Effects of topical mitomycin-C on the tracheal epithelia of rabbits following tracheostomy

Background/aim: We aimed to investigate the topical application of mitomycin-C (MMC) after the conventional tracheostomy in a rabbit model. Materials and methods: Twenty-four male New Zealand White rabbits were randomly divided among 3 equal groups (n: 8). Trache- ostomies were performed on 16 subjects. Group 1 which served as a control for all tracheal measurements. After tracheostomy, we applied sterile saline (group 2) or MMC at 0.8 mg/mL (group 3) around the tracheotomy site for 5 min. At the 3rd week after surgery, all tracheas were subjected to morphometric and histopathological examinations, including tracheal lumen diameter (LD), number of capillary vessels (CV), subepithelial tissue thickness (SETT), fibroblasts, and inflammatory cells (IC). Results: There was a statistically significant difference between the two tracheostomy groups themselves and the control group for LD (p = 0.035), CV (p = 0.006), SETT, fibroblasts, and IC (p < 0.001). Histopathological analysis showed the decreased LD, CV, SETT, IC, and fibroblasts compared to MMC with tracheostomy groups. MMC was more effective than saline for LD, CV, SETT, IC, and fibroblasts. Conclusion: Wound healing modulation may prevent scar formation. Fibrosis decreased following tracheostomy in the group treated with MMC. Fibroblasts appear to be key cells mediating these effects.

Sleep disturbances in patients with lung cancer in Turkey.

INTRODUCTION: Sleep quality is known to be associated with the distressing symptoms of cancer. The purpose of this study was to analyze the impact of cancer symptoms on insomnia and the prevalence of sleep-related problems reported by the patients with lung cancer in Turkey. MATERIALS AND METHODS: Assesment of Palliative Care in Lung Cancer in Turkey (ASPECT) study, a prospective multicenter study conducted in Turkey with the participation of 26 centers and included all patients with lung cancer, was re-evaluated in terms of sleep problems, insomnia and possible association with the cancer symptoms. Demographic characteristics of patients and information about disease were recorded for each patient by physicians via face-to-face interviews, and using hospital records. Patients who have difficulty initiating or maintaining sleep (DIMS) is associated with daytime sleepiness/fatigue were diagnosed as having insomnia. Daytime sleepiness, fatigue and lung cancer symptoms were recorded and graded using the Edmonton Symptom Assessment Scale. RESULT: Among 1245 cases, 48.4% reported DIMS, 60.8% reported daytime sleepiness and 82.1% reported fatigue. The prevalence of insomnia was 44.7%. Female gender, patients with stage 3-4 disease, patients with metastases, with comorbidities, and with weight loss > 5 kg had higher rates of insomnia. Also, patients with insomnia had significantly higher rates of pain, nausea, dyspnea, and anxiety. Multivariate logistic regression analysis showed that patients with moderate to severe pain and dyspnea and severe anxiety had 2-3 times higher rates of insomnia. CONCLUSIONS: In conclusion, our results showed a clear association between sleep disturbances and cancer symptoms. Because of that, adequate symptom control is essential to maintain sleep quality in patients with lung cancer.

Early and midterm results of single-port video-assisted thoracoscopic sympathectomy.

BACKGROUND: Video-assisted thoracoscopic sympathectomy (VATS) is the gold standard for patients with hyperhidrosis of the upper limbs. The primary aim of this retrospective study was to evaluate the midterm outcome and the degree of satisfaction of patients who underwent single-port VATS. METHODS: Forty three patients diagnosed with hyperhidrosis underwent T3, T4 VATS single-port approach, between January 2009 and May 2011. Early and midterm outcome with particular emphasis on patient satisfaction were collected by hospital chart and telephonic interview. RESULTS: The mean follow-up was 14 months. No major perioperative complication occurred except for chylothorax in a case. During the immediate postoperative period, all the patients reported palmar anhydrosis. Compensatory sweating (6.9%) and recurrence of hyperhidrosis (6.9%) are responsible mainly for dissatisfaction. No patients experienced moderate or severe chronic pain. CONCLUSIONS: Single-port VATS is a feasible and minimally invasive technique with a low incidence of chronic pain for the treatment of hyperhidrosis. A few patients may experience compensatory sweating and recurrence of hyperhidrosis. The degree of patient satisfaction with the midterm surgical results is high.

Sternal fractures: "Operative treatment" should be kept in mind.

Isolated sternal fracture is a benign condition which generally heals with conservative treatment. But sometimes surgical intervention is necessary due to pain, other organ injury and union problems. There are several ways for repair; however, the best method is not yet defined. In this report, we presented two cases who were treated surgically for different indications with different suture materials. When anatomically correction can be achieved, using suture materials is a safe and effective method.

Evaluation of rhomboid intercostal and subserratus plane block under direct vision for postoperative analgesia in thoracic surgeries: a prospective, randomized controlled trial.

OBJECTIVES: This study is designed to evaluate the efficacy of rhomboid intercostal and subserratus plane (RISS) block under the surgeon's direct vision for providing postoperative pain relief after thoracic surgeries. METHODS: Forty patients who underwent thoracotomy were prospectively recruited and randomly assigned to group R (intravenous patient-controlled analgesia + continued RISS block; n = 20) and group C (intravenous patient-controlled analgesia; n = 20). Numeric rating scale at rest and cough, at post-anaesthetic care unit, 1, 2, 6, 9, 12, 24 and 48 h, was used as the primary outcome measure. Secondary outcome measures were the amount of tramadol consumption, the number of patients required rescue analgesia, the occurrence of postoperative adverse effects, pulmonary functions and the overall satisfaction with pain management. RESULTS: Numeric rating scale scores both at rest and during coughing were significantly lower in group R than in group C at all time intervals (P < 0.001 in each). Tramadol consumption at 24 and 48 h was significantly lower in the group R block than in group C (P < 0.001 for each). None of the patients in group R requires rescue analgesia. The incidence of nausea and vomiting was similar among the groups. Compared with group C, change in lung function from baseline levels was significantly less in group R (P = 0.047 and P = 0.04 for FEV1 and FVC, respectively). The satisfaction scores in group R were significantly higher than that in group C (P < 0.001). CONCLUSIONS: Continuous RISS block improved postoperative outcomes of thoracic surgery in terms of reduced postoperative pain scores, sparing opioid consumption, pulmonary function and patient satisfaction.

Effects of flurbiprofen on CRP, TNF-α, IL-6, and postoperative pain of thoracotomy.

OBJECTIVE: The aims of this study were to evaluate serum levels of acute phase reactants, such as CRP and cytokines (TNF-α and IL-6) in patients who have undergone thoracotomy and to investigate the effects of flurbiprofen on postoperative inflammatory response. METHODS: Forty patients undergoing posterolateral thoracotomy were randomly divided into 2 groups of 20 each. Control group received tramadol (4 x 100 mg) intravenously for four days, and flurbiprofen group received both tramadol (4 x 100 mg) and flurbiprofen (2 x 100 mg). Blood samples were collected before surgery and at the 3th and 168th hours after surgical procedure to measure serum CRP, IL-6, and TNF-α. Pain visual analog scales were recorded daily during the first four postoperative days. Spirometric measurement of forced expiratory volume in the first second (FEV 1) was done before and four days after the operation. RESULTS: The serum CRP, IL-6, and TNF-α levels in both groups increased significantly at 3th hour after thoracotomy. Serum TNF-α levels did not differ significantly between the groups at postoperative 4th day. However, IL-6 and CRP were significantly lower in flurbiprofen group than in control group at the same day (p < 0.05). Visual analog scale was significantly lower in flurbiprofen group at 6th, 12th, 48th, 72th, and 96th hours postoperatively (p < 0.05). The patients receiving flurbiprofen had higher FEV 1 values when compared with control group at postoperative 4th day. CONCLUSIONS: Patients undergoing thoracotomy showed reduced postoperative pain, mean additional analgesic consumption, and serum IL-6 and CRP levels, when flurbiprofen was added to systemic analgesic therapy. Analgesia with anti-inflammatory drug may contribute to the attenuation of the postoperative inflammatory response and prevent postoperative pain in patients undergoing thoracotomy.

Management of tracheal stenosis after corrosive acid ingestion: A case report.

Although corrosive injury of the digestive tract is a well-known clinical entity, damages of the airway and a critically life-threatening condition, have not been clearly documented. Tracheal stenosis is very rare associated with corrosive acid ingestion. We report the case of a 4-year-old girl child who presented to the emergency department three weeks after accidentally drinking an acidic cleaning agent stored in an unlabeled bottle. Rigid bronchoscopy was administered to observe the stenosis. She was treated by serial dilation, repair of tracheal laceration, and placement of a temporary polyurethane-coated nitinol stent. Careful and accurate stent placement may provide significant and life-saving airway improvement as observed in the presenting pediatric case.

Does the use of postoperative low-molecular-weight heparin in patients with lung cancer increase tube drainage?

BACKGROUND: The objectives of this study are to assess the chest drainage volumes of patients undergoing anatomic resection of non-small cell lung carcinoma and to determine the safety and effectiveness of administering enoxaparin for thromboprophylaxis. METHODS: A total of 77 patients were included in the study. A study was conducted on the first group of 42 patients in which enoxaparin prophylaxis (enoxaparin, 40 mg) was subcutaneously injected once a day for a period of three days after the patients underwent anatomic pulmonary resection between March 2016 and March 2018. An enoxaparin-free group was identified and included 35 patients who received no enoxaparin prophylaxis after undergoing anatomic pulmonary resection between February 2013 and February 2016. We compared the changes in hemoglobin (Hb) levels, postoperative 3-day drainage volume, transfusion volume, pulmonary complications and length of stay between the two groups. RESULTS: No differences in postoperative Hb levels, chest drainage volume, transfusion volume, postoperative complications, and length of stay were observed between the two groups. Deep-vein thrombosis was noted in a patient in the enoxaparin-free group. No major bleeding was noted in either group. CONCLUSION: We found that for patients undergoing anatomic resection of primary lung cancer, the blood transfusion and chest drainage volumes did not differ, regardless of whether the patients were given enoxaparin. To the best of our knowledge, the impact of low-molecular-weight heparin on chest tube drainage volume for patients undergoing anatomic resection of non-small cell lung carcinoma has not been investigated before.

Pleural fluid penetration of moxifloxacin and doripenem: An experimental model of empyema.

OBJECTIVE: This study aimed to evaluate the penetration of moxifloxacin and doripenem into the pleural fluid (PF) using a rabbit model of empyema. METHODS: An empyema was induced using the intrapleural injection of turpentine (1 mL), followed 24 h later by instillation of 5 mL Klebsiella Pneumoniae (ATCC 33495), Fusobacterium nucleatum (ATCC 25586) and Streptokok Pneumoniae (ATCC 6305) into the pleural space. After an empyema was corroborated, Moxifloxacin (25 mg/kg-1) and Doripenem (20 mg/kg-1) were administered intraperitoneally. To determine the levels of antibiotics measured by High-Performance Liquid Chromatography in pleural and blood samples were obtained serially at 8, 24, 48 and 72nd hour. RESULTS: The penetration of both antibiotics into the PF was very good. The penetration rate of doripenem (area under the curve (AUC) for PF/blood (AUCPF/AUCblood) ratio=1.68) was better than moxifloxacin (ratio=0.78). Equalization time between the PF and blood concentration of doripenem was more quickly than moxifloxacin. Peak PF concentration of moxifloxacin was 0,81 µg/mL-1 and occurred 8 h after infusion and then gradually decreased; at the beginning of the blood and pleural fluid concentrations of doripenem were equal. While the pleura concentration was increasing, blood concentration was almost the same. Doripenem reached a peak concentration (0.54 µg/ml) 24 h post-administration. CONCLUSION: Differences were found in the penetration of the two antibiotics. Doripenem had convenient penetration PF compared to moxifloxacin. Due to the differences between human and rabbit pleural thickness, doripenem's pleural penetration should be examined in infection models in animals with equal pleura thickness and clinical trials.

Effectiveness of autologous blood injection in reducing the rate of pneumothorax after percutaneous lung core needle biopsy.

PURPOSE: To assess the effectiveness and safety of autologous intraparenchymal blood patch (IBP) application in reducing the frequency of pneumothorax (PTX) after percutaneous transthoracic pulmonary core needle biopsy. METHODS: The records of patients who underwent the transthoracic pulmonary core needle biopsy procedure under CT guidance between January 2015 and October 2018 were screened retrospectively. Patients whose traversed pulmonary parenchymal length was ≥20 mm during biopsy were included in the study irrespective of lesion size. The IBP procedure was made a department policy in November 2017; patients who underwent biopsy after this date comprised the IBP group, while those who underwent the procedure before this date comprised the control group. IBP recipients received 2-5 mL of autologous blood injection to the needle tract. Demographic data, procedural reports, tomography images, and the follow-up records of patients were assessed. RESULTS: A total of 262 patients were included in the study. Of the 91 patients that received an IBP, PTX developed in 13 (14.1%), with 7 (7.7%) requiring a thoracic tube. Of the 171 patients who did not receive an IBP, PTX developed in 45 (26.3%), with 19 (11.1%) requiring a thoracic tube. Patients who received an autologous IBP showed a significantly lower rate of PTX development versus those who did not (P = 0.01). Similarly, a significantly lower number of patients who received the blood patch required chest tube placement (P = 0.015). CONCLUSION: Autologous IBP is a safe, inexpensive and easy to use method that reduces the rate of PTX development and thoracic tube application after percutaneous core needle biopsies of the lung.

The effect of low-intensity pulsed ultrasound on rib fracture: An experimental study.

BACKGROUND: In this study, we aimed to investigate the effects of lowintensity pulsed ultrasound on rib fracture healing in a rat model. METHODS: A total of 72 male Wistar-Albino rats were randomly divided into three equal groups. To induce a rib fracture, right thoracotomy was performed under general anesthesia and a 0.5-cm segment was removed from the fourth and fifth ribs. After 24 h of surgery, low-intensity pulsed ultrasound was implemented according to the groups. Group 1 served as the control group for the observation of normal bone healing. Low-intensity pulsed ultrasound was applied at a dose of 20% (2 msn pulse-8 msn pause) 100 mW/cm2 and 50% (5 msn pulse-5 msn pause) 200 mW/cm2 for six min, respectively in Group 2 and Group 3. All subjects were followed for six weeks. Eight animals from each group were sacrificed at two, four, and six weeks for further assessment. Histological alterations in the bone were examined. RESULTS: Although there was no statistically significant difference in osteoblasts, osteoclasts, new bone formation, and lymphocyte count among the groups, histological consolidation was significantly increased by low-intensity pulsed ultrasound. While low-intensity pulsed ultrasound induced osteoblastic, osteoclastic, and new bone formation, it inhibited lymphocyte infiltration. CONCLUSION: Low-intensity pulsed ultrasound, either at low or high doses, induced the histological consolidation of rib fractures and inhibited lymphocyte infiltration. This effect was more prominent in the long-term and at higher dose with increased daily and total administration time. We, therefore, believe that accelerating the natural healing process in patients with rib fractures would enable to treat more effectively in short-term.

Surgical treatment and outcome of pulmonary hamartoma: a retrospective study of 10-year experience.

BACKGROUND: The present retrospective study was designed to review the clinicopathological features and outcome of surgical treatment of pulmonary hamartoma who underwent surgical operation between January 2008 and January 2018. METHODS: The information about the age and gender of patients, symptoms, history of tobacco consumption, the presence of malignancies, radiological and imaging findings, calcification in the hamartoma, location and size of the lesions, findings of preoperative diagnostic investigations, operative procedures, operative time, tube drainage duration, surgical complication, hospital stay after tumor resection, duration of follow-up, and outcome were recorded. RESULTS: The average size of the neoplasms was 2.72 cm. Five patients (20.8%) had malignancies, which occurred previously in two patients, and concomitantly in three patients. Twenty-four patients underwent surgical treatment which included enucleation in 14 (four cases had thoracoscopic surgery), wedge resection in 8 (six cases had thoracoscopic surgery), and lobectomy in 2 patients. A total of four postoperative complications were noted. The patients were followed up for 2-98 months. CONCLUSION: Enucleation was the main choice in our series. The follow-up for a long period revealed no malignant transformation and recurrence. Due to lack of the malignance after operation in our series, we presumed that the enucleation for pulmonary hamartoma was safe enough.

High levels of oxidative stress in patients with advanced lung cancer.

BACKGROUND AND OBJECTIVE: The aim of this study was to investigate oxidative stress status in different stages and histological types of lung cancer. METHODS: Forty-nine lung cancer patients, who had not received any therapy, and 20 healthy subjects were chosen for the study. Lung cancer patients were divided into those with early stage or advanced stage disease. The tumour type was adenocarcinoma in 24 patients, squamous cell carcinoma in 21 and large cell carcinoma in four. We measured serum nitrite, nitrate, ascorbic acid, retinol, beta-carotene and ceruloplasmin levels, and whole-blood malondialdehyde, reduced glutathione levels and catalase activity in patients with non-small cell lung carcinoma and healthy subjects. RESULTS: Statistically significant differences between the patient group and the control group were detected for all biochemical parameters. Mean malondialdehyde, nitrite, nitrate and ceruloplasmin levels and catalase activity were significantly higher in the group with advanced stage disease than in the control group. Mean beta-carotene, ascorbic acid and reduced glutathione levels were significantly lower in the group with advanced stage disease than in the control group. Mean malondialdehyde and nitrite levels were significantly higher in the patients with squamous cell carcinoma than in those with adenocarcinoma, and mean malondialdehyde level was also significantly higher in patients with squamous cell carcinoma than in those with large cell carcinoma. CONCLUSIONS: These results suggest that with advancing stage of lung cancer, the levels of oxidative stress increase, while levels of antioxidant molecules decrease. Patients with squamous cell carcinoma have higher oxidative stress as reflected by higher levels of malondialdehyde and nitrite.

The factors affecting persistent pneumothorax and mortality in neonatal pneumothorax.

The aim of this study was to present our experience in management of neonatal pneumothorax and factors contributing to persistent pneumothorax and mortality. Forty-two newborns were analyzed according to gestational age, birth weight, Apgar score, age of admittance, type of delivery, mother's age, side of pneumothorax, causes of pneumothorax, accompanying disorders, tube thoracostomy and mechanical ventilation durations, mean hospital stay, and deaths. Sixteen patients (38%) weighed less than 2500 g and 28 (66%) were preterm. The mean Apgar score at 5th minute was 6.2 (2-10). The pneumothorax was bilateral in 9 patients (21%). There was a defined underlying lung pathology in 26 (61%) patients and accompanying disorder in 14 (33%). Mean tube thoracostomy duration was 5 days (2-12). Twenty-five patients (59%) needed mechanical ventilation. Overall 10 babies died. Our findings indicated that underlying primary lung pathology, need for mechanical ventilation, and bilateral pneumothorax were major determinants of persistent pneumothorax and mortality in newborns.

Effectiveness of gabapentin in the treatment of chronic post-thoracotomy pain.

BACKGROUND: Chronic post-thoracotomy pain (CPTP) consists of different types of pain. Some characteristics of CPTP are the same as those of recognized neuropathic pain syndromes. OBJECTIVE: We aimed to determine the safety and efficacy of gabapentin (GP) in comparison to naproxen sodium (NS) in patients with CPTP. METHODS: Forty consecutive patients with CPTP after posterolateral/lateral thoracotomy were prospectively evaluated. Twenty patients were given GP and another 20 were given NS treatment. Visual Analogue Scale (VAS) and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scorings were performed pretreatment (day 0) and on the 15th, 30th, 45th and 60th days. Adverse events were questioned. The mean ages were 45.7+/-14.9 and 49.8+/-15.2 years and the mean durations of pain were 3.8+/-0.9 and 3.8+/-1.1 months, respectively. RESULTS: The mean pretreatment VAS scores (VAS0) were 6.4+/-0.6 and 6.8+/-0.6, the mean pretreatment LANSS scores (LANSS0) were 18.85+/-1.6 and 20.75+/-2.6 in GP and NS groups, respectively (p>0.05). Minor adverse events which did not mandate discontinuation of treatment were observed in seven patients (35%) in the GP and in four patients (20%) in the NS group. The number of patients with a VAS score <5 at the latest follow-up (VAS60 < 5) was 17 (85%) and 3 (15%) in GP and NS groups, respectively (p<0.001). Seventeen patients (85%) in the GP and 0 patients (0%) in the NS group had a LANSS score <12 at the latest follow-up. CONCLUSION: Gabapentin is safe and effective in the treatment of CPTP with minimal side effects and a high patient compliance. These results should be supported with multidisciplinary studies with larger sample sizes and longer follow-ups.

Using 99mTc-DTPA radioaerosol inhalation lung scan as compared with computed tomography to detect lung injury in blunt chest trauma.

BACKGROUND: Detection of pulmonary contusion in patients with blunt chest trauma is very important so as to commence therapy immediately to avoid irreversible damage. The purpose of our study was to evaluate the efficacy of technetium-99m diethylene triamine pentaacetic acid (99mTc-DTPA) aerosol inhalation lung scintigraphy in comparison with chest computed tomography (CT) in the diagnosis of pulmonary contusion at acute blunt chest trauma. METHODS: Twenty-nine patients with isolated blunt chest trauma were referred to the emergency department of our hospital, and nine healthy people participated in this study. Sixteen patients who had pulmonary contusion on CT scans were referred to as group 1, and 13 patients who had normal CT scans as group 2. Nine healthy people comprised a control group. 99mTc-DTPA aerosol inhalation lung scintigraphy was performed on the first day in all patients. RESULTS: The mean half time (T1/2) and penetration index values of 99mTc-DTPA clearance were significantly lower in groups 1 and 2 compared with the control group. Among the three groups, there were no significant differences in arterial blood gas analysis except for PO2. The mean T1/2 value of 99mTc-DTPA clearance did correlate with PO2 values but not with pH, PCO2, or HCO3 values. CONCLUSIONS: 99mTc-DTPA radioaerosol inhalation lung imaging may serve as a useful adjunct and supportive method to chest CT scanning for detecting mild pulmonary contusion.

Effect of octenidine dihydrochloride on viability of protoscoleces in hepatic and pulmonary hydatid diseases.

BACKGROUND: Use of effective scolicidal agents during puncture, aspiration or injection of a scolicidal agent and reaspiration (PAIR) and surgery for hydatid cysts are essential to reduce the recurrence rate. In this in vitro study, we tried to determine the scolicidal property of a new agent, octenidine dihydrochloride, and of various agents in different concentrations and exposure times. MATERIAL AND METHODS: Echinococcus granulosus protoscoleces were obtained from six patients with liver (n=3) and lung (n=3) hydatid cysts. Various concentrations of octenidine dihydrochloride (0.1%, 0.01% and 0.001% diluted form), povidone iodine (10%, 1% and 0.1% diluted) and 20% saline were used in this study. Viability of protoscoleces was determined with dye-uptake (0.1% eosin) and flame cell activity. RESULTS: Octenidine dihydrochloride 0.1% had strong scolicidal effect in 15 min and octenidine dihydrochloride 0.01% in 30 min. Sixty percent of protoscoleces lost viability at 5 min with octenidine dihydrochloride 0.1%. Viability ratio decreased to 20% at 10 min, and all of them died at 15 min. Povidone iodine 10% and 1% had strong scolicidal effects after 15- and 30 min of exposure, respectively. Saline 20% killed all the protoscoleces in 30-min exposure. CONCLUSION: Because of the rapid and strong scolocidal effectiveness of octenidine dihydrochloride on protoscoleces, it may be used as a scolocidal agent during both perioperative and in the PAIR method.

Acute effects of environmental tobacco smoke and dried dung smoke on lung histopathology in rabbits.

AIMS: To compare the effects of cigarette smoke and dried dung smoke exposure on the histopathology of lungs. METHODS: Three groups each with five rabbits were formed. The cigarette smoke group was exposed to cigarette smoke, the biomass group was exposed to dried dung smoke and the control group was exposed to dry air 1 hour daily for 1 month. At the end of 1 month, animals were sacrificed and lung tissues were examined histopathologically. RESULTS: Histopathological evaluation of rabbits' lungs revealed that intraparenchymal vascular congestion and thrombosis, intraparenchymal haemorrhage, respiratory epithelial proliferation, number of macrophages in the alveolar and bronchial lumen, alveolar destruction, emphysematous changes and bronchoalveolar haemorrhage scores were significantly increased in rabbits exposed to cigarette smoke compared with the control group. Respiratory epithelial proliferation, alveoli destruction and emphysematous change scores were significantly increased in rabbits exposed to dried dung smoke compared with the control group. CONCLUSION: Although less than the effects of cigarette smoke, dried dung smoke had severe histopathological effects on rabbits' lungs.

Effect of lung ischemia--reperfusion on oxidative stress parameters of remote tissues.

OBJECTIVE: Ischemia-reperfusion injury induces a systemic inflammatory response and production of reactive oxygen species, which potentially can be more detrimental than its local effects. Although the lung injury that is formed by the effects of ischemia-reperfusion injury on remote organs has been previously studied, no previous study that investigated the effects of pulmonary ischemia-reperfusion injury on remote organs has been considered. We hypothesized that the lung ischemia-reperfusion injury may cause the spread of inflammation to remote organs such as liver and heart. METHODS: Thirty New Zealand white rabbits were subjected to either sham operation or lung ischemia-reperfusion injury in various periods of time (60 min ischemia-60 min reperfusion and 120 min ischemia-60 min reperfusion, respectively). Pulmonary, myocardial and hepatic myeloperoxidase, protein sulfhydryl, thiobarbituric acid-reactive substances, and protein carbonyl levels were evaluated to show pulmonary, hepatic, and myocardial responses to lung ischemia-reperfusion injury. RESULTS: Reperfusion after 60 min of lung ischemia led to increased myeloperoxidase and protein carbonyl levels and decreased protein sulfhydryl groups in pulmonary tissue, increased myeloperoxidase and decreased protein sulfhydryl groups in hepatic tissue, and increased myeloperoxidase, thiobarbituric acid-reactive substances and protein carbonyl levels in myocardial tissue. Reperfusion after 120 min of lung ischemia led to increased thiobarbituric acid-reactive substance levels in pulmonary tissue, increased protein carbonyl and thiobarbituric acid-reactive substance levels in hepatic tissue, and decreased protein sulfhydryl groups in myocardial tissue. CONCLUSIONS: The data of the present study suggests that pulmonary ischemia-reperfusion induces liver and heart injury characterized by activated neutrophil sequestration and release of significant amounts of reactive oxygen species. The remote organ injury has to be kept in mind when performing a lung intervention or surgery and care should be taken to protect other organs remote from ischemia-reperfusion site.