A Kosar

Publications (5)6.51 Total impact

• Article: The value of surgical resection in patients with multidrug resistant tuberculosis.

  A Orki, A Kosar, R Demirhan, A Saygi, B Arman
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  ABSTRACT: Multidrug resistant tuberculosis (MDR-TB) still continues to be a serious health problem throughout the world. Although main treatment of MDR-TB is medical, surgical resection with adjuvant medical therapy may increase the chance of cure in selected patients. We performed surgical resections in 55 patients between 1997 and 2005; 36 were male and 19 were female with a median age of 34 years (range 13 to 66 years). Sputum was negative for 49 patients and positive for 6 patients in the preoperative period. Patients were treated according to a new therapy protocol for a mean of 3.7 months before the operation. Lobectomy was performed in 37 patients, pneumonectomy in 17 patients and lobectomy + segmentectomy in 1 patient. One patient with positive sputum preoperatively died in the early postoperative period (mortality: 1.81 %). Various complications occurred in 16 (29.09 %) patients. Prolonged air leak was the most common complication (n = 8). Bronchopleural fistula (BPF) + empyema occurred in 2 (3.63 %) patients. In the postoperative period, sputum negativity was achieved in all patients except three cases throughout the 57 months of follow-up (cure rate 94.5 %). Patients received drug therapy for 24 months postoperatively. Surgical resection with adjuvant drug therapy increases the chance of cure in patients with localized disease if they have an adequate cardiopulmonary reserve, favorable nutritional status and are treated with a new therapy protocol for at least 3 months.
  The Thoracic and Cardiovascular Surgeon 07/2009; 57(4):222-5. · 0.88 Impact Factor
• Article: Solitary fibrous tumor of the pleura.

  A Orki, A Kosar, O Akin, G Haciibrahimoglu, S B Arman
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  ABSTRACT: The aim of this study was to evaluate the clinical behavior of solitary fibrous tumors of the pleura and consider the optimal surgical approach for these rare tumors. We retrospectively reviewed the records of nine patients who underwent thoracotomy for tumor resection in our clinic between 1997 and 2006. Nine patients were operated in this period and their median age was 46 years. None of them had been exposed to asbestos. Symptoms were present in 8 patients. All patients underwent thoracotomy. The tumor originated from the visceral pleura in 7 patients and was parietal in 2. All tumors were totally excised. The median diameter of the tumors was 9 cm (range 4-24 cm). Pathological investigation reported the tumors to be a benign solitary fibrous tumor of the pleura in all 9 patients. Resection was complete in all patients. There was no postoperative mortality and no major complications. No recurrence was observed during a median follow-up of 74 months. Solitary fibrous tumors of the pleura are rare neoplasms and can have giant diameters. Complete surgical resection is the optimal treatment. The risk of malignant transformation of such large masses should be borne in mind.
  The Thoracic and Cardiovascular Surgeon 09/2008; 56(5):287-90. · 0.88 Impact Factor
• Article: The impact of immunohistochemical detection of positive lymph nodes in early stage lung cancer.

  C Tezel, A A Ersev, H Kiral, S Urek, A Kosar, M Keles, C Dudu, B Arman
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  ABSTRACT: Detection of micrometastatic disease is an interesting area in non-small cell lung cancer (NSCLC). We conducted a study to determine whether the detection of mediastinal lymph node spread by immunohistochemical (IHC) analysis offers some prognosis with respect to patients' disease-free survival or not. Between 1997 and 2003, twenty-one early stage lung cancer patients underwent complete resection with mediastinoscopy and systemic nodal dissection. Four hundred and twenty-six paraffin-embedded lymph node sections from 21 patients were analyzed. Epithelial specific-antigen Ab-9 and Keratin-Pan Ab-1 were used as IHC marker. Based on nodal spread four of the 21 patients (19.04%) were up-staged after IHC analysis. Two patients with stage IB (T2N0) up-staged to stage IIIA (T2N2); two patients staged as IIB (T2N1) up-staged to IIIA (T2N2). Statistical analysis showed that the lymphatic dissemination detected with IHC analysis was associated with reduced disease-free survival (DFS) (p = 0.002). Our study provides some indication that patients with lymphatic micrometastasis have a reduced DFS. Before creating a new TNM staging system, more information is needed to understand the prognostic impact of micrometastatic dissemination.
  The Thoracic and Cardiovascular Surgeon 04/2006; 54(2):124-8. · 0.88 Impact Factor
• Article: A survey analysis of thoracic surgeons in Turkey on mediastinal investigation of lung cancer.

  S Halezeroglu, A Tekin, A Kosar, B Arman
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  ABSTRACT: A total of 59 general thoracic surgeons of 21 academically based thoracic surgery centres in Turkey were surveyed to identify the attitudes toward mediastinal investigations in patients with lung cancer. The surgeons were asked 16 questions in five separate groups by survey questionnaire. Analyses of the replies were as follows: Group I: 37 (62.7%) of the respondents were working in 11 centres where > 100 patients are admitted or referred for lung cancer annually. More than 50 thoracotomies are performed for lung cancer annually in one third of the centres in which 28 (47.5%) respondents work. Group II: Among the diagnostic methods for evaluating mediastinum, surgeons most commonly used the computed tomography, mediastinoscopy, mediastinotomy and scalene lymph node biopsy. Invasive staging was done routinely by ten (16.9%) and selectively by 44 (74.6%). Group III: In patients with preoperatively histologically proven ipsilateral mediastinal lymph node involvement, 39 (66.1%) were advocates of operating. When the lymph node(s) was found to be positive at operation, 33 of them (55.9%) gave the decision with respect to the number, size and presence of pericapsular invasion of the node(s), while 24 (40.7%) decided to perform lung resection in every situation. Group IV: All accessible mediastinal nodes were said to be removed at thoracotomy by 37 (62.7%). Group V: Currently available methods for mediastinal investigation were found to be partially sufficient by 37 (62.7%). The most important factor in predicting postoperative survival was selected as nodal status by 27 (45.8%). It is noticed that nearly all thoracic surgeons in Turkey perform mediastinal investigation preoperatively in patients with lung cancer, however, the impact of lymph node status needs to be more commonly appreciated.
  Lung Cancer 03/1998; 19(3):191-6. · 3.43 Impact Factor
• Source

  Available from: Recep Demirhan

  Article: Management of postpneumonic empyemas in children.

  R Demirhan, A Kosar, I Sancakli, H Kiral, A Orki, B Arman
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  ABSTRACT: The optimal treatment of children with empyema remains controversial. The purpose of this clinical retrospective study was to assess different treatment options in the management of postpneumonic pediatric empyemas. From April 1997 to October 2005, 111 consecutive children (57 boys and 54 girls) were managed for pleural empyema. The mean age was 7.07 years (range: 18 months-14 years). Patients were divided into 3 groups depending on the treatment received: group I, chest tube alone (n = 89); group II, chest tube with fibrinolytics (n = 22); group III, thoracotomy with decortication (n = 19, consisting of 9 patients of group I and 10 of group II with unsuccessful treatment results). Chest tube alone, chest tube with fibrinolytics, and thoracotomy with decortication had complete response rates of 89.9%, 54.5%, and 100%, respectively. The hospital stay was 11.46 +/- 3.79 days for group I, 9.08 +/- 2.07 days for group II, and 6.32 +/- 2.54 days for group III. There was no statistically significant difference between group I and group II with regard to hospital stay (P = 0.040). Mild pain occurred in 4 children of group II after streptokinase instillation. Only one atelectasis appeared in group III during the postoperative period. Chest tube drainage is a safe, effective primary treatment of postpneumonic pediatric empyema. In cases where it is insufficient, thoracotomy with decortication can be used successfully with low morbidity and mortality rates.
  Acta chirurgica Belgica 108(2):208-11. · 0.43 Impact Factor