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Background Bronchoscopy and EBUS are standard procedures in lung cancer work-up but have low diagnostic yield in lesions outside the central airways and hilar/mediastinal lymph nodes. Growing evidence on introducing the EBUS endoscope into the oesophagus (EUS-B) in the same session as bronchoscopy/EBUS gives access to new anatomical areas that can be safely biopsied.Objective To summarize the current evidence of the added value of EUS-B-FNA to bronchoscopy and EBUS-TBNA in lung cancer work-up.Methods A narrative review.Results Few randomized trials or prospective studies are available. Prospective studies show that add-on EUS-B-FNA increases diagnostic yield when sampling abnormal mediastinal lymph nodes, para-oesophageal lung and left adrenal gland. A large retrospective series on EUS-B-FNA from retroperitoneal lymph nodes suggests high diagnostic yield without safety concerns, as do casuistic reports on EUS-B-FNA from mediastinal pleural thickening, pancreatic lesions, ascites fluid and pericardial effusions. No study has systematically assessed both diagnostic yield, safety, patient reported outcomes, adverse events and costs.Conclusion The diagnostic value of add-on EUS-B to standard bronchoscopy and EBUS in lung cancer work-up appears very promising without safety concerns, giving the pulmonologist access to a variety of sites out of reach with other minimally invasive techniques. Little is known on patient-reported outcomes and costs. Future and prospective research should focus on effectiveness aspects to clarify whether overall benefits of add-on EUS-B sufficiently exceed overall downsides.

ABSTRACTBackground In patients with recurrent pleural effusion, therapeutic thoracentesis is one way of relief. Correct prediction of which patients will experience relief following drainage may support the management of these patients. This study aimed to assess the association between ultrasound (US) characteristics and a relevant improvement in dyspnoea immediately following drainage.Methods In a prospective, observational study, patients with recurrent unilateral pleural effusion underwent US evaluation of effusion characteristics and diaphragm movement measured by M-mode and the Area method before and right after drainage. The level of dyspnoea was assessed using the modified Borg scale (MBS). A minimal important improvement in dyspnoea was defined as delta MBS ≥ 1.Results In the 104 patients included, 53% had a minimal important improvement in dyspnoea following thoracentesis. We found no association between US-characteristics, including diaphragm shape or movement (M-mode or the Area method), and a decrease in dyspnoea following drainage. Baseline MBS score ≥ 4 and a fully drained effusion were significant correlated with a minimal important improvement in dyspnoea (OR 3.86 (1.42–10.50), p = 0.01 and 2.86 (1.03–7.93), p = 0.04, respectively).Conclusions In our study population, US-characteristics including assessment of diaphragm movement or shape was not associated with a minimal important improvement in dyspnoea immediately following thoracentesis.

Background: Malignant pleural effusion (MPE) affects up to 15% of patients with malignancy, and the prevalence is increasing. Non-expandable lung (NEL) complicates MPE in up to 30% of cases. However, it is not known if patients with malignant pleural effusion and NEL are more symptomatic in activities of daily living compared to patients with MPE with expandable lung. Methods: This was an observational study on consecutively recruited patients with MPE from our pleural clinic. Before thoracentesis, patients completed patient-reported outcomes on cancer symptoms (ESAS), health-related quality of life (5Q-5D-5L), and dyspnoea scores. Following thoracentesis, patients scored dyspnoea relief and symptoms during thoracentesis. Data on focused lung ultrasound and pleural effusion biochemistry were collected. The non-expandable lung diagnosis was made by pleural experts based on radiological and clinical information. Results: We recruited 43 patients, including 12 with NEL (28%). The NEL cohort resembled those from previous studies concerning ultrasonography, pleural fluid biochemistry, and fewer cases with high volume thoracentesis. Patients with and without NEL were comparable concerning baseline demography. The 5Q-5D-5L utility scores were 0.836 (0.691–0.906) and 0.806 (0.409–0.866), respectively, for patients with and without NEL. We observed no between-group differences in symptom burden or health-related quality of life. Conclusion: While the presence of NEL affects the clinical management of recurrent MPE, the presence of NEL seems not to affect patients’ overall symptom burden in patients with MPE.

Background: Bronchoscopy and endobronchial ultrasound (EBUS) are standard procedures for the diagnosis and staging of patients suspected of lung cancer. If the patient simultaneously presents with suspicious liver lesions, it is tradition to refer the patient to a radiologist for ultrasound-guided percutaneous liver biopsy. Objective: The aim of this study was to investigate the results and complications when the pulmonologist performs all three procedures in the same setting. Methods: We retrospectively identified patients who during 2018–2020 underwent invasive workup of suspected lung cancer and liver metastases with percutaneous liver lesion biopsy with or without same-day endoscopy (bronchoscopy and EBUS). We compared diagnostic yield and safety of liver lesion biopsy stratified by same-day endoscopy or not. Results: In total, 89 patients were included, of whom 28 patients (31%) underwent same-day endoscopy. All liver lesion biopsies were fine-needle aspiration biopsies performed by experienced pulmonologists. No complications were reported, and overall diagnostic yield was 88%. The diagnostic yield was significantly lower in the same-day endoscopy group (71% vs. 95%), and undergoing endoscopy was significantly associated with having fewer liver lesions, higher prevalence of lung cancer, and lower overall prevalence of a malignant diagnosis. Conclusion: Liver biopsy in the same session as endoscopy during lung cancer workup was feasible and safe. Confounding by indication was present in our study.

Background: Non-expandable lung (NEL) has severe implications for patient symptoms and impaired lung function, as well as crucial implications for the management of malignant pleural effusion (MPE). Indwelling pleural catheters have shown good symptom relief for patients with NEL; hence, identifying patients early in their disease is vital. With the inability of the lung to achieve pleural apposition following thoracentesis and the formation of a hydropneumothorax, traditionally, chest X-ray and clinical symptoms have been used to make the diagnosis following thoracentesis. It is our aim to investigate whether ultrasound measurement of lung movement during respiration can predict NEL before thoracentesis, thereby aiding clinicians in their planning for the optimal treatment of affected patients. Methods: A total of 49 patients were consecutively included in a single-centre trial performed at a pleural clinic. Patients underwent protocolled ultrasound assessment pre-thoracentesis with measurements of lung and diaphragm movement and shear wave elastography measurements of the pleura and pleural effusion at the planned site of thoracentesis. Results: M-mode measurements of lung movement provided the best diagnostic ROC-curve results, with an AUC of 0.81. Internal validity showed good results utilising the calibration belt test and Brier test. Conclusion: M-mode measurement of lung movement shows promise in diagnosing NEL before thoracentesis in patients with known or suspected MPE. A validation cohort is needed to confirm the results.

This is the first paper to report sampling of pancreatic lesions by EUS-B-FNA.A 76 year old patient suspected of primary lung cancer presented with a 36 × 24 mm lesion in the pancreas. Thoracentesis showed malignant cells suggestive of mucinous adenocarcinoma, but immunohistochemistry was inconclusive.Due to rapid deterioration of performance status of this frail patient, the program was shortened to EUS-B-FNA of the pancreatic lesion, which showed mucinous adenocarcinoma suggestive of primary pancreatic cancer.We conclude that EUS-B-FNA from a pancreatic lesion in the hands of a chest physician is feasible and diagnostic of a tumor in pancreas.

Background:. Ulnar styloid fractures (USFs) are often associated with distal radial fractures (DRFs). When unstable DRFs are treated surgically, any associated USF is most commonly left untreated. The purpose of this study was to evaluate the effect of a concomitant USF on outcome after surgical stabilization of a DRF. Methods:. Data from 2 randomized controlled trials on the treatment of unstable DRFs were pooled. The effect of a USF on the QuickDASH, EQ-5D, pain, and range of motion at 2 years was evaluated. Results:. Two hundred and eighty-one patients were included; 177 (63%) had an associated, untreated USF. An unadjusted analysis demonstrated no significant difference in functional or patient-reported outcome measures (PROMs) at 2 years between patients with or without a concomitant USF. When controlling for confounding factors, the presence of a USF did not predict change in any of the PROMs from baseline to 2 years. A concomitant USF also did not predict change in grip strength or range of motion, except for a small effect on extension (−4.1°; 95% confidence interval, −7.5° to −0.8°; p = 0.02), which probably does not have clinical relevance. Conclusions:. A USF in combination with a DRF does not affect PROMs, range of motion, or grip strength. We recommend that concomitant USFs be left untreated when treating a DRF with surgical fixation. Level of Evidence:. Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.

Dental care workers are frequently exposed to various types of volatile organic and inorganic compounds. In addition to biological materials, these compounds include silica, heavy metals, and acrylic plastics. Such exposures may cause respiratory symptoms, but the nonspecific nature of these symptoms often means that the etiology is difficult to discern. The disease severity depends on the particle size and type of the inhaled compounds, as well as the duration and intensity of exposure, which varies markedly among dental workers. Here, we present two unique cases with the same occupational exposure. Both patients showed radiological changes in the lungs that were suspicious for lung cancer.The first patient did not undergo a biopsy due to cardiac comorbidities and risk of bleeding, and the diagnosis was based on thoracic computer tomography (CT) which confirmed multiple, bilateral, solid, smooth, partly calcified lung nodules, normal positron emission tomography (PET)-CT and the relevant occupational exposure. In the second case, a CT-guided biopsy and thoracoscopic resection was done with histopathological findings consistent with granuloma. The multi-disciplinary team decision of both cases was consistent with occupational exposure related lunge disease.This is the first case study report whereby same occupational exposure related health condition is compared with two different approaches. Respiratory clinicians should be aware of this potential diagnosis, especially for asymptomatic patients with relevant exposures. Careful attention to the occupational history may help to prevent unnecessary, invasive diagnostic procedures or surgeries.

Waldenström macroglobulinemia rarely presents as pulmonary symptoms, and even rarer as chylothorax. We present a patient who presented with bilateral pleural effusion and a 30 mm solid lesion in the lung. Biochemical analysis of the pleural fluid revealed chylothorax. The 18-fluorodeoxygenase positron emission tomography, bronchoscopy, endobronchial ultrasound, and cytological examination of the pleural fluid, showed no apparent cause of the chylothorax. The diagnostic breakthrough was made with flow cytometry of the pleural fluid, which revealed a small group of clonal B-cells. Biopsy from the parietal pleura and bone marrow led to the diagnosis Waldenström macroglobulinemia. This demonstrates that flow cytometry should be considered when routine diagnostics do not lead to a reach a specific diagnosis.

Predicting factors of diagnostic yield in electromagnetic navigation bronchoscopy (ENB) have been explored in a number of previous studies based on data from experienced operators. However, little is known about predicting factors when the procedure is carried out by operators in the beginning of their learning curve. We here aim to identify the role of operators’ experience as well as lesion– and procedure characteristics on diagnostic yield of ENB procedures in the hands of novice ENB operators. Four operators from three centers without prior ENB experience were enrolled. The outcome of consecutive ENB procedures was assessed and classified as either diagnostic or non-diagnostic and predicting factors of diagnostic yield were assessed. A total of 215 procedures were assessed. A total of 122 (57%) of the ENB procedures resulted in diagnostic biopsies. Diagnostic ENB procedures were associated with a minor yet significant difference in tumor size compared to non-diagnostic/inconclusive ENB procedures (28 mm vs. 24 mm; p = 0.03). Diagnostic ENB procedures were associated with visible lesions at either fluoroscopy (p = 0.003) or radial endobronchial ultrasound (rEBUS), (p = 0.001). In the logistic regression model, lesion visibility on fluoroscopy, but none of operator experience, the presence of a bronchus sign, lesion size, or location nor visibility on rEBUS significantly impacted the diagnostic yield. In novice ENB operators, lesion visibility on fluoroscopy was the only factor found to increase the chance of obtaining a diagnostic sample.

Pulmonary blastoma is an aggressive lung cancer with incidence ranging from 0.25–0.5 of all the reported lung cancers. Although, pulmonary blastoma is seen commonly in childhood its very rare in adults.Surgical treatment is often the treatment of choice, but benefits of neoadjuvant chemotherapy are unclear.People with DICER1 syndrome commonly develop Pulmonary blastoma and do have concomitant or previous history of benign or malignant tumours in extra pulmonary site like kidney, thyroid, ovary cervix testicle and eye.As per our knowledge, this is the first case of adult pulmonary blastoma previously diagnosed with urothelial cancer and a strong familial predilection of malignancy, with negative genetic test for DICER1 mutations.

Background Oncological treatment of primary pulmonary adenocarcinoma (AC) includes drugs targeting the pathways involving programmed death-ligand 1 (PD-L1), epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK). The aim of the study was to report the prevalence of these tumour markers in pleural fluid with cytology positive for pulmonary AC and the potential influence of volume pleural fluid tested. Methods We retrospectively reviewed all thoracenteses performed in a two-year period at our interventional unit at Department of Respiratory Medicine at Zealand University Hospital Naestved, Denmark. ALK and PD-L1 testing was done using immunohistochemistry and EGFR testing using next-generation sequencing. We included pleural fluid specimens containing malignant cells originating from primary pulmonary AC and with at least one tumour marker requested by the clinicians. Results When screening 927 pleural fluid specimens, we identified 57 in accordance with the inclusion criteria. PD-L1, ALK and EGFR were obtained in 35/55 (64%), 38/57 (67%) and 26/47 (55%), respectively. The prevalence did not increase when analysing volumes > 50 mL (p = 0.21–0.58) Conclusion Tumour markers in pleural fluid specimens containing cells from pulmonary AC can be demonstrated in more than half of the cases. Therefore, supplementary invasive procedures than thoracentesis could potentially await these analyses.

The use of the endobronchial ultrasound (EBUS) endoscope in the oesophagus, the so‐called EUS‐B procedure, for the diagnosis and staging of thoracic malignancy is quickly gaining ground. Pleural lesions located close to the oesophagus can be inaccessible to transthoracic biopsy and endoscopic procedures can be the only option. We here present two cases demonstrating that EUS‐B‐guided fine needle aspiration (EUS‐B‐FNA) of pleural lesions is possible. The first case demonstrates a EUS‐B‐FNA with malignant mesothelioma of a pleural lesion in a 70‐year‐old patient. In the second case, EUS‐B‐FNA diagnosed a pleural metastasis from adenoid cystic adenocarcinoma in a 75‐year‐old‐patient. In conclusion, we hereby demonstrate that EUS‐B‐FNA from pleural lesions is feasible and appears to be safe.

Malignant pleural effusion is an important and difficult differential diagnosis to pleural empyema. Epithelioid hemangioendothelioma is an uncommon vascular tumor, which typically occurs in liver, lung or bone. We present an extremely rare case of primary pleural epithelioid hemangioendothelioma mimicking pleural empyema. We conclude, that pleural epithelioid hemangioendothelioma should be kept in mind as a differential diagnosis in patients suspected of empyema.

Silicone from ruptured breast implants can cause lung symptoms mimicking cancer. The diagnosis may be established by transbronchial lung biopsy or surgery. We report a case of asymptomatic silicone induced granulomatous reaction in the lungs and mediastinal lymph nodes diagnosed with EBUS-TBNA. We conclude that this differential diagnosis should be kept in mind even in an asymptomatic patients and that EBUS-TBNA should be considered.

Flexible bronchoscopy and endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) are the pulmonologists´ basic procedures for the biopsy of suspicious lung lesions. If inconclusive, other guiding-modalities for tissue sampling are needed, computed tomography performed by a radiologist, or – if available – radial EBUS or electromagnetic navigation biopsy. We wanted to investigate if same-day X-ray fluoroscopy-guided transthoracic fine-needle aspiration biopsy (F-TTNAB) performed by the pulmonologist immediately after bronchoscopy and EBUS is a feasible alternative. We retrospectively identified consecutive patients in whom F-TTNAB followed a bronchoscopy and EBUS in the same séance. Patients in whom the suspicion of malignancy was invalidated after complete work up were followed for six months to identify false-negative cases. In total 125 patients underwent triple approach (bronchoscopy, EBUS and F-TTNAB) during the same séance. Malignancy was diagnosed in 86 (69%), and 77 of these (90%) were primary lung cancers. The diagnostic yield of F-TTNAB for malignancy was 77%, and sensitivity was 90%. Pneumothorax occurred in 35 (28%) patients, and was administered with pleural drainage in 22 (18% of all patients). No cases of prolonged haemoptysis were observed. The risk of pneumothorax differed insignificantly with lesion size ≤2.0 cm (27%) versus >2.0 cm (29%). We conclude that it is feasible for pulmonologist to perform F-TTNAB immediately after endoscopy as a combined triple approach in a fast-track workup of suspected lung cancer.

Background: The use of the endobronchial ultrasound (EBUS) scope in the oesophagus, the so-called EUS-B procedure, for the diagnosis and staging of lung cancer is quickly gaining ground. Case presentation: We here present a case demonstrating that EUS-B guided aspiration of intraperitoneal fluid (ascites) is possible. This has never been described before.The procedure was performed with the use of a 22 G needle in a 71 years old woman suspected of lung cancer. No complications were seen. Conclusion: We hereby demonstrate that EUS-B fine needle aspiration from ascites fluid is feasible and appears to be safe. Keywords: Ascites, Endoscopic ultrasound-guided fine needle aspiration, EUS-B-FNA, Interventional pulmonoloy, Lung cancer

Safety and clinical feasibility of injecting a novel liquid fiducial marker for use in image guided radiotherapy in 15 patients with non-small cell lung cancer are reported. No major safety or toxicity issues were encountered. Markers present at start of radiotherapy remained visible in cone beam computed tomography and fluoroscopy images throughout the treatment course and on computed tomography images during follow-up (0–38 months). Marker volume reduction was seen until 9 months after treatment, after which no further marker breakdown was found. No post-treatment migration or marker related complications were found. Keywords: Liquid fiducial marker, Image-guided radiotherapy, NSCLC, Endoscopic ultrasound, EBUS

Abstract Background Several studies published over the last decade indicate an increased incidence of distal radius fractures (DRF). With Norway having one of the highest reported incidence of DRFs, we conducted a study to assess the epidemiology of DRFs and its treatment in the catchment area of Akershus University Hospital (AHUS). Methods Patients 16 years or older who presented to AHUS with an acute DRF during the years 2010 and 2011 were prospectively recorded and classified according to the AO fracture classification system. The mechanism of injury and treatment modality were noted. Results Overall, 1565 patients with an acute DRF presented to the institution in 2010–2011, of which 1134 (72%) were women. The overall annual incidence was 19.7 per 10,000 inhabitants 16 years or older. Women had an exponential increase in incidence after the age of 50, though the incidence for both genders peaked after the age of 80 years. There was an even distribution between extra- and intra-articular fractures. Falling while walking outside was the most common mechanism of injury. Of the 1565 registered, 418 (26.7%) patients underwent surgery, with a volar locking plate being the preferred surgical option in 77% of the cases. Conclusion The overall incidence of distal radius fractures was lower in our study than earlier reports from Norway. Postmenopausal women had a higher risk of fracture than the other groups, and low-energy injuries were most dominant. 26.7% were treated operatively, which is higher than earlier reports, and might reflect an increasing preference for surgical treatment.

Background: The evaluation of patients with lung lesions is challenging. The nature of the lesion can be determined by pathological evaluation of biopsies. The pulmonologists will be met by increasing demands with regard to biopsy techniques including ultrasound-guided transthoracic needle biopsy (US-TTNB).Objective: The aim of this paper is to present the pulmonologist to a systematic step-by-step guide for performing US-TTNB and to assess the evidence for this approach. Method/results: Indications, contraindications and a step-by-step guide for the techniques used when performing US-TTNB are presented, and major complications and handling of these are described. Conclusion: US-TTNB performed by pulmonologists is a safe and feasible procedure.

The scientific background in expert-opinion papers for recommending Computed Tomography (CT) in unilateral pleural exudates is based on studies including patients with other findings than unilateral pleural effusions or selected patients undergoing thoracoscopy. Therefore, we performed a systematic review investigating the sensitivity of CT for predicting malignancy in patients with unilateral, non-transudative, pleural effusions. A search strategy was developed with the assistance of a medical information specialist at our university library. We searched PubMed/MEDLINE, EMBASE and Cochrane Library, ClinicalTrials.gov and articles citing the included studies. No date restrictions were applied (the first included paper was published in 2001 (1)), and only literature in English was included. We used the Quality Assessment of Diagnostic Accuracy Studies 2 for bias assessment. We registered the protocol at PROSPERO (CRD42018094830). Five studies were included, two prospective and three retrospective, all performed in Western Europe. No study reported diagnostic values for patients with unilateral, non-transudative pleural effusions only; one study did for unilateral pleural effusions. In the remaining studies, most patients had unilateral effusions and non-transudative effusions. Patients were primarily males and >70 years. All but one study found a high incidence of malignancy, dominated by malignant pleural mesothelioma. All studies were limited by risk of bias and applicability, predominantly regarding study population, pretests and index test. The current evidence supporting the sensitivity of CT for predicting malignancy in unilateral pleural effusions (both non-transudative and all types of effusion) is very low and did not allow meta-analysis. Standardization of patient population and CT protocol may facilitate conclusions of futures studies.

Background: Haemoptysis is a common symptom and can be an early sign of lung cancer. Careful investigation of patients with haemoptysis may lead to early diagnosis. The strategy for investigation of these patients, however, is still being debated. Objectives: We studied whether the combination of computed tomography (CT) and bronchoscopy had a higher sensitivity for malignant and non-malignant causes of haemoptysis than CT alone. Methods: The study was a retrospective, non-randomised, two-centre study and included patients who were referred from primary care for the investigation of haemoptysis. Results: A total of 326 patients were included in the study (mean age 60.5 [SD 15.3] years, 63.3% male). The most common aetiologies of haemoptysis were cryptogenic (52.5%), pneumonia (16.3%), emphysema (8.0%), bronchiectasis (5.8%) and lung cancer (4.0%). In patients diagnosed with lung cancer, bronchoscopy, CT and the combination of bronchoscopy and CT had a sensitivity of 0.61, 0.92 (p

Introduction: Surgical resection in patients with non–small cell lung cancer (NSCLC) may be associated with significant morbidity, functional limitations, and decreased quality of life. Objectives: The objective is to present health-related quality of life (HRQoL) changes over time before and 1 year after surgery in patients with NSCLC participating in a rehabilitation program. Methods: Forty patients with NSCLC in disease stage I to IIIa, referred for surgical resection at the Department of Cardiothoracic Surgery RT, Rigshospitalet, were included in the study. The rehabilitation program comprised supervised group exercise program, 2 hours weekly for 12 weeks, combined with individual counseling. The study endpoints were self-reported HRQoL (Functional Assessment of Cancer Therapy–Lung, European Organization for Research and Treatment in Cancer–Quality of Life Questionnaire-QLQ-C30, Short-Form-36) and self-reported distress, anxiety, depression, and social support (National Comprehensive Cancer Network Distress Thermometer, Hospital Anxiety and Depression Scale, Multidimensional Scale of Perceived Social Support), measured presurgery, postintervention, 6 months, and 1 year after surgery. Results: Forty patients were included, 73% of whom completed rehabilitation. Results on emotional well-being ( P < .0001), global quality of life ( P = .0032), and mental health component score ( P = .0004) showed an overall statistically significant improvement during the study. Conclusion: This feasibility study demonstrated that global quality of life, mental health, and emotional well-being improved significantly during the study, from time of diagnosis until 1 year after resection, in patients with NSCLC participating in rehabilitation.

The significant expansion of intermittent renewable energy sources can compromise the stability of energy grids due to the mismatch between instantaneous energy use and production. Buildings have a large potential for energy storage and demand-side management, which can offer energy flexibility to a Smart Grid system. Smart control of heating, ventilation and air conditioning systems is a great solution for improving flexible energy use, load shifting and power peak shaving. This numerical study compares the energy flexibility potential of three different heating and cooling systems implemented in a nearly zero-energy office building. The energy flexibility strategy consists in the modulation of heating / cooling indoor temperature set points according to an energy price signal. The energy flexibility assessment was performed based on the energy shifting ability, indoor thermal comfort level and economic benefits. This article establishes a better understanding of the flexibility potential of common and innovative heating / cooling technologies. Lindab Solus system has the highest load shifting ability with a flexibility index of 67.41%, followed by the radiator heating system, scoring a 59.92%, and the underfloor heating system with 56.65%. It is clear that the selection between different heating/ cooling systems can have a great impact on the energy flexibility of the grid system.

Purpose. To compare the thrombosis markers for thrombosis and fibrinolysis in patients undergoing hip versus knee arthroplasty. Methods. Seven women aged 38 to 61 years who underwent total hip arthroplasty (THA) and 7 women aged 57 to 67 years who underwent total knee arthroplasty (TKA) were studied. Thromboprophylaxis was given before and after surgery. In patients undergoing TKA, an automatic pneumatic tourniquet was used. Blood samples were drawn (1) before surgery (control value), (2) at wound closure (immediately before release of the tourniquet in TKA), and (3) 4 hours after surgery. Thrombosis markers (prothrombin fragment 1.2 [F1.2], plasmin/α2-antiplasmin complex [PAP], and D-dimer) of the 2 groups were compared. Results. The F1.2 level increased significantly at wound closure and remained elevated 4 hours after surgery in the THA group, whereas it was unchanged at wound closure but increased significantly 4 hours after surgery in the TKA group. The PAP level was constant peri- and post-operatively in the THA group, whereas it increased significantly 4 hours after surgery in the TKA group. The D-dimer level increased significantly at wound closure and 4 hours after surgery in the THA group, whereas it was unchanged at wound closure but increased significantly 4 hours after surgery in the TKA group. Conclusion. Systemic thrombin generation starts perioperatively in THA and after tourniquet deflation in TKA, indicating that wound blood must reach the systemic circulation to activate the relevant mediators.