Mehmet Ali Habesoglu

Clinical, radiologic, and functional evaluation of 304 patients with bronchiectasis

BACKGROUND: Bronchiectasis continues to be one of the major causes of morbidity and mortality in developing countries, with a probably underestimated higher prevalence than in developed countries. OBJECTIVE: To assess the clinical profile of adult patients with bronchiectasis. METHODS: We retrospectively reviewed the clinical, radiologic, and physiologic findings of 304 patients with bronchiectasis confirmed by high-resolution computed tomography. RESULTS: Mean age of participants (45.7% males, 54.3% females) was 56 ± 25 years and 65.8% of them were lifetime non-smokers. Most common identified causes of bronchiectasis were childhood disease (22.7%), tuberculosis (15.5%), and pneumonia (11.5%). The predominant symptoms were productive cough (83.6%), dyspnea (72%), and hemoptysis (21.1%). The most common findings on chest examination were crackles (71.1%) and rhonchi (28.3%). Types of bronchiectasis were cylindrical in 47%, varicose in 9.9%, cystic in 45.1%, and multiple types in 24.3%. Involvement was multilobar in 75.3% and bilateral in 62.5%. Of 274 patients, 20.8% displayed normal pulmonary function test results, whereas 47.4%, 8% and 23.7% showed obstructive, restrictive, and mixed pattern, respectively. Patients with cystic disease had a higher frequency of hemoptysis (42%) and a greater degree of functional impairment, compared to other types. CONCLUSION: In patients with bronchiectasis from southern Turkey, generally presenting with recurrent productive cough, hemoptysis, dyspnea, and persistent bibasilar rales, the etiology remains mainly idiopathic. Post-infectious bronchial destruction is one of the major identified underlying pathological processes. The clinical picture and the deterioration of the pulmonary function test might be more severe in patients with cystic type bronchiectasis.

Multiple primary chest wall hydatid cysts associated with spinal canal involvement

Primary multiple chest wall hydatid cysts associated with spinal canal involvement through an intervertebral foramen is an uncommon clinical entity. We present a 54-year-old man who underwent cystotomy and total resection of ribs five through seven via a left posterolateral thoracotomy followed by Th5-Th6 anterolateral partial pediculotomies for removal of cysts in the spinal canal. Although spinal reconstruction was not required, the chest wall defect was repaired with mersilene mesh-methyl methacrylate sandwich graft. Hydatid disease should be considered in the differential diagnosis of mass lesions located in the chest wall. In cases of spinal canal involvement, detailed visualization of spinal canal utilizing MRI and/or CT is essential for planning surgical approach.

Propylthiouracil-Associated Eosinophilic Pleural Effusion: A Case Report

We describe an unusual case of a patient with eosinophilic pleural effusion (EPE) associated with long-term propylthiouracil (PTU) administration. A 43-year-old woman was admitted to our hospital after complaining of chest pain. She had had Graves’ disease, which had been treated with PTU for 11 years. Right-sided pleural effusion was detected and the result of thoracentesis confirmed an EPE. The patient’s detailed medical evaluation failed to reveal any other cause of EPE. PTU was terminated since it was thought to be the cause. Despite withdrawal of the medication, however, the pleural effusion persisted for 6 weeks, and steroid therapy was planned for 15 days in decreasing dosages. During the control visit 10 days after the initiation of steroid therapy, no pleural effusion was observed, and the steroid was discontinued. Rechallenge with PTU produced recurrent pleural effusion. Therapy with PTU was again terminated, and treatment with methimazole and a brief course of low-dose corticosteroids were begun. Chest radiography revealed disappearance of the effusion within 10 days and it did not recur during a 1-year follow-up. To our knowledge, there is only 1 other case in the English-language literature describing EPE caused by PTU. Our report is of particular importance because it describes the development of that disorder in the 11th year of PTU treatment. It also shows that steroid therapy can be effective in treating drug-induced EPE.

Effect of radiological extent and severity of bronchiectasis on pulmonary function.

BackgroundThe aim of this study was to ascertain the effect of the extent and severity of bronchiectasis as determined with high-resolution computed tomography (HRCT) on lung function in patients with pure bronchiectasis, bronchiectasis and asthma, and bronchiectasis and chronic obstructive pulmonary disease (COPD).MethodsOne hundred nineteen patients (71 with pure bronchiectasis, 25 asthmatic patients with bronchiectasis, and 23 COPD patients with bronchiectasis) underwent HRCT and pulmonary function tests. Computed tomography features were scored by the consensus of 2 radiologists.ResultsThere were no statistically significant differences among the 3 patient groups regarding the extent of bronchiectasis, bronchial dilatation degree, bronchial wall thickening, decreased attenuation in the lung parenchyma, or presence of mucus in the large and small airways. In the pure bronchiectasis group, a negative correlation was found between forced vital capacity (FVC) % of predicted, forced expiratory volume in 1 sec (FEV1) % of predicted, the FEV1/FVC ratio and the extent of bronchiectasis, bronchial wall thickening, bronchial wall dilatation, and decreased attenuation. At multivariate analysis the main morphologic changes associated with impairment of FVC and FEV1 were the extent of bronchiectasis and a decreased attenuation in the lung parenchyma. The decrease in the FEV1/FVC ratio was associated with bronchial wall dilatation. No correlation was found between morphologic changes and indices of pulmonary function in the asthma and COPD patients.ConclusionsMorphologic changes associated with bronchiectasis do not influence lung function in patients with asthma and COPD directly, although they do play a role in impairing pulmonary function in patients with bronchiectasis alone.RiassuntoPremessaScopo di questo studio era verificare leffetto della estensione e della gravità delle bronchiectasie, determinate mediante tomografia computerizzata ad alta risoluzione (HRCT), sulla funzionalità respiratoria nei pazienti con bronchiectasie semplici, bronchiectasie e asma, e con broncopneumopatia cronica ostruttiva (BPCO) e bronchiectasie.Metodi119 pazienti (71 pazienti con bronchiectasie semplici, 25 pazienti asmatici con bronchiectasie, e 23 pazienti con BPCO e bronchiectasie) sono stati sottoposti ad HRCT e prove di funzionalità respiratoria. I punteggi delle HRCT sono stati attribuiti sulla base di un consenso tra 2 radiologi.RisultatiNon ci sono state differenze statisticamente significative tra i 3 gruppi di pazienti riguardo all’estensione delle bronchiectasie, al grado di dilatazione bronchiale, all’ispessimento della parete bronchiale, alla riduzione di attenuazione del parenchima polmonare, o alla presenza di muco nelle grandi e piccole vie aeree. Nel gruppo con bronchiectasie semplici, una correlazione negativa è stata trovata fra FVC (% del teorico), FEV1 (% del teorico), rapporto FEV1/FVC ed estensione delle bronchiectasie, ispessimento della parete bronchiale, dilatazione della parete bronchiale e riduzione di attenuazione. Lanalisi multivariata ha mostrato che i cambiamenti morfologici principali associati al deterioramento di FVC e FEV1 sono l’estensione delle bronchiectasie e la riduzione di attenuazione nel parenchima polmonare. La diminuzione del rapporto FEV1/FVC è associata a dilatazione della parete bronchiale. Nessuna correlazione è stata riscontrata tra le variazioni morfologiche e gli indici respiratori nei pazienti con asma e BPCO.ConclusioniLe modificazioni morfologiche associate a bronchiectasie non influenzano direttamente la funzionalità respiratoria nei pazienti con asma e BPCO, ma hanno un ruolo nel deterioramento della funzionalità respiratoria nei pazienti con bronchiectasie semplici.

Epidemiology of NIV for Acute Respiratory Failure in COPD Patients: Results from the International Surveys vs. the “Real World”

ABSTRACT Non-invasive ventilation (NIV) has been recommended as the first-line ventilation modality for acute respiratory failure (ARF) due to acute exacerbation of chronic obstructive pulmonary disease (AECOPD) based on strong evidence. However, everyday clinical practice may differ from findings of multiple randomized controlled trials. Physicians and respiratory therapists involved in NIV management have been queried about its utilization and effectiveness. In addition to these estimates, cohort studies and analysis of large inpatient dataset of patients with AECOPD and ARF managed with NIV have been extensively published over the last two decades. This review summarizes the perception of medical staff vs. the “real life” data about NIV use for ARF in AECOPD patients.