Surgical results and prognosis of patients with primary bronchogenic carcinoma aged less than 36 years

BACKGROUND AND OBJECTIVE: This study reports on the demographic features, clinico-pathological results and prognoses of patients aged less than 36 years diagnosed with non-small cell lung cancer (NSCLC). METHODS: This is an observational study of patients with primary NSCLC who had a surgical procedure at a tertiary thoracic surgery centre in Turkey. Data collected were age, gender, history of smoking, symptoms, postoperative histopathological diagnosis, stage, surgical procedure and survival. RESULTS: Of the 31 patients in the study, 27 were male (87%) and the median age was 32 years (10-35 years). Nineteen patients were smokers (61.2%). The most common presenting symptom was cough (n = 23, 67.7%). Histopathological diagnosis was squamous cell carcinoma (SCC, n = 17), adenocarcinoma (n = 12), lymphoepithelioma-like carcinoma (n = 1) and undifferentiated carcinoma (n = 1). Staging of the 17 patients with SCC (58.8%) was stage I and II (n = 10, 58%), and stage III (n = 7, 41%). Staging of the 13 patients with adenocarcinoma was stage IV (n = 2, 16%) and stage III patients (n = 8, 66%). Follow-up data were available on 22 patients (71%) and showed a median survival of 17.2 months. Two and 5-year survival rates were 54.5% and 45.5%, respectively. CONCLUSIONS: SCC comprised a relatively high proportion of NSCLC in these younger patients. Aggressive multimodality treatment may achieve satisfactory 2- and 5-year survival rates in young patients with NSCLC who usually present with advanced disease.     

Impairment of flow-mediated vasodilatation of brachial artery in patients with Cushing's Syndrome

Background Cushing’s Syndrome (CS) is associated with excess and premature cardiovascular disease. Endothelial dysfunction is the initiating event in the development of atherosclerosis. Endothelial function is assessed by flow-mediated dilatation (FMD) of brachial artery. The aim of this study was to assess FMD in patients with CS. Methods We prospectively evaluated 22 patients with CS (12 women, 10 men; aged 42 ± 11 years, serum cortisol 28.2 ± 14 μg/dl, 24-h urinary free cortisol (UFC) 269 ± 92 μg/day), and 23 control subjects (13 women, 10 men; aged 43 ± 10 years, serum cortisol 14 ± 4 μg/dl, 24 h cortisol 60 ± 22 μg/day). Endothelial function, measured as FMD of the brachial artery using ultrasound, was calculated in two groups. Endothelial function was evaluated by assessing 1-min postischemic FMD of the brachial artery. Results FMD was lower in patients with CS than that in those without (11.7 ± 4.8% vs. 15.8 ± 3.2%, P = 0.0001, respectively). There was no significant difference between two groups regarding baseline diameter of brachial artery. But, hyperemia diameter was lower in patients with CS than without CS (3.6 ± 0.22 mm vs. 3.9 ± 0.19 mm, P = 0.04, respectively) Conclusion Endothelium-dependent FMD may impair in patients with CS compared to controls. Measurement of endothelial function may identify high-risk individuals early and therapy to reduce or retard endothelial dysfunction in patients with CS may lead to decreased cardiovascular morbidity and mortality.     

Anxiety scores before and after genetic sonogram

Objective  The value of genetic sonogram is controversial in low-risk population. The aim of our study was to compare the anxiety levels among women with high risk and low risk for fetal chromosomal/structural defects. Materials and methods  A total of 115 consecutive pregnant women were included. The anxiety levels were assessed by the use of Turkish version of the standardized state-trait-anxiety-inventory. Before and after genetic sonogram, state and trait-anxiety was measured. Results  The mean state anxiety score before genetic sonogram was statistically, significantly higher than the mean score after the examination. Before genetic sonogram, the mean state-anxiety score of the women with high risk for fetal chromosomal/structural defects was significantly higher than the mean score of women with low risk. Following genetic sonogram, although the anxiety scores decreased, the scores of women with high risk still remained significantly higher than the scores of women with low risk and the anxiety scores significantly further increased among women with a positive minor or major ultrasound finding. Conclusion  Genetic sonogram presents an anxiety-inducing situation for the parents-to-be. The level of experienced anxiety was found to be proportional to the level of the perceived risk. Women with low risk for chromosomal/structural defects experienced lower anxiety than women with high risk. Following the examination, women with a negative result were found to have a significant reduction of anxiety and emotional relief whereas a positive test result led to a further increase in anxiety scores.     

Assessment of Left Ventricular Systolic Synchronization in Patients with Chronic Kidney Disease and Narrow QRS Complexes

Objective: The evidence of structural and functional cardiac abnormalities has been demonstrated by echocardiography in patients with chronic kidney disease (CKD). This study investigated whether left ventricular (LV) asynchrony is present in patients with CKD and normal QRS duration. Methods: Tissue synchronization imaging (TSI) was performed in 25 (56 ± 14 years) patients with CKD and narrow QRS complexes and 25 (51 ± 12 years) control subjects. LV asynchrony was identified on TSI images and the time to regional peak systolic velocity (Ts) in LV was measured by the six-basal–six-midsegmental model. Four TSI parameters of systolic asynchrony were computed when Ts was measured in ejection phase. Results: The standard deviation of Ts of 12 LV segments (33.6 ± 17.8 vs 16.7 ± 10 ms, P = 0.0001), standard deviation of Ts of the six basal LV segments (30 ± 20 vs 17.6 ± 9.6 ms, P = 0.008), maximal difference in Ts between any two of the 12 LV segments (102 ± 45 vs 54 ± 32 ms, P = 0.0001), and maximal difference in Ts between any two of the six basal LV segments (78 ± 50 vs 46 ± 22 ms, P = 0.007) were prolonged in patients with CKD compared with controls. The prevalence of LV systolic asynchrony was significantly higher in patients with CKD compared with controls (44% vs 12%, P = 0.01). The standard deviation of Ts of 12 LV segments were significantly associated with LV diameters, LV volumes, LV mass, blood pressure levels, and renal functions in univariate analysis. Conclusion: The results of this study indicate that LV systolic asynchrony may develop in patients with CKD.     

Huge intradiploic epidermoid cyst

A 60-year-old man presented with an occipital mass under the scalp and complained of headache, nausea, and dizziness. Magnetic resonance imaging showed a well-defined mass in the occipital scalp extending from the scalp through the cranium and several centimetres into the posterior fossa. There were well-defined margins in the deep portion and the mass was totally removed. Histological examination showed that the cystic structure was lined by squamous epithelium containing laminated keratin material. The pathological findings were consistent with the diagnosis of an epidermoid cyst. The patient was discharged free of symptoms.     

Nocturnal penile tumescence (NPT) and rigidity monitoring in neurogenic impotence: Interpretations and limitations

This paper describes the current state of nocturnal penile tumescence (NPT) testing for men with neurogenic impotence. The paper describes the development of the procedure and offers suggestions regarding interpretations of NPT and rigidity findings. In addition, the paper discusses techniques for assessing the neurogenic causes of impotence as well as other polysomnographic findings. Specific attention is given to somatic nerve function tests, autonomic erectile dysfunction and the investigation of cerebral autonomic and somatic projections. The paper concludes by discussing new avenues of study.     

Therapeutic apheresis: Results from a single center in Turkey.

BACKGROUND: Therapeutic apheresis (TA) is carried out for a broad spectrum of diseases and syndromes. AIM: We retrospectively evaluated the results of therapeutic apheresis (TA) including plasma exchange, therapeutic plateletpheresis, and leukapheresis during 2000-2006. METHODS: A total of 195 procedures were performed in 44 patients (25 male and 19 female, with a mean age of 52+/-15 years). These procedures consist of 165 plasma exchanges, 20 therapeutic plateletpheresis, and 10 leukapheresis. The most common indications were hematological, neurological, and metabolic diseases. Eighty-three percent of plasma exchange, 100% of plateletpheresis and leukapheresis belonged to indication Category I or II, according to the guidelines of the American Society for Apheresis. RESULTS: While hemoglobin levels significantly increased (p<0.05), platelet counts decreased (p<0.005) after plasma exchange. Hematological parameters did not statistically change significantly with leukapheresis (p>0.05). Platelet counts significantly decreased with plateletpheresis (p<0.001). Total complications were detected in 21% of the procedures. Adverse events (AE) were seen in 17% of the procedures. None of the patients died (Grade-IV) from any complication. AEs occurred in 14% (Grade-I), 1% (Grade-II), and 2% (Grade-III) of the procedures. The most common AEs were nausea/vomiting, hypotension, and abdominal pain. CONCLUSION: TA, an important procedure in Transfusion Medicine, is safely carried out in our center in several hematological, neurological, and metabolic diseases which are similar to previous reports.     

Multicenter retrospective analysis regarding the clinical manifestations and treatment results in patients with hairy cell leukemia: twenty‐four year Turkish experience in cladribine therapy

In this multicenter retrospective analysis, we aimed to present clinical, laboratory and treatment results of 94 patients with Hairy cell leukemia diagnosed in 13 centers between 1990 and 2014. Sixty‐six of the patients were males and 28 were females, with a median age of 55. Splenomegaly was present in 93.5% of cases at diagnosis. The laboratory findings that came into prominence were pancytopenia with grade 3 bone marrow fibrosis. Most of the patients with an indication for treatment were treated with cladribine as first‐line treatment. Total and complete response of cladribine was 97.3% and 80.7%. The relapse rate after cladribine was 16.6%, and treatment related mortality was 2.5%. Most preferred therapy (95%) was again cladribine at second‐line, and third line with CR rate of 68.4% and 66.6%, respectively. The 28‐month median OS was 91.7% in all patients and 25‐month median OS 96% for patients who were given cladribine as first‐line therapy. In conclusion, the first multicenter retrospective Turkish study where patients with HCL were followed up for a long period has revealed demographic characteristics of patients with HCL, and confirmed that cladribine treatment might be safe and effective in a relatively large series of the Turkish study population. Copyright © 2014 John Wiley & Sons, Ltd.