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AIM: To assess choroidal thickness in patients with severe obstructive sleep apnea syndrome (OSAS) and compare them with healthy controls, using spectral domain optical coherence tomography (OCT). METHODS: In this observational, cross-sectional study, choroidal thicknesses of 23 newly severe OSAS patients and 23 body mass index- age- and sex-matched healthy subjects were measured using a high-speed, high-resolution frequency domain-OCT device (λ=840 nm, 26000 A-scans/s, 5 µm axial resolution). All patients underwent a complete ophthalmic examination before the measurements. OCT measurements were taken at the same time of day (9:00 a.m.), in order to minimize the effects of diurnal variation. RESULTS: There was a statistically significant difference in median choroidal thickness between the OSAS patients (201 µm; range 145-237 µm) and the controls (324 µm; range 296-383 µm; P<0.001). There were significant differences at all measurement points (P<0.001 for all). The apnea-hypopnea index (AHI) values were more than 30 in all OSAS patients and the mean AHI was 48.57±6.54. The interexaminer intraclass correlation coefficient (ICC) for the mean choroidal thickness was 0.938 (95%CI, 0.908-0.985) and ICC was greater than 0.90 for all measurement points. CONCLUSION: The decreased choroidal thickness of patients with severe OSAS might be related to the the autonomic disregulation associated with this disease. Further studies are needed to evaluate the etiopathologic relationship between choroidal thickness and OSAS.

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This study aimed to examine the effects of differing intra-abdominal pressures on pulmonary function test results in laparoscopic cholecystectomy. Forty-five patients were operated on under 3 different intra-abdominal pressures: group A (8 mm Hg), group B (12 mm Hg), and group C (15 mm Hg). On the first day before and after the operation, forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), FEV1/FVC rate, peak expiratory flow speed (PEF), and maximal middle expiration speed (FEF25-75) values were measured using Vmax 229 spirometry. No significant differences were observed among the 3 groups regarding preoperative and postoperative FVC, FEV1, FEV1/FVC, PEF, and FEF25-75 values (P=0.96, P=0.73, P=0.48, P=0.34, and P=0.33, respectively). When the groups' preoperative and postoperative values were compared, FVC, FEV1, and PEF values significantly decreased in each group. The FEF25-75 values statistically significantly decreased in groups B and C when compared with their preoperative values; however, the decrease in group A was not significant. In conclusion, different intra-abdominal pressures during laparoscopic cholecystectomy had similar effects on pulmonary function test results. However, lower intra-abdominal pressures were associated with slightly more negative effects on FEF25-75 values.

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Dyspnea defined as an uncomfortable sensation of breathing is the main cause of disability in chronic obstructive pulmonary disease (COPD) patients. There is evidence that the underlying mechanisms of dyspnea are multifactorial. The aim of this study was to investigate these mechanisms causing dyspnea in COPD patients and the relationship between functional parameters, dyspnea scales and quality of life questionnaire. For this purpose 56 patients (11 female, 45 male) were recruited. Pulmonary function tests including airflow rates, lung volumes, maximal respiratory muscle forces, diffusing capacity, breathing pattern, arterial blood gas analyses as well as dyspnea scales MRC, baseline dyspnea index (BDI) and The Saint George Respiratory Questionnaire (SGRQ) were performed. The overall group showed moderate obstructive disease (FEV1%= 59.02 +/- 3.30) and mild hypoxemia with some air trapping (RV/TLC%= 52.00 +/- 2.00). MRC scale did not show any significant correlation with pulmonary function parameters. There was significant positive correlation between BDI and airflow rates, PImax, DLCO and air trapping. Breathing pattern parameters (Ti/Ttot, VT/Ti) also correlated with BDI. There was positive correlation between PaO2 and BDI (p< 0.001). SGRQ scores correlated significantly with FEV1, PImax, RV/TLC and P 0.1. There was also strong correlation between BDI and SGRQ scores. In conclusion, dyspnea is the result of multiple factors such as airflow limitation, decreased respiratory muscle strength, changes breathing pattern, hypoxemia, and air trapping which in turn affects quality of life in patients with COPD.

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Excessive daytime sleepiness (EDS) is a common but underrecognized and preventable cause of traffic accidents. It creates a problem of particular importance for professional drivers. We performed the Epworth Sleepiness Scale (ESS) and questionnaire related to their history of traffic accidents to 118 professional taxi drivers to determine the EDS and its effects on driving performance in taxi drivers. There were 58 (49.2%) subjects with loud snoring, 8 (5.9%) subjects with cardinal symptoms due to obstructive sleep apnea syndrome (OSAS) and 28 (23.7%) subjects with ESS > or =10 in the group of taxi drivers. Eighty (67.8%) drivers had been involved in a traffic accident. We found a significant relation between the number of traffic accident and EDS, witnessed apnea, cardinal symptom related to OSAS but not with snoring. The present data that sleepiness is a common symptom in taxi drivers and may be related to traffic accident.

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Up to date several hereditary disorders have been identified as prothrombic risk factors. The most common inherited thrombotic disorders include activated protein C resistance (factor V Leiden), prothrombin G20210A mutation, hyperhomocysteinemia, deficiencies of protein C, protein S, antithrombin III, and thrombomodulin. This article focuses on the clinical and the laboratory aspects of some of the inherited venous thrombotic disorders including the factor V Leiden, prothrombin G20210A mutation and protein S deficiency.

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