Oner Dikensoy

Alternative widely available, inexpensive agents for pleurodesis.

Purpose of review Pleurodesis is the one of the best options for the management of symptomatic patients with malignant pleural effusion, recurrent benign pleural effusion, and recurrent pneumothorax. Although talc, parenteral tetracycline derivatives, and bleomycin are the most commonly used agents for pleurodesis, parenteral tetracycline derivatives are not available worldwide, bleomycin is expensive, and concerns about the side effects of talc are growing. The purpose of this review is to provide information about other widely available agents for pleurodesis. Recent findings It has recently been shown that oral tetracycline/doxycycline is as effective and safe as parenteral doxycycline in producing pleurodesis in rabbits. Summary Oral forms of tetracycline derivatives, quinacrine, silver nitrate, iodopovidone, and other talc preparations such as facial talc can be used to create pleurodesis when commonly used agents are not available.

Diagnostic value of pleural fluid N-terminal pro-brain natriuretic peptide levels in patients with cardiovascular diseases

Background and objective:  The diagnosis of the cause of pleural effusions caused by cardiovascular diseases such as congestive heart failure (CHF) and acute pulmonary embolism is sometimes difficult. The purpose of the present study was to evaluate the utility of pleural fluid levels of N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) in differentiating pleural effusions due to CHF, pulmonary embolism and post‐coronary artery bypass graft (CABG) surgery.

Mesothelioma due to environmental exposure to erionite in Turkey

Purpose of review The prevalence of malignant mesothelioma due to erionite exposure in Central Anatolia is very high. In this report, we review the recent developments on this epidemic on the basis of previous literature. Recent findings Recently, it has been shown that erionite is poorly cytotoxic, induces proliferating signals and high growth rate in human mesothelial cells. Additionally, long-term exposure to erionite transforms human mesothelial cells in vitro, regardless of the presence of Simian Virus 40 sequences, leading to foci formation in cultured monolayers. It has also been confirmed that a genetic predisposition to erionite carcinogenesis is the cause of the mesothelioma epidemic in Cappadocia. Summary The data obtained recently on the epidemiology, etiology, and pathogenesis of the mesothelioma due to erionite exposure in Turkey are described.

Increased Pleural Fluid Adenosine Deaminase in Brucellosis Is Difficult to Differentiate from Tuberculosis

Pleural involvement in brucellosis is very rare. Current knowledge on brucella pleuritis is limited to a few case studies, and pleural adenosine deaminase (ADA) in brucellosis has not been studied previously. We report the pleural fluid characteristics, including ADA, of two cases with brucella pleurisy. Analysis of the pleural fluids revealed exudative effusions with increased ADA level, decreased glucose concentration, and lymphocyte predominance. The similarity with tuberculous pleurisy was remarkable. We suggest that brucellosis should be considered in the differential diagnosis of tuberculosis, especially in regions endemic for both diseases.

Drug-resistant tuberculosis at the University Hospital in Gaziantep, south-eastern Turkey

We aimed to determine the present status of drug resistance of Mycobacterium tuberculosis at the Gaziantep University Hospital in south-east Turkey. Data for 1995 to 1999 were retrospectively evaluated with respect to smear-positive cases, first positive culture for Mycobacterium tuberculosis for each patient and drug-susceptibility tests for the major antituberculous drugs. Cultures were done using the Bactec 460 TB method. A total of 106 (40.2%) strains were resistant to at least one drug. Single drug resistance was observed in 47 strains (17.8%) and resistance to two or three drugs was found in 28 and 29 strains (10.6 and 11.0%), respectively. Two strains (0.8%) were resistant to all four drugs. While multidrug resistance was observed in 52 (19.7%) strains, resistance to isoniazid + rifampin was observed in 20 (7.6%) strains. This retrospective study showed that combined drug resistance of M. tuberculosis is highly prevalent in southeastern Turkey. Possible reasons for the failure of current control policies were considered.

First report of pulmonary Nocardia otitidiscaviarum infection in an immunocompetent patient from Turkey

Nocardiosis is a rare disease, and worldwide, respiratory and disseminated infections are most often due to Nocardia asteroides which is recognised increasingly as an opportunistic infection in patients with underlying chronic debilitating disease or immunodeficiency. However, infection with N. otitidiscaviarum and pulmonary nocardiosis in an immune‐competent host remains very rare. We report a 65‐year‐old immune‐competent male with pulmonary N. otitidiscaviarum infection in whom complete cure was provided with a 6 months of antibiotic combination including trimethoprim‐sulfomethaxazol. This is the first report of pulmonary N. otitidiscaviarum infection in an immune‐competent patient from Turkey.

Bronchiolitis obliterans in a Case of Juvenile Rheumatoid Arthritis Presented with Pneumomediastinum

We present a case of bronchiolitis obliterans associated with juvenile rheumatoid arthritis in whom pneumomediastinum was the presenting manifestation. Diagnosis of bronchiolitis obliterans was made on the basis of the clinical history, pulmonary function tests and high-resolution computerized tomography scan findings. Pneumomediastinum resolved in a few days following high-dose nasal oxygen. This case shows that bronchiolitis obliterans can occur in patients with juvenile rheumatoid arthritis. Complicating pneumomediastinum in such cases should be considered as an indication of underlying bronchiolitis obliterans.

Effect of serum on diesel exhaust particles (DEP)-induced apoptosis of airway epithelial cells in vitro.

Patients with chronic airway diseases may be more susceptible to adverse effects of air pollutants including diesel exhaust particles (DEP). We investigated effects of foetal calf serum (FCS) on DEP-induced changes in airway epithelial cell apoptosis and inflammation. DEP (50-200 μg/ml) increased A549 cell viability in the absence of FCS. In the presence of 3.3%FCS, DEP (50-400 μg/ml) decreased A549 cell viability. N-acetylcysteine (NAC, 33 mM) and the c-jun N-terminal kinase (JNK) inhibitor (SP600125, 33 μM) further decreased the viability in the presence of DEP (200 μg/ml) and 3.3% FCS. Under serum-free (SF) condition, DEP (50 μg/ml) reduced apoptotic cells; however, when 3.3% FCS added to the culture medium, this effect was abolished. DEP (200 μg/ml) induced mRNA expression of p21(CIP1/WAF1) both in absence or presence of 3.3% FCS and enhanced JNK2 mRNA expression only in the presence of 3.3% FCS. Under SF condition, DEP (50 μg/ml) induced mRNA expression for p27 and p53, whereas cyclin E mRNA expression was inhibited by DEP (50 and 200 μg/ml). Furthermore, DEP (200 μg/ml) decreased the release of interleukin (IL)-8 in the absence of FCS. In conclusion, FCS modulates effects of DEP on cell death, cell cycle and apoptosis regulating proteins, and IL-8 release by activating oxidant stress pathways, JNK and NF-κB. Extravasation of serum, as occurs in the inflamed airways of patients with chronic airway diseases such as asthma and COPD, may render airway epithelial cells more susceptible to the deleterious effects of DEP.

Intrapleural hyperthermic perfusion chemotherapy in subjects with metastatic pleural malignancies

OBJECTIVES Malignant pleural effusion (MPE) means poor prognosis in the majority of cases. Intrapleural Hyperthermic perfusion chemotherapy (HIPEC) looks promising approach for these patients. We aimed to investigate whether cytoreductive surgery followed by HIPEC provides any survival benefit in cases with metastatic MPEs. METHODS Between January 2009 and December 2011, 19 patients with metastatic MPEs were treated with HIPEC following surgical interventions such as pleurectomy/decortication and/or lung resection (group 1). Comparison was done with historical control groups consisted of patients who received either talc pleurodesis or pleurectomy/decortication followed by systemic treatment for the management of metastatic MPEs between June 2007 and June 2008 (group 2 and 3). Statistical analyses including overall survival, disease free interval were done for the group comparisons. RESULTS Median survival in group 1, 2 and 3 were 15.4, 6, 8 months, respectively. One year survival was 54.7% in group 1 where it was 0.6% and 0.8% in group 2 and 3, respectively. There was no operative mortality. Morbidity was occurred in 1 patient in group 1 (5.3%). CONCLUSIONS HIPEC combined with cytoreductive surgery seems to be a promising treatment option for subjects with metastatic MPEs. Further studies are needed for the optimization of HIPEC method, drug of choice, and the best combination therapy for the multimodal treatment.

Antibiotic Resistance of Bacterial Ventilator-Associated Pneumonia in Surgical Intensive Care Units

Ventilator-associated pneumonia (VAP) is the most common infection in intensive care units. It is caused by prolonged hospitalization and results in high mortality rates. This retrospective clinical study, of 140 patients in a surgical intensive care unit, aimed to identify the bacterial agents responsible for VAP infection, and determine antibiotic resistance rates in VAP. Antibiotic sensitivity was evaluated by culturing and testing tracheal aspirates from patients with clinical and radiological findings of VAP. The bacteria isolated most frequently were Pseudomonas aeruginosa (33.9%), Staphylococcus aureus (30.0%), Acinetobacter baumannii (26.1%), and Enterobacter species (4.3%). A. baumannii was more prevalent than in previous years. The results of antibiotic sensitivity testing suggested sulbactam/cefoperazone as the most appropriate drug for treating these patients. We suggest, however, that when staphylococcal pneumonia is suspected, a glycopeptide (vancomycin or teicoplanin) or combined trimethoprimsulfamethoxazole is used as first-line therapy until sensitivity results are obtained. In conclusion, development of antibiotic policies for individual hospitals can reduce high antibiotic resistance rates due to VAP.