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Introduction: Pulmonary thromboembolism (PTE) has a wide range of clinical presentations. With the advances in computed tomography (CT) technology and easier access to CT, the incidence of incidentally diagnosed cases of PTE has increased. The main aim of our study was to determine the frequency of patients incidentally diagnosed with PTE and whether these patients differ from patients with symptomatic PTE in terms of case characteristics. Materials and Methods: We retrospectively analysed the charts of 148 patients with PTE diagnosed and treated in 2022. Demographic characteristics, thrombus localisation, risk factors, and treatment modalities were compared between symptomatic patients with clinically suspected PTE and patients with incidentally diagnosed PTE by imaging methods performed for other purposes without clinically suspected PTE. Result: Out of 148 patients with PTE, 42 (28.3%) were diagnosed incidentally. The rate of concomitant malignancy was significantly higher in patients with incidental PTE (54.8%) than in patients with symptomatic PTE (28.3%) (p < 0.01). There was no significant difference between symptomatic and incidental PTE patients in terms of the pulmonary artery segment in which the thrombus was located (p > 0.05). Conclusions: In our patient group, approximately one out of four patients diagnosed with PTE were incidentally diagnosed. Patients with malignancies may not have symptoms suspicious for PTE or their symptoms may go unrecognized.

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Background and Objectives: This study aims to analyze survival in peritoneal and hemodialysis patients using chest radiography and biochemical parameters, determine common dialysis etiologies and causes of death, reveal prognostic factors, and contribute to clinical practice. Materials and Methods: A retrospective cross-sectional study was conducted with data from 33 peritoneal dialysis and 37 hemodialysis patients collected between October 2018 and February 2020. Survival and mortality were retrospectively tracked over 70 months (October 2018-June 2024). Chest X-ray measurements (cardiothoracic index, pulmonary vascular pedicle width, right pulmonary artery diameter, diaphragmatic height) and biochemical parameters (urea, albumin, creatinine, parathormone, ferritin, hemoglobin, arterial blood gas, potassium) were analyzed for their impact on survival. Statistical analyses included descriptive statistics, chi-square test, Fisher's exact test, Bayesian analysis, McNemar test, Kaplan-Meier survival analysis, Cox regression, Bayesian correlation test, linear regression analysis (scatter plot), and ROC analysis. SPSS 20.0 was used for data analysis, with p < 0.05 considered statistically significant. Results: Hypertension, type 2 diabetes, and urogenital disorders were the main dialysis etiologies. Peritonitis (38.5%) and cardiovascular diseases (47.4%) were the leading causes of death in peritoneal and hemodialysis patients, respectively. Significant chest X-ray differences included pulmonary vascular pedicle width and pulmonary artery diameter in hemodialysis and diaphragm height in peritoneal dialysis. Kaplan-Meier showed no survival difference between methods. Cox regression identified age, intact parathormone levels, iPTH/PVPW ratio, and clinical status as survival and mortality factors. The iPTH/PVPW ratio cut-off for mortality prediction was ≤6.8. Conclusions: Age, intact parathormone levels, pulmonary vascular pedicle width, and clinical status significantly impact survival in dialysis patients. Management of hypertension and diabetes, management and follow-up of urogenital disorders, infection control, patient education, and regular cardiovascular check-ups may improve survival rates. Additionally, the iPTH/PVPW ratio can predict mortality risk.

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OBJECTIVE: The objective of this study is to find the relationship between incidence rate and mortality of acute pulmonary thromboembolism (PTE), and seasonal and meteorological factors. MATERIALS AND METHODS: The data from 234 patients who were hospitalized due to acute PTE in the emergency service or policlinics between 2001 and 2008 were investigated retrospectively. Cases that developed APE (acute pulmonary embolism) in the hospital were excluded. Seasons and months in which acute PTE was diagnosed were recorded. Mortality rates by months and seasons were evaluated. The mean pressure, temperature and humidity values were evaluated for periods of three days, seven days and one month before the day of presentation. The effects of meteorological factors on the severity (massive or non-massive) and mortality of APE were investigated. RESULTS: The incidence rate of acute APE showed a significant difference according to seasons (p=0.000). APE was diagnosed most commonly in spring and winter. The mean pressure values for three days, seven days and one month and the mean humidity values for three days for the dead patients were found to be significantly lower than those of the survived ones (p<0.05). The mortality rate for patients admitted in summer was significantly higher than the rates for other seasons (p=0.02). There were no seasonal differences among the massive APE incidences. Mortality rates were higher in summer because of the nonmassive APE patients rather than the massive patients. CONCLUSION: Acute PE is a disease whose incidence and mortality rates are affected by meteorological factors.

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PURPOSE: The primary purpose of our study was to compare the efficacies of two sonographic (US) probes, a high-frequency linear-array probe and a lower-frequency phased-array sector probe in the diagnosis of basic thoracic pathologies. The secondary purpose was to compare the diagnostic performance of thoracic US with auscultation and chest radiography (CXR) using thoracic CT as a gold standard. METHODS: In total, 55 consecutive patients scheduled for thoracic CT were enrolled in this prospective study. Four pathologic entities were evaluated: pneumothorax, pleural effusion, consolidation, and interstitial syndrome. A portable US scanner was used with a 5-10-MHz linear-array probe and a 1-5-MHz phased-array sector probe. The first probe used was chosen randomly. US, CXR, and auscultation results were compared with the CT results. RESULTS: The linear-array probe had the highest performance in the identification of pneumothorax (83% sensitivity, 100% specificity, and 99% diagnostic accuracy) and pleural effusion (100% sensitivity, 97% specificity, and 98% diagnostic accuracy); the sector probe had the highest performance in the identification of consolidation (89% sensitivity, 100% specificity, and 95% diagnostic accuracy) and interstitial syndrome (94% sensitivity, 93% specificity, and 94% diagnostic accuracy). For all pathologies, the performance of US was superior to those of CXR and auscultation. CONCLUSIONS: The linear probe is superior to the sector probe for identifying pleural pathologies, whereas the sector probe is superior to the linear probe for identifying parenchymal pathologies. Thoracic US has better diagnostic performance than CXR and auscultation for the diagnosis of common pathologic conditions of the chest. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:383-389, 2016.

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INTRODUCTION: Almost all data on the cost of nosocomial pneumonia (NP) in the literature is associated with ventilator-associated pneumonia. This study aims to determine the economic burden of nosocomial pneumonia in clinical inpatients. MATERIALS AND METHODS: Data on costs of the 154 adult patients (97 male, 57 female; mean age 64.53 ± 14.92) who were hospitalized in non-intensive care clinics and developed NP were recorded prospectively. The control group consisted of 148 patients without pneumonia matched for age (mean age 65.66 ± 13.86), sex (94 male), diagnosis, and hospitalization date. Data obtained from both groups of patients for the number of hospitalization days and the data obtained from the hospital automation program (Avicenna) for costs were compared using the Mann-Whitney U test. RESULTS: While the mean duration of hospitalization was 32.8 days in patients with NP, it was 9.8 (p< 0.0001) in the control group. The cost of hospital beds was $631 for NP patients and $153 for the controls (p< 0.0001). The total cost was $6241 for NP patients and $1117 for the controls (p< 0.0001). CONCLUSION: NP is a high-cost condition that increases the duration of hospitalization 3.5-fold, hospital-bed cost 4-fold, and the total cost 5-fold.

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Massive pulmonary embolism (MPE) is a life threatening disease, thrombolytic treatment could save lives. The aims of this study are to identify early and late mortality rates in patients with MPE who received thrombolytic treatment, and mortality related risk factors. All the hospital records for the MPE patients who received thrombolytic treatment between 1998 and 2006 were retrospectively investigated. Pulmonary embolism was diagnosed through computed tomografi scan and V/P scintigraphy. Due to MPE, 21 women total 41 patients who undergo tPA or streptokinase were included in the study. Kaplan-Meier for the survival analysis and cox regression analysis for determining the mortality related independent risk factors were used. Dying while staying in hospital was accepted as early or hospital mortality, after discharge from hospital as late mortality. Out of 41 patients, 12 of them died while they are hospitalized (hospital mortality; 29%) 6 of them died after they were discharged (late mortality; 21%). The average survival time among discharged patients was 2304 days (95% confidence interval: 1725-2884). Among those patients who took streptokinase or tPA, late or early mortality rates (p> 0.05) and survival time did not show significant difference (p= 0.8908). The presence of arrhythmia [p= 0.01; odds rate (OR): 6.25] and jugular vein distention (JVD) (p= 0.03; OR: 6.25) for hospital mortality and multiple ongoing health problems for the late mortality were identified as the independent risk factors. For the hospital mortality, the presence of JVD or arrhythmia, for prognostic sensitivity, specificity, positive predictive value and negative predictive value were recorded as 75%, 79%, 60% and 88% respectively. In conclusion, the presence of arrhythmia and/or JVD on a patient with MPE is a negative prognostic factor for hospital mortality. The presence of other ongoing health problems influences the survival time of the discharged patients.

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OBJECTIVE: The aims of this study were to determine the clinical success rates, effect of neutropenia on treatment success rates, risk factors related to mortality, and survival in patients who developed hospital-acquired pneumonia (HAP) while receiving immunosuppressive therapy. METHODS: Forty-three adult patients receiving immunosuppressive therapy who developed HAP were included in this prospective study. Transplantation patients and human immunodeficiency virus (HIV)-positive patients were not included. Antibiotic treatment was managed by a multidisciplinary team. The Kaplan Meier method was used for the survival analysis and Cox regression was used for the identification of mortality-related independent risk factors. The relationship between neutropenia and the clinical success rate was determined using the chi-square test. RESULTS: Although anti-pseudomonal antibiotics were started empirically in 40 of the 43 patients (93%) at the beginning of the treatment, the most frequently isolated pathogens were Acinetobacter spp. and Escherichia coli. The success rate at the end of the treatment was 65.1%. The survival rates for the 3rd, 14th, 42nd, and 365th days were 97%, 86%, 58%, and 19%, respectively. Elevated levels of urea [Hazard Ratio=1.01 (95% CI: 1.00-1.02)] and blood glucose [HR=1.01 (95% CI: 1.00-1.02)] were found to be independent risk factors affecting survival. The treatment success rate was higher in patients without neutropenia (n=23) than in those with neutropenia (n=20) (p=0.05). CONCLUSION: The treatment success rate was low in patients who developed HAP while receiving immunosuppressive therapy.

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A 47 year old woman who had a history of asthma for 15 years referred to our hospital because of infiltrates on her chest radiograph that not responded to antibiotic treatment. We found that she had eosinophilia in peripheral blood (38%) and bronchoalveolar lavage (54%), nasal polyposis, and transient pulmonary infiltrates, and in the base of these findings we diagnosed as Churg-Strauss Syndrome (CSS). She has been using montelukast for 2 years. By examining her previous medical records, we observed that while eosinophil rates in peripheral blood were normal before montelukast usage, after this therapy eosinophil rates were greater 10 percent. Therefore, we thought that CSS was to be associated with montelukast usage. After just montelukast therapy was discontinued, clinical and radiographic parameters and the eosinophil counts (20%) improved. We present this case of CSS associated with montelukast in whom spontaneous remission was observed without using corticosteroids and cytotoxic agents.

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BACKGROUND: Most physiological measurements of the pulmonary diffusing capacity use carbon monoxide (CO) as a tracer gas. Similar to CO, melatonin binds the hemoglobin in the blood. OBJECTIVE: The present study was designed to assess the effect of exogenous melatonin administration on pulmonary functions including diffusing capacity for carbon monoxide (DL(CO)) in healthy subjects. METHODS: The study was performed in a randomized, double-blind, placebo-controlled manner. DL(CO) was measured in 22 healthy male volunteers (age 18-25 years) who were randomized to melatonin (n = 11) and placebo administration (n = 11). At baseline, DL(CO), alveolar volume (V(A)) and other spirometric parameters such as forced expiratory volume in 1 s (FEV(1)), forced vital capacity (FVC), peak expiratory flow (PEF) and maximal voluntary ventilation (MVV) were measured. DL(CO) was then corrected for the hemoglobin concentration. Measurements were repeated in a double-blind fashion 60 min after the administration of melatonin (1 mg) or placebo. RESULTS: DL(CO) was significantly decreased (39.31 +/- 4.75 vs. 34.82 +/- 6.18 ml/min/mm Hg) 60 min after the melatonin administration (p = 0.01), while FEV(1), FVC, FEV(1)/FVC, PEF and MVV values did not demonstrate significant differences. Placebo administration did not result in significant alteration in any of these parameters. CONCLUSIONS: In healthy subjects, oral administration of melatonin acutely influences the DL(CO) without affecting other pulmonary function test results. We conclude that melatonin may have a reducing effect on the DL(CO) in the lungs.

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OBJECTIVE: Cisplatin-gemcitabine (PG) and cisplatin-etoposide (PE) combinations are active regimens for non-small cell lung cancer (NSCLC). The present study aimed to compare PG with PE in the treatment of patients with stage IIIB and IV NSCLC. METHODOLOGY: We conducted a prospective, multicentre trial. A total of 166 patients were enrolled into the study and received either gemcitabine (1,000 mg/m(2)) on days 1, 8 and 15 plus cisplatin (80 mg/m(2)) on day 2 every 4 weeks, or etoposide (100 mg/m(2)) on days 1, 2 and 3 plus cisplatin (80 mg/m(2)) on day 1 every 3 weeks. RESULTS: The overall response rate was superior in the PG group (54.8%vs 39.0%, P=0.045). There was no significant difference in survival between the two groups, with respective median and 1-year survival of 38 weeks and 33.3% for the PG group, and 34 weeks and 23.2% for the PE group. There was also no statistical difference for time to progression between the two groups. Neutropenia and thrombocytopenia were seen more frequently in the PG group (grade 3 neutropenia, 33.3%vs 15.9%, P=0.012; grade 3 thrombocytopenia, 27.4%vs 3.7%, P<0.001 and grade 4 thrombocytopenia, 10.7%vs 1.2%, P=0.018). CONCLUSION: PG is an active chemotherapy regimen and has a better response rate than PE in advanced NSCLC, although there was no difference in time to progression and overall survival. A higher incidence of haematological toxicity was seen with PG than with PE.

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The aim of the present study is to determine whether patients with primary spontaneous pneumothorax (PSP) are subject to oxidative stress. For this purpose, we measured the activities of red blood cell superoxide dismutase, which is an antioxidant enzyme, and the level of plasma malondialdehyde, which is one of the lipid peroxidation markers, in a group of patients with PSP. The study was carried out with 16 patients with PSP and 24 healthy individuals. The two groups were similar to each other in terms of sex, age and smoking attitudes. Erythrocyte superoxide dismutase activity was found to be significantly lower in patients with PSP than in the control group (p < 0.01). The plasma malondialdehyde levels were significantly high in patients with PSP (p < 0.01). Our results suggest that oxidative stress may contribute to the pathogenesis of PSP.

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