A rare case of primary ovarian mesonephric adenocarcinoma and a review of the literature.

OBJECTIVE: Are reported in the cervix in the female genital tract, has been reported in very few studies in the literature. In this report, we aimed to present a case with mesonephric carcinoma, which was detected in the ovary and is very rarely seen. CASE REPORT: In a case since the frozen section results of the left adnexal mass were reported as malignant. CONCLUSION: Ovarian mesonephric carcinoma is very rare and exhibits very different morphological patterns. Therefore, immunohistochemical and morphological findings should be evaluated together. If the pathological picture does not fit the common carcinomas of ovarian origin and this entity must be brought to mind, because, if these tumors with different molecular developmental pathways are diagnosed correctly, treatment schemes will change and targeted therapies will be developed too. KEY WORDS: Mesonephric carcinoma, Mesonephric like carcinoma, Ovarian carcinoma.

Evaluation of balance in patients with chronic obstructive pulmonary disease with practical tests.

INTRODUCTION: Patients with chronic obstructive pulmonary disease (COPD) have impaired balance and hence fall more frequently. Easy application of balance evaluation tests can prevent the loss of time in the outpatient clinic for patients with COPD. In this study, we aimed to compare the efficacy of Berg Balance Scale (BBS), a time-consuming but a widely used test, with other easy-to-perform tests such as the Single Leg Stance (SLS), Five Repetition Sit to Stand (5STS), Four Step Square (FSST), and Timed Up and Go (TUG) tests. METHODS: A total of 71 patients with COPD and 70 control subjects with matching demographic characteristics were included in the study. All patients undertook pulmonary function tests and their scores of 6-min walk-test (6MWT), modified Medical Research Council (mMRC) dyspnoea scale, COPD assessment questionnaire (CAT) and body mass index (B) were recorded. In addition, the severity of airway obstruction (O), the dyspnoea severity (D) and exercise capacity (E) (BODE) index scores were measured. All patients with COPD were classified into four groups, A to D, based on the GOLD 2017 criteria. All subjects undertook the BBS, SLS, 5STS, FSST and TUG tests. RESULTS: Balance tests revealed increased balance impairment in patients with COPD in comparison with the control subjects (P < .05). The BBS, SLS, FSST and TUG examinations suggested that balance impairment was frequent in Groups C and D patients with COPD (P < .05). FSST and TUG had the highest correlation with BBS (r = -.812 and -.842 and P < .001 and <.001, respectively). The results of FSST and TUG were the closest to those of BBS test. CONCLUSIONS: FSST and TUG tests can be applied for the assessment of bodily balance status among patients with COPD in outpatient clinics.

The effect of ankaferd blood stopper used for massive haemoptysis in a patient with mounier-kuhn syndrome: A case report.

Mounier-Kuhn Syndrome (MKS) is a rare disorder derived from the muscular and elastic tissue defects of the trachea and the main bronchial walls, characterized by tracheobronchomegaly. Patients may present with complaints of cough, phlegm, dyspnoea and haemoptysis. Haemoptysis may be minor and mixed with phlegm or it may be massive. Establishment of airway patency is a priority in the management of massive haemoptysis. Cold saline solution, diluted adrenaline or tranexamic acid may be administered via the endobronchial route to stop haemorrhage while establishing the airway patency. Ankaferd Blood Stopper (ABS) has a haemostatic property and can be locally administered to the airway. In this report, we aim to highlight the effects of ABS administered via an endobronchial route for emergency palliation of a patient with MKS presenting with massive haemoptysis.

The Levels of Serum Biomarkers in Stable Asthma Patients with Comorbidities.

The effects of comorbidities on systemic inflammation markers in stable asthmatics and the consequences of such effects have not been well evaluated. We aimed to evaluate the effect of comorbidities on clinical manifestations and systemic inflammation in asthmatic patients under control. The study group consisted of asthmatic patients who applied to our pulmonology outpatient clinic and volunteered to participate. 120 clinically stable asthma patients (71 females and 49 males) and 35 healthy controls (19 females and 16 males) with similar age, gender, and body mass index distributions were admitted to the study. The levels of osteopontin, interleukin 6 (IL-6), interleukin 8 (IL-8), interleukin 13 (IL-13), eosinophilic cationic protein, adiponectin, and high-sensitivity C-reactive protein of the individuals were evaluated using commercial ELISA kits by taking venous blood samples. Of 120 asthmatic subjects, 47 (39, 2%) had comorbidities and allergic rhinitis (15%) coexisted most frequently. Other comorbidities associated with asthma were gastroesophageal reflux, sinusitis, hypertension, diabetes, gastritis, and peptic ulcus respectively. There was no physician-diagnosed comorbidity in the control group. The levels of IL-6 and IL-8 were found higher in asthma group with comorbidities when compared to those with no comorbidities (p were 0.032 and 0.046, respectively). Comorbidities interfere with the diagnosis and treatment of asthma, besides affecting the disease control. Our findings suggest the possibility of the impact of comorbidities on systemic inflammation markers, especially IL-6 and IL-8. To evaluate the impact of comorbidities on asthma control and systemic markers, further studies are needed.

Body surface area: a new anthropometric measurement for obstructive sleep apnea syndrome.

INTRODUCTION: We aimed to explore the possibility of using body surface area (BSA) as a new anthropometric measurement in evaluation of OSAS. MATERIALS AND METHODS: Obesity was defined as having a BMI ≥ 30 kg/m2. BSA were calculated using the Mosteller and Boyd formulas. Totaly 426 (306 male) cases were included in this study. RESULT: The mean BMI was 33.0 kg/m2. The mean BSA was 2.06 m2 and 2.11 m2 respectively. BMI, AHI, oxygen desaturation, ODI and oxygen saturation were found different between the groups. Both BMI and BSA correlated positively with AHI, oxygen desaturation and ODI and negatively with oxygen saturation. There was no difference between BMI and BSA in mild cases in both gender. However, in moderate and severe cases, BMI and BSA were higher in males. We dedected that BSA and BMI display similar sensitivity and specificity values for the prediction of severe OSAS. CONCLUSIONS: To the best of our knowledge, this is the first study to examine the potential association between BSA and the severity of OSAS. As a result, we determined that BSA correlated with polisomnographic parameters as BMI. In severe OSAS BSA can be used as a predictor parameter like BMI.

TST, QuantiFERON-TB Gold test and T-SPOT.TB test for detecting latent tuberculosis infection in patients with rheumatic disease prior to anti-TNF therapy.

Introduction: Before starting tumour necrosis factor (TNF)-α blocking agents, standard tests should be used for the diagnosis of tuberculosis infection. The specificity of traditional tuberculin skin test (TST) is low in immunosuppressed patients due to prior Bacille Calmette Guérin (BCG) vaccination, non-tuberculous mycobacteria infections, false positive and negative results. In this study, we aimed to compare TST and Interferon-Gamma Release Assay (IGRA) tests for detecting latent tuberculosis infection in patients with rheumatic disease planned to receive TNF-α blocking agents. Materials and Methods: One hundred and nine patients (45 male, 64 female) with the diagnosis of rheumatoid arthritis (RA) (n= 70) and ankylosing spondylitis (AS) (n= 39) were included in the study. Age, sex, number of BCG scar, results of TST (using the Mantoux method), QuantiFERON-TB Gold test and T-SPOT.TB test were recorded for all patients. Correlation between the tests was assessed by Pearson correlation coefficient. Result: The mean age of RA and AS patients were 50 ± 13 (19-78 years). The prevalence of latent tuberculosis was 43.1% for TST, 39.4% for QuantiFERON-TB Gold test and 13.8% for T-SPOT.TB test, compared with the evaluation using the composite criteria such as close contact with active tuberculosis infection and/or suspicious fibrotic/calcific lesions on chest X-Ray without active tuberculosis infection. There was a moderate correlation between BCG scar number and TST (p< 0.001, r= 0.495), T-SPOT.TB test and QuantiFERON-TB Gold test (p= 0.007, r= 0.406), T-SPOT.TB test and composite criteria (p= 0.024, r= 0.343). The specificity of QuantiFERON-TB Gold test was 85.7%, and sensitivity was 73.9% for all patients with rheumatic disease. It was 73.5% and 66.7% for T-SPOT.TB test, respectively. The specificity of TST was 60.3% and sensitivity was 47.8% for TST. Conclusions: IGRA tests are not affected prior vaccination and useful for detecting latent tuberculosis infection in patients treated with corticosteroid due to lack of correlation between test negativity and corticosteroid therapy. Also, they are useful tests for diagnosis of latent tuberculosis infection as an alternative to TST due to their specificity and sensitivity.

[Genotypes of rhinoviruses in children and adults patients with acute respiratory tract infections]. / Akut solunum yolu enfeksiyonlu çocuk ve eriskin hastalarda rinovirüs genotiplerinin belirlenmesi.

Rhinovirus (RV) is one of the most frequent causative agent of acute respiratory tract infections in the world. The virus may cause a mild cold, as well as more serious clinical symptoms in patients with immune system deficiency or comorbidities. Rhinoviruses have been identified by molecular methods under three types: RV-A, RV-B and RV-C. In most of the cases, it was reported that RV-A and RV-C were related with lower respiratory tract infections and asthma exacerbations, while RV-B was rarely reported in lower respiratory tract infections. The main objective of this study was to investigate RV species by sequence analysis in nasopharyngeal samples in pediatric and adult patients who were admitted to hospital with acute respiratory tract infections and to establish the relationship between species and age, gender and clinical diagnosis of the patients. Secondly, it was planned to emphasize the efficiency of the sequence analysis method in the determination of RV species. One hundred twenty seven patients (children and adults) who were followed up with acute respiratory tract infections in our university hospital were evaluated between January 2014 and January 2016. Viral loads were determined by quantitative real-time PCR in RV positive patients detected by a commercial kit in nasopharyngeal swab specimens. Thirty-one samples whose viral loads could not be determined were excluded from the study. The remaining 96 samples (50 children and 46 adults) were retested by conventional PCR using the target of VP4/VP2 gene region. A total of 65 samples (32 adults and 33 children) with the bands (549 bp) corresponding to the VP4/VP2 gene regions after the conventional PCR were analyzed by DNA sequencing. A phylogenetic tree was constructed using the neighbour-joining method. After sequence analysis it was determined that 28 (43.07%) were RV-A, 7 (10.76%) were RV-B and 28 (43.07%) were RV-C; and moreover one of each enterovirus (EV) species EV-D68 (1.53%) and EV-C (1.53%) were detected. The distribution of the species in adults was: 15 (48.3%) RV-A, 5 (16.1%) RV-B and 11 (35.4%) RV-C. The distribution of the species in children was 13 (40.6%) RV-A, 2 (6.3%) RV-B and 17 (53.1%) RV-C. RV-A is more frequent in adults, while RV-C is more frequent among children. It has been observed that RV-C infection is detected in children with bronchiolitis, while RV-A infection is detected in adults with pneumonia. There was no statistically significant difference between RV species and clinical diagnosis, age and gender in both of the age groups (p> 0.05). In conclusion, this is the first study that reports the frequency of RV species in children and adult patients with acute respiratory tract infections; the frequency of RV-A and RV-C species were found to be similar but higher than RV-B species in all age groups. RV-C and RV-A was the highest species seen in children and adult patients, respectively. There is a need for further research to identify the types of RV circulating in the community and the prevalence of infections caused by the species.

Gastric involvement of sarcoidosis in a patient with multiple lung nodules.

Sarcoidosis is a granulomatous disorder mostly could involve intrathoracic structures. The gastric involvement is rare and the symptoms may be non-specific. We herein report a case of a 56-year-old female patient who was admitted due to chest tightness and discomfort. Computed tomography (CT) of the thorax revealed bilaterally nodular lesions in the lower lobes of the lung and pleural effusion on the left side. Positron emission tomography/CT showed lung nodules and gastric involvement with mesenteric lymphadenomegalies with pathological uptake of 18F-fluoro-2-deoxy-d-glucose. Pathological examination of the lung biopsy taken by thoracotomy demonstrated non-caseating granulomas. The gastric biopsies taken by endoscopy also showed non-caseating granulomas consistent with a diagnosis of sarcoidosis.

The knowledge and considerations of the physicians regarding the inhaler devices in asthma and COPD: the INTEDA-1 study.

INTRODUCTION: The present paper was aimed at indicating and discussing the possible problems related to inhaler devices by considering the knowledge and practices of the physicians regarding the inhalation therapies. MATERIALS AND METHODS: The present study is a prospective, cross-sectional survey carried out by Turkish Respiratory Society Inhalation Therapy Group between February 2010 and February 2011 with a participation of ten individual centres. Seven inhaler devices that were available on the market in the country were assessed. The data on the problems that 684 clinicians actively attending patients with respiratory disorders experienced in daily clinical practice or their evaluations of their patients were obtained through the questionnaire. RESULTS: The respondents, most of whom were pulmonologist (37.5%), and pediatrist (38.1%), had been,on average, 11.6 years in profession. The source of information on inhalers and administration techniques were reported to be mainly the internet and patient leaflets. Of the participants only 18.5% reported to have had adequate knowledge of inhaler devices and proper administration techniques. Most of the participants stated that they themselves provided the instructions of administration and that the method was often verbal explanation. The physicians believed that although approximately 60% of the patients used the drug correctly, 40.7% made critical mistakes to have adverse effects on the therapeutic outcome. The most important criteria on which the physians lay greater emphasis in choosing the inhaler devices were the physical capability, skills and age of the patients. CONCLUSION: The awareness of proper use of inhaler devices is a fundamental prerequisite for effective inhalation therapy has been improved in physicians. The results of the present study have shown that more effort is required for professional training. Assisting the physicans with medical personnel for training of the patients and educational motivation are required.

The role of molds in the relation between indoor environment and atopy in asthma patients.

BACKGROUND: The effect of mold fungi to allergic sensitization is not well-known. We aimed to evaluate the role of molds in the relation between indoor environment and atopy in asthmatics. MATERIALS AND METHODS: The air samples obtained from 66 stable asthmatics and 35 control subject's houses were sprayed into Sabouraud dextrose agar. Allergy skin testing were performed in both groups. The temperature and humidity of each house were measured. RESULTS: The incidence of atopy was similar in cases (59.1%) and controls (51.4%). The average amount of mold was 35.9 CFU/m(3) and 34.3 CFU/m(3), respectively. The number of household residents was positively correlated with the amount of molds. There was no difference in the amount of mold with respect to dosage of inhaler corticosteroids as well as symptom levels in asthmatics. The most frequently encountered allergens were Dermatophagoides farinae/Dermatophagoides pteronyssinus, grass/weeds and molds. Spending childhood in a village was more common among atopics. CONCLUSION: Living environment during the childhood might affect atopy and asthma. Based on the identification of molds as the second most frequent allergen after mites in our study population, assessment of mold sensitization as well as in forming patients about ways to avoid them seem likely to contribute to the effective management of uncontrolled asthma.

A hemiclamshell incision for a giant solitary fibrous tumor of the right hemithorax.

A 41-year-old female was admitted with respiratory distress. Chest radiographs showed opacity in the right hemithorax with mediastinal shift. Computed tomography (CT) scan showed a pleural mass with a 22 cm diameter occupying the whole right hemithorax and causing atelectasis. Magnetic resonance imaging (MRI) showed lower position of the right hemidiaphragm and the liver. Superior vena cava and heart were shifted to left. Presence of infiltration to the adjacent tissues could not be clearly evaluated because of pressure effect. Transthoracic needle biopsy specimen was reported to be benign. Because of the size and location of the mass, a hemiclamshell incision was chosen, which allowed excellent visualization and complete dissection of the giant tumor. The histopathology of the resected specimen confirmed solitary fibrous tumor. The patient was stabilized by careful observation and treatment. No complication except pneumonia in the postoperative first month occurred during the 22-month follow-up period.

Adipokines and systemic inflammation in weight-losing lung cancer patients.

BACKGROUND: Cancer cachexia is a devastating condition leading to loss of function and independence, decreased performance status, decreased quality of life, and poor prognosis. Adipokines play a role in a wide variety of physiological or pathological processes, including immunity and inflammation, in addition to having significant effects on metabolism and lipogenesis. The objective of the present study was to investigate the relationship of adipokines and systemic inflammation in weight-losing advanced-stage non-small-cell lung cancer (NSCLC) patients. METHODS: Sixty-three male NSCLC patients (stages III and IV) and 25 age- and sex-matched controls were included. NSCLC patients were further divided into subgroups as those with a>5% weight loss in last 6 months and those who did not. Serum leptin, adiponectin, and TNF-α concentrations were measured by ELISA using commercially available kits. RESULTS: The positive acute-phase reactants (APR) CRP, leukocyte, ferritin, thrombocyte, and fibrinogen were higher in the NSCLC group. Serum albumin level (which is a negative APR) was lower in the cancer group, whereas there was no difference in transferrin level between the groups. TNF-α and leptin concentrations were similar in the cancer group and the control group, whereas adiponectin was lower in the cancer group. There was a difference in thrombocyte and transferrin levels between patients with and without weight loss, whereas CRP, TNF-α, and adiponectin levels were similar. Leptin was lower in weight-losing cancer patients. However, there was no correlation between adipokines and markers of systemic inflammation. CONCLUSION: These results revealed a lack of association between adipokine levels and systemic inflammation with cancer cachexia.

The clinical importance of bone metabolic markers in detecting bone metastasis of lung cancer.

AIM: The aim of this study was to evaluate the role of bone metabolic markers in clinical evaluation of bone metastasis of lung cancer. MATERIALS AND METHODS: Sixty-five male patients with lung cancer were included in this trial, 77% of whom were diagnosed as having non-small cell lung cancer and 20% were small cell lung cancer. The presence of bone metastasis was investigated by whole-body bone scintigraphy via Tc-99m mostly (80%) and, in some cases, PET/CT (positron emission tomography and computerized tomography) which was performed for staging. Bone-specific alkaline phosphatase (BALP) and osteocalcin were measured in serum of the patients as markers of bone formation. N-terminal telopeptide (NTX) and ß-form of C terminal telopeptide (ß-CTX) were studied as bone destruction markers. RESULTS: The cases were divided into two groups according to the presence of bone metastasis. Twenty-three patients (35%) had bone metastasis. Serum levels of total ALP, BALP and NTX were significantly higher in the group with bone metastasis (p < 0.05). Osteocalcin and ß-CTX levels were not significantly different between two groups. According to ROC-curve analysis, at the threshold value of 22.38 µg/L, the sensitivity of BALP was 60.87% and the specificity was 69.05%. Similarly, at the threshold value of 25.69 nmol BCE, the sensitivity of NTX was 90.24% and the specificity was 43.4%. CONCLUSION: Bone metabolic markers are considered noninvasive, useful and cost-effective. However, more prospective studies are needed in order to use them for evaluation of bone metastasis in lung cancer.

Osteopontin as a marker of weight loss in lung cancer.

Although the role of osteopontin (OPN) in tumorigenesis and invasiveness is well-known, its role in systemic consequences of lung cancer has not been studied yet. The objective of the current study was to assess the value of osteopontin as a marker of weight loss in relation to systemic inflammation in non-small cell lung cancer (NSCLC) patients. A total of 63 male NSCLC patients (stage III and IV) and 25 age and sex-matched controls were included. The NSCLC patients were further divided into subgroups depending on whether they had > 5% weight loss in the last 6 months or not. Serum OPN and TNF-α concentrations were measured by ELISA using commercially available kits. Serum C-reactive protein (CRP) concentration was measured by the turbidimetric method. OPN (p = 0.001) and CRP (p < 0.001) concentrations were significantly higher in lung cancer patients compared to controls whereas TNF-α concentrations were similar in cancer and control groups (p = 0.063). There were 33 NSCLC patients (52.4%) with weight loss. Serum OPN concentration was found to be higher in this weight-losing group (p = 0.042). CRP concentration was also higher in the weight-losing group but the difference was not statistically significant (p = 0.246). TNF-α concentrations were similar in both subgroups (p = 0.094). In correlation tests, there was a positive correlation between OPN and CRP (r = 0.299, p = 0.044), but no correlation was detected between OPN and TNF-α (r = − 0.009, p = 0.930). A negative correlation was detected between OPN and BMI (r = − 0.246, p = 0.048). In addition to being an indicator of systemic inflammation in lung cancer patients, osteopontin may also be an indicator of weight loss.

The effects of body fat distribution on pulmonary function tests in the overweight and obese.

OBJECTIVES: To determine the predominant pulmonary function abnormality in overweight and moderately obese subjects and to evaluate the correlation between the severity of lung function impairment and the degree of obesity. METHODS: Fifty-three volunteers underwent physical examination, skin fold measurements, and standardized pulmonary function tests. Thirty-one women and 22 men with a mean age of 40.2 (18-66) years were studied. RESULTS: The reduction in functional residual capacity (FRC) and expiratory reserve volume (ERV) were the most common abnormalities in overweight and obese subjects. The reduction in static lung volume was correlated with the degree of obesity in women and men. Stepwise multiple regression coefficients were obtained separately for women and men. Subscapular skinfold was the best predictor in women for FRC and waist-to-hip ratio (WHR) and BMI were found the best for ERV. WHR was found predictive for forced vital capacity, total lung capacity, and FRC in men. CONCLUSIONS: The lung volumes are substantially affected in our overweight and obese subjects. This influence is focused on different parameters of respiratory functions in men and women in relation to body fat distribution.

Adiponectin as a biomarker of systemic inflammatory response in smoker patients with stable and exacerbation phases of chronic obstructive pulmonary disease.

BACKGROUND AND OBJECTIVE: Adiponectin is an adipose tissue-derived specific protein that has a role in energy homeostasis, that has a protective role against the development of insulin resistance and atherosclerosis and that exhibits anti-inflammatory properties. We investigated serum adiponectin as a biomarker of systemic inflammatory response and its relation with leptin, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and nitric oxide (NO) in chronic obstructive pulmonary disease (COPD) patients. MATERIAL AND METHODS: We studied 36 male patients with COPD (15 stable and 21 exacerbated) and 17 age and sex-matched healthy subjects. The adiponectin and leptin levels were measured by enzyme-linked immunosorbent assay. Serum CRP levels were measured using the nephelometric method. ESR was determined using the Westergren method and NO by the cadmium reduction method. RESULTS: Adiponectin levels in COPD patients were significantly higher than those in control subjects (p<0.001), whereas there were no differences in leptin or NO levels. Serum levels of CRP, ESR and adiponectin were significantly higher in the exacerbated COPD patients compared to the stable group (p<0.001, p = 0.033 and p = 0.024, respectively), whereas the differences in leptin and NO levels were not significant. Serum levels of adiponectin were not correlated with FEV(1), FEV(1)/FVC, dyspnoea score, BMI or other inflammatory parameters in the stable COPD group. CRP and ESR correlated negatively with FEV(1) in the stable COPD group. CONCLUSIONS: Adiponectin may be a marker of low-grade systemic inflammatory response in COPD. A further rise in serum adiponectin in the exacerbation period denotes that this may also be a biomarker of the exacerbation phase as well as CRP and ESR.

The effects of environmental tobacco smoke exposure before starting to smoke on cigarette quitting therapies.

We aimed to determine the effects of environmental tobacco smoke (ETS) exposure before starting to smoke on cigarette quitting therapies and to determine source environment/individuals for ETS exposure. 230 individuals were contacted. We investigated person/s with ETS exposure before starting to smoke, places/duration of exposure, sources of exposure, therapy methods/durations recommended. Training seminar was also assumed as a therapy method. Those who were administered nicotine replacement and/or bupropion for a minimum of one week, 169 patients who only attended the training programme were evaluated. 68 patients who stopped smoking defined as controls, 101 patients who did not were defined as cases. There was no difference between case and control groups in terms of ages at initiation of smoking, ages at initiation of regular smoking, number of cigarettes per-day, total package-year and nicotine dependence score. 218 patients were found to have ETS exposure before starting to smoke. The highest ETS exposure was determined to be indoors (85.7%) and of paternal origin (77.2%). The rates of cigarette smoke exposure of maternal origin were 32.7% in cases, 25.4% in controls (p= 0.009 OR= 2.8). The mother being a smoker was found to increase the risk of not being able to stop smoking by 2.8 times. The number of people causing ETS exposure was higher in cases compared to controls (p= 0.044). ETS exposure have negative effects on the outcomes of cigarette quitting therapies. Indoor ETS exposure is the leading source of exposure. Therefore, indoor ETS exposure should be prevented, mothers should be trained concerning this matter.

The value of C-reactive protein as a marker of systemic inflammation in stable chronic obstructive pulmonary disease.

BACKGROUND: Systemic aspects of chronic obstructive pulmonary disease (COPD) include oxidative stress and altered circulating levels of inflammatory mediators and acute-phase proteins. C-reactive protein (CRP) reflects total systemic burden of inflammation in several disorders and has been shown to upregulate the production of proinflammatory cytokines. The aim of this study was to evaluate circulating CRP levels to determine the value of CRP as a biomarker of systemic inflammation and as an indicator of malnutrition or severity of COPD in stable COPD patients in comparison to the proinflammatory cytokines tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6). METHODS: Thirty-five male patients with stable COPD and 30 age- and sex-matched subjects with normal pulmonary function were admitted to the study. Serum CRP levels were measured using a commercially available kit with the turbidimetric method. Serum TNF-alpha and IL-6 concentrations were measured with ELISA kits. RESULTS: Sixty percent of the patients had severe or very severe and 40% moderate COPD. Serum CRP was significantly higher in stable COPD patients than in control subjects (p<0.001), while TNF-alpha and IL-6 concentrations were not statistically different. Serum TNF-alpha was higher in severe or very severe COPD patients (p=0.046). When the COPD patients with a low BMI were compared to those with a normal-to-high BMI, there was a significant difference in CRP (p=0.034) and TNF-alpha (p=0.037). CONCLUSION: The present study confirms that circulating CRP levels are higher in stable COPD patients and may thus be regarded as a valid biomarker of low-grade systemic inflammation. In addition, CRP is significantly higher in COPD patients with a low BMI and thus, together with TNF-alpha, may be considered an indicator of malnutrition in COPD patients.

Can spirometry, pulse oximetry and dyspnea scoring reflect respiratory failure in patients with chronic obstructive pulmonary disease exacerbation?

OBJECTIVE: To evaluate the extent to which oximetry, spirometry and dyspnea scoring can reflect hypoxemia and hypercapnia among patients admitted to the emergency department (ED) with acute exacerbations of chronic obstructive pulmonary disease. SUBJECTS AND METHODS: Spirometry, oxygen saturation by pulse oximetry (SpO2), arterial blood gas analysis and dyspnea scoring assessments were made in the ED. Correlations of these parameters were evaluated by means of Pearson's test. Pulse oximetry cutoff values to express hypoxemia were demonstrated by receiver operating characteristic (ROC) curves. RESULTS: 76 patients with a mean age of 68.0 years were included in the study. Mean spirometric values, expressed as percentages of predicted values, were forced expiratory volume in 1 s (FEV1) = 23.1 +/- 9%; forced vital capacity (FVC) = 32.8 +/- 11%, and mean FEV1/FVC = 72.4 +/- 21.6%. While there was a positive correlation between the SpO2, SaO2 and PaO2 values (r = 0.91 and 0.80, respectively), a negative correlation (r = -0.74) was observed between PaCO2 and SpO2. In determining hypoxemia, both SpO2 and FEV1 were sensitive (83.9 and 90.3%, respectively) while dyspnea scoring was the most sensitive (93.5%). In the evaluation by means of an ROC curve, a saturation of 88.5% for the pulse oximeter was the best cutoff value to reflect hypoxemia (sensitivity 95.6%, specificity 80.6%). CONCLUSION: SpO2 alone appears to be as highly specific as a combination of other tests in the evaluation of hypoxemia. A cutoff value for SpO2 of < or = 88.5% is proposed as a criterion in screening for hypoxemia.

Correlates of erectile dysfunction in moderate-to-severe chronic obstructive pulmonary disease patients.

OBJECTIVE AND BACKGROUND: Erectile dysfunction (ED) has important negative effects on male quality of life and self-esteem. The aim of this study was to acquire an insight into the sexual status of COPD patients. METHODS: Ninety-five male patients aged 48-75 years, with moderate-to-severe stable COPD, and 30 age-matched subjects with normal pulmonary function were included. After clinical evaluation and measurement of serum sex hormones and TNF-alpha concentration, subjects were asked to answer the International Index of Erectile Function (IIEF) questionnaire as a method to diagnose and classify ED. RESULTS: Varying degrees of ED were detected in 87% of COPD patients and 83% of controls. Although the total percentages of subjects with various severities of ED seemed similar, moderate and severe ED was 57% in COPD group and 20% in control subjects, suggesting a more severe course of ED in COPD patients. ED score of COPD patients was not correlated with age, smoking burden, duration of COPD, FEV1%, PaO2, PaCO2, serum dehydroepiandrosterone-sulphate, testosterone or estradiol levels. When patients were subgrouped according to severity of ED, serum TNF-alpha concentration, used as a marker of systemic inflammatory status in COPD, was significantly higher in patients with moderate-to-severe ED compared with mild-moderate ED. CONCLUSION: The present study showed that ED is frequent and more severe in COPD patients than age-matched controls. Chronic systemic inflammation is likely to play a role in ED in COPD; the role of TNF-alpha should be evaluated further. Patients with COPD need comprehensive management including a detailed sexual evaluation.