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Öğe Elastofibroma dorsi management and outcomes: review of 16 cases(Oxford Univ Press, 2014) Karakurt, Ozgur; Kaplan, Tevfik; Gunal, Nesimi; Gulbahar, Gultekin; Kocer, Bulent; Han, Serdar; Sakinci, UnalElastofibroma dorsi (ED) is a rare, benign lesion arising from connective tissue, usually found at the inferior pole of the scapula. To date, only a few small series have been reported in the English literature and there are few data about the long-term outcomes after surgery. Our goal is to contribute a better understanding of this tumour and to determine the long-term outcomes after surgery. Sixteen patients with a diagnosis of ED were identified from the unit's database. The clinical presentation, diagnosis, pathological evidences and long-term outcomes were evaluated. There were 11 females and 5 males with a mean age of 61.1 years (range 38-78 years). The tumour was located on the right in 5 (31.2%) patients, on the left in 6 (37.5%) patients and bilaterally in 5 (31.2%). Six patients had painful scapular swelling resulting in restriction of movement of the shoulder whereas 10 reported only painful scapular mass. All 16 patients underwent complete resections. The tumour size ranged from 3 to 15 cm. The mean hospital stay was 3.1 +/- 1.4 days with a morbidity of 18.75% (seroma observed in 3 patients). The mean follow-up was 58.4 +/- 29.5 months (range 11-92 months). In 2 patients (12.5%) a new occurrence on the contralateral side was observed at the follow-up. Elastofibroma dorsi is a rare, ill-defined, pseudotumoural lesion of the soft tissues. Surgical treatment can be proposed if the lesion is symptomatic. Furthermore, at the follow-up, the possibility of new occurrences on the contralateral side should be kept in mind.Öğe Intrapericardial Gossypiboma in an Elderly Patient(Derman Medical Publ, 2013) Ozpolat, Berkant; Gunal, Nesimi; Yazkan, Rasih; Dural, KorayWe report a case of surgically retained pericardial sponge in an 82-year-old man who underwent sternotomy for coronary artery bypass operation four years ago. After the operation the chest x-ray showed a radiopaque filament at the retrocardiac region. This case report shows the serial radiological examinations by computed tomographic scans over 4 years demonstrating a well-defined mass adjacent to left ventricle with a radiopaque filament inside with pseudocystic changes in time. As far as we know this case is the first one in the literature showing the changes in a case of gossypiboma, as the patient refused surgery.Öğe Painful Chest Wall Swellings: Tietze Syndrome or Chest Wall Tumor?(Georg Thieme Verlag Kg, 2016) Kaplan, Tevfik; Gunal, Nesimi; Gulbahar, Gultekin; Kocer, Bulent; Han, Serdar; Eryazgan, Mehmet Ali; Sakinci, UnalBackground Tietze syndrome (TS) is an inflammatory condition characterized by chest pain and swelling of costochondral junction. Primary chest wall tumors may mimic TS. In this article, we report our experience of approximately 121 patients initially diagnosed as TS and determined chest wall tumor in some cases at the follow-up. Methods This is a retrospective review of patients diagnosed as TS by clinical examination, chest X-ray, electrocardiogram, routine laboratory tests, and computed tomography (CT) of chest: all treated and followed up between March 2001 and July 2012. There were 121 cases (41 males and 80 females; mean age, 39.6 +/- 3.2 years) of TS. Results In 27 patients with initial normal radiological findings, the size of swellings had doubled during the follow-up period (mean, 8.51 +/- 2.15 months). These patients were reevaluated with chest CT and bone scintigraphy and then early diagnostic biopsy was performed. Pathologic examination revealed primary chest wall tumor in 13 patients (5 malignant, 8 benign). CT had a sensitivity of 92.3% and a specificity of 64.2% in detection of tumors (kappa: 0.56, p = 0.002), whereas the sensitivity and the specificity of bone scan were 84.6 and 35.7%, respectively (kappa: 0.199, p = 0.385). Conclusion Primary chest wall tumors could mimic TS. Bone scintigraphy or CT is not specific enough to determine malignant and other benign disorders of costochondral junction. Therefore, clinicians should follow TS patients more closely, and in case of increasing size of swelling, early diagnostic biopsy should be considered.Öğe Quantative computerized tomography assessment of lung density as a predictor of postoperative pulmonary morbidity in patients with lung cancer(Ame Publ Co, 2015) Kaplan, Tevfik; Atac, Gokce Kaan; Gunal, Nesimi; Kocer, Bulent; Alhan, Aslihan; Cubuk, Sezai; Han, SerdarBackground: The aim of this study was to evaluate the pulmonary reserve of the patients via preoperative quantitative computerized tomography (CT) and to determine if these preoperative quantitative measurements could predict the postoperative pulmonary morbidity. Methods: Fifty patients with lung cancer who underwent lobectomy/segmentectomy were included in the study. Preoperative quantitative CT scans and pulmonary function tests data were evaluated retrospectively. We compare these measurements with postoperative morbidity. Results: There were 32 males and 18 females with a mean age of 54.4 +/- 13.9 years. Mean total density was -790.6 +/- 73.4 HU. The volume of emphysematous lung was (<-900 HU) 885.2 +/- 1,378.4 cm(3). Forced expiratory volume in one second (FEV1) (r=-0.494, P=0.02) and diffusion capacity of carbon monoxide (DLCO) (r=-0.643, P<0.001) were found to be correlate with the volume of emphysematous lung. Furthermore FEV1 (r=0.59, P<0.001) and DLCO (r=0.48, P<0.001) were also found to be correlate with mean lung density. Postoperative pulmonary morbidity was significantly higher in patients with lower lung density (P<0.001), larger volume of emphysema (P<0.001) and lower DLCO (P=0.039). A cut-off point of -787.5 HU for lung density showed 86.96% sensitivity and 81.48% specificity for predicting the pulmonary morbidity (kappa =-0.68, P<0.001). Additionally a cut-off point of 5.41% for emphysematous volume showed 84.00% sensitivity and 80.00% specificity for predicting the pulmonary morbidity (kappa = 0.64, P<0.001). According to logistic regression analyses emphysematous volume > 5.41% (P=0.014) and lung density <-787.5 HU (P=0.009) were independent prognostic factors associated with postoperative pulmonary morbidity. Conclusions: In this study, the patients with a lower lung density than -787.5 HU and a higher volume of emphysema than 5.41% were found to be at increased risk for developing postoperative pulmonary morbidity. More stringent precautions should be taken in those patients that were found to be at high risk to avoid pulmonary complications.Öğe A Rarely Seen Scapular Tumor: Chondrosarcoma(Derman Medical Publ, 2015) Gunal, Nesimi; Kaplan, Tevfik; Zorlu, Ekin; Ozpolat, Berkant; Dural, KorayChondrosarcoma originating from scapula is a rare occurrence accounting 5-7% of all bone chondrosarcomas. They generally originate from new cartilaginous tissue and radiologically the lesion shows cortical destruction with lytic or expansile features. Although the mainstay of the treatment is surgery, the efficacy of chemotherapy and adjuvant therapy in case of residual tumour is still contradictory due to its rare occurrence. Here we present a 56-year-old woman with a swelling on her lump who was diagnosed as scapular chondrosarcoma. Here, the diagnosis and treatment and the approach to the microscopic residual tumour after surgical intervention was presented with the review of relevant literature.Öğe The relation between scapula fracture and the severity of trauma in blunt thoracic trauma(Tubitak Scientific & Technical Research Council Turkey, 2018) Algan Kaya, Hatice; Eroglu, Oguz; Gunal, Nesimi; Coskun, Figen; Deniz, TurgutBackground/aim: The aim of this study was to determine the level of presence of scapula fractures (SFs) in cases of blunt thoracic trauma and to identify other injuries accompanying SF. Materials and methods: Blunt thoracic trauma cases with SF determined on direct radiography or computerized tomography (CT) were categorized as Group 1. Group 2 was constituted by selecting cases with high injury severity score (ISS) with no SE The demographic characteristics and all injuries of the patients were evaluated. Results: SF was determined in 77 (11.3%) patients (Group 1), and Group 2 consisted of 607 patients. The ISS was significantly higher in Group 1(27.7 +/- 16.1) than Group 2 (15.9 +/- 9.5) (P < 0.001). The rate of SF with direct radiography was only 9.1%, and more than 90% of patients were evaluated using CT. The most common accompanying injury to SF was rib fracture (44.2%), and the odds ratio was 2.4 (95% CI: 1.51-3.72). Conclusion: The incidence of SF in cases of blunt trauma was higher than in previous studies. The use of CT in blunt trauma can determine SF that cannot be identified through physical examination or radiography, and the most commonly observed accompanying damage in these patients is rib fracture.Öğe Rib fracture posing risk for aortic rupture(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2016) Gunal, Nesimi; Zorlu, Ekin; Kaplan, Tevfik; Dural, Koray; Ozpolat, BerkantA 50-year-old female patient was referred to emergency department with findings of shortness of breath and flail chest after a traffic accident. Her chest and abdomen computed tomography scan showed left hemopneumothorax, suspicious splenic bleeding, and multiple rib fractures. The fractured edge of the left sixth rib was posing a laceration threat against the descending aorta. After diagnostic laparotomy, left thoracotomy was performed, the fractured rib edge was resected before occurrence of any aortic injury, and the flail chest was stabilized. This article aims to draw attention to the importance of early intervention in posterior rib fractures posing injury threat against aorta and explain the possible mechanism.Öğe Right Axillary Sweating After Left Thoracoscopic Sypathectomy in Two-Stage Surgery(Derman Medical Publ, 2013) Ozpolat, Berkant; Gunal, Nesimi; Dural, KorayOne stage bilateral or two stage unilateral video assisted thoracoscopic sympathectomy could be performed in the treatment of primary focal hyperhidrosis. Here we present a case with compensatory sweating of contralateral side after a two stage operation.Öğe Single port thoracoscopic sympathectomy for primary palmar hyperhidrosis in adolescence(Tubitak Scientific & Technical Research Council Turkey, 2014) Gunal, Nesimi; Ozpolat, Berkant; Gunal, Yasemin Dere; Dural, KorayAim: Hyperhidrosis is defined as excessive sweating beyond the physiologic needs of a person. Palmar hyperhidrosis in the adolescent period may have an impact on school work and may cause psychological problems. In this study we aim to increase awareness of this disregarded problem. Materials and methods: We explicated the early outcomes of 7 consecutive adolescents, where single port video-assisted thoracoscopic sympathectomy was performed for primary palmar hyperhidrosis. Patients were evaluated for symptom resolution, which was defined as complete dryness, patient satisfaction, operative complications, and compensatory sweating. Results: In total 13 thoracoscopic procedures were done in 7 adolescents, consisting of 4 girls and 3 boys (median age = 16 years). Thoracoscopic sympathectomy achieved immediate complete dryness and all were very satisfied with the outcome of the procedure. Compensatory sweating was defined as mild by 4 (57%) patients. Conclusion: Thoracoscopic sympathectomy is safe and effective for the treatment of primary palmar hyperhidrosis in the adolescent period without any major side effects.
