Hasan Kahraman

Eight years follow-up of a case with idiopathic pulmonary hemosiderosis after corticosteroid therapy

Idiopathic pulmonary hemosiderosis is characterized by recurrent episodes of alveolar hemorrhage, hemoptysis, and secondary iron deficiency anemia with unknown etiology. It generally emerges in childhood and adolescence periods but rarely found in adulthood. Definite diagnosis is established by appearing the hemosiderin-laden macrophages at sputum, bronchoalveolar lavage, or open lung biopsy. We reported a male patient who was born in 1975, expectorated blood since 1995, and was diagnosed in 1998. He received many blood replacements. He admitted to our clinic in 2003 with complaints of coughing up blood, shortness of breath, and tiredness. We gave the corticosteroid therapy to patient for 6-month period. After treatment, the patient did not have any complaints. Clinicians should keep in mind that idiopathic pulmonary hemosiderosis may differ in localization on chest X-ray and corticosteroid treatment should be started when diagnosis is established.

Pneumoconiosis in dental technicians: HRCT and pulmonary function findings

BACKGROUND Pneumoconiosis is a form of diffuse interstitial lung disease, often resulting from occupational exposures. As dental prosthetic technicians (DPTs) build prostheses, they are exposed to many chemical materials that increase their risk of developing pneumoconiosis. AIMS To document pulmonary function and prevalence of pneumoconiosis in DPTs. METHODS A cross-sectional study of DPTs working in prosthetic laboratories who underwent pulmonary function test and high-resolution chest computed tomography (HRCT) scanning. RESULTS There were 76 participants and pneumoconiosis was diagnosed in 46%. The most commonly seen radiological finding was round opacities, present in 38%. Agreement among HRCT readers was moderate to good. As defined by HRCT, emphysema was diagnosed more often in those with a longer occupational history or a history of smoking, and low carbon monoxide diffusion capacity (DLCO), but not in those with pneumoconiosis. Forced expiratory rate and DLCO were significantly lower in those who had worked 16 years or more (all P < 0.05). DLCO values were significantly lower in technicians with emphysema and in current smokers (all P < 0.01). Round opacities were also present in a substantial proportion of DPTs who had 15 years or less exposure. Because HRCT is able to detect radiological changes of occupational lung disease very early, the prevalence of pneumoconiosis in our participants was quite high. CONCLUSIONS Pneumoconiosis identified by HRCT was present in almost half of DPTs surveyed. Appropriate education and workplace protection should be given to DPTs in order to prevent exposure to hazardous materials in dental prosthetics laboratories.

Temperament and character profiles of male COPD patients

BACKGROUND Chronic obstructive pulmonary disease (COPD) is a respiratory disorder, and is characterized by persistent airflow obstruction. These patients are exposed to severe physical limitations and substantial psychosocial trouble. The aims of this study were to determine the temperament and character profiles of personality in patients with COPD and to compare the results with those of healthy controls. METHODS Thirty-nine male COPD patients and 67 age- and gender-matched healthy controls completed the self-administered 240-item temperament and character inventory (TCI) and 14-item hospital anxiety and depression scale. The relationships between temperament and character personality profiles and clinical factors such as severity of COPD, anxiety, and depression were evaluated. RESULTS COPD patients had significantly higher mean scores of Harm avoidance and lower mean score of Self-directedness than those of healthy controls. In the COPD patients, the anxiety score was significantly higher (P=0.03) and the depression score was found to be insignificantly higher than that of control group. The TCI profiles were not correlated with the severity of COPD. In COPD patients, Self-directedness and Cooperativeness traits of TCI character negatively correlated with anxiety, but any of traits did not correlate with depression. CONCLUSIONS The present study defined the Harm avoidance score was higher and Self-directedness was lower in COPD patients and the COPD severity did not correlate with any of the personality trait. We suggest that during evaluation of COPD patients for treatment, personality trait should also be considered in clinical practice.

Protective Effects of Erythropoietin and N-Acetylcysteine on Methotrexate-Induced Lung Injury in Rats

OBJECTIVE Methotrexate (MTX) is known to have deleterious side effects on lung tissue. We aimed to investigate the effects of erythropoietin (EPO) and N-acetyl-cysteine (NAC) on MTX-induced lung injury in rats. STUDY DESIGN Animal experiment. MATERIAL AND METHODS Twenty-six female Sprague-Dawley rats were divided into 4 groups. Sham group, 0.3 mL saline; MTX group, 5 mg/kg MTX; EPO group, 5mg/kg MTX and 2000 IU/kg EPO; NAC group, 5 mg/kg MTX and 200 mg/kg NAC were administered once daily for 4 consecutive days. Malondialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT) and inflammation and congestion scores in lung tissues were evaluated. RESULTS In MTX group MDA were significantly higher, CAT and SOD were significantly lower than in sham, EPO and NAC groups (p<0.005). In EPO group MDA, CAT, and SOD were higher, but not significant than those in group NAC (p>0.005). In group MTX both scores were significantly higher than in sham (p<0.005). The congestion score of group MTX was significantly higher than those of group EPO and NAC (p<0.005). CONCLUSION EPO and NAC have significant preventive effects on MTX-induced lung injury in rats. Decreased antioxidant capacity and increased MDA level may cause the oxidative damage in MTX group. Also, higher antioxidant capacity and lower MDA level may be a response to oxidative stress in EPO and NAC groups.

Isolated Pancreatic Tuberculosis Mimicking Malignancy and Causing Obstructive Jaundice

Isolated pancreatic tuberculosis (TB) is unusual, but obstructive jaundice secondary to pancreaticobiliary TB is extremely rare. The mechanisms by which tuberculosis causes bile duct obstruction are varied. Here, we describe a patient with pancreatic tuberculosis which mimicked pancreatic carcinoma with biliary obstruction clinically–radiologically. A 60-year-old woman presented with a history of progressive jaundice, nausea, vomiting, and weight loss. There was no prior history of tuberculosis or family history of contact. Chest X-ray was normal. Abdominal ultrasound examination revealed an irregular hypoechoic lesion of 3 cm in the pancreatic head with dilation of entire bile duct system, mild dilated pancreatic duct, and distended gall bladder. Contrast-enhanced computed tomography (CT) scan showed a heterogeneous hypodense mass in the pancreatic head that cannot be a clear margin from pancreas and mild dilated pancreatic duct (Fig. 1). In addition, peripancreatic peripherally enhancing enlarged necrotic lymph nodes were seen (Fig. 2). A preliminary diagnosis of a periampullary carcinoma was made. Exploratory laparotomy revealed a mass and multiple peripancreatic lymph nodes. Histological examination of intraoperative frozen section of nodal biopsies showed granulomas with giant cells and no evidence of malignancy. Cholecystectomy and bilioduodenal anastomosis were performed. More lymph nodes and the mass biopsies were obtained for specific histological examination. This confirmed caseous granulomatous inflammation with abundant acid-fast bacilli on Ziehl–Neelsen staining (Fig. 3). Specific antituberculosis treatment was started. Six months later, the patient has no symptoms, neither jaundice; the CT control shows a complete resolution of the pancreatic mass (Fig. 4). Only 32 patients with obstructive jaundice due to isolated pancreatic tuberculosis have been reported in detail so far [1–25]. Four mechanisms have been identified [26]: Isolated TB of the pancreas itself may cause pseudoneoplastic obstructive jaundice [1–13], as in our case; it may be secondary to TB lymphadenitis causing compression [26–28]; biliary stricture after biliary tuberculosis, mimicking cholangiocarcinoma [29–31]; and TB can create a retroperitoneal mass leading to biliary tree obstruction [32, 33]. Several studies have reported that common bile duct (CBD) and the pancreatic duct are usually normal in patients with pancreatic tuberculosis, even with a centrally located head mass [18, 34, 35]. However, in our case, both the ducts were dilated. A recent study described that pancreatic duct was dilated in approximately 80% patients of pancreatic adenocarcinoma, whereas it was dilated in 17% of patients with pancreatic tuberculosis [7]. F. Ozkan (*) : E. Bulbuloglu :M. Yuksel Faculty of Medicine, Department of Radiology, Kahramanmaras Sutcu Imam University, 46050 Kahramanmaras, Turkey e-mail: sanjiv@ummc.edu.myc

Cryptogenic organising pneumonia presenting with bilateral hilar and mediastinal lymphadenopathy

Cryptogenic organising pneumonia is not considered in the differential diagnosis of bilateral hilar and mediastinal lymphadenopathy. We submitted a patient presenting with bilateral hilar and mediastinal lymphadenopathy. We suspected diagnosis of sarcoidosis, but the patient was diagnosed as cryptogenic organising pneumonia with the histological result. This is the second case report of cryptogenic organising pneumonia presenting with bilateral hilar and mediastinal lymphadenopathy.

The Affecting Factors and Comparison of Tuberculin Skin Test in Peritoneal Dialysis and Hemodialysis Patients

Compared with the general population, patients with chronic renal failure have increased tuberculosis (TB) prevalence and mortality rates. In this study, we aimed to investigate tuberculin skin test (TST) positivity rates in hemodialysis (HD) and peritoneal dialysis (PD) patients and the factors influencing TST positivity. Ninety-two HD patients and 44 PD patients who had been on HD and PD treatment for at least 3 months were recruited into the study. TST was administered in all patients. Positivity was defined as an induration diameter >10 mm. At least 5 mm of induration following skin testing together with a chest radiography indicating previous infection was defined as latent TB infection. TST positivity rates, diameter of TST indurations, and serum albumin levels in HD patients were higher than the PD patients. TST induration size was not correlated with any other parameters in both HD and PD groups. TST-positive patients had higher albumin levels and lower leukocyte count than the TST-negative patients. In TST-positive patients, albumin level was correlated with the duration of dialysis but TST induration size was not correlated with the lymphocyte count and albumin level. In our study, TST positivity of patients was found in 30.4% of HD patients, 9% of PD patients, and 23.5% of total patients. It is still recommended to use TST for the screening test of TB. We found a significant relationship between TST and albumin level. It should be remembered that TST response may be lower in PD patients, especially in cases in which TB is suspected.

Scimitar syndrome with renal agenesis

Partial pulmonary venous connection anomaly is relatively uncommon form of congenital heart diseases. The quite rare combination of this anomaly with hypoplasia of the right lung and dextroposition of the heart is designated as scimitar syndrome. Most cases are presented in infantile period and adult presentation is exceedingly rare. Our patient, a 38-year-old man, was admitted to a doctor with flu-like complaint and because of abnormalities on chest X-ray he was sent to our clinic. He did not have any chronic complaints such as shortness of breath and fatigue. After investigation, scimitar syndrome was diagnosed. Left renal agenesis was determined with abdominal examination. Best of our knowledge in literature we did not detect any case both with Scimitar syndrome and renal agenesis, and we wanted to report the asymptomatic adult Scimitar syndrome case with left renal agenesis.

A Case of Spontaneously Resolved Bilateral Primary Spontaneous Pneumothorax

DOI: 10.4328/JCAM.1036 Received: 19.04.2012 Accepted: 28.04.2012 Printed: 01.05.2015 J Clin Anal Med 2015;6(3): 380-1 Corresponding Author: Hasan Kahraman, Kahramanmaraş Sütçü İmam Üniversitesi, Yörükselim Mahallesi, Kahramanmaraş, 46050, Türkiye. T.: +90 3442212371 GSM: +905338164036 E-Mail:drhasankahraman@hotmail.com Özet Herhangi bir travma hikayesi ya da akciğer hastalığı olmayan kişilerde intraplevral boşlukta hava birikmesi durumuna, primer spontan pnömotoraks (PSP) olarak adlandırılır. Onaltı yaşında erkek hasta 3 gün önce başlayan nefes darlığı ve göğüs ağrısı şikâyeti ile başvurdu. Dinlemekle sağ akciğerde solunum sesinin şiddeti azalmıştı. Hastanın çekilen akciğer grafisinde sağda pnömotoraks saptanması üzerine hastaya göğüs tüpü takıldı. Anamnezinde, 2 ay önce nefes darlığı şikâyeti ile doktora başvurduğu, akciğer grafisi ve muayene bulgularına göre patolojik bir durumun olmadığı söylenmiş ve nefes darlığı 1-2 hafta içinde zamanla kaybolmuş. Hastanın 2 ay önceki grafisi retrospektif olarak incelendiğinde bilateral PSP olduğu görüldü. Spontan düzelmesi olan bilateral PSP vakasının nadir olması ve literatüre katkı sağlayacağı düşüncesi ile sunuldu. Göğüs ağrısı ve nefes darlığı ile kliniğe başvuran hastalarda ayırıcı tanıda pnömotoraks’ ın düşünülmesi gerekmektedir.

Bone Cement Pulmonary Embolism after Percutaneous Vertebroplasty

Percutaneous vertebroplasty (PVP) is a common procedure for treatment of painful vertebral fractures. Although PVP is considered minimally invasive, complications may occur during the procedure. Bone cement pulmonary embolism (CPE) is a severe and potentially life-threatening complication following vertebroplasty (VP). CPE commonly occurs after performing VP, but hemodynamically it has little clinical impact. Treatment strategies of CPE is still unclear.