Impact of preoperative computed tomography-determined quantity and quality of skeletal muscle on survival after resected non-small cell lung carcinoma.

OBJECTIVE: This study investigated the prognostic effect of preoperative skeletal muscle quantity and quality on survival after Non-Small Cell Lung Cancer (NSCLC) resection. METHODS: This retrospective study consisted of patients with NSCLC who underwent curative lung cancer resection between 2015 and 2020. Skeletal muscle quantity and quality, as determined by paravertebral muscle index (PVMI) and paravertebral muscle density (PVMD), were measured at the level of the twelfth thoracic vertebra on preoperative images of computed tomography. The patients were divided into two subgroups as low and high according to sex-specific median PVMI and PVMD values. Overall survival (OS) rates were compared according to low and high PVMI and PVMD using the Kaplan-Meier procedure, and prognostic factors after lung cancer resection were assessed using Cox's regression models. RESULTS: The study comprised 180 patients, with 89 patients in the low PVMI and PVMD groups and 91 patients in the high PVMI and PVMD groups. The OS rates in patients with low PVMI were less than in those with high PVMI (log-rank p = 0.037), with a median survival time of 52.5 months and 57.5 months, respectively. The OS rates in patients with low PVMD were less than in those with high PVMD (log-rank p < 0.001), with a median survival time of 50.8 months and 59.4 months, respectively. Low PVMI and low PVMD were independent prognostic factors of poor OS ([HR] = 1.77, P = 0.014; [HR] = 1.84, P = 0.038, respectively). CONCLUSION: Preoperative CT-determined low skeletal muscle quantity and quality have a poor prognostic effect on survival after NSCLC resection. Preoperative evaluation of these curable morphometric measures may shed light on pre-rehabilitation and nutritional support programs.

Low thoracic muscle mass index on computed tomography predicts adverse outcomes following lobectomy via thoracotomy for lung cancer.

OBJECTIVES: The aim of this study was to determine whether the preoperative thoracic muscle mass is associated with postoperative outcomes in patients undergoing lobectomy via thoracotomy for lung cancer. METHODS: Consecutive patients undergoing lobectomy were retrospectively reviewed. The thoracic muscle mass index (TMMI) was obtained at the level of the fifth thoracic vertebra on preoperative thoracic computed tomography (CT). Patients were analysed comparatively by being dividing into low and high muscle index groups by the median of sex-specific TMMI. The primary outcomes were the incidence of any or postoperative pulmonary complications. The secondary outcomes were postoperative intensive care unit (ICU) admission, length of stay (LOS) in the ICU, total hospital LOS, readmission and mortality. RESULTS: The study population consisted of 120 patients (63.6 ± 9.8 years; 74% male). Each groups included 60 patients. Major complications occurred in 28.3% (34/120) and readmission in 18.3% (22/120) of patients. The adjusted multivariable analysis showed that each unit increase in TMMI (cm2/m2) was independently associated with the rates of less any complications [odds ratio (OR) 0.92, P = 0.014], pulmonary complications (OR 0.27, P = 0.019), ICU admission (OR 0.76, P = 0.031), hospitalization for >6 days (OR 0.90, P = 0.008) and readmission (OR 0.93, P = 0.029). CONCLUSIONS: Low TMMI obtained from the preoperative thoracic CT is an independent predictor of postoperative adverse outcomes in patients following lobectomy via thoracotomy for lung cancer. TMMI measurements may contribute to the development of preoperative risk stratification studies in the future.

Clinical course of COVID-19 pneumonia in a patient undergoing pneumonectomy and pathology findings during the incubation period.

BACKGROUND: The cause of coronavirus disease 2019 (COVID-19) is severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Clinical information about patients undergoing lung resection while infected with this virus and pathological information about early COVID-19 pneumonia are still scarce. CASE PRESENTATION: A 69-year-old male patient underwent a right pneumonectomy for squamous cell lung carcinoma. Until the fourth postoperative day, the patient, who had minor radiological changes on chest x-ray, was asymptomatic. From this day, the COVID-19 test, which was performed after the appearance of symptoms such as fever and shortness of breath, lymphopenia and diffuse ground glass opacity in the left lung on computed tomography, was reported to be positive. The patient was given NIMV (non-invasive mechanical ventilation), and hydroxychloroquine, favipiravir and azithromycin in isolation intensive care, with the diagnosis of severe pneumonia. He was discharged on the 17th postoperative day with healing of the lung lesions. The pathology specimen of the patient, who was found to have been infected with SARS-CoV-2 before the day of surgery, was examined retrospectively. Irregular and severe pneumocyte hyperplasia, interstitial thickening, oedema, pronounced protein exudates, diffuse enlargement of the alveolar walls, macrophage infiltration and fibroblastic proliferation, which is an indicator of early organisation, were detected. CONCLUSION: We believe that the clinical course and pathology findings obtained after right pneumonectomy in a patient with pre-symptomatic COVID-19 pneumonia will guide the diagnosis and treatment of patients infected with SARS-CoV-2.

Massive hemoptysis due to welding fumes.

Many pulmonary problems such as lung cancer, occupational asthma, and pneumoconiosis have been described due to welding in the literature until now. This is the first case report of alveolar hemorrhage due to welding fumes presented with massive hemoptysis. We report a rare case of massive hemopthisis associated with welder's lung, with a discussion based on a review of the literature. ESTABLISHED FACTS: Many pulmonary diseases such as lung cancer, occupational asthma, and pneumoconiosis have been attributed welding fumes in the literature. Alveolar hemorrhage due to welding fumes has never defined before. NOVEL INSIGHTS: We herein report a case of alveolar hemorrhage presented with massive hemoptysis due to welding fumes. Clinicians should be aware of such rare but serious clinical picture which can occur in welding workers. Palliative measures and bronchoscopic Ankaferd Blood Stopper(®) application may help to stop bleeding.