Prevalence of atopy and allergic rhinitis in patients with adult non-cystic fibrosis bronchiectasis

Background/aim: Non-cystic fibrosis bronchiectasis (non-CF BR) is common in developing countries.Limited data are available regarding the impact of atopy, and no data are available regarding allergic rhinitis in patients with adult bronchiectasis.The aim of this study was to evaluate the prevalence of atopy and allergic rhinitis in the clinical conditions of patients with BR. Materials and methods: The study enrolled 101 patients who were diagnosed with non-CF BR using high-resolution computed chest tomography. Allergic rhinitis (AR) was defined by skin prick test (SPT) positivity and the presence of any nasal symptoms (watery runny nose, nasal obstruction, nasal itching, and sneezing). Results: The mean age of patients was 48 ± 15 years (range 18­82); 55 (54.5%) patients were female. SPT positivity was detected in 37 (36.6%) cases. AR was detected in 32 (31.7%) patients with non-CF BR. AR was related to dyspnea (P = 0.04) and number of admissions to an emergency department in the previous year (P = 0.01). Forced expiratory volume in 1 s and forced vital capacity in patients with and without AR were different (P = 0.01 and P = 0.01, respectively). AR was correlated with number of admissions to an emergency department in the last year (r = 0.417, P = 0.005). Conclusion: We concluded that atopy was detected in more than one-third of adult non-CF BR patients. This study demonstrated that non-CF BR patients might have AR; it might be important to be aware of nasal symptoms in non-CF BR patients.

Vitamin D Deficiency and Radiological Findings in Adult Non-Cystic Fibrosis Bronchiectasis.

OBJECTIVES: Vitamin D may play an important role in immunity and its deficiency has been related to increased respiratory infections. The aim of this study was to detect the prevalence of vitamin D deficiency and to investigate the relationship between radiological and clinical effects on adult bronchiectasis (BR) patients. MATERIALS AND METHODS: A total of 130 patients with BR and 73 healthy individuals (control group) were enrolled in this study. Radiological severity was assessed using Modified Reiff Score. RESULTS: The mean age of patients was 41.9±9.1 years (range, 18-85). The mean 25-hydroxyvitamin D (25(OH)D) level was 14.7±9.6 ng/mL in BR patients and 19.8±6.9 ng/mL in the control group (p=0.001). Moreover, 95 (73.1%) adult BR patients were categorized as vitamin D deficient. Patients in the vitamin D deficiency group had significantly higher Modified Medical Research Council scores than those in the group without vitamin D deficiency (p=0.036) The mean modified Reiff score was higher in the vitamin D deficient group than the without vitamin D deficiency group (6.9±3.8 vs 4.9± 2.7, p=0.001). Additionally, the vitamin D deficient group had lower forced vital capacity% predicted value (p=0.02). This model showed that Reiff score (OR, 1.285[1.039-1.590]; p=0.021) was independently related to vitamin D deficiency. CONCLUSION: We found that vitamin D deficiency is commonly seen in adult BR patients in a stable period. Moreover, it might be related to severe radiological findings on chest computed tomography and worse lung functions.

Validity and Reliability of the Assessment Tool for Asthma (ATA) Questionnaire: the ATA Study.

OBJECTIVES: A multicenter trial was designed to validate the "Assessment Tools for Asthma (ATA)" questionnaire, a newly developed questionnaire, which evaluates both asthma control and risk factors associated with asthma control with a single instrument. MATERIALS AND METHODS: This cross-sectional study involved 810 cases from 14 clinics in 9 Turkish cities. The ATA questionnaire and Asthma Control Test (ACT) were administered. The Visual Analog Scale (VAS) was used to evaluate the control status of 100 randomized cases. ATA is an eight-item physician-administered questionnaire. It comprises the following two sections-ATA1, assesses symptomatic control criteria, and the remaining section, queries the flare-up of asthma, control of comorbidities, treatment adherence, and inhaler technique. RESULTS: The mean scores for ATA1, ATA total, VAS, and ACT were 24.7±14.8, 53.8±19, 7.1±3, and 18.8±5.5, respectively. According to the ATA questionnaire, among all patients, 34.3% had controlled, 18.8% had partly controlled, and 46.9% had uncontrolled asthma. Furthermore, 16.6% patients had flare-ups between visits, 96.4% patients had uncontrolled comorbidity, 17% patients had irregular asthma treatment, and only 8.4% patients used the incorrect inhaler technique. The ATA questionnaire showed internal consistency (Cronbach's alpha coefficient=0.683). ACT, ATA1, and two specialists' evaluations using VAS correlated strongly with the ATA total scores (Spearman correlation coefficient (r) values: 0.776, 0.783, and 0.909, respectively; p-values: p<0.001, p<0.001, and p<0.001, respectively). According to Receiver Operating Characteristic analysis, the cut-off value of ATA was 50 (sensitivity=84.4%, specificity=82.40%). CONCLUSION: The validated ATA questionnaire may be a practical tool for physicians in asthma management.

The impact of ultrasonography-guided fine needle aspiration of no palpable supraclavicular lymph nodes on diagnosis and staging in advanced lung cancer.

Diagnosis and accurate staging of lung cancer is essential for selection of appropriate curative or palliative therapy and affects patient prognosis. Both invasive and non-invasive procedures are used for this purpose. We aimed to assess the frequency of no palpable supraclavicular lymph node metastases in lung cancer patients with enlarged mediastinal lymph nodes, and their impact on diagnosis and staging using ultrasound in this study. Lung cancer patients with no palpable supraclavicular lymph nodes and at least 2 enlarged mediastinal lymph nodes on computerized tomography underwent supraclavicular ultrasound examination. Ultrasound-guided fine needle aspiration (US-guided FNA) was performed when enlarged lymph nodes were present. Supraclavicular lymph node metastasis was confirmed cytologically via US-guided FNA in 16 (40%) of 40 patients. Upper paratracheal lymphadenomegaly was significantly higher in patients with supraclavicular metastases than in those without. No statistical significant differences were observed in the stage, cell types, and metastases of patients with or without supraclavicular metastases. In 3 patients US-guided FNA was used for diagnosis. More than one-third of lung cancer patients with enlarged mediastinal lymph nodes had supraclavicular lymph node metastases in present study. US-guided FNA is an easier, safer, and less invasive procedure than standard techniques used to diagnose lung cancer patients with enlarged mediastinal lymph nodes.

An elderly patient and an adult patients with isolated unilateral pulmonary arterial hypoplasia: Two cases reports and literature review of the literature.

Unilateral hypoplasia of a pulmonary artery (UHPA) is a rare condition that is usually associated with cardiac anomalies in childhood. In the absence of cardiac anomalies, patients may not be diagnosed until respiratory symptoms develop. We present two patients who were diagnosed as having isolated unilateral right pulmonary artery hypoplasia, one a woman aged 80 years, the other, a man aged 55 years. To our knowledge, woman is the oldest patient with UHPA in the English medical literature. Awareness of this condition may contribute to the early recognition of these cases and planning of appropriate treatment.

[Thoracic findings in neurofibromatosis]. / Nörofibromatoziste torasik bulgular.

Neurofibromatosis type 1 (von Recklinghausen' disease) is an autosomal dominant hereditary syndrome. It is characterized with multiple light brown (café-au-lait) spots, Lisch nodules and neurofibromas. Thorax and lungs are affected in various forms. Four cases with symptoms of thoracic involvement were investigated in our clinic. Mean age was 46. All cases had dyspnoea and cough; two of them had chest pain. Skin lesions of neurofibromatosis type 1 (NF 1) were pathologically confirmed in all cases. Moreover, case 3 had diffuse interstitial fibrosis and honeycomb pattern. Case 2 had thorax deformity, kyphoscoliosis and intrathoracic benign mass. Case 1 had two neurofibrosarcoma masses on the right hemithorax. Case 4 had multiple intrathoracic neurofibromas. Cases 1 and 3 died within two years after diagnosis due to malignancy and respiratory failure, respectively. Cases 2 and 4 are still under our control.

Cryptogenic organizing pneumonia: clinical and radiological features, treatment outcomes of 17 patients, and review of the literature.

BACKGROUND/AIM: We evaluated patients with cryptogenic organizing pneumonia (COP) who attended our clinic. MATERIALS AND METHODS: We retrospectively investigated the clinical and radiological findings, diagnostic methods, treatment, and follow-up outcomes of 17 patients who had been histopathologically diagnosed with COP. RESULTS: The mean age of the patients was 49.8 ± 10.4 years. The most common symptom was cough (n = 15; 88.2%) and the most common radiological finding (n = 10) was consolidation in the inferior lobes on thoracic computed tomography. The diagnosis of COP was made by open lung biopsy in 11 (64.7%) patients, transbronchial biopsy in 5 (29.4%), and video-assisted thoracoscopic surgery biopsy in 1 (5.9%). The mean follow-up period was 28.7 ± 25.0 (range: 3-85) months. Twelve patients received oral corticosteroid therapy and seven of them improved without any fibrotic changes. One patient refused treatment; a chest radiography of that patient was found to be normal at the end of the 20-month follow-up period. Three patients received no other therapy, as the lesion had been completely excised. CONCLUSION: Common symptoms included cough and dyspnea, while the main radiological presentation of COP was consolidation. Corticosteroids are a good treatment option in general, but relapse may occur.

Factors related to depression and anxiety in adults with bronchiectasis.

INTRODUCTION AND BACKGROUND: Patients with chronic lung diseases frequently have depressive and anxiety symptoms, but there are very few studies looking at this in patients with bronchiectasis. AIM: This study aimed to investigate depression and anxiety and related factors among patients with non-cystic fibrosis bronchiectasis. PATIENTS AND METHODS: This was a prospective study of 133 patients with bronchiectasis. Patients with confirmed diagnosis of bronchiectasis with high-resolution computed tomography were enrolled in the study. Patients that were clinically stable in the previous 4 weeks were evaluated with the Hospital Depression and Anxiety scale. Symptoms, pulmonary function tests, and medical treatments were recorded. RESULTS: The mean age of patients was 49.5±14.5 years (range, 18-77 years), and 81 (60.9%) patients were females. Twenty-eight (21.1%) patients had depression, and 53 (39.8%) had anxiety. Depression score was related to family situation (living with a partner), previous depression history and admission to an emergency department within the last year. Anxiety score was related to female gender, the family situation (living with a partner), previous depression history, and admission to an emergency department within the last year (P<0.05). Depression was positively correlated with hemoptysis, admission to an emergency department within the last year and living with a partner. Anxiety was positively correlated with education level, previous depression history, admission to an emergency department within the last year, and living with a partner. CONCLUSION: Patients with non-cystic fibrosis bronchiectasis are at increased risk for depression and anxiety. Untreated and undetected depressive/anxiety symptoms may increase physical disability, morbidity, and health care utilization. It is important for clinicians to be aware of the presence of depression and anxiety in bronchiectasis.

[Churg-Strauss syndrome (two case reports)]. / Churg-Strauss sendromu (iki olgu nedeniyle).

Churg-Strauss syndrome is a necrotizing vasculitis with multiple organ involvement characterized by asthma, peripheral blood eosinophilia, eosinophilic tissue infiltration and extravascular granulomas. A 35 years-old male with 6-months history of asthma and a 43 years-old female with 4-years history of asthma, were further examined due to clinical worsening and lesions on chest radiographs. They were finally diagnosed as Churg-Strauss syndrome. Clinical and radiological response to oral corticosteroid therapy was obtained.

Long-term Outcome of Patients With Undiagnosed Pleural Effusion.

INTRODUCTION: The cause of exudative pleural effusion cannot be determined in some patients. The longterm outcomes of patients with undiagnosed pleural effusion were analyzed. METHODS: Patients with exudative pleural effusion whose diagnostic procedures included pleural biopsy using video-assisted thoracoscopic surgery carried out between 2008 and 2012 were evaluated retrospectively. Patients diagnosed with non-specific pleuritis were included. Fifty-three patients with available follow-up data were included in the study. RESULTS: Forty men and 13 women (mean age 53.9±13.9 years) were included. Median follow-up time was 24 months. No diagnosis was given in 27 patients (51%), and a clinical diagnosis was given in 26 patients (49%) during the follow-up period. Malignant disease (malignant mesothelioma) was diagnosed in 2 (3.7%) patients. Other diseases were parapneumonic effusion in 12, congestive heart failure in 8, and miscellaneous in 4 patients. Volume of effusion at the time of initial examination and re-accumulation of fluid after video-assisted thoracoscopic surgery were associated with malignant disease (P=.004 and .0001, respectively). CONCLUSION: Although the probability is low, some patients with exudative pleural effusion undiagnosed after pleural biopsy via video-assisted thoracoscopic surgery may have malignant disease. Patients with an initially large volume of effusion that re-accumulates after examination should be closely monitored.

Patient and physician delay in the diagnosis and treatment of non-small cell lung cancer in Turkey.

AIM: The early diagnosis and treatment of lung cancer are important for the prognosis of patients with lung cancer. This study was undertaken to investigate patient and doctor delays in the diagnosis and treatment of NSCLC and the factors affecting these delays. MATERIALS AND METHODS: A total of 1016 patients, including 926 (91.1%) males and 90 (8.9%) females with a mean age of 61.5±10.1 years, were enrolled prospectively in this study between May 2010 and May 2011 from 17 sites in various Turkish provinces. RESULTS: The patient delay was found to be 49.9±96.9 days, doctor delay was found to be 87.7±99.6 days, and total delay was found to be 131.3±135.2 days. The referral delay was found to be 61.6±127.2 days, diagnostic delay was found to be 20.4±44.5 days, and treatment delay was found to be 24.4±54.9 days. When the major factors responsible for these delays were examined, patient delay was found to be more frequent in workers, while referral delay was found to be more frequent in patients living in villages (p<0.05). We determined that referral delay, doctor delay, and total delay increased as the number of doctors who were consulted by patients increased (p<0.05). Additionally, we determined that diagnostic and treatment delays were more frequent at the early tumour stages in NSCLC patients (p<0.05). DISCUSSION: The extended length of patient delay underscores the necessity of educating people about lung cancer. To decrease doctor delay, education is a crucial first step. Additionally, to further reduce the diagnostic and treatment delays of chest specialists, multidisciplinary management and algorithms must be used regularly.

Ultrasound guided fine-needle aspiration biopsy of metastases in nonpalpable supraclavicular lymph nodes in lung cancer patients.

BACKGROUND AND OBJECTIVES: To assess frequency and significance of enlarged nonpalpable supraclavicular lymph nodes with routine ultrasound (US) evaluation and US-guided fineneedle aspiration biopsy (FNAB) for the diagnosis and staging of patients with lung cancer. MATERIALS AND METHODS: 106 consecutive patients with lung cancer and nonpalpable supraclavicular lymph nodes were evaluated with cervical US for the presence of pathological lymph nodes. FNAB was performed in patients with nodes with short-axis > 5 mm, rounded shape and missing echogenic hilum. RESULTS: 27 (25.5%) patients had enlarged supraclavicular lymph nodes on US. Fourteen patients (13.2%) had cytologically proven lymph node involvement. Supraclavicular lymph node metastasis was more frequent in patients with mediastinal invasion (p = 0.0001) and patients with enlarged lymph nodes on upper paratracheal stations on thorax CT (p = 0.0001). No relation was found between supraclavicular lymph node involvement and T stage (p = 0.27), distant metastasis (p = 0.50) or histological type (p = 0.80). Three patients were upstaged from IIIA to IIIB status. US-guided FNAB was the only diagnostic method in 2 patients. CONCLUSION: US-guided FNAB is a simple and safe procedure which can document N3 stage of disease in lung cancer patients. Thereby more invasive and expensive diagnostic procedures can be avoided in selected lung cancer patients.

Silicosis in denim sandblasters.

BACKGROUND: During the past 2 decades, silica sand has been used widely in sandblasting denim in Turkey, which has resulted in an epidemic of silicosis. This study was conducted to summarize the clinical outcomes of formerly healthy young people who became disabled or died because of working in the textile industry. METHODS: The medical records of patients with silicosis due to denim sandblasting who were seen at our institution between 2001 and 2009 were reviewed. Follow-up data were assessed. Compensation and vital status of patients were determined, and survival analysis was performed. RESULTS: Thirty-two male patients diagnosed with silicosis due to denim sandblasting over an 8-year period were identified. Mean age was 31.5 years. They worked as denim sandblasters for a mean 66.4 h/wk for a median 28.5 months. Their mean cumulative exposure time to silica sand was 12,957 h. The median follow-up period was 29 months (range 3-101 months). The median latency period (time elapsed between initial exposure and diagnosis) was 5.5 years (range 2-14 years). Six of the followed patients (19%) died of progressive massive fibrosis. Nine of the patients (28%) were compensated because of silicosis. Just two patients with silicosis received compensation before they died. The mean survival rate was 78 months. The estimated 5-year survival rate was 69% for denim sandblasters with silicosis. CONCLUSIONS: Silicosis in young individuals after exposure in the textile sector suggests a lack of awareness of the hazards of silica outside of the traditional occupations associated with silicosis. Death from silicosis in young people suggests overexposure and unsafe working conditions as a result of a lack of control.