Evaluation of lung densitometric and volumetric changes in silicosis patients using three-dimensional software for multidetector CT and the relationship with profusion scores.

AIM: To evaluate the density and volume changes in the lungs of silicosis patients and their relationship with the disease severity classification of the International Labor Organization (ILO). MATERIALS AND METHODS: The multidetector computed tomography (CT) images of 44 patients diagnosed with silicosis and 32 controls that underwent thoracic CT due to trauma were evaluated. Patients with silicosis were divided into three categories according to the ILO classification. Data related to the total lung volume, total lung mean density, lung opacity score, percentage of lung high opacity, and mean density in the lower and upper lobes were obtained using three-dimensional (3D) software. RESULTS: There was no significant difference between the total lung mean densities of the silicosis and control groups (p=0.213); however, a significant difference was observed between the two groups in terms of the total lung volume (p<0.0001). According to the ILO classification, there was a significant difference between the disease severity categories in relation to the percentage of lung high opacity (p=0.000005). A strong correlation was detected between disease severity and high opacity percentage (p<0.0001, r=0.804). According to the ILO classification, there was also a significant difference between disease severity categories in terms of the lung opacity score (p=0.000144), as well as a moderate correlation between disease severity and opacity score (p<0.0001, r=0.580). CONCLUSION: Total lung volume is a CT finding that shows variation in exposure to crystalline silica. The percentage of high opacity determined using multidetector CT is an effective parameter in evaluating disease severity.

The efficiency of routine endotracheal aspirate cultures compared to bronchoalveolar lavage cultures in ventilator-associated pneumonia diagnosis.

OBJECTIVE: Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in Intensive Care Units (ICUs) and its mortality rate varies from 24% to 50%. The most important factor in decreasing the mortality is administering adequate antibiotics as early as possible. In this study, we investigate the efficiency of routine endotracheal aspirate (EA) cultures to identify the etiology of VAP earlier. MATERIALS AND METHODS: Fifty-nine patients who were accepted to our ICU with acute cerebrovascular disease with mechanical ventilation (MV) requirement were chosen for this study over a 12-month period. The patients intubated in our ICU were included in the study to exclude prior colonization. Upon ICU admission, the patient's; age, sex, comorbidities, diagnosis, acute physiology and chronic health evaluation II score, and sequential organ failure assessment (SOFA) score were recorded. When bronchoalveolar lavage (BAL) was performed, the SOFA score, temperature, leukocyte count, C-reactive protein levels, PaO2/FiO2ratio, PCO2, clinical pulmonary infection score value, length of MV, and presence of antimicrobiological treatments were recorded. Routine microbiological analysis was performed by EA (pre-VAP EA) twice weekly in all patients until the endotracheal tube was removed. When VAP was suspected, fiberoptic bronchoscopy examination with BAL was performed. A diagnosis of VAP was established when the BAL quantitative culture grew at least one microorganism at a concentration ≥104 cfu/mL. RESULTS: VAP was diagnosed in 41 (69%) of the 59 patients based on BAL culture results. Among 41 positive BAL cultures, pre-VAP EA identified the same microorganism with the same antibiotics resistance pattern in 23 (56%) patients. Regarding only late-onset VAP, pre-VAP EA identified the same microorganisms found by BAL culture in 17 (63%) of the 27 cases. Among 18 BAL culture negative patients, 7 (39%) patients had negative prior pre-VAP EA culture results. Acinetobacter baumannii was the most frequently isolated microorganism from BAL cultures (n = 21, 51%). The diagnostic value of pre-VAP EA results in predicting A. baumannii VAP documented with the following values (sensitivity: 62%; specificity: 95%, positive predictive value: 87%, negative predictive value: 82%). CONCLUSION: VAP patients should be treated with international guidelines, but if pre-VAP EA cultures identify multidrug resistant pathogens, the initial antibiotic therapy should cover these microorganisms. Thus, quantitative EA cultures are a useful noninvasive diagnostic tool in critically ill patients suspected of having pneumonia especially in the case of VAP.

Volumetric MRI assessment of brain regions in patients with refractory obsessive-compulsive disorder.

No prior study to date has examined the comparisons of the structures that have been implicated in obsessive-compulsive disorder (OCD) in patients with refractory OCD, those who are treatment-responded and healthy controls concurrently. Therefore, we performed a volumetric MRI study in patients with refractory OCD, those with treatment responding OCD and healthy controls. Morphometric MRI was used to compare in thirty patients with OCD and ten healthy controls. Of the patient group, ten were first applying patients, ten were treatment-responded and the rest were refractory OCD patients. As a whole group, OCD patients had increased white matter volume than healthy controls. First applying patients had significantly smaller left and right orbito-frontal cortex (OFC) volumes compared with treatment-responded patients and healthy controls, with a significant difference between refractory patients and treatment-responded patients and with no significant difference was found between the volume of first applying patients compared to that of refractory patients. Anterior cingulate exhibited a near-significant difference only between first applying patients and healthy controls on left side. First applying patients had significantly greater left and right thalamus volumes compared with treatment-responded patients and healthy controls and there was a considerable difference in regard to thalamic volumes between refractory patients and treatment-responded patients. Taken together, our findings suggest that reductions in OFC and increase in thalamic volumes may be associated with refractoriness of OCD and may not be due to changes in cingulate and caudate regions.

Effects of the blockade of cardiac sarcolemmal ATP-sensitive potassium channels on arrhythmias and coronary flow in ischemia-reperfusion model in isolated rat hearts.

Activation of ATP-sensitive K+ channels (K ATP) during ischemia leads to arrhythmias and blockade of these channels exert antiarrhythmic action. In this study, we investigated the effects of HMR1098, a sarcolemmal K ATP channel blocker and 5-hydroxydeconoate (5-HD), a mitochondrial K ATP channel blocker on cardiac function and arrhythmias in isolated rat hearts. The hearts were subjected to 30 min coronary occlusion, followed by 30 min reperfusion. In the preischemic period, both HMR 1098 and 5-HD slightly increased coronary perfusion pressure. Coronary occlusion increased the perfusion pressure and decreased the left ventricular developed pressure (LVDP) in both control and drug-treated hearts. However, inhibition of LVDP was greater and recovery of the perfusion pressure was lower in 30 micromol/l HMR1098 and 100 micromol/l 5-HD-treated hearts compared to control (P < 0.05). HMR1098, at 3 micromol/l, but not at 30 micromol/l, significantly reduced the ratio of bigeminis, couplets and salvos (P < 0.05). Ventricular tachycardia and ventricular fibrillation were not prevented by HMR1098, at both concentrations, and with 5-HD (100 micromol/l). These results suggest that blockade of sarcK ATP and mitoK ATP channels exert weak antiarrhythmic action, but reduce the recovery of coronary perfusion and contractile force, implying that both types of K(ATP) channels have beneficial role in the recovery of ischemic rat myocardium.

High serum leptin levels in depressive disorders with atypical features.

Leptin is thought to be related to vegetative symptoms of depression such as alterations in food intake and weight. Fifty-seven drug-free patients and 26 healthy controls were enrolled in this study. We have found that the serum leptin levels were higher in patients with atypical depressive disorder than in controls, but not in patients with non-atypical depressive disorder, however, body mass index, age, and gender were not significantly different between these groups. Probably, these findings seem to be associated with some features of the atypical depressive disorders such as weight gain, a result of hyperphagia.

Lipid peroxidation and antioxidant enzyme levels in patients with schizophrenia and bipolar disorder.

Recent data from several reports indicate that free radicals are involved in aetiopathogenesis of many human pathologies including neuropsychiatric disorders such as schizophrenia, bipolar disorder etc. In the present study, we aimed at determining and evaluating levels of malondialdehyde (MDA), a product of lipid peroxidation, and antioxidant enzyme superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activity levels in patients diagnosed with schizophrenia (n = 25) and bipolar disorder (n = 23). The control group was composed of 20 healthy subjects. There was a significant increase in MDA levels of patients with schizophrenia and bipolar disorder compared with controls. SOD and GSH-Px activity levels were significantly higher in the schizophrenic group compared with controls. SOD activity levels in bipolar the group were significantly higher than controls whereas there were no significant changes in GSH-Px activity levels in the bipolar group and controls. Significant differences between lipid peroxidation product and antioxidant enzyme (SOD and GSH-Px) activity levels in schizophrenic and bipolar disorder patients compared with controls leads us to believe that these differences are related to the heterogenities in aetiologies of these disorders.

Color and number preferences of patients with psychiatric disorders in eastern Turkey.

Color and number preferences have not been studied in healthy sublets and psychiatric patients in Turkey. The study group consisted of a total of 500 patients who had been referred to Firat University Medical Faculty Psychiatry Clinic between March and July 2000 and diagnosed with a psychiatric disorder according to DSM-IV criteria. Preferred colors were requested as a selection from the Lüscher Color Test. Then the patients were told to choose a number between 0 and 9. Green was the most frequently preferred of all colors and the number 3 was the most preferred number. Our results demonstrate that patients' choice of color and number reflect the region's religious and cultural milieu.

Heparin-induced thrombocytopenia after bone marrow transplantation: report of two cases.

Persistent thrombocytopenia and thrombotic complications are commonly observed in bone marrow transplant (BMT) patients. We describe two incidents following BMT in which heparin may have played a contributory role. One patient developed subclavian venous thrombosis following autologous BMT in spite of the severe thrombocytopenia. The second patient, who received an HLA-matched sibling allogeneic BMT, developed thrombocytopenia after a normal platelet recovery. Because of the clinical evidence and a normocellular bone marrow biopsy result, heparin-induced thrombocytopenia was suspected and heparin was discontinued. In 2 weeks, the patient was transfusion free and her platelet count returned to normal levels. These two cases demonstrate that heparin-induced thrombocytopenia may be responsible for some cases of post-BMT thrombocytopenia and thrombosis.

Infant mortality: a Turkish puzzle?

In this paper I examine the problem of high infant and child mortality in Turkey. In view of my research results, I argue for a re-evaluation of the theoretical paradigm that views childhood issues primarily in relation to mothers rather than within the dynamics of a broader cultural context. The present emphasis on mothers as a primary key to the problem reflects an extensive and implicit conceptualization of 'motherhood' that has penetrated scientific discourse and methodology. The research results presented here show that in our Istanbul sample most of the factors related to high child mortality are household and cultural conditions encircling the mother, and that only a few of the factors are direct attributes of the mother herself. These results have significant implications for research and policy on child health.