Akciðer enfeksiyonlarýna sekonder olarak plevral boþlukta biriken sývý parapnömonik efüzyon olarak adlandýrýlýr. Parapnömonik efüzyonlara sýklýkla bakteriyel ve viral pnömoniler neden olurlar ve bu efüzyonlarýn komplike olmasý ile plevral boþlukta pü birikerek ampiyem ortaya çýkar. Eriþkin ve çocuklarda en sýk ampiyeme sebep olan mikroorganizmalar, Streptococcus pneumoniae, Staphylococcus aureus ve Streptococcus pyogenes’tir. Klinik görünüm; sebep olan mikroorganizmaya, plevral alandaki pü oranýna ve hastanýn genel durumuna baðlýdýr. Taný radyolojik olarak konur. Plevral mayi drene edilmez ise geliþen ampiyem fizyopatolojik olarak üç aþamada kronik faza ilerler. Parapnömonik sývýlarýn erken tespit edilip, uygun antibiyoterapi ile ampiyem geliþiminin önlenmesi, daha invazif tedavilere gereksinimini azaltacaktýr. Ampiyemin tedavisinde ise videotorakoskopik delokülasyon/dekortikasyon veya torakotomi ile dekortikasyon gibi cerrahi yöntemler gerekir.

Parapneumonic effusion is fluid accumulation in the pleural space secondary to pulmonary infections. The most frequent causes of parapneumonic effusion are bacterial and viral pneumonias. As a result of complications in this fluid and collection of pus in the pleural space, empyema develops. Microorganisms that cause empyema most frequently in adults and children are; Streptococcus pneumoniae, Staphylococcus aureus and Streptococcus pyogenes. Clinical appearance depends on the causative microorganism, amount of pus in the pleural space and general status of the patient. The diagnosis is made radiologically. If pleural fluid is not drained, the empyema goes on to the chronic phase in three stages physiopathologically. Determining parapneumonic fluids earlier and preventing empyema by proper antibiotherapy will decrease the necessity for more invasive treatments. In the treatment of empyema, surgical methods such as video thoracoscopic deloculation/decortication or decortication with thoracotomy are applied.

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Malign plevral sývýlar günlük pratikte göðüs hastalýklarý uzmanlarýnýn karþýlaþtýðý en sýk problemlerden biridir. Malign plevral sývýlarýn tanýsý malign hücrelerin plevral sývý veya dokuda gösterilmesini gerektirir. Medikal torakoskopi plevral yüzeylerin direkt gözlemlenmesine, uygun alanlardan plevral biyopsi alýnmasýna, sývýnýn çýkarýlmasýna ve talkýn püskürtülmesi ile plöredezis yapýlmasýna olanak saðlar. En yaygýn kullaným alaný nedeni bilinmeyen eksüdatif vasýftaki plevral sývýlarýn deðerlendirilmesidir. Deneyimli ellerde iyi tolere edilen ve güvenli bir yöntemdir.

Malignant pleural effusion is one of the most common problems that chest physicians face in their everyday practice. The diagnosis of malignant pleural effusion requires either a histological or cytological demonstration of malignant cells in the pleural tissue or pleural fluid. Medical thoracoscopy allows direct visualization of the pleural surfaces, allowing pleural biopsies, removal of pleural fluid and pleurodesis, often using talc insufflation. The most common indication for thoracoscopy is evaluation of the undiagnosed exudative pleural effusions. When performed by well-trained personnel, thoracoscopy is a safe and well tolerated procedure.

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Dünyada akciðer transplantasyonu tarihçesi, deneysel çalýþmalarýn yapýlmaya baþlandýðý 20. yüzyýlýn ilk yýllarýndan itibaren James Hardy’ nin Amerika Birleþik Devletleri’nde 1963’te yaptýðý ilk klinik transplantasyona uzanýr ve hýzlanarak günümüze gelir. 2011 yýlýna kadar dünyada 40,000’in üzerinde kalp-akciðer ve akciðer transplantasyonu yapýlmýþtýr. Transplantasyon alanýndaki artan ihtiyaca ve baþarýlara paralel olarak transplant merkezleri ve hasta sayýlarý da giderek artmaktadýr. Türkiye’de 2009 yýlýnda Süreyyapaþa Göðüs Hastalýklarý ve Cerrahisi Eðitim ve Araþtýrma Hastanesi’ nde baþlayan akciðer transplantasyonlarý günümüzde iki merkezde aktif olarak yapýlmaktadýr. Bu derlemede, ülkemizdeki ilk baþarýlý akciðer transplantasyonu detaylandýrýlarak dünyada ve ülkemizdeki akciðer transplantasyonu tarihçesi gözden geçirilmektedir.

History of lung transplantation in the world dates back to the early 20 th century, continues to the first clinical transplantation performed by James Hardy in the United States of America in 1963 and comes to the present with increased frequency. Over 40.000 heart-lung and lung transplantations were carried out in the world up to 2011. The number of transplant centers and patients is flourishing in accordance with the increasing demand and success rate in that arena. Lung transplantations that started in Turkey at Sureyyapasa Teaching Hospital for Pulmonary Diseases and Thoracic Surgery in 2009 are being performed at two centers actively to date. This review covers a general outlook on lung transplantations both in the world and in Turkey with details of the first successful lung transplantation in our country.

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Amaç: Otoimmün hastalýklar belli bir organ veya hücre tipine yönelik immün reaksiyonlarý içerebilen, multisistemik hastalýklara yol açabilen durumlardýr. Otoimmün tiroiditin prevalansý %13,4 civarýndadýr ve çeþitli otoimmün hastalýklarla birlikte görülebilir. Biz de bu çalýþmamýzda interstisyel akciðer hastalýðý (ÝAH) ile otoimmün tiroid hastalýklarýnýn birlikteliðini deðerlendirmeyi planladýk.
Yöntemler: Çalýþmamýza ÝAH tanýsý ile takip edilen 24 olgu dahil edildi. Tüm olgulara tiroid fonksiyon testleri (TFT), tiroid otoantikorlarý ve tiroid ultrasonu ile deðerlendirme yapýldý. Endokrin Bölümü tarafýndan gerekli görülen olgulara tiroid iðne aspirasyon biyopsisi (TÝAB) yapýldý. Ayrýca diðer bir kolda otoimmün tiroidit tanýsý olan 19 hastaya da ÝAH yönünden deðerlendirilmesi için, akciðer grafisi, toraks yüksek çözünürlüklü bilgisayarlý tomografi (YÇBT), solunum fonksiyon testi (SFT) ve diffüzyon testi yapýldý.
Bulgular: ÝAH tanýsý olan 24 hastanýn yaþ ortalamasý 47,82±15,1 yýl idi (kadýn: 19, erkek: 5). ÝAH tanýlarý sýrasýyla sarkoidoz (n=10), tiplendirilemeyen (n=8), pulmoner langerhans hücreli histiyositozis (n=2), romatoid artrit akciðer tutulumu (n=2), pnömokonyoz (n=2) idi. Olgulardan 8 kiþide kronik tiroidit, 7 kiþide kronik tiroiditle birlikte multinodüler guatr (MNG), 2 kiþide diffüz guatr, 4 olguda MNG saptanýrken 3 kiþinin ise tiroid bulgularý normaldi. Mevcut bulgularla 15 hastada (%62,5) otoimmün tiroidit saptandý. Diðer kolda deðerlendirilen otoimmün tiroiditi olan 19 hastanýn tümü kadýndý ve yaþ ortalamasý 41,84±12,49 idi. Olgularýn hiçbirinde klinik, fizyolojik ve radyolojik olarak ÝAH ile uyumlu olabilecek bulgu yoktu.
Sonuç: Çalýþmamýzda ÝAH olan hastalarda otoimmün tiroidit birlikteliðini toplum prevalansýna göre anlamlý derecede yüksek tespit ettik. ÝAH tanýsý olan hastalarýn tiroid yönünden detaylý deðerlendirmelerinin yapýlmasýnýn olasý tiroid patolojisinin erken fark edilmesini saðlayacaðýný düþünmekteyiz.

Objective: Autoimmune diseases invlolve immune reactions to a particular organ or cell type and may lead to multisystemic diseases. The prevalance of autoimmune thyroiditis is 13.4% and it can exist together with other autoimmune diseases. In this study, we aimed to evaluate the association of interstitial lung disease (ILD) with autoimmune thyroid diseases.
Methods: In this study, 24 cases with the diagnosis of ILD were included. Thyroid function tests, thyroid auto-antibodies and thyroid ultrasonography were carried out on all cases. Thyroid fine needle biopsy was performed in some patients, with the indication of the endocrinology department, to confirm the diagnosis. On the other hand, 19 patients who were diagnosed with autoimmune thyroiditis were evaluated in terms of ILD with chest radiography, thorax high-resolution computed tomography, pulmonary function tests and diffusion test.
Results: The mean age of 24 patients diagnosed as ILD (19 females, 5 males) was 47.8±15.1 years. ILD diagnoses of patients were sarcoidosis (n=10), non-diagnostic (n=8), pulmonary Langerhans cell histiocytosis (n=2), pulmonary involvement of rheumatoid arthritis (n=2) and pneumoconiosis (n=2). Chronic thyroiditis (n=8), chronic thyroiditis with multinodular goiter (n=7), diffuse goiter (n=2) and multinodular goiter (n=4) were detected in cases with ILD. Only 3 patients’ thyroid findings were normal. Fifteen patients (62.5%) had autoimmune thyroiditis. On the other hand, the mean age of 19 patients with autoimmune thyroiditis (all patients were female) was 41.84±12.49 years. None of the patients had clinical, physiological or radiological findings for ILD.
Conclusion: In our study, we identified that the prevalence of autoimmune thyroiditis was significantly higher than normal in patients with ILD. We consider that detailed assessment in terms of thyroid disease will achieve early recognition of possible thyroid pathology for ILD diagnosed patients.

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Amaç: Poliklinikte kronik dispne nedenlerinin prospektif deðerlendirilmesi ve etkili tanýsal yaklaþým oluþturulmasý amaçlanmýþtýr.
Yöntemler: Kronik dispne için bir algoritma kullanýlarak prospektif çalýþma yapýldý. Tüm hastalar anamnez ve fizik muayeneyle deðerlendirildikten sonra kan testleri istendi, spirometri yapýldý ve akciðer filmi çekildi. Klinik olarak astým þüphesi olan ancak spirometride non-obstrüktif olan hastalarda metakolin provoakasyon testi yapýldý. Birinci basamak testler normal olan hastalarda yüksek rezolüsyonlu bilgisayar tomografi (YRBT), bilgisayar tomografi (BT), pulmoner anjiyografi ve transtorasik ekokardiyografiyle (TTE) ikinci basamak testler yapýldý.
Bulgular: Birinci basamak testlerle taný konulamayan kronik dispneli hastalarýn 58’ine ikinci basamak testler uygulandý. Klinik olarak astým þüphesi olan 12 hastada metakolin provoakasyon testi pozitifti ve astým tedavisine baþarýlý yanýt verdi. Bizim kullandýðýmýz algoritma ile hastalarýn yaklaþýk %90’ýna taný konuldu. Kronik dispnenin en sýk nedenleri astým (%27), kronik obstrüktif akciðer hastalýðý (KOAH) (%17), bronþiektazi (%13) ve kalp yetmezliði (%10) olarak izlendi.
Sonuç: Uyguladýðýmýz basamaklý tanýsal algoritma sonucu, kronik dispnenin sýklýkla nedeni havayolu ve kalp hastalýklarý olarak saptandý. Göðüs hastalýklarý polikliniðinde kronik dispneli hastalarda akciðer filmi ve spirometri birinci basamak testler olarak kullanýlabilir. Birinci basamak testler normal olduðu zaman, ikinci basamak testler olarak YRBT ve TTE’den yararlanýlabilir.

Objective: The aim of this study was to evaluate the causes of chronic dyspnea in patients of an outpatient clinic prospectively and to implement an efficient diagnostic approach.
Methods: A prospective study was performed with an algorithm for chronic dyspnea. After the patients were evaluated by the history and physical examination, blood tests, chest X-ray (CXR), and spirometry were performed in all cases. The methacholine inhalation challenge test was proposed as a diagnostic test in situations where clinical asthma is suspected and spirometric findings are non-obstructive. All patients whose basic tests were normal, high resolution computed tomography (HRCT), computed tomography (CT), pulmonary angiography, and transthoracic echocardiography (TTE) were performed as second step tests.
Results: As basic tests were non-diagnostic in 58 patients, second step tests were performed. Twelve patients with high clinical probability of asthma were positive on the methacholine inhalation challenge test and responded to asthma treatment. With this algorithmic approach, a final diagnosis was reached in 90% of the patients. The most frequent diagnoses were asthma (27%), chronic obstructive pulmonary disease (COPD) (17%), bronchiectasis (13%), and heart failure (10%).
Conclusion: As a result of this comprehensive protocol, most causes of chronic dyspnea were found to be airway and heart diseases. We would suggest that CXR and spirometry can be performed as first step tests. We consider that when the results of the basic tests are normal, both TTE and HRCT are very useful tests.

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Amaç: Sigara içenlerde KOAH’ýn erken dönemde saptanmasý, hastalýðýn ilerlemesini durdurmak için önemlidir. Çalýþmamýzda sigara býrakma polikliniðine baþvuran hastalarda, KOAH ve küçük havayolu hastalýðý (KHYH) sýklýðýný ve sigara içme alýþkanlýklarý ile solunum fonksiyon testleri (SFT) arasýndaki iliþkiyi araþtýrmayý amaçladýk.
Yöntemler: Sigara býrakma polikliniðine 2002 Nisan-2009 Nisan tarihleri arasýnda baþvuran tüm olgulara sigara içme alýþkanlýklarýný sorgulayan bir anket ve Fagerström Nikotin Baðýmlýlýk Testi uygulandý. Solunumsal semptomlarý sorgulanarak fizik muayeneleri yapýldý. KOAH ve KHYH tanýsý SFT ile GOLD kriterlerine göre konuldu. Ýstatistiksel analizlerde Ki-kare, T-testi ve Pearson korelasyon testleri kullanýldý.
Bulgular: Çalýþmaya alýnan 372 olgunun 200’ü (%53,8) kadýn, 172’si (%46,2) erkek, yaþ ortalamasý, 43,9±11,2 yýl idi. Olgularda sigara içme öyküsü 31,9±18,5 paket.yýl, Fagerstörm nikotin baðýmlýlýk testi skoru ortalama 5,5±2,5 olarak hesaplandý. Olgularýn 139’unda (%53) efor dispnesi, 120’sinde (%45,7) öksürük ve 68’inde (%26,1) balgam çýkarma þikayeti saptandý. Toplam 60 (%16) olguda KOAH, 122 (%32,7) olguda ise KHYH tanýsý konuldu. Yeni tespit edilen KOAH’lý olgularýn 20’si (%40,9) hafif, 27’si (%55,1) orta, 2’si (%4) aðýr derecede idi. Kýrk yaþ üstünde, erkeklerde ve 30 paket.yýl üstünde sigara içenlerde KOAH ve KHYH anlamlý olarak daha yüksek oranda bulundu (p<0,001). Sigara (paket.yýl) ile FEV1/FVC (r=0,42, p<0,001) ve FEF25-75 (r=0,34, p<0,001) korele bulunmuþken nikotin baðýmlýlýk testi skoru ile korelasyon izlenmedi.
Sonuç: Sigara býrakma polikliniðine baþvuran hastalarda özellikle erkek cinsiyette, 40 yaþ üstü ve 30 paket.yýl üstünde sigara içenlerde yüksek oranda erken dönem KOAH ve KHYH tespit edildi. Sigara býrakma polikliniklerinin KOAH için önemli bir risk faktörünü ortadan kaldýrmanýn yaný sýra erken tanýda da önemli rol oynadýðý sonucuna varýldý.

Objective: In smoking patients, the early diagnosis of COPD is important in order to stop the progression of the disease. In our study, we aimed to determine the frequency of COPD and small airways disease (SAD) and the relation between the smoking habit and pulmonary function tests in patients who were admitted to our smoking quitting outpatient clinic.
Methods: A questionnaire to determine the smoking habits and Fagerström Nicotine Dependence Test were administered to all patients admitted to the smoking quitting outpatient clinic between April 2002-April 2009. Physical examinations were made and respiratory symptoms were questioned. Patients were diagnosed as COPD and SAD according to the GOLD criteria. In statistical analyses, chi-square test, T-test and and Pearson correlation test were used.
Results: Of the 372 patients included in the study, 200 (53.8%) were women and 172 (46.2%) were men with the mean age of 43.9±11.2 years. The mean history of smoking was 31.9±18.5 packs.year, mean score for Fagerström Nicotine Dependence Test was 5.5±2.5. One hundred and thirty nine (53%) patients had effort dyspnea, 120 (45.7%) had cough and 68 (26.1%) had sputum as complaints. Sixty (16%) patients were diagnosed as COPD and 122 (32.7%) were diagnosed as SAD. Of patients who were newly diagnosed as COPD; 20 (40.9%) were mild, 27 (55.1%) were modarate, 2 (4%) were severe. COPD and SAD were statistically higher in patients over 40 years of age, with a smoking history of over 30 packs.year and in males (p<0.001). A correlation between smoking history (packs.year) and FEV1/FVC ratio (r=0.42, p<0.001) and FEF25-75 (r=0.34, p<0.001) was found. No correlation was found with the nicotine dependence test.
Conclusion: Early stage COPD and SAD were diagnosed in high ratio of patients admitted to smoking quitting outpatient clinic, who were male, over 40 years of age and had a smoking history of over 30 packs.year. It was concluded that smoking quitting outpatient clinics are important, not for only eliminating an important risk factor for COPD, but also for early diagnosis.

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Amaç: Devlet hastanelerinde (DH) görev yapan Göðüs Hastalýklarý Uzmanlarý’nýn çalýþma þartlarýný ve göðüs hastalýklarý hastanesinde (GHH) çalýþýyor olmanýn bu þartlarda meydana getirdiði farklýlýklarý ortaya koymak.
Yöntemler: Otuz altý ilde görev yapan 130 göðüs hastalýklarý uzmanýna anket formlarý iletildi. Anket formlarý demografik bilgiler, çalýþma yýllarý, çalýþma yükleri, hastanede göðüs hastalýklarý branþý ile ilgili olan donanýmlarýn mevcut olup olmadýðý, konsultasyonlar ve sevk zinciri ile iliþkili 30 sorudan oluþuyordu.
Bulgular: Cevap oraný %65 idi. Katýlýmcýlarýn %54,1’i GHH’nde çalýþmakta idi. %67,1’i çalýþma þartlarýný iyi buluyordu. Yaz döneminde GHH’nde DH’ne göre daha fazla sayýda poliklinik muayenesi ve yatan hasta takibi yapýlýyordu. GHH’de çalýþanlarýn %43,5’i, DH’nde çalýþanlarýn %73,7’si çalýþtýklarý hastanedeki göðüs hastalýklarý yatak sayýsýný; GHH’de çalýþanlarýn %24,4’ü, DH’nde çalýþanlarýn %55,3’ü göðüs hastalýklarý ile iliþkili donanýmlarý yetersiz buluyordu (p=0,005 ve p=0,004). Doktorlarýn %51,8’i invaziv mekanik ventilatör, %23,8’i kangazý, %20,2’si noninvaziv mekanik ventilatör, %3,6’sý spirometri, %11,9’u bronkoskopi bulunmayan hastanelerde çalýþýyordu. Maligniteler ve yoðun bakým ihtiyacý en sýk sevk gerekçelerini oluþturuyordu. Ankete katýlanlarýn %35,7’si sevk ettikleri hastanýn akýbetinden haberdar deðildi. En çok konsültasyon istenen bölüm kardiyoloji, en çok konsültasyona gidilen bölüm ise cerrahi klinikleriydi.
Sonuç: Göðüs Hastalýklarý ile iliþkili saðlýk hizmeti verilen birimin adý ne olursa olsun; hizmet verilen hasta grubunun yüksek mortalite ve morbidite oranlarýna sahip olduðu ve belirgin olarak mevsimsel yoðunluklarýn yaþandýðý dikkate alýnarak; yeterli yatak sayýsý ve ekipmana sahip olunmasý gerekmektedir. Göðüs Hastalýklarý uzmanlýk eðitimi taþrada karþýlaþýlacak sorunlarla baþa çýkabilecek düzeyde ve yeterli donanýmý saðlayacak þekilde standardize edilmelidir.

Objective: To examine working conditions of pulmonologists working in State Hospitals (SH) and to determine the differences caused by working in a Chest Diseases Hospital (CDH).
Methods: Questionnaires was sent to 130 pulmonologist working in 36 provinces. The questionnaire consisted of 30 questions about demographic data, years of work, daily work-load, equipment, consultations and referral priorities.
Results: Response rate was 65%. Of the participants 54.1% were working in a CDH. 67.1% of the pulmonologists were found to have good working conditions. The number of outpatient polyclinics and hospitalized patients were higher in CDH than SH in summer period. 43.5% of the participants working in CDH and 73.7% of the participants working in SH reported that the number of pulmonary department beds were insufficient (p=0.005). 24.4% of the participants working in CDH and 55.3% of the participants working in SH reported that equipment was insufficient (p=0.004). Percentages of the doctors working in hospitals who do not have invasive mechanical ventilation, arterial blood gas anaysis, noninvasive mechanical ventilation, spirometry and bronchoscopy were 51.8%, 23.8%, 20.2%, 3.6%, and 11.9%; respectively. Malignancies and the necessity of an intensive care unit were the most common reasons for transfer of patients. 35.7% of the participants were not informed about the outcome of these patients. Most of the consultations obtained from both cardiology and surgical departments, respectively.
Conclusion: Chest disease related health services; regardless of the name of the unit of service; taking high morbidity and mortality rates of the patients and seasonal workload into account; must have adequate equipment and number of beds. Pulmonologist training should be standardized to provide adequate features to deal with problems encountered in the provinces.

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Amaç: Pulmoner tromboemboli (PTE) mortalite ve morbiditesi yüksek bir hastalýktýr. Tedavi edilmemiþ PTE’de mortalite %30’dur. Bu çalýþmada amacýmýz kliniðimizde tetkik ve tedavileri yapýlmýþ olan embolili hastalarý; semptomlarý, risk faktörleri, fizik muayene, laboratuvar ve radyolojik bulgularý açýsýndan tekrar deðerlendirmektir.
Yöntemler: 2001-2006 yýllarý arasýnda bir eðitim ve araþtýrma hastanesi Göðüs Hastalýklarý Kliniði’nde PTE tanýsý konulmuþ hastalarýn dosyalarý retrospektif olarak deðerlendirildi. Ýstatistiksel analizler için SPSS 10,0 programý ile Mann-Whitney U testi kullanýldý.
Bulgular: Çalýþmaya yaþ ortalamasý 53,4±15,3 olan 41’i kadýn, 37’si erkek toplam 78 hasta dahil edildi. En sýk risk faktörleri sýrasýyla immobilizasyon (%34.6), derin ven trombozu varlýðý (%30,7), 65 yaþ üzerinde olmak (%28,2) ve cerrahi operasyon öyküsü (%24,3), sýk semptomlar ise, göðüs aðrýsý (%82,1), dispne (%67,9), taþikardi (%35,9), öksürük ve hemoptiziydi (%24,4). Taþikardi, inspiryum sonu ince raller, derin ven trombozu (DVT) bulgularý ve takipne en sýk saptanan fizik muayene bulgularýydý. Plevral sývý 23 hastada (%29,4) tespit edildi. D-dimer düzeyi 52 hastanýn 51’inde (%98,1) yüksek tespit edildi. Hastalarýn 43’üne (%55,1) ekokardiyografi yapýlmýþtý. En sýk bulgu pulmoner hipertansiyondu (%95,3). Bilateral alt ekstremite dopler ultrasonografi (USG) 60 (%76,9) hastaya yapýlmýþtý ve olgularýn %40’ýnda tek taraflý trombüs saptanmýþtý. Ventilasyon/perfüzyon (V/Q) sintigrafisi ile hastalarýn %51,3’üne taný konulmuþtu. Buna karþýn olgularýn %62,8’ine spiral bilgisayarlý tomografi (BT) ile taný konulmuþtu. Hastalarýn %63,6’sýnda hipoksemi, %54,5’inde hipokapni ve %4,5’inde hiperkapni mevcuttu. En sýk saptanan akciðer grafisi bulgularý plevral sývý (%29,5), konsolidasyondu (%19,2). Olgularýmýzda elektrokardiyografi (EKG)’de en sýk olarak sinüs taþikardisi gözlendi.
Sonuç: Çalýþmamýzda tespit ettiðimiz tüm bulgular literatür ile benzerlikler gösteriyordu. PTE özellikle risk faktörü olan hastalarda düþünülürse morbidite ve mortalite azaltýlabilir.

Objective: Pulmonary thromboembolism (PTE) is a disease with high morbidity and mortality. Mortality is 30% in untreated PTE. The aim of this study is to evaluate retrospectively the PTE patients treated in our clinic for symptoms, risk factors, physical examination, laboratory and radiologic findings.
Methods: The files of PTE patients, diagnosed in the Pulmonary Diseases Department of an Education and Research Hospital between 2001-2006, were evaluated retrospectively. SPSS 10.0 program and Mann-Whitney U Test were used for statistical analysis.
Results: Seventy-eight patients, 41 female 37 male, with a mean age of 53.4±15.3 were included in the study. The most common risk factors were immobilisation (34.6%), presence of deep venous thrombosis (30.7%), age >65 years (28.2%) and the history of surgical operation (24.3%). The common symptoms were chest pain (82.1%), dyspnea (67.9%), tachycardia (35.9%), cough and hemoptysis (24.4%). Tachycardia, end-inspiratory ralles, deep venous thrombosis (DVT) findings and tachypnea were the most common physical examination findings. In 23 patients (29.4%), pleural efusion was detected. D-dimer level was elevated in 51 (98.1%) of 52 patients. Echocardiography was performed in 43 (55.1%) patients. The most common finding was pulmonary hypertension (95.3%). Bilateral lower extremity venous doppler sonography was performed in 60 (76.9%) patients and unilateral thrombus was detected in 40% of them. Of the patients, 51.3% were diagnosed by ventilation/perfusison (V/Q) scintigraphy whereas 62.8% were diagnosed by spiral computed tomography (CT) 63.6% of patients had hypoxemia, 54.5% had hypocapnia and 4.5% had hypercapnia in arterial blood gass analyses. The most common chest x-ray findings were pleural effusion (29.5%) and consolidation (19.2%). Most frequently, sinus tachycardia was detected as an electrocardiography (ECG) finding in our patients.
Conclusion: All the findings of our study were similar to the literature. Morbidity and mortality can be reduced, when the possibility of PTE is kept in mind as a diagnosis, especially in patients with risk factors.

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Amaç: Bu makalede 2009 pandemisi esnasýnda polimeraz zincir reaksiyonu (PCR) ile pandemik influenza A (H1N1) virüsü pozitifliði saptanarak kliniðimizde izlenen olgularýn özelliklerini incelemeyi amaçladýk.
Yöntemler: Kliniðimize 21.10.2009-01.12.2009 tarihleri arasýnda pnömoni ön tanýsý ile yatan ve H1N1 pozitifliði saptanan olgularýn dosyalarý retrospektif olarak deðerlendirildi.
Bulgular: Pandemik H1N1 virüsü pozitif olan 10 olgunun 8’i erkek 2’si kadýndý. Olgularýn yaþ ortalamasý 39,8±14,6 yýl idi. Ýki olgu hastane personeli olup 4 olguda ek hastalýk vardý. En sýk karþýlaþýlan semptom nefes darlýðý (%80) iken bunu öksürük (%70), bulantý, kusma ve balgam çýkarma (%30) izliyordu. Olgularýn üçünde lökositoz ve sedim yüksekliði bulunuyordu. Akciðer filminde 8 olguda pnömonik infiltrasyon izlendi. Hastalar oral oseltamivir ve intravenöz levofloksasin ile tedavi edildi. Üç olguda akut respiratuar distres (ARDS) tablosu geliþti. ARDS geliþen olgulardan biri yaþamýný kaybetti.
Sonuç: Çalýþmamýzda incelenen olgularýn klinik, laboratur ve radyolojik verileri literatürle uyumlu bulunmuþtur. Viral pnömonili hastalarýn erken taný ve tedavisi, yakýn takibi hayat kurtarýcýdýr.

Objective: The aim of the present study was to analyze the features of patients with positive PCR tests for pandemic influenza A (H1N1) virus who were admitted to our clinic during the 2009 pandemic.
Methods: We included ten patients who were hospitalized with the prediagnosis of pneumonia between 21.10.2009-01.12.2009 with positive PCR results for pandemic H1N1 virus, and their files were retrospectively evaluated.
Results: Eight of the 10 patients were male and 2 were female. The mean age of the patients was 39.8±14.6 years. Two of the patients were hospital staff and four patients had comorbidities. The most common symptom was shortness of breath (80%), followed by cough (70%), nausea, vomiting and sputum (30%). Leukocytosis and increased sedimentation rate were detected in only 3 of the patients. In eight cases pneumonic infiltrations were detected in chest roentgenogram. Patients were treated with peroral oseltamivir and intravenous levofloxacin. Three cases progressed to acute respiratory distress syndrome (ARDS). One patient died of ARDS.
Conclusion: In conclusion, close follow-up of patients with viral pneumonia can be life saving.

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Timolipoma, anterior mediastenin nadir görülen lezyonudur ve tüm timus kaynaklý tümörlerin %2-9’unu oluþturur. Kýrk beþ yaþýnda kadýn hasta nefes darlýðý þikayeti nedeniyle kliniðimize baþvurdu. Bilgisayarlý akciðer tomografisinde, sol hemitoraksýn tamamýnýna yakýnýný dolduran, anteriordan sað mediastene uzanan, yað doku dansitesinde kitlesel lezyon izlendi. Sol torakotomi ile kitle total olarak çýkarýldý. Patoloji sonucu timolipoma olarak raporlandý. Timolipoma nadir olarak dev boyutlara ulaþabilir ve nefes darlýðý ile karþýmýza çýkabilir. Cerrahi eksizyon ile kesin taný ve tedavi mümkündür.

Thymolipoma is a rarely seen lesion of the anterior mediastinum and constitutes 2-9% of all thymic tumors. A 45 year old female patient was admitted to our clinic with a complaint of shortness of breath. A mass lesion with a fatty tissue density, pervading almost the entire left hemithorax extending anteriorly to the right mediastinum, was observed on the computed tomography of thorax. The mass was totally excised with a left thoracotomy. The pathologic examination was reported as thymolipoma. Thymolipoma may rarely reach a giant size and confronted with the shortness of breath. Definitive diagnosis and treatment are possible with surgical excision.

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Sað pulmoner arter kesintisi nadir bir konjenital bozukluktur. Bu yazýda, rastlantýsal olarak sað pulmoner arter kesintisi tanýsý konulan kadýn olgunun klinik ve radyolojik bulgularý tartýþýldý. Otuz iki yaþýndaki kadýn olgu terleme, sol tarafta daha fazla olmak üzere göðüs ve sýrt aðrýsý yakýnmalarý ile baþvurdu. Pulmoner bilgisayarlý tomografi anjiografide, sað pulmoner arterin, mediastinal kesimi yok iken sað hiler bölgede milimetrik boyutlu ve retrograt dolduðu düþünülen, kör sonlanan vasküler yapý dikkati çekti. Bronþiyal ve interkostal arterlerden oluþan kollateral vasküler dolaþým mevcuttu. Bu bulgularla hastaya sað pulmoner arter kesintisi tanýsý konuldu. Akciðer grafisinde hilusta pulmoner arter gölgesinin görülemediði durumda, pulmoner arter kesintisinden kuþku duyulmalýdýr. Pulmoner bilgisayarlý tomografi anjiografi taný konulmasý için yeterli bir görüntüleme yöntemidir.

Right pulmonary artery interruption is a rare congenital disorder. In this article, we discussed the clinical and radiological findings of a woman with right pulmonary artery interruption that was diagnosed incidentally. A 32-year-old female patient was admitted with the complaints of perspiration, chest and back pain more to the left side. Pulmonary computed tomography angiography revealed that there was no mediastinal part of the right pulmonary artery. A millimetric sized-retrograde filled-blind ended vascular structure was seen at the right hilum. There was a collateral arterial circulation formed from bronchial and intercostal arteries. The patient is diagnosed as right pulmonary artery interruption with theese findings. When there was no sign of a pulmonary artery at the hilum on the chest plain radiography, there must be a suspicion of interruption of the pulmonary artery. Pulmonary computed tomography angiography is an adequate imaging method for diagnosis.

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Pulmoner arteryovenöz malformasyon (AVM), pulmoner arteryal sirkülasyondan pulmoner venöz sirkülasyona arada kapiller yatak olmaksýzýn, direkt baðlantýsý olan anormal damarlardýr ve nadir görülürler. Otuz altý yaþýnda erkek hasta, tekrarlayan burun kanamasý, sað taraflý hafif goðus aðrýsý ve dudaklarda morarma yakýnmalarý ile baþvurdu. Toraks tomografisinde sað orta zonda en geniþ boyutu 5,5 cm ölçülen ve sol parakardiak arteryovenoz malformasyon olarak yorumlanan lezyonlar mevcuttu. Hastaya Pulmoner anjiografi ile bilateral AVM tanýsý konuldu ve her iki taraftaki lezyonlar transkateter embolizasyon ile baþarýlý bir þekilde tedavi edildi. Arteriyovenöz malformasyonlarýn nadir görülmesi ve dev AVM’larýn tedavisinde cerrahiden once embolizasyonun düþünülmesi gerekliliðini vurgulamak amacýyla olgumuzu sunduk.

Pulmonary arteriovenous malformations (PAVMs) are rarely seen direct communications between pulmonary arteries and pulmonary veins, without interposition of a capillary bed. A 36-year-old man was admitted to our clinic with the complaints of recurrent nasal bleeding, right-sided chest pain and purple discoloration of the lips. Computed tomography of the thorax revealed lesions likely to be arteriovenous malformations located at the right middle lobe, 5.5 centimeters in the largest diameter and at the left paracardiac area. He was diagnosed as bilateral PAVMs by pulmonary angiography and these bilateral lesions were treated successfully with transcatheter embolization. This case report is presented because of the rarity of PAVMs and to highlight the success of embolization in the management of large PAVMs.

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Son yýllarda yapýlan çalýþmalarda kronik obstrüktif akciðer hastalýðý (KOAH) ve kardiyovasküler hastalýklar (KVH) arasýndaki güçlü iliþkiye dikkat çekilmektedir. KOAH, ateroskleroz için önemli bir risk faktörü iken hava akýmlarýndaki küçük bir kýsýtlanma dahi iskemik kalp hastalýklarý için yüksek bir risk faktörüdür. Çalýþmamýzda KOAH’lý hastalarda kardiyovasküler risk faktörlerini deðerlendirdik. 33 olgu çalýþmaya alýndý ( % 82’si erkek). Ortalama yaþ 64±9.5 idi. Sigara alýþkanlýklarýnda %12 olgu aktif içici, %67 olgu býrakmýþ, %21 olgu sigara içmiyordu. KVH açýsýndan aile öyküsü % 9 hastada vardý. Solunum fonksiyon testlerine bakýldýðýnda; %9 olguda hafif, %30’unda orta, %12’sinde aðýr, %49’unda çok aðýr hava yolu obstrüksiyonu mevcuttu. Yüksek sistolik ve diastolik kan basýncý sýrasýyla %67 ve %52 olguda vardý. Kolesterol %49, trigliserid %15, LDL %54 hastada yüksekti. HDL hastalarýn %67’sinde düþük bulundu.
Sonuç olarak; Çalýþmamýzda KOAH’lý olgularda KVH açýsýndan çeþitli risk faktörleri saptandý. Bu iki durum arasýndaki iliþki tam olarak anlaþýlamamasýna raðmen bu konuda yapýlacak çalýþmalar ileride KOAH’lý hastalarda kardiyovasküler komplikasyonlarý azaltmaya yönelik yeni tedavi hedefleri saðlayacaktýr.

Several reports noticed that there is strong relationship between chronic obstructive pulmonary diseases (COPD) and cardiovasculer diseases (CVD). COPD is an important risk factor for atherosclerosis. Even modest reductions in expiratory flow volumes elevate the risk of ischemic heart diseases. We aim to evaluate risk factors for CVD on patient with COPD. There are 33 patients in this analysis (% 82 male). The average age was 64 ± 9.5 years. Smoking status was current smokers 12%, ex-smokers 67%, non-smokers 21 %. Family history for CVD was 9%. Air flow obstruction degrees were mild 9%, moderate 30%, severe 12%, very severe 49%. High systolic blood pressure and diastolic blood pressure were 67%, 52% respectively. High lipids; cholesterol 49%, triglyceride 15%, LDL 54%, and low HDL 67%.
In conclusion; although the mechanisms responsible for this association remain largely unknown, in our little COPD group have risk factors for CVD. Further studies for this subject may provide potential new therapeutic targets to reduce cardiovascular complication rate in COPD.

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