A case of Churg-Strauss syndrome treated with montelukast.

OBJECTIVE: To report a case of Churg-Strauss syndrome who had asthma and allergic rhinitis treated with montelukast. CLINICAL PRESENTATION AND INTERVENTION: A nonsmoking 59-year-old woman presented with fever, hemoptysis and dyspnea. Past medical history included allergic rhinitis and asthma which were diagnosed 18 years ago. The asthma was treated successfully with inhaled salmeterol and beclamethasone. She also received montelukast (10 mg/day) for 3 years. Although her chest X-ray was normal a week earlier, she had widespread bilateral pulmonary infiltrates on admission. She had leukocytosis (12.5 × 10(9)/l) with eosinophilia (15.6%). Her total IgE count was 550 U/ml. Testing for protoplasmic-staining antineutrophil cytoplasmic antibodies was positive. Bronchoalveolar lavage could not be performed due to bronchospasm and severe hypoxemia; however, mucosal biopsies were obtained, which revealed eosinophil leukocytes in the lumen and walls of small vessels. She was diagnosed to have Churg-Strauss syndrome and had remarkable clinical improvement on day 5 with high-dose of oral prednisolone (50 mg/day). Radiological improvement was detected at the end of the second week. CONCLUSION: This case shows the importance of being aware that leukotriene receptor antagonists could cause Churg-Strauss syndrome, in spite of the uncertainty about its mechanism.

Evaluation of clinical data and antibody response following influenza vaccination in patients with chronic obstructive pulmonary disease.

The present study investigated the antibody response against influenza vaccine and also the efficacy of vaccination on clinical findings in patients with Chronic Obstructive Pulmonary Disease (COPD) following influenza vaccination. A total of 82 cases with COPD (44 cases as vaccinated and 38 cases as unvaccinated) were evaluated clinically and 21 healthy volunteers were also included in the study as a control group. Influenza (A and B) Ig M and Ig G parameters were analyzed quantitatively in blood samples of the vaccinated group and healthy volunteers by ELISA method once before vaccination and one month and one year after vaccination. The presence of dyspnoea, increased sputum production and/or purulence were accepted as criteria of acute exacerbation. The number of hospital presentations was significantly lower in the vaccinated group and higher in severe cases with COPD in unvaccinated group. Vaccinated cases in the study group experienced significantly fewer episodes of pneumonia, hospitalization and intensive care. Quantitative influenza (A and B) antibody IgG levels significantly increased in these patients as well. In conclusion, seasonal influenza vaccination with the trivalent influenza split virion vaccine especially in severe or very severe COPD patients who need hospitalization was evaluated as beneficial in clinical use.

Nodular lymphoid hyperplasia of the lung: the role of positron emission tomography in diagnosis.

Pulmonary nodular lymphoid hyperplasia (NLH) is defined as reactive lymphoid proliferation forming solitary or multiple nodules or localized infiltrates localized in the lungs. Radiological presentations are generally solitary or multiple nodules, but air bronchograms and ground glass attenuation may be present. Patients mostly asymptomatic and the lesions were detected coincidentally on routine chest X-rays. We present a case of NLH with cavitary lesion arising in the lung of a 61 year-old man who admitted with cough and massive hemoptysis. The lesion had positive fluorodeoxyglucose (FDG) uptake. To our knowledge, this is the only patient reported in the literature presenting with massive hemoptysis and a cavitary lesion with positive FDG uptake.

The prognostic value of D-dimer in lung cancer.

BACKGROUND AND AIM: Activation of coagulation and fibrinolysis is frequently encountered among cancer patients. Such tumors are supposed to be associated with higher risk of invasion, metastases and eventually worse outcome. The aim of this study is to explore the prognostic value of blood coagulation tests for lung cancer patients. METHODS: Between 2009 and 2012, 72 newly diagnosed patients with lung cancer and 40 healthy subjects as control group were included in this prospective study. Patients were staged according to the seventh edition of the tumor, node, metastasis (TNM) classification. The treatment responses of patients were evaluated according to the World Health Organization (WHO) criteria. We measured plasma D-dimer level, activated partial thromboplastin time (APTT), prothrombin time (PT), international normalized ratio (INR), lactate dehhydrogenase (LDH), hemoglobin (Hb), platelet (Plt), white blood cells (WBC) count before, during and after chemotherapy. We investigated association of the results with stage and histologic type of the disease, as well as with response to therapy and survival in lung cancer patients. RESULTS: The median D-dimer, PT and INR levels of the patients with lung cancer were significantly higher than in the control group (P = 0,000). D-dimer, APTT, PT, INR, LDH levels after four cycles of treatment were significantly lower in responders than in nonresponders (P = 0,000). Plasma D-dimer levels were evaluated according to histopathological type and stage of diseases; D-dimer level was found significantly higher in metastatic disease (P < 0,5) and significantly lower in small cell lung cancer (SCLC) (P < 0,05). The mean follow-up was 574,14 ± 463,48 days. The mean survival was 750,866 ± 74,857 days (95% CI: 604,147 - 897,586). After second and fourth cycles of treatment, the plasma D-dimer, APTT, and LDH levels were higher in mortality group than in survival group (P = 0,000). After four cycles of treatment, the mean survival of the patients with serum D-dimer level above and below 1900 ng/mL was found to be significantly different (P = 0,000). CONCLUSION: The results suggest that determination of D-dimer plasma levels that is an inexpensive, easy and non invasive method may be useful in predicting clinical outcome, survival and treatment response of patients with lung cancer.

Are Meteorological Parameters a Risk Factor for Pulmonary Embolism? A Retrospective Analysis of 530 Patients.

BACKGROUND: The influence of meteorological conditions on cardiovascular morbidity and mortality has been known for a long time. However, few reports have been published on the influence of meteorological parameters on the occurrence of acute pulmonary embolism (PE). AIMS: In this retrospective study, we compared the meteorological parameters between PE patients with risk factors and idiopathic PE patients. STUDY DESIGN: Cross-sectional study. METHODS: Medical documentation of 1180 patients with suspected acute pulmonary embolism diagnosed between January 2010 and December 2012 was retrospectively analyzed. A total of 530 patients with PE confirmed by computed tomography pulmonary angiography and/or ventilation/perfusion scan were included for further analysis. We divided the patients into two groups: PE with risk factors (provoked) and PE without risk factors (unprovoked). The meteorological data were collected from the relevant time period: temperature, humidity, pressure, and wind velocity. As the exact time of PE onset was unknown, the meteorological values attributed to each patient were the means of the values in the months or weeks at the time of diagnosis of PE. RESULTS: The highest numbers of cases were seen in autumn (29.8%), followed by summer (28.9%), spring (22.1%), and winter (19.2%). In terms of months, the greatest number of cases occurred in June (57), followed by November (56) and October (54). Case distribution according to the months and seasons were statistically significant. The wind direction also affected the incidence of PE. There was a statistically significant positive correlation between case frequency and air temperature (r=0.300; p=0.031). No correlation was found between the unprovoked PE cases' monthly distribution and pressure, humidity, or temperature. However, there was a statistically significant positive correlation between the monthly distribution of the group with provoked PE cases and air temperature (r=0.586; p=0.045). CONCLUSION: A statistically significant inverse correlation between atmospheric pressure and temperature and the number of all PE cases was observed in our study, which is in accordance with other reports. However, in unprovoked PE cases, there was no correlation between meteorological parameters and case incidence.

[The resistance rates of Mycobacterium tuberculosis strains to antituberculosis drugs: evaluation of two years' data in Aegean region, Turkey]. / Mycobacterium tuberculosis suslarinin antitüberküloz ilaçlara direnç oranlari: ege bölgesine ait iki yillik verilerin degerlendirilmesi.

The aim of this study was to determine the primary, secondary and total resistance rates of Mycobacterium tuberculosis strains in the Aegean Region, Turkey, between November 1st 1999 and November 30th 2001. A total of 490 M. tuberculosis strains isolated from patients admitted to 27 different tuberculosis dispensaries, were evaluated. The isolates have been identified as Mycobacterium tuberculosis with the colony morphology, growth rate and standard biochemical tests, and their sensitivities to isoniazid, rifampicin and ethambutol were tested by using indirect proportion method. H37Rv, ATCC 35838 and ATCC 35825 were used as standard control strains. Clinical information could be obtained about 474 patients and it has been detected that 387 (81.6%) of them received no prior antituberculous therapy, while 87 of them (18.4%) received antituberculous therapy longer than one month. Primary, secondary and total resistance rates to one or more drugs was found as 18.4%, 32.2% and 20.9%, respectively. Primary, secondary and total resistance rates for isoniazid (INH) and rifampicin (R) were found as follows, respectively; 12.4%, 26.4%, 14.9% and 5.7%, 19.5%, 8.2%. Primary resistance rate against INH+R were found 4.4%, secondary resistance rate were 17.2% and total resistance rate were 6.8%, in the multi-drug resistant isolates. According to these results it could be concluded that, drug resistance which requires immediate solution, continues to be a major problem in our region.

The effect of augmentation therapy on bronchial inflammation in alpha1-antitrypsin deficiency.

alpha1-Antitrypsin (AAT) deficiency predisposes to bronchitis and emphysema associated with neutrophilic airway inflammation. The efficacy of augmentation therapy has not been proven clinically or by demonstrating an effect on airway inflammation. We treated 12 patients with four infusions of Prolastin (60 mg/kg) at weekly intervals and monitored both the serum and secretion concentrations of AAT as well as markers of neutrophilic inflammation, including myeloperoxidase, elastase, and the neutrophil chemoattractants interleukin-8 and leukotriene B(4). Serum AAT rose and was maintained above the protective threshold. In addition, AAT concentrations in the sputum rose from a mean of 0.17 microM (SEM +/- 0.04) before therapy to concentrations similar to nondeficient subjects (0.43 +/- 0.12) 1 week after the first infusion (p < 0.01). This was associated with a reduction in elastase activity (p < 0.002) and the chemoattractant leukotriene B(4) (p < 0.02), which fell from a median baseline value of 13.46 nM (range, 4.17-55.00) to 8.62 nM (4.23-21.59) the day following the last infusion. Although median values for myeloperoxidase and interleukin-8 also fell, the changes failed to achieve statistical significance. In summary, short-term therapy with AAT increased lung secretion concentrations and was associated with a fall in leukotriene B(4), which is thought to be central to the airway inflammation of AAT deficiency.