Metalloptysis after bilobectomy for lung cancer: Case report and literature review
Bibliographic record
Abstract
A 73-year-old female who underwent a right upper and middle lobectomy for stage 1 adenocarcinoma of the lung in May 2014 was referred to our respiratory service two years later for expectoration of surgical clips. She presented with a 5-day history of cough, increased sputum production, chills and sore throat. While these symptoms were resolving without treatment, she began experiencing metalloptysis and expectorated 30 surgical clips. In this context, a bronchoscopy and a CT chest with contrast were performed. The bronchoscopy demonstrated a normal surgical stump, no evidence of dehiscence, and absence of surgical clips noted in the airways. Imaging revealed air bubbles at the level of the surgical stump. Metalloptysis is an uncommonly described phenomenon meaning expectoration of surgical clips. Its management is uncertain in the literature. It has most commonly been described with thoracic surgery involving a bovine pericardium staple line in the lung, abnormal lung parenchyma or pulmonary infection. It has, however, been reported in one patient without evidence of underlying infectious process or lung parenchymal abnormalities. The majority reported late metallotypsis, whereas 2 cases were quite early in the postoperative course (in 30 days). This review has guided us to consider that the management of metalloptysis should include adequate imaging (CT chest) and a bronchoscopy. The aim is to eliminate a source of infection or other parenchymal abnormalities. Patients should be re-assured that expectoration of clips will not necessarily affect the surgical stump. Furthermore, the instances of metalloptysis may be understated in the literature.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.007 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".