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   Table of Contents - Current issue
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May-August 2018
Volume 20 | Issue 2
Page Nos. 53-110

Online since Friday, August 31, 2018

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ORIGINAL ARTICLES  

Diagnostic value of ultrasound guided transthoracic tru-cut biopsy in thorax malignancies p. 53
Coskun Dogan, Seda Beyhan Sağmen, Elif Torun Parmaksız, Nesrin Kıral, Ali Fidan, Sevda Sener Cömert, Banu Salepçi
DOI:10.4103/ejop.ejop_43_18  
AIM: To investigate the diagnostic value of ultrasound (US) guided transthoracic fine needle aspiration biopsy (TTFNA) and US guided transthoracic tru-cut biopsy (TTTCB) in malignant thorax lesions. MATERIALS AND METHODS: Patients who underwent US guided transthoracic biopsies between April 2014 and May 2017 were retrospectively evaluated. Patients who were diagnosed as thoracic malignancy and both TTTCB and TTFNA performed for the same lesion were included in the study. The diagnostic accuracy of TTTCB, TTFNA and their combination were analyzed. The diagnostic accurracy of methods were statistically compared by McNemar Test. RESULTS: Thirty two patients were included in the study. Ultrasound guided TTFNA and/or TTTCB were diagnostic in 30 (93.8%) of them. TTFNA was diagnostic in 23 (%71.8), TTTCB were diagnostic in 26 (%81.2) of these pateints. Seven (77.7%) of 9 patients in which TTFNA was not diagnostic, TTTCB was diagnostic. The diagnostic accuracy was 71.8% and 81.2% for TTFNA and TTTCB, respectively. When TTTCB and TTFNA were performed consecutively in the same procedure, the overall diagnostic accuracy was 93.7%. There was no difference between the diagnostic accuracy of US-guided TTFNA and TTTCB (P=0.508). The diagnostic accuracy of combination of TTFNA and TTTCB was significantly higher than that of TTFNA alone (P=0.016). During the procedures, pneumothorax which did not require chest tube insertion was detected as complication in 1 case (3.1%). CONCLUSION: Diagnostic accuracy of US-guided TTFNA and TTTCB is high and has no superiority to each other. Combining both procedures under the quidence of US increases the diagnostic accuracy statistically significantly.
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The effect of morphine delta receptor activity on ischemic postconditioning in lung ischemia reperfusion injury p. 59
Nuri Duzgun, Hıdır Esme, Ibrahim Kılınç, Mustafa Çalık
DOI:10.4103/ejop.ejop_13_18  
OBJECTIVE: In the context of the physiopathology of lung damage due to ischemia and reperfusion injury, we aimed to reveal the effects of the addition of morphine sulfate to ischemic postconditioning (PC) protocol. METHODS: In the present study, 48 Wistar albino female rats were employed. Group 1 was accepted as the Sham group that underwent thoracotomy through the fifth left intercostal space. Ischemia-reperfusion (IR) group: Thoracotomy and IR period. IRPC group: thoracotomy, IR period and ischemic PC. In IRPC3 and IRPC30 groups, in addition to ischemic PC different doses of morphine sulfate (3 μmol and 30 μmol) was administered. Tumor necrosis factor (TNF)-α, interleukin (IL)-1, and IL-10 levels were measured in the biochemical assessment of the lung tissue samples obtained. RESULTS: TNF-α and IL-1 (pro-inflammatory cytokines) have lower values, and IL-10 (anti-inflammatory cytokine) have higher values both in the groups which have been subject to PC and morphine. TNF-α and IL-1 levels in lung tissue were statistically significant between the IRPC3 group and the IR and IRPC groups. In addition, IL-10 level in lung tissue was statistically significant between the IRPC3 group and the IRPC group. CONCLUSION: In the present study conducted with experimental animals where morphine was also injected beside ischemic PC protocols, statistically significant differences were determined in the lung tissue analyses when we compared pro-inflammatory and anti-inflammatory cytokine values. We firmly believe that adding morphine to the lung transplantation protocols and PC will decrease IR damage.
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Robotic surgery in mediastinal cystic pathologies p. 65
Erkan Kaba, Kemal Ayalp, Tugba Cosgun, Alper Toker
DOI:10.4103/ejop.ejop_14_18  
PURPOSE: In this study, results of surgery for patients with mediastinal cystic pathology who were treated by the utilization of robotic surgery system were analyzed. MATERIALS AND METHODS: Prospectively collected data of 296 patients on whom robotic surgery system was used between October 2011 and June 2017 were retrospectively examined. Of these patients, 9 (3%) patients who were operated due to cystic pathologies of mediastinum were included in this study. Age, gender, docking, and console times of the robot, pathology results, length of hospital stay, anatomic localization of the lesions, blood transfusion requirement, conversion to open surgery, mortality, and morbidity rates were recorded. RESULTS: Five patients were male and 4 were female, and the mean age was 45.5 ± 21.2 years. The lesion was localized in anterior mediastinum in two patients, middle mediastinum in four patients, and in posterior mediastinum in three patients. Six patients underwent surgery with the diagnosis of bronchogenic cyst, one patient underwent surgery with the diagnosis of the pericardial cyst, and two patients underwent surgery with the diagnosis of the thymic cyst. The mean length of hospital stay was 3.3 ± 1.5 days. The median console time was 45 min (30–110 min) and the median docking time was 20 min (10–40 min). CONCLUSION: We consider that, with technical advantages provided to the surgeon in mediastinal surgery, robotic technology can be preferred in cystic pathologies of the mediastinum localized in areas that may pose challenges in dissection.
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How much are we aware of the increase in accompanying comorbidities in sarcoidosis? p. 70
Meltem Agca, Fatma Tokgöz Akyil, Ayşegül Berk, Sümeyye Alparslan Bekir, Dildar Duman, Merve Hörmet, Oğuzhan Akman, Tülin Sevim
DOI:10.4103/ejop.ejop_17_18  
OBJECTIVE: Sarcoidosis is a multisystem chronic disease characterized by granulomatous inflammation. It is reported that the frequency of other inflammatory and malignant diseases increases. The primary objective of the study is to determine the types of comorbid diseases and their frequency, and whether the risk of malignancies and autoimmune diseases such as rheumatoid arthritis and thyroid increases. The secondary objective is to identify the factors related to the comorbidities frequently detected. METHODS: The files of 694 patients who had the diagnosis of sarcoidosis between1998-2016 were evaluated. The frequency of comorbid diseases recorded was compared to the data of our country. RESULTS: Among the patients, 487 (70%) were female, and the mean age at diagnosis was 42.9 ± 11.8 (18-87). In 490 patients (70%) at least one comorbidity was detected. The most frequently detected comorbidities were systemic hypertension (22%), hepatosteatosis (16.9%), diabetes mellitus (16.4%), thyroid diseases (13.1%), and asthma (12%). Malignancy was found in a ratio of 4.0%, rheumatoid arthritis in 2.2%. The comparison to the frequencies across the country showed that the prevalence of diabetes mellitus, thyroid diseases, asthma, malignancy, and rheumatoid arthritis was higher. Diabetes, thyroid diseases, asthma were more frequent in women. The mean age of patients in which diabetes, thyroid diseases, asthma, rheumatoid arthritis or malignancy was detected as a comorbidity was higher than those without comorbidities. CONCLUSION: Comorbidities frequently occur among sarcoidosis patients, and the frequency of diabetes mellitus, thyroid diseases, asthma, malignancy, and rheumatoid arthritis is higher than the data of the country.
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The sleep quality of nurses and its influencing factors p. 78
Merve Tarhan, Aylin Aydin, Ersin Ersoy, Levent Dalar
DOI:10.4103/ejop.ejop_35_18  
BACKGROUND: It is a known fact that nurses who are obliged to maintain the continuity of quality and safety patient care have a serious risk of sleeping problems. From this point of view, the study was conducted to determine the sleep quality of nurses and its influencing factors. MATERIALS AND METHODS: This descriptive-cross-sectional study was carried out on 152 nurses working at a training and research hospital in Istanbul. A questionnaire form including Individual Characteristics Form, Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale (HAD), Epworth Sleepiness Scale (ESS), and Fatigue Severity Scale (FSS) was used to collect data. Descriptive tests, Chi-square test, Spearman's correlation analysis, and binary logistic regression analysis were used for statistical analysis. RESULTS: It was determined that 61.9% of nurses had poor sleep quality. While a weak positive correlation was found between PSQI, ESS, and HAD-D, a moderate correlation was determined between PSQI, FSS, and HAD-A. Age, working shifts, anxiety, and fatigue levels were found to be factors influencing sleep quality. CONCLUSIONS: The results of the study show that sleep quality of nurses is low in approximately two-thirds of them, and factors such as older age, night shift work, and high anxiety and fatigue levels have a negative effect on sleep quality. It is thought that the regulation of working life considering age, professional experience, and mental health status may be effective in order to increase the sleep quality of nurses.
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Effect of sputum bacteriology on the prognosis of patients with acute exacerbations of bronchiectasis in the Intensive Care Unit p. 85
Fatma Ciftci, Deniz Dogan Mülazimoglu, Serhat Erol, Aydin Çiledag, Akin Kaya
DOI:10.4103/ejop.ejop_16_18  
OBJECTIVE: In bronchiectasis cases, isolation of the bacterial infection agent is related with disease severity. The purpose of the study was to find the impact of bacterial infections on the prognosis of bronchiectasis exacerbations in patients hospitalized in the Intensive Care Unit (ICU). MATERIALS AND METHODS: A retrospective, single-center, clinical study was performed on 48 patients who were diagnosed as having bronchiectasis exacerbation in the ICU. Sputum cultures of the patients were collected at the time of ICU admission. Clinical characteristics, treatment with noninvasive ventilation, IV requirement, and mortality were recorded. RESULTS: The bacteriologic sputum examination was positive in 24 patients. The bacteriologic analysis of sputum cultures revealed Pseudomonas aeruginosa in 12 patients, Streptococcus pneumoniae in 4, Haemophilus influenzae in 3, Acinetobacter baumannii in 3, and Escherichia coli in 2 patients. Seventeen patients needed IV during ICU follow-up, 7 of whom died. Bacterial proliferation in sputum culture was correlated to IV treatment need (P = 0.005). The radiologic disease extent was greater in patients with culture proliferation (P = 0.028). The patients who needed IV treatment had a greater radiologic disease extent (P = 0.007), pulmonary artery systolic pressure pulmonary arterial pressure (PAP) (P = 0.004), C-reactive protein (P = 0.014), and number of hospital admissions (P = 0.017). A multiple regression analysis for treatment success involving the variables of PAP, culture results, and radiologic disease extent revealed that bacterial proliferation was the most important factor for treatment success (odds ratio: 2.05; confidential interval: [0.87–3.23]; P = 0.04). CONCLUSION: Positive bacterial examination of sputum is the most important prognostic factor for patients with bronchiectasis exacerbation admitted to the ICU.
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The approach to community-acquired pneumonia: A survey study p. 93
Berna Akinci Ozyurek, Arzu Erturk, Yusuf Aydemir, Nazan Sen, Dursun Alizoroglu, Mustafa Hikmet Ozhan
DOI:10.4103/ejop.ejop_37_18  
INTRODUCTION AND AIM: Community-acquired pneumonia (CAP), which is often seen in daily practice, is a lower respiratory tract and pulmonary parenchyma infection which develops in society and daily life with community-acquired pathogens in individuals with no known immune failure. Delay in the treatment of pneumonia is known to increase morbidity and mortality. Various scoring systems are currently used in the identification of treatment groups in pneumonia. With the aim of evaluating the approach to CAP cases, the infection. MATERIALS AND METHODS: Working Group of the Turkish Respiratory Research Association (TUSAD) prepared a 22-item questionnaire. RESULTS: The survey was published on the TUSAD official website between July 2013 and June 2016. A total of 78 individuals responded to the questionnaire on the website. CONCLUSION: The responses to the questionnaire could indicate the way forward for new guidelines for physicians in respect of the approach to CAP.
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BRIEF COMMUNICATION Top

Working at a dedicated hospital for respiratory diseases from the perspective of an anesthesiologist p. 99
Derya Ozden Omaygenc, Necati Çitak
DOI:10.4103/ejop.ejop_15_18  
Despite subsequent improvements at the last eighty years, thoracic surgery is still ranked at top spots by means of mortality and morbidity on the occasion of dealing with high risk patients mostly. This fact legitimates the stress and anxiety of anesthesiologists employed in high-volume thoracic surgery centers. To evaluate the level of satisfaction and determine major concerns, a survey was formed and sent to 30 anesthesiologists working at four major centers dedicated to respiratory diseases. 19 Replies were received and the collected data was shared. Degree of expertise and how it had been gained, quantity of night shifts, measures of personal relationships, availability of certain diagnostic and therapeutic tools, contribution to research activities and eventually level of satisfaction at all was questioned and ratings were noted. The level of acceptable satisfaction was determined to be 68.4%. Major concerns were seemed to be excess of night shifts; inability to use certain modalities like ecmo, ila, picco, ultrasound and video laryngoscopy; inadequate participation at research acts, and unfavorable inter-disciplinary relationships. Participants specified basic potential improvements to overcome these adversities as taking place in scientific activities and publishing process more frequently(38.8%) And regulating personal relationships (36.8%). Concisely, by taking concrete steps for solving these issues, a favorable work environment can be consituted. It is mandatory to emphasize that reciprocal acts of both anesthesists and respiratory disease specialists will certainly help promoting not only the institutions but also the quality of health service.
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CASE REPORTS Top

The case of idiopathic pleuroparenchymal fibroelastosis diagnosed by transbronchial biopsy p. 104
Huseyin Arpag, Muhammet Sayan, Nurhan Atilla, Fulsen Bozkus, Hasan Kahraman, Abdulkadir Yasir Bahar, Mahmut Tokur
DOI:10.4103/ejop.ejop_12_18  
Pleuroparenchymal fibroelastosis (PPFE) is claasified in idiopathic interstitial pneumonitis group is rarely seen. Etiology and pathophysiology of this entity are not completely understood. The prognosis is poor, and there is no effective treatment except for lung transplantation. Here, we presented a case of PPFE diagnosed by transbronchial biopsy through fiberoptic bronchoscopy and its histopathological and clinicoradiological features.
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Submassive pulmonary thromboembolism as a first sign of occult adenocarcinoma p. 107
Fatma Yildirim, Iskender Kara, Halil Çınar, Melda Türkoğlu, Gülbin Aygencel
DOI:10.4103/ejop.ejop_42_18  
Venous thromboembolism is one of the most common complications of cancer, which also contributes to mortality in cancer patients. Venous thromboembolism can be observed as the first manifestation of occult cancer. We present the case of a 54-year-old woman with deep vein thromboembolism and pulmonary embolism as the first signs of cancer, who was subsequently diagnosed with disseminated adenocarcinoma, most likely originated from the pancreatico-biliary system.
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