Türkiye’nin tütün kontrolünde 20 yýllýk deneyimi vardýr. Türkiye’de 1996 yýlýnda yürürlüðe giren tütün kontrolü kanunu ile ilk kez bazý kamusal alanlarda ve toplu taþýmada sigara içilmesi yasaklandý. Bu yasa ile ayrýca 18 yaþýndan küçük olan gençlere tütün ürünleri satýþý ve tütün ürünlerinin her türlü reklam ve tanýtýmýnýn yapýlmasý yasaklandý. Kanun ayrýca bütün televizyon kanallarýna ayda 90 dakikadan az olmamak üzere sigara içmenin zararlarý konularýnda yayýn yapma zorunluðu getirdi. Kanunun 12 yýl uygulanmasýndan sonra kapsamý geniþletildi, ikram sektörü iþletmeleri dahil olmak üzere bütün kapalý mekanlarda sigara içilmesi yasaklandý. Tam sigara dumansýz kapalý alan politikasýnýn geliþtirilmesi ve baþarýlý þekilde uygulanmasýnda politik kararlýlýðýn önemli etkisi olmuþtur. Tam dumansýz kapalý alan politikalarýnýn uygulanmasý ile iç ortam hava kalitesinde olumlu geliþme oldu, restoran, kafe gibi ikram sektörü iþletmelerinde çalýþanlar ve müþteriler kendilerini daha rahat hissetmeye baþladýlar ve ülkede sigara kullaným sýklýðýnda azalma meydana geldi. Türkiye’nin tütün kontrolü alanýndaki baþarýsýný DSÖ Genel Direktörü Dr. Margaret Chan þu sözlerle ifade etmiþtir: “Türkiye DSÖ MPOWER stratejilerinin tamamýný en üst düzeyde baþarýlý þekilde uygulayan ilk ve bugüne kadarki tek ülkedir. Bu, diðer ülkelerin örnek almasý ve izlemesi gereken bir modeldir”.
Tütün kontrolü alanýndaki baþarýlý uygulamalara raðmen halen geliþtirilmesi gereken hususlar vardýr. Bazý restoran ve barlarda özellikle gece saatlerinde kapalý alan yasaklarý bakýmýndan ihlaller olmaktadýr. Sigara kullaným sýklýðý azalmýþ olmakla birlikte diðer ülkelerle karþýlaþtýrýldýðýnda halen yüksek olduðu görülmektedir ve sigara fiyatlarý düþüktür. Tütün kontrolünün önemi ile ilgili olarak daha fazla eðitim ve farkýndalýk eðitimleri yapýlmalý, kapalý alan yasaklarý konusunda daha etkili denetim sistemi geliþtirilmeli ve tütündeki vergi yükü artýrýlmalýdýr.

Turkey has 20 years of experience with tobacco control. The first tobacco control law came into force in 1996. This law banned smoking in some indoor public places and public transportation, selling tobacco products to children, and all kinds of advertisement of tobacco products. The law made it a duty for television networks to broadcast programs and advertisements on the harms of smoking for 90 minutes per month. After 12 years of implementation, the law was amended to include all indoor public places, including hospitality venues, as smoke-free. Political commitment has been important in establishing comprehensive smoke-free policy and implementation. Following the implementation of 100% smoke-free public places, indoor air quality was improved, employees, and clients of hospitality places were more comfortable, and smoking prevalence was reduced. Dr. Margaret Chan, Director General of the World Health Organization (WHO), highlighted Turkey’s success as follows: “Turkey is the first and, to date, the only country in the world to attain the highest implementation score for all of WHO’s MPOWER measures. This is a model for other countries to follow.” However, still there are some areas to be developed. Violations at some indoor public places were seen, particularly at restaurants and bars during the late night period. Although smoking prevalence was reduced, the prevalence is still high and cigarette prices are too low when compared with some other countries. On the other hand, smoking among youth is increasing. More education and awareness programs should be done for the general public, more comprehensive inspections should be performed for smoke-free implementation, and higher taxes on tobacco products should be implemented.

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Intra-hospital transport is often needed for diagnostic and therapeutic procedures that cannot be performed at the bedside. However, moving patients from the safe environment of an Intensive Care Unit (ICU) can lead to a variety of complications and adverse events, the risk is even higher in ventilated patients. This review is intended as a guide on how to prevent and avoid these adverse events during intra-hospital transport of patients on non-invasive ventilation (NIV). Greater attention should be paid to NIV indications and the selection of the patients to be transported. Detailed planning, preparation, and communication between the ward of origin and destination site, appropriate equipment, skilled staff, and continuous monitoring are the key major determinants of success in transporting critically ill patients on NIV. These points are discussed and analyzed in detail.

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Amaç: Malign plevral mezotelyomanýn erken tanýsý ve ayýrýcý tanýsýnda tümör belirteçleri ümit verici çalýþma alanýdýr. Bu çalýþmada malign plevral mezotelyomalý hastalarýn metastatik malign plevral hastalýklar, benign plevral hastalýklar ve benign asbest plörezisi tanýlý hastalardan ayýrýmýnda hyaluronan, osteopontin, C-ERC / mesothelin, N- ERC / mesothelin ve syndecan – 1 serum seviyelerinin etkinliðini belirlemek amaçlanmýþtýr.
Metot: Toplam 230 hastadan alýnan serum örnekleri tümör belirteçlerinin tespiti için Enzyme-Linked Immunosorbent Assays ile analiz edildi.
Bulgular: Ýncelenen tüm belirteçler malign plevral mezotelyomalý hastalarý metastatik malign plevral hastalýðý olan hastalardan ayýrt etmek için yeterli duyarlýlýk ve özgüllüðü ortaya koyamadýlar. N-ERC / mesothelin malign plevral mezotelyomalý hastalarýn benign plevral hastalýklardan, özellikle de BAP’tan ayýrýmýnda orta derecede etkinlik gösterdi (sýrasýyla duyarlýlýklar %67 ve %73, özgüllükler %84 ve %86). C-ERC/mesothelin, N-ERC/mesothelin’den daha düþük etkinliðe sahipti, bununla birlikte osteopontin MPM’i diðer plevral hastalýklardan ayýrmada yüksek özgüllüðe sahipken (%80) düþük duyarlýlýða sahipti (%32). Hyaluronan ve syndecan-1 kendi baþlarýna biyobelirteç olarak yalnýzca sýnýrlý etkileri mevcuttur. Ancak, lojistik regresyon analizleri çalýþýlan tüm biyobelirteçlerin birleþtirildiði bir lojistik modelin, ROC eðrisinde AUC=0,75 bulunarak daha baþarýlý olduðunu göstermiþtir. Araþtýrýlan biyobelirteçler yeterli duyarlýlýk ve özgüllük deðerlerini saðlamakta yetersizdiler; ancak çalýþýlan tüm belirteçler geniþletilmiþ çok parametreli lojistik bir model için temel oluþturabilirler.
Sonuç: Yüksek N-ERC / mesothelin veya C-ERC/mesothelin seviyesi olan hastalarda mezotelyoma riski yüksektir; bu hastalar uygun invaziv iþlemlere tabii tutulmalýdýrlar. Tümör belirteç seviyesi yüksek olan hastalarda, histopatolojik taný ilk invaziv iþlemde fibrinöz plörit olarak gelse bile taný için daha ileri invaziv iþlemler yapýlmalýdýr.

Objective: Tumor biomarkers are promising study areas for the early or differential diagnosis of malignant pleural mesothelioma (MPM). This study aimed to determine the effectiveness of analyzing serum N-ERC/mesothelin, C-ERC/mesothelin, hyaluronan, osteopontin, and syndecan-1 levels for distinguishing patients with MPM from those with metastatic malignant pleural diseases (MMPDs), benign pleural diseases (BPDs), and benign asbestos pleurisy (BAP).

Methods: Tumor biomarker levels of serum samples of 230 cases were analyzed by enzyme-linked immunosorbent assays.

Results: All investigated biomarkers did not reveal sufficient diagnostic information to distinguish MPM from MMPD. N-ERC/mesothelin showed moderate ability to distinguish MPM from BPDs and particularly BAP (sensitivities of 67% and 73%, respectively, and specificities of 84% and 86%, respectively). C-ERC/mesothelin had a lower efficacy than N-ERC/mesothelin, whereas osteopontin had a high specificity for distinguishing MPM from other pleural diseases (80%) but with a poor sensitivity (32%). Hyaluronan and syndecan-1 had only limited effects as individual biomarkers. However, logistic regression analysis indicated that all the studied biomarkers could contribute, and a logistic model improved their performance, with the receiver operating characteristic curve plot showing an area under the curve of 0.75. Thus, the investigated biomarkers were unable to provide sufficient sensitivity and specificity levels; however, they all may contribute as a basis for an expanded logistic multiparameter model.

Conclusion: Patients with high N-ERC/mesothelin and C-ERC/mesothelin levels have a high risk for MPM; appropriate invasive procedures should be performed. The patients who have high tumor biomarker levels and undefinite histopathological investigation results at the first-line procedure, should be managed using further invasive procedures.

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Amaç: Türkiye’yi temsil eden bu araþtýrmada 15-24 yaþ arasýndaki gençlerde tütün ürünleri kullaným sýklýðý, pasif olarak tütün dumanýndan etkilenme durumlarýný, tütün kullanýmýný býrakma eðilimlerini deðerlendirmek ve gençlere yönelik etkili müdahalelerin geliþtirilmesine katký saðlamaktýr.
Yöntem: Araþtýrmada tüm Türkiye’yi temsil eden tabakalý örneklem yöntemi kullanýlan Türkiye Ýstatistik kurumu(TUÝK) Saðlýk Araþtýrmasý 2014 verileri kullanýlmýþtýr.
Bulgular: Örneklem grubu ülkedeki 15-24 yaþ grubu genci temsil etmektedir(11.750.297 genç).
Gençlerin yaklaþýk beþte biri (%18,5) her gün sigara içtiðini belirtmiþtir. Her gün tütün kullanan erkekler kadýnlardan daha fazladýr(p<0,001). Erkeklerin ilk sigara kullanma yaþý ortalama 14,9±3,19, kýzlarda 16,3±2,88’dir ve yaþ ortalamalarý arasýndaki fark istatistiksel olarak da anlamlýdýr( p<0,001). Erkekler arasýnda pasif olarak tütün dumanýndan etkilenme yüzdesi kadýnlara göre daha fazladýr(p=0,028). Erken yaþta sigaraya baþlayanlarýn günlük kullandýklarý sigara miktarý, geç yaþta sigaraya baþlayanlara göre daha fazladýr (p<0,05).
Sonuç: Tanýmlayýcý ve ileri analizler ülkemizdeki güçlü tütün kontrolü kanunlarýna raðmen gençlerin tütün kullanýmý ve pasif olarak tütün dumanýndan etkilenme açýsýndan risk altýnda olduðunu göstermektedir. Erken yaþta sigaraya baþlayanlarýn gençlerin daha fazla sigara içtiði ve daha zor sigarayý býraktýðý tespit edilmiþtir. Gençler için daha güçlü tütün kontrolü faaliyetleri geliþtirilmeli ve ülke çapýnda uygulanmalýdýr.

Objective: This study was carried out to show Turkey's prevalence of tobacco use among 15-24 year olds, to evaluate passively the affected cases, to determine the tendency to quit smoking and to contribute to the development of effective interventions for young people.

Methods: In this study, Turkey Statistical Institute (TurkStat) Health Survey 2014 data, representing the whole Turkey population, and a stratified sampling method were used.

Results: The sample group represented the population in the age group of 15–24 years in Turkey (11,750,297 young people). Nearly one of five young people (18.5%) was a daily smoker. The percentage of male daily smokers was significantly higher than that of female daily smokers (p<0.001). The initial age of smoking among males was 14.9±3.19 years, whereas that of females was16.3±2.88 years; this difference was statistically significant (p<0.001). The percentage of passive smoking among young males was significantly higher that among young females (p=0.028). The number of daily smoking cigarette was higher among individuals who started smoking at an early age than among those who started at an older age (p<0.005).

Conclusion: Descriptive and further analyses are showing that young people are at a risk for tobacco use and passive smoking despite the strong tobacco control law in our country. Young people who started smoking at earlier ages, smoke more numbers of cigarettes and do not want to quit. Stronger tobacco control activities for young people should be developed and implemented in the country.

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Objective: To study the high-resolution computed tomography (HRCT) findings of children on hemodialysis with abnormal spirometry.

Methods: This descriptive study included 25 children with chronic kidney disease on regular hemodialysis. They were selected from a pediatric hemodialysis unit during the period from June 2015 to January 2016. Spirometry was done, and those with abnormal values were assessed by HRCT of the chest and echocardiography.

Results: Among 25 children with abnormal spirometry on regular hemodialysis, there was a decrease in spirometric indices in patients on hemodialysis with a tendency to the restrictive pattern (19 patients; 76%). The following HRCT findings were detected: bilateral mild lower-lobe air trapping (centrilobular emphysema) in 14 patients (56%), diffuse bilateral ground-glass appearance in 2 patients (8%), mild hilar and perihilar bronchiectasis in 5 patients (20%), and cardiomegaly in 3 patients (12%).

Conclusion: Our results suggest that HRCT revealed many pathological findings that could not be detected on the chest X-ray, and some of these findings may explain the abnormal indications observed on spirometry.

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Amaç: Pulmoner rehabilitasyon(PR) programý uygulanan obez, pre-obez ve normal aðýrlýklý KOAH'lý hastalarda programýn kazanýmlarýný karþýlaþtýrmayý amaçladýk.
Gereç ve Yöntem: KOAH'lý (n: 135) hastalara PR öncesi pulmoner ve kardiyak sistem muayenesi ve solunum fonksiyon testleri (SFT) uygulandý. Tüm hastalarda göðüs grafileri, arteryel kan gazlarý (ABG), vücut kitle indeksi (BMI), yaþam kalitesi (YK) anketleri, anksiyete ve depresyon skorlarý ve mMRC skorlarý deðerlendirildi. Hastalarýn egzersiz kapasitesini belirlemek için 6 dakika yürüme testi (6 DYT) yapýldý. Tüm hastalara, 8 hafta boyunca, ayaktan PR programý uygulandý. Hastalar 8. hafta sonunda tüm parametreler açýsýndan tekrar deðerlendirildi.
Bulgular: Çalýþma grubu, 43 normal aðýrlýkta, 51 pre-obez ve 41 obez COPD hastasýndan oluþmaktaydý. PR programý öncesi gruplar arasýnda SFT, 6mWD, mMRC skorlarý ve YK anketleri açýsýndan istatistiksel olarak anlamlý fark bulunmadý (hepsi için p> 0.05). PR sonrasýnda üç grup pO2 ve SO2 düzeylerinde anlamlý olarak artmýþ ve mMRC ve YK anketleri skorlarý iyileþmiþtir (hepsi için p <0.05). 6 DYT ve yürüme iþi (YÝ), her üç grupta da PR sonrasýnda anlamlý olarak arttý (hepsi için p <0.001). Obez hastalarda 6 DYT, obez olmayan ve normal aðýrlýklý hastalara göre anlamlý olarak daha düþüktü (p = 0.049).
Sonuç: Preobez ve obez hastalar, gaz deðiþimi, dispne algýsý ve yaþam kalitesi bakýmýndan normal kilolu hastalara benzer þekilde PR’danfayda görmektedir. Ancak obez KOAH'lý hastalarda, preobez ve normal aðýrlýklý hastalarýn aksine egzersiz kapasitesi açýsýndan daha az iyileþme görülmüþtür.

Objective: We aimed to compare the gain of pulmonary rehabilitation (PR) in obese, pre-obese, and normal-weight patients with chronic obstructive pulmonary disease (COPD) who underwent a PR program.

Methods: COPD patients (n=137) underwent pulmonary and cardiac system examination and pulmonary function tests (PFTs) before PR. Chest X-rays, arterial blood gases, body mass index, quality of life (QOL) questionnaires, anxiety and depression scores, and Modified Medical Research Council dyspnea scale (MMRC) scores were evaluated in all patients. A 6-min walk test was performed to determine the exercise capacity of the patients. All patients underwent an 8-week outpatient PR program. The patients were reevaluated at the end of 8th week in terms of all parameters.

Results: The study group consisted of 44 normal-weight, 52 pre-obese, and 41 obese COPD patients. Before PR, there was no significant difference in terms of 6-min walk distance (6MWD), PFT, MMRC, or QOL scores between the groups (p>0.05 for all). After PR, partial arterial oxygen pressure and arterial saturation, MMRC, and QOL scores improved significantly in all three groups (p<0.05 for all). 6MWD and walkwork significantly increased after PR in all three groups (p<0.001 for all), but the gain in 6MWD was significantly lower in obese patients compared to pre-obese and normal-weight patients (p=0.049).

Conclusion: Pre-obese and obese patients benefit from PR similarly to the normal-weight patients in terms of gas exchange, dyspnea perception, and QOL. But it seems to be that exercise capacity improves less in obese COPD patients compared to pre-obese and normal-weight patients.

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Amaç: Literatürde obez bireylerin solunum fonksiyonlarý ile ilgili çalýþmalar bulunmakla birlikte, pre-obez bireylerle ilgili yeterli araþtýrma bulunmamaktadýr. Bu çalýþma, obez ve pre-obez bireylerin pulmoner fonksiyonlarýný, fiziksel aktivite düzeylerini ve saðlýkla ilgili yaþam kalitesini (SÝYK) karþýlaþtýrmayý amaçlamaktadýr.

Yöntem: Çalýþmaya 62 birey katýldý. Bireylerin demografik ve klinik bilgileri kaydedildi. Tüm bireyler, Solunum fonksiyon testi (SFT), kýsa form 36 Saðlýk Taramasý (SF-36), obeziteye özgü yaþam kalitesi ölçeði (OWLQOL), fiziksel aktivite anketi (IPAQ), modifiye modified medical research council (mMRC) ölçeði ile deðerlendirildi.

Bulgular: Obez kiþilerde dispne algýsý þiddeti, pre-obez kiþilerden anlamlý derecede yüksekti (p<0.05). Obez kiþilerde PFT parametreleri (FVC, FEV1, PEF, FEF25-75, FEF25-75%, MVV ve MVV%) anlamlý olarak düþüktü(p<0.05). Her iki grup da inaktif kiþiler olmasýna raðmen, obez kiþilerdeki inaktivite düzeyleri anlamlý derecede yüksekti(p<0.05). Obez kiþilerde SÝYK puanlarý anlamlý olarak düþüktü (p<0.05). BMI deðerleri dispne þiddeti, SF-36 alt skorlarý, OWLQOL skorlarý ve SFT parametreleri ile anlamlý korelasyon gösterdi (p<0.05).

Sonuç: Pre-obez bireylerde, artan BKÝ, bireylerin solunum fonksiyonlarýný olumsuz etkilemesine raðmen, obez bireylerde artmýþ BKÝ ve azalmýþ solunum fonksiyonlarý bireylerin fiziksel aktivite düzeylerini ve saðlýkla iliþkili yaþam kalitelerini de önemli ölçüde düþürmektedir.

Objective: There are studies regarding pulmonary functions of obese individuals in literature; however, there is insufficient data regarding pre-obese individuals. This study aimed to compare the pulmonary functions, physical activity levels, and health-related quality of life (HRQOL) of obese and pre-obese individuals.

Methods: The characteristics of 62 subjects participating in the study were recorded All subjects were evaluated using pulmonary function tests (PFT), short form-36 health survey (SF-36), obesity and weight loss quality of life measure (OWLQOL), international physical activity questionnaires (IPAQ), and modified medical research council (mMRC) scale.

Results: The severity of perceived dyspnea in obese subjects was significantly higher than that in pre-obese subjects. The PFT parameters (FVC, FEV1, PEF, FEF25–75, FEF25–75%, MVV, and MVV%) were significantly lower in obese subjects. Although individuals in both groups were inactive, the inactivity levels in obese subjects were significantly higher. HRQOL scores were significantly lower in obese individuals. The body mass index (BMI) was significantly correlated with dyspnea severity, SF-36 subscores, OWLQOL scores, and PFT parameters.

Conclusion: While an increasing BMI has an adverse effect on the pulmonary functions of pre-obese individuals, increased BMI coupled with reduced pulmonary functions causes a decrease in the physical activity levels and reduces HRQOL of obese individuals.

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Giriþ: Pulmoner hidatik kist hastalýðý rüptür, anaflaksi, pnömotoraks ve pulmoner hipertansiyona sebep olabilir. Amacýmýz pulmoner kist hidatik hastalýðýnýn klinik ve demografik özelliklerini analiz etmektir.
Metod: Pulmoner hidatik kistli çocuk ve eriþkin 171 hastanýn klinik özellikleri ve laboratuvar parametreleri, demografik karakteristikleri kaydedildi. Kistin perforasyon durumu, lokalizasyonu, çapý, sayýsý, hastalarýn yaþý, hastalarýn cinsiyeti kaydedildi. Fizik muayene ultrasonografi, bilgisayarlý tomografi ve serolojik testler ile kist hidatik teþhisi teyid edildi.
Tartýþma: Perfore kist 22 eriþkin ve 26 çocuk hastada gözlemlendi. Dev kist ise 23 çocuk 12 yetiþkin hastada vardý. Akciðer dýþý hidatik kist 21 yetiþkin ve 10 çocukta görüldü. ELISA Ig pozitifliði 30 çocuk ve 34 yetiþkinde belirlendi. On iki çocuk hastada drenaja cevap veren uzamýþ hava kaçaðý görüldü. Yetiþkin hastalarýn 14 ünde uzamýþ hava kaçaðý, üçünde ampiyem ve ekspansiyon kusuru mevcuttu. Çocuk ve eriþkinlerin hastanede kalma süresinin ortalamasý sýrasýyla 8,9 ve 10,45 gün idi
Sonuç: Demografik ve klinik özelliklerin, cerrahi iþlem ve hastalýðýn komplikasyonlarýnýn iyi anlaþýlmasý optimal takip ve tedavi seçimini belirlemeye katký saðlar.

Objective: Pulmonary involvement of hydatid cyst disease(HCD) may cause ruptur, anaphylaxis, pneumothorax and pulmoner hypertension. Our aim is to analyze demographical and clinical characteristics of pulmonary HCD.
Methods: Demographical characteristics, laboratory parameters and clinical features of 171 children and adult patients with pulmonary HCD were enrolled. Age, gender, result of ELISA test, duration of hospitalization, surgical method of cyst excision and number, diameter, localization and perforation status of cysts were recorded. Physical examination, ultrasonography, computed tomography and serologic tests were used to confirm diagnosis of hydatid cysts.
Results: Perforated cysts were observed in 26 children and 22 adults. Twenty three children and 12 adults had giant cyst. Extrapulmonary hydatid cysts were observed in 10 children and 21 adults. Elisa IgG positivity was determined in 30 children and 34 adults. Twelve children experienced long-lasting air leakage that all responded to drainage. In adults group, 14 patients had long-lasting air leakage and 3 had empyema and expansion defect. The mean duration of hospitalization of children and adult were 8.9 and 10.45 days, respectively.
Conlusion: Better understanding of demographic features, clinical characteristics, complications of disease and surgical procedure help to determine optimal follow-up and therapeutic choice

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Amaç: Bu çalýþmada,medikal tedaviye cevap vermeyen ve kiþilerin sosyal yaþamýný olumsuz yönde etkileyen, palmar ve aksiler hiperhidrozisli olgularda endoskopik torakal sempatektomi deneyimlerimizi sunmayý amaçladýk.
Materyal-Method: Nisan 2013-Temmuz 2014 tarihleri arasýnda kliniðimizde %55’i erkek (n: 11); ortalama yaþ 25.4 olmak üzere 20 olguya, ayný seansta iki taraflý uygulanan 40 endoskopik torakal sempatektomi ameliyatý retrospektif olarak incelendi. Tek port kullanýlarak 12 (%60) olguya T2-T3, 8 (%40) olguya T3- T4 sempatik ganglionlarýn ve kuntz sinirinin koter kullanýlarak ablasyonu yapýldý. Tüm olgularýn postoperatif akciðer grafisi çekildi. Uygulanan cerrahi teknik, ameliyat süresi, ameliyat sýrasý ve sonrasý komplikasyonlar, hasta memnuniyeti ve tedavinin uzun dönem sonuçlarý deðerlendirildi.
Bulgular: Olgularýn uzun dönem takiplerinde, 12 olguda (%60) vücudun çeþitli yerlerinde kompansatuar hiperhidroz geliþti. Hiç bir olguda nüks görülmezken, 18 olgu (%90) endoskopik torakal sempatektominin sonucundan memnun olduðunu, iki olgu (%10) ise kýsmen memnun olduðunu belirtti. Bir olguda (%5) ameliyat sonrasý giriþim gerektiren pnömotoraks, iki olguda giriþim gerektirmeyen ekspansiyon kusuru geliþti. Ameliyat süresi ortalama 34,2 /dakika idi. Cerrahi mortalite gözlenmedi. Ortalama takip süresi 12,4 ay (5-22) idi.
Sonuç: Endoskopik torakal sempatektomi ayrýntýlý anamnez alýndýktan sonra seçilmiþ palmar ve aksiler hiperhidrozlu olgularda geç dönemde geliþen kompansatuar terleme riskine raðmen düþük morbidite, mortalite ve uzun dönem takiplerde yüksek memnuniyet nedeni ile tercih edilebilecek bir yöntem olduðunu düþünmekteyiz.

Objective: In this study, we aimed to present our experience on endoscopic thoracic sympathectomy for palmar and axillary hyperhidrosis that does not respond to medical treatment and affects the social lives of people.

Methods: We retrospectively reviewed the data of 20 patients (11 men and 9 women) with a mean age of 25.4 (17–34) years who underwent 40 bilateral endoscopic sympathectomy operations in the same session in our clinic between April 2013 and July 2014. In 12 (60%) patients at the level of T2-T3 and in 8 (40%) patients at the level of T3-T4; the sympathetic ganglions and the Kuntz nerve were ablated by using a single port approach. Postoperative chest X-ray was performed to all patients. All data regarding surgical technique, duration of operation, perioperative and postoperative complications, patient satisfaction, and long-term outcomes were presented.

Results: In long-term follow-up, 12 (60%) patients developed compensatory hyperhidrosis in various body regions. There was no recurrence in any case. Eighteen patients were satisfied and two were partially satisfied with the results of endoscopic thoracic sympathectomy. One patient developed pneumothorax that required intervention, and there was expansion failure in two patients who did not require any intervention. The mean duration of operation was 34.2 (25–45) minutes. There was no surgical mortality. The mean duration of follow-up was 12.4 (5–22) months.

Conclusion: We conclude that endoscopic thoracic sympathectomy is a preferable method with a low mortality and morbidity and high satisfaction in the long-term, despite the risk of late onset compensatory perspiration in elective patients with palmar and axillary hyperhidrosis.

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51 yaþýnda kadýn hasta polikliniðimize nefes darlýðý, halsizlik ve kuru öksürük þikayetleri ile baþvurdu. Posteroanterior akciðer grafisinde bilateral orta ve alt alanlarda belirgin non homojen opasiteler mevcuttu. Toraks bilgisayarlý tomografi incelemesinde sað akciðer alt lob anterior segmentte hava bronkogramý içeren konsolidasyon, bilateral bronþiektaziler, ve her iki akciðerde yaygýn yamalý buzlu cam dansitesinde opasiteler, interstisyel imajlarda belirginleþme kaydedildi. Ampirik antibiyoterapi ile radyolojik gerileme olmadý. Bronkoskopik incelemede endobronþiyal lezyon saptanmadý. Bronþ lavajýnda üreme olmadý. Tru-cut biyopsinin patolojik incelemesinde tek bir alanda granülomun eþlik ettiði alveoler septal kalýnlaþma ve fibrozis, hafif kronik inflamasyon ve konjesyon bulgularý saptandý. Hastanýn klinik ve radyolojik bulgularý birlikte deðerlendirilip non-spesifik interstisyel pnömoni tanýsý kondu. Fizik muayenede el týrnaklarýnda kalýnlaþma ve eþlik eden sarý renk deðiþikliði, yüzde ve bacaklarda hafif gode býrakmayan ödem ve bilateral Velcro ralleri mavcuttu. Hastaya sarý týrnak sendromu tanýsý ile 14 günlk klaritromisin, 4 aylýk metilprednizolon ve E vitamini tedavisi uygulandý.Tedavi sonunda hastanýn klinik ve radyolojik bulgularýnýn tama yakýn gerilediði gözlendi.

A 51-year-old woman presented with complaints of dyspnea, fatigue, and non-productive cough. Chest X-ray showed bilateral lung infiltrates. Nonspecific air-space consolidation on anterior segment of the right lower lobe, bilateral bronchiectasis and infiltrates, patchy ground-glass opacities, and interstitial thickening were reported on thorax computed tomography which was non-responsive to antibiotics. After tru-cut biopsy which only revealed a single granuloma in a particular area, alveolar septal thickening and fibrosis, slight chronic inflammation with findings of congestion, lung involvement was considered to be associated with nonspecific interstitial pneumonia. The nails on all fingers displayed yellow discoloration with mild edema in the face and the legs. The final diagnosis was yellow nail syndrome. Short-term clarithromycin and long-term oral methylprednisolone with vitamin E treatment were successful. After 4 months, all components of the syndrome almost completely regressed.

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Pulmoner kist hidatik (KH) embolisi, karaciðer hidatidozunun nadir bir komplikasyonudur. Bu yazýda karaciðer hidatidoz öyküsü olan, uzun süreden beri devam eden dispne ve renal fonksiyonlarda bozulma ile baþvuran 88 yaþýndaki kadýn hasta sunulmaktadýr. Çekilen kontrastsýz multidedektör bilgisayarlý tomografi (MDBT) görüntülerinde sað pulmoner arter içerisinde sýnýrlarý net olarak seçilebilen kistik lezyon ve sað üst loba giden arter dallarý içerisinde birleþme eðilimi gösteren milimetrik kistik lezyonlar ile eþlik eden karaciðer kist hidatik hastalýðý izlendi. Klinik öykü, laboratuvar bulgularý ve görüntüleme özellikleri göz önüne alýndýðýnda hastaya pulmoner KH embolisi tanýsý kondu. Pulmoner KH embolisi hepatik kistin inferiyor vena kavaya rüptüre olmasýna baðlý ortaya çýkmakta olup akut embolizmden kronik pulmoner hipertansiyona kadar deðiþen spektrumda klinik bulgular verebilir. Tanýda kontrastlý MDBT daha kullanýþlý olmakla birlikte, emboli kliniði ve destekleyici öyküsü olan hastalarda kontrastsýz görüntüler de doðru tanýda yardýmcý olabilir.

An 88-year-old woman presented to our clinic with a long-term history of cough, dyspnea, and fatigue. She had no history of smoking or biomass exposure. Her medical history revealed that she was treated with an antibiotic for three months eight years ago, but she did not recall the name of the drug or the indication. The results of routine blood testing and physical examination were unremarkable however, renal function test results were poor. The C-reactive protein level was 23 mg/L. Cardiac enzymes were at normal levels. Chest X-ray revealed a right hilar lobulated mass. Intravenous contrast could not be infused due to high creatinine levels. Non-contrast-enhanced multidetector computed tomography (MDCT) of the chest showed a well-delineated, nodular, hypodense mass with fluid attenuation in the right pulmonary artery (Figure 1) and multiple millimetric, hypodense lesions filling the upper lobe branches and surrounding the parenchyma (Figure 2, 3). The right ventricle volume and main pulmonary artery width were within normal limits. There was no flattening or paradoxical bowing of the interventricular septum. There were no visible lesions in the right atrium. A hypodense lesion with visible septa was shown adjacent to the inferior vena cava at images through the abdomen (Figure 4).

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