Browsing by Publisher "BILIMSEL TIP PUBLISHING HOUSE"

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    A Case of Bilateral Tuberculosis with a Presenting Symptom of Massive Haemoptysis
    (BILIMSEL TIP PUBLISHING HOUSE) Özgen, A; Çelik, P; Gülcü, A; Konyar, I; Coskun, AS; Göktan, C; Yorgancioglu, A
    Haemoptysis may be observed in one third of patients with pulmonary tuberculosis at any time during their disease. Tuberculosis may present with atypical radiological findings in patients with underlying diseases such as Diabetes Mellitus (DM). We presented a 58-year-old male with DM who haemorrhaged from the right bronchial artery although having a radiological lesion in the left lung. He had a glassful of haemoptysis in a single episode lasting two days. Chest computarized tomography (CT) showed a consolidation partially forming a massive lesion in the left upper lobe. Bronchoscopy revealed a haemorrhagic residue in the right main bronchus and a blood clot in the left upper lobe. After aspiration a major hemorrhage was observed and bronchial arterial embolization (BAE) was performed to the right bronchial artery where extravasion of the contrast agent was determined. However, in the follow-up, as the findings of BAE were not consistent with the bronchoscopic and radiological findings, a CT angiography was performed for the evaluation of the vascular structures. No vascular pathology was determined although there were acinary infiltrations in both lungs. Also, the mycobacterial culture of the sputum was positive. Radiological, bronchoscopic and angiographic findings may not always correlate in patients with haemoptysis. Heamoptysis may result from different causes in pulmonary tuberculosis and bronchial arterial system is usually the source.
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    Lung Cancer and the Relationship Between Lung Cancer - Human Metapneumovirus
    (BILIMSEL TIP PUBLISHING HOUSE) Kaya, E; Coskun, AS; Akçali, S; Çelik, P; Sanlidag, T; Yorgancioglu, A
    It is aimed to investigate the prevelance of human metapneumovirus (hMPV) in bronchial lavage and blood samples of patients with lung cancer and the relationship between hMPV and lung cancer. Seventy patients with lung cancer and 30 healthy controls were included in the study. Bronchial lavage from patients with lung cancer and blood samples from patients with lung cancer and healthy controls were investigated for presence of hMPV with PCR. The mean age of 65 (93%) male and 5 (7%) female cases was 61.44 +/- 9.65 (44-81) in lung cancer patients. In control group the mean age of 20 (67%) male and 10 (33%) female cases was 51 (40-55). There were 54 (77%) nonsmall cell lung carcinoma (NCCLC) and 16 (23%) small cell lung carcinoma (SCLC). Nine (54%) patients with SCLC were staged as limited disease. Diagnosis of patients with NSCLC were 22 (41%) squamous cell carcinoma, 14 (26%) adenocarcinoma, 2 (4%) others. In 16 (29%) patients, histological type of the cancer was not identified. The number of patients with NSCLC was 2 (4%) in stage I, 1 (1%) in stage II, 2 (4%) in stage IIIA, 27 (50%) in stage IIIB, and 16 (30%) in stage IV. hMPV was not found in bronchial lavage and blood samples in patients with lung cancer and blood samples in controls with PCR method. Although it is estimated that the study population is at risk for hMPV presence because of old age, immune deficiency and smoking, no relationship between hMPV and lung cancer was observed. This may be a result of the small number of study population, absence of symptoms or methodological problems.
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    The Effect of Nicotine among Active, Passive Smoker Health Personnel
    (BILIMSEL TIP PUBLISHING HOUSE) Temel, O; Coskun, AS; Gok, S; Celik, P; Yorgancioglu, A
    Objective: It is aimed to evaluate the effect of environmental tobacco smoke among active and passive smoker and nonsmoker health staff. Material and Method: 209 volunteers were included; age, gender, occupation and smoking habits were recorded. Exhaled air carbon monoxide ( CO), urinary cotinine levels and Fagerstrom Nicotine Tolerance Questionnaire were performed. Results: 106 (55%) of 117 active, 66 (32%) passive smokers and 26 (13%) non-smokers were male and the mean age was 30.3+6.6 (18-55). 56 (27%), 33 (16%), 80 (38%), and 40 (19%) were doctors, nurses, assistant staff and officers respectively. Mean CO level was higher in active smokers (18 ppm) than passive smokers (1.9 ppm) and non-smokers (1.5 ppm) (p=0.001). Mean urinary cotinine level was higher in active smokers (949.5 ng/ml), than passive smokers (11.3 ng/ml) and non-smokers (0.00 ng/ml) (p=0.000). Nicotine consumption in active smokers was positively and significantly related with CO, urine cotinine levels and nicotine dependency (<0.05). Conclusion: It is concluded that environmental tobacco smoke has been found to be very high in hospitals and smoke-free hospital programs should ibe started immediately.
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    Levels of Cytokines Indicative of T Cell Response in Bronchoalveolar Lavage of Tuberculin Skin TestPositive Children
    (BILIMSEL TIP PUBLISHING HOUSE) Yuksel, H; Yilmaz, O; Onur, E; Sürücüoglu, S; Erdin, S; Kirmaz, C
    OBJECTIVES: The aim of the study was to evaluate the levels of interleukin (IL)-4, IL-10, transforming growth factor-beta (TGF-beta), IL-17, and IL-23 cytokines, which reflect different T lymphocyte responses, in bronchoalveolar lavage (BAL) samples of tuberculin skin test (TST)-positive children. MATERIAL AND METHODS: Twelve children with TST positivity, who underwent flexible videobronchoscopy (FB) to evaluate airway involvement and to obtain BAL to improve diagnostic yield, and 11 control children with negative TST, who underwent FB for other reasons, were enrolled in this case-control study. BAL samples were obtained from all children during the FB procedure. Levels of IL-4, interferon gamma (IFN-gamma), IL-10, TGF-beta, IL-17, and IL-23 were measured by the ELISA method. RESULTS: Mean age of the children enrolled in the TST-positive and -negative groups were 8.6 (4.3) vs. 6.8 (4.5), respectively (p=0.35). There was a trend of higher TGF-beta levels in TST-positive children compared with TST-negative children [557.9 (515.3) vs. 386.3 (208.1), respectively, p=0.07]. Mean levels of IL-23 were 39.2 (29.5) in TST-positive children vs. 46.2 (72.3) in TST-negative children (p=0.49). IFN-gamma, IL-4, IL-10, and IL-17 levels were not significantly different among the groups (p> 0.05 for all). CONCLUSION: Results of this study suggest that TGF-beta in BAL fluid of children with TST positivity tends to be higher than that in TSTnegative children, which indicates an increased activity of regulatory T lymphocytes that may decrease the Th1 immune response. TGF-beta might be studied in future research for its potential as a diagnostic modality and immunomodulatory treatment target.
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    Flexible Fiberoptic Bronchoscopy Experience in Childhood: Evaluation of 96 Cases
    (BILIMSEL TIP PUBLISHING HOUSE) Yüksel, H; Sögüt, A; Topçu, I; Yilmaz, Ö; Okkali, Z; Keles, G
    This study is presented to evaluate the results of flexible fiberoptic bronchoscopy performed at our Department of Pediatric Allergy and Pulmonology Unit. Data of the 96 pediatric patients who had undergone flexible fiberoptic bronchoscopy in our clinic between January 2003 and February 2007 were evaluated retrospectively. Forty six patients (47.9%) were female and fifty patients (52.1%) were male. The mean age was 73.8 +/- 49.7 months, with a range of 2 and180 months. The most common indications for bronchoscopy were: persistent and/or recurrent pneumonia (24%), atelectasis (22%), suspected foreign bodies (10%), pulmonary tuberculosis (9%) tracheoesophageal fistula (5%), stridor (4%), and others (pulmonary hypoplasia, bronchial hypoplasia, gastroesophageal reflux, bronchiectasis, pulmonary hemosiderosis, hydatid cyst). Bronchoscopy findings of 19 (20%) patients were normal, while those of 77 (80%) patients produced findings which aided diagnosis and therapy. Moreover, rare pulmonary diseases such as tracheal bronchus in two cases and bronchial mucoepidermoid carcinoma in one case with recurrent pneumonia were encountered. Complications were pulmonary edema in one case, laryngospasm in two cases, bronchospasm in one case, and fever in three cases. In conclusion pediatric FFB is an advanced diagnostic tool with high diagnostic value and a low and insignificant complication rate in experienced hands and technically advanced settings.
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    Changing pH of Bronchoalveolar Lavage Fluid in Patients Undergoing Extracorporeal Circulation
    (BILIMSEL TIP PUBLISHING HOUSE) Alat, I; Bayindir, Ü; Özkisacik, E; Tasbakan, S; Saribülbül, O; Büket, S; Yagdi, T; Yüksel, M
    Since bronchoalveolar lavage (BAL) fluid can give a dynamic impression of what is present or developing in situ on the air exchange surface, we worked with BAL fluid to solve the etiopathogenesis of pulmonary complications due to cardiopulmonary bypass (CPB). Forty BAL fluid samples were obtained in 10 patients, undergoing coronary artery bypass grafting (CABG) surgery. Samples were obtained at the following time periods: 1. preoperatively; 2. at the end of the first hour after anesthetic induction; 3. at the conclusion of 30 min. of crossclamp on CPB; 4. 20 h after CPB. Neither calcium nor potassium ions were detectable in any sample. Mean pH of preoperative bronchoalveolar lavage fluid was 6.361 (SD +/- 3,55.10(-2)) and the other mean pH values were 6.375 (SD +/- 0.44), 6.567 (SD +/- 0.165), 6.470 (SD +/- 9,29.10(-2)), respectively. There was not any significant change between the first two steps (p=0.241). Likewise, the change between the third and fourth samples was not statistically significant (p=0.074). However, the change between the second and third studies was statistically significant (p=0.005). And also, the change between preoperative and final studies was statistically significant (p=0.007). The mean recoveries of lavage fluids was about 64% in the first samplings, 75% in the second, 73.4% in the third, and 56% in the fourth. This study reveals that CPB alters one of the main favorable conditions of ecosystem in bronchoalveolar space, namely the pH. Besides, excessive mucous secretion in an involved lung due to CPB which limits making BAL is the reason for atelectasis. As reported in the previous studies, since bronchoalveolar pH changes affect substances like surfactant, this study will set the baseline for further studies.
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    Stenotrophomonas maltophilia as a Pathogen of Nosocomial Pneumonia: Seven Case Reports
    (BILIMSEL TIP PUBLISHING HOUSE) Özdemir, L; Özdemir, B; Havlucu, Y
    Stenotrophomonas maltophilia, which is often found in hospital environments, has become an increasingly common nosocomial pathogen. As a cause of nosocomial pneumonia in an intensive care government hospital here, 7 patients with S. maltophilia detected in their sputum cultures were evaluated with regard to age, gender, underlying diseases and risk factors, and antibiotic susceptibilities of laboratory and radiographic findings.
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    The Role of Endobronchial Biopsy in the Diagnosis of Pulmonary Sarcoidosis
    (BILIMSEL TIP PUBLISHING HOUSE) Göktalay, T; Çelik, P; Alpaydin, AÖ; Havlucu, Y; Coskun, AS; Isisag, A; Yorgancioglu, A
    OBJECTIVES: This study aimed to investigate the additional diagnostic value of endobronchial biopsy (EBB) in the diagnosis of pulmonary sarcoidosis. MATERIALS AND METHODS: This retrospective cross-sectional study included 59 patients with a preliminary diagnosis of sarcoidosis who were admitted to the Pulmonary Diseases Outpatient Clinic of a tertiary healthcare center between January 2005 and October 2012. The socio-demographic characteristics of the patients as well as clinical and radiological findings were recorded. All patients, irrespective of the presence of an endobronchial lesion (EBL), underwent fiberoptic bronchoscopy (FOB); two to four specimens were taken using EBB from the carina of the right middle lobe in the patients with EBL. RESULTS: Of the patients, 39 (66.1%) had normal bronchoscopic findings, while 5 had EBL. Diagnosis was based on EBB in 11 patients (18.6%). Six patients (15.3%) with normal bronchial mucosae were pathologically diagnosed by EBB. There was no statistically significant relationship between the diagnostic ratio of EBB and disease stage, extrapulmonary involvement, FOB findings, elevated lymphocyte rate in bronchoalveolar lavage (>= 13%), a CD4/CD8 ratio of >= 3.5, and serum angiotensin-converting enzyme (ACE) level (p > 0.05). CONCLUSION: EBB not only offers the advantage of a high diagnostic ratio in patients with mucosal abnormalities but also contributes to pathological diagnosis in patients with normal mucosa. We recommend using EBB to support diagnosis with a low complication rate for patients undergoing FOB with a preliminary diagnosis of sarcoidosis in healthcare centers, where endobronchial ultrasound (EBUS) is unavailable.
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    Infant who Developed Noncardiac Pulmonary Edema after Flexible Fiberoptic Bronchoscopy
    (BILIMSEL TIP PUBLISHING HOUSE) Yüksel, H; Topçu, I; Ikizoglu, HT; Yilmaz, Ö; Sögüt, A; Keles, G
    Pulmonary edema may be secondary to cardiac or noncardiac etiologies. Noncardiac pulmonary edema develops as a result of increased vasopermeability, leading to water and protein leak into the interstitium. Negative pressure at the level of the alveoli during flexible fiberoptic bronchoscopy (FFB) may lead to the development of pulmonary edema. This is a rare complication in infants undergoing FFB. Dignostic FFB was performed on a four month old female patient with hypoxic ischemic encephalopathy due to persistent upper respiratory findings. Additional respiratory tract anomalies were not observed in this case who was diagnosed as having laryngomalacia. She developed bronchospastic findings following FFB which improved with nebulized salbutamol treatment. Although her bronchospasm regressed two hours after the procedure, oxygen requirement continued and fine rales became prominent on pulmonary auscultation. Findings of pulmonary edema were observed in the chest X-ray. Mannitol at a dose of 0.5 mg/kg was administered with the diagnosis of pulmonary edema. Physical findings and vital signs normalized with treatment and oxygen requirement ceased. This case was discussed because pulmonary edema after FFB is a rare complication and this is the first experience with mannitol in the treatment.
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    Summary of Consensus Report on Preoperative Evaluation
    (BILIMSEL TIP PUBLISHING HOUSE) Özkan, M; Kirkil, G; Dilektasli, AG; Sögüt, A; Sertogullarindan, B; Çetinkaya, E; Coskun, F; Ulubay, G; Yüksel, H; Sezer, M; Özbudak, Ö; Ulasli, SS; Arslan, S; Kovan, T
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    Prevalence of Asthma and Allergic Symptoms in Manisa
    (BILIMSEL TIP PUBLISHING HOUSE) Sakar, A; Yorgancioglu, A; Dinç, G; Yüksel, H; Çelik, P; Dagyildizi, L; Coskun, E; Kaya, E; Özyurt, B; Özcan, C
    The aim of this study was to determine the prevalence of asthma and allergic symptoms in Manisa city centre (Turkey), to evaluate the data obtained and to review the prevalences reported from different parts of our country. Data were collected from 610 home visits and complete interviews were conducted with 1336 adults over the age of 18. The questionnaire was consisted of sociodemographic questions and European Community Respiratory Health Survey (ECRHS) questionnaire. The prevalences of current asthma, cumulative asthma, asthma-like symptoms were found as 1.2, 1.0, and 25.0% respectively in 20-44 years age group and allergic rhinitis, allergic dermatitis, family atopy were found as 14.5, 10.9, and 15.2% respectively in the overall group. Wheezing with breathlessness, wheezing in the absence of upper respiratory tract infection, waking up with shortness of breath and waking up with cough were detected in 9.1, 6.9, 6, and 16.1% of the study population respectively. Gender, age, active or passive smoking, familial history of atopy and in-house conditions are the factors that effect the prevalence of asthma and allergic symptoms. In this study, the prevalence of asthma in Manisa was found to be consistent with the low prevalence rates reported from different parts of our country.