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    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, Bülent
    Background: 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.
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    Feasibility of imprint cytology for evaluation of mediastinal lymph nodes in lung cancer
    (National Center for Biotechnology Information, 2006) Orki, Alpay; Tezel, Çağatay; Koşar, Altuğ; Ersev, Ayşe Alp; Dudu, Canan; Arman, Bülent
    Background: Intraoperative evaluation of mediastinal lymph nodes is a necessary step which helps us to decide whether or not to continue the operation of lung cancer. Imprint cytology (IC) can be used as an alternative method in staging. It is a more rapid and simpler procedure than frozen section (FS) analysis. Therefore, we compared the diagnostic accuracy of IC with permanent section on 1050 mediastinal lymph nodes. Methods: A total of 255 non-small cell lung cancer patients who underwent surgical procedure between January 1995 and April 2004 were included. There were 236 males and 19 females with a mean age of 54.2 years (range 26-79 years). In order to obtain lymph node samples mediastinoscopy was performed in 232 (91%), anterior mediastinotomy in 50 (20%) and video-assisted thoracoscopic surgery in 16 (6.3%) patients. During final pathological diagnosis, both imprint and permanent section slides were compared. Results: There were five false-positive and eight false-negative results. The sensitivity, specificity and the predictive values for positive and negative results were 93.1, 99.5, 95.6 and 99.1%, respectively. The overall efficiency was 98.8%. Conclusions: The diagnostic IC is an accurate, reliable, simple and less time-consuming method for evaluation of mediastinal lymph nodes in lung cancer, compared with FS method.
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    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, Bülent
    Background: 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.
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    One-stage operation via median sternotomy and phrenotomy for bilateral lung and liver hydatid disease
    (Springer Nature, 2005) Keleş, Murat; Dudu, Canan; Tezel, Çağatay; Koşar, Altuğ; Ürek, Şenol; Aydemir, Cüneyt; Arman, Bülent
    Background: Echinoccosis is an endemic disease throughout the world. We reviewed a series of 26 bilateral lung and liver hydatid treated surgically via median sternotomy and either phrenotomy or laparotomy. Aims: This study was conducted to emphasize the importance of one-stage operation via median sternotomy for multiple hydatid cysts. Materials and Methods: This study is a retrospective review of our surgical skills for treatment of hydatid cysts. From January 1990 to January 2001, 173 patients were operated for hydatid disease in Heybeliada Thoracic Surgery Center. Twenty-six (15%) of them had bilateral lung hydatid cysts including 17 concomitant liver cysts. Median sternotomy was performed in all of 26 cases and phrenotomy was commonly used to remove concomitant liver cysts at the same operation. Cystotomy without capitonnage was the most common operative procedure for both lung and liver cysts. Results: There was no operative and postoperative death. Post-operative complications occurred in only two patients; these were atelectasis and wound infection. The mean follow-up was 7.3 years (ranging from 1 to 12 years). No recurrence was recorded both in lung and in liver. Conclusions: One-stage operation using median sternotomy and phrenotomy should be preferred to stage thoracotomies in suitable cases with multiple hydatid cysts. Cystotomy without capitonnage and closure of the bronchial openings can be an alternative procedure in hydatid disease surgery. Albendozole treatment is necessary in the postoperative period to obtain good results without any recurrence,
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    Pulmoner aspergillomada cerrahi yaklaşım
    (Aves Yayıncılık, 2005) Koşar, Altuğ; Kıral, Hakan; Örki, Alpay; Keleş, Murat; Ürek, Şenol; Temürtürkan, Kemal; Dudu, Canan; Arman, Bülent
    Pulmoner aspergilloma, Aspergillus fumigatus’un akci¤er kavitelerinde kolonizasyonundan kaynaklanan ve hayat› tehdit eden bir hastal›kt›r. Bu çal›flma, pulmoner aspergillomada cerrahi tedavinin rolünü araflt›rmak amac› ile yap›ld›. Merkezimizde 1987 ile 2002 y›llar› aras›nda pulmoner aspergilloman›n tedavisi için 42 olguya 43 operasyon yap›ld›. Olgular›n 29’u erkek, 13’ü kad›nd› ve ortalama yafl 32 (21-68) idi. Olgular›n 38’inde (%90.5) altta yatan hastal›k tüberkülozdu. Yirmi bir (%50) olgunun gö¤üs radyografilerinde tipik olan fungus topu ve “air-crescent sign” vard›. Cerrahi endikasyonlar 29 (%69) olguda hayat› tehdit eden veya tekrarlayan hemoptizi, 12 (%28.6) olguda harap olmufl lob veya akci¤erdi. Olgular›n 26’s›na (%61.9) lobektomi (bir olguda ek olarak segmentektomi), 6’s›na pnömonektomi, 8’ine kavernomiyoplasti, 1’ine bilateral üst lobektomi ve 1’ine torakomiyoplasti yap›ld›. Postoperatif mortalite 3 (%7.1) olguda görüldü. Komplikasyonlar uzam›fl hava kaça¤› ve/veya ampiyem (5), bronkoplevral fistül (2), kanama (2) ve yara yeri infeksiyonuydu (2). Tüberküloz, pulmoner aspergilloma ile iliflkili en s›k görülen hastal›kt›r. Pulmoner aspergilloma tedavisinde cerrahi rezeksiyon en etkili tedavi yöntemidir. Genel durumu bozuk ve solunum fonksiyonlar› s›n›rl› oldu¤u için rezeksiyon yap›lamayan olgularda, kavernomiyoplasti hayat kurtar›c› bir yöntemdir.