Assessment of Palliative Care in Lung Cancer in Turkey.

OBJECTIVE: To investigate the symptoms of lung cancer in Turkey and to evaluate approaches to alleviate these symptoms. SUBJECTS AND METHODS: This study included 1,245 lung cancer patients from 26 centers in Turkey. Demographic characteristics as well as information regarding the disease and treatments were obtained from medical records and patient interviews. Symptoms were evaluated using the Edmonton Symptom Assessment Scale (ESAS) and were graded on a scale between 0 and 10 points. Data were compared using the χ2, Student t, and Mann-Whitney U tests. Potential predictors of symptoms were analyzed using logistic regression analysis. RESULTS: The most common symptom was tiredness (n = 1,002; 82.1%), followed by dyspnea (n = 845; 69.3%), appetite loss (n = 801; 65.7%), pain (n = 798; 65.4%), drowsiness (n = 742; 60.8%), anxiety (n = 704; 57.7%), depression (n = 623; 51.1%), and nausea (n = 557; 45.5%). Of the 1,245 patients, 590 (48.4%) had difficulty in initiating or maintaining sleep. The symptoms were more severe in stages III and IV. Logistic regression analysis indicated a clear association between demographic characteristics and symptom distress, as well as between symptom distress (except nausea) and well-being. Overall, 804 (65.4%) patients used analgesics, 630 (51.5%) received treatment for dyspnea, 242 (19.8%) used enteral/parenteral nutrition, 132 (10.8%) used appetite stimulants, and 129 (10.6%) used anxiolytics/antidepressants. Of the 799 patients who received analgesics, 173 (21.7%) reported that their symptoms were under control, and also those on other various treatment modalities (dyspnea: 78/627 [12.4%], appetite stimulant: 25/132 [18.9%], and anxiolytics/antidepressants: 25/129 [19.4%]) reported that their symptoms were controlled. CONCLUSION: In this study, the symptoms progressed and became more severe in the advanced stages of lung cancer, and palliative treatment was insufficient in most of the patients in Turkey.

What happens when oral tuberculosis is not treated?

Pulmonary tuberculosis (TB) is the most important form of the disease, although infection may also occur by way of the intestinal tract, tonsils and skin. Oral lesions consist of persistent ulcers or granulomatous masses. A 50 year old man had been diagnosed "necrotising granulomatous inflammation" following a biopsy of a lesion on lower lip, 21 months before at a medical centre. A chest-X-ray had not been performed and he had not been given any advise in respect of treatment. He was admitted to the hospital with cough, sputum, weakness, weight loss and lesions on his lower lip. In radiology, it was detected that he had supraclavicular, submental, cervical, mediastinal lymphadenopathies, pulmonary infiltrations with cavities, thickening and roughness on left oropharengial tonsil, thickenning on inner parts of larynx and bilateral surrenal thickening. The biopsy of lesions on larynx, tonsil and epiglottis revealed "necrotising granulomatous inflammation" and histopathology supported TB infection. Sputum acid-fast bacilli was positive and culture was positive for Mycobacterium tuberculosis complex. Two months of combination treatment resulted in a gradual relief of the symptoms, radiological response, disappearing of neck swelling and healing of lesions on lip, tonsil and larynx. Although unusual oral cavity manifestations of TB are rare, clinicians should be aware of possible occurrance.

Incidence of cross resistance between rifampicin and rifabutin in Mycobacterium tuberculosis strains in Izmir, Turkey.

Rifabutin is a spiro-piperidyl-rifamycin derived from rifamycin-S. This study was planned to determine the minimal inhibitory concentrations (MICs) of rifabutin and rifampicin against Mycobacterium tuberculosis strains and to investigate cross resistance between two drugs. The agar dilution method was performed for detection of MICs of rifabutin and rifampicin for 112 M. tuberculosis strains obtained from patients with active pulmonary tuberculosis. Cross resistance between rifampicin and rifabutin was detected in 73.1%. Rifabutin MICs for rifampicin resistant strains were three- to four-fold higher than rifabutin-susceptible and/or -resistant strains' MIC values for rifampicin. Despite having 73% cross-resistance with rifampicin in M. tuberculosis isolates, it was concluded that rifabutin might be a valid component of combination therapy in rifampicin resistant tuberculosis cases when the isolate is tested and detected susceptible to rifabutin.

Endobronchial low-grade MALT lymphoma causing unilateral hypertranslucency.

Mucosa-associated lymphoid tissue-derived lymphoma (MALT lymphoma) arises not only from the stomach but also from various non-gastrointestinal sites. A thirty two year old woman, suffering from breathlessness for one year, had been treated for bronchial asthma. A chest radiograph showed a mediastinum and heart transposition to the right side and emphysema of the left lung. In the thorax spiral tomography, a mass narrowing left main bronchi, five centimeters in length from the carina, was seen. A fiberoptic bronchoscopy revealed millimetric polypoid lesions those nearly totally obstructed the left main bronchi. The bronchoscopic biopsy showed a diagnosis of MALT lymphoma. She was seen for check-ups following chemotherapy but no further treatment has been carried out.

Tuberculosis of oral mucosa.

In secondary tuberculosis, lesions of the oral cavity may accompany lesions of the pharynx, lungs, lymph nodes or miliary tuberculosis. A 35-year-old male was suffering from swelling of his right cheek, cough, weakness and weight loss. There were local hyperemia and irregular oral mucous in the inner part of the right cheek. Chest x-ray showed bilateral nodular opacifications and a cavity of 2 cm. Acid-fast bacteria were present in sputum and Lowenstein-Jensen culture was positive. The pathological signs of the biopsy taken from the buccal mucosa including multistratified squamous epithelium were: tubercle structure, Langhans' giant cells and minimal cazeation necrosis. After anti-tuberculous chemotherapy oral and pulmonary lesions were almost in remission. Following this case report of lung tuberculosis accompanied by tuberculosis of oral mucosa, the literature related is reviewed.