Diagnosis: Adenocarcinoma (epithelial type malignant mesothelioma?) - US

A 32-year-old man presented to a physician with cough and phlegm symptoms in early August 1988. He was initially diagnosed as having bronchitis, and was prescribed antibiotics. However, the symptoms persisted, and a lung x-ray was taken when he started to experience pain in the right chest. The radiograph showed fluid in the right pleural space, and the patient was referred to Yedikule Chest Diseases Hospital on 6 September 1988. Another x-ray was taken there on 7 September 1988 ( Appendix US1 ). Biopsy was performed, and histopathological examination of the specimen at Istanbul University Pathology Department revealed the diagnosis as adenocarcinoma (or epithelial type malignant mesothelioma) ( Appendices US2 and US3 ). A CAT scan performed on 14 September 1988 demonstrated pleural effusion, collapse in the lover lobe, and fibro-nodular changes in all lobes in the right hemi-thorax ( Appendix US4 ). The patient's disease was stated to be inoperable, and was recommended to refer to an oncology clinic ( Appendix US2 ). However, the patient declined the chemotherapy proposal.

The patient presented to Dr. Ozel on 29 September 1988. On physical examination, there were dullness and pain on the lower half of the right hemi-thorax, and no breathing sound could be heard in the same region. The body temperature was 36.5° C, and the arterial pressure was 120/70 mm Hg. 0.3 cc dose of NOI caused the body temperature to rise to 38.2° C and the patient was recommended to receive N.O. treatment with 0.3cc of NOI to be given daily, six days per week. He was advised to adjust the dosage according to daily maximum body temperatures.

The patient came for a follow up on 3 December 1988. He had with him a roentgenogram taken on 28 November ( Appendix US5 ) that showed a decrease in the amount of the fluid in the right hemi-thorax. The patient's general condition had improved, his pain had lessened. He was recommended to continue the N.O. treatment.

The patient came to Dr. Ozel again on 15 April 1989. His general condition was excellent. A recently taken x-ray (of which the copy is unavailable) showed some sequel, and no sign of any disease in the left hemi-thorax. NOI injections were causing no more rise in body temperature. The patient was placed on a maintenance treatment with 0.3 cc of NOI to be given every two days.

He presented to Dr. Ozel on 15 October 1989 with an x-ray taken the previous day ( Appendix US6 ). The roentgenogram showed some sequel, no disease. He was recommended to end the N.O. treatment, to come intermittently for follow up.

Follow up roentgenographs taken on 24 November 1989 ( Appendix US7 ), 21 June 1990 ( Appendix US8 ), 28 May 1991 ( Appendix US9 ), and CAT scan performed on 31 August 2002 ( Appendix US10 ) demonstrated remission.

He visited Dr. Ozel on 2 June 2006. He had no medical complaints.