[Show abstract][Hide abstract]ABSTRACT: Objectives:
There is limited and contradictory information regarding the role of serum ischemia-modified albumin (IMA) in obstructive sleep apnea (OSA). In this study we examine the effects of OSA and obesity on IMA and interleukin-6 (IL-6), and detect whether IMA and IL-6 may be potential biomarkers in OSA.
Fifty-one males who underwent all night polysomnography test were included into the study. Body-mass index (BMI) and apnea-hypopnea index (AHI) of all patients were determined. Serum IMA and IL-6 levels, erythrocyte sedimentation rate (ESR), complete blood count, routine blood biochemistry and thyroid function tests were performed.
Mean IMA [0.36 (± 0.04) U/ml, 0.89 (± 0.15) U/ml], mean IL-6 [1.01 (± 0.19) pg/ml, 2.02 (± 1.19) pg/ml] and mean ESR [4.14 (± 2.5) mm/h, 14.35 (± 13.7) mm/h] levels showed significant difference between non-OSA and OSA groups (P = 0.005, P < 0.001, P < 0.001, respectively). Sensitivity of IMA in distinction of non-OSA/OSA was equal to IL-6 and higher than ESR. IMA was also a stronger predictive factor than IL-6 and ESR in the evaluation of OSA groups (severe/mild/moderate OSA and non-OSA). IMA was the sole distinctive biomarker in assessment of obese and non-obese cases. IMA correlated with IL-6, AHI and ESR.
Serum IMA may be a valuable oxidative stress indicator for OSA and could act as a better biomarker than IL-6 for reflecting the presence and the severity of OSA.
Full-text Article · Jun 2016 · Postgraduate Medicine
[Show abstract][Hide abstract]ABSTRACT: Introduction: Exhaled breath condensate (EBC) pH has been shown to be a good indicator of inflammation in the airways in several pulmonary diseases. Bronchial inflammation is an expected condition also in pulmonary tuberculosis and may play role in the extent of parenchymal infiltration. It is conceivable that EBC pH may be an useful marker in demonstrating the extent of airway inflammation in tuberculosis patients; however, there is limited clinical data about its role in pulmonary tuberculosis. In this prospective study we aimed to investigate the inflammation of the airways by EBC pH and to evaluate the relationship between the degree of smear positivity and the radiological extent of tuberculosis. Materials and methods: 19 untreated smear positive pulmonary tuberculosis cases and 31 healthy controls were included in the study. While the control group was investigated for only EBC pH, the patient group was investigated for EBC pH, chest X-ray, serum procalcitonin level and acido-alcohol resistant bacilli examination in sputum smear. Available parameters were compared statistically between healthy controls and patients. Results: Mean EBC pH was found to be significantly low in tuberculosis group (p <0.001). In the patient group, there was a moderate negative correlation between EBC pH and ARB positivity (p <0.02), moderate positive correlation between serum procalcitonin and erythrocyte sedimentation rate (p <0.02), moderate positive correlation between serum procalcitonin and radiological extent (p <0.008), a strong positive correlation between erythrocyte sedimentation rate and radiological extent (p <0.003). However, any statistically significant correlation was not observed between EBC pH and radiological extent. Conclusion: In this study it has been demonstrated that EBC pH was in association with pulmonary inflammation in tuberculosis and smear positivity but had no relationship with parenchymal infiltration. On account of this, we state that EBC pH may be useful in the assessment of the airway inflammation and bacillary load, but is not a good predictor of radiological extent of pulmonary tuberculosis.
Full-text Article · Jan 2016 · Acta Medica Mediterranea
[Show abstract][Hide abstract]ABSTRACT: Background/aim: Since blood bags have the ability for diffusion of gases, we investigated whether hyperbaric oxygen (HBO) exposure affects several vital parameters of stored blood.
Materials and methods: Bloods obtained from the same persons were used as both control and HBO groups and stored in pediatric
bags with citrate-phosphate-dextrose solution. HBO administration was performed at 2.5 atm for 90 min, started 1 day after blood
collection and repeated every 2 days for a total of 10 times. The study was terminated on the 21st day. Complete blood count, glucose,
pH, and osmotic fragility values were measured every week.
Results: Glucose and pH levels decreased in stored blood. In the HBO-exposed group, these decreases were less than in the control.
In addition, mean corpuscular and platelet volumes tended to increase during storing process, but with HBO, these indexes remained
lower, near physiologic levels. Another interesting finding of the study was the relative stable osmotic fragility ratio in the HBO group
compared to the control blood.
Conclusion: HBO exposure has positive effects on pH, stability of erythrocytes, and energy source (glucose) of the medium. Thus, we concluded that HBO may be a useful application for life and quality of stored blood.
Full-text Article · Feb 2015 · Turkish Journal of Medical Sciences
[Show abstract][Hide abstract]ABSTRACT: Idiopathic inflammatory myopathies are a heterogeneous group of autoimmune disorders along with muscle weakness. Pulmonary involvement is one of the main causes of mortality and morbidity. Our case has been diagnosed as dermatomyositis. She was referred to our clinic with the complaint of dyspnea. Radiography, diffusion and pulmonary function tests were normal. Ground glass opacities were detected in High Resolution Computarise Tomography (HRCT) of patient but patient was in the early period of interstitial lung disease. With the complaint of air hunger, respiratory muscle weakness was considered and Maximal Inspiratuar Pressure (MIP), Maximal Exspiratuar Pressure (MEP) are planned and measured 34% and 39% respectively. Ciyclophospamide was added to patient's steroid therapy. After two months of treatment, regression of ground glass opacities were detected and values of MIP and MEP were measured 92% and 94% respectively. It should be considered that respiratory function tests and chest radiographies could be insufficient in diagnosing respiratory muscle weakness and interstitial lung disease. In suspected cases HRCT should be taken and MIP, MEP should be measured. Measurement of MIP and MEP are parameters that can be used in diagnosis and response to treatment of respiratory muscle weakness.
Full-text Article · Jan 2015 · Gulhane Medical Journal
[Show abstract][Hide abstract]ABSTRACT: Coexistence of idiopathic pulmonary haemosiderosis and celiac disease (Lane-Hamilton Syndrome): A case of complete remission with a gluten-free diet Idiopathic pulmonary hemosiderosis is a rare disease of unknown etiology usually characterized by recurrent episodes of alveolar hemorrhage, hemoptysis and iron deficiency anemia. Celiac disease is an immune-mediated inflammation of the small intestine caused by sensitivity to dietary gluten and related proteins in genetically sensitive individuals. The coexistence of idiopathic pulmonary hemosiderosis and celiac disease, also known as Lane-Hamilton syndrome, is extremely rare. A 24-year-old man presented with history of recurrent hemoptysis, anemia and widespread ground glass opacities in both lungs on high resolution computed tomography scans. Transbronchial parenchymal biopsy by bronchoscopy revealed pulmonary hemosiderosis. Although he was no gastrointestinal symptoms, IgA antibodies against tissue transglutaminase was positive. Histological findings consistent with gluten enteropthy were found on intestinal biopsy. Since pulmonary function testing including carbon-monoxide diffusing capacity were normal, the patient was put on a gluten-free diet and has had no recurrences of hemoptysis over 2 months follow-up. Hemoglobin at 2 months follow up was normal and radiological findings completely disappeared.
Full-text Article · Jan 2015 · Gulhane Medical Journal
[Show abstract][Hide abstract]ABSTRACT: Unilateral pulmonary artery agenesis (UPA) is an uncommon congenital anomaly that results from the absence of ipsilateral sixth aortic arch development. Genetic and mechanical factors have been blamed so far; however, no significant etiological factor has been found up to now. UPA is mostly asymptomatic in adulthood, on the other hand, because of being associated with other congenital cardiac malformations, it is usually symptomatic in childhood. Therefore, the majority of adult patients are identified incidentally with PA chest radiographs performed for different reasons. Typical chest radiographic findings are ipsilateral volume loss, absence of hilar shadow, hemidiaphragm elevation, mediastinal displacement and hyperinflation of thecontrolateral lung. In symptomatic cases, the most frequent symptoms are recurrent pulmonary infections, dyspnea and exercise intolerance. In this article, because of its clinical importance, we report the case of a 16-yearold male who was diagnosed with right pulmonary artery agenesis with typical imaging findings.
Full-text Article · Jan 2015 · Gulhane Medical Journal
[Show abstract][Hide abstract]ABSTRACT: Brucellosis is a serious, multisystemic zoonotic disease, which is continuing to be endemic in the certain religions of the world. Because the signs and symptoms of the disease are not specific, the disease usually causes delay in the diagnosis and treatment. Every system can be affected in the body, but the musculoskeletal and osteoarticular systems are the most affected. Pulmonary involvement is rare but a serious complication. In this article we report a brucellosis case with the literature data, which was clinically and radiographically presented only with pneumonia. The diagnosis was confirmed by hemoculture and serologic tests.
[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.
Full-text Article · Jan 2014 · Annals of Clinical Microbiology and Antimicrobials
[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.
[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.
Full-text Article · May 2013 · International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases
[Show abstract][Hide abstract]ABSTRACT: Aim: Parachordoma, which is classified in the same class as mixed tumours and myoepithelioma according to The World Health Organisation 2002 classification, is a rare tumour of unknown origin. Recurrence and metastasis are rarely seen. We present a parachordoma case that had metastasised to the lungs.
Case: A 50 year-old man was referred to our institution following the appearance of mass lesions at a routine follow-up computed tomographic scan of the thorax. He was operated on due to a mass in the inguinal canal two years previously, which was diagnosed as parachordoma. Due to the detection of iliac bone metastasis,
pelvic irradiation had been delivered. Bilateral widespread mass and nodular lesions, prominently on the left lower lobe, were detected on computed tomographic scan. Diagnostic bronchoscopy revealed normal tracheobronchial tree anatomy and no visible tumour. Conventional transbronchial needle aspiration from right intermediate bronchus and transbronchial parenchymal biopsy from left lower lobe were performed. On pathologic specimens, tumour cells were observed to be stained with PanCK, AMA and Vimentin. Pathologic examination confirmed the diagnosis of parachordoma lung metastases. The patient was referred to the
oncology department for future treatment.
Conclusions: Parachordoma is an extremely rare tumour that was first described by Laskowski in 1951. Only a few lung metastases metastases of parachordoma cases have been reported in literature. Despite parachordoma’s generally indolent behaviour, our case adds evidence to the knowledge that parachordoma can metastasise to the lungs and the tumour can be sampled by conventional bronchoscopic procedures.
[Show abstract][Hide abstract]ABSTRACT: In this study, gelatin based biodegradable scaffolds (GS) containing various amounts of epidermal growth factor (EGF) were prepared and applied to full skin defects created on rats in order to investigate the EGF dose effect on healing process. Scaffolds were prepared by freeze drying
technique and stabilized with either glutaraldehyde (GA) or 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide (EDAC). In vitro cytotoxicity of the prepared scaffolds was assessed by using human skin fibroblast secondary culture (HS2). Scaffolds crosslinked with GA which showed no cytotoxicity
in vitro were selected for in vivo applications, loaded with different amounts of EGF (1 μg, 5 μg or 10 μg per cm3 of scaffold) and were applied onto full skin defects created on rats. Decrease in the wound size and level of reepithelization were examined
and the results showed that, all scaffolds, with or without EGF, demonstrated a potential to enhance wound healing. Healing process became faster and better parallel to the dose of EGF present in the scaffolds. Although wounds demonstrated better and faster healing parallel to the EGF content,
the dose should be optimized through examining the effects in molecular level before any clinical application.
Article · Apr 2013 · Journal of Biomimetics Biomaterials and Tissue Engineering