Investigation of the relationship between mean platelet volume and obstructive sleep apnea syndrome

Objective: Obstructive sleep apnea syndrome (OSAS) is characterized by recurrent upper airway obstruction and intermittent hypoxia during sleep. Intermittent hypoxia and increased inflammatory activity plays a role in increased risk of cardiovascular disease in the OSAS. OSAS is an important cause of morbidity and mortality and cardiovascular disorders are the most important complications of OSAS. Mean platelet volume (MPV) is a marker of platelet activation and function, and increased platelet volume is associated with increased platelet activity. Different diseases related with inflammation, hypoxia, vascular injury, thrombosis and atherosclerosis were found to be associated with MPV. In this study, we aimed to investigate the relationship between OSAS and MPV. Methods: In this retrospective study, data of sex and age matched 33 patients with moderate OSAS, 34 patients with severe OSAS and 30 healthy subjects were evaluated. Results: The mean MPV was found in control, moderate OSAS and severe OSAS groups as 7.83±1.00, 8.26±1.40 and 8.94±1.20 (fL) respectively. The mean MPV value was significantly higher in severe OSAS group than control subjects (p=0.001). In correlation analysis, there were positive correlation between MPV with apnea-hypopnea index and total sleep time, and negative correlation between MPV with platelet count and minimum oxygen saturation (Respectively, p=0.003 / R=0.295, p=0.030 / R=0.221, p=0.011 / R= -0.257, p=0.019 / R= -0.238). Conclusion: In this study, the increased MPV was associated with severe OSAS and the results of this study suggest that the platelet activation is increased in OSAS. Hypoxia caused by OSAS, due to the activated platelets, may play a role in the development of cardiovascular diseases which is an important cause of morbidity and mortality in OSAS. J Clin Exp Invest 2013; 4 (4): 492-49

The case of malignancy mimicking legionella pneumonia

Legionella pneumophila is a bacterium, which can grow inwater pipe networks and climate systems. Contaminationoccurs by aspiration of infected water or aerosol inhalation.It is usually presented with fever, bradycardia, andchange in mental status, hyponatremia, elevation of liverenzymes and deterioration of renal function. The definitediagnosis is established by detection of the antigens andcultivating in the culture medium. Also, malign lung tumorscan encounter with the same clinical findings, so lungcancer should be remembered in differential diagnosis.The patient hospitalized for the Legionella pneumophiladue to the physical examination and laboratory findingsduring the first evaluation in the emergency department.However, further examinations pointed to the cancer. Weaimed to emphasize the probability of malignant tumorsin terms of hyponatremia, increase in the liver enzymes,and failure in the renal functions, which were usually experiencedin emergency unit. J Clin Exp Invest 2013; 4(3): 390-392Key words: Legionella pneumophila, pneumonia, lung malignanc

Assessment of mean platelet volume in chronic obstructive pulmonary disease during stable period and acute exacerbation

Objective: Chronic obstructive pulmonary disease (COPD) is an important public health problem and it is associated with systemic inflammation. Mean platelet volume (MPV) is one of the markers indicating platelet activation, and it was found to be high in many diseases related to inflammation. In previous studies reported different results evaluating of MPV in COPD. In this study, we aimed to evaluate of C-reactive protein (CRP), white blood cell (WBC), and MPV in acute exacerbation of COPD and stable COPD patients. Methods: In this retrospective study, data of 40 patients with acute exacerbation of COPD, 43 stable COPD patients and 40 healthy subjects were evaluated. Results: The mean MPV, CRP and WBC were found in control, stable COPD and acute exacerbation of COPD groups, 7.9±1.1; 8.2±1.3 and 8.7±1.6 fL; 3.4±1.2; 5.2±3.5 and 27.5±23.6 mg/L; 7.8±1.6; 8.1±2.1 and 11.4±4.5 x103/ ϻL, respectively. The mean WBC and CRP in the acute exacerbation of COPD group were significantly higher than the other groups (for both values p ˂0.001). The mean MPV in the acute exacerbation of COPD group was found higher than in the other groups. The mean MPV values were significantly higher in patients of acute exacerbation than control subjects (p=0.030). Conclusion: The results of this study suggest that the increased MPV may be a marker for the evaluation acute exacerbation of COPD as well as the classic acute phase reactant CRP. J Clin Exp Invest 2013; 4 (4): 483-48

Papillary Thyroid Carcinoma with Lung Metastasis Arising from Dyshormonogenetic Goiter: A Case Report

Prior radiation exposure is the best known risk factor for thyroid cancers, and papillary thyroid carcinoma (PTC) may arise from dyshormonogenetic goiter. A 17-year-old female patient was admitted to the department of chest diseases with respiratory symptoms. The patient had undergone a thyroid surgery for goiter at the age of 9. A bilateral nodular opacity was detected by radiological examination. The histopathologic examination of the specimen obtained from computed tomography guided trucut biopsy was diagnosed as PTC. We present a very rare case of PTC with lung metastasis that had undergone subtotal thyroidectomy due to dyshormonogenetic goiter eight years ago

İnaktif Hepatit B’li bir hastada pnömonik varisella : Olgu sunumu

Nadir rastlanılmasına rağmen varicella zoster virus (VZV) ilişkili pnömoni, virüsün sıklıkla yetişkinleri etkileyen en ciddi komplikasyonudur ve yüksek mortaliteyle seyreder. Bu çalışmada Hepatit B virüs taşıyıcısı 29 yaşında bir erkek hastada VZV pnömonisi tanımlanmaktadır. Hasta beş gündür devam eden halsizlik, boğaz ağrısı, ateş, öksürük ve hafif dispne şikayetleri ile başvurdu. Ayrıca ekzantematöz veziküler döküntüleri vardı. Döküntüler saçlı deriyi de kapsayacak şekilde tüm vücuda yayılmıştı. Fakat hastanın ateşi yoktu ve vital bulgular normaldi. Deri muayenesi ile tüm vücutta papüloveziküllü yaygın polimorfik döküntü ve kabuklu lezyonlar görüldü. Serolojik bulgular, VZV IgM pozitif, VZV IgG pozitif ve HBsAg pozitif idi. Göğüs radyografisinde bilateral pnömonik infiltrasyonlar görüldü. Hastaya valasiklovir ve klaritromisin verildi. Deri lezyonları on gün sonra kayboldu ve hasta tam olarak iyileşti. Sonuç olarak yetişkin hastalarda nadiren oluşan VZV pnömonisinin erken tanısı ve antivirallerle etkin tedavisi ciddi komplikasyonların gelişmesini önleyebilir.Although rarely observed, varicella zoster virus (VZV)-related pneumonia is the most serious complication of the virus, which commonly affects adults and causes high mortality rates. In this study, we describe a case of VZV pneumonia in a 29-year-old male who is an inactive Hepatitis B virus carrier. The patient presented with a 5-day history of fatigue, sore throat, fever, cough and mild dyspnea. He also had an exanthematous vesicular rash. The rash had spread all over his body surface including the hairy skin. But he was not febrile and vital signs were normal. The skin examination exhibited a diffuse polymorphic rash with papules/vesicles, pustules and crusty lesions over the whole body. Serological findings were as follows: VZV IgM positive, VZV IgG positive and HBsAg positive. His chest X-ray showed bilateral pneumonic infiltrations. The patient was prescribed valacyclovir and clarithromycin. The skin lesions disappeared after ten days and the patient made a full recovery. We conclude that an early diagnosis of VZV pneumonia, which rarely occurs in adult patients and its effective treatment with antivirals may prevent the development of serious complications

BARYUM ASPİRASYONU: OLGU SUNUMU

ÖzetBaryumlu grafilerin çekimi sırasında baryum aspirasyonu nadir görülmekte olup, baryum aspire eden hastalar asemptomatik olabileceği gibi ölümle sonuçlanan vakalarda bildirilmiştir. Biz burada yutma güçlüğü nedeniyle baryumlu özefagus grafisi çekimi sırasında baryum aspire eden bir olgu sunuyoruz. 77 yaşında erkek hasta baryumlu özefagus grafisi çekimi sırasında gelişen öksürük, nefes darlığı şikayetleri ile acil servise başvurdu. Akciğer grafisinde; her iki ana bronşta ve sol akciğer alt zon medial bölümündeki bronşlarda opak madde izlendi. Hasta göğüs hastalıkları kliniğine baryum aspirasyonu tanısı ile yatırıldı. Toraks BT’de; özefagus proksimal kısmında trakeaya bası ve invazyon oluşturan kitle lezyonu izlendi. Bronkoskopi’de trakea arka duvarda dıştan bası ile daralma, mukozada infiltrasyon, ana karinada küntleşme izlendi. Trakea, ana karina düzeyinden punch biyopsi yapıldı. Biyopsi sonucu; yassı hücreli karsinom olarak raporlandı. Onkoloji kliniğiyle konsülte edilen hasta bu kliniğe devredildi.Anahtar Kelimeler: Baryum sülfat, Özefagus karsinomu, Solunumla aspirasyo

Impact of NEXUS Low-Risk Criteria on Cervical Injuries in a Turkish Tertiary-Care Hospital

Aim: In the present study, we aimed to determine the amount of unnecessary X-ray graphics that could lead to cost-load and radiation side effects using NEXUS Low-Risk Criteria (NLC) that was applied and evaluated in patients with cervical spine trauma in the Izmir Ataturk Training and Research Hospital’s emergency department.Materials and Methods: Between June 2010 and September 2010, the trauma patients admitted to the emergency department were evaluated retrospectively. The age, sex, NLC, mechanisms of trauma, radiological imaging, cost, radiation load, and degree of cervical injuries were assessed.Results: In the present study, 1317 patients with a possible cervical spine injury were included. It was confirmed that the numbers of excluded and included patients according to NLC were 1014 and 303, respectively. In excluded patients, 479 (36.3%) did not have any radiology, but in 535 (52.7%) of them, unnecessary radiological imaging studies were administered. The trauma mechanism was crash at the same level in 310 (23.5%) of the total and 267 (26.3%) of the excluded patients. In addition, in-vehicle traffic accident was observed in 64 (21.1%) included patients. It was found that the number of cervical spine injuries was four in the excluded and 10 in the included groups, which was confirmed according to NLC.Conclusion: The increase in the use of NLC leads to a decrease in both the cost and amount of radiation exposure in patients and health workers. In addition, the number of cancers due to iatrogenic etiologies in humans will be lower