Halen dünyada bir milyardan fazla sigara içen insan bulunmaktadýr. Türkiye’de sigara içme oraný 2009 yýlý Dünya Saðlýk örgütü verilerine göre yetiþkinlerde (>15 yaþ) %31, 25-44 yaþ grubundaysa %40’týr. Sigara en sýk rastlanýlan sekiz ölüm nedeni arasýnda altýncý sýrada yer almaktadýr. Sigara kullananlarýn yarýsý, sigaraya baðlý hastalýklar nedeniyle ölmektedir. Sigara nedeniyle ortaya çýkan hastalýklar arasýnda en sýk görülenler akciðer kanseri ve kronik obstrüktif akciðer hastalýðýdýr. Ýntertisyel akciðer hastalýklarý, bilinen ve bilinmeyen birçok etkenin akciðer parankiminde benzer patolojik deðiþikliklere yol açtýðý, birbirine benzer klinik, radyolojik ve fizyolojik bulgular veren bir hastalýk grubudur. Sigara kullanýmý ile iliþkili intertisyel akciðer hastalýklarý idiyopatik pulmoner fibrozis, respiratuar bronþiyolitis, deskuamatif interstisyel pnömoni ve pulmoner Langerhans hücreli histiyositozistir. Bu hastalýklar, sigaranýn neden olduðu diðer hastalýklardan daha az görülmekle birlikte, sigara kullanýmýnýn sonlandýrýlmasýyla büyük kýsmýnda klinik iyileþme görülmesi nedeniyle önemlidir.

There are more than one billion cigarette smoking people in the world. The percentage of cigarette smoking in Turkey, for adults is (>15 age) 31% and tobacco use is most prevalent among people aged 25–44 years. Cigarette smoking has the sixth place among the eight leading causes of death. Half of the people using cigarette die because of diseases caused by smoking. Lung cancer and chronic obstructive pulmonary disease are the most common diseases caused by smoking. Interstitial lung diseases are a group of diseases in which known or unknown etiology causes similar pathologic changes in the lung parenchyma and similar clinical, radiological and physiological findings. Idiopathic pulmonary fibrosis, desquamative interstitial pneumonia, respiratory bronchiolitis-associated interstitial lung disease and pulmonary Langerhans’ histiocytosis are interstitial lung diseases which are related with cigarette smoking. Although these diseases are not as common as other diseases caused by smoking, they are important because smoking cessation causes clinical improvement in most of them.

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Amaç: Sarkoidozda fleksibl bronkoskopinin (FB) tanýsal deðerini belirlemek.
Gereç ve yöntem: Prospektif olarak planlanan bu çalýþmaya, 2004-2007 yýllarý arasýnda kliniðimize baþvuran, klinik ve radyolojik olarak sarkoidoz düþünülen hastalar dahil edildi. Tüm hastalara, klinik, laboratuvar ve radyolojik deðerlendirmenin ardýndan FB yapýldý. Fleksibl bronkoskopi sýrasýnda yine tüm hastalara multipl mukoza biyopsileri, transbronþiyal akciðer biyopsisi (TBB) ve Wang’ýn haritalama sistemine göre konvansiyonel transbronþiyal iðne aspirasyonu (TBÝA) yapýldý. Alýnan materyallerin histopatolojik incelemesi sonucunda taný konulamayan olgularýn hepsine kesin taný için mediastinoskopi uygulandý. Bronkoskopinin ve bronkoskopi sýrasýnda uygulanan biyopsi tekniklerinin sensitiviteleri ayrý ayrý hesaplandý.
Bulgular: Çalýþmaya sarkoidoz ön tanýsýyla 49 hasta alýndý ancak tetkikler neticesinde 2 hasta sarkoidoz dýþý (tüberküloz) taný aldýðýndan çalýþmadan çýkarýldý. Sarkoidoz tanýsý alan 47 hastanýn 17’si (%36,2) erkek, 30’u (%63,8) kadýndý ve yaþ ortalamasý 40,55±13,65 yýl idi. Kýrk yedi olgunun 37’sinde FB ile tanýya ulaþýldý (sensitivite: %78,7). Bu 37 hastanýn altýsýna (%16,2) mukoza biyopsisi, 16’sýnda (%43,2) TBÝA, 20’sinde (%54,0) ise TBB ile taný konuldu. Olgularýn beþinde (%13,5) birden fazla bronkoskop yöntemiyle sonuç alýndý. TBB ile taný konulan 20 olgunun dokuzu (%45), parankim lezyonunun izlenmediði evre 0 ve I sarkoidozdu. FB ile taný konulamayan 10 hasta (%21,3) mediastinoskopi ile sarkoidoz tanýsý aldý.
Sonuç: Sarkoidoz hastalýðýnda, konvansiyonel bronkoskopik tekniklerin uygulanmasýyla olgularýn büyük bir kýsmýna taný konulabilmektedir. Evre 0 ve I sarkoidoz olgularýnda bile TBB’nin tanýsal verimliliði yüksektir. Dolayýsýyla sarkoidoz ön tanýsýyla izlenen hastalarda invazif tanýsal giriþimler yapýlmadan önce yapýlan FB ile tüm konvansiyonel teknikler uygulanmalýdýr.

Aim: To establish the diagnostic value of flexibl bronchoscopy (FB) in sarcoidosis.
Material and Methods: Patients considered as sarcoidosis according to the clinical and radiological findings between 2004-2007 were included in this prospective study. Flexibl bronchoscopy (FB) was performed to all patients after clinical, radiological and laboratory evaluation. Multiple mucosal biopsies were taken, transbronchial lung biopsy (TBB) and conventional transbronchial needle aspiration (TBNA) of mediastinal lymp nodes according to Wang’s mapping system were performed to all patients during FB. For the final diagnosis mediastinoscopy was performed if the bronchoscopic biopsies were non-diagnostic. The diagnostic value of bronchoscopy and bronchoscopic biopsy techniques were evaluated seperately.
Results: Of the 49 patients included in the study with the pre-diagnosis of sarcoidosis, 2 were diagnosed as tuberculosis finally, therefore these 2 patients were excluded from the study. Of the 47 patients diagnosed as sarcoidosis, 17 (36,2%) were male, 30 (63,8%) were female and mean age was 40,55±13,65 years. Of all patients, 37 were diagnosed as sarcoidosis by FB (78,7%). TBB findings were positive in 20 (54%), TBNA were positive in 16 (43,2%) and mucosal biopsies were positive in 6 (16,2%) patients. In 5 (13,5%) patients sarcoidosis were diagnosed by more than one bronchoscopic techniques. Of the 20 patients diagnosed by TBB, 9 (45%) were at the stage 0 and I with no paranchimal involvement.The FB techniques were nondiagnostic in 10 patients and sarcoidosis were diagnosed by mediastinoscopy in these patients.
Conclusion: The diagnosis of sarcoidosis can be established mostly by conventional bronchoscopic techniques. The diagnostic efficiency of TBB is high also in stage 0 and I pateints. Therefore in sarcoidosis suspected patients, pulmonologists should consider performing all of the conventional techniques during FB before the invasive diagnostic methods.

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Amaç: Pamuk tozu, tekstil iþ ortamlarýnda çalýþan iþçilerin akciðerlerini etkileyen bir faktördür. Solunum fonksiyon testleri (SFT) akciðer fonksiyonlarýndaki etkilenmeyi gösteren önemli bir yöntemdir. Çalýþmamýz kesitsel nitelikte olup, tekstil fabrikasýnda solunabilir toz oranlarý, çalýþma süreleri ve bu deðerlerin SFT üzerindeki etkisi araþtýrýldý.
Gereç ve yöntem: Yüz doksan altý iþçi, çalýþtýklarý ünitelere göre beþ gruba ayrýlarak, FEV1, FVC, FEV1/FVC, PEF, MEF25, MEF75 ve MMEF parametreleri ölçüldü. Çalýþma sürelerine, ortamýn toz miktarlarýna ve leke temizleme bölümünde maruz kalýnan solunabilir seviyedeki trikloretilen oranýna bakýldý. Ortam atmosferinde bulunan solunabilir toz konsantrasyonlarý, gravimetrik yöntemle hesaplandý.
Bulgular: Ortam toz miktarlarý kabul edilebilir deðerlere yakýndý. Toz miktarlarý bakýlmýþ gruplar ile SFT deðerleri kýyaslandý ve bazýlarýnda istatistiksel olarak anlamlý farklýlýklar saptandý. Çalýþma süreleri 1, 2, 3 ve üstü yýl olmak üzere üç grupta deðerlendirildi. Ortalama çalýþma süresi 2,2 yýl ve en uzun çalýþma süresi 8 yýl idi. Çalýþma süresi 3 yýl ve üstü olan grupta, FEV1/FVC, MEF25 ve MMEF parametrelerinde diðer gruplara kýyasla istatistiksel olarak anlamlý azalmalar saptandý (p<0,05). Trikloretilene maruz kalan iþçilerde, bu maddenin ortamda kabul edilebilir sýnýrlarda olmasýna ve FEV1/FVC, MEF25 ile MMEF deðerlerinde düþüþler saptanmasýna raðmen bu farklar istatistiksel olarak anlamlý deðildi (p>0,005).
Sonuç: Pamuk tozuna maruziyet ortamýnda ortalama 2,2 yýl gibi çalýþma süresinde bile bazý akciðer fonksiyonlarýnýn etkilendiði görüldü. Sonuç olarak, tekstil fabrikasýnda çalýþma süresinin uzamasýyla FEV1/FVC, MEF25 ve MMEF gibi SFT parametre deðerlerinde anlamlý düþüþler saptandý.

Aim: Cotton dust found in textile environment is a factor effecting the lungs of the textile workers. Pulmonary function tests (PFT) are important methods for determining affection of lung function. This cross-sectional study was performed in order to measure respirable dust amount, working periods and effects of these values on pulmonary functions.
Material and method: Hundred and ninety six textile workers were examined in 5 groups according to working locations. Parameters of FEV1, FVC, FEV1/FVC, PEF, MEF25, MEF75 and MMEF were measured. Working periods, dust concentration of environment and amount of soluble trichloroethilene in stain removing group were determined. The concentrations of soluble dust in the environment were measured by gravimetric method.
Results: Amounts of measured environmental dust were near to the acceptable levels and differences were determined among groups. Groups were compared according to the PFT values and some statistically significant differences were found. Working periods were divided into 3 groups as 1, 2 and ≥ 3 years. Mean working period was 2.2 years and maximal working period was 8 years. Statistically significant reductions were found in FEV1/FVC, MEF25, MMEF parameters of group 3 compared to group1 and 2 (p<0,005). In stain removing workers, while amount of soluble trichloroethilene was in acceptable range, FEV1/FVC, MEF25, and MMEF parameters were lower than other groups but the differences were not statistically significant (p>0,005).
Conclusion: It was seen that some of the lung functions were affected by mean 2.2 year working period with cotton dust exposure. As a result, by increasing working period, statistically significant reductions were found in parameters of FEV1/FVC, MEF25 and MMEF.

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Giriþ: Ýnsanlarda kronik hastalýða baðlý olarak geliþen cinsel fonksiyon bozukluklarý ve psikolojik durumla ilgili çok sayýda çalýþma mevcuttur ama bu hastalarýn eþlerindeki cinsel fonksiyon ve psikolojik durumla ilgili veriler yetersizdir.
Amaç: Biz bu çalýþmada bronþektazili olgularda kronik hastalýk haline eþlik eden prodüktif öksürük, kötü kokulu balgam çýkarma gibi semptomlarýn bu hastalarýn eþlerindeki cinsel fonksiyonlarda ve psikolojik durumda meydana getirdiði deðiþimi incelemeyi amaçladýk.
Yöntem: Çalýþma operasyon endikasyonu konulan 41 bronþektazili erkek hastanýn doðurganlýk çaðýndaki eþleri ile yapýldý. Olgular eþleri opere edilmeden önce ve operasyondan bir yýl sonra, cinsel durum için Kadýn Cinsel Fonksiyon Ýndeksi (Female Sexual Function Index: FSFI), depresyon deðerlendirmesi için Beck Depresyon Envanteri (BDI) ile deðerlendirildiler.
Bulgular: Eþleri opere olmadan önce kadýnlarýn %24,4’ünün BDI’ya göre þiddetli depresyon belirtileri gösterdiði ve bu olgularda depresyonun postoperatif dönemde, eþleri asemptomatik olduktan sonra %4,9’a gerilediði tespit edildi (p=0,001). Olgularýn FSFI ile deðerlendirilmesinde, preoperatif dönemde cinsel fonksiyon bozukluðunu gösteren skorlar elde edilirken, postoperatif dönemde bu deðerlerde belirgin bir düzelme ortaya çýktý (p=0,001).
Sonuç: Bu çalýþmada, eþlerindeki saðlýk sorunlarýnýn kadýnlarýn cinsel fonksiyonlarýnda ve duygu durumlarýnda çok belirgin bir deðiþiklik yaptýðý görülmüþ ve kadýnlardaki cinsel ve psikolojik saðlýðýn kalitesinin yükseltilmesi ve devamý için eþlerinin saðlýðýnýn korunmasý ve devamýnýn da çok önemli olduðu sonucuna varýlmýþtýr.

Introduction: Despite the numerous studies available on sexual disorders and psychological status in patients with chronic diseases, data regarding the sexual function and the psychological status of the patients’ partners are insufficient.
Aim: In this study we aimed to put forth the changes in sexual functions and psychological status in women caused by partners’ symptoms such as productive cough and foul smelling sputum that accompany chronic disease in bronchiectasis patients.
Methods: The study was conducted with fertile age partners of 41 male patients for whom an operation due to bronchiectasis was decided. The subjects were assessed using the Female Sexual Function Index (FSFI) for sexual functions and the Beck Depression Inventory (BDI) for depression before and 1 year after the operations.
Results: It was found that 24.4% of the women had exhibited severe depression symptoms according to BDI, and the number of the patients with severe depression was found to decrease to 4.9% after their spouses became asymptomatic in the postoperative period (p=0.001). In the assessment of cases with FSFI, while the scores indicating sexual dysfunction were obtained in the preoperative period, these values were found to improve significantly in the postoperative period (p=0.001).
Conclusion: In this study we have seen that the health problems of the partners caused significant alterations in sexual functions and mood of the women, and it was concluded that increasing the level and maintaining the health of the partners is essential for improvement of the quality of sexual and psychological health of women.

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Amaç: Kombine tip küçük hücreli akciðer kanseri nadir bir antite olup, tüm akciðer kanserli olgularýn %1-3’ünü oluþturur. Bu yazýda, bölümümüzde tedavi ve takipleri yapýlan kombine tip küçük hücreli akciðer kanserli olgularýn etyolojik, radyolojik, klinik, patolojik özellikleri ve tedavi yaklaþýmlarý deðerlendirilmekte ve literatür eþliðinde tartýþýlmaktadýr.
Gereç ve yöntem: 2005-2010 yýllarý arasýnda Kayseri Eðitim ve Araþtýrma Hastanesi Radyasyon Onkolojisi Bölümünde kombine tip küçük hücreli akciðer kanseri nedeniyle tedavi ve takipleri yapýlan 6 hastanýn verileri retrospektif olarak deðerlendirildi.
Bulgular: Hastalarýn beþi erkekti ve yaþ ortalamasý 54,5 (44-75) idi. Hastalarýn hepsinde sigara kullanma öyküsü, bir hastada ise asbest maruziyeti öyküsü vardý. En sýk görülen semptomlar nefes darlýðý, öksürük ve yorgunluktu. Olgulara bronkoskopik biyopsi ile taný konuldu. Dört olguda sýnýrlý hastalýk tespit edildi. Histopatolojik incelemede küçük hücreli komponenti epidermoid, large cell ve adenokarsinom komponenti ile birlikte görüldü. Histopatolojik sonuçlara göre kemoterapi ve radyoterapi uygulandý. Tedavi sonrasý 3 olguda stabil hastalýk, geri kalan olgularda tam cevap elde edildi. Dört olgu hastalýðýn progresyonuna baðlý olarak 8., 14., 20. ve 56. aylarda vefat etti. Ýki olgu halen remisyonda izlenmektedir.
Sonuç: Kombine tip küçük hücreli akciðer kanserinin evrelemesi, tedavisi ve takibi küçük hücreli akciðer kanserine benzemektedir.

Aim: Combined type small cell lung cancer is very rare and constitutes 1-3% of all cases with small cell lung cancer. The aim of this retrospective study is to analyze the epidemiological, radiological, pathological, clinical and therapeutic profiles of combined type small cell lung cancer and discussing them in view of the literature.
Material and methods: In this study we reported 6 cases of combined type small cell lung carcinoma treated at Kayseri Education and Research Hospital Department of Radiation Oncology from 2005 to 2010.
Results: Five cases were male. Median age at presentation was 54.5 (44-75) years. All patients were smokers and one patient had a history of asbestos exposure. The main presentation symptoms were dispnea, cough and fatigue. The initial diagnostic material was obtained by bronchoscopy. Four patients presented with limited disease. All of the cases showed a combination of small cell carcinoma with adenocarcinoma, large cell or squamous cell component. All of the patients received chemotherapy and radiotherapy. Three of them had stable disease and rest of them had complete response, gave partial response. Four patients died with the progression of disease at 8, 14, 20, and 56 months. Two patients are stil at remission.
Conclusion: This study shows that combined type small cell lung cancer is similar to small cell lung cancer in terms of diagnosis, treatment and follow up.

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Amaç: Bu çalýþmada, kliniðimizde Kasým 2003-Temmuz 2010 tarihleri arasýnda hidatik kist tanýsý ile opere edilen hastalarýn cerrahi tedavi sonuçlarý retrospektif olarak tartýþýldý.
Gereç ve yöntem: Kliniðimizde 50 eriþkin olgu akciðer hidatik kisti tanýsý ile opere edildi. Yirmi altý olgu erkek (%52), 24 olgu (%48) kadýndý. Olgularýn yaþ ortalamasý 45,8 (20-76) yýldýr. Olgularýn yaþ, cinsiyet gibi demografik özellikleri, þikâyetleri, klinik bulgularý, tanýsal ve radyolojik özellikleri, yapýlan cerrahi uygulamalar, cerrahi tedavi sonuçlarý ve cerrahi sonrasý izlemleri kayýt altýna alýnarak deðerlendirildi.
Bulgular: Hidatik kist 25 olguda sað hemitoraksta, 18 olguda sol hemitoraksta, yedi olguda bilateral yerleþimliydi. Kýrk dört hastaya kistotomi-kapitonaj (%88), beþ hastaya wedge rezeksiyon (%10), bir hastaya pnömonektomi (%2) uygulandý. Hastalara postoperatif iki ay boyunca albendazol tedavisi verildi, iki yýllýk takip süresince nüks saptanmadý.
Sonuç: Akciðer kistlerinin primer tedavisi cerrahidir. Hem kistin boþaltýlmasý ve germinatif membranýn çýkarýlmasý hem de parankim koruyucu niteliði ile kistotomi-kapitonaj yeterli iyileþme saðlayan bir yöntemdir.

Aim: In this study, the surgical results of patients operated with the diagnosis of hydatid cyst between November 2003 and July 2010 in our clinic were discussed retrospectively.
Material and method: A total of 50 adult patients were operated with the diagnosis of pulmonary hydatid cyst in our clinic. Twentysix cases (52%) were male, twenty-four cases (48%) were female. The mean age of patients was 45,8 (20-76) years. The demographic charactheristics of patients such as age and gender, symptoms, clinical findings, diagnostic and radiological features, surgical procedures, results of surgical treatments and postoperative followup results were evaluated based on the records.
Results: Twenty-five of hydatid cysts were located in the right hemithorax, 18 of them were located in the left hemithorax and 7 of hydatid cysts were located bilaterally. Cystotomy and capitonnage was performed in 44 (88%) patients, wedge resection was performed in 5 (10%) patients and 1 (2%) patient underwent pneumonectomy. All patients were treated with albendazole postoperatively for two months and there was no recurrence.
Conclusion: Primary treatment of lung hydatid cysts was surgery. The fluid of the cysts can be aspirated, germinative membrane can be removed and parenchyma can be protected with cystotomy-capitonnage method.For this reason, cystotomy capitonnage method provides enough improvement.

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Amaç: Endobronþiyal tüberküloz (EBTB), trakeobronþiyal aðacýn mikrobiyolojik ve histopatolojik incelemelerle kanýtlanmýþ tüberküloz enfeksiyonudur. Radyolojik görünümleriyle bronþiyal neoplazileri taklit edebilir. Etkili antitüberküloz tedaviyle basil yükü fazla olan enfeksiyonun kontrolü saðlanabilirken, bronþ stenozu gibi morbiditesi yüksek komplikasyonlar büyük bir sorun olarak kalmaktadýr. Radyolojik özellikleri ile akciðer malignitesi ön tasýyla yatýrýlan ve mikrobiyolojik/histopatolojik yöntemlerle endobronþiyal tüberküloz tanýsýna ulaþtýðýmýz hastalarýmýzý klinik, radyolojik ve bronkoskopik özelliklerini retrospektif olarak analiz ederek sunmayý uygun bulduk.
Gereç ve yöntem: Olgu serimizde, kliniðimize 2008-2010 tarihleri arasýnda baþvurmuþ, radyolojik özellikleriyle maligniteyi taklit eden ancak mikrobiyolojik ve histopatolojik incelemelerle endobronþiyal tüberküloz tanýsý almýþ on olgunun klinik, radyolojik ve bronkoskopik özellikleri retrospektif olarak incelenmiþtir ve genel hatlarýyla sunulmaktadýr.
Bulgular: Analizimize on olgu alýnmýþtýr. Ortalama yaþ 53,1 yýl ve E: K oraný 1: 2,3 bulunmuþtur. On olgunun dokuzunda antitüberküloz tedavi ile klinik, radyolojik ve mikrobiyolojik iyileþme gözlenmiþtir. Baþlangýçta fibrostenotik tipte olan bir olgudaysa antitüberküloz tedaviye raðmen gerilemeyen bronþ stenozu, uygulanan sistemik steroid tedavisine de yanýt vermemiþtir.
Sonuç: Radyolojik bulgularla malignite düþünülen her yaþtaki olgularda, ülkemiz gibi endemik bölgelerde tüberküloz akla getirilmelidir. Ýleri yaþtaki, tedaviye kadar geçen semptomatik süresi uzun olan ve baþlangýçta fibrostenotik tipte endobronþiyal tutulumu olan olgularda bronþ stenozu ve ona baðlý morbidite yüksektir. Tedavinin gecikmeden baþlatýlabilmesiyle olasý komplikasyonlarýn önüne geçilebilir ve bronþ stenozu gibi morbiditelerin düzeyleri düþürülebilir.

Aim: Endobronchial tuberculosis (EBTB) is defined as tuberculosis infection of the tracheobronchial tree that has been microbiologically and histopathologically proved. They may mimic bronchial neoplasms by radiographic appearance. Effective antituberculosis treatment can control the bacillary load, however the complications of infection, such as bronchial stenosis may lead to high morbidity. We conducted this retrospective analysis in order to review clinical, radiological and bronchoscopic features of endobronchial tuberculosis and to highlight the high effectiveness of immediate management of this disease on severe complications.
Material and methods: In our series of patients who were admitted to our clinics between 2008-2010 with the diagnosis of endobronchial tuberculosis by microbiological and histopathological examinations that mimic the radiologic features of malignancy were evaluated retrospectively and presented.
Results: Ten patients were admitted to this analysis. The mean age was 53.1 years. Male to female ratio was 1: 2.3. Clinical, radiological and microbiological recovery was observed in 9 of ten patients with antituberculosis treatment. One patient, initially diagnosed as fibrostenotic type bronchial stenosis and who did not respond antituberculosis treatment, did not respond to systemic steroid therapy either.
Conclusion: In patients of all ages with radiological findings suggestive of malignancy, tuberculosis should be considered in endemic areas like our country. In older patients whose durations of symtoms are long and who has fibrostenotic type bronchoscopic findings have high risk of developing bronchial stenosis and related morbidity. With early treatment, possible complications can be prevented and morbidity can be reduced.

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Amaç: Reekspansiyon akciðer ödemi (RAÖ) nadir görülen klinik bir durumdur. RAÖ pnömotoraks, plevral efüzyon veya atelektaziye sekonder kollabe akciðerin tedavisi sýrasýnda geliþen bir komplikasyondur. Bu yazýda RAÖ’li sekiz olgunun klinik süreci ve tedavi basamaklarý sunuldu.
Gereç ve yöntem: 2004–2010 yýllarý arasýnda RAÖ geliþen 8 olgunun verileri geriye dönük olarak incelendi. Olgular semptomlarý, primer patolojileri, uygulanan tedavi yöntemleri, klinik seyirleri, morbidite ve mortaliteleri açýsýndan deðerlendirildiler. Cerrahi müdahale öncesi ve sonrasý tüm olgular arteriyal kan gazý ve oksijen satürasyonu ile izlendiler.
Bulgular: Çalýþmaya dahil olan olgularýn 5’i (%67,5) kadýn, 3’ü (%37,5) erkek olup yaþ ortalamalarý 40±3,7 idi. Hastalarýn tümünde baþvuru anýnda nefes darlýðý ve 3 olguda göðüs aðrýsý yakýnmasý vardý. Primer patolojiler incelendiðinde 2 olguda pnömotoraks, 2 olguda malign plevral efüzyon, 3 olguda ampiyem ve 1 olguda kronik plörit tanýsý konulduðu saptandý. RAÖ 1 olguda dekortikasyon ameliyatý 7 olguda ise tüp torakostomi sonrasýnda geliþmiþti. Olgularýn tedavi öncesi kompansatuar solunum asidozu tablosu içerisinde olduklarý tespit edildi. Cerrahi müdahale sonrasý solunum asidozu düzeldi. Ancak, kan gazý ve oksijen satürasyon deðerleri cerrahi müdahaleden 2-4 saat sonra tekrar bozuldu. Tüp torakostomi uygulanan hastalarýn klinik olarak daha hýzlý bir düzelme gösterdikleri görüldü. Dekortikasyon yapýlan olgu ise kaybedildi.
Sonuç: Biz kronik akciðer kollapsýnýn cerrahi olarak düzeltilmesinin ve toraks cerrahisi sonrasý geliþen akciðer ekspansiyonunun RAÖ geliþimi için tehlikeli olabileceðini düþünüyoruz. Bu durumun önlenmesinde ilk adým her hasta için risk faktörlerini belirlemektir. Bu risk faktörleri düzeltilmeli ve telafi edilmelidir. Bir klinik ya da radyolojik þüphe olduðunda mortalite riski göz önünde bulundurularak, bu nadir ama potansiyel ciddi durumu önlemek için gerekli özenin gösterilmesi, erken ve daha etkin tedavi önlemlerinin alýnmasý gereklidir.

Aim: Reexpansion pulmonary edema (RPE) is a rarely seen clinical condition. RPE is a complication of the treatment of lung collapse secondary to pneumothorax, pleural effusion or atelectasis. In this article, eight cases of RPE were presented with treatment steps and clinical progress.
Material and Metods: The data of 8 cases with RPE were evaluated retrospectively between 2004 and 2010. Patients were evaluated for symptoms, primary pathologies, treatment modalities, clinical course, morbidity and mortality. All patients were monitored with arterial blood gases and oxygen saturation, before and after surgical intervention.
Results: Of the cases, five were (67,5%) famale, 3 (37,5%) were male with a mean age of 40±3,7. All cases had dyspnea and 3 cases had chest pain at the admission. Primary pathologies were pneumothorax at 2, malignant pleural effusion at 2, empyema at 3 cases and chronic pleuritis at 1 case. RPE developed after decortication in one case and after tube thoracostomy in 7 cases. It was demonstrated that the cases had compensatory respiratory acidosis before the treatment. Respiratory acidosis were improved after surgery. However, blood gases and oxygen saturation levels were worsened 2-4 hours after surgical intervention. It was noticed that the patients with tube thoracostomy showed a faster clinical improvement. The case of decortication had clinical deterioration and died.
Conclusions: We think that the surgical correction of chronic lung collapse and lung collapse which appears after thoracic surgery should be regarded as hazardous for RPE development. For the prevention of this situation the first step is to identify the risk factors for each patient. These risk factors should be corrected and compensated. When there is a clinical or radiological suspicion, considering the high risk of mortality, it is necessary to take the required care to avoid this rare, though potentially severe condition, as well as earlier and more aggressive therapeutic measures be taken.

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Pulmoner alveoler proteinozis, alveollerde ve distal hava yollarýnda lipoproteinöz madde birikimiyle karakterize nadir bir hastalýktýr. En sýk rastlanan semptomlar nefes darlýðý ve kuru öksürüktür. Radyolojik olarak bilateral simetrik alveoler konsolidasyon veya buzlu cam görüntüsü saptanýr. Taný sýklýkla klinik ve radyolojik bulgular eþliðinde transbronþiyal biyopsi örneði veya bronkoalveolar lavaj (BAL) ile alýnan intra alveoler materyalin periyodik asit-Schiff metodu ile pozitif boyanmasý ile konur. Pulmoner alveoler proteinosis için standart tedavi total akciðer lavajýdýr. Çalýþmamýzda, biri BAL diðeri açýk akciðer biyopsisi ile taný alan iki pulmoner alveoler proteinozis olgusu literatür eþliðinde sunulmuþtur.

Pulmonary alveolar proteinosis is a rare disease characterised with lipoproteinous material deposition in alveoles and distal airways. The most common symptoms are dyspnea and dry cough. The radiographic finding is bilateral, symmetric alveolar consolidation or ground-glass opacity. The diagnosis is mostly made by positive staining of transbronchial biopsy or bronchoalveolar lavage (BAL) material with periodic- acid-Schiff method accompanied by clinical and radiological findings. The standard treatment for pulmonary alveolar proteinosis is total lung lavage. In our study, two cases of pulmonary alveolar proteinosis, one diagnosed by open lung biopsy and the other with BAL, were presented with the literature.

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Spontan mediastinal amfizem, mediasten içinde travma dýþý nedenlerle hava olmasý durumudur. Daha çok genç eriþkinlerde görülen, rekürrensi nadir olan ve kendi kendini sýnýrlayan benign bir hastalýktýr. Yapýsal akciðer hastalýklarý, yoðun fiziksel aktivite ve Valsalva manevrasý baþta olmak üzere birçok etiyolojik faktör neden olabilmektedir. Ancak literatürde Reynaud fenomeni ve spontan mediastinal amfizem birlikteliði nadirdir. Bu yazýmýzda, 2 yýldýr Reynaud fenomeni nedeni ile takip edilen 21 yaþýndaki bir erkek hastada tekrar eden spontan mediastinal amfizem olgusunu sunuyoruz.

Free air in the mediastinum without any trauma is called spontaneous mediastinal emphysema. It is a self limiting benign disease which usually seen in young adults and recurrence is very rare. Altough it has many etiologies, structurial lung diseases, intense physical avtivity and Valsalva maneuver are the most common ones. But Raynaud’s phenomenon and the spontaneous mediastinal emphysema co-occurrence is very rare in the literature. In this article we present a recurrent spontaneous mediastinal emphysema in a 21 years old male patient who has Raynaud’s phenomenon for two years.

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Altmýþ bir yaþýnda erkek hasta bir aydýr devam eden sol yan aðrýsý, ateþ ve üþüme-titreme yakýnmalarýyla hastaneye baþvurdu. Arkaön akciðer grafisinde sol akciðer orta ve alt zonda, kalp ve hemidiyafragma konturunu silen homojen yoðunluk artýþý görüldü. Fizik bakýda ateþ 38°C, sol alt zonda matite ve solunum seslerinde azalma saptandý. Bilgisayarlý toraks tomografisinde solda plevral sývý ve komþuluðunda atelektazi saptandý. Torasentezle alýnan plevral sývý örneði eksuda niteliðindeydi. Fiberoptik bronkoskopide, sol alt lob anteromedial segment giriþini tamamen kapatan polipoid kitle görüldü. Bronkoskopik biyopsi patolojisi hamartom olarak rapor edildi. Lezyon bronkoskopi aracýlýðýyla kriyoterapi uygulanarak çýkarýldý. Tedavi sonrasý bilgisayarlý toraks tomografisinde patolojik bulgu saptanmadý. Sonuç olarak, endobronþiyal hamartomlar pnömoni ve atelektaziye neden olabilirler. Bu lezyonlarýn tedavisinde bronkoskopik yöntemler baþarýyla uygulanabilir.

A sixty-one-year-old man was admitted to the hospital with left sided chest pain, fever and chills. Chest X-ray showed opacity on left middle and lower zone abutting the left hemidiaphragm and left cardiac border. Body temperature was 38°C, physical examination of the chest revealed dullness and decreased breath sounds on left lower zone. Computed tomography of the thorax showed pleural effusion and associated atelectasis on left lung. Pleural effusion was an exudate. Fiberoptic bronchoscopy demonstrated a polypoid mass lesion totally obstructing the anteromedial segment of the left lower lobe. Pathologic diagnosis was hamartoma. It was removed with cryotherapy. Computed tomography of the thorax was normal after treatment. In conclusion, endobronchial hamartomas can cause pneumonia and atelectasis. Bronchoscopic treatment modalities can successfully be applied to these lesions.

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Otuz sekiz yaþýnda kadýn hasta üç aydýr devam eden göðüs aðrýsý yakýnmasýyla baþvurdu. Göðüs grafisinde sað orta ve alt zonda 8x6 cm boyutunda kitle saptandý. Bilgisayarlý toraks tomografisinde sað akciðerde kistik lezyon görüldü. Hastaya sað torakotomi uygulandý. Kitle 6. kotla iliþkide olup göðüs duvarýndan kaynaklanýyordu. Tümör çýkarýldý ve parsiyel kot rezeksiyonu yapýldý. Makroskopik olarak tümör yumuþak, düzgün yüzeyli, 8x5x4 cm boyutlarýnda, beyaz renkte bir kitle olarak görüldü. Mikroskopik olarak belirgin hücresel pleomorfizm, nekroz ve mitotik aktivite olmaksýzýn düz kas liflerinin oluþturduðu bant ve paketler içeriyordu. Ýmmünohistokimyasal olarak aktin ve vimentin pozitif, S-100 proteini negatifti. Takip süresince patolojik bulgu saptanmadý.

Thirty-eight-year-old female patient presented with 3 months history of chest pain. Chest x-ray showed a mass of 8x6 cm in size in the right middle and lower lung fields. Computed tomography of the thorax demonstrated a cystic lesion in the right lung. A right thoracotomy was performed. The mass originated from the chest wall with its base on the 6th rib. The tumor was excised and partial costal resection was performed. The macroscopic features of the tumor were a soft, smoothly surfaced white mass of 8x5x4 cm in size. Histopathologically, the tumor consisted of packets and bundles of smooth muscle fibers without significant celluler pleomorphism, necrosis and mitotic activity. Immunohistochemically, smooth muscle actin and vimentin was positive but S-100 protein was negative in tumour cells. No pathological finding was detected during follow-up.

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