In the last decade endobronchial ultrasound with real-time guided needle aspiration (EBUS-NA) has been recognized worldwide as a tool with remarkable impact on routine clinical practice. In the present review article, we focus on specific disease-related features of EBUS-NA, including diagnosis and staging of thoracic malignancies, sarcoidosis, tuberculosis and its role in the evaluation of isolated enlarged mediastinal lymph nodes. We also address some less common conditions and discuss emerging and future developments in EBUS technique.

Background: Cryotherapy is an actual treatment and diagnostic method in many fields of medicine. We aimed to evaluate the acute histopathological effects of cryotherapy application on lung tissue. Materials and Methods: In this study 10 male rabbits were used. After providing single lung ventilation of the rabbits, clamshell incision was performed for exploration. Four different cryotherapy applications were performed to determine the different histopathologic changes on atelectatic and ventilated lung, also the difference between one versus two-cycle applications. After all applications, firstly, air leak was checked, then specimens were taken to analyze the acute histopathologic effects. Results: After cryotherapy application, no air leak was detected on ventilated rabbit lung with a pressure of 30 cmH2O. There was no bleeding from lung tissue, but macroscopic parenchymal hematoma developed. The depth of necrosis in lung tissue was evaluated with histopathological analysis. In all samples, alveolar edema and congestion were observed but there was no statistical difference between the depth of necrosis regarding with different cryotherapy applications. Conclusions: This study indicated that different applications of cryotherapy on lung parenchyma is a safe method and do not affect the depth of necrosis in a statistically significant degree.

Background: The gold standard of treatment for non-small cell lung cancer (NSCLC) is anatomic pulmonary resection. Wider resection methods may be preferred due to the size or anatomic location of the tumor. One method of choice is bilobectomy due of the anatomy of the right lung. Materials and Methods: This study retrospectively analyzed 93 patients who were diagnosed with NSCLC and had bilobectomy, complete resection, and mediastinal lymph node dissection at our center between January 2005 and April 2013. Results: Forty-seven patients underwent superior bilobectomy (sBL), and 46 patients underwent inferior bilobectomy (iBL). Bilobectomy was performed due to fissure invasion in 51 (58.1%) patients, internal or external bronchial tumor invasion in 31 (33.3%) patients, external bronchial lymph node invasion in six (6.4%) patients, and vascular invasion in two (2.2%) patients. The bronchial invasion-based indications were significantly higher in the iBL group compared to the fissure invasion-based indications in the sBL group (P < 0.001). Conclusions: Bilobectomy leads to a substantial amount of parenchymal loss in the right lung, but it is a procedure that should be performed under the necessary conditions. It is obvious that performing bilobectomy under proper indications would result in good outcomes for lung cancer patients.

Background: Tumor size is one of the major prognostic determinants of non-small cell lung cancer (NSCLC). In the present study, we evaluated the effect of tumor size on survival in pN0M0 NSCLC patients. Materials and Methods: Between 1994 and 2013, 1975 NSCLC patients underwent surgery in our center. The study included 774 NSCLC patients with pathological stage N0M0, and these patients were divided into 8 groups according to tumor diameter, as follows, Group 1: 0-10 mm, Group 2: 11-20 mm, Group 3: 21-30 mm, Group 4: 31-40 mm, Group 5: 41-50 mm, Group 6: 51-60 mm, Group 7: 61-70 mm, and Group 8: > 70 mm. We aimed to evaluate the prognostic effect of tumor size on overall survival and to determine a cut-off point for tumor size. Results: The 5 year overall survival rate for groups 1 to 8 were 85.6%, 81.3%, 68.6%, 62.2%, 55%, 54.2%, 54.3%, and 45.6%, respectively. The mean follow-up time was 43.8 months. In multivariate analysis, age, tumor size, and surgical resection type had an independent prognostic value on survival. Conclusions: Tumor size is an independent prognostic factor for pN0M0 NSCLC patients. A tumor size of 4 cm was found to be the most suitable cut-off point for survival which may be of help in decision-making for adjuvant chemotherapy.

Germ cell tumors arise from errors occurring during the migration of embryonic stem cells to the gonads. They constitute 10-15% of malignant mediastinal tumors. Thirty-nine years old male patient was admitted with shortness of breath and gynecomastia. Positron emission tomography / Computed tomography (PET/CT) showed hypermetabolic mediastinal mass in the anterior mediastinum. Serum tumor markers were elevated. Mixed germ cell tumor was diagnosed via transthoracic tru-cut biopsy. After three cycles of systemic cisplatin, etoposide and bleomycin treatment, PET/CT showed a decreased metabolic activity but an increase in the size of mass. "Growing teratoma syndrome" was diagnosed. The excision of the mass was performed via a median sternotomy. Then autologous stem cell transplantation was performed. Patients was presented as a successful example of a multimodality treatment of a primary mediastinal germ cell tumor with GTS.

Background: Pulmonary sequestration is defined as nonfunctional lung tissue without a normal tracheobronchial tree that is supplied by an aberrant systemic artery. The awareness of the preoperative diagnosis could be very crucial for the safety of the operation. Materials and Methods: We retrospectively reviewed the records of 16 patients who underwent resection for pulmonary sequestration between 2006-2016. Nine of 16 cases (56%) were female, and the mean age of the patients was 38.5 ± 9.9 years. Fiberoptic bronchoscopy and standard computed thorax tomography were performed for diagnostic work-up in all cases. The patients were divided into 2 groups based on the presence (Group A) or abscence (Group B) of the preoperative diagnosis. Results: The most common presenting symptoms were cough and expectoration. Preoperative diagnosis of the sequestration was obtained in only 5 patients (31%). Bronchiectasis was the most common cause of false diagnosis, followed by hydatid disease, malignancy, and aspergillosis. Left-sided and intrapulmonary locations were dominant with 12 (75%) and 13 (81%) cases, respectively. Lobectomy was the most common type of surgical resection (75%) and thoracic aorta was the source of aberrant artery in 87% of the patients. Patients in group A were younger. Though intralobar and extralobar types were equally distributed in both groups, all cases in group B had intralobar type. The mean operation time, blood loss, the amount of drainage, and the hospital stay were all insignificantly longer in group B patients. Five of the 6 morbidities occured in group B patients, but the difference was not statistically significant. No mortality occured. Conclusions: Surgical resection provides definitive management, and is usually reserved for the patients with symptoms. Facilities for a definitive diagnosis should be performed in every case, because, although insignificant, the rate of morbidity is higher in the patients without a definitive diagnosis. Further studies concerning of more patients are required to obtain more comprehensive results.

Background: The main subtypes of chest wall deformities are pectus excavatum (PE) and pectus carinatum (PC). Although these are not life threatening diseases, some functional or physico-social disabilities due to the abnormal chest wall structure require treatment. The main stem of the treatment is surgical correction. Since the beginning of the 20th century various surgical techniques were introduced. In the last few decades some minimally invasive surgical techniques were also described. In the English literature many reports suggest that the vast majority of these abnormalities are PE. But in most of the reports patient groups consist of hospital admissions. The real frequency of this group of disease is controversial. Materials and Methods: In this report, a wide field study was designed to find the real frequency of the chest wall diseases. Total of 25117 children between 6-11 years of age were visited in the elementary schools of Kahramanmaras. The team members were a thoracic surgeon, a pulmonologist and a pediatrician. Results: A careful physical examination revealed that a total of 255 patients had different degrees of chest wall deformity. We found that PC (90.58%) was the most frequent type of deformity in contrast with the previous reports suggesting PE as the most frequent type. In our results only 5.49% of the patients had PE and 3.93% of the patients had mixed type PE+PC. The most frequent ECG abnormality seen in 49 cases (19% of cases with deformity) was a negative T wave on V1 derivation and a biphasic T wave configuration on V1-V2 derivations. 8 patients (3.13%) had concomitant scoliosis and 6 patients (%2.35) had different degrees of cardiomegaly. Conclusions: The real frequency of chest wall deformities is an enigma. When PE patients themselves or their family notice the abnormality, they may consider it as a big health problem and admit to a healthcare unit. But in contrast, PC patients mostly do not care about this disorder until adolescence, so admission rate is less then PE. We suggest that the real frequency of the chest wall deformities may be found only by widespread field studies. Moreover, we found more accompanying cardiac disorders in PC group, and this type of screening may allow early diagnosis of some cardiac diseases.

A 57-year-old male patient was admitted to our department with symptoms of dyspnea and hemoptysis, followed by a spontaneous expectoration of a small piece of solid tissue. He had two operations 13 and 3 years ago for perineal leiomyosarcoma and was on intermittent chemotherapy regimen until last year. Computerized chest tomography revealed an endotracheal mass with multiple metastatic nodular lesions at both lung fields. The pathologic examination of the expectorated tissue was found to be consistent with the metastasis of leiomyosarcoma. Solid polypoid endotracheal lesion adherent to the anterolateral wall and obstructing 70% of trachea was excised with the rigid bronchoscopy and argon laser.

Catamenial pneumothorax (CP) is a type of recurrent pneumothorax that occurs during menstrual periods in women. CP is a special type of pneumothorax related with the menstrual period and the treatment consists of both medical and surgical methods. First line of surgical treatment is exploration of thorax via VATS and revealing the pathophysiological factors of CP. Despite the surgical treatment techniques, a postoperative recurrence rate of CP is 30%. We present a recurrent pneumothorax case who had 5 pneumothorax episodes and diagnosed as CP. A left VATS apical wedge resection and pleurectomy was performed and oral contraceptive was administered. and she did not have a recurrent pneumothorax episode for last 2 years.

Bronchopleural fistula (BPF) represents a pathological communication between any part of bronchial tree and the pleural space. Mostly it is a rare yet serious complication of different pulmonary conditions like certain infections, trauma, malignancy and/or surgery, going along with significant mortality reported to be as high as 58%. Diagnosis of BPF is mostly done by evaluating these three data: clinical appearance, bronchoscopy and CT scan. The treatment of BPF may initially differ according to the time of appearance as well as clinical presentation. As most BPF goes along with empyema, it is, obviously, necessary to deal with it. This is most commonly achieved with a chest tube. Conservative management of BPF can be achieved using a significant variety of materials and methods with reportedly moderate to excellent results in the treatment of etiologically and sizably different BPF. Methyl-2-cyanoacrylate, fibrin sealant together with spongy calf bone, polidocanol - hydroxypolyethoxidodecane, amplatzer device, silver nitrate, stenting and endobronchial valves have all been employed in bronchoscopic treatment of a BPF. There is no evidence based guideline for its management, either surgically or endoscopically. The treatment of choice is always in the hands of the physician, preferably armed with the current knowledge and capacity of utilizing it.