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Eurasian J Pulmonol: 20 (3)
Volume: 20  Issue: 3 - December 2018
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REVIEW ARTICLE
1.Molecular genetics of lung cancer
Yasemin Çiçek, Pinar Aslan Kosar, Önder Öztürk
doi: 10.4103/ejop.ejop_33_18  Pages 111 - 117
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.

RESEARCH
2.Continuing practice is needed to maintain competency in endobronchial ultrasound‑guided transbronchial needle aspiration
Nur Şafak Alıcı, Ibrahim Onur Alıcı
doi: 10.4103/ejop.ejop_67_18  Pages 118 - 121
Giriş; Eğitimden sonra yetkili bir EBUS operatörünün yılda en az yirmi işlem yapması gerektiği kabul edilmiştir. Bununla birlikte, bu konuyu destekleyen literatür kısıtlıdır. Bu çalışma beş yıllık uzun süreli bir ara sonrasında deneyimli bir bronkoskopistinin geri dönüş performansı üzerine odaklanmaktadır. Amaç, ara verilen uygulamadan sonra tanı performansında olası bir düşüşün ortaya çıkarılmasıdır.
Yöntemler: Nisan-Eylül 2016 tarihleri arasında mediastinal veya hiler lezyonlar (lenfadenopati ve kitleler) için EBUS-TBİA uygulanan hastalar retrospektif olarak incelendi. Ardışık tüm hastalar çalışmaya dahil edildi. Tüm EBUS-TBNA prosedürleri, beş yıllık uzun ara sonrasında geri dönen ve EBUS uygulamasını tekrar başlatan tek deneyimli bir bronkoskopist tarafından gerçekleştirildi. Hastalar iki gruba ayrıldı: İlk yirmi olgu ve sonraki seksen olgu. EBUS'un tanısal performansı iki grup arasında karşılaştırıldı.
Bulgular: Ardışık 100 hasta dahil edildi (hasta başına 2.89 lezyon). Demografik ve sonografik veriler iki grup arasında farklı değildi. Genel olarak, 289 lezyonun 281'inde (% 97.2) EBUS-TBNA tanısal idi. EBUS-TBNA'nın birinci ve ikinci gruptaki duyarlılığı sırasıyla% 92.9 ve% 98.3 idi. Aradaki fark istatistiksel olarak anlamlıydı (p = 0.048).
Sonuç: Bu çalışma EBUS'ta uygulamaya devam edilmesi ihtiyacını göstermektedir. Bir operatör, yeterliliği korumak için yılda en az yirmi prosedür gerçekleştirmelidir.
Background: It has been accepted that after training, a competent 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 experience bronchoscopist after a five-year-long brake. The aim is to reveal a possible decrease in the diagnostic performance after discontinued practice.
Methods: The data of patients who have undergone EBUS-TBNA for mediastinal or hilar lesions (lymphadenopathies and masses) between April-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 five-year-long brake and re-started 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 two groups.
Results: One hundred consecutive patients were included (2.89 lesions per patient). Demographic and sonographic data were not different between two groups. In overall, EBUS-TBNA was diagnostic in 281 of 289 lesions (97.2%). The sensitivity of EBUS-TBNA in first and second groups were 92.9% and 98.3%, respectively. The difference was statistically significant (p=0.048).
Conclusion: This study shows the need for continuing practice in EBUS. An operator should perform at least twenty procedures per year to maintain competency.

3.Does subglottic secretion drainage prevent ventilator‑associated pneumonia?
Aysegul Erinc, Hatice Kutbay Ozcelik, Burcu Arpinar Yigitbas, Sibel Yurt, Filiz Kosar
doi: 10.4103/ejop.ejop_62_18  Pages 122 - 127
Amaç: Yoğun bakım ünitesine (YBÜ) pnömoni dışı nedenlerle yatırılıp endotrakeal entübasyonla takip edilen hastalarda, subglottik sekresyon drenajı (SSD) yapılabilen tüplerle standart endotrakeal tüplerin ventilatörle ilişkili pnömoni (VİP) insidansı açısından karşılaştırılması amaçlanmıştır.
Gereç ve Yöntem: Çalışma prospektif olarak tasarlandı ve Nisan 2012 ile Ocak 2013 tarihleri arasında YBܒne yatırılan hastalar ardışık olarak SSD endotrakeal tüp ve standart endotrakeal tüp gruplarına randomize edildi. YBܒne gelişi sırasında pulmoner infeksiyonu olanlar dışlandı. VİP insidansı açısından görüntüleme, kan ve balgam kültürleri rutin olarak ve gerektiğinde plevral sıvı ve bronşiyal lavaj örnekleri incelendi.
Bulgular: Toplam 42 hasta (E/K 27/15) çalışmaya dâhil edildi. Standart (n=30) ve SSD (n= 12) endotrakeal tüp gruplarının sırasıyla ortalama yaşı 71±10.4 ve 64.4±13.9 yıl (p >0.05), E/K dağılımı 18/12 ve 9/3 (p >0.05), APACHE II skorları 20.2±3.8 ve 17.0±3.8 (p 0.02), mekanik ventilasyonda kalış süreleri 15.9±11.5 ve 11.0±8.1 gün (p >0.05) ve takip süreleri 18.0±12.4 ve 15.5±12.2 gün (p >0.05). VİP insidansı açısından gruplar arasında istatistiksel açıdan anlamlı bir fark saptanmadı (standart vs SSD gruplarda sırasıyla %36.7 vs %33.3, p >0.05). Standart endotrakeal tüp kullanılan grupta mortalite oranı SSD grubuna göre daha yüksek saptandı (%70 vs %41, p>0,05), ancak aradaki fark istatistiksel açıdan anlamlı değildi.
Sonuç: Standart endotrakeal tüple kıyaslandığında, SSD yapılabilen entübasyon tüplerinin mekanik ventilasyonda kalış süresi, YBܒde kalış süresi ve VİP insidansı üzerinde istatistiksel açıdan anlamlı düzeyde olumlu etkisi gözlenmedi. Hasta sayısının kısıtlı olması nedeniyle bu bulguların daha fazla sayıda hasta ile yapılan çalışmalar ile yeniden değerlendirilmesi gerekmektedir.
Aim: To compare the incidences of ventilator associated pneumonia (VAP) in patients who were admitted into the intensive care unit (ICU) due to causes other than pneumonia and followed up under mechanical ventilation either with standard endotracheal intubation or endotracheal tubes with subglottic secretion drainage (SSD) function.
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 under mechanical ventilation and follow up of patients with standard (n 30) and SSD (n 12) intubation tubes were similar;71±10.4 vs 64.4±13.9 years (p >0.05), M/F 18/12 vs 9/3 (p >0.05), APACHE II scores 20.2±3.8 vs 17.0±3.8 (p 0.02), 15.9±11.5 vs 11.0±8.1 days (p >0.05) and 18.0±12.4 vs 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: As compared to standard endotracheal intubation, intubation with SSD tubes was not associated with improvement in any of duration under mechanical ventilation, duration in ICU, incidence of VAP and mortality. Limited number of patients requires that these findings should be confirmed with a larger study.

4.Frequency and duration of smoking scenes in Turkish movies
Nazmi Bilir, Hilal Özcebe, Şule Akçay, Elif Babaoğlu, Sema Canbakan, Burcu Cirit, Özlem Erçen Diken, Tijen Şengezer
doi: 10.4103/ejop.ejop_68_18  Pages 128 - 132
Türkiye’de kapsamlı tütün kontrolü kanunu tütün ürünlerinin reklam ve tanıtımı ile tütün endüstrisi tarafından sponsorlukları yasaklamıştır. Tütün ürünleri reklamı televizyonda, bilbordlarda ve yazılı basında yasaklanmıştır, ancak sinema filmlerine yönelik bir yasaklama söz konusu değildir. Sinema filmlerinde tütün ürünleri reklam ve tanıtımının sıklığı ve süresini incelemek amacı ile yapılan bu tanımlayıcı çalışmada 2016 yılının ikinci yarısında vizyonda olan Türk filmlerinden çok izlenen 60 film seçilmiştir. Üniversite mezunu iki genç erkek gözlemci çalışmanın amacı ve yöntemi konusunda eğitilmiştir. Daha sonra bu iki gözlemci birbirinden bağımsız olarak filmleri izlemişler ve sigara görüntüsü veya tütün ürünü görüntüsü olan sahneleri hazırlanmış olan form üzerinde işaretlemişlerdir. İzlenen 60 filmin 36 tanesinde (%60) sigara içilmesi veya tütün ürünü görüntüsü vardı. Bu filmlerde ortalama olarak 4,75 kez tütün ürünü görüntüsü vardı (ortanca değer 3). Tütün ürünü görüntüsünün ortalama süresi de yaklaşık olarak 3,5 dakika idi (198 saniye). Sigara içen kişiler çoğunlukla asıl karakter olan kişilerdi ve görüntüler çoğunlukla çocuklar ve gençler açısından çekici olabilecek şekilde heyecanlı veya romantik ortamlarda idi. Tütün Kontrolü Çerçece Sözleşmesi’ne (Madde 13) göre sinema filmlerinde sigara görüntüsü olması tütün ürünleri reklamı olarak kabul edilmelidir; bu durum çocuk ve gençlerin sigara içme davranışına yönelmesi bakımından önemlidir. Bu nedenle sinema filmlerinde sigara görüntüleri olmasının kontrol edilmesi özellikle çocuk ve gençlerin sigara içmeye yönelmesinin önlenmesi açısından önemlidir. Sinema filmleri içindeki sigara görüntülerinin azaltılması bakımından filmlerin içine tütün karşıtı mesajlar ve uyarı mesajları yerleştirilebilir.
Comprehensive tobacco control law in Turkey bans advertisement, promotion of tobacco products and sponsorship by tobacco industry. Advertisement of tobacco products were banned on television, bilboards and press media, but not on movie films. In order 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. 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 minutes (198 seconds). Smokers were mostly main characters and smoking occurrences were mostly in exciting or romantic atmosphere, which are attractive for young people. In the light of Framework Convention on Tobacco Control (Article 13), smoking scenes in movies is considered as kind of tobacco advertisement and promotion, which influences smoking behaviour particularly the young people. Therefore control and prevention of smoking occurrences in movies is important for protection of children and young people to start smoking. Some health warnings and anti tobacco messages may be placed in the movies, in order to reduce tobacco views in the movies.

5.Chest X‑ray: Is it still important in determining mortality in patients hospitalized due to chronic obstructive pulmonary diseases exacerbation in intensive care unit?
Elif Yelda Özgün Niksarlıoğlu, Ülkü Aka Aktürk
doi: 10.4103/ejop.ejop_70_18  Pages 133 - 137
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) fi ndings 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%, infi ltration in 54%, bronchiectasis in 31.7%, and unilateral or bilateral pleural effusion in 27% of the cases. Infi ltration 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.

6.Does activity held on World Asthma Day have an impact on the asthma knowledge and awareness of family physicians?
Serap Ozmen, Çiğdem Özdilekcan, Ilknur Bostancı, Ayşegül Ertuğrul, Zeynep Şengül Emeksiz, Semra Altıyaprak, Adem Özkara
doi: 10.4103/ejop.ejop_65_18  Pages 138 - 143
Amaç: Her yıl Dünya Astım Günü’nde hastalar ve hekimlerin astım farkındalığını arttırmak için bazı aktiviteler yapılmaktadır. Çalışmanın amacı, Dünya Astım Günü’nde uluslararası astım rehberi esas alınarak aile hekimlerine yapılan astım eğitiminin beceri ve bilgiler üzerinde etkisini araştırmaktı.
Metod: Yarı-deneysel olan çalışmamız, 3 Mayıs 2016 Dünya Astım Günü’nde başlandı. Eğitim, Global Initiative for Asthma (GINA) 2016 ile verildi. Yirmi beş soru içeren anket eğitim öncesi ve 6 ay sonra aile hekimlerine uygulandı.
Bulgular: Otuz iki aile hekiminin %62.5’i kadın ve aile hekimliği pratiği 32.61±26.01 ay (aralık: 1- 84 ay) idi. Aile hekimlerinin %59.4’ü astım eğitimini mezuniyet sonrası almıştı. Ankete katılanların %25’i astım rehberlerini günlük pratiklerinde kullanmaktaydı. Eğitim öncesi ve sonrasında, testte doğruluk oranları, aile hekimi uzmanlarında %58.4% - %77.6 ve aile hekimi asistanlarında %62.3-%75.9 idi. Astım tedavisi ve doğru inhaler ilaç kullanımına odaklı sorularda, eğitim sonrası doğruluk yüzdelerinde artış oldu (sırasıyla, %62.5 - %93.8; p=0.002, %56.2 -%90.6; p=0.007).
Sonuç: Çalışmamız, aile hekimlerinin mezuniyet sonrası ve asistanlık sırasında astım tanı ve tedavisi için rehberleri kullanmadığını gösterdi. Eğitim programının yardımıyla aile hekimlerinin tutumlarında pozitif değişim oldu. Aile hekimlerine de Dünya Astım Günü aktivitesinde eğitim verilmesi gerektiğini düşünüyoruz.
Objective: Annually, certain activities are performed on World Asthma Day (WAD) for the awareness of both patients and physicians about asthma. The aim of the study was to observe the effects of asthma education on the skills and knowledge of family physicians on World Asthma Day, which basically includes updated information of the international asthma guideline.
Methods: Our quasi-experimental study, started on 3rd of May 2016, WAD. Education was provided by GINA (Global Initiative for Asthma), 2016. A questionnaire including 25 questions was applied for family physicians prior to and six months after the education.
Results: In the investigation of 32 family physicians, 62.5% of whom were women, 32.6±26.0 months in family physician practice. 59.4% of family physicians had received education about asthma in their post graduate period. 25% of the participants were using asthma guidelines in their daily practice. In pre- and post-education, 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 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, 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. As an activity of WAD, we believe that education should also be focused on family physicians.

7.Prognostic analysis of surgical‑pathologic N1 disease in non‑small cell lung cancer: Single‑center experience with 276 cases
Serkan Yazgan, Ahmet Ucvet, Soner Gursoy, Ozgur Samancilar, Ezgi Cimen Guvenc
doi: 10.4103/ejop.ejop_18_18  Pages 144 - 149
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.

8.The effect of body mass index on pulmonary rehabilitation outcomes in patients with chronic obstructive pulmonary disease
Esra Pehlivan, Arif Balci, Esra Yazar, Elif Yelda Niksarlioglu, Lütfiye Kiliç
doi: 10.4103/ejop.ejop_22_18  Pages 150 - 156
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

9.The effect of positive airway pressure therapy on lipid profile
Ahmet Cemal Pazarli, Handan Inönü Köseoglu, Asiye Kanbay, Mehmet Akif Abakay
doi: 10.4103/ejop.ejop_25_18  Pages 157 - 161
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.

10.Does age have an impact on lung cancer survival?
Onur Akcay, Seyda Ors Kaya, Kenan Can Ceylan
doi: 10.4103/ejop.ejop_29_18  Pages 162 - 166
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.

CASE REPORT
11.Rarely occurrance of two diffuse idiopathic neuroendocrine cell hyperplasia cases
Nalan Ogan, Eylem Evrim Akpinar, Ayse Baha, Serdar Han, Haldun Umudum
doi: 10.4103/ejop.ejop_66_18  Pages 167 - 170
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.

12.Endobronchial metastasis of testicular germ cell tumor
Demet Turan, Mehmet Akif Özgül, Gamze Kirkil, Erdogan Çetinkaya
doi: 10.4103/ejop.ejop_32_18  Pages 171 - 173
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.

13.Presentation and surgical treatment of congenital pulmonary airway malformation in an adult
Cemal Aker, Cem Emrah Kalafat, Salih Bilen, Celalettin Ibrahim Kocatürk
doi: 10.4103/ejop.ejop_39_18  Pages 174 - 176
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.

QUIZ
14.A Young Male Patient Presented with Dyspnea, Hemoptysis, and Bilateral Pulmonary Nodular Infiltrations: What is Your Diagnosis?
Pelinsu Yılmaz, Bahar Ezgi Uçurum, Süda Tekin, Benan Çağlayan, Fatma Işıl Uzel
doi: 10.4103/ejop.ejop_69_18  Pages 177 - 179
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