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.

A few previous studies have reported that the patients with chronic obstructive pulmonary disease (COPD) have a 29.1% to 36.8% frequency of restless legs syndrome (RLS). In this study, we observed RLS symptoms in patients experiencing COPD exacerbation to better understand the relationship between the many clinical parameters of COPD and the presence of RLS and to attract the attention of specialists on the association between the two conditions. Twenty-two male patients in COPD exacerbation; 17 healthy individuals were evaluated in this study. The patients were evaluated using the 2003 RLS symptom criteria outlined by the International Restless Legs Syndrome Study Groups (IRLSSG). The Pittsburgh Sleep Quality Index and Epworth daytime sleepiness scale were used to assess the sleep quality of patients. The RLS symptoms were correlated with blood levels of laboratory and clinical parameters. Statistical analyses were performed using SPSS 17.0 statistical software packet. The Pittsburgh Sleep Quality Index and Epworth daytime sleepiness scale scores were increased in COPD patients and correlated significantly with RLS symptoms. It was found that 54.5% of COPD patients with acute exacerbations were observed to have RLS symptoms. The Pittsburgh Sleep Quality Index was significantly higher in COPD patients with RLS symptoms compared to COPD patients without RLS symptoms (p < 0.05). We did not observe any significant difference in the previously reported metabolic and clinical parameters associated with RLS in COPD patients with and without RLS. RLS symptoms increase during COPD exacerbation and lead to decreased sleep quality.

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.

Objectives: The frequency and success rates of lung transplant in patients with end-stage lung disease are increasing. In our study, we investigated the effects of preoperative pulmonary rehabilitation on pulmonary function, exercise capacity, and quality of life in patients who are candidates for lung transplant. Materials and Methods: This prospective study included 39 consecutive patients who were candidates for lung transplant. All patients underwent preoperative pulmonary rehabilitation for at least 3 weeks. Results: Our patient group included 25 male and 14 female patients with a mean age of 36 years (range, 15 -68 y). Although no significant improvement was shown in the forced expiratory volume in 1 second after pulmonary rehabilitation, significant improvements were observed in the Modified Medical Research Council dyspnea scores (P = .001) and 6-minute walk distance (P = .001). We also observed statistically significant improvements in the ShortForm 36 Quality of Life Questionnaire's physical function (P = .01) and emotional role (P = .02) subparameters. We also found a significant improvement in the Beck Depression Inventory score (P = .004). There was no correlation between Beck Depression Inventory scores before and after rehabilitation and 6-minute walk distance, Short-Form 36, and Modified Medical Research Council dyspnea scores. Conclusions: Our results suggest that preoperative pulmonary rehabilitation improves exercise capacity, reduces the sensation of dyspnea and muscle strength loss, and has a positive effect on the psychologic state of patients who are candidates for lung transplant. Key words: Dyspnea, Muscle loss, Psychologic assessment IntroductionLung transplant is the last treatment option for endstage lung disease patients for whom conservative treatments have failed. 1 A pulmonary rehabilitation (PR) program has an important role in this group of patients who have chronic lung diseases and complex medical histories. 2 Studies have shown positive effects of PR programs in patients who are on wait lists for transplant and have shown that postoperative outcomes are improved in patients who can obtain higher preoperative exercise capacity. 3 In chronic pulmonary diseases such as chronic obstructive pulmonary disease, bronchiectasis, and interstitial lung disease, the efficacy and reliability of exercise have been well-documented. [4][5][6] However, data are still scarce on the safety and efficacy of exercise in patients with end-stage lung disease who are transplant candidates. Evidence-based exercise training programs for pre-and postoperative stages of transplant have not yet been developed. Considering the exercise principles and recom mendations in the guidelines for the care of adults with chronic pulmonary disease, exercise training programs should be established to offer optimal health benefits for transplant candidates on wait lists. 7 Patients prepared for lung transplant are a select patient population with advanced chronic lung disease. These patients typically have ven...

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