Atila Akkoclu

The effects of body fat distribution on pulmonary function tests in the overweight and obese.

Objectives: To determine the predominant pulmonary function abnormality in overweight and moderately obese subjects and to evaluate the correlation between the severity of lung function impairment and the degree of obesity. Methods: Fifty-three volunteers underwent physical examination, skin fold measurements, and standardized pulmonary function tests. Thirty-one women and 22 men with a mean age of 40.2 (18–66) years were studied. Results: The reduction in functional residual capacity (FRC) and expiratory reserve volume (ERV) were the most common abnormalities in overweight and obese subjects. The reduction in static lung volume was correlated with the degree of obesity in women and men. Stepwise multiple regression coefficients were obtained separately for women and men. Subscapular skinfold was the best predictor in women for FRC and waist-to-hip ratio (WHR) and BMI were found the best for ERV. WHR was found predictive for forced vital capacity, total lung capacity, and FRC in men. Conclusions: The lung volumes are substantially affected in our overweight and obese subjects. This influence is focused on different parameters of respiratory functions in men and women in relation to body fat distribution.

Epidemiology and distribution of interstitial lung diseases in Turkey

There is very few data on the epidemiological features of interstitial lung diseases (ILD) in the literature. These studies on this subject suffer from limited number of patients.

Diabetes insipidus caused by pituitary gland metastasis accompanied by iris metastasis of small cell lung cancer: case presentation and review of the literature

Metastasis to the pituitary gland and iris is rarely seen in cancer patients. Breast cancer and lung cancer are the most common tumors that metastasize to these sites. Most lung cancer patients have non-small cell lung cancer and metastasis of small cell lung cancer to the pituitary gland and iris have been very rarely reported in the literature. Here we present a case of iris metastasis and pituitary gland metastasis which caused diabetes insipidus in a patient with small cell lung cancer.

The diagnostic role of dual-phase 18F-FDG PET/CT in the characterization of solitary pulmonary nodules

ObjectiveOur objective was to evaluate the diagnostic role of dual-phase 18F-fluorodeoxyglucose (18F-FDG) PET/computed tomography (CT) in the characterization of solitary pulmonary nodules (SPNs). Patients and methodsA total of 48 SPNs in 48 patients were included in this retrospective study. The final diagnosis was confirmed histopathologically or by follow-up CT. Two PET/CT scans were performed: the first (early scan) was performed 1 h after injection and the second (delayed scan) was performed 2 h later. Standardized uptake values (SUVs) [early and delayed SUVmax and SUVmean adjusted to body weight, body surface area (BSA), lean body mass (LBM) and blood glucose level (Glc)], retention index and nodule-to-mediastinum (nodule activity/subcarinal region of interest activity) ratios were calculated, along with the receiver operating characteristic curve. Intraobserver and interobserver variabilities among nuclear medicine physicians were analysed for the two phases. ResultsEighteen patients had malignant tumour, whereas 30 had benign lesions. The median (min−max) SUVmax was 1.5 (0.5–4.1) in the benign group and 3.6 (1.3–38) in the malignant group. With the threshold value of early SUVmax as 2.5 and 2.75 using the receiver operating characteristic curve, a sensitivity of 94–75%, specificity of 75–80% and an accuracy of 83–78% were calculated. With the same threshold values for delayed images, 94–100% sensitivity, 77–80% specificity and 83–88% accuracy were obtained. BSA-SUVmax, LBM-SUVmax and Glc-SUVmax did not show any advantage over other quantitative parameters in the SPN characterization. There was no variability in the results obtained between the two nuclear medicine physicians. ConclusionDual-phase PET/CT may increase the diagnostic potential of PET/CT in the characterization of SPNs. In this particular study group, a threshold value could not be determined for the retention index, but higher retention indices may show higher malignant potential in SPNs.

Investigation of inherited thrombophilias in patients with pulmonary embolism.

Inherited thrombophilias are thought to play an important role in the cause of pulmonary embolism and its recurrence. Ninety of 281 patients objectively diagnosed as pulmonary embolism between 2006 and 2009 were included in the study. The screening for thrombophilia included mutations of factor V Leiden (FVL), prothrombin (PTM) G20210A, methylene tetrahydrofolate reductase C677T-A1298C, the serum levels of antithrombin III, protein C, protein S, factor VIII and activated protein C resistance. Forty-two male (46.7%) and 48 female (53.3%) patients had a mean age of 62.6 ± 13.4 years. Patients with common thrombophilias comprised 30% of all cases (FVL: 19.1%, PTM G20210A: 3.4%, antithrombin III deficiency: 1.1%, protein C deficiency: 5.7%, protein S deficiency: 13.6%). A significant association between recurrence of pulmonary embolism (10 patients, 12.2%) and protein S deficiency was established (P = 0.040). Serum level of protein C was also significantly lower in the subgroup of recurrent pulmonary embolism (P = 0.049). FVL and PTM mutations were high in cancer patients; the presence of inherited thrombophilia was low with risk factors of surgery and immobilization. Genetic risk factors were high in patients with pulmonary embolism. Protein C and S deficiencies may play a role in pulmonary embolism recurrence. DVT or family history of pulmonary embolism was not found to be related to inherited thrombophilias. Surgery and immobilization were thought not to have priorities for detection of genetic risk factors. The high percentages of FVL and PTM mutations in cancer patients should be considered.

A prospective, multicentre clinical trial comparing cisplatin plus gemcitabine with cisplatin plus etoposide in patients with locally advanced and metastatic non-small cell lung cancer.

Objective:  Cisplatin‐gemcitabine (PG) and cisplatin‐etoposide (PE) combinations are active regimens for non‐small cell lung cancer (NSCLC). The present study aimed to compare PG with PE in the treatment of patients with stage IIIB and IV NSCLC.

Multiple distant metastases in a case of malignant pleural mesothelioma

Introduction Malignant pleural mesothelioma (MPM) is a malignant of mesodermal neoplasm and arises from multipotential mesothelial or subserosal cells of the pleura, pericardium and peritoneum. Case A seventy five year-old male patient was admitted with chest and lower limb pain. He was a heavy smoker and exposed to environmental asbestos in his childhood. PET-CT scans showed multiple pathological FDG uptakes in lungs and other organs. Biopsies performed from lung and anterior thigh muscles were reported as epitheloid type malignant pleural mesothelioma. Discussion We emphasize that unexpected distant metastases can be observed in MPM and occasionally primary diagnosis can be determined by the biopsy of the metastatic regions. This case also points out the role of PET-CT in the staging of malign mesothelioma by determining different metastatic sites.

Chaperonin (HSP60) and annexin-2 are candidate biomarkers for non-small cell lung carcinoma

Background: Lung cancer is responsible of 12.4% and 17.6% of all newly diagnosed cancer cases and mortality due to cancer, respectively, and 5-year survival rate despite all improved treatment options is 15%. This survival rate reaches 66% in the Stage 1 and surgically treated patients. Early diagnosis which could not be definitely and commonly achieved yet is extremely critical in obtaining high survival rate in this disease. For this reason; proteomic differences were evaluated using matrix assisted laser desorption ionization (MALDI) mass spectrometry in the subgroups of lung adenocarcinoma and squamous cell carcinoma. Methods: Fresh tissue samples of 36 malignant cases involving 83.3% (n = 30) men and 16.7% (n = 6) women patients were distributed into 2 groups as early and end stage lung cancer and each group were composed of subgroups including 18 squamous cell carcinoma (9 early stage cases, 9 end stage cases) and 18 adenocarcinoma cases (9 early stage cases, 9 end stage cases). The fresh tissues obtained from the tumoral and matched normal sites after surgical intervention. The differences in protein expression levels were determined by comparing proteomic changes in each patient. Results: In the subgroups of advanced stage adenocarcinoma; tumoral tissue revealed differences in expression of 2 proteins compared with normal parenchymal tissue. Of those; difference in protein expression in heat shock protein 60 (HSP60) was found statistically significant (P = 0.0001). Subgroups of early and advanced stage squamos cell carcinoma have differed in certain 20 protein expression of normal tissue and diseased squamos cell carcinoma. Of those, increased protein expression level of only annexin-2 protein was found statistically significant (P = 0.002). No significant difference was detected in early and advanced stage protein expressions of the tumoral tissues in the subgroups of adenocarcinoma and squamous cell carcinoma. Conclusions: We conclude that with respect to early diagnosis of lung cancer that HSP60 and annexin-2 proteins are the important biomarkers in the subgroups of adenocarcinoma and squamous cell carcinoma. We also consider that these 2 proteins are molecules which may provide critical contribution in evaluation of prognosis, metastatic potential, response to treatment, and in establishment of differential diagnosis between adenocarcinoma and squamous cell carcinoma.

Cervical Mediastinoscopy Versus Computed Tomography for Detecting Enlarged Mediastinal Lymph Nodes in Non-Cancerous Lung Diseases

Cervical mediastinoscopy (CM) is considered to be the gold standard for evaluating mediastinal lymph nodes. The aim of this study was to determine the diagnostic yield of computed tomography (CT) and CM for detecting enlarged mediastinal lymph nodes in non-malignant pulmonary diseases. We retrospectively investigated the correlation and differentiation between chest CT and CM findings in terms of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), in 30 patients with granulomatous lung disease diagnosed by CM and isolated enlarged lymph nodes seen on CT scans. Biopsy tissues from the lymph nodes in stations right, 1, 2, 3, 4, and 7, were obtained for pathological examination. The 30 patients comprised 11 men (mean age 47.1 ± 18.4 years) and 19 women (mean age 44.2 ± 14.0 years). Radiological examination showed that the diagnostic value of stations 2 and 4 was particularly high. Thus, when CM is used for diagnostic purposes, the small lymph nodes in station 1, obtained by careful dissection of the higher mediastinal region, can be helpful. Generally, there is no absolute consistency between the findings of CM and CT. For this reason, obtaining samples from each station regardless of CT findings is recommended.

The place of indirect venography tests after pulmonary computed tomography angiography in the diagnosis of pulmonary thromboemboli.

Aim To investigate the effectiveness of indirect computed tomography (CT) venography applied after pulmonary CT angiography to patients with suspected pulmonary embolism. Material and methods The study comprised 80 patients at high/moderate risk of pulmonary embolism (PE) according to the clinical findings. Computed tomography venography (CTV) was performed 3-3.5 minutes after taking pulmonary CTA images. Color Doppler ultrasonography (CDUS) of the lower extremities was applied to all patients before pulmonary CTA or within 24 hours after CTA. Results Pulmonary embolism was determined in a total of 19 patients (23%). Six patients had deep venous thrombosis on CTV examination even though the CDUS findings were normal. Accepting color Doppler ultrasonography findings as the gold standard, the sensitivity of CTV in determining deep vein thrombosis (DVT) was found to be 100%, specificity 91%, positive predictive value 60%, negative predictive value 100%, likelihood of giving a positive result 11.1, and likelihood of giving a negative result 0. There was a statistically significant good degree of correlation between the two methods (r = 0.741, p < 0.001). Conclusions Computed tomography venography examination applied after pulmonary CTA is a fast imaging technique that has high diagnostic value and can be an alternative to CDUS, especially when CDUS is insufficient in application and evaluation.