Lung sealant and morbidity after pleural decortication: a prospective randomized, blinded study

<p>Abstract</p> <p>Objectives</p> <p>Prolonged postoperative air leaks (AL) are a major cause of morbidity. Aim of this work was evaluating use of a Lung Sealant System (Pleuraseal™, Covidien, Mansfield, MA, U.S.A.) in pleural decortications for empyema thoracis.</p> <p>Methods</p> <p>From January 2008 to December 2008, 46 consecutive patients received pleural decortications for empyema thoracis. Post-procedural and malignancy-related empyemas were excluded. After hydro-pneumatic test and surgical correction of AL (until satisfaction), patients were assigned (23 per group) to Control or Sealant group. Control group underwent no additional interventions. In Sealant group, lung sealant was applied over AL areas. Following variables were measured daily: patients with AL; time to chest drainage (CD) removal; CD drainage volume at removal, postoperative length of hospital stay, postoperative C-reactive protein (CRP), and leukocyte counts. Personnel recording parameters were blinded to intervention. Two-tailed t-tests (normally distributed data) or Mann - Whitney U-test (not-normally distributed data) were used for evaluating significance of differences between group means or medians. Significance of any proportional differences in attributes were evaluated using Fisher's Exact Test. Statistical analysis was carried out using R-software (version 2.8.1).</p> <p>Results</p> <p>Groups were similar regarding demographic and baseline characteristics. No patients were withdrawn from study; no adverse effects were recorded. There were no significative differences on CRP and leukocyte levels between two groups. Compared with the Control group, in Sealant group significantly fewer patients had AL (30 versus 78%, <it>p = 0.012</it>), and drains were inserted for a shorter time (medians, 3 versus 5 days, <it>p = 0.05</it>). Postoperative hospitalization time was shorter in Sealant group than in control group, but difference was not significant (0.7 days, <it>p = 0.121</it>).</p> <p>Conclusions</p> <p>Pleuraseal™ Lung Sealant System significantly reduces AL following pleural decortications for empyema and, despite of not-increased infectious indexes, is suitable for routinely use, even in procedures with contaminated pleura.</p

Miocene formations and NE-trending right-lateral strike–slip tectonism in Thrace, northwest Turkey: geodynamic implications

In the Thrace Peninsula, Neogene units were deposited in two areas, the Enez Basin in the south and the Thrace Basin in the north. In the southwesternmost part of the peninsula, upper lowerlower upper Miocene continental to shallow marine clastics of the Enez Formation formed under the influence of the Aegean extensional regime. During the last stage of the transpressional activity of the NW-trending right-lateral strikeslip BalkanThrace Fault, which had controlled the initial early middle Eocene deposition in the Thrace Basin, a mountainous region extending from Bulgaria eastwards to the northern Thrace Peninsula of Turkey developed. A river system carried erosional clasts of the metamorphic basement southwards into the limnic depositional areas of the Thrace Basin during middle Miocene time. Deposition of fluvial, lacustrine, and terrestrial strata of the Ergene Formation, which conformably and transitionally overlie the Enez Formation, began in the late middle Miocene in the southwest part and in the late Miocene in the north-northeast part of the basin. Activity along the NE-trending right-lateral strikeslip faults (the XanthiThrace Fault Zone) extending from northeast Greece northeastwards through the Thrace Peninsula of Turkey to the southern shelf of the western Black Sea Basin began during the middle Miocene in the northern Aegean, at the beginning of the late Miocene in the southwest part, and at the end of the late Miocene in the northeast part of the Thrace region. Although the Neogene deposits in the Thrace Basin were evaluated as the products of a northerly fault, our data indicate that the NW-trending northerly fault zone became effective only during the initial stage of the basin development. The later stage deposition in the basin was controlled by the NE-trending XanthiThrace Fault Zone, and the deposits of this basin progressively evolved north/northeastwards during the late Miocene. During the late early Miocenelate Miocene interval, extension within the Thrace region was part of the more regional Aegean extensional realm, but from latest Miocene time, it has been largely decoupled from the Aegean extensional realm to the south