Background: This study aims to evaluate the diagnosis, surgical outcomes, and prognosis of patients with traumatic diaphragmatic rupture and discuss recent advancements in diagnostic technologies. Methods: Between January 2014 and January 2024, a total of 35 patients (27 males, 8 females; mean age: 45.3±14.2 years; range, 13 to 68 years) who underwent diaphragmatic repair for traumatic diaphragmatic rupture in three centers were retrospectively analyzed. Data including demographic characteristics of the patients, medical history, type of trauma, clinical findings, diagnostic methods used preoperatively, preoperative interventions, the establishment of an intraoperative diagnosis, associated organ injuries, side of the diaphragmatic rupture, type of surgical procedure, postoperative complications, and length of hospital stay were recorded. Results: Among the cases, penetrating trauma was the most common mechanism (62.9%). Among the 25 patients who underwent computed tomography, a preoperative diagnosis of diaphragmatic rupture was established in 14 (56%). The median defect size in the diaphragm was 5.7 cm in blunt trauma cases and 4.04 cm in penetrating trauma cases. The morbidity rate was 40%, and the mortality rate was 5.7%. The length of hospital stays for the surgically treated patients ranged from 4 to 16 days. Comparing the laparotomy and thoracotomy groups, the laparotomy group had a longer hospital stay (p=0.017) and had statistically significant data in terms of participation in multidisciplinary surgery (p=0.001). Conclusion: Diaphragmatic rupture should be considered in cases involving high-energy blunt trauma, particularly when multiple lower rib fractures, liver lacerations, or splenic lacerations are present, or in patients with a history of penetrating trauma to the thoracoabdominal region. As delays in diagnosis and treatment may increase morbidity and mortality, early recognition and prompt management are essential. The choice of surgical procedure should be guided by the presence or absence of concomitant injuries.

Background: In this study, we aimed to analyze the effects of admission time to the hospital and different variables on the treatment efficiency and to evaluate the recurrence during the clinical management process in patients with the diagnosis of primary spontaneous pneumothorax. Methods: A total of 149 patients with primary spontaneous pneumothorax (131 males, 18 females; mean age: 24.8±6.8 years; range, 17 to 35 years) treated in our clinic between January 2015 and December 2019 were retrospectively analyzed. Time from symptom onset to hospital admission (admission time) was classified as three periods: 72 h. Data including admission time, demographic and clinical characteristics, smoking history, body mass index, the use of pleurectomy or pleural abrasion during surgery were collected from the charts of the patients. Results: Admission time had no statistically significant effect on the length of hospital stay, recurrence, and the need for surgery. Male sex, smoking history, and lower body mass index had no significant effect on the recurrence. Recurrence and length of hospital stay did not significantly differ between the patients in whom pleurectomy or pleural abrasion added to the procedure during the operation. Conclusion: A longer interval between symptom onset and hospital admission and lower body mass index have no adverse effect on treatment outcomes and the recurrence in patients with primary spontaneous pneumothorax. Despite the fact that surgical treatment significantly decreases the recurrence rate, pleurectomy and pleural abrasion techniques have no significant difference on the clinical influence and recurrence of these patients.

OBJECTIVE: In this study, we evaluated the clinical characteristics and seasonal distribution of patients with primary spontaneous pneumothorax and examined the relationships between meteorological factors and pneumothorax development overall and in terms of first episode and recurrence. METHODS: The hospital records of 168 pneumothorax patients treated in our clinic between January 2016 and December 2020 were reviewed retrospectively. A cluster was defined as two or more patients with pneumothorax presenting within three consecutive days. Meteorological factors were compared between days with and without pneumothorax patients. This comparison was based on meteorological data from the day of symptom onset (D), the day before symptom onset (D1), and the difference between those days (D-D1). Meteorological data from the index day (D) were also compared between patients with first episode and recurrence of pneumothorax. RESULTS: The study included 149 (88.7%) men and 19 (11.3%) women. The mean age was 25.02 +/- 6.97 (range, 17-35; median, 26) years. Of note, 73 (43.4%) patients underwent surgery. The highest number of patients presented in November (n=19, 11.3%). In terms of season, most presentations occurred in autumn. Hum id ity was significantly lower on recurrence days compared with first episode (p=0.041). CONCLUSION: Our results indicated that meteorological factors (i.e., atmospheric pressure, humidity, wind speed, temperature, and precipitation) were not associated with pneumothorax development. By comparing the patients with first episode and recurrence, the humidity was significantly lower in the recurrence group.

Özet Amaç: Toraks travmaları tüm travma türleri arasında üçüncü sıklıkta görülmektedir. Bu çalışmada, acil servise toraks travması ile başvuran hastaların demografik özellikleri, travma nedenleri, gelişen patolojiler, tedavi yaklaşımları ve mortalite nedenlerinin analizlerini yapmak amaçlandı. Gereç ve Yöntemler: 2018 Ocak ile 2019 Aralık arasında travmatik pnömotoraks nedeniyle acil serviste değerlendirilen 127 hastanın hastane kayıtları geriye dönük olarak değerlendirildi ve analiz edildi. Bulgular: Çalışmaya dahil edilen 127 hastanın ortalama yaş 53,49 ±16.96 ve ortalama yatış süresi 7.63 ±3.65 idi. Travmatik pnömotoraks oluşturan künt travmalarda en sık sebebi trafik kazaları iken penetran travmalarda delici kesici alet yaralanması olarak tespit edildi. Kontüzyon şiddeti, kot kırığı sayısı ve yaş ile yatış süreleri arasında anlamlı ilişki tespit edildi (p=0,045, p=0,045 ve P<0,001). Multitravmalı pnömotoraks hastalarında nöroşirurjik patolojinin eşlik ettiği grupta mortalitede anlamlı bir fark görüldü(P<0,001). Sonuç: Travmatik pnömotoraks kaburga kırıkları ve kontüzyon sebebiyle oldukça önemli ve erken müdahale gerektiren bir patolojidir. Özellikle yaşlı hastalarda, kot kırığı sayısı fazla olan hastalarda ve akciğer kontüzyonunun eşlik ettiği durumlarda etkin medikal tedavi ve solunum fizyoterapisi çok büyük önem arz etmektedir.

Plevral hastalıklar klinikte karşımıza plevral kalınlaşma ve plevral efüzyon olarak çıkmaktadır. Plevral efüzyon, plevral boşlukta sıvı birikmesidir. Çalışmamızda, plevral efüzyon veya plevral kalınlaşma nedeni ile kliniğimize yatırdığımız ve Video Yardımlı Torakoskopik Cerrahi (VATS) yaptığımız hastaların klinik özelliklerini ve postoperatif patolojik sonuçlarını literatür bilgileri eşliğinde paylaşmayı amaçladık. Gereç ve Yöntem 2017 Ocak ile 2020 Ekim arasında plevral efüzyon ve plevral kalınlaşma nedeniyle Recep Tayyip Erdoğan Üniversitesi Eğitim Araştırma Hastanesi Göğüs Cerrahisi Kliniği’ne yatırılan ve VATS uygulanan 58 hastanın dosyaları retrospektif olarak incelendi. Hastaların yaş, cinsiyet, hastanede yatış süreleri belirlendi. Plevral sıvıların biyokimyasal testleri, sitolojileri, plevral biyopsi sonuçları ve hastanede yatış süreleri kaydedildi. Plevral biyopsilerin patolojileri malign ve benign olarak ayrılıp karşılaştırmalı olarak incelendi. Bulgular VATS ile biyopsi yapılan 58 hastanın 42’si (%72,4) erkek, 16’sı (%27,6) kadındı. Ortalama yaş 58,4 ±16,2 idi. Erkeklerin yaş ortalaması 58,2, kadınların yaş ortalaması ise 61,2 idi. Hastanede yatış süresi ortalama 4,1±1,4 gün idi. Hastaların 12’sinde (%20 ,6) plevral efüzyona eşlik eden plevral kalınlaşma mevcuttu. Plevral sıvı sitolojilerine bakıldığında 44 (%75,8) hastanın benign, 14 (%24,2) hastanın malign sitoloji olduğu görüldü. Biyopsi sonucu 17 (%29,3) hastada malign iken 41 (%70,7) hasta benign olarak değerlendirildi. Malign olarak sonuçlanan hastaların 11’i (%64,7) adenokarsinom idi. Benign sonuçların ise 29’u (%70,7) kronik aktif inflamasyon olarak sonuçlandı. Sonuç Analizlerimizin sonucunda, VATS’ın plevral hastalıkların tanı ve tedavisinde güvenle kullanılabilecek efektif minimal invaziv bir yöntem olduğunu düşünüyoruz.

Purpose: To investigate the efficacy of different doses of amifostine (AMI) and dexamethasone (DXM) on bilateral pulmonary contusion in rats. Methods: Forty-two Sprague Dawley rats were divided into six groups of seven animals each (control, pulmonary contusion (PC), PC + AMI 400 mg/kg, PC + AMI 200 mg/kg, PC + AMI 400 mg/kg + DXM, and PC + DXM-treated groups). RelAssay commercial kit was used to determine total oxidant status (TOS), total antioxidant status (TAS), and oxidative stress index (OSI). Nitric oxide (NO), inducible nitric oxide synthase (iNOS), interleukin-1 beta (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) activity associated with blunt trauma induced pulmonary damage were determined by enzyme-linked immunosorbent assay (ELISA). Blood gas was determined using a blood gas analyzer, while histopathological examinations were performed on the tissues by hematoxylin and eosin (H & E) staining method. Results: Significant improvement in biochemical parameters and histopathological findings were observed in the groups treated with dexamethasone and high-dose amifostine (400 mg/kg; p < 0.05). However, low-dose amifostine (200 mg/kg) and a combination of dexamethasone with amifostine (400 g/kg) was ineffective in balancing the biochemical changes due to trauma (p > 0.05). Conclusion: High-dose amifostine combined with dexamethasone mitigates trauma-induced damage in rat by preventing the elevation of key inflammatory markers. Further preclinical and clinical studies are required to determine the efficacy of amifostine in humans and to compare its activity with other agents.