Primary Pulmonary Extranodal Marginal Zone Lymphoma/Low Grade B-cell Lymphoma of MALT Type Combined with Well-Differentiated Adenocarcinoma

We describe a rare case of extranodal marginal zone/low-grade B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) combined with areas of well-differentiated adenocarcinoma. In addition, the MALT lymphoma was synchronously systemic, with involvement of the lung, stomach and duodenum.

Association between disease-related factors and balance and falls among the elderly with COPD: a cross-sectional study

BACKGROUND AND AIMS

To investigate the relationship between disease-related factors and balance, and a history of falls in chronic obstructive pulmonary disease (COPD).

METHODS

Thirty-six patients with COPD and twenty healthy individuals were studied. Pulmonary function (pulmonary function test), hypoxemia (analysis of arterial blood gases), history of falls and tripping (number of falls and tripping in the past year), balance (Berg's Balance Scale-BBS), quadriceps femoris muscle strength (manual muscle test), and exercise capacity (6-minute walking test-6MWT) were assessed.

RESULTS

BBS scores were significantly different between groups (p=0.001). BBS scores, frequency of falls and tripping were correlated in COPD patients (p ≤ 0.01). BBS score and frequency of falls were correlated with dyspnea and peripheral oxygen saturation measured after the 6MWT, partial arterial oxygen pressure, and arterial oxygen saturation values in COPD patients (p<0.05).

CONCLUSIONS

According to our results, hypoxemia, dyspnea and fatigue are disease- related factors, which are related with balance impairment and falls in COPD patients. For this reason, we suggest that assessment of and training to improve balance impairment among the elderly with COPD should be a component of pulmonary rehabilitation programs in clinical practice.

Extrapulmonary involvement in patients with sarcoidosis in Turkey

BACKGROUND AND OBJECTIVE

Extrapulmonary sarcoidosis is common, and is almost always associated with concomitant thoracic involvement. Extrapulmonary manifestations vary on the basis of gender, age at presentation and ethnicity. The aim of this study was to investigate extrapulmonary involvement in patients with sarcoidosis in Turkey.

METHODS

This study was conducted by Turkish Thoracic Society Clinical Problems Study Group. New cases of sarcoidosis between 1 June 2004 and 31 May 2006 were recorded on electronic case record forms sent to all potential investigators and information about extrapulmonary involvement was collected.

RESULTS

One hundred and nineteen of 293 patients (83 female, 36 male, mean age = 45 ± 12 years) had extrapulmonary involvement in this study (40.6%). The median time to diagnosis was 6 months and this was longer than patients with just thoracic sarcoidosis (P = 0.001). Extrapulmonary symptoms were present in 181 (61.8%) patients, and skin lesions, arthralgia and back pain were the commonest (33.4%, 20.8% and 16.4%, respectively). Incidence of organ involvement was independent of age with the exception of ocular involvement, which was higher in those under the age of 40 years (P = 0.007).

CONCLUSIONS

Skin and peripheral lymph node involvement were the most common sites of extrapulmonary involvement and ocular involvement was more common in those under the age of 40 years in patients with sarcoidosis in a Turkish population.

Comparison of Short Form-36 Health Survey and Nottingham Health Profile in moderate to severe patients with COPD

OBJECTIVE

To compare the health-related quality of life (HRQoL) assessed by Short Form-36 Health Survey (SF-36) and Nottingham Health Profile (NHP) on the basis of lung function and exercise capacity parameters in patients with moderate to severe chronic obstructive pulmonary disease (COPD).

METHODS AND MATERIALS

The investigation was a prospective, quality-of-life survey and cross-sectional study of 130 consecutive COPD patients. The NHP and SF-36 as generic HRQoL instruments, the Chronic Respiratory Disease questionnaire (CRQ) as a disease-specific HRQoL instrument and 6-minute walking test, severity of dyspnea, leg fatigue and lung function, were the measurements and instruments used in the study.

RESULTS

It was determined that the subscales of both questionnaires were generally related with the FEV(1), walking distance, CRQ, severity of dyspnea and leg fatigue values (P<0.05). The much higher correlation coefficient was determined between these parameters and NHP compared with the SF-36. Only NHP was found to be correlated with the age, body mass index and smoking consumption (P<0.05).

CONCLUSIONS

The stronger relation of NHP with the clinical and physical parameters of the patients compared with that of SF-36 may be associated with the increased sensitivity of NHP to the clinical state owing to the increasing respiratory symptoms of our old patients with moderate to severe obstruction and/or the more intelligible and easy-to-respond nature of NHP compared with SF-36.

Survivin Expression in Non–small-cell Lung Carcinomas: Correlation With Apoptosis and Other Apoptosis-related Proteins, Clinicopathologic Prognostic Factors and Prognosis

The role of survivin that regulates the biological behavior of non-small-cell lung carcinoma (NSCLC) is still controversial. We aimed to investigate survivin expression in NSCLC and to define any correlation with expressions of p53, bcl-2, bax, apoptotic index (AI), tumor cell proliferation, clinicopathologic variables, and overall survival. Tumors of 63 patients with NSCLC were examined for expressions of survivin, p53, bcl-2, bax, and Ki-67 by immunohistochemistry. AI was also evaluated. Results for each antibody were correlated with each other, and with clinicopathologic variables including age, sex, histologic subtype, TNM (T: primary tumor, N: regional lymph node metastasis, M: distant metastasis) stage, lymph node status, smoking history, and prognosis. Nuclear survivin expression was inversely correlated with p53 expression (P = 0.04, r = - 0.367), and tumor stage (P = 0.03, r = - 0.273), and positively correlated with tumor cell proliferation (P = 0.009, r = 0.329). Cytoplasmic survivin expression positively correlated with smoking history (P = 0.02, r = 0.282). Survivin/bax ratio was inversely correlated with AI (r: - 0.004). By Kaplan-Meier analysis, TNM stage (P < or = 0.001), lymph node metastasis (P = 0.04), and Ki-67 index (P < or = 0.001) were associated with survival, whereas survivin was not. In multivariate analysis, only TNM stage was an independent predictor. Although survivin and other apoptosis-related protein expressions fail to predict the clinical outcome, the present findings suggest that survivin is involved in tumor cell apoptosis and proliferation and may play a role in critical steps of cancer progression in NSCLC.

Comparison of the Sit-to-Stand Test with 6 min walk test in patients with chronic obstructive pulmonary disease

OBJECTIVE

To discuss the utility of Sit-to-Stand Test (STST) compared to the 6min walking test (6MWT) for the evaluation of functional status in patients with chronic obstructive pulmonary disease (COPD).

MATERIAL-METHOD

SUBJECTS

Fifty-three patients with stable COPD (mean forced expiratory volume in 1s (FEV(1)) 46+/-9% predicted, mean age 71+/-12 year) and 15 healthy individuals (mean FEV(1) 101+/-13% predicted and mean age 63+/-8) were included.

INTERVENTIONS

Functional performance was evaluated by STST and 6MWT. During the tests, severity of dyspnea (by Modified Borg Scale), heart rate, pulsed oxygen saturation (SpO(2), by Modified Borg Scale) (by pulse oxymeter), blood pressure were measured. The pulmonary function (by spirometry), quadriceps femoris muscle strength (by manual muscle test) and quality of life (by Nottingham Health Profile Survey) were evaluated.

RESULTS

The STST and 6MWT results were lower in COPD group than the healthy group (P<0.05). During the 6MWT the rise in the heart rate, systolic blood pressure and the decrease in SpO(2) were statistically significant according to STST in COPD groups (P<0.05). The STST and 6MWT were strongly correlated with each other in both groups (P<0.05). Similarly, they were correlated with age, quality of life, peripheral muscle strength and dyspnea severity in COPD groups (P<0.05).

CONCLUSION

Similar to 6MWT, STST is also able to determine the functional state correctly. Additionally, it produces less hemodynamical stress compared to the 6MWT. In conclusion, STST can be used as an alternative of the 6MWT in patients with COPD.

Accuracy and feasibility of dynamic contrast-enhanced 3D MR imaging in the assessment of lung perfusion: comparison with Tc-99 MAA perfusion scintigraphy

AIM

The aim of this study was to correlate findings of perfusion magnetic resonance imaging (MRI) and perfusion scintigraphy in cases where there was a suspicion of abnormal pulmonary vasculature, and to evaluate the usefulness of MRI in the detection of perfusion deficits of the lung.

METHODS

In all, 17 patients with suspected abnormality of the pulmonary vasculature underwent dynamic contrast-enhanced MRI. T1-weighted 3D fast-field echo pulse sequences were obtained (TR/TE 3.3/1.58 ms; flip angle 30 degrees; slice thickness 12 to 15 mm). The dynamic study was acquired in the coronal plane following administration of 0.1 mmol/kg gadopentetate dimeglumine. A total of 8 to 10 sections repeated 20 to 25 times at intervals of 1s were performed. Perfusion lung scintigraphy was carried out a maximum of 48 h before the MR examination in all cases. Two radiologists, who were blinded to the clinical data and results of other imaging methods, reviewed all coronal sections. MR perfusion images were independently assessed in terms of segmental or lobar perfusion defects in the 85 lobes of the 17 individuals, and the findings were compared with the results of scintigraphy.

RESULTS

Of the 17 patients, 8 were found to have pulmonary emboli, 2 chronic obstructive pulmonary disease with emphysema, 2 bullous emphysema, 2 Takayasu arteritis and 1 had a hypoplastic pulmonary artery. Pulmonary perfusion was completely normal in 2 cases. In 35 lobes, perfusion defects were detected using both methods, in 4 with MR alone and in 9 only with scintigraphy. There was good agreement between MRI and scintigraphy findings (kappa=0.695).

CONCLUSION

Pulmonary perfusion MRI is a new alternative to scintigraphy in the evaluation of pulmonary perfusion for various lung disorders. In addition, this technique allows measurement and quantification of pulmonary perfusion abnormalities.

Arteriovenous malformations of the lung: diagnosis by thin-section HRCT and Cine-MRI

We report a case in which a solitary large and multiple group of small pulmonary arteriovenous malformations were demonstrated by computed tomography and magnetic resonance images that could aid diagnosis and therapeutic planning without the need for catheter angiography.

CT and MRI appearance of a fistula between the right and left main bronchus caused by tracheobronchial tuberculosis

Tuberculosis of the trachea and main bronchi is a relatively rare disease seen predominantly in elderly patients. We present a case of a fistula between the right and left main bronchus owing to tuberculosis. We describe the CT and MRI appearances.

Technetium-99m-tetrofosmin scintigraphy in pulmonary tuberculosis

Technetium-99m-tetrofosmin, an agent that is widely used in myocardial imaging, has been reported to accumulate in several types of malignancies, including lung tumors. Yet, there is limited knowledge about its role in imaging infection or inflammatory lesions. The aim of this study was to investigate the role of 99mTc-tetrofosmin scintigraphy in pulmonary tuberculosis in cases with active and inactive tuberculosis in comparison with radiological and microbiological findings.

METHODS

Twenty-seven patients with active pulmonary tuberculosis (APTB) and 6 patients with inactive pulmonary tuberculosis (IPTB), proven by sputum smears and cultures, were included in this study. Mean age of the group was 42.6+/-13 yr. Nine months after therapy, 99mTc-tetrofosmin scintigraphy was repeated in 6 patients with APTB to evaluate response to therapy. Ten-minute anterior and posterior chest images were acquired 20 and 60 min after the injection of 370 MBq (10 mCi) 99mTc-tetrofosmin. The images were evaluated both visually and semiquantitatively by two blinded nuclear medicine physicians. For semiquantitative evaluation, regions of interest (ROIs) were drawn over the lesion (L) and nonlesion areas (NL). The mean count values of ROIs were obtained and L/NL ratios were calculated.

RESULTS

According to the visual evaluations, 99mTc-tetrofosmin uptake was Grade (+) in 4 (15%) and Grade (++) in 23 (85%) patients with APTB. Technetium-99m-tetrofosmin uptake was negative in 5 patients with IPTB. Grade (+) 99mTc-tetrofosmin uptake was observed in only one inactive case. After therapy, there was no 99mTc-tetrofosmin uptake in 3 patients, which correlated well with chest radiography and clinical findings. In the other 2 patients, 99mTc-tetrofosmin uptake was slightly decreased when compared with a previous scan that correlated with radiological and clinical findings. In 1 patient with bilateral lung disease, 99mTc-tetrofosmin uptake decreased on the right lung lesions, whereas the left lung lesions persisted with no change. The mean early and delayed L/NL ratios of APTB were 1.53+/-0.22 and 1.45+/-0.21, respectively. Although 99mTc-tetrofosmin uptake in APTB lesions was more visually marked in early images than that in delayed images, there was no statistically significant difference between these two sets of images.

CONCLUSION

Technetium-99m-tetrofosmin scintigraphy showed increased uptake in APTB lesions related to disease activity. After treatment, 99mTc-tetrofosmin uptake disappeared or decreased, correlating well with radiological and clinical findings. Technetium-99m-tetrofosmin scintigraphy may have a complementary role in the assessment of APTB as well as in follow-up treatment.

The effects of theophylline on serum alprazolam levels

Theophylline and benzodiazepines are frequently combined in clinical practice. Because of a number of case reports about antagonism of benzodiazepine-induced sedation by theophylline, we investigated serum alprazolam levels in a convenient sample of pulmonary medicine inpatients receiving theophylline and no theophylline. One mg of alprazolam was given daily for seven days to 6 patients receiving theophylline and 7 patients not receiving theophylline treatment. On days 2 through 7, trough serum alprazolam levels were measured. On day 7, blood samples were collected before (0 hour), and at 3, 6, 9 and 12 hours after alprazolam administration. In patients receiving theophylline, serum trough alprazolam levels were significantly lower during each day of the study. In patients receiving no theophylline, serum alprazolam levels were in the therapeutic range, except for two patients who had high alprazolam levels. In this small study, serum alprazolam levels were found to be consistently below the therapeutic range in patients receiving chronic theophylline treatment. Previously reported antagonism of anxiolytic effects of benzodiazepines by theophylline is probably due to the lower serum benzodiazepine levels in these patients.

The importance of pulmonary function tests in adenotonsillectomy indications

Children who had undergone adenotonsillectomy for recurrent adenotonsillitis showing no signs of clinical or radiological obstructive manifestations were evaluated with pulmonary function tests before, and one month after the operation. In relation to the result obtained by function tests, 60% of 45 cases (27) had the findings of mild obstructive pulmonary disease whereby these findings were in transient character that vanished after the operation. The following parameters were measured and found that they were all increased, mean FVC from 82.22 +/- 6.82 to 93.11 +/- 7.81 (p < 0.01), mean PEF from 77.60 +/- 8.38 to 88.60 +/- 5.57 (P < 0.01), mean FEVI from 74.28 +/- 11.68 to 90.15 +/- 7.28 (p < 0.01), mean FEF 25 from 71.44 +/- 11.53 to 83.53 +/- 6.40 (p < 0.01), mean FEF 50 from 69.53 +/- 14.53 to 84.37 +/- 7.72 (p < 0.01), mean FEF 75 from 70.08 +/- 12.15 to 85.48 +/- 7.15 (p < 0.01). In conclusion, pulmonary function tests could reveal the obstructive effects of adenotonsillar hypertrophy with no clinical or radiological obstructive findings, and could be useful in surgical indications of adenotonsillar hypertrophy dur to recurrent infections in children.