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 eighth staging system of non-small cell lung cancer and its practical implications

Staging is an essential part of the approach to patients with lung cancer. The primary goal of the tumor classification is to correctly describe the anatomic extent of the disease. The anatomic extent of the tumor has a major impact on the treatment selection and prognosis. The general approach to patients with non-small cell lung cancer include mediastinal staging and non-thoracic staging methods, history and physical examination, imaging, minimally invasive techniques, and invasive surgical techniques. The current lung cancer staging system is the eighth edition of the tumor, node, and metastasis (TNM) classification, which was took effect in January 2017. In this article, staging methods and the definitions for current T, N, M descriptors and the stage groups in non-small cell lung cancer are reviewed. New definitions of T, N, and M factors seem to better indicate the most optimal treatment option for an individual patient and to better predict the survival in patients

Pleural Fluid and Serum Leptin Levels in the Differential Diagnosis of Pleurisy

Objective: To investigate the diagnostic value of serum and pleural fluid leptin levels in the differentiation between transudate and exudate, tuberculosis and nontuberculosis pleural effusion, and different diseases in treatment-naïve patient groups with different diseases that present with pleural fluid (pleural fluid due to tuberculosis, malignant pleural fluid, transudative pleural fluid and parepneumonic pleural fluid).Methods: The study comprised a total of 78 consecutive cases (32 females and 46 males). The cases were assigned to two groups as transudative and exudative pleural effusion according to Light criteria. Cases with exudative fluid were divided into three groups; tuberculosis (TB), nonspecific (parapneumonic) and malignant pleural fluid. Weight and height were measured in all patients and body mass index (BMI) was calculated. Pleural fluid and serum leptin levels were measured in all disease groups and their diagnostic value was investigated.Results: Leptin levels were measured in the serum and pleural fluids and adenosine deaminase (ADA) level was studied in the pleural fluids of the patients. No statistically significant difference was determined between leptin levels of patients that were grouped according to their diagnosis (p<0.05). There was also no significant difference between transudate and exudates in terms of leptin and ADA levels. When the patients were grouped as TB and non-TB, no difference was found between the groups in terms of serum and pleural fluid leptin levels, whereas pleural ADA concentration was significantly higher in the tuberculosis group in comparison to the other group. A weak positive correlation was determined between body mass index and serum and pleural leptin levels (r=0.39 and r=0.42 respectively, p<0.001).Conclusion: Nevertheless the present study included a limited number of patients, serum and pleural leptin levels remained inadequate both in the differentiation between transudates and exudates and in achieving an etiological diagnosis. Despite the results suggesting a significant decrement in tuberculosis pleurisy, it is clear that further studies are needed on this subjectObjective: To investigate the diagnostic value of serum and pleural fluid leptin levels in the differentiation between transudate and exudate, tuberculosis and nontuberculosis pleural effusion, and different diseases in treatment-naïve patient groups with different diseases that present with pleural fluid (pleural fluid due to tuberculosis, malignant pleural fluid, transudative pleural fluid and parepneumonic pleural fluid).Methods: The study comprised a total of 78 consecutive cases (32 females and 46 males). The cases were assigned to two groups as transudative and exudative pleural effusion according to Light criteria. Cases with exudative fluid were divided into three groups; tuberculosis (TB), nonspecific (parapneumonic) and malignant pleural fluid. Weight and height were measured in all patients and body mass index (BMI) was calculated. Pleural fluid and serum leptin levels were measured in all disease groups and their diagnostic value was investigated.Results: Leptin levels were measured in the serum and pleural fluids and adenosine deaminase (ADA) level was studied in the pleural fluids of the patients. No statistically significant difference was determined between leptin levels of patients that were grouped according to their diagnosis (p<0.05). There was also no significant difference between transudate and exudates in terms of leptin and ADA levels. When the patients were grouped as TB and non-TB, no difference was found between the groups in terms of serum and pleural fluid leptin levels, whereas pleural ADA concentration was significantly higher in the tuberculosis group in comparison to the other group. A weak positive correlation was determined between body mass index and serum and pleural leptin levels (r=0.39 and r=0.42 respectively, p<0.001).Conclusion: Nevertheless the present study included a limited number of patients, serum and pleural leptin levels remained inadequate both in the differentiation between transudates and exudates and in achieving an etiological diagnosis. Despite the results suggesting a significant decrement in tuberculosis pleurisy, it is clear that further studies are needed on this subjec

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

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

Evaluation of the Prevalence of Barotrauma and Affecting Factors in Patients with COVID-19 during Follow-Up in the Intermediate Care Unit

It is known that pneumothorax (PX) and pneumomediastinum (PM) develop due to COVID-19 disease. The objective of our study was to determine the prevalence of PX/PM due to COVID-19 in the intermediate intensive care unit (IMCU) and to evaluate the factors causing barotrauma and also the clinical outcomes of these patients. A total of 283 non-intubated patients with COVID-19 pneumonia followed up in the IMCU in a 1-year period were included in the study. The patients were classified as group 1 (having barotrauma) and group 2 (without barotrauma). The rate of barotrauma was 8.1% (n = 23, group 1). PX developed on the right hemithorax in 12 (70.6%) patients. Group 1 had statistically significantly higher 28-day mortality rates compared with group 2 (p = 0.014). The eosinophil and d-dimer levels of the patients in group 1 were higher, while C-reactive protein (CRP), fibrinogen, and albumin levels were lower than Group 2 (p p = 0.017, p = 0.001, p p < 0.001, respectively). The similar rates of NIMV administration in our study groups support that barotrauma is not the only mechanism in the development of PX/PM. The findings of high blood eosinophil count and low blood levels of CRP, albumin, and fibrinogen in the barotrauma group of our study might be a pathfinder for future studies

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)