Necla Songür

SERUM INTERLEUKIN-6 LEVELS CORRELATE WITH MALNUTRITION AND SURVIVAL IN PATIENTS WITH ADVANCED NON-SMALL CELL LUNG CANCER

Aim To investigate the level of interleukin-6 in advanced non-small cell lung cancer and to analyze the relationship with malnutrition and survival. Methods and study design Seventy-one newly diagnosed advanced non-small cell lung cancer patients were enrolled in this prospective study. Malnutrition was defined by using subjective global assessment. Performance status was assessed by the Karnofsky scale. Serum levels of albumin, transferrin, C-reactive protein, lymphocytes/mm3, lactate dehydrogenase and growth hormone were determined before treatment. The patients were followed, and the factors affecting survival were analyzed. Results The mean follow-up after diagnosis was 180 days. IL-6 levels increased in 48 (68%) of 71 patients. According to the subjective global assessment, 28 (39%) patients were well nourished and 43 (61%) were malnourished. Of the 43 malnourished patients, 29 (41%) were moderately malnourished or suspected of being malnourished and 14 (20%) were severely malnourished. The IL-6 level was related to impaired performance status (P = 0.0001), severe malnutrition (P = 0.004), increased C-reactive protein (P = 0.013), higher growth hormone (P = 0.025) and transferrin (P = 0.03) levels. On univariate analysis, impaired performance status, moderate and severe malnutrition, decreased serum albumin and transferrin, a raised IL-6 and lactate dehydrogenase levels were the significant prognostic factors for survival. Multivariate analysis indicated that a raised IL-6, severe malnutrition and a low serum level of albumin were independent prognostic factors for survival in patients with advanced non-small cell lung cancer. Conclusions IL-6 secretion may play a role in the pathophysiology of malnutrition in advanced lung cancer. Results show a relation between elevated IL-6 serum levels and malnutrition, poor performance status, acute phase response and shorter survival in patients affected by advanced non-small cell lung cancer.

Habitual Snoring in Primary School Children: Prevalence and Association with Sleep-Related Disorders and School Performance

Objectives: To determine the prevalence of habitual snoring (HS) and its association with both day- and nighttime symptoms, school performance and behavioral disturbances in a sample of primary school children. Subjects and Methods: A cross-sectional study was performed on 1,605 children (819 boys and 786 girls) aged 7–13 years from 9 randomly selected primary schools located within the city limits of Isparta, Turkey. HS and sleep problems were assessed using a 55-item multiple-choice questionnaire. Results: Of the 1,605 questionnaires, 1,164 were fully completed and returned, giving a response rate of 72.5%. The overall prevalence of snoring was 38.9%, while HS accounted for 3.5%. The prevalence of HS among boys (25, 3.0%) was higher than among girls (16, 2.0%; χ2 for trend: p < 0.001, OR: 1.92, 95% CI: 1.01–3.66). There was an association between younger age and HS, as children aged 7–8 years had the highest prevalence (χ2 for trend: 0.054, OR: 1.85, 95% CI: 0.81–4.22). Habitual snorers had more daytime and nighttime symptoms. Allergic symptoms, daytime mouth breathing, shaking the child for apnea, restless sleep and hyperactivity were significant and independent risk factors and sleep-related symptoms for HS. A significant and independent association was found between poor school performance and hyperactivity, nocturnal enuresis, tooth grinding and low parental/maternal education in multivariate analysis. Conclusion: Children with HS were more likely to have sleep-related daytime and nighttime symptoms. No significant associ- ation was determined between HS and poor school performance.

Respiratory Symptoms, Pulmonary Function, and Reproductive History: Isparta Menopause and Health Study

OBJECTIVE We aimed to investigate the influence of reproductive factors on chronic respiratory symptoms and pulmonary function in a cross-sectional study of premenopausal and postmenopausal women 44-61 years of age. METHODS Self-reported data on respiratory symptoms were obtained from 1082 women. Usable forced expiratory volume in 1 second (FEV(1)) (2.27 +/- 0.44 L) and forced vital capacity (FVC) (2.75 +/- 0.55 L) measurements were obtained from 1070 women. The influence of reproductive factors on FEV(1), FVC, and chronic respiratory symptoms was assessed by linear and logistic regression analyses. RESULTS Menopause is associated with lower FEV(1) (p < 0.0001, r = -0.181) and FVC (p < 0.0001, r = -0.198) only in univariate analysis. The association disappears when age is adjusted for. However, association of menopause with increased odds of chronic cough plus phlegm is significant in multivariate analysis (odds ratio [OR] 1.84, 95% confidence interval [CI] 1.16-2.92, p = 0.0088). Among reproductive factors, only age at first birth is independently associated with FEV(1) (p = 0.01, r = 0.008) and FVC (p = 0.004, r = 0.013). Results were similar when restricting analyses to those who never smoked and after exclusion of asthmatics. CONCLUSIONS Postmenopausal status is independently associated with increased odds of chronic cough plus phlegm, whereas it does not appear to be independently associated with FEV(1) or FVC. Among the reproductive factors, age at first birth is the only independent predictor of FEV(1) and FVC. These findings suggest that reproductive factors may influence womens pulmonary health.

Maspin, VEGF and p53 Expression in Small Biopsies of Primary Advanced Lung Cancer and Relationship with Clinicopathologic Parameters

Maspin, one of the serine protease inhibitors, has been shown to inhibit tumor progression and metastasis. We aimed to investigate maspin, p53 and VEGF expression in patients with squamous cell carcinoma (SCC), adenocarcinoma (AC) and small cell lung carcinoma (SCLC). The study included 28 SCC, 18AC, 17 SCLC biopsy samples. We used the streptavidin biotin immunoperoxidase method to test for maspin, p53 and VEGF antibodies. Medical records of these patients were reviewed from archival files. Cytoplasmic maspin expression was detected in 89.3%, 77.8%, 52.9% of SCC, AC and SCLC, respectively. The rate was significantly higher in non-small cell lung cancer (NSCLC) and SCC than SCLC (p = 0.013, p = 0.021, respectively). The mean percentages of maspin expression were significantly higher in NSCLC, SCC and AC than in SCLC (p = 0.0001, p = 0.0001, p = 0.038, respectively). In ACs, maspin and p53 expressions were correlated, although this was not statistically significant (p = 0.053, r = 0.464), and maspin positive cases had a significantly higher T status compared to negative cases (p = 0.036). In SCC, the stage of disease was positively correlated with p53 (p = 0.007, r = 0.536) and negatively correlated with VEGF expression (p = 0.013, r = −0.498). Multivariate analysis demonstrated that stage of disease was a significant independent prognostic parameter in NSCLC (95% confidence interval: 1.067–3.969; p = 0.031). Although maspin expression is higher in SCC and AC, and is related with higher T status in AC, our data did not indicate its prognostic significance. Larger scale studies are needed to reveal the exact role of maspin in lung cancer pathogenesis.

Observations on environmental asbestos exposure in a high risk area

Background and objective:  Environmental asbestos exposure is causally associated with various pulmonary pathologies. In Turkey, one of the most important sources of asbestos exposure is dust originating from the walls of homes whitewashed with white stucco. The main asbestos types implicated are tremolite and, to a lesser extent, chrysotile. This study investigated the presence and effect of environmental asbestos exposure in a small village in Isparta, Turkey.

Gastroesophageal scintigraphy in the evaluation of adult patients with chronic cough due to gastroesophageal reflux disease.

ObjectiveThe aim of this study was to evaluate the findings of gastroesophageal scintigraphy (GES) with late lung imaging in adult patients with chronic cough due to gastroesophageal reflux disease and a group of healthy participants. MethodsFifty-five patients with chronic cough with reflux symptoms, and a control group of 12 healthy participants were examined. All patients had reflux esophagitis documented by upper gastrointestinal endoscopy and histology. All participants underwent laryngoscopic examination and GES. The correlation between gastroesophageal reflux and several related variables was evaluated. ResultsOverall, 51 patients (92.7%) had positive GES findings for pathologic reflux; 19 (37.2%) of these patients had proximal reflux; and the remaining 32 (62.7%) had distal reflux. The frequency, duration, and percentage volume of gastric content of reflux episodes were significantly greater in patients with proximal reflux than in patients with distal reflux (P<0.0001). No statistically significant differences were seen between proximal reflux and distal reflux patients in terms of pulmonary function parameters, duration of cough, and reflux symptoms scores. However, severe grade (B and C) of esophagitis and the posterior laryngitis were more common in the patients with proximal reflux. Late lung imaging demonstrated evidence of pulmonary aspiration in only three of 51 (6%) patients. ConclusionOur study suggests that GES with late lung imaging objectively showed the presence of pathologic distal and/or proximal reflux, but rarely pulmonary aspiration, in the majority of chronic cough patients with gastroesophageal reflux disease. As the chronic cough patients with proximal reflux have more severe reflux characteristics, this examination may be effective in screening and following up these patients.

Is gastroesophageal reflux contribute to the development chronic cough by triggering pulmonary fibrosis.

BACKGROUND/AIMS Previous studies have shown that the prevalence of abnormal acid reflux in fibrotic lung disease patients is high, and in particular, patients with secondary pulmonary fibrosis show higher esophageal acid exposure than normal controls. There are also some findings that, in patients with pathological reflux, pulmonary fibrosis may develop. The aim of this study is to investigate if pulmonary fibrosis is involved in the pathogenesis of chronic cough due to Gastroesophageal Reflux. MATERIALS AND METHODS A prospective study was performed in twenty-one patients with chronic cough due to gastroesophageal reflux who was diagnosed as reflux esophagitis by upper gastrointestinal endoscopy, histology, and in ten healthy controls without GER or any lung disease. All participitants underwent laryngoscopic examination and gastroesophageal scintigraphy with late lung imaging. Bronchoalveolar lavage fluid total and differential cell counts, T and B cell subsets, and the concentrations of IL- 1β and TNF-α were measured. RESULTS Reflux extending into the proximal esophagus was noted in 52.5%, and posterior laryngitis was present in 90.5% of the patients. No evidence of pulmonary aspiration was noted in the patients with reflux on scintigraphic examination. No significant difference was found between the GER and control groups in terms of cellular content, IL-1β and TNF-α levels or mean T cell subsets and B cell counts in bronchoalveolar lavage fluid. Forced expiratory volume in one second, forced vital capacity FEV1/FVC, total lung capacity, and carbon monoxide diffusion capacity values were within normal limits in the gastroesophageal reflux group. CONCLUSION Our findings do not support the hypothesis that gastroesophageal reflux leads to chronic cough by triggering alveolar epithelial injury and subsequent pulmonary fibrosis.

Farklı Sistem Tümörlerini Takiben Gelişen İkinci Primer Akciğer Kanserlerinin Analizi

Aims and background: This study aimed to investigate clinical characteristics and prognosis of secondarily developed lung tumors in the cases having different system malignancy and to evaluate the relationship with the primary tumor. Methods: Thirty patients diagnosed as second primary lung cancer those admitted to have been included in the study. Results: The patients were grouped; synchronous group (n:7, 16.7%) and metachronous group (n:2, 83.3%). The age of primary malignancy and second primary lung malignancy was median 59.5 (range, 38-82 years), and 63 years (range, 39-83 years) respectively. The rate of quitting smoking among all patients before the diagnosis of lung cancer was 50%, current smoker rate was 30%. Second cancer was detected in 50% of the patients within the first 2.5 years. The most frequent primary localization was larynx (40%). Majority of patients received surgical treatment for primary localized carcinoma, while for secondarily developed carcinoma, the most frequent treatment choice was chemotherapy and/or best supportive care. There was no statistical relationship between the response to treatment of first cancer and the duration of cancer developed secondarily (p=0.36). The overall survival of groups was found 24 months (95% confidence interval: 18.30 months) and 12 months (95% confidence interval: 10-14 months) respectively for synchronous and metachronous groups. Conclusions: Close follow-up on pulmonary system especially within the first 2.5 years after primary disease and encouragement on quitting smoking is important.

Küçük hücreli dışı akciğer kanserinde cilt metastazı: Beş olgu sunumu ve literatürün gözden geçirilmesi

Suleyman Demirel Universitesi TIP FAKULTESI DERGISI: 2009 Mart; 16 (1) Kucuk hucreli disi akciger kanserinde cilt metastazi: Bes olgu sunumu ve literaturun gozden gecirilmesi Ahmet Bircan*, Şule Kaya*, Onder Ozturk*, Metin Ciris**, Necla Songur* Ozet Akciger kanseri olgularinda cilt metastazi diger organ tutulumlarindan daha nadir gorulmektedir ve bildirilen cilt metastazi insidansi cesitli serilerde % 1-12 arasindadir. Olgularin % 7-23,8.inde ilk bulgudur. Klinigimizde 2003-2007 yillari arasinda histopatolojik olarak tani alan 257 akciger kanserli olgudan 5.inde (% 1,94) cilt metastazi tespit edildi. Olgularin erkek/kadin orani: 4/1, ortanca yas: 64.tu (yas araligi, 55-80). Olgularin hepsinde primer tumor kucuk hucreli disi akciger kanseri idi. Bes olgunun 2.sinde primer tumorun histopatolojik alt tipi adenokanser ve epidermoid kanserdi. Olgularin 1.inde cilt metastazi akciger kanseri tanisindan 1 ay sonra saptandi. Tani aninda tum olgular yaygin metastatik hastaliga sahipti. Cilt metastazini takiben ortalama sag kalim 2,4 aydi. Cilt metastazlari, kanserin vucuttaki yayginliginin artmasiyla gorunur hale gelen lezyonlardir ve gerek kotu prognozun ve gerekse terminal donemin habercisidir. Bu nedenle, akciger kanseri oykusune sahip olsun ya da olmasin, sigara icen hastalarda yeni ortaya cikan cilt lezyonlarindan mutlaka eksizyonel biyopsi yapilmalidir. Anahtar kelimeler: akciger kanseri, cilt, metastaz, kucuk hucreli disi akciger kanseri Abstract Cutaneous metastases from non-small cell lung cancer: Report of five cases and review of the literature Metastasis to the skin from lung cancer is much rare than metastasis to other organs and the reported incidence of skin metastases from lung cancer varies from 1-12 %. It may manifest as an initial finding in 7-23.8 % of patients with lung cancer. Five cases are diagnosed as cutaneous metastasis among 257 patients with lung cancer (1.94 %) followed in our department in the period from 2003 to 2007. The male/female ratio was 4/1 and the median age was 64 years (range; 55-80 y). Primary tumor was diagnosed as nonsmall cell lung cancer in all cases. The histopathologic subtypes were the adenocancer and epidermoid cancer in two cases. In one of the patients, skin metastasis was detected after one month from the diagnosis of lung cancer. All patients had an advanced metastatic disease at the time of diagnosis. The mean survival time was 2.4 months after the diagnosis of skin metastasis. Skin metastasis becomes apparent with the progression of the cancer and it is a harbinger of the poor prognosis and the terminal stage of the disease. Therefore an excisional biopsy must be done from every new developed skin lesion in the smokers even if they had a history of lung cancer or not. Key words: lung cancer, skin, metastasis, non-small cell lung cancer

Contents Vol. 18, 2009

493 Abstracts of Award-Winning Posters, 14th Annual Health Sciences Poster Conference, Faculty of Medicine, Health Sciences Centre, Kuwait University, Kuwait, April 21–23, 2009 498 Abstracts of Theses Approved for the MSc and PhD Degrees at the Faculty of Medicine, Health Sciences Centre, Kuwait University, Kuwait 504 Announcement 505 List of Reviewers 507 Author Index Vol. 18, 2009 510 Subject Index Vol. 18, 2009