Primer akciğer kanserli olgularda pre- ve postoperatif evrelemenin karşılaştırılması

To compare the concordance of pre- and postoperative pathological diagnosis and stages of the cases with surgically treated primary lung carcinoma. Thirty-two cases with surgically treated primary lung carcinoma were retrospectively reviewed for their pre- and postoperative pathological diagnoses and stages. In the preoperative assessment, lymph nodes of shortest transverse axis greater than 1 cm on thoracic computed tomography (TCT) were accepted as pathologic. By preoperative staging 46.9% of the patients were diagnosed with squamous cell carcinoma, while 21.9% were non-small cell lung carcinoma (NSCLC) whose subgroups were not defined. Only one case was diagnosed as adenocarcinoma. After surgical treatment, pathological examination of the specimens revealed squamous cell carcinoma in 40.6% of the cases, and with a marked increase, adenocarcinoma in 37.5%. Nineteen (59.4%) of the patients were found to have the same pre- and postoperative clinical and pathologic stage. The sensitivity and specifity of TCT for mediastinal nodes were 75% and 76.9%, respectively. The study demonstrated that the incidence of adenocarcinoma would increase if the subgroups of NSCLC were better determined, and also indicated the necessity of invasive staging in guidance of TCT for more accurate staging.Bu çalışmanın amacı, opere edilen primer akciğer karsinomlu olguların pre ve postoperatif patolojik tanı ve evreleme bulgularının uyumunu karşılaştırmaktır. Primer akciğer karsinomu tanısıyla opere edilen 32 olgunun pre ve postoperatif tanıları ile evreleme bulguları retrospektif olarak gözden geçirildi. Toraks bilgisayarlı tomografisinde (TBT) kısa çapı 1 cm'den büyük olan lenf bezleri patolojik kabul edildi. Cerrahi tedavi öncesi olguların %46.9'u skuamöz hücreli, %21.9'u alt grubu belirlenememiş küçük hücreli dışı akciğer kanseri (KHDAK) tanısı alırken, sadece bir olgu adenokarsinom olarak tanımlandı. Operasyon sonrasında yine skuamöz hücreli karsinomun birinci sırada (%40.6) yer aldığı, ancak adenokarsinom sıklığının (%37.5) belirgin şekilde arttığı dikkat çekti. 19 (%59.4) olgunun klinik ve patolojik evrelerinin aynı olduğu gözlendi. Mediastinal lenf bezlerini değerlendirmede TBT'nin duyarlılığı %75, özgüllüğü ise %76.9 olarak hesaplandı. Bu çalışma, KHDAK'lerin alt grupları daha iyi belirlendiğinde adenokanser sıklığının artacağını ve daha doğru bir evreleme için TBT rehberliğinde invaziv evrelemenin gerekliliğini işaret etmektedir

The Role of Non-Vitamin K Antagonist Oral Anticoagulants (NOACs) in Atrial Fibrillation: Treatment Management Based on Patient and Drug Characteristics

Data from Turkey revealed that atrial fibrillation patient percentage under adequate anticoagulation in Turkey is less than that in other countries due to multiple parameters such as treatment adherence problems, failure to follow guideline recommendations, negative perspective on the use of new drugs, drug costs, and payment conditions. The aim of this article is to provide physicians with a compiled resource that focuses on the differences between non-vitamin K antagonist oral anticoagulants and heterogeneity of atrial fibrillation patients by reviewing the global and national data from a multidisciplinary perspective and provide guidance on the choice of non-vitamin K antagonist oral anticoagulants in atrial fibrillation patients. A gastroenterologist, 2 neurologists, and 11 cardiologists from university and training and research hospitals in Turkey who are experienced in atrial fibrillation and non-vitamin K antagonist oral anticoagulant treatments gathered in 3 separate meetings to identify the review topics and evaluate the outcomes of the systematic literature search. Based on the pharmacological characteristics, clinical studies, and real-world data comparisons, it has been revealed that non-vitamin K antagonist oral anticoagulants are not similar. Thromboembolism and bleeding risks, renal and hepatic functions, coexisting conditions, and concomitant drug usage have been shown to affect the levels of benefits gained from non-vitamin K antagonist oral anticoagulant in atrial fibrillation patients. Although Turkish patients with atrial fibrillation have been observed to be younger, they are more likely to have coexisting cardiovascular conditions compared to the atrial fibrillation patients in other countries. Selection of an appropriate non-vitamin K antagonist oral anticoagulant in line with the available evidence and recent guidelines will provide substantial benefits to atrial fibrillation patients