Aim of the studyVascular endothelial growth factor (VEGF) is one of the parameters that has been studied in differential diagnosis of malignant fluids. This study is aimed at evaluate applicability of serum, fluid VEGF level and fluid to serum VEGF ratio in the diagnosis of malignant pleural mesothelioma (MPM).Material and methodsThe patients with pleural effusion over age of 18, between 2011 and 2015 were included in the study. They were divided into three groups: group 1 – mesothelioma patients; group 2 – other malignancies; and group 3 – benign aetiologies. Group 1 and 2 were termed as the malignant group. Fluid, serum VEGF levels, and the ratio of fluid/serum VEGF level were studied to evaluate the fluid/serum VEGF ratio in all groups.ResultsTwenty cases with mesothelioma, 44 cases with other malignancies, and 20 cases with benign aetiologies were included in this study. No statistically significant difference was found according to serum VEGF levels for all groups, (group 1: 437 ±324 pg/ml, group 2: 354 ±223 pg/ml, group 3: 373 ±217 pg/ml, p = 0.836), while fluid VEGF levels showed a statistically significant difference (group 1: 3359 ±700 pg/ml, group 2: 2175 ±435 pg/ml, group 3: 1092 ±435 pg/ml, p = 0.041). The ratio of fluid to serum VEGF levels showed a difference, at the significance limit, between the malignant (group 1 and group 2) and benign (group 3) groups (8.83 ±1.29 vs. 4.57 ±1.07, p = 0.059) but showed a statistically significant difference between the mesothelioma and benign groups (12.11 ±1.68 vs. 4.57 ±1.07, p = 0.044).ConclusionsThe VEGF fluid/serum ratio may be an applicable parameter in the differential diagnosis of malignant fluids, especially MPM.

Objectives: Malignant Pleural Mesothelioma (MPM) is a poor prognosis cancer that affects pleura. This study was designed for examination of the differences between MPM patients which who were received only supportive treatment and supportive treatment plus pleurodesis. Materials and methods: The files of 96 MPM patients were analyzed retrospectively who were followed up in Dicle University Medical Faculty Hospital. Age, gender, exposure of asbestos, diagnostic methods, histopatho-logical types and treatment regimens were recorded. Results: The mean age of 96 MPM patients were 60.4 ± 12.6 years. The sixty-three (65.6%) patients were male and 33 (34.4%) were female. A total 75 (78.1%) patients have environmental asbestos exposure and mean environmental asbestos exposure time was 33 years. The epithelial type of pleural mesothelioma was determined in 63 patients. Pleural fluid cytology was positive in 30 patients. The most detected symptom was dyspnea which was determined in 91 cases. Thirty patients were taken only supportive treatment and 66 were taken supportive treatment plus pleurodesis. The median survival time was 10 months in the total of the two groups. Median survival was 10.7 months, in the group that treated with pleurode-sis and 9.1 months in the group that not treated with pleurodesis. However, this difference was not statistically significant (p = 0.35). Conclusions: Malignant pleural mesothelioma is an aggressive form of cancer which is resistant to many therapeutic options. Progressive dyspnea is primary symptom in these patients and often depends on the pleural fluid. Pleurodesis is an option to control the fluid. However, there is not any contribution on survival, alone. Extensive investigations are needed on this topic. ÖZET Amaç: Malign Plevral Mezotelyoma (MPM) plevrayı tutan ve kötü prognozlu bir kanser türüdür. Bu çalışma, sadece destek tedavisi alan ve destek tedavisi ile birlikte plöredez uygulanan MPM hastaları arasındaki farkları inceleme amaçlı planlandı. Gereç ve yöntem: Dicle Üniversitesi Tıp Fakültesi Has-tanesinde takip edilen 96 MPM hastasının dosyası retros-pektif olarak incelendi. Yaş, cinsiyet, asbest teması, tanı yöntemleri, histopatolojik tip ve tedavi rejimleri verileri kaydedildi. Bulgular: Toplam 96 MPM hastasının yaş ortalaması 60,4 ± 12,6 yıldı. Altmış üç hasta erkek (% 65,6) ve 33 hasta kadındı (% 34,4). Toplam 75 (% 78,1) hastada çev-resel asbest teması vardı ve ortalama çevresel asbest te-ması süresi 33 yıldı. Toplam 63 (% 65,6) hastada epitelyal tip MPM saptandı. Plevral sıvı sitolojisi 30 hastada pozi-tif saptandı. En sık saptanan semptom 91 hastada olan nefes darlığıydı. Bu hastalardan otuzu sadece destek tedavisi almışken 66 hastaya destek tedavisi ile birlikte plöredez uygulanmıştı. Her iki grubun toplamında ortala-ma sağkalım süresi yaklaşık 10 aydı. Plöredez uygulanan grupta ortalama sağkalım 10,7 ay iken uygulanmayan grupta ise 9,1 ay idi. Fakat bu fark istatistiksel olarak an-lamlı bulunmadı (p= 0,35). Sonuç: Malign Plevral Mezotelyoma, bir çok tedavi seçe-neğ...

ÖZETPulmoner langerhans hücreli histiyositozis (PLHH), etyolojisi bilinmeyen ve sigara içenlerde görülen, nadir bir interstisyel akciğer hastalığıdır. Hastalıkta genellikle izole akciğer tutulumu vardır ve santral sinir sistemi tutulumu nadirdir. Bu olgu sunumunda, birinde takip, diğerinde ise tanı sırasında santral diabetes insipidus (Dİ) saptanan iki olgu sunulmaktadır. Olgular, yaşları sıra-sıyla 24 ve 39 olan, sigara içme öyküsü olan erkek hastalardı. İki olgunun da yüksek rezolüsyonlu bilgisayarlı tomografilerinde (YRBT) yaygın kistik lezyonlar izlenmiş olup, video-yardımlı torakoskopik cerrahiyle (VATS) alınan biyopsilerinde PLHH saptandı. Takipte solunum fonksiyonlarının bozulmuş olduğu görülen birinci olguya 0,5 mg/kg metil prednisolon başlandı. Bir ay sonra yapılan kontrolde PLHH için kısmi düzelme gözlenmesi üzerine tedavi 6 aya uzatıldı, tedavi bitiminde tam remisyon saptanarak steroid tedavisi kesildi. İki hastaya da Dİ için oral 0,1 mg/gün desmopressin başlandı, bir ay sonra tam klinik düzelme gözlendi.Anah tar kelimeler: Histiyositozis X, pulmoner Langerhan hücreli histiyositozis, diabetes insipidus ABST RACTPulmonary Langerhans' cell histiocytosis (PLCH) is an uncommon interstitial lung disease with an unknown etiology in smokers. Disease is usually seen with isolated lung involvement and central nervous system involvement is rare.Two PLCH cases, with central diabetes insipidus (DI) determined at diagnosis in one of the cases and during follow-up in the other, is being presented in this report. The patients' ages were 39 and 24, respectively and they were both male patients with a history of smoking. Widely cystic lesions were viewed at high-resolution computed tomography scans (HRCT) and PLCH was detected at the biopsies obtained by video-assisted thoracoscopic surgery (VATS), in both two cases. Therapy was started with 0.5 mg/kg methyl prednisolone for latter case, because of impairment in pulmonary function tests during follow up. On control, after one month therapy, partial improvement was seen for PLCH and the therapy was continued up to 6 months. At the end of the therapy complete remission was seen and corticotherapy was stopped. Desmopressin was started for both cases at 0.1 mg/day, orally. After one month of treatment clinical improvement was observed during control.

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Aim: Miliary tuberculosis (MTB) is a serious and rare form of tuberculosis. Studies comparatively reviewed children and adults with MTB are lacking.Methods: We retrospectively evaluated 56 pediatric and 26 adult MTB patients at a university hospital, between 1990 and 2003Results: The median age at presentation was 3.5 years for children and 38 years for adults. Thirtyeight of all patients of whom 86.8% were children had family history of tuberculosis Presenting symptoms and signs of adult and pediatric patients were loss of weight (51.8% vs. 61.5%), anorexia (76.9% vs. 57.8%), dyspnea (12.5% vs. 57.8%), diarrhea/vomiting (35.0% vs. 27.0%), fever (53.8% vs. 17.9%), hepatomegaly (30.8% vs. 51.8%), pulmonary crepitations (42.3% vs. 42.9) and cough (46.2% vs. 35.7%), respectively. The presenting symptoms/signs and laboratory abnormalities were generally more frequent in adults. Detected laboratory abnormalities were leukocytosis (73.2%), increased sedimentation rate (73.2%), anemia (52.4%), hypoalbuminemia (47.6%), elevated liver transaminases (36.6%), elevated lactate dehydrogenase (50.0%) and hyponatremia (25.6%) in whole study group. The diagnosis was proven microbiologically in 15 (18.3%) patients. Among 56 pediatric cases, there were 8 (14.3%) children with positive BCG scar and only 16 (28.6%) children with positive reaction to 5TU tuberculin test. Radiological findings of all patients, either on chest X-ray or high resolution computerized tomography, were characteristic for MTB. One fourth of patients had accompanying tuberculous meningitis. Predisposing factors for TB were found in 13 patients (15.9%). No patients had HIV infection. Overall 6 (7.3%) patients had died.Conclusion: High rate of history of family contact and low rate of BCG vaccination in our patients with MTB were significant public health problems. Identifying different features in children and adults may contribute to early diagnosis of MTB, which is highly relevant to its outcome.