Clinical significance of the expression of alpha-methylacyl-CoA racemase in squamous cell carcinoma and adenocarcinoma of the lung.

BACKGROUND: The role of alpha-methylacyl-CoA racemase (AMACR) in pathogenesis and diagnosis of different types of cancer has been investigated during last decade. This study is conducted to investigate AMACR expression in adenocarcinoma and squamous cell carcinoma (SCC) of lung and its correlation with clinical characteristics and survival. METHODS: The clinicopathologic characteristics of 146 patients who underwent a potentially curative surgical resection between June 2000-2009 in our clinic were reviewed retrospectively. The patients who were given adjuvant chemotherapy and/or radiotherapy, with an evidence of residual tumor at resection margin and who died due to postoperative mortality and due to reasons not related to lung cancer were excluded. Data from remaining 67 patients were analyzed for survival. For the correlation between progression and AMACR immunoreactivity, data from 62 patients who had postoperative follow up in our center were analyzed. RESULTS: AMACR immunoreactivity was observed more frequently in adenocarcinoma group than SCC group (p = 0,046). The samples with invasive adenocarcinoma--lepidic predominant pattern also showed high rates of positive staining (73%). We could not show a statistically significant correlation between AMACR immunostaining and degree of differentiation, age, gender, pathologic T status, N status, or stage. We failed to show a statistically meaningful effect of AMACR on overall and progression-free survival. CONCLUSION: Adenocarcinoma had higher rates of positive immunostaining for AMACR than SCC (p = 0,046). But the presence of AMACR expression did not have a statistically meaningful effect on overall and progression-free survival in adenocarcinoma and SCC of lung.

Effect of intrapleural povidone-iodine lavage on thyroid hormones in thoracic surgery.

OBJECTIVE: Povidone-iodine (PI) is an effective disinfectant used in many surgical operations. It is known that PI is absorbed by the skin after application. Absorption is even greater in infants, as their skin is thinner and more permeable. Iodine absorption in the orbita, neck and during abdominal surgery has been previously investigated, but such a study has not been performed for the pleura, which has a greater area and capacity for absorption. In this study, we investigated the effect of intraoperative povidone-iodine lavage on thyroid hormones during thoracic surgery. MATERIAL AND METHOD: Fifty patients without any thyroid pathology scheduled for thoracotomy were divided into 2 groups. Group A (n = 25) was given intraoperative saline lavage, while group B (n = 25) had povidone-iodine lavage. Levels of free T3 (FT3), free T4 (FT4) and thyroid-stimulating hormone (TSH) measured 1 day preoperatively and 1 day postoperatively were analyzed. RESULTS: There was a statistically meaningful change in FT3 levels ( P = 0.033) between groups, but the measured changes in FT4 and TSH levels were not statistically significant ( P = 0.98 and P = 0.71, respectively). FT3 scores for group A were decreased postoperatively compared to the scores for group B, but all results were in normal ranges. In group A, the changes between preoperative and postoperative levels of FT3 and FT4 were statistically significant, while changes in TSH levels were not. In group B, changes in FT4 levels were statistically significant and changes in FT3 and TSH levels were not. CONCLUSIONS: The scores show that the iodine absorbed by the pleura during intraoperative povidone-iodine lavage has an effect on thyroid function. Intrapleural PI lavage results in changes to some thyroid hormone levels due to pleural absorption. Thus, intrapleural PI lavage should be used with care.

Completion pneumonectomy for bronchiectasis: morbidity, mortality and management.

BACKGROUND: Completion pneumonectomy performed for benign causes is associated with a high morbidity and mortality. We analyzed the patients who underwent completion pneumonectomy procedure for bronchiectasis, which constitutes a specific benign condition, together with the indications for surgery, the difficulties encountered during operations and the postoperative results. METHODS: Records of all patients who underwent completion pneumonectomy for the diagnosis of brochiectasis between January 1991 and April 2006 at the thoracic surgery clinic of a training and research hospital specializing in chest diseases and chest surgery were retrospectively evaluated. The age and the gender of the patients, etiologic factors, symptoms, characteristics of the first operation, the time between the first operation and completion pneumonectomy, and postoperative follow-up are examined. RESULTS: During the evaluation period of more than 15 years, 23 patients underwent completion pneumonectomy. The median age of these 23 patients was 28 (range: 9 - 53); 17 of the patients were male and 6 were female. The most common indication for surgery was recurrent lung infections (n = 15). The most common symptoms were cough (n = 21), expectoration (n = 19), and hemoptysis (n = 15). The mean time between the first operation and the completion pneumonectomy was 4.9 years (range: 5 months - 11 years). Left completion pneumonectomy was performed in 14 and right completion pneumonectomy was performed in 9 cases. The mean duration of hospital stay was 16.7 days (range: 12 - 42 days). The course after surgery was uneventful in all patients. The mortality rate was 0 % and morbidity was 43.5 %. CONCLUSION: Although completion pneumonectomy for benign causes is a high risk procedure, it can be performed in selected patients with an acceptable morbidity and mortality after an effective preoperative medical therapy for inflammation of the lungs and with careful dissection at the operation.