Aims: There are no current data about the adverse effects of anxiety on patient intolerance during bronchoscopy.The aim of our study was to assess the correlation between anxiety and patient intolerance during bronchoscopy. Study Design:... more
Aims: There are no current data about the adverse effects of anxiety on patient intolerance during bronchoscopy.The aim of our study was to assess the correlation between anxiety and patient intolerance during bronchoscopy. Study Design: Retrospective research study Place and Duration of Study: Department of Pulmonary Diseases, Cerrahpasa Medical Faculty, between January 2010 and 2013 March. Methodology: Data from 94 patients were analyzed. The mean age of the patients was 59 years. Bronchoscopy was performed for lung cancer in 54, pulmonary nodules in 26 and pulmonary infiltration in 14 patients. Hospital Anxiety Depression scale was used to appraise the anxiety symptoms. Cytologic examination of bronchoalveolar lavage, and sputum samples were performed in each patient when available. Original Research Article British Journal of Medicine & Medical Research, 4(11): 2171-2180, 2014 2172 Results: The anxiety or fear profile of the patients before bronchoscopy were as follows: dyspnea (78%), malignant disease (74%), nasal, laryngeal or tracheal irritation (70%), bronchoscopic findings (68%), and hemorrhage (42%). Bronchoscopic examination was intolerable in 14 cases while there was great difficulty to perform the procedure in 18 patients. Cytologic analysis revealed severe in 18, moderate in 22, and mild dysplasia in 25 patients while it was normal in 29 subjects. Hospital Anxiety Depression scale was over eight in 33 patients. The scale was over eight in 13 out of 14 patients who were intolerant to bronchoscopy. Cytology revealed severe in one and moderate dysplasia in another patient intolerant to bronchoscopy. Conclusions: Anxiety appears to be the predominant factor for patient intolerance during bronchoscopy. Pulmonary function, atypical or dysplastic cytomorphological changes in sputum or bronchoalveolar lavage cytology did not show correlation with patient performance.
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Endobronchial involvement is a common feature of sarcoidosis. The mucosa may appear normal or there may be inflammatory changes with erythematous lesions, miliary nodules, and, rarely, mass-like lesions leading to obstruction. In patients... more
Endobronchial involvement is a common feature of sarcoidosis. The mucosa may appear normal or there may be inflammatory changes with erythematous lesions, miliary nodules, and, rarely, mass-like lesions leading to obstruction. In patients with bronchial lesions, the bronchial biopsy may be positive in three-quarters of patients. On the other hand, granulomas may be identified in one-third of patients with a normal mucosa. Current data on endobronchial sarcoidosis is primarily associated with the treatment and prognosis of obstructive mass-like granulomas. Data relevant to clinical features of superficial endobronchial involvement and its implications on prognosis and extrapulmonary organ involvement is lacking. The results of our two previous studies reveal that clinical findings of endobronchial disease may be different. These studies also suggest that there is a great difference between patients with no endobronchial involvement, limited and diffuse endobronchial disease in regard...
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A 54-year-old male presented with symptoms of fever, rigors, myalgia, dry cough, and dyspnea. Ten days earlier, he described a condition resembling an upper respiratory infection. The measured body temperature was 38.20°C. Scleral... more
A 54-year-old male presented with symptoms of fever, rigors, myalgia, dry cough, and dyspnea. Ten days earlier, he described a condition resembling an upper respiratory infection. The measured body temperature was 38.20°C. Scleral icterus, jaundice, conjunctival hyperemia, extensive ecchymoses at multiple sites on the body, an antecubital hematoma, bilateral basal rales, hepatomegaly, and splenomegaly were observed during the physical examination. The White Blood Cell Count (WBC) was determined to be 1,100/mm3, the Hemoglobin (Hgb) level was 11.8 g/dL, and the platelet count was 10,000/mm3.
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Research Interests: Medicine and Mesothelioma
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Research Interests: Medicine and Sarcoidosis
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Bu calisma ile juvenil romatoid artritli JRA cocuklarda hastaligin ve tedavide kullanilan onemli bir ilac olan metotreksatin MTKS solunum fonksiyonlari uzerine olan etkisi arastirildi Calismaya 34 JRA’li ve kontrol grubu olarak 21... more
Bu calisma ile juvenil romatoid artritli JRA cocuklarda hastaligin ve tedavide kullanilan onemli bir ilac olan metotreksatin MTKS solunum fonksiyonlari uzerine olan etkisi arastirildi Calismaya 34 JRA’li ve kontrol grubu olarak 21 saglikli cocuk alindi Juvenil romatoid artritli hastalarin 22’si MTKS kullanmakta idi Calismaya alinan tum cocuklara solunum fonksiyon testleri uygulandi Calisma sonuclarimiza gore MTKS alan ve almayan hasta gruplari arasinda solunum fonksiyonlari acisindan anlamli bir fark gozlenmedi Hastalik aktivitesi goz onunde bulunduruldugunda efor gerektiren PEF p=0 009 PEmax p=0 0023 gibi kas gucu parametrelerinin gostergeleri olarak sayilabilecek testlerde anlamli sonuclar elde edilldi Hastalar JRA alt gruplarina gore degerlendirildiginde sistemik baslangicli JRA grubunda difuzyon kapasitelerinde belirgin dusuk degerler saptandi p=0 037 Hasta grup ve kontrol grubu degerlendirildiginde gogus antropometrik olcumleri disinda anlamli sonuclar gozlenmedi aksiller p=0 0...
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The aim of this study is to assess the value of cytology in the diagnosis of pleural effusions. It is a retrospective review of the patients with pleural effusions admitted at our clinic in a 8-year period. We evaluated the cytological... more
The aim of this study is to assess the value of cytology in the diagnosis of pleural effusions. It is a retrospective review of the patients with pleural effusions admitted at our clinic in a 8-year period. We evaluated the cytological and diagnostic results of 470 patients. Male to female ratio was 3:1 with a mean age of 38.6 years (range 18-76 years). Samples were processed and evaluated according to the standard methods. Cytology results were reviewed and the patients were stratified according to the their final diagnosis of the 470 effusions, 40 were transudates. Among 430 exudates, 190 (74.8%) were malignant on pleural fluid analysis alone. Adenocarcinoma was the most common malignancy. Tuberculosis was the second most frequent etiology for the exudative effusions. Cells in benign or malignant effusions were easily recognized without further invasive evaluation, contributing to diagnosis and therapeutic decisions. Diagnostic power of cytology was high and showed a good correlation with the eventual Original Research Article British Journal of Medicine & Medical Research, 4(11): 2203-2211, 2014 2204 pathologic diagnosis, with an overall 70.6% sensitivity. Cytologic examination of the pleural fluid is a simple minimally invasive procedure as an initial step in the diagnostic work-up of patients with pleural effusions. It does not only provide high diagnostic sensitivity but also leads the clinician in the correct algorithm as the most informative and leading test even when not diagnostic on its own.
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Parapnomonik efuzyonlar (PPE) bakterial pnomonilerin en sik komplikasyonlarindan biridir. Ayrica bilinen en eski hastaliklardandir. Boyle olmasina karsilik gerekli girisimlerin gecikmesi yuksek mortalite ile sonuclanabilmektedir. Klinik... more
Parapnomonik efuzyonlar (PPE) bakterial pnomonilerin en sik komplikasyonlarindan biridir. Ayrica bilinen en eski hastaliklardandir. Boyle olmasina karsilik gerekli girisimlerin gecikmesi yuksek mortalite ile sonuclanabilmektedir. Klinik tablo, kucuk plevral efuz- yondan ciddi multilokuler efuzyonlara kadar degisebilmektedir. Her hastanin ciddiyetinin bireysel olarak degerlendirilmesi gerekir. Parapnomonik efuzyon oncelikle direkt grafi ve eger gerekirse lateral dekubitus, ultrason veya tomografiyle degerlendirilmelidir. Ikinci asamada yapilan torasentez klinisyenin en onemli rehberi niteligindedir. Torasentezle elde edilen plevra sivisinin biokimyasal ozelliklerine gore tedavi sekli belirlenir. Komplike ve komplike olmayan sivilarin ayriminda plevral efuzyonun pH, LDH, glikoz degerleri ile Gram boya ve kulturu buyuk onem tasir. Kucuk plevral efuzyonlar genellikle antibiyotik tedavisi ile duzelirken komplike veya lokule efuzyonlarin tedavisi icin mutlaka drenaj, fibrinolitikler ya da cerrahi girisim gerekir. PPE'larda basari icin erken tani ve uygun tedavinin baslanmasi esastir. PPE'larda bir evreden digerine gecis cok hizli olabildigi icin bir terapotik yaklasimdan sonuc alinabilmesi icin beklenecek maksimum sure 3 ile 4 gundur. Terapotik yontemlerden biri basarsiz kaldiginda daha invazif bir diger girisime gecis icin daha fazla beklenmemelidir. Bu nedenle hastanin seri torasentezlerle izlenmesinden kacinilmamalidir. Tedavi basarisizligi ve ciddi komplikasyonlarin gelismesinde en onemli neden farkli terapotik girisimler arasindaki surenin gereksiz yere uzun tutulmasidir. Parapnomonik efuzyonlu hastalarin takibinde gogus hastaliklari klinisyenleri tedaviyi yonlendirici bir pivot rolu oynarken, radyolog, mikrobiyoloji uzmanlari ve gogus cerrahlarinin katkilarindan yararlanilmalidir. Anahtar Kelimeler: Parapnomi; efuzyon; ampiyem; plevral; plorezi Cerrahpasa Tip Derg 2006; 37: 29 - 36 Parapneumonic Effusions and Empyema Abstract Parapneumonic pleural effusions present a difficult diagnostic and therapeutic challenge for the clinician. The spectrum ranges from a small pleural effusion that responds to antibiotic therapy to empyema with systemic infection. Today the physicians must be aware of the development of an parapneumonic effusion because the treatment failure mostly depends on the delay in diagnosis and instituting proper therapy. While simple parapneumonic effusions are easily managed with antibiotic treatment alone compli- cated effusions may require surgical interventions like tube thoracostomy, thoracoscopy or open drainage. This chapter reviews the current approach to parapneumonic pleural effusions.The clinical course, classification system for parapeumonic effusions, diagnostic and guidelines for the treatment of various stages of the pleural infection are described. Key Words: Pneumonia-bacterial; effusion; empyema; pleural; pleurisy Cerrahpasa J Med 2006; 37: 29 - 36
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... Cilt (Sayı) 35 (4) 202 NADİR BİR PLEVRAL EFÜZYON NEDENİ: OVER HİPERSTİMULASYON SENDROMU* Cüneyt TETİKKURT, İsmail ÇEPNİ, Pelin OCAL, Orçun KOÇAK, Merve BARBAROS ... Elektrolitler, kreatinin, BUN ve kara-ciğer enzimleri normal... more
... Cilt (Sayı) 35 (4) 202 NADİR BİR PLEVRAL EFÜZYON NEDENİ: OVER HİPERSTİMULASYON SENDROMU* Cüneyt TETİKKURT, İsmail ÇEPNİ, Pelin OCAL, Orçun KOÇAK, Merve BARBAROS ... Elektrolitler, kreatinin, BUN ve kara-ciğer enzimleri normal sınırlardaydı. ...
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summArY. Endobronchial tuberculosis (EBTB) is the tuberculous infection of the tracheobronchial tree, with microbial and his- topathological evidence. EBTB is present in 10-40% of patients with active tuberculosis. It can easily be... more
summArY. Endobronchial tuberculosis (EBTB) is the tuberculous infection of the tracheobronchial tree, with microbial and his- topathological evidence. EBTB is present in 10-40% of patients with active tuberculosis. It can easily be confused with other diseases since the clinical findings are non specific. A clear chest X-ray does not exclude the diagnosis because the X-ray appearances may be normal in 20% of patients. A "tree-in-bud" appearance is a charac - teristic high resolution computed tomography (HRCT) appearance in EBTB. Bronchoscopic examination is the key to diagnosis, and CT and bronchoscopy are the methods used for the assessment of treat- ment options. Early diagnosis with prompt treatment is important to prevent the serious complications of EBTB, such as bronchostenosis and bronchiectasis. Antituberculous chemotherapy is effective in controlling the infection but may not preclude residual bronchoste- nosis. Corticosteroid therapy for the prevention of bronchi...
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A 40-year-old female presented with cough, exertional dyspnea, abdominal pain with distention, fatigue, dry eyes and dry mouth. Past history revealed asthma. Physical examination was normal except for tachypnea. We found leukocytosis,... more
A 40-year-old female presented with cough, exertional dyspnea, abdominal pain with distention, fatigue, dry eyes and dry mouth. Past history revealed asthma. Physical examination was normal except for tachypnea. We found leukocytosis, azygos fissure on chest X-ray along with normal pulmonary function tests and arterial blood gases. Thorax computed tomography (CT) revealed bronchiectasis and ground glass opacities in both lungs. Abdominal CT demonstrated thrombosed proximal splenic artery aneurysm. Further diagnostic procedures were done and according to the positive Schirmer test and compatible histopathologic findings of the salivary gland, diagnosis of primary Sjögren’s syndrome was established. Splenic artery aneurysm is rare occurring in less than 1% of the population that usually appears as an incidental finding. This is the first case in literature that introduces Sjögren’s syndrome as a risk factor for splenic artery aneurysm. The silent presentation of the splenic artery an...
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Round atelectasis is a benign inflammatory condition most frequently observed in patients with asbestos exposure but it can also result from a variety of chronic pleural diseases like infection. It has not previously been described in... more
Round atelectasis is a benign inflammatory condition most frequently observed in patients with asbestos exposure but it can also result from a variety of chronic pleural diseases like infection. It has not previously been described in sarcoidosis. We report the occurrence of round atelectasis in four previ-ously diagnosed sarcoidosis patients who were under follow up at our outpatient clinic. Three patients had symptoms con-sisting of thoracic pain, dry cough and sensation of fullness at the posterior thorax, respectively. Chest roentgenogram showed subpleural or pleural based opacity with diameters ranging from 2 to 3 cm in each of the patients. Chest comput-erized tomography (CT) revealed features of round atelecta-sis. Fiberoptic bronchoscopy with transbronchial lung biopsy was performed. Diagnosis was confirmed by the histopatho-logic examination of the biopsy samples. The mechanical influence of a prior pleural effusion due to sarcoidosis may be the predominant mechanism underl...
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A 51-year-old man with Behçet’s disease complained of fever, dry cough and dyspnea during exertion. Chest CT showed ground glass opacities with interstitial septal thickening in both lungs. Bronchoalveolar lavage (BAL) revealed amorphous... more
A 51-year-old man with Behçet’s disease complained of fever, dry cough and dyspnea during exertion. Chest CT showed ground glass opacities with interstitial septal thickening in both lungs. Bronchoalveolar lavage (BAL) revealed amorphous and lipoproteinaceous material that was periodic acid-Schiff (PAS) stain positive. Transbronchial biopsy specimen demon-strated PAS positive alveolar eosinophilic material consistent with pulmonary alveolar proteinosis. Serum anti-granulo-cyte-macrophage colony stimulating factor (GM-CSF) anti-body was negative. Recent studies have reported anti-GM-CSF not present in the the serum of patients with secondary pulmonary alveolar proteinosis (PAP) but they have not reported so in patients with idiopathic PAP. We report a case of alveolar proteinosis in the setting of Behçet’s disease with spontaneous remission.
A 51-year-old man with Behçet’s disease complained of fever, dry cough and dyspnea during exertion. Chest CT showed ground glass opacities with interstitial septal thickening in both lungs. Bronchoalveolar lavage (BAL) revealed amorphous... more
A 51-year-old man with Behçet’s disease complained of fever, dry cough and dyspnea during exertion. Chest CT showed ground glass opacities with interstitial septal thickening in both lungs. Bronchoalveolar lavage (BAL) revealed amorphous and lipoproteinaceous material that was periodic acid-Schiff (PAS) stain positive. Transbronchial biopsy specimen demonstrated PAS positive alveolar eosinophilic material consistent with pulmonary alveolar proteinosis. Serum anti-granulocyte-macrophage colony stimulating factor (GM-CSF) antibody was negative. Recent studies have reported anti-GMCSF not present in the the serum of patients with secondary pulmonary alveolar proteinosis (PAP) but they have not reported so in patients with idiopathic PAP. We report a case of alveolar proteinosis in the setting of Behçet’s disease with spontaneous remission.
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A 66 male presented with left sided pleural pain, fatigue, loss of apetite and dyspnea in exertion. He was a smoker with a 90 pack-year smoking habit and did not have exposure to occupational agents. Past history revealed COPD and... more
A 66 male presented with left sided pleural pain, fatigue, loss of apetite and dyspnea in exertion. He was a smoker with a 90 pack-year smoking habit and did not have exposure to occupational agents. Past history revealed COPD and diabetes mellitus. Serum biochemistry and chest x-ray were normal. Thorax CT and abdomial CT did not reveal any pathologic findings while PET/CT showed increased FDG activity over the hepatosplenic surface areas. Histopathologic examination of the abdominal peritoneum was compatible with epitheloid mesothelioma. A standart chemotherapy with alimta and cisplatin was started. Following treatment symptoms regressed significantly and the patient was discharged. Clinicians should keep in mind that peritoneal mesothelioma may present with an atypical profile that may lead to a delayed diagnosis. An unusual clinical presentation is a diagnostic challenge for the physician that may cause identification of peritoneal mesothelioma at an advanced stage.
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Sarcoidosis is a systemic granulomatous disease of unknown etiology that can involve nearly all organs. Liver is the third most commonly affected organ following the lungs and the lymph nodes. Cases with liver sarcoidosis are usually... more
Sarcoidosis is a systemic granulomatous disease of unknown etiology that can involve nearly all organs. Liver is the third most commonly affected organ following the lungs and the lymph nodes. Cases with liver sarcoidosis are usually silent clinically while a few can progress to cirrhosis and portal hypertension in less than 1% of the patients. A 56 year old female was referred for ecchymosis, protuberant abdomen, bilateral pretibial and ankle edema. Medical history did not reveal any previous disease. Ascites, hepatomegaly, splenomegaly, and facial telengiectasies were present on physical examination. Chest x-ray and CT were normal. Papules and plaques on the knees developed six days after admission. Skin biopsy revealed granulomatous dermatitis. Serum ACE was 250 IU/L. Liver biopsy showed non-caseiting granulomas, severe hepatitis and fibrosis. Sarcoidosis was confirmed based on high serum ACE, histopathologic findings of the skin and liver biopsy samples that revealed non-caseiting granulomas. We report a case of sarcoidosis complicated by cirrhosis as the initial manifestation of the disease without lung involvement. An extensive literature review of sarcoidosis, Case Study British Journal of Medicine & Medical Research, 4(25): 4272-4277, 2014 4273 focusing on case reports, which presented with cirrhosis and portal hypertension without lung involvement, was made.
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... Year: 2010 Volume: 23 - Issue: 2. Title: Endobronchial Involvement in Miliary Tuberculosis. Author: Cuneyt Tetikkurt, MD ; Seza Tetikkurt, MD ; Nihal Bayar, MD ;Imran Ozdemir, MD. Abstract: SUMMARY. Endobronchial tuberculosis ...
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A case of sarcoidosis associated with chronic eosinophilic pneumonia
TNF-alpha inhibitors serve as important treatment options for a variety of immune mediated diseases with a major impact on the treatment of disabling inflammatory disorders. These agents submit a targeted strategy that contrasts with the... more
TNF-alpha inhibitors serve as important treatment options for a variety of immune mediated diseases with a major impact on the treatment of disabling inflammatory disorders. These agents submit a targeted strategy that contrasts with the nonspecific traditional immunosuppressive agents. However, significant complications and severe adverse effects may occur during treatment with these targeted TNF-alpha inhibitor drugs. One of the important side effect of TNFalpha blockers is increased risk for reactivation of latent tuberculosis and dissemination of tuberculosis infection.1–4
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The aim of our study was to determine the utility of the PFTs [Pulmonary Function Tests (PFTs)] and DLCO/VA [Diffusion Capacity/alveolar Volume (DLCO/VA)] in regard to the clinical prognosis of sarcoidosis patients. Another objective was... more
The aim of our study was to determine the utility of the PFTs [Pulmonary Function Tests (PFTs)] and DLCO/VA [Diffusion Capacity/alveolar Volume (DLCO/VA)] in regard to the clinical prognosis of sarcoidosis patients. Another objective was to assess the prognostic significance of PFTs, DLCO/ VA, extrapulmonary organ and endobronchial involvement when these features were evaluated in collaboration. One hundred ninety four sarcoidosis patients underwent PFT, DLCO/VA, thorax CT and bronchoscopy. Extrapulmonary organ involvement was classified into two groups as limited if less than two and as extensive if three or more extrapulmonary organs were involved. Endobronchial disease was denoted as limited if one bronchial biopsy site was positive and as diffuse if more than two biopsy sites were positive histopathologically. Sarcoidosis activity was evaluated in regard to progressive stage, detoriation of pulmonary function tests, permanent decline of DLCO/VA values, and the presence of severe...
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Halil Yanardag1, Cuneyt Tetikkurt2*, Muammer Bilir1, Seza Tetikkurt3 and Emre Yanardag4 1Professor, Department of Internal Medicine Medicine, Cerrahpasa Medical Faculty, Istanbul Cerrahpasa University, Istanbul, Turkey 2Professor,... more
Halil Yanardag1, Cuneyt Tetikkurt2*, Muammer Bilir1, Seza Tetikkurt3 and Emre Yanardag4 1Professor, Department of Internal Medicine Medicine, Cerrahpasa Medical Faculty, Istanbul Cerrahpasa University, Istanbul, Turkey 2Professor, Department of Pulmonary Medicine, Cerrahpasa Medical Faculty, Istanbul Cerrahpasa University, Istanbul, Turkey 3Professor, Department of Pathology, Demiroglu Bilim University Medical Faculty, Istanbul, Turkey 4Resident, Department of Internal Medicine, Haseki State Hospital, Istanbul, Turkey
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Idiopathic pleuropulmonary fibroelastosis is an extremely rare lung disease characterized by the combination of fibrosis of the visceral pleura and the fibroelastotic changes transcending in the subpleural lung parenchyma that... more
Idiopathic pleuropulmonary fibroelastosis is an extremely rare lung disease characterized by the combination of fibrosis of the visceral pleura and the fibroelastotic changes transcending in the subpleural lung parenchyma that predominantly affects the upper lobes with accompanying volume loss. It is mostly idiopathic while infection, autoimmunity, bone marrow or lung transplantation and genetic predisposition may be associated with the development of PPFE. The disease is exceptionally rare as approximately ninety cases have been reported in the literature currently. A 35-year-old female presented with exertional dyspnea, dry cough and weight loss. Physical examination demonstrated platythorax, suprasternal notch deepening and fine rales over the upper lobes. Blood count, serum biochemistry, autoimmunity and serologic markers for collagen vascular diseases were within normal limits. Arterial blood gases demonstrated a low pO2 (48 mm Hg) and a high pCO2 (54 mm Hg) values. Chest x-ray...
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A 64 year old male was admitted for fever, sputum and fluctuating hoarseness over the last three weeks. Physical examination revealed rales and decreased breath sounds over the lower right lower lung zones. He was a smoker with a 30-pack... more
A 64 year old male was admitted for fever, sputum and fluctuating hoarseness over the last three weeks. Physical examination revealed rales and decreased breath sounds over the lower right lower lung zones. He was a smoker with a 30-pack year history. Serum biochemistry was normal except for leukocytosis and a high CRP value. PFTs revealed a mild obstructive defect. Chest X-ray showed a dense parenchymal infiltration with air bronchograms in the right lower zone. Axial CT image revealed pneumonic consolidation and atelectasis of the right lower lobe while sagittal CT image demonstrated a nodular opacity located at the left upper division and the lingula bronchus carena. Bronchoscopic examination disclosed a pink submucosal nodule over the left vocal cord, complete obstruction of the lower lobe orifice with submucal tumoral infiltration and another submucal nodule in the left secondary carena between the upper division and lingula bronchus. Pathologic examination of the lower lobe ma...
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A 52 year old male presented with a swelling in the left parotid region and erythematous plaques with silvery scale on the arms. He had a 5 pack-year smoking history. The patient had sarcoidosis for eight, coronary atherosclerosis for... more
A 52 year old male presented with a swelling in the left parotid region and erythematous plaques with silvery scale on the arms. He had a 5 pack-year smoking history. The patient had sarcoidosis for eight, coronary atherosclerosis for five and COPD for three years. Family history did not reveal any disease. Physical examination revealed erythematous plaques with silvery scale on the arms. Electrocardiogram and chest X-ray revealed normal findings. Blood count and serum biochemistry were within normal limits. Thorax CT revealed randomly distributed micronodules in both lungs. PET/CT showed a hypermetabolic lesion in the posteromedial region of the left parotid gland. Pathologic examination of the cutaneous lesions revealed psoriasiform sarcoidosis. Histopathology of the transbronchial lung biopsy revealed non classified granulomatous inflammation while pathology of the needle aspiration biopsy of the parotid gland was compatible with papillary cystadenoma lymphomatosum. Histopatholog...
Research Interests: Medicine and Sarcoidosis
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A 64-year-old male with a history of stabile chronic obstructive pulmonary disease (COPD) presented with increasing dyspnea and sputum for the last two months. Complete blood count showed WBC 14x103/ml, Hgb: 14.2 g/dL and eosinophilia.... more
A 64-year-old male with a history of stabile chronic obstructive pulmonary disease (COPD) presented with increasing dyspnea and sputum for the last two months. Complete blood count showed WBC 14x103/ml, Hgb: 14.2 g/dL and eosinophilia. Blood biochemistry was normal. Chest x-ray showed hyperlucency while thorax computed tomography (CT) revealed obstructive lung disease and bronchiectasis. Pulmonary function tests demonstrated severe obstructive lung disease and a negative bronchoreversibility with a moderately reduced diffusing capacity/alveolar volume (DLCO/VA). ABG gases revealed significant hypoxemia. Sputum culture was negative. Total IgE was 1140 ng/ml. Aspergillus RAST, precipitins and aspergillusgalactomannan antigen were positive. CF genetic screening tests gave negative results. Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity reaction that occurs due to bronchial aspergillus colonization. It is most common in patients with asthma and cystic fibrosis. We...
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Sarcoidosis is a multisystem granulomatous inflammatory disorder frequently affecting the lungs, but also the liver, along with cirrhosis and portal hypertension occurring in less than 1% of the patients. A 56-year-old female presented... more
Sarcoidosis is a multisystem granulomatous inflammatory disorder frequently affecting the lungs, but also the liver, along with cirrhosis and portal hypertension occurring in less than 1% of the patients. A 56-year-old female presented with dyspnea, abdominal and leg swelling. Physical examination revealed finger clubbing, ascites and pretibial edema. Chest CT revealed diffuse micronodular opacities in both lungs without any enlarged thoracic lymph nodes. PFTs and DLCO/VA were moderately decreased. Transbronchial biopsy revealed non-caseified granulomas compatible with sarcoidosis. Serologic markers for infectious and autoimmune hepatitis were negative. Liver biopsy showed non-caseating granulomas, severe hepatitis and fibrosis. Stool, urinary analysis and antibodies for Schistosoma infection were negative. Final diagnosis was cirrhosis associated with stage III sarcoidosis. We report a case of sarcoidosis complicated by cirrhosis and portal hypertension with finger clubbing. Clinic...
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Sarcoidosis is a multisystemic disease that may lead to neurologic complications in 10% of the patients. Carpal tunnel syndrome is very rare in sarcoidosis. We present two identical twin sarcoidosis patients with carpal tunnel syndrome. A... more
Sarcoidosis is a multisystemic disease that may lead to neurologic complications in 10% of the patients. Carpal tunnel syndrome is very rare in sarcoidosis. We present two identical twin sarcoidosis patients with carpal tunnel syndrome. A number of factors may cause carpal tunnel syndrome like wrist anatomy, occupation, diabetes, rheumatoid arthritis, pregnancy and renal failure. Although the above factors do not directly cause carpal tunnel syndrome, they may increase your chances of developing or aggravate median nerve damage as it is in sarcoidosis. Sarcoidosis relevant neuropathy and granulomas may be the primary mechanism of sarcoidosis associated carpal tunnel syndrome. Although rare, carpal tunnel syndrome may be a feature of sarcoidosis that may lead to irreversible damage in cases of delayed diagnosis. The presence of this syndrome in identical twin patients may shed light into the pathogenesis and the genetic transmission of sarcoidosis with the associated carpal tunnel sy...
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A 63-year-old male presented with loss of appetite, subfebrile fever, swelling of the right hand and dyspnea on exertion for three months. Past medical history revealed methotrexate treatment of six months for rheumatoid arthritis. Chest... more
A 63-year-old male presented with loss of appetite, subfebrile fever, swelling of the right hand and dyspnea on exertion for three months. Past medical history revealed methotrexate treatment of six months for rheumatoid arthritis. Chest radiography and computed tomography (CT) revealed diffuse miliary nodules. PET/CT scan demonstrated diffuse FDG uptake in both lungs, in the spleen, in the right hand, the mediastinal and the axillary lymph nodes. MR of the right hand showed inflammatory arthritis. Histopathology of the right hand tru-cut biopsy revealed degenerative changes. Culture of the hand biopsy tissue was positive for mycobacterium tuberculosis. PET/CT may determine the biopsy and the sampling sites for the early diagnosis of patients with suspected miliary tuberculosis where lesion identification on other modalities may be difficult or unfeasible. High sensitivity for inflammatory diseases makes PET/CT a useful diagnostic utility for enabling early diagnosis in miliary tube...