Prognostic factors influencing survival in 35 patients with malignant peritoneal mesothelioma.

Malignant mesothelioma is a rare but highly lethal form of cancer that affects the serosal membranes. Malignant peritoneal mesothelioma (MPM) is the second most common form of malignant mesothelioma (pleural mesothelioma is the most common). The aim of this study was to evaluate prognostic factors influencing the survival of patients with MPM. A retrospective analysis was performed on 35 patients who were admitted to our hospital between March 2005 and July 2013. The patients' demographic and clinical data, laboratory results, radiological signs, Eastern Cooperative Oncology Group (ECOG) performance status (PS), and treatment outcomes were evaluated. The mean age of the 35 patients was 59.0±14.4 years, the mean survival time was 16.2±12.9 months, and the majority of the histopathological types of MPM were epithelial (68.6%). 82.9% of the patients had been exposed to asbestos, and the mean duration of exposure was 28.3±14.5 years. The most frequent symptoms were abdominal distention/pain, weight loss, dyspnea, and chest pain. The mean interval between the onset of symptoms and the diagnosis was 4.6±3.3 months. Platinum-based combination chemotherapy in combination with supportive care was used in the treatment of 68.6% of the patients, while supportive treatment alone was used in the others. Our results revealed that patients who were >60 years old (p=0.019), who were exposed to asbestos >20 years (p=0.033), who had an ECOG PS of 3 (p=0.000) were more likely to have a poor MPM prognosis.In conclusion, increased age, duration of environmental asbestos exposure and ECOG PS are important factors that influence the prognosis of MPM patients.

Diagnostic value of PET/CT in differentiating benign from malignant solitary pulmonary nodules.

PURPOSE: Solitary pulmonary nodules (SPNs) are round or oval lesions with a clear border with the surrounding parenchymal tissue and a radiologic diameter smaller than 3 cm which are not associated with atelectasis, pneumonia, lymphadenopathy, or chest wall pathologies. The purpose of the present study was to evaluate the efficacy of positron emission tomography (PET) / computerized tomography (CT) in differentiating benign from malignant SPNs. METHODS: In this retrospective study, 209 patients, who were diagnosed with SPN by thoracic CT and demonstrated positive or negative results for malignancy in the PET/ CT examination between January 2007 and June 2010, were enrolled. Among the 91 patients who gave consent for interventional procedures, performed were bronchoscopic endobronchial biopsy in 10, transbronchial biopsy in 15, bronchoscopic brushing in 4, transthoracic needle biopsy in 11, video-assisted thoracoscopy (VATS) in 4, lobectomy in 22, pneumonectomy in 2, and wedge resection in 23. The materials were histopathologically examined. RESULTS: 129 (61.72%) of the SPN cases were benign and 80 (38.27%) malignant. The mean SUVmax value for the benign SPNs was 2.06 ± 3.29 and 7.39±5.69 for the malignant SPNs (p=0.000). Positive correlation was found between the nodule diameter and risk for malignancy. A SUVmax value of 4 was found to have the best sensitivity and specificity. CONCLUSION: PET/CT was shown to be an accurate method in the differential diagnosis of benign from malignant solitary pulmonary nodules.

Relationship between 18 FDG PET-CT findings and the survival of 177 patients with malignant pleural mesothelioma.

BACKGROUND AND OBJECTIVES: Malignant pleural mesothelioma (MPM) is a fatal malignancy. Radiological imaging is necessary for the diagnosis, staging, and clinical management of patients with MPM. The 18 fluorodeoxyglucose positron emission tomography (18 FDG-PET) scan has proven useful in preoperative staging and as a prognostic tool in MPM. We aimed to investigate the relationship between the pre-treatment 18 FDG PET/CT results, together with other known clinical parameters, and the survival of patients with MPM in our region. PATIENTS AND METHODS: A retrospective analysis was performed on the data of 177 patients with MPM between April 2007 and April 2011. Pre-treatment 18 FDG PET/CT scans were done on all patients. Survival time was calculated by the Kaplan-Meier method. RESULTS: The mean age was 55.40 years. There were 56% male patients and 44% female patients. The mean survival time was 11 months from time of diagnosis. According to multivariate analysis results, being of male gender increased the poor prognosis 5.30 times, a Karnofsky performance score (KPS) < 60 increased a poor prognosis 2.18 times, being on "best supportive care" increased a poor prognosis 25.40 times, the stage III-IV increased a poor prognosis 11.13 times, and a level of maximum standardized uptake value (SUVmax) > 5 increased a poor prognosis 4.34 times. CONCLUSIONS: MPM remains a fatal prognosis. Significant predictors of survival include KPS, stage of disease, gender, treatment regimen and level of SUVmax. An understanding of the importance of these markers for MPM prognosis should allow targeted treatments to be developed.

Frequency of respiratory function disorders among dental laboratory technicians working under conditions of high dust concentration.

BACKGROUND AND OBJECTIVES: Dental laboratory technicians (DLTs) have much exposure to mineralogical dust that may have adverse effects on their lung health. The aim of our study was to investigate occupational dust exposure, and to determine the frequency of respiratory function disorders and radiologic abnormalities among DLTs. MATERIALS AND METHODS: The study enrolled 94 DLTs who were exposed to dust in dental laboratories and 94 control subjects. Dust concentrations in the workplaces were measured. RESULTS: The mean age of DLTs was 30.70 ± 9.84 years. No significant difference was found between the DLTs and the control groups for age or smoking status (p > 0.05). Spirometric values for the DLTs were found to be lower than the control group (p < 0.05). The mean working period for DLTs was 9.19±5.9 years. The pulmonary function test results for the DLTs showed that 65.9% had a normal pattern, 22.4% were restrictive, and 11.7% showed obstructive type pulmonary function disorder. Negative correlations were found between the working period time and Forced Expiratory Volume in 1 second in the DLTs (R = -0.675 p = 0.000). Negative correlations were also found between working period time and Forced Vital Capacity in the DLTs (R = -0.720 p = 0.000). All DLTs had chest X-rays and 16 (17%) of them showed radiological pneumoconiosis. CONCLUSIONS: This study showed a negative association between level of respiratory function and working period in DLTs.

An evaluation of cases of pneumonia that occurred secondary to hydrocarbon exposure in children.

OBJECTIVE: Hydrocarbon pneumonia is distinct among the types of childhood pneumonia in that it has a different pathogenesis and treatment and is preventable. In this study, the cases of 54 children with hydrocarbon pneumonia admitted to the Dicle University Medical Faculty Pediatric Chest Diseases Unit between the years 2006 and 2010 were analyzed retrospectively. PATIENTS AND METHODS: The medical records of 54 patients diagnosed with pneumonia after ingesting/inhaling hydrocarbons were analyzed retrospectively. Age, sex, presenting symptoms, clinical status, radiological and laboratory findings and response to treatment and prognosis were noted. RESULTS: 35 (64.8%) of the patients were male, 19 (35.2%) were female and the ages of the patients ranged from 1 to 5 with an average of 2.49 ± 0.80. The etiologies of the pneumonia were thinner (33%), naphta (3.7%) and kerosene. In 49 of the patients (90.7%), the symptoms started to occur the day the patient was exposed to hydrocarbons. The average length of hospital stay was 4.0 ± 2.3 days. Six patients were treated in the intensive care unit (ICU), and one patient with hydrocarbon pneumonia due to kerosene ingestion died. Inhaled corticosteroids were administered to 18 patients who were progressively deteriorating and inhaled salbutamol was given to 16 patients with bronchospasm. Patients with radiological findings on their chest X-rays and auscultatory findings were found to have longer hospital stays (p < 0.05). CONCLUSIONS: To prevent chemical pneumonia, precautions must be taken to stop children under 5 years of age from using/abusing chemical substances. Although some cases of chemical pneumonia lead to death, with diligent care and treatment, the outcomes are promising. The patients in this study group responded well to treatment with inhaled corticosteroids and salbutamol.

Effects of treatment regimens on survival in patients with malignant pleural mesothelioma.

BACKGROUND AND OBJECTIVE: In this study, we aimed to investigate the factors affecting the survival of patients with malignant pleural mesothelioma (MPM) according to their treatment regimens, including best supportive care (BSC), chemotherapy, surgical group and multimodality (MM) therapy. PATIENTS: A retrospective analysis was performed on clinical data and treatment outcomes of 400 patients registered in our hospital with MPM between January 1989 and April 2010. RESULTS: Mean age (p < 0.001), presence of asbestos exposure (p = 0.0014), presence of smoking history (p < 0.001), Karnofsky performance status (p < 0.001), histological subtype (p = 0.034) and stage (p < 0.001) variables were found to be significantly different among the four treatment regimens. Mean survival time of all patients was 12.32 months. Mean survival time 10.5 months for the BSC group, 15.7 for the surgical group, 16.02 for the chemotherapy group, and 26.55 for the MM group. There were significant differences in mean survival time among the four treatment regimens. In addition, a significant difference was found in survival time between the two chemotherapy groups (p = 0.032). Mean survival time for cisplatin + gemcitabine was found to be 14.49 months and for cisplatin + pemetrexed, 18.34 months. CONCLUSIONS: The MM group had better survival rates than the other groups. The new chemotherapy combination, cisplatin + pemetrexed, can be helpful in improving survival time.      

The incidence of mesothelioma has not decreased for the last twenty years in Southeast region of Anatolia.

BACKGROUND: Malignant pleural Mesothelioma (MPM) is a very rarely encountered tumor in the normal population. OBJECTIVES: To investigate the variations in incidence of MPM in Southeast region of Turkey. METHODS: We retrospectively investigated the data of 161 MPM patients who were diagnosed from January 2000 to December 2009. The residential areas were determined according to asbestos exposure which plays a role in MPM etiology; previously reported as having asbestos (Region 1) and asbestos has not been determined previously (Region 2). RESULTS: One hundred nine (109) of the patients (67.7%) included from the Region 1 and 52 of them (32.3%) included from the Region 2. MPM incidence of the last decade was 3.9/100,000 person/year for the whole region. In Region 1, 2000-2004 incidences was 12.6/100,000 person/year and 2005-2009 incidences was 14.9/100,000 person/year. In Region 2, 2000-2004 incidences was 0.4/100,000 person/year and 2005-2009 incidences was 1.0/100,000 person/year. According to the recently conducted incidence studies in our region, MPM incidence increased in region 1 and decreased in region 2. The number of patients applying to our hospital has increased in the last three years. CONCLUSION: This increase, in Region 1 may be associated with continuous use of asbestos.