Atilla Akkoçlu

Extrapulmonary involvement in patients with sarcoidosis in Turkey

Background and objective:  Extrapulmonary sarcoidosis is common, and is almost always associated with concomitant thoracic involvement. Extrapulmonary manifestations vary on the basis of gender, age at presentation and ethnicity. The aim of this study was to investigate extrapulmonary involvement in patients with sarcoidosis in Turkey.

Association between disease-related factors and balance and falls among the elderly with COPD: a cross-sectional study

Background and aims: To investigate the relationship between disease-related factors and balance, and a history of falls in chronic obstructive pulmonary disease (COPD). Methods: Thirty-six patients with COPD and twenty healthy individuals were studied. Pulmonary function (pulmonary function test), hypoxemia (analysis of arterial blood gases), history of falls and tripping (number of falls and tripping in the past year), balance (Berg’s Balance Scale-BBS), quadriceps femoris muscle strength (manual muscle test), and exercise capacity (6-minute walking test-6MWT) were assessed. Results: BBS scores were significantly different between groups (p=0.001). BBS scores, frequency of falls and tripping were correlated in COPD patients (p≤0.01). BBS score and frequency of falls were correlated with dyspnea and peripheral oxygen saturation measured after the 6MWT, partial arterial oxygen pressure, and arterial oxygen saturation values in COPD patients (p<0.05). Conclusions: According to our results, hypoxemia, dyspnea and fatigue are disease- related factors, which are related with balance impairment and falls in COPD patients. For this reason, we suggest that assessment of and training to improve balance impairment among the elderly with COPD should be a component of pulmonary rehabilitation programs in clinical practice.

Comparison of Short Form‐36 Health Survey and Nottingham Health Profile in moderate to severe patients with COPD

OBJECTIVE To compare the health-related quality of life (HRQoL) assessed by Short Form-36 Health Survey (SF-36) and Nottingham Health Profile (NHP) on the basis of lung function and exercise capacity parameters in patients with moderate to severe chronic obstructive pulmonary disease (COPD). METHODS AND MATERIALS The investigation was a prospective, quality-of-life survey and cross-sectional study of 130 consecutive COPD patients. The NHP and SF-36 as generic HRQoL instruments, the Chronic Respiratory Disease questionnaire (CRQ) as a disease-specific HRQoL instrument and 6-minute walking test, severity of dyspnea, leg fatigue and lung function, were the measurements and instruments used in the study. RESULTS It was determined that the subscales of both questionnaires were generally related with the FEV(1), walking distance, CRQ, severity of dyspnea and leg fatigue values (P<0.05). The much higher correlation coefficient was determined between these parameters and NHP compared with the SF-36. Only NHP was found to be correlated with the age, body mass index and smoking consumption (P<0.05). CONCLUSIONS The stronger relation of NHP with the clinical and physical parameters of the patients compared with that of SF-36 may be associated with the increased sensitivity of NHP to the clinical state owing to the increasing respiratory symptoms of our old patients with moderate to severe obstruction and/or the more intelligible and easy-to-respond nature of NHP compared with SF-36.

Apoptosis bcl-2 and p53 expression and their relation to tumour stage in non-small cell lung carcinomas (NSCLC).

Little quantitative data exist on the extent of apoptosis (genetically mediated cell deletion) and no data are available on its relation to p53 and bcl-2 expression and on its value as a prognostic factor in NSCLCs. We examined 38 NSCLCs (26 squamous, 8 adeno, 2 adenosquamous and 2 large cell carcinomas) for the frequency of apoptotic bodies by morphometric methods using haematoxylin eosin stained sections and for the bcl-2 and mutant p53 gene product expression using immunohistochemical techniques. We also evaluated the relation of apoptosis, bcl-2 and p53 expression to tumour stage and to each other. Eleven cases were in stage I, 5 were in stage II, 13 were in stage III and 9 were in stage IV. The mean apoptotic count was 9.52 (r: 2-26); 36.8% of cases were positive for bcl-2 and 76.3% of cases were positive for p53 expression. Statistical analysis did not show any correlation between tumour stage and any of the three tested parameters. There was no statistically significant relation between apoptosis and either p53 or bcl-2 expression. There are conflicting reports on the complex relationship between bcl-2, p53 and apoptosis. bcl-2 is suggested to have a prognostic value, independent from stage in SCLCs. Though we did not find any relation between stage and bcl-2 or apoptosis, it remains to be tested whether they have any independent prognostic value in larger series with survival data.

Paediatric endobronchial leiomyoma mimicking asthma

A 16-year-old male patient was admitted with complaints of cough, fever, dyspnoea, wheezing and haemoptysis for 2 months. Wheezing was bilateral but predominantly in the right lung fields. Inspiration and expiration were prolonged. In the emergency room, the initial diagnosis was bronchial asthma. His wheezing and dyspnoea did not respond to iv. theophylline, corticosteroids or inhaled salbutamol. Chest X-ray showed hyperinflation of the right lung, especially after full expiration. Mantoux test, acid-fast bacilli and sputum cultures were negative. Magnetic resonance revealed a soft tissue mass in the proximal part of the right main bronchus, and hyperinflation of the right lung (Plate 1). Fiberoptic bronchoscopy showed total occlusion in the proximal part of the right main bronchus. Bronchial leiomyoma was diagnosed in the biopsy specimen. In order to evaluate the extension of mass and distal bronchial distribution, selective bronchography via fiberoptic bronchoscopy was performed. Dionosil aqua was pooled proximal to the mass and the distal bronchial system could not be visualized. Bronchiectasis could visualize by lotrolan (Plates 2 and 3). Lung destruction, bronchiolitis obliterans and bronchiectasis were observed secondary to the endobronchial leiomyoma and right pneumonectomy was performed.

Primary pulmonary extranodal marginal zone lymphoma/low grade B-cell lymphoma of MALT type combined with well-differentiated adenocarcinoma

We describe a rare case of extranodal marginal zone/low-grade B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) combined with areas of well-differentiated adenocarcinoma. In addition, the MALT lymphoma was synchronously systemic, with involvement of the lung, stomach and duodenum.

The importance of pulmonary function tests in adenotonsillectomy indications.

Children who had undergone adenotonsillectomy for recurrent adenotonsillitis showing no signs of clinical or radiological obstructive manifestations were evaluated with pulmonary function tests before, and one month after the operation. In relation to the result obtained by function tests, 60% of 45 cases (27) had the findings of mild obstructive pulmonary disease whereby these findings were in transient character that vanished after the operation. The following parameters were measured and found that they were all increased, mean FVC from 82.22±6.82 to 93.11±7.81 (p<0.01), mean PEF from 77.60±8.38 to 88.60±5.57 (P<0.01), mean FEVI from 74.28±11.68 to 90.15±7.28 (p<0.01), mean FEF 25 from 71.44±11.53 to 83.53±6.40 (p<0.01), mean FEF 50 from 69.53±14.53 to 84.37±7.72 (p<0.01), mean FEF 75 from 70.08±12.15 to 85.48±7.15 (p<0.01). In conclusion, pulmonary function tests could reveal the obstructive effects of adenotonsillar hypertrophy with no clinical or radiological obstructive findings, and could be useful in surgical indications of adenotonsillar hypertrophy dur to recurrent infections in children.

Patient and physician delay in the diagnosis and treatment of non-small cell lung cancer in Turkey.

AIM The early diagnosis and treatment of lung cancer are important for the prognosis of patients with lung cancer. This study was undertaken to investigate patient and doctor delays in the diagnosis and treatment of NSCLC and the factors affecting these delays. MATERIALS AND METHODS A total of 1016 patients, including 926 (91.1%) males and 90 (8.9%) females with a mean age of 61.5±10.1 years, were enrolled prospectively in this study between May 2010 and May 2011 from 17 sites in various Turkish provinces. RESULTS The patient delay was found to be 49.9±96.9 days, doctor delay was found to be 87.7±99.6 days, and total delay was found to be 131.3±135.2 days. The referral delay was found to be 61.6±127.2 days, diagnostic delay was found to be 20.4±44.5 days, and treatment delay was found to be 24.4±54.9 days. When the major factors responsible for these delays were examined, patient delay was found to be more frequent in workers, while referral delay was found to be more frequent in patients living in villages (p<0.05). We determined that referral delay, doctor delay, and total delay increased as the number of doctors who were consulted by patients increased (p<0.05). Additionally, we determined that diagnostic and treatment delays were more frequent at the early tumour stages in NSCLC patients (p<0.05). DISCUSSION The extended length of patient delay underscores the necessity of educating people about lung cancer. To decrease doctor delay, education is a crucial first step. Additionally, to further reduce the diagnostic and treatment delays of chest specialists, multidisciplinary management and algorithms must be used regularly.

Photodynamic therapy as an adjunct to systemic treatment in a case with unilateral presumed vascularized choroidal tuberculous granuloma.

Intraocular tuberculosis cannot be diagnosed easily in some clinical circumstances. A 29-year-old otherwise healthy woman who was initially misdiagnosed and treated empirically with systemic steroids and sulfamethoxazole–trimethoprim for toxoplasmosis was referred to us for severe visual loss. We instituted quadruple antituberculosis treatment upon chest medicine consultation as all attempts, including consecutive intravitreal antibiotic injections, could not prevent the enlargement of lesion. Systemic antituberculosis treatment halted the fulminant course but the granuloma became vascularized. Because photodynamic therapy (PDT) has very recently been shown to reduce viable mycobacterial cells in animal experiments we performed PDT, and the vascularized tuberculous granuloma was successfully treated. PDT may have an antimycobacterial effect besides its well-known antiangiogenic effect.