Nurhan Koksal

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.

Effects of the sibutramine therapy on pulmonary artery pressure in obese patients

Aim:  Obesity is a major global public health problem. Previous drugs (dexfenfluramine and fenfluramine) used for the treatment of obesity have been withdrawn due to various cardiac side effects. Sibutramine is an anti‐obesity agent. The purpose of this study was to assess cardiac valve disease and pulmonary artery pressure (PAP) of the patients who used once daily doses of sibutramine.

High-sensitivity C-reactive protein in patients with metabolic syndrome

,!High-sensitivity C-reactive protein (CRP) has been shown to predict cardiovascular disease. Metabolic syndrome has been found to play a critical role in the development of cardiovascular disease. The purpose of this report is to assess the relationship between CRP and the metabolic syndrome. A total of 50 patients with metabolic syndrome and 40 healthy persons were included in the study. Plasma concentrations of CRP were measured by means of particle-enhanced immunonephelometry with the Behring nephelometer using N Latex CRP mono reagent. CRP levels were higher in patients with metabolic syndrome than control group (10.6 ±5.4 mg/L vs 3.5 ±0.8 mg/L, p<0.001). In partial correlation, plasma CRP positively correlated with body mass index (p<0.001), waist circumference (p<0.001), waist-to-hip ratio (p<0.01), total cholesterol (p<0.001), LDL-cholesterol (p=0.033), triglyceride (p=0.023), and fasting blood glucose (p=0.043) in patients with metabolic syndrome. HDL-cholesterol did not significantly correlate with CRP (p>0.05). In multiple regression analysis, body mass index (p<0.01), waist circumference (p<0.01), and fasting blood glucose (p<0.01) showed independent correlations with plasma CRP. CRP levels were found higher in patients with metabolic syndrome. These results suggest that abdominal obesity is the critical correlates of elevated plasma CRP levels found in patients with metabolic syndrome. These patients carrying high risk for cardiovascular events must be followed closely.

Eight years follow-up of a case with idiopathic pulmonary hemosiderosis after corticosteroid therapy

Idiopathic pulmonary hemosiderosis is characterized by recurrent episodes of alveolar hemorrhage, hemoptysis, and secondary iron deficiency anemia with unknown etiology. It generally emerges in childhood and adolescence periods but rarely found in adulthood. Definite diagnosis is established by appearing the hemosiderin-laden macrophages at sputum, bronchoalveolar lavage, or open lung biopsy. We reported a male patient who was born in 1975, expectorated blood since 1995, and was diagnosed in 1998. He received many blood replacements. He admitted to our clinic in 2003 with complaints of coughing up blood, shortness of breath, and tiredness. We gave the corticosteroid therapy to patient for 6-month period. After treatment, the patient did not have any complaints. Clinicians should keep in mind that idiopathic pulmonary hemosiderosis may differ in localization on chest X-ray and corticosteroid treatment should be started when diagnosis is established.

Comparison of the echocardiographic and pulmonary function test findings in orderly treated and untreated essential hypertensive patients

Objective: Although it has been well established that hypertension effects pulmonary functions negatively, the effect of regular antihypertensive therapy on pulmonary functions is not known. In this study, we aimed to compare the pulmonary function tests of the hypertensive patients taking regular antihypertensive therapy with those of the ones not taking any antihypertensive medicine, to document the differences in pulmonary functions of both hypertensive groups. Materials and Methods: Patients who had received antihypertensive treatment (Group I: 29 males, 24 females, mean age 42.3 ± 8.2 years), and untreated cases (Group II: 28 males, 22 females, mean age 43.4 ± 6.4 years) were included in the study. Patients with a history of coronary heart disease, respiratory diseases, smokers and those who were obese were excluded from the study. Results: Forced vital capacity (FVC) and forced expiratory volume at the first second (FEV 1 ) levels were found significantly lower in Group II (p < 0.05). In echocardiographic evaluation, the mitral E/A ratio of Group II was lower than that of Group I (p < 0.05). Isovolumetric relaxation time and deceleration time was higher in Group II than in Group I (p < 0.05). There was a significant association between pulmonary function tests and impaired left ventricular diastolic parameters; especially, mitral E/A ratio was significantly associated with decreased FVC and FEV 1 in Group II (respectively r = −0.695, p = 0.01 and r = −0.591, p = 0.03). Conclusion: FVC and FEV 1 levels in untreated hypertensive cases were lower than in those of treated hypertensive cases, and this may be caused by diastolic function rather than the systolic function. In the evaluation of dyspnea in hypertensive patients, it would be useful to examine respiratory function in addition to echocardiographic investigation.

Temperament and character profiles of male COPD patients

BACKGROUND Chronic obstructive pulmonary disease (COPD) is a respiratory disorder, and is characterized by persistent airflow obstruction. These patients are exposed to severe physical limitations and substantial psychosocial trouble. The aims of this study were to determine the temperament and character profiles of personality in patients with COPD and to compare the results with those of healthy controls. METHODS Thirty-nine male COPD patients and 67 age- and gender-matched healthy controls completed the self-administered 240-item temperament and character inventory (TCI) and 14-item hospital anxiety and depression scale. The relationships between temperament and character personality profiles and clinical factors such as severity of COPD, anxiety, and depression were evaluated. RESULTS COPD patients had significantly higher mean scores of Harm avoidance and lower mean score of Self-directedness than those of healthy controls. In the COPD patients, the anxiety score was significantly higher (P=0.03) and the depression score was found to be insignificantly higher than that of control group. The TCI profiles were not correlated with the severity of COPD. In COPD patients, Self-directedness and Cooperativeness traits of TCI character negatively correlated with anxiety, but any of traits did not correlate with depression. CONCLUSIONS The present study defined the Harm avoidance score was higher and Self-directedness was lower in COPD patients and the COPD severity did not correlate with any of the personality trait. We suggest that during evaluation of COPD patients for treatment, personality trait should also be considered in clinical practice.

Protective Effects of Erythropoietin and N-Acetylcysteine on Methotrexate-Induced Lung Injury in Rats

OBJECTIVE Methotrexate (MTX) is known to have deleterious side effects on lung tissue. We aimed to investigate the effects of erythropoietin (EPO) and N-acetyl-cysteine (NAC) on MTX-induced lung injury in rats. STUDY DESIGN Animal experiment. MATERIAL AND METHODS Twenty-six female Sprague-Dawley rats were divided into 4 groups. Sham group, 0.3 mL saline; MTX group, 5 mg/kg MTX; EPO group, 5mg/kg MTX and 2000 IU/kg EPO; NAC group, 5 mg/kg MTX and 200 mg/kg NAC were administered once daily for 4 consecutive days. Malondialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT) and inflammation and congestion scores in lung tissues were evaluated. RESULTS In MTX group MDA were significantly higher, CAT and SOD were significantly lower than in sham, EPO and NAC groups (p<0.005). In EPO group MDA, CAT, and SOD were higher, but not significant than those in group NAC (p>0.005). In group MTX both scores were significantly higher than in sham (p<0.005). The congestion score of group MTX was significantly higher than those of group EPO and NAC (p<0.005). CONCLUSION EPO and NAC have significant preventive effects on MTX-induced lung injury in rats. Decreased antioxidant capacity and increased MDA level may cause the oxidative damage in MTX group. Also, higher antioxidant capacity and lower MDA level may be a response to oxidative stress in EPO and NAC groups.

Kartagener's syndrome and polycystic kidney disease.

Sir, Kartageners syndrome (KS) is a clinical variant of primary ciliary dyskinesia (PCD) involving situs inversus associated with chronic airway infections [1]. Ciliopathy has now become recognized as a multisystem disease, of which PCD is an important subgroup. Other known ciliopathies include Bardet–Biedl syndrome, polycystic kidney and liver disease, nephronophthisis, Alstrom syndrome, Meckel–Gruber syndrome and some forms of retinal degeneration [2,3]. We report a patient with KS and polycystic kidney disease, presenting with severe renal failure. A 25-year-old woman who presented with fever, weakness, nausea, cough, dyspnoea, poor general condition and respiratory distress was admitted to our hospital. The patient was diagnosed 15 years previously with KS. On physical examination, blood pressure was 120/ 80 mmHg, heart rate was 117 beats/min and respiratory rate was 22 breaths/min. Heart sounds were distant and deep on cardiac auscultation. Bilateral crackles were determined in lungs. Her laboratory findings were as follows: serum sodium 112 mmol/l, chlorine 77 mmol/l, urea 442 mg/dl, creatinine 7.5 mg/dl, haemoglobin 6.5 g/dl, leucocytes 30 000, arterial blood gas pH 7.1, bicarbonate 8 mmol/l, pCO2 22 mmHg, C-reactive protein (CRP) 41 mg/l. Due to poor general condition of the patient, with acidosis, haemodialysis was started. Ultrasonographic examination of the abdomen revealed the situs inversus and polycystic kidney disease. The CT of the abdomen and thorax CT was performed (Figures ​(Figures11 and ​and22). Fig. 1 Bronchiectasis and dextrocardia in thorax CT. Fig. 2 Polycystic kidney in abdominal CT. To our knowledge, this is the first case of KS and polycystic kidney disease reported in the literature. Conflict of interest statement. None declared.

The Affecting Factors and Comparison of Tuberculin Skin Test in Peritoneal Dialysis and Hemodialysis Patients

Compared with the general population, patients with chronic renal failure have increased tuberculosis (TB) prevalence and mortality rates. In this study, we aimed to investigate tuberculin skin test (TST) positivity rates in hemodialysis (HD) and peritoneal dialysis (PD) patients and the factors influencing TST positivity. Ninety-two HD patients and 44 PD patients who had been on HD and PD treatment for at least 3 months were recruited into the study. TST was administered in all patients. Positivity was defined as an induration diameter >10 mm. At least 5 mm of induration following skin testing together with a chest radiography indicating previous infection was defined as latent TB infection. TST positivity rates, diameter of TST indurations, and serum albumin levels in HD patients were higher than the PD patients. TST induration size was not correlated with any other parameters in both HD and PD groups. TST-positive patients had higher albumin levels and lower leukocyte count than the TST-negative patients. In TST-positive patients, albumin level was correlated with the duration of dialysis but TST induration size was not correlated with the lymphocyte count and albumin level. In our study, TST positivity of patients was found in 30.4% of HD patients, 9% of PD patients, and 23.5% of total patients. It is still recommended to use TST for the screening test of TB. We found a significant relationship between TST and albumin level. It should be remembered that TST response may be lower in PD patients, especially in cases in which TB is suspected.

Scimitar syndrome with renal agenesis

Partial pulmonary venous connection anomaly is relatively uncommon form of congenital heart diseases. The quite rare combination of this anomaly with hypoplasia of the right lung and dextroposition of the heart is designated as scimitar syndrome. Most cases are presented in infantile period and adult presentation is exceedingly rare. Our patient, a 38-year-old man, was admitted to a doctor with flu-like complaint and because of abnormalities on chest X-ray he was sent to our clinic. He did not have any chronic complaints such as shortness of breath and fatigue. After investigation, scimitar syndrome was diagnosed. Left renal agenesis was determined with abdominal examination. Best of our knowledge in literature we did not detect any case both with Scimitar syndrome and renal agenesis, and we wanted to report the asymptomatic adult Scimitar syndrome case with left renal agenesis.