Bu çalýþmada malign plevral mezotelyoma (MPM) tanýsý alan 35 hasta (11 kadýn, 24 erkek) prospektif olarak incelendi. MPM tanýsý için plevra biyopsisi (%57.1), torakotomi (%34.3), subkutan nodül biyopsisi (%5.7) ve transtorasik iðne aspirasyonu (%2.9) yapýldý. Hastalar randomize olarak iki gruba ayrýldý. Grup 1'e dahil edilen 22 hastaya cisplatin + mitomycine-C ve grup 2'e dahil edilen 13 hastaya cisplatin + mitomycine-C + interferon ?2b(IF) tedavi protokolu (cisplatin 28 günlük kürün 1. gününde 60mg/m2 IV, mitomycine-C 28 günlük kürün 1. gününde 6mg/m2 IV, IF?2b kürler arasýnda haftada 3 kez 6x106 ünite sc) uygulandý. Bütün hastalarda KT sonrasý semptomatik cevap, toraks bilgisayarlý tomografisinde objektif cevap ve saðkalým araþtýrmasý yapýldý. Her iki grup karþýlaþtýrýldýðýnda semptomatik cevapta ve objektif cevapta istatistiksel olarak anlamlý bir fark gözlenmedi. Dört hastada IF alýmýna baðlý olan nezle benzeri semptomlar ve hafif ateþ görüldü. Grup 1'de median survi 10 ay olarak bulundu (%95 güvenilirlik aralýðý [CI], 8.13-11.87), grup 2'de ise 14 ay idi (%95 [CI], 8.27-19.73). Ýstatistiksel olarak Log-Rank testi ile karþýlaþtýrýlan iki grup arasýnda anlamlý fark bulunmadý (z=0.23, p>0.005). Sonuç olarak; cisplatin + mitomycin-C rejimine IF?2b eklenmesinin, IF?2b olmaksýzýn bu rejimi alan hastalar da incelendiðinde, saðkalýma anlamlý bir katkýda bulunmadýðý saptanmýþtýr.

Thirty five patients (11 female, 24 male) with malignant pleural mesothelioma (MPM) were examined prospectively. Diagnosis of MPM was achieved via pleural biopsy (57.1%), thoracotomy (34.3%), biopsy of subcutaneous nodule (5.7%), or transthoracic needle aspiration (2.9%). Patients were divided randomly into group 1 and 2. Group 1 consisted of 22 patients who received cisplatin+mitomycine-C and group 2 consisted of 13 patients who received cisplatin+mitomycine-C+IF-?2b (cisplatin 60 mg/m2 IV on day 1 of 28 day cycle; mitomycine-C 6 mg/m2 IV on day 1 of 28 day cycle; and IF-?2b 6x106 units sc three times a week between cycles). Objective response in computerized chest tomograph, symptomatic response, and survival rate have been examined in all patients. When we compared both groups, there were not statistically significant differences in symptomatic response and objective response to chemotherapy. We observed flu-like symptoms and mild fever in 4 patients which were related to IF administration. Median survival was 10 months (95% confidence interval [CI], 8.13 to11.87) in group 1 and 14 months in group 2 (95% CI, 8.27 to 19.73). There was not statistical significance between two groups according to Log-Rank test (z=0.23, p>0.005). As a conclusion, addition of IF to cisplatin and mitomycine-C regimen did not show a significant improvement in median survival when compared with cisplatin+mitomycine-C regimen alone.

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Obstrüktif uyku apne sendromu; horlama, apne ve gün boyu uyku hali gibi semptomlarla seyreden zaman zaman tüm organ ve sistemleri etkileyebilen bir solunumsal uyku bozukluðudur. Çeþitli genetik ve çevresel faktörlerden etkilenmesi nedeniyle toplumdan topluma sýklýðýnýn deðiþtiði bilinmektedir. Bu nedenle her toplumda prevalans çalýþmalarý yapýlmasý, hem varolan durumu ortaya koymak hem de taný için gerekli polisomnografi ünitelerine olan ihtiyacý belirlemek açýsýndan önemlidir. Bu çalýþmada Erzurum'da Obstruktif Sleep-Apne Sendromu (OSAS) ile iliþkili semptom prevalansý araþtýrýlmýþ ve horlama için %37, apne için % 10.4, hipersomnolans için % 36'lýk prevalans saptanmýþtýr. OSA sendromu için risk faktörü kabul edilen yaþ, cins, obesite ile semptomlar arasýnda anlamlý iliþki bulunmuþtur. Her üç semptomun birarada bulunma yüzdesi %4.3 olarak hesaplanmýþtýr.

Obstructive Sleep Apnea syndrome is a respiratory sleep disorder characterised by snoring, apnea and day time sleepiness and may some times affect all systems and organs since it is in fluenced by various genetic and enviromental fctors, prevalance may change from one population to another. That’s why prevalance studies is important in both displaying the current status and determining the needs for establishing new polysomnography units. In this study we investigated the symptom prevalance of obstructive sleep aprea syndrome (OSAS) and found the prevalances of snoring 37%, apnea 10.4% and hypersomnoloscence 36% respectively. We found a significant relationship between symptoms and age, gender, obesity, Frequency of existing three symptoms together was detected in 4-3% of the population.

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Bu çalýþmada; inhale steroidin (800mcg/gün budesonid turbuhaler) bronþ astmasý olgularýnda akciðer fonksiyonlarý, serum ECP, indükte balgam eozinofil ve eozinofilik katyonik protein (ECP) düzeyleri gibi, bazý enþamasyon göstergelerine etkisi araþtýrýlmýþtýr. En az 3 aydýr gereðinde kýsa etkili betamimetik dýþýnda tedavi almayan, stabil, hafif astmalý 15 (11K,4 E) olgudan indükte balgam elde edilmiþ, elde edilen balgama gerekli iþlemler uygulandýktan sonra süpernatantýnda ECP bakýlmýþ, altta kalan kýsým hücre ayýrýmý için kullanýlmýþtýr.Olgularýn tümüne 3 ay süre ile 800 mcg/gün inhale steroid (BUD) verilmiþ, 3 aylýk tedavi sonrasý serum ECP, indükte balgam ve SFT tekrarlanmýþtýr. Hastalar bu süre içinde tedavi deðiþtirmeyi gerektirecek bir atak geçirmemiþtir. Tedavi öncesi serum ECP düzeyi 25 ng/mL, tedavi sonrasý 14.9 ng/mL olarak saptanmýþ (p<0.05), tedavi öncesi indükte balgamda ECP düzeyi 121.73±66.32 ng/mL (25-200) iken, tedavi sonrasý 35.40±47.24 ng/mL (5-196) olarak bulunmuþtur (p<0.05). Eozinofiller ise tedavi öncesi %8.40±8.07, tedavi sonrasý % 6.92±4.70 olarak saptanmýþ, azalma olmasýna raðmen deðiþkenlik anlamlý bulunmamýþtýr (p>0.05). Tedavi öncesi 2536±196 mL olan FEV1, tedavi sonrasý 2817±149 mL ye çýkmýþ, artýþ istatistiksel olarak anlamlý bulunmuþtur. Ayný þekilde FEV1/FVC deðerlerindeki artýþ da anlamlýdýr (p<0.05). Balgam ECP düzeyi ile eozinofil yüzdesi arasýnda paralellik saptanmamýþtýr (p>0.05). Budesonidin indükte balgam ECP deðerlerini belirgin olarak azalttýðý, FEV1'de anlamlý düzelme saðladýðý görülmüþtür.Sonuç olarak; astmalý hastalarda tedavi etkinliðinin izleminde ve astmanýn kontrol altýnda olup olmadýðýnýn belirlenmesinde indükte balgamda ECP oldukça duyarlý bir parametredir.

In this study, we examined the effect of inhale budesonide (800mcg daily via turbohaler) on lung function and various markers of airway inflammation including peripheral blood eosinophilic cationic protein (ECP), eosinophils and ECP levels in induced sputum from 15 patients (11 female, 4 male) with mild stabl asthma needing short acting betamimetic therapy only at least for three months. Induced sputum was obtained from all patients and all off it was used for investigation.The collected sputum was processed immediately and supernatant of this was protected for ECP level and the portion under the supernatant was used for cell differentation. After three months of treatment with inhaled steroid all parameters were repeated. Peripheral blood ECP level was found 25 ng/mL and it was found 14.9 ng/mL after treatment (p<0.05). At baseline, mean ECP level in induced sputum was found 121.73±66.31 ng/mL and 35.40±47.24 ng/mL after therapy with inhaled steroid (p<0.05). The percentage of eosinophils in induced sputum decreased slightly from baseline to the end of treatment (8.40% to 6.92%) but this decrease was not statistically significant (p>0.05). Significant correlation was observed between FEV1 measurements before and after treatment (p<0.05). No correlation was found between ECP levels and percentage of eosinophils in induced sputum (p>0.05). We concluded that treatment with inhaled budesonide was associated with significant improvements in forced expiratory volume in one second and ECP levels. The ECP concentration in induced sputum could serve as useful and highly sensitive marker for evaluating the severity of asthma and monitoring airway inflammation to achieve the optimal control of asthma.

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KOAH'ta bronkodilatörlerin erken reversibiliteye etkilerini incelemek amacýyla, 15 KOAH'lý olguda salbutamol (2x100 mcg), ipratropium bromür (ÝB) (2x 20mcg), salbutamol ile ipratropium bromür kombinasyonu ( 2x100mcg + 2x20mcg) ve plasebo ile deðiþik günlerde reversibilite testi yapýlmýþtýr. Son 12 saattir inhale ya da oral bronkodilatör, son 24 saattir uzun etkili teofilin tedavisi almayan ve stabil dönemdeki KOAH'lý hastalara yapýlan reversibilite testlerinde bronkodilatör ve plasebo sonrasý 20. ve 60. dakikalarda FEV1 düzeyleri incelenmiþ ve reversibilite düzeyleri FEV1'de mutlak deðiþim ( ? abs), inisiyal döneme göre deðiþim (? %ini) ve predikte deðere göre deðiþim (? %pred) deðerlendirilmiþtir. Olgularda en yüksek reversibilite salbutamol ile ÝB kombinasyonu sonrasý 60. dakikada saptanmýþtýr (140±109 mL). Yirminci ve 60. dakikalar arasýnda tüm gruplarda istatistiksel olarak anlamlý fark olmamasýna karþýn ÝB ve salbutamol ile ÝB kombinasyonu sonrasý 60. dakikada reversibilite düzeyleri (109±138mL, 140±109mL) 20. dakikaya göre (98.4±119mL, 132±96mL) daha yüksek bulunmuþtur. Yine istatistiksel olarak anlamlý olmamasýna karþýn ÝB ve salbutamol ile birlikte ÝB sonrasý reversibilite düzeyleri tek baþýna salbutamolden (71±99mL, 62.1±102mL ) daha yüksek saptandý.

To evaluate the early reversibility effects of inhaled bronchodilators, 15 COPD patients were given salbutamol (SB) (2x100mcg), ipratropium bromide (IB) (2x20mcg), SB+IB (200mcg+ 40mcg) and placebo on different study days. Stable COPD patients included in the study refrained from inhaled steroids, theophylline and bronchodilators for at least 12 hr before the study. FEV1 was measured at 20 and 60 min after inhalation of bronchodilators and placebo. Reversibility was expressed as absolute change (abs), %of initial FEV1 (%ini), and % of predicted (%pred). The maximum reversibility was with salbutamol and IB combination at the 60 min(140±109 mL) with all 3 means of assessment. Although the 20 and 60 min evaluations in the groups did not disclose any statistically significant differences, 60 min reversibility tests with IB and salbutamol and IB combination (109±138mL, 140±109mL) were higher compared to the 20 min results (98.4±119mL, 132±96mL). Again IB and salbutamol and IB combination yielded the highest reversibility compared to salbutamol (71±99mL, 62.1±102mL) alone.

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Trakeal rezeksiyon sonrasý oluþan stenozu azaltmak amacýyla kullanýlan cerrahi yöntemlerin karþýlaþtýrýldýðý bir deneysel çalýþma yapýldý. Çalýþmada 30 adet Yeni Zelanda beyaz tavþaný rastgele 5 gruba bölündü. Grup I kontrol grubu, Grup II rezeksiyon yapýlmaksýzýn trakeal tam kesi ve yerinde primer anastomoz uygulanan cerrahi kontrol grubu, Grup III rezeksiyon sonrasý primer anastomoz uygulanan, Grup IV rezeksiyon sonrasý primer anastomozun dýþtan politetraþoroetilen (PTFE) ile desteklendiði ve Grup V ise trakea yerine PTFE konan gruplardý. Anastomoz yerinde en þiddetli stenoz Grup III ve Grup V'te izlendi (sýrasýyla % 28.77 ve % 39.34). Grup IV'te ise daha düþük derecede stenoz geliþti (% 13.17). Grup III, Grup IV ve Grup V stenoz yönünden karþýlaþtýrýldýðýnda aralarýndaki farklarýn istatistiksel anlamlý olduðu bulundu (sýrasýyla III ve IV için z=2.887; p=0.004; IV ve V için z=2.882; p=0.004). Buna göre greft konmasýný gerektirmeyecek boyutlarda trakea rezeksiyonu yapýldýktan sonra uygulanacak olan primer rekonstrüksiyonda anastomoz hattýnýn dýþtan PTFE ile desteklenmesinin stenozu azaltabileceði ve bu nedenle tercih edilebilecek cerrahi yöntem olduðu düþüncesindeyiz.

An experimental study was setup to compare various surgical technics used to reduce stenosis following tracheal surgery. Thirty New Zealand white rabbits were randomly divided into 5 groups. Group I was control group whereas Group II was surgical control group, with complete tracheal insicion without resection followed by primary anastomosis. In Group III, tracheal resection followed by primary anastomosis; in Group IV, tracheal resection followed by primary anastomosis with an external polytetraflouroethylene (PTFE) stent; and in Group V, tracheal resection followed by PTFE interpositioning were performed. In Group III and Group V, stenosis was prominent (28.77 % and 39.34 %, respectively). In Group IV, the degree of stenosis was low (13.17 %). When the stenosis degrees encountered in Group III, Group IV, and Group V were considered, statistically significant differences were found (for III and IV z=2.887; p=0.004; for IV and V z=2.882; p=0.004, respectively). Considering these facts, we conclude that in tracheal resections without the need of greft interpositioning, external PTFE stenting of the primary anastomosis line may result in low stenosis degree and thus may be the surgical technic of choice.

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Çalýþmanýn amacý büllöz akciðer hastalýklarýnýn tedavisinde torakotomi ile videotorakoskopik cerrahinin (VATS) sonuçlarýný karþýlaþtýrmaktýr. Kliniðimizde Aralýk 1993-Mayýs 1998 tarihleri arasýnda büllöz akciðer hastalýðý tanýsý almýþ toplam 40 hastaya operasyon uygulandý. Bu hastalarýn 26'sý torakotomi, 14'ü VATS ile opere edildi. Tüm hastalara büllektomi ve bunu takiben cerrahi plöredesis uygulandý. Torakotomi grubunda ortalama yaþ 37.3(7-57 yaþ), VATS grubunda ise 36.2(23-57 yaþ) olarak bulundu. Torakotomi grubunda operasyon süresi 85.12±15.25dak., VATS grubunda ise 115.25±22.14 dak. bulundu(p=0.0001). Post-op. komplikasyonlar; torakotomi grubunda 10 hastada, VATS grubunda ise 3 hastada uzayan hava kaçaðý (p=0.001) ve torakotomi ve VATS gruplarýnda ise 1 hastada ampiyem (p=0.07) görüldü. Post-op. ilk 12 saatteki analjezik kullanýmý(Diclofenac Na-mg) ; torakotomi grubunda 167.25±74.35 mg, VATS grubunda 87.10±35.25 mg bulundu(p=0.00001). Drenaj süreleri torakotomi grubunda 10.20±8.65 gün, VATS grubunda 8.60±4.65 gün (p=0.09) saptandý. Hastanede kalýþ süresi(gün); torakotomi grubunda 14.50±8.25, VATS grubunda 10.60±3.40 bulunmuþtur(p=0.0001). VATS düþük komplikasyon oraný, kýsa hastanede kalýþ süresi, düþük doz analjezik gereksinimi, erken post-operatif dönemdeki solunum fonksiyonlarýnda hafif azalma ve kozmetik açýdan torakotomiye alternatif ve uygun endikasyonlar konduðunda üstün bir yöntemdir

In this prospective study, the comparison of videothoracoscopy and thoracotomy in the treatment of bullous lung disease was made. In the last 4 years, 40 patients with bullous lung disease underwent surgical intervention. Thoracotomy was performed in 26 patients(Group T) and videothoracoscopy in 14 (Group V). We performed bullectomy followed by pleurodesis to all the patients. The duration of operation was 85.12±15.25 minutes in the thoracotomy group, 115.25±22.14 minutes in the VATS group(p=0.00001). The postoperative complications were prolonged air leaks(T group n:10, V group n:3 patients, p=0.001), and empyema(T and V groups n:1 patient, p=0.05). The time of drainage was 10.20±8.65 day in the thoracotomy group, 8.60±4.65day in the VATS group(p=0.09). The hospital stay was 14.50±8.25 day in the thoracotomy group, 10.60±3.40 day in the VATS group(p=0.0001). VATS is performed as an alternative to thoracotomy in the treatment of bullous lung disease. VATS is found to have the following advantages compared to thoracotomy: complications, postoperative use of analgesic, the period of hospital stay, and cosmetic. However, thoracotomy allow easy exploration, short operation time, low cost. As a result of all these fact, it can be said that the method to be used has to be decided on according to the surgeons initiative.

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Ýntratorasik lenfadenopatileri olan bronþ karsinomlu hastalarýn tanýsýnda ve evrelendirilmesinde transbronþial iðne aspirasyonu (TBÝA)'nun yararlý olduðu gösterilmiþtir. TBÝA'nýn sarkoidoz dýþýndaki, diðer benign hastalýklarda yaygýn olarak kullanýmý araþtýrýlmamýþtýr. Çalýþmamýzda hastanemize baþvuran ve mediastinal ve / veya hiler lenfadenopatisi olan hastalarda 19-gauge histoloji iðnesiyle yapýlan TBÝA'nýn taný deðeri araþtýrýldý. Yirmisekiz hastaya toplam 29 iþlem yapýldý. Yirmidokuz TBÝA iþleminin 23(%79)'ünde yeterli lenf bezi materyali alýndý. Yirmidokuz iþlemin 20(%69)' sinde, yeterli materyal alýnan 23 TBÝA iþleminin 20(%87)' sinde tanýsal baþarý saðlandý. TBÝA 28 hastanýn 13(%46)'ünde tek taný aracýydý. On tüberküloz olgusunun hepsinde (%100), 8 sarkoidozlu olgunun 7(%87.5)'sinde, 2 lenfoma olgusunun 1 (%50)'ine TBÝA ile taný konuldu. Bir olguda küçük hücreli akciðer karsinom metastazý ve 1 olguda nonspesifik lenfadenit tanýsý konuldu. Yetersiz materyal alýnan 5 olgunun 2'sinin son tanýsý sarkoidoz, 1'nin (TBÝA iþlemi 2 kez yapýlan) lenfoma olup, 2 olgunun ise son tanýlarý konulamamýþtý. Hiç bir olguda, TBÝA yapýlan yerde sýzýntý þeklinde kanama dýþýnda komplikasyon gözlenmedi. Sonuç olarak þeksible bronkoskopi eþliðinde 19-gauge histoloji iðnesiyle yapýlan TBÝA' nun intratorasik lenfadenopatilerde tanýsal baþarýsýnýn yüksek olduðu saptandý.

Transbronchial needle aspiration of intrathoracic lymph nodes has been shown to be useful in the diagnosis and staging of bronchogenic carcinoma. With the exception of sarcoidosis, the usefulness of TBNA has not been widely investigated in other benign diseases. In our study, we investigated the value of TBNA done by 19-gauge histology needle, in patients who had admitted to hospital because of mediastinal and/or hilar adenopathy. We performed 29 procedures in 28 patients. Adequate lymph node sampling was obtained in 23 of 29 (79 %), and diagnostic material was obtained in 20 of 29 procedures (69%). Twenty of 23 patients (87%) who had enough materials for hystologic means by TBNA, we succeded to make diagnosis. The tecnique was the only diagnostic procedure for 13 of 28 patients (46%). Ten of 10 tuberculosis patients(100%), 7 of 8 sarcoidosis patients (87.5%), 1 of 2 lymphoma patients (50%), one metastatic small cell carsinoma patient, and one nonspesific lymphadenitis patient, were diagnosed by TBNA. For two of 5 patients who had not enough hystologic materials the final diagnosis were sarcoidosis, for one patient (TBNA was made 2 times) lymphoma, and for 2 patients there were no diagnosis. No complications occured except minimal bleeding. As a conclusion; this study showed that, TBNA done by 19-gauge hystologic needle in the guide of fiberoptic bronchoscopy, is a successful diagnostic method in diagnosis of intrathoracic lymph nodes.

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Travma nedeniyle yapýlan akciðer rezeksiyonlarýný irdelemek amacýyla otuz yýlda, göðüs travmalý 4166 hastadan, akciðer rezeksiyonu geçiren 48'i deðerlendirildi. Yaralanma mekanizmasý % 37.5 (n: 18) ateþli silah, % 33.3 (n: 16) kesici - delici alet, % 29.2 (n: 14) künt travmaydý. Ortalama Yaralanma Aðýrlýk Skoru (YAS) 22.5 olup, künt travmada daha yüksekti (30.7) (p<0.05). Hastalarýn % 43.75'inde (n: 21) yandaþ yaralanma vardý. Acil servis torakotomisi yoktu. En sýk torakotomi endikasyonlarý kanama (n: 36) ve trakeobronþial yaralanmaydý (n: 7). Baþlýca rezeksiyon endikasyonlarý ise kontrol edilemeyen kanama ve parankim hasarýydý. Rezeksiyon oraný % 1.15 (48/4166) oldu. Rezeksiyonlarýn % 54.2'si (26/48) anatomik olmayan (wedge) rezeksiyon, % 35.4'ü (17/48) lobektomi ve % 10.4'ü (5/48) pnömonektomiydi. Morbidite % 36.6 (15/41) idi ve nedenleri þunlardý: yara enfeksiyonu 4, uzamýþ hava kaçaðý 3, atelektazi 2, ampiyem 2, monopleji 1, kanama 1, yaygýn ödem 1 ve pnömoni 1. Toplam mortalite % 14.6 (7/48), pnömonektomide ise % 60 (3/5) oldu. Pnömonektomi mortalitesi, daha küçük rezeksiyonlara göre yüksekti (p<0.05). Künt ve penetran travma nedeniyle yapýlan rezeksiyonlarýn mortalitesi arasýnda fark yoktu (% 17.4'e karþýlýk % 12) (p=0.597). Kaybedilen hastalarda YAS, sað kalanlardan yüksekti (41.4'e karþýlýk 23.9) (p<0.05). Sonuç olarak travmada akciðer rezeksiyonu, doðru endikasyon konduðunda hayat kurtarýcý olmaktadýr.

To explore lung resections due to lung trauma, of the 4166 patients with chest trauma in 30 years period, 48 underwent pulmonary resection were reviewed. Mechanism of injury was gunshot wound with 37.5 % (n: 18), stab wound with 33.3 % (n: 16) and blunt with 29.2 % (n: 14). Mean Injury Severity Score (ISS) was 22.5 and higher in blunt trauma (30.7) (p<0.05). Associated injuries were present in 43.75 % of patients (n: 21). No emergency service thoracotomy was present. Most frequent thoracotomy indications were bleeding (n: 36) and tracheobronchial injury (n: 7). Uncontrolled bleeding and parenchymal damage were main resection indications. Resection ratio was found 1.15 % (48/4166). Of resections, 54.2 % (26/48) was non – anatomic, 35.4 % (17/48) lobectomy and 10.4 % (5.48) pneumonectomy. Morbidity was 36.6 % (15/41) and causes: wound infection 4, prolonged air leak 3, athelectasis 2, empyema 2, monoplegia 1, bleeding 1, extensive edema 1 and pneumonia 1. Total mortality was 14.6 % (7/48) and 60 % (3/5) for pneumonectomy. Pneumonectomy mortality was higher compared to lesser resections (p<0.05). No mortality difference was present between blunt and penetrating trauma resections (17.4 % vs. 12 %) (p=0.597). ISS of died patients was higher compared to survivors (41.4 vs. 23.9) (p<0.05). Resection in lung trauma was life saving in the condition of correct indication established.

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Pulmoner sekestrasyon (PS) akciðerin nadir görülen doðumsal anamolilerden birisidir. PS' de kesin taný besleyici arterin aortografi ile gösterilmesiyle konur. Biz de 36 yaþýnda erkek, tekrarlayan akciðer infeksiyonu olan hastada mevcut intralober PS tanýsýný manyetik rezonans anjiografi (MRA) ile koyduk. MRA ile torasik aorttan çýkan diafragmayý geçip sol akciðer alt lob posterior'da bulunan pulmoner sekestrasyonu besleyen arter gösterildi. Hastaya kesin taný için aortografi uygulandý ve PS'nu besleyen arter gösterildi. Cerrahisinde morbidite ve mortalite geliþmedi. Daha az invaziv bir yöntem olmasý nedeniyle PS düþünülen hastalarda besleyici arteri göstermek amacýyla MRA 'nin kullanýlabileceðini düþünmekteyiz.

Pulmonary Sequestration (PS) is one of the congenital anomalies of lung that is very uncommon. The definitive diagnosis can be made by the aortographic visualization of the artery that supply the sequestrated area. Our patient was 36 year old male. He admitted to hospital many times because of repeated lung infections. We reach the diagnosis of intralober sequestration by MR angiography (MRA). The feeding arter was visualized as it leaves the thoracic aorta, passes the diaphragm and ends in the sequestrated area that is situated in posterior segment of left lower lobe. Aortography demonstrated anomalous systemic arterial supply to the PS in the patient. In his operation neither morbity nor mortality was observed. We suggest that MR angiography is an appropriate diagnostic method for intralober sequestration because it's a less invasive method.

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Bronþiollerde kýsmi veya tam týkanýklýða neden olan granülasyon dokusu, bronþiyal ve peribronþiyal fibrozis ile granülasyon dokusu ve eksudanýn alveollerin içine yayýlmasý durumu 'bronþiolitis obliterans organize pnömoni (BOOP)'olarak tanýmlanýr. Kliniðimizde son dört yýl içinde BOOP tanýsý alan dört olgu incelendi. Yaþ ortalamasý 46 (40-54) idi. Yakýnmalar, dispne, göðüs aðrýsý ve halsizlikti. Radyolojik olarak birer olguda retikülonodüler, kaviter, nodüler infiltrasyon ve alveolar konsolidasyon saptandý. Taný, üç olguda transbronþiyal doku biyopsisi, birinde açýk akciðer biyopsisiyle kondu. Nedenler; bir olguda toksik gaz inhalasyonu, bir olguda infeksiyondu. Ýki olguda ise herhangi bir etyolojik neden saptanamadý ve bu olgular, idyopatik BOOP olarak deðerlendirildi. Ýnfeksiyon kliniði sergileyen olgunun balgam, bronþ aspirasyon sývýsý ve bronkoalveoler lavaj sývýsýnda etken saptanamadý ancak antibiyoterapiyle kliniði düzeldi. Diðer üç olguya steroid tedavisi uygulandý. Toksik gaz inhalasyonuna maruz kalan olguda iki hafta sonra tama yakýn düzelme izlendi. Diðer iki olguda tedaviyle klinik, radyolojik ve diðer laboratuvar bulgularýnda belirgin düzelme saðlandý. Olgulardan elde edilen verilerle birlikte BOOP, literatür bilgileri ýþýðýnda gözden geçirildi.

Granulation tissue causing partial and complete obstruction of bronchioles, granulation tissue with bronchial and peribronchial fibrosis, and alveolar invasion by exudate are defined as bronchiolitis obliterans with organising pneumonia (BOOP). Four cases, who have been diagnosed as BOOP in our clinic the last four years, were reviewed. The mean age was 46 years (range: 40-54). Symptoms were dyspnea, thoracic pain and fatigue. Reticulonodular, cavitary, nodular infiltrates, and alveolar consolidation were determined radiologically in each, respectively. The diagnosis was made by transbronchial lung biopsy in three cases and by open lung biopsy in one. The cause was toxic gas inhalation in one and infection in the other one. No cause could be shown in the remaining two, and these were considered idiopathic BOOP. No pathologic agent was found in the sputum, bronchial aspirate, bronchoalveolar lavage fluid of the case, presenting with clinical picture of infection but this case recovered by antibiotherapy. Corticosteroid therapy was given to the other three cases. The case, suffering from toxic gas inhalation, recovered in two weeks almost completely. In the other two cases, there was significant improvement regarding clinical, radiological and laboratory findings after treatment. Together with the data, we have obtained from the cases above, BOOP was reviewed under the light of the literature.

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Eozinofilik akciðer hastalýklarý; basit pulmoner eozinofili, akut eozinofilik pnömoni, kronik eozinofilik pnömoni, idiopatik hipereozinofilik sendrom gibi nedeni bilinmeyen ve allerjik bronkopulmoner aspergillozis (ABPA), bronkosentrik granülomatozis, parazitik enfestasyonlar, ilaç reaksiyonlarý gibi nedeni bilinen ve Churg Strauss sendromu gibi eozinofilik vaskülitlerin oluþturduðu heterojen bir hastalýk grubudur. Bu hastalýklarýn tümü, primer veya sekonder periferik kan eozinofilisi veya pulmoner eozinofili ile karakterizedir. Biz de allerjik bronkopulmoner aspergillozis ve kronik eozinofilik pnömoni tanýsý koyduðumuz iki olgunun hastalýk paternleri temelinde eozinofilik akciðer hastalýklarýný tartýþtýk.

Eosinophilic pulmonary diseases are heterogenous group of disorders consisting of 1- diseases of unknown etiology (simple pulmonary eosinophilia, acute eosinophilic pneumonia, chronic eosinophilic pneumonia, idiopathic hipereosinophilic syndrome) 2- diseases of known etiology ( allergic bronchopulmonary aspergillosis, bronchocentric granulomatosis, parasitic infestations, drug reactions ) and 3- eosinophilic vasculitis like Churg Strauss syndrome. All of these are characterised with primary or secondary peripheric blood eosinophilia or pulmonary eosinophilia. We discussed eosinophilic pulmonary diseases on the basis of two cases diagnosed as allergic bronchopulmonary aspergillosis and chronic eosinophilic pneumonia.

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Üst solunum yollarý tüberkülozu, modern kemoterapi rejimlerinin kullanýldýðý günümüzde çok nadir olarak görülür. Aðýz, tonsiller, dil, burun, epiglot, larenks ve farenkste yerleþebilir. Larenks tüberkülozu hemen daima akciðer tüberkülozuna eþlik eder. Genellikle erkeklerde ve sigara içicilerde görülmesi, ses kýsýklýðý semptomu vermesi ve endoskopik kitle görünümü nedeniyle larenks maligniteleri ile karýþabilir. Farenks tüberkülozu ise daha çok çocuklarda ve primer infeksiyon þeklinde karþýmýza çýkar. Makroskopik görüntüsü maligniteleri taklit edebilir. Bu yazýda larenks, farenks ve akciðer tüberkülozlu bir olgu ile farenks tüberkülozlu bir olgu sunulmuþtur. Ýlk olgu 37 yaþýnda erkekti ve ön tanýsý larinks ve hipofarinks malignitesiydi. Larinks ve farinks biyopsilerinin histopatolojik incelemesinde kazeifikasyon gösteren tüberküloz granulomlarý görüldü. Olguda ayný zamanda akciðer tüberkülozu da bulundu. Ýkinci olgu 59 yaþýnda bayandý ve nazofarinkste tüberküloza baðlý kitle saptandý. Taný histopatolojik inceleme ile kondu. Ýki olguda da antitüberküloz tedavi baþarýlý oldu.

Since the introduction of effective chemotherapy, upper airway tuberculosis is rare. It involves oral cavity, tonsils, tongue, nose, epiglot, larynx and pharynx. Laryngeal tuberculosis is nearly always considered to be secondary to pulmonary infection. It may be confused with laryngeal malignancies, because it is usually seen in smoker male patients and it is generally accompanied by hoarseness and endoscopic mass appereance. Pharyngeal tuberculosis generally occurs in children and as primary infection. Macroscopic appereance may mimic malignancy. In this article, a case of tuberculosis of the larynx, pharynx, lung and a case of tuberculosis of the pharynx are presented. First case was 37 year-old male. His pre-diagnosis was larynx and hypopharynx malignancies. Histopathological examination of larynx and pharynx biyopsies showed tuberculoid granulomas with caseation. Also he had pulmonary tuberculosis. Second case was 59 year-old female. She had nasopharyngeal tuberculoid mass. Diagnosis was confirmed by histopathological examination. Antituberculous treatment was succesful in two cases.

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