Silicosis Appears Inevitable Among Former Denim Sandblasters: A 4-Year Follow-up Study.

BACKGROUND: The course of denim sandblasting silicosis is unknown. We aimed to reevaluate former sandblasters studied in 2007 for incident silicosis, radiographic progression, pulmonary function loss, and mortality and to examine any associations between these outcomes and previously demonstrated risk factors for silicosis. METHODS: We defined silicosis on chest radiograph as category 1/0 small opacity profusion using the International Labor Organization classification. We defined radiographic progression as a profusion increase of two or more subcategories, development of a new large opacity, or an increase in large opacity category. We defined pulmonary function loss as a ≥ 12% decrease in FVC. RESULTS: Among the 145 former sandblasters studied in 2007, 83 were reassessed in 2011. In the 4-year follow-up period, nine (6.2%) had died at a mean age of 24 years. Of the 74 living sandblasters available for reexamination, the prevalence of silicosis increased from 55.4% to 95.9%. Radiographic progression, observed in 82%, was associated with younger age, never smoking, foreman work, and sleeping at the workplace. Pulmonary function loss, seen in 66%, was positively associated with never smoking and higher initial FVC % predicted. Death was associated with never smoking, foreman work, number of different denim-sandblasting places of work, sleeping at the workplace, and lower pulmonary function, of which only the number of different places worked remained in multivariate analyses. CONCLUSIONS: This 4-year follow-up suggests that almost all former denim sandblasters may develop silicosis, despite short exposures and latency.

Frequency of Class I and II HLA alleles in patients with lung cancer according to chemotherapy response and 5-year survival.

INTRODUCTION: Lung cancer is the most common cause of cancer death in the world, and the most common type is non-small-cell lung cancer (NSCLC). At present, surgical resection, chemotherapy, and radiation therapy are the main treatments for patients with NSCLC, but unfortunately outcome remains unsatisfactory. OBJECTIVES: This study aimed to determine whether Class I and II histocompatibility leukocyte antigen (HLA) alleles are related with response to chemotherapy and survival of lung cancer. METHODS: A total of 65 NSCLC patients (56 men and 9 women, mean age 58.4 ± 11 years) were included in the study. Patient groups were compared with a control group of 88 unrelated healthy kidney or bone marrow donors in order to clearly identify susceptible and protective HLA alleles in lung cancer. Target lesions and tumor response were assessed using the Response Evaluation Criteria for Solid Tumors (RECIST) guidelines. Results were classified into two groups: complete-partial response and stable-progressive disease. RESULTS: We found that expression of HLA-A32, HLA-B41, HLA-B57, HLA-DRB1*13, and HLA-DQ5 were more frequent in the complete and partial response groups to chemotherapy than in the control group. The frequency of HLA-A11, HLA-A29, HLA-BW6, HLA-CW3, HLA-DR1*1, and HLA-DRB1*3 were determined to be higher in the stable and progressive disease groups taking chemotherapy than in the control group. Additionally, expressions of HLA-A2 and HLA-B49 were statistically related with 5-year survival. CONCLUSION: Our results suggested that expressions of HLA-BW6 and HLA-DRB1*13 alleles may be predictable markers for response to chemotherapy in lung cancer patients.

Helicobacter pylori infections in chronic obstructive pulmonary disease.

OBJECTIVE: We aimed to investigate the prevalence of Helicobacter pylori (H. pylori) in patients with chronic obstructive pulmonary disease (COPD) using the C-14 urea-breath test (C14UBT) and to determine whether there is an association between H. pylori infection and the severity of COPD. This is the first report in the literature of the use of C14UBT to investigate the prevalence of H. pylori in patients with COPD. MATERIALS AND METHODS: Fifty subjects with COPD (38 males and 12 females, aged 61±10 years) and 20 control subjects (10 males and 10 females, aged 55±11 years) were evaluated. C14UBT was used to determine H. pylori infection. RESULTS: The prevalences of H. pylori infection in subjects with COPD and in controls were 72% and 65%, respectively (p=0.56). Forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) values were significantly higher in the H. pylori-infected subjects with COPD than in the uninfected subjects (p=0.008 and p=0.006, respectively). CONCLUSION: The presence of H. pylori infection in COPD patients affects pulmonary functions, but the effects of H. pylori infection on the respiratory system and COPD are not clear.

Clinical value of detection of metastasis of carina in patients with non-small cell lung cancer.

BACKGROUND: Although the utility of blind biopsy in the detection of metastasis in the carina has been reported, submucosal fine needle aspiration (SMFNA) has not been evaluated. We investigated how SMFNA of the main carina and upper-lobe carina in addition to blind biopsy affect management of patients with NSCLC. METHODS: Thirty-five patients were evaluated. During fiberoptic bronchoscopy (FOB), five blind biopsy and three SMFNA specimens were collected from normal-appearing main carina (n = 35) and/or upper-lobe carina (n = 18). Subjects were staged for operability using traditional staging system, without knowing the blind biopsy or SMFNA results. Then, patients were staged again after results were made known. RESULTS: Thirty-five NSCLC patients were analyzed. The management of 12 patients (34%) was changed according to our results. Out of the patients, 8, 5 and one had microscopic metastasis in the main carina, ipsilateral upper-lobe carina and both, respectively. Although SMFNA were more diagnostic compared to blind forceps biopsy, there was no statistically difference between them. These procedures increased the success of detection of microscopic metastasis and the results changed management of those cases. CONCLUSION: SMFNA adds valuable information to blind biopsy, and their combination changed the management in one quarter of our NSCLC patients.

Acute inhalation injury.

Inhaled substances may cause injury in pulmonary epithelium at various levels of respiratory tract, leading from simple symptoms to severe disease. Acute inhalation injury (AII) is not uncommon condition. There are certain high risk groups but AII may occur at various places including home or workplace. Environmental exposure is also possible. In addition to individual susceptibility, the characteristics of inhaled substances such as water solubility, size of substances and chemical properties may affect disease severity as well as its location. Although AII cases may recover in a few days but AII may cause long-term complications, even death. We aimed to discuss the effects of short-term exposures (minutes to hours) to toxic substances on the lungs.

Lung cancer incidence in erzurum city.

OBJECTIVE: Known as an uncommon disease at the beginning of the 20(th) century, lung cancer has been the most frequent cause of cancer-related deaths in males since the 1950s and in females in the last two decades. The aim of this study was to determine the lung cancer incidence in Erzurum; its clinical properties, cancer subtypes, and application phases; the relationships of tumors with parameters of cigarette smoking and nutrition; radiological properties of the tumors; and the methods of diagnosis. MATERIALS AND METHODS: This study analyzed data from a prospective database. The study included the patients who applied in 2005 to the Chest Disease, Chest Surgery, Medical Oncology or Radiation Oncology section of Research Hospital, Faculty of Medicine, Ataturk University; the Erzurum Nihat Kitapçi Chest Diseases Hospital; or the Palandöken State Hospital and were diagnosed with lung cancer. A standard questionnaire was used to obtain information about the patients. The figures of the 2005 census issued by the State Institute of Statistics were used for incidence calculations. RESULTS: During the study period, 255 patients with a lung cancer diagnosis were accepted, 220 of whom were male (86.3%) and 35 were female (13.7%). The mean age of the patients was 63±1 years. The lung cancer incidence in Erzurum according to the data given by the hospitals that can diagnose lung cancer was determined to be 14.4/100.000. Lung cancer frequency increased with age, it was observed in males six times more frequently than females, and histopathologically non-small cell lung cancer and advanced phase lung cancer were more frequent. CONCLUSION: The lung cancer incidence for Erzurum was not different from that reported in other studies carried out both in the region and the whole country, and the lung cancer diagnosis was related to advanced age, male sexuality, active smoking and low socioeconomic state.

Analysis of HLA class I and II alleles regarding to lymph node and distant metastasis in patients with non-small cell lung cancer.

The aim of this study was to investigate the relation of HLA alleles in patients with non-small cell lung cancer (NSCLC). The incidence of class I and II HLA alleles of 63 patients with NSCLC were prospectively compared with the incidence of class I and II HLA alleles with 88 healthy controls. The number of cases with stage I and II (early stage) was 12 and there were 51 cases with stage III and IV (advanced stage). Metastasis rates of the regional lymph node in patients were as follow; N(0): n=10; N(1): n=13; N(2): n=26 and N(3): n=14. Lymph node metastasis was detected by pathological staging in 15 cases and by clinical staging in 48 cases. Lymph node metastasis was searched in all patients by a helical thorax CT. All distant metastasis were investigated by thorax CT, abdominal CT, brain CT or MRI and bone scintigraphy, and distant organ metastasis was detected in 25 cases. The patients and healthy controls were typed for HLA class I and II alleles. HLA-A2 was an independent risk factor for both critical lymph node (N(2 and 3)) involvement and distant metastasis. HLA-B44, -CW6 and -CW7 frequencies appear to be significant in controls compared to patients. HLA-A2 frequency was higher in patients with advanced stage than early stage, while HLA-A26, -B35 and -CW4 frequencies were more expressed in patients with early stage than in patients with advanced stage. Compared with controls, frequency of HLA-DRB1*07, -DQ02 and -DQ07 were lower expressed in patients. Compared patients with advanced stage, HLA-DRB1*07 was higher in patients with early stage. HLA-A2 was an independent risk factor for lymph node and distant metastasis, and the allele was significantly higher in patients with critical lymph node for surgery and distant metastasis. HLA-A26 appeared to be a significance protective allele against to metastases.

Stereological Evaluation of Tumor Regression Rates in Lung Cancer Using CT Via the Cavalieri Method.

OBJECTIVE: The aims of this study were to analyze the relevant methods of computed tomography (CT) and stereology with respect to the estimation of tumor volume and to determine whether the response rates measured by the stereological method correlate with those of conventional morphometric techniques in lung cancer. MATERIALS AND METHODS: The study group was composed of 32 patients, including 25 males and 7 females. All the subjects included were non-small celled lung cancer patients (NSCLC), and they were all treated with either chemotherapy (n=12) or chemotherapy plus radiotherapy (n=20) for locally advanced disease (Stage III A and Stage III B). All patients underwent contrast enhanced CT of the thorax before and after treatment. Tumor diameters were measured according to stereological methods, the World Health Organization (WHO) criteria and the Response Evaluation Criteria in Solid Tumors (RECIST). RESULTS: With all three methods (stereological method, RECIST and WHO), an improvement was observed in the mean tumor size. The response rates were 11.8 ± 117.5% (stereological method), 27.4 ± 38.8% (RECIST), and 38.7 ± 68.1% (WHO). Although the response rates in RECIST and WHO criteria were statistically significant (P=0.02 and P=0.045 for RECIST and WHO, respectively), the response rates with stereological measurements were not statistically significant (P=0.21), showing that response rates obtained by the Cavalieri method differ from those obtained through WHO and RECIST. The comparison between response rates obtained with each method shows that the stereological response rate was not correlated with the response rate in either RECIST or WHO, (r=-0.15, P=0.59 and r=-0.27, P=0.33 for RECIST and WHO, respectively), while there was good correlation between the WHO and RECIST response rates (r=0.87 and P<0.001). CONCLUSION: The Cavalieri principle is more suitable for the evaluation of tumor volumes in response to treatment in the management of advanced malignancies, in particular in patients with tumors of irregular shape or when the determination of treatment response is not clear.

Liver dysfunction in patients with acute pulmonary embolism.

AIM: Although liver injury due to cardiac, chronic respiratory and circulatory failure has been reported, this has yet to be studied in patients with pulmonary embolism (PE). We investigated liver injury in patients with acute PE. METHODS: We retrospectively reviewed 107 acute PE patients over a two-year period. Patients were categorized as having: (1) severe (P(a)O(2) < 45 mmHg), moderate (45 mmHg

Silicosis in Turkish denim sandblasters.

BACKGROUND: Sandblasting of jeans in small Turkish workshops has recently been recognized as a cause of silicosis. CASE SERIES: Between August 2004 and March 2006, we admitted 16 young men with a history of working in small workplaces producing sandblasted jeans. Of these, 14 presented with respiratory symptoms and the remaining two through awareness of their work colleagues. In the first two cases, open-lung biopsy was required to confirm the diagnosis of silicosis. Later cases were diagnosed through a combination of their work history and the clinical and radiological findings. The mean age at presentation was 23 years with mean duration of employment as a sandblaster being 3 years. The first two cases died and the remainder, except two, are still receiving treatment. CONCLUSION: The production of sandblasted jeans in small uncontrolled workplaces may entail significant exposure to silica and the development of rapidly fatal silicosis. Urgent action is required to prevent further cases and mortality.

The effect of nebulized NaHCO3 treatment on "RADS" due to chlorine gas inhalation.

Chlorine is one of the most common substances involved in toxic inhalation. As with all irritant gases, the airway injuries caused by chlorine gas may result in clinical manifestations similar to those of asthma. In this study, we investigated the effect of nebulized sodium bicarbonate (NSB) on the treatment and quality of life (QoL) of victims exposed to chlorine gas. Forty-four consecutive patients with reactive airways dysfunction syndrome (RADS) due to chlorine inhalation (40 females and 4 males, age range 17-56 yr) were included in this study. Patients were placed in control and treatment groups in a sequential odd-even fashion based on their order of presentation. Treatment of all patients included corticosteroids and nebulized short-acting beta2-agonists. Then the control group (n = 22) received nebulized placebo (NP), and the NSB group (n = 22) received NSB treatment (4 cm3 of 4.20% sodium bicarbonate solution). A quality of life (QoL) questionnaire and pulmonary function tests (PFTs) were performed before and after treatments in both groups. The most common symptoms were dyspnea (82%) and chest tightness (82%). Baseline characteristics of both groups were similar. Compared to the placebo group, the NSB group had significantly higher FEV1 values at 120 and 240 min (p < .05). Significantly more improvement in QoL questionnaire scores occurred in the NSB group compared to the NP group (p < .001). Thus, NSB is a clinically useful treatment, as tested by PFTs and QoL questionnaire, for patients with RADS caused by exposure to chlorine gas.

Barometric pressure and the incidence of pulmonary embolism.

OBJECTIVES: Reports in the literature suggest that weather changes may play a role in venous thrombotic disease. An increase in patients with pulmonary embolism (PE) during the spring season led us to investigate the relationship between atmospheric pressure (AP) and the incidence of PE, as diagnosed in most of the patients by helical CT angiography, and in the minority of patients by conventional pulmonary angiography and lung scanning. METHODS: We retrospectively investigated the charts of 91 consecutive patients with a diagnosis of PE who were evaluated by the Department of Pulmonary Medicine between August 2000 and September 2004. We documented AP changes as recorded by the Erzurum Provincial Department of Meteorology. Of the 91 patients, the diagnosis of PE was made by helical CT angiography in 84 patients, isotope lung scan in 5 patients, and conventional pulmonary angiography in 2 patients. RESULTS: More patients presented in the spring months (March, n = 15; April, n = 10; and May, n = 12) than during other seasons (p < 0.001). The frequency of PE was inversely related to general average AP (r = - 0.70; p < 0.01). When the average seasonal AP was correlated with the incidence of PE, however, the relationship was found to not be statistically significant (r = - 0.66; p = 0.34). There was no correlation between the severity of PE or mortality and AP. CONCLUSIONS: The incidence of PE was significantly higher in the spring months, when AP was low. A regional study to capture all PE patients will need to be done to confirm our findings. Other meteorologic factors should be investigated regarding their effect on thromboembolic disease.

A prospective, multicentre clinical trial comparing cisplatin plus gemcitabine with cisplatin plus etoposide in patients with locally advanced and metastatic non-small cell lung cancer.

OBJECTIVE: Cisplatin-gemcitabine (PG) and cisplatin-etoposide (PE) combinations are active regimens for non-small cell lung cancer (NSCLC). The present study aimed to compare PG with PE in the treatment of patients with stage IIIB and IV NSCLC. METHODOLOGY: We conducted a prospective, multicentre trial. A total of 166 patients were enrolled into the study and received either gemcitabine (1,000 mg/m(2)) on days 1, 8 and 15 plus cisplatin (80 mg/m(2)) on day 2 every 4 weeks, or etoposide (100 mg/m(2)) on days 1, 2 and 3 plus cisplatin (80 mg/m(2)) on day 1 every 3 weeks. RESULTS: The overall response rate was superior in the PG group (54.8%vs 39.0%, P=0.045). There was no significant difference in survival between the two groups, with respective median and 1-year survival of 38 weeks and 33.3% for the PG group, and 34 weeks and 23.2% for the PE group. There was also no statistical difference for time to progression between the two groups. Neutropenia and thrombocytopenia were seen more frequently in the PG group (grade 3 neutropenia, 33.3%vs 15.9%, P=0.012; grade 3 thrombocytopenia, 27.4%vs 3.7%, P<0.001 and grade 4 thrombocytopenia, 10.7%vs 1.2%, P=0.018). CONCLUSION: PG is an active chemotherapy regimen and has a better response rate than PE in advanced NSCLC, although there was no difference in time to progression and overall survival. A higher incidence of haematological toxicity was seen with PG than with PE.

Serum IL-18 levels in tuberculosis: comparison with pneumonia, lung cancer and healthy controls.

OBJECTIVE: The aim of the present study was to document the serum IL-18 levels in patients with pulmonary tuberculosis (P-TB), extrapulmonary tuberculosis (EP-TB), pneumonia, lung cancer and in healthy controls, and to investigate whether it may assist in the differential diagnosis of P-TB. METHODOLOGY: A total of 116 patients were included in the study. The study population consisted of patients with P-TB, EP-TB, pneumonia and lung cancer and controls. P-TB patients were graded according to sputum positivity and extent of disease. Serum levels of IL-18 (ELISA) were compared between groups and with other clinical measures of disease. RESULTS: Compared with the controls, all groups of patients had increased serum levels of IL-18. The highest mean concentration of IL-18 was observed in P-TB. Serum levels of IL-18 in the patients with P-TB correlated well with the extent of disease. CONCLUSIONS: Although increased serum levels of IL-18 were not specific for TB, the increased levels may favour active TB in radiologically advanced disease where CXR findings are difficult to interpret, and sputum smears or cultures are not helpful.

[The pathogens and their antibiotic sensitivities in hospital-acquired pneumonia cases]. / Hastane kökenli pnömoni olgularinda etkenler ve antibiyotik duyarliliklari.

Dynamic precautions in the early diagnosis and treatment of hospital acquired pneumonias are necessary because of their high mortality. In these patients, invasive diagnostic approaches may be needed since clinical and radiological findings and other non-invasive approaches frequently fail to establish the diagnosis. Thirty eight patients were prospectively included in the study. Average age of patients was 45.5 +/- 16.4 years; 31 were males (81.6%) and 7 (18.4%) were females. Pneumonia was detected in 9 (23.7%) cases during the first five days and in 29 (76.3%) cases after the fifth day of admission to the hospital. Bronchoscopic interventions diagnostic purpose were carried out in 25 (65.8%) patients. The culture results were negative in 7 (18.4%) cases. While more than one pathogen was determined on the cultures of 16 (42.1%) patients only one pathogen was isolated in the cultures of 15 (39.4%) cases. The frequently isolated pathogen on cultures was Staphylococci (45.4%). Other pathogens were Enterobacter spp., Pseudomonas spp., Escherichia coli, Serratia and Streptococcus pneumoniae according to their frequency on cultures. High resistance rates to the third generation cephalosporins were determined. Eleven of 17 deaths in 38 pneumonia cases were attributable to pneumonia. As a conclusion, isolation of pathogen and antibiotic resistance should be determined in the cases with hospital acquired pneumonia. Invasive diagnostic interventions were not avoided when necessary. Although pro-BAL and PSB methods were expensive, their use in selected cases may prevent unnecessary antibiotic use and contribute to a decrease in mortality rate.

Mediastinal lymphadenopathy due to mycobacterial infection.

Tuberculous lymphadenitis without pulmonary manifestation is an uncommon entity in developed countries, and the possibility of tuberculous infection is usually ignored in the differential diagnosis of lymphadenopathy. Therefore, appropriate treatment may be delayed. Paralysis of the recurrent laryngeal nerve caused by mediastinal lymphadenopathy due to tuberculosis is an extremely rare condition. In this paper, we present a patient who had vocal cord paralysis caused by tuberculous lymphadenopathy of the superior mediastinum. After anti-tuberculosis treatment, vocal cord function was only partially recovered, while the clinical, radiological, and laboratory abnormalities were completely recovered.

Reactive airways dysfunction syndrome in housewives due to a bleach-hydrochloric acid mixture.

The sudden onset of asthmalike symptoms and persistence of airway reactivity following an acute exposure to an irritant gas or vapor has been termed reactive airways dysfunction syndrome (RADS). A mixture of sodium hypochlorite (bleach, 40%) and hydrochloric acid (18%) is commonly used as a household cleaning solution in our region. From this mixture, chlorine gas is produced, which can cause airway damage and ensuing RADS. Here we describe findings of patients with RADS due to this cleaning mixture, and determine factors associated with a favorable outcome. Data were collected retrospectively on 55 symptomatic patients presenting to our emergency department after inhalation exposure to a mixture of bleach and hydrochloric acid. Symptoms, past medical and smoking history, details of the exposure, initial peak expiratory flow rate (PEFR) and oxygenation, and acute reversibility of airways obstruction were documented. All patients met previously defined criteria for the diagnosis of RADS, but did not undergo methacholine challenge testing and bronchoalveolar lavage or histopathologic study. Fifty patients were followed over the course of 3 mo. The majority of exposures (64%) occurred in the bathroom or kitchen. Only 21 of 55 (38%) patients showed an improvement in PEFR of 15% or greater following two beta(2)-agonist inhalation treatments. In follow-up, 48 patients (87%) improved clinically and functionally (FEV(1)). Seven patients (13%) deteriorated, with ARDS developing in two, one of whom died from respiratory failure. Advanced age, initial low PEFR, exposure in a small enclosed area, use immediately after mixing, and prolonged short- and long-term exposures were associated with a poorer prognosis. This descriptive study is the largest case series in the literature of RADS developing after exposure to a bleach-hydrochloric acid mixture. The optimum acute treatment and long-term outcomes for patients with RADS due to this combination still need to be determined.

The prevalence of exercise-induced bronchoconstriction among symptomatic sportsmen.

Exercise-induced bronchoconstriction (EIB) is a transient airflow obstruction that usually occurs 5 to 15 minutes after physical exertion. Although this condition is preventable, it is still underrecognized and affects the quality of life. The purpose of this study was to evaluate the prevalence of EIB, to find out whether self-reported symptoms were enough to establish the diagnosis of EIB and to define related symptoms and risk factors among symptomatic students of a Sports Academy in our city, which is situated at about 2,000 meters altitude and experiences a long winter period. A questionnaire was sent to students of the Sports Academy. After its evaluation, symptomatic students were invited to perform a pulmonary function test (PFT) before and after a six minute exercise test. Two hundred and seventy-seven students (205 males and 72 females, mean age: 20+/-4) from 12 different types of sport replied to the questionnaire. Of these subjects, 43% were symptomatic. Out of the 119 symptomatic students, 63 accepted our invitation. Three of them were excluded. After performing a six-minute exercise test, EIB was observed in 5 (8%) of them, whose symptoms were aggravated by cold weather. Our results suggest that EIB may be common among symptomatic sportsmen. Screening is important, since EIB could be prevented with appropriate diagnosis and treatment. Although respiratory symptoms during exercise may give important clues, only these symptoms are not sufficient to establish the diagnosis of EIB. Symptomatic patients should undergo further tests for EIB.

Color Doppler sonographically guided transthoracic needle aspiration of lung and mediastinal masses.

OBJECTIVE: This study investigated the diagnostic value of color Doppler sonographically guided transthoracic needle aspiration in lung and mediastinal masses. METHODS: B-mode and colorDoppler sonographic images were obtained in 48 patients with mediastinal or peripheral pulmonary tumors. Color Doppler sonography was used to show the vascular structures before the transthoracic needle aspiration procedure. It was also used to locate the needle tip during the procedure by showing the twinkling sign. This maneuver was performed with motion of the inner stylet. Pathologic and microbiological examination of the aspirates was made. RESULTS: Vascular structures were detected in 37 cases on color Doppler images and in 10 cases on B-mode images. Similarly, the needle tip was observed in 39 cases on color Doppler images but in only 9 cases on B-mode images. No complications were observed except partial pneumothorax in 2 cases. The method had sensitivity of 90.0%, specificity of 87.5%, a positive predictive value of 97.2%, a negative predictive value of 63.6%, and diagnostic accuracy of 89.6%. CONCLUSIONS: Color Doppler sonographically guided transthoracic needle aspiration is a safe diagnostic method in malignant lung tumors, especially peripheral tumors, because of its ability to differentiate vascular structures within a tumor before the transthoracic needle aspiration procedure. It provides additional information about the location of the needle tip.