Obesity, Charlson comorbidity index, and neutrophil-to-lymphocyte ratio in chronic obstructive pulmonary disease: relationship to disease severity.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a common chronic inflammatory lung disease with high mortality and morbidity rates. Obesity, various comorbid diseases, and inflammation often coexist in chronic obstructive pulmonary disease (COPD), exhibiting a complex interaction with disease severity. The aim of the study was to examine the relationship between COPD markers and obesity, the Charlson Comorbidity Index (CCI), and neutrophil/lymphocyte ratio (NLR). METHODS: Eighty male patients with stable COPD admitted to the pulmonology unit were included in the study. The presence of comorbidities was investigated in obese and non-obese individuals with COPD. Pulmonary function tests and the mMRC dyspnea scale were examined, and CCI scores were calculated. RESULTS: 60.9 % with mild/moderate COPD, and 64.7 % with severe COPD had a comorbid disease. The incidence of hypertension and diabetes was significantly higher in obese patients. The obesity rate was 41.3 % in patients with mild/moderate COPD (FEV1 ≥ 50) and 26.5 % in those with severe COPD (FEV1 < 50). There was a positive and significant correlation between CCI value and BMI and mMRC dyspnea scale. NLR was significantly higher in patients with FEV1 < 50 and mMRC ≥ 2. CONCLUSIONS: As a result, it is essential to screen obese patients with COPD, who are among the groups with the highest incidence of comorbidities, in terms of such diseases that exacerbate the symptoms of their disease. Findings may support the potential applicability of simple blood count indices (such as NLR) in the clinical assessment of disease in stable COPD patients (Tab. 4, Fig. 1, Ref. 46).

Thiol-disulfide as a novel indicator of obstructive sleep apnea.

INTRODUCTION: Obstructive sleep apnea (OSA) is an oxidative stress disease, which has been considered to be a notable risk and associated with increased cardiovascular morbidity and mortality. Thiol-disulfide homeostasis is as a novel indicator of oxidative stress. OBJECTIVES: We aimed to evaluate thiol-disulfide homeostasis in a large patient population with OSA. METHODS: A total of 230 with OSA and 40 healthy controls were included in the study. Inclusion criteria for OSA patients are having apnoea-hypopnoea index of ≥5/hour, being more than 18 years of age and having no previous treatment for OSA. Thiol-disulfide analysis was done for the patients and control group. Blood thiol-disulfide homeostasis was analysed using the new automatic method, developed by Erel and Neselioglu. RESULTS: Among all OSA subjects, 149 (64.8%) were males and the mean ages of the patients were 53.38 ± 10.22. Total thiol, native thiol (SH) and disulfide (SS) levels were significantly lower in OSA group compared to the control group (P < .001, P < .001 and P = .039 respectively). Also, total thiol and native thiol (SH) were significantly different between the groups according to OSA severity (mild-moderate to severe OSA) (P < .001 and P < .001 respectively). Thiol-disulfide redox parameters were correlated with apnoea-hypopnoea index (AHI) scores. CONCLUSION: The present prospective study showed that thiol/disulfide homeostasis was unbalanced in OSA patients. Especially, in OSA patients have low level of thiol/disulfide redox parameters when compared to healthy subjects. Evaluating thiol-disulfide homeostasis in OSA may be a contributing aspect to assessment and monitoring of the patient.

Exhaled carbon monoxide is a marker of heavy nicotine dependence.

BACKGROUND/AIM: Exhaled CO level provides an objective measure of a patient's smoking status. The relationship between CO levels and nicotine dependence is controversial. The aim of this study is to evaluate the relationship between exhaled CO levels and nicotine dependence as well as to demonstrate that exhaled CO levels may be used as a marker of nicotine dependence. MATERIALS AND METHODS: Two hundred eighty-nine patients (132 females, 157 males) were included in the study. Smoking duration, the age of smoking initiation, exhaled CO levels, and Fagerström Test for Nicotine Dependence (FTND) scores were recorded. The relationship between FTND scores and exhaled CO levels was investigated. RESULTS: There was a statistically significant correlation between FTND score and exhaled CO levels (P < 0.001). We found that a cut-off score of 7.5 ppm for exhaled CO may be useful as a marker for heavy smoking. The sensitivity and specificity of this cut-off score for exhaled CO was 69.3% and 49.3%, respectively (P < 0.001). CONCLUSION: We found that exhaled CO levels significantly correlated with FTND scores. For patients who are unable to provide reliable answers to questions in the FTND, exhaled CO measurements may be used as an alternative test for estimating the status of heavy smoking.

Clinical characteristics of 75 pandemic H1N1 influenza patients from Turkey; risk factors for fatality.

BACKGROUND/AIM: The 2009 influenza A (H1N1) pandemic caused mild to severe illnesses and led to death in some cases. In this study, we aimed to evaluate the relationship between the serum D-dimer levels, CURB-65 scores, and the severity of pneumonia among patients with H1N1 infections. MATERIALS AND METHODS: Sixty-eight patients who had probable H1N1 infections were evaluated by clinical, radiological, and laboratory methods. The H1N1 strain was specified by reverse transcription-polymerase chain reaction. Of 55 patients diagnosed with pneumonia, 18 exhibited H1N1 positivity and 37 patients did not. RESULTS: CURB-65 scores of pneumonia patients with H1N1 (group 1) were higher than those of patients without H1N1 (group 2) (P = 0.02). The D-dimer levels of group 1 were higher than those of group 2 (P = 0.001). Moreover, there was a positive correlation between D-dimer levels and CURB-65 scores in patients with H1N1-associated pneumonia (P = 0.001; r = 0.89). CONCLUSION: Increased D-dimer levels were observed in pneumonia patients with H1N1 infection, which predicted the severity of pneumonia.

The evaluation of hypermetabolic mediastinal-hilar lymph nodes determined by PET/CT in pulmonary and extrapulmonary malignancies: correlation with EBUS-TBNA.

BACKGROUND/AIM: We aimed to define the optimal SUV(max) cut-off value in determination of mediastinal-hilar lymph node metastasis, by comparing positive PET/CT results with the results of endobronchial ultrasound guided transbronchial needle aspiration biopsy (EBUS-TBNA). MATERIALS AND METHODS: Thirty-one patients with malignancy whose PET/CT imaging revealed a hypermetabolic mediastinal and/or hilar lymph node and who had undergone EBUS-TBNA were evaluated retrospectively. Histopathology was regarded as the gold standard. The diagnostic role of PET/CT in mediastinal/hilar lymph node metastasis was investigated and compared with the results of contrast-enhanced CT. RESULTS: When a SUV(max) value of 2.5 was used, the sensitivity, positive predictive value (PPV), and diagnostic accuracy of the PET/CT were 100%, 65.4%, and 65.4% respectively. In the ROC analysis, the SUV(max) cut-off value with the highest diagnostic accuracy (75%) was calculated as 6.3, and when this value was considered, the sensitivity, specificity, PPV, negative predictive value, and diagnostic accuracy of the PET/CT were determined as 70.6%, 83.3%, 88.9%, 60%, and 75% respectively (AUC: 0.779). The sensitivity, PPV, and diagnostic accuracy of the thorax CT were calculated as 91.1%, 72%, and 71.1%, respectively. CONCLUSION: When determining mediastinal-hilar lymph node metastasis via PET/CT, although a SUV(max) cut-off value of 6.3 increases specificity and diagnostic accuracy, we think that a SUV(max) cut-off value of 2.5 and above give more optimal results in routine practice.

Endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of lymphoma.

BACKGROUND: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is highly accurate in diagnosing mediastinal lymphadenopathies of lung cancer and benign disorders. However, the utility of EBUS-TBNA in the diagnosis of mediastinal lymphomas is unclear. The aim of this study was to determine the diagnostic value of EBUS-TBNA in patients with suspected lymphoma. MATERIALS AND METHODS: Sixty-eight patients with isolated mediastinal lymphadenopathy and suspected of lymphoma were included in the study. EBUS-TBNA was performed on outpatients under moderate sedation. The sensitivity, specificity, negative predictive value and diagnostic accuracy of EBUS-TBNA were calculated. RESULTS: Sixty-four patients were diagnosed by EBUS-TBNA, but four patients with non-diagnostic EBUS-TBNA required surgical procedures. Thirty-five (51.5%) patients had sarcoidosis, six (8.8%) had reactive lymphadenopathy, nine (13.3%) had tuberculosis, one (1.5%) had squamous cell carcinoma, two (2.9%) had sarcoma and fifteen (22%) had lymphoma (follicular center cell, large B-cell primary, and Hodgkin lymphomas in three, two, and ten, respectively). Of the 15 lymphoma patients, thirteen were diagnosed by EBUS and two by thoracotomy and mediastinoscopy. The sensitivity, specificity, negative predictive value, and diagnostic accuracy of EBUS-TBNA for the diagnosis of lymphoma were calculated as 86.7%, 100%, 96.4%, and 97%, respectively. CONCLUSIONS: EBUS-TBNA can be employed in the diagnosis of mediastinal lymphoma, instead of more invasive surgical procedures.

Endobronchial ultrasound-guided transbronchial needle biopsy for the diagnosis of mediastinal lymphadenopathy in patients with extrathoracic malignancies.

BACKGROUND/AIM: Mediastinal lymphadenopathy is common in extrathoracic malignancies and should not always be considered a metastatic lesion. The purpose of this study is to determine the diagnostic value of endobronchial ultrasound-guided transbronchial needle biopsy (EBUS-TBNA) in patients with extrathoracic malignancies. MATERIALS AND METHODS: This study included 54 consecutive patients with extrathoracic malignancies who had suspected mediastinal metastases and had undergone EBUS-TBNA for diagnosis. RESULTS: Using EBUS-TBNA, 27 of 54 patients (50%) were diagnosed with mediastinal metastases. Among patients with mediastinal metastases, 2 (3.7%) had a sarcoid-like reaction, 5 (9.3%) had tuberculosis, and 17 (31.5%) had reactive lymph nodes. In 3 cases (5.5%), a specific diagnosis could not be determined following EBUS-TBNA. Two patients underwent surgical staging of their mediastinal lymphadenopathy, which allowed the detection of mediastinal metastases in 1 patient and that of reactive lymph nodes in the other. The sensitivity, specificity, negative predictive value, and diagnostic accuracy of EBUS-TBNA for the diagnosis of extrathoracic malignancies were calculated as 93%, 100%, 92.6%, and 96.3%, respectively. CONCLUSION: EBUS-TBNA is a safe and effective procedure. We should consider whether EBUS-TBNA should be the primary diagnostic tool for the diagnosis of mediastinal lymphadenopathy in patients with extrathoracic malignancies.

Bronchoesophageal fistula.

Bronchoesophageal fistula (BEF) is an undesirable consequence of esophageal cancer. A BEF is encountered in 5% to 15% of patients with esophageal cancer. It is generally a life-threatening complication because of the development of recurrent pulmonary infection and sepsis. We present a case with esophageal cancer and acquired BEF. The fistula allowed herniation of the esophageal wall into the endobronchial lumen, causing significant obstruction of the airway lumen, findings not reported previously.

Obstructive fibrinous tracheal pseudomembrane.

Obstructive fibrinous tracheal pseudomembrane is a rare but potentially fatal complication associated with endotracheal intubation. Little is known about the mechanisms that play a role in the development of tracheal pseudomembrane, but it requires early diagnosis and treatment to prevent its major consequences. In this report, we present a case of obstructive fibrinous tracheal pseudomembrane, which developed a day after extubation in a patient who was intubated for 2 days. Therapeutic bronchoscopy was highly successful in removing the lesion and improving the clinical course.

Endobronchial involvement in non-Hodgkin lymphoma.

Non-Hodgkin lymphoma generally affects the thorax in nearly half of the cases, but endobronchial non-Hodgkin lymphoma is rare. A 65-year-old man presented with refractory cough and progressive dyspnea on exertion of 2 months' duration. The patient denied fever, weight loss, or night sweats. A chest x-ray revealed bilateral lower lobe infiltrates. A computed tomography scan of the chest revealed large matted mediastinal lymph nodes without clear margination. Bronchoscopic examination revealed bilateral endobronchial diffuse nodular lesions. Bronchial mucosal biopsy demonstrated B-cell lymphoma. The patient was treated with R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone) regimen with near-total resolution of endobronchial and parenchymal lesions.

A mass of myxofibrosarcoma in the lung.

Fibrosarcoma is a mesenchymal tumor constituted by malignant fibroblasts. Myxofibrosarcoma is one of the fibrosarcoma variants that mostly develops from dermal/subcutaneous tissues. The most common locations are the limbs, with rare occurrences in the chest, head, and neck. Since, to best of our knowledge, there is no such report in English literature, we hereby present a case of lung myxofibrosarcoma. A 47-year-old man who had chest pain for 4 months was admitted to our clinic. The chest X-ray revealed a homogeneous density in the left upper lung. His chest computed tomography (CT) scan showed a solid mass lesion of 52 x 58 mm in size at the apical segment of the left upper lobe. There was tumor invasion at the second and third ribs. CT-guided fine-needle tru-cut lung biopsy was performed. Histopathological evaluation result was high grade myxofibrosarcoma. Surgery was conducted. Myxofibrosarcoma is a surgically curable disease. However, local recurrences occur in 50% to 60% of the cases. Therefore, chemotherapy and/or radiotherapy is the suggested approach following surgery.

Aneurysm of an anomalous systemic artery supplying the normal basal segments of the left lower lobe: endovascular treatment with the Amplatzer Vascular Plug II and coils.

An anomalous systemic artery originating from the descending thoracic aorta supplying the normal basal segments of the lower lobe of the left lung without sequestration is a rare congenital anomaly. The published surgical treatments include lobectomy, segmentectomy, anastomosis, and ligation. In addition, endovascular treatment with coils has been reported. A second-generation occluder, the Amplatzer Vascular Plug II (AVP II), has a central plug and two occlusion disks and a finer, more densely woven nitinol wire, thus enabling faster embolization. This published case is the first successful occlusion of an aneurysm of an anomalous systemic artery with the AVP II and fibered coils, with 10 months of follow-up.

Endobronchial hamartoma.

Pulmonary hamartoma is a benign lung neoplasm and it comprises 6% of solitary pulmonary nodules. Two clinical types have been defined according to its location: intraparenchymal (90%) and endobronchial (10%). We report on a case of endobronchial hamartoma resected with electrocautery by a flexible bronchoscope (FB). A 57-year-old male patient was admitted to our clinic because of worsening dyspnea. The patient had been smoking 1 pack per day for 37 years. A solid smooth lesion with calcification, located in the distal part of the left main bronchus and partially obstructing the lumen of bronchus, was detected at computerized tomography. A mass lesion that moved with coughing was observed during FB. The polypoid mass was arising from the anterior wall of the left main bronchus. Punch biopsies were taken from the polypoid lesion and a diagnosis of bronchial papilloma was made after histopathologic examination. The patient underwent endobronchial electrosurgery and the lesion was excised using FB. Pathologic evaluation revealed it to be a cartilagenous hamartoma. In conclusion, endobronchial hamartomas are benign neoplasms of the tracheobronchial tree. Endoscopic treatment with flexible bronchoscopic electrocautery is safe and less invasive in experienced hands. Therefore, it should be considered as the primary treatment approach in selected cases.

Lung cancer and mesothelioma in towns with environmental exposure to asbestos in Eastern Anatolia.

OBJECTIVE: Our previous study demonstrated the presence of environmental tremolite and chrysotile asbestos fiber exposure in Hekimhan town in Malatya located in eastern Turkey. The aim of this study was to investigate whether environmental asbestos exposure increases the incidence of lung cancer and mesothelioma. METHOD: One hundred and forty-nine patients with mesothelioma and lung cancer living in the center or in the towns of Malatya were retrospectively analyzed. The Incidences of lung cancer and mesothelioma were calculated. RESULTS: The incidences of lung cancer and mesothelioma were 3.39/100,000 and 0.21/100,000, respectively, for the whole population of Malatya; while they were 8.23/100,000 and 1.45/100,000 in Hekimhan. The incidences were strikingly high (22.39/100,000 for lung cancer and 7.46/100,000 for mesothelioma) in Arguvan, another town in Malatya where an analysis for asbestos could not be performed. The overall incidence in Turkey was reported as 5.9/100,000 by the Health Ministry in 1994. The incidences of lung cancer were nearly 1.3-fold higher in Hekimhan and fourfold higher in Arguvan then in the general population of Turkey. CONCLUSION: The incidences of mesothelioma and lung carcinoma in Hekimhan were higher than those of the general population in Turkey, suggesting a role of environmental asbestos exposure in lung cancer and mesothelioma.

Apricot sulfurization: an occupation that induces an asthma-like syndrome in agricultural environments.

BACKGROUND: Several cases of bronchial asthma have been presenting with acute attacks during the seasons of apricot sulfurization. The aim of this study was to reveal the effects of sulfur dioxide (SO(2)) exposure on the airways of the workers involved in this process. METHODS: SO(2) levels in air were measured on 15 apricot farms, while the symptom scores of 69 workers were recorded before, during, and after SO(2) exposure. Physical examination and pulmonary function tests (PFT) of the workers were also done prior to and after exposure periods. RESULTS: The measured SO(2) concentrations ranged between 106.6 and 721.0 ppm. Dyspnea (80%), cough (78%), and eye and nose irritation (83-70%) were the most commonly observed symptoms. The workers had significant decreases in pulmonary functions after SO(2) exposure. Decrements in FEV(1), FEV(1)/FVC%, and FEF(25-75%) showed that the acute effect of SO(2) on pulmonary functions of the workers was mostly of obstructive pattern. CONCLUSIONS: Acute exposure to SO(2) induces "asthma-like syndrome" (ALS) in apricot sulfurization workers. SO(2) which has not been previously reported in agricultural environments as a cause of ALS may be considered as a new agent.

Organophosphate intoxication as a consequence of mouth-to-mouth breathing from an affected case.

We report three cases of organophosphate (OP) poisoning. One patient was a 19-year-old woman who drank OP compounds in an attempt at suicide. The other two patients became intoxicated on the way to the hospital during mouth-to-mouth breathing. The first patient died in the emergency department, and the other two were taken to the ICU. There, they were treated with atropine and pralidoxime. Three days later, all symptoms and signs had disappeared, and they were discharged from the hospital satisfactorily.