BACKGROUND:Invasive procedures such as bronchoscopic biopsy, bronchial washing, and bronchial brushing are widely used in diagnosis of lung cancers. The mean diagnostic rate with bronchoscopic forceps biopsy is 74% in central tumors. This study was designed to evaluate the efficacy of cryobiopsies in histopathological diagnosis.METHODS:Forty-one patients who had interventional bronchoscopy were included in this study. Three forceps biopsies and one cryobiopsy with cryorecanalization probe were obtained from each subject. Biopsies interpretations were done by one expert pathologist.RESULTS:Hemorrhage was the only complication in both procedures. There was no significant difference between these two procedures in the incidence of hemorrhage (P > 0.05). Mean diameters of samples taken with forceps biopsy and cryoprobe biopsy were 0.2 and 0.8 cm, respectively (P < 0.001). Thirty-two patients (78%) were diagnosed with forceps biopsies, and 38 patients (92.7%) were diagnosed with cryoprobe biopsies (P = 0.031).CONCLUSIONS:We concluded that cryoprobe biopsies were more successful than forceps biopsies in diagnosis. Nevertheless, further investigations are warranted to determine an efficacy of cryoprobe biopsy procedures and a rationale to use as a part of routine flexible bronchoscopy.
Serum neopterin levels can be used as a helper laboratory finding for the diagnosis of patients with tuberculosis. For this aim, further controlled studies are needed.
A 15-year-old male had a history of increasing dyspnea on exertion, cough, sputum production, fever, weakness, hemoptysis, and diarrhea. Chest radiography demonstrated bilateral alveolar consolidation. Bronchoalveolar lavage fluid analysis revealed extensive hemosiderin-laden alveolar macrophages. On the basis of iron deficiency anemia, diarrhea, raised antigliadin and antiendomysial antibodies, widespread villous atrophy, and crypt hyperplasia on intestinal biopsy, celiac disease was diagnosed. After treatment with a gluten-free diet, all his clinical symptoms and radiographic findings improved within two weeks.
A 43-year-old man presented with a 12-month history of recurrent haemoptysis. Postero-anterior chest X-ray of a patient with a history of a penetrating thoracic trauma 8 years previously showed a long wedge-shaped opacity just above the left hemidiaphragm, representing the 'tip of the knife' appearance, and penetrating from the lateral chest wall deep to the thoracic aorta. After consultation with the cardiovascular surgeons, it was decided that the patient should have an operation to remove the foreign body penetrating the aorta. During the operation, a piece of glass was located in the posterior segment of the left lower lobe, and it had also penetrated the aorta through to the posterior wall. The glass had a pointed end, was wedge-shaped and measured 8 cm x 3 cm x 0.5 cm. It was removed, and a 5-cm segment of aorta was replaced with dacron graft. Patients with penetrating chest trauma require routine chest X-rays as many will have a haemothorax, pneumothorax or a penetrating foreign body in the chest in the absence of clinical findings. Postero-anterior chest X-rays as well as lateral X-rays must be carefully and systematically examined for foreign bodies.
Lymphangioleiomyomatosis is an uncommon lung disease primarily affecting women of childbearing age. It is characterized by the progressive proliferation and infiltration of smooth muscle-like cells, which lead to cystic destruction of the lung parenchyma; obstruction of airways, blood vessels, and lymphatics; and loss of pulmonary function. We present the case of a 46-year-old female patient with chest pain, cough, sputum, and dyspnea on exertion for three weeks. Minimal pneumothorax was noted, and the patient was referred to our center for further investigation and treatment. High-resolution computed tomography revealed numerous bilateral thin-walled air cysts and interstitial thickening affecting the central and peripheral part of the upper zone of the lung. We performed an open-lung biopsy to confirm lymphangioleiomyomatosis. Our aim is to discuss the pathogenesis and other lesions noted in the differential diagnosis of this rare disease.
Distinguishing critical laboratory biomarkers for disease severity at the time of hospital presentation is important for early identification of patients who are most likely to have poor outcomes and effective use of health resources. This study aimed to evaluate whether electrolyte imbalances on hospital admission predict severe disease and mortality in patients with coronavirus disease 2019 (COVID-19). We retrospectively collected data on the blood electrolyte concentrations of 286 COVID-19 patients at admission. The correlations between electrolyte imbalances, inflammation, and thrombosis markers in COVID-19 patients were also evaluated. We assessed the predictive performance of baseline blood electrolyte concentrations for severe disease and death using receiver operating characteristic curve analysis and multivariate logistic regression methods. Abnormalities in serum sodium, calcium, and potassium levels at admission were found at 20.6%, 14%, and 4.2%, respectively in this study. In the receiver operating characteristic curve analyses, hypocalcemia and hyponatremia effectively predicted disease progression to hospitalization (area under the curve 0.82, P < .001 and 0.81, P < .001, respectively) and 30-day mortality (area under the curve 0.85, P < .001 and 0.91, P < .001, respectively). In the multivariate logistic regression analysis, baseline hypocalcemia was identified as an independent risk factor associated with the risk of hospitalization ( β = 2.019, P = .01; odds ratio: 7.53). Baseline hypocalcemia and hyponatremia effectively predicted disease progression toward hospitalization and 30-day mortality in patients with COVID-19. Clinicians should closely follow up or reevaluate COVID-19 patients with baseline electrolyte disorders.
998leural involvement in multiple myeloma is distinctly rare and accepted as an indicator of an unfavorable prognosis. [1][2][3] A high adenosine deaminase (ADA) level in the pleural fluid is especially frequent in pleural involvement due to tuberculosis and malignant and lymphoproliferative disease. 4 We present a case with myelomatous pleural effusion in which a significantly increased pleural fluid ADA level was detected. To our knowledge, this is the fourth case showing a high ADA activity in pleural effusion due to multiple myeloma. Myelomatous Pleural Effusion:A Rare Involvement in Multiple Myeloma:Case Report A AB BS S T TR RA AC CT T Mul tip le mye lo ma is a ne op las tic di sor der ca u sed by the pro li fe ra ti on of a sing le plasma cell clo ne and is as so ci a ted with the pro duc ti on of mo noc lo nal im mu nog lo bu lin. Mul tip le myelo ma ra rely in vol ves the ple u ra, and this in vol ve ment in di ca tes an un fa vo rab le prog no sis. We re port a 53-ye ar-old man with mul tip le mye lo ma and a mye lo ma to us right-si ded ple u ral ef fu si on with ele va ted ade no si ne de a mi na se (ADA) ac ti vity. The di ag no sis was ma de by exa mi na ti on of the ple ural flu id cyto logy and ple u ral bi opsy spe ci men. Syste mic che mot he rapy was ad mi nis te red to the pa ti ent, and ple u re de sis was per for med. Ho we ver, the pa ti ent di ed 3.5 months af ter the di ag no sis. In cre a sed ADA ac ti vity may be ob ser ved in mye lo ma to us ple u ral ef fu si on, and it may mi mic tu bercu lo us ple u ri tis.K Ke ey y W Wo or rd ds s: : Ple u ral ef fu si on; ade no si ne de a mi na se; mul tip le mye lo ma Ö ÖZ ZE ET T Mul tipl mi ye lo ma tek bir plaz ma hüc re klo nu nun pro li fe ras yo nu nun se bep ol du ğu, ne op lastik bir bo zuk luk tur ve mo nok lo nal im mü nog lo bu lin üre ti mi ile iliş ki li dir. Mul tipl mi ye lo ma na diren plev ra yı tu tar ve bu tu tu lum olum suz bir prog no za işa ret eder. Biz mul tipl mi ye lo ma sı ve art mış ade no zin de a mi naz (ADA) ak ti vi te si ile sağ ta raf lı mi ye lo ma töz plev ral efüz yo nu olan 53 ya şın da bir er kek has ta bil di ri yo ruz. Ta nı plev ral sı vı si to lo ji si ve plev ral bi yop si ör ne ği in ce le ne rek ko nuldu. Has ta ya sis te mik ke mo te ra pi ve ril di ve plö re dez ya pıl dı, an cak has ta ta nı dan 3.5 ay son ra öl dü. Mi ye lo ma töz plev ral efüz yon da ADA ak ti vi te sin de ar tış göz le ne bi lir ve bu du rum tü ber kü loz plö -ri ti tak lit ede bi lir.A An na ah h t ta ar r K Ke e l li i m me e l le er r: : Plev ral ef füz yon; ade no zin de a mi naz; mul tipl mi ye lom T Tu ur rk ki iy ye e K Kl li in ni ik kl le er ri i J J M Me ed d S Sc ci i 2 20 01 11 1; ;3 31 1( (4 4) ): :9 99 98 8--1 10 00 01 1
Progranulin has been considered to be a poor prognostic biomarker for some types of malignancies. However, the clinical significance of serum progranulin level and the prognostic value are still not explored in advanced stages of lung cancer. The current study investigates the prognostic significance of progranulin serum levels in advanced-stage non-small cell lung cancer (NSCLC) patients. This study involved 94 subjects (70 advanced-stage NSCLC patients and 24 healthy controls). Serum progranulin level was measured by enzyme-linked immunosorbent assay (ELISA) and was correlated with patient outcome. The association between circulating progranulin level and clinicopathological parameters was detected. Serum progranulin cut-off level predicting six-month survival was determined. Serum progranulin level was found significantly elevated in NSCLC patients than in the control group (p<0.001). We did not determine a significant difference between stage IIIB and stage IV NSCLC patients for serum progranulin levels (p=0.166). When we evaluated the laboratory parameters, only serum LDH level was found significantly correlated with serum progranulin level (p=0.043), also bone and liver metastasis showed a significant correlation with progranulin level (p=0.008 and p = 0.024, respectively). The cut-off level of serum progranulin in predicting six months of survival was determined as 16.03 ng/ml (AUC = 0.973, 95%Cl: 0.903-0.997, p<0.001) with 97.06% sensitivity and 88.89% specificity. Overall survival was determined shorter in patients with progranulin level ≥16 ng/ml than those with <16 ng/ml (p<0.001). Also, in the multivariate analysis using the Cox regression model serum progranulin level was found as an independent prognostic factor for NSCLC (p=0.001). Serum progranulin level may be a useful biomarker for predicting poor survival in advanced-stage NSCLC patients.
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