Metin Gorguner

Giant hydatid lung cysts

OBJECTIVE In this clinical retrospective study, we aimed to evaluate giant hydatid lung cyst cases as a different clinical entity that recorded in last 10 years in our clinic. METHODS Between February 1990 and May 2000, a total of 305 hydatid lung cyst cases from patients that had been operated were reviewed, and 67 (21.9%) cysts with more than 10 cm in diameters of them were regarded as a giant hydatid lung cyst. Further investigations were made with respect to different factors. RESULTS Thirty-six (54%) cases were male and 31 (46%) were female. The ages ranged between 5 and 54 (mean 21.6) years. The most common symptoms recorded were; cough (68%), thoracic pain (55%) and dyspnea (52%). Cyst sizes were ranged between 10 and 22 cm (mean 13.4) in diameters. Forty-two (62%) of them were in the right, 22 (33%) were in the left hemithorax, and three (5%) were located bilaterally. Cystotomy or cystectomy and capitonnage was the most frequent applied operation procedure (71%). Resection was performed in nine (13%) cases. Thirteen (19%) cases had air leakage more than 10 days in which five (7%) of them empyema occurred postoperatively. One case died due to respiratory failure in fourth postoperative day. The postoperative hospital stay ranged between 6 and 43 (mean 10.5) days. No recurrence was recorded in 1-5 years of a follow-up period. CONCLUSIONS Giant hydatid lung cysts must be regarded as a different clinical entity because of their early occurrence, having more serious symptoms, with frequent operative complications, and they need prolonged care with higher cost effects.

An epidemic of silicosis among former denim sandblasters.

Sandblasting denim using silica has emerged as a new cause of silicosis in Turkey. Following the discovery of several cases of silicosis in (young) workers who used this process, the frequency and main occupational risk factors of silicosis among former denim sandblasters in the region of Erzurum (Turkey) were evaluated. Demographic characteristics and information on working conditions were obtained by questionnaire and interview. In addition, spirometry testing was performed and chest radiographs were evaluated according to International Labour Office (ILO) classification of pneumoconioses in 157 former denim sandblasters. All subjects were male, with a mean (range) age of 23 (15–44) yrs. They had worked for a mean (range) of 36 (1–120) months, starting employment at a 17 (10–38) yrs of age. Most subjects (83%) had respiratory symptoms, especially dyspnoea (52%) but also chest pain (46%). Radiological evidence of silicosis (ILO score 1/0 or higher) was present in 77 (53%) out of 145 subjects with interpretable chest radiographs. These subjects had lower forced expiratory volume in one second and forced vital capacity. The risk of silicosis correlated with seniority (i.e. working as a foreman), exposure duration and number of places of work. Considering the high prevalence rate of silicosis in such workplaces, further problems are inevitable in the future unless effective measures are taken.

Silicosis Caused by Sandblasting of Jeans in Turkey: A Report of Two Concomitant Cases

Silicosis is a fibrotic disease of the lungs caused by inhalation, retention, and pulmonary reaction to crystalline silica. Crystalline silica exposure is widespread, and silica sand is an inexpensive and versatile component of many manufacturing processes. Its use and the incidence of silicosis are increased in industrial operations by the mechanization and the use of sandblasting, drilling, pulverizing, cutting, grinding tools and other pneumatic equipment. Sandblasting involves forcefully projecting a stream of abrasive particles onto a surface, usually with compressed air or steam. Mostly, silica sand is forced by compressed air onto the target surface. It has been commonly used in abrading metal or glass. Recently, it has been widely and increasingly used in sandblasting of jeans in Turkey. In this report, we present two concomitant cases of silicosis occurring in the same workplace, located in Istanbul, and caused by sandblasting of jeans. To our knowledge, there is no previous description of silicosis in such an occupation.

Reactive Airways Dysfunction Syndrome in Housewives Due to a Bleach–Hydrochloric Acid Mixture

The sudden onset of asthmalike symptoms and persistence of airway reactivity following an acute exposure to an irritant gas or vapor has been termed reactive airways dysfunction syndrome (RADS). A mixture of sodium hypochlorite (bleach, 40%) and hydrochloric acid (18%) is commonly used as a household cleaning solution in our region. From this mixture, chlorine gas is produced, which can cause airway damage and ensuing RADS. Here we describe findings of patients with RADS due to this cleaning mixture, and determine factors associated with a favorable outcome. Data were collected retrospectively on 55 symptomatic patients presenting to our emergency department after inhalation exposure to a mixture of bleach and hydrochloric acid. Symptoms, past medical and smoking history, details of the exposure, initial peak expiratory flow rate (PEFR) and oxygenation, and acute reversibility of airways obstruction were documented. All patients met previously defined criteria for the diagnosis of RADS, but did not undergo methacholine challenge testing and bronchoalveolar lavage or histopathologic study. Fifty patients were followed over the course of 3 mo. The majority of exposures (64%) occurred in the bathroom or kitchen. Only 21 of 55 (38%) patients showed an improvement in PEFR of 15% or greater following two β2-agonist inhalation treatments. In follow-up, 48 patients (87%) improved clinically and functionally (FEV1). Seven patients (13%) deteriorated, with ARDS developing in two, one of whom died from respiratory failure. Advanced age, initial low PEFR, exposure in a small enclosed area, use immediately after mixing, and prolonged short- and long-term exposures were associated with a poorer prognosis. This descriptive study is the largest case series in the literature of RADS developing after exposure to a bleach–hydrochloric acid mixture. The optimum acute treatment and long-term outcomes for patients with RADS due to this combination still need to be determined.

Determination of adenosine deaminase activity and its isoenzymes for diagnosis of pleural effusions

We aimed to investigate adenosine deaminase (ADA) activity and the activities of its ADA1 and ADA2 isoenzymes in pleural effusions and also sera with different aetiological origins.Methodology: The pleural effusions of 87 patients were examined. The patients were separated into four groups: transudates, parapneumonic, malignant, and tuberculous effusions. The cases were also designated as tuberculous or non‐tuberculous group. Adenosine deaminase activity was determined by the colorimetric method described by Giusti and Galanti.

The Effect of Nebulized NaHCO3 Treatment on "RADS" Due to Chlorine Gas Inhalation

Chlorine is one of the most common substances involved in toxic inhalation. As with all irritant gases, the airway injuries caused by chlorine gas may result in clinical manifestations similar to those of asthma. In this study, we investigated the effect of nebulized sodium bicarbonate (NSB) on the treatment and quality of life (QoL) of victims exposed to chlorine gas. Forty-four consecutive patients with reactive airways dysfunction syndrome (RADS) due to chlorine inhalation (40 females and 4 males, age range 17–56 yr) were included in this study. Patients were placed in control and treatment groups in a sequential odd–even fashion based on their order of presentation. Treatment of all patients included corticosteroids and nebulized short-acting β2-agonists. Then the control group (n = 22) received nebulized placebo (NP), and the NSB group (n = 22) received NSB treatment (4 cm3 of 4.20% sodium bicarbonate solution). A quality of life (QoL) questionnaire and pulmonary function tests (PFTs) were performed before and after treatments in both groups. The most common symptoms were dyspnea (82%) and chest tightness (82%). Baseline characteristics of both groups were similar. Compared to the placebo group, the NSB group had significantly higher FEV1 values at 120 and 240 min (p < .05). Significantly more improvement in QoL questionnaire scores occurred in the NSB group compared to the NP group (p < .001). Thus, NSB is a clinically useful treatment, as tested by PFTs and QoL questionnaire, for patients with RADS caused by exposure to chlorine gas.

Intramedullary spinal tuberculoma: a case report.

Study Design. A case report showing an intramedullary thoracic spinal tuberculoma secondary to pulmonary tuberculosis in a 16-year-old patient with findings of subacute spinal cord compression. Objectives. The significance and the use of magnetic resonance imaging in the diagnosis of intramedullary tuberculoma, and the treatment of the patient that involves surgically the excision of intramedullary lesion followed by appropriate antituberculous therapy. Summary of Background Data. Tuberculomas of spinal cord are rare entities. The possibility of intramedullary tuberculoma should be seriously considered when an intraspinal mass is found, provided that pulmonary tuberculosis is present in the history of the patient. Method. Th4–Th5 laminectomy was performed. Intramedullary tuberculoma was excised through a myelotomy. Antituberculous treatment was applied after the surgery. Results. Excellent clinical outcome was obtained with a combination of both medical and surgical treatments. Conclusion. The intramedullary spinal tuberculoma, although a rare entity, must be considered in the differential diagnosis of the spinal cord compression in patients with a history of tuberculosis, human immunodeficiency virus, and those who have a bad socioeconomic condition and bad nutrition habit. When confronted with a progressing neurologic deficit, a combination of microsurgical resection and antituberculous chemotherapy with the avoidance of steroids should be the choice of treatment for intramedullary tuberculomas.

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.

Hydatid disease of rib

Osseous hydatidosis, especially when located in the rib, is a very rare disease. In 1978, only 39 costal echinococcosis cases were published. The course of the disease is generally slow and laboratory tests are frequently negative. Diagnosis is generally made through the combined assessment of clinical, radiologic, and laboratory data. Living in a rural area is an important risk factor for the disease. The gold standard for therapy is radical removal of the involved ribs or chest wall. We present the case of a 63-year-old herdsman with costal echinococcosis and a review of the literature.

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.