Clinical and radiological characteristics of patients treated with the diagnosis of spontaneous pneumomediastinum

eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2021-03-18 6 1 1 6 10.26663/cts.2021.0001 128 article Clinical and radiological characteristics of patients treated with the diagnosis of spontaneous pneumomediastinum Burçin Çelik 1 Mehmet Gökhan Pirzirenli 1 Yasemin Bilgin Büyükkarabacak 1 Volkan Yılmaz 1 Selçuk Gürz 1 Ayşen Taslak Şengül 1 Ahmet Başoğlu 1 Department of Thoracic Surgery, Ondokuz Mayis University Medical School, Samsun, TurkeyBackground: Pneumomediastinum is defined as the presence of air in the mediastinal region. It is associated with events or diseases leading to a sudden increase in alveolar pressure. The air in the mediastinum may originate in the pharynx, the tracheobronchial tree or the esophagus. This study aimed to assess the clinical and radiological characteristics of patients who were diagnosed with spontaneous pneumomediastinum and received treatment at our clinic. Materials and Methods: A total of 23 patients who had spontaneous pneumomediastinum and were treated at our clinic between 2007 and 2019 were retrospectively assessed for their age, etiological factors, clinical and radiological characteristics; treatment and outcomes. Chest radiography and computed tomography of the thorax were used for diagnosis in all patients. Results: Of the patients, 15 were males and eight females and their mean age was 33.91 (15-82) years. The most common symptom on admission was shortness of breath (n = 12) and chest pain (n = 11). The etiological factors were excessive vomiting in six patients and excessive cough in five. Radiologically, the most common findings besides pneumomediastinum were subcutaneous emphysema (n = 6) and pneumothorax (n = 4). Of the patients, seven required esophagoscopy, four required bronchoscopy and no pathology was observed. All patients were fully recovered when they were discharged. Conclusions: The underlying etiological factor is crucial in pneumomediastinum. Conservative treatment methods are often sufficient in spontaneous pneumomediastinum patients with no pathology in endoscopic evaluation. https://cts.tgcd.org.tr/pdf.php?id=128 pneumomediastinumradiologyspontaneousconservative treatment eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2021-03-18 6 1 7 13 10.26663/cts.2021.0002 129 article Prognostic value of glasgow prognostic score in patients with non-small cell lung cancers undergoing pn2 pneumonectomy Cemal Aker 1 Celal Bugra Sezen 1 Altan Ceritoglu 1 Mustafa Vedat Dogru 1 Yunus Aksoy 1 Cem Emrah Kalafat 1 Volkan Erdogu 1 Levent Cansever 1 Muzaffer Metin 1 Department of Thoracic Surgery, Health of Sciences University, Yedikule Chest Diseases and Thoracic Surgery Health Application and Research Center, Istanbul, TurkeyBackground: The aim of this study was to assess the relationship between Glasgow Prognosis Score (GPS) and survival in patients who underwent pneumonectomy due to pN2 non-small cell lung cancer (NSCLC). Materials and Methods: A total of 45 patients who were determined to have pN2 disease after pneumonectomy between 2007 and 2016 were retrospectively analyzed. The patients were assigned a GPS between 0 and 2 as follows: elevated CRP level (>1.0 mg/dL) and hypoalbuminemia (<35 mg/dL) was classified as GPS 2, elevated CRP but albumin >35 mg/dL was classified as GPS 1, and CRP <1.0 mg/dl and albumin >35 mg/dL were classified as GPS 0. Results: Of the 45 patients included in the study, 42 (93.3%) were male and 3 (6.7%) were female. Eighteen (40%) of the patients had adenocarcinoma and 27 (60%) had squamous cell carcinoma. Skip pN2 (pN0N2) was detected in 10 patients. Mean follow-up time was 28 months. The 5-year survival rate was 40.2%. The main prognostic factors associated with survival were GPS and adjuvant therapy (p = 0.023, p = 0.001). Conclusions: In this study, there was no relationship between N1 status and survival in pneumonectomy patients with pN2 NSCLC, whereas GPS score and adjuvant therapy were found to be prognostically significant in terms of survival. https://cts.tgcd.org.tr/pdf.php?id=129 lung carcinomapneumonectomyGlasgow Prognostic Scoresurvivalprognosisprognostic scores eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2021-03-18 6 1 14 20 10.26663/cts.2021.0003 130 article Which factors significantly reduce long-term survival after pulmonary metastasectomy? Yunus Seyrek 1 Levent Cansever 2 Mehmet Ali Bedirhan 2 Department of Thoracic Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, TurkeyDepartment of Thoracic Surgery, Health Sciences University, Yedikule Chest Disease and Thoracic Surgery Application and Research Center, Istanbul, TurkeyBackground: In this study, a survival analysis was performed of patients who underwent pulmonary metastasectomy over the past 10 years in our clinic. We aimed to elucidate the factors that significantly affected overall survival and identify subgroups of patients who may not benefit from pulmonary metastasectomy. Materials and Methods: We retrospectively reviewed 68 patients with a history of extra-thoracic malignancy who underwent pulmonary metastasectomy between January 2009 and December 2018. The overall survival rate was analyzed according to age, sex, histological type of the primary tumor, metastatic side, surgical approach type, pulmonary resection type, number of nodules resected, diseasefree interval, and nodal status. Results: The actuarial survival rate after pulmonary metastasectomy was 78% (95% confidence interval [CI]: 71-84) at 2 years and 48% (95% CI: 41-52) at 5 years. Patients with disease free interval < 12 months had a far worse survival rate (p = 0.001). Patients with sarcoma had a significantly worse prognosis than those with epithelial tumors or melanoma (p = 0.001). Patients with negative nodal status had a significantly better prognosis (p = 0.001), while patients with metastatic hilar lymph nodes also had significantly better survival compared to patients with metastatic mediastinal lymph nodes (N2) (p = 0.001). Conclusions: Tumor histology is the main determinant of overall survival and prognosis after pulmonary metastasectomy. The presence of multiple metastases in different unilateral lobes and N2 disease appeared to be the worst prognostic factors. Patients with either of these two significant negative prognostic factors should be evaluated carefully via a multidisciplinary approach and pulmonary metastasectomy should be performed only in selected patients. https://cts.tgcd.org.tr/pdf.php?id=130 metastasectomypulmonarynegative prognostic factorslong term survival eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2021-03-18 6 1 21 25 10.26663/cts.2021.0004 131 article Postoperative complications and follow up after abramson surgery Tuba Apaydın 1 Murat Akkuş 1 Department of Thoracic Surgery, SBU Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, TurkeyBackground: Abramson technique is a worldwide technique used for minimally invasive treatment of pectus carinatum. We have performed this surgery since 2012. This article presents our experience about Abramson surgery. Materials and Methods: Between June 2012 and December 2019 64 patients with pectus carinatum underwent minimally invasive surgery. Results: Mean age of the patients were 14.4 years (range 8-25 years). 47 were male, 17 were female. All patients referred to our clinic with cosmetic complaints. 14 (21.8%) patients also had clinical symptoms in preoperative period. Mean duration of operation was 61 minutes. Mean blood loss was 30 ml and death wasn’t seen in any patient. Complication was seen in 15 (10.7%) patients in postoperative period. Splitting of cables was seen in 7 (10.9%) patients as the most common complication in the long term follow-up. Duration of hospitalization ranged from 3 to 15 days (average 5.1 ± 2.9 days). Reoperation was performed in 17 (26.5%) patients. Conclusions: Minimally invasive surgery is successful for the treatment of pectus carinatum. https://cts.tgcd.org.tr/pdf.php?id=131 chestpectusdeformitycongenitalthoracicminimally invasive surgeryfollow up study eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2021-03-18 6 1 26 32 10.26663/cts.2021.0005 132 article The factors affecting morbidity, mortality and survival in patients who underwent intrapericardial resections due to non-small cell lung cancer Atilla Pekçolaklar 1 Melike Nalbant 2 Muzaffer Metin 3 Department of Thoracic Surgery, Bursa City Hospital, Bursa, TurkeyDepartment of Pathology, Bursa City Hospital, Bursa, TurkeyDepartment of Thoracic Surgery, University of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Application and Research Center İstanbul, TurkeyBackground: Complete surgical resection has been the gold standard in the treatment of lung cancer. Intrapericardial approach may be required to resect the advanced stage tumors completely. This study aims to compare the morbidity and mortality rates of intrapericardial and standard pneumonectomies. Materials and Methods: The records of patients operated on due to non-small cell cancer between the years 2001 and 2008 were evaluated retrospectively. The data including age, sex, respiratory function tests, tumor site, cell type, stage, resection type, complications, mortality and survival rates were recorded. The morbidity, mortality and survival rates of intrapericardial and standard penumonectomies were compared. Results: The study included 126 cases with pneumonectomy (90 standard, 36 intrapericardial) with mean age of 56.6 ± 8.42 years. Major morbidity rates of intrapericardial and standard groups were 30.6% and 21.1% respectively, and the difference was not significant (p = 0.233). Mortality rates of intrapericardial and standard groups were 8.3% and 8.9% respectively, and the difference was not significant (p = 0.533). The mean survival of all patients was 24.13 ± 3.13 months. The survival rate was significantly in the intrapericardial group compared to standard group (23 months vs 32 months, p = 0.03). Conclusions: Intrapericardial approach is a safe method in the treatment of locally advanced lung cancer without increasing morbidity or mortality. https://cts.tgcd.org.tr/pdf.php?id=132 pneumonectomylung cancermortality eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2021-03-18 6 1 33 35 10.26663/cts.2021.0006 133 article Cyst of mullerian origin in anterior mediastinum: a case report Meral Selin Onay Mahmuti 1 Celal Bugra Sezen 1 Volkan Erdogu 1 Nurcan Unver 2 Muzaffer Metin 1 Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, TurkeyDepartment of Pathology, Yedikule Chest Diseases and Thoracic Surgery Eduation and Research Hospital, İstanbul, TurkeyIn this report, a case of Hattori’s cyst of Mullerian (HMC) origin, located in the anterior mediastinum is evaluated in light of the literature. A 33-year-old woman presented to our clinic with chest pain. A computed tomography scan of the patient’s thorax revealed a 5x6 cm lesion located on the left paracardiac region. Following the excision of the cyst, a diagnosis of mediastinal HMC was made. Our case shows that cases of MHC, which are rare in the posterior mediastinum, can also be seen in the anterior mediastinum and should be included in the differential diagnosis. https://cts.tgcd.org.tr/pdf.php?id=133 Hattori’s cystMullerian cystsurgerymediastinal cystmullerian differentiation eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2021-03-18 6 1 36 38 10.26663/cts.2021.0007 134 article A case of destroyed lung caused by a chronic lymphocytic leukemia with mass effect Kenan Can Ceylan 1 Canberk Heskiloğlu 1 Funda Cansun 2 Şeyda Örs Kaya 1 Ali Galip Yener 3 Department of Thoracic Surgery, University of Health Sciences, Dr Suat Seren Chest Diseases and Surgery Medical Practice and Research Center, İzmir, TurkeyDepartment of Thoracic Surgery, Sanliurfa Medical Practice and Research Center, Sanliurfa, TurkeyDepartment of Pathology, University of Health Sciences, Dr Suat Seren Chest Diseases and Surgery Medical Practice and Research Center, İzmir, TurkeyTuberculosis and bronchiectasis are the most common causes of the destroyed lung. Mediastinal masses, which cause bronchial compression, can also cause bronchiectasis. Chronic lymphocytic leukemia (CLL) is the most common subtype of leukemia, and it can rarely cause bronchiectasis and destroyed lungs by causing a mass effect in the mediastinum. A 50-year-old female patient with a history of tuberculosis in her childhood admitted to our clinic with dyspnea, cough, and chest pain. During the clinical examinations, a solid mass with approximately 46x33 mm in size was observed in the posterior mediastinum, compressing the left main bronchus and the entire left lung was destroyed. Since the patient had no definite diagnosis and was symptomatic, a surgical treatment was planned, and left pneumonectomy was performed together with mediastinal mass excision. As a result of the extracted specimen histopathology, bronchiectasis was present, and the mediastinal mass was consistent with chronic lymphocytic leukemia. The patient did not experience any postoperative complications and was referred to the oncology clinic for follow-up and treatment. Herein, we aimed to present a case with chronic lymphocytic leukemia mass in the posterior mediastinum compressing the left main bronchus, which caused bronchiectasis and destroyed lung with the literature’s accompaniment. https://cts.tgcd.org.tr/pdf.php?id=134 destroyed lungbronchiectasismediastinal neoplasmchronic lymphocytic leukemiathoracotomypneumonectomy eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2021-03-18 6 1 39 43 10.26663/cts.2021.0008 135 article Extracorporeal membrane oxygenation after blunt trauma: when? how? Mahmut Ozbey 1 Dursun Fırat Ergul 2 Department of Thoracic Surgery, Sivas Cumhuriyet University Faculty of Medicine, Sivas, TurkeyDepartment of Anesthesiology and Reanimation, Division of İntensive Care, Hitit University, Erol Olcok Training and Research Hospital, Çorum, TurkeyIn patients with acute respiratory distress syndrome (ARDS), mechanical ventilators (MV) are still key devices in the treatment. However, in cases where MV remains insufficient, extracorporeal membrane oxygenation (ECMO) is the most important treatment modality. Venovenous extracorporeal membrane oxygenation (VV-ECMO) was applied to a 42-year-old female patient due to ARDS developed after an in-car traffic accident, and it was successfully terminated. The case was presented to discuss the management of MV and ECMO in patients with ARDS developed after blunt trauma in the light of current literature. https://cts.tgcd.org.tr/pdf.php?id=135 multiple traumaacute respiratory distress syndromemechanical ventilationextracorporeal circulation