Long term effects of tear gases on respiratory system: analysis of 93 cases.

AIM: This study aimed to assess the long-term respiratory effects of tear gases among the subjects with history of frequent exposure. MATERIALS AND METHODS: A questionnaire by NIOSH and pulmonary function tests was performed in 93 males exposed to the tear gases frequently and 55 nonexposed subjects. RESULTS: The mean numbers of total exposure and last 2 years exposure were 8.4 ± 6.4 times, 5.6 ± 5.8 times, respectively. Tear gas exposed subjects were presented with a higher rate for cough and phlegm more than 3 months (24.7% versus 11.3%, P > 0.05). Mean FEV1/FVC and % predicted MMFR in smoker exposed subjects are significantly lower than those in smoker controls (81.7% versus 84.1%, P = 0.046 and 89.9% versus 109.6%, P = 0.0004, resp.). % predicted MMFR in nonsmoker exposed subjects is significantly lower than that in nonsmoker controls (99.4% versus 113.1%, P = 0.05). Odds ratios for chest tightness, exercise dyspnea, dyspnea on level ground, winter morning cough, phlegm, and daily phlegm were increased almost 2 to 2.5 folds among tear gas exposed subjects. CONCLUSION: The rates for respiratory complaints were high in the case of the exposure to the tear gases previously. Tears gas exposed subjects were found to be under the risk for chronic bronchitis.

Serum endothelial monocyte-activating polypeptide-II: a novel biomarker in patients with non-small-cell lung cancer.

BACKGROUND: Endothelial monocyte-activating polypeptide-II (EMAP-II) is a proinflammatory cytokine with antiangiogenic properties. Serum EMAP-II levels have not been investigated previously in non-small-cell lung cancer (NSCLC). The aim of this study was to examine the relationship between serum EMAP-II levels and clinicopathologic features, including prognosis, in patients with NSCLC. PATIENTS AND METHODS: We measured serum EMAP-II levels in 30 healthy control subjects and 48 patients with untreated NSCLC by enzyme linkedimmunosorbent assay. RESULTS: Patients with NSCLC had significantly higher serum EMAP-II levels than did the control group (492 pg/mL +/- 1126 pg/mL vs. 266 pg/mL +/- 1013 pg/mL; P = .015). No significant association was found between serum EMAP-II levels and various clinicopathologic features (age, smoking history, performance status, histopathology, tumor stage, lymph node stage, or distant metastasis). Median survival time was 10.13 months (range, 2-53.8 months). The high-EMAP-II (>or= 100 pg/mL) group had a shorter survival compared with the low-EMAP-II (< 100 pg/mL) group (P = .023), and the serum EMAP-II level was still an important predictor of survival in a multivariate analysis, along with disease stage. CONCLUSION: Our results showed that serum EMAP-II levels are significantly higher in patients with NSCLC than in healthy subjects and suggest it is of potential prognostic value.

High CD95 expression of BAL lymphocytes predicts chronic course in patients with sarcoidosis.

BACKGROUND AND OBJECTIVES: The prognosis of sarcoidosis is highly variable, with spontaneous remission in some patients. Apoptosis may be associated with spontaneous resolution of the granulomata. CD95 (Fas), an apoptotic molecule, and CD29 and CD45RO (T-cell memory markers) are expressed at higher levels on T lymphocytes from sarcoid patients compared with normal subjects. However, the prognostic significance of CD95, CD29 and CD45RO expression in sarcoidosis is not clear. It was hypothesized that expression of CD95 would correlate with spontaneous remission. METHODS: CD29, CD45, CD45RO and CD95 expression of BAL fluid and peripheral blood (PB) lymphocytes was studied with flow cytometry in 50 patients with sarcoidosis. Results of the 15 chronic patients and 21 patients who remitted spontaneously were compared. RESULTS: BAL CD95 (59 vs 8, P = 0.002), and PB CD95 (48 vs 18, P = 0.004) and PB CD45RO (50 vs 41, P = 0.003) expression was significantly higher in patients with chronic disease compared with those with spontaneous remission. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy for these markers were: BAL CD95 (cut-off: 42.5%) 73.3%, 85.7%, 78.6%, 81.8% and 80.6%; PB CD95 (cut-off: 25%) 86.7%, 66.7%, 65%, 87.5% and 75%; and PB CD45RO (cut-off: 44.5%) 80%, 61.9%, 60%, 81.3% and 69.4%, respectively. CONCLUSION: Levels of BAL and PB CD95 and PB CD45RO were unexpectedly elevated in patients with chronic disease and may be useful in predicting prognosis in patients with sarcoidosis. Further studies with more patients are necessary to confirm the prognostic role and cut-off value for these markers.

Exercise capacity in sarcoidosis. Study of 29 patients.

BACKGROUND AND OBJECTIVE: Sarcoidosis is a systemic granulomatous disease of unknown etiology. Aims of this prospective study are to evaluate degree of impairment in pulmonary function tests (PFT), arterial blood gas analysis (ABG), respiratory muscle strength, exercise capacity and correlation of these parameters with radiological stages; to further evaluate the use of cardiopulmonary exercise testing in assessment of extent of pulmonary disease; and to discuss the pathophysiologic mechanisms of limitation in exercise capacity in patients with sarcoidosis. PATIENTS AND METHOD: 29 patients with sarcoidosis were grouped according to their radiological stages (stage I: group 1; stage II, group 2; stage III, group 3). Groups 1, 2 and 3 included 11, 13 and 5 patients, respectively. PFT, cardiopulmonary exercise testing and ABG were performed for each patient. RESULTS: Evaluation of all patients showed a significant decrement in exercise capacity. Patients in stage III had decreased diffusing capacity and exercise capacity. There was limitation in exercise capacity in stage I patients who had completely normal spirometry and diffusing capacity. We also found a correlation between radiological stages of the disease and exercise capacity, diffusing capacity and ABG. CONCLUSIONS: Exercise capacity is impaired also in early stages of sarcoidosis and it was found to be the earliest impaired physiological parameter in sarcoid patients. Exercise intolerance, having mutifactorial basis, is correlated with radiological stages. Circulatory impairment and impaired heart rate response to exercise have effects on limitation in exercise capacity. Especially in advanced radiological stages of disease, ventilatory and gas exchange impairment also seems to be effective on limiting exercise in patients with sarcoidosis.

Exercise capacity in sarcoidosis. Study of 29 patients

FUNDAMENTO Y OBJETIVO: La sarcoidosis es una enfermedad sistémica granulomatosa de etiología desconocida. Los objetivos de este estudio prospectivo fueron evaluar el grado de deterioro delas pruebas funcionales respiratorias, la gasometría arterial, la fuerza de la musculatura respiratoria y la capacidad de ejercicio, así como la correlación de estos parámetros con los estadios radiológicos. Además, se decidió evaluar la utilización de las pruebas de ejercicio cardiorrespiratorio en la valoración de la extensión de la enfermedad pulmonar y, por último, discutir los mecanismos fisiopatológicos de limitación de la capacidad de ejercicio en los pacientes con sarcoidosis. PACIENTES Y MÉTODO: Se incluyó a 29 pacientes, que fueron agrupados según sus estadios radiológicos(estadio I, grupo 1; estadio II, grupo 2; estadio III, grupo 3). Los grupos 1, 2 y 3 incluyeron11, 13 y 5 pacientes, respectivamente. En cada paciente se realizaron pruebas de funcionalismo respiratorio, pruebas de ejercicio cardiorrespiratorio y gasometría arterial. RESULTADOS: Se observó una disminución significativa de la capacidad de ejercicio. Los pacientes del estadio III tenían una disminución de las capacidades de difusión y de ejercicio. Se observó una limitación de la capacidad de ejercicio en los pacientes del estadio I que, por otra parte, mostraron una capacidad de difusión y espirometría normales. También observamos una correlación entre los estadios radiológicos de la enfermedad y la capacidad de ejercicio, capacidad de difusión y gasometría arterial. CONCLUSIONES: La capacidad de ejercicio está deteriorada en los estadios iniciales de la sarcoidosis y éste fue el parámetro fisiológico más precozmente deteriorado en estos pacientes. La intolerancia al ejercicio, con una base multifactorial, se correlaciona con los estadios radiológicos. La afección circulatoria y la respuesta alterada de la frecuencia cardíaca al ejercicio tienen efectos sobre la limitación de la capacidad de ejercicio. Especialmente en los estadios radiológicos avanzados de la enfermedad, el deterioro ventilatorio y del intercambio gaseoso parecen tener asimismo influencia sobre la limitación del ejercicio en pacientes con sarcoidosis

BACKGROUND AND OBJECTIVE: Sarcoidosis is a systemic granulomatous disease of unknown etiology. Aims of this prospective study are to evaluate degree of impairment in pulmonary function tests (PFT), arterial blood gas analysis (ABG), respiratory muscle strength, exercise capacity and correlation of these parameters with radiological stages; to further evaluate the use of cardiopulmonary exercise testing in assessment of extent of pulmonary disease; and to discuss the pathophysiologic mechanisms of limitation in exercise capacity in patients with sarcoidosis. PATIENTS AND METHOD: 29 patients with sarcoidosis were grouped according to their radiological stages (stage I: group 1; stage II, group 2; stage III, group 3). Groups 1, 2 and 3 included 11,13 and 5 patients, respectively. PFT, cardiopulmonary exercise testing and ABG were performed or each patient. RESULTS: Evaluation of all patients showed a significant decrement in exercise capacity. Patients in stage III had decreased diffusing capacity and exercise capacity. There was limitation in exercise capacity in stage I patients who had completely normal spirometry and diffusing capacity. We also found a correlation between radiological stages of the disease and exercise capacity, diffusing capacity and ABG. CONCLUSIONS: Exercise capacity is impaired also in early stages of sarcoidosis and it was found to be the earliest impaired physiological parameter in sarcoid patients. Exercise intolerance, having mutifactorial basis, is correlated with radiological stages. Circulatory impairment and impaired heart rate response to exercise have effects on limitation in exercise capacity. Especially in advanced radiological stages of disease, ventilatory and gas exchange impairment also seems to be effective on limiting exercise in patients with sarcoidosis

Solitary adrenal metastasis in large cell carcinoma of lung.

Metastatic non-small cell lung cancer (NSCLC) has a poor prognosis. Adrenal metastasis (AM), in NSCLC, are present in 5-10% of patients at initial presentation. Several case reports have shown that operation of isolated AM results in longer survival time. We describe a 55 year-old man with diagnosis of NSCLC with operable lung tumor and solitary AM treated with combination of neoadjuvant chemotherapy followed by primary site and metastasis surgery. He was diagnosed on March 2002 and is still alive.

Effects of antithyroid medication on the flow-volume loop in patients with hyperthyroidism.

This prospective study was designed to evaluate the effects of hyperthyroidism on flow-volume loops in nonasthmatic 20 patients with hyperthyroidism. Thyroid related hormones (Total T3, Total T4 and TSH), thyroid gland volumes with ultrasonography, circumference of neck values and flow-volume loops were obtained at the beginning and after three months of antithyroid treatment. Propylthiouracil treatment was followed by a statistically significant decrease in thyroid gland volume and circumference of neck (p< 0.001 and p< 0.001, respectively). The most significant result was improvement of maximum midexpiratory flow rate (MMEFR) after propylthiouracil therapy for three months (p= 0.003). Increases in mean forced expiratory flow after 25% of FVC has been exhaled (FEF25), mean forced expiratory flow after 75% of FVC has been exhaled (FEF75) values were found consistent with the overall improvement in expiratory flow parameters (p= 0.044, p= 0.012 respectively). In conclusion, we speculated that improvement of expiratory flow parameters might be the earlier changes in flow volume loops of patients who were treated with propylthiouracil for hyperthyroidism.

Serum oxidant and antioxidant levels in diesel exposed toll collectors.

It has been suggested that exposure to diesel exhaust may lead to adverse effects due to the generation of oxidants. To evaluate the end products of oxidative stress in DE exposure, toll collectors who are considered a high risk group in regard to occupational toxins were compared to controls who had office-based occupations in the same company in this cross sectional study. A total of 38 toll collectors constituted the study group. All subjects were male. The toll collectors and 29 controls were similar regarding age, smoking status and duration of work. All subjects underwent a clinical examination and an interviewer-administrated questionnaire regarding respiratory symptoms, past medical and occupational history, and pulmonary function tests were performed in all subjects. Serum malondialdehyde (MDA), nitrite+nitrate and vitamin E levels were measured. Toll collectors showed higher serum MDA (5.76 +/- 2.15 micromol/L vs. 3.07 +/- 0.76 micromol/L, p=0.0001) and nitrite+nitrate levels (96.50 +/- 45.54 micromol/L vs. 19.32 +/- 11.77 micromol/L, p=0.0001) than controls. Vitamin E levels were similar in toll collectors and controls (10.57 +/- 3.44 mg/L and 9.72 +/- 2.44 mg/L, respectively, p=0.267). There was no difference between groups in terms of the findings of clinical examinations and respiratory symptoms. In pulmonary function parameters, only peak expiratory flow (PEF) in toll collectors was significantly lower than that of controls (88.9% predicted and 104.2% predicted, respectively, p=0.012). In conclusion, we suggest that serum MDA and nitrite+nitrate levels may be used as biological markers of oxidative stress related to DE exposure, but prospective controlled clinical studies are necessary to clarify the possible association between concentrations of MDA and nitrite+nitrate and pulmonary diseases related to DE exposure.

[Familial history of cancer and lung cancer]. / Ailesel kanser hikayesi ve akciger kanseri.

There are many studies supporting the family history in lung cancer. In this study, we observed 1500 with lung cancer cases diagnosed between the years 1995-2000 in our clinic, and investigated family tendency of lung cancer in a control group including partners of 600 patients with family history of cancer. We conducted face-to-face interviews with 100 patients with lung cancer, and with first degree relatives of the other 1400 patients with lung cancer. There were 600 positive family history of cancer. Control populations were matches of the cancer patients with positive family history of cancer. Cases and controls were asked to report on their family history of cancer, as well as smoking status of family members. In conclusion, in 40% of 1500 patients with lung cancer, there was positive family history of lung cancer with regard to malignity. This positive family history of cancer was consisted of 51.8% lung cancer, 35.5% digestive cancer and 12.7% other cancers such as breast, larynx, prostate and bone. In control group, the value of the positive family history of lung cancer with regard to malignity was 5.0% (p< 0.001). These results support the hypothesis of a genetic susceptibility by showing that the patients with lung cancer have significantly more positive family history of lung cancer and digestive cancer.

Respiratory symptoms and peak expiratory flow rates among furniture-decoration students.

This study was designed to evaluate the effects of furniture production, mainly including fir tree (aberia mulleriana), on respiratory health of young workers and to compare the results with those obtained from previous studies. Sixty-four furniture-decoration students (57 males and 7 females) and 62 controls (54 male, 8 female) from different departments in the same school were included into the study. All participants were assessed with a questionnaire (concerning history of occupational exposure, work-related respiratory and other symptoms, smoking history, previous asthma history), full physical examination, spirometric evaluation and chest radiograph. Participants then performed serial monitoring of peak expiratory flow rates (PEFR) at work and away from work within a month. Mean age of students was 20.9 +/- 3.7 years, 20.5 +/- 2.6 years in controls. There was no difference between study and control groups with regard to age, gender, smoking status and previous asthma history. Reported cough (23.4 % vs. 8.1 %) and shortness of breath (18.8 % vs. 6.5 %) were significantly higher in furniture-decoration students than in controls (p = 0.016 and p = 0.034, respectively). Furniture-decoration students had higher conjunctivitis (34.4 % vs. 9.7 %, p = 0.001) and rhinitis (34.4 % vs. 19.4 %, p = 0.044) history when compared with controls. Both students and controls were normal in terms of respiratory examination. PEF recordings were performed for approximately one month. Diurnal variability greater than 20 % was seen in 12/64 (18.7 %) of students at work, whereas it was detected in 4/62 (6.4 %) of controls (p = 0.034). When comparing for the presence of diurnal variability greater than 20 % in weekends, no difference was found between groups (p = 0.457). In conclusion, early detection of work-related respiratory changes by serial monitoring of peak expiratory flows should save the workers from hazardous respiratory effects of the furniture production, especially in young population.

Multiple endobronchial mass lesions due to sarcoidosis.

Sarcoidosis is a systemic granulomatous disease that primarily affects the lung and lymphatic systems of the body. The lungs are affected in over 90% of sarcoid patients. Although paranchymal lung disease is more common, the airways may also be involved. Bronchial mucosa is often affected in sarcoidosis, but endobronchial mass lesions are very rare. We present a case with multiple endobronchial mass lesions due to sarcoidosis.