Pulmonary artery leiomyosarcoma: A clinical dilemma.

Leiomyosarcomas are rare neoplasms of the smooth muscles. Primary pulmonary leiomyosarcomas, which constitute approximately 0.2%-0.5% of all primary lung malignancies, are extremely rare and highly lethal. They may originate from the smooth muscle cells of the bronchial wall, the blood vessels, or the pulmonary interstitium, and their rare occurrence, localization, and nonspecific clinical symptoms mean that correct diagnosis and proper management are often delayed. Here, we report a rapidly growing primary pulmonary leiomyosarcoma, which invaded the right atrium, vena cava superior, mediastinum, right hilar area, and left pulmonary artery within 4 months. On histopathology, a transthoracic needle biopsy of the mass confirmed leiomyosarcoma, and delayed presentation meant that there was a local spread to the neighboring structures at the time of diagnosis

An epidemiologic study of physician-diagnosed chronic obstructive pulmonary disease in the Turkish population: COPDTURKEY-1

Background/aim: Chronic obstructive pulmonary disease (COPD) is a common disease characterized by persistent airflow limitation and respiratory symptoms. It is a leading cause of morbidity and mortality all over the world. Our data on COPD in Turkey are limited. This study was intended to examine the epidemiologic characteristics of COPD in the Turkish population, between 2012 and 2016. Materials and methods: This population-based, descriptive, surveillance study examined physician-diagnosed COPD prevalence, incidence, and mortality in Turkey. The database of the Social Security System of Turkey was scanned and ICD-10 J44.0-J44.9 codes for diagnostic and/or therapeutic purposes were evaluated retrospectively. Results: In 2016, there were 3,434,262 cases of COPD (56.2\% men) in Turkey, and the mean age of patients was 61.62 +/- 14.76 years. From 2012 to 2016, the annual overall prevalence rates of physician-diagnosed COPD rose from 4.3\% to 5.8\%, which was a 35.0\% relative increase (P < 0.05). In women, this rate rose from 3.7\% to 5.1\% (38\% increase), and in men, it rose from 4.9\% to 6.7\% (37\% increase). During the study period, the overall incidence decreased from 8.5 per 1000 adults in 2012 to 6.3 per 1000 adults in 2016, representing a decrease of 26.6\% (P < 0.001). The annual incidence rates of physician-diagnosed COPD decreased 25.4\% in women and 27.9\% in men. The overall mortality was 4.3\% in 2012, and 4.2\% in 2016. The mortality rate in women was 3.5\% in 2012 and 3.7\% in 2016, and 5\% in 2012 and 4.7\% in 2016 in men. The mean prevalence by region was 5.26\% (range 3.79\%-7.65\%). The Black Sea region had the highest COPD prevalence. Conclusion: COPD is a very common and serious cause of morbidity and mortality in Turkey, as it is worldwide. Current data will contribute to a better understanding of the epidemiologic dimension of COPD in our country

Elderly idiopathic pulmonary fibrosis patients remain on therapy despite higher incidence of adverse events and dose reductions

Background: Idiopathic pulmonary fibrosis (IPF) predominantly affects people over the age of 60 years and its incidence increases with age. Limited data is available on the use of antifibrotics in the elderly IPF population. We aimed to examine the tolerability and safety of antifibrotics (pirfenidone, nintedanib) in elderly patients with IPF in a real-world setting. Methods: Medical records of 284 elderly (≥75 years) and 446 non-elderly IPF patients (<75 years) were retrospectively analyzed in this multi-center study. Patient characteristics, treatments, adverse events (AEs), tolerability, hospitalizations, exacerbations, and mortality were compared between the elderly and non-elderly group. Results: In the elderly group, the mean age was 79 years and the mean antifibrotic treatment duration was 26.1 months. The most commonly reported AEs were weight loss, loss of appetite and nausea. Elderly IPF patients had a significantly higher incidence of AEs (62.9% vs. 55.1%, p = 0.039) and dose reductions (27.4% vs. 18.1%, p = 0.003) than the non-elderly did, but the rate of discontinuation of antifibrotics was not different between groups (13% vs. 10.8%, p = 0.352). In addition, the severity of the disease, frequency of hospitalizations, exacerbations, and mortality rates were higher in elderly patients. Conclusion: The present study showed that elderly IPF patients experienced significantly increased AEs and dose reductions due to antifibrotic use, while the discontinuation rates of the drugs were similar to those of drugs used by non-elderly patients

Carotid intima-media thickness in chronic obstructive pulmonary disease and survival: A multicenter prospective study

Introduction Chronic obstructive pulmonary disease (COPD) is associated with increased cardiovascular morbidity and mortality. Carotid intima-media thickness (CIMT) is a noninvasive method assessing atherosclerosis. Objective It was aimed to determine relationship and survival between COPD and CIMT. Methods CIMT was measured using Doppler ultrasound (USG) in 668 stable COPD patients at 24 centers. Patients were followed-up for 2 years. Results There were 610 patients who completed the study. There were 200 patients CIMT with = 0.78 mm (group 2). There was a significant difference at the parameters of age, gender, smoking load, biomass exposure, GOLD groups and degree of airway obstruction (FEV1) between groups 1 and 2. Our results revealed positive correlations between mean CIMT and age, smoking load (pack-years), biomass exposure (years), exacerbation rate (last year), duration of hypertension (years) and cholesterol level; negative correlations between CIMT and FEV1 (P 0.05). Conclusion This study is the first regarding CIMT with combined GOLD assessment groups. It has revealed important findings supporting the increase in atherosclerosis risk in COPD patients. We recommend Doppler USG of the carotid artery in COPD patients at severe stages