Tonsillar metastasis of small cell lung carcinoma.

Metastasis to palatine tonsils are rare, accounting from only 0.8% of all tonsillar tumors, so far only 100 cases reported in the English literature. Only a few cases have been reported for small cell and non-small cell lung cancer as a primary site. With a diagnosis of small cell lung cancer, a 68-year-old male patient relapsed after six cycles of chemotherapy in tonsilla palatina and cervical lymph nodes. Patients died 26 months after being diagnosed with lung cancer and 2 months after detection of tonsil metastasis. We present the current case report because of the rarity of metastasis to tonsil in lung cancer.

Evaluation of clinical and functional parameters in female subjects with biomass smoke exposure.

BACKGROUND: Indoor air pollution and exposure to biomass smoke is a risk factor for pulmonary diseases among women in developing countries. We aimed to assess clinical and functional findings and exposure duration and to evaluate their relationships in patients who used biomass products as fuel and who presented to the clinic due to respiratory symptoms. METHODS: Fifty-five patients who had been referred to the hospital between January 2008 and December 2010 and who met the inclusion criteria were accepted to the study. Data on the place they live, biomass exposure duration, lung function parameters, and arterial blood gases were recorded. RESULTS: Statistically significant differences in FEV(1)%, FEV1 (L) and, FEV(1)/FVC existed between the subgroups of duration of biomass exposure (P = .001). FEV(1)% and FEV(1)/FVC were highest in the < 30 hour-years exposure group. In the presence of animal dung use, the odds ratio and 95% CI for the risk of FEV(1)/FVC < 70% was 3.5 (0.88-10.29). Subjects who used animal dung and wood for cooking and heating had severe and very severe FEV(1) stages. CONCLUSIONS: Biomass exposure can have effects on lung function test parameters. Animal dung use is primarily related to risk of deterioration of FEV(1)/FVC, when compared to other biomass fuels. Protective health measures should be taken by assessing the risks in areas where biomass exposure is intense, improving poor design of the stoves and ventilation, and switching to better clean energy sources such as natural gas and solar energy.

Short-term positive airway pressure therapy response in obstructive sleep apnea patients: impact of treatment on the quality of life.

INTRODUCTION: We aimed to assess the compliance of obstructive sleep apnea (OSA) patients of whom we planned positive airway pressure (PAP) therapy by using "Calgary Sleep Apnea Quality of Life Index (SAQLI)","Epworth Sleepiness Score (ESS)","OSAS Symptoms Questionnaire (OSQ)" and, to investigate the early effects of treatment on the quality of life. PATIENTS AND METHODS: A total of 30 adult (male/female: 23/7) OSA patients who applied to Sleep Research Laboratory at the University Hospital, complaining of symptoms related to sleep and polysomnographically verified as OSAS with PAP therapy indications were included to the study. Their written consent were obtained. RESULTS: Characteristics of the patients, OSAS symptoms, ESS and SAQLI sores were recorded. After a month, on the second visit, ESS, SAQLI and OSAS symptoms questionnaire had been repeated. All the patients have routinely used PAP devices for a period of a month. PAP therapy provided significant improvements in excessive daytime sleepiness, symptoms questionnaire and SAQLI scores (p< 0.001). There was a significant correlation between apnea hypopnea index (AHI) score and the improvements in emotional functioning (r = -0.374, p= 0.045). CONCLUSION: We concluded that the OSA patients can have remarkable benefits from PAP therapy during the early treatment period. This study increased the awareness of the patients about their illness and their perceived benefits related to PAP treatment. Emotional functioning improved prominantly as the disease's severity increased.

Obstructive sleep apnea syndrome and anthropometric obesity indexes.

BACKGROUND: The purpose of this study is to investigate whether the general body adiposity or regional adiposity was a risk factor in the evolution of obstructive sleep apnea syndrome (OSAS) by examining the relationships between the anthropometric obesity indexes such as waist (WC) and neck circumference index (NC), body mass index (BMI), and OSAS in Turkish adult population, and to access the possible differences by gender. METHODS: The data related to polysomnographic, demographic, and anthropometric indexes of the 499 subjects were examined retrospectively. The patients whose apnea-hypopnea index was ≥5 were determined as OSAS group. RESULTS: The avarage BMI, WC, and NC of the OSAS group (n = 431) were statistically higher than the control group (p < 0.001). According to logistic regression analysis, BMI, WC, and NC enlargement were observed as significant risk factors for OSAS development. Risk coefficients were determined 5.53 for NC, 4.48 for WC, and 2.22 for BMI. Cutoff point values for anthropometric obesity indexes as OSAS determiner were recorded as below: BMI for male >27.77 kg/m(2) and female >28.93 kg/m(2), NC index for male >40 cm and female >36 cm, and WC index for male >105 cm and female >101 cm. CONCLUSIONS: BMI, WC, and NC enlargement were determined as significant risk factors for OSAS development. This was an initial study to determine the cutoff points of which increase the OSAS risk in BMI, WC, and NC index in Turkish adult population.

Bronchial hyperreactivity and airway wall thickening in obstructive sleep apnea patients.

PURPOSE: Hypoxia/reoxygenation episodes in obstructive sleep apnea (OSA) results in the alteration of the oxidative balance, leading to the development of inflammation. Airway wall thickening and inflammatory changes are suggested as a primary cause of the airway hyperresponsiveness in asthmatics. Bronchial hyperreactivity (BH) may also occur in patients with OSA. We investigated the presence of BH and airway wall thickness in OSA and correlations with inflammatory markers. MATERIALS AND METHODS: Sixteen OSA patients and ten controls without allergic diseases were prospectively studied. Plasma pro-B-type natriuretic peptide (pro-BNP), fibrinogen, D-dimer, α1-antitrypsin, and high-sensitive C-reactive protein levels were measured. Airway wall thickness was evaluated with high-resolution CT, and BH was assessed by giving each subject a methacholine challenge test. RESULTS: In OSA patients, bronchial wall thickness, fibrinogen, D-dimer, α1-antitrypsin, high sensitive C-reactive protein, and pro-BNP levels were significantly greater than those in control subjects. Among the 16 patients, three had BH on methacholine challenge. Bronchial wall thickness(mm) was positively correlated with apnea-hypopnea index (AHI: number of apneas + hypopneas/hour of sleep), BMI, respiratory arousal index, nocturnal oxygen desaturation (NOD) duration (time in minutes with a nocturnal arterial oxygen saturation of <90% during sleep), and α1-antitrypsin levels. NOD duration also correlated with pro-BNP and fibrinogen levels. CONCLUSIONS: In OSA patients, walls of central airways were thicker than normal subjects. BH may have occurred in OSA patients. NOD duration correlated with inflammatory parameters and oxygen desaturation index 3% had an effect on the thickness of bronchial walls. But overall, AHI was found to be the only independent predictor of bronchial wall thickness.