Mustafa Çörtük

Aortic stiffness increases in proportion to the severity of apnoea–hypopnea index in patients with obstructive sleep apnoea syndrome

Obstructive sleep apnoea syndrome (OSA) and aortic stiffness are associated with an increased risk of cardiovascular morbidity and mortality. Although aortic stiffness increased in patients with OSA, the relationship between severity of OSA indicated with apnoea–hypopnea index (AHI) and aortic stiffness was not investigated in previous studies. The aim of this study is to investigate the relationship between the severity of OSA and aortic stiffness.

Mean platelet volume is associated with disease severity in patients with obstructive sleep apnea syndrome.

OBJECTIVE: Obstructive sleep apnea syndrome is associated with cardiovascular diseases and thromboembolic events. The mean platelet volume (MPV) is a predictor of cardiovascular thromboembolic events. The aim of the present study is to investigate the association between the MPV and disease severity in patients with obstructive sleep apnea syndrome. METHODS: We prospectively included 194 obstructive sleep apnea syndrome patients without cardiovascular disease (mean age 56.5±12.5 years) who were undergoing sleep tests. An overnight full laboratory polisomnography examination was conducted on each patient. The patients were divided into 3 groups according to the apnea-hypopnea index (AHI): (1) AHIlow group: 5≤AHI<15, (2) AHImid group: 1530. RESULTS: The highest MPV values were found in the AHIhigh group compared with other groups (p<0.05 for all). Multiple linear regression analysis indicated that the MPV was associated with the AHI (β=0.500, p<0.001) and the high sensitivity C-reactive protein (hs-CRP) level (β=0.194, p=0.010). CONCLUSION: The MPV is independently associated with both disease severity and inflammation in patients with obstructive sleep apnea syndrome.

Tracheobronchial Amyloidosis Mimicking Tracheal Tumor

Tracheobronchial amyloidosis is a rare presentation and accounts for about 1% of benign tumors in this area. The diagnosis of disease is delayed due to nonspecific pulmonary symptoms. Therapeutic approaches are required to control progressive pulmonary symptoms for most of the patients. Herein, we report a case of a 68-year-old man admitted with progressive dyspnea to our institution for further evaluation and management. He was initially diagnosed with and underwent management for bronchial asthma for two years but had persistent symptoms despite optimal medical therapy. Pulmonary computed tomography scan revealed severe endotracheal stenosis. Bronchoscopy was performed and showed endotracheal mass obstructing 70% of the distal trachea and mimicking a neoplastic lesion. The mass was successfully resected by mechanical resection, argon plasma coagulation (APC), and Nd-YAG laser during rigid bronchoscopy. Biopsy materials showed deposits of amorphous material by hematoxylin and eosin staining and these deposits were selectively stained with Congo Red. Although this is a rare clinical condition, this case indicated that carrying out a bronchoscopy in any patient complaining of atypical bronchial symptoms or with uncontrolled asthma is very important.

Mean Platelet Volume Decreases in Adult Patients With Obstructive Sleep Apnea After Uvulopalatal Flap Surgery.

Aim:The main purpose of the study was to investigate changes in mean platelet volume (MPV) values in patients with obstructive sleep apnea syndrome (OSAS) who had undergone uvulopalatal flap (UPF) surgery. Method:The study included a review of the medical records of 37 adult patients who had undergone UPF surgery after being diagnosed with OSAS. The baseline blood parameters of patients, including the MPV and platelet distribution width (PDW) values, were measured and repeated 3 months after treatment. Polysomnographic evaluations of the patients were also performed during admission and the 3rd month control. Comparisons of MPV values and their correlation with polysomnographic parameters were the main outcomes measured. Results:The blood parameters of all patients were similar except for MPV values, which were significantly lower after treatment (P < 0.001). Patients’ apnea hypopnea index (AHI) and apnea episodes were significantly reduced after the UPF surgery, whereas their oxygen saturation significantly increased (P < 0.001). The MPV values were not correlated with polysomnographic parameters (P > 0.05). Conclusion:The UPF surgery, which is a relatively simple surgical intervention to treat OSAS, alleviates nocturnal hypoxic episodes and lowers platelet volume. These may both be important predictors of adverse cardiovascular outcomes related to OSAS.

Primary pulmonary lymphoma: four different and unusual radiologic and clinical manifestations

Elif Tanriverdi, Murat Acat, Guler Ozgul, Kenan Abbasli, Sule Gul, Zehra Yasar, Mustafa Cortuk, Neslihan Akanil Fener, Hasan Akin, Mehmet Akif Ozgul and Erdogan Cetinkaya Department of Chest Diseases, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey; Department of Chest Diseases, Karab€uk University Faculty of Medicine, Karab€ uk, Turkey; Department of Chest Diseases, Ba gcılar Education and Research Hospital, _Istanbul, Turkey; Department of Chest Diseases, Abant _Izzet Baysal University Faculty of Medicine, Bolu, Turkey; Department of Pathology, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey; Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey

Oki stent application in different indications: Six cases.

We have used Oki stents for a number of different indications. After discovering that there are limited reports in the literature on these stents, we were motivated to share our experiences in Oki stenting.

Biventricular Myocardial Performance Is Impaired in Proportion to Severity of Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is an independent risk factor for cardiovascular morbidity and death. Little information is available regarding the relationship between the severity of OSA and myocardial performance in OSA patients who have normal ejection fractions. We prospectively investigated this relationship, using the tissue-Doppler myocardial performance index (TD-MPI). We conducted overnight, full-laboratory polysomnographic examinations of 116 patients, and calculated the left and right ventricular TD-MPIs. Patients were classified into 3 groups in accordance with their apnea-hypopnea index (AHI) levels: AHImild (≥5 to <15), AHImoderate (≥15 to <30), and AHIsevere (≥30). Left and right ventricular TD-MPI values were higher in the AHIsevere group than in the AHImild and AHImoderate groups (all P <0.05). In addition, right ventricular TD-MPI values in the AHImoderate group were higher than those in the AHImild group (P <0.05). Right ventricular TD-MPI was significantly associated with AHI (β=0.468, P <0.001), left ventricular TD-MPI, and right ventricular early-to-late filling velocities (E/A ratio) in multiple linear regression analysis. On the other hand, left ventricular TD-MPI was significantly associated with right ventricular TD-MPI and left ventricular E/A ratio (both P <0.05). Our results show that OSA severity, determined by means of AHI, is independently associated with impaired right and left ventricular function as indicated by TD-MPI in patients who have OSA and normal ejection fractions.

Simultaneous chronic invasive fungal infection and tracheal fungus ball mimicking cancer in an immunocompetent patient

Fungal infections of the lung are uncommon and mainly affect people with immune deficiency. There are crucial problems in the diagnosis and treatment of this condition. Invasive pulmonary aspergillosis and candidiasis are the most common opportunistic fungal infections. Aspergillus species (spp.) are saprophytes molds that exist in nature as spores and rarely cause disease in immunocompetent individuals. In patients with immune deficiency or chronic lung disease, such as cavitary lung disease or bronchiectasis, Aspergillus may cause a variety of aspergillosis infections. Here we present a case of a 57-year-old patient without immunodeficiency or chronic lung disease who was diagnosed with endotracheal fungus ball and chronic fungal infection, possibly due to Aspergillus. Bronchoscopic examination showed a paralyzed right vocal cord and vegetating mass that was yellow in color, at the posterior wall of tracheal lumen. After 3 months, both the parenchymal and tracheal lesions were completely resolved.

Successful Treatment of Bulla with Endobronchial Valves

Emphysematous bullae are a complication of end-stage COPD. Patients with large bullae and poor respiratory function have limited treatment options. Surgical resection is a recognized treatment, but functional improvement after bullectomy is not satisfactory in patients with forced expiratory volume in 1 s (FEV1) < 35% predicted. When this 59-year-old male end-stage COPD patient was assessed, he was cachectic and lung function tests showed a FEV1 of 0.56 L (19% predicted) and a RV of 7 L (314% predicted), while 6MWT was 315 m and MRC dyspnea score was 4. Chest X-ray revealed a massive bulla of 10 cm in diameter in the right middle lobe. A fibrobronchoscopy was performed under local anesthesia and 2 Zephyr 4.0 valves were placed in the right middle lobe. Chest X-ray and CT scan performed 36 days later showed the complete resolution of the bulla. Seven months later, the patient demonstrated an improvement in FEV1 (+30%) and a decrease in RV from 314 to 262% predicted. This case report shows that the Zephyr valves may be successfully used to treat a large bulla in the right middle lobe in a patient with diffuse emphysema and severely impaired lung function.

Efficacy and safety of endobronchial ultrasound-guided transbronchial needle aspiration through the pulmonary arteries for the diagnosis of left hilar lesions

Introduction Endobronchial ultrasonography (EBUS) is an endoscopic method that aids needle aspiration to see the bronchial wall and adjacent tissues with an ultrasound probe. Pulmonary arteries are rarely present between the bronchus wall and the tissue. In this case, it was necessary to make a selection between invasive processes and transbronchial needle aspiration (TBNA) through the pulmonary artery. There are few case reports about the safety of TBNA through the pulmonary artery. We aimed to present the results of EBUS guided TBNA through the pulmonary arteries. Materials and Methods The data on four cases (three men) in whom EBUS guided TBNA was performed through the pulmonary artery between August 2010 and December 2015 were reviewed retrospectively. Procedures were conducted under local anesthesia and conscious sedation. For TBNA, 22-gauge needles were used. Cases were monitored for 24 hour after the procedures. Antibiotic prophylaxis and onsite cytopathology were not used. Result All lesions existed were on the left hilar localization. Two of the diagnosed cases were carcinoma and one was the granulomatous lymphadenitis. We were not able to diagnose the last case. No complication was observed in any cases during the procedure. Conclusions EBUS guided TBNA through the pulmonary arteries at left hilar lesions is safe. The rate of diagnoses from the tissues obtained is high. No special preparation is needed for the cases have no the pulmonary hypertension.