Kaviter Lezyonun Bin Bir Yüzü: Pulmoner Emboli Tanısından Akciğer Kanserine Uzanan Bir Yolculuk

Kaviter lezyonların ayırıcı tanısında birçok hastalık bulunmaktadır. En sık enfeksiyon hastalıklarına bağlı olarak gelişmektedir. Ancak kaviter lezyonlar tetkik edilirken malignite tanısı da akılda bulundurulmalıdır. Kaviter lezyon ile takip edilen olgumuzda pulmoner emboli gelişmiş daha sonra ileri incelemelerde akciğer kanseri tanısı konul-muştur. Kaviter lezyonun radyolojik görünümlerine göre bazı hastalıklar öngörülebil-mesine rağmen, bazen radyolojik görünüm yanılgıya götürebilmekte, hatta son tanı-nın konulmasında gecikmeye neden olabilmektedir. Biz bu olgumuzu kaviteyle gelen genç hastada kaviteye eşlik eden birçok hastalığın bulunması, kaviter lezyona malig-nitenin eşlik etmesi ve tanıda gecikmenin nedenlerinin analiz edilebilmesi, kaviter lezyonlar incelenirken çok yönlü bakış açısının sağlanması gerekliliğini vurgulamak amacı ile sunduk

Is chronic respiratory disease a possible risk factor in acute pulmonary thromboembolism?

Objective: Although we frequently encounter pulmonary thromboembolism (PTE) in patients with chronic respiratory disease in our daily practice, only the presence of respiratory failure is stated as a risk factor in the guideline. In our study, it was aimed to investigate the frequency of acquired risk factors, especially chronic respiratory diseases, in acute PTE. Material and Methods: Our study was designed as a single-center observational descriptive study. Patients hospitalized with the diagnosis of acute PTE in our hospital were evaluated between August 01, 2016 and August 01, 2020. Results: A total of 157 patients were included in our study. The most common acquired risk factors were; being 65 years and older (n=80, 51%), arterial hypertension (n=65, 42.4%), obesity (n=35, 22.3%) and chronic respiratory disease (n=30, %19.1). No ac quired risk factor was found in 31 patients (19.2%). Chronic obstructive lung disease (n=22, 73.3%) was the most common disease among chronic respiratory diseases. Other respiratory diseases were interstitial lung disease (n=5, 16.7%), obstructive sleep apnea syndrome (n=2, 6.7%), and asthma (n=1, 3.3%). The presence of chronic respi ratory disease was significantly higher in men, patients aged 65 and over, and smokers. Conclusion: The frequency of PTE risk factors varies according to countries and socioe conomic level. Our data showed that chronic respiratory disease is more common in PTE patients than many diseases or conditions that are currently considered as risk factors

Bilgisayarlı Tomografi ile Hesaplanan Haunsfield Ünitesinin Plevral Sıvı Transüda-Eksüda Ayrımındaki Tanısal Değeri ve Plevral Sıvı Nötrofil/Lenfosit Oranı ile Karşılaştırılması

Amaç: Bu çalışmanın amacı, bilgisayarlı tomografide hesaplanan Haunsfield ünitesi (HU) değerinin plevral sıvı transüda-eksüda ayrımındaki değerini ortaya koymak ve ayrım açısından plevranın radyolojik özellikleri ve plevral sıvı nötrofil/lenfosit oranı (NLR) ile karşılaştırmaktır. Gereç ve Yöntemler: Çalışmada, 2008-2018 yılları arasında torasentez ile plevra sıvısı örneklemesi yapılan hastalar tek merkezde, retrospektif olarak incelendi. Toraks bilgisayarlı tomografide sıvının en fazla olduğu üç ayrı kesitten HU ölçümü yapıldı. HU için optimal cut-off değeri belirlendi. Plevranın bilgisayarlı tomografi görünümleri ve plevral sıvı NLR’nin transüda-eksüda ayrımındaki yeri karşılaştırıldı. Bulgular: Çalışmada 411 hasta incelendi. Tek taraflı plevra sıvılarının eksüda olma durumunun daha yüksek olduğu saptandı (p=0,001). Plevral nodül ve plevral lokülasyon özellikleri eksüda niteliğindeki sıvılarda daha sık görülmekle birlikte transüda-eksüda ayrımında istatistiksel olarak anlamlılık görülmedi. Plevral sıvı NLR ile transüda ve eksüda olma durumu arasında ve plevra sıvısı NLR ile HU değeri arasında bir ilişki izlenmemiş olup istatistiksel olarak anlamlı bir sonuca ulaşılamadı. Plevra sıvısı HU değeri ile transüda-eksüda ayrımında opaklı-opaksız çekimlerde anlamlı bir fark saptanmadı. Transüda-eksüda ayrımında HU için optimal cut-off değeri 7,9 olarak hesaplandı ve 7,9 değerine göre duyarlılık %45,8, özgüllük %86,3, pozitif prediktif değer %86,3, negatif prediktif değer %25,6 olarak saptandı. HU 7,9’un üzerinde olan hastaların; 7,9 ve altında olan hastalara göre 5,33 kat eksüda olma ihtimali fazla olarak bulundu (p=0,001). Sonuç: Çalışmamız plevra sıvısının bilgisayarlı tomografide HU değeri ile plevranın radyolojik özelliklerinin karşılaştırıldığı en geniş seridir. HU için optimal cut-off değeri 7,9 olup, HU değerinin 7,9’un altında olması transüda olma ihtimalini artırmaktadır. İnvaziv işlem yapılamayan ya da tanısal işlem öncesi transüda-eksüda ayrımında HU ölçümünün invaziv olmayan bir yöntem olarak kullanılabileceği düşünüldü

Clinical Characteristics and Transmission Routes of COVID-19 in the Early Period of the Pandemic in a Non-Covid Ward of Chest Diseases Hospital

Objective: In the early stages of the outbreak, Covid patients were followed-up in isolated Covid Wards, and the examinations of other pulmonary diseases continued in Non-Covid wards. Differential diagnosis between COVID-19 and infections caused by other pathogens is not adequately recognized. For this reason, it is even more difficult to identify patients who are infected with SARS-CoV2 or other pathogens. In the present study, the clinical characteristics and transmission routes of the Covid-19 cases in Non-Covid Wards within approximately 2 months’ time after the onset of the pandemic were analyzed speculatively. Method: In the early periods of the pandemic, quarantine wards were created for Covid patients in Chest Diseases Hospital, but there were also changes in Non-Covid patients and new Non-Covid hospitalizations. The clinical characteristics and transmission routes of the Covid cases in Non-Covid Ward were examined retrospectively and observationally between 10.03.2020 and 30.04.2020. Results: During this period, a total of 35 Covid cases were detected as a patient, companion and healthcare employees. The median age of the patients was 50 years (min-max 25-85). There were 17 patients (48.6%) who were not severe, and 18 severe patients (51.4%), and 10 (28.6%) patients died. A total of 25 (71,4%) of infected cases were verified with the SARS-CoV-2 Nucleic Acid Test, and 10 (28,6%) were diagnosed clinically and radiologically as possible COVID-19 cases. Being 65 years old or over, having comorbid diseases, especially COPD, the presence of dyspnea as a symptom and involvement on chest radiography were found to be significantly associated with survival (p0.027, 0.009, 0.038, 0.000 and 0.033, respectively). Lymphopenia, increase in neutrophil count, CRP and NLR value were found to be statistically related to survival (p 0.005, 0.001, 0.014 and 0.000, respectively). We found 4 super spreaders, one of whom was a companion, and 3 patients. Conclusion: Potential “super spreaders” can be the source of infection before the quarantine conditions are applied and comprehensive protection is implemented. For this reason, quarantine, use of personal protective equipment, application of social distancing, and the implementation of comprehensive preventive measures, such as disinfection, are crucial in controlling nosocomial infection

What are the Differences Between Smoker and Non-smoker COPD Cases? Is it a Different Phenotype?

OBJECTIVE: The most important risk factor for chronic obstructive pulmonary disease (COPD) is smoking. However, more than 25% of patients do not have a history of smoking. The intent of this study is to identify characteristics of COPD patients that are non-smokers.MATERIAL AND METHODS: The records of patients with COPD were retrospectively reviewed. Smoking history, comorbidities, exacerbations, biomass, and environmental tobacco smoke (ETS) exposures were identified. Also, age, gender, pulmonary function test (PFT) values, modified Medical Research Council (mMRC) dyspnea scores were recorded. Non-smokers exposed to any of the COPD risk factors above were grouped and the data were analyzed to determine the specific characteristics of COPD that applied to them.RESULTS: A total of 706 COPD patients were analyzed with a mean age of 67.2 ± 9.4. Of these patients, 93 (13.2%) were female and 613 (86.8%) were male. Of the 706 patients, 128 (18.1%) were non-smokers. The percentage of male patients having COPD was significantly lower in the non-smoker group (P < .001). However, biomass, ETS exposure in childhood, and a history of previous respiratory infection were significantly higher in the non-smoker group (P < .001). The mean body mass index (BMI) was greater in non-smokers than smokers.CONCLUSION: Non-smokers with COPD have more biomass, ETS exposure, and infection history in childhood. They also have less impairment of airflow limitation, better symptom scores, and greater BMIs. Smoking history can be used to determine a different phenotype

Prognostic Effects of Neutrophil-Lymphocyte Rates in Serum and Pleural Fluids in Malignant Pleural Fluids

Objective: Various studies have reported that the neutrophil-to-lymphocyte ratio in the serum (sNLR) may serve as a cost-effective and useful prognostic factor in patients with various cancer types. We investigated the clinical impact of NLR as a prognostic factor in malign pleural effusion (MPE) and sNLR on prognosis in MPE. Method: We retrospectively reviewed all of the patients who were diagnosed MPE. The relationship between sNLR and neutrophil-to-lymphocyte ratio in the malign pleural effusion (mNLR) value, age, Eastern Cooperative Oncology Group (ECOG), histopathologic type, serum albumin and lactate dehydrogenase (LDH) with survival were investigated. Results: A total of 222 patients with a mean age of 65.7±11.5 were included in the study. Patients with a mNLR value ?0.42 and a serum NLR value ?4.75 had a shorter survival (p: 0.000). Multivariate analysis, which showed that survival was significantly related mNLR value > 0.42 and/or sNLR value > 4.75 (Odds Ratio (OR): 2.66, %95 CI, 1,65-4,3 p: 0.001), serum LDH > 210 (OR = 1.8, %95 CI, 1,33-2,46 p: 0.001) and age > 65 (OR = 1.9, %95 CI, 1,41-2,55 p = 0.001). Conclusion: sNLR and mNLR may act as a simple, useful, and cost-effective prognostic factor in patients with MPE. Furthermore, these results may serve as the cornerstone of further research into the mNLR in the future. Although further studies are required to generalize our results, this information will benefit clinicians and patients in determining the most appropriate therapy for patients with MPE

Are Meteorological Parameters a Risk Factor for Pulmonary Embolism? A Retrospective Analysis of 530 Patients

Background: The influence of meteorological conditions on cardiovascular morbidity and mortality has been known for a long time. However, few reports have been published on the influence of meteorological parameters on the occurrence of acute pulmonary embolism (PE). Aims: In this retrospective study, we compared the meteorological parameters between PE patients with risk factors and idiopathic PE patients. Study Design: Cross-sectional study. Methods: Medical documentation of 1180 patients with suspected acute pulmonary embolism diagnosed between January 2010 and December 2012 was retrospectively analyzed. A total of 530 patients with PE confirmed by computed tomography pulmonary angiography and/or ventilation/perfusion scan were included for further analysis. We divided the patients into two groups: PE with risk factors (provoked) and PE without risk factors (unprovoked). The meteorological data were collected from the relevant time period: temperature, humidity, pressure, and wind velocity. As the exact time of PE onset was unknown, the meteorological values attributed to each patient were the means of the values in the months or weeks at the time of diagnosis of PE. Results: The highest numbers of cases were seen in autumn (29.8%), followed by summer (28.9%), spring (22.1%), and winter (19.2%). In terms of months, the greatest number of cases occurred in June (57), followed by November (56) and October (54). Case distribution according to the months and seasons were statistically significant. The wind direction also affected the incidence of PE. There was a statistically significant positive correlation between case frequency and air temperature (r=0.300; p=0.031). No correlation was found between the unprovoked PE cases’ monthly distribution and pressure, humidity, or temperature. However, there was a statistically significant positive correlation between the monthly distribution of the group with provoked PE cases and air temperature (r=0.586; p=0.045). Conclusion: A statistically significant inverse correlation between atmospheric pressure and temperature and the number of all PE cases was observed in our study, which is in accordance with other reports. However, in unprovoked PE cases, there was no correlation between meteorological parameters and case incidence

Do the Amount of Fluid, Histopathology, Radiology and Pleurodesis Status Affect the Survival in Malignant Pleural Effusions?

INTRODUCTION: The primary objective of this study was to identify the most common pleural malignancies leading to malign pleural effusion (MPE). The secondary objective was to evaluate the relationship between the amount of fluid and radiological findings, etiologies, treatment methods and survival. METHODS: We retrospectively included cases of MPE with a tissue diagnosis. RESULTS: The most common causes of MPE were lung cancer (73%), breast cancer (8.3%) and mesothelioma (7%). In patients who were offered chemical pleurodesis, pleurodesis was successful in nearly 31.1%. No relation wasfound between the amount of pleural fluid and cell type,survival, pulmonary, extrapulmonary malignancy and mesothelioma, Patients live longer if pleurodesis was successful (p = 0.005). Median survival of patients with MPE due to pulmonary, extrapulmonary and mesothelioma, ORCID: 0000-0002-8939-336X respectively were 77 ± 12.8, 150 ± 48.4 and 365 ± 0 days. The survival of the patients with mesothelioma was significantly longer than others (P: 0.000). DISCUSSION AND CONCLUSION: The main cause of MPE was lung cancer, followed by breast cancer, unknown primary and mesothelioma. Chemical pleurodesis was a viable palliative measure for MPE. Successful pleurodesis had a significant contribution to the survival

Clinical Effects of T790M Mutation in EGFR Tyrosine Kinase Inhibitor Resistant NSCLC Patients

INTRODUCTION: To compare patient characteristics between the T790M-positive and T790M-negative populations, and to analyze the post-progression survival (PPS) after initial tyrosine kinase inhibitor (TKI) failure in order to investigate the prognosis in patients undergoing rebiopsy. METHODS: We investigated the patient characteristics, including the initial EGFR-TKI response and T790M status at the time of rebiopsy or liquid biopsy, subsequent treatment after resistance to the initial EGFR-TKI (the presence of EGFR-TKI re-challenge), treatment just before biopsy and/or rebiopsy (EGFR-TKIs or chemotherapy), the timing of the rebiopsy (just after the initial EGFR-TKI failure or others). RESULTS: No difference was found between the two groups with T790M mutation positive and negative in terms of age, gender, and metastasis location. Only patients with positive T790M mutation had higher progression after TKI use compared to negative ones (p: 0.000). The progression-free median survival in patients using TKI was 19.33 months in the group with T790M mutation and 22.25 months in the negative group. Overall survival was found to be 75 months and 27.5 months in the T790M positive and negative group, respectively, and this was statistically significant. (p: 0.009). DISCUSSION AND CONCLUSION: Overall survival was significantly longer in the T790M positive group than in the T790M negative group. In addition, liquid biopsy can be performed several times for patients with progression after EGFR-TKI use and who do not want to undergo tissue biops