Stenotrophomonas maltophilia Pseudo-outbreak at a University Hospital Bronchoscopy Unit in Turkey.

OBJECTIVE: Stenotrophomonas maltophilia is an opportunistic pathogen found predominantly in the environment and hospital setting. Invasive procedures and treatment methods, instruments used for diagnosis and irrational antibiotic use play major roles in the spread of this pathogen. The study aimed to evaluate consecutive S maltophilia isolation from bronchoalveolar lavage samples during bronchoscopy procedure during a week. METHODS: Four patients consecutively had S maltophilia isolated during bronchoscopy between September 8 and 15, 2012. The identification of the isolates and their antibiotic susceptibility were studied by automated Vitek version 2.0 (Biomerieux, France) system. The clonal relationship between the isolates was studied by enterobacterial repetitive intergenic consensus (ERIC) polymerase chain reaction (PCR). RESULTS: Four consecutive S maltophilia isolates had identical band patterns and showed clonal relatedness. CONCLUSION: Bronchoscopy is a common invasive procedure that is utilized in chest diseases departments and intensive care units (ICUs). Contamination may take place due to inappropriate use and cause spread of infectious pathogens. In the current study, we detected consecutive S maltophilia strains with identical band patterns isolated within a week. After appropriate disinfection and cleaning procedures, no further isolation was detected.

The effects of neoadjuvant chemotherapy on pulmonary structures: a quantitative analysis.

BACKGROUND: The effects of neoadjuvant therapy on perioperative and postoperative outcomes of patients with stage IIIA non-small cell lung cancer remain controversial. We investigated histopathological changes possibly caused by neoadjuvant chemotherapy and their effect on the tensile forces of pulmonary structures. METHODS: A prospective study of 30 patients who had undergone lung resection was performed. The patients were divided into two groups. Group 1 included those who received neoadjuvant chemotherapy, and Group 2 included those who underwent surgery alone. Tensile stress tests were performed on freshly excised vascular and bronchial strips after lung resection. The pulmonary artery, veins, and bronchi that had not been invaded by the tumor were histopathologically examined in both groups. Intraoperative and postoperative complications were recorded. RESULTS: This study showed that the tensile strength of pulmonary vessels and bronchi was less in the neoadjuvant group than in the control group. There were statistically significant differences in the tissue strips obtained from arteries, veins, and bronchi between the two groups. In the chemotherapy group, most cases exhibited extensive fibrosis. There was no statistically significant difference in complications between the groups. CONCLUSIONS: Neoadjuvant chemotherapy did not increase postoperative morbidity or mortality. The decreased tensile strength of pulmonary vessels and bronchi after neoadjuvant therapy should alert thoracic surgeons to possible surgical complications.

[Functional results of surgical treatment of bronchiectasis in a developing country]. / Resultados funcionales del tratamiento quirúrgico de las bronquiectasias en un país en vías de desarrollo.

BACKGROUND: The prevalence of bronchiectasis has decreased significantly over recent decades in developed countries. However, resection for bronchiectasis still plays an important part in thoracic surgery practice in developing countries such as Turkey. This study was designed to evaluate the outcomes of surgical treatment for bronchiectasis, particularly in aspects related to the effects on functional well-being. PATIENTS AND METHOD: From January 1995 through December 2003, operations for bronchiectasis were performed in 81 patients. Demographic features, type of resection, and operative morbidity and mortality were evaluated. The outcomes related to overall "social" or nonpulmonary functional status were classified and compared according to a scale constructed to assess patients' well-being preoperatively and at the 6th postoperative month. RESULTS: The mean age was 24.4 years and 47 patients (58%) were male. Surgical treatment was lobectomy in 37 (45%), pneumonectomy in 10 (12%), segmentectomy in 13 (16%), and lobectomy plus segmentectomy in 22 (27%) of the operations. Complete resection of disease was achieved in 69 patients (85%). There was no operative mortality. The rate of morbidity was 18.3%. Improvement to a functional status of excellent was observed in 81.7% and improvement to a status of good was seen in 12.7% of patients; 5.6% experienced no change. The results of complete resection were significantly better than those of incomplete resection (P=.0015). CONCLUSION: Functional results of surgical treatment for bronchiectasis in this series suggest that the outcomes are favorable and promising, particularly in selected patients with sufficient pulmonary reserves and localized disease who are suitable for complete resection.

[Thoracic trauma: analysis of 987 cases]. / Gögüs travmalari: 987 olgunun analizi.

In Izmir Chest Diseases and Thoracic Surgery Training Hospital, Department of 1st Thoracic Surgery, between 1988 and 1998, 987 patients who were treated for their chest trauma were retrospectively reviewed in regard to their age, sex, cause of trauma, associated organ injuries, treatment modality, complication rate and mortality. In 710 (72%) cases of chest injuries were related to blunt trauma and 277 (28%) patients sustained penetrating trauma. 402 (41%) patients underwent tube thoracostomy only. While majority of patients (553 pts, 56%) were managed conservatively, only 32 (3%) underwent thoracotomy. Complication rate in our series was 4.6% and the most frequently atelectasis was seen. 13 patients died due to trauma related causes (mortality: 1.3%). There was no difference between blunt and penetrating trauma patients in view of morbidity and mortality rates (p = 0.29 and p = 0.10, respectively). Mean hospital stay among all patients was 9.6 +/- 8.6 days. This period was 10.0 +/- 8.5 days in blunt trauma group, and 8.4 +/- 8.6 days in penetrating trauma group. However this difference has reached statistical significance at a p value of 0.0068.