Meltem Tor

Review of Cases with Cystic Hydatid Lung Disease in a Tertiary Referral Hospital Located in an Endemic Region: A 10 Years’ Experience

Background: Echinococcus disease is endemic in sheep-and cattle-raising areas world wide. Its prevalence is also high in the Mediterranean region including Turkey. Objective: To determine the presentation, approach to surgical treatment and outcome of hydatid disease in an endemic region. Methods: From January 1989 to December 1998 288 patients, aged between 1 and 71 years with a mean age of 31 years (134 female, 154 male), were operated on for pulmonary hydatidosis. Clinical charts of the patients were reviewed retrospectively in a tertiary referral hospital. Results: Of 288 patients, 30 patients were asymptomatic, the rest (89%) were symptomatic, cough and chest pain being the most common symptoms. Fifty-three patients (18%) had associated liver hydatid cysts. Bilateral lung hydatid cysts were present in 18 patients (6%). Recurrent hydatid cysts were observed in 33 patients (11%). Seventy-seven patients (27%) presented with complicated hydatid cysts. Postoperative morbidity was observed in 3 patients [bronchopleural fistula (2), infection of the cyst space (1)] and postoperative mortality in 1 patient who presented with hydatid lung disease associated with liver and brain cysts. In the remaining 98.6%, no complications were noted. Conclusions: In conclusion, hydatidosis is still an important public health problem in Turkey and in an endemic country such as Turkey hydatid lung disease should be considered initially in a patient presenting with a corresponding chest roentgenogram and a compatible epidemiologic history. Surgery is indicated in all symptomatic and/or enlarging or infected cysts. When necessary lobectomy or wedge resection can be the procedure of choice. Single-stage combined resection is preferred in hydatid lung disease with associated liver hydatid cysts. Total postoperative complication and mortality rate is low and we recommend a close follow-up of the operated cases to diagnose postoperative recurrence early in its course.

Detection of SV40 DNA sequences in malignant mesothelioma specimens from the United States, but not from Turkey.

The incidence of malignant mesothelioma (MM) shows a strong epidemiological association with exposure to asbestos fibers. Recently, simian virus 40 (SV40) DNA sequences have been reported in MM tumor specimens from the United States and several European countries, and the SV40 tumor virus has been implicated as a potential co‐factor in the etiology of this disease. However, several large studies from the US, Finland, and Turkey did not detect SV40 sequences in MM samples. To address this discrepancy, MM specimens from Turkey and the US were analyzed in the same laboratory under identical conditions to detect the presence of SV40 DNA. We detected SV40 sequences in 4 of 11 specimens from the United States, but in none of the 9 Turkish samples examined. These findings suggest that geographical differences exist with regard to the involvement of SV40 in human tumors. J. Cell. Biochem. 84: 455–459, 2002.

Extrapulmonary tuberculosis in non-human immunodeficiency virus-infected adults in an endemic region

AIMS: Extrapulmonary tuberculosis (EPTB) still constitutes an important clinical problem. We aimed to evaluate the incidence and features of extrapulmonary tuberculosis. MATERIALS AND METHODS: We retrospectively evaluated 14,266 tuberculosis patients diagnosed between January 1999 and December 2003 in a tertiary care hospital in Istanbul. As many as 2,435 patients (17.1%) with EPTB were evaluated for the incidence and features. RESULTS: Of the 14,266 patients, 4,154 were female (29%) and 10,112 were male (71%) and were aged between 14 and 86 years with a mean age of 35 ± 14 years. As many as 660 (17.9%) patients were diagnosed as EPTB in 1999, 568 (17.8%) in 2000, 357 (13.7%) in 2001, 462 (22%) in 2002 and 388 (14.5%) in 2003. EPTB presented most commonly as pleurisy (66%), followed by lymphadenitis (23%). Lymphadenitis and pleurisy were more commonly observed among female TB patients (60%) and among male TB patients (59%) respectively. EPTB showed a significant female predilection (26.8%) compared to male patients (13.1%). Multi-organ involvement was observed in 37 (1.5%) patients (two organs in 33 and three organs in 4). As many as 197 (8%) EPTB cases had pulmonary tuberculosis simultaneously. CONCLUSIONS: EPTB still constitutes an important clinical problem. The rates of EPTB have remained constant despite the decline in pulmonary tuberculosis cases. In the current study, we present our experience of the incidence and features of EPTB patients without HIV infection. In this study, EPTB cases constituted one-fifth of all tuberculosis cases presented to our center in the study period.

Clinical Factors Affecting the Direct Cost of Patients Hospitalized with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Background: Chronic obstructive pulmonary disease (COPD) is a disease of increasing significance in terms of economic and social burden due to its increasing prevalence and high costs. Direct costs of COPD are mostly associated with hospitalization expenditures. In this study, our objective was to investigate the costs of hospitalization and factors affecting these costs in patients hospitalized due to acute exacerbation of COPD (AECOPD). Methods: A total of 284 patients hospitalized AECOPD were included in the study. Data were examined retrospectively using the electronic hospital charts. Results: Mean duration of hospitalization was 11.38 ± 6.94 days among study patients. Rates of admission to the intensive care unit, initiation of non-invasive mechanical ventilation (NIMV) and invasive mechanical ventilation (MIV) were 37.3% (n=106), 44.4% (n=126) and 18.3% (n=52) respectively. The rate of mortality was 14.8% (n=42). Mean cost of a single patient hospitalized for an AECOPD was calculated as

Smoking Prevalence, Behaviour and Nicotine Addiction among Coal Workers in Zonguldak, Turkey

1765 ± 2139. Mean cost of admission was

Fourteen-Year Trend of Tuberculosis Dynamics in the Northwest of Turkey

889 ± 533 in standard ward, and

Syncope as a presentation of acute pulmonary embolism.

2508 ± 2857 in intensive care unit (ICU). The duration of hospitalization, a FEV1% predicted value below 30%, having smoked 40 package-years or more, the number of co-morbidities, NIMV, IMV, ICU, exitus and the number of hospitalizations in the past year were among the factors that increased costs significantly. Hospital acquired pneumonia, chronic renal failure and anemia also increased the costs of COPD significantly. Conclusion: The costs of treatment increase with the severity of COPD or with progression to a higher stage. Efforts and expenditures aimed at preventing COPD exacerbations might decrease the costs in COPD.

Investigation of obstructive sleep apnoea syndrome prevalence among long-distance drivers from Zonguldak, Turkey

Smoking Prevalence, Behaviour and Nicotine Addiction among Coal Workers in Zonguldak, Turkey: Murat Unalacak, et al. Department of Family Medicine, Zonguldak Karaelmas University, Faculty of Medicine, Turkey—To assess the smoking status of coal workers, as coal dust exposure and concomitant cigarette smoking contribute to the increased prevalence of pulmonary interstitial fibrosis, chronic obstructive pulmonary disease and other pulmonary diseases. A survey was conducted to determine the smoking prevalence, behaviour and nicotine addiction in coal workers. The target population consisted of 475 underground coal workers who lived in Zonguldak city of Turkey, and we reached 389 of them. Each subject completed a detailed smoking history questionnaire (included 56 question). Chest X‐rays and pulmonary function tests were performed to evaluate patients’ related diseases and complications. Smoking status of the workers was as follows; Sixty‐nine never smokers (17.7%), 62 ex‐smokers (15.9%) and 258 current smokers (66.3%). The mean age of starting smoking was similar among ex and current smokers (15.9 ± 4.2 versus 15.0 ± 4.0). The most common reason for starting smoking was smoking interest (50%) and friends’ influence (15.5%). The most frequent reason stated for successful smoking cessation was experience of smoking—related symptoms or development of a medical condition (51%). The most important reason given by current smokers for smoking cessation attempts was increased chance of developing lung cancer, pneumoconiosis and other diseases (22.9%). Nicotine addiction was assessed by the Fagerstroem test. Mild (0–3 points), moderate (4–6) and severe (7 or more) addiction ratios were found to be 39.1%, 44.2% and 16.7 % respectively. Ex‐smokers had the highest prevalence of large and small airway obstruction on spirometry. Smoking prevalence is high in coal workers living in Zonguldak city of Turkey. Most of the smokers know that smoking is dangerous and want to quit smoking. A detailed smoking history during medical surveillance may help the occupational physician to develop a system in which such individuals can be referred to comprehensive smoking cessation programs.

Color Doppler Evaluation of the Retrobulbar Hemodynamic Changes in Chronic Obstructive Pulmonary Disease: COPD and Retrobulbar Hemodynamic Changes.

Background: The incidence of tuberculosis (TB) in different countries as estimated by the World Health Organization (WHO) vary from 23/100,000 and less in industrialized countries, 191/100,000 in Africa and 237/100,000 in South East Asia. Objectives: The aim of this study was to analyze the dynamics of TB in the northwest of Turkey, between 1988 and 2001. Methods: All pulmonary TB cases reported to the National Tuberculosis Center by local TB dispensaries during 1988–2001 were analyzed. The number of new and relapsed TB cases were documented and classified according to age and type of TB (standard classification of TB patients according to disease type: pulmonary, new, smear positive; pulmonary, smear negative; relapse, and extrapulmonary). We recorded information about the prevalence of TB in different patient groups (patients with a contact history, patients who were detected in active community screening or passive case finding), TB trends in different age groups, type of TB, patients who had relapses, percentage of patients who were lost to follow-up. Results: A total number of 288,996 patients were examined at Zonguldak Tuberculosis Dispensary between 1988 and 2001. Case notification rates of TB decreased over the study period. Respiratory TB was the most commonly encountered form of disease (>90%). The percentage of TB decreased in the 0- to 14-, 15- to 24-year-olds and increased in the 25- to 44- and 45- to 64-year-olds. Conclusion: Properly designed disease surveillance systems are critical for monitoring the TB trends so that each country can identify its own high-risk groups and target interventions to prevent, diagnose, and treat the disease.

Serum Asymmetric Dimethylarginine, Nitrate, Vitamin B12, and Homocysteine Levels in Individuals with Pulmonary Embolism

Purpose Syncope is an atypical presentation for acute pulmonary embolism (APE). There are conflicting data concerning syncope and prognosis of APE. Patients and methods One hundred and seventy-nine consecutive patients aged 22–96 years (median, 68 years) with APE were retrospectively enrolled in the study. Results Prevalence of syncope was 13% (n=23) at the time of presentation. Compared to patients without syncope, those with syncope had a higher rate of central embolism (83% vs 43%, respectively, P=0.002), right ventricular dysfunction (91% vs 68%, P=0.021), and troponin positivity (80% vs 39%, P=0.001) but not 30-day mortality (13% vs 10%, P=0.716). Multivariate analysis showed that central localization (odds ratio: 9.08) and cardiac troponin positivity (odds ratio: 4.67) were the independent correlates of the presence of syncope in the patients with APE. Frequency of cardiopulmonary disease was lower, and duration from symptom onset to hospital admission was shorter in patients with syncope (P=0.138 and 0.118, respectively), although not significant. Conclusion Syncope most likely represents an intermediate condition between massive APE and hypotension. In APE patients with syncope, the prognosis seems to depend on the underlying pathology, the patient’s age, comorbidities and duration from symptom onset to hospital admission, and the use of thrombolytic therapy.