Two Cases of Arnold-Chiari Malformation with Respiratory Failure

Arnold–Chiari malformation is defined as downward displacement of the brainstem and cerebellum through the foramen magnum. It has different clinical presentations and four subtypes. It is known that downward migration of posterior fossa components through the foramen magnum and associated lower cranial nerve palsy and brainstem compression can cause respiratory failure. Acute respiratory failure could mark the onset of the disease. Posterior fossa decompression performed to treat primary disease can improve the central sleep abnormalities. As respiratory failure is rarely seen, this paper presents two cases of Arnold–Chiari malformation with respiratory failure

Increased risk of tuberculosis in health care workers: a retrospective survey at a teaching hospital in Istanbul, Turkey

BACKGROUND: Tuberculosis (TB) is an established occupational disease affecting health care workers (HCWs). Determining the risk of TB among HCWs is important to enable authorites to take preventative measures in health care facilities and protect HCWs. This study was designed to assess the incidence of TB in a teaching hospital in Istanbul, Turkey. This study is retrospective study of health records of HCWs in our hospital from 1991 to 2000. RESULTS: The mean workforce of the hospital was 3359 + 33.2 between 1991 and 2000. There were 31 cases (15 male) meeting the diagnostic criteria for TB, comprising eight doctors, one nurse and 22 other health professionals. Mean incidence of TB was 96 per 100,000 for all HCWs (relative risk: 2.71), 79 per 100,000 for doctors (relative risk: 2.2), 14 per 100,000 for nurses and 121 per 100,000 (relative risk: 3.4) for other professionals. The mean incidence of TB in Turkey between 1991 and 2000 was 35.4 per 100,000. Incidence of TB was similar in the Departments of Chest Diseases and Clinical Medicine but there were no TB cases in the Basic Science and Managerial Departments. CONCLUSION: HCWs in Turkey who work in clinics have an increased risk for TB. Post-graduate education and prevention programs reduce the risk of TB. Control programs to prevent nosocomial transmission of TB should be established in hospitals to reduce risk for HCWs

Bronchoprovocation or reversibility in asthma patients with normal pulmonary function tests

Asthma is a reversible obstructive lung disease, which can be symptom free spontaneously or with the treatment. Thus, no obstruction can be determined in pulmonary function tests though patients are admitted to the physician with clinical symptoms. For the diagnosis of asthma, reversibility and bronchoprovocation tests are used. However patients have symptoms but not physical findings or obstruction in pulmonary function tests, they get better with medication. So, it is thought that there may be reversibility in these cases. In this study 5% or more increase in the initial value of FEV1 following salbutamol inhalation in pulmonary function tests of asthma patients with no obstruction but with clinical findings was considered positive reversibility test (modified reversibility test). Modified reversibility test's specificity and sensitivity was 54% and 55% respectively. As a result, it was concluded that modified reversibility test is not as useful as a diagnostic test as bronchoprovocation in this group of patients

Endobronchial Stenosis due to Wegener Granulomatosis

Wegener granulomatosis (WG) is characterized by a necrotizing granulomatous vasculitis. Computed tomography of the chest is effective in detecting lung involvement with pulmonary nodules with or without cavitations and airspace consolidation. We report a case of endobronchial stenoses in the setting of WG. A 48-year-old man was admitted with complaints of dyspnea, cough, and sputum. A computed tomography scan revealed consolidation and small cavitating nodules, and stenoses were observed during bronchoscopy endobronchial. Narrowing improved after pulse cyclophosphamide and prednisolone therapy. Endobronchial stenoses are rare in the course of WG, and occur even more rarely than subglottic stenosis. Combined treatment with cytotoxic and corticosteroid agents has improved prognosis and long-term survival in patients with WG

ARGON PLASMA COAGULATION USE IN PALLIATIVE TREATMENT OF TYPICAL-ATYPICAL CARCINOID TUMORS

Bronchial carcinoid tumors constitute 1-2% of all primary lung tumors. The main treatment for lung carcinoid tumors is surgery but bronchoscopic endobronchial therapy is also a palliative option for poor surgical candidates. This study will discuss the outcomes of bronchoscopic endobronchial treatment for two cases. Case 1 has a typical carcinoid tumor in right upper lobe and has multiple comorbidities. Case 2 is a patient with metastatic atypical carcinoid tumor who was operated before. We used argon plasma coagulation technique in treatment of both cases

Anastomotic Stenotic Complications After Tracheal Resections

Background: Treatment of anastomotic stenosis after tracheal resections is not well established. We aimed to share our experience with the management of this condition

Endobronchial Tuberculosis with Lobar Obstruction Successfully Treated by Argon Plasma Coagulation

Endobronchial tuberculosis (EBTB) is an infection of the tracheobronchial tree. A 17-year-old male patient with tuberculosis who developed middle lobe syndrome on antituberculous treatment is presented. The patient was admitted with complaints of fever, cough and weight loss. Right paracardiac and perihilar heterogeneous infiltrations were present. During fiberoptic bronchoscopy, the right middle lobe was found to be obstructed. Tuberculosis was diagnosed based on necrotizing granulomas in the bronchial biopsy and culture growth of M tuberculosis. After antituberculous and corticosteroid treatment, progression occurred. The endobronchial lesion was removed with argon plasma coagulation. After bronchoscopy, the patient's radiologic findings and clinical condition improved. In cases progressing despite steroid treatment, alternative treatments may be beneficial

Pneumomediastinum or lung damage in breath-hold divers from different mechanisms: a report of three cases

Normally pulmonary over-inflation is not an issue during breath-hold diving, in contrast to lung squeeze. Compared with compressed air diving, pulmonary barotrauma is rare in breath-hold diving. Several mechanisms can lead to an increase in intrathoracic pressure in breath-hold diving that may cause alveolar rupture. Here we report three cases of pulmonary barotrauma in breath-hold diving. Using high-resolution chest tomography, bullous damage in Case I, and pneumomediastinum in Cases 2 and 3 were detected. Transient neurological symptoms in Cases 1 and 2 suggested cerebral arterial gas embolism. The mechanisms that caused intrapulmonary overpressure were, respectively, lung packing ('buccal pumping'), considerable effort and straining at depth, and breathing compressed air at depth and ascending without exhaling. All three cases recovered without specific treatment such as recompression