Aspergillus spp. isolations from respiratory tract samples in Trakya University Hospital

The characteristics of cases diagnosed as aspergillosis and Aspergillus spp. strains isolated from the respiratory tract samples in Mycology Laboratory of Trakya University Hospital between January 2002 and May 2006 were investigated. In this period, 137 bronchoalveolar lavages, 95 sputum, nine tracheal aspirates, three lung biopsies and one bronchial biopsy of 85 patients were processed. The samples were incubated in 25 degrees C and 35 degrees C media by culturing on brain heart infusion agar with blood and Sabouraud dextrose agar. Presence of leucocytes and fungal structures were searched in the smear stained by Gram and Giemsa. The patient was defined as probable aspergillosis case, if he/she patient had clinical findings, lung infiltration or fungus ball radiologically, at least one risk factor predisposing to aspergillosis and isolation of Aspergillus spp. in lower respiratory tract samples without finding of other nonmycotic infection. Of 22 patients isolated Aspergillus spp., 13, six, two, one were internalized in chest diseases, haemotology, neurosurgery and oncology clinics, respectively. Seven positive cultures were considered as findings of aspergillosis. Aspergillus fumigatus, Aspergillus flavus and Aspergillus niger were isolated in three, two, and two patients, respectively. Fungal structures were detected in only one sample in the direct microscopical examination. Ages of seven patients, five were males and two were females, were between 15 and 60. Predisposing risk factors were acute leukemia in six patients and lung cancer in one patient. Five patients were neutropenic and one was neutrophylic. Fungus ball was detected in radiological imaging of one patient, had a pulmonary cavitary lesion. Conventional amphotericine B was used in their therapies. Antifungal agents were switched to caspofungin and itraconazole in two and one patients, respectively. Three patients died in four weeks after isolation of Aspergillus spp. Aspergillosis cases were not high in our hospital because of absence of transplantation center for bone marrow or solid organ.     

High plasma D-dimer level is associated with decreased survival in patients with lung cancer

AimsAn elevated plasma d-dimer level indicates the activation of coagulation and fibrinolysis. In the present study, we investigated the association of pre-treatment haemostatic parameters (d-dimer, fibrinogen and prothrombin fragment 1+2) with clinicopathological parameters and outcome in patients with lung cancer.Materials and methodsPlasma levels of d-dimer and other parameters were measured in 78 evaluable patients with lung cancer (60 non-small cell lung cancers, 18 small cell lung cancers). At diagnosis, 35 patients (44.9%) were locally advanced stage (IIIA/B) and 43 patients (55.1%) had metastatic disease (IV). Multivariate statistical analysis was carried out using Cox's proportional hazards model. The receiver operating characteristic curve was used to determine the cut-off values for d-dimer, fibrinogen and prothrombin fragment 1+2.ResultsThe median survival for all patients was 264 days (95% confidence interval 200–328 days). A significant association between the plasma levels of d-dimer and the response to chemotherapy was observed (P = 0.03). With the univariate analysis, tumour stage, pre-treatment plasma levels of d-dimer, fibrinogen, platelet count, lactate dehydrogenase concentration and Karnofsky performance status were predictive for survival. With the multivariate analysis (P ≤ 0.1), the plasma level of d-dimer (P < 0.001), tumour stage (P = 0.01) and Karnofsky performance status (P = 0.02) were identified as independent predictive factors. The median survival times were 405 days (95% confidence interval 165–644 days) and 207 days (95% confidence interval 146–267 days, P < 0.001), respectively, for patients with a low d-dimer level (≤0.65 μg/ml) and a high d-dimer level (>0.65 μg/ml).ConclusionsElevated plasma levels of d-dimer in patients with lung cancer are associated with decreased survival and a poor response to treatment. Pre-treatment for the d-dimer level may be useful in the prediction of survival and the response to treatment.     

A new clinical model in pulmonary embolism and its correlation with V/P scan results.

The study was prospectively designed to assess the correlation between a new clinical model empirically developed for acute pulmonary embolism (PE) and ventilation/perfusion (V/P) scan results. One hundred sixty consecutive patients with suspected acute PE underwent clinical evaluation before V/P scintigraphy. The clinical probability of PE was categorized according to a structured clinical model empirically developed as low, intermediate, or high, and the results were compared with those of V/P scintigraphy. Forty, 61, and 59 patients were classified as low, intermediate, and high clinical probability, respectively. Seventy-five percent (30/40) of the patients with low clinical probability were also of low scintigraphic probability or had a normal result (r(s): 0.39, p=0.000); 28% (17/61) of the patients with intermediate clinical probability demonstrated intermediate scintigraphic probability (r(s): 0.20, p=0.012); and 68% (40/59) of the patients with high clinical probability were also of high scintigraphic probability (r(s): 0.43, p=0.000). Overall, the correlation of two scoring systems was statistically significant (r(s): 0.39, p=0.000). Unilateral leg swelling (p=0.027), syncope or near syncope (p=0.002), amputation of a hilar artery (p=0.007), and electrocardiographic signs of right ventricular overload (p=0.000) prevailed in patients with high scintigraphic probability. "Syncope-near syncope or hemodynamic collapse" PLUS "electrocardiographic signs of right ventricular overload or hypoxemia" combination had the most significant correlation with a high scintigraphic probability (r(s): 0.31; p=0.000). In conclusion, the new clinical model empirically developed was significantly successful to provide comparable results with V/P scan. This consistency was particularly prominent in patients with low or high clinical probability for PE.     

99mTc-HMPAO brain perfusion single-photon emission computed tomography in children with Down syndrome: relationship to epilepsy, thyroid functions, and congenital heart disease

In recent years, it has been possible for patients with Down syndrome to live longer with advanced medical treatment and social support. As a result, the problems of these patients, such as thyroid diseases, leukemia, and Alzheimer disease, would be encountered more frequently. In this study, we aimed to perform the brain perfusion of children with Down syndrome by technetium 99m hexamethylpropylene amine oxime (99mTc-HMPAO) single-photon emission computed tomography (SPECT) and to determine the relationship between brain perfusion and epilepsy, thyroid function tests, congenital heart disease, and level of mental and motor development. Thirty patients with Down syndrome, aged between 1 and 15 years, were included in our study. Demographic data, the existence of epilepsy and congenital heart defects, the level of mental and motor development, serum levels of thyroid hormones, and autoantibodies were determined. All patients underwent computed tomography (CT) and/or magnetic resonance imaging (MRI). Cerebral SPECT was performed in all cases to evaluate the brain perfusion pattern. According to the visual evaluation of cerebral SPECT results, hypoperfusion was detected in 11 cases (37%). Patients with cerebral hypoperfusion (group 1) and patients with normal cerebral perfusion (group 2) were compared. There was no difference between group 1 and group 2 in terms of demographic data, congenital heart defects, IQ levels, thyroid hormones, and autoantibodies, but the incidence of epilepsy was significantly higher in group 1 (P<.001). When motor and mental development levels were compared, it was found that cases in group 1 were significantly more retarded in personal-social and fine motor skills (P<.05). The present study showed that cerebral hypoperfusion in children with Down syndrome is mostly related to epilepsy and the other coexisting conditions, congenital heart disease and hypothyroidism. Patients with cerebral hypoperfusion also have more retarded developmental levels, especially in personal-social and fine motor skills.     

Clearance of technetium-99m-labeled DTPA in hyperthyroidism without clinical evidence of lung disease, and relation to pulmonary function

OBJECTIVE: The mechanisms of dyspnea and exercise intolerance have not been fully elucidated. We aimed to investigate the clearance rate of technetium-99m diethyltriaminepentaaceticacid (Tc-99m DTPA) from lungs in hyperthyroid patients without clinical evidence of lung disease and to explore the interactions between their Tc-99m DTPA radioaerosol lung scintigraphy, spirometric measurements, and the levels of thyroid hormones. METHODS: We studied 19 hyperthyroid patients and 16 sex- and age-matched controls. Thyroid hormone levels were assessed. Spirometric lung function tests, diffusing capacity of the lung for carbon monoxide (DLCO) and the clearance rate of Tc-99m DTPA were performed in all participants. Ratio of DLCO value to the alveolar ventilation (DLCO/VA) and the means of half-time (T1/2) of Tc-99m DTPA clearance rate, which were used to evaluate alveolar-capillary membrane permeability, were calculated. RESULTS: There were no statistical differences between spirometric parameters (VC, FVC, FEV1/FVC, FEF 25-75) of the two groups (p > 0.05). Although the mean FEV1 level was significantly lower in the hyperthyroid patients than the control subjects (p < 0.01), in five patients FEV1 was only less than 80 percent of the predicted value. No significant difference in the means of DLCO, DLCO/VA or T1/2 values of Tc-99m DTPA clearance was observed between the two groups (p > 0.05). In hyperthyroid patients, there was a positive relation between DLCO/VA, DLCO/VA % and T1/2 values of Tc-99m DTPA clearance (p < 0.01, r = 0.732, p < 0.01, r = 0.742, respectively). The lung volumes and the levels of thyroid hormones did not show a significant relationship to T1/2 values of Tc-99m DTPA clearance in hyperthyroid group (p > 0.05). CONCLUSIONS: We conclude that increased thyroid hormones have no effect on permeability of alveolar-capillary membrane in hyperthyroid patients.     

Assessment of Tc-99m sestamibi tumor tissue uptake under the influence of increased arterial oxygen saturation

The aim of this study is to investigate the potential effect of increased arterial saturation of oxygen in the magnitude of technetium-99m-hexakis-isobutyl-isonitrile (99mTc-MIBI) uptake in tumor tissue and to compare the results with those of conventional 99mTc-MIBI tumor imaging in the same patient with lung cancer. A total of 26 lung cancer patients underwent initial SPECT (I-SPECT) and after oxygen inhalation SPECT (O2-SPECT). The early (ER) and delayed ratios (DR) of O2-SPECT mean+/-S.D. were significantly higher than those of I-SPECT mean+/-S.D. (2.07+/-0.57 vs. 1.90+/-0.48 and 2.02+/-0.45 vs. 1.83+/-0.39, respectively). There are increased rates for the relative tumor uptake of 99mTc-MIBI by 9% for ER and 10% for DR on the O2-SPECT compared to I-SPECT. We found that 99mTc-MIBI uptake increased significantly in the tumor tissue with O2-SPECT compared to I-SPECT. In conclusion, 99mTc-MIBI scintigraphy is one of the main methods for differentiating viable and nonviable tissue fractions in tumors. We consider that 99mTc-MIBI uptake increase after oxygen inhalation is an indicator of positive acute cellular response of the tumor tissue to the rising tissue oxygen level.     

Extrapulmonary involvement in patients with sarcoidosis in Turkey

Background and objective: Extrapulmonary sarcoidosis is common, and is almost always associated with concomitant thoracic involvement. Extrapulmonary manifestations vary on the basis of gender, age at presentation and ethnicity. The aim of this study was to investigate extrapulmonary involvement in patients with sarcoidosis in Turkey. Methods: This study was conducted by Turkish Thoracic Society Clinical Problems Study Group. New cases of sarcoidosis between 1 June 2004 and 31 May 2006 were recorded on electronic case record forms sent to all potential investigators and information about extrapulmonary involvement was collected. Results: One hundred and nineteen of 293 patients (83 female, 36 male, mean age = 45 ± 12 years) had extrapulmonary involvement in this study (40.6%). The median time to diagnosis was 6 months and this was longer than patients with just thoracic sarcoidosis (P = 0.001). Extrapulmonary symptoms were present in 181 (61.8%) patients, and skin lesions, arthralgia and back pain were the commonest (33.4%, 20.8% and 16.4%, respectively). Incidence of organ involvement was independent of age with the exception of ocular involvement, which was higher in those under the age of 40 years (P = 0.007). Conclusions: Skin and peripheral lymph node involvement were the most common sites of extrapulmonary involvement and ocular involvement was more common in those under the age of 40 years in patients with sarcoidosis in a Turkish population.     

Resting energy expenditure in manic episode

Objective:  We aimed to assess the resting energy expenditure in bipolar I disorder, manic episode patients.
Method:  Forty-two bipolar I disorder, manic episode patients that were treated in the inpatient psychiatry clinic of Trakya University Hospital and had met the necessary study criteria were included along with 27 controls. DSM-IV criteria and the Bech-Rafaelsen Mania Rating Scale were used to evaluate patients' diagnosis and severity of the manic episodes. The indirect calorimetry device was used to measure resting energy expenditure values.
Results:  Resting energy expenditure values of manic patients were found to be higher than those of the controls. Controls showed significant correlations between body mass index and resting energy expenditure, but manic patients did not exhibit similar correlations. There was also no relation between Bech-Rafaelsen Mania Rating Scale scores and resting energy expenditure values in manic patients.
Conclusions:  We found significantly increased resting energy expenditure values in bipolar I disorder, manic episode patients. These findings suggest a possible clinical use of resting energy expenditure for evaluation of bipolar I disorder manic episode and also suggest resting energy expenditure as a possible biological marker.     

Relationship Between Pregnancy-Associated Plasma Protein-A and Lung Cancer

BackgroundPregnancy-associated plasma protein-A (PAPP-A) has insulin-like growth factor (IGF)-dependent IGFBP-4 protease activity and plays an important role in amplifying local IGF-1 activity in wound healing, vascular repair, and bone remodeling. We postulated that PAPP-A may contribute to the availability and activity of IGFs, which affect lung cancer. Therefore, we determined the levels of PAPP-A in patients with lung cancer and their possible clinical significance.MethodsThe study population consisted of 83 patients with lung cancer and 33 healthy subjects as a control group. Serum PAPP-A levels were determined using an ultrasensitive enzyme-linked immunosorbent assay.ResultsThe serum PAPP-A levels were higher in patients with lung cancer [median (interquartile range) 10.7 (7.6–14.2) ng/mL] than in the control group [6.2 (5.2–9.8) ng/mL, P < 0.001]. There was a significant negative correlation between the serum PAPP-A levels and Karnofsky performance status (r = ?0.330; P < 0.001) and a positive correlation with patient age (r = 0.358; P < 0.001).ConclusionPAPP-A is a proatherosclerotic metalloproteinase that is also thought to be an inflammatory marker. We found that the serum PAPP-A levels increased in patients with lung cancer and postulated that PAPP-A levels may be a prognostic factor in such cases.