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OBJECTIVE: To determine the effects of tobacco use on the lungs before respiratory symptoms or basic functional disorders occur. MATERIAL AND METHODS: Forty-six active smokers between June 2018 and June 2019 who did not have any respiratory complaints, had no lung or chronic disease affecting the respiratory system, and consumed at least 20 packs/year were prospectively evaluated. In addition, a control group consisting of 50 non-smokers was formed. After confirming that spirometry and chest radiographs were normal, volunteers were taken to measure carboxymetry, plethysmography, respiratory muscle strength, and diffusion capacity, respectively. The changes in the lungs caused by smoking were analyzed with the data obtained from the measurements. RESULTS: Carbon monoxide values measured by carboxymetry were higher in smokers than non-smokers. Plethysmography tests showed that TLC, TLC%, FRC, FRC%, and RV values were statistically higher in smokers. No significant difference was found between FVC%, FEV1%, PEF, PEF%, MEF75, MEF75%, MEF50, MEF50%, MEF25, MEF25%, sRaw (eff), sRaw (eff%), Raw (eff), Raw (eff%), Raw (tot), Raw (tot%), IC, IC%, ERV, ERV%, RV% values and FEV1/FVC, FEV3/FVC, IC/TLC, and RV/TLC ratios. MIP, MIP%, MEP, MEP% values which measured respiratory muscle strength were similar in smokers and non-smokers. DLCO%, DLCO/VA, DLCO/VA%, DLCOc%, DLCOc/VA, and DLCOc/VA% were found to be lower in the smoker subjects. DLCO and DLCOc values were similar in both groups. CONCLUSION: Smoking causes the accumulation of toxic gas in the lungs, contributes to the development of hyperinflation and disrupts gas exchange. In our study, there was no evidence that airway resistance developed or respiratory muscles were affected.

Aim: To investigate the relationship between thrombus localization and the development of chronic thromboembolic pulmonary hypertension (CTEPH) in patients with acute pulmonary thromboembolism (PTE) and to determine the risk factors on the development of CTEPH and chronic thromboembolic disease (CTED). Methods: 91 patients who were diagnosed PTE with Computed Thorax Pulmonary Angiography (BTPA) between 2014-2018 and completed at least 3 months of anticoagulant treatment were evaluated. Medical histories, comorbidities, risk factors, symptoms, findings, thrombus localization, medical treatments, venous doppler and echocardiographic examinations, post-treatment symptoms and signs, Troponin-I, NT-proBNP, D-dimer and CRP values were recorded. These data were analyzed for development of CTEPH/CTED and survival. Results: Fifty six (61.5%) of the patients were female. 7 of 91 patients were diagnosed with CTEPH. Right/left ventricular diameter ratio>0.9, 3rd degree tricuspid insufficiency and pulmonary artery pressure (PAP)>36 mmHg has been statistically associated with development of CTEPH within the parameters evaluated at the time of diagnosis(p=0.011,p=0.007,p=0.0001). The thrombus localization in CTPA did not have any effect on survival and development of CTED. Tricuspid insufficiency, NT-proBNP elevation, abnormal findings on chest x-ray after treatment were found statistically significant development of CTED (p=0.009, p Conclusions: Patients with acute PTE should be closely monitored for development of CTEPH and CTED within the follow-up period after initial treatment.

The aim of this study is to evaluate of microbiological and inflammatory characteristics of exacerbations in COPD patients with previously undiagnosed radiographic bronchiectasis and the impact of bronchiectasis on exacerbation course. We enrolled 160 patients with COPD exacerbation. High-resolution computed tomography (HRCT) of chest was performed, and the presence of bronchiectasis was evaluated. The patients were classified into two groups: COPD with bronchiectasis and COPD without bronchiectasis. Serum CRP, procalsitonin and IL-8 concentration were measured. Sputum microbiological anaysis were performed. Microbiological and inflammatory characteristics of both groups were compared. The mean age of the patients was 66.57 ± 8.6 years. Bronchiectasis was diagnosed in 43 (26.8%) patients by HRCT. Sputum and purulent sputum symptoms were common in exacerbations of COPD with bronchiectasis group to without bronchiectasis group (p=0.001). Compared with those without bronchiectasis, COPD patients with bronchiectasis had a higher proportion of sputum culture positivity (55.8% vs 24.7%, p In conclusion, COPD exacerbations in patents with comorbid bronchiectasis is associated with more bacteriological load, an increase in both local and systemic inflammation and worse exacerbation course.

The aim of this study is to investigate whether COPD exacerbations of infectious origin are different clinically and prognostically from non-infectious origin or not. We recruited 160 COPD patients between October 2015-June 2016. Patients were divided into 3 groups (group-1:patiens with pneumatic infiltration, group-2: patients don’t have pneumatic infiltration, group-3:noninfective COPD exacerbations). Obtained from the patients clinical, microbiological, radiological and functional parameters were compared. In addition, patients were prospectively monitored discharge after 3 month post discharge mortality, hospital mortality, hospitalization. The mean age:66.57±8.6 years. Sputum and purulent sputum symptoms were common in infectious exacerbations of COPD group to non-infectious exacerbation of COPD group (p=0.001).Sputum culture positivity, accompanied by pneumonia and infectious exacerbations of COPD in the group, a higher proportion of non-infectious exacerbation of COPD was seen by the group. Charlson comorbidity index, was significantly higher in the group 1 than the group 2(p=0.039).Total of 35% patients had recurrent exacerbations in 3-month follow-up period, after exacerbations treatment. However, there was no significant difference between the groups in terms of recurrence rate of patients with exacerbations. Both the mortality rate during hospitalization, as well as a total of 3 months accompanied by pneumonia and mortality rate was significantly higher than the non-infectious exacerbation of COPD group in both infectious exacerbation of COPD group. Our study showed that the patients clinical and prognostic show a different pattern according to the etiology of exacerbations of COPD

F Fluorodeoxyglucose FDG PET CT have found wide application area especially in oncological patients In the present case diagnosis of sarcoidosis with skin nodules detected on FDG PET ndash CT for investigation of malignancy in an adult patient with a known diagnosis of psoriasis was presented Rare sarcoidosis with skin nodules together with psoriasis case FDG PET CT findings was demonstrated for the first time in the literature nbsp

Primary lung lymphoma is one of the rarest forms of lymphoma and pulmonary space-occupying lesions. This case report represents the F-18 fluorodeoxyglucose positron emission tomography/computed tomography images of the most severe form of the primary pulmonary lymphoma reported in the literature.

Objective: Although protein-calorie malnutrition and associated weight loss have been demonstrated in chronic obstructive pulmonary disease (COPD), the reasons for weight loss, as well as the relation of weight loss with hormonal and inflammatory markers is not clear. Therefore, the present study aimed to investigate the reasons for weight loss in COPD patients and the relation of weight loss with hormonal/inflammatory markers and hyperinflation. Methods: The present study included 60 patients with stable COPD who were admitted to the Chest Diseases Outpatient Clinic and 20 healthy controls. The patients were divided into three groups according to their body mass index (BMI); Group 1: BMI 25 kg/m2. The patients underwent pulmonary function testing and arterial blood gas analysis. Serum adiponectin, ghrelin, leptin, tumour necrosis factor (TNF) alpha, C-reactive protein (CRP), prealbumin and transferrin levels were measured. The results were evaluated by appropriate statistical methods. Results: Considering the patient groups together, leptin and ghrelin levels were found to be statistically significantly lower in the patient group (p=0.001 and p=0.003). Serum leptin level was found to be lower in Group 1 with a BMI 25 (p=0.031). No statistically significant difference was determined between the patients with and without hyperinflation in terms of serum ghrelin, leptin, adiponectin, TNF-α, prealbumin and transferrin levels. Conclusion: Decreased serum ghrelin and leptin levels were associated with weight loss. However, no relation could be identified between hyperinflation and hormonal markers. It was thought that further studies are needed in order to reach a definite conclusion.

Background: Recent studies investigated how health is affected by socio-economic status (SES) in COPD showed that low SES is a risk factor for adverse COPD health outcomes. Accordingly, we conducted this study with a hypothesis of “SES Shaping GOLD A-D Classification in Patients with COPD”. Methods: This is a cross-sectional study including 167 COPD patients. Patients were classified according to the GOLD 2014 Document. Comprehensive socio-demographic and clinical data were collected through the use of a predefined questionnaire. Education, household monthly income, marital status, insurance coverage and place of residence were used as the socio-economic status indicators. Results: Patients had a mean age of 63.1±8.3, FEV1% of 47.2±19, CAT score of 17.6±7.5. 16 (9.6%) of patients were classified as GOLD A, 44 (26.3 %) as GOLD B, 19 (11.4%) as GOLD C, and 88 (52.7%) as GOLD D groups. Significant differences among GOLD A-D groups, in terms of SES, were detected. The rate of patients with lower SES were significantly higher in the patients who have risk of exacerbation (GOLD C and D) compared without exacerbation risk (GOLD A and B) (χ2=9, p=0.029). The number of patients with frequent exacerbation was significantly higher in patients from rural areas and household monthly income. Household monthly income is a strong predictor of risk of exacerbation (p=0.04). Conclusions: This study indicate that low SES is associated with the risk of exacerbation and that it was a important determinant in evaluating patients with COPD according to GOLD A-D classification. Besides clinical factors, SES should be considered as a key patient-level marker in the management of the disease.

Dynamic hyperinflation (DH) and exercise limitation develop in patients with COPD; however, there is lack of knowledge about their long-term clinical consequences. We aimed to assess the impact of DH and exercise capacity in predicting mortality and also morbidity, as evaluated by emergency visits and hospital admissions in COPD patients during a 4-year period.We recruited 73 stable COPD patients. The relationships of different respiratory parameters (FEV(1)%, body mass index, 6 min walk test distance [6MWD], static hyperinflation as measured by the ratio of inspiratory capacity to total lung capacity (IC/TLC) at rest, DH as measured by the change between the post- and pre-exercise values of IC/TLC [ΔIC/TLC], P(aO(2)), and P(aCO(2))) with emergency visits and hospital admissions because of exacerbations and also with respiratory and all-cause mortality were assessed.The median follow-up period was 47 months (IQR 45-48 months, n = 73). During the follow-up there were 8 (11%) deaths. The ΔIC/TLC value was 3.9 ± 4.6%. The Kaplan-Meier survival curve showed that the cumulative survival rate was significantly lower in the patients with ΔIC/TLC4 and with 6MWD ≤ 439.56 m, using these values as thresholds. (The rates for sensitivity were 100% and 87.5%, and for specificity were 56.92% and 87.69%, respectively). The Cox proportional hazards model showed that DH (hazard ratio = 1.4, 95% CI = 1.09-1.84, P = .009) and 6MWD (hazard ratio = 0.98, 95% CI = 0.97-0.99, P = .006) were independent predictors of all-cause and respiratory mortality. 6MWD, FEV(1)%, IC/TLC, and ΔIC/TLC were found to be significantly related to emergency visits (r = -0.28, r = -0.41, r = -0.24, and r = 0.38, respectively) and hospital admissions (r = -0.41, r = -0.45, r = -0.36, and r = 0.28, respectively).DH and exercise capacity are reliable and independent predictors for mortality and morbidity in COPD patients. We propose that DH and exercise capacity be considered in the assessment of long-term clinical consequences of COPD patients.

Complicated pulmonary hydatid cyst disease can mimic tuberculosis, lung cancer, empyema and abscess. The diagnosis of complicated pulmonary hydatid cysts may not be easy. Bronchoscopy is not a routine procedure in hydatid cyst disease. However, it is inevitable when clinical and radiological appearance is atypical. A pulmonary hydatid cyst disease case with atypical clinical and radiological findings diagnosed by fiberoptic bronchoscopy was presented in this case report.

Aim: Although it is known that a substantial portion of the patients hospitalized because of pulmonary embolism(PE) have comorbidities, the effects of this comorbid conditions on the short term health. We aimed that investigate the effects of comorbidity on short-term health outcomes and hospital costs in patients with acute PE. Method: 50 patients followed up with a PE between August 2013-August 2014 were evaluated prospectively. Comorbidities, length of hospital stay, hospital mortality, hospital costs and hospital readmission within 3 months after hospital discharge and mortality rates were evaluated. Short-term health problems and risk factors associated with hospital costs were investigated. Survival analysis was performed for mortality according to the groups. Results: Mean age was 59.02±16.96,Charlson score 1.62±2.1. Five(11.1%) and 4(21.9%) patients died during hospitalization and within 3 months of discharge respectively. Comorbidity was determined in all 9 dead patients. Mortality rate and hospitalization period was higher in patients with a Charlson score greater than 2 when compared with patients with a Charlson score between 0 and 1(p=0.022,p=0.027).Mortality rate was higher in patients with malignant disease than those don9t have(p=0.0001). Hospitalization cost of massive PE group was determined to be higher than other groups(p=0.008). Conclusions: Comorbidity in PE is closely associated with hospital stay period and mortality, along with the PE severity is effective on hospitalization cost. Therefore, the short-term prognosis with a detailed evaluation and treatment of comorbidities is thought to be better.

Prostate-specific antigen (PSA) is the most important biochemical marker in the diagnosis and follow-up of patients with prostate cancer. In recent years, a relationship between PSA levels and hypoxic conditions has been described. However, no study has investigated the PSA levels in patients with chronic obstructive pulmonary disease (COPD). The aim of the present study was to investigate the impact of hypoxemia on serum total (tPSA) and free PSA (fPSA) levels in patients with COPD. Between January 2010 and January 2014, 95 male patients who hospitalized for acute exacerbations of COPD and 80 control subjects were enrolled in the study. Serum tPSA and fPSA levels and f/tPSA ratios were determined in all patients on the first day of hospitalization (exacerbation) and 7 days after the treatment (stable state). Statistical analysis included paired t test and Mann-Whitney U test. No statistically significant differences were found between COPD and control groups with regard to the baseline characteristics, except for smoking status. The levels of serum tPSA and fPSA during exacerbation of COPD were significantly higher than the levels of the stable period (p0.01), whereas f/tPSA ratio did not change (p0.05). Hypoxemia during acute exacerbation of COPD can cause a rise in serum tPSA and fPSA levels, but f/tPSA ratio is not affected. Acute exacerbation of COPD may be added to list of the events in which PSA measurements must be interpreted with caution.

This cross-sectional clinical study was conducted in order to explore the relationship between atopic disorders and migraine. We evaluated 186 consecutive patients with migraine. Patients with a history of atopic disorders were compared with the others during headache-free intervals, for their headache characteristics, pulmonary test (PFT) performances and immunological screenings, through appropriate statistical methods. Of the patients with migraine, 77 (41.4%) reported at least one atopic disorder. PFT screening showed a general decreased pulmonary capacity and an important correlation between a positive history of atopic disorders and both increased eosinophil and IgE levels in headache-free periods. It should be discussed whether screening with PFT or immunological tests helps in early detection of progressive lung disease which might develop in these patients.

The frequency and characteristics of headache in patients with chronic obstructive pulmonary disease (COPD) are not clear and there are only a few studies that have assessed the relationship between chronic hypoxaemia and headache. We performed this study in order to evaluate the frequency and characteristics of headache in COPD patients. A total of 119 patients, with a mean age of 63.4 +/- 8.2 years, diagnosed with moderate or severe stable COPD were included in the study. Overall 31.9% of the patients complained of headache and 45.4% were reported to have sleep disorders. There were significant effects of family history of COPD, having other systemic disorders or sleep disorders (snoring, bruxism, restless leg syndrome, etc.) and laboratory data of chronic hypoxaemia and airway obstruction on headache co-morbidity. In conclusion, possibly being a specific subtype of elderly headache, headache in patients with moderate or severe COPD is a common problem and future studies are needed to obtain more knowledge about its pathophysiological and clinical basis.

Several clinical studies have demonstrated the effectiveness of omalizumab in patients with severe allergic asthma but the treatment period has always been relatively short (4-12 months). In the literature, there are a few data about the long-term omalizumab therapy. We aimed to assess the long-term clinical and functional effectiveness of omalizumab treatment in severe allergic asthmatic patients,Medical records describing the patients' status before the start of treatment, and also having been registered at the end of 4th, 12th, and 36th months from the commencement of treatment, and at the last visit where the patient was evaluated were used for omalizumab effectiveness assessments. Twenty-six patients (female/male: 21/5) with severe allergic asthma, uncontrolled despite GINA 2006 Step 4 therapy, were included in the study. Effectiveness outcomes included spirometry measurements, level of asthma control measured by asthma control test (ACT), systemic glucocorticosteroid (sGCS) use, emergency room (ER) visits, and hospitalizations for severe exacerbations. In addition, the quality of life was assessed using the quality of life questionnaire AQLQ(S) before, 4, and 36 months after treatment,The mean age was 47.6 ± 13.9 and duration of allergic asthma was 22.7 ± 10.1 years. Serum total IgE levels were 322.0 ± 178.1 IU/mL. Mean duration of omalizumab treatment was 40.81 ± 8.2 months. FEV1 improved significantly at all control points versus baseline (p.05). The level of asthma control as evaluated by ACT improved significantly after treatment (p.05). We determined significantly reduced numbers of exacerbation, emergency visits, hospitalizations, sGCS, and SABA use by the end of 36 months (p.05). The proportion of patients with improvements larger than 1.5 points in AQLQ(S) total score was 80.7% at the 4th month and 96.1% at the 36th month of treatment,This study showed that long-term therapy with omalizumab for up to 3 years was well tolerated with significant improvement both in symptoms and lung functions. Accordingly, long-term omalizumab treatment may be recommended for responders.

Ewing sarcoma is a bone tumour that commonly appears between ages five and 10 in the diaphysis of the long bones and predominantly presents with pain and swelling. The case of an 18-year-old girl who presented with back pain, cough, dyspnea, weakness and fever is described. Chest radiograph showed a homogenous density in the middle and inferior zones of the right hemithorax. Thoracic computed tomography revealed a diffuse pleural effusion and a 6.99 cmx4.45 cm solid mass composed of lobulated, small cystic lesions and calcifications in the right hemithorax. Biochemical analysis of pleural fluid showed hemorrhagic effusion and exudate. A pleural needle biopsy demonstrated solid uniform tumour cells with narrowed cytoplasm, round nuclei and uncertain nucleoli. All of the tumour cell cytoplasms stained with CD99. The pathological examination supported Ewing sarcoma. Three-phase Tc-99m methylene diphosphonate scintigraphy of the whole body showed pathological tracer uptake in a broad area of the eighth costal bone and in smaller areas of the ninth and 10th costal bones. This case is reported because Ewing sarcoma is a rare cause of pleural effusion in clinical practice among younger adults.

Objective.— We attempted to investigate the relationship between migraine without aura (MwoA) and bronchial hyper-reactivity to postulate inflammation as an underlying mechanism in migraine. Background.— Comorbidity of migraine and atopic diseases such as asthma has been an argument for suspected immune system dysfunction in migraineurs. Methods.— Twenty patients with MwoA and 5 control subjects without history of atophy and asthma were included in study. Subjects with abnormal physical examination and chest radiographs were excluded. After a normal spirometry, methacholine bronchoprovocation test was performed in all subjects and controls according to 5 breath dosimeter methods. Results.— Sixteen of 20 patients and 2 of 5 control subjects were women. Mean ages were 37.5 (19-56) and 33.8 (26-43) years, respectively. Methacholine bronchoprovocation test was positive in 3 patients (15%) but was normal in all controls (0%). Conclusions.— The relationship between MwoA and bronchial hyper-reactivity may help to postulate the inflammation in migraine as an underlying mechanism.

Background The purpose of this study is to evaluate the most important sociodemographic factors on smoking status of high school students using a broad randomised epidemiological survey. Methods Using in-class, self administered questionnaire about their sociodemographic variables and smoking behaviour, a representative sample of total 3304 students of preparatory, 9th, 10th, and 11th grades, from 22 randomly selected schools of Mersin, were evaluated and discriminative factors have been determined using appropriate statistics. In addition to binary logistic regression analysis, the study evaluated combined effects of these factors using classification and regression tree methodology, as a new statistical method. Results The data showed that 38% of the students reported lifetime smoking and 16.9% of them reported current smoking with a male predominancy and increasing prevalence by age. Second hand smoking was reported at a 74.3% frequency with father predominance (56.6%). The significantly important factors that affect current smoking in these age groups were increased by household size, late birth rank, certain school types, low academic performance, increased second hand smoking, and stress (especially reported as separation from a close friend or because of violence at home). Classification and regression tree methodology showed the importance of some neglected sociodemographic factors with a good classification capacity. Conclusions It was concluded that, as closely related with sociocultural factors, smoking was a common problem in this young population, generating important academic and social burden in youth life and with increasing data about this behaviour and using new statistical methods, effective coping strategies could be composed.

Summary Rationale To evaluate bacterial colonization and the airway inflammatory response, and its relationship to the frequency of exacerbation in patients with stable chronic obstructive pulmonary disease (COPD). Methods Quantitative bacteriologic cultures, neutrophil elastase, myeloperoxidase (MPO), tumor necrosis factor alpha (TNF- α ) and interleukin (IL)-8 were measured in bronchoalveoler lavage (BAL) in 39 patients with stable COPD [19 with frequent exacerbation (⩾3/year), and 20 with infrequent] and in 18 healthy controls (10 smokers and 8 non-smokers). Results BAL revealed the microorganisms with potential pathogenicity above the established threshold (⩾10 3 cfu/ml) in 68.4% of patients with frequent exacerbation, 55% of infrequent exacerbation, 40% of smokers and 12.5% of non-smokers controls ( P = 0.05 ). BAL MPO, IL-8 and TNF- α levels were found to be significantly higher in COPD as compared to controls ( P = 0.001 ). However, only IL-8 level was significantly higher in COPD patients with frequent exacerbation as compared to infrequent ( P = 0.001 ). Airway bacterial load correlated with levels of airway inflammation markers in COPD ( P 0.05 ). Conclusion The bacterial load and airway inflammation contributes to each other in stable COPD. However, there is a link only between interleukine (IL)-8 and frequent exacerbations. Clearly, the relationship between bacterial colonization, airway inflammation and frequent exacerbations is of major importance in understanding of the COPD pathogenesis.

Objective: The relationship between neuropathy and increased morbidity in patients with COPD is clear, but few studies have assessed cranial neuropathies, especially optic nerve involvement, in COPD patients. We evaluated peripheral involvement of the optic nerve and determined factors influencing this condition in patients with severe COPD. Methodology: Twenty-eight patients, mean age 59.4 ± 9.4 years, diagnosed with severe stable COPD according to the GOLD criteria, and 20 age- and gender-matched healthy individuals, mean age 55.6 ± 8.5 years, were included in the study. All subjects underwent visual evoked potential (VEP) assessment together with detailed clinical and laboratory examination to exclude concurrent risk factors for neuropathy. Results: VEP assessment showed significant abnormalities in COPD patients (82.1%) (commonly amplitude abnormalities) when compared with healthy controls. Conclusions: The optic nerve is often involved in patients with severe COPD, possibly as part of a polyneuropathy, and this is related to acidosis, hypercarbia and airway obstruction, independent of disease duration, smoking and age. These results should be taken into consideration when determining management strategies for these patients.

Cough headache (CH) is a relatively rare, but an important complication of cough. The aim of this cross-sectional clinical study was to evaluate the frequency, characteristics and etiology of CH among the patients referred to our Outpatient Department with the complaint of cough, and to investigate the relationship between their cough and headache characteristics. We evaluated 96 females and 69 males, a total of 165 patients with cough. Among those, 57 patients (34.5%) had one or more cough complications and 32 patients (19.3%) were diagnosed as CH. Although it was known that most of the patients with CH had benign headache characteristics, the ratio of the symptomatic CH was not low (37.5% of the CH patients and 7% of patients with cough). Also, there was a significant correlation between the frequency of cough and the severity of headache. Logistic regression analysis showed that the incidence of CH was increased 0.4-fold, when frequency of cough increased. Age, sex, tobacco use ad the duration of cough were not found to be predictive factors for CH. Logistic regression analysis showed that the rate of cough complications increased 2.08-fold, when the duration of cough was longer than eight weeks (p=0.03) and 0.4-fold when the frequency of cough increased (p=0.02). In conclusion, CH is a relatively rare, but an important complication of cough and it commonly has an effective treatment available. Radiological work-up was crucial in ruling out other causes of headache and to confirm that the CH was truly benign.

Pulmonary function is altered in ankylosing spondylitis (AS) owing mainly to the restriction of chest wall involvement (limited chest expansion). The objective of this study was to investigate the relationship between chest expansion, respiratory muscle strength (MIP, MEP) maximum voluntary ventilation (MVV), and BASFI score in patients with AS. Twenty-three male patients with definite AS and 21 age-matched healthy male controls were recruited for the study. Patients with AS were assessed for functional status by BASFI. Measurement of chest expansion and lumbar spinal flexion (modified Schober) method was performed in all subjects. Pulmonary function tests were performed by spirometry. Respiratory muscle strength was evaluated by a mouth-pressure meter (MPM). Body mass index (kg/m2) was recorded in all individuals. Chest expansion and modified Schober measurement were significantly lower in AS patients (p

Thyroid metastasis of lung cancer is rarely observed in clinical practice. The primary cancers which metastasize to the thyroid gland are mostly renal cell carcinoma, lung cancer, and breast cancer. Transient destructive thyrotoxicosis is caused by massive metastasis of extrathyroid tumors. We herein present a case report of a patient with small cell carcinoma of lung with metastasis to the thyroid and thyrotoxicosis due to toxic multinodular goiter. A 66-year-old man complained of swelling around the right side of the neck, dyspnea, progressive weight loss, and palpitation starting since 3 months before his admission. The patient was diagnosed with small cell carcinoma of lung with metastasis to the thyroid and thyrotoxicosis due to toxic multinodular goiter. The case report presented here illustrates the challenge of making a definitive and adequate diagnosis, particularly if the patient presents with 2 potential causes of thyrotoxicosis. Thyroid scintigraphy is an important tool for differential diagnosis of thyrotoxicosis.

Results The mean age was 53.5±9.5 and duration of asthma was 21.2±11.2 years. Serum total IgE level was 380.3±196 IU/mL. Mean duration of omalizumab treatment was 54.6±15 months. Loss of asthma control was documented in 10/16 patients (62.5%). The mean time to the first moderate to severe asthma exacerbation after discontinuation was 2.68±2.2 months. No correlation was found between time to loss of control and duration of omalizumab treatment. The mean score of ACT in the time of discontinuation of omalizumab decreased from 22.13±1.2 to 21.06±1.5 at 3th months (p=0.0001) and to 19.3 ±2.0 at 12th months of discontinuation (p=0.005). The number of exacerbation within the last 12 months increased from 1.3±0.9 to 3.4±3.2 (p=0.006), and the number of hospitalization increased from 0.12±0.26 to 0.6±0.9 within 12 months of discontinuation. The mean score of AQLQ decreased from 4.17±0.8 to 3.26±0.7 at 12th months of discontinuation (p=0.0001).