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Transtorasik ultrasonografi (US) solunum hastalýklarý, acil ve yoðun bakým doktorlarý için vazgeçilmez bir araç haline gelmiþtir. Torasik patolojilerin geniþ bir yelpazede deðerlendirilmesinde bir yöntem olarak temel ekipman ve asgari eðitimli personel ile yapýlabilmektedir. Avantajlarý arasýnda bakým noktasýnda acil uygulama, düþük maliyet ve radyasyonsuz olmasý bulunmaktadýr. Transtorasik US’nin baþlýca endikasyonlarý; plevral efüzyon, plevral kalýnlaþma, diyafragma patolojisi yaný sýra göðüs duvarý ve plevra tümörlerinin kalitatif ve kantitatif deðerlendirilmesidir. Transtorasik US ayrýca pulmoner ödem dahil olmak üzere pnömonik konsolidasyon ve interstisyel sendromlar gibi plevraya bitiþik pulmoner patolojileri görselleþtirmede yararlýdýr. Transtorasik US pnömotoraks saptanmasýnda geleneksel akciðer grafisinden daha duyarlýdýr ve kaburga kýrýklarý gibi iskelet anormalliklerini teþhis etmede yararlýdýr. Torasentez ve plevra biyopsisi dahil transtorasik prosedürlere rehberlik etmede ideal bir araçtýr. Dahasý, transtorasik US rehberliðindeki prosedürler, sedasyon olmaksýzýn ve minimal izleme ile birlikte, tek bir klinisyen tarafýndan yapýlabilir. Göðüs duvarý, plevra, periferik akciðer ve mediastenden kaynaklanan ekstratorasik lenf nodlarý ve lezyonlarýnýn transtorasik US rehberliðinde ince iðne aspirasyonu ve/veya kesici iðne biyopsisi yapýlmasý güvenlidir ve deneyimli klinisyenlerin ellerinde yüksek verim saðlar. Transtorasik US ayný zamanda yaygýn pulmoner infiltrasyonlar, konsolidasyonlar ve akciðer abselerinin biyopsi ve aspirasyonunda potansiyel olarak rehberlik edebilir. Dahasý, transtorasik US pulmoner embolinin saptanmasýnda kullanýlabilmektedir.

Transthoracic ultrasonography (US) has become an essential tool for respiratory, emergency and critical care physicians. As a modality for the evaluation of a wide range of thoracic pathologies it can be performed with basic equipment and by personnel with minimum training. Its advantages include immediate application at the point-of-care, low cost and lack of radiation. The main indications for transthoracic US are the qualitative and quantitative assessment of pleural effusions, pleural thickening, diaphragmatic pathology, as well as chest wall and pleural tumours. US is also useful in visualising pulmonary pathologies that abut the pleura, such as pneumonic consolidation and the interstitial syndromes including pulmonary oedema. Transthoracic US is more sensitive than the traditional chest radiograph in the detection of pneumothoraces, and is useful in diagnosing skeletal abnormalities like rib fractures. It is the ideal tool to guide transthoracic procedures, including thoracocentesis and pleural biopsy. Moreover, US-guided procedures can be performed by a single clinician with no sedation and minimal monitoring. US-guided fine needle aspiration and/or cutting needle biopsy of extrathoracic lymph nodes, and lesions arising from the chest wall, pleura, peripheral lung and mediastinum are safe and have a high yield in the of hands of experienced clinicians. US can potentially also guide aspiration and biopsy of diffuse pulmonary infiltrates, consolidations and lung abscesses. Moreover, transthoracic US may be used in the detection of pulmonary embolism.

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Amaç: Malign plevral efüzyon, neoplastik hastalýklarda en sýk karþýlaþýlan klinik problemlerden biridir. Optimum tedavi yoktur.
Yöntemler: Bu yazýda malign plevral efüzyonlarýn cerrahi tedavisi konusunda en son makaleler gözden geçirildi. Plöredez teknikleri karþýlaþtýrýldý. Kalýcý kateter ve plöroperitoneal þant uygulamasý ve ileri cerrahi teknikler açýklandý.
Bulgular: Plöredez halen ilk tedavi seçeneði olsa da, kalýcý kateter uygulamasý özellikle tuzak akciðerli hastalarda ve plöredezin baþarýlý olmadýðý hastalarda giderek daha çok kabul görmeye baþladý. Plevrektomi, dekortikasyon, ektraplevral pnömonektomi gibi majör cerrahiler günümüzde sitoredüktif cerrahi olarak tanýmlanmakta ve bu cerrahiler uygulandýðýnda ek tedaviye ihtiyaç duyulmaktadýr.
Sonuç: Malign plevral efüzyon tedavisini geliþtirmek için yeni tedavi modaliteleri gerekmektedir.

Malignant pleural effusion is one of the most common clinical problems in neoplastic diseases. There is no optimum treatment available. Pleurodesis is the most frequent method used for the treatment of malignant pleural effusion. However, in cases where pleurodesis failed more invasive procedures such as permanent catheter application, pleurectomy, decortication and extrapleural pneumonectomy can be used. In this paper, surgical treatment of malignant pleural effusion, were evaluated by reviewing the most recent articles.

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Amaç: Toplumda geliþen pnömonide kullanýlan üç ciddiyet belirleme sisteminin, CURB-65, Pnömoni ciddiyet indeksi ve SMART-COP, 30 günlük mortalite ve yoðun solunum ve vazopressör destek gereksiniminin belirlenmesindeki verimlerinin karþýlaþtýrýlmasý amaçlanmýþtýr.
Yöntemler: Toplumda geliþen pnömoni tanýsý almýþ 84 olgu çalýþmaya alýndý ve 30 gün boyunca takip edildi. Skorlar baþvuru anýnda hesaplandý ve 30 günlük mortalite ve yoðun solunum ve vazopressör destek gereksinimiyle iliþkilendirildi.
Bulgular: Ortalama yaþ 58.6±18.7 yýldý. Toplumda geliþen pnömonide 30 günlük mortalite %7.1'di. 84 olgudan 14'ü (%16.7) Yoðun bakýmda takip edildi. CURB-65, PCÝ ve SMART-COP sistemlerinin 30 günlük mortalite ile iliþkili area under curve (AUC) deðerleri sýrasýyla 0.89, 0.89 ve 0.91 olarak; ve yoðun solunum ve vazopressör destek gereksinimi ile iliþkili AUC deðerleri de yine sýrasýyla 0.88, 0.91 ve 0.93 olarak hesaplandý.
Sonuç: Üç sistem de 30 günlük mortaliteyi ve yoðun solunum ve vazopressör destek gereksinimini doðru olarak belirledi ve birbirlerine karþý herhangi bir üstünlük gösteremediler.

Objective: The aim of this study was to compare the ability of CURB-65, pneumonia severity index and SMART-COP systems to predict 30-day mortality and the need for intensive respiratory and vasopressor support (IVRS).

Methods: We included 84 cases with community acquired pneumonia (CAP) and followed up for 30 days. The scores were calculated at admission and associated with the 30-day mortality and the need for intensive respiratory and vasopressor support.

Results: The mean age of patients was 58.6±18.7 years. The 30-day mortality level for CAP was 7.1%. Fourteen of 84 patients (16.7%) with CAP were followed in ICU. The area under curve (AUC) values of the three systems (CURB-65, PSI, and SMART-COP) for 30-day mortality were 0.89, 0.89 and 0.91, respectively, and for the need for IRVS was 0.88, 0.91 and 0.93, respectively.

Conclusion: The three systems accurately detected the need for IRVS and the 30-day mortality, but none individually demonstrated any advantage over the others.

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Giriþ: Çalýþmamýzda; astým ve KOAH’lý hastalarda tedaviyle oluþan tremor, çarpýntý ve kramp yan etkilerinin sýklýðý ile öngörülebilirliði araþtýrýlmýþtýr.
Yöntemler: Hacettepe Üniversitesi Týp Fakültesi Göðüs Hastalýklarý Anabilim Dalý’nda 2007 Þubat ayýnda, polikliniðe baþvuran 299 hastaya tanýlarý, tedavileri ve oluþan yan etkilere ait standart bir anket uygulandý. Hastalar, 15,30 ve 180. günlerde kontrole çaðrýldý veya telefonla durumlarý, yakýnmalarý açýsýndan prospektif olarak izlendi.
Bulgular: Çalýþmamýzda, 38 (%12.7) hastada ilaçla indüklenen tremor vardý. Bu hastalarýn 27 (%71.1) ‘inde astým tanýsý (p=0.004) ve 18 (%47.4)’inde çarpýntý þikayeti mevcuttu. Betamimetik ilaç kullanan hastalarda, hiç ilaç kullanmayanlara göre ilaçla indüklenen tremor riski 15.3 olarak saptandý. Yalnýzca betamimetik kullananlarda kramp oluþma riski artmýþtý. Çalýþmamýzda,32 (%84.2) hastada ilaçla indüklenen tremor 180.günde halen sürmekteydi.
Sonuç: Çalýþmamýzda tremor, kramp ve çarpýntý yan etkilerinin bildirilen oranlardan fazla olduðu görülmüþtür. Yan etkilerin; hastalýðýn kendisi, beta-2-agonistlerin kullanýmýyla direkt iliþkili
olduðu saptanmýþtýr. Literatürde yeralanýn aksine, ilaç yanetkilerine karþý büyük ölçüde tolerans geliþmediði izlendi.

Objective: To evaluate the frequency and predictability of side effects, including tremor, cramp, and palpitation, due to treatment in patients with chronic obstructive pulmonary disease and asthma.
Methods: We prepared a standard questionnaire for 299 patients concerning their diagnosis, treatment, and side effects of the treatment in February 2007 at Hacettepe University, Faculty of Medicine, Department of Pulmonary Diseases. We prospectively examined the clinical status of the patients and side effects of the treatment at the 15th, 30th, and 180th days of the treatment.
Results: In our study, there were 38 (12.7%) patients with drug-induced tremor. Of these, 27 (71.1%) had asthma (p=0.004) and 18 (47.4%) had anamnestic palpitation. Drug-induced tremor risk was 15.3 times higher in patients who used a beta-mimetic compared with those who used any drugs. Cramp risk increased with beta-mimetic use only. In our study, drug-induced tremor was still present at the 180th day of examination in 32 (84.2%) patients.
Conclusion: This study demonstrated that side effects, including tremor, palpitation, and cramp, were more common in our patients compared with those in other studies. These side effects were directly related to the primary disease and the use of beta-2-agonists. Another finding of our study is that tolerance did not develop as much as that reported in literature.

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Eriþkinde Yabancý Cisim Aspirasyonu: 28 Olgunun Analizi

Amac: Bu retrospektif çalýþmada amacýmýz giriþimsel pulmonoloji ünitemizde yabancý cisim aspirasyonu ile ilgili deneyimimizi tartýþmaktýr
Yöntemler: Çalýþmamýza Ocak 2008-Kasim 2014 yýllarý arasýnda giriþimsel pulmonoloji ünitemize yabancý cisim aspirasyonu nedeniyle refere edilerek giriþim uygulanan, yabancý cisim aspirasyonu kesinleþmiþ hastalar dahil edildi. Veriler hasta dosyalar retrospektif incelenerek elde edildi.
Bulgular: 28 hastanýn %64.3’ü kadýn ve yaþ ortalamasý 43.5±21.54 idi. En sýk baþvuru semptomunun öksürük (%96.3) olduðu görüldü. Hastalarýn yarýsý yabancý cisim aspirasyonunun ilk 24 saatinde baþvurdu. Tanýsal amaçlý fleksibl bronkoskopi yapýlan 5 olgunun 3’ünde yabancý cisim fob ile çýkartýldý. Rijit bronkoskopi 25 (%89.3) olguya yapýldý. 3 hastada yabanci cisim bronkoskopi ile saptanmayýp cerrahi ile cikarildi. Cikarilan yabanci cisimlerin %67.9’u inorganik özellikte cisimlerdi..
Sonuç: Eriþkin hastalarda yabancý cisim aspirasyonlarýnýn taný ve tedavisinde bronkoskopik giriþimler mortalite ve morbiditenin azaltýlmasýnda etkindir. Rijit bronkoskopi, yabancý cisim aspirasyonlarýnýn tedavisinde öncelikle tercih edilmelidir. Fakat deneyimli ellerde ve iyi seçilmiþ olgularda fleksibl bronkoskopide yabanci cisim aspirasyonu tedavisinde kullanýlabilir.

Objective: The aim of our study is to discuss our experience with foreign body aspirations in our Interventional Pulmonology Unit.
Methods: Patients who were referred to our Interventional Pulmonology Unit between January 2008 to November 2014 for foreign body aspiration and whom foreign body was sentential by intervention were included. Data were used from a retrospective analysis.
Results: From the 28 patients, 64.3% of them were women and mean age of the patients were 43.5±21.54 years. Most common presenting symptom was cough (96.3%). Half of the patients were presented in 24 hours after the procedure. From the 5 patients that have undergone diagnostic broncoscopy by fiberoptic bronchoscope, foreign body was removed in 3 of them. Rigid bronchoscopy was done in 25 (89.3%) of the patients. In 3 of the patients foreign body cannot be detected by bronchoscopy and removed by surgery. 67.9% of the foreign bodies that were removed were inorganic in nature.
Conclusion: Bronchoscopic approaches are effective to decrease mortality and morbidity for the diagnosis and treatment of foreign body aspirations in adults. Rigid bronchoscopic approach should be the first choice in foreign body aspirations but fiberoptic bronchoscopy can also be used in selective cases by experienced physicians.

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Amaç: Domuz gribi (H1N1) virüs enfeksiyonu olan çocuklarda radyolojik bulgularýn gözden geçirilmesi ve pediatrik yoðun bakým ünitesi ihtiyacýný belirleyen prognostik faktörlerin belirlenmesi amaçlandý.
Gereç ve Yöntem: Laboratuvar verileriyle H1N1 olduðu doðrulanmýþ ortalama yaþý 34 (1-216) ay olan 18 çocuðun (9 erkek, 9 kýz) akciðer akciðer grafisi ve bilgisayarlý tomografi bulgularý geriye dönük olarak deðerlendirildi.
Bulgular: Akciðer grafisi 15 (%83.3), bilgisayarlý tomografi 7 (%38.8) çocuða uygulandý. Anormal bulgular akciðer grafisi çekilenlerin %60’’ýnda, tomografi çekilenlerin %85.7’sinde saptandý. Radyolojik bulgular çoðunlukla difüz, bilateral ve asimetrikti. Buzlu cam görünümü (%66.6) en sýk görülen anormalik olup bunu retikülasyon (%38.8), nodül (%27.7), sadece konsolidasyon (%16.6), tomurcuklanan aðaç paterni (%11.1), buzlucam görünümüyle birlikte konsolidasyon (%5.5) ve septal çizgiler (%5.5) izledi. Lenfadenopati (%22.2), hava hapsi (%5.5), ve parankimal band (%5.5) diðer bulgulardý. Subplevral nodüller, lenfadenopatiler ve bazen buzlu cam görünümünü saptamada akciðer grafisi yetersiz bulundu. Nodül (p=0.04) varlýðýnýn yoðun bakým ihtiyacýný artýrdýðý saptandý
Sonuç: H1N1 enfeksiyonlu çocuklardaki en sýk radyolojik bulgu, bilateral, multifokal konsolidasyon alanlarýnýn eþlik ettiði veya etmediði asimetrik buzlucam görünümüdür. Subplevral nodüller, lenfadenopatiler ve bazen buzlu cam görünümünü saptamada akciðer grafisi yetersiz olmaktadýr. Nodül varlýðý, yoðun bakým ihtiyacýný belirleyen kötü bir prognostik faktördür.

Objective: The aim was to review the radiological findings and to find new prognostic factors that determine the need for pediatric intensive care unit (PICU) in children with swine-origin influenza (H1N1) virus infection.
Methods: Chest X-ray (CXR) and computed tomography (CT) findings of 18 children with laboratory-confirmed H1N1 infection (9 boys, 9 girls) with a median age of 34 (1–216) months were retrospectively evaluated.
Results: CXRs were performed in 15 (83.3%) and thorax CT in 7 (38.8%) children. Abnormal findings were detected in 60% of the patients who underwent CXR and 85.7% of the patients who underwent thorax CT. Radiological findings were mostly diffuse, bilateral, and asymmetric. Ground-glass opacity (GGO) (66.6%) was the leading abnormality and was followed by reticulation (38.8%), nodules (27.7%), consolidation only (16.6%), tree-in-bud pattern (11.1%), consolidation with GGO (5.5%), and septal lines (5.5%). Lymphadenopathy (22.2%), air trapping (5.5%), and parenchymal band (5.5%) were other recorded findings. CXR was found to be insufficient to detect subpleural nodules, lymphadenopathies, and sometimes GGO. Only existence of nodules (p=0.04) affected the need for PICU admission.

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Amaç: Bu çalýþmada 2008 yýlýnda tütün yasasýnýn yürürlüðe girmesinden üç yýl sonra Ankara’nýn kent merkezinde yer alan bir ilçesinde bulunan bazý kafe-restoranlarýn iþletmecileri/çalýþanlarý ile müþterilerinin yasa-uygulanmasýyla ilgili bazý bilgileri, tutum ve davranýþlarýnýn öðrenilmesi amaçlanmýþtýr.
Yöntemler: Tanýmlayýcý tipteki çalýþmada 105 kafe-restoran, 113 iþletmeci/çalýþan ve 386 müþteri ile yüz-yüze veri toplama tekniði ile 2 farklý form kullanýlarak görüþülmüþtür. Bir de iþletme gözlem formu kullanýlmýþtýr. SPSS 15.0 ile ki-kare, t-testi kullanýlmýþtýr. Araþtýrma için idari izin alýnmýþtýr.
Bulgular: Çalýþanlarýn yaþ ortalamasý 30,1±8,32;%82,3’ü erkek, %54,0'ý sigara kullanmakta; müþterilerin yaþ ortalamasý 27,7±8,61; %53,6’sý kadýn ve %39,4'ü sigara kullanmaktadýr. Pasif etkilenimin yol açabileceði sorunlar (p=0,024); sigaranýn ölüme sebep olabileceði konusunda sigara kullanan ve kullanmayan müþterilerin düþünceleri (p<0,001) arasýnda fark vardýr. Sigara kullananlarýn %80,3’ü, kullanmayanlarýn %74,3’ü alkol servisi olan restoranlarda yasak olduðunu belirtmiþtir. Yasanýn sigarayý býrakma konusunda yardýmcý olacaðý görüþüne katýlým sigara içmeyen ve içen çalýþanlar arasýnda; ayrýca sigara içmeyen ve içen müþteriler arasýnda istatistiksel olarak anlamlýdýr (p=0,004;p<0,001). Araþtýrmacýlarýn gözlemlerine dayalý olarak, iþletmelerin %7,6’sýnda yasak ile ilgili levhanýn bulunmadýðý, kullananlar, %12,6’sýnda kül tablasý olduðu saptanmýþtýr.
Sonuç: Tütün baðýmlýlýðý konusu bireysel bir sorun olmakla beraber tütün kullaným sýklýðý bir halk saðlýðý sorunudur. Bireysel yaklaþýmlarýn yanýsýra yasanýn toplumsal düzeyde kabul edilmesi ve uygulamalarýn benimsenmesi gerekmektedir. Sigara içen ve içmeyen bireylerin yasanýn sigara býrakmaya yararlý olacaðý konusunda fikir ayrýlýðý mevcuttur. Tütün kullanýmýnýn ve tütüne baðlý saðlýk sorunlarýnýn azaltýlmasý için kapsamlý tütün kontrolü uygulamalarýnýn denetlenmesi ve kurallara uymasý saðlanmalýdýr.
Anahtar Kelimeler: Ýþletme, Kafe, Restoran, Tütün, Yasa

Objective: This study was conducted in order to evaluate ideas of some cafe and restaurants’ clients and workers about the tobacco control law three years after entering into force in a central district in Ankara in 2008.
Methods: In the descriptive study;105 management, 113 worker and 386 client was visited, face to face interviews were done using two different questionnaire form and another form for managements’ evaluation. SPSS 15.0 statistical package program, Chi-square and t-tests were used. Administrative leave was taken.
Results: Mean age of workers was 30.1±8.32 years; 82.3% were men, 54.0% smoker; with clients the values are 27.7±8.61 years; 53.6% women and 39.4% were smokers. There’s a difference between smokers and non- smokers’ ideas about the hazards; death due to second-hand smoking (p=0.024; p<0.01). 80.3% of smokers and 74.3% of non-smokers knew the law in restaurants serving alcoholic beverages. Acceptance of the idea of the law could help to quit smoking was significantly different between smoker/non smoker workers and smoker/non smoker clients (p=0.004;p<0.001). According to observations, 7.6% of the managements didn’t have law related plaque, 94.1% had smoking free areas, 57.1% had show window, 22.7% had smoking individuals and 12.6% had ashtray.
Conclusion: Tobacco use is an individualistic reality but also a public health issue. Publicly acceptance of 45 law and implementations are needed besides individual perceptions. Implementations must be inspected and Smokers’ observance of the rules must be supplied in order to decrease tobacco use and related health complications.

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Amaç:
Eþ zamanlý kemoradyoterapi planlanan lokal ileri evre küçük hücreli dýþý akciðer kanseri olgularýnda myelosupresyon için risk faktörlerinin saptanmasý.
Yöntemler:
Ocak 2008 ve aralýk 2012 tarihleri arasýnda eþ zamanlý platin içeren kemoterapi ve radyoterapi alan 81 olgunun verileri retrospektif olarak incelendi. Yetmiþ dokuz olgu (%96,2) etoposide (50 mg/m2, intravenöz 1-5, 29-33 cü günler) artý cisplatin (50 mg/m2,1,8,29 ve 36 cü günler) ve 3 olgu (%3,8) docetaxel (20 mg/m2/hafta, 1-8 ci haftalar) artý cisplatin (20 mg/m2/hafta, 1-8 haftalar), toplam doz of 40-66.6 Gy olacak þekilde torasik radyoterapi ile eþ zamanlý uygulandý. Myelosupresyonla ( 3 veya 4’cü derece lökopeni, nötropeni, trombositopeni veya anemi) iliþkili risk faktörleri incelendi.
Bulgular:
3 veya 4’cü derece lökopeni, nötropeni, trombositopeni veya anemi sýrasýyla olgularýn %51,8, %53, 0, %8,6 ve %7,4’ünde geliþti. Çoklu deðiþkenli analizlerde nötropeni için risk faktörlerinin; tedavi öncesi performans durumu (p=0,032), beyazküre deðeri (p=0,023) ve kreatinin seviyesi (p=0,018) olduðu görüldü. Yine çoklu deðiþkenli analizlerde, beyazküre deðerinin (OR, 3,311; p=0,027; 95% CI, 1,148-9,545 ) kemoradyoterapiye baðlý lökopeni için risk faktörü olarak bulundu.
Sonuç:
Tedavi öncesi performans durumu kötü, beyaz küre sayýsý düþük ve kreatinin seviyesi yüksek hastalarda myelospresyon riski yüksektir. Hastalarýn bu özellikleri tedavi kararý verilirken dikkate alýnmalýdýr.

Objective: Concomitant chemoradiotherapy (CRT) is the standard treatment for patients with stage III non-small cell lung cancer (NSCLC). Myelosuppression can be a significant problem in concomitant CRT. The aim of this study was to assess the parameters obtained before concomitant CRT to define the risk factors for myelosuppression in patients with locally advanced NSCLC.
Methods: We retrospectively analyzed 81 patients with NSCLC who received concomitant platinum-based chemoradiotherapy between January 2008 and December 2012. Seventy-eight patients (96.2%) received etoposide (50 mg/m2, intravenously on days 1–5, 29–33) plus cisplatin (50 mg/m2, on days 1, 8, 29, and 36), and 3 patients (3.8%) received docetaxel (20 mg/m2/w, on weeks 1–8) plus cisplatin (20 mg/m2/w, on weeks 1–8) concurrently with thoracic radiotherapy to a total dose of 40–66.6 Gy. The risk factors were examined for their association with myelosupression (grade 3 or 4 leukopenia, neutropenia, thrombocytopenia, or anemia) by logistic regression analysis.
Results: Grade 3 or higher neutropenia, leukopenia, thrombocytopenia, or anemia occurred in 51.8%, 53%, 8.6%, and 7.4% of the patients, respectively. Multivariate analysis revealed that the risk factors for neutropenia were performance status (p=0.032), white blood cell count (p=0.023), and pretreatment creatinine level (p=0.018). On multivariate analysis, white blood cell count (OR, 3.311; p=0.027; 95% CI, 1.148–9.545) was found as significant risk factor for CRT-induced leukopenia
Conclusion: Patients with a poor pretreatment performance status, low white blood cell count, and high creatinine level are at a risk of myelosupression. These characteristics of the patients should be considered while making treatment decisions.

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Multipl primer akciðer kanserleri (MPAK) eþ zamanlý olarak saptandýklarýnda senkron, ilk lezyonun saptanmasýndan belli bir zaman sonra ikinci tümör saptanýyorsa metakron olarak isimlendirilirler. Senkron MPAK’lerin hem primer tümörlerin akciðer metastazlarýndan hem de akciðer dýþý tümörlerin multipl akciðer metastazlarýndan ayýrt edilmesi gerek sað kalým oranlarý gerekse de tedavi seçenekleri açýsýndan önemlidir. Bu çalýþmada kliniðimizde saptanan 3 senkron MPAK olgusunun klinik özellikleri, taný ve tedavi süreçleri incelenmiþtir.

Multiple primary lung cancers (MPLC) are named synchronous if determined simultaneously with the index tumor, and metachronous if the second tumor is diagnosed with an accepted time after the first tumor. It is important for both the rate of survival and treatment alternatives to differentiate synchronous MPLCs from the metastases of the primary lung tumors, and also from the multiple pulmonary metastases of the extra pulmonary tumors. In this study, clinical characteristics, diagnosis and treatment processes of three synchronous MPLC cases diagnosed in our department were assessed.

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Nontüberküloz mikobakteri (NTM) genellikle su ve toprak gibi çevresel kaynaklardan izole edilir. NTM’ye baðlý akciðer hastalýklarý genellikle yapýsal akciðer hastalýklarýnda görülür. Bu çalýþmada NTM akciðer enfeksiyonu olan 5 olgu bildiriyoruz.
Polimeraz Zincir Reaksiyonu (PCR) yöntemi ile, M Abscessus enfeksiyonlu 2, M. Chelonae 1, M. Gordoneae 1, M.Szulgai 1 olgu tanýmladýk. M Abscessus olgularýndan biri agresif tedaviye raðmen eksitus oldu, diðerinde tedavisiz klinik ve radyolojik progresyon gözlenmedi ve yaþadý. Tedavi verilmemesine raðmen M. Chelonae ve M. Gordoneae olgularýnda hastalýk progresyonu gözlenmedi. HRZE tedavisi verilen M.Szulgai olgusunda klinik-radyolojik regresyon görüldü.
NTM’ye baðlý akciðer hastalýklarýnýn doðru taný ve baþarýlý tedavisi için klinik, radyolojik ve mikrobiyolojik bulgularýn bilinmesi önemlidir.

Nontuberculous mycobacteria (NTM) are commonly isolated from environmental sources such as water and soil. Lung disease due to NTM commonly occurs in structural lung disease. Here, we report five cases of NTM. We identified two cases of Mycobacterium abscessus, one of M. chelonae, one of M. gordoneae, and one of M. szulgai by polymerase chain reaction (PCR). One of the patients with M. abscessus, despite aggressive treatment, died, whereas the other was alive and had no clinical and radiological progression without treatment. Without treatment, the progression of disease was not seen in the case of M. chelonae and that of M. gordoneae. Clinicoradiological regression occurred in the case of M. szulgai that was treated with HRZE. For correct diagnosis and the successful treatment of NTM pulmonary disease, knowledge of clinical, radiological, and microbiological findings is important.

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Pulmoner arter agenezisi sol veya sað pulmoner arterin proksimal kýsa segmentinde atrezinin olduðu nadir görülen bir konjenital anomalidir. Tek baþýna olabileceði gibi, Fallot tetralojisi, septal defektler veya pulmoner stenoz gibi kardiyak anomalilerle beraber de olabilir. Sýklýkla çocukluk yaþlarýnda tanýnýrlar ancak geç yetiþkin çaða kadar semptom vermeyebilirler. Biz de kliniðimizde 1998-2010 yýllarý arasýnda pulmoner arter agenezisi taný almýþ 5 vakamýzý retrospektif olarak literatür eþliðinde inceledik.

Pulmonary artery agenesis is a rare congenital abnormality in which atresia was encountered in the short segment of the right or left pulmonary arteries. It can be isolated or associated with cardiac abnormalities such as tetralogy of Fallot, septal defects or pulmonary stenosis. The majority of cases are diagnosed in childhood whereas some cases yield no symptoms until adulthood. We evaluated retrospectively 5 pulmonary artery agenesis cases diagnosed in our clinics between 1998-2010 with respect to the literature.

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Leflunomid (LEF) kullanýmýna baðlý interstisyel akciðer hastalýðý ölümcül olabilen oldukça nadir görülen bir durumdur. Bu yazýda LEF kullanýmýna baðlý interstisyel akciðer hastalýðý geliþen bir olgu sunulmuþtur. Altmýþ-üç yaþýnda, 37 yýldýr romatoid artrit tanýsýyla takipli ve son beþ aydýr LEF tedavisi (20 mg/gün) alan bir bayan hasta öksürük, solunum sýkýntýsý, ateþ ve koyu balgam çýkarma þikayeti ile hastanemize baþvurdu. Çekilen akciðer grafisinde bilateral alveolar konsolidasyon vardý. Yüksek rezolüsyonlu akciðer tomografisinde ise yaygýn buzlu cam görünümü ve interlobüler septal kalýnlaþma mevcuttu. Bu olguda, LEF tedavisinin kesilmesi ve oral steroid tedavisi sonrasýnda klinik ve radyolojik iyileþme görülmesi ile ilaca baðlý interstisyel akciðer hastalýðý tanýsý konuldu.
Sonuç olarak LEF kullanýmý sýrasýnda ortaya çýkan öksürük, solunum sýkýntýsý, ateþ gibi nonspesifik bulgularýn varlýðýnda ilaca baðlý interstisyel akciðer hastalýðý ayýrýcý tanýda dikkate alýnmalýdýr.

Leflunomide (LEF) induced interstitial pneumonitis is a very rare condition but potentially fatal. We report a case of LEF induced interstitial pneumonitis. A 63-year-old woman followed-up for 37 years with the diagnosis of rheumatoid arthritis treated with LEF (20 mg/day) since 5 months were admitted to our hospital with cough, dyspnea, fever, and dark sputum.Chest radiography represented bilateral alveolar consolidation. High-resolution computed tomography demonstrated diffuse ground-glass appearance and interlobular septal thickening. Since the patient’s clinics and radiologic findings improved dramatically after the cessation of LEF and recieving oral steriod therapy, she was diagnosed as drug-induced interstitial lung disease. In conclusion, when nonspecific clinical signs such as respiratory distress, cough and fever seen during the use of LEF, drug-induced interstitial lung disease should be kept in mind for the differantial diagnosis.

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What is your diagnosis

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