Ömer Özbudak

Doppler ultrasonography versus venography in the detection of deep vein thrombosis in patients with pulmonary embolism

In patients with acute pulmonary embolism (PE) the frequency of deep vein thrombosis (DVT) varies between 13–93%. The aim of this study was to compare Doppler ultrasonography (DUSG) and venography in the detection of DVT in patients with PE. Fifty-one patients who were clinically diagnosed as having PE from January 1st 2001 to January 31st 2005 were entered into the study and comorbid conditions and risk factors were noted. The diagnosis of PE was confirmed by ventilation-perfusion (V/Q) scintigraphy, spiral tomography and angiotomography while the diagnosis of DVT was made by DUSG and venography. DVT was confirmed by both DUSG and venography in 19 (37,3%) patients. In the remaining 32 patients DUSG was negative. Venography confirmed DVT in 6 of these patients while in 26 no DVT was found. The sensitivity and specifity of DUSG in the diagnosis of DVT were 76% and 100% respectively and the negative and positive predictive values were 81% and 100% respectively. The mean d-dimer concentration was 1187 in patients with DVT and 641 in patients without DVT (p > 0.05). Aquired risk factors were found in 4 of 6 patients with DVT, CRP was elevated in 5 (83%) and ALT-AST were elevated in 2 (33%). Although DUSG alone is considered sufficient for the diagnosis of DVT, venography still remains the gold standard in the diagnosis of DVT. Especially in patients with PE, where the diagnosis of DVT may increase the success of treatment, venography or other diagnostic tools may be used instead of a second DUSG if the first DUSG is negative.

Acute respiratory failure and tracheal obstruction in patients with posterior giant mediastinal (intrathoracic) goiter.

The extension of a thyroid goiter into the mediastinum, commonly known as a substernal goiter, is commonly located in the anterior mediastinum. Substernal enlargement of a goiter can cause compression of several mediastinal structures including the trachea. Tracheal compression may rarely lead to acute respiratory failure. We present a patient with tracheal compression and respiratory failure due to a posterior mediastinal goiter in the light of the literature.

Patient and physician delay in the diagnosis and treatment of non-small cell lung cancer in Turkey.

AIM The early diagnosis and treatment of lung cancer are important for the prognosis of patients with lung cancer. This study was undertaken to investigate patient and doctor delays in the diagnosis and treatment of NSCLC and the factors affecting these delays. MATERIALS AND METHODS A total of 1016 patients, including 926 (91.1%) males and 90 (8.9%) females with a mean age of 61.5±10.1 years, were enrolled prospectively in this study between May 2010 and May 2011 from 17 sites in various Turkish provinces. RESULTS The patient delay was found to be 49.9±96.9 days, doctor delay was found to be 87.7±99.6 days, and total delay was found to be 131.3±135.2 days. The referral delay was found to be 61.6±127.2 days, diagnostic delay was found to be 20.4±44.5 days, and treatment delay was found to be 24.4±54.9 days. When the major factors responsible for these delays were examined, patient delay was found to be more frequent in workers, while referral delay was found to be more frequent in patients living in villages (p<0.05). We determined that referral delay, doctor delay, and total delay increased as the number of doctors who were consulted by patients increased (p<0.05). Additionally, we determined that diagnostic and treatment delays were more frequent at the early tumour stages in NSCLC patients (p<0.05). DISCUSSION The extended length of patient delay underscores the necessity of educating people about lung cancer. To decrease doctor delay, education is a crucial first step. Additionally, to further reduce the diagnostic and treatment delays of chest specialists, multidisciplinary management and algorithms must be used regularly.

The Role of Nitric Oxide In Predicting Revisit of Patients With Exacerbated Chronic Obstructive Pulmonary Disease

BACKGROUND Chronic obstructive pulmonary disease (COPD) is associated with high mortality and morbidity. OBJECTIVE The aim of the present study was to determine the role of nitric oxide (NO) and other possible factors in predicting the revisit of patients with COPD exacerbation to the emergency department (ED). METHODS This is a prospective cohort study on patients with exacerbated COPD in the ED setting. Bedside nasal NO values were measured with a hand-held analyzer device. Revisit to the ED has been defined as any unscheduled visit to an ED or to primary physicians office within 2 weeks of the initial ED visit for worsening COPD symptoms. A follow-up survey via telephone was conducted on all patients at the end of 2 weeks. RESULTS The data from 64 patients who visited the ED once was compared to 28 revisits. Total of 92 patients were analyzed and variables were compared. The rate of revisits to the ED was 30%. Nasal NO measurement could not predict the revisits of patients with COPD exacerbation to the ED. The mean respiratory rate, exacerbations in previous year, home nebulizer therapy, prescribed antibiotic at discharge, home oxygen therapy, and abnormal chest x-ray studies were associated with increased rate of revisits to ED in univariate analysis. After multivariate analysis, only the mean respiratory rate at presentation and the prescribed antibiotic at discharge were significant determinants. CONCLUSIONS There was no statistically significant difference measured in NO level at presentation or before discharge between the groups. The mean respiratory rate at presentation and the prescribed antibiotic at discharge may predict the return of a COPD-exacerbated patient within 14 days to ED.

Metachronous malignant mesothelioma and pulmonary adenocarcinoma.

Abstract Th e prevalence of multiple primary malignant neoplasms in a single patient is reported in a wide variation. Th e co-existence of malignant mesothelioma and pulmonary carcinoma is a rare entity. Herein, we reported a 60-year-old man who was a retired employee and heavy smoker. He had a suspicious history of asbestos exposure. He complained of chest pain and computerized tomography revealed a mass in the lower lobe of left lung. Th e patient underwent a left lower lobectomy and was diagnosed as pulmonary adenocarcinoma. During follow-up two years aft er surgery, the patient complained of dyspnea and chest computerized tomography scan revealed right pleural effusion and diff use pleural thickening. For the differential diagnosis, the patient underwent wedge biopsy from the right lower lobe and was diagnosed as epithelial diff use malignant mesothelioma. Th e development of malignant pleural mesothelioma and lung carcinoma could be associated with asbestos exposure. However, a history of asbestos exposure is not required for the diagnosis. The influence of effective anticancer therapies that improve the survival rates and increase the population ages could be related to the occurrence of a second malignancy. ÖZ Bir hastada izlenen çoklu primer malign neoplazilerin prevalansı değişen oranlarda bildirilmiştir. Malign mezotelyoma ve pulmoner karsinomun birlikteliği ise nadir görülen bir antitedir. Olgumuz 60 yaşında emekli memur olan bir erkek hastadır. Ağır sigara içiciliği ve şüpheli asbest maruziyeti öyküsü vardır. Göğüs ağrısı ile başvurmuş ve bilgisayarlı tomografisinde sol akciğer alt lobda kitle tespit edilmiştir. Hastaya sol alt lobektomi uygulanmış ve pulmoner adenokarsinom olarak tanı almıştır. Bu cerrahiden 2 yıl sonra, takibinde hastanın nefes darlığı şikayeti üzerine, bilgisayarlı tomografisinde sağda plevral efüzyon ve difüz plevral kalınlaşma bulunmuştur. Hastaya ayırıcı tanı için sağ akciğer alt lob kama biyopsi uygulanmış ve epitelyal difüz malign mezotelyoma tanısı verilmiştir. Malign plevral mezotelyoma ve akciğer karsinomu gelişimi asbest maruziyeti ile ilişkili olabilir. Ancak tanı için asbest maruziyet öyküsünün olması gerekli değildir. Etkili antikanser tedavileri ile yaşam oranlarının yükselmesi ve popülasyon yaşının artması kişide ikinci malignitenin ortaya çıkması ile ilişkili olabilir.

Benefits of omalizumab on anxiety and depression in patients with severe asthma

Background: Asthma is one of the most common chronic diseases and may cause psychiatric disorders affecting the patients’ quality of life. In our study, we evaluated the effect of omalizumab treatment on anxiety disorder and depression using Beck Depression Scale (BDS) and State Trait Anxiety Inventory (STAI). Methods: Anxiety level was determined with STAI, whereas depression level was evaluated by BDS. Patients were asked to mark the questionnaires to reflect their emotional state before treatment, and to reflect their emotions they are feeding in the current moment. All patients receiving omalizumab treatment were included in the study. Patients with known neuropsychiatric disorder were excluded from the study. Results: A total of 20 patients with mean age of 50.25 years were enrolled in the study. Gender distribution was: 5(25%) male patients and 15(75%) female patients. All patients with severe asthma received omalizumab treatment. The omalizumab treatment period was shown for mean 17.6 months (2-40 months). In anxiety scales, there was statistically significant difference compared with pretreatment and posttreatment periods. Depression (moderate to severe) was present in 12 patients before omalizumab treatment and 3 patients after omalizumab treatment. Conclusions: Uncontrolled asthma as a chronic disorder can cause depressive symptoms and worsen quality of life. We believe by controlling asthma, quality of life will improvein such patients. In appropriate indication, omalizumab can improve depression and anxiety in asthma patients.

An asymptomatic case of tuberculosis mimicking malignancy

Tuberculosis is one of the most important public health problems. It is most commonly seen in the lungs. It is easy to diagnose pulmonary tuberculosis with typical clinical and radiological findings. In addition to the appearance of pneumonia and atelectasis, it may mimic bronchial asthma and malignancy more rarely. We present a case of asymptomatic tuberculosis mimicking malignancy radiologically.

Summary of Consensus Report on Preoperative Evaluation

INTRODUCTION The clinician has three aims in the preoperative evaluation: to determine the risk of preoperative complications, to decrease the risk of perioperative complications, and to eliminate the risk factors in patients who have a risk of complications in the postoperative period. For this purpose, an accurate preoperative evaluation would allow the patient to be operated on with minimum risk.

A 56 yr-old female with chronic cough and persistent infiltration on CT examination

A 56-yr-old female who had chronic dry cough for 1 yr was evaluated. She was otherwise healthy and immunocompetent. There was no history of past or present lung disease, smoking habit or recent oral operation.