Approaches in Diagnosis and Treatment of Patients with Idiopathic Pulmonary Fibrosis: A Questionnaire Study

Objective: As Turkish Respiratory Society Diffuse Parenchymal Lung Diseases-Pulmonary Vascular Diseases Study Group (TRS DPLD-PVD SG), we aimed to demonstrate the approaches of physicians with a questionnaire toward the patients with IPF in our country. Methods: An invitation letter including a questionnaire with 24 questions to assess the approaches they prefer in the patients with IPF and the capabilities of the departments they work at and a link for the questionnaire was directed to the mail groups of chest diseases and thoracic surgery specialists. Responses of the physicians who participated in the questionnaire were reviewed. Results: Thirty percent of the participants saw less than 5 patients with IPF in a year and 16.8% of them saw more than 21. 66.3% of participants stated that anamnesis, symptoms and clinical findings along with typical radiologic findings would be sufficient for the diagnosis, while 27.7% suggested that pathological findings should indicate IPF along with clinic and radiologic ones.When the methods used for tissue sampling were viewed; application rates of bronchoscopic transbronchial biopsy, thoracoscopic biopsy and open lung biopsy were found very close to one another.In the patients with the suspected disease of IPF, the fields in which the hesitation was the most problematic were respectively pathological examination of biopsies (73.2%) and interpretation of radiologic findings (49.5%). 37.6% of the patients with diagnosis of IPF were directed to experienced centers; medical treatment and drugless follow-up rates were respectively 33.6% and 14.8%. Among the participants, 29.7% suggested lung transplantation for all cases while 48.5% only preferred this operation in particular ones. Conclusion: Some of the results of our study is compatible with the guidelines of IPF, is to show that the quality of debate and confusion still continued in this regard

İdiyopatik Pulmoner Fibrozis Hastalarında Tanı ve Tedaviye Yaklaşım: Bir Anket Çalışması

Objective: As Turkish Respiratory Society Diffuse Parenchymal Lung Diseases-Pulmonary Vascular Diseases Study Group (TRS DPLD-PVD SG), we aimed to demonstrate the approaches of physicians with a questionnaire toward the patients with IPF in our country.Methods: An invitation letter including a questionnaire with 24 questions to assess the approaches they prefer in the patients with IPF and the capabilities of the departments they work at and a link for the questionnaire was directed to the mail groups of chest diseases and thoracic surgery specialists. Responses of the physicians who participated in the questionnaire were reviewed.Results: Thirty percent of the participants saw less than 5 patients with IPF in a year and 16.8% of them saw more than 21. 66.3% of partici-pants stated that anamnesis, symptoms and clinical findings along with typical radiologic findings would be sufficient for the diagnosis, while 27.7% suggested that pathological findings should indicate IPF along with clinic and radiologic ones.When the methods used for tissue samp-ling were viewed; application rates of bronchoscopic transbronchial biopsy, thoracoscopic biopsy and open lung biopsy were found very close to one another.In the patients with the suspected disease of IPF, the fields in which the hesitation was the most problematic were respectively pathological examination of biopsies (73.2%) and interpretation of radiologic findings (49.5%). 37.6% of the patients with diagnosis of IPF were directed to experienced centers; medical treatment and drugless follow-up rates were respectively 33.6% and 14.8%. Among the participants, 29.7% suggested lung transplantation for all cases while 48.5% only preferred this operation in particular onesObjective: As Turkish Respiratory Society Diffuse Parenchymal Lung Diseases-Pulmonary Vascular Diseases Study Group (TRS DPLD-PVD SG), we aimed to demonstrate the approaches of physicians with a questionnaire toward the patients with IPF in our country.Methods: An invitation letter including a questionnaire with 24 questions to assess the approaches they prefer in the patients with IPF and the capabilities of the departments they work at and a link for the questionnaire was directed to the mail groups of chest diseases and thoracic surgery specialists. Responses of the physicians who participated in the questionnaire were reviewed.Results: Thirty percent of the participants saw less than 5 patients with IPF in a year and 16.8% of them saw more than 21. 66.3% of participants stated that anamnesis, symptoms and clinical findings along with typical radiologic findings would be sufficient for the diagnosis, while 27.7% suggested that pathological findings should indicate IPF along with clinic and radiologic ones.When the methods used for tissue sampling were viewed; application rates of bronchoscopic transbronchial biopsy, thoracoscopic biopsy and open lung biopsy were found very close to one another.In the patients with the suspected disease of IPF, the fields in which the hesitation was the most problematic were respectively pathological examination of biopsies (73.2%) and interpretation of radiologic findings (49.5%). 37.6% of the patients with diagnosis of IPF were directed to experienced centers; medical treatment and drugless follow-up rates were respectively 33.6% and 14.8%. Among the participants, 29.7% suggested lung transplantation for all cases while 48.5% only preferred this operation in particular ones.Conclusion: Some of the results of our study is compatible with the guidelines of IPF, is to show that the quality of debate and confusion still continued in this regar

Unicentric Castleman&Apos;S Disease Presenting With Multiple Enlarged Lymph Nodes In Mediastinum

A case of unicentric Castleman's disease located in the mediastinum is presented. A 20 years old male suffering from cough had an image of right hilar enlargement on chest X-ray. Thorax CT revealed multiple enlarged lymph nodes both in right paratracheal and hilar region. Radionuclide accumulation was detected by 67Ga scintigraphy. Surgical removal of lymph nodes at paratracheal region was performed by mediastinoscopic excision and reported as reactive hyperplasia. Lymph nodes located in right hilum was excised by thoracotomy and histopathologic examination confirmed Castleman's disease. Our thought about this case was a dominant infiltrative mass with an associated lymphadenopathy. 67Ga scintigraphy imaging that we performed in our case can be a useful method in detection of Castleman's disease

Approaches of Physicians for the Diagnosis and Treatment of Pulmonary Thromboembolism: A Questionnaire Study

Objective: We aimed to demonstrate the approaches of physicians with a questionnaire toward the patients with pulmonary thromboembolism (PTE) in our country.Methods: An invitation letter including a questionnaire with 28 questions to assess the approaches they prefer in the patients with PTE and the capabilities of the departments they work at and a link for the questionnaire was directed to the mail groups of chest diseases specialists. Responses of the physicians who participated in the questionnaire were reviewed. Results: The examinations used to diagnose PTE such as D-dimer, troponin, echocardiographic Doppler ultrasonography and multidetector computed tomography (CT) have been performed in 94% of the institutions, ventilation/perfusion scintigraphy, MRI and pulmonary angiography examinations were performed in 50% of the instututions. While D-dimer test was performed in 73.2% of the institutions by quantitative ELISA; in 15.7% of them it was semiquantitative and in 11.6% of the instutitions it was performed by latex agglutination. 81% of physicians were seen to be using clinical probability scoring systems and most commonly used scoring method was seen to be Wells scoring with a rate of 90%. According to the simplified PESI score, 61.5% of the physicians reported to prefer outpatient treatment. In non-massive and submassive pulmonary thromboemboli patients, 86.2% of the physicians reported to prefer thr low molecular weight heparin (LMWH) treatment; vitamin K antagonist in maintenance treatment was also the most commonly resorted drug with a percentage of 84.9. Conclusion: The absence of the examinations used in the diagnosis and treatment of PTE in most institutions and difficulty to reach the available examinations at all hours of the day were significant facts. Especially; lack of access to high-sensitivity D-dimer test, bedside echocardiography used to assess right ventricular dysfunction, troponin and NT-proBNP makes us think about low adaptation to guidelinesObjective: We aimed to demonstrate the approaches of physicians with a questionnaire toward the patients with pulmonary thromboembolism (PTE) in our country.Methods: An invitation letter including a questionnaire with 28 questions to assess the approaches they prefer in the patients with PTE and the capabilities of the departments they work at and a link for the questionnaire was directed to the mail groups of chest diseases specialists. Responses of the physicians who participated in the questionnaire were reviewed. Results: The examinations used to diagnose PTE such as D-dimer, troponin, echocardiographic Doppler ultrasonography and multidetector computed tomography (CT) have been performed in 94% of the institutions, ventilation/perfusion scintigraphy, MRI and pulmonary angiography examinations were performed in 50% of the instututions. While D-dimer test was performed in 73.2% of the institutions by quantitative ELISA; in 15.7% of them it was semiquantitative and in 11.6% of the instutitions it was performed by latex agglutination. 81% of physicians were seen to be using clinical probability scoring systems and most commonly used scoring method was seen to be Wells scoring with a rate of 90%. According to the simplified PESI score, 61.5% of the physicians reported to prefer outpatient treatment. In non-massive and submassive pulmonary thromboemboli patients, 86.2% of the physicians reported to prefer thr low molecular weight heparin (LMWH) treatment; vitamin K antagonist in maintenance treatment was also the most commonly resorted drug with a percentage of 84.9. Conclusion: The absence of the examinations used in the diagnosis and treatment of PTE in most institutions and difficulty to reach the available examinations at all hours of the day were significant facts. Especially; lack of access to high-sensitivity D-dimer test, bedside echocardiography used to assess right ventricular dysfunction, troponin and NT-proBNP makes us think about low adaptation to guideline

Küçük Hücreli Dışı Akciğer Kanserli Bir Hastada Kütanöz Paraneoplastik Sendrom: Olgu Sunumu

Giriş: Paraneoplastik sendromlar, primer ya da metastatik tümörlerin uzak etkisi sonucu ortaya çıkan semptom ve bulgular olarak tanımlanır. Bu yazı- da, akciğer kanseri nedeniyle eritem annüler santrifüj (EAS) geliştiği saptanan bir hasta sunulmuştur. Olgu: Elli iki yaşında erkek hasta yaygın, kızarık, kaşıntılı deri döküntüsü şikayetleri ile başvurdu. Yapılan muayenede hastanın tüm vücudunda yaygın, yama tarzında birleşmeye eğilimli, sınırları belirsiz, eritemli eksfoliyatif soyulmalar saptandı ve görünüm “figüre eritem’’ olarak değerlendirildi. PA akciğer grafisinde; sol akciğer üst zonda suprahiler alanda 4x5 cm boyutunda kaviter homojen dansite artışı mevcuttu. Toraks BT’de; sol üst lobda suprahiler bölgede santral yerleşimli, üst lob bronşu ile iştirakı izlenen yaklaşık 4.5 cm çaplı kalın duvarlı kaviter lezyon ve parankimde mikronodüller mevcuttu. Bronkoskopik olarak sol üst lob bronş orifisinde mukozadan kabarık sınırları ve yüzeyi düzensiz mukozal lezyon izlendi ve bu lezyondan mukoza biyopsisi alındı. Aynı zamanda hastanın eritemli deri bölgelerinden de deri “punch” biyopsileri alındı. Akciğer mukoza biyopsisi sonucu; “skuamoz hücreli karsinoma” olarak rapor edildi. Hastanın fizik muayene sonucu ve deri punch biyopsi sonucu Figure eritem (EAS) olarak tanı kondu. Sonuç: Olgumuzda olduğu gibi kütanöz paraneoplastik sendrom malign hastalığın ilk bulgusu olarak karşımıza çıkabilir. Paraneoplastik sendromların tanı ve tedavisindeki başarı, daha erken kanser tanısına, yaşam kalitesinde iyileşmeye yol açacağı için önemlidir

Pulmonary alveolar proteinosis: Report of two cases

Pulmoner alveoler proteinozis, alveollerde ve distal hava yollarında lipoproteinöz madde birikimiyle karakterize nadir bir hastalıktır. En sık rastlanan semptomlar nefes darlığı ve kuru öksürüktür. Radyolojik olarak bilateral simetrik alveoler konsolidasyon veya buzlu cam görüntüsü saptanır. Tanı sıklıkla klinik ve radyolojik bulgular eşliğinde transbronşiyal biyopsi örneği veya bronkoalveolar lavaj (BAL) ile alınan intra alveoler materyalin periyodik asit-Schiff metodu ile pozitif boyanması ile konur. Pulmoner alveoler proteinosis için standart tedavi total akciğer lavajıdır. Çalışmamızda, biri BAL diğeri açık akciğer biyopsisi ile tanı alan iki pulmoner alveoler proteinozis olgusu literatür eşliğinde sunulmuştur.Pulmonary alveolar proteinosis is a rare disease characterised with lipoproteinous material deposition in alveoles and distal airways. The most common symptoms are dyspnea and dry cough. The radiographic finding is bilateral, symmetric alveolar consolidation or ground-glass opacity. The diagnosis is mostly made by positive staining of transbronchial biopsy or bronchoalveolar lavage (BAL) material with periodic- acid-Schiff method accompanied by clinical and radiological findings. The standard treatment for pulmonary alveolar proteinosis is total lung lavage. In our study, two cases of pulmonary alveolar proteinosis, one diagnosed by open lung biopsy and the other with BAL, were presented with the literature