Effectiveness of the polyglycolic acid patch in preventing prolonged air leakage after pulmonary decortication.

AIM: This study aimed to investigate the effectiveness of an absorbable polyglycolic acid patch (PGA) in the early prevention of alveolar air leaks after pulmonary decortication operations. METHODS: Between January 2016 and December 2019, files of 185 patients with pleural effusion, empyema, or hemothorax were examined retrospectively. Thirty-five patients who underwent decortication surgery were included in the study. Two-way posteroanterior (PA) chest x-ray, computed tomography (CT), pulmonary function tests (PFT), arterial blood gas, hemogram, and biochemical tests were performed for all patients before the operation. The patients were divided into two groups. Group 1 was composed of 16 patients (45.7%) with standard decortication, and Group 2 was formed with 19 patients (54.3%) with standard decortication + PGA patch. RESULTS: The median age was 55 years (minimum = 25, maximum = 75) and the vast majority (82.9%; n = 29) of patients were males. There was no significant difference between groups in age, aetiology, or sex. The most common etiological cause in both Group 1 and Group 2 was nonspecific infection (56.3% and 73.7%, respectively). When Group 2 and Group 1 were compared regarding median times (day) of air leak cessation (Group 2 = 4; Group 1 = 8.5), chest drain removal (Group 2 = 5; Group 1 = 10), and hospital discharge times (Group 2 = 8; Group 1 = 13),the durations were statistically significantly shorter in Group 2 than in Group 1 (P < 0.001). CONCLUSION: Use of the PGA patch in pulmonary decortication operations significantly reduced the duration of air leaks, drain removal, and discharge time from the hospital in the postoperative period.

The Use of Visual Analogue Scale Score as a Predicting Tool in Differentiating Renal Colic From Lumbar Back Pain.

Introduction Renal colic is often confused with low back pain (LBP) and other pathologies. Computed tomography (CT) is frequently used to reach a definitive diagnosis, but its use increases the exposure to radiation. Researchers have tried to predict urinary stones in patients presenting with flank pain. Several scoring systems have been introduced; however, none of them provide a prediction based on the physical examination of the patient upon initial presentation to the outpatient clinic. In this study, we aimed to investigate whether we can predict the presence of stone with visual analogue scale (VAS) questionnaire during the first admission. Materials and methods Patients with complaints of flank pain were started to be followed for three months in our urology clinic. After the definitive diagnosis was made the patients were classified into two groups: renal colic group (group 1; n=36) and the LBP group (group 2; n=30). Results In logistic regression analysis, the possibility of renal colic increased 5.4 times more per one-unit increase in the VAS score. In receiver operating characteristic (ROC) analyses, when the VAS was 4.5, the diagnosis of renal colic could be made with 88% sensitivity and 71% specificity. Conclusion If the VAS score is ≤ 4 in patients that have flank pain without limitation of movement, it is more likely to manage these patients with a simple medical treatment plan. In these patients, unnecessary ultrasonography (US) scans be reduced by 86.3% and unnecessary CT scans by 88.8%. A VAS score of ≥5 should warn the clinician about the necessity of routine urinary stone examinations.

Re-determination of upper reference range of follicular stimulating hormone in infertile men.

FSH in infertile patients may be measured in the normal range and abnormal semen analysis findings may be observed in patients with normal FSH values. A recent study predicts that the sperm morphology and concentration may be impaired if the FSH value is above 4.5 IU/L. Therefore, this study aimed to define a clinically more useful upper limit for FSH as an indicator for male infertility. In this study 1,893 infertile male patients were evaluated retrospectively. Physical examination, hormone analysis (total testosterone (TT), FSH, luteinizing hormone (LH), estradiol (E2), sex hormone binding globulin (SHBG) and prolactin (PRL)), semen analyzes were recorded and analyzed retrospectively. Logistic regression analysis, 95% confidence intervals and probability ratios were calculated to show the relationship between categorical hormone levels (quarters) and semen parameters. Hormone levels were categorized using the distribution quarters in the study population. FSH values of 62% of the cases with sperm concentration <15 million/ml were greater than 4.8 IU/L. 59.7% of patients with sperm count <39 million had FSH values greater than 4.8 IU/L. In conclusion, FSH values above 4.8 IU/L were found to be abnormal when the male factor was investigated for infertility. ABBREVIATIONS: FSH: Follicular Stimulating Hormone; GnRH: Gonadotropin-releasing Hormone; HPGA: Hypothalamic-Pituitary-Gonadal Axis; TT: Total Testosterone; LH: Luteinizing Hormone; E2: Estradiol; SHBG: Sex Hormone Binding Globulin; PRL: Prolactin; WHO: World Health Organization; AUC: Area Under the Curve.

Diagnosis and prognosis of traumatic pulmonary pseudocysts.

PURPOSE: Traumatic pulmonary pseudocysts (TPP) are rarely talked about, developing in less than 3% of patients with pulmonary parenchymal injuries. Resolution usually occurs within a few weeks to a few months. METHODS: A retrospective study was undertaken in 30 cases treated in Antalya Training and Research Hospital, Turkey, from January 2014 to December 2017. RESULTS: The 30 patients with TPP were 28 males (93.3%) and 2 females (6.7%) aged 14-64 years (mean age 31.9 years). Most of them are located in the right lower lobe (50%). The mean size of TPP was 2.07 cm. The overall resolution time for TPP was found to range from 8 to 124 days with a mean of 45.1 ± 32.9 days. CONCLUSIONS: Computed tomography (CT) is a more beneficial than chest radiograph for early diagnosis. Physicians should control follow-up chest radiograph or CT scans until the pseudocyst resolves. Conservative treatment is acceptable in most cases, but intervention may be necessary if complications show up.

Comparison of ultrasonography and computed tomography in the determination of traumatic thoracic injuries.

OBJECTIVE: In this study, the accuracy of bedside thoracic ultrasonography (TUSG) performed by emergency physicians with patients in the supine position was compared with that of thoracic computed tomography (TCT) for the determination of thoracic injuries due to trauma. METHODS: Patients who suffered the multiple traumas, whose thoracic trauma was identified on physical examination or TCT imaging were included in the study. TUSG was performed following a physical examination by the emergency physician who managed the trauma patient. Subcutaneous emphysema, pneumothorax, pulmonary contusions (PCs), hemothorax, pericardial effusion and tamponade, sternal and clavicular fractures and rib fractures were identified by TUSG. TCT imaging was performed after the ultrasonography examination was completed. RESULTS: Eighty-one patients were included in the study. TCT scans showed subcutaneous emphysema in 16 (19.8%) patients, pneumothorax in 21 (25.9%), PCs in 27 (33.3%), hemothorax in 20 (24.7%), sternum and clavicular fractures in 6 (7.4%) and rib fractures in 21 (25.9%). The sensitivity and specificity of ultrasonography varied for detecting the following pathologies: subcutaneous emphysema (56% and 95%), pneumothorax (86% and 97%), hemothorax (45% and 98%), PCs (63% and 91%), sternal fractures (83% and 97%), clavicular fractures (83% and 100%) and rib fractures (67% and 98%), respectively. CONCLUSION: In conclusion, ultrasound was found to be highly specific but only moderately sensitive for the identification of thoracic injuries.

Minimally invasive repair of pectus carinatum by modification of the Abramson technique.

INTRODUCTION: The minimally invasive pectus carinatum surgery described by Abramson has been performed in many centers. We modified the "sub-muscular tunnel creation" part of the original Abramson technique. AIM: To compare the operative time between the original Abramson technique and a lightly modified approach. MATERIAL AND METHODS: A retrospective review of 84 patients who underwent minimally invasive repair of pectus carinatum deformity between July 2008 and November 2017 was performed. We applied two different techniques, the original Abramson technique and the modified technique. Sixty-eight patients - 49 (72%) males and 19 (28%) females - underwent minimally invasive repair of a pectus carinatum deformity as described by Abramson (Abramson group). Sixteen patients - 13 (81%) males and 3 (19%) females - were operated on by our modified Abramson technique at our institution (Modified group). RESULTS: Eighty-four patients were included in this study: 68 patients from the Abramson group and 16 patients from the Modified group. There was no significant difference between the groups with respect to preoperative demographic features, including median age and sex. Median operative time was significantly shorter in the Modified group than the Abramson group (43 min, range: 32-54 min) in the Modified group vs. 30 min (range: 20-35 min) in the Abramson group (p < 0.001). CONCLUSIONS: This article describes a modification of a surgical technique that is safely and easily used in minimally invasive correction of pectus carinatum deformities, with minimal complications, high satisfaction rates and shorter operative time.

Minimally invasive repair of pectus carinatum: a retrospective analysis based on a single surgeon's 10 years of experience.

OBJECTIVES: Over the past decade, minimal invasive surgery for correction of pectus carinatum has gained worldwide acceptance. This study reviews our clinical experience with minimally invasive repair of pectus carinatum (MIRPC) since 2008. METHODS: Between 2008 and 2018, 101 patients (77 male, 24 female) underwent correction of pectus carinatum with the MIRPC technique. The mean age of the patients was 14.7 ± 4.8 (3-38) years. Over an 8 years' experience we slightly modified the original Abramson technique. All patients presented with cosmetic complaints and all had a flexible chest wall on "compression test". Early follow-up was on postoperative day 15 and 30. RESULTS: The mean operative time was 42.1 ± 16.9 min. The mean hospital stay was 4.2 ± 0.9 days. Postoperative complications included pneumothorax (n = 2, 1.9%), wound infection (n = 2, 1.9%), skin perforation (n = 2, 1.9%), intolerable pain (n = 1, 0.9%), skin hyperpigmentation (n = 1, 0.9%), and overcorrection (n = 1, 0.9%). Initial postoperative results were excellent in all patients. The bars were removed at a median of 24.8 ± 4.5 months in 44 of 101 patients. 43 of 44 (97.7%) patients whose bar were removed reported excellent results. CONCLUSIONS: MIRPC is a feasible procedure with low morbidity and excellent cosmetic results in the treatment of pectus carinatum deformities in selected patients.

The case study in the applicability of the improvements in the treatment of urinary system stone diseases in Anatolia: the last ten years with the sample of Western Black Sea region.

OBJECTIVE: The prevalence of stone diseases is high in Turkey. Thanks to the technological improvements and to the increase in the number of qualified and experienced specialists in the last thirty years, there has been an increase in the application of minimally invasive methods in the stone disease surgery. This study, with a sample survey of Western Black Sea region, aims at revealing the changes and improvements in the treatment of stone diseases in different centers in Anatolia within the last ten years. MATERIAL AND METHODS: Six centers in 4 of the provinces of the Western Black Sea Region were selected and the patients' files were retrospectively analyzed. The treatment methods that were recommended for and/or applied to the patients diagnosed with urinary stone diseases were recorded by years. The urinary stone diseases were divided into three separate groups; kidney, ureters and bladder. Treatment options were recorded into categories as open surgery, percutaneous nephrolithotripsy, retrograde intrarenal surgery, semirigid ureterorenoscopy, flexible ureterorenoscopy, and ESWL. RESULTS: A total of 26044 patients with stone diseases have been treated in the above-mentioned centers for the last 10 years. The distributions of the stone diseases in relation to their localization were as follows: - kidney stones: 9040 (34.7%), ureter stones: 15264 (58.6%), and bladder stones: 1740 (6.7%). As for the distribution of the treatment in relation to the treatment methods, it was seen that open surgery for 1032 (4%) patients, endoscopic surgery for 15038 (58%) patients, and ESWL for 9974 (38%) patients had been applied. While URS and PCNL are currently the commonly used treatment methods in the Western Black Sea Region, RIRS has begun to be used in a limited number of patients for the last 3 years. CONCLUSION: Though being a little late, the advances in endrourology offer practical applications in the Western Black Sea region as well. Although this study suggests implications for the evaluating of the periphery outcomes of the improvements in stone disease treatments, for the planning of training schemes, and for equipment planning, further research based on more data from more centers is needed to have a nation-wide perspective.

An unusual recurrent bilateral posterior mediastinal goiter after subtotal thyroidectomy: Case report.

INTRODUCTION: Surgical treatment of benign thyroid diseases need to be followed up closely, since recurrent thyroid nodules can be seen after subtotal thyroidectomy. Intrathoracic goiter (ITG) occurs in 10-30% of patients following subtotal thyroidectomy. In general these goiters are benign, having a malignant rate of only 2-22%. ITG grows slowly but steadily and in its process of development, it narrows the thoracic inlet by compressing the surrounding structures. Most of these can not located in the anterior mediastinum, others located in posterior retrovascular area. Bilateral posterior retrovascular goiters are very rare. PRESENTATION OF CASE: We report a case involving a 61-year-old woman with history of gradual-onset dyspnea who was referred to us for evaluation of a large mediastinal mass. She had undergone bilateral thyroid lobectomy for a cervical goiter 10 years ago. The mass was removed successfully via median sternotomy without complication. The patient recovered well and was discharged in 1 week. DISCUSSION: Most anterior mediastinal goiters can be resected through a transcervical approach, but if those extending beyond the aortic arch into the posterior mediastinum are better dealt with by sternotomy or lateral thoracotomy. CONCLUSION: Bilateral recurrent posterior mediastinal and retrovascular large goiters are better resected via sternotomy rather than lateral thoracotomy. The reason for that are the possibility of injury to large vascular structures and the difficulty of their management through lateral thoracotomy when cardiopulmonary bypass needed.

Can serum inflammatory parameters estimate outcome of pleurodesis in mesothelioma?

BACKGROUND: As pleurodesis causes systemic inflammation and is associated with considerable cost and morbidity during long-term follow up, the identification of patients who will experience an unsuccessful pleurodesis would be desirable. This study was aimed to investigate whether systemic inflammatory reaction induced by insuflation of talc into the pleura can predict the outcome of pleurodesis. METHODS: A total of 58 consecutive patients (26 men, 32 women) with malignant pleural mesothelioma underwent video-assisted thoracoscopy under general anaesthesia with monopulmonary ventilation between the years 2003 and 2006. Four grammes of asbestos-free and sterile talc were insuflated into the pleural space under direct vision. To assess the success of pleurodesis, chest radiographs were obtained at the 8th and 30th postoperative days. Venous blood samples were drawn both on admission and at the 24th hour after pleurodesis for the analysis of white blood cells, erythrocyte sedimentation rate and C-reactive protein. RESULTS: The mean age (standard deviation) of patients was 59.0 +/- 12.0 years. Pleurodesis was achieved (no effusion on chest radiograph) in 43 of 58 patients (74.1%)(group I), whereas it was unsuccessful in the remaining 15 patients (25.9%)(group II). There was a significant difference between two groups for basal and postpleurodesis levels of measured inflammatory parameters, C-reactive protein and erythrocyte sedimentation rate (for each, P < 0.05). However, the difference was not significant for white blood cells between the groups. CONCLUSION: Serum levels of inflammatory parameters (C-reactive protein and erythrocyte sedimentation rate) may be used to predict the success of pleurodesis in patients with malign mesothelioma who underwent thoracoscopic talc poudrage.