Amaç: Bu kesitsel araþtýrmada Celal Bayar Týp Fakültesi öðrencilerinde sigara içme sýklýðýnýn saptanmasý amaçlanmýþtýr.
Gereç ve yöntem: 2006-2007 öðrenim yýlýnda fakültedeki toplam 429 öðrenciden araþtýrmaya katýlmayý kabul eden 370’ine (%86.2) gözlem altýnda anket uygulanmýþtýr. Veri analizinde tanýmlayýcý istatistikler ve ki-kare testi kullanýlmýþtýr.
Bulgular: Yüz doksan dördü (%52.4) erkek olan öðrencilerin yaþ ortalamasý 20.62±1.83 yýldý. Öðrencilerin 45’i (%12.2) her gün, 6’sý (%1.6) bazen sigara içiyordu. Sigara içme yaygýnlýðý erkek öðrencilerde, kýz öðrencilerden belirgin derecede yüksekti (erkek: %21.1, kýz: %5.7) (p<0.001). Sýnýflar arasýnda sigara içme alýþkanlýðý açýsýndan anlamlý farklýlýk saptandý (p<0.001). En sýk sigaraya baþlama nedeni arkadaþlardý (%56.8). Halen sigara içen öðrencilerden 20’si (%39.2) sigarayý býrakmak istemekte, 10’u (%19.6) istememekte, 21’i (%41.2) ise kararsýzdý. Sigara içen öðrencilerden 40’ý (%78.4) sigarayý býrakmayý denemiþ olduðunu belirtti.
Sonuç: Sigara içme oranýnýn yüksek olduðu týp fakültesi öðrencilerinin sigara konusunda daha fazla bilinçlendirilmesi gerektiði söylenebilir.

Aim: In this cross-sectional study our aim was to determine the smoking prevalence in the students of Celal Bayar University Faculty of Medicine.
Material and methods: In the term of 2006-2007 there were 429 students in the faculty of medicine, we applied questionnaires under supervision to 370 students (86.2%) who accepted to participate in the study. For statistical analysis, descriptive statistics and chi-square test was used.
Results: The mean age of students was 20.62±1.83 years, 194 were male (52.4%). Forty five of the students (12.2%) were smoking regularly while 6 of them (1.6%) were occasional-smokers. The smoking prevalence was higher in males than females (male: 21.1%; female 5.7%; p<0.001). The difference among classes was significant (p<0.001). The main reason for beginning smoking was friends (56.8%). Of the students who have been smoking currently, 20 students (39.2%) wanted to quit smoking, 10 (19.6%) did not and 21 (41.2%) were undecided. Forty of the current smokers (78.4%) had tried to quit smoking previously.
Conclusion: It is concluded that medical students with high smoking prevelance should be educated more intensively about tobacco.

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Amaç: Bu çalýþma, Tokat Gaziosmanpaþa Üniversitesi öðrencilerinin sigara konusundaki tutum ve davranýþlarýný incelemek, sigara içiciliðinin sosyo-demografik özellikler ile iliþkisini araþtýrmak, nikotin baðýmlýlýðý konusundaki subjektif deðerlendirmeleri Fagerström Nikotin Baðýmlýlýk Testi (FNBT) ile karþýlaþtýrmak amacýyla yapýlmýþtýr.
Gereç ve yöntem: Çalýþmamýzda, GOP Üniversitesi bünyesindeki altý fakülteye baðlý 24 bölümdeki öðrencilere, demografik verilerini ve sigara alýþkanlýklarýný sorgulayan anket formu daðýtýldý. Sigara anket formu, altýsý FNBT sorularý, ikisi öðrencilerin alkol kullanýmlarý ilgili olmak üzere, 26 sorudan oluþmaktaydý.
Bulgular: Çalýþmaya dahil edilen 1870 öðrencinin %53’ü erkekti ve yaþ ortalamalarý 21.2±2 idi. Sigara içmeyi deneyenlerin %55’i ilk denemelerini 15 yaþýna kadar, %87’si 18 yaþýna kadar yapmýþtý. Düzenli sigara içme yaygýnlýðý genel olarak %36, erkeklerde %46, kýzlarda %24 idi ve fark anlamlýydý (p<0.001). Sigara içenlerin %22’si ilk kez üniversitede sigaraya baþlamýþtý. Günde içtikleri sigara miktarýný “çok” ve kendilerini “sigara baðýmlýsý” olarak tanýmlayan öðrencilerin FNBT skorlarý anlamlý derecede daha yüksek bulundu (p<0.001). Öðrencilerin %24’ü alkol kullanýyordu. Ev ortamýnda sigara içilmesi, annenin eðitimli olmasý, okul performansýnýn kötü olmasý ve alkol kullanýmý, sigara içiciliði ile iliþkili bulundu. Ayrýca annesi sigara içen çocuklarýn daha fazla nikotin baðýmlýsý olduklarý saptandý.
Sonuç: Sigara içenlerin önemli bir bölümü sigaraya ilk kez üniversitede baþlamaktadýr ve bu nedenle sigara karþýtý çalýþmalar için üniversiteler öncelikli hedeflerden biri olmalýdýr. Ev ortamýnda sigara içilmesi, annenin eðitimli olmasý, okul performansýnýn kötü olmasý ve alkol kullanýmý, sigara içiciliði ile iliþkili bulunmuþtur. Öðrenciler nikotin baðýmlýlýklarýný doðru algýlayabilmektedirler ve anneleri sigara içen öðrenciler daha fazla nikotin baðýmlýsý olmaktadýr. Bu nedenle sigara karþýtý kampanyalarda sigara içen annenin önemi özellikle vurgulanmalýdýr.

Aim: The aim of this study was to investigate the attitudes towards smoking, relations between smoking and demographic characters of students of Gaziosmanpaþa (GOP) University and compare their self perception of nicotine dependence and scores of Fagerström test for nicotine dependence (FTND).
Material and methods: The study was conducted in 24 departments of six faculties of GOP University by a questionnaire which contains 26 questions about demographic characters, nicotine dependence and also alcohol consumption.
Results: One thousand eight hundred seventy students were enrolled to the study and 53% of them were male. Mean age of the students was 21.2±2. Of the students, 55% has tried smoking before they were 15 years old and 87% before 18. Prevalance of current smokers was 36% (males 46%, females 24%, p<0.001). Of the smokers, 22% started to smoke in university. The ones who defined themselves as “nicotine dependent” and the amount of cigarettes they smoke as “many”, had significantly higher FTND scores. Growing in a house where family members smoke, having an educated mother, having poor school performance, and alcohol use were factors related with smoking. Furthermore, the ones whose mothers were smokers, were significantly more nicotine dependent.
Conclusion: Since significant number of students begin to smoke in university, universities should be the primary target for anti-smoking campaigns. Students are able to perceive their nicotine dependence properly. Smoking mothers have negative influences on smoking of their children and their nicotine dependence.This is why importance of smoking mother should be particularly emphasized in anti-smoking campaigns.

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Amaç: Stabil KOAH’lý hastalarda spirometrik ve nütrisyonel parametrelerin cinsiyet faktörü ile iliþkisini araþtýrmayý amaçladýk.
Gereç ve yöntem: Çalýþmaya, spirometrik deðerlendirmeyi etkileyebilecek ve malnütrisyon nedeni olabilecek ek sorunu olmayan stabil KOAH’lý hastalar dahil edildi. Olgulara SGRQ anketi yapýldý. Nütrisyonel parametreleri, spirometrik ve demografik verileri kaydedilerek deðerlendirildi.
Bulgular: Çalýþmada, 81’i erkek, 19’u kadýn ve hepsinde sigara öyküsü olan toplam 100 stabil KOAH’lý hasta (yaþ ortalamasý 65.1±4.3 yýl) prospektif olarak deðerlendirildi. %FEV1 (p=0.003), %FEF25-75 (p=0.011), %PEF (p=0.003) deðerlerinin ve sigara paket-yýl deðerlerinin (p=0.009) kadýnlarda anlamlý derecede düþük olduðu saptandý. VKÝ deðerlerinin kadýnlarda (30.7±6.6) erkeklere göre (27.4±4.9) anlamlý derecede yüksek olduðu görüldü (p=0.018). Erkeklerde triseps deri kalýnlýðý deðerinin anlamlý derecede düþük (p<0.001), Saint George Solunum Anketi (SGRQ) puanlarýnýn ise anlamlý derecede yüksek (p=0.036) olduðu gözlendi.
Sonuç: Sigara, KOAH oluþumunda en etkili ajandýr. KOAH’lý kadýnlarýn, daha az sigara içmelerine karþýlýk spirometrik deðerleri daha düþük bulunmuþtur. Buna raðmen nütrisyonel parametrelerinde belirgin kötüleþme olmayýþý ve SGRQ skorlarýnýn daha düþük olmasý, sistemik yanýta kadýn cinsiyetinde bir duyarsýzlýk olabileceðini düþündürmektedir.

Aim: We aimed to evaluate the relationship between sex factor, spirometric and nutritional parameters in patients with stable COPD.
Material and methods: Patients with stable COPD who had no additional problem that affects spirometric and nutritional results, were included in the study. By the application of SGRQ questionnarie nutritional parameters, spirometric and demographic findings of cases were recorded and evaluated.
Results: Totally 100 patients with stable COPD (81 males, 19 females and mean age 65.1±4.3 years) were evaluated prospectively. %FEV1 (p=0.003), %FEF25-75 (p=0.011), %PEF(p=0.003) values and smoking package-years (p=0.009) were found significantly higher in males. Body Mass Index values were significantly higher (p=0.018) in females (30.7±6.6) than males (27.4±4.9). In males higher triceps skin thickness values (p<0.001) and lower SGRQ scores (p=0.036) were found.
Conclusion: Smoking is the most important agent in devoloping of COPD. Although smoking duration was shorter in females spirometric findings were worse. In spite of this finding, because of better nutritional parameters and lower SGRQ scores, it is thought that there is insensitivity in females to systemic response.

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Amaç: Hastanemizin 2006 yýlýna ait tüberkülozlu (TB) asker olgu serisini sunmak ve diðer seriler ile karþýlaþtýrmak.
Gereç ve yöntem: Türk Silahlý Kuvvetleri’nin (TSK) en büyük TB tedavi merkezi özelliðini taþýyan hastanemizde, 2006 yýlý içinde taný konulan TB’li asker hastalarýn verileri geriye dönük olarak incelendi. Tüm hastalara bakteriyolojik muayene yapýldý. Taný konulan hastalar, uygun antitüberküloz tedavi baþlanarak, 6-12 ay boyunca takip edildi ve bu süre sonunda tedavi sonuçlarý deðerlendirildi.
Bulgular: 2006 yýlý boyunca, 177 (%92.7) yeni, 14 (%7.3) eski olmak üzere, toplam 191 TB’li asker olgu saptanmýþtýr. Yeni olgularýn 145’i (%81.9) akciðer tüberkülozu (ATB), 47’si (%18.1) ise akciðer dýþý tüberkülozdur (ADTB). ATB’li olgularýn 14’ünde ATB+ADTB birlikteliði vardý. ADTB olgularýnýn birinde ise birden fazla organ tutulumu vardý. ADTB olgularýnýn 40’ý (%85.1) plevra tüberkülozu, 3’ü (%6.4) tüberküloz lenfadenit, 2’si (%4.3) beyin tüberkülozu, 1’i (%2.1) tüberküloz orþit, 1’i (%2.1) de tüberküloz bursit olarak saptandý. ATB’li olgularýmýzýn 89’u (%61.4) yayma (+), 56’sý (%38.6) ise yayma (-) olarak saptandý. Tedavi sonuçlarýna göre, yayma (+) 89 olgumuzun 80’i (%89.9) kür, 1’i (%1.1) tedavi tamamlama olmak üzere, toplam 81’inde (%91) tedavi baþarýsý, 1’inde (%1.1) tedavi baþarýsýzlýðý, 7’sinde ise nakil (%7.9) vardý.
Sonuç: Merkezimizde, yayma pozitif hastalarda saptadýðýmýz kür sonuçlarýnýn, Dünya Saðlýk Örgütü tarafýndan istenilen %85’lik düzeyin üstünde olduðu gözlemlenmektedir.

Aim: To present a series of soldier cases with tuberculosis (TB) for the year of 2006 in our hospital and to compare them with the cases in other studies.
Material and methods: In this study, data was retrospectively analyzed for soldier patients diagnosed with tuberculosis (TB) in our hospital in 2006. Our hospital is the greatest TB treatment center of the Turkish Armed Forces (TAF). Microscopical examination was done for all cases. A proper treatment was initiated for all patients with a diagnose and they were followed during the next 6-12 months. At the end of that period, treatment results were assessed.
Results: During 2006 a total of 191 cases with TB were found. One hundred forty five of these cases (81.9%) were pulmonary tuberculosis (PTB) and 47 of them were (18.1%) extra pulmonary tuberculosis (EPTB). It was discovered that 177 of our cases (92.7%) were new and 14 of them were (7.3%) old. Fourteen PTB patients had EPTB at the same time. One patient had more than one extra pulmonary tuberculosis. Forty of total 47 EPTB cases (85.1%) were pleural TB. The number of smear positive and smear negative cases were 89 (61.4%), 56 (38.6%) respectively. In smear positive 89 cases, treatment outcomes were classified as follows: 80 cases (89.9%) were cured, one patient (1.1%) completed treatment. Treatment success was managed in a total of 81 cases (91%). One of smear positive patients (1.1%) was treatment failure, seven cases (7.9%) were transfered to other centers.
Conclusion: Our cure results in smear positive patients are above the rate of 85% targeted by WHO.

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Amaç: Fleksibl fiberoptik bronkoskopinin (FFB) lokal anestezi altýnda yapýlmasýna karþýlýk hastalar sýk sýk öksürük, aðrý ve boðulma hissinden yakýnýrlar. Propofol iyi bir sedasyon düzeyi, hemodinamik stabilite, amnezi ve hýzlý derlenme saðlar. Deksmedetomidin santral etkili bir a2 adrenoreseptör agonisttir, solunum depresyonu yapmadan amnezi ve analjezi saðlar. Bu çalýþmada FFB iþleminde kullanýlan deksmedetomidinin ve propofolün amnezi, tolerans ve hasta memnuniyeti üzerindeki etkileri karþýlaþtýrýlmýþtýr.
Gereç ve yöntem: Prospektif, çift kör, randomize olan bu çalýþmaya diagnostik FFB yapýlacak 30 hasta dahil edildi. Hastalar Grup D (deksmedetomidin, n=15) ve Grup P (propofol, n=15) olarak ayrýldýlar. Sedasyon düzeyi Ramsey sedasyon skalasý 3 olacak þekilde planlandý. FFB bitiminde hastalar, bir kez anestezist, iþlemden sonra da bronkoskopist tarafýndan amnezi, FFB iþlemine tolerans ve hasta memnuniyeti açýsýndan deðerlendirildiler.
Bulgular: Prosedürler, FFB iþlemi sýrasýnda sistolik ve diyastolik kan basýnçlarý ile derlenmede kalýþ süreleri benzerdi (p>0.05). Grup D’de diðer gruba göre kalp hýzý daha düþük, periferik oksijen satürasyonu daha yüksekti ancak bu fark istatistiksel olarak anlamlý deðildi (p>0.05). Gruplar karþýlaþtýrýldýðýnda amnezi, tolerans (aðrý, öksürük ve boðulma hissi) ve hasta memnuniyeti benzerdi (p>0.05). Çalýþma süresince sadece Grup P’de bir hasta desatüre oldu ama oksijen desteðinin artýrýlmasýyla periferik oksijen satürasyonu normal deðerlerine yükseldi.
Sonuç: FFB’de sedasyon süresince propofol ve deksmedetomidin benzer hemodinamik, solunumsal, amnezik özellikler göstermiþ, iþleme tolerans ve kabul edilebilirlik üzerinde benzer etkileri olmuþtur. Bu nedenle FFB süresince sedasyon tercih ediliyorsa, deksmedetomidin propofole alternatif olarak kullanýlabilir.

Aim: Eventough flexible fiberoptic bronchoscopy (FFB) is performed under local anesthesia, patients frequently complain of cough, pain and sensation of asphyxiation. Propofol supply a good sedation level, hemodynamic stability, amnesia and quick recovery. Dexmedetomidine is a centrally effective a2 adrenoreceptor agonist, it provides amnesia and analgesia without respiratory depression. The effects of dexmedetomidine and propofol usage during FFB on amnezia, tolerance and patient satisfaction are compared in this study.
Material and methods: Thirty patients undergoing diagnostic FFB were included in this prospective, randomized, double-blind study.. Patients were assigned to have either Grup D (dexmedetomidine n=15) or Grup P (propofol, n=15). The level of the sedation was adjusted to reach Ramsey sedation score 3. At the end of FFB, patients were first interrogated by the anesthezist and then by the bronchoscopist, about amnesia, tolerance and patient satisfaction for FFB.
Results: Demographic data, pulmonary function tests, diagnostic procedures, systolic and diastolic BP during FFB procedure and duration of recovery room staying were similar between two groups (p>0.05). Heart rate was lower and SO2 was higher in group D compared to group P but these differences were not statistically significant (p>0.05). In comparison of the groups, both dexmedetomidine and propofol shown similar effects on amnesia, tolerance (pain, cough, sensation of asphyxiation) and patient acceptance. One patient in Group P was desaturated during study, but peripheral oxygen saturation increased to baseline values with increasing oxygen supply.
Conclusion: Both propofol and dexmedetomidine had similar effects in cardiovascular and respiratory system, on amnesia, analgesia, cough, sensation of asphyxiation and pain during sedation on FFB. If sedation is preferred during FFB, dexmedetomidine can be used as an alternative to propofol.

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Amaç: Sarkoidozun atipik parankimal radyolojik bulgularýnýn önemini belirtmek.
Gereç ve yöntem: 2002-2007 yýllarý arasýnda histopatolojik olarak sarkoidoz tanýsý alan hastalar retrospektif olarak incelendi.
Bulgular: 2002-2007 yýllarý arasýnda sarkoidoz tanýsý alan 34 hasta vardý. Otuz dört sarkoidoz hastasýnýn altýsýnda (%17.6) atipik parankimal radyolojik bulgular saptandý. Hastalarýn ikisi kadýn (%33), dördü erkekti (%66) ve ortalama yaþlarý 30.5±10.1 idi. En sýk þikâyetleri halsizlik ve nefes darlýðýydý. Hastalarda saptanan atipik radyolojik bulgular bir hastada bilateral plevral efüzyon, 2.5 cm’lik soliter pulmoner nodül ile bilateral yamalý hava bronkogramlarý içeren konsolide alanlar (alveoler sarkoidoz), bir hastada tüm akciðer alanlarýný kapsayan difüz buzlu cam görünümü, bir hastada yaygýn mozaik perfüzyon görünümü ve kalan üç hastada bilateral alveoler sarkoidoz þeklindeydi.
Sonuç: Literatürde “büyük taklitçi” olarak da adlandýrýlan sarkoidozun atipik parankimal radyolojik bulgularý çeþitlidir. Klinik pratikte hastalarýn yaklaþýk %20’sinde görülebilmektedir. Bu yüzden atipik bulgularýn akýlda tutulmasý, daha erken taný ve tedavi olanaðý saðlayacaktýr.

Aim: To emphasize the importance of atypical paranchymal radiological findings of the sarkoidosis.
Material and methods: The sarcoidosis patients, which were histopathologically diagnosed between 2002-2007, were examined retrospectively.
Results: There were 34 patients, diagnosed as sarcoidosis between 2002-2007. In six of these 34 patients (17.6%) atypical paranchymal findings were determined. Two patients were female (33%), four patients were male (66%) and mean ages were 30.5±10.1. The most frequent complaints were dyspnea and fatigue. The determined atypical radiological findings were as follows: bilateral pleural effusion, solitary pulmonary nodule 2.5 centimeters in diameters, bilateral patchy consolidations involving air bronchograms (alveoler sarcoidosis) (one patient), diffuse ground-glass appereance (one patient), diffuse mosaic perfusion defect (one patient) and alveoler sarcoidosis (three patients).
Conclusion: The atypical paranchymal radiological findings of the sarcoidosis, which is also named as “great masquerader” in the literature, are various. These findings can be seen in approximately 20% of the patients in clinical practice. Therefore, keeping in mind the atypical radiological findings of sarcoidosis can provide early diagnosis and treatment.

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Amaç: Sarkoidozda plevra tutulumu çeþitli serilerde %0.3-7 arasýnda bildirilmektedir. Günümüzde geniþ çaplý bir otopsi çalýþmasý bulunmamasýyla birlikte, geçmiþteki olgu bazlý bildirilerde çok daha yüksek oranlara rastlanýlmaktadýr. Plevral tutulum hastalarýn ancak %2-4’ünde klinik belirti vermektedir ve direkt grafide efüzyon varlýðý %1-3 dolayýndadýr. Toraks BT’de plevral kalýnlaþma ve az miktarda sývý varlýðý ise daha sýk rastlanýlan bir bulgudur. Taný genellikle kolay ulaþýlabilir yerlerden (skalen lenf nodu, transbronþiyal) alýnan biyopsilerle doðrulandýðýndan, plevra tutulumuna ait bulgu olsa bile gösterilmesi çok az vakada gerekmektedir. Bu çalýþmada, açýk akciðer biyopsisi ile plevra tutulumu kanýtlanmýþ üç olgu ýþýðýnda sarkoidoz hastalarýmýzýn bazý özellikleri gözden geçirilmiþtir.
Gereç ve yöntem: 1992-2005 yýllarý arasýnda Süreyyapaþa Hastanesi’nde sarkoidoz tanýsý almýþ 30 olgu epidemiyolojik ve klinik özellikleri ile birlikte plevra tutulumu açýsýndan retrospektif olarak incelenmiþtir.
Bulgular: Yirmi yedi (%90) kadýn, üç (%10) erkek olguyu kapsayan çalýþmamýzda, yaþ ortalamasý 41.1±12.8 olarak bulundu (yaþ aralýðý 17-68). Hastalarýn beþinde (%16.7) sigara, dördünde (%13.3) tüberküloz anemnezi vardý. Olgularýn yedisinde (%23.3) dalak, dördünde (%13.3) karaciðer, üçünde (%10) plevra, ikisinde (%6.6) göz ve birinde (%3.3) deri tutulumu saptandý. Olgularýn yedisine (%23.3) açýk akciðer biyopsisi yapýlmýþtý ve üçünde nonkazeifiye granülomlar saptanarak plevral tutulum kanýtlandý.
Sonuç: Çalýþmamýzda, göðüs cerrahisi olmayan merkezlere göre sarkoidozlu olgularýmýzda daha yüksek oranda plevral tutulum saptanmýþtýr. Sarkoidozda plevra tutulumunun gerçek sýklýðýnýn belirlenmesi amacýyla, açýk akciðer biyopsisi sýrasýnda alýnacak plevral biyopsi örneðinin histopatolojik deðerlendirilmesinin önemi büyüktür.

Aim: The reported prevalence of pleural involvement in sarcoidosis varies between 0.3-7%. Although pleural involvement in sarcoidosis is considered to be more frequent in autopsy studies, we did not met any strict serial autopsy studies regarding pleural involvement reported in the literature. Clinical signs are observed in only 2-4% of patients and pleural effusion can be detected on X-ray in 1-3% of sarcoidosis cases. Pleural thickening and minimal pleural effusion is a more frequent finding in thorax CT. As the diagnosis is usually confirmed by biopsies taken from regions that are easily reached such as scalen lymph nodes, transbronchial biopsies, only in few cases confirmation is required for pleural involvement. In this study we examined our 30 sarcoidosis cases in the light of three cases with pleural involvement verified with open lung biopsy.
Material and methods: Thirty patients who had sarcoidosis diagnosis at Süreyyapaþa Hospital between 1992-2005 were evaluated retrospectively for epidemiologic, clinical characteristics and pleural involvement.
Results: Mean age of 30 patients (27 female, three male) was 41.1±12.8 years (range 17-68). Five cases (16.7%) had the history of smoking and four cases (13.3%) tuberculosis. Spleen involvement was seen in seven (23.3%), liver in four (13.3%), eye in two (6.6%), skin in one (3.3%) and pleura in three (10%) of the 30 patients. Sarcoidosis was diagnosed with open lung biopsy in seven (23.3%) patients, three of them had pleural involvement with noncaseating granulomas verifying pleural involvement.
Conclusion: In our study the diagnosis of sarcoidosis with pleural involvement was seen more frequently than the centres without surgical department. We believe that the histopathological evaluation of pleural biopsy material performed by open lung biopsy is crucial to show the real frequency of pleural involvement in sarcoidosis.

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Plevral sinovyal sarkom, plevranýn oldukça nadir görülen bir tümörüdür ve Ýngilizce literatürde sadece 16 olgu rapor edilmiþtir. Bu makalede, masif eksudatif hemorajik plevral efüzyonlu orta yaþlý bir primer sinovyal sarkom olgusu sunulmaktadýr.
Hasta, kliniðimize, dört aydýr süren öksürük, göðüs aðrýsý, gece terlemeleri ve kilo kaybýyla birlikte olan, zaman içerisinde gittikçe kötüleþen nefes darlýðýyla baþvurdu. Fizik muayenede sað hemitoraksta azalmýþ fremitus, perküsyonda matite mevcuttu ve solunum sesleri duyulamadý. Bilgisayarlý tomografide sað torasik boþlukta masif plevral efüzyon ve sað plevral yüzeyde, en büyüðü 2.4 cm çapýnda nodüller izlendi. Torasentezle alýnan hemorajik sývýnýn LDH ve protein incelemeleri sonucunda eksuda karakterinde olduðu gösterildi. Plevra biyopsisi ve plevral sývýnýn histositolojik incelemesi sonucu, kronik non-spesifik plörit olarak geldi. Bu sonuç üzerine daha ileri inceleme olarak VATS (Video -Assisted Thoracoscopic Surgery) yapýldý. VATS ile alýnan plevral doku örneðinin immünohistokimyasal analizinde tümör hücrelerinde pansitokeratin, vimentin, sitokeratin S, EMA ve S-100 ile pozitif; kalretinin, TTF-1, CEA ile negatif boyanma elde edildi. Bütün bu bulgular ýþýðýnda olgu “Primer Plevral Sinovyal Sarkom” olarak deðerlendirildi. Hastaya kemoterapi verildi.

Pleural synovial sarcoma is an exceptional neoplasm of the pleura and only 16 cases have been reported in the English language literature. In this report, we are presenting a case of middle aged male with massive exudative hemorrhagic pleural effusion.
The patient presented with progressively worsening shortness of breath for the past four months and cough, chest pain, night sweats and weight loss. Physical examination revealed decreased fremitus, dullness to percussion and absence of breath sounds at right hemithorax. A computed tomography scan revealed large pleural effusion in the right thoracic cavity. There were multiple nodules (bigest nodule was 2.4 cm) on the right pleura in CT. Thoracentesis showed hemorrhagic fluid with elevated lactate dehydrogenase (LDH) and protein suggestive of exudation. Histocytological analysis of pleural effusion and pleural biopsy showed chronic non-specific pleuritis. Because of this result, VATS (Video- Assisted Thoracoscopic Surgery) was done. Immunohistochemical analysis of VATS specimen revealed positive staining of the tumor cells for pancytokeratin, vimentin, cytokeratin S, EMA, S-100 and negative staining for calretinin, TTF-1, CEA. These findings led us to a diagnosis of primary synovial sarcoma of the pleura. The patient was given chemotherapy.

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Yetmiþ yedi yaþýnda erkek hasta, balgamla karýþýk hemoptizi ve ses kýsýklýðý yakýnmalarý ile kliniðimize baþvurdu. Yakýnmalarý, baþvurusundan beþ gün önce baþlamýþtý. Ayrýntýlý anamnez alýndýðýnda, þikâyetlerinin, kaynak suyuyla aðzýný çalkaladýktan sonra baþladýðý öðrenildi. Solunum sistemi muayenesinde stridor duyuldu; solunum sesleri bilateral azalmýþtý. Akciðer radyogramýnda bilateral üst zonlarda lineer fibrotik heterojen dansite artýþý, toraks bilgisayarlý tomografisinde bilateral apikal bölgelerde sekel fibrotik deðiþiklikler ve bilateral üst loblarda daha belirgin olan amfizematöz alanlar izlendi. Laboratuvar tetkiklerinde rutin hemogram ve biyokimyasal parametreleri normal idi. Arteriel kan gazý incelemesinde ýlýmlý hipoksi saptandý. Hemoptizi ve ses kýsýklýðý nedeniyle, olasý bir üst solunum yolu hastalýðýný ekarte etme amacýyla kulak burun boðaz hastalýklarý uzmaný ile konsülte edildi. Ýndirekt larengoskopide, larenkste rima glottisi büyük oranda obstrükte eden siyah-yeþil renkli canlý bir yabancý cisim izlendi. Genel anestezi altýnda süspansiyon larengoskopisi yapýlarak, yaklaþýk 5 cm uzunluðunda, siyah-yeþil renkli, canlý bir yabancý cisim çýkarýldý. Bronkoskopi incelemesinde bronþiyal aðacýn distal kýsmý normal bulundu. Yabancý cisim, parazitoloji kliniðine konsülte edildi ve hirudina medicina (týbbi sülük) olarak isimlendirildi.
Hirudina medicina ile kontamine kaynak suyuyla aðýz yýkama sonrasý hemoptizi geliþen olgumuz, nadir görülmesi nedeniyle sunulmuþtur.
Bu olgu sunumunu, larenks sülüðünün neden olduðu hemoptizinin ender görülmesi ve sülüðün çýkarýlmasý iþleminin olaðandýþýlýðý nedeniyle seçtik.

A 77 years old male patient admitted to our hospital with complaints of mild bleeding with sputum and hoarseness of voice. He told that the symptoms had begun suddenly five days ago. After our insistent questioning, he remembered that the symptoms had begun after washing his mouth and face with spring water. On his physical examination stridor was heard and bilateral reduction of breathing sounds was found. Chest X-ray showed linear fibrotic heterogeneous density at bilateral upper zones. Thoracic CT revealed sequel fibrotic changes at bilateral apical regions and emphysematous areas more prominent at bilateral upper lobes. Routine haemogram and biochemical analysis of blood were normal. Arterial blood gas analysis revealed mild hypoxia. In order to eliminate an upper airway disease ear-nose-throat specialist consultation was carried out, and surprisingly, a black-green colored alive foreign body which extremely obstructed rima glottis at larynx was observed by indirect laryngoscopy. The 5 cm long black-green colored alive foreign body was removed out by suspension laryngoscopy. Bronchoscopy, which was performed after the removing process, was normal. The foreign body was consulted by parasitology department. It was identified as hirudina medicina (medical leech).
Hirudina medicina can live in spring water and infect people while washing mouth with contaminated spring water.
We preferred to present this case, because laryngeal leech is a rare cause of haemoptysis and its removal process was extraordinary.

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Kist hidatik; özellikle tarým ve hayvancýlýðýn yaygýn olduðu ülkelerde sýk görülen, çoðunlukla köpek dýþkýsý ile insana bulaþan ekinokok çestodunun neden olduðu paraziter bir hastalýktýr.
Hastalýk parazitin yerleþtiði organda kistik lezyonlar oluþturmasý ile karakterizedir. En sýk yerleþtiði organlar karaciðer (%60) ve akciðerdir (%30). Bu iki organ dýþýnda vücudun tüm bölgelerinde atipik lokalizasyonlarda karþýmýza çýkabilir.
Bu çalýþmada, 31 yaþýnda bayan hastada, sol latissimus dorsi kasýnda lokalize kist hidatiði olgusu sunuldu. Toraks tomografisi incelemesi sonucunda sol latissimus dorsi kasýnda lobüle kontürlü, derin fasiyal ve müsküler uzaným gösteren 15320 cm boyutlarýnda kistik-solid kitle tespit edildi.
Genel anestezi altýnda kist kapsülü açýldý ve bir adet büyük ve çok sayýda küçük veziküller içeren kist total olarak eksize edildi. Patolojik inceleme sonucunda iskelet kasý kist hidatiði tanýsý konuldu.
Endemik bölgelerde, kaslarda iyi sýnýrlý kistik kitle tespit edilen hastalarýn ayýrýcý tanýsýnda kist hidatik düþünülmesi gerektiði kanaatindeyiz.

Hydatid cyst, frequent in sheep raising countries, is a parasitic disease caused by a cestode named echinococcus and spreaded to man generaly by dog faeces.
The disease is characterised with cystic lesions in involved organs. Liver (60%) and lung (30%) are mostly affected organs. It may also be seen in the other areas as atyptical localisations.
In this study, we present a 31 year-old famale patient diagnosed with hydatid cyst located at left latissimus dorsi muscle. We detected a solid-cystic mass showing lobulated contour, 15320 cm in diameter, deep fascial and muscular extension in the left latissimus dorsi muscle in thorax tomographia examination.
After the general anestezia, hydatid cyst and its capsule was removed totally. The diagnosis of hydatid cyst was confirmed histopathologically.
We consider that hydatid cyst should be included in differential diagnosis of a well-defined muscular cystic mass in the endemic areas.

Abstract | Full Text PDF

Abstract | Full Text PDF

Abstract | Full Text PDF