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Water-pipe smoking effects on pulmonary permeability using technetium-99m DTPA inhalation scintigraphy

ObjectiveAlthough extensive work has been done on cigarette smoking and its effects on pulmonary function, there are limited number of studies on water-pipe smoking. The effects of water-pipe smoking on health are not widely investigated. The aim of this study was to determine the effects of water-pipe smoking on pulmonary permeability.MethodsTechnetium-99m DTPA inhalation scintigraphy was performed on 14 water-pipe smoker volunteers (all men, mean age 53.7 ± 9.8) and 11 passive smoker volunteers (1 woman, 10 men, mean age 43.8 ± 12). Clearance half-time (T 1/2) was calculated by placing a monoexponential fit on the time activity curves. Penetration index (PI) of the radioaerosol was also calculated.ResultsPI was 0.58 ±0.14 and 0.50 ± 0.12 for water-pipe smokers (WPS) and passive smokers (PS) respectively. T1/2 of peripheral lung was 57.3 ± 12.7 and 64.6 ± 13.2 min, central airways was 55.8 ± 23.5 and 80.1 ± 35.2 min for WPS and PS, respectively (p ≤ 0.05). FEV1/FVC% was 82.1 ± 8.5 (%) and 87.7 ± 6.5 (%) for WPS and PS, respectively (0.025 < p ≤ 0.05).ConclusionsWe suggest that water-pipe smoking effects pulmonary epithelial permeability more than passive smoking. Increased central mucociliary clearance in water-pipe smoking may be due to preserved humidity of the airway tracts.

Gait speed as a functional capacity indicator in patients with chronic obstructive pulmonary disease

AIM: Walking distance is generally accepted as a functional capacity determinant in chronic obstructive pulmonary disease (COPD). However, the use of gait speed in COPD patients has not been directly investigated. Thus, the aim of our study was to assess the use of gait speed as a functional capacity indicator in COPD patients. METHODS: A total 511 patients with mild-to-very severe COPD and 113 healthy controls were included. The lung functions (pulmonary function test), general health- and disease-related quality of life (Medical Outcomes Study 36-Item Short-Form of Health Survey, St Georges Respiratory Questionnaire), and gait speed (6-minute walk test) were assessed. RESULTS: The mean gait speed values were slower in moderate (75.7 ± 14.0 m/min), severe (64.3 ± 16.5 m/min), and very severe (60.2 ± 15.5 m/min) COPD patients than controls (81.3 ± 14.3 m/min). There were significant correlations between gait speed and age, dyspnea-leg fatigue severities, pulmonary function test results (FEV1, FVC, FVC%, FEV1/FVC ratio, PEF, PEF%), and all subscores of Medical Outcomes Study 36-Item Short-Form of Health Survey and activity, impact and total subscores of St Georges Respiratory Questionnaire in patients with moderate, severe, and very severe COPD. However, these correlations were higher especially in patients with severe and very severe COPD. CONCLUSIONS: As a conclusion, according to our results gait speed slows down with increasing COPD severity. Also, gait speed has correlations with age, clinical symptoms, pulmonary functions, and quality of life scores in COPD patients. Thus, we consider that gait speed might be used as a functional capacity indicator, especially for patients with severe and very severe COPD.

Effect of home-based pulmonary rehabilitation in patients with idiopathic pulmonary fibrosis

ObjectiveThe aim of this study was to investigate the effects of a home-based pulmonary rehabilitation program on the functional outcome parameters in patients with idiopathic pulmonary fibrosis (IPF).DesignA prospective study.PatientsSeventeen patients diagnosed with IPF.MethodsA home-based pulmonary rehabilitation program was carried out in 17 IPF patients for 12 weeks. Dyspnea severity during daily life activities (Medical Research Council Scale), pulmonary function (pulmonary function test), exercise capacity (6-minute walking test, 6MWD), and general health related quality of life (Medical Outcomes Short Form-36) were evaluated.ResultsA significant decrease in perceived dyspnea (p = 0.003) and leg fatigue (p < 0.05) severities, and an increase in the 6MWD (p = 0.04) and general health related quality of life scores (health perception, physical role, and emotional status subscores) were found after the program (p < 0.05).ConclusionHome-based pulmonary rehabilitation may reduce dyspnea and fatigue severities, and improve exercise capacity and health-related quality of life in patients with IPF. In the treatment of IPF patients, home-based pulmonary rehabilitation programs should be placed alongside the routine treatment options.RiassuntoObiettivoScopo di questo studio era valutare gli effetti di un programma di riabilitazione respiratoria domiciliare sugli indicatori funzionali nei pazienti con fibrosi polmonare idiopatica(IPF). Disegno dello studio: Studio prospetticoPazientiDiciassette pazienti con diagnosi di IPFMetodiUn programma di riabilitazione respiratoria della durata di 12 settimane è stato applicato in 17 pazienti con IPF. Sono state oggetto di valutazione l’intensità della dispnea durante le attività quotidiane (Medical Research Council Scale), la funzionalità respiratoria (prove di funzionalità respiratoria), la capacità di esercizio fisico (test del cammino di 6 minuti - 6MWD), ed il livello complessivo di qualità della vita legato alla salute(Medical Outcomes Short Form-36)RisultatiAl termine del programma sono stati rilevati una riduzione significativa della gravità della dispnea percepita (p = 0,003) e dell’affaticabilità degli arti inferiori (p < 0,05), un incremento del 6MWD (p = 0,04) e punteggi del questionario sulla qualità di vita (nei sottogruppi di percezione del proprio stato di salute, ruolo fisico e di condizione emotiva) (p < 0,05)ConclusioniUn programma di riabilitazione respiratoria domiciliare può ridurre l’intensità della dispnea e dell’affaticabilità, migliorare la capacità di esercizio fisico e la qualità di vita rela tivaalla salute in pazienti con IPF. Nel trattamento dei pazienti con IPF i programmi di riabilitazione respiratoria domiciliari dovrebbero perciò essere inclusi nelle opzioni terapeutiche diroutine

Tc-99m-HMPAO uptake by bronchoalveolar cells.

Lung uptake of intravenously injected Tc-99m-HMPAO is observed in smokers and in lung toxicity due to various agents. We investigated the Tc-99m-HMPAO uptake of bronchoalveolar lavage (BAL) cells in the lungs after incubation inin vitro conditions (6 patients), intravenous injection (IV) (7 patients) and inhalation (INH) (6 patients) of Tc-99m-HMPAO in order to show whether BAL cells are also responsible for Tc-99m-HMPAO uptake in the lungs. Cell/supernatant (C/S) count ratio was 7.0±3.5, 29.3±40.8 and 8.4±4.5 forin vitro, IV and INH groups, respectively. C/Sin vitro showed a positive correlation with % alveolar macrophages (r=0.943, p=0.0048) and a negative correlation with % neutrophils (r=−0.945, p=0.0045). Cells/whole BAL fluid ratio correlated with the amount of daily cigarette consumption in INH group (r=0.95, p=0.0037). Tc-99m-HMPAO showed adherence to mucus after inhalation. Tc-99m-HMPAO diffuses into alveolar spaces after, injection and is present in BAL fluid and BAL cells both after injection and inhalation. Glutathione concentration and oxido-reductive state of the epithelial lining fluid and BAL cells may influence the lung uptake of Tc-99m-HMPAO.

Morgagni hernia: late diagnosis in a case with Down syndrome.

Accessible online at: www.karger.com/res A 37-year-old woman was admitted for right-sided chest pain for the previous 1–1.5 months. She had been taken to an emergency service for abdominal ache, nausea and vomiting 1.5 months previously. No chest X-ray was taken in the emergency service as pulmonary symptoms were absent. She was of short stature, and developmental retardation was evident besides her mongoloid face. In the pulmonary system, auscultation respiratory sounds were decreased in the right lower zone. The right cardiac contour was not easily detected on chest X-ray. A nonhomogenous increase in density, which had its convexity facing the lateral chest wall, was detected in the right middle and lower zones (fig. 1). A defect in the diaphragm localized at the cardiophrenic sinus in the anterior mediastinum, as well as herniated intestinal segments, were seen on the thorax CT (fig. 2). A hernia sac with a diameter of 20 cm showing adhesions to the anterior chest wall, pericardium and lung was seen during the surgery. Congenital diaphragmatic hernias usually develop posterolaterally, but Morgagni hernias (MHs) are retrosternal and account for 3% of congenital diaphragmatic hernias; they are 90% right-sided. In Down syndrome, accompanying abnormalities may be present. MH is an uncommon defect accounting for only 3% of such abnormalities. Hernias of Morgagni’s foramen are found on the medial or anterior side of the diaphragm and are localized parasternally or retrosternally [1]. Diagnosis is confirmed by showing an empty hernia sac with barium enema, CT or ultrasonography. Fusion of the pleuroperitoneal membrane with the septum transversum in the 8th fetal week makes up the diaphragm. MHs occur as a result of an embryological defect in the septum transversum between the lateral aspect of the diaphragm and the anterior chest wall [1]. A literature review showed variations in age distribution between neonatal and 12 years in patients with concurrence of Down syndrome and MH [2]. Although a transabdominal approach has been advocated, we performed transthoracic surgery because of adhesions to surrounding tissue in the present case. Treatment of MH is surgery even if cases are asymptomatic because of the risk of intestinal obstruction and perforation [1]. We wish to emphasize the association of Down syndrome with MH, which can stay asymptomatic until an advanced age. In such cases with late presentation, as there is the possibility of adhesion of the hernia sac to intrathoracic organs, a transthoracic surgical approach is preferred, which is an easy and safe procedure. References 1 Kı̇lı̇ç D, Nadir A, Döner E, Kavukcu Ş, Akal M, Özdemir N, Akay H, Ökten I: Transthoracic approach in surgical management of Morgagni hernia. Eur J Cardiothorac Surg 2001;20:1016–1019. 2 Becmeur F, Chevalier-Kauffmann I, Frey G, Sauvage P: Laparoscopic treatment of a diaphragmatic hernia through the foramen of Morgagni in children. A case report and review of eleven cases reported in the adult literature (in French). Ann Chir 1998;52:1060–1063. Fig. 1. Appearance of the lung before surgery in our case. Fig. 2. CT of the thorax showed significant omental fatty tissue and herniated intestinal segments in the right chest cavity. 1

Corticosteroid Responsive Sarcoidosis with Multisystemic Involvement Years after Initial Diagnosis: A Lymphoma Mimicker on 18-FDG PET/CT

Sarcoidosis is a chronic multisystemic inflammatory disease characterized by noncaseating epithelioid cell granulomas. 18-Fluorodeoxyglucose positron-emission tomography/computer tomography (FDG-PET/CT) is increasingly used in routine clinical practice to assess active sarcoidosis because it can detect active inflammatory granulomatous disease. However, active sarcoidosis lesions are observed to be hypermetabolic on FDG-PET/CT much like malignancies, which may lead to misinterpretation on imaging. In this case report, we present a rare case of sarcoidosis with multisystem involvement including lung, lymph nodes, bone, pleura, and soft tissue that mimicked lymphoma on FDG-PET/CT and responded to corticosteroid treatment.

Postpneumonectomy Bronchopleural Fistula Formation and Surgical Management

Bronchopleural fistulas and empyema are the most challenging problems after lung resection. We reviewed 4 cases of successful surgical treatment of postpneumonectomy bronchopleural fistulas. Three of the patients had empyema. Primary suturing and pleural decortication were performed in one patient, decortication and fistula repair with additional omentopexy were carried out in the other 3 patients. Recurrence in one patient was successfully treated by thoracoplasty; the others have had no recurrence on follow-up. We recommend aggressive surgical intervention as the most effective treatment for bronchopleural fistula and empyema after pulmonary resection.

Primary Pulmonary Paraganglioma

A 2-cm nodular mass was detected by thoracic computed tomography in the peripheral region of the right middle lobe of the lung in a 60-year-old female with a 5-year history of cough and respiratory distress. The resected tumor was diagnosed as a primary paraganglioma on pathologic examination.