In which stage we diagnose and how we treat lung cancer?

To determine the stage of the disease, performance status of the patients on admission and treatment modalities, records of 226 patients with lung cancer diagnosed between January 1992 and December 1999 were evaluated retrospectively. The mean age of the patients were 61.3 +/- 10.3 years (mean +/- standard deviation) and 217 (96%) were men and 9 (4%) were women. Of the 192 cases with non-small cell lung cancer 22.9% were stage 4, 40.6% were stage 3b, 22.4% were stage 3a, 4.2% were stage 2, 9.9% were stage 1. Of the 34 (15.1%) patients with small cell lung cancer, 26.5% were extensive and 73.5% were in limited stages. The performance status according to European Cooperative Oncology Group (ECOG) was between 0-2 in 88.4% and 3-4 in 11.6% of the cases. A positive correlation between the performance status and the stage of the disease was observed (p= 0.0331). It was detected that the performance status of the patients who underwent surgery was better than the patients who treated with radiotherapy (p= 0.0008). Radiotherapy (RT), chemotherapy (CT), surgery, combined therapy (RT + CT), adjuvant RT and palliative therapy were performed in 27%, 20.4%, 11.5%, 1.3%, 1.8% and 14.6% of the cases respectively. No information about treatment protocol was able to obtained in 23.4% of the patients, probably due to referrals, early deaths etc. In conclusion, more than half of our cases with lung cancer were diagnosed in advanced stages as a possible result of late admission to physician and surgery were performed in only a small part of the cases. It was detected that performance status of the patients operated was better than the patients treated with radiotherapy. On the other hand, combination therapy was applied in few cases.     

Prostatic adenocarcinoma metastasis in the thyroid gland

Metastasis from prostate to thyroid gland is very uncommon. Here we report a 77-year-old man who was admitted to the hospital because of a nodular goiter. A fine-needle aspiration biopsy of the nodule showed metastatic prostatic adenocarcinoma. This is the second case of a metastatic prostate carcinoma to the thyroid gland.     

External beam radiotherapy for localized prostate cancer

Radiotherapy (XRT) is a curative treatment option for prostate cancer (PCa). Recent XRT technologies allow higher dose therapy that lead to increased local control with less adjacent tissue damage. Additionally, receiving neo-adjuvant or adjuvant hormonotherapy (HT) during radiation therapy increases the curative effect. The aim of this paper is to review the current literature and guidelines on external beam radiation therapy for PCa. However, brachytherapy and radiosurgery, a recently evolving relatively new technology for the radiotherapeutic management of localized PCa, are beyond the scope of this paper.     

P-wave dispersion in patients with stable coronary artery disease and its relationship with severity of the disease

AIM: P-wave dispersion (PD) has been reported to be associated with inhomogeneous and discontinuous propagation of sinus impulses. The purpose of this study was to investigate the PD in patients with stable coronary artery disease (CAD) and to determine its relationship with severity of the disease. METHODS: We prospectively analyzed 66 subjects with normal coronary angiogram (group 1) and 68 patients with significant (> or =50%) coronary stenosis; 25 had 1-vessel disease (group 2), 27 had 2-vessel disease (group 3), and 16 had 3-vessel disease (group 4). The maximum and minimum P-wave duration (Pmax and Pmin) and PD were measured from the 12-lead surface electrocardiogram. Echocardiographic examination was also performed. Angiographic vessel score and Gensini score were used to evaluate the severity of CAD. RESULTS: Pmax was longer in groups 3 and 4 compared with group 1 (P = .001 for both comparison). PD was greater in groups 2, 3, and 4 compared with group 1 ( P < .001 for all comparison), and also in group 4 compared with group 2 (P = .001). However, there was no statistically significant difference among the groups regarding Pmin. In bivariate correlation, increased PD was correlated with presence of hypertension (r = 0.278, P = .013), left ventricular ejection fraction (r = -0.231, P = .044), left atrial diameter (r = 0.223, P = .032), presence of moderate to severe mitral regurgitation (r = 0.284, P = .017), vessel score (r = 0.465, P < .001), and Gensini score (r = 0.338, P = .005). Multiple linear regression analysis showed that only vessel score was independently associated with PD (beta = .471, P = .01). CONCLUSIONS: PD was found to be greater in patients with stable CAD than in controls and to be associated with severity of the disease.     

Poststreptococcal reactive arthritis in children: is it really a different entity from rheumatic fever?

Poststreptococcal reactive arthritis (PSRA) is an acute, nonsuppurative arthritis following documented streptococcal infections. Although most authors accepted it as a different entity, the differences from acute rheumatic fever (ARF) are not clear. To document and compare the clinical and laboratory characteristics of PSRA and ARF, 24 patients with PSRA and 20 with ARF were enrolled in the study. The latency period from upper respiratory tract infection was shorter in patients with PSRA ( P<0.01). However, 25% of the patients with ARF had also short (<10 days) latency periods. Although symmetric and nonmigratory arthritis were more frequent in patients with PSRA, there was no significant difference for the distribution of mono-, oligo-, and polyarticular disease between PSRA and ARF patients. The frequency of small joint and hip involvement was also similar between the patient groups. Unresponsiveness of articular symptoms to salicylate therapy within 72 h was more frequent in patients with PSRA (P<0.001). However, in a substantial part of the patients with ARF (nine patients, 45%), joint symptoms also had no response during the first 72 h. Since there is a considerable overlap of symptoms, signs, and laboratory features of PSRA and ARF, a line between these two entities could not be easily drawn. We conclude that these two conditions are actually different presentations of the same disease.