Is there a common definition for massive pleurisy?

The concept of massive pleurisy (MP) is frequently used to emphasize the significance of the amount of pleural effusion. However, there are significant disagreements about it due to the lack of a universal definition for MP. In our study, we sought to elucidate these distinctions. We employed a questionnaire comprised of visual and true/false sections. In the visual section, participants were shown real-time lung radiographs and schematic drawings and asked which ones were MP. On the other hand, suggestions regarding diagnosis, treatment, and consultations for MP were questionnaired. The study was comprised of 150 physicians from four distinct centers. On true/false and radiograph questions, physicians from the same branch exhibited differences of up to 50% (p < 0.05). On the level question, each branch involved reached a consensus (p = 0.003). In questions 3, 4, and 5, which also contained a true-false section, the branches gave varying responses, with the exception of the opinion that tube thoracostomy is unquestionably indicated in MP (p < 0.05). Establishing a common language for MP is crucial for clinician collaboration and appropriate patient management. Our study elucidates the divergences of opinion between branches and highlights the need for a unified definition.

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.

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.

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.

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.

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.

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.

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.

A pathology not be overlooked in blunt chest trauma: Analysis of 181 patients with bilateral pneumothorax.

BACKGROUND: Bilateral pneumothorax (BPTx) can become tension PTx and a cause of mortality, especially in severe multi-trauma patients. The purpose of this study was to analyze the incidence, morbidity, mortality, and associated factors of BPTx in multi-trauma patients in order to highlight the importance of the management of these cases, as well as complications, morbidity, and mortality. METHODS: The data of 181 patients with BPTx, from a total of 3782 trauma patients, were reviewed retrospectively. The details recorded were age, gender, mechanism of trauma, radiological findings, co-existing thoracic and extra-thoracic injuries, incidence of intubation, mortality, and injury severity score (ISS). The association between laterality of rib fracture, hemothorax, subcutaneous emphysema, and BPTx, and the effect of age and gender on these injuries, mortality, and ISS were analyzed. RESULTS: The patient group included 144 males, and the mean age was 36.07±15.77 years. The primary cause of trauma was a motor vehicle accident, seen in 67 (37.0%) patients. Bilateral rib fractures were detected in 75 (41.4%) patients. Hemothorax accompanied PTx in 41 (22.6%) patients bilaterally. The laterality of the rib fracture and hemothorax demonstrated a significant difference in the patient group over 60 years of age (p=0.017, p=0.005). Co-existing bilateral thoracic injuries were detected more often in this group. Twelve (17.6%) patients with only blunt chest trauma and 56 (82.4%) patients with multi-trauma were intubated. The difference between the 2 groups was not significant (p=0.532). The overall mortality rate was 18.2%. A comparison of ISS and mortality between the groups revealed no significant difference (p=0.22). CONCLUSION: The incidence of BPTx after multi-trauma is approximately 5%, so it must be taken into consideration, especially in severe multi-trauma patients, to reduce mortality. Older age and the number of rib fractures were determined to be risk factors for morbidity and mortality in trauma with BPTx.

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.

A rare tumor metastasis of bilateral lung: Epithelioid trophoblastic tumor.

A 44-year-old female patient with a history of a gestational trophoblastic tumor surgery was referred to our clinic upon detection of cystic-cavitary lesion showing slow progression in both lungs. It was decided to perform bilateral surgery in the patient for diagnosis and treatment purposes; first, left upper lobectomy and one month later, right lower lobectomy were applied. Histopathological examination results of the specimens obtained during both operations reported an "epithelioid trophoblastic tumor" metastasis. Aspergilloma was also noted in the tumor in left upper lobe at the same time. Epithelioid trophoblastic tumors, a very rare member of gestational trophoblastic tumors, can achieve distant organ metastasis. Surgical treatment remains important in these cases, which are mostly resistant to chemotherapy.

Analysis of the patients with simultaneous bilateral spontaneous pneumothorax.

BACKGROUND: Simultaneous bilateral spontaneous pneumothorax (SBSP) is an uncommon condition with limited data on its incidence in the literature. In this study, we aimed to describe the bilaterality in both primary and secondary spontaneous pneumothorax cases, and the clinical approach in simultaneous disease and prognosis of these patients. METHODS: A total of 16 patients who were followed with the diagnosis of bilateral spontaneous pneumothorax between January 2005 and January 2017 were retrospectively analyzed. The patients were divided into two groups: secondary spontaneous pneumothorax (SSP; Group 1, n = 11) and primary spontaneous pneumothorax (PSP; Group 2, n = 5). Demographic data, underlying lung pathologies, treatments applied, clinical findings and survival data were recorded. RESULTS: Of the patients in Group 1, four (36.3%) had chronic obstructive pulmonary disease (COPD), three (27.3%) had granulomatous lung disease, two (18.2%) had idiopathic pulmonary fibrosis, one (9.1%) had bronchiectasis and one (9.1%) had hypersensitivity reaction. Of these patients, four had bilateral tube thoracostomy, four had unilateral tube thoracostomy and the remaining three received medical treatment under follow-up. Of the Group 1 patients, six (54.6%) died during the 72-month follow-up period, while only one of these patients had COPD. All patients in Group 2 were treated using bilateral video-assisted thoracoscopic surgery either in the first or the second episode. CONCLUSIONS: These results suggest that simultaneous and bilateral occurrence of SPP is an indicator of an advanced lung pathology with a poor prognosis.

The prognostic value of carcinoembryonic antigen levels in blood and intraoperative pleural lavage fluid in non-small-cell lung cancer.

INTRODUCTION: There is no specific marker for lung cancer, but, in some lung cancer types, carcinoembryonic antigen (CEA) can reach high levels in the blood and pleural fluid. AIM: This study investigated the relationship of CEA levels in blood (CEAB) and intraoperative pleural lavage fluid (CEAP) in non-small-cell lung cancer (NSCLC) with the type, stage, and extent of lung cancer. MATERIAL AND METHODS: A total of 50 patients, who underwent surgery at our clinic due to NSCLC (group I) or benign lung pathology (group II), were assessed. For this prospectively designed study, 25 consecutive patients were included in each group, and their CEAB and CEAP levels were investigated. RESULTS: When the levels of CEAP were compared, the average value of group I (1.35 ng/ml) was significantly higher than the average value of group II (0.04 ng/ml) (p = 0.027). When CEA levels were examined separately, and average values were taken according to surgical pathology results, both CEAB and CEAP levels of adenocarcinoma patients were found to be higher than those of the other groups. This difference was only significant for the level of CEAP (p = 0.026). CONCLUSIONS: Although the average CEAB levels of patients with adenocarcinoma were higher than those of patients with other histopathological types, this difference was not statistically significant. However, we found that CEAP levels were significantly higher in patients with adenocarcinoma. These results have led us to consider that CEAP elevation is a more sensitive marker than the elevation of CEAB.