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    A Rare Form of Mesothelioma: Malignant Pleural Deciduoid Mesothelioma
    (Aves, 2014) Alar, Timucin; Ozcelik, Cemal; Kilinc, Nihal; Yilmaz, Ufuk
    Mesothelioma usually develops in elder male patients that are exposed to asbestos. Deciduoid mesothelioma is a rare variant of epithelioid mesothelioma and has a poorer prognosis than epithelioid mesothelioma. As this subtype was seen in the peritoneum of young females and its relation with asbestos was not definite, these lesions were formerly thought to be stimulated by endogenous hormones. In the subsequent years, a relation was established between this tumor and asbestos since it was seen in the pericardium and pleura of males. In this paper, we present a 64-year-old male patient with asbestos exposure, diagnosed as having malignant pleural deciduoid mesothelioma, in which a long survival was provided with chemotherapy after surgery.
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    Factors affecting the outcome of surgically treated non-iatrogenic traumatic cervical esophageal perforation: 28 years experience at a single center
    (Biomed Central Ltd, 2010) Onat, Serdar; Ulku, Refik; Cigdem, Kemal M.; Avci, Alper; Ozcelik, Cemal
    Background: We reviewed our experience with non-iatrogenic traumatic cervical esophageal perforations, paying particular attention to factors affecting the outcome of such cases. Methods: In total, 30 patients treated surgically between 1980 and 2008 for non-iatrogenic traumatic cervical esophageal perforation in our clinic were reviewed. Results: There were 25 male and 5 female patients with a median age of 27.5 years. The type of injury was external trauma in 21 (70%) patients and endoluminal injury in the remaining 9 (30%) patients. The mechanism of injury was gunshot in 16 patients, stabbing in 4, falling in 1 (extraluminal injury), and foreign body in 9 (endoluminal injuries). The overall mortality rate was 16.6% (5/30). The mortality rate for extraluminal injuries was 19%, and for endoluminal injuries was 11.1%. Mortality in patients treated within 24 h of sustaining injury was substantially less than in those for whom diagnosis and treatment were delayed (12.5 and 21.4%, respectively). The mortality rate was 33.3% (3/9) for patients with tracheal injuries and 9.5% (2/21) for those without tracheal injuries. Conclusions: A treatment delay greater than 24 h, the presence of tracheal injury, or extraluminal perforation significantly affected the outcome of surgically treated non iatrogenic traumatic cervical esophageal perforation.
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    Giant Mediastinal Mass: Thymolipoma
    (Lippincott Williams & Wilkins, 2011) Alar, Timucin; Ozcelik, Cemal; Klnc, Nihal
    A 26-year-old man presented with shortness of breath on exertion that was gradually getting worse. His history revealed a mass in the left hemithorax that had been growing on follow-ups. Physical examination only showed that the respiratory sounds were fainter on the left. Thoracic computerized tomography was performed to elucidate the left hemithorax lesion seen on chest x-ray and a giant mass of lipid density extending from the anterior mediastinum to the diaphragm and filling almost the entire left hemithorax was observed. Total excision of the 25 x 21 x 8 cm mass weighing 1580 g was performed with a left thoracotomy. The histopathology investigation of the mass was reported as thymolipoma. The case was presented because it is a rare mediastinal mass.
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    How does the type of thoracotomy affect the patient quality of life? A short form-36 health survey study
    (Springer, 2014) Alar, Timucin; Ceylan, Kenan Can; Kaya, Seyda Ors; Sevinc, Serpil; Sigirli, Deniz; Ozcelik, Cemal
    We evaluated whether the quality of life was affected in patients who had undergone various types of thoracotomy using the Short Form-36 Health Survey. The patients who had undergone thoracotomy for diagnosis or treatment between January and September 2011 in the Thoracic Surgery Department were investigated to determine the effect of the type of thoracotomy on the quality of life using the Short Form-36 Health Survey. The patients were classified into three groups. In Group I, the latissimus dorsi and the serratus anterior had both been preserved, and there was no muscle dissection, in Group II the latissimus dorsi muscle had been dissected and only the serratus anterior muscle has been preserved, and in Group III both muscles had been dissected, and the standard posterolateral muscle dissection had been performed. A total of 101 patients comprising 64 males (63.37 %) and 37 females (36.63 %), with a median age of 38 years, were included in this study. There were significant differences in all quality of life subscales between Groups I and III and between Groups II and III. The patients in Group I had the highest scores, while the patients in Group III had the lowest scores. There were no significant differences in five of the eight Short Form-36 subscales and one of the two summary scores values between Group I and Group II in females. We investigated the effect of the type of thoracotomy on the patient quality of life using the Short Form-36 Health Survey, and found that the standard posterolateral thoracotomy had a marked adverse effect on the quality of life compared to muscle-sparing thoracotomy. We also found that it is possible to use thoracotomy with serratus preservation rather than muscle-sparing thoracotomy in cases with benign diseases where a large field of view is required, such as for decortication and pulmonary hydatid cysts, without any significant decrease in the quality of life, especially in females.
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    Single-incision thoracoscopic surgery of pleural effusions for diagnosis and treatment
    (Springer, 2013) Alar, Timucin; Ozcelik, Cemal
    Several procedures such as video-assisted thoracoscopic surgery (VATS) are used to make a definite diagnosis in recurrent pleural effusions so that appropriate treatment can be arranged. Single-incision thoracoscopic surgery (SITS) is the most appropriate procedure that can be used for this purpose. The contribution of SITS to diagnosis and treatment is evaluated in this study that we conducted using a single thoracoport in patients with pleural effusion. Nineteen consecutive patients with pleural effusion that was recurrent or refractory to medical treatment were included in the study to be diagnosed and treated with SITS. Thoracentesis was performed and pleural fluid samples obtained in all patients before the procedure. Pleural effusion drainage was performed from the 11-mm single skin incision by using a 10.5-mm single thoracoport, and biopsy or talc pleurodesis was performed in the same session when needed. The median age of the patients was 56.68 +/- A 3.05 years and there were 11 males and 8 females. The total amount of fluid drained by SITS was 1,436 +/- A 227 mL and the surgery lasted 81.05 +/- A 5.36 min. In addition, partial decortication and/or deloculation were performed in six patients and talc pleurodesis in nine patients. Fifteen patients were diagnosed with benign and four patients with malignant pleural effusion by thoracentesis, while nine patients were diagnosed with benign and ten patients with malignant pleural effusion by SITS. We therefore had six cases diagnosed as benign with thoracentesis who were diagnosed with malignant disease after SITS. SITS presents both diagnosis and treatment options together for pleural effusions. We believe SITS should be preferred to conventional three-port VATS to minimize the spread of infection and tumor cells to the chest wall in infectious and malignant diseases.
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    Treatment of pediatric parapneumonic empyemas with pulmonary cavitary lesions
    (Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2013) Alar, Timucin; Ozcelik, Cemal; Onat, Serdar; Ozcelik, Zerrin; Bayar, Emin Sirri
    Background: This study aims to evaluate the treatment approach and timing of surgical intervention in pediatric parapneumonic empyema cases with cavitary lesions. Methods: Between January 1990 and December 2006, 38 patients (21 boys, 17 girls; mean age 4.1+2 years; range 1 to 15 years) from the pediatric age group treated for parapneumonic empyema with cavitary lung lesions at the Dicle University Faculty of Medicine Department of Thoracic Surgery were retrospectively analyzed. The demographic characteristics, symptom duration, radiological examinations, treatment methods, and time to recovery of cavitary lesions during the hospitalization and follow-up were evaluated. Results: A total of 13 patients (34%) were given medical treatment, while 25 (66%) underwent surgical treatment. The medical treatment group had a statistically significantly shorter inpatient duration than the surgical treatment group (p=0.010). Analysis of the postoperative inpatient duration revealed that the surgically treated patients stayed statistically significantly shorter in the hospital than the medical treatment group (p<0.001). A bronchopleural fistula (BPF) was found in eight (21%) patients and all were in the surgical treatment group. The mean time to recovery of cavitary lesions during follow-up was 48.7 +/- 8 days (range, 22-106 days). Conclusion: Treatment of parapneumonic pediatric empyema cases with cavitary lesions should include controlling the pleural process with standard empyema treatment, considering pneumonia treatment as an integral part of the disorder, performing surgical treatment if a bronchopleural fistula is present or otherwise waiting patiently for the cavitary lesions to regress and postponing open surgical treatment until the recovery period is completed.