Risk factors for post-acute sequelae of COVID-19 in hospitalized patients: An observational study based on a survey in a tertiary care center in Türkiye.

Introduction: Long COVID is a multisystem disease with various symptoms and risk factors. We aim to investigate the post-acute sequelae of COVID-19 and related risk factors in a tertiary care center. Materials and Methods: In this observational study, based on a survey of 1.977 COVID-19 patients hospitalized from April 2020 to January 2021, a retrospective assessment was carried out on 1.050 individuals who were reachable via telephone to determine their eligibility for meeting the inclusion criteria. Results: The data of 256 patients who reported at least one persistent symptom were analyzed. Long COVID prevalence was 24.3%. Among 256 patients (median age 52.8; 52.7% female; 56.63% had at least one comorbidity), dyspnea, fatigue, arthralgia-myalgia, cough, and back pain were the most common post-acute sequelae of COVID-19 (42.4%; 28.29%; 16.33%; 13.15% and 7.17%, respectively). The risk factors for the persistence of dyspnea included having lung diseases such as chronic obstructive pulmonary disease, a history of intensive care support, the requirement for long-term oxygen therapy, and a history of cytokine storm (p= 0.024, p= 0.026, p< 0.001, p= 0.036, p= 0.005, respectively). The correlation between lung involvement with post-discharge cough (p= 0.041) and dizziness (p= 0.038) was significant. No correlation between the symptoms with the severity of acute infection, age, and gender was found. When a multivariate regression analysis was conducted on the most common long COVID-related symptoms, several independent risk factors were identified. These included having lung disease for dyspnea (OR 5.81, 95% CI 1.08-31.07, p= 0.04); length of hospital stay for myalgia (OR 1.034, 95% CI 1.004-1.065, p= 0.024); and pulmonary involvement of over 50% during COVID-19 infection for cough (OR 3.793, 95% CI 1.184-12.147, p= 0.025). Conclusion: COVID-19 survivors will require significant healthcare services due to their prolonged symptoms. We hope that our findings will guide the management of these patients in clinical settings towards best practices.

Relationship between chest computed tomography findings and clinical conditions of coronavirus disease (COVID-19): A multicentre experience.

AIMS: This study aimed to investigate the clinical and chest computed tomography (CT) features associated with clinical parameters for coronavirus disease (COVID-19) in the capital of Turkey, Ankara. MATERIALS AND METHODS: Epidemiological, clinical features, laboratory findings and radiological characteristics of 1563 hospitalised patients with COVID-19 in Ankara were collected, reviewed and analysed in this study. The risk factors associated with disease severity were investigated. RESULTS: Non-severe (1214; 77.7%) and severe cases (349; 22.3%) were enrolled in the study. Compared with the non-severe group, the severe group were significantly older and had more comorbidities (ie, hypertension, diabetes mellitus, cardiovascular disease and chronic kidney disease). Smoking was more common in the severe group. Severe patients had higher respiratory rates and higher incidences of cough and dyspnoea compared with non-severe patients. Compared with the non-severe patients, the severe patients had increased C-reactive protein (CRP), procalcitonin, neutrophil to lymphocyte ratio (NLR) and CRP/albumin ratio and decreased albumin. The occurrence rates of consolidation, subpleural sparing, crazy-paving pattern, cavity, halo sign, reversed halo sign, air bronchogram, pleural thickening, micronodule, subpleural curvilinear line and multilobar and bilateral involvement in the CT finding of the severe patients were significantly higher than those of the non-severe patients. CONCLUSIONS: Many factors are related to the severity of COVID-19, which can help clinicians judge the severity of the patient and evaluate the prognosis. This cohort study revealed that male sex, age (≥55 years), patients with any comorbidities, especially those with cardiovascular disease, dyspnoea, increased CRP, D-dimer and NLR, and decreased lymphocyte count and CT findings of consolidation and multilobar involvement were predictors of severe COVID-19.

Factors affecting patients' comfort during fiberoptic bronchoscopy and endobronchial ultrasound.

OBJECTIVE: This study investigated the factors that can affect the comfort of patients who underwent diagnostic fiberoptic bronchoscopy (FOB) and diagnostic endobronchial ultrasonography (EBUS) for the first time and the effect of the patients' anxiety level on their comfort during the procedure. MATERIALS AND METHODS: We recorded the demographics of the patients, the medications they used previously, the anesthesia applied during the procedure, the experience of the operator, the insertion technique of the bronchoscope, the types of the bronchoscopic interventions during the procedure, the duration of the procedure, and the anxiety levels of the patients before the session. Patients' discomfort level before and after the procedure and anxiety levels before the procedure were evaluated using a visual analog scale (VAS), and willingness for repeating FOB and EBUS was assessed using a questionnaire. RESULTS: We found that longer examination time, higher anxiety level before the procedure, the nasal insertion of bronchoscope, and higher number of interventions are related to the increased discomfort during FOB and EBUS. Patients' willingness for repeating FOB and EBUS increased as the level of discomfort decreased during the procedure. CONCLUSION: The patient's anxiety level should be determined using a questionnaire before the FOB and EBUS procedures, and the operator should adjust their procedure according to the patients' anxiety level.

Total lesion glycolysis by 18F-FDG PET/CT is independent prognostic factor in patients with advanced non-small cell lung cancer.

BACKGROUND AND AIMS: To determine whether the primary tumor SUVmax and total lesion glycolysis (TLG) measured on 18 F-FDG PET/CT have prognostic significance in patients with non-small-cell lung cancer (NSCLC). METHODS: A retrospective review identified 142 patients NSCLC who underwent 18 F-FDG PET/CT at the time of diagnosis. The affect of the SUVmax and TLG of the primary tumor on survival were examined. RESULTS: Total 142 patients were included the study. Thirty-two patients were at early stage (stage I and II) and 110 patients were at advanced stage (stage III and IV). Both early and advanced stage patients were divided into two groups according to SUVmax 12 as low and high SUVmax groups. Overall survival (OS) of the low SUVmax group was significantly longer than higher SUVmax group for early-stage patients (35.8 ± 15.3 vs 21.8 ± 13.3, P = 0.013). But there was no differences in advanced stage patients for OS (16.1 ± 14.8 vs 17.0 ± 15.1, P = 0.862). Primary lesion TLG of the 99 patients were calculated. For advanced stage, the patients with the lower TLG had significantly longer survival time (P < 0.001). In multivariate analysis only TLG remained significant predictor of OS in advanced stage patients (HR and 95% confidence interval = 7.716 and 1.664-4.342, respectively). CONCLUSION: High SUVmax is related to poor OS in patients with surgically resected early stage (stage I and II) NSCLC, but it is not an independent prognostic factor. TLG is a prognostic measurement and it is independent predictor factor of survival for advanced stage NSCLC.

[Lung cancer and intensive care: which patient how long?] / Akciger kanseri ve yogun bakim: hangi hasta ne kadar?

Lung cancer still remains the leading cause of cancer death among all the cancer types. Early diagnosis is the most important factor for efficient treatment and disease management. Nowadays, several new methodologies are being used in clinical practise for diagnosis, staging and treatment of disease. Therefore, survival is prolonged even in patients who are not eligible for surgery. This has led to increase in the acceptance of lung cancer patients in intensive care units (ICU) due to both the disease and the treatments applied and also due to the comorbidity of the patients. However, it is unclear which lung cancer patient will benefit from intensive treatment. In this review, we shared the ICU admission reasons and prognosis of the early stage and advanced stage lung cancer patients and when these patients were referred to ICU and treatment modalities in ICU were discussed.

Hospitalization costs of lung cancer diagnosis in Turkey: Is there a difference between histological types and stages?

INTRODUCTION: To establish the direct costs of diagnosing lung cancer in hospitalized patients. MATERIALS AND METHODS: Hospital data of patients who were hospitalized and diagnosed as lung cancer between September 2013 and August 2014 were retrospectively analyzed. Patients who underwent surgery for diagnosis and who were initiated with cancer treatment during the same hospital stay were excluded from study. Histological types and stages of lung cancer were determined. Expenses were grouped as laboratory costs, pathology costs, diagnostic imaging costs, overnight room charges, medication costs, blood center costs, consumable expenditures' costs and inpatient service charges (including consultants' service, electrocardiogram, follow-up, nursing services, diagnostic interventions). RESULT: Of the 68 patients, 55 (81%) had non-small cell lung cancer (NSCLC), 13 (19%) had small cell lung cancer (SCLC). 47% of patients with NSCLC had stage 4 disease and 86% of patients with SCLC had extensive stage disease. Median total cost per patient was 910 (95% CI= 832-1291) Euros (€). Of all costs, 37% were due to inpatient service charges and 22% were medication costs. Median total cost per patient was 912 (95% CI= 783-1213) € in NSCLC patients and 908 (95% CI= 456-2203) € in SCLC patients (p> 0.05). In NSCLC group, total cost per patient was 873 (95% CI= 591-1143) € in stage 1-2-3 diseases and 975 (95% CI= 847-1536) € in stage 4 disease (p> 0.05). In SCLC group total cost per patient was 937 € in limited stage and 502 (95% CI= 452-2508) € in extensive stage (p> 0.05). CONCLUSIONS: There is no significant difference between costs related to diagnosis of different lung cancer types and stages in patients hospitalized in a university hospital.

Comparison of Single Agent Gemcitabine and Docetaxel in Second-Line Therapy for Advanced Stage Non-Small Cell Lung Cancer in a University Hospital in Turkey.

PURPOSE: To compare the efficacy and toxicity of gemcitabine versus docetaxel in a second-line setting of nonsmall cell lung cancer (NSCLC) patients previously treated with platin-based combination chemotherapy. MATERIALS AND METHODS: We retrospectively evaluated the medical records of 57 patients treated with single agent gemcitabine or docetaxel in second-line setting of advanced NSCLC who received one prior platinum-based therapy. RESULTS: The mean age was 56.7 ± 8.39 years with 55 ( 96.5%) males and two (3.5%) females. Forty of them received docetaxel and 17 gemcitabine. The mean number of chemotherapy cycles was 6.8 ± 4.0 in the gemcitabine group, while it was 4.6 ± 3.0 in the docetaxel group. Overall response rates were 8% and 12% (P=0.02) for gemcitabine and docetaxel, respectively. The median survival time was 22 versus 21 months for gemcitabine and docetaxel, respectively. The median times to progression were 8 and 5 months. There was no difference between the two groups in terms of incidence of adverse affects (40% vs 47.1%). All of the hematological side effects were grade 1/2. No major toxicity was encountered necessitating stopping the drug for either group. CONCLUSIONS: Treatment with gemcitabine demonstrated clinically equivalent efficacy with a significantly improved safety profile compared with those receiving docetaxel in the second-line setting for advanced NSCLC in this study. Based on these results, treatment with gemcitabine should be considered a standard treatment option for second-line NSCLC.

Tracheal Papilloma Treated with Cryotherapy and Interferon-α: A Case Report and Review of the Literature.

Tracheal papilloma (TP) is characterized by papillomatous growth of the bronchial epithelium that involves the trachea as a response to Human Papilloma Virus (HPV) infection. A 40-year-old male, with 3-month history of progressive dyspnea was admitted to our hospital, and there were no any other respiratory symptoms. Physical examination was unremarkable. Chest computed tomography (CT) showed that there was a papillomatous mass at the distal trachea. The lesion occupied 80% of tracheal lumen. This patient received cryotherapy and mechanical debridement under general anesthesia and postoperative pathology showed endotracheal papillomatosis. Patient was treated with interferon-α (IFN-α) and he showed no recurrence at the 8th month of his therapy.

Patient and physician delay in the diagnosis and treatment of non-small cell lung cancer in Turkey.

AIM: The early diagnosis and treatment of lung cancer are important for the prognosis of patients with lung cancer. This study was undertaken to investigate patient and doctor delays in the diagnosis and treatment of NSCLC and the factors affecting these delays. MATERIALS AND METHODS: A total of 1016 patients, including 926 (91.1%) males and 90 (8.9%) females with a mean age of 61.5±10.1 years, were enrolled prospectively in this study between May 2010 and May 2011 from 17 sites in various Turkish provinces. RESULTS: The patient delay was found to be 49.9±96.9 days, doctor delay was found to be 87.7±99.6 days, and total delay was found to be 131.3±135.2 days. The referral delay was found to be 61.6±127.2 days, diagnostic delay was found to be 20.4±44.5 days, and treatment delay was found to be 24.4±54.9 days. When the major factors responsible for these delays were examined, patient delay was found to be more frequent in workers, while referral delay was found to be more frequent in patients living in villages (p<0.05). We determined that referral delay, doctor delay, and total delay increased as the number of doctors who were consulted by patients increased (p<0.05). Additionally, we determined that diagnostic and treatment delays were more frequent at the early tumour stages in NSCLC patients (p<0.05). DISCUSSION: The extended length of patient delay underscores the necessity of educating people about lung cancer. To decrease doctor delay, education is a crucial first step. Additionally, to further reduce the diagnostic and treatment delays of chest specialists, multidisciplinary management and algorithms must be used regularly.

Importance of serum SELDI-TOF-MS analysis in the diagnosis of early lung cancer.

BACKGROUND: Different methods of diagnosis have been found to be inefficient in terms of screening and early diagnosis of lung cancer. Cancer cells produce proteins whose serum levels may be elevated during the early stages of cancer development. Therefore, those proteins may be recognized as potential cancer markers. The aim of this study was to differentiate healthy individuals and lung cancer cases by analyzing their serum protein profiles and evaluate the efficacy of this method in the early diagnosis of lung cancer. MATERIALS AND METHODS: 170 patients with lung cancer, 53 under high risk of lung cancer, and 47 healthy people were included in our study. Proteomic analysis of the samples was performed with the SELDI-TOF-MS approach. RESULTS: The most discriminatory peak of the high risk group was 8141. When tree classification analysis was performed between lung cancer and the healthy control group, 11547 was determined as the most discriminatory peak, with a sensitivity of 85.5%, a specificity of 89.4%, a positive predictive value (PPV) of 96.7% and a negative predictive value (NPV) of 62.7%. CONCLUSIONS: We determined three different protein peaks 11480, 11547 and 11679 were only present in the lung cancer group. The 8141 peak was found in the high-risk group, but not in the lung cancer and control groups. These peaks may prove to be markers of lung cancer which suggests that they may be used in the early diagnosis of lung cancer.

[False positive 18F-FDG PET/CT findings mimicking malignant disease in patients with pneumoconiosis (due to three case reports)]. / Pnömokonyozlu hastalarda malign hastaligi taklit eden yanlis pozitif 18F-FDG PET/BT bulgulari (üç olgu nedeniyle).

Besides the risk of developing pneumoconiosis and chronic obstructive pulmonary disease, potential lung cancer risk may also increase due to exposure to silica and other carcinogens. Patients with hemoptysis symptom referred to our clinic depending on different forms of mass images in their thorax computerize tomography (CT) scan with the suspicion of coal-worker pneumoconiosis and lung cancer were hospitalized for investigation and treatment. The results of routine tests, sputum acid-fast bacilli and sputum cytology were evaluated as normal. PET/CT was ordered from patients for identifying malignancy. In PET/CTs of the patients, a pathological level of 18F fluorodeoxyglucose uptake was identified in different forms of mass images observed previously in thorax CTs. All the pathological specimens obtained by fiberoptic bronchoscopic biopsy and/or by mediastinoscopy were reported as benign. We aimed to present three pneumoconiosis patients with false positive PET/CT findings in the light of relevant literature. As a result, we thought that pneumoconiosis must be in mind also when considering about false positive results of PET/CT.

[The effect of adhesion molecule CEACAM1 and chemokine receptor CXCR4 expression on prognosis of non-small cell lung cancer patients]. / Küçük hücreli disi akciger kanserli hastalarda adezyon molekülü CEACAM1 ve kemokin reseptörü CXCR4 ekspresyonunun prognoz üzerine olan etkisi.

Poor prognosis in the lung cancer result from early metastatic potential of the tumoral cells. The mechanisms of tumoral cell metastasis are complex. Adhesion molecules play an important role in metastatic process, which is cell-to-cell and cell-to-matrix interactions and chemokins which arrange the migration and growth of the cells are also important in metastatic biology. The aim of this study is to investigate the prognostic relevance of carcinoembrionic antigen cell adhesion molecule 1 (CEACAM1) and chemokine receptor CXCR4 expression in patients with non-small cell lung cancer (NSCLC). Using immunohistochemical analysis, we evaluated CEACAM1 and CXCR4 expression in parafine specimens from 50 patients with NSCLC confirmed histopathologically and the relationship between CEACAM1 and CXCR4 expression and the prognosis. Twenty-one (42%) patients were positive and 29 (58%) were negative for CEACAM1 expression. Patients whose tumors had CEACAM1-positive staining had a shorter duration of survival than patients whose tumors had no expression, but it was not significant statistically [8.93 ± 8, (median: 8) vs 12.3 ± 11.3, (median: 9), p> 0.36]. Twenty-three (46%) patients were positive and 27 (54%) were negative for CXCR4 expression. Patients whose tumors had CXCR4-positive staining had a longer duration of survival than patients whose tumors had no expression, but it was not significant statistically [12.8 ± 12.4, (median: 12) vs 9.3 ± 7.6, (median: 8), p> 0.14]. In conclusion, CEACAM1 and CXCR4 played a part in metastatic process in lung cancer may not affect on survival independently. The biologic mechanisms leading to the spread of tumor cells are complex and related multifactoriel process.

Polymorphisms in the vitamin D receptor gene and risk of lung cancer.

BACKGROUND: Differences between the individual variations in DNA may modulate lung cancer process. Many studies reported that Vitamin D Receptor (VDR) gene polymorphisms may influence the cancer risk due to their antiproliferative, antiangiogenic, antimetastatic and apoptotic effects. MATERIAL/METHODS: The genotype and haplotype frequencies of three polymorphisms of VDR, i.e. TaqI (rs731236), BsmI (rs1544410), and ApaI (rs7975232), were studied using PCR-RFLP in 137 patients with lung cancer and 156 controls. RESULTS: Differences were observed in genotype (P=0.024) and allele (P=0.011) frequencies of TaqI polymorphism due to the "T" allele. Furthermore, compared with the "tt" genotype, the odds ratio for the "TT" genotype increased 2.24 times (95%CI=1.05-4.77, P=0.037). Comparing cases and controls, smoking habit (P=0.012) and gender distribution (P=0.005) were found to increase the risk of lung cancer in patients with "TT" homozygotes, demonstrating the role of gene-environment interaction in lung cancer. In addition, when age and gender within the case group only were evaluated in relation to genotype, the adjusted odds ratios for the "TT" genotype increased 2.20 times (95%CI=1.01-4.78, P=0.047) for age and 2.24 times (95%CI=1.05-4.80, P=0.037) for gender. However, no differences were observed for the distribution of variant genotypes of the BsmI and ApaI polymorphisms (P>0.05). To evaluate the joint effects of these polymorphisms, haplotype analysis was performed which showed that the haplotype baT was associated with higher lung cancer risk compared with the most common haplotype BAt (P=0.026). CONCLUSIONS: This is perhaps the first study suggesting that TaqI polymorphism of the VDR gene might be a risk factor for lung cancer and that age, gender, and smoking habit could have an impact on lung cancer risk.

Genetic variations in the hypoxia-inducible factor-1alpha gene and lung cancer.

Hypoxia-inducible factor-1 (HIF-1), an important genetic component of angiogenesis, becomes stable as a response to tumor hypoxia and facilitates tumor survival. The polymorphisms of the HIF-1alphagene may cause changes in the activity of this protein, which serves as a transcription factor for many genes in tumorigenesis. In this study, we have investigated the relationship between seven HIF-1alphapolymorphisms [C > T substitution in intron 8 (rs10873142), T418I (rs41508050) in exon 10, P564P (rs41492849), L580L (rs34005929), P582S (rs11549465), A588T (rs11549467) in exon 12 and dinucleotide GT repeats in intron 13 (rs10645014)] among lung cancer patients in the Turkish population. Genomic DNA was isolated from 141 lung cancer cases and 156 controls and subjected to PCR for amplification. Genotyping was carried out with RFLP and DNA sequencing methods. There was no significant difference between the lung cancer cases and controls in terms of the distribution of genotyping frequencies of seven HIF-1alphapolymorphisms (P > 0.05). No significant relationship was found between the C > T substitution in intron 8 and P582S haplotypes and development of lung cancer. In addition, there were no significant associations between the genotypes and clinopathological characteristics of the cases examined. These findings show that polymorphisms in the HIF-1alphagene do not confer susceptibility to lung cancer.

[Approach for the interventional bronchoscopic treatment methods applied in tracheobronchial obstruction]. / Trakeobronsiyal obstrüksiyonlarda uygulanan girisimsel bronkoskopik tedavi yöntemlerinde yaklasim.

Bronchoscopy used commonly in the diagnosis and staging of the lung cancer was applied successfully in the palliative treatment of the patients with lung cancer. The patients with tracheobronchial obstruction may develop many symptoms like dyspnea, cough and haemoptysis, and atelectasis and pneumonia but these symptoms were recovered with applying interventional bronchoscopic methods. These methods are laser therapy, electrocautery, argon plasma coagulation, cryotherapy, brachytherapy, photodynamic therapy and airway stents. The obstructed airway was reopened by these bronchoscopic methods and dyspnea, atelectasis and post-obstructive pneumonia were relieved. In addition, with establishment of the airway patency, chemotherapy and/or radiotherapy may be applied to the patients with lung cancer. The treatment of tracheobronchial obstruction was achieved a thorough evaluation of the etiology, physiology, diagnostic and treatment options of the disease and a multidisciplinary team approach including anesthesiology, medical oncology, thoracic surgery, radiology and interventional pulmonology. In this multidisciplinary team approach, all of the doctors dealing with the diagnosis and treatment of lung cancer should know interventional bronchoscopic methods, endobronchial treatment, and indications of these procedures. The aim of this review is to fresh our knowledge about the interventional bronchoscopic treatment methods in patients with lung cancer.

Polymorphisms in the aurora-A gene is not associated with lung cancer in the Turkish population.

Lung cancer, a complex neoplasm of lung tissue, is influenced by several environmental and genetic factors which could be changed in each individual. Aurora-A gene is related to mitotic events such as: chromosome instability, cell cycle regulation, spindle formation, and kinetechore-microtubule connections. This centrosomic serine/threonine kinase provides a strong connection between mitotic errors and carcinogenesis. The genomic alterations such as single nucleotide polymorphisms (SNPs) can exist in molecular pathways of lung cancer. Therefore, we evaluated the role of genetic polymorphisms of Aurora-A gene in the lung cancer in the Turkish population. Genotypes of five Aurora-A polymorphisms (F31I, V57I, 6328G/A, P50L, and S104L) were determined in 102 healty controls and 102 new diagnosed lung cancer cases. All samples were genotyped with DNA sequence technique. There were not any genotype variations in P50L, S104L, and 6328G/A polymorphisms. The frequencies of both genotypes F31I and V57I in lung cancer patients were not significantly different from those in controls (p > 0.05). A multivariable logistic regression analysis including patient characteristics, such as age and gender, did not change the results.

An occult foreign body aspiration with bronchial anomaly mimicking asthma and pneumonia.

Foreign body aspiration has a wide range of outcomes, including immediate resolution, acute asphyxia, recurrent pulmonary disease and death. A 52-year-old man was misdiagnosed with asthma and pneumonia for 6 months. A thoracic computed tomography (CT) scan showed an endobronchial lesion in the right main bronchus. Fiberoptic bronchoscopy was performed and the teeth were detected in the right main bronchus, in addition to tracheal bronchus. Aspirated teeth were removed using a rigid bronchoscope under general anesthesia. The patient having a trauma should always be carefully and systematically examined for foreign bodies. A rapid diagnosis depends on high clinical suspicion, clinical signs and radiological findings and the clinician must be aware of all complications of foreign body aspiration.

[Factors affecting the prognosis in patients with primary lung cancer and brain metastases]. / Beyin metastazi bulunan primer akciger kanserli hastalarda prognozu etkileyen faktörler.

Brain metastases are frequent features during the course of patients with lung carcinoma. The aim of this study was to investigate prognostic factors for patients with brain metastasis from lung cancer. Eighty-eight patients with brain metastasis from lung cancer were enrolled in the study. Eighty-two of cases were male, six were female and the mean age was 57.5 +/- 10.4 years. The most common symptoms were headache (32.9%) and dizziness (32.9%). Fifty-two (59.1%) patients had solitary brain metastasis and the most frequent metastasing site was parietal lobe (34.1%). The median survival times were 3 months after diagnosis of lung carcinoma and 1.5 months after diagnosis of brain metastasis. Although the absence of brain metastasis at the moment of diagnosis, metachronous metastasis, central localization of the tumour, chemotherapy administration and surgical treatment of brain metastasis are good prognostic factors affecting survival after the diagnosis of lung carcinoma, the positive factors affecting survival after brain metastasis are central localization of tumour, chemotherapy administration and surgical treatment of brain metastasis. In conclusion, performing the combination of cranial radiotherapy, chemotherapy, surgical therapy and supporting therapy should be evaluated in all appropriate patients with brain metastasis from lung cancer.

[Airway inflammation and lymphocyte subset analysis in patients with chronic obstructive pulmonary disease and healthy smokers]. / Stabil kronik obstrüktif akciger hastaligi olan hastalar ile sigara içenlerde hava yolu inflamasyonu ve lenfosit alt tiplerinin analizi.

Chronic airway inflammation is reported to have an important role for the development of chronic obstructive pulmonary disease (COPD), in addition to smoking, genetic and environmental factors. The present study was aimed to investigate whether the airway inflammation differed in subjects with stable COPD and healthy smokers. A total of 35 subjects (18 patients with COPD and 17 healthy smokers) were enrolled in this study. Bronchoalveolar lavage (BAL) was performed via fiberoptic bronchoscope in all subjects and cell counts and profiles and lymphocyte subset were analyzed in BAL fluids. The number of neutrophils in BAL of subjects with stable COPD was significantly higher than that of the healthy smokers (p< 0.001), and the number of macrophages was significantly lower than that of the healthy smokers (p< 0.001). Although CD4+ T:CD8+ T lymphocyte ratio was higher in healty smokers, the difference was not significant (p> 0.05). As a result, the most marked cellular change in BAL of subjects with stable COPD is the increase in neutrophils and decrease in macrophages, suggesting a very important role in the chronic airflow limitation.