Medikal torakoskopi (MT), birçok klinikte olaðan olarak uygulanan, diðer klinik, radyolojik, laboratuvar ve sitolojik tetkiklerle taný konulamayan eksüda niteliðinde plevral sývýsý olan hastalarda etkinliði kanýtlanmýþ bir taný yöntemidir. MT, genel olarak hafif sedasyon ve lokal anestezi altýnda, endoskopi odasýnda rijit torakoskop ile uygulanýr; plevral aralýðýn doðrudan gözlenmesine ve görerek lezyon üzerinden biyopsi alýnmasýna imkan verir. Taný duyarlýlýðý malign plevral patolojilerde %90-95, plevral tüberkülozda %100 civarýndadýr. Ayrýca MT, taný amacýyla olduðu kadar tedavi amacýyla da kullanýlabilir. MT, invazif bir iþlem olmasýna karþýn komplikasyon oraný düþük, oldukça güvenilir bir taný yöntemidir. Gerek MT’nin kullaným avantajlarý gerek önümüzdeki yýllarda mezotelyoma ve malign plevral patolojilerin görülme sýklýðýndaki artýþ, MT kullanýmýnýn göðüs hastalýklarý kliniklerinde gittikçe yaygýnlaþmasýna neden olacaktýr. MT, kullanýmýndaki artýþa koþut olarak semirijit torakoskopi, florasan/otoflorasan torakoskopi, narrow-band imaging veya sývýsýz hastalarda torakoskopi uygulamalarý gibi yeni geliþmelere de sahip olacaktýr.

Medical thoracoscopy (MT) for cases of exudative pleural effusion without a diagnosis by either clinical, radiological, laboratory or cytological investigation is performed as an established diagnostic method for the diagnosis of pleural diseases which has been performed routinely in many clinics. MT was done mainly with a rigid thoracoscope under mild sedation and local anesthesia in an endoscopy room with basic monitoring. It allows for the direct inspection of the pleural space and biopsies taken under direct vision. The diagnostic yield is in the order of 90–95% for malignant disease and can be as high as 100% for pleural tuberculosis. Additionally, MT can be performed for therapeutic as well as diagnostic purposes. Although MT remains an invasive procedure, complications are infrequently seen. Due to both the advantages of MT and the gradually increasing incidence of mesothelioma and malignant pleural disease, the use of MT for pleural effusions will be increasing in pulmonary clinics in coming years. Additionally MT will have some new developments; such as semirigid thoracoscopy, florescent or auto-florescent thoracoscopy, narrow-band imaging, thoracoscopy in patients without pleural effusion.

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Perkütan trakeostomi (PT) son yýllarda yoðun bakýmda uzun süreli mekanik ventilasyon ihtiyacý olan hastalarda sýklýkla uygulanan bir prosedür haline gelmiþtir. PT’nin ideal zamanlamasý ve teknikleri önemli tartýþma konularý olmuþtur. Bu derlemede PT ile ilgili genel
konular (endikasyonlar, kontrendikasyonlar, zamanlama, hazýrlýk, teknikler, komplikasyonlar) ele alýnmýþ ve özellikle tekniklerin karþýlaþtýrýlmasý ile ilgili literatürle gözden geçirilmiþtir.

Percutaneous tracheostomy (PT) has become an oftenly used procedure in critically ill patients requiring prolonged mechanical ventilation in recent years. The ideal timing and techniques of PT have been topics of considerable debate. In this review, we address general issues regarding PT (indications, contraindications, timing, preparation, techniques, complications) and specifically review the literatures regarding the comparison of techniques.

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Amaç: Bu çalýþmada kronik obstrüktif akciðer hastalýðý (KOAH) olan hastalarda tiotropium tedavisine eklenen inhaler budesonidin yaþam kalitesi, egzersiz kapasitesi ve solunum fonksiyon testleri üzerine etkilerinin araþtýrýlmasý amaçlanmýþtýr.
Yöntemler: Kýrk KOAH’lý hasta rastgele iki gruba ayrýldý. Birinci gruptaki hastalar tiotropium inhaler kapsül 18 mcg 1 x 1, ikinci gruptaki hastalar ise da tiotropium inhaler kapsül 1 x 1 ve budesonide inhaler kapsül 400 mcg 2 x 1 kombinasyonu ile üç ay tedavi edildi. Hastalarýn hem baþlangýç, hem de 3 ay sonraki solunum fonksiyon testi parametreleri, 6 dakika yürüme testi, vücut yaðsýz kütlesi, vücut kitle indeksi ve St. George Solunum Anketi (SGRQ) sonuçlarý kaydedildi ve birbirleri ile karþýlaþtýrýldý. Çalýþmaya alýnan her iki grup arasýnda tüm parametrelerde baþlangýç deðerleri arasýnda istatistiksel olarak anlamlý fark saptanmadý
Bulgular: Çalýþmanýn sonunda iki grup arasýnda solunum fonksiyon testleri açýsýndan anlamlý farklýlýk izlenmedi (p>0,05). Yürüme mesafesinin Grup 2’de Grup 1’e göre anlamlý olarak (p=0,023) arttýðý ve yineGrup 2’de Grup 1’e göre SGRQ anket skorlarýnda olumlu yönde anlamlý deðiþiklikler olduðu gözlendi (semptom skoru: p<0,001, aktivite
skoru: p=0,001, impakt skoru: p=0,003 ve total skor için: p<0,001).
Sonuç: Bu sonuçlar, KOAH’lý hastalarda tiotropium/budesonide kombi nasyonunun tek baþýna tiotropium inhalasyonuna göre yaþam kalitesi ve egzersiz kapasitesini olumlu yönde etkilediðini, ancak akciðer fonksiyonlarýný iyileþtirmede ek bir katkýsýnýn olmadýðýný göstermiþtir.

Objective: The aim of this study was to evaluate the effects of adding inhaled budesonide to the tiotropium treatment on the pulmonary function tests, health-related quality of life and exercise capacity of patients with chronic obstructive pulmonary disease (COPD).
Methods: Forty study subjects with COPD were randomized to two groups. The patients in the first group was treated with 1x1 18 mcg of Tiotropium and the patients in the second group was treated with the combination of tiotropium (18 mcg 1x1) and budesonide (400 mcg 2x1) for three months. Pulmonary function tests, six minute walk test, body mass index and Saint George Respiratory Questionnaire (SGRQ) scores were recorded both at the beginning and 3 months later and the results at the begining and third month were compared with each other. There were no statistically significant difference in all basline parameters between the two groups.
Results: At the end of the study, no statistically significant differences were obtained between two groups in terms of pulmonary function tests (p>0.05). Significant improvements were observed on the parameters of walking distance (p=0.023) and SGRQ scores (symptom score: p<0.001, activity score: p=0.001, impact score: p=0.003 and total score: p<0.001) in Group 2 when compared with Group 1.
Conclusion: These results show that, in patients with COPD, tiotropium/budesonide combination is more effective than alone tiotropium inhalation in quality of life and exercise performance. But this combination is not more effective in improving lung functions.

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Amaç: Pulmoner rehabilitasyon (PR) programlarý; farklý organizasyonel yapýlanma ve program içerikleri ile hastane veya evde uygulanabilir. Bu çalýþmada evde direkt gözetimli multidisipliner PR programlarýnýn kronik solunum sorunlu olgularda etkinliðinin deðerlendirilmesi amaçlanmýþtýr.
Yöntemler: Eylül 2007-Mayýs 2012 tarihleri arasýnda merkezimize baþ vuran kronik solunum sorunlu 40 hasta çalýþmaya alýnmýþtýr. Tüm olgularýn PR öncesi ve sonrasý deðerlendirmelerinde, dispne algýsý; Medical Research Council (MRC) dispne skalasý, egzersiz kapasitesi; artan hýzda mekik yürüme testi (AHMYT) ve endurans mekik yürüme testi (EMYT), saðlýkla iliþkili yaþam kalitesi; St. George yaþam kalitesi anketi (SGRQ), psikososyal deðerlendirmede ise hastane anksiyete depresyon skalasý (HAD) kullanýlarak yapýlmýþtýr. Vücut kompozisyonu; biyoelektriksel impedans yöntemi ile deðerlendirilmiþtir. Hastalardan 10’u çeþitli nedenlerden dolayý evde PR programýný tamamlayamamýþtýr.
Bulgular: Kronik Obstrüktif Akciðer Hastalýðý (KOAH) tanýsý olanlarýn dispne algýlarý (p=0,026), egzersiz kapasitesi (p=0,001), yaþam kalitesi (p=0,001), vücut kompozisyonlarý (p=0,012), anksiyete depresyon skorunda (p=0,001) istatiksel anlamlý iyileþme saðlanmýþtýr. KOAH ve KOAH dýþý tüm olgularda dispne algýsý, egzersiz kapasitesi, yaþam kalitesi, anksiyete ve depresyon skorunda elde edilen kazanýmlar minimal klinik anlamlý düzeyin üzerinde bulunmuþtur.
Sonuç: Bu çalýþmada evde direkt gözetimli PR’nin seçilmiþ ileri evre KOAH ve KOAH dýþý akciðer hastalýklarýnda multidispliner ve deneyimli ekip yapýsýyla uygulandýðýnda etkin ve güvenilir olduðu gösterilmiþtir.

Objective: Pulmonary rehabilitation (PR) programs can be carried out in hospital or home basis with a different organizational aspect and program content. This study aimed to evaluate the efficacy of a multidisciplinary supervised home-based PR program in patients with chronic respiratory disorders.
Methods: Forty patients with chronic respiratory disorders who admitted to our center between September 2007 and May 2012 were enrolled. In all patients before and after PR, dyspnea was assessed with Medical Research Council (MRC) dyspnea scale, exercise capacity with Incremental Shuttle Walk Test (ISWT) and Endurance Shuttle Walk Test (ESWT), health related quality of life with St. Geoerge Respiratory Questionnaire (SGRQ), psychosocial evaluation with hospital anxiety and depression scale (HAD), the body composition with bioelectrical impedance method. Ten patients did not complete home-based PR for various reasons.
Results: In patients with Chronic Obstructive Pulmonary Disease (COPD), dyspnea sensation (p=0.026), exercise capacity (p=0.001), quality of life (p=0.001), body composition (p=0.012), anxiety and depression score (p=0.001) improvements were statistically significant. In all patients with COPD and non-COPD perception of dyspnea, exercise capacity, quality of life, anxiety and depression score improvements were above minimal clinically important differences.
Conclusion: In this study supervised home-based pulmonary rehabilitation has been shown as an effective and safe modality when applied by an experiencied and multidisciplinary team in selected severe COPD or non-COPD patients.

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Amaç: Sigara býrakmayý deðerlendirmek için kullanýlan ekspiryum havasýndaki karbonmonoksit (ekshale CO) düzeyini pek çok faktör etkilemektedir. Çalýþmamýzda küçük havayolunda obstrüksiyon (KHYO) varlýðýnýn ekshale CO düzeyine etkisini araþtýrmayý amaçladýk.
Yöntemler: Çalýþmaya 2014 Nisan-Aralýk tarihleri arasýnda sigara býrakma polikliniðine baþvuran olgular dahil edildi. Ýlk baþvuru tarihinde tüm olgularýn sigara içme öyküleri son 12 saat içinde en son ne zaman ve kaç adet sigara içtikleri sorgulandý. Tüm hastalara solunum fonksiyon testi (SFT) yapýldý, ekshale CO düzeyleri ölçüldü. CO düzeyi ile etkili faktörler arasýndaki iliþkiyi tespit etmek için Pearson Korelasyon Analizi yapýldý.
Bulgular: Çalýþmaya dahil edilen 167 olgunun yaþ ortalamasý 38,7±12,7,112’si (%67,1) erkek, 55’i (%32,9) kadýndý. Ortalama içilen sigara miktarý 23,3±16,4 paket-yýl, ekshale CO düzeyi 14,1±6,9 ppm, %FEF25-75 düzeyi 77,2±28,2 bulundu. Son 12 saat içinde en son içilen sigara ortalama 1,5±1,8 saat önce, içilen sigara adedi 7,2±5,0 bulundu. Elli yedi olguda (%34,1) SFT’de KHYO mevcuttu. Korelasyon analizi sonucunda ölçülen CO düzeyi ile sigara içme miktarý ve son 12 saatte içilen sigara adedi arasýnda pozitif yönde korelasyon (sýrasýyla p=0,03, r=0,228; p=0,000, r=0,511) son içilen sigara ile test arasýndaki süre ile negatif yönde korelasyon (p=0,023, r=-0,176) tespit edildi. SFT’de KHYO varlýðý ve %FEF25-75 düzeyi ile CO düzeyi arasýnda korelasyon tespit edilmedi (p>0,05).
Sonuç: Sigara içenlerde ekspiryum havasýnda ölçülen CO düzeyi, hastanýn toplam sigara içme miktarý, son 12 saatte içilen sigara adedi ve en son içilen saat ile yakýndan iliþkilidir. Küçük havayollarýnda obstrüksiyon olmasý ekshale CO’yu etkilememektedir

Objective: End-expiratory CO level, which is used to test smoking cessation is known to be effected by many factors. We aimed to evaluate effect of small airway obstruction (SAO) on end-expiratory CO levels.
Methods: The study population consisted of cases who applied to smoking cessation clinic between April-December 2014. The duration of smoking (pack-years), pulmonary function tests (PFT) and end-expiratory carbonmonoxide (CO) were noted at first visit. The cases were questioned for last time of smoking and amount of cigarettes they smoked within past 12 hours. Pearson correlation test was used to determine factors effecting CO levels.
Results: Mean age of 167 cases -112 male (67.1%), 55 female (32.9%) was 38.7±12.7 years. Mean duration of smoking was 23.3±16.4 pack-years, mean CO level was 14.1±6.9 ppm, mean FEF25-75% was 77.2±28.2. Mean period elapsed after last cigarette was 1.5±1.8 hours, mean number of cigarettes smoked within past 12 hours was 7.2±5.0. SAO was found in 50 cases (34.1%). Correlation analyses revealed that CO levels were correlated positively to duration of smoking and amount of cigarettes they smoked within past 12 hours (p=0.03, r=0.228; p=0.000, r=0.511, respectively) and negatively to the last time of smoking (p=0.023, r=0.176). SAO and in PFT was not correlated to CO level (p>0.05).
Conclusion: End-expiratory CO level is closely related to duration of smoking, number of cigarettes smoked within past 12 hours and period elapsed after last cigarette. Presence of SAO does not seem to effect CO levels.

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Amaç: Pulmoner sklerozan hemanjiomlu olgularýn klinik ve radyolojik bulgularýný, tedavi yöntemlerini ve takip sonuçlarýný deðerlendirmeyi amaçladýk.
Gereç ve Yöntem: Merkezimizde Ocak 2006-Nisan 2014 tarihleri arasýnda taný koyulan pulmoner sklerozan hemenjiomlu 8 olguyu geriye doðru olarak deðerlendirdik.
Bulgular: Çalýþma 4 kadýn ve 4 erken hastayý kapsýyordu. Taný sýrasýnda hastalarýn yaþý 23-79 yýl arasýnda (ortalama 56.1 yýl) deðiþiyordu. Ýki hasta yakýnmasýzdý. Yakýnmalý 6 hasta arasýnda en sýk yakýnma hemoptizi idi. Radyolojik bulgu 7 hastada soliter nodül veya kitle idi. Diðer hastada bilateral akciðer alanlarýnda multipl kitle ve nodüller saptandý. Tümör 7 olguda parankimal, 1 olguda endobronþiyal lokalizasyon gösteriyordu. Parankimal lokalizasyonlu 7 hasta cerrahi tedavi altýnda idi. Wedge rezeksiyon en sýk cerrahi yöntemdi. Sklerozan hemanjiom tanýsý 7 olguda cerrahi, 1 olguda bronkoskopi ile elde edildi. En yaygýn histolojik patern solid tipti. 2-76 ay arasýnda deðiþen takip süresi boyunca cerrahi tedavi uygulanan hastalar nüks olmaksýzýn mükemmel bir prognoza sahipti. Multipl lezyona sahip hasta tanýdan 1 ay sonra öldü.
Sonuçlar: Akciðerin sklerozan hemanjiomu nadir bir tümördür. Cerrahi rezeksiyon genellikle hem taný hem de tedavi için gerekir. Hastalar, cerrahi tedavi sonrasý nüks olmaksýzýn mükemmel bir prognoza sahiptirler.

Objective: We aimed to evaluate clinical manifestations, radiological findings, treatment, and outcomes of pulmonary sclerosing hemangioma (SH).
Methods: We retrospectively reviewed eight cases of pulmonary sclerosing hemangioma diagnosed at our institution from January 2006 to April 2014. Their demografic findings, symptoms, radiological appearences, diagnostic methods, treatments and surveys were recorded.
Results: There were four female and four male patients. The age at the time of diagnosis ranged from 23 to 79 years, with a mean age of 56.1 years. Two patients were asymptomatic. Among six symptomatic patients, hemoptysis was the most frequent symptom. The radiological feature was a solitary nodule or mass in seven cases. In the remaining case, there were multiple distinct masses and nodules in bilateral lung fields. The tumor involved lung parenchyma in seven cases and endobronchially located in the remaining patient. Seven patients with parenchymal location underwent surgery. Wedge resection was the most common surgical procedure. Diagnosis of SH was established by surgical biopsy in seven cases and by bronchoscopic biopsy in one case. The most common histological pattern was solid pattern. During the follow-up ranging from 2 months to 76 months, seven cases who underwent surgery had an excellent prognosis with no evidence of recurrence. The patient with multiple lesions died one month after diagnosis.
Conclusion: SH of the lung is a rare tumor. Surgical resection usually requires for both diagnosis and treatment of this tumor. The patients had excellent prognosis with no evidence of recurrence following surgery.

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Amaç: Gerekli ekipmanlarýn doðru kullanýlmasý baþarýlý bir noninvazif mekanik ventilasyon (NIMV) uygulamasýnýn anahtarýdýr. Eðitimli saðlýk personeli uygulamanýn önemli unsurlarýndan biridir. Bu noktadan hareketle çalýþma, üçüncü basamak bir göðüs hastalýklarý hastanesinde çalýþan hemþirelerin NIMV hakkýndaki bilgi düzeylerini belirlemek amacýyla tanýmlayýcý olarak gerçekleþtirildi.
Yöntemler: Çalýþma Yedikule Göðüs Hastalýklarý ve Göðüs Cerrahisi Eðitim ve Araþtýrma Hastanesi’nde çalýþan 147 hemþire ile gerçekleþtirildi. Verilerin toplanmasýnda araþtýrmacýlar tarafýndan geliþtirilen 36 soruluk anket formu kullanýldý. Verilerin analizinde sayý, yüzdelik, Mann-Whitney U ve Kruskal Wallis testleri kullanýldý.
Bulgular: Hemþirelerin %40,8’i NIMV hakkýnda daha önce eðitim almýþtý. Buna karþýn %24,5’i NIMV uygulamasýný kendi kendine öðrenmiþti. En az oranda doðru cevaplanan soru oronazal maskenin dezavantajlarýydý (%26,5). En fazla doðru cevaplanan ifade “Kaçak olmamasý için yüz maskeleri hastanýn yüzüne boþluk kalmayacak þekilde oturtulmalý ve burun köküne baský yapmamasý için uygun bantlanmalýdýr” ifadesiydi (%78,9). Kadýn ve lisansüstü mezun olan hemþirelerin NIMV sorularýndan aldýklarý toplam puan yüksek olup istatistiksel olarak anlamlýydý (p<0,05).
Sonuç: Etkili NIMV uygulamasý için eðitimli personel þarttýr. NIMV uygulamasýnda etkin rol alan hemþireler, bu konuda temel eðitim almalýdýr. Eðitim programý, tedavinin nasýl baþlanacaðý, endikasyonlar, takipten kimin sorumlu olacaðý ve dikkat edilmesi gereken noktalarý açýkça konu etmelidir. Bu eðitim teorik bilginin yanýnda klinik deneyim sürecini de içermelidir.

Objective: The correct use of necessary equipment is the key for a successful noninvasive mechanical ventilation (NIMV) practice. Trained health care personnel are important part of the practice. The current study was conducted to that end, with the aim of determining the level of knowledge about NIMV of nurses working in a training and research hospital as descriptive.
Methods: The study was conducted with 147 nurses who are working at Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital in Ýstanbul. Questionnaire form of 36 questions prepared by investigators was used to collect data. For the analysis of the results, numerical, percentages, Mann-Whitney U and Kruskal Wallis tests were used.’
Results: 40.8% nurses had received training about NIMV. By contrast, 24.5% stated that they had learned NIMV practices on their own. The lowest rate (26.5%) of correct answered question was “disadvantages of oronasal mask”. The most answered statement as true was “Face masks should be established to the patient’s face with no gaps for prevention of leaks and the mask should be worn not to pressure on nasal bridge” (78.9%). Female and postgraduate nurses‘ total scores obtained from NIMV questions were higher than others and were statistically significant (p<0.05).
Conclusion: The effective NIMV practices requires trained personnel. Nurses who have active role in NIMV practices should receive basic training in this topic. How will be started treatment, indications, who will be responsible for follow-up and points to take into consideration are mentioned clearly in the training program. This training programme should include processing of clinical experience as well as theoretical information.

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Amaç: Kronik obstrüktif akciðer hastalýðý (KOAH) önlenebilir ve tedavi edilebilir bir hastalýk olmasýna raðmen önemli bir saðlýk sorunu olmaya devam etmektedir. Akut alevlenme KOAH’lý hastalarýn hastaneye yatýþlarýnýn baþlýca nedenidir ve KOAH iliþkili saðlýk harcamalarýnýn önemli bir kýsmýný oluþturmaktadýr. Bu çalýþmada, KOAH akut alevlenme ile yatýrýlan hastalarýn 3. basamak üniversite hastanesinde maliyetini belirlemek amaçlandý.
Yöntemler: Gazi Üniversitesi Týp Fakültesi Hastanesi Göðüs Hastalýklarý Kliniði’ne 1 Eylül 2013-1 Eylül 2014 tarihleri arasýnda KOAH atak nedeniyle yatýrýlan hastalarýn maliyet verileri bilgi iþlem bölümünden alýnarak deðerlendirildi. Hastalarýn tetkik, tedavi hizmetleri, yatak, ilaç ve sarf malzeme ücretleri ayrý ayrý kaydedildi.
Bulgular: On iki aylýk süre içerisinde Göðüs Hastalýklarý Kliniði’ne toplam 790 hasta yatýrýlarak tetkik ve tedavi edildi. Bu hastalarýn 181’inin (%23,0) yatýþ nedeni KOAH, 99’unun (%12,5) yatýþ nedeni ise KOAH akut alevlenme idi. Medyan yaþlarý 70 (64-77) olan 99 hastanýn 77’si (%77,8) erkek, 22’si (%22,2) kadýn idi. Kýrk dokuz (%49,5) hasta acil servisten, 50 (%50,5) hasta poliklinikten yatýrýldý. Hastalarýn yatýþ süresi medyan 8 (6-13) gün idi. Doksan bir (%91,9) hasta tedavi sonrasý servisten taburcu edilirken, 8 (%8,1) hasta solunum yetmezliði nedeniyle yoðun bakým ünitesine alýndý, bu hastalarýn 7’si (%7,4) servise devredilirken, 2 (%2,1) hasta eksitus oldu. Hasta baþýna düþen total maliyet medyan 1.064 TL (726-1.866 TL) idi, bu maliyetin en önemli kýsmýný %36 ile ilaç ücretleri oluþturuyordu. Antibiyotik kullanýmýnýn olduðu grupta toplam maliyet antibiyotik kullanýlmayan gruba göre daha fazlaydý (medyan 1.162’a karþý 643 p=0,001). Hastalarýn maliyetleri üzerine komorbidite varlýðý, hipoksemi varlýðý ve noninvazif mekanik ventilasyon kullanýmýnýn bir etkisi saptanmadý (p>0,05).
Sonuç: KOAH akut alevlenme, Göðüs Hastalýklarý Kliniði’ne yatýrýlan hastalarda önemli bir ekonomik yük ve mortalite nedeni olmaya devam etmektedir.

Objective: Chronic obstructive pulmonary disease (COPD), although a preventable and treatable disease continues to be a major health problem. Acute exacerbations of COPD is a major cause of hospitalization of patients and it constitutes a significant portion of COPD-related health care costs. In this study, we aimed to determine the cost of patients hospitalized with acute exacerbations of COPD in a university hospital.
Methods: Data of the patients that were hospitalized due to COPD exacerbation between 1 September 2013-1 September 2014 in Hospital of Gazi University Medical Faculty were retrospectively analyzed. Cost data were gathered from data processing department. Costs were identified for drugs, laboratory tests, bed costs and other materials.
Results: A total of 790 patients were hospitalized during twelve months. Among these patients 181 (23.0%) patients had COPD and 99 (12.5%) were hospitalized due to acute exacerbation of COPD. Of these 99 patients 77 (77.8%) were male and 22 (22.2%) were female. Forty-nine (49.5%) patients were hospitalized from the emergency department, 50 (50.5%) patients were from the outpatient clinic. The median age was 70 (64-77) years old and median length of hospital stay was 8 (6-13) days. Ninety-one (91.9%) of them were discharged from the service. Eight (8.1%) patients were transfered to the intensive care unit (ICU) due to respiratory failure, and 7 of these patients (7.4%) hospitalized back to the service after treatment at ICU, 2 (2.1%) patients died. The median cost per patient was 1.064 (726-1.866) Turkish Lira (TL). Drug costs accounted the largest portion (36.0%) of the median cost, followed by bed cost (26.0%). Two (2.1%) of patients died in hospital. Although the number of patients without antibiotic usage is less (17.2% vs 82.8%); the median cost per patient in the antibiotic using group was higher than that were without antibiotic using (median 643 vs 1.162 TL p=0.001). Presence of a comorbidity, hypoxemia, noninvasive mechanical ventilation (NIMV) requirement were existing factors that didn’t increase the cost of patients (p>0.05). Only the use of antibiotics was detected as independent factors that increase the total cost (95% CI 0.487 to 12.984, p=0.030).
Conclusion: Acute exacerbation of COPD continues to be an important cause of mortality and economic burden in the hospitalized COPD patients in pulmonary clinics.

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Salmonella enfeksiyonu sýk görülür, ancak plevra tutulumu nadir olarak rapor edilmektedir. Salmonella enteritidis ile plevra ampiyemi olan sadece yedi olgu bildirilmiþtir; tümü önceden mevcut altta yatan immünosüpresyon veya malignite ile iliþkiliydi. Biz, saðlýklý görünen bir erkekte S. enteritidis ampiyemi olgusu rapor etmekteyiz. Ýleri takip ve gözlemde, sonunda hasta non-Hodgkin lenfoma ve kontralateral rekürren þilotoraks ile geldi. Ýkincisi, daha önce literatürde bu amaç için hiç tanýmlanmamýþ olan radyoaktif iþaretli rituksimab ile baþarýyla kontrol altýna alýndý.

Salmonella infection is common, but pleural involvement has rarely been reported. Only seven cases of Salmonella enteritidis pleural empyema have been reported; all had an associated preexisting underlying immunosuppresion or malignancy. We report the case of an apparently healthy man who developed S. enteritidis empyema. On further follow-up and surveillance, he eventually presented with non-Hodgkin’s lymphoma and a contralateral recurrent chylothorax. The latter was successfully controlled with radiolabeled rituximab, which has never been described for the above purpose in literature before.

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Churg strausse sendromu astým, alerjik rinit, kan ve dokuda eozinofilik infiltrasyon ve akciðerlerde geçici infiltrasyonlarla seyreden, nedeni bilinmeyen bir durumdur. Sýklýkla 3-4 dekatta görülür ve insidansý 2.4/1,000,000 civarýndadýr. Hastaneye baþvuruda nodüler akciðer infiltrasyonlarý, kaviter infiltrasyon, buzlu cam görünümü ve alveolar opasite bulunur. Ancak, endobronþiyal kitle þeklinde görülmesi beklenmeyen bir durumdur. Beþ yýldýr astým nedeniyle tedavi gören 45 yaþýndaki erkek hasta sunulmuþtur. Son takip vizitinde, akciðer filminde sað hilusta kitle görülmesi üzerine fiberoptik bronkoskopi yapýldý. Biyopsi materyelinin patolojik incelenmesi, Churg Strauss sendromunu doðruladý. Bronþiyal kitle, Churg-Strauss sendromunun beklenmeyen bir geliþ þeklidir ve pulmoner malignitelerle ayýrýcý tanýsýnda patolojik inceleme gereklidir.

Churg–Strauss syndrome is a condition with unknown etiology and asthma, allergic rhinitis, eosinophilic infiltration of blood and tissues, and transient infiltration of the lungs. It occurs mostly in the 3rd–4th decades of life with an incidence of 2.4/1000000. Presentation frequently involves nodular lung infiltrations, infiltrations with cavity, ground-glass appearance, and alveolar opacity. However, endobronchial mass is an unexpected presentation. In the current case report, we present a 45-year-old male patient who was receiving asthma therapy for 5 years. In the last follow-up visit, we identified a mass in the right hilum on X-ray radiography and performed fiberoptic bronchoscopy. Pathologic examination of biopsy material verified the diagnosis of Churg–Strauss syndrome. Bronchial mass is an unexpected presentation of Churg–Strauss syndrome and pathologic examination is essential to distinguish it from pulmonary malignancies.

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