Effect of symptom-to-treatment interval on prognosis in lung cancer.

AIMS AND BACKGROUND: To evaluate the relationship between delayed diagnosis and the degree of invasion and survival in lung cancer. METHODS: One hundred and three patients (96 men) with lung cancer were included. Stages in the diagnosis of lung cancer were classified as follows: symptom-to-doctor interval, i.e., the interval from the first symptoms related to the presence of lung cancer to the first consultation with a medical professional; doctor-to-diagnosis interval, i.e., the interval between the first medical visit and confirmation of the diagnosis; and diagnosis-to-treatment interval, i.e., the interval between diagnosis and complete TNM staging and treatment. The symptom-to-treatment interval (STI) was the sum of the 3 intervals. The degree of invasion was determined by the TNM classification. RESULTS: The patients were followed up for a mean period (= SD) of 7.4+/-8.7 months. Seventy-six (74%) patients were diagnosed with non-small cell lung cancer (NSCLC) and 27 patients (26%) with small cell lung cancer (SCLC). The mean length of STI was 120+/-101 days (median, 90). The mean length of the symptom-to-doctor interval was 63+/-62 days (median, 45), while the doctor-to-diagnosis and diagnosis-to-treatment intervals were 41 +/-82 days (median, 10) and 16+/-12 days (median, 12), respectively. When the STIs of the patients were correlated with tumor stage, tumor invasion, lymph node involvement and metastasis, no significant differences were found. Patients with an STI longer than 60 days had a significantly longer survival. Regarding the type of lung cancer and STI, the median survival was shorter in patients with an STI of less than 60 days both in NSCLC and SCLC, although this was not statistically significant in SCLC. CONCLUSIONS: The shorter the diagnostic interval, the shorter was the median survival in our study. The reason for the apparent discrepancy between poor prognosis of lung cancer patients in spite of early diagnosis might be much faster progression of the disease itself.

Hypobaric-hypoxia-induced pulmonary damage in rats ameliorated by antioxidant erdosteine.

Free radical-mediated injury to lung and pulmonary vasculature is an important mechanism in hypoxia-induced lung damage. In this study, we aimed to investigate the potential protective effects of erdosteine as an antioxidant agent on hypobaric hypoxia-induced pulmonary hypertension. Adult male rats were assigned randomly to three groups. The first group of rats was exposed to hypobaric-hypoxia and the second group was treated with erdosteine (20mg/kg, daily) for 2 weeks, during which time they were in a hypoxic chamber. These groups were compared with normoxic controls. All rats were sacrificed after 2 weeks. The hypoxia-induced increase in right ventricle to left ventricle plus septum weight ratio (from 0.20+/-0.01 to 0.26+/-0.01) was reduced significantly in the erdosteine-treated group (0.23+/-0.01). Malondialdehyde levels were elevated (from 0.33+/-0.11 to 0.59+/-0.02) and total antioxidant status was not changed significantly (from 1.77+/-0.42 to 2.61+/-0.23) by hypoxia. In contrast to the hypoxia-exposed group, malondialdehyde levels were significantly decreased in the erdosteine-treated group (0.37+/-0.02). Total antioxidant status (4.03+/-0.22) was significantly higher in erdosteine-treated rats when compared to non-treated rats. Histopathological examination demonstrated that erdosteine prevented inflammation and protected lung parenchyma and pulmonary endothelium of hypoxia-exposed rats.

Which patients are able to adhere to tuberculosis treatment? A study in a rural area in the northwest part of Turkey.

The purpose of this study was to investigate various factors, including demographical, socioeconomical, clinical and radiological features, of adherent and nonadherent patients with tuberculosis (TB) who were admitted to a university hospital between 1998 and 2003. One hundred and one patients (65.5%) and 53 patients (34.5%) met the criteria of adherence and nonadherence, respectively. A higher rate of adherence was observed among females than males (79.2 versus 58.4%, respectively, P = 0.012). Older patients were more nonadherent (P = 0.008). The adherence rate in non-smokers was significantly higher than that of smokers (81.4 and 52.4%, respectively, P = 0.000). Patients who underwent "family screening" were more adherent (75.7%) than those (39.5%) who did not (P = 0.000). Patients with pleurisy had higher adherence rates (81.3%), followed by patients with pulmonary TB (65.0%), while patients with extrarespiratory TB had the lowest adherence rates (45.5%) (P = 0.024). The presence of cough was significantly associated with adherence (P = 0.049). A significantly higher adherence rate was observed in patients without hemoptysis (P = 0001). A univariate logistic regression confirmed that age, smoking, family screening, type of TB, cough and hemoptysis had significant independent effects on the adherence to treatment of TB. High-risk patients may be identified and interventions tailored to promote adherence before concluding that the patient is willfully refusing treatment.

Relationship between arterial blood gas values, pulmonary function tests and treadmill exercise testing parameters in patients with COPD.

OBJECTIVE: There have been controversial reports regarding the relationship between exercise tolerance and resting pulmonary function in patients with COPD. The aim of this study was to examine the relationship between resting pulmonary function tests (rPFT) and cardiopulmonary exercise testing parameters (CETP) and their value in estimating exercise tolerance of patients. METHODOLOGY: In total, 45 patients with COPD (nine females, 36 males; mean age 61.2 +/- 11.2) and 21 healthy subjects (four females, 17 males; mean age 60.3 +/- 9.7) as a control group were studied. COPD patients (group I) were divided into three subgroups according to their FEV(1) (mild/group II: FEV(1) 60-79% of predicted; moderate/group III: FEV(1) 40-59%; severe/group IV: FEV(1) < 40%). In controls FEV(1) was >/= 80%. RESULTS: There were significant correlations between FEV(1) and CETP in group III (maximal O(2) consumption (mVO(2)), r= 0.35, P < 0.005; total treadmill time (TTT), r= 0.31, P < 0.01; total metabolic equivalent values (TMET), r= 0.29, P < 0.01)) and in group IV (mVO(2), r= 0.49, P < 0.001; TTT, r= 0.45, P < 0.005; TMET, r= 0.31, P < 0.01; peak heart rate (pHR), r= 0.29, P < 0.02; frequency of ventricular extrasystole (fVES), r=-0.27, P < 0.05). Additionally, in group IV there were significant correlations between PaO(2) and CETP (mVO(2), r= 0.41, P < 0.02; TTT, r= 0.38, P < 0.03; TMET, r= 0.31, P < 0.05; pHR, r= 0.29, P < 0.05; fVES, r=-0.28, P < 0.05). CONCLUSION: There are significant correlations of resting FEV(1)% predicted and PaO(2) values with CETP in patients with moderate and severe COPD and these parameters may also have a role as indicators of exercise tolerance in these COPD patients.

Effects of iohexol on ventilatory functions in patients undergoing diagnostic coronary angiography.

BACKGROUND AND OBJECTIVES: Adverse respiratory reactions have been reported with intravascular radiographic contrast media. The aim of the present study is to assess the effects of iohexol on pulmonary functions in patients undergoing diagnostic coronary angiography (CA). MATERIALS AND METHODS: 30 patients enrolled in the study. The respiratory functions of the patients were measured at three different stages during angiography (before, immediately after and 2 h later) and arterial blood gas analyses were performed at six stages during CA (before, immediately after the insertion of angiography catheter, 2 min after the injection of contrast agent, at the end of angiography, an hour and 2 h after angiography). A single, experienced angiographer performed the angiography procedures via radial artery route. Totally six multiple angled views of the left and right coronary arteries were recorded in all patients by hand injection. None of the patients were performed ventriculography. RESULTS: Angiography caused significant reduction in forced expiratory volume in 1 sec [FEV1] (from 103 +/- 15 to 95 +/- 17, p < 0.01), forced vital capacity [FVC] (from 99 +/- 13 to 95 +/- 18, p < 0.05) and maximum mid-expiratory flow rate [MMF] (from 95 +/- 33 to 84 +/- 29, p < 0.01) whereas there were no significant changes in the mean FEV1/FVC ratios at different stages of angiography. Statistically significant decrease in PaO2 (from 91 +/- 10 to 85 +/- 13 mmHg, p < 0.01) and arterial O2 saturation (from 97 +/- 1% to 96 +/- 1%, p < 0.01) were also observed. Data in present study showed a clinically insignificant but statistically significant restrictive impairment in pulmonary functions. CONCLUSIONS: Diagnostic CA using iohexol decreases ventilatory functions in a small but significant extent in patients without any overt pulmonary disease.