AMAÇ Akciðerin periferik lezyonlarý, plevral lezyonlar, mediastinal lezyonlar ve akciðerde lezyonu olup göðüs duvarý ve supraklavikular lenf bezi metastazý gibi torasik lezyonlarýn tanýsýnda toraks ultrasonografisi (USG) rehberliðinde yapýlan ince iðne aspirasyon biyopsilerinin (ÝAB) taný deðerini araþtýrmak.
MATERYAL METOD Ocak 2008-Aralýk 2016 tarihleri arasýnda torasik lezyonu olan ve toraks USG ile biyopsiye uygun bulunarak ÝAB yapýlan olgular çalýþmaya dahil edildi. Olgularýn demografik ve radyolojik bulgularý, USG ile tespit edilen lezyonlarýn boyutlarý, sonografik paternleri, lezyon baþýna ÝAB sayýsý, ÝAB ile gelen tanýlarý, taný gelmeyen olgularýn final tanýlarý, final taný yöntemleri ve komplikasyonlar kayýt edildi.
BULGULAR Olgularýn 188’ine (%72,6) periferik yerleþimli akciðer lezyonu için, 23’üne (%8,9) mediastinal kitle, 23’üne (%8,9) akciðerde kitlesi olup göðüs duvarý metastazý için, 18’ine (%6,9) supraklavikular lenf bezi metastazý için, 7’sine (%2,7) plevral lezyonu için ÝAB yapýldý. Taný baþarýlarý sýrasý ile (%78.7, %78.2, %95.6, %94,4) idi. Toplam 259 olgunun 211’ine (%81,4) taný kondu (195 (%92,4) malign, 16 (%7,6) benign). Ýþlemin genel taný baþarýsý %81,4, malign lezyonlar için %81,9, benign lezyonlar için %76,1 olarak hesaplandý. Majör komplikasyon olarak periferik yerleþimli akciðer lezyonu olan 5 olguda (%1.9) toraks tüpü takýlmasý gereken pnömotoraks geliþti.
SONUÇ Tüm torasik lezyonlarda USG rehberliðinde yapýlan ÝAB’ler taný oranlarý yüksek (%81,4), majör komplikasyon oranlarý düþük (%1.9) iþlemlerdir.

BACKGROUND To investigate the diagnostic value of fine-needle aspiration biopsy (FNAB) performed under the guidance of thoracic ultrasonography (USG) for the diagnosis of thoracic lesions such as peripheral lung lesions, pleural lesions, mediastinal lesions and chest wall or supraclavicular metastases of lung lesions.
METHODS Cases with thoracic lesions that were found eligible for biopsy by thoracic USG and underwent FNAB between January 2008 and December 2016,were included to the study. Demographical characteristics and radiological findings of the cases, lesion size as detected by USG, sonographic patterns, number of FNABs per lesion, diagnosis based on FNAB, final diagnosis of inconclusive cases and the methods used to establish the final diagnosis, and developed complications were recorded.
RESULTS FNAB was performed for peripheral lung lesion in 188 (72.6%), for mediastinal mass in 23 (8.9%), for chest wall metastasis of lung tumor in 23 (8.9%), for supraclavicular lymph node metastasis of lung tumor in 18 (6.9%) and for pleural lesion in 7 (2.7%) cases. Diagnostic accuracy was 78.7%, 78.2%, 95.6%, 94,4% respectively. A diagnosis could be made in 211 of 259 (81.4%) cases (195 (92.4%) malign, 16 (7.6%) benign). Overall diagnostic success of the procedure was81.4%, and the success rate to diagnose malign and benign lesions was 81.9% and 76.1%, respectively.Pneumothorax which needs pleural tube inplacement was seen in five patients with peripheral lesion as major complication.
CONCLUSIONUS USG-guided FNAB performed for thoracic lesions, is associated with a high rate of diagnostic success (81.4%) and a low rate of major complications (1.9%).

AMAÇ Toraksýn malign lezyonlarýnda torasik ultrasonografi (USG) rehberliðinde yapýlan trans torasik tru-cut biyopsi (TTTCB) iþlemlerinin tanýsal deðerini araþtýrmak.
MATERYAL-METOD Nisan 2014-Mayýs 2017 arasýnda toraks USG rehberliðinde biyopsi yapýlan olgularýn dosyalarý retrospektif incelendi. Final tanýsý torasik malignite gelen olgulardan tanýsal yöntem olarak ayný seansta ayný lezyona hem TTTCB hem de trans torasik ince iðne aspirasyon biyopsi (TTÝAB) yapýlan olgular çalýþmaya dahil edildi. TTTCB’nin ve TTÝAB’nin ayrý ayrý ve birlikte yapýlmalarýnýn tanýsal baþarýlarý hesaplandý. Ýþlemlerinin tanýsal baþarýsý Mc Nemar testi kullanýlarak karþýlaþtýrýldý.
BULGULAR Çalýþmaya 32 olgu dahil edildi. Toraks USG rehberliðinde yapýlan TTÝAB ve TTTCB ile 32 olgunun 30’unda (%93.8) tanýsaldý. TTÝAB bu 32 olgunun 23’ünde (%71.8), TTTCB 26’sýnda (%81.2) tanýsaldý. TTÝAB’nin tanýsal olmadýðý 9 olgunun 7’sinde (%77.7) TTTCB tanýsal olmuþtu. Yapýlan TTÝAB iþleminin taný baþarýsý %71,8, TTTCB iþleminin %81,2, TTTCB ve TTÝAB’nin ayný seansta birlikte uygulanmasý ile genel taný baþarýsý %93.7 olarak hesaplandý.
Torasik USG rehberliðinde tek baþýna yapýlan TTTCB iþlemi ile TTÝAB iþleminin tanýsal baþarýsý arasýndaki fark yoktu (p=0.508). Her iki iþlemin birlikte yapýlmasýnýn taný baþarýsý, tek baþýna TTÝAB yapýlmasýna göre anlamlý olarak yüksek bulundu (p=0,016). Ýþlemler sýrasýnda 1 olguda (%3.1) olguda tüp takýlmasýna gerek olmayan pnömotoraks geliþti.
SONUÇ Torasik USG rehberliðinde yapýlan TTÝAB ve TTTCB iþlemleri tanýsal baþarýsý yüksek iþlemlerdir ve birbirlerine üstünlükleri yoktur. USG rehberliðinde her iki iþlemin kombine edilmesi taný baþarýsýný istatistiksel anlamlý oranda artýrmaktadýr.

Aim: To investigate the diagnostic value of ultrasound (US) guided transthoracic fine needle aspiration biopsy (TTFNA) and US guided transthoracic tru-cut biopsy (TTTCB) in malignant thorax lesions.
Material and method: Patients who underwent US guided transthoracic biopsies between April 2014 and May 2017 were retrospectively evaluated. Patients who were diagnosed as thoracic malignancy and both TTTCB and TTFNA performed for the same lesion were included in the study. The diagnostic accuracy of TTTCB, TTFNA and their combination were analyzed. The diagnostic accurracy of methods were ststistically compared by McNemar Test.
Results: Thirty two patients were included in the study. Ultrasound guided TTFNA and/or TTTCB were diagnostic in 30 (93.8%) of them. TTFNA was diagnostic in 23 (%71.8), TTTCB were diagnostic in 26 (%81.2) of these pateints. Seven (77.7%) of 9 patients in which TTFNA was not diagnostic, TTTCB was diagnostic. The diagnostic accuracy was 71.8% and 81.2% for TTFNA and TTTCB, respectively. When TTTCB and TTFNA were performed consecutively in the same procedure, the overall diagnostic accuracy was 93.7%. There was no difference between the diagnostic accuracy of US-guided TTFNA and TTTCB (p=0.508). The diagnostic accuracy of combination of TTFNA and TTTCB was significantly higher than that of TTFNA alone (p=0.016). During the procedures, pneumothorax which didnot require chest tube insertion was detected as complication in 1 case (3.1%).
Conclusion: Diagnostic accuracy of US-guided TTFNA and TTTCB is high and has no superiority to each other. Combining both procedures under the quidence of US increases the diagnostic accuracy statistically significantly.

Amaç: Ýskemi ve reperfüzyona baðlý olarak ortaya çýkan akciðer hasarýnýn fizyopatolojisi baðlamýnda, iskemik ardkoþullama protokolüne Morfin sulfat ilavesinin etkisini araþtýrmayý amaçladýk.
Metod: Çalýþmada 48 diþi Wistar albino sýçan kullanýldý. Sol 5. Ýnterkostal aralýktan torakotomi yapýlan grup Sham grubu olarak kabul edildi. Ýskemi reperfüzyon (IR) grubunda torakotomi ve iskemi reperfüzyon periyodu uygulandý. Ýskemi reperfüzyon ardkoþullama (IRAK) grubunda torakotomi, iskemi reperfüzyon periyodu ve iskemik ardkoþullama uygulandý. Ýskemi reperfüzyon arkoþullama 3 ve 30 (IRAK3 ve IRAK30) gruplarýnda iskemik arkoþullamaya ilave olarak 3 ve 30 μmol Morfin sulfat dozlarý uygulandý. Akciðer doku örneklerinde TNF- α, IL-1 ve IL-10 seviyeleri ölçüldü.
Bulgular: Ardkoþullama ve Morfin uygulanan gruplarda proinflamatuar sitokin olan TNF-α ve IL-1 düþük deðerlere, antiinflamatuar sitokin olan IL-10 ise yüksek deðerlere sahipti. TNF-α ve IL-1 deðerlerinde IRAK3 ile IR ve IRAK gruplarý arasýnda anlamlý fark vardý. Ayrýca IL-10 deðerleri IRAK3 ile IRAK gruplarý arasýnda istatistiksel olarak anlamlý farka sahipti.
Sonuç: Çalýþmada iskemik ardkoþullama protokollerine ilave edilen morfinin proinflamatuar ve antiinflamatuar sitokin deðerleri karþýlaþtýrýldýðýnda istatistiksel olarak anlamlý sonuçlar elde edildi. Akciðer transplantasyon protokollerine morfinin eklenmesi ile ardkoþullamanýn iskemi reperfüzyon hasarýný azaltacaðýna inanýyoruz.

Objective: In the context of the physiopathology of lung damage due to ischemia and reperfusion injury, we aimed to demonstrate the effects of the addition of morphine sulphate to ischemic post-conditioning protocol.
Methods: In the present study, 48 Wistar albino female rats were employed. Group 1 was accepted as the Sham group that underwent thoracotomy through the fifth left intercostal space. IR group: thoracotomy and ischemia reperfusion period. IRPC group: thoracotomy, ischemia reperfusion period and ischemic post-conditioning. In IRPC3 and IRPC30 groups, in addition to ischemic post-conditioning different doses of morphine sulfate (3μmol and 30μmol) was administered. TNF- α, IL-1, and IL- 10 levels were measured in biochemical assessment of the lung tissue samples obtained.
Results: TNF-α and IL-1 (pro-inflammatory cytokines) have lower values and IL-10 (antiinflammatory cytokine) have higher values both in the groups which have been subject to postconditioning and morphine. TNF-α and IL-1 levels in lung tissue were statistically significant between the IRPC3 group and the IR and IRPC groups. In addition, IL-10 level in lung tissue were statistically significant between the IRPC3 group and the IRPC group.
Conclusion: In the present study conducted with experimental animals where morphine was also injected besides ischemic PC protocols, statistically significant differences were determined in the lung tissue analyses when we compared pro-inflammatory and anti-inflammatory cytokine values. We firmly believe that adding morphine to the lung transplantation protocols and post conditioning will decrease ischemia reperfusion damage.

Amaç
Bu çalýþmada, robotik cerrahi sistem kullanýlarak tedavileri yapýlan mediastinal kistik patolojisi olan hastalarýnýn sonuçlarý analiz edildi.
Materyal ve Metod
Ekim 2011-Haziran 2017 tarihleri arasýnda robotik cerrahi sistem kullanýlan 296 hastanýn prospektif toplanan datalarý retrospektif olarak incelendi. Bu hastalardan mediastenin kistik patolojileri sebebiyle opere olan 9 (%3) hasta çalýþmaya dahil edildi. Hastalarýn yaþý, cinsiyeti, robotun hastaya kenetlenme (docking) ve konsol süreleri, patoloji sonuçlarý, hastanede kalýþ süreleri, lezyonlarýn anatomik lokalizasyonlarý, kan transfüzyon ihtiyaçlarý, açýk cerrahiye geçme oranlarý, mortalite ve morbidite oranlarý kaydedildi.
Bulgular
Bu hastalarýn 5’i erkek 4’ü kadýn ve ortalama yaþ 45.5±21.2 idi. Lezyon 2 hastada ön, 4 hastada orta, 3 hastada ise arka mediastendeydi. Altý hasta bronkojenik kist, 1 hasta perikard kisti ve 2 hasta timik kist tanýlarý ile opere edildi. Ortalama hastane de kalýþ süreleri 3.3±1.5 gündü. Medyan konsol süresi 45 dakika (30 dakika-110 dakika) ve medyan docking süresi ise 20 dakikaydý (10 dakika-40 dakika). Hastalarýn hiçbirisine kan transfüzyonu uygulanmadý. Hiçbir hastada morbidite ve mortalite geliþmedi.
Sonuç
Biz mediasten cerrahisinde robotik teknolojinin, cerraha teknik üstünlükler saðlamasýyla, disseksiyonunda zorluk yaþanabilecek lokalizasyonda yerleþmiþ mediasten kistik patolojilerde tercih edilebileceðini düþünüyoruz.

Purpose
In this study, results of surgery for patients with mediastinal cystic pathology who were treated by the utilization of robotic surgery system were analyzed.
Material and Method
Prospectively collected data of 296 patients on whom robotic surgery system was used between October 2011 and June 2017 were retrospectively examined. Of these patients, 9 (3%) patients who were operated due to cystic pathologies of mediastinum were included in this study. Age, gender, docking and console times of the robot, pathology results, length of hospital stay, anatomic localization of the lesions, blood transfusion requirement, conversion to open surgery, mortality and morbidity rates were recorded.
Findings
Five patients were male and 4 were female, and the mean age was 45.5±21.2 years. The lesion was localized in anterior mediastinum in 2 patients, middle mediastinum in 4 patients, and in posterior mediastinum in 3 patients. Six patients underwent surgery with the diagnosis of bronchogenic cyst, 1 patient underwent surgery with the diagnosis of pericardial cyst, and 2 patients underwent surgery with the diagnosis of thymic cyst. The mean length of hospital stay was 3.3±1.5 days. The median console time was 45 minutes (30 minutes-110 minutes) and the median docking time was 20 minutes (10 minutes-40 minutes).
Conclusion
We consider that, with technical advantages provided to the surgeon in mediastinal surgery, robotic technology can be preferred in cystic pathologies of the mediastinum localized in areas that may pose challenges in dissection.

Amaç: Sarkoidoz, non-kazeifiye granülomatöz inflamasyon ile karakterize multisistemik kronik bir hastalýktýr. Diðer kronik inflamatuvar ve malign hastalýklarýn sýklýðýnda artýþ olduðu bildirilmektedir. Çalýþmanýn primer amacý sarkoidoz hastalarýnda komorbid hastalýk tiplerini ve sýklýðýný, özellikle romatoid artrit, tiroid hastalýklarý gibi oto-immün olanlar ve malignite riskinde artýþ olup olmadýðýný saptamaktýr. Sekonder amaç sýk saptanan komorbiditelerin iliþkili olduðu faktörleri belirlemektir.
Metod: Kliniðimizde 1998-2016 yýllarý arasýnda sarkoidoz tanýsý ile dosya açýlmýþ 694 hastanýn dosyasý retrospektif incelendi. Kaydedilen komorbid hastalýklarýn sýklýðý ülke verileri ile karþýlaþtýrýldý.
Bulgular: Hastalarýn 487’si (%70) kadýn ve taný anýnda yaþ ortalamasý 42.9±11.8 (18-87) idi. 490 (% 70) hastada en az bir komorbidite saptandý. Çalýþmada en sýk saptanan komorbiditeler sýrasýyla; sistemik hipertansiyon (%22), hepatosteatoz (%16.9), diabetes mellitus (%16.4), tiroid hastalýklarý (%13.1), astým (%12) idi. Malignite %4.0, romatoid artrit % 2.2 oranýnda bulundu. Ülke genelinde görülen sýklýklarýyla karþýlaþtýrýlmasýnda diabetes mellitus, tiroid hastalýklarý, astým, malignite ve romatoid artrit prevalansýnýn daha yüksek olduðu görüldü. Diyabet, tiroid, astým hastalýðý kadýnlarda daha sýk idi. Komorbidite olarak diyabet, tiroid, astým, romatoid artrit hastalýðý ve malignite saptanan hastalarýn yaþ ortalamasý olmayanlara göre daha ileriydi.
Sonuç: Sarkoidoz hastalarýnda komorbidite sýk izlenmekte olup, diabetes mellitus, tiroid hastalýklarý, astým, malignite ve romatoid artritin görülme sýklýðý ülke verilerine göre yüksektir.

Objective: Sarcoidosis is a multisystem chronic disease characterized by granulomatous inflammation. It is reported that the frequency of other inflammatory and malignant diseases increases. The primary objective of the study is to determine the types of comorbid diseases and their frequency, and whether the risk of malignancies and autoimmune diseases such as rheumatoid arthritis and thyroid increases. The secondary objective is to identify the factors related to the comorbidities frequently detected.
Methods: The files of 694 patients who had the diagnosis of sarcoidosis between1998-2016 were evaluated. The frequency of comorbid diseases recorded was compared to the data of our country.
Results: Among the patients, 487(70%) were female, and the mean age at diagnosis was 42.9 ± 11.8 (18-87). In 490 patients (70%) at least one comorbidity was detected. The most frequently detected comorbidities were systemic hypertension(22%), hepatosteatosis (16.9%), diabetes mellitus (16.4%), thyroid diseases (13.1%), and asthma (12%). Malignancy was found in a ratio of 4.0%, rheumatoid arthritis in 2.2%. The comparison to the frequencies across the country showed that the prevalence of diabetes mellitus, thyroid diseases, asthma, malignancy, and rheumatoid arthritis was higher. Diabetes, thyroid diseases, asthma were more frequent in women. The mean age of patients in which diabetes, thyroid diseases, asthma,rheumatoid arthritis or malignancy was detected as a comorbidity was higher than those without comorbidities.
Conclusion: Comorbidities frequently occur among sarcoidosis patients, and the frequency of diabetes mellitus, thyroid diseases, asthma, malignancy, and rheumatoid arthritis is higher than the data of the country.

Giriþ: Kaliteli ve güvenli hasta bakýmýnýn sürekliliðini saðlamakla yükümlü olan hemþirelerin uyku sorunlarý açýsýndan ciddi risk taþýdýklarý bilinen bir gerçektir. Bu düþünceden yola çýkýlarak hemþirelerin uyku kalitesi ve etkileyen faktörlerin belirlenmesi amacýyla çalýþma gerçekleþtirildi.
Yöntem: Tanýmlayýcý-kesitsel nitelikteki çalýþma, Ýstanbul’da bir eðitim araþtýrma hastanesinde çalýþan 152 hemþire ile gerçekleþtirildi. Bireysel Özellikler Formu, Pittsburgh Uyku Kalitesi Ýndeksi (PUKÝ), Hastane Depresyon ve Anksiyete Ölçeði (HAD), Epworth Uykululuk Ölçeði (EUÖ) ve Yorgunluk Þiddeti Ölçeði (YÞÖ) olmak üzere 5 bölüm ve 64 sorudan oluþan anket formu kullanýldý. Verilerin analizinde tanýmlayýcý testler, ki-kare testi, Spearman korelasyon analizi ve ikili lojistik regresyon analizi kullanýldý.
Bulgular: Hemþirelerin %61,9’unun düþük uyku kalitesine sahip olduðu belirlendi. PUKÝ ile EUÖ ve HAD-D arasýnda zayýf derecede, PUKÝ ile YÞÖ ve HAD-A arasýnda orta derecede pozitif iliþki görüldü. Yaþ, çalýþma þekli, anksiyete ve yorgunluk düzeylerinin uyku kalitesini etkileyen faktörler olduðu belirlendi.
Sonuç: Çalýþmanýn sonuçlarý hemþirelerin yaklaþýk üçte ikisinin uyku kalitesinin düþük olduðunu ve ileri yaþ, gece vardiyasýnda çalýþma, anksiyete ve yorgunluk düzeyi yüksekliðinin uyku kalitesini olumsuz etkilediðini göstermektedir. Hemþirelerin uyku kalitesinin arttýrýlmasýnda yaþ, mesleki deneyim ve ruhsal saðlýk durumu dikkate alýnarak çalýþma yaþamlarýnýn düzenlenmesinin etkili olabileceði düþünülmektedir.

Background: It is a known fact that nurses who are obliged to maintain the continuity of quality and safety patient care have a serious risk of sleeping problems. From this point of the study was conducted to determine the sleep quality of nurses and affecting factors.
Material and Methods: The descriptive-cross sectional study was carried out with 152 nurses working at a training and research hospital in Istanbul. A questionnaire form consisted of Individual Characteristics Form, Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale (HAD), Epworth Sleepiness Scale (ESS) and Fatigue Severity Scale (FSS) was used to collect data. Descriptive tests, chi-square test, Spearman correlation analysis, binary logistic regression analysis were used for statistical analysis.
Results: It was determined that nurses of 61,9% had poor sleep quality. While a weak positive correlation was found between PSQI and ESS, HAD-D, a moderate correlation was determined between PSQI and FSS, HAD-A. Age, working style, anxiety and fatigue levels were found to be factors affecting sleep quality.
Conclusion: The results of the study show that sleep quality of nurses is low in approximately two thirds of them and elder, night shift work, high anxiety and fatigue levels have a negative effect on sleep quality. It is thought that the regulation of working life considering age, occupational experience and mental health status may be effective in order to increase the sleep quality of nurses,

Amaç
Bronþektazi olgularýnda bakteriyel enfeksiyon etkenin izole edilmesi hastalýk þiddeti ile iliþkilidir. YBÜ’ nde bronþektazi alevlenmesi tanýsýyla hospitalize edilen olgularda enfeksiyon varlýðýnýn prognoza etkisinin deðerlendirilmesi amaçlanmýþtýr.
Yöntem
Tek merkezli retrospektif araþtýrmaya YBÜ’ ne bronþektazi alevlenme tanýsýyla yatýrýlan 48 hasta dahil edildi. Bu olgularýn YBÜ’ ne yatýrýldýklarý anda balgam kültürleri alýndý. Olgularýn klinik özellikleri, non-invaziv (NIV) ve invaziv ventilasyon (IV) ihtiyacý ve mortalite kaydedildi.
Bulgular
YBÜ’ ne kabulünde alýnan balgam kültüründe 24 hastada etken mikroorganizma görüldü. 12 hastada Pseudomonas aeroginosa, 4 hastada Streptokokus pneumonia, 3 hastada Hemophilus influenza, 3 hastada Acinetobacter baumannii ve 2 hastada Escherichia coli enfeksiyonu izlendi. 17 olgunun YBÜ’ nde takibinde IV ihtiyacý geliþti. Bu olgulardan yedisi takibinde ex oldu.
Balgam kültüründe üreme olmasý IV ihtiyacý ile iliþkili bulundu (p=0.005). Kültürde üreme olan grubun bronþektazi yaygýnlýðý daha fazlaydý (p=0.028). IV ihtiyacý olan ve prognozu kötü olan grupta bronþektazi yaygýnlýðý (p=0.007), PAP (p=0.004), CRP (p=0.014) ve son 1 yýlda hospitalizasyon sayýsý daha yüksek (p=0.017) bulundu. PAP, kültür sonucu ve bronþektazi yaygýnlýðý ile oluþturulan multipl lineer regresyon modelinde kültürde üreme olmasý en önemli faktör olarak izlendi (OR: 2.05, (CI: 0.875-3.230); p=0.04).
Sonuç
YBÜ’ nde takip edilen bronþektazi alevlenme olgularýnda balgam kültüründe üreme olmasý hastalýk prognozunda en önemli faktördür.

Objective
In bronchiectasis cases, isolation of the bacterial infection agent is related with disease severity. The purpose of the study was to find the impact of bacterial infections on the prognosis of bronchiectasis exacerbations in patients hospitalized in the intensive care unit (ICU).
Method
A retrospective, single-center, clinical study was performed on 48 patients who were diagnosed as having bronchiectasis exacerbation in the ICU. Sputum cultures of the patients were collected at the time of ICU admission. Clinical characteristics, treatment with non-invasive ventilation (NIV), invasive ventilation (IV) requirement, and mortality were recorded.
Results
The bacteriologic sputum examination was positive in 24 patients. The bacteriologic analysis of sputum cultures revealed Pseudomonas aeruginosa in 12 patients, Streptococcus pneumonia in 4, Hemophilus influenza in 3, Acinetobacter baumannii in 3, and Escherichia coli in 2 patients. Seventeen patients needed IV during ICU follow-up, 7 of whom died.
Bacterial proliferation in sputum culture was correlated to IV treatment need (p=0.005). The radiologic disease extent was greater in patients with culture proliferation (p=0.028). The patients who needed IV treatment had a greater radiologic disease extent (p=0.007), pulmonary artery systolic pressure (PAP) (p=0.004), C-reactive protein (CRP) (p=0.014), and number of hospital admissions (p=0.017). A multiple regression analysis for treatment success involving the variables of PAP, culture results, and radiologic disease extent revealed that bacterial proliferation was the most important factor for treatment success (OR: 2.05; CI: [0.87-3.23]; p=0.04).
Conclusion
Positive bacterial examination of sputum is the most important prognostic factor for patients with bronchiectasis exacerbation admitted to the ICU.

Toplumda geliþen pnömoni (TGP) günlük pratikte sýkça karþýlaþýlan, toplum içinde ve günlük yaþam sýrasýnda bilinen herhangi bir immün yetmezlik durumu olmayan kiþilerin toplumdan edindiði patojenlere baðlý olarak geliþen bir alt solunum yolu ve akciðer parenkimi infeksiyonudur. Pnömoni tedavisindeki gecikmenin morbidite ve mortaliteyi artýrdýðý bilinmektedir. Günümüzde pnömonide tedavi gruplarýný belirlemede, çeþitli skorlama sistemleri kullanýlmaktadýr. TGP olgularýna yaklaþýmýn deðerlendirilmesi amacýyla Türkiye Solunum Araþtýrmalarý Derneði (TÜSAD) Ýnfeksiyon Çalýþma Grubu tarafýndan 22 soruluk bir anket hazýrlanmýþtýr. Anket Temmuz 2013-Haziran 2016 tarihleri arasýnda TÜSAD’a ait resmi web sayfasýnda yayýnlanmýþtýr. Yetmiþ sekiz kiþi anketi internet sitesi üzerinden yanýtlamýþtýr. Anket sorularýna verilerin cevaplarýn hekimlerimizin TGP’ye yaklaþýmýný göstermesi açýsýndan yeni rehberlere öncülük edeceðini düþünmekteyiz.

Community-acquired pneumonia (CAP), which is often seen in daily practice, is a lower respiratory tract and pulmonary parenchyma infection which develops in society and daily life with community-acquired pathogens in individuals with no known immune failure. Delay in the treatment of pneumonia is known to increase morbidity and mortality. Various scoring systems are currently used in the identification of treatment groups in pneumonia. With the aim of evaluating the approach to CAP cases, the Infection Working Group of the Turkish Respiratory Research Association (TUSAD) prepared a 22-item questionnaire, which was published on the TUSAD official website between July 2013 and June 2016. A total of 78 individuals responded to the questionnaire on the website. The responses to the questionnaire could indicate the way forward for new guidelines for physicians in respect of the approach to CAP.

Geçtiðimiz seksen yýl içinde kaydedilen ilerlemelere raðmen; torasik cerrahi, çoðunlukla yüksek riskli hastalarla uðraþýlmasý itibariyle halen mortalite ve morbidite anlamýnda üst sýralarda yer alan bir disiplindir. Bu durumda, çok sayýda torasik cerrahi vakasýnýn yapýldýðý merkezlerde çalýþan anestezistler için de stres ve endiþe kaçýnýlmaz olmaktadýr.
Ýþte bu mevhumu aydýnlatmak, memnuniyet derecesini belirleyip, temel kaygýlarý ölçmek için bir anket oluþturuldu ve Türkiye'de göðüs hastalýklarý üzerine branþlaþmýþ dört büyük hastanede çalýþan 30 anesteziste gönderildi. 19 kiþiden alýnan cevaplar doðrultusunda elde edilen veriler burada paylaþýldý.
Tecrübe düzeyi ve nasýl kazanýldýðý, nöbet sayýsý, insan iliþkileri, taný ve tedavi araçlarýna ulaþma imkâný, bilimsel aktivitelere katýlým ve nihayetinde genel memnuniyet düzeyi sorgulandý ve rakamlar kaydedildi.
Katýlýmcýlarýn %68,4’ünün genel memnuniyeti kabul edilebilir düzeydeydi. Nöbetlerin fazlalýðý, ECMO, ILA, PICCO, ultrason, video laringoskop gibi araçlarýn kullanýlamamasý, bilimsel aktivitelerde yeterince yer alamamak ve diðer birimlerle iletiþimin bozuk olmasý temel sorunlar olarak görülmekteydi.
Yine katýlýmcýlar, bu olumsuzluklarýn üstesinden gelmek için yapýlabilecek temel iyileþtirmelerin araþtýrma ve yayýn sürecine katýlýmý arttýrmak (%38,8) ve kiþisel iliþkileri düzenlemek (%36,8) olduðu yönünde görüþ belirttiler.
Sonuç olarak, bu problemleri çözmeye yönelik somut adýmlar atýlarak, mutlu bir çalýþma ortamý yaratýlabileceði aþikardýr. Þunu mutlaka belirtmek gerekir ki; sadece kurumlarýn deðil genel saðlýk hizmetinin kalitesinin de arttýrýlmasý, ancak hem anestezistler hem de göðüs hastalýklarý ve göðüs cerrahisi uzmanlarýnýn karþýlýklý olarak olumlu davranýþ biçimleri sergilemesiyle mümkündür.

Despite subsequent improvements at the last eighty years, thoracic surgery is still ranked at top spots by means of mortality and morbidity on the occasion of dealing with high risk patients mostly. This fact legitimates the stress and anxiety of anesthesiologists employed in high-volume thoracic surgery centers.
To evaluate the level of satisfaction and determine major concerns, a survey was formed and sent to 30 anesthesiologists working at four major centers dedicated to respiratory diseases. 19 replies were received and the collected data was shared.
Degree of expertise and how it had been gained, quantity of night shifts, measures of personal relationships, availability of certain diagnostic and therapeutic tools, contribution to research activities and eventually level of satisfaction at all was questioned and ratings were noted.
The level of acceptable satisfaction was determined to be 68.4%. Major concerns were seemed to be excess of night shifts; inability to use certain modalities like ECMO, ILA, PICCO, ultrasound and video laryngoscopy; inadequate participation at research acts, and unfavorable inter-disciplinary relationships.
Participants specified basic potential improvements to overcome these adversities as taking place in scientific activities and publishing process more frequently(38.8%) and regulating personal relationships (36.8%).
Concisely, by taking concrete steps for solving these issues, a favorable work environment can be consituted. It is mandatory to emphasize that reciprocal acts of both anesthesists and respiratory disease specialists will certainly help promoting not only the institutions but also the quality of health service.

Ýdiopatik plöroparankimal fibroelastozis(PPFE) nadir görülen idiopatik interstisiel pnomönilerdendir. Etyoloji ve patofizyolojisi tam olarak bilinmemektedir.Prognozu kötü ve akciðer nakli dýþýnda etkin bir tedavisi bulunmamaktadýr.54 yaþýnda transbronþial biyopsi ile taný koyduðumuz, radyolojik ve histopatolojik özellikleri ile PPFE li bir olguyu literatür eþliðinde sunduk.

Pleuroparenchymal fibroelastosis (PPFE) classified in idiopathic interstitial pneumonitis group is rarely seen. Etiology and pathophysiology of this entity are not completely understood. The prognosis is poor and there is no effective treatment except for lung transplantation. Here we presented a case of PTFE diagnosed by transbronchial biopsy via fiberoptic bronchoscopy and its histopathological and clinicoradiological features.

Venöz tromboembolizm (VTE) kanser ile iliþkili en sýk görülen komplikasyonlardan biridir ve kanser hastalarýnda mortaliteyi artýrmaktadýr. Venöz tromboembolizm, gizli kanserin ilk bulgusu olarak ortaya çýkabilmektedir. Burada, 54 yaþýndaki bayan bir hastada VTE ve pulmoner tromboemboli ile ortaya çýkan daha sonra disemine pankreatiko-biliyer sistemden kaynaklý adenokarsinom tanýsý alan bir olgu sunulmuþtur.

Venous thromboembolism is a one of the most common complications of cancer, which also contributes to mortality in cancer patients. Venous thromboembolism can be the first manifestation of occult cancer. We present a case of 54-year-old woman with deep vein thromboembolism and pulmonary embolism as first signs of cancer who was subsequently diagnosed with disseminated adenocarcinoma, most likely of the pancreatico-biliar system.