Tüberküloz, tüm dünyada HIV’den sonra ikinci sýklýkla ölüme neden olan enfeksiyon hastalýðýdýr. Dünya Saðlýk Örgütü’nün (DSÖ) 2013 yýlýnda yayýnladýðý Tüberküloz Kontrol Raporuna göre, 2012 yýlýnda tüm dünyada yaklaþýk 2,5 milyon yeni olgu yayma pozitif akciðer tüberkülozu ve 1,9 milyon yeni olgu yayma negatif akciðer tüberkülozu (YNAT) hastasý vardýr. Akciðer tüberkülozunda yayma negatifliði sýk karþýlaþýlan bir klinik problemdir. YNAT tanýsý, mikrobiyolojik olarak doðrulanamadýðýnda klinisyenler için zordur. YNAT hastalarýnda, kültür sonuçlarý henüz sonuçlanmadýðýnda hastaya antitüberküloz tedavi baþlayýp baþlamama kararý çok önemlidir. YNAT tanýsý için yeni tanýsal metodlara ihtiyaç vardýr. Mikrobiyolojik ve serolojik yeni taný yöntemlerinin geliþtirilmesinin yanýnda, ülkemizdeki YNAT hastalarýnýn klinik ve radyolojik bulgularýný içeren, klinik tahmin skor sistemleri ve algoritmalarý oluþturulmalýdýr.

Tuberculosis (TB) is the second leading cause of death from an infectious disease worldwide, after the human immunodeficiency virus. There are almost 2.5 million new smear-positive pulmonary TB cases and 1.9 million new smear-negative pulmonary TB cases in 2013 according to the World Health Organization (WHO) Global Tuberculosis Report 2013. Smear negativity in pulmonary TB is a common clinical problem. Clinicians have difficulty in diagnosing smear-negative pulmonary TB without bacteriological confirmation. It is very important to decide whether or not to treat a patient with smear negative PTB when the culture results are pending. New diagnostic methods are required for the diagnosis of smear-negative pulmonary TB. In addition to the development of new microbiological and serological diagnostic tests, clinical prediction scoring systems and algorithms including clinical and radiological findings of smear-negative pulmonary TB patients in our country, should be established to facilitate the diagnosis of smear-negative pulmonary TB.

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Elektronik sigara, toplum saðlýðýný tehdit eden bir salgýn gibi yayýlmaktadýr. Son bir yýl içerisinde hem yetiþkinlerde hem de çocuklarda elektronik sigara kullanýmý 2 kat artmýþtýr ve týpký 1950 ve 1960’lardaki sigara reklamlarý gibi, televizyon, radyo, internet, dergiler ve her türlü reklam araçlarýnda e-sigara reklamlarý yer almakta ve mücadele edilmesi gereken çok ciddi bir saðlýk tehdidi olarak algýlanmasý gerekmektedir. Bu derlemenin amacý e-sigaranýn saðlýk üzerine etkilerinin bilimsel kanýtlar ile gözler önüne serilmesidir.

Electronic cigarette (e-cigarette) is spreading like an epidemic that threatens the public health. Last one year, e-cigarette use increased by 2 times in both adults and children, and just as the cigarette ads of 1950s and 1960s, e-cigarette ads are taking place in the television, radio, internet, magazines and in the all kinds of advertising media. E-sigara should be recognized as a serious health threat, and should be fought against it. The aim of this review is to show the effects of e-cigarette on health by the scientific evidences.

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Amaç: Türkiye Solunum Araþtýrmalarý Derneði Diffüz Parankimal Akciðer Hastalýklarý-Pulmoner Vasküler Hastalýklar Çalýþma Grubu(TÜSAD DPAH-PVH ÇG) olarak ülkemizdeki göðüs hastalýklarý ve cerrahisi hekimlerinin Ýdyopatik Pulmonary Fibrosis’li (ÝPF ) hastalara yaklaþýmýný bir anket ile ortaya koymayý amaçladýk.
Yöntem: ÝPF hastalarýnda taný ve tedaviye yaklaþýmýna ve çalýþtýklarý birimin özelliklerini deðerlendirmeye yönelik 24 soru içeren web tabanlý anket hazýrlandý. Ankete katýlým için hazýrlanan ve anket linkini içeren davet mektubu, Göðüs hastalýklarý, Göðüs cerrahisi uzmanlarýnýn mail gruplarýna gönderildi. Ankete katýlan hekimlerin verdiði yanýtlar deðerlendirildi. Bulgular: Katýlýmcýlarýn %30,6’sý yýlda 5’den az ÝPF hastasý, %16,8’i 21’den fazla ÝPF hastasý görüyordu. Katýlýmcýlarýn %66,3’ü ÝPF tanýsý için anamnez, semptom ve klinik bulgular ile birlikte tipik radyolojik bulgularýn olmasýnýn taný için yeterli olacaðýný, %27,7’si ise klinik ve radyolojik bulgularýn yaný sýra patolojik bulgularýnýn da IPF ile uyumlu olmasý gerektiðini belirttiler. ÝPF tanýsý için doku örneði alma konusunda kullanýlan yöntemlere bakýldýðýnda; bronkoskopik transbronþiyal biyopsi, torakoskopik biyopsi ve açýk akciðer biyopsi uygulama tercihlerinin hemen hemen ayný oranda olduðunu gözlemlendi.ÝPF düþünülen hastalarýn taný aþamasýnda en çok tereddütte düþülen alanlar sýrasýyla alýnan biyopsilerin patolojik deðerlendirilmesi (% 73,2) ve radyolojik bulgularýn yorumlanmasý (% 49,5) ile ilgili sorunlardý.ÝPF tanýsý konulan hastalarýn %37,6’sý deneyimli merkeze yönlendirilirken; medikal tedavi ve ilaçsýz takip de sýrasýyla %33,6 ve % 14,8 olarak saptandý. Katýlýmcýlarýn %29,7’si her zaman, %48,5’i ise bazen hastalarýna akciðer transplantasyonu önermekteydi. Sonuç: Çalýþmamýzýn sonuçlarýnýn bir kýsmý ÝPF kýlavuzlarý ile uyumlu olmakla birlikte, bu konudaki tartýþma ve kafa karýþýklýklarýnýn da halen devam ettiðini gösterecek niteliktedir.

Objective: As Turkish Respiratory Society Diffuse Parenchymal Lung Diseases-Pulmonary Vascular Diseases Study Group (TRS DPLD-PVD SG), we aimed to demonstrate the approaches of physicians with a questionnaire toward the patients with IPF in our country.

Methods: An invitation letter including a questionnaire with 24 questions to assess the approaches they prefer in the patients with IPF and the capabilities of the departments they work at and a link for the questionnaire was directed to the mail groups of chest diseases and thoracic surgery specialists. Responses of the physicians who participated in the questionnaire were reviewed.

Results: Thirty percent of the participants saw less than 5 patients with IPF in a year and 16.8% of them saw more than 21. 66.3% of participants stated that anamnesis, symptoms and clinical findings along with typical radiologic findings would be sufficient for the diagnosis, while 27.7% suggested that pathological findings should indicate IPF along with clinic and radiologic ones.When the methods used for tissue sampling were viewed; application rates of bronchoscopic transbronchial biopsy, thoracoscopic biopsy and open lung biopsy were found very close to one another.In the patients with the suspected disease of IPF, the fields in which the hesitation was the most problematic were respectively pathological examination of biopsies (73.2%) and interpretation of radiologic findings (49.5%). 37.6% of the patients with diagnosis of IPF were directed to experienced centers; medical treatment and drugless follow-up rates were respectively 33.6% and 14.8%. Among the participants, 29.7% suggested lung transplantation for all cases while 48.5% only preferred this operation in particular ones.

Conclusion: Some of the results of our study is compatible with the guidelines of IPF, is to show that the quality of debate and confusion still continued in this regard.

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Amaç: Uykuda hýzlý göz hareketlerinin görüldüðü (Rapid Eye Movement) REM dönemi, faringeal kas aktivitesinin azalarak üst solunum yolu kollapsýnýn belirgin arttýðý, obstrüktif solunumsal olaylarýn sýklýðý ve süresinin arttýðý, oksijen desatürasyonunun daha fazla görüldüðü bir dönemdir. REM iliþkili obstrüktif uyku apne sendromu (obstructive sleep apnea syndrome, OSAS), varlýðý ve tanýmlanmasý konusunda farklý görüþlerin ileri sürüldüðü, kimilerince OSAS’ýn baþlangýç prezentasyonu, kimilerince farklý bir OSAS klinik tipi olarak sýnýflandýrýlmaktadýr. Bu çalýþmada REM iliþkili olan ve olmayan OSAS’lý olgularýn, klinik ve polisomnografi (PSG) özelliklerinin karþýlaþtýrýlarak, REM iliþkili OSAS’ýn farklý bir OSAS klinik tipi mi, OSAS öncüsü mü olduðu yönünde yargýya varýlmasý amaçlanmýþtýr.
Yöntemler: Çalýþma retrospektif olarak yapýldý. Uykuda solunum bozukluðu ön tanýsý ile PSG yapýlan, apne-hipopne indeksi (AHÝ) ≥ 5 tespit edilerek OSAS tanýsý konulan olgular iki gruba ayrýldý: AHÝNREM < 5 olmak üzere, AHÝREM / AHÝNREM >2 olan ve en az 30 dakika süreyle REM kaydý elde edilen olgular ‘‘REM iliþkili OSAS’’, bu tanýma uymayanlar ‘‘REM iliþkili olmayan OSAS’’ olarak sýnýflandýrýldý.
Bulgular: Yaþ ortalamasý 51 ± 10 yýl olan 329 olgu çalýþmaya alýndý. Olgularýn 35 (%10.6)’i REM iliþkili, 294 (%89.4)’ü REM iliþkili olmayan gruptaydý. Yaþ, beden kitle indeksi, sigara öyküsü, ek hastalýklar açýsýndan gruplar benzerdi (p>0.05). REM iliþkili olgularda AHÝ daha düþük, REM, NREM Evre 3 süresi daha uzun, ortalama oksijen saturasyonu daha yüksekti (p<0.05).
Sonuç: Çalýþmamýzda gruplarýn yaþ, beden kitle indeksi, ek hastalýk görülme oranýnýn benzer tespit edilmesi; REM iliþkili OSAS’ýn, OSAS’ýn erken dönemi veya öncüsü olmaktan çok, farklý bir OSAS klinik tipi olduðunu düþündürmektedir.

Objective: Rapid Eye Movement (REM) is an entity in which collapsibility of upper respiratory tract increases. Different opinions have been proposed definition of REM-related obstructive sleep apnea syndrome (OSAS). Some authors classify REM-related OSAS as the first presentation or others as a different clinical type of OSAS. We aimed to compare clinical and polysomnographic findings of REM-related and non REM-related OSAS patients to test whether REM-related OSAS is a different clinical type OSAS or manifestation of early stage or onset of OSAS.
Methods: The study had a retrospective design. Patients with initial diagnosis of sleep related breathing disorders, were later diagnosed as OSAS based on apnea-hypopnea index (AHI) ≥ 5, and divided into two groups: Patients with AHINREM < 5 and, AHIREM / AHINREM >2 whose REM recordings were obtained for at least 30 minutes were defined as “REM-related OSAS”, and those who refute this description as “non REM-related OSAS.”
Results: A total of 329 cases with a mean age of 51 ± 10 years were included in the study. Thirty-five (10.6 %) cases of OSAS were REM-related, 294 (89.4 %) of them were non REM-related. Age, body mass index, smoking status, and concomitant diseases were comparable between groups (p>0.05). In REM related cases AHI were lower, duration of REM was longer, and mean oxygen saturations were comparatively higher (p<0.05).
Conclusion: Similarities between groups as for age, body mass index, concomitant disease suggest that REM-related OSAS is a different clinical type of OSAS, rather than early phase of OSAS.

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AMAÇ: Günümüzde astým ve kronik obstrüktif hava yolu hastalýklarýnýn tedavisinde inhalasyon teknikleri önemli yer tutmaktadýr. Ýnhalasyon tedavilerinin optimal terapötik etkinliði için inhalasyon cihazlarýnýn doðru uygulanmasý önemlidir. Ýnhaler tedavi alan hastalara birden fazla vizitte inhalasyon teknikleri gösterilmesi cihaz kullaným hatalarýný azaltmaktadýr. Hastalarýn en sýk baþvurduklarý birinci basamak saðlýk kuruluþlarýnda eksikliklerinin ve hatalarýnýn gözlemlenmesi önemlidir. Çalýþmamýzda bu kurumlarda çalýþan aile hekimlerinin inhaler cihazlarýnýn kullanýmý ile ilgili bilgilerini deðerlendirmeyi amaçladýk.
METOD: Birinci basamak saðlýk kuruluþlarýnda çalýþan aile hekimleri yüz yüze ziyaret edildi. Ziyaret günü kurumunda bulunan ve çalýþmaya katýlmayý kabul eden 50 aile hekimi çalýþmaya alýndý. Her aile hekimi için öncelikle 15 sorudan oluþan anket formu dolduruldu. Sonrasýnda yedi farklý inhalasyon cihazýnýn kullaným teknikleri 10 basamakta 10 puan üzerinden deðerlendirildi.
BULGULAR: Çalýþmaya katýlan aile hekimlerinin 28’i (%56) kadýn, 22’si (%44) erkekti. Yaþ ortalamalarý 36,3±6,7 yýl idi ve aile hekimi olarak çalýþma süreleri ortalama 5,12±2,8 yýldý. On dokuz aile hekimi daha önce inhaler cihaz eðitimi verilen bir toplantýya katýlmýþtý. Ortalama inhaler cihazlarý kullaným beceri skorlarý sýrasýyla ölçülü doz inhalerde 7,96±2,91, diskusda 7,54±3,93, handihalerde 7,28±4,04, aerolizerde 6,38±4,4, turbuhalerde 6,12±4,22, easyhalerde 5,98±4, sanohalerde 5,72±4,59 olarak bulundu.
SONUÇ: Hasta uyumu ve tedavi baþarýsýný artýrmak için aile hekimlerine inhaler cihaz eðitimi verilmesi gerektiðini düþünmekteyiz.

Objective: Nowadays, inhalation techniques have an important role in treatment of asthma and chronic obstructive pulmonary disease (COPD). Correct application of inhalation devices is important for optimal therapeutic efficacy. Showing inhalation techniques to patients receiving inhaler therapy in more than one visit reduce the device usage errors. It is important to observe the deficiencies and errors of the patients in the primary health care where the patients frequently admitted. In our study we aimed to evaluate the knowledge of family physians on inhaler device usage in their clinical practice.

Methods: Family physicians who work in primary health care services were visited face to face. Fifty family physicians who were in the institution at visit day and agreed to participate in the study were included in the study. The questionnaire consisting of 15 questions were asked each family physician. Then, seven different inhalation devices were evaluated with 10 step scoring system of inhaler device usage.

Results: Twenty eight (56%) physicians were female and 22 (44%) were male. The mean age was 36.3±6.7 years and mean working time as a family physician was 5.12±2.8 years. Nineteen physicians participated to a meeting about usage of inhaler devices in the past. Average scores for inhaler devices were found 7.96±2.91 for metered-dose inhaler, 7.54±3.93 for discus, 7.28±4.04 for handihaler, 6.38±4.4 for aerolizer, 6.12±4.22 for turbuhaler, 5.98±4 for easyhaler and 5.72±4.59 for sanohaler, respectively. There was no relation between the inhaler devices usage scores and sex, age, duration of being family physician (p>0.05). The average scores of physicians who participated to a training were better than the physicians who didn’t participate for metered-dose inhalers, turbuhaler, aerolizer and handihaler (p=0.049, p=0.05, p=0.013 and p=0.021, respectively).

Conclusion: We thought that training of family physicians for inhaler devices is necessary to improve patients’ compliance and successful treatment.

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Amaç: Pulmoner hamartom tanýlý olgularýn klinik, radyolojik, bronkoskopik ve terapötik özelliklerini araþtýrmak
Yöntem: Ocak 2007- Mayýs2012 tarihleri arasýnda taný konulan pulmoner hamartom olgularý geriye dönük olarak deðerlendirildi.
Bulgular: Pulmoner hamartomlu 13 olgunun yedisi erkek, altýsý kadýndý (erkek: kadýn oraný 1.2: 1). Hastalarýn yaþý 45 ile 68 yýl arasýnda deðiþiyordu. Üç olgu yakýnmasýzdý. Yakýnmalarýn süresi 1 hafta ile 2 yýl arasýnda deðiþiyordu. Akciðer grafisi tüm olgularda patolojik idi. Lezyon 9 olguda sað akciðerde lokalize olup alt lob sýklýðý mevcuttu. Dört olgu (% 30.8) endobronþiyal tip hamartoma sahipti. Tedavi yöntemi beþ olguda wedge rezeksiyon, dört olguda enükleasyon, üç olguda bronkoskopik yöntemler ve bir olguda lobektomi idi. Ýzlem süresi bir ay ile 54 ay arasýnda deðiþiyordu. Takip süresince nüks saptanmadý.
Sonuç: Pulmoner hamartomlar akciðerin yaygýn görülmeyen benign tümörleridir. Bu tümörler parankimal ve endobronþiyal lokalizasyon gösterebilirler. Pulmoner hamartomlarýn tedavisinde wedge rezeksiyon, enükleasyon ve bronkoskopik prosedürler gibi parankim koruyucu yöntemler seçilmelidir.

Objectives: To analyze clinical, radiographic, bronchoscopic, and therapeutic characteristics of a series of patients in whom pulmonary hamartoma had been diagnosed.
Methods: Retrospective review of cases of pulmonary hamartomas diagnosed by biopsy between January 2007 and May 2012 in a tertiary referral hospital in Istanbul, Turkey.
Results: Of the 13 patients with histologically confirmed pulmonary hamartoma, seven were men and six were women (approximately a 1.2: 1 sex ratio). Their age ranged from 45 to 68 years old. Three patients were asymptomatic. The duration of symptoms ranged from one week to two years. Chest radiograph findings were abnormal in all patients. The lesions were located in the right lung in nine cases, with lower lobe predilection. Among the patients with pulmonary hamartoma, four (30.8 %) had endobronchial hamartoma. Treatment modality was wedge resection in five cases, enucleation in four cases, bronchoscopic procedure in three cases and lobectomy in one case. Follow-up ranged from one month to 54 months. No tumor recurrence was encountered in the follow-up period.
Conclusions: Pulmonary hamartomas are uncommon benign lesions of the lung. They can be parenchymal or endobronchial in location. Parenchyma sparing surgical procedures such as wedge resection or enucleation and bronchoscopic intervention should be preferred in the treatment of pulmonary hamartomas.

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Amaç: Ýstanbul’da bir devlet lisesinde okuyan öðrencilerin sigara içme alýþkanlýklarý, nedenleri ve sigaranýn zararlarý ile ilgili bilgi düzeylerini deðerlendirmeyi amaçladýk.
Yöntemler: Ýstanbul Anadolu yakasýnda bir devlet lisesinde okuyan öðrencilere sigara ile ilgili tutum ve davranýþlarý deðerlendiren 15 soruluk bir anket uygulandý.Anketler tüm okula sýnýflarda,ayný ders saati içersinde, öðretmenler gözetiminde dolduruldu. Anketler daha sonra toplanarak deðerlendirmeye alýndý.
Bulgular: Anket sorularýmýz, ilgili okulda 415 öðrenci tarafýndan yanýtlandý. Öðrencilerin 263’ü(%63.3) kýz,152’si(%36.3) erkekti. 415 öðrencinin 349’u(%84) hiç sigara içmemiþken, 66 öðrenci(%15.9) sigara içen ve /veya sigara içip býrakmýþtý. Öðrencilerin 55’i(% 13.2) aktif sigara içmekteydi.Sigara içme nedenlerine bakýldýðýnda % 63.6’sý arkadaþlarý içtiði için, % 47.2’si sýnav stresi nedeniyle, % 40’ý ise aile içi sorunlarý nedeniyle içtiðini ifade etti. Sigara içen grupta arakadaþlarýnýn sigara içme oraný içmeyen gruba göre anlamlý olarak yüksek saptandý(p=0.0001).
Öðrencilerin sigaranýn zararlarý ile ilgili soruya doðru yanýt verme oranlarý %59 olarak saptandý.Sigara içen öðrencilerin %56.3’ü sigarayý býrakmayý düþünürken % 43.7’si sigarayý býrakmayý düþünmüyordu.Logistik regresyon analizi sonucunda arkadaþlarýnýn sigara içiyor olmasýnýn içmeyenlere göre sigara içme riskini yaklaþýk 8 kat artýrdýðý tespit edilmiþtir.
Sonuç: Ýlgili okulda sigara içme nedenleri arasýnda en sýk saptananlar;arkadaþlarýnýn sigara içmesi, sýnav stresi ve aile içi sorunlardý. Sigaranýn zarar verdiði sistemleri irdeleyen soruda öðrencilerin bilgi eksikliði olduðu saptandý.Arkadaþlarýnýn sigara içmesi sigara içme riskini 8 kat artýrmaktaydý. Bu bilgiler ýþýðýnda ilgili okulda, eðitim planlamasýnda sigaraya daha fazla yer verilmesinin uygun olacaðý kanaatindeyiz. Ayrýca rehberlik hizmetlerinin öðrencilerin aile içi sorunlarý ve sýnav stresleri ile daha yakýndan ilgilenmesi ve bu sorunlarla baþ etme konusunda yardýmcý olmalarý öðrencilerin zararlý maddelere yönelmesine engel olabilir kanaatindeyiz.

Objective: We aimed to evaluate smoking habits of students, reasons of smoking and students’ level of knowledge on the adverse effects of smoking in a state high school in Ýstanbul.
Methods: A 15-item questionnaire was administered to the students attending a state high school in Ýstanbul to evaluate their attitudes and behaviors towards cigarette smoking. The questionnaire was completed by each class of students at the same class period under the supervision of their teachers.
Results: The questionnaire was completed by 415 students at the respective school. While 349 students (84%) never smoke, 66 (15.9%) students were either current smokers or quitters. Fifty five of the students (13.2%) were active smokers. When we looked at the reasons of smoking, they reported that 63.6% smoked cigarettes because their friends did; 47.2% smoked cigarettes due to exam-related stress; and 40% smoked cigarettes due to family problems. The rate of smoking friends in the smoker group was significantly higher than in the non-smoker group (p=0.0001). A logistic regression analysis showed that having smoking friends was associated with an 8-fold increase in the risk of smoking compared to having no smoking friends.
Conclusion: The most common reasons of smoking at the school were friends who were smokers, exam-related stress and family problems. Having friends who smoke was associated with an 8-fold increase in the risk of smoking. We believe that counselling services’ close engagement with family problems of students and exam-related stress issues and helping them to cope with these problems may prevent their vulnerability to toxic substances.

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Amaç: Yabancý cisim aspirasyonu tespit edilen çocuklarýn, demografik ve klinik özelliklerinin belirlenmesi, ebeveyn eðitim düzeyleri ve gelir seviyesi ile olan iliþkilerinin deðerlendirilmesi planlanmýþtýr.
Yöntemler: Çalýþmamýzda, Necmettin Erbakan Üniversitesi Meram Týp Fakültesi Çocuk Göðüs Hastalýklarý bölümüne aspirasyon nedeniyle baþvuran ve yabancý cisim çýkartýlan 17 hasta çocuðun retrospektif verileri ile ayný yaþ ve cinsiyet daðýlýmýna uyan 60 saðlýklý çocuðun demografik özellikleri deðerlendirildi.
Bulgular: Hastalarýn yaþ ortalamasý 14,9±4,8 ay olup, hastalardan 9’u (%53) erkekti. En sýk baþvuru þikayeti ani baþlayan öksürük (%76,5) ve hýþýltý (%64,7) iken, çekirdek (%47) en sýk tespit edilen yabancý cisim oldu. Radyolojik incelemede en sýk bulgu havalanma farký (%76,5) iken, cisimler en sýk sað ana bronþtan (%47) çýkarýldý. Hasta grubunda bir evde 5 ve üstünde kiþi yaþama yüzdesi %76,5 iken, kontrol grubunda %46,6 idi (p=0,008). Hasta grubunun gelir düzeyi kontrol grubuna göre belirgin olarak düþüktü (p=0,02). Lise ve/veya üniversite eðitimi almamýþ anne oraný (%94,1), kontrol grubundaki annelere oranla (%63,3) daha yüksekti (p=0,03).
Sonuç: Bir çocukta ani baþlayan öksürük ve hýþýltý geliþtiði durumlarda yabancý cisim aspirayonu akla gelmelidir. Düþük gelir, kalabalýk aile ortamý ve annenin düþük eðitim düzeyi yabancý cisim aspirasyonu açýsýndan önemli risk faktörleri arasýnda deðerlendirilmelidir.

Objective: To evaluate the determination of demographic and clinical characteristics and the roles of parental education and income levels in foreign body aspirations in childhood.
Methods: Seventeen patients who admitted to the Necmettin Erbakan University Meram Faculty of Medicine, Department of Pediatric Pulmonology for foreign body aspirations and from whom the body is taken out were evaluated retrospectively, and compared with the demographic features of 60 matched healthy children with the same age and gender.
Results: The mean age of the patients was 14.9±4.8 months, and of the patients 9 (53%) were males. The most common symptoms at admission were sudden onset of cough (76.5%) and wheezing (64.7%), while sunflower peel (47%) was the most commonly detected foreign body. Difference in lung aeration was the most common finding (76.5%) in radiological imagings, and foreign bodies were mostly removed from right bronchus (47%). While 76.5% of the patients had 5 or more households, this ratio was 46.6% in control group (p=0.008). Income level of patient group was significantly lower compared to control group (p=0.02). The rate of mothers who did not have high school and/or university education was higher (94.1%) than the control group (63.3%) (p=0.02).
Conclusion: Foreign body aspiration should be the first reason to be thought when there is a sudden onset of cough and wheezing in a child. Low socioeconomic level, to be in a crowded family and low education level of the mother should be evaluated among risk factors for foreign body aspirations.

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Günümüzde kozmetik ve rekonstrüktif amaçla yaygýn olarak kullanýlan silikon meme implantlarýnýn halsizlik, kas aðrýsý, dispne gibi non-spesifik semptomlarla iliþkili olduðu bilinmektedir. Ýmplantlar yabancý cisim reaksiyonuna sebep olarak otoimmün ve konnektif doku hastalýklarýna sebep olabilmektedir. Hastalarýn semptomlarý implantýn çýkarýlmasýndan sonra iyileþmektedir. Burada egzersiz dispnesi ile baþvuran bir kadýn hasta sunuldu. Olgu 48 yaþýnda kadýn hasta olup belirgin atopi hikayesi mevcut idi. Solunum fonksiyon testlerinde obstruksiyon ve reversibilite saptanmadý. Hastanýn ileri tetkikleri sonucunda meme implant rüptürü saptandý. Hastanýn solunumsal semptomlarý rüptüre olmuþ meme implantýnýn çýkarýlmasý sonucu iyileþti.

We present a case of a 48-year-old woman with a significant history of atopy. She presented with a 1-month history of dyspnea on exertion. Pulmonary function testing was normal, with no obstruction or reversibility post-bronchodilation. Bilateral breast implant rupture was detected on further investigation for a left upper lobe nodule, and the patient underwent bilateral implant removal. There was an improvement in her respiratory symptoms. Systemic symptoms, labeled as “Autoimmune/Inflammatory Syndrome Induced by Adjuvants,” are known to be associated with breast implants, with 14% of women in a cohort developing autoimmune disease secondary to their implants. An improvement in symptoms has been demonstrated following breast implant removal.

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Entübasyona baðlý trakeal laserasyon nadir görülmekle birlikte mortalitesi yüksek bir komplikasyondur. Seksen bir yaþýnda bayan hasta solunum sýkýntýsý ve ateþ nedeni ile acil polikliniðimize baþvurdu. Pnömonisi olan ve solunum yetmezliði saptanan hasta noninvaziv mekanik ventilasyon (NIV)desteðine alýndý. NIV uygulamasý altýnda genel durumu kötüleþen, bilinci kapanan hasta entübe edilerek solunum yoðun bakým ünitesine alýndý. Yoðun bakým ünitesinde mekanik ventilasyon desteðindeki hastada cilt altý amfizemi geliþti. Endotrakeal tüp içerisinden yapýlan fiberoptik bronkoskopisinde trakeada 5 cm uzunluðunda laserasyon olduðu gözlendi. Acil rijit bronkoskopiye alýnan hastaya bir silikon düz ve bir metalik, karinal bacaklý trakeal stent yerleþtirilerek laserasyon alaný örtüldü. Takiplerinde cilt altý amfizemi kaybolan hasta olaðan weaning periyodunun ardýndan servise taburcu edildi.

Tracheal laceration causing elective intubation is a rarely seen complication with a high mortality. An eighty-one years old female applied to emergency room due to fever and respiratory distress. It has been stated the diagnosis of pneumonia and respiratory insufficiency and the non-invasive mechanical ventilation with mask has been performed. However, the respiratory failure has progressed and lost her consciousness. She was intubated and accepted to respiratory intensive care unit. After mechanical ventilation support it has been noticed subcutaneous emphysema and flexible fiberoptic bronchoscopy has been done via endotracheal tube. A 5cm long tracheal laceration has been revealed in lower part of trachea. The urgent rigid bronchoscopy has been performed and one silicone straight stent and a covered metallic bifurcated stent have been inserted. The araea of laceration has been covered totally. The subcutaneous emphysema disappeared incrementally and after weaning period the patient discharged to the ward.

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Liposarkomalar (LPS) mezenkimal neoplazmalar arasýnda tüm sarkomlarýn yaklaþýk olarak %15’ini ve primer mediastinal tümörlerinde %6’sýný oluþturmaktadýrlar. Liposarkomalar genellikle alt extremite ve retroperitoneumda bulunurlar, ayrýca abdomen, vulva ve kalça bölgesinde de raporlanmýþtýr. Bununla birlikte anterior mediastende primer liposarkom vakalarý oldukça seyrek olarak karþýmýza çýkmaktadýr. Biz buradaki mevcut makalemizde anterior mediastende yerleþmiþ hýzla ilerleyen ve metastazlarla seyreden primer miksoid liposarkoma olgusunu sunduk.

Liposarcomas (LPS) account for approximately 15% of all sarcomas among the mesenchymal neoplasms and 6% of primary mediastinal tumors. LPS, usually found in the lower extremities or retroperitoneum, have also been reported in the abdomen, vulva, and buttocks. However, primary LPS of the anterior mediastinum is extremely rare. In this paper, we present a case with a fast progressing metastatic primary myxoid liposarcoma of the anterior mediastinum.

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Pulmoner alveoler proteinozis (PAP), alveollerde ve terminal distal hava yollarýnda amorf, periyodik asit-schiff (PAS) pozitif lipoproteinöz materyal (sürfaktan fosfolipidleri ve protein) birikimi ile karakterize nadir bir diffüz akciðer hastalýðýdýr. Hastalarda en sýk görülen semptomlar; dispne, öksürük ve balgam çýkarmadýr. Yüksek çözünürlüklü bilgisayarlý tomografisinde (YÇBT); düzgün retiküler (septal) kalýnlaþma ile süperimpoze olan buzlu cam opasitelerinin oluþturduðu karakteristik coðrafik patern görülür. Hastalýðýn tanýsý için bronkoskopi ile bronkoalveoler lavaj (BAL) ve/veya transbronþiyal biyopsi yapýlmaktadýr. BAL’ýn tipik opak veya süt benzeri görünümü vardýr ve sitolojik incelemesinde; PAS-pozitif materyal içeren alveoler makrofajlar ve aselüler amorf eozinofilik PAS-pozitif materyal görülür. Herhangi bir yakýnmasý olmayan hastada tarama amaçlý çekilen akciðer grafisinde her iki akciðer üst zonlarda yamalý dansiteler izlenmesi üzerine yapýlan incelemeler ile PAP tanýsý konan bir olguyu sunduk.

Pulmonary alveolar proteinosis (PAP), is a rare diffuse lung disease characterized by the accumulation of amorphous, periodic acid-Schiff (PAS) lipoproteinaceous material (surfactant phospholipids and proteins) in the distal terminal airways and alveoli. Dyspnea, cough and sputum production are the most common symptoms in patients. High resolution computed tomography (HRCT) reveals the characteristic geographic pattern consisting of ground-glass opacities superimposed with smoothly thickened reticular (septal) lines. Bronchoalveolar lavage (BAL) and/or transbronchial biopsy with bronchoscopy is performed for the diagnosis. Opaque or milky appearance of BAL is typical and alveolar macrophages containing PAS-positive material and acellular amorphous eosinophilic PAS-positive material is observed with cytological examination of BAL. We presented a case without any sypmtoms who was diagnosed as PAP with diagnostic examinations because of both upper lung zone patchy densities on chest X-ray taken for screening.

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