Lung cancer associated with a single simultaneous solitary metastatic lesion in stomach: a case report with the review of literature.

Metastatic tumors of the stomach are rare. Although neoplasms from almost every tissue have been reported to metastasize to the stomach, lung cancer is a rare cause. We report the case of 46-years-old man presented with superior Vena Cava syndrome. Histopathological diagnosis was non-small cell lung cancer with computed tomography-guided needle biopsy of lung. Since gastric symptoms occurred during follow up of patient, upper gastrointestinal endoscopy performed. Upper gastrointestinal endoscopy and biopsy showed metastasis of stomach secondary to primary squamous cell lung cancer and additionally lack of another distant site metastasis indicated that gastric region was the single site of tumor spread.

Observations on environmental asbestos exposure in a high risk area.

BACKGROUND AND OBJECTIVE: Environmental asbestos exposure is causally associated with various pulmonary pathologies. In Turkey, one of the most important sources of asbestos exposure is dust originating from the walls of homes whitewashed with white stucco. The main asbestos types implicated are tremolite and, to a lesser extent, chrysotile. This study investigated the presence and effect of environmental asbestos exposure in a small village in Isparta, Turkey. METHODS: Samples of asbestos mine ore, whitewashed plaster from the interior walls of the houses and whitesoil from the outside walls of the houses were analysed. Chest radiographs of 132 villagers aged 30 years and over and living in the village during the study were obtained. Verbal histories from the relatives of people who had died from lung cancer or mesothelioma and hospital records contributed 13 cases to the study population, giving a total of 145 cases under study. RESULTS: Chrysotile fibres were found in the old asbestos mine sample, and zeolite in the whitesoil sample from the outside walls. Abnormal CXR were found in 19 subjects (14. 4%), the most common being pleural calcifications and/or pleural plaques (n = 14, 10.6%). A further five subjects with pleural calcifications and/or pleural plaques were identified from verbal autopsy and hospital records. Malignant pleural mesothelioma was present in one living subject and four of the deaths. A possible familial clustering of lung cancer and malignant mesothelioma was noted. CONCLUSION: While tremolite asbestos is the asbestos found in most white soil in Turkey, in this village chrysotile asbestos was found in the white soil. Familial clustering may indicate genetic susceptibility or increased environmental exposure in some families.

Habitual snoring in primary school children: prevalence and association with sleep-related disorders and school performance.

OBJECTIVES: To determine the prevalence of habitual snoring (HS) and its association with both day- and nighttime symptoms, school performance and behavioral disturbances in a sample of primary school children. SUBJECTS AND METHODS: A cross-sectional study was performed on 1,605 children (819 boys and 786 girls) aged 7-13 years from 9 randomly selected primary schools located within the city limits of Isparta, Turkey. HS and sleep problems were assessed using a 55-item multiple-choice questionnaire. RESULTS: Of the 1,605 questionnaires, 1,164 were fully completed and returned, giving a response rate of 72.5%. The overall prevalence of snoring was 38.9%, while HS accounted for 3.5%. The prevalence of HS among boys (25, 3.0%) was higher than among girls (16, 2.0%; chi(2) for trend: p < 0.001, OR: 1.92, 95% CI: 1.01-3.66). There was an association between younger age and HS, as children aged 7-8 years had the highest prevalence (chi(2) for trend: 0.054, OR: 1.85, 95% CI: 0.81-4.22). Habitual snorers had more daytime and nighttime symptoms. Allergic symptoms, daytime mouth breathing, shaking the child for apnea, restless sleep and hyperactivity were significant and independent risk factors and sleep-related symptoms for HS. A significant and independent association was found between poor school performance and hyperactivity, nocturnal enuresis, tooth grinding and low parental/maternal education in multivariate analysis. CONCLUSION: Children with HS were more likely to have sleep-related daytime and nighttime symptoms. No significant associ- ation was determined between HS and poor school performance.

Gastroesophageal scintigraphy in the evaluation of adult patients with chronic cough due to gastroesophageal reflux disease.

OBJECTIVE: The aim of this study was to evaluate the findings of gastroesophageal scintigraphy (GES) with late lung imaging in adult patients with chronic cough due to gastroesophageal reflux disease and a group of healthy participants. METHODS: Fifty-five patients with chronic cough with reflux symptoms, and a control group of 12 healthy participants were examined. All patients had reflux esophagitis documented by upper gastrointestinal endoscopy and histology. All participants underwent laryngoscopic examination and GES. The correlation between gastroesophageal reflux and several related variables was evaluated. RESULTS: Overall, 51 patients (92.7%) had positive GES findings for pathologic reflux; 19 (37.2%) of these patients had proximal reflux; and the remaining 32 (62.7%) had distal reflux. The frequency, duration, and percentage volume of gastric content of reflux episodes were significantly greater in patients with proximal reflux than in patients with distal reflux (P<0.0001). No statistically significant differences were seen between proximal reflux and distal reflux patients in terms of pulmonary function parameters, duration of cough, and reflux symptoms scores. However, severe grade (B and C) of esophagitis and the posterior laryngitis were more common in the patients with proximal reflux. Late lung imaging demonstrated evidence of pulmonary aspiration in only three of 51 (6%) patients. CONCLUSION: Our study suggests that GES with late lung imaging objectively showed the presence of pathologic distal and/or proximal reflux, but rarely pulmonary aspiration, in the majority of chronic cough patients with gastroesophageal reflux disease. As the chronic cough patients with proximal reflux have more severe reflux characteristics, this examination may be effective in screening and following up these patients.

Investigation of pulmonary involvement in inflammatory bowel disease in an experimental model of colitis.

BACKGROUND/AIMS: Inflammatory bowel disease (IBD) may also involve various extra-intestinal organs. Clinical studies have found asymptomatic/symptomatic pulmonary involvement in 1% to 6% of patients with IBD. The present study histopathologically investigated pulmonary involvement in an experimental model of colitis in order to demonstrate pulmonary tissue involvement in IBD and to expose potential etiological factors. It also explored the relation between inflammation and tissue concentrations of vascular endothelial growth factor (VEGF) and tumor necrosis factor α (TNF-α). METHODS: The study comprised 24 male Wistar albino rats. The rats were divided into four groups of six rats each. Acute colitis was induced in two separate groups using either the dextran sulphate sodium (DSS) or trinitrobenzene sulfonic acid (TNBS) method, while the other two groups were used as controls for each model of colitis. Wallace scoring was used for macroscopic assessment of colitis, and the lungs were histopathologically examined. Concentrations of VEGF and TNF-α in pulmonary tissue were measured by the enzyme-linked immunosorbent assay method. RESULTS: The number of animals that had alveolar hemorrhage was significantly higher in the TNBS-induced colitis and DSS-induced colitis groups compared to their own control groups (p = 0.015 and p = 0.015, respectively). VEGF and TNF-α concentrations in pulmonary tissues were significantly increased in both the TNBS colitis and DSS colitis groups compared to their own control groups (p = 0.002 and p = 0.004, respectively; and p = 0.002 and p = 0.002, respectively). CONCLUSIONS: The present study demonstrated that significant and serious histopathological changes directly associated with colitis occur in the lungs in IBD.

Serum interleukin-6 levels correlate with malnutrition and survival in patients with advanced non-small cell lung cancer.

AIM: To investigate the level of interleukin-6 in advanced non-small cell lung cancer and to analyze the relationship with malnutrition and survival. METHODS AND STUDY DESIGN: Seventy-one newly diagnosed advanced non-small cell lung cancer patients were enrolled in this prospective study. Malnutrition was defined by using subjective global assessment. Performance status was assessed by the Karnofsky scale. Serum levels of albumin, transferrin, C-reactive protein, lymphocytes/mm3, lactate dehydrogenase and growth hormone were determined before treatment. The patients were followed, and the factors affecting survival were analyzed. RESULTS: The mean follow-up after diagnosis was 180 days. IL-6 levels increased in 48 (68%) of 71 patients. According to the subjective global assessment, 28 (39%) patients were well nourished and 43 (61%) were malnourished. Of the 43 malnourished patients, 29 (41%) were moderately malnourished or suspected of being malnourished and 14 (20%) were severely malnourished. The IL-6 level was related to impaired performance status (P = 0.0001), severe malnutrition (P = 0.004), increased C-reactive protein (P = 0.013), higher growth hormone (P = 0.025) and transferrin (P = 0.03) levels. On univariate analysis, impaired performance status, moderate and severe malnutrition, decreased serum albumin and transferrin, a raised IL-6 and lactate dehydrogenase levels were the significant prognostic factors for survival. Multivariate analysis indicated that a raised IL-6, severe malnutrition and a low serum level of albumin were independent prognostic factors for survival in patients with advanced non-small cell lung cancer. CONCLUSIONS: IL-6 secretion may play a role in the pathophysiology of malnutrition in advanced lung cancer. Results show a relation between elevated IL-6 serum levels and malnutrition, poor performance status, acute phase response and shorter survival in patients affected by advanced non-small cell lung cancer.

Risk factors associated with postoperative pulmonary complications following oncological surgery.

The purpose of our study was to determine the incidence of different postoperative pulmonary complications (PPCs) and their associated risk factors in patients who have undergone various elective surgical procedures in an oncological surgery center. Ninety five adult patients were studied prospectively for one year period. For the study group, predictors of pulmonary complications of interest were determined as age, gender, body mass index, co morbid conditions (preexisting history of chronic obstructive pulmonary disease, asthma, bronchiectasis, restrictive lung disease), site and type of the operation, smoking history, The American Society of Anesthesiologists (ASA) physical status, physical examination and chest X- Ray findings, pulmonary function tests, type and duration of anesthesia, surgical incision site and length and presence of nasogastric tube suction. The PPC rate of our study group was 40% (38/95). Atelectasis and bronchospasm were the most frequently observed PPCs (13.7%) Among all the risk factors taken into consideration, only three were found to be significant independent predictors of pulmonary complications according to multivariate analysis as follows: incision location concerning abdomen (p= 0.008), duration of anesthesia per hour (p= 0.0001), values of FEV1 < 50% (p= 0.007). Our data revealed that the incidence of PPCs was high in our study group when compared to results of general population. Application of major resection surgeries for cancer patients can be an explanation for this result. Shortening the duration of surgery, avoiding general anaesthesia in selected group of patients may reduce the risk of PPCs.

Is gastroesophageal reflux contribute to the development chronic cough by triggering pulmonary fibrosis.

BACKGROUND/AIMS: Previous studies have shown that the prevalence of abnormal acid reflux in fibrotic lung disease patients is high, and in particular, patients with secondary pulmonary fibrosis show higher esophageal acid exposure than normal controls. There are also some findings that, in patients with pathological reflux, pulmonary fibrosis may develop. The aim of this study is to investigate if pulmonary fibrosis is involved in the pathogenesis of chronic cough due to Gastroesophageal Reflux. MATERIALS AND METHODS: A prospective study was performed in twenty-one patients with chronic cough due to gastroesophageal reflux who was diagnosed as reflux esophagitis by upper gastrointestinal endoscopy, histology, and in ten healthy controls without GER or any lung disease. All participitants underwent laryngoscopic examination and gastroesophageal scintigraphy with late lung imaging. Bronchoalveolar lavage fluid total and differential cell counts, T and B cell subsets, and the concentrations of IL- 1ß and TNF-α were measured. RESULTS: Reflux extending into the proximal esophagus was noted in 52.5%, and posterior laryngitis was present in 90.5% of the patients. No evidence of pulmonary aspiration was noted in the patients with reflux on scintigraphic examination. No significant difference was found between the GER and control groups in terms of cellular content, IL-1ß and TNF-α levels or mean T cell subsets and B cell counts in bronchoalveolar lavage fluid. Forced expiratory volume in one second, forced vital capacity FEV1/FVC, total lung capacity, and carbon monoxide diffusion capacity values were within normal limits in the gastroesophageal reflux group. CONCLUSION: Our findings do not support the hypothesis that gastroesophageal reflux leads to chronic cough by triggering alveolar epithelial injury and subsequent pulmonary fibrosis.

Comparison of 19- and 22-gauge needles in EUS-guided fine needle aspiration in patients with mediastinal masses and lymph nodes.

BACKGROUND/AIMS: Endoscopic ultrasound-guided fine needle aspiration is an established tissue-acquisition technique for mediastinal lesions. However, there are limitations to endoscopic ultrasound-guided fine needle aspiration of mediastinal masses in certain neoplasms and granulomatous diseases. Most studies have used 22-gauge aspiration and/or 19-gauge Tru-cut needles, and only limited data exist on larger-caliber aspiration needles. We aimed to compare prospectively the diagnostic yield of endoscopic ultrasound-guided fine needle aspiration using 19- and 22-gauge aspiration needles in patients with mediastinal lesions of unknown origin. MATERIAL AND METHODS: Using a consecutive entry design, 57 patients with mediastinal mass or lymph node, in whom previous investigations, including bronchoscopy and computed tomography-guided biopsy, had not provided a final diagnosis, underwent endoscopic ultrasound-guided fine needle aspiration biopsy using 19-gauge or 22-gauge aspiration needle. Determination of the adequacy and cytopathologic interpretation of fine needle aspiration materials were done by two pathologists blinded to the clinical condition of the patient. Fine needle aspiration specimens were placed in four categories as: (1) nondiagnostic, (2) benign, (3) granulomatous disease, and (4) malignant. RESULTS: Among 57 patients [35 (61.4%) with mediastinal lymph nodes and 22 (38.5%) with pulmonary masses], adequate tissue was obtained in 52 (91.2%) of the cases (with a mean of 3.3 needle passes). Correct cytopathologic diagnoses were made based on the endoscopic ultrasound-guided fine needle aspiration specimens obtained by 19- and 22-gauge needles in 96% and 92% of the samples, respectively (p>0.05). CONCLUSIONS: As concerns endoscopic ultrasound-guided fine needle aspiration of mediastinal masses and lymph nodes, the diagnostic sensitivity of aspirated material obtained using 19- and 22-gauge fine needle aspiration needles was found to be comparable in our study.

Maspin, VEGF and p53 expression in small biopsies of primary advanced lung cancer and relationship with clinicopathologic parameters.

Maspin, one of the serine protease inhibitors, has been shown to inhibit tumor progression and metastasis. We aimed to investigate maspin, p53 and VEGF expression in patients with squamous cell carcinoma (SCC), adenocarcinoma (AC) and small cell lung carcinoma (SCLC). The study included 28 SCC, 18AC, 17 SCLC biopsy samples. We used the streptavidin biotin immunoperoxidase method to test for maspin, p53 and VEGF antibodies. Medical records of these patients were reviewed from archival files. Cytoplasmic maspin expression was detected in 89.3%, 77.8%, 52.9% of SCC, AC and SCLC, respectively. The rate was significantly higher in non-small cell lung cancer (NSCLC) and SCC than SCLC (p = 0.013, p = 0.021, respectively). The mean percentages of maspin expression were significantly higher in NSCLC, SCC and AC than in SCLC (p = 0.0001, p = 0.0001, p = 0.038, respectively). In ACs, maspin and p53 expressions were correlated, although this was not statistically significant (p = 0.053, r = 0.464), and maspin positive cases had a significantly higher T status compared to negative cases (p = 0.036). In SCC, the stage of disease was positively correlated with p53 (p = 0.007, r = 0.536) and negatively correlated with VEGF expression (p = 0.013, r = -0.498). Multivariate analysis demonstrated that stage of disease was a significant independent prognostic parameter in NSCLC (95% confidence interval: 1.067-3.969; p = 0.031). Although maspin expression is higher in SCC and AC, and is related with higher T status in AC, our data did not indicate its prognostic significance. Larger scale studies are needed to reveal the exact role of maspin in lung cancer pathogenesis.

Respiratory symptoms, pulmonary function, and reproductive history: Isparta Menopause and Health Study.

OBJECTIVE: We aimed to investigate the influence of reproductive factors on chronic respiratory symptoms and pulmonary function in a cross-sectional study of premenopausal and postmenopausal women 44-61 years of age. METHODS: Self-reported data on respiratory symptoms were obtained from 1082 women. Usable forced expiratory volume in 1 second (FEV(1)) (2.27 +/- 0.44 L) and forced vital capacity (FVC) (2.75 +/- 0.55 L) measurements were obtained from 1070 women. The influence of reproductive factors on FEV(1), FVC, and chronic respiratory symptoms was assessed by linear and logistic regression analyses. RESULTS: Menopause is associated with lower FEV(1) (p < 0.0001, r = -0.181) and FVC (p < 0.0001, r = -0.198) only in univariate analysis. The association disappears when age is adjusted for. However, association of menopause with increased odds of chronic cough plus phlegm is significant in multivariate analysis (odds ratio [OR] 1.84, 95% confidence interval [CI] 1.16-2.92, p = 0.0088). Among reproductive factors, only age at first birth is independently associated with FEV(1) (p = 0.01, r = 0.008) and FVC (p = 0.004, r = 0.013). Results were similar when restricting analyses to those who never smoked and after exclusion of asthmatics. CONCLUSIONS: Postmenopausal status is independently associated with increased odds of chronic cough plus phlegm, whereas it does not appear to be independently associated with FEV(1) or FVC. Among the reproductive factors, age at first birth is the only independent predictor of FEV(1) and FVC. These findings suggest that reproductive factors may influence women's pulmonary health.

Pulmonary function tests and high-resolution CT in the detection of pulmonary involvement in inflammatory bowel disease.

GOALS: To assess the pulmonary involvement detected by pulmonary function tests (PFT) and high-resolution computed tomography (HRCT) in inflammatory bowel disease (IBD) patients and to investigate the relationship of the pulmonary abnormalities with respiratory symptoms and bowel disease activity. METHODS: 23 patients with ulcerative colitis, 13 patients with Crohn disease and 14 control subjects took part in this prospective, controlled study. In all patients, detailed clinical information was obtained and extent and activity of the bowel disease were established. Each patient underwent PFT and HRCT scanning. RESULTS: A pulmonary function abnormality was present in 21 of 36 patients. In IBD patients, DLCO were significantly lower, but RV/TLC was significantly higher than those of controls. HRCT revealed air trapping, fibrosis, emphysema, bronchiectasis and alveolitis in 19 patients. One-third of the patients with PFT abnormality, and 42% of the patients with HRCT abnormality were respiratory symptom free. Approximately 80% of the patients with pulmonary involvement had active bowel disease. CONCLUSIONS: Pulmonary involvement is common in patients with IBD. A high degree of suspicion is necessary to detect the pulmonary abnormality in IBD, because considerably large proportions of the symptom free patients have abnormal findings on HRCT and PFT.