Diagnostic and therapeutic treatment methods for intrathoracic extrapulmonary lipomas.

BACKGROUND: Lipomas are rarely seen tumors of adipose tissue that are benign in character. Although mostly located to the subcutaneous region, specifically in the upper back, neck, and shoulder, they may also occur in thoracic cavity. AIM: They aim of the study was to analyse clinical features and outcome of treatment of intrathoracic pleural lipomas. MATERIALS AND METHOD: We retrospectively evaluated the clinicopathological records of seven patients with intrathoracic lipomas who had undergone surgery between 2005 and 2017. We made analyses in terms of age, gender, admission complaints, lesion locations and dimensions, diagnostic techniques, operative procedures, histopathological features, and prognosis. RESULTS: Four women and three men with a mean age 62.7 (range, 48-75 years) were included. They had chest pain (n = 2), effort dyspnea (n = 1) as the admission symptom, whereas four patients were asymptomatic, whose lesions were detected on chest radiography on an incidental basis. The radiological features of the tumors were well-demarcated, homogenous lesions with fat density. Tumors of all cases were excised, which were located on the right side in two patients and left in five. We used video-assisted thoracoscopy in two patients, single-port video-assisted thoracoscopy in three patients, thoracotomy in two patients. All lesions were of parietal pleural origin and were located intrathoracically. They had a range of size between 4 and 10 cm, with an average of 6.7 cm. All cases were operated with complete resection. At a mean follow-up duration of 4.7 years no recurrence was noted. CONCLUSION: Intrathoracic lipomas are rare, benignly behaving tumors. As it may prove difficult to differentiate them from malignant lesions and they may grow in an invasive growth pattern, surgery should be pursued in all patients for both diagnosis and treatment.

Metastatic lung cancer associated with Warthin's tumour.

Warthin's tumors which can easily be subjected to misinterpretation are encountered commonly in clinical practice. Warthin's tumors which generally have the localization of parotid gland cauda and have a slow growing characteristic can rarely be seen aside from parotid gland; such as cervical lymph nodes and minor salivary glands. A 56-year-old patient's case that comprised atypical coexistence of Warthin tumor with PET/CT scan positive cervical lymph nodes during the diagnostic examination carried out for a pulmonary mass lesion is presented. While the transthoracic biopsy performed for the mass indicated non-small cell lung carcinoma, histopathologic diagnosis established for the lymph node reported Warthin tumor. Early detection of Warthin tumor may result in earlier diagnosis of lung cancer since patients with Warthin tumor have a higher risk of lung malignancy.

Hydrodissection with adrenaline-lidocaine-saline solution in laparoscopic cholecystectomy.

AIM: This investigation examined the effects of a solution injected to the gallbladder bed on operative time, bleeding, incidence of gallbladder perforation, and postoperative pain. METHODS: One hundred sixty-four consecutive patients with cholelithiasis were randomized into two clinically comparable groups. In group 1 (84 patients), 40 ml of saline-adrenaline-lidocaine solution was injected between the gallbladder and liver. In group 2 (80 patients), laparoscopic cholecystectomy was performed without hydrodissection. The time taken to dissect the gallbladder from the liver, bleeding from the liver bed, incidence of gallbladder perforation and spillage of bile and stones, duration of operation, amount of gas used for the laparoscopic cholecystectomy, conversion to open cholecystectomy, postoperative pain and pain localization were recorded. RESULTS: The mean dissection time, amount of gas used, incidence of gallbladder perforation, spillage of stones, and liver bed bleeding were not significantly different between the groups. There also was no significant difference between the groups regarding postoperative pain and pain localization. CONCLUSION: Hydrodissection did not reduce time to dissect the gallbladder from the liver or risk of gallbladder perforation. Similarly, adrenaline and lidocaine injection between the gallbladder and the liver did not effect bleeding from the dissection area and did not alter postoperative pain or pain localization.

Living donor kidney transplantation: how far should we go?

INTRODUCTION: The aim of this review was to describe the work that the Baskent University Faculty of Medicine has done to increase kidney donors' number in Turkey and also to discuss the major effects that donor-organ shortage is currently having worldwide. MATERIALS AND METHODS: From 1975 through 2003, our transplantation team at Hacettepe University Hospital and later at the Baskent University Transplantation Center (BUTC) performed 1451 kidney transplantations. Cadaver donation rates prior to and after the establishment of the National Coordination Center (NCC) were calculated and compared. Also, patient and graft survival rates for various groupings of transplantation types were compared. All statistical analysis was done using the log-rank test. RESULTS: Of all the renal transplantations completed in Turkey from 1975 to January 2004, 20% were performed by our team in our center. For the years 1990 through 2003, the 1-, 3-, and 5-year patient survival rates in the first-degree-living-related kidney transplantation group were 96%, 93%, and 91%, respectively, and the corresponding graft survival rates were 93%, 84%, and 81%. In the second-degree living-related group, the 1-, 3-, and 5-year patient survival rates were 94%, 90%, and 87%, respectively, and the corresponding graft survival rates were 93%, 86%, and 84%. For living-unrelated transplantations, the 1-, 3- and 5-year patient survival rates were 93%, 90%, and 83%, respectively, and the corresponding graft survival rates were 83%, 78%, and 76%. In the cadaver-kidney transplantation group, the 1-, 3- and 5-year patient survival rates were 85%, 78%, and 70%, respectively, and the corresponding graft survival rates were 82%, 64%, and 53%. During this same period, the 1-, 3-, and 5-year graft survival rates for our cadaver donors and living donors older than 55 years of age were 80%, 52%, 46% and 88%, 69%, 61%, respectively. CONCLUSION: Vigorous efforts by our group at Baskent University and by other transplant surgeons across the nation have increased the numbers of transplantations performed each year. As well, since the NCC was established in 2001, the number of cadaver-kidney transplantations has more than doubled. The initial results with this new nationwide organ-sharing system are promising, and there is every indication that this approach will continue to raise the number of transplant operations performed across Turkey each year. We suggest that Turkish citizens should consider changing our national policies on organ donation. Opt-out policies can increase the pool of cadaver-organ transplants. In addition, to increasing cadaver donation, we feel that living-related donation restricted to first- and second-degree relatives and acceptable non-blood-related donors (such as spouses) is the best path to expanding kidney transplantation worldwide.

Persistent peripheral nerve pathologies in patients with electric burns.

Clinical and electrodiagnostic evaluations were performed in 25 patients with electric burns who were injured 2 to 13 years before the study. Abnormal motor nerve conduct findings were detected in 12 of the patients. In nine patients, abnormalities were observed in more than one nerve. There was a positive relation noted between age and nerve lesions. Weakness was the most prominent clinical finding.

An eleven-year survey of electrical burn injuries.

One hundred eighty-six patients with electrical burns were treated within an 11-year period at The Hacettepe University Burn Unit. Both children and adults were treated in this burn unit. The main causes of injury were misuse of electrical appliances, inattentiveness, lack of education in safety precautions, and lack of parental supervision. Treatment consisted of first, normal resuscitation in which Ringer's lactate solution was administered (according to the Parkland formula). Fluid resuscitation was followed by debridement, fasciotomy, and escharatomy. Two major complications were encountered: musculoskeletal involvement in 44% of patients, which required major amputation in 79%, and acute renal failure in 14.51% of patients. In spite of treatment with peritoneal dialysis or hemodialysis, the mortality rate for patients with renal failure was quite high (59%). To decrease the number of complications, closer monitoring of patients and early surgical decompression were applied. The results of this survey demonstrate the need for burn prevention programs in Turkey. Physicians and health care officials have an obligation to educate the public about the prevention of electrical burns. The results of this study and other studies on electrical burns should be communicated to the public through every available means.

Role of serum nonsuppressible insulin-like activity (NSILA) in wound healing. I. Influence of thyroparathyroidectomy on serum NSILA and wound healing in the rat.

Serum contains a 90,000 molecular weight glycoprotein that exhibits insulin-like activity on adipocytes, skeletal muscle, and fibroblasts in tissue culture; however, this protein is physicochemically and immunochemically distinct from insulin and presently is termed "nonsuppressible insulin-like activity ("nsilA)." This study was designed to assess the response of serum NSILA to thyroparathyroidectomy (TPTHX) and to associate this response with tissue repair processes in the injured rat. It was postulated that NSILA modulates the fibroblastic response in wound healing. TPTHX decreased NSILA to 40 percent of control levels (p less than 0.001); 90 male animals subsequently were wounded by either a 10 percent third-degree burn or skin excision. Following injury, NSILA significantly increased in both control and TPTHX groups, but this acute-phase response was attenuated in TPTHX animals. Light microscopy of granulation tissue demonstrated a diminution in the fibroblastic response in TPTHX animals. Hydroxyproline analysis of granulation tissue revealed a significant decrease (p less than 0.025) in collagen content in TPTHX animals with low NSILA levels. The results suggest that serum NSILA levels are controlled, in part, by thyroid hormone and that NSILA may modulate the fibroblastic response of connective tissue repair processes.

Failure of angiotensin II inhibitor to modify hyperacute rejection.

The effect of angiotensin II inhibitor (sar1,gly8 angiotensin II) upon the pig-to-dog (10 pigs to 20 dogs) modified renal xenograft model has been studied. The angiotensin II inhibitor does not prevent hyperacute rejection (HAR). This implies that the vasocaonstriction which occurs during the HAR is not related to high levels of angiotensin II.

Renal transplantation. Complications in patients with juvenile diabetes.

Four cases of patients with juvenile diabetes who received kidney transplants are reported. Problems with selection and management are discussed, and the high mortality and morbidity rates in this group of patients is emphasized.