Surgery for bronchiectasis: the effect of morphological types to prognosis

Although the incidence has declined over the past years in societies with high socioeconomic status, bronchiectasis is still an important health problem in our country. To review and present our cases undergoing surgery for bronchiectasis in the past 12 years and their early and late term postoperative outcomes and our experience in bronchiectasis surgery and the effect of morphological type on the prognosis. The medical records of 62 cases undergoing surgical resection for bronchiectasis in the Clinics of Thoracic and Pediatric Surgery were evaluated retrospectively. The disease was on the left in 33 cases, on the right in 26 and bilateral in three cases. The most common surgical procedure was lobectomy. Forty one patients underwent pneumonectomy, lobectomy and complete resection including bilobectomy. Twenty-one [33.87%] cases underwent incomplete resection, of whom 11 [17.74%] underwent segmentectomy and 10 [16.13%] underwent lobectomy + segmentectomy. It was found that the rate of being asymptomatic was significantly higher in patients undergoing complete resection compared to those undergoing incomplete resection. Spirometric respiratory function tests were performed to assess the relationship between morphological type and the severity of disease. All parameters of respiratory function were worse in the saccular type and FEV 1 /FVC showed a worse obstructive deterioration in the saccular type compared to the tubular type. The success rate of the procedure increases with complete resection of the involved region. The morphological type is more important than the number and extension of the involved segments in showing the disease severity

Reactive oxygen metabolites can be used to differentiate malignant and non-malignant pleural efffusions

Increase in reactive oxygen metabolites [ROM] and free radicals is an important cause of cell injury. In this study, we investigated whether determination of ROM in pleural fluids of patients with malignant and non-malignant pleural effusions can be used as a tumor marker indicating malignant effusions in the differential diagnosis. Sixty subjects with exudative pleural effusion and 25 healthy individuals as the control group were included in the study. Of the subjects with pleural effusion, 50% were malignant and 50% were non-malignant. ROM was studied in the pleural fluids and sera of the subjects with pleural effusion and in the sera of those in the control group. The ROM values of smokers and non-smokers were compared in each group. The Student's t-test and the Mann-Whitney U test were used in order to detect differences between groups for descriptive statistics in terms of pointed features. The statistical significance level was set at 5% in computations, and the computations were made using the SPSS [ver.13] statistical package program. It was determined that the difference between the ROM values of subjects with malignant and non-malignant pleural effusions and the sera of the control group was significant in the malignant group compared to both groups [P=0.0001], and the sera ROM values of patients with non-malignant pleural effusion were significant compared to the control group [P=0.0001], and the ROM values of smokers were significant compared to non-smokers in each of the three groups [P=0.0001]. These findings indicate that sera ROM levels are increased considerably in patients with exudative effusions compared to that of the control group. This condition can be instructive in terms of serum ROM value being suggestive of exudative effusion in patients with effusions. Furthermore, the detection of pleural ROM values being significantly higher in subjects with malignant pleural effusions compared to non-malignant subjects suggests that ROM can be used as a tumor marker in the differential diagnosis of pleural effusions of unknown origin

Autologous blood pleurodesis: a good choice in patients with persistent air leak

The study compares the efficiency, side effects and complications of autologous blood pleurodesis with talcum powder and tetracycline. This prospective study evaluated 50 patients with persistent air leak resulting from primary and secssondary spontaneous pneumothorax between February 2004 and March 2009. The patients inclussded 32 [64.0%] males and 18 [36.0%] females with a median age of 39 years [range 14-69 years]. All cases had persistent air leak of more than seven days. Pleurodesis was performed using autologous blood in 20 [40.0%] patients, talc powder in 19 [38.0%] patients and tetracycline in 11 [22.0%] patients through a chest tube. Air leak cessation times after pleurodesis, side effects and pulmonary function tests [PFT] in the first and third months were measured. Recurrent primary spontaneous pneumothorax was the cause of persistent air leak in all cases. Air leaks were expiratory only in 54.0% of cases. We obtained a success rate of 75.0% using autologous blood, 84.2% using talc powder and 63.6% using tetracycline. Mean air leak termination interval was significantly [P < 0.001] shorter in patients treated with autologous blood in comparison to talc powder and tetracycline. We observed a significant [P < 0.05] decline in PFT in patients treated with talc powder compared with tetracycline and autologous blood. Vital capacity, FVC and FEV1 were significantly lower in patients treated with tetracycline compared with autologous blood. This study shows that autologous blood pleurodesis compared to talc powder and tetracycline is related with shorter leak cessation time and less pulmonary function decline in patients with persistent air leak. We think further randomized clinical trials of pleurodesis as treatment could increase its use in thorax surgery by demonstrating the safety and the efficacy of this procedure