Aylin Ozgen Alpaydin

Does high-frequency chest wall oscillation therapy have any impact on the infective exacerbations of chronic obstructive pulmonary disease? A randomized controlled single-blind study:

Objective: To investigate the impact of high-frequency chest wall oscillation in chronic obstructive pulmonary disease patients with infective exacerbation. Design: Clinical randomized controlled trial. Setting: Patients received high-frequency chest wall oscillation therapy at the Department of Pulmonology. Subjects: Stage III-IV chronic obstructive pulmonary disease patients hospitalized with acute infective exacerbation who had received high-frequency chest wall oscillation therapy were studied. Interventions: Patients were randomized into two groups, which were classified as I and II. All patients have been treated with bronchodilators, antibiotics, if necessary oxygen and patient education, as part of acute chronic obstructive pulmonary disease exacerbation protocol. Group II patients received additional high-frequency chest wall oscillation therapy. Main measures: Body mass index (B), forced expiratory volume in the first second (O), modified Medical Research Council dyspnea scale (D) and 6-minute walking test (E) (BODE) index, forced expiratory volume in the first second, dyspnea, exercise capacity, oxygenation parameters and hospitalization of duration were recorded at baseline and at three-days and five-days follow-up. Results: From April 2009 to July 2011, a total of 99 patients were assessed for eligibility, 50 patients were enrolled and randomized into two groups. A total of 50 (100%) patients (25 in Group I and 25 in Group II) were followed up for five days. Application of high-frequency chest wall oscillation therapy resulted in no significant advantage in all outcomes (p > 0.05). Mean (SD) baseline BODE index value in Group I was 7.72 (1.76), in Group II was 7.72(1.89) (p = 0.55). On the fifth-day assessment, mean (SD) BODE index value in Group I was 7.24 (1.83), in group II was 6.44 (2.46) (p = 0.18). Conclusions: The application of high-frequency chest wall oscillation therapy offers no additional advantages on infective exacerbations in chronic obstructive pulmonary disease.

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.

An unusual presentation of bronchial rupture.

Persistent hydropneumothorax was diagnosed in a 62-year-old female with a history of blunt trauma, although she was treated with chest tube and closed underwater seal drainage. Computed tomography and fiberoptic bronchoscopy findings were consistent with “fallen lung” syndrome. Fiberoptic bronchoscopy also found a cavitary lesion at the right tracheobronchial angle. Forceps biopsy of the cavitary lesion indicated bronchogenic carcinoma. Our final diagnosis was tracheobronchial complete rupture and fallen lung syndrome secondary to malignancy.

Preoperative parameters and their prognostic value in amyotrophic lateral sclerosis patients undergoing implantation of a diaphragm pacing stimulation system

Introduction: Amyotrophic lateral sclerosis (ALS) is a progressive neuromuscular disease with devastating and fatal respiratory complications. Diaphragm pacing stimulation (DPS) is a treatment option in diaphragm insufficient ALS patients. Ventilatory insufficiency depending on diaphragmatic failure is treated by the present study aimed to investigate prognostic value of preoperative clinical and functional characteristics of ALS patients undergoing implantation of a DPS system and to determine appropriate indications for the DPS system. Methods: The study included 34 ALS patients implanted with DPS system. All patients underwent multidisciplinary and laboratory evaluations before the surgery. The laboratory examinations included pulmonary function tests and arterial blood gas analysis. Survival rates were recorded in a 2-year follow-up after the surgery. Results: Twenty-eight of 34 patients with ALS survived after a 2-year follow-up. These patients were younger than those who died and had the disease for a longer time; however, the differences were not significant. Both right and left hemidiaghragms were thicker in the survived patients (P < 0.0001 for each). Pulmonary function tests revealed no significant differences between the patients who survived. Arterial blood gas analysis demonstrated lower partial pressure of carbon dioxide in the survived patients (P = 0.025). Conclusions: DPS implantation was more efficacious in ALS patients with mild respiratory failure and thicker diaphragm. Predictors of long-term effectiveness of DPS system are needed to be addressed by large-scale studies.

The Role of Endobronchial Biopsy in the Diagnosis of Pulmonary Sarcoidosis

Bronchofiberscopy (BFS) with endobronchial biopsy (EBB) was performed in 66 patients with pulmonary sarcoidosis (PS). Transbronchial biopsy (TBB) was made in 49 patients from this group to compare the diagnostic value of EBB and TBB. The normal endoscopic picture was observed in 19.6% of patients. Bronchial mucosal hypervascularization and thickening were found in 25.7% of cases; the signs of enlarged bronchopulmonary lymph nodes were detected in 13.6%; catarrhal endobronchitis in 10.6%, and tuberosity changes in 4.5%. Epithelioid granulomas in the bronchial mucosa were identified in 37.8% of cases (30.75 and 39.6% in the intact and abnormal mucosa, respectively). The diagnostic value of TBB was 65.3%. EBB could reveal epithelioid-cell granulomas in 4 of the 17 patients with negative TBB. The findings suggest that BFS with EBB should be included as a necessary diagnostic method for the examination of patients with PS.