Chest X-ray Findings and Prognostic Factors in Survival Analysis in Peritoneal Dialysis and Hemodialysis Patients: A Retrospective Cross-Sectional Study.

Background and Objectives: This study aims to analyze survival in peritoneal and hemodialysis patients using chest radiography and biochemical parameters, determine common dialysis etiologies and causes of death, reveal prognostic factors, and contribute to clinical practice. Materials and Methods: A retrospective cross-sectional study was conducted with data from 33 peritoneal dialysis and 37 hemodialysis patients collected between October 2018 and February 2020. Survival and mortality were retrospectively tracked over 70 months (October 2018-June 2024). Chest X-ray measurements (cardiothoracic index, pulmonary vascular pedicle width, right pulmonary artery diameter, diaphragmatic height) and biochemical parameters (urea, albumin, creatinine, parathormone, ferritin, hemoglobin, arterial blood gas, potassium) were analyzed for their impact on survival. Statistical analyses included descriptive statistics, chi-square test, Fisher's exact test, Bayesian analysis, McNemar test, Kaplan-Meier survival analysis, Cox regression, Bayesian correlation test, linear regression analysis (scatter plot), and ROC analysis. SPSS 20.0 was used for data analysis, with p < 0.05 considered statistically significant. Results: Hypertension, type 2 diabetes, and urogenital disorders were the main dialysis etiologies. Peritonitis (38.5%) and cardiovascular diseases (47.4%) were the leading causes of death in peritoneal and hemodialysis patients, respectively. Significant chest X-ray differences included pulmonary vascular pedicle width and pulmonary artery diameter in hemodialysis and diaphragm height in peritoneal dialysis. Kaplan-Meier showed no survival difference between methods. Cox regression identified age, intact parathormone levels, iPTH/PVPW ratio, and clinical status as survival and mortality factors. The iPTH/PVPW ratio cut-off for mortality prediction was ≤6.8. Conclusions: Age, intact parathormone levels, pulmonary vascular pedicle width, and clinical status significantly impact survival in dialysis patients. Management of hypertension and diabetes, management and follow-up of urogenital disorders, infection control, patient education, and regular cardiovascular check-ups may improve survival rates. Additionally, the iPTH/PVPW ratio can predict mortality risk.

[A rarely isolated bacterium in microbiology laboratories: Streptococcus uberis]. / Mikrobiyoloji laboratuvarlarinda nadir izole edilen bir etken: Streptococcus uberis.

Streptococcus uberis is a gram-positive bacterium that is mostly responsible for mastitis in cattle. The bacterium rarely has been associated with human infections. Conventional phenotyphic methods can be inadequate for the identification of S.uberis; and in microbiology laboratories S.uberis is confused with the other streptococci and enterococci isolates. Recently, molecular methods are recommended for the accurate identification of S.uberis isolates. The aim of this report is to present a lower respiratory tract infection case caused by S.uberis and the microbiological methods for identification of this bacterium. A 66-year-old male patient with squamous cell lung cancer who received radiotherapy was admitted in our hospital for the control. According to the chest X-Ray, patient was hospitalized with the prediagnosis of ''cavitary tumor, pulmonary abscess''. In the first day of the hospitalization, blood and sputum cultures were drawn. Blood culture was negative, however, Candida albicans was isolated in the sputum culture and it was estimated to be due to oral lesions. After two weeks from the hospitalization, sputum sample was taken from the patient since he had abnormal respiratory sounds and cough complaint. In the Gram stained smear of the sputum there were abundant leucocytes and gram-positive cocci, and S.uberis was isolated in both 5% sheep blood and chocolate agar media. Bacterial identification and antibiotic susceptibility tests were performed by VITEK 2 (Biomerieux, France) and also, the bacterium was identified by matrix assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS) based VITEK MS system as S.uberis. The isolate was determined susceptible to ampicillin, erythromycin, clindamycin, levofloxacin, linezolid, penicillin, cefotaxime, ceftriaxone, tetracycline and vancomycin. 16S, 23S ribosomal RNA and 16S-23S intergenic spacer gene regions were amplified with specific primers and partial DNA sequence analysis of 16S rRNA polymerase chain reaction (PCR) products were performed by 3500xL Genetic Analyzer (Applied Biosystems, USA). According to the partial 16S rRNA gene sequencing results, bacterium was confirmed as S.uberis. This report makes a significant contribution to the number of case reports of human infections caused by S.uberis as the identification was performed by current microbiological methods in our case. In conclusion, S.uberis should be evaluated as an opportunistic pathogen among the immunosuppressed patients and in addition to phenotypic bacteriological methods, the other recent microbiological methods should also be utilized for the identification.

Sonography of the chest using linear-array versus sector transducers: Correlation with auscultation, chest radiography, and computed tomography.

PURPOSE: The primary purpose of our study was to compare the efficacies of two sonographic (US) probes, a high-frequency linear-array probe and a lower-frequency phased-array sector probe in the diagnosis of basic thoracic pathologies. The secondary purpose was to compare the diagnostic performance of thoracic US with auscultation and chest radiography (CXR) using thoracic CT as a gold standard. METHODS: In total, 55 consecutive patients scheduled for thoracic CT were enrolled in this prospective study. Four pathologic entities were evaluated: pneumothorax, pleural effusion, consolidation, and interstitial syndrome. A portable US scanner was used with a 5-10-MHz linear-array probe and a 1-5-MHz phased-array sector probe. The first probe used was chosen randomly. US, CXR, and auscultation results were compared with the CT results. RESULTS: The linear-array probe had the highest performance in the identification of pneumothorax (83% sensitivity, 100% specificity, and 99% diagnostic accuracy) and pleural effusion (100% sensitivity, 97% specificity, and 98% diagnostic accuracy); the sector probe had the highest performance in the identification of consolidation (89% sensitivity, 100% specificity, and 95% diagnostic accuracy) and interstitial syndrome (94% sensitivity, 93% specificity, and 94% diagnostic accuracy). For all pathologies, the performance of US was superior to those of CXR and auscultation. CONCLUSIONS: The linear probe is superior to the sector probe for identifying pleural pathologies, whereas the sector probe is superior to the linear probe for identifying parenchymal pathologies. Thoracic US has better diagnostic performance than CXR and auscultation for the diagnosis of common pathologic conditions of the chest. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:383-389, 2016.

Economic burden of nosocomial pneumonia in non-intensive care clinics.

INTRODUCTION: Almost all data on the cost of nosocomial pneumonia (NP) in the literature is associated with ventilator-associated pneumonia. This study aims to determine the economic burden of nosocomial pneumonia in clinical inpatients. MATERIALS AND METHODS: Data on costs of the 154 adult patients (97 male, 57 female; mean age 64.53 ± 14.92) who were hospitalized in non-intensive care clinics and developed NP were recorded prospectively. The control group consisted of 148 patients without pneumonia matched for age (mean age 65.66 ± 13.86), sex (94 male), diagnosis, and hospitalization date. Data obtained from both groups of patients for the number of hospitalization days and the data obtained from the hospital automation program (Avicenna) for costs were compared using the Mann-Whitney U test. RESULTS: While the mean duration of hospitalization was 32.8 days in patients with NP, it was 9.8 (p< 0.0001) in the control group. The cost of hospital beds was $631 for NP patients and $153 for the controls (p< 0.0001). The total cost was $6241 for NP patients and $1117 for the controls (p< 0.0001). CONCLUSION: NP is a high-cost condition that increases the duration of hospitalization 3.5-fold, hospital-bed cost 4-fold, and the total cost 5-fold.

Characteristics of patients with symptomatic and incidental pulmonary thromboembolism.

Introduction: Pulmonary thromboembolism (PTE) has a wide range of clinical presentations. With the advances in computed tomography (CT) technology and easier access to CT, the incidence of incidentally diagnosed cases of PTE has increased. The main aim of our study was to determine the frequency of patients incidentally diagnosed with PTE and whether these patients differ from patients with symptomatic PTE in terms of case characteristics. Materials and Methods: We retrospectively analysed the charts of 148 patients with PTE diagnosed and treated in 2022. Demographic characteristics, thrombus localisation, risk factors, and treatment modalities were compared between symptomatic patients with clinically suspected PTE and patients with incidentally diagnosed PTE by imaging methods performed for other purposes without clinically suspected PTE. Result: Out of 148 patients with PTE, 42 (28.3%) were diagnosed incidentally. The rate of concomitant malignancy was significantly higher in patients with incidental PTE (54.8%) than in patients with symptomatic PTE (28.3%) (p < 0.01). There was no significant difference between symptomatic and incidental PTE patients in terms of the pulmonary artery segment in which the thrombus was located (p > 0.05). Conclusions: In our patient group, approximately one out of four patients diagnosed with PTE were incidentally diagnosed. Patients with malignancies may not have symptoms suspicious for PTE or their symptoms may go unrecognized.

Polysomnography findings and risk factors for sleep-disordered breathing in patients with systemic sclerosis.

OBJECTIVES: This study aims to evaluate polysomnography findings and risk factors for sleep-disordered breathing in patients with systemic sclerosis (SSc). PATIENTS AND METHODS: Thirty-nine patients (2 males, 37 females; mean age: 51.1±12.5 years; range, 21 to 76 years) who attended to the Rheumatology Clinic of Trakya University Medical Faculty between March 2014 and May 2014 were included in the study. Thoracic computed tomography, pulmonary function tests, carbon monoxide diffusion tests, echocardiography, and all-night polysomnography in a sleep laboratory were performed in all patients. Demographic and clinical characteristics of the patients were recorded. The Apnea-Hypopnea Index (AHI) scores were calculated. Disease activity was examined using the Medsger Disease Severity Scale (MDSS). Possible risk factors for sleep-disordered breathing were evaluated. RESULTS: Using the AHI of ≥5 for obstructive sleep apnea (OSA), 21 (53.8%) of the patients were classified as having OSA. There were no significant differences between the groups with and without OSA in terms of steroid use (p=0.4), CT involvement (p=0.3), and Warrick (p=0.6) and MDSS scores (p=0.5). Age, body mass index (BMI), and mean oxygen desaturation index were found to be significant in the univariate analysis (p<0.1); however, the multivariate analysis revealed only BMI as significant risk factor of OSA (p=0.028). In the multivariate analysis, the mean saturation was found to be significant risk factor for high pulmonary artery pressure (p<0.001). CONCLUSION: Although OSA is common in SSc, only increased BMI is a significant risk factor of OSA, but not lung involvement, Warrick scores, or MDSS scores.

[Effecting factors on survival in patients taking thrombolytic treatment due to massive pulmonary embolism]. / Masif pulmoner emboli nedeniyle trombolitik tedavi uygulanan hastalarda yasam süresi üzerine etki eden faktörler.

Massive pulmonary embolism (MPE) is a life threatening disease, thrombolytic treatment could save lives. The aims of this study are to identify early and late mortality rates in patients with MPE who received thrombolytic treatment, and mortality related risk factors. All the hospital records for the MPE patients who received thrombolytic treatment between 1998 and 2006 were retrospectively investigated. Pulmonary embolism was diagnosed through computed tomografi scan and V/P scintigraphy. Due to MPE, 21 women total 41 patients who undergo tPA or streptokinase were included in the study. Kaplan-Meier for the survival analysis and cox regression analysis for determining the mortality related independent risk factors were used. Dying while staying in hospital was accepted as early or hospital mortality, after discharge from hospital as late mortality. Out of 41 patients, 12 of them died while they are hospitalized (hospital mortality; 29%) 6 of them died after they were discharged (late mortality; 21%). The average survival time among discharged patients was 2304 days (95% confidence interval: 1725-2884). Among those patients who took streptokinase or tPA, late or early mortality rates (p> 0.05) and survival time did not show significant difference (p= 0.8908). The presence of arrhythmia [p= 0.01; odds rate (OR): 6.25] and jugular vein distention (JVD) (p= 0.03; OR: 6.25) for hospital mortality and multiple ongoing health problems for the late mortality were identified as the independent risk factors. For the hospital mortality, the presence of JVD or arrhythmia, for prognostic sensitivity, specificity, positive predictive value and negative predictive value were recorded as 75%, 79%, 60% and 88% respectively. In conclusion, the presence of arrhythmia and/or JVD on a patient with MPE is a negative prognostic factor for hospital mortality. The presence of other ongoing health problems influences the survival time of the discharged patients.

Hospital-acquired pneumonia in patients receiving immunosuppressive therapy.

OBJECTIVE: The aims of this study were to determine the clinical success rates, effect of neutropenia on treatment success rates, risk factors related to mortality, and survival in patients who developed hospital-acquired pneumonia (HAP) while receiving immunosuppressive therapy. METHODS: Forty-three adult patients receiving immunosuppressive therapy who developed HAP were included in this prospective study. Transplantation patients and human immunodeficiency virus (HIV)-positive patients were not included. Antibiotic treatment was managed by a multidisciplinary team. The Kaplan Meier method was used for the survival analysis and Cox regression was used for the identification of mortality-related independent risk factors. The relationship between neutropenia and the clinical success rate was determined using the chi-square test. RESULTS: Although anti-pseudomonal antibiotics were started empirically in 40 of the 43 patients (93%) at the beginning of the treatment, the most frequently isolated pathogens were Acinetobacter spp. and Escherichia coli. The success rate at the end of the treatment was 65.1%. The survival rates for the 3rd, 14th, 42nd, and 365th days were 97%, 86%, 58%, and 19%, respectively. Elevated levels of urea [Hazard Ratio=1.01 (95% CI: 1.00-1.02)] and blood glucose [HR=1.01 (95% CI: 1.00-1.02)] were found to be independent risk factors affecting survival. The treatment success rate was higher in patients without neutropenia (n=23) than in those with neutropenia (n=20) (p=0.05). CONCLUSION: The treatment success rate was low in patients who developed HAP while receiving immunosuppressive therapy.

Hospital-acquired pneumonia developed in non-intensive care units.

BACKGROUND: There are few studies about hospital-acquired pneumonia (HAP) developing in non-intensive care units (non-ICUs). OBJECTIVES: The aim of this study was to determine the incidence rate of non-ICU HAP, the risk factors associated with mortality and the survival rates of HAP patients at 6 weeks and 1 year. PATIENTS AND METHODS: Between March 2005 and February 2006, 154 adult patients (97 males) with HAP were prospectively evaluated. Immunocompromised patients who were developing pneumonia were excluded from the study. The HAP incidence was calculated and survival was noted at 6 weeks and 1 year later. Kaplan-Meier methods were used for survival analysis; Cox regression was used to identify the risk factors associated with HAP-induced mortality. RESULTS: During the study, and not counting those in the ICU, 45,679 adult patients were hospitalized. Of these, 154 patients developed HAP (incidence 3.3 cases/1,000 patients). The mean age of those developing HAP was 64.53 ± 14.92 years (range 15-98). Survival rates at the 3rd, 7th, 14th, 42nd and 365th day were 91, 89, 69, 49 and 29%, respectively. Independent risk factors associated with 6-week mortality were: age [relative risk (RR) 1.026; 95% confidence interval (CI) 1.008-1.045], chronic renal failure (RR 1.8; 95% CI 1.087-3.086), aspiration risk (RR 2.86; 95% CI 1.249-6.564), steroid use (RR 2.35; 95% CI 1.306-4.257), and multilobar infiltration (RR 2.1; 95% CI 1.102-4.113). CONCLUSION: HAP - even if it develops in non-ICU environments - is hard to treat and has a higher mortality rate.

[Churg-Strauss syndrome associated with montelukast]. / Montelukast ile iliskili Churg Strauss sendromu.

A 47 year old woman who had a history of asthma for 15 years referred to our hospital because of infiltrates on her chest radiograph that not responded to antibiotic treatment. We found that she had eosinophilia in peripheral blood (38%) and bronchoalveolar lavage (54%), nasal polyposis, and transient pulmonary infiltrates, and in the base of these findings we diagnosed as Churg-Strauss Syndrome (CSS). She has been using montelukast for 2 years. By examining her previous medical records, we observed that while eosinophil rates in peripheral blood were normal before montelukast usage, after this therapy eosinophil rates were greater 10 percent. Therefore, we thought that CSS was to be associated with montelukast usage. After just montelukast therapy was discontinued, clinical and radiographic parameters and the eosinophil counts (20%) improved. We present this case of CSS associated with montelukast in whom spontaneous remission was observed without using corticosteroids and cytotoxic agents.

Relation of the frequency and mortality of pulmonary thromboembolism with meteorological parameters.

OBJECTIVE: The objective of this study is to find the relationship between incidence rate and mortality of acute pulmonary thromboembolism (PTE), and seasonal and meteorological factors. MATERIALS AND METHODS: The data from 234 patients who were hospitalized due to acute PTE in the emergency service or policlinics between 2001 and 2008 were investigated retrospectively. Cases that developed APE (acute pulmonary embolism) in the hospital were excluded. Seasons and months in which acute PTE was diagnosed were recorded. Mortality rates by months and seasons were evaluated. The mean pressure, temperature and humidity values were evaluated for periods of three days, seven days and one month before the day of presentation. The effects of meteorological factors on the severity (massive or non-massive) and mortality of APE were investigated. RESULTS: The incidence rate of acute APE showed a significant difference according to seasons (p=0.000). APE was diagnosed most commonly in spring and winter. The mean pressure values for three days, seven days and one month and the mean humidity values for three days for the dead patients were found to be significantly lower than those of the survived ones (p<0.05). The mortality rate for patients admitted in summer was significantly higher than the rates for other seasons (p=0.02). There were no seasonal differences among the massive APE incidences. Mortality rates were higher in summer because of the nonmassive APE patients rather than the massive patients. CONCLUSION: Acute PE is a disease whose incidence and mortality rates are affected by meteorological factors.

A new clinical model in pulmonary embolism and its correlation with V/P scan results.

The study was prospectively designed to assess the correlation between a new clinical model empirically developed for acute pulmonary embolism (PE) and ventilation/perfusion (V/P) scan results. One hundred sixty consecutive patients with suspected acute PE underwent clinical evaluation before V/P scintigraphy. The clinical probability of PE was categorized according to a structured clinical model empirically developed as low, intermediate, or high, and the results were compared with those of V/P scintigraphy. Forty, 61, and 59 patients were classified as low, intermediate, and high clinical probability, respectively. Seventy-five percent (30/40) of the patients with low clinical probability were also of low scintigraphic probability or had a normal result (r(s): 0.39, p=0.000); 28% (17/61) of the patients with intermediate clinical probability demonstrated intermediate scintigraphic probability (r(s): 0.20, p=0.012); and 68% (40/59) of the patients with high clinical probability were also of high scintigraphic probability (r(s): 0.43, p=0.000). Overall, the correlation of two scoring systems was statistically significant (r(s): 0.39, p=0.000). Unilateral leg swelling (p=0.027), syncope or near syncope (p=0.002), amputation of a hilar artery (p=0.007), and electrocardiographic signs of right ventricular overload (p=0.000) prevailed in patients with high scintigraphic probability. "Syncope-near syncope or hemodynamic collapse" PLUS "electrocardiographic signs of right ventricular overload or hypoxemia" combination had the most significant correlation with a high scintigraphic probability (r(s): 0.31; p=0.000). In conclusion, the new clinical model empirically developed was significantly successful to provide comparable results with V/P scan. This consistency was particularly prominent in patients with low or high clinical probability for PE.

Effectiveness of Thoracic Ultrasonography in the Evaluation of the Severity of Pulmonary Involvement in Patients With Systemic Sclerosis.

OBJECTIVES: This study aims to investigate the effectiveness of thoracic ultrasonography (USG) in a single session in the evaluation of the severity of pulmonary involvement in systemic sclerosis. PATIENTS AND METHODS: A total of 48 consecutive systemic sclerosis patients (2 males, 46 females; mean age 50.8±11.9 years; range 21 to 76 years) followed-up in our center were included. A thoracic USG using a linear probe was performed for each patient to evaluate the parenchymal involvement by two pulmonary disease specialists. The number of B-lines (B-lines described USG sign of interstitial lung fibrosis) was recorded. Systolic pulmonary artery pressure was measured by means of using a phase probe to evaluate pulmonary hypertension in the same sequence. The same day, pulmonary function tests were conducted. Warrick score was calculated according high resolution computed tomography (HRCT) images which were evaluated independently from each other by a radiologist and a pulmonary disease specialist. Medsger severity scale was calculated for each patient according to the results of HRCT findings, pulmonary function test, and systolic pulmonary artery pressure. RESULTS: The number of B-lines detected on thoracic USG was correlated with the Warrick score (r=0.89; p=0.0001) and Medsger disease scale (r=0.55; p=0.0001) and negatively correlated with diffusing capacity of carbon monoxide (r= -0.56; p=0.0001) and forced vital capacity (r= -0.46; p=0.001). When HRCT was accepted as the gold standard; the sensitivity, specificity, positive predicted value, and negative predicted value for thoracic USG were 100%, 84.2%, 90.6%, and 100%, respectively. If thoracic USG was used instead of HRCT for the evaluation of Medsger scale, the results changed in only one of the 48 patients. CONCLUSION: Thoracic USG showed good correlation with HRCT findings for the evaluation of pulmonary parenchymal involvement in systemic sclerosis. Therefore, USG might be a noninvasive and useful tool for the long-term follow-up of systemic sclerosis patients after initial examination with USG and HRCT.

Comparison of generic and lung cancer-specific quality of life instruments for predictive ability of survival in patients with advanced lung cancer.

BACKGROUND: Our purpose is to examine the relationship of Health related quality of life measured by EORTC QLQc30, QLQ-LC13; FACT-L, LCSS, Eq5D) with survival in advanced lung cancer patients. A total of 299 Lung Cancer (LC) patients were, included in this national multicenter Project entitled of "the LC Quality of Life Project (AKAYAK). Baseline scores were analyzed by using Cox's proportional hazard regression to identify factors that influenced survival. Univariate and multivariate models were run for each of the scales included in the study. RESULTS: Mean and median survival were 12.5 and 8.0 months respectively. Clinical stage (as TNM), comorbidity; symptom scales of fatigue, insomnia, appetit loss and constipation were associated with survival after adjustment for age and sex. Global, physical and role functioning scales of QLQc30; physical and functional scales of LCS and TOI of the FACT-L was also associated with survival. Mobility and Usual activities dimensions of the Eq5D; Physical functioning and the constipation symptom scale of the QLQ-c30; and LCS and TOI scores of the FACT-L remained statistically significant after adjustment. LC13 and LCSS scales were not predictors of survival. CONCLUSIONS: HRQOL serves as an additional predictive factor for survival that supplements traditional clinical factors. Besides the strong predictive ability of ECOG on survival, FACT-L and the Eq5D are the most promising HRQOL instruments for this purpose.

Assessment of Tc-99m sestamibi tumor tissue uptake under the influence of increased arterial oxygen saturation.

The aim of this study is to investigate the potential effect of increased arterial saturation of oxygen in the magnitude of technetium-99m-hexakis-isobutyl-isonitrile (99mTc-MIBI) uptake in tumor tissue and to compare the results with those of conventional 99mTc-MIBI tumor imaging in the same patient with lung cancer. A total of 26 lung cancer patients underwent initial SPECT (I-SPECT) and after oxygen inhalation SPECT (O2-SPECT). The early (ER) and delayed ratios (DR) of O2-SPECT mean+/-S.D. were significantly higher than those of I-SPECT mean+/-S.D. (2.07+/-0.57 vs. 1.90+/-0.48 and 2.02+/-0.45 vs. 1.83+/-0.39, respectively). There are increased rates for the relative tumor uptake of 99mTc-MIBI by 9% for ER and 10% for DR on the O2-SPECT compared to I-SPECT. We found that 99mTc-MIBI uptake increased significantly in the tumor tissue with O2-SPECT compared to I-SPECT. In conclusion, 99mTc-MIBI scintigraphy is one of the main methods for differentiating viable and nonviable tissue fractions in tumors. We consider that 99mTc-MIBI uptake increase after oxygen inhalation is an indicator of positive acute cellular response of the tumor tissue to the rising tissue oxygen level.

Pulmonary alveolar proteinosis in a patient with acute lymphoid leukemia regression after G-CSF therapy.

Pulmonary alveolar proteinosis (PAP) is the intra-alveolar accumulation of periodic-acid schiff (PAS) positive material. PAP is one of the underrecognized causes of pulmonary infiltrates in patients with hematologic malignancies. Here, we present a patient with acute lymphoid leukemia (ALL) in first remission that developed fever and diffuse pulmonary infiltrates during the neutropenic stage of consolidation chemotherapy. The histopathologic examination of bronchoalveolar lavage (BAL) fluid and transbronchial biopsy specimen demonstrated the presence of PAS-positive eosinophilic material. Empirical antibiotherapy and granulocyte-colony stimulating factor (G-CSF) were given. After the correction of neutropenia with G-CSF, the patient's fever disappeared, acute phase reactants decreased, pulmonary infiltrates resolved. We present this case because it was the first patient in whom the correction of neutropenia with G-CSF was followed by resolution of PAP.

Trimodality treatment in patients with superior sulcus tumors: hopes and realities.

AIMS AND BACKGROUND: In late 2001 at our institution, we started offering induction radiochemotherapy as a treatment option for superior sulcus tumors. Our aim was to evaluate treatment choices and outcome in this patient group treated over the past 7 years at our institution. METHODS: The records of 34 patients were retrospectively reviewed and 33 were assessable for the analysis. RESULTS: Twenty of 28 patients with M0 disease had operable disease. The induction radiochemotherapy for superior sulcus tumors was possible in about two-thirds (14/20) of the cases with operable disease, with only one-third (5/14) of these having undergone surgery. The most common reason for not proceeding to surgery following induction radiochemotherapy was patient refusal (n = 5). The median follow-up of all 33 patients was 17 months. In curatively treated patients with (n = 11) or without surgery (n = 15), the median overall survival time was 26 months (range, 10-26) and 26 months (range, 7-71), respectively ( P = 0.534). Local-regional and/or distant failure developed in 20 of 26 patients treated curatively. In patients treated with the trimodality regimen (n = 5), no local-regional failure was observed, and distant failure occurred in one case. CONCLUSIONS: The trimodality treatment was possible in 25% of cases with operable disease due to the high rate of patient refusal to proceed to surgery following induction radiochemotherapy. No difference in survival was observed between patients treated with surgery and those treated with radiochemotherapy only because of a limited follow-up. So, the benefit of additional surgery is not clear, and a longer follow-up is needed before final conclusions can be drawn.

Acinetobacter pneumonia: Is the outcome different from the pneumonias caused by other agents.

BACKGROUND: The principal aim of the present study was to determine whether Acinetobacter spp. pneumonia differs from hospital-acquired pneumonias (HAPs) caused by other agents with respect to therapeutic success and survival rate. METHODS: This study includes 140 adult patients diagnosed with HAPs caused by identified etiologic agents between March 2005 and February 2006. These patients were divided into two groups according to the agent responsible for their infection (Acinetobacter spp. [n = 63] or non-Acinetobacter spp. [n = 77]). The groups were compared in terms of risk factors, therapeutic success and six-week survival rates. RESULTS: Previous antibiotic use and the risk of aspiration were independent factors responsible for the development of Acinetobacter spp. pneumonia. Hypoalbuminemia, steroid use and the use of a mechanical ventilator were determined to be mortality-associated independent risk factors for Acinetobacter spp. pneumonia. The clinical success rate at the end of therapy was 41.6% and, at the sixth week, the survival rate was 35% among patients in whom Acinetobacter spp. was the causative agent. Conversely, in the control group, these values were 43 and 32%, respectively (P > 0.05). We found that the use of the appropriate antibiotics for the treatment of Acinetobacter spp. pneumonia was an important factor in survival (P < 0.001). CONCLUSION: The outcomes of Acinetobacter spp. pneumonia do not differ from HAPs associated with non-Acinetobacter spp. in terms of therapeutic success and survival rates.