Obezite Hipoventilasyon sendromu, obeziteyle birlikte, baþka nörolojik, müskuler, mekanik veya metabolik sebep olmadan hiperkapniye yol açan hipoventilasyon, gündüz aþýrý uyku hali, uykuda solunum bozukluðu ile karakterize bir durumdur. Dünya ile beraber ülkemizde artan obezite salgýnýna paralel olarak görülme sýklýðý artmaktadýr. Beraberinde yol açtýðý artmýþ pulmoner hipertansiyon riski, düþük yaþam kalitesi ile önemli morbidite ve mortalite sebebidir. Bu hastalýðýn hekimler arasýnda farkýndalýðýnýn arttýrýlmasý; hastalara erken taný konup, uygun tedavi verilmesini saðlayacaktýr.

Obesity hypoventilation syndrome is characterized by obesity, hypoventilation with hypercapnia, somnolence and sleep related breathing disorders in the absence of significant lung, nerological, metabolic or respiratory muscle diseases. The prevalence of this disease increases rapidly both in worldwide and in our country as a result of the increasing trend in obesity. It is an important cause of both mortality and morbidity by causing pulmonary hypertension and low health related life quality. Increasing awareness of this disease in physicians will lead to early diagnosis and suitable treatment.

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Akciðer transplantasyonu, terminal dönemdeki akciðer hastalarý için yaþamý devam ettirebilmenin tek yoludur. Transplantasyon adaylarý ise, genel olarak transplantasyon dýþý cerrahi giriþimler için kontrendikasyon oluþturacak solunum yetmezliði olan bireylerdir. Bu makalede son yýllarda Ülkemizde de giderek artan sayýda merkezde uygulanan akciðer transplantasyonunda anestezi uygulamalarý ve erken dönem yoðun bakým izleminin özellikli yönlerini gözden geçirmeyi amaçladýk.

Lung transplantation is the unique way to survive for patients who are in the terminal stages of their disease. Candidates for transplantation, however, are individuals with respiratory failure, which constitutes a contraindication to non-transplant surgery in general. In this article we aimed to review the featured aspects of anesthesia application and early intensive care follow-up in lung transplantation which has been performed in an increasing number of centers in our country in recent years.

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Amaç: Ýnhale kortikosteroidler, astýmlý hastalarda bronþiyal mukozal inflamasyonu azaltýrlar. Ancak, kronik obstruktif akciðer hastalýðý (KOAH) olan hastalarda anti-inflamatuar etkinlikleri hakkýndaki bilgiler tartýþmalýdýr. Bu çalýþmanýn amacý, KOAH’lý hastalarda, inhale kortikosteroidlerin inflamatuar cevabýn azaltýlmasýnda etkinliklerinin deðerlendirmesidir.
Yöntemler: Hafif-orta düzeyde yeni baþlangýçlý KOAH tanýsý konmuþ 14 hasta (1. saniyede zorlu ekspiratuar volumü [FEV1]>beklenen deðerin %50’si) prospektif olarak deðerlendirmeye alýndý. Tüm hastalardan, üç aylýk inhale flutikason propionat (günde 2 kez; 500 μg) tedavisi öncesi ve sonrasýnda bronkoskopik inceleme ile endobronþiyal örneklemeler yapýldý. Histopatolojik inceleme elektron mikroskopisi ile gerçekleþtirildi ve uygulanan tedavinin anti-inflamatuar etkileri deðerlendirildi. Ayný zamanda, hastalarýn arter kan gazlarý ve pulmoner fonksiyonlarýndaki deðiþiklikler de incelendi.
Bulgular: Ýnhale flutikason propionat ile üç aylýk tedavinin sonucunda, epitel ödeminin gerilediði, bazal lamina kalýnlýðýnýn azaldýðý, siliyer yapýlarda iyileþmenin meydana geldiði, makrofaj ve lenfosit sayýlarýnýn belirgin olarak azaldýðý gözlendi. Pulmoner fonksiyonlarýn spirometri ile deðerlendirmesinde anlamlý düzelme saptanýrken, arter kan gazý analizlerinde farklýlýk izlenmedi.
Sonuç: Ýnhale flutikason propionat tedavisi ile KOAH’lý hastalarýn endobronþiyal örneklerinde anlamlý anti-inflamatuar etkiler ve pulmoner fonksiyonlarýnda belirgin düzelmeler saðlanmýþtýr.

Objective: Inhaled corticosteroids definitely alleviate bronchial mucosal inflammation in patients with asthma. Nevertheless, the data regarding their anti-inflammatory effects in patients with chronic obstructive pulmonary disease (COPD) is controversial. The aim of the present study is to assess the efficacy of inhaled corticosteroids in reduction of inflammatory response in patients with COPD.
Methods: A total of 14 subjects with the new diagnosis of mild to moderate COPD (forced expiratory volume in one second [FEV1] >50% of predicted value) were prospectively enrolled. Endobronchial sampling with bronchoscopic intervention was performed before and after three months of treatment with inhaled fluticasone propionate (FP) (500 μg twice daily). Histopathological evaluations were performed with electron microscopy and the anti-inflammatory effects of the medicine were evaluated. Differences in arterial blood gas analysis and pulmonary functions were also investigated.
Results: Three months treatment with FP revealed regression of the epithelial edema, decrease in the thickness of basal lamina, augmentation of the cilliary structures, reduction in the number of macrophages and lymphocytes in biopsy samples. Significant improvement of pulmonary functions was remarkable in spirometric test results. The difference in arterial blood gas analyses was not significant.
Conclusion: Treatment with FP provided significant anti-inflammatory effects on endobronchial tissue samples and remarkable improvement in pulmonary functions in patients with COPD.

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Amaç: Bu çalýþmanýn amacý Kronik Obstruktif Akciðer Hastalýðý (KOAH) tanýsý ile izlenen hastalarda anemi sýklýðýnýn ve aneminin yaþam süresi üzerine etkisinin belirlenmesidir.
Yöntemler: KOAH tanýsý ile 01 Ocak 2004 - 31 Aralýk 2008 tarihleri arasýnda izlenen hastalar, ICD-10 kodlarý kullanýlarak hastane bilgi iþlem sistemi veri tabaný aracýlýðýyla saptandý. Anemi tanýsý Dünya Saðlýk Örgütü kriterlerine göre konuldu. Hastalarda KOAH evrelemesi GOLD kriterlerine uygun olarak FEV1/FVC deðerlerine göre yapýldý. Mortalite 1 Ocak 2004 ile 1 Ocak 2010 tarihleri arasýnda herhangi bir tarihte yaþamýn kaybedilmesi olarak tanýmlandý.
Bulgular: Çalýþmaya 452 hasta dahil edildi. Hastalardan 222’sinin (%49,1) öldüðü belirlendi. Anemi 145 (%32,07) hastada saptandý. Ölen hastalar ile hayatta kalan hastalar karþýlaþtýrýldýðýnda, yaþ, hemoglobin, FEV1 ve %FEV1 deðerlerinde istatistiksel olarak anlamlý farklýlýk saptandý. Ölen hastalarýn %76,1’inde aðýr ve çok aðýr KOAH saptanýrken, yaþayan hastalarda bu oran %60,5 idi (p<0,001). Ölen hastalarda solid tümör daha sýk saptandý (p<0,001). Anemik hastalar, polisitemik ve normal hemoglobine sahip hastalara göre daha yaþlý bulunurken (p=0,017), her üç hasta grubunda FEV1, %FEV1 ve %FEV1/FVC deðerleri arasýnda istatistiksel olarak anlamlý bir fark saptanmadý. Anemik hastalarda ölüm oraný polisitemik ve normal hemoglobine sahip hastalara göre daha yüksek bulundu (p=0,002). Anemik hastalarýn %62,8’inde, polisitemik hastalarýn %72,7’sinde ve normal hemoglobine sahip hastalarýn %70,3’ünde aðýr ve çok aðýr KOAH saptanmýþ olup, her üç grup arasýnda bu açýdan istatistiksel olarak anlamlý bir fark bulunmadý.
Sonuç: Bu retrospektif çalýþmada anemi KOAH hastalarýnda polisitemiye göre daha sýk saptanmýþ ve anemik hastalarda mortalite oranýnýn arttýðý görülmüþtür. Ayrýca KOAH hastalarýnda FEV1 deðerleri düþtükçe mortalitenin arttýðý belirlenmiþtir.

Objective: The aim of this study was to determine the frequency of anemia and evaluate the impact of anemia on survival in patients with Chronic Obstructive Pulmonary Disease (COPD).
Methods: Records of patient followed up with a diagnosis of COPD between 01 January 2004 and 31 December 2008 were extracted from hospital database by using ICD-10 codes. Anemia was diagnosed according to the definitions of the World Health Organization. COPD was staged according to GOLD criteria based on FEV1/FVC levels. Mortality was defined as death at any time from 1 January 2004 to 1 January 2010.
Results: A total of 452 patients were included in the study. The 222 (49.1%) patients died. Anemia was detected in 145 (32.07%) of the patients. When death and surviving patients were compared; age, hemoglobin levels, FEV1 and FEV1% were statistically different. Severe and very severe COPD was detected in 76.1% of the dead patients while this rate was 60.5% in patients who survived (p<0.001). Solid tumour was more common in patients who died (p<0.001). Anemic patients were older than polycythemic patients and the normal hemoglobin group (p=0.017), while there were no statistically significant differences for FEV1, FEV1% and FEV1/FEV1%. The mortality rate was higher in patients with anemia than patients with polycythemia and normal hemoglobin level (p=0.002). Severe and very severe COPD were detected in 62.8% of anemic patients, 72.7% of polycythemic patients and 70.3% of the patients with normal hemoglobin. These rates were not statistically different between the three groups.
Conclusion: According to the results of this retrospective study, anemia was more prevalent than polycythemia in patients with COPD and the mortality rate was higher in anemic patients. In addition, the mortality rate increased when FEV1 values decreased.

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Amaç: Bu çalýþma, kömür madenlerinde çalýþýp emekli olmuþ ve kömür iþçisi pnömokonyozu (KÝP) tanýsý almýþ hastalarla, KÝP ile birlikte kronik obstrüktif akciðer hastalýðý (KOAH) tanýsý almýþ hastalarýn lateral akciðer grafilerindeki farklýlýklarý, geometrik morfometri yöntemiyle ortaya koymak amacýyla yapýlmýþtýr.
Yöntemler: Sadece KÝP hastalýðý bulunan 34 hasta Grup 1, KÝP hastalýðýna ek olarak KOAH tanýsý bulunan 32 hasta grup-2 olarak sýnýflandýrýldý. Gruplarýn lateral akciðer grafileri klasik morfometrik yöntemlere kýyasla çok daha hassas olan geometrik morfometri yöntemi ile araþtýrýlarak deðerlendirildi. Ýlk olarak 66 bireyin lateral akciðer film dosyalarý üzerine 11 referans noktasý tpsDig2 programý ile iþaretlendi. Bu iþlem her örnek için tekrarlanarak 66 örneðin referans noktasý koordinatlarýný içeren birer metin dosyasý (txt) oluþturuldu. Txt dosyalarýna Morpheus programý ile istatistiksel analizler yapýldý.
Bulgular: Grup 1 KÝP’li olgular ile Grup 2 KOAH+KÝP olgularý Manova test sonucuna göre anlamlý olarak farklý bulunmuþtur (p<0,05). Deformasyon gridleri incelendiðinde, bu farkýn fissüre ait olan 2 referans noktasýndan (=10 ve 11 nolu referans noktalarý) kaynaklandýðý açýkça söylenebilir.
Sonuç: Çalýþmamýzda, KÝP+KOAH olgularýnda, sadece KÝP tanýsý alan olgulara göre fissür trasesinde vertikal eksende anlamlý düzeyde bir sapma (=itilme) olduðu ortaya konulmuþtur.

Objective: This study was conducted with the aim of evaluating the differences on the lateral chest x-rays of retired male coal workers with coal workers’ pneumoconiosis (CWP) and chronic obstructive pulmonary diseases (COPD) together with CWP by the method of geometric morphometrics.
Methods: Thirty four patients with CWP were evaluated as Group 1 and 32 patients with CWP and COPD constituted Group 2. The lateral chest x-rays of both groups were investigated by the method of geometric morphometrics, which is much more sensitive than the traditional morphometric method. First, on the lateral chest film files of 66 individuals, 11 points of reference were marked using the tpsDig2 program. This process was repeated for each case so that a text file (txt) was created, which contained the coordinates of the reference points of 66 individuals. Statistical analysis was performed on the text files using the program Morpheus.
Results: There was a significant difference between Group-1 with CWP and Group-2 with CWP+COPD according to the results of the Manova test (p<0.05). By the analysis of deformation grids, this difference seemed to arise mainly from from the two reference points on the oblique fissure (reference points 10 and 11).
Conclusion: These findings suggest that in Group 2 patients, there is a deviation (=thrust) of the spectral trace of fissure in the vertical axis according to the Group 1 patients.

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Amaç: Proton pompa inhibitörleri (PPÝ) gastrointestinal hastalýklarda etkinliði kanýtlanmýþ en önde gelen ilaçlardýr. Bu ilaçlarýn etkinliði, gereðinden fazla kullanýlmalarýna ve buna baðlý potansiyel risklere yol açmaktadýr. Bu çalýþmada kliniðimize yatan toplumda geliþen pnömoni (TGP) hastalarýnda, PPÝ kullaným oranlarýný ve PPÝ kullanýmýnýn pnömoninin seyrine etkisini araþtýrmayý amaçladýk.
Yöntemler: Hastanemiz göðüs hastalýklarý kliniðinde pnömoni tanýsýyla yatýrýlan hastalar, PPÝ kullanýmý açýsýndan sorgulandý. Halen kullanmakta olan, son 3 ay içinde kullanmýþ olan, hiç kullanmamýþ olanlar kaydedildi. PPÝ kullaným oranlarý ve PPÝ kullanýmýnýn, tedavi süresi, hastanede yatýþ süresi, klinik düzelme, radyolojik düzelme, komplikasyon geliþimi, yoðun bakým gereksinimi ve mortalite üzerine etkisi deðerlendirildi.
Bulgular: Çalýþmaya 68 hasta alýndý. Hastalarýn ortalama yaþý 70,7±12,5 idi. PPÝ kullaným oranlarý (halen kullanan, daha önce kullanmýþ ve hiç kullanmamýþ) sýrasýyla %39, %11,8, %48,5 idi. Halen PPÝ kullanmakta olan hastalarda tedavi süresi, hastanede yatýþ süresi, klinik ve radyolojik iyileþme süresi hiç kullanmamýþlara göre daha uzun bulundu (sýrasýyla p=0,008, p=0,024, p=0,007, p=0,016). Komplikasyon oraný halen kullanmakta olan hastalarda hiç kullanmamýþlara göre daha yüksek orandaydý (%14,8’e karþý %6,1).
Sonuç: TGP’li hastalarýn %39’u halen PPÝ kullanmaktaydý. Bu hasta grubunda pnömoni daha aðýr seyretmektedir. TGP sýklýðýný ve morbiditesini azaltmak için PPÝ’larýn gereksiz kullanýmýndan sakýnýlmalýdýr.

Objective: Proton pump inhibitors (PPIs) are the primary drugs with proven efficacy in gastrointestinal diseases. The effectiveness of these drugs causes unneccessary use and potential risks. The aim of the study was to evaluate the rates of PPI use and its effect on the course of the disease in patients with community aqcuired pneumonia (CAP).
Methods: The patients who were hospitalized due to pneumonia were asked about the use of PPIs, whether they were a current user, user in the last 3 months or never used. The rates of PPI use and the effect of PPI use on clinical and radiological improvement, duration of treatment and hospitalization, development of complication, need of intensive care unit and mortality were evaluated.
Results: Sixty-eight patients were included in the study. The mean age of patients was 70.7±12.5 years. The rates of PPI use (current use, use in 3 months and never used) were as follows: 39%, 11.8% and 48.5% respectively. The duration of treatment and hospitalization, duration of clinical and radiological improvement were found longer in patients who were using PPI currently compared to never used (respectively; p=0.08, p=0.024, p=0.007, p=0.016). The rate of complications was higher in the current users than never users (14.8% vs 6.1%).
Conclusion: Thirty-nine percent of the patients with CAP were using PPI currently. The course of pneumonia was more severe in this group. The unneccessary use of PPIs should be avoided in order to decrease the incidence and morbidity of CAP.

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Amaç: Önceden tedavi görmemiþ ileri evre küçük hücreli-dýþý akciðer karsinomlu (KHDAK) bir grup hastada ve saðlýklý kontrol grubunda anemi sýklýðýný ve sistemik inflamasyonla iliþkisini deðerlendirmek için hematolojik deðiþkenleri ve çeþitli sistemik inflamasyon göstergelerini araþtýrdýk.
Yöntemler: Henüz tedavi almamýþ KHDAK olgularý ve kontrol gruplarýnda hemoglobin (Hb), C-reaktif protein (CRP) de dahil olmak üzere serum akut faz reaktanlarý (AFR) ve inflamatuvar sitokin (TNF-α, leptin ve osteopontin) düzeyleri ölçüldü. Sonuçlar Pearson’s korelasyon testi ve Mann-Whitney U tesi kullanýlarak deðerlendirildi.
Bulgular: Çalýþmaya yaþ ortalamalarý 65,6±9,8 yýl olan 63 erkek KHDAK olgusu dahil edildi. Ayný yaþ grubunda olan 25 saðlýklý gönüllü kontrol grubu olarak alýndý.Yirmi beþ (%40) KHDAK olgusunda taný konduðu sýrada anemi mevcut idi. Pozitif AFR olan CRP, lökosit, trombosit, ferritin ve fibrinojen düzeyleri KHDAK olgularýnda kontrol grubundan yüksekti (p<0,001, p=0,042, p<0,001, p=0,009, p<0,001). Serum albümini (negatif bir AFR) kanser grubunda daha düþüktü (p<0,001). Osteopontin kanser grubunda daha yüksek (p<0,001) iken leptin ve TNF-α konsantrasyonlarýnda fark yoktu. Hb ile hastalýðýn evresi, olgularýn performans skorlarý veya sitokinler arasýnda iliþki bulunmadý. Serum CRP ve trombosit konsantrasyonlarý anemisi olan kanser olgularýnda olmayanlara kýyasla daha yüksekti (p=0,012, p<0,001). Anemik kanser olgularýnda yine Hb; CRP ve trombosit ile ters, albümin ile doðru orantýlý bulundu.
Sonuç: Bu bulgular aneminin akciðer kanserinde sýk görüldüðünü ve sistemik inflamasyon ile iliþkili olduðunu doðrulamaktadýr.

Objective: We assessed hematological variables and various mar- kers of systemic inflammation in a population of previously untreated patients with advanced non-small cell lung cancer (NSCLC) and healthy controls to evaluate the frequency of anemia and its correlation with systemic inflammation.
Methods: In patients with untreated advanced NSCLC and control subjects, levels of hemoglobin (Hb), serum levels of acute phase reactants (APR) including C-reactive protein (CRP) and inflammatory cytokines (TNF-α, leptin and osteopontin) were assessed. They were analysed by Pearson’s correlation analysis and Mann-Whitney U test.
Results: Sixty-three male NSCLC patients with a mean age of 65.6±9.8 years were admitted to the study and 25 male healthy volunteers of the same age range were admitted as the control group. Twenty-five (40%) NSCLC patients had anemia during diagnosis of lung carcinoma. Positive APR CRP, leucocyte, thrombocyte, ferritin and fibrinogen were higher in the NSCLC group than the controls (p<0.001, p=0.042, p<0.001, p=0.009, p<0.001). Serum albumin (which is a negative APR) was lower in the cancer group (p<0.001). Osteopontin was higher in the cancer group (p<0.001) but there were no difference in leptin and TNF-α concentrations. There was no correlation between Hb and stage of the disease, performance score of patients or cytokines. Serum CRP and thrombocyte concentrations were higher in cancer patients with anemia than those without anemia (p=0.012, p<0.001). In the anemic subgroup of lung cancer patients, again Hb inversely correlated with CRP and thrombocyte and positively correlated with albumin.
Conclusion: This evidence confirms that anemia is common in lung cancer and its presence is related to systemic inflammation.

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Amaç: Prokalsitoninin (PCT) sarkoidoz tanýsýnda ve sarkoidoz ile tüberkülozun ayýrýcý tanýsýnda kullanýlýp kullanýlmayacaðýný belirlemeyi amaçladýk.
Yöntemler: Çalýþmaya histopatolojik olarak taný konulmuþ, tedavi almamýþ 35 sarkoidoz hastasý ile, bakteriyolojik veya histopatolojik olarak taný konulmuþ 23 yeni tüberküloz olgusu alýndý. Demografik veriler, anemnez, laboratuvar verileri - prokalsitonin (PTC), C-Reaktif protein (CRP), beyaz küre (WBC), sedimentasyon (ESR) ve klinik bulgular kaydedildi.
Bulgular: Çalýþmaya 58 hasta alýndý. Hastalarýn 23’ü (%39,7) erkek, 35’i (%60,3) kadýn idi. Yaþ ortalamasý sarkoidoz grubunda 42,6±14,1, tüberküloz grubunda 47,9±15,9 idi. Hastalarýmýzýn otuz beþi (%60,3) sarkoidoz ve 23’ü (%39,7) tüberküloz tanýlý idi. Tüberküloz tanýsý 15 hastada balgam yayma ve kültürü ile 8 hastada lenf nodu biyopsisi ile kondu. Sarkoidoz hastalarýnýn 20’sinde taný mediyastinoskopi,15’inde transbronþiyal biyopsi (TBB) ile kondu. PCT düzeyi için sarkoidoz ve tüberküloz arasýndaki istatistiksel olarak anlamlý bir fark yoktu (p=0,226). Ayrýca sarkoidozun evreleri ile prokalsitonin arasýnda istatistiksel olarak anlamlý iliþki yoktu (p=0,873).
Sonuç: Prokalsitoninin sarkoidoz tanýsý ve tüberküloz ile ayýrýcý tanýsýnda biyobelirteç olarak bir öneminin olmadýðýný saptadýk.

Objective: We aimed to investigate whether procalcitonin (PCT) is a useful biomarker for diagnosis of sarcoidosis and differentiate it from tuberculosis (TB).
Methods: Thirty-five histopathologically-verified sarcoidosis patients with no previous treatment and 23 tuberculosis patients, who were diagnosed bacteriologically or histopathologically, were included in the study. Demographic data, clinical history, laboratory findings-serum procalcitonin (PCT) level, C-reactive protein (CRP), white blood cell (WBC) and erythrocyte sedimentation rate (ESR) and clinical findings were recorded.
Results: Fifty-eight patients were included in the study. Twenty-three (39.7%) were male; 35 (60.3%) were female. Mean age was 42.6±14.1 and 47.9±15.9 years in sarcoidosis and TB groups respectively. Thirty-five (60.3%) had diagnoses of sarcoidosis and 23 (39.7%) TB. Of patients with TB; 15 were diagnosed via smear and culture while 8 were diagnosed via lymph node biopsies. Of patients with sarcoidosis; 20 were diagnosed with mediastinoscopy and 15 with transbronchial biopsies (TBB). There was no statistically significant difference for serum PCT level between sarcoidosis and tuberculosis (p=0.226). Additionally, PCT had no significant relationship with stages of sarcoidosis (p=0.873).
Conclusion: We estabilished that PCT is not a reliable biomarker neither diagnose of sarcoidosis nor differentiate it from TB.

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Pulmoner arteriyovenöz malformasyonlar (PAVM) pulmoner arter ve venler arasýnda anormal baðlantýlar ile karakterize pulmoner vasküler sistemin nadir görülen anomalileridir. Kliniðimizde opere ettiðimiz pulmoner arteriyovenöz malformasyon tanýlý 2 olguyu nadir olmasý nedeniyle sunduk. Olgularýmýzdan biri dispne, çomak parmak ve polisitemisi olan 14 yaþýnda erkekti. PAVM tanýsý pulmoner anjiografi ile konuldu. Ýkinci olgu hemoptizisi olan 9 yaþýnda erkekti. Ýki olguda da PAVM sað üst lob anterior segment yerleþimliydi. Olgulara segmentektomi ve wedge rezeksiyon yapýldý. Ýzole ve tek PAVM’da cerrahi tedavi minimal mortalite, morbidite ve lezyonda düþük rekürrens oraný ile baþarýlý bir tedavi yöntemidir.

Pulmonary arteriovenous malformations (PAVMs) are rare abnormalities of the pulmonary vascular system characterized by abnormal communications between the pulmonary artery and vein. We presented two cases who were operated in our clinic with PAVMs because of the rarity. One of our cases was a 14-year-old male, who had dyspnea, clubbing and policythemia. PAVM was diagnosed with pulmonary angiography. The second case was a 9-year-old male who had hemoptysis. Both cases had PAVM localized in the right upper lobe anterior segment. The patients underwent segmentectomy and wedge resection. Surgical treatment of an isolated, single PAVM is successful, with minimal mortality, morbidity and low recurrence rates of the lesion.

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Lejyonella enfeksiyonlarýnda çoklu-organ tutulumu sýklýkla görülmektedir. Bu yazýda, kliniðimize baþvuran 72 yaþýnda bir bayan hastada, plöroperikardial tutulum, tübüler disfonksiyon, mental durum bozukluðu ile seyreden ve idrarda Lejyonella antijeni pozitif saptanarak taný konulan Lejyonella olgusu, perikardial tutulumun nadir görülmesi nedeniyle sunulmuþtur.

Multi-organ involvement is common in Legionella infections. In this paper, a 72-year-old female patient with pleuropericardial involvement, renal tubular dysfunction and impaired mental status, diagnosed as Legionella infection with the positive urinary Legionella antigen is presented since pericardial involment of Legionella is rarely seen.

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Primer akciðer karsinomunda spontan pnömotoraks oldukça nadir olarak görülür ve insidansý %0,03-0,05 arasýndadýr. Bu çalýþmada spontan pnömotoraks nedeniyle kliniðimize baþvuran ve operasyon esnasýnda ayný zamanda küçük hücreli dýþý akciðer kanseri tanýsý konulan, 38 yaþýndaki erkek olgu sunulmakta ve spontan pnömotoraks ile akciðer kanseri arasýndaki iliþki irdelenmektedir.

Spontaneous pneumothorax is very rarely seen in primary lung cancer and the incidence is between 0.03-0.05%. In this study, a 38-year-old male patient admitted with spontaneous pneumothorax who was also diagnosed as non-small cell lung cancer during the operation was presented and the relationship between spontaneous pneumothorax and lung cancer was examined.

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Bilioplevral fistül (BPF) nadir görülen, safra yollarý ile plevral boþluk arasýnda geçiþ olmasý ile karakterize bir durumdur. Öyküsünde 2 yýl önce kolesistektomi operasyonu olan, 67 yaþýndaki kadýn hastamýz, saðda masif plevral efüzyon nedeniyle incelendi. Yeþil renkli plevral sývý örneði elde edilmesi, plevral mayii/serum total bilirubin oranýnýn >1,0 olmasý ve Gadobenate dimeglumine (Gd-BOPTA) kontrastlý manyetik rezonans kolanjiyografi (MRC) de plevraya kontrast madde geçiþinin görülmesiyle BPF tanýsý konuldu. Hastaya endoskopik retrograd kolanjiyopankreotografiyle papillotomi iþlemi yapýlarak toraksa safra kaçaðý engellendi. Nadir görülmesi nedeniyle olgumuzu literatür eþliðinde irdelemek amacýyla sunduk.

Biliopleural fistula (BPF) is a very rare entity, characterised by a passage between the pleural cavity and biliary system. Our case, a 67-year-old female patient, had undergone a cholecystectomy 2 years previously and complained of a massive right pleural effusion. Pleural fluid samples of thoracentesis obtained was green and we suspected BPF. Pleural fluid/serum total bilirubin ratio was >1.0. Diagnosis of BPF was confirmed by Gadobenate dimeglumine (Gd-BOPTA) contrast-enhanced magnetic resonance cholangiography (MRC). Bile leak of the pleural cavity was blocked using the process of the papillotomiyby Endoscopic retrograde choliangiopancreotography. We present our case to emphasize that BPF is a very rare situation, with the finding of green pleural fluid, confirmation of the diagnosis with Gd-BOPTA contrast-enhanced MRC and treatment with ERCP.

Abstract | Full Text PDF

Abstract | Full Text PDF