The comparison of pleurodesis effects of iodopovidone at different concentrations and magnesium silicate: An experimental study.

BACKGROUND: This experimental study aims to investigate the pleurodesis effects of iodopovidone at different concentrations (2% and 4%) and sterile talc in a rat model. METHODS: Forty male Wistar Albino rats were randomly divided into four equal groups including 10 rats in each group. Groups 1, 2, and 3 were designed as the study, and Group 4 as the control group. In Group 1, 4 g sterile talc was given in the slurry form at 20 mL 0.9% saline solution, in Group 2 and Group 3 10% iodopovidone solution were given at 4% and 2% concentrations, respectively, and in Group 4, 0.9% saline was only administrated as 3 mL into the pleural space. All rats were sacrificed on Day 30 and evaluated for macroscopic and microscopic examination. Microscopic evaluation was performed for alveolar collapse, alveolar hemorrhage, alveolar infiltration and fibrosis. Brain, liver, and kidney tissues were also examined. RESULTS: Iodopovidone macroscopically caused a significant adhesion similar to sterile talc at a concentration of 4%. The pleurodesis effect of iodopovidone at a concentration of 4% was significantly similar to talc, when microscopic parameters were evaluated. Granulomas due to sterile talc were observed in the opposite hemithorax. Brain, liver, and kidney examinations revealed no systemic distribution for both agents. CONCLUSION: Iodopovidone is a powerful alternative to sterile talc with its easy accessibility and low cost. In this study, 4% iodopovidone was found to provide effective and safe pleurodesis in rats. We believe that the use of this concentration in clinical studies would provide more effective results.

Which Is More Effective for Minimally Invasive Pectus Repair: Epidural or Paravertebral Block?

Objective: The aim of this study was to compare the effectiveness of epidural block (EDB) and paravertebral block (PVB) for minimally invasive pectus repair with the conventional method in terms of pain control during and after pectus operations, patient comfort, and length of stay in hospital. Materials and Methods: A retrospective review was made of patients who underwent minimally invasive pectus repair. The patients were allocated into three groups as follows: PVB group (Pre-emptive ultrasound-guided bilateral thoracic single injection PVB, n = 15); EDB group (Pre-emptive landmark-guided single injection thoracic EDB, n = 8); and Control group (Neither PVB nor EPB, n = 9). The intraoperative analgesic requirement was recorded, and a visual analog scale (VAS) for pain evaluation and the Postoperative Patient Satisfaction Scale were applied to all patients. Results: The intraoperative analgesic requirement, VAS scores, postoperative satisfaction level, and time to first requirement for postoperative analgesia were different between the control and PVB groups (P < .001) and between the control and EDB groups (P < .001), but not different between the PVB and EDB groups. Although the length of stay in hospital was shorter in the PVB and EDB groups compared to the control group, the difference was not statistically significant (P = .422). Conclusion: Epidural and bilateral paravertebral blockades performed in conjunction with general anesthesia decrease the intraoperative and postoperative need for analgesics, and might be beneficial for pain management and contribute to a shorter length of hospital stay for patients undergoing minimally invasive pectus repair operations. Both blockades also significantly improved the patient satisfaction.

The relation between scapula fracture and the severity of trauma in blunt thoracic trauma

Background/aim: The aim of this study was to determine the level of presence of scapula fractures (SFs) in cases of blunt thoracic trauma and to identify other injuries accompanying SF. Materials and methods: Blunt thoracic trauma cases with SF determined on direct radiography or computerized tomography (CT) were categorized as Group 1. Group 2 was constituted by selecting cases with high injury severity score (ISS) with no SF. The demographic characteristics and all injuries of the patients were evaluated. Results: SF was determined in 77 (11.3%) patients (Group 1), and Group 2 consisted of 607 patients. The ISS was significantly higher in Group 1 (27.7 ± 16.1) than Group 2 (15.9 ± 9.5) (P < 0.001). The rate of SF with direct radiography was only 9.1%, and more than 90% of patients were evaluated using CT. The most common accompanying injury to SF was rib fracture (44.2%), and the odds ratio was 2.4 (95% CI: 1.51­3.72). Conclusion: The incidence of SF in cases of blunt trauma was higher than in previous studies. The use of CT in blunt trauma can determine SF that cannot be identified through physical examination or radiography, and the most commonly observed accompanying damage in these patients is rib fracture.

Long-term survival after R0 resection of thymoma.

Background The aim of this study was to evaluate the results of R0 resection of thymoma to identify prognostic factors for long-term outcomes. Methods Data of 62 patients (28 male, 34 female) with a mean age of 47.26 ± 14.42 years, who underwent R0 resection for thymoma and were followed-up between February 2004 and March 2016, were analyzed retrospectively. Results Eight patients had a video-assisted thoracoscopic thymectomy and 54 had a transsternal extended thymectomy. During a mean follow-up of 128.67 ± 7.95 months, regional recurrence of thymoma was observed in 9 (14.5%) patients. Overall 5- and 10-year survival rates were 85.36% and 78.20%, respectively. The 5- and 10-year survival rates in patients aged < 50 years were significantly better than in those aged ≥ 50 years (92% and 72% vs. 88% and 39%, p < 0.0001). The 10-year overall survival of patients in Masaoka stage I and II was better than those in stage III (88.9%, 78.4%, 69.8%, respectively, log-rank p < 0.001). The 10-year survival of patients with World Health Organization histological type A, AB, and B1 thymomas was better than those with type B2 and B3 (log-rank test p < 0.001). In multivariate analysis, age < 50 years ( p = 0.001), Masaoka stage ( p = 0.006), histological type ( p = 0.001), and recurrence ( p = 0.04) were independent prognostic factors for survival. Conclusion Our study indicates that age < 50 years, Masaoka stage, histological type, and recurrence are the determinants of survival in surgically resected cases of thymoma.

Painful Chest Wall Swellings: Tietze Syndrome or Chest Wall Tumor?

BACKGROUND: Tietze syndrome (TS) is an inflammatory condition characterized by chest pain and swelling of costochondral junction. Primary chest wall tumors may mimic TS. In this article, we report our experience of approximately 121 patients initially diagnosed as TS and determined chest wall tumor in some cases at the follow-up. METHODS: This is a retrospective review of patients diagnosed as TS by clinical examination, chest X-ray, electrocardiogram, routine laboratory tests, and computed tomography (CT) of chest: all treated and followed up between March 2001 and July 2012. There were 121 cases (41 males and 80 females; mean age, 39.6 ± 3.2 years) of TS. RESULTS: In 27 patients with initial normal radiological findings, the size of swellings had doubled during the follow-up period (mean, 8.51 ± 2.15 months). These patients were reevaluated with chest CT and bone scintigraphy and then early diagnostic biopsy was performed. Pathologic examination revealed primary chest wall tumor in 13 patients (5 malignant, 8 benign). CT had a sensitivity of 92.3% and a specificity of 64.2% in detection of tumors (kappa: 0.56, p = 0.002), whereas the sensitivity and the specificity of bone scan were 84.6 and 35.7%, respectively (kappa: 0.199, p = 0.385). CONCLUSION: Primary chest wall tumors could mimic TS. Bone scintigraphy or CT is not specific enough to determine malignant and other benign disorders of costochondral junction. Therefore, clinicians should follow TS patients more closely, and in case of increasing size of swelling, early diagnostic biopsy should be considered.

Quantative computerized tomography assessment of lung density as a predictor of postoperative pulmonary morbidity in patients with lung cancer.

BACKGROUND: The aim of this study was to evaluate the pulmonary reserve of the patients via preoperative quantitative computerized tomography (CT) and to determine if these preoperative quantitative measurements could predict the postoperative pulmonary morbidity. METHODS: Fifty patients with lung cancer who underwent lobectomy/segmentectomy were included in the study. Preoperative quantitative CT scans and pulmonary function tests data were evaluated retrospectively. We compare these measurements with postoperative morbidity. RESULTS: There were 32 males and 18 females with a mean age of 54.4±13.9 years. Mean total density was -790.6±73.4 HU. The volume of emphysematous lung was (<-900 HU) 885.2±1,378.4 cm(3). Forced expiratory volume in one second (FEV1) (r=-0.494, P=0.02) and diffusion capacity of carbon monoxide (DLCO) (r=-0.643, P<0.001) were found to be correlate with the volume of emphysematous lung. Furthermore FEV1 (r=0.59, P<0.001) and DLCO (r=0.48, P<0.001) were also found to be correlate with mean lung density. Postoperative pulmonary morbidity was significantly higher in patients with lower lung density (P<0.001), larger volume of emphysema (P<0.001) and lower DLCO (P=0.039). A cut-off point of -787.5 HU for lung density showed 86.96% sensitivity and 81.48% specificity for predicting the pulmonary morbidity (kappa =-0.68, P<0.001). Additionally a cut-off point of 5.41% for emphysematous volume showed 84.00% sensitivity and 80.00% specificity for predicting the pulmonary morbidity (kappa =0.64, P<0.001). According to logistic regression analyses emphysematous volume >5.41% (P=0.014) and lung density <-787.5 HU (P=0.009) were independent prognostic factors associated with postoperative pulmonary morbidity. CONCLUSIONS: In this study, the patients with a lower lung density than -787.5 HU and a higher volume of emphysema than 5.41% were found to be at increased risk for developing postoperative pulmonary morbidity. More stringent precautions should be taken in those patients that were found to be at high risk to avoid pulmonary complications.

Elastofibroma dorsi management and outcomes: review of 16 cases.

OBJECTIVES: Elastofibroma dorsi (ED) is a rare, benign lesion arising from connective tissue, usually found at the inferior pole of the scapula. To date, only a few small series have been reported in the English literature and there are few data about the long-term outcomes after surgery. Our goal is to contribute a better understanding of this tumour and to determine the long-term outcomes after surgery. METHODS: Sixteen patients with a diagnosis of ED were identified from the unit's database. The clinical presentation, diagnosis, pathological evidences and long-term outcomes were evaluated. RESULTS: There were 11 females and 5 males with a mean age of 61.1 years (range 38-78 years). The tumour was located on the right in 5 (31.2%) patients, on the left in 6 (37.5%) patients and bilaterally in 5 (31.2%). Six patients had painful scapular swelling resulting in restriction of movement of the shoulder whereas 10 reported only painful scapular mass. All 16 patients underwent complete resections. The tumour size ranged from 3 to 15 cm. The mean hospital stay was 3.1 ± 1.4 days with a morbidity of 18.75% (seroma observed in 3 patients). The mean follow-up was 58.4 ± 29.5 months (range 11-92 months). In 2 patients (12.5%) a new occurrence on the contralateral side was observed at the follow-up. CONCLUSIONS: Elastofibroma dorsi is a rare, ill-defined, pseudotumoural lesion of the soft tissues. Surgical treatment can be proposed if the lesion is symptomatic. Furthermore, at the follow-up, the possibility of new occurrences on the contralateral side should be kept in mind.

Single port thoracoscopic sympathectomy for primary palmar hyperhidrosis in adolescence.

AIM: Hyperhidrosis is defined as excessive sweating beyond the physiologic needs of a person. Palmar hyperhidrosis in the adolescent period may have an impact on school work and may cause psychological problems. In this study we aim to increase awareness of this disregarded problem. MATERIALS AND METHODS: We explicated the early outcomes of 7 consecutive adolescents, where single port video-assisted thoracoscopic sympathectomy was performed for primary palmar hyperhidrosis. Patients were evaluated for symptom resolution, which was defined as complete dryness, patient satisfaction, operative complications, and compensatory sweating. RESULTS: In total 13 thoracoscopic procedures were done in 7 adolescents, consisting of 4 girls and 3 boys (median age = 16 years). Thoracoscopic sympathectomy achieved immediate complete dryness and all were very satisfied with the outcome of the procedure. Compensatory sweating was defined as mild by 4 (57%) patients. CONCLUSION: Thoracoscopic sympathectomy is safe and effective for the treatment of primary palmar hyperhidrosis in the adolescent period without any major side effects.

Traumatic pulmonary pseuodocysts: two case reports.

Traumatic pulmonary pseudocyst (TPP) is a rare complication, sometimes encountered after blunt thoracic trauma and even more rarely following penetrating injuries. It is more common among pediatric and young adult patients. Although TPP is usually benign in nature, complications associated with hemoptysis and secondary infection may develop. The treatment is conservative. In this report, we present two rare cases of TPP occuring after a high-speed accident and a stab wound injury, where conservative treatment provided good outcomes.

Intrathoracic humeral head fracture-dislocation: is removal of the humeral head necessary?

Intrathoracic fracture dislocation of the humeral head due to a blunt trauma is very rare. It may be accompanied by local and systemic injuries associated with high-energy trauma. Because a limited number of cases were reported, appropriate treatment modality remains unclear. A case of intrathoracic humeral head fracture-dislocation caused by a high-speed motor vehicle accident is presented herewith, along with the treatment methods used within the scope of the current literature.

Rapid pleurodesis in symptomatic malignant pleural effusion.

OBJECTIVE: The objective of the study was to see whether a rapid method of pleurodesis was superior to the standard protocol in patients with symptomatic malignant pleural effusion. METHODS: Between January 2000 and February 2003, a prospective randomised trial was carried out in a sequential sample of 27 patients with malignant pleural effusions documented cytopathologically. Twelve patients were allocated to group 1 (standard protocol) and 15 to group 2 (new protocol). A small-bore catheter (12 Fr) and oxytetracycline (35 mg/kg of body weight) were used in both groups. In group 1, patients had drainage until radiological evidence of lung re-expansion was obtained and the amount of fluid drained was less than 150 ml/day, before oxytetracycline was instilled. The catheter was removed when the amount of fluid drained after instillation was less than 150 ml/day. In group 2, patients had the oxytetracycline instilled in a fractionated-dose manner following frequent aspirations at 6h intervals. The catheter was removed when the total amount of fluid drained after instillation of the oxytetracycline [OT] was less than 150 ml/last three aspirations. Response was evaluated at 1, 3 and 6 months after pleurodesis. RESULTS: There was no statistically significant difference in the demographic features, site of the primary tumour, disease characteristics, and response rates in any evaluation period in both groups (P>0.05). However, the number of days of drainage and hospitalisation, and the cost were significantly lower in the second group (P<0.001). CONCLUSIONS: This new pleurodesis method provided shorter hospital stay resulting in superior cost-effectiveness and palliation without sacrificing the efficacy of pleurodesis.