Irfan Ucgun

Environmental asbestos exposure and malignant pleural mesothelioma.

Asbestos-related benign and malignant pleural diseases are endemic in some rural parts of central Turkey because of environmental exposure to asbestos fibres. We report here epidemiological data on 113 patients with diffuse malignant pleural mesothelioma (DMPM) diagnosed in our clinic in Eskişehir, located in central Turkey. Of the 113 patients, 59 were men and 54 women (male:female ratio = 1). Ninety-seven patients (86%) had non-occupational asbestos exposure; all were living in villages. Their mean age was 56 years. As the patients had been exposed to asbestos from birth, the latency period was equivalent to the age of the patients. Twenty-eight patients (29%) had lived in villages their entire lives. The other 69 (71%) had been born in a village but migrated to the city or had given up white-soil usage for various reasons. The mean exposure time was 55 years for those with a long exposure period and 25 years for those with a short exposure period, but there was no significant difference between the age of the disease appearance for both groups (55 and 56 years, respectively). Thus, the latency time of mesothelioma due to environmental exposure to asbestos was longer than that due to occupational exposure, but independent of the length of exposure. Soil samples from 67 villages were analysed, comprising a population of 10,120 villagers. Tremolite and some other types of asbestos were found. In conclusion, DMPM in our region is due to mainly to environmental exposure to asbestos. The risk is substantial as a large proportion of the villagers are exposed. After smoking, asbestos exposure is one of the most serious health hazards in our rural population.

Nonmalignant pleural lesions due to environmental exposure to asbestos: a field-based, cross-sectional study

The aim of the present study was to investigate the frequencies of asbestos-related benign pleural diseases in villagers environmentally exposed to asbestos and the factors affecting these frequencies. A field-based, cross-sectional study was designed. In total, 991 villagers from 10 villages, randomly chosen from 67 villages with known use of asbestos-containing white soil in central Anatolia (Turkey), were investigated. The type of asbestos in the white soil was determined for each village, as well as air-borne fibre concentrations. The villagers were investigated with small-size chest roentgenograms and epidemiological features were recorded. The air-borne fibre levels were generally low. Despite this, pleural plaques were found in 14.4% of the villagers, 10.4% had diffuse pleural fibrosis and 0.4% asbestosis. The significant variables for plaques were age, sex, type of asbestos fibre, e.g. actinolite and tremolite, and exposure duration, while there was a negative relationship with cumulative exposure. The variables affecting diffuse pleural fibrosis were age, exposure duration and cumulative exposure. In conclusion, villagers exposed to environmental asbestos have high frequencies of pleural plaques and diffuse pleural fibrosis, similar to occupationally exposed asbestos cohorts. Different types of asbestos appear to result in different frequencies of pleural lesions.

Acute phase reactants and cytokine levels in unilateral community-acquired pneumonia.

Background: Bacterial infection of the lower respiratory tract initiates an acute inflammatory response. Regulation of the inflammatory response in bacterial pneumonia depends on a complex interaction between immune cells and inflammatory cytokines. Objectives: We investigated the initial levels of proinflammatory cytokines and acute phase reactants (APR), e.g. C-reactive protein (CRP), upon presentation of community-acquired pneumonia (CAP) in relation to clinical and laboratory indices of infection. Methods: We prospectively studied 28 consecutive patients with unilateral CAP. Tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-6 and IL-8 concentrations were measured by ELISA in both bronchoalveolar lavage (BAL) fluid and serum. Results: The concentrations of IL1-β and IL-6 in BAL fluid were found to be significantly higher in the involved lung than those in either the noninvolved lung (p = 0.008 and p = 0.012, respectively) or serum (p = 0.002 and p = 0.025, respectively). Serum CRP concentrations were increased compared to those in the involved and noninvolved lung in BAL fluid (p = 0.000 and p = 0.000, respectively). In serum and BAL from involved lung, IL-6 concentrations were higher in the systemic inflammatory response syndrome (SIRS) group than in the non-SIRS group (p < 0.05), whereas CRP, TNF-α , IL-1β and IL-8 concentrations showed no difference between SIRS and non-SIRS. There was no significant correlation between the acute physiology and chronic health evaluation II score and the cytokines. Conclusions: Our results indicate that the CRP level is higher in the serum than in the BAL fluid in the lung, and that IL-6 is the most important cytokine for the determination of the severity of the disease.

Epidemiology of pleural mesothelioma in a population with non‐occupational asbestos exposure

Background and objective:  This study describes the epidemiology of malignant pleural mesothelioma (MPM) in a rural population with environmental asbestos exposure.

Relationship of Metabolic Alkalosis, Azotemia and Morbidity in Patients with Chronic Obstructive Pulmonary Disease and Hypercapnia

Background: Exacerbation of chronic obstructive pulmonary disease (COPD) is an important cause of morbidity and mortality, but the effect of metabolic compensation of respiratory acidosis (RA) on mortality is not fully understood. Objective: To investigate the relationship between metabolic compensation and mortality in COPD patients with RA. Methods: We prospectively investigated all COPD patients with RA admitted to the respiratory intensive care unit between February 2001 and March 2007. Two hundred and thirteen patients (159 male, 54 female; mean age 65 ± 10.8 years) were divided into three groups (71 patients each) according to base excess (BE) levels: (1) low BE, (2) medium BE, and (3) high BE. H+ concentration was calculated according to their standard formula and BE was calculated according to the Van Slyke equation. Results: The overall mortality rate was 24.9%. The group mortality rates were 32, 17 and 25% in the low, medium and high BE groups, respectively (p = 0.001). When patients were divided into three groups according to the HCO3– levels, the group mortality rate was 59.1% in the low HCO3– group and 19.8% in the high HCO3– group. Based on univariate analysis, six factors affecting mortality were identified. However, multivariate analysis showed that the levels of serum HCO3– (p = 0.013; OR: 0.552; CI: 0.345–0.882) and creatinine (p = 0.019; OR: 2.114; CI: 1.132–3.949) had an independent effect. Conclusion: In patients with COPD exacerbation and hypercapnia, the development of sufficient metabolic compensation and adequate renal function significantly decreases mortality.

Recombinant factor VIIa treatment for life‐threatening haemoptysis

Abstract:  Diffuse alveolar haemorrhage is a severe clinical disorder that may be life‐threatening. The early diagnosis of diffuse alveolar haemorrhage and prompt intervention is crucial. Recombinant factor VIIa has been used extensively for the treatment of haemophilia A and B patients. More recently, recombinant factor VIIa has been used successfully for the treatment of bleeding in patients without pre‐existing coagulopathy. We describe the successful use of recombinant factor VIIa in a patient with diffuse alveolar haemorrhage secondary to pulmonary–renal syndrome.

A general evaluation on pulmonary nocardiosis due to three patients presenting with a mass like radiographic appearance on chest X-ray

Akciger nokardiyozisi, immun duskun hastalarda gorulen onemli bir firsatci enfeksiyondur. Nocardia turleri tarafindan olusturulan bu enfeksiyon akut, subakut ve kronik hastalik olarak karsimiza cikabilir. Spesifik tedavisi olmasina ragmen tanisindaki guclukler nedeniyle mortalitesi yuksek bir enfeksiyondur. Bizim calismamizdaki nokardiya olgularinin tamami akciger nokardiyozisi seklinde idi. Olgularimizdan birincisi bir yildir immun supresif tedavi goren renal transplant alicisi, ikincisi sistemik lupus eritematozus nedeniyle uzun suredir yuksek doz kortikosteroid ve metotreksat kullaniyordu, ucuncusu ise yeni tani almis kronik bobrek yetmezlikli idi. Calismamizda tum hastalarin mikrobiyolojik tanilari bronkoalveoler yikamada nokardiya turlerinin izole edilmesi ile konuldu. Hastalarin tumu hastaneden iyileserek taburcu edildi. Bir hastada tedavi suresi 12 ay, bir tanesinde 2 ay, diger hastada ise 3 ay surdu. Olgularimizdan elde edilen bulgular isiginda akciger nokardiyozisi ile ilgili olarak su sonuclara ulasildi; Nokardiyozis ozellikle hucresel immunitesi baskilanmis hastalarda dusunulmelidir, nokardiya suphesi olustugunda bu bilgi laboratuvara iletilmeli ve tedavi suresi hastaligin agirligi ve radyolojik cevaba gore duzenlenmelidir.