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    Factors affecting response rates after thymectomy for myasthenia gravis
    (Derman Medical Publ, 2018) Yanik, Fazli; Karamustafaoglu, Yekta A.; Yoruk, Yener
    Aim: In our study, we report the clinical response obtained after transsternal extended thymectomy (TSET), the factors affecting the response, and the most appropriate timing of the operation. Material and Method: A total of 35 cases underwent TSET with the diagnosis of myasthenia gravis in our department from December 1996-June 2015. Twenty of the cases were females (57%) and fifteen (43%) were males with a mean age of 42 +/- 15 (14-68). The case registry has been analyzed retrospectively. Results: Postoperative histopathological examination revealed non-thymoma thymic pathologies in 19 (54%), thymoma in 16 (46%). Myasthenia gravis symptoms were staged according to the Osserman classification: 8 (22,9%) were stage I, 13 (37,1%) were stage IIa, 11 (31,4%) were stage IIb, and 3 (8,6%) were stage III, with no patients at stage IV. The duration of symptoms of <24 month before the operation was statistically significant for groups with and without thymoma (p<0,001). However, parameters of age, gender, preoperative Osserman stage, and pathological diagnosis were not statistically significant between groups. Discussion: Transsternal extended thymectomy allows for extended removal of all the mediastinal tissue in the anterior mediastinum with a low complication rate. Symptom duration before operation is the most important factor in response to treatment; therefore, patients must be operated on as soon as possible. Thymectomy also seems to be helpful for early stage MG.
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    Prognostic significance of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography-derived metabolic parameters in surgically resected clinical-N0 nonsmall cell lung cancer
    (Lippincott Williams & Wilkins, 2018) Aktas, Gul E.; Karamustafaoglu, Yekta A.; Balta, Cenk; Sut, Necdet; Sarikaya, Ismet; Sarikaya, Ali
    Objective Our aim was to assess the significance of metabolic positron emission tomography (PET) parameters for the prediction of occult mediastinal lymph node metastasis (OLM) and recurrence in patients with clinical-N0 nonsmall cell lung cancer (NSCLC) after surgical resection and lymph node dissection. Materials and methods We evaluated 98 patients with NSCLC [52 adenocarcinoma (ADC), 46 squamous cell carcinoma (SQCC)] who had undergone initial/preoperative fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18-FDG PET/CT). Eligibility criteria for participation were clinically staged as N0 and no FDG uptake in mediastinal lymph nodes on preoperative PET/CT. Clinicopathological characteristics and the diagnosis of recurrence were obtained by reviewing the hospital records. Metabolic parameters [maximum standardized uptake value, mean standardized uptake value, metabolic tumor volume (MTV), total lesion glycolysis] were determined on F-18-FDG PET/CT images. The association of metabolic parameters with OLM and recurrence was assessed. Results OLM was found in 26 (26.53%) patients. T-stage, central location, and lymphovascular invasion were associated with OLM (respectively, P = 0.007, 0.011, <0.001). None of the metabolic parameters was associated with OLM. Metabolic parameters of the tumor were significantly higher in patients with recurrence when the cohort was evaluated as a whole (P = 0.002, 0.005, 0.016, and 0.004, respectively). In particular, there was a significant association between recurrence and tumor size, grade, stage, MTV (P < 0.001), and TLG (P < 0.001) in ADC. This association was not found in SQCC. Multivariate analysis showed that MTV was an independent prognostic factor for recurrence and associated with disease-free survival. Conclusion Metabolic parameters of the primary tumor on preoperative 18F-FDG PET/CT could not predict OLM in patients with clinical-N0 NSCLC. MTV was an independent risk factor for recurrence in ADC, but not in SQCC. Copyright (C) 2018 Wolters Kluwer Health, Inc. All rights reserved.