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Introduction Patients with chronic obstructive pulmonary disease (COPD) hospitalized for an exacerbation are at risk of early readmission for any reason within 30 days of discharge. Understanding the frequency and risk factors related to readmission can provide valuable input for the development of readmission reduction strategies. The aim of this study was to investigate the frequency, specific risk factors and the cost analysis of early readmission for any reason within 30 days after discharge of the patients hospitalized for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Materials and methods In a prospective comparative case series study, 110 patients over 40 years of age who were hospitalized with AECOPD were included. The frequency of readmissions within 30 days of discharge after hospitalization for AECOPD was investigated. Those who were admitted to any hospital for any reason within 30 days after discharge were classified as the readmission group. Whereas nonhospitalized patients were defined as the nonreadmission group. Demographic, clinical, therapeutic, laboratory and financial data of the groups were evaluated. Result Thirty-four (30.9%) COPD patients were readmitted during the first 30 days post index hospitalization. In multivariate analysis, the best predictors of early readmission were the low forced expiratory volume in one second (FEV1) predicted % (FEV1%) (OR= 0.961, %95 CI 0.927-0.997 p= 0.034) and COPD diagnosis time (OR= 0.908, %95 CI 0.838-0.983 p= 0.017). Mean length of stay of the second hospitalization was longer than both the readmitted and nonreadmitted groups (8.3, 8.1 and 7.8 days respectively). While mean cost of second hospitalization was 1189$, mean cost of index hospitalization of the readmission group was 794$ and that of index hospitalization of nonreadmission group was 582$. Conclusions The frequency of readmissions within 30 days after discharge of the patients hospitalized for AECOPD are common and costly. Low FEV1 percentage and lower diagnosis time were found to be significant predictors for readmission within 30 days of the index hospitalization.

Background/aim: Diagnosis of interstitial lung diseases requires a multidisciplinary approach, and a gold standard for histological diagnosis is open lung biopsy. Transbronchial lung biopsy (TBLB) and in recent years an alternative method, cryobiopsy (TBLC), are used for the diagnosis of parenchymal lung lesions. The aim of this study is to compare the efficacy of concomitant conventional TBLB and TBLC.Materials and methods: A total of 82 patients who underwent TBLC for diagnosis of diffuse parenchymal lung diseases at Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital between 2015 and 2018 were screened retrospectively and included in the study. Of the patients, 53.7% (n: 44) were male, and 46.4% (n:38) of them were female. The mean age was 58.37 (±9.33) years. First TBLB and then TBLC were performed to all patients in the same session and their diagnostic performances were compared.Results: Although both procedures were done in the same session, 45 patients (54.9%) were diagnosed with TBLB and 75 patients (91.5%) were diagnosed with TBLC (P ˂ 0.001). Hemorrhage was observed in 39 patients (47.6%), but only one had a massive hemorrhage. Pneumothorax was observed in 6 patients (7.3%) and none of them required tube drainage.Conclusion: Transbronchial lung cryobiopsy is a promising technique for the diagnosis of parenchymal lung diseases compared to transbronchial lung biopsy.

OBJECTIVE: This study aimed to determine the ratio of fluoroquinolone (FQ) exposure before the diagnosis of patients with a new case of active pulmonary tuberculosis (TB) and to investigate the correlation of this treatment with the emergence of FQ-resistant strains. MATERIAL AND METHODS: In this retrospective comparative case series study, a total of 132 patients, who had been diagnosed with adult, culture-positive, active pulmonary TB were reviewed. The FQ group had 30 patients who had had ≥1 time and ≥7 days of FQ exposure within 1 year before the diagnoses. The control group included an equal number of patients with TB with similar demographic characteristics (non-FQ group). Ofloxacin (OFX) and moxifloxacin (MFX) resistance were examined at 2 different concentrations (2 and 4 mg/L for OFX; 0.25 and 0.5 mg/L for MFX). RESULTS: Of the 132 patients, 30 (22%) had 7 days or longer of FQ monotherapy within 1 year of initiation of anti-TB treatment. FQ resistance was detected in 2 (3.3%) patients. In the FQ group, MFX resistance at 0.25 mg/L concentration was observed in 1 patient, whereas another patient had OFX and MFX resistance at 4 mg/L and 0.5 mg/L concentrations, respectively. In the non-FQ group, no FQ resistance was detected in any of the patients. No statistically significant difference in terms of development of FQ resistance was found between the ratios of FQ and non-FQ groups (p=0.492). Although there was no statistically significant difference, 2 patients, in whom resistance was detected, had FQ exposure before their diagnosis. CONCLUSION: The FQ exposure ratio before the diagnosis is high (22%) in this cohort that includes patients with new active pulmonary TB, and the presence of patients with FQ resistance (even if only a few) should be a noteworthy and cautionary result in terms of FQ exposure and resistance development.

OBJECTIVES: In some studies, it has been hypothesized that anthracotic pigmentation in mediastinal lymph nodes is a sign of benign conditions and excludes metastasis from thoracic and extrathoracic malignancies. The aim of this study was to evaluate the clinical significance of mediastinal lymph node anthracosis in cancer patients who underwent endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). MATERIALS AND METHODS: In this study, medical data of patients with lung cancer or extrathoracic cancer who underwent EBUS-TBNA for investigation of mediastinal lymph node metastasis were evaluated retrospectively. EBUS-TBNA cytology reported as anthracotic pigmentation was included in this study. Patients were excluded from the study if cytology of aspirated lymph nodes reported as “benign,” “malignancy,” or “granulomatous inflammation.” RESULTS: There were 50 eligible patients. Thirty-one (62%) patients underwent EBUS-TBNA for lung cancer staging and 19 (38%) for evaluation of extrathoracic metastasis. A total of 120 lymph nodes were sampled. The most sampled station was subcarinal. EBUS-TBNA was false negative in eight of 31 (25.8%) lung cancer patients and one of 19 (5.2%) extrathoracic malignancy patients. CONCLUSIONS: Anthracotic pigmentation of lymph nodes in EBUS-TBNA cannot exclude metastasis in lung cancer patients and mediastinoscopy should be performed before surgery in this group. In patients with extrathoracic malignancy, anthracotic pigmentation is associated with benign conditions. However, further investigation with larger cohort is needed.

Endobronchial ultrasound (EBUS) is a technique for the detection of mediastinal abnormalities. A total of 548 EBUS procedures were performed for various indications, and in four cases (0.7%), filling defects in central pulmonary arteries were demonstrated fortuitously during the procedure. Subsequently, all patients underwent contrast-enhanced CT of the thorax to confirm the diagnosis of pulmonary thromboembolism (PTE). In three of the four cases, there was a concomitant lung cancer. PTE can be incidentally detected during EBUS; therefore, pulmonary arteries should be examined carefully during EBUS in all patients, particularly in patients with suspected or proven malignancy. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:441-444, 2017.

In this study, Mycobacterium tuberculosis complex was detected by BD ProbeTec ET system in 4716 respiratory and 167 nonrespiratory samples [mostly (98%) smear negative]. Sensitivity, specificity, positive and negative predictive values were 81.8%, 98.3, 85.1 and 97.9 for respiratory and 100%, 96.2, 64.7 and 100, for nonrespiratory samples, respectively. Among 149 (3.1%) ProbeTec DTB positive and culture negative samples, 72 (65 respiratory and seven nonrespiratory) (48.3%) were recovered from the patients who were evaluated as having TB infection. The system has been found as useful in early diagnosis of tuberculosis infection in association with the clinical, radiological and histopathological findings.

Background/aim: Mediastinal lymph nodes are the second most commonly affected lymph nodes in tuberculous lymphadenitis. It is often difficult to diagnose tuberculosis in patients with lymphadenopathy without parenchymal lesions. The aim of this study was to describe the diagnostic utility of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in patients with isolated mediastinal tuberculous lymphadenitis (MTLA). Materials and methods: This study included 527 patients who had undergone EBUS-TBNA between December 2012 and December 2014. Patients with the final diagnosis of MTLA were evaluated. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of EBUS-TBNA were calculated.Results: The prevalence of MTLA in all patients who had undergone EBUS-TBNA for mediastinal lymphadenopathy of unknown etiology was 5.2% (28/527). EBUS-TBNA was diagnostic in 21/28 (75%) patients, and the remaining 7 patients required additional procedures for confirmation of diagnosis. Sensitivity, specificity, PPV, NPV, and accuracy of combined cytopathological and microbiological examinations of EBUS-TBNA in the diagnosis of MTLA were 87.5%, 98.5%, 91.4%, 98%, and 94.4%, respectively. There were no major complications.Conclusion: EBUS-TBNA is a safe and effective procedure for the diagnosis of MTLA. When microbiological and cytopathological examinations of samples are combined, EBUS-TBNA demonstrates good diagnostic accuracy and NPV for the diagnosis of MTLA.

Aim: We aimed to evaluated results of eosinophilic and non-eosinophilic-COPD patients. Methods: The study was recorded 202 stable-COPD patients from January 2015 to December 2015. Patients were divided into two group according to percentage of peripheral blood eosinophil as non-eosinophilic ≤2 % (n=80) and eosinophilic >2 % (n=122). Results: There was no found significant difference in terms of age, gander, comorbidity and exacerbations between groups. FEV1 values were significantly higher and CAT scores were significantly lower in eosinophilic group. Number and percentage of neutrophils were found higher and number and percentage of lymphocytes were found lower in non-eosinophilic patients. Platelet distribution width (PDW) and platelet-to-lymphocyte ratio (PLR) were significantly higher in non-eosinophilic patients compare to eosinophilic patients (Figure 1) Conclusion: Although we did not find any difference in terms of the number of exacerbations between eosinophilic and non-eosinophilic stable COPD patients. Our results showed that non-eosinophilic stable COPD patients are more symptomatic and have more airflow limitation.

Aim: Endobronchial ultrasound (EBUS) transbronchial needle aspiration (TBNA) is an important diagnostic procedure for the interrogation of mediastinal lymph nodes. In this study, we aimed to evaluate the diagnostic contribution of EBUS-TBNA in the evaluation of intrathoracic tuberculous lymphadenitis. Methods: This retrospective study included 527 patients who had undergone EBUS-TBNA between December 2012 and December 2014. Final diagnosis of 527 patients and complications of the procedure were evaluated. Results from the procedures were recorded, including microscopy for acid-fast bacilli (AFB), cytology, mycobacterial cultures, standard bacterial cultures and the results of nucleic acid amplification techniques (NAAT). Final diagnosis of tuberculous lymphadenitis (TBLA) were evaluated and the sensitivity, negative predictive value (NPV) of EBUS-TBNA for TBLA were calculated. Results: Tuberculous was diagnosed in 28 patients (28/527, 5.2%). EBUS-TBNA diagnostic in 23 (82.1%) patients. In 5 TBLA patients, EBUS-TBNA was not able to confirm a diagnosis and additional procedures were required. Sensitivity of EBUS-TBNA for all microbiological tests was 53.5% in TBLA. The sensitivity for a composite microbiological and clinicopathological diagnosis of EBUS-TBNA was found 82.1 %. Sensitivity of NAAT was 14.8%. The negative predictive value (NPV) for microbiologic and composite clinicopathological investigation diagnosis was 97.8% and 99% respectively. Conclusions: EBUS-TBNA is a safe and effective procedure in the assessment of patients with TBLA. When microbiological tests and histological results are combined with high clinical suspicion, EBUS-TBNA demonstrates good diagnostic accuracy and NPV for the diagnosis of TBLA.

Introduction: There may be causes of mediastinal lymph node enlargement other than metastasis in cancer patients and anthracosis is one of them. Aim: The aim of this study was to evaluate if anthracotic lymph node detected by endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is a sign of benign conditions and excludes metastasis. Methods: Patients who underwent EBUS-TBNA for lung cancer staging or diagnosing mediastinal lymph node metastasis of ETM were included. Patients with EBUS-TBNA cytology reported as anthracotic pigments and also benign, malignancy or granulomatous inflammation were excluded. After EBUS-TBNA patients were underwent mediastinoscopy or radiological follow-up.If mediastinoscopic pathology was reported other than anthracosis or radiological follow-up showed lymph node enlargement,EBUS-TBNA was accepted as false negative. Results: Thirty one lung cancer and 19 ETM patients were included. Mediastinoscopy was performed in 23 lung cancer and 8 ETM patients. Remaing 8 lung cancer and 11 ETM patients were radiological follow-up. In lung cancer group, metastasis was reported with mediastinoscopy in 6 patients and 2 radiological follow-up patients had progression of lymph node enlargement. In ETM group only in 1 patient progression of lymph node enlargement was reported during radiological follow-up.As a result, EBUS-TBNA was false negative in 8 of 31 (25.8%) lung cancer patients and 1 of 19 (5.2%) ETM patients. Conclusion: In lung cancer patients anthracotic pigmentation of lymph nodes doesn9t exclude lymph node metastasis and mediastinoscopy should be performed before surgery. In extrathoracic malignancy patients, anthracotic pigmentation excludes metastasis.

Aim: We aimed to assess the platelet-to-lymphocyte ratio (PLR) and platelet parameters in patients with chronic obstructive pulmonary disease (COPD). Methods: A total of 60 stable COPD patients, 50 acute exacerbation COPD patients and 50 healthy controls were enrolled in this study. Results: The platelet distribution width and PLR were higher and the mean platelet volume was lower in the COPD patients during acute exacerbation compared with the stable patients and controls. The PLR was negatively correlated with the forced expiratory volume in 1 s. Conclusion: The PLR may be used as a useful and easily accessible tool for evaluating the ongoing inflammation during stable period and the disease severity during acute exacerbations in COPD patients.

Aim: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a safe and minimally invasive procedure that can be performed in outpatient settings. Several studies have demonstrated the usefulness of EBUS-TBNA in the diagnosis of sarcoidosis and malignant diseases. This study focused on the role of cell block (CB) analysis in determining the diagnostic yield of EBUS-TBNA in malignant diseases and sarcoidosis. Materials and Methods: The study was conducted at a training and research hospital. Records of patients who underwent EBUS-TBNA between March 2011 and December 2014 for diagnosed sarcoidosis or malignancy were retrospectively analyzed. Results of all EBUS-TBNA smears and CB were separately evaluated to determine the diagnostic value of each. Results: There were 84 sarcoidosis and 179 malignancy patients. In the malignancy group, CB contributed to cancer diagnosis in 15 (8.3%) patients and subclassification in 19 (10.6%) patients. In the sarcoidosis group, for 45.2% of patients (38/84), smears were not diagnostic but CB showed granulomatous inflammation. Conclusion: CB significantly increases the diagnostic yield of EBUS-TBNA for sarcoidosis. In our study, in the malignancy group the diagnostic yield was low but it was helpful for subclassification, especially for adenocarcinoma.

Background: Mean platelet volume (MPV) and platelet distribution width (PDW) reflects the platelets size and the rate of platelet production in bone marrow and it may used as an indicator of platelet activation and the severity of inflammation. It has been reported that elevated MPV values are associated with stable chronic obstructive lung disease(COPD).The aim of this study, was to assess MPV and PDW values in stable and acute exacerbation period in patients with COPD. Methods: This study included 60 stable COPD patients, 36 COPD patients during exacerbation and 50 healthy controls. The complete blood count parameters retrospectively reviewed. Results: MPV values were 9.56±1.07 and 8.4±0.74 fl during stable period and during exacerbation. MPV values were found significantly lower in acute exacerbation group compared to stable patients and controls. (both p

Background/aim: The aim of this study was to determine the diagnostic performance of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of mediastinal and hilar lymph nodes (LNs) in patients with known extrapulmonary malignancy. Materials and methods: Between March 2011 and August 2013, 378 EBUS-TBNA procedures were performed. Sixty-three (16.6%) of these were performed on known extrapulmonary malignancy patients. Results: There were 28 male and 35 female patients, with median ages of 65 years (min-max: 53-87) and 57 years (min-max: 39-76), respectively. From the 63 cases, 138 lymph nodes (LNs) were sampled with EBUS-TBNA (median: 2 LNs/patient; min-max: 1-4). Results of EBUS-TBNA revealed malignancy in 18 (28.5%) and nonmalignancy in 45 (71.5%). In the nonmalignant group, there were false negatives in 5 (7.9%), anthracosis in 13 (20.6%), reactive adenitis in 16 (25.3%), sarcoidosis in 7 (11.1%), and tuberculosis in 2 (3.1%), and 2 were not evaluated (lost to follow-up) (3.1%). The diagnostic sensitivity, accuracy, and negative predictive value of EBUS-TBNA per patient were 78.2%, 91.8%, and 88.3%, respectively. Conclusion: EBUS-TBNA is a safe, minimally invasive, and effective method and can be considered as the initial test for the histopathological diagnosis of mediastinal and hilar lymphadenopathy in patients with extrapulmonary malignancy.

A 61-year-old woman presented with an eosinophilic pleural effusion, secondary to transdiaphragmatic intrapleural spread of an hepatic hydatid cyst. Right posterolateral thoracotomy and frenotomy revealed a loculated pleural effusion associated with a 10 x 8 cm hydatid cyst in the posterior segment of the liver. Hydatid disease should be included in the differential diagnosis of eosinophilic pleural effusions in endemic regions.

Aim: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), which enables cytological examination of mediastinal lymph node (LN) aspiration samples, is a safe and minimally invasive method for diagnosis and staging of lung cancer and diagnosis of diseases affecting mediastinal LNs. In this study, we investigated the yield of EBUS-TBNA for diagnosis of lymphoma and reviewed the literature since the British Thoracic Society (BTS) guidelines were published. Materials and Methods: We retrospectively evaluated our database for patients who underwent EBUS between March 2011 and December 2014. One hundred eighty-nine patients with isolated mediastinal lymphadenopathy were included in the study. Patients with other causes of lymphadenopathy, such as lung cancer or extrathoracic malignancy, and those with pulmonary lesions accompanying mediastinal lymphadenopathy were excluded from the study. Patients with final diagnosed lymphoma were included in the study on the basis of a history of lymphoma or newly evaluated mediastinal lymphadenopathy. The sensitivity and negative predictive value (NPV) of EBUS-TBNA were calculated. Results: There were 13 patients with the final diagnosis of lymphoma. Eleven of them were new diagnoses and 2 patients were known chronic lymphocytic leukemia (CLL), and underwent EBUS-TBNA for determination of recurrence. Twelve EBUS-TBNA procedures were performed for suspected new cases. Three (25%) were diagnostic, 2 (16.7%) were suspicious for lymphoma and underwent further interventions for definite diagnosis, and 7 (58.3%) were false negative. All 3 patients diagnosed with EBUS-TBNA were non-Hodgkin lymphoma (NHL). None of the Hodgkin lymphoma (HL) cases could be diagnosed with EBUS-TBNA. The overall diagnostic sensitivity and NPV of EBUS-TBNA in detecting lymphoma was 65% and 96.1%, respectively. For the newly diagnosed lymphoma cases, EBUS-TBNA had a sensitivity of 61.1%. Conclusion: In conclusion, we believe that since the publication of the BTS guidelines, the value of EBUS-TBNA in the diagnosis of lymphoma still remains controversial. EBUS-TBNA can be the first diagnostic modality in diagnosis of recurrent lymphomas. However, for suspected new cases, especially for HL, the diagnostic yield of EBUS-TBNA is low and negative results do not exclude lymphoma. Further interventions such as mediastinoscopy should be performed for high-suspicion patients.

Behçet’s disease (BD) with pulmonary arterial aneurysm is rare and often associated with a poor prognosis. But there is also a chance that the aneurysm may completely resolve with medical therapy. A 39-year-old man presented with fever, malaise, bilateral chest pain, recurrent oral ulcers, and hemoptysis. The chest radiograph showed a round opacity in the right hilum. Computed tomography and magnetic resonance angiography (MRA) further revealed multiple, bilateral pulmonary arterial aneurysms consistent with the diagnosis of BD. The patient was started on a course of cyclophosphamide and corticosteroid therapy that resulted in cessation of his symptoms and complete resolution of radiologic findings. The chest radiograph and MRA reverted to normal on long-term follow-up. He is still alive and symptom-free 20 months after diagnosis.