Validity and Reliability of the Assessment Tool for Asthma (ATA) Questionnaire: the ATA Study.

OBJECTIVES: A multicenter trial was designed to validate the "Assessment Tools for Asthma (ATA)" questionnaire, a newly developed questionnaire, which evaluates both asthma control and risk factors associated with asthma control with a single instrument. MATERIALS AND METHODS: This cross-sectional study involved 810 cases from 14 clinics in 9 Turkish cities. The ATA questionnaire and Asthma Control Test (ACT) were administered. The Visual Analog Scale (VAS) was used to evaluate the control status of 100 randomized cases. ATA is an eight-item physician-administered questionnaire. It comprises the following two sections-ATA1, assesses symptomatic control criteria, and the remaining section, queries the flare-up of asthma, control of comorbidities, treatment adherence, and inhaler technique. RESULTS: The mean scores for ATA1, ATA total, VAS, and ACT were 24.7±14.8, 53.8±19, 7.1±3, and 18.8±5.5, respectively. According to the ATA questionnaire, among all patients, 34.3% had controlled, 18.8% had partly controlled, and 46.9% had uncontrolled asthma. Furthermore, 16.6% patients had flare-ups between visits, 96.4% patients had uncontrolled comorbidity, 17% patients had irregular asthma treatment, and only 8.4% patients used the incorrect inhaler technique. The ATA questionnaire showed internal consistency (Cronbach's alpha coefficient=0.683). ACT, ATA1, and two specialists' evaluations using VAS correlated strongly with the ATA total scores (Spearman correlation coefficient (r) values: 0.776, 0.783, and 0.909, respectively; p-values: p<0.001, p<0.001, and p<0.001, respectively). According to Receiver Operating Characteristic analysis, the cut-off value of ATA was 50 (sensitivity=84.4%, specificity=82.40%). CONCLUSION: The validated ATA questionnaire may be a practical tool for physicians in asthma management.

Silicosis in denim sandblasters.

BACKGROUND: During the past 2 decades, silica sand has been used widely in sandblasting denim in Turkey, which has resulted in an epidemic of silicosis. This study was conducted to summarize the clinical outcomes of formerly healthy young people who became disabled or died because of working in the textile industry. METHODS: The medical records of patients with silicosis due to denim sandblasting who were seen at our institution between 2001 and 2009 were reviewed. Follow-up data were assessed. Compensation and vital status of patients were determined, and survival analysis was performed. RESULTS: Thirty-two male patients diagnosed with silicosis due to denim sandblasting over an 8-year period were identified. Mean age was 31.5 years. They worked as denim sandblasters for a mean 66.4 h/wk for a median 28.5 months. Their mean cumulative exposure time to silica sand was 12,957 h. The median follow-up period was 29 months (range 3-101 months). The median latency period (time elapsed between initial exposure and diagnosis) was 5.5 years (range 2-14 years). Six of the followed patients (19%) died of progressive massive fibrosis. Nine of the patients (28%) were compensated because of silicosis. Just two patients with silicosis received compensation before they died. The mean survival rate was 78 months. The estimated 5-year survival rate was 69% for denim sandblasters with silicosis. CONCLUSIONS: Silicosis in young individuals after exposure in the textile sector suggests a lack of awareness of the hazards of silica outside of the traditional occupations associated with silicosis. Death from silicosis in young people suggests overexposure and unsafe working conditions as a result of a lack of control.

Ultrasound guided fine-needle aspiration biopsy of metastases in nonpalpable supraclavicular lymph nodes in lung cancer patients.

BACKGROUND AND OBJECTIVES: To assess frequency and significance of enlarged nonpalpable supraclavicular lymph nodes with routine ultrasound (US) evaluation and US-guided fineneedle aspiration biopsy (FNAB) for the diagnosis and staging of patients with lung cancer. MATERIALS AND METHODS: 106 consecutive patients with lung cancer and nonpalpable supraclavicular lymph nodes were evaluated with cervical US for the presence of pathological lymph nodes. FNAB was performed in patients with nodes with short-axis > 5 mm, rounded shape and missing echogenic hilum. RESULTS: 27 (25.5%) patients had enlarged supraclavicular lymph nodes on US. Fourteen patients (13.2%) had cytologically proven lymph node involvement. Supraclavicular lymph node metastasis was more frequent in patients with mediastinal invasion (p = 0.0001) and patients with enlarged lymph nodes on upper paratracheal stations on thorax CT (p = 0.0001). No relation was found between supraclavicular lymph node involvement and T stage (p = 0.27), distant metastasis (p = 0.50) or histological type (p = 0.80). Three patients were upstaged from IIIA to IIIB status. US-guided FNAB was the only diagnostic method in 2 patients. CONCLUSION: US-guided FNAB is a simple and safe procedure which can document N3 stage of disease in lung cancer patients. Thereby more invasive and expensive diagnostic procedures can be avoided in selected lung cancer patients.

The impact of ultrasonography-guided fine needle aspiration of no palpable supraclavicular lymph nodes on diagnosis and staging in advanced lung cancer.

Diagnosis and accurate staging of lung cancer is essential for selection of appropriate curative or palliative therapy and affects patient prognosis. Both invasive and non-invasive procedures are used for this purpose. We aimed to assess the frequency of no palpable supraclavicular lymph node metastases in lung cancer patients with enlarged mediastinal lymph nodes, and their impact on diagnosis and staging using ultrasound in this study. Lung cancer patients with no palpable supraclavicular lymph nodes and at least 2 enlarged mediastinal lymph nodes on computerized tomography underwent supraclavicular ultrasound examination. Ultrasound-guided fine needle aspiration (US-guided FNA) was performed when enlarged lymph nodes were present. Supraclavicular lymph node metastasis was confirmed cytologically via US-guided FNA in 16 (40%) of 40 patients. Upper paratracheal lymphadenomegaly was significantly higher in patients with supraclavicular metastases than in those without. No statistical significant differences were observed in the stage, cell types, and metastases of patients with or without supraclavicular metastases. In 3 patients US-guided FNA was used for diagnosis. More than one-third of lung cancer patients with enlarged mediastinal lymph nodes had supraclavicular lymph node metastases in present study. US-guided FNA is an easier, safer, and less invasive procedure than standard techniques used to diagnose lung cancer patients with enlarged mediastinal lymph nodes.

[Thoracic findings in neurofibromatosis]. / Nörofibromatoziste torasik bulgular.

Neurofibromatosis type 1 (von Recklinghausen' disease) is an autosomal dominant hereditary syndrome. It is characterized with multiple light brown (café-au-lait) spots, Lisch nodules and neurofibromas. Thorax and lungs are affected in various forms. Four cases with symptoms of thoracic involvement were investigated in our clinic. Mean age was 46. All cases had dyspnoea and cough; two of them had chest pain. Skin lesions of neurofibromatosis type 1 (NF 1) were pathologically confirmed in all cases. Moreover, case 3 had diffuse interstitial fibrosis and honeycomb pattern. Case 2 had thorax deformity, kyphoscoliosis and intrathoracic benign mass. Case 1 had two neurofibrosarcoma masses on the right hemithorax. Case 4 had multiple intrathoracic neurofibromas. Cases 1 and 3 died within two years after diagnosis due to malignancy and respiratory failure, respectively. Cases 2 and 4 are still under our control.

[Churg-Strauss syndrome (two case reports)]. / Churg-Strauss sendromu (iki olgu nedeniyle).

Churg-Strauss syndrome is a necrotizing vasculitis with multiple organ involvement characterized by asthma, peripheral blood eosinophilia, eosinophilic tissue infiltration and extravascular granulomas. A 35 years-old male with 6-months history of asthma and a 43 years-old female with 4-years history of asthma, were further examined due to clinical worsening and lesions on chest radiographs. They were finally diagnosed as Churg-Strauss syndrome. Clinical and radiological response to oral corticosteroid therapy was obtained.