THE AGGRESSIVE CLINICAL COURSE OF A PATIENT WITH BENIGN METASTASISING PLEOMORPHIC ADENOMA OF THE PAROTID GLAND WITHOUT LOCAL RECURRENCE

Benign metastasizing pleomorphic adenoma (BMPA) is an extremely rare tumour that is classified histologically. A 58-year-old-woman presented with Pleomorphic adenoma originated from the parotid gland with lung metastasis without local recurrence: There is no effective treatment except total excision and closely monitoring a benign PA with metastasis is important. Herein we report a rare case because several cases with metastasis without local recurrences have been reported in the literature. Keywords: Metastasizing pleomorphic adenoma, Parotid gland, Surgery

Current overview of awake, non-intubated, video-assisted thoracic surgery

Awake video-assisted thoracoscopic surgery (A-VATS) enables the surgeon to penetrate the tissue via a small incision and with less contact between the lung and atmospheric pressure; postoperative respiratory functions are also less affected than in open surgery. A-VATS is a safer technique than traditional VATS and non-intubated video-assisted thoracoscopic surgery (NI-VATS) because it does not require muscle relaxants and sedoanalgesics. In particular, diagnostic VATS for pleural effusions can be easily performed over a single port using only local anaesthetic. Anaesthesia-related risks increase even more for elderly patients and those with severe comorbidities. Although there are long and risky operations in thoracic surgery, general anaesthesia is not required for some thoracic surgery procedures. However, A-VATS is limited to minor procedures. Due to regional anaesthesia and sedation, NI-VATS is a safe and effective method for many indications. The results show that this method can be applied with low mortality and morbidity

Sublingual vs. intranasal dexmedetomidine sedation for flexible fiberoptic bronchoscopy procedure: a retrospective comparative study

OBJECTIVE: Flexible fiberoptic bronchoscopy (FOB) is an often-employed invasive method in diagnosing, staging, and treating lung diseases. Conventional sedative agents facilitate this process. Dexmedetomidine (DM) has low side effects and is easy to administer for trans-mucosal absorption. This study aimed to investigate trans-mucosal DM used with local anesthesia during the FOB procedure. PATIENTS AND METHODS: Fifty-nine cases were retrospectively analyzed who had undergone diagnostic flexible fiberoptic bronchoscopy (FOB) in our clinic between September 2016 and September 2019. The two methods (Group 1: Sublingual, and Group 2: Intranasal) employed during the FOB procedure for the local anesthesia were compared. RESULTS: Fifty-nine patients were included in the study, wherein forty-six were males (77.9%), and thirteen (22.1%) females had a mean age of 58.02±8.7 years (range: 39-72 years). Thirty-three patients were in Group 1 (Sublingual) and 26 in Group 2 (Intranasal). No significant differences were there between groups regarding age, gender, body mass index, or ASA physical status. Modified Aldrete Score >9 was significant to reach with time as a correlation between operator and patient satisfaction. Sedation scores for groups at 1st, 9th, 12th, and 15th min were similar. Excessive coughing was observed in two (7.7%) patients of Group 2 but in none of Group 1 (p=0.105). Patients in both groups had no complaints of swallowing, excessive body movement, or lower oxygen saturation during examination (p>0.05). There were no complications (hypotension, bradycardia, respiratory depression, allergy, permanent amnesia, nausea, and vomiting) observed in patients. CONCLUSIONS: Our study results revealed that easily administered trans-mucosal dexmedetomidine sedation is safely applied during flexible fiberoptic bronchoscopy for adequate sedation, high satisfaction, and low complication rates with no significant difference in sublingual or intranasal administration

The Comparison of Two Different Techniques of Remifentanil Administration During Implantable Vascular Access Device Procedures

Purpose: The aim was to compare analgesic efficacy and adverse effects of two different techniques of intravenous remifentanil administration in patients undergoing vascular; access device procedures with monitored anesthesia care. Design: A randomized, single-blinded controlled study. Methods: The patients (N = 92) were 30-80 years old and of American Society of Anesthesiologists Physical Status I-III. The first group was the continuous infusion group (group CI). Intravenous continuous remifentanil was infused after starting at a dosage of 0.1 mcg/kg/min, and the dose was raised incre-mentally up to 1 mcg/kg/min if required. The second group was intravenous bolus patient-controlled sedation analgesia (PCSA) with remifentanil infusion at a dose of 0.05 mcg/kg per minute and bolus of 0.1 mcg/kg with lock-out time of 3 minutes. In both groups, a bolus dose of 0.1 mcg/kg remifentanil was administered. The data evaluated include level of pain and sedation, total amount of remifentanil con-sumption, bolus doses of remifentanil, patient and surgeon satisfaction, hemodynamic data, and adverse events. Findings: In comparison between techniques, pain and sedation scores during procedure, duration of procedure, patient and surgeon satisfaction, additional rescue medication, and bolus doses were not statistically different (P > .05). The total amount of remifentanil administered was significantly lower in the infusion group than that in the bolus group (P = .031). Conclusions: For central venous access device procedures under monitored anesthesia care, remifentanil use in both infusion and bolus techniques could provide sufficient sedation and analgesia without serious adverse effects. Total remifentanil consumption amount in infusion group is lower than that in the bolus group. (c) 2021 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved

A rare mediastinal occurrence of neuroblastoma in an adult: case report

ABSTRACT CONTEXT: Neuroblastoma is the most common extracranial malignant solid tumor that occurs during childhood. It arises from primitive cells and is seen in the adrenal medulla and sympathetic ganglia of the sympathetic nervous system. CASE REPORT: We present a rare case of a 40-year-old man who was diagnosed with the onset of neuroblastoma arising in the mediastinum. He was treated by means of surgical resection in the superior mediastinum after neoadjuvant chemotherapy. The patient’s surgical outcome was satisfactory. CONCLUSION: There are still no standard treatment guidelines for adult neuroblastoma patients. Although they have a poor prognosis, the main treatment option should be complete surgery at an early stage. This situation may become clarified through biological and genetic studies in the future

Video assisted thoracic surgery outcomes for primary spontaneous pneumothorax, analysis of 56 cases, single university hospital experience

BACKGROUND/AIMS To evaluate patients with primary spontaneous pneumothorax (PSP) who were treated via the video-assisted thoracic surgery (VATS) procedure by means of clinical features, surgical outcomes, and follow-up results. MATERIAL and METHODS We retrospectively analyzed 56 consecutive patients who underwent VATS procedure for PSP between 2012 and 2018. There were 47 male and 9 female patients with a mean age of 26.01 +/- 7.4 (18-38) years. VATS was performed under general anesthesia with double lumen intubation. Apical wedge resection and mechanical abrasion or apical pleurectomy was performed in 60% of the patients with uniportal VATS and in 40% of the patients with two portal VATS by the same surgical team. RESULTS The operation indications were recurrence in 40 (71.5%) patients, prolonged air leak in 14 (25%), and bilateral pneumothorax in 2 (3.5%). Pleurodesis procedures included upper pleural mechanical abrasion in 44 (78.5%) patients and apical pleurectomy in 12 (22.5%). Bilateral VATS procedure was performed for two patients who had bilateral pneumothorax. The mean operation time, chest tube removal time, and length of hospital stay were 26.04 +/- 4.61 (20-45) min, 1.4 +/- 0.6 (1-3) days, and 1.7 +/- 0.8 (2-4) days, respectively. No significant difference was found between uniportal and biportal VATS or mechanical abrasion and apical pleurectomy groups compared with statistical evaluation with demographic and clinical features and surgical outcomes (p>0.05). There was no mortality, and complications occurred in 16 (28.5%) patients. Only 3 (5.3%) recurrence occurred during the mean follow-up period of 48.4 +/- 11.4 (9-70) months. CONCLUSION Video-assisted thoracic surgery stapled bullectomy for PSP when followed by mechanical pleurodesis is still the gold standard and is a reliable, safe method with a low recurrence rate, complication, length of hospital stay, and quicker recovery time. The formation of new bullae-blebs could be related to continued smoking behavior that can be seen as the main reason for late period recurrences

Pulmonary Nodular Lymphoid Hyperplasia: A Rare Case Mimicking Malignancy

Pulmonary nodular lymphoid hyperplasia (PNLH) is a reactive lymphoid proliferation manifesting as multiple solitary nodules or localized infiltrates in the lungs. It is a type of benign lymphoproliferative disease that can affect the lungs. We present the case of a 41-year-old female patient with respiratory symptoms such as productive cough, left chest pain, and dyspnea. Imaging findings revealed two lesions with lobulated contour in the left upper lobe apicoposterior segment and left lower lobe superior segment. After examining the minimally invasive diagnostic methods, this rare PNLH case mimicking malignancy was both diagnosed and treated by surgery. Further studies including more patients and longer follow-ups are needed for this rare disease