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Study Objective: To evaluate the usefulness of endobronchial argon plasma coagulation (APC) for the treatment of hemoptysis and neoplastic airway obstruction.Design: Retrospective study.Setting: Bronchoscopy unit of a university hospital.Patients: A total of 60 patients with bronchogenic carcinoma (n = 43), metastatic tumors affecting the bronchi (n = 14), or benign bronchial disease (n = 3). Indications for intervention were hemoptysis (n = 31), symptomatic airway obstruction (n = 14), and both obstruction and hemoptysis (n = 25). Hemoptysis was stratified as a volume of > 200 mL/d (n = 6), > 50 to 200 mL/d (n = 23), or < or = 50 mL/d but persistence for > 1 week (n = 27). The mean (+/- SD) duration of hemoptysis was 16.5 +/- 16.1 days before intervention. Obstruction sites were the trachea (n = 8), mainstem bronchi (n = 21), and lobar bronchi (n = 30). In 24 cases, the patient had obstructions at multiple sites. The mean size of the pretreatment obstruction was 76 +/- 24.9%.Interventions: APC, a noncontact form of electrocoagulation, was performed via flexible bronchoscopy. Sixty patients underwent 70 procedures. Conscious sedation without endotracheal intubation was used in all patients except four, who were mechanically ventilated because of underlying respiratory failure.Measurements and Results: All patients with hemoptysis experienced a resolution of bleeding immediately after APC. Hemoptysis from treated sites did not recur during a mean follow-up duration of 97 +/- 91.9 days. Patients with endoluminal airway lesions had an overall decrease in mean obstruction size to 18.4 +/- 22.1%. All patients with obstructive lesions, except one who died of sepsis, experienced symptom improvement. In these patients, symptom control was maintained during a median follow-up period of 53 days (range, 18 to 321 days). There were no complications related to the procedure.Conclusions: APC is effective for the treatment of endoluminal hemoptysis and airway obstruction. The procedure can be performed in an outpatient setting or at the bedside in the ICUs. APC provides a simpler, lower-risk alternative to other interventional endobronchial techniques. [ABSTRACT FROM AUTHOR]

Background: In this study, renal transplant recipients with tuberculosis of different organs, were retrospectively analysed with respect to prevalence, outcome and drug toxicity. [ABSTRACT FROM PUBLISHER]

Heparin induced thrombocytopenia (HIT) is an important complication of heparin treatment. In this article, we presented a case of HIT who was treated with fondaparinux, which is the only alternative anticoagulant agent in our country. A 48 year-old male patient was referred to our clinic when bilateral main pulmonary arterial thromboses were detected by spiral computerized tomography after he sought consultation for chest pain, dyspnea and presyncope of 3 days duration. In the physical examination, tachypnea, tachycardia, cyanosis, hypotension, neck vein distention, hepatomegaly and hepatojugular reflux were recorded. After the diagnosis of massive PTE, unfractionated heparin (UFH) infusion was started following the treatment with r-tPA. UFH was stopped due to the rapid fall in thrombocyte count (39000/mm[3]) on the second. day of treatment. PF4-heparin antibodies detected by ELISA were positive. Anticogulant therapy was followed with fondaparinux. Oral anticoagulant therapy was started when the thrombocyt count reached >100000/mm[3] on the sixth day of treatment. [ABSTRACT FROM AUTHOR]

Background: Our aim is to determine the caregiver burden of chronic obstructive lung disease (COPD) patient's caregivers, and to determine whether there is a workday loss., Methods: 252 COPD patients and their caregivers were included. Disease information of the patients were recorded and a questionnaire was applied. Socio-demographic characteristics of the caregivers were recorded and a questionnaire consisting of 24 questions including COPD disease, treatment and loss of working days, and the Zarit Scale were used., Results: 128(50.8%) of the patients according to GOLD were group-D, 97(38.5%) of the patient's relatives were working, 62(24.7%) were not able to go to work for 1-14 days, and 125(57.1%) spent outside the home from 1-14 nights, because those accompanied to patients. In univariate analysis were detected modified medical research council (mMRC) (p < 0.001), CAT (p < 0.001), the number of comorbidities of patients (p = 0.027), forced expiratory volume in 1 FEV1cc (p = 0.009), FEV1% (p < 0.001), the presence of long term oxygen therapy (LTOT), and the number of comorbidities of the patient's relatives (p = 0.06) increased the care load. In multiple linear regression analysis, age (p = 0.03), COPD assessment test (CAT) score (p = 0.001), FEV1% (<0.068) and the number of comorbidities of patients (p = 0.01) and the number of comorbidities of caregivers (p = 0.003) increased the caregiving burden., Discussion: In COPD increases caregiving burden. This burden is greater in symptomatic patients and when comorbidities are present. Psychosocial and legal regulations should be investigated and solutions should be produced for the caregivers of COPD patients.

Aim: Wrong use of an inhaler arising from a lack of knowledge can negatively affect treatment management. Therefore, this study was performed with the aim of determining the effects on treatment management of inhaler training carried out under the leadership of a nurse in individuals with medium and advanced stage chronic obstructive pulmonary disease (COPD)., Methods: This was an experimentally designed pre-test post-test study with a control group. Participants were interviewed four times in 1 year. The experimental group performed inhaler training. A Patient Description and Follow-Up Form, an Inhaler Drug Use Skill Chart, the Morisky eight-item Medication Adherence Scale, the COPD Assessment Test, and the St. George Respiration Questionnaire were used to collect data. Data analysis was performed by SPSS, using nonparametric tests., Results: Although there was no significant difference between the groups, a reduction in hospital visits and admissions because of attacks was seen in the experimental group (p = .239, p = .492). It was found there was a greater increase in the correct use of the inhaler in the experimental group than in the control group, and that correct use of the handihaler increased significantly (p = .008). Also, the increases in adherence to treatment (p = .006) and quality of life (p = .010) in the experimental group were significantly different from the control group. In the control group, the annual decline in forced expiratory volume in 1 s increased significantly (p = .016)., Conclusions: It was seen that long-term inhaler training given by nurses at regular intervals made a significant contribution to treatment management., (© 2020 Japan Academy of Nursing Science.)

Objectives: To evaluate the characteristics of patients who developed tuberculosis while receiving tumor necrosis factor-alpha (TNF-α) antagonists and the related factors with tuberculosis., Methods: Patient's demographics, tuberculin skin test (TST), isoniazid prophylaxis and type of TNF-α antagonist were recorded. TST conversion (≥5 mm increase) was evaluated for patients who had baseline and 1-year TST., Results: Files of 1887 patients who were receiving TNF-α antagonists between August 2005 and June 2015 were evaluated. TST significantly increased at the end of 1 year (n = 748 baseline:7.36 ± 7.2 mm vs. 1 year:9.52 ± 7.5 mm, P < 0.001). One-third of patients (31.2%) who had negative TST at baseline had positive TST at 1 year. Tuberculosis developed in 22 patients (1.16%). The annual incidence of tuberculosis was 423/100 000 patient-year. TNF-α antagonist indications were ankylosing spondylitis (n = 8), inflammatory bovel diseases (n = 7) and rheumatoid arthritis (n = 4). Ten (45.5%) patients received infliximab, six (27.3%) patients received etanercept and six (27.3%) patients received adalimumab. Nineteen (86.4%) patients were under isoniazid prophylaxis. Twelve patients had extrapulmonary tuberculosis (54.5%; four lymph node, three pleura, two periton, one pericarditis, one intestinal, one joint). Atypical mycobacterium was detected in one patient. Adalimumab treatment (9.5× increase), male sex (15.6× increase) and previous tuberculosis disease history (11.5× increase) were risk factors for active tuberculosis. Conversion of TST was not found related with tuberculosis., Conclusions: Despite the high proportion of isoniazid prophylaxis, the incidence of tuberculosis in our patients receiving TNF-α antagonist was higher than the literature. Adalimumab treatment, male sex and previous tuberculosis disease history were found as risk factors for tuberculosis., (© 2017 John Wiley & Sons Ltd.)

Introduction: Conflicting results has been achieved in a small number of clinical studies evaluating the efficiency of magnesium sulphate (MS) in COPD exacerbations. We aimed to investigate the efficiency of nebulised MS in COPD exacerbations., Patients and Methods: Twenty patients who met the study criteria were randomized into two groups. All patients were treated with O2, antibiotics and oral corticosteroids. Additionally one group received ipratropium bromide (IB) 500 µg together with MS 151 mg/dose, while the other group received IB together with placebo. The patients were followed-up with forced expiratory volume in 1 second (FEV1) and visual analogue scale dyspnea scores for 48 hours. Peak expiratory flow rates (PEFRs) were measured before and 10, 30, 60 and 120 minutes after each nebule treatment., Result: The baseline characteristics of the patients in both groups were similar. The FEV1 values measured at 24 and 48 hours did not show significant changes compared to baseline in both groups. Dyspnea scores in both groups decreased significantly in the first day, and in only MS group in the second day. The % change in the dyspnea score at the end of first day was significantly more in the MS group [-23.8% (13.6)] compared with the placebo group [-9.4% (12.9)] (p= 0.002). The % changes in PEFRs at 10 minutes [4.7 (7.5) and -3.5 (6.0), p= 0.005] and 30 minutes [8.2 (6.7) and 1.3 (5.5), p= 0.03] were significantly greater in the MS group compared with the placebo group on the first day. No side effects developed due to MS., Conclusion: Nebulised MS is a cheap, feasible and safe drug that can be added to the standart bronchodilator treatment since it provides additional relief of dyspnea in patients with COPD exacerbations. This needs to be evaluated in future clinical studies including greater number of patients.

Background: In patients being considered for lung-resection surgery, quantitative perfusion scintigraphy is used to predict postoperative lung function and guide the determination of lung-resection candidacy. Vibration-response imaging has been proposed as a noninvasive, radiation-free, and simpler method to predict postoperative lung function. We compared vibration-response imaging to quantitative perfusion scintigraphy for predicting postoperative FEV(1) and diffusing capacity of the lung for carbon monoxide (D(LCO))., Methods: We enrolled 35 candidates for lung resection. Twenty-five patients had preoperative FEV(1) and D(LCO) MEASUREMENTS:, Results: The vibration-response-imaging measurements showed strong correlation with the quantitative-perfusion-scintigraphy measurements of predicted postoperative FEV(1)% (r = 0.87, P < .001), predicted postoperative FEV(1) (r = 0.90, P < .001), and predicted postoperative D(LCO)% (r = 0.90, P < .001). There was a correlation between predicted postoperative FEV(1) (% and L) measured via quantitative perfusion scintigraphy and the actual postoperative FEV(1) (% and L) (r = 0.47, P = .048, r = 0.73, P < .001). There was no difference between the vibration-response-imaging measurements and the actual postoperative measurements of predicted postoperative FEV(1) (% and L). There was a correlation between predicted postoperative FEV(1) (% and L) measured via vibration-response imaging and actual postoperative FEV(1) (% and L) (r = 0.52, P = .044, r = 0.79, P < .001). The mean differences between the predicted and actual postoperative FEV(1) values were 49 mL with vibration-response imaging, versus 230 mL with quantitative perfusion scintigraphy. Neither the vibration-response imaging nor the quantitative perfusion scintigraphy predicted postoperative D(LCO)% values agreed with the actual postoperative D(LCO)% values., Conclusions: Vibration-response imaging may be a good alternative to quantitative perfusion scintigraphy in evaluating lung-resection candidacy.

BACKGROUND: Simpler and radiation free alternatives have been researched to estimate postoperative lung functions. Objective of the study is to investigate the reliability of predicted postoperative (ppo) forced expiratory volume in 1 second (FEV₁) and carbon monoxide diffusion capacity (DLCO) calculated by vibration response imaging (VRI) to guide the selection of patients for lung resection surgery in comparison with quantitative perfusion scintigraphy (Q scan). METHODS: 35 candidates for lung resection were enrolled in the study for preoperative and postoperative evaluation of FEV₁ and DLCO. RESULTS: Totally 25 patients had preoperative tests. VRI measurements showed strong correlation with Q scan measurements of predicted postoperative (ppo) FEV₁% (r= .87, p<.001), ppo FEV₁(L) (r=.90, p<.001) and ppo DLCO% (r=.90, p<.001). There was a correlation between ppo FEV₁ (% and L) calculated by Q scan and postoperative actual FEV₁ (% and L) (r=.47, p<.05; r=.73, p<.001). There was no difference between VRI measurements of ppo FEV₁(% and L) and postoperative actual FEV₁ values. There was a correlation between ppo FEV₁ (% and L) calculated by VRI and postoperative actual FEV₁(% and L) (r= .52, p<.05; r= .79, p<.001). The mean differences between ppo and postoperative actual FEV₁ values was 49ml for VRI versus 230ml for Q scan. Both VRI and Q scan ppo DLCO% did not show agreement with postoperative actual DLCO%. CONCLUSIONS: VRI, which is a non-invasive, radiation free and simple test, may be valuable in the preoperative evaluation of lung resection surgery. It may be a good alternative to Q scan.

Background: Obstructive sleep apnea has been linked with metabolic syndrome characterized by dyslipidemia, dyscoagulation, hypertension, and diabetes mellitus type 2 and their cardiovascular consequences. This study was designed to determine the effects of 8 weeks of therapy with continuous positive airway pressure (CPAP) on insulin resistance, glucose, and lipid profile, and the relationship between leptin and insulin-resistance parameters in patients with moderate-to-severe obstructive sleep apnea., Methods: In 44 patients, serum cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, very low-density lipoprotein, leptin, and insulin parameters were measured at baseline and after 8 weeks of CPAP. Insulin resistance index was based on the homeostasis model assessment (HOMA-IR) method. Insulin sensitivity (HOMA-S) and insulin secretion capacity (HOMA-beta) also were calculated. Thirteen patients were excluded from statistical analyses due to noncompliant CPAP usage (<4 h night(-1))., Results: In 31 patients who used CPAP for > or =4 h night(-1), CPAP therapy reduced total cholesterol (P < 0.05), low-density lipoprotein (P < 0.05), and leptin (P < 0.05). Circulating leptin levels showed significant correlation with both HOMA-S and HOMA-IR at baseline and follow-up (P = 0.03 for all). In addition, there was no correlation between HOMA-IR and the severity of sleep apnea, which was shown by apnea-hypopnea index., Conclusions: In patients with moderate-to-severe obstructive sleep apnea, compliant CPAP usage may improve insulin secretion capacity, reduce leptin, total cholesterol, and low-density lipoprotein levels. Leptin showed significant relationship with insulin resistance, and this relationship remained after 8 weeks of CPAP therapy.

Objective: Numerous clinical manifestations have been described in association with Cushing's syndrome. There are no eligible data on pulmonary function tests in Cushing's disease (CD). We aimed to asses pulmonary function tests including spirometry in a series of patients with active CD., Materials and Methods: This cross-sectional study comprised 10 patients with Cushing's disease (F/M, 9/1). The forced expiratory volume in 1st second (FEV1), the forced vital capacity (FVC), the FEV1/FVC ratio and the forced expiratory flow over the middle half of the FVC (FEF 25-75%) values and predicted values were determined by spirometry., Results: Mean age, height, weight, body mass index were 36.7+/-12.6 yrs (range 22-63 years), 156.9+/-8.4 cm, 74.1+/-10.7 kg, 29.6+/-3.8 kg/m(2), respectively. Spirometric abnormalities (impairment of FEV1, FVC, FEV1/FVC and FEF 25-75 values) were not detected, and there were no significant differences compared to reference values. Disease duration and cortisol concentrations by HDDSTs were negatively correlated with predicted FEV1/FVC values and the percentage of predicted FEV1 ratios, respectively., Discussion: The lung volume and ventilatory performance by spirometry were not disturbed in patients with endogenous hypercostisolism due to Cushing's disease.

Purpose: The aim of this study was to evaluate the efficacy of PET imaging and compare it with the performance of CT in mediastinal and hilar lymph node staging in potentially operable non-small cell lung cancer (NSCLC)., Methods: Fifty-nine patients with potentially resectable NSCLC who underwent preoperative PET and CT imaging were enrolled into this prospective study. All patients underwent surgical evaluation by means of mediastinoscopy with mediastinal lymph node sampling (14 patients) or thoracotomy (45 patients)., Results: The prevalence of lymph node metastases was 53%. Overall, the sensitivity, specificity, accuracy, PPV, and NPV of PET were 79%, 76%, 78%, 86%, and 76% for N0 and N1 lymph nodes and 76%, 79%, 80%, 67%, and 83% for N2 lymph nodes, while those values for CT were 66%, 43%, 58%, 68%, and 43% for N0 and N1 stations and 43%, 66%, 54%, 41%, and 66% for N2 lymph nodes, respectively. PET correctly differentiated cases with mediastinal lymph node involvement (N2) from those without such involvement (N0 or N1) in 76% of cases. Statistical analysis of the diagnostic accuracy of nodal involvement showed that PET improves diagnostic accuracy significantly in the detection of both N0 or N1 and N2 status in the individual patient based on analysis, compared with CT (P < 0.01 and P < 0.01, respectively). When preoperative nodal staging was compared with postoperative histopathological staging, 38 (65%) patients were correctly staged, 9 (15%) were overstaged, and 12 (20%) were understaged by PET, while 29 patients (49%) were correctly staged, 13 (22%) were overstaged, and 17 (29%) were understaged by CT., Conclusion: It has been clearly shown that PET is more accurate than CT for the differentiation of N0 or N1 from N2 disease in patients with NSCLC. However, PET imaging alone does not appear to be sufficient to replace mediastinoscopy for mediastinal staging in patients with lung cancer, especially in geographic regions with high granulomatous or inflammatory mediastinal disease prevalence.

Heparin induced thrombocytopenia (HIT) is a life-threatening complication that can be seen in the course of heparin treatment. The syndrome is much likely to be seen during treatment with standard heparin but it can also be seen due to low molecular weight heparins. In this article, we presented a case of HIT who was given low molecular weight heparin for prophylaxis that developed massive pulmonary thromboembolism. The patient was successfully treated with lepirudin infusion and no complications due to treatment was seen.

Background: Obstructive sleep apnea syndrome (OSAS) influences endothelial function and causes hypertension., Objectives: Our aim was to evaluate the role of endothelial dysfunction in the pathogenesis of hypertension in OSAS., Methods: Twenty-three patients with OSAS but without hypertension and 15 healthy normotensive subjects were investigated. The presence or absence of OSAS was evaluated with a sleep study. Endothelial function was investigated with brachial artery ultrasound examination., Results: Baseline characteristics were equivalent between the two groups. Minimal oxygen saturation and apnea-hypopnea indexes in the OSAS and control groups were 62.9 +/- 16.5 versus 94.9 +/- 1.1% (p < 0.0001) and 53.1 +/- 20.3 versus 3.8 +/- 0.9 (p < 0.0001), respectively. There was not statistically significant difference between basal brachial artery diameters measured in the morning and in the evening in all groups. Flow-mediated dilation (FMD) values measured in the morning were lower than those measured in the evening in both OSAS patients and the control group: FMD of OSAS patients was 6.04 +/- 3.18% in the morning and 10.38 +/- 4.23% in the evening hours (p = 0.001), and FMD of control subjects was 10.9 +/- 2.6% in the morning and 13.9 +/- 2.32 in the evening hours (p = 0.002). Differences in FMD values measured both in the morning and evening hours in OSAS patients were lower compared with those in control subjects (p < 0.0001 in the morning hours and p = 0.003 in the evening hours)., Conclusions: We detected a prominent diurnal deterioration in endothelial function in normotensive OSAS patients compared with healthy subjects. This deterioration may occur due to ongoing hypoxemia during the night and it may be a possible cause of hypertension and atherosclerotic cardiovascular diseases in patients with OSAS.

Reported is the successful treatment of a 24-year-old male with adenocystic carcinoma involving the tracheal carina, in which the tumor extended along the right main bronchus across the orifice of the right upper lobe. The patient underwent a carinal resection plus right upper lobectomy and reconstruction of the carina, resulting in neither anastomotic complication nor recurrence of disease during 28 months of follow-up.

Background: Tuberculosis is an important cause of morbidity and mortality in renal transplant recipients, but there are insufficient data regarding the efficacy and complications of therapy and of INH prophylaxis., Methods: This study is a retrospective review of the records of 880 renal transplant recipients in two centers in Turkey., Results: Tuberculosis developed in 36 patients (4.1%) at posttransplant 3-111 months, of which 28 were successfully treated. Eight patients (22.2%) died of tuberculosis or complications of anti-tuberculosis therapy. Use of rifampin necessitated a mean of 2-fold increase in the cyclosporine dose, but no allograft rejection occurred due to inadequate cyclosporine levels. Hepatotoxicity developed in eight patients during treatment, two of whom died due to hepatic failure. No risk factor, including age, gender, renal dysfunction, hepatitis C, or past hepatitis B infection, was found to be associated with development of hepatic toxicity. A subgroup of 36 patients with a past history of or radiographic findings suggesting inactive tuberculosis, was considered to be at high risk for developing active disease, of whom 23 were given isoniazid (INH) prophylaxis. None versus 1 of 13 (7.7%) of cases with and without INH prophylaxis, respectively, developed active disease (P>0.05). None of the patients receiving INH had hepatic toxicity or needed modification of cyclosporine dose., Conclusions: These data show that tuberculosis has a high prevalence in transplant recipients, that it can effectively be treated using rifampin-containing antituberculosis drugs with a close follow-up of serum cyclosporine levels, and that INH prophylaxis is safe but more experience is needed to define the target population.