The evaluation of preoperative diagnostic approach to solitary pulmonary nodule with solid structure [Solid yapıdaki soliter pulmoner nodüle preoperatif tanısal yaklaşımın değerlendirilmesi]

Aim: Management of patients with solitary pulmonary nodules (SPN) after a thorough radiological evaluation may differ among different health centers. In this study in a set of radiologically solid SPN cases we aimed to compare the patients undergone surgical excision without histopathological evaluation with the patients undergone histopathological evaluation for decision of surgery. Material and Method: The patients diagnosed to have SPN between July 2009 and 2010 were retrospectively evaluated. Results: Among 42 patients enrolled in the study, 13 (%31) undergone diagnostic and therapeutic surgery (group 1), 29 (%69) undergone additional diagnostic procedures like bronchoscopy, transthoracic fine needle aspiration biopsy (TTFNAB), positron emission tomography (PET) or follow up computed tomography before decision of surgery. Malignant disease was detected in 29 cases (%69); 12 cases (%92) in group 1, and 17 (%58) cases in group 2 (p=0,035). In group 2, 11 patients (%37) were diagnosed or suspected to have malignant disease preoperatively and had proven malignancy by surgery. Out of 18 patients whose histopathological biopsy evaluation were nondiagnostic or benign, 6 (%33) had diagnosis of malignant disease after surgery, 11 patients (%61) were diagnosed to have benign disease by surgery of follow up, and 1 patient was lost in follow up. 33 patients (%79) undergone surgery among all SPN patients, 4 cases refused to have surgery although preoperative malignancy was detected or were inoperable due to comorbidities. 4 patients were thought to have benign disease in follow up period. All patients in both groups were hospitalized for diagnosis and treatment, except one patient in group 2. Medium hospitalization time was 11,76±4.22 days in group 1 and 17±12.21 in group 2 (p=0,09). Discussion: In patients that have radiologically solid SPN and that are thought to have malignant disease with preoperative radiological evaluation, additional diagnostic procedures and biopsies have limited diagnostic value and lengthens hospitalization times. In 1/3 of cases who undergone additional diagnostic procedures after detection of SPN, his-topathological diagnosis was false negative or insufficient. © 2015, Journal of Clinical and Analytical Medicine. All rights reserved

Effect of isolation of Candida species from respiratory specimens on prognosis [Solunum örneklerinden Candida türlerinin i·zole edilmesinin prognoza etkisi]

Objective: Candida species are often isolated from respiratory specimens of patients with a history of long duration of hospitalization, immunosuppression, diabetes, alcoholism, history of wide spectrum antibiotic or corticosteroid usage. The aim of this retrospective study is to investigate the effect of isolation of Candida species from respiratory specimens on prognosis. Material and Method: Patients in the Department of Chest Disease in whom Candida species had been grown in ?2 respiratory specimens obtained at the same or at different time periods within the last two years were enrolled in the study. Demographic features of the patients, risk factors for fungal infection, and the effect of this infection on prognosis were evaluated. Results: Out of 47 cases (mean age 67.6±14.6 yrs, 33 males) enrolled in the study, 29 were diagnosed as pneumonia at admission. The most frequent species isolated was C. albicans (68.1%). Fifty bacterial agents were isolated from respiratory specimens of 29 patients (61.7%) initially or on follow-up along with Candida species. Immunosuppression was detected in 28 patients (59.6%). Mean duration of hospitalization was 22.3±15.2 days and 26 patients (55.3%) died. Radiologically, multiple-zone involvement, C. tropicalis isolation, high APACHE II score, co-existing bacterial infection, low PaO 2/FiO 2 ratio, and low albumin levels were found to be associated with mortality. Conclusion: This study showed that Candida species could also be isolated in respiratory specimens of non-immunosuppressed patients and mortality was high. It was concluded that bacterial co-infection and C. tropicalis isolation affected the prognosis negatively