Hasan Kaynar

Primary hydatid cysts of the mediastinum

Hydatid disease remains a serious health problem for the Mediterranean countries, such as Turkey. Living in a rural area is an important risk factor for the disease. Hydatid cysts are usually located in the liver, lung, and brain. Mediastinal hydatid disease is very rare that have been only anecdotally in the literature. The objective of this study was to evaluate the clinical and radiographic findings and surgical treatment of this unusual lesion. Between 1985 and 2002, 11 cases with primary mediastinal hydatid cyst were treated surgically at our clinic. Median age was 28.4 and ranged from 19 to 46 years. Symptoms included chest pain in nine patients (82%), and cough in six patients (54%). The cyst was located in the anterior mediastinum in four patients (36%), in the posterior mediastinum in five patients (45%) and in the middle mediastinum in two patients (18%). All cysts were intact except one cyst that ruptured into right intrapleural space. Surgical approach was right thoracotomy in five patients (45%), left thoracotomy in three patients (27%), and median sternotomy in three patients (27%). Total pericystectomy was chosen as the surgical procedure in all patients except four (36%), who had cystectomy and local curettage for cyst located vital structures. There were no complications and mortality postoperatively. Primary hydatid cysts of the mediastinum are distinct clinical entity that must be considered when caring for a patient with a mediastinal mass in endemic regions. Because of surrounding vital structures the cyst should be treated without delay.

Prevalence and risk factors of allergies in Turkey: Results of a multicentric cross-sectional study in children

The Prevalence And Risk Factors of Allergies in Turkey (PARFAIT) study was planned to evaluate prevalence and risk factors of asthma and allergic diseases and also to find out which geographical variables and/or climatic conditions play a role determining the prevalence of allergic diseases in Turkish school children. Study was planned as cross‐sectional questionnaire‐based. About 25,843 questionnaires from 14 centers were appropriate for analysis. Parental history of allergy, having an atopic sibling and other atopic disease in index case was significant risk factors for all allergic diseases. Breast feeding decreased the risk of current asthma (OR: 0.92, CI: 0.86–0.99) and wheezing (OR: 0.93, CI: 0.87–0.99) but not allergic rhinitis and eczema. Respiratory infection in the past was an important risk factor for the occurrence of allergic diseases especially for asthma which was increased 4.53‐fold. Children exposed to household smoke were significantly at higher risk of asthma, wheezing, and allergic rhinitis (OR: 1.20, CI: 1.08–1.33; OR: 1.21, CI: 1.09–1.34; and OR: 1.32, CI: 1.21–1.43, respectively). All allergic diseases were increased in those children living in areas which have altitude of below 1000 m and mean yearly atmospheric pressure above 1000 mb. The study has suggested that household and country‐specific environmental factors are associated with asthma, wheezing, allergic rhinitis, and eczema risk during childhood in Turkey.

Prevalence and Risk Factors of Allergies in Turkey (PARFAIT): results of a multicentre cross-sectional study in adults

The Prevalence and Risk Factors of Allergies in Turkey (PARFAIT) study was planned to evaluate the prevalence of and risk factors for asthma and allergic diseases in Turkey. The present analysis used data from 25,843 parents of primary school children, obtained from a cross-sectional questionnaire-based study. A total of 25,843 questionnaires from 14 centres were evaluated. In rural areas, the prevalences asthma, wheezing, allergic rhinitis and eczema in males were: 8.5% (95% confidence interval (CI) 7.9–9.1%), 13.5% (95% CI 12.8–14.2%), 17.5% (95% CI 16.7–18.2%) and 10.8% (95% CI 10.2–11.4%), respectively; and in females were: 11.2% (95% CI 10.9–11.8%), 14.7% (95% CI 14.3–15.1%), 21.2% (95% CI 20.4–22.0%) and 13.1% (95% CI 12.4–13.8%), respectively. In urban areas, the corresponding prevalences in males were: 6.2% (95% CI 5.8–6.6%), 10.8% (95% CI 10.3–11.3%), 11.7% (95% CI 11.4–12.0%) and 6.6% (95% CI 6.2–7.0%), respectively; and in females were: 7.5 % (95% CI 7.9–7.1%), 12.0% (95% CI 11.7–12.3%), 17.0% (95% CI 16.4–17.6%) and 7.3% (95% CI 6.9–7.7%), respectively. Having an atopic first-degree relative or any other atopic diseases had significant effects on the prevalence of allergic diseases. Housing conditions, such as living in a shanty-type house, visible moulds at home and use of wood or biomass as heating or cooking material were associated with one or more allergic diseases. Although genetic susceptibility is strongly associated, country- and population-based environmental factors may contribute to increased prevalence rates of allergic diseases.

Bone mineral density in patients with obstructive sleep apnea syndrome.

PurposeObstructive sleep apnea syndrome (OSAS) is a disorder that is characterized by repetitive pauses in breathing during sleep. Airway obstruction episodes can lead to ischemia or hypoxia in tissues. Hypoxia may also have an effect on bone metabolism. In this study, we aim to investigate both the bone metabolic abnormalities and bone mineral density (BMD) in OSAS patients compared to individuals without OSAS.MethodsTwenty-one male patients with OSAS and 26 control subjects, also male, enrolled in this study. Serum calcium, phosphorus, alkaline phosphatase, and urinary desoxypiridinoline levels were measured in all participants, and BMD was evaluated using DEXA (Hologic QDR 2000). The BMD was measured in the lumbar spine (L1–L4), the femoral neck, and total femur region.ResultsNo statistically significant difference was noted between the two groups with respect to demographic data, except for body mass index (BMI). We adjusted the statistical analyses in line with the BMI and noted significant differences between OSAS patients and control subjects with regard to lumbar L1–L4 t score, lumbar L1–L4 BMD, and femoral neck BMD values (p ≤ 0.001). We find significant correlations with lumbar L1-L4 BMD (r = −0.4; p = 0.023) and lumbar L1–L4 t score values (r = −0.5; p = 0.012).ConclusionOur study indicates that there is a relationship between OSAS and osteoporosis. However, further controlled studies comprising a greater number of patients are needed to investigate the relationship between osteoporosis and OSAS.

Color Doppler Sonographically Guided Transthoracic Needle Aspiration of Lung and Mediastinal Masses

Objective. This study investigated the diagnostic value of color Doppler sonographically guided transthoracic needle aspiration in lung and mediastinal masses. Methods. B‐mode and color Doppler sonographic images were obtained in 48 patients with mediastinal or peripheral pulmonary tumors. Color Doppler sonography was used to show the vascular structures before the transthoracic needle aspiration procedure. It was also used to locate the needle tip during the procedure by showing the twinkling sign. This maneuver was performed with motion of the inner stylet. Pathologic and microbiological examination of the aspirates was made. Results. Vascular structures were detected in 37 cases on color Doppler images and in 10 cases on B‐mode images. Similarly, the needle tip was observed in 39 cases on color Doppler images but in only 9 cases on B‐mode images. No complications were observed except partial pneumothorax in 2 cases. The method had sensitivity of 90.0%, specificity of 87.5%, a positive predictive value of 97.2%, a negative predictive value of 63.6%, and diagnostic accuracy of 89.6%. Conclusions. Color Doppler sonographically guided transthoracic needle aspiration is a safe diagnostic method in malignant lung tumors, especially peripheral tumors, because of its ability to differentiate vascular structures within a tumor before the transthoracic needle aspiration procedure. It provides additional information about the location of the needle tip.

Serum IL-18 levels in tuberculosis: Comparison with pneumonia, lung cancer and healthy controls

Objective:  The aim of the present study was to document the serum IL‐18 levels in patients with pulmonary tuberculosis (P‐TB), extrapulmonary tuberculosis (EP‐TB), pneumonia, lung cancer and in healthy controls, and to investigate whether it may assist in the differential diagnosis of P‐TB.

The Effect of Pulmonary Hypertension on Left Ventricular Diastolic Function in Chronic Obstructive Lung Disease: A Tissue Doppler Imaging and Right Cardiac Catheterization Study

Pulmonary hypertension (PH) caused by chronic obstructive lung disease (COLD) essentially involves the right heart. Also left ventricular (LV) systolic and diastolic functions may be affected.

Effectiveness of pharmacologic therapies on smoking cessation success: three years results of a smoking cessation clinic

BackgroundPharmacologic therapies have an important role in the success of interventions for smoking cessation. This study aims to determine the efficacy of several pharmacologic treatments in patients who applied to a smoking cessation clinic.MethodsThis retrospective study includes 422 patients who presented to our smoking cessation clinic between January 2010 and June 2013, used the pharmacologic treatment as prescribed and completed the one-year follow-up period. All patients were assessed using the Fagerström Test for Nicotine Dependence (FTND) and received both behavioral therapy and pharmacotherapy. Patients’ smoking status at one year was assessed by telephone interview.ResultsThe patients were 24.3% female (103/422) and 75.7% male (319/422) with a mean age of 38 ± 10 years. Patients were divided into three groups: varenicline (166 patients), bupropion (148 patients) and nicotine replacement therapy (108 patients).The smoking cessation rates of these groups were 32.5%, 23% and 52.8%, respectively, and were statistically significant (p > 0.001). The overall success rate was 35%. Further analysis revealed that pharmacologic therapy (p > 0.001) and gender (p = 0.01) were factors that showed statistically significant effects on smoking cessation rates. Males had higher success rates than females. The overall relapse rate was 21.6% and the bupropion group showed the highest relapse rate among treatment groups. Lack of determination emerged as the most important factor leading to relapse.ConclusionNicotine replacement therapy was found to be more effective at promoting abstinence from smoking than other pharmacologic therapies.

PREVALENCE OF LEFT-HANDEDNESS AMONG PATIENTS WITH DIFFERENT RESPIRATORY DISEASES

We investigated the prevalence of left-handedness among patients with different respiratory diseases. Hand preference was assessed using the modified Edinburg Handedness Inventory. There was a statistically significant decline in left-handedness with shortened life span in patients. Difference among the rates of left-handedness in different pulmonary diseases was significant. The rate of left-handedness was lowest in patients with chronic obstructive pulmonary disease (2.14%) and pneumonia (2.04%) and highest in patients with asthma (12.96%). The results suggest that left-handed subjects may be protected from certain pulmonary diseases while being more susceptible to others.

Breast mass caused by rib tuberculosis abscess

Tuberculosis involving ribs and presenting with breast mass is a very rare entity and only a few cases have been reported in the literature previously. A 35 year-old patient had a retromammarial abscess revealed by a mass in the medial quadrant of right breast. Midsternal incision for abscess drainage and a partial resection of involved ribs was performed. Histopathologic evaluation revealed rib tuberculosis and secondary abscess formation in the right breast. This unusual manifestation of tuberculosis should be included in differential diagnosis of high-risk patients presenting with a breast mass.