Objective:Chronic thromboembolic disease (CTED) is characterized by persistent pulmonary thromboembolic occlusions without pulmonary hypertension. Early surgical treatment by performing pulmonary endarterectomy (PEA) may improve symptoms. The goal of the study was to review our experience and early outcome of PEA in patients with CTED.Methods:Data were prospectively collected on all patients who underwent PEA between 2011 and 2015. Patients with CTED and a mean pulmonary artery pressure (mPAP) of <25 mm Hg were identified. All patients were in New York Heart Association (NYHA) functional class II or III. Measured outcomes were in-hospital complications, improvement in cardiac function and exercise capacity, and survival after PEA. Patients were reassessed at 6 months following surgery.Results:A total of 23 patients underwent surgery. There was no in-hospital mortality, but complications occurred in six patients (26%). At 6 months following surgery, 93% of the patients remained alive. Following PEA, the mPAP fell significantly from 21.0±2.7 mm Hg to 18.2±5.5 mm Hg (p<.001). Pulmonary vascular resistance also significantly decreased from 2.2±0.7 wood to 1.5±0.5 wood (p<.001). The 6-min walking distance significantly increased from 322.6±80.4 m to 379.9±68.2 m (p<.001). There was a significant symptomatic improvement in all survivors in NYHA functional classes I or II at 6 months following surgery (p=.001).Conclusion:PEA in selected patients with CTED resulted in significant improvement in symptoms. The selection of patients for undergoing PEA in the absence of pulmonary hypertension must be made based on patients’ expectations and their acceptance of the perioperative risk.

Background Antiphospholipid syndrome is an autoimmune disease characterized by the occurrence of venous and/or arterial thrombosis. Chronic thromboembolism is one of the known established pathogenesis of pulmonary hypertension, known as chronic thromboembolic pulmonary hypertension. Pulmonary endarterectomy is the treatment of choice for chronic thromboembolic pulmonary hypertension. The aim of this study is to evaluate the efficacy and risk of pulmonary endarterectomy in patients with antiphospholipid syndrome-associated chronic thromboembolic pulmonary hypertension. Methods Data were prospectively collected and retrospectively analyzed, for patients who underwent pulmonary endarterectomy between March 2011 and March 2020. Results Seventeen patients (4 male and 13 female) were identified. Thirteen patients had primary antiphospholipid syndrome and 4 had secondary antiphospholipid syndrome. The mean age was 34.82 ± 10.07 years and the mean time interval between the diagnosis and surgery was 26.94 ± 17.35 months. Dyspnea on exertion was the main symptom in all patients. Seven patients had previous deep vein thrombosis, 5 patients had a history of recurrent abortions, and 2 patients had hemoptysis. Following surgery, mean pulmonary artery pressure decreased from 47.82 ± 13.11 mm Hg to 22.24 ± 4.56 mm Hg ( P < .001), and pulmonary vascular resistance improved from 756.50 ± 393.91 dyn/s/cm −5 to 298.31 ± 132.84 dyn/s/cm −5 ( P < .001). There was no in-hospital mortality with a mean follow-up of 75.29 ± 40.21 months. The functional capacity of all patients improved from 269.46 ± 111.7 m to 490 ± 105.34 m on a 6-minute walking test. Conclusions Pulmonary endarterectomy is a safe and curative treatment in patients with antiphospholipid syndrome-associated chronic thromboembolic pulmonary hypertension. It has a favorable outcome by increasing the quality of life. A multidisciplinary experienced chronic thromboembolic pulmonary hypertension team is critical in the management of these unique patients.

Öz Konuşmak insanın en temel özelliğidir ve kişiler arasında gerçekleşir. İnsanlar dil sayesinde toplum olurlar. Dil aynı zamanda iletişim aracı olarak da tanımlanabilir. Bu iletişim ses yoluyla iki veya daha fazla birey arasında gerçekleşir. Konuşan dinleyene bir anlamı (ma'nâ) iletir; dinleyen konuşanın konuşmasından bir şey anlar (mefhum). Konuşan ile dinleyen aynı anlam üzerine konduklarında anlaşma meydana gelir. Aksi takdirde anlaşmazlık olur. Dil ile iletilen bir bilgi veya istektir. Dolayısıyla konuşmak bir bilgi veya bir istek alışverişidir. İnsan bilmediği bir şeyi talep etmeyeceği için dilsel iletişimde temel olan bilgidir. Dilin iyi kullanımı sağlıklı bir bilgi ve istek akışını gerçekleştirir. Bu durum dil üzerinden toplumun mutlu olması anlamına gelir. Bu itibarla dil toplumu kuşatan ve toplumun içinde eğitim-öğretim gördüğü bir okul gibidir. Kısacası dil toplumun okuludur. Başka deyişle dil toplumun evidir. Toplum sağlıklı olmak istiyor ise kendi evine iyi bakmalı, onu iyi kullanmalıdır. Aslında her konuşma bir öğrenme ve öğretme faaliyetidir. Toplum içinde dil yoluyla herkes herkese bir şey öğretir ve herkes herkesten bir şey öğrenir. Bilgi edinmenin kendine özgü kuralları vardır. Ayrıca konuşmanın da kendine özgü kuralları vardır. Bilgi düşünme ile kazanıldığı için düşünmenin yasalarını inceleyen bilim mantık; konuşmanın yasalarını inceleyen bilim gramerdir. Dilbilim ile mantık birbirinin aynısı olmamakla birlikte bilgi dil ile iletildiği, öğrenme ve öğretme dil ile gerçekleştiği için mantıkçının, mantığı anlattığı dilin mantığını bilmesi zorunludur. Mantıkçı kullandığı dilin mantığını göz önüne almalıdır.

Objectives Minimally invasive oesophagectomy has improved over time becoming faster and less invasive. We have changed our technical approach from multiportal to uniportal VATS (video-assisted thoracoscopic surgery) oesophagectomy over the years. In this study we analyzed our results with uniportal VATS oesophagectomy technique. Methods This study was a retrospective analysis of 40 consecutive patients with the intent to perform uniportal VATS oesophagectomy for oesophageal cancer between July 2017 and August 2021. Demographic criteria, comorbidities, neoadjuvant therapy, intraoperative data, complications, length of stay, pathological data, 30 and 90-day mortality and 2-year survival data were recorded. Results Forty patients (21 female) were operated (Median age 62.9 [53.5–70.25]). Eighteen patients (45%) received neoadjuvant chemoradiation. The chest part of all cases was started with uniportal VATS and thirty-one (77.5%) was completed uniportally (34 Ivor Lewis, 6 McKeown). The median thoracic operation time in minimally invasive Ivor Lewis oesophagectomy was 90 min (77.5–100). The median time for uniportal side to side anastomosis was 12 min (11–16). Five (12.5%) patients had leak, four were intrathoracic. Twenty-eight (70%) patients had squamous cell carcinoma, eleven adenocarcinoma and one squamous cell carcinoma with sarcomatoid differentiation. Thirty-seven (92.5%) patients had R0 resection. The mean number of lymph nodes dissected was 24 ± 9.5. 30-and 90-day mortality was 2.5% (n = 1). The mean follow-up was 44 ± 2.8 months. 2-year survival was 80%. Conclusions Uniportal VATS oesophagectomy is a safe, fast and feasible alternative to other minimally invasive and open approaches. Comparable results to contemporary series are observed in perioperative and oncologic outcomes.

Situs inversus totalis is inverse placement of intra-thoracic and abdominal organs identical with a mirror image. Herein, we present a rare case of situs inversus totalis and gastroesophageal junction carcinoma treated with minimally invasive Ivor Lewis esophagectomy. A 73-year-old male patient presented with dysphagia and a diagnosis of adenocarcinoma was made. He underwent three-port laparoscopic gastric conduit preparation without using a liver retractor. Esophageal mobilization in the chest was completed with biportal video-assisted thoracoscopic surgery technique and a completely side-to-side stapled anastomosis. The patient is still alive without recurrence four years after surgery. Minimally invasive Ivor Lewis esophagectomy can be performed in these cases; however, a careful planning and rethinking of the anatomy for correct intraoperative orientation are needed. Similar surgical and oncological outcomes are expected in this patient population.