Video-Assisted Thoracoscopic Surgery for the First Episode of Primary Spontaneous Pneumothorax

The aim of this study was to evaluate the use of a videothoracoscopic surgical (VATS) approach as the “first-line” treatment for primary spontaneous pneumothorax (PSP). One hundred sixteen patients who were diagnosed with pneumothorax and underwent surgery with VATS technique between January 2016 and January 2018 were included in the study. We observed 60 patients with a first episode of PSP and 56 patients with recurrent PSP who had undergone prior chest tube application. Surgery was done in the first 24 h after hospital admission. Duration of hospital stay and pneumothorax recurrence rate were recorded. Pain level was assessed on the fifteenth day after surgery using the numerical rating scale (NRS). Recurrent pneumothorax patients who were treated with chest tube application after their first episode were asked to evaluate their preference for surgery over chest tube via a questionnaire. Intraoperative bleb/bullous structures were detected in 102 (87.93%) of 116 patients. In the questionnaire of 56 patients with recurrent pneumothorax who had previously undergone chest tube, 44 (78.6%) stated that they would immediately accept operation instead of the chest tube, if recommended. The length of hospitalization was significantly less in patients who underwent surgery in the first episode. There was no statistical difference between pain scores. Employing VATS as the first-line treatment for PSP provides benefits of early return to normal daily life, better clinical satisfaction, and psychosocial outcomes. © 2020, Association of Surgeons of India

Do we really know the duration of pain after rib fracture?

Introduction: The duration of pain after rib fracture is the question physicians are most frequently asked. The duration of pain following a traumatic rib fracture without any comorbidity is not widely published. Aim: We report our experience to investigate the duration of pain following isolated traumatic rib fractures without any traumatic comorbidity. Material and methods: We examined 182 patients with isolated rib fracture without any trauma to other body parts. The numeric rating scale (NRS) for pain was used to rate the level of pain. The NRS pain scores were evaluated in the emergency department at presentation, on the 15th day, and at the 3rd and 6th months of trauma. The Mann-Whitney U test was performed for the statistical analysis. Results: The pain level of young patients on the 15th day and at the third month and sixth month was lower than that in the old group, and the difference was statistically significant. While patients with two rib fractures had a higher pain level in the emergency room than those with one rib fracture, there was no statistically significant difference at other time points. In patients with anterior fractures, the pain level was significantly lower than in the lateral and posterior regions, whereas in the lateral fractures, the pain score was significantly higher than others at all time points except at the 6th month. The pain score of displaced fractures was significantly higher than that of non-displaced ones at all time points except the 6-month follow-up. Conclusions: Rib fractures cause significant pain and need appropriate medication. The time of the 6th month could be an important milestone. © 2018 Termedia Publishing House Ltd. All rights reserved

A thymic neuroendocrine carcinoma presenting with upper gastrointestinal bleeding: A case report

Neuroendocrine carcinomas of the thymus are rare clinical entities, which can be complicated by endocrine abnormalities. These tumors are frequently associated with ectopic adrenocorticotropic hormone production giving rise to Cushing's syndrome. Herein, we describe a 23-year-old male case with upper gastrointestinal bleeding as the initial presentation of a thymic neuroendocrine carcinoma. This case was reported due to its extremely exceptional occurrence. © 2017 All right reserved by the Turkish Society of Cardiovascular Surgery