Factors influencing postoperative recurrence of early-stage non-small cell lung cancer.

PURPOSE: This study aims to explain the factors that may influence recurrence after surgical resection for early non-small cell lung cancer (NSCLC). METHODS: A retrospective analysis was made of 302 patients who underwent lung resection for stage I-IIA NSCLC in our clinic between January 2014 and August 2021. RESULTS: The recurrence rate was higher in patients with squamous cell carcinoma (SCC) than in those with adenocarcinoma (AC) (p = 0.004). Disease-free survival (DFS) was shorter in SCC (p = 0.004). According to histopathological subtypes, the presence of lymphovascular invasion (LVI), vascular invasion (VI), visceral pleural invasion (VPI) and tumor spread through air spaces (STAS) caused an increased risk of recurrence ((p = 0.004), (p = 0.001), (p = 0.047), (p = < 0.001)) and shorter DFS ((p = 0.002), (p = < 0.001), (p = 0.038), (p = < 0.001)). LVI and VI was more common in patients with distant recurrence (p = 0.020, p = 0.002), while the STAS was more common with locoregional recurrence (p = 0.003). CONCLUSION: The presence of LVI, VI, VPI, and STAS are negative risk factors for recurrence and DFS in all patients and in patients with AC. In patients with SCC, the diagnosis of SCC itself and the presence of STAS were risk factors for recurrence and DFS. Moreover, the risk of distant recurrence is higher in the presence of LVI or VI, and the risk of locoregional recurrence in the presence of STAS is higher.

Bibliometric Analysis of 50 Most Cited Articles Comparing Lobectomy with Sublobar Resection.

BACKGROUND: Recent years have seen an increase in the number of studies of the sublobar resection approach in non-small cell lung cancer (NSCLC) surgery. The purpose of this bibliometric analysis is to assess the significance and impact of articles comparing sublobar resection and lobectomy in NSCLC surgery. MATERIAL AND METHODS: The Web of Science database was searched to identify studies comparing sublobar resection and lobectomy in NSCLC surgery published between 2005 and 2020 (accessed: September 11, 2020). The 50 most cited articles were analyzed by years, countries, authors, authors' affiliations, journals, journals' addresses, and impact factors. RESULTS: The bibliometric analysis revealed that the most cited article had 443 citations, while the total number of citations of all articles was 2,820. The mean number of citations, in turn, was 56.4 ± 75.62 (1-443) times. The highest number of publications over the past 15 years was in 2016, with eight articles. The Annals of Thoracic Surgery (n = 10; 20%) had the highest number of publications on the list. The articles included in the present study were mostly (n = 35, 70%) published in U.S. journals. While multiple subject matters and analyses were presented by many studies, survival was the topic of greatest interest, with 37 (74%) studies. CONCLUSION: This study revealed that interest in studies comparing sublobar resection with lobectomy has increased in recent years. It also presents both quantitative and qualitative analyses of the most cited articles in the literature on this topic. Therefore, it can serve as a guide for researchers.

The significance of immunonutrition nutritional support in patients undergoing postoperative adjuvant chemotherapy for lung cancer: case-control study.

BACKGROUND: In this study, the effect of postoperative early nutritional supplementation on the course of the disease was investigated in patients who were operated for non-small cell lung cancer and received adjuvant chemotherapy. METHODS: The study examined the data of patients who anatomical pulmonary resection for non-small cell lung cancer and who were treated with adjuvant chemotherapy at our clinic between January 2014 and January 2020. Patients who received early postoperative nutritional supplements and those who continued with a normal diet were compared in terms of complications, mortality, recurrence, and survival. RESULTS: The study sample consisted of 68 (84%) male and 13 (16%) female patients, and the mean duration of postoperative follow-up was 31.6 ± 17.9 (4-75) months. Metastasis was identified in eight (17.4%) patients in GrupNS (Nutritional Supplements) compared to 10 (28.6%) patients in GroupC (Control) (p = 0.231). Of the total, 11 (23.9%) patients died in GroupNS compared to 13 (37.1%) in GroupC (p = 0.196). Mean survival was 58.9 ± 3.8 (95% CI: 4.0-75.0) months in GroupNS compared to 43.5 ± 4.6 (95% CI: 6.0-66.0) months in GroupC (p = 0.045). CONCLUSION: Early nutritional supplements should be considered as having a positive effect especially on survival in this specific patient group involving factors with high catabolic effects, such as neoplasia, operation, and chemotherapy together.

Long-Term Outcomes and Course of Compensatory Sweating after Endoscopic Sympathicotomy.

BACKGROUND: Endoscopic thoracic sympathicotomy is an effective approach to the treatment of idiopathic localized hyperhidrosis, and compensatory sweating is the main reason for patient dissatisfaction. Our study discusses both the long-term outcomes of sympathicotomy and the course of compensatory sweating. METHODS: Patients with palmar and/or axillary hyperhidrosis who were operated by the same surgical team between January 2008 and December 2014 were included in the study. After at least 5 years (60 months) from operation, patients were questioned about their treatment outcomes by using an original survey form. RESULTS: Of the 137 patients included in the study, 88 (64.2%) were female and 49 (35.8%) were male. The mean time from the operation to the survey interview was 80.9 ± 14.1 (64-136) months. After operation, complaints disappeared in 95.1% of the patients, and decreased in 4.9% with palmar hyperhidrosis. Complaints completely disappeared in 12.9% and decreased in 81.7% of the patients with axillary hyperhidrosis. Ninety-seven (70.8%) of the patients described increased sweating in some parts of their body after operation but only 47 reached an uncomfortable intensity. The number of patients who regretted the operation due to the compensatory sweating was 13 (9.5%). The patients' overall scoring of the operation and procedure was calculated as 8.0 ± 2.1 (0-10 points) out of 10. CONCLUSION: Endoscopic thoracic sympathicotomy's long-term outcomes are also satisfactory in the treatment of palmar and axillary hyperhidrosis. Compensatory sweating may decrease over time, only a minority of patients will express regret at undergoing the treatment.

Association of Daily Step Count with the Prolonged Air Leak in Thoracic Surgery Patients.

BACKGROUND: In thoracic surgery clinics, patients are encouraged to walk; however, to our knowledge, there is no data regarding the minimum step count necessary to protect them from complications. In our study, we aim to ascertain the relationship between walking and prolonged air leak (PAL), which is one of the most common complications following thoracic surgery. METHODS: Patients, who were being followed-up at our clinic between December 2016 and July 2017, were separated into three groups and were investigated prospectively. The groups were established as follows: Group I, included patients with spontaneous pneumothorax; Group II, comprised patients who were applied sublobar lung resection; and Group III, comprised (pneumonectomy excluded) patients who were applied anatomic lung resection. All the patients were supplied with a standard pedometer. The step counts of the patients were recorded prospectively, beginning from the first postoperative day, and an attempt was made to establish the relationship between the patients' daily and mean step counts and the development of PAL. RESULTS: PAL developed in 11 (39.29%) of the 28 patients in Group I; in 1 (2.04%) of the 49 patients in Group II and in 22 (36.07%) of the 61 patients in Group III. When receiver operating characteristic (ROC) analysis was applied to the data of Group I, and when the cut-off value for the first-day step count was confirmed to be 2,513 steps, it was revealed that the development of PAL could be determined with a sensitivity of 100% and a specificity of 100%. The analysis of the patients in Group III revealed significant correlations between the first-day and second-day step counts, and the development of PAL (p = 0.017 and 0.007, respectively). The development of PAL decreased as walking was maximized. CONCLUSION: Early and sufficient mobilization decreases the likelihood of postoperative complications. Our study defines concepts, such as post-operative daily step count, target step count, and step count protecting from PAL, and in this regard, we consider it to be a primary study in the literature.

Pulmonary Metastasectomy of Sarcoma: Is the Ratio of Surgical Margin to Nodule Size a Prognostic Factor?

BACKGROUND: Main prognostic factors of improved survival after pulmonary metastasectomy (PM) for osteogenic and soft tissue sarcomas are suggested as histological type, number and size of pulmonary nodules, and disease-free interval (DFI). METHODS: Sixty-nine patients who underwent PM between January 1999 and December 2017 were evaluated retrospectively. Relations between parameters and prognostic risk factors for overall survival (OS) and disease-free survival (DFS) were evaluated. RESULTS: Osteosarcoma was the most common histologic type (36.2%) and 21 of 25 cases were seen under the age 20 years (p < 0.001). Comparison of patient groups including osteosarcoma and nonosteosarcoma patients showed significant difference according to age (p < 0.001), nodule size (p = 0.033), ratio of surgical margin to nodule size (p = 0.007), and DFI (p = 0.039). Univariate analysis showed that the number of nodules (p = 0.008), ratio of surgical margin to nodule size (p = 0.001), and localization of nodule (p = 0.039) were significant factors associated with DFS. Also, nodule size (p = 0.042), number of nodules (p = 0.003), ratio of surgical margin to nodule size (p < 0.001), and laterality (p = 0.027) were significant prognostic factors associated with OS. Cut-off values of ratio of surgical margin to nodule size for DFS and OS were calculated as 0.94. Logistic regression analysis determined the ratio of surgical margin to nodule size as the common significant risk factor for DFS and OS. CONCLUSIONS: Our study showed that the ratio of surgical margin to nodule size ≥ 1 should be taken as a common risk factor for DFS and OS. Therefore, resection of nodules with the possible widest surgical margin is an important point of PM.

Assessment of Cardiac Complications in Patients Undergoing Pulmonary Resection.

BACKGROUND: Patients who underwent lung resection in our clinic were retrospectively investigated in terms of development of postoperative cardiac complications. METHODS: The file records of 207 patients who underwent lung resection between the years 2010 and 2014 were reviewed. One hundred and eighteeen (118) (57%) of the patients were evaluated by the preoperative cardiologist and the risk level of the patients was determined according to the Lee index. Postoperative cardiac complication relation was compared with each parameter. RESULTS: The difference between the mean age of the patients with and without complication was statistically significant (p=0.024). When the patients were grouped as over and under 65 years old, the risk of developing postoperative complications was higher and statistically significant (p=0.015) in patients over 65 years of age. When the patients were evaluated in line with the presence of additional disease, smoking and electrocardiogram (ECG) findings, patients with hypertension developed more complications than those without hypertension (p=0.002). When the logistic regression was adjusted according to age and sex, the development of cardiac complications in patients with hypertension was 3.25 times greater. CONCLUSIONS: It should be kept in mind that the presence of hypertension in patients who will undergo lung resection and advanced age increases the risk of cardiac complications and that preoperative cardiology care may be appropriate for these patients.

Is the Risk of Postoperative Atrial Fibrillation Predictable in Patients Undergoing Surgery Due to Primary Lung Cancer?

BACKGROUND: Atrial fibrillation (AF) is a type of cardiac arrhythmia which is commonly seen following lung resection. There is currently no algorithm which can predict which patients will develop postoperative AF (PAF). The present study aims to identify the risk factors for the development of PAF and high-risk patients with PAF along with multiple risk factors. MATERIALS AND METHODS: A total of 887 patients, who underwent lung resection due to primary lung malignancy at our clinic between January 2000 and December 2016, were retrospectively analysed. Group 1 (n=44) consisted of the patients who developed PAF and Group 2 (n=843) consisted of the patients without PAF. Age and sex of the patients, comorbidities, previous diagnosis of malignancy, and surgery-related variables were evaluated using statistical methods for their effects on the development of AF. A score was assigned to each identified risk factor and scores of the patients were calculated. The risk of developing PAF was evaluated based on this scoring system. RESULTS: We found that ≥60 years of age and the diagnosis of chronic obstructive pulmonary disease (COPD) were significant risk factors for the development of PAF (p<0.05). The risk of developing PAF was not associated with male sex, previous history of malignancy, presence of comorbidities, and the type of surgery applied. There was an increased risk of AF with increasing scores in the risk calculation system. CONCLUSION: Advanced age and the presence of COPD were found to be associated with an increased risk of developing PAF. In addition we found a significant increase in the risk of developing PAF in the presence of multiple factors, although they did not reach statistical significance alone.

Bibliometric analysis of 40 most cited articles comparing video-assisted thoracic surgery and robotic-assisted thoracic surgery in lung cancer (1997-2021).

Background: In recent years, conventional thoracoscopic surgery has been accepted as the traditional treatment method in the non-small cell lung cancer (NSCLC). VATS and RATS, which are the techniques of this surgical method, have been increasing their effectiveness and applicability of late years. The aim of this bibliometric analysis is to evaluate the importance and efficiency of articles comparing VATS and RATS techniques. Materials and methods: Studies comparing VATS and RATS published between 1997 and 2021 were identified in the Web of Science database (accessed on 31. 12. 2021). The 40 most cited studies were analyzed in terms of publication years, country of study, authors, institutions that the authors were affiliated with, journal, journal address and impact factor. Results: While an article was cited a maximum of 187 times when the citations made by the authors were excluded from the analysis, it was observed that all publications were cited a total of 1946 times. It was seen that an average of 51. 30 ± 47. 73 (8-187) articles were cited. In the 25-year, the highest number of publications was reached in 2019, while eight articles were published this year. The Annals of Thoracic Surgery (n = 13, 32. 5 %) was the journal in which the articles in the list were published the most. Most of the articles in our study (n = 31, 77.5 %) were published in US journals. While many studies presented more than one topic and analysis, the topic of most interest in 19 (47.5 %) studies was postoperative complications. Conclusion: This bibliometric analysis reflects important and qualified articles comparing VATS and RATS technique in thoracic surgery, but it can also be used to explain or explain the performance and results of these techniques, their positive and negative aspects, and their superiority over each other.

A Case Report of Lung Transplantation After Hematopoietic Stem Cell Transplantation and Literature Review.

Pulmonary complications may occur after hematopoietic stem cell transplantation for hematologic malignancies. Lung transplantation is the only treatment option for end-stage lung failure. We presented a case of acute myeloid leukemia who received a hematopoietic stem cell transplantation and underwent bilateral lung transplantation with end-stage usual interstitial pneumonia and chronic obstructive lung disease. This case showed that lung transplantation could be successfully applied in properly selected hematologic malignancy patients with long disease-free survival, like lung transplantations performed for other indications.

The Importance of tumor markers in patients undergoing resection for lung metastasis of colorectal carcinoma.

OBJECTIVES: In patients with suitable conditions, complete resection is a potential curative treatment for lung metastases of colorectal cancers (CRC). Various prognostic factors affecting survival have been reported in these patients. In our study, the prognostic significance of CEA and CA19-9 tumor markers in patients who underwent lung resection for CRC metastasis was researched. METHODS: Fifty-three patients who underwent lung resection for CRC metastasis between January 2015 and July 2021 were included in the study. The relationship between preoperative and postoperative CEA and CA19-9 values, survival times, tumor size, and preoperative CEA and CA19-9 levels were investigated. RESULTS: Patients with high preoperative and postoperative CEA had shorter survival (OS) compared with patients with lower values (p ≤ 0.001 and p = 0.009, respectively). Disease-free survival (DFS) was also shorter in patients with higher preoperative CEA values (p = 0.008). For patients with higher preoperative and postoperative CA 19-9 values, OS and DFS were shorter (p = 0.013 and p ≤ 0.001) and (p = 0.042 and p ≤ 0.001), respectively. There was a weak positive correlation between preoperative CEA value and tumor size (p = 0.008, Pearson correlation coefficient = 0.360). However, a strong positive correlation between preoperative CA19-9 value and tumor size was discovered (p ≤ 0.001, Pearson correlation coefficient = 0.603). CONCLUSION: In our study, it was shown that preoperative-postoperative CEA and CA19-9 levels in patients with metastatic colon carcinoma are associated with overall survival.

Survival of pleurectomy-decortication and hyperthermic chemotherapy in mesothelioma.

Background: This study aims to evaluate overall survival, diseasefree survival, and prognostic factors in patients undergoing pleurectomy-decortication and hyperthermic intrathoracic chemotherapy with the diagnosis of malignant pleural mesothelioma. Methods: Between January 2020 and November 2021, a total of 53 patients (27 males, 26 females; mean age: 58.1±1.3 years; range, 39 to 81 years) who underwent pleurectomy-decortication and hyperthermic intrathoracic chemotherapy with the diagnosis of malignant pleural mesothelioma were retrospectively analyzed. Data including characteristics, comorbidities, postoperative complications, recurrence and mortality status of the patients were recorded. Overall survival and disease-free survival and prognostic factors were evaluated. Results: The median disease-free survival was 11.67 months and the median overall survival was 24.60 months. The median disease-free survival was 8.80 months in men and 13.17 months in women, indicating a statistically significant difference as it showed that recurrence was detected earlier in male patients (p=0.037). The median disease-free survival and overall survival was 6.13 months and 11.70 in cases diagnosed with biphasic mesothelioma, respectively, while it was 11.67 months and 25.46 months in cases with epithelial mesothelioma, respectively. Pathological subtype was found to be an effective prognostic factor for both survival (p=0.049 and p<0.001, respectively). Conclusion: Hyperthermic intrathoracic chemotherapy following cytoreductive surgery is a preferable and tolerable method in the treatment of malignant pleural mesothelioma. While evaluating surgical indications, it should be kept in mind that cases with epithelial mesothelioma may benefit more from surgical treatment.

Diagnostic efficacy of intraoperative histopathological examination of lesions with unknown diagnosis suspicious for malignancy.

Objective: In this study, the efficiency of intraoperative histopathological examination (frozen section examination; FS) in patients operated per suspected lung malignancy was evaluated. Methods: The data of 136 patients who underwent surgery in our clinic due to suspected lung malignancy between January 2020 and June 2021 was evaluated prospectively. Results: The FS was inconclusive in 7.3 % of the 136 patients. In contrast, the accuracy of differentiating between benign and malignant lesions was 99.2 %, while the rate of false negative was 0.8 % in 126 patients with a prediagnosis. FS examination led to an accurate diagnosis in 91.9 % of the 98 patients without a history of extrapulmonary malignancy (EPM), with a false negativity rate of 1 %, whereas a paraffin-embedded examination was recommended in 7.1 %. The accuracy of the FS was 98.9 % in 91 patients prediagnosed based on an FS, with a false negativity rate of 1.1 %. In the same group of patients, the FS examination was successful in establishing the subtype in 32.9 % of the patients with primary lung cancer (PLC), whereas the efficacy of the FS examination in determining the subtype was better in benign diseases (63.6 % vs 32.9 %, p = 0.009). The FS examination was unable to differentiate between benign and malignant lesions in 92.1 % of patients with EPM but differentiated between primary and metastatic lesions in 48.3 % of patients who had malignancy. Furthermore, FS examination successfully guided surgery in 89 patients with no history of EPM (90.8 %) and 20 patients (52.6 %) with a history of EPM. Conclusion: Although FS is insufficient in subtyping lung cancers and distinguishing PLC and metastasis, it is an important and effective diagnostic approach with its overall ability to distinguish benign and malignant lesions and guiding surgical procedures.

Relationship between survival and erythrocyte sedimentation rate in patients operated for lung cancer.

Background: This study aims to investigate the relationship between preoperative erythrocyte sedimentation rate and survival in patients undergoing pulmonary resection due to lung cancer. Methods: Between January 2011 and July 2017, a total of 575 patients (433 males, 142 females; mean age: 61.2±9.9 years; range, 29 to 82 years) who were operated due to primary lung cancer in our clinic were retrospectively analyzed. The patients were grouped according to erythrocyte sedimentation rate to analyze the relationship between erythrocyte sedimentation rate and survival. Results: The mean overall survival time was 61.8±1.7 months in 393 patients with an erythrocyte sedimentation rate of ≤24 mm/h and 48.9±2.9 months in 182 patients with an erythrocyte sedimentation rate of ≥25 mm/h (p<0.001). Among the patients with Stage 1-2 disease, the mean survival time was 66.2±1.9 in patients with an erythrocyte sedimentation rate of ≤24 mm/h and 53.8±3.2 in patients with an erythrocyte sedimentation rate of ≥25 mm/h (p=0.008). The mean survival time in patients with adenocarcinoma was 62.4±2.4 months in patients with ≤24 mm/h erythrocyte sedimentation rate and 46.1±4.6 months in patients with ≥25 mm/h erythrocyte sedimentation rate (p=0.003). Conclusion: The relationship between elevated erythrocyte sedimentation rate and poor prognosis in patients with the same stage of the disease is promising for the use of erythrocyte sedimentation rate as a prognostic marker.

The importance of autologous blood transfusion in lung transplantation and cardiovascular surgeries.

BACKGROUND: In this study, we aimed to investigate the effect of using autologous blood recovery systems on transfusion-related complications in patients undergoing lung transplantation and cardiovascular surgeries. METHODS: Between May 2016 and May 2019, a total of 104 patients (90 males, 14 females; mean age: 59.3±16.4 years; range, 12 to 89 years) in whom cell-saver and autologous blood recovery systems were used during lung transplantation or cardiovascular surgeries were retrospectively analyzed. The patients were divided into two groups as Group 1 (n=61) consisting of patients who received autologous blood transfusion and as Group 2 (n=43) consisting of patients who did not. Data including demographic and clinical characteristics of the patients, operation data, and postoperative complications were recorded. RESULTS: The total amount of transfused blood/blood product was found to be significantly higher in Group 1 (p=0.018). However, transfusionrelated complications were found to be higher in Group 2 (p=0.0261). There was no significant difference in the length of hospital stay between the groups. CONCLUSION: Autologous blood transfusion may prevent the development of transfusion-related complications by reducing the amount of allogenic transfusion in major surgical procedures. In our study, the autologous blood transfusion was used in critical patients with major bleeding and, therefore, the total amount of transfused blood/blood product was higher in these patients. Nevertheless, lower complication rates in this patient group emphasize the importance of autologous blood transfusion.

Pneumothorax: A Rare Entity During Pregnancy.

Pneumothorax is a rarely seen condition during pregnancy, when changes in the respiratory physiology can sensitize the mother and fetus to the signs of hypoxia. Symptoms of pneumothorax, such as dyspnea, tachypnea, and chest pain, can also be attributed to pregnancy and complications with pregnancy and this can lead to misdiagnoses. The limitations in the use of diagnostic tests, such as chest X-ray and computed tomography, make treatment more difficult. Here, we report of two cases admitted to our hospital due to spontaneous pneumothorax during pregnancy. The diagnosis of pneumothorax was made based on a thorax ultrasonography in both patients, whereas a chest X-ray was used in the follow-up period, without the need for a thorax tomography. While one patient was treated via a tube thoracostomy, the other was treated via video-assisted thoracoscopic surgery.

Multidisciplinary Assessment of Planning and Resection of Complex Bone Tumor Using Patient-Specific 3D Model.

Oncological interventions in thoracic cavity have some important problems such as choice of correct operative approaches depending on the tumor, size, extension, and location. In sarcoma surgery, wide resection should be aimed for the curative surgery. Purpose of this study was to evaluate pre-operative planning of patient-specific thoracic cavity model made by multidisciplinary surgeon team for complex tumor mass for oncological procedures. Patient's scans showed a large mass encroaching on the mediastinum and heart, with erosion of the adjacent ribs and vertebral column. Individual model of this case with thoracic tumor was reconstructed from the DICOM file of the CT data. Surgical team including six interdisciplinary surgeons explained their surgical experience of the use of 3D life-size individual model for guiding surgical treatment. Before patients consented to surgery, each surgeon explained the surgical procedure and perioperative risks to her. A questionnaire was applied to 10 surgical residents to evaluate the 3D model's perception. 3D model scans were useful in determining the site of the lesion, the exact size, extension, attachment to the surrounding structures such as lung, aorta, vertebral column, or vascular involvement, the number of involved ribs, whether the diaphragm was involved also in which order surgeons in the team enter the surgery. 3D model's perception was detected statistical significance as < 0.05. Viewing thoracic cavity with tumor model was more efficient than CT imaging. This case was surgically difficult as it included vital structures such as the mediastinal vessels, aorta, ribs, sternum, and vertebral bodies. A difficult pathology for which 3D model has already been explored to assist anatomic visualization was mediastinal osteosarcoma of the chest wall, diaphragm, and the vertebral column. The study helped to establish safe surgical line wherever the healthy tissue was retained and enabled osteotomy of the affected spinal corpus vertically with posterior-anterior direction by preserving the spinal cord and the spinal nerves above and distal the tumor. 3D tumor model helps to transfer complex anatomical information to surgeons, provide guidance in the pre-operative planning stage, for intra-operative navigation and for surgical collaboration purposes. Total radical excision of the bone tumor and reconstructions of remaining structures using life-size model was the key for successful treatment and better outcomes. The recent explosion in popularity of 3D printing is a testament to the promise of this technology and its profound utility in orthopedic oncological surgery.

Quantitative measurement of air leak in patients with chest drains.

BACKGROUND: This study aims to evaluate a new method that detects peak air leak speed and peak air leak flow, investigate the correlation between the amount of air leak and development of prolonged air leak, and identify patients who are at risk of developing prolonged air leak after lung resection. METHODS: In this prospective trial, the amount of air leak was measured with the assistance of an anemometer connected to the top of a standard underwater drainage system, and a mobile phone with android operating system. Patients who underwent tube thoracostomy for spontaneous pneumothorax were assigned to group 1 (18 males, 1 female; mean age 31.6±10.9 years; range, 18 to 70 years), whereas patients who underwent lung resection for benign or malignant lung diseases were assigned to group 2 (37 males; 16 females; mean age 56.9±15.6 years; range, 18 to 80 years). The receiver operating characteristics analysis was performed for the statistical analysis of the data. RESULTS: Prolonged air leak was observed in five patients (26.3%) in group 1 and in six patients (11.3%) in group 2. In group 1, first measurement on postoperative day zero could detect prolonged air leak development with 100% sensitivity and 92.9% specificity. Similarly, in group 2, measurements on day zero could detect prolonged air leak development with 100% sensitivity and 87.2% specificity. CONCLUSION: Compared to similar products, this newly developed measuring device may be widely used in clinics with its low cost and ease of use. Measured peak air leak flow values can predict patients who may develop prolonged air leak. Patent work for the device is ongoing.

Traumatic diaphragmatic rupture: look to see.

OBJECTIVE: Traumatic diaphragmatic rupture (TDR) is a rare but potentially life threatening clinical entity with a high incidence of associated injuries. In this article, our experience with this challenging diagnosis is presented. METHODS: In this study, a total of 68 patients with TDR, were operated in our center between July 1994 and September 2005. Study group was analyzed retrospectively. The etiological factors, management and outcomes were discussed. RESULTS: The mean age was 32.9 years with a female to male ratio of 9/59. TDR was right-sided in 16.2% (n=11) and left-sided in 83.8% (n=57). The cause of the rupture was penetrating trauma in 51 (75%), and blunt trauma in 17 (25%). Only three patients (4.4%) had late diagnosis. Associated injuries were seen in 91% (n=62) of the patients. The most common used incision was a laparotomy incision (89.6%). Morbidity and mortality were encountered in 13.1% (n=9) and 16.2% (n=11) patients, respectively. CONCLUSIONS: Although rare, diaphragmatic rupture must be suspected in any patient with thoracoabdominal injury. Early diagnosis of TDR is sometimes difficult and depends on a high index of suspicion. Surgical repair is necessary even for small tears. The most common approach is the transabdominal approach, which allows a complete exploration of the abdominal organs for associated injuries. The transthoracic approach might be used in most cases with latent diaphragmatic rupture.

[Congenital cystic adenomatoid malformation of the lung resembling bronchiectasis in an adult]. / Bronsektaziyi andiran eriskin konjenital kistik adenomatoid malformasyon olgusu.

Congenital cystic adenomatoid malformation (CCAM) of the lung is a rare anomaly which is characterized by a proliferation of dilated bronchiolar-like air spaces. It is generally seen in newborns and infants. When seen in adults, which is more uncommon, it presents itself mostly with recurrent pulmonary infections. In this article, 31-year-old man with cough and purulent expectoration and a history of recurrent pulmonary infections who had cystic changes resembling bronchiectasis at the left lower lobe on the computed tomography of the chest and diagnosed CCAM-type 2 after the histopathological examination of the left lower lobectomy specimen is presented.