IntroductionProlonged air leak in secondary spontaneous pneumothorax (SSP) patients remains one of the biggest challenges for thoracic surgeons. This study investigates the feasibility, effectiveness, clinical outcomes, and economical benefits of the autologous blood patch pleurodesis method in SSP.Material and methodsFirst-episode SSP patients undergoing autologous blood patch pleurodesis for resistant air leak following underwater-seal thoracostomy, between January 2010 and June 2013 were taken into the study. Timing and success rate of pleurodesis, recurrence, additional intervention, hospital length of stay, and complications that occurred during follow-up were examined from medical records, retrospectively.ResultsThirty-one (27 male, 4 female) SSP patients with expanded lungs on chest X-ray and resistant air leak on the 3rd post-interventional day were enrolled. Mean age was 53.7 ± 18.9 years (range: 23-81). Twenty-four patients were treated with tube thoracostomy, 2 with pezzer drain, and 5 with 8 F pleural catheter. 96.8% success was achieved; air leak in 29 of 31 patients (93.5%) ceased within the first 24 hours. No procedure-related complication such as fever, pain or empyema was seen. Late pneumothorax recurrence occurred in 4 (12.9%) patients; 1 treated with talc pleurodesis where the other 3 necessitated surgical intervention.ConclusionsAutologous blood patch pleurodesis is a safe, effective, and easily performed procedure with no need of any additional equipment or extra cost. This method can be applied to all patients with radiologically expanded lungs and continuous air leak after 48 hours following water-seal drainage thoracostomy, to reduce hospital stay duration, unnecessary surgical interventions, and the expenses.

Background Patients with N1 non-small cell lung cancer represent a heterogeneous population. The aim of this study is to determine the difference of survival rate between subtypes of N1 disease in surgically resected non-small cell lung cancer patients and to compare the survival in these patients with multi-N1 and single N2 (skip metastasis) disease. Methods Patients who underwent anatomical pulmonary resection in our institution between 2007 and 2014 with a pathological diagnosis of N1 and single N2 positive non-small cell lung cancer were included in the study. N1 positive patients were divided into three groups as single hilar; single interlobar, lobar, or segmental; and multiple N1 positive patients. These groups were compared among themselves as well as with incidentally found single N2 patients. Results A total of 1,742 patients who had non-small cell lung cancer underwent anatomical lung resection. The survival was better in single hilar lymph nodes than other subtypes of N1 disease (p = 0.015). There was no statistically significant difference in terms of survival between the other subtypes of N1 disease (p = 0.332). The difference in survival for single N2 disease compared with multi-N1 was not statistically significant (p = 0.054). Also, when we divided the groups as single and multi-N1, there was a significant difference in survival (p = 0.025). Conclusion Single hilar lymph nodes with direct invasion have better survival rate than other subtypes of N1. Also, patients with multiple N1 positive lymph nodes have similar survival results compared with single N2 patients. Our results should be confirmed with larger series to better explain N1 disease.

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Background Spontaneous pneumothorax usually occurs as a result of rupture of a subpleural bleb or emphysematous bulla. Spontaneous pneumothorax, which is more common in younger age groups, might be the first sign of pulmonary malignancy, especially when it manifests in older patients. Methods Data of all patients who were treated for spontaneous pneumothorax in our clinic between June 2013 and June 2017 were examined retrospectively. The demographic characteristics, diagnostic methods, pathologic subtypes, and treatment protocols applied in patients diagnosed with malignancy during the treatment period were investigated. Results Out of 1187 patients, 9 (0.8%) had incidental pulmonary malignancies. Metastatic lung cancer was detected in 2 of 9 patients, while primary lung cancer was detected in the other 7. Six patients were operated on and the other 3 were referred for oncologic treatment for various reasons. Conclusions We suggest that cases of spontaneous pneumothorax in advanced age should be evaluated in a more detailed fashion, and further investigations should be carried out with suspicion of an underlying pulmonary malignancy.

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Background: Pulmonary carcinosarcoma (PC) is a rare malignant tumour of the lung. Due to its rarity, few studies have been reported and its clinicopathological characteristics and treatment outcomes remain unclear. The aim of the present study was to evaluate clinical, radiological and pathological findings and treatment outcomes of patients with PC. Methods: We retrospectively reviewed the records of the Pathology Department from the beginning of 2005 to the end of 2013. Results: The present study included eight cases with PC. All patients were male and their ages ranged from 56 to 77 years, with a mean age of 63.1 years. The most common radiological finding was a solitary mass, followed by atelectasis and mass. All patients underwent surgical resection, in the form of lobectomy (n = 6), bilobectomy inferior (n = 1) and pneumonectomy (n = 1). Pathological diagnosis of PC was made by surgical resection, in all patients. Pathologically, the epithelial component of the tumour was squamous cell carcinoma in four patients and adenocarcinoma in four patients. The most common sarcomatous component was spindle cell, followed by chondrosarcoma. Four patients received adjuvant chemotherapy. Survival time for four of the patients was shorter than one year. The median survival time was 21.5 months (range: 1-75 months). Conclusions: Pulmonary carcinosarcoma of the lung is a rare biphasic tumour. Complete surgical resection is the treatment of choice. The prognosis of patients with PC is poor despite complete surgical resection and adjuvant chemotherapy.

Advances in computer technology have permitted development of virtual reality images of the tracheobronchial tree using data sets derived from helical CT of the chest. Peripheral pulmonary lesions (PPL) are common incidental findings. Their rising incidence has paralleled the increasing use of computed tomography (CT) as CT is approximately three times more sensitive than plain chest radiography (CXR) scans. Electromagnetic navigation bronchoscopy (ENB) is an exciting new bronchoscopic technique that promises accurate navigation to peripheral pulmonary target lesions. CTguided transthoracic needle aspiration (TTNA) is a common method of obtaining tissue and whilst its pooled sensitivity for malignancy of %90 is impressive it also has a false negative rate of %20-30. Furthermore it is complicated by minor pneumothorax in approximately %25 of cases and major pneumothorax requiring a chest tube in %5 of cases. The main advantage of using bronchoscopic techniques rather than transthoracic biopsy is its superior safety profile. Electromagnetic navigation-guided bronchoscopy has the potential to improve the diagnostic yield of transbronchial biopsies without additional fluoroscopic guidance, and may be useful in the early diagnosis of lung cancer, particularly in nonoperable patients.

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