[Show abstract][Hide abstract] ABSTRACT: One of the obstacles to organ donation and transplantation in Turkey is that of religious beliefs and, at this point, religious officials constitute a key aspect of this problem. Positive or negative viewpoints held by religious officials regarding organ donation and transplantation are influential in guiding the public. This descriptive study was conducted for the purpose of describing religious officials' viewpoints on this subject. To determine the opinions of 40 religious officials from among the imams and muezzins working in Zeytinburnu District Mufti (Religious Officials Superior) Station who participated in a normal meeting in April and who fully completed the survey. A 27-question survey form was used that consisted of open-ended and closed questions, 5 of which were on socio-demographic characteristics, 13 on viewpoints on organ donation and transplantation, and 9 on the Islamic viewpoint regarding organ donation and transplantation. For the analysis of the results, Student's t test and one-way ANOVA tests were used. It was found that all of the religious officials believed in the importance of organ donation, 80 % considered donating their organs, and 5 % had made an organ donation. Of the religious officials who had not donated organs, 35 % gave an answer that there was no specific reason and 27.5 % stated that they had never considered the subject. While the number of those stating that they would donate the organs of a close associate who had died, 77.5 % of them who did not want to donate gave as their reason the idea that if it were him, he would perhaps not want to give his organs after death. Of the religious officials questioned, 92.5 % asserted that the religion of Islam looked positively on organ donation and transplantation, 55 % stated that the knowledge of religious officials in the country was inadequate regarding this subject, and 65 % said that for interest in organ donation to increase, religious officials should make speeches and raise the issue with the public in conversations, meetings, and sermons. Fully 85 % asserted that for interest in organ donation in Turkey to increase, religious officials have to lead on the subject. Of those questioned, 52.5 % considered their knowledge on organ donation and transplantation to be adequate and that they had obtained 52.5 % of such information from seminars/conferences, 50 % from television/radio, and 45 % from Directorate of Religious Affairs publications. However, 40 % expressed that they did not know where organ donations were made. One reason for inadequate organ donation in Turkey is that of incorrect religious beliefs. Thus, it is necessary that informative efforts are made by the Directorate of Religious Affairs through in-house training programs, and that healthcare, religious, and legal officials work jointly to inform the public about organ donation, organ transplantation, and brain death. Additionally, religious officials should donate organs by the way of example and, to increase their sensitivity, healthcare professionals should go more frequently to mosques and Mufti Stations.
Journal of Religion and Health 03/2014; · 1.02 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Mean Platelet Volume (MPV) reflects the size of platelets. It has been shown to be inversely correlated with inflammation in some chronic inflammatory diseases. This prospective study aimed at showing the usability of MPV as an inflammation marker in patients with active pulmonary tuberculosis (PTB) by comparing them to healthy controls. Additionally, its relationship with other inflammatory markers such as C-reactive protein (CRP) and Erythrocyte Sedimentation Rate (ESR) as well as with radiological extent of disease was examined.
The study included 82 patients with active PTB and 95 healthy subjects (the control group). A whole blood count was done; CRP and ESR levels were compared; and in the PTB group, the relationship of radiological extent of disease with MPV and other inflammation markers was investigated.
MPV was 7.74+/-1.33 /muL in the PTB group and 8.2+/-1.13 /muL in the healthy group (p=0.005). The blood platelet count, and the CRP and ESR values were significantly higher in the active PTB group than in the control group (p<0.0001). While radiologic disease extent and MPV had no correlation (p=0.80), the CRP (r=0.26, p=0.003) and ESR levels (r=0.39, p=0.003) were significantly correlated with radiologic disease extent.
MPV was found lower in PTB patients than in healthy controls. MPV does not reflect the severity of the disease. Using MPV as an inflammation marker in PTB and assessing it as a negative acute phase reactant do not seem very reliable.
Multidisciplinary respiratory medicine 02/2014; 9(1):11. · 0.05 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Synovial sarcoma (SS) is a rare tumor originating from mesenchymal tissue and accounting for approximately 5-10% of all soft tissue sarcomas. A rare case of primary pulmonary SS in an asymptomatic 18-year-old man admitted to our hospital for investigation of a 6 × 6.5 cm, oval-shaped, well-delineated pleural based peripheral mass in the left lower lobe in his thorax CT is presented. Left lower lobectomy was done. Immunohistochemically, tumor cells were positive for cytokeratin, epithelial membrane antigen (EMA), and vimentin so that the histopathological diagnosis was compatible with biphasic spindle cell type SS in the lung.
Case reports in pulmonology. 01/2014; 2014:537618.
[Show abstract][Hide abstract] ABSTRACT: AIM: Obstructive sleep apnea syndrome (OSAS) may promote hyperglycemia and insulin resistance. Our aim is to investigate the effect of OSAS on the fasting plasma glucose, glycosylated hemoglobin (HbA1c), and C reactive protein (CRP) in nondiabetic patients. MATERIAL AND METHODS: Blood parameters of consecutive 90 non diabetic patients whom polysomnografic evaluations were done in our sleep laboratory was evaluated. Among these 61 patients with normal fasting blood glucose were classified due to their apne-hipopnea index (AHI) as mild (n=16, 26.2%), moderate (n=18, 29.5%) and severe (n=27, 44.2%) OSAS. The fasting plasma glucose, HbA1c and CRP were measured. RESULTS: Mean age of the patients was 47.7±11.2 years, 72% male. HbA1c, fasting glucose levels show positive correlation with BMI (r=.503, P=.00; r=.258, P=.045). No relation of HbA1c to apnea index nor AHI was detected while positive corelation of fasting glucose and CRP was detected (r=.262, P=.042; r=.258, P=.045). HbA1c, fasting glucose and CRP levels show negative correlation with minimum SpO2 levels (by order of r=-.302, P=.018; r=-.368, P=.004; r=-.365, P=.004). HbA1c, fasting glucose levels and CRP levels show positive correlation with mean desaturation index (time duration in which SpO2<90% by pulse oxymeter) (r=.263, P=.041; r=.311, P=.015; r=.283, P=.027). CONCLUSIONS: Although no relation in between increased HbA1c or glucose levels and severity of OSAS was detected in nondiabetic OSAS patients, the correlation with the night hypoxia was detected. This could also show the effect of night time hypoxia on glucose metabolism in OSAS patients.
Archivos de Bronconeumología 05/2013; · 2.17 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Angiosarcoma is a rare soft tissue tumour and constitutes less than 1% of all soft tissue cancers. Pleural angiosarcomas are extremely rare and have an aggressive course. We report the case of a 79-year-old female patient who presented with complaints of increasing dyspnoea on exertion and homogeneous opacification of the left hemithorax on chest radiograph. Epithelioid angiosarcoma was determined on pleural tissue obtained by video-assisted thoracoscopic surgery (VATS).
Journal of the Pakistan Medical Association 02/2013; 63(2):265-7. · 0.41 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Postintubation stenosis is the most frequent cause of benign tracheal stenosis and may cause reintubation and delay in weaning of intensive care unit patients. This case study describes typical patients with tracheal stenosis and the management of these patients. Five patients requiring reintubation and mechanical ventilation due to early intubation-related stenosis are discussed. Stridor developed in three cases after extubation. In these cases, bronchoscopy revealed tracheal stenosis. Dilatation and silicone stent placement were performed using rigid bronchoscopy. The other two patients were on ventilators when they were admitted to the intensive care unit and their stenoses were also treated by rigid bronchoscopy. Hypercapnia and hypoxia resolved after intervention in three cases. Of the remaining two patients, one had the tracheostomy closed and in the other patient ventilation was stopped but the tracheostomy was maintained. Tracheal stenosis developing in the subglottic region after extubation, especially after exposure to cuff pressure, may lead to reintubation. A tracheostomy may hinder the diagnosis of progressive stenosis and may lead to unnecessary maintenance of ventilator treatment. Early intubation-related tracheal stenosis should therefore be considered in cases of weaning or extubation failure and prompt appropriate investigation and treatment.
Anaesthesia and intensive care 01/2013; 41(1):108-12. · 1.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Tuberculosis may be complicated with empyema and fistula in patients with cellular immune deficiency. The case presented was a 39-year-old male patient with diagnosis of rheumatoid arthritis developed hydropneumothorax while taking steroid and immunosuppressive treatment and examination of pleural fluid revealed acid-fast bacilli. The patient was admitted to the intensive care unit due to respiratory failure and underwent bronchoscopic examination due to air leakage. The right middle lobe was obliterated by using an endobronchial Watanabe Spigot (EWS), and the amount of leakage decreased considerably after the procedure. On day 7, chest tube drainage was removed, and empyema was drained with a Pezzer drain. On day 50, upon the cessation of empyema drainage, spigots were removed with rigid and flexible bronchoscope. In conclusion, EWS use in the treatment of bronchopleural fistula is an effective, safe and a reversible procedure.
Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia. 06/2012;
[Show abstract][Hide abstract] ABSTRACT: Cellular immunity abnormalities are associated with sarcoidosis. Normal cellular immunity is required for adequate humoral immunity; therefore, a decreased humoral immune response is possible in patients with sarcoidosis. We evaluated humoral immunity by vaccinating patients with sarcoidosis against tetanus.
We screened 60 patients with sarcoidosis (42 females, average age 39 +/- 11 years) and 40 healthy subjects as a control (23 females, average age 38 +/- 9 years). Of the 51 sarcoidosis patients and 33 controls that did not have sufficient tetanus antibody titers, 48 patients and 31 controls agreed to be vaccinated and were included in the vaccination program. Blood serum samples were collected from the subjects before and after vaccination and evaluated for tetanus toxoid IgG antibodies with an enzyme-linked immunosorbent assay (ELISA).
As a result of the vaccination, 24 of the sarcoidosis patients (50%) and 7 of the controls (23%) had insufficient antibody responses (p = 0.019). No relationship was found in sarcoidosis patients between the rate of having sufficient antibody levels and disease duration, activation state, and radiographic staging of the disease. Conversely, mean lymphocyte numbers were significantly lower in patients with insufficient tetanus antibody levels (p = 0.013).
Tetanus vaccinations in sarcoidosis patients are less effective than in healthy controls, suggesting that patients with sarcoidosis have a hyporesponsive humoral immune system.
Sarcoidosis, vasculitis, and diffuse lung diseases: official journal of WASOG / World Association of Sarcoidosis and Other Granulomatous Disorders 03/2012; 29(1):3-10. · 1.63 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We report a 50 years old female who was admitted to our clinic for investigation of pneumonia. She had responded to antibiotics but full regresson was not observed. Chest x-rays demonstrated lobar consolidation. Fiberoptic bronchoscopy revealed a vegetative whitish membranous material in the medial segment of right middle lobe. Pathological and microbiological examination of the bronchoscopic material showed features of a pulmonary hydatid cyst with cuticle. The diagnosis was confirmed by serology and lobe resection. Patient had presented in an unusual way for diagnosis of hydatid cyst.
Journal of the Pakistan Medical Association 11/2011; 61(11):1128-9. · 0.41 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Medical thoracoscopy is a valuable tool in the management and investigation of pleural diseases. It has advantages when compared to conventional closed pleural biopsy and video-assisted thoracoscopic surgery. However, the use of this technique is limited in Turkey. The present report is about the first experience with semi-rigid thoracoscope that was implemented in our country. Four patients underwent medical thoracoscopy in September 2009 with the new device. All patients were referred due to non-diagnostic closed pleural biopsy. The use of the device was simple and fabulous views were obtained. All biopsy specimens of the 4 patients were histologically adequate. Definite diagnosis was enabled in 3 of the 4 patients when clinical features and CT findings combined with thoracoscopic specimens. The design is similar to the fiberoptic bronchoscope, respiratory physicians can easily adapt to its use. It is also compatible with most video operating systems and light sources used in endoscopy suites. The convenient use and compatibility with most endoscopic systems are raising the importance of the device. However, biopsy size from semirigid thoracoscope might cause diagnostic difficulty when compared to rigid thoracoscope.
[Show abstract][Hide abstract] ABSTRACT: Laser therapy is a well-known technique which has been safely used for almost thirty years to treat endobronchial obstruction. Nd : YAG and Nd : YAP lasers are commonly used lasers, whose safety and efficacy have been investigated in several large series. Diode laser is a new laser system which has been mainly used in urology, endovascular surgery, ENT, and dermatology. In recent years it has been effectively used in endobronchial treatments.
In this study, 61 patients who underwent endobronchial treatment with a diode laser in the Interventional Pneumology Unit of our hospital were retrospectively evaluated. Fifty-one patients were male. Mean age was 54.72 ± 13.81 years, and a total of 90 laser applications were given. In 39 cases, palliation of a malign obstruction was achieved while cure was achieved in 19 cases with benign obstruction. No major complication other than minor hemorrhage in 4 cases and temporary hypoxia in 2 cases was observed.
Diode laser can be used as an effective and safe modality for endobronchial treatment.
The Thoracic and Cardiovascular Surgeon 04/2011; 60(2):140-4. · 0.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Patients with squamous cell carcinoma of the head and neck constitute a high risk group for synchronous and metachronous tumours.
This study aimed to investigate the usefulness of white light and autofluorescence bronchoscopy in the evaluation of pre-malignant and early neoplastic lesions in patients with laryngeal cancer, who are at high risk of concomitant lung cancer.
This prospective, cross-sectional study included 30 patients who had undergone total laryngectomy for squamous cell carcinoma of the larynx. The tracheobronchial system was investigated for the presence of pre-malignant and malignant lesions, using a combination of white light and autofluorescence bronchoscopy. Biopsies were obtained from areas with a pathological appearance, and histopathological studies were performed.
All patients had a permanent tracheostomy. Light and autofluorescence bronchoscopy indicated that the tracheobronchial system was normal in 11 patients. A total of 27 biopsies was taken from the remaining 19 patients, and revealed invasive squamous cell carcinoma in one patient and pre-malignant changes in six.
Bronchoscopy is a valuable and practical tool for screening patients at high risk of lung cancer, and requires minimal intervention especially in patients with a permanent tracheostomy. Of the various bronchoscopic techniques becoming available, autofluorescence bronchoscopy shows promise for the detection of pre-invasive malignant changes of the tracheobronchial system in patients previously operated upon for laryngeal cancer.
The Journal of Laryngology & Otology 11/2010; 125(2):181-7. · 0.68 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The effect of positive airway pressure treatments in different modalities on the cardiovascular consequences of the disease in sleep apnea patients is still unclear. We aimed to compare auto-titrating positive airway pressure (APAP) and conventional continuous positive airway pressure (CPAP) in terms of improving heart rate variability (HRV) in obstructive sleep apnea patients. This was a prospective study done in a tertiary research hospital. All patients underwent a manual CPAP titration procedure to determine the optimal pressure that abolishes abnormal respiratory events. Then patients underwent two treatment nights, one under APAP mode and one under conventional CPAP mode with a 1-week interval. Forty newly diagnosed obstructive sleep apnea patients were enrolled in the study. We compared heart rate variability analysis parameters between the APAP night and the CPAP night. This final analysis included the data of 28 patients (M/F: 22/6; mean age = 46 +/- 10 years). Sleep characteristics were comparable between the two treatment nights, whereas all-night time domains of HRV analysis such as HF, nuLF, and LF/HF were different between APAP and CPAP nights (2.93 +/- 0.31 vs. 3.01 +/- 0.31; P = 0.041; 0.75 +/- 0.13 vs. 0.71 +/- 0.14; P = 0.027; and 4.37 +/- 3.24 vs. 3.56 +/- 2.07; P = 0.023, respectively). HRV analysis for individual sleep stages showed that Stage 2 LF, nuLF, nuHF, LF/HF parameters entirely improved under CPAP treatment whereas APAP treatment resulted in nonsignificant changes. These results suggest that despite comparable improvement in abnormal respiratory events with APAP or CPAP treatments, CPAP may be superior to APAP in terms of correcting cardiovascular alterations in sleep apnea patients.
Beiträge zur Klinik der Tuberkulose 04/2010; 188(4):315-20. · 2.06 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Hemodialysis (HD) patients are at increased risk of reactivation of latent tuberculosis (TB) infection (LTBI). LTBI screening of this population is recommended. The QuantiFERON-TB Gold assay (QFT-G) may be more accurate than the tuberculin skin test (TST) in the detection of LTBI. We prospectively compared the results of QFT-G to TST in HD patients.
We examined 100 patients and performed TST and QFT-G tests. Data obtained from patients and medical records included medical history (past history of TB, Bacillus Calmette-Guerin [BCG] vaccination, history of contact with previous TB cases), radiography reports (chest x-ray with changes consistent with old TB), and basic laboratory findings.
Forty-three of 100 patients (43%) had a positive QFT-G test result and 34 (34%) had a positive TST test result. Overall agreement between the QFT-G and the TST was 65% (concordance [k]=0.26, P=0.01). Discordant test results were seen in 13 TST-positive/QFT-G-negative patients and in 22 TST-negative/QFT-G-positive patients. Before BCG vaccination and radiographic reports (of old TB changes) were associated with discordant test results. On multivariate analysis, a positive QFT-G test was associated with contact with previous TB cases (P=0.026) and radiographic report (P=0.034), whereas a positive TST test also was associated with a history of BCG vaccination (P=0.015).
QFT-G test results were more closely associated with TB risk factors than were positive TST results. Additionally, the QFT-G test was not affected by BCG vaccination. We concluded that QFT-G test is a more useful diagnostic method than TST for detecting LTBI in HD patients.
[Show abstract][Hide abstract] ABSTRACT: Pleural effusion due to congestive heart failure (CHF) typically are transudates. Light's criteria may be insufficient in determining if the pleural effusion is transudative or exudative in patients with CHF. The aim of our study was to assess the diagnostic performance of the amino-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) in pleural fluid and serum for the identification of pleural effusion owing to heart failure.
The study prospectively evaluated NT-proBNP in serum and pleural fluid from patients with effusion owing to heart failure (n=51) and other causes (n=64). Measurements were made of levels of NT-proBNP by an electrochemiluminiscence immunoassay. The discriminative properties of NT-proBNP levels in identifying pleural effusion due to heart failure were determined by receiver operating characteristic curve (ROC) analysis and compared to the diagnostic value of finding a transudate by Light's criteria and serum-pleural fluid albumin gradients.
Serum and pleural fluid NT-proBNP levels were significantly elevated in patients with pleural effusion owing to heart failure. The area under ROC for the diagnosis of pleural effusion from heart failure was similar for pleural fluid (0.973, 95% CI: 0.914-0.995) and serum (0.968, 95% CI: 0.890-0.989) NT-proBNP.
NT-proBNP levels in either pleural fluid or serum have high diagnostic values and they are easily useable parameters in the diagnosis of heart failure-related pleural effusion.
Internal Medicine 02/2009; 48(5):287-93. · 0.97 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Surgical treatment of typical bronchial carcinoid tumors varies from bronchoscopic excision to major resective procedures. Polypoid shaped typical carcinoid tumor detected in two female patients who were admitted to our clinic with the pre-diagnosis of asthma and lung cancer. In both cases, polypoid typical carcinoid tumors were excited by argon plasma coagulation using rigid bronchoscopy. It should not be forgotten that bronchoscopic approach and simple excision is an effective and safe procedures for the treatment of typical bronchial carcinoid tumors in selected cases these polypoid type lesions.
[Show abstract][Hide abstract] ABSTRACT: The aim of the study was to explore the relation between hospitalization and the success of therapy in lung tuberculosis. Three hundred and fifty one hospitalized human immunodeficiency virus (HIV) negative, smear positive cases of pulmonary tuberculosis were studied. All cases were World Health Organization (WHO) category 1 patients. The patients with chronic additional disease and those who developed complication during therapy were excluded. Three hundred and six outpatients attending to local dispensaries were also included as control group. The groups were compared with respect to completion rates at 6 months of therapy. The average age was 37.48 + or - 13.87 years; 204 patients were women (31.1%). For inpatients, mean hospital stay was 25.4 + or - 14.2 days. A total of 304 (86.6%) hospitalized patients completed their treatment; the remaining 47 (13.4%) cases were not followed-up. No significant relation was observed between the length of hospital stay and completion of therapy (p> 0.05); 295 (96.4%) outpatients successfully completed their treatment. The probability of not completing the therapy was significantly higher for hospitalized patients (RR: 3.72 95% CI: 1.96-7.05 p< 0.05). Our results show that in category 1 patients without concomitant disorders, initiation of treatment at hospital has an adverse influence on the outcome of treatment, as reflected by the percentage of completers.
[Show abstract][Hide abstract] ABSTRACT: Endobronchial ultrasound guided fine-needle aspiration (EBUS-TBNA) is an accurate, safe and minimally invasive technique for the analysis of mediastinal lymph nodes. The aim of our study was to assess the value of EBUS probe using single-channel bronchoscope. Twenty-two patients who undervent EBUS-TBNA with proven non-small cell lung cancer and enlarged (> 1 cm) mediastinal lymph node at chest computed tomography were retrospectively enrolled in the study. The mean age of the patients was 56.8 + or - 9.0 (45-76), and all of them were men. Mean size of sampled 32 lymph nodes was 19.9 + or - 6.5 mm (10-30). The average number of needle passes was 3.2 + or - 0.9 (1-5). Adequate material was found in 31 (97%) of the lymph nodes. In 15 (68.1%) of the patients lymph node metastasis was detected. Of 7 patients with negative cytology, a mediastinoscopy was done. There were no complications other than minimal hemorrhage. The sensitivity of EBUS-TBNA was calculated as 88.2%, whereas the specificity was 100% and accuracy was found to be 90.9%. EBUS guided TBNA of mediastinal lymph nodes is a safe approach which can be a tool for obtaining adequate material and high diagnostic yield in staging of non-small cell lung cancer.