Search

Purpose: The treatment of Pulmonary Embolism (PE) which is a life-threatening disease must be planned considering the risk-benefit relationship. In this study, patients with PE given thrombolytic therapy, low-molecular-weight heparin, and warfarin were monitored for 5 years to compare them in terms of hemorrhage side effects due to therapy. Method: A total of 219 patients were included in the study. 50.2% (n=109) of the patient’s were female and 49.8% (n=110) were male, (p=0.20). Clinical findings, radiologic and laboratory parameters, treatments and side effects were recorded. A total of 121 (55.25%) patients were given thrombolytic therapy (Group 1 n=121). Enoxaparin therapy was given to 205 patients (Group 2). During therapy maintenance, warfarin therapy was conducted for 159 patients (Group 3). Results: Cerebral hemorrhage observed in 1 case (0.83%) in group 1, 2 case (0.98%) in group 2 and 1 cases (0.62%) in group 3 (p>0.05). Gastrointestinal system (GI) bleeding happened 2 cases (1.65%) in group 1 and 2 cases (0.98%) in group 2 (p>0.05). Minor bleeding was observed at similar rates due to the treatments. There was no fatality due to hemorrhage. There is no significant difference in terms of death, recurrence, residual chronic thrombus, and chronic PE in the follow-up for five years between the rt-PA group (group1) and non-rt-PA group (p>0.05). Conclusion: According to our results; major hemorrhage was observed similarly in thrombolytic, enoxaparin, and warfarin therapy. Study results about the rate of cerebral hemorrhage related to thrombolytic therapy were low in contrast to the results reported in the literature before.

Introduction The risk of tuberculosis is higher in cases who have used antiTNF treatments. However, it is not clearly known whether there is a relationship between other biologic agents and the risk of developing tuberculosis or not. We aimed to investigate the prevalence of active tuberculosis among patients with rheumatic disease treated with biologic drugs. Materials and methods The study was performed at a tertiary referral center from January 2015 to December 2019. A total of 2000 patients with rheumatic diseases were screened and 461 patients were enrolled in the study due to regular records. They were underwent LTBI screening tests and were followedup at least 1 year after TNF inhibitor treatment initiation. Result The median age of all patients was 48 (min-max: 19-80). 283 patients (61.3%) were female and 178 (38.7%) were male. The most common diseases were ankylosing spondylitis (67.2%), rheumatoid arthritis (26%) and psoriatic arthritis (5.2%). Anti-TNF treatments were given to 85.2% of all cases and other biologic treatments were given to 14.8%. Tuberculin skin test was applied to 429 patients and 70.4% positivity was found. Quantiferon-TB test was applied to 93 patients and 20.4% positivity was found. 320 patients were treated for LTBI due to positive tuberculin skin test and/or positive quantiferon-TB test. TB was developed in only one patient out of 393 patients who were treated with anti-TNF treatments and the the prevalence of TB development was found 255/100.000. Conclusions The incidence of tuberculosis was quite low in our patients with rheumatic disease who were receiving anti-TNF treatment compared to previous studies. Also, in patients who were using other biological treatments, no TB cases were developed.

Among the various clinical scoring methods used for the prediagnosis of pulmonary embolism (PE), Wells criteria is the most common. It relies on the findings and story of deep venous thrombosis (DVT), PE and malignancy. It is known that atrial fibrillation (AF) is a risk factor for PE like as DVT or malignancy. We aimed to evaluate the possibility of diagnosing more patients with PE by including AF in the Wells criteria. This prospective study included 250 patients admitted to the emergency department with PE findings. Wells scoring and Wells scoring with AF were performed for each patient. Out of 250 patients, 165 patients were diagnosed as PE. Wells score was >4 in 61.8% of patients with PE and 28.2% of patients without PE. Out of false negative 63 patients with PE, 21 of them had AF. According to Wells scoring with AF the score of 148 (89.7%) patients with PE diagnosis was ≥3, whereas the score of 45 (52.9%) patients without PE was ≥3. AF was detected in 15.8% of patients with PE. The sensitivity of Wells score with AF was significantly higher than that of the Wells score (p

Behcet's disease is a chronic inflammatory multi-systemic vasculitis. Recurrent oral and genital aphthous ulcers, uveitis, arthritis, arterial aneurysms, venous thrombosis, gastrointestinal system lesions and skin lesions can be seen. Large, medium or small arteries and veins may be involved. While venous lesions cause occlusion, arterial lesions can cause both occlusion and aneurysm. Major forms of pulmonary involvement include pulmonary artery aneurysm, arterial and venous thrombosis, pulmonary infarction, recurrent pneumonia, and pleurisy. In Behcet's disease, pulmonary thromboembolism (PE) is often associated with endothelial damage. Neutrophils play an important role in the pathogenesis of thrombosis. Coagulation components such as fibrinogen, thrombin, factor Xa and factor VIIa activate the inflammatory cascade and induce vascular events. It is important to understand the pathogenesis of vascular events in determining the effective treatment strategy. Here we present a patient with Behcet's disease who was presented with pulmonary embolism and was investigated for the etiology of thrombosis.

Objectives: To compare dynamic thiol/disulfide homeostasis between patients with community-acquired pneumonia (CAP) and healthy controls. Methods : This prospective, case-control study was conducted in the Department of Pulmonary Diseases, Ankara Ataturk Training and Research Hospital, Yildirim Beyazit University, Ankara, Turkey, between August 2016 and August 2017. In total, 50 hospitalized patients with CAP and 35 healthy individuals were enrolled. Patients with comorbidities and smokers were excluded. The thiol/disulfide state was evaluated in each group. Thiol levels (native/total) and % polymorhonuclear leukocytes and C-reactive protein levels association were evaluated in patients with CAP. Results : There was no significant difference between the CAP and control groups in age or gender (both, p greater than 0.05). The disulfide (SS) levels were similar between the 2 groups ( p= 0.148). The total thiol (TT) and native thiol (SH) levels were significantly lower (all, p= 0.001) and the SS/TT levels were significantly higher ( p= 0.019) in the CAP group compared with the controls. Conclusions : This study showed that the oxidant/antioxidant ratio was shifted to the oxidative side in CAP patients. An abnormal thiol/disulfide state may be an important factor in the pathogenesis and monitoring the treatment response. The thiol resources may use for treatment in CAP and may positively affect the prognosis. Saudi Med J 2018; Vol. 39 (5): 495-499 doi: 10.15537/smj.2018.5.22111 How to cite this article: Parlak ES, Alisik M, Hezer H, Karalezli A, Hasanoglu HC, Erel O. Evaluation of dynamic thiol/disulfide redox state in community-acquired pneumonia. Saudi Med J . 2018 May;39(5):495-499. doi: 10.15537/smj.2018.5.22111.

Objective: To investigate the relationship between serum values of magnesium and the parameters of the pulmonary function tests (PFT) in patients with chronic asthma. Subjects and Methods: This study recruited 50 patients with chronic stable asthma and 40 healthy individuals as a control group. Data on age, sex, severity of asthma, PFT, and details of drug therapy were obtained from each group. Serum magnesium, potassium, phosphorus, calcium, and sodium levels were also measured. To evaluate differences between groups, the Student t test or Mann-Whitney U test was performed for continuous variables, and the χ2 test for categorical variables. Results: In the asthma group, 10% (n = 9) of the patients had hypomagnesemia and 5.5% (n = 5) had hypophosphatemia. Patients with asthma were divided into two groups: the hypomagnesemic group (n = 9) and the normomagnesemic group (n = 41). Forced expiratory volume in 1 s (FEV1), FEV1%, peak expiratory flow (PEF), and PEF% were lower in the hypomagnesemic group than in the normomagnesemic group (p = 0.02). Multiple logistic regression analysis revealed a statistically significant association between hypomagnesemia and PFT in the hypomagnesemic asthmatic group. The correlations of age with FEV1, FEV1%, PEF, and PEF% were as follows: p = 0.00, r = 0.29; p = 0.00, r = 0.43; p = 0.03, r = 0.22; p = 0.00, r = 0.38; and p = 0.03, r = 0.22, respectively. The correlation of serum magnesium levels with PFT (FEV1, FEV1%, PEF, PEF%) were as follows: p = 0.001, r = 0.29; p = 0.001, r = 0.43; p = 0.03, r = 0.22; and p = 0.001, r = 0.38, respectively. The other electrolytes were within the normal range in both groups. Conclusion: In this study, hypomagnesemia and hypophosphatemia were found to be the most common electrolyte abnormalities in patients with chronic stable asthma. FEV1, FEV1%, PEF, and PEF% were significantly lower in asthmatic patients with hypomagnesemia compared to asthmatic patients with normomagnesemia.

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Angiotensin converting enzyme inhibitors (ACEi) can increase ACE2 in human tissues and increase the adhesion of Sars-CoV-2. In our study, we aimed to investigate the relationship between serum ACE level with antihypertensive drugs (especially ACEi) and clinical severity. METHODS: A total of 200 symptomatic Sars-CoV-2 patients who were hospitalized or diagnosed in an outpatient clinic were included in the study. The patients were divided into 4 groups as mild, moderate, severe and very severe. There were 43 patients in the mild, 54 patients in the moderate, 53 patients in the severe, and 50 patients in the very severe patient group. Later, 200 patients were divided into 2 groups as mild-moderate (n:97) and severe-very severe patient group (n:103). Serum ACE, complete blood count, C-reactive protein (CRP), procalcitonin and biochemical analysis were evaluated. The demographic data, comorbidities, medications and symptoms of the patients were recorded. RESULTS: The mean age of mild, moderate, severe and very severe patients was 50.4±21.51, 57.13±14.81, 64.34±13.02, 74.88±11.18 respectively (p

Recombinant tissue plasminogen activator (rt-PA) is the most commonly used thrombolytic agent in patients with high risk and intermediate to high mortality risk acute pulmonary embolism (PE). Clinical trials have shown early efficacy and safety of low-dose rt-PA. This study investigated the effects of low-dose rt-PA treatment on acute PE in long-term prognosis, recurrence of pulmonary thromboembolism, or the development of late complications. In this study, 48 patients undergoing low-dose rt-PA for the relative contraindications of thrombolytic therapy and 48 patients undergoing standard-dose therapy were evaluated retrospectively. Long-term follow-up investigated the chronic PE, recurrence, and causes of morbidity and mortality. In both treatment groups, embolism-induced mortality and overall mortality rates were similar in the first 30 days (p=1.000, p=0.714, respectively). Overall mortality rates in long-term follow-up were 41.7% in the low-dose treatment group and 16.7% in the standard-dose treatment group (p=0.013). The mortality rate at the first year was higher in the low-dose-treated group (p=0.011) and most of the deaths were due to accompanying comorbidities. There was no difference in PE recurrence and duration of recurrence between the groups (p=0.598, p=0.073, respectively). Intracranial hemorrhage due to therapy developed in one patient in both groups. Low-dose thrombolytic therapy in acute PE reduces PE-related mortality in the early period. Long-term follow-up showed that thrombolytic therapy did not affect mortality rates independently of the dose and PE recurrence.

Nitrofurantoin is an antimicrobial agent commonly used for urinary tract infections. This drug may cause pulmonary toxicities, the manifestations of which range from acute self-limiting reactions to chronic pathologies. Here, we report the case of a 72-year-old male who was admitted with progressive cough and dyspnea for 4 months. On physical examination, his respiratory rate was 26/min and oxygen saturation was 84% at rest while breathing room air. Chest examination revealed bilaterally fine crackles. His thorax computed tomography showed bilateral widespread ground-glass opacities and interlobular and intralobular septal thickening. His blood test revealed antinuclear antibody positivity. He had been using nitrofurantoin for a long time for urinary tract infection. He had a high score on Naranjo Adverse Drug Reaction Probability Scale. When he was a diagnosed, he had a respiratory failure due to lung damage. Patients using nitrofurantoin should be followed up closely for drug toxicity.

Aim: Clinical features in sarcoidosis are very variable and can present with numerous phenotypes depending on organ involvements, clinical onset (acute, subacute, and chronic) and response to therapy. In this study, we aimed to evaluate the clinical findings, diagnostic methods and treatments of patients with sarcoidosis by 10-years data in our hospital in Turkey.Materials and Methods: The study was carried out between January 2018 and January 2019. The patients were screened retrospectively from the hospital information system. Clinical details were collected using a structured data collection form.Results: 172 patients were included in our study. 122 (70.9%) were female and 50 (29.1%) were male. The mean age at diagnosis was50.18 ± 13.73 years in all patients, while female patients’ mean age was 52.86 ± 13.06, male patients’ was 43.66 ± 13.24 (p

We present 2 cases of pulmonary thromboembolism (PTE). The first case, a 50-year-old man, was admitted to the emergency department because of sudden onset dyspnea and left side chest pain. He was diagnosed with intermediate-risk (submassive) PTE, and thrombolytic treatment was commenced. The patient fully recovered, but 5 days later, he was diagnosed with a new, high-risk PTE. The second patient, a 23-year-old woman, presented with syncope, dyspnea, and chest pain for 2 days. She was diagnosed with high-risk (massive) PTE. Thrombolytic treatment was commenced, and the patient fully recovered, too. But the later patient was also diagnosed with a new PTE 4 days later. We applied repeated thrombolytic treatment in the patients due to repeated PTE. The first patient fully recovered and was discharged from the hospital, but the second patient died because of gastrointestinal bleeding and renal insufficiency. A repeated thrombolytic treatment could be an alternative treatment for these patients, considering treatment's risks.

Background/aim: Exhaled CO level provides an objective measure of a patient's smoking status. The relationship between CO levels and nicotine dependence is controversial. The aim of this study is to evaluate the relationship between exhaled CO levels and nicotine dependence as well as to demonstrate that exhaled CO levels may be used as a marker of nicotine dependence. Materials and methods: Two hundred eighty-nine patients (132 females, 157 males) were included in the study. Smoking duration, the age of smoking initiation, exhaled CO levels, and Fagerström Test for Nicotine Dependence (FTND) scores were recorded. The relationship between FTND scores and exhaled CO levels was investigated. Results: There was a statistically significant correlation between FTND score and exhaled CO levels (P < 0.001). We found that a cut-off score of 7.5 ppm for exhaled CO may be useful as a marker for heavy smoking. The sensitivity and specificity of this cut-off score for exhaled CO was 69.3% and 49.3%, respectively (P < 0.001). Conclusion: We found that exhaled CO levels significantly correlated with FTND scores. For patients who are unable to provide reliable answers to questions in the FTND, exhaled CO measurements may be used as an alternative test for estimating the status of heavy smoking.

Objective: To identify the etiologic and demographic features of uveitis cases admitted to the Ankara Ataturk Education and Research Hospital in Turkey and to determine the frequency of lung disease in these cases. Materials and Methods: The records of 140 uveitis cases followed up in our hospital were retrospectively examined. The patients underwent systemic and complete ophthalmologic examinations. Laboratory and radiological examinations were performed for the etiology of uveitis. The age and sex of the patients, anatomic localization, and the etiology of uveitis were evaluated. Results: The mean age±standard deviation of 140 patients included in the study was 39.6±14.9 years. The proportion of fe- male/male was 61 (43.6%)/79 (56.4%). The cases were put into 4 groups according to their anatomical localizations: anterior uveitis (48.6%; n=68), posterior uveitis (28.6%; n=40), panuveitis (31.1%; n=31), and intermediate uveitis (0.7%; n=1). Idio- pathic uveitis accounted for the majority of all cases (n=69, 49.3%). Behcet's disease was the second most common diagnosis (n=41, 29.3%), followed by uveitis associated with sarcoidosis (n=8, 5.7%). Anterior uveitis was the most common anatomical localization (n=68, 48.6%) and posterior uveitis followed it (n=40, 28.6%). Conclusion: The etiologic distribution of uveitis varies with the geographical location. The most frequently seen form of uveitis in our clinic is idiopathic. Among diseases leading to uveitis and primarily affecting the lung, Behcet's disease comes first and it is followed by sarcoidosis.

Objective: To evaluate serum copeptin levels in acute pulmonary embolism (APE) patients and healthy controls and to determine the role of the serum copeptin level in the diagnosis and severity of APE. Methods: This prospective, case-control study was conducted in the Department of Chest Diseases. Fifty patients newly diagnosed with pulmonary embolism and 39 healthy individuals were enrolled. The diagnosis of APE was confirmed by computed tomography angiography. Copeptin levels were evaluated in both groups. All APE patients were evaluated with echocardiography to identify right ventricular dysfunction and to measure the pulmonary artery systolic pressure (PASP). Patients with APE were classified according to the risk of early mortality. The correlation between early mortality risk and PASP and copeptin levels was evaluated in patients with APE. Results: There was no significant difference between the APE and control groups in age or gender (both, p>0.05), and serum copeptin levels were similar between the two groups (p=0.309). The relationship between serum copeptin levels and early mortality risk and PASP in the APE group was also evaluated. There was no correlation between early mortality risk and serum copeptin levels and PASP. Conclusion: The serum copeptin level, which is an important prognostic marker for cardiovascular diseases, may not be a suitable biomarker for APE.

Radiation-induced lung diseases are common after radiotherapy of the chest wall or intrathoracic organs. The damage of radiations is ground-glass opacity, consolidation, fibrosis, traction bron chiectasis, and volume loss. Development of pleural fluid or a new mass is rarely seen. A solid lesion was detected in the computed thoracic tomography of 53 year-old male patient. The lesion was at the apex of the right lung, 66x61 mm in size and invading the trachea, esophagus and right subclavian artery. Weekly chemotherapy and radiotherapy were applied concurrently, and the tumor was quickly disappeared, leaving its place to an unexpected cavitary lesion. The case has been reported because of its rarity in the literature.

Background: Thrombolytic therapy is considered to be the most effective treatment for high risk/life-threatening PE, and could also be effective for some intermediate risk PE with right ventricular dysfunction and/or myocardial. In this study, we aimed to evaluate the long-term efficacy and safety of half-dose recombinant tissue plasminogen activator (rt-PA) in PE treatment. Materials and Methods: 96 patients with the diagnosis of massive or submassive PE, who had thrombolytic therapy were evaluated retrospectively. 46 patients who were treated with 50 mg/1 hour (h) rt-PA were included in the study group. In the control group, 46 patients who treated with 100mg/2 h intravenous infusion of rt-PA were included. All patients were evaluated for radiological findings, echocardiographic changes, PE recurrence, chronic PE, and all-cause mortality. Result: There were no significant differences between the groups in terms of demographic data, the type of embolism, average symptom durations, initial systolic pulmonary artery pressures (sPAP) and oxygen saturation values, D-Dimer and troponin (p> 0.05). There was no difference between groups in terms of mortality rates in the first month and after the first year of treatment (p = 0.384, p = 1.000, respectively). Fifth year survival rates were similar between the groups (p> 0.05). Conclusion: It is considered that with half-dose treatment and reduced bleeding complications and also with sharing data that is indicating the same efficacy, the optimal therapeutic dose may change in the future.

Background: Endothelial damage and dysfunction are risk factors for venous thromboembolism and are strongly associated with increased oxidative stress and inflammation. Objectives: The aim of this prospective case–control study is to evaluate relationship between dynamic thiol/disulfide homeostasis and high-density lipoprotein cholesterol (HDL-C) levels in both patients with pulmonary embolism (PE) and healthy control. Methods: This study enrolled 45 patients newly diagnosed with PE and 39 healthy individuals. The diagnosis of PE was confirmed by spiral computed tomography. In both groups, the thiol/disulfide status and plasma HDL-C levels were evaluated. Results: There was no significant difference between the PE and control groups in age or gender (both p>0.05). The disulfide (SS) levels were similar between the two groups (p=0.340). The total thiol, native thiol (SH), and HDL-C levels were significantly lower (all p=0.001), and the SS/SH levels were significantly higher (p=0.009), in the PE group compared with the controls. We also evaluated the HDL-C and thiol/disulfide status parameters in the PE group. Correlation analysis showed a significant positive correlation between HDL-C and the native and total thiol measurements and a significant negative correlation between HDL-C and SH/SS. Conclusion: This study showed that the oxidative/antioxidative balance shifted towards the oxidative side in PE. Abnormal thiol/disulfide status and lower HDL-C levels may be important factors in the pathogenesis of PE.

Background: Oxidative stress and environmental oxidants resulting from oxidant/antioxidant imbalance play an important role in respiratory tract diseases and inflammation. Objectives: The aim of this prospective case–control study is to evaluate dynamic thiol/disulfide homeostasis relationship between patients with community-acquired pneumonia (CAP) and healthy control. Methods: This study enrolled 38 patients with CAP and 35 healthy individuals. The patients with comorbidies and smokers were excluded. In both groups, the thiol/disulfide status levels were evaluated. Results: There was no significant difference between the pneumonia and control groups in age or gender (both p>0.05). The disulfide (SS) levels were similar between in the two groups (p=0,066). The total thiol, native thiol (SH), SS/SH levels were significantly lower in the CAP group compared with the controls (respectively; p=0,001; p=0,001; p=0,028). We also evaluated the pneumonia severity index (PSI) and thiol/disulfide status parameters in the CAP group. Correlation analysis showed a significant negative correlation between PSI and the native and total thiol measurements (respectively; r=-0,341, p=0,036; r=-335, p=0,40). Conclusion: This study showed that the oxidative/antioxidative balance shifted to the oxidative side in the CAP. Abnormal thiol/disulfide status may be an important factor in the pathogenesis of the CAP.

The optimal treatment approach of haemodynamically stable patients with acute pulmonary embolism (PE) remains controversial. Absence of RV dilatation or the ratio of RVD/LVD ( [Med-Science 2020; 9(4.000): 939-49]

Cardiac sarcoidosis is an infiltrative, granulomatous inflammatory disease of the myocardium. Generally, it can be difficult to diagnose cardiac sarcoidosis clinically because of the non-specific nature of its clinical manifestations. This property can be based on the presence of any clinical evidence of sarcoidosis in the other organs. We present two cases of cardiac sarcoidosis so as to demonstrate its different clinical manifestations. The first patient displayed no cardiac symptoms; the electrocardiogram showed an incidental right bundle branch block. Her cardiac magnetic resonance imaging (CMRI) revealed late-phase opaque material enhancement involving the inferior and inferoseptal segment of the left ventricle. The second patient was severely symptomatic in terms of cardiac involvement, and a transthoracic echocardiogram revealed global hypokinesia and septal brightness; his ejection fraction decreased to 45 %. These cases highlighted the challenges encountered in the diagnosis and treatment of cardiac sarcoidosis. CMRI should be considered in all patients who have suspected findings for cardiac involvement.

Background Endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA) is a diagnostic method for tuberculosis (TB). This study was conducted to determine the efficiency of polymerase chain reaction (PCR) testing for detecting TB lymphadenitis in samples obtained by EBUS-TBNA. Materials and Methods A total of 93 consecutive patients with hilar/mediastinal lymphadenopathies and diagnosed with granulomatous diseases through histopathological evaluation were included in the study. The specimens provided by EBUS-TBNA were evaluated through pathological, microbiological, and molecular tests. Results Eighty-nine (95.7%) of the 93 patients had histopathologically granulomatous diseases by EBUS-TBNA. Tuberculosis was diagnosed in 27 (30.3%) patients and sarcoidosis was diagnosed in 62 (69.7%) patients. Four (4.3%) patients were diagnosed through mediastinoscopy. Endobronchial ultrasound–guided transbronchial needle aspiration had an overall diagnostic efficiency in TB of 96.9%, a sensitivity of 90.9%, and a specificity of 100%. Mycobacterium tuberculosis PCR was positive in 17 of the 30 patients. The sensitivity of PCR was 56.7%, the specificity was 100%, and the general efficiency of the test was 96.4%. Conclusions As a result, the use of M. tuberculosis PCR in the EBUS-TBNA specimens provides a rapid and an accurate diagnosis of TB. Therefore, we recommend the use of M. tuberculosis PCR in the EBUS-TBNA specimens as a rapid diagnostic method for mediastinal lymphadenopathies in patients with suspected TB.

Reactive airway dysfunction syndrome (RADS) is a disease that causes bronchial hyper-reactivity with asthma-like symptoms within 24 hours, and it causes high-level irritant exposure in patients who did not have any previous lung disease. In general, the patient’s radiological findings are normal, although some changes are often seen. Pulmonary edema is rarely seen radiologically. In a 43-year-old female patient’s thorax computed tomography (CT) scan after the inhalation of a mixture of hydrochloric acid and sodium hypochloride, ground glass opacities, which implies bilaterally pulmonary edema, are detected. This case is presented because RADS is rarely accompanied by pulmonary edema.

Sarkoidozda gastrointestinal sistem (GIS) tutulumu nadirdir. GIS’de en sik tutulum yeri mide olup antrum tutulumu daha siktir. GIS sarkoidozu pulmoner sarkoidozun bir parcasi olabilecegi gibi tek basina da olabilir. En sik semptomlar epigastrik agri ve bulantidir. Tani mide endoskopisi sirasinda alinan mukozal biyopsilerde nonkazeifiye granulomlarin gorulmesiyle konur. Klinigimizde daha once sarkoidoz tanisi konulan, ilacsiz takip edilen ve dispeptik yakinmalari nedeniyle yapilan GIS endoskopisi sonucu tani alan, steroid tedavisine iyi yanit veren mide sarkoidozu hastasi sunuldu.

H1N1 infections have high mortality and morbidity around the world. Our case is 36 years old woman, was admitted to emergency service with tachycardia and dyspnea. Then she was transferred to the chest disease clinic with bilateral pneumonia. But in a few hours she was taken to intensive care unit for close follow-up and intubation. Her nasopharyngeal swabs were found positive for H1N1. She didn’t improve despite anti-viral and antibiotics. Fiberoptic bronchoscopy was applied, diffuse hyperemia and hemorrhage from right lower lobe was seen. 60 mg/day prednisolone was started and at the third day of treatment she was extubated and her vital signs became better. This case shows that steroid therapy makes rapid improvement at H1N1 pneumonia patients with alveolar hemorrhage.

INTRODUCTION Transbronchial needle aspiration (TBNA) by the guide of endobronchial ultrasonography (EBUS) is a diagnostic method which may be used in diagnosing benign granulomatous diseases in contemporary practice. In this study, we planned to evaluate the diagnostic value of TBNA by the guide of EBUS for benign granulamatous diseases and to investigate the impact of cytological, microbiologic and tuberculosis (TB)-polimerase chain reaction (PCR) results in specimens. MATERIALS AND METHODS Thirty-four patients (20 female, 14 male) who had EBUS-TBNA and histopathological diagnosis of granulamatous inflammatory reaction were included in the study. The mean age of patients was 49.62 ± 12.72 years (26-72). The specimens provided by EBUS-TBNA were evaluated for pathologic, microbiologic, and molecular (TB-PCR) examinations. RESULTS As a result of clinical, radiological and laboratory studies of the patients with granulomatous inflammation, 13 (38.2%) patients had TB, 21 (61.7%) patients had sarcoidosis. Diagnoses of histopathological granuloma were established by EBUS-TBNA in 30 (88.2%) patients among patients with isolated mediastinal lymphadenopathies. Seven of mediastinal TB lymphadenopathies patients were TB-PCR positive. The sensitivity of PCR was 54% and the specificity was 100%, general efficiency of the test was found to be 82%. CONCLUSION In cases with granulomatosis lymphadenopathies, TB-PCR specimens which achieved by EBUS-TBNA results provided important contribution for the TB diagnosis. Therefore, we thought that TB-PCR is a diagnostic method to be studied in the cases who investigating for mediastinal lymphadenopathies.

Fibrosarcoma is a mesenchymal tumor constituted by malignant fibroblasts. Myxofibrosarcoma is one of the fibrosarcoma variants that mostly develops from dermal/subcutaneous tissues. The most common locations are the limbs, with rare occurrences in the chest, head, and neck. Since, to best of our knowledge, there is no such report in English literature, we hereby present a case of lung myxofibrosarcoma. A 47-year-old man who had chest pain for 4 months was admitted to our clinic. The chest X-ray revealed a homogeneous density in the left upper lung. His chest computed tomography (CT) scan showed a solid mass lesion of 52 x 58 mm in size at the apical segment of the left upper lobe. There was tumor invasion at the second and third ribs. CT-guided fine-needle tru-cut lung biopsy was performed. Histopathological evaluation result was high grade myxofibrosarcoma. Surgery was conducted. Myxofibrosarcoma is a surgically curable disease. However, local recurrences occur in 50% to 60% of the cases. Therefore, chemotherapy and/or radiotherapy is the suggested approach following surgery.

Pulmonary embolism (PE) is a fatal disease that arises from genetic and environmental factors. There is little evidence for low high-density lipoprotein cholesterol (HDL-C) with hyperhomocysteinemia to lead to PE. Therefore, we evaluated homocysteine levels and lipid profile in PE patients and to display risk for PE. Forty six patients with proven PE and 46 healthy controls were included in the study. Homocysteine and serum lipid levels were calculated and compared in both groups. There were no significant differences between two groups in terms of total cholesterol, triglyceride, and low-density lipoprotein cholesterol. In PE group, HDL-C levels were found significantly lower in comparison to the control group ( P = .004). Mean homocysteine levels were significantly higher in PE group than in the control group ( P = .001). High-density lipoprotein cholesterol levels were significantly low in which homocysteine levels were high in the PE group. We thought that low HDL-C level with hyperhomocysteinemia is susceptible to PE.

BACKGROUND: In renal transplant recipients, evaluation of pulmonary complications and investigation of reduction interventions are important due to the potentially fatal results of pulmonary complications after transplant surgery. However, data are lacking about pulmonary complications in renal transplant recipients with living- or deceased-renal donors. Therefore, we aimed to assess the pulmonary complications in living- versus deceased-donor renal transplant recipients. METHODS: We retrospectively searched the medical records of patients who underwent renal transplantation in our tertiary referral center between 2013 and 2018. Sociodemographic characteristics, pulmonary complications, and major comorbidities were compared according to the donor type (living or deceased). RESULTS: Fifty-two of 100 transplantations from living donors and 48 of 100 transplantations from deceased donors were formed the patient groups. There were no statistically significant differences in terms of sociodemographic and clinical characteristics between the groups except with regard to pneumonia complication. The pneumonia rates were 11/48 (22.9%) and 3/52 (5.8%), P = 0.020, for the deceased- and living-donor renal transplant recipients, respectively. Deceased-donor transplant recipients had a 4.8-fold risk of developing pneumonia (odds ratio, 4.8; 95% confidence interval, 1.2–18.6; P = 0.021). CONCLUSION: Deceased-donor renal transplant recipients are more vulnerable to pulmonary complications than are living-donor ones and should thus be monitored closely.

Background/aim: The 2009 influenza A (H1N1) pandemic caused mild to severe illnesses and led to death in some cases. In this study, we aimed to evaluate the relationship between the serum D-dimer levels, CURB-65 scores, and the severity of pneumonia among patients with H1N1 infections. Materials and methods: Sixty-eight patients who had probable H1N1 infections were evaluated by clinical, radiological, and laboratory methods. The H1N1 strain was specified by reverse transcription-polymerase chain reaction. Of 55 patients diagnosed with pneumonia, 18 exhibited H1N1 positivity and 37 patients did not. Results: CURB-65 scores of pneumonia patients with H1N1 (group 1) were higher than those of patients without H1N1 (group 2) (P = 0.02). The D-dimer levels of group 1 were higher than those of group 2 (P = 0.001). Moreover, there was a positive correlation between D-dimer levels and CURB-65 scores in patients with H1N1-associated pneumonia (P = 0.001; r = 0.89). Conclusion: Increased D-dimer levels were observed in pneumonia patients with H1N1 infection, which predicted the severity of pneumonia.

Hydatid cyst (HC) is a parasitic disease that may involve many organs, especially the lung and the liver. Pulmonary artery location of the hydatid cyst is extremely rare, but it may cause life-threatening complications. We report a case of a hydatid cyst that completely filled the left main pulmonary artery and its distal part without cardiac involvement. Thoracic computed tomography showed filling defects in the pulmonary arteries. Endobronchial ultrasound was performed for differential diagnosis and it showed a cystic lesion. Hydatid cyst-specific IgE and hem agglutination test results were positive. In the literature, cases like this in which the diagnosis of pulmonary hydatid cyst is made by endobronchial ultrasound are not usually seen. Although many imaging modalities such as plain chest radiography, cross-sectional imaging (MDCT and MRI), echocardiography and conventional pulmonary angiography have been used in the diagnostic approach, we recommend endobronchial ultrasound for the differential diagnosis of cases with cystic formation.

Introduction Pulmonary embolism (VTE) comes in different degrees of severity from massive pulmonary embolism to nonmassive pulmonary embolism with no symptoms or hypoxia. Thrombolytic therapy is a lifesaver especially for patients who are in the high-risk group. In this study, we aimed at evaluating symptoms and clinical and laboratory findings in patients who had a diagnosis of massive or submassive VTE and treated with 50-mg recombinant tissue plasminogen activator (rt-PA) per hour for various problems as opposed to the standard dose, which is 100 mg every 2 hours. Materials and Methods Forty-six patients with a diagnosis of massive or submassive VTE who received thrombolytic therapy were evaluated retrospectively. Twenty-three patients who were treated with 50-mg rt-PA per hour were included in the study group. On the other hand, 23 patients who were treated with 100 mg of intravenous infusion of rt-PA every 2 hours were included in the control group. Echocardiographic assessment of the right ventricular size, systolic pulmonary artery pressure (sPAP), oxygen saturation, systemic arterial pressure, and heart rate before the thrombolytic therapy and in the first 24 hours after the administration of therapy were checked and noted in both of the groups. Results No significant difference was found between the 2 groups with regard to demographic data, Wells scores, type of embolism, average symptom duration, sPAP, and oxygen saturation. Differences in recovery, as inferred from vital symptoms and sPAP measurements, were not significant between the 2 groups. Conclusions Lower-dose thrombolytic therapy showed similar efficacy versus the standard dose in VTE. Thrombolytic therapy is a life-saving treatment in massive VTE. Furthermore, a harm/benefit analysis may lead to the administration of half-dose therapy in selected cases when it is contraindicated for various reasons.

Crazy-paving sign is a pattern seen on multislice computed tomography images of the lungs. It is characterized by a reticular pattern superimposed on ground-glass opacity. It was first described in the late 1980s in patients with pulmonary alveolar proteinosis, but has now been described in some other diseases of the lung. Enlarged mediastinal lymph nodes can be seen in infectious and specific inflammatory diseases and malignancies. The present report describes a case of a 44-year-old man in whom congestive heart failure presented with a crazy-paving appearance and enlarged lymph nodes of the lungs on the chest computed tomography scan.

Obstructive fibrinous tracheal pseudomembrane is a rare but potentially fatal complication associated with endotracheal intubation. Little is known about the mechanisms that play a role in the development of tracheal pseudomembrane, but it requires early diagnosis and treatment to prevent its major consequences. In this report, we present a case of obstructive fibrinous tracheal pseudomembrane, which developed a day after extubation in a patient who was intubated for 2 days. Therapeutic bronchoscopy was highly successful in removing the lesion and improving the clinical course.

Non-Hodgkin lymphoma generally affects the thorax in nearly half of the cases, but endobronchial non-Hodgkin lymphoma is rare. A 65-year-old man presented with refractory cough and progressive dyspnea on exertion of 2 months' duration. The patient denied fever, weight loss, or night sweats. A chest x-ray revealed bilateral lower lobe infiltrates. A computed tomography scan of the chest revealed large matted mediastinal lymph nodes without clear margination. Bronchoscopic examination revealed bilateral endobronchial diffuse nodular lesions. Bronchial mucosal biopsy demonstrated B-cell lymphoma. The patient was treated with R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone) regimen with near-total resolution of endobronchial and parenchymal lesions.

Background High sensitive C-reactive protein (hs-CRP) has been shown to be associated with asthma in recent studies. However, the relationship between hs-CRP and the control of asthma has not been clearly identified yet. Objective To investigate the association of hs-CRP with asthma control test (ACT), which reveals the degree of asthma control, and to compare hs-CRP in adults with mild and moderate asthma in chronic, stable asthmatic patients. Methods Thirty patients with physician-diagnosed asthma (11 mild, 19 moderate), and 30 healthy patients were enrolled in the study. In addition to medical history and physical examination, asthma was assessed according to GINA guideline. Respiratory function tests (RFT) and ACT were performed. The serum hs-CRP levels of all cases patients were measured. Results The levels of hs-CRP in asthmatic patients were significantly higher than those in the control cases (p = 0.002). The serum hs-CRP levels in the moderate asthmatics were significantly higher than those in the mild asthmatic ones (p = 0.04). When asthmatic cases were divided into two groups according to ACTs; the levels of hs-CRP in the groups of ACT ≤ 20 (uncontrolled groups) were significantly higher than the groups of ACT ≥ 20 (controlled groups) (p = 0.02). The hs-CRP levels showed significant correlations with ACT (p = 0.00, r = −0.91) and asthma severity (p = 0.04, r = 038) in asthmatic patients. Conclusion In conclusion it was shown that hs-CRP is related with asthma severity and ACT, and hs-CRP is a potential sensitive marker which reveals the severity and the control of asthma.

The purpose of this study was to evaluate the usefulness of a new parameter, pleural adenosine deaminase (PADA), for separating transudative pleural effusion from exudative pleural effusion, and to compare the results with other tests (albumin gradient and protein gradient).From November 2001 to January 2003, 359 consecutive patients with pleural effusion who underwent a diagnostic thoracentesis were included in the study. Effusions were individually classified as transudates or exudates after the careful evaluation of all clinical data and biochemical parameters of pleural fluid and serum of patients on the basis of Light's criteria. The means and standard deviations of PADA, pleural/serum ADA (P/S ADA) ratio, albumin gradient and protein gradient were evaluated for transudative and exudative effusions. The best cut-off values for each test were identified by using the receiver operating characteristic (ROC) curve. The optimum cut-off level was determined by selecting points of test values that provided the greatest sum of sensitivity and specificity.There were 113 transudates and 246 exudates. For each test, differences in mean value between the transudate group and the exudate group were statistically significant (t test, P0.001). The optimum cut-off levels for PADA and P/S ADA were 15.3 U/L and 0.66 U/L, respectively. ROC analysis confirmed previous recommendations for albumin gradient (12 g/L) and protein gradient (31 g/L). For detecting exudates, the PADA test yielded a sensitivity and specificity of 85.8% and 82.3%, respectively. Sensitivity and specificity of the albumin gradient were found to be 88.5% and 79.3%, and of the protein gradient 85% and 83.2%, respectively. The areas under the curve (AUC) data and accuracy demonstrated similar discriminative properties in the examined tests.The measurement of PADA is suggested as a reliable test in the separation of pleural exudates from transudates with accuracy similar to that of the albumin gradient and protein gradient.

While the trend of cigarette consumption in some developed countries is on the decline, it has been noted that in many developing countries, smoking is on the increase. Compared to developed countries, there are more male smokers than female smokers in these countries. The aim of this study was to investigate the prevalence and characteristics of the smoking habit in patients having lung cancer (LC) and to find out if there is any relationship with the smoking habit and the pathological diagnosis in our patient population. This hospital-based study was carried out between 1990 and 1996 in two major medical centres. LC was diagnosed in 1046 patients, 966 of whom were males (93%), and the remaining 80 (7%) of whom were females. Upon diagnosing the male patients, it was noted that 83% were current smokers (CS), 12% were ex-smokers (ES defined as abstinence from smoking at least for 1 year), and the remaining 5% were non-smokers (NS). In the female population the findings were as follows, 16% were CS; 8% were ES, and 76% were NS. The period of abstinence in the ES was 10 years or less in 77% of the patients. Among the male patients, squamous cell carcinoma was the most common tumor type seen in the CS group (46%) while adenocarcinoma (45%) was the most commonly seen tumor in the NS group. On the other hand, in the females, CS, the most commonly noted tumor types were small cell (54%), and adenocarcinoma (39%) was most frequently found in NS group. These results indicate that ES patients having LC in this study was quite low. On the other hand, in contrast to the findings of many other studies, from developed countries, the majority of male LC patients were in the CS group, however the majority of female LC patients were in the NS group. This smoking habit data obtained from our LC patients suggests that, similar to underdeveloped or developing countries, smoking cessation rates are very low in men during the past decade, and interestingly smoking rates may increase in women in the near future in our country. (C) 1998 Elsevier Science Ireland Ltd. All rights reserved.

Objectives: Venous thromboembolis is a clinical condition that often occurs from deep vein thrombosis of lower extremity. The incidence of deep venous thrombosis in the etiology of pulmonary thromboembolism may be as high as 90%. Doppler ultrasonography of lower extremities is recommended generally to determi- nate the etiology of pulmonary thromboembolism. The aim of this study is to present the importance of upper extremity thrombosis in pulmonary thromboembolism. Materials and Methods: Between 2010- 2012, 236 patientsfollowed with the diagnosis of pulmonary throm- boembolism were included in the study. Lower and upper extremity doppler examination was performed to all patients to determinate the cause. Results: The mean age of patients is 64,7± 16,9 (22- 95); 56,8% (134) were female, 43,2% (102) were men. According to the classification of pulmonary thromboembolism , 37 (15,7%) patients had massive, 103 (43,6%) patients had submassive, 96 (40,7%) patients had nonmassive embolism. Lower extremity deep ve- nous thrombosis was detected in 109 (46,2%) patients, both lower and upper extremity in 10 (4,2%) patients and only upper extremity in 20 (8,4%) patients. Eventually, deep venous thrombosis was detected in 129 (54,6%) patients. Thrombosis of the upper extremity was detected in 20 (16,8%) patients. Conclusions: Upper extremity thrombosis has been found as important as lower extremity thrombosis in the etiology of venous thromboembolism. Upper extremity thrombosis does not always occur in patients with malignancy or central venous catheters It should be kept in mind that, in hospitalized patients with peripheral vascular vein catheter, the upper extremity thrombosis may also occur.

Summary Aim: The purpose of this study was to evaluate the clinical usefulness of Tc-99m (V) DMSA in patients suspected of lung cancer and determine whether this agent may have value in differentiation between small cell (SCLC) and non-small cell (NSCLC) lung carcinoma. Methods: Thirty-six patients with clinical and radiological suspicion of primary lung carcinoma were injected 450-600 MBq of Tc-99m (V) DMSA intravenously. Whole body and planar anterior, posterior thorax images were obtained 4-5 h after injection of the radioactive complex. Results: Histo-pathological results confirmed 23 NSCLC, 10 SCLC and 1 metastatic lung carcinoma and 2 lung abscess. Nineteen of the 23 (82%) NSCLC and all of the 10 (100%) SCLC cases showed Tc-99m (V) DMSA uptake. Single metastatic lung cancer also accumulated radiotracer. Lung abscess did not show uptake. Lesion/Nonlesion (L/N) ratio of SCLC (1.59 ± 0.32) and NSCLC (1.43 ± 0.19) tumour types did not show statistical difference (p >0.05). Tc-99m (V) DMSA whole body imaging also showed bone metastases. Conclusion: Tc-99m (V) DMSA is a noninvasive and cheap imaging method to detect malignant lung cancers and their bone metastases but, differentiation of SCLC and NSCLC is not possible.