A patient with massive hemoptysis treated by videothoracoscopic clipping of the causative aberrant artery.

Massive hemoptysis is a life-threatening situation and can have a variety of underlying causes. Bronchial arteries are mostly the source of bleeding but in rare cases an aberrant systemic artery may be present, causing hemoptysis. Here, we present a patient in whom an aberrant systemic artery was defined to be the cause of hemoptysis. Obstruction of this artery by videothoracoscopic clipping was curative for the patient's hemoptysis.

The value of surgical resection in patients with multidrug resistant tuberculosis.

BACKGROUND: Multidrug resistant tuberculosis (MDR-TB) still continues to be a serious health problem throughout the world. Although main treatment of MDR-TB is medical, surgical resection with adjuvant medical therapy may increase the chance of cure in selected patients. METHODS: We performed surgical resections in 55 patients between 1997 and 2005; 36 were male and 19 were female with a median age of 34 years (range 13 to 66 years). Sputum was negative for 49 patients and positive for 6 patients in the preoperative period. Patients were treated according to a new therapy protocol for a mean of 3.7 months before the operation. RESULTS: Lobectomy was performed in 37 patients, pneumonectomy in 17 patients and lobectomy + segmentectomy in 1 patient. One patient with positive sputum preoperatively died in the early postoperative period (mortality: 1.81 %). Various complications occurred in 16 (29.09 %) patients. Prolonged air leak was the most common complication (n = 8). Bronchopleural fistula (BPF) + empyema occurred in 2 (3.63 %) patients. In the postoperative period, sputum negativity was achieved in all patients except three cases throughout the 57 months of follow-up (cure rate 94.5 %). Patients received drug therapy for 24 months postoperatively. CONCLUSIONS: Surgical resection with adjuvant drug therapy increases the chance of cure in patients with localized disease if they have an adequate cardiopulmonary reserve, favorable nutritional status and are treated with a new therapy protocol for at least 3 months.

Radiometric vs. agar proportion methods for assessing ethionamide resistance and its clinical effects in multidrug-resistant tuberculosis.

SETTING: Three centres for the treatment of multidrug-resistant tuberculosis (MDR-TB) in Istanbul, Turkey: Heybeliada Centre for Chest Diseases and Thoracic Surgery, Süreyyapasa Centre for Chest Diseases and Thoracic Surgery and Yedikule Centre for Chest Diseases and Thoracic Surgery. OBJECTIVE: To evaluate the presence of ethionamide (ETH) resistance and its effect on time to sputum smear negativity in MDR-TB patients who had not previously received second-line anti-tuberculosis drugs. DESIGN: Drug susceptibility testing for isoniazid (INH), rifampicin (RMP), ethambutol, streptomycin and ETH was performed on 50 patients treated between August 2004 and May 2005. Indirect agar proportion and BACTEC methods were used to determine ETH susceptibility. RESULTS: Of the patients who were resistant to at least INH and RMP, 11 (22%) (three [27.3%] new and eight [72.7%] retreatment) were resistant to ETH with the BACTEC method. Of 18 new patients, three (16.6%) were ETH-resistant using the BACTEC method compared to 8/32 (25%) retreatment patients. The mean time to smear negativity was 75.2 days in ETH-resistant patients and 50 days in susceptible patients (P < 0.05). Both ETH-resistant and -susceptible groups were homogeneous for factors that may have a possible effect on time to conversion. CONCLUSION: Not only ETH resistance but also age and radiologically advanced disease adversely affected time to sputum conversion.

Patterns of delays in diagnosis amongst patients with smear-positive pulmonary tuberculosis at a teaching hospital in Turkey.

In total, 151 newly diagnosed patients with smear-positive pulmonary tuberculosis were studied. The mean time from the onset of symptoms to the first visit to a physician was 46.4 days; the mean referral delay was 28.9 days; the mean delay in diagnosis was 2.4 days; and the mean delay in treatment initiation was 0.8 days. There was a delay in consulting a physician by 49% of patients. A low index of suspicion for tuberculosis on the part of the physician and healthcare system and laboratory delays were the most common reasons for delays in diagnosis.

Alterations in superoxide dismutase activities, lipid peroxidation and glutathione levels in thinner inhaled rat lungs: relationship between histopathological properties.

Paint thinner has widespread use in industry. The use of thinner among children as a narcotic agent has become a social and health problem. There is some evidence that organic solvents may express their toxicity by the way of reactive oxygen species (ROS) induced cell damage. ROS has been shown to induce lipid peroxidation in biological membranes. This study examined peroxidative and histopathological changes in the rat lung, during 5 weeks of thinner inhalation. Significant increases were found in lipid peroxidation (MDA+4-DHA) levels related to the duration of inhalation. As opposed to increases in the lipid peroxidation levels, significant decreases in superoxide dismutase activities and glutathione levels were observed from the third inhalation week to the end of the fifth week. At the beginning of the inhalation slight inflammatory changes, intraalveolar and interstitial extravasation and oedema in lung parenchyma were noted. As the inhalation period extended, chronic inflammatory changes, alveolar epithelial proliferation, collapse, emphysematous changes and interstitial fibrosis in lung were detected.

Cytologic diagnosis of complicated pulmonary unilocular cystic hydatidosis. A study of 131 cases.

OBJECTIVE: To determine the value of cytochemical stains and microscopic techniques for the detection of true hydatid elements (primary cytologic criteria) and to evaluate the efficacy of granulomatous elements (secondary cytologic criteria) for the diagnosis of complicated pulmonary unilocular cystic hydatidosis (CPUCH). STUDY DESIGN: Sputum, bronchial washing and bronchial brushing specimens obtained from 131 patients with a presumptive diagnosis of CPUCH were reviewed. RESULTS: CPUCH was histopathologically proven in 111 of 131 patients. Scolices were found in 11 patients in Papanicolaou-EA65 (PAP-EA65)-stained slides. Special stains and dark field microscopy (DFM) did not make any additional contribution to specifying the nature of the scolexlike objects. Hooklets were found in 26 patients in PAP-EA65-stained slides. Masson's trichrome stain and DFM revealed hooklets in 37 and 50 cases, respectively. Laminated membrane fragments were found in 14 patients in PAP-EA65-stained slides. Gomori's methenamine silver stain and DFM demonstrated laminated membrane fragments in 25 and 33 cases, respectively. Secondary cytologic criteria, such as multinucleated giant cells, degenerated squamous cells, dyskaryotic squamous cells, excessive amounts of eosinophils, plasma cells, lymphocytes, histiocytes, necrotic debris, fibrinoid material and erythrocytes, were considered to be suggestive of hydatid disease when there are more than three such factors in patients with a presumptive diagnosis of CPUCH. CONCLUSION: Though DFM examination is superior to cytochemical stains used in this study, both cytochemical stains and DFM are useful in increasing the sensitivity of cytologic detection of true hydatid elements, especially hooklets and laminated membrane fragments. They should be used as auxiliary techniques. Secondary cytologic criteria are suggestive of the diagnosis of CPUCH, and special care should be taken when there are more than three such factors in cytologic specimens.

Value of fibreoptic bronchoscopy in the diagnosis of complicated pulmonary unilocular cystic hydatidosis.

Complicated pulmonary unilocular cystic hydatidosis (CPUCH) is a serious condition, which requires immediate treatment. The aim of the present study was to evaluate the efficacy of fibreoptic bronchoscopy (FOB) in the final diagnosis of CPUCH. Of 1,726 cases, who underwent FOB evaluation between 1990 and 1994 in our centre, 24 patients (17 females and 7 males), who had proven CPUCH after thoracotomy, were included in this study. Fourteen of the 24 cases were diagnosed in the preoperative period by cytological and histopathological evaluation of FOB material, whereas the remaining 10 cases with presumed CPUCH underwent thoracotomy for final diagnosis. Of the 14 cases diagnosed by FOB (11 females and 3 males); none had concomitant extrapulmonary hydatid disease. Whitish-yellow membranes were seen in 12 of the cases during FOB. Whilst cuticular particles, degenerated scoleces, and hooklets were seen in 14 cases in bronchial lavage, these elements were identified in brushing material in only seven. In 10 of the 14 cases, cytological diagnosis was confirmed by FOB biopsies before thoracotomy. It is concluded that whilst the clinical, radiological and laboratory findings are presumptive, fibreoptic bronchoscopic examination and the cytological and histopathological examination of material obtained during that procedure are conclusive for the diagnosis of complicated pulmonary unilocular cystic hydatidosis.