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Yayın Bronchoscopic narrow band imaging technique in diagnosis of lung malignancy(BAYCINAR MEDICAL PUBL-BAYCINAR TIBBI YAYINCILIK, 2012) Yayli, Nursel; Dabak, Gul; Levent, Ender; Saygi, Attila; Aksoy, FerdaBackground: In this study, we aimed to investigate the diagnostic value of bronchoscopic narrow-band imaging (NBI) in cancerous, precancerous and recurrent malignant lesions and whether NBI was superior to white light bronchoscopy (WLB). We also evaluated whether the combination of NBI and WLB might contribute to the success of a biopsy. Methods: Between May 2006 and December 2008, 30 patients (27 males, 3 females; mean age 62 +/- 8 years; range 44 to 82 years) with indication for bronchoscopy, 18 years of age and over were evaluated in this prospective and partially blinded study. The NBI with the bronchoscopy was performed, followed by WLB. A total of 81 biopsy samples were taken from the tissue with normal and abnormal appearance. Results: The sensitivity of NBI technique was 50.0%, the specificity was 54.9%, the positive predictive value was 39.47% and negative predictive value was 65.12%. The sensitivity of WLB technique was 56.66%, the specificity was 64.71%, the positive predictive value was 48.57% and negative predictive value was 71.74%. The malignancy detection rate of NBI technique was 6.25% in areas with normal findings on WLB. Conclusion: Our results showed that the use of the NBI technique was not superior to WLB in terms of contribution for the diagnosis in patients with a preliminary diagnosis of lung malignancy.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 Comparison of the sixth and seventh editions of the TNM staging systems with regard to non-small cell lung carcinoma(BAYCINAR MEDICAL PUBL-BAYCINAR TIBBI YAYINCILIK, 2012) Duzgun, Yeliz; Saygi, Attila; Levent, Ender; Yilmaz, Huri Ozkan; Koksal, Hulya; Soylu, Akin Cem; Kutlu, Cemal AsimBackground: In this study, we aimed to compare the clinical tumor node metastasis (TNM) and pathological TNM staging of non-small cell lung cancer (NSCLC) using the sixth and seventh editions of the TNM staging and to establish whether there was any concordance between these editions. Methods: The records of 60 patients (57 males, 3 females; mean age 57 10 years; range 34 to 81 years) who were operated between January 2007 and October 2009 diagnosed with NSCLC in our clinic were retrospectively analyzed. Both clinical (pre-thoracotomy) and pathological (post-thoracotomy) staging were performed separately according to the sixth and seventh editions of the TNM systems. Results: With the sixth edition, the concordance rate for the clinical and pathological T stage was 73.3% while the concordance rate for the clinical TNM and pathological TNM stage was 48.3%. Twenty percent of the patients were clinically underestimated, and 31.7% were overestimated. The seventh edition of the TNM staging yielded concordance rates of 61.7% for the clinical and pathological T stage and 41.7% for the clinical TNM and pathological TNM stage was 41.7%. With this edition, 28.3% of the patients were clinically underestimated, and 30% were overestimated. Clinical and pathological TNM staging according to seventh edition were similar to the previous stages in 81.7% and 70% of the patients, respectively while understaging was seen in 6.7% and 5.0%, respectively. Overstaging occurred in 11.7% and 25.0% of the patients, respectively. Conclusion: In our study, the concordance rate for the clinical TNM and pathological TNM stage was lower for the seventh edition of the staging systems than for the sixth editon. This result suggests the importance of invasive staging and systematic lymph node dissection. Based on our samples with early stage, we believe that there should be no change in the treatment for patients with upstaging according to the seventh edition of the staging system.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 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 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 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).
