Are oropharyngeal exercises effective in Obstructive Sleep Apnea Syndrome?

OBJECTIVE: This study has been conducted to examine the effects of posture, cervical region and oropharyngeal exercises in patients with Obstructive Sleep Apnea Syndrome (OSAS). METHOD: Thirty patients with OSAS have been randomly divided into two groups. The first group received supervised exercise program including oropharyngeal, posture and cervical region exercises for 12 weeks. The patients in the control group have been informed about the posture but the exercise was not recommended. Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), Short Form 36 (SF-36), International Physical Activity Questionnaire-Short Form (IPAQ-SF) and 6 Minute Walk Test (6MWT) have been used in the evaluation of individuals participating in the study. Evaluations have been made at the beginning of the treatment and at the end of the 12-week exercise program. RESULTS: Statistically significant improvements have been observed in the exercise group in PSQI total value, ESS score, SF-36 General Health Subscale and 6MWT (p< 0.05). Statistical significance could not be reached for other parameters. CONCLUSIONS: Sleep quality, general health, and functional capacity have been found to improve in OSAS patients with oropharyngeal exercises.

Predictive models for tuberculous pleural effusions in a high tuberculosis prevalence region.

BACKGROUND: Patients with pleural effusions who reside in geographic areas with a high prevalence of tuberculosis frequently have similar clinical manifestations of other diseases. The aim of our study was to develop a simple but accurate clinical score for differential diagnosis of tuberculosis pleural effusion (TPE) from non-TB pleural effusion (NTPE). METHODS: This was an unblinded, prospective study of Turkish patients 18 years of age or older with pleural effusion of indeterminate etiology conducted from June 2003 to June 2005. Unconditional logistic regression models were used to discriminate TPE cases from NTPE cases. Standard errors for the area under the curve (AUC) were calculated using the Mann-Whitney method. Data were statistically significance if two-tailed P < 0.05. RESULTS: A total of 63.3% (157/248) of the patients had TPE while 36.7% (91/248) of the patients had other etiologies for pleural effusions. We were able to provide a predictive model of TPE that included age <47 years and either pleural fluid adenosine deaminase enzyme (PADA) >35 U/l or pleural serum protein ratio >0.710. However, only the combination of age <47 and PADA >35 U/l was significant (odds ratio [OR]: 7.46; 95% confidence interval [CI]: 3.99-13.96). The generated summary score (range = 0-6) was significantly predictive of TPE (OR: 2.91; 95% CI: 2.18-3.89) and with high AUC (0.79). CONCLUSION: We propose an affordable model that includes age <47 years and PADA >35 U/l for timely diagnosis of TPE in geographical regions with a high prevalence of TB.

CPAP compliance in patients with obstructive sleep apnea syndrome.

Obstructive sleep apnea syndrome (OSAS) is characterized by repeated cessations of breathing during sleep. Major symptoms of this disease are excessive daytime sleepiness, snoring, and witnessed apnea. Most of the patients are treated with CPAP. In this study, we aimed to evaluate the factors affecting adherence to the CPAP treatment. Seventy-one patients were enrolled to this study. Patients were divided into three groups according to CPAP usage. Group I consisted of patients who had never used CPAP, group II consisted of patients who had used CPAP occasionally, and group-III patients had used CPAP treatment regularly. Group-III patients had higher apnea-hypopnea index (AHI) than groups I and II (respectively, 56.6 +/- 27.7, 26.3 +/- 7.5, and 32.3 +/- 7.06; p < 0.000 for both). Oxygen desaturation index was significantly higher in group-III patients comparing to groups I and II (44.6 +/- 22.3, 15.9 +/- 8.3, and 25.6 +/- 9.5; p < 0.000 for all). Our findings have shown that only very severe patients use the CPAP device regularly (mean AHI 56.6 +/- 27.7). Compliance to CPAP treatment seemed to be poor in patients with moderate to severe, AHI about 30, OSAS. Considering the well-established benefits of CPAP treatment in patients with true indications, patients should be encouraged to use CPAP regularly, and complications of OSAS should be keynoted.

Effect of corticosteroids on hemostasis and pulmonary arterial pressure during chronic obstructive pulmonary disease exacerbation.

BACKGROUND: Hemodynamic and hemostatic abnormalities are reportedly frequent in chronic obstructive pulmonary disease (COPD). OBJECTIVES: We investigated the changes in systolic pulmonary artery pressure (PAPs) and hemostatic status and the effects of systemic steroid treatment (SST) during COPD exacerbation. METHODS: Consecutive 26 male and 4 female patients as well as 10 controls were enrolled. The nonsteroid treatment (NST) group received standard treatment without steroids, and the other group received additional SST. Initial values of blood gases, spirometry and PAPs, P-selectin, D-dimer and fibrinogen levels, activities of thrombocyte aggregation, antithrombin III (AT III), protein C (PC), protein S, activated PC resistance (APCR), prothrombin time and partial thromboplastin time were obtained and compared with values at day 10. RESULTS: Improvement in spirometry and blood gases was more prominent with SST. At presentation, patients had higher PAPs, P-selectin, D-dimer and fibrinogen but lower AT III levels than controls. PAPs and fibrinogen levels significantly decreased in the SST group while P-selectin levels further increased in the NST group. The D-dimer level significantly decreased in both groups. Means of AT III, PC and protein S increased in the SST and decreased in the NST group, but only the decrease in PC in the NST group was meaningful. Compared with the controls, AT III levels in the NST group and activated PC resistance in the SST group were significantly decreased. Thrombocyte aggregation tests suggested an incline after 10 days in both groups. CONCLUSIONS: We suggest that in patients with COPD exacerbation, addition of systemic corticosteroids to treatment results in better outcome in normalization of PAPs, hemostasis, pulmonary functions and blood gases.

The effect of inhaled budesonide and formoterol on bronchial remodeling and HRCT features in young asthmatics.

Asthma is a chronic disease that may cause remodeling of the airways. We aimed to observe the effects of the combined use of inhaled budesonide and formoterol on both the reversibility of remodeling and structural changes in the airways. Thirty-six male patients (age range, 20-31) with mild-to-moderate persistent asthma were given inhaled formoterol and budesonide treatment for three months. Bronchial diameter (BD) and bronchial wall thickness (BWT), as measured by high-resolution computerized tomography, and reticular basement membrane thickness (RBMT), assessed in bronchoscopic biopsy specimens, were compared with pretreatment findings. Twenty-two age-matched male controls were also enrolled. BDs of the patients were significantly smaller than in the controls, whereas BWT and RBMT were greater. After three months BWT and RBMT of the subsegmental airways significantly decreased and BD increased. There was a prominent eosinophilic and lymphocytic infiltration in the bronchial mucosa of the asthmatics, and the eosinophilic infiltration significantly improved with treatment. Both serum total IgE and eosinophil counts were related to eosinophilic infiltration in the biopsy samples (r = 0.494 and r = 0.463, respectively). FEV(1) was positively correlated with the diameters of the segmental and subsegmental airways (r = 0.491 and r = 0.265, respectively) and negatively correlated with BWT of the subsegmental airways (r = -0.293) and with the RBMT of both the segmental and subsegmental airways (r = -0.597 and r = -0.590, respectively). We suggest that treatment with inhaled formoterol and budesonide may reverse increased RBMT and BWT as part of remodeling in patients with asthma.

Kikuchi-Fujimoto Disease: analysis of 244 cases.

Kikuchi-Fujimoto Disease (KFD) was first described in Japan in 1972. The disease frequently mimics tuberculous lymphadenitis, malign lymphoma, and many other benign and malignant conditions. To our knowledge, there is no previous study comparing the clinical and laboratory characteristics of patients from different geographical parts of the world. We searched literature records beginning from 1991 and analyzed epidemiological, clinical, and laboratory data of 244 patients (including cases diagnosed in our institution) reported in 181 publications. Of the 244 cases, 33% were male and 77% were female. Mean age was 25 (1-64) and 70% was younger than 30. Most of the cases were reported from Taiwan (36%), USA (6.6%), and Spain (6.3%). Fever (35%), fatigue (7%) and joint pain (7%) were the most frequent symptoms, while lymphadenomegaly (100%), erythematous rashes (10%), arthritis (5%), hepatosplenomegaly (3%), leucopenia (43%), high erythrocyte sedimentation rate (40%), and anemia (23%) being the most common findings. KFD was associated with SLE (32 cases), non-infectious inflammatory diseases (24 cases), and viral infections (17 cases). SLE was more frequent in cases from Asia than Europe (28 and 9%, respectively). The disease was self-limiting in 156 (64%) and corticosteroid treatment was necessary in 16 (16%) of the cases. The mortality rate was 2.1%. Early diagnosis is crucial as the clinical and laboratory presentation generally imitates situations needing lengthy and costly diagnostic and therapeutic interventions. Additionally, association with SLE needs further investigation.

Does the primary Lung Cancer rate increase among females?

Lung cancer is still the most frequently seen malignancy among males where as females are less affected. Recently the lung cancer prevalence has been reported to increase among females in parallel to the increment in cigarette consumption. In our 2 clinic 11.2% (44 cases) of 393 primary lung cancer cases between 1993-1997 were female. We evaluated the demographical characteristics and yearly distribution of our female patients. Mean age was 64+/-12.1 and 18.2% of the patients were smokers. The main complaints were dyspnoea (59%), chest pain (57%), fatigue (47%), cough (45%)and sputum production (32%). The cell type distribution rates were as follows;adenocarcinoma 45.4%, squamous cell cancer 29.5%, small cell cancer 20.5% and large cell cancer 4.6%. The diagnostic methods used were sputum cytology (27.3%),transbronchial biopsy and lavage (38.6%), thoracocentesis and pleural biopsy (15.8%),transthoracic fine needle aspiration (13,6%) and open lung biopsy (4.7%). As a result,we found a low percentage of smokers but a high rate of adenocarcinomas among our female patients.

[A case of arteriovenous malformation seen as an endobronchial lesion]. / Endobronsiyal olarak görülen bir arteriyovenöz malformasyon olgusu.

Pulmonary arteriovenous malformation (PAVM) is an abnormal communication between pulmonary arteries and pulmonary veins, and congenital form is seen more prevalently. The classic radiological appearance is a round, well-circumscribed lesion. PAVM was observed in a 22-year-old male as an endobronchial lesion, and treated by wedge resection. Reviewing the literature, we identified only one case report that describes endobronchial view of PAVM.

Pulmonary function tests and thyroid hormone concentrations in patients with chronic obstructive pulmonary disease.

OBJECTIVE: To evaluate the relationship between pulmonary function tests, arterial blood gases, and thyroid gland functions in patients with chronic obstructive pulmonary disease (COPD). SUBJECTS AND METHODS: Thirty-two patients (mean age 64.1 +/- 7.3 years, range 53-84 years) with stable COPD (mean duration of disease 11.1 +/- 9.1 years, range 1-30 years) and 15 healthy control cases participated in the study. Pulmonary function, arterial blood gas, and thyroid hormone concentration were measured, and thyroid ultrasonography and scintigraphy were also performed. RESULTS: The values of the pulmonary function tests (vital capacity, forced vital capacity, forced expiratory volume in 1 s and peak expiratory flow) and PaO2 were lower in the study than control group (p < 0.001), but the values of PaCO2 and concentration of free 3,5,3'-triiodothyronine (fT3) were higher in the study than control group (p < 0.01) although thyroid hormone concentrations were within normal limits in all cases. However, there was no difference between the values of thyroid-stimulating hormone and free thyroxine in both the study and control groups and therefore association could not be established between them on the one hand and pulmonary function test and arterial blood gases on the other hand. Only the values of PaCO2 and fT3 were positively associated; all other values were negatively associated with fT3. CONCLUSION: Changes in pulmonary function tests and arterial blood gases seem to be associated with fT3 concentrations in patients with COPD. Increased respiratory workload could affect thyroid functions.

Detection of thoracotomy-induced alterations in cell- and humoral-mediated immune response.

OBJECTIVE: It is well known that thoracotomy leads to several complications. In this study, effects of thoracotomy on cellular and humoral immunities have been investigated. Leukocyte counts and lymphocyte counts of 100 patients operated by thoracotomy have been determined preoperatively and on the postoperative 3rd hour, and 1st, 2nd, 3rd, 5th days. Also lymphocyte surface markers (CD3, CD4, CD8, CD4/CD8, CD19, CD16/56) and immunoglobulin levels (IgG, IgA, IgM, IgE) in 40 out of 100 patients in the preoperative period and postoperatively twice on 7th day and then in the 3rd week have been detected. MATERIALS AND METHODS: For the methodology hemocounter, flow cytometer, immunoprecipitation, and enzyme-linked immunosorbent assay were used. RESULTS: A marked increase in leukocyte count while a marked decrease in lymphocyte count has been observed after thoracotomy (P<0.001). There was not any significant alteration in levels of lymphocyte surface markers and immunoglobulins in the postoperative period (P>0.2). CONCLUSION: According to these results, leucocytosis occurred but lymphocyte count decreased in the early postoperative period. Immunoglobulin levels and subpopulation of lymphocytes were not affected from the operative stress.