Does ischemia-modified albumin level predict severity of obstructive sleep apnea?

OBJECTIVE AND AIM: Ischemia-modified albumin (IMA) is a newly recognized marker of chronic inflammation used to evaluate oxidative stress status in patients with various diseases. We explored the possible relationship between IMA levels and obstructive sleep apnea (OSA). METHODS: In this retrospective study, 169 of 216 sequential patients being evaluated for suspicion of OSAS met inclusion criteria. Polysomnography confirmed OSA in 86 patients (51%) while 81 patients (49%) without OSA were categorized as control subjects. All study participants were tested for blood IMA level, neutrophil/lymphocyte ratio (NLR), C-reactive protein (CRP) level, and red blood cell distribution width (RDW). RESULTS: The serum IMA level was significantly higher in patients with OSAS than controls (p = 0.008). The serum IMA level increased significantly as OSAS severity increased (r = 0.50, p < 0.001) and was positively correlated with the AHI (r = 0.41, p < 0.001), CRP level (r = 0.31, p = 0.004), body mass index (r = 0.24, p = 0.022), RDW (r = 0.31, p = 0.03), oxygen desaturation index (ODI) (r = 0.22, p = 0.02), and negatively correlated with the hemoglobin concentration (r = - 0.28, p = 0.04) and minimum hemoglobin oxygen saturation (SpO2) (r = - 0.25, p = 0.02). Receiver operator curve (ROC) analysis showed that the optimal serum IMA, CRP, RDW, and NLR values were not different for predicting OSAS diagnosis (areas under the curves (AUC) = 0.62, 0.59, 0.60, and 0.43, respectively). However, the serum IMA level was superior in reflecting OSAS severity (AUC = 0.78) compared to CRP, RDW, and NLR values (AUC = 0.61, 0.53, and 0.51, respectively) (all p < 0.001). CONCLUSION: Like other markers of inflammation, blood IMA levels were significantly elevated in patients with OSA. However, blood IMA level was a better predictor of disease severity than the other markers.

Airway stents: a retrospective evaluation of indications, results and complications in our 10-year experience.

INTRODUCTION: Tracheobronchial stents (TBS) are the principal modalities in the management of central airway obstruction with intrinsic tracheobronchial pathology and extrinsic airway compression. The aim of the study is to assess the indications, surveillance management, complications, and long-term outcomes of the TBS managed by rigid bronchoscopy (RB) in our 10-year experience. MATERIALS AND METHODS: The files of all patients who underwent stenting in two centers from November 2008 to September 2018 were reviewed for background data, type of disease, and indication for the placement of stents, symptoms, treatment, complications and outcome. RESULT: 305 patients were stented with 342 TBS. TBS were placed in both malignant (n= 223) and benign airway diseases (n= 82). The median length of stent stay was 88 (34-280) days in patients with malignancies and 775 (228-2085) days in benign diseases. There was no stent-related mortality. Mucostasis (19%) and granulation tissue formation (17%) were the most common stentrelated complications. Benign nature of the disease, tumors metastatic to tracheobronchial tree, lenght of stent stay, and shape of stent were associated with the development of complications. CONCLUSIONS: TBS offer a safe and effective therapy for patients with both benign and malign tracheobronchial pathologies.

What have we learned in interventional pulmonology in the past decade?

Background/aim: The increasing number of lung diseases and particularly pulmonary malignancies has intensified the need for diverse interventions in the field of interventional pulmonology. In recent years we have seen many new developments and expanding applications in the field of interventional pulmonology. This has resulted in an increased number and variety of performed procedures and differing approaches. The purpose of the present study is to provide information on patient characteristics, range of interventions, complication rates, and the evolving approach of an experienced center for interventional pulmonology. Materials and methods: We retrospectively examined the records of 1307 patients who underwent a total of 2029 interventional procedures in our interventional pulmonology department between January 2008 and December 2017. Results: About half of the interventional procedures (47.2%) were performed on patients with airway stenosis due to malignant disease. Among patients with benign airway stenosis, the most frequent reason for intervention was postintubation tracheal stenosis. The number of patients who developed complications was 81 (6.2%), and the most common complication was hemorrhage (n = 31, 2.99%); 94.9% (n = 1240) of interventional procedures were performed under general anesthesia, without complications or deaths associated with anesthesia. Only one death (0.076%) occurred in the perioperative period. A total of 18 patients (1.38%) died in the 30-day perioperative and postoperative period. None of the patients with benign airway stenosis died. Conclusion: Interventional bronchoscopy is an invasive but considerably safe and efficient procedure for selected cases and effective treatment modality for airway obstructions, massive hemoptysis, and foreign body aspiration. Interventional pulmonology is a field of pulmonary medicine that needs effort to progress and provide an opportunity to witness relevant developments, and increase the number of competent physicians and centers.

A novel biochemical marker for community-acquired pneumonia: Ischemia-modified albumin.

INTRODUCTION: Community-acquired pneumonia (CAP) is a frequent cause of hospitalization and a leading cause of mortality worldwide. Early diagnosis and the initiation of appropriate antibiotic therapy are essential to reduce pneumonia-related morbidity and mortality. CRP is a well-established biomarker in many clinical settings, but has been traditionally considered not specific enough to be a useful guide in the diagnostic process of pneumonia. There is still a need for more specific and practical markers in CAP for diagnosis. The aim of this study was to investigate the diagnostic value of ischemia-modified albumin (IMA) levels in the diagnosis of CAP in the Emergency Department. METHODS: The study included 81 patients admitted with CAP and 81 control patients. Initial hour levels of IMA and CRP were measured. The IMA mean levels were compared between the study and control group. Correlation analyses were performed to investigate the association of serum IMA levels with CRP. RESULTS: Mean levels of IMA were 0.532±0.117IU/ml in the study group and 0.345±0.082IU/ml in the control group. IMA levels were significantly higher in the study group compared to the control group. The IMA level of 0.442IU/ml had sensitivity of 75.3% and specificity of 91.3% and was positively correlated with CRP levels (r=0.506; p<0.05). CONCLUSION: Blood IMA levels significantly increase in adult patients presenting with CAP. IMA may be considered as a novel biomarker in the diagnosis of CAP.

Place of vibration response imaging in preoperative lung cancer patients.

INTRODUCTION: In this study, we aimed to investigate the role of the vibration response imaging (VRI) as the second-line test in preoperative evaluation of the patients with non-small cell lung cancer (NSCLC) and in prediction of the predicted postoperative forced expiratory volume in one second (ppo FEV1). MATERIALS AND METHODS: A total of 31 patients scheduled for surgery underwent pulmonary function tests (PFTs), VRIxp and quantitative lung perfusion scintigraphy (LPS) in order to predict postoperative lung functions. PFTs and VRI were repeated between 4th and 6th postoperative weeks and FEV1 and FEV1% values were compared with preoperative VRI and ppo-FEV1 calculated with perfusion scintigraphy. Statistical analysis of 31 patients under postoperative follow-up was performed in two parts. In the first part, two preoperative prediction methods (ppo based on perfusion and ppo calculated with VRI), and in the second part, estimated values and postoperative actual values (considering postoperative spirometric values as standard) were compared. RESULTS: An agreement rate of 52% was found between the ppo values calculated with VRI and with perfusion. This rate was low, although respective predictive values for ppo VRI and ppo perfusion were 84% and 47%, suggesting that ppo VRI was more significant than LPS for prediction of the 1st month postoperative value in the patients included in this study. CONCLUSIONS: VRIxp has a high-accuracy rate in prediction postoperative FEV1. It is seemed as an alternative to quantitative perfusion scintigraphy for preoperative evaluation, because it can be easily applied at the bedside as a radiation free and non-invasive method.

Red blood cell distribution and survival in patients with chronic obstructive pulmonary disease.

BACKGROUND: Cardiovascular disease (CVD) contributes significantly to mortality in chronic obstructive pulmonary disease (COPD). Red blood cell distribution width (RDW), an automated measure of red blood cell size heterogeneity that is largely overlooked, is a newly recognized mortality marker in patients with established CVD. It is unknown whether RDW is associated with mortality in COPD patients. AIMS: To study the prognostic value of RDW in patients with COPD and to compare the value of this measurement with cardiac, respiratory, and hemotological status. METHOD: We performed retrospective analyses of 270 patients stable with COPD who were admitted to our hospital between January 2007 and December 2009. Demographic, clinical, echocardiographic, and laboratory characteristics were registered and recorded COPD deaths were registered as outcomes. RESULTS: In the overall patients, the RDW level had a mean value of 15.1 ± 2.4. RDW was positively correlated with C-reactive protein (CRP) (p = 0.008, r = 0.21), right ventricular dysfunction (RVD) (p < 0.001, r = 0.25), and pulmonary arterial hypertension (PAH) (p = 0.03, r = 0.14). Variables (p < 0.1) included in the univariate survival analysis were forced expiratory volume in 1 second (FEV1% predicted), RDW levels, age, PaCO2, albumine and CRP levels, presence of CVD, presence of anemia, presence of RVD, and presence of PAH. Subsequent multivariate analysis suggested that RDW levels (1.12; 95% CI, 1.01 to 1.24; p = 0.01), and presence of RVD (2.6; 95% CI, 1.19 to 5.8; p = 0.01) were independently related to mortality. CONCLUSION: Elevated RDW levels were associated with increased mortality risk in stable COPD patients.

Primary pulmonary non-Hodgkin's lymphoma: ten cases with a review of the literature.

INTRODUCTION: Primary pulmonary non-Hodgkin's lymphoma (PPNHL) of the lung occurs very rarely. To clarify clinical features, treatment alternatives and outcomes, we evaluated our surgically diagnosed PPNHL cases. MATERIALS AND METHODS: A retrospective review of PPNHL cases from January 2004 to December 2009 was performed. Demographic and clinical data are presented as means or medians. Overall survival was estimated using the Kaplan-Meier method. Survival rates were compared using the log-rank test. A p value < 0.05 was considered significant. RESULTS: Patients were eight males and two females with a median age of 50 years (range, 29-76 years). In 40% of the patients, antigenic stimulation, immune-suppression or auto-immune disease could not been found. All patients were symptomatic at presentation. Surgical procedures were needed to obtain a diagnosis (nine wedge resections and one pneumonectomy). Eight patients had an extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma), and two had diffuse large B-cell lymphomas. The patients were treated with observation (pneumonectomy case), chemotherapy (n= 7), and chemotherapy and radiotherapy (n= 1). Five-year survival was 76%. Difference in survival rates of patients with bilateral vs. unilateral disease were not statistically different. CONCLUSIONS: On contrary of the literature, PPNHL can occur with absence of antigenic stimulation, and patients generally have some symptoms. Chemotherapy or surgery can be used to treat PPNHL. Patient survival is good.

Use of airway stents to treat malignant tracheobronchial fistulas: Our six-year experience.

Background: This study aims to investigate the indications, safety, complications, and long-term outcomes of airway stenting in the treatment of malignant tracheobronchial fistulas. Methods: The medical records of a total of 34 patients (24 males, 10 females; mean age: 55.4+13 years; range, 23 to 76 years) with malignant tracheobronchial fistulas treated with airway stenting between February 2014 and August 2020 were retrospectively analyzed. Data including demographic features, diagnosis, symptoms, treatment, complications and outcomes were recorded. Results: Thirty-eight airway stents were inserted in 34 patients with malignant tracheobronchial fistulas, including 19 patients with malignant tracheobronchial esophageal fistulas and 15 patients with bronchopleural fistulas. The clinical success and the technical success rates were 91% and 100%, respectively. No perioperative death or severe complications occurred. Chronic complications (>24 h) occurred in eight (23%) patients with malignant tracheobronchial fistula. Median follow-up was 3.5 (range, 1.4 to 5.5) months in patients with malignant tracheobronchial esophageal fistulas and 18 (range, 9.5 to 26.5) months in patients with bronchopleural fistulas. Mortality rates were 79% and 61%, respectively. Conclusion: Airway stent insertion provides a secure and effective treatment for patients with malignant tracheobronchial fistulas.

Immunoglobulin G4 Related Lung Disease.

Immunoglobulin G4 related disease (IgG4-RD) is a relatively newly defined disease known for multiple organ involvement. Histopathologically, the disease is characterized by lymphoplasmatic inflammation, fibrosis, and enhanced levels of IgG4-positive plasma cells in tissues. IgG4-RD has been reported in almost every organ system. With pulmonary involvement, lesions have been described in the lung parenchyma, airways, pleura, and the mediastinum. Glucocorticoids are the first choice of treatment, but additional immunosuppressive drugs may be administered in refractory patients. In this article, we report a patient with IgG4 syndrome who had lung parenchyma, mediastinum, aorta wall, and pancreatic involvement. Histopathological findings and high serum IgG4 level established the diagnosis of IgG4-related disease. The patient was treated successfully with glucocorticoids.

Value of endobronchial ultrasound in staging non-small cell lung cancer.

Endobronchial ultrasound guided fine-needle aspiration (EBUS-TBNA) is an accurate, safe and minimally invasive technique for the analysis of mediastinal lymph nodes. The aim of our study was to assess the value of EBUS probe using single-channel bronchoscope. Twenty-two patients who undervent EBUS-TBNA with proven non-small cell lung cancer and enlarged (> 1 cm) mediastinal lymph node at chest computed tomography were retrospectively enrolled in the study. The mean age of the patients was 56.8 + or - 9.0 (45-76), and all of them were men. Mean size of sampled 32 lymph nodes was 19.9 + or - 6.5 mm (10-30). The average number of needle passes was 3.2 + or - 0.9 (1-5). Adequate material was found in 31 (97%) of the lymph nodes. In 15 (68.1%) of the patients lymph node metastasis was detected. Of 7 patients with negative cytology, a mediastinoscopy was done. There were no complications other than minimal hemorrhage. The sensitivity of EBUS-TBNA was calculated as 88.2%, whereas the specificity was 100% and accuracy was found to be 90.9%. EBUS guided TBNA of mediastinal lymph nodes is a safe approach which can be a tool for obtaining adequate material and high diagnostic yield in staging of non-small cell lung cancer.

[The incidence of sick euthyroid syndrome in non-small cell lung cancer patients]. / Küçük hücreli disi akciger kanserli olgularda hasta ötiroid sendromu sikligi.

Our study aimed to determine the frequency of sick euthyroid syndrome (SES) among patients diagnosed as non-small cell lung cancer (NSCLC) and its association with the stage of the disease, Karnofsky index (KI), and nutritional parameters. We enrolled 80 consecutive patients with newly diagnosed NSCLC. Cases with NSCLC were staged by using TNM system. The cases were examined for thyroid function tests, KI and nutritional evaluation before treatment. Moreover, cases were investigated for their overall survival ratio at sixth, twelfth, and eighteenth months. Out of 80 patients, sick euthyroid syndrome (SES) were identified in 28 (35%). SES was more frequent among stage III (26%) and stage IV (62%) cases. The body mass index (BMI), KI and serum albumin level were detected to be significantly low in cases with SES when compared to cases without SES. SES was found to be negatively correlated with BMI, KI and serum albumin level, and it was positively correlated with disease stage. SES was frequently seen in cases with NSCLC. SES can be used as a predictor of poor prognosis.

Vascular endothelial growth factor and tumor necrosis factor genes polymorphisms in Turkish patients with sarcoidosis.

Polymorphism at -857 locus of tumor necrosis factor (TNF)-alpha gene is considered to be a predisposition factor in sarcoidosis and held responsible for pathogenesis of the disease and polymorphism at +813 locus of vascular endothelial growth factor (VEGF) gene is thought to decrease predisposition to sarcoidosis. In our study, we examined and compared these polymorphisms in healthy Turkish control subjects and Turkish patients with sarcoidosis. We examined gene polymorphisms in 70 cases which were histopathologically diagnosed as sarcoidosis and 80 healthy subjects without any history of a chronic disease. 5 cc of blood were collected in tubes with EDTA from all of the cases. TNF-alpha-857 gene polymorphism and VEGF+813 gene polymorphism were determined using PCR + RFLP method after DNA isolation. TNF-alpha promoter polymorphism, at position -857, revealed no differences in genotype and allele frequency between patients and control subjects but more relapses were found in sarcoidosis patients who have this polymorphism. Considering the VEGF polymorphism at position +813, we observed a significant increase in the frequency of rarer T allele at this position in healthy subjects compared with sarcoidosis patients. VEGF gene polymorphism at +813 locus may diminish susceptibility to sarcoidosis. TNF-alpha-857 gene polymorphism influence severity of the disease.

YKL-40, Soluble IL-2 Receptor, Angiotensin Converting Enzyme and C-Reactive Protein: Comparison of Markers of Sarcoidosis Activity.

The aims of this study were to describe the clinical, radiological and immunological features of a population of sarcoidosis patients and to analyse chitinase-3-like protein 1 (YKL-40), soluble interleukin-2 receptor (sIL-2R), neopterin concentrations and adenosine deaminase (ADA) activity in serum of these patients in order to understand their potential as disease markers. Fifty-nine patients affected by chronic sarcoidosis, in active (20 patients) and inactive (39 patients) phase according to the clinical, radiological and laboratory criteria were studied. Serum YKL-40, sIL-2R, high-sensitive C-reactive protein (hs-CRP), neopterin levels and ADA activities were evaluated and compared with those of 25 healthy controls. Individuals with chronic sarcoidosis were significantly higher serum YKL-40, sIL-2R, neopterin, hs-CRP concentrations, angiotensin converting enzyme (ACE) and ADA activity than those of control subjects. Sarcoidosis patients in the active phase of the disease were significantly higher YKL-40, sIL-2R, hs-CRP levels and ACE activity than those in the inactive phase, while ADA activities and neopterin levels did not display any significant difference between the active and inactive disease groups. In comparison to the other parameters, as panel measurement of the serum YKL-40, sIL-2R, ACE and hs-CRP indicate a greater discrimination between active and inactive disease. The results indicate that serum YKL-40, sIL-2R, ACE and hs-CRP concentrations may be useful marker for monitoring sarcoidosis disease activity.

The role of GSTM1 gene polymorphisms in lung cancer development in Turkish population.

BACKGROUND: Glutathione S-transferase (GSTs) plays an important role in the detoxification of many xenobiotics involved in the etiology of cancer. In different ethnic groups, variations in null allele frequency have been observed. We have investigated GSTM1 gene polymorphisms in healthy subjects and lung cancer patients in the Turkish population and reviewed the control subjects of the studies performed in the Turkish population. METHODS: Following blood sampling from patients and controls, DNA samples were extracted from the whole blood and were amplified by using polymerase chain reaction (PCR) method in all of the 256 cases, consisting of 102 previously diagnosed with lung cancer and 154 healthy controls. RESULTS: The prevalence of GSTM1-null genotype in the lung cancer patients was 49%, compared to 52.6% in the control group (OR = 1.39, 95% CI = 0.70-1.90, p = 0.57). There were also no significant relationships in GSTM1 genotypes among histopathologic types of lung cancers (p > 0.05). The frequency of GSTM1 was found to be 41.2% (n = 1809) when the control subjects of the studies performed in Turkish population were reviewed. CONCLUSION: We have observed that GSTM1 genotype is not an independent risk factor for lung cancer.

Red Blood Cell Distribution Width in Patients With Chronic Obstructive Pulmonary Disease and Healthy Subjects. / Amplitud de distribución eritrocitaria en pacientes con enfermedad pulmonar obstructiva crónica y en sujetos sanos.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) increases the risk of cardiovascular disease (CVD). Red blood cell distribution width (RDW) is accepted as a powerful predictor of outcomes in patients with CVD. AIMS: To study RDW in patients with COPD, and to compare the value of this measurement with clinical, echocardiographic, nutritional and laboratory status. Secondly, we aimed to determine the effect of smoking on RDW values in healthy subjects. METHODS: One hundred and seventy-five patients with stable COPD and 210 healthy controls were enrolled in the study. Demographic, clinical, nutritional status, echocardiographic, and laboratory characteristics, RDW values were recorded and compared. RESULTS: RDW values were higher in the COPD group than in controls (15±2.3% vs. 13.8±2.5%, p<0.001). In COPD patients, RDW levels positively correlated with CRP levels (r=0.27, P<.001), albumin levels (r=0.23, P=.04), right ventricular dysfunction (RVD) (r=0.24, P=.001), pulmonary hypertension (PAH) (r=0.1, P=.02), and presence of CVD (r=0.24, P=.02). In multivariable logistic regression suggested that presence of CVD (4.3; 95% CI: 1.3 to 11; P=.01), and presence of RVD (3.1; 95% CI: 1.7 to 8.3; P=.02) were independently related to elevated RDW levels in COPD patients. In the healthy population, correlations analysis showed only a significant correlation between RDW and cigarette smoking years (r=0.57, P<.001). CONCLUSION: RDW is independently associated with CVD and RVD in patients with COPD. In the healthy population, RDW is also associated with smoking status.

Predictive value of the tuberculin skin test and QuantiFERON-tuberculosis Gold In-Tube test for development of active tuberculosis in hemodialysis patients.

BACKGROUND: Hemodialysis (HD) patients are at increased risk of reactivation of latent tuberculosis infection (LTBI) compared with the general population. QuantiFERON-TB Gold (QFT-G) for LTBI detection is more promising than tuberculin skin test (TST) in HD patients. AIM: In our study, we evaluated the value of the TST and QFT-G In-Tube (QFG-IT) test in the development of active tuberculosis (TB), in the HD patients, and in healthy controls. METHODS: The study enrolled 95 HD patients and ninety age-matched, healthy controls. The TST and QFG-IT were performed. All the subjects were followed up 5 years for active TB disease. RESULTS: Compared to the healthy controls, a high prevalence of LTBI was found in the HD patients by QFG-IT (41% vs. 25%). However, no significant difference was detected by TST (32% vs. 31%). Four HD patients and one healthy control progressed to active TB disease within the 5-year follow-up. For active TB discovered subjects, QFG-IT was positive in all, but TST was positive in two (one patient and one healthy control). In HD patients; sensitivity, specificity, positive and negative predictive values of QFG-IT, and TST for active TB was 100% and 25%, 62% and 67%, 10%, and 3%, and 100% and 95%, respectively. Receiver operating curve analysis revealed that the results are significantly different (P = 0.04). CONCLUSION: QFG-IT test is a more useful diagnostic method than TST for detecting those who will progress to active TB in HD patients.

Are soluble IL-2 receptor and IL-12p40 levels useful markers for diagnosis of tuberculous pleurisy?

BACKGROUND: The differential diagnostic utilities of the levels of soluble interleukin (IL)-12p40 and the IL-2 receptor in sera and pleural effusions were evaluated in patients with exudative pleural effusions. METHODS: We enrolled a total of 120 patients with exudative pleural effusions. The clinical, radiological, and histopathological diagnoses were tuberculous pleurisy in 52, malignant pleurisy in 39, and parapneumonic effusions in 29 patients. RESULTS: We measured serum IL-12p40 and adenosine deaminase (ADA) levels in patients with tuberculous pleurisy and in a control group treated for pleural effusion to determine if such levels were useful in the diagnosis of pleural effusion (p < 0.005). Definite microbiological or histopathological diagnoses of tuberculous pleurisy or pleural effusion were recorded, and we found that ADA and serum soluble IL-2 receptor levels aided in diagnosis (p < 0.001). The levels of ADA and soluble IL-2 in pleural effusions afforded sensitivities and specificities of 84.62% and 82.69% and of 70.59% and 80.88%, respectively. The soluble IL-2 receptor level afforded a sensitivity and specificity of 82.69% and 52.9%. IL-12p40 levels in pleural effusions and sera afforded sensitivities and specificities of 80.77% and 80.77% and of 60.29% and 39.71%, respectively. CONCLUSION: Soluble IL-2 receptor levels in patients with tuberculous pleurisy serve as markers of disease in non-endemic countries, similarly to ADA levels.

Diagnosing latent tuberculosis in immunocompromised patients measuring blood IP-10 production capacity: an analysis of chronic renal failure patients.

OBJECTIVE: Patients undergoing haemodialysis for chronic renal failure-hemodialysis (CRF-HD) are at risk of latent tuberculosis infection (LTBI). The effectiveness of using blood IP-10 production capacity to diagnose LTBI in CRF-HD patients was analysed. METHODS: The study enrolled 50 CRF-HD patients. Interferon-γ release assay (IGRA) was done using QuantiFERON-TB Gold In Tube (QFG-IT) system. Blood IP-10 production capacity was measured using the QFG-IT system tubes. Tuberculin skin testing (TST) was performed on the same day and the test results were compared. RESULTS: TST turned out to be positive in 36.4% of the patients and QFG-IT in 54% of them. After stimulation with specific tuberculosis antigens, blood IP-10 levels increased noticeably. The antigen-stimulated blood IP-10 level was significantly higher in patients who were either TST or QFG-IT positive than in patients whose tests were negative (p=0.0001). Using 4.02 pg/mL as the threshold for stimulated blood log-transformed IP-10 level, good agreement was observed between IP-10 and QFG-IT results (κ=1). CONCLUSION: Blood IP-10 level, which can be measured simply, provides results equivalent to IGRAs for the diagnosis of LTBI in CRF-HD patients.

Primary pulmonary synovial sarcoma: a very rare presentation.

Synovial sarcoma (SS) is a rare tumor originating from mesenchymal tissue and accounting for approximately 5-10% of all soft tissue sarcomas. A rare case of primary pulmonary SS in an asymptomatic 18-year-old man admitted to our hospital for investigation of a 6 × 6.5 cm, oval-shaped, well-delineated pleural based peripheral mass in the left lower lobe in his thorax CT is presented. Left lower lobectomy was done. Immunohistochemically, tumor cells were positive for cytokeratin, epithelial membrane antigen (EMA), and vimentin so that the histopathological diagnosis was compatible with biphasic spindle cell type SS in the lung.