Associations between polymorphisms of IL-17F and IL-17A genes with disease activity and clinical outcome of Ankylosing Spondylitis.

Aims In this study, we aimed to investigate the associations between the 7383A/G and 7488A/G polymorphisms of the interleukin (IL)-17F gene and the G197A polymorphism of the IL-17A gene with disease activity and clinical outcomes in Turkish patients with ankylosing spondylitis (AS). METHODS: The study included 101 AS patients and 106 healthy controls. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels, in addition to scores of the Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Metrology Index and Bath Ankylosing Spondylitis Functional Index (BASFI) of the patients, were recorded. The frequencies of genotypes 7383A/G and 7488A/G of the IL-17F and G197A of IL-17A genes and alleles were compared between the patients and healthy controls. MAJOR RESULTS: There were significant differences in the allele frequencies and genotype distribution of IL-17F 7488A/G. There were also significant differences in the CRP levels and BASFI scores of patients due to the genotype distribution of the IL-17F 7488A/G polymorphism (p= 0.029, 0.045, respectively). CONCLUSIONS: This study suggests that the IL-17F 7488A/G polymorphism may be associated with susceptibility to AS, disease activity and functional status in Turkish patients. Further studies with larger numbers of AS patients, with a long-term follow-up, are needed to elucidate the observed relations.

A comparative study of conventional physiotherapy versus robotic training combined with physiotherapy in patients with stroke.

BACKGROUND: There has been a growing interest in the use of robotic therapy to improve walking ability in individuals following stroke. OBJECTIVES: The aim of this retrospective study was to compare conventional physiotherapy (CP) with robotic training (RT) combined with CP and to measure the effects on gait, balance, functional status, cognitive function, and quality of life in patient with stroke. METHODS: We retrospectively identified 107 cases of new cerebral stroke. They were allocated into 2 groups. In the RT group (n = 36), patients received RT (Lokomat; 2 times per week) combined with CP (3 times per week) for at least 30 sessions. In the CP group (n = 71), patients received a program at least 30 sessions, 5 times per week. The evaluation parameters included modified Ashworth Spasticity Scale (MASS), Brunnstrom Recovery Scale (BRS), Functional Independence Measure (FIM), Functional Ambulation Categories (FAC), Berg Balance Scale (BBS), Mini-Mental State Examination (MMSE), and Short Form-36 (SF-36) Health Survey. RESULTS: Posttreatment results showed significant improvements for all parameters (except lower extremity MASS scores) in both groups. However, when we compared the percentage changes of parameters at discharge relative to pretreatment values, improvements in FIM, MMSE, and all subparts of SF-36 were better in the RT group (P < .05). Comparison of posttreatment evaluation parameters for categorical variables showed that the lower extremity categories in the BRS were significantly better in the RT group than the CP group (P < .05). CONCLUSION: RT combined with CP produced better improvement in FIM, MMSE, BRS lower extremity categories, and all subparts of SF-36 of the patients with subacute and chronic stroke (up to 1 year) than the CP program.

Effect of aquatic exercise on ankylosing spondylitis: a randomized controlled trial.

Ankylosing spondylitis (AS) is a chronic systemic inflammatory disease that affects mainly the axial skeleton and causes significant pain and disability. Aquatic (water-based) exercise may have a beneficial effect in various musculoskeletal conditions. The aim of this study was to compare the effectiveness of aquatic exercise interventions with land-based exercises (home-based exercise) in the treatment of AS. Patients with AS were randomly assigned to receive either home-based exercise or aquatic exercise treatment protocol. Home-based exercise program was demonstrated by a physiotherapist on one occasion and then, exercise manual booklet was given to all patients in this group. Aquatic exercise program consisted of 20 sessions, 5× per week for 4 weeks in a swimming pool at 32-33 °C. All the patients in both groups were assessed for pain, spinal mobility, disease activity, disability, and quality of life. Evaluations were performed before treatment (week 0) and after treatment (week 4 and week 12). The baseline and mean values of the percentage changes calculated for both groups were compared using independent sample t test. Paired t test was used for comparison of pre- and posttreatment values within groups. A total of 69 patients with AS were included in this study. We observed significant improvements for all parameters [pain score (VAS) visual analog scale, lumbar flexion/extension, modified Schober test, chest expansion, bath AS functional index, bath AS metrology index, bath AS disease activity index, and short form-36 (SF-36)] in both groups after treatment at week 4 and week 12 (p < 0.05). Comparison of the percentage changes of parameters both at week 4 and week 12 relative to pretreatment values showed that improvement in VAS (p < 0.001) and bodily pain (p < 0.001), general health (p < 0.001), vitality (p < 0.001), social functioning (p < 0.001), role limitations due to emotional problems (p < 0.001), and general mental health (p < 0.001) subparts of SF-36 were better in aquatic exercise group. It is concluded that a water-based exercises produced better improvement in pain score and quality of life of the patients with AS compared with home-based exercise.

Absence of the arteria profunda femoris / Ausencia de la arteria femoral profunda

At arteria femoralis, arteria profunda femoris is the main branch feeding the thigh. After iliofemoral embryological evolution many variations can be seen in this vessel. The absence of a. profunda femoris is one of the rare seen variation among these variations. Knowing the anatomy and variations of a. profunda femoris well, is important in low extremity ischemia, vessel surgery and angiography applications. In this study, 1036 films belonging to low extremity found in the Radiology department of School of Medicine of Cumhuriyet University were examined as retrospective. Among these films at four of them of male cases, absence of a. profunda femoris was detected. In cases at ages of 32, 37, 47 and 53 respectively, in the first and second case at the right low extremity there was no a. profunda femoris and at the left low extremity it was seen that a. circumflexus femoris medialis and a. circumflexus femoris lateralis emerged from a. profunda femoris. In the third case it was detected that at left low extremity a. profunda femoris did not exist, and at right low extremity a. circumflexus femoris lateralis emerged from a. profunda femoris, and a. circumflexus femoris medialis emerged from a. femoralis. In the fourth case at left low extremity there was no a. profunda femoris and at right low extremity it was seen that at a. profunda femoris and a. femoralis were in unsteady course. The absence of a. profunda femoris had 0,4 percent. The results were discussed by comparing with literature data.

La arteria femoral profunda, se origina de la arteria femoral, siendo la rama principal que alimenta al muslo. Después de la evolución embriológica de las aa. iliofemorales, muchas variaciones pueden verse en este vaso. La ausencia de una a. femoral profunda es una rara variación observada dentro de estas variaciones. Conocer la anatomía y las variaciones de la a. femoral profunda, es importante para la isquemia de los miembros inferiores, cirugía vascular y aplicaciones en angiografía. En este estudio, fueron examinadas retrospectivamente 1036 placas imagenológicas del miembro inferior, pertenecientes al departamento de Radiología de la Facultad de Medicina de la Cumhuriyet University. Entre estas placas, en cuatro casos pertenecientes a hombres, se detectó la ausencia de la a. femoral profunda. Los casos comprendieron a individuos cuyas edades eran 32, 37, 47 y 53 años, respectivamente. En el primer y segundo caso en el miembro inferior derecho no había una a. femoral profunda y en el miembro inferior izquierdo, se vio que la aa. circunflejas femorales medial y lateral se originaban de la a. femoral profunda. En el tercer caso se observó ausencia de la a. femoral profunda en el miembro inferior izquierdo, y en el miembro inferior derecho, la a. circunfleja femorale lateral se originaba desde la a. femoral profunda, y la a. circunfleja femoral medial se originaba desde la a. femoral. En el cuarto caso en el miembro inferior izquierdo, no existía la a. femoral profunda y en el miembro inferior derecho se observó que tanto la a. femoral como la a. femoral profunda tenían un curso variable. La ausencia de la a. femoral profunda fue del 0,4 por ciento. Los resultados fueron analizados y comparados con la literatura.

Uso de n-acetilcisteína para la prevención de la nefropatía inducida por contraste en ratas / No disponible

Objetivo: Hasta la fecha no existe un tratamiento efectivo para la nefropatía inducida por contraste (CIN). Recientemente, la N-acetilcisteína (NAC) ha dado algunos resultados prometedores en la prevención de CIN. En este estudio se analizó los efectos estructurales de la NAC en la CIN. Material y métodos: Se asignó 40 ratas albinas Wistar macho de manera aleatoria en 4 grupos: el grupo 1 (n=9) que recibía solo agua destilada, el grupo 2 (n=10) que recibió medio de contraste (CM), el grupo 3 (n=8), que recibió contraste más NAC y el último grupo (n=10) que recibió solo NAC. Al final del tercer día se extrajo los riñones izquierdo y derecho y se les realizó un examen histopatológico. Todas las secciones de tejido fueron examinadas con un microscopio óptico por el mismo histopatólogo buscando alteraciones sin conocer el tratamiento recibido. Se calcularon las puntuaciones de daño glomerular, las de daño arteriolar y las de daño tubulointersticial. Resultados: Hubo diferencias significativas entre las puntuaciones de daño glomerular, arteriolar y tubulointersticial en todos los grupos (p<0,05). Las puntuaciones de daño glomerular, arteriolar y tubulointersticial de los grupos 1 y 4 no fueron significativamente diferentes entre sí (p>0,05). Las puntuaciones de daño renal en el grupo 3 fueron mayores que en grupo 1 y en el grupo 4, pero significativamente menores que las puntuaciones del grupo 2 (p<0,05). Conclusión: La NAC podría ser útil para evitar el daño tisular renal por CIN, especialmente en pacientes de alto riesgo (AU)

Objective: To date, there is no effective treatment of contrast induced nephropathy (CIN).N-acetylcysteine (NAC) has yielded some promising results recently in the prevention of CIN. In this study, the structural effects of NAC on CIN were analyzed. Material and methods: Fourty adult Wistar albino male rats were randomly allocated to four groups. The first group was the control group (n = 9) which received only distilled water; second group was the contrast group (n = 10) which received CM; the third group was the contrast plus NAC group (n = 8) which received CM and was treated with NAC; and the last group was NAC group (n = 10) which received only NAC. At the end of the 3rd day, the right and left kidneys were removed and reserved for histopathological examination. All tissue sections were examined with light microscope looking for histopathological changes by the same experienced renal pathologist, without knowledge of the prior treatment. Histopathological examination was conducted in a blinded fashion, and glomerular injury scores, arteriolar injury scores and tubulointerstitial injury scores were calculated. Results: There was a significant difference among the scores of glomerular injury, arteriolar injury and tubulointerstitial injury in all groups (p < 0.05). The scores of glomerular, arteriolar and tubulointerstitial injury of the group-1 and group-4 were not significantly different from each other (p < 0.05). Renal injury scores in group-3 group were higher than in group-1 and-4,but significantly lower than the scores of the Group-2 (p < 0.05). Conclusion: NAC could be useful to prevent the renal tissue from CIN, especially in high-risk patients (AU)

Treatment of multiloculated empyema thoracis using minimally invasive methods.

INTRODUCTION: The purpose of this study was to investigate the results of minimally invasive treatment modalities in early stage multiloculated empyema thoracis. METHODS: The minimally invasive treatment modalities of 114 patients with Class 5 thoracic empyema were retrospectively reviewed. The patients' demographics, symptoms, diagnostic studies, treatment options and complications were evaluated. RESULTS: A total of 47 patients underwent tube thoracostomy, 23 patients underwent fibrinolytic therapy with streptokinase and 44 patients underwent video-assisted thoracoscopic surgery (VATS) deloculation and debridement. No statistical differences were found in the patients' age, gender, Gram stain and antibiotherapy before intervention among the groups. Illness days before intervention was significantly longer in the tube thoracostomy group than in the others. The VATS group had a shorter drainage time and hospital stay than the others. The VATS and fibrinolytic therapy groups had lower complication rates and less open decortication requirements than the tube thoracostomy group. Success rates were 66, 95 and 100 percent in the tube thoracostomy, fibrinolytic therapy and VATS groups, respectively. In total, there were 35 patients with complications. The most frequent complication was air space. Two inhospital mortalities occurred. CONCLUSION: In patients with early stage multiloculated empyema, VATS deloculation and debridement is superior to tube thoracostomy alone and fibrinolitic therapy in reducing drainage time and hospital stay. It has a relatively high success rate without significant morbidity. Therefore, VATS decortication may be recommended as a first-line therapy in early stage multiloculated empyema thoracis.

Very important histopathological factors in patients with resected non-small cell lung cancer: necrosis and perineural invasion.

BACKGROUND: The current staging system provides an anatomical classification of lung tumors; its secondary purpose is to allow the prognostic stratification of patients into homogeneous groups after surgery. In this work, intratumoral perineural invasion, lymphatic and blood vessel invasion together with the necrosis content of the tumor exclusive of the non-small cell cancer staging system were studied. METHODS: During a 4-year period, 152 patients operated for non-small cell lung cancer (NSCLC) at our hospital were analyzed. Mean age of patients was 55.7 +/- 10.1 years. RESULTS: Overall 5-year survival was 42.2 %. Mediastinal lymph node involvement, tumor size, incomplete resection, pneumonectomy, presence of necrosis and perineural invasion were significant prognosticators ( P = 0.03, 0.04, 0.0001, 0.046, 0.0246, < 0.0001, respectively). Multivariate analysis revealed that N status, perineural invasion, and the presence of necrosis were independent prognostic factors ( P = 0.006, P = 0.001, P = 0.001, respectively). Patients who had stage I tumor with necrosis and perineural invasion had a lower survival rate than those with stage IIIA tumor without these histopathological features ( P = 0.04). The presence of these histopathological characteristics in stage IIIA patients was a sign of a poorer prognosis ( P = 0.0001). CONCLUSIONS: Perineural invasion and the presence of necrosis independently indicated a dismal prognosis and their prognostic power is comparable to those of the TNM classification. These factors could be candidates for better survival stratification and the indicators of the need for adjuvant therapy in early stage lung cancer patients.

Lichen simplex chronicus as a symptom of neuropathy.

BACKGROUND: The main cause of lichen simplex chronicus (LSC) is not known but there is evidence to suggest that neurological abnormalities may be implicated in its aetiology. AIM: To investigate neuropathy in patients with LSC on the limbs. METHODS: In total, 23 consecutive patients [15 women (65.2%) and 8 men (34.8%); mean +/- SD age 48.2 +/- 14.03 years, range 20-71] with LSC on the limbs were included in the study. Mean +/- SD duration of disease was 22.86 +/- 21.38 months (range 1-60). Radiography, magnetic resonance imaging (MRI) and electrophysiological studies were performed for all patients. RESULTS: In total, 8 patients (34.8%) had LSC on the arms and 15 patients (65.2%) had LSC on the legs; 3 (37.5%) of the 8 patients with LSC on the arms and 6 (40%) of the 15 patients with LSC on the legs had radiculopathy in the electrophysiological studies. The prevalence of radiculopathy in patients with LSC on the limbs was higher than in asymptomatic subjects in the electrophysiological studies. CONCLUSIONS: Damage to the peripheral nervous system, such as radiculopathy and neuropathy, can play a critical role in the aetiology of LSC on the limbs. Both nerve-root compression in MRI scans and radiculopathy in nerve-conduction studies are common findings in asymptomatic subjects, but they seem to be more common in patients with LSC on the limbs. Therefore, these patients should be evaluated for the possibility of underlying neuropathy.

Achieving efficient anti-adhesion in re-mediastinoscopy: an experimental study in rats.

OBJECTIVE: Re-mediastinoscopy can be a difficult procedure due to fibrosis in the mediastinum. We have investigated the effect of an anti-adhesive barrier agent "hylan B gel" on the formation of adhesions after dissection in the superior mediastinum in a rat model. METHODS: The study was conducted in 70 male Sprague-Dawley rats weighing 300 g. The strap muscles were divided by a midline cervical incision. The anterior and lateral aspects of the trachea were dissected to the level of the carina. Hylan B gel (Sepragel Sinus, Genzyme Company, Redgefield, NJ, USA) was used to create an anti-adhesive barrier. The rats who were subjected to surgery were sacrificed on postoperative days 14 and 28. All rats were previously divided into 5 groups: Sham group (n = 10); Group 1 (n = 15) surgery alone, sacrificed on day 14; Group 2 (n = 15) surgery and Sepragel, sacrificed on day 14; Group 3 (n = 15) surgery alone, sacrificed on day 28; Group 4 (n = 15) surgery and Sepragel, sacrificed on day 28. Histopathological analysis was performed to study the effect of the anti-adhesive agent. Scores were calculated based on collagen fibrosis, fibroblasts, granulation tissue, muscle alterations/inflammation, histiocytes, mononuclear giant cells, inflammation and vascular proliferation. RESULTS: Collagen fibrosis and fibroblast scores, which represent adhesions, were significantly higher in Groups 1, 2, 3, 4 than in the Sham group ( P < 0.01). The degree of adhesions on day 14 was found to be higher in Group 1 compared to Group 2 ( P < 0.01). Adhesions on day 28 were higher in Group 3 compared to Group 4 ( P < 0.01). There were no differences between groups with regard to foreign body reactions ( P > 0.05). CONCLUSION: Adhesions causing technical difficulty during re-mediastinoscopy can be reduced by the application of anti-adhesive agents during the primary procedure.

The cutaneous silent period in carpal tunnel syndrome.

OBJECTIVES: The cutaneous silent period (CSP), a sustained voluntary contraction following a painful stimulus applied over the appropriate dermatome produces a brief period of electrical silence, may be useful if the routine nerve conduction studies and needle electromyography are insufficient to diagnose entrapment neuropathies. MATERIAL AND METHODS: To investigate whether symptomatic or asymptomatic patients with entrapment neuropathies are differed in terms of CSP, one hundred fifty four hands of 58 patient and 19 controls were studied according to the clinical and electrophysiological findings. RESULTS: CSP latency and duration could be affected in severe forms of entrapment neuropathies. However, even in patients with dysesthetic pain -which lead to the belief that small fibers may be involved-, results of electrophysiological evaluation could not support the clinical findings. CONCLUSION: In this study it was suggested that CSP studies provide no additional information in entrapment neuropathies.

The place of computed tomography as a guidance modality in percutaneous nephrostomy: analysis of a 10-year single-center experience.

BACKGROUND: Percutaneous nephrostomy (PCN) has been established as an effective technique for urinary decompression or diversion. This procedure may be performed with the guidance of fluoroscopy, ultrasonography, a combination of fluoroscopy and ultrasonography, computed tomography (CT), or magnetic resonance imaging. PURPOSE: To retrospectively review experience with CT-guided PCN over a 10-year period in a single center. MATERIAL AND METHODS: All CT-guided PCN procedures performed in adults at our institution between 1995 and 2005 were evaluated. In 882 patients, 1113 nephrostomy catheters were inserted. Interventional radiologists or radiology residents under direct attending supervision inserted all catheters. During the PCN procedure, bleeding, sepsis, and injuries to adjacent organs were regarded as major complications. Clinical events requiring nominal therapy with no sequelae were regarded as minor complications. RESULTS: PCN procedures were performed via 1-3 punctures in patients with grades 0-1 and 2 hydronephrosis, and via 1-2 punctures in patients with grade 3 hydronephrosis. They were carried out with a procedure time ranging from 9 to 26 min. All PCNs were considered as technically successful, and no major complications were observed. There were minor complications including transient macroscopic hematuria (28.6%, 19.9%, and 4.9% in patients with hydronephrosis grades 0-1, 2, and 3, respectively) and perirenal hematomas in a total of eight patients. No patient required additional intervention secondary to complications of the PCN procedure. CONCLUSION: CT-guided PCN is an efficient and safe procedure with major and minor complication rates below the accepted thresholds. It can be used for the management of patients requiring nephrostomy insertion in inpatient settings, and might be a preferable procedure in patients with minimal or no dilatation of the renal pelvis.

Thoracic surgical operations performed under local anesthesia and sedation for diagnosis and treatment.

Generally, the operative procedures for the diagnosis or treatment of mediastinal, intrathoracic and/or chest wall lesions requiring rib resection are performed under general anesthesia. Although evidence suggests that thoracoscopy can be performed under local anesthesia, no report has indicated that some major thoracic procedures can be accomplished without general anesthesia. In our study, we advocate that certain surgical procedures could be performed under local anesthesia with a performance similar to that of general anesthesia. Thirty patients underwent thoracic procedures with local anesthesia and sedation for diagnosis and treatment. Seventeen of the patients were men, and the mean age of the patients was 49.6 years (range 16 to 71 years). There were 13 diagnostic procedures, and 17 procedures were for treatment purposes. The operative procedures performed using only local anesthesia were mini-thoracotomy (n = 9), mediastinotomy (n = 4), revision of a full-thickness posterolateral thoracic incision (n = 7), resection of the chondroma (n = 4), Eloesser flap (n = 1), metastasectomy of the chest wall (n = 3), empyectomy (n = 1), and video-assisted thoracoscopy (n = 2). Severity of pain was evaluated by VAS. There were no oral or intravenous analgesic requirements in the early postoperative period. No complications attributable to the procedure were observed. Thoracic surgical procedures for diagnosis and treatment performed under local anesthesia are simple, effective, economical and comfortable for the patient.

Giant intraosseous lipoma of the rib.

Lipoma is defined as a benign tumor consisting of a circumscribed mass of adipose tissue. Intraosseous lipomas represent fewer than 0.08% of all primary bone tumors. We present an unusual case of intraosseous lipoma arising from the left 10th and 11th ribs and extending to the subdiaphragmatic area and abdomen. Lipoma of the rib is an extremely rare disorder presenting diagnostic challenges.

Transcutaneous electric nerve stimulation for the treatment of postthoracotomy pain: a randomized prospective study.

BACKGROUND: Insufficient relief of postthoracotomy pain is a major cause of increased rates of postoperative complications including inadequate coughing, mucous plugging, hypoxia, compromised ventilation or even bacterial lung infection. We aimed to assess the efficacy of transcutaneous electric nerve stimulation (TENS) in patients with postthoracotomy pain. METHODS: Forty patients scheduled to undergo posterolateral thoracotomy were randomly allocated to receive either TENS or patient-controlled intravenous morphine. Postoperative pain was evaluated using a visual analogue scale (VAS) and the Prince Henry pain scale. Pulmonary function was evaluated and an intergroup comparison was done. RESULTS: On the first three days following surgery, the VAS intensity of the TENS group did not differ significantly from that of the morphine group ( P > 0.05), and on the first two days following thoracotomy, the Prince Henry scale of the TENS group was not statistically significantly different. However, the VAS intensity was significantly lower than that of the control group on the fourth ( P = 0.044), fifth ( P = 0.016), sixth ( P = 0.009), seventh ( P = 0.008), eighth ( P = 0.004), ninth ( P = 0.002), tenth ( P = 0.001), fifteenth ( P = 0.002), thirtieth ( P < 0.001), forty-fifth ( P < 0.001) and sixtieth ( P < 0.001) days. The Prince Henry scale of the TENS group was found to be significantly diminished from the 3rd to the 60th day. TENS significantly reduced the analgesic requirements from day 5 to 60 ( P < 0.01). No noticeable side effect was observed in the TENS group during the study period. CONCLUSION: This study demonstrated that TENS provided a better pain relief and comfort compared to PCA from the fourth postoperative day onwards, and this pain-reducing effect continued for at least two months postoperatively.

The prognostic importance of trauma scoring systems for blunt thoracic trauma.

BACKGROUND: Early identification and aggressive management of blunt thoracic trauma are essential to reduce the significant rates of morbidity and mortality. The aim of this study was to evaluate the independent predictive value of 5 different trauma scoring systems (Revised Trauma Score [RTS], Trauma and Injury Severity Score [TRISS], Injury Severity Score [ISS], Lung Injury Scale [LIS], and Chest Wall Injury Scale [CWIS]) with respect to prognostic factors such as tube thoracostomy duration, the need for mechanical support and thoracotomy, the length of hospital and ICU stay, morbid conditions, and deaths of patients with blunt thoracic trauma. METHODS: The records of 152 patients with blunt thoracic trauma were reviewed and data consisting of the patients' age and gender, blood pressure and respiratory rate on admission, the extent of chest wall and intrathoracic injury, types of associated injuries, Glasgow Coma Scale (GCS) scores, the need for mechanical support and thoracotomy, tube thoracostomy duration, length of hospital and ICU stay, morbid conditions, and deaths were collected. The relations between the trauma scoring systems and prognostic factors were evaluated by multivariate analysis. RESULTS: The analysis showed that only TRISS was an independent predictor of mortality and only LIS was an independent predictor of morbidity, the need for thoracotomy, and tube thoracostomy duration. TRISS and LIS were independent predictors of the length of ICU stay. ISS, CWIS, and LIS were independent predictors of the need for mechanical support. RTS, TRISS, ISS and LIS were independent predictors of the length of hospital stay. CONCLUSIONS: The LIS grade appeared to correlate with the severity of blunt thoracic injury and was found to be the most useful scoring system in predicting the outcomes of these patients.

Is lobe-specific lymph node dissection appropriate in lung cancer patients undergoing routine mediastinoscopy?

BACKGROUND: The extent and the necessity of lymph node dissection has yet to be defined after resectional surgery for lung cancer. We aimed to analyze the lobe-specific extent of lymph node positivity in patients who underwent preoperative mediastinoscopy as a routine strategy. METHODS: A total of 280 patients with non-small cell lung cancer with negative mediastinoscopy were operated on in our center between January 1997 and June 2003. Hilar and mediastinal lymphadenectomy was performed in every patient. RESULTS: The most commonly involved lymph nodes were found to be paratracheal station lymph nodes (n = 83; 96.5 %) for right upper lobe tumors, subcarinal station lymph nodes (n = 52; 88.1 %) for right lower lobe carcinomas, aorticopulmonary lymph nodes (n = 62; 92.5 %) for left upper lobe and subcarinal station lymph nodes (n = 49; 96.0 %) for left lower lobe tumors. In the patients with right upper lobe, right lower lobe and left lower lobe tumors, the presence of a tumor at these stations was found to be an indicator for poor prognosis ( P = 0.033, P = 0.0038 and P = 0.0016, respectively). Patients with multiple station N2 disease did not survive beyond 3 years. CONCLUSIONS: In patients who underwent routine mediastinoscopy, lobe-specific lymph node dissection could be recommended. Patients with multilevel N2 involvement did not seem to benefit from resectional surgery.

Beneficial effects of supplemental nitric oxide donor given during reperfusion period in reperfusion-induced lung injury.

BACKGROUND: Reperfusion injury is a perplexing cause of early graft failure after lung transplantation and today we know that reperfusion may be more harmful to tissues than the preceding ischemia. We hypothesized that administration of the nitric oxide donor nitroglycerin (NTG) during flush perfusion and reperfusion periods would ameliorate reperfusion-induced lung injury. METHODS: Using an IN SITU normothermic ischemic lung rabbit model, three groups were studied (n = 7/group): (1) NTG given during flush perfusion (ischemia group); (2) NTG given in the flush perfusion and the reperfusion period (reperfusion group); and (3) no NTG (control group). All groups were flushed with low potassium dextran glucose solution. Blood gas analysis, tissue nitrite (nitric oxide metabolite) level analysis, bronchoalveolar lavage (BAL) fluid examination and morphological examinations were performed. RESULTS: Compared with the ischemia group, the reperfusion group had significantly improved arterial oxygenation (318 +/- 31.4 mmHg vs. 180 +/- 14.7 mmHg, P < 0.05), decreased BAL fluid neutrophil percentage (21 +/- 1.9 % vs. 30 +/- 5.6 %, P < 0.05), increased tissue nitrite level (32.55 +/- 4.12 nmol/g vs. 27.81 +/- 1.05 nmol/g, P < 0.05), and decreased tissue histopathological lesion scores (0.42 +/- 0.53 vs. 1.14 +/- 0.37, P < 0.05). CONCLUSIONS: This study suggests that nitric oxide donors supplemented during flush perfusion and reperfusion have more beneficial effects on lung functions against reperfusion injury than any other treatment modalities during IN SITU normothermic ischemic lung model.

Blunt and penetrating traumatic ruptures of the diaphragm.

BACKGROUND: The difficulties in diagnosing traumatic diaphragmatic rupture (TDR) at the first admission are the most common causes of morbidity and mortality. The purpose of this study was to review our experience with the management of TDR in order to identify the factors contributing to diagnostic delay and associated morbidity and mortality. METHODS: Fourteen patients with TDR were treated in our hospital between January 2000 and June 2005. They have been investigated retrospectively. RESULTS: The study identified 9 men (64 %) and 5 women (36 %), with ages ranging from 19 to 65 years (mean 35.3 years). Rupture of the diaphragm was left-sided in 10 (71 %) and right-sided in 4 (29 %) of the patients. Blunt trauma accounted for the injuries of 11 patients (79 %). Early diagnosis was obtained in 9 patients (64 %). The diagnosis was established preoperatively in 8 patients (57 %), and intraoperatively in 4 (29 %). The diagnosis was missed in 2 (14 %) patients in the first operation. Multiple associated injuries were observed in 12 patients (85 %). Postoperative complications were encountered in five patients (35 %), and the overall mortality was 7 %. CONCLUSIONS: Diaphragmatic rupture should be suspected in all blunt or penetrating traumas of the thorax and abdomen, and the presence of such an injury should be excluded before terminating the exploratory procedure.