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Competing Interests: The authors report no conflict of interest.

Background  Hyperhidrosis is a dysfunction of the autonomic nervous system that results in regional excessive sweating, mostly in the hands, armpits, and feet. A permanent and effective treatment of hyperhidrosis can be achieved by interruption of the thoracic sympathetic chain with endoscopic thoracic sympathectomy (ETS). However, some side effects, particularly compensatory sweating (CS), are the limitations of this procedure. The mechanism of CS and the associated risk factors are still controversial. The aim of this retrospective study was to determine the relationship with various parameters associated with CS in patients undergoing ETS. Materials and Methods  ETS was performed on a total of 95 patients for palmar hyperhidrosis, axillary hyperhidrosis and facial blushing by the same surgeon. The mean age of the patients was 26.41 (± 7) years, and 54 (56.8%) were males. Palmar hyperhidrosis was present in 54 (56.8%) patients, axillary hyperhidrosis in 33 (34.7%) patients, and facial blushing in 8 (8.5%) patients. Moreover, 38 (40%) patients also had plantar sweating. The severity of CS was rated into three scales as less, moderate, and severe. Results  Regarding the severity of CS, 55 (57.9%) patients had no or less CS, 28 (29.5%) had moderate CS, and 12 (12.6%) patients had severe CS. Higher age group had a significant increased risk of severe CS ( p  = 0.03) ( r  = 0.262). Patients with body mass index (BMI) > 25 kg/m 2 had a statistically significantly increased risk of severe CS ( p  = 0.016). Facial blushing resulted in severe CS in a significantly higher proportion of patients than by palmar and axillary hyperhidrosis ( p  = 0.001). The level of surgery was another important risk factor for CS, with the T2 level showing an increased risk of severe CS compared with T3 level ( p  < 0.001). Furthermore, plantar sweating was inversely and significantly related to the development of CS. Patients with plantar sweating had a significantly decreased incidence of developing CS ( p  = 0.015). Conclusion  CS after thoracic sympathectomy for primary hyperhidrosis is the most displeasing and restrictive side effect. This study demonstrates that older age, operation level, facial blushing, and high BMI are risk factors for CS, as have been shown in several similar studies. An interesting finding of the present study is that there was a decreased incidence of CS among patients with plantar sweating. This situation may help us to distinguish high risk for CS before ETS operation., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (Georg Thieme Verlag KG Stuttgart · New York.)

Background: Lung cancer is the leading cause of cancer mortality in the world. Many factors can protect against or facilitate its development. A TNF family member TRAIL, has a complex physiological role beyond that of merely activating the apoptotic pathway in cancer cells. Vitamin D is converted to its active form locally in the lung, and is also thought to play an important role in lung health. Our goal was to investigate the possible clinical significance of serum sTRAIL and 1,25-dihydroxyvitamin D(3) levels in patients with non-small cell lung cancer (NSCLC)., Materials and Methods: Totals of 18 consecutive adenocarcinoma and 22 squamous cell carcinoma patients with stage-IV non-small cell lung cancer referred to our institute were included in this study. There were 12 men and 6 women, with ages ranging from 38 to 97 (mean 60.5) years with adenocarcinoma, and 20 men and 2 women, with ages ranging from 46 to 80 (mean 65) years with squamous cell carcinoma. Serum levels of sTRAIL and 1,25-dihydroxyvitamin D(3) were measured in all samples at the time of diagnosis., Results: sTRAIL levels in NSCLC patients were higher than in the control group. Although there was no correlation between patient survival and sTRAIL levels, the highest sTRAIL levels were correlated with age and cigarette smoking in the adenocarcinoma patients. sTRAIL level in healthy individuals were correlated with serum 1,25-dihydroxyvitamin D(3)., Conclusions: Serum sTRAIL concentrations were increased in NSCLC patients, and correlated with age and smoking history, but not with overall survival.

Sarcoidosis is a systemic disease characterized by noncaseating granulomas. Thyroid involvement is rare in sarcoidosis. In this paper, two sarcoidosis patients who demonstrated cold thyroid nodules are presented. A 42-year-old woman presented with multinodular goiter and was diagnosed as having sarcoidosis when noncaseating granulomas were observed during the pathological examination of the thyroidectomy specimen. Enlarged mediastinal lymph nodes were observed in the routine preoperative chest X-ray in another 53-year-old woman, while she was being prepared to undergo a thyroidectomy. The pathological examination of the thyroid specimens showed noncaseating granulomas in both patients, and the diagnosis was confirmed by either hepatic biopsy or chest X-ray findings. In conclusion, thyroid involvement should be suspected in sarcoidosis patients who present with cold nodules in the thyroid. Furthermore, if noncaseating granulomas are observed in thyroid specimens after a thyroidectomy in an otherwise healthy person, the patient should be evaluated further for sarcoidosis.

Background: Traumatic diaphragma rupturesare difficult to diagnose and generally with associated organe injuries. The aim ofthe study is to evaluate the factors effect on mortality., Methods: Twenty-three patients with traumatic diaphragma injuries, admitted to our hospital were retrospectively evaluated for demographics, diagnosis, otherorgan injuries, treatment, mortalityand morbidity., Results: All patients were male and the mean age was 24.7 10.0. The diaphragma injuries were observed during laparatomy in 19 patients (%82.6), during laparatomy and thoracotomy in 2 (%8.7). The injuries were diagnosed with fluid drainage from thorax tube during peritoneal lavage in 2 patients (%8. 7). All patients, but one, had other organ injuries (%95.7), most commonly in stomach, spleen and liver. Seven patients died during peroperative or postoperative peiod (%30.4). When these seven patients were compared to survived patients, it was observed that age and trauma score were statistically related to mortality rate (p<0.05), but the lenght ofthe diaphragmatic injury was not related to mortality rate (p > 0.05)., Conclusion: Traumatic diaphragma injuries are generally diagnosed during laparatomy and associated with other organ injuries. The high mortality rate in patients with traumatic diaphragma injuries, is not related to the characteristics ofthe diaphragma injury, but it is closely related to concomitant problems such as patient is age and trauma score.

We retrospectively evaluated 572 patients with thoracic trauma from total of 2163 trauma patients who admitted to 2nd General Surgery Emergency Service of Kartal Education and Research Hospital from January 1997 to February 2000. 501 of the patients (87.5%) were male and 71 (12.5%) were female. The range of ages 2-84 and mean age was 32.2. 337 (59%) patients had blunt and 235 (41%) had penetrating thoracic trauma. While traffic accidents (72%) were determined as the most common ethiological factor for blunt thoracic trauma, penetrating and cutting instruments injuries (82%) were the most common factor for penetrating thoracic trauma. Accompanying trauma were observed in 37.5% of cases. 332 (58%) tube thoracostomy, 185 (32.5%) conservative treatment, 41 (7.1%) thoracotomy 14 (2.4%) mechanical ventilation were carried out. The rates of mortality were 6.8% and of morbidity 3.3%. Early diagnosis and immediate appropriate treatment in thoracic trauma increases the survival.