon 12 mutations from the tumor samples and surgical margins of 34 non-small-cell lung cancer patients. P53 gene mutations were analyzed by single strand conformational polymorphism analysis, heterodublex analysis and DNA sequencing. K-ras codon 12 mutations were analyzed by the mutagenic PCR-restricted fragment length polymorphism method. Results A p53 mutation was detected only in primary tumors of 3 out of 34 patients (8.82%). These mutations were clustered in exon 5. Moreover, a k-ras codon 12 mutation was detected in both the primary tumor and the surgical margin tissues of 2 out of 34 patients (5.88%). Conclusions The detected mutation rate was low, in the range given in the literature. We think that different mechanisms related to other genes and individual genetic differences might play a role in cancer formation in our study group. We believe that molecular studies are necessary to identify biomarkers and to determine genetic alterations in histopathologically normal surgical margins.

Although considerable knowledge exists on the tumor biology of lung cancer, there is still a need to assess molecular events for the clinical management of the disease. We studied the pattern of chromosomal imbalances in 45 non-small cell Lung carcinomas (NSCLC) by comparative genomic hybridization (CGH) and correlated the results with clinicopathological features including immunohistochemical (IHC) expression of the epidermal. growth factor receptor (EGFR). Twenty-one tumors were squamous cell carcinomas (SCC) and 24 non-squamous cell lung carcinomas (NSCC) comprising 9 adenocarcinomas (ADC), 9 large cell carcinomas (LCC), 4 sarcomatoid carcinomas and 2 adenosquamous carcinomas. The mean number of individual imbalances was 7.1 for SCC (mean gains, 3.8; mean tosses, 3.4) and 6.4 for NSCC (mean gains, 4.5; mean tosses, 1.9). Several individual imbalances correlated significantly with increasing number of imbalances, that were +1q, -3p, +3q, -5q, -8p, +8q, +7p, +12p, and +14q. Altogether, the most frequent imbalances were +3q (49%), +5p (49%), -5q (36%), +8q (29%), -8p (24%), -3p (22%), +7p (22%), +12p (22%), +14q (20%), +18p (20%), +1q (18%), and +7q (18%). Among these, +3q and +18p correlated significantly with SCC, and +5p and +14q with NSCC. Remarkably, overlapping imbalances included +3q26, +7p11 in SCC and +1q21, +3q24, +12p11, and +14q12 in NSCC. EGFR expression was higher in SCC than in NSCC and correlated with +3q in the entire series. In addition, +12p correlated significantly with disease progress with the exception of nodal involvement in NSCC as well as with disease progress, regardless of nodal involvement, in the entire series. In conclusion, the present study contributes to the molecular biological characterization of NSCLC histological subtypes and through evaluation of molecular events to the recently emergent focus on novel markers for lung cancer treatment.

Objective: The hypothesis was tested that preoperative multiple-injection thoracic paravertebral blocks reduce opioid requirements and promote early ambulation after video-assisted thoracic surgery procedures. Design: Prospective, randomized, controlled, blinded study. Setting: Single-university hospital. Participants: Fifty consenting patients undergoing video-assisted thoracic surgery. Interventions: Patients were randomly assigned to receive preoperative multiple-injection thoracic paravertebral blocks (PVB group, n = 25) or preoperative multiple subcutaneous saline injections at the same site as in the PVB group (control group, n = 25). Measurements and Main Results: Intraoperative fentanyl consumption was lower in the PVB group (p < 0.01). The time to first analgesic requirement was longer, and pain score at this time was lower in the PVB group (p < 0.05 and p < 0.01, respectively). Postoperative pain scores both at rest and coughing were lower during the first 4 hours in the PVB group than those in the control group (p < 0.01 for 0 hours and p < 0.05 for 1, 2, and 4 hours). Cumulative morphine consumption was significantly less in the PVB group at all time points (p < 0.05 for 12 hours and p < 0.01 for all other time points), but there were no significant differences in sedation scores between the 2 groups. There were no complications because of the blocks. Patient satisfaction with the analgesia was significantly greater (p < 0.05), and first mobilization and hospital discharge were quicker (p < 0.01 and p < 0.05, respectively) in the PVB group. Conclusion: Perioperative multiple-injection'thoracic paravertebral blocks with bupivacaine containing epinephrine provided effective pain relief and a significant reduction in opioid requirements. This approach may also contribute to earlier postoperative ambulation after video-assisted thoracic surgery.

Objective: The purpose of this study was to compare lumbar epidural morphine and lumbar epidural tramadol with respect to onset and duration of analgesia, analgesic efficacy, and drug-related side effects after muscle-sparing thoracotomy. Design: Prospective, randomized, double-blind, clinical study. Setting: Single university hospital. Participants: Forty patients who underwent elective muscle-sparing thoracotomy. Interventions: Before anesthesia induction, an epidural catheter was placed in the L2-3 or L3-4 interspace using the loss-of-resistance technique. On arrival at the intensive care unit, patients were randomized to receive doses of either 100 mg of tramadol (group T) or 4 mg of morphine (group M) via the lumbar epidural catheter. Each dose was diluted in 10 mL of normal saline. On awakening from anesthesia, if the patient's pain score on a 0- to 100-mm visual analog scale was above 40 mm, the initial epidural drug dose was administered. The initial injection in each case was taken as time 0. Subsequent pain scores above 40 mm were considered indications for epidural dosing; each patient was allowed 2 doses in the first 12 hours postoperatively and 2 more in the second 12 hours. Measurements and Main Results: The groups' analgesia onset times were similar, but duration of analgesia was significantly shorter in group T than in group M (p < 0.01). There were no differences between the groups with respect to pain scores at rest or during coughing at any of the time points investigated. Sedation scores were lower in group T than in group M at 1, 2, 3, 4, and 8 hours (p value range, 0.0001-0.05). Compared with group T, group M showed significantly greater drops in arterial oxygen tension from baseline at 3, 4, 8, and 12 hours (p value range, 0.0001-0.05). The group means for arterial carbon dioxide tension and respiratory rate were similar at all time points investigated. Conclusion: The study revealed that the quality of analgesia achieved with repeated doses of lumbar epidural tramadol after muscle-sparing thoracotomy is comparable to that achieved with repeated doses of lumbar epidural morphine. Compared with morphine, lumbar epidural tramadol results in less sedation and a less-pronounced decrease in oxygenation.

Modern kanser tedavi yaklaşımları ile kürabilite ve sağkalım arttığı için tedavi sonrası ikinci primer tümör görülme sıklığı da artmıştır. İkinci primer tümör insidansının; erkek cinsiyette, ileri yaşta ve ilk tanıdan itibaren geçen süre ile ilişkili olarak arttığı bildirilmiştir. İkinci primer akciğer kanseri insidansı en çok akciğer kanserli hastalarda incelenmiş ve %0.5 oranında bulunmuştur. Akciğerde saptanan nodülün metastaz veya ikinci primer tümör olup olmadığının ayırımı önemlidir. İkinci primer akciğer kanserini intrapulmoner metastazdan ayırtedici tanı kriterleri olarak; farklı histolojik tip, karsinoma insitu orijin ve radyolojik olarak primer akciğer kanserini destekleyecek görünüm olması gerektiği bildirilmiştir. Renal hücreli karsinomlu bir olgumuzda ilk tanıdan 31 ay sonra ikinci primer akciğer kanseri saptanması üzerine ikinci primer akciğer tümörlü olgularımız değerlendirilmiştir. Cure rates and survival have shown dramatic improvement for patients with cancer due to modern cancer treatments. The incidence of second primary malignancy seems to have increased in recent years and were significantly associated with gender (male), age and calendar year at diagnosis of the first cancer. The incidence of second primary carcinoma of the lung was evaluated in most cases of primary lung cancer. The average incidence of second lung cancer in patients with lung cancer was found as 0.5%. Distinguishing single lung metastasis from primary lung cancer in patients with a solitary lung nodule is important. The criteria for diagnosing lung cancer as a second primary or intrapulmonary metastase were declared to be the different histologic type, origination from carcinoma in situ and gross appearance suggestive of primary lung cancer according to radiologic findings. We found second primary lung cancer in a patient 31 months after initial diagnosis of primary renal cell carcinoma. Thereby, we reviewed second primary lung malignancies.

Genetic alterations on the primary tumoral tissues and surgical borderline tissues of 51 patients with NSCLC on which radiotherapy and chemotherapy had not been performed were analyzed by using the FISH method with locus-specific probes for p53 tumor suppressor gene and c-myc oncogene and centromere-specific probes for chromosome 17 and chromosome 8 on which these genes are located. P53 deletions were detected in 7 patients (13.7%), c-myc amplification in 4 patients (7.8%), monosomy 17 in 2 patients (3.9%) and trisomy 8 in 3 patients (5.8%), and a high level of polyploidy in tumoral tissues of 6 patients (11.7%). P53 deletion and c-myc amplification were found at surgical borderlines of 2 patients and 1 patient, respectively. Although both p53 deletion and c-myc amplification have low frequency at surgical border tissues, not only their detection is important for the follow-up of recurrency and metastasis, but it is also important for genetical and pathological staging. The results of this study show that c-myc amplification in NSCLC is related to the shortening of survival (p < 0.01). C-myc amplification and p53 deletion are also effective for the occurrence of metastasis (p < 0.05) and the effect of c-myc amplification in this matter is much higher than p53 deletion. The gain or loss of copy number of chromosome 8 and monosomy 17 show parallel effects with c-myc amplification and p53 deletion, respectively, on the clinicopathological behavior of tumors.

Background: Arterial involvement is a rare but serious condition in the course of Behcet's disease. We aimed to assess the results of therapeutic approaches in our patients with arterial lesions caused by Behcet's disease. Patients and methods: The records of 534 patients with Behcet's disease between 1987 and 2002 were retrospectively evaluated for the presence of arterial lesions. All patients were followed up regularly, at 3 to 6 months intervals. Results: Arterial lesions were diagnosed in 21 (3.9%) patients. Eight of these patients had pulmonary artery aneurysms (PAA), and the other 13 patients had non-pulmonary arterial lesions. Urgent surgical intervention was performed in three patients with PAA leading to death in all three. In addition, three other patients died due to massive haemoptysis at home despite to immunosuppressive therapy. Only two out of eight patients with PAA are still alive who were treated with cyclophophamide and corticosteroids. Thirteen operations were performed in 7 out of 13 patients having non-puhnonary arterial lesions. Although ten of the operations were primary operations, three reoperations had to be performed. A stent-graft was applied for the management of an iliac artery aneurysm in one patient. Only one patient died 8 years after the first non-pulmonary arterial involvement following a type IV thoracoabdominal aortic aneurysm repair Five patients with arterial occlusive lesions were successfully treated by corticosteroids. Conclusions: Pulmonary artery aneurysms in Behcet's disease patients have a poor prognosis despite any form of therapy. High dose corticosteroids alone can be successfully used for isolated non-pulmonary arterial occlusive lesions, unless disabling symptoms occur. Surgery or stent-graft insertion is indicated,for non-pulmonary arterial aneurysms because these aneurysms entail high risk of complications.

Pulmoner arter sarkomları nadir görülür. Klinik ve radyolojik bulguların özgün olmaması nedeniyle genellikle tanı ameliyat sırasında veya otopsilerde konur. Hemoptizi yakınmasıyla araştırılan 53 yaşında erkek olgunun göğüs röntgenogramlarında ve BT incelemesinde sağ akciğer hilusunda kitle ve akciğerde nodül saptandı. BT eşliğinde transtorasik iğne biyopsisi yapılarak pulmoner arter sarkomu tanısı kondu. Bu yazıda, olgumuzun klinik ve radyolojik bulguları literatür verileri ışığında sunulmuştur. Primary pulmonary artery sarcomas are extremely rare tumors. The clinical presentation and radiological findings of these tumors are usually nonspesific, and correct diagnosis is often delayed until surgical exploration and autopsy in performed. Chest radiograph and CT examination showed right hilar mass and a nodule in the right lower lobe in a 53-year-old man with a history of hemoptysis. CT-guided transthoracic needle biopsy of the mass was revealed sarcoma of the pulmonary artery. In this report, we present clinical and radiological findings of a case of pulmonary artery sarcoma in the light of literature.

AIM: To investigate prognostic factors of survival following curative, non-palliative surgical removal of lung metastases secondary to colorectal cancer (CRC). METHODS: Between 1999 and 2009, a radical metastasectomy with curative intent was performed on lung metastases in 21 patients with CRC (15 male and 6 female; mean age: 57.4 +/- 11.8 years; age range: 29-74 years) who had already undergone primary tumour resection. RESULTS: The mean number of lung metastases ranged from one to five. The mean overall survival was 71 +/- 35 mo (median: 25 mo). After adjusting for potential confounders, multivariable Cox regression analyses predicted only the number of lung metastases (1 vs >= 2; hazard ratio: 7.60, 95% confidence interval: 1.18-17.2, P = 0.03) as an independent predictor of poor survival following lung resection for metastatic CRC. CONCLUSION: Resection of lung metastases is a safe and effective treatment in selected CRC patients with single lung metastases. (C) 2012 Baishideng. All rights reserved.

The most important dilemma in the diagnosis of ventilator-associated pneumonia (VAP) based on only clinical findings is overdiagnosis. The aim of the study is to prospectively evaluate the Clinical Pulmonary Infection Score (CPIS) in relation to VAP diagnosis. Design. Prospective, in a cohort of mechanically ventilated patients. Setting. The intensive care unit of a university hospital. Patients. Fifty patients, on mechanical ventilation therapy for more than 48 hours, suspected of having VAP were enrolled in the study and bacteriologic confirmation was done by bronchoalveolar lavage (BAL) culture. Interventions. Bronchoscopy with BAL fluid culture after establishing a clinical suspicion of VAP in patients having no prior antibiotic therapy or no change in current antibiotic therapy within last three days before BAL. CPIS scores during diagnosis were 6+/-2 (3-9) (median+/-QR, maximum-minimum) and it was 7+/-2 (2-9) at the 72nd hour, in 41 cases with a diagnosis of VAP. In cases with no diagnosis of VAP, the CPIS scores were found to be 6+/-2 (4-8) and 5+/-3 (2-7), respectively. There was no significant difference between the VAP group and the non-VAP group at diagnosis, but was significant at 72nd hour (respectively, p=0.551 and p=0.025). CPIS scores during diagnosis were 6+/-3 (4-8) (median+/-QR, maximum-minimum) and 7+/-4 (2-8) at the 72nd hour, in 14 cases with a diagnosis of early-onset VAP. In cases with a diagnosis of late-onset VAP, the CPIS scores were found to be 6+/-2 (3-9) and 7+/-2 (3-9), respectively. There was no significant difference between the early-onset VAP group and the late-onset VAP group. In conclusion, the CPIS results should be evaluated carefully in the clinical setting during the diagnosis.

Chylothorax due to right-sided heart failure was diagnosed in a 3.5-year-old, male Rottweiler, based on the clinical, radiological, and echocardiographic examinations, and serum biochemical test results (pleural fluid cytology and triglyceride levels of the serum and pleural fluid). En bloc ligation of thoracic duct along with its branches and pleural abrasion were performed after the failure of the initial medical management including pleural drainage via tube thoracostomy, and enalapril, furosemide, and low-fat diet (Prescription Diet Canine r/d, Hill's Pet Product, Topeka, Kansas, USA). Combination medical and surgical therapy resulted in an excellent postoperative outcome. Six months after surgery the dog had no evidence of clinical signs of right-sided heart failure or chylothorax and the severity of echocardiographic abnormalities (right atrial dilatation and tricuspid regurgitant jet velocity) was reduced. 3,5 yaşında, erkek bir Rottweiler’da klinik, radyolojik, ekokardiyografik muayene ve serum biyokimyasal test sonuçlarına dayanarak (plevral sıvı sitolojisi ve serum ve plevral sıvı trigliserid düzeyleri) sağ kalp yetmezliğine bağlı şilotoraks tanımlandı. Tüp torakostomi ile plevral drenaj, enelapril, furosemide ve düşük yağlı diyeti (Prescription Diet Canine r/d, Hill’s Pet Product, Topeka, Kansas, ABD) içeren ilk tedavi planının etkisiz olmasından sonra torasik kanal ve kollarının en-blok ligatürü ve plevral abrazyon operasyonu yapıldı. Medikal tedavi ile birlikte operasyon mükemmel postoperatif sonuç gösterdi. Postoperatif 6. ayda köpekte şilotoraks ve sağ kalp yetmezliğinin klinik bulguları görülmezken, ekokardiyografik anormalitelerin şiddeti (sağ atrial dilatasyon ve trikuspid regürgitant jet velositesi) azaldı.