The association between glycemia and clinical outcomes in patients with diabetes mellitus and pulmonary thromboembolism

ABSTRACT Objective: Various studies have shown that diabetes mellitus (DM) increases the risk of thrombosis in the venous system as well as in the arterial system. In this study, it was aimed to evaluate the association between admission blood glucose levels and clinical severity, recurrence, and mortality in pulmonary embolism in patients with DM. Materials and methods: This study was designed as a retrospective cross-sectional study. Patients with DM who were admitted to a tertiary care hospital due to pulmonary embolism (PE) between 2014 and 2019 were included. Demographic characteristics, radiological findings, clinical class of embolism, and mortality data were retrieved from hospital records. Patients with and without recurrent disease, as well as patients who survived and died, were compared. Also, patients were classified according to quartiles of admission blood glucose levels. The quartiles were compared in terms of mortality, clinical, class, and recurrence. Results: Two hundred ninety-three patients with DM and PE were included in the study. Patients with adverse outcome had significantly higher admission blood glucose levels (respectively, 197.9 ± 96.30 mg/dL vs. 170.7 ± 74.26 mg/dL; p = 0.03). Patients in the third and fourth quartile of admission blood glucose levels (>152 mg/dL) had significantly more severe disease with a higher proportion of massive and sub-massive PE and higher pro-BNP levels (respectively, p = 0.01 and 0.02). Conclusion: Non-survived patients and recurrent disease were associated with higher admission blood glucose levels. Also, patients with admission blood glucose levels higher than 152 mg/dL tend to have clinically more severe diseases.

The association between glycemia and clinical outcomes in patients with diabetes mellitus and pulmonary thromboembolism.

Objective: Various studies have shown that diabetes mellitus (DM) increases the risk of thrombosis in the venous system as well as in the arterial system. In this study, it was aimed to evaluate the association between admission blood glucose levels and clinical severity, recurrence, and mortality in pulmonary embolism in patients with DM. Materials and methods: This study was designed as a retrospective cross-sectional study. Patients with DM who were admitted to a tertiary care hospital due to pulmonary embolism (PE) between 2014 and 2019 were included. Demographic characteristics, radiological findings, clinical class of embolism, and mortality data were retrieved from hospital records. Patients with and without recurrent disease, as well as patients who survived and died, were compared. Also, patients were classified according to quartiles of admission blood glucose levels. The quartiles were compared in terms of mortality, clinical, class, and recurrence. Results: Two hundred ninety-three patients with DM and PE were included in the study. Patients with adverse outcome had significantly higher admission blood glucose levels (respectively, 197.9 ± 96.30 mg/dL vs. 170.7 ± 74.26 mg/dL; p = 0.03). Patients in the third and fourth quartile of admission blood glucose levels (>152 mg/ dL) had significantly more severe disease with a higher proportion of massive and sub-massive PE and higher pro-BNP levels (respectively, p = 0.01 and 0.02). Conclusion: Non-survived patients and recurrent disease were associated with higher admission blood glucose levels. Also, patients with admission blood glucose levels higher than 152 mg/dL tend to have clinically more severe diseases.

A Scoring System to Determine the Risk Factors Causing Recurrent Pulmonary Thromboembolism.

BACKGROUND: The risk of recurrence in pulmonary embolism is the highest in the first week after the acute event. Although it decreases over time, it may remain high for months depending on compliance with treatment and the nature of the underlying risk factor. Our study aimed to identify risk factors that lead to recurrence in pulmonary thromboembolism (PTE) patients and establish an easy-to-use scoring system that determines the risk of recurrence after the first embolism. METHODS: We retrospectively evaluated 1452 patients who were diagnosed with acute PTE between 7/1/2014 and 7/1/2019. Demographic data, comorbidities and clinical data of the patients, and risk factors were recorded. The relationship of the examined parameters with recurrent PTE was evaluated. RESULTS: Diabetes mellitus (DM), hypertension, obesity, and the presence of at least one hereditary risk factor were found to be associated with recurrence. The sensitivity of our score was 66.9%, the specificity was 63.2%, the positive predictive value was 19%, and the negative predictive value was 93.7%. The risk of recurrence in the patients identified as high-risk in the scoring system was 3.47 times higher than those identified as low-risk. CONCLUSION: In terms of risk of recurrence, special attention should be paid to patients with diabetes, HT, obesity and any of the hereditary risk factors. Using scoring systems to determine the risk of recurrence will be valuable and interesting as it is easy-to-use, gives quick results and provides quantitative results.

The Relationship between COVID-19 Severity and Bacillus Calmette-Guérin (BCG)/ Mycobacterium tuberculosis exposure history in healthcare workers: a multi-center study.

The COVID-19 pandemic has brought countries' health services into sharp focus. It was drawn to our group's attention that healthcare workers (HCWs) had a lower mortality rate against higher COVID-19 incidence compared to the general population in Turkey. Since risk of exposure to tuberculosis bacillus among healthcare workers are higher than the population, we aimed to investigate if there is a relationship between BCG and Mycobacterium tuberculosis exposure history with COVID-19 severity in infected HCWs. This study was conducted with 465 infected HCWs from thirty-three hospitals to assess the relationship between COVID-19 severity (according to their hospitalization status and the presence of radiological pneumonia) and BCG and Mycobacterium tuberculosis exposure history. HCWs who required hospital admission had significantly higher rates of chronic diseases, radiological pneumonia, and longer working hours in the clinics. Higher rates of history of contact and care to tuberculosis patients, history of tuberculosis, and BCG vaccine were observed in hospitalized HCWs. HCWs who had radiological pneumonia had a significantly increased ratio of history of care to tuberculosis patients and a higher family history of tuberculosis. The findings from our study suggest that the lower mortality rate despite the more severe disease course seen in infected HCWs might be due to frequent exposure to tuberculosis bacillus and the mortality-reducing effects of the BCG vaccine.

Value of Cancer Ratio plus and Cancer Ratio Formulation in Distinguishing Malignant Pleural Effusion from Tuberculosis and Parapneumonic Effusion.

Background: The aim of our study is to determine the clinical availability accessibility of cancer ratio and cancer ratio plus formulations, previously validated and reported to have clinical value in distinguishing malignant pleural effusion from tuberculosis pleurisy and parapneumonic effusion. Materials and Methods: Retrospective study of patients hospitalized with Malignant Pleural Effusion (MPE), tuberculosis (TPE) and pararapneumonic effusion (PPE) between 2009 and 2018. Results: Totally 232 patients, 101(43.5 %) having MPE, 86 (37.1 %) having PPE and 45 (19.4 %) TPE were examined. When compared with each other, "serum LDH / PS Lymphocyte %", "Cancer ratio" and "Cancer ratio plus" values were statistically different between the groups (p = 0.021, p <0.001 and p = 0.015, respectively). In multivariate logistic regression analysis, cancer ratio, serum LDH: pleural fluid lymphocyte count ratio was in positive correlation with MPE. The sensitivity and specificity of "cancer ratio", "cancer ratio plus" and "ratio of serum LDH: pleural fluid lymphocyte count" were 84.2 % (95% CI 75.6- 90.7) and 52.7 (95% CI 43.8- 61.5), and 82.2 % (95% CI 73.3- 89.1) and 45.8 (95%CI 37.1- 54.7), 53.5% (95% CI 43.3- 63.5) and 67.2% (95% CI 0.68-0.94) at the cut-off level of >14.25, >28.7, and >636, respectively. When considering only MPE and TPE patients, the specificity of cancer ratio and cancer ratio plus increased. Conclusion: The cancer ratio plus rate (the ratio of "cancer ratio"formulation to the percentage of differential pleural lymphocyte count) was almost the same as the cancer ratio in separating the malignant pleural effusion from the TPE and PPE, while it has better specificity only in differentiating malignant effusions from tuberculosis effusions.

Regional distribution of genetic mutation in lung cancer in Turkey (REDIGMA).

INTRODUCTION: The results of standard chemotherapy in lung cancer are not very satisfactory, so it is important to identify genetic mutations that provide targeted therapies. Recent reports have suggested influences of racial difference on the frequency of mutation in lung cancer. We aimed to determine the frequency and regional distribution of genetic mutations of non-small cell lung cancer (NSCLC) in Turkey. MATERIALS AND METHODS: Regional distribution of genetic mutations in lung cancer in Turkey (REDIGMA) study was carried out as a prospective, cross-sectional, observational study in a large number of centers in which lung cancer patients were followed and could perform genetic mutation analysis on patients' biopsy materials. RESULT: The 703 patients (77.7% male, mean age 63.3 ± 12.5 years) who were diagnosed as NSCLC from 25 different centers were included in the study. Tumor samples from patients were reported as 87.1% adenocarcinoma, 6.4% squamous cell carcinoma and 6.5% other. Mutation tests were found to be positive in 18.9% of these patients. The mutations were 69.9% EGFR, 26.3% ALK, 1.6% ROS and 2.2% PDL. Mutations were higher in women and non-smokers (p<0.000, p<0.001). Again, the frequency of mutations in adenocarcinoma was higher in metastatic disease. There was no difference between the patient's age, area of residence, comorbidity and clinical stage and mutation frequency. CONCLUSIONS: Our study revealed that the EGFR mutation rate in Turkey with NSCLC was similar to East European, African-American and Caucasian patients, and was lower than in East Asia.

Immunization status in chronic obstructive pulmonary disease: A multicenter study from Turkey.

OBJECTIVE: The purpose of this study is to detect the prevalence and the factors associated with influenza and pneumococcal vaccination and outcomes of vaccination during 2013-2014 season in patients with chronic obstructive pulmonary disease (COPD) in Turkey. METHODS: This was a multicenter retrospective cohort study performed in 53 different centers in Turkey. RESULTS: During the study period, 4968 patients were included. COPD was staged as GOLD 1-2-3-4 in 9.0%, 42.8%, 35.0%, and 13.2% of the patients, respectively. Influenza vaccination rate in the previous year was 37.9%; and pneumococcus vaccination rate, at least once during in a life time, was 13.3%. Patients with older age, higher level of education, more severe COPD, and comorbidities, ex-smokers, and patients residing in urban areas had higher rates of influenza vaccination. Multivariate logistic regression analysis showed that advanced age, higher education levels, presence of comorbidities, higher COPD stages, and exacerbation rates were associated with both influenza and pneumococcal vaccination. The number of annual physician/outpatient visits and hospitalizations due to COPD exacerbation was 2.73 ± 2.85 and 0.92 ± 1.58 per year, respectively. Patients with older age, lower education levels, more severe COPD, comorbid diseases, and lower body mass index and patients who are male and are residing in rural areas and vaccinated for influenza had significantly higher rates of COPD exacerbation. CONCLUSIONS: The rates of influenza and pneumococcal vaccination in COPD patients were quite low, and the number of annual physician/outpatient visits and hospitalizations due to COPD exacerbation was high in Turkey. Advanced age, higher education levels, comorbidities, and higher COPD stages were associated with both influenza and pneumococcal vaccination.

Contributing factors to mortality rates of pulmonary tuberculosis in intensive care units.

BACKGROUND: Tuberculosis (TB) remains an important health problem worldwide. TB patients sometimes require intensive care unit (ICU) treatment. The aim of this study is to establish special features and mortality rates of pulmonary TB patients in ICUs and identify the factors contributing to ICU mortality. METHODS: Medical records of adult patients (>18 years) with a diagnosis of TB who were admitted to the ICU of a referral hospital for chest diseases between 2004 and 2010 were reviewed retrospectively. Demographic characteristics, comorbidities, APACHE II scores, symptoms, radiologic appearance of the disease, bacteriological and laboratory investigations, need and type of mechanical ventilation support (invasive, non-invasive), characteristics related to ICU stay, length of ICU stay, mortality and factors affecting mortality were recorded and analysed. RESULTS: Forty patients (33 male) with active pulmonary TB with a median age of 55 years (43-63 years) and a median APACHE II score of 22 (17-26) were followed up in the ICU. Patients who needed invasive mechanical ventilation had significantly longer ICU stays than patients who were treated with non-invasive ventilation or medical therapy (Log rank p = 0.014). Mortality was 72.5%. The only independent risk factor for mortality was having an APACHE II score ≥18. CONCLUSION: The mortality of TB patients who needed ICU support remains high. This higher mortality rate seems related to multi-organ failure, requiring invasive mechanical ventilation and high APACHE II scores.

Assessment of Extrapulmonary Tuberculosis in Two Provinces of Turkey.

BACKGROUND: Tuberculosis (TB) is one of the main health issues in Turkey. Extrapulmonary TB cases have significant proportion comparing pulmonary TB cases. The aim of the study was to evaluate the extrapulmonary tuberculosis (EPTB) cases in two regions of Turkey, which have different demographic and socioeconomic characteristics. METHODS: In this retrospective cohort study, EPTB cases between 2000 and 2005 in Van and Izmir Provinces of Turkey were analyzed and compared for symptoms, age groups, vaccination status, diagnostic procedures and social-economical conditions within two provinces. Descriptive analytic methods were used. RESULTS: Total of 397 EPTB cases were reviewed retrospectively in Izmir and Van provinces. Pleural TB was most often seen EPTB form (47.6% vs. 32.6%) and female/male ratio was similar in both groups. Patients were in older ages in Izmir Province. Chest pain (20% vs. 32%), cough (33% vs. 26%) and night sweatiness (29% vs. 36%) were leading complaints. Low BCG vaccination rate and higher childhood EPTB were found in Van group, in contrary elderly EPTB was more often in of Izmir group. CONCLUSION: Frequency of severe forms of EPTB is more often in younger ages in lower social economical condition areas.

A randomized controlled trial comparing the ventilation duration between adaptive support ventilation and pressure assist/control ventilation in medical patients in the ICU.

BACKGROUND: Adaptive support ventilation (ASV) is a closed loop mode of mechanical ventilation (MV) that provides a target minute ventilation by automatically adapting inspiratory pressure and respiratory rate with the minimum work of breathing on the part of the patient. The aim of this study was to determine the effect of ASV on total MV duration when compared with pressure assist/control ventilation. METHODS: Adult medical patients intubated and mechanically ventilated for > 24 h in a medical ICU were randomized to either ASV or pressure assist/control ventilation. Sedation and medical treatment were standardized for each group. Primary outcome was the total MV duration. Secondary outcomes were the weaning duration, number of manual settings of the ventilator, and weaning success rates. RESULTS: Two hundred twenty-nine patients were included. Median MV duration until weaning, weaning duration, and total MV duration were significantly shorter in the ASV group (67 [43-94] h vs 92 [61-165] h, P = .003; 2 [2-2] h vs 2 [2-80] h, P = .001; and 4 [2-6] days vs 4 [3-9] days, P = .016, respectively). Patients in the ASV group required fewer total number of manual settings on the ventilator to reach the desired pH and Paco2 levels (2 [1-2] vs 3 [2-5], P < .001). The number of patients extubated successfully on the first attempt was significantly higher in the ASV group (P = .001). Weaning success and mortality at day 28 were comparable between the two groups. CONCLUSIONS: In medical patients in the ICU, ASV may shorten the duration of weaning and total MV duration with a fewer number of manual ventilator settings. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01472302; URL: www.clinicaltrials.gov.

Effectiveness and safety of a protocolized mechanical ventilation and weaning strategy of COPD patients by respiratory therapists.

INTRODUCTION: Prior researches have showed that weaning protocols may decrease the duration of mechanical ventilation. The effect of these protocols on chronic obstructive pulmonary disease (COPD) patients is unknown. The purpose of this study was to evaluate the impact of an extensive mechanical ventilation protocol including weaning applied by a respiratory therapist (RT) on the duration of mechanical ventilation and intensive care unit (ICU) stay in COPD patients. MATERIALS AND METHODS: A novel mechanical ventilation protocol including weaning was developed and initiated for all intubated COPD patients by a respiratory therapist. Outcomes of patients treated using this protocol during a 6-month period were compared to those of patients treated by physicians without a protocol during the preceding 6 months. RESULTS: A total of 170 patients were enrolled. Extubation success was significantly higher (98% vs. 78%, P=0.014) and median durations of weaning, mechanical ventilation and ICU stay compared with time to event analysis were significantly shorter in the protocol based group (2 vs. 26 hours, log rank P<0.001, 3.1 vs. 5 days, log rank P<0.001 and 6 vs. 12 days, log rank P<0.001, respectively). Patients who were successfully extubated and patients in the protocol based group were more likely to have shorter ventilation duration [HR: 1.87, 95% confidence intervals (CI): 1.13-3.08, P=0.015 and HR: 2.08, 95% CI: 1.40-3.10, P<0.001 respectively]. CONCLUSIONS: In our center, a protocolized mechanical ventilation and weaning strategy improved weaning success and shortened the total duration of mechanical ventilation and ICU stay in COPD patients requiring mechanical ventilation.

Markers of lower respiratory tract infections in emergency departments.

BACKGROUND: Acute respiratory tract infections are the common causes for admission to emergency department. Appropriate diagnosis and initiating treatment on time are important for reducing morbidity and mortality rate due to lower respiratory tract infection (LRTI). The aim of this study is to determine if C-reactive protein (CRP) levels and white blood cells (WBC) count are considerable markers to help rapid diagnosis and prediction of antibiotic need for lower respiratory infections in emergency departments. The relationships between infectious agents and those markers have also been evaluated. METHODS: Study subjects and control group were selected by defined criteria. Patients were analyzed and assessed for CRP and WBC, sputum Gram stain and culture besides routine laboratory tests and chest X-Rays. RESULTS: One hundred and ninety four episodes out of 175 patients were evaluated for the study. CRP level and WBC count were detected significantly higher in patients ofstudy group than in those of control group. Pseudomonas aeruginosa and Haemophilus influenzae were the pathogens most often isolated. CONCLUSION: In conclusion, CRP and WBC sputum are important markers for diagnosis of LRTI at the emergency departments and results of microbiological analysis of respiratory specimens were correlated with these markers. TRIAL REGISTRATION: Registation number of ethic committee of Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital: 28.04.2006/114.

Why do patients with interstitial lung diseases fail in the ICU? a 2-center cohort study.

BACKGROUND: Admitting patients with interstitial lung disease (ILD) to the ICU is controversial, due to their associated high mortality when they require invasive mechanical ventilation. We aimed to determine the risk factors for mortality in ILD patients requiring ICU support due to acute respiratory failure. METHODS: An observational cohort study was performed in 2 chest diseases teaching hospitals. We included all ILD patients with acute respiratory failure admitted between 2008 and 2010. Subject demographics, noninvasive ventilation (NIV) and invasive ventilation use, and mortality were obtained from medical records. Subjects receiving NIV were divided based on their continuous or non-continuous demand for NIV. NIV failure was defined as intubation for invasive ventilation, or death during NIV. Cox regression analysis was used to determine the hazard ratio for NIV failure. RESULTS: We enrolled 120 subjects: 71 male, median age 66 years. The types of ILD were idiopathic pulmonary fibrosis (n = 96), collagen vascular disease (n = 10), silicosis (n = 9), drug induced (n = 3), and eosinophilic pneumonia (n = 2). The median (IQR) Acute Physiology and Chronic Health Evaluation (APACHE II) score was 24 (19-31), and 75 (62.5%) subjects received NIV on ICU admission, 47 (62.7%) of whom needed continuous NIV. The NIV failure rate was 49.3% (n = 37). The mortality rates of continuous NIV, non-continuous NIV, invasive ventilation, and total ICU were 61.7% (29/47), 10.7% (3/28), 89.7% (61/68), 60% (72/120), respectively. APACHE II > 20 and continuous NIV demand indicated significant risk for NIV failure: hazard ratio 2.77 (95% CI 1.19-6.45), P < .02, and 5.12, (1.44-18.19), P < .01, respectively. CONCLUSIONS: Because of higher mortality, physicians should consider invasive ventilation cautiously in the ICU management of ILD patients with acute respiratory failure. NIV may be an option in less severely ill patients with APACHE II score < 20.

Tracheobronchopathia osteochondroplastica: four cases.

Tracheobronchopathia osteochondroplastica (TO) is a rare and benign disorder of unknown cause affecting the large airways. It is characterized by the presence of multiple osseous and cartilaginous nodules in the submucosa of the trachea and main bronchi that is characterized by the progression of submucosal bone and/or cartilage including nodules through the lumen of trachea and bronchus. We present four cases that were diagnosed TO while investigating for the causes of hemoptysis and chronic cough. We plan to emphasize TO in differential diagnosis in proper patients.

Assessment of lymph node tuberculosis in two provinces in Turkey.

The aim of this study was to evaluate lymph node tuberculosis (LNT) cases in two provinces in Turkey with different demographic and socioeconomic characteristics. A total of 109 LNT cases were reviewed retrospectively. The cases were analyzed and compared for symptoms, findings, age, vaccination status, and diagnostic procedures. Socioeconomic conditions were also assessed for the two provinces. A palpable cervical node was considered a significant predictor for all LNT. Mediastinal lymph node involvement was found to be common in cases of pulmonary manifestation of LNT. Female patients were predominantly from the Van Province, while older patients were found to be from Izmir Province. LNT should be suspected in lymphadenitis patients of all age-groups especially in young adolescents with cervical lymph node enlargements. In the presence of mediastinal lymphadenopathy, pulmonary tuberculosis should be investigated.

Survival from severe pandemic H1N1 in urban and rural Turkey: a case series.

BACKGROUND: Pandemic influenza A (H1N1) was a serious health problem during the winter of 2009-2010 in Turkey. OBJECTIVE: To clarify the clinical and demographic characteristics of patients who needed intensive care in our region. METHODS: We conducted a prospective cohort study from November 2009 to February 2010 of demographic characteristics, clinical course, management strategies, 28-day mortality, and stay in the intensive care unit (ICU). RESULTS: During the study period, in our ICU we followed 18 patients (10 female) with H1N1. Their median (and IQR) age was 39 y (24-52 y), their median (and IQR) Acute Physiology and Chronic Health Evaluation (APACHE II) score was 16 (10-25), and 7 (39%) of them lived in rural places. All 18 patients had acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). The most common risk factors for severe H1N1 infection were obesity (33%), COPD (16%), and pregnancy (11%). Thirteen patients (72%) needed mechanical ventilation at ICU admission. Mortality was 50% (9/18) at day 28. Significantly more survivors were urban dwellers than rural (82% vs 0%, P < .001). There were also statistically significant differences between survivors and nonsurvivors in success of noninvasive ventilation, time to confirmation of the H1N1 virus after ICU admission, creatinine, lactate dehydrogenase, pH, P(aCO(2)), and P(aO(2))/F(IO(2)). CONCLUSIONS: The most common clinical presentation was ALI/ARDS in H1N1 patients who needed intensive care. Living in rural areas might have affected those patients' access to advanced ICU facilities and early ventilatory support. Failure of noninvasive ventilation, late diagnosis, late antiviral therapy, high APACHE II score, and living in a rural area were associated with mortality.

Tuberculosis in diabetics: features in an endemic area.

Diabetes mellitus (DM) is known as one of the factors that increases the risk of tuberculosis (TB). TB can also show atypical clinical presentation and localization in diabetics. The aim of the study was to evaluate the features of TB in diabetics in our region. Between 1997 and 2003, all cases of diabetic TB patients and an equal number of non-diabetics treated and followed at the Esrefpasa Tuberculosis Dispensary were analyzed retrospectively. A total of 78 (7.3%) TB cases in DM patients was encountered among 1,063 TB cases. Cavity formation and atypical localization were more often found in diabetics (P<0.05). Duration of treatment was longer in diabetics (P<0.05). The rate of drug resistance was higher in DM cases, but cure rates were similar between groups. A diagnosis of TB should be considered in diabetics with an abnormal chest radiograph, in the presence of absence of specific clinical symptoms, in endemic regions. Diabetic TB cases should be followed especially closely in terms of cure time and drug resistance.

Patterns of drug resistance in pulmonary tuberculosis cases in the Izmir district, Turkey.

Antituberculosis drug resistance patterns were investigated among the new and previously treated pulmonary tuberculosis (TB) cases in Izmir district, retrospectively. Proportions of resistance patterns were determined using a number of resistant cases using as a denominator. Resistance to at least one drug was found in 304 (29.7%) patients in 1023 a total of tuberculosis cases. 182 new and 82 previously treated consecutive pulmonary tuberculosis cases were investigated. Patterns were examined as single and/or probable combinations of isoniazid (H), rifampicin (R), ethambutol (E) and streptomycin (S). Single drug resistance mode, mono S, and HS resistance patterns were the highest proportions in comparison with other modes and patterns in both new and previously treated cases. HRS pattern showed a significant proportion and proportions of quadruple mode were higher than triple mode in previously treated cases. Proportions of patterns associated with R were detected more than expected. Surveillance of proportions of anti-TB drug resistance is important as well as surveillance of resistance rates.

[Factors affecting the prognosis in patients with primary lung cancer and brain metastases]. / Beyin metastazi bulunan primer akciger kanserli hastalarda prognozu etkileyen faktörler.

Brain metastases are frequent features during the course of patients with lung carcinoma. The aim of this study was to investigate prognostic factors for patients with brain metastasis from lung cancer. Eighty-eight patients with brain metastasis from lung cancer were enrolled in the study. Eighty-two of cases were male, six were female and the mean age was 57.5 +/- 10.4 years. The most common symptoms were headache (32.9%) and dizziness (32.9%). Fifty-two (59.1%) patients had solitary brain metastasis and the most frequent metastasing site was parietal lobe (34.1%). The median survival times were 3 months after diagnosis of lung carcinoma and 1.5 months after diagnosis of brain metastasis. Although the absence of brain metastasis at the moment of diagnosis, metachronous metastasis, central localization of the tumour, chemotherapy administration and surgical treatment of brain metastasis are good prognostic factors affecting survival after the diagnosis of lung carcinoma, the positive factors affecting survival after brain metastasis are central localization of tumour, chemotherapy administration and surgical treatment of brain metastasis. In conclusion, performing the combination of cranial radiotherapy, chemotherapy, surgical therapy and supporting therapy should be evaluated in all appropriate patients with brain metastasis from lung cancer.