Evaluation of the Relationship between FeNO and Clinical Risk Stratification for Early Mortality in Pulmonary Embolism

BACKGROUND

Pulmonary embolism (PE) is a common complication of deep vein thrombosis that causes high mortality and morbidity. This study aimed to determine the relationship between clinical risk scoring for early mortality and fractional exhaled nitric oxide (FeNO) in PE patients.

METHODS

The study included a total of 98 subjects, 68 patients diagnosed with PE in the emergency department, and 30 healthy controls. Patients with PE were grouped according to clinical scoring of early mortality risk as low (n = 20), moderate-low (n = 24), and moderate-high (n = 24) risk. FeNO levels were measured after diagnosis.

RESULTS

FeNO levels were significantly higher in patients with moderate-high risk PE compared to the other three groups and in those with moderate-low risk PE compared to the control group (p < 0.001 for all). Moderate to strong positive correlations were observed between FeNO level and mean pulmonary artery pressure (r = 0.818, p = 0.01), troponin-I (r = 0.67, p = 0.01), pro-BNP (r = 0.762, p = 0.01), and D-dimer levels (r = 0.652, p = 0.01). A FeNO cutoff value of 7.5 ppb had 84% sensitivity and 78% specificity in differentiating moderate-high risk PE from moderate-low risk PE.

CONCLUSIONS

FeNO may be as reliable, noninvasive, and easily accessible as cardiac biomarkers in clinical risk scoring for early mortality in PE patients.

Effect of atmospheric pressure changes on the development of pulmonary embolism: a retrospective analysis of 8 years of data

BACKGROUND

Pulmonary embolism (PE) is a condition with high mortality, and determining its etiology is as important as its treatment. There are limited studies in the literature examining the effect of atmospheric pressure (AP) change on PE.

OBJECTIVES

Analyze the effect of AP level and the change in AP level on the development of PE according to year, season and months.

DESIGN

Retrospective SETTING: Department of tertiary care center PATIENTS AND METHODS: Patients with diagnosed or presumed PE who were followed up in the Erzurum Atatürk University Medicine Chest Diseases Clinic between 2012 and 2020 (8 years) were retrospectively screened for inclusion in the study by examining hospital records. Daily AP values were obtained electronically through official correspondence with the Erzurum Regional Meteorological Directorate. Patients diagnosed with PE were recorded using the hospital database and anamnesis forms. The dates of admission to hospital were recorded. Risk factors leading to the development of PE were identified using the records.

MAIN OUTCOME MEASURES

Relationship between AP values and the incidence of PE.

SAMPLE SIZE

592 RESULTS: APmin, APmax, and APmean were significantly lower on days with PE cases compared to days without PE cases (P<.001 for all). ΔAPmin, ΔAPmax, and ΔAPmean values were all negative on days with PE, but only the difference in ΔAPmin was significant (P=.04).

CONCLUSIONS

This study showed that lower AP values were significantly associated with the incidence of PE. In particular, a drop in APmin compared to the previous day seemed to be most associated with PE development.

LIMITATIONS

Retrospective design and only applicable to region.

CONFLICT OF INTEREST

None.

Behçet's Disease: Different Systemic Manifestations at Different Ages

Behçet's disease, an inflammatory condition, can involve various systems. The disease usually manifests with dermatologic and ocular signs but can also cause serious symptoms due to pulmonary or neurologic involvement. Although the onset may occur at any age, it typically emerges in the second to fourth decades of life. As in the case presented here, Behçet's disease can manifest with the central nervous system involvement early in life and pulmonary involvement in adulthood.

Comparison of high-flow and conventional nasal cannula oxygen in patients undergoing endobronchial ultrasonography

BACKGROUND

Oxygen therapy is required to prevent hypoxaemia during the endobronchial ultrasonography (EBUS) procedure.

AIMS

To compare the effectiveness of oxygen therapy delivered through high-flow nasal cannula (HFNC) and conventional nasal cannula (CNC) in patients undergoing EBUS. The primary outcome was the proportion of patients who desaturated. Patient compliance and satisfaction were also evaluated.

METHODS

This single-centre prospective interventional study was conducted in a tertiary hospital among patients who presented to the EBUS unit in 2018 and 2019. Patients were randomly assigned to the HFNC group or the CNC group.

RESULTS

The study included 170 patients (111 men and 59 women) with a mean age of 58 ± 14 years. The number of patients experiencing desaturation while receiving oxygen was statistically significantly lower (P < 0.001) in the HFNC group (n = 5) compared with the CNC group (n = 26). Oxygen therapy was adjusted in two patients in the CNC group due to desaturation. Saturation was significantly higher in the HFNC group (P < 0.0001) at the end of the EBUS procedure. Heart rate at the end of EBUS was lower in the HFNC group, but this difference was not statistically significant (96 ± 16 vs 101 ± 19, P = 0.13). Five patients in the HFNC group and 18 patients in the CNC group reported discomfort during the procedure (P = 0.006).

CONCLUSION

Oxygen therapy delivered by HFNC seems to be safer and more effective than by CNC in patients undergoing EBUS. Oxygen therapy with HFNC may be considered as an alternative to CNC because it may increase patient comfort and thereby improve compliance.

The Protection Potential of Antioxidant Vitamins Against Acute Respiratory Distress Syndrome: a Rat Trial

Acute respiratory distress syndrome (ARDS) is a fatal disease that includes inflammation formed by septic and non-septic causes. Reactive oxygen radicals (ROS) play a key role in ARDS pathophysiology and constitute the base of damage process. Antioxidant vitamins are used for inhibiting hazardous effects of radicals. Therefore, effects of antioxidant vitamins such as α-lipoic acid (ALA), vitamin E (VITE), and C (VITC) were investigated on oleic acid (OA)-induced ARDS rat model. Furthermore, high and low dose of methylprednisolone (HDMP, LDMP) was used for comparing effects of the vitamins. In this study, 42 male rats were divided to seven groups named control, OA, ALA, VITE, VITC, LDMP, and HDMP. OA was intravenously administered to all groups except control group and other compounds were orally administered (ALA, VITE, and VITC: 100 mg/kg, LDMP: 5 mg/kg, HDMP: 50 mg/kg) after OA injections. OA increased MDA level in lung tissue and TNF-α and IL-1β cytokine levels in serum. ALA, VITE, VITC, and both dose of MP significantly decreased the cytokine levels. Although OA reduced SOD, CAT, and GSH levels in lung tissue, the vitamins and LDMP markedly enhanced the levels except for HDMP. Furthermore, OA showed thickening in bronchi and alveolar septum, hyperemia in vessels, and inflammatory cell infiltrations in lung tissue histopathological examinations. Antioxidant vitamins may be useful for premedication of ARDS and similar disorders. However, methylprednisolone was not found sufficient for being a therapeutic agent for ARDS.

Sulfasalazine-Induced Interstitial Fibrosis

Sulfasalazine has been used in the treatment of inflammatory bowel disease for over 60 years. Although the drug is frequently associated with gastrointestinal adverse effects, pulmonary adverse effects are very rare. Herein, we report a case of interstitial fibrosis resulting from 4-month sulfasalazine therapy for ulcerative colitis in a patient under long-term follow-up in our clinic due to chronic obstructive pulmonary disease.

Comparison of long-term outcomes of 50 and 100 mg rt-PA in the management of acute pulmonary thromboembolism

BACKGROUND

Pulmonary thromboembolism (PTE) is a life-threatening disease. In this study, we aimed to evaluate long-term outcomes of the use of 50 mg recombinant tissue-type plasminogen activator (rt-PA) in the management of PTE in terms of relapse, pulmonary hypertension (PH), mortality and hemorrhage and to compare with the use of 100 mg rt-PA.

METHODS

The study was designed as a retrospective cohort. Patients who were diagnosed as acute PTE and received either 50 or 100 mg rt-PA in a tertiary care hospital between 2010 and 2015 were included in the study. Rates of relapse, PH, mortality (in-hospital and long-term) and hemorrhage (major and minor) were calculated for each treatment group.

RESULTS

A total 117 patients, 73 females and 44 males, were evaluated. Eighty-three patients were administered 100 mg rt-PA, and 34 were administered 50 mg rt-PA. The mean age was lower in the 100 mg group compared to the 50 mg group (61 ± 15 vs 69 ± 14 years). There was a significant decrease in PH in each group at 3 months follow-up (P < .001). Although statistically nonsignificant, the relapse rate was lower in the 50 mg rt-PA group, but the 5-year mortality rate was higher in 50 mg rt-PA group (35.2% vs 27.7%, P = .50). Mortality was associated with older age and presence of malignancy.

CONCLUSIONS

Our results suggest that both doses of rt-PA have similar efficacy. The high mortality rate in the 50 mg group may have resulted from patient selection.

Assessment of Palliative Care in Lung Cancer in Turkey

OBJECTIVE

To investigate the symptoms of lung cancer in Turkey and to evaluate approaches to alleviate these symptoms.

SUBJECTS AND METHODS

This study included 1,245 lung cancer patients from 26 centers in Turkey. Demographic characteristics as well as information regarding the disease and treatments were obtained from medical records and patient interviews. Symptoms were evaluated using the Edmonton Symptom Assessment Scale (ESAS) and were graded on a scale between 0 and 10 points. Data were compared using the χ2, Student t, and Mann-Whitney U tests. Potential predictors of symptoms were analyzed using logistic regression analysis.

RESULTS

The most common symptom was tiredness (n = 1,002; 82.1%), followed by dyspnea (n = 845; 69.3%), appetite loss (n = 801; 65.7%), pain (n = 798; 65.4%), drowsiness (n = 742; 60.8%), anxiety (n = 704; 57.7%), depression (n = 623; 51.1%), and nausea (n = 557; 45.5%). Of the 1,245 patients, 590 (48.4%) had difficulty in initiating or maintaining sleep. The symptoms were more severe in stages III and IV. Logistic regression analysis indicated a clear association between demographic characteristics and symptom distress, as well as between symptom distress (except nausea) and well-being. Overall, 804 (65.4%) patients used analgesics, 630 (51.5%) received treatment for dyspnea, 242 (19.8%) used enteral/parenteral nutrition, 132 (10.8%) used appetite stimulants, and 129 (10.6%) used anxiolytics/antidepressants. Of the 799 patients who received analgesics, 173 (21.7%) reported that their symptoms were under control, and also those on other various treatment modalities (dyspnea: 78/627 [12.4%], appetite stimulant: 25/132 [18.9%], and anxiolytics/antidepressants: 25/129 [19.4%]) reported that their symptoms were controlled.

CONCLUSION

In this study, the symptoms progressed and became more severe in the advanced stages of lung cancer, and palliative treatment was insufficient in most of the patients in Turkey.

A comparison of two different culture methods for use in the diagnosis of pulmonary tuberculosis

OBJECTIVE

Tuberculosis (TB) continues to be a significant health problem worldwide. Pulmonary TB is a contagious disease. To control the spread of TB, the disease must be diagnosed early and treated effectively.

MATERIALS AND METHODS

In this study, we determined the rates and periods of TB bacterial reproduction using the Lowenstein-Jensen (LJ) and the Mycobacterium Growth Indicator Tube (MGIT) culture systems in respiratory specimens obtained from 105 suspected TB cases that applied to our service.

RESULTS

Using either the LJ or MGIT method, the reproduction rates of TB cultures from 91 positively diagnosed cases were determined to be 69.2% and 92.3% (p=0.116), respectively. The reproduction period for these same cultures was determined to be 29.7±10.0 days and 12.1±6.1 days (p<0.0001), respectively. The culture positivity rate determined using both the LJ and MGIT methods together was found to be significantly higher than the rate determined using either LJ or MGIT separately (p<0.0001).

CONCLUSION

For the early diagnosis of pulmonary tuberculosis, which is essential for controlling the spread of TB, the routine use of the MGIT system, which is a rapid, automated and non-radiometric method, combined with the LJ method would effectively increase the diagnosis rate in order to control tuberculosis outbreaks.

Smoking prevalance and the degree of nicotine dependence among healthcare workers at the ataturk university medical facility

OBJECTIVE

In this study, we aimed to investigate smoking prevalence and the degree of nicotine dependence in our hospital healthcare workers.

MATERIALS AND METHODS

This study was conducted between January 2008 and June 2008 in our hospital (Medical Facility of Atatürk University). A total of 691 (370 females, 321 males) subjects were included in this study. A questionnaire, including demographic findings, tobacco consumption information and the Fagerström nicotine dependence test, was distributed to healthcare workers and collected.

RESULTS

The questionnaire was answered by 691 health workers, 46.5% of whom were male, and 53.5% of whom were female. Overall, the rate of smoking was 36.9%; 48% of males and 27.6% of females were current smokers. When classified according to clinic, the greatest rate of smoking was in the psychiatry clinic (60.0%), and the lowest rate of smoking was in the ear, nose and throat (ENT) Clinic (0.0%). Thirty-four percent of nurses, 18.7% of doctors, 45.5% of officers, and 50.4% of ancillary staff were smokers. According to education level, 50% of the cases (smokers) graduated from primary school, 45% of the cases graduated from high school and 26.9% of the cases graduated from university. The major reason for the initiation of smoking was attention-seeking behavior. The age at smoking initiation was 7 to 20 years in 83.9% of cases and 21 to 35 years in the remaining 16.1%. Thirty-five percent of smokers had very low levels of dependence, while 11.9% had very high levels dependence. Ninety-two percent of cases indicated they would prefer to work at a smoke-free hospital. Ninety-five percent of cases would support making this facility a smoke-free hospital.

CONCLUSION

The smoking rate was 36.9% amongst our hospital health workers. Smoking prevalence was higher in males (48%) than females (27.6%). The greatest smoking rate was amongst ancillary staff. Ninety-five percent of healthcare workers were supportive of a law requiring hospitals to be smoke-free.

Is atmospheric pressure change an Independent risk factor for hemoptysis?

Objective: Hemoptysis is one of the most important and challenging symptoms in pulmonary medicine. Because of the increased number of patients with hemoptysis in certain periods of the year, we aimed to investigate whether atmospheric changes have an effect on the development of hemoptysis with or without a secondary cause.

Methods: The data of patients presenting with hemoptysis between January 2006 and December 2011 were analyzed. Data on the daily atmospheric pressure (hectopascal, hPa), relative humidity (%), and temperature (^o C) during that time were obtained.

Results: A total of 232 patients with hemoptysis, 145 male (62.5%) and 87 female (37.5%) with an average age of 48.1(±17.6), were admitted to our hospital between 2006 and 2011. The highest admission rates were in the spring season, the highest in May (n=37, 15.9%), and the lowest admission rates were in December (n=10, 4.3%). A statistically significant negative correlation was found between the number of hemoptysis cases and mean atmospheric pressure but no relative humidity or outdoor temperature.

Conclusion: Hemoptysis is very much influenced by weather factors; in particular, low atmospheric pressures significantly affect the development of hemoptysis. Fluctuations in atmospheric pressure may also play a role in hemoptysis.

Serum and bronchial aspiration fluid HE-4 levels in lung cancer

Human epididymis 4 (HE-4) protein has been proposed as a tumor marker for lung and ovarian cancer. This study was designed to measure HE-4 levels in bronchial aspiration fluid (BAF) of patients with lung cancer and to describe the relationship of BAF HE-4 with known systemic increase in serum HE-4 levels. Sixty-four patients with lung cancer, 38 with benign lung disease and 19 healthy subjects, were enrolled in our study. The BAF was obtained during routine bronchoscopic procedure in patient groups. HE-4 levels in serum and BAF were measured with the commercially available kit by an enzyme-linked immunosorbent assay. Serum HE-4 levels were significantly higher in patients with lung cancer group (204.2 ± 22.9 pmol/L) than in benign lung disease group (135 ± 26.9 pmol/L, p = 0.001) and healthy subjects (14.8 ± 7.0 pmol/L, p < 0.0001). No significant difference was observed in terms of BAF HE-4 values in two patient groups. BAF HE-4 levels were significantly higher than those of serum levels in both patient groups (p < 0.0001). Serum HE-4 level was correlated with tumor stage (p = 0.001) and age (p < 0.0001) in the lung cancer group. The areas under the receiver operating characteristic (ROC) curve of serum HE-4 was 0.784 (95 % confidence interval (CI), 0.701-0.867) and that of BAF HE-4 was 0.496 (95 % CI, 0.382-0.610). This study shows that a systemic increase in serum of HE-4 is more prominent than a local increase of HE-4 (BAF), so this may suggest the feasibility of using serum instead of BAF samples for HE-4 measurements in lung cancer cases.

Two different dosages of nebulized steroid versus parenteral steroid in the management of COPD exacerbations: a randomized control trial

BACKGROUND

The study aimed to compare the efficacy and safety of nebulized steroid (NS) with systemic corticosteroids (SC) and to determine optimal NS dose in the treatment of patients with COPD exacerbations requiring hospitalization.

MATERIAL AND METHODS

The study was a randomized, parallel design trial. Eligible patients (n=86) were randomly allocated to 1 of the 3 treatment groups: parenteral corticosteroid (PS) (n=33), 4 mg (NB) (n=27), or 8 mg NB (n=26). Partial pressure of arterial oxygen (PaO2), carbon dioxide (PaCO2), pH, and oxygen saturation (SaO2) were evaluated at baseline, 24 h, 48 h, and discharge. Airway obstruction (forced vital capacity [FVC] and forced expiratory volume 1 s [FEV1]) was evaluated at admission and discharge.

RESULTS

There were no significant differences between the groups for all parameters at all time periods, except for higher FEV1 value in the 8-mg NB group at baseline. In groups, significant differences were determined for FVC, FEV1, PaO2, and SaO2 (p<0.001), but not for PaCO2 and pH, in comparison to their baseline values. As adverse events, hyperglycemia and oral moniliasis were observed in the PS group (n=4) and in the NB groups (n=5), respectively, and treatment change was required in 9 patients (2 patients in the PS group and 7 patients in the NB groups) (p=0.57).

CONCLUSIONS

Nebulized budesonide may be used as an alternative to SC because of its equal effectiveness and lesser systemic adverse effects. The choice of optimal dosage needs to be evaluated carefully because adverse effect and dropout rates varied according to dosage. However, there is a need for further studies including more severe cases and evaluating long-term outcomes or relapses comparing the 3 arms.

Effectiveness of pharmacologic therapies on smoking cessation success: three years results of a smoking cessation clinic

BACKGROUND

Pharmacologic therapies have an important role in the success of interventions for smoking cessation. This study aims to determine the efficacy of several pharmacologic treatments in patients who applied to a smoking cessation clinic.

METHODS

This retrospective study includes 422 patients who presented to our smoking cessation clinic between January 2010 and June 2013, used the pharmacologic treatment as prescribed and completed the one-year follow-up period. All patients were assessed using the Fagerström Test for Nicotine Dependence (FTND) and received both behavioral therapy and pharmacotherapy. Patients' smoking status at one year was assessed by telephone interview.

RESULTS

The patients were 24.3% female (103/422) and 75.7% male (319/422) with a mean age of 38 ± 10 years. Patients were divided into three groups: varenicline (166 patients), bupropion (148 patients) and nicotine replacement therapy (108 patients).The smoking cessation rates of these groups were 32.5%, 23% and 52.8%, respectively, and were statistically significant (p > 0.001). The overall success rate was 35%. Further analysis revealed that pharmacologic therapy (p > 0.001) and gender (p = 0.01) were factors that showed statistically significant effects on smoking cessation rates. Males had higher success rates than females. The overall relapse rate was 21.6% and the bupropion group showed the highest relapse rate among treatment groups. Lack of determination emerged as the most important factor leading to relapse.

CONCLUSION

Nicotine replacement therapy was found to be more effective at promoting abstinence from smoking than other pharmacologic therapies.

Effectiveness of pharmacologic therapies on smoking cessation success: three years results of a smoking cessation clinic

Background: Pharmacologic therapies have an important role in the success of interventions for smoking cessation. This study aims to determine the efficacy of several pharmacologic treatments in patients who applied to a smoking cessation clinic. Methods: This retrospective study includes 422 patients who presented to our smoking cessation clinic between January 2010 and June 2013, used the pharmacologic treatment as prescribed and completed the one-year follow-up period. All patients were assessed using the Fagerström Test for Nicotine Dependence (FTND) and received both behavioral therapy and pharmacotherapy. Patients’ smoking status at one year was assessed by telephone interview. Results: The patients were 24.3% female (103/422) and 75.7% male (319/422) with a mean age of 38 ± 10 years. Patients were divided into three groups: varenicline (166 patients), bupropion (148 patients) and nicotine replacement therapy (108 patients).  The smoking cessation rates of these groups were 32.5%, 23% and 52.8%, respectively, and were statistically significant (p < 0.001). The overall success rate was 35%. Further analysis revealed that pharmacologic therapy (p < 0.001) and gender (p = 0.01) were factors that showed statistically significant effects on smoking cessation rates. Males had higher success rates than females. The overall relapse rate was 21.6% and the bupropion group showed the highest relapse rate among treatment groups. Lack of determination emerged as the most important factor leading to relapse. Conclusion: Nicotine replacement therapy was found to be more effective at promoting abstinence from smoking than other pharmacologic therapies.

The incidence and severity of pulmonary hypertension in obstructive sleep apnea with hypothyroidism

Background

Hypothyroidism and obstructive sleep apnea (OSA) are both common health problems and can be seen together. Each of these 2 diseases can cause pulmonary hypertension (PH). We aimed to determine whether hypothyroidism with OSA has a significant effect on the frequency and severity of PH.

Material/Methods

A total of 236 patients were included in the study. Patients were divided into 3 groups: Group I, Obstructive Sleep Apnea (n=149); Group II, Hypothyroidism (n=56); and Group III, Obstructive Sleep Apnea-Hypothyroidism (n=31). All patients underwent polysomnography and echocardiography and serum levels of thyroid-stimulating hormone (TSH) and free thyroxine 4 (FT₄) were analyzed.

Results

There were 167 male and 69 female participants, and the mean age was 47.8±11.5 (Group I: 81.9% male, 18.1% female; Group II: 44.6% male, 55.4% female; Group III: 64.6% male, 35.4% female). Distribution of mean pulmonary arterial pressure on echocardiography was statistically different among the 3 groups (x²=14.99, p=0.006). When adjusted according to the apnea-hypopnea index (AHI), age, and body mass index (BMI), a significant relation with PH was determined (p=0.002).

Conclusions

The combination of hypothyroidism with OSA is associated with an increased frequency and severity of PH. When PH is found out of line with the severity of OSA, thyroid dysfunction should be investigated.

Low-molecular-weight heparin use with thrombolysis: is it effective and safe? Ten years' clinical experience

BACKGROUND

There is no data on the use of subcutaneous low-molecular-weight heparin (SC LMWH) in cases that require thrombolysis.

OBJECTIVE

Having used SC LMWH with thrombolytics for more than 10 years, we aimed to review our data, share our experiences and find out whether the use of SC LMWH with thrombolytics had been effective and safe.

METHOD

This is a retrospective cohort study. Patients who were diagnosed as acute pulmonary embolism (PE) and received either SC LMWH treatment or SC LMWH with thrombolytics in our hospital (a tertiary hospital) between 2000 and 2010 were included in the study. For both treatments, the rates of mortality and complications were calculated.

RESULTS

A total of 392 patients, 210 female (53.5%) and 182 male (46.5%) with an average age of 60 years, ±16 SD, with acute PE, were included in the study. Of these patients, 107 (27.2%) were massive and 285 (72.8%) were nonmassive and were administered SC LMWH plus thrombolytics and only SC LMWH, respectively. The mortality rate was 16.8% (18 of 107) in patients who were massive and 3.5% (10 of 285) for those who were nonmassive (p < 0.001). Major hemorrhage occurred in 3.7% (n = 4) and 0.7% (n = 2) and minor hemorrhage in 12.1% (n = 13) and in 3.8% (n = 11) of the cases who received SC LMWH plus thrombolytics and SC LMWH, respectively.

CONCLUSION

SC LMWH use with thrombolytics seems to be feasible and safe. Prospective, large, randomized control trials are still required in order to confirm these results.

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.

Clinical value of detection of metastasis of carina in patients with non-small cell lung cancer

BACKGROUND

Although the utility of blind biopsy in the detection of metastasis in the carina has been reported, submucosal fine needle aspiration (SMFNA) has not been evaluated. We investigated how SMFNA of the main carina and upper-lobe carina in addition to blind biopsy affect management of patients with NSCLC.

METHODS

Thirty-five patients were evaluated. During fiberoptic bronchoscopy (FOB), five blind biopsy and three SMFNA specimens were collected from normal-appearing main carina (n = 35) and/or upper-lobe carina (n = 18). Subjects were staged for operability using traditional staging system, without knowing the blind biopsy or SMFNA results. Then, patients were staged again after results were made known.

RESULTS

Thirty-five NSCLC patients were analyzed. The management of 12 patients (34%) was changed according to our results. Out of the patients, 8, 5 and one had microscopic metastasis in the main carina, ipsilateral upper-lobe carina and both, respectively. Although SMFNA were more diagnostic compared to blind forceps biopsy, there was no statistically difference between them. These procedures increased the success of detection of microscopic metastasis and the results changed management of those cases.

CONCLUSION

SMFNA adds valuable information to blind biopsy, and their combination changed the management in one quarter of our NSCLC patients.

Serum IL-18 levels in tuberculosis: comparison with pneumonia, lung cancer and healthy controls

OBJECTIVE

The aim of the present study was to document the serum IL-18 levels in patients with pulmonary tuberculosis (P-TB), extrapulmonary tuberculosis (EP-TB), pneumonia, lung cancer and in healthy controls, and to investigate whether it may assist in the differential diagnosis of P-TB.

METHODOLOGY

A total of 116 patients were included in the study. The study population consisted of patients with P-TB, EP-TB, pneumonia and lung cancer and controls. P-TB patients were graded according to sputum positivity and extent of disease. Serum levels of IL-18 (ELISA) were compared between groups and with other clinical measures of disease.

RESULTS

Compared with the controls, all groups of patients had increased serum levels of IL-18. The highest mean concentration of IL-18 was observed in P-TB. Serum levels of IL-18 in the patients with P-TB correlated well with the extent of disease.

CONCLUSIONS

Although increased serum levels of IL-18 were not specific for TB, the increased levels may favour active TB in radiologically advanced disease where CXR findings are difficult to interpret, and sputum smears or cultures are not helpful.

Barometric Pressure and the Incidence of Pulmonary Embolism

OBJECTIVES

Reports in the literature suggest that weather changes may play a role in venous thrombotic disease. An increase in patients with pulmonary embolism (PE) during the spring season led us to investigate the relationship between atmospheric pressure (AP) and the incidence of PE, as diagnosed in most of the patients by helical CT angiography, and in the minority of patients by conventional pulmonary angiography and lung scanning.

METHODS

We retrospectively investigated the charts of 91 consecutive patients with a diagnosis of PE who were evaluated by the Department of Pulmonary Medicine between August 2000 and September 2004. We documented AP changes as recorded by the Erzurum Provincial Department of Meteorology. Of the 91 patients, the diagnosis of PE was made by helical CT angiography in 84 patients, isotope lung scan in 5 patients, and conventional pulmonary angiography in 2 patients.

RESULTS

More patients presented in the spring months (March, n = 15; April, n = 10; and May, n = 12) than during other seasons (p < 0.001). The frequency of PE was inversely related to general average AP (r = - 0.70; p < 0.01). When the average seasonal AP was correlated with the incidence of PE, however, the relationship was found to not be statistically significant (r = - 0.66; p = 0.34). There was no correlation between the severity of PE or mortality and AP.

CONCLUSIONS

The incidence of PE was significantly higher in the spring months, when AP was low. A regional study to capture all PE patients will need to be done to confirm our findings. Other meteorologic factors should be investigated regarding their effect on thromboembolic disease.

Usefulness of induced sputum and fibreoptic bronchoscopy specimens in the diagnosis of pulmonary tuberculosis

We investigated the diagnostic value of induced sputum (IS) and bronchial lavage (BL) specimens in patients with suspected pulmonary tuberculosis who had negative spontaneous sputum specimens or who were unable to produce sputum spontaneously. IS specimens and BL specimens obtained using flexible fibreoptic bronchoscopy from 55 patients were evaluated for the presence of acid-fast bacilli (AFB) and cultured for Mycobacterium tuberculosis. Positive results were found with IS smear in 23 patients, BL smear in 26 patients, and IS or BL culture in 42 patients. Culture of BL specimens had a higher sensitivity than IS or BL smears or culture of IS specimens. The highest sensitivity rate was obtained with a positive BL or IS culture (86%). For early diagnosis (a positive IS or BL smear), the sensitivity was 57%. IS has a higher sensitivity rate than spontaneous sputum for the detection of tuberculosis, and fibreoptic bronchoscopy is useful for the early diagnosis of tuberculosis when AFB are not detected in spontaneous or induced sputum specimens.

The prevalence of exercise-induced bronchoconstriction among symptomatic sportsmen

Exercise-induced bronchoconstriction (EIB) is a transient airflow obstruction that usually occurs 5 to 15 minutes after physical exertion. Although this condition is preventable, it is still underrecognized and affects the quality of life. The purpose of this study was to evaluate the prevalence of EIB, to find out whether self-reported symptoms were enough to establish the diagnosis of EIB and to define related symptoms and risk factors among symptomatic students of a Sports Academy in our city, which is situated at about 2,000 meters altitude and experiences a long winter period. A questionnaire was sent to students of the Sports Academy. After its evaluation, symptomatic students were invited to perform a pulmonary function test (PFT) before and after a six minute exercise test. Two hundred and seventy-seven students (205 males and 72 females, mean age: 20+/-4) from 12 different types of sport replied to the questionnaire. Of these subjects, 43% were symptomatic. Out of the 119 symptomatic students, 63 accepted our invitation. Three of them were excluded. After performing a six-minute exercise test, EIB was observed in 5 (8%) of them, whose symptoms were aggravated by cold weather. Our results suggest that EIB may be common among symptomatic sportsmen. Screening is important, since EIB could be prevented with appropriate diagnosis and treatment. Although respiratory symptoms during exercise may give important clues, only these symptoms are not sufficient to establish the diagnosis of EIB. Symptomatic patients should undergo further tests for EIB.

Mediastinal lymphadenopathy due to mycobacterial infection

Tuberculous lymphadenitis without pulmonary manifestation is an uncommon entity in developed countries, and the possibility of tuberculous infection is usually ignored in the differential diagnosis of lymphadenopathy. Therefore, appropriate treatment may be delayed. Paralysis of the recurrent laryngeal nerve caused by mediastinal lymphadenopathy due to tuberculosis is an extremely rare condition. In this paper, we present a patient who had vocal cord paralysis caused by tuberculous lymphadenopathy of the superior mediastinum. After anti-tuberculosis treatment, vocal cord function was only partially recovered, while the clinical, radiological, and laboratory abnormalities were completely recovered.

Color Doppler sonographically guided transthoracic needle aspiration of lung and mediastinal masses

OBJECTIVE

This study investigated the diagnostic value of color Doppler sonographically guided transthoracic needle aspiration in lung and mediastinal masses.

METHODS

B-mode and colorDoppler sonographic images were obtained in 48 patients with mediastinal or peripheral pulmonary tumors. Color Doppler sonography was used to show the vascular structures before the transthoracic needle aspiration procedure. It was also used to locate the needle tip during the procedure by showing the twinkling sign. This maneuver was performed with motion of the inner stylet. Pathologic and microbiological examination of the aspirates was made.

RESULTS

Vascular structures were detected in 37 cases on color Doppler images and in 10 cases on B-mode images. Similarly, the needle tip was observed in 39 cases on color Doppler images but in only 9 cases on B-mode images. No complications were observed except partial pneumothorax in 2 cases. The method had sensitivity of 90.0%, specificity of 87.5%, a positive predictive value of 97.2%, a negative predictive value of 63.6%, and diagnostic accuracy of 89.6%.

CONCLUSIONS

Color Doppler sonographically guided transthoracic needle aspiration is a safe diagnostic method in malignant lung tumors, especially peripheral tumors, because of its ability to differentiate vascular structures within a tumor before the transthoracic needle aspiration procedure. It provides additional information about the location of the needle tip.