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Yayın Bronchogenic cysts of the lung: report of 29 cases(Elsevier, 2009) Koşar, Altuğ; Tezel, Çağatay; Orki, Alpay; Kiral, Hakan; Arman, BülentBackground:Intrapulmonary bronchogenic cysts are congenital anomalies of the tracheobronchial tree and foregut.The aim of this retrospective study was to review the diagnosis, clinical and histological features, operative techniques,outcomes and follow-up of intrapulmonary bronchogenic cysts treated in a single institute.Methods:Twenty-nine patients with intrapulmonary bronchogenic cysts were treated surgically between 1990 and2005. There were 17 female and 12 male patients and their ages ranged from 7 to 68 years. Patients were divided into twogroups according to surgical procedure. Resection (lobectomy or wedge resection) was performed on Group I (n= 18),and partial excision with de-epithelisation was performed on Group II (n= 11).Results:Twenty-fivepatients(86.2%)weresymptomatic.Coughandsputumwerethemostcommonsymptoms.Twenty-four of the 29 BCs were simple cysts (82.7%) whereas 5 (17.3%) were complicated cysts. Postoperative hospital stay was4.55±0.86 days in group I and 6.54±3.34 days in group II (P= 0.172). Complications in Group I were pneumonia in onecase and wound infection in two cases; prolonged air leakage were observed in two cases of Group II. No statisticaldifference was determined between the complication rates of the two groups (P= 0.91). However a significant differencewas determined between the complication rates of simple and complicated cysts (P= 0.026). Two cases in Group II showedrecurrence, whereas no recurrence occurred in Group I. (P= 0.065) No postoperative mortality was observed in any of thegroups.Conclusions:All bronchogenic cysts should be treated surgically. We believe that partial excision with de-epithelisationmay be an alternative to resection in symptomatic patients with limited respiratory capacity.Yayın Clinicopathologic demonstration of complex bronchopulmonary foregut malformation(National Center for Biotechnology Information, 2008) Kiral, Hakan; Tezel, Çağatay; Koşar, Altuğ; Keleş, MuratBronchopulmonary foregut malformations are rare and often prove to be extremely difficult to diagnose. The presented case is a 44-year-old man complaining about cough and hemoptysis. These symptoms continued despite medical treatment. A computed thorax tomographic scan depicted a paravertebral cystic lesion. The patient underwent surgical exploration, and communication between the cyst and the esophagus was found. A left lower lobectomy was performed. The pathologic result confirmed a duplication cyst of mixed bronchogenic and esophageal type with bronchiectasis of the lower lobe. We present this unusual malformation complex especially in an adult with the review of the literature.Yayın Detecting the limits of bronchial closure methods in an animal model(Thieme, 2006) Tezel, Çağatay; Ürek, Şenol; Keleş, Murat; Kiral, Hakan; Koşar, Altuğ; Dudu, Canan; Arman, BülentBackground: Bronchopleural fistula is a serious complication of major lung resections that may lead to mortality. An experimental animal model was designed to find out the safest bronchial closure method by comparing leakage rates under pressure. Methods: The tracheobronchial trees of 50 freshly dead sheep were prepared for either manual closure or closure with a stapler. After left pneumonectomy, the specimens were divided into five groups (n = 10); 3/0 Premilene® suture was used with two “u” sutures + interrupted sutures in Group I; in Group II, 3/0 Premilene® sutures with continuous horizontal mattress + over-over continuous sutures were used. In Group III and IV the same techniques were used with 3/0 Vicryl®. A stapler was used in Group V. Specimens were intubated with an endotracheal tube, connected to a sphygmomanometer, and subsequently positioned under water. The pressure level at which we detected air bubbles indicated the limits of the technique. Results: The median leakage pressure resistance was significantly lower in Group III (135 mm Hg) (p = 0.001). The best results were achieved by using the continuous horizontal mattress + over-over continuous suture technique. No statistical significance difference was found between the stapler group, Groups I, II, and IV in terms of median leakage pressures. Conclusions: This trial suggests that manual suture closure using an appropriate technique and monofilament materials is as safe as the stapler.Yayın Effect of capitonnage and cystotomy on outcome of childhood pulmonary hydatid cysts(National Center for Biotechnology Information, 2006) Koşar, Altuğ; Orki, Alpay; Hacıibrahimoğlu, Gökhan; Kiral, Hakan; Arman, BülentObjective: In this clinical retrospective study cystotomy and capitonnage were compared in patients with childhood pulmonary hydatid cysts with regard to postoperative period. Methods: Between 1990 and 2004, 60 children with pulmonary hydatid cysts were treated surgically. There were 33 boys and 27 girls aged from 3 to 16 years. Cystotomy and closure of bronchial openings were performed in all patients. The patients were divided into 2 groups. While the residual cyst cavity was closed by means of capitonnage in group A (n = 37), cystotomy was applied in group B (n = 23). Results: There was no mortality in either group. Chest tubes were removed after 3.59 +/- 1.04 days in group A and 5.83 +/- 2.84 days in group B. The hospital stay was 4.86 +/- 1.43 days for group A and 7.22 +/- 3.34 days for group B. Prolonged air leak was found in 2 children in group A and 7 children in group B. There was a significant difference between group A and group B with regard to chest tube removal time (P = .001), hospital stay (P = .003), development of prolonged air leak (P = .004), and all complications (P = .031). Follow-up information was available for 49 children, ranging from 13 to 86 months (mean, 56 months). Recurrence was seen in 2 children of group A and 1 child of group B during the follow-up period (P = .698). Conclusion: Capitonnage for pulmonary hydatid cysts is superior to cystotomy because it reduces morbidity (especially prolonged air leak) and hospital stay.Yayın The impact of immunohistochemical detection of positive lymph nodes in early stage lung cancer(National Center for Biotechnology Information, 2006) Tezel, Çağatay; Ersev, Ayşe Alp; Kiral, Hakan; Koşar, Altuğ; Keleş, Murat; Dudu, Canan; Arman, BülentBackground: Detection of micrometastatic disease is an interesting area in non-small cell lung cancer (NSCLC). We conducted a study to determine whether the detection of mediastinal lymph node spread by immunohistochemical (IHC) analysis offers some prognosis with respect to patients' disease-free survival or not. Methods: Between 1997 and 2003, twenty-one early stage lung cancer patients underwent complete resection with mediastinoscopy and systemic nodal dissection. Four hundred and twenty-six paraffin-embedded lymph node sections from 21 patients were analyzed. Epithelial specific-antigen Ab-9 and Keratin-Pan Ab-1 were used as IHC marker. Results: Based on nodal spread four of the 21 patients (19.04%) were up-staged after IHC analysis. Two patients with stage IB (T2N0) up-staged to stage IIIA (T2N2); two patients staged as IIB (T2N1) up-staged to IIIA (T2N2). Statistical analysis showed that the lymphatic dissemination detected with IHC analysis was associated with reduced disease-free survival (DFS) (p = 0.002). Conclusions: Our study provides some indication that patients with lymphatic micrometastasis have a reduced DFS. Before creating a new TNM staging system, more information is needed to understand the prognostic impact of micrometastatic dissemination.Yayın Management of postpneumonic empyemas in children(National Center for Biotechnology Information, 2008) Demirhan, Recep; Koşar, Altuğ; Sancaklı, İrfan; Kiral, Hakan; Orki, Alpay; Arman, BülentObjective: The optimal treatment of children with empyema remains controversial. The purpose of this clinical retrospective study was to assess different treatment options in the management of postpneumonic pediatric empyemas. Methods: From April 1997 to October 2005, 111 consecutive children (57 boys and 54 girls) were managed for pleural empyema. The mean age was 7.07 years (range: 18 months-14 years). Patients were divided into 3 groups depending on the treatment received: group I, chest tube alone (n = 89); group II, chest tube with fibrinolytics (n = 22); group III, thoracotomy with decortication (n = 19, consisting of 9 patients of group I and 10 of group II with unsuccessful treatment results). Results: Chest tube alone, chest tube with fibrinolytics, and thoracotomy with decortication had complete response rates of 89.9%, 54.5%, and 100%, respectively. The hospital stay was 11.46 +/- 3.79 days for group I, 9.08 +/- 2.07 days for group II, and 6.32 +/- 2.54 days for group III. There was no statistically significant difference between group I and group II with regard to hospital stay (P = 0.040). Mild pain occurred in 4 children of group II after streptokinase instillation. Only one atelectasis appeared in group III during the postoperative period. Conclusion: Chest tube drainage is a safe, effective primary treatment of postpneumonic pediatric empyema. In cases where it is insufficient, thoracotomy with decortication can be used successfully with low morbidity and mortality rates.Yayın Pneumonectomy in children for destroyed lung: evaluation of 18 cases(Elsevier, 2010) Koşar, Altuğ; Orki, Alpay; Kiral, Hakan; Demirhan, Recep; Arman, BülentBackground. Destroyed lung is an uncommon condition; it describes a nonfunctional lung and is most often caused by inflammatory diseases. Surgical resection is used to resolve or prevent complications and improve quality of life. We reviewed our experience in surgery for destroyed lung in children. Methods. The records of 18 children aged 16 years and younger who had undergone pneumonectomy for destroyed lung between 1991 and 2007 were analyzed retrospectively. Results. Eighteen children, 10 males (55.5%) and 8 females, aged 5 to 16 years, with a mean age of 12.3 underwent pneumonectomy. Cough was the major presenting symptom (n 18, 100%). The median preoperative period for symptoms was 6 years. Radiologic diagnostic methods included chest radiograph, computed tomography, bronchoscopy, and bronchography. Bronchiectasis (n 13), tuberculosis (n 4), and aspergillosis (n 1) were the main pathologies. Five patients had tuberculosis history, and tuberculosis culture was positive in 2 patients. Pneumonectomy was applied to the left side in 14 and right side in 4 patients. There was no mortality. Complication occurred in 3 patients (atelectasis [n 1], fistula and empyema [n 1], and wound infection [n 1]). Atelectasis was treated with bronchoscopy and stoma was needed for another patient for empyema. The mean follow-up was 64.9 months (range, 19 to 164 months). In their follow-up period, scoliosis was found in 1 patient. Conclusions. The morbidity and mortality rates of pneumonectomy are acceptable for selected and well prepared children. Antibiotics and antituberculosis treatment in certain cases and good timing in pneumonectomy are essential. Children grew and developed normally after pneumonectomy.Yayın Spontan pnömotoraks: 348 olgunun geriye dönük olarak değerlendirilmesi(Ulusal Travma ve Acil Cerrahi Dernegi, 2009) Demirhan, Recep; Koşar, Altuğ; Eryiğit, Hatice; Kiral, Hakan; Yıldırım, Mehmet; Arman, BülentAMAÇ Spontan pnömotoraks’lı (SP) hastalar iki gruba ayrılarak yaş, cinsiyet, tanı yöntemleri, uygulanan tedavi şekli ve sonuçları açısından geriye dönük olarak değerlendirildi. GEREÇ VE YÖNTEM Haziran 1997 ile Mayıs 2005 tarihleri arasında SP nedeniyle tedavi edilen 348 hasta (320 erkek, 28 kadın; ort. yaş 34,5; dağılım 14-80) çalışmaya alındı. Hastaların 274’ü (%78,7) primer SP’li, 74’ü (%21,3) sekonder SP’li idi. Sekonder SP’li hastalarda tüberküloz en sık sebepti. Hastaların %10’una ilk tedavi olarak nazal oksijen ve aspirasyon, %90’ına tüp torakostomi uygulandı. BULGULAR Nazal oksijen ve aspirasyon ile başarı oranı primer SP’li hastalarda %85,7, sekonder SP’li hastalarda %66,7 olarak bulundu. Tüp torakostomi ile başarı oranı primer SP ve sekonder SP’li hastalarında benzerdi (%88,4 ve %85,7). Tüp torakostominin başarısız olduğu primer SP’li 29 (%11,6) hastanın 15’ine aksiller torakotomi, 14’üne video yardımlı torakoskopik cerrahi (VATS) yapıldı. VATS ile cerrahi uygulanan bir (%7,1) hastada nüks meydana geldi. SONUÇ Tüp torakostominin başarı oranı hem primer SP’li, hem de sekonder SP’li hastalarda yüksektir. Bununla beraber tüp torakostominin başarısız olduğu hastalarda cerrahi yöntemler güvenle ve düşük nüks oranları ile uygulanabilir.Yayın Spontaneous pneumothorax: retrospective analysis of 348 cases(TURKISH ASSOC TRAUMA EMERGENCY SURGERY, 2009) Demirhan, Recep; Kosar, Altug; Eryigit, Hatice; Kiral, Hakan; Yildirim, Mehmet; Arman, BuelentBACKGROUND In this study, spontaneous pneumothorax (SP) cases were divided into two groups and retrospectively evaluated according to age, sex, diagnostic methods, treatments, and results. METHODS Between June 1997 and May 2005, 348 patients (320 males, 28 females; mean age 34.5; range 14 to 80 years) with SP were enrolled into our study. There were 274 (78.7%) primary SP and 74 (21.3%) secondary SP patients. Tuberculosis was the most common cause in secondary SP patients. Nasal oxygen and aspiration was the first-line therapeutic option in 10% of patients and tube thoracostomy was performed in 90%. RESULTS Nasal oxygen and aspiration success ratio wits 85.7% in primary SP patients and 66.7% in secondary SP patients. Tube thoracostomy Success ratio was nearly the same in patients with primary and secondary SP (88.4% and 85.7%). Of the 29 patients (11.6%) with primary SP with unsuccessful result of tube thoracotomy, 15 underwent axillary thoracotomy and 14 underwent video-assisted thoracoscopic surgery (VATS). One patient among these 14 who underwent VATS (7.1%) had recurrence. CONCLUSION Tube thoracostomy success ratio was high in both primary and secondary SP patients. Surgical procedures can be applied safely, with low recurrence rate, when the tube thoracostomy remains unsuccessful.
