Gender difference in clinical presentation of Turkish patients with pulmonary tuberculosis.

The study was aimed to investigate the diagnostic differences between male and female patients in pulmonary tuberculosis in a tertiary 660 bedded Educational Respiratory Medicine Hospital, Istanbul, Turkey. A retrospective study was conducted with the new diagnosed, 50 men and 50 female pulmonary tuberculous patients. Age, symptoms, personal history, radiologic and sputum smear findings were collected from their files. 44 male and 42 female patients were enrolled to the study. Male patients tended to be older, smoke more, get alcohol more, lose weight more and have sputum smear positivity more than the female patients. Neither the time of diagnosis nor the radiologic appearance differed statistically. The radiologic appearance, not the clinic symptoms, help to diagnose tuberculosis in female patients; especially in those with no weight loss and sputum smear negativity.

Long-term exposure to biomass fuel and its relation to systolic and diastolic biventricular performance in addition to obstructive and restrictive lung diseases.

BACKGROUND: Previous studies have demonstrated an increased risk for cardiovascular events and pulmonary disease in patients with biomass fuel exposure (BFE). However, biventricular heart function has yet to be investigated in these patients. Left ventricular (LV) myocardial performance index (LVMPI), which is an index of global ventricular function, incorporates ejection, isovolumic relaxation, and contraction times. In this study, pulmonary function and biventricular heart function were investigated in nonsmoking female patients with BFE. METHODS: Our study population consisted of 46 female patients with BFE (group 1) and 31 control subjects (group 2). Pulmonary function tests and transthoracic echocardiographic examination were performed. Right ventricular myocardial performance index (RVMPI) and LVMPI were obtained by tissue Doppler imaging echocardiography (TDI). RESULTS: BFE caused obstructive and restrictive spirometric impairments. RVMPI was higher in group 1 (0.55 ± 0.07) than group 2 (0.46 ± 0.06) (P = 0.042) and LVMPI was higher in group 1 (0.54 ± 0.08) than group 2 (0.47 ± 0.05) (P = 0.032). Also, pulmonary artery systolic pressure was higher in group 1 than group 2 (P = 0.02). CONCLUSIONS: BFE causes both obstructive and/or restrictive lung disease and systolic and diastolic biventricular dysfunction. Nonetheless, long-term studies are needed to understand on BFE-related ventricular dysfunctions and to document subsequent cardiovascular events.

Unusual presentation of hydatid cyst: diagnosis with bronchoscopy.

Hydatid disease is one of the major health problems in countries where hydatidosis is endemic. Atypical radiological findings may lead to misdiagnosis or delay in diagnosis in these patients. A 13-year-old boy was presented who admitted to the hospital with a history of cough and hemoptysis for six months. He had a non-resolving pneumonia. Bronchoscopy showed endobronchial lesion and the diagnosis of hydatid disease was confirmed by pathological examination.

Mortality rates and risk factors associated with nosocomial Candida infection in a respiratory intensive care unit.

To determine the incidence and mortality rate of nosocomial Candida infections (NCI) with respect to associated risk factors in the respiratory intensive care unit (RICU) patients. Data of 163 RICU patients were analyzed for NCI in 2006 retrospectively. Diagnosis of NCI; at least one Candida spp. was isolated in patients with severe sepsis, hospitalized > 1 day intensive care unit (ICU). NCI positive vs. NCI negative were compared with respect to invasive procedure, comorbidities, mortality. Risk factors were analyzed by logistic regression test. NCI positive in 26 (15.9%) patients were mean age: 65 +/- 15 years (female/male ratio: 8/18). Candida albicans/non-albicans ratio was 13/13. ICU stay was longer in NCI positive than NCI negative (48.2 +/- 7.5 days vs. 10.3 +/- 0.8 days; p< 0.001). Higher mortality rates were demonstrated in NCI positive (14.6% vs. 30.8%; p< 0.05). Risk factors for NCI were as follow: Invasive mechanical ventilations (IMV), central catheters and related infections, total parenteral nutrition, multiple antibiotics, ventilator associated tracheobronchitis (VAT) (p< 001 for all and, odd ratio: 95% CI: 6.27, 2.05-19.16; 28.3, 4.61-32.04; 10.93, 4.04-29.56; 2.12-88.98; 14.99, 5.6-40.08, respectively) and sepsis and ventilator associated pneumonia (VAP) (p< 0.01, 7.34, 1.66-32.35; 3.87, 1.42-10.52, respectively). Presence of catheters and related infections, IMV, multiple antibiotics use, parenteral nutrition, VAT, sepsis and VAP were founded as major risk factors for our patients with NCI. Because of longer ICU duration and higher mortality in NCI patients with treated antifungal drugs, risk factors must be evaluated carefully in the ICU.

BNP levels in patients with long-term exposure to biomass fuel and its relation to right ventricular function.

UNLABELLED: Previous studies have demonstrated a consistent increased risk for cardiovascular events and pulmonary disease in patients with biomass fuel exposure (BFE). However right ventricular (RV) function have not been investigated yet in these patients. In this study, pulmonary function, right ventricular function and their relations with Brain Natriuretic Peptide (BNP) were investigated in non-smoking female patients with BFE. METHODS: Our study population consisted of 39 female patients with BFE (group 1) and, 31 control subjects (group 2). Pulmonary function tests and transthoracic echocardiographic examination were performed. Right ventricular volumes, diameters and tissue velocities were obtained by tissue Doppler echocardiography. BNP levels were measured and correlated to right ventricular measurements and pulmonary artery pressure. RESULTS: In BFE group, obstructive and restrictive spirometric findings were found. RV diameters, volumes and pulmonary artery pressure were higher in group 1 than group 2. BNP levels were well correlated with right ventricular end diastolic diameter and pulmonary artery pressure. A suspicion is also arised that toxic chemicals in biomass fuel may play a role in RV dysfunction. CONCLUSION: Biomass fuel exposure not only cause obstructive and/or restrictive lung disease but also leads to systolic and diastolic right ventricular dysfunction. BNP levels may be used to monitor pulmonary artery pressure and right ventricular enlargement in these patients.

Chlorine-induced extensive tracheobronchial necrosis concomitantly benzene-induced pancytopenia presented with severe pneumonia.

We report a case of 25-year-old woman with severe tracheobronchial necrosis caused by chlorine released from a mixture household cleaning agents. She subsequently exposed benzene while she was fixing the seats with benzene containing gum. The case was found interesting with its history, delayed diagnosis, bronchoscopic features, and fatal outcome. We presented its bronchoscopic and pathological images which has not been shown in the literature up to date.

Six minute walking distance in kyphoscoliosis patients with chronic respiratory failure.

AIM: To evaluate kyphoscoliosis patients with chronic hypercapnic respiratory failure (CHRF) using the six minute walk test (6MWT) distance (6MWD) and cardio-pulmonary function tests. METHOD: This prospective cross-sectional study was carried out in a tertiary training and research hospital in Turkey. Kyphoscoliosis patients with CHRF on home mechanical ventilation (HMV) followed in a respiratory intensive care unit (RICU) out-patient clinic were enrolled. Patients' demographics were recorded as well as transthoracic echocardiography (ECHO), 6MWD, spirometry, arterial blood gas (ABG) values and high resolution chest computed tomography. 6MWT results were compared with other parameters. RESULTS: Thirty four patients with kyphoscoliosis and chronic respiratory insufficiency admitted to our outpatient clinic were included in the study but 25 (17 M) patients underwent 6MWT (8 patients walked with oxygen supplement due to PaO2 < 60 mm Hg). The mean 6MWD was 274.4 ± 76.2 (median 270) m and median 6MWD predicted rate was 43.7% (inter quartile ratio, IQR, 37.6% to 47.7%). Median HMV use was 3 years (IQR 2-4). 6MWD predicted rate, body mass index (BMI), HMV duration were similar in male and female patients. 6MWD correlated well with age, BMI, dyspnea score for baseline 6MWT (r: - 0.59, p < 0.002, r: - 0.58, p < 0.003, r: - 0.55, p < 0.005 respectively) but modestly with forced expiratory volume in one second, pulse rate for baseline 6MWT, pulse saturation rate, fatigue and dyspnea score at end of 6MWT (r: - 0.44, p < 0.048; r: 0.44, p < 0.027; r: - 0.43, p < 0.031; r: - 0.42, p < 0.036; r: - 0.42, p < 0.034 respectively). 6MWD predicted rate was only correlated with dyspnea score at baseline (r: - 0.46, p < 0.022). The systolic pulmonary arterial pressure (PAPs) in 6 (24%) cases was more than 40 mmHg, in whom mean PaO2/FiO2 was 301.4 ± 55.4 compared to 280.9 ± 50.2 in those with normal PAPs (p > 0.40). CONCLUSION: The 6MWT is an easy way to evaluate physical performance limitation in kyphoscoliosis patients with chronic hypercapnic respiratory failure using home mechanical ventilation. Nearly 275 m was the mean distance walked in the 6MWT, but rather than distance in meters, the 6MWD predicted rate according to gender and body mass index equation might be a better way for deciding about physical performance of these patients. Dyspnea score at baseline before the 6MWT may be the most important point that affects 6MWD in this patient population.

Pressure vs. volume control in COPD patients intubated due to ARF: a case-control study.

To compare volume- and pressure- controlled ventilation (VCV-PCV) as an initial ventilatory mode in chronic obstructive pulmonary disease (COPD) patients. Case-control study conducted in respiratory intensive care unit (RICU) at a large teaching hospital, between January 2002 and January 2004. PCV was applied in 20 COPD patients with ARF more than 24 hours. Their outcomes were compared with those of a control group of 20 COPD patients matched on age, sex, Acute Physiology Assessment and Chronic Health Evaluation (APACHE) II score, pH and PaCO(2) at the time of intubation previously treated with VCV. The effectiveness of matching was 99%. Groups were compared according to complication and mortality rates, total duration of invasive mechanical ventilation (IMV) and length of RICU stay. Mortality and complication rates, and length of RICU stay were similar in groups but, the mean duration of MV was longer in PCV (198 +/- 177 h vs. 79 +/- 56 h, p< 0.003). PCV group spended significantly longer IMV hours for weaning period (138.6 +/- 164 vs. 34 +/- 33 h, p< 0.01), pre-weaning periods of IMV were found similar. These data suggest that both ventilatory approach have similar outcomes in COPD patients with ARF. Randomize-controlled trials are needed to confirm our results.

[Follow-up hemoglobin concentrations in ICU: relationship between diagnostic blood loss and daily fluid balance]. / Yogun bakimda hemoglobin takibi: tanisal kan kaybi ve günlük sivi dengesi ile iliskisi.

UNLABELLED: To evaluate DeltaHb (daily changes of hemoglobin concentrations) in nonbleeding critically ill patients, and to investigate its relation with diagnostic blood loss (DBL) and fluid balance (FB). Hospital records of 34 nonseptic patients who stayed in respiratory intensive care unit (RICU) at least 72 hours with no evidence of acute bleeding, renal failure and bleeding diathesis, were evaluated retrospectively. Demographics, clinical features, acute physiology assessment and chronic health evaluation (APACHE) II scores, daily Hb levels, DBL and FB were recorded. Correlation statistics was performed between DeltaHb and DBL and FB. We compared the patients with DeltaHb > or =0.5 g/dL/day (group A) and the patients with DeltaHb < 0.5 g/dL/day (group B) in the first three days. The mean age was 55 +/- 14, Hb level was 13.2 +/- 1.7 g/dL at admission and 12.6 +/- 2.3 g/dL at discharge from RICU. DBL was 25.2 +/- 7.4 mL/d, and FB was 251 +/- 1783 mL/d for the first day in intensive care unit. DBL was lesser in subsequent days than in the first day but it wasn't significant. DeltaHb was -0.54 +/- 1.5 g/dL for the first three days, while it was -0.23 +/- 1.5 g/dL for subsequent four days (p= 0.9). DeltaHb in the first three days has no correlation with DBL and FB. Age, sex, APACHE II score, clinical features, DBL and FB were not differed between Group A and Group B. CONCLUSION: No relation was found between DeltaHb and DBL, and also FB; but studies like this are important to indicate that Hb concentrations may decrease in critically ill patients without any reason such as bleeding.

Extrapulmonary tuberculosis in non-human immunodeficiency virus-infected adults in an endemic region.

AIMS: Extrapulmonary tuberculosis (EPTB) still constitutes an important clinical problem. We aimed to evaluate the incidence and features of extrapulmonary tuberculosis. MATERIALS AND METHODS: We retrospectively evaluated 14,266 tuberculosis patients diagnosed between January 1999 and December 2003 in a tertiary care hospital in Istanbul. As many as 2,435 patients (17.1%) with EPTB were evaluated for the incidence and features. RESULTS: Of the 14,266 patients, 4,154 were female (29%) and 10,112 were male (71%) and were aged between 14 and 86 years with a mean age of 35 +/- 14 years. As many as 660 (17.9%) patients were diagnosed as EPTB in 1999, 568 (17.8%) in 2000, 357 (13.7%) in 2001, 462 (22%) in 2002 and 388 (14.5%) in 2003. EPTB presented most commonly as pleurisy (66%), followed by lymphadenitis (23%). Lymphadenitis and pleurisy were more commonly observed among female TB patients (60%) and among male TB patients (59%) respectively. EPTB showed a significant female predilection (26.8%) compared to male patients (13.1%). Multi-organ involvement was observed in 37 (1.5%) patients (two organs in 33 and three organs in 4). As many as 197 (8%) EPTB cases had pulmonary tuberculosis simultaneously. CONCLUSIONS: EPTB still constitutes an important clinical problem. The rates of EPTB have remained constant despite the decline in pulmonary tuberculosis cases. In the current study, we present our experience of the incidence and features of EPTB patients without HIV infection. In this study, EPTB cases constituted one-fifth of all tuberculosis cases presented to our center in the study period.

Does needle size affect diagnostic yield of transthoracic needle biopsy in malignant pulmonary lesions? Comparison of 18-, 22- and 25-gauge needles in surgical specimens.

OBJECTIVE: To evaluate the effect of needle size on the diagnostic yield of transthoracic needle aspiration biopsy in malignant pulmonary lesions. METHODS: The study assessed samples from 35 patients who underwent surgery for lung cancer. We used surgical specimens for needle aspiration biopsy. Aspirations were performed with 25-, 22- and 18-gauge, 9 cm in length aspirating needles. All pathology preparations were coded. At the end of the study period, all needle aspiration preparations were interpreted by the same pathologist. RESULTS: Lobectomy was performed in 19 patients, pneumonectomy in 15 and bilobectomy in one. Squamous cell carcinoma was the most frequent tumour type, followed by adenocarcinoma. The diagnostic yield of aspiration biopsy was 85.7% for 18-gauge needle and 82.9% for both 22-gauge and 25-gauge needles. There was no statistically significant difference for the three needles with respect to diagnostic yield (P > 0.05). Cell type concordance for 18-, 22- and 25-gauge needles was 70%, 65.6% and 65.6%, respectively. There was no statistically significant difference for the three needles with respect to cell type concordance (P > 0.05). CONCLUSION: Needle size did not affect diagnostic yield or accuracy for malignant lesions. Smaller needles such as 22-gauge needle would appear to be suitable for transthoracic needle aspiration biopsy in the diagnosis of malignant pulmonary lesions.

Histopathological diagnosis of endobronchial endometriosis treated with argon laser.

The authors present a case of endobronchial endometriosis with catamenial haemoptysis. The lesion was diagnosed as endobronchial endometriosis based on histopathological examination of a bronchial biopsy from the right second carina. Fibreoptic bronchoscopic examination revealed a tiny hyperaemic submucosal area with bleeding and a brown-coloured diverticulum at bottom of this lesion encompassing a 2-cm2 area at the right second carina. Multiplanar reconstructions of a spiral CT scan revealed a 0.5-cm lesion that looked like a diverticulum at the right second carina. The patient was treated with argon laser at bronchoscopy. Following treatment, the patient has been asymptomatic with no recurrence of haemoptysis.

Pleural complications of pulmonary hydatid disease.

OBJECTIVE: The aim of this study was to determine the incidence and diagnostic features of pleural manifestations of pulmonary hydatid disease. METHODOLOGY: Patients with pleural pathology in association with surgery for pulmonary hydatid disease over an 8-year period were evaluated. RESULTS: Twenty-nine (6%) of 474 patients with histologically confirmed pulmonary hydatid disease had pleural abnormalities. The diagnosis was determined preoperatively in 22 patients and was based on radiographic, clinical, and/or serology findings. Bronchoscopic specimens were diagnostic in two of seven patients who had bronchoscopy. Five patients were not diagnosed until surgery. Radiographic abnormalities consisted of pleural thickening and/or free fluid without intrapleural rupture of the cysts in 21 patients. Eight patients had a hydropneumothorax. Sixteen patients had an exudative, uncomplicated effusion. The remaining patients had empyemas. All patients had resection of the pulmonary cysts, and 20 also underwent a pleurectomy. The mean length of hospital stay was 23 +/- 14 days. There was no hospital mortality. CONCLUSION: Pleural lesions associated with pulmonary hydatid disease are rare and have a variable radiographic appearance. In regions in which echinococcal disease is endemic, a high level of clinical suspicion is necessary for diagnosis and appropriate management of this condition.

Modified slide tracheoplasty for the management of tracheobroncopathia osteochondroplastica.

In this paper we report a case with tracheobroncopathia osteochondroplastica presented with a long segmental tracheal stenosis. Modified slide tracheoplasty was undertaken for the management of the stenosis. In our modification, the oblique tracheal cut was performed from left to right to widen the latero-lateral dimension of tracheal lumen. We assume that preservation of the lateral longitudinal vessels of the trachea results in better healing at the suture line. Postoperative course was uneventful and the patient remains on clinical follow-up for 15 months without any problem.