A recruitment maneuver improves apneic oxygenation.

BACKGROUND: Apneic oxygenation (AO) is applied during surgery and in intensive care units. Even with AO, apnea is associated with progressive hypoxemia, limiting the tolerable amount of time in AO. This experimental study evaluates the effects of a recruitment maneuver (RM) on oxygenation, CO2 retention, and survival times during prolonged apnea, supported or not supported with intratracheal apneic oxygenation. METHODS: Following Ethic Committee approval, 15 male Sprague-Dawley rats were anesthetized and ventilated with PCV and FiO2:1 for 15 minutes. After obtaining a basal arterial blood-gas sample, the rats were randomized into 3 groups and disconnected from the ventilator: group (G) 1 (N.=6): AO with a cannula inserted into the carina; G2 (N=6): RM (40 cm H2O CPAP applied for 30 seconds) before AO; and G3 (N.=3): no application after disconnection (G3 was stopped after the first 3 subjects died within 3 minutes). Further arterial blood-gas samples were taken after 1, 3, and 6 minutes (T1, T3, and T6). Survival times after the start of AO were recorded. RESULTS: G2 was associated with significantly higher values of PaO2 at T3 and T6 when compared to G1 (345±56 vs. 233±65 mm Hg at T3 and 258±31 vs. 180±31 mm Hg at T6, respectively, P<0.05). There were significant changes in PaO2, pH, and PaCO2 over time in all subjects, but no differences were observed between G1 and G2 in pH or PaCO2. Survival time in G2 was significantly longer as opposed to G1 (G1: 10.3±2.3 min; G2: 14.3±3.6 min; P<0.05). CONCLUSION: RM prior to AO prolongs tolerance to apnea, probably by increasing the time before intolerable hypoxemia occurs, without a significant difference in PaCO2 levels.

Isokinetic muscle strength after thoracotomy: standard vs. muscle-sparing posterolateral thoracotomy.

BACKGROUND: The aim of the study was to compare the effects of conventional posterolateral thoracotomy and muscle-sparing posterolateral thoracotomy on pulmonary and muscle strength. METHODS: From January 2003 to December 2004, 50 randomized patients with a diagnosis of primary lung cancer underwent pulmonary resection. The patients were divided into two groups: Group I (n=25) underwent conventional posterolateral thoracotomy, while Group II (n=25) had muscle-sparing thoracotomy. The groups were compared in terms of shoulder abduction/adduction isokinetic muscle strength and respiratory muscle strength. RESULTS: A comparison of maximal expiratory pressure and maximal inspiratory pressure preoperatively and postoperatively and of maximal expiratory pressure and maximal inspiratory pressure preoperatively and at 3 months postoperatively showed statistically significant differences (P<0.05). CONCLUSION: For the preservation of muscle strength, especially in patients whose jobs involved manual work, muscle-sparing posterolateral thoracotomy should be the first choice rather than conventional thoracotomy. Moreover, if necessary, the latissimus dorsi muscle can be used more extensively as a flap after muscle-sparing posterolateral thoracotomy procedures.

Recurrent apical cardiac hydatid cyst presenting with angina.

Hydatid disease is a parasitic infection caused by the larvae of tapeworm Echinococcus Granulosus. Hydatid cyst of the heart is an uncommon presentation of human echinococcosis which may lead to life-threatening conditions. We present a rare case of recurrent pericardial cyst in a 42-year-old man presenting with chest pain and ECG findings. We were able to avoid risks of resternotomy with a limited anterolateral thoracotomy. A direct enucleation of the cyst was possible without the need for cardiopulmonary bypass. He was free of complications at 6-month follow-up. Diagnosis should be suspected in every case of anginal symptoms or cyst-like mass in persons coming from areas where echinococcus granulosus is endemic.

Prediction of cardiopulmonary morbidity after resection for lung cancer: stair climbing test complications after lung cancer surgery.

BACKGROUND: The objective of this study was to assess the role of a modified stair climbing test in predicting postoperative cardiopulmonary complications. METHODS: A consecutive series of 150 patients who had undergone pulmonary resection for lung carcinoma formed the prospective database of this study. All patients performed a preoperative modified stair climbing test. Univariate and multivariate analyses were performed to identify predictors of postoperative cardiopulmonary complications. RESULTS: With univariate analysis, the patients with complications had a lower pre-exercise and postexercise percentage of oxygen saturation. PaO (2) levels were found to be lower and a greater change in oxygen desaturation during exercise was noted. Logistic regression analysis showed that the percent of oxygen saturation pre-exercise and the change in percent of oxygen desaturation during exercise were independent and reliable predictors of cardiopulmonary morbidity. CONCLUSIONS: A modified stair climbing test is a safe, economical and simple test capable of predicting cardiopulmonary complications.

Isolated lung perfusion with Paclitaxel and docetaxel: comparison of the early effects on pulmonary physiology.

BACKGROUND: This study was designed to compare the early effects of docetaxel and paclitaxel on pulmonary physiology after isolated lung perfusion. METHODS: Rats underwent isolated left lung perfusion with docetaxel in group 1 (n = 5), paclitaxel in group 2 (n = 5), and 0.9 %NaCl in the control group (n = 5). Ventilation pressures, compliance of the lungs, blood gas analysis and histopathological results were compared between the groups. RESULTS: In group 1 and group 2, the decrease in PaO (2) (p = 0.008) and increase in ventilation pressures were significantly higher than in the control group ( P = 0.016). In group 2, pCO (2) retention was higher compared to the docetaxel perfusion group ( P = 0.016). In the histochemical assessment, intra-alveolar hemorrhage and mononuclear cell infiltration were dense and perivascular edema was not present in group 1. In group 2, perivascular and intraalveolar edema were found to be dense. CONCLUSION: Perfusion by either of the chemotherapeutics resulted in an alteration of lung physiology in rat lungs. If isolated lung perfusion is administered using chemotherapeutics from the taxanes group, it is suggested that docetaxel could be the first choice for isolated lung perfusion.

Treatment of a benign tracheoesophageal fistula in a ventilator dependent quadriplegic patient.

Management of an acquired benign tracheoesophageal fistula in a patient who is dependent on mechanical ventilation is controversial, since the usual procedure is weaning before repair. Here, we describe surgical treatment of a tracheoesophageal fistula in a quadriplegic patient with 28 months of follow-up, who has to remain permanently on mechanical ventilation with a tracheostomy cannula.

An external support technique for the malacic trachea--treatment of tracheomalacia.

A 76-year-old woman was found to have a large, substernal, intrathoracic goiter. During excision, the trachea was found to be malacic. The trachea was sutured to a 16-mm ringed Gore-Tex (Gore & Associates, Arizona, USA) graft with Vicryl (Ethicon, Johnson & Johnson, USA) sutures. The graft was placed on the external surface of the trachea and surrounded the trachea almost 300 degrees. The patient was discharged on postoperative day seven without complications. She was seen at follow-up six months later and found to be free of complications.

Resection of the tracheal carina in an eight-year-old child: a case report.

An 8-year-old girl, who had been mechanically ventilated for 2 days, was referred to our clinic with total atelectasis of the right lung. Bronchoscopic examination showed an endobronchial mass lesion which was located on the right side of the carina. Carinal resection was performed and the patient was discharged on postoperative day 7. We presented this case report because of the rarity of tracheal tumors in childhood and to discuss the recommended surgical technique for pediatric carinal resection.

An unusual localization of thymoma.

A 41-year-old man with myasthenia gravis was referred to our clinic to undergo a thymectomy by video-assisted thoracic surgery. After physical examination of the thorax and evaluation by computed tomography, a mass lesion was noticed in the neck and thymectomy was performed by partial sternotomy combined with a cervical incision. The cervical thymoma was discontinuous with the thymus. Thymoma in the neck has rarely been reported. In this case report we emphasize the possible presence of thymoma in the neck and the importance of neck evaluation in patients with myasthenia gravis.

Comparison of early postoperative results of thymectomy: partial sternotomy vs. videothoracoscopy.

BACKGROUND: The aim of this study was to compare the early postoperative results of thymectomy operations after partial sternotomy and videothoracoscopy for myasthenia gravis. METHODS: A total of 51 thymectomy operations were reviewed. The surgical procedure was simple thymectomy with partial sternotomy in the first 19 patients (Group I) and videothoracoscopic thymectomy (Group II) in the remaining patients. Both groups were compared in terms of preoperative data (age, gender, classification, duration of disease, medications), operative data (operation time, the mean amount of drainage, the duration of chest tube drainage), and postoperative data (duration of hospital stay, complications and pain). RESULTS: Groups were statistically uniform in terms of preoperative and operative data. Statistically significant differences were noted for the duration of chest tube drainage (48.8 vs. 29.8 hours, p < 0.001), the amount of drainage (264.4 vs. 178.6 ml, p = 0.001), the length of hospital stay (5.6 vs. 2.3 days, p = 0.000), and the visual analogue scale score (4.8 vs. 3.1, p < 0.001). CONCLUSIONS: Thymectomy with videothoracoscopic surgery demonstrated a more comfortable and faster recovery period without deterioration in myasthenic status.

Perioperative pneumoperitoneum after lobectomy -- bilobectomy operations for lung cancer: a prospective study.

BACKGROUND: The aim of this study is to identify the effectiveness of perioperative pneumoperitoneum to prevent air leak after the lobectomy-bilobectomy operations for lung cancer. METHODS: A prospective study was designed on consecutive 50 patients who had lobectomy-bilobectomy operations for lung cancer and whose remnant lung had failed to fill the half of the hemithoracic cavity under 30 cm H(2)O positive pressure ventilation during the operation with totally relaxed diaphragm. The patients were divided into two groups: group 1 (25 patients) with perioperative pneumoperitoneum, group 2 (25 patients) without perioperative pneumoperitoneum. RESULTS: The statistical analysis between the two groups did not show any significant difference in terms of age, preoperative FEV1, and the type of resection. Perioperative pneumoperitoneum significantly reduced the duration of postoperative air leak (2.2 +/- 1.15 days vs. 6.04 +/- 3.27 days p < 0.0001) and total chest tube drainage time (3.84 +/- 0.98 days vs. 7.88 +/- 3.16 days p < 0.001). CONCLUSION: Perioperative pneumoperitoneum after lobectomy-bilobectomy operations for lung cancer is an effective method to decrease air leak and chest tube drainage time.