Ismail Savas

Sister chromatid exchange rate from pleural fluid cells in patients with malignant mesothelioma

This study assessed the impact of malignant mesothelioma on the frequencies of sister chromatid exchange (SCE) in the pleural effusion cells. Ten patients with mesothelioma and 20 control subjects were included in the study. The control subjects were the patients with tuberculosis pleurisy, and the remaining 10 subjects of control group were healthy volunteers and only heparinized blood samples were collected from these subjects. The pleural effusion cells were cultured with conventional culture methods. The samples were obtained from the patients after histopathologic confirmation of the malignancy but before the initiation of chemotherapy or radiotherapy. At the end of the culture period and 48 h prior the harvesting, BrdU was added into flasks. Totally, 100 metaphases were scored for each sample. In this study, we found that the SCE frequencies of malignant pleural mesotheliomas were significantly higher than the control subjects (P<0.001). Six of 10 patients came from central Anatolia, which is of great importance due to high rate of exposure to asbestosis in this region.

Combination and comparison of two models in prognosis of pulmonary embolism: Results from TUrkey Pulmonary Embolism Group (TUPEG) study☆

BACKGROUND Clinical parameters, biomarkers and imaging-based risk stratification are widely accepted in pulmonary embolism(PE). The present study has investigated the prognostic role of simplified Pulmonary Embolism Severity Index (sPESI) score and the European Society of Cardiology (ESC) model. METHODS This prospective cohort study included a total of 1078 patients from a multi-center registry, with objectively confirmed acute symptomatic PE. The primary endpoint was all-cause mortality during the first 30days, and the secondary endpoint included all-cause mortality, nonfatal symptomatic recurrent PE, or nonfatal major bleeding. RESULTS Of the 1078 study patients, 95 (8.8%) died within 30days of diagnosis. There was no significant difference between non-low-risk patients ESC [12.2% (103 of 754;)] and high-risk patients as per the sPESI [11.6% (103 of 796)] for 30-day mortality. The nonfatal secondary endpoint occurred in 2.8% of patients in the the sPESI low-risk and 1.9% in the ESC low-risk group. Thirty-day mortality occurred in 2.2% of patients the sPESI low-risk and in 2.2% the ESC low-risk group (P=NS). In the present study, in the combination of the sPESI low-risk and ESC model low-risk mortality rate was 0%. CONCLUSIONS The sPESI and the ESC model showed a similar performance regarding 30-day mortality and secondary outcomes in the present study. However, the combination of these two models appears to be particularly valuable in PE.

Association of cadmium but not arsenic levels in lung cancer tumor tissue with smoking, histopathological type and stage.

BACKGROUND To evaluate association of lung cancer with arsenic and cadmium levels measured in tumor tissue. MATERIALS AND METHODS Ninety-five patients with lung cancer tumor tissue obtained surgically were included in this study. Arsenic and cadmium levels were measured and levels of metals were compared among types of lung cancer and with reference to patient data. RESULTS The histopathologic diagnoses of the 95 cases were SCC, 49, adenocarcinoma, 28, large cell, 11 and SCLC, 1. Mean tumor arsenic and cadmium levels were 149.3±129.1μg/kg and 276.3±219.3μg/kg, respectively. Cadmium levels were significantly associated with smoking (p=0.02), histopathologic type (p=0.005), and TNM staging (r=0.325; p=0.001), although arsenic was not related to any parameter (p>0.05). There was no relation between metal levels and mortality (p>0.05). CONCLUSIONS We found a significant association between tumor cadmium levels of patients with lung cancer and smoking, histopathologic type and staging, although there was no relation with arsenic levels.

Vascular Endothelial Growth Factor in Benign and Malignant Pleural Effusions

OBJECTIVE Vascular endothelial growth factor (VEGF) is a potent inducer of capillary permeability and its role as a crucial mediator in pleural fluid formation has been established. This study was conducted to assess the usefulness of VEGF for diagnosing malignant and non-malignant pleural effusions of various causes. PATIENTS AND METHODS VEGF levels in pleural effusions collected from 52 patients (20 with malignant effusion, 12 with tuberculous effusion, 10 with transudative effusion, and 10 with parapneumonic effusion) were assessed by enzyme-linked immunosorbent assay. RESULTS The median level of VEGF was significantly higher (P = .001) in exudative effusions (10.16 pg/mL) than in the transudative effusions (3.82 pg/mL). Although malignant pleural fluids tended to have higher median and mean levels of VEGF compared to tuberculous effusions, the difference was not statistically significant. Pleural VEGF levels in subtypes of lung cancer and in malignant effusions of different origins were not significantly different. CONCLUSIONS In conclusion, although VEGF levels in pleural effusions of different origins vary, they were only able to discriminate exudates from transudates significantly in this study. Further studies in larger groups of patients are needed to establish the role of VEGF in diagnosing malignant and/or tuberculous effusions.

El factor de crecimiento endotelial vascular en los derrames pleurales benignos y malignos

Objetivo El factor de crecimiento endotelial vascular (VEGF) es un potente inductor de la permeabilidad capilar y desempena un papel clave como mediador en la formacion del derrame pleural. Este estudio se ha realizado para evaluar la utilidad del VEGF en el diagnostico de los derrames pleurales malignos y no malignos de diversas causas. Pacientes y metodos Mediante la tecnica de inmunoabsorcion ligada a enzimas se determinaron las concentraciones de VEGF en los derrames pleurales correspondientes a 52 pacientes (20 con derrame pleural maligno, 12 con derrame de origen tuberculoso, 10 con derrame de tipo trasudado y 10 con derrame paraneumonico). Resultados La concentracion media del VEGF fue significativamente mayor (p = 0,001) en los derrames pleurales (10,16 pg/ml) de tipo exudado que en los derrames de tipo trasudado (3,82 pg/ml). Aunque los derrames pleurales malignos mostraron una tendencia a las concentraciones medianas y medias mayores de VEGF, en comparacion con los derrames de origen tuberculoso, la diferencia no fue estadisticamente significativa. Tampoco fueron significativamente diferentes las concentraciones pleurales de VEGF en los distintos subtipos de cancer pulmonar, y tampoco en los derrames malignos de distintos origenes. Conclusiones Aunque las concentraciones de VEGF son distintas en los derrames pleurales de origenes diferentes, en nuestro estudio no han permitido discriminar los exudados de los trasudados. Son necesarios nuevos estudios de investigacion sobre grupos mas numerosos de pacientes con objeto de establecer el papel que puede desempenar la concentracion de VEGF en el diagnostico de los derrames malignos, tuberculosos o ambos.

Patient and physician delay in the diagnosis and treatment of non-small cell lung cancer in Turkey.

AIM The early diagnosis and treatment of lung cancer are important for the prognosis of patients with lung cancer. This study was undertaken to investigate patient and doctor delays in the diagnosis and treatment of NSCLC and the factors affecting these delays. MATERIALS AND METHODS A total of 1016 patients, including 926 (91.1%) males and 90 (8.9%) females with a mean age of 61.5±10.1 years, were enrolled prospectively in this study between May 2010 and May 2011 from 17 sites in various Turkish provinces. RESULTS The patient delay was found to be 49.9±96.9 days, doctor delay was found to be 87.7±99.6 days, and total delay was found to be 131.3±135.2 days. The referral delay was found to be 61.6±127.2 days, diagnostic delay was found to be 20.4±44.5 days, and treatment delay was found to be 24.4±54.9 days. When the major factors responsible for these delays were examined, patient delay was found to be more frequent in workers, while referral delay was found to be more frequent in patients living in villages (p<0.05). We determined that referral delay, doctor delay, and total delay increased as the number of doctors who were consulted by patients increased (p<0.05). Additionally, we determined that diagnostic and treatment delays were more frequent at the early tumour stages in NSCLC patients (p<0.05). DISCUSSION The extended length of patient delay underscores the necessity of educating people about lung cancer. To decrease doctor delay, education is a crucial first step. Additionally, to further reduce the diagnostic and treatment delays of chest specialists, multidisciplinary management and algorithms must be used regularly.

Is oxygen saturation variable of simplified pulmonary embolism severity index reliable for identification of patients, suitable for outpatient treatment.

The pulmonary embolism severity index (PESI) or simplified version (sPESI) are widely validated risk scores for the identification of eligible patients for outpatient treatment. Saturation is one of these criteria. For this metric, saturation of 90% or greater is assigned zero points. However, 90% saturation does not always exclude hypoxemic respiratory failure.

Frequency of vitamin K oxidoreductase complex subunit-1 (VKORC1) polymorphisms and warfarin dose management in patients with venous thromboembolism

Warfarin works by inhibiting VKORC1, so polymorphisms of this gene modify the required drug dose. The aim of this study is to examine the relation between therapeutic weekly dose of warfarin and C1173T/G1639A polymorphism of VKORC1 in patients with VTE. Seventy-five patients with VTE were enrolled. Weekly warfarin doses and time (day) to reach therapeutic INR were evaluated retrospectively along with VKORC1–C1173T and G1639A alleles. The mean weekly warfarin dose was lower and time to reach therapeutic INR was shorter in homozygote alleles (AA and TT) (p < 0.05). The multivariate regression model was produced, R2 = 0.05% for age (p = 0.04), R2 = 6% for VKORC1 (p = 0.03), the model for estimating warfarin dose R2 = 17% (p > 0.05). In particular, patients who need overdose of warfarin or whose bleeding score is high, study of these polymorphisms can be considered.

Clinical characteristics of elderly patients with pulmonary embolism and risk factors for recurrence

Introduction: Elderly patients are at increased risk for pulmonary embolism (PE) and recurrence. Aim: To define clinical characteristics of elderly PE patients and risk factors for recurrence. Method: We retrospectively analysed PE patients aged 75 and over between 2010 and 2015. Results: There were 73 patients. Main risk factors for PE were:bedridden (24.6%), recent hospitalization (13.7%), active cancer (12.3%), recent surgery (5.4%) and previous deep vein thrombosis (DVT) history (6.8%). In hospital mortality was 2.7% (2 patients). One patient with previous multiple myeloma who was entubated due to respiratory failure and other patient died during catheter directed thrombolysis. Forty patients (56.3%) were discharged with warfarin, 30 (42.3%) with low molecular heparin and one with rivaroxaban. There wasn9t any in hospital bleeding. After discharge 5 patients (6.8%) had bleeding (3 epistaxis, 1 hematuria and 1 gastrointestinal). Patient with gastrointestinal bleeding died. Others didn9t need interventional procedures for bleeding. Eleven PE and 5 previous DVT total 16 (21.9%) venous thromboembolism (VTE) patients had recurrent PE. Statistically significant risk factors for recurrence were inadequate treatment of index VTE (p 0.048) and previous DVT history (p 0.048). Bedridden, recent hospitalization, comorbidities and discharge with warfarin or LMWH and treatment duration were not statistically significantly different between two groups. Conclusion: Duration of anticoagulation should comply with guidelines. Prophylaxis with LMWH is mandatory for hospitalized patients with previous VTE history. Major bleeding risk is low and shouldn9t be a reason for inadequate treatment or prophylaxis.