ObjectiveInterstitial lung diseases (ILDs) are diverse pulmonary disorders marked by diffuse lung inflammation and fibrosis. The variability in characteristics and treatment approaches complicates diagnosis and management. In advanced cases requiring transplantation, determining indications and selecting suitable candidates presents additional challenges.MethodsOf all patients with non-IPF ILD between December 2016 to December 2022 were analyzed retrospectively. Patients were categorized into two groups: transplanted patients and deceased patients on the waiting list. Clinical data and survival outcomes were compared between groups.ResultsOf the 43 patients, 20 underwent lung transplantation while 23 died awaiting transplantation. Waiting list mortality was 53.4%, with median waiting times similar between groups (3 months for transplant patients and 6 months for those on the waiting list). There were no significant differences between groups in age, gender, height, BMI, 6-minute walk test (6MWT), or forced vital capacity (FVC). The prevalence of pulmonary hypertension (PH) was 76.7% in right heart catheterizations, similar in both groups. One single and 19 bilateral lung transplants were performed. Overall, 13 of the 20 patients survived to discharge from the hospital. One-year mortality was 7/20 (35%). The median follow-up was 34 months, with a 1-year conditional survival of 90.9% at 3 years and 70.7% at 5 years.ConclusionsThis study underscores the importance of further research into non-IPF ILDs. Lung transplantation remains a viable option that can significantly enhance both the quality and longevity of life for patients with advanced ILD.

Bronchoscopy plays a critical role in the diagnosis and management of lung transplant recipients. We retrospectively evaluated the safety, complications, and efficacy of transbronchial biopsy (TBB) in detecting and grading early rejection. We retrospectively assessed the complications associated with TBB and the adequacy of pathological diagnoses in patients who underwent lung transplantation at Koşuyolu Yüksek İhtisas Training and Research Hospital from December 1, 2016, to April 30, 2023. In this study, we retrospectively analyzed 290 TBB procedures performed on 59 out of 94 lung transplant recipients. Of the study cohort, 72.9

Objective Lung transplantation is the only life-saving treatment for lung diseases that do not respond to medical treatment. Heart-lung harvesting requires a careful procedure to protect an adequate donor left atrial cuff around the junction of the superior and inferior pulmonary veins. This study aims to describe inadequate left atrial cuff during harvest and techniques of reconstruction at the threshold of literature. Methods Left atrial cuff complications were retrospectively analyzed in consecutive lung transplant procedures between December 2016 and December 2021. Donor and patient demographics, reconstruction material and method of application and postoperative follow-up were examined. Results In the study period, 84 consecutive lung transplant procedures were performed. Reconstruction of the inadequate left atrial cuff was 3.7% (6/162) for atrial anastomoses. However, the inadequate left atrial cuff was 9.1% (5/55) in heart-lung harvesting. Donor aorta graft was used in 4 patients and Dacron mesh was used on the bilateral atrial cuff in one patient. Hospital mortality occurred in one patient. One patient died 6 months later due to antibody-mediated rejection. The follow-ups of the other three patients are continuing without any problems. Conclusions Inadequate left atrial cuff complications occurring in heart-lung harvest seem to be more common than in the literature. Techniques of reconstruction for the inadequate left atrial cuff is vital for the patient who has reached irreversible progress in surgery for the recipient, as well as increasing the number of organs.

A 61-year-old male patient with bilateral lung transplantation was admitted to the outpatient clinic with increasing respiratory distress for a month. Bilateral diaphragm eventration was observed in his examinations. Bilateral diaphragm plication was successfully performed abdominally in the patient who had a complaint despite supportive treatment. The respiratory capacity of the patient returned to normal. The abdominal approach may be a good alternative option in cases where intrathoracic surgery cannot be performed due to adhesions in patients with eventration after lung transplantation. KEY WORDS: Acquired eventration, Diaphragm, Lung transplantation.

The highly contagious and rapidly spreading coronavirus 2 (SARS-CoV 2) has been associated with the development of severe acute respiratory syndrome, a potentially fatal disease. A patient who underwent coronary artery bypass surgery for an acute myocardial infarction developed acute respiratory failure due to coronavirus 2 (SARS-CoV-2) pneumonia in the early postoperative period. The patient was placed on mechanical ventilation (MV) and V-V (veno-venous) ECMO (Extracorporeal Membrane Oxygenation) support. Here we discuss the application of decortication in the patient due to the development of pneumothorax and prolonged air leak empyema in the follow-up, and the subsequent development of pleural thickening. Copyright © 2022 LookUs Scientific. All rights reserved.

Background/objective: Lung transplantation is a well-established treatment in patients who have bronchiectasis with diffuse involvement, and with a progressive decline in respiratory function despite maximal medical therapy. We have aimed to present pre-transplantation factors and our results of lung transplantation for non-cystic fibrosis bronchiectasis. Methods: Patients who underwent lung transplantation for non-cystic fibrosis bronchiectasis between the dates of December 2016 and July 2019 were included. The patients' clinical parameters, pulmonary function tests, microbiological results, cardiac parameters, intraoperative data, and lung transplant outcomes were assessed retrospectively. Results: Bilateral lung transplantation for bronchiectasis were performed in eleven patients. The mean age was 36.5 years (range 22-57 years). There were 4 (36.4%) female patients and 7 (63.6%) male patients. All patients had a high score as per the bronchiectasis severity index (BSI). The FACED score was moderate in six patients and severe in five patients. Preoperative colonization with Pseudomonas aeruginosa was observed in five patients. Hospital mortality was 18.2% (2/11). The 1-year mortality was 27.2% (3/11). Eight patients were alive. The mean follow-up period of patients with survival was 28.2 months (range 13-42 months). One patient was diagnosed with chronic lung allograft dysfunction (CLAD). The 3year survival rates were 73%. Conclusion: Lung transplantation for bronchiectasis with end-stage lung disease can improve the quality of life and increase survival in selected patients. Further studies are needed to identify the optimal time for lung transplantation referral due to the availability of limited data. (c) 2021 Asian Surgical Association and Taiwan Robotic Surgery Association. Publishing services by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/ by/4.0/).

Aim: Lung transplant recipients are the highest risk group in terms of infective complications among solid organ transplants. It has improved the management of the most common infectious complications with the aid of advances in diagnostic methods, prophylaxis, and therapeutic strategies. In the present study, we evaluated the results of microbiological culture samples by the bronchoscopic method.Methods: This retrospective cohort study included patients who were admitted between November 2016 and May 2019 in a Lung Transplantation Department. We evaluated the results of bacteria detected in the lavage fluid obtained by serial bronchoscopy in the first year after lung transplantation in lung transplant patients. We divided the patients into two groups: those with acute rejection and those without. The two groups were compared according to their culture of growth and analyzed.Results: Of the 77 patients included in the study, 77.2% were male. In the first year after transplantation, 79 bronchoscopic lavage cultures were positive in the follow-up. While bacterial culture positivity by post-transplant bronchial lavage was found to be 62% in the first 3 months, it decreased to 43.6% between the third month and the first year. There was no significant difference between the groups with and without acute rejection of lavage culture growth.Conclusion: This study revealed the importance of the bronchoscopic method in terms of the detection of microbiological findings and the prempitic antibiotic therapy approach in the evaluation of lung infections in lung transplant patients.

Background In this study, we aimed to evaluate the value of transthoracic echocardiography in the estimation of pulmonary artery pressure and to identify the presence of pulmonary hypertension in lung transplant candidates with end-stage lung disease. Methods Between January 2012 and September 2020, a total of 244 patients (166 males, 78 females; mean age: 48.6±13.8 years; range, 18 to 77 years) who were diagnosed with end-stage lung disease due to various underlying conditions and underwent right heart catheterization and transthoracic echocardiography within 72 h were retrospectively analyzed. Hemodynamic parameters of the patients were compared. Correlation analysis was performed among the values estimated by transthoracic echocardiography and measured by right heart catheterization for pulmonary artery pressure measurements. Results The median pulmonary artery systolic pressure with right heart catheterization was 43 mmHg and 40 mmHg using transthoracic echocardiography. A positive correlation was seen between the pulmonary artery systolic pressure estimated by transthoracic echocardiography and right heart catheterization (r=0.718; p<0.001). The sensitivity, specificity, and positive and negative predictive values of pulmonary artery systolic pressure measurement were 76.30%, 64.22%, 72.54%, and 68.63%, respectively. Conclusion This study revealed a strong positive correlation between the pulmonary artery systolic pressure evaluated with transthoracic echocardiography and measured with right heart catheterization. Pulmonary hypertension detection by these two methods showed acceptable sensitivity and specificity. Transthoracic echocardiography may be a useful and practical method to monitor pulmonary artery pressure trends both initially and in the subsequent follow-up of cardiac hemodynamics in lung transplant candidates.

Introduction: The aim of this study was to evaluate the delayed chest closure (DCC) results in patients who underwent lung transplantation. Methods: Sixty patients were evaluated retrospectively. Only bilateral lung transplantations and DCC for oversized lung allograft (OLA) were included in the study. Six patients who underwent single lung transplantation, four patients who underwent lobar transplantation, two patients who underwent retransplantation, and four patients who underwent DCC due to bleeding risk were excluded from the study. Forty-four patients were divided into groups as primary chest closure (PCC) (n=28) and DCC (n=16). Demographics, donor characteristics, and operative features and outcomes of the patients were compared. Results: The mean age was 44.5 years. There was no significant difference between the demographics of the groups (P>0.05). The donor/recipient predicted total lung capacity ratio was significantly higher in the DCC group than in the PCC group (1.06 vs. 0.96, P=0.008). Extubation time (4.3 vs. 3.1 days, P=0.002) and intensive care unit length of stay (7.6 vs. 5.2 days, P=0.016) were significantly higher in the DCC group than in the PCC group. In the DCC group, postoperative wound infection was significantly higher than in the PCC group (18.6% vs. 0%, P=0.19). Median survival was 14 months in all patients and there was no significant difference in survival between the groups (16 vs. 13 months, P=0.300). Conclusion: DCC is a safe and effective method for the management of OLA in lung transplantation.

Electrical storm is a life-threatening medical emergency that requires immediate diagnosis and treatment. It can remain a clinical challenge despite anti-arrhythmic drugs and catheter ablation therapies. Autonomic modulation techniques have gained increased recognition in the treatment of refractory electrical storm cases. In our case, we present a patient with recurrent ventricular tachycardia/fibrillation episodes one week after a myocardial infarction. Patient's arrhythmia was refractory to antiarrhythmic drugs and hemodynamical status was unstable, thus catheter ablation under temporary mechanical circulatory support was the initial strategy. Ventricular fibrillation episodes relapsed 48 h after catheter ablation and we proceeded with autonomic modulation treatment options. Bilateral stellate ganglion blockade was performed under ultrasound guidance using bupivacaine. Sinus bradycardia was present and no ventricular arrhythmias were detected on post-procedure ECG. Stellate ganglion blockade was complemented with video-assisted thoracoscopic cardiac sympathetic denervation. After the last procedure, patient remained on sinus rhythm, was hemodynamically stable and extubated successfully.

Objectives: Lung transplant is the most important treatment approach that improves the life expectancy and quality of life for patients with cystic fibrosis with end-stage lung disease. In this study, we retrospectively analyzed patients with cystic fibrosis who were referred to our lung transplant program in Turkey. Materials and Methods: We evaluated 14 patients with cystic fibrosis who were referred to our lung transplant clinic between December 2016 and December 2019. The characteristics of the patients at the time of referral to our lung transplant clinic, survival, and lung transplant results were recorded. Results: Four patients died on the wait list, 3 patients were not eligible for lung transplant, and lung transplant was performed in 7 patients. The mean age of all patients was 22.8 years (range, 11-41 years), and the mean age for patients who underwent lung transplant was 27.5 years (range, 21-41 years). The mean time of suitable donor offer or survival life was 140 days in the patients who were referred for lung transplant. The 1-year mortality rate was 28.6% (2 of 7 patients) after lung transplant. One patient died of chronic lung allograft dysfunction at the 25th month after lung transplant. Four patients were alive without any problems. Conclusions: Lung transplant is the final treatment method for patients with cystic fibrosis with terminal period lung disease. To provide the best benefit, patients should be evaluated for transplant early. Cystic fibrosis care clinics and lung transplant clinics should work in coordination in order to increase the number of lung transplants and improve outcomes.

INTRODUCTION[|]The primary treatment of primary spontaneous pneumothorax (PSP) is still controversial. The large-bore thoracic catheter has traditionally been used, but there is now a global trend toward the increased use of the small-bore thoracic catheters (SBTC). The present study aims to compare the use of SBTC and chest tube (CT) in first-line treatment of PSP.[¤]METHODS[|]This prospective randomized study included 90 patients diagnosed with PSP. The patients were randomly distributed into two groups. In the first group, catheter thoracostomy was applied with an 8 French thorax catheter and in the other group, a tube thoracostomy with a 28 French chest tube. The parameters used for comparison in this study were defined as pneumothorax side, pneumothorax size, pain, need of additional analgesia, malpositioning drain, duration of air leakage, duration of hospitalization, complications and recurrence.[¤]RESULTS[|]In the evaluation of pain using the Numerical Rating Scale (NRS) at 1, 4, 12 and 24 hours after the application, the mean NRS values of the SBTC patients were seen to be lower than those of the CT patients but at 1, 12 and 24 hours, the difference was not statistically significant. At the 4th hour, the difference was determined to be statistically significant (p=0.022). The duration of air leakage was 1.7+-1.4 days for the SBTC group and 2.2+-1.9 days for the CT group. The period of termination of the drain was 3.3+-1.2 days for the SBTC group and 4.0+-1.7 days for the CT group. The duration of hospitalization was 3.5+-1.3 days for the SBTC group and 4.5+-1.9 days for the CT group.[¤]DISCUSSION AND CONCLUSION[|]No significant difference was determined in respect of air leakage, hospital stay, failure rates or complications between the two procedures. When compared concerning postoperative pain, ease of application, patient comfort and incision scar, SBTC can be considered to be subjectively superior to CT, and can be used safely in the treatment of PSP.[¤]

The pectoralis major muscle flap is the most commonly used option for chest wall reconstruction. However, its utilization should be avoided in chest wall tumors infiltrating the muscle. This article presents the utilization of the caudal part of the pectoralis major muscle as a pedicled flap in cases requiring the resection of the cranial part of the muscle due to tumor infiltration. Fourteen patients with a mean age of 60.3 years were operated for malignant thoracic wall tumors between 2011 and 2014. All tumors were located on the upper thoracic area with a mean defect size of 16.6 × 12 cm. During tumor resection, the thoracoacromial vessels and pectoral branch were preserved and dissected until reaching the pectoralis muscle. After the resection of the cranial part of the muscle, the caudal part is prepared as a pedicled island flap and used for the coverage of the resultant defect. The mean postoperative follow-up period was 10.9 months. All flaps survived without any partial or total flap loss. A case of local recurrence, two cases of hematoma requiring drainage, and two cases of local wound-healing problems were the encountered complications. The pectoral kite flap is a versatile and reliable option for the coverage of small to medium upper chest wall defects with minimal morbidity, and it gives the reconstructive surgeon the opportunity to use the non-infiltrated caudal part of the pectoralis muscle instead of an unnecessary resection of the whole muscle.

BACKGROUND:Primary spontaneous pneumothorax (PSP) is usually seen in young male smokers. Pathophysiology of PSP remains unclear, and studies concerning emotional status are scarce. The aim of this study is to investigate psychological factors associated with primary spontaneous pneumothorax.METHODS:The Beck Depression Inventory, Beck Anxiety Inventory, State-Trait Anger Expression Inventory, and State-Trait Anxiety Inventory were administered.RESULTS:A total of 40 patients and 40 healthy controls were included in this study. The mean age in the patient group was 24.60 years, while that in the control group was 26.45 years. The difference was not significant. The weight and body mass index of the patient group were significantly lower compared to those of the control group. The mean Beck Anxiety Inventory scores in the patient and control groups were 10.37 ± 11.34 and 8.25 ± 10.60, respectively. Anxiety levels did not differ between the groups (p = 0.389). The mean Beck Depression Inventory scores of the patient and control groups were 8.20 ± 8.37 and 6.80 ± 7.57, respectively, but the difference was not significant (p = 0.435). When the anger structures of the groups were compared, no difference was found in any sub-scale. Trait anxiety scores were higher in the patient group compared to those in the control group, but the difference was not significant (p = 0.369).CONCLUSIONS:This study's findings indicated that anger, anxiety, and depression levels did not differ between the primary spontaneous pneumothorax and healthy groups.

ObjectivesThe aim of the study was to evaluate the effectiveness of (28F) chest tube thoracostomy (TT) and (8F) small-bore thorax catheter (TC) in treatment of primary spontaneous pneumothorax patients.

Introduction: Primary spontaneous pneumothorax (PSP) is usually seen in young, male smokers. Pathophysiology of PSP remains unclear, also the number of research concerning emotional status are scarce. The aim of this study is to investigate psychological factors associated with PSP. Method: Participants were recruited from male patients who admitted to department of thoracic surgery outpatient clinic with the diagnosis of PSP in an education and research hospital. Beck depression inventory (BDI), Beck anxiety inventory (BAI), state–trait anger expression inventory (STAXI), state-trait anxiety inventory (STAI) were administered respectively to all patients. Results:Twenty five patients and 25 healthy controls were included in this study. Mean age of patient group was 24.80± 5.77 years, of control group was 26.76 ± 6.78 years and difference was not significant (p=0.277). The weight and body mass index of the patient group significantly lower than the control group respectively. Mean BAI scores in patient and control group was 12.28 ±12.65 and 5.84±6.91 respectively. Anxiety levels were not different in two group (p=0.97). Mean BDI score of patients and control group were 9.12±9.93, 5.24±5.61 respectively but the difference was insignificant (p=0.32). When anger structures of the groups were compared, state anger subscale was higher in patient group but was insignificant(p=0.491). Trait anxiety scores were higher in patient group, but not differ significantly (p=0.71). Conclusion: This preliminary report of our study does not indicate any significant difference between the patient and healthy control. But we continue to recruit patients for enlarging our sample that would give more precise results.

Hypoplasia of the lung is a congenital or acquired condition that is characterized by a decrease in the size, number, or both of vascular, alveolar, and bronchial elements.1 This developmental abnormality can lead to unusual clinical signs. Most patients described in the literature are newborns and infants.1,2 Chronic infections in childhood can also cause lung hypoplasia. We present a patient with left lung hypoplasia and right lung hyperinflation that was diagnosed after a condition mimicking bilateral pneumothorax.