Pulmonary Embolism Originating from a Hepatic Hydatid Cyst Ruptured into the Inferior Vena Cava: CT and MRI Findings.

Pulmonary embolism due to hydatid cysts is a very rare clinical entity. Hydatid pulmonary embolism can be distinguished from other causes of pulmonary embolism with contrast-enhanced computed tomography (CECT) and magnetic resonance imaging (MRI). MRI especially displays the cystic nature of lesions better than CECT. Here we report a 45-year-old male patient with the pulmonary embolism due to ruptured hydatid liver cyst into the inferior vena cava.

The effect of theophylline on the prevention of mechanical ventilation-induced diaphragm atrophy in rats.

BACKGROUND: Movement disorders and atrophy occur in the diaphragm, the most important muscle of respiration, because of mechanical ventilation (MV). OBJECTIVES: In this animal model, we aimed to evaluate the effect of intravenous theophylline administration on the prevention of mechanical ventilation-induced diaphragmatic atrophy. MATERIAL AND METHODS: In our study, 30 healthy male Sprague-dawley rats were used. They were divided into 3 equal groups. Group 1: the control group (no MV); group 2: the placebo group that received MV; Group 3: the theophylline group composed of rats that received both MV and theophylline therapy. In all 3 groups, the diaphragmatic atrophy was evaluated histopathologically. RESULTS: In the histopathological examination, no macroscopic thickening and microscopic atrophy were observed in the diaphragm in the control group. In the placebo group (group 2), macroscopically definite thickening was observed in all rats, and microscopically, heavy (+++) atrophy was observed. In the theophylline group (group 3), there was no atrophy in one rat. In 8 rats, light (+), and in 1 rat medium (++) atrophy was observed. CONCLUSIONS: In our study, it was shown that atrophy occurred in the diaphragms of rats after MV, and the atrophy was decreased after theophylline administration.

Evaluation of performance of quantiferon assay and tuberculin skin test in end stage renal disease patients receiving hemodialysis.

PURPOSE: End stage renal disease (ESRD) cases are associated with increased risk of tuberculosis. There is no gold standard method for detecting latent tuberculosis infection (LTBI) in ESRD. The aim of the present study was to analyze the performance of the tuberculin skin test (TST) and QuantiFERON-TB Gold in tube (QFT-G) in cases receiving hemodialysis (HD). METHODS: The TST and QFT-G were prospectively performed in 96 ESRD cases undergoing HD. The agreement of the QFT-G and TST was assessed in two TST cut off values (10 mm and 5 mm) in Bacille Calmette Guèrin (BCG) vaccinated and non-vaccinated cases. RESULTS: Of 96 cases 67 were BCG vaccinated and 29 were BCG non-vaccinated. QFT-G was positive in 39.6% cases and indeterminate in 3.1%. TST was positive in 43.8% of cases in cut off value of 10 mm and positive in 58.3% of cases in cut off value of 5 mm. Agreement between TST and QFT-G results was fair in both BCG vaccinated and non-vaccinated cases in either cut off values, except in cut off value of 10 mm in BCG vaccinated cases in which the agreement was moderate. CONCLUSION: The agreement between QFT-G and TST test is fair and there is no significant difference in both cut off values of TST in screening of LTBI in ESRD cases receiving HD.

Unexplained acute respiratory distress syndrome after varicocele surgery; report of a case.

Acute respiratory distress syndrome (ARDS) is a syndrome of acute respiratory failure that is associated with several clinical disorders including direct pulmonary injury and indirect pulmonary injury. Vascular surgical patients are at risk for ARDS. A 23-year old man was admitted to our respiratory intensive care unit with short of breath, cyanosis and agitation which was developed acutely after varicocele operation under epidural anesthesia lasted for one hour. Bupivacain, fentanyl, remifentadyl and midazolam were used for epidural anesthesia. Oxygen saturation was 81% while breathing oxygen at FiO(2) of 0.5. Arterial blood gas analysis showed hypoxemia with respiratory alkalosis with a PaO(2)/FiO(2) score of 100. A chest radiograph demonstrated bilateral alveolar opacities. Bedside echocardiography was performed which revealed no evidence of global hypokinesia, all the chambers were normal, left ventricular ejection fraction was 65%. A diagnosis of ARDS was made and the patient was initiated on noninvasive mechanical ventilation. He was gradually weaned off the NIMV and discharged after a total hospital stay of four days. We report an ARDS case due to unexplained etiology after varicocele operation under epidural anesthesia and managed successfully with noninvasive mechanical ventilation.

2009 H1N1 influenza and experience in three critical care units.

AIM: We describe futures of ICU admission, demographic characteristics, treatment and outcome for critically ill patients with laboratory-confirmed and suspected infection with the H1N1 virus admitted to the three different critical care departments in Turkey. METHODS: Retrospective study of critically ill patients with 2009 influenza A(H1N1) at ICU. Demographic data, symptoms, comorbid conditions, and clinical outcomes were collected using a case report form. RESULTS: Critical illness occurred in 61 patients admitted to an ICU with confirmed (n=45) or probable and suspected 2009 influenza A(H1N1). Patients were young (mean, 41.5 years), were female (54%). Fifty-six patients, required mechanical ventilation (14 invasive, 27 noninvasive, 15 both) during the course of ICU. On admission, mean APACHE II score was 18.7±6.3 and median PaO(2)/FIO(2) was 127.9±70.4. 31 patients (50.8%) was die. There were no significant differences in baseline PaO(2)/FIO(2 )and ventilation strategies between survivors and nonsurvivors. Patients who survived were more likely to have NIMV use at the time of admission to the ICU. CONCLUSION: Critical illness from 2009 influenza A(H1N1) in ICU predominantly affects young patients with little major comorbidity and had a high case-fatality rate. NIMV could be used in 2009 influenza A (H1N1) infection-related hypoxemic respiratory failure.

The acute effect of bi-level positive airway pressure on heart rate variability in chronic obstructive pulmonary disease patients with hypercapnic respiratory failure.

OBJECTIVE: Non-invasive mechanical ventilation (NIMV) has the potential to improve sympathovagal control of heart rate. The aim of this study was to investigate the acute effects of NIMV on heart rate variability (HRV) in chronic obstructive pulmonary disease (COPD) patients with hypercapnic respiratory failure (HRF). METHODS: In this prospective study 28 COPD patients (64+/-10 years) with HRF underwent electrocardiographic Holter monitorization. Both time domain (TD) and frequency domain (FD) means of HRV analysis were measured for two hours before and during NIMV application. For the TD, mean-RR, SDNN, SDANN, SDNN index, RMSSD, pNN50 and HRV triangular index were measured. For FD, high frequency (HF) and low frequency (LF) were detected. To compare HRV parameters before and during bi-level positive airway pressure (BiPAP) application; paired sample t test was used for normally distributed variables and Wilcoxon signed rank test was used for the variables that were not normally distributed. Pearson correlation test was used to analyze the correlation between HRV and blood gas parameters during BiPAP application. RESULTS: High frequency power of HRV (39 (18-65) ms2 vs. 28 (12-50) ms2, p<0.05), HRV triangular index (9 (3-17) units vs. 6 (2-13) units, p<0.05) and pNN50 (59% (13-110) vs. 42% (5-84), p<0.05), were higher during NIMV than before noninvasive mechanical ventilation. CONCLUSIONS: We think that NIMV may improve heart rate variability indices of parasympathetic modulation of heart rate in COPD cases with HRF and decrease arrhythmic potential.

Detection and quantification of the parenchymal abnormalities in emphysema using pulmo-CT.

We aimed to determine the degree and extent of parenchymal abnormalities on pulmo-CT in patients with emphysema. The study group consisted of 29 patients (18 male, 11 female; mean age 57.9+/-13). The diagnosis was based on clinical symptoms, pulmonary function tests (PFT) values, and chest CT findings. All of the patients CT scans were obtained during suspended deep inspiration from the apices to the costophrenic angles. The mean lung attenuation (MLD) and parenchymal abnormalities related to emphysema were quantitatively calculated with tables, histograms and graphics at the whole lung. The lung density measurements revealed a mean density of -898.48+/-51.37 HU in patients with emphysema and -825.1+/-25.5 HU in control group. In addition, mean percentage of subthreshold attenuation values was found as 12.03+/-15.75 and 1.07+/-0.83 in patients with emphysema and control group, respectively. Compared with control group, the patients with emphysema had a significantly lower inspiratory MLD (p<0.05). Additionally, statistically significant correlations were seen between the MLD and percentage of subthreshold values (r=0.44, p<0.05). In contrast, there was poor correlation between PFT measurements and the subthreshold values. In conclusion, pulmo-CT is a quick, simple method for quantitative confirmation of the presence of parenchymal abnormalities of lung as mosaic attenuation and should be used in combination with other radiological methods and PFT as it gives additional information to routine examinations in patients with emphysema.

Association of serum reactive oxygen metabolite levels with different histopathological types of lung cancer.

BACKGROUND: Oxygen is required for respiration and the energetic processes that enable aerobic life. Costs associated with oxygen use are free radical and reactive oxygen metabolite (ROM) formations, which create oxidative stress and contribute to various processes including aging, degenerative diseases and cancer. Additionally, they may have a role in the pathogenesis of lung cancer with different histopathological types. OBJECTIVES: In this study, we aimed to investigate the degree of oxidative stress in different types of carcinoma such as small cell carcinoma and non-small cell carcinoma, including epidermoid carcinoma and adenocarcinoma, and to find out whether the degree of oxidative stress shows any difference among them and whether it can be used as an index for their differential diagnosis. METHODS: Thirty-eight patients with lung cancer and 26 healthy persons were included in the study. Of the patients with lung cancer, 14 had epidermoid carcinoma, 12 adenocarcinoma and 12 small cell carcinoma. Serum ROM levels were detected by using an available commercial kit according to the manufacturer's instructions. RESULTS: The ROM levels were significantly lower in the controls than in the patients (p<0.001). Although all subtypes had significantly high ROM levels compared with the controls, the highest significance was found in the small cell carcinoma (p<0.001), and then in the adenocarcinoma and epidermoid carcinoma (p<0.01 and p<0.01, respectively). CONCLUSIONS: In the light of these data, it might be possible to conclude that the serum ROM levels increase in patients with different types of lung cancers and may be an index parameter for lung cancer. It could be thought that this increase, particularly in small cell carcinoma, may contribute to its poor progression.

Comparison of the short-term effects of salmeterol and formoterol on heart rate variability in adult asthmatic patients.

STUDY OBJECTIVES: We investigated the effects of beta2-adrenergic agonists salmeterol and formoterol on heart rate variability (HRV) in adult asthmatic patients using time-domain measures of HRV. PATIENTS: Thirty-nine adult patients with asthma were studied. All patients showed a mild-to-moderate decrease in baseline FEV1. Any diseases that might have influenced the autonomic function were excluded. All patients underwent a complete physical examination and medical history that revealed no cardiovascular disease or medication. METHODS: The beta2-adrenergic inhaled agonists salmeterol, 50 microg, and formoterol, 12 microg, were used in the study. HRV analysis was performed for each 5-min segment: 5 min and 10 min before inhalation of the study drug, and 5, 10, 15, 20, 25, and 30 min after inhalation. Time-domain parameters of HRV were calculated: (1) the SD all normal-to-normal intervals; (2) the SD of the mean of all normal-to-normal intervals in all 5-min segments of the entire recording; (3) the root mean square of differences between adjacent normal-to-normal intervals; (4) the mean of the SD of all normal-to-normal intervals in all the 5-min intervals; and (5) the SD of the SD of all normal-to-normal intervals in all the 5-min intervals. RESULTS: Baseline HRV parameters were not significantly different between formoterol and salmeterol groups. There were no significant differences in HRV parameters after formoterol and salmeterol inhalation. The HRV parameters in each 5-min segment in the formoterol group were not statistically significant different when compared to the same segment in the salmeterol group. CONCLUSION: Salmeterol and formoterol have no short-term adverse effects on HRV.

Tuberculin skin test results and the booster phenomenon in two-step tuberculin skin testing in hemodialysis patients.

Patients with chronic renal failure are at increased risk for tuberculosis (TB). Centers for Disease Control and Prevention (CDC) have recommended annual skin testing for TB, with tuberculin-purified protein derivative (PPD), in patients with chronic renal failure. Uremia alters the macrophage function, which can lead to anergy for skin tests. The aim of this prospective study was to determine the prevalence of positive tuberculin skin test (TST) and the booster effect of TST in hemodialysis patients living in a relatively underdeveloped portion of the country. Material and Methods. Patients were recruited from Van (Yuzuncu Yil University Hospital, Yuksek Ihtisas Hospital) and the Mus State Hospital). At the time of this study, a total of 143 patients were under hemodialysis treatment in these hemodialysis centers, and among them, 124 were included in the study. Informed consent was obtained before inclusion in the study. A positive PPD was an induration of >10 mm in response to five tuberculin units of PPD (RT23-Tween 80), at 72 h. TST-negative patients received a booster TST 10 days later, approximately 10 cm away from the previous intracutaneous injection. The test dose could not be increased due to unavailability of this kind of preparation. The test was performed and interpreted in the same way. Skin testing was performed in June and December 2003. Patients with known active TB are not included in the study. Testing was not done in hospitalized patients to rule out effects of other disease states. Results. Mean age of the patients was 45.3 +/- 16 (range 13-82) years. All patients were on HD treatment twice (n: 14) or three times (n: 110) weekly. Duration of dialysis before TST was 30 +/- 17 (12-84) months. With the first test (n: 14), 11.3% of the patients showed a positive reaction; the second test added (n: 15) 12.1% more TST-positive patients, reaching a total of (n: 29) 23.4% of the patients with a positive TST. The

Demonstrating the effect of theophylline treatment on diaphragmatic movement in chronic obstructive pulmonary disease patients by MR-fluoroscopy.

INTRODUCTION: The purpose of this study was to determine the increase in diaphragmatic excursion of patients with chronic obstructive pulmonary disease (COPD) treated with theophylline by MR-fluoroscopy which is an innovative method to demonstrate effectiveness of this treatment. MATERIALS AND METHODS: Investigations were performed on a 0.3 T open MR unit. MR-fluoroscopy images of 30 patients with COPD were obtained before and after theophylline treatment. Diaphragmatic movement values were recorded for evaluation. RESULTS: The response of the diaphragmatic movement in COPD patients treated with theophylline was evaluated by MR-fluoroscopy and an increase of 48% in diaphragmatic contractility was determined after the treatment. The increase in contractility was found to be parallel with respiratory function tests and clinical status. CONCLUSION: Diaphragmatic movement and response to the medical therapy in patients with COPD can be evaluated by MR-fluoroscopy method which can allow accurate measurements.

MR fluoroscopy-guided transthoracic fine-needle aspiration biopsy: feasibility.

The purpose of this study was to evaluate the feasibility of using an open-configuration magnetic resonance (MR) imaging system with MR fluoroscopic guidance to perform percutaneous transthoracic fine-needle aspiration biopsy in patients with lung masses. Percutaneous transthoracic aspiration biopsies were performed with MR fluoroscopic guidance in 14 patients. The masses were 2-7 cm in diameter (mean, 4.1 cm). The needle was positioned by using a free-hand technique with MR fluoroscopic guidance. The needle tip reached the target lesion, and biopsy was performed. Analysis of the biopsy specimens facilitated a specific diagnosis in all patients. Pneumothorax was noted in two patients (14%) with chronic obstructive pulmonary disease. Study results showed that the described MR fluoroscopy-guided transthoracic biopsy technique can be used safely and successfully for lung masses. MR fluoroscopy can be used to reach the target lesion easily and accurately.

Prevalence of chronic bronchitis-asthma symptoms in biomass fuel exposed females.

OBJECTIVES: We investigated whether exposure to biomass fuel is a potential risk factor for chronic bronchitis and asthma among females in rural area in Van (east Turkey). METHODS: The effect of indoor pollution producing various respiratory symptoms was studied in 177 females. Of these, 90 were those who used biomass fuel and 87 were nonusers of biomass fuel. A part of the European Community Respiratory Health Survey quastionnaire and British Medical Research Council questionnaire were used. RESULTS: Asthma related symptoms (AS) (wheezing, and combination of wheezing without a cold and wheezing with breathlessness) were reported in 63.3% of those who used biomass fuel, and in 12.9% of nonusers (p<0.0001). The use of asthma medication was reported as 3.3% of biomass fuel users, and in 2.7% of nonuser (p>0.05). Long term cough and/or morning cough together with sputum (chronic bronchitis symptoms (BS) was reported as 58.9% in the user group, and 29.4% in the nonuser group (p<0.0001). Significant differences in AS and BS were found between biomass fuel user and nonuser groups in the rural area. CONCLUSIONS: The results of this study showed a significant association between symptoms of chronic bronchitis-asthma and biomass fuel usage in females living in a rural area.

Extrapulmonary tuberculosis in high prevalence of tuberculosis and low prevalence of HIV.

The authors' data show a higher rate of pleural and meningeal involvement among extrapulmonary TB cases than expected by previous works. Special attention should be given to tuberculous meningitis cases among all extrapulmonary TB cases because of its high mortality rate. The most common extrapulmonary involvement is pleural. Pleural involvement is most common among the young male military service personnel. These data underscore the importance of determining pleural involvement among extrapulmonary TB cases and emphasize the need to consider clinic and epidemiologic differences in the diagnosis and evaluation of extrapulmonary TB. Finally, it seems unlikely that HIV infection currently has a role in the cause of extrapulmonary TB in the authors' region.