Atilla Can

Background/Objectives: Surgical resection remains an important treatment option for selected patients with bronchiectasis who have persistent symptoms, recurrent pulmonary infections, or hemoptysis despite medical therapy. This study evaluated perioperative and follow-up outcomes after pulmonary resection for bronchiectasis in a predominantly video-assisted thoracoscopic surgery (VATS)-treated cohort. Methods: This retrospective single-center cohort included patients who underwent pulmonary resection for bronchiectasis between January 2009 and January 2026. Baseline and follow-up data were analyzed at the patient level, whereas operative and perioperative outcomes were assessed at the procedure level. Follow-up duration was calculated from the most recent resection to the last available clinical assessment. Results: Thirty-four patients underwent 37 pulmonary resections. Multilobar disease was present in 14 procedures (37.8%). VATS was used in 30 procedures (81.1%) and thoracotomy in 7 (18.9%). Median hospital stay was 11 days (range, 4–41). Postoperative complications occurred after 6 procedures (16.2%), with no 30-day mortality. Complete or partial symptomatic improvement occurred after 31 procedures (83.8%). Median follow-up was 20.8 months (interquartile range, 5.9–58.8; range, 0.4–144.2). At the last available clinical assessment, 23 patients (67.6%) had no recorded symptoms; recurrent hemoptysis occurred in 1 (2.9%) and recurrent pulmonary infection in 2 (5.9%). Conclusions: Pulmonary resection for bronchiectasis was associated with acceptable morbidity, no 30-day mortality, and a high rate of postoperative clinical improvement in this VATS-dominant cohort. Most patients had no recorded symptoms at their last available clinical assessment, while recurrent hemoptysis and pulmonary infection were uncommon.

Objective: Early treatment failure following initial tube thoracostomy remains a major clinical challenge in patients with first-episode primary spontaneous pneumothorax (PSP). This study aimed to identify clinical predictors of early treatment failure and evaluate its association with short-term clinical outcomes.Materials and Methods: This retrospective single-center study included 80 consecutive patients with first-episode PSP treated with initial tube thoracostomy between January 2014 and January 2026. Early treatment failure was defined as persistent air leak 48 hours after tube insertion despite a functioning drainage system. Demographic, laboratory, and radiological variables were analyzed using univariable and multivariable binary logistic regression. Receiver operating characteristic (ROC) analysis was performed for continuous variables.Results: Early treatment failure occurred in 39 patients (48.8%). In univariable analysis, blebs and/or bullae (OR 4.455, 95% CI 1.530–12.969; p=0.006) and residual pneumothorax on the first-day chest radiograph (OR 2.875, 95% CI 1.148–7.200; p=0.024) were significantly associated with early treatment failure. After multivariable adjustment, only the neutrophil-to-lymphocyte ratio remained independently associated (OR 2.201, 95% CI 1.088–4.452; p=0.028). Early treatment failure was associated with prolonged air leak, increased VATS requirement, longer chest tube duration, and longer hospital stay (all p

Sternal fractures (SF) are relatively uncommon but clinically important injuries, frequently accompanied by rib fractures, pulmonary complications, and the need for intensive care unit (ICU). Despite advances in imaging and trauma management, prognostic assessment in SF remains challenging. In particular, the comparative performance of commonly used trauma severity scores-Injury Severity Score (ISS), New Injury Severity Score (NISS), and Trauma and Injury Severity Score (TRISS)-has not been clearly established in this patient group. This retrospective observational study included 393 adult patients diagnosed with SF at a tertiary trauma center. The prognostic performance of ISS, NISS, and TRISS for ICU admission was evaluated using ROC analysis, pairwise ROC comparison, multivariable logistic regression, and exploratory decision-tree modeling. In-vehicle traffic accidents were the most common mechanism of injury (60.1%). Most patients were managed conservatively (95.7%), with an overall mortality rate of 3.1%. ROC analysis showed good discriminatory ability for ICU admission with NISS (AUC [Area Under the Curve] 0.876) and ISS (AUC 0.847), whereas TRISS performed moderately (AUC 0.743). In multivariable models, ISS and NISS remained independently associated with ICU admission. Decision-tree analysis identified rib fractures, abnormal respiratory findings, and high injury severity scores as key predictors of ICU admission. Although mortality is low, SF are associated with considerable morbidity. Rib fractures, fracture location, and injury severity scores are important prognostic indicators. In this exploratory single-center cohort, ISS and NISS showed better discrimination for ICU admission than TRISS; however, these findings should be interpreted cautiously and require validation in larger prospective studies.

Introduction:Morel-Lavallée lesions are rare closed degloving injuries resulting from traumatic shear forces that separate the subcutaneous tissue from the underlying fascia. Although they most frequently occur in the pelvis and thigh, thoracolumbar involvement is exceedingly uncommon and may be underrecognized in trauma settings, leading to delays in diagnosis.Case Report:A 22-year-old man was admitted following a motor-vehicle accident with left-sided pulmonary contusion and pneumothorax and was managed conservatively. On the second day of hospitalization, his hemoglobin level abruptly fell to 5 g/dL despite stable daily thoracic imaging. Subsequent cross-sectional studies revealed a 25-cm hematoma extending from the thoracolumbar region into the left gluteal and lateral thigh compartments, consistent with a Morel-Lavallée lesion. The patient was managed conservatively with compression and transfusion of four units of erythrocyte suspension, resulting in clinical stabilization and full recovery.Conclusion:Thoracolumbar Morel-Lavallée lesions are rare but may lead to substantial concealed blood loss. They should be considered in trauma patients presenting with unexplained anemia. Early imaging—CT for rapid assessment and MRI for definitive characterization—supports timely diagnosis, and carefully selected patients may achieve complete recovery with vigilant conservative management.

Background: Pediatric pulmonary resections are performed for a wide spectrum of congenital, infectious, and neoplastic diseases; however, clinical outcomes and surgical approaches remain subjects of ongoing evaluation. Aims: To evaluate the indications, surgical techniques, and clinical outcomes of pediatric pulmonary resections. Study design: A retrospective, single-center case series. Methods: Medical records of 41 pulmonary resection procedures performed in pediatric patients were reviewed retrospectively. Data on demographic characteristics, type of resection, laterality, pathological diagnoses, and postoperative outcomes were analyzed. Results: Wedge resection was the most frequently performed procedure (75.6%), while bullous emphysema was the most common pathological diagnosis (51.2%). Of all resection procedures, 86.1% were associated with benign and 13.9% with malignant conditions. No major postoperative complications and no 90-day mortality were documented in the reviewed records. During follow-up, three patients died, all of whom had malignant diagnoses. Conclusion: In this retrospective single-center mixed-pathology case series, pediatric pulmonary resections were associated with favorable observed perioperative outcomes, with no documented major postoperative complications or 90-day mortality. Operative strategy was individualized according to lesion type, extent, and surgical feasibility, while follow-up deaths were confined to patients with malignant diagnoses.

Objectives: Tracheobronchial foreign-body aspiration is a clinically significant condition in adults. Although classical teaching attributes the right-sided predominance to the steeper, shorter, and wider morphology of the right main bronchus, this explanation has not been empirically validated in patients with confirmed foreign-body aspiration. Methods: This retrospective study included adult patients (≥18 years) who underwent bronchoscopic removal of foreign bodies from the right or left main bronchus between 2012 and 2025. Only individuals with available preoperative chest radiographs were analyzed. Measurements included tracheobronchial angles, bronchial and tracheal diameters, bronchial lengths, and estimated airway volumes calculated under cylindrical assumptions. Results: Of 35 included patients, 26 (74.3%) had right-sided and 9 (25.7%) had left-sided bronchial foreign bodies. At the population level, the right main bronchus was significantly steeper, wider, and shorter than the left; however, these anatomical differences did not distinguish patients with right- versus left-sided foreign bodies. Tracheobronchial angles, tracheal dimensions, bronchial diameters, and diameter ratios were all similar between the two groups (p > 0.05). In contrast, right bronchial length and volume were significantly greater in patients with right-sided foreign bodies (p = 0.004 for both). Exploratory ROC analysis further suggested that a right bronchial length exceeding 23.28 mm may be associated with an increased tendency toward right-sided migration within this cohort. Conclusions: Increased right bronchial length and volume may facilitate a preferential pathway for airflow continuity toward the right bronchial tree. These findings challenge long-standing anatomical assumptions and highlight the need to incorporate geometric and airflow-dynamic factors into future models of aspiration mechanics.

Background and Objectives: Thoracic trauma usually results in high morbidity and mortality. It is the leading cause of death in patients within the first four decades of life. In this study, we aimed to identify risk factors for intensive care mortality and to evaluate factors affecting clinical outcomes and complications in patients with thoracic trauma who were treated in the intensive care unit (ICU). Materials and Methods: This was a retrospective, single-center study. Patients diagnosed with thoracic trauma and followed up in the ICU between 1 May 2023 and 1 January 2025 were included. Critically ill patients aged 18 years and older whose admission blood values were available and who had undergone radiological imaging were included in the study. Patients were grouped as Survivors or Non-survivors. The primary outcome was to determine risk factors for mortality. The secondary outcome was to evaluate factors affecting clinical outcomes and complications. The tertiary outcome was to determine the predictive value of the Injury Severity Score (ISS), Acute Physiology and Chronic Health Evaluation II (APACHE II), and Glasgow Coma Scale (GCS) for mortality. Results: A total of 104 patients (male/female ratio: 76/28) were included in the study. Twenty-four patients (23.1%) died, and eighty (76.9%) were discharged. Age in the Non-survivor group was found to be significantly higher (59.33 ± 22.21 vs. 40.50 ± 17.71; p < 0.001), and the proportion of women was also significantly higher in the Non-survivor group (p = 0.0082). Mortality was associated with advanced age, female sex, lower GCS score (p < 0.001), higher APACHE II scores (p < 0.001), and the presence of comorbid conditions (p = 0.003), including head trauma (p = 0.024) and cardiac arrest before ICU admission (p = 0.011). The Non-survivor group more frequently required mechanical ventilation (p < 0.001), vasopressor support (p < 0.001), and continuous renal replacement therapy (p < 0.001), and they developed ventilator-associated pneumonia (p < 0.001) and acute respiratory distress syndrome (p < 0.001) at higher rates. ICU length of stay was also significantly longer in the Non-survivor group (p = 0.045). The APACHE II score demonstrated the highest discriminatory performance, emerging as the strongest clinical predictor of mortality (AUC = 0.751, 95% CI: 0.630–0.872; p < 0.001). Age (OR: 1.06) and serum lactate levels (OR: 1.57) consistently emerged as strong independent predictors of mortality. The presence of head trauma significantly increased the risk of mortality, particularly in the APACHE II-adjusted model (OR: 9.08). The APACHE II–based model yielded high specificity (96.3%) and accuracy (88.5%), with good discrimination (AUC = 0.894) and the highest Nagelkerke R² (0.548). Conclusions: Factors that may shorten the length of ICU stay include infection control, early correction of acidosis, and maintenance of hemodynamic stability, which may reduce mortality. APACHE II was more closely related to overall clinical severity than the other scoring systems. Our data indicate that age-related frailty and acute physiological derangement, as best represented by the APACHE II score, are more significant determinants of survival than anatomic injury severity alone.

Introduction: We evaluated the clinical attitudes of thoracic surgery specialists and residents in Turkey toward thoracic surgery in elderly patients, their perceptions of geriatric support in surgical decision-making, and their educational needs. Materials and Method: This descriptive, cross-sectional survey study included thoracic surgery specialists, academic surgeons, and residents currently practicing in Turkey. Data were collected anonymously via Google Forms between July and September 2025. The questionnaire comprised items related to demographic characteristics, surgical decision-making, geriatric support, multidisciplinary approach, and educational needs. Statistical analysis included descriptive statistics, comparative tests, effect size calculations, and multivariable logistic regression analysis. Results: The study recruited 103 participants. A large majority of participants (90.3%) reported that minimally invasive approaches were advantageous for patients aged ≥65 years, and strong agreement was observed with the statement that chronological age alone should not be considered a contraindication to surgery. Overall performance status was identified as the primary determinant in surgical decision-making. Overall, 62.1% of participants reported limited access to geriatric specialists at their institution, and 60.2% stated that they had not received structured education on the management of elderly patients. In addition, residents demonstrated a more indecisive attitude toward nonoperative approaches compared with specialists and academic surgeons, with 60.0% of residents reporting uncertainty. Conclusion: Thoracic surgeons support an individualized, multidisciplinary approach to surgical care in elderly patients, but limited access to geriatric support and gaps in education restrict the full implementation of this approach in clinical practice. Stronger geriatric-based multidisciplinary models and educational programs could improve the quality of care for elderly patients when they undergo thoracic surgery. Keywords: Aged; Thoracic Surgery; Geriatrics; Patient Care Team; Decision Making.

Background: Sclerosing pneumocytoma (SP) is a rare benign pulmonary neoplasm that can mimic malignancy on radiologic imaging, presenting a diagnostic challenge. Case: A 56-year-old woman was evaluated for an incidentally detected 30 mm solid mass in the the left lower lobe. PET/CT revealed increased FDG uptake (SUVmax: 5.5), and MRI showed marked contrast enhancement suggestive of a neuroendocrine tumor. Bronchoscopy revealed no endobronchial involvement. Pulmonary function was sufficient for resection. Given the lesion’s central location, imaging findings concerning for malignancy, and absence of a preoperative diagnosis, video-assisted thoracoscopic lobectomy with mediastinal lymph node dissection was performed. Histopathological and immunohistochemical analysis confirmed SP. The postoperative course was uneventful, and no recurrence was observed during 14 months of follow-up. Conclusion: SP should be included in the differential diagnosis of solitary pulmonary nodules. In patients with radiological features mimicking malignancy, anatomical resection may be required for definitive diagnosis and oncological safety.