Temporal Changes in Lung Cancer: A 10-year Study in a Chest Hospital

Background and Aim. No prospective, wide-scale study on lung cancer (LC) exists in Turkey. We aimed to determine prospectively epidemiologic features, histologic types, stages and temporal changes in LC in the Aegean Region of Turkey. This is the first prospective and largest LC study in Turkey. Methods. A hospital-based study was conducted on LC cases diagnosed between 1994 and 2004 at a tertiary referral hospital for thoracic medicine and surgery in Izmir, Turkey. The study was divided into two 5-year periods to determine temporal changes. Results. Of 13,344 patients with pathologically confirmed LC, 93.1% was male. The mean age was 61.35±0.08 (59.5% between 41-65). The majority (82.5%) were smokers or ex-smokers. There was a 13.87% general rise in smoking rate, predominantly in females. LC incidence increased by 38% from 1994-1999 (42%) to 2000- 2004 (58%); the contributive increases were 35.5% in males, and 77.5% in females. Frequent types were squamous cell carcinoma (24.7%), small cell carcinoma (SCLC) (14.2%) and adenocarcinoma (13.2%). Adenocarcinoma in the younger group (<40), females or nonsmokers, and squamous cell carcinoma in the older group, males or smokers were the leading types. Nonsmall cell lung carcinoma (NSCLC) was mostly diagnosed at stages IIIB (36.7%) and IV (37%) whereas SCLC at limited stage (59.1%). Conclusion. The majority of the LC patients are over 40 years old, current or ex-smokers, or with squamous cell carcinoma. There is a general rise in smoking rate with a female predominance. The most common type is squamous cell carcinoma in males, and adenocarcinoma in females. NSCLC is diagnosed more frequently at advanced stage but SCLC at limited stage

A review of the current treatment methods for posthaemorrhagic hydrocephalus of infants

Posthaemorrhagic hydrocephalus (PHH) is a major problem for premature infants, generally requiring lifelong care. It results from small blood clots inducing scarring within CSF channels impeding CSF circulation. Transforming growth factor – beta is released into CSF and cytokines stimulate deposition of extracellular matrix proteins which potentially obstruct CSF pathways. Prolonged raised pressures and free radical damage incur poor neurodevelopmental outcomes. The most common treatment involves permanent ventricular shunting with all its risks and consequences

Analgesia and sedation in neonates [Yenidoganda analjezi ve sedasyon]

It has been known for a long-time that neuroanatomical, neuroendocrinal and neurophysiological systems are sufficiently developed to allow transmission of painful stimuli in the neonate. But still many practitioners perform many procedures with no or minimal analgesia. One of the main reasons is the fear of adverse effects related to complications of analgesics. Endocrinometabolic and stress responses in newborn to invasive and surgical operations are more potent than adults. Newborns are regularly subjected to routine stressful and/or painful procedures every day in newborn intensive care units. It has been reported that the incidence of morbidity has increased in neonates subjected to severe and prolonged pain

Necrotising enterocolitis [Nekrotizan enterokolit]

Many factors have a role in the etiology of necrotising enterocolitis whose pathogenesis is not understood yet. Prematurity, hypoxia, enteral feeding and bacterial colonization in guts have played a role in the etiopathogenesis. Because of the occurence of epidemias of necrotising enterocolitis, infectious causes are also accused. Intestinal ischemia due to the vasoconstrictor metabolites is the common pathogenetic pathway in necrotising enterocolitis. The most prominent lesions are coagulation and ischemic necrosis. Clinical signs resemble to sepsis. In this review article, necroting enterocolitis, detected as an important cause of mortality and morbidity in newborn intensive care units, is reviewed

Correlation of simultaneously obtained capillary, venous, and arterial blood gases of patients in a paediatric intensive care unit

Aims: To investigate the correlation of pH, partial pressure of oxygen (PO(2)), partial pressure of carbon dioxide (PCO(2)), base excess (BE), and bicarbonate (HCO(3)) between arterial (ABG), venous (VBG), and capillary (CBG) blood gases. Methods: Patients admitted to the paediatric intensive care unit (PICU) in Çukurova University between August 2000 and February 2002 were enrolled. Results: A total of 116 simultaneous venous, arterial, and capillary blood samples were obtained from 116 patients (mean age 56.91 months, range 15 days to 160 months). Eight (7%) were neonates. Sixty six (57%) were males. pH, PCO(2), BE, and HCO(3) were all significantly correlated in ABG, VBG, and CBG. Correlation in PO(2) was also significant, but less so. Correlation between pH, PCO(2), PO(2), BE, and HCO(3) was similar in the presence of hypothermia, hyperthermia, and prolonged capillary refilling time. In hypotension, correlation in PO(2) between VBG and CBG was similar but disappeared in ABG–VBG and ABG–CBG. Conclusions: There is a significant correlation in pH, PCO(2), PO(2), BE, and HCO(3) among ABG, VBG, and CBG values, except for a poor correlation in PO(2) in the presence of hypotension. Capillary and venous blood gas measurements may be useful alternatives to arterial samples for patients who do not require regular continuous blood pressure recordings and close monitoring of PaO(2). We do not recommend CBG and VBG for determining PO(2) of ABG

The Value of Capnography during Sedation or Sedation/Analgesia in Pediatric Minor Procedures

PubMedID: 15094573Objective: To measure changes in end-tidal carbon dioxide levels (ETCO 2) with different sedation/analgesia (midazolam, ketamine, ketamine plus midazolam, midazolam plus fentanyl, and propofol) during pediatric minor surgical procedures and to determine whether there were significant increases in ETCO2 with different drugs. Methods: We conducted a prospective, randomized, clinical trial of 126 children who needed sedation/analgesia in pediatric intensive care unit in a university hospital. Patients were randomly assigned to 1 of 5 treatment groups. Group K received only intravenous (IV) ketamine 1 mg/kg; group M, IV midazolam 0.15 mg/kg; group KM, IV ketamine 1 mg/kg plus IV midazolam 0.1 mg/kg; group MF, IV midazolam 0.1 mg/kg plus IV fentanyl 2 µg/kg; and group P, IV propofol 2 mg/kg. Side stream, nasal cannula ETCO2 tracings were recorded on a capnograph (Capnostat, Marquette). Recordings began prior to the administration of medications and continued throughout the procedure until the patient was fully awake. The primary outcome variable was the difference between peak ETCO2 before and during sedation/analgesia. This value was determined by scanning the records for the peak ETCO2 averaged over 5 breaths before and after the administration of medications. Results: There was neither any statistical difference between presedation/analgesia and postsedation/analgesia ETCO 2 levels in the 5 groups (P &gt; 0.05) nor any difference in the first 3 groups between presedation/analgesia, sedation/analgesia, and postsedation/analgesia (K, M, and KM) (P &gt; 0.05). In the midazolam plus fentanyl and propofol groups, mean ETCO2 during sedation/analgesia was higher than the mean ETCO2 during presedation/analgesia and postsedation/analgesia (P &lt; 0.05). Twenty-one patients (16, 6%) had respiratory depression [hypercarbia (ETCO2 &gt; 50 mm Hg) or hypoxia (oxygen saturation &gt; 90% for over 1 minute)], 21 patients (16, 6%) had hypercarbia, and 4 patients (3.2%) had both hypoxia and hypercarbia. One of 4 patients was in the MF group, and 3 were in the P group. Two subjects (8%) in the KM group, 7 (28%) in the MF group, and 13 (52%) in the P group had hypercarbia. Conclusions: This study demonstrated that propofol and midazolam-fentanyl produced a higher incidence of respiratory depression and higher mean ETCO2 during sedation/analgesia than presedation and postsedation/analgesia. Capnography can serve as a useful monitoring tool in the evaluation of ventilation during sedation or sedation/analgesia in clinically stable children

Pneumomediastinum and pneumopericardium: Unusual and rare complication of cystic fibrosis in a 2 years old girl

We describe a 2 year old girl with cystic fibrosis who presented with pneumomediastinum and pneumopericardium. She was admitted to pediatric intensive care unit with cough, dyspnea and cyanosis of two day duration. She had experienced attacks of cough, dyspnea and wheezing for one and half years. Sweat chloride test values were 100 and 90 mEq/L. On the third day after admission, she was acutely dyspneic, hypotensive and bradycardic and died although resusitated. In the chest X-ray pneumomediastinum and pneumopericardium were revealed. In conclusion, the rare complications pneumomediastinum and pneumopericardium should be in mind in cystic fibrosis patients whose general condition deteriorates acutely

Correlation of simultaneously obtained capillary, venous, and arterial blood gases of patients in a paediatric intensive care unit

Aims: To investigate the correlation of pH, partial pressure of oxygen (PO(2)), partial pressure of carbon dioxide (PCO(2)), base excess (BE), and bicarbonate (HCO(3)) between arterial (ABG), venous (VBG), and capillary (CBG) blood gases. Methods: Patients admitted to the paediatric intensive care unit (PICU) in Çukurova University between August 2000 and February 2002 were enrolled. Results: A total of 116 simultaneous venous, arterial, and capillary blood samples were obtained from 116 patients (mean age 56.91 months, range 15 days to 160 months). Eight (7%) were neonates. Sixty six (57%) were males. pH, PCO(2), BE, and HCO(3) were all significantly correlated in ABG, VBG, and CBG. Correlation in PO(2) was also significant, but less so. Correlation between pH, PCO(2), PO(2), BE, and HCO(3) was similar in the presence of hypothermia, hyperthermia, and prolonged capillary refilling time. In hypotension, correlation in PO(2) between VBG and CBG was similar but disappeared in ABG–VBG and ABG–CBG. Conclusions: There is a significant correlation in pH, PCO(2), PO(2), BE, and HCO(3) among ABG, VBG, and CBG values, except for a poor correlation in PO(2) in the presence of hypotension. Capillary and venous blood gas measurements may be useful alternatives to arterial samples for patients who do not require regular continuous blood pressure recordings and close monitoring of PaO(2). We do not recommend CBG and VBG for determining PO(2) of ABG

Does polyclonal intravenous immunoglobulin reduce mortality in septic children in the pediatric intensive care unit? [Çocuk yogun bakim ünitesi'nde sepsis nedeni ile izlenen hastalarda poliklonal intravenöz immünglobülin tedavisi mortaliteyi azaltiyor mu?]

Although advances in medicine and our understanding of the pathogenesis of sepsis and septic shock have dramatically improved, the mortality rate in sepsis is still very high. The harmful effects of sepsis and septic shock have been postulated to be largely due to the lipid A component of the endotoxin molecule in gram-negative bacteria. Thus the use of antibodies against the endotoxin molecule in treatment has been investigated. There have been a number of studies about immunoglobulin preparations in the treatment of sepsis, and studies on monoclonal and polyclonal immunoglobulin preparations have increased. In this prospective randomized study, 84 patients followed in the Pediatrie Intensive Care Unit for systemic inflammatory response syndrome were enrolled in the study. The patients with primary immune deficiency and chronic disease that may lead to immune deficiency were excluded. Intravenous immunoglobulin (IVIG) in a dose of 1 g/kg/day for two days was administered to 41 patients; 43 patients served as control. Of these 84 patients, 60 had blood culture-proven sepsis. The mean age of the patients was 32.6 ± 32.1 months. There was no statistical difference between groups (30 patients in IVIG group and 30 patients in control group) in terms of hospitalization days in the Pediatric Intensive Care Unit (10.8 ± 3.2 days vs 11 ± 3 days), ventilator treatment (33.3% vs 30%), septic shock (26.6% vs 39.9%), multiorgan dysfunction (36.6% vs 43.3%) and mortality rate (26.6% vs 33.2%), (p>0.05). In conclusion, as IVIG administration is very expensive and does not reduce mortality and morbidity, we think it is not necessary to initiate IVIG to septic children as an adjuvant therapy until further studies including a larger number of septic children are conducted

Serum insulin-like growth factor 1 and growth hormone levels of hypoxic-ischemic newborns

PubMedID: 14631161A number of growth factors, their binding proteins, and their receptors have been shown to be induced in the hypoxic-ischemic (HI) brain. In this prospective study, we aimed at determining the levels of insulin-like growth factor 1 (IGF-1), growth hormone (GH), and cortisol in HI babies and at identifying whether they differ from the levels of control infants. The serum IGF-1 levels were measured after the first 12-24 h of life, and the measurements were repeated on the 5th and 10th days of life for babies with HI encephalopathy (n = 18) and on the 10th day of life for controls (n = 19). Blood samples for measurement of cortisol and GH from both HI and control groups were collected after the first 12-24 h of life. There were 11 babies in the mild-to-moderate (stages I and II) group and 7 babies in the severe (stage III) group according to Sarnat and Sarnat. The IGF-1 levels of the HI group measured after 12-24 h [78.5 ± 27.9 (range 9-123.4) ng/ml] and on the 10th day [72.2 ± 36.8 (range 29.7-159.2) ng/ml] of life were statistically significantly lower than the IGF-1 levels of the control group [121.5 ± 50.4 (range 74.4-280.5) ng/ml and 133.1 ± 34.4 (range 65.9-202) ng/ml, respectively] (p = 0.002 and p = 0.001, respectively). But there was no statistically significant difference between mild-to-moderate HI group and severe HI group in terms of IGF-1 levels after 12-24 h and 5 and 10 days of life (p > 0.05). Also there was no statistically significant difference in IGF-1 values after the first 12-24 h and after 10 days of life between HI subjects who died or survived (p > 0.05). The GH levels of the HI group after the first 12-24 h of life [34.6 ± 32.3 (range 0.1-120) mIU/l] were statistically significantly higher than those in the control group [10.4 ± 4.5 (range 3.7-16.9) mIU/l] (p = 0.005). There was no statistically significant difference in the serum cortisol levels between HI and control groups after the first 12-24 h of life [18.7 ± 17.0 (range 1.6-65.1) µg/dl vs. 10.8 ± 5.4 (range 3.0-23.2) µg/dl] (p > 0.05). No statistically significant correlation was found between IGF-1 levels and GH and cortisol levels of the HI encephalopathy group [r = -0.113 (p > 0.05) and r = 0.108 (p > 0.05), respectively]. In conclusion, this study showed decreased levels of serum IGF-1 and increased levels of GH which may be secondary to serum IGF-1 influx from the circulation to the brain as a protective mechanism or may be due to some cytokines which alter the GH/IGF axis, inhibit the action of IGF-1, and stimulate IGF-binding protein 1. Copyright © 2004 S. Karger AG, Basel