BackgroundFebrile neutropenia (FN) is a life-threatening condition that requires urgent management in the emergency department (ED). Recent progress in the treatment of neutropenic fever has underscored the importance of risk stratification. In this study, we aimed to determine independent factors for prediction of poor outcomes in patients with FN.Material/MethodsWe retrospectively evaluated 200 chemotherapy-induced febrile neutropenic patients who visited the ED. Upon arrival at the ED, clinical data, including sex, age, vital signs, underlying systemic diseases, laboratory test results, estimated GFR, blood cultures, CRP, radiologic examinations, and Multinational Association of Supportive Care in Cancer (MASCC) score of all febrile neutropenic patients were obtained. Outcomes were categorized as “poor” if serious complications during hospitalization, including death, occurred.ResultsThe platelet count <50 000 cells/mm3 (OR 3.90, 95% CI 1.62–9.43), pulmonary infiltration (OR 3.45, 95% CI 1.48–8.07), hypoproteinemia <6 g/dl (OR 3.30, 95% CI 1.27–8.56), respiratory rate >24/min (OR 8.75, 95% CI 2.18–35.13), and MASCC score <21 (OR 9.20, 95% CI 3.98–21.26) were determined as independent risk factors for the prediction of death. The platelet count <50 000 cells/mm3 (OR 3.93, 95% CI 1.42–10.92), serum CRP >50 mg/dl (OR 3.80, 95% CI 1.68–8.61), hypoproteinemia (OR 7.81, 95% CI 3.43–17.78), eGFR ≤90 ML/min/1.73 m2 (OR 3.06, 95% CI 1.13–8.26), and MASCC score <21 (OR 3.45, 95% CI 1.53–7.79) were determined as independent risk factors for the prediction of poor clinical outcomes of FN patients. Platelet count, protein level, respiratory rate, pulmonary infiltration, CRP, MASCC score, and eGFR were shown to have a significant association with outcome.ConclusionsThe results of our study may help emergency medicine physicians to prevent serious complications with proper use of simple independent risk factors besides MASCC score.

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Munchausen's syndrome is a psychiatric disorder in which patients inflict on themselves an illness or injury for the primary purpose of assuming the sick role. These patients can present with many different complaints and clinical symptoms including self-inflicted bleeding. This report describes a case of lately diagnosed Munchausen's syndrome who presented with hemoptysis and developed hematochezia and hematuria during the hospitalization period. Physicians should always consider this rare disorder in cases presented with bleeding symptoms of unknown origin.

AbstractIn rare cases, pseudomesotheliomatous tumors spread diffusely within the pleura to form an encasing mass, which may be confused with diffuse malignant mesothelioma (DMM). A 73-year-old male presented with chest pain, dyspnea and a significant loss of weight and appetite. His radiological and clinical features suggested DMM. However, immunohistochemical studies revealed a primary squamous cell cancer of the lung. To the best of our knowledge, this is the first case report of pseudomesotheliomatous primary squamous cell lung cancer in Turkey, and also the seventh case worldwide. The present report aims to present this case, along with a review of the medical literature.

CitationOner E, Unlu M, Cimen P, Kır P, Aygun Z. A rare treatment modality and its unusual complication: Pneumomediastinum and subcutaneous emphysema following argon plasma coagu- ABSTRACTArgon plasma coagulation (APC) is an effective non-contact electrosurgery tool and the use of APC in interventional pulmonology is relatively recent. Successful endobronchial APC has been described in debulking malignant airway tumors, controlling hemoptysis, removing granulation tissue from stents or anastomoses, and treating various benign airway disorders. Main complications related to APC are pneumomediastinum, subcutaneous emphysema, pneumothorax, airway fire, and burned bronchoscope. These complications are reported in less than 1% of the all cases. This report describes a case of very rare complication of APC (concomitant pneumomediastinum and subcutaneous emphysema) following an attempt to relief airway obstruction caused by a lung malignancy.