Nihat Kodalli

Transarterial microcatheter glue embolization of the bronchial artery for life-threatening hemoptysis: technical and clinical results.

OBJECTIVES To report our experience with transarterial glue embolization of the bronchial artery for life-threatening hemoptysis. MATERIALS AND METHODS Twenty-five patients underwent bronchial artery embolization, using coaxial microcatheter technique, with a liquid agent, n-butyl-2-cyanoacrylate (NBCA), named glue, for life-threatening hemoptysis. The technical and clinical outcomes were followed in terms of immediate control of bleeding, recurrence of hemoptysis and complications of the procedure. RESULTS Four patients had acute hemoptysis when they were evaluated. The average number of arteries embolized per patient was 2.9. BAEs were successful in controlling hemoptysis immediately in all 25 patients (100%) and in 24 patients (96%) at 1 month follow-ups. One patient had recurrent hemoptysis on the tenth day after embolization. The follow-up time ranged from 2 to 63 months (mean 14 months). Six patients (25%) died all as a result of their disease process. Bleeding recurred in 3 patients after 30 days (7th, 11th, 12th months). One patient had vomitting attacks with dysphagia after the procedure that lasted 24h. Three patients had transient thoracic pain lasting 3-5 days. There were no procedure related spinal or vascular complications. CONCLUSIONS Glue embolization with microcatheter technique is a safe and effective treatment in cases of life-threatening hemoptysis with a very high rate of success and low rate of complications.

Use of T Cell-Based Diagnosis of Tuberculosis Infection to Optimize Interpretation of Tuberculin Skin Testing for Child Tuberculosis Contacts

BACKGROUND Treatment of recent tuberculosis infection in children aged <2 years is essential, because of high risk of progression to disease, but diagnosis is hindered by the inaccuracy of the tuberculin skin test (TST). More-accurate T cell-based tests of infection could enhance diagnosis by optimizing interpretation of the TST results. METHODS A total of 979 child tuberculosis contacts in Istanbul underwent the TST and enzyme-linked immunospot assay. Using enzyme-linked immunospot test results as a reference standard, we assessed the effect of age and bacille Calmette-Guérin (BCG) vaccination on the sensitivity and specificity of the TST, and we computed the optimal TST cutoff points, using receiver operating characteristic curves. RESULTS With a TST cutoff point of >or=10 mm, the sensitivity of the TST was 66% for children aged <2 years, which was lower than that for older children (P= .006). Specificity was 75% for BCG-vaccinated children, compared with 92% for unvaccinated children (P= .001). Optimal cutoff points improved TST specificity for children with 1 BCG scar, with little loss of sensitivity. Despite the use of optimal cutoff points, TST sensitivity remained <70% for children aged <2 years, specificity remained <87% for BCG-vaccinated children aged >or=2 years, and overall accuracy was low for children with >1 BCG scar. CONCLUSIONS Negative results of the TST cannot exclude tuberculosis infection for child tuberculosis contacts aged <2 years, which supports the use of preventive therapy regardless of the TST results for this age group. In children aged >or=2 years, the accuracy of the TST can be improved by adjustment of cutoff points for BCG-vaccinated children but remains poor for children with >1 BCG scar. This methodology can define optimal TST cutoff points for diagnosis of tuberculosis infection tailored to target populations.

Epithelioid hemangioendothelioma with multiple organ involvement

Epithelioid hemangioendothelioma is a rare vascular neoplasm of uncertain malignant potential. Various reports document metastatic or concurrent epithelioid hemangioendothelioma in several sites, most commonly with combined lung and liver involvement. The concurrent involvement of multiple sites at presentation may cause diagnostic problems because epithelioid hemangioendothelioma can mimic other neoplastic processes. Although it is a chemoresistant disease, chemotherapy is usually advised for patients with metastatic or concurrent involvement. Here we document the presentation, treatment, and outcome of two cases with concurrent involvement of the lung and liver.

Thorax high resolution computerized tomography findings in asthmatic children with unusual clinical manifestations.

BACKGROUND It has been consistently observed in high resolution computerized tomography (HRCT) scans that asthmatic patients manifest more abnormalities related to airways remodeling than do normal subjects. OBJECTIVE To find the underlying abnormalities in the lungs of asthmatic children with unusual manifestations. METHOD Asthmatic children not responding as expected to inhaled steroid therapy with or without localized permanent or temporary recurrent auscultation findings (rales) were evaluated with chest radiographs and HRCT scans. Bronchoscopy was performed on the ones with localized rales. RESULTS The sample consisted of 16 asthmatic children (6 girls and 10 boys, mean age = 7.75+/-4.43 years). Chest radiograph abnormality rate was 44% and the thorax HRCT scan abnormality rate was 75% (56% fibrotic retractions, 38% atelectasis, 19% bronchiectasis, and 19% bronchial wall thickening). Two patients with localized permanent rales and with right middle lobe (RML) atelectasis in HRCT scan underwent bronchoscopy which revealed RML syndrome due to mucus plugging in one and lymph node pressure in the other. In one patient with localized temporary recurrent rales and major bronchiectasis in HRCT scan, bronchoscopy revealed bronchitis. The patient with RML syndrome due to mucus plugging required lobectomy. CONCLUSION We conclude with this experience that thorax HRCT scanning may be a helpful adjunct in the evaluation of an asthmatic children with atypical clinical findings.

Stage IV Hodgkin's Disease presenting with spinal epidural involvement and cauda equina compression as the initial manifestation: Case report

Hodgkins disease very rarely presents clinically, initially with a paraspinal mass, but this should be considered in the differential diagnosis. A patient presenting with back pain was diagnosed to have Stage IV Hodgkins disease. MRI revealed an extradural and intraspinal soft tissue mass with bone infiltration. The importance of MRI in the early evaluation of a paraspinal mass and in determining the extent of the disease is emphasized.

Evaluation of parietal pleural invasion of lung cancers with breathhold inspiration and expiration mri

The goal of this study was to investigate the feasibility of detecting invasion of the parietal pleura by lung cancer with inspiratory-expiratory magnetic resonance imaging (MRI). Twenty-three patients with lung cancer in contact with pleura were studied with multisectional MRI during deep inspiration and expiration on the axial and coronal planes. Changes in the tumors relation relative to the chest wall markers, vertebral bodies, or mediastinal structures were noted. Surgical correlation was available for each case. Twelve tumors were located at the right middle and lower lobes. Five patients who had a significant change in the position of the tumor were found not to have pleural invasion at surgery. The remaining seven tumors without change in their position with respiration were surgically found to invade the parietal pleura. Only 1 of the 11 upper lobe and apical segments of the lower lobe-located tumors showed a change in its position, which had no parietal pleural invasion at surgery. The remaining 10 tumors did not show any movement. Four of them had parietal pleural invasion that were surgically proven, and six tumors had no parietal pleural invasion at surgery. In conclusion, MRI performed during deep inspiration and expiration is a complementary method in detecting parietal pleural invasion for the tumors located in the lower and middle lobes.

Hilar lymphocele following blunt trauma

Abstract. We present a case of traumatic hilar lymphocele which occurred following blunt trauma without any reported injury.

Double balloon esophageal catheter for diagnosis of tracheo-esophageal fistula.

Abstract. Congenital H-type and recurrent tracheo-esophageal fistulas (TEF) are always difficult to diagnose. For a more accurate diagnosis we designed a new double balloon catheter, which is a modification of esophageal dilatation balloon. The catheter has two balloons to occlude the esophagus proximal and distal to the fistula. The fistula can be identified by passing of the contrast material to the tracheal tree, which was injected into the esophageal segment between the inflated balloons. To prove the efficiency of this catheter, a TEF was created surgically in a New Zealand rabbit. On the postoperative fourteenth day the catheter was tried and the fistula could be visualized easily by injecting the contrast material. We think this technique may be of use in the diagnosis of TEF in children.

Extranodal pulmonary marginal zone B-cell lymphoma ☆

Aim Extranodal mucosa-associated lymphoid tissue (MALT) arises a number of epithelial tissues, including the stomach, salivary gland, lung, small bowel, and elsewhere. Here we present a male patient with an uncommon site of extranodal MALT such as a pelvic mass diagnosed after a long period of evaluation, which initially presented with an incidental pulmonary nodule. Method We report a 60 years old man presenting with pulmonary nodules and consolidation. He refused invasive procedures and 3 years later was administered to our clinic with disseminated pulmonary nodules on chest X-ray. Subsequently a thin needle aspiration biopsy was performed and candida geotrichum was suspected in the specimen of the lung biopsy by light microscopic examination. After this time the patient was referred to our clinic, bronchoscopy, mediastinoscopy and abdominal computerized tomography (CT) scans were performed. Results Lymphoid hyperplasia was seen in the mediastinal lymph nodes biopsy specimens and the pelvic mass (52 × 18 mm) on the superior iliac muscles not related to any organs. Thin needle biopsy revealed MALT lymphoma and pathological examination of pulmonary nodule was similar to pelvic mass (MALT lymphoma). After the diagnosis, the thin needle biopsy of lung was repeated. The specimen appeared to be similar to the pelvic mass (MALT lymphoma) in the pathologic examination. The patient survived 5 years after initial diagnosis. Conclusion MALT has an affinity for the different tissues however has not been located in the pelvis. Our case represent an unusual presentation in a 60 years old man with lung and a pelvic mass.

A case of mediastinal lymphangioma: endosonographic appearance

Mediastinal lymphangioma is a rare, benign disease characterized by an abnormal proliferation of lymphatic vessels. Although a definitive diagnosis can be best made by surgical resection, computed tomography (CT) and magnetic resonance imaging (MRI) can be used as radiological methods to diagnose a pulmonary lymphangioma preoperatively. Endoscopic ultrasonography is a new method for visualizing pathological changes in the mediastum and may be used for preoperative diagnosis of a pulmonary lymphangioma, which is a rare example of a mediastinal disease.