Erythrocyte Sedimentation Rate May Predict Diagnosis of Lymphoma Without Fine-needle Aspiration Biopsy: A Retrospective Study

Objective:To assess the relationship between routine blood values recorded before fine-needle aspiration biopsy (FNAB) and final diagnosis in patients whose diagnoses could not be confirmed with FNAB, necessitating surgical excisional biopsy (SEB) as a second invasive procedure.Method:The data of patients who could not be diagnosed via FNAB and who underwent SEB of the cervical lymph node between March 2014 and March 2019 in the otolaryngology department of a research hospital were evaluated retrospectively. According to the definitive diagnosis determined by SEB, the cases were divided into 3 groups as follows: 1) benign, 2) other malignancies, 3) lymphoma.Results:The frequency of males in the other malignancies group was significantly higher compared to the other two groups (p=0.007). Compared to the other two groups, C-reactive protein levels were statistically significantly lower in the benign group (p=0.001). Erythrocyte sedimentation rate (ESR) in the lymphoma group was significantly higher than in the other groups (p35.5 mm/hr (area under the curve= 0.784, 95% confidence interval: 0.708-0.861, p<0.001).Conclusion:Although ESR is non-specific for the diagnosis of lymphoma in asymptomatic patients, it may be a supportive marker to reduce repetitive invasive procedures in symptomatic patients who may require cervical lymph node biopsy for diagnosis

International expert consensus on the management of bleeding during VATS lung surgery

Intraoperative bleeding is the most crucial safety concern of video-assisted thoracic surgery (VATS) for a major pulmonary resection. Despite the advances in surgical techniques and devices, intraoperative bleeding is still not rare and remains the most common and potentially fatal cause of conversion from VATS to open thoracotomy. Therefore, to guide the clinical practice of VATS lung surgery, we proposed the International Interest Group on Bleeding during VATS Lung Surgery with 65 experts from 10 countries in the field to develop this consensus document. The consensus was developed based on the literature reports and expert experience from different countries. The causes and incidence of intraoperative bleeding were summarised first. Seven situations of intraoperative bleeding were collected based on clinical practice, including the bleeding from massive vessel injuries, bronchial arteries, vessel stumps, and bronchial stumps, lung parenchyma, lymph nodes, incisions, and the chest wall. The technical consensus for the management of intraoperative bleeding was achieved on these seven surgical situations by six rounds of repeated revision. Following expert consensus statements were achieved: (I) Bleeding from major vascular injuries: direct compression with suction, retracted lung, or rolled gauze is useful for bleeding control. The size and location of the vascular laceration are evaluated to decide whether the bleeding can be stopped by direct compression or by ligation. If suturing is needed, the suction-compressing angiorrhaphy technique (SCAT) is recommended. Timely conversion to thoracotomy with direct compression is required if the operator lacks experience in thoracoscopic angiorrhaphy. (II) Bronchial artery bleeding: pre-emptive clipping of bronchial artery before bronchial dissection or lymph node dissection can reduce the incidence of bleeding. Bronchial artery bleeding can be stopped by compression with the suction tip, followed by the handling of the vascular stump with energy devices or clips. (III) Bleeding from large vessel stumps and bronchial stumps: bronchial stump bleeding mostly comes from accompanying bronchial artery, which can be clipped for hemostasis. Compression for hemostasis is usually effective for bleeding at the vascular stump. Otherwise, additional use of hemostatic materials, re-staple or a suture may be necessary. (IV) Bleeding from the lung parenchyma: coagulation hemostasis is the first choice. For wounds with visible air leakage or an insufficient hemostatic effect of coagulation, suturing may be necessary. (V) Bleeding during lymph node dissection: non-grasping en-bloc lymph node dissection is recommended for the nourishing vessels of the lymph node are addressed first with this technique. If bleeding occurs at the site of lymph node dissection, energy devices can be used for hemostasis, sometimes in combination with hemostatic materials. (VI) Bleeding from chest wall incisions: the chest wall incision(s) should always be made along the upper edge of the rib(s), with good hemostasis layer by layer. Recheck the incision for hemostasis before closing the chest is recommended. (VII) Internal chest wall bleeding: it can usually be managed with electrocoagulation. For diffuse capillary bleeding with the undefined bleeding site, compression of the wound with gauze may be helpful

A Giant Cervical Lymphangioma

Cervical lymphangiomas are benign congenital malformations of lymphatic system usually seen in children under 2 years of age. It is rare in adults. They can be seen in any part of the body but the most common area in the neck region is posterior triangle. They usually present as asymptomatic masses. There are various ways of treatment, but the most common treatment modality is surgical resection. Here, the authors present a giant lymphangioma in the neck region of an adult who is treated with surgical resection without any complication