Ender Levent

Bronchial hyperreactivity and airway wall thickening in obstructive sleep apnea patients

PurposeHypoxia/reoxygenation episodes in obstructive sleep apnea (OSA) results in the alteration of the oxidative balance, leading to the development of inflammation. Airway wall thickening and inflammatory changes are suggested as a primary cause of the airway hyperresponsiveness in asthmatics. Bronchial hyperreactivity (BH) may also occur in patients with OSA. We investigated the presence of BH and airway wall thickness in OSA and correlations with inflammatory markers.Materials and methodsSixteen OSA patients and ten controls without allergic diseases were prospectively studied. Plasma pro-B-type natriuretic peptide (pro-BNP), fibrinogen, D-dimer, α1-antitrypsin, and high-sensitive C-reactive protein levels were measured. Airway wall thickness was evaluated with high-resolution CT, and BH was assessed by giving each subject a methacholine challenge test.ResultsIn OSA patients, bronchial wall thickness, fibrinogen, D-dimer, α1-antitrypsin, high sensitive C-reactive protein, and pro-BNP levels were significantly greater than those in control subjects. Among the 16 patients, three had BH on methacholine challenge. Bronchial wall thickness(mm) was positively correlated with apnea–hypopnea index (AHI: number of apneas + hypopneas/hour of sleep), BMI, respiratory arousal index, nocturnal oxygen desaturation (NOD) duration (time in minutes with a nocturnal arterial oxygen saturation of <90% during sleep), and α1-antitrypsin levels. NOD duration also correlated with pro-BNP and fibrinogen levels.ConclusionsIn OSA patients, walls of central airways were thicker than normal subjects. BH may have occurred in OSA patients. NOD duration correlated with inflammatory parameters and oxygen desaturation index 3% had an effect on the thickness of bronchial walls. But overall, AHI was found to be the only independent predictor of bronchial wall thickness.

Lung cancer and pregnancy

Lung cancer in the pregnant woman is a very rare and dramatic coincidence with poor prognosis. Treatment depends on the gestational week of the pregnancy, patients medical status, social, personal, familial, and even religious beliefs. We present a case of adenocarcinoma of the lung in a 34-year-old pregnant patient whose initial complaints were cough, dyspnea, fever and fatigue. She was diagnosed with pneumonia at another hospital, and antibiotic therapy was administered. Meanwhile, at 28 weeks she delivered a preterm low-birth-weight baby. Chest X-ray and thorax CT revealed a mass lesion in the upper left lung lobe. After admission to our clinic, needle aspiration of left supraclavicular lymph node and bronchoscopic biopsy from upper lobe bronchus showed a non-small lung cancer; adenocarcinoma. Brain MRI was normal. PET CT revealed multiple bone metastases. Multidisciplinary Tumor Committee at our hospital referred her to the Oncology Department as an advanced stage IV disease. Chemotherapy was administered with paclitaxel and carboplatin for a total of 12 weeks. Reassessment of the patient revealed new bone metastases and crizotinib was administered since her tumor was found positive for EML4-ALK mutations. The treatment was well tolerated. During a follow up period of 6 months her clinical condition was stable and no adverse events were encountered.

Homocysteine levels and echocardiographic findings in obstructive sleep apnea syndrome.

Background: The obstructive sleep apnea syndrome (OSAS) is characterized by repeated upper airway obstruction during sleep together with decreases in oxygen saturation leading to a series of pathological events, primarily in the cardiovascular system. Elevated plasma homocysteine levels have recently been considered as an independent risk factor for vascular disease, and increased levels are attributed to cardiovascular diseases. Objectives: We aimed to investigate the possible relationship between homocysteine levels and echocardiographic findings in OSAS patients at different stages of disease. Methods: Thirty-eight patients (23 males and 15 females) with polysomnographically verified OSAS (mean age, 49 ± 12 years, range 27–74) and a mean body mass index of 31.27 ± 5.24 kg/m2 (range 22.60–47.90) were prospectively studied. Plasma levels of homocysteine, cholesterols, triglycerides, vitamin B12 and high-sensitive C-reactive protein (hsCRP), as well as echocardiographic and lung function parameters were assessed. Results: Homocysteine levels were elevated in all OSAS groups and were statistically significantly different between the mild and moderate/severe groups. Significant differences were present between the variables nocturnal oxygen desaturation (NOD), respiratory arousal and light sleep among the mild and moderate/severe groups. We found a significant positive correlation between homocysteine levels and NOD duration, and hsCRP levels were positively correlated with the apnea-hypopnea index and NOD duration. Conclusions: In all OSAS groups, homocysteine levels were elevated regardless of the presence of cardiac dysfunction. Echocardiographic abnormalities were primarily left-ventricular (LV) hypertrophy and LV diastolic dysfunction and could be observed in all OSAS severity groups.

Nonsevere acute pulmonary embolism: prognostic CT pulmonary angiography findings.

Purpose To retrospectively evaluate the prognostic parameters of computed tomography (CT) pulmonary angiographic findings in nonsevere (hemodynamically stable) pulmonary embolism (PE) patients and to assess the predictive value of these parameters for mortality within 1 month of the initial diagnosis. Materials and Methods Retrospectively, 67 consecutive patients (28 men, 39 women; mean age, 63.25 ± 18 years) from 2 centers with nonsevere PE diagnosed using CT and a clinical evaluation were included in the current study. Using consensus reading, 2 readers blinded to the patients’ clinical outcomes quantified the right ventricle short axis to left ventricle short axis ratio in the axial plane, vascular measurements, reflux of contrast medium into the inferior vena cava and azygos vein, ventricular septal bowing, and clot load using the Qanadli scoring system. The Simplified Pulmonary Embolism Severity Index (sPESI) and pulmonary parenchymal findings were also evaluated. All CT pulmonary angiographic parameters were compared with the risk of death within 1 month using logistic regression analysis. Results Fifty-nine patients survived (88.1%), and 8 patients (11.9%) died because of PE. The sPESI and 2 parenchymal findings (multiple wedge-shaped opacities or consolidation accompanied by a wedge-shaped opacity) were significantly related to mortality. In the univariate analysis, neither the cardiovascular CT parameters nor the clot burden was significant between the survivors and nonsurvivors (P > 0.05). Conclusions In clinically nonsevere PE patients, the sPESI and significant parenchymal findings were the CT parameters related to 1-month mortality.

Idiopathic chylothorax in geriatrics: the oldest case report so far

Abstract Chylothorax is a rare condition characterized by accumulation of chylous fluid in the pleural space resulting in impaired ductus thoracic integrity. It can be an outcome of a traumatic process, although there are a few non-traumatic and/or idiopathic cases in current literature. In this article, we present the oldest case report so for, who is an 87-year-old woman complaining of acute respiratory distress symptoms with pleural effusion having no trauma history. The patient was analyzed for the disease etiology strenuously. Thoracentesis was performed together with imaging modalities and detailed systemic laboratory tests. Non-surgical treatment was successful as the outcome.