Gökhan Çelik

Diagnostic value of leptin in tuberculous pleural effusions

It is suggested that leptin may be involved in inflammation. Although relation between leptin levels and active pulmonary tuberculosis has been studied, there is no information about relation between leptin levels and tuberculous pleural effusions (TPE).

Extrapulmonary involvement in patients with sarcoidosis in Turkey

Background and objective:  Extrapulmonary sarcoidosis is common, and is almost always associated with concomitant thoracic involvement. Extrapulmonary manifestations vary on the basis of gender, age at presentation and ethnicity. The aim of this study was to investigate extrapulmonary involvement in patients with sarcoidosis in Turkey.

Transformation of a Ruptured Giant Pulmonary Artery Aneurysm into an Air Cavity After Transcatheter Embolization in a Behçet’s Patient

Pulmonary artery aneurysms due to Behçet’s disease are mainly seen in young males and very rarely in females. To our knowledge there are only 10 cases reported in the related literature. Emergent transcatheter embolization was performed in a female patient with a known history of Behçet’s disease in whom massive hemoptysis developed because of rupture of a giant pulmonary artery aneurysm. At 6-month follow-up, transformation of the aneurysm sac into an air cavity was detected. To our knowledge, such a transformation has never been reported in the literature before. Embolization of the pulmonary artery aneurysm and the mechanism of cavity transformation are reviewed and discussed.

Ocular Involvement in Sarcoidosis

Purpose: To evaluate ocular involvement in patients with sarcoidosis. Methods: The prevalence of ocular manifestations was studied in 139 Turkish patients with sarcoidosis as a cross section. Color photography and fluorescein angiography were performed on patients suspected of having ocular involvement. Results: Ocular involvement was seen in 12.9% patients. Of 18 patients with ocular sarcoidosis, 39% had anterior and posterior involvement, 28% only anterior, 11% only posterior, 16.7% conjuctival, and 5.6% eyelid involvement. There was no statistically significant relationship between radiological grading and ocular involvement. Conclusions: The most common ocular involvement in this study was both anterior and posterior segment involvement.

High CD95 expression of BAL lymphocytes predicts chronic course in patients with sarcoidosis.

Background and objectives:  The prognosis of sarcoidosis is highly variable, with spontaneous remission in some patients. Apoptosis may be associated with spontaneous resolution of the granulomata. CD95 (Fas), an apoptotic molecule, and CD29 and CD45RO (T‐cell memory markers) are expressed at higher levels on T lymphocytes from sarcoid patients compared with normal subjects. However, the prognostic significance of CD95, CD29 and CD45RO expression in sarcoidosis is not clear. It was hypothesized that expression of CD95 would correlate with spontaneous remission.

Exercise capacity in sarcoidosis. Study of 29 patients

BACKGROUND AND OBJECTIVE Sarcoidosis is a systemic granulomatous disease of unknown etiology. Aims of this prospective study are to evaluate degree of impairment in pulmonary function tests (PFT), arterial blood gas analysis (ABG), respiratory muscle strength, exercise capacity and correlation of these parameters with radiological stages; to further evaluate the use of cardiopulmonary exercise testing in assessment of extent of pulmonary disease; and to discuss the pathophysiologic mechanisms of limitation in exercise capacity in patients with sarcoidosis. PATIENTS AND METHOD 29 patients with sarcoidosis were grouped according to their radiological stages (stage I: group 1; stage II, group 2; stage III, group 3). Groups 1, 2 and 3 included 11, 13 and 5 patients, respectively. PFT, cardiopulmonary exercise testing and ABG were performed for each patient. RESULTS Evaluation of all patients showed a significant decrement in exercise capacity. Patients in stage III had decreased diffusing capacity and exercise capacity. There was limitation in exercise capacity in stage I patients who had completely normal spirometry and diffusing capacity. We also found a correlation between radiological stages of the disease and exercise capacity, diffusing capacity and ABG. CONCLUSIONS Exercise capacity is impaired also in early stages of sarcoidosis and it was found to be the earliest impaired physiological parameter in sarcoid patients. Exercise intolerance, having mutifactorial basis, is correlated with radiological stages. Circulatory impairment and impaired heart rate response to exercise have effects on limitation in exercise capacity. Especially in advanced radiological stages of disease, ventilatory and gas exchange impairment also seems to be effective on limiting exercise in patients with sarcoidosis.

Subcutaneous sarcoidosis with plantar involvement.

Sarcoidosis is a multisystem granulomatous disorder of an unknown etiology. Subcutaneous sarcoidosis is a rare manifestation of sarcoidosis, and plantar involvement is extremely rare and there is only one such case report in the medical literature. Herein we present an interesting case of a patient who was diagnosed as having subcutaneous sarcoidosis at a plantar localization because plantar involvement is extremely rare and also because of the successful outcome after performing intralesional corticosteroid therapy.

Microscopic polyangiitis with unusual lung involvement.

Abstract:  Microscopic polyangiitis (MPA) is a non‐granulomatous, systemic and small vessel vasculitis accompanied by segmental necrotizing glomerulonephritis with no evidence of other small vessel disease. We report a patient with weakness, fever, and arthralgia whose CXR and thoracic CT showed widespread nodular infiltration. His proteinase‐3 anti‐neutrophilic cytoplasmic antibody (c‐ANCA) was positive. The serum creatinine was increased and haematuria subsequently developed. Renal biopsy revealed a focal segmental necrotizing glomerulonephritis which was compatible with MPA. He was treated with high‐dose corticosteroid and cyclophosphamide. Because of a worsening CXR and hypoxaemia, mechanical ventilation was applied. Despite this he died of respiratory failure following 20 days of treatment. Nodular infiltration is an unusual radiological pattern in patients with MPA and is the reason for this report.

Vascular Endothelial Growth Factor in Benign and Malignant Pleural Effusions

OBJECTIVE Vascular endothelial growth factor (VEGF) is a potent inducer of capillary permeability and its role as a crucial mediator in pleural fluid formation has been established. This study was conducted to assess the usefulness of VEGF for diagnosing malignant and non-malignant pleural effusions of various causes. PATIENTS AND METHODS VEGF levels in pleural effusions collected from 52 patients (20 with malignant effusion, 12 with tuberculous effusion, 10 with transudative effusion, and 10 with parapneumonic effusion) were assessed by enzyme-linked immunosorbent assay. RESULTS The median level of VEGF was significantly higher (P = .001) in exudative effusions (10.16 pg/mL) than in the transudative effusions (3.82 pg/mL). Although malignant pleural fluids tended to have higher median and mean levels of VEGF compared to tuberculous effusions, the difference was not statistically significant. Pleural VEGF levels in subtypes of lung cancer and in malignant effusions of different origins were not significantly different. CONCLUSIONS In conclusion, although VEGF levels in pleural effusions of different origins vary, they were only able to discriminate exudates from transudates significantly in this study. Further studies in larger groups of patients are needed to establish the role of VEGF in diagnosing malignant and/or tuberculous effusions.

El factor de crecimiento endotelial vascular en los derrames pleurales benignos y malignos

Objetivo El factor de crecimiento endotelial vascular (VEGF) es un potente inductor de la permeabilidad capilar y desempena un papel clave como mediador en la formacion del derrame pleural. Este estudio se ha realizado para evaluar la utilidad del VEGF en el diagnostico de los derrames pleurales malignos y no malignos de diversas causas. Pacientes y metodos Mediante la tecnica de inmunoabsorcion ligada a enzimas se determinaron las concentraciones de VEGF en los derrames pleurales correspondientes a 52 pacientes (20 con derrame pleural maligno, 12 con derrame de origen tuberculoso, 10 con derrame de tipo trasudado y 10 con derrame paraneumonico). Resultados La concentracion media del VEGF fue significativamente mayor (p = 0,001) en los derrames pleurales (10,16 pg/ml) de tipo exudado que en los derrames de tipo trasudado (3,82 pg/ml). Aunque los derrames pleurales malignos mostraron una tendencia a las concentraciones medianas y medias mayores de VEGF, en comparacion con los derrames de origen tuberculoso, la diferencia no fue estadisticamente significativa. Tampoco fueron significativamente diferentes las concentraciones pleurales de VEGF en los distintos subtipos de cancer pulmonar, y tampoco en los derrames malignos de distintos origenes. Conclusiones Aunque las concentraciones de VEGF son distintas en los derrames pleurales de origenes diferentes, en nuestro estudio no han permitido discriminar los exudados de los trasudados. Son necesarios nuevos estudios de investigacion sobre grupos mas numerosos de pacientes con objeto de establecer el papel que puede desempenar la concentracion de VEGF en el diagnostico de los derrames malignos, tuberculosos o ambos.