There is a subclinical activation of coagulation and fibrinolysis system in lung cancer. Alterations in hemostatic system are seen frequently in lung cancer correlated with the prognosis of disease. In this prospective study, our purpose was to investigate the prognostic significance of hemostatic markers in patients with lung cancer. The study comprised 58 patients (22 squamous cell carcinoma, 16 adenocarcinoma, 20 small cell carcinoma). There were 55 men (95%)and 3 women (5%) with a mean age of 61 years range (36-74). Plasma level of platelets (PLT), prothrombin time (PT), active partial thromboplastin time (aPTT), antithrombin III (AT III), fibrinogen (F) and D-dimer level were measured before the initiation of any therapy. Patients were followed up for 17 (12-20) months. The median survival was determined as 6.4 months. Three histopathologic groups; squamous cell carcinoma, adenocarcinoma and small cell carcinoma were compared for the hemostatic parameters. There were no statistically significant differences among the histopathologic types for any of the parameters (P > 0.05). Patients were divided into two groups as patients without distant metastasis (stages I,II,III) and with distant metastasis (stage IV). The group with distant metastasis had higher level of D-dimer than the other group (P < 0.05). However, there were no statistically significant differences for D-dimer level between stages IIIB and IV (P > 0.05). Patients having high D-dimer and low AT III level had poor survival in our study. Thus, high level of D-dimer and low AT III level were determined as correlated with short survival (P < 0.05). These results suggest that elevated plasma level of D-dimer and low AT III level might be a sign of poor prognosis in patients with lung cancer.

IGF-1 and IGFBP-3 levels both in serum and ELF might serve a clinical significance in patients with lung cancer. However, further studies comprising more cases are needed to investigate the clinical significance of IGF-1 and IGFBP-3 in lung cancer.

Localization of survivin expression might have an important regulatory mechanism in carcinogenesis and tumor progression. Nuclear survivin expression in tumor tissues might predict the prognosis in NSCLC, whereas cytoplasmic survivin has no prognostic significance.

A 43-year-old man presented with a 12-month history of recurrent haemoptysis. Postero-anterior chest X-ray of a patient with a history of a penetrating thoracic trauma 8 years previously showed a long wedge-shaped opacity just above the left hemidiaphragm, representing the 'tip of the knife' appearance, and penetrating from the lateral chest wall deep to the thoracic aorta. After consultation with the cardiovascular surgeons, it was decided that the patient should have an operation to remove the foreign body penetrating the aorta. During the operation, a piece of glass was located in the posterior segment of the left lower lobe, and it had also penetrated the aorta through to the posterior wall. The glass had a pointed end, was wedge-shaped and measured 8 cm x 3 cm x 0.5 cm. It was removed, and a 5-cm segment of aorta was replaced with dacron graft. Patients with penetrating chest trauma require routine chest X-rays as many will have a haemothorax, pneumothorax or a penetrating foreign body in the chest in the absence of clinical findings. Postero-anterior chest X-rays as well as lateral X-rays must be carefully and systematically examined for foreign bodies.

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