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OBJECTIVES: In the last 20 years, with the use of computed tomography (CT) angiography, the number of patients diagnosed with pulmonary thromboembolism (PTE) has increased. At the same time, data show that pulmonary embolism mortality has also reduced in this duration. MATERIAL AND METHODS: In this study, we analyzed records of patients with PTE (using ICD's) in the hospital automation system from 2001 to 2013. Data regarding age, sex, date of diagnosis, diagnosis of cancer, hemodynamic status, initial and maintenance treatment, hospital length of stay, and hospital mortality were recorded. Primary endpoints of the study were hospital length of stay and all-cause hospital mortality. RESULTS: The total number of patients included in the study was 1185. The median age was 61 years in 2001 and 71 years in 2013. The number of patients who were diagnosed using CT increased from 10% to 92.8%. Between 2001 and 2013, the number of patients diagnosed with PTE increased, and of all patients with PTE, 13.7% was diagnosed in 2009. The hospital length of stay of 13 days declined to 9 days. The use of a vena cava filter in 2007 was 1.1% and that in 2013 was 4.6%. Mortality rate was 15%, however hospital mortality did not significantly differ over the years but varied between 9.4% and 18.8%. Increased use of thrombolytics in patients with massive PTE has been observed over the years. Massive PTE ratio in 2006 was 8.5% and thrombolytic use was 5.8%, however in 2013, these ratios were 2.6%, 6% respectively (p=0.017). CONCLUSION: Finally, despite the increased number of patients diagnosed with PTE over the years, the mortality rate was not observed to have changed from 2001 to 2013. [ABSTRACT FROM AUTHOR]

Objective: We aimed to demonstrate the approaches of physicians with a questionnaire toward the patients with pulmonary thromboembolism (PTE) in our country. Methods: An invitation letter including a questionnaire with 28 questions to assess the approaches they prefer in the patients with PTE and the capabilities of the departments they work at and a link for the questionnaire was directed to the mail groups of chest diseases specialists. Responses of the physicians who participated in the questionnaire were reviewed. Results: The examinations used to diagnose PTE such as D-dimer, troponin, echocardiographic Doppler ultrasonography and multidetector computed tomography (CT) have been performed in 94% of the institutions, ventilation/perfusion scintigraphy, MRI and pulmonary angiography examinations were performed in 50% of the instututions. While D-dimer test was performed in 73.2% of the institutions by quantitative ELISA; in 15.7% of them it was semiquantitative and in 11.6% of the instutitions it was performed by latex agglutination. 81% of physicians were seen to be using clinical probability scoring systems and most commonly used scoring method was seen to be Wells scoring with a rate of 90%. According to the simplified PESI score, 61.5% of the physicians reported to prefer outpatient treatment. In non-massive and submassive pulmonary thromboemboli patients, 86.2% of the physicians reported to prefer thr low molecular weight heparin (LMWH) treatment; vitamin K antagonist in maintenance treatment was also the most commonly resorted drug with a percentage of 84.9. Conclusion: The absence of the examinations used in the diagnosis and treatment of PTE in most institutions and difficulty to reach the available examinations at all hours of the day were significant facts. Especially; lack of access to high-sensitivity D-dimer test, bedside echocardiography used to assess right ventricular dysfunction, troponin and NT-proBNP makes us think about low adaptation to guidelines. [ABSTRACT FROM AUTHOR]

Aim: The myocardial performance index (Tei index), plasma N-terminal pro B-type natriuretic peptide (NT-proBNP), and ischemia-modified albumin (IMA) were used to investigate the effect of obstructive sleep apnea syndrome (OSAS) on right ventricular function. Materials and methods: Twenty-three patients diagnosed with OSAS (moderate or severe AHI > 15) by polysomnography at Karadeniz Technical University Medical Faculty Chest Disease Clinic between September 2009 and September 2010 were included. The Tei index, Nt-proBNP, and IMA were measured in all patients before CPAP treatment and 3 months after the diagnosis. Results: Patients with OSAS had statistically significantly higher right ventricular Tei indices than the control group (P < 0.05). There was no significant difference between the groups in terms of NT-proBNP or IMA values. The systolic blood pressure of the patient group was significantly lower (P < 0.05) after CPAP treatment, but there was no difference in the Tei index, NT-proBNP, or IMA values. Conclusion: We conclude that plasma NT-proBNP and IMA levels are not effective as the Tei index for showing myocardial damage in patients with OSAS, and that these parameters are inadequate to show the effect of CPAP treatment on right ventricular myocardial function. [ABSTRACT FROM AUTHOR]

Objective: The role of increased troponin level in risk stratification of acute pulmonary embolism (PE) is well documented. However, relation between right ventricular (RV) myocardial performance (Tei) index and cardiac troponin-T (cTn-T) has not been well investigated. The purpose of this observational prospective study was to assess the relationship between the RV Tei index and cTn-T in patients with acute normotensive PE. Methods: Thirty-eight patients with acute PE diagnosed by computed spiral tomography pulmonary angiography were enrolled to this prospective observational study. All study population underwent a comprehensive echocardiographic study including tissue Doppler imaging within first 12 hours of admission. cTn-T levels were measured on admission. Follow-up echocardiography was performed routinely at the 7th day of hospitalization. Echocardiographic evaluation was repeated at 90 days in patients with insufficient improvement of RV Tei index. The difference between the baseline and follow-up data was analyzed using the paired sample t-test or Wilcoxon test according to normality of distribution. Results: The mean of the RV Tei index was 0.46 ± 0.14 and the mean systolic pulmonary artery pressure (sPAP) was 40 ± 20 mmHg. Increased cTn-T level was detected in 37% of the patients (normal value 0.01< ng/mL). Significant correlations were observed between RV Tei index and sPAP with cTn-T levels (r=0.467 and r=0.468, p<0.001, respectively). In logistic regression analysis, RV Tei index was associated with positive cTn-T values (OR-136, 95% CI: 1.3-14657, p=0.039). After the anticoagulant treatment, RV Tei index and sPAP were significantly improved. Conclusion: RV Tei index is frequently impaired in patients with acute PE and a significant recovery is seen after the treatment. Therefore, RV Tei index may be used both the diagnosis of RV dysfunction and the assessment of treatment effectiveness. RV Tei index is may predict myocardial injury in PE. [ABSTRACT FROM AUTHOR]

Aim: Stenotrophomonas maltophilia is a nosocomial pathogen of increasing importance. Empiric antibiotic therapy for S. maltophilia infection is difficult because the microorganism is resistant to a number of agents typically used for health care associated infections, thus potentially increasing mortality. This study investigates 23 nosocomial pneumonia cases caused by S. maltophilia, the antibacterial sensitivity of the bacterium and the effect on mortality of suitable empiric therapy. Materials and methods: Twenty-three patients with nosocomial pneumonia caused by S. maltophilia between January 2000 and December 2006 at the Karadeniz Technical University Hospital were retrospectively investigated. Results: Suitable empiric therapy was used with 12 patients (52.2%), but the therapies administered to the other 11 patients were inappropriate for S. maltophilia infection. Eight (72.7%) of the patients who were not given suitable empiric antibiotherapy died (P = 0.002). Conclusion: The appropriate empiric antibiotic was administered to only 12 of the patients. The mortality rate among those patients to whom appropriate empiric antibiotics were not administered was high, proving that suitable empiric therapy is vitally important. Due to the increase in mortality, it is essential to initiate appropriate empiric therapy by carefully evaluating the risk factors for S. maltophilia in nosocomial pneumonia and taking sputum and bronchoalveolar lavage specimens without delay. [ABSTRACT FROM AUTHOR]

Hennekam syndrome was defined as a syndrome characterized by a new autosomal recessive, severe lymphedema in legs, face and genitalia with intestinal lymphangiectasia, various face anomalies and severe mental retardation. A 21 years old male patient was examined due to bilateral pleural effusion. There were edema in both legs and eyelids, swelling in the scrotum and operation scar, broad forehead and face, depressed nasal bridge, epicanthal folds and micrognathia in the physical examination. Chylothorax was diagnosed due to level of pleural triglyceride (650 mg/dL). Lymphatic flow delayed in both lower extremities in lymphoscintigraphy. The patient was diagnosed as Hennekam syndrome due to face anomalies, lymphedema, epilepsy, chylothorax and mild mental retardation. [ABSTRACT FROM AUTHOR]

Objective: To present a case of endobronchial metastasis from a seminoma mimicking a primary pulmonary mass on X-ray radiograph. Clinical Presentation and Intervention: A 27-year-old man presented with a 1-month history of hemoptysis. Thorax computerized tomography of the patient obtained at the level of the main right bronchi demonstrated a mass with a size of 7 × 6 cm and a peripheral lobulated nodule. Bronchoscopic examination showed narrowing and multiple nodules in the right upper and right intermediary lobar bronchi. Histopathological examination of bronchial biopsies and brushing confirmed endobronchial metastasis of the testicular seminoma. Conclusion: This case shows the prognostic significance of distinguishing endobronchial metastasis from primary lung carcinoma. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Introduction: Pulmonary embolism (PTE) is a common cardiovascular emergency. We aimed to predict mortality in the acute phase and to assess the development of pulmonary hypertension in the chronic period with the combined use of red cell distribution width (RDW) and echocardiography (ECHO) for the prognosis of PTE., Material and Methods: Cases diagnosed with acute PTE were prospectively monitored in our clinic. The initial data of 56 patients were evaluated. The subjects were separated into two groups basing on RDW; group 1 had RDW ≥ 15.2%, while group 2 had RDW < 15.2%., Results: Ninety-eight patients were enrolled in the study. We established the sensitivity (73.3%) and the specificity (73.2%) of RDW to determine mortality in the cases with PTE. RDW ≥ 15.2% value was significant as an independent risk factor for predicting mortality (OR:7.9 95% CI, 1.5-40.9 p = 0.013) in acute PTE. The mean tricuspid annular plane systolic excursion (TAPSE) value was significantly different between the group-1 (RDW ≥ 15.2%, 2.20 cm (± 0.43)) and group-2 (RDW < 15.2%, 1.85 cm (± 0.53))(p = 0.007). The threshold value for tricuspid jet velocity was > 2.35m/s, the sensitivity and specificity were 76.9% and 61.9%, respectively for predicting mortality (AUC: 0.724, 95% CI: 0.591-0.858, p = 0.033)., Conclusion: Our results indicate that high RDW levels are an independent predictor of mortality in acute PTE. Lower TAPSE levels show right heart failure in PTE patients; this may also be indicative of right ventricular systolic function. We believe that developing new scoring systems, including parameters such as RDW, TAPSE, and tricuspid jet velocities, may be effective in determining the prognosis of pulmonary embolism.