Comparison of health-related quality of life and exercise capacity according to stages in patients with non-small cell lung cancer.

INTRODUCTION: The aim of this study is to compare the exercise capacity and health-related quality of life parameters according to stages of patients with non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: Fifty-two patients (who are able to ambulate independently) with stage I-II (group early-stage, n= 17) and stage IIIA-IV NSCLC (group advanced-stage, n= 35) were included. Exercise capacity (six minute walking test), strength of the peripheral muscle (Back and Leg Dynamometer), performance status (Karnofsky performance status scale), health-related quality of life- HRQOL (European Organization for Research and Treatment of Cancer Quality of life measure and Short Form-36 Health Survey), depression and anxiety (Hospital Anxiety and Depression Scale) were evaluated. RESULTS: No difference was found in age, body mass index, respiratory symptoms and the distribution of disease cell types between two groups (p> 0.05). In advanced-stage group, pulmonary function test values, peripheral muscle strength, walking distance and health-related quality of life scores especially the categories of functional capacity and pain were established significantly lower compared to early-stage group (p ≤ 0.05). Depression and anxiety levels were confirmed to be similar between groups (p> 0.05). CONCLUSION: The exercise capacity of patients with advanced-stage NSCLC is lower due to reduced pulmonary functions and peripheral muscle strength compared to patients with early-stage NSCLC. Therefore, we can conclude that reduced exercise capacity negatively impacts functional categories of health related quality of life of patients with advanced-stage NSCLC.

Extrapulmonary involvement in patients with sarcoidosis in Turkey.

BACKGROUND AND OBJECTIVE: Extrapulmonary sarcoidosis is common, and is almost always associated with concomitant thoracic involvement. Extrapulmonary manifestations vary on the basis of gender, age at presentation and ethnicity. The aim of this study was to investigate extrapulmonary involvement in patients with sarcoidosis in Turkey. METHODS: This study was conducted by Turkish Thoracic Society Clinical Problems Study Group. New cases of sarcoidosis between 1 June 2004 and 31 May 2006 were recorded on electronic case record forms sent to all potential investigators and information about extrapulmonary involvement was collected. RESULTS: One hundred and nineteen of 293 patients (83 female, 36 male, mean age = 45 ± 12 years) had extrapulmonary involvement in this study (40.6%). The median time to diagnosis was 6 months and this was longer than patients with just thoracic sarcoidosis (P = 0.001). Extrapulmonary symptoms were present in 181 (61.8%) patients, and skin lesions, arthralgia and back pain were the commonest (33.4%, 20.8% and 16.4%, respectively). Incidence of organ involvement was independent of age with the exception of ocular involvement, which was higher in those under the age of 40 years (P = 0.007). CONCLUSIONS: Skin and peripheral lymph node involvement were the most common sites of extrapulmonary involvement and ocular involvement was more common in those under the age of 40 years in patients with sarcoidosis in a Turkish population.

Clinical presentations and diagnostic work-up in sarcoidosis: a series of Turkish cases (clinics and diagnosis of sarcoidosis).

Sarcoidosis is an idiopathic granulomatous disease. It usually affects the lung. The diagnosis may be problematic since the known causes of granulomatous inflammation must be excluded. This multicenter study aimed to evaluate the clinical presentations and diagnostic approaches of sarcoidosis. The study protocol was sent via internet, and the participants were asked to send the information (clinical, radiological and diagnostic) on newly diagnosed sarcoidosis cases. 293 patients were enrolled within two years. Pulmonary symptoms were found in 73.3% of the patients, and cough was the most common one (53.2%), followed by dyspnea (40.3%). Constitutional symptoms were occured in half of the patients. The most common one was fatigue (38.6%). The most common physical sign was eritema nodosum (17.1%). The most common chest radiograhical sign was bilateral hilar lymphadenomegaly (78.8%). Staging according to chest X-ray has revealed that most of the patients were in Stage I and Stage II (51.9% and 31.7%, respectively). Sarcoidosis was confirmed histopathologically in 265 (90.4%) patients. Although one-third of the bronchoscopy was revealed normal, mucosal hyperemi (19.8%) and external compression of the bronchial wall (16.8%) were common abnormal findings. The 100% success rate was obtained in mediastinoscopy among the frequently used sampling methods. Transbronchial biopsy was the most frequently used method with 48.8% success rate. Considering sarcoidosis with its most common and also rare findings in the differential diagnosis, organizing the related procedures according to the possibly effected areas, and the expertise of the team would favour multimodality diagnosis.

The effect of in-patient chest physiotherapy in lung cancer patients.

GOALS OF WORK: The aim of our study was to investigate the effect of the in-patient chest physiotherapy (ICP) in patients with lung cancer. PATIENTS AND METHODS: Eighteen patients with stage IIIA, IIIB, or IV lung cancer (3 females and 15 males) were included. The demographic characteristics and the clinical history of the patients were recorded. Pain (visual analog scale), pulmonary function (pulmonary function test), functional capacity (6-min walking test, Karnofsky performance status (KPS) scale), and health-related quality of life (Nottingham Health Profile (NHP)) parameters were evaluated. The ICP program, including breathing control, breathing exercises, relaxation training, upper and lower extremity exercises, mobilization, and transcutaneous nerve stimulation, was designed to meet each patient's individual needs. MAIN RESULTS: After the exercise program, there was a significant decrease in the severity of the dyspnea, fatigue, and pain symptoms (p < 0.05), improvement in the physical mobility, pain, energy, emotional status and sleep subcategories of the NHP (p < or = 0.05), and increase in the 6-min walking distance (75 +/- 15.95 m, p = 0.003). However, pulmonary function test results and KPS scores did not show statistically significant changes (p > 0.05). CONCLUSIONS: ICP programs may be beneficial to lung cancer patients by reducing respiratory symptoms, pain, and improving health-related quality of life and exercise capacity. For this reason, the results of this study suggest that ICP programs, which are prepared by taking the individual requirements of lung cancer patients, should be placed in the treatment of the lung cancer.

Primary pulmonary extranodal marginal zone lymphoma/low grade B-cell lymphoma of MALT type combined with well-differentiated adenocarcinoma.

We describe a rare case of extranodal marginal zone/low-grade B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) combined with areas of well-differentiated adenocarcinoma. In addition, the MALT lymphoma was synchronously systemic, with involvement of the lung, stomach and duodenum.

Photodynamic therapy as an adjunct to systemic treatment in a case with unilateral presumed vascularized choroidal tuberculous granuloma.

Intraocular tuberculosis cannot be diagnosed easily in some clinical circumstances. A 29-year-old otherwise healthy woman who was initially misdiagnosed and treated empirically with systemic steroids and sulfamethoxazole-trimethoprim for toxoplasmosis was referred to us for severe visual loss. We instituted quadruple antituberculosis treatment upon chest medicine consultation as all attempts, including consecutive intravitreal antibiotic injections, could not prevent the enlargement of lesion. Systemic antituberculosis treatment halted the fulminant course but the granuloma became vascularized. Because photodynamic therapy (PDT) has very recently been shown to reduce viable mycobacterial cells in animal experiments we performed PDT, and the vascularized tuberculous granuloma was successfully treated. PDT may have an antimycobacterial effect besides its well-known antiangiogenic effect.

Survivin expression in non-small-cell lung carcinomas: correlation with apoptosis and other apoptosis-related proteins, clinicopathologic prognostic factors and prognosis.

The role of survivin that regulates the biological behavior of non-small-cell lung carcinoma (NSCLC) is still controversial. We aimed to investigate survivin expression in NSCLC and to define any correlation with expressions of p53, bcl-2, bax, apoptotic index (AI), tumor cell proliferation, clinicopathologic variables, and overall survival. Tumors of 63 patients with NSCLC were examined for expressions of survivin, p53, bcl-2, bax, and Ki-67 by immunohistochemistry. AI was also evaluated. Results for each antibody were correlated with each other, and with clinicopathologic variables including age, sex, histologic subtype, TNM (T: primary tumor, N: regional lymph node metastasis, M: distant metastasis) stage, lymph node status, smoking history, and prognosis. Nuclear survivin expression was inversely correlated with p53 expression (P = 0.04, r = - 0.367), and tumor stage (P = 0.03, r = - 0.273), and positively correlated with tumor cell proliferation (P = 0.009, r = 0.329). Cytoplasmic survivin expression positively correlated with smoking history (P = 0.02, r = 0.282). Survivin/bax ratio was inversely correlated with AI (r: - 0.004). By Kaplan-Meier analysis, TNM stage (P < or = 0.001), lymph node metastasis (P = 0.04), and Ki-67 index (P < or = 0.001) were associated with survival, whereas survivin was not. In multivariate analysis, only TNM stage was an independent predictor. Although survivin and other apoptosis-related protein expressions fail to predict the clinical outcome, the present findings suggest that survivin is involved in tumor cell apoptosis and proliferation and may play a role in critical steps of cancer progression in NSCLC.

[Pneumocystis jirovecii Pneumonia in a Patient with Interstitial Lung Disease]. / Interstisyel Akciger Hastaligi Zemininde Gelisen Pneumocystis jirovecii Pnömonisi.

Pneumocystis pneumonia (PCP) caused by Pneumocystis jirovecii (P. jirovecii) is an opportunistic pulmonary infection that occurs in immunocompromised patients. Here, a 49-year-old female patient who was admitted to our hospital with respiratuary distress and whose bronchoalveolar lavage (BAL) fluid specimens had P. jirovecii and Aspegillus fumigatus was presented. She had been treated with corticosteroids because of interstisial lung disease and she was also diabetic. It is important to define the coinfection developed in the presence of immunosuppression.

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.

Association of macrophages, mast cells and eosinophil leukocytes with angiogenesis and tumor stage in non-small cell lung carcinomas (NSCLC).

The association between inflammatory cells, including tumor associated macrophage (TAM), mast cell (MC) and eosinophil leucocyte (EL) densities and angiogenesis, as well as the relation of TAM, MC and EL densities and angiogenesis to tumor stage were investigated in specimens of 63 non-small cell lung carcinoma (NSCLC). Fifteen cases were in stage I, 12 were in stage II, 33 were in stage III and 3 were in stage IV. ELs and MCs were identified by hematoxilen-eosin and toluidine-blue histochemical stains, respectively. TAMs were shown by immunohistochemistry for CD68. Microvessels demonstrated by immunohistochemistry for CD31 were quantified by a stereological method and vascular surface density (VSD) and microvessel number (NVES) were calculated. There was not any statistically significant correlation between tumor's stage and VSD, TAM and EL counts. MC count and NVES were found to be higher in early stages. VSD and NVES were not associated with EL, MC and TAM counts. The lack of consistent correlation of angiogenesis to the stage of disease in this study supports the view that tumor angiogenesis is not a significant prognostic factor in NSCLCs. The absence of correlation between MCs, ELs and TAM counts and angiogenesis and absence of any relation between ELs and TAMs and tumor stage are discordant with the results of some of the previous studies in NSCLCs and in other tumors. The differing results may be due to wide variations in methodologies which were used for demonstration of inflammatory cells and vessels and variations in the degree of activation and complexity of functions of these cells.

Association between disease-related factors and balance and falls among the elderly with COPD: a cross-sectional study.

BACKGROUND AND AIMS: To investigate the relationship between disease-related factors and balance, and a history of falls in chronic obstructive pulmonary disease (COPD). METHODS: Thirty-six patients with COPD and twenty healthy individuals were studied. Pulmonary function (pulmonary function test), hypoxemia (analysis of arterial blood gases), history of falls and tripping (number of falls and tripping in the past year), balance (Berg's Balance Scale-BBS), quadriceps femoris muscle strength (manual muscle test), and exercise capacity (6-minute walking test-6MWT) were assessed. RESULTS: BBS scores were significantly different between groups (p=0.001). BBS scores, frequency of falls and tripping were correlated in COPD patients (p ≤ 0.01). BBS score and frequency of falls were correlated with dyspnea and peripheral oxygen saturation measured after the 6MWT, partial arterial oxygen pressure, and arterial oxygen saturation values in COPD patients (p<0.05). CONCLUSIONS: According to our results, hypoxemia, dyspnea and fatigue are disease- related factors, which are related with balance impairment and falls in COPD patients. For this reason, we suggest that assessment of and training to improve balance impairment among the elderly with COPD should be a component of pulmonary rehabilitation programs in clinical practice.

Comparison of Short Form-36 Health Survey and Nottingham Health Profile in moderate to severe patients with COPD.

OBJECTIVE: To compare the health-related quality of life (HRQoL) assessed by Short Form-36 Health Survey (SF-36) and Nottingham Health Profile (NHP) on the basis of lung function and exercise capacity parameters in patients with moderate to severe chronic obstructive pulmonary disease (COPD). METHODS AND MATERIALS: The investigation was a prospective, quality-of-life survey and cross-sectional study of 130 consecutive COPD patients. The NHP and SF-36 as generic HRQoL instruments, the Chronic Respiratory Disease questionnaire (CRQ) as a disease-specific HRQoL instrument and 6-minute walking test, severity of dyspnea, leg fatigue and lung function, were the measurements and instruments used in the study. RESULTS: It was determined that the subscales of both questionnaires were generally related with the FEV(1), walking distance, CRQ, severity of dyspnea and leg fatigue values (P<0.05). The much higher correlation coefficient was determined between these parameters and NHP compared with the SF-36. Only NHP was found to be correlated with the age, body mass index and smoking consumption (P<0.05). CONCLUSIONS: The stronger relation of NHP with the clinical and physical parameters of the patients compared with that of SF-36 may be associated with the increased sensitivity of NHP to the clinical state owing to the increasing respiratory symptoms of our old patients with moderate to severe obstruction and/or the more intelligible and easy-to-respond nature of NHP compared with SF-36.