Relation between carotid intima-media thickness, serum paraoxonase levels and severity of obstructive sleep apnea syndrome.

NTRODUCTION: Obstructive sleep apnea (OSA) has a significant effect on the development of cardiovascular complications. The aim of this study was to evaluate the relationship between carotid intima-media thickness (IMT), paraoxonase 1 (PON 1) enzyme levels and severity of OSA. MATERIAL AND METHODS: A total of 120 cases were included in the study with 30 cases in each group, as follows: Group 1 (AHI 30/h). Blood samples of the patients were taken to measure serum PON1 activity. Carotid IMT of all patients included in the study was measured by means of echocardiography using vascular probe and results were recorded. RESULTS: With regard to carotid IMT, a statistically significant increase was detected as severity of OSA increased (p < 0.001). A positive relationship was detected between IMT level and total oxygen desaturation time, oxygen desaturation index and SpO2 time < 90 % (p < 0.01). When the groups were compared, a statistically significant decline was observed in serum PON 1 level as severity of OSA increased (p < 0.05). CONCLUSIONS: The findings of our study indicate that PON1 and carotid IMT might be used as indicators of vascular damage in patients with OSA. Depending on the severity of OSA, measurement of PON1 enzyme activity in conjunction with carotid IMT may help us in predicting the cardiovascular risk in patients with OSA (Tab. 4, Fig. 2, Ref. 27).

Tuberculosis in Solid-Organ Transplant Recipients in Turkey: Meta-Analysis From the Tuberculosis Study Group of Turkish Transplantation Society, Solid Organ Transplantation Infections.

OBJECTIVES: Tuberculosis risk in solid-organ transplant recipients is more than the general population, although tuberculosis incidence has been reported to decrease 5% in the last decade in Turkey. In Turkey, solid-organ transplants started in 1975; however, routine pretransplant tuberculosis risk screening programs are still not established. Therefore, we conducted a meta-analysis of tuberculosis prevalence, clinical forms, and prognosis of tuberculosis in solid-organ transplant recipients. MATERIALS AND METHODS: We searched PubMed, Web of Knowledge, Google Scholar, EBSCOhost, and Scopus databases in English and Turkish Medical Index of Turkish Academic Network and Information Center, Turkish Citation Index, Turkish Medline, Central Thesis of ULAKBIM databases in Turkish (from inception until December 2018) for national and international reference lists of all relevant papers. We used standard methodological procedures (Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009). RESULTS: We found 199 published studies in English and 26 in Turkish. After exclusion of noneligible studies, there were 10 retrospective research articles and 16 case reports. There were 148 (3.2%) tuberculosis cases with 4553 solid-organ transplant recipients (4031 renal, 522 liver). Of the tuberculosis cases, 50 (33.8%) were pulmonary, 21 (14.2%) were pulmonary and extrapulmonary, 13 (8.8%) were miliary, 27 (18.2%) were disseminated, and 37 (25.0%) were extra-pulmonary tuberculosis cases involving a maximum of 2 organs. There were 19 cases (12.8%) of graft lost. Of the patients with tuberculosis, 34 (19.9%) died resulting from either tuberculosis or other reasons. CONCLUSIONS: In this meta-analysis, most of the centers did not perform pretransplant risk evaluations; every center had different clinical procedures and follow-ups. Tuberculosis prevalence in solid-organ transplant recipients differs according to study population. Case reports were mostly about extrapulmonary tuberculosis. All such patients should be followed-up by a standard regimen during pretransplant and posttransplant periods. Prospective studies should be considered.

American Society of Anesthesiologists Classification Versus ARISCAT Risk Index: Predicting Pulmonary Complications Following Renal Transplant.

OBJECTIVES: Patients with chronic renal failure are prone to pulmonary complications. Renal transplant recipients should undergo complete preoperative evaluation to determine risk of postoperative pulmonary complications. The American Society of Anesthesiologists classification and the Assess Respiratory Risk in Surgical Patients in Catalonia risk index correlate well with incidence of postoperative pulmonary complications. Here, we compared their accuracy in predicting pulmonary complications following renal transplant. MATERIALS AND METHODS: We retrospectively reviewed medical records of renal transplant recipients between years 2004 and 2015. We collected patient data on Assess Respiratory Risk in Surgical Patients in Catalonia risk index, including demographics, smoking history, comorbidities, preoperative pulmonary risk score, laboratory results, surgery information, history of lower respiratory tract infection 1 month pretransplant, urgency of surgery, American Society of Anesthesiologists classification, and pulmonary complications within 1 month posttransplant. RESULTS: Of 172 patients (123 males; mean age 38.82 y), 22 (12.8%) developed pulmonary complication during the first month posttransplant, including effusion (9 patients), pneumonia (10 patients), respiratory inefficiency (2 patients), and pulmonary embolism (1 patient). Atelectasis was observed in 95.4% of patients with complications. A positive correlation was observed between age and development of complications (r = 0.171; P = .025). Regarding risk score, 75% of patients at high risk and 19.5% at intermediate risk developed pulmonary complications. Patients with low-risk scores had significantly lower complications than intermediate- and high-risk groups (P < .001). A positive correlation was observed between preoperative risk score and complications (r = 0.34; P < .001). There was no association between the American Society of Anesthesiologists scores and postoperative complications (P = .7). CONCLUSIONS: The American Society of Anesthesiologists classification was found to be a weaker modality to predict pulmonary complications after renal transplant; as it relates to the general health status, than the Assess Respiratory Risk in Surgical Patients in Catalonia risk index.

Culture-Positive Pulmonary Aspergillosis Infection: Clinical and Laboratory Features of Solid-Organ Transplant Recipients.

OBJECTIVES: Aspergillosis is a common fungal infection among solid-organ transplant recipients. Even after awareness of this infection occurs, there are still gaps in nonculture diagnostic tests, which can delay treatment initiation. Here, we aimed to define the common traits of pulmonary aspergillosis infection among solid-organ transplant recipients, thus shedding light on prevention and early diagnosis. MATERIALS AND METHODS: We conducted a database search of patients at Baskent University who had a positive aspergillosis culture between January 2010 and March 2016. Among 20 patients identified, 15 (mean age of 50.93 ± 11.17 y, 2 female and 13 male patients) with solid-organ transplant were included in the study. RESULTS: Of the 15 study patients, 7 were heart transplant, 6 were kidney transplant, and 2 were liver transplant recipients. Three patients had positive aspergillosis cultures from extrapulmonary specimens (1 brain biopsy and 2 wound swap cultures). Other patients with positive cultures were from bronchoalveolar lavage (6 patients), sputum (4 patients), both bronchoalveolar lavage and sputum (1 patient), and deep tracheal aspiration specimen (1 patient). Aspergillus fumigatus was the most common species. Mean hospitalization duration was 31.53 days (range, 2-135 d). Although all patients had positive culture results, 7 patients (46.7%) had negative galactomannan test results at the time of culture specimen collection. Positive galactomannan test results were statistically higher in 6 heart transplant patients (P = .045). All patients had fever at presentation, and 13 patients had been referred to the pulmonary disease department before positive culture results were obtained. CONCLUSIONS: Risk factors for pulmonary aspergillosis and its clinical presentation in solid-organ transplant recipients are still unclear. Although the expected time for aspergillosis infection in solid-organ transplant recipients is 6 months after transplant, clinicians must remember the nonspecific presentation of infections in these patients and be aware of the reliability of diagnostic tools.

Smoking Is Related to Postoperative Pulmonary Complications and Graft Outcomes in Renal Transplant Patients.

OBJECTIVES: Renal transplant is an important treatment option for end-stage renal disease. A successful kidney transplant improves the quality of life and reduces the mortality risk compared with maintenance dialysis in patients with end-stage renal disease. Several immunologic and nonimmunologic factors are responsible for graft outcomes in renal transplant patients. Our study was performed to evaluate the role of smoking on postoperative pulmonary complications and graft outcomes in renal transplant patients. MATERIALS AND METHODS: Our study retrospectively analyzed 1740 patients who had renal transplants between 1987 and 2014 at Baskent University. Patients with smoking data were included in the study. Patient demographic, smoking status, comorbid diseases, postoperative pulmonary complications, graft outcomes, and clinical features were recorded. The relation between postoperative pulmonary complications and risk factors was investigated. RESULTS: Our study included 131 adult renal transplant recipients who had smoking data. The incidence of postoperative pulmonary complications was 16% (21 patients) in the first month after surgery. Smoking history was found in 52 patients (39.7%). There was a statistically significant relationship between the presence of atelectasis and smoking history (P = .004). A positive and statistically significant correlation was detected between atelectasis and pack-years smoking (r = 0.424; P = .001). We evaluated graft rejection within 1 month after transplant regardless of being acute cellular or humoral rejection. The relation between smoking history and graft rejection within 1 month after transplant was significant (P = .011). CONCLUSIONS: Renal transplant patients who are smokers have an increased risk for early postoperative pulmonary complications. Furthermore, cigarette smoking contributes to allograft loss in renal transplant patients. Smoking cessation before surgery can reduce the risk of early postoperative complications.

Awareness of Respiratory Failure Can Predict Early Postoperative Pulmonary Complications in Liver Transplant Recipients.

OBJECTIVES: Cardiovascular and respiratory system complications are the most common causes of early mortality after liver transplant. We evaluated the causes of respiratory failure as an early postoperative pulmonary complication in liver transplant recipients. MATERIALS AND METHODS: Patients who underwent orthotropic liver transplant between 2001 and 2014 were retrospectively evaluated. Clinical and demographic variables and pulmonary complications at the first and second visit after transplant were noted. The first visit was within the first week and the second was between 1 and 4 weeks after transplant. An arterial oxygen saturation value below 90% in room air for at least 1 day was considered a medically significant respiratory failure. RESULTS: Our study included 204 (148 men and 56 women; mean age 43.0.4 ± 13.06 y) adult liver transplant recipients (46 from deceased and 158 from living donors). At the first visit after transplant, 161 patients (79%) had postoperative pulmonary complications, including pleural effusion accompanied by atelectasis (47.1%), only atelectasis (17.2%), and only pleural effusion (10.3%). At the second visit, complications included atelectasis associated with pleural effusion (12.3%) and pneumonia (12.3%). All patients had documented respiratory failure at the first visit, and 92 patients (45.1%) had respiratory failure at the second visit. Causes of respiratory failure at the first visit included atelectasis in 35 patients (17.2%) and atelectasis accompanied by pleural effusion in 96 patients (47.1%). At the second visit, 25 of 161 patients (25.3%) had respiratory failure due to pneumonia. Other causes included atelectasis accompanied by pleural effusion (24.2%) and pleural effusion (23.2%). Ninety-seven patients had no pulmonary complications. The mortality rate was 6.4% within the first visit and 8.7% within the second visit. CONCLUSIONS: Pneumonia, atelectasis, and pleural effusion can cause respiratory failure within the first month after liver transplant. Early pulmonary examination, diagnosis, and treatment can improve patient survival.

Pulmonary Hypertension Improves After Orthotopic Liver Transplant in Patients With Chronic Liver Disease.

OBJECTIVES: Pulmonary hypertension is a common finding in chronic liver disease patients that has prognostic significance. In this study, we aimed to evaluate the prevalence and severity of pulmonary hypertension in patients undergoing orthotopic liver transplant. We also evaluated pulmonary artery pressure changes after transplant surgery. MATERIALS AND METHODS: The records of adult patients with chronic liver disease who underwent orthotopic liver transplant at our center between 2004 and 2015 were retrospectively evaluated. Clinical and demographic variables and laboratory data were noted. Transthoracic Doppler echocardiographic examination reports were obtained. Using continuous-wave Doppler examination, systolic pulmonary artery pressure values were calculated. Pulmonary hypertension was defined as systolic pulmonary artery pressure ≥ 30 mm Hg. Among 208 adult patients who underwent orthotopic liver transplant, 203 who had Doppler echocardiographic examination were enrolled. RESULTS: The mean age of patients was 42.1 ± 14.1 years (range, 16-67 y), and 143 (70.4%) were men. During preoperative assessment, pulmonary hypertension was identified in 47 patients (23.2%), of whom 10 displayed systolic pulmonary artery pressure > 50 mm Hg. Compared with preoperative values of systolic pulmonary artery pressure (46.8 ± 8.4 mm Hg), a significant reduction in mean values (to 39.3 ± 13.3 mm Hg) was observed postoperatively (P = .007). CONCLUSIONS: The findings of this study indicate that pulmonary hypertension is a common finding in adult chronic liver disease patients undergoing orthotopic liver transplant. A significant improvement occurs in systolic pulmonary artery pressure values following transplant surgery. Regarding the prevalence and prognostic significance of pulmonary hypertension, all patients with chronic liver disease should be evaluated with transthoracic Doppler echocardiography before transplant.

Prevalence, Cause, and Treatment of Respiratory Insufficiency After Orthotopic Heart Transplant.

OBJECTIVES: Heart transplant is the best treatment for end-stage heart failure. Respiratory insufficiency after heart transplant is a potentially serious complication. Pulmonary complications, pulmonary hypertension, allograft failure or rejection, and structural heart defects in the donor heart are among the causes of hypoxemia after transplant. In this study, we evaluated the prevalence of hypoxemia and respiratory insufficiency in patients with orthotopic heart transplant during the early postoperative period. MATERIALS AND METHODS: We retrospectively evaluated the medical records of 45 patients who had received orthotopic heart transplant at our center. Clinical and demographic variables and laboratory data were noted. Oxygen saturation values from patients in the first week and the first month after transplant were analyzed. We also documented the cause of respiratory insufficiency and the type of treatment. RESULTS: Mean age was 35.3 ± 15.3 years (range, 12-61 y), with males comprising 32 of 45 patients (71.1%). Two patients had mild chronic obstructive pulmonary disease and 1 had asthma. Twenty-five patients (55.6%) had a history of smoking. Respiratory insufficiency was noted in 9 patients (20%) during the first postoperative week. Regarding cause, 5 of these patients (11.1%) had pleural effusion, 2 (4.4%) had atelectasis, 1 (2.2%) had pneumonia, and 1 (2.2%) had acute renal failure. Therapies administered to patients with respiratory insufficiency were as follows: 5 patients had oxygen therapy with nasal canula/mask, 3 patients had continuous positive airway pressure, and 1 patient had mechanical ventilation. One month after transplant, 2 patients (4.4%) had respiratory insufficiency 1 (2.2%) due to pleural effusion and 1 (2.2%) due to atelectasis. CONCLUSIONS: Respiratory insufficiency is a common complication in the first week after orthotopic heart transplant. Identification of the underlying cause is an important indicator for therapy. With appropriate care, respiratory insufficiency can be treated successfully.

A 10-year experience of tuberculosis in solid-organ transplant recipients.

OBJECTIVES: Tuberculosis remains an important problem in solid-organ transplant patients due to their immunocompromised state. The objective of the present study was to report the incidence, demographic characteristics, and various presentations of tuberculosis in solid-organ transplant recipients. MATERIALS AND METHODS: We evaluated a total of 999 patients (male/female = 665/334, 661 renal and 338 liver transplants) who underwent solid-organ transplant between 2003 and 2013. The medical records of all patients were retrospectively reviewed. Patients' demographics, transplant type, primary site of tuberculosis specimen culture and pathology results, chest radiograph, and thoracic computed tomography findings, total blood count and chemistry were all recorded. RESULTS: Among the 999 subjects, 19 patients (1.9%) (male/female: 15/4, mean ± SD age, 42 ± 18.5 y) were diagnosed with tuberculosis. The majority of patients (85%) were diagnosed with tuberculosis within 6 months after transplant, and 15% were diagnosed within 3 months. Most diagnoses of tuberculosis were based on histopathologic examination of biopsy material. Of these patients, 9 were diagnosed with pulmonary tuberculosis, 8 had extrapulmonary tuberculosis, and 2 had both. Nontuberculosis mycobacteria infections were detected in 3 patients. CONCLUSIONS: Even with a negative exposure history, tuberculosis can manifest as different clinic presentations in solid-organ transplant patients on immunosuppressive drugs, particularly in the first 6 months after transplant. Therefore, clinicians should always consider tuberculosis as the potential cause of an infectious disease with unknown cause to successfully diagnose and manage solid-organ transplant recipients.

Long-term risk of pulmonary embolism in solid-organ transplant recipients.

OBJECTIVES: Solid-organ transplant recipients can develop chronic hypercoagulation that increases the incidence of pulmonary embolism. Here, we evaluate the frequency of pulmonary embolism in solid-organ transplant recipients during the first 10 years after transplantation and evaluate the risk factors for its development. MATERIALS AND METHODS: The medical records of solid-organ transplant recipients who were treated between 2003 and 2013 were retrospectively reviewed. The reviewed data included demographics, type of transplant, comorbidities, procoagulation factors, thromboembolism prophylaxis, and the timing and extent of pulmonary embolism. RESULTS: In total, 999 solid-organ transplant recipients are included in this study (661 renal and 338 liver transplant recipients) (male: female ratio = 665:334). Twelve renal (1.2%) and 1 liver transplant recipient (0.3%) were diagnosed with pulmonary embolism. Pulmonary embolism developed 1 year after transplantation in 10 patients: 1 patient developed pulmonary embolism < 3 months after transplantation, and the other 9 patients developed pulmonary embolism within 3 to 6 months. No patients had a prior history of deep venous thrombosis or pulmonary embolism. Five patients received tacrolimus, 7 patients received sirolimus, and 1 patient received cyclosporine. Ten patients received prednisolone, and 8 patients received mycophenolate mofetil. All patients were homozygous normal for factor V Leiden and prothrombin genes. One patient was homozygous abnormal, and 1 patient had a heterozygous mutation in the methylenetetrahydrofolate reductase gene. Two patients were treated with low-molecular-weight heparin, while the remaining patients received warfarin. Eight patients were treated for 6 months, and the remainder received longer treatments. CONCLUSIONS: Here, the incidence of pulmonary embolism in solid-organ transplant recipients is 1.2%. Renal transplant recipients are at higher risk of developing pulmonary embolism than liver transplant recipients. The factors that increase the risk of pulmonary embolism in solid-organ transplant recipients appear to be multifactorial and include genetic predisposition.

Postoperative pulmonary complications in living-liver donors: a retrospective analysis of 188 patients.

OBJECTIVES: Living-donor liver transplant has become a viable option and an important source of hepatic grafts. The goal of this study is to establish postoperative pulmonary complications of liver donation surgery in our center. MATERIALS AND METHODS: Data from 188 subjects (median age, 33.7 ± 8.4 y; male/female, 51.1%/48.9%) who had liver donation surgery from 1988 to 2013 were analyzed retrospectively. Patient demographic and clinical features were recorded. Postoperative complications and the correlation of risk factors for postoperative pulmonary complications were investigated. RESULTS: The incidence of early postoperative complications was 17% (n = 32), and 16 of these patients had postoperative pulmonary complications (8.5%); 2 of the postoperative pulmonary complications were detected on the day of surgery and the other 14 complications were observed between the second and seventh day after surgery. Most postoperative pulmonary complications were minor complications including atelectasis, pleural effusion, and pneumonia. There was 1 major postoperative pulmonary complication: pulmonary embolism that occurred on the fourth day after surgery in 1 patient. Late pulmonary complications also were reviewed and no late postoperative pulmonary complications were observed. There was no significant difference in early and late postoperative pulmonary complications between ex-smokers and smokers. Postoperative atelectasis was significantly higher in patients with body mass index ≤ 20 kg/m ² than patients with body mass index > 21 kg/m ² (P = .027). In our study population, no postoperative mortality was recorded. CONCLUSIONS: We believe that preoperative weight reduction strategies and early mobilization with postoperative respiratory physiotherapy could be important factors to reduce postoperative pulmonary complications in liver donors.

Invasive pulmonary aspergillosis in heart transplant recipients.

OBJECTIVES: Invasive pulmonary aspergillosis is the most common invasive mycosis in heart transplant recipients. Early clinical recognition of this complication is difficult and laboratory data is not specific. Our aim was to study the characteristics of invasive pulmonary aspergillosis infections in heart transplant recipients. MATERIALS AND METHODS: Between 2007 and 2013, there were 82 patients who underwent heart transplant at our institution, including 6 patients who were diagnosed with invasive pulmonary aspergillosis. Medical records of these patients were reviewed for demographic, clinical, and radiographic features, microbiology data, serum galactomannan levels, antifungal treatment, and overall outcomes. RESULTS: The most common species causing the infection was Aspergillus fumigatus. The infection was encountered irrespective of the duration since the transplant. Bronchoalveolar lavage with positive culture for Aspergillus species and/or abnormal serum galactomannan level was suggestive of invasive pulmonary aspergillosis. CONCLUSIONS: In our opinion, empiric antifungal therapy should be commenced as soon as invasive pulmonary aspergillosis is suspected in heart transplant recipients to reduce mortality. Although the duration of antifungal therapy for invasive pulmonary aspergillosis is debatable, heart transplant recipients may require long-term therapy to avoid recurrence.

Long-term pulmonary infections in heart transplant recipients.

OBJECTIVES: Pulmonary infections are life-threatening complications in heart transplant recipients. Our aim was to evaluate long-term pulmonary infections and the effect of prophylactic antimicrobial strategies on time of occurrence of pulmonary infections in heart transplant recipients. MATERIALS AND METHODS: Patients who underwent heart transplantation between 2003 and 2013 at Baskent University were reviewed. Demographic information and data about immunosuppression and infectious episodes were collected. RESULTS: In 82 heart transplant recipients (mean age, 33.85 y; 58 male and 24 female), 13 recipients (15.8%) developed pulmonary infections (mean age, 44.3 y; 9 male and 4 female). There were 12 patients who had dilated cardiomyopathy and 1 patient who had myocarditis before heart transplantation; 12 patients received immunosuppressive therapy in single or combination form. Pulmonary infections developed in the first month (1 patient), from first to third month (6 patients), from third to sixth month (1 patient), and > 6 months after transplantation (5 patients). Chest computed tomography showed consolidation (unilateral, 9 patients; bilateral, 4 patients). Multiple nodular consolidations were observed in 2 patients and a cavitary lesion was detected in 1 patient. Bronchoscopy was performed in 6 patients; 3 patients had Aspergillus fumigatus growth in bronchoalveolar lavage fluid, and 2 patients had Acinetobacter baumannii growth in sputum. Treatment was empiric antibiotics (6 patients), antifungal drugs (5 patients), and both antibiotics and antifungal drugs (2 patients); treatment period was 1-12 months in patients with invasive pulmonary aspergillosis. CONCLUSIONS: Pulmonary infections are the most common cause of mortality in heart transplant recipients. A. fumigatus is the most common opportunistic pathogen. Heart transplant recipients with fever and cough should be evaluated for pulmonary infections, and invasive pulmonary aspergillosis should be suspected if these symptoms occur within the first 3 months. Immediately starting an empiric antibiotic is important in treating pulmonary infections in heart transplant recipients.

Pleural effusion in patients with end-stage liver disease who are candidates for transplant.

OBJECTIVES: The purpose of this retrospective study was to determine the rate of occurrence and features of pleural effusion in patients referred to our institution for liver transplant. MATERIALS AND METHODS: This study included 135 patients (43 women, 92 men) with a mean age of 40 years (range, 16-66 y). Patient characteristics such as history of pulmonary disease and types of respiratory symptoms were recorded. The chest radiographs of every study patient were examined. RESULTS: Of the 135 study patients, 16 (11.9%) had respiratory symptoms upon admission to the hospital, and 49 (36.3%) had abnormalities on their chest radiographs. The most common radiographic abnormality was elevated right hemidiaphragm in 32 patients (23.7%), followed by pleural effusion in 22 (16.2%), atelectasis in 21 (15.5%), hilar enlargement in 18 (13.3%), and elevated left hemidiaphragm in 9 (6.6%). Seventeen of 22 patients (77.3%) had right pleural effusion, 4 (18.2%) had bilateral, and 1 (4.5%) had left pleural effusion. Of the 10 patients undergoing thoracentesis, 9 had transudates and 1 had an exudate. CONCLUSIONS: Preoperative pleural effusion is a common problem in patients who are candidates for a liver transplant. Most of these patients have right transudative pleural effusion.

Early pulmonary complications of liver transplant.

OBJECTIVES: Pulmonary complications are a leading problem after a liver transplant. This study sought to predict postoperative early complications by a chest radiograph performed after a transplant among adult orthotopic liver transplant recipients. MATERIALS AND METHODS: One hundred thirty-five patients (43 women, 92 men; mean age, 40 y; range, 16-66 y) were included and their medical data reviewed retrospectively. A postoperative chest radiograph of each patient was evaluated to check for pulmonary complications. RESULTS: Smoking history was noted in 61 patients (45.2%). Postoperative first chest radiograph evaluation showed normal findings in 56 patients (41.5%). Right pleural effusion was found in 25 patients (18.5%), and atelectasis was found in 25 (18.5%). Bilateral pleural effusion was the second most-frequent finding on postoperative radiograph (14.8%). Effusion accompanied by atelectasis was found in 3 patients (2.2%). Other postoperative chest radiograph findings were consolidation (n=2, 1.5%), left pleural effusion (n=2, 1.5%), and bronchiectasis (n=2, 1.5%). CONCLUSIONS: We investigated the reflection of the first chest radiograph after liver transplant on postoperative early complications. Postoperative first chest radiograph can be an inexpensive and accessible diagnostic tool for predicting postoperative problems.

[Associations between TGF-ß1 G/A and TNF-α 308 G/A gene polymorphisms with airway resistance in chronic obstructive pulmonary disease]. / Kronik obstrüktif akciger hastaliginda TGF-ß1 G/A ve TNF-α 308 G/A gen polimorfizmleri ile hava yolu direncinin degerlendirilmesi.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is an important morbidity and mortality cause all over the world. Although specific gene region has not been defined in the pathogenesis of COPD, cytokine gene polymorphisms like tumor necrosis factor-alfa (TNF-α) and transforming growth factor-beta1 (TGF-ß1) may contribute to the development of COPD. The aim of the present study was to evaluate the associations between airway resistance with TGF-ß1 G/A and TNF-α 308 G/A gene polymorphisms in COPD patients. PATIENTS AND METHODS: 264 subjects were included to the study (Group 1; 75 COPD patients, Group 2; 139 subjects with at least 10 packet year smoking history without airflow obstruction, Group 3; 50 healthy subjects). Pulmonary function tests and body plethysmography to measure airway resistance were performed to the subjects. TGF-ß1 800 G/A and TNF-α 308 G/A gene polymorphisms were evaluated. Chi-square, Anova and correlation analysis were used for statistical analysis. RESULTS: There were significant difference among COPD stages in terms of TNF-α 308 G/A polymorphism (p< 0.05). Thirteen (23.6%) stage 1 COPD patients had TNF-α 308 G/A polymorphism and the other did not have. We did not find statistically significant difference among COPD stages in terms of TGF-ß1 800 G/A polymorphism (p> 0.05). TNF-α and TGF-ß1 genotypes and TNF-a 308 G/A and TGF-ß1 800 G/A polymorphisms were not different among study groups. Moreover, no significant differences betweeen subjects with and without increased airway resistance in terms of TNF-α 308 G/A and TGF-ß1 800 G/A polymorphisms were present. CONCLUSION: These results can suggest the lack of association between TNF-α 308 G/A and TGF-ß1 800 G/A gene polymorphisms with COPD development and airway resistance in Turkish population.

[Rapid eye movement related obstructive sleep apnea syndrome: antropometric and polysomnographic findings]. / Hizli göz hareketleri ile iliskili obstrüktif uyku apne sendromu: Antropometrik ve polisomnografik bulgular.

INTRODUCTION: Obstructive sleep apnea syndrome is characterized by episodic narrowing of the upper respiratory ways accompanied by an oxygen desaturation during sleep. REM-related obstructive sleep apnea syndrome, comprises a subgroup of sleep disordered breathing with a 10-36% frequency. The aim of the present study is to analyze the frequency, the antropometric and polygraphic features of REM-related obstructive sleep apnea syndrome. MATERIALS AND METHODS: A total of 427 cases [332 males (77.4%) and 95 females (22.6%)] with definitive obstructive sleep apnea syndrome diagnosis with polysomnography records were included into the study. RESULTS: Of all the cases, 108 (25.3%) were REM-related sleep respiratory disorder. There was no difference between the two groups with regard to age and sex. However, the obstructive sleep apnea syndrome group non-related to REM demonstrated a more severe obstructive sleep apnea syndrome and a longer neck circumference. Superficial sleep was longer in the REM non-related group, while deep refreshing sleep (Non-REM 3) was longer in the REM-related group. The subgroup analysis of the REM-related group with regard to sex revealed a higher body mass index in the female subgroup. CONCLUSION: REM-related sleep respiratory disorder is more often in mild-to-moderate obstructive sleep apnea syndrome cases, the male/female ratio of REM-related sleep respiratory disorder is not different from the obstructive sleep apnea syndrome prevalence in the community.

[Pulmonary involvement of scleroderma presenting with nodules]. / Nodüllerle seyreden skleroderma akciger tutulumu.

Scleroderma is a generalized connective tissue disease characterised by inflammatory, vascular and fibrotic changes of skin and a variety of internal organs. Pulmonary disease is estimated to occur in 70% to 85% of patients with scleroderma. Lung involvement is usually seen as diffuse and bilateral basilar reticulonodular infiltrates. A 45 year old woman was admitted to the hospital because of coughing for a period one month and detected multiple, diffuse, irregular pulmonary nodules reported in chest computerised tomography. The thickening of the skin of the fingers, face and neck, sclerodactyly and the loss of substance from the finger pad were found in physical examination. No clinical or laboratory findings suggesting malignancy was found. Elevated liver function tests, antinuclear antibody, antimitochondrial antibody and anticentromer antibody were detected in blood analyse. In the bronchoalveolar lavage of the patient whose DLCO was decreased, 61% lymphocyte, 13% eosinophil was seen. The computerised tomography guided lung biopsy was reported as nonspecific interstitial pneumonia, liver biopsy was reported as portal inflammation and fibrosis. With these findings the patient was diagnosed as scleroderma and treated with cyclophosphamid and corticosteroid. At the end of the first month of the treatment nodular lesions were disappeared in the chest computerised tomography. With the unusual radiologic manifestation, scleroderma should be also considered in the etiology of multipl pulmonary nodules.

[Venous thromboembolism in intensive care unit patients]. / Yogun bakim hastalarinda venöz tromboembolizm.

In intensive care units, venous thromboembolism (VTE) is a life threatening, clinically important issue. The diagnosis of VTE is significantly complicated, even in patients except intensive care units and there is no consensus between clinicians about its treatment. The factors such as heterogeneity of intensive care units patients, the association of thrombosis and bleeding risks in the majority of patients, the non-specific signs and symptoms of VTE, the feasibility limitations of diagnostic methods are caused difficulties in the diagnosis and treatment of VTE. In this review, it has been aimed to remind VTE issue in the intensive care units, by review the investigations about the diagnosis, treatment and thromboprophylaxis of VTE.

Comparative effects of losartan and nifedipine therapy on exercise capacity, Doppler echocardiographic parameters and endothelin levels in patients with secondary pulmonary hypertension.

OBJECTIVE: Pulmonary hypertension (PHT) is associated with high mortality and morbidity. Interest has increased in the use of drugs that, because of their neurohumoral inhibitory effects, inhibit the renin angiotensin system. In this study, we sought to examine whether losartan therapy is non-inferior to nifedipine in the treatment of secondary PHT. METHODS: This prospective randomized study consisted of 63 patients (mean age, 63.7+/- 9.1 years) with PHT who underwent Doppler echocardiographic examination. A baseline 6-minute walk test (6MWT) and cardiopulmonary exercise test (CPET) were performed, and the endothelin-1 level of each patient was measured. Patients were assigned to two groups receiving treatment with nifedipine (n=30) and losartan (n=33). After 2 months of treatment, those measurements were repeated. The groups were compared with regard to effectiveness for the studied parameters using 2*2 factorial ANOVA design for repeated measurements. RESULTS: When posttreatment values were compared with baseline values in both groups, the following statistically significant changes were noted: the mean values of both mean and systolic pulmonary artery pressures (PAPs) were reduced (p<0.05) on Doppler echocardiography; exercise duration, work rate, and end-tidal carbon dioxide pressure (PETCO2) were higher (p<0.05 for all); and the minute ventilation (VE) and ventilatory equivalents for carbon dioxide (VE/VCO2) were lower (p<0.05 for both) according to the results of a CPET. No statistically significant change was noted in the mean levels of serum endothelin-1. With regard to the results cited above, no statistically significant difference was detected between the losartan and nifedipine groups (p>0.05). CONCLUSION: The findings of this study indicate that losartan is non-inferior to nifedipine for reducing PAP and improving exercise capacity. However, the short-term use of losartan or nifedipine had no statistically significant effect on endothelin-1 levels in patients with secondary PHT.