The effect of hypoxia on hearing function

Background/aim: This study was conducted to determine the critical partial oxygen pressure (pO2) value that would impair hearing function by evaluating the effects of hypoxia on hearing function in subjects diagnosed with chronic obstructive pulmonary disease (CPOD). Materials and methods: The study included 25 male and 5 female patients referred to our clinic who were diagnosed with COPD, according to spirometry and PaO2 values, and who did not show pathology upon autoscopic examination. The control group consisted of 14 female and 16 male patients who had no lung disease and were in the same age range as the COPD group. Results: A statistically significant difference was found between the two groups for distortion-product otoacoustic emission (DPOAE) (P < 0.001). The COPD group was divided into two groups according to pO2 levels (pO2 ≤ 70 and pO2 > 70) in order to find a critical pO2 level which might cause significant change at a certain audiological extent. Conclusion: Hypoxia causes long-term decline in hearing thresholds, deterioration of DPOAE results, and prolongation of I­V interpeak latency in auditory brainstem response. However, the critical oxygen level that disrupts hearing function could not be determined.

[The treatment results of retreatment pulmonary tuberculosis patients in our clinic]. / Klinigimizde yeniden tedavi rejimi uygulanan akciger tüberkülozlu olgularin sonuçlari

164 human immunodeficiency virus (HIV) seronegative pulmonary tuberculosis cases treated in our clinic between January 1997 to December 2005 and included in category two treatment group were evaluated retrospectively. All the cases were male. The mean age was 43.72 ± 12.73 years. The mean duration of disease was 3.96 ± 4.80 years. The patients had used mean 4.62 ± 0.86 types of drugs. The patients were hospitalized for mean 100.54 ± 67.43 days. 23 (14%) patients were defined as treatment failure. 42 (25.6%) patients were relapse and 99 (60.4%) were defaulter. Mean time of conversion was 2.62 ± 1.84 months. Conversion rate was higher in relapse cases (76.2%) compared with treatment failure (56.5%) and defaulter (57.6%). In 140 patients, resistance tests were performed. 73 (52.1%) patients had any drug resistance. 45 (32.1%) patients had multidrug resistance. Among all the patients, 7 (4.3%) patients had died. 48 (29.3%) patients defaulted. 33 (20.1%) had treatment failure. 76 (46.3%) had cured. The cure rate was 65.5% in patients who were in control. 36.4% of defaulters were out of control. This rate was significantly higher than relapse and treatment failure cases (p= 0.014). Cure rate in defaulters (38.4%) were significantly lower than relapses (61.9%) and treatment failures (52.2%). There was a significant relationship between any drug resistance and cure and conversion. There was also a significant relationship between positive second and third ARB and culture and treatment success. As a result, a chance to retreatment regimen can be given in relapses and treatment failures before deciding minor drug therapy because they have higher cure rates than defaulters. Defaulters are hard to cure. They have the tendency to default again and they have higher resistance rates. The multi drug resistance rate in all patients was about 32% and 46.7% of these have cured with retreatment regimen. Bacteriological follow up of treatment outcome is effective in management of therapy.

Mild and severe forms of tuberculosis in diabetic and non-diabetic patients.

BACKGROUND: The aim of the present study was to compare the frequency of pleural tuberculosis in patients with and without diabetes mellitus (DM). METHODS: Three hundred consecutive patients who were smear positive for pulmonary tuberculosis or isolated pleural tuberculosis were enrolled in the study. Patients' age and smoking status (pack-years) were recorded. Patients were divided into two groups: those with and without DM. RESULTS: All patients enrolled in the study were male. Mean (± SD) patient age was 42.4 ± 15.9 years. Of the 300 patients in the study, 48 had DM. There was no significant difference in the distribution of pulmonary tuberculosis and isolated pleural tuberculosis between patients with and without DM (P > 0.05). However, there was a significant difference in mean pack-years of smoking between patients with pulmonary tuberculosis and those with isolated pleural tuberculosis for all patients; patients with isolated pleural tuberculosis had a significantly lower number of pack-years of smoking (P <  0.05). CONCLUSION: Severe pulmonary involvement in DM patients may be due to smoking status.

Assessment of diagnostic enzyme-linked immunosorbent assay kit and serological markers in human brucellosis.

This study was performed to evaluate commercial brucella immunoglobulin G and M enzyme-linked immunosorbent assay (IgG and IgM ELISA) kits for the diagnosis of human brucellosis and to suggest a candidate prognostic marker for human brucellosis. We determined the serum levels of brucella IgG, IgM, C-reactive protein (CRP), soluble CD14 (sCD14), and neopterin in patients with brucellosis and compared them with those of normal healthy persons, patients with tuberculosis, and patients with other diseases. It was found that the sensitivity of ELISA to diagnose brucellosis was high when both IgG and IgM ELISA were used together. This study showed that serum CRP, sCD14, or neopterin levels were significantly high during the course of human brucellosis. The above markers, alone or in combination, might have the potential to evaluate treatment outcomes in human brucellosis. The markers that can predict the variability of agglutination titer was also determined. It was found that the titer value alone does not fully represent disease status.

[A rare form of urinary bladder cancer metastasis to lung]. / Mesane kanserinin akciger metastazinin nadir bir formu.

Sixty-seven year old male patient has attended with cough and sputum complaint. He had been operated because of transitional cell urinary bladder carcinoma four years ago. He had previous medical history of pulmonary tuberculosis 27 years ago. In chest X-ray, multiple cavitary appearances were present. In computerized tomography (CT) of the thorax, bilateral multiple cavities were seen. Sputum smear examinations for acido resistant bacilli (ARB) were negative for nine times. CT guided fine needle aspiration biopsy was performed and he was diagnosed as "pulmonary metastasis of transitional cell urinary bladder cancer". This patient is presented because of the interesting radiological appearance and rare presentation of the case.

Serum adenosine deaminase enzyme and plasma platelet factor 4 activities in active pulmonary tuberculosis, HIV-seropositive subjects and cancer patients.

The aim of this study was to determine the serum adenosine deaminase (ADA) and plasma platelet factor (PF-4) activities in patients with active pulmonary tuberculosis, HIV seropositive subjects, cancer patients (acute and chronic type lymphoblastic leukaemia) and to compare them with the results of healthy individuals. Eighty-eight subjects were enrolled in this study, 24 patients with active pulmonary tuberculosis, 20 patients with HIV seropositive subjects, 24 patients with cancer, 12 patients with acute type lymphoblastic leukaemia, 12 patients with chronic type lymphoblastic leukaemia) patients and 20 healthy individuals. ADA activity was determined in serum samples using colorimetric method and plasma PF4 activity was measured by using a sandwich-type enzyme immunoassay. When all study groups were compared with the control group, mean serum ADA activities were found to be significantly (p<0.01) higher in the sera of patients with active pulmonary tuberculosis (median, range: 39 IU/l), HIV seropositive subjects (median, range: 31 IU/l) than in the sera of cancer patients (median, range: 15) and healthy controls (median, range: 32 IU/l). Plasma PF-4 activities in active pulmonary tuberculosis patients (median, range: 84 IU/ml) were found to be significantly elevated when compared to HIV seropositive subjects (median, range: 59 IU/ml), cancer patients (median, range 55 IU/ml) and healthy individuals (median, range: 56 IU/ml) (p<0.01). Serum ADA and plasma PF-4 activities showed significant alteration in patients with active pulmonary tuberculosis compared to patients with HIV seropositive subjects, cancer patients and healthy individuals. In conclusion, we suggest that serum ADA and PF-4 activities can be used in the diagnosis of tuberculosis as an supplementary laboratory test in combination with clinical and laboratory findings. Further controlled studies are necessary to determine the importance of the PF-4 and ADA activities in patients with active pulmonary tuberculosis, HIV seropositive subjects and cancer patients.

[Evaluation of a commercial enzyme immunoassay for the detection of interferon gamma levels in active tuberculosis patients and vaccinated healthy subjects]. / Aktif tüoberkülozlu hastalar ve asili saglikli bireylerde interferon gamma düzeylerinin saptanmasinda ticari bir enzim immon yonteminin degerlendirilmesi.

The detection of plasma interferon gamma (IFN-g) levels has an important value for the evaluation of cell mediated immune response to Mycobacterium tuberculosis. The aim of this study was to investigate the plasma IFN-g levels by a commercial enzyme immunoassay (ELISA) and to compare the levels between recently diagnosed culture positive lung tuberculosis patients and BCG vaccinated healthy controls. Twenty-three patients with active lung tuberculosis (13 males, 10 females) and 34 BCG vaccinated healthy adults (16 male, 18 female) have been included in the study. The control subjects were questioned about passed tuberculosis infection and/or a contact with tuberculosis patients. No risk factors for exposure to M. tuberculosis were found in the control group. IFN-g levels were measured by QuantiFERON-TB (Cellestis, Australia) kit, and 22 of patients and 17 of control subjects were found to be positive. As a result, the sensitivity of QuantiFERON-TB test was high (95.6%), however its specificity was quite low (50%). In conclusion, QuantiFERON-TB may be used as a supplementary diagnostic test in patients considered to have active tuberculosis, before treatment. As BCG is in routine vaccination programme and the number of active tuberculosis cases is high in our country, this test seems to be invalid for the diagnosis of latent tuberculosis. Therefore, more specific tests that are not affected by the vaccine response, are required for the diagnosis of latent tuberculosis.

[The features of cases of intrathoracic lymphomas]. / Intratorasik lenfoma olgularimizin özellikleri.

In this study, 18 patients who had been diagnosed as intrathoracic lymphoma between January 1999 and August 2001 had been evaluated retrospectively to guide the diagnostic approaches. 12 (66.6%) of the patients were male and 6 (33.4%) were female. The mean age was 46.47 +/- 17.31. The leading symptoms were disapnea, cough, weight loss and fever. The most frequently seen laboratory findings were decreased hemoglobin and hematocrit rates (72.2%) and increased Lactate Dehydrogenase levels (44.4%). Radiologically, 18 (100%) patients had mediastinal lymph node enlargement, 8 (44.4%) patients had bilateral and 6 (33.3%) had unilateral hilar enlargement, 3 (16.6%) patients had appearance of mass lesion, 1 (5.5%) had appearance of consolidation, 2 (11.1%) patients had atelectasis, 3 (16.6%) patients had appearance of pleural effusion. Histopathological diagnosis were undertaken with lymph node biopsies in 11(61.1%) patients, with bronchial biopsies in 2 (11.1%) patients, with pleural biopsy in 1 (5.5%) patient, with lymph node and bronchial biopsies in 3 (16.6%) patients, with lymph node and pleural biopsies in 1 (5.5%) patient. 11 (61.1%) patients were diagnosed as Hodgkin Disease (nine as nodular type, two as mixed cellular type). 7 (38.9%) patients were diagnosed as non Hodgkin Lymphoma. After taking diagnosis the patients were sent to medical oncology clinics for follow up and therapy. These findings showed that different locations of intrathoracic lymphomas could be seen with nodal or extranodal presentations so it must be taken into account in differential diagnosis of other pathological conditions.