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Yayın A 33-year-old female with cough and dyspnoea mimicking asthma bronchiale(European Respiratory Society, 2005) Öztürk, E.; Dabak, G.; Koşar, Altuğ; Sungun, F.; Saygı, A.A 33-year-old female patient, without prior chest symptomatology, was referred to hospital with symptoms of cough, dyspnoea and chest pain, which had persisted for the last 3.5 months. Her medical history revealed that she had been admitted to the emergency department when her symptoms first developed. At this point she had been prescribed non-specific antibiotic and bronchodilating treatment, as paracardiac infiltration was detected on chest radiography and wheezing on auscultation. At follow-up, she was told that the infiltration on chest radiography had regressed; however, cough and chest tightness persisted and progressed.Yayın Akciğer kanserinin cerrahi tedavisinde sleeve rezeksiyonlarının yeri(Maltepe Üniversitesi, 2013) Kosif Mısırlıoğlu, Aysun; Alpay, Levent; Kanbur, Serdar; Koşar, Altuğ; Sönmez, Hakan; Demir, Mine; Baysungur, Volkan; Yalçınkaya, İrfan; Örki, TülayAmaç: Bronşial sleeve rezeksiyonlar akciğerin habis ve selim patolojilerinde pnömonektomi operasyonunun alternatifi olarak geliştirilmiş tekniklerdir. Gereç ve Yöntem: Bu çalışma İstanbul Süreyyapaşa Göğüs Cerrahi merkezinde Eylül 1994- Mayıs 2009 tarihleri arasında 71 hastaya uygulanan sleeve rezeksiyonları incelemek amacıyla yapılmıştır. Bulgular: Uzun dönem takipte sleeve rezeksiyon uygulanan hastalardan 26'sı kaybedildi, ortalama takip süresi 33 ay, maksimum takip süresi 120 aydı. Standart sapması 27.7 olarak bulundu. İki yıllık sağkalım %67.2 (ort.57.3 ay±7.5) olarak saptandı.Komplikasyonların ortaya çıkmasıyla; operasyon yapılan taraf, anastomoz şekli ( tek- tek, devamlı sütür ), olguların yaşı arasındaki ilişki araştırıldı ancak istatistiksel olarak anlamlı bir sonuç bulunamadı. (Sırasıyla; p=0.09, p=0.4, p=0.3 ).Operasyon tarafının sağ ya da sol olmasının sağkalıma etkisi araştırıldığında istatistiksel olarak anlamlı bir sonuç bulunamadı (p=0.13). Sağ kalım oranlarını, komplikasyonların varlığına göre değerlendirdiğimizde istatistiksel olarak anlamlı olmamakla birlikte, anlamlıya yakın sonuç elde edildi (p= 0.08). Sağkalım oranlarının, uygulanan ek cerrahi işlemlerden etkilendiği istatistiksel olarak anlamlı bulundu (p= 0.03). N faktörü; N0, N1 ve N2 olmak üzere üç ayrı gruba ayrıldı ve sağkalıma etkisi araştırıldı ve istatistiksel olarak anlamlı bulundu ( p= 0.03). 2 yıllık sağkalım N0'da % 81.5, N1'de % 63, N2'de % 21 olarak bulundu. Tümör çaplarının sağkalıma etkisi istatistiksel olarak anlamlı bulunmadı ( p=0.6) Sonuç: Sleeve rezeksiyonlar diğer rezeksiyonlar gibi düşük mortalite ve morbidite ile yapılabilir.Yayın Akciğerin parazitik hastalıkları: hidatik kist epidemiyolojisi(Türkiye Klinikleri, 2012) Koşar, AltuğHidatik kist hastalığı tarım ve hayvancılıkla uğraşan, fakat çevre sağlığı ve koruyucu hekimlik hizmetlerinin yetersiz kaldığı toplumlarda görülen paraziter bir hastalıktır. Hidatik kist hastalığı Avrupa, Kuzey ve Güney Amerika\\nın da bazı kısımlarının dahil olduğu, dünyanın büyük kısmında önemli bir morbidite ve mortalite nedenidir. Türkiye\\de hidatidozdan en sık sorumlu olan tür Echinococcus granulosus\\tur. Daha az sıklıkla Echinococcus multilocularis görülmektedir. Hastalık Doğu, Güney Doğu ve İç Anadolu bölgelerimizde sık görülmektedir. Ülkemizde hastalığın görülme oranı 100 000 kişide 5,7 olarak bildirilmektedir. Önleme ve kontrol mekanizmalarının etkili çalışması hastalığın azaltılmasında önemlidir.Yayın Akciğerin parazitik hastalıkları: hidatik kist yaşam döngüsü(Türkiye Klinikleri, 2012) Koşar, AltuğHidatik kist hastalığı tarım ve hayvancılıkla uğraşan, çevre sağlığı ve koruyucu hekimlik önlemlerinin yetersiz kaldığı toplumlarda görülen Echinococcus isimli sestodun neden olduğu önemli bir paraziter hastalıktır. Kistin erişkin hali ana konak olan kedi, köpek, kurt, tilki, çakal gibi hayvanların ince barsaklarında yerleşirken, larvası ara konak olan insan, koyun, sığır gibi hayvanlarda hidatik kist hastalığına neden olmaktadır. Echinococcus granulosus 2-8 mm boyunda, 0.6 mm enindedir ve 3-4 halkadan oluşur. Son halkanın içinde 400-800 adet yumurta bulunmaktadır. Yumurtalar enfekte hayvanın dışkısı ile dış ortama atılır. Ana konak olan hayvanların kıllarında, yattığı yerlerde ve dışkılarının bulaştığı su ve besinlerle (taze sebze, meyve) yumurtaların oral yolla alınması ile insana bulaşmaktadır. Ara konağın ölmesi sonucu larva şeklini içeren iç organların ana konak tarafından yenmesiyle parazit yaşam döngüsünü tamamlanmış olur.Yayın Barclay tekniği ile karina rezeksiyonu(Turkish Society of Cardiovascular Surgery and Turkish Society of Thoracic Surgery, 2008) Kir, Altan; Koşar, Altuğ; Kadıoğlu, Salih Zeki; Atasalihi, Ali; Mısırlıoğlu, Aysun KosifElli dört yaşında kadın hastaya, sol trakeobronşiyal bileşkede saptanan adenoid kistik karsinom nedeniyle karina rezeksiyonu yapıldı. Barclay yöntemiyle, sağ ana bronş trakeaya uç-uca, sol ana bronş intermedier bronşa uç-yan anastomoze edildi. Ameliyat sonrası dokuzuncu ayda yapılan fiberoptik bronkoskopide anastomoz hattı normal bulundu.Yayın Benign akciğer hastalıklarında tamamlama pnömonektomileri(Maltepe Üniversitesi, 2011) Tezel, Çağatay; Kıral, Hakan; Koşar, Altuğ; Örki, Alpay; Arman, Bülent; Ürek, ŞenolAmaç: Benign akciğer hastalıklarında cerrahi müdahale peroperatif ve postoperatif komplikasyonları da beraberinde getirmektedir. Çalışmanın amacı, bu grup hastalarda uygulanmış tamamlama pnömonektomilerinin; endikasyon, komplikasyon ve postoperatif sonuçlarını incelemektir. Yöntemler: 16 yıllık bir süreçte benign akciğer hastalığı nedeniyle tamamlama pnömonektomisi gerektiren toplam 27 hasta geriye dönük incelendi. Benign etiyoloji nedeniyle 23 hastada tamamlama pnömonektomisi uygulandı. Bu hasta grubunda etiyoloji, ameliyat tekniği ve komplikasyonları etkileyen faktörler araştırıldı. Bulgular: Tamamlayıcı pnömonektomi endikasyonları; 23 hastada benign (bronşektazi:14, tüberküloz:5, bronkoplevral fistül:2, akciğer nekrozu:2) hastalıklar idi. Ameliyat sonrası bronkoplevral fistül ve ampiyem 6 olguda gelişti. Bronkoplevral fistül gelişimi açısından; tüberküloz, sağ/sol farkı ve güdük kapama teknikleri arasında istatistiksel bir fark tespit edilemedi. Otuz günlük operatif mortalite %8.69 (2/23) idi. Mortalite görülen olgularda BPF oranı anlamlı düzeyde yüksek bulundu (p<0.01). Bu grupta 5 yıllık hastalıksız sağ kalım oranı %78.9 olarak gerçekleşti. Sonuç: Tamamlayıcı pnömonektomleri standart pnömonektomiden daha yüksek mortalite oranlarına sahiptir. Benign inflamatuar hastalıklarda ve özellikle de tüberkülozlu hastalarda komplikasyon oranlarının daha yüksek olduğu gösterilmiştir.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 Comparison of integrated positron emission tomography/computed tomography and mediastinoscopy in mediastinal staging of nonsmall cell lung cancer: analysis of 212 patients(Royal Belgian Society for Surgery, 2012) İskender, İlker; Kapıcıbaşı, Hasan Oğuz; Kadıoğlu, S. Z.; Sevilgen, Gökçen; Tezel, Çağatay; Koşar, Altuğ; Atasalihi, A.; Kir, AnBackground : Mediastinal staging is crucial to determine the prognosis and treatment options for patients with non-small cell lung cancer (NSCLC). In this study, we compared the results of integrated positron emission tomography-computerised tomography (PET/CT) with those of mediastinoscopy in mediastinal staging of NSCLC patients. Methods : PET/CT and mediastinoscopy was performed on 250 consecutive patients diagnosed with NSCLC between September 2005 and March 2008. Thirty-eight patients were excluded from the study. Standard cervical mediastinoscopy was performed in all patients, and simultaneous extended cervical mediastinoscopy was performed in 52 patients with left sided lesions. Patients with negative mediastinoscopy underwent resection. The pathological results were correlated with PET/CT findings. Results : A total of 212 patients (199 male, 13 female ; mean age : 58.3 years) were evaluated. In PET/CT analysis 60 true-positive, 45 false-positive, 103 true-negative and 4 false-negative patients were found. The rate of PET/CT positivity of mediastinal lymph nodes was 49.5%. The sensitivity, specificity, positive and negative predictive values and accuracy for PET/CT were 93.8%, 69.6%, 57.1%, 96.3% and 76.9% respectively. The incidence of N2 disease in NSCLC patients with negative mediastinal lymph node uptake on PET/CT was 3.7% (4 of 107). In univariate analysis, right upper lobe tumours were significantly (p < 0.05) more associated with occult N2 disease. Conclusions : In patients with positive mediastinal lymph node uptake on PET/CT invasive mediastinal staging appears necessary for exact staging. Mediastinoscopy can be omitted in NSCLC patients with negative mediastinal uptake on PET/CT in regions where the rate of PET/CT positivity of mediastinal lymph nodes is high.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 Diagnostic algorithm in patients with superior vena cava syndrome and efficacy of cervical mediastinoscopy(Royal Belgian Society for Surgery, 2014) Alpay, Levent; Laçin, Tunç; Koşar, Altuğ; Mısırlıoğlu, A. K.; Öztaş, S.; Coşkun, T.; Baysungur, V.; Yalçınkaya, I.Background : Superior vena cava syndrome (SVCS) is the result of the direct obstruction of the superior vena cava by malignancy and/or mediastinal lymphadenopathy. Our aim is to propose a diagnostic algorithm for undiagnosed superior vena cava syndrome patients and compare the diagnostic value, mortality and morbidity rates in patients diagnosed by mediastinoscopy. Methods : Ninety-seven patients with SVCS underwent diagnostic management starting with the least invasive technique and proceeding to more advanced and invasive methods between January 2000 and June 2013. Seventy one (73%) patients received histopathologic diagnosis using local biopsy, endobronchial biopsy by fiberoptic bronchoscopy and/or endobronchial ultrasound (EBUS) and CT-guided fine needle aspiration biopsy. Twenty six patients out of 97 patients who had superior vena cava syndrome underwent cervical mediastinoscopy for definitive diagnosis. Four patients (three male and one female) received histopathologic diagnosis using EBUS with the use of this method in our institution after 2010. Results : Of 26 patients who underwent cervical mediastinoscopy, 11 had small cell lung carcinoma, six had squamous cell lung carcinoma, three had adenocarcinoma, two had lymphoma, one had thymoma, one had tuberculosis, one had seminoma and one had chronic fibrous mediastinitis. Definitive tissue diagnosis was obtained in all patients. No perioperative mortality was recorded. One patient had minor bleeding which was controlled without additional surgical intervention. Conclusions : We propose a diagnostic algorithm in undiagnosed patients with superior vena cava syndrome. We conclude that cervical mediastinoscopy is a safe, fast and effective technique to establish pathologic diagnosis, and directs the physicians to apply the appropriate treatment in clinically diagnosed superior vena cava syndrome when less invasive techniques have been unsuccessful.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 experimental use of N-Butyl cyanoacrylate tissue adhesive in pulmonary wedge resections(Elsevier, 2012) Koşar, Altuğ; Kapıcıbaşı, Oğuz; Alpay, Levent; Mısırlıoğlu, Aysun K.; Sönmez, Hakan; İskender, İlker; Demirhan, RecepBackground: In this experimental study, the effectiveness of N-butyl cyanoacrylate tissue adhesive on preventing air leakage after pulmonary wedge resection was observed. Methods: Twenty pairs of sheep lungs were used. Before initiating the study, the sheep lungs were ventilated to identify any air leakage from the parenchyma. On positive results, those sheep lungs were then excluded from the study. Wedge resection was performed on the right and left lower lobes of sheep lungs by clamping the edges forming a triangle of 5 cm × 5 cm × 5 cm. One side of parenchyma was sutured by 3/0 vicryl (Group A) while the other side of parenchyma was sealed by N-butyl cyanoacrylate (Group B). After waiting for 5 min for N-butyl cyanoacrylate to dry, the sheep lungs were intubated by 6 F endotracheal tubes. The lungs were soaked in a bath tub filled with 10 cm deep water and inflated by 40 mmHg pressure to record any air leakage from the parenchyma partially sutured by vicryl and sealed by N-butyl cyanoacrylate. Results: Air leakages were observed on the parenchyma surfaces of group of lungs (100%) sutured by vicryl (minimal 30%, mild 50% or massive 20% levels), while only on four of (20%) the other group of lungs sealed by N-butyl cyanoacrylate,minimal airleakage was observedontheparenchymal surface.There was anextremely significantdifferencebetween Group A and Group B in terms of the development of air leakage (p = 000). Conclusion: We consider that, N-butyl cyanoacrylate could be used effectively and safely to prevent air leakage from the pulmonary wedge resection surface.Yayın False-positivity of mediastinal lymph nodes has negative effect on survival in potentially resectable non-small cell lung cancer(National Center for Biotechnology Information, 2012) İskender, İlker; Kadıoğlu, Salih Zeki; Coşgun, Tuğba; Kapıcıbaşı, Hasan Oğuz; Sağıroğlu, Gönül; Koşar, Altuğ; Kir, AnOBJECTIVES: It has been shown that increased metabolic activity of primary tumour has a negative effect on survival in non-small cell lung cancer (NSCLC) staged with positron emission tomography integrated computed tomography (PET/CT). We hypothesized that an increased metabolic activity of mediastinal lymph nodes would have worse survival even if it is false. METHODS: Three hundred and twenty-eight consecutive patients with NSCLC histology were imaged with PET/CT within 90 days of surgery between September 2005 and March 2009. Patients who had neoadjuvant chemotherapy (n = 22), patients with prior history of NSCLC (n = 9) or other malignancies within 5 years (n = 11) were excluded from the study. Patients with negative mediastinoscopy underwent resection. Pathological results were revised according to the seventh tumor-node-metastasis staging system. Kaplan–Meier test was used for survival. Log-rank and Cox analyses were used for comparisons. RESULTS: A total of 286 patients (262 male; mean age: 58.5 years) were evaluated. There were 22 (6.7%) operative deaths and none of the patients were lost to follow-up. The median follow-up in the remaining 264 patients was 26 months (range, 2–61 months). Tumour size, nodal spread and stage were all strongly associated with survival from NSCLC (P < 0.001). There were 63 true-positive, 65 falsepositive (FP), 152 true-negative (TN) and six false-negative findings on mediastinal staging after PET/CT. The maximum standardized uptake value of primary tumour was significantly higher in FP patients than in TN patients (P = 0.012). After excluding pN2-positive patients, TN patients had better survival than FP patients (P = 0.006). Multivariate analysis showed that false-positivity of mediastinal lymph nodes was independently associated with worse survival (hazard ratio = 0.63; P = 0.02). There were 146 patients with pT1-4, pN0 treated with R0 surgical resection. Disease-free survival and overall survival were also significantly better for TN patients in completely resected group (P = 0.009 versus 0.016). CONCLUSIONS: We have shown that false-positivity of mediastinal lymph nodes had yielded worse survival in surgically staged or resected NSCLC patients staged with PET/CT. This result may help to allocate patients with potentially poor prognosis for considered additional therapy.Yayın Farklı evrelemeler ve karşılaştırmaları, evrelemeyle ilgili yorum ve tartışmalar(Türkiye Klinikleri, 2011) Koşar, AltuğMalign plevral mezotelyoma nadir görülen bir tümördür. Ancak son yıllarda görülme sıklığı giderek artmaktadır. Oldukça agresif davranışı nedeni ile kötü bir prognoza sahiptir. Malign plevral mezotelyoma için bugüne kadar önerilen en az 6 değişik evreleme sistemi vardır. Ancak doğruluk değeri yüksek ve evrensel olarak kabul gören bir evreleme sistemi de halen yoktur. Tüm önerilen evreleme sistemleri cerrahi yapılan hastaları temel almaktadır. Bu nedenle klinik evreleme için gerçekten pratik değildirler. Son dönemlerde malign plevral mezotelyomanın evrelendirilmesinde en doğru ve en yaygın kullanılan evrelendirme sistemi International Mesothelioma Interest Group'un 1995 yılında önerdiği TNM esaslı evreleme sistemidir. Union Internationale Contre le Cancer ve American Joint Committee on Cancer 2002 yılında bu evreleme sistemini benimsemiştir. Ancak bu evreleme sisteminin de klinik ve patolojik evrelendirmesi arasında farklılıklar vardır. Nodal durumun klinik tanımlaması ve tümör durumunun patolojik tanımlamasında eksiklikler vardır. Bu yüzden International Mesothelioma Interest Group evreleme sisteminin de ileri dönemlerde revizyona ihtiyacı olduğu görülmektedir.Yayın 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, BülentBackground: 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.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 İnterkostal nevraljinin nadir bir nedeni: Göğüs duvarının ancient schwannoması(2017) Örki, Alpay; Koşar, Altuğ; Ünsal, Miraç Ayşen; Kelten, Bilalİnterkostal nevralji, interkostal sinir boyunca yayılan ağrı ile karakterize nadir bir durumdur. Torasik tümörler çoğunlukla mediasten kaynaklı olup, primer tümörlerin ancak %5-10'dan azı interkostal sinirlerden orijin alır. Bu hastalar genellikle asemptomatik olurlar. Biz burada göğüs duvarı schwannoması nedeniyle ciddi interkostal ağrı ile başvurmuş 42 yaşında bir erkek hastayı sunduk. Cerrahi rezeksiyon sonrası schwannomanın nadir bir türü olan ancient schwannoma tanısı alan hasta, sonrasında ağrısız izlenmiştir.Yayın Is there any maximum standardized uptake value variation among positron emission tomography scanners for mediastinal staging in non-small cell lung cancer?(National Center for Biotechnology Information, 2011) İskender, İlker; Kadıoğlu, Salih Zeki; Koşar, Altuğ; Atasalihi, Ali; Kir, AltanThe maximum standardized uptake value (SUVmax) varies among positron emission tomography-integrated computed tomography (PETyCT) centers in the staging of non-small cell lung cancer. We evaluated the ratio of the optimum SUV cut-off for the lymph nodes to the max median SUV of the primary tumor max max max (ratioSUV ) to determine SUV variations between PETyCT scanners. The previously described PET predictive ratio (PPR) was also evaluated. PETyCT and mediastinoscopy andyor thoracotomy were performed on 337 consecutive patients between September 2005 and March 2009. Thirty-six patients were excluded from the study. The pathological results were correlated with the PETyCT findings. Histopathological examination was performed on 1136 N2 lymph nodes using 10 different PETyCT centers. The majority of patients (group A: 240) used the same PETyCT scanner at four different centers. Others patients were categorized as group B. The ratioSUV for groups A and B was 0.18 and 0.22, respectively. The same ratio for centers 1, 2, 3 and 4 was 0.2, 0.21, 0.21, and 0.23, max respectively. The optimal cut-off value of the PPR to predict mediastinal lymph node pathology for malignancy was 0.49 (likelihood ratio q2.02; sensitivity 70%, specificity 65%). We conclude that the ratioSUV was similar for different scanners. Thus, SUV is a valuable cut- max max off for comparing-centers.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.