Role of surgical fixation in rib fractures: an experimental study

eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2018-08-18 3 2 38 42 10.26663/cts.2018.0008 43 article Role of surgical fixation in rib fractures: an experimental study Okan Karataş 1 Hakan Işık 2 Kuthan Kavaklı 2 Ersin Sapmaz 2 Hasan Çaylak 2 Sedat Gürkök 2 Onur Genç 2 Alper Gözübüyük 2 Department of Thoracic Surgery, Sinop Ataturk State Hospital, Sinop, TurkeyDepartment of Thoracic Surgery, Gulhane Training and Research Hospital, Ankara, TurkeyBackground: Rib fractures occur usually after thoracic traumas. Multiple and displaced fractures are occasionally associated with respiratory complications. That is why treatment for rib fractures should be done properly to prevent respiratory complications. This experimental study was performed to investigate the effects of early and late period rib fixation, on respiratory functions in an animal model with multiple displaced rib fractures, and to design a multiple displaced rib fracture treatment model. Materials and Methods: Twenty-four, New Zealand rabbits were used in this study. The subjects are divided into three groups. All subjects’ three consecutive ribs on right hemithorax were fractured and displaced surgically. Subjects in group I were observed without any further surgical process. In group II, subjects were undergone to a second surgery process to fix the fractured two ribs by titanium plate one week after the initial operation. In group III, subjects’ three consecutive ribs were fractured and two ribs were fixed by titanium plates at the same operation session. Then subjects’ respiratory functions, survivals and health status were observed. Results: Oxygen saturation in first week (p = 0.032), clinical survival and health status were better than the other groups in group III. Fracture healing was better in fixation groups, radiologically and clinically. Conclusions: Early rib fixation operation is recommended for multiple displaced rib fractures to prevent secondary respiratory complications. https://cts.tgcd.org.tr/pdf.php?id=43 multiple displaced rib fracturerib fixationrib stabilization eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2018-08-18 3 2 43 50 10.26663/cts.2018.0009 44 article Do we need a new suvmax threshold value for the evaluation of mediastinal lymph nodes? Özgur Ömer Yıldız 1 Serdar Özkan 2 Göktan Temiz 3 Ömer Cenap Gülyüz 4 Nurettin Karaoğlanoğlu 5 Department of Thoracic Surgery, Yildirim Beyazit University, Yenimahalle Education and Research Hospital, Ankara, TurkeyDepartment of Thoracic Surgery, Medova Hospital, Konya, TurkeyDepartment of Thoracic Surgery, Adana City Education and Research Hospital, Adana, TurkeyDepartment of Thoracic Surgery, Adıyaman University Education and Resarch Hospital, Adiyaman, TurkeyDepartment of Thoracic Surgery, Yildirim Beyazit University, Faculty of Medicine, Ankara, TurkeyBackground: Mediastinal lymph node involvement is the most important factor determining the treatment and the prognosis with non-small cell lung cancer (NSCLC). In our study, the role of PET-CT was assessed in the evaluation of intrathoracic lymph node involvement in patients with preoperative NSCLC. Materials and Methods: The study included 510 cases selected according to the criteria identified between January 2009 and July 2011. PET-CT staging and thorax-CT, size of lymph nodes, histological type of tumor, mediastinal lymph nodes taken and the pathological results were assessed. Results: SUVmax cut-off value was taken as 2.5 for the metastatic analysis of lymph nodes in PETCT and N1 and N2 lymph node stations were evaluated. Sensitivity for the N2 lymph node stations, was 74.7%, specificity 49.4%, Positive Predictive Value 25.4%, Negative Predictive Value 89,.5% and accuracy 54.1% (p < 0.001). Following the statistical analysis, the new SUVmax cut-off value for the N1 lymph node groups was calculated as 3.34, and for N2 lymph node groups 5.6. Based on the new SUVmax cut-off value for N2 lymph node groups, the sensitivity of PET-CT was calculated as 43.2%, specificity 94.4%, PPV 64.1%, NPV 87.8% and accuracy 84.9% (p < 0.001). Conclusions: Calculating a new cut off value of SUVmax all around the world would increase the NPV of PET-CT and so it would reduce to use of invasive methods. PPV of PET-CT is still not at an acceptable level, so positive results of PET-CT for mediastinal lymph node staging should be confirmed with invasive diagnostic techniques. https://cts.tgcd.org.tr/pdf.php?id=44 non-small cell lung cancerlymph nodePET-CTstaging eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2018-08-18 3 2 51 54 10.26663/cts.2018.00010 45 article Granulomatous disease in patients operated due to provisional diagnosis of lung cancer Ezgi Çimen Güvenç 1 Ahmet Üçvet 1 Soner Gürsoy 1 Özgür Samancılar 1 Bengisu Arabacı 1 Tarık Yağcı 1 Yeliz Erol 1 Department of Thoracic Surgery, University of Health Sciences, Dr Suat Seren Chest Diseases and Surgery, Medical Practice and Research Center, Izmir, TurkeyBackground: The granulomatous reaction is a response that can occur in many infective, toxic, allergic, autoimmune, neoplastic, and etiologically unknown conditions. Hundreds of different agents that can cause this response. The most common granulomatous disease in Turkey and in developing countries is mycobacterial infection-related tuberculosis. This study was carried out to show the prevalence of patients operated in our clinic due to provisional diagnosis of lung cancer and diagnosed with granulomatous disease. Materials and Methods: 380 patients who underwent diagnostic and therapeutic videothoracoscopy or thoracotomy due to provisional diagnosis of malignancy, and were diagnosed with granulomatous disease in consequence of histopathological examination between the years of 2011 and 2016 were included in the study. Patients were examined with regard to their clinical characteristics. Results: Granulomatous disease was detected histopathologically in 28 (7.3%) of them. The final histopathological diagnosis was tuberculosis in 20 patients (71.4%), sarcoidosis in 3 patients (10.7%), infection in 2 patients (7.1%), rheumatoid nodule in 2 patients (7.1%), and allergic angiitis in one patient (3.5%). Conclusions: In regions where tuberculosis is frequent, such as Turkey, granulomatous diseases should be considered in the differential diagnosis of lesions suspicious for malignancy. https://cts.tgcd.org.tr/pdf.php?id=45 granulomatous diseasetuberculosissarcoidosislung cancer eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2018-08-18 3 2 55 61 10.26663/cts.2018.00011 46 article Analysis of risk factors in surgical treatment of lung cancer patients over 70 years of age: how effective are the cardiac risk score and age? Funda İncekara 1 Deniz Kaygusuz Tikici 1 Selma Mine Kara Apaydın 1 Şevki Mustafa Demiröz 1 Koray Aydoğdu 1 Ebru Sayılır Güven 1 Selim Şakir Erkmen Gülhan 1 Göktürk Fındık 1 Sadi Kaya 1 Department of Thoracic Surgery, Ataturk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, TurkeyBackground: In this study, the age and cardiac risk factors on mortality, and complications after surgical treatment in lung cancer patients were investigated. Materials and Methods: Between January 2014 and November 2016, 485 patients who underwent lung resections for lung cancer in our clinic, were retrospectively evaluated. Under the age of 70, 412 patients and over 70, 73 patients were grouped as group 1 and 2. Results: Lobectomy was performed in 333 patients (80.8%), pneumonectomy in 43 (10.4%), bilobectomy in 30 (0.7%), segmentectomy in 3 (0.7%) and sleeve lobectomy in 3 (0.7%) in group 1; lobectomy in 65 (89%), pneumonectomy in 4 (5.4%), and sleeve lobectomy in 4 (5.4%) in group 2. Surgical mortality was observed in 5 patients (1.2%) in group 1 and 6 patients (8.2%) in group 2. Complications were observed in 99 patients (24%) in group 1 and 23 patients (17%) in group 2. The mean expected mortality with cardiac risk score in group 1 was 1.24 and 3.5 in group 2. The expected mortality with cardiac risk score and complication rates were tabulated as low, moderate, high and there was no statistically significant difference between score and complication (p = 0.551). Conclusions: According to our study, there were no significant differences in terms of complications, morbidity, mortality and survival rates. There was only a relative increase in surgical mortality over the age of 70, so patients should be carefully treated during and after the surgery. Surgery should be the first treatment to perform in selected patients with lung cancer over the age of 70. https://cts.tgcd.org.tr/pdf.php?id=46 cardiac risk factorlung cancermortalitysurgery eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2018-08-18 3 2 62 65 10.26663/cts.2018.00012 47 article Pulmonary alveolar proteinosis: a case report Serdar Özkan Özgür Ömer Yıldız 2 Department of Thoracic Surgery, Medova Hospital, Konya, TurkeyDepartment of Thoracic Surgery, Diskapi Yildirim Beyazit Education and Resarch Hospital, Ankara, TurkeyPulmonary alveolar proteinosis (PAP) is a rare disease characterized by accumulation of material in the alveoli of the lungs. It is generally diagnosed in middle-aged men. The most common complaints are cough and dyspnea. Characteristic radiological findings of PAP include nodular infiltration with a tendency to merge and ground glass density, septal thickening and resemblance to paving stone. Typical findings include periodic acid-Schiff (PAS) stain positive materials in the alveolar proteinosis, milky appearance of bronchoalveolar lavage (BAL), interstitial opacities, thickened interlobular septa, and patchy central or peripheral ground-glass opacities in the lung parenchyma in the chest CT. The most effective proved treatment is whole lung lavage. The aim of the treatment in PAP cases is to restore the alveolar gas exchange by removing excess surfactant accumulated in the alveoli. https://cts.tgcd.org.tr/pdf.php?id=47 alveolar proteinosisbronchoalveolar lavagedyspnea eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2018-08-18 3 2 66 69 10.26663/cts.2018.00013 48 article A descending necrotizing mediastinitis case treated with early surgical intervention Timuçin Alar 1 Oğuz Güçlü 2 İsmail Ertuğrul Gedik 1 Department of Thoracic Surgery, Canakkale Onsekiz Mart University Medical Faculty, Canakkale, TurkeyDepartment of Otorhinolaryngology, Canakkale Onsekiz Mart University Medical Faculty, Canakkale, TurkeyDescending necrotizing mediastinitis (DNM) can be described as a rare but severe infection that can develop after primary pharyngeal or odontogenic infections. The most important factor affecting the morbidity and mortality in DNM is early diagnosis and prompt treatment with early aggressive surgical drainage. Herein, we present a case of mediastinitis that developed after deep cervical infection that was treated with early surgical intervention, changing the course of the disease. https://cts.tgcd.org.tr/pdf.php?id=48 mediastinitissurgeryinfection eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2018-08-18 3 2 70 73 10.26663/cts.2018.00014 49 article Surgical results of herpes zoster and lung cancer association in preoperative period Onur Derdiyok 1 Yelda Tezel 2 İlker Kolbaş 1 Serda Kanbur 1 Çağatay Tezel 1 Levent Alpay 1 Volkan Baysungur 1 Department of Thoracic Surgery, Sureyyapasa Chest Disease and Thoracic Surgery Education and Research Hospital, Istanbul, TurkeyDepartment of Pulmonary Disease, Haydarpasa Numune Education and Research Hospital, Istanbul, TurkeyHerpes zoster also known as shingles is a disease caused by the reactivation of varicella zoster virus. It often starts with erythema as the first finding. Maculopapular vesicles may form painful rashes with maturations, which may be painful at baseline before the onset of rash. Here, the postponement of the operation due to the central mass located in the left lobe of the patient due to herpes zoster, and the possible results were presented. https://cts.tgcd.org.tr/pdf.php?id=49 herpes zosterlung carcinomamediastinoscopypneumonectomy eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2018-08-18 3 2 74 77 10.26663/cts.2018.00015 50 article Inflammatory myofibroblastic tumor: a case of a rare tumor of lung Hüseyin Çakmak 1 Arif Osman Tokat 2 Nazlı Topbaşı 3 Aydın Aslan 4 Department of Thoracic Surgery, Ankara Medicalpark Hospital, Ankara, TurkeyDepartment of Thoracic Surgery, Bozok University Medical Faculty, Yozgat, TurkeyDepartment of Chest Disease, Ankara Medicalpark Hospital, Ankara, TurkeyDepartment of Radiodiagnostic, Ankara Medicalpark Hospital, Ankara, TurkeyInflammatory myofibroblastic tumor (IMT) is a rare thoracic lesion, the diagnosis of which should be supported by histological and immunochemical examinations. Although this is known as a benign tumor, it should be completely resected, and patients should be closely monitored to avoid any local invasion or recurrence. This article presents a 34-year-old female patient who has endobronchial polypoid IMT that is rarely seen among IMT patients. Inferior lobectomy and lymph node sampling was performed. The patient had no local recurrence and metastasis free at the end of first year postoperatively and follow-up is ongoing. https://cts.tgcd.org.tr/pdf.php?id=50 inflammatory myofibroblastic tumorsolitary fibrous tumorlung cancer eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2018-08-18 3 2 78 81 10.26663/cts.2018.00016 51 article Pulmonary congenital cystic adenomatoid malformation accompanied with hamartoma in an adult: report of a case Gökhan Çakıroğlu 1 Mehmet Oğuzhan Özyurtkan 2 Zeliha Arslan Ulukan 3 Uğur Temel 4 Department of Pathology, Istanbul Aydin University Medical Faculty, Istanbul, TurkeyThoracic Surgery, Medicana International Istanbul Hospital, Istanbul, TurkeyDepartment of Pulmonology, Istanbul Arel University Medical Faculty and Medicana International Istanbul Hospital, Istanbul, TurkeyDepartment of Thoracic Surgery, Istanbul Sisli Hamidiye Etfal Research and Training Hospital, Istanbul, TurkeyCongenital cystic adenomatoid malformation (CCAM) is mostly recognized in children and adult presentation is rare. Here, a 42-year-old male patient was presented. He had a previous history of pneumothorax, and radiologically there were multiple bullous lesions in the right upper lobe, as well as a nodular lesion of 2 cm. He underwent right upper lobectomy and middle lobe wedge resection which revealed CCAM type I and hamartoma of the lung. Less than 70 adult cases of CCAM have been reported in the literature. Lung cancer accompanying CCAM or malignant transformation in adult are rarely described. But to our knowledge, this is the first adult case of CCAM with hamartoma. CCAM should be considered in the differential diagnosis of multicycstic lesions in adults with a history of pneumothorax, and the surgical resection is the treatment of choice. https://cts.tgcd.org.tr/pdf.php?id=51 hamartomalobectomycystic adenomatoid malformation of lung eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2018-08-18 3 2 82 84 10.26663/cts.2018.00017 52 article Rapidly growing chest wall tumor of a pregnant woman: ewing’s sarcoma Ali Özdil 1 Önder Kavurmacı 2 Tevfik İlker Akçam 1 Taner Akalın 3 Seda Akgün Kavurmacı 4 Department of Thoracic Surgery, Ege University School of Medicine, Izmir, TurkeyDepartment of Thoracic Surgery, Bozyaka Training and Research Hospital, Izmir, TurkeyDepartment of Pathology, Ege University School of Medicine, Izmir, TurkeyDepartment of Obstetrics and Gynecology, Ataturk Training and Research Hospital, Izmir, TurkeyThe incidence of coexistence of pregnancy and malignancy is approximately 1 in 1000-3000. Soft tissue sarcomas compose a very little portion of malignancies and Ewing’s sarcoma is one of these tumors, which is very rare, and the most lethal of all. We report a 37-year-old female at gestational age of 23 weeks with a rapidly growing tumor on the right chest wall and managed with chest wall resection and reconstruction. The togetherness of pregnancy and Ewing’s sarcoma is a rare entity and there is no exact information for treatment in the literature except a few case reports. https://cts.tgcd.org.tr/pdf.php?id=52 Ewing’s sarcomapregnancychest wall eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2018-08-18 3 2 85 89 10.26663/cts.2018.00018 53 article Primary malignant mediastinal germ cell tumor in childhood Selim Şakir Erkmen Gülhan 1 Leyla Nesrin Acar 1 Merve Şengül İnan 1 Şule Yeşil 2 Pınar Bıçakcıoğlu 1 Department of Thoracic Surgery, Ataturk Chest Disease and Thoracic Surgery Research and Training Hospital, Ankara, TurkeyDepartment of Pediatric Hematology and Oncology, Dr. Sami Ulus Woman’s Health and Children Education and Research Hospital, Ankara, TurkeyPrimary malignant mediastinal germ cell tumors are rare in childhood. Despite the metastasis to lung, liver, brain and bone is possible but sternal metastasis is unusual. Both tumor and its metastases treated with surgical resection, if possible followed by chemotherapy. We present a case primary malignant germ cell tumor, which has metastasis to lung and to sternum. We performed complete tumor resection, metastasectomy, sternal resection and then reconstructed by titanium plate and polypropylene graft. https://cts.tgcd.org.tr/pdf.php?id=53 chest wall tumorgerm cell tumorreconstruction of sternum eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2018-08-18 3 2 90 101 10.26663/cts.2018.00019 54 article Current advances in early detection, residual disease monitoring and treatment response in lung cancer: liquid biopsy Ebru Sayılır Güven 1 Selim Şakir Erkmen Gülhan 1 Department of Thoracic Surgery, Ataturk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, TurkeyLung cancer exhibits the highest mortality rate of all malignant tumors, and only a minority of non-small cell lung cancer (NSCLC) patients are diagnosed with localized, early stage tumors. Unfortunately, NSCLC is usually detected at advanced and inoperable stages. Tumor biomarkers can detect early stage lung cancer independently or in combination with low-dose computed tomography-based screening techniques. A liquid biopsy is a noninvasive modality for the pathological and molecular characterization of cancer, and it can be isolated from bodily fluids. There are a variety of biological elements that can be isolated from the peripheral blood, such as exosomes, circulating cell-free (tumor) DNA, circulating tumor cells, and microRNA. A liquid biopsy can be used to detect somatic mutations before treatment and dynamically during treatment, and to monitor the treatment response. It can also be used for minimal residual disease quantification, and to determine the emergence of therapy resistance. Despite the numerous research studies showing successful results, clinically available lung cancer biomarkers do not have sufficiently high specificity and sensitivity for widespread use. Therefore, universal experimental and therapeutic research regarding advanced molecular diagnostics has become necessary. https://cts.tgcd.org.tr/pdf.php?id=54 biomarkerliquid biopsylung cancer