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.

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.

Thoracic empyema is a collection of pus in the pleural space. Empyema necessitatis is a rare complication of empyema, characterized by the dissection of pus through the soft tissues of the chest wall and eventually through the skin. We present nine cases of empyema necessitatis, including etiology, duration, and characteristics of clinical history, kind of surgery used, and treatment choices.

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

Palpable lesion(s) noticed in a patient with thoracic disease may be a useful diagnostic tool and it often gives a clue for further management. In this study, we searched the diagnostic value of palpable lesions in patients with thoracic pathology suspected clinically and/or radiologically. We prospectively examined the correlations of clinical/radiologic and pathologic findings of 72 palpable lesions from 68 patients who presented with suspect for a thoracic disease from two tertiary medical centers. Thirty‐two lesions (44.4%) were diagnosed as malignant either by fine‐needle aspiration (FNA) only or FNA with confirmatory biopsy. The most common malignancy was non‐small‐cell carcinoma (10) followed by adenocarcinoma (6), and small‐cell carcinoma (5). The most common localization of the palpable lesions was cervical region (20.8%) followed by left supraclavicular (13.8%) and anterior chest wall (13.8%). FNA was effective in obtaining an accurate diagnosis in 66.6% of the patients. Tissue confirmation of FNA was performed in 54 patients. The sensitivity, specificity, negative predictive value, and positive predictive value of FNA in distinguishing a malignant lesion from a benign disease for these palpable lesions were 75, 97, 96, and 80, respectively. One false negativity and one false positivity were also found. Abnormal radiologic features were not correlated with having a malignant palpable lesion. Evaluation of the palpable lesions by FNA and tissue biopsy together is effective for initial triage of the patients with suspect for a thoracic pathology. FNA alone is a convenient and easy method for this purpose especially when the material is immediately assessed for specimen adequacy. Diagn. Cytopathol. 2013. © 2011 Wiley Periodicals, Inc.

To evaluate the effectiveness of electrocoagulation of bullae/blebs and apical pleurectomy via videothoracoscopic approach.

Background: 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 and 2005. There were 17 female and 12 male patients and their ages ranged from 7 to 68 years. Patients were divided into two groups 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 11 (n = 11).Results: Twenty-five patients (86.2%) were symptomatic. Cough and sputum were the most common symptoms. Twenty-four of the 29 BCs were simple cysts (82.7%) whereas 5 (17.3%) were complicated cysts. Postoperative hospital stay was 4.55 +/- 0.86 days in group I and 6.54 +/- 3.34 days in group 11 (P = 0.172). Complications in Group I were pneumonia in one case and wound infection in two cases; prolonged air leakage were observed in two cases of Group II. No statistical difference was determined between the complication rates of the two groups (P = 0.91). However a significant difference was determined between the complication rates of simple and complicated cysts (P = 0.026). Two cases in Group II showed recurrence, whereas no recurrence occurred in Group I. (P = 0.065) No postoperative mortality was observed in any of the groups.Conclusions: All bronchogenic cysts should be treated surgically. We believe that partial excision with de-epithelisation may be an alternative to resection in symptomatic patients with limited respiratory capacity. (Heart, Lung and Circulation 2009;18:214-218) (C) 2008 Australasian Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand. Published by Elsevier Inc. All rights reserved.

BACKGROUND: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.

Pleural empyema is a serious problem which affects any age group and still there is no standard approach. Our purpose in this study was to assess the safety, feasibility and efficacy of the video-assisted thoracoscopic surgery (VATS). Between 1997 and 2004 83 patients with empyema were enrolled in this study. Fifty-four patients were male, 29 females and the mean age was 39.4. The mean duration time of symptoms before VATS was 27.3 days. Twenty-two patients were in group-5, 44 in group-6 and 17 in group-7 according to Light's classification of parapneumonic effusions and empyema. Twenty-one patients underwent chest tube before VATS because of their conditions. VATS was converted to thoracotomy in 13 patients. All patients underwent debridement and irrigation during VATS. The cure was achieved in 58 (69.9%) patients with the mean 7.63 days drainage time. Twelve patients were underwent open decortication in the follow-up period. Ten of them were group-7 and 2 in group-6 (p= 0.006). The diagnosis was achieved in 60 (72.3%) patients as nonspecific pleuritis, tuberculosis in 19 and various diagnosis in 4. There was no mortality and minor complications occured in 14 patients. VATS is a safety and efficacy procedure in the treatment of early stage empyema. Use of VATS in early period of multiloculary empyema, prevents patients from unnecessary thoracotomies.

Objectives: The aim of this study is to evaluate the clinical behavior of the solitary fibrous tumors of pleura and the optimal surgical approach for these rare tumors. Material and Methods: We have reviewed the records of six patients who underwent tumor resection in our clinic between 1997 and 2004 retrospectively. Results: Six patients were operated in this period and the mean age was 42.3 years. None of them have been exposed to asbestosis. Symptoms were presented in five patients. All patients underwent thoracotomy. Tumor was originated from visceral pleura in five patients and parietal pleura in one. All patients underwent tumor excision. Mean diameter for tumor was 14cm (range 6 to 24). Pathology results were reported as benign solitary fibrous tumor of the pleura for all the six patients. Resection was complete in all patients. There was no postoperative mortality and major complications. No recurrence has been observed during the mean 53.5 months follow-up. Conclusion: Solitary fibrous tumors of the pleura are rare neoplasms and can reach to giant diameters. Complete surgical resection is the optimal treatment for these tumors and risk of malignancy in larger masses should be remembered. ©2007, Firat University, Medical Faculty

Bronchial rupture due to tracheobronchial trauma is a very rare condition. Early evaluation is necessary in order to avoid irreversible changes such as fibrosis and bronchial stenosis. Cases with post-traumatic hemo-pneumothorax, pneumomediastinum, subcutaneous emphysema and atelectasis require consideration of bronchial laceration with urgent bronchoscopy and early surgery, if needed. A 15 year-old patient with a history of blunt chest trauma two years ago presented with symptoms of pulmonary infection. Radiological and bronchoscopic evaluation revealed right upper lobe atelectasis secondary to fibrosis. Patient underwent right upper lobectomy.

Bronchial rupture due to tracheobronchial trauma is a very rare condition. Early evaluation is necessary in order to avoid irreversible changes such as fibrosis and bronchial stenosis. Cases with post-traumatic hemo-pneumothorax, pneumomediastinum, subcutaneous emphysema and atelectasis require consideration of bronchial laceration with urgent bronchoscopy and early surgery, if needed. A 15 year-old patient with a history of blunt chest trauma two years ago presented with symptoms of pulmonary infection. Radiological and bronchoscopic evaluation revealed right upper lobe atelectasis secondary to fibrosis. Patient underwent right upper lobectomy.

OBJECTIVE: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.