Nurhan Atilla

Prevalence of and factors affecting pulmonary hypertension in hemodialysis patients.

Background: Pulmonary hypertension (PH) has been reported to be high among end-stage renal disease (ESRD) patients. Objectives: The aim of this study was to investigate the role of arteriovenous fistula (AVF) flow in the pathogenesis of PH and the prevalence of PH in patients with chronic renal failure (CRF) and to suggest other possible etiologic factors. Methods: The prevalence of PH was prospectively estimated by Doppler echocardiography in 116 ESRD patients on regular hemodialysis (HD). Laboratory and clinical variables were compared between patients with and without PH (groups 1 and 2, respectively). PH was defined as systolic pulmonary artery pressure (SPAP) over 30 mm Hg. Patients with PH underwent further evaluation by 2 pulmonologists. AVF flow was measured by Doppler ultrasonography. Blood tests including arterial blood gases, hemoglobin, serum calcium, phosphorus and parathyroid hormone were determined. Results: PH was found in 25 (21.6%) patients (group 1) with an SPAP of 37.9 ± 2.8 mm Hg. Mean AVF flow was increased (1,554 ± 207.60 ml/min) in group 1. Left ventricular ejection fraction (LVEF) was significantly different between the 2 groups (55.3 ± 11.5 and 64.4 ± 40, respectively; p < 0.05). Neither significant primary lung disease nor parenchymal lesions were detected in group 1. PH showed a significant difference for cigarette smoking (p < 0.05). In group 1 the prevalence of cigarette smoking was higher. The main etiology of CRF was diabetes mellitus with a ratio of 44% in group 1. Conclusion: Our study demonstrated a surprisingly high prevalence of PH among patients receiving long-term HD. PH was related to high AVF flow, low LVEF and cigarette smoking. AVF flow and cigarette smoking are important correctable causes of PH. Early detection is important in order to avoid the serious consequences.

Protective Effects of Alpha-Lipoic Acid on Methotrexate-Induced Oxidative Lung Injury in Rats

ABSTRACT Objective: Oxidative stress is one of the major causes of methotrexate induced lung injury (MILI). Alpha-lipoic acid (ALA), which occurs naturally in human food, has antioxidative and anti-inflammatory activities. The aim of this study was to research the potential protective role of ALA on MILI in rats. Methods: Twenty one rats were randomly subdivided into three groups: control (group I), methotrexate (MTX) treated (group II), and MTX+ALA treated (group III). Lung injury was performed with a single dose of MTX (20 mg/kg) to groups 2 and 3. On the sixth day, animals in all groups were sacrificed by decapitation and lung tissue and blood samples were removed for histological examination and also measurement the levels of interleukin-1-beta (IL-1β), malondialdehyde (MDA), glutathione (GSH), tumour necrosis factor-alpha (TNF-α), myeloperoxidase (MPO), and sodium potassium-adenosine triphosphatase (Na+/K+ATPase). Results: In MTX group tissue GSH, Na+/K+ATPase activities were lower, tissue MDA, MPO and plasma IL-1?, TNF-? were significantly higher than the other groups. Histopathological examination showed that lung injury was less severe in group 2 according to group 3. Conclusions: Oxidative damage of MTX in rat lung is partially reduced when combined with ALA.

Cerebral Venous Thrombosis and Pulmonary Embolism with Prothrombin G20210A Gene Mutation.

A 25-year-old man presented with symptoms of syncope, cough, headache and hemoptysis. Cranial MR and venography showed thrombus formation in the right transverse sinus and superior sagittal sinus. Computed tomographic pulmonary angiography (CTPA) showed an embolic thrombus in the right pulmonary truncus and lung abscess. The patient was young, and there were no signs of lower extremity deep venous thrombosis or other major risk factors for pulmonary embolism (PE) including cardiac anomaly. The only risk factor we were able to identify was the presence of the prothrombin G20210A gene mutation. Anticoagulant treatment with oral warfarin (10 mg daily) and imipenem (4X500 mg) was started. The patient was hospitalized for antibiotic and anticoagulation therapies for three weeks and was discharged on lifelong treatment with warfarin (5 mg daily).

Association of neutrophil/lymphocyte ratio with the degree ofinterstitial lung disease in systemic sclerosis

BACKGROUND/AIM Determining the severity of systemic sclerosis related interstitial lung disease (SSc-ILD) is based on clinical and radiological findings, inflammation marker levels, and carbon monoxide diffusing capacity of the lung (DLCO). Recently studies are ongoing for objective and easy markers. Neutrophil/lymphocyte ratio (NLR) is shown to be a good marker for inflammation in recent clinical trials. In this study, we aimed to identify the possible relationship between NLR and carbon monoxide transfer coefficient (KCO) of SSc-ILD patients. MATERIALS AND METHODS Fifty-nine patients with systemic sclerosis (SSc) were enrolled in the study. We used high-resolution computed tomography for diagnosis and used DLCO to evaluate degree of lung involvement. Complete blood cell counts and acute phase reactants were included as laboratory assessments. RESULTS NLR values were significantly higher in the SSc-ILD group (3.66 ± 1.32 vs. 2.85 ± 1.12, P = 0.01) and correlated negatively with KCO. The NLR cut-off value was 3.21, its sensitivity was 81%, and its specificity was 81%. CONCLUSION NLR level may serve as a marker of lung involvement in the presence of ILD in patients with SSc.

Bone Cement Pulmonary Embolism after Percutaneous Vertebroplasty

Percutaneous vertebroplasty (PVP) is a common procedure for treatment of painful vertebral fractures. Although PVP is considered minimally invasive, complications may occur during the procedure. Bone cement pulmonary embolism (CPE) is a severe and potentially life-threatening complication following vertebroplasty (VP). CPE commonly occurs after performing VP, but hemodynamically it has little clinical impact. Treatment strategies of CPE is still unclear.

A Case of Organizing Pneumonia with Migratory Pulmonary Infiltrates

Organizing pneumonia (OP) can mimic several parenchymal lung diseases. A 39 year old man tailor, complaining of fever, cough and dyspnea was admitted to our hospital. Examination of the chest revealed rales at the bilateral lower-middle zone. The posteroanterior chest radiograph showed alveolar opacity at the right lower zone. The patient was hospitalized with the probable diagnosis of bacterial pneumonia, and started cephtriaxon 2gr/day and dirithromycin 500 mg/day empirically. Clinical and radiological improvement didn’t appear. PPD and acid fast bacilli in sputum were negative. Two weeks later, the chest radiograph showed that the opacities were migrated to the right middle zone. Open lung biopsy was done. As pathologic findings were consistent with OP, corticosteroid treatment was given. The alveolar opacities disappeared at the control HRCT two months after the start of steroid therapy. Early diagnosis is life-saver and OP must be included in the differential diagnosis when pulmonary infiltrates don’t regress with treatment.

Serum telomerase levels in smokers and smokeless tobacco users as Maras powder

Introduction To the best of our knowledge, no previous study regarding the serum telomerase levels in Maras powder users (MPUs) has been founded. The aim of the current study was to investigate serum telomerase levels in smokers and MPUs. Materials and Methods The study was carried out with 98 patients (36 MPUs, 32 smokers and 30 non-smokers). Blood samples were collected, and after having measured the serum telomerase and malondialdehyde (MDA) levels of the patients, comparison were made between the groups. Result It has been observed that the serum telomerase and MDA levels of smokers (p< 0.001) and MPUs (p< 0.001) were significantly higher compared to those of the non-smoker control subjects. In addition, the levels of serum telomerase and MDA were observed to be higher in the MPU group compared to those of the smoker group (p< 0.001). Conclusions The levels of serum telomerase and MDA were observed to be higher among MPUs and smokers. In this context, it may be useful to further measure and assess telomerase activity in such patients in order to better determine the harmful effects associated with these habits.

A Case of Pulmonary Alveolar Microlithiasis Diagnosed by Transbronchial Biopsy

Pulmonary alveolar microlithiasis is a rare infiltrative pulmonary disease, in which intraalveolar accumulation of small stones (microliths) consisting of calcium phosphatite occurs. It is an autosomal recessive disorder. The disease occurs as a result of the disruption of type IIb sodium phosphate cotransporter in type II alveolar cells after the mutation of SLC34A2. Majority of patients are diagnosed between age 20 and 40. Here, we present a case of alveolar microlithiasis that was diagnosed with transbronchial biopsy.

Changes in Cerebral Blood Flow in Patients with Familial Mediterranean Fever

INTRODUCTION It is known that there is a relationship between systemic inflammation and atherosclerosis. Atherosclerosis is one of the best-known causes of cerebrovascular diseases. The aim of this study was to assess cerebral blood flow velocity using transcranial Doppler (TCD) ultrasonography in patients with familial Mediterranean fever (FMF). METHODS A total of 30 patients aged from 20 to 50 years with FMF were enrolled in the FMF group consecutively. The control group (non-FMF group) consisted of 30 age- and sex-matched randomly selected patients without FMF who had other diagnoses such as fibromyalgia and did not have risk factors for atherosclerosis. Bilateral peak-systolic, end-diastolic, and mean blood flow velocities in the middle cerebral artery (MCA), values of Goslings pulsatility index, and values of Pourcelots resistance index were recorded using TCD ultrasonography by a neurosonologist blinded to the FMF and control groups. RESULTS There were 30 participants in the FMF group in remission (male/female: 4/26, mean age: 34.7±5.9 years) and 30 participants in the control group (male/female: 4/26, mean age: 32.3±4.7 years). C-reactive protein levels and bilateral blood flow velocities in the MCA were significantly higher in the FMF group than in the control group. CONCLUSIONS This study suggests that persistent clinical and subclinical inflammation in patients with FMF causes an increase in cerebral blood flow velocities. Our findings provide an insight into this association between FMF and cerebrovascular diseases.

Septik Pulmoner Emboli, Olgu Sunumu

Septic pulmonary embolism is a condition characterized by non-specific symptoms such as fever, chest pain, cough and pulmonary infiltrates that developing secondarily to any infectious source. It is a phenomenon which has predisposing factors such as congenital heart disease, iv drug usage, long-term catheterization. It is characterized with abscess and infarct formation in lungs secondarily to hematogenous spread of coagulated blood containing microorganisms from right heart to the lungs. Early diagnosis and broad-spectrum antibiotics are the main factors determining the prognosis of septic pulmonary embolism which has high morbidity and mortality. In our case, patient admitted to our clinic with chest pain, cough, fever and haemoptysis. It has bilateral cavitary lesions in lung scanning. However, it has high sedimentation and C-reactive protein level, primary infection could not detected. In more detailed anamnesis of patient, there was a history of dental abscess treatment. It was diagnosed with septic pulmonary embolism and treated with non-specific antibiotherapy and healed fastly. The aim of this case report is to provide an overview of septic pulmonary embolism, with existing literature.