Evaluation of the Hospitalized Coronavirus Disease 2019 Patients in First 3 Months of the Pandemic.

OBJECTIVE: Data about Turkish coronavirus disease 2019 patients are limited. We evaluated hospitalized coronavirus disease 2019 patients who were followed up in the first 3 months of the pandemic. MATERIAL AND METHODS: This retrospective, single-center, observational study included 415 confirmed hospitalized coronavirus disease 2019 patients. The patients were divided into groups, namely, mild, moderate, and critically ill patients. Symptoms at the time of admission, clinical, laboratory, and imaging findings were examined. RESULTS: In our study, 6.74% of coronavirus disease 2019 patients had severe disease, 59.5% were male, and the mortality rate was 11.3%. Diabetes mellitus and chronic obstructive pulmonary disease were more frequently seen in critically ill patient groups and hypertension in moderate patient groups. Anemia and aspartate aminotransferase levels were higher in non-survivors among mild coronavirus disease 2019 patients. In the moderate patients' group, aspartate aminotransferase, lactate dehydrogenase, international normalized ratio, ferritin, and D-dimer levels were higher and lymphocyte, hemoglobin levels were lower; in the critically ill patients' group, platelets were lower and uric acid levels were higher in non-survivor patients. CONCLUSION: In mild patients, anemia, lymphopenia, and increased aspartate aminotransferase levels; in moderate patients, leukopenia, anemia, and increased aspartate aminotransferase, lactate dehydrogenase, international normalized ratio, ferritin, and D-dimer levels; in the critically ill patient group, lower platelet and increased uric acid levels should be followed closely as they are mortality predictors.

Cement Pulmonary Embolism Due to Percutaneous Vertebroplasty.

BACKGROUND: Bone cement is an uncommon cause of foreign-body pulmonary embolism. CASE PRESENTATION: A 65-year-old woman with wheeze presented with multiple linear opacities with bone density on chest x-ray. She reported percutaneous vertebroplasty 4 months prior. Non-- contrast chest computerized tomography showed peripheral cement emboli in the pulmonary arteries. The patient received conservative treatment. CONCLUSION: Clinicians should be aware of this potential complication following vertebroplasty. It is necessary to perform a chest x-ray after the procedure.

Pulmonary barotrauma during hookah diving: a case report.

When commercial sea harvesters have dive accidents, it is sometimes difficult to obtain an accurate dive history and make a definitive diagnosis. We report a sea harvest diver who dived to collect sea snails (Rapana venosa) by using a hookah dive system. He experienced mediastinal and subcutaneous emphysema due to interruption of breathing airflow. Thoracic computed tomography performed one year prior to the accident revealed paramediastinal subpleural blebs on both lung apices. Emphysema was resolved by administering normobaric oxygen.

Middle Lobe Syndrome Associated with Bronchial Anthracofibrosis.

Bronchial anthracofibrosis has been defined as airway narrowing associated with dark pigmentation on bronchoscopy without an appropriate history of pneumoconiosis or smoking. We present a case of a 67-year-old, non-smoking female patient who was referred to our clinic for two years of persistent cough. Spirometry was within normal limits. Radiological evaluation showed right middle lobe atelectasis and positron emission tomography-positive mediastinal lymph nodes. Bronchoscopy revealed black airway discoloration and distortions. In conclusion, we propose monthly radiological controls before an invasive procedure in such cases if a strong suspicion of malignancy/tuberculosis is not present.

An uncommon cause of multiple pulmonary nodules; hereditary hemorrhagic telangiectasia.

Hereditary hemorrhagic telangiectasia (HHT), or Rendu-Osler-Weber syndrome (ROWS) is a very rare hereditary disease. The diagnosis is based on the clinical findings such as recurrent epistaxis, telangiectases, visceral arteriovenous malformations (AVMs) and family history. AVMs are found in the liver, lung or brain and could mimick the masses of these organs. Radiologic evaluation plays a critical role during diagnostic and therapeutic management of ROWS. Hence, radiologists should be aware of the diagnosis of HHT in the patients with AVMs, history of epistaxis and family history. We report a patient with multiple pulmonary AVMs secondary to HHT who has referred to our interventional radiology department for computed tomography guided transthorasic lung biopsy procedure with suspicious of malignancy.

Pancreatic involvement in small cell lung cancer.

BACKGROUND: Few data are available concerning incidence, clinical picture, and prognosis for pancreatic metastases of small cell lung carcinoma. In this paper we review the related literature available in English language. CONCLUSIONS: Although pancreatic metastases are generally asymptomatic, they can rarely produce clinical symptoms or functional abnormalities. The widespread use of multi-detector computerised tomography (CT) in contemporary medical practice has led to an increased detection of pancreatic metastases in oncology patients. Tissue diagnosis is imperative because radiological techniques alone are incapable of differentiating them from primary pancreatic tumours. Pancreatic metastases occur in the relative end stage of small cell lung cancer. The main complications of these lesions, although rare, are acute pancreatitis and obstructive jaundice. Early chemotherapy can provide a survival benefit even in patients with mild acute pancreatitis or extrahepatic biliary obstruction.

[Paradoxical radiologic progression despite appropriate anti-tuberculous therapy]. / Uygun Antitüberküloz Tedaviye Ragmen Paradoks Radyolojik Progresyon.

Clinical or radiological deterioration of tuberculosis despite appropriate anti-tuberculous therapy is defined as paradoxical response. Since identification of paradoxical response presents difficulties, this issue is not only of medical importance but also of legal importance. In this report, a tuberculosis case who got worse paradoxically during the course of anti-tuberculous therapy, was presented. Human immunodeficiency virus (HIV)-negative 68-year-old male patient was admitted to the hospital with the complaints of cough, chest pain, and weight loss. Computed tomography of the chest revealed an irregular non-homogenous opacity involving the apical and posterior segments of superior lobe of the right lung. Since acid-fast bacilli were detected in the sputum sample, active pulmonary tuberculosis was diagnosed and four-drug regimen treatment (isoniazid 300 mg/day, rifampicin 600 mg/day, pyrazinamide 2 g/day, etambutole 1.5 g/day) was initiated. At the end of the first month of therapy radiological lesions increased. There was no endobronchial lesion on bronchoscopy, and no acid-fast bacilli in bronchial lavage fluid. Therapy protocol was not changed, however radiological lesions regressed gradually. It was concluded that temporary deteriorations might occur in previous pulmonary infiltrates in patients who were under appropriate anti-tuberculous therapy. The gold standard for monitorization of anti-tuberculous therapy is microbiological methods rather than the radiological ones. Comorbid conditions, drug reactions, patient compliance and treatment failure are important parameters in the differential diagnosis. This case was presented to emphasize the importance of tuberculosis which is still prevalent in Turkey.

Cervical necrotizing fasciitis associated with descending necrotizing mediastinitis.

We report a case of potentially fatal cervical necrotizing fasciitis and descending necrotizing mediastinitis due to deep neck infection in a 66-year-old male patient with no history or evidence of immunocompromising disorders. On admission, he had painful neck movements and the skin over his neck was red, hot and tender. A computerized tomography (CT) scan of his neck and chest showed evidence of air collection in soft tissues. He was treated with broad-spectrum intravenous antibiotics and early massive cervical drainage. Prompt diagnosis by CT of the neck and chest enabled an early surgical treatment of cervical necrotizing fasciitis. Although acute mediastinitis is a fatal infection involving the connective tissues that fill the interpleural spaces and surround the median thoracic organs, an extensive cervicotomy combined with appropriate antibiotics can prevent the need for mediastinal drainage.

Prognostic factors for 100 patients with malignant pleural mesothelioma.

The aim of this study was to investigate the effects of various clinical, laboratory characteristics, and therapeutic modalities on the survival of patients with malignant pleural mesothelioma. One hundred consecutive patients with a pathologically proven diagnosis of malignant pleural mesothelioma treated between 1993 and 2005 were included in the study. Using a Cox proportional hazard model, comorbidity, weight loss, breathlessness, and performance status were identified as independent prognostic factors. Comorbidity had interestingly favorable effect on the survival. Treated patients with chemotherapy had significantly longer survival than those treated with best supportive care. However, it was necessary to complete at least 6 cycles for a survival benefit. In conclusions, comorbidity information should be recorded in the recent prognostic studies. The drugs used for the comorbidity may improve survival.

Pulmonary lymphangitic sarcomatosis and a review of the literature.

Intrapulmonary spread of a sarcoma via lymphatics is a rare cause of death in a young adult. A 31-year old man was admitted to our hospital complaining of dyspnea and malaise of 2 months' duration. A chest radiography revealed bilateral hilar enlargement, and reticulonodular infiltrations. Thoracic CT-scans demonstrated mediastinal lymphadenopathy, thickening of interlobular septa, polygonal lines, and thickening of bronchovascular bundles. The diagnosis was made by open-lung biopsy. The patient died within 3 months after diagnosis. Pulmonary lymphangitic sarcomatosis is a rare but important manifestation of an angiosarcoma. Optimal treatment of these patients is not well defined, but a trial of chemotherapy may be warranted.

Transudates in malignancy: still a role for pleural fluid.

INTRODUCTION: The aims of this study were to determine the distribution of transudates and exudates among pathologically proven malignant pleural effusions, and to demonstrate the necessity for cytologic studies in patients with a transudative effusion. MATERIALS AND METHODS: This study is a retrospective review of all subjects diagnosed with malignant or paramalignant pleural effusion over a 10-year period at a tertiary hospital. The study included 67 subjects with malignant mesothelioma, 45 subjects with metastatic disease, and 36 subjects with paramalignant effusions. RESULTS: There were 55 female and 93 male subjects; the mean age of the sample was 62 years. Malignant pleural effusions were transudative in 1.5% of malignant mesotheliomas, 6.8% of metastatic diseases, and 11.1% of paramalignant effusions. CONCLUSIONS: Cytological examination of pleural fluid in patients with unexplained transudative effusion is essential to rule out malignant processes.

[Sternal tuberculosis]. / Sternum tüberkülozu.

Isolated involvement of the sternum is rare, representing less than 1% of tuberculous osteomyelitis. In this report, a 51-years-old woman who was admitted to the hospital with a localized solid mass in the sternum has been presented. A soft, painful mass measuring 3 cm in diameter in the lower sternum was detected during physical examination. Radiological investigation revealed presternal soft tissue and bone expansion in the posterior side of lower sternum. The patient was treated with non-specific antibiotics for a suspected diagnosis of osteomyelitis but the lesion did not show any regression. Since the microbiological analysis of fine needle aspiration fluid demonstrated acid-fast bacilli in direct microscopy and Mycobacterium tuberculosis was isolated from the culture, anti-tuberculous therapy consisting of isoniazid (INH), rifampicin (RIF), pyrazinamide (PZA), and ethambutol (ETM) was started. Sputum and urine cultures of the patient yielded negative results in terms of tuberculosis. After the first month of the therapy, her skin lesion was completely healed. Since the strain was found to be resistant to isoniazid, the maintenance therapy has been applied as INH + RIF + PZA for nine months. The history of the patient indicated that one of her relatives had skin tuberculosis on the face. As a result the patient has been successfully treated with anti-tuberculosis combination therapy together with surgical debridement.

Pleural fluid findings as prognostic factors for malignant pleural mesothelioma.

The aim of this study was to determine the prognostic value of pleural fluid glucose, lactate dehydrogenase (LDH), albumin, total protein, and total leukocyte levels in patients with malignant pleural mesothelioma. We retrospectively analyzed 71 consecutive patients (33 men and 38 women) who were referred to the department of chest diseases in a university hospital. Pleural fluid glucose levels, the ratio of pleural fluid to serum LDH>1.0, and total leukocyte count were significant predictors for the survival in univariate analysis. However, none of these variables emerged as statistically significant from the multivariate Cox model. In conclusion, our results showed that there is an inverse correlation between the intensity of inflammation and survival.

The changing epidemiological trends for carcinoma of the lung in Turkey.

OBJECTIVE: To compare epidemiological parameters for lung cancer in the last 2 decades (1986-1995 versus 1996-2005). METHODS: Data on demographic characteristics, and histological subtype of lung cancer patients were retrospectively collected by a chart review in Cumhuriyet University Hospital, Sivas, Turkey for the period of 1993-2005. All other full-text papers that report epidemiological data for lung cancer in Turkey were also searched for meta-analysis. RESULTS: A total of 25,604 patients were analyzed in the last 2 decades. The mean age at the time of diagnosis was 59.4 years, and 92.5% of the patients were males. In the last decade, the rate of squamous cell carcinoma decreased from 61-50%, however, the rate of small cell carcinoma increased from 19-24%, and the rate of adenocarcinoma from 20-26%. CONCLUSION: There was a shift in the male/female ratio in Turkey. The rate of squamous cell carcinoma decreased, however, small cell carcinoma and adenocarcinoma increased progressively.

Eosinophilic bronchitis without asthma.

BACKGROUND: Eosinophilic bronchitis without asthma causes chronic coughs without the physiologic features of asthma. The aim of this study was to review the clinical features, pathogenesis, diagnosis, treatment and prognosis of this condition. METHODS: The current literature was reviewed using Pubmed for all studies published in the English language using the search term 'eosinophilic bronchitis'. RESULTS: Eosinophilic bronchitis presents as normal spirometry, without evidence of airway hyperresponsiveness, and normal peak expiratory flow variability. When compared with asthma, mast cell recruitment to the superficial airways and mast cell activation appear to be a feature of eosinophilic bronchitis. In contrast, mast cell infiltration in the smooth muscle is significantly higher in asthma patients than in either eosinophilic bronchitis patients or healthy control subjects. In this condition, the absence of high IL-13 expression can contribute to the normal airway reactivity. The cough usually responds well to inhaled corticosteroids but dose and duration of treatment remain unclear. The condition can be transient, episodic or persistent unless treated, and occasionally, patients may require long-term treatment with oral corticosteroids. CONCLUSIONS: The condition is an important cause of chronic coughs which are corticosteroid responsive. The study of eosinophilic bronchitis suggests that eosinophil-dependent mechanisms are generally not important in the pathogenesis of asthma.