Radiation exposure in acute myeloid leukaemia, diffuse large B-cell lymphoma, and multiple myeloma patients in the first year following diagnosis.

Purpose: Radiological examinations are critical in the evaluation of patients with haematological malignancies for diagnosis and treatment. Any dose of radiation has been shown in studies to be harmful. In this regard, we assessed the radiation exposure of 3 types of haematological malignancies (diffuse large B-cell lymphoma [DLBCL], acute myeloid leukaemia [AML], and multiple myeloma [MM]) in our centre during the first year after diagnosis. Material and methods: In the first year after diagnosis we retrospectively reviewed the radiation exposure data of 3 types of haematological malignancies (DLBCL, AML, and MM). The total and median CED value (cumulative effective radiation dose in millisieverts [mSv]) of each patient was used. Each patient's total and median estimated CED value was calculated using a web-based calculator and recorded in millisieverts (mSv). Results: The total radiation doses in one year after diagnosis (CED value) were 46.54 ± 37.12 (median dose: 36.2) in the AML group; 63.00 ± 42.05 (median dose: 66.4) in the DLBCL group; and 28.04 ± 19.81 (median dose: 26.0) in the MM group (p = 0.0001). There was a significant difference between DLBCL and MM groups. Conclusions: In all 3 haematological malignancies, the radiation exposure was significant, especially in the DBLCL group, within the first year of diagnosis. It is critical to seek methods to reduce these dosage levels. In diagnostic radiology, reference values must be established to increase awareness and self-control and reduce patient radiation exposure. This paper is also the first to offer thorough details on the subject at hand, and we think it can serve as a guide for further investigation.

Can 18Fluoro-deoxy-glukose-Positron Emission Tomography/Computed Tomography be a Useful for Decision of Elective Surgery in Thoracic Aortic Aneurysm.

Thoracic aortic aneurysm (TAA) should be treated before the complications with prophylactic surgery. However, important number of ruptures have been occurred below the cut-off size for surgery. In addition, in some cases, who in the cut-off value limit, decision of surgery may sometimes be difficult. 18Fluoro-deoxy-glukose positron emission tomography/computed tomography (18FDG-PET/CT) may useful such situations. We present a case that, TAA in 18FDG-PET/CT in a patient with larynx carcinoma. He had a TAA with near the cut-off value and increased metabolic activity in baseline imaging. After 3 months, SUVmax value increased and elective surgery was performed. We think that aneurysms may be another pathology that 18FDG-PET/CT potentially be useful apart from imaging malignant diseases.

Can PET/CT be used more effectively in pleural effusion evaluation?

PURPOSE: Sometimes, characterization of pleural effusion (PE) can be challenging especially in patients whom invasive procedures/recurrent invasive procedures cannot be performed. The main purpose of the study is to answer this question, Can 18F-FDG-PET/CT contribute to reduction in the number of invasive procedures or patients undergoing to invasive procedures? Results may increase the effectiveness of patient management by facilitating clinical decision-making, especially in patients who cannot undergo invasive/recurrent invasive procedures. METHODS: Sixty-seven patients' 18F-FDG-PET/CT, pleural fluid cytologies (PFCs) and, if any, pleural biopsies were re-assessed. If patient's PFC/biopsy was malignant, effusion was considered as malignant. If two consecutive PFCs were negative in patients without biopsy, effusion was considered as benign. Characterization was based on consensus with baseline/follow-up 18F-FDG-PET/CT and clinical parameters in patients with one negative PFC (n = 6). RESULTS: None of the 18F-FDG-PET/CT parameters could characterize PE alone. However, if PE maximum standardized uptake value (SUVmax) > 1.3 or PE SUVmax/mean standardized uptake value of mediastinal blood pool (MBP SUVmean) > 1.2 was combined with at least one of the following, specificity and positive predictive value (PPV) were 100%, accuracy was around 90%. Diffuse-nodular/nodular pleural thickness, post-obstructive atelectasis, nodule/mass with SUVmax > 2.5 in lung, multiple pulmonary nodules. All 29 patients who had SUVmax > 1.3 together with at least one of the mentioned four parameters diagnosed malignant pleural effusion (MPE). However, sensitivity and negative predictive value (NPV) were still insufficient. CONCLUSION: Patients who have contraindications for invasive diagnostic methods, and meet the aforementioned criteria may be considered as MPE primarily. On the other hand, if PE SUVmax < 1.3 or PE SUVmax/MBP SUVmean < 1.2 with the negativity of the all four parameters mentioned above, it is difficult to say that this can be considered as benign pleural effusion (BPE) according to our results.

Association between endometriosis and increased arterial stiffness.

BACKGROUND: Endometriosis is a common gynecologic disease associated with systemic inflammation and atherogenic risk factors. Therefore, women with endometriosis may have increased cardiovascular risk. AIMS: We aimed to evaluate arterial stiffness using cardio-ankle vascular index (CAVI) in women with and without endometriosis. METHODS: We enrolled 44 patients with endometriosis and 76 age­matched controls without endometriosis.Endometriosis was diagnosed based on histopathologic examination or magnetic resonance imaging. Arterial stiffness was evaluated using CAVI in all study participants. RESULTS: No differences were observed between patients and controls in terms of age (median [interquartile range, IQR], 30 [24.25-5] years and 26 years [24-35] years, respectively), body mass index (median [IQR], 23.31 [20.82-24.98] kg/m2 and 23.74 [21.13-26.78] kg/m2, respectively), or waist circumference (median [IQR], 69 [64-75] cm and 72 [65-81.25] cm, respectively). C­reactive protein levels were higher in women with endometriosis than in controls (median [IQR], 0.27 [0.14-0.68] mg/dl vs 0.12 [0.06-0.24] mg/dl; P <0.001). Left ventricular ejection fraction, left ventricular mass index (LVMI), relative wall thickness, as well as systolic and diastolic blood pressures were similar in both groups. Women with endometriosis had higher CAVI than controls (mean [SD], 5.961 [0.644] vs 5.554 [0.654]; P = 0.001). Elevated arterial stiffness was observed in the endometriosis group also after adjustment for age and LVMI. CONCLUSIONS: Our results indicate increased arterial stiffness measured by CAVI in women with endometriosis. Therefore,clinicians should be aware that these patients may be at increased cardiovascular risk.

Arterial stiffness measured by cardio-ankle vascular index is greater in non-obese young women with polycystic ovarian syndrome.

AIM: The association of metabolic abnormalities and polycystic ovarian syndrome (PCOS) has been documented, but few studies have focused on cardiovascular risk in these women. The aim of this study was to compare arterial stiffness by using the cardio-ankle vascular index (CAVI) in PCOS women with controls, and to evaluate whether any clinical or laboratory variables had independent associations with it. METHODS: A group of 160 women, matched for age and body mass index were recruited. Diagnosis of PCOS was made according to the Rotterdam criteria. Arterial stiffness using CAVI was evaluated in non-obese young woman, with and without PCOS. RESULTS: In the PCOS group (n = 80), 60 cases (75%) had findings of hyperandrogenism, 59 (73.8%) had ovulatory dysfunction, and 70 (87.5%) had an ultrasonographic appearance of polycystic ovaries. Women with PCOS had significantly higher mean CAVI values when compared to subjects without PCOS (5.78 ± 0.64 vs 5.28 ± 0.77, P < 0.001). Multiple regression analysis revealed that androgen excess was associated with increased arterial stiffness, independent of ovulatory dysfunction, polycystic ovaries, body mass index and age. CONCLUSION: This data suggests that vascular compliance is decreased in young women with PCOS. Androgen excess is independently associated with increased arterial stiffness.

Complications, Additional Surgery, and Joint Survival Analysis After Medial Open-Wedge High Tibial Osteotomy.

The reported incidence of complications following medial open-wedge high tibial osteotomy (MOWHTO) varies. The authors sought to assess the complications, additional surgeries, and joint survival following MOWHTO in patients with isolated medial compartment arthrosis during a mean follow-up of 10 years. This retrospective study involved patients implanted with spacer plates, angle adjustable plates, or inverse L-type plates with wedges between 2000 and 2010. A total of 504 knees from 441 patients were examined. Mean age of the study population was 52.6±7.0 years, with 56 (11.1%) knees from men and 448 (88.9%) from women. The 10-year Kaplan-Meier joint survival rate was 94.8%. Overall complication rate for MOWHTO was 63.7%, with complications in 20.3% of treated knees requiring additional surgery. In this population, although the overall complication rate and the need for additional surgery were high, the need for additional surgery resulting from serious complications was low (2.6%). The high joint survival rate and low rate of additional surgery for serious complications indicate that MOWHTO can be safely applied in patients with isolated medial gonarthrosis. [Orthopedics. 2020;43(5):303-314.].

Open reduction of a total talar dislocation: A case report and review of the literature.

BACKGROUND: Total talar dislocation (TTD) is very uncommon for many orthopedic surgeons and emergency/trauma specialists. Scarce cases of TTD have been reported, mainly in the form of open fracture-dislocation injury. CASE SUMMARY: We report a very rare injury of closed TTD with a follow-up period of 36 mo. Initial closed reduction was not successful because of a fractured highly unstable medial malleolus displaced into the ankle mortise, blocking the relocation of the talus. The patient was able to walk pain-free after the 3rd month of surgery. At the 36-mo follow-up, there were 10 degrees of flexion loss and 10 degrees of extension loss in the tibiotalar joint. Furthermore, 5 degrees of subtalar joint inversion-eversion loss was present. CONCLUSION: Open reduction should be performed for closed TTDs unless closed reduction is successful.

Dual-Lumen Balloon Catheter Technique for Onyx Embolization of Spinal Dural Arteriovenous Fistula.

Spinal dural arteriovenous fistula (SDAVF) is the most common type of spinal vascular malformation. The main purpose of endovascular treatment is to occlude the fistula site and the proximal part of the draining vein. However, this is not always possible because of the difficulty of selective catheterization in patients with tortuous feeding arteries, as well as the risk of reflux of the liquid embolic agent. Herein, we present three cases in which a dual-lumen balloon catheter together with a liquid embolic agent was used to occlude the SDAVF. Complete and persistent occlusion was confirmed by magnetic resonance images taken at 6 months after the treatment. Using the dual-lumen balloon catheter technique in cases of long and tortuous feeder arteries supplying the SDAVF can result in safe and successful embolization.

Clinical and Radiological Comparison of Effects of Platelet-Rich Plasma, Hyaluronic Acid, and Corticosteroid Injections on Temporomandibular Joint Osteoarthritis.

There are few studies in the literature that comparatively evaluate the use of intra-articular orticosteroids (CS), hyaluronic acid (HA), and platelet-rich plasma (PRP). In this study, the authors aimed to compare the clinical results of intra-articular CS, HA, and PRP injections in patients who presented to the authors' clinic with temporomandibular joint (TMJ) pain and clinically diagnosed with TMJ-osteoarthritis. Patients were evaluated in 2 groups as those patients who felt pain on lateral (n = 31), and posterior (n = 43) palpation. Patients who were evaluated in the study were randomly assigned to 3 different treatment groups as Group 1 (PRP), Group 2 (HA), and Group 3 (CS). Pain felt on the TMJ on lateral and posterior palpation was assessed before treatment and every month for 3 months using a 5-point pain scale. Presence of crepitation, loss of function, and loss of strength were assessed before treatment and every month for 3 months. Significant changes were observed in the PRP and HA groups when the patients were evaluated according to the VAS scores evaluated at different follow-up times for TMJ pain on lateral palpation. Significant changes were observed in the PRP, HA, and CS groups when VAS scores were evaluated according to the patients' follow-up times for TMJ pain on lateral palpation. In conclusion, the findings of this study have shown that intra-articular PRP injections decreased TMJ palpation pain more effectively compared with the HA and CS groups.

An exceptional group of non-small cell lung cancer difficult to diagnose: Evaluation of lipid-poor adrenal lesions.

In some non-small cell lung cancer (NSCLC) patients, lipid-poor adrenal adenomas cannot be adequately differentiated from metastases using imaging methods. Invasive diagnostic procedures also have a low negative predictive value (NPV) in such cases. The current study aims to establish a specific and clinically practical metabolic parameter for lipid-poor adrenal lesions (ALs) in NSCLC patients. This diagnostic approach may prevent unnecessary abdominal enhanced computed tomography (CT), magnetic resonance imaging, or invasive diagnostic procedures. Sixty-four NSCLC patients with 69 lipid-poor ALs and 28 control patients with 30 benign lipid-poor ALs, who underwent FDG-PET/CT, were retrospectively reviewed. Two morphological and four metabolic parameters were analyzed in FDG-PET/CT images of NSCLC and control patients. Baseline and post-chemotherapy images of 64 NSCLC patients were re-evaluated according to the PERCIST 1.0. In cases where ALs could not be differentiated, follow-up FDG-PET/CT images were re-examined. The receiver operating characteristic (ROC) curve method was used for the evaluation of diagnostic parameters. Out of 69 ALs, 39 were determined as metastatic lesions (adrenal metastasis), while 30 lesions were considered non-metastatic (adrenal adenomas). The mean attenuation value, SUVmax AL/SUVmax primary tumor, SUVmax, SUVmax AL/liver, and SUVmax AL/SUVmean liver were significantly different between metastatic and benign ALs from NSCLC patients. The SUVmax AL/SUVmean liver ≥1.81 had the best positive (PPV, 94.3%) and negative (NPV, 82.4%) predictive values, and the highest specificity (93.3%), sensitivity (84.6%) and accuracy (86.9%). Lipid-poor ALs with SUVmax AL/SUVmean liver ≥1.81 can be accepted as malignant in NSCLC. However, if SUVmax AL/SUVmean liver is <1.81, a pathologic examination is required. Utilizing this cut-off value to decide on adrenal core biopsy may prevent its unnecessary use. Moreover, this diagnostic approach can save time and reduce the healthcare costs.

Emissary veins prevalence and evaluation of the relationship between dural venous sinus anatomic variations with posterior fossa emissary veins: MR study.

PURPOSE: The aim of this study was to find the prevalence of emissary veins and to compare the visibility of these emissary veins with the anatomic variations of the dural venous sinuses detected in magnetic resonance venography (MRV). MATERIALS AND METHODS: All MR images of two hundred twenty patients were evaluated retrospectively. Posterior cranial fossa emissary veins diameter measurements were performed in the axial plane. The anatomic variations of the venous sinuses in MRVs of all patients were recorded. Accordingly, the presence of the emissary veins was compared with the dural venous sinus anatomic variations. p < 0.05 was considered statistically significant. An inter-observer reliability analysis was performed. RESULTS: The prevalence of emissary veins in MRI was found in the right mastoid emissary vein (MEV) 82.7% and left MEV 81.4%. Occipital emissary vein (OEV) was present in 63 patients (28.6%) for the first radiologist (R1), and it was present in 61 patients (27.7%) for the second radiologist (R2) (K = 0.978). A statistically significant correlation was detected between the diameter of the left MEV and gender (p < 0.05) for both radiologists. There was a statistically significant difference between the left MEV and OEV and transverse sinus anatomic variations. CONCLUSION: MR imaging is a noninvasive and irradiating imaging method for detecting posterior fossa major emissary veins, and we recommend using MR imaging for preoperative evaluation of posterior fossa major emissary veins and related dural venous sinuses.

Liver abscesses after transcatheter arterial embolization.

OBJECTIVE: This study aimed to evaluate the clinical features, radiological findings, risk factors, and management of liver abscesses following transcatheter arterial chemoembolization (TACE) therapy in patients with primary and metastatic liver cancer. METHODS: The medical records of 163 patients who were treated with TACE in our hospital for a total of 313 times between January 2012 and January 2018 were reviewed. The incidence rate of patients who developed liver abscesses after undergoing treatment, the computed tomography findings of the abscesses, predisposing risk factors, and the method of treatment were evaluated. RESULTS: Formation of liver abscesses was observed after treatment in four of the 163 (2.4%) patients and in four (1.3%) of the 313 chemoembolization procedures. Additionally, bilioenteric anastomosis was found in two patients and diabetes mellitus in two patients. CONCLUSION: Formation of liver abscesses after TACE is a rare, but serious, complication. Physicians should be aware of the predisposing risk factors of TACE because of the possibility of death.

Carotico-vertebral Doppler Ultrasonography in Patients with Idiopathic Vertigo.

BACKGROUND: In the present study, we investigated the relationship between caroticovertebral Doppler USG measurement results and Vertigo Symptom Scale-Short Form (VSS-SF) in patients with idiopathic vertigo. METHODS: Fifty patients with idiopathic vertigo and 30 healthy subjects were included into the study. Ear, Nose & Throat (ENT) examination, audiological examination, routine hemogram, biochemichal tests and temporal magnetic resonance imaging were performed to diagnose "idiopathic vertigo". By carotico-vertebral Doppler ultrasonography (USG), common carotid artery (CCA) area, intima media thickness; and vertebral artery dimension were measured on the right and left side of the study and control groups. RESULTS: CCA area values were not different between the study and control groups; and between the right and left sides of the each group. On the left side, intima media thickness and vertebral artery dimension values of the vertigo group were significantly higher than those of the control group. Correlation tests showed that CCA area and intima media thickness values on the right and left side were positively correlated with each other. Moreover, in patients with higher right; or left intima media thickness values, left vertebral artery dimensions decreased. Older age was associated with higher intima media thickness in right and left sides. When CCA values decreased on the right side, VSS-SF values increased; and patients' complaints for vertigo got higher. Linear regression analysis (Backward LR) results also showed that the significant compounding factor on VSS-SF was right CCA area. As right CCA area decreased, VSS-SF increased with more vertigo complaints. Whereas, vertigo complaints and VSS-SF decreased when right CCA increased. CONCLUSION: We concluded that a decrease in the right CCA were linked with higher VSS-SF scores and increasing vertigo symptoms. Whereas, a decrease in the left CCA area and left crabial blood supply are more important related to the left hemispheric dominance in right-handed people. Moreover, an increase in the intima media thickness was also detected in the vertigo patients and it probably causes a decrease in the central blood flow.

Risk Factors for Postembolization Syndrome After Transcatheter Arterial Chemoembolization.

BACKGROUND: Transarterial Chemoembolization (TACE) is a minimally invasive treatment in managing unresectable liver primary neoplasms or liver metastases. Postembolization Syndrome (PES) is the most common adverse effect after TACE procedures. OBJECTIVE: We investigate the risk factors for the development of PES after TACE therapy in patients with primary or metastatic liver tumors. METHODS: In a retrospective analysis of 163 patients who underwent TACE between 01/01/2012 and 31/01/2018, patients that were given medication due to pain, fever, nausea or vomiting were evaluated and noted with PES. Analyses were made to evaluate factors such as age, gender, chemotherapy agent and dose, tumor size, tumor type, a particle used for embolization, multiple tumor treatments and selective application of the procedure, which may lead to PES after TACE. RESULTS: In a total of 316 patients, PES was observed at a rate of 55 percent after TACE. Tumor size, number of tumors treated and adopting super selective fashion in the procedure were found to be related to the development of PES. No relationship was found between age, gender, presence of ascites, tumor type, size of embolic agent and drug type and the development of PES. CONCLUSION: A treated tumor measuring >5 cm, treating more than one tumor, and the failure to perform the procedure in a super selective fashion increase the risk of PES development after TACE.

Color Doppler ultrasonography is a reliable diagnostic tool in the diagnosis of extracranial vertebral artery dissections.

The purpose of this study was to evaluate the role of color Doppler sonography (CDS) in the diagnosis of extracranial vertebral artery dissections (EVADs). One hundred and fifty consecutive patients (age range 21-51 years, mean 44 years) with a clinical suspicion of vertebral artery dissection (VAD) were included in this study. All patients underwent CDS of vertebral arteries as the first-line imaging modality. Cervical T1-weighted fat-saturated axial MR images served as the gold standard. Of the 150 patients with a clinical suspicion of VAD, 27 patients were ultimately diagnosed with EVADs based on fat-saturated T1-weighted MR imaging. MR imaging was considered positive when crescentic hyperintensity (methemoglobin signal) was demonstrated at the wall of the vertebral artery. CDS was positive in 21 of these 27 patients and revealed either intramural hematoma or a dissecting membrane with two lumina. The most frequent site of involvement was the V1 to proximal V2 segment. The sensitivity, specificity, and positive and negative predictive values of CDS in the diagnosis of EVADs were 77.8, 98.4, 91.3, and 95.3%, respectively. CDS is a reliable diagnostic tool in the diagnosis of EVADs.

Results of a long-term performance and follow-up of Endovenous Laser Ablation procedures performed for treating great saphenous vein incompetence.

OBJECTIVE: To assess the value of endovenous laser ablation (EVLA) for treating great saphenous vein (GSV) incompetence. METHODS: We reviewed the overall results of EVLA procedures performed on 554 patients in our clinic between March 2011 and December 2015. Evaluations were made concerning the situations of the great saphenous vein (GSV), the energy used in the treatments, and the results obtained. We also investigated if there was a possibility to detect failure of EVLA treatment at an early stage. RESULTS: From a total of 657 GSVs that were subjected to EVLA treatment, the procedure was found to be successful for 611 GSVs and unsuccessful for 46 GSVs (success rate: 93%). In 38 of the 46 GSVs, a thrombus formation was detected by color Doppler ultrasonography (CDUS) at the postoperative first month (82.6%). CONCLUSION: EVLA is a reliable and successful method utilized for the treatment of GSV incompetence. It is concluded that the detection of a thrombus in the GSV tract during the first postoperative follow-up month is an indicator for revascularization.

Primary hydatid cyst in the posterior thigh, and its percutaneous treatment.

Hydatid cyst (echinococcosis) is an endemic parasitic disease, usually encountered in those dealing with agriculture and livestock. The most frequently affected organs are the liver and the lungs. The disease is very rarely encountered in soft tissues. Diagnosing a soft-tissue hydatid cyst may be challenging unless the mass possesses the characteristic features of a hydatid cyst. Soft-tissue hydatid cysts may be treated percutaneously, just like those encountered in the liver. In this case report, we present the radiological findings and modified percutaneous aspiration-injection-reaspiration (PAIR) treatment of a hydatid cyst located in the posterior aspect of the thigh.

Sonographic assessment of subacromial bursa distension during arm abduction: establishing a threshold value in the diagnosis of subacromial impingement syndrome.

PURPOSE: In this study, we aimed to establish a quantitative threshold value in the diagnosis of subacromial impingement syndrome by measuring the thickness of the subacromial bursa during abduction and adduction. MATERIALS AND METHODS: Forty-five patients with subacromial impingement syndrome and 54 healthy individuals underwent dynamic shoulder ultrasonography. The subacromial bursa, between the supraspinatus tendon margin and peribursal adipose tissue, was measured between the acromion and humeral head at its widest part. The subacromial impingement ratio was calculated by dividing the subacromial bursa thickness during abduction to the subacromial bursa thickness during adduction. Shapiro-Wilk test was used in the assessment of normal distribution of parameters. RESULTS: The mean subacromial bursa thickness in the abduction position was 1.8 ± 1.1 mm in the study group and 0.9 ± 0.3 mm in the control group. The mean subacromial bursa thickness in the adduction position was 0.9 ± 0.5 mm in the study group and 0.8 ± 0.3 mm in the control group. The subacromial impingement ratio showed a statistically significant difference between groups (p < 0.0001), and the ratio being 2.0 ± 0.5 in the study group and 1.2 ± 0.1 in the control group. For measurements performed in the abduction position, the best cut-off value was calculated as 1.3 mm, and sensitivity and specificity were 70.6 and 85.2%, respectively. The best cut-off value was 1.4 for the subacromial impingement ratio, and sensitivity and specificity were 88.2 and 96.3%, respectively. CONCLUSION: Subacromial impingement ratio is a very practical and reliable method in subacromial impingement syndrome diagnosis.

Thorax Computed Tomography Findings in Patients with Erectile Dysfunction.

OBJECTIVE: Diabetes mellitus, smoking, dyslipidemia, and obesity play an important role in the etiology of erectile dysfunction, particularly in cases with vascular insufficiency. These risk factors also target the lungs due to their systemic effects. MATERIALS AND METHODS: Patients with penile vascular insufficiency determined at Doppler ultrasonography and undergoing thoracic computerized tomography for various reasons were included in this study. A history of acute thoracic trauma, pneumonic consolidation, or pelvic surgery and trauma were regarded as exclusion criteria. RESULTS: Thirty-seven male patients with identified vascular insufficiency (age 54.48 ± 13.62 years) were enrolled. Mass lesions with a malignant morphology were present in two patients. The most common mediastinal/vascular pathology was atherosclerosis, while the most common parenchymal lesion was emphysematous aeration. Other findings included parenchymal fibrotic bands, atelectasis, interstitial thickening, bronchiectasis, air trapping, aortic aneurysm, a dilated pulmonary artery, hiatal hernia, and pericardial effusion. CONCLUSION: Erectile dysfunction may be an early sign of cardiovascular diseases. Care must be taken in terms of existing or potential pulmonary pathologies in these patients due to their sharing common risk factors with systemic effects.