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author:("bilipid, S.")
1.  Pathologic and Clinical Characteristics of Elderly Patients With Breast Cancer: A Retrospective Analysis of a Multicenter Study (Anatolian Society of Medical Oncology) 
International Surgery  2014;99(1):2-7.
There is very little information about breast cancer characteristics, treatment choices, and survival among elderly patients. The purpose of this multicenter retrospective study was to examine the clinical, pathologic, and biologic characteristics of 620 breast cancer patients age 70 years or older. Between June 1991 and May 2012, 620 patients with breast cancer, recruited from 16 institutions, were enrolled in the retrospective study. Patients had smaller tumors at diagnosis; only 15% of patients had tumors larger than 5 cm. The number of patients who had no axillary lymph node involvement was 203 (32.7%). Ninety-three patients (15.0%) had metastatic disease at diagnosis. Patients were characterized by a higher fraction of pure lobular carcinomas (75.3%). The tumors of the elderly patients were also more frequently estrogen receptor (ER) positive (75.2%) and progesterone receptor (PR) positive (67.3%). The local and systemic therapies for breast cancer differed according to age. An association between age and overall survival has not been demonstrated in elderly patients with breast cancer. In conclusion, the biologic behavior of older patients with breast cancer differs from younger patients, and older patients receive different treatments.
PMCID: PMC3897335  PMID: 24444261
Breast cancer; Elderly patients; Clinical characteristics; Pathologic characteristics
2.  The Comorbidity of Reduplicative Paramnesia, Intermetamorphosis, Reverse-Intermetamorphosis, Misidentification of Reflection, and Capgras Syndrome in an Adolescent Patient 
Case Reports in Psychiatry  2014;2014:360480.
Delusional misidentification syndromes may be superimposed on neurological or psychiatric disorders and include delusional beliefs that the people, objects, or places around the patient change or are made to change with one another. In this paper, an adolescent patient displaying Capgras syndrome, metamorphosis, reverse-intermetamorphosis, misidentification of reflection, and reduplicative paramnesia was presented. The findings that our patient struggled with visuospatial tests applied in the acute phase as well as the observation that she refused to meet her family face-to-face while accepting to speak on the phone may support the role of right hemisphere and visuospatial functions in the development of those syndromes. Further studies or case series evaluated more extensively are needed to reveal the relationship between right hemisphere functions and delusional misidentification syndromes.
PMCID: PMC4190062  PMID: 25328744
3.  Vitamin B12, folate, and homocysteine levels in patients with obsessive–compulsive disorder 
It is known that elevated serum homocysteine, decreased folate, and low vitamin B12 serum levels are associated with poor cognitive function, cognitive decline, and dementia. Current literature shows that some psychiatric disorders, mainly affective and psychotic ones, can be related to the levels of vitamin B12, folate, and homocysteine. These results can be explained by the importance of vitamin B12, folate, and homocysteine in carbon transfer metabolism (methylation), which is required for the production of serotonin as well as for other monoamine neurotransmitters and catecholamines. Earlier studies focused on the relationship between folate deficiency, hyperhomocysteinemia, and depressive disorders. Although depressive and anxiety disorders show a common comorbidity pattern, there are few studies addressing the effect of impaired one-carbon metabolism in anxiety disorders – especially in obsessive–compulsive disorder (OCD). This study aimed to measure the levels of vitamin B12, folate, and homocysteine specifically in order to see if eventual alterations have an etiopathogenetic significance on patients with OCD. Serum vitamin B12, folate, and homocysteine concentrations were measured in 35 patients with OCD and 22 controls. In addition, the Structured Clinical Interview for the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition, Text Revision, Yale–Brown Obsessive Compulsive Scale, Hamilton Rating Scale for Depression, and Hamilton Rating Scale for Anxiety were conducted for each patient. It was found that vitamin B12 levels were decreased and homocysteine levels were increased in some OCD patients. Homocysteine levels were positively correlated with Yale–Brown compulsion and Yale–Brown total scores. In conclusion, findings of this study suggest that some OCD patients might have vitamin B12 deficiency and higher homocysteine levels.
PMCID: PMC4164291  PMID: 25228807
obsessive–compulsive disorder; vitamin B12; folate; homocysteine; obsession; compulsion
4.  Motivation for treatment in patients with substance use disorder: personal volunteering versus legal/familial enforcement 
Motivation for treatment on the part of patients with addictive disorders is known to affect their prognosis, and lack thereof is reported to be among the most common reasons for failed treatment adherence and relapse after treatment. This study evaluated the relationship between volunteering, personality, demographic factors, and motivation for treatment.
The study was conducted at a substance dependence center in the eastern part of Turkey. Forty-five patients (mean age 37.9±11.2 years) with a substance use disorder were included. They were assessed using the Structured Clinical Interview for DSM (Diagnostic and Statistical Manual of Mental Disorders) Axis II disorders. Depression and anxiety were evaluated using the Beck depression and anxiety inventories, and motivation for treatment was measured using the Turkish version of the Texas Christian University Motivation for Treatment scale.
All patients had been using substances daily and 41 (88.9%) had been using multiple drugs. The most commonly used substance was heroin (n=18, 40%). Voluntary admission was a predictor of motivation for treatment (P<0.05). Having a personality disorder and higher depression scores were related to less motivation for treatment.
Motivation for treatment is affected by external factors such as type of admission and internal factors such as personality disorder and depression. Investigation of ways to encourage voluntary admission for treatment instead of enforced strategies may be helpful for achieving higher levels of motivation for treatment in substance users.
PMCID: PMC4155996  PMID: 25210453
substance use; motivation; treatment; voluntary; personality; depression
5.  Prognostic factors related with survival in patients with pancreatic adenocarcinoma 
World Journal of Gastroenterology : WJG  2014;20(31):10802-10812.
The prognosis in patients with pancreatic cancer is poor and this cancer is the fourth leading cause of cancer-related death worldwide. Although surgical resection is the only curative treatment of choice for pancreatic cancer, the majority of patients are diagnosed at an advanced stage, thus only 10%-15% of them are suitable for curative resection and the overall survival is less than 5%. Chemotherapy for metastatic disease is to palliate symptoms of patients and to improve survival. Therefore, prognostic factors are important and a correct definition of poor prognostic factors may help to guide more aggressive adjuvant or aggressive treatment protocols in patients with pancreatic cancer. This article reviews the prognostic factors affecting survival of patients with pancreatic cancer in the light of recent advances in the literature.
PMCID: PMC4138460  PMID: 25152583
Pancreatic cancer; Prognostic factors; Survival; Carbohydrate antigen 19-9; Treatment
6.  Dynamic multidetector computed tomography findings of hepatocellular carcinoma of hepatitis B virus-positive and -negative patients 
Cancer Imaging  2014;14(1):9.
The objective of this study was to retrospectively investigate and compare multidetector computed tomography findings of hepatocellular carcinoma (HCC) in hepatitis B virus (HBV)-positive and -negative patients.
Triphasic (arterial, portal venous, and delayed phases) dynamic multidetector computed tomography (CT) was performed in 83 patients with HCC, 48 of whom were HBV-positive. The diagnosis of HCC was established with typical CT imaging findings (68 patients) or histopathological evaluation (15 patients). Distribution of solitary, multiple, and diffuse HCC, portal/hepatic vein thrombosis, metastasis, and patients with high alpha-fetoprotein levels in the HBV-positive and -negative groups were compared using the Kolmogorov–Smirnov test. Lesion size, alpha-fetoprotein levels, arterial, portal, delayed enhancement, and washout of lesions were compared using the Student’s t-test.
Hypervascular tumors were observed in 72 (87%) patients, and hypovascular tumors were found in 11 (13%) patients. The mean alpha-fetoprotein value of HBV-positive patients with HCC was significantly higher than the mean alpha-fetoprotein value of HBV-negative patients (P < 0.05). Portal/hepatic vein thrombosis and metastasis were more frequently observed in HBV-positive patients (P < 0.05). The frequencies of solitary, multiple, and diffuse lesions in HBV-positive and -negative patients were not significantly different (P > 0.05). The mean diameters, arterial, portal, and delayed phase attenuations, and washout of HCC were not significantly different (P > 0.05).
Multidetector CT imaging findings of HCC in HBV-positive and -negative patients are alike. Portal/hepatic vein thrombosis and metastasis are more frequently observed in HBV-positive patients. Alpha-fetoprotein levels are higher in HBV-positive patients.
PMCID: PMC4331841  PMID: 25608603
Multidetector computed tomography; Hepatocellular carcinoma; Hepatitis B virus; Dynamic imaging
7.  Treatment options in patients with metastatic gastric cancer: Current status and future perspectives 
Despite advances in the treatment of gastric cancer, it remains the world’s second highest cause of cancer death. As gastric cancer is often diagnosed at an advanced stage, systemic chemotherapy is the mainstay of treatment for these patients. However, no standard palliative chemotherapy regimen has been accepted for patients with metastatic gastric cancer. Palliative chemotherapy including fluoropyrimidine, platin compounds, docetaxel and epirubicin prolongs survival, and improves a high quality of life to a greater extent than best supportive care. The number of clinical investigations associated with targeted agents has recently increased. Agents targeting the epidermal growth factor receptor 1 and human epidermal growth factor receptor 2 (HER2) have been widely tested. Trastuzumab was the first target drug developed, and pivotal phase III trials showed improved survival when trastuzumab was integrated into cisplatin/fluoropyrimidine-based chemotherapy in patients with metastatic gastric cancer. Trastuzumab in combination with chemotherapy was thus approved to be a new standard of care for patients with HER2-positive advanced esophagogastric adenocarcinoma. Thus, the evaluation of HER2 status in all patients with metastatic gastroesophageal adenocarcinoma should be considered. Other agents targeting vascular endothelial growth factor, mammalian target of rapamycin, and other biological pathways have also been investigated in clinical trials, but showed little impact on the survival of patients. In this review, systemic chemotherapy and targeted therapies for metastatic gastric cancer in the first- and second-line setting are summarized in the light of recent advances.
PMCID: PMC3983446  PMID: 24744580
Gastric cancer; Chemotherapy; Targeted therapy; Metastasis; Advanced-stage
8.  Primary Signet Ring Cell Carcinoma of the Lung with Cerebellar Metastasis Showing Full Response to Cisplatin and Docetaxel Therapy 
Introduction. Primary signet ring cell carcinoma (SRCC) of the lung is a very rare disease. We describe a new case of primary SRCC of the lung with cerebellar metastasis, which responded well to the therapeutic approach with cisplatin and docetaxel. Case Report. A 41-year-old female patient (nonsmoker) was consulted to our oncology outpatient clinic after cerebellar metastasectomy. The histopathological diagnosis was SRCC metastasis. The primary tumor was unknown. The PET-CT imaging showed a hypermetabolic mass in the right middle lobe of the lung and hypermetabolic mediastinal lymph node stations. Oesophagogastroduodenoscopy and colonoscopy showed no evidence of gastrointestinal system tumor. The clinical diagnosis of primary SRCC of the lung was made and the administration of six rounds of cisplatin and docetaxel treatment was planned. After the chemotherapy the PET-CT scan to evaluate the therapy response showed full metabolic regression of the primary tumor and the mediastinal lymph nodes. There was no evidence of new metastasis. Conclusion. Primary SRCC of the lung is a very rare disease with poor prognosis. There are not many cases in literature and no standardized chemotherapy protocols. Cisplatin and docetaxel may be a good treatment option.
PMCID: PMC3970380  PMID: 24716057
9.  Venous Intravasation as a Complication and Potential Pitfall During Hysterosalpingography: Re-Emerging Study with a Novel Classification 
Presently, hysterosalpingography (HSG) is used as a means to evaluate women with infertility and repetitive pregnancy loss. Venous intravasation is a complication and potential pitfall during HSG and analogous procedures including hysteroscopy. The aim of our study was to assess the venous intravasation and to obtain critical information for more secure and more accurate procedures. In particular, the primary goal of the present study was to compare HSG without and with intravasation to identify differences seen on HSG and to assess the predisposing factors of intravasation. The secondary goal was to describe clinical- and imaging-based novel classification of intravasation.
Materials and Methods:
This study included a patient cohort of 569 patients who underwent HSG between 2008 and 2011 at our center in the absence (control group) or presence (study group) of intravasation. Intravasation classified from level 0 (no intravasation) to level 3 (severe intravasation) was compared with preprocedural (demographic and clinical) and procedural (HSG) data. Data were analyzed using Statistical Package for Social Sciences (SPSS) statistical software.
Of the 569 patients undergoing HSG, 528 showed no intravasation and 41 (7.2%) patients showed intravasation when associated with preprocedural (leukocytes, menometrorrhagia, secondary infertility, ectopic pregnancy, abortus, polycystic ovaries, endometriosis, and interventions) and procedural (pain, scheduling, endometrial-uterine nature, and spillage) parameters. Moreover, intravasation was lower in women with smooth endometrium, triangular uterus, and homogeneous peritoneal spillage. No association was found between age, tubal patency, increased pressure, and intravasation.
Using a novel classification method, intravasation can be observed in women during HSG and associates with preprocedural and procedural predisposing factors in subsumed conditions. This classification method will be useful for improving the efficiency and accuracy of HSG and related procedures by minimization of severe complications caused by intravasation.
PMCID: PMC3935269  PMID: 24605262
Complications; hysterosalpingography; novel classification; potential pitfalls venous intravasation
10.  Arterial distensibility in patients with ruptured and unruptured intracranial aneurysms: Is it a predisposing factor for rupture risk? 
A risk factor assessment that reliably predicts whether patients are predisposed to intracranial aneurysm (IA) rupture has yet to be formulated. As such, the clinical management of unruptured IA remains unclear. Our aim was to determine whether impaired arterial distensibility and hypertrophic remodeling might be indicators of risk for IA rupture.
The study population (n=49) was selected from consecutive admissions for either unruptured IA (n=23) or ruptured IA (n=26) from January to December 2010. Hemodynamic measures were taken from every patient, including systolic and diastolic blood pressure using a sphygmomanometer. Unruptured IA and ruptured IA characteristics, including aneurysmal shape, size, angle, aspect ratio, and bottleneck factor, were measured and calculated from transverse brain CT angiography images. With ultrasound, the right common carotid artery intima-media thickness was measured, as well as the lumen diameter during systole and diastole. Arterial wall strain, distensibility, stiffness index, and elastic modulus were calculated and compared between patients with unruptured IAs and ruptured IAs. A p-value less than 0.05 was considered statistically significant.
General demographic data did not differ between patients with unruptured IAs and ruptured IAs. Greater mean intima-media thickness (p=0.013), mean stiffness index (p=0.044), and mean elastic modulus (p=0.026) were observed for patients with ruptured IAs. Moreover, mean strain (p=0.013) and mean distensibility (p=0.024) were decreased in patients with ruptured IAs.
Patients with ruptured IAs demonstrated decreased arterial distensibility and increased intima-media thickness at the level of the carotid arteries. By measuring these parameters via ultrasound, it may be possible to predict whether patients with existing IAs might rupture and hemorrhage into the subarachnoid space.
PMCID: PMC3762537  PMID: 23974299
ruptured; intracranial aneurysm; predisposing factors; elasticity; carotid intima-media thickness; ultrasound
11.  First Diagonal Coronary Artery: Left Ventricular Fistula Presenting as Unstable Angina 
Case Reports in Cardiology  2013;2013:908162.
Coronary artery fistulae are characterized by communications between a coronary artery and a cardiac chamber or another vascular structure. They are usually congenital, but acquired forms may occur. Most patients are usually asymptomatic. However, some studies have emphasized that the incidence of symptoms and complications increases with age, particularly after the age of 20 (Liberthson et al. 1979, Hong et al. 2004). We aimed to present a very rare form of fistula originating from the first diagonal artery and connecting into the left ventricle.
PMCID: PMC4008094  PMID: 24826299
12.  An incidental case of biliary fascioliasis with subtle clinical findings: US and MRCP findings 
Radiology and Oncology  2013;47(2):125-127.
Fascioliasis is a disease caused by the trematode Fasciola hepatica. Cholangitis is a common clinical manifestation. Although fascioliasis may show various radiological and clinical features, cases without biliary dilatation are rare.
Case report
We present unique ultrasound (US) and magnetic resonance cholangiopancreatography (MRCP) findings of a biliary fascioliasis case which doesn’t have biliary obstruction or cholestasis. Radiologically, curvilinear parasites compatible with juvenile and mature Fasciola hepatica within the gallbladder and common bile duct were found. The parasites appear as bright echogenic structures with no acoustic shadow on US and hypo-intense curvilinear lesions on T2 weighted MRCP images.
Imaging studies may significantly contribute to the diagnosis of patients with subtle clinical and laboratory findings, particularly in endemic regions.
PMCID: PMC3691091  PMID: 23801908
fascioliasis; ultrasonography; magnetic resonance cholangiopancreatography
13.  Thoracic Primitive Neuroectodermal Tumor: An Unusual Case and Literature Review 
Case Reports in Pulmonology  2013;2013:326871.
We describe herein a rare case of a primary primitive neuroectodermal tumor (PNET) in the mediastinum of a 75-year-old man. Grossly, the tumor was located in the left upper anterior mediastinum. Transcutaneous fine-needle biopsy (TCNB) revealed small round-cell proliferation. The expression immunohistochemical analysis was confirmed the diagnosis of PNET. He was successfully treated with chemotherapy and is alive with no sign of recurrence for 17 months after the diagnosis.
PMCID: PMC3674718  PMID: 23762725
14.  Are Breast Masses in Teenagers Always Benign? Undifferentiated Mesenchymal Sarcoma in a 14-Year-Old Girl 
Breast Care  2012;7(2):144-146.
This article is concerned with the evaluation of an adolescent breast mass using imaging methods.
Case Report
A 14-year-old girl presented with progressive asymmetric enlargement of the left breast. She had felt a breast lump about 4 months earlier, and over the last 2 months it had been growing progressively. Tumor markers, including AFP, CEA, CA15-3, and CA125, were all normal. Ultrasonography showed a hypoechoichyperechoic, solid mass. Magnetic resonance imaging of the breast revealed a well marginated mass with hypointensity on T1-weighted images and mild hyperintensity on T2-weighted images, which showed mild contrast uptake. Biopsy revealed an undifferentiated malignant mesenchymal sarcoma. The patient underwent mastectomy with axillary lymph node sampling. After the operation, she received 3 cycles of chemotherapy and radiotherapy.
Due to the rarity of breast sarcoma and inadequate imaging methods to establish an exact diagnosis, radiologists and clinicians may misdiagnose and merely follow these tumors. As in our case, the histology of the patient may be the leading factor in the management of these tumors. Even in very young patients, progressively growing breast masses should alert the clinician to check for malignancy verified by biopsy.
PMCID: PMC3376362  PMID: 22740802
Breast lump; Sarcoma, undifferentiated; MRI; Adolescent breast cancer
15.  Signet Cell Carcinoma of Colon in a Nineteen-Year-Old Patient: A Case Report 
Signet cell carcinoma, which is a subtype of adenocarcinoma, usually originates from the stomach. However, it can also originate from the colon, rectum, gallbladder, pancreas, urinary bladder, and breast. We represent a 19-year-old boy diagnosed with signet cell tumour while he was being evaluated for an initial diagnosis of inflammatory bowel disease.
PMCID: PMC3590504  PMID: 23509649
16.  Squamous Cell Carcinoma Arising in a Mature Cystic Teratoma 
Introduction. Malignant transformation in a mature cystic teratoma of the ovary is a rare complication. Squamous cell carcinoma is the most common transformation. We describe a new case of squamous cell carcinoma arising in a mature cystic teratoma. Case Report. A premenopausal 52-year-old female patient is diagnosed with vaginal bleeding. According to examination made on the women and the pelvic scanning, 7 cm mass is found on the right adnexa of the patient. Total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, pelvic lymph node dissection, and debulking were the treatments completed on the patient. According to histopathological diagnosis, squamous cell carcinoma arising in a mature cystic teratoma is diagnosed as a reason for the mass in the right adnexa of the patient. Conclusion. The prognosis of the malign transformation of MCT depends on surgery stage; however it is extremely poor. The patient should receive chemotherapy regardless of stage. We have decided to administer second cycle carboplatin and paclitaxel treatments on the patient.
PMCID: PMC3540696  PMID: 23320213
17.  Stomach Metastasis in a Patient with Prostate Cancer 4 Years after the Initial Diagnosis: A Case Report and a Literature Review 
Prostate cancer commonly metastasizes bones and lymph nodes, but it very rarely spreads to the gastrointestinal tract. However, only five cases of prostate cancer metastatic to the stomach have been previously reported in the literature. We report a case of a 69-year-old man with metastatic prostate cancer who presented with upper gastrointestinal bleeding (UGB) 4 years after the diagnosis. Esophagogastroscopy revealed multiple ulcerations in the gastric body and histopathological examination confirmed gastric metastasis that originated from prostate cancer. Chemotherapy could not be given because of patient's refusal. He was treated with LHRH agonist. We suggest that for a man with prostate cancer diagnosed with UGB, stomach metastasis should be considered in the differential diagnosis of UGB.
PMCID: PMC3517835  PMID: 23243531
18.  Mood disorder with mixed, psychotic features due to vitamin b12 deficiency in an adolescent: case report 
Vitamin B12 is one of the essential vitamins affecting various systems of the body. Reports of psychiatric disorders due to its deficiency mostly focus on middle aged and elderly patients. Here we report a case of vitamin B 12 deficiency in a 16-year old, male adolescent who presented with mixed mood disorder symptoms with psychotic features. Chief complaints were “irritability, regressive behavior, apathy, crying and truancy” which lasted for a year. Premorbid personality was unremarkable with no substance use/exposure or infections. No stressors were present. The patient was not vegetarian. Past medical history and family history was normal. Neurological examination revealed glossitis, ataxia, rigidity in both shoulders, cog-wheel rigidity in the left elbow, bilateral problems of coordination in cerebellar examination, reduced swinging of the arms and masked face. Romberg’s sign was present. Laboratory evaluations were normal. Endoscopy and biopsy revealed atrophy of the gastric mucosa with Helicobacter Pylori colonization. Schilling test was suggestive of malabsorbtion. He was diagnosed with Mood disorder with Mixed, Psychotic Features due to Vitamin B12 Deficiency and risperidone 0.5 mg/day and intramuscular vitamin B12 500 mcg/day were started along with referral for treatment of Helicobacter pylori. A visit on the second week revealed no psychotic features. Romberg’s sign was negative and cerebellar tests were normal. Extrapyramidal symptoms were reduced while Vitamin B12 levels were elevated. Risperidone was stopped and parenteral Vitamin B12 treatment was continued with monthly injections for 3 months. Follow-up endoscopy and biopsy at the first month demonstrated eradication of H. pylori. He was followed monthly for another 6 months and psychiatric symptoms did not recur at the time of last evaluation. Despite limitations, this case may underline the observation that mood disorders with psychotic features especially with accompanying extrapyramidal symptoms lacking a clear etiology may be rare manifestation of vitamin B12 and/or folate deficiency in children and adolescents and be potentially amenable to treatment.
PMCID: PMC3404901  PMID: 22726236
Vitamin B12; psychosis; mood disorder; extrapyramidal symptoms
19.  Our eight-year surgical experience in patients with pulmonary cyst hydatid 
In this clinical retrospective study, we aimed to investigate our experinces and whether capitonnage is an effective therapy method for a pulmonary hydatid cyst or not.
Material and methods
A total of 412 patients with hydatid cyst operated in our hospitals were evaluated retrospectively between January 2003 and January 2011. In order to create a study group to compare the hydatid cyst operations with and without capitonnage in our department, 60 uncomplicated patients with the diagnosis of hydatid cyst who had undergone operations in the previous two years, were divided into two groups; while no capitonnage was performed and bronchial leaks were closed in one group, standard cystotomy plus the capitonnage operation was performed in the second group. All patients underwent surgery.
In many patients, one or more symptoms were present on admission (339 cases, 82%). Perforated cysts/ nonperfore cysts rate was statistically significant (p = 0.001). There was no statistical difference between patients with or without capitonnage in terms of morbidity rates between patients with or without capitonnage (p = 0.041). However, morbidity rates were higher in the group without capitonnage. There were found statistically significant between capitonnage and non capitonnage groups in terms of length of hospital stay (p=0.001).
In the surgical treatment, resection should be avoided as much as possible. An average time of 3-5 minutes should be allocated and capitonnage should be performed. Capitonnage should always be performed in the surgical treatment of hydatid cyst. We believe that povidone iodine per se provides sufficient disinfection.
PMCID: PMC3272688  PMID: 22328950
Cyst; thoracotomy; capitonnage; albendazole
20.  Surgical treatment of right middle lobe syndrome in children 
Annals of Thoracic Medicine  2012;7(1):8-11.
Right middle lobe syndrome is a rare entity in children, causing high morbidity. Our experience of these patients including their clinical and laboratory characteristics, indications forsurgical management, postoperative courses, and follow-up results was evaluated.
A retrospective analysis was performed involving 20 children with right middle lobe syndrome who were hospitalized and treated with surgical resection of the right middle lobe in Van Training and Research Hospital and Yüzüncüyil university hospital, Turkey, between January 2002 and January 2011.
The mean age of the patients was 10.5 years (range, 5 to 15 years). Twelve patients were boys and eight were girls. The most frequent symptom was chronic cough (75%). Hemoptysis was present in two (10%) patients. One patient was being treated for asthma. 25% positive cultures were identified among the patients. Streptococcus pneumoniae was the most frequently identified agent in sputum. All patients underwent chest computed tomography. There were bronchiectasis in 11 (55%) patients, atelectasis and bronchiectasis in five (25%) patients, and destroyed lung in four (20%) patients. A narrowed middle lobe bronchus was shown in 15 (75%) patients. Bronchoscopy was performed in 18 (90%) patients. Stenosis due to external compression was seen in 12 (60%) patients, hyperemia and bronchitis in two (10%) patients, granulation tissue in two (10%) patients, and dense secretions in two (10%) patients. A history of doctor-diagnosed tuberculosis was present in two (10%) patients. These patients had completed antituberculous treatment. The patients had been symptomatic for the last 1 to 10 years (mean, 4 years) and had received several medical treatments. All patients (totally 20 patients) underwent right middle lobe resection. In one patient, a bronchial abnormality was found intraoperatively. One patient died on postoperative day 10 due to a brain abscess. Three other patients had postoperative complications (15%). Mean duration of follow-up of the patients was 4.5 years (range, 2 months to 12 years). Seventeen patients were asymptomatic, and two patients had improved.
Children with right middle lobe syndrome unresponsive to medical treatment should undergo early lobe resection to avoid serious complications and the progression of the disease to other segments or lobes.
PMCID: PMC3277046  PMID: 22347343
Atelectasis; bronchiectasis; children; pulmonary resection; right middle lobe
21.  Frequency of pleural effusion in acute bronchiolitis and its effect on prognosis 
To analyze the frequency of pleural effusion and the effect on prognosis in children with acute bronchiolitis.
A total of 69 infants aged 1-24 months with acute bronchiolitis were studied between September 2009 and December 2010. All patients'age, sex, breastfeeding duration, exposure to smoking, history of using vitamin D, symptoms duration, physical examination and laboratory findings were recorded. Bronchiolitis score and predisposing factors that influence the disease process were determined. Thorax ultrasonography was carried out in all patients, who were evaluated on the 3rd and 7th day of the treatment.
Mean age of patients (43 boys, 26 girls) was 11.97 ± 0.69 months (median 11 months). Breastfeeding duration was 8.26 ± 0.56 months (median 8 months). According to bronchiolitis score, 52 patients (75.4%) had mild and moderate bronchiolitis and 17 (24.6%) had severe bronchiolitis; 34 patients (49.2%) had pleural effusion. There was no relation between pleural effusion and symptoms. Frequency of pleural effusion was significantly higher in patients with risk factors.
This study demonstrated that most of the acute bronchiolitis cases in the infants studied were accompanied by pleural effusion. Pleural effusion in acute bronchiolitis had no effects on prognosis.
PMCID: PMC3436624  PMID: 22958273
Acute bronchiolitis; children; pleural effusion
22.  A long-term study assessing the factors influencing survival and morbidity in the surgical management of bronchiectasis 
Although the prevalence of bronchiectasis decreased significantly in developed countries, in less developed and in developing countries, it still represents a significant cause of morbidity and mortality. The aim of this retrospective study is to present our surgical experiences, the morbidity and mortality rates and outcome of surgical treatment for bronchiectasis.
We reviewed the medical records of 129 patients who underwent surgical resection for bronchiectasis between April 2002 and April 2010, at Van Training and Research Hospital, Thoracic Surgery Department. Variables of age, sex, symptoms, etiology, and surgical procedures, mortality, morbidity and the result of surgical therapy were analyzed retrospectively.
Mean age was 21.8 year (the eldest was 67 year, the youngest was 4 years-old). Male/female ratio was 1.86 and 75% of all patients were young population under the age of 40. Bilateral involvement was 14.7%, left/right side ratio according to localization was 2.1/1. The most common reason for bronchiectasis was recurrent infection. Surgical indications were as follows: recurrent infection (54%), hemoptysis (35%), empyema (6%), and lung abscess (5%). There was no operative mortality. Complications occurred in 29 patients and the morbidity rate was 22.4%. Complete resection was achieved in 110 (85.2%) patients. Follow-up data were obtained for 123 (95%) of the patients. One patient died during follow-up. The mean follow-up of this patient was 9 months. Mean postoperative hospitalization time was 9.15 ± 6.25 days. Significantly better results were obtained in patients who had undergone a complete resection.
Surgical treatment of bronchiectasis can be performed with acceptable morbidity and mortality at any age. The involved bronchiectatic sites should be resected completely for the optimum control of symptoms.
PMCID: PMC3261112  PMID: 22152759
Bronchiectasis; surgical management; morbidity
23.  Comparison of the methods of fibrinolysis by tube thoracostomy and thoracoscopic decortication in children with stage II and III empyema: a prospective randomized study 
Pediatric Reports  2011;3(4):e29.
Today, in spite of the developments in imaging methods and antibiotherapy, childhood pleural empyema is a prominent cause of morbidity and mortality. In recent years, it has been shown that there has been an increase in the frequency of pleural empyema in children, and antibiotic resistance in microorganisms causing pleural empyema has made treatment difficult. Despite the many studies investigating thoracoscopic debridement and fibrinolytic treatment separately in the management of this disease, there is are not enough studies comparing these two treatments. The aim of this study was to prospectively compare the efficacy of two different treatment methods in stage II and III empyema cases and to present a perspective for treatment options.
We excluded from the study cases with: i) thoracoscopic intervention and fibrinolytic agent were contraindicated; ii) immunosuppression or additional infection focus; iii) concomitant diseases, those with bronchopleural fistula diagnosed radiologically, and Stage I cases. This gave a total of 54 cases: 23 (42.6%) in stage II, and 31 (57.4%) cases in stage III. These patients were randomized into two groups of 27 cases each for debridement or fibrinolytic agent application by video-assisted thoracoscopic decortication (VATS). The continuity of symptoms after the operation, duration of thoracic tube in situ, and the length of hospital stay in the VATS group were of significantly shorter duration than in the streptokinase applications (P=0.0001). In 19 of 27 cases (70.37%) in which fibrinolytic treatment was applied and in 21 cases of 27 (77.77%) in which VATS was applied, the lung was fully expanded and the procedure was considered successful. There was no significant difference with respect to success rates between the two groups (P=0.533). The complication rate in our cases was 12.96% and no mortality was observed. Similar success rates in thoracoscopic drainage and enzymatic debridement, and the low cost of enzymatic drainage both served to highlight intrapleural streptokinase treatment as a reliable method in reducing the need for surgery in complicated empyema.
PMCID: PMC3283197  PMID: 22355514
child; empyema; fibrinolysis; thoracoscopic decortication.
24.  Therapeutic strategies for complications secondary to hydatid cyst rupture 
Objective: Clinical approach and therapeutic methods are important in cases with complicated hydatid cysts of the lung. This study was designed to retrospectively investigate cases with hydatid cysts, thereby discussing diagnostic methods, treatment modalities, and rates of morbidity and mortality in line with the literature. Methods: 176 cases with perforated hydatid cysts, who presented to our clinic and underwent surgery between 2003 and 2011, were included in the study. There were 71 (40.34%) females and 105 males (59.66%) with a mean age of 27.80±14.07. The most common symptom was dyspnea (44.31%) and the most common radiological finding was the water lily sign (21.02%). 88.06% of the cases were surgically treated by Cystotomy+closure of bronchial opening+ capitonnage, 3.97% by wedge resection, 4.54% by segmentectomy and 3.40% by lobectomy. Results: The cysts exhibited multiple localization in 24 cases (13.63%), bilateral localization in 14 cases (7.95%), with the most common localization (43.75%) being the right lower lobe. While the hydatid cyst rupture occurred due to delivery in three (1.70%), trauma in 11 (6.25%), and iatrogenic causes in seven (3.97%) cases, it occurred spontaneously in the rest of the cases (88.08%). Fourteen of the cases with spontaneously occurring rupture (7.95%) were detected to have received anthelmintic treatment for hydatid cyst during the preoperative period (albendazole). The rate of morbidity was 27.27% and the rate of mortality was 1.13% in our study. Two cases recurred during a one-year follow-up (1.13%). Conclusion: Hydatid cyst rupture should be considered in the differential diagnosis of cases with pleural effusion, empyema, pneumothorax and pneumonia occurring in endemic regions. Symptoms occurring during and after perforation lead to errors in differential diagnosis. Performing the surgery without delay favorably affects postoperative morbidity and mortality. While parenchyma-preserving surgery is preferential, there is a need for resection in perforated hydatid cysts.
PMCID: PMC3182515  PMID: 21977236
Hydatid cyst; rupture; management
25.  Case Report: Soft Tissue Metastasis from Immature Teratoma of the Testis: Second Case Report and Review of the Literature 
Testicular cancer, like other histopathologic types, commonly metastasizes to the lungs, liver, and brain. Spread to soft tissue, however, is rare with only four cases with seminoma reported. However, one case with metastasis of testicular immature teratoma to soft tissue was documented previously.
Case Description
We report the case of a 38-year-old man with recurrent immature teratoma of the testis who presented with a painless soft tissue mass in the left thigh previously treated with standard chemotherapy. After removal of the soft tissue mass, his serum alpha-fetoprotein level had returned to the normal range.
Literature Review
To our knowledge, this is the second case of immature teratoma of the testis metastasized to soft tissue.
Purposes and Clinical Relevance
We suggest that for a man with testicular cancer who has a soft tissue mass, metastasis of soft tissue from testicular cancer and other solid malignancies should be considered in the differential diagnosis of a soft tissue mass together with primary soft tissue sarcoma.
PMCID: PMC2919860  PMID: 19937408

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