Turgut Teke

RISK FACTORS FOR POSTOPERATIVE PULMONARY COMPLICATIONS IN UPPER ABDOMINAL SURGERY

Background:  Pulmonary complications are the most frequent cause of postoperative morbidity and mortality in upper abdominal surgery (UAS). We aimed to examine the influence of possible preoperative, operative and postoperative risk factors on the development of early postoperative pulmonary complications (POPC) after UAS.

The relation between Lp-PLA2 levels with periodic limb movements

ObjectiveLipoprotein-associated phospholipase A2 (Lp-PLA2), a novel marker of vulnerable plaque to prone rupture, is a predictor of both cardiovascular event and cerebrovascular event, and highly sensitive-C-reactive protein (hs-CRP) is an acute-phase response protein implicated in a broad range of cardiovascular diseases. We aimed to examine the association between periodic limb movements in sleep (PLMs) with circulating Lp-PLA2 and hs-CRP levels in patients with PLMs.MethodsSeventy patients with newly diagnosed PLM with polysomnography were enrolled this study. Patients were divided into two groups according to PLM index (normal PLM index, <15; elevated PLM index, ≥15). Lp-PLA2 and hs-CRP concentrations were measured in serum samples by turbidimetric and nephelometric methods, respectively. The concentrations of these parameters were compared between two groups and correlation analysis was performed between PLMs and Lp-PLA2 and hs-CRP levels.ResultsLp-PLA2 levels and hs-CRP were significantly increased in elevated PLM index group compared with the control group (206.8 ± 78.1 vs 157.8 ± 56.7, p = 0.003, and 4.2 ± 3.5 vs 2.4 ± 2.1, p = 0.02, respectively). PLM index was positively correlated with Lp-PLA2 levels (r = 0.40, p = 0.001) and hs-CRP (r = 0.24, p = 0.05). In the linear regression model, Lp-PLA2 was an independent predictor of PLM index (R2 = 0.36, p = 0.005).ConclusionThis study demonstrated an independent linear relation between PLM index and Lp-PLA2. In addition, it was seen increased Lp-PLA2 and hs-CRP levels in patients with elevated PLM index. Based on these results, we can suggest that risk of vascular events may be increased in patients with PLMs and with increased PLM index.

Myasthenia gravis with acute respiratory failure in the emergency department

Acute respiratory failure (ARF) is defined as a sudden malfunction in the ability of respiratory system to maintain adequate gas exchange. Acute hypercapnic respiratory failure develops as a result of ventilation deficiency and it is defined as an increase of PaCO2 above 45 mmHg. Myasthenia Gravis (MG) is a sporadically developing auto-immune deficiency where the neuro-muscular transmission is affected and it is one of the important reasons for neurologically-induced respiratory distress. Here, we report a case of a 75-year-old male patient previously undiagnosed MG, who presented with ARF. MG is not a common entity that we encounter daily. Patients on occasions may present to the emergency department because of acute exacerbation. Though most of them were known cases, we should be aware of some unrecognized cases and should consider MG as a differential diagnosis for patients with acute respiratory failure.

Assessment of Palliative Care in Lung Cancer in Turkey

Objective: To investigate the symptoms of lung cancer in Turkey and to evaluate approaches to alleviate these symptoms. Subjects and Methods: This study included 1,245 lung cancer patients from 26 centers in Turkey. Demographic characteristics as well as information regarding the disease and treatments were obtained from medical records and patient interviews. Symptoms were evaluated using the Edmonton Symptom Assessment Scale (ESAS) and were graded on a scale between 0 and 10 points. Data were compared using the χ2, Student t, and Mann-Whitney U tests. Potential predictors of symptoms were analyzed using logistic regression analysis. Results: The most common symptom was tiredness (n = 1,002; 82.1%), followed by dyspnea (n = 845; 69.3%), appetite loss (n = 801; 65.7%), pain (n = 798; 65.4%), drowsiness (n = 742; 60.8%), anxiety (n = 704; 57.7%), depression (n = 623; 51.1%), and nausea (n = 557; 45.5%). Of the 1,245 patients, 590 (48.4%) had difficulty in initiating or maintaining sleep. The symptoms were more severe in stages III and IV. Logistic regression analysis indicated a clear association between demographic characteristics and symptom distress, as well as between symptom distress (except nausea) and well-being. Overall, 804 (65.4%) patients used analgesics, 630 (51.5%) received treatment for dyspnea, 242 (19.8%) used enteral/parenteral nutrition, 132 (10.8%) used appetite stimulants, and 129 (10.6%) used anxiolytics/antidepressants. Of the 799 patients who received analgesics, 173 (21.7%) reported that their symptoms were under control, and also those on other various treatment modalities (dyspnea: 78/627 [12.4%], appetite stimulant: 25/132 [18.9%], and anxiolytics/antidepressants: 25/129 [19.4%]) reported that their symptoms were controlled. Conclusion: In this study, the symptoms progressed and became more severe in the advanced stages of lung cancer, and palliative treatment was insufficient in most of the patients in Turkey.

Gluteal region muscle metastasis from squamous cell lung carcinoma

Lung cancer is known as a disease leading to metastases to all types of organs. Although covering a large part of the body and of much blood building-up, skeletal muscles are rare metastatic areas. In autopsies, less than 1% of malignant cancers that are spread hematogenously is known to lead to metastasis. A 51-yearold male patient diagnosed with squamous cell lung cancer and known to be in regression via screening after the administration of 32-day curative radiotheraphy and 6-cycle chemotherapy, the patient was radiologically followed-up. Four months later, he was admitted to outpatient clinic with the complaint of left hip pain. Magnetic resonance imaging revealed a lesion of nodular, necrotic metastatic mass within left gluteus muscles. As a result of tru-cut biopsy performed for the solid lesion, metastasis of carcinoma was detected. As also in our case, metastatic muscle disease should be suspected in patients with muscle pain.

A case report of primary tuberculosis of the tongue

At present, the rate of extrapulmonary tuberculosis is gradually increasing among all tuberculosis cases. The secondary tuberculosis of oral cavity represents 0.2-1.5% of all cases with extrapulmonary tuberculosis. Although incidence of oral lesions secondary to pulmonary tuberculosis ranges from 0.4% to 1.5%, primary tuberculosis of the tongue occurs very rare, and it is published only as isolated case reports. A male patient presented to our dermatology clinic with complaints of painful ulcerated white plaques on the tip of his tongue lasting for three months, and an excisional biopsy showed granulomatous inflammation with caseification necrosis. Pulmonary and systemic examination showed no evidence of pulmonary or other extra-pulmonary tuberculosis, and he was initiated therapy for diagnosis of primary tuberculosis of the tongue. We found that the lesion completely resolved during the follow up visit after 1 month. Primary tuberculosis of the tongue should be for differential diagnosis of resistant painful oral lesions.