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13-Year Experience with Penetrating Trauma Patients
(Aves Yayincilik, Ibrahim Kara, 2009) Karamustafaoglu, Yekta Altemur; Yavasman, Ilkay; Kuzucuoglu, Mustafa; Mammedov, Ruestem; Yener, Yoruk
Objectives: Thoracic injuries occur in approximately 25-30% of all trauma cases. Among these, 70% is blunt trauma and 30% is penetrating trauma. We presented our clinical experience with penetrating thoracic trauma patients in the last 13 years. Patients and Methods: We retrospectively assessed 200 cases of penetrating thoracic trauma (184 males (%92), 16 females (%8); mean age 27.4 years; range 11 to 80 years) urgently hospitalized at our clinic between 1995-2008. Results: In 153 (76.5%) cases sharp penetrating trauma and in 47 (23.5%) patients gunshot wounds were seen. Intrapleural pathology was found in 174 (87%) cases and extrathoracic organ injury was found in nine cases. Surgical treatment included chest tube thoracostomy in 173 (86.5%) cases and other conservative treatment methods were applied in 27 (13.5%) cases. Thoracotomy was required in 39 (19.5%) of the cases. The morbidity rate was 7.5% and mortality rate was 0.5%. Conclusion: In penetrating thoracic trauma cases, except emergency thoracotomy patients, conservative treatment methods are applied in most of the patients. Trauma with intrathoracic organ injury increases the mortality and morbidity, and requires fast and well-organized multidisciplinary approach.
3-Year Follow-Up After Uniportal Thoracoscopic Sympathicotomy for Hyperhidrosis: Undesirable Side Effects
(Mary Ann Liebert, Inc, 2014) Karamustafaoglu, Yekta Altemur; Kuzucuoglu, Mustafa; Yanik, Fazli; Sagiroglu, Gonul; Yoruk, Yener
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.
An analysis of overall survival in patients who have undergone lung metastasectomy operations for lung metastases of colorectal cancers and malignancies other than colorectal cancer
(Kuwait Medical Assoc, 2019) Yanik, Fazli; Karamustafaoglu, Yekta Altemur; Yoruk, Yener
Objective: To compare the survival and factors affecting survival between patient groups with primary colorectal cancers and malignancies other than colorectal cancer, who underwent curative pulmonary metastasectomy Design: Retrospective study Setting: Trakya University School of Medicine, Edirne, Turkey Subjects: Forty-four cases who underwent curative metastasectomy in our clinic between January 2006 and August 2015 Interventions: Primary colorectal cancers (Group 1 = 14 cases), malignancies other than colorectal cancer (Group 2 = 30 cases) Main outcome measure(s): Age, gender, type of primary malignity, disease-free survival, adjuvant therapy, number of radiological nodules, number and type of operations, number and site of nodules resected, presence of relapse, and mean survival Results: Two cases (4.7%) underwent lobectomy, and a total of 123 nodules were excised in 38 cases (86.3%) using thoracotomy and in four cases (9%) using video thoracoscopic surgery. The median survival value was 33 +/- 5.4 months (range:22.2 - 43.7 months) in Group 1, and 28 +/- 6.8 months (range:14.5 - 41.4 months) in Group 2; the cumulative value was 33 +/- 3.7 months (range:25.6 - 40.3 months). Survival did not differ significantly between the groups (p=0.738). Age (p=0.81), gender (p=0.35), disease-free survival (p=0.24), number of metastatic nodules (p=0.60), presence of synchronous-metachronous tumor (p=0.94), adjuvant chemotherapy (p=0.96), adjuvant radiotherapy (p=0.86), and relapse of disease (p=0.07) were not significantly correlated with survival. Conclusion: Survival and factors that affected survival did not differ significantly between the two groups that underwent metastasectomy. It was indicated that the primary tumor is not an effective factor in the selection of patients who would undergo metastasectomy.
Can Awake Thoracoscopy Procedure be Performed with the Help of Thoracic Paravertebral Anesthesia?
(IBN SINA TRUST, 2018) Yanik, Fazli; Karamustafaoglu, Yekta Altemur; Copuruoglu, Elif; Sagiroglu, Gonul
Aim: The aim of this study was to present our experience with 11 patients who were spontaneously breathing with Awake Video Thoracoscopy (AVATS) procedure with the help of TPB because of rareness in the literature. Materials and Methods: Between December 2015 and December 2017, a total of 125 VATS cases were performed; 11 cases underwent VATS operation with the help of TPB; age, gender, operation performed, duration of operation, time of onset of mobilization-oral intake, duration of hospital stay, Visual Analogue Scale (VAS) scores were evaluated retrospectively. Results: All cases were treated with uniportal AVATS procedure with the help of TPB. The mean age was 40,3 +/- 17,4 years (range 18-64 years), nine (82%) of the pateints were male and two (18%) were female. Operation procedures included wedge resection in eight (73 %) patients (six of them for pneumothorax, two of them for diagnosis), in three (27%) patients pleural biopsy (one of them used talc pleurodesis). There were no perioperative events. The mean operation time was 27,7 +/- 6,4 minutes (range, 20-40 min) and the mean anesthesia time was 25 +/- 3,8 minutes (range 20-30 min). The mean time of mobilizitation, oral intake opening time and length of hospital stay was 1,1 +/- 0,4 hours (1-2 hours), 3,5 +/- 0,5 hours (3-4 hours), 2,6 +/- 0,5 days (2-3 days), respectively. Conclusion: Awake Video Asssited Thoracoscopic Surgery with the help of TPB has less side effects and less complication risks than other awake procedures with the help of other regional anesthesia techniques. We conclude that; although AVATS with the help of TPB has some minor complications, it has advantages such as early discharge, early mobilization and early oral intake, low pain levels in well-selected patient groups.
Cervical Cystic Lymphangioma, Rarely Detected in Adults with Rapid Progression, 2 Case Reports
(Ibn Sina Trust, 2023) Yanik, Fazli; Karamustafaoglu, Yekta Altemur; Yoruk, Yener
Cystic Lymphangioma(CL) is rarely detected in adulthood. We presented two cases with neck swelling at an advanced age. Both of cysts were located in the cervico-mediastinally and showed rapid progression. The cysts were excised successfully and there was no recurrence in the follow-up period. Although there are many alternatives in treatment, CL, which is rare in adults, can be treated with surgical excision successfully in appropriate cases to definitively prevent recurrence and complications.
Comparison of Implantable Central Venous Ports: Subclavian Versus Juguler Access
(Derman Medical Publ, 2013) Karamustafaoglu, Yekta Altemur; Yagci, Sevinc; Kocal, Sedat; Yoruk, Yener
Aim: Today, implantable central venous ports (ICVP) are increasingly used in oncology patients and provide easy vascular access for delivery of chemotherapy, other intravenous treatments, as fluids, blood products and parenteral nutrition solutions. In this study, we present our experience and comparison of efficacy and incidence of complications between subclavian versus jugular access in oncology patients and provide easy vascular access for delivery of chemotherapy. Material and Method: Three hundred ten implantable central venous ports (ICVP) were implanted via the subclavian vein (SV) in 145 patients (66 men, 79 women) with average age of 56.55 (18-86) and were implanted via the external jugular vein (EJV) in 165 patients (75 men, 90 women) with average age of 56.81 (19-81) between November 1.2006 and June 3, 2009. Results: There was no mortality caused by ICVP. As early complications, pneumothorax developed immediately after the procedure in 7 patients and arterial puncture in 34 patients. As late complications, infections developed in 10 patients, breakage of the catheter in one patient, malposition of catheter in one patient, jugular vein thrombosis in one patient. There was significant higher rate total implantation time in SV group (41610 catheter days) comparing with EJV group (23861 catheter days) ( p=0.0001. Discussion: According to experience, there was no difference rates of complication of catheter between the two groups despite a longer stay in SV group (complication numbers 28 in SV group. 28 in EJV group). It should be noted that this study took place at a single centre experience with a limited number of cases included and more research needs to be done to determine new and better ways to long-term vascular access.
Comparison of the Effects of the Sixth and Seventh TNM Staging on Survival in Operable Non-Small Cell Lung Cancer
(Aves Press Ltd, 2018) Kuzucuoglu, Mustafa; Karamustafaoglu, Yekta Altemur; Yoruk, Yener
BACKGROUND/AIMS In our study, cases who have been operated due to the diagnosis of non-small cell lung cancer (NSCLC) were staged by the 7th edition of the tumor, node, and metastasis (TNM) staging system and analyzed with respect to the survival association between previous and novel TNM systems. MATERIAL and METHODS The study included 136 patients operated with a diagnosis of NSCLC between January 1, 2000 and January 1, 2010 at our clinic. Patients comprised 9 (6.62%) females and 127 (93.38%) males. The age range and mean age of the cases were 30-76 years and 59.4 years, respectively. RESULTS Histopathological examination detected squamous cell carcinoma, adenocarcinoma, adenosquamous cell carcinoma, bronchioalveolar carcinoma, and large cell carcinoma in 88 (64.8%), 41 (30.2%), 4 (2.9%), 1 (0.7%), and 2 (1.4%) cases, respectively. No statistically significant association was found between mortality and tumor type (p=0.184). According to the 7th edition of the TNM staging system, of the cases, 18 (13.2%), 40 (29.4%), 22 (16.2%), 33 (24.3%), and 23 (16.9%) were stage IA, stage IB, stage IIA, stage IIB, and stage IIIA, respectively. There was a statistically significant association between mortality and tumor stage in our study (p=0.028). In addition, applying the 6th edition of the TNM staging revealed a statistically significant association between mortality and tumor stage (p=0.017). CONCLUSION Tumor stage was found to be the most important factor affecting survival in our study group. No statistically significant difference was determined between the subgroups when the previous and novel staging systems were compared.
A comparison of thoracic or lumbar patient-controlled epidural analgesia methods after thoracic surgery
(Bmc, 2014) Sagiroglu, Gonul; Meydan, Burhan; Copuroglu, Elif; Baysal, Ayse; Yoruk, Yener; Karamustafaoglu, Yekta Altemur; Huseyin, Serhat
Background: We aimed to compare patient-controlled thoracic or lumbar epidural analgesia methods after thoracotomy operations. Methods: One hundred and twenty patients were prospectively randomized to receive either thoracic epidural analgesia (TEA group) or lumbar epidural analgesia (LEA group). In both groups, epidural catheters were administered. Hemodynamic measurements, visual analog scale scores at rest (VAS-R) and after coughing (VAS-C), analgesic consumption, and side effects were compared at 0, 2, 4, 8, 16, and 24 hours postoperatively. Results: The VAS-R and VAS-C values were lower in the TEA group in comparison to the LEA group at 2, 4, 8, and 16 hours after surgery (for VAS-R, P = 0.001, P = 0.01, P = 0.008, and P = 0.029, respectively; and for VAS-C, P = 0.035, P = 0.023, P = 0.002, and P = 0.037, respectively). Total 24 hour analgesic consumption was different between groups (175 +/- 20 mL versus 185 +/- 31 mL; P = 0.034). The comparison of postoperative complications revealed that the incidence of hypotension (21/57, 36.8% versus 8/63, 12.7%; P = 0.002), bradycardia (9/57, 15.8% versus 2/63, 3.2%; P = 0.017), atelectasis (1/57, 1.8% versus 7/63, 11.1%; P = 0.04), and the need for intensive care unit (ICU) treatment (0/57, 0% versus 5/63, 7.9%; P = 0.03) were lower in the TEA group in comparison to the LEA group. Conclusions: TEA has beneficial hemostatic effects in comparison to LEA after thoracotomies along with more satisfactory pain relief profile.
The efficacy of thoracic epidural and paravertebral blocks for post-thoracotomy pain management
(Termedia Publishing House Ltd, 2013) Sagiroglu, Gonul; Baysal, Ayse; Copuroglu, Elif; Karamustafaoglu, Yekta Altemur; Sagiroglu, Tamer; Yuksel, Volkan; Huseyin, Serhat
Introduction: The definition of pain focuses mainly on tissue damage and provides information regarding pathophysiological changes in the human being [1]. Patients experience pain as a response to this tissue damage after surgery and the pain intensity after thoracotomies is known to be severe [2]. Aim of the study: Our goal was to investigate the efficacy and adverse effects of thoracic epidural and paravertebral blocks for post-thoracotomy pain management. Material and methods: In a prospective, randomized double blinded study, patients were divided into thoracic epidural (EPI group, n = 30) and paravertebral (PVB group, n = 30) groups. A bolus dose of 10 ml of 0.25% bupivacaine was followed by a continuous infusion of 0.1 ml kg(-1) h(-1) for a total of 24 hours. A visual analog scale (VAS) was used to evaluate pain at rest (VAS-R) and after coughing (VAS-C) at baseline (after extubation), 2, 4, 12 and 24 hours after surgery. The duration of catheter insertion, morphine consumption, complications and side effects were collected. Results: In comparison of EPI and PVB groups, VAS-R and VAS-C scores were similar at baseline and at 2, 4, 12 and 24 hours after surgery (p > 0.05). The incidence of hypotension was higher and the duration of catheter insertion was longer in the EPI group in comparison to the PVB group (p = 0.038, p < 0.0001, respectively). Conclusions: For post-thoracotomy pain, both thoracic epidural analgesia and paravertebral block techniques provide sufficient pain relief. As paravertebral block is an easier and quicker technique with lower incidence of hypotension, it should be considered as a good alternative to thoracic epidural technique to establish postoperative analgesia.
Esophageal self-expandable metal stent placement for the palliation of dysphagia due to lung cancer
(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2019) Yanik, Fazli; Karamustafaoglu, Yekta Altemur; Yoruk, Yener
Background: This study aims to report our experience with esophageal self-expendable metal stents for the palliation of malignant dysphagia and tracheoesophageal fistulas caused by lung cancer. Methods: Esophageal self-expandable metal stents were deployed in 56 patients (55 males, 1 female; mean age 63.5 years; range, 42 to 79 years) with malignant dysphagia due to lung cancer between August 2002 and May 2018. Of the patients, 34 had received previous chemoradiotherapy, eight only chemotherapy, and three only radiotherapy, while four had pneumonectomy. Tracheoesophageal fistula was coexisting in 12 patients (21%). Stents were inserted under fluoroscopic control over guide-wire in 28 patients and under flexible endoscopic control in the remaining 28 patients. One stent was used in all patients, except two patients with tracheoesophageal fistula, one patient who had an external compression causing downward migration of stent, and two patients who had tumor progression. Results: Dysphagia improved in all patients after stent insertion. Tracheoesophageal fistula was sealed off in all patients. All patients remained asymptomatic without dysphagia symptoms during the follow-up period except for two patients who underwent gastrostomy. All patients with tracheoesophageal fistula died. Their mean duration of survival was 2.8 months. Of the patients with tracheoesophageal fistula, one died of mediastinitis, one died of esophageal perforation, while the others died of cancer-related reasons. Of the dysphagia patients without tracheoesophageal fistula, all died except for two patients. Mean duration of survival in this group was 4.3 months. Conclusion: Dysphagia in lung cancer may have many underlying reasons. Self-expandable metal stents may provide satisfactory relief of dysphagia symptoms with minimal morbidity after a single procedure in patients with limited lifespan.
Evaluation of Chrisofix® Chest Orthosis Application in Patients with Traumatic Rib Fractures
(Ibn Sina Trust, 2024) Isikli, Ayse Gokce; Yanik, Fazli; Karamustafaoglu, Yekta Altemur; Yoruk, Yener
Background: The Chrisofix (R) Chest Orthosis is an effective and easy to use device for the treatment of rib fractures. It is used as a supportive treatment to reduce the pain levels and complication risks of the patients. Methods: Patients hospitalized with the diagnosis of rib fractures in the Thoracic Surgery Service of a university hospital were retrospectively scanned in an online computer program between October 2018 and October 2021. The study sample consisted of patients with the treatment (30) and control (30) groups. Results: Visual Analog Scale and incidence of atelectasis of the patients in the experimental group (The Chrisofix (R) Chest Orthosis) is statistically significantly lower than the control group (P < 0.05). In both the experimental and control groups, no statistically significant difference was found between the variables of patient's demographic and clinical characteristics (p > 0.05). Conclusions: In the study, with the use of The Chrisofix (R) Chest Orthosis, a significant decrease was observed in the Visual Analog Scale and the incidence of atelectasis.
Experience in totally implantable venous port catheter: Analysis of 3,000 patients in 12 years
(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2018) Yanik, Fazli; Karamustafaoglu, Yekta Altemur; Karatas, Adem; Yoruk, Yener
Background: This study aims to present our experience with patients who were performed totally implantable venous port catheter. Methods: Demographics-clinical features, surgical results and complications of 3,000 patients (1,824 males, 1,176 females; mean age 61.04 +/- 11.5 years; range, 18 to 88 years) who were performed totally implantable venous port catheter between March 2005 and March 2017 were evaluated retrospectively. Totally implantable venous port catheter indications, complications, catheter duration of stay, reasons for catheter removal and statistical analysis information were reported in detail by reviewing patient records. Results: Of the cases, the Seldinger method was used in 98%, 1% (n=36) had the catheter inserted with superficial Doppler ultrasonography, while the veins were not found in 1% (n=29) and these patients were excluded from the study. Totally implantable venous port catheter was inserted via right internal jugular vein in 2,095 patients (70%), via right subclavian vein in 470 patients (16%), via left internal jugular vein in 290 patients (10%), and via left subclavian vein in 106 patients (3%). Mean duration of stay for totally implantable venous port catheter was 46.7 months (range, 1 to 78 months). Complications were detected in a total of 288 patients (9.6%), 153 (5.1%) being early and 135 (4.5%) being late. The most common oncologic indication was colorectal cancer. The rate of port removal was 298/3,000 (9.9%) and the main reasons were infection, thrombosis, pain, and end of treatment. Totally implantable venous port catheter was required to be inserted twice in 33 patients (1%) and thrice in 14 patients (0.5%). Totally implantable venous port catheter had malposition in eight patients and all were revised successfully with over the guide method. Conclusion: Totally implantable venous port catheter may increase the quality of life in cancer patients. Despite possible complications, totally implantable venous port catheter is safe and comfortable for long-term intravenous treatment. Possible complications may be prevented or managed when totally implantable venous port catheter is performed by surgeons with adequate experience.
Extra-Abdominal Aggressive Fibromatosis Presenting As an Intrathoracic Tumor
(Aves Yayincilik, Ibrahim Kara, 2010) Yoruk, Yener; Karamustafaoglu, Yekta Altemur; Sezer, Yavuz Atakan; Ibis, Abdil Cem
Tumors of fibrous tissue origin (fibromatosis) in chest and mediastinum have been rarely reported in the literature. Herein, we report a rare case of aggressive fibromatosis presenting as an intrathoracic tumor. A 36-year-old woman admitted to our hospital due to a feeling of oppression and pain in the left chest. A chest X-ray, thorax computed tomography revealed a large mass filling two thirds of lower left thorax. Widely surgical resection of the tumor was performed thoracotomy via seventh intercostal space. The tumor was 20x15x15 mm in size and diagnosed pathologically as aggressive fibromatosis. The patient has been well without recurrence for 15 months after surgery.
An interesting mediastinal cyst case: Benign cystic mesothelioma
(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2018) Yanik, Fazli; Karamustafaoglu, Yekta Altemur; Ozpuyan, Fulya; Yoruk, Yener
Anterior mediastinal, well-defined, ametabolic cystic lesion was detected incidentally in a 69-year-old male patient. Uniportal video-thoracoscopic surgery was performed to the lesion for diagnosis and treatment purposes. Histopathological findings were in accordance with benign cystic mesothelioma. Benign cystic mesothelioma has been defined in the abdomen, particularly among females of reproductive age. Benign cystic mesothelioma originating from mediastinal pleura is very rare entity and was not defined in the literature. To our knowledge, we present this rare and interesting mediastinal cystic lesion for the first time in the literature.
Intrathoracic Desmoplastic Fibroblastoma: A Rare Localization
(Derman Medical Publ, 2013) Karamustafaoglu, Yekta Altemur; Yanik, Fazli; Yoruk, Yener
Desmoplastic Fibroblastoma (Collagenous Fibroma) is an extremely rare which is a recently described tumor that may arise in the subcutaneous tissue or skeletal muscle. Herewith was reported a case of a Desmoplastic Fibroblastoma with an intrathoracic localization. A 56-year-old man referred with a painless right intrathoracic tumor. Physical examination was normal and electrocardiography, abdominal ultrasonography and routine blood tests were unremarkable. The chest X ray showed consolidation with lobulated contour in right lower zone. Thorax computerized tomography (CT) revealed 10x15 cm mass filling right lower hemithorax. The patient underwent right posterolateral thoracotomy and the tumor was totally removed and histopathologic diagnosis revealed a rare desmoplastic fibroblastoma. Postoperative course was uneventful.
An Irresectable Giant Plasmacytoma: Report of a Case
(Bilimsel Tip Publishing House, 2008) Karamustafaoglu, Yekta Altemur; Yoruk, Yener; Tiryaki, Sevinc; Balkanli, Kunter
A 71 year old man was admitted with left arm, shoulder and back pain. Thorax computerised tomography showed a cranio-caudal 20 cm expanding tumor with invasion of the clavicle and scapula and humeral head Pathology confirmed plasmacytoma from the incisional biopsy. Primarily, chemoradiotherapy was scheduled.
Leser-Trelat sign of patient with recurrent pleural effusion
(Kare Publ, 2015) Yanik, Fazli; Karamustafaoglu, Yekta Altemur; Karatas, Adem
Leser-Trelat sign includes the combined sudden onset of seborrheic keratosis and internal malignancy, most commonly adenocarcinoma of the stomach. A case of Leser-Trelat sign in a 75-year-old healthy woman is presented. To search for an underlying malignancy, the invasive and noninvasive investigations were performed and found to reveal any evidence of malignancy. To date, almost all cases of Leser-Trelat sign have been reported in association with an underlying malignancy. There have been a few report associated with healthy individuals in literature.
Lung cancer coincidentally found in the bulla
(Springer India, 2008) Karamustafaoglu, Yekta Altemur
Several cases of lung cancer lying within giant bullae have been reported in recent years, such that some authors have considered an association between the two diseases. Giant bulla was detected on the chest X ray and thoracic computed tomography in a 50 year old man. Left lower lobectomy was performed for emphysematous lung destruction. The postoperative histopathological diagnosis was adeno carcinoma arising from the wall of giant bulla. It must be noted that occult cancer may exist at the wall of giant bullae, so annual radiological followup should be applied. On the basis of this experience and review of the literature, it is suggested that physicians should always pay careful attention to the generation and complication of cancer while treating bullous disease in heavy smoking individuals.
Management of a difficult infectional disease: Descending necrotizing mediastinitis
(J Infection Developing Countries, 2018) Yanik, Fazli; Karamustafaoglu, Yekta Altemur; Yoruk, Yener
Introduction: Descending Necrotizing Mediastinitis (DNM) is the fatal form of mediastinitis and mostly develops as a complication of peritonsillar abscesses or dental-odontogenic infections. The aim of this study is to evaluate clinical and surgical feature of the patients with DNM who were managed in our clinic. Methodology: We retrospectively evaluated 13 consecutive patients with the diagnosis of DNM between February 2005 and February 2018. All of them had the typical physical appearance, history and radiological findings. Results: Ten (77%) patients were male, 3 (23%) patients were female with a median age of 48.2 (18-76 years). All patients underwent Cervico-Mediastinal Drainage (CMD) with debridement of the necrotic and infected tissues. Other supplimantary surgical procedures were tube thoracostomy (n = 8), VATS mediastinal drainage (n = 4), tracheostomy (n = 2) and thoracatomy (n = 1). The median time to diagnosis of DNM, tube drainage (inserted after CMD) removal time, tube thoracostomy removal time, lenght of hospital stay were 1.8 (range 1-4) days, 13.6 (range 10-20), 12.6 days (range 10-27) and 21.5 days (range 15-30), respectively. Appropriate and potent antibiotics were used according to the fever-CRP response with the consultation on infectious disease specialist. Two patients were lost due to fulminant sepsis (n = 1) and massive cervical haemorrhage (n = 1). Overall mortality rate was 15%. Complications were recorded in 6 patients (46%). Conclusions: The critical point in the management of DNM is the correct diagnosis, rapid surgical intervention with antibiotherapy and close follow-up for possible complications. We concluded that the combination of minimally invasive management as VATS-tube thoracostomy with CMD is the most appropriate surgical interventions.
Nonintubated versus intubated thoracoscopic bullectomy for primary spontaneous pneumothorax: A multicenter propensity-matched analysis
(Sage Publications Inc, 2022) Elkhouly, Ahmed G.; Karamustafaoglu, Yekta Altemur; Galvez, Carlos; Rao, Madhuri; Lerut, Philip; Grimonprez, Annelies; Abu Akar, Firas
Background We aimed at comparing in a multicenter propensity-matched analysis, results of nonintubated versus intubated video-assisted thoracic surgery (VATS) bullectomy/blebectomy for primary spontaneous pneumothorax (PSP). Methods Eleven Institutions participated in the study. A total of 208 patients underwent VATS bullectomy by intubated (IVATS) (N = 138) or nonintubated (NIVATS) (N = 70) anesthesia during 60 months. After propensity matching, 70 pairs of patients were compared. Anesthesia in NIVATS included intercostal (N = 61), paravertebral (N = 5) or thoracic epidural (N = 4) block and sedation with (N = 24) or without (N = 46) laryngeal mask under spontaneous ventilation. In the IVATS group, all patients underwent double-lumen-intubation and mechanical ventilation. Primary outcomes were morbidity and recurrence rates. Results There was no difference in age (26.7 +/- 8 vs 27.4 +/- 9 years), body mass index (19.7 +/- 2.6 vs 20.6 +/- 2.5), and American Society of Anesthesiology score (2 vs 2). Main results show no difference both in morbidity (11.4% vs 12.8%; p = 0.79) and recurrence free rates (92.3% vs 91.4%; p = 0.49) between NIVATS and IVATS, respectively, whereas a difference favoring the NIVATS group was found in anesthesia time (p < 0.0001) and operative time (p < 0.0001), drainage time (p = 0.001), and hospital stay (p < 0.0001). There was no conversion to thoracotomy and no hospital mortality. One patient in the NIVATS group needed reoperation due to chest wall bleeding. Conclusion Results of this multicenter propensity-matched study have shown no intergroup difference in morbidity and recurrence rates whereas shorter operation room time and hospital stay favored the NIVATS group, suggesting a potential increase in the role of NIVATS in surgical management of PSP. Further prospective studies are warranted.

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