Oropharyngeal candidiasis with dry-powdered fluticasone propionate: 500 microg/day versus 200 microg/day.

We aimed to determine the frequency of oropharyngeal candidiasis and its clinical correlates in the asthmatic patients who use fluticasone propionate (FP) as a dry powdered inhaler. We selected four groups of patients: 62 asthmatic patients who were taking 200 microg/d FP, 122 asthmatics who were taking 500 microg/d FP, 50 asthmatic patients who had not been on inhaled corticosteroid (ICS) treatment and 40 normal non-asthmatic subjects. The frequency of positive swabs for Candida colonization was higher in 500 microg/d FP group than asthmatics without ICS use (chi2 = 6.8, p < 0.05) and normal controls (chi2 = 4.9, p < 0.05), whereas it wasn't different in the 200 microg/day FP group when compared to controls. When we considered patients who used ICS, the most effective variables affecting the occurrence of Candida colonization were washing of the throat by the patients (OR = 9.4, 95 % Confidence Interval [CI] = 3.9-22.7, p < 0.0001) and duration of ICS use more than 12 months (OR = 2.5, 95 % CI = 1.1-2.6, p < 0.05). The present study showed that in the patients who use ICS, the most important determinants on colonization were not washing the throat regularly and duration of ICS use for more than 12 months.

Oropharyngeal candidiasis with dry-powdered fluticasone propionate: 500 mg/day versus 200 mg/day

We aimed to determine the frequency of oropharyngeal candidiasis and its clinical correlates in the asthmatic patients who use fluticasone propionate (FP) as a dry powdered inhaler. We selected four groups of patients: 62 asthmatic patients who were taking 200 ìg/d FP, 122 asthmatics who were taking 500 ìg/d FP, 50 asthmatic patients who had not been on inhaled corticosteroid (ICS) treatment and 40 normal non-asthmatic subjects. The frequency of positive swabs for Candida colonization was higher in 500 ìg/d FP group than asthmatics without ICS use (÷2 = 6.8, p < 0.05) and normal controls (÷2 = 4.9, p < 0.05), whereas it wasn't different in the 200 ìg/day FP group when compared to controls. When we considered patients who used ICS, the most effective variables affecting the occurrence of Candida colonization were washing of the throat by the patients (OR = 9.4, 95 % Confidence Interval [CI] = 3.9-22.7, p < 0.0001) and duration of ICS use more than 12 months (OR = 2.5, 95 % CI = 1.1-2.6, p < 0.05). The present study showed that in the patients who use ICS, the most important determinants on colonization were not washing the throat regularly and duration of ICS use for more than 12 months

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Nonmalignant pleural lesions due to environmental exposure to asbestos: a field-based, cross-sectional study.

The aim of the present study was to investigate the frequencies of asbestos-related benign pleural diseases in villagers environmentally exposed to asbestos and the factors affecting these frequencies. A field-based, cross-sectional study was designed. In total, 991 villagers from 10 villages, randomly chosen from 67 villages with known use of asbestos-containing white soil in central Anatolia (Turkey), were investigated. The type of asbestos in the white soil was determined for each village, as well as air-borne fibre concentrations. The villagers were investigated with small-size chest roentgenograms and epidemiological features were recorded. The air-borne fibre levels were generally low. Despite this, pleural plaques were found in 14.4% of the villagers, 10.4% had diffuse pleural fibrosis and 0.4% asbestosis. The significant variables for plaques were age, sex, type of asbestos fibre, e.g. actinolite and tremolite, and exposure duration, while there was a negative relationship with cumulative exposure. The variables affecting diffuse pleural fibrosis were age, exposure duration and cumulative exposure. In conclusion, villagers exposed to environmental asbestos have high frequencies of pleural plaques and diffuse pleural fibrosis, similar to occupationally exposed asbestos cohorts. Different types of asbestos appear to result in different frequencies of pleural lesions.

Prognostic factors in diffuse malignant pleural mesothelioma: effects of pretreatment clinical and laboratory characteristics.

The aim of this study was to investigate the effects of various pretreatment clinical and laboratory characteristics on the survival of patients with diffuse malignant pleural mesothelioma (DMPM). One hundred histopathologically confirmed DMPM patients were evaluated. Fifty-nine were treated with chemoimmunotherapy while 41 who had refused chemoimmunotherapy received supportive therapy alone. The following pretreatment characteristics were evaluated in both univariate and multivariate Cox regression analyses: age, gender, Karnofsky performance score (KPS), histology asbestos exposure, presence of chest pain, dyspnoea, weight loss, symptom duration, smoking history, disease location, platelet count, haemoglobin, white blood cell (WBC) count, serum lactate dehydrogenase (LDH) and extent of disease (stage). Univariate analysis showed that patients with age > or = 75 years, male gender, smoking history advanced stages above stage I disease, KPS < 70, WBC count > or = 8450 and LDH level > or = 500 IU l(-1) have a worse prognosis. With multivariate Cox regression analyses, age > or = 75 years, advanced stages above stage I disease, KPS < 70 and LDH level > or = 500 IU l(-1) were found to be indicators of a poorer prognosis. In conclusion, in our study each of low performance status, older age, advanced stage disease, high LDH level and prognosis were found to be related.

Low prevalence of allergy to cockroach and latex in asthmatic patients in Eskisehir (Anatolia), Turkey.

Allergy to cockroach and latex are said to be causes of asthma particularly in some groups. We studied allergy to cockroach and latex in asthmatic patients from Eskisehir (Anatolia), Turkey in order to determine whether these allergens play an important role in the Anatolian region. A total of 216 asthmatic patients (mean age 43.7+/-11.0 years) were skin tested with common aeroallergens, Blatella germanica and latex. Sixty-three patients were allergic (29.1%) and 153 were nonallergic (70.8%) according to skin test results. Sensitization to pollens (57%) and mites (55.5%) was most common among allergic patients. We found a low sensitization to cockroach (4.7%) and latex (1.4%). We suggested that cockroach sensitization plays a small role in sensitization in our geographic area and that latex sensitization is low in allergic asthmatic patients who were referred for reasons other than latex-related symptoms.

[Respiratory allergy to moulds among adults in Eskisehir Anatolia), Turkey]. / L'allergie respiratoire aux moisissures chez les adultes en Eskisehir (Anatolie), Turquie.

Allergy to moulds has been known for several decades. But it is rarely isolated in contrast to the other pneumallergens. Prevalence of sensitization to moulds varies from one country to the another. We investigated the allergy to moulds using skin prick tests in adult patients with asthma and/or rhinitis in Eskisehir (Anatolia), Turkey. Cladosporium and Aspergillus were found to be the most common causes in the study population (115 patients). Isolated mould allergy was found as 4.3% with the exclusion of common non-fungal respiratory allergens, among them Cladosporium was the most common cause.

An unusual case of esophageal tuberculosis in an adult.

Tuberculous infection of the esophagus is a rare disease and usually occurs secondary to tuberculous mediastinal lymphadenopathy. We report a 74-year-old woman presenting with dysphagia and weight loss. The chest radiograph showed punctuated calcifications lining from the right hilar region to the paracardiac region. Upper gastrointestinal endoscopy revealed a 0.5 x 5 cm lesion localized in the 25th cm of the esophagus covered partly with normal mucosa, partly demonstrating ulcerous areas. Biopsy revealed granulomatous infiltrates being tuberculoid in type. Thorax CT showed a calcified lymph node at the right hilum. The patient did not give consent to therapy and died 1 month later.

Prevalence of occupational asthma among automobile and furniture painters in the center of Eskisehir (Turkey): the effects of atopy and smoking habits on occupational asthma.

BACKGROUND: Occupational asthma (OA) is a respiratory disorder characterized by airway hyperreactivity caused by agents present in the workplace. For determination of the prevalence of OA among car and furniture painters exposed to isocyanate in the center of Eskisehir, Turkey, a clinical and epidemiologic prospective study in three phases was done, incorporating 312 (89.4%) of the painters. METHODS: Of these subjects, 190 (61%) were furniture painters and 122 (39%) automobile painters. In the first phase of the study, a modified questionnaire and pulmonary function test (PFT) were done. During the second phase, peak expiratory flow rate (PEFR) was monitored in 52 subjects whose complaints were confirmed and who agreed to a month of such monitoring. In the third phase, nonspecific bronchial provocation tests (NSBPT) with histamine were done on 23 of the PEFR-monitored workers. RESULTS: Finally, through questionnaire, typical history, PFT, PEFR monitoring, and NSBPT, 30 workers (9.6%) were diagnosed as having OA. Smoking habits and atopy in the OA-diagnosed workers were found to be statistically significantly high in comparison to the other workers. CONCLUSIONS: It was concluded that OA is a common disorder among automobile and furniture painters, and smoking habits and atopy were seen to have a significant effect on OA occurrence.

Comparative analysis of biochemical parameters for differentiation of pleural exudates from transudates Light's criteria, cholesterol, bilirubin, albumin gradient, alkaline phosphatase, creatine kinase, and uric acid.

The differentiation of pleural effusions as being either transudate or exudate is the first step in the diagnosis of pleural effusions. The aim of this study was to compare the efficiency of the various biochemical parameters to the traditional criteria of Light et al., for differentiating exudates from transudates. Ninety-three pleural fluid and sera specimens were obtained and classified as transudates or exudates on the basis of their diagnosis. Of the 93 pleural fluids, 21 were transudates, 72 were exudates. The efficiencies of different parameters for detection of exudates were as follows: The criteria of Light 96%; effusion cholesterol concentration 77%; serum-fluid albumin gradient 67%, pleural/serum alkaline phosphatase ratio 83%; effusion creatine kinase levels 91%; pleural/serum creatine kinase ratio 83%, and effusion uric acid 71%. Pleural/serum uric acid ratio was insignificant for the purpose of this study.

Malignant localized fibrous tumor of the pleura occurring in a person environmentally exposed to tremolite asbestos.

A case is presented of a malignant localized pleural fibroma occurring in a 60-year-old Turkish female who was environmentally exposed to tremolite. The tumor was excised but recurred 3 years later when it was again excised. It is possible that more radical surgery at initial presentation with chest wall resection would have been advantageous.

CT-guided pleural needle biopsy in the diagnosis of malignant mesothelioma.

OBJECTIVE: Our goal was to determine the sensitivity of CT-guided closed pleural needle biopsy (CPNB) for the histopathologic diagnosis of diffuse malignant pleural mesothelioma (DMPM). MATERIALS AND METHODS: Thirty patients with DMPM were studied with CT-guided CPNB. Tumor specimens were classified according to their cell types. RESULTS: In 25 (83.3%) patients, the diagnosis was made by CT-guided CPNB. The remaining five patients were diagnosed by thoracoscopy, thoracotomy, or excisional biopsy of the chest wall mass. Pneumothorax was observed in 9.5% of patients and local seeding of tumor in 21.7% of patients who underwent CPNB. CONCLUSION: Properly performed CPNB under CT guidance may yield an increased sensitivity for the diagnosis of diffuse malignant pleural mesothelioma.

Chromosome analysis in pleural effusions. Efficiency of this method in the differential diagnosis of pleural effusions.

Various laboratory methods are being used to acquire diagnosis in pleural effusions. However, about 20% of the effusions cannot be diagnosed reliably. Cytogenetic analysis in pleural effusion is not used routinely, although many numerical and/or structural chromosome abnormalities have been observed in malignant pleural effusions. In this study, a total of the 61 pleural effusion samples, 34 malignant which included 19 diffuse pleural malignant mesothelioma, 15 metastatic malignant pleural effusions and 27 benign, were analyzed by direct chromosome analysis method. To the findings obtained in the study, 85.3% (29/34) of the 34 patients with malignant pleural effusion had numerical and/or structural abnormalities, and 3 of them had no mitosis. The patients who had benign pleural effusion indicated no numerical and/or structural abnormalities. We have concluded that if a pleural effusion cannot be reliably differentiated by the usual laboratory methods and especially malignancy is strongly suspected, cytogenetic analysis can be used to differentiate malignant effusions from benign effusions with a small rate of error, and also it can indicate that more invasive diagnostic procedures are necessary.