Abstract | Full Text PDF

Akciðer nakil olgularý, hayat boyu yoðun bir immünsuresif tedavi almak zorundadýrlar. Bu tedavi onlarý, özellikle kýþ döneminde, baþta viral nedenler olmak üzere, solunum yolu enfeksiyonlarýna (SYE) yatkýn hale getirir. Solunum yolu enfeksiyonlarýnýn, akut veya kronik allograft rejeksiyonu gibi çok aðýr ve korkulan sonuçlarý olabileceði için, erken taný ve tedavi önerilmektedir. Tüm akciðer nakil olgularý evlerinde günlük solunum fonksiyonu takibi yaparlar. Bu takip sýrasýnda SYE þüphesi doðuracak semptom ve bulgular görüldüðünde nakil merkezi ile hemen baðlantý kurmalarý konusunda eðitimlidirler. Nakil merkezine SYE þüphesi ile baþvuran hastadan viral ve bakteriyolojik inceleme için nazofarengeal sürüntü alýnýr. Sonrasýnda önlem olarak geniþ spektrumlu antibiyotik, antiviral ve intravenöz immünglobülin tedavi baþlanýr. Tedavi süresi virolojik örneklemelerin sonuçlarýna göre belirlenir. Ayrýca SYE’den korunmak için tüm nakil olgularýmýza ve ev içi temaslýlarýna mevsimsel influenza aþýsý yapýlýr ve özel hijyen önlemleri önerilir.

Lung transplant recipients require life-long profound immunosuppression, making them prone to respiratory tract infections (RTIs), in particular viral infections, during the winter season. Since RTIs may have severe consequences, of which acute or chronic allograft dysfunction is feared most, early diagnosis and treatment are recommended. Patients monitor lung function daily at home and are instructed to contact the transplant center in case of signs and symptoms suspicious of RTIs. We then obtain nasopharyngeal swabs for viral and bacteriological examination and initiate pre-emptive treatment with antivirals, broadband antibiotics, and sometimes intravenous immunoglobulins. Treatment duration is guided by virology sampling results. As preventive measures, we provide vaccination against seasonal influenza for patients and household contacts and recommend specific daily hygiene measures.

Abstract | Full Text PDF

Akciðer kanseri, lenfoma, meme kanseri, kemik iliði transplantasyonu, ösefagus kanseri gibi hastalýklarýn tedavisi için uygulanan radyoterapi (RT), akciðerlerin radyasyona maruz kalmasýna neden olmaktadýr. Akciðerin iyonizan radyasyona oldukça duyarlý olmasý nedeniyle RT sonrasý radyasyonun indüklediði akciðer hastalýklarý sýk görülür.
Bu makalede RT’ye sekonder akciðer hastalýklarý, bu hastalýklarýn taný ve tedavisi literatür bilgileri eþliðinde irdelenmiþtir.

Radiotherapy (RT), used for the treatment of cancers, such as lung cancer, lymphoma, breast cancer, bone marrow transplantation, and esophageal cancer, causes the exposure of lungs to radiation. Since the lungs are very sensitive to ionizing radiation, radiation-induced lung diseases due to radiation therapy are usually common. In this article, lung diseases secondary to RT and the diagnosis and treatment of these diseases were evaluated in light of the literature.

Abstract | Full Text PDF

Amaç: Bu çalýþmada kronik obstrüktif akciðer hastalarýnda (KOAH), görsel amfizem skoru ile deðerlendirilen amfizemin yaygýnlýðý ile akciðer fonksiyonlarýnýn deðiþik indeksleri ve hastalarýn hayat kaliteleri arasýndaki iliþki araþtýrýldý.
Yöntemler: Seksen-iki KOAH hastasýna yüksek rezolusyonlu bilgisayarlý tomografi (YRBT) çekildi, amfizemin ciddiyeti ve yaygýnlýðýnýn hesaplanmasýnda görsel amfizem skoru kullanýldý. Tüm hastalar deðerlendirme esnasýnda stabildi. Tüm hastalarýn ayrýntýlý hikayeleri ve semptomlarý kaydedildi, saðlýk iliþkili hayat kaliteleri ve solunum fonksiyon testleri ölçüldü.
Bulgular: Tüm hastalarýn görsel amfizem skoru ortalamasý 2.10±1.26 idi. GOLD (Global Initiative for Chronic Obstructive Lung Disease) evre 3 olan hastalarda ortalama amfizem skoru 2.88±1.01 iken GOLD evre 2 hastalarýnda 1.54±1.13 idi (p<0.001). Pulmoner amfizem skoru ile sigara paket-yýl arasýnda anlamlý bir korelasyon vardý (r=0.58, p<0.001). Görsel amfizem skorunun, FEV1 (r=-0.56, p<0.0001), FVC (r=-0.38, p=0.001), FEV1/FVC (r=-0.43, p<0.001), PEF (r= -0.44, p<0,001) ve karbon monoksit difüzyon kapasitesi (DLCO) (r=-0.50, p<0.001) ile ters yönde korelasyonu vardý. Amfizem skoru ile SGRQ arasýnda bir korelasyon saptanmadý.
Sonuç: Bu veriler deðiþik þiddetdeki stabil KOAH hastalarýnda, YRBT görsel amfizem skorunun hava yolu obstrüksiyonunun fonksiyonel indeksleri ve azalmýþ akciðer difüzyon kapasitesi ile arasýnda bir korelasyon olduðunu ve pulmoner amfizem varlýðýnýn en iyi FEV1 and DLCO ile gösterildiðini ileri sürmektedir.

Objective: A study was undertaken to investigate whether the extent of emphysema, visually confirmed by high-resolution computed tomography (HRCT), in patients with COPD was associated with different indices of lung function and health-related life quality of patients with COPD.
Methods: Eighty-two patients with COPD underwent HRCT scanning; visual assessment of HRCT scan was used in the calculation of the assessment of the severity and extent of emphysematous destruction. The patients were clinically stable at the time of the evaluation. For all subjects, a detailed interview of disease history and symptoms, health-related quality of life (HRQL) measurement, and pulmonary function tests were performed.
Results: The mean visual emphysema score in all patients was 2.10±1.26. While the mean emphysema score in patients with COPD GOLD (Global Initiative for Chronic Obstructive Lung Disease) stage 3 was 2.88±1.01, it was 1.54±1.13 in patients with COPD GOLD stage 2 (p<0.001). There was a significant correlation between the percentage of pulmonary emphysema and the numbers of pack-years smoked (r=0.58, p<0.001). The visual emphysema score was inversely correlated with FEV1 (r=-0.56, p<0.0001), FVC (r=-0.38, p<0.001), FEV1/FVC (r=-0.43, p<0.001), PEF (r=-0.44, p<0,001) and with carbon monoxide diffusion capacity (DLCO) (r=-0.50, p<0.001). There was no correlation between emphysema score and SGRQ.
Conclusion: These data suggest that HRCT visual scores correlate with functional indices of airflow obstruction and impaired lung diffusing capacity in patients with stable chronic obstructive pulmonary disease of varying severity, and the presence of pulmonary emphysema is best represented by FEV1 and DLCO

Abstract | Full Text PDF

Amaç: Bu makalede, pulmoner metastazektomilerin saðkalýma olan katkýsý ve saðkalýma etki eden diðer prognostik faktörler araþtýrýldý.
Yöntemler: Ocak 2000 - Ocak 2012 tarihleri arasýnda 126 hastaya 148 pulmoner metastazektomi uygulandý. Hastalarýn 78’i erkek, 48’u kadýn olup ortalama yaþ 32 idi. Hastalar yaþ, cinsiyet, primer tümör histolojisi, lezyon sayýsý, ameliyat teknikleri, komplet ve inkomplet rezeksiyon sayýlarý, mediasten lenf nodu tutulumu, hastalýksýz yaþam süreleri ve ek tedavi yönünden incelendi. Prognostik faktörlerin iki ve beþ yýllýk saðkalým üzerine etkileri deðerlendirildi.
Bulgular: Hastalarýn çoðunluðu (%84) asemptomatik idi. 126 hastaya 148 cerrahi giriþim uygulandý. Olgularýn 63’unde (%50) sarkom, 58’inde (%46) epitelyal tümör ve 5’inde (%4) melanom metastazý saptandý ve tümünde komplet (R0) rezeksiyon gerçekleþtirildi. Ameliyat sonrasý ortalama hastanede kalýþ süresi 5,4 (2-8) gün, morbidite oraný %6,3, mortalite oraný %1,6 idi. Epitelyal tümörler, sarkomlar ve melanomlar için ortanca sürvi 42, 27 ve 11 ay (p=0,029); hastalýksýz yaþam süreleri ise 32, 21 ve 7 ay olarak saptandý (p<0,001). Soliter metastazlý hastalarýn ortanca sürvisi 30 ay iken, 2-3 metastatik lezyon bulunanlarýn 18 ay, 4 ve daha fazla metastaz mevcut hastalarýn ise 15 ay olarak bulunmuþtur (p=0,012). Primer malignite tanýsý ile metastaz ortaya çýkýþý arasýndaki hastalýksýz geçen süre 12 aydan kýsa olanlar hastalarýn, 12 aydan daha sonra metastaz ortaya çýkan hastalara göre sürvilerinin anlamlý olarak daha düþük olduðu da gözlenmiþtir (16/30 ay, p=0,003). Mediastinal lenf nodu tutulumu da, baðýmsýz bir kötü prognostik faktör olarak bulunmuþtur (p=0,044).
Sonuç: Pulmoner metastazlarýn cerrahi rezeksiyonu güvenli ve efektif bir tedavi þeklidir. Tümörlerin histopatolojisi, hastalýksýz yaþam süresi, metastaz sayýsý ve mediastinal lenf nodu tutulumu önemli prognostik göstergeler olarak bulunmuþtur

Objective: Evaluating the benefits of metastasectomy and the possible prognostic factors associated with overall survival after surgical treatment.
Methods: Between January 2000 and January 2012, 148 pulmonary metastasectomy operations were performed on 126 patients (78 males, 48 females), with a median age of 32. Data were examined retrospectively for age, gender, primary tumor histology, number of lesions, operative techniques, resection margins, mediastinal lymph node involvement, time to metastasis, and additional therapies. Effects of possible prognostic factors on 2-year and 5-year survival were then evaluated.
Results: Most patients (84%) were asymptomatic; 126 patients underwent 148 metastasectomy operations. Definitive pathology revealed sarcoma in 63 (50%), epithelial tumor in 58 (46%), and melanoma in 5 (4%). Complete resection (R0) was achieved in all patients. Average postoperative hospital length of stay was 5.4 (range: 2-8) days. Morbidity was 6.3%, and 30-day mortality was 1.6%. Median overall survivals were found to be 42, 27, and 11 months (p=0.029), with median disease-free intervals of 32, 21, and 7 months for epithelial tumors, sarcomas, and melanomas, respectively (p<0.001). The median survival of patients with single, 2 to 3, and 4+ metastatic nodules was 30, 18, and 15 months, respectively (p=0.012). Median survival of patients with a disease-free interval of less than 12 months was 16 versus 30 months in those with an interval of more than 12 months (p=0.003). Additional mediastinal lymph node involvement was directly correlated with a worse outcome (p=0.044).
Conclusion: Pulmonary metastasectomy is a safe and effective choice of treatment. Univariate analyses verified that histopathology of the tumor, disease-free interval, number of metastatic lesions, and lymph node involvement were significant prognostic factors in patients undergoing pulmonary metastasectomy.
Objective: Evaluating the benefits of metastasectomy and the possible prognostic factors associated with overall survival after surgical treatment.
Methods: Between January 2000 and January 2012, 148 pulmonary metastasectomy operations were performed on 126 patients(78 male, 48 female), with median age of 32. Data were examined retrospectively for age, gender, primary tumor histology, number of lesions, operative techniques, resection margins, mediastinal lymph node involvement, time-to-metastasis, and additional therapies. Effects of possible prognostic factors on 2-year and 5-year survivals are then evaluated.
Results: Most patients (84%) were asymptomatic. 126 patients underwent 148 metastasectomy operations. Definitive pathology revealed sarcoma in 63 (50%), epithelial tumor in 58 (46%) and melanoma in 5 (4%). Complete resection (R0) was achieved in all. Average postoperative hospital length-of-stay was 5.4 (range: 2-8) days. Morbidity was 6.3% and 30-day mortality was 1.6%. Median overall survivals were found to be 42, 27 and 11 months (P=0.029); with median disease-free intervals of 32, 21, and 7 months for epithelial tumors, sarcomas, and melanomas, respectively (P<0.001). Median survivals of patients with single, 2 to 3, and 4+ metastatic nodules were 30, 18 and 15 months, respectively (P=0.012). Median survivals of patients with disease-free interval of less than 12 months were 16 vs. 30 months of those with an interval more than 12 months (P=0.003). Additional mediastinal lymph node involvement was directly correlated with worse outcome (P=0.044).
Conclusion: Pulmonary metastasectomy is a safe and effective choice of treatment. Univariate analyses verified the histopathology of tumor, disease-free interval, number of metastatic lesions, and lymph node involvement were significant prognostic factors in patients undergoing pulmonary metastasectomy.

Abstract | Full Text PDF

Amaç: Kronik obstrüktif akciðer hastalýðýnda (KOAH) yýlda en az 2 hastane yatýþý “sýk yatýþ” olarak tanýmlanmaktadýr. Ancak, klinik pratiðimizde bazý hastalarýn 2-3 ay aralýklarla tekrarlayan yatýþlarýna tanýk oluyoruz. Çalýþmamýzda, sýk yatýþa neden olabileceðini düþündüðümüz faktörler seçilmiþ bir hasta grubunda araþtýrýlmýþtýr.
Yöntemler: Çalýþmaya yýlda en az 2 hastane yatýþý olan 34 KOAH hastasý alýndý. Tüm olgularýn demografik özellikleri, laboratuvar bulgularý, fiziksel aktivite skorlarý, komorbiditeleri ve solunum fonksiyonlarý kaydedildi, transtorasik ekokardiyografileri ve fiberoptik bronkoskopileri (FOB) yapýldý. Olgular, yýlda 2 yatýþý olanlar (Grup 1) ve 2’den fazla yatýþý olanlar (Grup 2) olmak üzere iki gruba ayrýldý. Gruplar, yatýþ sýklýðýný arttýrdýðý düþünülen parametreler açýsýndan karþýlaþtýrýldý.
Bulgular: Hastalarýn 28’i erkek (%82), yaþ ortalamasý 65±8 (46-82) ve ortalama yatýþ sayýsý 3,3±1,3 (2-6) idi. Grup 1’de 12, Grup 2’de 22 hasta vardý. Grup 2’de ileri yaþ, düþük fiziksel aktivite, ileri evrede bulunma, 10 yýldan uzun süreli hastalýk, evde nebulizatör ve oksijen kullanýmý Grup 1’e göre anlamlý yüksek bulundu. Grup 2 hastalarýn ortalama FEV1 (% beklenen) düzeyi %47,9 iken Grup 1’de %56 idi (p=0,003). Komorbidite sayýsý Grup 1’de ortalama 1,5, Grup 2’de 2,7 (p=0,014) bulundu. Pulmoner hipertansiyon (n=11) ve kalp yetmezliði (n=10) sadece Grup 2 hastalarýnda saptandý (p=0,003, p=0,006). Fiberoptik bronkoskopide 17 (%50) hastada aþýrý dinamik hava yolu kollapsý (ADHK) saptandý, bunlarýn 16’sý (%94) Grup 2’de idi. Lojistik regresyon analizinde, ADHK varlýðý ve FEV1 (%beklenen) düþüklüðü yatýþ sayýsýný etkileyen baðýmsýz faktörler olarak saptandý.
Sonuç: Sýk hastane yatýþý olan KOAH olgularýnda, ADHK varlýðý ve FEV1 düþüklüðünün yatýþ sýklýðýný daha da arttýrabileceði ortaya konulmuþtur.

Objective: Frequent hospitalizations in chronic obstructive pulmonary disease (COPD) patiens is defined as 2 or more hospitalizations per year. However, in our clinical practice we observe hospitalizations with 2-3 months intervals in some patients. In this study, we investigated the factors suspected to be related to more frequent hospitalizations in a selected patient population.
Methods: Thirty-four COPD patients hospitalized at least twice per year were included in the study. Patients’ demographics, laboratory findings, physical activity scores, comorbidities and pulmonary function tests were recorded; transthoracic echocardiography and fiberoptic bronchoscopy (FOB) were performed. Patients were categorised into two groups as: Groups were compared in terms of parameters which are thought to increase the frequency of hospitalization.
Results: Twenty eight (82%) of the patients were male. The mean age was 65±8(46-82 years), mean hospitalization number was 3.3±1.3 (2-6). Twelve patients were in Group 1, 22 in Group 2. Older age, lower physical activity, advanced stage, longer duration of the disease, using nebulisator and home-oxygen were significantly higher in Group 2. FEV1 (pred%) was significantly lower in Group 2 (47.9%) than Group 1 (56%). The comorbididities were significantly higher in Group 2 (p=0.014). Pulmonary hypertension (n=11) and heart failure (n=10) were detected only in Group 2 (p=0.003, p=0.006). FOB revealed excessive dynamic airway collapse (EDAC) in 17 (50%) patients; and 16 of them (94%) were in Group 2. Existence of EDAC and lower FEV1 value were found to be independent factors for more frequent hospitalizations.
Conclusion: It is revealed that the presence of EDAC and decrease in FEV1 can increase the frequency of hospitalization in frequently hospitalized COPD patients.

Abstract | Full Text PDF

Amaç: Sigara içen saðlýk çalýþanlarýnda “Tütün Ürünlerinin Zararlarýnýn Önlenmesi ve Kontrolü Hakkýnda Kanun” sonrasý yaklaþýmlarýný deðerlendirmek, kanundan sonra sigara ile ilgili davranýþ deðiþikliklerini incelemek ve deðiþiklikler ile iliþkili faktörleri belirlemektir.
Yöntemler: Çalýþma popülasyonunu, Çorum ilindeki devlet hastaneleri, 112 acil servisinde çalýþan ve sigara içicisi olan 1.096 saðlýk çalýþaný oluþturmuþtur. Anket formlarý katýlýmcýlara elden ulaþtýrýldý. Anket, demografik veriler, sigara içme alýþkanlýklarý ve sigara yasaðý ile iliþkili 32 kapalý uçlu sorudan oluþturuldu. Veriler, katýlýmcýlarýn kendilerinin doldurduðu anket ile elde edildi. Verilerin istatiksel analizi SPSS 16.0 programý ile yapýldý.
Bulgular: Anketi cevaplandýrma oraný %47,7 idi. Katýlýmcýlarýn %85’i yasa hakkýnda olumlu görüþ bildirdi. Sosyodemografik verilerden sadece saðlýk sektöründeki çalýþma yýlýnda artýþ, olumsuz görüþle iliþkili bulundu. Ýçilen yýl sayýsý, paket-yýlý ve baðýmlýlýk seviyesi arttýkça yasaya olumlu bakýþ azalýyordu. Dýþarýda sigara içmeye utananlar, daha önce býrakmayý denemiþ olanlar ve çocuklarýn yanýnda sigara içmeyenler daha çok olumlu görüþ bildirdi.
Sonuç: Sigara içen saðlýk çalýþanlarýnýn sigara yasaðýna yaklaþýmlarý toplum ile benzerdir. Tütün mücadelesindeki rolleri “rol modeli olma sorumluluðu” ile baþlayan saðlýk çalýþanlarý, sigara kontrol programlarýnda öncelikli olarak ve bütüncül yaklaþýmla ele alýnmalýdýr.

Objective: To evaluate approaches of active smoker health care workers to the Law on Prevention of Harmful Effects of Tobacco and Tobacco Products, to determine smoking behaviour changes and factors associated with this changes after the law.
Methods: Study population established by 1096 active smoker health care workers that was working at state hospitals and 112 emergency department in Çorum. Questionnaires were delivered by hand to the participants. The survey was created from 32 closed-ended questions associated with demographic findings, smoking habbits and smoking ban. Data were obtained through questionaires filled out by participants. Statistical Package for SPSS 16.0 was used for analysis.
Results: Response rate was 47.7%. Eighty five percent of the participants had a positive opinion toward the ban. In sociodemographic characteristics only number of years of service in healthcare was associated with the opinion toward the ban. Years smoked, pack-years and addiction level were associated with a negative opinion toward the ban. Participants who were annoyed to smoke outdoors, who had tried to quit, and who do not smoke in the same envorinment with children tended to express a positive opinion.
Conclusion: Approaches of active smoker health care workers to the smoking ban is similar to society. Health professionals whose role in the fight against tobacco is started by “the responsibility of being a role model” should be taken to smoking control programs as a priority and with a holistic approach.

Abstract | Full Text PDF

Amaç: Kronik obstrüktif akciðer hastalýðý (KOAH) ciddi ekonomik yükü olan sýk görülen bir saðlýk sorunudur. Çalýþmamýzda, hastaneye yatýrýlmayý gerektiren KOAH alevlenmelerinin maliyetine etki eden klinik faktörleri belirlemeyi amaçladýk.
Yöntemler: Çalýþmamýza KOAH alevlenme nedeniyle hastaneye yatýrýlan 241 olgu dahil edildi. Hastane kayýtlarýnýn retrospektif olarak incelenmesi ile veriler elde edildi.
Bulgular: Olgularýn ortalama hastanede kalýþ süresi 9.6+4.6 gündü. Toplam maliyet ortalama 1103.2±557.3 Türk Lirasý (TL) idi. Cinsiyete göre hastanede kalýþ süresi ve toplam maliyet deðerlendirildiðinde, erkek ve kadýn olgularýn hastanede kalýþ süresi ve toplam maliyeti açýsýndan anlamlý fark izlenmedi ( sýrasýyla p=0.78 ve p=0.28). 65 yaþ üzeri olgular deðerlendirildiðinde hastanede kalýþ süresi ve toplam maliyet açýsýndan diðer olgularla aralarýnda anlamlý fark olmadýðý görüldü (sýrasýyla, p =0.77 ve p=0.92). Komorbite varlýðýnda olgularýn toplam maliyetlerinin anlamlý olarak arttýðý gözlendi (p= 0.008). Maliyet bileþenleri incelendiðinde toplam ilaç ve antibiyotik maliyetleri ile genel laboratuvar maliyetlerinin komorbiditesi olan olgularda daha yüksek olduðu görüldü (p=0.02, p=0.003 ve p<0.001). Hastanede kalýþ süresinin komorbidite varlýðýnda arttýðý gözlendi, ancak istatistiksel olarak anlamlý deðildi (p=0.09). Komorbidite sayýsý arttýkça hastanede kalýþ süresinin ve toplam saðlýk maliyetlerinin anlamlý arttýðý gözlendi (p=0.02 ve p=0.008). Olgularýn sosyal güvence tiplerinin toplam maliyet ve hastanede kalýþ süresine etkisi görülmedi (p=0.16 ve p=0.21)
Sonuç: KOAH alevlenmelerinde komorbidite varlýðýnýn hastanede kalýþ süresi ve direkt maliyet miktarlarýný anlamlý olarak arttýrdýðý görülürken, cinsiyet, yaþ ve sosyal güvence tipinin herhangi bir etkisi gözlenmedi.

Objective: Chronic obstructive pulmonary disease (COPD) is a major public health problem with severe economic consequences. In this study, we tried to estimate the clinical factors affecting the economic cost of COPD exacerbations requiring hospitalization.
Methods: A total of 241 patients who were hospitalized due to COPD exacerbations were included in the study. Data were examined retrospectively using hospital charts.
Results: The average length of the hospital stay of the patients was 9.6±4.6 days. The average total direct cost for hospitalization was 1103.2±557.3 Turkish Lira (TL). The length of hospital stay or total costs were not different between male and female patients (respectively, p=0.78 and p=0.28) or between patients above 65 years old and others (respectively, p =0.77 and p=0.92). Presence of comorbidities increased total costs significantly (p=0.008). The total costs of medications and antibiotic costs, together with laboratory costs, were significantly higher in patients with comorbidities (p=0.02, p=0.003, and p<0.001). Length of hospital stay also tended to be higher in patients with comorbidities, but it was not statistically significant (p=0.09). Total costs and length of hospital stay tended to increase as the number of comorbidities increased (p=0.02 and p=0.008). Type of social insurance did not affect total costs or length of hospital stay (p= 0.16 and p=0.21).
Conclusion: Length of hospital stay and direct costs of hospitalized COPD exacerbations significantly increased in the presence of comorbidities, while age, sex, and type of insurance did not have any significant effects.

Abstract | Full Text PDF

Amaç: Ýtfaiyeciler, yangýna müdahaleleri sýrasýnda, dumana maruz kalýrlar. Yangýn dumaný, birçok hava kirleticilerini içerir. Duman maruziyeti, pulmoner ve kardiyovasküler hastalýk riskini artýrabilmektedir. Bu çalýþmanýn amacý, çalýþan itfaiyecilerde, uzun dönem mesleksel duman inhalasyonunun solunum fonksiyonlarý üzerine etkisinin ve iliþkili risk faktörlerinin araþtýrýlmasýdýr.
Yöntemler: Ankara Numune Eðitim ve Araþtýrma Hastanesi’ne Þubat 2012-Mart 2012 tarihlerinde tarama programý kapsamýnda baþvuran, çalýþan 523 itfaiyeci retrospektif olarak deðerlendirilmiþtir. Yangýnda aktif olarak çalýþan 250 kiþi, kontrol grubu olarak da masabaþýnda çalýþan 273 kiþi çalýþmaya alýnmýþtýr. Ýtfaiyecilerin yaþ, cinsiyet, boy, kilo, spirometrik (FEV1, FVC, FEV1/FVC, PEF, FEF25- 75) ölçümleri, sigara içme durumlarý ve süreleri, meslekte çalýþtýklarý süre, komorbiditeleri deðerlendirilmiþtir.
Bulgular: Çalýþmadan elde edilen verilere göre, aktif olarak yangýna katýlan itfaiyecilerde, düþük riskli gruba göre FEV1 deðerlerinde anlamlý olarak azalma saptanmýþtýr. Çalýþma süresinin solunum fonksiyonlarýný anlamlý olarak etkilemediði görülmüþtür.
Sonuç: Aktif çalýþan itfaiyecilerde, duman maruziyetine baðlý olarak solunum fonksiyonlarýnda azalma görülmüþtür. Ýtfaiyecilerde duman maruziyetine baðlý hastalýklarýn geliþimi, solunum yollarýný koruyacak daha efektif aparatlarýn geliþtirilmesi, farklý yangýn tiplerinde döngülü çalýþma, sigara býraktýrma ve düzenli yýllýk taramalarla önlenebilir.

Objective: During interventions, firemen are exposed to fire smoke. Fire smoke contains many air pollutants. Smoke exposure may increase the risk of pulmonary and cardiovascular diseases. The aim of this study was to evaluate the effect of long-term occupational smoke inhalation on respiratory functions and related risk factors in working firemen.
Methods: Between February and March 2012, 523 working firemen were retrospectively evaluated within the scope of a screening program in Ankara Numune Training and Research Hospital. The study included 250 firemen actively participating in a fire and a control group of 273 firemen working in the office. Detailed evaluation of the firemen included age, gender, height, weight, spirometric measurements (FEV1, FVC, FEV1/FVC, PEF, FEF25-75), smoking status and duration, duration of work, and comorbidities.
Results: According to the results obtained from the study, FEV1 values were significantly decreased in firemen actively participating in firefýghts compared to the low-risk group. The duration of the study did not significantly affect pulmonary functions.
Conclusion: Respiratory functions decrease in active working firefighters. Development of diseases related to exposure to smoke may be prevented by the development of more effective apparatus protecting from smoke, working in cycles in different fire types, quitting smoking, and regular annual screenings.

Abstract | Full Text PDF

Mukormikozis; Zygomycetes sýnýfý mantarlarýn neden olduðu, özellikle immün yetmezliði olan hastalarda ortaya çýkan, nadir fakat sýklýkla ölümcül seyreden fýrsatçý bir mantar enfeksiyonudur. Enfeksiyona genellikle sporlarýn inhalasyonu neden olduðundan en sýk paranazal sinüsler ve akciðerler etkilenir. En sýk altta yatan hastalýklar diyabetes mellitus ve hematolojik malignitelerdir. Sýklýkla bakteriyel pnömoni gibi baþlamaktadýr, klinik ve radyolojik bulgularý nonspesifiktir. Bu nedenle mukormikozis tanýsý için yüksek þüphe indeksi gereklidir. Tedavide, kombine medikal ve cerrahi tedavi yöntemleri önerilmektedir. Biz de endobronþiyal tutulumla seyreden pulmoner mukormikozis olgusunu sunmayý amaçladýk.

Mucormycosis is a rare but usually fatal opportunistic infection caused by fungi in the class of Zygomycetes and expecially seen in patients with diabetes mellitus and hematologic malignancies. Since the infection is usually caused by inhalation of spores, the paranasal sinuses and lungs are most commonly affected. Diabetes mellitus and hematologic malignancies are most common underlying diseases. Infection usually initiates like bacterial pnuemonia and clinic, radiologic findings are nonspesific. Because of these high index of suspicion is necessary to diagnose mucormycosis. Combined medical and surgical treatment modalities are recommended. We aimed to present a case of pulmonary mucormycosis presenting with endobronchial involvement.

Abstract | Full Text PDF

Mukopolisakkaridoz tip IVA (Morquio sendromu); otozomal resesif geçiþli, lizozomal depo bozukluðu ile giden N-asetil galaktozamin 6 sülfataz (GALNS) gen defekti olan multisistemik bir hastalýktýr. GALNS eksikliðine baðlý kondroitin 6 sülfat ve keratan sülfatýn dokularda birikimi görülür.
Bu makalede, torakal deformiteye ve inspiratuar kas güçsüzlüðüne baðlý tip 2 solunum yetmezliði, pulmoner hipertansiyon ve üst hava yollarýnda yaygýn mukopolisakkarid birikimine baðlý olarak ortaya çýkan obstrüksiyon neticesinde obstrüktif uyku apne sendromu (OUAS) görülen, noninvaziv mekanik ventilasyon ile baþarýlý þekilde tedavi ettiðimiz Morquio sendromlu bir olguyu literatür eþliðinde sunduk.

Mucopolysaccharidosis type IVA (Morquio syndrome) is a multisystemic autosomal recessive transitive disease induced by an N- acetylgalactosamine 6 sulfatase (GALNS) gene defect, progressing with lysosomal stock failure. The accumulation of chondroitin 6 sulfate and keratin sulfate is observed in the tissues due to GALNS deficiency. We presented a case in which Morquio syndrome was successfully treated with noninvasive mechanical ventilation in accordance with the literature. The case had obstructive sleep apnea syndrome (OSAS) induced by an obstruction that emerged as a result of type 2 respiratory insufficiency resulting from throcal deformity, inspiratory muscle weakness, pulmonary hypertension, and the accumulation of diffuse mucopolysaccharide in the upper respiratory tract.

Abstract | Full Text PDF

Toraks içi organlara ya da toraks duvarýna uygulanan radyoterapi sonrasýnda radyasyona baðlý akciðer hastalýklarý sýk görülür. Radyasyona baðlý geliþen hasarlar arasýnda buzlu cam opasitesi, konsolidasyon, fibrozis, traksiyon bronþektazisi ve volüm kaybý yer alýr. Nadir olarak plevral sývý ya da yeniden kitle oluþumu görülebilir. Elli üç yaþýndaki erkek olguda, toraksýn bilgisayarlý tomografisinde sað akciðer apeksinde 66x61 mm boyutlarýnda, trakea, özefagus ve sað subklaviyen arteri invaze eden solid lezyon saptanmýþ ve uygulanan eþ zamanlý haftalýk kemoterapi ve konformal radyoterapi sonrasýnda lezyonun hýzlýca yok olup yerini tamamen kaviter lezyona býraktýðý izlenmiþtir. Literatürde nadir rastlanmasý nedeniyel bu olgu sunulmuþtur.

Radiation-induced lung diseases are common after radiotherapy of the chest wall or intrathoracic organs. The damage of radiations is ground-glass opacity, consolidation, fibrosis, traction bronchiectasis, and volume loss. Development of pleural fluid or a new mass is rarely seen. A solid lesion was detected in the computed thoracic tomography of 53 year-old male patient. The lesion was at the apex of the right lung, 66x61 mm in size and invading the trachea, esophagus and right subclavian artery. Weekly chemotherapy and radiotherapy were applied concurrently, and the tumor was quickly disappeared, leaving its place to an unexpected cavitary lesion. The case has been reported because of its rarity in the literature

Abstract | Full Text PDF

Lenfanjiyoleyomiyomatozis (LAM) nadir görülen bir interstisyel akciðer hastalýðýdýr. Hastalar genellikle nefes darlýðý ve spontan pnömotoraks ile kliniðe baþvururlar. Bugün için LAM’da etkinliði ispatlanmýþ bir medikal tedavi yöntemi olmamakla beraber, progesteron klinik pratikte yaygýn kullanýlan ilaçlardan biridir. Bu sunumda tekrarlayan pnömotorakslarla seyreden bir LAM olgusunda yaklaþýk 1 yýllýk progesteron tedavisinin etkisi deðerlendirilmiþtir.

Lymphangioleiomyomatosis (LAM) is a rare interstitial lung disease. Patients with LAM usually present with progressive dyspnea and spontaneous pneumothorax. Although there is no sufficient evidence to support the routine use of any treatment in LAM, progesterone is one of the widely used drugs. This report evaluates the effect of one year progesterone treatment in a patient with LAM presenting with recurrent pneumothorax.

Abstract | Full Text PDF

Abstract | Full Text PDF

Abstract | Full Text PDF

Abstract | Full Text PDF

Abstract | Full Text PDF