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Öğe Comparison of awake and intubated video-assisted thoracoscopic surgery in the diagnosis of pleural diseases: A prospective multicenter randomized trial(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2019) Kocaturk, Celalettin; Kutluk, Ali Cevat; Usluer, Ozan; Onat, Serdar; Cinar, Huseyin Ulas; Yanik, Fazli; Ozpolat, BerkantBackground: This study aims to compare the safety and diagnostic accuracy of awake and intubated video-assisted thoracoscopic surgery in the diagnosis of pleural diseases. Methods: This prospective randomized study was conducted between October 2016 and April 2018 and included 293 patients (201 males, 92 females; mean age 53.59 years; range, 18 to 90 years) from five medical centers experienced in video-assisted thoracoscopic surgery. The patients were randomized into two groups as awake video-assisted thoracoscopic surgery with sedoanalgesia (non-intubated) and video-assisted thoracoscopic surgery with general anesthesia (intubated). Patients with undiagnosed pleural effusions and pleural pathologies such as nodules and masses were included. Conditions such as pain, agitation, and hypoxia were indications for intubation. The groups were compared in terms of demographic data, postoperative pain, operative time, complications, diagnostic accuracy of the procedures, and cost. All patients completed a follow-up period of at least 12 months for samples that were non-specific, suspicious for malignancy or inadequate. Results: Awake video-assisted thoracoscopic surgery was performed in 145 and intubated video-assisted thoracoscopic surgery was performed in 148 patients. Pleural disease was unilateral in 83% (243/293) and bilateral in 17% (50/293) of the patients. There was no difference between the groups in terms of presence of comorbidity (p=0.149). One patient in the awake video-assisted thoracoscopic surgery group (0.6%) was converted to general anesthesia due to refractory pain and agitation. As postoperative complications, fluid drainage and pneumonia were observed in one patient in the awake video-assisted thoracoscopic surgery group (0.6%) and fluid drainage was detected in one patient in the video-assisted thoracoscopic surgery group (0.6%). There were no differences in pain intensity measured with visual analog scale at postoperative 4, 8, 12, or 24 hours (p>0.05). Distribution and rates of postoperative pathological diagnoses were also similar (p=0.171). Both operative cost and total hospital cost were lower in the awake video-assisted thoracoscopic surgery group (p<0. 001, p=0.001). Conclusion: Our study showed that awake video-assisted thoracoscopic surgery is safe, has similar reliability and diagnostic accuracy compared to video-assisted thoracoscopic surgery performed under general anesthesia, and is less costly. Awake video-assisted thoracoscopic surgery can be the first method of choice in all patients, not only in those with comorbidities.Öğe The effect of basic fibroblast growth factor and adipose tissue-derived mesenchymal stem cells on wound healing, epithelization and angiogenesis in a tracheal resection and end-to-end anastomosis rat model(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2013) Ozpolat, Berkant; Gurpinar, Ozer Aylin; Ayva, Ebru Sebnem; Gazyagci, Serkal; Niyaz, MehmetBackground: This experimental study aims to investigate whether basic fibroblast growth factor, adipose tissue-derived from mesenchymal stem cells, or a combination of both, has an effect on wound healing, epithelization and angiogenesis in a tracheal resection and end-to-end anastomosis rat model. Methods: During the first phase of the study, mesenchymal stem cells were isolated by the primary explant culture technique from the abdominal adipose tissue of rats. When the cells became confluent, they were passaged and characterized by using immunofluorescence staining technique. The cells were cryopreserved for an in vivo application. The rats were divided into four groups, including: the basic fibroblast growth factor (group 1), the mesenchymal stem cells (group 2), the mesenchymal stem cells and basic fibroblast growth factor (group 3) and control group (group 4). The rats were sacrified at day 60 and the anastomosis was evaluated macroscopically for granulation tissue formation, the stenosis and presence of tracheocutaneous fistula formation, and also microscopically for stenosis, epithelium regeneration, inflammation, collagen formation and neovascularization. Results: The inflammation was significantly lower in the study groups (p=0.004, p=0.014, p=0.004), whereas the collagen formation and epithelial regeneration were significantly higher in the study groups, compared to the control group (p=0.015, p=0.022, p=0.026 and p=0.002, p=0.001, p=0.002). Conclusion: Both basic fibroblast growth factor and adipose tissue-derived mesenchymal stem cells increased epithelial regeneration and connective tissue organization in this rat model. They may be used as an adjuvant therapy to surgical resection in patients undergoing tracheal resection.Öğe Identification of the concentration of iodopovidone pleurodesis in rats for the maximal effectiveness(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2013) Yazkan, Rasih; Ozpolat, Berkant; Duman, Levent; Bircan, Sema; Bozkurt, Kemal Kursat; Gunes, SedatBackground: This study aims to investigate the efficacy and safety of different doses of iodopovidone for pleurodesis and to evaluate the histopathological changes in thyroid tissue. Methods: Thirty-eight male Albino Wistar rats (260-320 g, 6-8 months old) included in this experimental study were randomly divided into four groups. Groups 1, 2, and 3 were given 2 mL/kg intrapleural iodopovidone at concentrations of 1%, 2%, 4%, respectively, while group 4 was administered intrapleural saline. The surfaces were graded by macroscopic and microscopic examination on Day 30 and thyroid tissues were histopathologically examined. Results: Iodopovidone at concentrations of 2% and 4% resulted in significantly more adhesions and inflammatory response. Four percent iodopovidone produced nonsignificant microscopic changes in the contralateral visceral pleural surface. No vacuolization in thyroid tissue showing hyperthyroidism was observed in the groups. Conclusion: We suggest that 2% iodopovidone is enough for an effective and safe pleurodesis and the concentration of iodopovidone may be raised to 4% in unsuccessful cases. However, as the study was conducted on rats, it still remains to be elucidated that the similar results can be achieved in human studies.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 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.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.
