Kronik olarak pestisidlere maruz kalmanýn akciðerlerdeki etkisini ortaya koymak amacýyla bu çalýþma yapýldý. Tarým ilacý satýþý yapan 13 iþyerinde çalýþmakta olan biri kadýn (%4.8) 20'si erkek (%95.2) toplam 21 olgu, kontrol grubu olarak pestisid maruziyeti olmayan 10 saðlýklý olgu çalýþmaya alýndý. Anket formu ile solunumsal semptomlar sorgulandý ve olgulara solunum fonksiyon testi (SFT) yapýldý. Olgularýn yaþ ortalamasý 36.86±15.22 yýl (16-66) idi. Olgularýn %52.4'ü 5 yýldan daha az süreyle iþyerinde çalýþmaktaydý. Sigara içenler çalýþma grubunda 13 kiþi (%61.9), kontrol grubunda 7 kiþi (%70) idi. Altý olguda (%28.6) balgam, yine ayný oranda hýrýltýlý solunum tespit edildi. Öksürük %14.3, dispne %9.5 oranýndaydý. Çalýþma grubunda solunum fonksiyon testi parametreleri normal sýnýrlarda olmakla birlikte kontrol grubuyla kýyaslandýðýnda FVC, FVC % ve FEV1 %'si açýsýndan istatistiksel olarak anlamlý düþmeler olduðu görüldü (sýrasýyla p<0.05, p<0.01, p<0.05). Pestisid maruziyetinin klinik etkisini görmek amacýyla olgularýn serum asetil kolinesteraz aktiviteleri (AKA) de deðerlendirildi. Bir olgu dýþýnda AKA normal sýnýrlarda bulundu, semptomlar ve SFT parametreleri ile arasýnda istatistiksel olarak anlamlý iliþki tespit edilmedi. Sonuç olarak kronik pestisid maruziyetinin solunum sistemi üzerine semptomlar ve SFT parametrelerinde deðiþikler oluþturabilecek kadar etkili olabildiði, fakat AKA'ni etkilemediði düþünüldü. Çalýþma grubumuzun azlýðý nedeniyle daha ileri sonuçlar elde etmek amacýyla daha büyük gruplarý deðerlendirmenin doðru olacaðý kanaatine varýldý.

This study was carried out to bring out the effect of chronic exposure to pesticide in lungs. Total 21 cases, female (4.8%) and 20 males (95.2%), in 13 employment places selling agricultural drug and 10 healthy cases who did not expose to pesticide were included in the study. Respiratory symptoms were evaluated as based on the questionnaire form and pulmonary function test (PFT) was carried out on the cases. The mean age of cases was 36.86±15.22 (16- 66) years and 52.4% of them have been working less than 5 years in those places. 13 persons (61.9%) in the study group and 7 (70%) in the control were smoking. Sputum in 28.6%, wheezing in 28.6%, cough in 14.3% and dyspnea in 9.55% of cases were deteced in the study group. The parameters of respiratory function test in the study group were within normal limits, but values of FVC, FVC % and FEV1 % were statistically significant lower than that in the control (p<0.05, p<0.01 and p<0.05, respectively). Also, serum acetyl cholinesterase activity (ACA) were evaluated to observe the clinical effect of pesticide exposure in the cases. ACA was within in normal limits in all the cases but one, and it wasn’t determined and significant relation between the activities and symptoms and PFT parameters. In conclusion, it was thought that chronic exposure to pesticide may affect the respiratory system in the ratio that may cause to changes on symptoms and PFT parameters but has no any effect ACA. And our opinion is that to obtain further results, the study should be carried out in larger groups.

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Çalýþmanýn amacý egsoz gazlarýnýn trafik polislerinin solunum sistemi üstündeki etkilerini incelemektir. Bu amaçla prospektif bir çalýþma düzenlendi. Çalýþmaya Ankara'nýn kavþaklarýnda çalýþan trafik polisleri (n: 251) ve saðlýklý kontroller (n:80) alýndý. Özgeçmiþ, fizik inceleme bulgularý, bazý spirometrik parametreler ve göðüs filmleri çalýþmanýn baþýnda ve iki yýl sonra deðerlendirildi. Çalýþmanýn baþlangýcýndan iki yýl sonra trafik polislerinde solunumsal yakýnma ve fizik inceleme bulgularýnda anlamlý düzeyde artýþ gözlendi. Baþlangýçta trafik polislerinin bazal spirometrik deðerleri kontrollerden daha yüksekti ancak iki yýl sonra hem sigara kullanan, hem de kullanmayan trafik polislerinde pulmoner fonksiyonlarýn kontrollerden daha fazla düþtüðünü gözlemledik. Trafik polislerinde yýllýk FEV1 kaybý 26 ml iken (sigara kullananlar ve kullanmayanlar için sýrayla; 28 ml ve 24 ml) kontrollerde 7 ml idi. Sonuçlar trafik polisliðinin solunum sistemi ile ilgili yakýnmalarda artýþ ve solunum fonksiyon testlerinde bozulmayla birlikte kronik akciðer hastalýklarý yönünden riskli bir meslek olabileceðini düþündürmektedir.

Aim of this study is to evaluate the effects of exhaust emmisions on pulmonary system of traffic policemen. A prospective study was designed for this purpose Traffic policemen (n: 251) who were occupied in the cross roads of Ankara city and healthy controls (n: 80) were included to this study. Anamnestic informations, physical examination findings, some spirometric values and chest x-rays were obtained at the beginning of the study and repeated two years later. Significant increase in symptoms and physical findings related with pulmonary system in traffic policemen was observed at the end of two years. Basal spirometric values of traffic policemen were higher than controls at the beginning but we found higher decline of pulmonary functions in both smoker and non smoker traffic policemen than controls. Annual mean FEV1 loss was 26 ml for traffic policemen (28 ml and 24 ml for smokers and non smokers respectively) and 7 ml for control group. Our results pointed out that traffic policemen as an occupation had got potential risks regarding increase in pulmonary symptoms and deterioration of pulmonary function tests.

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Bu çalýþma Amerikan Toraks Derneði (ATS) kriterlerine göre hastanede veya yoðun bakýmda yatarak izlenmesi gereken, Grup 3 ve 4 toplum kökenli pnömoni (TKP)'li 73 eriþkin hasta üzerinde yapýldý. Hastalarýn 43'ü erkek (% 58.9), 30'u kadýn (%41.1) ve ortalama yaþ 49.2 (16- 88) idi. Grup 3 TKP'lerde en sýk alt lob tutulumu (%53.5) gözlenirken, Grup 4 TKP'lerde ise en sýk bilateral akciðer tutulumu (%53.4) gözlendi. Bilateral ve birden fazla lob tutulumu Grup 4 TKP'li 23 kiþide (%76.7) tespit edildi. Multilober ve bilateral radyolojik tutulumu olan hastalarýn PaO2 ve Satürasyon (SaO2) deðerleri, lober tutulumu olanlarla karþýlaþtýrýldýðýnda daha düþüktü (p<0.05). Tedavi sonrasýndaki hastalarýn PaO2, PaCO2 ve SaO2 deðerleri ise birbirine benzer olarak bulundu. Bilateral veya multilober tutulum arasýnda PaO2, PaCO2 ve SaO2 deðerlerinde anlamlý farklýlýk saptanmadý (p>0.05). Komplikasyon 10 hastada (%13.7) gözlendi, bunlarýn 3'ünde multilober tutulum ve 6'sýnda bilateral tutulum vardý. Bilateral tutulumun olmasý komplikasyon geliþimi ile iliþkili bulundu (p<0.05). Sonuç olarak radyolojik tutulum alanýnýn yaygýnlýðýna paralel olarak hastalarýn PaO2 ve SaO2 deðerleri düþmekte ve bu hastalarda komplikasyon geliþme riski artmaktadýr.

In this study we investigated the relations between arterial blood gases (ABG) and radiographic findings of community acquired pneumonia (CAP) which classification recommended the 1993 American Thoracic Society guidelines. Group 3 consist of 43 (%58.9) patients with CAP and Group 4 consist of 30 (%41.1) patients with CAP. The mean age was 49.2 (16-88) years; 43 patients (%58.9) were male and 30 (%41.1) were female. The most common radiographic feature were lower lobe (%53,5) infiltrations in Group 3 CAP and bilateral infiltration in Group 4 CAP. Twenty three patients (%76,7) of Group 4 CAP had bilateral and multilober infiltration. The patients who had multilober and bilateral radiographic infiltration had lower PaO2 and O2 saturation compared to patients with lober infiltration (p<0,05). PaO2, PaCO2 and O2 saturations were similar at the end of the therapy (p>0,05). Complications were seen in 10 patients (%13,7), 3 of them had multilober and 6 of them had bilateral radiographic infiltration. Bilateral radiographic infiltration had statistically significant correlation with the complication (p<0,05). As a result, if the radiographic infiltration of a patient is bilateral or multilober, then the patient would develop lower PaO2 and O2 saturation and will have increased risk of complications compared to patients with lober infiltration.

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Akciðer tüberkülozunun bakteriyolojik tanýsýnda Mycobacteria Growth Indicator Tube (MGÝT) yönteminin deðerini araþtýrmak amacýyla yapýlan bu çalýþmada klinik ve radyolojik olarak akciðer tüberkülozu düþünülen 42 olgudan alýnan 126 balgam örneðinin homojenizasyon ve konsantrasyon sonrasý yayma mikroskopisi yapýldýktan sonra MGÝT ve Löwenstein Jensen (LJ) kültür ortamlarýna ayrý ayrý ekilerek sonuçlar karþýlaþtýrýldý. MGÝT yöntemi ile izolasyon oraný % 65, LJ yöntemiyle % 68.3 bulundu (p<0.0001). Ortalama üreme süresi LJ besiyerinde 29.6±10.8 (min:13 - max: 60) gün, MGÝT'te 15.5±11.2 (min: 3-max: 44) gün idi (p<0.0001). LJ yöntemine göre MGÝT yönteminin duyarlýlýðý % 88.3, özgüllüðü % 85, pozitif kestirim deðeri % 92.6, negatif kestirim deðeri % 77.2 bulundu. MGÝT yönteminin Mycobacterium tuberculosis gösterilmesinde hýzlý sonuç veren güvenilir bir yöntem olduðu ve rutin kullanýma girmesinin yararlý olacaðý sonucuna varýldý.

We aimed to evaluate the value of Mycobacteria Growth Indicator Tube (MGIT) method for the diagnosis of pulmonary tuberculosis in this sudy. 126 sputum samples of 42 cases considered as pulmonary tuberculosis clinically and radiologically have been cultured on MGIT and Lowenstein Jensen (LJ) culture media separately and the results have been compared. The isolation rates with MGIT and LJ method were 65 % and 68.3% respectively (p<0.0001). The mean proliferation times with MGIT and LJ method have been found 15.5±11.2 (min: 3-max: 44) and 29.6±10.8 (min:13 - max: 60) day, respectively (p<0.0001). The sensitivity, specifity, positive predictive value and negative predictive value of MGIT were 88.3%, 85%, 92.6% and 77.2%, respectively. The demonstration of Mycobacterium tuberculosis with MGIT method is a rapid and reliable method and we concluded that applying this method routinely will be useful.

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Fleksibl fiberoptik bronkoskopi (FFB) uygulamasý sýrasýnda geliþen oksijen desatürasyonunun derecesini, uygulamaya ait faktörleri ve hastalarýn solunumsal parametreleriyle iliþkisini saptamak amacýyla 55 hasta çalýþmaya alýndý. FFB uygulamasýyla tüm hastalarda pulse oksimetre ile oksijen satürasyonunda (SpO2) düþme saptandý (ortalama % 8.5). FVC deðeri ile SpO2'deki düþüþ arasýnda anlamlý iliþki (p= 0.023) saptandý. SpO2 deðeri % 90'ýn altýna inen 26 olgu ile % 90 ve üzerinde kalan 29 olgu arasýnda yaþ, cins, içilen sigara miktarý, FVC, FEV1, PaO2, FFB uygulama süresi ve verilen lavaj sývýsý miktarlarý yönünden anlamlý fark yoktu. Bu nedenle FFB uygulanan tüm hastalarda iþlem süresince SpO2 deðeri izlenmelidir.

In order to evaluate the severity of oxygen desaturation during the flexible fiberoptic bronchoscopy (FFB) to determine the interventional factors and the relation of these factors with pulmonary functional parameters 55 patients were included in our study.. The interventional factors and the relation of these factors with patients' pulmonary function parameters were also determined. Arterial oxygen desaturation (SpO2) measured by pulse oxymeter decreased after FFB procedure in all patients (mean 8.5 %). There is a statistically significant correlation between the FVC value of patients and the amount of decrease in SpO2 (p= 0.023). These cases were divided into two groups, Group I (n= 26) with SpO2< 90% and the others (n= 29) SpO2 90%. There is no difference between these groups according to age, sex, cigarette smoking, FVC, FEV1, PaO2, the duration of FFB procedure and the amount of given lavage fluid. Our results suggest that SpO2 must be closely monitored for all FFB performed patients.

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Önemli bir halk saðlýðý sorunu olan sigara içme alýþkanlýðý toplumun çeþitli kesimlerinde deðiþik oranlarda saptanmaktadýr. Türkiye'de sigara içme sýklýðý 15 yaþ ve üzerindeki grupta %44.5'dur (erkeklerde %62.8, kadýnlarda %24). Sigaraya baþlama yaþý 18'in altýndadýr. Çalýþmamýzda bireylerin sigaraya baþlama yaþý dönemlerinde yüksek oranda etkili olabileceði düþünülen öðretmenlerin sigaraya bakýþlarý ve sigara alýþkanlýklarý ile ilgili özelliklerini saptamak amacýyla 1999 yýlýnda Elazýð ilinde lise ve dengi okullarýnda görev yapan 533 öðretmene anket uygulanarak sonuçlarýn tartýþýlmasý amaçlandý. Ankete katýlan öðretmenler "rastgele örnekleme yöntemi" ile seçildi. Öðretmenlerin 225'inin (%42.2) sigara içtiði saptandý. Bunlarýn 187'si (%83.1) erkekti. Özellikle yabancý dil (%55.9) ve sosyal branþ öðretmenlerinde (%43.9) sigara içme oranýnýn yüksek olduðu saptandý. Sigara içenlerin 110'u (%48.9) 35 yaþ üzerindeydi ve %51.5'inin sigara içmeye baþlama yaþý 16-20 yaþlarý arasýndaydý. Sigaraya baþlama nedenleri içinde özenti ve merak %44.9 oranýyla birinci neden olarak bulundu. Alýþkanlýk hem erkek (%70.1) hem de kadýnlarda (%55.3) halen sigara içme nedenleri arasýnda ilk sýrada idi. %69.3'ünün (156/225) sigarayý býrakmayý düþündüðü saptandý. Öðretmenlerin %48'i (n=108) çocuklarýnýn yanýnda, %10.7'si (n=24) öðrencilerinin yanýnda sigara içiyordu. Sonuç olarak bu konuda sigara karþýtý kampanyalarýn geliþtirilmesi, pasif içicilerin ve özellikle 10-20 yaþ grubunun korunmasý ile bu yaþ grubunun eðitiminde en çok etkisi olan öðretmenlerin sigara baðýmlýlýðý, zararlarý ve býrakma yöntemleri konusunda eðitilmeleri gerektiði görüþündeyiz.

The habit of smoking, an important problem of public health, has been seen in various classes of the society in different proportions. The frequency of smoking in Turkey is 44.5 % in the group of 15 years old and over, (62.8% of male, and 24% of female). The age to begin smoking is under 18. Teachers’ view of cigarette and their habits of smoking were thought to affect the individuals’ age of beginning cigarette. Our study aimed to discuss the results of a questionnaire applied to 533 teachers of high school in Elazýð at 1999. The teachers who partipicated the questionnaire were chosen with “ causal sampling method ”. It has been fixed that 225 (42.2%) of the teachers have smoked. 187 (83.1%) of them was female. It is discovered that especially among the teachers of foreign languages (55.9%) and of social branches (43.9%), the ratio of smoking was high. 110 of the smokers (48.9%) are over 35 years old, and the age beginning smoking of 51.5% of them is between 16- 20. The first reason to start smoking is affectation and curiosity, and has a proportion of 44.9% among the other causes. The habitance is still the first cause of smoking both male and female. It is brought out that 69.3% (156/225) of the participiants thought to leave smoking. 48% (n=108) of the teachers smoke besides their children, 10.7% (n=24) of them smoke beside their students. Consequently, in this topic we argue that campaigns which are against smoking should be developed. Passive smokers, especially who are between the age of 10-20 and the teachers who are most effectual persons for those groups should be trained about the habit of smoking, its damages and the methods to quit it.

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Bu çalýþmanýn amacý, akciðer kanserlerinde serumda total kreatin kinaz (CK) ve kreatin kinaz-MB (CK-MB) izoenzimi deðiþimlerini izlemek, bu deðiþikliklerin kanserin hücre tipi ve yaygýnlýðý ile iliþkisini saptamak ve tanýya katkýsýný belirlemektir. 1996-1998 yýllarýnda akciðer kanseri tanýsý alan, herhangi bir tedavi uygulanmamýþ 58 olguda; serum total CK ve 35 olguda CK-MB deðerleri prospektif olarak incelendi. Kontrol grubu olarak aktif akciðer tüberkülozlu olgular seçildi. Serum total CK ve CK-MB deðerleri akciðer kanserli tüm olgularda kontrol grubuna göre anlamlý olarak yüksek bulundu. Hastalýðýn evreleri arasýnda veya küçük hücreli ve küçük hücreli dýþý akciðer kanseri arasýnda total CK ve CK-MB deðerlerinde anlamlý farklýlýk yoktu. Adenokanserli hastalarda CK-MB deðerleri, küçük hücreli akciðer kanserli olgularda hem total CK hem de CK-MB deðerleri kontrol grubuna göre anlamlý olarak yüksek bulundu. Bu yüksekliðin kreatin kinazýn ektopik üretimine veya tümör dokusunun nekrozuna baðlý olabileceði düþünüldü. Kontrol grubunda da yüksek deðerlerin olmasý nedeniyle, total CK ve CKMB'nin akciðer kanseri için spesifik tümör belirleyicisi olamayacaðý sonucuna varýldý.

The purpose of this study is; to follow the changes of serum total creatin kinase (CK) and isoenzyme creatin kinase-MB (CK-MB) in lung cancer, determine their relation with the type and dissemination of cancer, find out the addition for diagnosis. Serum total CK levels in 58 and CK-MB levels in 35 cases -diagnosed lung cancer in 1996-1998 and not having any treatmentwas determined prospectively. Cases with active pulmonary tuberculosis were choosen as control group. In all cases with lung cancer, serum total CK and CKMB levels were found significantly higher than control group. There were no significant difference for total CK and CK-MB between stages of the disease or small cell and non small cell lung cancer. CK-MB in cases with adenocancer, both total CK and CK-MB in cases with small cell lung cancer were found significantly higher than control group. This increase was thought to depend on the ectopic production of creatin kinase or necrosis of tumor tissue. Since there was also higher levels in control group, it was concluded that total CK and CK-MB could not be spesific tumor marker for lung cancer.

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Aspergilloma, genellikle iyileþmiþ tüberküloz kavitelerinde geliþen bir hastalýktýr. Aspergilloma tedavisinde cerrahi önemli bir seçenektir. Bu çalýþmada, cerrahi tedavi uygulanmýþ aspergillomalý hastalarda bu tedavinin baþarý durumunun deðerlendirilmesi amaçlanmýþtýr. Merkezimizde 1992-1999 yýllarý arasýnda cerrahi tedavi uygulanmýþ 20 aspergillomalý hastanýn dosyalarý retrospektif olarak incelendi ve Kasým 1999'da son kontrolleri yapýlarak anamnez, klinik, radyolojik ve laboratuvar bulgularý, histopatolojik sýnýþandýrma, operasyon tipleri ve uzun dönem takip sonuçlarý deðerlendirildi. Hastalarýn 14'ü erkek, 6'sý kadýn olup yaþ ortalamasý 46 (31-66) idi. Olgularýn 19'unda (%95) geçirilmiþ tüberküloz öyküsü olduðu, 15 hastanýn (%75) hemoptizi nedeniyle opere edildiði, radyolojik olarak 18 hastada (% 90) "aircrescent" bulgusunun bulunduðu saptandý. Üç hastaya bronþ lavajý, 1 hastaya ise transbronþial biopsi ile taný konuldu. 15 hastaya ( %75) lobektomi uygulandý. Hastalar histopatolojik olarak kompleks ve basit aspergilloma olarak sýnýþandýrýldý. Kompleks aspergillomalý 11 olgunun 3'ünde (%27) mortalite, 4'ünde (%36) morbidite, 9 basit aspergillomalý hastanýn ise 3'ünde ( % 33) morbidite geliþti. Kontrole gelen 12 hastanýn (6'sý basit aspergilloma, 6'sý kompleks aspergilloma) ortalama 35 ay (5-70 ay) süre ile takipleri yapýldý. Bu olgularda klinik þikayetlerin devam etmediði ve rekürrens geliþmediði saptandý. Bu çalýþma pulmoner rezervi yeterli olan aspergillomalý hastalarda semptomlarýn giderilmesinde cerrahi tedavinin etkin olduðunu, parenkim lezyonu ile birlikte olan kompleks aspergillomalý olgularda ise yüksek mortalite oraný nedeniyle gerekirse diðer tedavi yöntemlerinin tercih edilebileceðini göstermektedir.

Aspergilloma is a disease that commonly develops in healed tuberculosis cavities. Surgery is an important option for the treatment of aspergilloma. The purpose of our study was to evaluate the efficacy of surgery on the long-term survival of patients with aspergilloma. We retrospectively evaluated 20 patients who underwent surgery for aspergilloma between 1992–1999 at our hospital. Patients were followed until November 1999. We evaluated past medical history, clinical complaints, radiological findings, laboratory findings, histopathologic findings, type of operation and long- term outcome. 14 patients were male and 6 patients were female. The mean age was 46 (range, 31- 66). 19 patients had a previous history of pulmonary tuberculosis. 15 patients underwent surgery for hemoptysis. 18 patients had air crescent sign. Bronchoscopy was diagnostic in three patients with bronchial lavage and in one patient with transbronchial biopsy. 15 cases underwent lobectomy. The patients were divided into two groups: complex aspergilloma ( the patients with parenchymal lesions) and simple aspergilloma (the patients without parenchymal lesions). Mortality was seen in 3 cases of complex aspergilloma. Morbidity was seen in 4 cases of complex aspergilloma and in 3 cases of simple aspergilloma. We followed 12 patients (6 simple aspergilloma and 6 complex aspergilloma ) for 5–70 months with a mean follow-up of 35 months. We did not find any recurrence in radiological or clinical findings. The present study proves that surgery is an effective method of choice in simple aspergilloma patients with adequate pulmonary function, and other treatment modalities should be considered for patients with complex aspergilloma because of high mortality.

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24 yaþýndaki kadýn hasta ampiyem tanýsý ile acil tüp torakostomi yapýlarak kliniðimize yatýrýldý. Supraklavikuler bölgede geliþen 5x6 cm boyutlarýndaki deriden kabarýk, hiperemik ve vücuda göre daha sýcak olan bölgeye, yatýþýndan sonraki 5. gün insizyon yapýlarak 150 cc sývý boþaltýldý. Perikardiyal efüzyon ve hýzla tamponad geliþmesi üzerine, 19. gün perikard boþluðuna kateter konularak 500 cc sývý drene edildi. 23. gün bilgisayarlý toraks tomografisinde, kalbi sola iten paramediastinal apse poþu tespit edilerek, tüp mediastinostomi yapýldý ve 500 cc sývý drene edildi. Kontrol için istenen manyetik rezonans görüntülemesi ile mediastinde rezidü apse poþu görülmesi nedeni ile, 44. gün sað mini torakotomi yapýldý, ancak herhangi bir patoloji bulunamadý. Hasta 50. gün taburcu edildi.

A 24-year old woman was referred to our hospital with a diagnosis of empyema and an emergency tube thoracostomy was performed. Supraclavicularly located collection with tuberous tender and hyperemic appearance was 6 x 5 cm in size and was drained on 5th day followed by internalization of the patient. Since pericardial effusion and consequent cardiac tamponade was developed, pericardiocentesis was done and 500 ml pericardial fluid was aspirated. A thoracic CT disclosed a persistent paramediastinal pus cavity deplacing heart to the left side. A tube mediastinostomy was performed and 500 ml purulent fluid was drained. MRI showed persistent residual abcess sack. For this reason, a right exploratory mini-thoracotomy was done, but, no pathologic formation was discovered. The patient was discharged home on 50th day.

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41 yaþýnda erkek hasta sað yan aðrýsý, nefes darlýðý, kilo kaybý þikayetleri ile baþvurdu. PA Akciðer grafisinde sað alt zonda medialde homojen gölge koyuluðu izlendi. Toraks BT'de saðda parakardiak konumlu solid kitle lezyonu mevcuttu. Malign mezenþimal tümör (sarkom) tanýsý anterior mediastinotomi ile konuldu. Nadir ve kötü seyirli bir olgu olmasý nedeniyle literatür eþliðinde sunuldu.

A fourtyone years old male patient was admitted to our clinic with right sided chest pain, dyspnea and weight loss. Chest X-ray revealed homogeneous opacity at the right lower zone. Thorax CT revealed a solid mass lesion at the right paracardiac area. Anterior mediastinotomy was performed and biopsy materials revealed malign mesenchymal tumour (sarcoma). Patient is presented with related literature, because it is a rare case showing poor prognosis.

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KOAH tedavisinde inhalasyon yoluyla ilaç kullanmak hýzlý etki, düþük dozda ilaç kullanýmý ve yan etki azlýðý gibi avantajlar saðlar. Özellikle akut ataklar sýrasýnda yüksek dozda ilaç gereksinimi, hastalarýn inhaler cihazlarý iyi kullanamamasý halinde nebülizatörlerde kullanýlabilir. Sürekli yüksek dozda ilaç kullanmayý gerektiren ve inhalasyon tekniði iyi olmayan hastalar evde de nebülizatör kullanabilirler. Ancak nebülizatör kullanýmý faydalarýnýn yanýsýra artmýþ infeksiyon riskini de beraberinde getirir. Ayrýca yüksek dozda ilaç kullanýmý nedeniyle bazý ilaç yan etkilerinin dikkatle izlenmesi gereklidir.

Bronchodilator therapy is an important component of COPD management. The inhaler route have some advantages as fast effectiveness,low dose medication and low incidence of side effects. Especially during acute attacks, since necessary of larger doses and inadequaetly inhaler technique, nebulizers could be used. If the patient needs countiniously high doses medication and he/she was very ill, nebulizers could be advised domiciliary. But nebulizers have some disadvantages, as incrased enfection risk,and high incidence of side effects (hyperpotasemmia, urine retantion etc)

Abstract | Full Text PDF