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Akciğer Kanserli Bir Hastada Endobronşiyal Brakiterapi Uygulaması
(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2005) Gülbaş, Hülya; Erkal, Haldun Şükrü; Yıldırım, Zeki; Kuzucu, Akın; Serin, Meltem
Endobronşiyal brakiterapi, cerrahi tedavinin uygun olmaması nedeni ile radyoterapi uygulanacak olan akciğer kanserli hastalarda endobronşiyal yerleşimli lezyonların kontrol olasılığının arttırılması ya da endobronşiyal yerleşimli lezyonlara bağlı yakınmaların palyasyonunun sağlanması amacı ile tek başına ya da eksternal radyoterapi ile birlikte kullanılabilen bir tedavi yöntemidir. Bu yazıda, Radyasyon Onkolojisi Anabilim Dalı’nda akciğer kanserli bir hastada gerçekleştirilen ilk endobronşiyal brakiterapi uygulaması anlatılmaktadır.
Arterial myocardial revascularization using bilateral radial artery 17years after right pneumonectomy
(Texas Heart Instıtute Journal, 2004) Erdil, Nevzat; Nisanoğlu, Vedat; Toprak, Hüseyin İlksen; Erdil, Feray Akgül; Kuzucu, Akın; Battaloğlu, Bektaş
fter coronary artery bypass grafting (CABG), patients with a previous pneumonectomy are predisposed to a substantial risk of cardiopulmonary complications. The best surgical strategy for performing CABG on After patient with a single lung is unclear from the literature;1 few such cases have been reported.1-4 To our knowledge, this is the 1st report of arterial myocardial revascularization with use of bilateral radial arteries and fast-track anesthesia in a patient with a previous pneumonectomy
Benign Bir Mediasten Kitlesi: Kavernöz Hemanjioma
(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2001) Soysal, Ömer; Kuzucu, Akın; Özgel, Mehmet
Kavernöz hemanjioma nadir bir benign ön mediasten kitlesidir ve çevre organ vey a yapılara bası ile semptomatik olabilir. Radyolojik olarak tarnsal ve tipik özellikleri yoktur. Cerrahi eksizyon küratiftir ve malign dejenerasyon bildirilmemiştir. Mediastinoskopik biyopsi ile tanısı konan ve torakotomi ile total eksizyon yapılan bir me diastinal hemanjiom olgusu sunulmuştur.
Bronkojenik kist ve konjenital lobar amfizem: Cerrahi tedavi ile düzeltilebilen iki konjenital respiratuar distres olgusu
(2002) Soysal, Ömer; Kuzucu, Akın; Akyol, Ali
Öz: Bronkojenik kist ve konjenital lobar amfizem yenidoğan ve erken infant döneminde komşu akciğer veya hava yoluna bası nedeniyle solunum zorluğuna neden olabilmektedir. Tanıda akciğer grafisi, bilgisayarlı tomografi, özefagografi ve bronkoskopi önemlidir. Solunum zorluğuna neden olan ve kist eksizyonu uygulanan bir bronkojenik kist olgusu ve lobektomi ile tedavi edilen bir konjenital lobar amfizem olgusu sunulmuştur.
Bronşektazi zemininde gelişen multiple tümörlet ve karsinoid tümör
(Journal of Clinical and Experimental Investigations, 2012) Erbey, Ahmet; Karadağ, Neşe; Ulutaş, Hakkı; Kuzucu, Akın; Soysal, Ömer
Öz: Pulmoner tümörlet, multifokal nöroendokrin hücre proliferasyonudur ve pulmoner karsinoidler için prekürsör lezyon olarak kabul edilir. Bu çalışmada, 52 yaşında bronşektazi nedeniyle sol alt lobektomi ve lingulektomi yapılan bir hasta tartışıldı. Cerrahi spesmenin histopatolojik değerlendirmesinde bronşektatik zeminde multiple tümörlet ve karsinoid tümör saptandı. Başlık (İngilizce): Multifocal tumorlets and a carcinoid tumor associated with bronchiectasis Öz (İngilizce): Pulmonary tumorlet is multifocal neuroendocrine cell proliferation believed to be precursor lesion to pulmonary carcinoids. A 52-year-woman underwent a left lower lobectomy and lingulectomy for bronchiectasis. Histopathologically, multiple tumorlets and a carcinoid tumor were detected in the surgical specimen.
Chest injury due to blunt trauma
(European journal of cardio-thoracic surgery, 2003) Liman, Şerife Tuba; Kuzucu, Akın; Taştepe, Abdullah İrfan; Ulaşan, Neslihan; Topçu, Salih
Given its importance in trauma practice, we aimed to determine the pathologies associated with blunt chest injuries and to analyze the accurate identification of patients at high risk for major chest trauma. Methods: We reviewed our experience with 1490 patients with blunt chest injuries who were admitted over a 2-year period. Patients were divided into three groups based on the presence of rib fractures. The groups were evaluated to demonstrate the relationship between the number of rib fractures and associated injuries. The possible effects of age and Injury Severity Score (ISS) on mortality were analyzed. Results: Mean hospitalization time was 4.5 days. Mortality rate was 1% for the patients with blunt chest trauma, 4.7% in patients with more than two rib fractures and 17% for those with flail chest. There was significant association between the mortality rate and number of rib fractures, the patient’s age and ISS. The rate of development of pneumothorax and/or hemothorax was 6.7% in patients with no rib fracture, 24.9% in patients with one or two rib fractures and 81.4% in patients with more than two rib fractures. The number of rib fractures was significantly related with the presence of hemothorax or pneumothorax. Conclusion: Achieving better results in the treatment of patients with chest wall injury depend on a variety of factors. The risk of mortality was associated with the presence of more than two rib fractures, with patients over the age of 60 years and with an ISS greater than or equal to 16 in chest trauma. Those patients at high risk for morbidity and mortality and the suitable approach methods for them should be acknowledged.
Complicated hydatid cysts of the lung clinical and therapeutic issues
(Annals of thoracic surgery, 2004) Kuzucu, Akın; Soysal, Ömer; Özgel, Mehmet; Yoloğlu, Saim
The clinical presentation and the preoperative and postoperative complications associated with pulmonary hydatid cysts depend on whether the cyst is intact or ruptured. The aim of this study was to review the problems encountered in treating ruptured pulmonary hydatid cysts and to highlight the risks associated with chemotherapy and the delay of surgical treatment in pulmonary hydatid disease. Methods. The medical records for 67 patients of pulmonary hydatidosis were retrospectively investigated. The patients were divided into two groups based on whether the pulmonary cyst was intact (group 1, n 34) or complicated (group 2, n 33). A complicated cyst was defined as one that had ruptured into a bronchus or into the pleural cavity. All patients were treated surgically. Data related to symptoms, preoperative complications, surgical procedures performed, postoperative morbidity, hospitalization time, and cyst recurrence were collected from each individual’s records, and the group findings were compared. Results. In most cases of intact pulmonary hydatid cysts, the lesions were either incidental findings or the patient had presented with cough, dyspnea and chest pain. In addition to these symptoms, the patients with complicated cyst had presented with problems such as expectoration of cystic contents, repetitive hemoptysis, productive sputum, and fever. The differences between the groups with respect to the rates of preoperative complications and postoperative morbidity, frequency of decortication, and hospital stay were statistically significant (p < 0.05). Conclusions. Surgery is the primary mode of treatment for patients with pulmonary hydatid disease. Complicated cases have higher rates of preoperative and postoperative complications and require longer hospitalization time and more extensive surgical procedures than uncomplicated cases. This underlines the need for immediate surgery in any patient who is diagnosed with pulmonary hydatidosis.
Dieulafoys disease a cause of massive hemoptysis that is probably underdiagnosed
(Annals of thoracic surgery, 2005) Kuzucu, Akın; Gürses, İclal; Soysal, Ömer; Kutlu, Ramazan; Özgel, Mehmet
Dieulafoy’s disease is a vascular anomaly characterized by the presence of a tortuous dysplastic artery in the submucosa. The condition was first described as a cause of gastrointestinal bleeding in the stomach. Recently, there have been a few reports of Dieulafoy’s disease involving the respiratory tract. Herein, we report 2 patients with massive hemoptysis who were treated with surgical resection and later diagnosed with bronchial Dieulafoy’s disease.
Early postoperative candida colonization in alimentary canal in patients undergoing open heart surgery
(J Cardiovasc Surg (Torino), 2005) Alat, İlker; Kuzucu, Akın; Battaloğlu, Bektaş
AIM: To examine the frequency and factors predisposing to candidiasis in the digestive tract in the early postoperative period after open heart surgery. METHODS: One hundred patients undergoing open heart surgery were enrolled in this study. Patients were divided into 2 groups in regard to Candida spp. colonization. Group A means increased Candida spp. colonization after open heart surgery (31/100). Group B indicates unchanged Candida spp. colonization after open heart surgery (69/100). Samples were obtained from both oral and anal mucosa in 3 different periods of operation: 1) preoperatively (stage 1), 2) at the end of the first hour in the intensive care unit (stage 2), 3) 24 hours after operation (stage 3). Findings were compared with both preoperative and intraoperative parameters. For fungal isolation Sabourauds dextrose agar and blood agar were used. RESULTS: In Group A (31), there was a significant relationship between the samples in stage 1 and 2 (p=0.031), and also a significance between stage 1 and 3 (p=0.048). Comparison between Candida positive and negative groups (Group A and B) did not reflect any statistical significance (p>0.05). CONCLUSIONS: Candida colonization in the alimentary canal in the early postoperative period after open heart surgery is due to individual preoperative features. However, early postoperative Candida colonization in the digestive tract is not a risk factor for sepsis unless the patient has an additional risk factor leading to prolongation of length of stay in the intensive care unit.
Extraskeletal ewings sarcoma presenting with multifocal intrathoracic mass lesions associated with mediastinal shift
(Annals of thoracic surgery, 2006) Kuzucu, Akın; Erkal, Haldun Şükrü; Soysal, Ömer; Serin, Meltem
Extraskeletal Ewing’s sarcoma is an uncommon disease that predominantly involves the soft tissues of the trunk or the extremities. This article presents a patient with multifocal intrathoracic mass lesions involving the mediastinum and the lingula associated with mediastinal shift, eventually diagnosed as extraskeletal Ewing’s sarcoma.
False positive 18F FDG uptake in mediastinal lymph nodes detected with positron emission tomography in breast cancer a case report
(Case Reports in Medicine, 2013) Uğurluer, Gamze; Kibar, Mustafa; Yavuz, Sinan; Kuzucu, Akın; Serin, Meltem
Breast cancer is the most frequently diagnosed cancer among females. It is accepted that lymph node involvement with metastatic tumor and the presence of distant metastasis are the most important prognostic factors. Accurate staging is important in determining prognosis and appropriate treatment. Positron emission tomography with computed tomography detects malignancies using 2-[18F]-fluoro-2-deoxy-d-glucose (18F-FDG PET CT) with high accuracy and they contribute to decisions regarding diagnosis, staging, recurrence, and treatment response. Here, we report a case of false positive metastatic mediastinal lymph nodes that were diagnosed by 18F-FDG PET CT in a 40-year-old breast cancer patient who had undergone preoperative evaluation. Right paratracheal, prevascular, aorticopulmonary, precarinal, subcarinal, hilar, and subhilar multiple conglomerated mediastinal lymph nodes were revealed in addition to left breast mass and axillary lymph nodes. Mediastinoscopy was performed with biopsy and pathology was reported as granulomatous lymphadenitis. In conclusion, any abnormal FDG accumulation in unusual lymph nodes must be evaluated carefully and confirmed histopathologically.
Giant mediastinal parathyroid adenoma presenting with a hyperthyroid crisis and leading to postoperative hungry bone syndrome
(European Journal of Surgery, 2002) Kuzucu, Akın; Soysal, Ömer; Şavlı, Haluk
Göğüs duvarında soliter plazmasitoma: Olgu sunumu
(Türk Göğüs Kalp Damar Cerrahisi Dergisi, 2005) Kuzucu, Akın; Soysal, Ömer; Kaya, Emin; Özgel, Mehmet
Öz: Soliter plazmasitoma plazma hücrelerinden köken alan nadir bir tümördür. Kırk sekiz yaşında kadın hasta, sol hemitoraksta son 10 günde artan ağrı yakınmasıyla başvurdu. Fizik muayenede sol hemitoraks posteriorda, sekizinci kottan köken alan ağrılı ve solid yapıda kitle palpe edildi. Kitlenin varlığı akciğer grafisi ve bilgisayarlı tomografi görüntüleriyle doğrulandı. Büyüklüğü 8x5 cm olan lezyonun kotu destrükte görüldü. Total kemik sintigrafisinde başka kemik tutulumu görülmedi. Kitle, üst ve alt interkostal kaslar, kot ve yakın komşuluğu nedeniyle vertebral transvers çıkıntı ile birlikte tamamen eksize edildi. Histopatolojik tanı plazmasitoma olarak bildirildi. Cerrahi sınırları negatif olan hastada radyoterapiye gerek görülmedi. Ameliyat sonrası 23 aylık izlemde hastanın herhangi bir sorunu yoktu. Başlık (İngilizce): A case of solitary plasmacytoma of the chest wall Öz (İngilizce): Solitary plasmacytoma is a rare tumour of plasma cell origin. A 48-year-old woman presented with a complaint of pain in the left hemithorax, which increased in severity for the past 10 days. On physical examination, a painful and solid mass was palpated posterior to the left hemithorax. Radiography of the chest and computed tomography confirmed the mass lesion, 8x5 cm in size, originating from the eighth rib with destruction to the rib. Total bone scintigraphy showed no bone involvement other than the lesion. Total excision of the mass was performed together with the upper and lower intercostal muscles, the eighth rib, and the vertebral transverse process due to close proximity. Histopathologic diagnosis was plasmacytoma. Because surgical margins were tumor free, radiotherapy was not considered. The patient did not have any complaint during a follow-up of 23 months.
Hydatid cysts of the lung lesion size in relation to clinical presentation and therapeutic approach
(Surg Today, 2014) Kuzucu, Akın; Ulutaş, Hakkı; Çelik, Muhammet Reha; Yekeler, Erdal
Purposes The aim of this study was to assess the relationship between the pulmonary hydatid cyst size and the clinical presentation, surgical approach, and postoperative outcome. We review the problems encountered in treating large pulmonary hydatid cysts and highlight the risks associated with the rupture of the cyst and a delay of the surgical treatment. Methods The medical records of 169 patients surgically treated for lung hydatid cysts were reviewed. Patients were divided into two groups based on cyst size: group 1 (n = 128) with small (\10 cm) cysts and group 2 (n = 41) with giant (C10 cm) cysts. Data related to symptoms, preoperative complications, surgical procedures performed and postoperative morbidity were analyzed and compared. Results In both groups, the most common symptom was chest pain, followed by dyspnea and cough, respectively. There were no differences between the two groups with respect to cyst-associated parenchymal or pleural complications before surgery (p = 0.80). In the large majority of cases, the surgical treatment was cystotomy, removal of the cystic membrane and capitonnage. Wedge resection was performed in nine patients in total (seven in group 1, two in group 2) and one patient in group 2 required a lobectomy. Decortication was required significantly more frequently in group 2 than in group 1 (p = 0.001). Sixteen patients in group 1 and 10 patients in group 2 developed postoperative complications (p = 0.19). There was no peri or postoperative mortality. There was no difference between the groups with respect to the duration of hospitalization (p = 0.17). Two patients with complicated hydatid cysts in group 1 had recurrent lesions during follow-up, whereas there was no recurrence in group 2. Conclusion All pulmonary hydatid cysts should be surgically treated as soon as possible after their diagnosis in order to avoid complications. Most of these lesions, regardless of size, can be surgically managed with procedures that preserve the maximal lung parenchyma and yield excellent outcomes.
Idiopathic laryngotracheal stenosis effective definitive treatment with laryngotracheal resection
(Journal of thoracic and cardiovascular surgery, 2004) Ashiku; Simon K.; Kuzucu, Akın; Grillo; Hermes C.; Wright; Cameron D.; Wain; John C.; Lo; Bruce; Mathisen; Douglas J.
Little was known about idiopathic laryngotracheal stenosis when it was first described. We have operated on 73 patients with idiopathic laryngotracheal stenosis, have confirmed its mode of presentation and response to surgical therapy, and have established long-term follow-up. Methods: Charts of 73 patients treated surgically for idiopathic laryngotracheal stenosis between 1971 and 2002 were retrospectively reviewed. Results: All patients were treated with a single-staged laryngotracheal resection, with (36/73) and without (37/73) a posterior membranous tracheal wall flap. Nearly all were women (71/73), with a mean age of 46 years (range, 13-74 years). Twenty-eight (38%) of 73 had undergone a previous procedure with laser, dilation, tracheostomy, T-tube, or laryngotracheal operations. After laryngotracheal resection, the majority of patients (67/73) were extubated in the operating room, and 7 required temporary tracheostomies, only 1 of whom was among the last 30 patients. All were successfully decannulated. There was no perioperative mortality. Principal morbidity was alteration of voice quality, which was mild and tended to improve with time. Sixty-seven (91%) of 73 patients had good to excellent long-term results with voice and breathing quality and do not require further intervention for their idiopathic laryngotracheal stenosis. Conclusion: Idiopathic laryngotracheal stenosis is an entity that occurs almost exclusively in women and is without a known cause. It is not a progressive process, but the timing of the operation is crucial. Single-staged laryngotracheal resection is successful in restoring the airway while preserving voice quality in more than 90% of patients. Protective tracheostomy is now rarely required (1/30). Long-term follow-up shows a stable airway and improvement in voice quality
İleri yaşta saptanan konjenital timik kist olgusu: Nadir bir antite
(2010) Kuzucu, Akın; Ulutaş, Hakkı
Timik kistler nadir görülmektedir ve tüm mediasten kitlelerinin %1-2’sini oluşturur. Konjenital veya edinsel olarak gelişebilir. Dört yıldır kronik obstruktif akciğer hastalığı (KOAH) hastası olan 72 yaşında erkek hasta, Postero-Anterior (P-A) akciğer grafisinde, mediastinal genişleme ve bilgisayarlı toraks tomografisinde, anterior mediastende 6x2 cm boyutlu hipodens, düzgün konturlu kistik kitle lezyonu saptanarak kliniğimize kabul edildi. Median sternotomi ile lezyon total eksize edildi. Postoperatif dönemde komplikasyon gelişmeyen hasta 4. gün şifa ile eksterne edildi. Lezyonun patolojik incelemesi timik kist olarak raporlandı. Timik kistler nadir görülmektedir. Çoğunlukla asemptomatik oldukları için ileri yaşlara kadar gözden kaçabilirler ve tesadüfen saptanırlar. Diğer benign ve malign mediastinal lezyonlardan ayrımının net olarak yapılamaması ve düşükte olsa malignite potansiyeli taşıması nedeniyle timik kistlerde tercih edilen tedavi yaklaşımı total eksizyondur.
İleri Yaşta Saptanan Konjenital Timik Kist Olgusu: Nadir Bir Antite+
(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2010) Ulutaş, Hakkı; Kuzucu, Akın
Timik kistler nadir görülmektedir ve tüm mediasten kitlelerinin %1-2’sini oluşturur. Konjenital veya edinsel olarak gelişebilir. Dört yıldır kronik obstruktif akciğer hastalığı (KOAH) hastası olan 72 yaşında erkek hasta, Postero-Anterior (P-A) akciğer grafisinde, mediastinal genişleme ve bilgisayarlı toraks tomografisinde, anterior mediastende 6x2 cm boyutlu hipodens, düzgün konturlu kistik kitle lezyonu saptanarak kliniğimize kabul edildi. Median sternotomi ile lezyon total eksize edildi. Postoperatif dönemde komplikasyon gelişmeyen hasta 4. gün şifa ile eksterne edildi. Lezyonun patolojik incelemesi timik kist olarak raporlandı. Timik kistler nadir görülmektedir. Çoğunlukla asemptomatik oldukları için ileri yaşlara kadar gözden kaçabilirler ve tesadüfen saptanırlar. Diğer benign ve malign mediastinal lezyonlardan ayrımının net olarak yapılamaması ve düşükte olsa malignite potansiyeli taşıması nedeniyle timik kistlerde tercih edilen tedavi yaklaşımı total eksizyondur.
Intrapleural fibrinolytic treatment management of 85 cases
(Journal of Turgut Ozal Medical Center, 2015) Ulutaş, Hakkı; Çelik, Muhammet Reha; Kuzucu, Akın
Fibrous cortex developes over the lung in 7-10 days if the benign or malign pleural effusion consisting of blood, coagulum or empyema could not be drained. Thus, clinical conditions like trapped lung, restrictive lung disease, or dyspnea may appear as a result of fibrinous pleuritis. Both streptokinase and tissue plasminogen activator (tPA) are involved in the breakdown of proteins and fibrin. Hence, intrapleural fibrinolytic treatment (IPFT) may prevent invazive procedures by avoiding fibrous cortex develepment if it is applied at a proper time. Materials and Methods: Eighty five cases undergoing IPFT by tube or catheter thoracostomies between 2003-2013 are evaluated retrospectively. Patients have been evaluated according to age, symptoms, diagnosis, and response to treatment. Results: The mean age of the patients was 45.5 (65 males and 20 females). IPFT was performed in 30 patients with empyema, and in 20 and 13 patients due to postoperative or posttraumatic organised hematomas, respectively. Eleven patients underwent IPFT for loculated benign pleural effusions while 9 patients recieved the treatment for loculated malign pleural effusions. Complicated hydropneumothorax was the indication for IPFT in 2 patients. A total of sixty patients received tube thoracostomy while 25 patients underwent catheter thoracostomy. Tree patients had decortication and 4 underwent video assisted thoracoscopic (VATS) drainage due to failure of IPFT. Aseptic pleural space remained in 12 patients at the end of our study. One of the patients required blood transfusion and additional medical treatment for intrapleural hemorrhage secondary to the local absorption of the IPFT. Conclusion: IPFT is a safe, effective treatment which can be performed prior to much invasive surgical procedures in patients with loculated empyema, clotted hemothorax, or postoperative hematoma, and benign or malign pleural effusions which can not be drained due to high fibrinous contents.
Intrapleural Fibrinolytic Treatment: Management of 85 Cases
(2015) Kuzucu, Akın; Ulutaş, Hakkı; Çelik, Muhammet Reha
Amaç: Komplike plevral efüzyonlarda sadece tüp ve katater torakostomi ile sıvıyı drene etmek her zaman mümkün olmaz. Dreneedilemeyen kan, pıhtı, ampiyem, benign veya malign plevral sıvılarda 7-10 gün içinde akciğer üzerinden fibröz bir kabuk oluşmaya başlar. Budurum ise tuzaklanmış akciğer ve akciğer restriksiyonu, sekonder ampiyem ve dispne ile sonuçlanır. Streptokinaz yada Tissue PlazminojenActivatörü (tPA), fibrin ve diğer bazı proteinleri parçalayarak etki etmekte olup uygun zamanda yapılan fibrinolitik tedavi ile bu süreçkesintiye uğratılıp, akciğer üzerinde fibröz kabuk gelişimi önlenerek hasta daha invaziv işlemlerden kurtarılabilir.Gereç ve Yöntemler: Bu çalışmada 2003- 2013 yılları arasında tüp yada kateter torakostomisi ile intraplevral fibrinolitik tedavi (IPFT)uygulanan 85 olgu retrospektif olarak incelendi. Olgular yaş, cinsiyet, semptom, tanı ve tedaviye yanıt açısından değerlendirildi.Bulgular: Olguların 65i erkek, 20si kadın, yaş ortalaması 45.5 idi. Otuz olguya ampiyem, 13 olguya travma sonrası gelişen organizehematom, 20 olguya postoperatif, 9 olguya malign plevral efüzyon, 11 olguya benign hastalıklara bağlı drene olmayan loküle plevralefüzyon ve 2 olguya hidropnömotoraks sonrası gelişen komplikasyonlar nedeniyle intraplevral fibrinolitik tedavi uygulandı. Olguların 25sinekateter torakostomi, 60 olguya tüp torakostomi uygulandı. Olguların 7sinde IPFT başarısız oldu, 4 olguya dekortikasyon, 3 olguya VATS(video-assisted thoracoscopic surgery) ile debridman uygulandı. Oniki olguda aseptik kısmi poş kaldı. Bir olguda lokal etkiye bağlı, kantransfüzyonu ve medikal tedavi ile kontrol altına alınan intraplevral kanama saptandı.Sonuç: Loküle ampiyemlerde, pıhtılı hemotoraks ve postoperatif organize hematomlarda, yoğun fibrinli, drenajı olmayan malign plevralefüzyon ve benign plevral efüzyonlarda daha invaziv cerrahi girişimlerden önce uygulanacak IPFT güvenli, etkili, başarısı yüksek, yan etkisi azbir uygulamadır.
İntraplevral fibrinolitik tedavi uygulamaları: 85 olguluk seri sunumu
(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2015) Ulutaş, Hakkı; Çelik, Muhammet Reha; Kuzucu, Akın
Amaç: Komplike plevral efüzyonlarda sadece tüp ve katater torakostomi ile sıvıyı drene etmek her zaman mümkün olmaz. Drene edilemeyen kan, pıhtı, ampiyem, benign veya malign plevral sıvılarda 7-10 gün içinde akciğer üzerinden fibröz bir kabuk oluşmaya başlar. Bu durum ise tuzaklanmış akciğer ve akciğer restriksiyonu, sekonder ampiyem ve dispne ile sonuçlanır. Streptokinaz yada Tissue Plazminojen Activatörü (tPA), fibrin ve diğer bazı proteinleri parçalayarak etki etmekte olup uygun zamanda yapılan fibrinolitik tedavi ile bu süreç kesintiye uğratılıp, akciğer üzerinde fibröz kabuk gelişimi önlenerek hasta daha invaziv işlemlerden kurtarılabilir. Gereç ve Yöntemler: Bu çalışmada 2003- 2013 yılları arasında tüp yada kateter torakostomisi ile intraplevral fibrinolitik tedavi (IPFT) uygulanan 85 olgu retrospektif olarak incelendi. Olgular yaş, cinsiyet, semptom, tanı ve tedaviye yanıt açısından değerlendirildi. Bulgular: Olguların 65’i erkek, 20’si kadın, yaş ortalaması 45.5 idi. Otuz olguya ampiyem, 13 olguya travma sonrası gelişen organize hematom, 20 olguya postoperatif, 9 olguya malign plevral efüzyon, 11 olguya benign hastalıklara bağlı drene olmayan loküle plevral efüzyon ve 2 olguya hidropnömotoraks sonrası gelişen komplikasyonlar nedeniyle intraplevral fibrinolitik tedavi uygulandı. Olguların 25’sine kateter torakostomi, 60 olguya tüp torakostomi uygulandı. Olguların 7’sinde IPFT başarısız oldu, 4 olguya dekortikasyon, 3 olguya VATS (video-assisted thoracoscopic surgery) ile debridman uygulandı. Oniki olguda aseptik kısmi poş kaldı. Bir olguda lokal etkiye bağlı, kan transfüzyonu ve medikal tedavi ile kontrol altına alınan intraplevral kanama saptandı. Sonuç: Loküle ampiyemlerde, pıhtılı hemotoraks ve postoperatif organize hematomlarda, yoğun fibrinli, drenajı olmayan malign plevral efüzyon ve benign plevral efüzyonlarda daha invaziv cerrahi girişimlerden önce uygulanacak IPFT güvenli, etkili, başarısı yüksek, yan etkisi az bir uygulamadır.

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