Value of Preoperative Platelet-to-Lymphocyte and Neutrophil-to-Lymphocyte Ratios in Predicting Postoperative Atrial Fibrillation in Patients Undergoing Lung Resection.

Background: The aim of this study was to investigate the association between the platelet/lymphocyte ratio (PLR) and the neutrophil/lymphocyte ratio (NLR) and postoperative atrial fibrillation (POAF) after lung resection. Methods: After the implementation of the exclusion criteria, 170 patients were retrospectively analyzed. PLR and NLR were obtained from fasting complete blood counts before surgery. POAF was diagnosed using standard clinical criteria. The associations between different variables and POAF, NLR, and PLR were calculated using univariate and multivariate analyses. The receiver operating characteristics (ROC) curve was used to determine the sensitivity and specificity of PLR and NLR. Results: Of the 170 patients, 32 with POAF (mean age =71.28±7.27 y, 28 males and 4 females) and 138 patients without POAF (mean age =64.69±10.31 y, 125 males and 13 females) were identified, and the difference in the mean age was statistically significant (P=0.001). It was found that PLR (157.67±65.04 vs 127.52±56.80; P=0.005) and NLR (3.90±1.79 vs 2.04±0.88; P=0.001) were statistically significantly higher in the POAF group. In the multivariate regression analysis, age, lung resection size, chronic obstructive pulmonary disease, NLR, PLR, and pulmonary arterial pressure were independent risk factors. In the ROC analysis, PLR had a sensitivity of 100% and a specificity of 33% (AUC, 0.66; P<0.001), and NLR had a sensitivity of 71.9% and a specificity of 87.7% (AUC, 0.87; P<0.001). A comparison of AUC between PLR and NLR showed that NLR was statistically more significant (P<0.001). Conclusion: This study showed that NLR was a stronger independent risk factor than PLR for the development of POAF after lung resection.

Pleural multicystic mesothelial proliferation that presented with hemothorax.

Pleural multicystic mesothelial proliferation is a very rare serosal pathology. In this paper, we share a pleural multicystic mesothelial proliferation case arrives the emergency service with sudden chest pain and dyspnea complaint that presented with hemothorax complication. In the literature, there is only one pleural multicystic mesothelial proliferation issue that is determined by coincidence. Even though being a rare benign pathology; pleural multicystic mesothelial proliferation can cause some vital complications as a hemothorax.

A hemiclamshell incision for a giant solitary fibrous tumor of the right hemithorax.

A 41-year-old female was admitted with respiratory distress. Chest radiographs showed opacity in the right hemithorax with mediastinal shift. Computed tomography (CT) scan showed a pleural mass with a 22 cm diameter occupying the whole right hemithorax and causing atelectasis. Magnetic resonance imaging (MRI) showed lower position of the right hemidiaphragm and the liver. Superior vena cava and heart were shifted to left. Presence of infiltration to the adjacent tissues could not be clearly evaluated because of pressure effect. Transthoracic needle biopsy specimen was reported to be benign. Because of the size and location of the mass, a hemiclamshell incision was chosen, which allowed excellent visualization and complete dissection of the giant tumor. The histopathology of the resected specimen confirmed solitary fibrous tumor. The patient was stabilized by careful observation and treatment. No complication except pneumonia in the postoperative first month occurred during the 22-month follow-up period.

Teratoma during Pregnancy with Positive Estrogen and Progesterone Receptors and Elevated Ca19-9 Antigen Levels.

We present a 27-year-old female patient admitted with an anterior mediastinal mass. She complained of chest discomfort and hemoptysis which began seven months prior. She had given birth five months prior. Thoracic X-ray showed an anterior mediastinal mass. Thorax computed tomography (CT) confirmed a well-defined anterior mediastinal mass with 13 × 12 cm diameter, extending to the right hemithorax. It was composed of cystic spaces and discrete areas like soft tissue and fat. Serum Ca 19-9 level was elevated. CT features were consistent with a mature teratoma. During median sternotomy, the tumor revealed adhesions to the right lung and the right subclavian artery. Histologically, the tumor was diagnosed as a mature teratoma. Estrogen and progesterone receptors were detected to be positive in the resected tissue. We conclude that alterations in hormone levels during pregnancy might be the cause of rapid tumor growth which leads to hemoptysis.

Infecções relacionadas a cateteres torácicos / Thoracic catheter-related infections

OBJETIVO: Determinar o status de colonização de uma amostra de pacientes que recebeu cateteres torácicos (CTs) e correlacionar esse status a possíveis fatores prognósticos. MÉTODOS: Estudo retrospectivo com 48 pacientes (17 mulheres e 31 homens) que receberam CTs no Departamento de Cirurgia Torácica do Hospital Universitário Adnan Menderes, localizado na cidade de Aydin, Turquia, entre dezembro de 2008 e março de 2009. Amostras de sangue para cultura foram coletadas da porção distal dos CTs e de cada um dos 48 pacientes. Procuramos por correlações entre culturas positivas e possíveis fatores prognósticos de infecção. RESULTADOS: Resultados positivos de cultura em amostras de CT ocorreram somente 3 pacientes, em sangue em 2, e nas duas amostras em outros 2. A idade avançada correlacionou-se com culturas positivas das amostras de CT e sangue (r = 0,512 e r = 0,312, respectivamente; p < 0,05), assim como o uso prolongado do CT e com culturas positivas das mesmas amostras (r = 0,347 e r = 0,372, respectivamente; p < 0,05). Houve uma correlação significativa entre o status cirúrgico dos pacientes (aqueles submetidos a cirurgias) e culturas positivas somente das amostras de CT (p < 0,05), mas a presença de malignidade inoperável correlacionou-se com o crescimento bacteriano em ambos os tipos de amostras (p < 0,05 para ambos). CONCLUSÕES: Os fatores de risco acima citados aumentam o risco de infecções. No caso de pacientes com CTs e que apresentam tais fatores de risco, é imperativo que se utilize uma profilaxia com antibióticos de amplo espectro.

OBJECTIVE: To determine the incidence of local and systemic infection in a sample of patients catheterized with thoracic catheters (TCs) and to identify the prognostic factors for catheter-related infection. METHODS: A retrospective study involving 48 patients (17 females and 31 males) catheterized with TCs between December of 2008 and March of 2009 in the Thoracic Surgery Department of the Adnan Menderes University Hospital, located in Aydin, Turkey. Blood samples for culture were collected from the distal end of each TC and from each of the 48 patients. We looked for correlations between positive culture and possible prognostic factors for catheter-related infection. RESULTS: Culture results were positive in TC samples only for 3 patients, in blood samples only for 2, and in both types of samples for another 2. Advanced age correlated significantly with positive culture in TC samples and in blood samples (r = 0.512 and r = 0.312, respectively; p < 0.05 for both), as did prolonged catheterization (r = 0.347 and r = 0.372, respectively; p < 0.05). There was a significant correlation between having undergone surgery and positive culture in TC samples only (p < 0.05). However, having an inoperable malignancy correlated with bacterial growth in blood and in TC samples alike (p < 0.05 for both). CONCLUSIONS: Risk factors, such as advanced age, prolonged catheterization, comorbidities, and inoperable malignancy, increase the risk of catheter-related infection. It is imperative that prophylaxis with broad-spectrum antibiotics be administered to patients who present with these risk factors and might be catheterized with a TC.

[Minimally invasive approach in the pleural fluids]. / Plevral efüzyonlarda minimal invaziv yaklasim.

The excess production or depleted absorbtion of pleural fluid is the major mechanism of pleural effusion formation. Primary lung pathologies or pathologies that originated from the other organs can be cause of pleural effusion. The search for suitable, practical and ideal treatment is continued at the present day. We have reviewed 94 patients with pleural effusion that have been treated by 10F catheter with local anesthesia in 2007-2008. The patient with dispenea, massive effusion or reoccurrent pleural effusion have been administrated pleural catheter through 7th or 8th intercostal interspace with local anesthesia. The mean age of patients (58 male, 36 female) was 57.2 (26-94). The most common etiologic causes were primary broncho carcinoma (34 cases 36.1%), cardiac failure (11 cases 11.1%) and empyema (eight cases 9.5%). Fifty three (56.3%) have been administrated pleurodesis because of treatment failure or reoccurrence. In 19 of these cases (20.2%), pleurodesis was successful. Pleurodesis agent was talc or tetracycline according to patients pain threshold. The treatment methods of pleural effusion include thoracentesis, thoracoscopy, tube thoracostomy and catheters with permanent tunnel. The simple and small-diameter catheters are administrated easily with minimal morbidity and no mortality. It's not only used in malign effusion but also used in benign effusion. Finally, simple catheter can be first treatment choice in short-term therapy and alternative choice in long-term therapy because of it's administrating facility, effectiveness in pleurodesis and cost-effectiveness.

Thoracic catheter-related infections.

OBJECTIVE: To determine the incidence of local and systemic infection in a sample of patients catheterized with thoracic catheters (TCs) and to identify the prognostic factors for catheter-related infection. METHODS: A retrospective study involving 48 patients (17 females and 31 males) catheterized with TCs between December of 2008 and March of 2009 in the Thoracic Surgery Department of the Adnan Menderes University Hospital, located in Aydin, Turkey. Blood samples for culture were collected from the distal end of each TC and from each of the 48 patients. We looked for correlations between positive culture and possible prognostic factors for catheter-related infection. RESULTS: Culture results were positive in TC samples only for 3 patients, in blood samples only for 2, and in both types of samples for another 2. Advanced age correlated significantly with positive culture in TC samples and in blood samples (r = 0.512 and r = 0.312, respectively; p < 0.05 for both), as did prolonged catheterization (r = 0.347 and r = 0.372, respectively; p < 0.05). There was a significant correlation between having undergone surgery and positive culture in TC samples only (p < 0.05). However, having an inoperable malignancy correlated with bacterial growth in blood and in TC samples alike (p < 0.05 for both). CONCLUSIONS: Risk factors, such as advanced age, prolonged catheterization, comorbidities, and inoperable malignancy, increase the risk of catheter-related infection. It is imperative that prophylaxis with broad-spectrum antibiotics be administered to patients who present with these risk factors and might be catheterized with a TC.