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Postintubation stenosis is the most frequent cause of benign tracheal stenosis and may cause reintubation and delay in weaning of intensive care unit patients. This case study describes typical patients with tracheal stenosis and the management of these patients. Five patients requiring reintubation and mechanical ventilation due to early intubation-related stenosis are discussed. Stridor developed in three cases after extubation. In these cases, bronchoscopy revealed tracheal stenosis. Dilatation and silicone stent placement were performed using rigid bronchoscopy. The other two patients were on ventilators when they were admitted to the intensive care unit and their stenoses were also treated by rigid bronchoscopy. Hypercapnia and hypoxia resolved after intervention in three cases. Of the remaining two patients, one had the tracheostomy closed and in the other patient ventilation was stopped but the tracheostomy was maintained. Tracheal stenosis developing in the subglottic region after extubation, especially after exposure to cuff pressure, may lead to reintubation. A tracheostomy may hinder the diagnosis of progressive stenosis and may lead to unnecessary maintenance of ventilator treatment. Early intubation-related tracheal stenosis should therefore be considered in cases of weaning or extubation failure and prompt appropriate investigation and treatment. [ABSTRACT FROM AUTHOR]

The article describes several cases of early tracheal stenosis that caused extubation failure and prolonged dependency on ventilators. The patients in each case required reintubation and mechanical ventilation because of early-intubation related stenosis. Three of the patients developed stridor following extubation and were found to have tracheal stenosis through bronchoscopy. It was found that a tracheostomy can be a factor in failing to diagnose progressive stenosis.

OBJECTIVE: To evaluate the usefulness of heart rate variability analysis (HRV) analysis from the long duration electrocardiogram (ECG) recordings as a screening test for the diagnosis of moderate-to-severe obstructive sleep apnea syndrome (OSAS). METHODS: Recordings from 87 patients who were admitted to sleep laboratory for polysomnographic study (PSG) were evaluated. Finally 30 cases with apnea-hypopnea index (AHI)>=15/hour included in patient's group (male/female: 22/8; mean age: 49±10 years) and 21 cases with AHI<5 were included in control group (male/female: 10/11; mean age: 48±11 years). From the ECG recordings taken as a part of PSG, time -domain and frequency -domain HRV parameters were evaluated and their accuracy in the diagnosis of OSAS was investigated using ROC analysis. RESULTS: Statistically significant differences were found in HRV variables in time- domain parameters such as SDNN, SDNN index; frequency-domain parameters VLF, LF, nuLF, nuHF, LF/HF and geometric parameter HRV triangular index values in between groups. Cut- off value of 16 for the HRV triangular index was found to be 50% sensitive and 85.7% specific with a positive likelihood ratio (LR) of 3.50% and negative LR of 0.58% When the total power was higher than 9.611, then the analysis sensitivity was 53.3%, specificity was 95.6%, positive LR was 11.2% and negative LR was 0.49% When the SDNN was higher than 83 then its sensitivity was 80%, specificity was 76.2%, positive LR was 3.36% and negative LR was 0.26% For the cut off value of 62 calculated for SDNN index, sensitivity was 73.3%, specificity was 85.7%, positive LR was 5.13% and negative LR was 0.31%, for the cut off value of 9.12 was calculated for VLF, sensitivity was 90.4% specificity was 50% positive LR was 1.81% and negative LR was 0.19%. CONCLUSION: Heart rate variability analysis done over routine single channel ECG data gathered through routine Holter applications may be helpful in distinguishing moderate-to-severe OSAS patients from mild OSAS patients and non-OSAS control subjects. [ABSTRACT FROM AUTHOR]

Aim Laser therapy is a well-known technique which has been safely used for almost thirty years to treat endobronchial obstruction. Nd : YAG and Nd : YAP lasers are commonly used lasers, whose safety and efficacy have been investigated in several large series. Diode laser is a new laser system which has been mainly used in urology, endovascular surgery, ENT, and dermatology. In recent years it has been effectively used in endobronchial treatments.Material and Method In this study, 61 patients who underwent endobronchial treatment with a diode laser in the Interventional Pneumology Unit of our hospital were retrospectively evaluated. Fifty-one patients were male. Mean age was 54.72 ± 13.81 years, and a total of 90 laser applications were given. In 39 cases, palliation of a malign obstruction was achieved while cure was achieved in 19 cases with benign obstruction. No major complication other than minor hemorrhage in 4 cases and temporary hypoxia in 2 cases was observed.Conclusion Diode laser can be used as an effective and safe modality for endobronchial treatment. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to evaluate the relation between the level of depression and anxiety and peripheral blood T lymphocyte subpopulation in patients with active pulmonary tuberculosis. Material and Method: Thirty-two consecutive patients newly diagnosed with active pulmonary tuberculosis were enrolled. Depression and anxiety were evaluated with Hamilton Scale and T lymphocytes with flow cytometry method. Results: All the cases were male and the mean age was 30.66 (±11.58) years. The diagnosis was based on bacteriological analysis. Mean cell counts were (in mm3) leukocyte 9175 (±2252), lymphocyte 1764.56 (±790), CD3% 64.30 (±9.88) CD19% 7.79 (±3.45), CD4% 36.82 (±10.93), CD8% 26.64 (±10.00), CD16/56% 16.46 (±8.64), active T 6.19% (±3.14) and CD45% 93.75 (±4.11). Mean depression score was 1.91 (±2.66) and anxiety score was 1.47(±1.95). There was an inversely proportional, moderately significant statistical relationship between radiological dissemination of the disease and CD16/56 and active T cells. A moderately significant statistical decrease in CD16/56 level was observed with the higher depression score. Conclusion: The relationship between depression and CD16/56 might indicate that the nervous system has probably a part in the signal pathway between APCs and NK T lymphocytes. Considering the importance of the NK cells in the battle with the bacilli, we can presume that the inverse relation of the depression scores with CD16/56 lymphocytes levels increases the predisposition to the disease. [ABSTRACT FROM AUTHOR]