Assessment of Palliative Care in Lung Cancer in Turkey.

OBJECTIVE: To investigate the symptoms of lung cancer in Turkey and to evaluate approaches to alleviate these symptoms. SUBJECTS AND METHODS: This study included 1,245 lung cancer patients from 26 centers in Turkey. Demographic characteristics as well as information regarding the disease and treatments were obtained from medical records and patient interviews. Symptoms were evaluated using the Edmonton Symptom Assessment Scale (ESAS) and were graded on a scale between 0 and 10 points. Data were compared using the χ2, Student t, and Mann-Whitney U tests. Potential predictors of symptoms were analyzed using logistic regression analysis. RESULTS: The most common symptom was tiredness (n = 1,002; 82.1%), followed by dyspnea (n = 845; 69.3%), appetite loss (n = 801; 65.7%), pain (n = 798; 65.4%), drowsiness (n = 742; 60.8%), anxiety (n = 704; 57.7%), depression (n = 623; 51.1%), and nausea (n = 557; 45.5%). Of the 1,245 patients, 590 (48.4%) had difficulty in initiating or maintaining sleep. The symptoms were more severe in stages III and IV. Logistic regression analysis indicated a clear association between demographic characteristics and symptom distress, as well as between symptom distress (except nausea) and well-being. Overall, 804 (65.4%) patients used analgesics, 630 (51.5%) received treatment for dyspnea, 242 (19.8%) used enteral/parenteral nutrition, 132 (10.8%) used appetite stimulants, and 129 (10.6%) used anxiolytics/antidepressants. Of the 799 patients who received analgesics, 173 (21.7%) reported that their symptoms were under control, and also those on other various treatment modalities (dyspnea: 78/627 [12.4%], appetite stimulant: 25/132 [18.9%], and anxiolytics/antidepressants: 25/129 [19.4%]) reported that their symptoms were controlled. CONCLUSION: In this study, the symptoms progressed and became more severe in the advanced stages of lung cancer, and palliative treatment was insufficient in most of the patients in Turkey.

Predictive value of optical nerve sheath diameter to Eyeball Transverse Diameter ratio on mortality of head trauma.

OBJECTIVE: Optic nerve sheath diameter (ONSD) and Eyeball Transverse Diameter (ETD) can be measured to determine cranial pressure due to intracranial injury. The study aimed to measure the diagnostic potential of ONSD and ETD to predict mortality in head traumas. PATIENTS AND METHODS: This cross-sectional study included 483 patients who applied to the emergency department with head trauma and analyzed characteristics, Rotterdam Computed Tomography Score (RCTS), Glasgow Coma Score (GCS), ETD, and ONSD. ONSD was calculated from 3 mm proximal to the optic disc in the section by tomography and manually divided to ETD to generate ONSD/ETD (Index). RESULTS: GCS, RCTS, ONSD (right: R; left: L), and Index (right: R; left: L) indicated a significant difference between mortal and non-mortal trauma (p < 0.001). In ROC analysis of the mortality prediction for the ONSD-R, the sensitivity and the specificity were 83.3% and 57.1% (p = 0.001), while those were 91.7% and 68.2% for ONSD-L (p = 0.0001). In Index-R, the sensitivity and specificity were 74% and 84.5% (p = 0.0001), while those were 75.2% and 85% for Index-L (p = 0.0001). CONCLUSIONS: The index, which can be measured easily by the proportion of ONSD and ETD at admissions to Emergency Departments by CT, can provide crucial information to physicians in predicting the mortality of patients with head trauma.

Vascular endothelial growth factor gene +813CC polymorphism of foetus is associated with preterm labour but not with pre-eclampsia in Turkish pregnant women.

We investigated the effect of polymorphism at +813 locus of vascular endothelial growth factor (VEGF) gene on predisposition to preterm labour and pre-eclampsia (PE). We examined polymorphism of the VEGF +813 gene of foetuses from umbilical cord blood in 31 cases of preterm labour, 34 pre-eclamptic and 58 healthy term labour. VEGF +813 gene polymorphisms were studied using a polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) analysis. In preterm group, foetal CC genotype was found at 80.6%, and CT genotype was seen at 19.4%. No any TT genotype was detected in preterm group. CC genotype of VEGF 813 gene was significantly more frequent than CT genotype (P = 0.04). Foetuses with CC genotype VEGF+813 gene have an increased risk for preterm labour. C allele frequency was 90.3 and 76.7% in preterm and control groups, respectively. T allele frequency was 9.7 and 23.3% in preterm and control groups, respectively. C allele was significantly associated with preterm labour (P = 0.02). OR of C and T alleles for preterm labour was 2.8 (CI: 1.1-7.2). In PE group, foetal CC genotype of +813 locus was found in 67.6%, and CT genotype was seen in 29.4%. Only one TT genotype was detected in 2.9% of PE group. There was no association between PE and VEGF gene genotypes and alleles at +813 locus. These results suggest that foetal VEGF gene polymorphism of +813 CC seems to be highly associated with preterm labour, whereas in PE, foetal VEGF gene polymorphism at +813 locus is not related. Especially, C allele was significantly associated with preterm labour. Carriage of the +813C allele of the VEGF gene has been found 2.8 times increased susceptibility to the development of preterm labour in Turkish women and may be an independent risk factor for prematurity. There was no association between PE and VEGF gene genotypes and alleles at +813 locus. We suggest to search for foetal aetiologies or genetic susceptibility in preterm labour, whereas in PE, not foetal, but maternal susceptibility is to be investigated.

Coronary artery calcifications in hemodialysis patients and their correlation with the prevalence of erectile dysfunction.

INTRODUCTION: Our aim in this study was to investigate the prevalence and correlation with coronary artery calcium scores (CACS) and erectile dysfunction (ED) among hemodialysis patients. PATIENTS AND METHODS: Thirty-five male patients with chronic renal failure were selected to participate in this study. All patients underwent examinations for CACS using 16-channel multidetector computed tomography. The presence and severity of ED were determined by calculating the erectile function domain of the self-administered International Index of Erectile Function (IIEF). RESULTS: The patients' ages ranged from 22 to 78 with a mean of 51.6 years. The mean duration of hemodialysis was 75.7 months (range = 12 to 232). Twenty-six patients had a history of one or more systemic diseases. The prevalence of any level of ED was 82.9% for all hemodialysis patients, and severe ED, 40%. The CACS was significantly higher among patients with severe ED (P = .032). The IIEF-5 score was also shown to have a moderate negative correlation with the CACS (r = -.420, P = .012). Age, duration of hemodialysis, body mass index, diabetes mellitus, hypertension, coronary heart diseases, hyperlipidemia, thyroid disease, depression, tobacco consumption, and medication were not associated with the presence of ED (P > .05). CONCLUSION: ED is prevalent in hemodialysis patients. Although many possible factors contribute to ED, the severity of ED increases with greater CACS.

Mediastinal Thymolipoma: An Evaluation of the Clinical and Radiological Features and the Surgical Outcomes in 11 Cases

ABSTRACT Background: Thymolipoma is a rare benign tumour of the mediastinum, accounting for 2%-9% of all thymic tumours. Although many case reports have been published in the literature, few studies have analysed the clinical and radiological features and the surgical outcomes of this tumour. Objective: To evaluate the clinical and radiological features and the surgical outcomes of the patients with thymolipoma. Methods: We reviewed the records of the Pathology Department from the beginning of 2005 to the end of 2013. Results: We identified 11 patients with thymolipoma. There were eight male and three female patients. Their ages ranged from 27 to 72 years, with the mean age of 40 years. All patients described pulmonary or extrapulmonary symptoms. Two patients (18.2%) had myasthenia gravis. Chest X-ray was normal in four patients. Computed tomography of the thorax revealed a mass located in the anterior mediastinum in all patients. It showed fat attenuation in 4 of 11 patients (36.4%). Thymectomy was performed in all patients. The surgical approach was thoracotomy in five, sternotomy in four and video-assisted thoracic surgery in two patients. Thymolipomas ranged in size from 4 to 33 cm. One patient died 2 years after surgery. None of the remaining patients had evidence of recurrence on follow-up. Conclusion: Thymolipoma is a rare tumour of the thymus. It may be associated with myasthenia gravis. Surgical resection is the treatment of choice in the patients with thymolipoma. Complete surgical resection is the cure in most patients.

Combination of chemotherapy and recombinant interferon-alpha in advanced non-small cell lung cancer.

Some studies have shown that the combination of chemotherapy and interferon in non-small cell lung cancer (NSCLC) and other solid tumors is feasible and possesses antitumor activity. Our study was aimed at verifying whether the addition of recombinant human interferon alpha (rh-IFN alpha) to combined chemotherapy would be able to increase the response rate and survival of patients with NSCLC. Thirty-eight patients with previously untreated advanced NSCLC were evaluated in this study. Median age of patients was 57 years; performance status according to ECOG 0 and 1, 37 pts (97%); stage IIIB, 27 pts (71%); stage IV, 11 pts (29%). Histology was squamous cell carcinoma in 53%, adenocarcinoma 44% and large cell carcinoma 3%. Our schedule consisted of 80 mg/m2 cisplatin I.V., 100 mg/m2 etoposide I.V., 10 million U rh-IFN alpha IM and 10 million U rh-IFN alpha I.V. on first day of treatment, every 3 weeks. None of the patients had complete response. Partial response rate was 34%. Median response duration was 7 months (range 3-19 months), median survival time was 11 months (range 4-41 months). Twenty-nine percent of patients had grade 3 nausea and vomiting, 24% had grade 2 leucopenia, 5% had grade 2 cardiotoxicity, 2.6% had flu-like syndrome. According to these results, in advanced NSCLC, the addition of rh-IFN alpha did not increase the cisplatin-etoposide combined chemotherapy induced response rate and survival time.

Hemoptysis: a retrospective analysis of 108 cases.

A retrospective analysis of 108 patients admitted to the hospital for hemoptysis in the year 2000 was performed. The aim of the study was to clarify the etiologic distribution of hemoptysis and the relation of etiology to the severity and recurrence of it. Of the cases, 79 were men and 29 were women, and the mean age was 51.74 +/- 17.51. In 77 of the cases it was the first attack, while in 31 it was recurrent. According to the severity of hemoptysis, it was classified as "mild" (<30 cm3), "moderate" (30-100 cm3), "severe" (100-600 cm3) and "massive" (>600 cm3). Lung cancer was the leading cause of hemoptysis (34.3%) followed by bronchiectasis (25.0%), tuberculosis (17.6%), pneumonia (10.2%) and pulmonary embolism (4.6%). Statistical analysis by chi-square test revealed that most of the lung cancer patients had mild hemoptysis (odds ratio 3.5; P<0.05), and the most frequent etiology in recurrent hemoptysis was bronchiectasis (odds ratio 3.25; P=0.01). Most of the lung cancer patients were male (P=0.002). The two leading causes of hemoptysis in our study are similar to many previous reports. The high rate of tuberculosis in our study is probably due to the high prevalence of tuberculosis in our country.

Ifosfamide, cisplatin and etoposide (ICE) combined chemotherapy with recombinant human granulocyte colony-stimulating factor support in small cell lung cancer.

This study was aimed to evaluate the effect of ifosfamide, cisplatin and etoposide (ICE) combined chemotherapy in small cell lung cancer (SCLC), and to test the feasibility of adding recombinant human granulocyte colony-stimulating factor (rhG-CSF) to aggressive chemotherapy. Thirty consecutive, previously untreated, patients with SCLC (17 with limited disease and 13 with extensive disease) entered this study. The ICE regimen consisted of ifosfamide (I) 4 g/m2 i.v. with same dose mesna i.v. on first day, cisplatin (C) 25 mg/m2 i.v. on days 1 to 3 and etoposide (E) 100 mg/m2 i.v. on days 1 to 3. A total of 30 MU rhG-CSF i.v. were given from day 7 to 14 if WBC were lower than 3000 x 10(6)/L, neutrophils were lower than 1000 x 10(6)/L. Overall response (OR) rate was 93% with a complete response (CR) rate of 23%. Median survival was 12 months [95% confidence interval (CI): 11-14] and median response duration was 10 months [95% CI: 8-10]. Thirty-seven percent of patients had grade 3 neutropenia, 40% had grade 3 anemia, and 1% had grade 2 thrombocytopenia. Nonhematologic toxicity was mild with nausea and vomiting being the most common. RhG-CSF, which reduced leukopenic nadirs and shortened the neutropenic period, was also well tolerated. This chemotherapy protocol seems to be active, well tolerated and is currently being compared with various conventional chemotherapies.

Evaluation of pulmonary complications of radiotherapy in breast cancer patients.

PURPOSE: To study the early and late pulmonary complications of radiotherapy (RT) in patients with operated breast cancer who received postoperative RT. PATIENTS AND METHODS: Radiation pneumonia (RP) and radiation fibrosis (RF) rates were evaluated after 3 and 18 months from the end of RT, using the Radiation Therapy Oncology Group and the European Organization for the Research and Treatment of Cancer (RTOG/ EORTC) combined toxicity classification scale. Evaluation included physical examination, high resolution computed tomography (HRCT) of the thorax, and pulmonary function tests (PFTs). The incidence of RP and RF, the relationship between RP and RF and possible predisposing factors and the impact of RT on the PFTs were analyzed. RESULTS: Between December 2000 and March 2001 35 patients were included in the study. Due to several reasons 29 patients were evaluable for RP and 25 for RF. On the 3rd month post-RT, 17 (59%) patients developed RP. Three (18%) of the cases were grade 1, 13 (76%) grade 2 and 1 (6%) grade 3. One patient was radiologically diagnosed with early RF. When evaluated for RF, 9 (36%) of 25 patients were found to have RF. Four (45%) of them were grade 1, and 5 (55%) grade 2. FEV1, FEV1/FVC, VC, FVC values showed different degrees of decline on the 3rd month. The most prominent change occurred with DLCO/ VA ratio which decreased by 20%. On the 18th month, all values returned to at least the pretreatment levels. CONCLUSION: RT-induced RP and RF are quite frequent. As clinical findings are generally nonspesific, radiological findings of RP and RF should be known. Early and late effects on PFTs are generally mild and transient.

Prognostic factors in patients with small cell lung carcinoma.

BACKGROUND: The current prognosis in patients with small cell lung cancer (SCLC) is unsatisfactory, even though there have been considerable improvements in diagnosis and treatment. METHODS: We retrospectively analyzed all consecutive patients with small cell lung carcinoma between 1995 and 2007 in a Turkish chest hospital. A total of 116 SCLC patients initially presented with limited disease, while 92 small cell lung carcinoma patients were found to be extensive. RESULTS: The mean age of the patients (18 women and 190 men) was 56 years. The median survival was 74 weeks. Performance status, superior vena cava syndrome (SVCS), stage, elevated white blood cell count, elevated lactate dehidrogenase levels, short symptom duration (

Hepatotoxicity of antituberculosis therapy (rifampicin, isoniazid and pyrazinamide) or viral hepatitis.

SETTING: Department of Chest Diseases, Gazi University Faculty of Medicine and Atatürk Chest Diseases Hospital, Ankara, Turkey. OBJECTIVE: The primary purpose of this study was to assess the contributory role of viral hepatitis in antituberculosis drug hepatotoxicity. DESIGN: Serologic markers for viral hepatitis were studied in 57 patients who developed acute hepatitis during antituberculosis therapy with rifampicin and isoniazid. RESULTS: Among 705 adult tuberculous patients, 57 (8.1%) developed acute hepatitis during therapy with rifampicin and isoniazid. Serologic markers confirmed the presence of hepatitis B in 6 (10.5%) and hepatitis C in 4 (7%) of the 57 patients. Acute hepatitis A was not diagnosed in any of the patients. CONCLUSION: Hepatitis occurring during antituberculosis therapy may not be drug-induced in all patients. Apart from the other factors mentioned above the endemicity of viral hepatitis in developing countries could be responsible for the higher incidence of antituberculosis-drug hepatitis.