[The effect of acute internal problems for mortality in respiratory intensive care unit patients]. / Gögüs hastaliklari yogun bakim ünitesindeki akut dahili sorunlarin mortaliteye etkisi.

Acute internal problems in the respiratory intensive care unit (ICU) and risk factors affecting mortality in the acute treatment applications were investigated. All patients in 20-bed intensive care unit for chest diseases enrolled to this prospective observational cohort study during 2008. Patients were classified as living in group 1 and deaths in group 2. Demographics and acute internal problems (arrhythmias, acute kidney-liver failure, dopamine, doputamin, perlinganit infusion) were recorded. Multiple regression analysis was performed for factors affecting mortality. There were 603 patients during the study period, group 1, n= 503 (83.4%), group 2, n= 100 (16.6%). Both groups were similar in terms of age and gender. Odds ratio (OR), 95% confidence interval (CI), p value for internal problems of acute risk factors for mortality were found as; septic shock OR: 22.52, CI 8.11-62.57, p< 0.000; need of perlinganit infusion OR: 9.28, CI: 1.61-53.37, p< 0.012; the presence of arrhythmia, OR: 7.81, CI: 3.46-17.65, p< 0.000; acute renal failure, OR: 2.88, CI: 1.24-6.65, p< 0.013 and the need for dopamine OR: 2.83, CI: 1.06-7.65, p< 0.037, respectively. Internal problems such as cardiac and renal dysfunction can devolop in respiratory ICU patients with pulmonary diseases and these problems constitude additional risk factors for mortalitiy. While the number of ICU is increasing with new health policies, each internal requirement and personnel equipped to treat the problem quickly must be considered.

Analysis of young and elderly advanced stage nonsmall-cell lung carcinoma cases.

OBJECTIVE: Even though there have been considerable improvements in the diagnosis and treatment of lung cancer, the prognostic factors for elderly patients with advanced nonsmall-cell lung cancer (NSCLC) remain insufficient. Therefore, our aim is to compare the prognostic factors for elderly and young cases with advanced stage NSCLC. METHODS: The data of 370 advanced stage young (<65 years old) and elderly (>or=65 years old) NSCLC patients (Stage IIIB or IV) treated between 1995 and 2008 were retrospectively evaluated for the study at the oncology department. Demographic characteristics, treatment response, comorbidities, pleural effusion, performance status, and overall survival (OS) were correlated with patient clinical features and smoking habits at the time of diagnosis. RESULTS: Of the 370 patients, 284 (76.8%) were in the younger group and 86 (23.2%) were in the older group. The rates of stages (IIIB, IV) were similar in the elderly and younger groups. At the time of diagnosis, poor performance status, comorbidity, weight loss, anemia, and smoking status were more effective prognostic factors for elderly cases than younger ones. The treatment responses were also significantly different between the two age groups when the presenting symptom was weight loss: 18.7% of the younger group had progressive disease compared with 57.1% of the older group (P = 0.017). CONCLUSION: We concluded that treatment responses of the younger group were less affected by weight loss. These analyses suggest that weight loss at presentation can be useful in predicting disease response in patients with advanced stage elderly NSCLC.

Evaluation of pulmonary hydatid cyst cases.

BACKGROUND: The incidence of pulmonary hydatid cyst has been high in developing countries such as Turkey. OBJECTIVE: The aim of this study was to evaluate the clinical presentation, treatment and outcomes of pulmonary hydatid cyst disease at a tertiary centre. METHODS: A total of 138 patients, aged between 9 and 72 years with pulmonary hydatid cyst were diagnosed between 2000 and 2008 in 2nd thoracic surgery clinic at our hospital. Clinical characteristics of patients, epidemiological features, cyst diameters and localizations, laboratory findings, surgical approaches were recorded and analyzed. RESULTS: The most frequent symptoms of pulmonary hydatid cyst were chest pain and cough (44.9%, 37.6%). According to cyst size, there was no difference between younger than twenty and older age groups (p>0.05). Twenty-two patients had complicated cyst cases. Most of them were symptomatic (90.9%). Association of complicated cyst with hepato-pulmonary involvement was significantly higher as compared with single hydatid cyst (p=0.01). Cystectomy was performed in 84.05% of patients and post-operative mortality was seen in only one patient due to pulmonary embolism. CONCLUSION: Association of lung and liver hydatid cyst increased the risk of occurrence of a complicated pulmonary hydatid cyst. Choice of surgical approach had satisfactory results and post-operative mortality was low.

Multiple primary malignancies involving lung: an analysis of 40 cases.

We aimed to assess the incidence of multiple primary malignancies in primary lung cancer patients. We retrospectively evaluated the clinical files of 1038 primary lung cancer patients diagnosed in 2004. Forty patients (3.9 %) had multiple primary malignancies. There were 34 men (85 %) and 6 women (15 %). Their mean age was 62.4 +/- 8.6 years. While 35 cases were smokers, 5 cases were nonsmokers. Tumour pathology of the lung was squamous cell carcinoma in 15 cases, adenocarcinoma in 10 cases, small cell carcinoma in 3 cases and non-small cell carcinoma in 12 cases. There were 2 primary tumours in 37 cases and 3 primary tumours in 3 cases. The first detected tumour was located in larynx in 11 cases, in genitourinary system in 9 cases, in intestine in 5 cases, in lung in 3 cases and in other organs in 12 cases. The mean interval between the first and the second tumour was 77 months with a range of 1 months to 32 years. This interval was shorter than 6 months in 4 cases. Treatment modality for the first detected tumour was surgery in 35 cases. The last primary tumour was treated with surgery in 12 cases. In conclusion, the development of multiple primary tumours is not a rare phenomenon. Patients with a malignancy should be followed for development of a second primary malignancy. The treatment of lung cancer in patients with a previous malignancy should be the same as for lung cancers presenting as the first cancer.

Mediastinal thymolipoma: an analysis of 10 cases.

Thymolipoma is a benign tumour composed of thymic elements and adipose tissue. It may be associated with myasthenia gravis or immune disorders. We aimed to evaluate the clinical and radiological features of thymolipoma. The clinical data from 10 cases of thymolipoma, diagnosed at our centre between 2002 and 2004, were analysed retrospectively. There were six female and four male patients, whose ages ranged from 16 to 67 years, with a mean age of 34.1 years. All but two patients had pulmonary or extrapulmonary symptoms. Five patients also had myasthenia gravis. All thymolipomas were localized in the anterior superior mediastinum. The surgical approach was sternotomy in nine cases and thoracotomy in one case. Thymectomy was performed on all patients. Thymolipomas are unusual tumours and may be associated with myasthenia gravis. Surgical resection is the most appropriate treatment modality.

[Cell type accuracy of transthoracic fine needle aspiration in primary lung cancer]. / Primer akciger kanserinde transtorasik ince igne aspirasyonunun hücre tipi uyumu.

In this study, we aimed to evaluate the diagnostic accuracy of transthoracic fine needle aspiration (TFNA) specimens in establishing the specific cell type in primary lung cancer and to study the influence of several factors on this accuracy. Forty-six patients with lung cancer diagnosed by TFNA specimens who subsequently underwent thoracotomy between April 2003 and December 2005 were included. Fourty-one patients were men and five were women with a mean age of 59.8 +/- 10 years (34-68 years). TFNA was performed by 22-Gauge Chiba needle with computed tomography guided in all patients. There was cell agreement in 38 of 46 cases (82.6%, Kappa= 0.73). The concordance was 70.8% (Kappa= 0.65) in cases with squamous cell carcinoma and 100% (Kappa= 0.74) in cases with adenocarcinoma (p= 0.01). Stage of the tumor, the diameter and location of the lesion had no effect on cell type agreement (p> 0.05). The concordance was 63.6% in poor differentiated tumors and 92.9% in well differentiated tumors (p> 0.05). Our results pointed out that tumor cell type was the only factor effecting tumor cell type agreement between TFNA and thoracotomy.

[Does tumor type and sex distribution of primary lung cancer change? The comparison of the results of 2004 and previous years]. / Primer akciger kanserinde tümör tipi ve cinsiyet dagilimi degisiyor mu? 2004 Yili sonuçlarinin daha önceki yillar ile karsilastirilmasi.

The aim of the present study was to evaluate the tumor cell type and sex distribution of patients diagnosed with primary lung cancer during 2004. Patients with primary lung cancer were detected from pathology records. Clinical files of patients were analyzed retrospectively. 1403 patients with primary lung cancer were included in the study. 1238 (88.2%) patients were male and 165 (11.8%) were female and female to male ratio was 1/7.5. When the ratio was compared with 1/10.9 in 1998, the ratio of female patients was determined to increase. Tumor cell type was squamous cell carcinoma in 577 (41.1%) patients, adenocarcinoma in 359 (25.6%), small cell carcinoma in 184 (13.1%), nonsmall cell carcinoma in 115 (8.2%) and other malign tumors in 21 (1.5%) patients. Tumor cell type was not detected in 147 (10.5%) patients. When 147 patients were excluded from the study, the frequency of squamous cell carcinoma was 45.9%, adenocarcinoma was 28.6% and small cell carcinoma was 14.6%. The results of our study show that squamous cell carcinoma is the most frequent tumor cell type in our center and the ratio of female patients is increasing.

[Cell type agreement between bronchoscopic biopsy and thoracotomy specimens in primary lung cancer]. / Primer akciger kanserinde bronkoskopik biyopsi ve torakotomi materyalleri arasinda hücre tipi uyumu.

The aim of this study was to evaluate the diagnostic accuracy of bronchial biopsy specimens in establishing the specific cell type in primary lung cancer and to study the influence of several factors on this accuracy. 127 patients with lung cancer diagnosed by bronchoscopic biopsy specimens who subsequently underwent thoracotomy between April 2003 and December 2005 were included. There was cell agreement was between bronchoscopic biopsy and thoracotomy in 114 (89.8%) cases. The cell agreement was 92.5% in cases with squamous cell carcinoma and 42.8% in cases with adenocarcinoma (p= 0.002). Stage of the tumor, localization and morphology of the lesion had no effect on cell type agreement (p> 0.05). Cell type agreement in lesions without necrosis was higher (p= 0.09). Cell type agreement was 100% in well differentiated tumors, 94% in moderate differentiated tumors and 66.7% in poor differentiated tumors (p= 0.001). Similar results was demonstrated by the diameter of the tumor (p= 0.008); the smaller the diameter, the greater the cell agreement. In conclusion, cancer-cell type designation from bronchoscopic biopsy specimens is not without erroneous. The degree of cell differentiation is the most important factor affecting cell agreement.

[Thymic cysts: a report of six cases]. / Timik kistler: Alti olgu nedeniyle.

Thymic cysts are rarerly encountered lesions which are only 1 to 2% of all mediastinal masses. We present six patients with thymic cysts diagnosed between 2000 and 2004 in this report. There were three male and three female patients whose ages ranged from 34 to 64 years (mean age, 46 years). Four patients are nonsmoker. None of the patients had a previous history of an etiologic factor such as trauma, surgical procedure or evidence of significant inflammation. While one patient was asymptomatic, there were chest pain in three patients, cough in two patients, hemoptysis in two patients and dyspnea in one patient. Thymic cyst was located in anterior mediastinum in five patients and in upper mediastinum in one patient. Cysts were resected with thoracotomy in four cases and with sternotomy in two cases. Their size ranged from 5 to 9 cm in diameter. In pathologic examination, two cysts were multilocular. In conclusion, thymic cysts are rare masses. Differential diagnosis of mediastinal masses, especially anterior mediastinal masses should be included thymic cysts.

A rare association: Castleman's disease and pemphigus vulgaris.

Castleman disease is a reactive lymph node hyperplasia of unknown origin that often involving the thorax although it may involve all parts of the body. It is usually seen in young adults and presents an asymptomatic course. It is usually located to anterior and middle mediastinum. Pemphigus vulgaris is a bullous skin disease in which immune mechanisms take place in the pathogenesis. Mouth and oropharynx are the most commonly involved structures. IgG antibodies against the epidermal intracellular structures are essential in the diagnosis. We have wanted to discuss a 28 years old female with the literature review since the association between pemphigus vulgaris and Castleman's disease is rare.