Practical Utility of Diagnostic Clinical Breast Examination in the Diagnosis of Breast Cancer.

Objectives We aimed to investigate the effectiveness of physician-performed diagnostic clinical breast examination (DCBE) for the diagnosis of breast cancer in clinical practice and to determine the rates of breast cancer diagnosed with DCBE compared to the results of breast ultrasonography (US), mammography (MG), and histopathology. Methods In the retrospective cohort study, the files of female patients diagnosed with breast cancer and admitted to the general surgery outpatient clinics of a university hospital over a 10-year period (2011-2021) were examined. Patients with complete DCBE findings in their files were identified and analyzed (n = 1,091). The examinations of the patients were performed by general surgery specialists with 5-22 years of experience and by radiologists with 4-15 years of experience. Results The mean age of breast cancer diagnosis of the patients was 55.1 ± 13.5 years. While the sensitivity of DCBE was found to be 88.9%, MG sensitivity was 89.8% and breast US sensitivity was 95.1%. Cancer was detected by MG, breast US, and DCBE in 47.9% (n = 523), by breast US and DCBE in 38.9% (n = 424), by MG and breast US in 5.6% (n = 61), by DCBE alone in 3.6% (n = 39), by MG and DCBE in 2.4% (n = 26), and by breast US alone in 1.6% (n = 18). Early-stage breast cancer (p = 0.00) consisted of 73.2% (n = 383) of cancers detected with DCBE, breast US and MG, 74.6% (n = 316) of cancers detected with DCBE and breast US, 93.4% of cancers detected with breast US and MG (n = 57), 92.3% (n = 24) of cancers detected with DCBE and MG, 94.4% (n = 17) of cancers detected with breast US alone, and 69.2% of cancers detected with DCBE alone (n = 27). Conclusions CBE still maintains its importance in societies where screening participation and awareness of breast cancer are low. A breast cancer diagnosis is often done after a complaint of a palpable mass in the breast, and only then are more advanced-stage breast cancers are seen. CBE is among the important diagnostic methods preventing breast cancer from being overlooked, especially in places where health resources are limited.

Smoking Behavior of Heart Transplant Patients: A Retrospective Study.

OBJECTIVES: Smoking is an important risk factor for development of complications in heart transplant patients and plays an important role in the mortality of these patients. The aim of this study was to compare the survival of heart transplant patients after transplant versus their smoking status before transplant. MATERIALS AND METHODS: Patients who had heart transplant procedures at the Baskent University Hospital Cardiovascular Surgery Department between 2005 and 2016 were analyzed retrospectively with regard to their smoking status and survival after transplant. We divided the 51 included adult patients into 2 groups: nonsmokers and ex-smokers. Data were analyzed with SPSS software (Statistical Package for Social Sciences for Windows, version 23.0, SPSS Inc., Chicago, IL, USA). Descriptive statistics are shown as means ± standard deviation, and differences between means were determined with t tests. Survival statistics were evaluated with Kaplan-Meier analyses using log-rank test. RESULTS: Of 51 heart transplant patients, 40 were male (78.4%) and 11 were female (21.6%) patients. Mean age was 42.5 ± 14.2 years in male patients and 30.4 ± 13.2 years in female patients (95% confidence interval, 2.4-21.8). Although 36 patients(70.6%) were still living at follow-up, 15 patients had died (29.4%). According to smoking status, 30 patients (58.8%) were nonsmokers and 21 patients (41.2%) were ex-smokers, who showed smoking rate of 23.7 ± 26.0 packs/year. We found that patients who were nonsmokers survived longer; however, at time of analysis (September 30, 2017), survival was not mature yet for the nonsmoking group. Median survival time for patients who were ex-smokers was 93.0 months(log-rank test = .099) CONCLUSIONS: Our study showed that patients in the nonsmoking group survived longer after heart transplant. Early smoking cessation can prolong survival of heart transplant patients.

Utility of Mean Platelet Volume to Diagnose Pneumonia in Patients With Solid-Organ Transplant.

OBJECTIVES: Despite improved success with solid-organ transplant procedures, recipients remain at risk for infections, including pneumonia, due to their immunosuppressive regimens. In solid-organ transplant patients, clinical findings of pneumonia can be nonspecific, and diagnosis of pneumonia may be difficult as several conditions (drug lung, hypervolemia, infections, hemorrhage) can led to pulmonary infiltrates, mimicking pneumonia in these patients. The role of mean platelet volume, a predictor of inflammatory disease, with elevated values inversely correlated with inflammatory problems, in the diagnosis of pneumonia has not yet been investigated in solid-organ transplant patients. Here, we retrospectively investigated mean platelet volume in diagnosis of pneumonia in transplant patients. MATERIALS AND METHODS: Medical records of solid-organ transplant patients from 2011 to 2016 were reviewed for demographic, clinical, radiographic, laboratory, and microbiology data. Transplant type, immunosuppressive drugs, and clinical outcomes were noted. Pneumonia diagnosis was based on clinical respiratory symptoms and signs, imaging findings, positive microbiological tests, pathologic findings, laboratory findings, or effective clinical treatment trials. RESULTS: Our study included 70 patients (47 male/23 female; mean age of 46 ± 14 years), comprising 26 liver and 44 renal transplant recipients. Pneumonia was diagnosed radiologically in 30 patients (42.9%), with procalcitonin positive in 11 patients (36.7%), C-reactive protein elevated in 29 patients (96.7%), and leukocytes increased in 6 patients (20%). When laboratory measurements were compared with mean platelet volume, mean platelet volume values were significantly lower in patients with pneumonia who had elevated procalcitonin levels (P = .038). CONCLUSIONS: We found that mean platelet volume for diagnosis of pneumonia in solid-organ transplant patients was not a promising tool. Considering the difficulties in caring for transplant patients with pulmonary infiltrates, clinical decisions should be based on clinical, laboratory, microbiological, and radiologic findings.

Smoking Behaviors of Renal Transplant Recipients: An Analysis of 113 Patients.

OBJECTIVES: Smoking is the most important remediable risk factor for the progression of renal diseases. Smoking has serious adverse effects, such as cardiovascular disease, kidney function impairment, and cancer in kidney transplant recipients who are already at high risk for these diseases. In this study, our objective was to evaluate descriptive characteristics and smoking status of renal transplant recipients. MATERIALS AND METHODS: We evaluated 113 patients who underwent renal transplant at Baskent University Hospital between 1990 and 2015. The medical records of all patients were retrospectively reviewed. Patient demographics, cause of renal diseases, mortality status, smoking status, and amount of smoking were recorded. RESULTS: In our study, 82 patients (72.7%) were male and 31 were female. The mean age was 38.50 ± 12.94 years. Causes of renal failure were as follows: 15.9% from hypertension, 12.4% from diabetes mellitus (all types), 8% from glomerulonephritis, 8% from vesicoureteral reflux, 6.2% from polycystic kidney disease, 17.6% other, and 31.9% unknown. Comorbid systemic disease was found in 57.6% of the patients. Fifty patients (44.2%) were current smokers, and 63 patients (55.8%) were nonsmokers. Mean age of smokers was 44.68 ± 10.60 years, with most being male patients (92.0%). There was a statistically significant difference between smoking status and sex (P < .001). The presence of comorbid diseases was significantly different between smokers and nonsmokers (P = .001). The smoking status of patients with hypertension (28.2%) was significantly different (P = .032) than others. CONCLUSIONS: Smoking cessation is associated with substantial health benefits for all smokers. For kidney transplant recipients, cigarette smoking has many adverse effects, causing cardiovascular disease and other comorbid diseases. Therefore, every attempt should be made to encourage kidney transplant candidates to stop smoking.