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.

Lung function impairment in women aged over 40 years: The critical role of abdominal obesity.

SUMMARY: It is known that obesity causes to impairment of pulmonary functions. This impairment worsens with aging. There are studies about obesity showing that the uses of abdominal measurements instead of BMI are more accurate.: PURPOSE: The aim of our study is to investigate the correlation of waist circumference in the women aged over 40 years with obesity to the respiratory function tests and chest expansion. MATERIALS AND METHODS: In our study, BMI, waist circumference and chest expansion of 64 women over 40-year old were measured and the values obtained were compared with the results of respiratory function tests. RESULTS: There was a positive correlation between the age of the patients with waist circumference and DLCO/VA. A negative correlation was found between the age and MVV. The weight increase was associated with an increase in waist circumference and DLCO/VA. It was observed that waist circumference and DLCO/VA were increased and chest expansion was decreased when BMI was increased. A positive correlation was determined between MVV and the other respiratory function parameters, FEV1, FVC, FEV1/FVC and FIVC (p < 0.01). Similarly, the increase in DLCO was found to be correlated with the values of FEV1, FVC and FIVC. FIVC was correlated only with FEV1 and FVC. CONCLUSION: In this study, it was observed that respiratory function tests of women over 40-year old with obesity were associated with anthropometric measurements. But, studies with larger sample sizes and prospective studies are needed to provide more accurate information about the importance of DLCO/VA for the assessment of pulmonary function in obese women.

Small cell lung cancer diagnosed with metastasis in parotid gland.

Among all parotid gland tumors, small cell cancer is rare, seen in only 1.7%. Tumoral findings in the parotid gland may sometimes be caused by metastasis, and diagnosis in these patients may be made at this metastatic focus. A 59-year-old male patient presented with a 3 x 4-cm painless mass in front of the mandibula. A malignant epithelial tumor was diagnosed after the histopathologic examination of the fine-needle aspiration biopsy specimen. The patient did not give consent for urgent parotidectomy. One month later, he presented again, indicating the growth of the mass. On the examination, it was noted that the mass had enlarged and become ulcerated. Incisional biopsy was applied for this lesion. The biopsy material revealed small cell cancer. Scanning of other systems was performed with the suspicion of a metastatic tumor, which revealed a mass with an undefined border separating it from the right main bronchus and numerous hypodense focuses in the patient's liver on thoracoabdominal computed tomography. In addition to the multiple metastatic focuses in the cranium, there were multiple bone metastases in the vertebra and the proximal parts of the bilateral femurs on bone scintigraphy. Due to bronchoscopy, an endobronchial lesion was seen on the right upper lobe bronchus, the biopsy material obtained from this area was diagnosed as small cell lung cancer. This case was presented because of its rarity as a first diagnostic site. Parotid gland small cell cancer metastasis from the lung is rare, and if a careful examination is not performed, primary focus may be overlooked, negatively affecting the lifetime survival rate and the prognosis of the patient.

Leptin, visfatin, insulin resistance, and body composition change in chronic obstructive pulmonary disease.

OBJECTIVE: The aim of the study was to compare endocrine parameters such as leptin, visfatin, insulin resistance, exercise capacity and body composition change, the pulmonary functions test (PFT) and arterial blood gases (ABG) parameters of chronic obstructive pulmonary disease (COPD) patients and in healthy controls. MATERIALS AND METHOD: Fifty-five patients with COPD and without malnutrition and 25 healthy controls were included in our study. The serum leptin, visfatin, tumor necrosis factor alpha (TNF-alpha) and insulin resistance, body fat-free mass (FFM) and fat mass (FM) were measured in the groups. Additionally, body mass index (BMI) was calculated and the 6-minute walk test (6MWT), PFT and ABG analyses were performed in all of the cases. RESULTS: No difference in BMI between the COPD group and controls was determined. Serum leptin and visfatin levels, FFM and 6MWT distance were significantly lower in the patients with COPD (p < 0.001, p = 0.001, p = 0.032, p < 0.001, respectively). A correlation was found between serum leptin levels and BMI (r = 0.333, p = 0.027), and with FM (r = 0.365, p = 0.029). Serum visfatin level was correlated with the percentage of forced expiratory volume in the first second in the patients with COPD (r = 0.371, p = 0.013). HOMA-IR (Homeostasis model assessment of insulin resistance) and serum TNF-alpha levels in the patients with COPD were found to be significantly higher than controls (p = 0.001, p < 0.001). CONCLUSION: These results may be earlier signs for further diseases that can emerge in the advanced stages in patients with COPD. Evaluating the patients not only with the pulmonary function and also systemically, contributes to minimizing the mortality and morbidity.

Inspiratory and expiratory HRCT findings in Behçet's disease and correlation with pulmonary function tests.

PURPOSE: The purpose of our study was to describe the pulmonary parenchymal changes of Behçet's disease using high-resolution computed tomography and to correlate them with pulmonary function tests. MATERIALS AND METHODS: Thirty-four patients with Behçet's disease (18 men, 16 women), 3 of whom were symptomatic, were included as the study group. Four of 34 patients were smokers. Twenty asymptomatic volunteers (12 men, 8 women), 4 of whom were smokers, constituted the control group. The pulmonary function tests and high-resolution computed tomography were performed for both groups. RESULTS: Inspiratory high-resolution computed tomography findings were abnormal in nine patients (26.5%) of the study group. In eight patients, there were multiple abnormalities, whereas one patient had only one abnormality. Pleural thickening and irregularities, major fissure thickening, emphysematous changes, bronchiectasis, parenchymal bands, and irregular densities, and parenchymal nodules were the encountered abnormalities. Inspiratory high-resolution computed tomography scans were normal in the control group. On expiratory scans, there was statistically significant difference between study group and control group when air trapping, especially grades 3 and 4, was compared (P<0.01). Pulmonary function tests of both the study and the control groups were in normal ranges, and there was no statistically significant difference between the two groups according to pulmonary function tests (P>0.05). DISCUSSION AND CONCLUSION: High-resolution computed tomography is sensitive in the demonstration of pulmonary changes in patients with Behçet's disease. End-expiratory high-resolution computed tomography examination is very useful and necessary to show the presence of air trapping, thus the presence of small airway disease, even if the patient is asymptomatic or has normal pulmonary function tests.

Clivus metastasis of squamous cell carcinoma: a rare location.

Lung cancer is the most frequently encountered cancer in humans and commonly metastasizes to brain and bone. Metastasis to the clivus is very rare and there have been no previous reports. A 51-year-old woman was admitted to our hospital complaining of headache, and left shoulder, arm and back pain. The chest X-ray showed a left paracardiac mass measuring 4x4 cm in diameter and the thorax computed tomographic examination revealed a 4x4 cm mass in the left lower lobe, left hilar and mediastinal lymphadenopathy, and multiple lytic lesions in the thoracic vertebral bodies. Head magnetic resonance imaging showed a mass in the clivus with bony destruction. Bronchoscopic examination revealed an exophytic endobronchial lesion in the left lower bronchus lumen and a biopsy was taken from this lesion. The histopathological diagnosis was "poorly differentiated squamous cell carcinoma". A punch biopsy was taken from the clivus via the transnasal-transphenoidal route. Histopathological findings of this biopsy were similar to the primary site tumor. We report a rare case of clivus metastasis from squamous cell lung cancer.

Bronchiolitis obliterans organizing pneumonia associated with sulfasalazine in a patient with rheumatoid arthritis.

Pulmonary toxicity and blood dyscrasias are rare side effects of sulfasalazine. Pulmonary pathology is variable, the most common being eosinophilic pneumonia with peripheral eosinophilia, and interstitial inflammation with or without fibrosis. We here present the case of a 68-year-old female patient treated for 6 months with sulfasalazine for rheumatoid arthritis. On laboratory examination, eosinophil count was 97 x 10(3) mm(3). Thorocoscopic biopsy was performed. Histopathologic diagnosis was bronchiolitis obliterans organizing pneumonia (BOOP). This is the first case in the literature to present with sulfasalazine-induced BOOP in a patient with seronegative RA.

Is chest expansion a determinant of pulmonary muscle strength in primary fibromyalgia?

OBJECTIVE: To examine the possible relationship between chest expansion and pulmonary muscle strength in patients with primary fibromyalgia (PFM). METHODS: Forty-one consecutive women with PFM were compared with age and body mass index matched 40 healthy women concerning pulmonary function tests, chest expansion, and maximum respiratory pressures indicating pulmonary muscle strength, and endurance (MVV). Pain was scored according to a visual analog scale (VAS). Chest pain was scored on a 10 point scale. RESULTS: There was no significant difference between the two groups regarding chest expansion (P > 0.05). Maximum inspiratory and expiratory pressures (MIP, MEP) were lower in fibromyalgia patients than controls (P < 0.05). However, chest expansion and dyspnea score were insignificant between groups (P > 0.05). CONCLUSION: Reduced maximum respiratory pressures (MIP, MEP) may result from isometric type pulmonary muscle dysfunction as a result of low physical performance in fibromyalgia patients, despite insignificant finding of chest expansion and dyspnea score according to controls.

Handgrip strength, pulmonary function tests, and pulmonary muscle strength in fibromyalgia syndrome: is there any relationship?

OBJECTIVE: It has been reported that patients with fibromyalgia syndrome (FMS) have lower maximal respiratory pressures than healthy subjects, indicating reduced pulmonary muscle strength. It has also been reported that patients with FMS have reduced grip strength. In this study, we aimed to examine the possible relationship between handgrip strength as a determinant of peripheral muscle strength and pulmonary muscle strength in patients with FMS by comparing them with healthy controls. METHODS: Forty-one consecutive women with FMS (diagnosed according to the American College of Rheumatology 1990 criteria) were compared with 40 age- and body mass index-matched healthy female controls. Pulmonary function tests were assessed by spirometry. Maximal pulmonary pressures were evaluated using an oral pressure meter. A dyspnea score was obtained. Pain was scored according to visual analogue scale and chest pain was classified (0-9) in fibromyalgia patients. Chest expansion was also measured in the two groups. Tender points were also evaluated in FMS patients. Grip strength (Jamar handheld dynamometer) was also measured in the two groups. RESULTS: The difference in pulmonary function tests was not statistically significant between groups. Maximal respiratory pressures (maximum inspiratory pressure and maximum expiratory pressure) and endurance (maximum ventilatory volume) were significantly lower in patients with FMS than in controls. There was also a statistically significant difference between groups regarding grip strength. There was also significant correlation between maximal inspiratory pressure and maximal expiratory pressure values and handgrip strength in patients with FMS. CONCLUSION: These data indicate that handgrip strength may be a determinant of pulmonary muscle strength in fibromyalgia patients.

The protective effects of acetylsalicylic acid on free radical production in cisplatin induced nephrotoxicity: an experimental rat model.

Cisplatin-induced nephrotoxicity is closely associated with an increase in lipid peroxidation. In several previous reports it was claimed that acetylsalicylic acid (ASA) shows its therapeutic potential as a free radical scavenger. The aim of the study was to investigate effects of ASA on cisplatin induced nephrotoxicity in an experimental rat model. Control animals (n:7) were administered 1 mL saline solution intraperitoneal (i.p.). Cisplatin group (n:7) was treated with a single dose of cisplatin i.p. (6 mg/kg), ASA group (n:7) was treated with i.p. (2.5 mg/kg) per day during the study, cisplatin plus ASA group (n:7) was administered single dose cisplatin i.p. (6 mg/kg) plus ASA (2.5 mg/kg) during 5 days. At the end of the study, Catalase (CAT), Glutathione Peroxidase (GSH-Px), Superoxide Dismutase (SOD), Nitric Oxide Synthase (NOS) enzymes activities and Malondialdehyde (MDA), Antioxidant Potential (AOP) levels were measured in both erythrocytes and renal tissues. Urea and creatinine levels and renal tissue necrosis in cisplatin plus ASA group were significantly lower than cisplatin group (p = 0.000, p = 0.014, p = 0.015). SODr activities and MDAr levels of cisplatin plus ASA group were also significantly lower than cisplatin group (p = 0.000, p = 0.029). These results show that cisplatin and ASA combination decreases the levels of urea and creatinine, reduces necrosis and improves antioxidant enzyme activities, MDA and AOP in rat kidney.

Pulmonary function tests, respiratory muscle strength, and endurance of patients with osteoporosis.

BACKGROUND: It has been shown that patients with thoracic kyphosis due to osteoporosis have diminished pulmonary function. The aim of this study was to determine the pulmonary function, respiratory muscle strength, and endurance of patients with osteoporosis who did not have compression fractures. METHODS: The patient group consisted of 88 recently diagnosed postmenopausal osteoporotic women without spinal fractures. They were matched for age and body mass index with 54 healthy women, who formed the control group. Bone mineral density, pulmonary function test (PFT), maximum voluntary ventilation (MVV), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP) measurements of both groups were performed. RESULTS: There were no significant differences between the two groups regarding PFT parameters and MIP and MEP. However, osteoporotic patients had significantly lower MW values. CONCLUSION: Women with postmenopausal osteoporosis without spinal compression fractures have normal PFT, MIP, and MEP values, but they have reduced respiratory muscle endurance.