Publications by authors named "Funda Oztuna"

47 Publications

[The cost of pulmonary thromboembolism treatment].

Tuberk Toraks 2020 Sep;68(3):293-304

Clinic of Chest Diseases, Çakmak Erdem Hospital, Istanbul, Turkey.

Introduction: Primary aim of this study is to determine the financial burden of Vitamin K Antagonists (VKA), low molecular weight heparins (LMWH) and new oral anticoagulants (NOAC) which are used in the treatment of the pulmonary thromboembolism (PTE). Secondary aim is to show long term complications of the treatment options.

Materials And Methods: The patients who are diagnosed with PTE between May 2016 and March 2018 at Faculty of Medicine Karadeniz Technical University Hospital were observed prospectively. Hospitalization costs were calculated on patients who were treated only for PTE by hospitalized in the Chest Diseases Service in the acute period. Maintenance costs were calculated over all patients who regulary admitted to our outpatient clinic with the diagnosis of PTE. Data were presented as mean ± SD and median ± interquartilee range. A p-value of <0.05 was accepted to be significant.

Result: Fifty five (37.2%) of the patients were male, 93 (62.8%) were female and the median age was 68 (range 18-95). The median hospitalization time and cost of patients who are discharged with VKA (n: 22) compared with patients discharged with LMWH (n: 22) was found to be increased (1316.82 TL 7,5 days / 803.36 TL, 5 days p<0.001). Statistical analysis could not be performed with NOAC (n: 2). In the analysis of sixth month costs, LMWH cost was found to be higher than VKA cost (6.927.15 ± 2.687.67 TL/698.29 ± 483.51 TL p<0.001). However VKA treatment tended to be less expensive than treatment with NOACs (698.29 ± 483.51 TL/1.050.81 ± 300.28 TL p= 0.140).

Conclusions: In the acute period of PTE, VKA increases the length of hospitalization and hospital costs in patients treated at the hospital. In the maintenance period, VKA tends to have a lower cost compared to NOACs.
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http://dx.doi.org/10.5578/tt.70104DOI Listing
September 2020

Can artificial intelligence distinguish between malignant and benign mediastinal lymph nodes using sonographic features on EBUS images?

Curr Med Res Opin 2020 Dec 24;36(12):2019-2024. Epub 2020 Oct 24.

Pulmonary Medicine, Karadeniz Technical University, Trabzon, Turkey.

Aims: This study aimed to develop a new intelligent diagnostic approach using an artificial neural network (ANN). Moreover, we investigated whether the learning-method-guided quantitative analysis approach adequately described mediastinal lymphadenopathies on endobronchial ultrasound (EBUS) images.

Methods: In total, 345 lymph nodes (LNs) from 345 EBUS images were used as source input datasets for the application group. The group consisted of 300 and 45 textural patterns as input and output variables, respectively. The input and output datasets were processed using MATLAB. All these datasets were utilized for the training and testing of the ANN.

Results: The best diagnostic accuracy was 82% of that obtained from the textural patterns of the LNs pattern (89% sensitivity, 72% specificity, and 78.2% area under the curve). The negative predictive values were 81% compared to the corresponding positive predictive values of 83%. Due to the application group's pattern-based evaluation, the LN pattern was statistically significant ( = .002).

Conclusions: The proposed intelligent approach could be useful in making diagnoses. Further development is required to improve the diagnostic accuracy of the visual interpretation.
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http://dx.doi.org/10.1080/03007995.2020.1837763DOI Listing
December 2020

Prognostic value of red cell distribution width and echocardiographic parameters in patients with pulmonary embolism.

Adv Respir Med 2019 ;87(2):69-76

Department of Pulmonary Medicine, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.

Introduction: Pulmonary embolism (PTE) is a common cardiovascular emergency. We aimed to predict mortality in the acute phase and to assess the development of pulmonary hypertension in the chronic period with the combined use of red cell distribution width (RDW) and echocardiography (ECHO) for the prognosis of PTE.

Material And Methods: Cases diagnosed with acute PTE were prospectively monitored in our clinic. The initial data of 56 patients were evaluated. The subjects were separated into two groups basing on RDW; group 1 had RDW ≥ 15.2%, while group 2 had RDW < 15.2%.

Results: Ninety-eight patients were enrolled in the study. We established the sensitivity (73.3%) and the specificity (73.2%) of RDW to determine mortality in the cases with PTE. RDW ≥ 15.2% value was significant as an independent risk factor for predicting mortality (OR:7.9 95% CI, 1.5-40.9 p = 0.013) in acute PTE. The mean tricuspid annular plane systolic excursion (TAPSE) value was significantly different between the group-1 (RDW ≥ 15.2%, 2.20 cm (± 0.43)) and group-2 (RDW < 15.2%, 1.85 cm (± 0.53))(p = 0.007). The threshold value for tricuspid jet velocity was > 2.35m/s, the sensitivity and specificity were 76.9% and 61.9%, respectively for predicting mortality (AUC: 0.724, 95% CI: 0.591-0.858, p = 0.033).

Conclusion: Our results indicate that high RDW levels are an independent predictor of mortality in acute PTE. Lower TAPSE levels show right heart failure in PTE patients; this may also be indicative of right ventricular systolic function. We believe that developing new scoring systems, including parameters such as RDW, TAPSE, and tricuspid jet velocities, may be effective in determining the prognosis of pulmonary embolism.
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http://dx.doi.org/10.5603/ARM.2019.0012DOI Listing
December 2019

Current Statement of Intensive Care Units in Turkey: Data obtained from 67 Centers.

Authors:
Özlem Ediboğlu Özlem Yazıcıoğlu Moçin Ezgi Özyılmaz Cüneyt Saltürk Tuğba Önalan Gülşah Seydaoğlu Turgay Çelikel Hüseyin Arıkan Sena Ataman Cenk Kıraklı Zerrin Özçelik Sema Kultufan İskender Kara Atilla Kara Emine Dağlı Selma Duru Bülbül Kadriye Kahveci Metin Dinçer Nimet Şenoğlu Hüseyin Özkarakaş İlhan Bahar Melike Cengiz Atilla Ramazanoğlu Burcu Çelik Ümmügülsün Gaygısız Gülay Kır Ahmet Bindal Belgin Akan Işıl Özkoçak Turan Fatma Yıldırım Burcu Başarık Zeliha Arslan Ulukan Serdar Efe Murat Sungur Şahin Temel Seval İzdeş Derya Hoşgün Nurhan Karadeniz Eylem Tuncay Nezihe Çiftarslan Gökşenoğlu İlim Irmak Utku Datlı Avşar Zerman Devrim Akdağ Levent Özdemir Gülseren Elay Yücel Karaçayır Arzu Topeli Pervin Hancı Esat Kıvanç Kaya Pınar Güven Hilal Sazak Semih Aydemir Gülbin Aygencel Yusuf Aydemir Zahide Doğanay Özgür Kömürcü Volkan Hancı Emre Karakoç Didem Sözütek Güven Coşkun Güngör Ateş Civan Tiryaki Ayşe Nur Soytürk Nermin Kelebek Girgin Gülbahar Çalışkan Oben Bıyıklı Necati Gökmen Uğur Koca Aydın Çiledağ Kezban Özmen Süner İsmail Cinel Mustafa Kemal Arslantaş Fethi Gül Recai Ergün Nafiye Yılmaz Defne Altıntaş Leyla Talan Murat Yalçınsoy Mehmet Nezir Güllü Perihan Ergin Özcan Günseli Orhun Yusuf Savran Murat Emre Tokur Serdar Akpınar Pelin Şen Gül Gürsel İrem Şerifoğlu Ender Gedik Öner Abidin Balbay Türkay Akbaş Sinem Cesur Hülya Yolacan Seda Beyhan Sağmen Pervin Korkmaz Ekren Feza Bacakoğlu Begüm Ergan Ersin Günay Muzaffer Sarıaydın Dursun Ali Sağlam Sait Karakurt Emel Eryüksel Funda Öztuna Emine Sevil Ayaydın Mürtezaoğlu Hakan Cinemre Ahmet Nalbant Öznur Yağmurkaya Tuğba Mandal Belgin İkidağ

Turk Thorac J 2018 10 13;19(4):209-215. Epub 2018 Sep 13.

Clinic of Intensive Care Unit, American Hospital, Gaziantep, Turkey.

Objectives: We aimed to obtain information about the characteristics of the ICUs in our country via a point prevalence study.

Material And Methods: This cross-sectional study was planned by the Respiratory Failure and Intensive Care Assembly of Turkish Thoracic Society. A questionnaire was prepared and invitations were sent from the association's communication channels to reach the whole country. Data were collected through all participating intensivists between the October 26, 2016 at 08:00 and October 27, 2016 at 08:00.

Results: Data were collected from the 67 centers. Overall, 76.1% of the ICUs were managed with a closed system. In total, 35.8% (n=24) of ICUs were levels of care (LOC) 2 and 64.2% (n=43) were LOC 3. The median total numbers of ICU beds, LOC 2, and LOC 3 beds were 12 (8-23), 14 (10-25), and 12 (8-20), respectively. The median number of ventilators was 12 (7-21) and that of ventilators with non-invasive ventilation mode was 11 (6-20). The median numbers of patients per physician during day and night were 3.9 (2.3-8) and 13 (9-23), respectively. The median number of patients per nurse was 2.5 (2-3.1); 88.1% of the nurses were certified by national certification corporation.

Conclusion: In terms of the number of staff, there is a need for specialist physicians, especially during the night and nurses in our country. It was thought that the number of ICU-certified nurses was comparatively sufficient, yet the target was supposed to be 100% for this rate.
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http://dx.doi.org/10.5152/TurkThoracJ.2018.170104DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6196900PMC
October 2018

Syncope as a subject of the risk assessment of pulmonary thromboembolism to be used for: A cross-sectional study.

Clin Respir J 2018 Jun 26;12(6):2136-2140. Epub 2018 Mar 26.

Chest Department, Recep Tayyip Erdoğan University, Rize, Turkey.

Introduction: Syncope is infrequent in pulmonary thromboembolism (PTE) yet might be indicative of haemodynamic instability. The prognostic role of syncope in PTE has not been well documented.

Objectives: In this study, the association between risk classification of the European Society of Cardiology and syncope was investigated in the normotensive PTE patients.

Methods: We retrospectively screened electronic medical records of patients who were admitted in 2 tertiary care hospital and diagnosis of PTE with computed tomography pulmonary angiography. Patients with hypotension (high risk) at the time of admission were excluded from the study.

Results: Of 5% patients (16/322) had syncope with the proportion of 81.3% (13/16) in the intermediate high risky group, 18.7% (3/16) in intermediate low risk group and 0% in low risk group. Mortality rate was higher in subjects with syncope (25% vs 11.1%) although it was not it was not statistically significant (P = NS). In those with syncope, the central venous thrombus was more frequent than those without it (78.6% vs 30.1%, P = .008). Only heart rate and intermediate high-risk group were retained as independent predictors of syncope selection in the multivariate logistic regression.

Conclusion: Although syncope is positively correlated with the severity of PTE, it does not predict the prognosis alone. Nonetheless, syncope in patients with PTE can be considered as an important alarming stimulus for clinical course.
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http://dx.doi.org/10.1111/crj.12784DOI Listing
June 2018

Does the Incidence and Mortality of Pulmonary Thromboembolism Change Over the Years?

Turk Thorac J 2017 Jul 1;18(3):78-81. Epub 2017 Jul 1.

Department of Chest Diseases, Karadeniz Technical University School of Medicine, Trabzon, Turkey.

Objectives: In the last 20 years, with the use of computed tomography (CT) angiography, the number of patients diagnosed with pulmonary thromboembolism (PTE) has increased. At the same time, data show that pulmonary embolism mortality has also reduced in this duration.

Material And Methods: In this study, we analyzed records of patients with PTE (using ICD's) in the hospital automation system from 2001 to 2013. Data regarding age, sex, date of diagnosis, diagnosis of cancer, hemodynamic status, initial and maintenance treatment, hospital length of stay, and hospital mortality were recorded. Primary endpoints of the study were hospital length of stay and all-cause hospital mortality.

Results: The total number of patients included in the study was 1185. The median age was 61 years in 2001 and 71 years in 2013. The number of patients who were diagnosed using CT increased from 10% to 92.8%. Between 2001 and 2013, the number of patients diagnosed with PTE increased, and of all patients with PTE, 13.7% was diagnosed in 2009. The hospital length of stay of 13 days declined to 9 days. The use of a vena cava filter in 2007 was 1.1% and that in 2013 was 4.6%. Mortality rate was 15%, however hospital mortality did not significantly differ over the years but varied between 9.4% and 18.8%. Increased use of thrombolytics in patients with massive PTE has been observed over the years. Massive PTE ratio in 2006 was 8.5% and thrombolytic use was 5.8%, however in 2013, these ratios were 2.6%, 6% respectively (p=0.017).

Conclusion: Finally, despite the increased number of patients diagnosed with PTE over the years, the mortality rate was not observed to have changed from 2001 to 2013.
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http://dx.doi.org/10.5152/TurkThoracJ.2017.16050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5783086PMC
July 2017

[Bilateral total lung lavage in a patient with pulmonary alveolar proteinosis].

Tuberk Toraks 2017 Sep;65(3):249-254

Department of Pathology, Faculty of Medicine, Karadeniz Tecnical University, Trabzon, Turkey.

Pulmonary alveolar proteinosis (PAP) is a rare pulmonary disease characterised by alveolar accumulation of surfactant composed of proteins and lipids. Three main categories of PAP have been defined depending on the aetiology: primer/idiopathic, neonatal/congenital, secondary and exogenous/environmental exposure. Radiologically diffuse ground glass opacities, interlobular and intralobular septal thickening is seen. Although open lung biopsy is accepted as the gold standard in diagnosis, it can be diagnosed by showing bronchoalveolar lavage (BAL) fluid with a milky appearance and periodic acid-schiff (PAS) positive globules in biopsy with clinical and radiological findings. Theraphy for PAP are supportive care (oxygen), total lung lavage, inhale/subcutaneous granulocyte macrophage colony stimulating factor (GM-CSF), rituximab, plasmapheresis, lung transplantation. We report a case of PAP presented with cough and shortness of breath, diagnosed with BAL and transbronchial lung biopsy, treated by total lung lavage by reviewing literature.
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http://dx.doi.org/10.5578/tt.50708DOI Listing
September 2017

Prognostic Value of Uric Acid for Pulmonary Thromboembolism.

Respir Care 2017 Aug 20;62(8):1091-1096. Epub 2017 Jun 20.

Department of Pulmonary Medicine.

Background: Pulmonary thromboembolism is a serious cardiovascular condition with considerable morbidity and mortality. Clinical studies have indicated that hyperuricemia is an independent risk factor for cardiovascular events. The aim of this study was to investigate possible value of the serum levels of uric acid (UA) in predicting 30-d pulmonary thromboembolism-related mortality.

Methods: Pulmonary thromboembolism was confirmed by computed tomography pulmonary angiography, demographic data, troponin, systolic pressure and pulse on admission, and simplified pulmonary embolism severity index assessment. UA levels were analyzed on admission. The primary end point was all-cause mortality during the first 30 d.

Results: A total of 337 acute pulmonary thromboembolism subjects, of whom 59% were females, were enrolled. The median (interquartile range) serum UA level was 5.35 (4.1-7.3) mg/dL. Serum UA levels of deceased subjects were higher than those of alive subjects during the study period (6.9 [4.6-10.0] mg/dL vs 5.2 [4.1-7.0] mg/dL, = .038). In the receiver operating characteristic analysis, the area under the curve was 0.650 (CI 0.732-0.960) for UA levels for all-cause mortality. A level of serum UA ≥ 5 mg/dL showed 73% sensitivity and 88% negative predictive value for all-cause 30-d mortality. A weak correlation was determined between the UA levels and age (r = 0.25, < .001) and any troponin (r = 0.267, < .001). Serum UA level was an independent predictor of short-term mortality in pulmonary thromboembolism (odds ratio 1.2, = .002).

Conclusions: Serum UA levels may be a potential biomarker for predicting outcome in patients with acute pulmonary thromboembolism.
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http://dx.doi.org/10.4187/respcare.05433DOI Listing
August 2017

Diagnostic value of suPAR in differentiating noncardiac pleural effusions from cardiac pleural effusions.

Clin Respir J 2016 Jan 4;10(1):61-6. Epub 2014 Aug 4.

Pulmonary Medicine, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey.

Introduction: Soluble urokinase plasminogen activator receptor (suPAR) is a newly discovered inflammatory biomarker. suPAR has not been previously studied in differentiating noncardiac pleural effusion (PF) from cardiac PF. The aim of our study was to assess the diagnostic value of suPAR in PF.

Methods: The concentration of PF-suPAR was measured by a commercialized enzyme-linked immunosorbent assay in a prospective cohort of 74 patients with PF, 18 patients with PF due to cardiac failure (CF) and 56 patients with noncardiac PF. The area under the curve quantified the overall diagnostic accuracy of the tests.

Results: The median pleural fluid suPAR level was found as 23 (5.4-102.8) ng/mL. The median PF-suPAR level in CF was significantly lower than that of noncardiac effusions [11.8 (5.4-28.9) ng/mL vs 26.7 (8.2-102.8) ng/mL, respectively, P < 0.001]. The area under the receiver operating characteristic curve was 0.878 (95% confidence interval: 0795-0.962, P < 0.001) for noncardiac pleural fluid suPAR. The sensitivity, specificity and positive predictive value of PF-suPAR for noncardiac effusions at the cutoff level of ≥17.6 n/mL was 88%, 83% and 94%, respectively. The suPAR level in PF was found to correlate with all of the biochemical parameters of PF.

Conclusions: suPAR is a potential new marker for the discrimination between cardiac and noncardiac PF.
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http://dx.doi.org/10.1111/crj.12186DOI Listing
January 2016

Prognostic value of red cell distribution width in patients with sarcoidosis.

Clin Respir J 2015 Jan 17;9(1):34-8. Epub 2014 Feb 17.

Department of Pulmonary Medicine, Karadeniz Technical University, School of Medicine, Trabzon, Turkey.

Background: Sarcoidosis is a multisystem granulomatous disorder of unknown etiology. There are no data on the indications for specific tests or optimal frequency for monitoring of the disease activity in sarcoidosis.

Methods: Complete blood counts, demographics and pulmonary function data from sarcoidosis patients evaluated between 2006 and 2012 were collated retrospectively. During follow-up, the latest red cell distribution width (RDW) values of the patients were recorded. The prognosis and diagnosis of sarcoidosis was based on according to the guideline. Sarcoidosis progression was classified as follows: remission, stable disease and progreesive disease.

Results: The diagnosis was based on histopathological findings in 93 out of 138 (67.4%) patients. In our cohort, the baseline mean RDW levels were 14.1% ± 1.2. The RDW distribution by stage was as follows: stage I: 14.0% (± 1.6), II: 14.2% (± 1.5), III: 13.8% (± 0.9) and IV: 15.8% (± 2.0). In patients with stage IV, baseline and follow-up values of RDW were found to be significantly higher than the other stages. While the mean baseline RDW was 14.8 (± 1.4) in the progressive disease, upon follow-up, the mean RDW had increased to 16.5% (± 1.4) (P = 0.021), No difference was found between the baseline and follow-up levels of RDW in the regressive and stable groups.

Conclusions: Serial RDW levels may be beneficial marker to predict progression of sarcoidosis.
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http://dx.doi.org/10.1111/crj.12101DOI Listing
January 2015

Predictive value of troponins and simplified pulmonary embolism severity index in patients with normotensive pulmonary embolism.

Multidiscip Respir Med 2013 May 28;8(1):34. Epub 2013 May 28.

Department of Pulmonary Medicine, Karadeniz Technical University, School of Medicine, Trabzon, Turkey.

Background: To investigate whether 2 cardiac troponins [conventional troponin-T(cTnT) and high sensitive troponin-T(hsTnT)] combined with simplified pulmonary embolism severity index (sPESI), or either test alone are useful for predicting 30-day mortality and 6 months adverse outcomes in patients with normotensive pulmonary embolism(PE).

Methods: The prospective study included 121 consecutive patients with normotensive PE confirmed by computerized tomographic(CT) pulmonary angiography. The primary end point of the study was the 30-day all-cause mortality. The secondary end point included the 180-day all-cause mortality, the nonfatal symptomatic recurrent PE, or the nonfatal major bleeding.

Results: Overall, 16 (13.2%) out of 121 patients died during the first month of follow up. The predefined hsTnT cutoff value of 0.014 ng/mL combined with a sPESI ≥1 'point(s) were the most significant predictor for 30-day mortality [OR: 27.6 (95% CI: 3.5-217) in the univariate analysis. Alone, sPESI ≥1 point(s) had the highest negative predictive value for both 30-day all-cause mortality and 6-months adverse outcomes,100% and 91% respectively.

Conclusions: The hsTnT assay combined with the sPESI may provide better predictive information than the cTnT assay for early death of PE patients. Low sPESI (0 points) may be used for identifying the outpatient treatment for PE patients and biomarker levels seem to be unnecessary for risk stratification in these patients.
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http://dx.doi.org/10.1186/2049-6958-8-34DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3668152PMC
May 2013

General Characteristics and Prognostic Factors of Pneumonia Cases Developed During Pandemic (H1N1) Influenza-A Virus Infection in Turkey.

Balkan Med J 2013 Mar 1;30(1):68-73. Epub 2013 Mar 1.

Department of Chest Diseases, Faculty of Medicine, Istanbul University, İstanbul, Turkey.

Objective: Unlike seasonal influenza, seen in previous years, the strain identified in the 2009 influenza-A pandemic involved high mortality. In this study, prognostic factors and general characteristics of pneumonia cases developed in Turkey during the H1N1 pandemic between October 2009 and January 2010 were analyzed.

Study Design: Multicenter retrospective study.

Material And Methods: This multicentric retrospective study was conducted between August and October 2010 and patients' data were collected by means of standard forms.

Results: The study included 264 pneumonia cases, collected from 14 different centers. Mean age was 47.5±18.6 years. Nineteen patients (7.2%) were pregnant or had a new birth and comorbid diseases were detected in 52.3% of all patients. On admission, 35 (13.8%) cases had altered mental status. Overall, 32.6% were treated in intensive care units (ICU) and invasive/non-invasive mechanical ventilation was performed in 29.7%. The mean duration of ICU stay was 2.9±6.2 and total hospital stay was 12.0±9.4 days. Mortality rate was 16.8% (43-cases). The length of ICU treatment, total hospital stay, and mortality were significantly higher in H1N1-confirmed patients. Mortality was significantly higher in patients with dyspnea, cyanosis, and those who had altered mental status on admission. Patients who died had significantly higher rate of peripheral blood neutrophils, lower platelet counts, higher BUN, and lower SaO2 levels.

Conclusion: This study showed that pneumonia developed during H1N1 pandemic in our country had resulted in a high mortality. Mortality was especially high among patients with cyanosis, altered mental state and those with lower SaO2.
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http://dx.doi.org/10.5152/balkanmedj.2012.089DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4116019PMC
March 2013

Adult inflammatory myofibroblastic tumor of the trachea: case report and literature review.

Respir Care 2013 Jul 18;58(7):e72-6. Epub 2012 Dec 18.

Department of Pulmonary Medicine, Farabi Hospital of Chest Diseases, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.

Inflammatory myofibroblastic tumor of the trachea is a rare benign tumor in adults. It is mostly seen before the age of 16. We describe a 20-year-old female patient who presented with stridor. She had a fixed obstruction on spirometry, and computed tomography and bronchoscopy confirmed tracheal thickening and stenosis below the vocal cords and bronchial wall thickening at the level of the carina. Bronchoscopic biopsy confirmed an inflammatory myofibroblastic tumor. She recovered after mechanical dilatation and resection via rigid bronchoscopy, followed by corticosteroid therapy.
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http://dx.doi.org/10.4187/respcare.02198DOI Listing
July 2013

Relationship between cardiac troponin-T and right ventricular Tei index in patients with hemodynamically stable pulmonary embolism: an observational study.

Anadolu Kardiyol Derg 2012 Dec 11;12(8):659-65. Epub 2012 Sep 11.

Department of Chest Diseases, Faculty of Medicine, Karadeniz Teknik University, Trabzon-Turkey.

Objective: The role of increased troponin level in risk stratification of acute pulmonary embolism (PE) is well documented. However, relation between right ventricular (RV) myocardial performance (Tei) index and cardiac troponin-T (cTn-T) has not been well investigated. The purpose of this observational prospective study was to assess the relationship between the RV Tei index and cTn-T in patients with acute normotensive PE.

Methods: Thirty-eight patients with acute PE diagnosed by computed spiral tomography pulmonary angiography were enrolled to this prospective observational study. All study population underwent a comprehensive echocardiographic study including tissue Doppler imaging within first 12 hours of admission. cTn-T levels were measured on admission. Follow-up echocardiography was performed routinely at the 7th day of hospitalization. Echocardiographic evaluation was repeated at 90 days in patients with insufficient improvement of RV Tei index. The difference between the baseline and follow-up data was analyzed using the paired sample t-test or Wilcoxon test according to normality of distribution.

Results: The mean of the RV Tei index was 0.46 ± 0.14 and the mean systolic pulmonary artery pressure (sPAP) was 40 ± 20 mmHg. Increased cTn-T level was detected in 37% of the patients (normal value 0.01< ng/mL). Significant correlations were observed between RV Tei index and sPAP with cTn-T levels (r=0.467 and r=0.468, p<0.001, respectively). In logistic regression analysis, RV Tei index was associated with positive cTn-T values (OR-136, 95% CI: 1.3-14657, p=0.039). After the anticoagulant treatment, RV Tei index and sPAP were significantly improved.

Conclusion: RV Tei index is frequently impaired in patients with acute PE and a significant recovery is seen after the treatment. Therefore, RV Tei index may be used both the diagnosis of RV dysfunction and the assessment of treatment effectiveness. RV Tei index is may predict myocardial injury in PE.
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http://dx.doi.org/10.5152/akd.2012.218DOI Listing
December 2012

Predictive factors for fatality in pandemic influenza A (H1N1) virus infected patients.

Saudi Med J 2012 Feb;33(2):146-51

Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Karadeniz Technical University, Trabzon, Turkey.

Objective: To determine predictive fatality criteria based on clinical and laboratory findings on admission to hospital in patients diagnosed with pandemic influenza A (H1N1) virus infection.

Methods: The study was conducted at the School of Medicine, Karadeniz Technical University, Trabzon, Turkey. Demographic, clinical, and laboratory data for hospitalized cases with a diagnosis of A (H1N1) virus infection between October 2009 and May 2010 were analyzed retrospectively. Patients were divided into 2 groups: fatal (group I) and non-fatal (group II). The 2 group's demographic, clinical, and laboratory data were compared on admission.

Results: Ten (20%) of the 50 patients included in the study died. The average age of group I was significantly higher than that of the group II. No significant difference was observed between the groups in terms of underlying chronic diseases and pregnancy. Fever, phlegm, shortness of breath, tachypnea, cyanosis were observed at significantly higher levels in group I compared to group II. Serum hemoglobin, glucose, albumin levels, arterial oxygen saturation were significantly lower in group I compared to group II; aspartate transaminase, alanine aminotransferase, C-reactive protein, procalcitonin, blood urea nitrogen levels, time between onset of symptoms and commencement of antiviral treatment were all significantly higher in group I.

Conclusion: This study shows that in addition to demographic characteristics and clinical findings, prognosis of patients with A (H1N1) virus infection can be determined beforehand with various laboratory tests. But these parameters, which can guide the clinician in the prior identification of potentially fatal A (H1N1) cases will contribute to the provision of supporting treatment and, when necessary, intensive care services for such patients.
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February 2012

[Fondaparinux treatment in heparin induced thrombocytopenia:a case report].

Tuberk Toraks 2011 ;59(2):178-83

Department of Chest Diseases, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.

Heparin induced thrombocytopenia is a serious complication of heparin therapy that has a high levels of morbidity and mortality due to thrombotic complications. Heparin induced thrombocytopenia usually develops between days 5 and 14 (inclusive) following initiation of heparin. When heparin induced thrombocytopenia is suspected, heparin should be discontinued and treatment with a direct thrombin inhibitor should be initiated. Heparin induced thrombocytopenia occurs more frequently with unfractionated heparin than with low molecular weight heparin. In this manuscript, we presented a case diagnosis with heparin induced thrombocytopenia who was given low molecular weight heparin for prophylaxis. We tried to make an overview of new treatment choices along with current literature.
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http://dx.doi.org/10.5578/tt.1692DOI Listing
February 2012

Prognostic significance of PaO2/PaCO2 ratio in normotensive patients with pulmonary embolism.

Clin Respir J 2012 Apr 19;6(2):104-11. Epub 2011 Jul 19.

Department of Pulmonary Medicine, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.

Introduction: Risk stratification remains controversial in patients with normotensive pulmonary embolism (PE). The debate has recently focused right ventricular dysfunction detected by echocardiography or spiral computed tomography (CT) and cardiac biomarkers.

Objectives: The utility of the PaO(2)/PaCO(2) ratio to predict the short-term prognosis of PE is not currently known and that is the aim of the present study.

Materials And Methods: This study retrospectively enrolled 99 (34 males, 65 females, 67 ± 15 years) consecutive patients with acute PE, diagnosed by spiral chest tomography pulmonary angiography (CTPA). On admission, cardiac troponin T (cTn-T) was measured and on CTPA both right ventricle diameter and left ventricle diameter was calculated (RV/LV ratio). During the first 24 h after admission, all the patients had initial arterial blood gas collected under room air. Receiver-operating characteristic (ROC) analysis was performed to determine the optimal PaO(2)/PaCO(2), RV/LV ratio and cTn-T cutoff level with regard to prognosis.

Results: In-hospital mortality was 12.1% and all-cause 90-day mortality was 15.2%. Ten of 15 patients who died had a PaO(2)/PaCO(2) ≤ 1.8 based on ROC analysis (P < 0.014).The cutoff level of PaO(2)/PaCO(2) ≤ 1.8 had a high negative predictive value of 93% for mortality. Multivariable analysis revealed that PaO(2)/PaCO(2) ≤ 1.8 Hazard Ratio (HR): 16.8 [95% CI: 2.6-108, P < 0.003] was the most significant independent predictor, whereas cTn-T, pO(2) < 60 mmHg and cardiac failure were nonsignificant factors. In addition, PaO(2)/PaCO(2) ≤ 1.8 showed significant survival differences for overall mortality rates in Kaplan-Meier analysis (P < 0.012).

Conclusion: The PaO(2)/PaCO(2) measurement is a highly useful and practical measurement to predict prognosis in patients with acute PE. Moreover, it appears to be a more accurate predictor than RV/LV ratio and cTn-T levels in patients with normotensive PE.
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http://dx.doi.org/10.1111/j.1752-699X.2011.00253.xDOI Listing
April 2012

C-reactive protein alone or combined with cardiac troponin T for risk stratification of respiratory intensive care unit patients.

Respir Care 2011 Jul 21;56(7):1002-8. Epub 2011 Feb 21.

Department of Chest Diseases, Karadeniz Technical University School of Medicine, Trabzon, Turkey.

Background: Mortality is high among patients admitted to intensive care units (ICUs). Several prognostic markers have been described in such patients, but the literature contains no data comparing C-reactive protein (CRP) and cardiac troponin T (cTn-T), nor of a combination of CRP and cTn-T in the same patient group in the ICU.

Methods: This was a retrospective electronic data review of patients who presented to the emergency department for respiratory reasons between December 2007 and December 2009 and in whom CRP and cTn-T levels were measured. Patients with a diagnosis of pulmonary embolism and acute coronary syndrome were excluded. We recorded demographics, chronic diseases, admission diagnosis, Simplified Acute Physiology Score II (SAPS II), ICU stay, and CRP and cTn-T concentrations.

Results: We included the records of 158 patients. Mean ICU stay was 9.9 days (range 1-65 d), and mean hospital stay was 14.1 days (range 1-72 d). For predicting mortality, receiver operating characteristic analysis gave a CRP cutoff value of ≥ 10 mg/dL, and a CTn-T cutoff value of ≥ 0.01 ng/mL. For CRP the mortality area under the curve was 0.691 (95% CI 0.608-0.775), the sensitivity was 65%, and the specificity was 70%. For cTn-T the mortality area under the curve was 0.733 (95% CI 0.655-0.812), the sensitivity was 78%, and the specificity was 56%. Of the patients who died, 65% had CRP ≥ 10 mg/dL and 78% had cTn-T ≥ 0.01 ng/mL. On multivariable regression analysis, CRP ≥ 10 mg/dL was associated with 6.6-fold higher (95% CI 1.7-21.3) ICU mortality. There was no advantage for models that combined CRP and cTn-T. CRP alone was more valuable in predicting ICU mortality than in combination with troponin or SAPS II.

Conclusions: Elevated CRP is an independent early prognostic marker of mortality risk in ICU patients. We suspect that a CRP-based prognosis strategy may be useful.
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http://dx.doi.org/10.4187/respcare.01007DOI Listing
July 2011

Effect of early or delayed administration of warfarin with heparin on thrombosis in pulmonary thromboembolism.

Med Princ Pract 2011 20;20(2):181-6. Epub 2011 Jan 20.

Department of Chest Diseases, School of Medicine, Karadeniz Technical University, Trabzon, Turkey.

Objective: The aim of this study was to investigate the effect of early or delayed warfarin administration with unfractionated heparin (UFH) on coagulation parameters in pulmonary thromboembolism (PTE).

Patients And Methods: This study was performed between November 2006 and July 2007. Thirty-three patients with PTE were sequentially slotted to early (n = 16) and delayed (n = 17) warfarin treatment groups. In the early group, both UFH infusion and warfarin were started simultaneously and in the delayed group, warfarin was added (1-3 days later) based on when partial thromboplastin time reached the therapeutic level with UFH. The proteins C and S, D-dimer, hematocrit levels, and platelet counts for all patients were studied prior to treatment and 6, 24, and 48 h after warfarin treatment. In order to determine the overall effect of early and delayed warfarin treatment on clot formation, a thromboelastogram was performed simultaneously.

Results: In both groups, a similar chronological decrease in protein C levels reaching maximum at 24 h with warfarin treatment was observed. However, intragroup or intergroup decreases in protein S levels were not different. On thromboelastogram, INTEM and EXTEM clotting times were significantly prolonged chronologically, but this prolongation was not different between groups.

Conclusion: The suppressor effect of warfarin on proteins C and S in the early period of double anticoagulant treatment did not appear to aggravate the risk of thrombosis in patients with PTE in whom warfarin was started simultaneously with UFH.
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http://dx.doi.org/10.1159/000319767DOI Listing
May 2011

Cloninger's temperament and character dimension of personality in patients with asthma.

Int J Psychiatry Med 2010 ;40(3):273-87

Erenkoy Mental Research and Training Hospital, Istanbul, Turkey.

Objective: Psychosocial factors have been implicated as being important in the onset and/or exacerbation of asthma. This study was performed to evaluate the personality profiles of asthma patients.

Method: Ninety-five asthmatic, 98 psoriatic patients, and 96 healthy controls completed the Temperament and Character Inventory (TCI), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI). The relationships between asthma illness duration, asthma severity score, depression, anxiety, and temperament and character personality variables were evaluated.

Results: Asthmatic patients had significantly higher mean scores on the BAI, Harm Avoidance, Persistence, and Self-transcendence dimensions and lower scores on the BDI, Novelty Seeking, and Reward Dependence dimensions of the TCI than the psoriatic patients. Significant group effect was found for the BDI and BAI scores in between groups. Significant differences in TCI scores were found across groups except for Persistence and Self-transcendence. Post hoc tests revealed significantly lower Novelty Seeking, higher Harm Avoidance, lower Reward Dependence, and higher Self-transcendence scores in patients with asthma. Regression analysis revealed a significant effect between duration of illness and Persistence and Self-transcendence. Illness severity had a significant effect on the Harm Avoidance. Anxiety scores had significant effect on the Harm Avoidance, Self-directedness, and Self-transcendence. Depression scores had no significant effect on any of the TCI dimensions.

Conclusions: Asthmatic patients can be distinguished by a specific pattern of temperament (low NS) and character (high ST) dimensions and compared with both psoriatic patients and healthy controls. Illness duration is associated with ST scores, and illness severity is associated with HA.
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http://dx.doi.org/10.2190/PM.40.3.dDOI Listing
January 2011

Swine H1N1 infection in a renal transplant recipient.

Exp Clin Transplant 2010 Dec;8(4):318-20

Department of Nephrology, Karadeniz Technical University, School of Medicine.

Influenza pandemics have been observed in several periods throughout history. The first influenza pandemic of the 21st century began in Mexico in 2009 and has spread rapidly all over the world. Swine H1N1 has been officially declared a pandemic by the World Health Organization in June 2009. As has been observed in previous pandemics, pregnant women, adolescents, and immunosuppressed individuals are affected more severely in this pandemic. Despite several reports about the pandemic, there have not been any reports of swine H1N1 infection in individuals who underwent renal transplant. The aim of the current study was to present oseltamivir therapy in a swine H1N1-infected patient who underwent renal transplant 10 months earlier, and was thus under immunosuppressive treatment. To the best of our knowledge, this is the first case report of a swine H1N1 infection in a renal transplant recipient.
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December 2010

The relationship between socio-demographic characteristics of patients and diagnostic delay in acute pulmonary thromboembolism.

Ups J Med Sci 2011 Mar 11;116(1):72-6. Epub 2010 Nov 11.

Karadeniz Technical University, School of Medicine, Department of Chest Diseases, Trabzon, Turkey.

Background: In pulmonary thromboembolism (PE), delay to diagnosis is very common. In this study, we examined the role of patients and the socio-demographic characteristics in delayed diagnosis of PE.

Patients And Methods: We evaluated 156 PE patients for the dates of symptom onset, the dates of first visit to a health institution and diagnosis, signs and symptoms, and the socio-demographic characteristics. Delays were analyzed using the Mann-Whitney U test, and the predictors were analyzed using logistic regression analysis.

Results: Of the patients, 60.3% visited a health institution within the first day of the symptoms. Mean time from symptoms to the first admission to a health institution (patient delay) was 2.04 ± 3.89 days (median 0 day, range 0-30). Current smoking, a high level of education, and co-morbidity were associated with longer patient delays. The time interval from first symptom to the diagnosis (total delay) was 7.93 ± 10.05 (median 4 days, range 0-45) days. While hypotension, syncope, and previous surgery/trauma were significantly associated with a shorter total delay, a previous visit to any health institution was associated with longer total delay.

Conclusion: In conclusion, although some socio-demographic characteristics of patients such as smoking, educational status, and co-morbid diseases were found to be associated with delayed visit to any health institution, our results showed that physician or health system delays were more prominent in delayed diagnosis of PE.
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http://dx.doi.org/10.3109/03009734.2010.530701DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3039763PMC
March 2011

Combined risk stratification with computerized tomography /echocardiography and biomarkers in patients with normotensive pulmonary embolism.

Thromb Res 2010 Dec;126(6):486-92

Karadeniz Technical University, School of Medicine, Department of Chest, Trabzon, Turkey.

Background: Right ventricular dysfunction (RVD) detected by computerized tomography (CT)/echocardiography or elevated biomarkers is associated with a poor prognosis for pulmonary embolism (PE). However, these prognostic factors have not previously been concomitantly elucidated in the same patient group.

Methods: This prospective study included 108 consecutive patients with normotensive PE confirmed by CT pulmonary angiography (CTPA). On admission, patient serum NT-proBNP and troponin T (Tn-T) levels were measured, and echocardiography was performed within 24 hours after diagnosis of PE. Receiver operating characteristic (ROC) analysis was performed to determine the optimal echocardiographic end-diastolic diameters of the right ventricle, the ratio of the right ventricle to left ventricle (RV/LV ratio) on CTPA, and NT-proBNP and Tn-T cut-off levels with regard to prognosis.

Results: All-cause 30-day mortality was 13% and PE-related mortality was 5.6%. RVD was defined as a right/left ventricular dimension ratio≥1.1 on CTPA and RV>30 mm on echocardiography by ROC analysis. A cut-off level of NT-proBNP≤90 pmol/ml had a high positive predictive value of 98% for survival, whereas NT-proBNP>300 and Tn-T≥0.027 had a negative predictive value, for all-cause deaths, of 95% and 96%, respectively. PE mortality in patients with NT-proBNP>300 and Tn-T≥0.027 reached 64%. In univariable analysis, the combination of Tn-T≥0.027 ng/ml with a echocardiographic RVD were the most significant predictors of overall mortality and PE-related death [HR: 14 (95% CI: 4.6-42,) and HR: 37.6 (95% CI: 4.4-324)], respectively. In multivariable Cox's regression analysis, NT-proBNP>300 and Tn-T≥0.027 HR: 26.5 (95% CI: 4.1-169.9, p<0.001) were the best combination to predict all-cause of mortality.

Conclusions: The combination of NT-proBNP and Tn-T clearly appears to be a better risk stratification predictor than biomarkers plus RVD on CT/ echocardiography in patients with normotensive PE.
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http://dx.doi.org/10.1016/j.thromres.2010.08.021DOI Listing
December 2010

Etiological agents of community-acquired pneumonia in adult patients in Turkey; a multicentric, cross-sectional study.

Tuberk Toraks 2010 ;58(2):119-27

Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.

This cross-sectional study was intended to investigate the etiology of community-acquired pneumonia (CAP) in adult patients receiving no prior antibiotic therapy. Etiological agents were identified in 137 (62.8%) of 218 patients, the most frequent being Streptococcus pneumoniae (14.7%), Mycoplasma pneumoniae (13.8%) and respiratory syncytial virus (10.1%). A single pathogen was detected in 50.9% of cases and mixed pathogens in 11.9%. Typical pathogens were determined in 35.8% of cases, atypical pathogens in 20.2% and viral pathogens in 20.6%. Chronic obstructive pulmonary disease was a common (42.7%) comorbidity. S. pneumoniae was the most common pathogen in adult patients with CAP. Atypical pathogens were more common in patients < 65 years old, M. pneumoniae being the most common in this age group. Our results suggest that initial empiric antibiotic treatment in patients with CAP should cover S. pneumoniae and M. pneumoniae in Turkey.
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January 2011

The role of risk factors in delayed diagnosis of pulmonary embolism.

Am J Emerg Med 2011 Jan 9;29(1):26-32. Epub 2010 Mar 9.

Department of Chest Diseases, Karadeniz Technical University, Trabzon, Turkey.

Background: Despite diagnostic advances, delays in the diagnosis of pulmonary embolism (PE) are common.

Objective: In this study, we aimed to investigate the relationship between delays in the diagnosis of PE and underlying risk factors for PE.

Methods: We retrospectively evaluated the records of 408 patients with acute PE. Patients were divided into 2 groups, surgical or medical, based on risk factors leading to the embolism. Analysis involved demographic characteristics of the patients, dates of symptom onset, first medical evaluation, and confirmatory diagnostic tests. Diagnostic delay was described as diagnosis of PE more than 1 week after symptom onset.

Results: The mean time to diagnosis for all patients was 6.95 ± 8.5 days (median, 3 days; range, 0-45 days). Of the total number of patients, 29.6% had presented within the first 24 hours and 72.3% within the first week. The mean time to diagnosis was 4.4 ± 7.6 days (median, 2 days; range, 0-45 days) in the surgical group and 8.0 ± 8.6 days (median, 4 days; range, 0-45 days) in the medical group (P = .000). The mean time to diagnosis in the medical group was approximately 4 times greater than that of the surgical group on univariate analysis. Early or delayed diagnosis had no significant impact on mortality in either group.

Conclusion: Delay in the diagnosis of PE is an important issue, particularly in medical patients. We suggest that a public health and educational initiative is needed to improve efficiency in PE diagnosis.
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http://dx.doi.org/10.1016/j.ajem.2009.07.005DOI Listing
January 2011

Investigation of relationship between the D-dimer and ischemia-modified albumin levels with the radiological imaging-based pulmonary embolism severity score in acute pulmonary embolism.

Anadolu Kardiyol Derg 2010 Aug;10(4):346-52

Department of Emergency Medicine, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.

Objective: To investigate possible relationship between the D-dimer and ischemia-modified albumin (IMA) levels and radiological imaging-based severity scores in pulmonary embolism (PE) based on two different radiological characteristics; the pulmonary arterial obstruction index (PAOI) and the right ventricle/left ventricle (RV/LV) ratio.

Methods: In this prospective cohort study, forty-seven patients presenting to the emergency department and definitively diagnosed with PE using spiral computerized tomography (CT) were initially enrolled in the study. Levels of IMA and D-dimer were assessed colorimetrical and immuno-turbidimetric methods, respectively. The PAOI and RV/LV ratios were calculated from CT images. The levels of biochemical parameters between the groups were compared with use of Mann-Whitney U and Kruskal-Wallis tests and relationship between the radiological scores were assessed using the Spearman correlation test.

Results: Analysis of the calculated PAOI and RV/LV ratio revealed a significant correlation between them (r=0.36, p=0.023). D-dimer levels differed considerably among the mild (=40%), moderate (40%-60%) and severe (60%) groups constituted on the basis of PAOI (p=0.039). This difference stemmed from those in D-dimer levels in the mild group, PAOI =40 % and the severe group, PAOI 60% (p=0.02; Z= -2.328). In addition, D-dimer levels and PAOI revealed a positive correlation, but no similar correlation was determined between D-dimer levels and RV/LV. There were no significant correlations between IMA and D-dimer levels, PAOI and RV/LV ratios.

Conclusion: In the biochemical determination of severity of PE based on radiological characteristics, D-dimer may be a more relevant marker than IMA, which has been proposed as a new marker.
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http://dx.doi.org/10.5152/akd.2010.094DOI Listing
August 2010

Pulmonary atelectasis and survival in advanced non-small cell lung carcinoma.

Ups J Med Sci 2010 Aug;115(3):176-80

Department of Chest Diseases, Karadeniz Technical University, School of Medicine, Trabzon, Turkey.

Atelectasis was reported as a favorable prognostic sign of pulmonary carcinoma; however, the underlying mechanism in those patients is not known. In this study, we aimed to investigate prospectively the potential impact of atelectasis and/or obstructive pneumonitis (AO) on survival and the relation between atelectasis and some laboratory blood parameters. The study was conducted on 87 advanced stage non-small cell lung cancer (NSCLC) patients. Clinical and laboratory parameters of patients at first presentation were recorded, and patients were divided into two groups according to the presence of AO in thorax computed tomography (CT). Survival was calculated using Kaplan-Meier and univariate Cox's regression analyses. Laboratory parameters that might be related with prolonged survival in atelectasis were compared using chi-square, Student's t, and Mann-Whitney U tests. Of the patients, 54% had stage IV disease, and AO was detected in 48.3% of all cases. Overall median survival was 13.2 months for all cases, 10.9 months for patients without AO, and 13.9 months for patients with AO (P=0.067). Survival was significantly longer in stage III patients with AO (14.5 months versus 9.2 months, P=0.032), but not in stage IV patients. Patients with AO in stage III had significantly lower platelet counts (P=0.032) and blood sedimentation rates than did those with no AO (P=0.045). We concluded that atelectasis and/or obstructive pneumonitis was associated with prolonged survival in locally advanced NSCLC. There was also a clear association between atelectasis and/or obstructive pneumonitis and platelets and blood sedimentation rate.
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http://dx.doi.org/10.3109/03009731003695624DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2939518PMC
August 2010

Mediastinal lymph nodes: assessment with diffusion-weighted MR imaging.

J Magn Reson Imaging 2009 Aug;30(2):292-7

Medical School of Karadeniz Technical University, Farabi Hospital, Department of Radiology, Trabzon, Turkey.

Purpose: To prospectively determine whether the diffusion-weighted magnetic resonance imaging is useful to distinguish between malignant and benign mediastinal lymph nodes.

Materials And Methods: Thirty-five patients (14 women, 21 men; mean age 52 years) with 91 lymph nodes in the mediastinum detected by computed tomography underwent 1.5 Tesla (T) diffusion-weighted MR imaging before mediastinoscopy (n = 29) and mediastinotomy (n = 6). Diffusion-weighted MR images were acquired with a b factor of 50, and 400 s/mm(2) using single-shot echo-planar sequence.

Results: Of the 35 patients, 18 had diagnosis of malignant tumor. Of the 18 patients with tumor, 8 had nonsmall cell carcinoma, and 10 had small cell carcinoma. Ninety-one mediastinal lymph nodes were detected in the 35 untreated patients: 19 were pathologically diagnosed as metastatic lymph nodes, and 72 lymph nodes were diagnosed as nonmetastatic lymph nodes, including 50 sarcoidosis, 14 reactive lymphoid hyperplasia, and 8 necrotizing granulamatous lymphadenitis. The apparent diffusion coefficient (ADC) was significantly lower in metastatic lymph nodes (1.012 +/- 0.025 x 10(-3) mm(2)/s; P < 0.0005) than in benign lymph nodes (1.511 +/- 0.075 x 10(-3) mm(2)/s). On the ADC map, malignant nodes showed hyperintense (n = 2, 10.52%), hypointense (n = 14, 73.68%), and mixed intensity (n = 3; 15.78%), whereas benign nodes showed hyperintense (n = 57; 79.16%), hypointense (n = 3; 41.6%), isointense (n = 6; 8.33%), and mixed intensity (n = 6; 8.33%).

Conclusion: Diffusion-weighted MR with ADC value and signal intensity can be useful in differentiation of malignant and benign mediastinal lymph nodes.
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http://dx.doi.org/10.1002/jmri.21850DOI Listing
August 2009