Can intrapleural alteplase treatment be an alternative to videothoracoscopic deloculation and decortication in pleural empyema?

INTRODUCTION: Chest tube drainage is the first step in the management of complicated pleural effusions that have turned into empyema. In cases where adequate drainage cannot be provided or deloculation is required, intrapleural fibrinolytic therapy or surgical deloculation can be performed. Alteplase is a suitable agent for intrapleural fibrinolytic therapy. On the other hand, video-assisted surgery is an effective and minimally invasive treatment option for lung re-expansion. AIM: The effect of intrapleural alteplase irrigation applied through the thoracic tube in the treatment of pleural empyema was investigated and whether it could be an alternative technique to video-assisted thoracoscopic surgery was evaluated. MATERIAL AND METHODS: The results of patients who were treated for empyema in our clinic were evaluated retrospectively. Twenty-one patients who underwent tube thoracostomy + intrapleural alteplase and 28 patients who underwent VATS deloculation were included in the study. RESULTS: The study included 35 male and 14 female patients. There were 21 patients in group 1, and 28 patients in group 2. The mean age was 50.6. The average length of thoracic tube stay was determined as 7.1 and 6.96 days. The duration of hospital stay in this group was 6.73 and 6.35 days. In 17 (81%) patients in group 1, the treatment was discontinued without the need for surgery. CONCLUSIONS: VATS-D is an effective option in the treatment of pleural empyema. However, as seen in our study, intrapleural alteplase application is at least as effective as VATS-D in terms of treatment success.

First experiences in non-intubated, video-assisted thoracoscopic surgery: a single-centre study.

INTRODUCTION: Video-assisted thoracoscopic surgery (VATS) with non-intubated technique is safely performed under spontaneous breathing and sedation. With this surgery, many complex thoracic surgical interventions can be successfully applied. AIM: We shared the results of our patients who underwent mediastinal biopsy, pleural biopsy, lung wedge resection, pneumothorax surgery, and pleural delocculation with non-intubated VATS. MATERIAL AND METHODS: Patients who underwent surgery with non-intubated VATS between March 2015 and May 2020 in our clinic were included in the study. The patients were evaluated in terms of many factors such as age, gender, applied surgical intervention, diagnosis, side of surgery, duration of surgery, and time of hospital stay, and the results were recorded retrospectively. RESULTS: Twenty of the patients were male and 12 were female. Regarding comorbid diseases in our patient group, 13 had extra-thoracic malignancy, 7 had hypertension, 6 had heart disease, 5 had chronic obstructive pulmonary disease and asthma, and 4 had diabetes mellitus. Pleural drainage and biopsy were performed in 10 patients and wedge resection in 8 patients. Bullectomy and apical pleural abrasion were performed in 6 patients, mediastinal mass biopsy was performed in 4 patients, and delocculation was performed in 4 patients due to empyema. CONCLUSIONS: The non-intubated VATS approach can be safely applied in procedures such as lung resections, pleural or mediastinal interventions, and pneumothorax surgery. With this technique, the absence of intubation and mechanical ventilation facilitates the return to normal respiratory physiology, and we think that the recovery time of the patient, the duration of hospital stay, and treatment costs are reduced.

Analysis of lung volume reduction surgery results with video-assisted thoracoscopic surgery in emphysematous lung patients.

AIM: In our study, we aimed to evaluate the results of patients who underwent lung volume reduction surgery with video-assisted thoracoscopic surgery due to diffuse or upper lobe limited emphysema. MATERIAL AND METHODS: Patients who underwent lung volume reduction surgery (LVRS) for emphysema in our clinic between March 2015 and January 2020 were included in the study. The files of the patients were evaluated retrospectively. Age, gender, smoking history, hospitalization time, drain removal time, complications, and postoperative pulmonary function test values were evaluated in the patient records. RESULTS: Twenty-four of the patients were male and 2 were female. The average age was determined as 49.6. Twenty-six patients underwent 31 surgical procedures, 5 of which were bilateral. Twenty-seven of them were performed by videothoracoscopic LVRS. Preoperative mean forced expiratory volume in 1 s (FEV1) value was 32.7%, total lung capacity 132%, residual volume 280%. The average length of hospital stay was found to be 7.75 days (4-19), and the time to remove the thorax drain was 9.5 (4-23) days. FEV1: 1.78 (48.5%) was found in the pulmonary function tests of the patients at the 6th month postoperative controls. According to preoperative FEV1, 48.3% improvement was detected. CONCLUSIONS: Volume reduction surgery is a treatment method that positively affects the natural course of emphysema in addition to quitting smoking and oxygen therapy. Patients with predominantly emphysema in the upper lobes, low exercise capacity, and appropriate FEV1 values benefited most from this treatment.

The relationship between the heart-type fatty acid binding protein levels, carotid intima media thickness and epicardial fat thickness in patients with obstructive sleep apnea syndrome.

INTRODUCTION: In this study, we aimed to evaluate the relationship between carotid artery intima-media thickness, epicardial fat thickness measurement and the levels of heart-type fatty acid binding protein (hFABP) in patients with obstructive sleep apnea syndrome (OSAS). MATERIALS AND METHODS: Ninety-nine newly diagnosed OSAS patients and fifty non-OSAS control subjects were enrolled in this study. In both groups, demographic data such as age, sex, body mass index (BMI) were recorded and carotid intima-media thickness (CMIT) and epicardial fat thickness (EFT) were measured. hFABP levels were determined using the enzyme-linked immunosorbent assay (ELISA) method according to the manufacturer's protocols. RESULT: Patients with OSAS 67% male, 33% female gender is determined. The mean age of control group was 43.28 ± 12.12 years and group of OSAS was 47.85 ± 11.55 years (p= 0.026). In OSAS group; 38 mild OSAS (38.38%), 23 moderate OSAS (23.23%) and 38 severe OSAS (38.38%) patients were identified. In OSAS patients, average of apnea hypopnea index (AHI) was 29.83/hours. A positive correlation was observed between BMI with EFT and CMIT (p< 0.05). hFABP levels in OSAS group average was 2.65 ± 2.1 ng/mL and in control group average was 1.62 ± 0.90 ng/mL and this was statistically significant (p= 0.002). EFT, in the control group average was 5.3 ± 2.04 mm, while the average was 4.3 ± 1.79 mm in the OSAS group (p= 0.019). The correlation was observed between the CMIT and EFT (p< 0.001). There was no significant difference in BMI and gender between OSAS and control groups. No accompanying cardiovascular disease was detected in patients with OSAS. CONCLUSIONS: This study suggests EFT and hFABP can be used as a predictive value in determining cardiovascular risk in OSAS patients.

A subxiphoid uniportal video-assisted thoracoscopic surgery for synchronous bilateral pulmonary metastasis: A case report.

The subxiphoid incision has been widely used in videothoracoscopic surgery in recent years. This minimally invasive technique allows to reach both lungs from a single port. With the future development of the surgical instruments required for the technique, it is expected to become more commonly used. Herein, we report the first case of bilateral pulmonary metastasectomy performed with a subxiphoid single incision in Turkey.

Evaluation of surgical procedures in primary mediastinal cysts and tumors: single-center experience.

AIM: In this study, we aimed to evaluate the results of our patients with a primary mediastinal mass and the surgical techniques applied in our clinic retrospectively. MATERIAL AND METHODS: Between March 2015 and March 2019, the results and treatment protocols of 32 patients with a primary mediastinal mass or cysts who were followed up and treated in our clinic were evaluated retrospectively. Twenty-six patients who underwent surgery for biopsy or resection were included in the study. RESULTS: Sixteen of our patients were male and 10 were female. The mean age was 39 years. 80.2% of our patients were symptomatic and 19.2% were asymptomatic and a mediastinal mass was incidentally detected in these asymptomatic patients. The most common symptom was dyspnea with frequency of 38.4%. In terms of localization, the mass was lateralized on the right side in 7 patients, on the left side in 5 patients. In 13 patients, the tumor was located in the posterior mediastinum. 8 patients underwent anterior mediastinotomy and 1 patient underwent biopsy with video-assisted thoracoscopic surgery (VATS). Most commonly a thymus-derived mass was seen. Fifteen patients underwent excision with VATS, 3 thoracotomy, 2 sternotomy and in 1 patient VATS assisted anterior minithoracotomy was performed. CONCLUSIONS: Mediastinal tumors and cysts have different histopathological features. Robotic surgery and VATS-assisted surgery are increasingly used in surgical excision.