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   Table of Contents - Current issue
September-December 2018
Volume 20 | Issue 3
Page Nos. 111-181

Online since Monday, December 31, 2018

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Molecular genetics of lung cancer p. 111
Yasemin Cicek, Pinar Aslan Kosar, Önder Öztürk
Lung cancer is one of the most common cancers with high mortality and is described as one of the leading causes of cancer-related deaths worldwide. Lung cancer is classified into two main histological groups: small cell lung cancer (SCLC) and non-SCLC (NSCLC). Using tobacco products is the most important risk factor for lung cancer development and appears to be responsible for 80%–90% of total lung cancers. It is thought that lung cancer is the end result of exposure to environmental risk factors in people with genetic susceptibility. Lung cancer cells contain many genetic alterations such as mutation, amplification, insertion, deletion, and translocation. The information obtained from research suggests that these genetic changes are also associated with characteristics such as smoking status, race, and gender. Significant progress has been made in the last 10–15 years to understand the molecular basis of lung cancer, and the discovery of oncogenic precursor mutations has created new pathways in the NSCLC classification and has also provided new therapeutic targets for anticancer therapy. With the introduction of targeted agents such as epidermal growth factor receptor and anaplastic lymphoma kinase in the treatment of adenocarcinomas in an effective manner, personalization of treatment strategies has become especially important for advanced lung cancer patients. The 2015 World Health Organization guideline for the classification of lung cancer recommends the preservation of pathologic specimens for molecular examinations and emphasizes the importance of molecular testing in the individualized treatment of advanced lung cancer patients.
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Continuing practice is needed to maintain competency in endobronchial ultrasound-guided transbronchial needle aspiration p. 118
Nur Safak Alici, Ibrahim Onur Alici
BACKGROUND: It has been accepted that after training, a competent endobronchial ultrasound (EBUS) operator should perform at least twenty procedures per year. However, the literature supporting this subject is scarce. This study focuses on the return performance of an experienced bronchoscopist after a 5-year long break. The aim of this study is to reveal a possible decrease in the diagnostic performance after discontinued practice. MATERIALS AND METHODS: The data of patients who have undergone EBUS-guided transbronchial needle aspiration (EBUS-TBNA) for mediastinal or hilar lesions (lymphadenopathies and masses) between April and September 2016 were reviewed retrospectively. All consecutive patients were involved in the study. All EBUS-TBNA procedures were performed by a single experienced bronchoscopist who have returned after a 5-year long break and restarted to perform EBUS. The patients were divided into two groups: first twenty cases and subsequent eighty cases. The diagnostic performance of EBUS was compared between the two groups. RESULTS: One hundred consecutive patients were included (2.89 lesions per patient) in the study. Demographic and sonographic data were not different between the two groups. In overall, EBUS-TBNA was diagnostic in 281 (97.2%) of 289 lesions. The sensitivity values of EBUS-TBNA in the first and second groups were 92.9% and 98.3%, respectively. The difference was statistically significant (P = 0.048). CONCLUSIONS: This study shows the need for continuing practice in EBUS. An operator should perform at least twenty procedures per year to maintain competency.
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Does subglottic secretion drainage prevent ventilator-associated pneumonia? p. 122
Aysegul Erinc, Hatice Kutbay Ozcelik, Burcu Arpinar Yigitbas, Sibel Yurt, Filiz Kosar
AIM: To compare the incidence of ventilator-associated pneumonia (VAP) in patients who were admitted to the intensive care unit (ICU) for reasons other than pneumonia and followed up under mechanical ventilation either with standard endotracheal tubes or endotracheal tubes with subglottic secretion drainage (SSD). MATERIALS AND METHODS: Patients who were admitted to the ICU between April 2012 and January 2013 were prospectively and sequentially randomized to standard endotracheal and SSD intubation groups. Patients with pulmonary infection at ICU admission were excluded. Pulmonary imaging, blood, and sputum cultures were routinely screened, and pleural fluid and bronchial lavage examinations were done on demand. RESULTS: Mean age, gender distribution, APACHE II scores, duration of mechanical ventilation, and follow-up of patients with standard (n = 30) and SSD (n = 12) intubation tubes were similar; 71 ± 10.4 versus 64.4 ± 13.9 years (P > 0.05), male/female 18/12 versus 9/3 (P > 0.05), APACHE II scores 20.2 ± 3.8 versus 17.0 ± 3.8 (P = 0.02), 15.9 ± 11.5 versus 11.0 ± 8.1 days (P > 0.05), and 18.0 ± 12.4 versus 15.5 ± 12.2 days (P > 0.05), respectively. The incidence of VAP was similar in both groups (36.7% vs. 33.3%, P > 0.05, in standard vs. SSD groups, respectively). The mortality rate was higher in the standard intubation group, but the difference was not statistically significant (70% vs. 41%, P > 0.05). CONCLUSION: Compared to standard endotracheal intubation, intubation with SSD tubes was not associated with an improvement in the duration of mechanical ventilation, length of stay in the ICU, incidence of VAP, and mortality rate. Due to the limited number of patients included in this study, the results have to be confirmed in larger studies on more patients.
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Frequency and duration of smoking scenes in Turkish movies p. 128
Nazmi Bilir, Hilal Ozcebe, Sule Akcay, Elif Babaoglu, Sema Canbakan, Burcu Cirit, Ozlem Ercen Diken, Tijen Sengezer
BACKGROUND: Comprehensive tobacco control law in Turkey bans advertisement, promotion of tobacco products and sponsorship by the tobacco industry. Advertisement of tobacco products was banned on television, billboards and press media, but not on movie films. METHODS: To evaluate the frequency and duration of smoking in the movies, 60 most watched Turkish films which were on the vision during the second half of 2016 were determined for this descriptive study. Two young males having a university degree were trained on the aim and methodology of the study. Then the two observers viewed the films independently and recorded smoking scenes or direct appearance of tobacco products on a standard form. RESULTS: There were tobacco products or smoking views in 36 (60%) out of total 60 movies. In these movies there were 4.75 times tobacco occurrences as an average (median 3). Average duration of smoking occurrences was almost 3.5 min (198 s). Smokers were mostly main characters and smoking occurrences were mostly in exciting or romantic atmosphere, which are attractive for young people. DISCUSSION: In the light of Framework Convention on Tobacco Control (Article 13), smoking scenes in movies are considered as kind of tobacco advertisement and promotion, which influences smoking behavior particularly the young people. Therefore, control and prevention of smoking occurrences in movies are important for the protection of children and young people to start smoking. Some health warnings and anti-tobacco messages may be placed in the movies, to reduce tobacco views in the movies.
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Chest X-ray: Is it still important in determining mortality in patients hospitalized due to chronic obstructive pulmonary diseases exacerbation in intensive care unit? p. 133
Elif Yelda Ozgun Niksarlioglu, Ülkü Aka Aktürk
OBJECTIVE: The present research aims to evaluate the effects of chest X-rays on mortality among patients who were hospitalized due to the exacerbation of chronic obstructive pulmonary disease (COPD) in intensive care unit (ICU) of a secondary care hospital. MATERIALS AND METHODS: Sixty-three patients (39 males, 60.9%), who were hospitalized in ICU due to COPD exacerbation between December 1, 2011, and December 31, 2012, were retrospectively reviewed in this study. Data, including demographics, smoking history, arterial blood gas measurements, posterior-anterior lung radiography (PALR) findings and mortality, were collected from the medical records. RESULTS: The mean age of the patients was 70.5 years (standard deviation [SD]: 13.3, range 44–88 years). Of all the cases, 42 (85.7%) had at least one comorbidity. The most common comorbidities were hypertension (34, 53.9%) and heart failure (19, 30.2%). Mean duration of hospital stay was 8 days (SD: 5.7, range: 2–26). Mechanical ventilation support was required in 17 (27%) cases. In total, seven female and four male patients died during hospitalization (17.7%). PALR indicated emphysema in 60.3%, infiltration in 54%, bronchiectasis in 31.7%, and unilateral or bilateral pleural effusion in 27% of the cases. Infiltration and pleural effusion in PALR were more common among the patients who died (died/alived 10/11 vs. 24/52, P = 0.008 and 6/11 vs. 11/52, P = 0.026, respectively). The multivariate model for mortality showed that only age (odds ratio 0.821, CI: 0.687–0.948, P = 0.044) was independently related to mortality. CONCLUSION: As a basic imaging method, PALR still remains as an important diagnostic tool for COPD patients hospitalized in ICU, and it may contribute to the prediction of mortality.
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Does activity held on World Asthma Day have an impact on the asthma knowledge and awareness of family physicians? p. 138
Serap Ozmen, Ilknur Bostanci, Aysegül Ertugrul, Zeynep Sengül Emeksiz, Cigdem Ozdilekcan, Semra Altiyaprak, Adem Ozkara
OBJECTIVE: Annually, certain activities are performed on World Asthma Day (WAD) for the awareness of both patients and physicians about asthma. The study aimed to observe the effects of asthma education on the skills and knowledge of family physicians on WAD, which basically includes updated information of the international asthma guideline. MATERIALS AND METHODS: Our quasi-experimental study was started on May 3, 2016, WAD. Education was provided by the Global Initiative for Asthma, 2016. A questionnaire including 25 questions was applied for family physicians before and 6 months after the education. RESULTS: In the investigation of 32 family physicians, 62.5% were women, with 32.6 ± 26.0 months in family physician practice. 59.4% of the family physicians had received education about asthma in their postgraduate period. Twenty-five percent of the participants were using asthma guidelines in their daily practice. In pre- and posteducation, the percentage of accuracy in the tests was 58.4%–77.6% among specialists and 62.3%–75.9% among trainees of family physicians. The percentage levels of accuracy developed in the questions of focusing asthma treatment and correct inhaler medication use after the education program were 62.5%–93.8% (P = 0.002) and 56.2%–90.6% (P = 0.007), respectively. CONCLUSIONS: Our study revealed that family physicians did not have a tendency to use guidelines for asthma diagnosis and treatment. With the aid of the education program, their attitude changed positively. We believe that family asthma physicians should also be trained in “WAD” activities.
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Prognostic analysis of surgical-pathologic N1 disease in non-small cell lung cancer: Single-center experience with 276 cases p. 144
Serkan Yazgan, Ahmet Ucvet, Soner Gursoy, Ozgur Samancilar, Ezgi Cimen Guvenc
OBJECTIVE: Patients who receive surgical treatment due to non-small cell lung cancer (NSCLC) and have surgical-pathologic N1 (pN1) disease represent a heterogeneous group. Differences in lymph node (LN) level (hilar or intrapulmonary LNs) may influence patient survival. The aim of this study was to evaluate the prognostic factors, including the level of N1 LN involvement. METHODS: Patients undergoing complete resection at a single center between January 2000 and January 2017 and diagnosed with surgical-pN1 NSCLC were analyzed retrospectively. Patients were examined in terms of demographic characteristics, preoperative and postoperative management, survival rates, as well as variables affecting survival. RESULTS: The mean follow-up duration was 50.9 ± 41.2 months (between 2.7 and 204 months); median and 5-year survival rates were 71.5 months and 53.7%, respectively. Five-year survival rates of patients aged 60 and below (n = 144) and patients over the age of 60 (n = 132) were 59.7% and 46.9%, respectively (P = 0.001). Five-year survival rates for patients receiving and not receiving adjuvant therapy were 58.4% and 45.3%, respectively (P = 0.02). When surgical-pN1 involvement was assessed with regard to localization, 5-year survival was 59.1% in hilar involvement, 52.4% in intrapulmonary involvement, and 49.4% in involvement of both zones at the same time (P = 0.58). In Cox regression analysis, variables affecting survival were age group and adjuvant therapy (P = 0.001 and P = 0.012, respectively). CONCLUSION: Surgical-pN1 localization or pleural involvement does not have a significant effect on survival, whereas advanced age and further T classification affect survival adversely. Adjuvant therapy, on the other hand, has a significantly positive effect on survival.
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The effect of body mass index on pulmonary rehabilitation outcomes in patients with chronic obstructive pulmonary disease p. 150
Esra Pehlivan, Arif Balci, Esra Yazar, Elif Yelda Niksarlioglu, Lütfiye Kiliç
CONTEXT: Although pulmonary rehabilitation (PR) is increasingly used in patients with chronic obstructive pulmonary disease (COPD), the factors affecting the gains obtained from PR are still not clear. AIMS: We aimed to investigate the effect of body mass index (BMI) on PR outcomes in COPD. SETTINGS AND DESIGN: The study was a retrospective–descriptive study. SUBJECTS AND METHODS: Patients with BMI of 18.5–25 kg/m2 were referred to as Group 1 (n = 15) and patients with BMI ≥25 kg/m2 as Group 2 (n = 17). All patients received PR for 8 weeks. Six-min walking distance (6MWD), forced expiratory volume in 1-s, forced vital capacity (FVC), carbon monoxide diffusing capacity (DLCO), maximal inspiratory pressure (MIP), modified Medical Research Council dyspnea scale (mMRC), and COPD assessment test (CAT) scores were compared. STATISTICAL ANALYSIS USED: Paired t-test, Wilcoxon rank, and Mann–Whitney-U test were used for statistical analysis. RESULTS: Thirty-two patients were included in the study. Baseline parameters were similar except 6MWD. Following PR, 6MWD, mMRC, and CAT scores were significantly improved in both the groups (P < 0.05). A significant difference was found in favor of Group 1 for FVC (P = 0.039) and MIP (P = 0.018), while no difference was detected in DLCO. CONCLUSIONS: In this study, PR yielded similar gains between COPD patients with high BMI and those with normal BMI in terms of exercise capacity, dyspnea, and disease symptom severity. The only additional gains were achieved in the respiratory functions of patients with normal weight. All COPD patients should be referred to PR, regardless of the BMI, taking into account the resulting PR gains.
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The effect of positive airway pressure therapy on lipid profile p. 157
Ahmet Cemal Pazarli, Handan Inönü Köseoglu, Asiye Kanbay, Mehmet Akif Abakay
CONTEXT: Obstructive sleep apnea syndrome (OSAS) emphasize the concurrence and interaction of disorders of lipid metabolism and components of metabolic syndrome (MS) such as insulin resistance. AIMS: The aim of this study is to observe the effect of positive airway pressure (PAP) treatment on the lipid profile during 1-year follow-up of patients diagnosed with OSAS. SETTINGS AND DESIGN: This was a single-center, retrospective, observational study. MATERIALS AND METHODS: A total of 168 OSAS patients were diagnosed in our sleep laboratory and were recommended for PAP therapy. Among these patients, 64 patients who received effective PAP treatment for 1 year, and who did not have the comorbid disease, history of lipid-lowering treatment, or history of lifestyle change, dietary regulation or attempt to loose weight during the 1-year follow-up period were included in the study. Pretreatment measurement parameters including body weight, waist, neck and hip circumference, body mass index (BMI), blood lipid levels (total cholesterol [TC], triglyceride [TG], high-density lipoprotein [HDL], low-density lipoprotein [LDL]), and Epworth sleepiness scale (ESS) score were compared with the 3rd and 12th months parameters. STATISTICAL ANALYSIS USED: SPSS version 16 (SPSS Inc., Chicago, IL, USA) was used for the statistical analyses. RESULTS: The study included 64 (38 M, 26 F) patients (mean age of 53.1 years). The mean apnea-hypopnea index was 50.84 h. Although TC, HDL, LDL, and TG levels did improve with the PAP treatment (all P < 0.05), no significant decrease was observed with respect to the BMI, hip, neck, and waist circumference (all P > 0.05). There were statistically significant changes in sleep efficiency, oxygen desaturation index, and ESS score (P < 0.05). CONCLUSIONS: The results show that effective PAP treatment has beneficial effects on the blood lipid profile, which enhances sleep efficiency and sleep quality in patients.
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Does age have an impact on lung cancer survival? p. 162
Onur Akcay, Seyda Ors Kaya, Kenan Can Ceylan
OBJECTIVE: Lung cancer is the most diagnosed and the most frequent cause of cancer-related deaths in the world. Nonsmall cell lung cancer (NSCLC) prognosis in younger patients is controversial. In this study, surgical survival of young age group with NSCLC was analyzed retrospectively. MATERIALS AND METHODS: A total of 1043 patients who underwent anatomical lung resection and mediastinal lymph node dissection were analyzed between January 2005 and December 2013. Patients were divided into two groups in terms of age being below 45 years and younger (Group 1) and over 45 years (Group 2). RESULTS: There were 68 patients in Group 1 and 975 patients in Group 2. Male/female rate was 2.4 and 14, respectively (P < 0.001). Adenocarcinoma was more diagnosed in Group 1 (47.1%), and squamous cell carcinoma was more seen in Group 2 (54.7%). The pathological diagnosis was statistically significant (P < 0.001). All groups' median survival time was 51 months, and 5-year survival rate was 47.1%. Group 1 and 2 survival rates were 64 and 48 months, respectively, with Group 1 having significantly better results than Group 2 (P < 0.001). The 5-year survival rate of female patients included in Group 1 was 73%, whereas it was 44.7% in Group 2 (P < 0.001). Age is determined to have remarkable impact on the survival with Cox-regression test (P < 0.001, 95% confidence interval). CONCLUSION: The survival which is significantly better in younger patients may encourage aggressive approaches for these patients. The effect of age on prognosis and survival should be evaluated with multicenter studies.
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Rarely occurrance of two diffuse idiopathic neuroendocrine cell hyperplasia cases p. 167
Nalan Ogan, Eylem Evrim Akpinar, Ayse Baha, Serdar Han, Haldun Umudum
Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare disease which needs a long time for diagnosis and usually defined by case reports and small series. We reported two cases, one with 67 and the other with 66-years-old, both of them were female. They presented with long-lasting complaints of cough and shortness of breath. Computed tomography of patients showed multiple nodules on the basis of lungs, and additionally, mosaic perfusion was seen in the first case. Tissue samples were taken with video-assisted thoracic surgery, and the patients were diagnosed with DIPNECH by immunohistochemical examination. We wanted to emphasize the importance of DIPNECH which is a rare clinical entity causing chronic respiratory symptoms which should be considered in differential diagnosis of multiple pulmonary nodules.
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Endobronchial metastasis of testicular germ cell tumor p. 171
Demet Turan, Mehmet Akif Özgül, Gamze Kirkil, Erdogan Çetinkaya
Endobronchial metastasis (EBM) of extrapulmonary malignancies is rarely reported; on the other hand, germ cell tumors (GCTs) are extremely rare. This report describes a case of a testicular germ cell tumor presenting as a polypoid endobronchial mass. A 48-year-old male patient had a history of hemoptysis for several weeks. He had undergone orchiectomy due to testicular GCT 20 years ago. Computerized tomography of the thorax obtained endobronchial polypoid lesion in the right intermediate bronchus. Rigid bronchoscopy was applied; right intermediate bronchus was obliterated with a polypoid lesion. The lesion was coagulated with argon plasma coagulation, and debris was removed by biopsy forceps. Pathological examination of the specimen was somatic-type GCT. No recurrence was observed during the follow-up of the patient. We want to present our case to emphasize the importance of distinguishing EBM from primary lung carcinoma which treatment and survival are quite different.
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Presentation and surgical treatment of congenital pulmonary airway malformation in an adult p. 174
Cemal Aker, Cem Emrah Kalafat, Salih Bilen, Celalettin İbrahim Kocatürk
Congenital pulmonary airway malformation (CPAM) is a congenital lung disease that is usually diagnosed in the prenatal or neonatal period but is rarely seen in adults as well. In this report, we present a 26-year-old male patient who presented to our clinic with respiratory difficulty due to a CPAM that affected the entire right lung, caused mediastinal and diaphragmatic compression, and led to extensive diffuse hemorrhage from the adjacent structures that required massive transfusion.
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A young male patient presented with dyspnea, hemoptysis, and bilateral pulmonary nodular infiltrations: What is your diagnosis? p. 177
Pelinsu Yilmaz, Bahar Ezgi Ucurum, Süda Tekin, Benan Caglayan, Fatma Isil Uzel
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Reviewers, 2018 p. 181

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