Temporal changes in lung cancer: a 10-year study in a chest hospital.

BACKGROUND AND AIM: No prospective, wide-scale study on lung cancer (LC) exists in Turkey. We aimed to determine prospectively epidemiologic features, histologic types, stages and temporal changes in LC in the Aegean Region of Turkey. This is the first prospective and largest LC study in Turkey. METHODS: A hospital-based study was conducted on LC cases diagnosed between 1994 and 2004 at a tertiary referral hospital for thoracic medicine and surgery in Izmir, Turkey. The study was divided into two 5-year periods to determine temporal changes. RESULTS: Of 13,344 patients with pathologically confirmed LC, 93.1% was male. The mean age was 61.35 +/- 0.08 (59.5% between 41-65). The majority (82.5%) were smokers or ex-smokers. There was a 13.87% general rise in smoking rate, predominantly in females. LC incidence increased by 38% from 1994-1999 (42%) to 2000-2004 (58%); the contributive increases were 35.5% in males, and 77.5% in females. Frequent types were squamous cell carcinoma (24.7%), small cell carcinoma (SCLC) (14.2%) and adenocarcinoma (13.2%). Adenocarcinoma in the younger group (<40), females or non-smokers, and squamous cell carcinoma in the older group, males or smokers were the leading types. Non-small cell lung carcinoma (NSCLC) was mostly diagnosed at stages IIIB (36.7%) and IV (37%) whereas SCLC at limited stage (59.1%). CONCLUSION: The majority of the LC patients are over 40 years old, current or ex-smokers, or with squamous cell carcinoma. There is a general rise in smoking rate with a female predominance. The most common type is squamous cell carcinoma in males, and adenocarcinoma in females. NSCLC is diagnosed more frequently at advanced stage but SCLC at limited stage.

Isolated interrupted inferior vena cava with azygos continuation mimicking paraesophageal lymph node enlargement.

We report a case of interrupted inferior vena cava with azygos continuation diagnosed as a isolated finding in a patient with lung carcinoma. Findings of the unopacified CT scan initially simulated a paraesophageal lymphadenopathy. The contrast-enhanced spiral CT scan showed a dilated azygos vein in the absence of definable inferior vena cava.

Urinary uric acid excretion as an indicator of severe hypoxia and mortality in patients with obstructive sleep apnea and chronic obstructive pulmonary disease.

OBJECTIVE: Uric acid (UA) is the end product of adenosine triphosphate degradation, and could increase due to hypoxia. We investigated the association of UA metabolites with nocturnal hypoxemia, apnea-hypopnea index (AHI), noninvasive mechanical ventilation (NIMV) usage and five-year mortality. MATERIALS/SUBJECTS AND METHODS: We obtained urinary specimen before and after the night polysomnography in order to measure UA excretion and overnight change in urinary UA/creatinine ratio (ΔUA/Cr) in 75 subjects (14 controls, 15 chronic obstructive pulmonary disease (COPD) without nocturnal hypoxemia (NH), 15 COPD with NH, 16 obstructive sleep apnea syndrome (OSAS) without NH, 15 OSAS with NH). Percentage of time spent below SaO2 of 90% (T90%) for >10% of sleep time was considered as nocturnal hypoxemia. Patients were contacted after 5 years with a questionnaire including information on the use of NIMV treatment (n: 58) and urinary specimen analysis (n: 35). RESULTS: T90% was found to be significantly correlated with UA excretion (coefficient: 0.005, 95%CI: 0.003-0.007) and ΔUA/Cr (coefficient: 0.8, 95%CI: 0.3-1.2) after adjustments for age, gender, body mass index and apnea-hypopnea index. Median and IQR (interquartile range) of baseline UA excretion were 0.79 (0.51-0.89) and 0.41 (0.31-0.55) in 10 deceased and 58 surviving patients, respectively (p=0.001). UA excretion median and IQR of baseline and 5 years of NIMV treatment were 0.41 (0.36-0.57) and 0.29 (0.23-0.37), respectively (p=0.01). CONCLUSION: UA excretion, as a marker of tissue hypoxia, may be useful in the management of OSA and COPD patients.

Technetium-99m-tetrofosmin scintigraphy in pulmonary tuberculosis.

UNLABELLED: Technetium-99m-tetrofosmin, an agent that is widely used in myocardial imaging, has been reported to accumulate in several types of malignancies, including lung tumors. Yet, there is limited knowledge about its role in imaging infection or inflammatory lesions. The aim of this study was to investigate the role of 99mTc-tetrofosmin scintigraphy in pulmonary tuberculosis in cases with active and inactive tuberculosis in comparison with radiological and microbiological findings. METHODS: Twenty-seven patients with active pulmonary tuberculosis (APTB) and 6 patients with inactive pulmonary tuberculosis (IPTB), proven by sputum smears and cultures, were included in this study. Mean age of the group was 42.6+/-13 yr. Nine months after therapy, 99mTc-tetrofosmin scintigraphy was repeated in 6 patients with APTB to evaluate response to therapy. Ten-minute anterior and posterior chest images were acquired 20 and 60 min after the injection of 370 MBq (10 mCi) 99mTc-tetrofosmin. The images were evaluated both visually and semiquantitatively by two blinded nuclear medicine physicians. For semiquantitative evaluation, regions of interest (ROIs) were drawn over the lesion (L) and nonlesion areas (NL). The mean count values of ROIs were obtained and L/NL ratios were calculated. RESULTS: According to the visual evaluations, 99mTc-tetrofosmin uptake was Grade (+) in 4 (15%) and Grade (++) in 23 (85%) patients with APTB. Technetium-99m-tetrofosmin uptake was negative in 5 patients with IPTB. Grade (+) 99mTc-tetrofosmin uptake was observed in only one inactive case. After therapy, there was no 99mTc-tetrofosmin uptake in 3 patients, which correlated well with chest radiography and clinical findings. In the other 2 patients, 99mTc-tetrofosmin uptake was slightly decreased when compared with a previous scan that correlated with radiological and clinical findings. In 1 patient with bilateral lung disease, 99mTc-tetrofosmin uptake decreased on the right lung lesions, whereas the left lung lesions persisted with no change. The mean early and delayed L/NL ratios of APTB were 1.53+/-0.22 and 1.45+/-0.21, respectively. Although 99mTc-tetrofosmin uptake in APTB lesions was more visually marked in early images than that in delayed images, there was no statistically significant difference between these two sets of images. CONCLUSION: Technetium-99m-tetrofosmin scintigraphy showed increased uptake in APTB lesions related to disease activity. After treatment, 99mTc-tetrofosmin uptake disappeared or decreased, correlating well with radiological and clinical findings. Technetium-99m-tetrofosmin scintigraphy may have a complementary role in the assessment of APTB as well as in follow-up treatment.

Carboplatin plus etoposide for extensive stage small-cell lung cancer: an experience with AUC 6 doses of carboplatin.

AIMS: The aim of this study is to investigate the activity and toxicity of etoposide with AUC 6 doses of carboplatin in patients with previously untreated extensive disease - small-cell lung cancer (SCLC). MATERIALS AND METHODS: 88 eligible patients were treated with chemotherapy comprised of carboplatin AUC of 6, IV day 1 and etoposide 100 mg/m 2 , IV day 1-3. This schedule was repeated every 21 days for maximum of six cycles. RESULTS: Patients characteristics: Median age, 62 years; 84 male; ECOG PS 0-1 in 73 patients, PS 2-3 in 15 patients. A total of 431 cycles were administered (median, 6.0). The complete and partial response rates were 23.9% and 45.5%, respectively. Median overall survival (OS) was 9.0 months (95% confidence interval [CI], 8.09 - 9.90 m); 84 patients died. The 1- and 2-year survival probabilities were 33.6% and 5.3%, respectively. The median progression-free survival in patients of 65 was 7.2 months (95% CI, 5.81 - 8.58), 12-month PFS rate was 10%. The median OS was 11.6 months (95% CI, 8.52 - 14.67 m) and 7.5 months (95% CI, 5.61 - 9.38 m) in patients with non-liver and liver metastasis, respectively (P = 0.024). The median OS was 9.3 months (95% CI, 7.83 - 10.76 m) and 7.5 months (95% CI, 5.58 - 9.44 m) in patients with single and multiple distant metastasis, respectively (P = 0.02). Grade 3-4 neutropenia, thrombocytopenia, and anemia were detected in 57.9%, 15.9%, and 11.4% of patients, respectively. Febrile neutropenia was developed in 12 patients. CONCLUSION: Etoposide with AUC 6 doses of carboplatin is active and tolerable in patients with extensive disease - SCLC.

Bronchogenic cysts: clinicopathological presentation and treatment.

The aim of this study was to evaluate the preoperative and operative presentations of one paediatric and 30 adult patients with bronchogenic cyst of the mediastinum (n = 11) and lung (n = 20). At initial presentation, six patients were asymptomatic and 25 were symptomatic. The mean age of asymptomatic and symptomatic patients was 25 and 33 yrs, respectively. Six patients presented with complications, including superior vena cava syndrome, tracheal compression, pneumothorax, pleurisy and pneumonia. Two patients who were asymptomatic when initially observed eventually needed surgery because of the development of symptoms or enlargement of the cyst size. In one patient, the cyst was not seen on the chest radiograph but appeared as a lobulated nodule of 2 cm diameter in a chest computerized tomography (CT) scan. Operative difficulties were encountered in 13 patients, all of whom were symptomatic preoperatively. In conclusion, life-threatening complications occurred in these patients. Despite various diagnostic studies, definitive tissue diagnosis was established only by means of surgical excision. The frequency of operative difficulties in symptomatic cysts was higher than those of asymptomatic cysts. Surgery may be considered as the treatment of choice even when the cyst is asymptomatic, since complications are not uncommon.