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REVIEW ARTICLE
Chest drain size: Does it matter?
David J McCracken, Ioannis Psallidas, Najib M Rahman
January-April 2018, 20(1):1-6
DOI:10.4103/ejop.ejop_2_18  
Pleural disease is common with an increasing incidence and so represents a significant proportion of the workload for respiratory physicians. Chest drain insertion continues to be considered a mainstay of pleural disease management however the optimum drain size required for various pleural conditions remains unclear. Traditionally large-bore chest drains were inserted through a surgical technique of blunt dissection however smaller bore Seldinger (guidewire) drains have dramatically increased in popularity in recent times most likely due to ease of insertion and perceived increased patient tolerability. Despite British Thoracic Society Guidelines advocating a preference for small-bore chest drains, their use remains controversial. We aim to review the literature in each category of pleural disease including pneumothorax, malignant pleural effusion and pleural infection, regarding chest drain size, comparing the role, effectiveness and complications of each.
  3,695 498 -
ORIGINAL ARTICLES
Can neutrophil/lymphocyte ratio and platelet/lymphocyte ratio be used in differential diagnosis of Stage I sarcoidosis from tuberculosis lymphadenopathy?
Cengiz Ozdemir, Sinem Nedime Sökücü, Seda Tural Önür
January-April 2018, 20(1):22-26
DOI:10.4103/ejop.ejop_1_18  
OBJECTIVE: It is challenging to differentiate mediastinal lymph node enlargement caused by tuberculosis (TB) and sarcoidosis as both diseases may cause granulomatous inflammation. The objective of this study is to evaluate the use of neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) as possible markers in the differential diagnosis of Stage I sarcoidosis and TB lymphadenopathy in patients who present with mediastinal lymph nodes and no parenchymal involvement. MATERIALS AND METHODS: A total of 19 TB, 55 sarcoidosis, and 32 control patients, whose clinical records were available, were included in this retrospective study. All patients had a granulomatous reaction revealed on their lymph node biopsy specimen. The complete blood count at the time of diagnosis was included in the study. RESULTS: NLR and PLR were both significantly increased in Stage 1 sarcoidosis patients compared to controls while only PLR was significantly increased in the TB group (for sarcoidosis, NLR P < 0.001 and PLR P < 0.001; for TB, NLR P = 0.12; PLR P = 0.017). There were neither significant differences in serum NLR nor PLR between sarcoidosis and TB groups. CONCLUSION: Although NLR and PLR are useful tools to differentiate Stage 1 sarcoidosis from controls and PLR may be used to differentiate TB lymphadenopathy from controls, these parameters may not be used to differentiate between Stage 1 sarcoidosis and TB lymphadenopathy.
  2,444 282 -
Does anthracosis reported in endobronchial ultrasound-guided transbronchial needle aspiration exclude metastasis?
Serhat Erol, Ceyda Anar, Onur Fevzi Erer, Zekiye Aydogdu, Serir Aktogu
January-April 2018, 20(1):12-16
DOI:10.4103/ejop.ejop_5_18  
OBJECTIVES: In some studies, it has been hypothesized that anthracotic pigmentation in mediastinal lymph nodes is a sign of benign conditions and excludes metastasis from thoracic and extrathoracic malignancies. The aim of this study was to evaluate the clinical significance of mediastinal lymph node anthracosis in cancer patients who underwent endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). MATERIALS AND METHODS: In this study, medical data of patients with lung cancer or extrathoracic cancer who underwent EBUS-TBNA for investigation of mediastinal lymph node metastasis were evaluated retrospectively. EBUS-TBNA cytology reported as anthracotic pigmentation was included in this study. Patients were excluded from the study if cytology of aspirated lymph nodes reported as “benign,” “malignancy,” or “granulomatous inflammation.” RESULTS: There were 50 eligible patients. Thirty-one (62%) patients underwent EBUS-TBNA for lung cancer staging and 19 (38%) for evaluation of extrathoracic metastasis. A total of 120 lymph nodes were sampled. The most sampled station was subcarinal. EBUS-TBNA was false negative in eight of 31 (25.8%) lung cancer patients and one of 19 (5.2%) extrathoracic malignancy patients. CONCLUSIONS: Anthracotic pigmentation of lymph nodes in EBUS-TBNA cannot exclude metastasis in lung cancer patients and mediastinoscopy should be performed before surgery in this group. In patients with extrathoracic malignancy, anthracotic pigmentation is associated with benign conditions. However, further investigation with larger cohort is needed.
  2,304 282 -
The sleep quality of nurses and its influencing factors
Merve Tarhan, Aylin Aydin, Ersin Ersoy, Levent Dalar
May-August 2018, 20(2):78-84
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.
  2,159 360 -
Prediction of postoperative pulmonary complications in lung cancer surgery: Is proportion of emphysema important?
Tevfik Ilker Akcam, Seyda Ors Kaya, Onur Akcay, Ozgur Samancilar, Serpil Sevinc, Seher Susam, Kenan Can Ceylan
January-April 2018, 20(1):7-11
DOI:10.4103/ejop.ejop_8_18  
OBJECTIVE: Preoperative evaluation in thoracic surgery is highly important to determine surgical suitability, estimate postoperative pulmonary complications, and for patient follow-up. However, there is neither a definite explanation about the possible complications nor a gold standard method. MATERIALS AND METHODS: In this study, 297 patients undergoing anatomic lung resection for primary lung carcinoma were retrospectively evaluated. To form a homogeneous group, all factors that increase the rate of pulmonary complication were excluded except emphysema. Patients who did not meet these criteria were removed from the study. The study continued with 104 other patients. This patient subgroup was divided into groups according to Goddard Classification– Score (GdCS). The correlation between GdCS and other variables was statistically investigated. RESULTS: According to the GdCS of 104 patients, the patient distribution was as follows: 10 patients (9.6%) were G0, 28 patients (26.9%) were G1, 42 patients (40.4%) were G2, 22 patients (21.2%) were G3, and 2 patients (1.9%) were G4. Thirty-five (33.6%) of 104 patients had a pulmonary complication during the postoperative follow-up. The average drainage time was longer for higher GdCS scores, and the rate of exposition to a pulmonary complication was higher in the patients with increased GdCS. CONCLUSION: In view of these findings, Goddard's scoring for chronic obstructive pulmonary disease-emphysema patients was considered likely to be an indicative parameter in the preoperative evaluation and postoperative follow-up of thoracic surgery patients.
  2,028 297 -
Can the da Vinci robotic system be alternative to open surgery for schwannoma in posterior mediastinum?
Erkan Kaba, Tugba Cosgun, Kemal Ayalp, Alper Toker
January-April 2018, 20(1):17-21
DOI:10.4103/ejop.ejop_7_18  
OBJECTIVE: In the present study, the outcomes and technical details of patients who underwent surgical resection for benign schwannoma with the da Vinci robotic system are presented. MATERIALS AND METHODS: In the scope of our robotic surgery program, 26 (8.7%) patients out of 296 patients were operated using the da Vinci robotic system. Five patients (19.2%) who underwent surgery of benign schwannoma were included in the study. Prospectively, collected data of these patients were retrospectively evaluated. Age, gender, robot docking and console times, length of hospital stay, anatomic localizations of the lesions, pathology results, blood infusion needs, and mortality and morbidity rates of the patients were recorded. RESULTS: All patients were male, and the mean age was 43.2 ± 12.1 years. The mean length of hospital stay was 3 ± 0.9 days. The mean console time was 27.6 ± 18.8 min, and the mean docking time was 12 ± 4 min. None of the patients received blood transfusion. Utility incision was made in only one patient. Postoperative ptosis was detected in two patients with tumors where located in the apical region, and no mortality occurred. CONCLUSION: Due to the advantages of robotic surgery to the surgeon, patients with schwannoma in extreme locations that would pose challenges in dissection could be operated with da Vinci system.
  1,970 215 -
Features of endobronchial metastases from extrathoracic malignancy and positron emission tomography-computerized tomography findings
Coskun Dogan, Seda Beyhan Sağmen, Elif Torun Parmaksız, Ali Fidan, Nesrin Kıral, Banu Salepçi, Sevda Şener Cömert
January-April 2018, 20(1):37-42
DOI:10.4103/ejop.ejop_10_18  
OBJECTIVE: We aimed to investigate radiological and bronchoscopic aspects of endobronchial metastases (EBMs) from extrapulmonary cancers and the correlation of EBM with findings of integrated positron emission tomography-computed tomography (PET-CT) findings. MATERIALS AND METHODS: Patients who underwent bronchoscopic evaluation between January 2013 and December were analyzed retrospectively. Patients with endobronchial lesions in the airways and histopathologically diagnosed with extrapulmonary cancer metastasis were included in the study. RESULTS: A total of 16 patients with EBM who underwent bronchoscopic biopsies were evaluated. The patients consisted of 10 (62.5%) females and 6 (37.5%) males and the mean age was 61.8 ± 9.1. The common primary cancer related to EBM was breast 9 (%56.4). The mean interval from diagnosis of primary cancer to EBM was 55.1 ± 48.5 (1–180) months. A total of 13 (81.2%) cases were assessed with the PET-CT report. The mean SUVmaxvalue of the lung lesions was calculated as 9.8 ± 4.3. According to PET-CT, 92.4% of the cases had extrapulmonary metastasis. The mean survival duration from diagnosis of EBM was 8.5 ± 6.7 (1–21) months in 9 deceased patients. CONCLUSION: The most frequent extrapulmonary primary tumors with endobronchial metastasis were breast and the mean survival time was usually short. It was reported that most cases were multimetastatic. It was concluded that PET-CT can play a role in identifying the EBM and other organ metastasis and was important tool in planning the treatment.
  1,930 215 1
CASE REPORTS
Fatal aspiration of iodine oral contrast
Zeljko Vucicevic, Vesna Vucelic
January-April 2018, 20(1):50-52
DOI:10.4103/ejop.ejop_9_18  
We report on a case of massive iodine oral contrast aspiration with consequential cardiorespiratory arrest. The patient was successfully resuscitated and treated with mechanical ventilatory support and an urgent bronchoscopy toilet with only modest success. Instead of esophagography, the X-ray image showed an almost classical “bronchography.” A few hours later, the chest X-ray was indicative of acute noncardiogenic pulmonary edema. Respiratory status additionally deteriorated due to bilateral pleural effusions, severe exacerbation of chronic obstructive pulmonary disease, and heart failure, and the patient died of multiorgan failure 8 days after admission to the Intensive Care Unit. The incidence of fatal complications of oral iodine contrast aspiration is very rare but can be even lower if fully cooperative, and well-instructed patients are selected. Special attention should be paid to those with any kind of swallowing difficulties.
  1,902 142 -
Waterpipe (narghile, hookah) tobacco smoking-induced acute eosinophilic pneumonia
Ali Nihat Annakkaya, Ege Güleç Balbay, Özlem Öztürk, Binnur Önal, Fuat Aytekin, Öner Balbay
January-April 2018, 20(1):46-49
DOI:10.4103/ejop.ejop_3_18  
Acute eosinophilic pneumonia (AEP) is characterized by a febrile illness, diffuse pulmonary infiltrates, hypoxemic respiratory failure, and pulmonary eosinophilia. A temporal relationship has been described in a number of patients between the development of AEP and the recent onset of cigarette smoking. A 22-year-old male patient with no known chronic disease was admitted to the emergency service for 3 days with the complaints of cough, fever, dyspnea, and pleuritic chest pain. He was formerly a nonsmoker but was a waterpipe (narghile, hookah) tobacco smoker as a new habit once a night for the last 2 months. The erythrocyte sedimentation rate and C-reactive protein are elevated. Arterial blood gases revealed moderate hypoxemia. Computed tomography scans included bilateral, random, and patchy ground-glass opacities and also small bilateral pleural effusions. Echocardiograhic examination was normal. We had accepted the patient as an acute eosinophilic pneumonia due to rapid response to corticosteroid treatment, no microorganism in bronchoalveolar lavage (BAL) culture, and predominant eosinophilia was observed (70%–80%) in BAL.
  1,781 155 -
Meandering pulmonary vein: Very rare incidental finding
Murat Serhat Aygun, Mustafa Çalık, Saniye Goknil Çalık
January-April 2018, 20(1):43-45
DOI:10.4103/ejop.ejop_4_18  
Meandering pulmonary vein (MPV) is a rarely seen pulmonary vascular anomaly and confused with the scimitar syndrome which is more commonly seen. In this paper, we presented a case of left MPV which mimes arteriovenous malformation. A 30-year-old man was referred to our clinic for pulmonary nodule detected in routine evaluation before employment examination. Diagnosis of MPV was made by Pulmonary CT angiography. It showed abnormal drainage of upper lob pulmonary vein to the inferior pulmonary vein and form abnormal common pulmonary vein which shouldn't be exist. Because of any symptoms no further examination was recommended. According to our best knowledge to date only 17 cases reported in the literature. MPV diagnosis has been significantly changed by the means of advances in CT technology. Non-invasive diagnosis is possible with modern multisectional CT that clearly shows the anatomy of veins and enables the detailed MPV examination. Hereby, unnecessary radiological examination or surgery can be prevented.f veins and enables the detailed MPV examination.
  1,745 159 1
ORIGINAL ARTICLES
The effect of cognitive functions on the ability to learn how to use a Diskus device in patients with chronic obstructive pulmonary disease
Baykal Tulek, Nart Bedin Atalay, Ercan Kurtipek, Gülfem Yildirim, Fikret Kanat, Mecit Süerdem
January-April 2018, 20(1):27-32
DOI:10.4103/ejop.ejop_6_18  
OBJECTIVE: Dry powder inhalers are a group of inhaled medications commonly used for the treatment of chronic obstructive pulmonary disease (COPD). Although they can be more easily administered than metered dose inhalers, there is a high rate of errors in device use. The present study aims to evaluate the relationship between the ability to learn how to use a Diskus device and cognitive functions in patients with COPD. MATERIALS AND METHODS: The study included 30 inhaler-näive patients who were newly diagnosed with COPD. During their first visit, patients were administered a broad array of standardized neuropsychological tests and given a training on inhaler use. During the second visit, patients were divided into two groups according to their performance in the use of Diskus device: effective and ineffective. RESULTS: Twenty-nine patients who completed the study showed a negative correlation between the cognitive test scores and Diskus training parameters. The number of errors and duration of training increased as the cognitive scores decreased. In Visit 2, a comparison between patients with ineffective and effective use of the Diskus device showed that cognitive function scores were higher in those with effective use. CONCLUSIONS: Evaluation of cognitive functions in COPD patients is important in establishing an effective inhalation treatment.
  1,696 187 -
Relationship between hematological examination, glucose, HbA1clevel, and disease stages in patients with obstructive sleep apnea syndrome
Erhan Ugurlu, Ilknur Can, Mehmet Sercan Ertürk, Ismail Hakki Akbudak, Nese Dursunoglu, Sibel Ozkurt
January-April 2018, 20(1):33-36
DOI:10.4103/ejop.ejop_11_18  
OBJECTIVE: Obstructive sleep apnea syndrome (OSAS) is an episodic disease that is characterized by intermittent partial interruption of breathing during sleep, which results in low oxygen levels in organs and tissues. The characteristic symptoms of OSAS include snoring, apnea or hypopnea, and excessive daytime sleepiness. Our aim is to determine the early diagnosis of diabetes and to initiate treatments for OSAS patients according to the results of polysomnography (PSG) in the sleep polyclinic based on fasting blood glucose and HbA1c levels in patients with known OSAS without diabetes. MATERIALS AND METHODS: Patients who applied to the sleep polyclinic of the Pamukkale University and were diagnosed with OSAS using PSG were included in the study. RESULTS: A total of 44 patients with OSAS and a control group consisting of 47 people meeting these criteria were included. Compared with the control group, the patient groups showed significantly higher Hb values (P < 0.05) and lower mean corpuscular volume (P < 0.05). Significant negative correlations were found between glucose levels and mean O2saturation values in patients with severe OSAS (apnea–hypopnea index > 30) (r = −0.583, P = 0.02). CONCLUSION: In conclusion, even though significant differences were not found in the glucose and HbA1c levels of patients with OSAS, glucose metabolism was deteriorated when saturation was decreased in severe OSAS. Therefore, glucose levels should be observed frequently, particularly in severe cases of OSAS or in patients with hypoxia, regardless of the stage. More attention should also be paid to the development of diabetes.
  1,614 173 -
Diagnostic value of ultrasound guided transthoracic tru-cut biopsy in thorax malignancies
Coskun Dogan, Seda Beyhan Sağmen, Elif Torun Parmaksız, Nesrin Kıral, Ali Fidan, Sevda Sener Cömert, Banu Salepçi
May-August 2018, 20(2):53-58
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.
  1,290 285 -
How much are we aware of the increase in accompanying comorbidities in sarcoidosis?
Meltem Agca, Fatma Tokgöz Akyil, Ayşegül Berk, Sümeyye Alparslan Bekir, Dildar Duman, Merve Hörmet, Oğuzhan Akman, Tülin Sevim
May-August 2018, 20(2):70-77
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.
  1,057 185 -
The approach to community-acquired pneumonia: A survey study
Berna Akinci Ozyurek, Arzu Erturk, Yusuf Aydemir, Nazan Sen, Dursun Alizoroglu, Mustafa Hikmet Ozhan
May-August 2018, 20(2):93-98
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.
  1,071 160 -
Robotic surgery in mediastinal cystic pathologies
Erkan Kaba, Kemal Ayalp, Tugba Cosgun, Alper Toker
May-August 2018, 20(2):65-69
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.
  1,005 162 -
REVIEW ARTICLE
Molecular genetics of lung cancer
Yasemin Cicek, Pinar Aslan Kosar, Önder Öztürk
September-December 2018, 20(3):111-117
DOI:10.4103/ejop.ejop_33_18  
Lung cancer is one of the most common cancers with high mortality and is described as one of the leading causes of cancer-related deaths worldwide. Lung cancer is classified into two main histological groups: small cell lung cancer (SCLC) and non-SCLC (NSCLC). Using tobacco products is the most important risk factor for lung cancer development and appears to be responsible for 80%–90% of total lung cancers. It is thought that lung cancer is the end result of exposure to environmental risk factors in people with genetic susceptibility. Lung cancer cells contain many genetic alterations such as mutation, amplification, insertion, deletion, and translocation. The information obtained from research suggests that these genetic changes are also associated with characteristics such as smoking status, race, and gender. Significant progress has been made in the last 10–15 years to understand the molecular basis of lung cancer, and the discovery of oncogenic precursor mutations has created new pathways in the NSCLC classification and has also provided new therapeutic targets for anticancer therapy. With the introduction of targeted agents such as epidermal growth factor receptor and anaplastic lymphoma kinase in the treatment of adenocarcinomas in an effective manner, personalization of treatment strategies has become especially important for advanced lung cancer patients. The 2015 World Health Organization guideline for the classification of lung cancer recommends the preservation of pathologic specimens for molecular examinations and emphasizes the importance of molecular testing in the individualized treatment of advanced lung cancer patients.
  944 222 -
INVITED REVIEW ARTICLE
How to optimize aerosol drug delivery during noninvasive ventilation: What to use, how to use it, and why?
Arzu Ari
January-April 2019, 21(1):1-8
DOI:10.4103/ejop.ejop_10_19  
Much evidence supports the use of non-invasive ventilation (NIV) in patients who have acute and chronic respiratory failure and aerosolized medications are increasingly used in this patient population. Successful application of aerosol therapy during NIV depends on the effectiveness of the drug deposition in the lungs. Previous evidence showed that many factors impact aerosol delivery to patients receiving NIV. Those factors include mode of ventilation, ventilator parameters, type of ventilator circuit, the position of the aerosol device, the location of leak port, type of exhalation valve, humidity, enhanced condensational growth, type of aerosol device, and interface as well as delivery technique. The purpose of this paper is to review the available evidence related to aerosol therapy during NIV and provide recommendations to optimize aerosol drug delivery to patients receiving NIV.
  946 218 -
ORIGINAL ARTICLES
The effect of morphine delta receptor activity on ischemic postconditioning in lung ischemia reperfusion injury
Nuri Duzgun, Hıdır Esme, Ibrahim Kılınç, Mustafa Çalık
May-August 2018, 20(2):59-64
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.
  976 166 -
The effect of body mass index on pulmonary rehabilitation outcomes in patients with chronic obstructive pulmonary disease
Esra Pehlivan, Arif Balci, Esra Yazar, Elif Yelda Niksarlioglu, Lütfiye Kiliç
September-December 2018, 20(3):150-156
DOI:10.4103/ejop.ejop_22_18  
CONTEXT: Although pulmonary rehabilitation (PR) is increasingly used in patients with chronic obstructive pulmonary disease (COPD), the factors affecting the gains obtained from PR are still not clear. AIMS: We aimed to investigate the effect of body mass index (BMI) on PR outcomes in COPD. SETTINGS AND DESIGN: The study was a retrospective–descriptive study. SUBJECTS AND METHODS: Patients with BMI of 18.5–25 kg/m2 were referred to as Group 1 (n = 15) and patients with BMI ≥25 kg/m2 as Group 2 (n = 17). All patients received PR for 8 weeks. Six-min walking distance (6MWD), forced expiratory volume in 1-s, forced vital capacity (FVC), carbon monoxide diffusing capacity (DLCO), maximal inspiratory pressure (MIP), modified Medical Research Council dyspnea scale (mMRC), and COPD assessment test (CAT) scores were compared. STATISTICAL ANALYSIS USED: Paired t-test, Wilcoxon rank, and Mann–Whitney-U test were used for statistical analysis. RESULTS: Thirty-two patients were included in the study. Baseline parameters were similar except 6MWD. Following PR, 6MWD, mMRC, and CAT scores were significantly improved in both the groups (P < 0.05). A significant difference was found in favor of Group 1 for FVC (P = 0.039) and MIP (P = 0.018), while no difference was detected in DLCO. CONCLUSIONS: In this study, PR yielded similar gains between COPD patients with high BMI and those with normal BMI in terms of exercise capacity, dyspnea, and disease symptom severity. The only additional gains were achieved in the respiratory functions of patients with normal weight. All COPD patients should be referred to PR, regardless of the BMI, taking into account the resulting PR gains.
  909 163 -
Chest X-ray: Is it still important in determining mortality in patients hospitalized due to chronic obstructive pulmonary diseases exacerbation in intensive care unit?
Elif Yelda Ozgun Niksarlioglu, Ülkü Aka Aktürk
September-December 2018, 20(3):133-137
DOI:10.4103/ejop.ejop_70_18  
OBJECTIVE: The present research aims to evaluate the effects of chest X-rays on mortality among patients who were hospitalized due to the exacerbation of chronic obstructive pulmonary disease (COPD) in intensive care unit (ICU) of a secondary care hospital. MATERIALS AND METHODS: Sixty-three patients (39 males, 60.9%), who were hospitalized in ICU due to COPD exacerbation between December 1, 2011, and December 31, 2012, were retrospectively reviewed in this study. Data, including demographics, smoking history, arterial blood gas measurements, posterior-anterior lung radiography (PALR) findings and mortality, were collected from the medical records. RESULTS: The mean age of the patients was 70.5 years (standard deviation [SD]: 13.3, range 44–88 years). Of all the cases, 42 (85.7%) had at least one comorbidity. The most common comorbidities were hypertension (34, 53.9%) and heart failure (19, 30.2%). Mean duration of hospital stay was 8 days (SD: 5.7, range: 2–26). Mechanical ventilation support was required in 17 (27%) cases. In total, seven female and four male patients died during hospitalization (17.7%). PALR indicated emphysema in 60.3%, infiltration in 54%, bronchiectasis in 31.7%, and unilateral or bilateral pleural effusion in 27% of the cases. Infiltration and pleural effusion in PALR were more common among the patients who died (died/alived 10/11 vs. 24/52, P = 0.008 and 6/11 vs. 11/52, P = 0.026, respectively). The multivariate model for mortality showed that only age (odds ratio 0.821, CI: 0.687–0.948, P = 0.044) was independently related to mortality. CONCLUSION: As a basic imaging method, PALR still remains as an important diagnostic tool for COPD patients hospitalized in ICU, and it may contribute to the prediction of mortality.
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Frequency and duration of smoking scenes in Turkish movies
Nazmi Bilir, Hilal Ozcebe, Sule Akcay, Elif Babaoglu, Sema Canbakan, Burcu Cirit, Ozlem Ercen Diken, Tijen Sengezer
September-December 2018, 20(3):128-132
DOI:10.4103/ejop.ejop_68_18  
BACKGROUND: Comprehensive tobacco control law in Turkey bans advertisement, promotion of tobacco products and sponsorship by the tobacco industry. Advertisement of tobacco products was banned on television, billboards and press media, but not on movie films. METHODS: To evaluate the frequency and duration of smoking in the movies, 60 most watched Turkish films which were on the vision during the second half of 2016 were determined for this descriptive study. Two young males having a university degree were trained on the aim and methodology of the study. Then the two observers viewed the films independently and recorded smoking scenes or direct appearance of tobacco products on a standard form. RESULTS: There were tobacco products or smoking views in 36 (60%) out of total 60 movies. In these movies there were 4.75 times tobacco occurrences as an average (median 3). Average duration of smoking occurrences was almost 3.5 min (198 s). Smokers were mostly main characters and smoking occurrences were mostly in exciting or romantic atmosphere, which are attractive for young people. DISCUSSION: In the light of Framework Convention on Tobacco Control (Article 13), smoking scenes in movies are considered as kind of tobacco advertisement and promotion, which influences smoking behavior particularly the young people. Therefore, control and prevention of smoking occurrences in movies are important for the protection of children and young people to start smoking. Some health warnings and anti-tobacco messages may be placed in the movies, to reduce tobacco views in the movies.
  803 128 -
Effect of sputum bacteriology on the prognosis of patients with acute exacerbations of bronchiectasis in the Intensive Care Unit
Fatma Ciftci, Deniz Dogan Mülazimoglu, Serhat Erol, Aydin Çiledag, Akin Kaya
May-August 2018, 20(2):85-92
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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Does subglottic secretion drainage prevent ventilator-associated pneumonia?
Aysegul Erinc, Hatice Kutbay Ozcelik, Burcu Arpinar Yigitbas, Sibel Yurt, Filiz Kosar
September-December 2018, 20(3):122-127
DOI:10.4103/ejop.ejop_62_18  
AIM: To compare the incidence of ventilator-associated pneumonia (VAP) in patients who were admitted to the intensive care unit (ICU) for reasons other than pneumonia and followed up under mechanical ventilation either with standard endotracheal tubes or endotracheal tubes with subglottic secretion drainage (SSD). MATERIALS AND METHODS: Patients who were admitted to the ICU between April 2012 and January 2013 were prospectively and sequentially randomized to standard endotracheal and SSD intubation groups. Patients with pulmonary infection at ICU admission were excluded. Pulmonary imaging, blood, and sputum cultures were routinely screened, and pleural fluid and bronchial lavage examinations were done on demand. RESULTS: Mean age, gender distribution, APACHE II scores, duration of mechanical ventilation, and follow-up of patients with standard (n = 30) and SSD (n = 12) intubation tubes were similar; 71 ± 10.4 versus 64.4 ± 13.9 years (P > 0.05), male/female 18/12 versus 9/3 (P > 0.05), APACHE II scores 20.2 ± 3.8 versus 17.0 ± 3.8 (P = 0.02), 15.9 ± 11.5 versus 11.0 ± 8.1 days (P > 0.05), and 18.0 ± 12.4 versus 15.5 ± 12.2 days (P > 0.05), respectively. The incidence of VAP was similar in both groups (36.7% vs. 33.3%, P > 0.05, in standard vs. SSD groups, respectively). The mortality rate was higher in the standard intubation group, but the difference was not statistically significant (70% vs. 41%, P > 0.05). CONCLUSION: Compared to standard endotracheal intubation, intubation with SSD tubes was not associated with an improvement in the duration of mechanical ventilation, length of stay in the ICU, incidence of VAP, and mortality rate. Due to the limited number of patients included in this study, the results have to be confirmed in larger studies on more patients.
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CASE REPORTS
Presentation and surgical treatment of congenital pulmonary airway malformation in an adult
Cemal Aker, Cem Emrah Kalafat, Salih Bilen, Celalettin İbrahim Kocatürk
September-December 2018, 20(3):174-176
DOI:10.4103/ejop.ejop_39_18  
Congenital pulmonary airway malformation (CPAM) is a congenital lung disease that is usually diagnosed in the prenatal or neonatal period but is rarely seen in adults as well. In this report, we present a 26-year-old male patient who presented to our clinic with respiratory difficulty due to a CPAM that affected the entire right lung, caused mediastinal and diaphragmatic compression, and led to extensive diffuse hemorrhage from the adjacent structures that required massive transfusion.
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