Body composition in patients with stable chronic obstructive pulmonary disease: comparison with malnutrition in healthy smokers.

OBJECTIVE: Although malnutrition (body mass index (BMI)<18.5kg/ m(2)) has been associated with impaired health status in patients with chronic obstructive pulmonary disease (COPD), the effects of body composition (body fat and protein percentage) in patients with COPD have not been clearly demonstrated. MATERIALS AND METHODS: A total of 180 stable patients with COPD at the stages of moderate, severe, very severe, and 50 healthy subjects were included in this prospective study. All subjects underwent a clinical evaluation, spirometry tests, anthropometric measurements and blood analysis. RESULTS: Frequency of underweight was higher in COPD (11.7%) patients than the control group (8%). The frequency of underweight increased as the severity of COPD worsens. There was body decomposition (protein or fat depletion) in not only all underweight patients but also some normal/overweight COPD patients, as well as in the healthy subjects. Deterioration in FEV1 (L), and FEV1/FVC was more evident in underweight patients with protein and fat depletion compared to normal/overweight patients (p=0.004, and p=0.005). Inspiratory and expiratory respiratory muscle power was lower in under-weight patients with depletion than in normal/overweight patients (p=0.02, and p=0.01). DLCO and DLCO/VA were significantly lower in underweight patients than in normal/overweight patients (p=0.003, and p=0.004), they were also lower in normal/overweight patients with depletion than in normal/overweight patients with no depletion (p=0.01, and p=0.07). Normal/overweight patients with protein depletion had the most frequent number of exacerbations than others (p=0.04). CONCLUSION: These results show that the body decomposition is important in patients with COPD. Assessment of body composition should be a part of nutritional assessment besides BMI in patients with COPD.

Health-related quality of life in patients with sleep-related breathing disorders: relationship with nocturnal parameters, daytime symptoms and comorbid diseases.

BACKGROUND: Sleep-related breathing disorders (SRBD) are frequently encountered health problems in the general population. Habitual snoring and obstructive sleep apnea/hypopnea syndrome (OSAHS) constitute most SRBD diagnoses. Although the decrease in quality of life is a well-known entity in SRBD patients, there is not enough data regarding the underlying pathophysiological mechanisms to explain this deterioration. OBJECTIVES: The aim of this study was to investigate which parameters were affecting the quality of life in patients with SRBD. METHODS: Medical Outcome Survey - Short Form 36 (SF-36) and Epworth Sleepiness Scale were used in 135 patients with SRBD (69 patients with OSAHS and 66 patients with habitual snoring), and Charlson comorbidity index was calculated. Acquired data were compared with leading symptoms and polysomnographic findings in these patients. RESULTS: All SF-36 scores were significantly decreased in SRBD patients. However, there were no significant differences in the SF-36 scores of these patients. Also, no significant correlation was found between the severity of OSAHS and the SF-36 scores. Similarly, none of the polysomnographic parameters was found significantly correlated with SF-36 scores. In contrast, all SF-36 scores were influenced by body mass index, Epworth Sleepiness Scale score, mean nocturnal saturation and the presence of coexisting diseases. CONCLUSIONS: According to the results of multiple variance analysis, we concluded that the quality of life depends on a number of collaborative factors such as obesity, mean nocturnal saturation, symptoms related to SRBD and the presence of comorbid diseases, rather than only on one independent parameter in the patients with SRBD.

Analysis of the factors related to mortality in patients with bronchiectasis.

BACKGROUND: Bronchiectasis is a common disabling but rarely fatal disease. However the long-term prognosis and risk factors for mortality are not well known. OBJECTIVE: The aim of this study was to determine prospectively the survival and predictive factors of mortality in patients with bronchiectasis, during 4-year follow-up. PATIENTS AND METHODS: From September 2000 to January 2005 survival of bronchiectasis (as evaluated by computed tomography) and predictors of mortality were assessed in 98 outpatients. Fifty-one of the patients had self-reported history of pulmonary infection including tuberculosis. Baseline data, reevaluated in every single year according to scheduled visits. RESULTS: The mean age was 61+/-10 and 74% of the patients were female. In total, 16 patients (16.3%) died; mean survival time was 44.06+/-1.6 months. The survival rates were 97%, 89%, 76%, 58% at 1, 2, 3 and 4 years, respectively. Cox proportional hazard model revealed that long-term mortality was significantly associated with age, body mass index (BMI), Medical Research Council (MRC) dyspnea scale, vaccination, radiographic extent, hypoxemia, hypercapnia and functional parameters. However, MRC and BMI had more significant effects on the mortality than the functional parameters. CONCLUSIONS: These results suggest that high BMI, regular vaccination and scheduled visits may have beneficial effects on the survival of bronchiectasis. Besides, presence of hypoxemia, hypercapnia, dyspnea level and radiographic extent were more closely correlated with mortality.

Side effects due to primary antituberculosis drugs during the initial phase of therapy in 1149 hospitalized patients for tuberculosis.

OBJECTIVE: Side effects of the most commonly used primary antituberculosis (anti-TB) drugs may be mild as well as fatal. The aim of this study was to evaluate the side effects of and the risk factors for developing side effects against anti-TB drugs. PATIENTS AND METHODS: Records of 1149 patients with established tuberculosis who initially received anti-TB therapy were evaluated retrospectively. The major side effects, which resulted in a definitive termination from 1 or more drugs related to anti-TB therapy, and the risk factors associated with these side effects, were analyzed. RESULTS: Ninety-five patients (8.3%), constituting 104 cases in total, experienced side effects. Although the frequency of drug reactions were increased from 0.6% at ages <20 to 5.2% at ages 20-40, no gender or age differences were observed between patients who did and did not have side effects. While asymptomatic liver function disturbance was established in 56 of the patients (4.9%) with initiation of anti-TB therapy, the rate of hepatotoxicity was found to be 2.4% in this present study. No age or gender differences were observed among those who had hepatotoxicity and who had not. The major side effects were ototoxicity (1.7%), hepatotoxicity (0.8%), neuropsychiatric manifestations (0.7%), and hyperuricemia (0.6%). CONCLUSIONS: It must be remembered that severe side effects associated with anti-TB drugs were encountered with different frequencies especially among patients hospitalized for pulmonary tuberculosis, and these patients should be followed up by closer monitoring for side effects related to anti-TB drugs.

Microscopic polyangiitis with unusual lung involvement.

Microscopic polyangiitis (MPA) is a non-granulomatous, systemic and small vessel vasculitis accompanied by segmental necrotizing glomerulonephritis with no evidence of other small vessel disease. We report a patient with weakness, fever, and arthralgia whose CXR and thoracic CT showed widespread nodular infiltration. His proteinase-3 anti-neutrophilic cytoplasmic antibody (c-ANCA) was positive. The serum creatinine was increased and haematuria subsequently developed. Renal biopsy revealed a focal segmental necrotizing glomerulonephritis which was compatible with MPA. He was treated with high-dose corticosteroid and cyclophosphamide. Because of a worsening CXR and hypoxaemia, mechanical ventilation was applied. Despite this he died of respiratory failure following 20 days of treatment. Nodular infiltration is an unusual radiological pattern in patients with MPA and is the reason for this report.

The prognostic significance of vascular endothelial growth factor levels in sera of non-small cell lung cancer patients.

BACKGROUND: Angiogenesis, the formation of new blood vessels from the existing vascular bed, is essential step for the growth and invasion of the primary tumor. Vascular endothelial growth factor (VEGF) is known to play crucial role in tumor angiogenesis. Increased serum VEGF levels may be associated with poor prognosis in patients with non-small cell lung cancer (NSCLC). METHODOLOGY: In the present study, we measured plasma VEGF levels in 20 normal subjects and 75 patients with untreated NSCLC; 23 operable (stages I, II, IIIA) and 52 inoperable (stages IIIB, IV) (Histology: squamous cell carcinoma, 40; adenocarcinoma, 27; undetermined, 8). VEGF was measured by enzyme-linked immunosorbent assay. RESULTS: The median VEGF level in patient group was 119 pg/ml (29-1235), which was significantly higher than the control group (P = 0.044). Median survival of patients was 210 days (30-220). The patients were divided into high VEGF (> 119 pg/ml) and low VEGF (< 119 pg/ml) groups using the median value as a cut-off. It was investigated if there were significant associations between serum VEGF level and clinico-pathological parameters like age, sex, histopathological diagnosis and TNM staging. Also high VEGF and low VEGF patient groups were compared according to the median survival. CONCLUSIONS: Serum VEGF level is significantly associated with the clinical staging of the patients (operable and inoperable) (P = 0.031) and it also correlates with the prognosis of the patients (P = 0.0006).

Elevated levels of circulating matrix metalloproteinase-9 in non-small cell lung cancer patients.

Elevated levels of matrix metalloproteinase have been implicated as playing important role in tumour progression in several types of cancers. Our aim was to determine whether these enzyme might be a useful tumour marker for lung cancer and also to evaluate the correlation of circulating levels of matrix metalloproteinase-9 (MMP-9) with tumour histology, staging, nodal status, metastasis and prognosis. Blood samples were collected from 35 nonsmall cell lung cancer patients who were diagnosed histologically, and 14 healthy controls. The MMP-9 levels were significantly higher in the cancer group (p< 0.001). However no significant correlation between several clinical features (such as histology of the tumour, staging, tumour status, or nodal status) and plasma MMP-9 levels have been observed. Though it does not show statistical significance, more patients with metastasis seemed to have higher MMP-9 levels. At the end of six month 11 patients were out of follow-up. Among the remaining 24 patients eight patients had lower MMP-9 levels, seven were survivors at the end of six months. Sixteen patients had MMP-9 levels above the threshold. Only 10 have survived to six months. In conclusion MMP-9 can serve as a marker for metastasis and can be valuable in the follow-up of lung cancer patients.

[The evaluation of excessive daytime sleepiness in taxi drivers]. / Taksi sürücülerinde gündüz asiri uyku hali ile trafik kazalari arasindaki iliski.

Excessive daytime sleepiness (EDS) is a common but underrecognized and preventable cause of traffic accidents. It creates a problem of particular importance for professional drivers. We performed the Epworth Sleepiness Scale (ESS) and questionnaire related to their history of traffic accidents to 118 professional taxi drivers to determine the EDS and its effects on driving performance in taxi drivers. There were 58 (49.2%) subjects with loud snoring, 8 (5.9%) subjects with cardinal symptoms due to obstructive sleep apnea syndrome (OSAS) and 28 (23.7%) subjects with ESS > or =10 in the group of taxi drivers. Eighty (67.8%) drivers had been involved in a traffic accident. We found a significant relation between the number of traffic accident and EDS, witnessed apnea, cardinal symptom related to OSAS but not with snoring. The present data that sleepiness is a common symptom in taxi drivers and may be related to traffic accident.

[A case of aggressive fibromatosis of posterior mediastinum]. / Posterior mediasten yerlesimli agresiv fibromatözis olgusu.

Aggressive fibromatosis is a rarely seen soft tissue tumor. They originate principally from deep seated fascial or musculoaponeurotic structures. Although they are considered histologically benign, they behave locally aggressive. Posterior mediastinal localisation is very rare. The patient who was investigated because of a lesion located in posterior mediastinum and a thoracal magnetic resonance imaging revealed a mass with a dimension of 20 x 6 x 5 cm, started at the level of thoracal fourth vertebra reaching the L1 vertebra, was diagnosed as aggressive fibromatosis by a biopsy obtained after a right posterior thoracotomy performed by thoracic surgery. A minimal regression was established nine months after radiotherapy by thoracal MRI. This case of aggressive fibromatosis, which was asymptomatic and whose posterior mediastinal mass did not increased its dimensions during six years of follow-up, was presented.

[Hepatopulmonary syndrome]. / Hepatopulmoner sendrom.

Liver diseases affect lungs. Pulmonary vascular diseases are observed in hepatic diseases and portal hypertension have a wide spectrum that varies from intrapulmonary vascular dilatation to increased pulmonary vascular resistance with pulmonary hypertension. Hepatopulmonary syndrome is a syndrome characterized portal hypertension, intrapulmonary vascular dilatation and abnormal oxygenation (hypoxaemia). This review summarizes the clinicopathologic features, diagnostic criteria, and management of hepatopulmonary syndrome.