Evaluation of the anatomical and electrical axis of the heart after pneumonectomy

Aim: To investigate the position of the heart after pneumonectomy and, also to find out how the changes in the electrical axis of the heart contribute for the possible electrocardiographic and echocardiographic changes. Methods: Ninety-eight patients with pneumonectomy were included to this observational study. To calculate the rotation of the heart and angle measurement two perpendicular lines, one septal and another atrioventricular, were drawn on the images acquired from thoracic computed tomography. Thoracic CT were taken at every 3 months for the first two years. On electrocardiograms net QRS vectors, amplitudes of p waves, findings of right and left ventricular hypertrophy, and other possible changes were recorded. Results: The mean age of all patients was 55.51 ± 8.9. Right pneumectomy was performed in 40 (57%) and left pneumonectomy in 30 cases (43%) cases. There was no significant change regarding both the angle of rotation and the amount of pleural effusion between the findings of the second and first year after the operation. The QRS shift was significantly more pronounced in patients with left pneumonectomies than right pneumonectomies. On echocardiography these cases showed right ventricular hypertrophy and increased pulmonary artery pressures in the second year when compared to the preoperative period. Conclusions: The current study showed that many significant changes occurred in the electrocardiographic and echocardiographic parameters of the heart after pneumonectomy

Synchronous chondrosarcoma originating from two distant ribs

A chondrosarcoma is a rare bone tumour derived from cartilage-producing malignant mesenchymal cells. A 25-year-old male patient was operated upon to treat a chondrosarcoma arising in the left 2nd and 6th ribs. The tumour underwent en bloc wide resection in collaboration with a plastic surgeon for reconstruction of the resected area. Costal chondrasarcoma is very rare but chondrosarcoma arising from two ribs at the same time has not been reported before in the literature

Giant chest wall tumour invading the abdominal cavity: simultaneous reconstruction of the chest wall and hemidiaphragm

WOS: 000254552400017PubMed: 1837773

Giant chest wall tumour invading the abdominal cavity: simultaneous reconstruction of the chest wall and hemidiaphragm

[No abstract available

Comparison of awake and intubated video-assisted thoracoscopic surgery in the diagnosis of pleural diseases: A prospective multicenter randomized trial

Ozpolat, Berkant/0000-0002-6203-7306WOS: 000492824600021PubMed: 32082924Background: This study aims to compare the safety and diagnostic accuracy of awake and intubated video-assisted thoracoscopic surgery in the diagnosis of pleural diseases. Methods: This prospective randomized study was conducted between October 2016 and April 2018 and included 293 patients (201 males, 92 females; mean age 53.59 years; range, 18 to 90 years) from five medical centers experienced in video-assisted thoracoscopic surgery. The patients were randomized into two groups as awake video-assisted thoracoscopic surgery with sedoanalgesia (non-intubated) and video-assisted thoracoscopic surgery with general anesthesia (intubated). Patients with undiagnosed pleural effusions and pleural pathologies such as nodules and masses were included. Conditions such as pain, agitation, and hypoxia were indications for intubation. The groups were compared in terms of demographic data, postoperative pain, operative time, complications, diagnostic accuracy of the procedures, and cost. All patients completed a follow-up period of at least 12 months for samples that were non-specific, suspicious for malignancy or inadequate. Results: Awake video-assisted thoracoscopic surgery was performed in 145 and intubated video-assisted thoracoscopic surgery was performed in 148 patients. Pleural disease was unilateral in 83% (243/293) and bilateral in 17% (50/293) of the patients. There was no difference between the groups in terms of presence of comorbidity (p=0.149). One patient in the awake video-assisted thoracoscopic surgery group (0.6%) was converted to general anesthesia due to refractory pain and agitation. As postoperative complications, fluid drainage and pneumonia were observed in one patient in the awake video-assisted thoracoscopic surgery group (0.6%) and fluid drainage was detected in one patient in the video-assisted thoracoscopic surgery group (0.6%). There were no differences in pain intensity measured with visual analog scale at postoperative 4, 8, 12, or 24 hours (p>0.05). Distribution and rates of postoperative pathological diagnoses were also similar (p=0.171). Both operative cost and total hospital cost were lower in the awake video-assisted thoracoscopic surgery group (p<0. 001, p=0.001). Conclusion: Our study showed that awake video-assisted thoracoscopic surgery is safe, has similar reliability and diagnostic accuracy compared to video-assisted thoracoscopic surgery performed under general anesthesia, and is less costly. Awake video-assisted thoracoscopic surgery can be the first method of choice in all patients, not only in those with comorbidities

Analysis of 282 patients with thoracic trauma

Amaç: Yaşamın ilk 30 yılında travmaya bağlı ölümlerin %20-25’ini göğüs travmaları oluşturmaktadır. Bu çalışmada, üç yıllık süre içinde merkezimizde izlenen toraks travmalı olgular değerlendirildi. Çalışma planı: Çalışmaya, 2003-2006 tarihleri arasında toraks travması nedeniyle merkezimizde tedavi edilen, 15 yaş üzerindeki 282 hasta (240 erkek, 42 kadın; ort. yaş 41±16; dağılım 16-98) alındı. Hastalar yaş, cinsiyet, travma etyolojisi, klinik bulgular, eşlik eden yaralanmalar, ameliyat endikasyonları, uygulanan cerrahi girişimler, gelişen komplikasyonlar ve mortalite açısından incelendi. Bulgular: Yaş ortalaması erkeklerde 43±17 (dağılım 16- 98), kadınlarda 33±10 (dağılım 16-61) bulundu (p<0.001). Travmaların erkeklerde görülmesi anlamlı derecede fazlaydı (p<0.001). Olguların 175’inde (%62.1) izole toraks travması, 107’sinde (%37.9) multipl travma vardı. Olguların 242’sinde (%85.8) künt, 40’ında (%14.2) penetran travma görüldü. Yaralanma nedeni 164 hastada (%58.2) trafik kazasıydı. Künt göğüs travması geçiren 101 olguda ek yaralanma görüldü. İki olguda büyükbaş hayvanların neden olduğu penetran yaralanma görüldü. Penetran travma geçiren sadece iki kadın hasta vardı. Tedavi sırasında künt toraks travması geçiren yedi hastada ventilatör desteği kullanıldı. Penetran göğüs travmalarının tümünde, künt göğüs travmalarının 150’sinde (%62) tüp torakostomi kullanıldı. Toplam 11 hastada torakotomi ve sternotomi uygulandı. Mortalite beş hastada görüldü; bunların hepsinde primer patoloji göğüs travması dışındaki nedenlerdi. Pnömotoraks ve akciğer kontüzyonları ulusal kaynaklarda bildirilen oranlardan daha yüksek bulundu. Hiçbir hastada kalp yaralanması gözlenmedi. Sonuç: Künt travma nedenleri arasında ilk sırayı motorlu taşıt kazaları almış olduğundan, ülkemiz genelinde olduğu gibi Zonguldak’ta da trafik kurallarına uyum konusunda halkın bilinçlendirilmesinin gerekli olduğu düşünüldü.Background: Thoracic trauma accounts for 20-25% of all deaths due to trauma during the first four decades of life. In this study, we reviewed patients who presented with thoracic trauma to our center during a three-year period. Methods: The study included 282 patients (240 males, 42 females; mean age 41±16 years; range 16 to 98 years) over 15 years of age, who were admitted to our emergency outpatient clinic with thoracic trauma between 2003 and 2006. The patients were evaluated with respect to age, gender, etiology, clinical findings, accompanying injuries, surgical indications, surgical interventions, complications, and mortality. Results: The mean age was 43±17 years (range 16 to 98 years) in men, and 33±10 years (range 16 to 61 years) in women (p<0.001). Men were involved in traumas significantly more than women (p<0.001). Isolated thoracic trauma was seen in 175 patients (62.1%) and multiple trauma in 107 patients (37.9%). Injuries were blunt in 242 patients (85.8) and penetrating in 40 patients (14.2%). Traffic accidents were the leading cause of traumas (n=164, 58.2%). Blunt thoracic injuries were accompanied by associated injuries in 101 patients. Two patients had penetrating thoracic injuries caused by animals. There were only two women with penetrating injuries. Seven patients with blunt thoracic injuries required ventilatory support. Tube thoracostomy was used in all penetrating thoracic injuries and in 150 patients (62%) with blunt trauma. Eleven patients underwent thoracotomy and sternotomy. Mortality occurred in five patients, all of whom had primary injuries other than thoracic trauma. The rates of pneumothorax and lung contusion were higher than those reported in domestic literature. None of the patients had cardiac injuries. Conclusion: Considering the high rate of traffic accidents in the etiology of blunt thoracic injuries, increasing public awareness for, and attitudes towards, safety driving measures is of special importance in Zonguldak and nationwid

Endoscopic and Surgical Treatment of Benign Tracheal Stenosis: A Multidisciplinary Team Approach

WOS: 000456816300003PubMed ID: 29877219Purpose: Surgical resection and reconstruction are considered the most appropriate approaches to treat post-intubation tracheal stenosis (PITS). Bronchoscopic methods can be utilized as palliative therapy in patients who are ineligible for surgical treatment or who develop post-surgical re-stenosis. We investigated treatment outcomes in patients with benign tracheal stenosis. Methods: A retrospective review was performed in patients who were diagnosed with PITS. Tracheal resection was performed for operable cases, whereas endoscopic interventions were preferred for inoperable cases with a complex or simple stenosis. Results: In total, 42 patients (23 treated by bronchoscopic methods, 19 treated by surgery) took part in this study. No significant differences were observed in segment length, the proportion of obstructed airways, or vocal cord distance between the two groups. In all, 15 patients in the bronchoscopic treatment group received a stent. Following the intervention, the cure rates in the bronchoscopic and surgical treatment groups were 43.47% and 94.7%, respectively. A multidisciplinary approach resulted in a cure or satisfactory outcome in 90.5% of the patients while failure was noted in 9.5% of the patients. Conclusion: Bronchoscopic methods are associated with a lower cure rate compared to surgery. A multidisciplinary approach was helpful for treatment planning in patients with PITS