Bülent Tutluoğlu

Platelet Function and Fibrinolytic Activity in Patients with Bronchial Asthma

Platelets have the capacity to release mediators with potent inflammatory or anaphylactic properties. Platelet factor-4 (PF4) and beta-thromboglobulin (BTG) are two of these mediators. On the other hand, plasminogen activator inhibitor-1 (PAI-1) and tissue plasminogen activator (tPA) are two important mediators of fibrinolysis. Both mediators are secreted mainly by vascular endothelium. Plasma levels of PF4, BTG, PAI-1, and tPA may show changes in chronic inflammatory diseases such as asthma. This study examined the role of thrombocytes and the function of the endothelium ın asthmatic patients during an attack and during a stable phase. Eighteen patients with known allergic asthma who came to our emergency department with an asthma attack and 14 control subjects were included in the study. Blood samples were taken after starting therapy with salbutamol inhalation. Lung function tests were performed after receiving the first emergency therapy for asthma. Plasma levels of PF4, BTG, PAI-1, tPA were determined before starting steroid therapy and after receiving 1 week of steroid therapy. Plasma levels of PF4 among patients with an asthma attack were significantly higher than those of controls (150.5±8.92 IU/mL vs. 92.5±7.63 IU/mL, p<0.001). A further increase in plasma PF4 levels was detected after steroid therapy (163.5±9.16 IU/mL). Plasma BTG levels of patients on admission were not statistically different from those in the control group (140.4±6.34 IU/mL vs. 152.2±8.71 IU/mL). An increase was detected after therapy (171.6±7.27 IU/mL) and post-treatment plasma levels were statistically meaningful versus the controls. Plasma levels of tPA and PAI were statistically higher than those in controls in asthmatic patients on admission (6.01±2.72 vs. 5.4±2.3 ng/mL for tPA and 75.2±27.2 ng/mL vs. 32.7±14.3 ng/mL for PAI-1). Further increases were detected in two parameters after 1 week of therapy with steroids (tPA levels were 6.85±2.96 ng/mL and PAI-1 levels were 83.5±29.6 ng/mL). There seems to be an increased activity of platelets during an asthma attack. Elevated PAI-1 and tPA levels may also indicate the activated endothelium in asthma. Increases of plasma levels of PAI-1 and tPA after steroid therapy need further investigation because elevated PAI-1 levels enhance airway remodeling.

Sensitization to horse hair, symptoms and lung function in grooms

Objective This study aimed to investigate the rate of occupational sensitization to horse hair in grooms and whether occupational exposure to horse hair increases respiratory and allergic symptoms and affects lung function in grooms or not.

The respiratory effects of occupational polypropylene flock exposure

The present study evaluated the possible effects of exposure to polypropylene flock on respiratory health and serum cytokines in a cross-sectional study of workers from a plant in Turkey. A total of 50 polypropylene flocking workers were compared to a control group of 45 subjects. All subjects filled out a respiratory questionnaire and underwent a physical examination, a chest radiograph and pulmonary function testing, including single breath carbon monoxide diffusing capacity (DL,CO). Serum interleukin-8 (IL-8) and tumour necrosis factor-alpha (TNF-α) were measured. Additionally, high resolution computed tomography (HRCT) of the chest was performed in 10 exposed workers with low DL,CO. Work-related respiratory symptoms were reported in 26% of the exposed subjects and in 13.3% of the controls. Logistic regression analysis showed that the risk of respiratory symptoms increased 3.6 fold in polypropylene flocking workers when compared to controls. Parameters of the study group, including per cent predicted: forced vital capacity, forced expiratory volume in one second, forced mid-expiratory flow 25–75% and DL,CO, were significantly lower than in controls. Multivariate analyses showed that being a polypropylene flocking worker was a predictive factor for impairment of pulmonary function. Serum IL-8 and TNF-α levels were increased in the study group compared with the controls. HRCT revealed peribronchial thickening and diffuse ground glass attenuation in some subjects. The present study suggests the presence of subtle or the beginning of interstitial lung disease in these polypropylene flocking workers.

The Ala allele at Val762Ala polymorphism in poly(ADP-ribose) polymerase-1 (PARP-1) gene is associated with a decreased risk of asthma in a Turkish population.

Background and objective. It has been suggested that inhibition of poly (ADP-ribose) polymerase-1 (PARP-1), either pharmacologically or by a gene knockout provides significant protection against systemic or tissue inflammation in animal models. The aim of this study was to analyze the association of the PARP-1 Val762Ala polymorphism, which has beenreported to be associated with decreased enzymatic activity, in Turkish patients with adult asthma. Methods. A total of 112 subjects with stable asthma and 180 normal controls from the same geographic region were studied and polymerase chain reaction-based restriction analysis was used to identify Val762Ala polymorphism of the PARP-1. Results. In univariate analysis, PARP-1 762 AA genotype conferred a 3.4 fold reduction in risk (OR = 0.297, 95% CI = 0.105-0.813; P = 0.014), while heterozygous VA genotype conferred an even greater level of protection (OR = 0.06; 95%CI, 0.026-0.14; P < 10−6). In addition, wild type PARP-1 762 V allele had 5 times the risk of developing asthma than those without the allele (OR 0.199, CI 0.118-0.334, P = 10−6). Conclusions. These findings suggest that PARP-1 V762A variants may be one of the factors participating in protection or susceptibility to asthma in our population.

Sensitization to sunflower pollen and lung functions in sunflower processing workers

Background: This study aimed to investigate whether exposure to sunflower pollen (Helianthus annuus) increases both sensitization and respiratory symptoms, and whether or not it affects lung functions in sunflower processing workers.

FEF25–75/FVC measurements and extrathoracic airway obstruction in obstructive sleep apnea patients

The aims of this study were to evaluate patients with obstructive sleep apnea syndrome (OSAS) with regards to dysanapsis (airway size relative to lung size) and to demonstrate the differences between the patients with and without extrathoracic airway obstruction. The study population consisted of 15 patients with OSAS and 14 age and body mass index (BMI) matched control subjects. OSAS patients and control subjects showed similar characteristics in FEV1, FEV1/FVC, FEF25–75, and FEF25–75/FVC ratios. Expiration reserve volume was significantly higher in the control group than in OSAS patients (p<0.01). Six patients exhibited extrathoracic airway obstruction while awake. Of these, three had also a sawtooth pattern in their flow–volume curves. The remaining nine patients had no extrathoracic airway obstruction and had lower apnea–hypopnea indexes (AHI) than the obstruction group (p<0.05). OSAS patients and age- and BMI-matched healthy controls had similar characteristics in terms of dysanapsis. In addition, there was no relation between the FEF25–75/FVC ratio and AHI, MinO2, and MeanO2. Extrathoracic airway obstruction may be a feature of only severe OSAS patients.

DNA repair gene XRCC1 polymorphisms and the risk of asthma in a Turkish population

Polymorphisms have been identified in several DNA damage repair genes. These polymorphisms may effect DNA repair capacity and modulate asthma susceptibility. In this study, we aimed to determine the two polymorphisms in DNA repair gene, x-ray repair cross-complementing group 1 (XRCC1), in a sample of Turkish patients with asthma, and evaluate their association with asthma development. We used polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) to analyze XRCC1 Arg194Trp and XRCC1 Arg399Gln polymorphisms in 116 patients with asthma and in 180 disease-free controls. Our data showed a positive association between the polymorphisms of codons 194 (odds ratio [OR] = 1.97, 95% confidence interval [CI] = 1.06-3.66, and p = 0.03 for Arg/Trp genotype) and 399 (OR = 1.87, 95% CI = 1.12-3.13, and p = 0.02 for Arg/Gln genotype, and OR = 2.59, 95% CI = 1.24-5.43, and p = 0.01 for Gln/Gln genotype) and asthma risk. No statistically significant difference was found for the allelic and genotypic distributions of the polymorphisms in XRCC1 gene between mild and moderate asthmatic patients. A combined analysis of the effect of XRCC1 codons 194 and 399 revealed the highest risk (OR = 4.17, 95% CI = 1.77-9.83, and p = 0.001) for carriers of the polymorphic alleles in both of these codons. These results suggest that the risk of asthma may be associated with DNA repair mechanisms, and understanding these mechanisms will help identify individuals at increased risk of developing asthma and should lead to improved treatment of asthma.

Effects of Heparin on Hypertonic Potassium Chloride—Induced Bronchoconstriction

BACKGROUND: Changes in bronchial osmolarity is a well-known factor for bronchoconstriction. Recently, nonisotonic aerosols have begun to be used for the assessment of bronchial hyperreactivity. Hypertonic KCl can cause bronchoconstriction even in non-symptomatic asthmatic patients. OBJECTIVE: To evaluate the protective role of heparin on hypertonic KCl-induced bronchospasm in asthma. METHODS: Thirty-eight asthmatic patients were included in this double-blind, placebo-controlled study. On day 1 of the study, after performing the respiratory function test (RFT), patients had inhaled KCl 10% and RFTs were done after 20 minutes. On day 2 of the study, after the basal RFT, 18 patients inhaled NaCl 0.9% 0.2 mL/kg solution. After the completion of this procedure, patients waited for 20 minutes and inhaled KCl 10% 10 mL, and RFTs were repeated 20 minutes later. The second group consisted of 20 patients who inhaled heparin 1000 units/kg after the RFTs were performed. Twenty minutes later, they inhaled KCl 10% and waited for 20 minutes. Finally, RFTs were done and compared with those from the other group. RESULTS: In the control group, forced expiratory volume in one second (FEV1) decreased 17.4% on day 1 and 16.4% on day 2. In the heparin-treated group, FEV1 decreased 18.6% on day 1, but almost no change occurred after this group was treated with heparin before inhalation of hypertonic KCl on day 2. CONCLUSIONS: Heparin was found to be highly protective against hypertonic KCl—induced bronchospasm in bronchial asthma.

Descending necrotizing mediastinitis: a case report

Abstract Descending necrotizing mediastinitis (DNM) is a relatively rare inflammatory pathology with high mortality rates unless an appropriate surgical treatment is undertaken. Early evaluation by means of thoracic computed tomography (CT) scanning is extremely useful for diagnosis and surgical treatment planning. We present a case of DNM in a 38-year-old man. He was admitted to hospital with a history of cough, fever and shortness of breath persisting for 15 days. Physical examination revealed orthopnoea, tachypnoea, and edema of the head and neck. Tonsils and the walls of the hypo- and oropharynx were hyperemic and hypertrophic, and tonsils were covered with an exudative membrane. Plain chest X-ray showed widening of the superior mediastinum. On CT examination there were air and air–fluid levels within mediastinal dense fatty planes that extended from the thoracic inlet to the subcarinal region along the retrotracheal–paraesophageal area. No contrast leakage into the mediastinum was detected with esophagography. Because of suspicion of mediastinitis and worsening of the patient’s symptoms, he underwent right thoracotomy. Widespread purulent material was observed in the middle and posterior mediastinal compartments. Mediastinal drainage, followed by extensive debridement of the necrotic tissue were carried out. Bacteriologic result from materials obtained through the mediastinal drainage yielded methicillin-resistant Staphylococcus aureus. Intravenous antibiotic (glycopeptides) therapy was performed. After the cultures of drained fluid became negative and control CT scan revealed complete regression of the pathologic findings, the patient was discharged from hospital.

Bronchial Hyperreactivity in Non-Cystic Fibrosis Bronchiectasis

1 Müsellim Benan1, Uzel Işıl1, Börekçi Şermin1, Tutluoğlu Bülent1, Aygün Gökhan2, Yaşar Hatice2, Halis Nigar1, Erk Müzeyyen1 1Göğüs Hastalıkları Anabilim Dalı, 2Mikrobiyoloji Anabilim Dalı, İstanbul Üniversitesi, Cerrahpaşa Tıp Fakültesi, İstanbul, Türkiye Bronşektazide Bronş Aşırı Duyarlılığı / Bronchial Hyperreactivity in Bronchiectasis Bronchial Hyperreactivity in Non-Cystic Fibrosis Bronchiectasis