The treatment effect on peripheral B cell markers in antibody positive myasthenia gravis patients

B cells play a major role in the pathophysiology of myasthenia gravis (MG) with their ability to produce disease specific, pathogenic antibodies. However, their status during disease development and follow-up stages of the disease in the peripheral blood may need further studies to determine useful markers. In this study, we aimed to detect B cell associated factors concerning immunosuppressive treatment in generalized non-thymomatous MG patients. Although CD19⁺ B cell distribution did not vary among disease subgroups, expressions of both CD38 and BAFFR were altered on B cells in MG patients under immunosuppressive therapy. Serum levels of BAFF were elevated in untreated MG patients as compared to treated MG patients and healthy controls. B cell activation factors may show profound alterations due to immunosuppression.

The comparison of efficacy of single intraarticular steroid injection versus the combination of genicular nerve block and intraarticular steroid injection in patients with knee osteoarthritis: a randomised study

OBJECTIVES

The aim of this study is to evaluate the efficacy of genicular nerve block (GNB) and intraarticular corticosteroid injection (IACSI) in patients with knee osteoarthritis (OA).

METHODS

Forty patients with Kellgren-Lawrence grade 2-4 knee OA were included for the study. Patients were divided into two groups randomly as IACS and IACS + GNB groups. All patients were evaluated with ultrasound for cartilage thickness, patellar tendon thickness, quadriceps tendon thickness and quadriceps muscle cross-sectional area (QMA). Pain intensity of the patients was evaluated with visual analogue scale and the Leeds Assessment of Neuropathic Symptoms and Signs pain scale. Functional status of the patients was evaluated with Western Ontario and Mc Master Universities Osteoarthritis Index. Quality of life of the patients was assessed with Nottingham Health Profile (NHP). All assessments were measured and compared at baseline, 1st month and 3rd month after treatment.

RESULTS

All evaluation parameters were significantly improved in IACSI and IACSI + GNB groups. However, the improvement was better in IACSI + GNB group compared to those in IACSI group in terms of all evaluation parameters except QMA (0.10 ± 0.18 and 0.11 ± 0.22, respectively) and NHP scores in 1st month evaluation (- 3.11 ± 6.99 and - 3.54 ± 1.74, respectively).

CONCLUSIONS

When combined with IACSI, GNB yields better analgesic effect and improves function in patients with knee OA compared to only IACSI.

Adherence to GOLD guideline treatment recommendations among pulmonologists in Turkey

Background

Low adherence to Global initiative for chronic Obstructive Lung Disease (GOLD) guideline recommendations has been reported worldwide. There has been no study on the adherence to GOLD guidelines for COPD treatment in Turkey.

Objectives

To investigate the rates of adherence to GOLD 2010 guidelines for COPD treatment among pulmonologists.

Design

A multi-center, cross-sectional, observational study was carried out in eleven pulmonary outpatient clinics across Turkey. Adherence to GOLD was evaluated through hospital records. Demographic and clinical data were recorded.

Results

Study included 719 patients (mean age: 62.9±9.7 years; males 85.4%) of whom 16 was classified as GOLD Stage I, 238 as II, 346 as III, and 119 as IV, and only 59.5% received appropriate treatment. Rates of guideline adherence varied across GOLD stages (I, 6.3%; II, 14.7%; III, 84.4%; and IV, 84%). Causes of inappropriate therapies were overtreatment (Stage I, 100% and Stage II, 91.1%), undertreatment (Stage III, 3.3% and Stage IV, 10.9%) and lack of treatment (Stage II, 3.8%; Stage III, 2.3%; and Stage IV, 5.9%). The most preferred regimen (43.4%) was long-acting β2-agonist-inhaled corticosteroid-long-acting muscarinic antagonist. Overall, 614 patients (89%) received treatment containing inhaled corticosteroid.

Conclusion

Pulmonologists in Turkey have low rates of adherence to GOLD guidelines in COPD treatment. Inappropriateness of therapies was due to overtreatment in early stages and excessive use of inhaled corticosteroid (ICS) in all disease stages.

Equine herpes virus type 1 (EHV-1) and 4 (EHV-4) infections in horses and donkeys in northeastern Turkey

The herpesviruses infections in equides are caused by five different serotypes of viruses, belonging to family Herpesviridae. The goal of this study was to conduct a seroepidemiological investigation of equine herpesvirus type 1 (EHV-1) and type 4 (EHV-4) in horses and donkeys raised in two provinces and their villages in northeastern Turkey. A total of 666 samples from 423 horses and 243 donkeys that were not immunized against these infections were tested with ELISA. While 52.48% of tested horse sera was found to carry specific antibodies to EHV-1, 83.69% of these serums were found to carry specific antibodies to EHV-4. 51. Eighty-five percent of analyzed donkey samples tested positive for EHV-1 and 64.20% of these samples tested positive for EHV-4 antibodies. When the horse and donkey samples were evaluated together, 52.25% were seropositive for EHV-1 and 76.58% were seropositive for EHV-4. This study showed that EHV-1 and EHV-4 infections are quite common in the horses and donkeys being raised in the areas where the study was carried out. In addition, since the area where the study was carried out in the borders of Armenia and Georgia, the high level of seropositive results for these infections leads to the conclusion that we should consider the risk of diseases spreading to neighboring countries. This is the first study to serologically identify EHV-1 and EHV-4 infections in donkeys raised in Turkey.

Fire-eater's pneumonia characterized by pneumatocele formation and spontaneous resolution

Liquid hydrocarbons derived from petroleum are widely used in industry and in households. Aspiration of massive amounts may lead to an acute and fatal form of exogenous lipoid pneumonia (fire-eater's pneumonia). We present a rare case of chemical pneumonitis following accidental lamp oil aspiration characterized by pneumatocele formation and spontaneous resolution. Initial findings on posteroanterior chest radiographs were smoothly circumscribed lower zone masses with and without air-fluid levels. Chest computed tomography also showed multiple thin-walled cavities with and without air-fluid levels. Complete resolution of findings despite initial severe presentation without corticosteroid or antibiotic treatment is noteworthy.

Primary pulmonary teratoma: Report of a case and the proposition of "bronchotrichosis" as a new term

Primary pulmonary teratoma is a very rare disease. Most follow a benign course and are incidental findings during routine chest X-rays. Hair found in sputum or in bronchus detected during bronchoscopy is also a rare condition and is usually caused by mediastinal teratoma. This case report is of a 36-year-old man who presented with halitosis. A fiber-optic bronchoscopy revealed coarse hair originated from the right upper lobe. The patient was successfully treated by right upper lobectomy, and pathology confirmed primary pulmonary teratoma. We recommend that "bronchotrichosis" could be used as a new term for such a sign.

Application of multivariate statistical techniques in the assessment of surface water quality in Uluabat Lake, Turkey

The application of different multivariate statistical approaches for the interpretation of a complex data matrix obtained during the period 2004-2005 from Uluabat Lake surface water is presented in this study. The dataset consists of the analytical results of a 1 year-survey conducted in 12 sampling stations in the Lake. Twelve parameters (T, pH, DO, PO(-3)(4), NH(4)-N, NO(2)-N, NO(3)-N, SO(3-)(4), BOD, COD, TC, FC) were monitored in the sampling sites on a monthly basis (except December 2004, January and February 2005, a total of 1,296 observations). The dataset was treated using cluster analysis, principle component analysis and factor analysis on principle components. Cluster analysis revealed two different groups of similarities between the sampling sites, reflecting different physicochemical properties and pollution levels in the studied water system. Three latent factors were identified as responsible for the data structure, explaining 77.35% of total variance in the dataset. The first factor called the microbiological factor explained 32.34% of the total variance. The second factor named the organic-nutrient factors explained 25.46% and the third factor called physicochemical factors explained 19.54% of the variances, respectively.

Airborne Alternaria and Cladosporium species and relationship with meteorological conditions in Eskisehir City, Turkey

Alternaria and Cladosporium, known as the most allergenic spores were first collected by means of Durham gravimetric sampler from Eskisehir atmosphere from January 1, 2000 to December 31, 2001. The daily, monthly and annual variations in spores/cm(2) of Cladosporium and Alternaria were recorded. During this period, a total of 10.231 spores belonging to Cladosporium and Alternaria genera were recorded. Of these spores, 5,103 were identified in 2000 and 5,128 in 2001. While 63.09% of the total spores were those of Cladosporium, 36.91% were of Alternaria. Relationships between airborne fungal spore presence and meteorological conditions were statistically investigated. A Shapiro-Wilk test revealed that the airborne Cladosporium and Alternaria spores differed from a normal distribution. Thus, a Friedmann test was performed followed by a Pearson Correlation Analysis. The effects of rainfall, temperature and wind speed on Cladosporium and Alternaria numbers were non-significant according to the sites and months (p > 0.05), but the effects of relative humidity on Cladosporium and Alternaria numbers were significant (p < 0.01). Spore concentrations reached to their highest levels in May 2001.

The role of HLA-DRB1 shared epitope alleles in predicting short-term response to leflunomide in rheumatoid arthritis

OBJECTIVES

To investigate the role of shared epitope (SE) alleles in the short-term clinical response to leflunomide for the treatment of active RA.

METHODS

In an open-label, multi-centre study of 16-weeks duration, 93 patients (82% female) fulfilling ARA 1987 RA criteria were treated with leflunomide (100 mg loading dose for 3 days, then 20 mg/day as the maintenance dose). The primary efficacy criterion was the response status according to the European League Against Rheumatism (EULAR) response criteria using Disease Activity Score-28 (DAS28) activity measure. SE determinations have been undertaken by polymerase chain reaction and sequence-specific oligonucleotide genotyping methods.

RESULTS

The mean (s.d.) Disease Activity Score-28 (DAS28) was 5.1 (1.3) before the treatment, which was significantly decreased after 16 weeks [3.0 (1.1), P < 0.001]. According to the EULAR response criteria, 55 patients (59.1%) were classified as good responders. SE was positive in 51 (54.8%) of the patients, with 13 (13.9%) having SE homozygosity or carrying any two SE alleles. Among SE-positive patients, 68.6% (35/51) were good responders, compared with 47.6% (20/42) in SE negatives (P = 0.04). No difference was present according to SE hetero- or homozygosity (68.4 vs 69.2%). RF was also present significantly more frequently in the SE-positive group compared with negatives (78.4 vs 57.1%, P = 0.03). However, no significant difference was observed in the prevalence of RF positivity in patients with a good clinical response (72.7 vs 63.2%, P = 0.32).

CONCLUSIONS

The results suggest that HLA-DRB1 SE presence may favourably affect the outcome of leflunomide monotherapy in an unselected group of RA patients with an active disease and naive to leflunomide.

FACTORS AFFECTING HOPELESSNESS LEVELS OF TURKISH PRETEENAGERS ATTENDING PRIMARY SCHOOL: A STRUCTURAL EQUATION MODEL

This study was designed to determine the factors affecting hopelessness about the future of 10–12-year-old Turkish primary school students. Firstly, descriptive factor analysis was applied in order to determine the factors affecting hopelessness levels, then a structural equation model (SEM) was utilized to describe the relationship between the specified factors and hopelessness; these relationships were tested by LISREL 8.54. The results indicated that the preteenagers' level of hopelessness was adversely affected by support received from parents and friends. The hopelessness level was also significantly affected by the preteenagers' positive self-definition and parents' educational level.

Clinical comparison of anti-MuSK- vs anti-AChR-positive and seronegative myasthenia gravis

We compared 65 anti-acetylcholine receptor (AChR)-negative myasthenia gravis (MG) patients, including 32 anti-muscle-specific tyrosine kinase (MuSK)-positive (49%) and 33 anti-MuSK-negative (seronegative) (51%) patients, with 161 anti-AChR-positive MG patients. The anti-MuSK-positive group had a higher frequency of bulbar involvement and respiratory crises. The seronegative group was in between the anti-MuSK positive and the anti-AChR positive groups, being closer to the latter, with regard to the severity of the disease. At the end of follow-up, the outcome of the anti-MuSK-positive patients was not different from that of the anti-AChR-positive patients, although their maintenance corticosteroid dose was higher. The seronegative patients had better outcome than the other two groups.

Factors associated with the development of atrial fibrillation in COPD patients: the role of P-wave dispersion

BACKGROUND

Supraventricular tachyarrhythmia is a common problem in chronic obstructive pulmonary disease (COPD) patients. The purpose of this study is to analyze the factors associated with paroxysmal atrial fibrillation (AF) in COPD patients.

METHODS

Forty COPD patients (38 male, 2 female, mean age 60 +/- 9 years) and 33 healthy controls (29 male, 4 female, mean age: 58 +/- 10 years) were included in this study. Echocardiography, 24-hour ambulatory and 12-lead ECG, pulmonary function tests, arterial blood gases, and serum electrolytes were measured. On ECG, maximum (P(max)) and minimum (P(min)) duration of P wave and its difference, P-wave dispersion (PWd), were measured.

RESULTS

On echocardiography, diastolic dysfunction was found in 14 of the 40 (35%) COPD patients. Heart rate variability analysis revealed that COPD patients had decreased SDANN, SDNN, SDNNIDX in time-domain, and decreased LF in frequency domain parameters. Fourteen of the 40 COPD patients (35%) had AF. Patients with AF were older (57 +/- 10 vs 64 +/- 5 years, P = 0.03) and had lower SDANN, SDNN, and LF/HF ratio as compared to patients without AF in univariate analysis. All P-wave intervals (P(max), P(min,) and PWd) were increased in COPD patients compared to controls. P-wave dispersion was significantly increased in COPD patients with AF, as compared to patients without AF (57 +/- 11 vs 44 +/- 7 ms, P = 0.001). In logistic regression analysis PWd was found to be the only factor associated with the development of AF (P = 0.04).

CONCLUSIONS

The presence of AF was significantly related to the prolongation of PWd, but not with pulmonary function, arterial blood gasses, and left and right atrial function.

Interleukin (IL)-12, IL-2, and IL-6 gene polymorphisms in Takayasu's arteritis from Turkey

Takayasu's arteritis (TA) is a chronic arterial inflammation of unknown etiology involving mainly the aorta and its major branches. Genetic polymorphisms of cytokines are screened as susceptibility factors for TA in Turkey. A total of 94 patients with TA were investigated for the genetic polymorphisms of the interleukin genes IL12, IL2,and IL6 and were compared with 108 healthy control subjects using polymerase chain reaction-sequence-specific primer method. The frequencies of IL12B 1188 C allele (p = 0.03, OR = 1.7) and CC genotype (p = 0.007, OR = 3.7) were both higher in TA patients than in control subjects. TT genotype at IL2-330 (p = 0.006, OR = 2.4) and GG genotype at IL6-174 (p = 0.04, OR = 1.9) were more frequent in TA patients. Lower prevalence of GT genotype at IL2-330 (p = 0.005, OR = 0.4), CG genotype at IL6-174 (p = 0.001, OR = 0.4), and AG genotypes at IL6-598 (p = 0.01, OR = 0.4) were also detected. The polymorphism of IL-12 as well as IL-6 and IL-2 genes may contribute to susceptibility and pathogenesis of TA by altering cytokine production and inducing inflammation.

[Comparison of computed tomography and magnetic resonance imaging to diagnose brain metastasis in non-small cell lung cancer]

To investigate the value of simultaneously obtained brain computed tomography (CT) and magnetic resonance imaging (MRI) to diagnose brain metastasis in non-small cell lung cancer (NSCLC) patients with or without neurological symptoms. Sixty-two patients (58 male, 4 female) who were admitted to Yedikule Chest Hospital and Thoracic Surgery Center between January 2000-December 2003 and whom were diagnosed with NSCLC were included in the study. Ages of patients varied between 40-85 (61 +/- 11). All patients had hemogram and routine blood chemistry as well as chest X-ray, thorax CT, brain CT, brain MRI, FOB and a complete neurological exam. Brain metastasis were detected in 22 of 62 (35.5%) patients by using brain MRI and 16 (72.7%) of these hadn't had any neurological symptoms or signs. The difference to detect the brain metastasis between brain MRI and CT was statistically significant (p < 0.01). Nine of the 22 cases (14.5%) who were found to have brain metastasis by using MRI were stage I. While brain CT showed solitary brain metastasis in five patients, 4 (80%) of them were found to have multiple metastases when MRI studies were used. We concluded that, in an attempt to make correct staging and treatment of NSCLC and hence to investigate the brain metastasis in NSCLC patients including early stage ones, brain MRI is superior to brain CT study.

Risk factors and recurrence patterns in 203 patients with hemoptysis

Management of hemoptysis requires prompt diagnosis and patient stabilization especially in massive hemoptysis as a potentially life-threatening condition. This retrospective study was designed to determine the etiologic distribution of hemoptysis, the role of the fiberoptic bronchoscopy (FOB) as a diagnostic tool, and to clarify potential risk factors for massive hemoptysis and recurrences. A total of 203 patients (181 male, 22 female) with hemoptysis admitted to our hospital were evaluated retrospectively. Tuberculosis was the leading cause of hemoptysis (n = 89; 43.8%) followed by lung cancer (21.7%) and chronic bronchitis (n = 11; 5.5%). FOB plays an essential role for localization of bleeding and diagnosis, although no bronchoscopic abnormality was found in our 31 patients (15.3%). Twenty-nine of the patients (14.3%) had recurrent hemoptysis and hemoptysis lasting longer than five days was found as a risk factor for recurrences (p = 0.02). Having lung cancer was an independent negative risk factor for recurrent hemoptysis using multivariate analysis (n = 44; p = 0.034). Twenty two of the patients (10.8%) had severe hemoptysis and managed medically. In our study, tuberculosis, lung cancer and heavy cigarette smoking were revealed as independent predictors of massive hemoptysis (p = 0.016, 0.001, 0.041 respectively). Hemoptysis is a common respiratory symptom that always requires investigation by using FOB and radiography in order to determine exact site of bleeding and etiology. Hemoptysis continuing more than five days and lung cancer diagnosis may indicate recurrent bleeding and need more attention.

Serological evidence of West Nile Virus (WNV) in mammalian species in Turkey

In this study, the sera collected from a variety of mammalian species (ass-mules, cat, cattle, dog, horse, human and sheep) in 10 representative provinces of Turkey, were surveyed for the presence of neutralizing antibodies to West Nile virus (WNV). Overall, 1 of 40 (2.5%) ass-mules, 4 of 100 (4%) cattle, 43 of 114 (37.7%) dogs, 35 of 259 (13.5%) horses, 18 of 88 (20.4%) humans and 1 of 100 (1%) sheep, tested positive for WNV-neutralizing antibodies. The results indicate that a wide range of mammals are exposed to a West Nile-related virus and this could contribute to the long-term survival of this virus in the absence of overt disease.

Endothelial dysfunction in patients with asthma: the role of polymorphisms of ACE and endothelial NOS genes

OBJECTIVES

Polymorphisms of the angiotensin converting enzyme (ACE) and endothelial nitric oxide (eNOS) genes have been implicated in asthma pathogenesis. Angiotensin II and NO have important roles in maintaining vascular tone. In this study, the relationship between endothelial dysfunction and ACE and eNOS gene polymorphisms was investigated in patients with asthma.

METHODS

This cross-sectional, controlled study was conducted at the Yedikule Chest Disease Hospital and Cardiology Center in a University Hospital. Forty-nine patients with asthma (18 male, 31 female; mean age: 33+/-12 years) and 49 age- and sex-matched healthy controls (20 male, 29 female; mean age: 30+/-8 years) were included. Pulmonary function tests and flow-mediated dilatation of the brachial artery [endothelium dependent dilatation (EDD)] were examined by high-resolution ultrasonography. The ACE and eNOS genotypes were determined by PCR.

RESULTS

Asthma patients showed lower EDD (12+/-6% vs. 22+/-6%, p<0.001) as compared to controls. The EDD was correlated with both predicted value of FEV1 (r=0.31, p=0.04) and predicted value of FVC (r=0.37, p=0.013). Conversely, EDD values in patients with moderate asthma were significantly lower than those in patients with mild asthma (10.1+/-5.2% vs. 14.1+/-5.7%, p=0.017). However, the ACE and eNOS genotype distribution was not significantly different between controls and asthma groups. Furthermore, EDD was not associated with both gene polymorphism of ACE and eNOS.

CONCLUSION

Patients with asthma have decreased vasodilatatory response to shear stress (EDD). Decreased EDD is correlated with the severity of asthma, but not with the distribution of ACE and eNOS genotypes.

Diagnostic Value of Transbronchial Needle Aspiration by Wang 22-Gauge Cytology Needle in Intrathoracic Lymphadenopathy

OBJECTIVES

The aim of this study was to investigate the diagnostic value of transbronchial needle aspiration (TBNA) performed with a Wang 22-gauge cytology needle in patients with mediastinal and/or hilar adenopathy.

DESIGN

Cross-sectional study.

SETTING

Tertiary care training hospital.

PATIENTS

TBNA procedures were performed using a flexible bronchoscope and a 22-gauge Wang needle in 60 consecutive patients (36 women and 24 men; mean age, 39 +/- 16 years [+/- SD]) who had mediastinal or hilar adenopathy identified on CT of the chest.

RESULTS

Adequate lymph node sampling was obtained from 59 of 60 patients (98%). We were able to make a diagnosis in 45 of 60 patients (75%). TBNA was the only tool of diagnosis in 30 of the 60 patients (50%). Diagnoses included tuberculosis (n = 21), sarcoidosis (n = 21), carcinoma (n = 15), and lymphoma (n = 3). Adequate material was obtained from 20 of 21 patients with tuberculosis. The diagnosis made by TBNA was tuberculosis in 13 of 20 cases (65%). In 12 patients, diagnosis of tuberculosis was made cytologically; for the remaining 1 patient, mycobacterial culture was used. TBNA was the only diagnostic tool utilized in 8 of 20 patients with tuberculosis (40%). Diagnostic material was obtained from 16 of 21 patients with sarcoidosis (76%). In sarcoidosis, TBNA provided the only diagnostic specimen in 13 of 21 patients (62%). In all 15 patients with carcinoma (100%), diagnostic materials were obtained. Adequate but nondiagnostic samples were obtained from two patients with lymphoma, and one patient had lymphoma successfully diagnosed with TBNA. No complications were seen except minimal bleeding.

CONCLUSION

TBNA performed with a Wang 22-gauge cytology needle is an effective and safe way of obtaining cytologic specimens from intrathoracic lymph nodes and can rapidly provide diagnosis, both in malignant and benign mediastinal diseases. Hopefully, this technique will reduce further need for more invasive surgical procedures.

Gene polymorphisms of endothelial nitric oxide synthase enzyme associated with pulmonary hypertension in patients with COPD

In this cross-sectional controlled study, we aimed to investigate the role of polymorphisms of the angiotensin-converting enzyme (ACE) and endothelial nitric oxide synthase (eNOS) genes on pulmonary hypertension (PH) in patients with chronic obstructive pulmonary disease (COPD). Forty-two (41 male, 1 female, mean age: 62 +/- 7 years) COPD patients and 40 (all male, mean age: 60 +/- 8 years) healthy controls were included. Respiratory function tests, arterial blood gases, and echocardiographic examinations were performed. ACE and eNOS genotypes were determined using PCR. The ACE and eNOS genotype distribution was not significantly different between COPD patients and controls. On comparing pulmonary artery pressures in different eNOS genotypes, the mean pulmonary artery pressure (Ppa) in patients with the BB genotype was significantly higher than in patients with the nonBB genotypes (41.3 +/- 17.7 mmHg vs. 27.3 +/- 11.2 mmHg, P = 0.02). However, there was no difference in ACE genotype distributions between COPD patients with and without pulmonary hypertension. In stepwise linear regression analysis for predicting pulmonary artery pressure, PaO2 and polymorphism of eNOS gene were found to be independent variables. In conclusion, BB-type polymorphism of the eNOS gene has been associated with PH in addition to hypoxemia. However, ACE gene polymorphism was not found to be associated with PH.

A STATISTICAL ANALYSIS OF THE EFFECTS ON SURVIVORS OF THE 1999 EARTHQUAKE IN TURKEY

In the 17 August 1999 Kocaeli Earthquake about 20,000 people died and 3,000,000 were affected either directly or indirectly. A survey of earthquake victims in Kocaeli and Adapazari (two cities in North-Western Turkey) was conducted 8 months after this major earthquake to find out its physically and psychologically destructive effects. For this purpose a questionnaire containing 25 questions was given to 800 people in Kocaeli and Adapazari where the most destruction and greatest number of deaths occurred. Results indicate that changes in expectations from life after an earthquake are highly correlated with gender, marital status, and education level

A MODEL FOR RISKY DRIVING ATTITUDES IN TURKEY

Different research traditions have attempted to explain individual differences in risky driving behavior and traffic accident involvement. This study was designed to improve a model for risky driving attitudes (RDA) and to understand the mechanisms underlying drivers' risk-taking behavior in traffic. The questionnaire used in this study was composed of “the driver's behavior” questionnaire, improved by Reason, Manstead, Stradling, Baxter, and Campbell, (1990), and “the scales measuring attitudes and behavior” questionnaire, improved by Ulleberg and Rundmo (2003). The questionnaire survey was carried out among 600 drivers. Analysis revealed that risky drivers' attitudes are related to factors such as obedience to speed rules, risk-taking tendency in traffic and positive attitudes towards traffic.

CONSUMER BEHAVIOR IN SHOPPING CENTER CHOICE

This study was designed to research factors which consumers consider when choosing a shopping center and to develop a suggestion model for shopping center choice. First a questionnaire about choosing a shopping center was formed. Then the questionnaire was given to 300 randomly chosen consumers and collected on the next day. Two hundred and sixty-two fully filled out questionnaires were analyzed. Besides demographic questions, effective factors determining people's shopping center choice were asked for 17 items. Four models related to latent variables assumed to affect choice of a shopping center were tested by using the LISREL computer program with Structural Equation Modeling (SEM). Features of materials sold and geographical location of shopping center play very important roles in choice of a shopping center.

Fagerstrom test for nicotine dependence: reliability in a Turkish sample and factor analysis

Fagerstom Test for Nicotine Dependence (FTND) has often been used as a measure of physical dependence on nicotine. In this study, we aimed to verify the usefulness of FTND and Heaviness of Smoking Index (HSI) in a sample of Turkish smokers and present relationship among interrelated items in our Turkish version of FTND by factor analysis. One hundred sixty nine smokers, 104 (61.5%) males, 65 (38.5%) females smoker were administered the Turkish translation of FTND. Fifty-two current smokers selected randomly from 169 were administered the questionnaire for test- retest reliability analysis. The Turkish version of FTND had moderate reliability (Cronbach alpha: 0.56). One FTND item (question 3: hate- most to give up) performed poorly on construct reliability tests. Factor 1 was loaded by questions 1 (first cigarette after awakening), 4 (number of cigarettes per day), 5 (smoking status during the first hours), 6 (smoking if ill), 2 (refrain from smoking in forbidden places) and factor 2 was separately loaded by question 3. Question 3 did not have significant correlation with the total score and the response to this question was significant between test and retest. The Turkish version of FTND may become a measuring tool in the assessment of smoking cessation programs. However, question 3 must be used attentively and preferably an explanation should be made to enable a clear understanding of the question to the Turkish smokers as they take the test.

A case report of endobronchial semi-invasive aspergillosis

Pulmonary aspergillosis may be classified under three main categories. These are invasive pulmonary aspergillosis, allergic bronchopulmonary aspergillosis and aspergilloma. Sometimes more than one form of the disease may be present at the same time. Semi-invasive aspergillosis is different from aspergilloma in that there is local invasion of the lung tissue. We have observed a previously healthy 42 year old female with a solitary pulmonary nodule on her radiograms. A diagnosis of endobronchial semi-invasive aspergillosis was established in this patient. We aimed to present this case report with a review of the literature.

Prognostic significance of DNA topoisomerase II-alpha (Ki-S1) immunoexpression in endometrial carcinoma

OBJECTIVE

In order to determine the significance of proliferative activity (PA) in endometrial carcinomas, we analysed the expression of cell cycle-related antigens in routinely processed tissue.

MATERIALS AND METHODS

Serial sections of 113 endometrial carcinoma specimens were immunostained with the monoclonal antibody DNA Topoisomerase II-alpha (Ki-S1). In addition to Topoisomerase II-alpha (Ki-S1) staining, histologic type, International Federation of Gynecology and Obstetrics (FIGO) stage. FIMO grade, depth of myometrial invasion, tumor size, lymphovascular space invasion, serosal and/or adnexal involvement, lymph node metastasis, age and peritoneal cytology were evaluated as prognostic indicators. The median follow-up time was 23 (range, 1 to 126 ) months.

RESULTS

FIGO stage, FIGO grade, tumor size, lymphovascular space invasion, lymph node metastasis, peritoneal cytology and Topoisomerase II-alpha (Ki-S1) expression all significantly influenced survival in univariate analyses (p < or = 0.05). In the Cox regression analysis, Topoisomerase II-alpha (Ki-S1), serosal and/or adnexal involvement, and lymph node metastasis expression were the only variables with independent prognostic impact (p < or = 0.05), whereas FIGO stage, FIGO grade, histologic type FIGO grade, depth of invasion, tumor size, lymphovascular space invasion, age and peritoneal cytology had no independent influence (p > 0.05). Topoisomerase II-alpha (Ki-S1) staining was significantly elevated in advanced (Stage II, III, IV) as opposed to early (Stage I) carcinomas (p < or = 0.05).

CONCLUSION

The association with established prognosticators for endometrial carcinomas, and the results of uni- and multivariate analysis indicate that the additional evaluation of DNA Topoisomerase II-alpha (Ki-S1) peptide antibody (PA) is useful for classifying patients into subgroups with low and high risk of relapse which might help to individualize the therapeutic strategy in endometrial carcinomas.

Comparison of clinical and surgical-pathologic staging of the patients with non-small cell lung carcinoma

OBJECTIVE

Clinical staging of non-small cell lung cancer helps to determine the extent of disease and separate patients with potentially resectable disease from those that are unresectable. Since, clinical staging is based on radiologic and bronchoscopic findings, overstaging or understaging may occur comparing to the final surgical-pathologic evaluation. We aimed to analyze preoperative and postoperative stagings in order to evaluate stage migrations and our surgical strategy for marginally resectable patients.

METHODS

We did a retrospective analysis of 180 patients with non-small cell lung cancer who underwent resectional surgery between 1994 and 2000. In all patients, a thoracic computerized tomography and bronchoscopy were performed to define clinical staging (cTNM).

RESULTS

In 86 patients (47.7%) clinical and surgical-pathologic staging concurred. When comparing T subsets alone, correct staging, overstaging and understaging occurred in 133 (73.9%), 28 (15.5%), 47 (26.1%) patients, respectively. Only 13 of 21 patients (61.9%) who were thought to have T4 tumor preoperatively were found to have pT4. Also six patients with cT2 and five patients with cT3 were subsequently found to have T4 disease according to pathology. Clinical staging overestimated the nodal staging in 35 patients (19.4%), while underestimated the lymph node involvement in 45 patients (25%).

CONCLUSION

Construction of cTNM stage remains a crude evaluation, preoperative mediastinoscopy in every patient must be performed. Preoperative limited T4 disease is not to deny surgery to patients since a considerable number of patients with cT4 are to be understaged following surgery.

Ventricular arrhythmias in patients with COPD are associated with QT dispersion

STUDY OBJECTIVE

QT dispersion (QTd) and late potentials derived from signal-averaged ECG (SAECG) have been proposed as noninvasive predictors of cardiac arrhythmias that occur in patients with COPD. In this study, we aimed to investigate QTd and SAECG in patients with COPD.

DESIGN

Cross-sectional study.

SETTING

Teaching chest disease hospital and cardiology center in a university hospital.

PATIENTS

Thirty patients with COPD (28 men and 2 women; mean +/- SD age, 60 +/- 9 years) and 31 age- and sex-matched control subjects (28 men and 3 women; mean age, 57 +/- 7 years) were included.

MEASUREMENTS AND RESULTS

Respiratory function tests, arterial blood gas analyses, echocardiographic examinations, rhythm Holter recordings, and heart rate variability (HRV) analyses were performed in addition to the measurements of QT intervals and SAECG. Patients with COPD had higher rate of ventricular premature beats (VPBs) as compared to control subjects (924 +/- 493 beats vs 35 +/- 23 beats, p = 0.009). Eight patients with COPD (27%) had nonsustained runs of ventricular tachycardia (VT). QTd rates were significantly increased in patients with COPD as compared to control subjects (57.7 +/- 9.9 ms vs 37.5 +/- 8.2 ms, p < 0.001). On comparing patients with COPD with and without runs of VT, patients with VT had longer QTd (67 +/- 10 ms vs 55 +/- 8 ms, p = 0.001). However no difference in any HRV and late potential parameters were found between patients with COPD with and without runs of VT. VPB rates were strongly correlated with QTd in patients with COPD (r = 0.61, p < 0.001). On SAECG analysis, patients with COPD had significantly increased total QRS duration as compared to control subjects. Nine of the 30 patients with COPD (30%) had positive late potentials. However, QTd and VPB rates were also similar between patients with COPD with and without late potentials.

CONCLUSIONS

The development of ventricular arrhythmia in patients with COPD was associated with increased QTd. Increased QTd may be associated with autonomic changes seen in patients with COPD.

Transbronchial needle aspiration in the diagnosis of intrathoracic lymphadenopathy

BACKGROUND

Transbronchial needle aspiration (TBNA) of intrathoracic lymph nodes has been shown to be useful in the diagnosis and staging of bronchogenic carcinoma. The usefulness of TBNA has not been widely investigated in benign disease other than sarcoidosis.

OBJECTIVES

We investigated the diagnostic value of TBNA in consecutive patients who were referred to Yedikule Hospital of Chest Disease and Thoracic Surgery because of mediastinal and/or hilar adenopathy.

METHODS

A total of 29 TBNA procedures were performed in 28 patients who had mediastinal or hilar adenopathy identified by computed tomography of the chest. TBNA of enlarged lymph nodes was performed using a flexible bronchoscope (BF 30T, Olympus) and a 19-gauge needle capable of obtaining core biopsy specimens (MW-319 Mill-Rose Laboratories, Mentor, Ohio, USA) from endobronchial or endotracheal locations. All patients had at least three examinations of sputum smears for acid-fast bacilli prior to bronchoscopy and the results of sputum smears were found to be negative.

RESULTS

Adequate lymph node samplings were obtained by TBNA in 23 of 29 (79%) procedures. Diagnostic samples were obtained by TBNA in 20 of 29 (69%) procedures. We were able to make a diagnosis in 20 of 23 (87%) patients in whom adequate lymph node samples were obtained by TBNA. TBNA was the only means of diagnosis in 13 of 28 (46%) patients. The diagnoses provided using TBNA were tuberculosis in all of 10 patients (100%), sarcoidosis in 7 of 8 patients (87.5%), lymphoma in 1 of 2 patients (50%), small cell carcinoma in 1 patient and nonspecific lymphadenitis in 1 patient. No complication was observed and there was only minimal bleeding.

CONCLUSIONS

We conclude that TBNA, using 19-gauge histologic needles through a flexible bronchoscope, is a valuable tool in the diagnosis of intrathroracic adenopathy, particularly in patients with tuberculosis and sarcoidosis. TBNA should be considered in the diagnosis of intrathoracic adenopathy before other invasive procedures.

Natural killer cell activity in multidrug-resistant pulmonary tuberculosis

BACKGROUND

Multidrug-resistant pulmonary tuberculosis (MDRTB), a major problem in developing countries, may result from either insufficiency of host cellular immune response or mycobacterial mechanisms which has been more intensively investigated so far.

OBJECTIVES

The aim of the study was to investigate natural killer cell activity (NKA) and T lymphocyte subsets in HIV- patients with secondary MDRTB.

METHODS

20 male patients with MDRTB (mean age 38 +/- 8 years), 15 nonresistant tuberculosis male patients (NRTB) (mean age 36 +/- 11 years) and 12 healthy male controls (mean age 35 +/- 8 years) were included. The percentages of CD3+, CD4+, CD8+, CD25+, CD11b+ and CD16+56+ cells were measured by flow-cytometric analysis of peripheral blood lymphocytes (PBL). NKA was evaluated using the anticandidal index method.

RESULTS

The mean tuberculin response was higher in MDRTB and NRTB patients compared to controls (15.4 +/- 3.8, 15.1 +/- 3.3 and 10.9 +/- 2.8 mm, respectively; p < 0.001). There was no significant correlation between PPD response and PBL subsets or NKA. The percentages of both CD3+ and CD3+CD4+ T lymphocytes were significantly lower in MDRTB (62.4 +/- 12.1 and 33.9 +/- 9.0%) compared to NRTB (70.8 +/- 7.5 and 42.9 +/- 8.6%; p < 0.05). Patients with MDRTB had significantly lower NKA compared to NRTB and controls (30.9 +/- 11.3, 49.7 +/- 15.5 and 40.0 +/- 8.5%, respectively; p < 0.01).

CONCLUSION

This reduction in NKA may suggest a role for impaired NK function in the pathogenesis of MDRTB in HIV- patients.

Penetration of ciprofloxacin into pleural fluid

The penetration of oral 1000 mg/day ciprofloxacin into pleural fluid is investigated in 15 patients with exudative pleural effusion. After 4 days of ciprofloxacin therapy ciprofloxacin concentrations were measured in plasma and pleural exudate simultaneously by high-performance liquid chromatography (HPLC). Mean serum ciprofloxacin level was 1.58 +/- 0.91 mg/L and mean pleural exudate concentration was 1.00 +/- 0.59 mg/L. The concentrations achieved were all above the MIC90 of the majority of Gram-positive and Gram-negative pathogens. It is concluded that ciprofloxacin penetrates well into the pleural fluid.