Outcome of patients diagnosed with fibrinous pleuritis after medical thoracoscopy.

BACKGROUND: In patients with post- medical thoracoscopy histopathological diagnoses of fibrinous pleuritis, confusion can occur concerning subsequent procedures. This issue is particularly important in regions where mesothelioma is prevalent. We aimed to identify false negatives among patients where mesothelioma was common due to asbestos exposure whose histopathological diagnosis following thoracoscopy was fibrinous pleuritis. We also determined risk factors associated with patients that required additional advanced invasive procedures for diagnosis. METHODS: Overall, 287 patients who underwent thoracoscopy were included in the study. Patients diagnosed with fibrinous pleuritis as a result of thoracoscopy were followed for 2 years regarding this condition. More invasive procedures were performed on patients who showed no recuperation or developed pleural disease again during the follow-up period. RESULTS: Fibrinous pleuritis was observed in 101 (35.2%) patients. Follow-up of these patients revealed that the false negative rate was 18% for malignant pleural diseases. The thoracoscopist's opinion regarding the pleural space, computed tomography scan findings indicating malignancy, pain and female gender were determined to be risk factors for malignant pleural diseases. CONCLUSIONS: In regions where mesothelioma is prevalent and one of the above-stated risk factors is present, patients whose post-thoracoscopy histopathological diagnosis is fibrinous pleuritis should be treated with a more advanced invasive diagnosis procedure.

Occupational exposures as risk factors for asthma and allergic diseases in a Turkish population.

PURPOSE: There has been no community-based epidemiological study on the relation of occupational exposures with asthma, rhinitis, and eczema in Turkey. We examined the relationship between occupational exposures and adult-onset asthma, wheezing, allergic rhinitis, and eczema in a Turkish adult population. METHODS: The data was collected from 1,047 adults, selected randomly from five distant family health centers. Questionnaires were filled by family practitioners with the help of interviews. The data included physician-diagnosed asthma, allergic rhinitis, eczema, wheezing, and occupational exposures. RESULTS: Wheezing in all the subjects was associated with past exposure to irritants (OR: 1.7, 95%CI: 1.0-2.9), wood/coal smoke (OR: 2.3, 95%CI: 1.0-5.3), metal dust (OR: 2.6, 95%CI: 1.2-5.7), volatile fumes (OR: 2.5, 95%CI: 1.1-5.3), and paper dust (OR: 3.7, 95%CI: 1.5-8.9). Past exposure to dust (OR: 4.1, 95%CI: 1.2-14.2) and to irritants (OR: 6.5, 95%CI: 2.0-20.4) were associated with increased prevalence of wheezing in nonsmokers, whereas current exposure to irritants was associated with decreased prevalence of wheezing (OR: 0.1, 95%CI: 0.01-0.9) in these subjects. In subjects who were regular smokers, exposure to metal dust (OR: 2.8, 95%CI: 1.2-6.5), volatile fumes (OR: 2.3, 95%CI: 1.0-5.3), and paper dust (OR: 3.3, 95%CI: 1.3-8.6) were the main causes for wheezing. Physician-diagnosed eczema was associated with occupational exposure to chemical fumes (OR: 3.7, 95%CI: 1.3-10.6). CONCLUSION: The present study showed that occupational exposures were associated with wheezing and eczema prevalence in the studied population. Nonsmokers could be more vulnerable to respiratory effects of occupational exposures due to healthy smokers effect.

Immediate type drug hypersensitivity reactions and associated risk factors in an adult Turkish men population.

The study aimed to assess the prevalence and associated risk factors of immediate-type hypersensitivity reactions (HRs) to drugs in workers. The data consisted of 1152 questionnaires obtained from adult men that consisted of questions on HRs induced by drugs. The prevalence of self-reported drug HRs was 3.6% for all reactions. HRs were most common to beta-lactam antibiotics (51.2%) followed by nonsteroid antiinflammatory drugs (NSAIDs) (41.5%). Multivariate analysis showed that family atopy was associated with drug HRs to both antibiotics (Odds Ratio (OR) 95% Confidence Interval (CI) (3.32 (1.15-9.56)) and NSAIDs (3.70 (1.09-12.51)). Drug HRs of any type were associated with atopic family history (3.23 (1.43-7.24)), ever asthma diagnosis (2.74 (1.07-7.02)), ever allergic rhinitis (2.70 (1.25-5.84)), and ever eczema (3.80 (1.55-9.30)). Drug related skin manifestations were associated with family history of atopic diseases (4.07 (1.76-9.41)), ever allergic rhinitis (2.84 (1.24-6.5)), ever asthma diagnosis (3.16 (1.19-8.39)), and ever eczema diagnosis (4.59 (1.82-11.57)). Systemic manifestations of drug HRs were associated with only asthma diagnosis (4.66 (1.25-17.41)). Risk groups should be followed closely as candidates for immediate type HRs to antibiotics and NSAIDs in also relatively healthy and young aged adult men.

Prognostic factors according to the treatment schedule in malignant pleural mesothelioma.

OBJECTIVES: In this study, we aimed to investigate the factors affecting the survival of patients with malignant pleural mesothelioma (MPM) according to their treatment schedules, including those treated with best supportive care, chemotherapy, and multimodality therapy. METHODS: We evaluated 235 patients with MPM. The patients were classified into three groups according to their treatment schedules: the best supportive care group, the chemotherapy group, and the multimodality therapy group. Prognostic factors were determined for all patients and for the three groups by univariate and multivariate analyses. However, the effectiveness of treatment schedules as a prognostic factor was not evaluated in this study. RESULTS: After adjusting for therapy in a Cox model, a Karnofsky Performance Status (KPS) < or = 70, a right side tumor, serum lactate dehydrogenase >500 IU(-1), a nonepithelial subtype, and stage 3 to 4 disease were determined by multivariate analyses to be unfavorable prognostic factors for all the patients. A KPS < or = 70, serum lactate dehydrogenase >500 IU(-1), a nonepithelial subtype, and stage 3 to 4 disease were associated with a poor prognosis for the best supportive care group. The single unfavorable prognostic factor for the chemotherapy group was a KPS < or = 70. A right side tumor and a nonepithelial subtype were associated with a poor prognosis for the multimodality therapy group. CONCLUSIONS: The patients with an epithelial subtype, a good KPS, and an early-stage tumor had a good prognosis, even if they did not receive any treatment. The only prognostic factor for the chemotherapy group was KPS. The histologic subtype and stage of the tumor were not related to the prognosis in this group. A mixed subtype and a right side tumor were unfavorable prognostic factors for the multimodality therapy group. These findings may be useful in counseling patients and in planning further studies.