Yüksek akým nazal oksijen (HFNO) tedavisinin nazofarengeal direnci azaltmasý, nazofarengeal ölü boþluðu temizlemesi, farinskte pozitif basýnç oluþturmasý, akciðerlerde alveoler rekrutmenti artýrmasý, havayollarýný nemlendirmesi, inspire edilen oksijen fraksiyonunu (FiO2) artýrmasý ve mukosiliyer klerensi iyileþtirmesi gibi konvansiyonel oksijen destek cihazlarýna göre birçok fizyolojik avantajlarý mevcuttur. Son zamanlarda eriþkin kritik hastalarýn tedavisinde HFNO’nun kullanýmý artmýþtýr ve deðiþik hastalýk durumlarýndaki birçok hastada kullanýlmaktadýr. Buna raðmen kritik hastalarda HFNO’nun güvenli ve etkin kullanýmýna dair kabul gören rehberler yoktur. Bu derleme HFNO’nun pozitif fizyolojik etkilerini, etki mekanizmalarýný ve klinik uygulamalarýný mevcut yayýnlanmýþ literatürler eþliðinde özetlemektedir.

High-flow nasal oxygen (HFNO) therapy has several physiological advantages over traditional oxygen therapy devices, including decreased nasopharyngeal resistance, washing out of the nasopharyngeal dead space, generation of positive pressure in the pharynx, increasing alveolar recruitment in the lungs, humidification of the airways, increased fraction of inspired oxygen and improved mucociliary clearance. Recently, the use of HFNO in treating adult critical illness patients has significantly increased, and it is now being used in many patients with a range of different disease conditions. However, there are no established guidelines to direct the safe and effective use of HFNO for critical patients. This review summarizes the positive physiological effects, mechanisms of action, and the clinical applications of HFNO with available published literatures.

Abstract | Full Text PDF

Akciðer nakli son dönem akciðer yetmezliði olan hastalar için geçerli bir tedavi seçeneði olmaktadýr. Ancak bekleme listesindeki hastalardaki artýþa karþýlýk donör havuzu gerektiði kadar artmamaktadýr. Bekleme listesindeki hastalarýn nakil olamadan kaybedilme oraný bekleme listesindeki hastalarýn dörtte birinden fazladýr. Bu problemi çözmek için marjinal kabul edilen donörlerin de kullanýmýný gündeme gelmiþtir ve Ex-vivo akciðer perfüzyonu (EVLP) uygulanmaya baþlanmýþtýr. Bunun yanýsýra akciðer nakilleri iskemi reperfüzyon hasarý baþta olmak üzere pek çok sebepten dolayý halen istenilen baþarý oranlarýnda deðildir. Pek çok merkezde baþarý oranýnýn düþmesine yol açan bu etkenlere yönelik tedavi yöntemleri araþtýrýlmaktadýr. Günümüzde baþta marjinal donörleri nakil öncesi tekrar deðerlendirme amaçlý geliþtirilen EVLP’nin deneysel çalýþmalarda kullanýlmasý gündeme gelmiþtir. Biz de yazýmýz ile deneysel çalýþmalarda EVLP modelini irdelemek istedik.

Lung transplantation is an accepted treatment modality for end-stage lung diseases. However, the donor pool is not getting larger in comparison to the number of patients on the waiting list. Of the patients on the waiting list for lung transplant, more than a quarter dies while waiting. Utilization of marginal donors became an issue, and ex-vivo lung perfusion (EVLP) was started to be performed to solve this problem. Besides that, success in lung transplantation has not reached a satisfactory level for various reasons including ischemia reperfusion injury. Treatment options against these reasons that cause low success of lung transplantations are being investigated by many centers. Nowadays, EVLP that was initially developed to re-evaluate marginal donors has become a method for studies in experimental models. In our article, we want to review EVLP models in experimental studies.

Abstract | Full Text PDF

Amaç: Kronik Obstruktif Akciðer Hastalarýnda (KOAH) akut ataklar ve egzersiz performansý iliþkisi net deðildir. Bu çalýþmada amacýmýz son bir yýlda akut atak ile acil baþvurusu olan ve olmayan KOAH hastalarýnýn egzersiz performanslarýný karþýlaþtýrmak ve acil baþvuru sayýsý ile egzersiz performansý iliþkisini incelemektir.
Yöntem: Çalýþmaya katýlan 206 hastanýn son bir yýldaki acil baþvuru sayýlarý kaydedildi. Altý dakika yürüme testi, modifiye Medical Research Council(mMRC) Dispne Skalasý, Body Pletismograf, Karbonmonoksit diffüzyon testi ve arter kan gaz analizleri yapýldý.
Bulgular: Hastalarýn 127 tanesinde son bir yýlda en az bir kez acil baþvurusu vardý. Bu hastalarda son bir yýlda acil baþvurusu olmayanlara göre egzersiz performansý, dispne, pulmoner fonksiyonlar ve oksijenasyon anlamlý olarak daha kötüydü (p<0.05). Acil baþvuru sayýsý egzersiz performansý, dispne, oksijenasyon, 1. saniyedeki zorlu ekspiratuar volüm, 1. saniyedeki zorlu ekspiratuar volümün zorlu vital kapasiteye oraný ve karbonmonoksit difüzyon kapasitesi deðerleri ile korele bulundu (p<0.05).
Sonuç: KOAH hastalarýnda egzersiz performansý düþük olup, yüksek acil baþvuru sayýsý ile iliþkilidir. Bu nedenle egzersiz performansýný arttýrýcý uygulamalarýn acil baþvuru sayýsýný azaltacaðýný düþünmekteyiz.

Objective: The relationship between acute exacerbation and exercise performance in chronic obstructive pulmonary disease (COPD) is unclear. The aim of this study was to compare exercise performance between patients with COPD who visited and did not visit an emergency department in the last year; we also aimed to investigate the correlation between frequency of emergency visits and exercise performance.
Methods: We recorded the number of emergency department visits of 206 COPD patients. The six-minute walk test, the modified Medical Research Council Dyspnea Scale, body plethysmographs, carbon monoxide diffusion tests, and arterial blood gas analysis were practiced.
Results: We had one hundred twenty seven participants visited an emergency department at least once in the last year. Exercise performance, dyspnea, pulmonary functions, and oxygenation were significantly poorer in those patients (p<0.05). The number of emergency department visits was correlated with exercise performance, dyspnea, oxygenation, forced expiratory volume in one second forced expiratory volume in one second/forced vital capacity, and carbon monoxide diffusion capacity (p<0.05).
Conclusion: Exercise performance was poor and negatively related to the frequency of emergency department visits in COPD patients. We concluded that exercise performance-enhancing implementations may contribute to reduce the frequency of emergency department visits.

Abstract | Full Text PDF

Objective: To assess diaphragm thickness and to assess its effect on inspiratory muscles’ strength in patients with chronic obstructive pulmonary disease (COPD).
Methods: Case-control study was conducted on 113 male patients with COPD compared to 114 age-matched non-COPD males. Spirometric indices, maximum inspiratory pressure (MIP%), maximum expiratory pressure (MEP%), 6-min walk distance (6MWD), PaO2, PaCO2, and ultrasound measurement of diaphragm thickness were performed for all participants. The studied COPD cases were classified according to the diaphragm muscle thickness into a group with normal diaphragm muscle thickness (thickness end expiration ≥1.8 mm) and a group with diaphragm muscle thinning (thickness end expiration <1.8 mm).
Results: Thickening fraction (TF) on right side, spirometric indices, MIP%, MEP%, were significantly lower in patients with COPD than in controls. Patients with diaphragm muscle thinning represented 11.5% of patients with COPD which represent 21.7% of cases with severe-to-very severe COPD. In patients with diaphragm muscle thinning, age, smoking index, and PaCO2 were significantly higher, whereas body mass index (BMI), TF bilaterally, forced expiratory volume (FEV)1%, MIP%, MEP%, 6MWD, and PaO2 were significantly lower than those with normal diaphragm muscle thickness. Additionally, TF and MIP% showed a significant negative correlation with age, smoking index, and PaCO2 and a significant positive correlation with FEV1, PaO2, BMI, and 6MWD. By multiple logistic regression analysis, the most significant factors relevant to the diaphragm muscle thinning were forced vital capacity (FVC)%, smoking index, forced expiratory flow rate at 25-75% of vital capacity (FEF)25%–75%, and FEV1%.
Conclusion: Thinning of the diaphragm was related to COPD severity, smoking index, and older age. Reduced inspiratory muscles’ strength (MIP%) was related to diaphragm thickness (TF), FEV1/FVC ratio, smoking index, and FVC%. Assessment of diaphragm thickness in COPD patients is recommended with early implementation to pulmonary rehabilitation program.

Abstract | Full Text PDF

Amaç: Biyolojik tedavi molekülü olan omalizumab’ýn astým tedavisinde multifaktöryel kullanýmý olduðunu bilinmektedir. Mekanizmasýnýn halen bilinmeyenleri mevcuttur. Çalýþmamýzda omalizumab tedavisi alan orta ve ileri astým hastalarýný biyobelirteç salýnýmý ve hastalýk özelliklerini immun sistem ile iliþkilendirmeyi amaçladýk.
Materyal ve metod: Aðýr astým hastalýðý olan hastalar (n=15, Grup IA- tedavi öncesi ve Grup IB- tedavi sonrasý) omalizumab tedavisine alýndý. Yaþ ve cinsiyet olarak eþ olan 25 saðlýklý kontrol grubuna Grup II olarak dahil edildi. Her iki grubun ilk kontrolleri sýrasýnda (Grup IA and II) ve astýmlý hastalarýn 12 aylýk tedavi sonrasýnda kan örnekleri alýndý (Group IB). Homosistein (Hcy), eozinofilik katyonik peptid (ECP), 25-hidroksivitamin D (25(OH)D), IL-1β, soluble OX2 (sCD200) serum seviyeleri ve klinik takipte fraksiyonel ekshale nitric oksid (FeNO), solunum fonksiyon testleri ve astým kontrol ölçeði (ACT) deðerlendirildi.
Bulgular: Tedavi sonrasý 25(OH) D seviyesi ve solunum fonksiyon testlerinin FEV1 ve FVC seviyeleri anlamlý derecede artmýþtý. Ayrýca total IgE, Hcy, ECP, FeNO ve sCD200 seviyeleri anlamlý derecede azalmýþtý. Regresyon analizleri ile Grup IA hastalarýnda ACT-FEV1, ve ACT- FVC arasýnda pozitif korelasyon saptanýrken, FeNO-yaþ ve FeNO-ECP arasýnda negative korelasyon saptandý.
Tartýþma: Sonuçlarýmýz astýmlý hastalarýn klinik durumlarý ile serum biyomolekülleri arasýndaki uyum ile potansiyel kullanýmlarýný ve omalizumab tedavisi için takip parametresi olarak kullanýlabilirliklerini desteklemektedir.

Objective: The mechanism of biological treatment molecule called omalizumab used in asthma treatment is thought to be versatile; however, the mechanism still remains unknown. This study was undertaken in severe asthma patients underwent omalizumab treatment, in order to investigate the relationship between biomarker expression and disease characteristics related to the immune system.
Methods: Consecutive patients with severe asthma disease (n=15; Group IA, pretreatment and Group IB, post-treatment) underwent omalizumab treatment. Control group was age- and sex-matched including 25 healthy in Group II. Blood samples from both the groups were taken during their first visit (Group IA and II) and then after 12 months of treatment in asthmatic patients (Group IB). Serum levels of homocysteine (Hcy), eosinophil cationic peptide (ECP), 25-hydroxyvitamin D (25(OH)D), interleukin-1β (IL-1β), soluble OX2 (sCD200) and clinical follow-up tests including fractional exhaled nitric oxide (FeNO), asthma control test (ACT), and pulmonary function tests were evaluated.
Results: After the treatment, 25(OH)D levels and pulmonary function tests, including forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) levels, were significantly increased. Furthermore, total immunoglobulin E (IgE), Hcy, ECP, FeNO, and sCD200 levels were dramatically diminished. Regression analysis revealed positive correlations between ACT-FEV1 and ACT- FVC and between FeNO-age and FeNO-ECP for Group IA patients. Negative correlations were detected between ACT-IgE, age-FEV1, FeNO-FEV1, and FeNO-FVC for Group IA patients.
Conclusion: Our results suggest that the potential use of serum biomolecules in concordance to the clinical status of the asthmatic patients might be a follow-up tool for the omalizumab therapy.

Abstract | Full Text PDF

Giriþ: Çoðu çocukta astým tanýsý klinik olarak konabilmesine raðmen, akciðer grafileri astým ataklarýnda neredeyse rutin olarak istenmektedir. Bu çalýþmanýn amacý pediyatrik astýmlý çocuklarda akciðer grafilerinin hangi sýklýkta istenildiði ve bunlarý etkileyen faktörleri saptamaktýr.
Materyal ve Metod: Bu kesitsel çalýþma Çocuk Alerji ve Ýmmunoloji bölümümüze 6 aylýk bir zaman periyodunda gelen pediyatrik astýmlý hastalarýn elektronik radyografik kayýtlarýndan yapýldý. Ebeveynlerden daha ileri veriler için bir anket oluþturuldu.
Sonuçlar: Yaþlarý 21 – 192 ay arasýnda deðiþen toplam 100 astýmlý çocuk kaydý deðerlendirildi. Akciðer grafilerinin ortalama sayýsý 3.9+3.8 (minimum-maksimum: 1-30). Çocuklarýn %51’inin 3 veya daha fazla akciðer grafisi vardý. Astým tanýsý öncesi akciðer grafilerinin sayýsý ile antibiyotik kullanýmý arasýnda pozitif bir korelasyon vardý (r=0.222, p=0.026). Akciðer grafilerinin sayýsý ile hastalarýn yaþý ve astým taný yaþý arasýnda ters bir iliþki bulundu (sýrasýyla, r=-0.335, p=0.001; r=-0.211, p=0.035). Diðer yandan akciðer grafilerinin sayýsý ile hastaneye baþvuru arasýnda pozitif bir korelasyon vardý (r=0.205, p=0.040). Ek olarak antibiyotik kullanýmý ve yýllýk hastaneye baþvuru ve astým ataklarý arasýnda pozitif korelasyon saptandý (sýrasýyla, r= 0.428, p= 0.000; r= 0.292, p= 0.003).
Sonuç: Çalýþmamýzýn sonuçlarý çocukluk çaðý astýmýnda özellikle küçük yaþtaki çocuklarda akciðer grafisi istemlerinin yüksek olduðunu gösterdi.

Objective: Although many children with asthma can be diagnosed clinically, chest radiographs are routinely requested in asthma attacks. The aim of this study is to determine how often chest radiographs are requested and the factors affecting these requests in pediatric patients with asthma.
Methods: This cross-sectional study was performed by studying the electronic radiographic records of pediatric patients with asthma who were referred to our Pediatric Allergy and Immunology Department over a six-month period. A questionnaire was designed to obtain further information from the parents of the patients.
Results: The records of 100 children with bronchial asthma, aged 21 to 192 months, were evaluated. The average number of chest radiographs was 3.9±3.8 (between 1-30). Fifty-one percent of the children underwent three or more chest radiographs. There was a positive correlation between the number of chest X-rays before asthma diagnosis and the frequency of antibiotic usage (r=0.222, p=0.026). An inverse correlation was found between the number of chest radiographs and the patients’ ages and the age at which asthma was diagnosed (r=−0.335, p=0.001; r=−0.211, p=0.035, respectively). In contrast, there was a positive correlation between the number of chest X-rays and the number of hospital admissions (r=0.205, p=0.040). A positive correlation between the frequency of antibiotic usage and the annual number of hospital admissions was determined (r=0.428, p=0.000). Furthermore, a positive correlation between the frequency of antibiotic usage and the frequency of asthma attacks was observed (r=0.292, p=0.003).
Conclusion: The results of our study show that the use of chest radiographs is high in cases of childhood asthma, especially in younger children.

Abstract | Full Text PDF

GÝRÝÞ-AMAÇ: Ekstratorasik malignitelere baðlý intratorasik lenf nodu büyümeleri sýk görülmektedir. Endobronþiyal Ultrasonografi eþliðinde transbronþiyal iðne aspirasyonu (EBUS-TBÝA) sýklýkla mediastinal veya hiler lenf nodlarýn tanýsý ile akciðer kanseri evrelemesinde kullanýlmakla birlikte santral hava yollarýna komþu lezyonlarýn tanýsýnda, tümörün bronþ duvarý invazyonunun derinliðini belirlemede ve nadiren santral pulmoner emboli saptanmasýnda kullanýlmaktadýr. Ancak EBUS-TBÝA ile saptanmýþ ekstratorasik malignitelere baðlý lenf nodu metastazlarýný içeren az sayýda çalýþma mevcuttur. Bu çalýþmayla mediastene metastaz yapan ekstratorasik malignitelerin tanýsýnda lineer (doðrusal-konveks) problu EBUS (CP-EBUS) eþliðinde alýnan TBÝA’ nýn rolünü belirlemek amaçlanmýþtýr.
MATERYAL-METOD: Kliniðimizde Mart 2010- Temmuz 2015 tarihleri arasýnda ekstratorasik malignitesi olan tanýsal amaçlý CP-EBUS TBÝA uygulanan 190 hasta retrospektif olarak incelendi.
BULGULAR: Ekstratorasik malignite tanýsýyla baþvuran 190 hastanýn demografik özellikleri tablo 1 de sunulmuþtur. 190 hastanýn 61’i malign (%32), 121 ‘i( %63) benign, 3’ü%(1,5) tanýsal deðil, 5 (%3,5)hastadan milimetrik lenf nodu izlendiði için örnek alýnmadý. Hastalarýn EBUS-TBNA ile aldýklarý tanýlar ile hastalarýn son tanýlarý þekil 1 de belirtilmiþtir. Malign hastalarýn 40’ý metastaz, 19’u primer akciðer CA, birisi hodgkin lenfoma, ikisi maligniteyle (mediastinoskopiyle skuamöz hücreli akc CA tanýsý aldý) uyumlu idi. Tanýsal olmayan üç hastadan birisi takipte reaktif lenf nodu olarak tespit edildi; diðer ikisi ileri tetkikle taný aldýlar. EBUS-TBÝA 'nýn ekstratorasik malignitelerin intratorasik metastazlarýný saptamadaki sensitivitesi %95.3,spesivitesi %100, negatif prediktif deðeri %97.6, tanýsal deðeri %98.4'tür.
SONUÇ: EBUS-TBÝA, akciðer kanseri tanýsý ve evrelemesinde olduðu gibi ekstratorasik malignitelere baðlý intratorasik lenf nodu metastazlarýnýn saptanmasýnda da basit, güvenilir ve yeterli bir yöntemdir

Objective: Intrathoracic lymph node enlargement is common among patients with extrathoracic malignancies. While endobronchial ultrasound-guided-transbronchial needle aspiration (EBUS-TBNA) is often used for diagnosing mediastinal or hilar lymph nodes and for staging lung cancer, there are still a few studies demonstrating the use of EBUS-TBNA for determining intrathoracic metastases from extrathoracic malignancies. The aim of this study is to evaluate the role of EBUS-TBNA for the diagnosis of extrathoracic malignancies.
Methods: From March 2010 to July 2015, 190 patients with known extrathoracic malignancy, who underwent diagnostic convex probe (CP)-EBUS-TBNA due to suspicion of metastases, were included in the study. The patients’ data were retrospectively investigated.
Results: The findings of EBUS-TBNA were examined; 61 patients (32%) were malignant, 121 (63%) were benign, and 3 (1.5%) were not diagnostic. Five patients (3.5%) were not sampled because of the millimetric size of the lymph nodes. There was no progression at the 12-month follow-up in these patients. Among the malignancy patients, 40 had extrathoracic malignancy-related intrathoracic metastases. The diagnosis of the lymph nodes with EBUS-TBNA and the final diagnosis at follow-up are given as summarized. The size of the lymph node decreased during clinical follow-up in one of the three non-diagnostic patients (accepted as having reactive lymph node). The other two patients were diagnosed as malignant using mediastinoscopy (having esophageal cancer and squamous cell lung cancer). The sensitivity was found to be 95.3%, specificity was 100%, the negative predictive value was 97.6%, and the diagnostic accuracy rate was 98.4%.
Conclusion: EBUS-TBNA is a simple, reliable, and adequate diagnostic method for determining intrathoracic lymph node metastases related to known extrathoracic malignancies.

Abstract | Full Text PDF

GÝRÝÞ: Sigara içme alýþkanlýðý, ayný evde yaþayan insanlarýn alýþkanlýklarý ile de etkileþim halindedir.Ansiyete ve depresif belirtileri olan kiþilerin daha çok sigara içtiði bilinmektedir. Çalýþmamýzda, sigara býrakma polikiniklerine baþvuran hasta ve eþlerinin ruhsal durumlarýnýn ve partner desteðinin sigara býrakma tedavisine olan etkisinin araþtýrýlmasý amaçlandý.

MATERYAL-METOD: Temmuz 2014-Ocak 2015 tarihleri arasýnda, merkezlerimizin Sigara Býrakma Polikliniði’ne baþvuran, sigara býrakma tedavisi baþlanan kiþiler ve eþleri deðerlendirmeye alýndý.Çiftlerden, Evlilik Uyum Ölçeði ve Hastane Anksiyete Depresyon Ölçeði’ni doldurmalarý istendi. Sigara býrakma tedavisi baþlanan katýlýmcýlar, tedaviden 6 ay sonra kontrol amaçlý çaðýrýlarak sigara býrakma durumlarý gözden geçirildi. Katýlýmcýlara, sigara býrakmaya eþlerinin desteðini deðerlendirmek için PIQ anketi uygulandý.

BULGULAR: Çalýþmaya dahil edilen 94 katýlýmcýnýn %55'i eþleriyle birlikte sigara býrakmak için polikliniðe baþvurdu. Tedavi süreci sonunda katýlýmcýlarýn %55.3’ü sigarayý býrakmada baþarýlý oldu. Eþiyle sigara býrakmak için baþvuranlarýn %42.3’ü sigarayý býrakabilmiþti; çiftlerin %96.2’sinde sigara býrakma konusunda ayný sonuç tespit edildi. Sigaranýn býrakýlamamasý ile, katýlýmcýlarýn kendisinde ve partnerlerinde anksiyete ve depresyon riskinin yüksek olmasý (katýlýmcý: p=0.028 ve 0.037;partner: p=0.003 ve 0.007), partnerin sigara içiyor oluþu (p<0.01) ve evlilik uyumunun düþük olmasý (p<0.01) arasýnda istatistiki açýdan bir iliþki mevcuttu.Lojistik regresyon analizinde partner desteði ve partnerin sigara içme durumu sigara býrakmaya baðýmsýz etki eden faktörler olarak bulundu.

SONUÇ: Sigara býraktýrma programýna alýnacak hastalarda, ruhsal açýdan mevcut durum ve partner desteði önemlidir. Sigara içmeyen aile bireylerinin varlýðý, kiþinin sigarayý býrakmasýný kolaylaþtýrýcý bir faktördür. Bu süreçte çiftlerde tedavi öncesinde mevcut anksiyete ve depresif belirtilerin tespit edilip gerekli önlemlerin alýnmasý ve eþlerinin sigara býrakma konusundaki desteði sigara býrakma tedavi baþarýsýný artýracaktýr.

Objective: The habit of smoking is more common in members of a family living in the same house. People with psychiatric symptoms smoke more cigarettes. We conducted a study to examine whether the psychological status of couples and partner support affects smoking cessation success.
Methods: The outpatients who started taking a therapy for smoking cessation between July 2014 and January 2015 in our clinic were included in this prospective, single-center study. Each couple was assessed on the basis of the Marital Adjustment Scale (MAS) and Hospital Anxiety-Depression Scale (HADS). The smoking status of the participants was assessed after 6 months, and they filled out the Partner Interaction Questionnaire (PIQ).
Results: Of 141 volunteers, 55% joined the smoking cessation program as couples. A total of 55.3% of the participants managed to quit smoking. Further, 42.3% of couples quitted smoking. Nearly 96.2% of couples had the same result regarding smoking cessation. The smoking cessation rate was significantly lower in couples with high anxiety depression scores (participant: p=0.028 and 0.037; partner: p=0.003 and 0.007), smoker partners (p<0.01), and participants with low marital adjustments (p<0.01). Logistic regression analysis showed that the independent parameters affecting smoking cessation success were support and the smoking status of partners (p<0.001 and 0.021, respectively).
Conclusion: Partner support and psychological status were important parameters associated with smoking cessation. The presence of non-smoker partners made quitting smoking easier. Reducing anxiety and depressive symptoms and support of partners may help in smoking cessation.

Abstract | Full Text PDF

Amaç: Kendiliðinden sigara býrakanlarýn oraný azalmýþ görünmesine raðmen, azýmsanmayacak kadar çoktur. Sigara býrakma tedavilerinde ilaçlarýn kullanýmýnýn artmasýyla kendiliðinden sigara býrakanlara daha az önem verilmektedir. Bu çalýþmada kendiliðinden sigara býrakanlara etkili olan sebeplerin ortaya çýkarýlmasýnýn býrakma sürecine katkýsýnýn deðerlendirilmesi amaçlandý.
Yöntemler: Araþtýrmaya herhangi bir farmakolojik veya psikolojik destek tedavisi almamýþ olan, 18 yaþ ve üstü kiþiler alýndý. Araþtýrma, %95 güven düzeyinde ±3,09 hata payýyla yapýldý. Yaþ,cinsiyet, öðrenim durumlarý, meslekleri,aylýk gelirleri, sigara içme durumlarý ve býrakmaya etkili olan faktörler sorgulandý.
Bulgular: Katýlýmcýlarýn yarýsý (509 kiþi,%50,5) erkek ve yarýsý (498 kiþi,%49,5) kadýndý. Katýlýmcýlarýn yaþlarý ortanca 35(18-87) idi. Kadýnlarýn yaþý ortanca 35(18-83) iken erkeklerin yaþý ortanca 36(18-87)idi.Ýstanbul’dan 351(%35), Ankara’dan 301(%30), Konya’dan 207(%20), Antalya’dan 148(%15) kiþi ile görüþüldü. Bu çalýþmanýn sonunda yardým almaksýzýn sigara býrakmada en etkili faktörün kiþinin kendi hastalýðý olduðu gösterildi. Ýkinci sýrada hastalanma korkusu ve üçüncü sýrada aile bireylerinin baskýsý vardý. Hastalýk nedeniyle sigara býrakanlar en çok solunum sistemi hastalýklarý nedeniyle sigarayý býrakmýþlardý. En korkulan hastalýk ise kanserdi. Kendiliðinden sigara býrakanlarda, daha uzun yýllar sigara içenlerin daha az sigara býrakma deneme sayýsýyla sigara býraktýðý görüldü. Maddi durumun kötü olmasýnýn da sigara býrakmada dördüncü sýrada etkili olduðu görüldü.
Sonuç: Yardým almaksýzýn sigara býrakmada kiþinin kendi hastalýðý yanýsýra hastalanma korkusu da önemli bir faktördür. Bu nedenle sigara býrakma sürecinde ve özellikle gençlerin sigara içmesini önlemek amacýyla tasarlanacak projelerde bu konulara önem verilmesi gerektiði düþünüldü. Sigara satýþ ücretlerinin artýrýlmasý da bu konuda önemlidir. Kapalý alanda sigara içilmesini önlemek amacýyla çýkarýlan kanunlara uyum da özellikle gençlerin sigaranýn zararlarý ile ilgili düþüncelerini etkileyebilir.

Objective: This study aimed to evaluate the contribution which effective factors on who self-quitting smoking.
Methods: The study had been included in over 18 years old people who not received any pharmacological treatment or psychological support. The research was performed at the 95% ±3.09 confidence interval. Age, gender, educational status, occupation, monthly income, smoking situation and effective factors on self-quitting smoking.
Results: The participants had been 50.9% (509) male and 49.5 (498) female. Median age was 35 (18-87) years old; female’s median age 35 (18-83) and male’s median age 36 (18-87). From Ýstanbul 351 (35%), Ankara 301 (30%), Konya 207 (20%), Antalya 148 (15%) were people interviewed. This study had been the most effective factor in unassisted smoking cessation one’s own disease. The second factor had been getting fear of sick and third family pressure.The most people had been quit smoking due to diseases of respiratory system. The most fearful disease was cancer. Financial status was forth effective factor on quitting smoking.
Conclusion: As a result effective factors on unassisted smoking cessation had been getting fear of sick as well as own disease. Therefore, in the process of quitting smoking, and especially young people in the project will be designed to prevent smoking was thought should be given to these issues. Also important in this regard is increasing the cigarette sales price. The compliance with laws issued to prevent smoking in closed areas, in particular young people can influence their thoughts about the hazards of smoking.

Abstract | Full Text PDF

Eisenmenger’s syndrome is a severe type of congenital heart disease characterized by severe pulmonary arterial hypertension. In the cases that the pressure in pulmonary circulation exceeds the systemic pressure, there appears a right-to-left shunting of blood. Consequently, the syndrome exists hypoxemia and cyanosis. Hypercapnia is not common in these patients; however, it might coexist with hypoxemic failure if there are other restrictive pathologies associated. Meanwhile, it has been described high prevalence of sleep disorders in Down syndrome. There is no evidence about the role of noninvasive ventilation in the management of these patients. We present a 39-year-old man, suffering of Down and Eisenmenger’s syndrome with multiple cardiac decompensations and obstructive sleep apnea (OSA), who was admitted to hospital due to severe somnolence, edema, and dyspnea. We observed a hypercapnic respiratory acidosis that ameliorated with noninvasive ventilation (NIV). The patient returned home with nocturnal NIV as a new treatment, and no further admission to hospital was seen in the following two years. To our knowledge, this is the first report about the utility of NIV in Eisenmenger’s and Down syndrome patients.

Abstract | Full Text PDF

Objective: To report our experience in treating 10 consecutive patients with recalcitrant subcutaneous emphysema (SE) using two different types of subcutaneous drains.
Methods: A retrospective review of our experience in managing 10 cases of recalcitrant SE. The method that we employed consisted of creating a subcutaneous tunnelization of the pre-pectoral space, under previous local anesthesia, and inserting three Penrose drains (small rubber tubes) or a multifenestrated Argyle drain in the tunnels.
Results: The placement of the subcutaneous drains resolved SE in all 10 cases within a mean time of 5.3 days. No local or systemic complications were observed, but patients with the Argyle drain showed worse tolerance, presenting local pain that required treatment with additional analgesics.
Conclusion: The subcutaneous drain treatment of the recalcitrant SE is a simple, safe, and effective method that should be used in clinical practice for the better comfort of patients. In our series, Penrose drains were better tolerated than the multifenestrated Argyle drains.

Abstract | Full Text PDF