Erhan Ugurlu

New aspect for systemic effects of COPD: eye findings.

Chronic obstructive pulmonary disease (COPD) has multisystemic implications and comorbidities. Hypoxia and systemic inflammation are thought to involve oculary structures. In this study, our aim is to evaluate retinal nerve fiber and choroidal thickness and retinal vessel diameter using the spectral‐domain optical coherence tomography (SD‐OCT) in COPD subjects.

Effects of Serum Leptin and Resistin Levels on Cancer Cachexia in Patients With Advanced-Stage Non–Small Cell Lung Cancer

Introduction: Cancer cachexia is one of the most frequent effects of malignancy, is often associated with poor prognosis, and may account for up to 20% of cancer deaths. The aim of our study was to evaluate the relationship of cancer cachexia and serum levels of resistin and leptin in patients with advanced non–small cell lung cancer. Methods: A total of 67 chemotherapy-naïve patients with advanced-stage non–small cell cancer and a control group containing 20 healthy individuals without a known chronic disease were enrolled in this study. All individuals in the control group were age and sex matched. Demographic, anthropometric, laboratory data and serum levels of adipokines were measured for 2 groups. Progression-free survival and overall survival were estimated using the Kaplan-Meier method. Survival among various factors was calculated using the log-rank test. Results: Patients presented significantly higher serum resistin (P = .0001) and lower serum leptin levels (P = .025) than the control group. Lower serum levels of leptin were correlated with overall survival (P = .011). Conclusions: Serum leptin and resistin levels play key role as proinflammatory cytokines in lung cancer and cancer cachexia; however, their use as diagnostic or prognostic markers is not possible yet, and further large-scale studies are required to confirm our findings.

Symptom prevalence and risk factors for asthma at the rural regions of Denizli, Turkey

OBJECTIVE This study was conducted using a standardised method (ECRHS) to identify the prevalence of asthma symptoms and risk factors in adults who lives in the rural regions of Denizli province. METHODS This study was designed as a cross-sectional study to investigate the prevalence of asthma and asthma symptoms in adults older than 18 years old, around the rural regions of Denizli. Data were collected by personal interview and filling in questionnaires between July 2009 and September 2009. RESULTS A total of 1,343 individuals were enrolled. Prevalence of current asthma was 5.9%, having an asthma-like symptom was 34.0% and allergic rhinitis was 2.5%. Most common asthma symptoms were woken by an attack of breathlessness (20.5%, n=275), woken by attack of cough (19.9%, n=267) and wheezing (12.7%, n=171). CONCLUSIONS Asthma is an important disease that may occur not only in cities but also at country sides. In rural areas risk factors for asthma and asthma-like symptoms compared to urban areas may show some differences.

Awareness about disease and pulmonary rehabilitation in chronic obstructive pulmonary disease: A survey study

Purpose: Superiority of pulmonary rehabilitation (PR) in patients with COPD have been entered the major guidelines of the disease and become gold standard of care in the management of COPD. Our aim is to evaluate the patients’ awareness about their own illness and PR which supports behavioral interventions by encouraging exercise training, cooperative self-management depending on the patients themselves. Materials and methods: The study was included 200 patients. Patients who are competent enough to complete the questionnaire and diagnosed as COPD according to Global Inıtıatıve for Chronic Obstructive Lung Disease(GOLD) criteria and at least 1 year on follow patients enrolled in the study. Questionnaire which is employed in our study is developed by a review of the current literature and consist of 3 parts. First part aims to investigate socio-demographics like age, gender, education and whereabouts. Second part (questions 1-9) evaluate the knowledge and awareness of COPD and 3rd part (10-22) investigate the awareness of PR. Results: Among the patients 93% (n=186) were male and 7% (n=14) were female. Mean age was 65.11±10.00 years. Mean duration of the disease was 7.8±6.69 years. Correct answer rates to the questions “is there another treatment modality for COPD other than medication” and “have you ever heard a treatment named pulmonary rehabilitation” were 14.5% and 7.5%, respectively. Conclusion: We found that the awareness of pulmonary rehabilitation is very low. Therefore, in our opinion it is essential to find out new methods, novel strategies to increase the awareness of pulmonary rehabilitation in COPD patients. Pam Med J 2018;11(2):151-156

Effect of reduction mammoplasty on the pulmonary function tests

Introduction Bilateral breast reduction surgery is the surgical treatment of bilateral breast hypertrophy. This is one of the most common breast surgery requested by women, and performed by plastic surgeons. The reasons that patients want this surgery are to re-size sagging breasts aesthetically, and to get rid of somatic symptoms such as shoulder, chest, back, and neck pain. We believe that the objective positive effects of breast reduction surgery exist beside aesthetic. In our study, our aim is to elicit positive effects of surgery on lungs, if there are, by making pulmonary function test and carbon monoxide diffusion test before surgery and after 6 months of surgery. Materials and Methods Thirty patients agreed to participate in the study. Study is completed with 19 patients. Pulmonary function test and carbon monoxide diffusion test were made to all patients in preoperative and 6 months of postoperative period. Lung roentgenogram of all patients was performed and height, weight, body mass index were measured. Saturation level was measured. Result There was a meaningful increase in FEV1 and FVC values in the postoperative period in comparison with pulmonary function test performed in preoperative period. DLCO in postoperative period decreased meaningfully as compared to the preoperative period. Conclusions Breast reduction surgery seems to have positive effects on pulmonary function test values and relaxes patients clinically. Patients with big breasts should be evaluated from this perspective if they apply chest diseases clinic with shortness of breath.

Pulmonary langerhans cell histiocytosis case with diabetes insipidus and tuberculosis

A 19-year-old male patient was observed due to having central diabetes insipidus (DI) for five years. He had a history of smoking 5–10 cigarettes a day for two years, but stopped smoking from the last month. The computerized tomography revealed thin-walled cystic lesions in different sizes more dominantly in the upper lobes and consolidated areas in the left upper and lower lobes. The wedge resection from the right lower lobe revealed pulmonary langerhans cell histiocytosis. Follow-up acid-fast bacteria (AFB) examinations revealed (+++) and antituberculous treatment was started. On the 40th day of the anti-tuberculosis treatment, the patient applied once again due to fever and chest pain. Although infiltrations persisted in the left upper and middle zones in the postero-anterior lung rontgenogram, right-sided pneumothorax was detected. The case is considered tuberculosis and the patient continued to receive anti-TB treatment under the close supervision.

Effect of serum interleukin-1 receptor antagonist level on survival of patients with non-small cell lung cancer

Due to poor prognosis in advanced non-small cell lung cancer (NSCLC), new effective markers are required in the monitoring of the disease. The present study aimed to investigate the association between the serum IL-1 receptor antagonist (IL-1Ra) level, overall survival (OS), and treatment response in NSCLC, and to evaluate the usefulness of the serum IL-1Ra level as a prognostic marker for NSCLC. Eighty patients (72 men and 8 women) and 40 healthy volunteers (13 men and 27 women) were included in the present study. The median progression-free survival was 16 weeks for patients with high serum IL-1Ra levels, and 35 weeks for patients with low serum IL-1Ra levels (P=0.027). The median OS was 38 weeks in patients with a high serum IL-1Ra level, and 62 weeks in patients with a low serum IL-1Ra level (P=0.065). The results of the present study have demonstrated that there was a significant correlation between IL-1Ra levels and NSCLC progression and survival, although the correlation between IL-1Ra levels and the response to treatment was not statistically significant. Therefore, the pre-treatment IL-1Ra level has been identified as a putative prognostic factor for NSCLC.

Relationship between hematological examination, glucose, HbA1c level, and disease stages in patients with obstructive sleep apnea syndrome

OBJECTIVE: Obstructive sleep apnea syndrome (OSAS) is an episodic disease that is characterized by intermittent partial interruption of breathing during sleep, which results in low oxygen levels in organs and tissues. The characteristic symptoms of OSAS include snoring, apnea or hypopnea, and excessive daytime sleepiness. Our aim is to determine the early diagnosis of diabetes and to initiate treatments for OSAS patients according to the results of polysomnography (PSG) in the sleep polyclinic based on fasting blood glucose and HbA1c levels in patients with known OSAS without diabetes. MATERIALS AND METHODS: Patients who applied to the sleep polyclinic of the Pamukkale University and were diagnosed with OSAS using PSG were included in the study. RESULTS: A total of 44 patients with OSAS and a control group consisting of 47 people meeting these criteria were included. Compared with the control group, the patient groups showed significantly higher Hb values (P < 0.05) and lower mean corpuscular volume (P < 0.05). Significant negative correlations were found between glucose levels and mean O2saturation values in patients with severe OSAS (apnea–hypopnea index > 30) (r = −0.583, P = 0.02). CONCLUSION: In conclusion, even though significant differences were not found in the glucose and HbA1c levels of patients with OSAS, glucose metabolism was deteriorated when saturation was decreased in severe OSAS. Therefore, glucose levels should be observed frequently, particularly in severe cases of OSAS or in patients with hypoxia, regardless of the stage. More attention should also be paid to the development of diabetes.

Impaired Hemorheology in Exacerbations of COPD

Background Chronic obstructive pulmonary disease (COPD) is characterized by progressive airflow limitation. Cardiovascular-related comorbidities are established to contribute to morbidity and mortality especially during exacerbations. The aim of the current study was to determine alterations in hemorheology (erythrocyte aggregation, deformability) in newly diagnosed COPD patients and their response to medical treatment and to compare with values of COPD patients with exacerbations. Materials and Methods The study comprised 13 COPD patients, 12 controls, and 16 COPD patients with exacerbations. The severity of COPD was determined according to Global Initiative for Chronic Obstructive Lung Disease guidelines. Red blood cell (RBC) deformability and aggregation were measured by an ektacytometer. Results RBC deformability of COPD patients with exacerbations was decreased compared to the other groups. Erythrocyte aggregation and plasma fibrinogen of COPD patients determined during exacerbations were higher than control. Conclusion Decreased RBC deformability and increased aggregation associated with exacerbations of COPD may serve as unfavorable mechanisms to worsen oxygenation and thus clinical symptoms of the patient. Treatment modalities that modify rheological parameters might be beneficial.

The Right Inferior Pulmonary Vein Related Inflammatory Myofibroblastic Tumor in an Adult Case

Inflammatory myofibroblastic tumor (IMT) is a rare neoplasm, which is derived of mesenchymal origin. Here we present an adult case with IMT, the origin of which was considered to be right inferior pulmonary vein. A male patient who was 52 years old, admitted to our outpatient clinic with the complaint of shortness of breath. He had cigarette smoking history for 30 years. On direct posterior - anterior X-Ray of the chest, a well-circumscribed mass with calcification in right hilum of the lung was observed. There was a mass which was extending to the inferior inferior pulmonary vein from right hilum of the lung, was measured 70 × 60 mm on computed tomography of the chest. Hamartoma, teratoma and Castleman Disease were among the possible diagnoses. On diagnostic bronchoscopy, signs of pressure from outside to the bronchi of the right middle and lower lobe was observed. Surgical excision is decided and the mass was totally excised through a muscle-sparing thoracotomy. The mass thought to arise from the inferior pulmonary vein on intraoperative inspection and right inferior lobe excision is undertaken by intrapericardial approach. No postoperative complication is encountered. Histological examination of the mass indicated inflammatory myofibroblastic tumor. Main treatment of IMT is surgical excision with negative surgical margin. Here in we present an IMT which is encountered at an unexpected location is excised completely with right lower lobe excision by an intrapericardial approach.