Drug allergy in tertiary care in Turkey: results of a national survey. The ADAPT study: adult drug allergy perception in Turkey.

BACKGROUND: No data are available on the incidence of drug hypersensitivity (DH) reactions in outpatient settings of tertiary allergy/immunology clinics. Our aims were to document the frequency of outpatient hospital admissions due to DH reactions to allergy/immunology clinics in adults and the management of these reactions in real life. We also investigated whether drug allergy affected social and medical behaviours of the patients. METHODS: This multi-centre study was performed for one year with the participation of 11 out of 16 tertiary allergy/clinical immunology clinics in Turkey. The study group consisted of the patients with DH reactions. Results of a questionnaire including drug reactions and management were recorded. RESULTS: Among 54,863 patients, 1000 patients with DH were enrolled with a median of 2.1% of all admissions. In real life conditions, the majority of approaches were performed for finding safe alternatives (65.5%; 1102 out of 1683) with 11.7% positivity. Diagnostic procedures were positive in 27% (154/581) of the patients. The majority of the patients had higher VAS scores for anxiety. A total of 250 subjects (25%) reported that they delayed some medical procedures because of DH. CONCLUSION: Our results documented the frequency of admissions due to DH reactions to allergy/clinical immunology clinics for the first time. Although physicians mostly preferred to perform drug tests in order to find safe alternatives, considering the fact that DH was confirmed in 27% of the patients, use of diagnostic tests should be encouraged, if no contraindication exists in order to avoid mislabelling patients as DH.

An epidemiological study in an Anatolian village in Turkey environmentally exposed to tremolite asbestos.

After several cases of malignant pleural mesothelioma (MPM) were detected in the village of Kureysler in the Kütahya district of western Turkey, an epidemiological study was conducted. A questionnaire was completed by 124 villagers who were older than 20 years and standard posteroanterior chest X-rays were taken. The films were evaluated by three chest physicians. Samples of the white stucco that had been used by almost all villagers for indoor painting for many years were mineralogically examined. Chest X-rays showed that 23 (18%) had pleural plaques and calcifications compatible with asbestos exposure. Male sex and old age were associated with occurrence of pleural plaques. An analysis of white stucco samples revealed tremolite asbestos. In conclusion, tremolite fibers might be the cause of the high incidence of pleural plaques and MPM cases in the village of Kureysler.

Percutaneous treatment of pulmonary hydatid cysts.

PURPOSE: To evaluate the safety and efficacy of percutaneous drainage of pulmonary hydatid cysts. METHODS: Eleven pulmonary hydatid cysts in eight patients were drained percutaneously after 1-2 years of treatment with mebendazole (50 mg/kg/day). Percutaneous needle aspiration was carried out under ultrasound (US) in six patients and computed tomography (CT) in two patients. Nine cysts were close to, and two cysts were distant from the thoracic wall. After aspiration, hypertonic (15%) saline solution was instilled for up to 35% of the estimated volume of the cyst and aspirated 5-10 min later. Follow-up ranged from 8 to 31 months (mean 16.3 months). RESULTS: Neither anaphylactic shock nor death occurred in any of the eight patients. One patient developed fever, ipsilateral hydropneumothorax, and contralateral pleural effusion. One patient suffered from fever, pneumothorax, and abscess and was treated surgically; one developed fever and dyspnea. The volume reduction during follow-up was 47%-93%. The cystic contents turned into a pseudotumor appearance with a thick irregular contour on CT and higher Hounsfield units. On US, the cysts showed a heterogeneous content with internal echoes representing detached and degenerated membranes, and the fluid content almost completely disappeared. CONCLUSION: We believe that percutaneous therapy of pulmonary hydatid disease is an effective alternative to surgical treatment in patients who have failed medical therapy.

Bronchial asthma in a patient with Usher syndrome: case report.

The Usher syndrome is a recessively inherited disorder characterized by the associated deficits of sensorineural hearing impairment and a progressive retinal degeneration called retinitis pigmentosa. A case of Usher syndrome is reported in a 22-year-old atopic patient with asthma. To our knowledge, such an association has not been described previously in the literature.

Peritoneal mesothelioma: sonographic findings in nine cases.

Ultrasonographic findings in nine cases of peritoneal mesothelioma are presented. The most common findings were sheet-like or nodular peritoneal thickening, soft tissue masses, fixation of the intestinal loops, mesenteric thickening, and minimal ascites which was disproportional to the degree of tumor dissemination. The authors found that abdominal sonography, using 3.75-7.5 MHz transducers, is a useful imaging method for diagnosis of peritoneal mesothelioma in high-risk groups.

Life threatening chylous pleural and pericardial effusion in a patient with Behçet's syndrome.

Chylothorax and chylopericardium secondary to thrombosis of the superior vena cava and the innominate and subclavian veins were diagnosed in a patient with Behçet's syndrome. Immunosuppressive treatment, diet, and underwater seal drainage led to a diminished volume of pleural fluid and pericardial fluid and to a diminished concentration of triglyceride in them; pleurodesis with tetracycline was then performed.

CT findings in malignant pleural mesothelioma related to nonoccupational exposure to asbestos and fibrous zeolite (erionite).

Endemic malignant pleural mesothelioma (MPM) in Turkey is related to two mineral fibers, tremolite asbestos and fibrous zeolite (erionite). Thirteen cases of MPM from the Cappadocian area, where the soil is rich in erionite, and 29 cases of MPM, from villages whose occupants have high asbestos exposure, were examined by CT. The CT findings of the two groups of MPM were compared with respect to the configuration of the pleural lesions, stage of disease, fissural involvement, pleural effusion, presence of calcified pleural plaques, and chronic fibrosing pleuritis. In erionite-related MPM the pleural lesions were flat and smooth in 69.1%; in asbestos-related MPM the lesions were nodular in 55.1%. Stage IV disease, calcified pleural plaques, and chronic fibrosing pleuritis were more common in the erionite-related MPM. The rest of the findings were similar in both groups. The early radiological diagnosis of erionite-related MPM may be even more difficult because of the similarity of the pleural lesions to chronic fibrosing pleuritis.

Endobronchial hamartoma removed by rigid bronchoscope.

An endobronchial hamartoma of the right lower lobe was discovered in a 60 yr old female patient. She had been diagnosed and treated for chronic intractable bronchial asthma for more than 10 yrs. The endobronchial hamartoma was successfully removed with a rigid bronchoscope.

Endobronchial tuberculosis. A report on 15 cases.

Fifteen patients were diagnosed between 1973 and 1987 at Hacettepe University Hospital as having endobronchial tuberculosis. They were subjected to bronchoscopy because of provisional diagnoses of primary bronchogenic carcinoma in 7 cases, bronchial asthma in 3 cases, tuberculosis in 2 cases and hydatid cyst, foreign body aspiration and bronchiectasis in 1 case each. In those patients in whom the initial clinical diagnosis was primary bronchogenic carcinoma, it was difficult to differentiate endobronchial tuberculosis either by radiography or bronchoscopy.