Multiple endobronchial lipomas which were treated by bronchoscopical resection

SummaryBronchial benign tumors are very rare; however, endobronchial lipomas are responsible for 0.1–0.5% of all lung tumors (1,2). Clinical symptoms depend on the severity of bronchial obstruction and the effects on parenchyma. It is more common in men and more frequently observed in the right bronchial system (3). We present a 76-year-old woman with two separate endobronchial lipomas in the upper lobe and intermediary bronchi, who applied with cough and sputum. The patient was successfully treated with electrocautery snare technique. After this procedure, thorax CT showed bronchiectasis of right lower zone. Thoracotomy was not taken into consideration. After 2-year follow-up the patient has no complaint

Can immune parameters be used as predictors to distinguish between pulmonary multidrug-resistant and drug-sensitive tuberculosis?

Introduction: Despite the development and wide implementation of Directly Observed Therapy Strategies (DOTS), multidrug-resistant tuberculosis (MDR-TB) remains a serious global health threat. In this study, the role of host immune response in patients with MDR-TB is investigated and compared with that of patients with smear-positive drug-sensitive tuberculosis (SP-TB

The relationship of bronchiectasis to airway obstruction and inflammation in patients with chronic obstructive pulmonary disease

Background: Chronic obstructive pulmonary disease (COPD) and bronchiectasis are diseases of respiratory tract with significant mortality and morbidity. These two diseases can be seen together occasionally and are thought to change each other's course by adversely affecting the prognosis. The aim of our study was to identify the signs of bronchiectasis in COPD patients, to investigate its possible effects on disease prognosis, and to evaluate these signs for diagnostic convenience. Materials and Methods: This prospective study included a total of s[table 60] moderate/severe COPD patients who were admitted to Yedikule Chest Diseases and Chest Surgery Training and Research Hospital between January 2015 and February 2016. The patients were divided into two groups according to the presence of bronchiectasis as confirmed radiologically: 35 patients in the bronchiectasis group and 25 patients in the control group. Demographic data of the patients were questioned and systemic inflammation parameters, spirometric measurements, blood gas analysis, and clinical evaluation findings were recorded. Results: Bronchiectasis was detected in 58.3% of COPD patients. Patients in two groups are similar in sociodemographical, spirometrical and clinical parameters (P > 0.05). Laboratory tests showed similar result in between two groups but carbon dioxide(CO2) values in the blood gas analysis were found to be higher in the bronchiectasis group (P < 0.05). The increase in the number of bronchiectasis segments was shown to reduce the FEV1/FVC (P < 0.05). In the overall evaluation, FEV1%, mMRC, FVC% and CRP levels were found to be associated with exacerbations in COPD (P < 0.05). The use of antibiotics increased as FEV1% and FEV1/FVC levels of patients decreased (P < 0.05). In addition, sputum polymorphonuclear leukocyte (PMNL) values were correlated with spirometric values and as sputum PMNL values increased, spirometric values were found to decrease (P < 0.05 for FEV1% and FVC%). Conclusion: Bronchiectasis is common in COPD patients. In two divided groups, blood gas carbon dioxide values, which affect mortality, were shown to be higher in the bronchiectasis group. This is a new addition to literature that bronchiectatic COPD patients are experiencing different respiratory failure patterns affecting mortality. Diffuse type bronchiectasis has more effect in spirometric results of COPD patients. Also, airway obstruction in COPD is well correlated with elevated sputum PMNL values which represent airway inflammation and if this is combined with high clinical suspicion it guides to a cost effective way for guiding radiological investigations for bronchiectasis

Does subglottic secretion drainage prevent ventilator-associated pneumonia?

AIM: To compare the incidence of ventilator-associated pneumonia (VAP) in patients who were admitted to the intensive care unit (ICU) for reasons other than pneumonia and followed up under mechanical ventilation either with standard endotracheal tubes or endotracheal tubes with subglottic secretion drainage (SSD). MATERIALS AND METHODS: Patients who were admitted to the ICU between April 2012 and January 2013 were prospectively and sequentially randomized to standard endotracheal and SSD intubation groups. Patients with pulmonary infection at ICU admission were excluded. Pulmonary imaging, blood, and sputum cultures were routinely screened, and pleural fluid and bronchial lavage examinations were done on demand. RESULTS: Mean age, gender distribution, APACHE II scores, duration of mechanical ventilation, and follow-up of patients with standard (n = 30) and SSD (n = 12) intubation tubes were similar; 71 ± 10.4 versus 64.4 ± 13.9 years (P > 0.05), male/female 18/12 versus 9/3 (P > 0.05), APACHE II scores 20.2 ± 3.8 versus 17.0 ± 3.8 (P = 0.02), 15.9 ± 11.5 versus 11.0 ± 8.1 days (P > 0.05), and 18.0 ± 12.4 versus 15.5 ± 12.2 days (P > 0.05), respectively. The incidence of VAP was similar in both groups (36.7% vs. 33.3%, P > 0.05, in standard vs. SSD groups, respectively). The mortality rate was higher in the standard intubation group, but the difference was not statistically significant (70% vs. 41%, P > 0.05). CONCLUSION: Compared to standard endotracheal intubation, intubation with SSD tubes was not associated with an improvement in the duration of mechanical ventilation, length of stay in the ICU, incidence of VAP, and mortality rate. Due to the limited number of patients included in this study, the results have to be confirmed in larger studies on more patients

18F-FDG PET-CT features of primary primitive neuroectodermal tumor of the chest wall

A case of primary primitive neuroectodermal tumor (PNET) of the chest wall in an adolescent is presented with imaging findings including 18F-fluorodeoxyglucose (18F-FDG) positron-emission computed tomography (PET-CT). To date, radiological description of the PNET of the chest wall has mainly been carried out by radiographic analysis, computed tomography (CT), and magnetic resonance imaging (MRI). We demonstrated that 18F-FDG PET-CT visualizes the active focus of glucose metabolism of PNET of the chest wall and is effective for the preoperative evaluation of patients with this tumor

Burden of community-acquired pneumonia in adults over 18 y of age

This study aimed to determine the economic burden and affecting factors in adult community-acquired pneumonia (CAP) patients (≥ 18 years) by retrospectively evaluating the data of 2 centers in Istanbul province, Turkey. Data of outpatients and inpatients with CAP from January 2013 through June 2014 were evaluated. The numbers of laboratory analyses, imaging, hospitalization days, and specialist visits were multiplied by the relevant unit costs and the costs of the relevant items per patient were obtained. Total medication costs were calculated according to the duration of use and dosage. The mean age was 61.56 ± 17.87 y for the inpatients (n = 211; 48.6% female) and 53.78 ± 17.46 y for the outpatients (n = 208; 46.4% male). The total mean cost was €556.09 ± 1,004.77 for the inpatients and €51.16 ± 40.92 for the outpatients. In the inpatients, laboratory, medication, and hospitalization costs and total cost were significantly higher in those ≥ 65 y than in those <65 y. Besides the hospitalization duration, specialist visit, imaging, laboratory, medication, and hospitalization costs and total cost were significantly higher in those hospitalized more than once than in those hospitalized once. While the specialist visit cost was higher in the inpatients with comorbidities, the imaging cost was higher in the outpatients with comorbidities. CAP poses a higher cost in inpatients, elders, and individuals with comorbidities. Costs can be decreased by rational decisions about hospitalization and antibiotic use according to the recommendations of guidelines and authorities. Vaccination may decrease medical burden and contribute to economy by preventing the disease, especially in risk groups

The comparative value of pleural fluid adenosine deaminase and neopterin levels in diagnostic utility of pleural tuberculosis

Introduction: The aim of the present study was to evaluate and compare the diagnostic accuracy of pleura levels of adenosinedeaminase (ADA) and neopterin for the differential diagnosis of pleural tuberculosis (TP)