Definition of postresectional residual pleural space

Background: Complications of the residual postoperative pleural space (RPPS) after partial pulmonary resections increase hospital stay, cost and morbidity. The objectives of this study were to define and identify the long-term outcome of RPPS. Methods: A total of 140 partial pulmonary resections were performed in a 3-year period. Fifty-eight (41.4%) patients who had RPPS on the first postoperative day were followed up. We examined the chest x-rays of these patients on postoperative day 1 and 7 and week 4 and 12, and we documented any complications and reoperations. Results: RPPS persisted in 6 patients (10.4%) and was reabsorbed in 44 patients (75.8%) in the 12th week. Residual spaces were complicated in 8 patients (13.7%), of whom 4 (6.8%) had reoperation and 4 (6.8%) were redrained. Reoperated patients had a mean of 13 ( standard deviation [SD] 2.4, range 11-16) days of postoperative hospitalization, whereas redrained patients had a mean of 58.5 (SD 21.7, range 36-88) days of additional hospitalization. Conclusions: We determined air leakage and space infection to be the major complications of the RPPS. Infectious complications were noticed in the postoperative third and fourth weeks (14-30 d), and reoperated patients had a shorter duration of postoperative hospitalization. Early operation is recommended in complicated pleural space patients. The space that is not complicated until the end of the first month can be defined as benign. This study demonstrated that follow-up of a benign space after the first postoperative month is not necessary

Effectiveness of PET Scan in Postoperative Long Term Follow up of Patients with Nonsmall Cell Lung Cancer

Aim: There is very few data about the use of positron emission tomography [PET] in the long term follow up of patients operated for lung cancer. We aimed to evaluate the effectiveness of PET scan in detecting distant metastases in the long term follow up of asymptomatic patients operated for non-small cell lung cancer [NSCLC]. Material and Method: PET scan was performed to sixty five asymptomatic patients. The patients who had a positive PET scan for metastasis underwent MRI and/or biopsy to verify metastasis. Result: : Mean age of the patients was 58.09 +/- 8.64 [44-82] years, and 57 [87.7 %] of them were male. Forty eight [73.8%] of the patients had epidermoid cell, 15 [23.1%] had adeno and 2 [% 3.1] had large cell carcinoma. Postoperative stage of 1 [1.5%] patient was 1A, 14 [21.5%] of them were stage 1B, 1 [1.5%] of them was stage 2A, 27 [41.5%] of them were stage 2B and 22 [33.8%] of them were stage 3A. PET scan detected metastasis in 7 [10.8%] patients. In one patient PET scan was proven to be false positive. Sites of metastases in PET scan were lung in 3 [4.5%] patients, vertebra in 3 [4.6%] patients and tibia in 1 [1.5%] patient. In detecting distant metastases accuracy rate of PET was calculated as 98%, sensitivity was 100%, and specificity was 98%. Discussion: In asymptomatic patients with NSCLC, PET imaging appears to be useful as an alternative to conventional imaging to rule out unsuspected systemic disease in the postoperative long term follow up

Impact of traumatic rib fractures on pulmonary morbidity and mortality: A multicenter prospective study

WOS: 00020937040214

Effectiveness of gabapentin in the treatment of chronic post-thoracotomy pain

Background: Chronic post-thoracotomy pain (CPTP) consists of different types of pain. Some characteristics of CPTP are the same as those of recognized neuropathic pain syndromes. Objective: We aimed to determine the safety and efficacy of gabapentin (GP) in comparison to naproxen sodium (NS) in patients with CPTP. Methods: Forty consecutive patients with CPTP after posterolateral/lateral thoracotomy were prospectively evaluated. Twenty patients were given GP and another 20 were given NS treatment. Visual Analogue Scale (VAS) and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scorings were performed pretreatment (day 0) and on the 15th, 30th, 45th and 60th days. Adverse events were questioned. The mean ages were 45.7 +/- 14.9 and 49.8 +/- 15.2 years and the mean durations of pain were 3.8 +/- 0.9 and 3.8 +/- 1.1 months, respectively. Results: The mean pretreatment VAS scores (VAS(0)) were 6.4 +/- 0.6 and 6.8 +/- 0.6, the mean pretreatment LANSS scores (LANSS(0)) were 18.85 +/- 1.6 and 20.75 +/- 2.6 in GP and NS groups, respectively (p > 0.05). Minor adverse events which did not mandate discontinuation of treatment were observed in seven patients (35%) in the GP and in four patients (20%) in the NS group. The number of patients with a VAS score <5 at the latest follow-up (VAS(60) < 5) was 17 (85%) and 3 (15%) in GP and NS groups, respectively (p < 0.001). Seventeen patients (85%) in the GP and 0 patients (0%) in the NS group had a LANSS score <12 at the latest follow-up. Conclusion: Gabapentin is safe and effective in the treatment of CPTP with minimal side effects and a high patient compliance. These results should be supported with multidisciplinary studies with larger sample sizes and longer follow-ups. (c) 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved