Overview of chest wall deformities.

Chest wall deformities are congenital disorders characterized by abnormal development and appearance of the thoracic wall. The most common form is the pectus excavatum deformity, known as shoemaker's chest. Pectus carinatum, known as pigeon chest, is the second most common deformity. In general, most patients are asymptomatic, but cardiopulmonary problems may accompany the disease. The indication for treatment is mostly cosmetic. Treating patients before they reach adulthood increases the chance of success. Surgical treatment can be open or minimally invasive.

Extended resections in the treatment of locally advanced lung cancer.

Background: This study aims to evaluate surgical outcomes and prognosis in patients who underwent extended lung resection for locally advanced lung cancer. Methods: Between January 2015 and December 2019, a total of 61 patients (60 males, 1 female; mean age: 61.7±12.2 years; range, 32 to 90 years) with locally advanced non-small-cell lung cancer who underwent extended lung resection were retrospectively analyzed. Data including age, sex, comorbid diseases, symptoms, smoking status, pulmonary function test results, tumor location, methods used for preoperative tissue diagnosis, histopathological cell type, type of surgical resection, pathological stage, nodal involvement, postoperative complications, types of adjuvant therapy, and mortality rate were recorded. Survival and the factors affecting survival were examined. Results: Seven (11.4%) patients had Stage IIIB, 40 (65.5%) patients had Stage IIIA, and 14 (22.9%) patients had Stage IB disease. Intrapericardial pneumonectomy accounted for 30 (49.1%) of all extended lung resections. Chemotherapy was administered to 31 (50.8%) patients and chemoradiotherapy to 24 (39.3%) patients in the postoperative period. In the survival analysis, 70-month survival rate was calculated as 63.9% and the median survival was 48 months. There was a statistically significant association between survival with adjuvant chemotherapy and chemoradiotherapy (p=0.003). The mortality rate at 70 months of follow-up was 36.1%. Conclusion: Extended lung resection contributes significantly to the improvement of survival rates in carefully selected locally advanced cases. Particularly with adjuvant chemotherapy, local recurrences can be prevented, and survival rates can be improved.

Frequency and Predictors of Pulmonary Arterial Stump Thrombosis following Pneumonectomy or Lobectomy.

OBJECTIVES: Pulmonary artery stump thrombosis (PAST) following pneumonectomies/lobectomies is rare; its clinical importance is unknown. The objectives of this study were to analyze the prevalence and risk factors of PAST and the clinical significance in patients with pneumonectomy/lobectomy. METHODS: All adult cases who underwent pneumonectomy/lobectomy in our hospital for any reason and who underwent control contrast-enhanced thoracic CT during the follow-up period were included in the study. Demographic and clinical features of the patients, data on surgery, and the features of thrombi were recorded. RESULTS: During the 4-year study period, a total of 454 patients underwent pneumonectomy/lobectomy (93 pneumonectomy and 361 lobectomy). Among the patients, 202 patients (50 pneumonectomy and 152 lobectomy) with at least one follow-up thorax CT were included in the analyses. PAST was detected in 9 (4.5%) of 202 patients and mostly seen in patients with pneumonectomy (lobectomy: 2.6% vs. pneumonectomy: 10%, p = 0.043) and in patients whose pulmonary artery was ligated by using stapler (suture ligation 1% vs. stapler: 7.4%, p = 0.034). Pulmonary artery stump was also longer in patients with PAST (8.48 ± 11.22 mm vs. 23.55 ± 11.22 mm, p < 0.001). Univariate logistic regression analysis showed that pneumonectomy and longer pulmonary artery stump length were found to be significantly associated with PAST (p = 0.041 and p = 0.001, respectively). CONCLUSIONS: PAST was detected in 4.5% of our subjects undergoing lobectomy/pneumonectomy. PAST was found to be significantly higher in subjects who underwent pneumonectomy, those with longer pulmonary artery stump, and those with pulmonary artery stump ligated by using stapler.

The Effects of Nitrofurazone on Wound Healing in Thoracoabdominal Full-thickness Skin Defects.

INTRODUCTION: The use of topical antibiotics on wound healing has been a matter of debate for many years because of the effectiveness. OBJECTIVE: The aim of this study is to investigate the potential effects of topical nitrofurazone, an antibacterial agent, on the healing of full-thickness skin defects created in a laboratory setting. MATERIALS AND METHODS: A total of 42 adult male Sprague Dawley rats were divided into 2 groups: group A (control group; n = 21) and group B (nitrofurazone group; n = 21). Circular full-thickness skin defects about 1 cm x 1 cm in size were formed in the left thoracoabdominal regions of all rats. Local physiological saline was applied to the wound once daily in the control group, and a thin layer of nitrofurazone cream was applied to the wound topically once daily in the nitrofurazone group. The defect sizes of all rats were photographed at baseline and days 3, 7, and 10 of the experiment, and wound size reduction was measured macroscopically on the computer to calculate the healing rates. A total of 7 rats from each group were euthanized on days 3, 7, and 10, and their defected regions were resected. The removed specimens were evaluated histopathologically and scored for inflammatory cells, collagen accumulation, granulation tissue formation, reepithelization, and features of the skin defect (eg, layers of the skin affected, size, whether it involves any abscess-necrosis). Statistical significance was set at P ⟨ .05. RESULTS: The healing rate had higher values in group B at days 7 and 10 of the experiment (P ⟨ .001). A comparison of the group scores showed that there were statistically significant differences in favor of group B. No statistically significant difference was found between the 2 groups with respect to granulation tissue formation. CONCLUSIONS: Topically applied nitrofurazone produced positive effects accelerating the wound healing process.

One-lung ventilation duration-dependent stress response in thoracotomies and the effect of a low-volume, high-frequency differentiated ventilation strategy on this response.

BACKGROUND: This study aims to investigate the effect of ventilation of the non-ventilated lung in patients undergoing one-lung ventilation by a separate low-tidal-volume (1 mL/kg) ventilator at high frequency (30/min) on preventing the effect of one-lung ventilation-associated oxidative damage. METHODS: The study included 45 patients (24 males, 21 females; mean age 54.6±7.7 years; range, 18 to 65 years) with an American Society of Anesthesiologists risk group of 1 to 2 and scheduled for elective thoracotomy. Patients were randomly divided into three groups as those due for thoracotomy without one-lung ventilation (group 1, n=15), those due for thoracotomy with one-lung ventilation (group 2, n=15), and those due for thoracotomy in whom both lungs were ventilated (group 3, n=15). Blood specimens were collected for ischemia-modified albumin, malondialdehyde, and lactate measurements one minute before one-lung ventilation (t0), 30 minutes after one-lung ventilation (t1), 60 minutes after one-lung ventilation (t2), and at postoperative 24th hour (t3). For group 1, t0 was defined as the time at which the thorax was opened. RESULTS: A statistically significant increase in ischemia-modified albumin, malondialdehyde, and lactate levels occurred in group 2 as the duration of one-lung ventilation increased (p<0.01). Plasma ischemia-modified albumin and malondialdehyde levels in group 3 were statistically significantly lower at t1, t2, and t3 compared with group 2 (p<0.01). Plasma lactate levels were significantly lower in group 3 at t1 (p<0.05) and t3 compared with group 2 (p<0.01). CONCLUSION: Separate ventilation of the non-ventilated lung with low tidal volume and high frequency reduces the response to one-lung ventilation-associated oxidative stress in thoracic surgery.

Effects of Endoscopic Thoracic Sympathectomy on Raynaud's Disease.

INTRODUCTION: Raynaud's disease is a disorder that is characterized by attacks of pain, cyanosis, redness, and numbness in the upper extremities caused by vasospasm of digital arteries due to cold or emotional stress. We aimed at demonstrating our experiences with endoscopic thoracic sympathectomy (ETS) in the treatment of Raynaud's disease. METHODS: From 48 patients who underwent ETS for various reasons at our department between January 2014 and January 2015, we reviewed 9 patients with Raynaud's disease (18.7%) with respect to their demographic characteristics such as gender and age, postoperative complications, short-term results, side effects, recurrence of symptoms, and long-terms results. RESULTS: The symptoms and findings reappeared and the number and dosage of the drugs used returned to their preoperative levels in 66.6% of the patients at month 6, and in all patients except 1 at the end of the 1st year. CONCLUSION: ETS should be considered an ultimate choice for patients with Raynaud's disease who have treatment-resistant severe symptoms and serious complications, disturbed social and daily lives, and impaired quality of life, and all patients should be properly informed before the surgery about the possibility of a high rate of recurrence.

A Comfortable Solution To Tracheal Anastomosis Protection: Tracheal Retention Sutures.

Fixation of the chin to the anterior chest wall is the most commonly used method of reducing anastomotic tension following a segmental resection of the trachea and reconstruction with primary anastomosis. However, the sutures required for this method may lead to various organic and psychological problems. In five patients who underwent tracheal resection and primary anastomosis, retention sutures were placed on the proximal and distal-lateral edges of the anastomotic line rather than placing a Guardian chin stitch. All patients were mobilised in the early postoperative period and were able to perform their routine daily activities without restrictions. During their average 14.4 months of follow-up, no complications were found in their anastomotic lines during their clinical, radiological, and bronchoscopic assessments. The placement of tracheal retention sutures proved an inexpensive and reliable method to reduce anastomotic tension without additional surgical burden, and was effective in terms of patient comfort.

Comparison of T2 and T3 sympathectomy for compensatory sweating on palmar hyperhidrosis.

BACKGROUND: An otherwise successfully performed endoscopic thoracic sympathectomy (ETS) to treat palmar hyperhidrosis (PH) often has a serious side effect: compensatory sweating (CS). This side effect occurs in other parts of the body to a disturbing extent. The objective of this study is to determine whether there is a relationship between the level of ETS performed on patients with PH, and the occurrence and severity of postoperational CS. METHODS: Between January 2014 and January 2015, ETS procedures were performed on 25 randomly selected consecutive subjects (group A) at T2 level, and on another 25 subjects (group B) at T3 level, who all felt severely handicapped due to PH. All subjects were assessed in terms of their demographic characteristics including gender and age, as well as postoperative complications, short-term results, side effects, recurrence of symptoms, and long-term results. RESULTS: The symptoms disappeared in all subjects in short-term, and no recurrence was seen in their short or long-term follow-ups. At the end of year one, CS developed at a rate of 12% in group A and 8% in group B, particularly in their back and abdominal regions. The overall satisfaction with the procedure in year one was 96% in group A and 100% in group B. CONCLUSION: When an ETS performed at T2 or T3 level for PH involves only the interruption of the sympathetic chain, with a limitation on the range of dissection and avoidance of any damage to ganglia, sweating is stopped completely. No recurrence of PH is encountered, and CS develops only at low rates and severities.

Relationship of spontaneous pneumothorax cases seen in Eastern Black Sea region with meteorological changes.

The relationship of climate changes or weather conditions with the incidence of pneumothorax has been explored for many years. We aimed at revealing the effects of meteorological changes on the incidence of pneumothorax in the Eastern Black Sea region where spontaneous pneumothorax cases are seen relatively more frequently. The records of 195 subjects (179 males and 16 females) who had been monitored and treated due to spontaneous pneumothorax between January 2006 and December 2012 at our clinic were reviewed retrospectively, and their relationship was investigated with the meteorological data obtained by going through the database archive records of the 11th Regional Meteorology Directorate for the years between 2006 and 2012. Wind velocity was observed to be less in the days of having spontaneous pneumothorax than in the days of having no spontaneous pneumothorax, and the difference was found statistically significant (P = 0.026). The people of our region whose active lifestyle is reflected in their working life, social life, and even in their folk dances usually take a rest in the days of slower wind speed. We think that this state of resting leads to an increase in the frequency of spontaneous pneumothorax.

The Perforation of the Superior Vena Cava Secondary to the Left Subclavian Dialysis Catheter.

INTRODUCTION: The perforation of the superior vena cava during the placement of dialysis catheter and consequent hemothorax is a rare serious complication. CASE REPORT: Dialysis catheter was placed in the left subclavian vein in a 69-year-old male patient with chronic renal insufficiency who was hospitalized for intracerebral hematoma. During hemodialysis a day after the procedure, the patient was noted having right-sided hemothorax, causing lethargy, dyspnea, hypotension, and bradycardia. Right tube thoracostomy was performed and 1500 cc of hemorrhagic fluid was drained. Under general anesthesia, the right posterolateral thoracotomy was performed and the tip of the dialysis catheter was found in the pleural space, penetrating the anteromedial side of the superior vena cava. The perforation area was repaired by suturing with 3-0 prolene, and the dialysis catheter was removed externally. Postoperative period was uneventful, and tube thoracostomy was terminated on day 4. CONCLUSION: Establishing the diagnosis early and accurately and performing appropriate surgery would be lifesaving in superior vena cava perforation due to dialysis catheter.

Adult inflammatory myofibroblastic tumor of the trachea: case report and literature review.

Inflammatory myofibroblastic tumor of the trachea is a rare benign tumor in adults. It is mostly seen before the age of 16. We describe a 20-year-old female patient who presented with stridor. She had a fixed obstruction on spirometry, and computed tomography and bronchoscopy confirmed tracheal thickening and stenosis below the vocal cords and bronchial wall thickening at the level of the carina. Bronchoscopic biopsy confirmed an inflammatory myofibroblastic tumor. She recovered after mechanical dilatation and resection via rigid bronchoscopy, followed by corticosteroid therapy.

A case of intratracheal schwannoma presenting at the emergency department with a diagnosis of asthmatic attack.

Primary tumors of the tracheobronchial tree are rare, and benign tumors are even rarer. Patients with tracheobronchial tumors are at times wrongly diagnosed with asthma. A 77-year-old woman presented to our Emergency Department with increasing dyspnea and stridor. She had been treated for bronchial asthma for the last 7 years. Due to the presence of the stridor, a cervical soft tissue computed tomography scan was performed. It revealed a tracheal polyp at the level of the thyroidal isthmus. Polyp excision with rigid bronchoscopy was performed by a thoracic surgeon. This case demonstrates that intratracheal masses should be considered in patients with dyspnea and stridor or in patients with asthma refractory to usual treatment.

Ischemia-modified albumin in the diagnosis of pulmonary embolism: an experimental study.

STUDY OBJECTIVE: We designed this experimental study to determine the value of ischemia-modified albumin in the diagnosis of pulmonary embolism. METHODS: Twenty-four mature female New Zealand rabbits were divided into 4 groups, each consisting of 6 animals. These were classified into group 1 ,the control group; group 2, the deep venous thrombosis group; group 3, the deep venous thrombosis with pulmonary embolism group; and group 4, the pulmonary embolism-alone group. Deep venous thrombosis was produced by ligation of the iliac vein. To establish pulmonary embolism, 2 clots were administered from the iliac vein. Blood samples were taken from all the groups at hours 0, 1, 3, and 6 for ischemia-modified albumin measurement. RESULTS: Pulmonary embolism was established in all the rabbits in groups 3 and 4, and this was confirmed by tomographic and histologic findings. Measurement of mean ischemia-modified albumin levels for all rabbits at hours 0, 1, 3, and 6 revealed that mean ischemia-modified albumin levels in groups 3 and 4 were statistically significantly higher than those in groups 1 and 2. There was no difference between the mean ischemia-modified albumin levels in groups 1 and 2 nor between groups 3 and 4. The alteration in ischemia-modified albumin levels over time was statistically significant. CONCLUSIONS: The results of our experimental study demonstrate that ischemia-modified albumin levels may be useful in the diagnosis of pulmonary embolism.

Mediastinal lymph nodes: assessment with diffusion-weighted MR imaging.

PURPOSE: To prospectively determine whether the diffusion-weighted magnetic resonance imaging is useful to distinguish between malignant and benign mediastinal lymph nodes. MATERIALS AND METHODS: Thirty-five patients (14 women, 21 men; mean age 52 years) with 91 lymph nodes in the mediastinum detected by computed tomography underwent 1.5 Tesla (T) diffusion-weighted MR imaging before mediastinoscopy (n = 29) and mediastinotomy (n = 6). Diffusion-weighted MR images were acquired with a b factor of 50, and 400 s/mm(2) using single-shot echo-planar sequence. RESULTS: Of the 35 patients, 18 had diagnosis of malignant tumor. Of the 18 patients with tumor, 8 had nonsmall cell carcinoma, and 10 had small cell carcinoma. Ninety-one mediastinal lymph nodes were detected in the 35 untreated patients: 19 were pathologically diagnosed as metastatic lymph nodes, and 72 lymph nodes were diagnosed as nonmetastatic lymph nodes, including 50 sarcoidosis, 14 reactive lymphoid hyperplasia, and 8 necrotizing granulamatous lymphadenitis. The apparent diffusion coefficient (ADC) was significantly lower in metastatic lymph nodes (1.012 +/- 0.025 x 10(-3) mm(2)/s; P < 0.0005) than in benign lymph nodes (1.511 +/- 0.075 x 10(-3) mm(2)/s). On the ADC map, malignant nodes showed hyperintense (n = 2, 10.52%), hypointense (n = 14, 73.68%), and mixed intensity (n = 3; 15.78%), whereas benign nodes showed hyperintense (n = 57; 79.16%), hypointense (n = 3; 41.6%), isointense (n = 6; 8.33%), and mixed intensity (n = 6; 8.33%). CONCLUSION: Diffusion-weighted MR with ADC value and signal intensity can be useful in differentiation of malignant and benign mediastinal lymph nodes.