Sevin Baser

Peripheral neuropathy in chronic obstructive pulmonary disease.

ABSTRACT The aim of this study was to evaluate the frequency and characteristics of peripheral nervous system involvement in chronic obstructive pulmonary disease and its relation with proinflammatory cytokines such as TNF-α, IL-6, IGF-1 and CRP. Forty chronic obstructive pulmonary disease patients with a mean age 62.8 ± 5.5 years and 33 healthy controls with a mean age of 61.8 ± 7.4 were included into this study. All subjects were evaluated with standard motor and sensory nerve conduction studies. Serum TNF-α, IL-6, CRP and IGF-1 were measured. The muscle strengths of three muscle groups (knee extensors, shoulder abductors and flexors) were assessed with a hand-held dynamometer. Peripheral neuropathy was detected at 15%% of chronic obstructive pulmonary disease patients. Ulnar motor and sensory nerves, left sural nerve distal latencies were found significantly prolonged than healthy volunteers (p == 0.011), peroneal nerve conduction velocities was found lower in patients than in healthy controls (p == 0.021), tibial nerve amplitudes was found lower in patients than healthy controls (p == 0.046). CRP and TNF-α were found significantly higher in chronic obstructive pulmonary disease patients and IGF-1 was found significantly lower in chronic obstructive pulmonary disease patients. There was no correlations between proinflammatory cytokines, CRP and electrophysiological findings. Left sural nerves sensory nerve action potential amplitude was correlated positively with FEV1%% (r == 0.425; p == 0.009). Muscle strength at the shoulder and knee were significantly reduced in patients with COPD when compared with controls. The frequency of neuropathy was higher in chronic obstructive pulmonary disease when compared with the healthy controls. Chronic obstructive pulmonary disease patients have subclinical peripheral nerve involvements.

Respiratory Effects of Chronic Animal Feed Dust Exposure

Respiratory Effects of Chronic Animal Feed Dust Exposure: Sevin Baser, et al. Pulmonology Department, Pamukkale University Medical Faculty, Turkey

Respiratory Symptoms and Pulmonary Functions of Workers Employed in Turkish Textile Dyeing Factories

Dyes are known to be a causative agent of occupational asthma in workers exposed to them. We have evaluated respiratory symptoms among textile workers. The study population comprised 106 exposed workers and a control (unexposed) group. Data were collected by a questionnaire. PFTs (Pulmonary Function Test) were performed. Among the exposed workers 36.8% defined phlegm. Respiratory symptoms were not significantly different between two groups. The employment duration of the exposed workers with phlegm was longer than those without phlegm (p = 0.027). The mean % predicted of FEF25–75 of the exposed workers was found to be significantly lower than the control (unexposed) group (p = 0.01). Our study suggests that textile dyeing might cause respiratory symptoms in workers.

A 26‐yr-old female with persistent cough

A 26‐yr-old female was referred to the Chest Dept of thePamukkale University Medical School, Turkey, for the investigation of coughing and abnormal chest roentgenogram. She suffered flu 3 weeks prior to this and her coughing was persisting since then. She denied fever, phlegm, dyspnoea, wheeze, night sweats and haemoptysis. Before a splenectomy at aged 18 yrs, blood transfusions had been applied monthly. Physical examination revealed a blood pressure of 120/80 mmHg, pulse rate of 96 beats per min, respiratory rate of21 breaths per min and marked hepatomegaly. Chest examination results were normal. Haematological examination showed a haemoglobin level of 1.38 mmol·L−1 (89.3 g·L−1), haematocrit value of 0.19, mean corpuscular volume of 91.4 fL, mean corpuscular haemoglobin concentration of 466 g·L−1, red blood cell count of 2.1×1012 cells·L−1, reticulocyte count of 0.14, white blood cell count of 23×109 cells·L−1, and platelet count of 1072×109 platelets·L−1. Serum biochemical findings were as follows: aspartate aminotransferase 85 U·L−1, alanine aminotransferase 84 U·L−1, blood urea nitrogen 1.33 mmol urea·L−1, total protein 73 g·L−1, total bilirubin 30.8 µmol·L−1, iron 36.7 µmol·L−1, ferritin 2.3 g·L−1, and total iron binding capacity 40.3 µmol·L−1. The chest …

Potential utility of p63 expression in differential diagnosis of non-small-cell lung carcinoma and its effect on prognosis of the disease

Background P63 is a gene located in chromosome 3q27–29, which has been implicated in regulation of stem cell commitment and promotion of squamous differentiation in various tissues. The aim of this study was to investigate whether there was a correlation between p63 expression, differential diagnosis of lung carcinoma, and prognosis. Material/Methods Immunohistochemical expression of p63 in 62 lung carcinomas was investigated and mRNA analysis using RT-PCR method was done in 6 selected cases. Results When cases were evaluated for p63 staining, 24 of 25 (96%) squamous cell carcinomas were strongly positive. Six of 20 adenocarcinomas (25%) and 1 (100%) large cell carcinoma (except neuroendocrine carcinoma) were mildly positive. p63 staining was statistically significant in favor of squamous cell carcinoma than other tumors (p<0.001). Forty percent of squamous cell carcinomas had squamous carcinoma in situ, whereas adenocarcinomas had none. There was a significant statistical difference between squamous cell carcinoma and adenocarcinoma (p=0.002). p63 was strongly positive in all of 12 squamous carcinoma in situ cases. In 6 cases where mRNA analysis was performed by RT-PCR method, DNp63 was strongly positive in 3 squamous cell carcinomas, mildly positive in 1 adenocarcinoma, and negative in 1 carcinoid tumor. TAp63 was strongly positive in non-tumoral lung tissue but negative in all tumors, except 1 squamous cell carcinoma. Conclusions Our data suggest that poorly differentiated squamous cell carcinoma had strong and widespread staining for immunohistochemical expression of p63. Therefore, p63 can be a useful marker in differentiating squamous cell carcinoma from poorly differentiated adenocarcinoma and squamous cell carcinoma from large cell neuroendocrine carcinoma.

Giovanni Battista Morgagni (1682–1771)

Giovanni Battista Morgagni (1682–1771) is considered the father of neuropathology and one of the most important innovators in the history of medicine. In his “opus magnum” De sedibus et causis morborum per anatomen indagatis (The Seats and causes of diseases investigated by anatomy), he established pathological anatomy as a science by correlating clinical histories with autopsy findings.

Binasal cannula versus face mask for oxygen therapy in patients with chronic pulmonary disease.

Oxygen therapy, which is ordered frequently for patients with chronic pulmonary disease, remains a cornerstone of modern medical practice. This study was conducted to compare the efficiency and comfort of a binasal cannula versus a face mask during oxygen therapy. Sixty hypoxemic patients participated in this randomized controlled study. While each patient was hypoxemic, arterial blood gas analysis was performed before oxygen supplementation was begun. Arterial oxygen saturation was continuously monitored during oxygen therapy with a face ask or a binasal cannula. Subjects were allowed to return to their oxygen saturation level in room air before the device for oxygen treatment was changed. The same procedure was then repeated with the other device. Patient comfort was evaluated through the use of a questionnaire that was completed after each treatment period. The mean age±standard deviation was 62±13 y. No statistically significant difference was noted in oxygen saturation levels achieved with the 2 devices. The binasal cannula reached target oxygen levels (P=.007) more quickly than the face mask. The binasal cannula was reported to be significantly more comfortable (P=.0001), and had significantly fewer reports of dyspnea and restlessness, and was less of a nuisance (P=.019, P=.0001, and P=.0001, respectively). The binasal cannula was preferred for oxygen therapy by 71% of study patients. Although the efficiency of the 2 devices did not differ remarkably, Transmission and reproduction of this material in whole or part without prior written approval are prohibited. the binasal cannula was regarded as a more comfortable and time-saving device for delivery of oxygen therapy to hypoxic patients.

Syndrome of inappropriate antidiuretic hormone secretion due to excessive intake of memantine.

An 84-year-old male patient was referred to our clinic with delirium. He had a 6 years history of Alzheimer’s disease, but no other systemic disease was documented in his medical history. His doctor had prescribed a regimen of 10 mg/day of donepezil and memantine. However, his wife, i.e., his primary caregiver, had been giving him 30 mg/day of memantine for a month by mistake. He was not taking any other drugs. For the past 2 days, he had been unable to recognize his relatives, was lethargic, and was experiencing visual hallucinations. His blood pressure was 125/74 mmHg, and his pulse was 85 beats per minute. A physical examination did not show any signs of distended jugular veins, pedal edema, ascites, decreased skin turgor, or dry mucous membranes, indicating a euvolemic state. His urine output was normal. His neurological examination was normal aside from the delirium. The following tests were conducted: complete blood count (CBC), blood biochemistry, prothrombin time (PT), activated partial thromboplastin time (APTT), urine examination, sedimentation, thyroid function tests, thyroid autoantibodies, arterial blood gases, vitamin B12, folate, liver function tests, renal function tests, and electrolytes. Moreover, a lung X-ray and electrocardiogram were done. The tests revealed that his blood sodium level was below normal, i.e., 116 mmol/L. The other laboratory results and examinations were normal. The initial diagnosis was that he was suffering from the syndrome of inappropriate antidiuretic hormone (SIADH) secretion, so we focused our examinations according to this diagnosis. The patient’s blood osmolarity had decreased to 243 mOsm/kg (\275 mOsm/kg). Sodium output in the urine had increased to 83 mmol/L (\20 mmol/L). His blood urea nitrogen and plasma uric acid were 5 mg/dL (8–23 mg/dL) and 2.9 mg/dL (3.4–7 mg/dL), respectively, and he had a normal acid/base and potassium balance. He was diagnosed with SIADH resulting in delirium, and treatment was started by administering 3 % intravenous saline with infusion rates based on the patient’s electrolyte levels checked every 12 h. We also restricted the patient’s water intake. Given the circumstances, we believed that the etiology of the SIADH in this patient was the overdose of memantine. Therefore, we stopped administering memantine. The patient’s condition improved within 1 week of treatment. When the patient was diagnosed with SIADH, we investigated other factors and etiologies. His pulmonary examination and thorax tomography were normal. Moreover, no adrenal or thyroid insufficiencies were found. Additionally, no other findings except global cerebral atrophy was evident on cranial MRI. He was not using any other drugs that might cause SIADH. After release from the hospital, the patient’s sodium level remained at normal levels. SIADH is a disorder of impaired water excretion caused by the inability to suppress the secretion of antidiuretic hormone (ADH). It is characterized by hyponatremia, inappropriately increased urine osmolality, increased urine sodium, and decreased serum osmolality in a euvolemic & Çağatay Öncel cagatayoncel@yahoo.com

Occupational Exposure and Thoracic Malignancies, Is There a Relationship?

Occupational Exposure and Thoracic Malignancies, Is There a Relationship ?: Sevin BASER, et al. Department of Pulmonary Medicine, Pamukkale University Medical Faculty, Turkey—The aim of this study was to evaluate the effect of occupational exposure in the occurrence of lung cancer.

A Case of Organising Pneumonia Associated with Streptococcus pneumoniae

ÖZET Organize pnömoni, birçok klinik ve radyolojik durumla ilişkili inflamatuar bir akciğer hastalığıdır. Hiçbir solunumsal sıkıntısı olmayan 57 yaşındaki kadın hastanın yaklaşık 1 aydır devam eden uyku hali, halsizlik, yorgunluk, terleme, baş dönmesi yakınmaları mevcuttu. Akciğer grafisinde, bilateral yama tarzı infiltrasyonları olması nedeniyle ileri tetkiki yapıldı. Transtorasik tru-cut biyopsi sonucunda organize pnömoni (OP) tanısı kondu. Başlangıçta hiçbir etiyolojik faktör saptanamamışken, BAL sıvısında Streptococcus pneumoniae üremesi üzerine organize pnömoninin, mikrobiyolojik bir nedene ikincil OP olabileceği düşünüldü. Hastaya 1 mg/kg/gün prednizolon tedavisi başlandı ve 6 ay süreyle, azaltılan dozlarda verildi. Tedavi sonu kontrolünde, hastanın en belirgin yakınması olan uyku halinin tamamen geçtiği, olgunun klinik olarak iyileştiği ve radyolojik olarak lezyonların tama yakın gerilediği görüldü.