Diagnostic value of transthoracic needle biopsy in lung tumors.

OBJECTIVE: Thoracic ultrasonography is widely used in imaging peripheral lesions and invasive interventional procedures. The aim of this study was to assess the diagnostic value of thoracic ultrasonography-guided transthoracic needle aspiration biopsy and the factors affecting the diagnosis of peripheral tumoral lung lesions. METHODS: The lesion size, biopsy needle type, number of blocks, complications, and pathology results were compared in 83 patients between January 2015 and July 2018. The cases with pathological non-diagnosis and definite pathological diagnosis were determined. For the assessment of the factors affecting diagnosis, the size of the lesions and the biopsy needle type were evaluated. Biopsy preparations containing non-diagnostic atypical cells were referred to a cytopathologist. The effect of the cytopathological examination on the diagnosis was also evaluated. RESULTS: Pathological diagnosis was made in 66.3% of the cases; cell type could not be determined in 22.9% of the cases, and they were referred to a cytopathologist. After the cytopathologist's examination, the diagnosis rate increased to 80.7%. Diagnosis rates were higher when using tru-cut than Chiba and higher in cases with tumor size >2 cm than smaller. CONCLUSION: Thoracic ultrasonography-guided transthoracic needle aspiration biopsy is a preferred approach to the diagnosis of peripheral tumoral lung lesions, given its high diagnostic rate, in addition to being cheap, highly suitable for bedside use, and safe, and the lack of radiation exposure.

Is Obesity a Potential Risk factor for Poor Prognosis of COVID-19?

BACKGROUND: Coronavirus disease 2019 (COVID-19) continues to cause major mortality and morbidity worldwide even after a year of its emergence. In its early days, hypertension, diabetes, and cardiovascular diseases were noted as poor prognostic factors, while obesity gained attention at a later stage. In the present study, unfavorable clinical outcomes (transfer to the intensive care unit, invasive mechanical ventilation, and mortality) were investigated in obese patients with COVID-19. MATERIALS AND METHODS: In this retrospective study we analyzed patients with positive polymerase chain reaction test in tertiary care hospital between March-May 2020. They were divided into 3 groups according to body mass index (BMI) as normal, overweight, and obese (BMI: 18.5 - 24.99 kg/m², 25 - 29.99 kg/m², and ≥ 30 kg/m², respectively). We compared clinical features and laboratory findings of these groups and recorded adverse clinical outcomes. Multivariate logistic analysis was performed for unfavorable outcomes. RESULTS: There were 99 patients (35%), 116 (41%), and 69 patients (24%) in the normal-weight, overweight, and obese group, respectively. Among all patients, 52 (18%) patients were transferred to the intensive care unit (ICU), 30 (11%) patients received invasive mechanical ventilation (IMV), and 22 patients (8%) died. Obese patients had minimum 1 more comorbidity than normal BMI patients (73% vs. 50%, P = 0.002), and a longer median (interquartile range [IQR]) duration of hospitalization (8 [5 - 12] vs. 6 [5 - 9]) days, P = 0.006). Obese participants had higher concentrations of serum C-reactive protein, procalcitonin, ferritin than non-obese patients (P <0.05 in all). In a multivariate analysis, obesity was associated with ICU admission (adjusted odds ratio [aOR]: 2.99, 95% confidence interval [CI]: 1.26 - 7.04, P = 0.012). Moreover, IMV requirement was associated with obesity (aOR: 8.73, 95% CI: 2.44 - 31.20, P = 0.001). Mortality occurred in 16%, 9%, and 1% of the obese group, overweight group, and normal-weight group, respectively (Chi-square trend analysis, P = 0.002). CONCLUSION: Obesity is a risk factor for adverse outcomes and caused increased mortality, hence requiring close follow-up.

Use of Radiology, D-Dimer, and Mean Platelet Volume Combination as a Prognostic Marker in Hospitalized Coronavirus Disease-19 Patients.

INTRODUCTION: The search for biomarkers that could help in predicting disease prognosis in the Coronavirus Disease-2019 (COVID-19) outbreak is still high on the agenda. OBJECTIVE: To find out the efficacy of D-dimer and mean platelet volume (MPV) combination as a prognostic marker in hospitalized COVID-19 patients with bilateral infiltration. MATERIALS AND METHODS: Study design: Retrospective observational cohort. Patients who were presented to our hospital between March 16, 2020 and June 07, 2020 were reviewed retrospectively. The primary outcome of the study was specified as the need for intensive care, while the secondary outcomes were duration of treatment and hospitalization. Receiver operator curve (ROC) analyzes were carried out to assess the efficacy of D-dimer and MPV parameters as prognostic markers. RESULTS: Between the mentioned dates, 575 of 1,564 patients were found to be compatible with COVID-19, and the number of patients who were included in the study was 306. The number of patients who developed the need for intensive care was 40 (13.1%). For serum D-dimer levels in assessing the need for intensive care, the area under the curve (AUC) was found to be 0.707 (95% CI: 0.620-0.794). The AUC for MPV was 0.694 (95% CI: 0.585-0.803), when D-dimer was ≥1.0 mg/L. When patients with a D-dimer level of ≥1.0 mg/L were divided into two groups considering the MPV cut-off value as 8.1, the rate of intensive care transport was found to be significantly higher in patients with an MPV of ≥8.1 fL compared to those with an MPV of <8.1 fL (32.6 vs. 16.0%, p = 0.043). For the prognostic efficacy of the combination of D-dimer ≥ 1.0 mg/L and MPV ≥ 8.1 fL in determining the need for intensive care, following values were determined: sensitivity: 57.7%, specificity: 70.8%, positive predictive value (PPV): 32.0%, negative predictive value (NPV): 84.0%, and accuracy: 63.0%. When D-dimer was ≥1.0, the median duration of treatment in MPV <8.1 and ≥8.1 groups was 5.0 [interquartile range (IQR): 5.0-10.0] days for both groups (p = 0.64). The median length of hospital stay (LOS) was 7.0 (IQR: 5.0-10.5) days in the MPV <8.1 group, while it was 8.5 (IQR: 5.0-16.3) days in the MPV ≥ 8.1 group (p = 0.17). CONCLUSION: In COVID-19 patients with a serum D-dimer level of at least 1.0 mg/L and radiological bilateral infiltration at hospitalization, if the MPV value is ≥8.1, we could predict the need for intensive care with moderate efficacy and a relatively high negative predictive value. However, no correlation could be found between this combined marker and the duration of treatment and the LOS.

What are the Prevalence of Abdominal Aortic Aneurysm in Patients with Chronic Obstructive Pulmonary Diseases and the Characteristics of These Patients?

OBJECTIVE: To determine the prevalence of abdominal aortic aneurysm (AAA) in patients with chronic obstructive pulmonary disease (COPD) and to assess the characteristics of these patients. MATERIALS AND METHODS: Stable COPD patients (age, >40 years) were included in the study between January 2014 and June 2014. Patients with acute exacerbations and a previous lung resection were excluded. Data regarding demographic characteristics were recorded. The modified Medical Research Council (mMRC) dyspnea scale was used to assess the severity of breathlessness. The COPD Assessment Test (CAT) was performed. Abdominal aortic diameter was measured using abdominal ultrasonography (AUS), and AAA was diagnosed as an aortic diameter of ≥30 mm at the renal artery level. RESULTS: In total, 82 patients were examined. AAA was detected in five (6.1%) patients. Diabetes mellitus, hypertension, and coronary artery disease were present in four patients with AAA. The average mMRC score was 3.2±0.4, and the mean CAT score was 18.4±6.0. Aneurysmal diameter was >50 mm in four patients and 37 mm in one patient. Statistically significant differences were found between patient with AAA and those without AAA with respect to the mean abdominal aortic diameters at the renal artery and iliac artery levels (p=0.012 and 0.002, respectively). CONCLUSION: Our findings suggest that AAA is associated with COPD, with a prevalence rate of 6.1%. AAA is usually asymptomatic until a clinical status of rupture, which is associated with a higher mortality risk. Early diagnosis of AAA is lifesaving. In COPD patients, AAA might be easily determined using AUS, which is a noninvasive and relatively cheap procedure.

A comparison of propofol-midazolam and midazolam alone for sedation in endobronchial ultrasound-guided transbronchial needle aspiration: a retrospective cohort study.

OBJECTIVES: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a new, minimally invasive, bronchoscopic technique used in the evaluation of inthrathoracic lymph nodes.Use of sedation drugs before the procedure differs among centres. There is no standardization about sedation before EBUS-TBNA.We used a policy decision to shift from use of propofol with midazolam vs midazolam alone in a large tertiary hospital to evaluate the diagnostic yield and safety of EBUS-TBNA procedure. METHODS: Files of all the patients who were performed EBUS-TBNA between the dates of September 2010 and May 2014 were surveyed. All the EBUS-TBNA cases were performed under sedation of propofol and midazolam with an accompanying anesthesiologist in the beginning, however, sedation is applied with midazolam without an accompanying anesthesiologist after April 2013 due to changes in sedation policy. The diagnostic yield and complication rates were compared by chi-squared analysis between two groups. RESULTS: The files of 340 EBUS-TBNA performed patients were evaluated. Of the patients 274 eligible patients were analysed. 152 patients who fulfilled the inclusion criteria were analysed in propofol-midazolam (P) sedated group and 122 patients were analysed in midazolam (M) group. There is no statistically significant difference between two different sedated groups in terms of age and gender. Diagnostic value was detected as 77.6% in P group and 85.7% in M group and the difference was not statistically significant. No difference between complication rates of both groups was observed. CONCLUSION: Both sedation-types for performing EBUS-TBNA showed similar diagnostic value and complication rates in our study. Propofol with midazolam application requires with an accompanying anaesthesiologist, therefore, it increases cost. EBUS-TBNA procedures had been performed in safe with no decrease in diagnostic yield under moderate sedation.

Role of the Neutrophil-Lymphocyte Ratio in the Differential Diagnosis of Exudative Pleural Effusion.

OBJECTIVES:: Pleural effusion is a common diagnostic and clinical problem. The differential diagnosis of pleural effusion may be difficult and may require several procedures, including invasive ones. Certain studies have investigated biochemical parameters to facilitate the diagnosis of exudative pleural effusion; however, it remains a challenging problem in clinical practice. We aimed to investigate the potential role of the neutrophil-lymphocyte ratio, which can be easily obtained by determining the cell count of the pleural fluid, in the differential diagnosis of exudative pleural effusion. METHODS:: Records from patients who underwent thoracentesis and pleural fluid analysis between May 1, 2013, and March 1, 2015, were obtained from the electronic database of our hospital. The patients who met the inclusion criteria were divided into five groups according to their diagnosis: malignant pleural effusion, para-malignant pleural effusion, para-pneumonic effusion, tuberculosis-related effusion or other. The neutrophil-lymphocyte ratio value was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count. The patient groups were compared according to the given parameter. RESULTS:: A total of 465 patients who met the inclusion criteria among 1616 patients with exudative pleural effusion were included in the study. The mean neutrophil-lymphocyte ratio value was significantly lower in tuberculosis-related pleural effusion compared to malignant, para-pneumonic and para-malignant effusions (p=0.001, p=0.001, p=0.012, respectively). The areas under the curve for tuberculosis pleurisy compared to malignant, para-pneumonic and para-malignant effusions were 0.38, 0.36, and 0.37, respectively. Lower cut-off values had higher sensitivity but lower specificity for tuberculosis pleurisy, while higher cut-off values had higher specificity but lower sensitivity for this condition. CONCLUSION:: The pleural fluid neutrophil-lymphocyte ratio, which is an inexpensive, reproducible, and easily calculated hematological parameter, may facilitate the differential diagnosis of pleural effusion.

Role of the Neutrophil-Lymphocyte Ratio in the Differential Diagnosis of Exudative Pleural Effusion

OBJECTIVES: Pleural effusion is a common diagnostic and clinical problem. The differential diagnosis of pleural effusion may be difficult and may require several procedures, including invasive ones. Certain studies have investigated biochemical parameters to facilitate the diagnosis of exudative pleural effusion; however, it remains a challenging problem in clinical practice. We aimed to investigate the potential role of the neutrophil-lymphocyte ratio, which can be easily obtained by determining the cell count of the pleural fluid, in the differential diagnosis of exudative pleural effusion. METHODS: Records from patients who underwent thoracentesis and pleural fluid analysis between May 1, 2013, and March 1, 2015, were obtained from the electronic database of our hospital. The patients who met the inclusion criteria were divided into five groups according to their diagnosis: malignant pleural effusion, para-malignant pleural effusion, para-pneumonic effusion, tuberculosis-related effusion or other. The neutrophil-lymphocyte ratio value was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count. The patient groups were compared according to the given parameter. RESULTS: A total of 465 patients who met the inclusion criteria among 1616 patients with exudative pleural effusion were included in the study. The mean neutrophil-lymphocyte ratio value was significantly lower in tuberculosis-related pleural effusion compared to malignant, para-pneumonic and para-malignant effusions (p=0.001, p=0.001, p=0.012, respectively). The areas under the curve for tuberculosis pleurisy compared to malignant, para-pneumonic and para-malignant effusions were 0.38, 0.36, and 0.37, respectively. Lower cut-off values had higher sensitivity but lower specificity for tuberculosis pleurisy, while higher cut-off values had higher specificity but lower sensitivity for this condition. CONCLUSION: The pleural fluid neutrophil-lymphocyte ratio, which is an inexpensive, reproducible, and easily calculated hematological parameter, may facilitate the differential diagnosis of pleural effusion.

[The evaluation of nutritional status of stable COPD patients and to investigate the effect of nutritional status on perception of dyspnea, exercise capacity, body composition, hospitalisation and life quality]. / Kronik obstrüktif akciger hastalarinda beslenme durumunun belirlenmesi ve vücut kompozisyonu, dispne algisi, egzersiz kapasitesi, atak sayisi ile iliskisi.

INTRODUCTION: Malnutrition is a comorbidity oftenly seen in COPD patients who have progressive chronic inflammation and severity. In this prospective study, we aimed to determine the nutritional status of stable COPD patients and to investigate the impact of nutritional status on perception of dyspnoea, exercise capacity, body composition, hospitalisation and life quality. MATERIALS AND METHODS: COPD patients were assessed using previous smoking story, physical examination and irreversible airway obstruction. This study was done with 50 COPD patients older than 65 years of age and 30 control subjects. Exclusion criteria were also the co-existance of malignancies, malabsorbtion, DM, neurological diseases, renal failure and unstable cardiac diseases known to influence the nutritional state. The obstruction degree was evaluated by spirometry, nutritional status was classified by the MNA questionnaire, perception of dyspnoea was assessed by the MMRC scale, exercise capacity was assessed by the 6MWT, life quality was assessed by the CAT scale. Body composition parameters FM, FFM and FMI were analyzed and hospitalisations during 6 months after discharge were recorded. RESULT: The COPD patients were divided into three groups as without malnutrition (n= 25,%50), under risk of malnutrition (n= 19,%38) and malnourished (n= 6,%12). The COPD severity, MMRC dyspnoea score, CAT score and hospitalisations during 6 months following were higher among the malnourished patients. On the other hand, body mass index, 6MWT results, FM and FFM were lower in malnourished patients. A positive correlation between FFM and 6MWT and a negative correlation between FFM and hospitalisation were observed. CONCLUSIONS: MNA is a well-developed questionnaire which evaluates malnutrition in COPD patients. We determined that malnourished COPD patients have higher airway obstruction degree, perception of dyspnoea, CAT score and lower exercise capacity and FFM. FFM is an independent predictor of exercise capacity and rehospitalisation during 6 months.

Non-tuberculous mycobacteria infection: 75 cases.

INTRODUCTION: Non-tuberculosis mycobacterium is especially seen in AIDS and non-immunosuppressant patients. This study was designed to evaluate data relating to non-tuberculosis mycobacterium content in patients' sputum for the clinical importance. PATIENTS AND METHODS: During 2009-2010 at Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital clinics, 75 patients [30 women (40%) and 45 men (69%); mean age (SD): 48.7 (15.9) years] with non-tuberculosis mycobacterium were determined by the rapid test and NAP test in Mycobacteria Growth Indicator Tube (MGIT), which had atypical growth in 51.864 Lowenstein-Jensen. Identification was done with Hsp65PCRREA methods in 32 (43%) cases. Treatment management, radiology, bacteriology, co-morbidity, treatment outcomes were evaluated from medical records, calling patients and from tuberculosis dispensaries. RESULTS: In 9 (28%) patients Mycobacterium abscessus, in 8 (25%) patients Mycobacterium avium complex (MAC), in 5 (16%) patients Mycobacterium kansasii was found with identification Hsp65PCRREA methods. In 18 (24%) of 75 cases with American Thoracic Society definition and treatment criteria, treatment was administered using major and minor drugs. Standard tuberculosis treatment was administered in 25 (33%) of the 75 cases. In 8 of 25 (32%) cases identification of non-tuberculosis mycobacterium was evident. In 32 of 75 cases follow up was performed with no treatment. One positive atypical growth culture was identified in 23 (72%) of 32 patients. Treatment was administered in 43 cases while 25 (58%) of 43 were cured, 3 (7%) of 43 were default and 3 (7%) died. Drug resistance was the outcome in 36 cases. While 31 (86%) had any drug resistance, 27 (75%) had HR drug resistance. Past history of tuberculosis treatment was evident in 20 (40%) cases. Respiratory and non-respiratory diseases were identified equally in 18 (38%) cases. Radiological consolidation in 28 (65%), and cavity in 16 (37%) cases were determined. CONCLUSION: In order to carry out the right treatment and epidemiologic evaluation, it is important to identify non-tuberculosis mycobacterium by culture methods.

Endobronchial schwannoma with massive hemoptysis.

A 56-year-old man was admitted to our hospital with a complaint of massive hemoptysis. Bronchoscopy revealed a tumor obstructed the orifice of the right lower lobe bronchus. The diagnosis of endobronchial schwannoma was made by broncho-fibroscopic biopsy. Schwannomas are benign tumors which originate from schwann cells. They rarely occur in the trachea or bronchus. On the other hand symptoms in pulmonary schwannoma are usually mild. Massive hemoptysis is extremely rare. We report a case of endobronchial schwannoma complicated by massive hemoptysis.

Vascular endothelial growth factor immunostaining correlates with postoperative relapse and survival in non-small cell lung cancer.

BACKGROUND: Angiogenesis is an early step in tumor progression, and vascular endothelial growth factor (VEGF) is an important angiogenic factor. In this study, we investigated the prognostic significance of VEGF immunostaining in tumor tissues of non-small cell lung cancer (NSCLC) patients during a 5-year follow-up period. METHODS: The study comprised 50 male patients diagnosed with NSCLC with a mean age of 57.26 +/- 8.64 years (range: 40-74 years). All patients had early stage NSCLC and none of the patients received chemo- or radiation therapy before surgery. VEGF immunostaining was performed in tumor tissues and immunoreactivity was graded as negative (0-10%), weak (10-50%), and strong (>50% tumors are stained). RESULTS: VEGF staining was weak in 20 (40%) specimens and strong in 13 (26%) specimens, whereas VEGF staining was negative in 17 (34%) specimens. Strong VEGF staining showed a significant correlation with both short time of relapse (p = 0.0001) and short survival (p = 0.0005). Multivariate analysis using Cox regression model was performed to determine the independent prognostic factors. Age (p = 0.029, OR: 1.05), tumor stage (p = 0.001, OR: 14.89), and VEGF staining (p = 0.006, OR: 4.65) were all found as independent prognostic factors in NSCLC. CONCLUSIONS: Strong VEGF immunostaining in tumor tissues was found to be an important prognostic factor for time to relapse and survival in patients with early stage disease.

A Behçet's disease patient with intracardiac thrombus, pulmonary artery aneurysms complicating recurrent pulmonary thromboembolism.

Intracardiac thrombus and pulmonary embolism is a very rare manifestation of Behçet's disease. A twenty-years-old man was admitted to hospital due to dyspnea, haemoptysis, fever and partially loss of vision. On dynamic thorax computed tomography (CT), there was aneurysmatic dilatation and thrombus in bilateral pulmonary artery segments and also findings of pulmonary thromboembolism. A diagnosis of Behçet's disease was made based on his clinical course and radiological findings. During treatment, the patient was admitted two times to the hospital because of recurrent pulmonary thromboembolism. At the 10th months of follow up, partially dissolution of the thrombi and pulmonary defects were observed and right ventricular thrombus was revealed by dynamic thorax CT. On a follow up period of 16 months the patient is still under treatment and doing well. We present this case because Behçet's disease is a rarely considered cause of recurrent pulmonary embolism and intracardiac thrombus which is seen under treatment.

Pleural adenosine deaminase in the separation of transudative and exudative pleural effusions.

OBJECTIVE: The purpose of this study was to evaluate the usefulness of a new parameter, pleural adenosine deaminase (PADA), for separating transudative pleural effusion from exudative pleural effusion, and to compare the results with other tests (albumin gradient and protein gradient). METHODS: From November 2001 to January 2003, 359 consecutive patients with pleural effusion who underwent a diagnostic thoracentesis were included in the study. Effusions were individually classified as transudates or exudates after the careful evaluation of all clinical data and biochemical parameters of pleural fluid and serum of patients on the basis of Light's criteria. The means and standard deviations of PADA, pleural/serum ADA (P/S ADA) ratio, albumin gradient and protein gradient were evaluated for transudative and exudative effusions. The best cut-off values for each test were identified by using the receiver operating characteristic (ROC) curve. The optimum cut-off level was determined by selecting points of test values that provided the greatest sum of sensitivity and specificity. RESULTS: There were 113 transudates and 246 exudates. For each test, differences in mean value between the transudate group and the exudate group were statistically significant (t test, P<0.001). The optimum cut-off levels for PADA and P/S ADA were 15.3 U/L and 0.66 U/L, respectively. ROC analysis confirmed previous recommendations for albumin gradient (12 g/L) and protein gradient (31 g/L). For detecting exudates, the PADA test yielded a sensitivity and specificity of 85.8% and 82.3%, respectively. Sensitivity and specificity of the albumin gradient were found to be 88.5% and 79.3%, and of the protein gradient 85% and 83.2%, respectively. The areas under the curve (AUC) data and accuracy demonstrated similar discriminative properties in the examined tests. CONCLUSIONS: The measurement of PADA is suggested as a reliable test in the separation of pleural exudates from transudates with accuracy similar to that of the albumin gradient and protein gradient.

Does acid reflux cause pulmonary disease?

BACKGROUND/AIMS: Gastroesophageal reflux is considered as a factor in pulmonary diseases. The aim of this study was to assess whether gastroesophageal reflux is associated with abnormalities in lung function in patients without respiratory disease. METHODS: Forty- four patients with reflux symptoms were studied prospectively. Standardized methods of esophageal manometry and ambulatory 24-h esophageal pH testing were used throughout the study period, along with a standardized reflux and respiratory symptom questionnaire. Spirometric measurements were performed in all patients. RESULTS: Reflux to distal esophagus was observed in 9 patients, to proximal esophagus in 4 and to both distal and proximal in 20 of the 44 patients. Eleven patients revealed reflux neither to distal nor proximal esophagus. Respiratory function tests of these groups showed no significant differences (p>0.05). CONCLUSION: There is no correlation between esophageal acid events and respiratory function tests. There are no data to answer the question of whether or not reflux precedes onset of cough/asthma. Better-designed prospective cohort studies may provide further insight.

Role of biochemical tests in the diagnosis of exudative pleural effusions.

OBJECTIVES: To examine the diagnostic utility of pleural adenosine deaminase (PADA), pleural lactate dehydrogenase (PLDH), and several other biochemical tests in bronchogenic carcinoma and malignant mesothelioma, and to compare biochemical characteristics of their fluid with nonmalignant pleural effusions. DESIGN AND METHODS: This study consisted of 226 patients diagnosed with malignant (75), tuberculous (65), and parapneumonic pleural effusions (86). We examined the following biochemical parameters in the pleural fluid and serum: adenosine deaminase, lactate dehydrogenase, glucose level, protein level, pleural fluid/serum ADA ratio (P/S ADA), P/S LDH ratio, and P/S protein ratio. RESULTS: Parapneumonic pleural effusions had a significantly higher level of PLDH and of P/S LDH than malignant and tuberculous pleural effusions (P = 0.000), and malignant pleural effusions had a higher level of PLDH than tuberculous pleural effusions. Tuberculous and parapneumonic effusions had significantly higher levels of PADA than those of malignant effusions (P = 0.000). When the 54 patients having bronchogenic carcinoma were compared to the remaining 21 mesothelioma patients, the former had a lower median level of PADA (P = 0.001) with a higher level of PLDH (P = 0.05). CONCLUSION: Our results show that high pleural LDH and low PADA levels are suggestive of pleural effusion due to bronchogenic carcinoma, whereas high levels of PADA alone can be indicative of tuberculous pleural effusion and high levels of both markers can show complicated parapneumonic effusions or empyema.

An unusual renal presentation of Wegener's granulomatosis.

A 63-year-old woman was admitted to our clinic with arthralgia, microhematuria and a pleural based solid mass in lower lobe basal segment of right lung seen in computerised tomogram of thorax. She was diagnosed as Wegener's granulomatosis by histopathological findings of right thoracotomy, wedge resection and decortication. The patient had positive antineutrophil cytoplasmic antibodies (c-ANCA) in serum and tissue specimens. Histopathologic examination of the renal biopsy specimen revealed the diagnosis of tubulointerstitial nephritis. We report this case because of the unusual histologic type of renal involvement by reviewing the literature.