Technetium-99m-hexamethylpropylene amine oxime lung scintigraphy findings in patients with Behçet's disease.

AIM: Behçet's disease (BD) is a multisystem disorder that is characterized by vasculitis, and consists of a triad of recurrent ulcers of the oral and genital mucosa with relapsing uveitis. The prevalence of pulmonary involvement varies in the range of 1-10% in various studies, and its complications are severe and life threatening. To objectively assess the degree of pulmonary vascular endothelial damage in BD, the lung uptake, and the clearance rate of technetium-99m-hexamethylpropylene amine oxime (Tc-99m-HMPAO) were determined. METHODS: Twenty-three nonsmoking patients with BD (10 female, 13 male) and 11 (six female, five male) healthy nonsmoking controls underwent Tc-99m-HMPAO lung scanning, pulmonary function tests (PFT), chest radiograph examination, contrast-enhanced spiral chest computed tomography scanning, and high-resolution computed tomography examinations. Immediately after the bolus injection of 740 MBq of Tc-99m-HMPAO posterior sequential images were obtained at 1-s intervals for 150 s and subsequent images were obtained at one frame per minute (min) over a 10-min period, using a double-headed gamma camera equipped with a low-energy all-purpose parallel hole collimator. Dynamic images were used to calculate the Tc-99m-HMPAO lung clearance rate (T1/2). Simultaneously, a static anterior image, including a large part of the liver, was obtained of 5-min duration at 10 min after the injection. Regular regions of interests were drawn over the midportion of the right lung and the highest activity area of the liver parenchyma was selected and lung/liver (L/Li) uptake ratios were calculated to represent the degree of pulmonary vascular endothelial damage. RESULTS: Chest radiograph, high-resolution computed tomography, and computed tomography findings in patients with BD were nonspecific for BD. There was also a statistically significant difference between patients with BD (30.26 ± 10.55 s) and normal controls (19.53 ± 6.24 s) on their T1/2 values (P = 0.0004). The results show that the L/Li ratios on the Tc-99m-HMPAO lung scan were significantly higher in patients with BD (0.60 ± 0.19) than those in normal controls (0.39 ± 0.07) (P = 0.0021). Using a cutoff value of 0.50, 15 of 23 (65%) patients with BD had increased L/Li ratios. No correlation was found between the mean T1/2 values of Tc-99m-HMPAO clearance and the PFT in patients with BD. The L/Li ratios were not correlated with PFT in patients with BD. CONCLUSION: The degree of pulmonary vascular endothelial damage was represented as increased L/Li ratios and decreased lung clearance rate measured on the Tc-99m-HMPAO lung scan in patients with BD. Our results indicated that determining the T1/2 values and the L/Li ratios on Tc-99m-HMPAO lung imaging should be an objective method to assess subclinical pulmonary damage even in the early stages of BD in the patients.

Extrapulmonary involvement in patients with sarcoidosis in Turkey.

BACKGROUND AND OBJECTIVE: Extrapulmonary sarcoidosis is common, and is almost always associated with concomitant thoracic involvement. Extrapulmonary manifestations vary on the basis of gender, age at presentation and ethnicity. The aim of this study was to investigate extrapulmonary involvement in patients with sarcoidosis in Turkey. METHODS: This study was conducted by Turkish Thoracic Society Clinical Problems Study Group. New cases of sarcoidosis between 1 June 2004 and 31 May 2006 were recorded on electronic case record forms sent to all potential investigators and information about extrapulmonary involvement was collected. RESULTS: One hundred and nineteen of 293 patients (83 female, 36 male, mean age = 45 ± 12 years) had extrapulmonary involvement in this study (40.6%). The median time to diagnosis was 6 months and this was longer than patients with just thoracic sarcoidosis (P = 0.001). Extrapulmonary symptoms were present in 181 (61.8%) patients, and skin lesions, arthralgia and back pain were the commonest (33.4%, 20.8% and 16.4%, respectively). Incidence of organ involvement was independent of age with the exception of ocular involvement, which was higher in those under the age of 40 years (P = 0.007). CONCLUSIONS: Skin and peripheral lymph node involvement were the most common sites of extrapulmonary involvement and ocular involvement was more common in those under the age of 40 years in patients with sarcoidosis in a Turkish population.

Assessment of alveolar epithelial permeability with Tc-99m DTPA aerosol scintigraphy in patients with Sjogren syndrome.

Sjögren's syndrome (SjS) is a systemic autoimmune disease that mainly affects the exocrine glands and usually presents as persistent dryness of the mouth and eyes. Lung disease in SjS has been reported to occur early following clinical presentation of the disease. In this study, technetium-99m diethylene triamine penta-acetic acid (Tc-99m DTPA) aerosol inhalation scintigraphy was used to assess the pulmonary membrane permeability in patients with primary SjS. A total of 18 patients with primary SjS and 13 healthy controls were investigated. Clinical evaluation, chest X-ray examination, pulmonary function tests, Tc-99m DTPA aerosol scintigraphy were performed in all the cases. The presence of respiratory symptoms (dyspnea and cough), duration of sicca symptoms were recorded. The clearance half time of Tc-99m DTPA radioaerosols in patients with SjS (20.49 +/- 2.56 min) was faster when compared to normal controls (42.32 +/- 13.28 min) (P = 0.000) which means that there is a significant increase in lung permeability in patients with SjS compared to the controls. There is also a significant difference between PI of patients with SjS (0.34 +/- 0.09) and that of controls (0.42 +/- 0.07) (P = 0.012). According to the results of our preliminary study, one can detect pulmonary involvement by Tc-99m DTPA aerosol inhalation scintigraphy in patients with primary SjS.

Three atypical pulmonary hydatidosis lesions mimicking bronchial cancer from Turkey.

Hydatid disease is endemic in Turkey. Echinococcus granulosus causes cystic echinococcosis mostly in the liver and lung. Although pulmonary hydatid cysts can be diagnosed by clinical and radiological findings, atypical or complicated lung lesions may be misdiagnosed. In the present study, three cases with hemoptysis and atypical lung lesions were diagnosed and treated as lung cancer or tuberculosis based on the clinical and laboratory findings along with the imaging data and fiberoptic bronchoscopy evaluation. Eventually, pathological examination of the bronchoscopic biopsy material confirmed the definitive diagnosis as pulmonary hydatidosis. The three patients presented herein emphasize the importance of considering pulmonary hydatid disease in the definitive diagnosis of atypical lung lesions such as bronchial carcinoma in echinococcosis endemic areas.

Assessment of alveolar epithelial permeability in Behçet's disease with 99mTc-DTPA aerosol scintigraphy.

OBJECTIVE: Behçet's disease (BD) is a multisystem disorder characterized by vasculitis, and consists of a triad of recurrent ulcers of the oral and genital mucosa with relapsing uveitis. The prevalance of pulmonary involvement varies in the range of 1-10% in various studies and its complications are severe and life threatening. In this study, we investigated the changes of pulmonary epithelial permeability of patients with BD using technetium-99m diethylene triamine penta-acetic acid ((99m)Tc-DTPA) aerosol scintigraphy, so as to begin the therapy regimen as soon as possible. METHODS: Twenty-one nonsmoking patients with BD (8 women, 13 men; mean age 38.67 +/- 8.86 years) and 15 healthy volunteer nonsmoking controls (8 women, 7 men; mean age 50.87 +/- 12.45 years) underwent (99m)Tc-DTPA aerosol inhalation scintigraphy and pulmonary function tests (PFTs). Subjects inhaled 1480 MBq of (99m)Tc-DTPA for 4 min in the supine position. Scintigraphic data were recorded dynamically (1 frame/min) in the posterior projection on a 64 x 64 matrix for a 30-min period using a double-headed gamma camera (Infinia, GE, Tirat Hacarmel, Israel) equipped with a low-energy all-purpose parallel hole collimator. Half time of (99m)Tc-DTPA clearance (T (1/2)) was calculated by placing a mono-exponential fit on the curves. Penetration index (PI) was also calculated by dividing the peripheral total counts by the sum of the peripheral and central total counts on the first minute image, in order to quantify the distribution of the inhaled aerosol. RESULTS: The clearance half time of (99m)Tc-DTPA radioaerosols in the BD patients (24.81 +/- 6.22 min) was faster than in the normal control group (46.53 +/- 22.41 min) (P = 0.004). There was also a significant difference between PI of the patients with BD (0.15 +/- 0.03) and that of the controls (0.21 +/- 0.06) (P = 0.002). No correlation was found between the mean T (1/2) values of (99m)Tc-DTPA clearance or the spirometric measurements in the BD patients. Penetration indices were not correlated with PFT in the BD patients. CONCLUSIONS: Lung epithelial permeability of the patients with BD was significantly higher than that of the normal subjects. The results of this study demonstrated that the assessment of lung epithelial permeability using (99m)Tc-DTPA aerosol scintigraphy could predict the presence of lung involvement in the early stages of BD.

[Sensitivity of cough with capsaicin in smokers]. / Sigara içenlerde kapsaisin ile öksürük duyarliligi.

In this study, effect of long term smoking on sensitivity of cough reflex was investigated. Healthy, current smoker male and female was evaluated by capsaicin cough challenge test and they were compared with healthy, non-smoker persons with similar age and gender, prospectively. In current smokers, there were 50 male and 39 female, in non-smoker control group, there were 20 male and 21 female. Mean and log C5 dosage in current smoker and non-smoker groups and mean and log C5 dosage in current smoker according to gender were calculated by using Mann-Whitney U-test. Results of capsaicin cough challenge test in current and non-smoker groups were evaluated by using Pearson Chi-Square test and Fisher's Exact test. In current smokers comparison of results of capsaicin cough challenge test with smoking history (age with first smoking, duration, pocket year and smoking per day) was evaluated by using Mann-Whitney U-test. Mean C5 and mean log C5 dosage were found decreased in current smokers when they were compared to control group (p< 0.00). In current smoker group mean C5 and mean log C5 dosage were found decreased in male (p< 0.002). When the results of capsaicin cough challenge test were compared between current smoker and control groups, sensitivity of cough reflex in concentration with 0.49, 0.98, 1.95, 3.9, 7.8, 15.6 microM was significantly decreased in current smoker group. Also there was a significant correlation between concentration with 0.98, 1.95, 3.9, 7.8, 15.6, 31.2 microM, and duration of smoking and pocket year of smoking. Also there was a correlation between concentration with 15.6, 31.2, 62.5, 125 microM and smoking per day. This results were correlated with hypothesis about inhibition of C-fibers with nicotin or decrease of C-fibers' sensitivity due to induction of neuropeptide wasting.

Thorax perfusion CT in non-small cell lung cancer.

OBJECTIVES: We aimed to determine the perfusion differences according to the histological type, stage, volume and prognoses in the non-small cell carcinoma by thorax perfusion CT. MATERIALS AND METHODS: Twenty-four non-small cell carcinoma patients were included in the study. Thorax perfusion CT was done to evaluate the tumors in terms of perfusion parameters: blood flow (BF) and time to peak (TTP) values. RESULTS: The total blood flow of the tumor in squamous cell carcinoma was significantly higher than adenocarcinoma (p=0.031). There was no statistical difference between the perfusion parameters and other parameters. CONCLUSIONS: Perfusion CT may help us in evaluating non-small cell carcinomas.

Effect of severity of asthma on quality of life.

This study is aimed to evaluate the health related quality of life (HRQL) in asthmatics and the probable association between HRQL and disease severity and also other demographic factors by using a generic scale, SF-36 questionnaire. One-hundred and two asthmatics were enrolled. The scores of the 8 domains of SF-36 questionnaire were evaluated according to age, gender, status of education and compared with the severity of asthma. The mean age of 84 (83%) female and 18 (17%) male patients was 42.86 +/- 11.15. Fifty-two of them was well educated (51%) and 50 was poorly educated (49%). Atopy ratio was 81%. Mild intermittent, mild persistent and moderate-severe persistent groups were 27 (26%), 46 (45%) and 29 (29%) respectively. Female gender were worse in physical functioning (p= 0.000), physical role difficulties (p= 0.0049), vitality (p= 0.045) and social functioning (p= 0.025). Poorly educated group were worse in physical functioning (p= 0.001), physical role difficulties (p= 0.039), vitality (p= 0.045), emotional role difficulties (p= 0.046), general health (p= 0.030) and mental health (p= 0.044). Mental health was worse in the presence of atopy (p= .035). Physical functioning was better in mild intermittent group than moderate and severe persistent group (p= 0.024). General health was better in mild intermittent group than mild persistent group (p= 0.018), moderate and severe persistent group (p= 0.015). Vitality and emotional role difficulties was better in mild intermittent than mild persistent group (p= 0.042, p= 0.007). The HRQL scores and severity of asthma is well correlated like other objective parameters. So one of the primary goals in management of asthma should also improve QOL as well as functional parameters.

The frequency of wheezing phenotypes and risk factors for persistence in aegean region of Turkey.

The aim of the study was to determine the prevalence of wheezing and evaluate the risk factors for its persistence in children. Survey data was collected on 725 children aged 17 years or below. The mean age was 8.94 +/- 5.16 years; 22.1% of them were reported to have had a wheezing episode at any point in their lives. A wheezing episode was reported in 18.1% of children 3 years of age or younger and persisted in 51% of these subjects; 69.6% of ever wheezers had late onset wheezing. Persistence was significantly common in males. Perinatal disease, lack of breast feeding, and low income were significant risk factors for persistence. In summary, breast feeding, perinatal disease, and income status may be significant risk factors influencing wheezing peristence and consequent asthma.

[Unusual foreign body aspiration]. / Nadir görülen bir yabanci cisim aspirasyonu.

Tracheobronchial foreign body aspiration in adults is rare when compared to children. In this case report, 76 year old female patient who aspirated a screw of tracheostomy cannula which was taken out by fiberoptic bronchoscopy (FOB) was presented. This case showed us that education of patients about stoma care is important. The FOB can be used safely to get foreign body from distal airways.

Effects of latanoprost and betaxolol on cardiovascular and respiratory status of newly diagnosed glaucoma patients.

AIMS: To investigate the cardiovascular and respiratory effects of topical latanoprost 0.005% and topical betaxolol 0.25% monotherapy in newly diagnosed glaucoma patients. METHODS: Fortynewly diagnosed glaucoma patients were enrolled in this prospective, observer-masked, randomized, parallel study. Patients received either latanoprost 0.005% or betaxolol 0.25% for a duration of 3 months. Baseline evaluation included intraocular pressure (IOP) measurement and cardiorespiratory examinations including pulse rate, systolic and diastolic blood pressure measurements and spirometry. These measurements were repeated after 3 months. RESULTS: Both latanoprost and betaxolol reduced IOP significantly (p = 0.001). After 3 months of therapy, the mean pulse rate, systolic and diastolic blood pressure values of the betaxolol group were reduced (p = 0.027, p = 0.07 and p = 0.016, respectively). No significant changes occurred in the cardiovascular measurements of the latanoprost group (p > 0.05). There were no significant changes in any of the spirometric measurements tested for both groups (p > 0.05). CONCLUSION: Both latanoprost and betaxolol are safe concerning respiratory functions. Betaxolol may cause small changes in the cardiovascular system, suggesting that blood pressure and pulse rates should be checked before and in regular intervals after prescribing it for the elderly. Latanoprost seems to be a safe medication in view of absence of systemic cardiovascular and respiratory side effects.

The prevalence of asthma and allergic symptoms in Manisa, Turkey (A western city from a country bridging Asia and Europe).

The aim of this study was to determine the prevalence of asthma and allergic symptoms in Manisa city center, Turkey, to evaluate the determinants effective on those values, and to review the prevalence rates reported from different parts of the country. Data were collected from 610 households and complete interviews were conducted with 1,336 adults over 18 years of age by using European Community Respiratory Health Survey-ECRHS questionnaire. The prevalences of current asthma, cumulative asthma and asthma-like symptoms were found in 1.2, 1.0 and 25.0%, respectively, of the 20-44 years age group and the prevalences of allergic rhinitis, allergic dermatitis and family atopy were found in 14.5, 10.9, and 15.2%, respectively, in all age group. Wheezing with breathlessness, wheezing without cold, woken up with shortness of breath and woken up with cold were reported by 9.1%, 6.9%, 6% and 16.1% of the study population, respectively. Gender, age, active or passive smoking, family atopy and home condition effect on prevalence of asthma and allergic symptoms. In this study prevalence of asthma correlated with the studies reporting low prevalence rates of Turkey.

[Evaluation of silicosis in ceramic workers]. / Seramik fabrikasi isçilerinde silikozis.

This study is aimed to evaluate the incidence of silicosis and the relation of it with personal and work-related factors among workers exposed to silica in ceramic factory. Workers were evaluated by respiratory symptoms, physical examination, pulmonary function and radiological findings. Occupational and Enviromental Pulmonary Disease Evaluation Questionnaire of the Turkish Thoracic Society Enviromental and Occupational Pulmonary Diseases Working Group was used. 365 of 626 workers had exposure to silica and the rest 261 were concerned as control group. There was no difference between mean age, duration of work and smoking pack year among the groups (p> 0.05). Cough and sputum rates were higher in silicosis group FEV1 and FVC values were lower in silica group but this was not statistically significant. When the two subgroups of silica group (the workers in high dust concentration and the ones in low concentration) were compared, the high concentrated group had significantly more sputum but the other symptoms and pulmonary functional parameters were not different significantly. 24 workers had parenchymal densities adjusted with pneumoconiosis. The workers with the pneumoconistic finding, had a higher mean age and longer duration of work. As a conclusion, ceramic industry has risk for silicosis. And the risk increase by time and age.

A case of a small cell lung carcinoma presenting with jaundice due to pancreatic metastasis.

Though the high incidence of pancreatic metastasis of lung cancer has been reported in autopsy series, symptomatic cases with jaundice due to that is very rare. Dominant histological type with pancreatic metastases is small cell carcinoma and prognosis is poor. Hereby, we report a case initially presenting with gastroenterologic symptoms as jaundice, nausea, vomiting, weight loss and abdominal pain and then diagnosed as primary small cell carcinoma of the lung with metastasis to pancreas. He underwent a palliative surgery due to obstructive jaundice. This presented case is a rare one with its priority of gastroenterologic symptoms rather than pulmonary complaints.

[Endobronchial metastasis from urinary bladder cancer]. / Mesane kanserinin endobronsiyal metastazi

A rare case, a case of endobronchial metastasis from urinary bladder carcinoma is reported. A 70 years-old man was admitted with hematuria. He has a mass in urinary bladder and a mass in lung. He has no pulmonologic symptom. He is a smoker with 75 pack-years. Thorax computerized tomography revealed a mass in left lung upper lobe. Bronchoscopy demonstrated an endobronchial tumor in left upper lobe, apikoposterior segment. Histopathologically diagnosis was endobronchial metastasis from urinary bladder carcinoma. He received five courses of chemotherapy (cisplatin + gemcitabine). The mass was regressed after three months. Our patient lived for one year from diagnosis.

Short-term effects of montelukast in stable patients with moderate to severe COPD.

This study aims to investigate the possibility of additional value of leukotriene receptor antagonist (LTA) on dyspnea score, arterial blood gases (ABG), pulmonary function tests (PFTs), and quality of life (St. George QoL) in chronic obstructive pulmonary disease (COPD) patients. In this randomized, prospective, single-blind, and controlled study, 117 non-reversible COPD patients defined by global initiative for chronic obstructive lung disease (GOLD) criteria were randomized to receive ipratropium bromide, formoterol and montelukast (n:58, montelukast group) or ipratropium bromide and formoterol (n:59, control group) after a 2-week run-in period. There was no significant demographic difference between the two groups (P>0.05). Baseline ABG, PFT, visual analoque scores (VAS), and QoL scores were obtained and at first month and second month, PFT, VAS, and QoL scores were repeated and ABG was obtained at second month and the values were compared with baseline values. As the result of the comparison, there was significant increase in vital capacity, FVC, FEV1, VAS, and PaO2 parameters (P<0.05), and a significant decrease in the QoL scores (P<0.05) in the montelukast group. These parameters did not show any difference in the control group (P>0.05). Sputum samples that could be obtained in 24 of the COPD patients were evaluated and in the montelukast group, there was a decrease in neutrophilic activity after treatment (n:13) (P:0.059). These results suggest that LTA that is used additionally in routine treatment protocol can produce additive improvement on PFT, dyspnea score and especially QoL in patients with stable COPD and for these reasons, LTA may be taken into account when there is need for an additional anti-inflammatory treatment in COPD patients.

[High resolution computed tomography findings in patients with asthma]. / Astimli Olgularda Yüksek Rezolüsyonlu Bilgisayarli Tomografi Bulgulari.

Recent studies suggest that thoracal high resolution computed tomography (HRCT) of the thorax can detect the irreversible structural changes in chronic asthma cases. This study is aimed to evaluate these possible changes and their relation with asthma severity. Twenty-eight stable asthmatic patients with normal conventional radiography and 10 healthy controls were included. Twenty of the patients were female (71.4%) and the mean age of the group was 43 +/- 10.5 (30-61). The groups were divided into 2; as group 1 included mild intermittent and mild persistent cases, and group 2 included moderate and severe persistent cases. Asthma and control group, and group 1 and 2 were compared according to the thickness of airwall (T), thickness to outer diameter (T/D), wall area (WA), the percentage wall area (WA%). HRCT showed that air trapping, bronchiectasis, fibrotic lesions and airwall thickening were significantly more common in asthma group (p< 0.05). Emphysema, acinar pattern, collapse and mucoid impact were common in asthma group (p> 0.05). The incidence of T and WA was higher in asthma group but also did not reach statistical significance and the thickening of airwall in small airways was significantly more in asthma group. Any correlation between HRCT findings and asthma severity was not found. So reversible and irreversible bronchial and parenchymal changes, detected by HRCT but not by plain chest radiograms, may be present in asthma cases. The early detection of these changes may lead more aggressive asthma management.