Mediastinitis is the infection of thoracic cavity occurring in the space between the two mediastinal pleural sheets. There are acute and chronic types of mediastinitis cases. The infection can progress in acute, subacute or chronic phases. Acute mediastinal infections usually occur after cardiac or thoracic surgery, due to esophageal perforations, or infections of the oropharyngeal region. A necrotizing mediastinal infection occurs due to an infection of neck which progressing at superior-inferior planes. Acute mediastinitis cases have high mortality rates and display progressive features.

Mediastinitis is an inflammation of the mediastinum. Descending necrotizing mediastinitis (DNM) is the most common form of mediastinitis. Symptoms of severe oropharyngeal infection, radiological evidence of mediastinitis, documentation of necrotising mediastinitis at surgery, and a relationship between the infection and a necrotizing process are all diagnostic criteria. The worsening conditions of fever, neck and chest pain, and respiratory distress are presenting features. Without aggressive surgical drainage, DNM may become fatal. Early diagnosis and prompt therapy play a crucial role in the management of mediastinitis. We aimed to compare the clinical features of mediastinitis. DNM cases that were treated in our clinics in the last 10 years were retrospectively reviewed. Patients with DNM were divided into three groups according to tomographic images. Demographic characteristics, accompanying diseases, anatomical localization, medical and surgical management, other clinical features, and morbidity and mortality rates of patients were collected and compared with univariate analysis. The adequacy of neck exploration or the need for additional surgery was determined by preoperative and postoperative computerized tomography evaluation. The etiologic causes of DNM were oropharyngeal in 12 cases and dental in 18 cases. The mean age of the 19 men and 11 women was 37 years. Mediastinal localization according to a computerized tomography image was type I in 11 patients, type IIA in 6 patients, and type IIB in 13 patients. The most common accompanying disorders were diabetes mellitus in 16.6%, cardiac disease in 10.0%, and hepatic in 3.3%. Neck exploration was performed in almost all cases. When the physicians failed to manage the patient with a single neck exploration procedure, mediastinoscopy, tube thoracostomy, and thoracotomy were added. In the series, 7/30 (23%) patients died. The mean duration of an intensive care unit stay was 29 days. Bacterial growth was cultured in 14 patients including all nonsurvivors. Because the prognosis is poor and the disease is more likely to spread below the carina in delayed cases, regardless of the aetiology or type of mediastinitis, aggressive surgery should be performed immediately.

Introduction: Malignant pleural mesothelioma (MPM) is a malignant tumor that is associated mostly with asbestos exposure. The present study was to evaluates the diagnostic value of neopterin, periostin, YKL-40, Tenascin-C (TNC), and Indolamine 2,3-dioxygenase (IDO) as noninvasive markers of malign pleural mesothelioma. Methods: Included in the study were 30 patients diagnosed with malign pleural mesothelioma, and 25 people as a control group. Biomarker levels were determined using an enzyme immunoassay . A Mann-Whitney U test and Spearman correlation methods were used for the statistical analysis. Results: All evaluated biomarkers were found to be significantly higher in the MPM group than in the control group (p < 0.05). There was no effect of such variables as gender, age or MPMsubtype on the parameters (p > 0.05) in the patient group. All biomarkers were positively correlated with each other (p < 0.001). Conclusions: The current non-invasive biomarkers that can be used in the diagnosis of MPM yielded significant results and can make important contributions to the early diagnosis of MPM.

Tuberculosis (TB) and thoracic malignancy mimic each other clinically, and pose diagnostic challenges. Both diseases are characterised by similar symptoms. We aimed to emphasise that some forms of TB are associated with misleading clinical and radiological manifestations. We present a retrospective study of clinical and pathological results of 10 cases with a preliminary presumptive diagnosis of thoracic malignancy. All patients were found to have TB without evidence of malignancy and were successfully treated with standard antibiotherapy after completion of diagnostic procedures. TB should be considered as a noteworthy differential diagnosis in patients living in TB-endemic countries, and biopsy plays a vital role in correctly diagnosing TB. Key Words: Mass, Neoplasm, Pulmonary, Tuberculosis.

Objective: To assess the severity caused by button batteries in esophagus. Methods: A total of 32 patients admitted with ingesting button batteries were retrospectively evaluated. Chest X-ray was ordered for diagnosis. Hospital stays, interventions, complications and mortality of the patients were collected. The time between the patients ingested the buton battery and its removal was defined as its duration in esophagus. All the patients underwent rigid esophagoscopy under general anaesthesia. Buton batteries at the first narrowing were removed by magyl clamp. Results: Of 32 patients, 21 were females, with a mean age of 22 months. The mean duration of ingestion was 17 hours. The mean hospital stay was 10 days. Of the patients, 75% were admitted within 24 hours. Complication rate was 19% and mortality rate was 6%. There was a strong correlation among the number of the cases and the coming years (p < 0.001). The regression was between the number of cases per year (outcome variable) and the years of the study (explanatory variable), (p < 0.001, R = 0.644, Figure 3). There was a significant finding that more cases (90%) were admitted in the last 12 years compared with the number in first 12 years (p < 0.001). There were no complications in cases in which the button battery was impacted in esophagus for less than 24 hours; however; eight cases whose duration was more than 24 hours resulted in complications in six patients and fatality in two patients (p < 0.001). Conclusion: Batteries should be removed upon its diagnosis. Otherwise, the injury in the esophageal mucosa may be caused by delay and can cause an increase in morbidity and mortality.

Desenden nekrotizan mediastinit (DNM) nadir görülen, fakat yüksek oranda ölümcül seyreden bir durumdur.DNM, mediastendeki hayati organların etrafında nadir görülen enfeksiyöz bir hastalıktır.Zamanında tanı konulmaz ve uygun olarak tedavi edilmezse sonuç fatal olur.Tedavideki gecikme enfeksiyonun mediastene yayılmasına

Konjenital lober amfizem; akciğerin bir veya daha fazla lobunun hiperekspansiyonu, bunun çevredeki normal akciğer dokusuna basısı ve mediastinal kayma ile karakterli bir respiratuvar distres nedenidir.Yeni doğan döneminde solunum sıkıntısına yol açmakla birlikte, ender olarak semptomların ortaya çıkışı altıncı

Objective: Pulmonary involvement of hydatid cyst disease (HCD) may cause rupture, anaphylaxis, pneumothorax, and pulmonary hypertension. Our aim was to analyze demographical and clinical characteristics of pulmonary HCD. Methods: Demographical characteristics, laboratory parameters, and clinical features of 171 children and adult patients with pulmonary HCD were analyzed. Age, gender, ELISA test results, duration of hospitalization, surgical method of cyst excision and number, diameter, localization, and perforation status of cysts were recorded. Physical examination, ultrasonography, computed tomography, and serologic tests were used to confirm diagnosis of hydatid cysts. Results: Perforated cysts were observed in 26 children and 22 adults. Twenty-three children and 12 adults had a giant cyst. Extrapulmonary hydatid cysts were observed in 10 children and 21 adults. ELISA IgG positivity was determined in 30 children and 34 adults. Twelve children experienced long-lasting air leakage and responded to drainage. In the adult group, 14 patients had long-lasting air leakage and 3 had empyema and expansion defect. The mean duration of hospitalization for children and adults was 8.9 and 10.45 days, respectively. Conclusion: A better understanding of demographic features, clinical characteristics, complications of disease, and surgical procedures helps to determine optimal follow-up and the therapeutic choice.

The majority of chest pain in children is idiopathic or as­sociated with locomotor system pathologies. Albeit car­diac and other thoracic malign tumors may cause chest pain, malignancies usually show rapid clinical onset and are presented with multiple systemic symptoms. It is not a usual finding for chest pain being the sole initial symp­tom. Herein, we report two children who were presented with chest pain as an initial symptom and diagnosed with fibrosarcoma and lymphoma afterwards. Therefore, we want to emphasize that cardiac and pericardial malignant tumors should be remembered in differential diagnosis of chest pain in children.

The purpose of this study was to investigate the potential value of certain biomarkers in predicting the presence of malignant pleural mesothelioma (MPM) in individuals environmentally exposed to asbestos.

OBJECTIVES Spontaneous pneumothorax refers to the leakage of air into the space between the parietal and the visceral layers of the pleura. It occurs with or without a known lung disease. We aimed to investigate the effects of atmospheric pressure, humidity, and temperature changes on the incidence of spontaneous pneumothorax (SP). MATERIAL AND METHODS This study included 551 patients with spontaneous pneumothorax retrospectively screened between January 2009 and December 2013. The medical data of the patients were accessed via their medical records on the hospital automation system. The atmospheric pressure, temperature, humidity rate, amount of precipitation, and wind velocity on the day of spontaneous pneumothorax were obtained from the data provided by the general directorate of meteorology. The three consecutive days on which at least 2 cases of SP presented were collectively considered as a cluster. The study data were analyzed with the SPSS version 15 software package, using the Chi-square and the Student's t tests. A p value less than 0.05 was considered statistically significant. RESULTS Of the 552 patients included in the study, 89.3% had primary spontaneous pneumothorax and 10.7% had secondary spontaneous pneumothorax. Ninety-two percent of the patients were male and 8% were female. The mean age was 24 years. Clustering was observed in 71.7% of the study population. No significant differences were observed between yearly and monthly SP incidences. There were, however, differences between the days with SP and the days without SP with respect to atmospheric pressure, ambient temperature, wind velocity, and humidity rate. The differences between the atmospheric pressures were not statistically significant, although the differences between the ambient temperature and the humidity rate were statistically significant (p≤ 0.05). CONCLUSION We determined that the changes in the ambient temperature and the humidity rate affected the rate of spontaneous pneumothorax by altering the meteorological conditions.

Sternal cleft is a rare natal abnormality resulting from complete or partial failure of the sternal bars to fuse.It may occur with abdominal and/or thoracic malformations.Clinical features may vary depending on the associated disorders.Early repair may yield better results.Herein, we present a three-month-old girl with sternal cleft operated.

Primer pulmoner lenfoma, tum akciger tumorlerinin yalnizca %0,5’ini teskil eden ve intrapulmoner lenfatiklerden kaynaklanan nadir bir tumordur. Radyolojik olarak kitle ve konsolidasyon seklinde gorulebilmesi nedeniyle, primer veya metastatik akciger kanseri, pnomoni, sekestrasyon ve atelektazi gibi bircok hastaligin ayirici tanisinda dusunulmelidir. Iki yildir sikâyetleri olan 44 yasinda erkek hastanin toraks bilgisayarli tomografide sol akciger lingular segmentte kalp’le sinirlari net ayirt edilemeyen 65x68 mm ebatinda kitle saptandi. Tanisal torakotomide histopatolojisi lenfoma ile uyumlu geldi ve lingula ve alt lob apikal segmentinide icine alacak sekilde wedge rezeksiyonu uygulandi. Bu calismada, oksuruk ve halsizlik sikâyetiyle yatirilarak primer akciger (dusuk grade B-hucreli) lenfomasi tanisi konulan olguyu sunmayi amacladik.

e20086 Background: VEGF is one of the parameters that has been studied in differential diagnosis of malign fluids. This study is aimed to evaluate applicability of serum, fluid VEGF level and fluid to serum VEGF ratio in the diagnosis of MPM. Methods: The patients with pleural effusion over age of 18, between period of 2011 and 2015 were included in the study. They were separated into three groups: group 1: mesothelioma patients, group 2: other malignancies and group 3: benign etiologies. Group 1 and 2 were accepted as malign group. For evaluate fluid/serum VEGF ratio In all groups, fluid, serum VEGF levels and ratio of fluid/serum VEGF level were studied. Results: 20 cases with mesothelioma, 44 cases with other malignancies and 20 cases with benign etiologies were included in this study. No statistically significant difference were found according to serum VEGF levels for all groups, (group 1: 437±324 pg/ml, group 2: 354±223 pg/ml, group 3: 373±217 pg/ml, p:0.836), while fluid VEGF levels showed statistically significant difference (group1: 3359±700 pg/ml, group 2: 2175±435 pg/ml, group 3: 1092±435 pg/ml, p:0.041). Ratio of fluid to serum VEGF levels showed no statistical difference between malign (group 1 and group 2) and benign (group 3) groups. (8.83±1.29 vs. 4.57±1.07, p:0.059), but showed statistically significant difference between mesothelioma and benign groups. (12.11±1.68 vs. 4.57±1.07, p:0.044). Conclusions: VEGF can be an applicable parameter in the differential diagnosis of malign fluids, especially malign pleural mesothelioma. Further studies need to be done to support the applicability of fluid/serum VEGF ratio as a promising parameter for differential diagnosis of the malign fluids. However these parameters should be evaluate with others parameters that using for differantial diagnosis malign fluids.

Sağ orta lob sendromu, sağ orta lobda inatçı ya da tekrarlayan atelektaziler ile karakterize

Primary pulmonary lymphoma, which is constitutes only 0,5% of all lung tumors, is a rare tumor arising from in­trapulmonary lymphatics. Due to presentation with mass and consolidation, many diseases, require to be consid­ered in the differential diagnosis such as primary or meta­static lung cancer, pneumonia, pulmonary sequestration and atelectasis radiologically. A 44 years old male patient with complaints for two years, with 65x68 mm pulmo­nary mass lesion in left upper lobe and lingular segments which has boundaries could not be distinguished by heart border, was interned. Diagnostic thoracotomy applied and histopathology was obtained as pulmonary lymphoma. Wedge resection including lingula and lower lobe api­cal segments was performed. In this study, we aimed to present a case hospitalized with complaints of cough and fatigue and diagnosed as primary pulmonary ( low-grade B-cell) lymphoma.