Painful chestwall swellings: tietze syndrome or chest wall tumor?

Objective Tietze syndrome (TS) is an inflammatory condition characterized by chestpain and swelling of costochondral junction. Primary chest wall tumors maymimic TS. Inthis article, we report our experience of approximately 121 patients initially diagnosedas TS and determined chest wall tumor in some cases at the follow-up.Methods This is a retrospective review of patients diagnosed as TS by clinicalexamination, chest X-ray, electrocardiogram, routine laboratory tests, and computedtomography (CT) of chest: all treated and followed up between March 2001 andJuly 2012. There were 121 cases (41males and 80 females;mean age, 39.6 3.2 years)of TS.Results In 27 patients with initial normal radiological findings, the size of swellings haddoubled during the follow-up period (mean, 8.51 2.15 months). These patients werereevaluated with chest CT and bone scintigraphy and then early diagnostic biopsy wasperformed. Pathologic examination revealed primary chest wall tumor in 13 patients(5 malignant, 8 benign). CT had a sensitivity of 92.3% and a specificity of 64.2% indetection of tumors (kappa: 0.56, p ¼ 0.002), whereas the sensitivity and the specificityof bone scan were 84.6 and 35.7%, respectively (kappa: 0.199, p ¼ 0.385).Conclusion Primary chest wall tumors could mimic TS. Bone scintigraphy or CT is notspecific enough to determine malignant and other benign disorders of costochondraljunction. Therefore, clinicians should follow TS patients more closely, and in case ofincreasing size of swelling, early diagnostic biopsy should be considered

A rare entity bilateral first rib fractures accompanying bilateral scapular fractures

First rib fractures are scarce due to their well-protected anatomic locations. Bilateral first rib fractures accompanying bilateral scapular fractures are very rare, although they may be together with scapular and clavicular fractures. According to our knowledge, no case of bilateral first rib fractures accompanying bilateral scapular fractures has been reported, so we herein discussed the diagnosis, treatment, and complications of bone fractures due to thoracic trauma in bias of this rare entity

A rare and serious syndrome that requires attention in emergency service: traumatic asphyxia

Traumatic asphyxia is a rare syndrome caused by blunt thoracoabdominal trauma and characterized by cyanosis, edema, and subconjunctival and petechial hemorrhage on the face, neck, upper extremities, and the upper parts of the thorax. Traumatic asphyxia is usually diagnosed by history and inspection; however, the patient should be monitored more closely due to probable complications of thoracoabdominal injuries. Treatment is conservative, but the prognosis depends on the severity of the associated injuries. Herein we present a traumatic asphyxia due to an elevator accident in a 32-year-old male patient and discuss the diagnosis, treatment, and prognosis by reviewing the relevant literature

Myastenia Gravis için timektomi yapılan hastaların postoperatif birinci ve beşinci yıl sonuçlarının karşılaştırılması

Amaç: Myastenia gravis hastalarının tedavisinde timektominin etkinliği tartışmalıdır. Bu çalışmada myastenia graviste uzun dönem takip sonuçlarına göre timektomi etkinliğinin araştırılması amaçlandı.Gereç ve Yöntemler: Ocak 1995 ile Ocak 2004 arasında myastenia gravis nedeniyle sternotomi ve ekstended timektomi uygulanan 27 hastanın birinci ve beşinci yıllardaki klinik sonuçları istatistiksel olarak karşılaştırıldı.Bulgular: Hastaların postoperatif birinci ve beşinci yıllardaki klinik sonuçları arasında istatistiksel fark saptanmadı.Sonuçlar: Uzun dönem sonuçlarının iyi olması nedeniyle timektomi myastenia gravis tedavisinde güvenilir bir yöntemdir. Timektomi sonrası birinci ve beşinci yıllar sonunda elde edilen sonuçlar arasında farklılık yokturAim: The efficiency of thymectomy for treating patients with Myasthenia gravis is a controversial issue. Thus, this study aimed to investigate the efficiency of thymectomy in the treatment of myasthenia gravis based on long-term follow-up results.Material and Methods: The first and fifth year clinical outcomes of 27 patients who had undergone median sternotomy and extended thymectomy for myasthenia gravis between January 1995 and January 2004 were compared statistically.Results: No statistically significant differences were found between the postoperative first and fifth year clinical outcomes of the patients.Conclusions: Thymectomy is a reliable method in the treatment of myasthenia gravis with respect to its long-term outcomes. The outcomes obtained at the end of the first and fifth year of thymectomy are not differen

Examining the Relationships Among Teachers' Work Engagement, Teamwork Attitudes, and Efficacy for Classroom Diversity

The purpose of this quantitative research is to examine the relationships among teachers' work engagement, teamwork attitudes, and efficacy for classroom diversity within the scope of structural equation modeling. The sample of the study consists of 355 teachers involved in the Project Supporting the Integration of Syrian Children into the Turkish Education System (PIKTES) during the 2020-2021 academic year. The Teachers' Teamwork Attitude Scale, Work Engagement Scale, and Teacher EfficacyScale for Classroom Diversity have been used for collecting the data. Four hypotheses were developed based on the structural model created within the context of this study. Accordingly, (i) teachers' work engagement is claimed to positively affects both teachers' efficacy for classroom diversity as well as their (ii) teamwork attitude; and (iii) teachers' efficacy for classroom diversity is claimed to positively affect their teamwork attitude, and (iv) teachers' work engagement is also claimed to positively affect their teamwork attitude through their efficacy for classroom diversity. To verify these hypotheses, the relationships among the variables were determined first, and all the variables were seen to have moderately positive relationships. Based on these relations, the given structural model was then created and tested using path analysis. The findings showed all the hypotheses to have been proven confirmed

The prognostic factors in lung cancer

Amaç: Akciğer kanseri tüm dünyada kansere bağlı ölümlerde kadınlarda ve erkeklerde birinci sırada yer almaktadır. Cerrahi rezeksiyon küçük hücreli dışı akciğer kanserli (KHDAK) hastalarda en önemli tedavi şeklidir. Ancak rezeksiyon uygulanan erken evre hastalarda bile sağkalım istenilen seviyelere ulaşamamaktadır. Bu çalışmanın amacı cerrahi rezeksiyon uygulanan KHDAK hastalarında sağ kalım üzerinde etkili olabilecek faktörlerin araştırılmasıdır.Gereç ve Yöntemler: 2003 ile 2006 yılları arasında KHDAK nedeniyle cerrahi rezeksiyon uygulanan 71 hastada çalışmaya dahil edildi. Hastalar, bir yıllık takip sonunda hayatta olanlar (Grup I, n 37) ile bir yıllık takip sonunda exitus olanlar veya nüks gelişenler (Grup II, n 34) olmak üzere iki gruba ayrıldı. Bu gruplar arasında hastaların, şikayet, laboratuar bulguları, tümör yerleşim yeri, çapı, lenf nodu durumu, evre ve tedavi şekli açısından farklılıklar araştırıldı.Bulgular: En büyük tümör çapı grup I'de ortalama 40,2 mm, grup II'de ise 51,0 mm idi (P 0,05). Otuzdört hastada N0, 17 hastada N1, 20 hastada da N2 vardı ve lenf nodu evresi grup I'de anlamlı olarak düşük saptandı (P 0,05). Her iki grup evre yönünden evre I, II ve III olarak karşılaştırıldı ve evre grup I'de anlamlı olarak düşük saptandı (P 0,05). Grup I ve grup II için ortalama CEA değerleri sırasıyla 3,26 ile 7,67 ng/mL'ydi (P 0,05). Grup I ve grup II için ortalama CA 19-9 değerleri sırasıyla 13,35 ve 30,04 ng/mL'ydi (P 0,05). Her iki grup arasında balgam çıkarma dışında anlamlı fark saptanmadı (P 0,05).Sonuçlar: Akciğer kanseri için tanımlanan prognostik faktörler farklılıklar göstermektedir. TNM evreleme sistemi KHDAK'li hastalarda prognozu en doğru yansıtan faktör olarak görünmekle birlikte aynı grup içinde serum CEA seviyesi benzeri faktörler de prognoza etki edebilmektedir. Ancak klinik heterojeniteden dolayı KHDAK'li tek bir hastanın prognozunu belirlemek zordurAim: Lung cancer is the leading cause of cancer related deaths among women and men worldwide. Surgical resection is the treatment of choice in patients with non-small cell lung cancer (NSCLC). However, survival does not reach to desired levels even in patients with resection in an early stage. The aim of this study is to investigate the factors that may affect on survival in patients with NSCLC.Material and Methods: Seventy-one lung cancer patients who treated with surgical resection between 2003 and 2006 were included in this study. The patients were divided into two groups as, group I the surviving patients (n 37) and group II the patients died or with recurrent cancer (n 34), after a follow-up period of one year. These two groups were compared for symptoms, laboratory findings, tumor localization, tumor size, lymph node status, stage and treatment modality.Results: The mean longest dimension of the tumor was 40.2 mm in group I and 51.0 mm in group II (P 0.05). N status was significiantly lower in group I (P 0.05) as 34 patients have N0, 17 patients have N1 and 20 patients have N2 disease. Stage comparison was done according to stage I, II and III and stage was significantly lower in group I (P 0.05). The mean level of CEA was 3.26 and 7.67 ng/mL in group I and II, respectively (P 0.05). The mean level of CA 19-9 was 13.35 and 30.04 ng/mL in group I and II, respectively (P 0.05). There was no significant difference for symptoms except for sputum complaint (P 0.05).Conclusion: Prognostic factors identified for lung cancer show variations. TNM staging system seems to be the most accurate factor reflecting the prognosis in patients with NSCLC, while different factors such as CEA may influence on prognosis in the same patients. However, it is difficult to determine the prognosis of an individual, because of the clinical heterogenity of NSCL

The prevalence of chest wall deformity in Turkish children

Background/aim: This study aimed to identify children who have chest wall deformity, the prevalence of deformity, and the factors affecting the psychological and physical disorders caused by the deformity. Materials and methods: The study was conducted among 14,108 girls and boys aged 11-14 years, who were 5th-8th grade secondary school students in Ankara Province between October 2014 and March 2015. Results: Of the 14,108 students in our study, the mean age of the children was 12.53 +/- 1.11 years (median 12.54, 11-14 years) and chest wall deformity was detected in 199 (1.41\%) students. Male/female and pectus carinatum/pectus excavatum ratios were 2.16 and 1.59, respectively. According to multivariate logistic regression analysis, physical disturbance was found to be statistically significantly higher among children in age group 11 {[}adjusted OR (95\% CI) =16.01 (1.89-135.61), P < 0.0111 and in children who were aware of the deformity {[}adjusted OR (95\% CI) = 0.31 (0.13-0.71), P < 0.006], and psychological disturbance was found to be statistically significantly higher in girls {[}adjusted OR (95\% CI) 15.44 (1.68-141.59), P < 0.0151 and in those with a presence of family history {[}adjusted OR (95\% CI) - 18.66(1.92-181.60), P < 0.0121. Conclusion: In this study conducted in a large population, chest wall deformities were found to be more prevalent in boys (0.96\%) and pectus carinatum was found as the most common deformity type in our country, contrary to the literature

The Impact of CoronaVac Vaccination on 28-day Mortality Rate of Critically Ill Patients with COVID-19 in Türkiye

Background:Vaccines against coronavirus disease-19 (COVID-19) have been effective in preventing symptomatic diseases, hospitalizations, and intensive care unit (ICU) admissions. However, data regarding the effectiveness of COVID-19 vaccines in reducing mortality among critically ill patients with COVID-19 remains unclear.Aims:To determine the vaccination status and investigate the impact of the COVID-19 vaccine on the 28-day mortality in critically ill patients with COVID-19.Study Design:Multicenter prospective observational clinical study.Methods:This study was conducted in 60 hospitals with ICUs managing critically ill patients with COVID-19. Patients aged ≥ 18 years with confirmed COVID-19 who were admitted to the ICU were included. The present study had two phases. The first phase was designed as a one-day point prevalence study, and demographic and clinical findings were evaluated. In the second phase, the 28-day mortality was evaluated.Results:As of August 11, 2021, 921 patients were enrolled in the study. The mean age of the patients was 65.42 ± 16.74 years, and 48.6% (n = 448) were female. Among the critically ill patients with COVID-19, 52.6% (n = 484) were unvaccinated, 7.7% (n = 71) were incompletely vaccinated, and 39.8% (n = 366) were fully vaccinated. A subgroup analysis of 817 patients who were unvaccinated (n = 484) or who had received two doses of the CoronaVac vaccine (n = 333) was performed. The 28-day mortality rate was 56.8% (n = 275) and 57.4% (n = 191) in the unvaccinated and two-dose CoronaVac groups, respectively. The 28-day mortality was associated with age, hypertension, the number of comorbidities, type of respiratory support, and APACHE II and sequential organ failure assessment scores (p < 0.05). The odds ratio for the 28-day mortality among those who had received two doses of CoronaVac was 0.591 (95% confidence interval: 0.413-0.848) (p = 0.004).Conclusion:Vaccination with at least two doses of CoronaVac within six months significantly decreased mortality in vaccinated patients than in unvaccinated patients