Kansere baðlý ölüm nedenleri arasýnda akciðer kanseri erkeklerde birinci sýrada, kadýnlarda da ikinci sýrada yer almaktadýr. Amerika Birleþik Devletleri’nde akciðer kanseri hastalarýnýn 5 yýllýk hayatta kalma oraný %16’dýr. Akciðer kanseri hastalarýnýn sadece %15’i taný aþamasýnda 1. evrededir. Hastalarýn %50’den daha fazlasýnýn taný anýnda IV. evre olduklarý görülmektedir. Çoðu akciðer kanseri hastasýna, hastalýk ileri düzeye ulaþtýðýnda kendini gösteren belirti ve semptomlar ortaya çýkana kadar taný konulamamaktadýr. Akciðer kanserinin tedavi oranýnýn artýrýlmasý için, hasta asemptomatik iken ve kanser yayýlmadan önce daha fazla sayýda vaka tespit edilmelidir. Yüksek risk altýndaki bireylerde düþük-doz bilgisayarlý tomografi (DDBT) taramasý, akciðer kanserinin erken evrelerde teþhis edilmesine yardýmcý olabilir. ABD’de yüksek risk altýndaki bireylerde DDBT taramasý, standart haline gelmektedir ve akciðer kanserinden kaynaklanan ölümlerin sayýsýnda, sigaranýn býrakýlmasý ile birlikte önemli ölçüde bir azalma saðlamaktadýr. Bu makalede, DDBT ile akciðer kanseri taramasý hakkýnda son zamanlarda yapýlmýþ olan çalýþmalar incelenmiþtir.

Lung cancer is the leading cause of cancer deaths in males and the second leading cancer cause of death in females. The 5-year survival of all lung cancer patients in the United States is 16%. Only 15% of new lung cancers are stage I at the time of diagnosis, and over 50% of patients have stage IV lung cancer at diagnosis. Most lung cancers are not diagnosed until the patient presents with signs or symptoms of disease, and these are usually due to advanced-stage disease. If we are going to increase the cure rate for lung cancer, then more cases must be detected while the patient is asymptomatic and before the cancer has spread. Screening of high-risk individuals with low-dose computed tomography (LDCT) may help in diagnosing the lung cancer at earlier stages. Screening with LDCT in high-risk individuals is becoming the standard of care in the United States and, along with smoking cessations, offers the best opportunity for decreasing a substantial number of lung cancer deaths. In this article, recent manuscripts about lung cancer screening with LDCT have been reviewed.

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Tütün kullanýmýnýn saðlýk, sosyal, çevresel, ekonomik vb. zararlarý ortaya konduktan sonra öncelikle geliþmiþ ülkelerden baþlamak üzere son yarým yüzyýl boyunca tütün kontrolü yönünde çeþitli çalýþmalar yapýlmaya baþlamýþtýr. Bu amaçla, tütün baðýmlýsý olan kiþilere yönelik bireysel müdahale teknikleri baþarý ile kullanýlmaktadýr. Ancak tütün kontrolü çalýþmalarý yalnýzca tütün kullanan kiþilere yönelik çalýþmalar olmamalýdýr. Bu amaçla sigara kullanan kiþilerin bu davranýþtan vazgeçmelerini saðlama yönündeki bireysel yaklaþýmlarýn yaný sýra, toplumsal düzeyde de çeþitli uygulamalar yapýlmalýdýr. Bu çalýþmalarýn bazýlarý týbbi yöntemlerin kullanýlmasý þeklindedir, bazý uygulamalar ise yasal düzenlemeleri gerektirir. Bireysel ve toplumsal düzeydeki düzenleme ve uygulamalarýn, topluma tanýtýlmasý ve uygulanmasýnýn saðlanmasý bakýmýndan da sosyal pazarlama yöntemlerinin dikkate alýnmasý gereklidir. Bu derlemede, tütün kullanýmýnýn azaltýlmasý amacý ile tütün baðýmlýlýðýnýn taný ve tedavisi þeklindeki bireysel uygulamalar ve toplumsal düzeyde yasal düzenlemelerle birlikte bu konuda sosyal pazarlama yaklaþýmlarýnýn yeri ve önemi konularýnda bilgi verilmektedir.

After putting forward the health, social, environmental, economic and other consequences of tobacco use, beginning with developed countries over the last half a century, a number of studies to control tobacco use have been initiated. For this purpose, intervention techniques for tobacco-dependent individuals are being successfully used. However, tobacco control studies should not be just for those people using tobacco. Therefore, apart from the individual approaches enabling people to quit smoking, some social studies should be performed as well. Some of these studies may include the use of medical methods, while others will necessitate legal regulations. With regard to the introduction and implementation of individual and social programs and regulations, social marketing methods should be taken into consideration. In this review, together with information given on individual implementation in the form of the diagnosis and treatment of tobacco dependence to decrease the use of tobacco and legal regulations at the societal level, information about the place and importance of social marketing approaches in this subject is provided.

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Hayvanlarda insan Akut respiratuar distres sendromu (ARDS) özelliklerini oluþturmaya yönelik olarak çok sayýda farklý modeller geliþtirilmiþtir, fakat insan ARDS’sindeki histopatolojik bileþenlerin tümünü tatminkar düzeyde sergileyen tek bir hayvan modeli yoktur. Bu yüzden bir ARDS hayvan modelini seçerken, çalýþma hipotezi olarak test edilecek olan ARDS anahtar özelliðini dikkate almak ve sonra o özellikleri sergileyebilecek en uygun modeli oluþturmak önemlidir. Bu derlemenin amacý, ARDS’nin nedenlerine ve fizyopatolojisine kýsaca deðindikten sonra, en çok kullanýlan deneysel hayvan modellerini ve bu modellerin özelliklerini özetlemektir.

Although many various models have been improved in order to form human features of Acute Respiratory Distress Syndrome (ARDS) in animals, there is no single animal model that satisfactorily exhibits all of the histopathological components of human ARDS. Therefore, when choosing an ARDS animal model, it is important to consider the ARDS key property to be tested as a study hypothesis and choose the most appropriate model that can display that property. After mentioning the reasons and physiopathology of ARDS briefly, the purpose of this review is to summarise the most common experimental animal models and the features of these models.

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Amaç: Plevral efüzyon (PE), göðüs hastalýklarý klinik pratiðinde etyolojik tanýdaki güçlükler nedeniyle önemli bir yer tutar. Sývý nedenleri, incelemenin yapýldýðý bölge, klinik ve deðerlendirilen popülasyona göre deðiþiklik gösterir. Bu çalýþmada, spesifik göðüs hastalýklarý hastanesinde bulunan kliniðimizde, PE nedeniyle tetkik ettiðimiz eriþkin hastalarý deðerlendirmeyi amaçladýk.
Yöntemler: Haziran 2010 ile Temmuz 2013 tarihleri arasýnda kliniðimizde yatýþý olan, PE nedeniyle tetkik edilen, sývýnýn örneklendiði ve gerektiðinde ileri invaziv iþlemlerin uygulandýðý 240 hastanýn dosyalarý retrospektif olarak deðerlendirildi. Hastalarýn demografik özellikleri, sývý analizleri, taný yöntemleri ve tanýlarý gözden geçirildi.
Bulgular: Olgularýn %68’i erkek, yaþ ortalamasý 58±20, en sýk baþvuru þikayeti nefes darlýðý idi. Plevral sývý miktarý %56 olguda orta miktardaydý. Sývýlarýn %87’si eksüdatif vasýftaydý. Kýrk olguda glukoz deðeri 60 mg/dL’nin altýnda, 39 olguda adenozin deaminaz deðeri 40 U/L’nin üzerinde idi. Tüberküloz (TB) plörezi tanýsý büyük oranda klinik olarak konulmuþtu. Uygulanan invaziv iþlemlerden kapalý plevra biyopsisi %47, fiberoptik bronkoskopi %21 oranýnda taný saðlamýþtý. Maligniteye baðlý 61 PE’nin 38’i primer akciðer kanseri, 8’i malign mezotelyoma nedenliydi. Bu efüzyonlarýn mezotelyoma dýþýnda %66’sý malign efüzyon özelliðindeydi ve ilk torasentezin bu tanýya katkýsý %40 olarak saptandý.
Sonuç: Serimizde en sýk saptanan PE nedenleri kadýn hastalarda TB, erkek hastalarda pnömoni ve 3. sýklýkta akciðer kanseriydi. Çalýþmamýzda torasentez dýþýnda toplam 160 olguda invaziv iþlem uygulanmýþtýr. On olguda ise efüzyon etiyolojisi aydýnlatýlamamýþtýr.

Objective: Pleural effusion (PE) takes an important place in the clinical practice of thoracic diseases because of the difficulties in establishing an etiological diagnosis. The causes of effusion differ depending on the region where the examination is carried out, the clinic and the population involved. In this study, we aimed to evaluate adult patients who were examined due to PE in our clinic at a specific hospital for chest diseases.
Methods: The recordings of 240 patients who were hospitalised between June 2010 and July 2013 in our clinic and examined due to PE were retrospectively evaluated. Their fluid samples were taken and the patients were exposed to advanced invasive procedures when necessary. Demographic features of the patients, fluid analyses, diagnostic methods and diagnoses were reviewed.
Results: Of the cases, 68% were male. The mean age was 58±20 years and the most common complaint for admission was shortness of breath. The amount of pleural fluid was moderate in 56% of the cases. Eighty seven percent of the fluids were exudative. The concentration of glucose was below 60 mg/dL in 40 patients and the concentration of adenosine deaminase was above 40 U/L in 39 patients. The diagnosis of tuberculosis (TB) pleurisy was established to a great extent. Of the invasive procedures, closed pleural biopsy and fiberoptic bronchoscopy contributed to the diagnosis at rates of 47% and 21%, respectively. Of 61 malignancy-induced PEs, 38 were due to primary lung cancer and 8 were due to malignant mesothelioma. Apart from mesothelioma, 66% of these effusions were malignant effusions and contribution of the initial thoracentesis to this diagnosis was found to be 40%.
Conclusion: In our serial study, the most common causes of PE was TB in female patients, and pneumonia in male patients. Invasive procedures except thoracentesis were performed for 160 cases in total in the study. In 10 cases, the etiology of effusion could not be identified.

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Amaç: Tüberküloz ile hiperkoagülabilite arasýnda bir iliþki olduðu bildirilmiþtir. Hiperkoagülabilitenin oluþtuðu durumlarda vücut yanýt olarak fibrinolitik sistemi aktive etmektedir. Bu çalýþmada, tüberküloz plörezi (TP) olgularýnda fibrinolitik parametrelerin deðerlerini ve tanýya katkýsýný araþtýrmayý amaçladýk.
Yöntemler: Tüberküloz plörezi (30 olgu), malign plevral efüzyon (8 olgu), transüdatif plevral efüzyon (6 olgu) içeren 44 olgu çalýþmaya alýndý. Transüdatif ve malign sývýlar kontrol grubunu oluþturdu. Olgularýn plevra sývýsý ve plazma D-Dimer, fibrinojen, doku plaz­minojen aktivatör (t-PA), plaz­minojen aktivatör inhibitör 1(PAI-1), t-PA/PAI-1 kompleksi düzeyleri ile serum ve plevral sývý, adenozindeaminaz (ADA), glukoz, laktat dehidrogenaz (LDH), total protein ve albümin düzeyleri ölçüldü.
Bulgular: Tüberküloz plörezili olgularda, plevral sývý fibrinojen ve plevral sývý PAI-1 deðerleri, Mann-Whitney U testine göre TP olgularýnda istatistiksel olarak anlamlý derecede yüksek bulundu (p≤0,05 ve p≤0,001).
Sonuç: Tüberküloz plörezide hiperkoagülasyon arttýðýndan fibrinolitik sistem de aktive olmaktadýr ve fibrinolitik parametreler artmaktadýr. Tüberküloz plörezi tanýsýnýn klasik yöntemlerle konulamadýðý durumlarda bu parametrelerden yararlanýlabilinir.

Objective: The presence of a relationship between tuberculosis and hypercoagulability has been reported. In the case of the occurrence of hypercoagulability, the body responds by activating the fibrinolytic system. In this study, we aimed to investigate the values of fibrinolytic parameters and their contribution to the diagnosis in patients with tuberculosis pleurisy (TP).
Methods: Forty four patients with tuberculosis pleurisy (30 cases), malignant plural effusion (8 cases), and transudative pleural effusion (6 cases) were involved in the study. Transudative and malignant fluids constituted the control group. The concentrations of pleural fluid and plasma D-Dimer, fibrinogen, tissue plasminogen activator (t-PA), plasminogen activator inhibitor 1 (PAI-1), t-PA/PAI-1 complexes and serum, and pleural fluid, adenosine deaminase (ADA), glucose, lactate hydrogenase (LDH), total protein and albumin levels of the cases were measured.
Results: In the patients with tuberculosis pleurisy, the values of pleural fluid fibrinogen and pleural fluid PAI-1 were found to be significantly higher according to the results of Mann-Whitney U test (p≤0.05 and p≤0.001, respectively).
Conclusion: In tuberculosis pleurisy, fibrinolytic system activates in parallel with the increased hypercoagulation and fibrinolytic parameters also increase. These parameters can be benefited unless the diagnosis of tuberculosis pleurisy can be established through conventional diagnostic methods.

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Amaç: Kronik obstrüktif akciðer hastalýðý (KOAH) akut ataðýnda hipoksemi, sistemik inflamasyon gibi nedenler ile birçok sistemik etkiler meydana gelmektedir. Bu çalýþmada, KOAH akut atak ile hastaneye baþvuran hastalarda akut ataðýn arteriyel sertlik üzerine etkileri araþtýrýldý.
Yöntemler: Çalýþmaya Uludað Üniversitesi Göðüs Hastalýklarý Kliniðine, Mayýs 2011 ile Aralýk 2011 tarihleri arasýnda baþvuran ve GOLD Taný ve Tedavi Rehberi kriterlerine göre KOAH tanýsý alan, KOAH akut ataklý 25 hasta ve 21 gönüllü olgu alýndý.
Bulgular: Arteriyel sertlik deðerleri hafif, orta ve ileri derecede hipoksemi olanlarda sýrasýyla 1498.00±699.35 dyne/sec/cm-5, 2095.09±883.31 dyne/sec/cm-5, 2077.66±99.15 dyne/sec/cm-5 ölçüldü. Hipoksemi þiddeti ile arteriyel sertlik arasýnda istatistiksel anlamlý korelasyon saptanmadý (p>0.05). Fakat hafif hipoksemi (PaO2≥60 mmHg) ve orta, ileri hipoksemi (PaO2<60 mmHg) deðerleri arasýnda, AS deðerlerine göre istatistiksel anlamlý fark saptandý (p=0.047). Hasta grubunda, saðlýklý kontrol grubuna göre AS yüksek, büyük arter elastik indeksi, küçük arter elastik indeksi düþük saptandý ve istatistiksel olarak anlamlý bulundu (p=0.002, p=0.043 ve p=0.036, sýrasýyla).
Sonuç: KOAH’ ýn akut alevlenme döneminde PaO2≥60 mmHg olduðu zaman ölçülen arteriyel sertlik deðerlerine göre, PaO2<60 mmHg olduðu zaman ölçülen deðerlerinin daha yüksek olduðu saptanmýþtýr. Kronik obstrüktif akciðer hastalýðý olan akut ataktaki hastalarda saðlýklý kontrol grubuna göre AS deðeri anlamlý yüksek, büyük arter elastik indeksi, küçük arter elastik indeksi anlamlý düþük saptanmýþtýr.

Objective: Acute exacerbation in chronic obstructive pulmonary disease (COPD) can result in a major systemic effect due to hypoxemia and systemic inflammation. In our study, we investigated the effects of acute exacerbation of COPD on arterial stiffness (AS) in patients admitted to our hospital.
Methods: Enrolled in the study were 21 healthy volunteers who constituted the control group and 25 patients who had been admitted to our hospital between May and December 2011 with acute exacerbation of COPD diagnosed based on Global Initiative for Chronic Obstructive Lung Disease Diagnosis and Treatment Guidelines.
Results: The average AS values were 1498.00±699.35 dyne.sec.cm-5 in patients with mild hypoxemia, 2095.09±883.31 dyne.sec.cm-5 in those with moderate hypoxemia, and 2077.66±99.15 dyne.sec.cm-5 in those with severe hypoxemia. There was no statistically significant correlation between severity of hypoxemia and AS value (p>0.05). But, there was a statistically significant difference in values of AS, compared between mild hypoxemia (PaO2≥60 mm Hg) and moderate and severe hypoxemia (PaO2<60 mm Hg) (p=0.047). Arterial stiffness was significantly higher, while the large artery elasticity index (LAEI) and small artery elasticity index (SAEI) were lower in the patient group as compared to the control group (p=0.002, p=0.043, and p=0.036, respectively).
Conclusion: In PaO2<60 mmHg AS values were higher than in PaO2≥60 mmHg during acute exacerbation of COPD. The AS value was significantly higher while LAEI and SAEI were significantly lower in the patient group as compared to the control group.

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Amaç: Kliniðimizde yatarak tedavi gören 70 yaþ ve üzeri pnömoni olgularýnýn analizi ve tedavi baþarýsýna etkili faktörleri belirlemek.
Yöntemler: Ocak 2012-Ocak 2013 tarihleri arasýnda kliniðimizde pnömoni tanýsý ile yatarak tedavi gören hastalarýn dosyalarý retrospektif olarak incelendi. Yetmiþ yaþ ve üzeri olanlar çalýþmaya dahil edildi. Ölen veya yoðun bakým ünitesine nakledilen olgular tedavi baþarýsýzlýðý olarak kabul edildi, tedavi baþarýsýzlýðý olanlar ile taburcu edilen hastalarýn verileri karþýlaþtýrýldý.
Bulgular: Olgulardan 55’inin 70 yaþ ve üzeri olduðu tespit edildi. Olgularýn yaþ ortalamasý 79,7±6,3 yýl (70-97); 27’si (%49,1) erkek, 28’i (%50,9) kadýndý. Tedavi baþarýsýzlýðý kabul ettiðimiz grupta toplam 7 olgu (%12,7), tedavisi baþarýlý grupta toplam 48 olgu (%87,3) bulunmaktaydý. Tedavi baþarýsýzlýðý grubunda yaþ ortalamasý 83,8 ±6,8 yýl (75-97), en sýk semptom %57,1 ile öksürük, en sýk eþlik eden hastalýk %42,9 ile diyabetes mellitus, %42,9 ile serebrovasküler hastalýk idi. Tedavisi baþarýlý olan olgularda yaþ ortalamasý 79,1 ±6,0 yýl (70-94), en sýk semptom %66,7 ile öksürük, en sýk eþlik eden hastalýk %50 ile hipertansiyon ve konjestif kalp yetmezliði ve %33,3 ile kronik obstrüktif akciðer hastalýðý idi. Tedavi baþarýsýzlýðý kadýnlarda (p=0,04), bakýmevinde yaþayanlarda (p=0,04), multilober tutulum olanlarda (p=0,009), plevral sývý varlýðýnda (p=0,03) ve Türk Toraks Derneði pnömoni sýnýflamasýna göre grup 3 pnömoni sýnýfýnda olanlarda (p=0,04) anlamlý düzeyde daha yüksek bulundu. Tedavinin baþarýlý olduðu grupta serum sodyum düzeyleri anlamlý derecede düþüktü.
Sonuç: Ýleri yaþ pnömoni olgularýnda hastanýn bakýmevinde yaþýyor olmasý, kadýn cinsiyette olmasý, radyolojik olarak multilober tutulumlu pnömoninin olmasý ve plevral sývý varlýðý, olgunun grup 3 pnömoni sýnýfýnda olmasý tedavi baþarýsýzlýðýna etkili faktörlerdir.

Objective: The aim of this study was to analyse those pneumonia patients at the age of 70 years and above, who were hospitalised in our clinic and to determine the factors affecting treatment success.
Methods: The recordings of the patients who were hospitalised in our clinic due to the diagnosis of pneumonia between January 2012 and January 2013 were retrospectively evaluated. Patients aged 70-years and older were involved in the study. Those patients who died or transferred to the intensive care unit were considered treatment failure. The data obtained for the patients with treatment failure and for the patients discharged from hospital in good health were compared.
Results: Of the cases, 55 were found to be 70 years old and above. The mean age of the patients was 79.7±6.3 years (70-97). Twenty seven patients (49.1%) were male and 28 patients (50.9%) were female. The group with treatment failure included 7 patients (12.7%) and the group with treatment success included 48 patients (87.3%). In the group with treatment failure, the mean age was 83.8±6.8 (75-97) years, the most common symptom was cough (57.1%), and the most common concurrent diseases were diabetes mellitus (42.9%) and cerebrovascular disease (42.9%). In the group with treatment success, the mean age was 79.1 ±6.0 years (70-94), the most common symptom was cough (66.7%), the most common concurrent diseases were hypertension and congestive heart failure (50%) and chronic obstructive pulmonary disease (33.3%). Treatment failure was found to be significantly higher in women (p=0.04), in individuals living in nursing homes (p=0.04), in patients with multilobar involvement (p=0.009), in the presence of pleural fluid (p=0.03) and in patients in the pneumonia Group 3 class according to the pneumonia classification system of the Turkish Thoracic Society (p=0.04). In the group with treatment success, the concentrations of serum sodium were significantly lower.
Conclusion: In advanced age pneumonia cases, living in a nursing home, being female, having a radiological presence of multilobar involvement and pleural fluid, and being in the pneumonia Group 3 class were more likely to be associated with treatment failure.

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Amaç: Bu çalýþmada, sigara býrakma polikliniðinde takip edilen hastalarda sigara býrakma baþarýsýný etkileyen faktörleri ve polikliniðimizin sigara býrakma hýzlarýný araþtýrmayý amaçladýk.
Yöntemler: Haziran 2011-Haziran 2012 tarihleri arasýnda, igara býrakma polikliniðine baþvuran 320 olgudan 12 aylýk takipleri tamamlanabilen 241 olgu çalýþmaya alýndý. Olgulardan rutin biyokimyasal ve hematolojik testler, solunum fonksiyon testi, elektrokardiyografi ve posteroanterior akciðer grafisi istendi. Ayrýca tüm olgulardan, Fagerström nikotin baðýmlýlýk testi, anksiyete ve depresyon deðerlendirme ölçekleri ile demografik verilerin yer aldýðý poliklinik formunun doldurulmasý istendi. Kullandýklarý ilaçlar ve süreleri kaydedildi. Hastalarýn sigara býrakma baþarýlarý ve baþarýya etki eden faktörler deðerlendirildi.
Bulgular: Genel olarak 1. yýl sonunda sigara býrakma hýzý %37,3 idi. Sigara býrakan ve býrakamayan grup arasýnda deðerlendirmede demografik özellikler benzerdi. Býrakamayan grupta konsantrasyon güçlüðü, sinirlilik, Fagerström baðýmlýlýk derecesi (p<0,001) ve iþyerinde içilen sigara sayýsý daha fazlaydý (p<0,001). Sigara býrakan grupta kilo artýþý daha fazla idi. Olgularýn %27,4’üne davranýþsal eðitim (DE), %56’sýna davranýþsal eðitim ve Nikotin replasman tedavisi (DE+NRT), %9,5’ine DE+Bupropion, %2,5’ine DE+ Vareniklin, %4,6’sýna DE+ Bupropion+NRT baþlanmýþtý. Býrakma hýzlarý sýrasýyla %15,2, %43,7, %52,2, %66,7 ve %45,5 idi. Yeterli sürede farmakolojik tedavi verilmesi ile býrakma hýzlarýda anlamlý olarak artmaktaydý (p<0,001).
Sonuç: Sigara býrakma süreci, her olgu için bireysel deðerlendirilmesi gereken zor bir süreçtir. Bu süreçte yeterli davranýþsal eðitim ve uygun bireylere yeterli sürede farmakolojik destek tedavi verilmesi baþarý hýzýný arttýracaktýr.

Objective: The aim was to investigate the factors affecting the quitting smoking success of the patients followed in the smoking cessation outpatient clinic and the rate of quitting smoking in this clinic.
Methods: From the 320 cases who applied to the smoking cessation clinic, 241 cases with a 12 month follow-up completed between June 2011 and June 2012 were included in the study. Routine biochemical and hematological tests, respiratory function test, electrocardiography, and posteroanterior chest radiography were requested from the cases. Moreover, the cases were requested to complete the Fagerstrom nicotine dependence test, anxiety and depression assessment scale and the outpatient clinic’s form, including demographic data. The medicines taken and the duration of use were recorded. The quitting smoking success of the patients and the factors affecting this success were evaluated.
Results: Generally, at the end of the first year, the rate of quitting smoking was 37.3%. The demographic characteristics of the groups who quit smoking and who failed to quit smoking were similar. Fagerstrom dependence degree (p<0.001) and the number of cigarettes smoked at the workplace (p<0.001) were higher. The individuals included in the group who quit smoking put on more weight. Overall, 27.4% of the patients received behavioural education (BE), 56% of them received behavioural education and nicotine replacement therapy (BE+NRT), 9.5% of them received BE+Bupropion, 2.5% of them received BE+Varenicline, and 4.6% of them received BE+Bupropion+NRT treatments. The rates of quitting smoking were 15.2%, 43.7%, 52.2%, 66.7% and 45.5%, respectively. With the administration of pharmacological treatment for a sufficient time, the rates of quitting smoking rose meaningfully (p<0.001).
Conclusion: Quitting smoking is a difficult process that has to be evaluated individually for every case. In this process, the administration of sufficient behavioural education and pharmacological treatment with sufficient time for appropriate individuals will increase the success rate.

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Amaç: Uyku bozukluklarý kiþinin üretkenliðini ve performansýný olumsuz yönde etkileyerek yaþam kalitesinin azalmasýna neden olan önemli bir halk saðlýðý sorunudur. Uyku düzeninin bozulduðu vardiyalý çalýþan kiþilerde uyku bozukluklarýnýn görülme sýklýðý çok belirgindir. Çoðu vardiyalý çalýþan saðlýk çalýþanlarýnda obstrüktif uyku apne sendromu (OUAS) ile ilgili yeterli veri yoktur ve bu çalýþma saðlýk çalýþanlarýnda tüm gece polisomnografi (PSG) testi ile yapýlan ülkemizdeki ilk çalýþmadýr. Çalýþmamýzda hastanemizde görevli hemþire ve asistan doktorlarda horlama ve OUAS sýklýðýný araþtýrmayý amaçladýk.
Yöntemler: Hastanemizde görevli olan ve çalýþmaya katýlmayý kabul eden tüm hemþire ve asistan doktorlara yüz yüze görüþme yöntemiyle anket uygulandý. Horlama þikayetine, tanýklý apne ve/veya gündüz aþýrý uykululuk hali (GAUH) eþlik eden kiþilere tüm gece PSG tetkiki önerildi. Polisomnografi yapýlan olgularda OUAS sýklýðý ve OUAS saptanan ve saptanmayan olgularda nöbet tutma oranlarý karþýlaþtýrýldý.

Bulgular: Çalýþmaya 257 kiþi katýldý. Katýlýmcýlarýn %63’ünü hemþireler, %37’sini ise asistan doktorlar oluþturuyordu. Olgularýn %34,2’si erkek idi. Olgularýn yaþ ortalamasý 28,8±3,7 (19-39 yýl), vücut kitle indeksi ortalamasý 24,03±3,85 kg/m2 idi. Çalýþmaya katýlanlarda aylýk tutulan gece nöbet ortalamasý 7,6±3,8 gün idi. Olgularýn %28,8’inde (n=74) horlama, %2,7’sinde (n=7) tanýklý apne, %7,8’inde (n=20) GAUH (Epworth uykululuk skalasý ≥11) tespit edildi. PSG önerilen 20 kiþiden 4’ü (%1.6) PSG çalýþmasýný reddetti. 16 olguya (%6.2) PSG yapýldý. PSG sonuçlarýna göre, OUAS prevalansýnýn saðlýk çalýþanlarýnda %4,7, vardiyalý çalýþan saðlýk personelinde ise %5,1 olduðunu bulduk. OUAS tespit edilenlerin %91,7’si (11/12) nöbet tutmaktayken, OUAS tespit edilmeyenlerin %83,3’ü (204/245) nöbet tutmaktaydý (p=0,697). OUAS saptananlarýn hepsi erkek iken, OUAS saptanmayanlarýn %31’i erkek idi (p<0,001).
Sonuç: Çok fazla dikkat ve konsantrasyon gerektiren iþlerde çalýþan saðlýk çalýþnalarýnda uyku bozukluklarýna baðlý semptomlar sorgulanarak, þüpheli olgularda tanýsal inceleme ve tedavi yapýlmalýdýr.

Objective: Sleep disorders are important public health issues that decrease the individuals’ quality of life by affecting their productivity and performance in a negative way. The frequency of sleep disorders among people who work shifts with irregular sleep patterns is apparent. For healthcare providers, most of whom work shifts, the available data related to obstructive sleep apnea syndrome (OSAS) are insufficient. Also, this is the first study that has been conducted using an all-night polysomnography (PSG) for health staff in our country. In our study, we aimed to investigate the prevalence of snoring and OSAS among the nurses and resident doctors working at our hospital.
Methods: Face-to-face interviews were performed with all nurses and resident doctors who worked at our hospital and agreed to participate in our study. All-night PSG examination was recommended to participants with concurrent witnessed apnea and/or excessive daytime sleepiness (EDS) with snoring. The frequency of OSAS was evaluated in cases exposed to polysomnography, and those with and without OSAS were compared in terms of shift rates.
Results: The study included 257 participants. Of these, 63% were nurses and 37% were resident doctors; overall, 34.2% of the cases were male. The mean age was 28.8±3.7 (19-39) years and the mean body mass index was 24.03±3.85 kg/m2. Among the participants, the mean number of monthly night shifts was 7.6±3.8. Also, 28.8% of the participants (n=74) experienced snoring, 2.7% (n=7) had witnessed apnea, and 7.8% (n=20) had EDS (Epworth sleepiness scale≥11). Four (1.6%) of the 20 participants who were proposed to undergo PSG refused this examination. Sixteen cases were exposed to PSG (6.2%). According to the PSG results, the prevalence of OSAS was 4.7% among all healthcare providers and 5.1% among the health staff working shifts. Of the cases with OSAS, 91.7% (11/12) were working shifts while 83.3% (204/245) of those without OSAS were working shifts (p=0.697). All of the cases diagnosed with OSAS were male, but 31% of the cases without OSAS were male (p<0.001).
Conclusion: For those healthcare providers who are engaged in duties requiring significant amounts of attention and concentration, the symptoms related to sleep disorders should be questioned and diagnostic evaluation and treatment should be performed for suspected cases.

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Amaç: Dünyada olduðu gibi, ülkemizde de hekimler arasýnda bronkoskopi uygulamalarýnda tutum ve davranýþ farklýlýklarý vardýr. Türkiye Solunum Araþtýrmalarý Derneði, Giriþimsel Pulmonoloji Çalýþma Grubu olarak ülkemizde bronkoskopi uygulamasý yapan hekimlerin tutum ve davranýþlarýný bir anket ile ortaya koymayý amaçladýk.
Yöntemler: Tanýsal ve giriþimsel bronkoskopi uygulamalarýna iliþkin 23 soru içeren web tabanlý ankete katýlým için hazýrlanan ve anket linkini içeren davet mektubu, göðüs hastalýklarý, göðüs cerrahisi, anestezi ve reanimasyon uzmanlarýnýn e-posta gruplarýna gönderildi. Ankete katýlan hekimlerin verdiði yanýtlar deðerlendirildi. Anketten elde edilen sonuçlar genel olarak ve branþ temelinde istatistiksel analizlerle deðerlendirildi.
Bulgular: Anketi 93 göðüs hastalýklarý, 30 göðüs cerrahisi, 23 anesteziyoloji olmak üzere toplam 146 uzman hekim yanýtladý. Ankete katýlan hekimlerin %73’ü üniversite veya eðitim araþtýrma hastanesinde çalýþýyordu, katýlýmcýlarýn %47’si yýlda 100’den fazla bronkoskopi yapýyordu. Katýlýmcýlarýn %36’sý yaptýklarý bronkoskopilerin % 38’inde sedasyon yapmadýklarýný belirttiler. Diðer taraftan, sedasyon için en fazla tercih edilen ilaç midazolam (%78) idi. Topikal anestezi yöntemi olarak lidokain nebülizasyonu göðüs hastalýklarý uzmanlarýnýn %77’si tarafýndan kullanýlýrken, göðüs cerrahisi ve anesteziyoloji uzmanlarýnda bu oran sýrasýyla %13 ve %8 olarak saptandý (p<0,001).GH’lerin %38’i tanýsal bronkoskopilerinin % 23’ünü genel anestezi altýnda yapýyordu. Ýþlem sýrasýnda nabýz oksimetresi takibi % 97, suplemental Oksijen kullanýmý ise % 87 oranýnda bulundu. Göðüs hastalýklarý uzmanlarýnýn % 60’ý bronkoskopi eðitimi için, deneyimli bir uzman denetiminde en az 100 iþlem yapýlmasýný, % 40’ý ise ayný sayýnýn en az 50 olmasýný yeterli görüyordu.
Sonuç: Anket verileri ülkemizdeki bronkoskopi deneyimi hakkýnda bilgi vermektedir. Bu tür anketlerin soru çeþitliliðinin ve katýlýmcý sayýsýnýn arttýrýlarak tekrarlanmasýnýn önemli bir veri kaynaðý oluþturacaðý düþüncesindeyiz.

Objective: As in the rest of the world, there are differences in attitudes and behaviours among physicians in bronchoscopy applications in our country as well. The aim of this study was to put forward the attitudes and behaviours of bronchoscopists using a questionnaire as the Working Group of Interventional Pulmonology of Turkish Respiratory Society.
Methods: The invitation letter prepared individuals for participation in the web-based questionnaire containing 23 questions on the implementation of diagnostic and interventional bronchoscopy; the link to the questionnaire was sent to the e-mail groups of pulmonologists, thoracic surgeons and anesthesia and intensive care specialists. The responses of the physicians participating to the questionnaire were evaluated. The results obtained from the questionnaire were evaluated generally and on the basis of medical branches by statistical analyses.
Results: The questionnaire was answered by a total of 146 specialists including 93 pulmonologists, 30 thoracic surgeons and 23 anesthesiologists. In total, 73% of the physicians responding to the questionnaire were working at the University or Training and Research Hospital and 47% of the respondents were conducting more than 100 bronchoscopies per year. Here, 36% of the respondents stated that in the bronchoscopies that they carried out, they did not sedate their patients. On the other hand, the most commonly preferred medication for sedation was midazolam (78%). While 77% of the pulmonologists used nebulised lidocaine as a topical anesthetic, these rates were 12.5% and 8.3% respectively for thoracic surgeons and anaesthesiologists (p<0.001). Also, 38% of pulmonologists were conducting 23% of the diagnostic bronchoscopies under general anesthesia. During bronchoscopy, the pulse oximetry follow-up was found to be 97%, and the supplemental oxygen administration was 87%. Overall, 60% of the pulmonologists thought that at least 100 procedures must be performed under the supervision of a specialist during bronchoscopy training and 40% of them were of the opinion that the number of procedures undertaken must be at least 50.
Conclusion: The data of the survey give information about the practice of bronchoscopy in Turkey. It is suggested that the repetition of such questionnaires by increasing the variety of questions and the number of participants will provide an important data source.

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“Behçet Sendromu”, 1973’te bir Türk Dermatoloðu olan Hulusi Behçet tarafýndan oral aftöz ülser, genital ülser ve göz belirtileri klinik üçlemesi ile tanýmlanmýþtýr. Vasküler, kutanöz, pulmoner, nörolojik, romatizmal, gastrointestinal ve genitoüriner sistem tutulumlarý ile ortaya çýkabilir. Behçet sendromunda pulmoner tutulumun ana öðeleri; pulmoner arter anevrizmalarý, arteriyel ve venöz tromboz, pulmoner infarkt, tekrarlayan pnömoni, bronþiolit obliterans organize pnömoni ve plörezidir.
Bu yazýda, hemoptizisi bronþiyal arterler ile pulmoner arter arasýndaki anastomoz ile parankimal yýkýmdan kaynaklanan ve bu nedenle Behçet sendromu için farklý bir damarsal tutulumu olduðu düþünülen genç bir erkek olgu sunulmuþtur.

“Behçet’s Syndrome” was described as the triple-symptom complex of oral aphthous ulcers, genital ulcers and uveitis by Hulusi Behçet, a Turkish dermatologist, in 1937. It can present with vascular, cutaneous, pulmonary, neurological, rheumatologic, gastrointestinal and genitourinary system involvements. The main components of pulmonary involvement in Behçet’s Syndrome are pulmonary artery aneurysms, arterial and venous thrombosis, pulmonary infarction, recurrent pneumonia, bronchitis obliterans organising pneumonia and pleurisy. This study presented a case of a young man with hemoptysis resulting from anastomosis between the bronchial arteries and pulmonary artery and parenchymal destruction, and thus had a different vascular involvement for Behçet’s syndrome.

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Pulmoner hamartom, akciðerin en sýk görülen iyi huylu tümörüdür. Boyutu genellikle 4 cm’den küçüktür ve 10 cm’den büyük pulmoner hamartom nadirdir. Hava dolu kistik alanlar içeren pulmoner hamartom nadir görülen bir formdur. Bu yazýda; nadir görülmesi nedeniyle, öksürük ve nefes darlýðý þikayeti ile baþvuran 49 yaþýndaki dev pulmoner kistik hamartom olgusu sunulmuþtur.

Pulmonary hamartoma is the most common benign neoplasm of the lung. Its size is usually smaller than 4 cm, and a pulmonary hamartoma larger than 10 cm is rare. Pulmonary hamartoma with air-filled cystic areas is also a rare form. Since it is a rare condition, in this article, we reported a case of giant pulmonary cystic hamartoma in a 49-year-old patient admitted with cough and breathing difficulty.

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Göðüs aðrýsý, aðýz kuruluðu, bayýlma, dudak ve ayaklarda morarma, nefes darlýðý yakýnmalarý ile acil servisimize baþvuran 57 yaþýnda kadýn hastada, hipotansiyon, taþikardi, takipne ve siyanoz saptandý. Diyabetik ketoasidozu olan hastanýn spiral toraks bilgisayarlý tomografisinde, sol ve sað ana pulmoner arter ile sað pulmoner arterin segmental dallarýnda trombüs saptandý. Hemodinamik þok tablosundaki hastaya acil serviste masif pulmoner emboli tanýsýyla fibrinolitik tedavi baþlandý. Etiyolojiye yönelik yapýlan araþtýrmalarda B12 eksikliði ve hiperhomosisteinemi saptandý. Diyabetik ketoasidozun yarattýðý hipovolemi ve B12 eksikliðine baðlý hiperhomosisteineminin sinerjist etkisi ile oluþan masif pulmoner embolinin birlikte görüldüðü bu olgu nadir görülmesi nedeniyle sunuldu.

A 57-year-old woman with no prior history was admitted to our emergency department with complaints of chest pain, dyspnea, xerostomia, syncope, and cyanosis on her lips and feet. On her physical examination, cyanosis, tachypnea, hypotension and sinus tachycardia were revealed. On the spiral computed tomography of the thorax of the patient with diabetic ketoacidosis, thrombus was detected in the left and right main pulmonary artery and segmental branches of the right pulmonary artery. The fibrinolytic treatment was initiated in the emergency department for the patient with hemodynamic shock due to the diagnosis of acute massive pulmonary embolism. Etiological examinations revealed B12 deficiency and hyperhomocysteinemia. This case, with the presentation of massive pulmonary embolism, resulted from the synergistic effect of hyperhomocysteinemia associated with B12 deficiency; hypovolemia caused by diabetic ketoacidosis was reported owing to its rareness.

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Primer lenfoepitelyoma benzeri karsinoma (LEBK), akciðerin nadir görülen tümörlerindendir. Sýk olarak nazofarenks, mide, tükürük bezi ve timus kaynaklýdýr. Bu bölge lokalizasyonlarýnda sýklýkla Epstein- Barr Virüsü (EBV) ile iliþkilidir. Öksürük ve sýk tekrarlayan oral aft, akciðer grafisinde kitle görünümü ile kliniðimize baþvuran 68 yaþýnda erkek hastada yapýlan transtorasik iðne biyopsisi küçük hücreli dýþý akciðer kanseri ile uyumlu idi. Sýk tekrarlayan aftöz lezyonlar için yapýlan nazofarenks biyopsisinde EBV tespit edildi. Olguya sað üst lobektomi ve mediasten diseksiyonu uygulandý. Postoperatif patoloji sonucu LEBK olarak yorumlandý. Lenfoepitelyoma benzeri karsinomanýn akciðer kanserinin nadir görülen bir alt tipi olmasý nedeniyle, olgumuzu literatür eþliðinde sunduk.

Primary lymphoepithelioma-like carcinoma (LELC) is a rare form of lung cancer. It often originates in the nasopharynx, stomach, salivary gland and thymus. Most of the time, its localisation in this area is associated with Epstein-Barr Virus (EBV). Transthoracic needle biopsy findings, which were performed for a 68-year-old male patient with the complaints of cough and frequently recurring oral aphthae, and mass appearance on his chest radiography, were found to be consistent with non-small cell lung cancer. Nasopharyngeal biopsy carried out for frequently recurring aphthous lesions revealed EBV. The patient was exposed to right upper lobectomy and mediastinal dissection. Postoperative pathological findings were interpreted as evidence for LELC. We have presented our case with a literature review because lymphoepithelioma-like carcinoma is a rarely seen subtype of lung cancer.

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Amaç: Göðüs hastalýklarýnda öykü alma aþamasýnda, bireylerin mesleki ve çevresel maruziyetleri ile sigara kullanma öykülerini ayrýntýlý olarak kaydetmek hastalýk tanýsýnda çok önem taþýmaktadýr. Bu çalýþmada, göðüs hastalýklarý polikliniðinde alýnan meslek anamnezlerinin kalitesini araþtýrmak planlanmýþtýr.
Yöntemler: Týp fakültesi göðüs hastalýklarý polikliniðine ayaktan baþvurmuþ 320 ardýþýk hastanýn (158 kadýn, 162 erkek) kayýtlarý retrospektif olarak deðerlendirildi. Kayýtlarda bireylerin meslek öykülerinin ayrýntýlý olarak alýnýp alýnmadýðý, çevresel maruziyetlerin ve sigara kullanýmýnýn sorgulanma þekli deðerlendirildi.
Bulgular: Kadýn hastalarýn yaþ ortalamasý 51,6±173 iken, erkeklerinki 55,1±16,1 idi. En sýk karþýlaþýlan meslekler; ev hanýmý (%37,5), çiftçi (%12,8) ve iþçi (%12,2) idi. Ayrýntýlý meslek öyküsü %21,9 oranýnda alýnmýþ ve erkeklerde (%79) kadýnlardan (%31) daha yüksek oranda bulunmuþtu (p=0.001). Ýþçilerin %60’ýnda çalýþýlan iþyeri sorgulanýrken, halen çalýþýlan iþten önceki iþler %10,6 oranýnda sorgulanmýþtý. Toplam 9 bireye (%2,8) yaþadýðý ortam sorulmuþtu. Sigara kullanýmý olgularýn %90,6’sýnda sorgulanmýþtý. Toplam 290 sigara kullanan olgunun 183’üne (%63,1) paket.yýl sorgulamasý yapýlmýþtý.
Sonuç: Göðüs hastalýklarý polikliniðinde ayrýntýlý mesleki anamnez, çevresel maruziyet öyküsü ve sigara kullanýmý öyküsü kayýtlarýnýn yeterli derecede yapýlmadýðý gözlenmiþtir.

Objective: Detailed examination of occupational and environmental exposure of the individuals and their use of cigarette during history-taking stage in Chest Diseases is crucial. This study was planned to investigate the qualities of occupational anamneses carried out in the Outpatient Clinic of Chest Diseases.
Methods: The recordings of 320 consecutive outpatients (158 female and 162 male) admitted to the Outpatient Clinic of Chest Diseases in the Faculty of Medicine were evaluated retrospectively. During this evaluation, whether occupational histories of the patients had been taken in detail or not and the manner in which questioning was performed regarding environmental exposure and smoking were assessed.
Results: The mean age was 51.6±17.3 years in female patients and 55.1±16.1 years in male patients. The most common occupations were housewife (37.5%), farmer (12.8%) and worker (12.2%). Detailed occupational history-taking rate was 21.9% and was found to be higher in males (79%) than in females (31%) (p=0.001). Of the workers, 60% had been questioned regarding their current workplaces, while only 10.6% had been questioned about their previous workplaces. In total, 9 patients (2.8%) had been asked about the environment in which they live. The smoking habits had been questioned in 90.6% of the cases. Of the 290 patients who had been smoking, 183 (63.1%) had been questioned about the amount of cigarettes smoked in a year (packs.year).
Conclusion: It was observed that extensive occupational anamnesis and a history of environmental exposure and smoking were not taken adequately in the Outpatient Clinic of Chest Diseases.

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