Erratum to: Evaluation of gene expression levels in the diagnosis of lung adenocarcinoma and malignant pleural mesothelioma.

[This corrects the article DOI: 10.5606/tgkdc.dergisi.2020.17279.].

Local treatment of pain in Tietze syndrome: A single-center experience.

BACKGROUND: In this study, we present our experiences with local injections of triamcinolone and prilocaine in patients diagnosed with Tietze syndrome. METHODS: Between January 2016 and January 2019, a total of 28 patients (12 males, 16 females; median age: 33 years; range, 21 to 51 years) who were diagnosed with TS in our clinic were retrospectively analyzed. Triamcinolone hexacetonide and prilocaine hydrochloride were injected into painful joints. At first week, pain sensation of the patients was recorded using the Pain Rating Scale developed by the British Pain Society. Pain was also assessed at one, two, and three weeks after injections qualitatively and based on physical examination. RESULTS: At one week, the pain severity before the local injection treatment was above average the pain-related discomfort rates, and the response was quite favorable after the treatment (p=0.005 and p=0.001, respectively). A statistically significant rating was observed for treatment response and success (p=0.003). Totally 75% of the patients experienced more than 70% reduction in pain level after the injection. CONCLUSION: Our treatment approach involving injection of a mixture of steroid and a local anesthetic provides a rapid relief from pain, irrespective of age, sex, or employment status in patients diagnosed with Tietze syndrome.

Management of COVID-19 in the Intensive Care Unit.

INTRODUCTION: A novel coronavirus was identified in the last days of 2019, which caused a cluster of pneumonia cases in Wuhan, China. Since Coronavirus Disease 2019 (COVID-19) was identified and caused a pandemic, morbidity and mortality caused by acute respiratory distress syndrome (ARDS) and other disease-related complications are being struggled against in intensive care units (ICUs). METHODS: In this chapter, clinical features, epidemiological properties, and management of critically ill COVID-19 patients aree discussed with the support of recent literature. RESULTS: Since there isn't a definitively proven treatment for the disease, the management of critical illness is adequate supportive medical care based upon the basic principles of critically ill patient management. Supportive oxygen therapy modalities and mechanical ventilation strategies are most challenging issues during the course of the disease in ICUs. Additionally, using combinations of investigational drugs is beneficial for the management of the disease. Because the disease is highly contagious, infection control measures to stop the disease's nosocomial spread are crucial. CONCLUSION: The basis of management in critically ill COVID-19 patients is providing adequate ICU care. Additionally, a combination of promising treatment strategies specific to the disease may be beneficial and should be monitored carefully.

A non-surgical option in large bronchopleural fistulas: Bronchoscopic conical stent application.

BACKGROUND: This study aims to compare the results of the open surgical approach versus endobronchial conical stent application in the treatment of extensive fistulas. METHODS: Between December 2004 and April 2016, a total of 36 patients (34 males, 2 females; mean age 59.6±8.1 years; range, 40 to 72 years) with a bronchopleural fistula of ≥8 mm in diameter and underwent either conventional open surgery with stump-supported intercostal muscle flap or endobronchial ultra-flex expandable stenting were retrospectively analyzed. The demographic and clinical characteristics of the patients, operative data including the length of hospital stay, thoracic drainage time, and early mortality, and survival data were recorded. RESULTS: The mean hospitalization time was 17.4±4.5 days for the bronchoscopic group and 22.5±6.7 days for the invasive surgery group (p=0.026). The median time to removal of thoracic drains was 15 (range, 10 to 30) days for the bronchoscopic group and 26 (range, 14 to 55) days for the surgical group (p=0.027). Early mortality rates of both approaches were in favor of the bronchoscopic approach (χ2=7.058; p=0.008). Two-year survival rate was 76.47% (n=13) in the bronchoscopic group and 70% (n=7) in the surgical group. There was no statistically significant difference in the survival rates between the two groups (χ2=0.132; p=0.716). CONCLUSION: Our study results suggest that bronchoscopic approach can be the first choice in the treatment algorithm of fistulas with a diameter of ≥8 mm presenting with empyema in selected cases.

Do oral amino acid supplements facilitate the healing of rat lung injuries?

OBJECTIVES: Prolonged air leaks following lung injury cause extended hospital stays. This study investigated the effect of nutritional supplements containing arginine, glutamine and ß-hydroxy ß-methyl butyrate, which were theoretically proven to accelerate wound healing, on air leak and wound healing parameters in a rat lung injury model. METHODS: Twenty-eight female rats were randomly divided into 4 groups. Experimental groups were given glutamine (Resource Glutamine®) or a mixture of arginine, glutamine and ß-hydroxy ß-methyl butyrate (Abound®) as a dietary supplement at isonitrogenous and isocaloric doses. On day 3, standard sized lung injuries were created in all rats except the sham group. The rats were sacrificed on day 6, and the lungs were removed for air-leak threshold pressure measurement and histopathological and biochemical analyses. RESULTS: Loss of body mass was greater in the glutamine group than in the other groups (P = 0.004). Rats that received the amino acid mixture had better results for mature collagen fibre density (P = 0.002) and inflammation suppression (P = 0.003). The sham group had higher values for air-leak threshold pressure and all other histochemical parameters compared to the other groups. Hydroxyproline level did not differ significantly in any of the groups. CONCLUSIONS: Our results indicated that an oral amino acid mixture was effective in the healing of lung injuries. Isolated glutamine supplementation had an adverse impact on body mass. Randomized clinical studies including larger series are needed. Hydroxyproline does not seem to be a suitable marker for this purpose.

Evaluation of gene expression levels in the diagnosis of lung adenocarcinoma and malignant pleural mesothelioma.

BACKGROUND: This study aims to evaluate gene expression levels in the diagnosis of lung adenocarcinoma and malignant pleural mesothelioma both which have a distinct treatment and prognosis. METHODS: Between January 2012 and January 2014, 12 newly diagnosed patients with a lung adenocarcinoma, 12 patients with malignant pleural mesothelioma, and eight healthy individuals as the control group were included. After treatment of the fresh samples of lung adenocarcinoma stored at -80°C for ribonucleic acid isolation, and paraffin-embedded tissues of patients with malignant pleural mesothelioma were deparaffinized, complementary deoxyribonucleic acid synthesis and expression of 84 genes associated with deoxyribonucleic acid repair were analyzed via real-time polymerase chain reaction assay. According to the expression of tumor cells, expression of each fold change was calculated. RESULTS: The BRCA1, BRCA2, CDK7, MLH3, MSH4, NEIL3, SMUG1, UNG, XRCC2, and XRCC4 genes showed more than five-fold higher expression in the patients with lung adenocarcinomas, compared to the control group. The patients with malignant pleural mesothelioma showed a five-fold higher expression in the APEX2, BRCA1, BRCA2, CDK7, MLH1, MLH3, MSH3, MSH4, NEIL3, PARP2, PARP3, PMS1, RAD50, RAD51, RAD51B, RAD51D, RAD52, RPA3, SMUG1, UNG, XPA, XRCC2, and XRCC4 genes, compared to the control group. Comparing malignant pleural mesothelioma with lung adenocarcinoma cases, we found that CDK7, MLH1, TREX1, PRKDC, XPA, PMS1, UNG, and RPA3 genes were overexpressed. CONCLUSION: Our study results showed differences between expression profiles of deoxyribonucleic acid repair genes in lung adenocarcinoma and malignant pleural mesothelioma cells. Based on our study results, we suggest that TREX1, PRKDC, and PMS1 genes may play a key role in the differential diagnosis of these two entities.

The benefits of early rib fixation for clinical outcomes of flail chest patients in intensive care unit.

BACKGROUND: In the present study, we aimed to compare clinical results of conservative and surgical stabilization approaches and to investigate the effect of early reduction in patients with a flail chest. METHODS: Between March 2013 and December 2017, 34 patients (23 males, 11 females; mean age 43.7±12.1 years; range, 20 to 74 years) with a flail chest who underwent early rib fixation were included in the surgical group and 29 patients with a flail chest (19 males, 10 females; mean age: 45.7±15.8 years; range, 24 to 74 years) who were followed with the conservative approach were included in the conservative treatment group between February 2012 and December 2017. We applied early rib reduction on the first or the next day (within 24 to 36 h) of trauma. The length of hospitalization, the presence of pneumonia and septic complications in the postoperative period, mortality, mechanical ventilation duration, tracheostomy rate, respiratory function test results, and pain scores were recorded and compared between the groups. RESULTS: The length of stay in the hospital and intensive care unit, and duration of mechanical ventilation were statistically significantly higher in the conservative treatment group than the surgery group (p<0.001, p<0.001, and p<0.001, respectively). None of the patients required tracheostomy in the surgical group, while five patients required tracheostomy in the conservative treatment group (p=0.004). Mortality rates were 2.94% and 20.69% in the surgery and conservative treatment groups, respectively (p=0.027). Pain scores were statistically significantly different in favor of the surgical group compared to the conservative treatment group (p=0.0038 and p=0.044, respectively). CONCLUSION: The results of our study show that early fixation and weaning reduce the need for mechanical ventilation, length of hospitalization, the need for tracheostomy, and mortality rates. This approach also provides a significant improvement in the long-term pain complaints and pulmonary function tests of patients with a flail chest.

Determination of severity of deformity with rib length to costal cartilage length ratio in thorax deformities.

BACKGROUND: This study aims to investigate whether rib length to costal cartilage length ratio is effective in determining the severity of chest wall deformity. METHODS: The study included 72 patients (64 males, 8 females; mean age 18.5±6 years; range, 6 to 40 years) who were operated because of chest wall deformity and 38 control subjects (22 males, 16 females; mean age 14.6±4.2 years; range, 6 to 25 years). Of the patients, pectus excavatum was detected in 69 and pectus carinatum in three. All participants' rib length-costal cartilage length ratio index, Haller index, correction index and computed tomography depression index were measured and compared. RESULTS: In patient group, there was a mild-level significant negative relationship between computed tomography depression index and rib length-costal cartilage length ratio index (p<0.05). Except for the computed tomography depression index, there was no significant relationship between rib length-costal cartilage length ratio index and other indexes and control group indexes in patient group. Rib length was higher than costal cartilage length in patient group compared to control group. There was no statistically significant difference between patient and control groups in terms of costal cartilage length (p>0.05). CONCLUSION: Contrary to what would be expected, there was no significant difference between patient and control groups in terms of costal cartilage length. Therefore, studies with larger series are required to demonstrate if costal cartilage length is effective in determining the severity of chest wall deformities.

Chaperonin (HSP60) and annexin-2 are candidate biomarkers for non-small cell lung carcinoma.

BACKGROUND: Lung cancer is responsible of 12.4% and 17.6% of all newly diagnosed cancer cases and mortality due to cancer, respectively, and 5-year survival rate despite all improved treatment options is 15%. This survival rate reaches 66% in the Stage 1 and surgically treated patients. Early diagnosis which could not be definitely and commonly achieved yet is extremely critical in obtaining high survival rate in this disease. For this reason; proteomic differences were evaluated using matrix assisted laser desorption ionization (MALDI) mass spectrometry in the subgroups of lung adenocarcinoma and squamous cell carcinoma. METHODS: Fresh tissue samples of 36 malignant cases involving 83.3% (n = 30) men and 16.7% (n = 6) women patients were distributed into 2 groups as early and end stage lung cancer and each group were composed of subgroups including 18 squamous cell carcinoma (9 early stage cases, 9 end stage cases) and 18 adenocarcinoma cases (9 early stage cases, 9 end stage cases). The fresh tissues obtained from the tumoral and matched normal sites after surgical intervention. The differences in protein expression levels were determined by comparing proteomic changes in each patient. RESULTS: In the subgroups of advanced stage adenocarcinoma; tumoral tissue revealed differences in expression of 2 proteins compared with normal parenchymal tissue. Of those; difference in protein expression in heat shock protein 60 (HSP60) was found statistically significant (P = 0.0001). Subgroups of early and advanced stage squamos cell carcinoma have differed in certain 20 protein expression of normal tissue and diseased squamos cell carcinoma. Of those, increased protein expression level of only annexin-2 protein was found statistically significant (P = 0.002). No significant difference was detected in early and advanced stage protein expressions of the tumoral tissues in the subgroups of adenocarcinoma and squamous cell carcinoma. CONCLUSIONS: We conclude that with respect to early diagnosis of lung cancer that HSP60 and annexin-2 proteins are the important biomarkers in the subgroups of adenocarcinoma and squamous cell carcinoma. We also consider that these 2 proteins are molecules which may provide critical contribution in evaluation of prognosis, metastatic potential, response to treatment, and in establishment of differential diagnosis between adenocarcinoma and squamous cell carcinoma.