Venous hemangioma of the anterior mediastinum.

Mediastinal hemangiomas are rare tumors, with an incidence of 0.5% or less. We herein present a case of venous hemangioma in the anterior mediastinum. A 61-year-old man was admitted to our hospital complaining of dyspnea. Computed tomography scan of the thorax showed a 2.5 × 3.2 × 2 cm mass in the anterior mediastinum. Using a median sternotomy approach, the tumor was completely removed. Pathological examination confirmed a venous hemangioma.

Early Detection of Bi-ventricular and Atrial Mechanical Dysfunction Using Two-Dimensional Speckle Tracking Echocardiography in Patients with Sarcoidosis.

PURPOSE: Sarcoidosis is a systemic inflammatory disease with unknown etiology involving several organs. Myocardial involvement, pericarditis, severe rhythm abnormalities, and heart valve disease due to papillary muscle dysfunction are some of the cardiac manifestations. Conventional echocardiographic methods remain insufficient for the determination of subclinical myocardial dysfunction in patients with sarcoidosis. In our study, we investigated the impact of sarcoidosis on bi-ventricular and atrial functions using two-dimensional (2D) speckle tracking echocardiography (STE). METHODS: Forty patients with sarcoidosis and 20 age and sex-matched controls were recruited into study. All subjects underwent a transthoracic echocardiography for the evaluation of ventricular and atrial functions with 2D STE. RESULTS: Left ventricular (LV) dimensions, LV ejection fraction, and right ventricular (RV) systolic velocity were similar between the two groups. Left atrial (LA) diameter was significantly higher in sarcoidosis patients than controls. Eighteen (45%) patients in the sarcoidosis group and 1 (5%) patient in the control group had LV diastolic dysfunction. LV global longitudinal, radial, circumferential strain, twist, untwists, and RV global longitudinal strain values were significantly lower in sarcoidosis patients compared to controls. LA and RA reservoir functions were also significantly lower in sarcoidosis patients than controls. CONCLUSION: Although impaired LV diastolic function was detected using conventional parameters, only novel advanced echocardiographic modalities demonstrated impaired bi-ventricular and atrial mechanical functions in patients with sarcoidosis.

Conventional markers in determination of activity of sarcoidosis.

AIM AND BACKGROUND: Currently, there are no objective criteria to determine sarcoidosis activity. The present study aimed to discover a sensitive serum marker that would determine the activity of sarcoidosis and can be used during disease follow-up. METHODS: Forty-eight patients with sarcoidosis and twenty healthy volunteers as a control group were included in the study. On their control visits, the patients were divided into active and inactive groups based on their clinical, physiological, and radiological status. Angiotensin converting enzyme (ACE), adenosine deaminase (ADA), total IgE (T-IgE), C-reactive protein (CRP), serum amyloid-A (SAA), and soluble interleukin-2 receptor (sIL2R) serum levels and classical findings of activity were compared, and the utilization of these parameters as markers of activity was investigated. RESULTS: Thirty-nine cases were female (female/male: 39/9) and the mean age was 44.29±10.9years. Thirty-seven cases were active and 11 cases were inactive. Serum ACE, ADA, sIL2R, and SAA levels were significantly higher while T-IgE levels were lower in the sarcoidosis cases. A comparison of the markers between active and inactive cases showed that only SAA was significantly higher (p<0.001). sIL2R was elevated in cases with extra-pulmonary involvement (p<0.014). The area under the curve value was rather high for ADA (0.98 CI: 0.96-1.0); it also had high sensitivity (93.8%) and specificity (100%), and therefore had the highest diagnostic value (96.6%). CONCLUSION: The current study showed that SAA wil be helpfull for detecting the activity of srcoidosis, IL2R measurement in exploring the extra-pulmonary organ involvement.

Ischemia-modified albumin and advanced oxidation protein products as potential biomarkers of protein oxidation in Alzheimer's disease.

BACKGROUND: The aim of the present study was to determine the systemic levels of oxidative stress markers, such as ischemia-modified albumin (IMA), advanced oxidation protein products (AOPP), ferric reducing antioxidant power (FRAP) and the prooxidant-antioxidant balance (PAB), to clarify protein redox homeostasis in patients with Alzheimer's disease, and to compare them with mentally healthy persons of the same age. METHODS: A total of 38 patients with Alzheimer's disease (AD) and 34 sex- and age-matched mentally healthy control subjects were included in this study. RESULTS: The patients had significantly higher AOPP, IMA and PAB in the patient group than in the control group (P = 0.004, P = 0.001, P = 0.007, respectively). The FRAP was significantly lower in the patients with AD than in the control subjects (P = 0.002), and according to the receiver operating characteristic curves, the IMA and AOPP areas are below the 0.700 receiver operating characteristic curve line (area under the curve 0.817 and 0.730, respectively; 95% CI 0.709-0.898 and 0.612-0.828, respectively). CONCLUSIONS: Increased IMA, AOPP and PAB, and decreased FRAP are likely to be results of oxidative stress, a condition in which an imbalance occurs between the production and inactivation of reactive oxygen species in AD. The IMA could be used for the better evaluation of clinical status, as well as the independent characteristic symptoms of AD, for the purposes of routine clinical laboratory analysis.

Diagnostic value of repeated sputum examinations in pulmonary tuberculosis: how many sputum specimens are adequate?

The aim of this study was to assess the value of examining multiple sputum specimens in the diagnosis of pulmonary tuberculosis (PTB). We analyzed sputum smear and culture results of patients diagnosed with culture-proven PTB during 2002. In 1027 patients, the diagnosis was established by detection of Mycobacterium tuberculosis bacilli in sputum samples. The number of sputum specimens submitted to laboratory was one in 634 cases, two in 167 cases, three in 186 cases and more than three in 48 cases. 760 (74%) cases had positive smear examination result. The first sputum smear examination was positive in 82.3% of smear positive cases. Either the first or the second sputum was diagnostic in 94.9% of these cases. Smear examination of third sputum revealed 4.2% additional diagnostic yield. In 863 (84%) cases, culture examination of the first sputum was positive. The second and the third sputum culture examinations revealed additional diagnostic yield of 11% and 4.5%, respectively. Percent 95 of culture-proven cases were diagnosed with the first two sputum cultures. In conclusion the majority of PTB cases can be diagnosed with the examination of two sputum specimens. Three or more sputum specimens submitted obtain a small additional diagnostic yield.

[The factors affecting Beck depression scale in asthmatic patients]. / Astimli hastalarda Beck depresyon ölçegini etkileyen faktörler.

Symptoms of asthma can be intensified and/or mixed with depression since depression can cause asthmatic symptoms like complaints even in normal people. In the present study, depression index and its influencing parameters were examined in asthmatic patients. A questionnaire including sociodemografic features was applied to 120 patients, accepted as asthmatic according to the Thoracic Society Guidelines, who were following up in our asthma and allergy outpatient clinic. There were 98 female and 22 male patients and the mean age was 38.19 +/- 10.99. Physical examination, PEF and spirometric measures were made in all patients. Also daytime and nighttime symptom score, Q score, Beck depression score were applied to patients. Beck Depression Index (BDI) was in range of 0 and 37 and the mean was 11.26 +/- 8.54 (mild). According to the cut-off values, BDI scores were obtained as absent, mild, moderate and severe, 59%, 27%, 9%, 7% respectively. The mean BDI score was higher in female patients (12.32 +/- 8.77) than in male patients (6.55 +/- 5.41) and in married patients (11.91 +/- 8.77) than in unmarried ones (7.56 +/- 6.00). According to the results of FEV(1) values, PEF changes, there were no significant difference obtained between groups (p> 0.05). The mean value of BDI was found to be significantly high in patients with moderate and high daytime and nighttime score and Q score (p< 0.05). In conclusion, we think that, while evaluating the severity of asthma, if the spirometric results are not correlated with the symptoms then psychological conditions of the patients should be taken into consideration.

[Bird fancier's lung disease (report of two cases)]. / Kus besleyicisi hastaligi (iki olgu nedeniyle).

Bird fancier's lung disease (BFLD) is a hypersensitivity pneumonia which develops in response to organic bird products. Two patients (25 y/M, 43 y/F) were admitted to our clinic with complaints of dyspnea, fewer and weight loss, both had history of pigeon exposure and we investigated them for BFLD. First patient had restrictive pulmonary function tests with DLCO of 49%, and the second patient had obstructive pulmonary function tests with DLCO of 33%. HRCT of both patients revealed nodular infiltrations. With these findings and history of pigeon exposure (the first patient at his job, the second patient at home) the diagnosis of BFLD was established. First patient had complete remission after removal of pigeons from the environment. Initial inhaled corticosteroid and later systemic corticosteroid therapy was given to second patient. In conclusion, if BFLD, a rare disease, is considered initially in the differential diagnosis and environmental exposure is evaluated, the diagnosis and treatment is possible.

[Two sisters with breast tuberculosis]. / Meme tüberkülozlu iki kiz kardes.

Breast tuberculosis is a rare form of extrapulmonary tuberculosis. Two sisters diagnosed with mammary tuberculosis and having a family history concerning pulmonary tuberculosis in other siblings were presented in this study; and thereby breast tuberculosis was discussed by evaluating similar cases of breast tuberculosis published in our country. The ultrasonography examinations of the cases (26/F, 27/F) with history of mass, enlargement, pain and discharge complaints were reported as being consistent with fibrotic mastopathy and inflammation. Patients having the diagnosis of breast tuberculosis after the excisional biopsy were undergone HRZE treatment. After the antituberculosis regimen, a complete resolution of the lesion in the breast was observed in our first case which had concurrent pulmonary tuberculosis. The lesion of our second subject who had isolated mammary tuberculosis showed marked improvement. Our cases are still being followed up without any complaints. In conclusion, breast tuberculosis should become a part of differential diagnosis of breast diseases in populations with high incidence of tuberculosis as our country.

Typical pulmonary carcinoid tumors: presentation and outcome of 24 cases.

BACKGROUND: The aim of the study was to determine the presenting clinical-radiological features and outcomes of typical pulmonary carcinoid tumors in our center. MATERIAL/METHODS: The medical records of 24 patients with typical pulmonary carcinoid tumor diagnosed between January 1995 and December 2003 were retrospectively reviewed. Follow-up information on patients was obtained from direct patient contact in February 2004. RESULTS: There were 17 female and 7 male patients with a mean age of 40.3 years (range: 17-69 years). Sixteen patients (66.7%) were nonsmokers. The most frequent presenting symptom was cough, followed by hemoptysis. Twenty-three patients had an abnormal chest X-ray, showing atelectasis in seven. Bronchoscopy revealed mass lesion in all cases. In 13 cases, tumor was located in the lobar bronchi. Diagnosis of carcinoid tumor was established with bronchoscopy in 19 patients and with thoracotomy in five cases. While surgery was the treatment modality in 23 patients, one patient refused treatment. Lobectomy was performed in 15 cases and six of them were sleeve lobectomy. One patient died two days after operation due to ischemic heart disease, two were lost to follow-up, and 21 patients were still alive. Survival for the 21 patients was between 5 and 96 months. Eight patients had survival of more than five years. CONCLUSIONS: Our data suggest that typical pulmonary carcinoids are different from major lung cancer types with respect to sex, age predilection, and smoking history. Surgery is the treatment of choice for pulmonary carcinoid tumors. These patients had excellent prognosis after surgical treatment.

[Adenosquamous carcinoma of the lung (an analysis of 13 cases)]. / Akcigerin adenoskuamöz karsinomu (13 olgu nedeniyle).

Adenosquamous carcinoma of the lung is a rare disease. The biological behavior and clinicopathologic characteristics of this tumor have not been well described. In this study, we retrospectively evaluated 13 patients with adenosquamous carcinoma of the lung diagnosed at our center between January 2001 and May 2004. There were 12 males and 1 female whose ages ranged from 45 to 69 years, with a mean age of 55.9 years. Ten patients were smoker. The most frequent symptoms were chest pain and cough. Bronchoscopic examination detected that tumor was centrally located in four cases and was peripherally located in nine cases. Preoperative pathological diagnosis was squamous cell carcinoma in eight patients, non-small cell lung carcinoma in four patients and adenocarcinoma in one patient. One patient was in pathological stage IA, three patients in stage IB, one patient in stage IIA, two patients in stage IIB, five patients in stage IIIA, and one patient in stage IIIB. Twelve patients underwent resection (six, lobectomy; five, pneumonectomy; one, bilobectomy). Five of 12 patients received adjuvant therapy. Five patients died of disease within 3 and 21 months. Seven patients have had survival time between 9 and 31 months.

Occult bronchial foreign body aspiration in adults: analysis of four cases.

Occult tracheobronchial foreign body aspirations are infrequently seen in adults because there is usually a high index of suspicion. Occult foreign bodies can remain undetected for months to years and often are misdiagnosed. The aim of this paper is to report the cases of four adult patients with occult bronchial foreign body aspiration. None of the patients had a previous history of aspiration. One patient had been misdiagnosed as having asthma. One was thought to have tuberculosis, while unresolved pneumonia was present in another. A CXR showed the presence of a foreign body in only one patient because it was metallic. The foreign bodies included a stone, a tooth fragment, a bone fragment, and a needle. The foreign bodies were removed using a rigid bronchoscope in two patients and via a surgical procedure in the other two. In conclusion, tracheobronchial foreign body aspiration should always be taken into consideration in the differential diagnosis of radiographic lesions or chronic respiratory symptoms that are poorly explained, even in the absence of a previous history of aspiration.

Computed tomography-guided transthoracic fine-needle aspiration in diagnosis of lung cancer: a comparison of single-pass needle and multiple-pass coaxial needle systems and the value of immediate cytological assessment.

OBJECTIVES: The aim of the present study was to compare single-pass needle and multiple-pass coaxial needle systems and to evaluate the value of immediate cytological assessment during the procedure in the diagnosis of lung cancer with CT-guided transthoracic fine-needle aspiration. METHODOLOGY: One hundred and forty-three consecutive patients who underwent CT-guided transthoracic fine-needle aspiration were divided into three groups. In the first group (group A, 48 patients), a single-pass needle was used for aspiration, but immediate cytological examination was not performed. In the second group (group B, 48 patients), a single-pass needle was used for aspiration and a pathologist immediately assessed the adequacy of the sample obtained. In the third group (group C, 47 patients), a multiple-pass coaxial needle was used for aspiration and a pathologist immediately assessed the adequacy of the sample obtained. RESULTS: The mean number of fine-needle aspirations was 1.25 in group A, 1.39 in group B and 1.34 in group C (group A vs group B, P = 0.08). The diagnostic accuracy was 83.3, 97.9 and 100.0%, respectively (group A vs group B, P = 0.03; group B vs group C, P > 0.05). Although immediate cytological assessment resulted in adequate samples being obtained from all patients in groups B and C, adequate samples were obtained in 41 of 48 patients (85.4%) in group A (P = 0.004). There was no statistically significant difference among the groups with respect to the rate of pneumothorax. CONCLUSIONS: A single-pass needle technique in transthoracic fine-needle aspiration is preferred because there is no significant difference between single-pass needle and multiple-pass coaxial needle systems with respect to the diagnostic accuracy and the complication rate and, in addition, the single-pass needle has a lower cost. The results of the present study suggest that immediate cytological assessment during the procedure reduces an inadequate sampling rate, thus increasing the diagnostic accuracy of the procedure.

Primary endobronchial leiomyoma: a case report.

Pulmonary leiomyoma is a rare benign tumor. It has been usually described as a single case. The aim of this paper is to present a case of endobronchial leiomyoma. A 43 year-old nonsmoker female presented to our center with complaint of cough and sputum production for two years. Her chest roentgenogram showed consolidation on lower zone of right lung. Computed tomography of thorax demonstrated a mass lesion partially obstructing lateral segment bronchus of right middle lobe and consolidation on right lower lung field. Fiberoptic bronchoscopy detected mass obstructing lateral segment bronchus of right middle lobe. The biopsy specimen obtained by fiberbronchoscopy revealed the diagnosis of endobronchial leiomyoma. There was no pathologic finding in uterine examination. Bilobectomy inferior was performed. The patient was healthy six months later.

[Evaluation of 105 cases with tuberculous pleurisy]. / Tüberküloz plörezili 105 olgunun degerlendirilmesi.

Tuberculous pleurisy has still importance in the group of exudative pleurisy. In this study we aimed to evaluate clinical, radiological, biochemical, bacteriological and histopathological findings of 105 cases with tuberculous pleurisy retrospectively, between January 1999 and December 2002. Female/male ratio was approximately 1/9 and mean age was 32.6 (range: 15-68). The common symptoms were chest pain (75.2%), cough (54.3%) and dyspnea (47.6%). In 17% cases parenchymal lesions were seen in the chest radiography while parenchymal lesions were found 52% of patients by computed tomography. Adenosine deaminase levels in pleural fluid were high in 80% of cases. PPD reactions was found positive in 84.7% of case. Sputum was studied in 52 cases. In 6 (11.5%) patients both ARB and culture were positive but in 4 (7.7%) patients was only culture positive. Pleural fluid ARB examination of all patients was negative whereas culture was positive only in 5 (5%) of patients. In two patients pleural biopsy material culture was positive for ARB. Cytological examination of pleural fluid revealed lymphocyte predominance in 81 (81%) of cases. Eighty one patients had pleural biopsy and pathologic evaluation revealed tuberculosis in 59 (73%) of them. At the end of the treatment 24 (23%) patients had pleural thickening. Pleural fluid LDH level of the patients with pleural thickening was higher than the other patients significantly (p=0.024). It is concluded that, pleural biopsy is the most effective diagnostic method for the tuberculous pleurisy and in the patient with elevated pleural LDH level, pleural thickening seems more.

[The influence of sarcoidosis on quality of life]. / Sarkoidozun yasam kalitesi üzerine etkisi.

In the follow up of chronic illnesses like sarcoidosis, the psychological and social dimensions are getting more important in addition to the clinical parameters. It is the quality of life (QoL) that brings psychological and social dimensions in to the clinic. In this study we aimed to investigate the QoL of patients suffering from sarcoidosis. Study Short Form (SF-36) QoL scala was applied to 70 sarcoidosis patients who have been followed up in our center at least for a year. Among these patients 49 were females, 21 were males and the mean age was 43.27 +/- 11.97, mean disease duration was 3.55 +/- 1.80 (1-8 years). In our study, we found that variables belonging to sarcoidosis influence the QoL as well as the patient herself/himself. While age and female gender influenced almost all parameters of QoL, in cases with symptoms physical component had been influenced most. Diffusing capacity (DLCO) showed positive correlation with many of the parameters of QoL, whereas disease stage did negative. Patients' income and their to be treatment did not affect QoL. In conclusion, we suggest that QoL may help to follow up and decide on the treatment of sarcoidosis along with the other treatment criteria.

Factors affecting delays in diagnosis and treatment of pulmonary tuberculosis in a tertiary care hospital in Istanbul, Turkey.

BACKGROUND: To investigate delays in the diagnosis and treatment of inpatients with smear-positive pulmonary tuberculosis and to identify factors affecting these delays. MATERIAL/METHODS: 204 hospitalized patients with smear-positive pulmonary tuberculosis were identified. The clinical files of the patients were analyzed and questionnaires were created. RESULTS: Mean application interval was 31.4 days, mean referral interval was 22.1 days, mean diagnosis interval was 3.3 days, and mean initiation of treatment interval was 1.4 days. Patient delay was present in 34.8 percent of the patients. The application interval was shorter for patients having an index case for tuberculosis (p=0.039) and for those with good economic status (p<0.005). 167 patients (81.9%) had institutional delay. The referral interval was longer for female patients than for male patients (p=0.015). The most common causes of institutional delays were a low index of suspicion for tuberculosis, health care system delays, and underutilized chest X-ray examinations. One hundred and three patients (50.5%) had delays in diagnosis and 51 patients (25.0%) had delays in treatment. The most frequent reason for diagnostic delay was health care system delays (35.9%). CONCLUSIONS: There were several delays in the diagnosis of tuberculosis patients. For an effective tuberculosis control, efforts should be made to reduce these delays. Physicians and the public should be educated about tuberculosis. Health care system and laboratory delays should be improved.

CT- guided transthoracic fine needle aspiration of pulmonary lesions: accuracy and complications in 294 patients.

BACKGROUND: The purpose of this study was to prospectively evaluate the effectiveness of CT-guided transthoracic fine needle aspiration in the diagnosis of pulmonary lesions and to determine the complication rate of this procedure. MATERIAL/METHODS: A prospective review was undertaken of 316 patients who underwent CT-guided transthoracic fine needle aspiration performed at our center between October 2000 and April 2001. Twenty-two patients were excluded because no final diagnosis was achieved. The present study included 294 patients. All fine needle aspirations were performed with a 22-gauge aspirating needle under CT guidance. RESULTS: An accurate diagnosis was made in 228 of 259 malignant lung lesions (88%). A specific diagnosis was obtained in 34.3% of the benign lesions. The sensitivity for malignancy and specificity for benign lesions were 88% and 100%, respectively. Positive and negative predictive values were 100% and 53%, respectively. There was no false-positive diagnosis for malignancy. Sensitivity was 87% for centrally located lesions and 89.3% for peripherally located lesions (p>0.05). Complications included pneumothorax, 24 of 294 cases (8.2%); chest tube, 3 cases (12.5%); minor hemoptysis, 5 cases (1.7%); and pulmonary hemorrhage, 4 cases (1.4%). CONCLUSIONS: Our results suggest that this procedure has high diagnostic accuracy and an acceptable rate of complications.

Extrathoracic staging of non-small cell bronchogenic carcinoma: relationship of the clinical evaluation to organ scans.

OBJECTIVE: The aim of this study was to investigate the value of systemic evaluation of extrathoracic extension of non-small cell lung cancer and to assess the value of the clinical evaluation in detecting extrathoracic metastases. METHODOLOGY: The study included 90 patients [87 men, three women; mean age 57.5 years (range 28-76)] with potentially resectable non-small cell carcinoma. Fifty-two were squamous cell carcinomas and 38 were adenocarcinomas. Organ-specific and non-organ-specific clinical findings suggesting metastases were analysed and computed tomographic scans of the brain and abdomen and whole-body bone scanning were performed in all patients. RESULTS: Extrathoracic metastases were detected in 23 (25.5%) of 90 patients. The metastases were located in the following areas: brain (n = 12, 13.3%); bone (n = 9, 10%); liver (n = 5, 5.6%); and adrenal gland (n = 5, 5.5%). Histological analysis revealed metastases in 21.1% (11/52) of the squamous cell carcinomas and 31.6% (12/38) of the adenocarcinomas (P > 0.05). Eleven (47.8%) of the 23 patients with extrathoracic metastases had no organ-specific clinical findings suggesting metastases. Eight patients with squamous cell carcinomas were intrathoracic T1N0 stage and in two (25%) of these patients extrathoracic metastases were detected. These patients had no organ-specific or non-organ-specific clinical factors suggesting metastases. CONCLUSIONS: Evaluation of extrathoracic extension should be routinely performed in all patients with newly diagnosed lung cancer. This approach will prevent many unnecessary thoracotomies.