Deniz Dogan

Retina nerve fiber layer and choroidal thickness changes in obstructive sleep apnea syndrome

ABSTRACT Objectives: The purpose of this study was to determine the effects of obstructive sleep apnea syndrome (OSAS) on the submacular and peripapillary retinal nerve fiber layer (RNFL) and choroidal thickness (ChT). Methods: Eighty-four eyes of 42 male patients with OSAS and 112 eyes of 56 aged-matched and body mass index-matched healthy male subjects were enrolled in this case-control study. The ChT and peripapillary RNFL thickness was measured using enhanced depth imaging optical coherence tomography. The ChT and RNFL thickness measurements of the groups were compared, and correlations among the Apnea Hypopnea Index (AHI) values and these measurements were calculated. Right and left eyes were separately evaluated. Results: There were no significant differences in the subfoveal and temporal ChT between the groups (p > 0.05). The OSAS group had significantly thicker ChT at 0.5 and 1.5 mm nasal to the fovea in both eyes than the control group (p < 0.05). The peripapillary ChT were significantly thicker in the OSAS group at all segments except for the temporal and superotemporal segments when compared with the control group (p < 0.05 for all quadrants except temporal and superotemporal). When compared with controls, the OSAS group had significantly thinner nasal RNFL thickness in the right eye (p = 0.01) and thinner mean RNFL thickness in both eyes (p < 0.001). Other RNFL thickness measurements were similar between groups (p > 0.05). Between AHI and mean RNFL thickness showed a median negative correlation (r = − 0.411, p = 0.001). Conclusion: The choroidal thickening in patients with OSAS may be associated with the pathophysiology of the neurodegeneration process of the disease.

Assessment of the role of serum ischemia-modified albumin in obstructive sleep apnea in comparison with interleukin-6

ABSTRACT Objectives: There is limited and contradictory information regarding the role of serum ischemia-modified albumin (IMA) in obstructive sleep apnea (OSA). In this study we examine the effects of OSA and obesity on IMA and interleukin-6 (IL-6), and detect whether IMA and IL-6 may be potential biomarkers in OSA. Methods: Fifty-one males who underwent all night polysomnography test were included into the study. Body-mass index (BMI) and apnea-hypopnea index (AHI) of all patients were determined. Serum IMA and IL-6 levels, erythrocyte sedimentation rate (ESR), complete blood count, routine blood biochemistry and thyroid function tests were performed. Results: Mean IMA [0.36 (± 0.04) U/ml, 0.89 (± 0.15) U/ml], mean IL-6 [1.01 (± 0.19) pg/ml, 2.02 (± 1.19) pg/ml] and mean ESR [4.14 (± 2.5) mm/h, 14.35 (± 13.7) mm/h] levels showed significant difference between non-OSA and OSA groups (P = 0.005, P < 0.001, P < 0.001, respectively). Sensitivity of IMA in distinction of non-OSA/OSA was equal to IL-6 and higher than ESR. IMA was also a stronger predictive factor than IL-6 and ESR in the evaluation of OSA groups (severe/mild/moderate OSA and non-OSA). IMA was the sole distinctive biomarker in assessment of obese and non-obese cases. IMA correlated with IL-6, AHI and ESR. Conclusion: Serum IMA may be a valuable oxidative stress indicator for OSA and could act as a better biomarker than IL-6 for reflecting the presence and the severity of OSA.

Is there any superiority among diagnostic methods in organizing pneumonia in terms of clinical features of the patients

Background Organizing pneumonia (OP) can be idiopathic or secondary to some clinical situations. If an etiological cause is not present, this phenomenon is called cryptogenic OP. Secondary OP is associated with various diseases that are known to induce the OP. Objectives The aim of this study was to evaluate the clinical features of the cases with OP and compare the patients diagnosed by bronchoscopic transbronchial biopsy with patients diagnosed by surgical lung biopsy. Patients and methods Medical records of 41 patients diagnosed with OP between 2004 and 2014 were reviewed retrospectively. Results Totally, 41 patients with OP were identified. In all, 39.02% of the cases were diagnosed by bronchoscopic methods, and 60.97% of the cases were diagnosed by surgical procedures. Although the frequency of ground glass opacities, consolidations, and micronodules was higher in the group diagnosed by bronchoscopy, mass-like lesions were more common in the cases diagnosed by surgery. Bronchoscopy, performed in 30 patients totally, had a diagnostic efficacy of 53.33%. Diagnostic value of bronchoscopy was significantly higher in cryptogenic OPs. Although diffuse radiological pattern was more common in “successful bronchoscopy” group, frequency of focal pattern was higher in “failed bronchoscopy” group. Ground glass opacity in successful bronchoscopy group and mass-like lesions in failed bronchoscopy group reached significant differences. Conclusion There were significant differences between the diagnostic procedures in terms of radiological patterns. This is the first study about the relationship between the diagnostic methods and the characteristics of OP.

Is Multiple Bilateral Thoracic Anomaly Different From Poland’s Syndrome?

After reading the inspirational presidential address by Douglas E. Wood [1], I feel obliged to contribute. Although The Annals of Thoracic Surgery publishes topics in cardiovascular and thoracic surgery, I, as a cardiac surgeon and member of the Society of Thoracic Surgeons, would like to bring to your attention my thesis, entitled (translated) “A Narrative Reflection on Negative Coronary Artery Bypass Graft Surgery Outcomes: The Spiritual Experience of a Surgeon.” Reflection on one’s clinical practice asks for introspection about professional as well as personal life [2]. Furthermore, narrative knowledge contributes to an individual’s insight into specific experiences [3]. The practical theologian is interested in the integration of the individual person’s story with the story of God and considers it as epistemologically important [4]. With this thesis I took the reader on a personal, spiritual journey by means of an auto ethnographical study design. Henri Nouwen points out that for a person to grow spiritually, three movements of the spirit need to be completed [5]. These three movements were applied to construct the thesis. The inner struggle that a surgeon experiences when a patient dies or experiences complications requires movement from loneliness to solitude. My individual series of patients who underwent coronary artery bypass grafting (CABG) was presented for a hermeneutical investigation with the view to spiritual transformation. A physician should furthermore provide hospitality instead of hostility towards the patient. Nouwen indicates that the last spiritual movement should be from illusion to prayer. I addressed this by asking an evocative question about how God acts in cardiac operations. Amy Ai has done much work over many years on prayer and the outcomes after cardiac surgical procedures [6]. God is neither questioned nor proved, but God was drawn into my time-space to make sense of the negative outcomes after CABG. In a shared Christian spirituality, using the Delphi survey, fellow surgeons were invited to elucidate on spiritual issues. This interdisciplinary research confirms that the sciences need not to function in isolation, but that medical science and theology can join in the establishment of a meaningful existential existence. Mentors with brilliant minds trained me. I watched colleagues with skillful hands. I would like to emphasize the spiritual side of the cardiac surgeon’s make-up.

Effect of aspiration risk on mortality in older age pneumonia cases

The incidence of community-acquired pneumonia (CAP) increases with age and is the leading cause of morbidity and mortality in older ages. Development of aspiration in these cases is one of the most important reasons to increase mortality. We retrospectively reviewed the data of sixty ninepatients over 65 years of age who were admitted with the diagnosis of community acquired pneumonia in order to determine the effects of aspiration risk factors on hospital stay and mortality. According to risk factors (neurological diseases, COPD, immobilization, cancer, etc.), cases were divided into two groups as high and low risk of aspiration. We aim to compared hospital stay and mortality in these groups. A total of sixty nine patients were included in this study. There were thirty patients in the group with high aspiration risk (group I) and thirty nine patients in the group with low aspiration risk (group II). CURB-65 scores were similar between the groups; however, pneumonia severity index was statistically higher in group II patients (p = 0.002). Mortality rates were significantly higher in group I (nine versus one) (p = 0.001). This was also valid for hospitalization times (11.7 ± 4.6 versus 8.4 ± 3.9 days, respectively) (p = 0.004). We found that the high risk of aspiration in advanced pneumonia cases was associated with prolonged hospital stay and increased mortality. At the same time there was a correlation between pneumonia severity index and hospital stay.

Relationship between Pulmonary Artery Stiffness and Functional Capacity in Patients with Heart Failure with Reduced Ejection Fraction

Background and Objectives Functional capacity varies significantly among patients with heart failure with reduced ejection fraction (HFrEF), and it remains unclear why functional capacity is severely compromised in some patients with HFrEF while it is preserved in others. In this study, we aimed to evaluate the role of pulmonary artery stiffness (PAS) in the functional status of patients with HFrEF. Methods A total of 46 heart failure (HF) patients without overt pulmonary hypertension or right HF and 52 controls were enrolled in the study. PAS was assessed on parasternal short-axis view using pulsed-wave Doppler recording of pulmonary flow one centimeter distal to the pulmonic valve annulus at a speed of 100 mm/sec. PAS was calculated according to the following formula: the ratio of maximum flow velocity shift of pulmonary flow to pulmonary acceleration time. Results PAS was significantly increased in the HFrEF group compared to the control group (10.53±2.40 vs. 7.41±1.32, p<0.001). In sub-group analysis of patients with HFrEF, PAS was significantly associated with the functional class of the patients. HFrEF patients with poor New York Heart Association (NYHA) functional capacity had higher PAS compared those with good functional capacity. In multivariate regression analysis, NYHA class was independently correlated with PAS. Conclusion PAS is associated with functional status and should be taken into consideration as an underlying pathophysiological mechanism of dyspnea in patients with HFrEF.

Prognostic Value of Unchangeable Risk Factors for and the Radiologic Scoring System in Ventilator-Associated Pneumonia

Yaz›flma Adresi / Address for Correspondence: Nesrin Öcal, e.posta: nesrinbaygin@yahoo.com DOI: 10.5152/dcbybd.2016.1194 ©Telif Hakkı 2016 Türk Dahili ve Cerrahi Bilimler Yoğun Bakım Derneği Makale metnine www.dcyogunbakim.org web sayfasından ulaşılabilir. ©Copyright 2016 by Turkish Society of Medical and Surgical Intensive Care Medicine Available online at www.dcyogunbakim.org Bu araştırma, 18. Ulusal Yoğun Bakım Kongresi’nde (6-10 Nisan 2016, Antalya, Türkiye) sunulmuştur. This study was previously presented at 18th National Intensive Care Congress (6-10 April 2016, Antalya, Turkey). Objective: There are insufficient data in the literature on the comparative evaluation of unchangeable risk factors for ventilator-associated pneumonia (VAP), such as the personal characteristics and/or the existing features of patients on admission to the intensive care unit, together with radiographic findings. In this study, we aimed to investigate mortality risk factors and the possible prognostic role of radiological extent of pneumonia in patients with VAP.

Comparison of the clinical features and hematopoietic stem cell transplantation outcomes of mediastinal malignant germ cell tumors with nonmediastinal extragonadal placements

Objective Even though the primary mediastinal extragonadal germ cell tumors (EGCTs) are rare, they are noteworthy in the differential diagnosis of mediastinal masses. In this study, we aimed to identify the clinical features of mediastinal malignant GCTs and compare the results of hematopoietic stem cell transplantation between mediastinal and nonmediastinal malignant EGCTs. Method Data of the patients with EGCT who were treated and underwent hematopoietic stem cell transplantation at our hospital between 1988 and 2015 were retrieved retrospectively. Results were compared between mediastinal and nonmediastinal EGCTs. Results Data of 65 patients diagnosed with EGCT (37 [56.92%] cases with mediastinal EGCT and 28 [43.07%] cases with nonmediastinal EGCT) were assessed. The clinical stages, frequency of pretransplant status, mean pretransplant time, and mean number of chemotherapy lines before hematopoietic stem cell transplantation were not significantly different between groups. Although the overall survival did not significantly differ between groups, the 5-year survival was significantly higher in mediastinal EGCTs (P=0.02). Yolk sac tumor was significantly more common in mediastinal EGCTs (P=0.05). Mortality rates were higher in seminomas and yolk sac tumors in all cases, higher in embryonal carcinomas in mediastinal EGCT group and higher in yolk sac tumors in nonmediastinal EGCT group. While choriocarcinomas had more aggressive courses in mediastinal EGCTs, seminomas and yolk sac tumors had poorer prognosis in nonmediastinal EGCTs. Short pretransplant time and persistence of elevated posttransplant βhCG and AFP levels were the significant mortality risk factors both in mediastinal and nonmediastinal EGCTs. Conclusion Mediastinal placement of EGCT was not a poor prognostic factor; furthermore, the 5-year survival was significantly higher in mediastinal EGCTs. According to our knowledge, this is the first study that compares the clinical outcomes of hematopoietic stem cell transplantation of mediastinal and nonmediastinal malignant EGCTs.

Parathyroid adenoma upstaging the lung cancer

Mediastinal staging of NSCLC with noninvasive methods such as PET/CT can be misleading when a mediastinal disease accompany. Histopathologic confirmation should be made before any treatment plan. Herein, we presented a case of parathyroid adenoma upstaging the lung cancer.