The effect of thoracic trauma scoring system in thoracic trauma patients with rib fracture.

OBJECTIVE: Rib fractures are common in thoracic trauma patients. There are various factors, including flail chest, pulmonary contusion, and accompanying conditions, affecting morbidity and mortality. The study aimed to identify high-risk patients for morbidity and mortality with a scoring system that the authors created. METHODS: Cases over the age of 18 admitted due to trauma and diagnosed with rib fractures between 1 January 2019 and 1 March 2023, were included. Trauma scores were determined by applying the new trauma scoring system. Trauma scores and other variables regarding morbidity and mortality were evaluated. RESULTS: A total of 1023 cases were included in the study. The total trauma scores were higher in bilateral and multiple fractures. In those without respiratory failure, the total score was statistically significantly lower than in the groups with respiratory failure. The total score was significantly higher in those who needed surgery, those who were hospitalized, and those who needed intensive care compared to the non-surgical groups. However, there was no correlation between intensive care unit stay and total score. Trauma mechanism, presence of additional extrathoracic pathology, and thoracic trauma-age score were independent predictors of survival. CONCLUSION: The present study demonstrated that the number of rib fractures and the presence of pulmonary contusion did not have an effect on mortality and morbidity. The presence of extrathoracic pathology and age significantly affect survival.

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.

Relationship between the Size and Location of the Mass and Hilar and Mediastinal Lymph Node Metastasis in Early and Locally Advanced Non-small Cell Lung Cancer.

OBJECTIVE: To determine whether there is a relationship between the size and location of the mass and lymph node metastasis in non-small cell lung cancer. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of Medical Oncology of Trakya University, from November 2013 to November 2018. METHODOLOGY: Records of 112 patients, who were followed up for non-small cell lung cancer, were retrospectively reviewed. Patients with distant organ metastasis (M1) and distant lymph node metastasis (N3), a previous history of malignancy, synchronous or metachronous tumors, and those for whom required data could not be obtained were excluded. Lymph nodes were evaluated according to pathology reports in patients undergoing invasive procedures. In patients without invasive procedures, lymph node larger than 1 cm in thorax CT, SUV above 2.5 in PET, and acceptance of metastasis at the Oncology Council was considered decisive. Diameter of the tumor, the shortest distance between the tumor and the mediastinum, the shortest distance between the tumor and the hilum, and the diameters of the largest mediastinal or hilar lymph nodes were measured from the thoracic computed tomography (CT) taken at the time of the diagnosis. The relationship between these values and lymph node metastasis was statistically evaluated. RESULTS: Upon consideration of thoracic CT measurements, lymph node metastasis was found to have a statistically significant relationship with tumors with a large diameter (>55 mm) (p<0.001), tumors close to the mediastinum (<7 mm) (p=0.003), and tumors close to the hilum (<60 mm) (p=0.045). The evaluation of the distinctiveness of markers in diagnosis through ROC analysis showed AUC of 0.70 (p<0.001) for the largest tumor diameter, and the risk of lymph node metastasis was higher for lesions above 55 mm. CONCLUSION: In thorax CT, Large tumor size, tumor close to mediastinum, tumor close to hilum, large lymph node, and high SUV value of lymph node in PET-CT are associated with increased chances of metastasis.

Topographic evaluation of sternal foramen patients with thoracic computed tomography.

PURPOSE: In our study, we aimed to determine the topographic analysis of sternal foramen cases incidentally detected in patients underwent thoracic computed tomography. MATERIALS AND METHODS: Patients aged 18 and over who were admitted to the thoracic surgery outpatient clinic for various reasons and underwent thoracic computed tomography (CT) between January 1, 2018 and January 1, 2019 were evaluated retrospectively. Thoracic CT scans of all patients with sternal foramen were evaluated by applying 3D bone configuration to evaluate foramina in the sternum and ribs. The data obtained were analyzed statistically by SPSS (Statistical Package for Social Sciences Version 21.0). RESULTS: Nine hundred and twelve patients were evaluated and sternal foramen prevalence was found to be 8.44% in our study. Of the 68 patients included in the study, 48 were male and 20 were female. The sternal foramen was localized in the corpus in 66.2% of the patients, whereas it was localized in xiphoid in 33.8%. Nine patients had scoliosis deformity and three patients had foramen in the rib. CONCLUSION: Sternal foramen is a more common defect than thought, and should be kept in mind in clinical practice to prevent complications.

A Case of Immunoglobulin (Ig) G4-related Sclerosing Periaortitis Mimicking Mediastinal Malignant Tumor.

Sclerosing mediastinitis was first described by Oulmont in 1855. The aggressive fibro-inflammatory process that occurs in the mediastinum is the end result of a number of inflammatory processes. It is thought that hypersensitivity reactions to various antigens, autoimmune reactions, and idiopathic fibro-inflammatory responses play a role in the etiology of the disease. It has been shown in recent years that immonoglobulin (Ig) G4-related autoimmune diseases may lead to sclerosing mediastinitis. In this study, a rare case of Ig G4-related sclerosing periaortitis is presented in a 50-year male patient. The disease responded well to steroid treatment, but soon recurred following stoppage of the treatment. The treatment with deflazacort was started again; and he responded well. The lesion disappeared within six months of retreatment.

Effect of mitomycin-C applied through different approaches following tracheal surgery on development of granulation tissue and level of nephrotoxicity in rats.

BACKGROUND: This study aims to evaluate the effect of mitomycin-C applied through different drug administration approaches on the development of granulation tissue in the field of surgery and renal functions in rats which underwent tracheal surgery. METHODS: Fifty male adult Sprague Dawley rats (weighing mean 200 g to 300 g) were divided into five groups. An incision was performed between the fifth and sixth cartilage ring of the trachea in all groups under anesthesia and the incision was primarily repaired with a 6/0 monofilament absorbable suture. A single dose of mitomycin-C 0.5 mg was applied in the experimental animals appropriate with their assigned groups as topical, intraperitoneal injection, injection to the wound edges, and through inhalation. No mitomycin-C was administered in one group which was accepted as the control group. Rats were sacrificed four weeks after surgery and their tracheas were excised subsequently. Tracheal tissue samples were histopathologically evaluated in terms of epithelization, fibrosis, amount of fibroblasts, angiogenesis, and inflammatory response. Diameter and wall thickness of the tracheas were measured. Blood urea and creatinine levels were evaluated for nephrotoxicity, and the rats were immunohistochemically examined for glomerular pathology. RESULTS: Epithelization was statistically significantly decelerated (p<0.01), diameter of the trachea was statistically significantly larger (p<0.05), and wall thickness of the trachea was significantly thicker in the group with topical mitomycin-C application compared to the control group (p<0.01). CONCLUSION: Topically applied mitomycin-C following tracheal surgery slows down epithelization and, thus, decreases the development of granulation tissue and maintains a wider diameter of the trachea.

Massive Bochdalek diaphragmatic hernia in adult with hypoplastic lung.

Bochdalek diaphragmatic hernia is generally congenital and rarely diagnosed incidentally in adults. A 21-year-old man presented with a diaphragmatic hernia suspected during routine examination. Chest radiography showed the colon and small intestine herniating into the left hemithorax and the ileocecal appendix in the superior thoracic apertura. We performed a thoracoabdominal incision and the stomach, omentum, colon, and small intestine were retracted back into the abdomen. The diaphragm was repaired with Prolene mesh following adhesiolysis. Two months later, there was no recurrence but no lung expansion. The space was filled with effusion, but the patient had no complaints.

3-year follow-up after uniportal thoracoscopic sympathicotomy for hyperhidrosis: undesirable side effects.

OBJECTIVE: Endoscopic thoracic sympathectomy or sympathicotomy, for the treatment of palmar, axillary, and plantar hyperhidrosis, is generally performed at one or two levels, between T2 and T5. Compensatory sweating (CS) is a severe and undesirable side effect of this procedure. Here, we describe the success of treatment and degree of postoperative CS in sympathicotomy patients. SUBJECTS AND METHODS: This study included 80 patients treated by uniportal (5-mm) thoracoscopic sympathicotomy (electrocautery) for primary hyperhidrosis over a 6-year period (2007-2013). Sympathicotomy was performed bilaterally at T2 for blushing (n=2), T2-T3 for palmar-only hyperhidrosis (n=34), T2-T4 for palmar and axillary hyperhidrosis (n=39), and T3-T4 for axillary-only hyperhidrosis (n=5). Outcome was assessed 2 weeks postsurgery at the clinic and annually thereafter by telephone questionnaire. Mean follow-up time was 35.2±23.3 months. Questionnaires assessed patients' degree of sweating, postoperative CS, overall satisfaction, and complications. RESULTS: Seventy-one patients (88.7%) were very satisfied, whereas only 9 (11.3%) were dissatisfied with the procedure. Complication incidence was 7.5%, and CS occurred in 77.5% of patients. Therapeutic success rate was 97.5%; complete relief of hyperhidrosis was achieved in 72 (90%) patients, whereas 8 (10%) experienced recurrence. CONCLUSIONS: CS is a frequent side effect of thoracoscopic sympathicotomy. We recommend all patients undergoing this procedure should be warned of the potential risk of developing severe CS.

A rarely seen mucoepidermoid carcinoma of the left main bronchus.

Mucoepidermoid carcinomas (MEC) are rare malignant tumors that originate in the submucosal bronchial glands, and complete resection usually correlates with favorable prognosis. A 54-year-old male patient was diagnosed with high-grade MEC in the left main bronchus via bronchoscopy. After the patient was diagnosed with metastatic lung cancer, chemotherapy was started. Two years after the diagnosis, the patient is still alive.

Transabdominal subcostal approach in surgical management of Morgagni hernia.

OBJECTIVE: Morgagni hernia is an uncommon type of diaphragmatic hernias whose pathophysiology is not clear. We aimed to retrospectively evaluate morbidity, mortality, and treatment outcomes in 13 cases of Morgagni hernia treated with the subcostal approach. MATERIAL AND METHODS: Between 1993 and 2009, 13 patients with Morgagni hernia were operated in our department. Of the 13 patients with a median age of 65 years (range: 13-78), 12 were female. Chest roentgenograms, thorax computed tomography (CT), and barium enema roentgenographic studies were used as diagnostic utilities. The contents of the hernia, as diagnosed with CT and confirmed at surgery, were omentum and colon in all patients. RESULTS: All the patients were operated electively except one patient on ventilation treatment. Transabdominal repair with the subcostal approach was performed in all patients. There was no operative morbidity and mortality. The median hospital stay was 8 days (range: 6-14 days). There was no recurrence during the follow-up of 48.8 months (1-132 months). CONCLUSION: We recommend the transabdominal subcostal approach in patients with Morgagni hernia for surgical exposure, easy repair of the hernia sac, and low morbidity.