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Accessory cardiac bronchus (ACB) is a rare congenital anomaly mainly located in the medial wall of the intermediate bronchus. This anomaly can present with dyspnea, recurrent infections, and hemoptysis. It usually has a blind ending, which may have an impact on airflow patterns and lobar distribution regardless of its diameter and depth. There have been very few cases with ACB. However, the airflow pattern and lobar distribution have not been well studied. In our case with ACB, the proportion of airflow in the right lung was higher than in the model without ACB, while mean airflow velocities were similar in both models. In this regard, quantitative lung ventilation scintigraphy could be better than the anatomical formula in predicting postoperative forced expiratory volume 1 in patients with accessory cardiac bronchus who will undergo lung resection.

Objective Exacerbations in patients with COPD may still be unpredictable, although the general risk factors have been well defined. We aimed to determine the role of a novel parameter, area under flow-volume loop, in predicting severe exacerbations. Methods In this single-centre retrospective cohort study, 81 COPD patients over 40 years of age with high grade of dyspnea (having a CAT score of ≥10) and a history of ≥1 moderate exacerbation in the previous year were included. Area under flow-volume curve (AreaFE%) was obtained from pulmonary function test graph and calculated from Matlab programme. Univariate and multivariate logistic regression analyses were performed to determine independent risk factors of the severe exacerbation. Results Patients with severe exacerbation (n = 70, 86.4 %) were older. They had lower FEV1%, FVC%, 6MWD, AreaFE% and higher CAT score than patients without exacerbation. After performing multivariate analysis, high CAT score and low AreaFE% value were found to be independent risk factors for severe exacerbation (OR: 1.12, 95 % CI: 1.065–1.724; p = 0.01 and OR: 1.18, 95 % CI: 0.732−0.974; p = 0.02). Conclusions We found that a low AreaFE% value was an independent risk factor in addition to a high CAT score and these both have an excellent discriminative ability in predicting the risk of severe exacerbation

Degerli Meslektaslarimiz, Plevra hastaliklari, gunumuzde insidansi giderek artan ve hem gogus hastaliklari hem de gogus cerrahisi kliniklerinin pratiginde yaygin bir is yuku olusturan sorun halinde karsimiza cikmaktadir. Cok genis sebeplere dayali bir dagilim gosteren plevra patolojilerinin tani ve tedavi yontemi multidisipliner yaklasim gerekmektedir. Bu konuyla ilgili cikarilan eserler oldukca degerli teorik bilgiler icermekle birlikte pratik ve vaka noktasinda bilgi birikimini gerektigi olcude yansitmadigi gozlenmektedir. Bu dusunceden yola cikarak, plevral hastaliklari ve cerrahi tedavi yaklasimini olgu sunumlari esliginde ozetleyen alaninda bu yonuyle ilk eser olan bu kitabi degerli okuyucularimiza sunmaktan gurur duyuyoruz. Bu eserde gunumuzdeki plevra patolojilerine yaklasim, guncel tani rehberleri ve cerrahi tedavideki yenilikler, gogus hastaliklari ve gogus cerrahisi alanlarinda kursu sahibi olan degerli hocalarimiz tarafindan olgular esliginde islenmistir. Klinik tecrubelerin kanita dayali yontemlerle aktarildigi, vakalarin guncel pratigimizde rehberlik edecegi bir kaynak olarak titizlikle hazirlanmistir. Eserin tum bolumlerinin hazirlik asamasinda emegi gecen kiymetli hocalarimiza ayri ayri sukranlarimizi sunariz. Kiymetli meslektaslarimiza faydali olmasi temennisiyle…. Kizlarimiz Zulal, Elif, Defne, Gokcen ve tum saglik calisanlarinin cocuklarina armagan olmasi dilegiyle

BACKGROUND/AIM: SARS-CoV-2, a ribonucleic acid coronavirus, rapidly spread worldwide within a short timeframe. Although different antiviral, anti-inflammatory, and immunomodulatory drugs are used, current evidence is insufficient as to which drug is more efficient. Our study compared favipiravir and lopinavir/ritonavir (LPV/RTV) therapies in inpatient care for coronavirus disease 2019 (COVID-19) pneumonia. MATERIALS AND METHODS: Demographic data, test results, treatments, and latest status of patients receiving inpatient COVID-19 pneumonia therapy were recorded. The initial favipiravir and LPV/RTV receiving groups were compared regarding the need for intensive care units (ICU) and mortality. Logistic regression analysis was performed by including variables showing significant differences as a result of paired comparisons into the model. RESULTS: Of the 204 patients with COVID-19 pneumonia, 59 (28.9%), 131 (64.2%), and 14 were administered LPV/RTV, favipiravir, and favipiravir with LPV/RTV, respectively. No difference was found in age, sex, presence of comorbidity, and tocilizumab, systemic corticosteroid, and plasma therapy use between patients administered with these three different treatment regimens. The mean mortality age of the patients was 71±14.3 years, which was substantially greater than that of the survivors (54.2±15.5 years). Compared with patients administered with LPV/RTV, ICU admission and mortality rates were lower in patients administered with favipiravir. CK-MB, AST, CRP, LDH, and creatinine levels were higher, whereas lymphocyte counts were lower in patients who died. Age, AST, CRP, LDH, and neutrophil counts were higher in patients needing ICU, and eosinophil and lymphocyte counts were significantly lower. Logistic regression analysis showed that favipiravir use independently decreased mortality (P=0.006). CONCLUSION: The use of favipiravir was more effective than LPV/RTV in reducing mortality in hospitalized patients with COVID-19.

Mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have all been investigated as novel inflammatory markers of cardiac and oncological diseases, while there is only a limited number of studies investigating these markers in chronic obstructive pulmonary disease (COPD). In the present study we examine NLR, PLR; and other markers, such as eosinophil, MPV, plateletcrit (PCT), platelet distribution width (PDW), red cell distribution width (RDW), and C-reactive protein (CRP) in patients with stable and acute exacerbation of COPD.Stable COPD (Group 1, n=140), COPD with acute exacerbation (Group 2, n=110), and healthy controls (Group 3, n=50) were included in the study. Leukocyte, CRP, hemoglobin (HB), RDW, platelet, MPV, PCT, PDW, neutrophil, lymphocyte, eosinophil, NLR, and PLR were analyzed in all groups.HB, leukocyte, platelet, neutrophil, eosinophil, MPV, PCT, CRP, NLR, and PLR were significantly higher, while the lymphocyte was lower in Group 1 than in Group 3. Leukocyte, neutrophil, RDW, CRP, NLR, and PLR were significantly higher, while lymphocyte was lower in Group 2 than in Group 3. Leukocyte, neutrophil, RDW, CRP, NLR, and PLR were significantly higher, while HB, platelet, MPV, PCT, and lymphocyte were significantly lower in Group 2 than in Group 1. NLR and PLR increased significantly in patients with bronchiectasis when compared to those without in Group 1.Our study results suggest that NLR, PLR and RDW can be used as simple and cost-effective markers for the evaluation of severity of exacerbation and for predicting hospitalization and further exacerbations in patients with COPD.Srednji nivo trombocita (MPV), odnos neutrofila i limfocita (NLR) i odnos trombocita i limfocita (PLR) su istraženi kao novi zapaljenski markeri srčanih i onkoloških bolesti. Međutim, postoji ograničen broj studija koje istražuju ove markere u hroničnoj opstruktivnoj bolesti pluća (HOBP). Cilj je bio da se ispitaju NLR, PLR i drugi markeri kao {to su eozinofili, MPV, trombociti (PCT), širina širenja trombocita (PDW), širina distribucije eritrocita (RDW), C-reaktivni protein (CRP) kod pacijenata sa stabilnim i akutnim pogoršanje HOBP.Ispitivani su stabilna HOBP (grupa 1, n = 140), HOBP sa napadom (grupa 2, n = 110), i zdrave kontrole (grupa 3, n = 50). U svim grupama analizirani su leukociti, CRP, hemoglobin (Hb), RDW, trombociti, MPV, PCT, PDW, neutrofili, limfociti, eozinofili, NLR, PLR.Hb, leukociti, trombociti, neutrofili, eozinofili, MPV, PCT, CRP, NLR, PLR bili su značajno veći, dok su limfociti bili manji u grupi 1 nego u grupi 3. Leukociti, neutrofili, RDW, CRP, NLR, PLR bili su znatno viši, dok su limfociti bili bio niži u grupi 2 nego u grupi 3. Leukociti, neutorfili, RDW, CRP, NLR, PLR bili su znatno viši, dok su Hb, trombociti, MPV, PCT, limfociti bili znatno niši u grupi 2 nego u grupi 1. NLR i PLR bili su značajno povećani kod pacijenata sa bronhiektazom u poređenju sa onima koji nisu u grupi 1.Zaključak: Naši rezultati istraživanja ukazuju na to da su NLR, PLR i RDW jednostavni i isplativi markeri za procenuozbiljnosti pogoršanja i predviđanja za hospitalizaciju i dalju procenu pogoršanja kod pacijenata sa HOBP.

Lung cancer is the leading cause of cancer-related death among all types of cancers. In lung cancer patients, hospitalization rates in intensive care units (ICUs) are gradually increasing due to both illness- and treatment-related complications. A 61-year-old male patient who had undergone radiotherapy for small cell lung cancer (SCLC) was admitted to the ICU on the 3rd day of his treatment because of hypercapnic respiratory failure. High-flow oxygen therapy was started. The mass lesion showed rapid progression. Chemotherapy was performed for SCLC which is a chemosensitive tumor.

Introduction Chronic obstructive pulmonary disease (COPD) is associated with increased cardiovascular morbidity and mortality. Carotid intima-media thickness (CIMT) is a noninvasive method assessing atherosclerosis. Objective It was aimed to determine relationship and survival between COPD and CIMT. Methods CIMT was measured using Doppler ultrasound (USG) in 668 stable COPD patients at 24 centers. Patients were followed-up for 2 years. Results There were 610 patients who completed the study. There were 200 patients CIMT with = 0.78 mm (group 2). There was a significant difference at the parameters of age, gender, smoking load, biomass exposure, GOLD groups and degree of airway obstruction (FEV1) between groups 1 and 2. Our results revealed positive correlations between mean CIMT and age, smoking load (pack-years), biomass exposure (years), exacerbation rate (last year), duration of hypertension (years) and cholesterol level; negative correlations between CIMT and FEV1 (P < 0.05). According to logistic regression model, compared with group A, risk of CIMT increase was 2.2-fold in group B, 9.7-fold in group C and 4.4-fold in group D (P < 0.05). Risk of CIMT increase was also related with cholesterol level (P < 0.05). Compared with infrequent exacerbation, it was 2.8-fold in the patients with frequent exacerbation (P < 0.05). The mean survival time was slightly higher in group 1, but not significant (23.9 vs 21.8 months) (P > 0.05). Conclusion This study is the first regarding CIMT with combined GOLD assessment groups. It has revealed important findings supporting the increase in atherosclerosis risk in COPD patients. We recommend Doppler USG of the carotid artery in COPD patients at severe stages. WOS:000470921200006 2-s2.0-85066013688 PubMed: 30942958

Domiciliary noninvasive mechanical ventilation (NIMV) is used for treating patients with hypercapnic chronic obstructive pulmonary disease (COPD). We aimed to evaluate the association between adherence to the treatment and subsequent hospitalizations and costs. Data from 54 (27 adherent; 27 non-adherent) patients with COPD who were undergoing NIMV treatment at home for 6 months. We assessed adherence based on digitally recorded data and checked hospital records for clinical and laboratory data, rehospitalization rates, and costs during the following 6 months. Nocturnal NIMV usage, mean daily usage of the device, and time to first hospitalization were higher in the treatment-adherent group (p .001, p .001, and p=.006, respectively). The percentage of active smokers, device leaks above 30 L/min, length of hospital stay, rehospitalization rates, and costs were significantly higher in the treatment-non-adherent group (p = 05, p = 006, p = 004, p = 006, and p = 01, respectively). The most frequent reasons for not using NIMV in the treatment-non-adherent group were a decreased need, dry mouth, mask incompatibility, and gastrointestinal complaints. Adherence to NIMV treatment decreases the subsequent hospitalizations rates and noncompliance leads to complications. Findings of this study may help physicians in convincing patients diagnosed with COPD of the need for correct NIMV use to prevent hospitalizations and reduce the costs of COPD treatment.

Tracheal laceration as a result of elective intubation is a rarely seen complication with a high mortality. An eighty-one years old, female patient who was followed in the intensive care unit and treated with mechanical ventilation, developed subcutaneous emphysema after intubation. Fiberoptic bronchoscopy performed via the endotracheal tube revealed laceration in the trachea 5 cm in length.. The urgent rigid bronchoscopy has been performed and one silicone straight stent and a covered metallic bifurcated stent have been inserted. The araea of laceration has been covered totally. The subcutaneous emphysema disappeared incrementally and after weaning period the patient discharged to the ward.

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.

Background: COPD is a major cause of death and studies continue about phenotyping COPD patients . Bronchiectasis is frequently seen in moderate and severe COPD patients.so we have done our work to examine the frequency of bronchiectasis in moderate and severe COPD patients and to evaluate and compare the patients with and without bronchiectasis in terms of clinical ,functional and bacteriologic features Materials and Methods: Our study was a prospective, cross-sectional study including COPD patients and they were divided into two groups according to the presence of radiologic bronchiectasis . After the patients were questioned demographic , systemic inflammation values , spirometry, blood gas values and clinical evaluations were recorded. Results: Bronchiectasis, due to the high airway inflammation caused by the disease in COPD is a factor affecting the frequency of attacks . We found that 35 COPD patients have bronchiectasis and 25 copd patients have not. Patients with bronchiectasis have high co2 values and we determine that if number of pmnl increases , spirometric values decreases in all patients. Conclusion: PMNL sputum levels used in conjunction with spirometry to determine the frequency of exacerbations in patients with COPD. Hypoxia was related with bronchiectasis in previous publications ,it is not shown in our study but we determined that the relation of high co2 values with bronchiectasis

Introduction: The role of inhaled corticosteroids in the treatment of chronic obstructive pulmonary disease (COPD) is well known. Even at higher doses, inhaled corticosteroids are believed to have no association with the incidence of lower respiratory infections. However, recent large center studies have reported a rising incidence of pneumonia after the use of inhaled corticosteroids alone or in fix combination. In this study we aimed to investigate the role of inhaled corticosteroid type in COPD patients hospitalized for pneumonia at our hospital. Results: There were 54 (71%) males and 22 (29%) females. Mean age was 66 (41-93) years. Smoking history was remarkable in 64 (84%) patients who had a median smoking history of 43 pack/year (4-130 p/y). Twelve patients had a positive biomass history. There were 14 (18.4%) grade 0, 17 (22.4%) grade 1, 32 (42.1%) grade 2, 12 (15.8%) grade 3 and 1 (1.3%) grade 4 COPD patients. Mean leucocyte and CRP levels at admission and discharge were 13.8*103mm3, 9.6*103mm3 and 131 mg/L, 24 mg/L respectively. Given inhaled corticosteroids were budesonide and fluticasone. Budesonide was used in 39 (51%), fluticasone in 31 (41%) and interchangeably in 6 (8%) patients. Discussion: In COPD patients who develop pneumonia during follow up, the choice of inhaled corticosteroids has no significant effect on the development of pneumonia. This study is limited by its smaller sample size and the lack of a control group; however, it can serve as a pilot study for future studies that will enroll larger patient cohorts.

Background: To evaluate and compare the diagnostic efficiency of serum (s) and pleural (p) levels of adenosine deaminase (ADA)-1, ADA-2, total ADA, and interferon-gamma (IFN-γ) for the differential diagnosis of pleural tuberculosis (TB). Methods: Clinical and analytic data of 93 consecutive patients with pleural effusions from May 2012 to February 2013 were prospectively evaluated. The study population included 43 pleural TB, 23 malignancies, and 27 other exudates. The median and interquartile range of ADA-1, ADA-2, total ADA, and IFN-γ were evaluated according to their underlying diseases. Results: There were no significant differences in sADA-1 and sIFN-γ values among each group. pADA-1, pADA-2, total pADA, and pIFN-γ levels were significantly higher in patients with pleural TB than in other patients (p < 0.0001). As for pleural TB receiving operating characteristic (ROC) curves identified the following results. The best cut-off value for pADA-2 was 20.37 U/L and it yielded a sensitivity and specificity of 95.35% and 86%, respectively. Taking a cut-off value of 40.68 U/L for total pADA, the sensitivity and the specificity were found to be 88.37% and 88%, respectively. ROC curve identified 110 U/L as the best cut-off value for pμg/ml, while the sensitivity and the specificity were 74.42% and 68%, respectively. Finally, the best cut-off value for pADA-1 was 16.8 U/L and yielded a sensitivity and specificity of 69.77% and 68%, respectively. Conclusions: To distinguish pleural TB, pleural levels of ADA-2 have the highest sensitivity among the different diagnostic parameters and may find a place as routine investigation for early detection of TB in the future.

A case of primary primitive neuroectodermal tumor (PNET) of the chest wall in an adolescent is presented with imaging findings including 18F-fluorodeoxyglucose (18F-FDG) positron-emission computed tomography (PET-CT). To date, radiological description of the PNET of the chest wall has mainly been carried out by radiographic analysis, computed tomography (CT), and magnetic resonance imaging (MRI). We demonstrated that 18F-FDG PET-CT visualizes the active focus of glucose metabolism of PNET of the chest wall and is effective for the preoperative evaluation of patients with this tumor.