Introduction: Lung herniation is defined as a protrusion of the lung parenchyma with its pleura through the intercostal space. It is a rare condition and usually occurs after thoracic trauma and surgical interventions. A few cases of lung herniations have been reported after video-assisted thoracoscopic surgery (VATS) but only two cases have been reported after VATS lobectomy. Aim: The VATS procedure has become the dominant method of lung cancer surgery, but there is no case series about the complications of lung herniation in the literature. We aim to define some risk factors and possible ways of prevention of lung herniation after VATS resection. Material and methods: This study retrospectively analyses 650 (550 anatomic, 100 non-anatomic sublobar resections) patients who underwent lung resections for lung cancer in our department between 2012 and 2018. We detected lung herniation in 3 patients after VATS resection. Results: Asymptomatic lung hernias may be managed by close observation but because of the risk of incarceration of the pulmonary parenchyma, surgery is often necessary. The main steps of treatment involve: identification of the hernia, freeing of all adhesions, reduction of the lung tissue back into the thoracic cavity and repairing the defect of the chest wall. Conclusions: By this retrospective case series, we defined some patient-related and surgeon-related risk factors and some basic recommendations for prevention of this complication.

No abstract

BACKGROUND:Trauma is an important health problem in children, and improvement in trauma care on the national level is possible only through the knowledge gathered from trauma registry systems. This information is not available in our country, because there is no current trauma registry system in the hospitals. Our aim in this paper is to explain the trauma registry system we have developed and to present the first year's data. METHODS:The planned trauma registry system was integrated into the emergency department registry system of 14 hospitals in the Izmir province. The data of pediatric patients with multiple trauma have been recorded automatically through the registry system. Demographics, vital signs, mechanism, the type of trauma, anatomical region, Injury Severity Score (ISS), Pediatric Trauma Score (PTS), Glasgow Coma Scale (GCS) score, the length of hospital stay, and the need for blood transfusion/endotracheal intubation/surgery/ hospitalization were evaluated by the patient transfer status and outcome. RESULTS:At the end of one year, a total of 356 pediatric major trauma patients were included in the study. The most common type of trauma was blunt trauma (91.9%), and the most common mechanism was vehicle-related traffic accident (28.1%). In the group with the Glasgow Outcome Scale ≤3; the age was greater, ISS was higher, and PTS was lower. Motorcycle accidents, sports injuries, and penetrating injuries were more frequent in this group. All scores were significantly different between direct and transferred patients. The referral time to the hospital of the transferred patients was longer than directly admitted patients, but the results were not different. CONCLUSION:Pediatric major trauma is an important cause of mortality and morbidity, and our trauma registry system, which is a successful example abroad, is insufficient in our country. We hope that the trauma registry system we planned and the pilot application we started will be expanded to include other hospitals throughout the country with the aim of developing a national registry system.

Bu çalışmada pulmoner karsinoid tümörlerde sağkalımı etkileyen prognostik faktörler incelendi. Ça lış mapla nı:1 Ocak 2005-31 Aralık 2016 tarihleri arasında, pulmoner karsinoid tümör dolayısıyla rezeksiyon uygulanan olgularda cinsiyet, yaş, sigara kullanımı, eşlik eden hastalık, tümörün yerleşim yeri, T durumu, N durumu, histolojik tip ve patolojik evre geriye dönük olarak gözden geçirildi. Bul gu lar: Çalışmamıza 40 tipik ve 7 atipik karsinoid tümör olmak üzere 47 hasta (18 erkek, 29 kadın; ort yaş 50.5 yıl; dağılım, 23-74 yıl) dahil edildi. Tüm hastalara anatomik rezeksiyon ve sistematik mediastinal lenf nodül diseksiyonu uygulandı. Patolojik değerlendirmede altı hastada lenfatik tutulum saptandı (%12.8; 4 pN 1 ve 2 pN 2). Tipik grupta (n=40) üç hasta N 1 (%7.5) ve bir hasta N 2 (%2.5) olarak sınıflandırıldı. Atipik grupta (n=7) bir hasta N 1 (14.3%) ve bir hasta N 2 (14.3%) olarak sınıflandırıldı. Çalışma boyunca, tipik histolojisi olan dört (%10) ve atipik histolojisi olan iki (%28.6) hastada nodal tutulum vardı. Nodal tutulum olan altı hastanın tamamına adjuvan tedavi uygulandı. Atipik histoloji (p= 0.005) ve nodal tutulum (p= 0.008) istatistik çalışmada kötü prognostik faktör olarak saptandı. So nuç: Pulmoner karsinoid tümörün cerrahi tedavisinde, sistematik hiler ve mediastinal lenf nodu diseksiyonunun önemli rolü vardır. Anah tar söz cük ler: Nodal tutulum; prognostik faktörler; pulmoner karsinoid tümör.

Background:Predominant histologic subtypes have been reported as predictors of survival of patients with pulmonary adenocarcinoma.Aims:To evaluate the predictive value of histologic classification in resected lung adenocarcinoma using the classification systems proposed by the International Association for the Study of Lung Cancer, American Thoracic Society, European Respiratory Society, and World Health Organization (2015).Study Design:Cross-sectional study.Methods:The histologic classification of a large cohort of 491 patients with resected lung adenocarcinoma (stages I-III) was retrospectively analyzed. The tumors were classified according to their predominant component (lepidic, acinar, papillary, solid, micropapillary, and mucinous), and their predictive values were assessed for clinicopathologic characteristics and overall survival.Results:The patient cohort comprised 158 (32.2%) patients with solid predominant, 150 (30.5%) with acinar predominant, 80 (16.3%) with papillary predominant, 75 (15.3%) with lepidic predominant, 22 (4.5%) with mucinous, and 5 (1.0%) with micropapillary subtype, and 1 (0.2%) with adenocarcinoma in situ. Overall 5-year survival of 491 patients was found to be 51.8%. Patients with lepidic, acinar, and mucinous adenocarcinoma had 70.9%, 59.0%, and 66.6% 5-year survival, respectively, and there was no statistically significant difference between them. Whereas patients with solid, papillary, and micropapillary predominant adenocarcinoma had 41.0%, 40.5%, and 0.0% 5-year survival, respectively. Compared to other histologic subtypes, patients with solid and papillary predominant adenocarcinoma had significantly lower survival than those with lepidic (p<0.001, p=0.002), acinar (p<0.001, p=0.008), and mucinous (p=0.048, p=0.048) subtypes, respectively. The survival difference between patients with solid subtype and those with papillary subtype was not statistically significant (p=0.67).Conclusion:Solid and papillary histologic subtypes are poor prognostic factors in resected invasive lung adenocarcinoma.

Background: Until the reclassification by the International Association for the Study of Lung Cancer, the term bronchoalveolar carcinoma (BAC) has been used for many years. Accordingly, the terms BAC and mixed adenocarcinoma were replaced by the terms such as adenocarcinoma in situ, minimally invasive adenocarcinoma, lepidic dominant type adenocarcinoma, mucinous minimally invasive adenocarcinoma, and mucinous invasive adenocarcinoma. The aim of this study was to retrospectively evaluate the cases diagnosed as BAC and mixed type adenocarcinoma operated in our clinic and to compare the clinical and survival characteristics of these cases according to the new classification. Materials and Methods: 37 patients who were operated in our clinic between January 2005 and December 2014 and diagnosed as BAC and mixed adenocarcinoma containing BAC components were included in the study. Pathologic slides were re-reviewed by the pathologists of our hospital and reclassified according to the predominant histologic subtype. In addition to the predominant cell type, the ratio of other cell types were also specified in 5% ratio slices. Results: The histopathological diagnoses of 37 formerly BAC patients, 14 of whom were mixed type, were changed as 33 lepidic, two mucinous, one adenocarcinoma in situ and one micro-invasive adenocarcinoma. The 5-year survival rate for lepidic predominant histological subtype was 70.3, while it was 50% (p = 0.533) for the two mucinous cases. Conclusions: The predominant cell type distribution used in the new classification of IASLC is more effective in determining survival and is more suitable for use in treatment and follow-up programs.

No abstract

BACKGROUND: The present study aims to assess whether there are any differences in the management and outcome of polytrauma patients with thoracic trauma in trauma units of two different hospitals in the same country; one hospital is near the Syrian border. METHODS: A retrospective analysis (January 2012 to January 2014) of 348 polytrauma casualties with thoracic trauma from Manisa Celal Bayar University Hospital (MH) were compared according to age, gender, mechanism of injury, associated injuries, abbreviated injury scale (AIS), injury severity score (ISS), treatment modalities, and mortality with 917 patients of Şanlıurfa Training and Research Hospital (SH) registry (near the Syrian border). RESULTS: Of the 348 patients in the MH, 230 (66%) and of the 917 patients in the SH, 697 (76%) were males (p<0.001). Mean age was 45.6±18.3 yrs in the MH group and 26.4±22.4 yrs in the SH group (p<0.001). The SH patients had a larger proportion of stab wounds (MH; 9% vs. SH; 17%, p<0.05), gunshot injuries (MH; 5% vs. SH; 18%, p<0.05), higher mean ISS (MH; 30.2±8.4 vs. SH; 42.8±10.2, p<0.001), and increased mortality (MH; 2.6% vs. SH; 11.1%, p<0.001). AIS abdomen was the highest component in the SH registry (AIS abdomen = 4.8±0.7), whereas AIS extremities were the highest component in the MH registry (AIS extremities = 3.6±0.2). CONCLUSION: Significantly different demographic features, mechanisms of injury, worse outcomes and higher mortality rates in SH demonstrate and reflect the surgical challenges depending on the combat environment. Two hospitals in Turkey, one seemingly adjacent to a war zone and another with the more standard civilian experience highlight the impact of the Syrian conflict on the Turkish healthcare system.