Long-term silicone airway stents may present challenges during removal, particularly when rigid bronchoscopy cannot be performed. We present the case of a 46-year-old woman with a tracheoesophageal fistula who had a silicone stent placed 15 years earlier following surgical repair after difficult intubation during hysterectomy. Due to the tracheal anatomy, rigid intubation was unsuccessful at that time, necessitating prolonged stent placement. Recently, the patient presented with dyspnea and wheezing, and bronchoscopy revealed distal stenosis near the stent. In our clinic, flexible bronchoscopy and balloon dilation were performed. Initial attempts to remove the stent using foreign-body forceps were unsuccessful due to fragmentation. The stent was ultimately removed using an endotracheal tube cuff, a technique that, to our knowledge, has not been previously described. Following stent removal, cryotherapy was applied to treat granulation tissue, and follow-up bronchoscopy demonstrated significant improvement. This case, representing one of the longest reported follow-ups of a silicone airway stent, highlights an effective alternative technique for stent removal that avoids high-risk surgery and may contribute to airway management strategies.
BACKGROUND AND AIM: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death and disability worldwide. Precise survival estimates and identification of mortality risk factors are crucial for managing COPD. This prospective study aimed to investigate the survival rate and identify predictors of mortality in patients with COPD. METHODS: We investigated the association of various factors with three-year survival rates in our COPD cohort. Patients (n=176) underwent baseline assessments including demographics, comorbidities, questionnaires, laboratory findings, and long-term oxygen therapy/bilevel positive airway pressure (LTOT/BPAP) use. The primary endpoint was completion of three-year follow-up, and the secondary endpoint was all-cause mortality. Cox regression analysis was used to explore factors associated with mortality. Survival analysis was performed using the Kaplan-Meier method. RESULTS: This prospective cohort study of 176 COPD patients (65.4 years old, mostly male) identified a three-year overall survival rate of 86.4%. Age >= 68.5 years (p<0.001), Charlson Co-morbidity Index (CCI) scores >= 4.5 (p<0.001), and eosinophil counts <= 45 cells/mu L (p<0.001) were independently associated with poorer survival. LTOT use (p=0.001) was also associated with reduced survival. CONCLUSIONS: In this prospective cohort study, age, CCI, LTOT use, and baseline eosinophil count were associated with survival and identified as predictors of mortality. An age cut-off of >= 68.5 years and a CCI cut-off score of >= 4.5 were associated with increased mortality risk, while lower baseline eosinophil counts (cells/mu L) predicted poorer survival in this COPD cohort.
BACKGROUND AND AIM: Malignant pleural effusion (MPE) is a common complication of advanced cancer. Both large-bore chest tubes (>= 20 Fr) and small-bore catheters (<= 14 Fr) are used for drainage and pleurodesis; however, their effects on patient comfort and clinical outcomes remain unclear. This study compared comfort, efficacy, pleurodesis success, and complication rates between these methods. METHODS: This prospective comparative study enrolled 146 patients with MPE who underwent physician-directed allocation to receive either a large-bore (n=73) or small-bore (n=73) intercostal catheter (ICC) under local anesthesia, followed by talc pleurodesis after lung re-expansion. Outcomes included procedure duration, pain scores, drainage parameters, pleurodesis success, complications, and four-week follow-up. RESULTS: Baseline characteristics were comparable between groups. Large-bore tubes required a longer insertion time (23.6 +/- 2.6 vs. 11.0 +/- 1.8 min, p<0.001) and were associated with higher pain scores immediately post-insertion (6.9 +/- 1.4 vs. 4.9 +/- 1.3, p<0.001), at 6 hours (5.1 +/- 1.3 vs. 3.7 +/- 1.1, p<0.001), and at 24 hours (3.3 +/- 1.2 vs. 2.4 +/- 1.0, p<0.001). Drainage volume was higher (1594 +/- 340 vs. 1331 +/- 415 mL, p<0.001), and time to complete drainage was shorter (34.9 +/- 8.8 vs. 39.5 +/- 10.5 h, p=0.005) in the large-bore group. Pleurodesis success was comparable (71.2% vs. 68.5%, p=0.686), as was drainage efficacy (80.8% vs. 76.7%, p=0.544). Blockage occurred more frequently in small-bore catheters (5.5% vs. 1.4%, p=0.366), whereas infection (6.8% vs. 1.4%, p=0.209) and dislodgement (5.5% vs. 2.7%, p=0.681) were more common with large-bore tubes. CONCLUSIONS: Both large- and small-bore chest tubes were effective for pleurodesis in MPE. Large-bore tubes enabled faster and higher-volume drainage but were associated with greater pain and longer procedure times, whereas small-bore tubes provided better patient comfort with comparable efficacy. Small-bore tubes are preferable in most cases, while large-bore tubes may be suitable when rapid, high-volume drainage is required.
Hypersensitivity pneumonitis is a rare disease that affects the pulmonary, cardiovascular, and musculoskeletal systems. Severe desaturation and hypoxemia reduce exercise capacity and exacerbate symptoms. Rehabilitation is essential for these patients to prevent symptom progression and manage the adverse effects of hypoxemia. This study aimed to present the pre- and post-rehabilitation outcomes of three patients with hypersensitivity pneumonitis who completed individualized rehabilitation programs in our unit. The programs included aerobic ex- ercise training, inspiratory muscle training, resistance exercises, and neuromuscular electrical stimulation, delivered two-three times per week over six-eight weeks. Functional exercise ca- pacity was assessed using the six-minute walk test; upper-extremity functional capacity with the six-minute pegboard and ring test; respiratory muscle strength with a mouth pressure device; peripheral muscle strength with a hand-held dynamometer; dyspnea using the Modified Medical Research Council scale; and physical activity level with a metabolic holter and the International Physical Activity Questionnaire - Short Form. Forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) values increased in two cases. FEV1/FVC improved in one case and remained unchanged in another. Forced expiratory flow at 25% to 75% of the pulmonary volume (FEF25-75%) and diffusing capacity of the lung for carbon monoxide (DLCO) increased in one case and decreased in another, while peak expiratory flow (PEF) increased in both. Respiratory muscle strength significantly improved in all cases. Inspiratory muscle endurance improved in two cases. Upper- and lower-extremity exercise capacity and peripheral muscle strength increased in all cases. Dyspnea and physical activity levels also improved across the board. This study indicates that a well-structured, individualized pulmonary rehabilitation (PR) program, tailored to the patient's needs, can improve dyspnea, physical activity, muscle strength, and pulmonary function in individuals with hypersensitivity pneumonitis.
BACKGROUND AND AIM: Long-term oxygen therapy (LTOT) improves survival and outcomes in chronic respiratory failure. This multicenter study assesses the factors affecting adherence in patients undergoing long-term oxygen therapy and evaluates its impact on the frequency of hospital visits. METHODS: Clinical and demographic data of patients receiving LTOT who were admitted to the study centers between January 1 and June 30, 2024, were recorded. Patients who adhered to LTOT for >= 15 hours per day, including both daytime and nighttime use, were classified as fully adherent. Data from adherent patients were compared with those of non-adherent patients. Factors affecting LTOT adherence were determined using logistic regression analysis. RESULTS: Among the 374 patients who met the inclusion criteria, 40.6% were classified as adherent to LTOT. Emergency room visits (median: 3/year) and hospital admissions (median: 1/ year) were more frequent among LTOT-adherent patients over the past year. Regression analysis identified a body mass index (BMI) <25 kg/m(2) and type 2 respiratory failure as independent predictors of LTOT adherence. Among patients with type 2 respiratory failure, those with a BMI <25 kg/m(2) were found to be more likely to adhere to LTOT, with a specificity of 74.1% and a sensitivity of 44.9%. A reduction in the frequency of emergency room visits was observed in the group that adhered to LTOT for one year. CONCLUSIONS: A BMI <25 kg/m(2) and type 2 respiratory failure can predict adherence to LTOT.
BACKGROUND AND AIM: Pneumoconiosis occurs as a result of an inflammatory response. Despite precautions, it continues to be an important public health issue worldwide. Monitoring prognosis in pneumoconiosis is particularly important because no effective disease-modifying treatment currently exists. In recent years, hemogram parameters have been increasingly investigated as prognostic indicators across various diseases. This study aimed to compare hemogram parameters between patients with pneumoconiosis and workers with similar occupational exposure who had not been diagnosed with pneumoconiosis. METHODS: A total of 207 patients with pneumoconiosis and 193 controls were included in the study. Collected data included demographic characteristics, occupational history, hemogram parameters, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and radiological imaging findings. RESULTS: Lymphocyte (Lym), hemoglobin (Hb), mean corpuscular volume (MCV), and mean platelet volume (MPV) levels were found to be significantly lower, whereas white blood cell (WBC) count, red cell distribution width (RDW), platelet count (PLT), platelet distribution width (PDW), NLR, PLR, and SII levels were significantly higher in the pneumoconiosis group compared to the control group. Statistically significant differences were also observed in WBC, neutrophil (Neu), Lym, PLT, NLR, PLR, and SII levels across different International Labour Organization (ILO) profusion categories and large opacity sizes. When a cut-off value of 2.4 was applied for NLR among pneumoconiosis cases, the presence of complicated pneumoconiosis was 3.8-fold more prevalent (p<0.001). Similarly, using a PLR cut-off value of 131.2, the likelihood of complicated pneumoconiosis increased 3.0-fold (p=0.002). In addition, applying an SII cut-off value of 522.06 resulted in a 3.6-fold higher detection rate of complicated pneumoconiosis (p=0.001). CONCLUSIONS: Pneumoconiosis may continue to progress even after exposure has ended. In addition to radiological imaging and pulmonary function tests, routine monitoring of hemogram-derived inflammatory markers such as NLR, PLR, and SII could provide important prognostic insights. These parameters could serve as accessible, cost-effective indicators to support clinical follow-up in affected individuals.
BACKGROUND AND AIM: Chronic obstructive pulmonary disease (COPD) is a systemic condition. Oxidative stress and air trapping may lead to alterations in diaphragm mobility and thickness. Therefore, assessing diaphragm function in these patients is of great importance. The aim of this study is to evaluate diaphragm thickness and mobility using ultrasonography in COPD patients and to determine their relationship with clinical classification and exacerbation frequency. METHODS: This single-center, prospective study assessed diaphragm excursion, diaphragm thickness, inspiratory and expiratory durations, contraction speed, and thickening fraction using ultrasound. Spirometry and diffusing capacity for carbon monoxide were performed, and lung volumes and capacities were calculated. Patients were followed for three months to record the number and severity of exacerbations and hospitalizations. Diaphragm parameters were compared with clinical and functional tests to examine their association with COPD classification and exacerbations. RESULTS: A total of 81 patients, 70 of whom were male, were included in the study. Diaphragm excursion during deep inspiration showed a significant negative correlation with FEV1 classification (r=-0.38, p<0.001). Significant correlations were also observed between diaphragm excursion during deep inspiration and residual volume (RV) (%; L) (r=-0.39, p<0.001; r=-0.37, p<0.001) and the residual volume/total lung capacity ratio (RV/TLC) (r=-0.52, p<0.01). Diaphragm excursion during deep inspiration significantly decreased with increasing Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage (p=0.007). No significant differences were found between diaphragm thickness and either GOLD or FEV1 classification. During the three-month follow-up, patients with lower diaphragm excursion during deep inspiration experienced significantly more exacerbations (p=0.012). CONCLUSIONS: Our study demonstrated that diaphragmatic excursion during deep inspiration is associated with GOLD classification, FEV1 severity, and the frequency of acute exacerbations. Our findings suggest that diaphragmatic dysfunction in this context is more closely related to impaired mobility than to reduced muscle thickness. Although diaphragmatic excursion was significantly associated with exacerbation risk in univariate analysis, it did not remain an independent predictor after multivariable adjustment. Further longitudinal studies are warranted to better define the prognostic significance of diaphragmatic excursion in COPD.
BACKGROUND AND AIM: Interstitial lung disease (ILD) includes a spectrum of lung disorders with various causes, pathological changes, treatment strategies, and prognoses. Lung biopsy is often cru- cial for diagnosing ILD subtypes, especially in complex cases. However, biopsy procedures carry signif- icant risks due to potential postoperative complications. This study aimed to assess the rate and types of postoperative complications in ILD patients following lung biopsy and to examine their relationship with patient demographics, lung function, and comorbidities. METHODS: We conducted a retrospective, cross-sectional review of ILD patients who underwent surgi- cal lung biopsy at Akdeniz University Hospital between January 1, 2017 and December 31, 2022. Data collected included demographics, comorbidities, pulmonary function tests (forced expiratory volume in one second [FEV1] and forced vital capacity [FVC]), type of surgery (video-assisted thoracoscopic surgery [VATS] or thoracotomy), biopsy location, hospital stay duration, and postoperative complications (pneumonia, prolonged air leak, hypoxia, pneumothorax, subcutaneous emphysema, pleural effusion, and mortality). Statistical analyses were performed to identify factors associated with complication rates. RESULTS: Among the 140 patients analyzed, the mean age was 56.9 +/- 11.1 years, with 50.7% female. Postoperative complications occurred in 22.1% of patients, with hypoxia, pneumonia, and prolonged air leak being the most frequent. Lower FEV1 was significantly associated with higher complication rates (p=0.018), while hospital stays longer than five days were also associated with increased complication rates (p<0.001). Sex, body mass index (BMI), and comorbidities showed no significant associations with complication rates. CONCLUSIONS: Our findings reveal an increased risk of complications in ILD patients undergoing lung biopsy, particularly among those with lower FEV1 and longer hospital stays. These results under- score the importance of thorough preoperative evaluation and suggest that VATS may be preferable to more invasive methods for ILD diagnosis.
