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.

Amelioration of radiation-induced lung injury by halofuginone: An experimental study in Wistar-Albino rats.

To evaluate effects of halofuginone (H) on radiation-induced lung injury (RILI), 60 rats were divided into six groups: Group (G) 1 control, G2 radiotherapy (RT) only, G3 and G4 2. 5 and 5 µg H and G5 and G6 RT + 2.5 and 5 µg H groups, respectively. A single dose of 12 Gy RT was given to both lungs. H was applied intraperitoneally with daily doses, until animals were killed at 6 and 16 weeks after RT. At 6th and 16th weeks of RT, five rats from each group were killed. Lung tissues were dissected for light and electron microscopy. Chronic inflammation, fibrosis and transforming growth factor-beta (TGF)-ß scores of all study groups were significantly different at 6th and 16th week ( p < 0.001). Chronic inflammation, fibrosis and TGF-ß scores of G2 were higher than G5 and G6 at 6th and 16th weeks of RT. At 16th week, fibrosis and TGF-ß scores of G5 were higher than G6 ( p = 0.040 and 0.028, respectively). Electron microscopical findings also supported these results. Therefore, H may ameliorate RILI. The effect of the H was more prominent at higher dose and after long-term follow-up. These findings should be clarified with further studies.

Achieving efficient anti-adhesion in re-mediastinoscopy: an experimental study in rats.

OBJECTIVE: Re-mediastinoscopy can be a difficult procedure due to fibrosis in the mediastinum. We have investigated the effect of an anti-adhesive barrier agent "hylan B gel" on the formation of adhesions after dissection in the superior mediastinum in a rat model. METHODS: The study was conducted in 70 male Sprague-Dawley rats weighing 300 g. The strap muscles were divided by a midline cervical incision. The anterior and lateral aspects of the trachea were dissected to the level of the carina. Hylan B gel (Sepragel Sinus, Genzyme Company, Redgefield, NJ, USA) was used to create an anti-adhesive barrier. The rats who were subjected to surgery were sacrificed on postoperative days 14 and 28. All rats were previously divided into 5 groups: Sham group (n = 10); Group 1 (n = 15) surgery alone, sacrificed on day 14; Group 2 (n = 15) surgery and Sepragel, sacrificed on day 14; Group 3 (n = 15) surgery alone, sacrificed on day 28; Group 4 (n = 15) surgery and Sepragel, sacrificed on day 28. Histopathological analysis was performed to study the effect of the anti-adhesive agent. Scores were calculated based on collagen fibrosis, fibroblasts, granulation tissue, muscle alterations/inflammation, histiocytes, mononuclear giant cells, inflammation and vascular proliferation. RESULTS: Collagen fibrosis and fibroblast scores, which represent adhesions, were significantly higher in Groups 1, 2, 3, 4 than in the Sham group ( P < 0.01). The degree of adhesions on day 14 was found to be higher in Group 1 compared to Group 2 ( P < 0.01). Adhesions on day 28 were higher in Group 3 compared to Group 4 ( P < 0.01). There were no differences between groups with regard to foreign body reactions ( P > 0.05). CONCLUSION: Adhesions causing technical difficulty during re-mediastinoscopy can be reduced by the application of anti-adhesive agents during the primary procedure.

Giant intraosseous lipoma of the rib.

Lipoma is defined as a benign tumor consisting of a circumscribed mass of adipose tissue. Intraosseous lipomas represent fewer than 0.08% of all primary bone tumors. We present an unusual case of intraosseous lipoma arising from the left 10th and 11th ribs and extending to the subdiaphragmatic area and abdomen. Lipoma of the rib is an extremely rare disorder presenting diagnostic challenges.

Thoracic surgical operations performed under local anesthesia and sedation for diagnosis and treatment.

Generally, the operative procedures for the diagnosis or treatment of mediastinal, intrathoracic and/or chest wall lesions requiring rib resection are performed under general anesthesia. Although evidence suggests that thoracoscopy can be performed under local anesthesia, no report has indicated that some major thoracic procedures can be accomplished without general anesthesia. In our study, we advocate that certain surgical procedures could be performed under local anesthesia with a performance similar to that of general anesthesia. Thirty patients underwent thoracic procedures with local anesthesia and sedation for diagnosis and treatment. Seventeen of the patients were men, and the mean age of the patients was 49.6 years (range 16 to 71 years). There were 13 diagnostic procedures, and 17 procedures were for treatment purposes. The operative procedures performed using only local anesthesia were mini-thoracotomy (n = 9), mediastinotomy (n = 4), revision of a full-thickness posterolateral thoracic incision (n = 7), resection of the chondroma (n = 4), Eloesser flap (n = 1), metastasectomy of the chest wall (n = 3), empyectomy (n = 1), and video-assisted thoracoscopy (n = 2). Severity of pain was evaluated by VAS. There were no oral or intravenous analgesic requirements in the early postoperative period. No complications attributable to the procedure were observed. Thoracic surgical procedures for diagnosis and treatment performed under local anesthesia are simple, effective, economical and comfortable for the patient.

The prognostic importance of trauma scoring systems for blunt thoracic trauma.

BACKGROUND: Early identification and aggressive management of blunt thoracic trauma are essential to reduce the significant rates of morbidity and mortality. The aim of this study was to evaluate the independent predictive value of 5 different trauma scoring systems (Revised Trauma Score [RTS], Trauma and Injury Severity Score [TRISS], Injury Severity Score [ISS], Lung Injury Scale [LIS], and Chest Wall Injury Scale [CWIS]) with respect to prognostic factors such as tube thoracostomy duration, the need for mechanical support and thoracotomy, the length of hospital and ICU stay, morbid conditions, and deaths of patients with blunt thoracic trauma. METHODS: The records of 152 patients with blunt thoracic trauma were reviewed and data consisting of the patients' age and gender, blood pressure and respiratory rate on admission, the extent of chest wall and intrathoracic injury, types of associated injuries, Glasgow Coma Scale (GCS) scores, the need for mechanical support and thoracotomy, tube thoracostomy duration, length of hospital and ICU stay, morbid conditions, and deaths were collected. The relations between the trauma scoring systems and prognostic factors were evaluated by multivariate analysis. RESULTS: The analysis showed that only TRISS was an independent predictor of mortality and only LIS was an independent predictor of morbidity, the need for thoracotomy, and tube thoracostomy duration. TRISS and LIS were independent predictors of the length of ICU stay. ISS, CWIS, and LIS were independent predictors of the need for mechanical support. RTS, TRISS, ISS and LIS were independent predictors of the length of hospital stay. CONCLUSIONS: The LIS grade appeared to correlate with the severity of blunt thoracic injury and was found to be the most useful scoring system in predicting the outcomes of these patients.

Blunt and penetrating traumatic ruptures of the diaphragm.

BACKGROUND: The difficulties in diagnosing traumatic diaphragmatic rupture (TDR) at the first admission are the most common causes of morbidity and mortality. The purpose of this study was to review our experience with the management of TDR in order to identify the factors contributing to diagnostic delay and associated morbidity and mortality. METHODS: Fourteen patients with TDR were treated in our hospital between January 2000 and June 2005. They have been investigated retrospectively. RESULTS: The study identified 9 men (64 %) and 5 women (36 %), with ages ranging from 19 to 65 years (mean 35.3 years). Rupture of the diaphragm was left-sided in 10 (71 %) and right-sided in 4 (29 %) of the patients. Blunt trauma accounted for the injuries of 11 patients (79 %). Early diagnosis was obtained in 9 patients (64 %). The diagnosis was established preoperatively in 8 patients (57 %), and intraoperatively in 4 (29 %). The diagnosis was missed in 2 (14 %) patients in the first operation. Multiple associated injuries were observed in 12 patients (85 %). Postoperative complications were encountered in five patients (35 %), and the overall mortality was 7 %. CONCLUSIONS: Diaphragmatic rupture should be suspected in all blunt or penetrating traumas of the thorax and abdomen, and the presence of such an injury should be excluded before terminating the exploratory procedure.

Beneficial effects of supplemental nitric oxide donor given during reperfusion period in reperfusion-induced lung injury.

BACKGROUND: Reperfusion injury is a perplexing cause of early graft failure after lung transplantation and today we know that reperfusion may be more harmful to tissues than the preceding ischemia. We hypothesized that administration of the nitric oxide donor nitroglycerin (NTG) during flush perfusion and reperfusion periods would ameliorate reperfusion-induced lung injury. METHODS: Using an IN SITU normothermic ischemic lung rabbit model, three groups were studied (n = 7/group): (1) NTG given during flush perfusion (ischemia group); (2) NTG given in the flush perfusion and the reperfusion period (reperfusion group); and (3) no NTG (control group). All groups were flushed with low potassium dextran glucose solution. Blood gas analysis, tissue nitrite (nitric oxide metabolite) level analysis, bronchoalveolar lavage (BAL) fluid examination and morphological examinations were performed. RESULTS: Compared with the ischemia group, the reperfusion group had significantly improved arterial oxygenation (318 +/- 31.4 mmHg vs. 180 +/- 14.7 mmHg, P < 0.05), decreased BAL fluid neutrophil percentage (21 +/- 1.9 % vs. 30 +/- 5.6 %, P < 0.05), increased tissue nitrite level (32.55 +/- 4.12 nmol/g vs. 27.81 +/- 1.05 nmol/g, P < 0.05), and decreased tissue histopathological lesion scores (0.42 +/- 0.53 vs. 1.14 +/- 0.37, P < 0.05). CONCLUSIONS: This study suggests that nitric oxide donors supplemented during flush perfusion and reperfusion have more beneficial effects on lung functions against reperfusion injury than any other treatment modalities during IN SITU normothermic ischemic lung model.