Browsing by Author "Yaldiz, S"
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Item Prognostic Effects of Predominant Histologic Subtypes in Resected Pulmonary AdenocarcinomasYaldiz, D; Kaya, SÖ; Ceylan, KC; Acar, A; Aydogdu, Z; Gürsoy, S; Yaldiz, SBackground: Predominant histologic subtypes have been reported as predictors of survival of patients with pulmonary adenocarcinoma. Aims: To evaluate the predictive value of histologic classification in resected lung adenocarcinoma using the classification systems proposed by the International Association for the Study of Lung Cancer, American Thoracic Society, European Respiratory Society, and World Health Organization (2015). Study Design: Cross-sectional study. Methods: The histologic classification of a large cohort of 491 patients with resected lung adenocarcinoma (stages I-III) was retrospectively analyzed. The tumors were classified according to their predominant component (lepidic, acinar, papillary, solid, micropapillary, and mucinous), and their predictive values were assessed for clinicopathologic characteristics and overall survival. Results: The patient cohort comprised 158 (32.2%) patients with solid predominant, 150 (30.5%) with acinar predominant, 80 (16.3%) with papillary predominant, 75 (15.3%) with lepidic predominant, 22 (4.5%) with mucinous, and 5 (1.0%) with micropapillary subtype, and 1 (0.2%) with adenocarcinoma in situ. Overall 5-year survival of 491 patients was found to be 51.8%. Patients with lepidic, acinar, and mucinous adenocarcinoma had 70.9%, 59.0%, and 66.6% 5-year survival, respectively, and there was no statistically significant difference between them. Whereas patients with solid, papillary, and micropapillary predominant adenocarcinoma had 41.0%, 40.5%, and 0.0% 5-year survival, respectively. Compared to other histologic subtypes, patients with solid and papillary predominant adenocarcinoma had significantly lower survival than those with lepidic (p<0.001, p=0.002), acinar (p<0.001, p=0.008), and mucinous (p=0.048, p=0.048) subtypes, respectively. The survival difference between patients with solid subtype and those with papillary subtype was not statistically significant (p=0.67). Conclusion: Solid and papillary histologic subtypes are poor prognostic factors in resected invasive lung adenocarcinoma.Item Surgery Offers High Cure Rates in Multidrug-resistant TuberculosisYaldiz, S; Gursoy, S; Ucvet, A; Kaya, SOPurpose: Drug resistance has become a major problem in the treatment of tuberculosis, and pulmonary resection in combination with chemotherapy appears to be an effective measure for the treatment. The purpose of this study was to investigate the results of resection for multidrug-resistant pulmonary tuberculosis (MDR-TB). Patients and Methods: We retrospectively reviewed case files from January 2003 to December 2006 of 13 patients with MDR-TB underwent pulmonary resection. Results: Of 13 patients, 7 (53.9%) were sputum positive for mycobacterium tuberculosis preoperatively, though after surgery, they were sputum negative. Lobectomy was performed in 8 (61.5%) and pneumonectomy, in 5 (38.5%). In the lobectomy group, 2 patients had an additional superior segmentectomy and 1 had a middle lobectomy for other segmental or lobar lesions. Operative mortality was 7.6% (1/13). There were no late surgical deaths. In the early postoperative period, 3 patients had serious complications (postoperative bleeding, prolonged air leak, expansion deficit, bronchopleural fistula and empyema) that were resolved with surgery (morbidity 23.0%). The 12 patients who survived the operation received appropriate chemotherapy and were followed up for 24-37 months. None of the patients relapsed, and the overall cure rate was 92.3% (12/13). Conclusion: Even with high morbidity in the early post-operative period, surgery, in addition to medical therapy, offers higher cure rates than only medical therapy; however, meticulous preoperative evaluation of patients is needed.Item Papillary predominant histological subtype predicts poor survival in lung adenocarcinomaYaldiz, D; Acar, A; Kaya, SÖ; Aydogdu, Z; Gursoy, S; Yaldiz, SBackground: This study aims to investigate whether papillary predominant histological subtype can predict poor survival in lung adenocarcinoma. Methods: Between January 2005 and December 2016, a total of 80 patients with papillary predominant subtype lung adenocarcinoma (70 males, 10 females; mean age 60.7 years; range, 42 to 79 years) operated in our clinic were included in the study. These patients were compared with those having lepidic, acinar, and mucinous subtypes. Overall and five- year survival rates were evaluated. Results: Five-year survival was 40.5% in papillary predominant histological subtype, while this rate was 70.9%, 59.0%, and 66.6% in lepidic, acinar, and mucinous subtypes, respectively. Papillary subtype showed significantly poor survival compared to lepidic (p=0.002), acinar (p=0.008), and mucinous subtypes (p=0.048). In Stage 1 disease, it was more evident (papillary, 47.5%, lepidic 86.9% [p=0.001], acinar 69.3% [p=0.040], and mucinous 90.0% [p=0.050]). Conclusion: Our study results suggest that papillary predominant subtype predicts poor survival in lung adenocarcinoma and these cases may be candidates for adjuvant treatment modalities even in the earlier stages of disease.Item Pitfalls in the surgical treatment of undiagnosed lung lesions and cystic pulmonary hydatidosisYaldiz, D; Batihan, G; Ceylan, KC; Yaldiz, S; Susam, SBackground Hydatid cysts can mimic many lung pathologies radiologically, as well as some malignant or benign lung tumors may show hydatid cyst-like radiological features. The aim of our study is to present our clinical experience and recommendations by analyzing the cases that create diagnostic difficulties by presenting a common radiological pattern with a pulmonary hydatid cyst. Methods The patients who were operated on with a preliminary diagnosis of hydatid cyst but were diagnosed differently, and who were operated on with different prediagnoses and unexpectedly diagnosed with hydatid cyst were included in the study. The clinical and radiological features of the patients were documented, and the features of the cases that could cause difficulties in diagnosis and treatment for the surgeon were revealed. Results A total of 20 patients who were radiologically suggestive of hydatid cyst but were diagnosed differently or unexpectedly diagnosed as hydatid cyst were included in the study. Lung cancer, bronchogenic cyst, or bronchiectasis were detected in 13 patients who were radiologically suggestive of hydatid cyst. There were 7 patients who were diagnosed with hydatid cysts, although they did not have specific radiological findings. Conclusions While hydatid cysts can mimic many lung pathologies, many benign or malign parenchymal lung pathologies may exhibit hydatid cyst-like radiological features. Therefore, in regions where a hydatid cyst is endemic, the surgeon should consider all possibilities while managing the cases. Clinical registration number: Institutional Review Board of the Dr Suat Seren Chest Diseases and Chest Surgery Education and Research Center (No. 49109414-604.02).Item Data Analysis of 1811 Major Trauma Patients Admitted to the Emergency Departments of Thirteen HospitalsYaldiz, D; Akbulut, G; Anil, M; Öztan, MO; Yaldiz, SObjective: Our objective was to determine metrics and measure the trauma-related emergency care quality. Methods: Patients with majortrauma admitted to emergency departments of 13 hospitals in the north region of Izmir between January 01, 2014, and December 31, 2014, were included in this study. For the definition of major trauma, guideline of Centers for Disease Control (CDC) for field triage of injured patients version 2011 was used. Age, time passed in emergency, first order timing, number of consultations and amount of time taken by the consultations, number of deaths in emergency departments and intensive care units, number of radiological tests applied to patients, total score of interventional applications, and total billing were recorded. Results: In one-year period, 2,415,361 patients applied to selected hospitals' emergency departments, and 1811 patients (0.07%) were accepted as major trauma. The mean age of the patients was 29.4 years. The meantime passed in emergency was 28.3 h. The mean number of consultations and amount of time taken by consultations were 1.6 and 26.2 h, respectively. The number and mean X-ray, ultrasound, computerized tomography, and magnetic resonance imaging numbers were 3910 and 2.16; 518 and 0.29; 2805 and 1.55; 114 and 0.06, respectively. The total mortality rate was 1.04% (19 patients). Conclusion: This is a preliminary study presenting the data obtained from different level hospitals in the region, and indicators in such a high number of patient group were evaluated for the first time. We believe that as national emergency care is built and strengthened with data, management of care for patients with trauma will improve.Item Capitonnage Results in Low Postoperative Morbidity in the Surgical Treatment of Pulmonary EchinococcosisYaldiz, S; Gursoy, S; Ucvet, A; Yaldiz, D; Kaya, SBackground. The main surgical techniques in the treatment of pulmonary echinococcosis are cystotomy alone, cystotomy and capitonnage, enucleation, and pericystectomy. Controversy persists regarding the selection of surgical technique. We reviewed our experience to identify the impact of capitonnage on outcomes. Methods. A single-institution retrospective analysis was made of the 308 consecutive patients with thoracic hydatid disease treated surgically during 17 years. Results. The most common presenting symptoms were cough and chest pain. At presentation, 69 patients (22.4%) had complicated hydatid disease, cyst rupture into bronchus in 62 and into pleural cavity in 7. Bilateral involve-ment occurred in 37 patients (12.0%), simultaneous hepatic cysts in 36 (11.6%), and intrathoracic extrapulmonary involvement in 14 (4.5%). Surgery consisted of cystotomy with capitonnage in 271 patients (92.2%), cystotomy and closure of bronchial openings in 20 (6.8%), and lobectomy in 3 (1.0%). Hospital mortality was zero; postoperative complications developed in 21 patients (6.8%). Conclusions. Cystotomy with capitonnage has a low complication rate. Pulmonary resection is best limited to patients with parenchymal destruction secondary to infection. (Ann Thorac Surg 2012;93:962-7) (C) 2012 by The Society of Thoracic SurgeonsItem Do we really know the duration of pain after rib fracture?Tulay, CM; Yaldiz, S; Bilge, AIntroduction: The duration of pain after rib fracture is the question physicians are most frequently asked. The duration of pain following a traumatic rib fracture without any comorbidity is not widely published. Aim: We report our experience to investigate the duration of pain following isolated traumatic rib fractures without any traumatic comorbidity. Material and methods: We examined 182 patients with isolated rib fracture without any trauma to other body parts. The numeric rating scale (NRS) for pain was used to rate the level of pain. The NRS pain scores were evaluated in the emergency department at presentation, on the 15th day, and at the 3rd and 6th months of trauma. The Mann-Whitney U test was performed for the statistical analysis. Results: The pain level of young patients on the 15th day and at the third month and sixth month was lower than that in the old group, and the difference was statistically significant. While patients with two rib fractures had a higher pain level in the emergency room than those with one rib fracture, there was no statistically significant difference at other time points. In patients with anterior fractures, the pain level was significantly lower than in the lateral and posterior regions, whereas in the lateral fractures, the pain score was significantly higher than others at all time points except at the 6th month. The pain score of displaced fractures was significantly higher than that of non-displaced ones at all time points except the 6-month follow-up. Conclusions: Rib fractures cause significant pain and need appropriate medication. The time of the 6th month could be an important milestone.Item Pleural Giant Solitary Fibrous Tumor and Immunohistochemical ProfileNese, N; Yaldiz, S; Ovali, G; Isisag, APleural solitary brous tumor is a rare and slow growing intrathoracic neoplasm. It originates from submesenchymal cells of parietal or, more commonly, visceral pleura. Although most cases follow a benign clinical course, it has been reported that a malignant outcome is seen in 7,5-37% of cases. We present here a case considered as pleural solitary brous tumor with malignant potential. A 74-yearold woman presented with dyspnea and computerized tomography showed a mediastinal mass connected to the pleura. The tumor was removed by surgery. Grossly, the tumor was lobulated, welldemarcated and mostly encapsulated. Its weight was 754 gr. and it measured 17x12x5.5 cm. The cut surface had a whorled appearance. Focal necrosis and myxoid degenerative areas were noted. Histopathologically, hypocellular areas characterized by uniform, small spindle cells in a collagen rich stroma and hypercellular areas were seen. The tumor had a prominent branching vascular network. Although mitosis was infrequent, necrosis was common. Tumoral cells were strongly immunoreactive for CD34, bcl-2 and vimentin by immunohistochemistry. Cytokeratin, actin, S100, CD117 and desmin were negative. The ratio of Ki-67 positive cells was 10%. the patient was diagnosed as pleural solitary brous tumor with malignant potential because of hypercellularity and presence of large necrotic areas although increased mitosis and pleomorphism were almost absent. : ere was no recurrence or metastasis 15 months after the surgery.Item Oblique Chest X-Ray: An Alternative Way to Detect PneumothoraxTulay, CM; Yaldiz, S; Bilge, APurpose: To identify occult pneumothorax with oblique chest X-ray (OCXR) in clinically suspected patients. Methods: In this retrospective study, we examined 1082 adult multitrauma patients who were admitted to our emergency service between January 2016 and January 2017. Clinical findings that suggest occult pneumothorax were rib fracture, flail chest, chest pain, subcutaneous emphysema, abrasion or ecchymosis and moderate to severe hypoxia in clinical parameters. All of these patients underwent anteroposterior chest X-ray (APCXR), but no pneumothorax could be detected. Upon this, OCXR was performed using mobile X-ray equipment. Results: Traumatic pneumothorax was observed in 421 (38.9%) of 1082 patients. We applied OCXR to 26 multitrauma patients. Occult pneumothorax was evaluated at 22 patients (2.03%) in 1082 multitrauma patients. The 22 patients who had multitrauma occult pneumothorax on OCXR were internated at intensive care unit (ICU) and follow-up was done using OCXR and APCXR. Conclusions: OCXR can be an alternative imaging technique to identify occult pneumothorax in some trauma patients at emergency room and also follow period at ICU.Item A thymic neuroendocrine carcinoma presenting with upper gastrointestinal bleeding: A case reportYaldiz, S; Yaldiz, D; Tulay, CM; Isisag, ANeuroendocrine carcinomas of the thymus are rare clinical entities, which can be complicated by endocrine abnormalities. These tumors are frequently associated with ectopic adrenocorticotropic hormone production giving rise to Cushing's syndrome. Herein, we describe a 23-year-old male case with upper gastrointestinal bleeding as the initial presentation of a thymic neuroendocrine carcinoma. This case was reported due to its extremely exceptional occurrence.Item Video-Assisted Thoracoscopic Surgery for the First Episode of Primary Spontaneous PneumothoraxTulay, CM; Yaldiz, SThe aim of this study was to evaluate the use of a videothoracoscopic surgical (VATS) approach as the first-line treatment for primary spontaneous pneumothorax (PSP). One hundred sixteen patients who were diagnosed with pneumothorax and underwent surgery with VATS technique between January 2016 and January 2018 were included in the study. We observed 60 patients with a first episode of PSP and 56 patients with recurrent PSP who had undergone prior chest tube application. Surgery was done in the first 24 h after hospital admission. Duration of hospital stay and pneumothorax recurrence rate were recorded. Pain level was assessed on the fifteenth day after surgery using the numerical rating scale (NRS). Recurrent pneumothorax patients who were treated with chest tube application after their first episode were asked to evaluate their preference for surgery over chest tube via a questionnaire. Intraoperative bleb/bullous structures were detected in 102 (87.93%) of 116 patients. In the questionnaire of 56 patients with recurrent pneumothorax who had previously undergone chest tube, 44 (78.6%) stated that they would immediately accept operation instead of the chest tube, if recommended. The length of hospitalization was significantly less in patients who underwent surgery in the first episode. There was no statistical difference between pain scores. Employing VATS as the first-line treatment for PSP provides benefits of early return to normal daily life, better clinical satisfaction, and psychosocial outcomes.Item Comparison of thoracic epidural and paravertebral analgesia for postoperative pain control after thoracotomyÖztürk, T; Topcu, I; Yaldiz, S; Özbakkaloglu, A; Asik, K; Yentür, AObjectives: In the present randomized, controlled, and blinded study, the effects of thoracic paravertebral analgesia were compared to those of epidural analgesia on postoperative pain, hemodynamics, and respiration rate following thoracotomy. Methods: Patients scheduled for elective open-lung surgery were included. One hour prior to surgery, thoracic epidural catheters were used in 18 patients (ED group), and ultrasound-guided paravertebral catheters were used in 17 patients (PV group). Standard general anesthesia was administered to all. Following anesthesia, postoperative analgesia of levobupivacaine 0.1% and morphine 0.1 mg mL(-1) was administered via catheter. Patient-controlled analgesia (PCA) regime with tramadol was initiated, and amounts of local anesthetics and tramadol demanded and delivered within the first 24 hours were recorded. Visual analog scale (VAS) pain score, sedation score, side effects, and vital signs (blood pressure, heart rate, and respiratory rate) were assessed by an observer blinded to patient data at 1, 2, 3, 4, 6, 12, and 24 hours. Results: Differences in PCA bolus demands and deliveries were not statistically significant between the PV group (26.8 +/- 1.3 and 33.1 +/- 4.5) and the ED group (25.1 +/- 3.5 and 32.5 +/- 4.3). Neither were differences in VAS scores statistically significant (p = 0.3). Rates of sedation among the PV group were lower than those of the ED group at 1 hour (p = 0.001). Five patients in the ED (% 28) group experienced hypotension (p = 0.02). Conclusion: Paravertebral block with levobupivacaine 0.1% and morphine 0.1 mg mL(-1) may be an alternative form of pain relief following thoracotomy.Item An Unusual Presentation of Bronchial RuptureGoktalay, T; Yaldiz, S; Alpaydin, AO; Goktan, C; Celik, PPersistent hydropneumothorax was diagnosed in a 62-year-old female with a history of blunt trauma, although she was treated with chest tube and closed underwater seal drainage. Computed tomography and fiberoptic bronchoscopy findings were consistent with fallen lung syndrome. Fiberoptic bronchoscopy also found a cavitary lesion at the right tracheobronchial angle. Forceps biopsy of the cavitary lesion indicated bronchogenic carcinoma. Our final diagnosis was tracheobronchial complete rupture and fallen lung syndrome secondary to malignancy.Item Comparative analysis of two different Turkish hospital reports on polytrauma patients with thoracic traumaYaldiz, S; Tulay, CM; Yaldiz, D; Arpat, AH; Bayülgen, A; Pirzirenli, MG; Balta, CBACKGROUND: The present study aims to assess whether there are any differences in the management and outcome of polytrauma patients with thoracic trauma in trauma units of two different hospitals in the same country; one hospital is near the Syrian border. METHODS: A retrospective analysis (January 2012 to January 2014) of 348 polytrauma casualties with thoracic trauma from Manisa Celal Bayar University Hospital (MH) were compared according to age, gender, mechanism of injury, associated injuries, abbreviated injury scale (AIS), injury severity score (ISS), treatment modalities, and mortality with 917 patients of Sanliurfa Training and Research Hospital (SH) registry (near the Syrian border). RESULTS: Of the 348 patients in the MH, 230 (66%) and of the 917 patients in the SH, 697 (76%) were males (p<0.001). Mean age was 45.6 +/- 18.3 yrs in the MH group and 26.4 +/- 22.4 yrs in the SH group (p<0.001). The SH patients had a larger proportion of stab wounds (MH; 9% vs. SH; 17%, p<0.05), gunshot injuries (MH; 5% vs. SH; 18%, p<0.05), higher mean ISS (MH; 30.2 +/- 8.4 vs. SH; 42.8 +/- 10.2, p<0.001), and increased mortality (MH; 2.6% vs. SH; 11.1%, p<0.001). AIS(abdomen) was the highest component in the SH registry (AIS(abdomen) = 4.8 +/- 0.7), whereas AIS extremities were the highest component in the MH registry (AIS(extremities) = 3.6 +/- 0.2). CONCLUSION: Significantly different demographic features, mechanisms of injury, worse outcomes and higher mortality rates in SH demonstrate and reflect the surgical challenges depending on the combat environment. Two hospitals in Turkey, one seemingly adjacent to a war zone and another with the more standard civilian experience highlight the impact of the Syrian conflict on the Turkish healthcare system.