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

Does Pulmonary Embolism Differ Between Genders in Terms of Clinical, Laboratory Findings, Prognosis and Mortality?

Amaç: Pulmoner Tromboemboli (PTE) mortal ve tanı konulması zor bir hastalıktır. Bulgularınınnonspesifik olması nedeniyle zaman zaman tanıya ulaşmak oldukça zor olmaktadır. Malignite,immobilite, geçirilmiş cerrahi, trombofili, ilerlemiş yaş, genetik faktörler majör risk faktörleridir.PTE’de cinsiyetin prognoz ile ilişkisi hakkında yapılan çalışmalarda oldukça farklı sonuçlar bulunmaktadır. Biz bu çalışmada prognoz, yoğun bakım yatışı, laboratuvar ve radyolojik testler açısından cinsiyet farklılıklarını değerlendirmeyi amaçladık.Yöntem: Ocak 2012 ve Aralık 2015 tarihleri arasında Akut PTE tanılı toplam 348 hastanın verileri retrospektif olarak tarandı. Bu hastaların tümü 3. basamak bir göğüs hastalıkları hastanesiolan merkezimizin acil servisine başvurmuş hastalardı. Prognoz sınıflandırılmaları yapılırkenAvrupa Kardiyoloji Topluluğu (ESC) ve Avrupa Solunum Topluluğu (ERS) tarafından ortak tasarlanan PTE kılavuzu temel alındı.Bulgular: Hastaların yaş ortalaması 62,7 iken erkek hastalar daha genç olarak bulundu. Yaş ortalamasının kadınlarda daha yüksek olmasıyla uyumlu olarak kadınların basitleştirilmiş PulmonerEmboli Ciddiyet Endeksi (sPESI) skoru daha yüksek olarak gözlemlendi. Kadınların kötü prognostik faktörleri daha fazla olmasına rağmen her iki cinsiyet arasında erken mortalite açısındananlamlı bir fark bulunmadı.Sonuç: Yaş ortalamaları ve sPESI skorları arasında fark olmasına rağmen; kadınlarla erkekler arasında erken mortalite farkı bulunmadı. PTE’de cinsiyet çalışması farklı çalışmalarda farklı sonuçlarvermesi ve izlem protokollerini etkileyebilecek olmasından dolayı yeni çalışmalara açık bir alandır.Objective: Pulmonary thromboembolism (PTE) is a disease that mortal and hardly diagnosed. Since findings of PTE are nonspesific diagnosed can be so hard sometimes. Major risk factors are malignancy, immobility, previous surgery, thrombophilia, advanced age, and genetic factors. Studies on the relationship between gender and prognosis in PTE have very different results. In this study, we aimed to evaluate gender differences in terms of prognosis, intensive care admis- sion, laboratory, and radiological tests. Method: We retrospectively analyzed the data of 348 patients diagnosed with Acute PTE between January 2012 and December 2015. All of these patients were patients who applied to the emergency department of our center, which is a third step chest diseases hospital. We used the PTE guideline jointly designed by the European Society of Cardiology (ESC) and the European Respiratory Society (ERS) for prognosis classifications. Results: The mean age of the patients was 62.7, while the male patients were younger. Women’s sPESI scores and mean ages were observed higher than men. Although women had more bad prognostic factors, no significant difference was found between both genders in terms of early mortality. Conclusion: Although there is a difference between mean age and simplified Pulmonary Embolism Severity Index (sPESI) scores; no difference in early mortality between men and women. Gender studies in PTE are an area that is open to new studies, since the studies conducted on this subject give quite different results and these results may affect the follow-up protocols

Pneumothoraxes after CT-guided percutaneous transthoracic needle aspiration biopsy of the lung: A single-center experience with 3426 patients

Introduction: The purpose of this study is to determine how long patients who developed pneumothorax were followed up on in the emergency department, how many patients required chest tube placement, and what factors influenced the need for a chest tube in patients who underwent computed tomography (CT)-guided percutaneous trans -thoracic fine needle aspiration biopsy (PTFNAB).Materials and Methods: Patients who developed pneumothorax following CT-guided PTFNAB were analyzed retrospectively. In cases with pneumotho-rax, the relationship between chest tube placement and the size of the lesion, the lesion depth from the pleural surface, the presence of emphysema, and the needle entry angle were investigated. It was determined how long the patients were followed up in the emergency department, when a chest tube was pla-ced, and when patients who did not require chest tube placement were discharged.Results: CT-guided PTFNAB was performed in 3426 patients within two years. Pneumothorax developed in 314 (9%) cases and a chest tube was placed in 117 (37%). The risk factor for chest tube placement was found to be the lesion depth from the pleural surface. The lesion depth from the pleural surface of >24 mm increased the risk of chest tube placement by 4.8 times. Chest tubes were placed at an average of five hours (5.04 +/- 5.57).Conclusion: This study has shown that in cases with pneumothorax that required chest tube placement, the lesion depth from the pleural surface is a risk factor. Patients who developed pneumothorax on CT during the procedure had chest tubes placed after an average of five hours

Detection of Pneumocystis jirovecii by PCR in patients with lung cancer: A preliminary study

Introduction: Infection complications in lung cancer (LC), one of the most common cancers in the world, are still among the most important causes of death. Of them, P. jirovecii, which is as an opportunistic infection, causes a life-threatening type of pneumonia in cancer patients. This preliminary study aimed to determine the incidence and clinical status of P. jirovecii by PCR in lung cancer patients compared to the conventional method. Material and methods: Sixty-nine lung cancer patients and fSorty healthy individuals were included in the study. After sociodemographical and clinical features were recorded, sputum samples were collected from attenders. Firstly, microscopic examination was made with Gomori's methenamine silver stain and then PCR was performed.Results: P. jirovecii was detected in three of 69 lung cancer patients by PCR (4.3%), but not by microscopy. However, healthy individuals were negative for P. jirovecii by both methods. Based on clinical and radiologi-cal findings, P. jirovecii was evaluated as probable infection in one patient and colonization in the other two patients. Although PCR is more sensitive than conventional staining methods, it cannot distinguish probable and proven infections from pulmonary colonization.Discussion: It is important to evaluate the decision of infection together with laboratory, clinical and radiolog-ical findings. Moreover, PCR may enable to know the colonization and to take precautions such as prophy-laxis, due to the risk of colonization turning into an infection in immunocompromised patient groups. Further studies involving larger populations and evaluating the colonization-infection relationship in patients with solid tumors are needed.(c) 2023 SFMM. Published by Elsevier Masson SAS. All rights reserved.Funding This work is supported by TUBITAK with Project No: 120N924.TUBITAK [120N924

Can the Progression of COVID-19 Pneumonia be Predicted?

Background: Coronavirus disease-2019 (COVID-19) remains a major cause of morbidity and mortality. There are many parameters affecting the progression of the disease. The purpose of the present study was to evaluate and compare the initial data of patients hospitalized with the diagnosis of COVID-19 pneumonia, who progressed during the hospitalization period, with other patients who recovered or remained stable, and to investigate the risk factors that can be used to predict the disease progression. Materials and Methods: Patients, who received inpatient treatment with the diagnosis of COVID-19 pneumonia, were included in the study retrospectively. Two groups were created from all patients according to their progression in hospital follow-ups: Group 1: Progression group and group 2: Recovery/stabilization group. If patients had clinical, laboratory and/or radiological deterioration or died during follow-up, these patients were included in the progression group. If patients recovered or remained stable, these patients were also included in the recovery/stabilization group. The demographic data, initial hemogram, biochemical parameters and radiological data of the patients were recorded. Results: It was determined in the univariate analysis that the age, smoking status, comorbidity, heart disease, chronic obstructive pulmonary disease, cancer, dyspnea, fever, leukocytosis, lymphopenia, elevated neutrophil-lymphocyte ratio (NLR), C-reactive protein, albumin, lactate dehydrogenase, ferritin, D-dimer, troponin-T, pro-B-type natriuretic peptide (pro-BNP) were risk factors predicting disease progression all p-values3.545 [area under curve (AUC)=0.752; p332.8 (AUC=0.752; p4.58 (AUC=0.730; p<0.001) in predicting progression. Conclusion: The identification of risk factors predicting progression is important in reducing morbidity and mortality rates. Fever, NLR, D-dimer troponin-T and pro-BNP are important parameters that can be used to predict progression

Is the Effect of Pulse Corticosteroid Different From the Lower Dose on Mortality in Hospitalized Patients with COVID-19 Pneumonia?

Introduction: The novel coronavirus disease-2019 (COVID-19) is a disease with high mortality and morbidity. The aim of this study was to investigate the prognostic effect of pulse corticosteroid therapy in patients with COVID-19 pneumonia. Materials and Methods: Patients who were hospitalized due to COVID-19 pneumonia between June 2020 and December 2020 were included in the study. All data were retrospectively obtained. Age, gender, smoking history, presence of chronic disease, and laboratory parameters of the patients were recorded. Information about radiological involvement, respiratory failure, corticosteroid treatment/ pulse corticosteroid treatment status, transfer to the intensive care unit, and mortality was obtained. Results: Two-hundred and sixty-one patients were included in the study. There were 231 patients in the lower dose and 30 patients in the pulse dose corticosteroid group. The median age of the patients was similar in both pulse corticosteroid and lower dose corticosteroid groups [respectively; median 59 years (IQR= 19 years) vs. 60 years (IQR= 20 years), p= 0.66]. CRP levels were significantly higher and blood lymphocyte count was significantly lower in the pulse dose corticosteroid group (p= 0.01, p= 0.02). Eight patients (3.5%) died in the lower dose corticosteroid group and five patients (16.7%) died in the pulse dose corticosteroid group; the difference was statistically significant (p= 0.01). Propensity score matching according to age, sex, respiratory failure, CRP, ferritin, and LDH levels, revealed no difference in mortality between pulse dose or lower dose corticosteroid therapy (p= 0.71). Conclusion: In the context of COVID-19 treatment, the administration of pulse-dose corticosteroid therapy does not appear to confer a beneficial effect on mortality when compared to lower-dose therapy

Pulmoner Emboli Klinik, Laboratuvar Bulguları, Prognoz ve Mortalite Açısından Cinsiyetler Arasında Farklılık Gösterir mi?

Amaç: Pulmoner Tromboemboli (PTE) mortal ve tanı konulması zor bir hastalıktır. Bulgularınınnonspesifik olması nedeniyle zaman zaman tanıya ulaşmak oldukça zor olmaktadır. Malignite,immobilite, geçirilmiş cerrahi, trombofili, ilerlemiş yaş, genetik faktörler majör risk faktörleridir.PTE’de cinsiyetin prognoz ile ilişkisi hakkında yapılan çalışmalarda oldukça farklı sonuçlar bulunmaktadır. Biz bu çalışmada prognoz, yoğun bakım yatışı, laboratuvar ve radyolojik testler açısından cinsiyet farklılıklarını değerlendirmeyi amaçladık.Yöntem: Ocak 2012 ve Aralık 2015 tarihleri arasında Akut PTE tanılı toplam 348 hastanın verileri retrospektif olarak tarandı. Bu hastaların tümü 3. basamak bir göğüs hastalıkları hastanesiolan merkezimizin acil servisine başvurmuş hastalardı. Prognoz sınıflandırılmaları yapılırkenAvrupa Kardiyoloji Topluluğu (ESC) ve Avrupa Solunum Topluluğu (ERS) tarafından ortak tasarlanan PTE kılavuzu temel alındı.Bulgular: Hastaların yaş ortalaması 62,7 iken erkek hastalar daha genç olarak bulundu. Yaş ortalamasının kadınlarda daha yüksek olmasıyla uyumlu olarak kadınların basitleştirilmiş PulmonerEmboli Ciddiyet Endeksi (sPESI) skoru daha yüksek olarak gözlemlendi. Kadınların kötü prognostik faktörleri daha fazla olmasına rağmen her iki cinsiyet arasında erken mortalite açısındananlamlı bir fark bulunmadı.Sonuç: Yaş ortalamaları ve sPESI skorları arasında fark olmasına rağmen; kadınlarla erkekler arasında erken mortalite farkı bulunmadı. PTE’de cinsiyet çalışması farklı çalışmalarda farklı sonuçlarvermesi ve izlem protokollerini etkileyebilecek olmasından dolayı yeni çalışmalara açık bir alandır