The assessment of the malignant mesothelioma cases and environmental asbestos exposure in Sivas province, Turkey.

One of the most significant diseases related to environmental asbestos exposure is malignant mesothelioma (MM). Sivas province is located in the Central Anatolia where asbestos exposure is common. We aimed to study clinical, demographical and epidemiologic features of the patients with MM in Sivas, along with the history of asbestos exposure. In total, 219 patients with MM who were diagnosed in our hospital between 1993 and 2010 were retrospectively analyzed in terms of demographical and clinical features. Rock, soil and house plaster samples were taken from the habitats of those patients and were evaluated with optical microscopy and X-ray diffraction methods. The age of the patients ranged between 18 and 85 years. The male-to-female ratio was 1.4:1. Most of the patients confirmed an asbestos exposure history. The most frequent symptoms of the patients were chest pain (60 %) and dyspnea (50 %). The gap between the start of first symptoms and the diagnosis date was approximately 4 months in average. The plaster materials used in most of the houses were made up of mainly carbonate and silicate minerals and some chrysotile. Ophiolitic units contained fibrous minerals such as serpentine (clino + orthochrysotile) chiefly and pectolite, brucite, hydrotalcite and tremolite/actinolite in smaller amounts. MM is not primarily related to occupational asbestos exposure in our region, and hence, environmental asbestos exposure may be indicted. Yet, single or combined roles and/or interactions of other fibrous and non-fibrous minerals in the etiology of MM are not yet fully understood and remain to be investigated.

Clinical characteristics, treatment and survival outcomes in malignant mesothelioma: eighteen years' experience in Turkey.

BACKGROUND: Malignant mesothelioma (MM) is an insidious tumor with poor prognosis, arising from mesothelial surfaces such as pleura, peritoneum and pericardium. We here aimed to evaluate the demographic, clinical, and radiological features of patients with MM followed in our center as well as their survival. METHODS: The study included 228 patients (131 male, 97 female) who were followed up in our institution between 1993 and 2010 with the diagnosis of MM. RESULTS: The mean age was 59.1 years in men and 58.7 years in women and the sex ratio was 1.4:1 in favor of males. Environmental asbestos exposure was present in 86% of the patients for a mean duration of 40±20 years (range: 3-70). Pleural effusion and thoracic/abdominal pain were the most common presenting signs and symptoms (70.2% and 57.8%, respectively). One hundred-thirteen (66%) patients were treated with platinum-based combination chemotherapy (PBCT) plus supportive care (SC) and 67 (34%) patients received SC alone. The median follow-up time was 10.0 months. The median overall survival was significantly improved with PBCT plus SC compared to SC alone (11.4 vs. 5.1 months; p=0.005). The 6, 12, 18, and 24-month survival rates were significantly improved with PBCT plus SC compared to SC alone (72%, 43%, 19%, and 2% vs. 49%, 31%, 11%, and 1%). CONCLUSION: The survival of patients with MM improved in patients treated with PBCT. The survival advantage continued 12- and 24-month after the initial time of combination chemotherapy.

Oxidative stress levels in exhaled breath condensate associated with COPD and smoking.

BACKGROUND: COPD is characterized by chronic air-flow limitation. Smoking is the most important factor in the pathogenesis of COPD. Smoking is associated with increased oxidative stress in the lungs. In this study our aim was to evaluate the differences in the burden of oxidative stress in patients with COPD, smokers, and non-smokers by measuring hydrogen peroxide (H(2)O(2)), malondialdehyde (MDA), and 8-isoprostane levels in the exhaled breath condensate (EBC) samples. METHODS: Eighty subjects were included in the study. Group I (no. = 25) had COPD, Group II (no. = 26) was smokers, and Group III (no. = 29) was nonsmokers. The severity of the COPD and dyspnea was assessed according to the results of pulmonary function tests (PFTs) and Medical Research Council (MRC) scale. RESULTS: The mean age of the subjects was 58 ± 8.9 years. While 8-isoprostane and H(2)O(2) levels were significantly higher in subjects with COPD (44.8 ± 40.2 pg/mL and 1.9 ± 0.8 µmol/L) and smokers (41.3 ± 26 pg/mL and 1.7 ± 0.7 µmol/L) than non-smokers (15.8 ± 6.9 pg/mL and 0.8 ± 0.4 µmol/L), levels were similar between smokers and COPD subjects. MDA levels were similar between the 3 groups (P = .31). There was no correlation between 8-isoprostane and H(2)O(2) levels and PFT parameters. There was a significant positive correlation between dyspnea grade on the MRC scale and 8-isoprostane levels (r = 0.805, P < .001). CONCLUSIONS: Even if respiratory function tests are within normal limits, oxidant burden in lungs of smokers is equivalent to that in COPD patients. 8-isoprostane could be useful in assessing symptom severity and health status of COPD patients.

Oxidative status in the lungs associated with tobacco smoke exposure.

BACKGROUND: Oxidative stress has a critical role in inflammatory responce against tobacco smoke (TS). Testing exhaled breath condensate (EBC) samples is one of the methods used for assessment of airway inflammation caused by TS. We aimed to investigate oxidative stress in the lungs associated with TS and to evaluate the effect of this stress with pulmonary function tests (PFTs). METHODS: We included 69 subjects as three groups into the study (Group I; 26 smokers, Group II; 21 passive smokers, Group III; 22 non-smokers without TS exposure). Levels of malondialdehyde (MDA), 8-hydroxydeoxyguanosine (8-OHdG), nitrite/nitrate [index of nitric oxide (NO) production], vitamin C, superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px) were measured in EBC samples collected using a condenser and PFTs were performed. RESULTS: The levels of MDA, 8-OHdG, SOD and GSH-Px were higher in smokers. NO levels gradually increased from Group I to Group III. MDA levels were lower in Group III than Group II. The levels of vitamin C were similar in all groups. We determined negative correlation between 8-OHdG levels and forced expiratory volume in one second (FEV1), and maximum mean expiratory flow (MMEF), and a positive correlation between SOD levels and FEV1. CONCLUSIONS: TS exposure affected the balance between oxidative stress and antioxidant capacity of lungs. Preventing environmental TS exposure might decrease oxidative damage. Increased levels of 8-OHdG and SOD levels could be assessed as an early sign of airway damage.

[Evaluation of the knowledge and manner of workers of workplaces in Tokat about the ban on restriction of indoor smoking]. / Tokat'da kapali alanlarda sigara içiminin engellenmesine dair yasaya iliskin isletme çalisanlarinin bilgi ve tutumlarinin degerlendirilmesi.

To evaluate the knowledge and manner of cafe, pub and restaurant (with/without alcohol) workers in our city center about the ban on restriction of indoor smoking. To determine the preparation about the ban, smoking characteristics of workers, the knowledge on passive smoking. A questionnaire was performed to workers. The type of workplace, the number of workers, existence of a restriction of indoor smoking, any preparation about the ban were asked. The job of worker, whether the worker has a knowledge on the ban or not, the idea of the workers on the necessity and practicability of the ban were asked. Smoking history and the knowledge about passive smoking of workers were recorded. Fagerstrom nicotine dependent test (FNDT) was performed to smokers. Eighty four work places with 568 workers included in the study. The questionnaire was performed to 337 workers whose mean age was 29.1/years. 292 of workers were male. 190 of cases were current smokers. 166 of cases (49.3%) know the meaning of passive smoking. Alcohol offering was made at 8 of workplaces. Smoking was forbidden in 20 of workplaces. A preparation was performed about the ban in 30 of (46.9%) other workplaces. 88.4% of workers have knowledge on the ban, 64.7% of them know the punishment of the noncompliance of the ban. 81.3% of the workers believe the necessity and 45.7% of them believe the practicability of the ban. Smokers and especially who's FNBT > 5 have a stronger belief on the necessity and practicability of the ban. We determined that the preparation about the ban was inadequate although there was an little time for the put into practice the law. So we think that the controls of workplaces should be happened frequent.

An unusual case of Wegener's granulomatosis with tongue involvement.

Wegener's granulomatosis is a type of vasculitis characterized by necrotizing granulomatosis respiratory tract lesions and necrotising glomerulonephritis. Nasal, lung and renal biopsies and positive antineutrophil cytoplasmic antibody (c-ANCA) analysis is helpful in diagnosis. Early diagnosis and treatment is critical in prognosis. A 42 years-old male had dyspnea, coughing, hemoptysis, fatigue, loss of appetite, night sweating and arthralgia. Violaceous palpable, purpuric lesions were detected on the sublingual region of the mouth. On chest X-ray, there was nonhomogeneous infiltration in the parenchyma of both lungs. There was alveolar density involving upper lobes of both lungs detected in thoracal computerized tomography as well as patchy densities on the right lung upper-middle lobes. A nasal mucosa biopsy showed strongly destructive vasculitis. c-ANCA test was positive. We report an unusual case with Wegener's granulomatosis, characterized by a rare presentation of tongue involvement and atypical lung radiology with alveolar opacity.

Denim sandblasting and silicosis two new subsequent cases in Turkey.

UNLABELLED: In our country quartz is widely used for denim sandblasting and new cases with silicosis are defined. Silicosis is a preventable occupational lung disease caused by inhaled dust containing crystalline silica and no effective treatment for silicosis is available (1). CASE 1: A 23-years old man was admitted to the hospital with dyspnea on effort and cough. He had worked in a denim manufacturing factory for three years at sandblasting and dyeing. Physical examination revealed decreased breath sounds. Chest X-ray showed bilateral reticulonodular densities predominantly at middle and lower zones and minimal pneumothorax. Hypoxemia was determined in arterial blood gas analysis (BGA). Pulmonary function tests (PFTs) showed restrictive disorder. Lymphocytic alveolitis was demonstrated in the bronchoalveolar lavage fluid. Open lung biopsy revealed interstitial fibrosis and foreign particles which were seen more clearly under polarized light in interstitial areas. The patient was diagnosed as accelerated silicosis. CASE 2: A 25-years old man was admitted to the hospital with shortness of breath and haemopthysis. Two years ago, he had worked at the same place for 1.5 years. Bilateral reticulonodular densities at middle and lower zones and minimal unilateral pneumothorax were seen in chest X-ray. Restrictive disorder at PFT and hypoxemia in BGA were observed. Because of the similarity of complaints, radiological findings and occupational history with the former patient, no other further and invasive procedure was planned and the patient was diagnosed as accelerated silicosis. CONCLUSION: The usage of sandblasted denims increase recently and denim sandblasting is being frequently made especially in small work places. Since there is no definite treatment for silicosis, it is important to take necessary precautions to improve the conditions of the factories.

[The prevalence of sleep related disorders among the drivers and it's relation with traffic accidents]. / Sürücülerde uyku ile ilgili hastaliklarin prevalansi ve trafik kazalari ile iliskisi.

Studies consistently show that patients with sleep related diseases (SRD) have higher accident rates. Polysomnography (PSG) is the gold standard for the diagnosis of SRD. Sleep habits questionnaires are also useful tool for research of the prevalence of SRD on large populations. The aim of this study is to investigate the prevalence of SRD and SRD related traffic accidents on the whole population of professional drivers in Sivas city. A questionnaire that includes questions about drivers' background such as how long they have been driving, if they had any accidents, and if they drive just in Sivas city or inter state. This questionnaire composed of 50 questions about SRD and was asked to drivers answer them face to face. Three hundred forty male drivers participated for this study. Their mean age was 39.5+/-9.3 (21-68) years. The mean driving duration was 13.3+/-7.9 years. The percentage of drivers who drove in Sivas was 52.1% and 47.9% of the drivers drove inter state. The percentage of drivers who had at least one accident was 36.3%. The prevalence of habitual snoring, insomnia, sleep apnea, nocturnal myoklonus were 41.2%, 39.1%, 32.9%, and 33.6% respectively. The traffic accident Odds ratio was 1.619 for drivers with habitual snoring (95% CI, 1.034 to 2.536, p=0.02). In conclusion, this study found out that drivers with habituel snoring seems to have tendency (approximately 2-folds) of involving in traffic accidents than drivers who do not have habituel snoring. Polysomnography of candidate drivers with sleep disordered symptoms has to be logical before giving to driving license.

Prevalence of asthma and related symptoms in Sivas, Central Anatolia.

BACKGROUND: In our clinical experience, asthma is an important health problem in our region, but we did not know its prevalence. OBJECTIVE: The main objective of our study was to assess the prevalence of asthma in Sivas, a city in Central Anatolia. METHODS: A cross-sectional study was performed using a screening questionnaire adopted from European Community Respiratory Health Survey (ECRHS). A total of 5448 adults of both genders between 20 and 107 yr of age living in Sivas, a city in the central region of Anatolia in Turkey, participated in the survey. Of the cohort, 2691 were men (49.4%) and 2757 (50.6%) were women. RESULTS: The mean age was 38.2 yr (SD = 12.7 yr), almost half of the study population was at or younger than 40 yr of age. The prevalence of wheezing in the last 12 months, diagnosis of asthma, asthma attack in the last 12 months, and use of asthma medicine were 20.9%, 4.5%, 4.9%, and 3.4%, respectively. Awakening with chest tightness, with shortness of breath, or with cough were reported as 14.2%, 14.8%, and 22.7%, respectively. The prevalence of respiratory symptoms related to asthma was statistically higher in women than that of men (p = 0.000, OR 1.346, 95% CI: 1.228-1.475). Those who had asthma/allergic symptoms in their family members were significantly younger than others (p: 0.001). CONCLUSIONS: The results of this study demonstrate that symptoms suggestive of asthma are quite common and constitute a major health problem in Sivas, Turkey. This study also showed that, despite a high rate of reported symptoms exists, the rate of diagnosis and treatment of asthma is low among the adult population in Sivas.

Strong association between the GSTM1-null genotype and lung cancer in a Turkish population.

Glutathione S-transferases are possibly related to the detoxification of many xenobiotics involved in the etiology of cancer. To investigate the role of the glutathione S-transferase M1 deletion (GSTM1-null) in lung cancer, the polymerase chain reaction was used to determine the GSTM1 genotypes of lung cancer patients (n=101) and hospital (n=206) in a Turkish population. The prevalence of the GSTM1-null genotype in the case group was 48%, compared to 18% in the control group, giving an odds ratio (OR) of 4.14 (95% confidence interval [CI]=2.36-7.27). The analysis of patients by histologic type of lung cancer (10% adenocarcinoma, 43% squamous cell carcinoma, 26% small cell carcinoma, and 11% large cell carcinoma) showed no association between histopathologic type of lung cancer and GSTM1-null genotype. When the interaction between the GSTM1-null genotype and smoking status was analyzed, among the 67 smokers, the GSTM1-null genotype was found in 37 (55%) with an OR of 2.58 (95% CI=1.00-6.73) indicating a significant association. However, no association was found between smoking exposure (<30 and > or =30 packs/year) and GSTM1-null genotype. We conclude that, in this study the null GSTM1 genotype is an independent risk factor for the development of lung cancer for Turkish population.

Evaluation of pulmonary changes due to biomass fuels using high-resolution computed tomography.

Biomass fuels are frequently used in rural areas of the world for cooking and heating frequently. It has been reported that the use of these fuels causes hazardous effects on the lungs. In this study, we evaluated the pulmonary changes due to the use of biomass fuels in a female population that lives in our territory by high-resolution computed tomography (HRCT). The study analyzed three groups of women. The first group comprised those subjects who were exposed to biomass without respiratory symptoms (group 1; n=32). The second group comprised those individuals that were exposed to biomass and showed respiratory symptoms, such as cough, sputum production, and dyspnea (group 2; n=30). The third group was composed of women who were not exposed to biomass and also had no respiratory symptoms (group 3; n=30). Women with a history of concomitant pulmonary diseases were excluded from the study. All groups were examined with HRCT. Groups 1 and 2 (individuals exposed to biomass fuels) had more pathologic findings than group 3 (not exposed to biomass fuels). Ground-glass appearance was seen in 71.9% in group 1, 23.3% in group 2, and 3.3% in group 3. The difference between the groups was statistically significant (p<0.05). Fibrotic bands were seen 50% in group 1, 63.3% in group 2, and only 6.7% in group 3 (p<0.001). Exposure to biomass fuels was the cause or predisposing factor for many pulmonary diseases, ranging from chronic bronchitis to diffuse lung diseases. We believe that these pathological changes due to biomass fuels can be detected earlier by HRCT and the diseases might be prevented or treated earlier.

[The skin manifestations in patients with lung cancers]. / Akciger Kanserli Hastalarda Deri Bulgulari.

It is also common to observe skin manifestations in many internal malignancies. The lung cancer is a frequently seen internal cancer. Due to its gradually increasing incidence, it has become the first reason of death from cancer also in women by overtaking the breast cancer. Although pathognomonic skin manifestations are not reported in lung cancers, it is emphasized that lung cancer must be remembered when non specific signs such as digital clubbing, hypertrophic osteoatropathy, cyanosis due to superior vena cava syndrome, oedema, telengiectasia, acanthosis nigricans are observed. Because a few reports are present about this subject in literature, 44 patients which had the diagnosis of lung cancer in Cumhuriyet University Faculty of Medicine were evaluated according to the their dermatological manifestations. 47.7% of these patients had digital clubbing; meanwhile 25% telengiectasia of the chest forewall, 22.7% lip cyanosis, 9% long eyelash, 2.27% pruritus, 2.27% hypertrophic pulmonary osteoarthropathy and 2.27% Leser Trelat sign were established.

Tracheobronchial rupture: a considerable risk for young teenagers.

Tracheobronchial (TB) ruptures are ten times lower in children than in adults. Despite its rarity in the literature, we found that it is as common as in adults in our series. We investigated TB ruptures in childhood regarding age, trauma presentation, injury localization and treatment options. From 1994 through 2001, eight children (six male, two female) were admitted to our department with TB injury. All patients were healthy prior to trauma. The average and median ages were 9.8 and 11, respectively. All patients except one (iatrogenic) were suffering from blunt thoracic trauma. There were seven main bronchial (five right, two left) and one tracheal wounds. Six of the ruptures were circumferential. Urgent (n=6) and delayed (n=2) thoracotomies were performed; 'end-to-end' anastomosis (n=4), pneumonectomy (n=2) and 'primary suturing' (n=2) were applied. We had no mortality. Main bronchus rupture was overlooked in two patients as one of them had almost totally normal clinical appearance, and the other one had negative endoscopic findings. Both of these patients were successfully operated within 3 months. Our limited experience showed us that these kinds of injuries threaten school age population as well. False negative bronchoscopic results increase when additional injuries accompany. TB ruptures should be always taken into consideration after blunt chest trauma. Early or late repair of the lesion should be decided depending on the patient's clinical course.