Thoracic Surgery

Background: We found nimotuzumab combined with chemotherapy showed good efficacy in patients with squamous cell lung cancer. Now we try to evaluate efficacy and safety of nimotuzumab combined with chemotherapy as first line therapy for advanced lung squamous cell carcinoma. Methods: A retrospective analysis of clinical data was conducted in patients with advanced lung squamous cell carcinoma, who were treated by nimotuzumab during

Bu çalışmada Göğüs Cerrahisi uzmanlık eğitimi veren Üniversite Hastaneleri ve Eğitim ve Araştırma Hastanelerinin Göğüs Cerrahisi kliniklerinde görev yapan asistanların aldıkları cerrahi eğitim konusundaki görüşleri sorgulanarak, genel bir yaklaşım oluşturulmaya çalışıldı. Ça lış ma pla nı: Türk Tabipleri Birliği yayınlarından Tıpta Uzmanlık Eğitimi isimli kitapta yer alan ve uzmanlık eğitimi gören hekimlerin eğitime ilişkin görüşlerinin incelendiği araştırmadan esinlenerek, beşi açık uçlu olmak üzere 19 soruluk bir anket formu düzenlendi. Anket formundaki sorular, yedi farklı hastanede göğüs cerrahisi uzmanlık eğitimi alan 52 asistana yöneltildi. Sonuçlar, SPSS istatistik yöntemi kullanılarak değerlendirildi. Bul gu lar: Ankete katılan 52 asistan arasından 21'i (%40.4), Göğüs Cerrahisi branşını seçme nedeni olarak ilgi duyduğu alan olması olarak belirtti. Sekiz katılımcı (%15.4) Tıpta Uzmanlık Sınavı tercihi sıralamasında Göğüs Cerrahisi uzmanlık dalını 4. sırada işaretlediklerini bildirdi. Otuz iki katılımcı (%61.5) eğitim aldıkları klinikte "asistan eğitim programı" bulunduğunu belirtirken, 30 katılımcı (%57.7) eğitici sıfatı bulunanların ders anlatmadığını ifade etti. Yirmi beş katılımcı (%48.1) çalıştıkları birimdeki yönetim biçimini "hiyerarşik" olarak tanımladı. Ankete katılan asistanların %67'si, ihtisas süresinin yeterli olduğu görüşünde birleşti. Bilgi edinme kaynağı ile ilgili olarak sorulan soruya 29 katılımcı (%55.7) "kıdemli asistan" şeklinde görüş bildirdi. Çalışma şeklinin sorgulandığı soruda, yüksek oranda (%78.8) "stresli" yanıtı alındı. So nuç:Alınan yanıtlar, Türkiye'de verilen Göğüs Cerrahisi asistanlık eğitiminde belirli bir stantardizasyon olmadığı görüşünü destekler niteliktedir. Bu çalışmada teorik ve pratik eğitimin yeterince ve belirli bir düzen içinde yapılmadığı, çalışma şeklinin ise stresli olduğu sonucuna varılmıştır. Anah tar söz cük ler: Anket; göğüs cerrahisi asistanlığı; eğitim. Background: In this study, we aimed to constitute a general approach, by investigating opinions of the residents who were trained in the Thoracic Surgery Department in the University Hospitals and Research and Training Hospitals on thoracic surgery training. Methods: A-19-question questionnaire including five open-ended questions was developed with the guidance of a survey which was published in the Medicine Speciality training, one of the publications of Turkish Medical Association, investigating opinions of the residents on residency training. The questionnaire was administered to 52 residents who were trained in Thoracic Surgery Department in seven health care centers. Statistical analysis was performed using SPSS software. Results:Twenty one (40.4%) of 52 respondents reported that they chose to be specialist on Thoracic Surgery, as they were interested. Eight respondents (15.4%) reported that they marked Thoracic Surgery speciality as fourth preference in the Medical Speciality Exam. Thirty two respondents (61.5%) stated that they were assigned to a training program, while 30 respondents (57.7%) reported that they were not trained by a teaching physician. Twenty five respondents (48.1%) defined the administration as hierarchical. A total of 67% of the respondents reported that the duration of residency was reasonable. Twenty nine respondents (55.7%) reported that senior residents were useful resource for them. The majority of the respondents (78.8%) replied to the question on working environment that they were working under stressful conditions. Conclusion: Our study results support that no standard training program on Thoracic Surgery is available in residency in Turkey. We conclude that theoretical education is not being efficiently harmonized with training in clinical practice on a regular basis, beyond stressful working conditions.

Thoracic traumas have an important place among all injuries as they can cause significant mortality and morbidity. The thoracic injuries are the large part of trauma with head and extremity injuries. Thoracic traumas are divided into two groups, including penetrating and blunt. The primary causes for penetrating traumas are wounds caused by gunshot and sharp objects. The lungs are the most injured organ in penetrating thoracic traumas with many organ injuries accompanied. This case report is about a rebar impalement into bilateral hemitoraces and pericardium after falling down in spite of any injury is not occurred in heart, lung and great vessels. The fact that an injury to such an extent does not cause any intrathoracic catastrophic event is something that has not been reported in the past.

Objective: Pneumomediastinum (PM) can be observed after blunt and penetrating chest trauma. Most of the patients with PM due to trauma can be managed conservatively. This study aimed to evaluate the cases with PM on thorax computed tomography (CT) after blunt chest trauma (BCT). Methods: Medical records of patients with PM due to BCT between January 2000 and December 2014 were reviewed retrospectively. Thorax CT was used to verify pneumomediastinum in all patients. Twenty-four patients which had different causes of PM (penetrating trauma, iatrogenic, spontaneous) were excluded from the study. Data of sixty-nine patients with the diagnosis of PM secondary to BCT and who were observed without any further procedure for the cause of PM, were evaluated retrospectively. Results: There were 59 male and 10 female patients with the mean age of 47.60 ± 17.47 years (range, 16 to 80 years). The most common cause of PM etiology was traffic accident with a rate of 38 (55.06%) patients, followed by fall from height in 25 (36.24%), compression in 3 (4.35%) and drubbing in 3 (4.35%) patients. There was a 12.46 ± 6.42 days (range, 6 to 28 days) mean duration of chest tube drainage which was performed for accompanying pathologies like pneumothorax and hemothorax. No complication was determined for short and long term follow-up of patients when all hospital records were analyzed in terms of complication. Conclusions: PM after BCT may be a marker of esophageal and tracheobronchial injury and invasive procedures like bronchoscopy and endoscopy can be needed for differential diagnosis. We evaluated 69 patients in good general status and no need for intensive care management with PM in this study and observed them without any further procedure. As a result of these findings we concluded that for the PM patients after BCT with uneventful clinical course, conservative treatment without any further procedure is a safe and sufficient method.

Objectives: Pneumomediastinum (PM) can be observed after blunt and penetrating chest trauma or it can be seen either spontaneously or due to iatrogenic causes. We aimed to evaluate the cases with PM on thorax computed tomography (CT) after blunt chest trauma (BCT). Methods: The records of 93 patients who were hospitalized with the diagnosis of PM between January 2000 and December 2014 were analyzed retrospectively. Pneumomediastinum was verified with thorax CT in all patients. Twenty-four patients were excluded for different causes (penetrating trauma, iatrogenic, spontaneous) of PM. We evaluated the data of 69 patients (59 males, 10 females) with the diagnosis of PM secondary to BCT and who were

Spontaneous splenic rupture is a quite rare entity that may develop secondary to some special situations (lymphoma, post-abdominal surgey etc). In the literature, the case of a patient has been reported following thoracic surgery. In a patient who had undergone right upper lobectomy for pulmonary carcinoma, signs of acute abdomen and low levels in the hemogram were detected on the fifth postoperative day; therefore, the patient underwent further investigations. A radiological evaluation revealed splenic rupture, and the patient was operated on. A case is presented that may be fatal and requires emergency response and that has to be kept in mind, although it is extremely rare. A case of spontaneous splenic rupture has been presented that may be fatal and requires emergency response; this should be kept in mind, although it is extremely rare.

which has a different clinical profile and path of spread. So our purpose was to explore the correlations between status of EGFR mutations and distant metastases. Methods: A total of 1391 patients with nonesmall cell lung cancer identified with status of EGFR mutations from August 2010 to May 2015 at Shanxi Cancer Hospital were enrolled. The associations among EGFR mutations, clinical factors, and distant metastases at initial diagnosis were evaluated. The data of distant metastases of the brain, bone, liver, lung, adrenal gland, and other sites were verified using imaging. The chi-square or Fisher exact test was used to compare the proportion between two groups of patients with and without EGFR mutations among different demographic characteristics. The uni-variable and multivariate analysis of the correlation between different metastatic sites and clinical characteristics was performed using a logistic regression model. Results: Patients harboring EGFR mutation were more likely to be female (P<0.001) with no smoking history (P<0.001), adenocarcinoma (P¼0.001), higher ECOG performance scores (P¼0.049), brain metastases (P¼0.048), lung metastases (P<0.001), and bone metastases (P¼0.002). The status of EGFR mutation achieved statistical difference both in univariate analysis (P<0.001) and in multivariate analysis (P¼0.001). The ECOG performance status (P<0.001), smoking (P¼0.031), pathology (P<0.001), T stages (P<0.001) and N stages (P<0.001) also had a statistically significant correlation with distant metastases. Associations between EGFR mutation status and distant metastases were found in brain (P<0.001) and lung metastases (P¼0.001) in multivariate analysis, but they were not found with other types of metastasis. T stages were closely correlated with lung metastases (P<0.001). The pathologic type of non-squamous cell carcinoma associated with higher brain (P¼0.029), and adrenal gland metastases (P¼0.033) than squamous cell carcinoma. N involvement only showed statistically significant differences for metastasis of the bone (P¼0.029), lung (P<0.001), brain (P<0.001), liver (P¼0.005), and adrenal gland (P¼0.005) and other sites (P<0.001). The results in EGFR subtype analysis showed 19del mutations was associated with total metastases (OR1.487, 95%CI 1.077e2.054, P¼0.016) brain (OR 1.852, 95% CI1.211e2.832, P¼0.004), and lung metastases (OR 1.726, 95%CI1.168e2.551 P¼0.006). The exon 21 point mutations associated with total (OR 1.398, 95%CI 1.005e1.945, P¼0.047) and liver metastases (OR 1.821, 95%CI 1.052e3.151, P¼0.032). Conclusion: The EGFR mutations in NSCLC are independently correlated with distant metastases. Subgroup analyses showed that patients with 19del mutations probably developed distant metastases more readily than those with exon 21 point mutations.