A rare phenomenon, primary pulmonary smooth muscle tumor and its management.

Smooth muscle tumors of uncertain malignant potential, the borderline tumors arising from the smooth muscle cells, usually grow slowly and do not fulfill the diagnostic criteria of leiomyosarcoma and its variants, but may behave in a malignant manner. A 15-year-old female patient with an endobronchial mass in the left main bronchus on thoracic computed tomography underwent thoracotomy and tracheobronchoplasty with a wide and safe margin. Histopathological evaluation revealed a smooth muscle tumor of uncertain malignant potential. There were no complications related to the operation during the hospital stay. At six months of surgery, there were no symptoms or signs suggesting any recurrence in her follow-up. In conclusion, In conclusion, pulmonary leiomyomas may rarely present as an endobronchial mass and may mimic asthma by causing respiratory symptoms developing as attacks due to displacement of the mass within the lumen.

Picturing asthma in Turkey: results from the Turkish adult asthma registry.

INTRODUCTION: National data on asthma characteristics and the factors associated with uncontrolled asthma seem to be necessary for every country. For this purpose, we developed the Turkish Adult Asthma Registry for patients with asthma aiming to take a snapshot of our patients, thereby assigning the unmet needs and niche areas of intervention. METHODS: Case entries were performed between March 2018 and March 2022. A web-based application was used to record data. Study outcomes were demographic features, disease characteristics, asthma control levels, and phenotypes. RESULTS: The registry included 2053 patients from 36 study centers in Turkey. Female subjects dominated the group (n = 1535, 74.8%). The majority of the patients had allergic (n = 1158, 65.3%) and eosinophilic (n = 1174, 57.2%) asthma. Six hundred nineteen (32.2%) of the patients had obese asthma. Severe asthma existed in 670 (32.6%) patients. Majority of cases were on step 3-5 treatment (n: 1525; 88.1%). Uncontrolled asthma was associated with low educational level, severe asthma attacks in the last year, low FEV1, existence of chronic rhinosinusitis and living in particular regions. CONCLUSION: The picture of this registry showed a dominancy of middle-aged obese women with moderate-to-severe asthma. We also determined particular strategic targets such as low educational level, severe asthma attacks, low FEV1, and chronic rhinosinusitis to decrease uncontrolled asthma in our country. Moreover, some regional strategies may also be needed as uncontrolled asthma is higher in certain regions. We believe that these data will guide authorities to reestablish national asthma programs to improve asthma service delivery.

Risk factors associated with survival in surgically treated large cell neuroendocrine carcinoma of the lung.

Introduction: Pulmonary large cell neuroendocrine carcinomas (LCNEC) are one of the rare malignant neoplasms of the lung. A standard management model for LCNEC has not yet been established and the poor prognostic factors and treatment modalities are still uncertain. Aim: LCNEC are fairly rare and have a poor prognosis. Determination of the risk factors associated with survival can contribute to its management. Material and methods: In this retrospective study, we analyzed the data of 42 patients. We obtained the data about the age, gender, smoking history, symptoms, tumor size, tumor location, pathological type, TNM stage, treatments, surgical modality, length of hospital stay, postoperative complications, disease-free survival and total survival from the hospital electronic files of the patients. Then we analyzed the relationship between these data and survival. Results: 40 (95.24%) were male, and the mean age was 64.26 ±8.62. 12 (28.57%) patients were in stage I, 14 (33.3%) were in stage II, 15 (35.71%) were in stage III and only 1 (2.38%) patient was in stage IV. 15 (35.71%) had sublobar resection (wedge resection (n = 13) + segmentectomy (n = 2), 24 (57.14%) had lobectomy and 3 (7.14%) had pneumonectomy. The mean overall survival (OS) time was 34.86 ±30.11 months. 1-year, 3-year and 5-year survival rates of the patients were 73.80%, 47.61% and 19.04%, respectively. T stage (HR = 8.956, 95% CI: 1.521-11.034, p = 0.005) N stage (HR = 5.984, 95% CI: 1.127-7.982, p = 0.028) were independent risk factors for OS. Conclusions: The overall survival in LCNEC was poor and the tumor size and the nodal stage were independent risk factors for overall survival.

Risk factors for mediastinitis and mortality in pneumomediastinum.

Introduction: Pneumomediastinum (PM) is a self-limiting disease with a good prognosis. Mediastinitis is a rare but potentially fatal complication of PM. Identification of risk factors for mediastinitis is essential for better management. Methods: This is a single-center, retrospective study conducted in a university hospital. Adult patients with PM between January 2016 and June 2020 were involved in the study. The data about age, gender, symptoms, signs, treatment, development of mediastinitis, hospital stay, and mortality were investigated. Results: In total, 79 patients with PM were analyzed. The most common symptom was dyspnea(58;73.4%) and the most common sign was subcutaneous emphysema (48;60.7%). Thirty(37.9%) of them were iatrogenic PM (IPM), while 22 (27.9%) were spontaneous PM (SPM) and27 (34.2%) were traumatic PM (TPM). Mediastinitis developed in 17 (12 from IPM, 4 from TPM,1 from SPM) patients, and 11 (58.8%) of these patients died. The incidence of mediastinitis in the IPM group was significantly higher than in the TPM and SPM group (respectively, P = 0,03,P = 0,01). There was no significant difference between the age, gender, symptoms, and signs of those with or without mediastinitis. Mortality was lower in TPM and SPM than IPM (respectively,P = 0,05, P = 0,03), and hematological malignancy was remarkably common in patients who died from mediastinitis in the TPM and SPM group. Conclusion: Mediastinitis and mortality were significantly higher in IPM, while hematological malignancy was remarkably prevalent in patients deceased from mediastinitis in TPM and SPM.

Alterations in plasma miR-21, miR-590, miR-192 and miR-215 in idiopathic pulmonary fibrosis and their clinical importance.

BACKGROUND: Many studies have revealed that microRNA (miRNA) molecules may take part in idiopathic pulmonary fibrosis (IPF). But, the role of miRNAs in the development of IPF is not yet clear. METHODS: We investigated the plasma levels of miR-21, miR-590, miR-192, and miR-215 in IPF (n = 88) and healthy control (n = 20) groups in this study. We compared the expression levels of target miRNAs in patients with IPF and healthy participants. We grouped the patients with IPF according to age, forced vital capacity, carbon monoxide diffusing capacity (DLCO), gender-Age-pulmonary physiology (GAP) score, the presence of honeycombing and compared the expression levels of target miRNAs in these clinical subgroups. RESULTS: 82 (93.18%) of the patients with IPF were male and the mean age was 66.6 ± 8.6 years. There was no significant difference between the gender and age distributions of IPF and the control group. The mean plasma miR-21 and miR-590 levels in IPF group were significantly higher than in the control group (p < 0.0001, p < 0.0001, respectively). There was no significant difference between the miR-192 and miR-215 expression levels of the IPF and control group. Both miR-21 and miR-590 correlated positively with age (p = 0.041, p = 0.007, respectively) while miR-192 and miR-215 displayed a negative correlation with age (p = 0.0002, p < 0.0001, respectively). The levels of miR-192 and miR-215 increased as the GAP score decreased. The levels of miR-192 in patients with honeycombing were significantly lower than in those without honeycombing (p = 0.003). CONCLUSIONS: Our study showed that both miR-21 and miR-590 were overexpressed in IPF. The miR-21 and miR-590 were associated with DLCO, while miR-192 and miR-215 were associated with the GAP score and honeycombing.

Pulmonary aspergilloma management: 5 years of experience from a tertiary hospital.

Introduction: Pulmonary aspergilloma (PA) is a chronic lung infection. Lobectomy is the recommended surgical modality. However, recent studies have suggested that wedge resection may be better than lobectomy. Aim: We compared short-term complications and mortality according to surgical methods in pulmonary aspergilloma. Material and methods: In this study, we analyzed the patients diagnosed with PA in the period 2015-2019 at a tertiary hospital. We obtained the data about the age, gender, smoking history, symptoms, radiological findings, operation technique, complications, length of hospital stay, and mortality from the electronic patient files. Then we compared short-term complications and mortality according to surgical methods in PA. Results: Of a total of 27 PA patients, 22 (81.5%) were male, with a mean age of 48.1 ±15.6 years. The most common symptom was dyspnea (48.1%). Nineteen (70.0%) of the patients had wedge resection and 6 (22.3%) of the patients had a lobectomy. Prolonged air leak and empyema were the most common postoperative complications. Prolonged air leak was significantly more common in lobectomy than in wedge resection (p = 0.046). There was no significant difference in other complications, hospital stay length, intensive care unit stay length or mortality between lobectomy and wedge resection. Conclusions: Wedge resection can be safely performed in aspergilloma. Prolonged air leak was less common in wedge resection than in lobectomy.

Anxiety and depression as possible criteria in the treatment of bronchiectasis.

BACKGROUND: The aim of this study was to investigate the effect of bronchiectasis operation on anxiety and depression. METHODS: Between August 2014 and March 2019, a total of 167 patients with bronchiectasis (107 males, 60 females; mean age: 43.5±13.9 years; range, 18 to 84 years) who received medical (n=70) and surgical (n=97) treatment were retrospectively analyzed. Data including patients" characteristics, operation indication, operation type, and bronchiectasis localization were obtained from the electronic patient files. The patients were reached via phone calls and evaluated whether the operation provided a significant symptomatic improvement and whether the symptoms disappeared. The number of exacerbations/hospitalizations associated with bronchiectasis within the last year was also questioned. The anxiety and depression status of the patients in both groups was assessed by the Hospital Anxiety and Depression Scale. RESULTS: Eleven (15%) patients in the medical group and 10 (10%) patients in the surgical group had an anxiety score above 7. Twenty-one (30%) patients in the medical group and 10 (10%) patients in the surgical group had a depression score above 7. Both the anxiety and depression scores were significantly lower in the surgical group than the medical group (p<0.001). Annual exacerbation and annual hospitalization rates were also significantly lower in the surgical group (p<0.001). CONCLUSION: Our study results suggest that patients with bronchiectasis treated medically rather than surgically are more prone to be anxious and depressive. The benefits of surgical treatment in patients with bronchiectasis is not limited to improving symptoms and decreasing the frequency of exacerbations/hospitalizations. We believe that surgical treatment also reduces anxiety and depression and improve the quality of life. While making a surgical decision, the anxiety/depression status of bronchiectasis patients should be considered.

Is ASA Classification Useful in Risk Stratification for EBUS-TBNA?

OBJECTIVE: The efficiency and safety of American Society of Anesthesiologists (ASA) in predicting peri-bronchoscopic morbidity and mortality is an increasing concern as endobronchial ultrasound (EBUS) gains popularity. The purpose of this study is to investigate whether the ASA classification is useful in risk stratification for EBUS. MATERIAL AND METHODS: The patients who underwent EBUS and had anesthesia assessment before the procedure, were enrolled. Data about the age, gender, comorbidity, ASA score, and complications were collected retrospectively from their medical files. RESULTS: A total of 221 patients with ASA class documentation in anesthesia assessment before EBUS, were enrolled in the study. The study population comprised 125 (56.6%) male and 96 (43.4%) female patients with a mean age of 59.08 ± 11.15 years. Comorbidity was present in 161 patients (72.9%), of which hypertension (64%) was the most common. There was no significant difference between the pre-bronchoscopic and post-bronchoscopic values of oxygen saturation (SpO2), systolic and diastolic blood pressure, and heart rate (respectively P = .83, P = .12, P = .15, P = .89). The most frequent complication during EBUS was desaturation that happened in 109 (49.3%) patients. There was no correlation between ASA score and complications (P > .999). There was no statistically significant difference in ASA scores with respect to complications (P = .14). The sensitivity and the specificity of pre-bronchoscopic evaluation in predicting the post-anesthesia care unit (PACU)/intensive care unit (ICU) requirement, were 83.3% and 61%, respectively. The significant deciding factors for post-bronchoscopic follow-up sites were found to be as ASA and age (respectively, P = .025, P < .001). CONCLUSION: There was no correlation between ASA and complications. To organize PACU/ICU beds more efficiently, a better scoring system is required.

The Effect of Vitamin D Deficiency in Chronic Obstructive Pulmonary Disease.

OBJECTIVE: It has been suggested that Vitamin D Deficiency (VDD) worsens lung functions and COPD lowers vitamin D levels, but this has not been proven yet. MATERIAL AND METHODS: The study was carried out between January 2014 and September 2015. All the COPD patients with 25 (OH) D3 measurements were included in this study. The patients < 40-year-old, or with a smoking history of less than 10 package-year, or with asthma, bronchiectasis, pneumonia, tuberculosis, cancer, were excluded from the study. Medical records about age, gender, pulmonary function test, body mass index (BMI), annual exacerbations/hospitalizations, modified British Medical Research Council (mMRC) level and serum 25 (OH) D3 were obtained. RESULTS: The data of 216 (83.8% male) patients were examined in the study. The mean age was 66.88 ± 10.3 years. The mean vitamin D level was 21.1 ± 13.73 ng/mL. Of the patients, 57.9% had VDD, and even 19.9% were in severe VDD. Only 26.4% had adequate vitamin D level. There was a significant in BMI, FEV1, FVC, annual exacerbation and hospitalisations between the patients with vitamin D levels > 20 ng / mL and ≤ 20 ng / mL. Vitamin D level of patients with mMRC level 1 was significantly higher than those with mMRC 2, 3, 4 (respectively P = .03; P = .026; P = .014). CONCLUSION: In this study, we found that lung function was worse in COPD patients with VDD and VDD increased with increasing severity of COPD.