Prognostic factors and their effects on mortality in patients with COVID-19 with pneumothorax.

Background: The aim of this study was to investigate the factors affecting pneumothorax development, lung expansion difficulty, and the impact on mortality in novel coronavirus 2019 (COVID-19) patients. Methods: Between March 2020 and January 2021, a total of 6,108 COVID-19 patients (3,050 males, 3,058 females; mean age: 49±17.6 years, range, 12 to 89 years) who presented to our hospital were retrospectively analyzed. The patients were divided into two groups. Group 1 (the COVID-19-pneumothorax group) consisted of patients developing pneumothorax while under treatment for COVID-19. Group 2 (COVID-19-without pneumothorax group) consisted of consecutive patients with pulmonary involvement during the same period, requiring intensive care, but not developing pneumothorax. Biochemical test results were examined for the day of hospitalization, day of transfer to intensive care unit, and Day 5 of intensive care unit stay. Lung parenchyma involvement rates on thoracic computed tomography, duration of drainage, duration of intensive care unit stay, and morbidity/mortality data were investigated. Results: Of all patients with COVID-19, 2,342 were admitted to our clinic and 460 needed intensive care. Pneumothorax developed in 21 patients (0.34% of all patients and 0.9% of hospitalized patients). Significant involvement diffusion on computed tomography, ferritin and D-dimer elevation, and low lymphocyte (%) values were observed in the COVID-19 patients with pneumothorax. Pneumothorax development, and ferritin and D-dimer elevation were most correlated with mortality at regression analysis. There was a significant difference in difficulty in lung expansion between COVID-19 patients who developed pneumothorax and who did not. Conclusion: Pneumothorax may develop in COVID-19 patients whose biochemical parameters worsen, and expansion difficulty may be experienced, which is likely to be associated with mortality.

The association between pneumothorax onset and meteorological parameters and air pollution.

BACKGROUND: The aim of this study was to investigate the possible relation of meteorological parameters and air pollutant particle concentrations with the incidence of spontaneous pneumothorax in the Bolu region of Turkey. METHODS: Between January 2015 and February 2019, a total of 200 patients (175 males, 25 females; mean age 42.5±19.9 years, range, 10 to 88 years) with spontaneous pneumothorax were retrospectively analyzed. For each day, standard weather parameters including daily average temperature, relative humidity, wind speed, actual pressure, and daily total precipitation and concentration of air pollutants (PM10 and SO2) were recorded. RESULTS: During the study period, there were 200 cases with spontaneous pneumothorax within 178 days. The number of days with spontaneous pneumothorax represented 11.8% of the total number of days (1,504 days). In the study, 76.9% of the days with spontaneous pneumothorax were clustered. All meteorological (temperature, humidity, pressure, wind speed, and precipitation) and air pollution parameters (PM10 a nd SO2) were available for 1,438 days (95.61%) and 853 days (56.71%), respectively. There was a significant relationship between spontaneous pneumothorax and air temperature (r=-0.094, p=0.001), and air pollution (PM10, r=-0.080, p=0.020; SO2, r=-0.067, p=0.045). CONCLUSION: Our study results show a relationship between spontaneous pneumothorax and air temperature, and air pollution. Preventing air pollution, which is a public health problem, can lead to a reduction in spontaneous pneumothorax.

Is Pectus Excavatum a Risk Factor for Spontaneous Pneumothorax? "Haller Index Measurements in Patients with Primary Spontaneous Pneumothorax".

Aim: In this study, we aimed to retrospectively investigate whether pectus excavatum (PE) is a risk factor for the development of primary spontaneous pneumothorax (PSP) and to determine its role in the etiology of the disease. Materials and Methods: Chest-computed tomography (CT) of the patients who were treated for spontaneous pneumothorax between January 2015 and December 2017 in our clinic was examined, and their Haller indices were measured (group I). The patients in the control group who underwent chest CT for other reasons during the same period and were in the same age with the group I were also included in the study (group II) Results. In group I, for patients with PE, the mean Haller index was 2.41, while it was 2.09 in the control group (group II). There was a significant difference between the two groups. Conclusions: PE deformities in the chest wall may predispose to the development of spontaneous pneumothorax, and PE may be among the etiologic factors of spontaneous pneumothorax. Therefore, there is a need for studies involving larger patient groups.

Surgery for Pulmonary Hydatidosis in Turkey in 2014: A Nationwide Study.

OBJECTIVES: Turkey remains among the countries where hydatid disease is endemic. In this study, it was aimed to determine the number of operations performed for the treatment of pulmonary hydatid disease in Turkey during 2014 and to present the distribution of these operations according to the different regions of the country. MATERIALS AND METHODS: The Turkish Thoracic Society Thoracic Surgery Study Group connected with the thoracic surgeons in each city through telephone. A data set was sent by email. The age, sex, contact with animals that might be a risk of gaining the hydatid disease, the side of the disease, the type of surgical method, other organ involvement were recorded and collected from each data set to form the final data, and the results were evaluated. Turkey comprises of 81 cities that are grouped in seven different regions. The number of operations was calculated for each city and region to present the distribution. RESULTS: Overall, 101 centers from 81 cities were considered in the study. A total of 715 pulmonary hydatid cyst operations were performed in 690 patients during the study period. The most common operation technique was cystotomy and capitonnage through thoracotomy (76%). The highest incidence rate of operated patients was in the Eastern Anatolian Region (2.15 patients per 100 000 person-years). CONCLUSION: Pulmonary hydatid disease still has a high incidence rate particularly in the southeast and east of Turkey, which are mainly rural areas and where stockbreeding is very common. Cystotomy and capitonnage is still the most common surgical method used to treat pulmonary hydatid cysts. Preventive methods should be performed strictly in these cities and regions to decrease the risk of infection.

The effects of ankaferd blood stopper on the recovery process in an experimental oesophageal perforation model.

BACKGROUND: Oesophageal perforation is a life-threatening pathology that is generally treated conservatively; however, surgical procedures are frequently performed. A topical haemostatic agent, Ankaferd Blood Stopper (ABS), also has beneficial wound-healing effects. AIMS: This study aimed to determine the effects of ABS following experimental oesophageal perforations. STUDY DESIGN: Animal experiment. METHODS: The experimental rats were classified into 6 groups (with 7 rats in each group). Pairs of groups (primary repair alone and primary repair + ABS) were terminated in the 1(st), 2(nd), and 3(rd) weeks following injury. The oesophageal perforations, which were 8-10 mm in length, were created using a nasogastric tube. The perforation sites were repaired with a 6-0 polyglactine thread in the primary repair groups. Additionally, ABS was sprayed over the perforation site in the treatment groups. Each oesophagus was evaluated histopathologically. RESULTS: There were fewer microabscesses and areas of necrosis in the ABS groups compared with the primary repair groups. The histopathological evaluation revealed that the ABS groups had less inflammation and more re-epithelisation compared to the primary repair groups (p=0.002 and p=0.003, respectively). Fibrosis in the ABS groups was moderate in the 2(nd) week and mild in the 3(rd) week. Comparing the groups with respect to the time intervals, only the 1(st) week groups showed a significant difference in terms of re-epithelialisation (p=0.044). CONCLUSION: Topical ABS application on the repaired experimental oesophageal perforation regions led to positive wound-healing effects compared with the rats that were administered the primary repair alone.

The effect of erythropoietin to pulmonary injury and mast cells secondary to acute pancreatitis.

BACKGROUND: Acute pancreatitis is a life-threatening necroinflammatory disease that is characterized by systemic inflammatory response syndrome and acute lung injury even in its very first days. Erythropoietin (EPO) is a hormone considered as an antiapoptotic and cytoprotective with observed receptors of anti-inflammatory effect on organs apart from the liver and the kidneys. In this study, the effects of EPO on pulmonary mast cells and on secondary injury caused by acute pancreatitis are investigated. METHODS: Twenty one Wistar Albino rats were divided into three groups--sham, control, and EPO groups-with 7 rats per group. Pancreatitis was induced by administering 4.5% sodium taurocholate into the pancreatic duct. A 1000 U/kg/day dosage (three times) of EPO was administered to the EPO group. Blood urea nitrogen (BUN), creatinine, amylase, and troponin I in the serum were studied; and lung, kidney, brain, and heart tissues were examined histopathologically. RESULTS: There were no histopathological changes in the other organ tissues except for the lung tissue. Compared to the control group, the EPO group showed significantly reduced alveolar hemorrhage, septal neutrophil infiltration, lung wall thickness score, and mast cell count in the lung tissue. CONCLUSIONS: Administration of EPO reduces the mast cell count and lung wall thickness, and it reduces the alveolar hemorrhage and septal infiltration induced by acute pancreatitis.

A unique case of right-sided Poland syndrome with true dextrocardia and total situs inversus.

Poland syndrome has been reported to be associated with true dextrocardia, but not with true situs inversus. In this report, we describe the first patient with total situs inversus in medical literature and try to highlight the syndrome's probable etiology and pathogenetic mechanisms in utero.

Prognostic stratification of patients with T3N1M0 non-small cell lung cancer: which phase should it be?

In the 1997 revision of the TNM staging system for lung cancer, patients with T3N0M0 disease were moved from stage IIIA to stage IIB since these patients have a better prognosis. Despite this modification, the local lymph node metastasis remained the most important prognostic factor in patients with lung cancer. The present study aimed to evaluate the prognosis of patients with T3N1 disease as compared with that of patients with stages IIIA and IIB disease. During 7-year period, 313 patients with non-small cell lung cancer (297 men, 16 women) who had resection were enrolled. The patients were staged according the 2007 revision of Lung Cancer Staging by American Joint Committee on Cancer. The Kaplan-Meier statistics was used for survival analysis, and comparisons were made using Cox proportional hazard method. The 5-year survival of patients with stage IIIA disease excluding T3N1 patients was 40%, whereas the survival of the patients with stage IIB disease was 66% at 5 years. The 5-year survival rates of stage III T3N1 patients (single-station N1) was found to be higher than those of patients with stage IIIA disease (excluding pT3N1 patients, P = 0.04), while those were found to be similar with those of patients with stage IIB disease (P = 0.4). Survival of the present cohort of patients with T3N1M0 disease represented the survival of IIB disease rather than IIIA non-small cell lung cancer. Further studies are needed to suggest further revisions in the recent staging system regarding T3N1MO disease.

Bronchocentric granulomatosis in a patient with rheumatoid arthritis.

Bronchocentric granulomatosis is an uncommon entity which has no specific clinical, radiological and immunological features. It is usually diagnosed at morphological examination of biopsy or resected lung material. Aetiology of bronchocentric granulomatosis is unclear. A 49-year-old female patient, who was followed up with diagnosis rheumatoid arthritis in our outpatient clinic, presented with right lobe nodular lesion in chest radiography. Right thoracotomy and wedge resection was performed. Pathological examination revealed bronchocentric granulomatosis. Bronchocentric granulomatosis has been rarely reported in rheumatoid arthritis. This case might be a proof that bronchocentric granulomatosis may be one of the respiratory manifestations of rheumatoid arthritis.

Accuracy of positron emission tomography in mediastinal node assessment in coal workers with lung cancer.

The purpose of this study was to explore the accuracy of (18)F-fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography (PET/CT) in the assessment of mediastinal lymph node in coal workers who had non-small cell lung cancer. We retrospectively reviewed 42 retired coal workers who had lung cancer without distant metastasis, between May 2007 and May 2010. Regarding the mediastinal lymph nodes, when the standard uptake value was greater than 2.5, it was considered "malignancy positive." After histological examination of the mediastinal lymph nodes, anthracotic and metastatic ones were detected. The results of PET/CT were analyzed to determine its accuracy. Of these 42 patients, PET/CT detected 47 positive mediastinal lymph nodes in 24 patients with a mean SUV maximum of 6.2 (2.6-13.8). One hundred and thirty-one mediastinal lymph node foci were dissected. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FDG-PET/CT in detecting nodal metastases were 84% (16/19), 65% (15/23), 66% (16/24), 83% (15/18), and 74% (31/42) on a per-patient basis, respectively. Mediastinal node staging with FDG-PET/CT in coal workers is insufficient due to the high false-positive rates due to the presence of pneumoconiosis. In these patients, an invasive technique such as mediastinoscopy seems mandatory for confirmation of ipsilateral or contralateral mediastinal lymph node metastasis.

Effect of Ankaferd Blood Stopper on air leakage in the lung and prevention of bleeding: an experimental study.

BACKGROUND: Air leakage and hemorrhage are important causes of morbidity and mortality in operations and traumas of the lung. Ankaferd Blood Stopper is a herbal product used for stopping hemorrhage. In our study, we investigated the efficacy of Ankaferd Blood Stopper in the prevention of air leakage in the lung and bleeding. METHODS: A total of twenty-one Wistar-Albino rats weighing 240 ± 20 grams were used in our study. An equal amount of injury was created in all groups by performing left thoracotomies. No interventions were made on tissue injury in the first group, and suturing was performed in the second group, and Ankaferd was applied in the third group. Air leakage and duration of bleeding were recorded in all groups. RESULTS: A statistically significant difference was found between the three groups in terms of air leakage time (p = 0,0001) and bleeding time (p = 0,0001). While a significant effect of Ankaferd was detected in terms of air leakage compared to standard surgery (p = 0,017), no difference was found in terms of bleeding time. CONCLUSIONS: Ankaferd Blood Stopper ceases the air leakage in the lung parenchyma significantly and effectively. No significant difference is seen compared to the standard surgery group, although it ceases bleeding significantly.

Lactate dehydrodgenase levels predict pulmonary morbidity after lung resection for non-small cell lung cancer.

OBJECTIVE: The prevention of pulmonary complication after pulmonary resection for non-small cell lung cancer may minimize postoperative mortality rates and hospitalization period. The purpose of this study was to identify preoperative factors associated with the development of pulmonary complications after lung resections to help predict which patients are at increased risk for morbidity. METHODS: From January 2000 to June 2003, 108 consecutive pulmonary resections were performed for non-small cell lung cancer in our institution. The following information was recorded: demographic, clinical, functional, and surgical variables. We evaluated all complications, which arose after pulmonary resection during hospitalization. The risk of complication was evaluated using univariate and multiple logistic regression analysis to estimate odds ratio. RESULTS: Sixty-six lobectomies, 31 pneumonectomies, 11 bilobectomies and four wedge resections were done. Forty-nine complications were realized in all patients. A logistic regression analysis on relevant variables showed that only the increased serum lactate dehydrogenase (LDH) levels (>320 U/l) was a significant predictor of a pulmonary complication (P=0.03). Age, side of resection, low FEV(1), stage of the disease, low partial arterial oxygen pressure, low partial arterial carbon dioxide pressure, cigarette smoking and concomitant disease were not significant predictors of morbidity. CONCLUSION: Patients who have higher serum LDH levels are at increased risk for developing postoperative morbidity. Postoperative physical therapy and medical care might be intensified in those patients at high risk.

Prognostic significance of surgical-pathologic multiple-station N1 disease in non-small cell carcinoma of the lung.

OBJECTIVES: The surgical outcome of pathologic N1 disease in resectable non-small cell lung carcinoma (NSCLC) is controversial. The prognosis of the patients with multiple/bulky N2 disease was invariably dismal. However, the prognostic significance of tumor involvement in more than one hilar or intralobar lymph node station has not been fully described. METHODS: From 1996 to 2002, 181 patients with NSCLC had complete resection. Four levels of N1 nodes and N2 nodes were identified using the new regional lymph node classification for lung cancer staging. There were 67 patients (37%) with no nodal disease (N0), 43 patients (24%) with N1 and 71 patients (39%) with N2 disease. The N1 subgroup cases were reviewed. The prognostic significances of single and multiple N1 diseases were tested. RESULTS: The cumulative postoperative survival at 3 and 5 years was 57 and 29%, respectively. The survival associated with single-station N1 disease was significantly better than that of multiple-station N1 disease (45 vs 32% at 5 years; P=0.03). Five-year survival was similar in patients with multiple N1 disease and patients with single-station N2 involvement (32 vs 31% at 5 years; P=0.84). However, no patient survived when tumor was detected in more than one mediastinal station (i.e. multiple N2 disease). CONCLUSIONS: It was suggested that N1 disease is a compound of two subgroups: one involving in one node and the other (multiple N1 disease) in which the postoperative prognosis was not statistically different from that of N2 disease.

Nonanatomic prognostic factors in resected nonsmall cell lung carcinoma: the importance of perineural invasion as a new prognostic marker.

BACKGROUND: A number of prognostic factors have been reported for resected nonsmall cell lung carcinoma. Although none of them reported to have greater prognostic impact than the TNM staging system, which is based on anatomical descriptions of tumors, the prognoses of a significant number of patients are not in agreement with real survival of the patients. Moreover, certain histopathologic properties of the tumor (such as lymphatic and vascular invasion) could help to predict the survival of the patients. METHODS: A retrospective study was conducted on 82 surgically resected nonsmall cell lung carcinomas, and the following prognostic factors were evaluated in univariate analysis: age, gender, clinical and surgical-pathologic T and N status, histologic type of tumor, grade of differentiation, lymphatic invasion, vascular invasion, and perineural invasion. RESULTS: Lymphatic invasion and perineural invasion of the tumor were found to be significant prognostic factors (p = 0.02 and p = 0004). Blood vessel invasion (venous or arterial involvement) had no prognostic impact (p > 0.05). According to multivariate analyses, three factors were selected as prognostic indicators: (1) clinical N status (p = 0.027), (2) lymphatic invasion (p = 0.027) and (3) perineural invasion (p = 0.0148). By combining these factors we identified a poor prognostic subgroup of patients with stage I disease. CONCLUSIONS: Our study showed that lymphatic vessel and perineural invasion of the tumor could be prognostic factors, along with anatomical determinants such as cN and surgical-pathologic stage of the pulmonary carcinoma.