Drugs which antagonize tumor necrosis factor alpha (TNF-alpha) are known to increase the risk of tuberculosis. We aimed to evaluate the risk of tuberculosis in patients treated with anti-TNF-alpha, in Turkey. Two hundred and forty patients receiving anti-TNF-alpha, from December 2005 to December 2007, were included in the study. All participants provided a history and underwent a physical examination, a chest X-ray, and a tuberculin skin test. Isoniazid treatment was initiated in those patients with a latent infection, and they were followed up at 2-month intervals. A Bacillus Calmette-Guerin (BCG) scar was present in 184 patients (77.6%). The mean tuberculin skin test induration of patients on admission was 10.7+/-7.0 mm. Male gender and the presence of a BCG scar were predictors of a higher tuberculin skin test result (P<0.05), while there was no significant effect of age on the tuberculin skin test (P>0.05). Of the 240 subjects, 229 (95.4%) received methotrexate or corticosteroid treatment prior to anti-TNF-alpha therapy. Isoniazid treatment preceded anti-TNF-alpha administration in 185 (77.1%) of the 240 patients. Two patients developed tuberculosis (incidence 833/100,000). There was no correlation between initial and 12-month tuberculin skin test results (P>0.05). Tuberculin skin test conversion was detected in five subjects during the 12-month follow-up; however, none developed active tuberculosis. One patient developed a drug reaction secondary to etanercept, and another demonstrated hepatotoxicity due to isoniazid. This study shows that anti-TNF-alpha therapy increases the risk of tuberculosis, despite treatment of latent infection.

Management of cryptogenic massive hemoptysis is difficult, and conservative treatment may be inadequate to stop the hemorrhage. Surgery is not a reasonable option because there is no underlying identifiable pathology. This study aimed to investigate the radiologic findings and bronchial artery embolization outcomes in cryptogenic hemoptysis, and to compare the results with non-cryptogenic hemoptysis. We evaluated 26 patients with cryptogenic hemoptysis and 152 patients with non-cryptogenic hemoptysis. A comparison of the bronchial artery abnormalities between the cryptogenic and non-cryptogenic hemoptysis groups showed that only extravasation was more statistically significant in the cryptogenic hemoptysis group than in the non-cryptogenic hemoptysis group, while the other bronchial artery abnormalities, such as bronchial artery dilatation, hypervascularity, and bronchial-to-pulmonary shunting, showed no significant difference between groups. Involvement of the non-bronchial systemic artery was significantly greater in the non-cryptogenic hemoptysis group than in the cryptogenic hemoptysis group. While 69.2% of patients with cryptogenic hemoptysis also had hypervascularity in the contralateral bronchial arteries and/or ipsilateral bronchial artery branches other than the bleeding lobar branches, this finding was not detected in non-cryptogenic hemoptysis. Embolization was performed on all patients using polyvinyl alcohol particles of 355-500 µm. Hemoptysis ceased in all patients immediately after embolization. While recurrence of hemoptysis showed no statistically significant difference between the cryptogenic and non-cryptogenic hemoptysis groups, it was mild in cryptogenic hemoptysis in contrast to mostly severe in non-cryptogenic hemoptysis. Transarterial embolization is a safe and effective technique to manage cryptogenic hemoptysis.

Nocardiosis is a rare disease, and worldwide, respiratory and disseminated infections are most often due to Nocardia asteroides which is recognised increasingly as an opportunistic infection in patients with underlying chronic debilitating disease or immunodeficiency. However, infection with N. otitidiscaviarum and pulmonary nocardiosis in an immune-competent host remains very rare. We report a 65-year-old immune-competent male with pulmonary N. otitidiscaviarum infection in whom complete cure was provided with a 6 months of antibiotic combination including trimethoprim-sulfomethaxazol. This is the first report of pulmonary N. otitidiscaviarum infection in an immune-competent patient from Turkey.

Tuberculosis verrucosa cutis (TBVC) is a rare form of skin tuberculosis in Western communities, and is generally seen in certain risk groups. A 52-year-old housewife with recalcitrant generalized cutaneous and mucosal lichen planus (LP) of more than a 20-year duration presented with an erythematous-edematous plaque with a warty surface containing deep hemorrhagic fissures and numerous orifices draining purulent material on the back of her left hand. On the basis of clinical, histological and bacteriological findings, TBVC was diagnosed. The patient was successfully treated with isoniazid, rifampicin, ethambutol and pyrazinamide. Interestingly, all lichen lesions improved completely with this therapy. To the best of our knowledge, this is the first documented case of TBVC associated with LP, which was cured by antitubercular polychemotherapy. The case is presented because it reflects a possible reciprocal causal relationship between two cutaneous conditions of different natures.

BACKGROUND AND OBJECTIVESObstructive sleep apnea (OSA) is common in adult population and may cause many adverse clinical results. We aimed to investigate possible changes in cardiopulmonary exercise capacity in OSA patients after positive airway pressure treatment.DESIGN AND SETTINGSPatients who were admitted to Gaziantep University Pulmonary Diseases Sleep Center and diagnosed OSA were included. Studies carried out between May 2010 and July 2011. Sixty-five consecutive patients were included in this prospective study.PATIENTS AND METHODSSixty-five adult sleep clinic patients diagnosed with OSA by polysomnography and in whom continuous positive airway pressure (CPAP) ventilation therapy was indicated were included. Cardiopulmonary exercise capacity was assessed by bicycle ergometry during diagnostic workup and at least 4 weeks later.RESULTSThere were 57 (87.7%) males. The mean age was 45.29 (10.57) years, apnea-hypopnea index 38.02 (23.19 events/h, body mass index 31.72 (4.87) kg/m2. Patients were grouped with respect to compliance with CPAP. The peak oxygen consumption (VO2) did not change in the CPAP compliant group (n=33) (22.52 [6.62] mL/[min.kg] to 21.32 [5.26] mL/[min.kg]; P=.111), and decreased from 21.31 (5.66) mL/(min.kg) to 19.92 (5.40) mL/(min.kg) (P=.05) in the CPAP noncompliant group. Work rate increased from 84.0% to 85.0% in the CPAP compliant group and decreased from 79.6% to 77.1% in the noncompliant group (P=.041). In the group that used the device, ventilation (VE)/VCO2 at anaerobic threshold (AT) declined from 28.42 to 27.36; however, it increased from 27.41 to 27.81 in the group that did not use the device (P=.033).CONCLUSIONSDecline in the exercise capacity was prevented in patients with OSA after 4 weeks of CPAP therapy. The changes in VE/VCO2 at AT suggest the reversal of pathophysiologic changes in OSA with the CPAP therapy that may improve cardiac function and cause more efficient ventilation.

A young male with complaints of cough, dyspnea and hemoptysis was admitted. He was using fluticasone propionate and salmeterol for two years for his asthma. Leukotriene receptor antagonist was prescribed two weeks prior to his admission and no reduction of his inhaled steroid therapy was performed. Eosinophil count was detected as 1460/mm 3 (15%) and immunoglobulin E level was 547 IU/mL. Thorax computerized tomography revealed patchy infiltration. Increased eosinophilic inflammation were detected in bronchoalveolar lavage fluid and transbronchial biopsy. He received prednisolone treatment for Churg-Strauss syndrome. Improvement was observed on three months follow up period. He has no complaint in his follow up.

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ÖZET Akciğer kanserinin evrelemesinde PET/BT ile kombine edilen transbronşiyal iğne aspirasyon biyopsisinin yeri Bu çalışmada pozitron emisyon tomografi/bilgisayarlı tomografi (PET/BT) incelemesi rehber alınarak uygulanan transbronşi p= 0.046].