Intercostal neuralgia is a rare condition that causes pain along the intercostal nerves. Neural tumors of the chest mostly arise from mediastinum and only less than 5-10% of primary tumors originate from intercostal nerves. These patients are usually asymptomatic. Herein, we report a 42-year-old male patient with severe intercostal neuralgia due to the schwannoma of the chest wall. The patient underwent surgical resection and his histopathological diagnosis was a very rare type of schwannoma: ancient schwannoma. Resecting the tumor relieved his pain

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.

Background: The most common cause of pleural empyema are parapneumonic effusions, and lung cancer is a rare cause of empyema. The aim of the present study is to analyse the results of the thoracoscopic treatment of empyema before definitive oncological treatment.Methods: Retrospective descriptive study of 332 patients including different clinical variables between 2002 and 2010.Results: Among 332 patients with empyema, the etiology of this disease was lung cancer in 11 patients. Ten of these patients were male and one was female (median age, 57.9 years; range, 46-76). The initial treatment was tube thoracostomy in 8 patients and video-assisted thoracoscopic surgery in 3 patients. Thoracoscopic debridement was performed in 4 patients whose tube thoracostomy underperformed because of insufficient drainage. The methods used for diagnosis of lung cancer were fiberoptic bronchoscopy and video-assisted thoracoscopic surgery. Surgical resection was performed on 7 suitable patients following infection control. Postoperative bronchopleural fistula and empyema occurred after pneumonectomy in one case. No operative mortality was observed. The mean survival time was 32.8 months for patients undergoing resection.Conclusions: Empyema could be a rare presentation of lung cancer and those suitable for surgical treatment should undergo standard treatment with reasonable results. (C) 2014 AEC. Published by Elsevier Espana, S.L.U. All rights reserved.

ObjectivesThe aim of the study was to evaluate the effectiveness of (28F) chest tube thoracostomy (TT) and (8F) small-bore thorax catheter (TC) in treatment of primary spontaneous pneumothorax patients.

Aim: Bronchial sleeve resections are developed as alternative techniques to pneumonectomy operation in malignant and benign pathologies of the lung. Patients and Methods: This study was carried out between September 1994 and May 2009 in order to examine 71 patients who underwent sleeve resection in Istanbul Sureyyapasa Chest Surgery Center. Results: Twenty-six of the patients died in long term follow-up, mean and maximum follow-up duration was 33 months and 120 months, respectively. Standard deviation was 27.7. General survival rate in two years was 67.2% (mean 57.3±7.5 months). With the development of complications; the relationships between operation side, anastomosis technique (seperate, continuous suture), patients’ age were investigated, however statistically significant results were found (p=0.09, p=0.4, p=0.3, respectively). The effect on survival was investigated between right and left sided operation, no significant results were found statistically (p=0.13). When survival rates were analysed according to the presence of complications; better statistical results were found, however still with no statistical significance (p= 0.08). It was statistically significant that survival rates were affected by additional surgical procedures (p= 0.03). It was also statistically significant that N factor, which was divided into three groups: N0, N1 and N2, had an influence on survival (p=0.03). The two-year survival rate was 81.5% in N0, 63% in N1, 21% in N2. There was no statistically 6 GİRİŞ Pulmoner cerrahide maksimum sağlam dokunun korunması amaçtır. Sleeve rezeksiyonlar ana bronşla birlikte lobların çıkarılmasını ve karşılıklı anastomozunu içeren modern ve ideal bir cerrahi yöntemdir (1,2). Parankim koruyucu operasyonların tercih edilme nedenlerinden en önemlisi, solunum fonksiyon testlerinin daha ileri bir rezeksiyona müsaade etmediği durumlardır. Literatürde sleeve rezeksiyon yapılma oranı %3-19 arasında değişmektedir (2,3). Bu oranın düşük olma sebebi muhtemelen tekniğinin çok zahmetli olması ve lokal nüksten çekinilmesidir. Bronşiyal stenoz ve atelektazi major komplikasyonlardır. Bronkoskopi, bilgisayarlı tomografi ve magnetik rezonans görüntüleme, tümör invazyon genişliğini değerlendirmede yardımcıdır ve işlemi planlamada gereklidir. Ancak son karar daima operasyon sırasında lezyonun görünüşü ve kesit yüzeyinin frozen section ( F/S) değerlendirmesi ile verilir. Sleeve rezeksiyon kararında ilk adım bronkoskopidir. Bronkoskopide, doku tanısı ve bronşiyal rezeksiyonun genişliğini tanımlamak için; lezyondan, planlanan cerrahi sınırların proksimal ve distal alanlarından biyopsi örneklemeleri yapılır. Bu çalışmamızda kliniğimizde akciğer kanseri nedeniyle sleeve rezeksiyon yapılan hastaların sağkalımları, oluşan komplikasyonlara hastanın yaşı, rezeksiyon yapılan taraf ve anastomoz şeklinin etkisi ile tümör yeri, yaş, lenf nodu tutulumu, ek cerrahi işlem, komplikasyon durumunun sağkalım üzerindeki etkileri istatistiksel olarak incelendi. GEREÇ VE YÖNTEMLER Süreyyapaşa Göğüs Cerrahi Kliniğinde Eylül 1994Mayıs 2009 tarihleri arasında 71 hastaya sleeve rezeksiyon uygulandı. Küçük Hücreli Dışı Akciğer Kanseri nedeniyle sleeve rezeksiyon uygulanan olguların sayısı 51 idi. Çalışmamıza, karsinoid tümörler, adenoid kistik karsinom, bronş fraktürü ve hamartom nedeniyle sleeve rezeksiyon yapılan olgular dahil edilmedi. Preoperatif değerlendirmede; tüm hastalara fizik muayene, solunum fonksiyon testi, göğüs tomografisi, bronkoskopi, iğne biyopsisi, fizik muayenesi yapıldı. Uzak metastaz araştırmasında kraniyal magnetik rezonans görüntüleme, bilgisayarlı batın tomografisi, kemik sintigrafisi, ve son dört yılda yapılan olgularda pozitron emisyon tomografisi yapıldı. Küçük hücreli dışı akciğer kanseri nedeniyle sleeve rezeksiyon uygulanan 51 olgunun kırkında (%78.4) herhangi bir ek cerrahi işleme gerek duyulmadı. Bunun haricinde kalan 11 olguya (%21.6) ek cerrahi işlem uygulandı. Pulmoner arter Yapılan Rezeksiyonlar Adet % Sağ sleeve üst lobektomi 22 43.1 Sağ sleeve pnömonektomi 11 21.6 Sol sleeve üst lobektomi 9 17.7 Sağ sleeve üst bilobektomi 6 11.7 Sağ sleeve alt bilobektomi 1 2.0 Sol sleeve alt lobektomi 1 2.0 Sağ trakeal sleeve üst lobektomi 1 2.0 Toplam 51 100.0 Tablo 1: Yapılan Rezaksiyonların Dağılımı significant effect on survival by tumor diameters (p=0.6). Conclusion: Sleeve resections can be performed with low mortality and morbidity rates like other resections.

Bronchial carcinoid tumours were in the past defined as benign and classified as "bronchial adenomas". Currently bronchial carcinoid tumours are considered to be part of a spectrum of malignant neoplasms with neuroendocrine differentiation. Bronchial carcinoid tumours are classified by pathologic features as typical carcinoid tumours or atypical carcinoid tumours with different clinical course prognosis. The most common symptoms are cough, hemoptysis and recurrent pulmoner infection. Paraneoplastic syndromes are uncommon and include Carcinoid syndrome, Cushing's syndrome, and ectopic growth hormone-releasing hormone secretion. Bronchial carcinoid tumours are generally central location for this reason being visible by bronchoscopy. Endobronchial biopsy via bronchoscopy is safe, with a very low risk of bleeding. Atypical carcinoid tumours affected preferentially patients older than typical carcinoid tumours and demonstrated a more aggressive oncological behaviour with a high percentage of nodal involvement and distant metastases. The primary treatment is complete surgical resection (especially parenchymasparing procedures for typical carcinoid tumours) and formal mediastinal lymph node dissection. Long term prognosis is excellent in typical carcinoid tumours, although it is worse in atypical carcinoid tumours.

The aim of this clinical study was to evoluate effectiveness of titanium meshplate for chest wall reconstruction after chest wall tumor resection. Between 2009 and 2012, 6 patients with chest wall tumors were treated surgically. There were 3 female and 3 male patients and their ages ranged from 26 to 76 years. The patients were admitted due to chest pain and swelling. Tumors were placed on sternum in 3 of the patients and on anterolateral chest wall in 3 of them. After tumor resection, defect size ranged from 10 cm. x 14 cm. to 12 cm. x 20 cm. Chest wall reconstructions were performed using titanium meshplate and pedicled muscular flaps. Titanium meshplates were fixed in ribs and/or sternum by titanium wires or screws. ![Figure][1] Postoperative pathology for sternal tumors were condrosarcoma, malign melanoma and liposarcoma, and for chest wall tumors they were osteocondroma, malign fibrous histiocytoma and lymphoma. There were no paradoxial movement, difficulty in breathing, or prosthesis-related complications during the follow-up period. Only in one patient muscular flap necrosis has occured. Therefore second operation was performed for removal of necrotic muscular flap. The mean postoperative follow-up period was 15 months (range, 2–36 months). We consider that, titanium meshplate is an easily applicable and suitable material to use in the reconstruction of large chest wall defect. [1]: pending:yes

Background : 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.

Background: 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 x 5 cm x 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 air leakage was observed on the parenchymal surface. There was an extremely significant difference between 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. (Heart, Lung and Circulation 2012;21:711-714) (C) 2012 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier Inc. All rights reserved.

Fifty-one years old male with shortness of breath increased by effort since one year. The patient was smoking 30 packs of cigarette per year. Inspiration sounds were decreased on the left hemithorax. Pulmonary function test results were; FEV1: 2.21 L (60%), FVC: 3.22 L (70%), PEF: 3.71 L (42%), FEV 1/FVC: 68.6%. The computerized thorax tomography, showed a 155x127 mm soft tissue mass on the left anterior mediastinal region, pressing vascular structures, and heart, and causing atelectasis on the upper lobe. Incisional biopsy was taken from the mass via mediastinotomy at a differenet hospital; the pathology result was malignant diffuse lymphoma. PET-CT was applied for staging. 2R mediastinum hypermetabolic lymph node station, with 14.5 mm diameter was detected (SUV max: 5.4). The mass SUV max: was 8.7. Chemotherapy was applied to the patient with diagnose of lymphoma. However, due to lack of regression of mass, biopsy slides were reexamined; the diagnosis was changed to be carcinoid tumor. The mass was decided to be surgically removed by median sternotomy. The mass was quite vascular, and had tight adhesions between the lung and pericardium. The result of frozen section of the mass was reported to be atypical carcinoid tumor. The mass was removed totally. Mesh was placed instead of excised pericardium. The mass weight was 1300gr, size was 17.5x 15x 9.5 cm. No tumor was detected within surgical margins. Chromogranin, Synaptofizin, CK, and CD 56 was positive at the immunohistochemical panel. Microscopic findings were confirmed atypical carcinoid tumor. In conclusion, mediastinal carcinoid tumors are very rare. Their origin of tumor is difficult to determine. Surgery is the current treatment method.

Amac: Benign akciger hastaliklarinda cerrahi mudahale peroperatif ve postoperatif komplikasyonlari da beraberinde getirmektedir. Calismanin amaci, bu grup hastalarda uygulanmis tamamlama pnomonektomilerinin; endikasyon, komplikasyon ve postoperatif sonuclarini incelemektir. Yontemler: 16 yillik bir surecte benign akciger hastaligi nedeniyle tamamlama pnomonektomisi gerektiren toplam 27 hasta geriye donuk incelendi. Benign etiyoloji nedeniyle 23 hastada tamamlama pnomonektomisi uygulandi. Bu hasta grubunda etiyoloji, ameliyat teknigi ve komplikasyonlari etkileyen faktorler arastirildi. Bulgular: Tamamlayici pnomonektomi endikasyonlari; 23 hastada benign bronsektazi:14, tuberkuloz:5, bronkoplevral fistul:2, akciger nekrozu:2 hastaliklar idi. Ameliyat sonrasi bronkoplevral fistul ve ampiyem 6 olguda gelisti. Bronkoplevral fistul gelisimi acisindan; tuberkuloz, sag/sol farki ve guduk kapama teknikleri arasinda istatistiksel bir fark tespit edilemedi. Otuz gunluk operatif mortalite %8.69 2/23 idi. Mortalite gorulen olgularda BPF orani anlamli duzeyde yuksek bulundu p

OBJECTIVES 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 false-positive (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.