ABSTRACT
As bronchial carcinoids are known to be notably rare, adequate histochemical investigations couldn’t have been carried out on these types of tumors hitherto. In this study, we investigated bronchial cytokines in a carcinoid tumor localized in the left main bronchus. Bronchial resection and reconstruction was performed without the lung resection. Bronchial lavage samples were obtained from both sides of main bronchial system preoperatively and postoperatively. TNF-α, IL-8 and IL6 levels were measured by ELİSA. Preoperative TNF-α and IL-8 levels were found to be 2- folds and 5-folds higher on the tumor side respectively (TNF-α; 14.184 pg/ml and IL-8; 3359.86 pg/ml) compared to tumor-free bronchial system (TNF-α; 6.886 pg/ml, IL-8; 615.072 pg/ml). Interestingly, both cytokine levels were found to be equal and within normal ranges on both sides subsequent to bronchial resection and reconstruction. There were no significant difference in IL-6 levels between two bronchial systems preoperatively (IL-6 levels of right bronchus, 16.44 pg/ml; levels of left bronchus, 19.11 pg/ml). However, there was more than four-fold increase in postoperative levels (IL-6 level; 89.41 pg/ml). In our study, we found that preoperative TNF-α and IL-8 levels were higher compared to the postoperative ones; whereas IL-6 levels showed a significant increase, postoperatively. These findings led us through the idea that carcinoid tumors might be activating the inflammatory process among TNF-α and IL-8 and the surgical bronchoplastic procedure could be the cause of enhanced IL-6 response.
ABSTRACT
Surgical management of the cancer with empyema has rarely been reported in the literature because few of such cases are operable. Many patients might be misevaluated because of the incorrect staging associated with an acute or sub-acute infection. Even in the presence of an operable tumor mass; surgeons behave timid to these patients because of the possibility of infective postoperative complications. The balance between expected benefits and possible risk of surgical intervention is also important. If it is indicated, by the time pleural empyema is restored, procedures such as resection and even bronchoplasty should be performed. 59-years old patient with squamous cell carcinoma that completely obstructed left basal segments and caused to empyema. A thoracic catheter was inserted. Multiple pleural irrigations were done and proper antibiotherapy. Pathologic diagnosis of pleural fluid and pleural biopsy were benign. Pleural cultures were negative and amount of empyema fluid volume has decreased within two months. Positron emission tomography (PET) revealed a 2.5 cm sized left infrahilar tumor, right paratracheal, prevascular and subcarinal lymph nodes and non-homogeneous increased pleural activity. Mediastinal lymph nodes were evaluated as reactive with mediastinoscopy. Left lower lobectomy and lingulectomy were performed with bronchial resection and pathologic stage was 2A (T1bN1MO).
ABSTRACT
OBJETIVO: Determinar o status de colonização de uma amostra de pacientes que recebeu cateteres torácicos (CTs) e correlacionar esse status a possíveis fatores prognósticos. MÉTODOS: Estudo retrospectivo com 48 pacientes (17 mulheres e 31 homens) que receberam CTs no Departamento de Cirurgia Torácica do Hospital Universitário Adnan Menderes, localizado na cidade de Aydin, Turquia, entre dezembro de 2008 e março de 2009. Amostras de sangue para cultura foram coletadas da porção distal dos CTs e de cada um dos 48 pacientes. Procuramos por correlações entre culturas positivas e possíveis fatores prognósticos de infecção. RESULTADOS: Resultados positivos de cultura em amostras de CT ocorreram somente 3 pacientes, em sangue em 2, e nas duas amostras em outros 2. A idade avançada correlacionou-se com culturas positivas das amostras de CT e sangue (r = 0,512 e r = 0,312, respectivamente; p < 0,05), assim como o uso prolongado do CT e com culturas positivas das mesmas amostras (r = 0,347 e r = 0,372, respectivamente; p < 0,05). Houve uma correlação significativa entre o status cirúrgico dos pacientes (aqueles submetidos a cirurgias) e culturas positivas somente das amostras de CT (p < 0,05), mas a presença de malignidade inoperável correlacionou-se com o crescimento bacteriano em ambos os tipos de amostras (p < 0,05 para ambos). CONCLUSÕES: Os fatores de risco acima citados aumentam o risco de infecções. No caso de pacientes com CTs e que apresentam tais fatores de risco, é imperativo que se utilize uma profilaxia com antibióticos de amplo espectro.
OBJECTIVE: To determine the incidence of local and systemic infection in a sample of patients catheterized with thoracic catheters (TCs) and to identify the prognostic factors for catheter-related infection. METHODS: A retrospective study involving 48 patients (17 females and 31 males) catheterized with TCs between December of 2008 and March of 2009 in the Thoracic Surgery Department of the Adnan Menderes University Hospital, located in Aydin, Turkey. Blood samples for culture were collected from the distal end of each TC and from each of the 48 patients. We looked for correlations between positive culture and possible prognostic factors for catheter-related infection. RESULTS: Culture results were positive in TC samples only for 3 patients, in blood samples only for 2, and in both types of samples for another 2. Advanced age correlated significantly with positive culture in TC samples and in blood samples (r = 0.512 and r = 0.312, respectively; p < 0.05 for both), as did prolonged catheterization (r = 0.347 and r = 0.372, respectively; p < 0.05). There was a significant correlation between having undergone surgery and positive culture in TC samples only (p < 0.05). However, having an inoperable malignancy correlated with bacterial growth in blood and in TC samples alike (p < 0.05 for both). CONCLUSIONS: Risk factors, such as advanced age, prolonged catheterization, comorbidities, and inoperable malignancy, increase the risk of catheter-related infection. It is imperative that prophylaxis with broad-spectrum antibiotics be administered to patients who present with these risk factors and might be catheterized with a TC.