Association of Intermittent and Continuous Hypoxaemia with Carotid and Brachial Arterial Intima-Media Thicknesses

ABSTRACT Objective: To assess the carotid and brachial arteries' intima-media thicknesses (IMTs) in cases with intermittent (obstructive sleep apnoea syndrome (OSAS)) and continuous (chronic obstructive pulmonary disease (COPD)) hypoxaemia together with other confounding demographic and biochemical factors. Methods: The study was prospectively performed on 197 patients allocated in three groups: 80 with severe OSAS, 80 with severe COPD patients and 37 healthy controls. These groups were compared in terms of demographics, biochemical markers and IMTs of the right and left carotid and brachial arteries. Results: Carotid and brachial arterial IMTs were found to be higher in both patient groups than the control group (p < 0.001). Similarly, levels of haemoglobin, haematocrit, cholesterol, triglycerides, low-density lipoproteins (LDL), C-reactive protein and D (domain)-dimer were significantly increased in patient groups. Oxygen saturations (p < 0.001) and ejection fractions (p = 0.001) were found to be worse and D-dimer levels (p = 0.010) were elevated more prominently in COPD patients, whereas, cholesterol (p < 0.001), hemoglobin (p = 0.004) and LDL (p = 0.001) levels were higher in the OSAS group. Except the right carotid IMT, which was increased significantly in OSAS patients, IMT measurements were similar in the OSAS and COPD groups (p < 0.001). Conclusion: We have shown that both intermittent and continuous hypoxia result in remarkable alterations in carotid IMT and brachial IMT. Further prospective trials are warranted to confirm and extend these findings, including the biochemical markers, which may aid in the diagnosis and follow-up of patients suffering from hypoxaemia.

Clinical and prognostic features of patients with pandemic 2009 influenza A (H1N1) virus in the intensive care unit.

OBJECTIVE: To investigate the clinical and prognostic features of patients admitted to intensive care unit (ICU) with pandemic 2009 influenza A (H1N1) virus. METHODS: Patients admitted to the intensive care unit for severe pneumonia associated with pandemic 2009 influenza A (H1N1) virus were evaluated. RESULTS: The study included 20 patients with the mean age of 36±13. Of the 20 subjects, 17 (85%) had underlying conditions. Of the 20 patients, 11(55%) were discharged and 9 (45%) died. Cardinal symptoms were fever, myalgia, and hemoptysis with the rates of 85 %, 75 % and 45 %, respectively. All patients had pneumonic infiltrations in their chest roentgenograms. Main laboratory findings were lymphopenia, high creatin phosphokinase (CPK) and Lactate dehydrogenase (LDH) levels. All patients had positivity on real time reverse transcription-polymerase chain reaction (RT-PCR). None of the patients had pandemic 2009 influenza A (H1N1) virus vaccination. None of them had taken oseltamivir within 48 hours. Main reasons for mortality were cardiovascular complications and ventilatory associated pneumonia due to Acynetobacter baumannii. CONCLUSION: Early diagnosis and antiviral treatment in these cases seem to be the best approach to avoid serious illness. Special attention should be given to patients having underlying conditions such as cardiovascular and pulmonary diseases and pregnancy.

Bronchobiliary fistula due to hydatid disease of the liver: a case report.

As a complication of hydatid cyst disease of the liver, bronchobiliary fistula is a rare condition and manifests as bilioptysis. We report the case of a 34 year-old man with echinococcosis of the liver who developed a bronchobiliary fistula which manifested as chronic cough and bile stained sputum. A chest X-ray showed an unilateral infiltrate in the costodiaphragmatic angle. Bronchoscopy revealed bile filling the right basal bronchi. Magnetic resonance cystography revealed that the hepatic bile ducts communicated with the right basal pleural space. Percutaneous transhepatic drainage was applied. When the patient was reevaluated, the hydatid cyst had eroded into the pleural space, and a pleural effusion had developed. The condition of the patient deteriorated. Hence, surgical therapy was performed. After surgery, the condition of the patient improved. He was discharged from the hospital in good condition.

Extrahepatic biliary obstruction caused by small-cell lung cancer: a case report.

The pancreas is a rare site of metastasis from small-cell lung cancer (SCLC). We present the case of a pancreatic metastasis of small-cell lung cancer associated with jaundice, in which, initially, the case was evaluated as a primary pancreatic carcinoma and pancreaticoduodenectomy was performed. We also review the reported cases of pancreatic metastases from SCLC.

Functional and radiological impairment in women highly exposed to indoor biomass fuels.

OBJECTIVE: The aim of this study was to describe the lung function and the computed tomographic features in a selected group of non-smoking women with chronic obstructive pulmonary disease and biomass fuel exposure. METHODOLOGY: Thirty female patients currently exposed to biomass smoke were prospectively investigated for further evaluation using high resolution computed tomography (HRCT), pulmonary function tests and blood gas analysis. RESULTS: The mean age was 59 +/- 11 years. The patients were exposed to biomass smoke for 37.4 +/- 10 years. Pulmonary function tests revealed severe obstruction. The most common HRCT findings were increased lung volume or diffuse emphysema, thickening of interlobular septae, focal emphysematous areas, increased cardiothoracic ratio, and increased bronchovascular arborization. CONCLUSION: Biomass fuel has deleterious effects on pulmonary function and structure leading to obstructive and restrictive pathologies.

Evaluation of diaphragmatic movement with MR fluoroscopy in chronic obstructive pulmonary disease.

The aim of this study was to show reduction of the diaphragmatic excursion with MR fluoroscopy in patients with chronic obstructive pulmonary disease (COPD) and to compare the results with pulmonary function test (PFT). The study included 13 men and 10 women (average age 56.2) with COPD, and 9 men and 6 women (average age 55.8) as a control group. MR fluoroscopy images with Spoiled Gradient-echo pulse sequence was obtained during deep inspiration and expiration. After examination, over cine-loop display, the highest and lowest positions of the diaphragm were identified and the distance of excursion was measured. Differences in the diaphragmatic excursion between patient and healthy subjects were compared. We have also compared MR fluoroscopy results with PFT. In each person of both groups, excursion of the diaphragm was demonstrated clearly in cine-loop display. Differences of excursion between deepest and highest point of diaphragm were on average 26 and 20 mm, respectively, in the right and left side in patients and 69 and 56 mm in healthy group. Significant correlation was found between expiratory volume in 1 s and MR fluoroscopy results. MR fluoroscopy study showed that there were significant statistical differences in diaphragmatic excursion between patients with COPD and healthy subjects. Expiratory volume in 1 s is closely associated with the diaphragmatic excursion. MR fluoroscopy would seem to be a useful method for showing diaphragmatic excursion.

Surgical treatment of hydatid cyst of the lung: review of 30 cases.

Hydatid cyst disease is still a problem in Turkey, especially in the east Anatolian region, as well as in many other places in the world. A retrospective review was made of the surgical treatment of 30 patients with pulmonary hydatid cysts during the last 3 yrs. Nineteen patients were male and 11 female with an average age of 23.5 yrs (range 4-44 yrs). Cystotomy and capitonnage were performed in 28 of the 30 cases (93.4%). The transdiaphragmatic route or simultaneous laparotomy was preferred when the liver was involved. Albendazole was used in four patients with multiple hydatid cyst due to probable recurrence in the postoperative period. Cough and chest pain were the prominent symptoms in the majority of cases. A single lobe was affected in 22 patients. Unilateral multiple foci were present in four patients and bilateral multiple foci in four. Six patients had concomitant liver cysts. Morbidity was low and no mortality was seen. No recurrences were seen on control chest radiographs during the last 2-yr follow-up. In the treatment of hydatid cyst of the lung, conservative surgical methods such as cystotomy and capitonnage still remain the treatment of choice. Medical treatment could be used for prophylactic purposes and in some instances, but the percutaneous aspiration method should not be performed.

Relapsing polychondritis.

In this article, we report on a 40-year-old man with relapsing polychondritis (RP) of the tracheobronchial tree without clinical manifestations of other systems including nasal septum and earlobe cartilage involvement. The illness was diagnosed histologically, and treatment with procaine penicillin was successful. RP is an unusual systemic disorder characterized by widespread inflammation and destruction of cartilage tissues. The main cause is usually autoimmune. In RP various clinical manifestations including nasal chondritis, arthritis, scleritis, damage to tracheal and bronchial cartilage, and aortic, cardiac, and renal involvement may occur. Isolated tracheobronchial involvement is very rare. The diagnosis must be based on a combination of clinical and pathologic features. If diagnosed early, appropriate treatment may prevent life-threatening airway obstruction.