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Introduction: Video-assisted thoracoscopic surgery (VATS) is a common surgical procedure. Aim: To find out how educating patients using multimedia affects their pain and anxiety before and after VATS surgery. Material and methods: The study included 50 patients who underwent VATS between December 2017 and December 2018. The subjects were divided into two groups: the multimedia information group (MIG) and the control group (n = 25). The subjects underwent STAI-T testing, preoperative and postoperative STAI-S testing, and pulmonary function tests (PFT) before surgery and after surgery. Results: The patients in the MIG had higher baseline anxiety levels than those in the control groups. There were no significant differences between the two groups in terms of demographic information, surgical characteristics, or vital signs. There was a statistically significant difference in the preoperative (p = 0.001) and the postoperative (p = 0.0001) pain scores between MIG and control groups. The postoperative STAI-S scores of MIG increased, but this increase was not significant. In both groups, there was no significant difference in the changes in systolic blood pressure (p = 0.656) or respiratory rate (p = 0.05). There was no difference between post-training and pre- and post-operative pain scores in both groups. Conclusions: Providing multimedia information before surgery has some effect on pain. However, providing multimedia information does not reduce postoperative anxiety.
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AIM: To assess how metastatic lesions with a higher maximum standard uptake value than the primary tumor affect survival in patients with lung cancer. METHODS: The study enrolled 590 stage-IV lung cancer patients treated at Afyonkarahisar Health Sciences University Hospital between January 2013 and January 2020. We retrospectively collected data on histopathological diagnosis, tumor size, metastasis site, and maximum standard involvement values of primary metastatic lesions. Lung cancers with the maximum standard uptake value of the primary tumor higher than that of the metastatic lesion were compared with lung cancers with the maximum standard uptake value of the primary tumor lower than that of the metastatic lesion. RESULTS: In 87 (14.7%) patients, the maximum standard uptake value was higher in the metastatic lesion than in the primary lesion. These patients experienced significantly higher mortality risk in both univariate and multivariate survival analyses (adjusted hazard ratio 2.25 [1.77-2.86], <0.001) and had shorter median survival (5.0 [4.2-5.8] vs 11.0 [10.2-11.8] months, P<0.001). CONCLUSIONS: The maximum standard uptake value could be a potential new prognostic factor for survival in lung cancer.
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Neoplasias Pulmonares , Humanos , Estudos Retrospectivos , Transporte Biológico , Coleta de Dados , Hospitais UniversitáriosRESUMO
BACKGROUND: Sarcoidosis, a multisystemic disease of unknown etiology, is characterized by non-caseating granulomatous inflammation. This study aimed to investigate the efficiency of atherogenic indices and ultrasonographic evaluation of carotid artery on predicting atherosclerosis in patients with sarcoidosis. METHODS: The study included 44 subjects followed with diagnosis of sarcoidosis and 53 age and gender matched healthy subjects as controls. Laboratory findings, pulmonary function tests and carotid artery ultrasonography of all participants were evaluated. RESULTS: Of the participants with sarcoidosis 70.5% was female and the mean age was 35.36±7.18 years, while 64.2% of the control group were female and the mean age was 33.58±8.13 years (P=0.511 and P=0.191, respectively). High-density-lipoprotein cholesterol level in the sarcoidosis group was significantly lower than that of the control group (P=0.017), while other cholesterol levels were higher than those of the controls (P<0.05). Intima-media thickness (IMT) and peak systolic velocity (PSV) of carotid artery were higher in patients with sarcoidosis (P<0.001 and P=0.009, respectively). Atherogenic indices (Atherogenic Index (AI), Atherogenic Coefficient (AC) and Cardiogenic Risk Ratio (CRR)) were higher in sarcoidosis group compared to the controls (P<0.001, for all parameters). IMT was positively correlated with PSV, AI, AC, and CRR. A positive correlation between PSV and atherogenic indices was also detected. CONCLUSIONS: Sarcoidosis may be a predisposing factor for atherosclerosis. Atherogenic indices, IMT of carotid artery and PSV might be considered predictors for atherosclerosis and cardiovascular diseases in asymptomatic sarcoidosis patients.
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OBJECTIVE: Tracheal pathologies are life-threatening in all age groups and may result in death if urgent action isn't taken. The aim of this study was to present cases of rare and life-threatening tracheal pathologies and discuss the management of these in the light of literature. METHODS: A retrospective analysis was made of 8 patients who underwent surgery for emergency tracheal pathologies in our clinics between 2013 and November 2018. The patients were evaluated in terms of age, gender, etiology, symptoms, location of pathology, surgical approach, treatment technique, and length of hospital stay. RESULTS: Of the 8 cases with tracheal pathology, 4(50%) had tracheal rupture, 3(37.5%) had tracheal stenosis due to prolonged post-intubation, and one (12.5%) had a tracheal tumor. The cases with tracheal rupture comprised 2 females and 2 males with a mean age of 28.5 years (range, 16-48 years). The cases with tracheal stenosis were 2 females and 1 male with a mean age of 29.3 years (range, 25-36 years). The patient with a tracheal tumor was 34 years old and had been diagnosed late. Preoperative mortality as a result of hypoxia was seen in one case with carina rupture. No postoperative morbidity or mortality were observed in all 7(87.5%) cases who underwent surgery. CONCLUSION: Early diagnosis, treatment, determination of the location and form of the pathology is very important in tracheal pathologies. In surgical treatment, wide resection should be avoided as much as possible, and the surgical approach should be determined according to the shape of the pathology, wiht end-to-end anastomosis and/or primary repair applied when possible. KEY WORDS: Surgery, Tacheal tumor, Tracheal stenosis, Tracheal rupture.
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Neoplasias da Traqueia , Estenose Traqueal , Feminino , Humanos , Masculino , Adulto , Traqueia/cirurgia , Estenose Traqueal/etiologia , Estenose Traqueal/cirurgia , Ruptura/complicações , Neoplasias da Traqueia/complicações , Estudos Retrospectivos , Emergências , Intubação Intratraqueal/efeitos adversos , Resultado do TratamentoRESUMO
Reexpansion pulmonary edema is a rare but fatal clinical condition that develops during the treatment of pneumothorax, pleural effusion and collapsed lung after atelectasis. A 31-year-old male patient was referred to our clinic with the complaint of stinging back pain that started 3 days ago and dyspnea developed during the last 24 hours. Physical examination and radiologic examinations revealed total pneumothorax in the right hemithorax. After tube thoracostomy, his general condition deteriorated and bilateral reexpension edema developed in the lungs. The patient was admitted to the intensive care unit and was discharged on the 5th day after medical treatment. Our case is the first case of bilateral reexpansion pulmonary edema seen after unilateral spontaneous pneumothorax when literature review is performed. In order to emphasize the importance of rapid diagnosis and treatment, it is presented in the light of the literature.
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Pneumotórax/etiologia , Pneumotórax/cirurgia , Edema Pulmonar/etiologia , Adulto , Dispneia/etiologia , Humanos , Unidades de Terapia Intensiva , Masculino , Derrame Pleural/etiologia , Edema Pulmonar/diagnóstico por imagem , Radiografia , ToracotomiaRESUMO
Although foreign body aspiration is common in children and the elderly, it is very rare in young people. However, headscarf needle aspiration is common in Muslim societies, especially in young people. In needle aspirations that cannot be removed by bronchoscopic methods, thoracotomy is frequently essential method due to the sliding of the needle to the distal part of the lung. A 21-year-old female patient was referred from our emergency department to our clinic with the preliminary diagnosis of needle aspiration. Needle was not visualized by fiberoptic bronchoscopy. Video-assisted thoracoscopic surgery (VATS) was performed and the needle was removed successfully by a maneuver which we encountered for the first time in the literature. Our patient was discharged on the second postoperative day.
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Corpos Estranhos/cirurgia , Pulmão , Tecido Parenquimatoso , Cirurgia Torácica Vídeoassistida/métodos , Feminino , Corpos Estranhos/diagnóstico por imagem , Humanos , Adulto JovemRESUMO
BACKGROUND: In this study, we evaluated the cardiopulmonary and psychosocial effects of endoscopic thoracal sympathectomy (ETS) by clipping procedure at the level of Th4 and effects of ETS on quality of life of patients with hyperhidrosis. METHODS: We performed a prospective study in 52 patients complaining of local sweating who applied to our clinic. Cardiac maximal treadmill stress test (CMTST), pulmonary function tests, Beck anxiety-depression inventory, Liebowitz social anxiety scale and SF-36 quality of life questionnaires were administered at preoperative period and postoperative 6th month. RESULTS: In the pulmonary function test, we found a minimal decrease in FEV1, and FEV1/FVC. There were no significant change in 'resting pulse rate', 'resting systolic and diastolic blood pressures' during CMTST between before and after operation. There was a significant difference in peak heart rate before CMTST, post-exercise diastolic blood pressure, and age-predictive maximal heart rate between before and after clipping procedure. In the SF-36 questionnaire, all parameters were improved. In the Beck depression-anxiety inventory and the Liebowitz social anxiety scale significant improvement was achieved in all parameters. CONCLUSION: ETS by clipping procedure at the Th4 level is advised to be a safe and effective method for management of hyperhidrosis patients.
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Hiperidrose/psicologia , Hiperidrose/cirurgia , Simpatectomia/métodos , Adolescente , Adulto , Ansiedade/etiologia , Pressão Sanguínea , Depressão/etiologia , Teste de Esforço , Feminino , Volume Expiratório Forçado , Frequência Cardíaca , Humanos , Masculino , Período Pós-Operatório , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Qualidade de Vida , Toracoscopia , Capacidade Vital , Adulto JovemRESUMO
Tracheal ruptures are rarely seen and potentially high life-threatening injuries. Cervical tracheal injuries occur due to the penetrant trauma rather than the blunt trauma. On the other hand, total cervical tracheal rupture due to the blunt trauma is so rare. A 32 year-old male patient was admitted to the emergency service with complaints of breathlessness and stridor resulting from a traffic accident. Thorax computed tomography of the patient revealed total cervical tracheal rupture under the cricoid cartilage level. Emergency tracheostomy was opened and distal airway safety was provided in operating room. The patient underwent an anastomosis with Collar's incision and was discharged in 16th days postoperatively without any complication other than hoarseness.
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Broncoscopia/métodos , Traumatismo Múltiplo , Lesões do Pescoço/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Traqueia/lesões , Traqueostomia/métodos , Ferimentos não Penetrantes/cirurgia , Acidentes de Trânsito , Adulto , Humanos , Masculino , Lesões do Pescoço/cirurgia , Ruptura , Traqueia/diagnóstico por imagem , Traqueia/cirurgia , Ferimentos não Penetrantes/diagnósticoRESUMO
OBJECTIVE: Cystic echinococcosis (CE) is a globally prevalent zoonotic disease. METHODS: Demographic, clinical, laboratory, and follow-up data of patients between May 2009 and 2015 were retrospectively analyzed by screening data from a hospital automation system. RESULTS: A total of 238 (females, n=139 and males, n=99) patients with a mean age of 40.6±20.58 years were included. Less than half (40.8%) of the patients were living in the countryside. Hepatic involvement of CE was most frequently (72.2%) seen. A majority (75.6%) of the patients were symptomatic, but abdominal pain was the most frequently seen symptom. For diagnosis, in all patients, imaging modalities were used, while in 66% of the patients, serological methods were also employed. The patients received both medical and surgical treatments (78.5%, n=187), only surgical treatment (10.5%, n=25), or only medical treatment (8.8%, n=21). Surgical treatment was performed for patients with hepatic (n=139/176, 80.6%), pulmonary (n=78/94, 82.9%), splenic (n=7/9; 77.7%), and mesenteric (n=6/7, 85.1%) cysts, and patients cases with brain, bone, muscle, omentum, bladder, and adrenal cysts had undergone surgical intervention. CONCLUSION: Publication of regional data is important in terms of epidemiological considerations and may aid in the formulation of standard treatment approaches.
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Equinococose/diagnóstico , Zoonoses/diagnóstico , Dor Abdominal , Adulto , Animais , Equinococose/epidemiologia , Equinococose/terapia , Equinococose Hepática/diagnóstico , Equinococose Hepática/epidemiologia , Equinococose Hepática/terapia , Equinococose Pulmonar/diagnóstico , Equinococose Pulmonar/epidemiologia , Equinococose Pulmonar/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Recidiva , Estudos Retrospectivos , Fatores de Risco , Turquia/epidemiologia , Adulto Jovem , Zoonoses/epidemiologia , Zoonoses/parasitologiaRESUMO
BACKGROUND: The goal of the present study was to evaluate the antioxidant effects of melatonin on pulmonary contusion (PC) caused by isolated blunt thoracic trauma (BTT) in an experimental rat model. MATERIALS AND METHODS: A total of 49 rats were divided into three groups: control group (CG), trauma group (TG), and melatonin group (MG). PC was induced by isolated BTT for all the groups except the control group. Intraperitoneal melatonin was administered to the MG after trauma. Blood and tissue samples were collected from the groups. Malondialdehyde (MDA), total oxidant capacity and total antioxidant capacity (TAOC), arterial blood gas, and other biochemical parameters such as urea, creatinine, alanine aminotransferase (ALT), and aspartate aminotransferase were measured. Lung tissue samples were collected for histopathology. RESULTS: On day 2, blood MDA and total oxidant capacity levels were lower, and TAOC levels were higher in the MG compared with the TG (P < 0.001). Blood pH, PO2, and PCO2 of the MG significantly improved on day 2 compared with the TG (P ≤ 0.001). Compared with the TG, histologic damage scores of the MG decreased on day 2 (P = 0.013). Urea, creatinine, ALT, and aspartate aminotransferase levels of the MG on day 2 were lower than TG parameters (P = 0.01, P = 0.02, P = 0.05, and P < 0.001, respectively). CONCLUSIONS: Our findings demonstrate that melatonin can improve the histopathology of PC and distant organs such as liver and kidney by diminishing oxidative stress. All these findings suggest that melatonin may be an effective new therapeutic agent for PC caused by BTT.
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Lesão Pulmonar Aguda/tratamento farmacológico , Antioxidantes/uso terapêutico , Contusões/tratamento farmacológico , Melatonina/uso terapêutico , Lesão Pulmonar Aguda/sangue , Lesão Pulmonar Aguda/patologia , Animais , Gasometria , Contusões/sangue , Contusões/patologia , Avaliação Pré-Clínica de Medicamentos , Pulmão/patologia , Masculino , Estresse Oxidativo , Distribuição Aleatória , Ratos Sprague-DawleyRESUMO
BACKGROUND: Inadequate relief of postthoracotomy pain is a major reason of increased occurrence of postoperative complications. We aimed to investigate and compare the effects of transcutaneous electrical nerve stimulation (TENS) and paravertebral block (PVB) to relieve pain after thoracotomy procedures. MATERIALS AND METHODS: We studied 40 patients who underwent thoracotomy. Patients were randomly allocated to receive either PVB (group P, n = 20) or TENS (group T, n = 20) for postoperative pain. The electrodes of TENS were placed 2 cm under and 2 cm over the thoracotomy cut on both posterior and anterior sides. The surgeon inserted paravertebral catheters using direct vision at the end of the surgery. A patient-controlled analgesia (PCA) device was connected to all patients. Visual analog scales, patient demand, and consumption of tramadol were evaluated postoperatively. RESULTS: Mean visual analog scale (VAS) values were significantly lower in group P for all time points. The patients in group P needed lower amounts of opioid (tramadol) and the difference was statistically significant (258.4 ± 13.52 mg vs. 314.4 ± 8.65 mg, p = 0.005). In addition, the number of demand attempts recorded from the PCA device was significantly lower in group P (14.95 ± 13.64 vs. 26.7 ± 17.34, respectively and p < 0.001). CONCLUSION: TENS has beneficial effects for pain relief after thoracotomy, without any side effects; however, it cannot provide sufficient pain relief when compared with PVB.
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Bloqueio Nervoso/métodos , Dor Pós-Operatória/terapia , Toracotomia/efeitos adversos , Estimulação Elétrica Nervosa Transcutânea/métodos , Anestésicos Locais/uso terapêutico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Estudos Retrospectivos , Vértebras Torácicas , Resultado do TratamentoRESUMO
AIM: In this study, we aimed to investigate the effect of written informed consent and comprehensive multimedia information on the anxiety level of patients, consumption of sedatives, difficulties during bronchoscopy, complications and duration of procedure. METHODS: 150 patients undergoing bronchoscopy were included to this study. They were randomized into two groups Multimedia information group (MIG, n = 75) and written-informed consent group (WICG, n = 75)). Signed written informed consent was obtained from all patients. Patients in MIG group watched comprehensive multimedia presentation. State anxiety scores of all patients were evaluated with State and Trait anxiety inventory (STAI-S). RESULTS: STAI-S score of patients in MIG (40.31 ± 8.08) was lower than patients in WICG (44.29 ± 9.62) (P = 0.007). Satisfaction level was higher in MIG (P = 0.001). Statistically higher difficulties during passage through vocal cords and interventions during bronchoscopy were present in WICG group (P = 0.013 and P = 0.043, respectively). Total midazolam dose during bronchoscopy, and duration of bronchoscopy were statistically lower in MIG patients (P < 0.001 and P = 0.045, respectively). Difficulties during waiting period, passage through nasal/oral route, applications of local anesthesia and complication frequency were similar in both groups. CONCLUSION: Besides reducing the state anxiety, multimedia information can reduce the dose of sedation, shorten the processing duration and reduce the difficulties during bronchoscopy.
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OBJECTIVE: Some treatment modalities may cause losses in patients' life comfort because of the treatment process. Our aim is to determine the effects of thoracic surgery operations on patients' quality of life. MATERIALS AND METHODS: This is a multicenter and prospective study. A hundred patients, who had undergone posterolateral thoracotomy (PLT) and/or lateral thoracotomy (LT), were included in the study. A quality of life questionnaire (SF-36) was used to determine the changes in life comfort. SF-36 was performed before the operation, on the first month, third month, sixth month and twelfth month after the operation. RESULTS: Seventy-two percent (n = 72) of the patients were male. PLT was performed in 66% (n = 66) of the patients, and LT was performed in 34% (n = 34) of the patients. The types of resections in patients were pneumonectomy in four patients, lobectomy in 59 patients and wedge resection in 11 patients. No resection was performed in 26 patients. Thoracotomy caused deteriorations in physical function (PF), physical role (RP), bodily pain (BP), health, vitality and social function scores. The deteriorations observed in the third month improved in the sixth and twelfth months. The PF, RP, BP and MH scores of the patients with lung resection were much more worsened compared with the patients who did not undergo lung resection. CONCLUSION: Thoracic surgery operations caused substantial dissatisfaction in life comfort especially in the third month postoperatively. The worsening in physical function, physical role, pain and mental health is much more in patients with resection compared with the patients who did not undergo resection.
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Toracotomia/psicologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Prospectivos , Qualidade de Vida , Inquéritos e Questionários , Toracotomia/métodos , Resultado do TratamentoRESUMO
PURPOSE: Hydatid cyst (HC) disease is a zoonotic disease caused by the larvae of Echinococcus granulosus. We report our experience of treating HC manifesting aggressive characteristics. METHODS: Between January, 2010 and December, 2013, 40 patients underwent surgery for HC disease in our department. The subjects of this study were six patients whose disease followed an aggressive and invasive clinical course. The HC disease in these patients involved the vertebrae, chest wall, mediastinum, diaphragm, and lung, with destruction of the lung. RESULTS: There were four men and two women, with a mean age of 47 years (range 12-81 years). Treatment consisted of cystectomy and additional procedures, such as corpectomy and resection of the chest wall, approaching the liver and spleen with phrenotomy and lobectomy. One patient suffered prolonged biliary drainage, and another had a bronchopleural fistula and atelectasis. One patient died of empyema 1 month postoperatively. The mean hospital stay was 9 days. CONCLUSION: In some patients, HCs can act as an aggressive tumor, involving the surrounding tissues, organs, and even bony structures. Aggressive HCs may cause various sequelae and require extended surgical interventions in addition to cystectomy.
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Equinococose/diagnóstico , Adulto , Idoso de 80 Anos ou mais , Criança , Progressão da Doença , Equinococose/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de DoençaRESUMO
Cervical necrotizing fasciitis (CNF) is a rare, rapidly advancing infection that involves the skin, the subcutaneous fibrofatty tissue, as well as the superficial and deep fascia and can cause life-threatening complications. The most frequent initiating factors in the head and neck region are a primary odontogenic infection, a peritonsillar infection, as well as posttraumatic or iatrogenic skin and mucosal injuries. Necrotizing fasciitis (NF) can expand within hours, and the reported mortality rate is up to 75% with delay interference. If the patients have any risk factors, poor prognosis can be seen. In this study, 1 patient with CNF with a history of peritonsillar infection and 2 patients with CNF who had a history of odontogenic infection with spreading to the temporal region and the mediastinum were described, with information of the literature and a clinical experience that was gained from 5 patients with NF who were seen at our clinic in the recent year, despite the fact that CNF was not seen up to last year. None of the patients had any risk factors. One of them had a worse clinical state with ascending infection to the temporal region, cranial nerve paralysis, and descending necrotizing mediastinitis, but he recovered from NF. After the oral intake began, dyspnea due to aspiration was seen and he died because of sepsis and multiorgan dysfunction. We aimed to attract attention to the importance of dental pathologies and increased mortality in a healthy patient.
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Paralisia Facial/etiologia , Fasciite Necrosante/microbiologia , Infecção Focal Dentária/microbiologia , Mediastinite/etiologia , Infecções por Acinetobacter/diagnóstico , Acinetobacter baumannii/fisiologia , Adulto , Idoso de 80 Anos ou mais , Infecções por Bacteroidaceae/diagnóstico , Candidíase/diagnóstico , Doenças dos Nervos Cranianos/etiologia , Feminino , Humanos , Masculino , Pescoço/patologia , Paralisia/etiologia , Prevotella/fisiologia , Prognóstico , Infecções Estreptocócicas/diagnóstico , Estreptococos Viridans/fisiologiaRESUMO
BACKGROUND: The most commonly observed pathology in chest traumas is rib fracture, and the most important clinical symptom is severe pain. AIMS: To investigate the effectiveness of intramuscular opioid (IMO), intravenous patient-controlled analgesia (IVPCA) and the Fentanyl transdermal therapeutic system (TTS) in the management of rib fracture pain. STUDY DESIGN: Prospective randomized clinical trial. METHODS: In our prospective and randomised study, we included 45 patients with a diagnosis of multiple rib fractures. There were three groups and intercostal nerve blockage (ICB) in the first day and oral paracetamol for five days was administered to each group as standard. In Group IMO (n=15), 4×40 mg pethidine HCl was administered to the patients, while in Group IVPCA (n=15) this was 5 µg/mL continuous intravenous fentanyl and was 50 µg fentanyl TTS in Group TTS (n=15). The demographics, injury data and vital signs of the patients were recorded. Pain was scored using Visual Analogue Scale (VAS). The pain during lying down (VASl) and mobilisation (VASm) was detected. RESULTS: There were no differences between the three groups regarding age, sex, the trauma pattern, the number and distribution of costal fracture localisations, the presence of additional pathology, complications, thoracal catheter and the duration of thoracal catheter. No significant difference between the groups regarding systolic and diastolic arterial tension, number of breaths and beats in a minute was observed (p>0.05). We observed an improvement in the mean VAS score after treatment in all three groups. The mean VASl score significantly decreased after treatment in each group (p<0.05). The mean VASl and VASm scores measured on the 1(st), 2(nd), 3(rd), 4(th) and 5(th) days were found to be higher in Group IMO than in Groups IVPCA and TTS; however, these differences were not statistically significant (p>0.05). CONCLUSION: In the analgesia of patients with multiple rib fractures, TTS administration with ICB showed similar effectiveness with IVPCA administration with ICB. In the management of pain due to multiple rib fractures, TTS administration is a safe, non-invasive and effective procedure.