Tratamiento efectivo de la hemoptisis mediante aplicación endobronquial del hemostásico Ankaferd / Effective Management of Hemoptysis Via Endobronchial Application of Ankaferd Hemostat

La hemoptisis es una manifestación sintomática de una enfermedad torácica que puede ser grave y poner en peligro la vida, y requiere una evaluación y tratamiento urgentes. El objetivo del presente estudio fue evaluar la eficacia hemostásica de la aplicación endobronquial de la solución Ankaferd Blood Stopper(R) (ABS) en pacientes con hemoptisis. Este estudio retrospectivo se realizó en 20 pacientes con hemoptisis en los que se aplicó ABS endobronquial mediante 25 broncoscopias. La aplicación endobronquial de ABS tuvo éxito en 23 de las 25 broncoscopias. Se repitió la aplicación de ABS a causa de una recidiva hemorrágica en 4 pacientes. Esta es la primera serie de casos que describe el uso de la aplicación endobronquial de ABS, un nuevo agente hemostásico que constituye un método eficaz para el tratamiento de la hemorragia, sobre todo en lesiones malignas endobronquiales locales. Pensamos que la aplicación broncoscópica de ABS puede ser un método terapéutico alternativo y de apoyo en casos de hemoptisis no controlada

Hemoptysis is symptomatic of potentially serious and life-threatening chest disease and requires urgent evaluation and treatment. The aim of this study was to evaluate the hemostatic efficacy of endobronchial application of Ankaferd Blood Stopper(R) (ABS) solution in patients with hemoptysis. This retrospective study included 20 patients with hemoptysis in whom endobronchial ABS was applied in 25 bronchoscopic procedures. Endobronchial application of ABS was successful in 23 of the 25 bronchoscopic procedures. ABS application was repeated due to recurrent bleeding in 4 patients. This is the first case series demonstrating the endobronchial application of ABS, a novel hemostatic agent, effective in the management of bleeding, especially in local endobronchial malignant lesions. Bronchoscopic ABS application may be an alternative supportive therapeutic method in cases of uncontrolled hemoptysis

Effective management of hemoptysis via endobronchial application of Ankaferd hemostat.

Hemoptysis is symptomatic of potentially serious and life-threatening chest disease and requires urgent evaluation and treatment. The aim of this study was to evaluate the hemostatic efficacy of endobronchial application of Ankaferd Blood Stopper(®) (ABS) solution in patients with hemoptysis. This retrospective study included 20 patients with hemoptysis in whom endobronchial ABS was applied in 25 bronchoscopic procedures. Endobronchial application of ABS was successful in 23 of the 25 bronchoscopic procedures. ABS application was repeated due to recurrent bleeding in 4 patients. This is the first case series demonstrating the endobronchial application of ABS, a novel hemostatic agent, effective in the management of bleeding, especially in local endobronchial malignant lesions. Bronchoscopic ABS application may be an alternative supportive therapeutic method in cases of uncontrolled hemoptysis.

Diagnostic efficacy of computed tomography-guided transthoracic needle aspiration and biopsy in patients with pulmonary disease.

BACKGROUND: Computed tomography-guided transthoracic needle aspiration (TTNA) and biopsy (TTNB) is a well established, safe, and rapid method of reaching a definitive diagnosis for most thoracic lesions. The present study aimed to determine the roles of TTNA and TTNB in the diagnosis of pulmonary diseases and to compare the results using these two techniques. METHODS: TTNB and TTNA were performed in 105 patients admitted to our clinic due to peripheral pulmonary lesions between May 2005 and November 2007. Needle biopsies were performed using 18-gauge Tru-Cut® biopsy needles and aspirations was performed using 18-20-22-gauge Chiba needles. RESULTS: Malignant lesions diagnosed by TTNB were non-small cell lung carcinoma (51 patients, 73%), small cell lung carcinoma (nine patients, 13%), malignant tissue (three patients, 5%), lymphoma (two patients, 3%), thymoma (two patients, 3%), plasmacytoma (one patient, 1%), rhabdomyosarcoma (one patient, 1%), and metastasis (one patient, 1%). The malignant lesions diagnosed by TTNA were non-small cell lung carcinoma in eleven patients (92%) and malignant tissue in one patient (8%). Three (100%) of the benign lesions diagnosed by TTNB were granulomas and two (100%) benign lesions diagnosed by TTNA were infarctions. When the diagnostic value of TTNB and TTNA was compared, TTNB was significantly superior. Malignant lesions were identified in 70 (84%) and benign lesions were identified in three (4%) of the 83 patients in the TTNB group. Ten (12%) patients in the TTNB group could not be diagnosed. Malignant lesions were found in 12 (55%) and benign lesions were found in two (9%) of the 22 patients in the TTNA group. Negative results were obtained in eight (36%) patients. The diagnostic sensitivity, specificity, and accuracy of TTNB was calculated to be 92%, 100%, and 93%, respectively (Table 5). The diagnostic sensitivity, specificity, and accuracy of TTNA was 78%, 100%, and 82%, respectively. TTNB had a sensitivity of 92% (70/76) in malignant cases and 100% (3/3) in benign cases, while the sensitivity of TTNA in malignant and benign cases was 75% (3/4) and 67% (2/3), respectively. CONCLUSION: TTNB is a safe and easy procedure which provides a highly accurate diagnosis of benign and malignant lung lesions without causing a significant increase in complication rates.

An intracerebral mass: tuberculosis or sarcoidosis?

Sarcoidosis is an idiopathic, chronic granulomatous disease and it can affect almost any organ. In autopsy series, it has been reported that the central nervous system involvement has occurred in 5-16% of the patients with sarcoidosis, while the neurological symptoms have occurred only in 3-9% of them. A 40-year-old female patient was admitted to the hospital with complaints of aphasia, balance disorder and drowsiness. An intracerebral mass was detected on cranial CT scans and neurosarcoidosis was diagnosed with clinical, radiological and histopathological findings.

The prevalence of "pigeon breeder's disease" in a Turkish city and review of the literature.

Hypersensitivity pneumonitis (HP) is a rarely encountered inflammatory interstitial lung disease caused by various antigens. Studies in the literature report contradictory rates about its prevalence. The aim of the present study was to determine the prevalence of "pigeon breeder's disease" (PBD) among pigeon breeders in Samsun province. The present study was performed in two phases. In the first phase, we contacted the Samsun Serinofil Association (Samsun Serinofil Dernegi) and a detailed questionnaire was given to the pigeon breeders to fill out. In the second phase, advanced diagnostic tests such as chest X-ray, high-resolution chest computed tomography, pulmonary function tests, natural provocation, bronchoalveolar lavage (BAL), and transbronchial lung biopsy (TBLB) were used to verify the diagnosis in those suspected with PBL. The questionnaire was administered to 185 male volunteers, of whom 11 had suspicious findings. Of eight subjects in whom the natural provocation was performed, one had a positive (acute PBL) response. After discontinuation of exposure, clinical improvement was observed in the second subject (subacute HP), of whom the radiological findings, BAL, and TBLB results were consistent with PBL. The third subject, who had dyspnea for 28 years, was diagnosed with chronic PBL. Consequently, the prevalence of PBL and the positivity of the natural provocation were 1.6 and 12.5%, respectively. In the present study, in which the prevalence of PBL was determined using natural provocation for the first time, the prevalence of HP (1.6%) was quite low compared with previous studies. The present study has demonstrated that a study solely based on a questionnaire is not adequate in determining the prevalence of HP.

The role of serum CA-125 levels and CA-125 tissue expression positivity in the prediction of the recurrence of stage III and IV epithelial ovarian tumors (CA-125 levels and tissue CA-125 in ovarian tumors).

PURPOSE: The present study investigates the effects of serum CA-125 level and CA-125 tissue positivity on first-year recurrences in patients with stage III/IV epithelial ovarian tumors. METHODS: Of the 101 patients with EOC who had undergone systematic pelvic/para-aortic lymphadenectomy between January 2003 and December 2007 recurrence did not develop in patients with stage I/II EOC. Fifty-five patients with FIGO stage III/IV EOC were evaluated in terms of serum CA-125 level and CA-125 tissue positivity. Preoperative CA-125 levels, under 35 IU/l were considered normal. To determine the expression of CA-125 immunohistochemically, stainings exceeding 10% were considered as positive. RESULTS: The relationship between CA-125 values and recurrence was significant in stage III/IV patients (p = 0.041/p = 0.006). The relationship between CA-125 values and recurrence was significant in the patients with serous tumor, endometrioid tumor, clear cell tumor, and undifferentiated tumor (p = 0.034/p = 0.044/p = 0.039/p = 0.043 respectively, p < 0.05). It was insignificant in mucinous tumor (p = 0.667). The relationship between CA-125 tissue expression positivity and recurrence development was significant in stage III/IV patients (p = 0.041/p = 0.029). It was significantly correlated with recurrence in the patients with serous tumor, endometrioid tumor, clear cell tumor, mucinous tumor, and undifferentiated tumor (p = 0.034/p = 0.044/p = 0.047/p = 0.036/p = 0.043 respectively, p < 0.05). CONCLUSION: We were able to show that serum CA-125 values and CA-125 tissue expression can be used as markers to predict the risk of early recurrence. Many factors play an important role in the prediction of early recurrences in advanced stage EOC.

A prospective evaluation of hemoptysis cases in a tertiary referral hospital.

BACKGROUND AND AIMS: Hemoptysis is symptomatic of a potentially serious and life-threatening thoracic disease. The purpose of this study was to evaluate the relative frequency of the different causes of hemoptysis, the change of the frequency of diseases, the value of the evaluation process and the outcome in a tertiary referral hospital. METHODS: A prospective study was carried out on consecutive patients presented with hemoptysis. RESULTS: A total of 178 patients (136 male, 42 female) were included to the study. Lung cancer (51), pulmonary embolism (23) and bronchiectasis (23) constituted most of the diagnosis. The most frequent cause of hemoptysis in males was by far lung carcinoma (50). Twelve cases of bronchiectasis and 11 cases of pulmonary embolism were observed in females. While lung cancer and pulmonary embolism were associated with mild to moderate amounts of bleeding (84% and 100%, respectively), patients with active tuberculosis and pulmonary vasculitis had severe to massive hemoptysis (50% and 44%, respectively). Transthoracic and other organ biopsies, spiral computed tomography (CT) angiography (X pres/GX model TSX-002a, Toshiba, Tochigi Ken, Japan) and aortography yielded high diagnostic results in our group (100%, 67%, 59% and 100%, respectively). The most frequent final diagnosis in patients with normal chest radiograph was pulmonary embolism (seven cases). CONCLUSIONS: Lung cancer, pulmonary embolism and bronchiectasis were the main causes of hemoptysis in this prospective cohort; however, this is the first report showing pulmonary embolism as a leading cause of hemoptysis. CT angiography with high-resolution CT should be the primary diagnostic modality if the initial investigation is inconclusive in hemoptysis cases.

Vena caval thromboses.

BACKGROUND: Patients with vena caval (VC) thrombosis have been reported with a variety of clinical presentations, which may create a diagnostic challenge for physicians. OBJECTIVE: The objective of the study was to evaluate the clinical characteristics of patients with VC thrombosis. PATIENTS AND METHODS: Files and all imaging methods of consecutive patients with superior or inferior VC thrombosis with or without pulmonary embolism (PE) between January 26, 2001, and May 12, 2006, were retrospectively studied in detail. RESULTS: In our series, VC thromboses within the inferior and superior VC were detected in 28 patients, mostly by combined computed tomographic venography and spiral computed tomographic pulmonary angiography. Nine of these 28 patients (32.1%) had VC thromboses without PE (7 patients with isolated and 2 patients with nonisolated VC thrombosis). Key symptoms and findings in the 9 patients without PE were unexplained dyspnea and tachypnea, respectively. CONCLUSIONS: Many patients with VC thrombosis do not have peripheral vein thrombosis. Moreover, nearly one third of patients with VC thrombosis have negative pulmonary angiograms but do have dyspnea and tachypnea.

[The evaluation of 92 interstitial lung disease patients]. / Klinigimizde interstisyel akciger hastaligi tanisi alan 92 hastanin incelenmesi.

Interstitial lung diseases (ILD) include many acute and chronic pulmonary disorders. We aimed to evaluate the patients diagnosed as ILD in our clinic. Between January 2000 and August 2004, 92 patients were included in the study. Fifty eight (63%) of our patients were female, 34 (37%) were male and the median age was 50.2 + or - 14.2 (19-80) years. The most frequent diagnoses were sarcoidosis in females, and IPF in males. The diagnostic methods used were as follows; clinically and radiologically in 36 (39.1%) patients, bronchoscopy in 33 (34.8%) patients, mediastinoscopy in 10 (10.9%) patients, open lung biopsy in 8 (8.7%) patients, skin biopsy in 2 (2.2%), oral mucosal biopsy in 1 (1.1%), lymph node biopsy in 1 (1.1%), renal biopsy in 1 (1.1%) and pleural fluid examination in 1 (1.1%). Bronchoscopic biopsies were diagnostic in 60.9% of sarcoid patients. Twelve (48%) IPF patients had an occupational toxic exposure history. Medical treatment were given to 80 patients. There were good clinical and radiological response in patients with sarcoidosis (96.9%) and cryptogenic organizing pneumonia (COP) (85.7%), however disease was stable in CTD patients and only three of idiopathic pulmonary fibrosis (IPF) patients (15.7%) responded to treatment. In IPF patients, diagnosis was established medially 35.7 months later after the first symptom appeared. Two of the IPF patients had also lung cancer. Treatment related complications occurred in six patients. Fourteen patients died during the follow-up period and eight were IPF. ILD is frequently encountered in general practice of pulmonary physicians and should be considered in differential diagnosis during routine pulmonology clinic. Sarcoidosis and IPF were the most commonly seen diseases. Although ILD is a difficult challenge to diagnose in clinical practice, it may be diagnosed by means of clinical features, radiologic techniques and several biopsy procedures.

Effects of two exercise interventions on pulmonary functions in the patients with ankylosing spondylitis.

OBJECTIVE: The aim of this study was to evaluate the impact of two different home-based daily exercise programs on pulmonary functions in the patients with ankylosing spondylitis (AS). METHODS: Fifty-one patients with AS were distributed into three groups. Group 1 (n=19) was given a conventional exercise regimen. Group 2 (n=19) received exercises based on the Global Posture Reeducation (GPR) method. Group 3 (n=13) was accepted as the control group. Patients were assessed according to pain, functional capacity (The Bath Ankylosing Spondylitis Functional Index - BASFI), disease activity (The Bath Ankylosing Spondylitis Disease Activity Index - BASDAI), chest expansion, pulmonary function parameters, and 6-min walk distance (6MWD) test. RESULTS: Although there were significant improvements for BASDAI and BASFI scores in all groups, significant improvements in the VAS pain, chest expansion, pulmonary function parameters and 6MWD test were observed in the exercise groups. The improvements in pain, functional capacity, disease activity, chest expansion, pulmonary function parameters and 6MWD test were better in the exercise groups than in the control group. The GPR method resulted in greater improvements than the conventional exercise program in specific pulmonary function parameters like forced vital capacity, forced expiratory volume in 1s, and peak expiratory flow parameters. CONCLUSION: Both exercises are efficient in improving pulmonary functions. Since the improvements in pulmonary function tests were greater in the patients who performed the exercise according to GPR method, motivated patients should be encouraged to perform this exercise program.

Role of bacteria in acute exacerbations of chronic obstructive pulmonary disease.

BACKGROUND AND STUDY OBJECTIVE: Infections are major causes of acute exacerbations of chronic obstructive pulmonary disease (COPD) which result in significant mortality and morbidity. The primary aim of the study was to determine the microbiological spectrum including atypical agents in acute exacerbations. The secondary aim was to evaluate resistance patterns in the microorganisms. METHODS: The sputum culture of 75 patients admitted to our clinic from January 1, 1999 to December 31, 2002 was evaluated prospectively, for aerobic Gram-positive and Gram-negative bacteria, and serologically for Chlamydophila pneumoniae and Mycoplasma pneumoniae. Sensitivity patterns in potentially pathogenic microorganisms (PPMs) were also investigated. RESULTS: An infectious agent was identified in 46 patients, either serologically or with sputum culture. Pathogens most commonly demonstrated were: Haemophilus influenzae (30%), Chlamydophila pneumoniae (17%), and Mycoplasma pneumoniae (9%). Mixed infections were diagnosed in 9 patients. PPMs showed a high resistance rate to commonly used antibiotics. CONCLUSION: We have shown that microorganisms causing acute exacerbations of COPD are not only typical bacteria (46%) but also atypical pathogens (26%), with unpredictable high rates. Typical agents showed a high resistance to commonly used antibiotics.

Massive pulmonary emboli and CT pulmonary angiography.

BACKGROUND: Massive pulmonary embolism (PE) is a devastating form of PE which usually results in acute right ventricular failure and death within 1-2 h. OBJECTIVES: To retrospectively assess pulmonary vascular, cardiac, pleural, and parenchymal findings on CT pulmonary angiography (CTPA) in patients with a diagnosis of massive PE (systolic blood pressure <90 mm Hg, syncope and/or shock). METHODS: In 33 consecutive patients with proven massive PE, hemodynamic severity was assessed by the extent of right ventricular dysfunction (RVD); diameter of the main pulmonary artery; the shape of the interventricular septum; and the extent of obstruction to the pulmonary arterial circulation (CT obstruction index). RESULTS: Central pulmonary arteries were embolized in all patients. RVD was detected in all patients (94% of them had severe RVD); the diameter of the main pulmonary artery was wider than normal in 76% of the patients; the shape of the interventricular septum was abnormal in all patients, and the CT obstruction index was higher than or equal to 50% in 85% of the patients. Wedge-shaped pleural-based consolidation was the most common parenchymal abnormality (36%). Pleural effusions were seen in 26 patients (79%). Twenty-eight patients were alive, and only the use of thrombolytic therapy was found to be statistically significant. CONCLUSIONS: In patients with acute massive PE, embolization of the central pulmonary arteries, RVD and displacement of the interventricular septum are commonly seen with CTPA. A CT obstruction index of >50% is commonly observed in massive PE. There was no association between CTPA findings and survival.

Comparison of vinorelbine-Cisplatin with gemcitabine-Cisplatin in patients with advanced non-small cell lung cancer.

PURPOSE: The objective of this trial was to compare cisplatin-plus-vinorelbine regimen with cisplatin-plus-gemcitabine regimen in patients with stage IIIB-IV non-small cell lung cancer (NSCLC). PATIENTS AND METHODS: Chemonaive patients with stage IIIB-IV NSCLC received either vinoelbine 30 mg/m(2) (days 1 and 8) plus cisplatin 80 mg/m(2) (day 1) every 21 days (VC arm) or gemcitabine 1250 mg/m(2) (days 1 and 8) plus cisplatin 80 mg/m(2) (day 1) every 21 days (GC arm). RESULTS: One hundred thirtyfour patients (67 VC and 67 GC) were included to the study. Overall response rates for the VC arm (31.2%) were not significantly different from that of the GC arm (34.3%). There were no differences in overall survival and one-year survival rates. Median survival and one-year survival rates for the VC and GC groups were 10.6 and 11.5 months, 45% and 46.8%, respectively. Grade 3-4 thrombocytopenia was significantly higher on the GC arm (VC 1.4% v GC 8.9%, p < 0.05), as was febrile neutropenia on the VC arm (VC 8.9% v GC 1.4%, p < 0.05). CONCLUSION: VC and GC demonstrated similar efficacy but there were differences in toxicity profiles.

Pulmonary involvement in Behçet's disease.

BACKGROUND: Behçet's disease (BD) is a multisystem vasculitis and pulmonary involvement in BD is reported to indicate poor prognosis and high mortality. OBJECTIVES: The aims of this study were to report on patients with pulmonary involvement and to discuss pulmonary artery thrombus and small-sized vasculitis associated with BD, with respect to previously published cases. METHODS: Fifteen patients with BD and pulmonary involvement were included in this study. Massive hemoptysis was observed in all patients having pulmonary artery aneurysm (PAA). RESULTS: Eleven patients had macroscopic pulmonary vascular disease (2 PAA, 3 PAA and thrombi and 6 only thrombi) and 3 patients had microscopic pulmonary vascular disease. The remaining patient had pulmonary cryptococcosis. CONCLUSIONS: Data regarding treatment and outcomes of patients having BD-related pulmonary emboli/infarct and small-sized vasculitis are limited. Pulmonary vasculitis affects different levels of the pulmonary artery in BD and should be classified as macroscopic and microscopic vascular disease. 'Pulmonary artery thrombosis' should be used instead of 'pulmonary emboli'. Spiral CT angiography is the best radiological tool for evaluation of pulmonary problems in BD. Treatment of vasculitis should be based on the type of vascular disease and may vary among different types of vascular disease. Anticoagulation can be used in patients with microscopic vascular disease and nonaneurysmal macroscopic vascular disease. More studies are needed to clarify this issue.

Isolated pleural and pericardial effusion in a patient with ankylosing spondylitis.

Ankylosing spondylitis (AS) is a chronic seronegative spondyloarthritis with the major histocompatibility antigen HLA B27. Pulmonary involvement in AS is rare and is usually in the form of upper lobe fibrocavitary disease. Herein, we present a case with recurrent pleural and pericardial effusion without apical fibrobullous disease who responded to prednisolone treatment well. It is believed that this is the first case report complicating AS without parenchymal involvement in the literature.

Pulmonary vasculitis in behcet disease: a cumulative analysis.

STUDY OBJECTIVES: The aims of this study were to investigate the frequency of pulmonary problems in Behçet disease (BD), and to discuss lesser-known features of pulmonary BD such as clinical characteristics, analysis of prognosis, and evaluation of treatment options with respect to the previously published cases. DESIGN: We conducted a comprehensive review of the literature to analyze cumulated data about pulmonary involvement in BD. SETTING: We found 159 articles regarding pulmonary disease associated with BD in May 2003. PATIENTS: The evaluation of these articles demonstrated 598 pulmonary problems in 585 cases. RESULTS: Pulmonary artery aneurysms (PAAs) are the most common pulmonary lesion in BD, and these are almost always associated with hemoptysis. Seventy-eight percent of patients with aneurysms have concomitant extrapulmonary venous thrombi or thrombophlebitis. Other pulmonary problems are reported in BD, and these are principally related to vascular lesions and radiologic abnormalities. CONCLUSIONS: Pulmonary vascular problems, either PAA or involvement of small-sized vessels, are the main pulmonary disorders in BD. Immunopathologic findings indicate that the underlying pathogenesis is pulmonary vasculitis, which may result in thrombosis, infarction, hemorrhage, and PAA formation. Patients with small nonspecific radiologic abnormalities should be followed up closely since early diagnosis of vascular lesions may be life-saving. Immunosuppression is the main therapy for the treatment of a vasculitis. It is important that pulmonary angiitis is not mistaken for pulmonary thromboembolic disease since fatalities have occurred in BD shortly after initiation of anticoagulation/thrombolytic treatment.

Preoperative embolization in surgical treatment of a primary hemangiopericytoma of the rib: a case report.

Primary hemangiopericytoma of the rib is extremely rare and only a few cases have been reported. A 62-yr-old man presented with an aching chest pain and dyspnea. Thoracic computed tomography revealed a homogenous mass expanding the right seventh rib. A diagnosis of hemangiopericytoma was established by percutaneous needle biopsy. Preoperative embolization of the feeding vessels of the tumor was performed in order to prevent perioperative bleeding. There was no significant bleeding during the surgery, where complete resection of the tumor with 7th to 9th ribs with a surgical margin of 5 cm was performed. Postoperative course was uneventful and there has been no recurrence for thirteen months. To our knowledge, there has been no report to apply a preoperative embolization of a primary hemangiopericytoma of the rib.