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Yayın Analysis of obstructive sleep apnea patients with "sawtooth sign" on the flow-volume curve(SPRINGER HEIDELBERG, 2011) Levent, Ender; Sariman, NesrinThe aims of the present study are to determine whether there is an obstructive sleep apnea (OSA) subgroup presenting with sawtooth sign on the spirometric flow-volume curve, and to identify the clinical importance of the sawtooth sign in these patients. The study subjects consisted of 134 OSA patients (a parts per thousand yen18 years) whose spirometric tests were made on the same day with the polysomnography. Patients without sawtooth sign were taken as the control group. Patients with sawtooth sign and control subjects were retrospectively analyzed in terms of distinctive demographic, anthropometric, polysomnographic, and spirometric characteristics. OSA patients with sawtooth sign (n = 36) had greater neck circumference and body weight, and were taller than control subjects (n = 98). Patients with sawtooth sign were mainly males (p < 0.01). Female/male ratios were similar in control subjects. The presence of coronary artery disease was higher (p = 0.024), and current smokers were more (p = 0.014) among the patients with sawtooth sign than control subjects. In logistic regression analysis, the presence of sawtooth sign and age were the only statistically significant parameters (p = 0.028 and p = 0.002, respectively) that affect the likelihood of coronary artery diseases. There were no differences among the groups with regard to age, BMI, wrist circumference, and other comorbid conditions. The duration time of oxygen desaturation (< 90%), avarage, and longest duration of total apnea were longer (p = 0.050, p = 0.034 and p = 0.014, respectively) and the obstructive apnea index was more (p = 0.035) in OSA patients with sawtooth sign when compared to control subjects. There were no differences with regard to other polysomnographic parameters, sleep architecture, Epworth sleepiness score, and spirometric parameters. As an OSA subgroup, the OSA patients with sawtooth sign may have more frequent and longer duration of obstructive apneas, longer duration time of oxygen desaturation, and greater risk for the coronary artery disease.Yayın Bronchial hyperreactivity and airway wall thickening in obstructive sleep apnea patients(SPRINGER HEIDELBERG, 2011) Sariman, Nesrin; Levent, Ender; Cubuk, Rahmi; Yurtlu, Sirin; Aksungar, Fehime BenliHypoxia/reoxygenation episodes in obstructive sleep apnea (OSA) results in the alteration of the oxidative balance, leading to the development of inflammation. Airway wall thickening and inflammatory changes are suggested as a primary cause of the airway hyperresponsiveness in asthmatics. Bronchial hyperreactivity (BH) may also occur in patients with OSA. We investigated the presence of BH and airway wall thickness in OSA and correlations with inflammatory markers. Sixteen OSA patients and ten controls without allergic diseases were prospectively studied. Plasma pro-B-type natriuretic peptide (pro-BNP), fibrinogen, D-dimer, alpha 1-antitrypsin, and high-sensitive C-reactive protein levels were measured. Airway wall thickness was evaluated with high-resolution CT, and BH was assessed by giving each subject a methacholine challenge test. In OSA patients, bronchial wall thickness, fibrinogen, D-dimer, alpha 1-antitrypsin, high sensitive C-reactive protein, and pro-BNP levels were significantly greater than those in control subjects. Among the 16 patients, three had BH on methacholine challenge. Bronchial wall thickness(mm) was positively correlated with apnea-hypopnea index (AHI: number of apneas + hypopneas/hour of sleep), BMI, respiratory arousal index, nocturnal oxygen desaturation (NOD) duration (time in minutes with a nocturnal arterial oxygen saturation of < 90% during sleep), and alpha 1-antitrypsin levels. NOD duration also correlated with pro-BNP and fibrinogen levels. In OSA patients, walls of central airways were thicker than normal subjects. BH may have occurred in OSA patients. NOD duration correlated with inflammatory parameters and oxygen desaturation index 3% had an effect on the thickness of bronchial walls. But overall, AHI was found to be the only independent predictor of bronchial wall thickness.Yayın A Case of Rib Tuberculosis and Chest Wall Abscess with Multi-Drug Hypersensitivity Reactions(ANKARA MICROBIOLOGY SOC, 2015) Akduman Alasehir, Elcin; Sariman, Nesrin; Yaman, Gorkem; Olgac, Muge; Saygi, AttilaExtrapulmonary tuberculosis is the reactivation of the remaining latent organism which spreads during primary infection by the lymphohematogenous way. It should be considered in the differential diagnosis especially in endemic countries for tuberculosis. Tuberculosis (TB) treatment is based on the principle of the combined use of several drugs. As a result of the combination therapy there can be life threatening side effects which can lead to improper use of medications and may also cause drug resistance. In this report, we present an 85-year-old male patient desensitized due to the development of allergy against multi-drugs with rib tuberculosis and chest wall abscess to whom, culture, drug susceptibility and genotypical tests were applied. In November 2012, the patient applied to a medical center with complaints of swelling and pain under the right rib, underwent rib resection and eventually diagnosed as rib TB by histopathological examination. However, the anti-TB treatment was discontinued due to the hypersensitivity reactions in the skin and in addition to the hepatic and renal dysfunction side effects. The patient had widespread redness, rash and pruritus on the body and the laboratory findings were as follows; ALT: 114 U/L, AST: 152 U/L, ALP: 93 U/L, GGT: 26U/L, blood urea nitrogen (BUN): 26 mg/dL and creatinine: 1.7 mg/dL. After the disapperance of the complaints within 3 days of drug discontinuation, isoniazid treatment was initiated. However, the new treatment was also discontinued when the reactions reoccurred. Afterwards, the patient developed hypersensitivity reactions against the combination of streptomycin and ethambutol. The patient refused any further treatment and was discharged from the hospital. The patient was untreated for the last 5 months and admitted to our clinic with a fistulized swelling and abscess in the right chest wall. Bacteria was not detected in the acid-fast staining of the abscess material, however Mycobacterium tuberculosis was isolated from culture by MGIT (Mycobacteria Growth Incubator Tube; BBL MGIT, BD, USA) system. The spoligotyping revealed that the genotype was Haarlem 1. Major drug susceptibility testing against rifampin, streptomycin, ethambutol, isoniazid, and pyrazinamide yielded sensitivity to those drugs. Minor drug susceptibility testing against paraaminosalicylic acid, ethionamide, kanamycin, capreomycin and ofloxacin was found to be sensitive. A regimen of isoniazid 300 mg/day, ethambutol 1000 mg/day and moxifloxacin 400 mg/day was initiated. Rapid oral desensitization against isoniazid and ethambutol were repeated on two consecutive days. The patient continued antituberculosis therapy for 12 months without adverse reactions. The chest wall fistula was closed. Abscess was drained surgically. Clinical and radiological improvements were achieved. The patient remains clinically disease free and continues his regular follow ups. This case is presented to emphasize about the importance of culture and susceptibility testing in extrapulmonary tuberculosis cases and desensitization in drug hypersensitivity reactions.Yayın Evaluation of Clinical and Functional Parameters in Female Subjects With Biomass Smoke Exposure(DAEDALUS ENTERPRISES INC, 2013) Koksal, Hulya; Saygi, Attila; Sariman, Nesrin; Alici, Emel; Yurtlu, Sirin; Yilmaz, Huri; Duzgun, YelizBACKGROUND: Indoor air pollution and exposure to biomass smoke is a risk factor for pulmonary diseases among women in developing countries. We aimed to assess clinical and functional findings and exposure duration and to evaluate their relationships in patients who used biomass products as fuel and who presented to the clinic due to respiratory symptoms. METHODS: Fifty-five patients who had been referred to the hospital between January 2008 and December 2010 and who met the inclusion criteria were accepted to the study. Data on the place they live, biomass exposure duration, lung function parameters, and arterial blood gases were recorded. RESULTS: Statistically significant differences in FEV1%, FEV1 (L) and, FEV1/FVC existed between the subgroups of duration of biomass exposure (P = .001). FEV1% and FEV1/FVC were highest in the <30 hour-years exposure group. In the presence of animal dung use, the odds ratio and 95% CI for the risk of FEV1/FVC < 70% was 3.5 (0.88-10.29). Subjects who used animal dung and wood for cooking and heating had severe and very severe FEV1 stages. CONCLUSIONS: Biomass exposure can have effects on lung function test parameters. Animal dung use is primarily related to risk of deterioration of FEV1/FVC, when compared to other biomass fuels. Protective health measures should be taken by assessing the risks in areas where biomass exposure is intense, improving poor design of the stoves and ventilation, and switching to better clean energy sources such as natural gas and solar energy.Yayın Homocysteine Levels and Echocardiographic Findings in Obstructive Sleep Apnea Syndrome(KARGER, 2010) Sariman, Nesrin; Levent, Ender; Aksungar, Fehime Benli; Soylu, Akin Cem; Bektas, OsmanBackground: The obstructive sleep apnea syndrome (OSAS) is characterized by repeated upper airway obstruction during sleep together with decreases in oxygen saturation leading to a series of pathological events, primarily in the cardiovascular system. Elevated plasma homocysteine levels have recently been considered as an independent risk factor for vascular disease, and increased levels are attributed to cardiovascular diseases. Objectives: We aimed to investigate the possible relationship between homocysteine levels and echocardiographic findings in OSAS patients at different stages of disease. Methods: Thirty-eight patients (23 males and 15 females) with polysomnographically verified OSAS (mean age, 49 +/- 12 years, range 27-74) and a mean body mass index of 31.27 +/- 5.24 kg/m(2) (range 22.60-47.90) were prospectively studied. Plasma levels of homocysteine, cholesterols, triglycerides, vitamin B(12) and high-sensitive C-reactive protein (hsCRP), as well as echocardiographic and lung function parameters were assessed. Results: Homocysteine levels were elevated in all OSAS groups and were statistically significantly different between the mild and moderate/severe groups. Significant differences were present between the variables nocturnal oxygen desaturation (NOD), respiratory arousal and light sleep among the mild and moderate/severe groups. We found a significant positive correlation between homocysteine levels and NOD duration, and hsCRP levels were positively correlated with the apnea-hypopnea index and NOD duration. Conclusions: In all OSAS groups, homocysteine levels were elevated regardless of the presence of cardiac dysfunction. Echocardiographic abnormalities were primarily left-ventricular (LV) hypertrophy and LV diastolic dysfunction and could be observed in all OSAS severity groups. Copyright (C) 2009 S. Karger AG, BaselYayın Lung cancer and pregnancy(ELSEVIER IRELAND LTD, 2013) Sariman, Nesrin; Levent, Ender; Yener, Nese Arzu; Orki, Alpay; Saygi, AttilaLung cancer in the pregnant woman is a very rare and dramatic coincidence with poor prognosis. Treatment depends on the gestational week of the pregnancy, patient's medical status, social, personal, familial, and even religious beliefs. We present a case of adenocarcinoma of the lung in a 34-year-old pregnant patient whose initial complaints were cough, dyspnea, fever and fatigue. She was diagnosed with pneumonia at another hospital, and antibiotic therapy was administered. Meanwhile, at 28 weeks she delivered a preterm low-birth-weight baby. Chest X-ray and thorax CT revealed a mass lesion in the upper left lung lobe. After admission to our clinic, needle aspiration of left supraclavicular lymph node and bronchoscopic biopsy from upper lobe bronchus showed a non-small lung cancer; adenocarcinoma. Brain MRI was normal. PET CT revealed multiple bone metastases. Multidisciplinary Tumor Committee at our hospital referred her to the Oncology Department as an advanced stage IV disease. Chemotherapy was administered with paclitaxel and carboplatin for a total of 12 weeks. Reassessment of the patient revealed new bone metastases and crizotinib was administered since her tumor was found positive for EML4-ALK mutations. The treatment was well tolerated. During a follow up period of 6 months her clinical condition was stable and no adverse events were encountered. (c) 2012 Elsevier Ireland Ltd. All rights reserved.Yayın Microscopic bilateral posterior cordotomy in severe obstructive sleep apnea syndrome with bilateral vocal cord paralysis(SPRINGER HEIDELBERG, 2012) Sariman, Nesrin; Koca, Oncel; Boyaci, Zerrin; Levent, Ender; Soylu, Akin Cem; Alparslan, Sumeyye; Saygi, AttilaVocal cord paralysis is a rare cause of obstructive sleep apnea syndrome (OSAS). Recurrent laryngeal nerve injury after thyroid gland surgery is one of the leading causes of acquired vocal cord paralysis. A 46-year-old woman with OSAS due to bilateral abductor vocal cord paralysis was presented. She had thyroidectomy 30 years ago and had a weak, breathy voice. She had been referred with a history of high-pitched snoring, apnea witnessed by her spouse, and excessive daytime sleepiness for the last 5 years. Full-night polysomnography revealed that her apnea-hypopnea index was 72/h and minimal oxygen saturation level was 81%. There was no REM and deep sleep periods. Ear-nose-throat consultation offered an endoscopic bilateral posterior cordotomy operation via microscopic suspension laryngoscopy (MLS) as a treatment option. Instead of using a nasal positive airway pressure (nCPAP) device, she was treated surgically. Her OSAS resolved completely within 5 months of the surgery. Her phonation was preserved, and symptoms such as snoring and hypersomnolance disappeared. In OSAS patients with bilateral vocal cord paralysis, MLS-associated bilateral posterior cordotomy can be a choice of treatment as an alternative to nCPAP application.Yayın Miliary Pulmonary Metastases of Malign Pleural Mesothelioma(Aves, 2011) Levent, Ender; Sariman, Nesrin; Soylu, Akin CemMalign pleural mesothelioma is characterized as an aggressive tumor that spreads widely on the pleura and invases directly thoracic structures. Miliary metastases are very rare in malignant pleural mesotheliomas. However, they can be observed at the time of diagnosis in some of the cases when the primary lesion is not detected and in some others in the later stages. For this reason one should suspect malignant mesotheliomas in the differential diagnosis when presentation is with diffuse miliary or micronodular pulmonary lesions. Immunehistochemical studies are helpful especially in differential diagnosis of other metastases when the primary lesion is not known. Here, a 58 year-old woman having mixed type malignant pleural mesothelioma is being presented because she had miliary pulmonary metastases revealed in thorax CT at the 9th month of the diagnosis. She was not a smoker and there was no history of asbest exposition. The patient died due to respiratory insufficiency at the 17th month of the diagnosis.Yayın Nonsevere Acute Pulmonary Embolism: Prognostic CT Pulmonary Angiography Findings(LIPPINCOTT WILLIAMS & WILKINS, 2015) Atasoy, Mehmet Mahir; Sariman, Nesrin; Levent, Ender; Cubuk, Rahmi; Celik, Omer; Saygi, Attila; Atasoy, Isil; Sahin, SinanPurpose: To retrospectively evaluate the prognostic parameters of computed tomography (CT) pulmonary angiographic findings in nonsevere (hemodynamically stable) pulmonary embolism(PE) patients and to assess the predictive value of these parameters for mortality within 1 month of the initial diagnosis. Materials and Methods: Retrospectively, 67 consecutive patients (28 men, 39 women; mean age, 63.25 +/- 18 years) from 2 centers with nonsevere PE diagnosed using CT and a clinical evaluation were included in the current study. Using consensus reading, 2 readers blinded to the patients' clinical outcomes quantified the right ventricle short axis to left ventricle short axis ratio in the axial plane, vascular measurements, reflux of contrast medium into the inferior vena cava and azygos vein, ventricular septal bowing, and clot load using the Qanadli scoring system. The Simplified Pulmonary Embolism Severity Index (sPESI) and pulmonary parenchymal findings were also evaluated. All CT pulmonary angiographic parameters were compared with the risk of death within 1 month using logistic regression analysis. Results: Fifty-nine patients survived (88.1%), and 8 patients (11.9%) died because of PE. The sPESI and 2 parenchymal findings (multiple wedge-shaped opacities or consolidation accompanied by a wedge-shaped opacity) were significantly related tomortality. In the univariate analysis, neither the cardiovascular CT parameters nor the clot burden was significant between the survivors and nonsurvivors (P > 0.05). Conclusions: In clinically nonsevere PE patients, the sPESI and significant parenchymal findings were the CT parameters related to 1-month mortality.Yayın Obstructive sleep apnea syndrome and anthropometric obesity indexes(SPRINGER HEIDELBERG, 2012) Soylu, Akin Cem; Levent, Ender; Sariman, Nesrin; Yurtlu, Sirin; Alparslan, Sumeyye; Saygi, AttilaThe purpose of this study is to investigate whether the general body adiposity or regional adiposity was a risk factor in the evolution of obstructive sleep apnea syndrome (OSAS) by examining the relationships between the anthropometric obesity indexes such as waist (WC) and neck circumference index (NC), body mass index (BMI), and OSAS in Turkish adult population, and to access the possible differences by gender. The data related to polysomnographic, demographic, and anthropometric indexes of the 499 subjects were examined retrospectively. The patients whose apnea-hypopnea index was a parts per thousand yen5 were determined as OSAS group. The avarage BMI, WC, and NC of the OSAS group (n = 431) were statistically higher than the control group (p < 0.001). According to logistic regression analysis, BMI, WC, and NC enlargement were observed as significant risk factors for OSAS development. Risk coefficients were determined 5.53 for NC, 4.48 for WC, and 2.22 for BMI. Cutoff point values for anthropometric obesity indexes as OSAS determiner were recorded as below: BMI for male > 27.77 kg/m(2) and female > 28.93 kg/m(2), NC index for male > 40 cm and female > 36 cm, and WC index for male > 105 cm and female > 101 cm. BMI, WC, and NC enlargement were determined as significant risk factors for OSAS development. This was an initial study to determine the cutoff points of which increase the OSAS risk in BMI, WC, and NC index in Turkish adult population.Yayın OBSTRUCTIVE SLEEP APNEA SYNDROME IN GERIATRIC PATIENTS(Güneş Kitabevi Ltd Sti, 2012) Levent, Ender; Sariman, NesrinIntroduction: We aimed to evaluate the obstructive sleep apnea syndrome (OSAS) profile in geriatric OSAS patients and assess the differences between the older and younger OSAS population. Materials and Method: Seven hundred and six OSAS patients (>= 18 years), 107(15.2%) of whom were in the geriatric group were included in the study. Their demographic, anthropometric, polysomnographic characteristics and comorbidities were compared with the OSAS patients <65 years of age. Results: Sixty-two (57.9%) of the geriatric patients were male. Mean age was 72 +/- 6years (range:65-89) and apnea-hypopnea index (AHI) was 37.02 +/- 22.46/h. Geriatric patients had significantly higher AHI, lower sleep efficiency, shorter deep sleep and REM periods, longer REM latency, lower basal/minimum/average oxygen saturations and longer <90% oxygen desaturation/apnea/hypopnea durations when compared to the younger age group. In the geriatric group, comorbidities were more frequent than the younger group. When independent risk factors were investigated with regard to comorbidities in OSAS; age, male gender, severity of OSAS and oxygen desaturation duration were found to affect the presence of coronary artery disease. Conclusion: In geriatric OSAS patients, severe OSAS and comorbidities were more frequent than those <65 years of age. Especially in geriatric patients with coronary artery disease, presence of OSAS should be considered as a factor that affects morbidity and mortality.Yayın Pneumomediastinum and subcutaneous emphysema without pneumothorax in an asthmatic patient(Wolters Kluwer Medknow Publications, 2008) Levent, Ender; Sariman, NesrinPneumomediastinum with subcutaneous emphysema is caused by a sustained increase in the alveolar and intrabronchial pressure due to asthmatic bronchospasm, physical activity and excessive coughing or vomiting. Pneumomediastinum should be considered in the differantial diagnosis of chest pain in healthy adolescents and young adults. Chest Xray and computerized tomography (CT) were diagnostic in all cases. A 68-year-old asthmatic male was admitted to our department with sudden onset, severe chest and back pain and dyspnea that developed during excessive coughing. The chest X-ray was normal. CT of the thorax, when performed, revealed the diagnosis of pneumomediastinum and subcutaneous emphysema and a fracture on the 8th rib posteriorly. Interestingly there was neither pneumothorax nor haemothorax.Yayın Primary Pulmonary Mucinous (Colloid) Adenocarcinoma that Arose in the Cavernomyoplasty Area in a Patient with Tuberculosis: A Rare Case Report(DE GRUYTER OPEN LTD, 2017) Yener, Nese A.; Sariman, Nesrin; Atasoy, Mehmet M.; Midi, Ahmet; Orki, AlpayPrimary pulmonary mucinous (colloid) adenocarcinoma is a rare type of lung cancer. Its arising in the cavernomyoplasty area has not been reported before. We here describe a sixty-year-old man with a previous history of multidrug-resistant and surgically-treated tuberculosis who was diagnosed as primary mucinous adenocarcinoma in the cavernomyoplasty site. We discuss the relevant literature on this rare entity.Yayın Relationship of T-stage and nodal metastases according to the up-to-date clinical TNM staging in lung cancer(BAYCINAR MEDICAL PUBL-BAYCINAR TIBBI YAYINCILIK, 2012) Yilmaz, Huri Ozkan; Saygi, Attila; Sariman, Nesrin; Marasli, Dida; Duzgun, Yeliz; Koksal, Hulya; Orki, AlpayBackground: This study aims to evaluate the relationship between the clinical T (cT)-stage and metastases (M) in patients with non-small cell lung cancer (NSCLC), comparing the 6th revised edition (old) and 7th revised edition (new) of the TNM staging system and to assess the potential divergent effects of staging on the course of treatment. Methods: A retrospective analysis of 136 patients (123 males, 13 females; mean age 60.8 years; range 25 to 83 years) who were diagnosed with NSCLC between January 2007 and January 2009 were conducted. Several variables including age, gender, smoking status previous radiological and/or bronchoscopic findings, and diagnostic and screening techniques which were used to diagnose metastases were determined. Clinical staging (cTNM) was assessed using the 6th and 7th revised editions of the TNM staging system. Results: A total of 41 patients (30.1%) had squamous cell carcinoma, 29 (21.3%) had adenocarcinoma and 66 (48.5%) had histologically not otherwise specified NSCLC. Staging was changed for 23 of the patients, while lower stage of disease, compared to baseline, was found in 15 patients, based on the 7th edition of TNM the staging system. The most significant changes were observed in stages 3A and 3B, whereas no difference was seen in stage 1 disease. According to the 6th edition of TNM staging system in terms of M distribution, 72 (%52.9) had no metastases, whereas 64 (%47.1) had metastatic disease. According to the 7th edition in terms of M distribution, one more patient was diagnosed with non-metastatic disease, increasing the number of the patient in this group up to 73 (53.6%). Of 63 patients with metastases, 17 (%12.5) had intrapulmonary metastases (M1a), while 46 (%33.9) had distant metastases (M1b). No significant difference was seen between the groups in terms of N distribution. Different treatment modalities were followed in 11 of 136 patients (8.1%). Conclusion: Our study results showed comparable results in both groups, including 6th edition and 7th edition of the TNM staging system, suggesting a concordance rate of 96.9% (r=0.968; p<0.0001). A poor correlation between T-stage and M score was obtained when the 6th edition of TNM staging system is used (r=0.170; p=0.048), whereas a stronger correlation between T-stage and M score was observed, using the 7th revised edition of the TNM staging system (r=0.190; p=0.027).
