Epidemiological features of Turkish patients with sarcoidosis.

Epidemiological characteristics of sarcoidosis differ according to geographical distribution. The aim of our study was to disclose epidemiological characteristics in our country. The data was collected from investigators, who sent information on newly-diagnosed patients via internet. In 2 years 198 female and 95 male patients were enrolled to the study (f/m:2.08). Mean age of patients was 44+/-13 years (17-90). Mean age of male patients was 38+/-12 while mean age of female patients was 48+/-13 (p<0.001). 73.4% of patients were nonsmokers (85.4% of females; 48.4% of males; (p<0.001)). About 50% of our 293 patients were housewives. Familial sarcoidosis was found in 3 patients' first degree relatives. Estimated annual incidence of sarcoidosis for Turkey was calculated as 4 per 100,000 person. According to our study, 2/3 of sarcoidosis patients were women; mean age of patients was 45 and the disease began 10 years later in female patients. 80% of patients were nonsmokers; negative relation between sarcoidosis and smoking was evident especially in women. Familial sarcoidosis frequency was lower compared to other studies in the literature. There was no occupational exposure history in our patients. Our incidence rate, is similar with the results of other European studies.

Improving of the accuracy of in vitro-in vivo linear correlation using kinetic models for ultra sustained release theophylline tablets.

The objective of the current study was to establish and evaluate a new technique to increase the accuracy of the in vitro/in vivo linear correlation of single and multiple dose ultra-sustained release theophylline (USRT) preparation (Xantium) in hospitalized patients. In vitro dissolution data for theophylline were collected for 24 h using a USP I (basket) and USP II (paddle) methods. In vivo plasma concentration data were obtained from 8 patients after administration of either single or multiple doses of theophylline. Both in vitro and in vivo results were evaluated by zero-order, first-order, RRSBW, Hixson-Crowell, Higuchi, Hopfenberg, Langenbucher, modified Langenbucher and (Bt)a kinetic models. The individual linear correlations between each in vitro and in vivo percent results and their kinetic distributions were established and regression equations were obtained. The determination coefficient results of the linear kinetic correlations were found to be 0.994 and 0.997 for single and multiple doses by basket method and 0.992 and 0.998 for single and multiple doses by paddle method, respectively. Furthermore, the results of the linear correlations were found as 0.953 and 0.950 for single and multiple doses by basket method and 0.963 and 0.962 for single and multiple doses by paddle method respectively. Therefore, this study suggested that the accuracy of the linear correlation could be improved signilicantly by using linear kinetic correlation.

Effect of chemotherapy on pulmonary epithelial permeability in lung cancer.

The aim of this study is to investigate the effect of one-course chemotherapy on the pulmonary epithelial permeability. Eighteen patients (18 male; mean age: 59+/-10 years) with lung cancer (11 non-small cell, 7 small cell) inhaled 40 mCi (1,480 MBq) (99m)Tc-diethylenetriaminepentaacetic acid (DTPA). Thirty images of 1-min duration were acquired from posterior projection. The first 7 min of the decay-corrected time activity curves were used to calculate lung clearance half-time. Clearance half-times of (99m)Tc-DTPA from the peripheral regions of the lungs were 42+/-19 min before and 56+/-34 min after chemotherapy (p=0.009); from the central regions, clearance half-times were 112+/-94 min before and 160+/-125 min after chemotherapy (p=0.005). This decrease in clearance rate might be related to decreasing mucociliary clearance rate due to the toxic effect of the chemotherapy regimen on cilia movement and/or mucus structure. (99m)Tc-DTPA radioaerosol study can be used to monitor the toxic effects of chemotherapy on the pulmonary epithelium and possibly on mucociliary function.

Tuberculosis of the tongue secondary to pulmonary tuberculosis.

Both secondary and primary tuberculosis of the tongue and oral cavity are rare. A case of tuberculosis of the tongue secondary to pulmonary tuberculosis in a 41-yr-old male patient is described. The clinical manifestation, diagnosis and response to the antituberculosis treatment are considered.

Tc-99m erythromycin lactobionate inhalation scintigraphy in parenchymal lung diseases.

We have investigated Technetium 99m erythromycin lactobionate (Tc 99m EL) clearance from the lungs after inhalation, in the presence of an alveolitis. Eighteen patients (6 sarcoidosis, 7 idiopathic fibrosis, and 5 miliary tuberculosis) were imaged after the patients inhaled 1,110 MBq of Tc 99m EL. Clearance half time for the first 45 min, for 24 h, and retention at 24 h correlated with percentage of lymphocytes in bronchoalveolar lavage fluid (BAL) (r = .729, r = .883, and r = .826, respectively). There was a positive correlation between peripheral penetration (PP) and forced expiratory volume in 1 s (FEV1) (r = .806) and forced vital capacity (FVC) (r = .781). Retention was more marked in sarcoidosis compared with tuberculosis (0.025 < p < or = 0.05). Radioaerosol lung imaging may reflect the pulmonary function impairment in parenchymal lung diseases. Retention of Tc 99m EL may be related to number of BAL cells or presence of a lymphocytic alveolitis. Long residency time of Tc 99m EL in the lungs implies that erythromycin can also be administered by inhalation for therapeutic purposes.

Serum and pleural fluid levels of alpha-L-fucosidase and sialic acid have no diagnostic value in malignant pleural effusions.

The association of biological markers with cancer has been recognized for many decades. To determine whether alpha-L-fucosidase (ALF) and sialic acid (SA) are sensitive markers in malignant pleural effusions, they were investigated in serum and pleural fluid of 64 consecutive pleurisy patients, and in serum of 23 healthy subjects as a control group. The serum ALF (sALF) and serum SA (sSA) values of malignant and nonmalignant groups were higher than that of the control group, but the differences were statistically significant only for sSA determinations (p < 0.05). Values of sALF, sSA, pleural ALF (pALF), and pleural SA (pSA) were higher in the malignant group than the nonmalignant group, but no significant difference was found between the two groups. In conclusion, neither alpha-L-fucosidase nor sialic acid will be useful in the detection of malignant pleural effusions.

Lung clearance of inhaled 99Tcm-erythromycin lactobionate in non-smokers and smokers.

99Tcm-labelled erythromycin lactobionate (99Tcm-EL) was used as a radioaerosol for lung ventilation imaging in humans after animal studies had shown slow clearance of 99Tcm-EL from the alveolar spaces. We performed inhalation studies in 26 volunteers: 11 non-smokers, 13 smokers (3 of whom smoked one cigarette just before inhalation of 99Tcm-EL) and 2 patients with pulmonary emboli (PE). The PE patients were imaged by both 99Tcm-EL and xenon-133 (133Xe) for comparison. The image quality with 99Tcm-EL was comparable to that with 133Xe, showing good peripheral penetration. The biological clearance half-lifes for 99Tcm-EL were 3.9 +/- 1.1 h in the non-smokers, 5.9 +/- 2.2 h in the smokers and 9.8 +/- 6.6 h in the three subjects who smoked a cigarette just before inhalation of the aerosol. 99Tcm-EL was cleared more slowly in the smokers and after smoke exposure, which could have indicated alveolar macrophage uptake. 99Tcm-EL can be used as an alternative to 99Tcm-diethylenetriamine pentaacetate (99Tcm-DTPA) in ventilation imaging, thus overcoming the problem of the fast clearance of 99Tcm-DTPA in smokers.

Bronchogenic cysts: clinicopathological presentation and treatment.

The aim of this study was to evaluate the preoperative and operative presentations of one paediatric and 30 adult patients with bronchogenic cyst of the mediastinum (n = 11) and lung (n = 20). At initial presentation, six patients were asymptomatic and 25 were symptomatic. The mean age of asymptomatic and symptomatic patients was 25 and 33 yrs, respectively. Six patients presented with complications, including superior vena cava syndrome, tracheal compression, pneumothorax, pleurisy and pneumonia. Two patients who were asymptomatic when initially observed eventually needed surgery because of the development of symptoms or enlargement of the cyst size. In one patient, the cyst was not seen on the chest radiograph but appeared as a lobulated nodule of 2 cm diameter in a chest computerized tomography (CT) scan. Operative difficulties were encountered in 13 patients, all of whom were symptomatic preoperatively. In conclusion, life-threatening complications occurred in these patients. Despite various diagnostic studies, definitive tissue diagnosis was established only by means of surgical excision. The frequency of operative difficulties in symptomatic cysts was higher than those of asymptomatic cysts. Surgery may be considered as the treatment of choice even when the cyst is asymptomatic, since complications are not uncommon.

Clinical spectrum of pulmonary and pleural tuberculosis: a report of 5,480 cases.

The aim of the present study was to investigate the epidemiological, clinical, laboratory and radiological features of patients with active pulmonary tuberculosis (TB) (with or without pleural involvement) or with pleural TB (in the absence of radiological parenchymal disease). A systematic predetermined form, including 60 items regarding the above-mentioned features, was completed for 5,480 patients. Sputum smear and culture data, radiological findings, and additional extrapulmonary involvement were evaluated in the patients with pulmonary TB (n = 5,094). Epidemiological features, and other clinical and laboratory characteristics were investigated in all patients (n = 5,480). TB was more common among persons aged 20-39 yrs, males, and those living in large urban centres in our region. There were 4,268 newly detected patients (78%), and 1,212 active ex-patients (22%) who had history of previous antituberculosis treatment. Additional extrapulmonary involvement was found in 455 patients (9%). Sputum samples were smear-positive in 3,916 (79%), and culture-positive in 3,748 cases (76%). Most common radiological patterns were parenchymal infiltrate in 5,017 (99%), and cavitation in 3,363 (66%). Unusual radiological patterns were also noted, i.e., lower lung field TB (LLFTB) in 317 cases (6.2%), pneumothorax in 78 cases (1.5%), and miliary pattern in 66 cases (1.3%). In conclusion, because of the more frequent occurrence in the younger age group, it is considered that the prevalence of disease is still high and that the transmission of tubercle bacilli is not decreasing in our region. The highest risk group consisted of male subjects and those living in urban centres. The high percentage of active ex-patients suggests that new control programmes for tuberculosis are required in Turkey.

The diagnostic value of tuberculostearic acid in tuberculous pleural effusions.

Tuberculostearic acid (TBSA) (10-methyloctadecanoic acid) is a structural component of mycobacteria and is not normally present in human tissues. The detection of this fatty acid in various clinical specimens, such as sputum, bronchial aspirate, pleural fluid and cerebrospinal fluid, is a rapid, sensitive and specific test for the diagnosis of tuberculosis. As rapid diagnostic methods are also needed in tuberculous pleurisy, this study was planned on 21 patients with pleurisy. The methods of gas chromatography, mass spectrophotometry combined with selected ion monitoring were used. The patients were divided into two groups: 11 with tuberculous effusion and 10 with nontuberculous patients. In the tuberculous group, TBSA was detected in 6 of the 11 patients, whereas in the nontuberculous group it was detected in 12 of the 10 patients. The sensitivity of the test was 54%, the specificity was 80%, the positive predictive value was 75%, the negative predictive value was 61%, and the efficacy was 66%. Therefore, tuberculostearic acid cannot be considered to be more useful than conventional methods in the diagnosis of tuberculous effusions, due to low sensitivity and high cost.

Lung clearance of aerosolized 99mTc erythromycin lactobionate in rabbits.

In order to assess the lung clearance of aerosolized 99mTc Erythromycin Lactobionate (EL), 99mTc EL was administered to 9 New Zealand rabbits by inhalation. 5 rabbits inhaled cigarette smoke before 99mTc EL. Clearance half times were 3.0 +/- 0.9 hours in normals, 5.5 +/- 1.0 hours after smoke exposure. Clearance was not affected after destroying the surfactant layer. Slower clearance after smoke exposure may be due to the inhibition of mucociliary clearance. 99mTc EL can be considered as an alternative radioaerosol for ventilation imaging.