Stabil KOAH'lı hastalarda sistemik inflamasyon ve metabolik sendrom Giriş: Kronik obstrüktif akciğer hastalığı (KOAH) sistemik inflamasyonla ilişkili gibi görünen ekstrapulmoner etkilere sahiptir. Genel popülasyonda sistemik inflamasyonun önemli belirleyicilerinden biri olan metabolik sendromla KOAH arasındaki ilişki henüz netleşmemiştir. Bu çalışmanın amacı; farklı evrelerdeki stabil KOAH'lı hastalarda ve yaş, cinsiyet açısından eşleştirilmiş kontrol grubunda metabolik sendrom frekansını ve sistemik inflamasyon belirteci olan C-reaktif protein (CRP) düzeylerini değerlendirmektir. Hastalar ve Metod: Çalışmaya 91 stabil KOAH'lı hasta ve 42 kontrol birey alındı. KOAH ağırlığı GOLD (Global Initiative for Chronic Obstructive Lung Disease) kriterlerine göre belirlendi. Metabolik sendrom tanısında ATP III (The National Cholesterol Education Program's Adult Treatment Panel III) kriterleri kullanıldı. Hasta ve kontrol grubunda alınan venöz kan örneğinde CRP düzeyleri ölçüldü. Bulgular: Metabolik sendrom frekansı hasta grubunda, özellikle GOLD I, II'de, kontrol grubundan daha yüksek bulundu (p= 0.004). Metabolik sendromun abdominal obezite, hipertansiyon ve hiperglisemi komponentlerinin frekansı hasta grubunda daha yüksek bulundu (p< 0.0001). Artmış CRP düzeyleri kontrol grubunda ve hasta grubun tüm evrelerinde, metabolik sendrom olanlarda, olmayanlara göre daha yüksek orandaydı (p= 0.047, p= 0.217, p< 0.001, p= 0.05, p= 0.467). Sonuç: Bu çalışma metabolik sendrom frekansının stabil KOAH'lı hastalarda, kontrol grubundan ve Türk popülasyonundan daha yüksek olduğunu göstermiştir. Abdominal obezite, hipertansiyon ve hiperglisemi hasta grubunda anlamlı derecede daha sıktı. Sistemik inflamasyon metabolik sendromu olan KOAH'lı hastalarda olmayanlara göre daha yoğundu.

OBJECTIVE:Because pulmonary embolism (PE) and COPD exacerbation have similar presentations and symptoms, PE can be overlooked in COPD patients. Our objective was to determine the prevalence of PE during COPD exacerbation and to describe the clinical aspects in COPD patients diagnosed with PE.METHODS:This was a prospective study conducted at a university hospital in the city of Ankara, Turkey. We included all COPD patients who were hospitalized due to acute exacerbation of COPD between May of 2011 and May of 2013. All patients underwent clinical risk assessment, arterial blood gas analysis, chest CT angiography, and Doppler ultrasonography of the lower extremities. In addition, we measured D-dimer levels and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) levels.RESULTS:We included 172 patients with COPD. The prevalence of PE was 29.1%. The patients with pleuritic chest pain, lower limb asymmetry, and high NT-pro-BNP levels were more likely to develop PE, as were those who were obese or immobile. Obesity and lower limb asymmetry were independent predictors of PE during COPD exacerbation (OR = 4.97; 95% CI, 1.775-13.931 and OR = 2.329; 95% CI, 1.127-7.105, respectively).CONCLUSIONS:The prevalence of PE in patients with COPD exacerbation was higher than expected. The association between PE and COPD exacerbation should be considered, especially in patients who are immobile or obese.

OBJECTIVE: Pulmonary embolism (PE) is an important complication of major orthopedic surgery. The aim of this study was to evaluate the incidence of venous thromboembolism (VTE) and factors influencing the development of VTE in patients undergoing major orthopedic surgery in a university hospital. METHODS: Patients who underwent major orthopedic surgery (hip arthroplasty, knee arthroplasty, or femur fracture repair) between February of 2006 and June of 2012 were retrospectively included in the study. The incidences of PE and deep vein thrombosis (DVT) were evaluated, as were the factors influencing their development, such as type of operation, age, and comorbidities. RESULTS: We reviewed the medical records of 1,306 patients. The proportions of knee arthroplasty, hip arthroplasty, and femur fracture repair were 63.4%, 29.9%, and 6.7%, respectively. The cumulative incidence of PE and DVT in patients undergoing major orthopedic surgery was 1.99% and 2.22%, respectively. Most of the patients presented with PE and DVT (61.5% and 72.4%, respectively) within the first 72 h after surgery. Patients undergoing femur fracture repair, those aged ≥ 65 years, and bedridden patients were at a higher risk for developing VTE. CONCLUSIONS: Our results show that VTE was a significant complication of major orthopedic surgery, despite the use of thromboprophylaxis. Clinicians should be aware of VTE, especially during the perioperative period and in bedridden, elderly patients (≥ 65 years of age).

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Background/aim: Sonographic assessment of diaphragm structure and function would be a useful clinical tool in patients with chronic obstructive pulmonary disease (COPD). Our aim was to determine the muscle thickness of the diaphragm and the usefulness of clinical practice in patients with COPD. Materials and methods:The diaphragmatic thickness of 34 COPD patients and 34 healthy subjects was measured during tidal volume (Tmin) and deep inspiration (Tmax) on both sides using a B-mode ultrasound. The body mass index and the modified Medical Research Council (mMRC) index values were reported.Results: There was no correlation among TminR (P = 0.134), TminL (P = 0.647), TmaxR (P = 0.721), and TmaxL (P = 0.905) between the patients with COPD and the control group. There was also no significant difference between diaphragmatic thickness and COPD severity, respiratory function (P = 0.410), and frequency of exacerbations (P = 0.881) and mMRC (P = 0.667). Conclusion:Diaphragmatic dysfunction in COPD is related to mobility restriction rather than muscle thickness.