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.

Patterns of drug resistance in pulmonary tuberculosis cases in the Izmir district, Turkey.

Antituberculosis drug resistance patterns were investigated among the new and previously treated pulmonary tuberculosis (TB) cases in Izmir district, retrospectively. Proportions of resistance patterns were determined using a number of resistant cases using as a denominator. Resistance to at least one drug was found in 304 (29.7%) patients in 1023 a total of tuberculosis cases. 182 new and 82 previously treated consecutive pulmonary tuberculosis cases were investigated. Patterns were examined as single and/or probable combinations of isoniazid (H), rifampicin (R), ethambutol (E) and streptomycin (S). Single drug resistance mode, mono S, and HS resistance patterns were the highest proportions in comparison with other modes and patterns in both new and previously treated cases. HRS pattern showed a significant proportion and proportions of quadruple mode were higher than triple mode in previously treated cases. Proportions of patterns associated with R were detected more than expected. Surveillance of proportions of anti-TB drug resistance is important as well as surveillance of resistance rates.

Three atypical pulmonary hydatidosis lesions mimicking bronchial cancer from Turkey.

Hydatid disease is endemic in Turkey. Echinococcus granulosus causes cystic echinococcosis mostly in the liver and lung. Although pulmonary hydatid cysts can be diagnosed by clinical and radiological findings, atypical or complicated lung lesions may be misdiagnosed. In the present study, three cases with hemoptysis and atypical lung lesions were diagnosed and treated as lung cancer or tuberculosis based on the clinical and laboratory findings along with the imaging data and fiberoptic bronchoscopy evaluation. Eventually, pathological examination of the bronchoscopic biopsy material confirmed the definitive diagnosis as pulmonary hydatidosis. The three patients presented herein emphasize the importance of considering pulmonary hydatid disease in the definitive diagnosis of atypical lung lesions such as bronchial carcinoma in echinococcosis endemic areas.

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.

In vitro antibacterial activities of oral care products against ventilator-associated pneumonia pathogens.

BACKGROUND: Oral and oropharyngeal decontamination is one of the main issues for preventing ventilator-associated pneumonia (VAP). OBJECTIVE: The objective of the study was to detect and compare in vitro antibacterial activities of 3 oral care products (OCP) against major VAP pathogens. METHODS: Stabilized hydrogen peroxide (H(2)O(2)); 0.2% chlorhexidine gluconate (CHX); and a commercial product including glucose oxidase, lactoperoxidase, lysozyme, and lactoferrin (GLLL) were selected for this study. In total, 32 VAP isolates were studied by 2 different methods. Bacterial suspension was inoculated onto OCP-absorbed plates in the first method, and OCP was dropped onto bacteria inoculated plates in the second method. Two different bacterial suspensions were used as 10(-2) and 10(-4) dilutions of 0.5 McFarland turbidity. RESULTS: In the first method, 6 (18%), 6 (18%), and 0 isolates in 10(-2) dilution and 13 (40%), 19 (59.3%), and 2 (6.2%) isolates in 10(-4) dilution of 0.5 McFarland bacterial turbidity were inhibited by CHX, H(2)O(2), and GLLL, respectively. In the second method, 31 (96.8%), 30 (93.7%), and 0 isolates in 10(-2) dilution and 32 (100%), 32 (100%), and 5 (15.6%) isolates in 10(-4) dilution were suppressed. In all dilutions and methods, antibacterial activity of CHX and H(2)O(2) were found more effective than GLLL against VAP pathogens (P < .05). CONCLUSION: CHX and H(2)O(2) have good antibacterial effects against most isolated VAP pathogens in vitro. They could be suggested as oropharyngeal decontamination agents for reducing VAP incidence.

Sex-related differences in COPD Assessment Test scores of COPD populationswith or without significant anxiety and/or depression.

BACKGROUND/AIM: Sex-related differences have not been thoroughly explored in chronic obstructive pulmonary disease (COPD). We aimed to evaluate possible sex-related differences in COPD Assessment Test (CAT) scores of COPD patients with or without significant anxiety and/or depression. MATERIALS AND METHODS: Stable COPD patients were prospectively enrolled in the study between July 2013 and April 2014. Levels of anxiety, depression, dyspnea, and health-related quality of life parameters were assessed using specific questionnaires, including the CAT and others. Demographic and clinical data were recorded and physiological tests were performed. All the data were compared to determine any sex-related differences. RESULTS: A total of 128 COPD patients (86 men, 42 women, mean age: 60.5 ± 9.3 years) were included. The women were significantly younger and had lower pack-years of cigarette smoking, and higher biomass smoke exposure, but displayed similarly severe COPD as compared to men. Beck anxiety (13.5-11) and Beck depression (15-11) inventory results were significantly higher in women than men (P = 0.04, P = 0.01). No statistically significant difference was found between the sexes in terms of CAT score, Modified Medical Research Council score, or COPD stage parameters (P > 0.05). CONCLUSION: Female patients have higher levels of depression and anxiety scores but present the same CAT scores related to COPD severity as compared to men.

[Factors affecting the prognosis in patients with primary lung cancer and brain metastases]. / Beyin metastazi bulunan primer akciger kanserli hastalarda prognozu etkileyen faktörler.

Brain metastases are frequent features during the course of patients with lung carcinoma. The aim of this study was to investigate prognostic factors for patients with brain metastasis from lung cancer. Eighty-eight patients with brain metastasis from lung cancer were enrolled in the study. Eighty-two of cases were male, six were female and the mean age was 57.5 +/- 10.4 years. The most common symptoms were headache (32.9%) and dizziness (32.9%). Fifty-two (59.1%) patients had solitary brain metastasis and the most frequent metastasing site was parietal lobe (34.1%). The median survival times were 3 months after diagnosis of lung carcinoma and 1.5 months after diagnosis of brain metastasis. Although the absence of brain metastasis at the moment of diagnosis, metachronous metastasis, central localization of the tumour, chemotherapy administration and surgical treatment of brain metastasis are good prognostic factors affecting survival after the diagnosis of lung carcinoma, the positive factors affecting survival after brain metastasis are central localization of tumour, chemotherapy administration and surgical treatment of brain metastasis. In conclusion, performing the combination of cranial radiotherapy, chemotherapy, surgical therapy and supporting therapy should be evaluated in all appropriate patients with brain metastasis from lung cancer.

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.

Prognostic factors affecting survival in malignant pleural mesothelioma: analysis of 125 subjects.

AIM OF THE STUDY: Determining the pre-treatment prognostic factors in malignant pleural mesothelioma is important in terms of estimating the course of the disease and selecting patients who are candidate for multimodal therapy. The aim of the study was to determine the prognostic factors affecting survival in patients with malignant pleural mesothelioma. STUDY DESIGN: One hundred and twenty-five patients who had been diagnosed histologically as having malignant pleural mesothelioma over the past 5 years were evaluated retrospectively. Relationships of survival of the patients with their age, gender, exposure to asbestos, smoking history, platelet, hemoglobin, leukocyte (WBC) and serum LDH values, histology, performance score and stage of disease were examined. RESULTS: Advanced clinical stage, N2 nodal involvement and the presence of distant metastasis were found to be related to survival. Sarcomatous histology was found to be a poor prognostic factor independently of other factors. CONCLUSIONS: We showed that histological subtype and stage of disease were the most important parameters in planning the treatment, especially in determining the patients who were candidate for multimodal treatment and in estimating the prognosis.