Fatih Yakar

Does hormonal control obviate positive airway pressure therapy in acromegaly with sleep-disordered breathing?

INTRODUCTIONnAcromegaly is a disease in which uncontrolled release of growth hormone occurs after closure of epiphyseal plates, causing changes in the body that can lead to sleep disordered breathing (SDB). No definite guidelines regarding the treatment of SDB in acromegaly are available. In this study, we aimed to investigate the prevalence of SDB in acromegaly and whether hormonal control alters the necessity of positive airway pressure (PAP) therapy in acromegaly patients with SDB.nnnMETHODSnForty-two acromegaly patients were included in the study and divided into two groups according to disease status, i.e., active or well controlled. All patients underwent polysomnography. Fourteen patients with active acromegaly were diagnosed with SDB and were evaluated for PAP therapy with polysomnography both before and 6 months after disease control was achieved.nnnRESULTSnSleep-disorder breathing was diagnosed in 22 of 42 patients, 7 of 20 patients with controlled-disease and 15 of 20 patients with active diseases. There were significant reductions in respiratory disturbance index (RDI), apnea index, desaturation index, central apnea number, and rapid eye movement-phase RDI at the control polysomnography. Initially, PAP therapy was indicated in 12 of 14 patients and PAP therapy indication held in 11 patients after acromegaly control was achieved.nnnCONCLUSIONnOur study revealed that over half of patients with acromegaly had SDB. Furthermore, SDB severity decreases with acromegaly treatment; however, this decrease does not change the indication for PAP therapy; therefore, PAP therapy should not be delayed in acromegalic SDB patients.

Combination and comparison of two models in prognosis of pulmonary embolism: Results from TUrkey Pulmonary Embolism Group (TUPEG) study☆

BACKGROUNDnClinical parameters, biomarkers and imaging-based risk stratification are widely accepted in pulmonary embolism(PE). The present study has investigated the prognostic role of simplified Pulmonary Embolism Severity Index (sPESI) score and the European Society of Cardiology (ESC) model.nnnMETHODSnThis prospective cohort study included a total of 1078 patients from a multi-center registry, with objectively confirmed acute symptomatic PE. The primary endpoint was all-cause mortality during the first 30days, and the secondary endpoint included all-cause mortality, nonfatal symptomatic recurrent PE, or nonfatal major bleeding.nnnRESULTSnOf the 1078 study patients, 95 (8.8%) died within 30days of diagnosis. There was no significant difference between non-low-risk patients ESC [12.2% (103 of 754;)] and high-risk patients as per the sPESI [11.6% (103 of 796)] for 30-day mortality. The nonfatal secondary endpoint occurred in 2.8% of patients in the the sPESI low-risk and 1.9% in the ESC low-risk group. Thirty-day mortality occurred in 2.2% of patients the sPESI low-risk and in 2.2% the ESC low-risk group (P=NS). In the present study, in the combination of the sPESI low-risk and ESC model low-risk mortality rate was 0%.nnnCONCLUSIONSnThe sPESI and the ESC model showed a similar performance regarding 30-day mortality and secondary outcomes in the present study. However, the combination of these two models appears to be particularly valuable in PE.

Prognostic importance of central thrombus in hemodynamically stable patients with pulmonary embolism

BACKGROUNDnThe association between mortality and localization of central thrombus in hemodynamically stable patients with pulmonary embolism (PE) is unclear. Sufficient data are not available to help clinicians to select between low molecular weight heparin (LMWH), unfractionated heparin (UFH) and thrombolytics for the management of central thrombus. The present study aims to investigate whether central thrombus in the pulmonary artery affects 30-day mortality rate, and to compare the outcomes of different treatment approaches in patients with central thrombus.nnnMETHODSnThis multi-central, prospective, observational study included 874 hemodynamically stable patients with PE confirmed by multidetector computed tomography scan. The localization of the emboli was evaluated and categorized as central (saddle or at least one main pulmonary artery), lobar or distal. The primary study outcome was 30-day all-cause mortality.nnnRESULTSnLocalization of the emboli was central in 319 (36.5%) patients, lobar in 264 (30.2%) and distal in 291 (33.2%) patients. Seventy-four (8.5%) patients died during the 30-day follow-up period. All-cause mortality rate was 11.9%, 6.8% and 6.2% in patients with central, lobar, and distal emboli, respectively (p < 0.001). Multivariate analysis did not show that hemodynamically stable central thrombus was an independent predictor of mortality. Additionally, mortality rate was not significantly different between UFH, LMWH and thrombolytic therapy groups.nnnCONCLUSIONSnThe present study showed that central thrombus was not an independent predictor of mortality in hemodynamically stable PE patients. LMWH and UFH were similarly effective in the treatment of this patient group.

COPD: an underdiagnosed disease at hospital environment

SummaryBackground and AimChronic obstructive pulmonary disease (COPD) is a serious disease with morbidity and mortality due to delayed diagnosis until significant symptoms arise. We aimed to assess the utility of spirometry and COPD Assessment Test (CAT) in detecting undiagnosed COPD patients in a localized area.Material and MethodsPeople who came to the hospital for patient visit or examination with a smoking history ofu2009>u200910 pack-years (>u200940 years old), and with no known chest disease were invited to study. The participants completed a questionnaire and performed spirometry. Spirometry was performed according to ATS/ERS Task Force on spirometry. COPD was defined as according to the Global Initiative for Chronic Obstructive Lung Disease guidelines.ResultsThere were 800 subjects screened, and 648, capable of performing spirometry, were included to the study. The mean age was 48.3u2009±u20099.0 and 38u2009% of the study population was male. Post-bronchodilator FEV1/FVC ratio was lower than 0.70 in 17u2009% of the subjects. Median (25–75 percentiles) total CAT scores and among the questions of CAT; cough, phlegm, chest tightness and breathlessness scores for COPD and non-COPD subjects were; 15(9–22) vs 12(6–18) (pu2009u2009=u2009.004), 2(1–3) vs 1(0–2) (pu2009u2009<u2009.001), 2(0–3) vs 1(0–3) (pu2009u2009=u2009.004), 3(1–4) vs 2(0–3) (pu2009u2009>u2009.001), 4(3–5) vs 3(2–4) (pu2009u2009=u2009.001), respectively. Symptom prevalence was as follows: exertional dyspnea 91u2009%, dyspnea 80.9u2009%, cough 56.3u2009% and phlegm 58.3u2009% in COPD.ConclusionOur study showed that spirometric screening together with the CAT questionnaire may improve the awareness of disease and may determine undiagnosed patients.ZusammenfassungHintergrund und Ziel der StudieDie chronisch obstruktive Lungenerkrankung (COPD) ist eine ernsthafte Erkrankung mit einer Morbidität und Mortalität vor allem auf Grund verspäteter Diagnosestellung oft erst nach Auftreten von Symptomen. Ziel unserer Studie war es, die Nützlichkeit der Spirometrie und des COPD Assessments Test (CAT) bei der Erfassung von Patienten mit einer vorher nicht bekannter COPD in einer begrenzten Umgebung zu erfassen.Material und MethodenPersonen, die das Spital zum Krankenbesuch oder für eine Untersuchung aufsuchten, die eine Raucher Anamnese vonu2009>u200910 Packungsjahren (u2009>u200940 Jahre alt) hatten und bei denen keine Erkrankung des Thorax bekannt war, wurden eingeladen, an der Studie teilzunehmen. Es wurde bei den Teilnehmern nach Ausfüllen eines Fragebogens eine Spirometrie entsprechend der „ATS/ERS Task Force on Spirometry“ durchgeführt. Eine COPD wurde entsprechend der Leitlinien der „Global Initiative for Chronic Obstructive Lung Disease“ diagnostiziert.Ergebnisse800 Personen wurden zur Teilnahme an der Studie aufgefordert. Die 648 dieser Personen, die in der Lage waren, sich einer Spirometrie zu unterziehen, wurden in die Studie aufgenommen. Das mittlere Alter lag bei 48,3 ± 9,0 und 38u2009% der Teilnehmer waren männlich. Der post-bronchodilatorische FEV1/FVC Quotient war bei 17u2009% der Teilnehmer unter 0,70.Folgende mediane Werte (25–75 Perzentile) für die Gesamt CAT Scores und für die CAT Fragen Husten, Schleim, Engegefühl in der Brust und Atemnot wurden bei den COPD Patienten, beziehungsweise bei den Personen ohne COPD erhoben: 15 (9–22) vs 12 (6–18) (p = 0,004), 2 (1–3) vs 1 (0–2) (p < 0,001), 2 (0–3) vs 1 (0–3) (p = 0,004), 3 (1–4) vs 2 (0–3) (p > 0,001), 4 (3–5) vs 3 (2–4) (p = 0,001). Es ergab sich bei den COPD Patienten folgende Prävalenz von Symptomen: Belastungsdyspnoe bei 91u2009%, Dyspnoe bei 80,9u2009%, Husten bei 56,3u2009%, Schleim bei 58,3u2009%.SchlussfolgerungUnsere Studie zeigt, dass ein Screening mit Spirometrie gemeinsam mit der Erhebung eines CAT Fragebogens das Bewusstsein für eine COPD verbessern kann und dass auf diese Art die Diagnose bei Patienten erstellt werden kann, bei denen die Erkrankung vorher nicht bekannt war.

Intense FDG uptake on PET/CT in the upper and lower respiratory system indicative of Wegener's granulomatosis

Wegeners granulomatosis (WG) is an uncommon systemic vasculitis, which involves the upper and lower respiratory tracts and the kidneys. Because the patients generally present with clinical manifestations that are similar to common diseases, WG may be initially misdiagnosed as infection or malignancy. We report the case of a 55-year-old male presenting with weight loss, cough, hemoptysis, low-grade fever, and pulmonary nodules detected on the thoracic CT scan. Malignancy was initially suspected, so a PET/CT was performed. It demonstrated intense FDG uptake in the upper and lower respiratory system. The diagnosis of WG was based on PET findings, elevated serum levels of inflammatory markers, and the presence of c-ANCA. We consider that the knowledge of FDG-PET/CT findings may help to make an easier and earlier diagnosis of WG.

Acromegaly and Sleep Disordered Breathing

Acromegaly is the result of oversecretion of growth hormone and IGF-1 and the disease can affect several organ systems. Sleep Disordered Breathing (SDB) is a frequent disease in acromegaly patients. The mechanism of SDB is somewhat different in acromegaly patients than SDB in normal population. Although central apneas can be seen, obstructive apneas according to structural changes complicate the course of the disease. Treatment of SDB is as important as the treatment of acromegaly. In this review, we searched the medical literature and summarized the etiology, pathogenesis, mechanism of SDB development and treatment of SDB in acromegaly patients.

Relationship of CTLA4 and CD28 polymorphisms with lung involvement, HRCT findings and pulmonary function tests in Turkish patients with ankylosing spondylitis

Ankylosing spondylitis (AS) is a multisystem disorder with ocular, pulmonary, and cardiovascular involvement. The incidence of pulmonary involvement varies from 1 to 52%. Abnormal T‐cell function‐derived immune responses are involved in AS pathogenesis. Numerous genes such as CTLA4 and CD28 control T‐cell functions. In this study, we aimed to address the relationship between CTLA4 and CD28 polymorphisms and lung involvement in Turkish patients with AS.