Clinical Characteristics of Patients with Bronchioloalveolar Carcinoma: A Retrospective Study of 44 Cases

WOS: 000328269400062PubMed ID: 23992004Background: Bronchioloalveolar carcinoma (BAC) is considered a subtype of adenocarcinoma of the lung. Recently BAC has been variously termed adenocarcinoma in situ, minimally invasive adenocarcinoma, lepidic predominant invasive adenocarcinoma, and invasive mucinous adenocarcinoma. The aim of the study was to analyze and detect prognostic factors of patients with BAC over a 7-year period. Materials and Methods: This retrospective single-center study included 44 patients with BAC. The impact on survival of fifteen variables (gender, age, smoking status, cough, dyspnea, hemoptysis, fever, chest pain, sputum, metastasis number, Karnofsky performance status, pT, pN, TNM stage, cytotoxic chemoterapy) were assessed. Results: Median age was 55 years (38-83). Most patients were male (63.6%) and stage IV (59.1%). Twenty-one patients (47.7%) received cytotoxic chemotherapy (platinum-based regimens) for metastatic disease. Objective response rate was 33.3% (4 partial, 3 complete responses). Stable disease was observed in nine in patients (42.8%). Disease progression was noted in 5 (23.8%). The median OS for all patients was 12 months (95% CI, 2.08-22.9 months). Independent predictors for overall survival were: Karnofsky performance status (HR:3.30, p 0.009), pN (HR:3.81, p 0.018), TNM stage (HR:6.49, p 0.012) and hemoptysis (HR:2.31, p 0.046). Conclusions: Karnofsky performance status, pN, TNM stage and hemoptysis appear to have significant impact on predicting patient survival in cases of BAC

Solunumsal yoğun bakım ünitesinde florokinolon kullanımının hastane kökenli MRSA enfeksiyonu gelişimine ve prognoza etkisi

Methicillin-resistant Staphylococcus aureus (MRSA) which exhibits a worldwide spread, has become a serious public health problem. There are several studies indicating that there may be a relationship between the high rate of MRSA infections and long-term use of fluoroquinolones. the aim of this study was to investigate the effect of fluoroquinolone (FQ) use in the respiratory intensive care unit (ICU) on the development of the hospital-acquired MRSA infection and mortality. This was a single center experi- ence, in which the clinical and laboratory data of the patients who were hospitalized in the respiratory ICU for two years, were retrospectively evaluated. the relationship between FQ use and the develop- ment of MRSA infection was evaluated with correlation analysis, and its relationship with the mortal- ity was evaluated with regression analysis. A total of 302 patients were included in the study and 93 (30.7%) of them were found to be treated with FQs. Sixty-four of those 93 patients were male and the mean age was 71.1 ± 12.5 years. During the follow-up, MRSA infections developed in 11.9% (36/302) of the patients, and the rate of MRSA infection in FQ using patients was 15.1% (14/93), of them eight were ventilator-associated pneumonia (VAP) and six were secondary bacteremia. Although a positive correlation was found between FQ use and the development of MRSA infection, it was not statistically significant [P= 0.521 (Spearman), p= 0.037 (Pearson)]. in addition cut-off values for CRP and leukocyte counts, which were checked when a patient with FQ use admitted to the ICU, were determined as 7.85 mg/L and 7.650/mm3, respectively. the analysis of the relationship between CRP, leukocyte counts and the development of MRSA infection revealed a statistically significant positive relationship between high leukocyte levels (> 7.650/mm3) and the development of MRSA infection (P= 0.017, p= 0.246), but no such relationship for the CRP levels (P= 0.121, p= 0.178). the mortality rate in patients with FQ use was found as 42% (39/93), and it was determined that malignancy, history of admission to hospital in the previous six months and the presence of a hospital-acquired infection increased the risk of mortal- ity (p= 0.020, p= 0.038 and p= 0.024, respectively). in the multivariate analysis, four independent risk factors related to the mortality in patients under FQ treatment were determined, namely malignancy (OR: 2.280, p= 0.002), re-intubation practices (OR: 4.071, p= 0.005), VAP (OR: 5.097, p= 0.009) and the use of FQ > 7 days (OR: 3.63, p= 0.003). in conclusion, our data indicated that the use of FQs in the ICU did not increase the development of hospital-acquired MRSA infection significantly, and FQ use for more than seven days was an independent risk factor for mortality. Additionally, it was thought that high leukocyte counts might be a predictive marker for the development of MRSA infection.Metisiline dirençli Staphylococcus aureus (MRSA), dünya çapında yaygın, ciddi bir halk sağlığı sorunu haline gelmiştir. Bazı çalışmalarda, MRSA enfeksiyonlarının yüksek oranda görülmesiyle uzun süreli florokinolon (FQ) kullanımı arasında bir ilişki olabileceği belirtilmektedir. Bu çalışmada, solunumsal yoğun bakım ünitesi (YBÜ)’nde FQ kullanımının, hastane kökenli MRSA enfeksiyonu gelişimi ve mortalite üzerine etkisinin araştırılması amaçlanmıştır. Tek merkez deneyimi olarak, iki yıl boyunca solunumsal YBÜ’de izlenen hastaların klinik ve laboratuvar verileri retrospektif olarak değerlendirilmiştir. FQ kullanımının MRSA enfeksiyonu gelişimiyle olan ilişkisi korelasyon analizi, mortalite ile olan ilişkisi de regresyon analizi kullanılarak araştırılmıştır. Çalışmaya dahil edilen 302 hastanın 93 (%30.7)’ünde FQ tedavisi kullanıldığı belirlenmiş; yaş ortalamaları 71.1 ± 12.5 yıl olan bu hastaların 64’ünün erkek olduğu gözlenmiştir. İzlem sırasında hastaların %11.9 (36/302)’unda MRSA enfeksiyonu gelişmiş; FQ tedavisi uygulanan hastalarda ise MRSA enfeksiyonu görülme oranı %15.1 (14/93) olarak saptanmıştır. FQ tedavisi alan ve MRSA enfeksiyonu gelişen 14 hastanın sekizinde ventilatörle ilişkili pnömoni (VİP), altısında sekonder bakteriyemi belirlenmiştir. FQ kullanımıyla MRSA enfeksiyonu gelişimi arasında pozitif bir korelasyon saptanmakla birlikte, bu durum istatistiksel olarak anlamlı bulunmamıştır [P= 0.521 (Spearman), p= 0.037 (Pearson)]. Çalışmada ayrıca, FQ kullanılan hastaların YBÜ’ye yatışı sırasında bakılan CRP ve lökosit düzeyleri için sınır değerleri belirlenmiş (sırasıyla; 7.85 mg/L ve 7650 hücre/mm3) ve bu değerlerin MRSA enfeksiyonu gelişimiyle ilişkisi araştırılmıştır. Buna göre, yüksek lökosit düzeyleri (> 7650/mm3) ile MRSA enfeksiyonu gelişimi arasında pozitif ve anlamlı bir ilişki saptanırken (P= 0.017, p= 0.246), CRP düzeyleriyle anlamlı bir ilişki (P= 0.121, p= 0.178) gözlenmemiştir. FQ kullanılan hastalarda mortalite oranı %42 (39/93) olarak izlenmiş; malignite varlığı, son altı ay içinde hastaneye yatış hikayesi ve hastane enfeksiyonu gelişiminin, mortalite riskini artırdığı (sırasıyla; p= 0.020, p= 0.038 ve p= 0.024) saptanmıştır. Yapılan çok değişkenli analiz sonucunda FQ kullanılan hastalarda, malignite (OR: 2.280, p= 0.002), re-entübasyon uygulamaları (OR: 4.071, p= 0.005), VİP gelişimi (OR: 5.097, p= 0.009) ve 7 günden uzun süre FQ kullanımı (OR: 3.63, p= 0.003) olmak üzere mortalite ile ilişkili dört bağımsız risk faktörü tanımlanmıştır. Sonuç olarak verilerimiz, YBÜ’de yatan hastalarda florokinolon kullanımının, hastane kaynaklı MRSA enfeksiyonu gelişimini anlamlı olarak artırmadığını ve > 7 gün FQ kullanımının, mortaliteyi etkileyen bağımsız bir risk faktörü olduğunu göstermiş; ayrıca YBÜ’ye yatış anındaki yüksek lökosit düzeylerinin, MRSA enfeksiyonu gelişimi açısından bir öngörü belirteci olabileceğini düşündürmüştür

Tuberculosis Case Presented with a Solid Mass Lesion in the Lung

Tuberculosis (TB), especially in least developed and developing countries is a serious health problem all over the world. Particularly in areas with a high incidence of TB it can occur with many different clinical and radiological findings. In our case we presented a patient that we thought to be lung cancer, however diagnosed as tuberculosis after the evaluations. We think that in countries with high tuberculosis incidence and prevalence such as our country, tuberculosis should be kept in mind in differential diagnosis in every clinical and radiological feature

Tuberculosis Case Presented with a Solid Mass Lesion in the Lung

Tüberküloz (TB), özellikle az gelişmiş ve gelişmekte olan ülkelerde olmak üzere tüm dünyada ciddi bir sağlık sorunudur. Özellikle TB insidansının yüksek olduğu bölgelerde çok farklı klinik ve radyolojik bulgularla ortaya çıkabilmektedir. Bu yazıda klinik ve radyolojik bulguları nedeniyle akciğer kanseri düşündüğümüz ve yaptığımız tetkikler sonucu tüberküloz tanısına ulaştığımız bir hastayı sunduk. Ülkemiz gibi TB insidans ve prevalansının yüksek olduğu ülkelerde her türlü klinik ve radyolojik görünümde TB’un ön tanılar arasında olması gerektiği düşüncesindeyiz.Tuberculosis (TB), especially in least developed and developing countries is a serious health problem all over the world. Particularly in areas with a high incidence of TB it can occur with many different clinical and radiological findings. In our case we presented a patient that we thought to be lung cancer, however diagnosed as tuberculosis after the evaluations. We think that in countries with high tuberculosis incidence and prevalence such as our country, tuberculosis should be kept in mind in differential diagnosis in every clinical and radiological feature

Effects on prognosis of hematologic parameters in patients with small cell lung cancer

Purpose: The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are prognostic factors for various types of cancer. In this study, we assessed the association of NLR and PLR with the prognosis of small-cell lung cancer (SCLC) in patients who received the standard treatment. Material and Methods: We retrospectively reviewed patients who were diagnosed with SCLC and treated with the standard chemotherapy at Suleyman Demirel University Chest Diseases and Dr. Suat Seren Chest Diseases and Thoracic Surgery. Results: In total, 136 patients were evaluated. Patients' clinic characteristics and hematologic tests data at initial diagnosis were collected. The univariate analysis of all SCLC patients indicated that favorable prognostic factors were gender, disease stage, the number of metastatic sites, good performance status and received treatment according to the stage. Moreover, univariate analysis showed that low lymphocyte count (<1590) and high neutrophil-lymphocyte ratio ( and #8805;3.7) predicted poor prognosis in SCLC. Median overall survival (OS) was worse in the high-NLR group. In the multivariate analysis, NLR, stage, the number of metastatic sites, karnofsky performance status (KPS), received treatment were independent prognostic factors for OS. Conclusion: This study demonstrated that the NLR could help to predict poor prognosis in SCLC patients before treatment. Larger prospective studies are required to confirm these findings. [Cukurova Med J 2016; 41(2.000): 333-341