Nebülizerler akciðer hastalýklarýnýn tedavisinde aerosol ilaçlarin uygulanmasý için yaygýn bir þekilde kullanýlmaktadýr. Nebulizerler ölçülü doz inhaler (ÖDÝ) için gerekli olan el nefes koordinasyonunu gerçekleþtiremeyen ya da kuru toz inhaler için ihtiyaç duyulan akým hýzýný saðlayamayan hastalar için seçilen aerosol cihazlarýdýr. Üç tip nebulizer mevcuttur: (1) Jet nebulizer, (2) Ultrasonik nebulizer ve (3) Mesh nebulizer. Bu makalenin amacý piyasada mevcut olan nebulizer tiplerini açýklamak ve onlarýn aerosol ilaç verimindeki etkinliðini deðerlendirmektir. Ayrýca bu makale akciðer hastalýklarýnýn nebülizerlerle optimum tedavisi için gerekli olan strateji önerilerinide kapsamaktadýr.

For over a century, nebulizers have been commonly used to deliver aerosolized medications in the treatment of patients with pulmonary diseases. They are the aerosol device of choice when patients can not coordinate inhalation and actuation needed for the use of the pressurized metered-dose inhalers (pMDIs) or are not able to provide the necessary inspiratory flow required by the dry powder inhaler (DPI) for effective aerosol drug delivery. Three types of nebulizers exist: (1) jet nebulizers, (2) ultrasonic nebulizers, and (3) mesh nebulizers. The purpose of this paper is to explain the types of nebulizers available on the market and to evaluate their efficiencies in aerosol drug delivery while suggesting strategies for the optimal treatment of patients with pulmonary diseases.

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Bronþektazi ve kronik obstrüktif akciðer hastalýðý (KOAH) patofizyolojik, klinik ve spirometrik açýlardan pek çok ortak özelliðe sahiptirler. Yüksek çözünürlüklü bilgisayarlý tomografi (YÇBT) incelemelerinin artan ve yaygýnlaþan kullanýmýna baðlý olarak bronþektazi, kronik öksürük ve nefes darlýðý yakýnmalarý ile baþvuran hastalar daha fazla saptanýr hale gelmiþtir. Farklý KOAH fenotiplerinin belirlenmesi, hastalýðýn hem tedavi seçenekleri hem de klinik sonuçlarý açýsýndan önemlidir. Kronik Obstrüktif Akciðer Hastalýðý ve bronþektazinin birlikte izlendiði hastalar, daha aðýr KOAH ve daha kötü seyir gösteren farklý bir fenotip olabilir. Çok sayýda yazar; KOAH’lý hastalarda artmýþ inflamasyon, daha uzun ve aðýr alevlenmeler, potansiyel patojenik bakterilerle bronþ mukozasýnýn daha fazla kolonizasyonu ve en önemlisi daha kötü prognozla iliþki gösteren yüksek bronþektazi prevalansý gözlemiþlerdir.

Bronchiectasis and chronic obstructive pulmonary disease (COPD) share many pathophysiological, clinical and spirometric characteristics. Along with the increasing and widespread use of high resolution computed tomography (HRCT) scanning, bronchiectasis has become more detectable in patients presenting with chronic cough and shortness of breath. Identification of different phenotypes of COPD is important in terms of both therapeutic options and clinical outcomes of the disease. Co-occurrence of chronic obstructive pulmonary disease and bronchiectasis might be a different phenotype with more severe COPD and poorer prognosis. Many authors observed high prevalence of bronchiectasis in COPD patients showing association with increased inflammation, more severe and longer exacerbations, higher colonization of bronchial mucosa with potential pathogenic bacteria, and, the most important, with poorer prognosis.

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Amaç: Plevral sývý ile baþvuran, henüz tedavi almamýþ farklý olgu gruplarýnda (tüberküloza baðlý plevral sývý, malign plevral sývý, transüdatif plevral sývý ve parapnömonik plevral sývý), serum ve plevral sývý leptin düzeyinin; hastalýk gruplarý arasýnda, transüda - eksüda ayrýmýnda ve tüberküloz - non tüberküloz plevral efüzyonlu hasta gruplarýndaki tanýsal deðerini araþtýrmak.
Yöntemler: Çalýþmaya toplam 78 ardýþýk olgu (32 kadýn, 46 erkek) alýndý. Olgular, Light kriterlerine göre transüdatif ve eksüdatif plevral efüzyon olmak üzere iki gruba ayrýldý. Eksüdatif sývýlar ise kendi içinde; tüberküloz (TB), nonspesifik (parapnömonik) ve malign plevral sývý olmak üzere üç gruba ayrýldý. Hastalarýn tümünde boy ve kilo ölçümü yapýlarak, vücut kitle indeksleri (VKÝ) hesaplandý. Tüm hastalýk gruplarýnda plevra ve serum leptin düzeyleri ölçülerek taný deðeri araþtýrýldý.
Bulgular: Hastalarýn serum ve plevra sývýlarýnda, leptin düzeyi ile plevral sývýda adenozin deaminaz (ADA) düzeyi çalýþýldý. Tanýlara göre gruplandýrýlan hastalarýn plevral sývýlarýnda, serum leptin deðerleri bakýmýndan istatistiksel olarak anlamlý farklýlýk saptanmadý (p<0,05). Transüda - eksüda ayýrýmýnda da ölçülen leptin ve ADA düzeyleri arasýnda anlamlý olarak fark bulunamadý. Olgular, TB ve TB dýþý olarak gruplandýðýnda, serum ve plevra leptin düzeylerinde her iki grup arasýnda fark saptanmazken, tüberküloz grubu plevra sývýsý ADA düzeyi, diðer gruba göre anlamlý derecede yüksek bulundu. Vücut kitle indeksi ile hem serum hem de plevra leptin düzeyleri arasýnda zayýf derecede pozitif korelasyon bulundu (sýrasýyla r=0,39 ve r=0,42, p<0,001).
Sonuç: Çalýþmamýz az sayýda olgu içermekle birlikte, serum ve plevra leptin düzeyleri, gerek transüda - eksüda ayýrýmýnda, gerekse etyolojik tanýya ulaþmada yeterli olmamýþtýr. Özellikle tüberküloz plörezilerde anlamlý derecede düþüklük saptandýðýna yönelik bulgular olsa da, konu ile ilgili daha baþka çalýþmalara ihtiyaç olduðu açýktýr

Objective: To investigate the diagnostic value of serum and pleural fluid leptin levels in the differentiation between transudate and exudate, tuberculosis and nontuberculosis pleural effusion, and different diseases in treatment-naïve patient groups with different diseases that present with pleural fluid (pleural fluid due to tuberculosis, malignant pleural fluid, transudative pleural fluid and parepneumonic pleural fluid).
Methods: The study comprised a total of 78 consecutive cases (32 females and 46 males). The cases were assigned to two groups as transudative and exudative pleural effusion according to Light criteria. Cases with exudative fluid were divided into three groups; tuberculosis (TB), nonspecific (parapneumonic) and malignant pleural fluid. Weight and height were measured in all patients and body mass index (BMI) was calculated. Pleural fluid and serum leptin levels were measured in all disease groups and their diagnostic value was investigated.
Results: Leptin levels were measured in the serum and pleural fluids and adenosine deaminase (ADA) level was studied in the pleural fluids of the patients. No statistically significant difference was determined between leptin levels of patients that were grouped according to their diagnosis (p<0.05). There was also no significant difference between transudate and exudates in terms of leptin and ADA levels. When the patients were grouped as TB and non-TB, no difference was found between the groups in terms of serum and pleural fluid leptin levels, whereas pleural ADA concentration was significantly higher in the tuberculosis group in comparison to the other group. A weak positive correlation was determined between body mass index and serum and pleural leptin levels (r=0.39 and r=0.42 respectively, p<0.001).
Conclusion: Nevertheless the present study included a limited number of patients, serum and pleural leptin levels remained inadequate both in the differentiation between transudates and exudates and in achieving an etiological diagnosis. Despite the results suggesting a significant decrement in tuberculosis pleurisy, it is clear that further studies are needed on this subject.

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Amaç: Antrakozis, bronþiyal mukozada siyah pigment birikimiyle karakterizedir. Bronþiyal mukozada destrüksiyon ve deformite yaparak antrakofibrozise sebep olabilir. Bu çalýþmada, bronkoskopik olarak antrakozis-antrakofibrozis saptanan olgularýn altta yatan nedenlerini ve klinik özelliklerini araþtýrmayý amaçladýk.
Yöntemler: Çalýþmaya 2002-2012 yýllarý arasýnda bronkoskopik antrakozis - antrakofibrozis saptanan 109 hasta alýndý. Altta yatan nedenler ve klinik özellikler medikal kayýtlar incelenerek analiz edildi. Çalýþma retrospektif kohort olarak planlandý.
Bulgular: Çalýþmaya, ortalama yaþlarý 67,8±9,8 (34-85) olan, 52 erkek (%47,7) ve 57 kadýn (%52,3) hasta dahil edildi. Hastalarýn 66’sýnda (%60,6) biyokütle maruziyeti, 38’inde (%34,9) sigara anamnezi ve 5’inde (%4,5) mesleksel maruziyet mevcuttu. Bronkoskopide; 34 hastada antrakozis, 75 hastada antrakofibrozis saptandý. Sað üst lob (76 hasta, %69,7) ve sol üst lob (74 hasta, %67,9) en çok etkilenen lokalizasyonlar, öksürük (%58,7) ve nefes darlýðý (%49,5) en sýk saptanan semptomlardý, bunlarý göðüs aðrýsý (%36,7) takip ediyordu. Radyolojik olarak en sýk saptanan bulgular atelektazi (%65,1) ve konsolidasyon (%55) idi. Hastalarýn, %46,8’inde kronik obstrüktif akciðer hastalýðý (KOAH), %24,8’inde pnömoni, %18,3’ünde tüberküloz ve %10,1’inde malignite vardý.
Sonuç: Bronþiyal antrakozis-antrakofibrozis saptanan olgularda en önemli risk faktörü biomass maruziyetidir. Bu hastalar; KOAH, pnömoni, tüberküloz ve maligniteyi içeren çeþitli pulmoner hastalýklar açýsýndan deðerlendirilmeli ve takip edilmelidirler.

Objective: Anthracosis is characterized by accumulation of black pigment in the bronchial mucosa. It may cause anthracofibrosis by leading to mucosal destruction and deformity. In the present study, we aimed to investigate the underlying reasons and clinical characteristics of cases, in which anthracosis-anthracofibrosis was detected via bronchoscopy.
Methods: The study comprised of 109 patients, in whom anthracosis –anthracofibrosis was detected by bronchoscopy between 2002 and 2012. Underlying reasons and clinical characteristics of the patients were analysed by reviewing medical records. The study was designed as a retrospective cohort study.
Results: The present study included 52 males (47.7%) and 57 females (52.3%) with a mean age of 67.8±9.8 (34-85) years. Of the patients, 66 (60.6%) had exposure to biomass smoke, 38 (34.9%) had a history of smoking and 5 (4.5%) had occupational exposure. In bronchoscopy, 34 patients were shown to have anthracosis and 75 patients had anthracofibrosis. The right upper lobe (76 patients, 69.7%) and the left upper lobe (74 patients, 67.9%) were the most commonly involved sites; cough (58.7%) and dyspnoea (49.5%) were the most common symptoms, followed by chest pain (36.7%). The most common radiological findings were atelectasis (65.1%) and consolidation (55%). Of the patients, 46.8% had chronic obstructive pulmonary disease (COPD), 24.8% had pneumonia, 18.3% had tuberculosis and 10.1% had malignancy.
Conclusion: Biomass smoke exposure is the most important risk factor for patients with anthracosis-anthracofibrosis. Such patients should be evaluated and followed-up for various pulmonary diseases including COPD, pneumonia, tuberculosis and malignancy.

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Amaç: Kronik obstrüktif akciðer hastalýðýnda (KOAH), protein-kalori malnütrisyonu ile buna baðlý kilo kaybý geliþtiði gösterilmekle birlikte, kilo kaybý nedenleri ve kilo kaybý ile hormonal ve inflamatuar belirteçler arasýndaki iliþki net deðildir. Çalýþmamýzýn amacý KOAH’lý hastalardaki kilo kaybýnýn nedenlerini, kilo kaybý ile hormonal, inflamatuar belirteçler ve hiperinflasyon arasýndaki iliþkiyi araþtýrmaktýr.
Yöntemler: Çalýþmamýza, Göðüs Hastalýklarý Polikliniði’ne baþvuran 60 stabil KOAH’lý hasta ve 20 saðlýklý kontrol alýndý. Hastalar vücut kitle indekslerine (VKÝ) göre 3 gruba ayrýldý: 1. grup VKÝ <20 kg/m2, 2. grup VKÝ 20-25 kg/m2 ve 3. grup VKÝ >25 kg/m2 olarak belirlendi. Hastalara solunum fonksiyon testleri ve arter kan gazý analizi yapýldý. Serum adiponektin, grelin, leptin, tümor nekroz faktör (TNF) alfa, C-reaktif protein (CRP), prealbümin ve transferrin düzeyleri çalýþýldý. Sonuçlar uygun istatistiksel yöntemlerle deðerlendirildi.
Bulgular: Hasta grubu bütün olarak deðerlendirildiðinde, leptin ve grelin düzeyleri hasta grubunda istatistiksel olarak anlamlý derecede düþük bulundu (p=0,001 ve p=0,003). Serum leptin düzeyi VKÝ <20 olan 1. Grupta, diðer KOAH’lý hastalara ve kontrol grubuna göre düþük bulundu (p<0,001). Adiponektin düzeyi VKÝ <20 olan grupta, VKÝ >25 olan gruba göre daha düþük bulundu (p=0,031). Serum grelin, leptin, adiponektin, TNF-α, prealbümin ve transferrin düzeyleri açýsýndan hiperinflasyonu olan ve olmayan hastalar arasýnda istatistiksel olarak anlamlý bir fark saptanmadý.
Sonuç: Azalmýþ serum grelin ve leptin düzeyleri, kilo kaybý ile iliþkili idi. Bununla birlikte hiperinflasyon ve hormonal belirteçler arasýnda iliþki bulunmadý. Bu konunun açýklýða kavuþmasý için daha ileri çalýþmalara ihtiyaç olduðu düþünüldü.

Objective: Although protein-calorie malnutrition and associated weight loss have been demonstrated in chronic obstructive pulmonary disease (COPD), the reasons for weight loss, as well as the relation of weight loss with hormonal and inflammatory markers is not clear. Therefore, the present study aimed to investigate the reasons for weight loss in COPD patients and the relation of weight loss with hormonal/inflammatory markers and hyperinflation.
Methods: The present study included 60 patients with stable COPD who were admitted to the Chest Diseases Outpatient Clinic and 20 healthy controls. The patients were divided into three groups according to their body mass index (BMI); Group 1: BMI <20 kg/m2, Group 2: BMI 20-25 kg/m2 and Group 3: BMI >25 kg/m2. The patients underwent pulmonary function testing and arterial blood gas analysis. Serum adiponectin, ghrelin, leptin, tumour necrosis factor (TNF) alpha, C-reactive protein (CRP), prealbumin and transferrin levels were measured. The results were evaluated by appropriate statistical methods.
Results: Considering the patient groups together, leptin and ghrelin levels were found to be statistically significantly lower in the patient group (p=0.001 and p=0.003). Serum leptin level was found to be lower in Group 1 with a BMI <20 as compared to the other COPD patients and the control group (p<0.001). Adiponectin level was lower in the group with a BMI <20 as compared to the group with a BMI >25 (p=0.031). No statistically significant difference was determined between the patients with and without hyperinflation in terms of serum ghrelin, leptin, adiponectin, TNF-α, prealbumin and transferrin levels.
Conclusion: Decreased serum ghrelin and leptin levels were associated with weight loss. However, no relation could be identified between hyperinflation and hormonal markers. It was thought that further studies are needed in order to reach a definite conclusion.

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Amaç: Persistan hipotansiyon veya þok ile baþvuran akut pulmoner embolisi (PE) olan hastalar yüksek riskli olarak kabul edilir. Hemodinamik olarak stabil akut PE’li hastalar, sað ventrikül disfonksiyonu ve / veya miyokard hasar biyobelirteçlerinin seviyelerine göre düþük ve orta risk grubu olarak sýnýflandýrýlýr. Bu çalýþmada, hemodinamik olarak stabil akut PE nedeniyle baþvuran hastalarýn eritrosit daðýlým geniþliði (RDW) parametresinin klinik yararýný araþtýrmayý amaçladýk.
Yöntemler: 2008-2010 yýllarý arasýnda hastanemizde akut PE tanýsý konmuþ tüm hastalar retrospektif olarak çalýþmaya dahil edilmiþlerdir. Baþvuru sýrasýnda hipotansiyon, malignite öyküsü, kalp yetmezliði ve anemi bulunan hastalar çalýþma dýþý býrakýlmýþtýr. Normotansif akut PE hastalarý düþük ve orta risk olmak üzere 2 gruba ayrýlmýþtýr. Bu ayrým ekokardiyografik sað ventrikül disfonksiyonu, Troponin T pozitifliði, ve NT-proBNP yüksekliði kriterlerine göre yapýlmýþtýr. Düþük ve orta riskli akut PE gruplarýnda RDW deðerleri karþýlaþtýrýlmýþtýr.
Bulgular: Troponin T, NT-proBNP ve ekokardiyografik bulgular baz alýnarak 32 hasta orta riskli, 34 hasta düþük riskli PE olarak deðerlendirilmiþtir. RDW deðerleri orta riskli grupta düþük riskli gruba göre anlamlý olarak yüksek bulunmuþtur (14.77±0.54‘e karþý 14.09±0.43; p=0.036)
Sonuç: Hemodinamik olarak stabil akut PE hastalarýnda RDW deðerlerinin incelenmesi düþük ve orta riskin belirlenmesinde yardýmcý olabilir.

Objective: Patients with acute pulmonary embolism (PE) presenting with persistent hypotension or shock are considered to be high-risk, while hemodynamically stable patients with acute PE are classified as low- or moderate-risk, depending on their right ventricular dysfunction and/or levels of biomarkers indicating myocardial injury. In this study, we assessed the clinical benefits of knowing the red cell distribution width (RDW) parameter in patients with hemodynamically stable acute PE.
Methods: All patients diagnosed with acute PE in our hospital between 2008 and 2010 were retrospectively included in the study. Patients with hypotension, a history of malignancy, heart failure, and/or anemia were excluded. Patients with normotensive acute PE were divided into either a low- or moderate-risk group. This classification was made according to echocardiographic right ventricular dysfunction, positive troponin T, and the level of NT-proBNP. RDW values of low and moderate acute PE risk groups were compared.
Results: Thirty-two patients were assessed as moderate-risk and 34 patients were low-risk PE. RDW values of the moderate-risk group were significantly higher than those of the low-risk group (14.77±0.54 vs. 14.09±0.43; p=0.036, respectively).
Conclusion: Analysis of RDW values can help to determine the low and moderate risk levels of hemodynamically stable patients with acute PE.

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Amaç: Kronik Obstrüktif Akciðer Hastalýðý (KOAH) tanýsý olan hastalarda, alevlenme sýrasýnda pnömoni varlýðýnýn klinik, demografik ve biyokimyasal verilerle iliþkisinin vaka-kontrol gruplarý olarak deðerlendirilmesi amaçlanmýþtýr.
Yöntemler: Prospektif olarak planlanan çalýþmaya 3. basamak Göðüs Hastalýklarý kliniðinde, 2007-2008 tarihleri arasýnda, akut alevlenme tanýsý ile hastaneye yatýrýlan ve pnömonisi bulunmayan KOAH’lý hastalar ile pnömoni tanýsý konulan KOAH olgularý dahil edilmiþtir. Yatýþ sýrasýnda, klinik ve radyolojik bulgularý ile pnömoni tanýsý konulan hastalar pnömonik alevlenme grubuna (PA), belirgin bir infiltrasyonu olmayan olgular ise non-pnömonik alevlenme grubuna (n-PA) dahil edilmiþtir. Tüm hastalarýn demografik ve biyokimyasal verileri ile solunum fonksiyon testleri ve alevlenme süreleri araþtýrýlmýþtýr. Elde edilen veriler kategorik deðiþkenler için ki-kare testi, parametrik deðiþkenler Student’s t-test kullanýlarak karþýlaþtýrýlmýþ, p <0,05 anlamlý kabul edilmiþtir. Deðiþkenler arasýndaki iliþkiye pearson korelasyon testiyle bakýlmýþtýr.
Bulgular: Çalýþmaya pnömonisi bulunmayan akut alevlenme bulgularý taþýyan 30 hasta (23 erkek, 7 kadýn; ortalama yaþ±SD: 69±7) ile pnömoni tanýsý alan 30 KOAH hastasý (23 erkek, 7 kadýn; ortalama yaþ±SD: 69±9) alýndý. Ýki grup arasýnda yaþ, cinsiyet, diyabet varlýðý, yýllýk alevlenme sayýsý ve önceki antibiyotik kullanýmý açýsýndan daðýlým farký izlenmemiþtir. Pnömoni ile seyretmeyen alevlenme grubunda, içilen sigara miktarý (59±36 paket.yýla karþýn 38±37paket.yýl; p<0,05) ve hastalýk (KOAH) süresi (15±11 yýla karþýn 7,7±8 yýl; p<0,05) daha uzun bulunmuþtur. Laboratuvar bulgularý içinde C-reaktif protein (CRP), laktat dehidrogenaz (LDH) ve lökosit sayýlarýnda her iki grup arasýnda fark saptanmazken, pnömonisi olmayan alevlenme grubunun daha düþük 1.saniye zorlu ekspiratuvar volüm (FEV1) deðerine (%33,5±10’a karþýn %55±19; p<0,05 ) sahip olduðu bulunmuþtur.
Sonuç: Birincisaniye zorlu ekspiratuvar volüm (FEV1) yüzdesi daha düþük, hastalýk süresi daha uzun ve daha aðýr sigara tiryakisi olan KOAH olgularýnýn, pnömoni ile seyretmeyen alevlenmelere daha yatkýn olduðu sonucuna varýlmýþtýr.

Objective: It was aimed to evaluate the relation between the presence of pneumonia and clinical, demographic and biochemical data of patients with a diagnosis of Chronic Obstructive Pulmonary Disease (COPD) during exacerbation in case-control groups.
Methods: The present study, which was designed as a prospective study, included COPD cases with or without pneumonia diagnosis, hospitalized between 2007 and 2008 in a tertiary chest diseases clinic for acute exacerbation. Patients that were diagnosed with pneumonia based on clinical and radiological findings at the time of hospitalization were assigned to the pneumonic exacerbation (PE) group and the cases without significant infiltration were assigned to the non-pneumonic exacerbation (n-PE) group. All patients were investigated in terms of demographic and biochemical data, as well as pulmonary function tests and time to exacerbation. Data were compared using chi-square test for categorical variables and student t-test for parametric variables, and a p <0.05 was considered significant. Relation between variables was analysed by Pearson correlation test.
Results: The study included 30 patients (23 males and 7 females; mean age±SD: 69±7 years) with signs of exacerbation without pneumonia and 30 COPD patients (23 males and 7 females; mean age±SD: 69±9 years) with a diagnosis of pneumonia. No difference was determined between the groups in terms of age, gender, presence of diabetes, number of annual exacerbations, and previous antibiotic use. The amount of cigarette smoking (59±36 pack.year versus 38±37 pack.year; p<0.05) was higher and disease duration (COPD) (15±11 years versus 7.7±8 years; p<0.05) was longer in the exacerbation group without pneumonia. Among laboratory findings, whilst there was no difference between the groups in terms of C-reactive protein (CRP), lactate dehydrogenase (LDH) and leukocyte counts, it was observed that forced expiratory volume in 1 second (FEV1) (33.5±10% versus 55±19%; p<0.05 ) was lower in the exacerbation group without pneumonia.
Conclusion: It is concluded that COPD patients who were more serious cigarette addicts, had a lower forced expiratory volume in 1 second (FEV1) and a longer disease duration are more prone to exacerbations without pneumonia.

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Amaç: Astým, çocukluk çaðýnýn en sýk görülen kronik hastalýðýdýr. Magnezyum ise insan vücudunda en çok bulunan minerallerden biridir ve astým tedavisinde kullanýlmaktadýr. Ülkemizde eriþkin astýmlýlarda magnezyumla ilgili çalýþmalar varsa da, çocuklarda henüz veri bulunmamaktadýr. Bu çalýþmada, astýmlý çocuklardaki serum magnezyum düzeyleri saðlýklý çocuklarýnki ile karþýlaþtýrýlmýþtýr.
Yöntemler: Ocak 2009 ve Aðustos 2010 tarihleri arasýnda hastanemize baþvuran 5-17 yaþ arasýndaki hafif-orta persistan astýmlý çocuklar çalýþmaya alýndý. Akut astým krizinde olan 50 hastada, stabil astým tedavisi alan 50 hastada, astým tanýsý dýþýnda diðer özellikleriyle eþ durumda olan ve baþka nedenlerle hastanemize baþvuran 50 çocuktaki serum magnezyum düzeyine bakýldý. Test Roche-Hitachi Modular P biyokimya analizöründe fotometrik yöntemle yapýldý. Serum Mg normal deðerleri 1,59-2,10 mg/dL olarak deðerlendirildi ve p<0,05 olmasý istatistiksel olarak anlamlý kabul edildi.
Bulgular: Tüm hastalar, yaþ ortalamalarý ve cinsiyet daðýlýmý olarak birbirine benzer özellikte idi. Stabil astým tedavisi gören ve saðlýklý çocuklarda normal aralýktaki deðerler sýrasýyla 1,89±0,32 ve 1,93±0,34 mg/dL bulunmasýna raðmen, akut astým krizine girmiþ çocuklarda serum Mg deðerleri ortalama 1,62±0,26 mg/dL bulundu. Ancak bu ölçümler normal sýnýrlarda olmasýna raðmen, alt deðerlerdeydi (p<0,001).
Sonuç: Etkinliði kesin ispatlanmamýþ olmakla birlikte, magnezyum akut astým ataðýnda hem intravenöz hem de inhaler formda kullanýlmaktadýr. Astýmlýlarda vücut magnezyumundaki deðiþikliklerin ortaya konmasý, magnezyumun tedavideki yerinin net olarak belirlenmesinde yol gösterici olacaktýr. Bu çalýþmada da gösterildiði gibi, akut atakta serum magnezyum seviyesi eksilme eðilimindedir.

Objective: Asthma is the most common chronic disease of childhood, and magnesium is one of the most frequently found minerals in human body and it is used in the treatment of asthma. Although there are studies on magnesium levels in adult patients with asthma, there is yet no data on the levels of magnesium in children. The present study compared the levels of serum magnesium between the children with asthma and healthy children.
Methods: Children aged between 5 and 17 years with mild-moderate persistent asthma, who were admitted to our hospital between January 2009 and August 2010, were included in the study. Serum magnesium levels were measured in 50 patients with acute asthma attack, in 50 patients receiving treatment for stable asthma, and in 50 children admitted to the hospital for any reason and matched with asthma patients except for the diagnosis of asthma. The test was performed by photometric method using Roche-Hitachi Modular P biochemistry analyzer. The normal range of serum Mg was considered to be 1.59-to-2.10 mg/dL and p<0.05 was considered statistically significant.
Results: All three groups were similar in terms of mean age and gender distribution. Although mean serum magnesium levels were within the normal range in healthy children and in children treated for stable asthma (1.89±0.32 and 1.93±0.34 mg/dL respectively), it was 1.62±0.26 mg/dL in children having an asthma attack, which was within the normal range but close to the lower limit (p<0.001).
Conclusion: Although its efficacy has not been definitely proven, magnesium is used either via intravenous route or as inhaler in acute asthma attack. Knowledge about the changes in body magnesium levels of asthma patients would be a guide for revealing the role of magnesium in the treatment of asthma. As was shown in the present study, magnesium levels tend to decrease in the body during acute attack.

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Miksoma, kalbin en sýk görülen primer tümörüdür. Primer kardiyak miksomalarýn yaklaþýk %75’i sol atriyumda yerleþir ve sporadik olmaya meyillidirler. Miksomalar nadiren asemptomatiktir, bazen baþvuru semptomlarý solunumsal hastalýklarla karýþabilir.
Polikliniðimize nefes darlýðý, göðüs aðrýsý þikayeti ile baþvuran 29 yaþýndaki erkek hastanýn pulmoner emboli ön tanýsýyla tetkik edilirken, çekilen toraks bilgisayarlý tomografisinde sað atriyum ve sað ventrikül içerisinde kontrastlanma göstermeyen yaklaþýk 8x4 cm boyutlarda hipodens sýnýrlarý belirsiz yer kaplayýcý lezyon görünümü izlendi. Ekokardiyografik inceleme ile miksoma tanýsý doðrulanan hastaya intrakardiyak kitle eksizyonu yapýldý.
Olgumuzu, sað atriyum ve sað ventrikülde yerleþimli olmasý nedeniyle ve solunumsal semptomlarla baþvuran hastalarda, altta yatan kardiyak bir patolojinin de akýlda bulundurulmasý gerektiðini hatýrlatmak açýsýndan sunmayý uygun bulduk.

Myxoma is the most common primary tumour of the heart. Approximately 75% of primary cardiac myxomas are located in the left atrium and tend to be sporadic. Myxomas are rarely asymptomatic and presenting symptoms may sometimes be confused with respiratory diseases.
A 29-year-old male patient was admitted to our outpatient clinic with shortness of breath and chest pain. In the thoracic computed tomography, which was performed for the pre-diagnosis of pulmonary embolism, a hypodense space-occupying lesion, approximately 8X4 cm in size, with irregular margins that did not show contrast enhancement in the right atrium and right ventricle, was identified. The patient, whose diagnosis of myxoma was confirmed by echocardiographic examination, underwent excision of the intracardiac mass.
The present case was deemed to be suitable for presentation since the myxoma was located in the right atrium and right ventricle, as well as to remind that an underlying cardiac pathology should be considered in patients presenting with respiratory symptoms.

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Mezotelyoma, sýklýkla asbest maruziyeti olan yaþlý erkek hastalarda geliþir. Desiduoid mezotelyoma, epiteloid mezotelyomanýn nadir bir varyantýdýr ve prognozu epiteloid mezotelyomaya göre daha kötüdür. Bu alt tipin önceleri genç kadýnlarýn peritonlarýnda görülmesi ve asbest ile iliþkisinin kesin olmamasý nedeniyle bu lezyonlarýn endojen hormonlar ile uyarýldýðý düþünülmüþtür. Sonraki yýllarda, erkeklerde perikard ve plevrada görülmesinden dolayý asbest ile bu tümörün olasý iliþkisi kurulmuþtur. Bu yazýmýzda, asbest maruziyeti olan plevral malign desiduoid mezotelyoma saptadýðýmýz ve cerrahi sonrasý kemoterapi ile uzun bir saðkalým saðladýðýmýz 64 yaþýndaki bir erkek hastayý aktarýyoruz.

Mesothelioma usually develops in elder male patients that are exposed to asbestos. Deciduoid mesothelioma is a rare variant of epithelioid mesothelioma and has a poorer prognosis than epithelioid mesothelioma. As this subtype was seen in the peritoneum of young females and its relation with asbestos was not definite, these lesions were formerly thought to be stimulated by endogenous hormones. In the subsequent years, a relation was established between this tumor and asbestos since it was seen in the pericardium and pleura of males. In this paper, we present a 64-year-old male patient with asbestos exposure, diagnosed as having malignant pleural deciduoid mesothelioma, in which a long survival was provided with chemotherapy after surgery.

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Elastofibroma dorsi nadir görülen bir yumuþak doku tümörüdür. Genellikle vücudun arka kýsýmlarýnda görülen bu kitleler en sýk göðüs duvarýnda, özellikle de subskapular bölgede yerleþir. Manyetik rezonans ve bilgisayarlý tomografi bulgularýyla, histopatolojik inceleme ile lezyonun benign yapýsýnýn ortaya konulmasý hastayý cerrahiden kurtarýr. Patogenezi bilinmemektedir fakat öne sürülen mekanizmalardan biri omuz çevresinin tekrarlayan mekanik travmalarýdýr. Bu yazýda uzun süre egzersiz (aerobik) yapan 49 yaþýndaki bir kadýn hastanýn sýrtýndan eksize edilen eþ zamanlý bilateral elastofibrama sunulmuþtur.

Elastofibroma dorsi is a rare, slow-growing tumor-like process. It is typically found in the soft tissue compartment between the inferior scapula and the chest wall of an elderly person. Although its findings in magnetic resonance images and computed tomography usually allow a prospective diagnosis, recognizing the benign nature of the lesion with histopathological evaluation is important to avoid radical surgery. Its pathogenesis is unknown, but one of the postulated mechanisms is repetitive mechanical trauma around the shoulder girdle. We report a synchronously diagnosed bilateral elastofibroma excised from the back of a 49-year-old woman who had doing aerobic exercise for a long time.

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Konjenital lober amfizem (KLA), nadir bir konjenital pulmoner malformasyondur ve bir veya birden fazla akciðer lobunun hiperinflasyonu ile karakterizedir. Hastalýk, genellikle 6 aylýktan küçüklerde görülmektedir ve eriþkin çaðda çok nadirdir. Biz, burada eriþkin yaþta dispne þikayeti nedeniyle astým tedavisi kullanan; ancak astým tedavisinden fayda görmemesi üzerine anksiyolitik ilaçlar verilen bir KLA olgusunu sunduk. Hastanýn tanýsý klinik, radyolojik ve sintigrafik olarak kondu. Eriþkin yaþta nefes darlýðý þikayeti ile doktora baþvuran hastalarýn akciðer grafisinde tek taraflý lokalize havalanma artýþý varlýðýnda, nadir görülen bir hastalýk olmasýna raðmen, KLA ön tanýlardan biri olmalýdýr.

Congenital Lobar Emphysema (CLE) is a rare congenital pulmonary malformation and it is characterized by hyperinflation of one or more lobes of the lungs. The disease is usually encountered in infants aged less than 6 months and it is very rare in adulthood. Herein, we presented a patient with CLE, who received asthma treatment for dyspnoea complaint in adult age but was switched to anxiolytic medications as no benefit was achieved from asthma treatment. The diagnosis of the patient was made clinically, radiologically and scintigraphycally. Although it is a rarely encountered condition, CLE should be considered among the prediagnosis, in patients with localized unilateral hyperinflation on chest x-ray, presenting with dyspnoea in adult age.

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