Diagnostic and Therapeutic Role of Electrocautery Snare Use in Endobronchial Polypoid Lesions.

INTRODUCTION: Electrocautery with a snare probe offers a tool for the treatment of endobronchial polyps. The aim of this study was to demonstrate the efficacy of the snare probe in patients undergoing rigid bronchoscopy due to central airway obstruction. METHODS: This retrospective descriptive study included patients who underwent rigid bronchoscopy with an electrocautery snare probe for the diagnosis and/or treatment of endobronchial polyps in an interventional pulmonology unit. RESULTS: The mean age of the 47 patients (38 men) with endobronchial polypoid lesions was 61.5 years. Six lesions (12.8%) were located in the trachea, 6 (12.8%) in the right main bronchus, 11 (23.4%) in the left main bronchus, and 24 (51.1%) in the lobar bronchi. Twenty-eight lesions (59.5%) were malignant. Prior to the procedure, 6 (12.8%) patients had grade 1 obstruction, 6 (12.8%) had grade 2 obstruction, 15 (31.9%) had grade 3 obstruction, and 20 (42.6%) had grade 4 obstruction. In terms of airway obstruction after the procedure, grade 1 was present in 46 (97.9%) patients and grade 2 was present in 1 (2.1%) patient. No major complication developed in 93.6% of the patients. During a mean follow-up period of 48 months, 85.1% of the patients did not experience recurrence. CONCLUSION: Our results demonstrate that the snare probe can be used to effectively and reliably establish airway patency in patients with central airway obstruction due to endobronchial polypoid lesions.

The impact of deep venous thrombosis on 90 day mortality in chronic obstructive pulmonary disease patients presenting with pulmonary embolism.

BACKGROUND: There are a limited number of studies investigating the effect of deep venous thrombosis (DVT) in patients presenting with both pulmonary embolism and chronic obstructive pulmonary disease. The aim of this study is to investigate the prevalence and prognostic significance of DVT in patients with PE-COPD. METHODS: COPD patients admitted with a diagnosis of PE to our tertiary hospital between January 2016 and January 2021 were retrospectively evaluated with an electronic hospital database. Univariate and multivariate Cox regression analyses were performed to reveal independent prognostic factors. RESULTS: Two hundred thirty-three patients (mean age 65.1 ± 12.2, 158 men (67.5 %)) were included. DVT was present at the time of diagnosis in 45 (19.31 %) of the patients. Patients with DVT tend to have more comorbidities, central pulmonary embolism, higher CRP and d-dimer levels, and SPESI score (p<0.05). After performing multivariate analyses, the presence of DVT (HR=3.48, CI: 1.02- 11.88, p = 0.046), ischemic heart disease (HR=3.82, CI: 1.38- 10.80, p = 0.01), and malignancy (HR=4.85, CI: 1.53- 15.41, p = 0.007) were found to be independent factors in predicting 90-day mortality. CONCLUSIONS: In PE-COPD patients, co-existing DVT may predict a worse outcome.

Late Diagnosis of Foreign Body Aspiration in Adults: Case Series and Review of the Literature.

BACKGROUND: Tracheobronchial foreign body (FB) aspiration (FBA) is a life-threatening emergency mostly observed in childhood and advanced age. With early diagnosis, the FB can be removed using bronchoscopic methods without causing irreversible damage. METHODS: This was a single-center, retrospective observational study. Subjects diagnosed with FBA via either bronchoscopic methods and/or radiological findings, having no medical history of aspirated FB, and who were detected to have aspirated FB for longer than 30 days were included in the study. Medical records and radiological and bronchoscopic findings of the subjects were investigated from the hospital information database system. RESULTS: Of the 255 patients with FBA, 17.6% (N = 45) were diagnosed late. The mean age was 53 y; 28% were female, and 60% of the subjects had a history of ever smoking. The estimated residence time of the FB in the bronchial system was 22.8 months. The most common complaints were cough and shortness of breath. Forty-two percent of the aspirated FBs were organic material. FB artifact could be observed in 6.7% of posteroanterior chest radiographs and 65% of thorax computed tomography (CT) scans. Rigid bronchoscopy had been primarily preferred as therapeutic interventional procedure. It was also found that the artifact most frequently resided in the right bronchial system and was most commonly found in the right lower lobe, while granulation tissue was formed in 85% of the subjects. CONCLUSIONS: The findings of the present study demonstrate that subjects tended to forget the FBA, leading to insidious respiratory system symptoms, with recurrent infections. In cases with an endobronchial mass lesion image on thorax CT, clinicians should consider the possibility of FBA. Delayed diagnosis of both organic and inorganic FB may cause granulation tissue.

Triglyceride-glucose index as a predictor of obstructive sleep apnoea severity in the absence of traditional risk factors / Índice de triglicerídeos-glicose como preditor de gravidade da apneia obstrutiva do sono na ausência de fatores de risco tradicionais

Abstract Objective We evaluated the association between the triglyceride-glucose (TG) index, a marker of insulin resistance, and obstructive sleep apnoea (OSA) severity in patients without diabetes mellitus, obesity, and metabolic syndrome. Methods This retrospective cohort study included 1,527 patients. We used univariate and multivariate analyses to identify the independent predictors associated with OSA. Results Most patients were males (81.5%) with a mean age of 43.9 ± 11.1 (15-90) years. Based on the apnoea-hypopnea index (AHI), 353 (23.1%) patients were included in the control group, whereas 32.4%, 23.5%, and 21% had mild, moderate, and severe OSA, respectively. The TG index values demonstrated significant associations with OSA patients compared with the control group (p = 0.001). In addition, the mean values of the oxygen desaturation index (ODI), AHI, minimum oxygen saturation, and total sleep time percentage with saturation below 90% demonstrated statistically significant differences among the TG index groups (p: 0.001; p:0.001; p:0.001; p:0.003). The optimal TG index cutoff value to predict OSA was 8.615 (AUC = 0.638, 95% CI = 0.606-0.671, p = 0.001). In multivariate logistic regression analysis, after adjusting for age, sex, and body mass index, the TG index was independently associated with OSA patients. Conclusion The TG index is independently associated with increased risk for OSA. This indicates that this index, a marker for disease severity, can be used to identify severe OSA patients on waiting lists for PSG.

Resumo Objetivo Avaliamos a associação entre o índice triglicerídeos-glicose (TG), um marcador de resistência à insulina, e a gravidade da apneia obstrutiva do sono (AOS) em pacientes sem diabetes mellitus, obesidade e síndrome metabólica. Métodos Este estudo de coorte retrospectivo incluiu 1.527 pacientes. Utilizamos análises univariadas e multivariadas para identificar os preditores independentes associados à AOS. Resultados A maioria dos pacientes era do sexo masculino (81,5%) com idade média de 43,9 ± 11,1 anos (15-90). Com base no índice apneia-hipopneia (IAH), 353 (23,1%) pacientes foram incluídos no grupo de controle, enquanto 32,4%, 23,5% e 21% tinham AOS leve, moderada e grave, respectivamente. Os valores do índice TG demonstraram associações significativas com pacientes com AOS em comparação com o grupo de controle (p = 0,001). Além disso, os valores médios do índice de dessaturação de oxigênio (IDO), IAH, saturação mínima de oxigênio e porcentagem de tempo total de sono com saturação abaixo de 90% demonstraram diferenças estatisticamente significativas entre os grupos de índice TG (p = 0,001; p = 0,001; p = 0,001; p = 0,003). O valor de corte ideal do índice TG para prever a AOS foi de 8,615 (AUC=0,638, IC de 95% = 0,606-0,671, p = 0,001). Na análise de regressão logística multivariada, após o ajuste para idade, sexo e índice de massa corporal, o índice TG foi independentemente associado a pacientes com AOS. Conclusão O índice TG está independentemente associado a um maior risco de AOS. Isso indica que este índice, um marcador de gravidade da doença, pode ser usado para identificar pacientes com AOS grave em listas de espera para polissonografia.

Tracheal Stenosis After Prolonged Intubation Due to COVID-19.

OBJECTIVES: The authors aimed to evaluate the characteristics and management outcomes of patients who developed tracheal stenosis after invasive mechanical ventilation (IMV) due to COVID-19. DESIGN, SETTING, AND PARTICIPANTS: The data of 7 patients with tracheal stenosis and 201 patients without tracheal stenosis after IMV due to COVID-19 between March 2020 and October 2021 were retrospectively analyzed. INTERVENTIONS: Flexible bronchoscopy was performed for the diagnosis of tracheal stenosis and the evaluation of the treatment's effectiveness, and rigid bronchoscopy was applied for the dilatation of tracheal stenosis. MEASUREMENTS AND MAIN RESULTS: In the follow-up period, tracheal stenosis was observed in 7 of 208 patients (2 women, 5 men; 3.3%). The patients were divided into 2 groups as patients with tracheal stenosis (n = 7) and patients without tracheal stenosis (n = 201). There were no statistically significant differences between the 2 groups in terms of age, sex, body mass index, and comorbidities (p > 0.05). The mean duration of IMV of the patients with tracheal stenosis was longer than patients without tracheal stenosis (27.9 ± 13 v 11.2 ± 9 days, p < 0.0001, respectively). Three (43%) of the stenoses were web-like and 4 (57%) of them were complex-type stenosis. The mean length of the stenoses was 1.81 ± 0.82 cm. Three of the patients were treated successfully with bronchoscopic dilatation, and 4 of them were treated with tracheal resection. CONCLUSIONS: Tracheal stenosis developed in 7 of 208 (3.3%) patients with COVID-19 who were treated with IMV. The most important characteristic of patients with tracheal stenosis was prolonged IMV support.

The Role of Serum Galectin-3 Levels in Patients with Sarcoidosis.

INTRODUCTION: Galectin-3 is a multifunctional protein, the levels of which increase in the presence of diseases that progress with pulmonary fibrosis. This study investigated the role of galectin-3 levels in the staging and assessing of the severity of sarcoidosis. METHODS AND SUBJECTS: Seventy-three subjects were studied; 25 were healthy individuals and 48 patients had pathologically confirmed diagnosis of sarcoidosis in which other potential causes had been ruled out. Galectin-3 levels were measured and compared in terms of such parameters as hemogram, biochemistry, age, body mass index, and smoking status. RESULTS: The mean galectin-3 levels of the sarcoidosis patients (14.87 ± 5.57) were significantly higher than those in the healthy subjects (11.81 ± 2.67), and the mean galectin-3 levels differed significantly among different stages of the disease (p < 0.05). The serum galectin-3 level in patients with stage 2, 3, and 4 sarcoidosis was found to be higher than in patients with stage 0 and 1 sarcoidosis and the control group. In addition, serum galectin-3 levels in the sarcoidosis patients had significant positive correlations with blood urea nitrogen, alkaline phosphatase, white blood cells, red blood cell, hemoglobin, and neutrophil levels (34.9% [p < 0.05]; 40.1% [p < 0.05]; 41.2% [p < 0.01]; 43.3% [p < 0.01]; 34.7% [p < 0.05]; and 40.6% [p < 0.01], respectively) and a significant negative correlation with the platelet distribution width levels (p < 0.05). CONCLUSION: Serum galectin-3 levels are significantly elevated in sarcoidosis patients with parenchymal involvement at stage 2 or higher, suggesting that serum galectin-3 levels can be used to estimate disease severity in sarcoidosis.

Management of recurrent hemoptysis: a single-center experience.

BACKGROUND: A successful planning methodology for patients with hemoptysis promises overall improvement in patient care. Conducted in a reference center for chest diseases, the present study aims to analyze characteristics and predictors of interventional methods in patients with recurrent hemoptysis. METHODS: The present study is a single-center, retrospective observational study. Between 2015 and 2018, 5973 patients with follow-up data until 2021 requiring more than one hospitalization due to recurrent hemoptysis were investigated. Patient characteristics, the amount of hemoptysis, baseline admission parameters, interventional procedures of bronchial artery embolization (BAE), fiberoptic bronchoscopy, rigid bronchoscopy, and surgical resections applied were analyzed according to number of hospitalizations and outcome. RESULTS: : Hospital admission numbers were higher in patients with sequela of tuberculosis, bronchiectasis and lung cancer. While lung cancer was the most frequent underlying reason in recurrent admissions, it was determined that as the amount of bleeding increased, the number of admissions also increased to the hospital, and BAE and rigid bronchoscopy were performed more frequently in the groups with less frequent admissions. There was no statistically significance between the amount of bleeding, and the interventional procedure alone or in combination with another procedure (p > 0.05). DISCUSSION: In conclusion, patients with certain diseases may experience frequent hospital admissions due to hemoptysis. Recurrent admissions may get better results with BAE and rigid bronchoscopy. We think that these procedures should be preferred in the foreground of suitable patient selection in line with available facilities and experience.

Seizures in patients with respiratory disease - a retrospective single center study.

OBJECTIVE: Seizures are a neurological condition commonly experienced during the follow-up period after systemic or metabolic disorders. The aim of the present study was to determine the etiological factors of seizures in patients at a tertiary care chest clinic. METHODS: We reviewed all neurology consultations that were requested due to seizures in inpatient clinics in a tertiary care hospital specializing in respiratory disorders between January 2011 and January 2018 were retrospectively reviewed. RESULTS: The present study included 705 of 2793 (25.2%) patients who requested consultations for seizures during the study period. The mean age of the sample was 64.05±17.19 years. Of the 705 patients, 307 (43.5%) had a previous history of epilepsy (Group I) and 398 (56.5%) had a first-time seizure and were considered to have symptomatic seizures (Group II). Multiple factors played roles in the development of seizures in 54.8% of the patients. In most patients, metabolic causes, systemic infections, and drug use were identified and an intracranial metastatic mass lesion was the major cause in patients with lung cancer. Rates of hypoxemia and respiratory acidosis were significantly higher in patients with symptomatic seizures (Group II) than in patients with primary epilepsy (Group I). CONCLUSIONS: Blood gas changes such as hypoxemia and respiratory acidosis were among the factors statistically associated with the development of symptomatic seizures in patients with respiratory diseases. Additionally, hypoxemia, hypercapnia, and respiratory acidosis were correlated with mortality in patients hospitalized for respiratory system diseases who requested consultations for seizures.

Seizures in patients with respiratory disease - a retrospective single center study / Convulsões em pacientes com doença respiratória - estudo retrospectivo de centro único

ABSTRACT Objective: Seizures are a neurological condition commonly experienced during the follow-up period after systemic or metabolic disorders. The aim of the present study was to determine the etiological factors of seizures in patients at a tertiary care chest clinic. Methods: We reviewed all neurology consultations that were requested due to seizures in inpatient clinics in a tertiary care hospital specializing in respiratory disorders between January 2011 and January 2018 were retrospectively reviewed. Results: The present study included 705 of 2793 (25.2%) patients who requested consultations for seizures during the study period. The mean age of the sample was 64.05±17.19 years. Of the 705 patients, 307 (43.5%) had a previous history of epilepsy (Group I) and 398 (56.5%) had a first-time seizure and were considered to have symptomatic seizures (Group II). Multiple factors played roles in the development of seizures in 54.8% of the patients. In most patients, metabolic causes, systemic infections, and drug use were identified and an intracranial metastatic mass lesion was the major cause in patients with lung cancer. Rates of hypoxemia and respiratory acidosis were significantly higher in patients with symptomatic seizures (Group II) than in patients with primary epilepsy (Group I). Conclusions: Blood gas changes such as hypoxemia and respiratory acidosis were among the factors statistically associated with the development of symptomatic seizures in patients with respiratory diseases. Additionally, hypoxemia, hypercapnia, and respiratory acidosis were correlated with mortality in patients hospitalized for respiratory system diseases who requested consultations for seizures.

RESUMO Objetivo: Convulsões são uma condição neurológica comumente vivenciada durante o período de acompanhamento após distúrbios sistêmicos ou metabólicos. O objetivo do presente estudo foi determinar os fatores etiológicos das convulsões em pacientes de uma clínica torácica de atendimento terciário. Métodos: Foram revisadas retrospectivamente todas as consultas neurológicas solicitadas devido a convulsões em clínicas de internação em um hospital terciário especializado em distúrbios respiratórios entre janeiro de 2011 e janeiro de 2018. Resultados: O presente estudo incluiu 705 dos 2.793 (25,2%) pacientes que solicitaram consultas para convulsões durante o período do estudo. A idade média da amostra foi de 64,05±17,19 anos. Dos 705 pacientes, 307 (43,5%) tinham história prévia de epilepsia (Grupo I) e 398 (56,5%) tiveram uma convulsão inicial e foram considerados como tendo crises sintomáticas (Grupo II). Vários fatores desempenharam papel no desenvolvimento de convulsões em 54,8% dos pacientes. Na maioria dos pacientes, causas metabólicas, infecções sistêmicas e uso de drogas foram identificadas e uma lesão em massa metastática intracraniana foi a principal causa em pacientes com câncer de pulmão. As taxas de hipoxemia e acidose respiratória foram significativamente maiores em pacientes com crises sintomáticas (Grupo II) do que em pacientes com epilepsia primária (Grupo I). Conclusões: Alterações dos gases sanguíneos, como hipoxemia e acidose respiratória, foram alguns dos fatores estatisticamente associados ao desenvolvimento de convulsões sintomáticas em pacientes com doenças respiratórias. Além disso, hipoxemia, hipercapnia e acidose respiratória foram correlacionadas com a mortalidade em pacientes hospitalizados por doenças do sistema respiratório que solicitaram consultas para convulsões.

Comparison of silicon and metallic bifurcated stents in patients with malignant airway lesions.

INTRODUCTION AND OBJECTIVE: Silicon and metallic are two types of stents in use. In this study, we compared complications and long-term survival among patients who received silicon or fully covered, bifurcated self-expandable metallic stents (SEMS) for a malignant tracheobronchial obstruction and/or tracheo/bronchial oesophageal fistulas. METHODS: Patients in whom Y-shaped stents were used from January 2013 to June 2017 in our interventional pulmonology unit were evaluated retrospectively from patient files. RESULTS: Of the 47 patients, 30 (23 males, 76.7%) were in the silicon stent group and 17 (14 males, 82.4%) were in the covered SEMS group. No differences between the groups were detected in ECOG status, pathological properties of the disease, radiotherapy or chemotherapy history before the procedure, symptoms at presentation, or comorbidities. The most common symptom was dyspnoea (96.7% and 100%), and the most common comorbidity was chronic obstructive pulmonary disease (26.7% and 23.5%). A total of 20 complications (42.6%) were seen, with no significant difference between the groups (silicon, 40%; SEMS, 47.1%; P = . 62). Mean survival was 164.51 ± 38.83 days for the silicon stent group and 254.45 ± 103.32 days for the SEMS group (P = .588). No differences were observed in 30-, 90- or 180-day mortality between the two groups (P = .966, .846 and .534, respectively). CONCLUSIONS: No significant differences in symptom palliation, insertion safety, complication rate or survival were detected between the two types of stent.

Use of interventional bronchoscopic treatment in small cell lung cancer.

AIMS: Small cell lung cancer (SCLC) constitutes 15%-25% of all lung cancers. Their treatment approach is different from nonsmall cell lung cancer. Central airway obstruction develops at the time of diagnosis or eventually at some time as the disease progress. Quick relief of symptoms with chemotherapy will cause to postpone interventional bronchoscopy which divest patient from benefits of this procedure. There is a few data about the use of interventional bronchoscopy in SCLC. SUBJECTS AND METHODS: Between January 2005 and December 2012, rigid bronchoscopy under general anaesthesia was done in a total of 944 cases. Among them, 52 consecutive SCLC cases were evaluated retrospectively. STATISTICAL ANALYSIS: Survival was calculated from the date of application of therapeutic bronchoscopy using statistical software. RESULTS: From the 52 cases (41 males) mean age of the patients were 56,87 ± 10,16 (range 34-78). Most common obstruction areas were distal trachea and carina invasion involving both main bronchus (n: 12; 23%). Most common method used was mechanical desobstruction after coagulation with diode diode laser or APC. A total of 16 stents was applied to 15 of the cases from 52 cases (28.8%). Most common used stent was silicon Y stent (n: 11). Most common complication during the procedure was bleeding that was mild in 11 cases and massive in 1. One patient died during the procedure (1.9%). CONCLUSIONS: Multimodal interventional bronchoscopic methods seem to be a last option but may be useful in the management of advanced airway obstruction in the setting of SCLC. The choice of modality may be chosen depending upon individual patient characteristics as appropriate.

Are flexible bronchoscopic cryoextraction practices an alternative to rigid bronchoscopy?

INTRODUCTION: We aimed to evaluate the efficacy of flexible bronchoscopic cryoextraction in the treatment of airw ay obstruction arise from mucus plugs and blood clots and present our experience. MATERIALS AND METHODS: The present study evaluated patients who previously underwent unsuccessful flexible bronchoscopy for the removal of secretions and blood clots in the central airway and who underwent flexible bronchoscopic cryoextraction between January 2013-November 2017. RESULT: The study included seven patients with a mean age of 58.29 ± 18.56 years (28-76). Three patients underwent bedside intervention in the intensive care unit, and four patients underwent an intervention in the bronchoscopy unit. Seven patients underwent a total of nine sessions of cryoextraction. Severe complications or mortality did not occur during the cryoextraction sessions. CONCLUSIONS: Flexible bronchoscopic cryoextraction offers a safe treatment strategy as an alternative to rigid bronchoscopy in patients in whom airway patency cannot be achieved using other flexible bronchoscopic interventions. and accuracy of PET was higher compared to CT with this cut-off value.

Bronchoscopic Treatment of Benign Endoluminal Lung Tumors.

Background and Aim: Endobronchial benign tumors are a rarely seen clinical entity but may cause significant symptoms. Endobronchial treatment has the potential for relieving symptoms while saving the patient from invasive surgical procedures. No trials have been published that present and compare the various endobronchial treatment modalities for endobronchial benign tumors. The aim of the present study is to define safety and efficacy of endobronchial treatment in patients with benign endobronchial tumors from the point of complications and success rate. Methods: This study is a retrospective cohort study from a review of medical charts. Eligibility criteria included diagnosis of a benign endobronchial tumor. Our institution's bronchoscopy and pathology database was searched for specific benign tumors, and the results were further detailed based on the endobronchial location. Results: Forty-four patients with pathologically confirmed benign endobronchial tumors were included. Tumor regression was achieved in all patients with diode laser and argon plasma coagulation in combination with or without cryotherapy and without any major complication. There were no significant differences between the use of either diode laser or of argon plasma coagulation as a modality with immediate effect from the occurrence of residual tissue that needed cryotherapy (P > 0.05). There were no major complications. Eight patients had minor complications including minor bleeding (6 patients) and hypertension (2 patients) that were controlled medically. Thirty-one patients (70%) had very good response, and 13 patients (30%) had good response as defined in literature before. Conclusion: Diode laser and argon plasma coagulation in combination with or without cryotherapy are safe and effective methods for endobronchial treatment of benign endobronchial tumors.

Endoscopic and Surgical Treatment of Benign Tracheal Stenosis: A Multidisciplinary Team Approach.

PURPOSE: Surgical resection and reconstruction are considered the most appropriate approaches to treat post-intubation tracheal stenosis (PITS). Bronchoscopic methods can be utilized as palliative therapy in patients who are ineligible for surgical treatment or who develop post-surgical re-stenosis. We investigated treatment outcomes in patients with benign tracheal stenosis. METHODS: A retrospective review was performed in patients who were diagnosed with PITS. Tracheal resection was performed for operable cases, whereas endoscopic interventions were preferred for inoperable cases with a complex or simple stenosis. RESULTS: In total, 42 patients (23 treated by bronchoscopic methods, 19 treated by surgery) took part in this study. No significant differences were observed in segment length, the proportion of obstructed airways, or vocal cord distance between the two groups. In all, 15 patients in the bronchoscopic treatment group received a stent. Following the intervention, the cure rates in the bronchoscopic and surgical treatment groups were 43.47% and 94.7%, respectively. A multidisciplinary approach resulted in a cure or satisfactory outcome in 90.5% of the patients while failure was noted in 9.5% of the patients. CONCLUSION: Bronchoscopic methods are associated with a lower cure rate compared to surgery. A multidisciplinary approach was helpful for treatment planning in patients with PITS.

Recovery process and determinants of adverse event occurrence in bronchoscopic procedures performed under general anaesthesia.

OBJECTIVE: Regarding the fact that rigid bronchoscopy is generally performed under general anaesthesia and this patient subgroup is remarkably morbid, encountering procedure and/or anaesthesia related complications are highly likely. Here, we aimed to assess factors influencing recovery and detect possible determinants of adverse event occurrence during these operations performed in a tertiary referral centre. METHODS: Eighty-one consecutive ASA I-IV patients were recruited for this investigation. In the operating theatre after induction of anaesthesia and advancement of the device, maintenance was provided with total intravenous anaesthesia. Neuromuscular blockage was invariably administered, and patients were ventilated manually. In addition to preoperative demographic and procedural characteristics, perioperative hemodynamic variables, recovery times and observed adverse events were noted. RESULTS: Basic demographic properties, ASA and Mallampati scores, and procedure specific variables as lesion localization, lesion and procedure type were comparable among groups assembled with reference to event occurrence. Patients who had experienced adverse event had higher heart rates. Recovery times were comparable between Event (-) and Event (+) groups. Relationship of recovery process were individually tested with all variables and only lesion type was detected to have an effect on respiration and extubation times. Among all parameters only procedural time seemed to be associated with adverse event occurrence (mins, 22.9 ± 11.9 vs 41.6 ± 28.8, P < .001). CONCLUSION: Recovery times related with return of spontaneous respiration were significantly lower in procedures performed for treatment of tumoral diseases in this study and procedure length was determined to be the ultimate factor which had an impact on adverse event occurrence.

Modified Mallampati Score Improves Specificity of STOP-BANG Questionnaire for Obstructive Sleep Apnea.

BACKGROUND: An accurate, clinical screening tool for obstructive sleep apnea (OSA) that identifies patients for further diagnostic testing would assist in the diagnosis of this comorbidity. One example, the STOP-BANG questionnaire (SBQ), has been validated as a screening tool with high sensitivity. However, its specificity may result in a high false-positive rate. The aim of this study to determine if addition of the Modified Mallampati score to the SBQ improves its specificity. METHODS: The authors studied 162 patients referred to the Sleep Disorders Clinic at Yedikule Chest Disease Education and Research Hospital. All patients were prospectively screened for risk of OSA using the SBQ, their oral anatomy was assessed by Modified Mallampati scoring, and sleep quality characterized by polysomnography. Polysomnography results were reviewed when available and the predictive performance of the SBQ and the modified SBQ scoring models were compared. RESULTS: In the authors' study an SBQ score ≥3 yielded sensitivities of 0.85, 0.86, and 0.91 for Apnea-Hypopnea Index (AHI) ≥5/h, AHI ≥15/h, and AHI ≥30/h, respectively, and specificities of 0.09, 0.10, and 0.18. The modified SBQ with a cutoff of ≥4 (>3) points for AHI levels of >5, >15, and >30 yielded respective sensitivities of 0.84, 0.86, and 0.91 and specificities of 0.25, 0.26, and 0.27. CONCLUSIONS: The author's results from indicated the modified SBQ with a cutoff of >3 points in this study was more specific than the standard SBQ but no less sensitive, and may be used in identifying OSA patients for further diagnostic evaluation or avoiding unnecessary testing.