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Öğe Effects of treatment regimens on survival in patients with malignant pleural mesothelioma.(2013) Abakay A.; Abakay O.; Tanrikulu A.C.; Sezgi C.; Sen H.; Kaya H.; Kucukoner M.In this study, we aimed to investigate the factors affecting the survival of patients with malignant pleural mesothelioma (MPM) according to their treatment regimens, including best supportive care (BSC), chemotherapy, surgical group and multimodality (MM) therapy. A retrospective analysis was performed on clinical data and treatment outcomes of 400 patients registered in our hospital with MPM between January 1989 and April 2010. Mean age (p < 0.001), presence of asbestos exposure (p = 0.0014), presence of smoking history (p < 0.001), Karnofsky performance status (p < 0.001), histological subtype (p = 0.034) and stage (p < 0.001) variables were found to be significantly different among the four treatment regimens. Mean survival time of all patients was 12.32 months. Mean survival time 10.5 months for the BSC group, 15.7 for the surgical group, 16.02 for the chemotherapy group, and 26.55 for the MM group. There were significant differences in mean survival time among the four treatment regimens. In addition, a significant difference was found in survival time between the two chemotherapy groups (p = 0.032). Mean survival time for cisplatin + gemcitabine was found to be 14.49 months and for cisplatin + pemetrexed, 18.34 months. The MM group had better survival rates than the other groups. The new chemotherapy combination, cisplatin + pemetrexed, can be helpful in improving survival time.Öğe Fibulin-3 as a diagnostic biomarker in patients with malignant mesothelioma(Asian Pacific Organization for Cancer Prevention, 2015) Kaya H.; Demir M.; Taylan M.; Sezgi C.; Tanrikulu A.C.; Yilmaz S.; Bayram M.Background: New tumour biomarkers are being intensely investigated for malignant mesothelioma (MM). Fibulin-3 is produced in MM but its role remains uncertain. The aim of this study was to evaluate the validity of measuring serum fibulin-3 in the diagnosis and prognosis of MM. Materials and Methods: This prospective study was performed on 43 patients and 40 healthy controls who were admitted to our hospital between January 2012 and January 2014. Data from MM patients, including demographic and clinical features, routine laboratory data, levels of serum fibulin-3, and treatment outcomes were defined as potential prognostic factors. The receiver operating characteristic (ROC) curve for fibulin-3 was used to detect the cut-off value with highest sensitivity and specificity. Univariate survival analysis was performed using the Kaplan-Meier method in patients with MM. Afterwards, the possible factors identified with univariate analyses were entered into the cox regression analysis. Results: Our results revealed that patients with MM had significantly higher serum levels of fibulin-3 than controls. The results showed that the best cut-off point was 36.6 ng/ml with an AUC (area under the curve)=0.976, sensitivity=93.0% and specificity=90.0. In our study, the initial significant poor prognostic factors were advanced stage, high white blood cell count, high platelet count, high C-reactive protein (p<0.05 for each variable). Later, according to multivariate analysis the results showed only advanced stage as significant parameter (p=0.040). Conclusions: We determined that real use for serum fibulin-3 was not for prognosis but for diagnosis in MM. Also advanced stage was associated with poor MM prognosis.Öğe An overview of thrombolytic treatment for pulmonary embolism: A single Centre experience(Acta Medica Mediterranea, 2014) Şen H.S.; Abakay Ö.; Sezgi C.; Yilmaz S.; Taylan M.; Kaya H.; Tanrikulu A.C.Introduction: A massive pulmonary embolism (MPE) has a poor prognosis and high mortality. Thrombolytic therapy is preferred in patients with life-threatening symptoms such as hypotension, cardiogenic shock, and right ventricular failure due to the risk of severe bleeding. Materials and methods: This is a retrospective analysis of patients who were hospitalized with the diagnosis of pulmonary embolism (PE) and given thrombolytic therapy in the chest diseases clinic of a tertiary university hospital between January 2008 and November 2013. Results: The subjects' mean age was 59.54 ± 13.76 years. Fourteen of 39 patients who were treated with thrombolytic therapy were male (35.89%) and 25 (64.10%) were female. The symptoms experienced by the patients included dyspnea in 39 patients, chest pain in 35 patients, hemoptysis in 6 patients, syncope in 13 patients and cough in 10 patients. Risk factors were advanced age (> 60 years) in 19, immobilization in 19, malignancy in 3, major surgery in 11 patients. The in-hospital mortality analysis showed that 32 patients were discharged and 7 patients died. Four patients died from their pulmonary embolism and 3 patients died because of a major bleeding complication. Conclusions: Pulmonary embolism is a disease that may lead to death within hours secondary to acute right heart failure. Early diagnosis and treatment can be life saving. Thrombolytic therapy has been shown to improve hemodynamic parameters in the early period post-PE. An increased risk of bleeding is one of the most important drawbacks of thrombolytic therapy. Nonetheless, it can be a life-saving therapy in properly selected patients.Öğe The predictive value of CRP, CEA, IL-6, IL-8, and TNF? in the diagnosis of malignant pleural effusions(2012) Sen H.S.; Abakay O.; Dalli A.; Sezgi C.; Abakay A.; Coskunsel M.Aim: In this study, we investigated the potential utility of some simple, rapid, biochemical tests that detect the tumor markers interleukin 6 (IL-6), interleukin 8 (IL-8), tumor necrosis factor alpha (TNF?), C reactive protein (CRP), and carcinoembryonic antigen (CEA) in diagnosing malignant pleural effusions (MPEs) in exudative pleural fluids. Material and Methods: The study included 70 patients who had exudative PEs. The presence of CRP, CEA, IL-6, IL-8, and TNF? were investigated in the patients' pleural fluids. The cases were grouped into a malignant pleural effusion (PE) group (n = 27) and a benign PE group (n = 43) according to their etiological diagnosis, and the median levels of CRP, CEA, IL-6, IL-8, and TNF? in the two groups were compared. Results: The levels of pleural fluid CEA and IL-6 were significantly higher in the malignant PE group compared with the benign PE group (p <0.01 and p = 0.002, respectively). A meaningful difference was not found between the median value of the pleural fluid CRP IL-8 and TNF? levels in the two groups (p >0.05). We used Roc curve analysis to determine the sensitivity and specificity of CEA as a marker of malignant pleural effusion. When the CEA cut-off point was 1 ng/ml, the sensitivity was found to be 85%, and the specificity was found to be 51%. When the CEA cutoff point was 17 ng/ml, the sensitivity was 29%, and the specificity was 97%. Conclusion: Although the number of cases in the study is low, our findings suggested that CEA and IL-6 may be useful in distinguishing whether exudative PEs are malignant or benign.Öğe Pulmonary findings in patients with fascioliasis(Acta Medica Mediterranea, 2013) Sezgi C.; Cicek M.; Sen H.S.; Kaya H.; Taylan M.; Abakay A.; Abakay O.Aim: Fasciola hepatica (FH) is sporadically found in the humans and causes disease by involving the bile ducts. However, it is rarely localized ectopically in the lungs; typical and atypical involvement of lung have been shown. The aim of this study is to investigate pulmonary findings for clinical, radiologic and laboratory in patients with fascioliasis. Materials and methods: All patients included in this study were diagnosed with fascioliasis. Diagnosis of fascioliasis was made by IgG antibody detection with ELISA, detection of parasite eggs with stool examination, radiologic images and clinical findings and laboratory parameters. Diseases involving in the differential diagnosis of lung involvement were individually evaluated when an abnormality was detected on chest radiography. Additional biochemical and microbiologic tests were performed. Thoracic computed tomography (CT), fiberoptic bronchoscopy and thoracentesis were performed. When other diseases were eliminated, the patient was diagnosed with fascioliasis. Results: Lung involvement was detected in 3 out of 56 patients (5.35%). The most prominent symptoms were right hypochondrial pain, chest pain, cough and dyspnea. Hepatomegaly and pulmonary rales were the most common physical examination findings. On radiologic imaging of the lung, ground-glass densities were detected in one patient, infiltration in one and pleural effusion was detected in the other. Conclusion: Although Fasciola hepatica may only affect the lungs rarely, the presence of respiratory symptoms and physical examination findings in the acute period of diagnosis should suggest lung abnormality.Öğe Spinal tuberculosis: A retrospective chart review(Acta Medica Mediterranea, 2014) Sezgi C.; Taylan M.; Kaya H.; Sen H.S.; Abakay O.; Bulut M.; Abakay A.Aims: Background and objectives: This study aimed to investigate the clinical characteristics, diagnostic methods, and therapeutic outcomes in patients with spinal tuberculosis (TB) in Southeastern Turkey Methods: Patients diagnosed with spinal TB at Dicle University Hospital, Diyarbakir, Turkey, between October 2005 to December 2010 were enrolled in the study retrospectively. Patients were evaluated for the following: Clinical presentation, underlying diseases, laboratory results, imaging findings, medical therapies, and treatment outcomes Results: A total of 23 patients including 14 men and 9 women with spinal TB, also known as Pott's disease, were enrolled. The study subjects' ages ranged from 17 to 69 years with a mean age of 38.4 years. Patients most often presented with back pain (69.5%, n=16) and fever (56.5%, n=13), and the most frequent physical finding was spinal tenderness (91.3%). Only 17.4% of the patients demonstrated neurological deficits and no paraplegia was observed. The time interval between onset of symptoms and treatment initiation was 3.2 months. Of all the patients, 47.8% exhibited Pott's disease in the thoracolumbar region while 34.8% only had thoracic involvement. On average, 2.5 vertebrae were diseased in this cohort. Furthermore, 82.6% of the patients had paraspinal and psoas abscesses. All patients were treated with anti-TB therapy. However, 26.1% required additional surgery, and one patient with miliary TB died. The mean treatment course lasted for 12.3 months. Conclusions: It may be possible to refine methods of spinal TB detection and diagnosis by studying thoracolumbar pathology in young adults with Pott's disease in endemic countries such as Turkey. By studying the clinical progression of this disease, the delay between symptom onset and diagnosis may be decreased so that complications such as paraplegia and surgical interventions are avoided.
