Pulmonary Mucormycosis in an Immunocompetent Patient: A Rare Life-threatening Case.

Pulmonary mucormycosis is a rare but life-threatening, fungal infection that usually occurs in patients with immunocompromised conditions, such as diabetes mellitus and hematologic malignancies. Anti-fungals and/or surgery are treatment modalities for this disease. Isolated pulmonary mucormycosis in immunocompetent patient is extremely rare and a mortal fungal infection. Late diagnosis may cause increased morbidity and mortality. We report herein a case of an immunocompetent 37-year female, who presented with a massive hemoptysis and was treated with urgent right lower lobectomy on a suspicion of fungus ball on tomography scan. The specimen was reported as pulmonary mucormycosis on histopathological examination. Key Words: Mucormycosis, Hemoptysis, Cavitary lesion, Immunocompetent.

Comparative analysis of two different Turkish hospital reports on polytrauma patients with thoracic trauma.

BACKGROUND: The present study aims to assess whether there are any differences in the management and outcome of polytrauma patients with thoracic trauma in trauma units of two different hospitals in the same country; one hospital is near the Syrian border. METHODS: A retrospective analysis (January 2012 to January 2014) of 348 polytrauma casualties with thoracic trauma from Manisa Celal Bayar University Hospital (MH) were compared according to age, gender, mechanism of injury, associated injuries, abbreviated injury scale (AIS), injury severity score (ISS), treatment modalities, and mortality with 917 patients of Sanliurfa Training and Research Hospital (SH) registry (near the Syrian border). RESULTS: Of the 348 patients in the MH, 230 (66%) and of the 917 patients in the SH, 697 (76%) were males (p<0.001). Mean age was 45.6±18.3 yrs in the MH group and 26.4±22.4 yrs in the SH group (p<0.001). The SH patients had a larger proportion of stab wounds (MH; 9% vs. SH; 17%, p<0.05), gunshot injuries (MH; 5% vs. SH; 18%, p<0.05), higher mean ISS (MH; 30.2±8.4 vs. SH; 42.8±10.2, p<0.001), and increased mortality (MH; 2.6% vs. SH; 11.1%, p<0.001). AISabdomen was the highest component in the SH registry (AISabdomen = 4.8±0.7), whereas AIS extremities were the highest component in the MH registry (AISextremities = 3.6±0.2). CONCLUSION: Significantly different demographic features, mechanisms of injury, worse outcomes and higher mortality rates in SH demonstrate and reflect the surgical challenges depending on the combat environment. Two hospitals in Turkey, one seemingly adjacent to a war zone and another with the more standard civilian experience highlight the impact of the Syrian conflict on the Turkish healthcare system.

Comparison of Videothoracoscopy and Thoracotomy in Surgical Treatment of Pulmonary Hydatid Cyst Disease.

OBJECTIVE: To evaluate the outcomes of videothoracoscopic and open surgeries for pulmonary hydatid cysts. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Thoracic Surgery, Faculty of Medicine, Balikesir University, Turkey, between May 2015 and March 2020. METHODOLOGY: Patients who underwent surgery for pulmonary hydatid cysts were evaluated retrospectively, for the age, gender, symptoms, cyst size and localisation, preferred surgery, duration of surgery, the extent of the intraoperative bleeding, duration of the chest drainage, hospitalisation time, and postoperative complications. The relationship between the categorical variables was examined with the Chi-square and Fisher's exact tests and the relationship between the non-parametric data and continuous variables with the Mann-Whitney U-test. RESULTS: A total of 60 patients included in the study; 23 underwent videothoracoscopic surgery and 37 had thoracotomy. There were no statistically significant differences between groups as gender, age, location and size of cyst. The videothoracoscopic surgery has superiority to thoracotomy group in terms of lower duration of operation, less perioperative bleeding (p = 0.005), early chest tube removal and lower hospitalisation time (both p <0.001). But there were no statistical difference between groups in complication rates (p = 0.340). CONCLUSION: Videothoracoscopic removal of pulmonary hydatid cyst is a safe and advantageous procedure comparing to thoracotomy. There is a need for prospective studies with a larger sample size. Key Words: Hydatid cyst, Thoracoscopic surgery, Thoracotomy, VATS.

Evaluation of YouTube Videos in Video-Assisted Thoracoscopic Pulmonary Lobectomy Education.

Background: YouTube® (YouTube, San Bruno, CA) is the most popular, public domain, free access video source. The educational value of the videos is difficult to determine. This study aimed to determine the evaluation of video-assisted thoracoscopic surgery (VATS) lobectomy videos as an educational source on the YouTube platform. Materials and Methods: VATS lobectomy, as a keyword, was searched on YouTube and sorted by the number of visualizations. The top 25 most viewed VATS lobectomy videos uploaded to YouTube were analyzed. The videos were evaluated for critical view of safety (CVS) and LAParoscopic surgery Video Educational GuidelineS (LAP-VEGaS). Results: There were ∼1670 videos for the search term "VATS lobectomy." There were 16 primary surgeons from 8 different countries. Most of the videos (n = 19) were affiliated to an academic institution. There was a positive significant correlation between author's h-index and number of likes. Videos showed conformity to CVS assessment with a rate of 56.5%. LAP-VEGaS conformity to educational content (e.g., audio or written commentary) and case presentation was very low. Conclusions: Using videos of VATS lobectomy in training may have great potential to improve surgical opinion. YouTube is user driven and these videos are not peer reviewed. This article showed issues concerning safety violations. We believe that professional societies should focus on promoting and disseminating valuable educational videos.

Conservative Treatment Approach in Primary Spontaneous Pneumothorax.

OBJECTIVE: To evaluate the efficacy and pain levels of minimally invasive approaches in the treatment of primary spontaneous pneumothorax (PSP). STUDY DESIGN: Observational study Place and Duration of Study: Department of Thoracic Surgery, Balikesir University, Turkey, from August 2017 to August 2019. METHODOLOGY: Patients with primary spontaneous pneumothorax aged over 18 years, hospitalised in the thoracic surgery department, and treated with conservative and minimally invasive approaches were included in the study. These approaches included continuous oxygen inhalation and small bore thorax catheter drainage. Patients were evaluated for age, gender, pneumothorax level, treatment modality, duration of discharge and recurrence. The obtained data were analysed statistically. RESULTS: A total of 80 patients (76 males, 4 females) had a mean age of 28.8 ±9.47 years. While 24 (30%) of the patients were treated conservatively, 56 patients (70%) underwent drainage with 8 F thorax catheter. Two patients who had conservative treatment primarily, later underwent drainage with an 8 F thorax catheter due to the lack of response to treatment. One patient underwent videothoraco-scopic bulla excision and partial parietal pleurectomy because of the nonexpandable lung. The average length of hospital stay was 3.55 ±1.41 days. CONCLUSION: Conservative treatment and treatment with small catheters are effective approaches in spontaneous pneumothorax patients. Patients with PSP should be managed first with minimally invasive approaches.

Prognostic significance of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography-derived metabolic parameters in surgically resected clinical-N0 nonsmall cell lung cancer.

OBJECTIVE: Our aim was to assess the significance of metabolic positron emission tomography (PET) parameters for the prediction of occult mediastinal lymph node metastasis (OLM) and recurrence in patients with clinical-N0 nonsmall cell lung cancer (NSCLC) after surgical resection and lymph node dissection. MATERIALS AND METHODS: We evaluated 98 patients with NSCLC [52 adenocarcinoma (ADC), 46 squamous cell carcinoma (SQCC)] who had undergone initial/preoperative fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT). Eligibility criteria for participation were clinically staged as N0 and no FDG uptake in mediastinal lymph nodes on preoperative PET/CT. Clinicopathological characteristics and the diagnosis of recurrence were obtained by reviewing the hospital records. Metabolic parameters [maximum standardized uptake value, mean standardized uptake value, metabolic tumor volume (MTV), total lesion glycolysis] were determined on F-FDG PET/CT images. The association of metabolic parameters with OLM and recurrence was assessed. RESULTS: OLM was found in 26 (26.53%) patients. T-stage, central location, and lymphovascular invasion were associated with OLM (respectively, P=0.007, 0.011, <0.001). None of the metabolic parameters was associated with OLM. Metabolic parameters of the tumor were significantly higher in patients with recurrence when the cohort was evaluated as a whole (P=0.002, 0.005, 0.016, and 0.004, respectively). In particular, there was a significant association between recurrence and tumor size, grade, stage, MTV (P<0.001), and TLG (P<0.001) in ADC. This association was not found in SQCC. Multivariate analysis showed that MTV was an independent prognostic factor for recurrence and associated with disease-free survival. CONCLUSION: Metabolic parameters of the primary tumor on preoperative F-FDG PET/CT could not predict OLM in patients with clinical-N0 NSCLC. MTV was an independent risk factor for recurrence in ADC, but not in SQCC.