Is preoperative pulmonary rehabilitation effective in the postoperative period after lung resection?

Objective: Investigating the effects of the preoperative short term intensive pulmonary rehabilitation program applied for patients who have undergone lung resection by thoracotomy, on lung functions, complication rates and length of hospital stay during the postoperative period. Methods: A prospective randomized trial of sixty patients were enrolled who would undergo pulmonary resection by thoracotomy and were randomly divided in two groups. Intensive pulmonary rehabilitation was performed on these patients in the study group 3 hours a day throughout 7 days during the preoperative period. Groups were compared with respect to their spirometric pulmonary functions, respiratory parameters, blood gas parameters, complication rates and length of hospital stay. Results: Total incidence rate of complications in the patients from the control group significantly increased(p=0,028). When patients who underwent lobectomy and wedge resection were observed, length of hospital stay of those in the control group was seen to be statistically higher in comparison with the study group(p<0,05). Conclusion: We consider that it will be very beneficial to perform a short term and intensive pulmonary rehabilitation program on every patient possible who is planned to undergo thoracotomy and lobectomy or wedge resection treatment.

What are the independent prognostic factors in patients undergoing esophagectomy for esophageal cancer?

Background: This study aims to investigate the prognostic factors affecting survival in patients undergoing surgical treatment for esophageal cancer. Methods: A total of 50 patients (33 males, 17 females; mean age: 57.8±11.8 years; range, 28 to 80 years) who underwent esophagectomy for esophageal cancer in our clinic between January 2008 and March 2018 were retrospectively analyzed. Prognostic factors affecting survival were investigated. Data including age, sex, tumor size, histological and macroscopic type, tumor stage, T and N categories, the total number of resected lymph nodes and metastatic lymph node ratio, differentiation degree, vascular and perineural invasion, proximal surgical margin distance, adjuvant therapy, and the presence of postoperative complications were recorded. Results: The patients after radical surgery with a tumor size of <3 cm, macroscopic type non-ulcerative-infiltrative squamous cell carcinoma pathology, Stage 1 disease, pT1-2, pN0, well-differentiated groups, no perineural invasion, a metastatic lymph node ratio of <0.2, proximal surgery margin length of 5 to 10 cm, and no postoperative complications had higher five-year survival rates. However, when the effects of these factors on overall survival were examined independently, none of them had a statistically significant effect (p>0.05). The main factors affecting the prognosis were Stage ≥2 disease, postoperative complications, and proximal surgical margin less than 5 cm. Conclusion: Our study results suggest that Stage 1 disease, a proximal surgical margin length of more than 5 cm, and the absence of complications are associated with longer survival times and these patients are greatly benefited from surgical treatment.

Anxiety and depression as possible criteria in the treatment of bronchiectasis.

BACKGROUND: The aim of this study was to investigate the effect of bronchiectasis operation on anxiety and depression. METHODS: Between August 2014 and March 2019, a total of 167 patients with bronchiectasis (107 males, 60 females; mean age: 43.5±13.9 years; range, 18 to 84 years) who received medical (n=70) and surgical (n=97) treatment were retrospectively analyzed. Data including patients" characteristics, operation indication, operation type, and bronchiectasis localization were obtained from the electronic patient files. The patients were reached via phone calls and evaluated whether the operation provided a significant symptomatic improvement and whether the symptoms disappeared. The number of exacerbations/hospitalizations associated with bronchiectasis within the last year was also questioned. The anxiety and depression status of the patients in both groups was assessed by the Hospital Anxiety and Depression Scale. RESULTS: Eleven (15%) patients in the medical group and 10 (10%) patients in the surgical group had an anxiety score above 7. Twenty-one (30%) patients in the medical group and 10 (10%) patients in the surgical group had a depression score above 7. Both the anxiety and depression scores were significantly lower in the surgical group than the medical group (p<0.001). Annual exacerbation and annual hospitalization rates were also significantly lower in the surgical group (p<0.001). CONCLUSION: Our study results suggest that patients with bronchiectasis treated medically rather than surgically are more prone to be anxious and depressive. The benefits of surgical treatment in patients with bronchiectasis is not limited to improving symptoms and decreasing the frequency of exacerbations/hospitalizations. We believe that surgical treatment also reduces anxiety and depression and improve the quality of life. While making a surgical decision, the anxiety/depression status of bronchiectasis patients should be considered.

Significance of tumor length as prognostic factor for esophageal cancer.

Our study indicated the relationship between tumor length and clinicopathologic characteristics as well as long-term survival in esophageal cancer. A total of 116 patients who underwent curative surgery for thoracic esophageal cancer with standard lymphadenectomy in 2 fields between 2000 and 2010 were included in the study. The medical records of these patients were retrospectively reviewed. The patients with tumor length 3 cm had a highly significant difference in the involvement of adventitia and lymph node stations. The patients with tumor length 3 cm had significantly lower rates of involvement of the adventitia and lymph node stations. Tumor length could have a significant impact on both the overall survival and disease-free survival of patients with resected esophageal carcinomas and may provide additional prognostic value to the current tumor, node, and metastasis staging system before patients receive any cancer-specific treatment.

[A rare complication after Velpeau bandage: hemopneumothorax]. / Velpeau bandaji sonrasi nadir bir komplikasyon: Hemopnömotoraks.

Velpeau bandage is a treatment method that fixes the arm to the body in cases of fractures and dislocations at the region of shoulder. Velpeau bandage very rarely leads to complications. This case report involves a 45-year-old male admitted to the emergency service after trauma. Glenoid and multiple rib fractures were detected in radiological examinations. A transient Velpeau bandage was performed before surgical correction. Patient had dyspnea and chest pain 24 hours after bandage application. An obvious displacement at the rib fracture sites and hemopneumothorax were seen in the chest X-ray. A chest tube was inserted into the patient. Glenoid fracture was corrected surgically. Patient was discharged on the sixth day. He has no problems at readmission after the first month.

Trauma does not aggravate deleterious effects of ischemia reperfusion injury on the lung.

OBJECTIVES: Our purpose was to investigate the effects of ischemia-reperfusion injury on traumatized lungs. MATERIALS AND METHODS: Twenty-four Wistar rats were used in the study. Rats were randomly divided into 4 groups. In the control group (group 1), only anesthesia and ventilation were used. In group 2, only lung ischemia-reperfusion injury was instituted. In group 3, only blunt chest trauma was instituted. And in group 4, lung ischemia reperfusion injury, consisting of 24 hours after the constitution of blunt chest trauma, was used. Lung damage and systemic inflammation parameters were evaluated. RESULTS: All parameters (alveolar degeneration grades, alveolar macrophage and lymphocyte counts, antioxidant enzyme activities, cytokine levels, and bronchoalveolar lavage fluid albumin level) were higher in all groups than they were in the control group (P < .05). Only tissue malondialdehyde, tissue interleukin-8, and serum glutathione peroxidase levels were significantly higher in the lung ischemia-reperfusion group than they were in the trauma group (P < .05). The trauma + ischemia reperfusion group showed no significant difference when compared with the only ischemia-reperfusion or only trauma groups in any parameters (P > .05). CONCLUSIONS: The findings showed that lung trauma does not aggravate the deleterious effects of lung ischemia-reperfusion injury.

Antioxidant enzymes and lipid peroxidation in cold ischemic lung preservation.

OBJECTIVES: Our purpose was to investigate antioxidant enzymes and lipid peroxidation in time course ischemic lung preservation in rats. MATERIALS AND METHODS: Thirty-six Wistar rats were divided into 6 groups of 6 rats each. After having been anesthetized, the rats were intubated and connected to a rodent ventilator. Lung-heart blocks were excised. In the control group, the lungs were immediately stored at -80 degrees C after removal. The lungs from the other groups were preserved in 40 mililiters of low potassium dextran solution at 4 degrees C for 6, 12, 24, 48, and 72 hours, respectively. Antioxidant enzyme activity and malondialdehyde levels were then measured. RESULTS: Superoxide dismutase activity significantly increased at the 12th hour and remained higher up to the 72nd hour (P < .001). Glutathione peroxidase activity was higher than that in the control group from the 6th to the 24th hour but was significant only at the 12th hour (P < .001) and decreased below the level in the control group after the 48th hour. Catalase activity was significantly higher than that in the control group in all preservation periods (P < .001). The nitric oxide level slowly increased and reached a significantly higher level than that in the control group at the 24th and 72nd hours (P = .028) and then decreased to the level found in the control group. The malondialdehyde level slightly increased from the 6th to the 24th hour, but that increase, when compared with the level in the control group, had no statistical significance (P = .110). CONCLUSIONS: In ischemic lung preservation, oxidative stress begins during the early phase of preservation and continues for up to 72 hours. Although oxidative stress continues for a significant period, an antioxidant mechanism adequately prevents its harmful effects on the lung. Thus no significant lipid peroxidation occurred in long-term ischemic lung preservation in the murine model studied.

A case of cervical bronchogenic cyst presenting with hoarseness in an adult.

A twenty-eight year old male with a cervical mass, complaining of hoarseness and weight loss, was referred to our clinic. A 3 x 4 cm cystic lesion localizing in the region of the suprajugular notch was seen with the aid of computerized chest tomography. A cervical ultrasound confirmed that it was a cystic lesion. It was discovered that the right vocal cord was paralytic after an ear-nose-throat examination. A percutaneous needle biopsy did not provide a diagnosis. The cyst was completely excised via suprajugular incision. Histopathologic examination showed that it was a bronchogenic cyst. The hoarseness was completely eliminated immediately after cystic removal. The patient was discharged after the third postoperative day. After a six-month of follow-up, no recurrence was detected.

Benign metastasizing leiomyoma.

A 41-year-old woman presented with chest pain and a cough. There was a solitary pulmonary nodule in the upper-left lobe. The patient had no history of neoplasm except a hysterectomy for uterine leiomyoma five years before. Six months after the first presentation, the tumor showed a gradual increase in size; an explorative thoracotomy was performed. The histopathologic examination showed a tumor consisting of well-differentiated spindle-shaped cells with intervening collagen. She was readmitted 8 months after the operation because of right-sided spontaneous pneumothorax. Multiple pulmonary nodules appeared when the lung was re-expanded by chest tube drainage. In conclusion, uterine leiomyomas can metastasize to various organs, such as lungs, despite having a benign pathologic appearance.

Strength of esophageal closure techniques with and without tissue reinforcement.

OBJECTIVES: The purpose of this study was to investigate the effects of esophagotomy closure techniques on the esophageal bursting pressure. MATERIALS AND METHODS: Altogether, 122 freshly dead sheep esophagi received from the local slaughterhouse were prepared for manual closure. After esophagotomy, the specimens were divided into four groups. An interrupted mucosal suture pattern (n = 30), an interrupted mucosal-submucosal suture pattern (n = 30), an interrupted mucosal-submucosal + over-over continuous muscular suture pattern (n = 32), and an interrupted mucosal-submucosal + reinforcement with a diaphragmatic part with full-thickness interrupted U suture pattern (n = 30) were used for esophagotomy closure; 4-0 silk was used in all specimens. Bursting pressures were measured with a sphygmomanometer. RESULTS: We found a statistically significant difference among the bursting pressures of all groups (p < 0.001). The bursting pressure values gradually increased from group 1 to group 4 (47.6 +/- 22.7, 86.2 +/- 49.5, 185.4 +/- 53.5, and 226.8 +/- 62.4 mmHg, respectively). Reinforcing the esophageal suture line with tissue significantly increased the bursting pressure compared to the other groups. CONCLUSIONS: Each layer of the esophagus significantly contributes to strengthening esophageal wall tension with primary esophageal closure, and reinforcement of the esophageal suture with tissue provides an additional significant increase in the bursting pressure of the esophagus.