Mounier-Kuhn syndrome (tracheobronchomegaly): An analysis of eleven cases.

BACKGROUND AND AIM: Mounier-Kuhn syndrome (MKS) is a congenital disorder characterized by tracheobronchomegaly resulting from the absence of elastic fibers in the trachea and main bronchi or atrophy and thinning of the smooth muscle layer. In this syndrome, dead space associated with tracheobronchomegaly increases and discharge of secretions decreases because of ineffective coughing. The most common complications are recurrent lower respiratory tract infections and bronchiectasis. We examined the clinical characteristics, radiological features, and related complications of patients with MKS. METHODS: The cases were obtained between September 2007 and November 2015. Computed tomography scans of the chest were used to diagnose tracheobronchomegaly. RESULTS: All cases (a total of 11) were males with a mean age of 63 ± 13 (range, 38-80) years. The mean diameter of the trachea was 31.53 ± 2.99 mm; the mean transverse diameter was 31.69 ± 3.10 mm and the mean sagittal diameter was 31.36 ± 3.01 mm. Complaints at the time of presentation included chronic cough, purulent sputum, dyspnea, and hemoptysis. There were recurrent pulmonary infections in seven cases, bronchiectasis in six, and tracheal diverticulum in four at the time of diagnosis. CONCLUSIONS: In this article, 11 cases with various rarely seen complications are presented and evaluated in the light of current literature. We recommend that if chronic cough, recurrent pulmonary infections, and bronchiectasis seen in a patient, MKS should be kept in mind.

Usefulness of admission red blood cell distribution width as a predictor of severity of acute pulmonary embolism.

BACKGROUND: Previous researches have represented a considerable relation between acute pulmonary embolism (PE) and red blood cell distribution width (RDW). To the authors' knowledge no research has been informed in subjects with PE severity. Pulmonary arterial obstruction index (PAOI) is associated with the severity of acute PE. OBJECTIVES: In our investigation, we purposed to assess the relation between PAOI and RDW and the benefit of these factors in the detection of PE severity. METHODS: We retrospectively investigated the demographic information, probability of clinical scores, laboratory parameters, serum D-dimer levels, and echocardiographic findings of systolic pulmonary artery pressure (PAP) in Acute PE individuals who were diagnosed by computed tomography of pulmonary arterial angiography. Right ventricular dysfunction (RVD) on CT was assessed by calculating the right ventricular/left ventricular (RV/LV) diameter ratios on transverse (RV/LVtrans). RESULTS: The information of 131 patients with acute PE and 51 (64.6%) female and 28 (35.4%) male healthy control were evaluated. Acute PE group's RDW values were higher than control subjects (P < .0001). RDW (%) level was remarkable higher in patients with massive PE than in patients with nonmassive PE. There were statistically considerable differences in terms of PAOI and systolic pulmonary arterial pressure (sPAP) between nonmassive and massive PE patients (P < .0001 for all). CONCLUSIONS: PAOI was correlated with PE severity, D-dimer level, sPAP and clinical probability scores. PAOI was correlated with RDW levels. RDW levels, an inexpensive and easily measurable laboratory factor, were considerable associated with the severity and presence of PE.

Swyer-James-Macleod syndrome mimicking an acute pulmonary embolism: a report of six adult cases and a retrospective analysis.

BACKGROUND AND AIM: In patients with pulmonary embolism (PE), a pulmonary radiograph may reveal oligemic fields (the Westermark sign) associated with sites of occlusion of the pulmonary arteries, interruption or loss of the artery line (the knuckle sign), and even unilateral hyperlucency attributable to reduced overall lung vascularity. In Swyer-James-Macleod syndrome (SJMS), which develops as a result of bronchiolitis obliterans, unilateral hyperlucency is evident because of emphysema and hypoplasia of the pulmonary artery and its branches. Therefore, SJMS cases with clinical and laboratory data compatible with PE may in fact be confused with PE. The cases of six adult patients who were initially presumed to have PE but on further investigation were diagnosed with SJMS are presented in this report, which thus can serve as a guide for diagnosis of similar cases in future. METHODS: We studied six adult patients who presented with dyspnea. Their pulmonary radiographs revealed lobar/unilateral hyperlucency and PE was initially suspected. The pulmonary artery and branches thereof exhibited parenchymal emphysema and hypoplasia, and we thus diagnosed SJMS. RESULTS: We studied 4 males and 2 females with a mean age of 51 years (range, 20-73 years). Left lung involvement was evident in five cases. CONCLUSION: Unilateral hyperlucency may be a feature of both PE and SJMS. Although these conditions are very different, both present similarly in radiographic terms and may be easily confused when the clinical data and the anamnesis raise a suspicion of PE, causing unnecessary testing and treatment.

The effects of treatment in patients with childhood asthma on the elastic properties of the aorta.

INTRODUCTION: The study aimed to investigate the effects of treatment in patients with childhood asthma on the elastic properties of the aorta and cardiovascular risk. METHODS: The study was performed in 66 paediatric patients diagnosed with bronchial asthma (BA). All patients were administered the ß2 agonist, salbutamol, for seven days, followed by one month of montelukast and six months of inhaled steroid treatment. All patients underwent conventional transthoracic echocardiographic imaging before and after treatment. Aortic elasticity parameters were considered to be the markers of aortic function. RESULTS: Aortic elasticity parameters, including aortic strain (15.2 ± 4.8 and 18.8 ± 9.5%, p = 0.043), aortic distensibility (7.26 ± 4.71 and 9.53 ± 3.50 cm2/dyn, p = 0.010) and aortic stiffness index (3.2 ± 0.6 and 2.8 ± 0.5, p = 0.045 showed significant post-treatment improvement when compared to pre-treatment values. Tricuspid annular plane systolic excursion (TAPSE) was also observed to improve after treatment (1.81 ± 0.38 and 1.98 ± 0.43, p = 0.049). CONCLUSION: The study demonstrated that when provided at appropriate doses, medications used in BA may result in an improvement in aortic stiffness.

Is Decreased Mean Platelet Volume in Allergic Airway Diseases Associated With Extent of the Inflammation Area?

OBJECTIVE: The aim of this study was to determine the relationship between mean platelet volume (MPV) level and the extent of airway inflammation in allergic airway diseases and in subgroups by comparison of inflammatory markers. MATERIALS AND METHODS: A retrospective examination was made of 250 patients with allergic airway disease in the symptomatic phase, who had been newly diagnosed or who had abandoned treatment for at least 6 months. These patients were separated into 3 groups of asthma without allergic rhinitis (A - AR, n = 107), asthma with allergic rhinitis (A + AR, n = 83) and allergic rhinitis without asthma (AR - A, n = 60). RESULTS: The MPV values of the study groups were found to be significantly lower than those of the control group (P < 0.001). MPV was determined to be negatively correlated with white blood cells, neutrophil count, platelet count and immunoglobulin E level in the study groups. The lowest MPV value was determined in the A + AR group (8.035 ± 1.05fL), which had the most extensive airway involvement, and the highest MPV value was determined in the AR - A group (8.109 ± 1.11fL) with the least airway involvement. MPV level sensitivity and the specificity of the best cutoff level were 74.5% and 40.8%, respectively. The cutoff level of 8.18fL for MPV level was found to have moderate sensitivity and low specificity for predicting pulmonary embolism. CONCLUSIONS: The results of this study showed that MPV is lower in allergic airway diseases and a negative correlation was determined between MPV and inflammation markers but no statistically significant difference was determined between MPV and extent of the inflammation area.

Pulmonary alveolar proteinosis in a marble worker.

Pulmonary alveolar proteinosis (PAP) is a rarely seen disease of the alveoli, characterized by accumulation of proteinous material, which stains positive with periodic acid Schiff, in the alveoli. Secondary PAP may develop as a result of occupational exposure to materials such as silica and indium. In the paper, together with a review of the relevant literature, we present an uncommon case of a 47-year old male, marble worker who was diagnosed with PAP associated with a 12-year history of exposure to marble dust. Int J Occup Med Environ Health 2016;29(5):871-876.

Increased Exhaled 8-Isoprostane and Interleukin-6 in Patients with Helicobacter pylori Infection.

BACKGROUND: Helicobacter pylori (H. pylori) infection triggers both local inflammation, usually in gastric mucosa, and chronic systemic inflammation. It is assumed that this local and systemic inflammation is caused by extracellular products excreted by H. pylori. The aim of this study was to investigate the possible association between H. pylori infection and a local inflammatory response in the airway by using exhaled breath condensate technique. MATERIALS AND METHODS: This study includes 41 H. pylori seropositive patients who have gastric symptoms and 27 healthy control subjects. Pulmonary function tests (PFT), chest X ray, and physical examination were performed in all patients and interleukin-6 (IL-6), 8-isoprostane and nitrotyrosine levels were measured in exhaled breath condensate. RESULTS: Levels of IL-6 and 8-isoprostane in exhaled breath condensate (EBC) were significantly higher in H. pylori positive patients than control subjects (p < 0.05). Nitrotyrosine levels were also higher in H. pylori positive patients but the difference was not statistically significant. Both groups had similar leukocyte counts, C-reactive protein (CRP) levels and PFT parameters. CONCLUSION: H. pylori infection causes an asymptomatic airway inflammation which can be detected by exhaled breath condensate. The clinical importance of this inflammation remains unclear.

Influence of obstructive sleep apnea on ischemia-modified albumin levels and carotid intima-media thickness.

Obstructive sleep apnea (OSA) is associated with an increased risk of atherosclerosis. Carotid intima-media thickness (CIMT) is strongly associated with the presence of significant risk factors for cardiovascular disturbances. A disturbance in the oxidative/antioxidative balance is involved in the pathogenesis of OSA and cardiovascular diseases. Ischemia-modified albumin (IMA) is suggested as a novel marker of oxidative stress; IMA can be defined as decreased binding of transitional metal ions to serum albumin in oxidative status. The purpose of this research was to evaluate the influence of OSA on IMA levels and CIMT. In total, 61 individuals with OSA with no comorbidities and 24 healthy controls with a similar body mass index and age were enrolled in this study. Serum levels of IMA, CIMT (estimated radiologically), and polysomnographic parameters, were determined and interpreted. Serum IMA levels were significantly higher in individuals with OSA compared with the control group (p=0.0003). CIMT was significantly higher in the OSA group compared with the control group (0.88± 0.26 mm vs 0.75±0.17 mm, p=0.005). The CIMT and serum IMA levels were positively correlated with the apnea-hypopnea index (r=0.35 and r=0.32, respectively), and with the oxygen desaturation index (r=0.34 and r=0.29, respectively) at baseline. Increased IMA levels and CIMT may be related to increased oxidative stress and risk of atherosclerosis in individuals with OSA.

Depressive Symptoms in Patients with Obstructive Sleep Apnea.

OBJECTIVES: Different studies have investigate depressive symptom degree within sleep disordered patients with obstructive sleep apnea (OSA). However, little is known and unclear about OSA in patients with depression symptom in the literature. The purpose of this study was to investigate patients with OSA would have a higher prevalence of depression symptom relative to control patients. MATERIAL AND METHODS: 72 patients with OSA (AHI ≥ 5) and 24 control subjects (AHI < 5) were assessed for depression symptom using the Beck Depression Inventory. Participants were underwent an overnight polysomnography assessment. An apnea-hypopnea index ≥ 5 events per hour was used as diagnosis for OSA. The associations between each total score on the Beck Depressive Inventory (BDI) and polysomnographic parameters were examined by correlation analysis. RESULTS: We demonstrated that BDI scores has statistically significant correlation with the OSA in our present study according to similar previous studies (p= 0.008). Oxygen Desaturation Index (ODI) has correlated with BDI (r= 0.31). CONCLUSION: These findings show that the frequency depression symptom is higher among individuals with OSA. Patients with OSA should be screened cautiously for depressive disorders.

What should be done in the event of simultaneous massive pulmonary embolism and myocardial infarction with ST elevation?

Massive pulmonary embolism (MPE) and acute myocardial infarction (AMI) are life-threatening conditions with well-known diagnosis and treatment. Symptoms and findings such as dyspnea, chest pain, hypotension, ECG changes and elevation of cardiac enzymes are seen in both diseases. However, MPE and AMI are rarely simultaneous in a single case. This report presents an 85-year-old patient with simultaneous MPE and AMI with ST elevation. While treatment strategies for both MPE and AMI have been adequately described, it is not clear which treatment to choose when both emergency pathologies occur simultaneously in one patient. This case report discusses the treatment of these two diseases in such a case.

Effect of resveratrol on treatment of bleomycin-induced pulmonary fibrosis in rats.

Resveratrol has a preventive potential on bleomycin-induced pulmonary fibrosis in prophylactic use; however, it was not studied in the treatment of the fibrosis. This study investigated the role of resveratrol on the treatment of bleomycin-induced pulmonary fibrosis. Intratracheal bleomycin (2.5 mg/kg) was given in fibrosis groups and saline in controls. First dose of resveratrol was given 14 days after bleomycin and continued until sacrifice. On 29th day, fibrosis in lung was estimated by Aschoft's criteria and hydroxyproline content. Bleomycine increased the fibrosis score (3.70 ± 1.04) and hydroxyproline levels (4.99 ± 0.90 mg/g tissue) as compared to control rats (1.02 ± 0.61 and 1.88 ± 0.59 mg/g), respectively. These were reduced to 3.16 ± 1.58 (P = 0.0001) and 3.08 ± 0.73 (P > 0.05), respectively, by resveratrol. Tissue malondialdehyde levels in the bleomycin-treated rats were higher (0.55 ± 0.22 nmol/mg protein) than that of control rats (0.16 ± 0.07; P = 0.0001) and this was reduced to 0.16 ± 0.06 by resveratrol (P = 0.0001). Tissue total antioxidant capacity is reduced (0.027 ± 0.01) by bleomycine administration when compared control rats (0.055 ± 0.012 mmol Trolox Equiv/mg protein; P = 0.0001) and increased to 0.041 ± 0.008 (P = 0.001) by resveratrol. We concluded that resveratrol has some promising potential on the treatment of bleomycin-induced pulmonary fibrosis in rats. However, different doses of the drug should be further studied.

Influence of snoring on microalbuminuria in diabetic patients.

OBJECTIVE: Obstructive sleep apnea (OSA) and snoring are known independent risk factors for insulin resistance. Microalbuminuria is an early marker of diabetic nephropathy and an independent risk factor for cardiovascular disease. The aim of our study was to search the prevalence of self-reported snoring and high-risk pre-test OSA diagnosis in diabetic patients and search the influence of snoring on microalbuminuria. METHODS: A total of 237 diabetic patients (mean age, 58.6 ± 12.4 years; 126 males), were asked to complete the Berlin Questionnaire that includes questions about snoring, witnessed apnea, tiredness, history of high blood pressure and/or BMI < 30 kg/m(2). Also, their past and current medical records were reviewed for their medications, diabetic control, and complications like neuropathy, retinopathy, and microalbuminuria. RESULTS: According to the Berlin Questionnaire, a high pre-test probability for the diagnosis of OSA was found in 47.3% of the patients. Snoring was detected in 60.3% of the patients. The mean Epworth Sleepiness Scale score was 7.8 ± 4.6 and 31.6% of the patients reported excessive daytime sleepiness. We found that the both BMI and waist circumferences were significantly associated with snoring and high-risk pre-test OSA. There were no differences for age, gender, fasting glucose, HbA1c, and lipid panels between snorers and non-snorers, and between high-risk pre-test OSA and low-risk pre-test OSA patients. Microalbuminuria was significantly more common in patients who snore. Although snoring was independently associated with microalbuminuria, there were no differences between groups for other microvascular diabetic complications. CONCLUSION: Prevalence of OSA-related symptoms was very common in diabetic patients and further prospective studies are needed to elucidate the role of OSA's effect on diabetic control and complications.