Predictive factors for fatality in pandemic influenza A [H1N1] virus infected patients

To determine predictive fatality criteria based on clinical and laboratory findings on admission to hospital in patients diagnosed with pandemic influenza A [H1N1] virus infection. The study was conducted at the School of Medicine, Karadeniz Technical University, Trabzon, Turkey. Demographic, clinical, and laboratory data for hospitalized cases with a diagnosis of A [H1N1] virus infection between October 2009 and May 2010 were analyzed retrospectively. Patients were divided into 2 groups: fatal [group I] and non-fatal [group II]. The 2 group's demographic, clinical, and laboratory data were compared on admission. Ten [20%] of the 50 patients included in the study died. The average age of group I was significantly higher than that of the group II. No significant difference was observed between the groups in terms of underlying chronic diseases and pregnancy. Fever, phlegm, shortness of breath, tachypnea, cyanosis were observed at significantly higher levels in group I compared to group II. Serum hemoglobin, glucose, albumin levels, arterial oxygen saturation were significantly lower in group I compared to group II; aspartate transaminase, alanine aminotransferase, C-reactive protein, procalcitonin, blood urea nitrogen levels, time between onset of symptoms and commencement of antiviral treatment were all significantly higher in group I. This study shows that in addition to demographic characteristics and clinical findings, prognosis of patients with A [H1N1] virus infection can be determined beforehand with various laboratory tests. But these parameters, which can guide the clinician in the prior identification of potentially fatal A [H1N1] cases will contribute to the provision of supporting treatment and, when necessary, intensive care services for such patients

Effect of early or delayed administration of warfarin with heparin on thrombosis in pulmonary thromboembolism

The aim of this study was to investigate the effect of early or delayed warfarin administration with unfrac-tionated heparin [UFH] on coagulation parameters in pulmonary thromboembolism [PTE]. This study was performed between November 2006 and July 2007. Thirty-three patients with PTE were sequentially slotted to early [n = 16] and delayed [n = 17] warfarin treatment groups. In the early group, both UFH infusion and warfarin were started simultaneously and in the delayed group, warfarin was added [1-3 days later] based on when partial thromboplastin time reached the therapeutic level with UFH. The proteins C and S, D-dimer, hematocrit levels, and platelet counts for all patients were studied prior to treatment and 6.24, and 48 h after warfarin treatment. In order to determine the overall effect of early and delayed warfarin treatment on clot formation, a thromboelastogram was performed simultaneously. In both groups, a similar chronological decrease in protein C levels reaching maximum at 24 h with warfarin treatment was observed. However, intragroup or intergroup decreases in protein S levels were not different. On thromboelastogram, INTEM and EXTEM clotting times were significantly prolonged chronologically, but this prolongation was not different between groups. The suppressor effect of warfarin on proteins C and S in the early period of double anticoagulant treatment did not appear to aggravate the risk of thrombosis in patients with PTE in whom warfarin was started simultaneously with UFH

Endobronchial metastasis from testicular seminoma

To present a case of endobronchial metastasis from a seminoma mimicking a primary pulmonary mass on X-ray radiograph. Clinical Presentation and Intervention: A 27-year-old man presented with a 1-month history of hemoptysis. Thorax computerized tomography of the patient obtained at the level of the main right bronchi demonstrated a mass with a size of 7 x 6 cm and a peripheral lobulated nodule. Bronchoscopic examination showed narrowing and multiple nodules in the right upper and right intermediary lobar bronchi. Histopathological examination of bronchial biopsies and brushing confirmed endobronchial metastasis of the testicular seminoma. This case shows the prognostic significance of distinguishing endobronchial metastasis from primary lung carcinoma

Time course from first symptom to the treatment of lung cancer in the eastern black sea region of Turkey

To determine the delay between the onset and the diagnosis and treatment of patients with lung cancer in two cancer centres in the Eastern Black Sea Region of Turkey. Subjects and The records of 226 patients [217 males, 9 females] were evaluated retrospectively for the dates noted for the onset of symptoms, first presentation to a physician, histopathological diagnosis and start of treatment. The median time intervals from the appearance of the first symptom to definitive diagnosis and treatment were calculated. The patients presented to their physicians 30 [range 2-365] days after their complaints began. The time that elapsed between admission and histopathological diagnosis and between the diagnosis and initiation of therapy were 8 [range 1-210] and 17.5 days [range 0-206], respectively. The median time span from presentation to treatment was 30 days [range 1-253]. There were no significant time interval differences between onset of symptoms and first presentation and the subsequent diagnostic and therapeutic processes for histopathology, stage of the tumour and treatment procedures [p > 0.05]. Reasons for the delayed treatment of lung cancer patients were late presentation to the physician and the long time interval between tissue diagnosis and treatment. This delay was mostly associated with a large number of patients and delayed appointments for imaging procedures - the result of organisational problems within the health services of Turkey

Wegener's granulomatosis with parotid gland involvement and pneumothorax

Wegener's granulomatosis is a systemic vasculitis characterized by necrotizing granulomatous lesions mostly involving the upper and lower respiratory tract. The disease rarely causes parotid gland involvement and pneumothorax. We report a case of Wegener's granulomatosis involving parotid gland, and complicated with a pneumothorax. Clinical Presentation: A 45-year-old man admitted with a 3-week history of painful left parotid gland enlargement and hemoptysis. On physical examination a painful and hard mass was detected on the left pre-auricular area. Cervical CT revealed a 2 ' 1.5 cm hypodense lesion mimicking an abscess on the left parotid gland. Chest radiograph and thorax CT demonstrated nodular and cavitating opacities on the right and left upper zones. There were numerous erythrocytes in urine sediment. The drained pus material from the parotid abscess demonstrated only gram-positive cocci [Staphylococcus aureus]. Two weeks treatment with teicoplanin resulted in no improvement. Meanwhile, parotid gland biopsy revealed necrotizing granulomatous inflammation. There was a sixfold increase in serum cANCA levels. With the diagnosis of Wegener's granulomatosis, cyclophosphamide and prednisolone were initiated. However, 1 month later, pneumothorax developed as a complication of rupture of a cavitary lesion. Parotid gland swelling may be the initial presenting symptom of Wegener's granulomatosis. It can be confused with infectious or malignant diseases of the gland, and the lung involvement may be complicated with pneumothorax