Frequency and Predictors of Pulmonary Arterial Stump Thrombosis following Pneumonectomy or Lobectomy.

OBJECTIVES: Pulmonary artery stump thrombosis (PAST) following pneumonectomies/lobectomies is rare; its clinical importance is unknown. The objectives of this study were to analyze the prevalence and risk factors of PAST and the clinical significance in patients with pneumonectomy/lobectomy. METHODS: All adult cases who underwent pneumonectomy/lobectomy in our hospital for any reason and who underwent control contrast-enhanced thoracic CT during the follow-up period were included in the study. Demographic and clinical features of the patients, data on surgery, and the features of thrombi were recorded. RESULTS: During the 4-year study period, a total of 454 patients underwent pneumonectomy/lobectomy (93 pneumonectomy and 361 lobectomy). Among the patients, 202 patients (50 pneumonectomy and 152 lobectomy) with at least one follow-up thorax CT were included in the analyses. PAST was detected in 9 (4.5%) of 202 patients and mostly seen in patients with pneumonectomy (lobectomy: 2.6% vs. pneumonectomy: 10%, p = 0.043) and in patients whose pulmonary artery was ligated by using stapler (suture ligation 1% vs. stapler: 7.4%, p = 0.034). Pulmonary artery stump was also longer in patients with PAST (8.48 ± 11.22 mm vs. 23.55 ± 11.22 mm, p < 0.001). Univariate logistic regression analysis showed that pneumonectomy and longer pulmonary artery stump length were found to be significantly associated with PAST (p = 0.041 and p = 0.001, respectively). CONCLUSIONS: PAST was detected in 4.5% of our subjects undergoing lobectomy/pneumonectomy. PAST was found to be significantly higher in subjects who underwent pneumonectomy, those with longer pulmonary artery stump, and those with pulmonary artery stump ligated by using stapler.

Fungal culture results and clinical effects of bronchoscopy specimens.

Introduction: Early isolation of the fungal pathogen and early initiation of treatment affect mortality and morbidity rates. The purpose of this study was to reveal the frequency of determination of fungal pathogens in bronchoscopy unit patients. Materials and Methods: The study was designed retrospectively. All patients who underwent bronchoscopy for any reason were enrolled. The patients with suspected fungal infection were divided into three groups after the procedure: 1) Proven fungal infection, 2) Colonization, 3) Without infection. Result: One thousand one hundred and twenty-eight patients were included in the study. Fungal infection was suspected in 188 (16.7%) patients before bronchoscopy. After the examination of the bronchoscopic materials, it was determined that 59 (5.2%) patients had proven fungal infection, 148 (13.1%) patients had colonization, and 921 (81.7%) patients did not have fungal infection. The radiological findings of the patients that were indicative of fungal infection before bronchoscopy were observed as consolidation in 391 (34.7%) and nodule in 413 (36.6%). Fungal growth in bronchoscopic cultures was found in 186 (16.4%) patients, and the most common fungus was Candida albicans (C. albicans) in 110 (9.7%). The treatment was not changed according to the culture results in the patients. No treatment was initiated in the other 108 (98.2%) patients with C. albicans. One hundred and sixty-five (88%) of all fungal growths were detected in the BAL/bronchial lavage fluid. While 29 (45%) of them had not received antifungal treatment before, antifungal treatment was started after bronchoscopy. Conclusions: C. albicans was isolated the most among all bacterial and fungal agents in all patient groups that were immunosuppressed or not at a routine bronchoscopy unit. Diagnostic bronchoscopic sampling should be performed at the early stages of clinically or radiologically suspected fungal illness.

Timeline of critically ill 2019 SARS-CoV-2 cases after onset of illness: Intensive care data from Turkey.

Introduction: This study aimed to evaluate the epidemiological, clinical, laboratory characteristics and treatment and clinical outcomes of severe COVID19 cases from a 3rd degree intensive care unit in Turkey. Materials and Methods: The study was conducted in a level three, 16-bed COVID intensive care unit. The investigation was planned as a retrospective and observational study. Patients who were admitted with COVID-19 pneumonia and respiratory failure in the intensive care unit between March 2020 and March 2021 and followed up due to critical illness were evaluated. Result: A total of 213 patients that were admitted to the intensive care unit with the diagnosis of COVID-19 pneumonia were included in the study. Median age of the patients was 66 (IQR 56.5-74) years, and 134 (62.9%) were males. One hundred and sixty-six (77.9%) of the patients had at least one comorbidity. Patients were followed up mainly with invasive mechanical ventilation [104 (48.8%)] and high flow nasal cannula [67 (31.5%)]. Median number of days was 7 (IQR 4-10) and included the first symptom onset to intensive care admission. The time to intubation was 9 (IQR 4-15) days, and the median day to intensive care discharge was 16 (IQR 11-23). After the symptoms started, first tocilizumab 9 (IQR 5-11) and pulse steroid treatment 8 (IQR 3-11) were found to be close to each other. In total, 95 (44.6%) of the 213 patients died. Conclusions: SARS-CoV-2 associated viral disease can progress after simple symptoms to hospital admission in a median of four days and to intensive care admission requiring intubation in a median of nine days. We believe that a better understanding of the clinical course of COVID-19 and its change between centers can be revealed through sharing information from different countries and centers.

Effect of tocilizumab on intensive care patients with Covid-19 pneumonia, a retrospective cohort study.

BACKGROUND: In this study, the efficacy of an IL-6 antagonist, Tocilizumab, administered in the early period was studied in intensive care patients with COVID-19 pneumonia followed by hypoxic and systemic inflammation not receiving mechanical ventilation support. METHODS: Patients with COVID-19 pneumonia who have signs of hypoxia and systemic inflammation and/or who have acute bilateral infiltrates on chest radiograph and who received tocilizumab treatment were compared with the patients who received standard medical therapy. Patients who were followed up with COVID-19 pneumonia and respiratory failure between March 2020 and March 2021 were retrospectively evaluated in the study. A 400 mg - 800 mg iv dose (depending on weight) of Tocilizumab was administered. The primary endpoint was determined as intensive care unit mortality. RESULTS: A total of 213 patients who were admitted with respiratory failure associated with COVID-19 to our third-level intensive care unit were evaluated. Of these patients, the study was conducted with 50 patients in the tocilizumab treatment group and 92 patients in the standard treatment group. During the intensive care period, 26 patients (28.3%) in the standard treatment group and 12 patients (24%) in the group receiving tocilizumab died. The adjusted hazard ratio for mortality in the tocilizumab group was 0.39 (95% confidence interval [CI], 0.186 to 0.808; p = 0.001 by log-rank test). During the intensive care period, 22 patients (24.8%) in the standart treatment group and 16 patients (32%) in the tocilizumab group were intubated. The adjusted hazard ratio for a primary outcome intubation in the tocilizumab group was 0.71 (95% confidence interval [CI], 0.355 to 1.424; p = 0.184 by log-rank test).

[Bronchiectasis in Turkey: Under the light of national publications]. / Ulusal yayinlar isiginda Türkiye'de bronsektazi.

In this review, we aimed to determine the etiopathogenesis, diagnosis and treatment of non-cystic fibrosis bronchiectasis in the light of scientific studies conducted in our country. For this purpose, Pubmed, Web of Science ve Ulakbim TR Dizin were searched and the publications available as of July 2019 were evaluated and the findings of these studies were summarized and presented.

[The cost of pulmonary thromboembolism treatment]. / Pulmoner tromboemboli tedavisinde maliyet.

INTRODUCTION: Primary aim of this study is to determine the financial burden of Vitamin K Antagonists (VKA), low molecular weight heparins (LMWH) and new oral anticoagulants (NOAC) which are used in the treatment of the pulmonary thromboembolism (PTE). Secondary aim is to show long term complications of the treatment options. MATERIALS AND METHODS: The patients who are diagnosed with PTE between May 2016 and March 2018 at Faculty of Medicine Karadeniz Technical University Hospital were observed prospectively. Hospitalization costs were calculated on patients who were treated only for PTE by hospitalized in the Chest Diseases Service in the acute period. Maintenance costs were calculated over all patients who regulary admitted to our outpatient clinic with the diagnosis of PTE. Data were presented as mean ± SD and median ± interquartilee range. A p-value of <0.05 was accepted to be significant. RESULT: Fifty five (37.2%) of the patients were male, 93 (62.8%) were female and the median age was 68 (range 18-95). The median hospitalization time and cost of patients who are discharged with VKA (n: 22) compared with patients discharged with LMWH (n: 22) was found to be increased (1316.82 TL 7,5 days / 803.36 TL, 5 days p<0.001). Statistical analysis could not be performed with NOAC (n: 2). In the analysis of sixth month costs, LMWH cost was found to be higher than VKA cost (6.927.15 ± 2.687.67 TL/698.29 ± 483.51 TL p<0.001). However VKA treatment tended to be less expensive than treatment with NOACs (698.29 ± 483.51 TL/1.050.81 ± 300.28 TL p= 0.140). CONCLUSIONS: In the acute period of PTE, VKA increases the length of hospitalization and hospital costs in patients treated at the hospital. In the maintenance period, VKA tends to have a lower cost compared to NOACs.

[A rare disease; Erdheim-Chester disease presenting with spontaneous pneumothorax]. / Nadir bir hastalik; spontan pnömotoraks ile basvuran Erdheim-Chester hastaligi.

Erdheim-Chester disease (ECD) is a rare non-Langerhans histiocytosis of unknown etiology, it is characterized by organ infiltration of foamy histiocytes. Diagnosis of ECD involves the analysis of histiocytes in tissue biopsies: these are typically CD68+ CD1a-. These characteristic histiocytes may be found in almost any tissue in cases of ECD. We present an interesting case of ECD that was presented by spontaneous pneumothorax and neurological involvement.

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.

[Causes of mediastinal/hilar granulomatous lymphadenitis]. / Mediastinal/hiler granülomatöz lenfadenit etyolojisi.

INTRODUCTION: Granulomatous lung disease (GLD) is caused by a wide range of conditions and it is challenge for pulmonologist. A detailed history of exposures is fundamental in GDL and has been found pivotal to reach a precise diagnosis. MATERIALS AND METHODS: Between September 2014 and December 2016, the distribution of patients diagnosed with granulomatous lymphadenitis in the mediastinal/hilar lymph nodes by endobronchial ultrasound (EBUS) or mediastinoscopy was analyzed. To be listed as 'confident', a diagnosis of sarcoidosis required compatible histological, radiological and clinical findings in conjunction with negative cultures. Infectious entities listed as 'confident' had either microorganisms in tissue section, positive culture, positive serology or positive antigen detection in a consistent clinical pathological setting. RESULT: Granulomatous lymphadenitis was detected in 110 patients. The included 110 cases consisted of 70.9% women and median age of 53 (range 44-61) years. The final diagnosis of the patients was accepted to be sarcoidosis in 79 (71.8%), sarcoid like granulomas in 7 (6.4%), tuberculosis in 4 (3.6%), silicosis in 4 (3.6%), drug-associated granuloma in 2 (1.8%), hypersensitivity pneumonitis in 1 (0.9%), Chron disease in 1 (0.9%), unspecified in 12 (10.9%). Three patients were classified as tuberculosis based on culture. CONCLUSIONS: In this study, we found that the most common cause of granulomatous lymphadenitis was sarcoidosis. Contrary to expectations, the number of patients diagnosed with tuberculosis was very low.

Sleep disturbances in patients with lung cancer in Turkey.

INTRODUCTION: Sleep quality is known to be associated with the distressing symptoms of cancer. The purpose of this study was to analyze the impact of cancer symptoms on insomnia and the prevalence of sleep-related problems reported by the patients with lung cancer in Turkey. MATERIALS AND METHODS: Assesment of Palliative Care in Lung Cancer in Turkey (ASPECT) study, a prospective multicenter study conducted in Turkey with the participation of 26 centers and included all patients with lung cancer, was re-evaluated in terms of sleep problems, insomnia and possible association with the cancer symptoms. Demographic characteristics of patients and information about disease were recorded for each patient by physicians via face-to-face interviews, and using hospital records. Patients who have difficulty initiating or maintaining sleep (DIMS) is associated with daytime sleepiness/fatigue were diagnosed as having insomnia. Daytime sleepiness, fatigue and lung cancer symptoms were recorded and graded using the Edmonton Symptom Assessment Scale. RESULT: Among 1245 cases, 48.4% reported DIMS, 60.8% reported daytime sleepiness and 82.1% reported fatigue. The prevalence of insomnia was 44.7%. Female gender, patients with stage 3-4 disease, patients with metastases, with comorbidities, and with weight loss > 5 kg had higher rates of insomnia. Also, patients with insomnia had significantly higher rates of pain, nausea, dyspnea, and anxiety. Multivariate logistic regression analysis showed that patients with moderate to severe pain and dyspnea and severe anxiety had 2-3 times higher rates of insomnia. CONCLUSIONS: In conclusion, our results showed a clear association between sleep disturbances and cancer symptoms. Because of that, adequate symptom control is essential to maintain sleep quality in patients with lung cancer.

[Bilateral total lung lavage in a patient with pulmonary alveolar proteinosis]. / Pulmoner alveoler proteinozisli hastada iki tarafli total akciger lavaji.

Pulmonary alveolar proteinosis (PAP) is a rare pulmonary disease characterised by alveolar accumulation of surfactant composed of proteins and lipids. Three main categories of PAP have been defined depending on the aetiology: primer/idiopathic, neonatal/congenital, secondary and exogenous/environmental exposure. Radiologically diffuse ground glass opacities, interlobular and intralobular septal thickening is seen. Although open lung biopsy is accepted as the gold standard in diagnosis, it can be diagnosed by showing bronchoalveolar lavage (BAL) fluid with a milky appearance and periodic acid-schiff (PAS) positive globules in biopsy with clinical and radiological findings. Theraphy for PAP are supportive care (oxygen), total lung lavage, inhale/subcutaneous granulocyte macrophage colony stimulating factor (GM-CSF), rituximab, plasmapheresis, lung transplantation. We report a case of PAP presented with cough and shortness of breath, diagnosed with BAL and transbronchial lung biopsy, treated by total lung lavage by reviewing literature.

The Significance of the Relative Lymphocyte Count as an Independent Predictor of Cardiovascular Disease in Patients with Obstructive Sleep Apnea Syndrome.

OBJECTIVE: The aim of this study was to determine whether or not relative lymphocyte count (RLC) is associated with cardiovascular disease (CVD) in patients with obstructive sleep apnea syndrome (OSAS). SUBJECTS AND METHODS: In this study, 141 patients diagnosed with OSAS using polysomnography were enrolled. Patients were classified according to the severity of OSAS as determined by the apnea-hypopnea index (AHI) and presence of CVD. Lymphocyte count and other hematological parameters at complete blood count were determined and compared between patients with and without CVD. Multivariate regression analysis was used to estimate the associated factors for presence of CVD. RESULTS: Absolute and relative lymphocyte counts were lower in the OSAS patients with CVD compared to those without CVD (mean absolute lymphocyte counts: 2.0 × 103 vs. 2.5 × 103 µl, p = 0.004, and mean RLC: 28.3 vs. 33.9%, p = 0.001, respectively). OSAS patients with CVD (14.2) had higher red cell distribution width values than the patients without CVD (13.4) (p = 0.005). Multivariate analysis identified RLC as an independent predictor of CVD in patients with OSAS (odds ratio = 0.9, 95% CI: 0.85-1.0, p = 0.042). CONCLUSION: RLC was identified as an independent predictor of CVD in patients with OSAS. Since RLC is a widely available diagnostic tool with no additional costs over the routinely performed complete blood count, it can be used for predicting CVD in patients with OSAS.

Platelet indices in obstructive sleep apnea: the role of mean platelet volume, platelet distribution widht and plateletcrit.

INTRODUCTION: Because studies report controversial findings of mean platelet volume (MPV) and platelet distribution width (PDW), we aimed to investigate platelet indices in patients with obstructive sleep apnea (OSA). MATERIALS AND METHODS: One hundred seventy three patients with OSA and 43 control subjects included in analyses. Patients with an apnea-hypopnea index (AHI) ≥ 5 were considered to have OSA and an AHI < 5 were considered as control. Platelet indices (MPV, PDW, plateletcrit) were obtained from routine analysis of blood samples using an automated blood cell counter. RESULT: Among platelet indices, only PDW was higher in patients with OSA, especially in severe OSA when compared to control group (16.80 ± 0.56 vs. 16.21 ± 1.51, p= 0.015 and 16.82 ± 0.06 vs.16.21 ± 1.51, p= 0.014, respectively). Correlation analysis showed a significant but a weak correlation between the PDW and AHI (r= 0.161, p= 0.018) and the PDW and the desaturation index (r= 0.171, p= 0.016). The ROC curve analysis showed that the optimal cut-off value, distinguishing patients with OSA from those in control group, for PDW was 16.62 (sensitivity 57.8%, specificity 58.1%, AUROC 0.60, p= 0.042). After the exclusion of patients with comorbid diseases (cardiovascular diseases, diabetes mellitus and chronic inflammatory diseases), we also found weak but a significant correlation between PDW and AHI (r= 0.179, p= 0.040). CONCLUSIONS: In conclusion, among the platelet indices, only PDW was found to be higher in patients with OSA, especially in severe OSA. PDW was also correlated with apnea-hypopnea index and oxygen desaturation index.

[Inflammatory bowel disease and pulmonary embolism: Because of 3 cases]. / Inflamatuvar bagirsak hastaligi ve pulmoner emboli: 3 olgu nedeniyle.

Thromboembolic complications are an important cause of morbidity and mortality in inflammatory bowel diseases (IBD). Thromboembolic events are observed more frequently during acute flare of the disease, especially patients received steroid therapy. Increase in awareness and especially anticoagulation prophylaxis in these patients are extremely important. In this article, three cases with diagnosed pulmonary thromboembolism (PE) were presented accompanied by the current literature.

Association of Fragmented QRS with Subclinical Left Ventricular Dysfunction in Patients with Obstructive Sleep Apnea.

OBJECTIVE: We aimed to investigate whether fragmented QRS (fQRS) is associated with subclinical left ventricular (LV) dysfunction in patients with obstructive sleep apnea (OSA). SUBJECTS AND METHODS: A total of 141 patients with OSA who had normal LV ejection fraction (LVEF) were included in the study. The fQRS was defined as the presence of an additional R wave, notching of R or S wave or the presence of fragmentation in 2 contiguous electrocardiography (ECG) leads. Subclinical LV dysfunction was defined as the presence of a tissue Doppler-derived Tei index of ≥ 0.5 in the absence of impaired LVEF (<50%) as assessed by transthoracic echocardiography. RESULTS: Of the 141 patients, 71 (50.4%) had subclinical LV dysfunction. Overall, the prevalence of the fQRS was 61% (86/141). Patients with fQRS had significantly higher Tei indices than those without fQRS [median 0.66, interquartile range (IQR) 0.39 vs. median 0.40, IQR 0.15, p < 0.001]. The presence of fQRS on ECG predicted subclinical LV dysfunction in univariate logistic regression analysis [odds ratio (OR) 6.69, 95% confidence interval (CI) 3.10-14.43]. The association remained significant after adjusting for all potential confounders (OR 4.59, 95% CI 1.94-10.87). CONCLUSION: fQRS on ECG was an independent predictor of subclinical LV dysfunction in patients with OSA. This simple tool might help to identify OSA patients who could be at risk for developing overt cardiac dysfunction.

Red cell distribution width: a new predictor for chronic thromboembolic pulmonary hypertension after pulmonary embolism.

The most important long-term complication of pulmonary thromboembolism is chronic thromboembolic pulmonary hypertension (CTEPH) that is associated with considerable morbidity and mortality. It is uncertain why some patients with acute pulmonary embolism (PE) develop CTEPH and others do not. Elevated red cell distribution width (RDW) has been associated with adverse outcomes of heart failure, PE, and idiopathic pulmonary hypertension. The aim of the present study was to investigate whether RDW might be a predictor of CTEPH in PE patients or not. This study is a retrospective cohort study. A total of 203 consecutive patients with acute PE were included. The RDW was higher in the CTEPH patients than the patients without CTEPH (17.04 ± 3.46, 14.64 ± 1.82, respectively, p = 0.015). RDW was also higher in the CTEPH patients at the time of diagnosis of CTEPH during follow-up compared with the baseline RDW level at the time of PE diagnosis (18.63 ± 3.58, 17.02 ± 3.59, respectively, p = 0.014). The optimal cutoff value of the RDW for predicting CTEPH was 14.65. The area under the curve of RDW for the prediction of CTEPH was 0.735 (95% confidence interval (CI): 0.600-0.869); in cases with RDW levels >14.65%, the specificity, sensitivity, and negative predictive value for CTEPH were 62% (95% CI: 0.55-0.69), 75% (95% CI: 0.47-0.92), and 96.7% (95% CI: 0.91-0.99), respectively. A multivariate regression analysis showed that RDW, hazard ratio: 1.58 (95% CI: 1.09-2.30), was a predictor of CTEPH (p = 0.016). High level of RDW was an independent predictor of CTEPH in PE patients. Therefore, RDW levels may provide a prediction for CTEPH in PE patients.

Red cell distribution width in patients with obstructive sleep apnea syndrome.

BACKGROUND: Red cell distribution width (RDW) has been shown to be associated with adverse outcomes in left-sided heart failure, pulmonary hypertension, and in patients in the ICU. However, the role of RDW is unknown in patients with obstructive sleep apnea syndrome (OSAS), especially in OSAS patients with cardiovascular diseases. METHODS: One hundred thirty-seven patients were investigated by polysomnography (PSG) for OSAS. The patients were classified as a control group or as the OSAS group according to the apnea-hypopnea index (AHI). The RDW, hemoglobin level, and mean corpuscular volume (MCV) were determined. C-reactive protein (CRP) levels were measured. RESULTS: The RDW values were higher in the OSAS group than in the controls [13.6% (12-23%) vs. 12.9% (11.7-14.5%), p=0.003]. The RDW values were higher in patients with cardiovascular diseases [13.7% (11.7-23.2%) vs. 13.2% (12-16.9%), p=0.001]. RDW ≥ 13.6% (odds ratio [OR] =1.5 [95% CI = 1.0-2.0], p = 0.014) was found to be associated with increased risk for cardiovascular disease in patients with OSAS on multivariate analysis. It was also shown that there was a significant correlation between the RDW and the AHI (r=0.272), age (r=0.362), mean SaO(2) (r=0.375), systolic pulmonary artery pressure (r=0.435), and CRP level (r=0.275) in study population. CONCLUSIONS: RDW is a newly recognized and widely available diagnostic tool with no additional cost over the routinely performed hemogram. RDW is independently associated with cardiovascular disease in patients with OSAS in our cross-sectional study.

Diagnostic Value of Radiographic Characteristics of Mediastinal and Hilar Lymph Nodes in Sarcoidosis.

OBJECTIVE: In this study, it was aimed to investigate the diagnostic value of thorax computed tomography, which is a non-invasive method, in diagnosing sarcoidosis. MATERIALS AND METHODS: In our Faculty of Medicine, Department of Chest Diseases between January 1, 2013, and July 1, 2019, the data of 816 patients who underwent endobronchial ultrasonography for mediastinal lymph node sampling and other sampling methods, such as mediastinoscopy, thoracotomy, etc., if the histopathological diagnosis could not be reached, were retrospectively screened and 192 patients (sarcoidosis: 62, non-sarcoidosis: 130 patients) who met the inclusion criteria were included in the study. Patients diagnosed with sarcoidosis and patients diagnosed with non-sarcoidosis were compared in terms of thorax computed tomography findings (medi- astinal lymph nodes and lung parenchymal involvement). RESULTS: Right upper paratracheal (72.6 vs. 46.9%, P = .001) and paraaortic lymph node involvement (79.0% vs. 60.8%, P = .01), hilar symmetry (88.5 vs. 58.3%, P < .001), and homogeneity in lymph nodes (80.6% vs. 56.9%, P = .001) were found to be significantly higher in the sarcoidosis group. Lymph node sizes were smaller in the sarcoidosis group and the mean density (51.3 Hounsfield unit vs. 44.1 Hounsfield unit, P = .002) was significantly higher. In the multivariate logistic regression analysis, the presence of homogeneity in the lymph nodes is 4.3-fold more likely to increase sarcoidosis, the presence of hilar symmetry 9.1-fold, the involvement of the right lower paratracheal lymph node 2.7-fold, the mean lymphadenopathy density >48 Hounsfield unit 4.3-fold, the maximum diameter of lymphadenopathy less than 27.5 mm 4.7-fold. CONCLUSION: This study revealed that the localization, size, density, and homogeneity of mediastinal lymph nodes will help clinicians to diagnose patients with sarcoidosis without using invasive methods.

The role of risk factors in delayed diagnosis of pulmonary embolism.

BACKGROUND: Despite diagnostic advances, delays in the diagnosis of pulmonary embolism (PE) are common. OBJECTIVE: In this study, we aimed to investigate the relationship between delays in the diagnosis of PE and underlying risk factors for PE. METHODS: We retrospectively evaluated the records of 408 patients with acute PE. Patients were divided into 2 groups, surgical or medical, based on risk factors leading to the embolism. Analysis involved demographic characteristics of the patients, dates of symptom onset, first medical evaluation, and confirmatory diagnostic tests. Diagnostic delay was described as diagnosis of PE more than 1 week after symptom onset. RESULTS: The mean time to diagnosis for all patients was 6.95 ± 8.5 days (median, 3 days; range, 0-45 days). Of the total number of patients, 29.6% had presented within the first 24 hours and 72.3% within the first week. The mean time to diagnosis was 4.4 ± 7.6 days (median, 2 days; range, 0-45 days) in the surgical group and 8.0 ± 8.6 days (median, 4 days; range, 0-45 days) in the medical group (P = .000). The mean time to diagnosis in the medical group was approximately 4 times greater than that of the surgical group on univariate analysis. Early or delayed diagnosis had no significant impact on mortality in either group. CONCLUSION: Delay in the diagnosis of PE is an important issue, particularly in medical patients. We suggest that a public health and educational initiative is needed to improve efficiency in PE diagnosis.

C-reactive protein alone or combined with cardiac troponin T for risk stratification of respiratory intensive care unit patients.

BACKGROUND: Mortality is high among patients admitted to intensive care units (ICUs). Several prognostic markers have been described in such patients, but the literature contains no data comparing C-reactive protein (CRP) and cardiac troponin T (cTn-T), nor of a combination of CRP and cTn-T in the same patient group in the ICU. METHODS: This was a retrospective electronic data review of patients who presented to the emergency department for respiratory reasons between December 2007 and December 2009 and in whom CRP and cTn-T levels were measured. Patients with a diagnosis of pulmonary embolism and acute coronary syndrome were excluded. We recorded demographics, chronic diseases, admission diagnosis, Simplified Acute Physiology Score II (SAPS II), ICU stay, and CRP and cTn-T concentrations. RESULTS: We included the records of 158 patients. Mean ICU stay was 9.9 days (range 1-65 d), and mean hospital stay was 14.1 days (range 1-72 d). For predicting mortality, receiver operating characteristic analysis gave a CRP cutoff value of ≥ 10 mg/dL, and a CTn-T cutoff value of ≥ 0.01 ng/mL. For CRP the mortality area under the curve was 0.691 (95% CI 0.608-0.775), the sensitivity was 65%, and the specificity was 70%. For cTn-T the mortality area under the curve was 0.733 (95% CI 0.655-0.812), the sensitivity was 78%, and the specificity was 56%. Of the patients who died, 65% had CRP ≥ 10 mg/dL and 78% had cTn-T ≥ 0.01 ng/mL. On multivariable regression analysis, CRP ≥ 10 mg/dL was associated with 6.6-fold higher (95% CI 1.7-21.3) ICU mortality. There was no advantage for models that combined CRP and cTn-T. CRP alone was more valuable in predicting ICU mortality than in combination with troponin or SAPS II. CONCLUSIONS: Elevated CRP is an independent early prognostic marker of mortality risk in ICU patients. We suspect that a CRP-based prognosis strategy may be useful.