Undiagnosed Hypothyroidism in Obstructive Sleep Apnea Syndrome

Objective Lethargy, apathy, daytime sleepiness are common features of Obstructive sleep apnea syndrome (OSAS). These features are already seen in hypothyroidism. OSAS is more frequent in obese patients and overt hypothyroidism may substantially add to this risk. We aimed to evaluate the incidence of hypothyroidism in cases applying with OSAS symptoms who have no known clinical thyroid disease to evaluate the necessity of thyroid hormone screening in OSAS. Materials and Methods The study population consisted of patients with no known history of thyroid disease. All patients were screened in the sleep laboratory for one night and polysomnography. Serum thyroid-stimulating hormone (TSH) levels were measured by chemiluminescence method in patients referred to our sleep center for an overnight sleep study. Results Of 1473 subjects, 1406 (95.5%) were diagnosed as OSA (Apnea-hypopnea index (AHI)>5). Elevated TSH levels were detected in 3 cases in the nonapneic group (4.47%) and 54 cases in the OSAS group (3.90%). In mild-moderate OSAS group, the mean TSH value was 2.02 µU /ml and in patients with severe OSAS this value was 2.44 µU/ml, though the difference was not statistically significant (p=0.08). AHI was found to be weakly correlated with TSH values, though the correlation was statistically significant (r=0.05, p=0.04). Mean TSH values were not correlated with oxygen desaturation index (ODI) or lowest oxygen saturation values (r=0.02 and r=-0.02, respectively). Conclusion The measurement of TSH levels in suspected OSAS cases may help both differential diagnosis between OSAS and hypothyroidism, but subclinical hypothyroidism was not found more common in patients with OSAS

The Association of the Hospital Anxiety and Depression Scores with the Symptoms and Polysomnography Findings in Patients Referred with the Symptoms of Obstructive Sleep Apnea Syndrome

Objective: Several studies have investigated the association between obstructive sleep apnea syndrome (OSAS) and depression and anxiety; however, the relationship is still not understood very well. In this study we aimed to investigate the association between the hospital anxiety and depression (HAD) scores and the symptoms and polysomnographic (PSG) findings in patients referred with OSAS symptoms. Materials and Methods: Patients who referred with snoring, witnessed apnea and daytime sleepiness symptoms and patients who had full-night PSG were included in this study. Illiterate patients were not included in the study. Epworth sleepiness scale and HAD scores was self-administered by the patients. Patients were compared according to HAD scores for symptoms, comorbidities, and PSG findings. Also, the correlation between HAD and PSG findings, symptoms and Epworth scores (ES) of the patients were analyzed. Results: Out of 149 patients who included in the study mean age was 48±11, mean body mass index (BMI) was 31±5, and 63% were male. Of the patients 127 (85%) had OSAS. Of the patients 32 (21%) had a high likelihood of depression (DS >10) and 24 (16%) of anxiety (AS >10). ESS and asthma rate were significantly higher in DS >7 subjects compared to DS 10 subjects compared to AS 0.05). There were correlations between DS and age, female gender and mean oxygen saturation; AS and female gender, BMI, ES and excessive daytime sleepiness. Conclusion: We did not find any association between hospital anxiety depression score and presence of OSAS and apnea hypopnea index in our study. Excessive daytime sleepiness was found as the most important factor related to depression and anxiety scores in our patients

Akciğerin Sarkomatoid Karsinomlarının Klinik ve Radyometabolik Özellikleri

Amaç: Akciğerin sarkomatoid karsinomlarının SK klinik ve radyometabolik PET-BT özelliklerinin incelenmesi ve bu özelliklerin sağ kalım üzerine etkisini araştırmak. Gereç ve Yöntem: Ocak 2014-Aralık 2016 arasında akciğer kanseri tanısı alan olguların kayıtları retrospektif olarak incelendi. Küçük hücreli dışı akciğer kanseri KHDAK ve SK tanısı alan olguların dosyaları ayrıldı. Bu olguların klinik ve radyometabolik özellikleri birbirleri ile karşılaştırıldı. Gruplara ait veriler Ki Kare, Mann Whitney U ile karşılaştırıldı. Sağ kalım analizleri Kaplan-Meier, Logrank yöntemi ile hesaplandı. Tüm testlerde

Evaluation of patients with fibrotic interstitial lung disease: Preliminary results from the Turk-UIP study

OBJECTIVE: Differential diagnosis of idiopathic pulmonary fibrosis (IPF) is important among fibrotic interstitial lung diseases (ILD). This study aimed to evaluate the rate of IPF in patients with fibrotic ILD and to determine the clinical-laboratory features of patients with and without IPF that would provide the differential diagnosis of IPF. MATERIAL AND METHODS: The study included the patients with the usual interstitial pneumonia (UIP) pattern or possible UIP pattern on thorax high-resolution computed tomography, and/or UIP pattern, probable UIP or possible UIP pattern at lung biopsy according to the 2011 ATS/ERSARS/ALAT guidelines. Demographics and clinical and radiological data of the patients were recorded. All data recorded by researchers was evaluated by radiology and the clinical decision board. RESULTS: A total of 336 patients (253 men, 83 women, age 65.8 +/- 9.0 years) were evaluated. Of the patients with sufficient data for diag-nosis (n=300), the diagnosis was IPF in 121 (40.3%), unclassified idiopathic interstitial pneumonia in 50 (16.7%), combined pulmonary fibrosis and emphysema (CPFE) in 40 (13.3%), and lung involvement of connective tissue disease (CTD) in 16 (5.3%). When 29 patients with definite IPF features were added to the patients with CPFE, the total number of IPF patients reached 150 (50%). Rate of male sex (p<0.001), smoking history (p<0.001), and the presence of clubbing (p=0.001) were significantly high in patients with IPE None of the women <50 years and none of the men <50 years of age without a smoking history were diagnosed with IPE Presence of at least 1 of the symptoms suggestive of CTD, erythrocyte sedimentation rate (ESR), and antinuclear antibody (FANA) positivity rates were significantly higher in the non-IPF group (p<0.001, p=0.029, p=0.009, respectively). CONCLUSION: The rate of IPF among patients with fibrotic ILD was 50%. In the differential diagnosis of IPF, sex, smoking habits, and the presence of clubbing are important. The presence of symptoms related to CTD, ESR elevation, and EANA positivity reduce the likelihood of IPF

Can positron emission tomography/computed tomography be predictive of diagnostic success in endobronchial biopsies performed through a fiber-optic bronchoscopy in lung cancer?

PURPOSE: The purpose of this study is to investigate the effect of homogeneous/heterogeneous (necrotic) involvement and maximum standardized uptake value (SUVmax) value of the lesion on positron emission tomography-computed tomography (PET-CT) of patients who underwent fiberoptic bronchoscopy (FOB) for prediagnosis of lung cancer and biopsy for endobronchial lesion on the diagnostic success of biopsy procedure. METHODS: Between January 2014 and December 2016, patients with final diagnosis of pulmonary malignancy as determined by FOB biopsy and patients who failed to be diagnosed by FOB biopsy and diagnosed with pulmonary malignancy by a different diagnostic method were examined. These patients were divided into two groups as those with diagnosis by FOB biopsy (Group 1) and those who failed to be diagnosed by this method and diagnosed with pulmonary malignancy by a different diagnostic method (Group 2). The SUVmax values of the two groups were compared with lesion characteristics of homogeneous, heterogeneous involvement/presence of necrotic component as shown by PET-CT. Group data were assessed by Chi-square test and Mann–Whitney U-test. In all tests, P < 0.05 was considered significant. FINDINGS: A total of 193 participants with a mean age of 61 ± 9.4 were included in the study. There were 128 (66.3%) cases in Group 1 and 65 (33.7%) cases in Group 2. The mean SUVmax value was 16.4 in Group 1 and 15.1 in Group 2. There was no statistically significant difference between the two groups (P = 0.329). Homogeneous involvement was present in 103 (80.3%) cases in Group 1 versus 42 (64.6%) cases in Group 2. In the presence of homogeneous PET-CT involvement, diagnosis rate by biopsy was significantly higher (P = 0.016). CONCLUSION: We concluded that the high SUVmax value of the mass lesion on PET-CT did not increase the diagnostic value of the biopsy procedure in patients prediagnosed with lung cancer and that the diagnostic success of FOB biopsy was poor in cases where PET-CT showed heterogeneous involvement of the mass lesion

Expiratory and Inspiratory Muscle Functions in Obstructive Sleep Apnea Syndrome

Objective Obstructive sleep apnea syndrome (OSAS) patients are thought to experience increased resistive load due to both anatomical and functional changes. This can possibly contribute to respiratory muscle dysfunction. We aimed to measure daytime maximal inspiratory and expiratory pressures, in order to find out respiratory muscle functions in OSAS. Materials and Methods Patients admitted to our sleep laboratory for one-year period were prospectively analysed. All the cases had undergone overnight polysomnography. All cases had pulmonary function tests performed by the same experienced technician in the morning following sleep study. The study population consisted of 51 (37.8%) female and 84 (62.2%) male patients, with a mean age of 47. Results Apnea hypopnea index (AHI) was found to be correlated with forced expiratory volume in one second (FEV1) and forced volume vital capacity (FVC) values and FVC%. FEV1/FVC, maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) values did not seem to be correlated with AHI. FVC (L), FVC%, FEV1, FEV1%, MIP, MIP% and MEP were similar in patients with and without OSAS. OSAS patients had significantly lower MEP% values. FVC, FEV1 and MEP% showed significant differences in different stages of the disease. Other parameters were similar in all groups. Conclusion In this study we demonstrated that maximal expiratory muscle strength of awake OSAS patients was lower, whereas inspiratory muscle strength was similar in subjects with and without OSAS

Orta kulak atelektazisinde CPAP tedavisinin etkinliği: Çift kör, plasebo-kontrollü klinik çalışma

SB-010Orta kulak atelektazisinde CPAP tedavisinin etkinliği: Çiftkör, plasebo-kontrollü klinik çalışmaSevtap Akbulut1, Mehmet Gokhan Demir2, Banu Musaffa Salepci3, Gulten Aktin Gungor3, Necdet Demir4, Derya Berk1,11 2 3 4AMAÇ: Orta kulak atelektazisi olan hastalarda sürekli pozitif hava yolu basıncı (CPAP) tedavisinin etkisini araştırmak.GEREÇ VE YÖNTEM:Çalışma prospektif, çift kör, randomize olarak gerçekleştirildi. Orta kulak atelektazisi tanısı alan 54 hastarandomize edilerek 14 cm H2O basınçta CPAP tedavisi (CPAP grubu) ve 0 cm H2O basınçta CPAP tedavisi (Plasebo grubu), haftada bir seans ve her bir seans 3 saat olacak şekilde, 4 seans uygulandı. Hastalar 5.haftada, 3.ayda ve 6.ayda takip edildi.Sonuçların değerlendirilmesinde otomikroskopik muayene, timpanometrik ve odyolojik inceleme kullanıldı.BULGULAR:CPAP grubu 35 atelektatik kulaktan oluşurken Plasebo grubunda 32 atelektatik kulak mevcuttu. Tüm takip muayenelerinde, CPAP grubunda Plasebo grubuna göre daha fazla sayıda kulakta Evre 1 atelektaziye gerileme gözlendi veya normal timpanik membran izlendi (p&lt;0,05). CPAP grubunun orta kulak basınçlarında 5. haftada, 3.ayda ve 6.ayda Plasebo grubuna göre artış görüldü (p&lt;0,05). CPAP grubunda, farklı takip muayeneleri arasında orta kulak basınçları açısından istatistiksel anlamlı bir fark izlenmedi (p&gt;0,05). Altıncı ayda, CPAP grubunun saf ses hava iletim eşikleri ortalamasında Plasebogrubuna göre belirgin bir düzelme izlendi (p&lt;0,05).SONUÇ: CPAP uygulanımı orta kulak atelektazisi olan hastalarda orta kulağa pozitif basınç uygulamak için güvenilir ve iyi tolere edilebilen bir yoldur. Hastaların orta kulak basınçlarında artışa önemli derecede katkı sağlayarak atelektazi derecesinde düzelmeye yol açar.Anahtar Kelimeler:Orta kulak atelektazisi, Orta kulak basıncı, Odyometri, Sürekli pozitif havayolu basıncı (CPAP), Timpanometri

Features of endobronchial metastases from extrathoracic malignancy and positron emission tomography-computerized tomography findings

OBJECTIVE: We aimed to investigate radiological and bronchoscopic aspects of endobronchial metastases (EBMs) from extrapulmonary cancers and the correlation of EBM with findings of integrated positron emission tomography-computed tomography (PET-CT) findings. MATERIALS AND METHODS: Patients who underwent bronchoscopic evaluation between January 2013 and December were analyzed retrospectively. Patients with endobronchial lesions in the airways and histopathologically diagnosed with extrapulmonary cancer metastasis were included in the study. RESULTS: A total of 16 patients with EBM who underwent bronchoscopic biopsies were evaluated. The patients consisted of 10 (62.5%) females and 6 (37.5%) males and the mean age was 61.8 ± 9.1. The common primary cancer related to EBM was breast 9 (%56.4). The mean interval from diagnosis of primary cancer to EBM was 55.1 ± 48.5 (1–180) months. A total of 13 (81.2%) cases were assessed with the PET-CT report. The mean SUVmaxvalue of the lung lesions was calculated as 9.8 ± 4.3. According to PET-CT, 92.4% of the cases had extrapulmonary metastasis. The mean survival duration from diagnosis of EBM was 8.5 ± 6.7 (1–21) months in 9 deceased patients. CONCLUSION: The most frequent extrapulmonary primary tumors with endobronchial metastasis were breast and the mean survival time was usually short. It was reported that most cases were multimetastatic. It was concluded that PET-CT can play a role in identifying the EBM and other organ metastasis and was important tool in planning the treatment