A case of lung adenocarcinoma in patient with left clavicular pain

Akciğer adenokanseri özellikle 40 yaş altında sigara içmeyen kadınlarda görülür ve önlenebilir ölüm sebepleri arasında ilk sırada yer alır. Son 2 yıldır sol klavikula üzerinde ağrısı olan 62 yaşındaki erkek hastanın özgeçmişinde 40 yıl boyunca 1 paket/gün sigara kullanım öyküsü, fizik muayenesinde ise sol klavikula medialinde ve sol sternokostal eklem üzerinde hassasiyet saptandı. Yapılan radyolojik incelemelerde, akciğer grafisinde, sol hilustan perifere doğru uzanan 4,5x5 cm boyutlarında kitle izlendi. Tüm vücut pozitron emisyon tomografisi/bilgisayarlı tomografi de sol sternokostal eklemde 0,6 cm çapında hipermetabolizma olan bölge saptandı ve bunun dejenerasyon veya travma sonucu olabileceği düşünüldü. Sol akciğer alt lob posterobazal segmentte 4,5x5,2x4,5 cm boyutlarındaki kitlede malignite düzeyinde hipermetabolizma izlendi. Sol alt lob apikal subsegmentlerden transbronşiyal akciğer biyopsisi ve bronkoalveoler lavaj yapıldı. Olguya adenokarsinom, grade 1-2 tanısı verildi. Bunun üzerine hastaya sol alt lobektomi ve lenf nodu disseksiyonu yapıldı. Patoloji sonucu iyi differansiye adenokarsinom, papiller komponenti baskın tip geldi. Akciğer kanserinde erken tanı ve tedavi prognozda çok önemlidir. Olgu sunumunda sol klavikula ağrısıyla başvuran hastada anamnez, fizik muayene ve takibin önemi vurgulanmaktadır.Lung adenocarcinoma is usually seen in non-smoking women under the age of 40 and occupies the first place among the preventable causes of death. A 62-year-old male patient who had pain on the left clavicle for 2 years had a history of smoking 1 pack/day for 40 years and his physical examination showed that he had tenderness on the medial left clavicle and left sternocostal joint. The patient's radiological examination revealed a 4.5x5 cm mass extending from the left hillus to the periphery by pulmonary radiography. A whole-body positron emission tomography / computed tomography was performed and an area, 0.6 cm in size, with hypermetabolic activity was found on the left sternocostal joint. It was speculated that the area may have resulted from degeneration or trauma. The mass which was located in the posterobasal segment of the lower lobe of the left lung and which was 4.5x5.2x4.5 cm in size was found hypermetabolic to the extent of malignancy. Tracheobronchial lung biopsy and bronchoalveolar lavage were performed from the left lower lobe apical subsegments. The case was diagnosed as adenocarcinoma grade 1-2. Whereupon left lower lobectomy and lymph node dissection were carried out. Pathology result showed that the patient had a well-differentiated adenocarcinoma with a dominant papillary component. Early diagnosis and treatment are extremely important in the prognosis of lung cancer. The present case report highlights the importance of anamnesis, physical examination and follow-up in the patient who presented with left clavicle pain

Attitude of Family Physicians to Depression Treatment

Objective: Cognitive Behavioral Terapy and pharmacotherapy are experimentaly proven to be effective in treatment of depression. In this study, the attitude of Family Physicians for patients with depression towards depression treatment have been investigated. Method:100 Family Physicians (FP) participated to the research who were reached between 29 October 2008- 29 December 2008. A questionnaire including 32 questions was performed. The collected data are analyzed by Descriptive Statistic Study, Chi-Square, Mann-Whitney U and Kruskal-Wallis H tests. Results: It was found that the Family Physicians who answered the question that the psychotherapy of the depressive patients should be performed the specialists as yes has a lower level of feeling of self sufficiency about monitoring and treatment of the depression than the ones giving the answer as no (p=0.026). It was found that there was a significant relation between giving positive answers to the questions about abnormalities related to biochemistry of heavy depression occurrences and psychotherapy tends to be unsuccessful for the depressive patients ( p [JCBPR 2018; 7(2.000): 62-71

Family Medicine Residency Training: Where, How Much, How and When?

KARA, ISMAIL HAMDI/0000-0003-2022-1882; KARA, ISMAIL HAMDI/0000-0003-2022-1882WOS: 000372103700013In this article, it will be discussed of the setting and the importance of the family medicine residency training in field related workshop framework that was made in the WONCA Europe Conference 2015. Family medicine residency training consists of three basic pillars: Rotations in hospital and other health care facilities, educational activities in family medicine departments and training in primary care settings. Between 1985 and 2011, formal residency training was consisted only of hospital rotations. With the rapid growth of family medicine departments in universities and clinics in research and training hospitals since 1995, educational activities of departments have increasingly been an important part of residency training. In 2011, with the acceptance of new core curriculum by TUK (Specialty Board in Medicine) obligatory rotations were decreased to 18 months. After a long term effort, necessary regulatory changes have been made to enable residency training in primary care. Although valuable contributions have been made by Turkish Association of Family Physicians (TAHUD), Turkish Board of Family Medicine (TAHYK) and Academy of Family Medicine residency training in primary care settings is still needed to be discussed and clarified

A comparison of the efficacy of varenicline and bupropion and an evaluation of the effect of the medications in the context of the smoking cessation programme

Introduction Within the context of the support program for smoking cessation, initiated by the Turkish Ministry of Health in 2011, those who present at ‘smoking cessation’ centres and are found to be suitable for pharmacological treatment are given varenicline and bupropion free of charge. As the smoking cessation programme is centralized, the selection of the medication is made randomly to provide a fixed distribution rate. The aim of this study was to evaluate the efficacy of both varenicline and bupropion in smoking cessation and to evaluate the effect of the smoking cessation programme. Material and Methods A total of 405 individuals who met the study criteria were included in the study. Smoking habits and degree of dependence were determined in all the participants with the Fagerstrom test for nicotine dependence (FTND) and bupropion or varenicline therapy was initiated in those who were eligible. Patients were followed up at 15 days then at 1, 2, 3, 6 and 12 months after smoking cessation. A level of CO < 5 ppm and ‘point prevalence abstinence’ were used as the criteria of success for smoking cessation and this evaluation showed the non-smoking status in the previous 7 days. Results The mean age of the participants was 35.19 ± 7.73 years and 82.8% (n = 334) were male. Of the participants, 60.2% (n = 244) were given varenicline and 39.8% (n = 161) bupropion. The mean FTND and package/year was not significantly different between the groups. The rates of success in the 1st and 2nd weeks, and 1st, 3rd and 6th months were significantly higher in the varenicline group than in the bupropion group (p < 0.05). At the end of one year, the rate of smoking cessation was determined as 13.9% (n = 34) in the varenicline group and 6.2% (n = 10) in the bupropion gruop. The difference was statistically significant (p = 0.015). At the end of 1 year when the previous 7 days smoking status was evaluated with the ‘point prevalence abstinence’ measurement as the success criteria, success rates were 20.5% with varenicline and 18.6% with bupropion and the difference was not significant (p = 0.646). The individuals who used the medications for 45 days or longer were more successful in smoking cessation (p < 0.001). The most common reasons given for discontinuing the medication were the side-effects (31.5%). No significant difference was determined between the groups in respect of the side-effects observed. Conclusions Although the rates of smoking cessation in all the other control points were higher with varenicline than with bupropion, no significant difference was found between the success rates of varenicline and bupropion used in smoking cessation based on the last 7 days at the end of one year. Those who used the medications for 45 days or longer were more successful in smoking cessation

Cupping Therapy Combined with Rehabilitation for the Treatment of Radial Palsy: a Case Report

This case report demonstrates the beneficial effects of cupping therapy (CT) in a 35-year-old man who is diagnosed with a fracture of the radial shaft due to a motorcycle accident. One year after the treatment started, pseudoarthrosis developed in the radius and an autogenous iliac bone graft was performed. However, extension dysfunction in the wrist became evident. After another 6 months of physical therapy and rehabilitation, no improvements were observed. Therefore, CT and adjunctive electrostimulation were performed, after 30 days of treatment, marked recovery of muscle function and full wrist extension were observed, as determined by electromyography and a grade 5/5 on the Medical Research Council power of wrist extension scale. The results in this case study suggest that CT in conjunction with adjunctive electrostimulation, may accelerate functional recovery from postoperative radial palsy, and provide a useful alternative treatment in this situation