[Show abstract][Hide abstract] ABSTRACT: We evaluated patients admitted to the intensive care units with the diagnosis of community acquired pneumonia (CAP) regarding initial radiographic findings.
A multicenter retrospective study was held. Chest x ray (CXR) and computerized tomography (CT) findings and also their associations with the need of ventilator support were evaluated.
A total of 388 patients were enrolled. Consolidation was the main finding on CXR (89%) and CT (80%) examinations. Of all, 45% had multi-lobar involvement. Bilateral involvement was found in 40% and 44% on CXR and CT respectively. Abscesses and cavitations were rarely found. The highest correlation between CT and CXR findings was observed for interstitial involvement. More than 80% of patients needed ventilator support. Noninvasive mechanical ventilation (NIV) requirement was seen to be more common in those with multi-lobar involvement on CXR as 2.4-fold and consolidation on CT as 47-fold compared with those who do not have these findings. Invasive mechanical ventilation (IMV) need increased 8-fold in patients with multi-lobar involvement on CT.
CXR and CT findings correlate up to a limit in terms of interstitial involvement but not in high percentages in other findings. CAP patients who are admitted to the ICU are severe cases frequently requiring ventilator support. Initial CT and CXR findings may indicate the need for ventilator support, but the assumed ongoing real practice is important and the value of radiologic evaluation beyond clinical findings to predict the mechanical ventilation need is subject for further evaluation with large patient series.
Annals of Clinical Microbiology and Antimicrobials 01/2014; 13(1):5. · 1.51 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Bronchology Global Case ReportsSESSION TYPE: Global Case ReportPRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PMINTRODUCTION: Bronchopleural fistula (BPF) is a complication, mostly encountered after lung surgery and invasive diagnostic procedures but it's rarely seen due to tuberculosis. The standard methods of treating persistent air leak include continued chest tube suction, Heimlich valves or surgical repair. In patients not suitable for surgery due to extensive inflamatory process, bronchoscopic approaches may bring to a successful conclusion. This is the first description of the use of a removable, one-way, endobronchial valve(EBV) to treat BPFs with non-resolving spontaneous pneumothorax complicating extensive cavitary pulmonary tuberculosis(PTB).CASE PRESENTATION: 21-year-old- male patient was admitted with complaints of cough and sputum for 10 days. Chest X ray showed cavitary lesions with reticulonodular changes in the right upper lung field. Sputum smear was positive for acid fast bacilli. Thus, the patient was diagnosed as PTB and antituberculosis therapy was started. Three days later, the patient developed acute dyspnea and right chest pain. Chest X ray demonstrated a right hydropneumothorax. A chest tube drainage was applied on the right side. Even under negative pressure, chets tube drainage did not work and radiological controls showed no resolution of hydropneumothorax. Because of the early period of PTB and intense inflammation of lung parenchyma, surgical treatment was not considered at this stage and open drainage was performed. Thorax CT scans revealed partly collapse of upper lobe and completely collapse of lower lobe. After possible places of air leakage was observed, it was planned to insert EBVs in related segments of upper lobe. Occlusion of apical and posterior segments was attempted using the balloon catheter passed through a bronchoscope and the air leak stopped immediately. After that, two EBVs were placed in the apical and one was placed in the posterior-segment bronchi. After a while, air leak stopped and, thorax CT showed complete resolution of hydropneumothorax and almost complete regression of cavities after 3 months.DISCUSSION: There are successful case reports using EBVs for spontaneous pneumothorax and prolonged air leak due to lung surgery, empyhema, malignancy and thoracic trauma1-3. To our knowledge, this is the first case that used a one-way endobronchial valve to manage severe air leak due to extensive PTB.CONCLUSIONS: One-way endobronchial valve replacement for a bronchopleural fistula may be the initial approach before surgical procedures in critically ill patient.Reference #1: Feller-Kopman D, Bechara R, Garland R, et al. Use of a removable endobronchial valve for the treatment of bronchopleural fistula. Chest 2006; 130:273-275Reference #2: Anile M, Venuta F, De Giacomo T, et al. Treatment of persistent air leakage with endobronchial one-way valves. J Thorac Cardiovasc Surg 2006; 132:711-712Reference #3: Travaline JM, McKenna RJ, Jr., De Giacomo T, et al. Treatment of persistent pulmonary air leaks using endobronchial valves. Chest 2009; 136:355-360DISCLOSURE: The following authors have nothing to disclose: Mehmet Aydogan, Alper Gündogan, Ergun Uçar, Hasan Çaylak, Orhan Yücel, Ergun Tozkoparan, Sedat Gürkök, Hayati BilgiçNo Product/Research Disclosure Information.
[Show abstract][Hide abstract] ABSTRACT: Interstitial Lung Disease Global Case ReportsSESSION TYPE: Global Case ReportPRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PMINTRODUCTION: Organizing pneumonia (OP) is an interstitial lung disease characterized by diagnosed by its histopathologic pattern of granulation tissue and inflammatory changes in the surrounding alveoli with varied bronchiolar involvement. The most common cause of OP is idiopathic, however other disorders including connective tissue disorders, hypersensitivity pneumonitis, eosinophilic pneumonias, aspiration, inhalational injury, drugs, radiation, infection, and hematologic malignancies may cause OP. With immunomodulatory, antineoplastic, antiangiogenetic, and antiinflammatory properties, thalidomide is used as an effective chemotherapy agent with widespread application. Although thalidomide induced pulmonary toxicity has seen less often, it has vital importance. Here, we report a case report of thalidomide induced organizing pneumonia in multiple myeloma patient on thalidomide treatment.CASE PRESENTATION: A 75-year-old male patient with one year history of multiple myeloma was put on with thalidomide treatment additionally methylprednisolone and melphalan as well. He had no known history of smoking and cardiopulmonary disease. He had slightly dyspnea approximately for a month but on the fifth month of the treatment he experienced an abrupt onset of fever, chills, cough and sputum. He had right basal inspiratory crackles on auscultation Chest x-ray demonstrated reticular opacities in the right lower zones, hilar zone and paracardiac zone and bilateral upper zones. Thalidomide was immediately discontinued, and he was empirically treated with antibiotics (moxifloxacin). Due to ongoing fever for three days and non-response to empiric antibiotics, his treatment was extended to linezolid, imipenem, and voriconazole. The patient's dyspnea rapidly worsened over the ensuing days. His SaO2 in room air and at resting was 80%. High resolution chest computed tomography (HRCT) revealed ground glass opacities with areas of consolidation involving bilateral upper and lower lobes. He subsequently underwent a bronchoscopy with bronchoalveolar lavage (BAL) and transbronchial lung biopsy (TBB). An extensive evaluation was made for infectious agents. Sputum, blood cultures and BAL for Pneumocystis jirovecii, as well as bacterial, viral, fungal, and mycobacterial evaluations, were negative. TBB revealed interstitial fibrosis, type II pneumocyte proliferation,and morphologic findings of bronchiolitis obliterans. There was no evidence of infection or malignancy. He was treated with prednisone for three months with the diagnosis of bronchiolitis obliterans organizing pneumonia. Within days he experienced rapid resolution of his symptoms, his dyspnea and cough improved and his room air oxygen saturation increased to 95%. A chest CT eight weeks later documented significant improvement. He has had neither recurrence of pulmonary symptoms nor admission to a pulmonary clinic again.DISCUSSION: The incidence of thalidomide-induced pulmonary toxicity remains unknown. To our recent knowledge, thalidomide has been cited as the cause of 11 reported cases of pulmonary toxicity in the literature, majority of cases are pneumonitis but there are three cases of interstitial pneumonia, one case of organizing pneumonia, and one case of eosinophilic pneumonia. According to the literature the most common presenting complaints were fevers, chills, fatigue, and dyspnea. High-resolution CT scanning is the most sensitive method to detect pneumonitis radiographically. Diffuse or patchy ground-glass opacities are the most common radiographic findings, followed by reticulonodular patterns, patchy consolidation, and pulmonary nodules. The majority of patients had no response to empiric antibiotics and later responded well to withdrawal of the drug with or without high-dose steroids.CONCLUSIONS: Clinicians must be aware of this potential toxicity in immunocompromised patients who especially have pulmonary complaints with unidentifiable infectious agent and no response to antibiotics.Reference #1: Vahid B, Marik PE. Pulmonary complications of novel antineoplastic agents for solid tumors. Chest 2008;133:528-38.Reference #2: Vahid B, Marik PE. Infiltrative lung diseases: complications of novel antineoplastic agents in patients with hematological malignancies. Can Respir J 2008;15:211-6.Reference #3: Geyer HL, Viggiano RW, Lacy MQ, et al. Acute lung toxicity related to pomalidomide. Chest 2011;140:529-33.DISCLOSURE: The following authors have nothing to disclose: Alper Gündogan, Mehmet Aydogan, Tuncer Ozkisa, Gökhan Özgür, Önder Öngörü, Ergun Uçar, Oral Öncül, Hayati BilgiçNo Product/Research Disclosure Information.
[Show abstract][Hide abstract] ABSTRACT: The aims of this study are to identify factors predicting mortality in patients with chronic obstructive pulmonary disease (COPD) and community-acquired pneumonia (CAP) requiring intensive care unit (ICU) admission and to examine whether noninvasive ventilation treatment reduces mortality.
An analysis was performed on data from patients with CAP hospitalized in the ICUs of 19 different hospitals in Turkey between October 2008 and January 2011. Predictors of mortality were assessed by both univariate and multivariate statistical analyses.
Two hundred eleven patients with COPD and CAP were included. The overall ICU mortality was 23.9%. Noninvasive ventilation treatment (odds ratio [OR], 0.12; 95% confidence interval [CI], 0.03-0.49; P = .003), hypertension (OR, 0.13; 95% CI, 0.02-0.93; P = .042), bilateral infiltration (OR, 13.92; 95% CI, 2.94-65.84; P = .001), systemic corticosteroid treatment (OR, 0.19; 95% CI, 0.35-0.96; P = .045), length of ICU stay (OR, 0.65; 95% CI, 0.47-0.89; P = .007), and duration of invasive mechanical ventilation (OR, 1.11; 95% CI, 1.01-1.22; P = .032) were independent factors related to mortality.
Noninvasive ventilation, hypertension, systemic corticosteroid treatment, and shorter ICU stay are associated with reduced mortality, whereas bilateral infiltration and longer duration of invasive mechanical ventilation are associated with increased risk of mortality in patients with COPD and CAP requiring ICU admission.
Journal of critical care 09/2013; · 2.13 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Severe community-acquired pneumonia (SCAP) is a fatal disease. This study was conducted to describe an outcome analysis of the intensive care units (ICUs) of Turkey. METHODS: This study evaluated SCAP cases hospitalized in the ICUs of 19 different hospitals between October 2008 and January 2011. The cases of 413 patients admitted to the ICUs were retrospectively analyzed. RESULTS: Overall 413 patients were included in the study and 129 (31.2%) died. It was found that bilateral pulmonary involvement (odds ratio (OR) 2.5, 95% confidence interval (CI) 1.1-5.7) and CAP PIRO score (OR 2, 95% CI 1.3-2.9) were independent risk factors for a higher in-ICU mortality, while arterial hypertension (OR 0.3, 95% CI 0.1-0.9) and the application of non-invasive ventilation (OR 0.2, 95% CI 0.1-0.5) decreased mortality. No culture of any kind was obtained for 90 (22%) patients during the entire course of the hospitalization. Blood, bronchoalveolar lavage, and non-bronchoscopic lavage cultures yielded enteric Gram-negatives (n=12), followed by Staphylococcus aureus (n=10), pneumococci (n=6), and Pseudomonas aeruginosa (n=6). For 22% of the patients, none of the culture methods were applied. CONCLUSIONS: SCAP requiring ICU admission is associated with considerable mortality for ICU patients. Increased awareness appears essential for the microbiological diagnosis of this disease.
International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases 05/2013; · 2.17 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Pulmonary sequestration is a rare, usually a cystic mass which is composed of nonfunctioning pulmonary tissue that does not communicate with the tracheobronchial tree. In computed tomography pulmonary sequestration is seen as usually a discrete mass lesion, with or without cystic changes, associated with local emphysematous areas located in lower lobes. We present a case of pulmonary sequestration located in apicoposterior segment of left upper lobe and presented as a solitary pulmonary nodule having smooth margins different from the classical radiological appearance of pulmonary sequestration.
[Show abstract][Hide abstract] ABSTRACT: Chronic eosinophilic pneumonia (CEP) is an idiopathic eosinophilic pulmonary disease characterized by an abnormal and marked accumulation of eosinophils in the lung. Common presenting complaints include cough, fever, dyspnea, wheezing, and night sweats. Common laboratory abnormalities are peripheral blood and BAL eosinophilia. The pathognomonic radiographic finding is bilateral peripheral infiltrates. Corticosteroids are the mainstay of therapy, and dramatic improvement follows treatment. Relapses are common, and most patients require prolonged therapy. Side effects associated with chronic corticosteroid therapy must be monitored. Our case was that of a 36-year-old woman who had characteristic clinical and radiologic features. She was treated with corticosteroids but she needed prolonged therapy, and side effects occurred. Because the patient had high IgE levels and a positive skin prick test result, we used omalizumab for the treatment. The patient responded well. To our knowledge, this is the first CEP case in the literature successfully treated with omalizumab.
[Show abstract][Hide abstract] ABSTRACT: Chitotriosidase is an accepted marker of macrophage activation. In this study, we investigated serum chitotriosidase levels in pulmonary tuberculosis (PTB).
Forth-two patients with PTB and 30 healthy subjects were enrolled in the study. The radiological extent of PTB, radiological sequela after treatment, and the degree of smear positivity were assessed. Chitotriosidase levels were measured by a fluorometric method.
The serum chitotriosidase levels of the PTB patients were significantly higher than those of the control subjects (39.73±24.97 vs. 9.63±4.55 nmol/mL/h, P<0.001). After completion of the standard 6-month antituberculous treatment, chitotriosidase levels in PTB patients significantly decreased (10.47±4.54 nmol/mL/h, P<0.001). Chitotriosidase levels correlated significantly with the radiological extent of PTB, degree of smear positivity, and post-treatment radiological sequela score (r=0.439, r=0.449, and r=0.337, respectively).
This study demonstrated that serum chitotriosidase levels increase in PTB; therefore, chitotriosidase can be used as a marker of disease activity, severity, and response to treatment.
Annals of Laboratory Medicine 05/2012; 32(3):184-9. · 1.48 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of the present study was to investigate serum lactate dehydrogenase (LD) levels in patients with silicosis due to denim sandblasting (SDDS) and also to investigate possible correlations between serum LD levels and the degree of radiological extent of disease (RED) and pulmonary function tests.
Forty-four males with SDDS and 32 healthy male subjects were included in the study. Patients and healthy controls were compared for serum LD levels. Correlations between serum LD levels, RED and spirometric values were investigated.
Patients with SDDS had significantly higher serum LD levels than healthy controls. Patients with complicated SDDS had significantly higher serum LD levels than patients with simple SDDS. Significant correlations were found between serum LD levels and RED values. Significant correlations were found between serum LD levels and spirometric parameters.
High serum LD levels might be considered as a marker of pulmonary parenchymal involvement in patients with SDDS. This study also suggests that the increase in serum LD levels might be closely related to the degree of pulmonary involvement in SDDS patients.
Clinical Chemistry and Laboratory Medicine 03/2012; 50(3):483-8. · 2.96 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The results of sputum culture for Mycobacterium tuberculosis must be awaited in most cases, which delays the start of treatment in patients with sputum smear-negative pulmonary tuberculosis. We investigated whether plasma chitotriosidase activity is a strong marker for early diagnosis of tuberculosis in patients for whom a bacillus smear is negative and tuberculosis culture is positive.
Clinical, radiological, and laboratory features were evaluated in 75 patients, 17 of whom were diagnosed as having active tuberculosis by negative acid-fast bacillus smear and positive culture, 38 as having sequel tuberculosis which was radiologically and microbiologically negative, and 20 who served as healthy controls. Serum chitotriosidase activity levels were measured in both cases and controls.
The mean age of the cases with active pulmonary tuberculosis, cases with sequel lesions, and controls was 23 ± 2.4 years, 22 ± 1.7 years, and 24 ± 2.1 years, respectively. Serum chitotriosidase levels were 68.05 ± 72.61 nmol/hour/mL in smear-negative, culture-positive pulmonary tuberculosis cases (Group A) and 29.73 ± 20.55 nmol/hour/mL in smear-negative, culture-negative sequel pulmonary tuberculosis cases (Group B). Serum chitotriosidase levels from patients in Group A were significantly higher than in Group B and Group C. There was no statistically significant difference in serum chitotriosidase levels between cases with sequel pulmonary tuberculosis (Group B, smear-negative, culture-negative) and healthy controls (Group C).
In patients with active tuberculosis and a negative sputum smear for acid-fast bacillus, plasma chitotriosidase activity seems to be a strong marker for diagnosis of active disease which can be used while awaiting culture results.
[Show abstract][Hide abstract] ABSTRACT: Both of the diagnosis and treatment evaluation are time-consuming conditions in patients with pulmonary and pleural tuberculosis. The aim of this study was to establish the validity of tumor markers CA 125, CA 15-3, and CA 19-9 in the diagnosis of pulmonary and pleural TB and to verify the success of the treatment protocol.
The levels of tumor markers CA 125, CA 15-3, and CA 19-9 were measured before and after treatment in 67 TB patients, 54 of whom had pulmonary TB and 13 of whom had pleural TB. All values were compared with the results of a healthy control group of 44 subjects.
CA 125 and CA 15-3 levels were significantly high when compared with those of the healthy control group and there was a significant decrease in both tumor marker levels after treatment in patients with pulmonary TB (P < 0.001 and P < 0.004, respectively). However, the difference found in CA 19-9 levels before and after treatment in patients with pulmonary TB was not statistically significant (P < 0.08). When the CA 125, CA 15-3, and CA 19-9 values of the pulmonary TB group before treatment were compared with that of the healthy control group, the results were statistically significant in all parameters except CA 19-9 (P < 0.001, P < 0.001, and P < 0.09 for CA 125, CA 15-3, and CA 19-9, respectively). In the patients with pleural TB, CA 125, CA 15-3, and CA 19-9 values did not change significantly after treatment.
The authors suggest that CA 125 and CA 15-3 tumor markers may be important for verification of the success of treatment protocol in pulmonary TB, as the differences found for these tumor markers between the pre- and the posttreatment periods are statistically significant.
OncoTargets and Therapy 01/2012; 5:385-90. · 1.34 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: It is aimed to present the usefulness of inspiratory muscle trainer (IMT) in treatment of a 20-year-old male patient with diaphragmatic paralysis and tetraplegia due to spinal cord injury (SCI), and supporting effect of IMT in recovering from respiratory failure by rendering his diaphragm functions. The treatment was applied through the tracheostomy cannula by a modified IMT device. After applying IMT for three weeks, it was observed that the diaphragm recovered its functions in electromyography (EMG) test. As a result, in this study, we present a case where a patient could live without any respiratory device for the rest of his life with the help of modified IMT.
[Show abstract][Hide abstract] ABSTRACT: Methemoglobinemia, one of the rare causes of cyanosis and hypoxemia, may occur in congenital and acquired forms. Coexistence of cyanosis and hypoxemia suggests an etiology associated with an underlying cardiac disease firstly, but if any cardiac pathology exists pulmonary diseases are investigated generally. Considering bronchial asthma in a young patient with shortness of breath is usual. On the other hand, evaluating all the signs and symptoms together with laboratory results is important in diagnosis of rare diseases such as methemoglobinemia. In this paper we present a congenital methemoglobinemia case who was treated with bronchodilator therapy for a period of nearly five years because of misdiagnosis of asthma.
Respiratory Medicine Case Reports. 01/2012; 6:11–12.
[Show abstract][Hide abstract] ABSTRACT: To investigate serum prolidase activity (SPA) in patients with pulmonary tuberculosis (PTB).
Twenty-nine PTB patients and 32 controls were included in the study. PTB patients (cavitary and non-cavitary) and controls were compared in terms of mean SPA. Correlations were evaluated between SPA and acute phase reactants.
Mean SPA was significantly higher in PTB patients than in the control group. Mean SPA was significantly higher in patients with cavitary TB than non-cavitary TB. Mean SPA in patients with mild PTB was lower than patients with moderate and severe disease. We found significant correlations between SPA and CRP, ESR, albumin, platelet counts, HDL-cholesterol and LDH activity.
This study has shown that PTB patients have higher SPA than controls. The increase in SPA might be related to tissue destruction, increased immunoglobulin, complement levels and increased fibroblastic activity; all of which are involved in the natural history of PTB.
Scandinavian journal of clinical and laboratory investigation 07/2011; 71(6):467-72. · 1.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Bronchiolitis obliterans organizing pneumonia (BOOP) was described in 1985 as a distinct entity, with different clinical, radiographic, and prognostic features than the airway disorder obliterative bronchiolitis and the interstitial fibrotic lung disorder usual interstitial pneumonia/idiopathic pulmonary fibrosis.The BOOP pattern may be idiopathic or may occur secondary to some of the following clinical conditions: Idiopathic pulmonary fibrosis, Wegener granulomatosis; at the wall of lung abscesses, lymphomas, other neoplasms or after healing of infectious diseases. At these conditions, clinical symptoms are primarily due underlying disorders.We presented a case of BOOP mimicking a malignant disorder and occurring after Aspergillus infection in a patient with chronic obstructive pulmonary disease.
[Show abstract][Hide abstract] ABSTRACT: We investigated the role of oxidative stress in the pathogenesis of reexpansion pulmonary edema (RPE) and effect of alpha-lipoic acid (ALA) in the prevention of RPE.
There were 4 groups consisting of 10 rats in each group; control group (CG), α-lipoic acid group (ALAG), reexpansion pulmonary edema group (RPEG), reexpansion pulmonary edema plus α-lipoic acid group (RPE + ALAG). In all the groups, all rats were sacrificed 2 hours after the reexpansion of lungs. To indicate oxidative stress malondialdehyde (MDA), and to indicate antioxidant status superoxide dismutase (SOD), catalase (CAT) and glutathione peroxides (GPx) were measured in the lungs of rats.
Mean MDA value was lower in CG (7.02 ±0.14) and in ALAG (6.95 ±0.11) than the other groups (p = 0.001). It was highest in RPEG (8.89 ±0.21) (p = 0.001). It was lower in RPE + ALA G (7.21 ±0.32) than RPEG (p = 0.001). Antioxidant levels: GPx (37.21 ±3.01), CAT (2.87 ±0.14) and SOD (100.12 ±12.39) were lowest in RPEG among all groups (p = 0.001). These values were GPx (45.21 ±3.54), CAT (3.24 ±0.21) and SOD (172.36 ±15.48) in RPE + ALA G and were greater than those of RPEG (p = 0.001). While normal pulmonary parenchyma was seen in 2 rats in RPE + ALAG, it was not seen in RPEG. Pulmonary edema was seen in 1 rat in RPE + ALAG; however, it was seen in 3 in RPEG.
Oxidative stress might have an important role in the pathogenesis of RPE. In addition, ALA treatment might contribute in preventing RPE.
Archives of medical science : AMS. 12/2010; 6(6):848-53.