The costs of hospitalization in patients with acute exacerbation of chronic obstructive pulmonary disease

Sevket Ozkaya1, Serhat Findik2, Atilla Guven Atici21Rize University, Department of Pulmonary Medicine, Rize, Turkey; 2Ondokuz Mayis University, Department of Pulmonary Medicine, Atakum, Samsun, TurkeyIntroduction: Chronic obstructive pulmonary disease (COPD) is a major public health problem. It imparts a substantial economic burden on individuals and society. Acute exacerbations are the main cause of hospital admissions and hospitalizations in patients with COPD in Turkey.Objectives: We aimed to determine the costs of hospitalization in patients with acute exacerbations of COPD (AECOPD).Results: A total of 7832 (1556 women, 6276 men) patients were hospitalized due to acute exacerbations of COPD between 2005–2009 in the Samsun Chest Diseases and Thoracic Surgery Hospital, northern Turkey. The mean age was 64.6 ± 19.8 years old and median length of hospital stay was 14.8 ± 9.5 days. The mean cost per admission was US$718 ± 364. Drug costs accounted for the largest portion (53.5%) of the mean cost, followed by bed cost (19.6%). One hundred seventy-four (2.2%) of the total hospitalized patients with AECOPD died in hospital.Conclusion: AECOPD continues to have both significant economic burden and high mortality rate.Keywords: COPD, acute exacerbation, hospitalization, cost

Comparison of Vinorelbine-Cisplatin with Gemcitabine-Cisplatin in Patients with Advanced Non-Small Cell Lung Cancer

Purpose The objective of this trial was to compare cisplatin-plus-vinorelbine regimen with cisplatin-plus-gemcitabine regimen in patients with stage IIIB-IV non-small cell lung cancer (NSCLC). Patients and Methods Chemonaive patients with stage IIIB-IV NSCLC received either vinoelbine 30 mg/m 2 (days 1 and 8) plus cisplatin 80 mg/m 2 (day 1) every 21 days (VC arm) or gemcitabine 1250 mg/m 2 (days 1 and 8) plus cisplatin 80 mg/m 2 (day 1) every 21 days (GC arm). Results One hundred thirtyfour patients (67 VC and 67 GC) were included to the study. Overall response rates for the VC arm (31.2%) were not significantly different from that of the GC arm (34.3%). There were no differences in overall survival and one-year survival rates. Median survival and one-year survival rates for the VC and GC groups were 10.6 and 11.5 months, 45% and 46.8%, respectively. Grade 3-4 thrombocytopenia was significantly higher on the GC arm (VC 1.4% v GC 8.9%, p < 0.05), as was febrile neutropenia on the VC arm (VC 8.9% v GC 1.4%, p < 0.05). Conclusion VC and GC demonstrated similar efficacy but there were differences in toxicity profiles

Role of bacteria in acute exacerbations of chronic obstructive pulmonary disease

Levent Erkan, Oguz Uzun, Serhat Findik, Didem Katar, Ahmet Sanic, Atilla G AticiOndokuz Mayis University, Faculty of Medicine, Department of Pulmonary Medicine, Samsun, TurkeyBackground and study objective: Infections are major causes of acute exacerbations of chronic obstructive pulmonary disease (COPD) which result in significant mortality and morbidity. The primary aim of the study was to determine the microbiological spectrum including atypical agents in acute exacerbations. The secondary aim was to evaluate resistance patterns in the microorganisms.Methods: The sputum culture of 75 patients admitted to our clinic from January 1, 1999 to December 31, 2002 was evaluated prospectively, for aerobic Gram-positive and Gram-negative bacteria, and serologically for Chlamydophila pneumoniae and Mycoplasma pneumoniae. Sensitivity patterns in potentially pathogenic microorganisms (PPMs) were also investigated.Results: An infectious agent was identified in 46 patients, either serologically or with sputum culture. Pathogens most commonly demonstrated were: Haemophilus influenzae (30%), Chlamydophila pneumoniae (17%), and Mycoplasma pneumoniae (9%). Mixed infections were diagnosed in 9 patients. PPMs showed a high resistance rate to commonly used antibiotics.Conclusion: We have shown that microorganisms causing acute exacerbations of COPD are not only typical bacteria (46%) but also atypical pathogens (26%), with unpredictable high rates. Typical agents showed a high resistance to commonly used antibiotics.Keywords: chronic obstructive pulmonary disease, acute exacerbation, infection, atypical pathogens, Haemophilus influenza

Preoperative Embolization in Surgical Treatment of a Primary Hemangiopericytoma of the Rib : A Case Report

Primary hemangiopericytoma of the rib is extremely rare and only a few cases have been reported. A 62-yr-old man presented with an aching chest pain and dyspnea. Thoracic computed tomography revealed a homogenous mass expanding the right seventh rib. A diagnosis of hemangiopericytoma was established by percutaneous needle biopsy. Preoperative embolization of the feeding vessels of the tumor was performed in order to prevent perioperative bleeding. There was no significant bleeding during the surgery, where complete resection of the tumor with 7th to 9th ribs with a surgical margin of 5 cm was performed. Postoperative course was uneventful and there has been no recurrence for thirteen months. To our knowledge, there has been no report to apply a preoperative embolization of a primary hemangiopericytoma of the rib

A case of endobronchial lipoma mimicking bronchial asthma

Sevket Ozkaya1, Hasan Demir1, Serhat Findik21Samsun Chest Diseases and Thoracic Surgery Hospital, Samsun, Turkey; 2Department of Pulmonary Medicine, Faculty of Medicine, Ondokuz Mayis University, Kurupelit, Samsun, TurkeyAbstract: Endobronchial lipoma is a rare neoplasm of the tracheobronchial tree and it may cause irreversible pulmonary damage due to recurrent pneumonia. Rarely, it may mimic bronchial asthma. We present a 53-year-old woman with an endobronchial lipoma, which had been treated as a bronchial asthma for four years. She also had developed recurrent pneumonia three times.Keywords: endobronchial lipoma, asthma, radiology, bronchoscop

Asymptomatic double aortic arch

Muzaffer Sariaydin1, Serhat Findik1, Atilla Guven Atici1, Sevket Ozkaya2, Aziz Uluisik11Department of Pulmonary Medicine, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey; 2Department of Pulmonary Medicine, Faculty of Medicine, Rize University, Rize, TurkeyAbstract: A 51-year-old male patient with a past history of lung tuberculosis was referred to our clinic for routine control. The patient reported no complaints and chest X-ray was normal. Three-dimensional thoracic computed tomography revealed a balanced-type double aortic arch with no compression of trachea or esophagus.Keywords: double aortic arch, asymptomatic, adult, three dimensional computed tomograph

An Unusual Cause of Precordial Chest Pain

Extraskeletal chondrosarcoma in anterior mediastinum is very rare. A 45-year-old male patient was admitted to the hospital with precordial chest pain. A large and well-shaped mass in the anterior mediastinum was seen radiologically, and there was a clearly compression of the heart by the mass. The lesion was totally resected, and extraskeletal mediastinal chondrosarcoma was histopathologically diagnosed. We aimed to present and discuss the radiologic, clinic, and histopathologic features of unusual presentation of extraskeletal chondrosarcoma in a case

Endobronchial tuberculosis: histopathological subsets and microbiological results

Abstract Background Endobronchial tuberculosis (EBTB) is defined as a tuberculous infection of the tracheobronchial tree with microbial and histopathological evidence, with or without parenchymal involvement. Bronchoscopic appearances of EBTB have been divided into seven subtypes: actively caseating, edematous-hyperemic, fibrostenotic, tumorous, granular, ulcerative, and nonspecific bronchitic. However, information for establishing a definite microbiological diagnosis in each of these categories is lacking. We aimed to present bronchoscopic appearances and percentages for the EBTB subtypes and to compare bronchoscopic appearances with microbiological positivity in bronchial lavage fluid. Methods From 2003 to 2009, 23 biopsy-proven EBTB patients were enrolled in the study. Diagnosis of EBTB was histopathologically confirmed in all patients. Results The commonest subtype was the edematous-hyperemic type (34.7%); other subtypes in order of occurrence were: tumorous (21.7%), granular (17.3%), actively caseating (17.3%), fibrostenotic (4.3%), and nonspecific bronchitic (4.3%). Although all patients were sputum-smear-negative for acid-fast bacilli (AFB), 26% of patients were smear-positive for AFB in the bronchial lavage fluid. The bronchial lavage fluid grew Mycobacterium tuberculosis in 39.1% of all patients. The bronchial lavage smear positivity for AFB in the bronchial lavage fluid was 75%, 25%, 20%, 12.5%, 0%, and 0% for the granular, actively caseating, tumorous, edematous-hyperemic, fibrostenotic, and nonspecific bronchitic subtypes of EBTB, respectively. Culture positivity for Mycobacterium tuberculosis in bronchial lavage fluid was 75%, 50%, 40%, 25%, 0%, and 0%, respectively. Conclusion The commonest subtype of EBTB was the edematous-hyperemic subtype. The granular type had the highest smear positivity and culture positivity for Mycobacterium tuberculosis in bronchial lavage fluid. Bronchoscopy should be performed in all patients suspected to have EBTB.</p

Evaluation of plasma and milk haptoglobin concentrations in the diagnosis and treatment follow-up of subclinical mastitis in dairy cows

The purpose of this study was to examine whether plasma and milk haptoglobin (Hp) concentrations could be an alternative method for the diagnosis and treatment follow-up of subclinical mastitis (SM) in dairy cows. In the study, 14 cows with subclinical mastitis (SM) in more than one udder quarter and 5 healthy control cows were used. Cows in the non-treated group (GNT; n=6) did not receive any treatment while cows in the treated group (GT; n=8) were treated with intramammary cefquinom sulphate on the second week. Healthy cows were evaulated as Control group (GC). Plasma Hp concentrations did not differ within groups and between groups (p&gt;0.05). When compared milk Hp concentrations within groups, there was a slight increase in GT on the third week (p&lt;0.05) and the concentrations in GNT and GC did not reveal any difference (p&gt;0.05). A relationship between CMT scores, SCC values, plasma Hp and milk Hp concentrations was not established. It was concluded that plasma Hp and milk Hp are not useful parameters to diagnose and monitor the treatment efficacy of subclinical mastitis in dairy cows