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Öğe Bilateral Chylothorax After Severe Vomiting in a Child(Elsevier Science Inc, 2012) Yekeler, Erdal; Ulutas, HakkiIn the etiology of chylothorax, traumas and malignancies are the first two leading causes. Today in pediatric patients, the most common cause of chylothorax includes the complications secondary to cardiothoracic operations. Bilateral chylothorax is rarely observed after severe vomiting leading to increase in intrathoracic pressure. In idiopathic chylothorax, bilateral localization is dominant. A 9-year-old girl who presented to our emergency department with the complaints of dyspnea and back pain following severe vomiting received a diagnosis of bilateral chylothorax. The patient was treated with the insertion of a bilateral chest tube, and pleurodesis was performed in left hemithorax. Examination did not reveal a pathology to this condition, except the vomiting observed 2 days previously after the meal. (Ann Thorac Surg 2012;94:e21-3) (C) 2012 by The Society of Thoracic SurgeonsÖğe Bronchiectasis: Retrospective Analysis of Clinical and Pathological Findings in a Tertiary-Care Hospital(Wiley-Hindawi, 2022) Akatli, Ayse Nur; Ulutas, Hakki; Samdanci, Emine Turkmen; Celik, Muhammet RehaBackground. Bronchiectasis is still a challenging chronic lung disease in developing countries. Patients with bronchiectasis can also have pulmonary hypertension. There are sparse data on the prevalence of pulmonary hypertension in patients with bronchiectasis. Materials and methods. Archived H&E-stained slides of 141 patients histopathologically diagnosed with bronchiectasis were reevaluated. Cases were categorized into 4 subgroups based on histology: tubular, varicose, follicular, and cystic. In addition, concomitant histopathological changes were also reevaluated. For patients with available CT sections, main, right, and left pulmonary artery (PA) diameters and PA/aorta ratio were measured with regard to pulmonary hypertension. Results. Of the cases, 70% (n = 89) were female and 30% (n = 52) were male, with a mean age of 36.58 in females and 33.84 in males. Histopathologically, 43% (n = 68) of the cases showed follicular, 37% (n = 59) showed varicose, 35% (n = 56) showed tubular, and 28% (n = 45) showed cystic bronchiectasis morphology. All cases showed chronic inflammation, fibrosis, muscle destruction, and cartilage destruction. Aspergillus were present in 11% of the cases showing cystic morphology. Approximately 17% of the cases (n = 24) were found to have neuroendocrine cell proliferations. In cases with medial hypertrophy, a statistically significant increase in the left pulmonary artery diameter was radiologically determined. Conclusions. Medial hypertrophy was found to be significant with regard to indicating a radiological increase in left pulmonary artery diameter. Vascular changes observed in bronchiectasis cases and the presence of neuroendocrine cell proliferations should be specified in pathology reports, and aspergilloma should be carefully investigated in cases with predominant cystic morphology.Öğe The esophageal rapunzel syndrome: a case of a trichobezoar in the esophagus(Pagepress Publ, 2023) Agar, Mehmet; Celik, Muhammet Reha; Ulutas, Hakki; Gulcek, Ilham; Kalkan, MuhammedRapunzel syndrome is a form of trichobezoar, a rare form of bezoar, especially seen in individuals with hair pulling (trichotillomania) and hair eating (tricophagia) habits, that extends from the pylorus into to the duodenum, jejunum and even the colon. We report the case of a 37-year-old woman with a trichobezoar in the esophagus, causing esophageal rupture that required an urgent surgical intervention.Öğe Fibrinolytic therapy for parapneumonic empyema during pregnancy(Elsevier Science Bv, 2012) Ulutas, Hakki; Yekeler, Erdal; Sak, Zafer Hasan Ali; Doru, Ihsan; Kuzucu, AkinPneumonia and parapneumonic complicated effusion during pregnancy is uncommon but poses potentially serious risks to both mother and fetus. Enzymatic debridement of the pleural cavity with fibrinolytic agents is a noninvasive option that can facilitate drainage and prevent the need for surgery. Herein, we describe the cases of two pregnant women with parapneumonic empyema who were successfully treated with intrapleural fibrinolytic therapy. (C) 2011 Elsevier Ltd.Öğe Foreign-body aspiration mimicking asthma in pre-school age group: A case report(2019) Ozbey, Mehmet Yavuz; Topal, Erdem; Ulutas, Hakki; Celik, Muhammet RehaÖğe Gastro-Bronchial Fistula in the Long-Term Follow-up of Operated Case with Esophageal Carcinoma(Modestum Ltd, 2013) Yekeler, Erdal; Ulutas, Hakki; Altuntas, BayramThe development of a fistula between the gastric tube and the bronchial system represents a very rare but potentially catastrophic complication after intrathoracic esophagogastrostomy for esophageal carcinoma. A 67-years-old male patient, who underwent Ivor-Lewis surgery due to esophageal carcinoma six years ago, had persistence of complaints especially to increased cough immediately after food intake.Öğe A Giant Primary Liposarcoma of the Anterior Mediastinum(Derman Medical Publ, 2015) Yekeler, Erdal; Ulutas, Hakki; Ozmen, Sevilay AkalpLiposarcomas are uncommon tumors originated from the primitive mesenchymal cells. Mediastinal liposarcoma is a very rare localization, accounting less than 1% of all the mediastinal tumors. These tumors may remain asymptomatic until they reach a giant size due to pleural space and elasticity of the lungs. Complete resection is not always possible in the poorly differential types invading the mediastinal vital organs. In this article, we presented a 34 years-old man patient with an anterior mediastinum localized liposarcoma that was asymptomatic until last 3 months and reached to giant sizes and complete successful surgical intervention.Öğe Hydatid cysts of the lung: lesion size in relation to clinical presentation and therapeutic approach(Springer, 2014) Kuzucu, Akin; Ulutas, Hakki; Celik, M. Reha; Yekeler, ErdalThe 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. 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 (a parts per thousand yen10 cm) cysts. Data related to symptoms, preoperative complications, surgical procedures performed and postoperative morbidity were analyzed and compared. 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. 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.Öğe Is it possible to achieve more accurate mediastinal nodal radiotherapy planning for NSCLC with PET/CT?(Pakistan Medical Assoc, 2020) Simseki, Fikri Selcuk; Koroglu, Reyhan; Elmali, Ferhan; Comak, Aylin; Ulutas, Hakki; Balci, Tansel Ansal; Asik, MuhammedObjective: To assess whether more accurate mediastinal lymph nodes radiotherapy can be performed with fluorodeoxyglucose positron emission tomography / comuted tomography. Methods: The retrospective study was conducted at Inonu University Medical Faculty, Malatya, Turkey, and Afyon Kocatepe University Medical Faculty, Afyon, Turkey, and comprised record of patients histopathologically diagnosed with non-small cell lung carcinoma and who underwent fluorodeoxyglucose positron emission tomography / computed tomography between January 2013 and December 2016. Surgery and pathology reports of the patients were reviewed. Histopathologically proven malignant and benign lymph nodes were re-identified with fluorodeoxyglucose positron emission tomography / computed tomography imaging. Anatomical and metabolic parameters of lymph nodes were re-assessed by specialists and compared with histopathology reports. Maximum standardised uptake values were used to assess sensitivity, specificity, positive predictive value, and negative predictive values. SPSS 22 was used for data analysis. Results: The study included 144 mediastinal lymph nodes related to 42 patients who had a mean age of 62.4 +/- 9.8 years (range: 41-79 years). In terms of subtypes of the primary squamous cell carcinoma was found in 24(57.2%) patients, adenocarcinoma in 12(27.5%), and other subtypes in 6(15.3%) patients. Of the 144 lymph nodes, 48(33.3%) were metastatic. Sensitivity, specificity, positive predictive value, and negative predictive value were 92.8%, 64.3%, 56.9%, and 94.7%, respectively when maximum standardised uptake value >2.5 was used as the malignancy criterion. When lymph node maximum standardised uptake value / liver standardised uptake value-mean >1.69 was used as the criterion, the sensitivity, specificity, positive predictive value, and negative predictive value were 95.83%, 91.67%, 85.2%, and 97.8%, respectively. When the same values with lymph node >8mm was used as the criterion, the four resultant values were 89.6%, 93.8%, 87.8%, and 94.7%, respectively. When lymph node was replaced with mean attenuation >35 as the criterion, the consequent values were 79.2%, 93.8%, 86.4%, and 90.0%, respectively. Conclusion: Lymph node maximum standardised uptake value / liver standardised uptake value-mean >1.69 was associated with higher negative predictive value and more useful positive predictive value compared to maximum standardised uptake value >2.5. When this parameter was used along with short axis or mean attenuation value, there were no significant increase in positive predictive value, but there was a decrease in negative predictive value.Öğe Management of spontaneous pneumothorax in patients with COVID-19(Oxford Univ Press, 2022) Ulutas, Hakki; Celik, Muhammet Reha; Gulcek, Ilham; Kalkan, Muhammed; Agar, Mehmet; Kilic, Talat; Gulcek, EmineOBJECTIVES: The coronavirus disease 2019 (COVID-19) pneumonia may cause cystic features of lung parenchyma which can resolve or progress to larger blebs. Pneumothorax was more likely in patients with neutrophilia, severe lung injury and a prolonged clinical course. The timely diagnosis and management will reduce COVID-19-associated morbidity and mortality. METHODS: We present 11 cases of spontaneous pneumothorax managed with chest tube thoracostomy or high-dose oxygen therapy. Isolated spontaneous pneumothorax was detected in all cases. RESULTS: Eight cases were male and 3 cases were female. There were bilateral ground-glass opacities or pulmonary infiltrates in the parenchyma of the 10 cases. We detected neutrophilia, lymphopaenia and increased C-reactive protein, Ferritin, lactate dehydrogenase, D-Dimer, interleukin-6 levels in almost all cases. Chest tube thoracostomy was sufficient to treat pneumothorax in our 9 of case. In 2 cases, pneumothorax healed with high-dose oxygen therapy. Favipiravir and antibiotic treatment were given to different 10 patients. In our institution, all patients with COVID-19 infection were placed on prophylactic or therapeutic anticoagulation, unless contraindicated. The treatments of patients diagnosed with secondary spontaneous pneumothorax during the pandemic period and those diagnosed with secondary spontaneous pneumothorax in the previous 3 years were compared with the durations of tube thoracostomy performed in both groups. CONCLUSIONS: The increased number of cases of pneumothorax suggests that pneumothorax may be a complication of COVID-19 infection. During medical treatment of COVID-19, pneumothorax may be the only reason for hospitalization. Although tube thoracostomy is a sufficient treatment option in most cases, clinicians should be aware of the difficulties that may arise in diagnosis and treatment.Öğe Primary pulmonary glomangioma(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2017) Celik, Muhammet Reha; Sahin, Nurhan; Akatli, Ayse Nur; Ulutas, HakkiGlomangiomas are benign soft tissue tumors derived from the glomus bodies surrounding arteriovenous anastomoses. In this article, we report a 40-year-old female patient admitted to our clinic due to chest pain whose computed tomography of the chest revealed a solitary lesion of 4 cm in diameter. The lesion was removed with video-assisted thoracoscopic wedge resection. The histopathological diagnosis was reported as glomangioma. Glomus bodies almost never exist in the lung parenchyma; thus, pulmonary glomangiomas are extremely rare lesions. They can easily be confused with more common primary or metastatic lesions of the lungs. Risk of recurrence is low for this tumor and sublobar complete resection is the treatment of choice for definitive diagnosis and curative treatment.Öğe The Role of CD90 in the Differential Diagnosis of Pleural Malignant Mesothelioma, Pulmonary Carcinoma and Comparison with Calretmm(Frontiers Media Sa, 2017) Sahin, Nurhan; Akatli, Ayse Nur; Celik, Muhammet Reha; Ulutas, Hakki; Samdanci, Emine Turkmen; Colak, CemilPleural Malignant Mesothelioma (MM) is a fatal disease that has been associated with asbestos exposure. Differential diagnosis between the pleural infiltration of pulmonary carcinomas and MM is rather difficult particularly for epitheloid type mesothelioma. We aimed to investigate the utility of CD90, a cancer stem cell marker, in the differential diagnosis of MM and lung carcinoma, its prognostic significance and compare its value with that of Calretinin. Ninety pathology specimens including MM (n:30), pulmonary adenocarcinoma (n:30) and pulmonary squamous cell carcinoma (n:30) were used in this study. Immunohistochemical comparision of CD 90 and Calretinin was made in all groups. Calretinin was positive in 20 cases with MM (64.5 %), and was negative in 10 (32.3 %). CD 90 was positive in 25 of these cases (80 %) and negative in 5 (16 %). On the other hand pulmonary adenocarcinomas and squamous cell carcinomas showed positivity with CD90, 63,6 % and 73 %, respectively. We think that CD 90 has no place in the differential diagnosis between mesothelioma and pulmonary carcinoma because of the low specificity in spite of the high sensitivity.Öğe The role of current surgical therapy for pediatric/adolescent and adult patients with bronchiectasis(Baycınar medıcal publ-baycınar tıbbı yayıncılık, ornek mh dr suphı ezgı sk saray apt no 11 d 6, atasehır, ıstanbul 34704, turkey, 2017) Ulutas, Hakki; Celik, Muhammet Reha; Kuzucu, AkinBackground: This study aims to compare clinical manifestations, surgical indications, surgical procedures, postoperative complications, and outcomes of surgical treatment in pediatric and adult patients with bronchiectasis. Methods: Between January 2000 and December 2013, a total of 99 patients (40 males, 59 females; mean age 33.3 years; range 10 to 67 years) who underwent surgery for bronchiectasis at the Department of Thoracic Surgery were retrospectively analyzed. Group 1 (n=28) were pediatric patients (<= 18 years) and group 2 (n=71) were adult patients (>18 years). Clinical symptoms, criteria surgical treatments applied, surgical treatment approaches, postoperative complications, the length of hospital stay, and treatment outcomes were evaluated. Results: In both groups, the most common symptom was productive cough, followed by recurrent infections. There were no significant differences in the frequency of these symptoms between the groups. In total, 104 surgeries were performed. Of 29 surgeries in group 1, 26 were thoracotomies and three were video-assisted thoracoscopic surgery. Of 75 surgeries in group 2, 60 were thoracotomies and 15 were video-assisted thoracoscopic surgery. Postoperative complications were seen in eight operations (27.6%) in group 1 and 18 operations (24%) in group 2. There was no intra- or postoperative mortality. All 28 patients in group 1 showed improvement after surgery, while 23 outcomes (82.1%) were rated excellent (complete remission) and five outcomes (17.9%) were rated improved (reduced symptoms). In group 2, 63 outcomes (88.7%) were excellent and seven outcomes (9.9%) were rated improved; however, one patient (1.4%) showed no improvement. Conclusion: In selected cases, surgical treatment for bronchiectasis is satisfactory and associated with acceptable mortality and morbidity rates, irrespective of the age of the patient. Based on our study results, surgery can cure this condition and can improve the quality of life, even when not curative.Öğe Role of Prolene Mesh in Late Postpneumonectomy Empyema: Esophageal Pleural Fistula(Elsevier Science Inc, 2012) Yekeler, Erdal; Altuntas, Bayram; Ulutas, Hakki[Abstract Not Available]Öğe Surgical management of upper- and lower-lobe bronchiectasis without middle lobe involvement: is middle lobectomy necessary?(W B Saunders Co-Elsevier Inc, 2012) Ulutas, Hakki; Celik, M. Reha; Kuzucu, AkinPostoperative quality of life is a crucial factor in decisions regarding surgical management of bronchiectasis. The goal of surgical treatment in such cases is to eradicate diseased portions of lung while preserving as much healthy lung parenchyma as possible. The volume of remaining lung must be sufficient to fill the pleural space. In patients with bronchiectasis, it is extremely unusual to have upper- and lower-lobe involvement without middle lobe involvement. A normal-sized middle lobe alone is usually not adequate to fill the right hemithorax. When the disease involves both the upper and lower lung lobes, surgeons must assess whether pneumonectomy is required. Herein, we describe the case of a patient with bronchiectasis who was successfully treated with upper and lower lobectomy and preservation of the middle lobe. (C) 2012 Elsevier Inc. All rights reserved.Öğe Thymic Seminoma with Regressive Changes Obscured by Granulomatous Reaction(Coll Physicians & Surgeons Pakistan, 2022) Akatli, Ayse Nur; Samdanci, Emine; Celik, Muhammet Reha; Alan, Saadet; Ulutas, Hakki; Akpolat, NusretPrimary thymic seminoma is an exceedingly rare tumour. There are few case reports about mediastinal thymic seminoma accompanied by secondary changes. We report a case of a 29-year male admitted to our hospital because of chest pain and dyspnea for 8 months. Computed tomography of the thorax revealed hypodense, solid masses showing calcification and cystic degeneration in the anterior mediastinum. Histopathological examination of the resected specimen revealed a diagnosis of thymic seminoma with regressive and reactive changes. The present case was unique in its presentation as a primary seminoma showing combination of cystic degeneration, follicular hyperplasia, fibrosis, calcification and granulomatous reaction in one case. High level of suspicion is necessary to identify seminomas in a thymic lesion accompanied by secondary changes. Excluding the possibility of metastasis from testicular seminoma is very important before making this diagnosis.