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Aim: In the clinical course of Chronic Obstructive Pulmonary Disease (COPD), exacerbations thatare defined as worsening of respiratory symptoms (dyspnoea, cough, sputum production) may occur,which causes poor prognosis and require additional treatments. Cost-effective mortality predictors arevaluable for the treatment management of COPD. We aimed to investigate whether serum uric acid(UA) and serum uric acid to creatinine ratio (UCR) are predictors of mortality and hypoxemia in patientswith acute exacerbations of COPD (AECOPD).Material and Methods: 105 patients with AECOPD who were hospitalized in a reference chest hospitalbetween January 2014 and December 2018 were evaluated retrospectively in this cross-sectional study.The associations between UA and UCR and long-term mortality, hypoxemia, comorbidity, FEV1 value,and Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive PulmonaryDisease (GOLD) stage were analyzed.Results: In the present study including 105 patients with AECOPD (97 males, mean age of 65±9 years),a significant correlation was found between hyperuricemia and mortality (95% CI:1.15-10.72, p=0.027;95% CI:1.16-4.12, p=0.016, respectively), while no correlation was found between UCR and mortality(p=0.051, p=0.053, respectively). Low UA level was associated with hypoxemia significantly (p=0.022),but no association was observed between UCR and hypoxemia (p=0.094).Conclusion: It appears that UA is more important for predicting long-term mortality in patients withAECOPD than UCR. We suggest that UA can be used as a biomarker of long-term mortality for theidentification of high-risk COPD patients that require frequent clinical follow-up and intense treatmentmanagement., Amaç: Kronik Obstrüktif Akciğer Hastalığı (KOAH) klinik seyrinde, kötü prognoza neden olan, ektedavi gerektiren, solunum semptomlarında (dispne, öksürük, balgam) kötüleşme olarak tanımlananalevlenmeler gözlenebilir. Maliyet-etkin mortalite öngörücüleri, KOAH’ın tedavi yönetimi için değerlidir.Akut KOAH alevlenmeleri olan serum ürik asit (ÜA) ve serum ürik asitin kreatinine oranının (ÜKO) mortalite ve hipoksemi için belirleyici olupolmadığını araştırmayı amaçladık.Gereç ve Yöntemler: Bu gözlemsel kesitsel çalışmada, Ocak 2014 ile Aralık 2018 arasında bir referans göğüs hastanesinde yatan 105KOAH alevlenmesindeki hasta retrospektif olarak değerlendirildi. ÜA ve ÜKO ile uzun vadeli mortalite, hipoksemi, komorbidite, FEV1 değeri,KOAH’ın tanı, tedavi ve önlenmesi için küresel strateji (GOLD) evreleri arasındaki ilişkiler analiz edildi.Bulgular: KOAH alevlenmesindeki toplam 105 hastayı (97’si erkek, ortalama yaş 65±9 yıl) içeren bu çalışmada hiperürisemi ile mortalitearasında anlamlı bir korelasyon bulunurken (sırasıyla, p=0.027; p=0.016), ÜKO ile mortalite arasında korelasyon bulunmadı (sırasıyla,p=0.051, p=0.053). Düşük ÜA seviyesi hipoksemi ile anlamlı olarak ilişkiliydi (p=0.022), ancak ÜKO ile hipoksemi arasında bir ilişki gözlenmedi(p=0.094).Sonuç: KOAH alevlenmesindeki hastaların uzun vadeli mortalitesini öngörmede serum ÜA’nin ÜKO’na göre daha değerli olduğugörülmektedir. Sık klinik takip ve yoğun tedavi yönetimi gerektiren yüksek riskli KOAH hastalarının tanımlanması için serum ÜA’in uzunvadeli mortalitenin biyobelirteci olarak kullanılabileceğini öneriyoruz.

INTRODUCTION Hyponatremia is shown to prolong hospitalization and increase mortality. The role of hyponatremia in chronic obstructive pulmonary disease is widely studied with a focus on hospitalized patients. OBJECTIVES To investigate whether hyponatremia increases the probability of re-exacerbations in non-hospitalized patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). METHODS Patients with AECOPD who required an emergency department (ED) visit and who were discharged home were included in this single-center, retrospective study. Demographics and laboratory values were compared between patients with hyponatremia (

Introduction and objective Silicon and metallic are two types of stents in use. In this study, we compared complications and long-term survival among patients who received silicon or fully covered, bifurcated self-expandable metallic stents (SEMS) for a malignant tracheobronchial obstruction and/or tracheo/bronchial oesophageal fistulas. Methods Patients in whom Y-shaped stents were used from January 2013 to June 2017 in our interventional pulmonology unit were evaluated retrospectively from patient files. Results Of the 47 patients, 30 (23 males, 76.7%) were in the silicon stent group and 17 (14 males, 82.4%) were in the covered SEMS group. No differences between the groups were detected in ECOG status, pathological properties of the disease, radiotherapy or chemotherapy history before the procedure, symptoms at presentation, or comorbidities. The most common symptom was dyspnoea (96.7% and 100%), and the most common comorbidity was chronic obstructive pulmonary disease (26.7% and 23.5%). A total of 20 complications (42.6%) were seen, with no significant difference between the groups (silicon, 40%; SEMS, 47.1%; P = . 62). Mean survival was 164.51 ± 38.83 days for the silicon stent group and 254.45 ± 103.32 days for the SEMS group (P = .588). No differences were observed in 30-, 90- or 180-day mortality between the two groups (P = .966, .846 and .534, respectively). Conclusions No significant differences in symptom palliation, insertion safety, complication rate or survival were detected between the two types of stent.

Introduction The interval from the peak to the end of the electrocardiographic T wave (Tp-Te) may correspond to malignant ventricular arrhythmias. In this study we aimed to assess Tp-Te variability and investigate the transmural dispersion of repolarisation in pulmonary sarcoidosis disease without proofed cardiac involvement. Material and methods This was a retrospective case-control study that included patients who had a pathologic and radiologic diagnosis of sarcoidosis. All data of the patients' demographic features and electrocardiographs were analysed. Results We enrolled 78 patients with sarcoidosis and 54 healthy volunteers as controls in our study. Men comprised 36% of the sarcoidosis group and 27% of controls. The mean age in the sarcoidosis and control group was 45.4 ±8.7 years (range: 23-58 years) and 44.6 ±11.9 years (range: 21-73 years), respectively. There was no significant difference between the groups for age or sex (p = 0.654, p = 0.246, respectively). There was a significant increase in Tp-Te results in all precordial leads in the sarcoidosis group compared with the control group (p < 0.05). Conclusions Pulmonary sarcoidosis is suspected to have cardiac involvement; therefore, we need to develop new approaches. We present strong evidence that Tp-Te intervals were increased in patients with pulmonary sarcoidosis, which suggests that there may be a link between sarcoidosis and ventricular arrhythmias without proofed cardiac involvement.

Seda Tural Onur,1 Samim Emet,2 Sinem Nedime Sokucu,1 Imran Onur2 1Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Chest Disease, Zeytinburnu, Istanbul, Turkey; 2Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey Introduction: The interval from the peak to the end of the electrocardiographic (ECG) T wave (Tp–Te) can estimate cardiovascular mortality and ventricular tachyarrhythmias.Objectives: In this study, we aimed to define a new ECG parameter in patients with COPD.Methods: This was a cross-sectional observational study that included COPD patients who were diagnosed previously and followed up in the outpatient clinic. All data of the patients’ demographic features, history, spirometry, and electrocardiographs were analyzed.Results: We enrolled 134 patients with COPD and 40 healthy volunteers as controls in our study. Patients already known to be having COPD who were under follow-up for their COPD and diagnosed as having COPD according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria were included. Men comprised 82.8% of the COPD group and 73.2% of controls. The mean age in the COPD and control group was 60.2±9.4 and 58.2±6.7 years, respectively. There was no significant difference between the groups for age or sex (p=0.207, p=0.267, respectively). There were 46 (34.3%) patients in group A, 23 (17.2%) patients in group B, 26 (19.4%) patients in group C, and 46 (29.1%) patients in group D as COPD group. There was a significant increase in Tp–Te results in all precordial leads in the COPD group compared with the control group (p

Purpose: Surgical resection and reconstruction are considered the most appropriate approaches to treat post-intubation tracheal stenosis (PITS). Bronchoscopic methods can be utilized as palliative therapy in patients who are ineligible for surgical treatment or who develop post-surgical re-stenosis. We investigated treatment outcomes in patients with benign tracheal stenosis. Methods: A retrospective review was performed in patients who were diagnosed with PITS. Tracheal resection was performed for operable cases, whereas endoscopic interventions were preferred for inoperable cases with a complex or simple stenosis. Results: In total, 42 patients (23 treated by bronchoscopic methods, 19 treated by surgery) took part in this study. No significant differences were observed in segment length, the proportion of obstructed airways, or vocal cord distance between the two groups. In all, 15 patients in the bronchoscopic treatment group received a stent. Following the intervention, the cure rates in the bronchoscopic and surgical treatment groups were 43.47% and 94.7%, respectively. A multidisciplinary approach resulted in a cure or satisfactory outcome in 90.5% of the patients while failure was noted in 9.5% of the patients. Conclusion: Bronchoscopic methods are associated with a lower cure rate compared to surgery. A multidisciplinary approach was helpful for treatment planning in patients with PITS.

AIMS: Small cell lung cancer (SCLC) constitutes 15%-25% of all lung cancers. Their treatment approach is different from nonsmall cell lung cancer. Central airway obstruction develops at the time of diagnosis or eventually at some time as the disease progress. Quick relief of symptoms with chemotherapy will cause to postpone interventional bronchoscopy which divest patient from benefits of this procedure. There is a few data about the use of interventional bronchoscopy in SCLC. SUBJECTS AND METHODS: Between January 2005 and December 2012, rigid bronchoscopy under general anaesthesia was done in a total of 944 cases. Among them, 52 consecutive SCLC cases were evaluated retrospectively. STATISTICAL ANALYSIS: Survival was calculated from the date of application of therapeutic bronchoscopy using statistical software. RESULTS: From the 52 cases (41 males) mean age of the patients were 56,87 ± 10,16 (range 34-78). Most common obstruction areas were distal trachea and carina invasion involving both main bronchus (n: 12; 23%). Most common method used was mechanical desobstruction after coagulation with diode diode laser or APC. A total of 16 stents was applied to 15 of the cases from 52 cases (28.8%). Most common used stent was silicon Y stent (n: 11). Most common complication during the procedure was bleeding that was mild in 11 cases and massive in 1. One patient died during the procedure (1.9%). CONCLUSIONS: Multimodal interventional bronchoscopic methods seem to be a last option but may be useful in the management of advanced airway obstruction in the setting of SCLC. The choice of modality may be chosen depending upon individual patient characteristics as appropriate.

Introduction We aimed to evaluate the efficacy of flexible bronchoscopic cryoextraction in the treatment of airw ay obstruction arise from mucus plugs and blood clots and present our experience. Materials and methods The present study evaluated patients who previously underwent unsuccessful flexible bronchoscopy for the removal of secretions and blood clots in the central airway and who underwent flexible bronchoscopic cryoextraction between January 2013-November 2017. Result The study included seven patients with a mean age of 58.29 ± 18.56 years (28-76). Three patients underwent bedside intervention in the intensive care unit, and four patients underwent an intervention in the bronchoscopy unit. Seven patients underwent a total of nine sessions of cryoextraction. Severe complications or mortality did not occur during the cryoextraction sessions. Conclusions Flexible bronchoscopic cryoextraction offers a safe treatment strategy as an alternative to rigid bronchoscopy in patients in whom airway patency cannot be achieved using other flexible bronchoscopic interventions. and accuracy of PET was higher compared to CT with this cut-off value.

Background and Aim. Endobronchial benign tumors are a rarely seen clinical entity but may cause significant symptoms. Endobronchial treatment has the potential for relieving symptoms while saving the patient from invasive surgical procedures. No trials have been published that present and compare the various endobronchial treatment modalities for endobronchial benign tumors. The aim of the present study is to define safety and efficacy of endobronchial treatment in patients with benign endobronchial tumors from the point of complications and success rate.Methods. This study is a retrospective cohort study from a review of medical charts. Eligibility criteria included diagnosis of a benign endobronchial tumor. Our institution’s bronchoscopy and pathology database was searched for specific benign tumors, and the results were further detailed based on the endobronchial location.Results. Forty-four patients with pathologically confirmed benign endobronchial tumors were included. Tumor regression was achieved in all patients with diode laser and argon plasma coagulation in combination with or without cryotherapy and without any major complication. There were no significant differences between the use of either diode laser or of argon plasma coagulation as a modality with immediate effect from the occurrence of residual tissue that needed cryotherapy (P>0.05). There were no major complications. Eight patients had minor complications including minor bleeding (6 patients) and hypertension (2 patients) that were controlled medically. Thirty-one patients (70%) had very good response, and 13 patients (30%) had good response as defined in literature before.Conclusion. Diode laser and argon plasma coagulation in combination with or without cryotherapy are safe and effective methods for endobronchial treatment of benign endobronchial tumors.

Background Endobronchial metastases (EBM) are rarely observed, but they are caused by a number of different tumors. Bronchoscopy is the main approach for both differential diagnosis and to maintain endoluminal palliation. In this study, consecutive EBM cases that had been diagnosed and treated were evaluated in a retrospective cohort. Methods In total, 18 pathologically verified patients with EBM originating from extrathoracic tumors who were referred to our interventional pulmonology unit with respiratory symptoms were retrospectively evaluated. Tumor type, metastasis location, treatment method and frequency, and complications were evaluated. Results In total, there were 18 patients (13 women) with EBM enrolled in this study. All were diagnosed by a bronchial biopsy. The mean age of the patients was 48±15.24 years (range: 24–76 years). The most frequent sites of origin of the metastases were the bone (5) and kidney. Obstructions were observed in the tracheas of 12 patients, in the right main bronchi of 10, and in the left main bronchi of 11. Twelve airway stents were placed in nine patients. The removal of the obstruction was effective in the remaining patients. The mean number of treatment applications was 1.47 (range: 1–3). Hemorrhage, mucostasis, and granulation were observed. The median follow-up duration was 528 days (range: 62–1177 days). The median survival time for the patients who died was 122 days (range: 2–885 days). Conclusions EBM is rare, and bronchoscopy is the primary method of diagnosis, followed by palliation, if necessary.

Background/aim: Tracheobronchomalacia (TBM) leads to the obstruction of expiratory airflow and interference with secretion clearance. Stabilization of the airway wall using a silicon stent or laser coagulation of the posterior wall may be treatment options.1397645907This study aimed to retrospectively analyze which interventional bronchoscopic method could be used to provide airway stabilization and gain control of symptoms and for whom this method could be used. Materials and methods: Fifteen patients who had received treatment in our interventional pulmonology unit were analyzed. We analyzed the techniques used, stent duration, complications, and long-term treatment success retrospectively. Results: Stents were used in 10 patients: 4 patients had silicon Y-stents and 4 patients had silicon tracheal stents. Stents were removed due to early migration in 3 patients. In 5 of the 71397645907cases, the stent was removed due to frequent obstructions of the stent due to recurrent severe mucostasis. A suitable stent was not found for one patient who had an extremely enlarged trachea. Good clinical results were achieved in just two cases. The frequency of admissions to the emergency room and hospitalizations were diminished during the follow-up time in these two patients. Conclusion: Silicon stents may be a good treatment option in selected patients with TBM and dynamic collapse. However, our patients were high-risk; thus, the criteria for candidates for bronchoscopic treatment should be carefully defined.

BACKGROUND: Hemodialysis (HD) patients are at increased risk of reactivation of latent tuberculosis infection (LTBI) compared with the general population. QuantiFERON-TB Gold (QFT-G) for LTBI detection is more promising than tuberculin skin test (TST) in HD patients. AIM: In our study, we evaluated the value of the TST and QFT-G In-Tube (QFG-IT) test in the development of active tuberculosis (TB), in the HD patients, and in healthy controls. METHODS: The study enrolled 95 HD patients and ninety age-matched, healthy controls. The TST and QFG-IT were performed. All the subjects were followed up 5 years for active TB disease. RESULTS: Compared to the healthy controls, a high prevalence of LTBI was found in the HD patients by QFG-IT (41% vs. 25%). However, no significant difference was detected by TST (32% vs. 31%). Four HD patients and one healthy control progressed to active TB disease within the 5-year follow-up. For active TB discovered subjects, QFG-IT was positive in all, but TST was positive in two (one patient and one healthy control). In HD patients; sensitivity, specificity, positive and negative predictive values of QFG-IT, and TST for active TB was 100% and 25%, 62% and 67%, 10%, and 3%, and 100% and 95%, respectively. Receiver operating curve analysis revealed that the results are significantly different (P = 0.04). CONCLUSION: QFG-IT test is a more useful diagnostic method than TST for detecting those who will progress to active TB in HD patients.

Sulfasalazine is a compound of 5-aminosalicylic acid and sulfapyridine joined by an azo bond. There are only case reports in the literature about pulmonary toxicity caused by this drug. A 23-year old man diagnosed as ulcerative colitis 3 months ago admitted to our hospital with a 1 month history of fever, cough, dyspnoea. He didn9t respond to antibiotics. He was a nonsmoker and had been on sulfazalazine and mesalazine treatment for 8 weeks. All of his medications were held on admission. He had fever (38.6 °C) with respiratory rate of 20/min with normal oxygen saturations in room air Physical examination revealed crepitation over right lung on auscultation. Chest radiograph showed multilobar pulmonary infiltrates dominated right lung peripherally. He has peripheral eosinophilia. For differential diagnosis, an autoimmune screen, Ig E level and parasite search in his feces was negative. Sputum culture was negative for pathogenic bacteria and acid-fast bacilli. HRCT revealed patchy consolidations at all zones of the right lung and upper zone of left lung, peribronchial and interlobuler septal thickenings, ground glass opasities. No endobronchial pathology was detected. Bronchoalveolar lavage done from medial segment of right middle lobe was negative for viral, tuberculous and fungal infections. The differential cell count showed 20% eosinophils. After withdrawal of sulfazalazine, pulmonary infiltrates started to regress in the control chest radiograph but respiratory symptoms were not resolved completely so oral prednisone treatment was started. 2 weeks later, his chest radiograph was dramatically improved with near complete resolution of the pulmonary infiltrates. The patient is in our follow up for 6 months without any symptoms.

Background/Aim: Obstructive sleep apnea syndrome (OSAS) is associated with intermittent episodes of hypoxia, endothelial dysfunction and associated cardiovascular problems. Our aim was to investigate whether OSAS-related hypoxia alters the expression of rho-associated protein kinase (ROCK), a marker of chronic hypoxia and endothelial dysfunction. Materials and Methods: ROCK1 and ROCK2 levels were measured by immunoblotting in peripheral blood mononuclear cells (PBMC) of 47 OSAS patients and 17 healthy controls. Results: OSAS patients showed significantly lower PBMC ROCK1 and ROCK2 levels than healthy controls in the morning, but not in the evening. ROCK1/2 levels were correlated with blood triglyceride, visceral adiposity index, minimum oxygen saturation, C-reactive protein concentration, lymphocyte levels and sleep efficiency. Conclusion: Intermittent hypoxia induced by OSAS does not permanently alter ROCK protein expression levels. OSAS appears to be associated with endothelial dysfunction through inflammation and lipid metabolism pathways.

INTRODUCTION: Many studies have evaluated the relationship between the NLR and PLR in patients with obstructive sleep apnea (OSA), and have shown that they are related to inflammation. We evaluated whether 3 months of continuous positive airway pressure (CPAP) treatment in patients with moderate to severe OSA without any comorbidities would affect the NLR and PLR values. METHODS: Full blood count parameters were evaluated before and after 3 months of CPAP treatment in patients with a diagnosis of moderate to severe OSA without any comorbidities. RESULTS: Twenty-nine patients (18 [62.1%] males) were enrolled. The mean body mass index (BMI) was 34.85±5.75 kg/m2, the apnea-hypopnea index score was 49.85±27.42, and CPAP was 9.34±1.77. No significant change in BMI was observed after the third month of treatment. Although the Epworth Sleepiness Scale (ESS) score decreased significantly (p=0.000), no changes were observed in the NLR, PLR, or C-reactive protein level (p>0.05). Mean platelet volume and red blood cell distribution width changed significantly after treatment (p=0.01; p

Resumen Objetivo La inflamacion del endotelio vascular y el aumento del estres oxidativo son factores patogenicos importantes del sindrome de apnea obstructiva del sueno (SAOS). El objetivo de este estudio fue determinar las concentraciones de las proteinas de estres (HSP) 27, HSP70 y HSP90, L-arginina y dimetilarginina simetrica (ADMA) en pacientes con SAOS y establecer su relacion con factores de riesgo cardiovascular (CV). Material y metodos En el estudio se incluyo a 40 pacientes con SAOS, 26 de los cuales presentaban factores de riesgo CV tradicionales (obesidad, hipercolesterolemia, diabetes, hipertension y tabaquismo) y 14 no los presentaban, y 20 sujetos de control que no padecian SAOS. A todos los pacientes se les realizo una evaluacion polisomnografica completa y se extrajeron muestras de sangre en la manana siguiente al estudio diagnostico. Resultados No se observaron diferencias significativas entre grupos en las concentraciones sericas de HSP27 y HSP70. En los pacientes con SAOS, con o sin factores de riesgo CV, se observaron aumentos significativos de las concentraciones de HSP90 y ADMA y disminuciones significativas de las concentraciones de L-arginina, en comparacion con los sujetos de control, aunque no hubo diferencias entre los subgrupos. En todos los pacientes con SAOS, las concentraciones sericas de HSP70 se correlacionaron positivamente con porcentajes de tiempo con saturacion Conclusion Las concentraciones sericas de HSP90 y ADMA aumentaron y las de L-arginina disminuyeron en pacientes con SAOS, independientemente de los factores de riesgo CV que presentasen. Estos resultados indican la presencia de estres oxidativo y disfuncion endotelial en pacientes con SAOS.

The purpose of this study was to evaluate results from computed tomography pulmonary angiography (CTPA) indicative of right ventricular dysfunction (RVD), and to assess the relationship of these results with cardiac biomarkers and mortality among patients with acute PE. This retrospective study involved 118 patients with acute PE proved by CTPA. CTPA variables were analyzed and compared with cardiac biomarkers and echocardiography (ECHO) findings. Compared with ECHO, the sensitivity, specificity, positive predictive value, and negative predictive value of CTPA for detection of RVD were 85.7, 91.7, 93.7, and 81.5 %, respectively. ROC curve analysis for prediction of RVD resulted in areas under the curve of 0.925 for RV dimension (95 % CI 0.879−0.971, p

Objective: The aim of our study is to discuss our experience with foreign body aspirations in our Interventional Pulmonology Unit. Methods: Patients who were referred to our Interventional Pulmonology Unit between January 2008 to November 2014 for foreign body aspiration and whom foreign body was sentential by intervention were included. Data were used from a retrospective analysis. Results: From the 28 patients, 64.3% of them were women and mean age of the patients were 43.5±21.54 years. Most common presenting symptom was cough (96.3%). Half of the patients were presented in 24 hours after the procedure. From the 5 patients that have undergone diagnostic broncoscopy by fiberoptic bronchoscope, foreign body was removed in 3 of them. Rigid bronchoscopy was done in 25 (89.3%) of the patients. In 3 of the patients foreign body cannot be detected by bronchoscopy and removed by surgery. 67.9% of the foreign bodies that were removed were inorganic in nature. Conclusion: Bronchoscopic approaches are effective to decrease mortality and morbidity for the diagnosis and treatment of foreign body aspirations in adults. Rigid bronchoscopic approach should be the first choice in foreign body aspirations but fiberoptic bronchoscopy can also be used in selective cases by experienced physicians.

Introduction The gold standard therapy for obstructive sleep apnoea syndrome (OSAS) is continuous positive airway pressure (CPAP). Our study evaluated the relationship between first night satisfaction and CPAP compliance, and the effect of using the titration method in this relationship. Methods Between January 2012 and December 2012, 40 patients with the diagnosis of OSAS and without comorbidities, who had undergone CPAP titration, were included. Of these, 20 patients had undergone manual titration (MT) with polysomnography, whereas 20 patients had undergone auto-adjusted CPAP (APAP) titration. Questionnaires were administered during the morning of the titration night. The first-year adherence to treatment and patient compliance were evaluated. Results Forty patients were randomised in two groups; 35 patients who could procure the CPAP and were available at the end of the first year completed the study. From the 35 patients, 20 (6 males; 40%) were in the MT group while 15 (6 males; 30%) were in the APAP group. No significant difference was detected between the mean titration pressure levels obtained with the MT or APAP group. There was no difference in terms of responses to the questions on the questionnaire between the two groups. At the first-year evaluation, no significant difference was detected between the groups. Conclusions The titration method used to detect CPAP pressure, MT, or APAP does not affect patient satisfaction on the day following the titration night, and does not affect first-year compliance.

WOS: 000350052900006 PubMed ID: 25549699 Background: The differential diagnostic utilities of the levels of soluble interleukin (IL)-12p40 and the IL-2 receptor in sera and pleural effusions were evaluated in patients with exudative pleural effusions. Methods: We enrolled a total of 120 patients with exudative pleural effusions. The clinical, radiological, and histopathological diagnoses were tuberculous pleurisy in 52, malignant pleurisy in 39, and parapneumonic effusions in 29 patients. Results: We measured serum IL-12p40 and adenosine deaminase (ADA) levels in patients with tuberculous pleurisy and in a control group treated for pleural effusion to determine if such levels were useful in the diagnosis of pleural effusion (p < 0.005). Definite microbiological or histopathological diagnoses of tuberculous pleurisy or pleural effusion were recorded, and we found that ADA and serum soluble IL-2 receptor levels aided in diagnosis (p < 0.001). The levels of ADA and soluble IL-2 in pleural effusions afforded sensitivities and specificities of 84.62% and 82.69% and of 70.59% and 80.88%, respectively. The soluble IL-2 receptor level afforded a sensitivity and specificity of 82.69% and 52.9%. IL-12p40 levels in pleural effusions and sera afforded sensitivities and specifi cities of 80.77% and 80.77% and of 60.29% and 39.71%, respectively. Conclusion: Soluble IL-2 receptor levels in patients with tuberculous pleurisy serve as markers of disease in non-endemic countries, similarly to ADA levels.

The cardiovascular complications caused by obstructive sleep apnea (OSA) decrease after continuous positive airway pressure treatment (CPAP). Mean platelet volume (MPV), platelet distribution width (PDW), and red cell distribution width (RDW) are newly recognized tools for assessing cardiovascular risk.From a selection of patients with symptoms of nocturnal snoring and/or excessive daytime sleepiness, 36 males with an apnea-hypopnea index (AHI)30/h and 22 age-matched normal male controls with AHI5/h were included. Patients with OSA underwent another night of CPAP titration, and 11 patients were excluded at the 6-month evaluation due to poor compliance with the home CPAP therapy. Complete blood count parameters of compliant patients and the control group were evaluated.Compared to controls, MPV values were significantly higher (p = 0.025) in OSA patients, but no significant differences in PDW or RDW were found (p0.05). Six months of CPAP therapy resulted in significantly lower MPV values but increased values of PDW and RDW in patients with severe OSA (p = 0.001, p = 0.007, p = 0.001, respectively).Our data suggest that complete blood count parameters in OSA patients such as MPV, PDW and RDW change significantly after CPAP therapy.

Objetivo El sindrome de apnea obstructiva del sueno (SAOS) puede fomentar la hiperglucemia y la resistencia a la insulina. Nuestro objetivo es investigar el efecto del SAOS sobre la glucosa plasmatica en ayunas, la hemoglobina glucosilada (HbA1c) y la proteina C reactiva (PCR) en pacientes no diabeticos. Material y metodos Se determinaron los parametros de analitica hematica de 90 pacientes no diabeticos consecutivos en los que se realizaron evaluaciones polisomnograficas en nuestro laboratorio del sueno. Un total de 61 de estos pacientes con una glucemia en ayunas normal fueron clasificados segun el indice de apnea-hipopnea (IAH) como casos leves (n = 16, 26,2%), moderados (n = 18, 29,5%) o graves (n = 27, 44,2%) de SAOS. Se efectuaron determinaciones de la glucosa plasmatica en ayunas, la HbA1c y la PCR. Resultados La media de edad de los pacientes fue de 47,7 ± 11,2 anos, y el 72% eran varones. Los niveles de HbA1c y de glucosa en ayunas presentan una correlacion positiva con el IMC (r = 0,503, p = 0,00; r = 0,258, p = 0,045). No se detecto relacion alguna de la HbA1c con el indice de apnea ni con el IAH, mientras que si se observo una correlacion positiva de la glucosa en ayunas con la PCR (r = 0,262, p = 0,042; r = 0,258, p = 0,045). Los niveles de HbA1c, glucosa en ayunas y PCR muestran una correlacion negativa con los valores de SpO2 minima (con valores de r = �0,302, p = 0,018; r = �0,368, p = 0,004; r = �0,365, p = 0,004, respectivamente). Los niveles de HbA1c, glucosa en ayunas y PCR muestran una correlacion positiva con el indice de desaturacion medio (tiempo durante el que la SpO2 es < 90% segun la pulsioximetria) (r = 0,263, p = 0,041; r = 0,311, p = 0,015; r = 0,283, p = 0,027). Conclusiones Aunque no se detecto relacion alguna entre el aumento de los niveles de HbA1c o de glucosa y la gravedad del SAOS en los pacientes con SAOS no diabeticos, si se detecto una correlacion con la hipoxia nocturna. Esto podria poner de manifiesto el efecto de la hipoxia nocturna sobre el metabolismo de la glucosa en los pacientes con SAOS.

Aim Obstructive sleep apnea syndrome (OSAS) may promote hyperglycemia and insulin resistance. Our aim is to investigate the effect of OSAS on the fasting plasma glucose, glycosylated hemoglobin (HbA1c), and C reactive protein (CRP) in nondiabetic patients. Materials and methods Blood parameters of consecutive 90 non diabetic patients whom polysomnografic evaluations were done in our sleep laboratory was evaluated. Among these 61 patients with normal fasting blood glucose were classified due to their apne-hipopnea index (AHI) as mild (n=16, 26.2%), moderate (n=18, 29.5%) and severe (n=27, 44.2%) OSAS. The fasting plasma glucose, HbA1c and CRP were measured. Results Mean age of the patients was 47.7±11.2 years, 72% male. HbA1c, fasting glucose levels show positive correlation with BMI (r=.503, P=.00; r=.258, P=.045). No relation of HbA1c to apnea index nor AHI was detected while positive correlation of fasting glucose and CRP was detected (r=.262, P=.042; r=.258, P=.045). HbA1c, fasting glucose and CRP levels show negative correlation with minimum SpO2 levels (by order of r=–.302, P=.018; r=–.368, P=.004; r=–.365, P=.004). HbA1c, fasting glucose levels and CRP levels show positive correlation with mean desaturation index (time duration in which SpO2 Conclusions Although no relation in between increased HbA1c or glucose levels and severity of OSAS was detected in nondiabetic OSAS patients, the correlation with the night hypoxia was detected. This could also show the effect of night time hypoxia on glucose metabolism in OSAS patients.

Primary malignant melanoma of the lung is an uncommon neoplasm that may be confused with more conventional types of lung cancer. We report a case of primary malignant melanoma of the lung in a 53-year-old man presenting with hemoptysis. Clinical and pathological review confirmed primary malignant melanoma of the lung. Tumor seeding was occurred as a complication of needle-track implantation. Relevant clinical and histopathological features and the criteria for diagnosis are reviewed.

Tuberculosis can mimic all pathological considerations of the lung and can present in many various forms and appearances. Most common radiographic appearances are cavitary, fibroproductive, exudative, acinary, micro and macronodular and miliary types. Six patients (5 men; ages ranging from 38 to 74 years) who presented at our clinic during previous years were evaluated. In this case series report we discussed the consideration that, very rarely, postprimary lung tuberculosis presenting with large nodular and masslike forms in a chest X-ray or tomography scan, can be considered as having a neoplastic pattern.

Reaching the differential diagnosis of tuberculosis and sarcoidosis can be difficult due to granulomatous inflammation. Determining alkaline phosphatase (ALP) activity in serum for the differential diagnosis of tuberculosis and sarcoidosis. This study comprised 104 acid-fast bacilli (AFB) positive patients with pulmonary tuberculosis, 90 patients with biopsy-proven sarcoidosis and 43 healthy controls were included. ALP activity was measured at the first admission of the patients. There was a significant difference between the tuberculosis and the control (p= 0.03). Also, there was a significant difference between the tuberculosis and sarcoidosis (p= 0.034) According to the comparison of tuberculosis and sarcoidosis, the cut-off value was determined as 71.50 IU/L, which had sensitivity of 80%, specificity of 51%, PPV of 66%, NPV of 69%, accuracy of 67%, and the AUC was 0.728. ALP, as a little-known marker for tuberculosis and sarcoidosis, was increased in the pulmonary tuberculosis compared with the sarcoidosis. As such, it may be a useful tool for the differentiation of tuberculosis and sarcoidosis.

Bronchobiliary fistula (BBF) is a rare condition in which an abnormal communication exists between the bile ducts and the bronchial tree. Malignancy is the most common etiology of BBF, although many others are possible. A 74-year-old male patient with an inoperable Klatskin tumor presented with a complaint of yellow-green sputum and cough; the patient underwent fiber-optic bronchoscopy based on a preliminary diagnosis of bronchobiliary fistula. Using fiber-optic rigid bronchoscopy, the laterobasal segment of the lower right lung lobe was occluded using three pieces of 5-mm Endobronchial Watanabe Spigot. Bile drainage subsequently ceased. A bronchoscopic approach provides an alternative option for BBF treatment, particularly in patients who choose not to undergo surgery, or for whom surgery is not an option due to their underlying general condition.

Seda Tural Onur,1 Sinem Nedime Sokucu,1 Levent Dalar,2 Sinem Iliaz,1 Kaan Kara,1 Songül Buyukkale,3 Sedat Altin1 1Department of Chest Diseases, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, 2Department of Pulmonary Medicine, Faculty of Medicine, Istanbul Bilim University, 3Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey Background: Malignant mesothelioma (MM) is an aggressive asbestos-related pleural tumor. The incidence is increasing with intensive use of asbestos in developing countries. We need an easily accessible, inexpensive, and reliable method for determining the low survival time prognosis of this tumor. The aim of our study was to investigate the viability of neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) as prognostic indicators in MM. Patients and methods: Thirty-six patients with MM, whose histopathologic diagnosis and follow-up were performed by our clinic and whose complete archive data were accessible, were included in this retrospective study. The patients’ histopathologic disease types and stages, complete blood count parameters at diagnosis, and survival were recorded. Results: Eighteen of the patients with MM were male and the remaining 18 of them were female; the average follow-up period was 24.83±3.61months. The PLR levels of the patients were statistically significant (P