Levent Dalar

Can red blood cell distribution width predict severity of obstructive sleep apnea syndrome

STUDY OBJECTIVES Red blood cell distribution width (RDW) is a newly recognized risk marker for various diseases. We evaluated the value of RDW in predicting the severity of obstructive sleep apnea syndrome (OSAS). METHODS From retrospective analyses of 526 patients admitted to our sleep laboratory for polysomnography between January 2010 and July 2011, 108 patients with complete medical records and hemogram analyses were evaluated. RESULTS The study population consisted of 108 patients (age: 49.16 ± 11.1 [range 16-76] years; 72 [66.7%] males). In the overall population, the mean RDW was 14.04 (± 2.37), and 31 patients (28.7%) had RDW > 15. RDW increased significantly with increased severity of OSAS (p = 0.046) and was positively correlated with the apnea-hypopnea index (p = 0.002, r = 0.300), even in the non-anemic group (p = 0.013, r = 0.291). The apnea-hypopnea index was significantly higher in the group with high RDW (> 15; p = 0.046). RDW was negatively correlated with sleep time (p = 0.028, r = 0.217), average oxygen saturation of hemoglobin (p = 0.003, r = -0.239), and minimum desaturation value (p = 0.016, r = -0.235). CONCLUSIONS In patients referred with a clinical diagnosis of OSAS, RDW may be a marker for the severity of the condition. As RDW is usually included in a complete blood count, it could provide an inexpensive tool for triaging OSAS patients for polysomnography evaluation.

Bronchoscopic Treatment in the Management of Benign Tracheal Stenosis: Choices for Simple and Complex Tracheal Stenosis

BACKGROUND Bronchoscopic treatment is 1 of the treatment choices for both palliative and definitive treatment of benign tracheal stenosis. There is no consensus on the management of these patients, however, especially patients having complex stenoses. The aim of the present study was to assess, in the largest group of patients with complex stenoses yet reported, which types of tracheal stenosis are amenable to optimal management by bronchoscopic treatment. METHODS The present study was a retrospective cohort study including 132 consecutive patients with benign tracheal stenoses diagnosed between August 2005 and January 2013. The mean age of the study population was 52 ± 18 years; 62 (47%) were women and 70 (53%) were men. Their lesions were classified as simple and complex stenoses. RESULTS Simple stenoses (n = 6) were treated with 12 rigid and flexible bronchoscopic procedures (mean of 2 per patient); 5 stents were placed. The total success rate was 100%. Among the 124 complex stenoses, 4 were treated directly with surgical intervention. In total, 481 rigid and 487 flexible bronchoscopic procedures were performed in these patients. In this group, the success rate was 69.8%. CONCLUSIONS From the present study, we propose that after accurate classification, interventional bronchoscopic management may have an important role in the treatment of benign tracheal stenosis. Bronchoscopic treatment should be considered as first-line therapy for simple stenoses, whereas complex stenoses need a multidisciplinary approach and often require surgical intervention. However, bronchoscopic treatment may be a valid conservative approach in the management of patients with complex tracheal stenosis who are not eligible for operative treatment.

Evaluation of Six Patients with Pulmonary Carcinosarcoma with a Literature Review

Background. Carcinosarcoma of the lung is a rare malignant neoplasm. We evaluated the diagnosis and treatment of six carcinosarcoma cases, including a synchronous tumour and a solitary pulmonary tumour, along with the clinical and histological features and survival times. Methods. From a retrospective analysis of 1076 non-small-cell lung cancer resections performed between January 1996 and January 2011, six patients (0.5%) with pulmonary carcinosarcoma (all males; mean age 58 years; range 53–66) who underwent surgical treatment were studied. Results. The mean tumour pathological T diameter was 7.2 cm (median 6 cm, range 3–14.5 cm). Only one patient was diagnosed with carcinosarcoma preoperatively. The clinical presentation and tumour localisations differed. The operations performed were a lobectomy (n = 4), pneumonectomy (n = 1), and bilobectomy (n = 1). Histologically, the epithelial characteristics of the tumours were consistent with squamous cell carcinoma in most of the patients. A complete resection was performed in all six patients. No mortality occurred in the early postoperative period. The median survival time was 9 (3–25) months. Conclusion. The preoperative diagnosis of carcinosarcoma of the lung is difficult due to the composition of the different histopathological structures. Complete surgical resection is the treatment of choice for pulmonary carcinosarcoma, although further studies are needed.

Correlation between the intima-media thickness and Framingham risk score in patients with sleep apnea syndrome.

BACKGROUND In the present study, we want to demonstrate the correlation between obstructive sleep apnea syndrome (OSAS) whose independent effect on carotid artery intima-media thickness (IMT) was demonstrated, with Framingham risk score (FRS) showing the overall cardiovascular risk. METHODS IMT of the carotid artery was measured with ultrasonography and 10-year risk of coronary heart disease (CHD) was defined with FRS in 90 consecutive patients referred to our sleep clinic and who underwent polysomnography (PSG), with vascular risk factors and without a clinical atherosclerotic disease. RESULTS IMT and FRS were found to be statistically significantly increased in the severe OSAS group compared to the other two groups. Carotid IMT was found to be significantly positively correlated with, apnea-hypopnea index (AHI), oxygen desaturation index (ODI) and time duration with oxygen saturation (SpO2) <90%, and negatively correlated with minimum oxygen saturation at sleep (minimum SpO2) and mean SpO2. In control and mild OSAS group IMT and FRS have significantly positive correlation (r: 0.501, P: 0.027; r: 0.625, P<0.001), while in severe OSAS group no significant correlation was detected between IMT and FRS (r: 0.321, P: 0.06). In the regression analysis AHI and ODI were found to be an independent predictor of carotid IMT. ODI was found to have an independent effect on the progression of atherosclerosis. CONCLUSIONS Increased carotid IMT in severe OSAS group could not be explained with the classical risk factors. In this respect, FRS might be insufficient to determine correctly the cardiovascular risk and protection strategies against the disease in OSAS patients.

Complete blood count alterations after six months of continuous positive airway pressure treatment in patients with severe obstructive sleep apnea.

STUDY OBJECTIVES The cardiovascular complications caused by obstructive sleep apnea (OSA) decrease after continuous positive airway pressure treatment (CPAP). Mean platelet volume (MPV), platelet distribution width (PDW), and red cell distribution width (RDW) are newly recognized tools for assessing cardiovascular risk. METHODS From a selection of patients with symptoms of nocturnal snoring and/or excessive daytime sleepiness, 36 males with an apnea-hypopnea index (AHI) > 30/h and 22 age-matched normal male controls with AHI < 5/h were included. Patients with OSA underwent another night of CPAP titration, and 11 patients were excluded at the 6-month evaluation due to poor compliance with the home CPAP therapy. Complete blood count parameters of compliant patients and the control group were evaluated. RESULTS Compared to controls, MPV values were significantly higher (p = 0.025) in OSA patients, but no significant differences in PDW or RDW were found (p > 0.05). Six months of CPAP therapy resulted in significantly lower MPV values but increased values of PDW and RDW in patients with severe OSA (p = 0.001, p = 0.007, p = 0.001, respectively). CONCLUSION Our data suggest that complete blood count parameters in OSA patients such as MPV, PDW and RDW change significantly after CPAP therapy.

Endobronchial Treatment of Carcinoid Tumors of the Lung

BACKGROUND Bronchial carcinoid tumors are known as low-grade malignancies. Surgery has been proposed as the best treatment of choice for lung carcinoids. However, less invasive treatment approaches may be considered due to low-grade malignancy potential of such tumors. The aim of this study was to review the results of endobronchial treatments of carcinoid tumors of the lung and to compare with the outcome after surgery. METHODS Initial complete tumor eradication with an endobronchial treatment was attempted for 29 patients. Diode laser or argon plasma coagulation was used during these treatments. Cryotherapy or laser treatments were applied consecutively in patients for whom there was good bronchoscopic visualization of the distal and basal tumor margins and no evidence of bronchial wall involvement. Surgery was performed in cases of atypical carcinoid and in cases of nonvisualization of the basal and distal part of the tumor. RESULTS Overall, 29 patients have been included (median age 58 years; range, 23-77 years). Median follow-up has been 49 months (range, 22-94 months). A total of 24 patients (69%) had typical carcinoid tumor, 5 patients (31%) had atypical carcinoid tumor. Initial endobronchial treatment provided complete tumor eradication in 21 of 29 patients (72%). Of the eight other patients (28%), two were atypical carcinoids, and underwent surgical treatment. There was no tumor-related death and no recurrence during the follow-up in both groups. There was no difference for survival or recurrence between the surgical and the endobronchial treatment group of patients (p > 0.05). CONCLUSION Endobronchial treatment may be considered as safe, effective treatment for typical carcinoid tumors in the central airways. Addition of initial endobronchial treatment had no negative effect on the surgical outcome.

Is Mean Platelet Volume Really a Severity Marker for Obstructive Sleep Apnea Syndrome without Comorbidities

Obstructive sleep apnea syndrome (OSAS) is a common disorder that can lead to significant cardiovascular complications. Several studies have reported increased platelet activation and aggregation in patients with OSAS. In this study we aimed to show a correlation between mean platelet volume (MPV) and severity of OSAS in patients with OSAS without any overt cardiac disease or diabetes. The polysomnography recordings of 556 consecutive patients admitted to the sleep laboratory between January 2012 and July 2012 were retrospectively evaluated. The relationship between polysomnographic parameters and biochemical parameters was assessed. Polysomnographic results of 200 patients (154 males [77%]; mean age, 44.5 ± 11.4 years) were included. No correlation was observed between MPV and the average oxygen saturation index, the minimum desaturation index, or the oxygen desaturation index in the study population as well as in severe OSAS group (AHI > 30). The only correlation was found between MPV and AHI in the severe OSAS group (P = 0.010). MPV was not correlated with OSAS severity in patients without any overt cardiac disease or diabetes. These findings raise doubts about the suggestion that MPV might be a marker for OSAS severity, as recommended in earlier studies. Thus, further prospective data are needed.

Application of non-invasive mechanical ventilation in an asthmatic pregnant woman in respiratory failure: a case report

The use of non-invasive mechanical ventilation (NIV) during an asthma attack is controversial. We report a case of a 28-year-old female patient in her 16th week of pregnancy with community-acquired pneumonia who presented during an asthma attack, which led to hypoxic respiratory failure. She was successfully treated using NIV. This case is worth discussing as it includes two clinical conditions in which NIV is often considered contraindicated.

The relationship between the attitudes of patients’ relatives towards organ donation and transplantation and their social profiles

Objective: In our country organ donations have not been achieved at the desired level and the reason of this issue is that social consciousness in this regard has not been created yet. In this study, the aim was to determine the relationship between the attitudes of patients’ relatives towards organ donation and their social profiles. Material and Methods: Of 206 subjects who agreed to participate in the study among patient’s relatives of the inpatients hospitalised in Yedikule Chest Disease Education and Research Hospital between September 5th and 11th of 2011, were included in the study. Sociodemographic characteristics and the attitudes of the participants were collected with a questionnaire prepared by the investigators. Percentages, one-way analysis of variance (ANOVA) test and Student’s t-test were used to analyze the results. Results: The results showed that 88.3% of the participants did not donate organs to date, 45.6% did not know where to apply for organ donation, 62.1% has no information about the subject and 74% were approving organ donation. 40.8% were hesitant to donate the organs of a relative when he/she lost his/her life. We determined that subjects who are male, single, college graduate, worker, with a high economic status, without a chronic disease, who follow the news, who make use of their spare time properly, with non-crowded households and who are from Aegean region had positive attitudes about organ donation and transplantation; whereas participants who are female, married, illiterate, housewife, with low economic status, with a chronic disease, who do not follow the news, who do not have free time at home, with crowded households and who are from Black Sea region were found to have negative attitudes (p

Bronchoscopic palliation to treat endobronchial metastasis of the tracheobronchial tree

BACKGROUND Endobronchial metastases (EBM) are rarely observed, but they are caused by a number of different tumors. Bronchoscopy is the main approach for both differential diagnosis and to maintain endoluminal palliation. In this study, consecutive EBM cases that had been diagnosed and treated were evaluated in a retrospective cohort. METHODS In total, 18 pathologically verified patients with EBM originating from extrathoracic tumors who were referred to our interventional pulmonology unit with respiratory symptoms were retrospectively evaluated. Tumor type, metastasis location, treatment method and frequency, and complications were evaluated. RESULTS In total, there were 18 patients (13 women) with EBM enrolled in this study. All were diagnosed by a bronchial biopsy. The mean age of the patients was 48±15.24 years (range: 24-76 years). The most frequent sites of origin of the metastases were the bone (5) and kidney. Obstructions were observed in the tracheas of 12 patients, in the right main bronchi of 10, and in the left main bronchi of 11. Twelve airway stents were placed in nine patients. The removal of the obstruction was effective in the remaining patients. The mean number of treatment applications was 1.47 (range: 1-3). Hemorrhage, mucostasis, and granulation were observed. The median follow-up duration was 528 days (range: 62-1177 days). The median survival time for the patients who died was 122 days (range: 2-885 days). CONCLUSIONS EBM is rare, and bronchoscopy is the primary method of diagnosis, followed by palliation, if necessary.