May 2013

Original Article

Fiberoptic Bronchoscopy in Lung Cancer: Gender, Histologic Type and Localization

Ersin Demirer1 , Dilaver Taş1 , Ömer Ayten1 , Akın Yıldızhan2 , Cenk Kılıç3 , Atilla Uysal4 , Oğuzhan Okutan1 , Zafer Kartaloğlu1

1 GATA Haydarpasa Training Hospital, Department of Pulmonary Diseases, Istanbul, 2 GATA Haydarpasa Training Hospital, Department of Thoracic Surgery, Istanbul, 3 Faculty of Medicine, Gulhane Military Medical Academy, Department of Anatomy, Ankara, 4 Yedikule Hospital For Chest Diseases and Thoracic Surgery Educational and Training Hospital, Department of Pulmonary Disases, Istanbul, Türkiye

DOI: 10.4328/AEMED.17
Abstract
Aim: Lung cancer is one of the leading causes of death in both men and women in the world among cancer deaths. Fiberoptic bronchoscopy (FOB) is one of the diagnostic procedures used in diagnosis, staging and treatment of lung cancer. In this study we investigated the localization and subtypes of lung cancer observed with FOB and analyze the distribution of cancer in the tracheobronchial tree. Material and Method: The records of a bronchoscopy unit were retrospectively reviewed during the period of January 1, 2004 and January 1, 2010. Localization of lung cancer observed with FOB, histopathologic types of cancer and characteristics of patients were analyzed. Results: Total FOB record was 1372 and 172 cases were diagnosed with lung cancer (27 female and 145 male) with endobronchial mass. Ninety eight cases had cancer in right lung while 72 cases in the left lung, 1 case in the main carina and 1 case in the lower trachea. One hundred twenty one cases were diagnosed with non-small cell lung cancer (NSCLC) and 41 cases with small cell lung cancer (SCLC). Metastasis was observed in 11 cases. There was a significant difference between right and left lung in terms of localization. The distribution of lung cancer was dominant at upper lobe bronchi. The distribution of cancer types were significantly different between men and women. The most common type was an epidermoid carcinoma (47.7%), followed by SCLC (23.8%). The most common NSCLC type was epidermoid carcinoma in men whereas adenocarcinoma in women. SCLC distribution was similar in both men and women (23.4% in men and 25.9% in women). There was no association between lung cancer types and distribution of cancer at right or left lung side. Discussion: The distribution of lung cancer was dominant at upper lobe bronchi. The distribution of lung cancer types were significantly different between men and women. The most common NSCLC type was epidermoid carcinoma in men whereas adenocarcinoma in women. SCLC distribution was similar in both men and women.
Keywords
Fiberoptic Bronchoscopy; Localization; Lung Cancer
Corresponding Author: Ersin Demirer, GATA Haydarpaşa Eğitim Hastanesi, Göğüs Hastalıkları Servisi, İstanbul, Türkiye. T.: +90 2165422020 F.: +90 2163487880 E-Mail: drersin73@yahoo.com
How to Cite: Ersin Demirer, Dilaver Taş, Ömer Ayten, Akın Yıldızhan, Cenk Kılıç, Atilla Uysal, Oğuzhan Okutan, Zafer Kartaloğlu . Fiberoptic Bronchoscopy in Lung Cancer: Gender, Histologic Type and Localization. J Ann Eu Med 2013;1(2): 35-40
 
 

The “When and Why” Behind Failure of a Fiberoptic Bronchoscopy

Ersin Demirer1 , Metin Aytekin2 , Atilla Uysal3 , Dilaver Taş1 , Oğuzhan Okutan1 , Turgut Öztutgan1 , Zafer Kartaloğlu1 , Niyazi Ümit Çitici1

1 GATA Haydarpaşa Eğitim Hastanesi, Göğüs Hastalıkları Servisi, İstanbul, 2 Cleveland Clinic, Lerner Research Institute, Cleveland, 3 Yedikule Göğüs Hastalıkları ve Göğüs Cerrahisi Eğitim ve Araştırma Hastanesi, İstanbul, Türkiye

DOI: 10.4328/AEMED.18

Abstract

Aim: Fiberoptic bronchoscopy (FOB) has an important role in the diagnosis of respiratory diseases. In this study, we reviewed records of the bronchoscopy from a teaching and research hospital and documented complications and reasons for failure before and during FOB (B-FOB and D-FOB, respectively) Material and Method: FOB records between January 1, 2005 and January 1, 2010 were reviewed. Complications were classified as cardiac, respiratory, intolerance for FOB and other. Time of the complication was designated as B-FOB and D-FOB. Cases were grouped as patients with malignancy (M) and non-malignancy cases (NM). Results: Total number of cases involving FOB was 1372. Sixty-six (4.8%) cases had complications in the bronchoscopy unit. 18 (27%) had cardiac complications (1 arrest, 3 arrhythmia, 9 hypertension, 5 tachycardia), 9 (14%) had respiratory complications (all hypoxia), 32 (48%) had intolerance for FOB, and 7 (11%) had other complications (2 narrowed trachea, 2 vomiting, 1 severe chest deformity, 2 syncope). 17 cases were female (8 with M), and 49 were male (15 with M). The mean age in the M group was significantly higher compared to the NM group (64.7±14.2 vs. 39.1±21.9; p<0.01). Gender distribution was not significantly different between the M and NM groups. Complications were reported in 14 (21%) cases B-FOB (5 with M), and 52 cases (79%) D-FOB (18 with M). The types of complications occurring B-FOB or D-FOB were not significantly different. However, 9 of 14 (64%) cases had cardiac complication B-FOB, and 9 of 52 (17%) cases had cardiac complications D-FOB. Cardiac complications were observed more frequently B-FOB compared to D-FOB (p<0.01). 2 of 14 (14%) cases had respiratory complications B-FOB, 7 of 52 (13%) cases had respiratory complications D-FOB. Cardiac complications were observed in 8 of 23 (35%) cases with M and 10 of 43 (23%) cases with NM, a difference that was not statistically significant. Respiratory complications occurred at a rate comparable with other complications B-FOB and D-FOB. 7 of 23 (30%) cases with M had respiratory complications while 2 of 43 (5%) cases with NM experienced respiratory complications, a rate of incidence that was significantly greater among the M group compared to the NM group (p<0.05). Discussion: Respiratory, cardiac, intolerance, and other complications can be observed B-FOB or D-FOB, all affecting the success of the procedure. In this study, cardiac complications were observed more frequently B-FOB and the respiratory complication rate was significantly higher among patients with M, an observation that might be partly attributable to the increased age of this group.

Keywords

Bronchoscopy Unit; Complication; Fiberoptic Bronchoscopy; Malignancy

Corresponding Author: Ersin Demirer, GATA Haydarpaşa Egitim Hastanesi, Gogus Hastaliklari Servisi, Selimiye Mah. Tibbiye Cad. 34668, Istanbul, Türkiye. T.: +90 2165422020 F.: +90 2163487880 E-Mail: drersin73@yahoo.com

How to Cite: Ersin Demirer, Metin Aytekin, Atilla Uysal, Dilaver Taş, Oğuzhan Okutan, Turgut Öztutgan, Zafer Kartaloğlu, Niyazi Ümit Çitici . The “When and Why” Behind Failure of a Fiberoptic Bronchoscopy. J Ann Eu Med 2013;1(2): 31-4

A Clinical and Epidemiological Study on the Age of Circumcision in Turkey

Erdal Türk1 , Fahri Karaca2 , Yesim Edirne2

1 Izmir University School of Medicine, Department of Pediatric Surgery, Izmir, 2 Denizli State Hospital, Clinics of Pediatric Surgery, Denizli, Turkey

DOI: 10.4328/AEMED.15

Abstract

Aim: Circumcision is performed mostly for social and religious reasons in 99% of the male population in our country. We evaluated the age range of children circumcised at Denizli State Hospital during the 2010 and 2011 summer periods together with past studies in this study. Material and Method: This study was conducted on a total of 2145 children who were circumcised at the Denizli State Hospital between 2010 and 2011summer periods. Children aged 6 and over underwent the procedure under local anesthesia whereas general anesthesia was used for children aged 0-6 in addition to older children who were afraid of the procedure and others with additional anomalies. Results: Of the 2145 cases, a total of 1637 cases (76.3%) aged 6-17 with a mean age of 7.81±1.67 years underwent circumcision under local anesthesia and the remaining 508 cases (23.7%) with a mean age of 4.23±2.99 years underwent the procedure under general anesthesia. The most common age group was 6 to 8 years (61.8%) while children aged over 12 years made up a much smaller group (2.5%). In conclusion, we found the most common age group to undergo circumcision in our country to be 6-8 years, in common with other studies from our country. Discussion: Although it is desired that circumcision be performed between the ages of 0 and 3 years and at the operating room, the large candidate population in our country and the ritual characteristic of the procedure outweighing the health-related benefits means that it is mostly done at the primary school age. As specialists, we need to increase awareness of the best age for circumcision among the population, taking our country’s conditions into account.

Keywords

Circumcision; Age of Circumcision; Local Anesthesia; General Anesthesia

Corresponding Author: Erdal Türk, Izmir University, Medical School, Department of Pediatric Surgery, Medical Park Hospital Karsiyaka, İzmir, Turkey. T.: +90 2323995050 F.: +90 2323995087 E-Mail: eturk19@yahoo.de

How to Cite: Erdal Türk, Fahri Karaca, Yesim Edirne. A Clinical and Epidemiological Study on the Age of Circumcision in Turkey. J Ann Eu Med 2013;1(2): 27-30

Vacuum Assisted Treatment of Chest Wall Defect Occurring After a Gunshot Injury

Ali Çelik1 , Erdal Yekeler2 , Ertan Aydın3 , Ülkü Yazıcı3 , Nurettin Karaoğlanoğlu3
1 Gazi University School of Medicine, Department of Thoracic Surgery, Besevler, 2 Türkiye Yüksek İhtisas Hospital, Department of Thoracic Surgery, Sıhhıye, 3 Atatürk Chest Disease and Thoracic Surgery, Training and Research Hospital, Department of Thoracic Surgery, Kecioren, Ankara, Türkiye
 
DOI: 10.4328/AEMED.16
Abstract
34-year old female patient was referred to our clinic after wounded by firearm. In the patient who had a thorax wall defect in the deltopectoral region where posterior plan was seen when looking from anterior, the defect was treated by forming granulation tissue with the help of latissimus dorsi muscle flap and vacuum assisted closure method. The patient who did not have an additional problem except for minimal limitation in the post-treatment shoulder movements has been monitored for 2 years.
Keywords
Chest Wall; Latissimus Dorsi; Vacuum Assisted Closure
Corresponding Author: Ali Celik, Gazi University School of Medicine, Department of Thoracic Surgery, 06550, Besevler, Ankara, Türkiye. T.: +90 3122025891 GSM: +905304045467 E-Mail: alicelik78@gmail.com
 
How to Cite: Ali Çelik, Erdal Yekeler, Ertan Aydın, Ülkü Yazıcı, Nurettin Karaoğlanoğlu .Vacuum Assisted Treatment of Chest Wall Defect Occurring After a Gunshot Injury. J Ann Eu Med 2013;1(2): 44-6

 

Case Report

Dental Extraction Under Deep Sedation in a Patient with Rubinstein-Taybi Syndrome: Case Report

Alkan Metin1 , Pampal Hasan Kutluk2 , Dayanir Hakan2 , Arslan Mustafa2 , Isik Berrin2

1 Oral and Maxillo Facial Surgery Department of Dentistry Faculty, 2 Anaesthesia and Reanimation Department of Medicine Faculty, University of Gazi, Besevler, Ankara, Turkey

DOI: 10.4328/AEMED.10

Abstract

Rubinstein-Taybi Syndrome (RTS), is a genetic disorder caused by a heterozygous mutation on chromosome 16. This multiple congenital anomaly syndrome is characterized with mental retardation, craniofacial deformities and finger anomalies. Children with RTS generally encounter severe dental problems and need interventions under sedation or general anesthesia. A 14-yr old boy with RTS is scheduled for dental treatment at Gazi University Faculty of Dentistry. Preoperative physical findings of the patient with limited cooperation revealed microcephalia, retrognatia, and broad thumbs. His Mallampati score was II. After placing an intravenous cannula and establishing standard monitarization, %50/50 O2/N2O was administered via nasal mask while maintaining spontaneous ventilation. Afterwards, midazolam and ketamine were given to obtain desired level of sedation. Although treatment under deep sedation has been performed without any adverse events for this patient, we believe that all the precautions mentioned in the algorithms should strictly be taken against possible difficult airway.

Keywords

Deep Sedation; Rubinstein-Taybi Syndrome

Corresponding Author: Metin Alkan, Oral and Maxillo Facial Surgery Department of Dentistry Faculty, University of Gazi, Besevler, Ankara, Turkey. T.: +90 3122025316 F.: +90 3122026213 E-Mail: metoalkan@gmail.com

How to Cite: Alkan Metin, Pampal Hasan Kutluk, Dayanir Hakan, Arslan Mustafa, Isik Berrin . Dental Extraction Under Deep Sedation in a Patient with Rubinstein-Taybi Syndrome: Case Report. J Ann Eu Med 2013;1(2): 41-3

Original Image

Cardiac Injury Due to an Utility Knife Hanging on the Chest Wall

Sezai Çubuk, Okan Karataş, Orhan Yücel

Gulhane Military Medical Academy, Thoracic Surgery Department, Ankara, Türkiy

DOI:10.4328/AEMED.13

Penetrating thoracic traumas concerning heart or major vascular injuries can be life-threatening. In our case, we aimed to present a patient with cardiac injury, who has remarkable images. Twenty-one year old male patient who is taking antipsychotic treatment had wounded himself in the anterior chest wall with an utility knife as attempting a suicide. Evaluation of the patient revealed a foreign body in the left hemithorax, left pleural effusion and pericardial effusion (Picture 1a). Left thoracotomy was performed because of the sharp-edged foreign body which is greater than 1,5 cm in the neighborhood of the heart. A sharp foreign body protruding from the anterior chest wall (Picture 1b,1c), hematoma in pericardial fatty tissue (Picture 1b), pericardial effusion and haemothorax was detected on the exploration of the thoracic cavity. Following the removal of the foreign body, pericardial hematoma was evacuated by opening the pericardium. In the evaluation of myocardium, an injury approximately 1.5 cm in depth was detected millimeters away from the left anterior descending vein (Picture 1d). Damage was repaired with 6/0 pledged sutures (Picture 2). No complications had occured in his follow-up and the patient was discharged afterwards.

Corresponding Author: Sezai Çubuk, GMMA, Thoracic Surgery Department, Ankara, Türkiye. P.: +90 3123045192 E-Mail: sezaicubuk@gmail.com

How to CiteSezai Çubuk, Okan Karataş, Cardiac Injury Due to an Utility Knife Hanging on the Chest Wall. Orhan Yücel. J Ann Eu Med 2013; DOI:10.4328/AEMED.13