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.

Morgagni hernia: transabdominal or transthoracic approach?

BACKGROUND: Morgagni hernias are rare and constitute less than 2% of all diaphragmatic hernias. Treatment is primarily surgical and transthoracic or transabdominal route approach methods are amenable. In this study, we compared the results of our Morgagni hernia cases, which underwent either transabdominal or transthoracic method of surgery. METHODS: We retrospectively analyzed the records of 20 patients we operated on for Morgagni hernias between 1997 and 2011 in our clinic. Age, sex, presenting symptoms, lesion location, diagnoses, applied surgical method, duration of the hospital stay, morbidity and mortality rates were reviewed. Six of the cases were (30%) approached via thoracotomy and 14 (70%) were laparotomy. The hernial sac was resected in all cases. Diaphragmatic defects were repaired using nonabsorbable sutures in all cases except in one case where prolen mesh used. RESULTS: Thirteen cases (65%) were female and seven (35%) were male. Mean age was 44.1 +/- 25.3 years (1-73 years). Hernias were located on the right side in 18 cases, the left side in one, and bilaterally located in one case. Herniated organs were: omentum in 19 (95%), transverse colon in 18 (90%), small bowel in 4 (20%), stomach in 3 (15%), and left lobe of the liver in one (5%) case. No complication was observed in patients who underwent laparotomy, and wound infection occurred in one patient who underwent thoracotomy. Hospital stays in thoracotomy and laparotomy groups are 7 and 6.2 days, respectively. There were no mortalities observed. There was no recurrence during the follow-up of 36.4 months (10-116 months). CONCLUSION: Our findings showed that both surgical methods have similar and satisfactory results. Although transthoracic approach was preferred in previous cases, the transabdominal approach was preferred in later ones because we assumed that the later procedure is less invasive for the patient. We prefer and propose the abdominal approach for the surgical management of Morgagni hernias.

Pre-school children with hydatid lung disease.

BACKGROUND: Hydatid cyst disease is a major health problem in developing countries and it usually settles in the lungs in children. This study aimed to present pre-school children with lung hydatid cysts cases that underwent surgical treatment. METHODS: The authors retrospectively investigated 42 consecutive pre-school patients who were diagnosed and surgical treated for hydatid cysts in their clinic between January 1998 and December 2011. RESULTS: Seventeen (40.5%) patients were female and 25 (59.5%) patients were male. The average age of the patients was 5.2 +/- 1.3 (between 2-7 years). The most common symptoms were cough (74%), chest pain (26.2%), and fever (26.2%). Twenty-eight cases had cysts in only one lung; in five cases, the cysts were in a single lung and the liver, in six cases, in bilateral lungs and liver, and in three cases, in bilateral lungs. The average cyst diameter was 6.2 +/- 2.4 (2-12) cm. In five cases, there were combined interventions to the right lung and liver cysts with a transdiaphragmatic approach. Nine patients with bilateral hydatid cysts underwent operations. Muscle protector thoracotomies were performed in eight cases. Cystotomy and capitonnage were applied to all lung cysts. One patient underwent a bronchoscopy for postoperative atelectasis. In one case, postoperative fever was observed. There was no postoperative mortality. Postoperative average hospital stay was 7.2 +/- 2.1 (3-13) days. CONCLUSION: Surgery is the definitive treatment for lung hydatid cysts. The most important way to protect against the adverse effects of a thoracotomy is to eliminate the routes of transmission.

Occult urinary incontinence in elderly women and its association with geriatric condition.

OBJECTIVE: Many older women are hesitated to initiate discussions about urinary symptoms and their incontinence. The aim of this study is to determine the prevalence of occult urinary incontinence in outpatient older women and to evaluate its association with other geriatric conditions. PATIENTS AND METHODS: 100 female patients 65 years and older were assessed at the geriatric outpatient clinic. The validated form of the Turkish version of the International Consultation on Incontinence Questionnaire-Short Form was used to evaluate urinary incontinence and quality of life. Comprehensive geriatric assessment including activities of daily living, instrumental activities of daily living, mini mental state examination and geriatrics depression scale was performed. The number of falls, comorbid conditions and number of medications were noted. The association between urinary incontinence and geriatric domains were evaluated with logistic regression analysis. RESULTS: A total of 100 patients were evaluated, 64 of them included in the study. The median age of patients was 72.5. The rate of urinary incontinence was found 40.6%. The association between urinary incontinence and quality of life, performance status and comorbidity was found statistically significant with logistic regression (p = 0.033, p = 0.005, p = 0.031 respectively). Half of the patients with UI believe that it is part of normal aging and no definite treatment is available. CONCLUSIONS: Occult urinary incontinence is a significant problem in older women that inversely affecting the quality of life. The study suggests that awareness and education regarding incontinence should be increased among elderly patients and screening of urinary incontinence is an important part of the geriatric assessment. The evaluation and management of functional status and comorbid conditions should be the initial step during incontinence management in elderly patients.

The status of iron absorption in older patients with iron deficiency anemia.

OBJECTIVE: The aim of this study is to evaluate the iron absorption status by using the oral iron absorption test (OIAT) in older patients with iron deficiency anemia (IDA) in comparison with younger patients. PATIENTS AND METHODS: This is a cross-sectional study including 100 patients with iron deficiency anemia. Patients were divided in two groups; group 1 who is 65 and older and group 2 who is younger than 65. OIAT in which a fasting serum iron level is compared with a second serum iron level obtained three hours following oral ingestion of iron sulfate was performed. An increase in serum iron of at least 100 mcg/dL indicates that oral iron absorption is adequate. The Independent-Samples t-test was used to show the statistical difference between the means of two groups. RESULTS: There were 100 patients in the study; 69 of them have completed the study. The means of the oral iron absorption test results of the groups was compared with an independent t-test, which showed that the mean of group 1 was lower than group 2 and this was statistically significant (p = 0.001). The mean of OIAT results was 86.1 and 163.5 in group 1 and 2 respectively. CONCLUSIONS: In our knowledge, the present study is among the first that shows the status of iron absorption objectively by using OIAT in older patients. Our study shows iron absorption is decreased in older patients with IDA in comparison with younger patients. In the light of this finding; OIAT should be offered before initiating treatment in older patients when IDA is diagnosed and intravenous iron treatment should be considered more on the base of results.

The predictive value of epidemiological characteristics, clinical and laboratory findings in adult lymphadenopathy etiology.

OBJECTIVE: Our aim was to determine the presence or absence of malignant etiology in the epidemiological, clinical and laboratory results of patients undergoing lymph node biopsies. PATIENTS AND METHODS: This study was carried out between January 2013 and April 2014. We enrolled a total of 150 adult patients who had lymph node biopsies. 73 of these were females (48.7%) and 77 were males (51.3%). The epidemiological characteristics, clinical and laboratory findings were evaluated and compared with the pathological results. RESULTS: Leukopenia (p=0.05) thrombocytopenia (p=0.03) and increased lactate dehydrogenase levels (p=0.01) were found to be associated with the malignancy. In the cervical, submandibular, axillary and inguinal areas lymphadenopathy was generally seem to be benign while the rate of malignancy was higher in the intra-abdominal and supraclavicular regions. In those cases who had a lymph node index of below 2 there was a higher rate of malignancy (p=0.04). In cases which lymphadenopathy accompanied by splenomegaly has been found associated with malignancy (p=0.009). No association with regards to malignancy was found with the erythrocyte sedimentation rate, C-reactive protein and hepatomegaly. CONCLUSIONS: According to the results of the study five variables including cytopenia, lactate dehydrogenase levels, splenomegaly, lymph node index below 2, intra-abdominal and supraclavicular lymphadenopathy were concluded to be the most suitable means of predicting malignant etiology.

Two dimensional numerical prediction of deflagration-to-detonation transition in porous energetic materials.

This paper describes a two-dimensional code developed for analyzing two-phase deflagration-to-detonation transition (DDT) phenomenon in granular, energetic, solid, explosive ingredients. The two-dimensional model is constructed in full two-phase, and based on a highly coupled system of partial differential equations involving basic flow conservation equations and some constitutive relations borrowed from some one-dimensional studies that appeared in open literature. The whole system is solved using an optimized high-order accurate, explicit, central-difference scheme with selective-filtering/shock capturing (SF-SC) technique, to augment central-diffencing and prevent excessive dispersion. The sources of the equations describing particle-gas interactions in terms of momentum and energy transfers make the equation system quite stiff, and hence its explicit integration difficult. To ease the difficulties, a time-split approach is used allowing higher time steps. In the paper, the physical model for the sources of the equation system is given for a typical explosive, and several numerical calculations are carried out to assess the developed code. Microscale intergranular and/or intragranular effects including pore collapse, sublimation, pyrolysis, etc. are not taken into account for ignition and growth, and a basic temperature switch is applied in calculations to control ignition in the explosive domain. Results for one-dimensional DDT phenomenon are in good agreement with experimental and computational results available in literature. A typical shaped-charge wave-shaper case study is also performed to test the two-dimensional features of the code and it is observed that results are in good agreement with those of commercial software.

Numerical prediction of steady-state detonation properties of condensed-phase explosives.

Within the scope of this study, a computer code named BARUT-X has been developed to calculate the detonation properties of C-H-N-O based condensed-phase explosives using the Chapman-Jouguet (C-J) theory. Determination of the detonation properties is performed in chemical equilibrium and steady-state conditions. Unlike other codes in the literature which use steepest descent optimization method, BARUT-X uses a nonlinear optimization code based on Generalized Reduced Gradient algorithm to compute the equilibrium composition of the detonation products. This optimization code provides a higher level of robustness of the solutions and global optimum determination efficiency. The Becker-Kistiakowsky-Wilson's (BKW) equation of state (EOS) is applied to the high-density gaseous detonation products at high pressures. BARUT-X uses RDX, TNT, BKWR, and BKWN set of constants in the BKW EOS. In addition, the Cowan-Fickett's EOS is applied for the compressible solid carbon in the detonation products. The calculated detonation properties for several condensed-phase explosives by BARUT-X have been compared with those computed by EXPLO5 and FORTRAN BKW codes as well as the experimental data in terms of detonation velocity and detonation pressure. Satisfactory agreement is obtained from these comparisons.