Bronchiectasis in Türkiye: Data from a Multicenter Registry (Turkish Adult Bronchiectasis Database).

Background: Bronchiectasis is a chronic lung disease characterized by permanent bronchial wall dilatation. Although it has been known as an orphan disease, it has recently gained attention because of registry-based studies and drug research. Aims: We aimed to use a multicenter database to analyze and compare data regarding the etiology, associated comorbidities, microbiological characteristics, and preventive strategies of bronchiectasis in Türkiye to those of other countries. Study Design: A multicenter prospective cohort study. Methods: The multicenter, prospective cohort study was conducted between March 2019 and January 2022 using the Turkish Adult Bronchiectasis Database, in which 25 centers in Türkiye participated. Patients aged > 18 years who presented with respiratory symptoms such as cough, sputum, and dyspnea and were diagnosed with non-cystic fibrosis bronchiectasis using computed tomography were included in the study. Demographic information, etiologies, comorbidities, pulmonary functions, and microbiological, radiological, and clinical data were collected from the patients. Results: Of the 1,035 study participants, 518 (50%) were females. The mean age of the patients was 56.1 ± 16.1 years. The underlying etiology was detected in 565 (54.6%) patients. While postinfectious origin was the most common cause of bronchiectasis (39.5%), tuberculosis was identified in 11.3% of the patients. An additional comorbidity was detected in 688 (66.5%) patients. The most common comorbidity was cardiovascular disease, and chronic obstructive pulmonary disease (COPD) and bronchiectasis was identified in 19.5% of the patients. The most commonly detected microbiological agent was Pseudomonas aeruginosa (29.4%). Inhaled corticosteroids (ICS) were used in 70.1% of the patients, and the frequency of exacerbations in the last year was significantly higher in patients using ICS than in nonusers (p < 0.0001). Age [odds ratio (OR): 1.028; 95% confidence interval (CI): 1.005-1.051], cachexia (OR: 4.774; 95% CI: 2,054-11,097), high modified medical research council dyspnea scale score (OR: 1,952; 95% CI: 1,459-2,611), presence of chronic renal failure (OR: 4,172; 95% CI: 1,249-13,938) and use of inhaled steroids (OR: 2,587; 95% CI: 1,098-6,098) were significant risk factors for mortality. Mortality rates were higher in patients with COPD than in those with no COPD (21.7-9.1%, p = 0.016). Patients with bronchiectasis and COPD exhibited more frequent exacerbations, exacerbation-related hospitalizations, and hospitalization in the intensive care unit in the previous year than patients without COPD. Conclusion: This is the first multicenter study of bronchiectasis in Türkiye. The study results will provide important data that can guide the development of health policies in Türkiye on issues such as infection control, vaccination, and the unnecessary use of antibiotics and steroids.

Evaluation of Exudative Pleural Effusions: A Multicenter, Prospective, Observational Study.

PURPOSE: The aim of this study is to determine the diagnostic performances of pleural procedures in undiagnosed exudative pleural effusions and to evaluate factors suggestive of benign or malignant pleural effusions in tertiary care centers. METHODS: This was a multicenter prospective observational study conducted between January 1 and December 31, 2018. A total of 777 patients with undiagnosed exudative pleural effusion after the initial work-up were evaluated. The results of diagnostic procedures and the patients' diagnoses were prospectively recorded. Sensitivity, specificity, and accuracy estimates with 95% confidence intervals were used to examine the performance of pleural procedures to detect malignancy. RESULTS: The mean age ± SD of the 777 patients was 62.0 ± 16.0 years, and 68.3% of them were male. The most common cause was malignancy (38.3%). Lung cancer was the leading cause of malignant pleural effusions (20.2%). The diagnostic sensitivity and accuracy of cytology were 59.5% and 84.3%, respectively. The diagnostic sensitivity of image-guided pleural biopsy was 86.4%. The addition of image-guided pleural biopsy to cytology increased diagnostic sensitivity to more than 90%. Thoracoscopic biopsy provided the highest diagnostic sensitivity (94.3%). The highest diagnostic sensitivity of cytology was determined in metastatic pleural effusion from breast cancer (86.7%). CONCLUSION: The diagnostic performance increases considerably when cytology is combined with image-guided pleural biopsy in malignant pleural effusions. However, to avoid unnecessary interventions and complications, the development of criteria to distinguish patients with benign pleural effusions is as important as the identification of patients with malignant pleural effusions.

18F-FDG PET/CT texture analysis of anthracotic lymph nodes detected with EBUS and comparison with cytological findings.

OBJECTIVE: Lymph node metastasis is the most important factor both in the selection of treatment since many alternatives have been created in recent years, and in the evaluation of prognosis in lung cancer. The most unpredictable cause of lymph node false positivity in fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) is anthracosis. The aim of this study is to compare 18F-FDG PET/CT texture information of anthracotic (ALN) and metastatic (MLN) lymph nodes, after re-evaluation of the cytological samples obtained from anthracotic lymph nodes by EBUS-TBNA. SUBJECTS AND METHODS: Ninety nine patients, 78 of whom had primary lung cancer were included in the study. Two hundred and three lymph nodes from 99 patients sampled by EBUS-TBNA and diagnosed cytologically as ALN or MLN were evaluated retrospectively. All ALN were classified as grades 1, 2 and 3 cytologically. Volume of interest (VOI) of 203 lymph nodes was re-drawn and maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) values were recorded. RESULTS: There was a statistically significant difference in MTV and TLG values in MLN and all ALN grades. However, only grade 1-2 ALNs could be differentiated from MLNs with SUVmax, and no statistically significant difference was found in grade 3 ALN and MLN. Metabolic tumor volume and TLG values over 4.10cm3 and 26.57 showed 60% and 59% sensitivity and 83% and 94 specificity respectively for the identification of MLN. CONCLUSION: The contribution of MTV and TLG values of 18F-FDG PET/CT to the differential diagnosis of ALN is much more valuable than SUVmax values, especially for grade 3 anthracosis. It was thought that cytological reporting of only grade 3 ALN could make a better contribution to the 18F-FDG PET/CT evaluation analysis.

Rapid On-site Evaluation and Final Cytologic Diagnoses Correlation During Endobronchial Ultrasonography.

BACKGROUND: The cost-effectiveness and low rate of inadequate sampling with the use of rapid on-site evaluation (ROSE) along with endobronchial ultrasonography (EBUS) is well established. Our aim in this study was to evaluate the correlation of ROSE during EBUS and final cytologic diagnosis and also to see if ROSE might predict the subtype of lung cancer. PATIENTS AND METHODS: All consecutive subjects who attended our clinic between January 2016 and January 2019 for the evaluation of pathologic mediastinal and/or hilar lymph nodes (LNs)/mass using EBUS were enrolled into our prospective study. ROSE was performed in the same operating room with EBUS. ROSE results during EBUS were recorded. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of ROSE compared with the final cytologic diagnosis were evaluated. RESULTS: We enrolled 684 LN/mass lesions belonging to 328 patients into this study. When we compared ROSE results and final cytologic diagnosis, these procedures agreed on 91.6% of the LNs (P<0.001). The sensitivity of ROSE and final cytologic diagnosis for granulomatous inflammation was 72.5%, and for lung cancer, it was 89.2% (P<0.001). The sensitivity of ROSE for the adenocarcinoma subtype of lung cancer was 67.7%, and it was 70% for small cell lung cancer. CONCLUSION: ROSE may help to recognize non-small cell lung cancer during EBUS, especially the adenocarcinoma subtype of lung cancer, which will help ensure having sufficient material for molecular analysis.

Appropriate use of tocilizumab in COVID-19 infection.

OBJECTIVE: This study aimed to describe the effectiveness and optimum use of tocilizumab (TCZ) treatment by the support of clinical, laboratory and radiologic observations. METHODS: All patients were followed up in the hospital with daily interleukin-6 (IL-6), C-reactive protein (CRP), ferritin, d-dimer, full blood count, and procalcitonin. Thoracic computed tomography (CT) was performed on admission, when oxygen support was necessary, and seven days after TCZ started. Disease course of the patients was grouped as severe or critical, according to their clinical, laboratory and radiologic evaluations. RESULTS: Forty-three patients were included: 70% were male; the median age was 64 years (minimum-maximum: 27-94); and six (14%) patients died. The median duration of oxygen support before the onset of TCZ was shorter among the severe patient group than the critical patient group (1 vs. 4 days, p < 0.001). Three cases of 21 (14%) who received TCZ in the ward were transferred to ICU, and none of them died. The levels of IL-6, CRP, ferritin, d-dimer, and procalcitonin were significantly lower in the severe cases group than the critical cases group (p = 0.025, p = 0.002, p = 0.008, p = 0.002, and p = 0.001, respectively). Radiological improvement was observed in severe cases on the seventh day of TCZ. Secondary bacterial infection was detected in 41% of critical cases, but none of the severe ones. CONCLUSION: Earlier use of TCZ in COVID-19 infection was beneficial for survival, length of hospitalization and duration of oxygen support. The recommendation for administration of TCZ was based on an increase in requirement of oxygen support, progression in thoracic CT, and elevation of inflammation markers, including IL-6, CRP, ferritin, and d-dimer, and decrease in % lymphocytes.

The role of endobronchial ultrasonography elastography for predicting malignancy.

BACKGROUND: This study aims to investigate the role of endobronchial ultrasonography elastography in predicting malignancy. METHODS: Between January 2016 and December 2016, a total of 221 lymph nodes were biopsied using the endobronchial ultrasonography-guided transbronchial needle aspiration from 119 consecutive patients (69 males, 50 females; mean age 63.2±12.4 years; range, 16 to 86 years) were included. Lymph nodes were scored by elastography according to their colors in four categories before the procedure. The strain ratio was calculated based on the region of interest after three measurements. RESULTS: Of the patients, 93 were diagnosed with a malignancy through endobronchial ultrasonography-guided transbronchial needle aspiration biopsy. The mean lymph node score of benign versus malignant lesions was 2.2±1.0 and 3.2±1, respectively (p<0.001). There was a positive correlation between the lymph node scores and lymph node diameter, strain ratio, ≥3 of lymph node scoring, the sensitivity for malignancy was 79% and specificity was 60%. The mean strain ratio for malignant and benign lymph nodes was 22.2±30.1 and 5.2±1.7, respectively (p<0.001). With a cut-off value of ≥2.47 of strain ratio, the sensitivity for malignancy was 75% and specificity was 65%. The combined use of positron emission tomography and lymph node score or strain ratio yielded 80.4% and 61.2% sensitivity and 80% and 70.3% specificity for malignancy, respectively. CONCLUSION: Endobronchial ultrasonography elastography is useful in predicting malignancy of the lymph nodes. When combined with positron emission tomography, specificity and positive predictive value for malignancy increase.

Regional distribution of genetic mutation in lung cancer in Turkey (REDIGMA).

INTRODUCTION: The results of standard chemotherapy in lung cancer are not very satisfactory, so it is important to identify genetic mutations that provide targeted therapies. Recent reports have suggested influences of racial difference on the frequency of mutation in lung cancer. We aimed to determine the frequency and regional distribution of genetic mutations of non-small cell lung cancer (NSCLC) in Turkey. MATERIALS AND METHODS: Regional distribution of genetic mutations in lung cancer in Turkey (REDIGMA) study was carried out as a prospective, cross-sectional, observational study in a large number of centers in which lung cancer patients were followed and could perform genetic mutation analysis on patients' biopsy materials. RESULT: The 703 patients (77.7% male, mean age 63.3 ± 12.5 years) who were diagnosed as NSCLC from 25 different centers were included in the study. Tumor samples from patients were reported as 87.1% adenocarcinoma, 6.4% squamous cell carcinoma and 6.5% other. Mutation tests were found to be positive in 18.9% of these patients. The mutations were 69.9% EGFR, 26.3% ALK, 1.6% ROS and 2.2% PDL. Mutations were higher in women and non-smokers (p<0.000, p<0.001). Again, the frequency of mutations in adenocarcinoma was higher in metastatic disease. There was no difference between the patient's age, area of residence, comorbidity and clinical stage and mutation frequency. CONCLUSIONS: Our study revealed that the EGFR mutation rate in Turkey with NSCLC was similar to East European, African-American and Caucasian patients, and was lower than in East Asia.

Can positron emission tomography/computed tomography be predictive of diagnostic success in endobronchial biopsies performed through a fiber-optic bronchoscopy in lung cancer?

PURPOSE: The purpose of this study is to investigate the effect of homogeneous/heterogeneous (necrotic) involvement and maximum standardized uptake value (SUVmax) value of the lesion on positron emission tomography-computed tomography (PET-CT) of patients who underwent fiberoptic bronchoscopy (FOB) for prediagnosis of lung cancer and biopsy for endobronchial lesion on the diagnostic success of biopsy procedure. METHODS: Between January 2014 and December 2016, patients with final diagnosis of pulmonary malignancy as determined by FOB biopsy and patients who failed to be diagnosed by FOB biopsy and diagnosed with pulmonary malignancy by a different diagnostic method were examined. These patients were divided into two groups as those with diagnosis by FOB biopsy (Group 1) and those who failed to be diagnosed by this method and diagnosed with pulmonary malignancy by a different diagnostic method (Group 2). The SUVmax values of the two groups were compared with lesion characteristics of homogeneous, heterogeneous involvement/presence of necrotic component as shown by PET-CT. Group data were assessed by Chi-square test and Mann-Whitney U-test. In all tests, P < 0.05 was considered significant. FINDINGS: A total of 193 participants with a mean age of 61 ± 9.4 were included in the study. There were 128 (66.3%) cases in Group 1 and 65 (33.7%) cases in Group 2. The mean SUVmax value was 16.4 in Group 1 and 15.1 in Group 2. There was no statistically significant difference between the two groups (P = 0.329). Homogeneous involvement was present in 103 (80.3%) cases in Group 1 versus 42 (64.6%) cases in Group 2. In the presence of homogeneous PET-CT involvement, diagnosis rate by biopsy was significantly higher (P = 0.016). CONCLUSION: We concluded that the high SUVmax value of the mass lesion on PET-CT did not increase the diagnostic value of the biopsy procedure in patients prediagnosed with lung cancer and that the diagnostic success of FOB biopsy was poor in cases where PET-CT showed heterogeneous involvement of the mass lesion.

A New Modality for the Diagnosis of Bleomycin-induced Toxicity: Ultrasonography.

OBJECTIVE: To evaluate the role of ultrasonography (USG) in the diagnosis of bleomycin-induced pulmonary toxicity (BT). MATERIAL AND METHODS: The study included patients with suspected BT during treatment with bleomycin due to various oncologic diseases between June 2015 and May 2017. The patients initially underwent clinical and high-resolution computed tomography (HRCT) examinations and pulmonary function tests (PFT)-diffusing capacity of the lung for carbon monoxide (DLCO), followed by registration of USG findings-number of comet tail artifact (CTA) images by a different pulmonologist. We compared the findings from USG, HRCT, and PFT-DLCO tests between BT and non-BT groups. With the diagnosis based on clinical-radiologic and PFT-DLCO assessments taken as the gold standard, we determined the sensitivity and specificity of the USG outcomes for diagnosis of BT. RESULTS: The study included a total of 30 patients. Nine patients were diagnosed as having BT according to their clinical and radiologic findings and PFT-DLCO measurements. The mean number of CTA images was 68.7±22 in patients with BT vs 28.2±9.3 in those without BT (P<.001). The difference in CTA images between the patients with and without ground glass density was statistically significant (28.3±9.5 and 64.6±24.5, respectively, P<.001). In patients with BT, there was a negative correlation between the number of CTAs and DLCO% and FVC% values (P=.004; P=.016). USG had a sensitivity of 100%, and a specificity of 95% diagnosing BT in selected patients. CONCLUSION: In bleomycin-induced toxicity, USG findings are correlated with HRCT and PFT-DLCO findings, with a remarkably increased number of CTAs in BT. Thoracic USG examination is a diagnostic tool with a high sensitivity and specificity for diagnosing BT.

Relationship of asymmetric dimethylarginine levels with disease severity and pulmonary hypertension in chronic obstructive pulmonary disease.

BACKGROUND: Asymmetric dimethylarginine (ADMA) has emerged as a risk marker for many conditions related to pulmonary hypertension (PH); however, little is known about ADMA and symmetric dimethylarginine (SDMA) plasma concentrations in chronic obstructive pulmonary disease (COPD). Our interest centers on the role of ADMA in regulation of endothelial function in COPD and secondary PH. The aim of the present study was to evaluate the serum ADMA, SDMA, and L-arginine concentrations in COPD and its association with PH. METHODS: Patients with diagnosis of COPD underwent pulmonary function tests, echocardiography, and laboratory investigations including ADMA, SDMA, and L-arginine. RESULTS: Serum concentrations of ADMA, SDMA, and L-arginine tend to increase as COPD progresses. Patients with PH had higher concentrations of ADMA, SDMA, and L-arginine compared to cases with normal pulmonary arterial pressure (PAP); the difference was not statistically significant. CONCLUSIONS: Our results show that increased ADMA, SDMA, and L-arginine concentrations are associated with increased PAP measurements in patients with COPD, however, the relationship is not statistically significant.

The Effect of Pulmonary Function Testing on the Success of Smoking Cessation.

BACKGROUND: In several studies, low spirometric levels have been shown to increase the success rates of smoking cessation, whereas other studies have indicated that pulmonary function has no effects on quitting smoking. Given the fact that there are contradictory results on this subject, we aimed to investigate the effect of identifying airway obstruction via spirometry and its explanation to subjects on the success rate of smoking cessation in the short term. METHODS: Subjects who were admitted to the smoking cessation out-patient clinic, underwent pulmonary function tests (PFTs) and completed at least 3 months of the cessation program following their admittance were included in the study. At the first interview, all subjects were asked about their comorbid diseases and smoking habits. PFTs were performed. Subjects who had an obstruction on PFT were informed that their condition was smoking-related, and that further deterioration could be prevented following smoking cessation. Then the smoking cessation date was determined together with the subject, and one of the smoking cessation medicines was prescribed. All subjects were given control appointments twice for the first month and once per month for the following 2-month follow-up period. Subjects who had CO levels between 0 and 5 parts per million were considered as non-smokers. RESULTS: The mean age of the 563 subjects was 41.9 ± 12.1 y 340 subjects (60.4%) were male. A total of 162 subjects (28.8%) came to the follow-up visits following the first interview. The success of smoking cessation for 3 months was 11.3% for all subjects and 39.5% for subjects who came to follow-up visits. Of the subjects with obstruction on PFT; 22.8% stopped smoking, whereas 8.4% of the subjects without obstruction did so (P < .001). The percentage of subjects with obstruction on PFT was significantly higher (P < .001) and the FEV1 % (P = .005), FEV1/FVC (P < .001), and forced expiratory flow 25-75% (P = .008) levels were significantly lower in the quitters compared with the non-quitters. Logistic regression analysis showed that age (P = .001) and the presence of obstruction on PFT (P = .029) were independent variables. CONCLUSIONS: Advanced age and the presence of obstruction on PFT increase the success of smoking cessation. Pulmonary function tests should be performed on all patients who apply to smoking cessation out-patient clinics, and patients should be informed about their condition.

Complications of Convex-Probe Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: A Multi-Center Retrospective Study.

BACKGROUND: Infrequent serious complications of convex-probe endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) have been reported. The aim of this study was to assess serious complications related to convex-probe EBUS-TBNA and to determine the complication rate in a large group of subjects. METHODS: In this retrospective study, a 15-item questionnaire on features of cases with EBUS-TBNA complications was sent to experienced bronchoscopists performing convex-probe EBUS-TBNA at 3 pulmonary centers. The medical records were then reviewed by these bronchoscopists to complete the questionnaire. Hemorrhage responsive to topical treatment, temporary laryngospasm/bronchospasm, transient oxygen desaturation, and fever lasting <24 h were excluded. Only complications requiring further treatment/intervention were considered serious. The rate of serious complications was calculated from the obtained data. RESULTS: In a total of 3,123 cases within a 5-y period, EBUS-TBNA was performed for staging lung cancer in 15.8%, diagnosis in 67.5%, and diagnosis and staging in 16.3%. Of the 3,123, 11.6% had parenchymal lesions adjacent to major airways. EBUS-TBNA was performed 11,753 times (3.76/case) at 6,115 lymph node stations and lesions (1.92/station or lesion). Five serious complications were recorded (0.16%): fever lasting >24 h, infection of bronchogenic cyst, mediastinal abscess, pericarditis, and pneumomediastinitis with empyema, each in one case. Four complications occurred in cases diagnosed with benign disease by EBUS-TBNA. All complications were treated with broad-spectrum antibiotics. Four subjects were hospitalized for 21.7 ± 20.7 d. CONCLUSIONS: Convex-probe EBUS-TBNA is a safe method in general. However, serious complications, including infections, can be encountered rarely. All precautions should be taken for complications before and during the procedure.

Can a Computer-Based Prescription of Free Medication Increase Smoking Cessation Rates Efficiently?

OBJECTIVES: In 2011, in the context of a research project, bupropion and varenicline were distributed to smoking cessation clinics by the Ministry of Health of Turkey to be prescribed free of charge by a computer-based system. In the present study, we compared smoking cessation rates between patients who were prescribed free medications during the period of the project and those who had to pay for their medication. MATERIAL AND METHODS: Six hundred four patients who applied during the project period were given either bupropion or varenicline, which were prescribed using an algorithm-based computer system. Three hundred sixteen patients who applied after that period were prescribed medicines deemed appropriate by the attending physician but had to pay for the medication on their own. Follow-up visits were arranged for one year. Carbon monoxide (CO) levels in the expired air were used as indicators of cessation. RESULTS: A total of 537 patients began treatment, of which 438 (81.6%) applied during the first period (group 1) and 99 (18.4%) applied during the second period (group 2). The mean age and concomitant disease presence were higher in the second-period patients (p< 0.05). Advanced age, comorbidities, pathological findings in spirometry, and chest X-ray were also higher in those who paid for the cost of their treatment (p= 0.009, 0.001, 0.006, 0.001, respectively). Smoking cessation rates were found to be 14.8% and 27.3% after six months (p= 0.008) and 10.7% and 18.2% after one year (p= 0.059), respectively, for group 1 and group 2. Age, dependence score, cigarettes smoked (as pack-years), and percentage of patients who paid for the treatment were found to be significantly higher (p< 0.001, 0.021, 0.018, 0.001, respectively) for those who quit smoking at the end of six months. For the patients who quit smoking at the end of one year, age was found to be significantly higher (p= 0.008), and the number of males was higher, although the difference was not statistically significant (p= 0.05). When logistic regression analysis was applied, age, dependence score, and paid treatment were found to be independent variables (p= 0.002, 0.008, 0.012, respectively) for those who quit smoking at the end of six months. Only age was found to be an independent variable for those who quit smoking at the end of one year (p= 0.029). CONCLUSION: More smokers could receive treatment by the distribution of free drugs. However, quitting rates at the end of six months were higher when patients had to pay for their treatment. On the other hand, quitting rates at the end of one year were not affected by whether the treatment was paid for or free of charge. The most important factor increasing quitting rates at the end of six months and one year was found to be advanced age.

Endobronchial ultrasound-guided transbronchial needle aspiration in diagnosing intrathoracic tuberculous lymphadenitis.

AIMS: Patients with suspected tuberculosis without pulmonary lesions and with intrathoracic lymphadenopathy often pose a diagnostic challenge. The aim of this study was to describe the diagnostic utility of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in patients with isoleted intrathoracic lymphadenopathy due to tuberculosis (TB). MATERIALS AND METHODS: Cases with tuberculous lymphadenitis (TBLA) as the final diagnosis were analysed among patients in whom EBUS-TBNA had been performed. All patients underwent routine clinical assessment and a CT scan prior to EBUS-TBNA. Demographic data, pathological findings, and microbiological results were recorded. All patients received 6-month antituberculous treatment, followed-up regularly and recovered both on clinical and radiological basis. RESULTS: Forty-four patients were included. EBUS-TBNA diagnosed TB intrathoracic lympadenopathy in 42 (95.4%) patients. In 2 patients, EBUS-TBNA was not able to confirm a diagnosis and additional procedures were required. Cytopathological findings alone revealed TB in 32 (72.7%) patients. One of the patients (2.2%) was smear positive while microbiological investigations provided a positive culture of TB in 22 (50%) patients. TB culture was positive in 10 of 12 patients in whom cytopathologic evaluation was not able to diagnose. Addition of mycobacterium culture to cytopathologic investigation s improved the diagnostic yield from 72.7% to 95.4%. CONCLUSION: EBUS-TBNA is a safe and effective first line investigation for evaluating isolated intrathoracic tuberculous lympadenopathy. Addition of mycobacterium culture to cytopathologic investigation improves the sensitivity of EBUS-TBNA.

The utility of endobronchial ultrasound-guided transbronchial needle aspiration in mediastinal or hilar lymph node evaluation in extrathoracic malignancy: Benign or malignant?

OBJECTIVE: Newly arising enlarged or hypermetabolic mediastinal/hilar lymph nodes (LNs) in patients with previously diagnosed extrathoracic malignancies raise suspicion of metastasis. Relatively high proportion of these LNs is due to a benign condition. We aimed to determine frequency of malignant LNs and role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for clarification of the origin of suspicious LNs in these patients. METHODS: Consecutive patients with a known extrathoracic malignancy and suspected hilar/mediastinal LN were included in this prospective study. Computed tomography (CT) of thorax and positron emission tomography-CT of all patients were taken. LNs with short axis >1 cm at CT of thorax and SUV ≥ 2.5 were accepted suspicious for malignancy. All patients underwent EBUS-TBNA for pathological verification of LNs. Patients with benign diagnosis either underwent invasive procedures or were followed up. The results were evaluated for frequency of malignant hilar/mediastinal LNs and sensitivity, specificity, and diagnostic values of EBUS-TBNA. RESULTS: A total of 48 cases with a mean age of 57.4±11.6 were included. All cases had the diagnosis of an extrathoracic malignancy. 78 LNs were aspirated with EBUS-TBNA in 48 cases (1.62 LNs/patient). The mean short axis of aspirated LNs was 1.51±0.63. Results of EBUS-TBNA revealed malignancy in 15 cases (31.2%), tuberculosis in six cases (12.5%), sarcoidosis in four cases (8.3%), and reactive adenitis in 23 cases (48%). The sensitivity, specificity, and negative predictive value of EBUS-TBNA for malignancy were 83.3%, 100%, and 90.9%, respectively. When both benign and malignant diseases were considered, sensitivity, specificity, negative predictive value, and diagnostic accuracy of EBUS-TBNA were 89.2%, 100%, 86.9%, and 93.7%, respectively. CONCLUSIONS: The ratio of benign LNs in patients with extrathoracic malignancies is relatively high. EBUS-TBNA is a safe, minimally invasive, and effective method for clarification of intrathoracic LNs.

[Clinical, radiological and bronchoscopic evaluation of inhalation injury cases treated at a burn center]. / Yanik merkezimizde takip edilen inhalasyon yanigi olgularinda, klinik, radyolojik ve bronkoskopik degerlendirme.

BACKGROUND: We aimed to introduce inhalation injury, pulmonary complications and mortality-related factors on the basis of clinical, radiological and bronchoscopic findings in patients with inhalation burns. METHODS: Between January 2009 and January 2010, patients hospitalized in the intensive care unit (ICU) of a burn center who were diagnosed as inhalation burn and underwent bronchoscopy were included in the study. Demographic findings, burn type, burn percentage, clinical-laboratory features, chest Xray findings on the first and fifth days, and bronchoscopic lesions were obtained from patient files. Bronchoscopic findings were classified, and bronchoscopic score for each patient was calculated. Clinical, laboratory and radiological findings, length of stay in the ICU, and bronchoscopic scores of patients who were discharged versus of those who died were compared, and mortality-related factors were investigated. RESULTS: Twenty-nine patients (25 male, 4 female; mean age 40.1 +/- 3.4 years) were included. Radiological abnormalities were found in 41.3% and 65.5% of patients on the first and fifth days of hospitalization, respectively. There were no complications related to bronchoscopy. Percentage of burn and duration of stay in the ICU were higher in patients who died than in discharged patients (20.4%-48.5%, p = 0.003; mean: 7.0-13.7 days, p = 0.037, respectively). Of patients who died, 79.1% showed radiological abnormality and 50% had acute respiratory distress syndrome (ARDS) on the fifth day of hospitalization. There were no pathologic findings on chest X-ray and no ARDS was seen on the fifth day in patients who were discharged (p < 0.05). CONCLUSION: Inhalation burns in patients with cutaneous burns cause a high percentage of pulmonary complications and increase mortality. Bronchoscopy must be performed early for diagnosis, and close follow-up of these patients is necessary.

The role of convex probe endobronchial ultrasound guided transbronchial needle aspiration in the diagnosis of malignant mediastinal and hilar lymph nodes.

BACKGROUND: In the diagnosis of malignant lymph nodes (LNs) and staging of lung cancer, sampling of mediastinal and hilar LNs is essential. Mediastinoscopy is known as the gold standard. Convex probe (CP) endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) is a noninvasive and highly sensitive diagnostic method in mediastinal and hilar LN sampling. OBJECTIVES: Evaluating the role of CP-EBUS-guided TBNA in the diagnosis of mediastinal and hilar LNs suspicious of malignancy. PATIENTS AND METHODS: One hundred twenty patients with a known lung malignancy or hilar/mediastinal LNs detected by thoracic computed tomography (CT) and/or positron emission tomography (PET)-CT suspicious for malignancy were included in this prospective study. The procedure was performed by Olympus 7.5 MHz CP endoscope and EU C2000 processor by the oral route under topical anesthesia and conscious sedation. After visualization of LNs, their dimensions were recorded. Aspiration was considered as "insufficient" if there were inadequate lymphocytes on the smears. Diagnosis of "malignancy" on cytologic examination was considered as the "final diagnosis". If diagnosis was negative for malignancy, more invasive procedures were performed to confirm the diagnosis. RESULTS: Twenty four females and 96 male patients (mean age, 57.8 ± 9.1) were included. A total of 177 LN stations were aspirated in 120 patients. In 82 patients, the diagnosis was malignant by EBUS-guided TBNA and in the remaining 38; the diagnosis was established by further invasive procedures. Of the 38 EBUS-guided TBNA negative patients, 28 were diagnosed as non-malignant and 10 were malignant. The sensitivity, diagnostic accuracy and negative predictive value of CP EBUS-guided TBNA were 89.1%, 91.6% and 73.6%, respectively. No major complications were seen. CONCLUSION: As an alternative method to mediastinoscopy, EBUS-guided TBNA is a safe and noninvasive procedure with high sensitivity in the diagnosis of malignant mediastinal LNs.

Sensitivity of convex probe endobronchial sonographically guided transbronchial needle aspiration in the diagnosis of granulomatous mediastinal lymphadenitis.

OBJECTIVES: The purpose of this study was to investigate the sensitivity and diagnostic value of convex probe endobronchial sonographically guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of granulomatous mediastinal lymphadenitis. METHODS: Patients clinically and radiologically suspected to have granulomatous mediastinal disease and followed in our clinic between October 2008 and July 2010 were included. Convex probe EBUS with local anesthesia and under conscious sedation and EBUS-TBNA from hilar and mediastinal lymph nodes were performed after physical examination, chest radiography, computed tomography of the thorax, and routine biochemical analysis. Detection of noncaseating/caseating granulomas was accepted as sufficient for diagnosis of sarcoidosis/tuberculosis in the presence of clinical and radiologic findings. For patients whose EBUS-TBNA results were nondiagnostic, a definitive diagnosis was reached by invasive procedures. The sensitivity of EBUS-TBNA in the diagnosis of granulomatous lymphadenitis and diagnostic accuracy in granulomatous hilar/mediastinal lymphadenopathies was calculated. RESULTS: Seventy-two patients were included in study (20 male and 52 female; mean age ± SD, 46.22 ± 13.94 years). In 72 cases, 121 lymph node aspirations were performed. The average lymph node short axis was 1.96 cm. With EBUS-TBNA among the 72 cases, 35 were diagnosed as sarcoidosis and 16 as tuberculous lymphadenitis. A definitive diagnosis could not be reached with EBUS-TBNA in 21 cases. As a result, 9 of these EBUS-TBNA-negative cases were diagnosed as reactive lymphadenitis, 9 as sarcoidosis, and 3 as tuberculosis by invasive procedures. The sensitivity values of EBUS-TBNA for diagnosis of sarcoidosis, tuberculosis, and granulomatous diseases were 79.5%, 84.2%, and 80.9%, respectively. The diagnostic accuracy of EBUS-TBNA for granulomatous diseases was 83.3%. No major complications occurred. CONCLUSIONS: In the diagnosis of granulomatous lymphadenitis, EBUS-TBNA, with high sensitivity and a minimum complication rate, is an alternative to mediastinoscopy.

[A rare complication of port catheter]. / Nadir görülen port kateter komplikasyonu.

Central venous ports are used in long term therapies of cancer patients. The insertion technique and maintenance of central venous ports is very important to avoid catheter associated complications. Widely used central venous ports in cancer patients should be periodically maintained and evaluated by expert physicians. The most frequent complications of central venous ports are catheter obstruction, infection, venous thrombosis and extravasation. In this paper, a rare intrapulmonary catheter dislocation is presented.

Palatal Pillar implants for the treatment of simple snoring.

OBJECTIVES: In this study the efficacy of palatal implants for treatment of snoring was evaluated. PATIENTS AND METHODS: Seventeen patients (10 males, 7 females; mean age 49.2+/-7.8 years; range 31 to 66 years) with primary snoring and an apnea-hypopnea index of less than 15 were treated with palatal implants after clinical and endoscopic examination. Snoring-related symptoms were evaluated at baseline and 90 days after surgery and polysomnography was performed. Patients and their spouses completed questionnaires and visual analog scales (VAS) evaluating snoring, apneas, and the intensity, duration, and social effects of daytime sleepiness at baseline and 90 days after surgery. Pre- and postoperative assessment results were compared. RESULTS: Epworth sleepiness scale score was significantly decreased in the postoperative period (p<0.05). Postoperative mean VAS snoring, apnea, and daytime sleepiness scores were also significantly improved (p<0.01). No patients reported worsening of apnea, 5.9% of patients reported no change in apnea, and 94.1% of patients reported a marked decrease in apneas. In the postoperative period, 76.4% of patients reported reduced snoring, and 88.3% of patients reported reduced daytime sleepiness. CONCLUSION: Palatal implants have been demonstrated to be a safe and effective treatment for snoring with minimal patient discomfort. Establishing realistic pretreatment expectations can maximize patient satisfaction.