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Öğe A Case of Chylothorax with Interesting Etiology(2018) Ogan, Nalan; Aakpınar, Evrim Eylem; Kaplan, Tevfik; Türker, Gökçe; Gülhan, MeralChylothorax occurs when chylous fluid from the lymphatic system accumulates in the pleural space due to damage to the ductus thoracicus. The milky fluid contains a high concentration of triglycerides in the form of chylomicrons. The initial test for diagnosis is analysis of the pleural fluid. It may be associated with a number of traumatic and nontraumatic conditions. Chylothorax was diagnosed in a patient who underwent an operation for a thoracic vertebra fracture 4 years earlier who presented with bronchitis. Fixation pins in the lower thoracic vertebra inserted in the operation were observed on thorax computerized tomography. No other etiological cause for chylothorax was found based on the patient history, physical examination, or advanced examinations. It was decided that the collapse and fracture operation had a late complication. This case is presented as an interesting etiological cause of chylothorax as, to our knowledge, there is no similar case in the literature.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 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 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.
