Bu çalýþmaya Harran Üniversitesi Týp Fakültesi Göðüs Hastalýklarý polikliniðine 2001 temmuz-2002 temmuz tarihleri arasýnda baþvuran 420 (%62 kadýn, %38 erkek) bronþ astýmlý olgu alýndý. Olgularýn yaþ ortalamasý 34±9, hastalýk süreleri 5.7±5.8 yýldý. Hastanemize baþvurduklarý anda 22 olgu hafif intermittan, 114 olgu hafif persistan, 270 olgu orta persistan, 14 olgu aðýr persistan astým evresindeydi. 174 olguda allerjik rinit, 24 olguda nazal polip, 2 olguda Samter sendromu vardý. Olgularýn 254'üne cilt testi yapýldý. Bunlarýn 88(%35)'inde cilt testi pozitif bulundu. Cilt testi pozitif olgularýn 5(%5.7)'inde ev tozu akarýna karþý, 2(%2.3)'sinde aðaç polenlerine karþý, 77(%87.5)'sinde çayýr polenlerine karþý, 2(%2.3)'sinde yabani ot polenlerine karþý ve 2(%2.3)'sinde epidermal karýþýmlara karþý pozitif cilt testi elde edilirken mantar sporlarýna karþý pozitiþik saptanamamýþtýr. Astým taný ve tedavisinde standardizasyon saðlamak çok önemlidir. Bu standardizasyonu saðlayabilmek amacýyla fianlýurfa'daki bronþ astýmlý olgularýn klinik özelliklerini, laboratuvar bilgilerini, bize baþvurmadan önce kullandýklarý tedaviyi, acil baþvuru ve hospitalizasyon sayýsýný belirleyerek, bölgemizde astýmlý olgularýn verilerine ulaþmak, bu olgularýn taný ve tedavilerindeki eksiklikleri görmeyi amaçladýk.

420 patients (62 % female, 38% male) with bronchial asthma who attended to the Department of Chest Diseases of the Medical Faculty of Harran University between July 2001 and July 2002 were included in the study. Mean age of patients was 34± 9 years and the duration of disease was 5.7± 5.8 years. The disease was staged in the first visit as follows: 22 patients had intermittant asthma, 114 patients had mild persistant asthma, 270 patients had moderate persistant asthma and 14 patients had severe persistant asthma. 174 patients had accompanying allergic rhinitis, 24 patients had nasal polyposis and 2 patients had Samter syndrome. Skin test was applied to 254 patients. 88 patients (35%) had positive skin test results. 5 (5.7%) of these 88 patients responded positively to house dust mites, 2 (2.3%) of them to tree pollens, 77 (87.5%) of them to grass pollens, 2 (2.3%) of them to weed pollens and 2 (2.3%) of them to epidermal mixtures. No positive reaction to mould spores was observed. Standardization is crucial in the diagnosis as well as in the treatment of asthma. This study aimed to document the clinical characteristics, laboratory findings, treatment modalities before attendance, hospitalization rates, emergency department visits of the patients with asthma in fianlýurfa. This type of documentation can help to make the data of the patients easily available and also to find out the possible deficiencies in the diagnosis and treatment.

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Hasta ötiroid sendromu (HÖS), tiroid hastalýðý olmaksýzýn altta yatan ciddi bir hastalýðýn seyrinde ortaya çýkan ve tiroid hormon düzeylerindeki deðiþikliklerle karakterize bir sendromdur. Solunum yolu hastalýklarýnda da tiroid hormon seviyelerinde deðiþiklikler olduðu bildirilmiþtir. Çalýþmamýzýn amacý, kronik obstrüktif akciðer hastalýðý (KOAH) tanýsý ile izlenmekte olup akut atak geliþen hastalardaki HÖS sýklýðýnýn saptanmasý ve bunun atak sýrasýndaki PaO2 (arteriyel parsiyel oksijen basýncý), PaCO2 (arteryel parsiyel karbondioksid basýncý) ve SpO2 (oksijen satürasyonu) ile iliþkisini incelemekti. Bu amaçla akut atak nedeni ile yatýrýlan KOAH tanýlý yirmi ardýþýk hasta arteriyel PaO2, PaCO2, SpO2 ve tiroid fonksiyonlarý yönünden incelendi. Yirmi hastanýn 12'sinde (%60) HÖS saptanýrken, HÖS ve PaO2'deki azalma arasýnda bir iliþki saptanmadý. Tiroid hormon düzeyleri ve PaO2, PaCO2, SpO2 arasýnda da korelasyon saptanmadý.

Sick euthyroid syndrome (SES) is characterized by alterations in circulating thyroid hormone levels in the absence of a thyroid disease and occurs in patients suffering from serious diseases.There have been articles reporting of decreasing thyroid hormone levels in respiratory diseases. The aim of our study was to evaluate the incidence of SES in patients with chronic obstructive pulmonary disease (COPD) hospitalized with acute exacerbation. 20 consequtive patients with a diagnosis of COPD hospitalized because of an acute exacerbation in the Department of Pneumonology at Cerrahpafla Medical Faculty were evaluated according to their PaO2, PaCO2, SpO2 and thyroid hormone levels. 12 (60%) of the patients had alterations of thyroid hormone levels in accordance with SES diagnosis. There was no relation between SES and the decrease in arterial PaO2 levels. No correlation was found between PaO2, PaCO2, SpO2 and the thyroid hormone levels.

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Uykuda solunum bozukluklarýnýn tanýsýnda 'polisomnografi' altýn standart özelliðini korumaktadýr. Bu yöntemin zahmetli ve pahalý olmasý nedeni ile daha ucuz alternatiþer arayýþýna gidilmiþtir. Bu nedenle, özellikle Obstruktif Uyku Apne Sendromu (OSAS) tanýsýnda poligrafik yöntemler giderek artan sýklýkta kullanýlmaktadýr. OSAS kliniði olan olgulara, ayrýntýlý anamnez, Epworth Uykululuk Skalasý anketi, fizik muayene, solunum fonksiyon testleri uygulandý. Uyku laboratuvarýnda, gözetim altýnda, ASDA (American Sleep Disorders Association)'nýn Kategori III sistem olarak sýnýþandýrdýðý, 8 kanallý POLY-MESAM (PM) (MAP: Martinsried, Germany) ünitesi ile kardiopulmoner uyku çalýþmasý yapýldý. Uyku çalýþmasýna alýnan 4'ü kadýn, 16'sý erkek toplam 20 olgunun yaþ ortalamalarý 46±14 (17-69) idi. Olgularýn %40'ýnda ortalama 12±18 paket-yýl sigara anamnezi mevcuttu. Horlama %95 (19/20), gündüz aþýrý uyku hali %75 (15/20), tanýklý apne %70 (14/20) oranýnda tespit edildi. Epworth uykululuk skalasý ile Apne-Hipopne indeksi (AHÝ) anlamlý olarak (pozitif) korelasyon gösteriyordu (p<0,001, r=0,783). Çalýþmaya alýnan olgularda, uyuklama nedeni ile trafik kazasý (5/20) ve noktüri (12/20) öyküsü olanlarýn OSAS (AHÝ>5) sýklýðý anlamlý olarak yüksek bulundu (sýrasýyla p=0,03 ve p=0,006). OSAS klinik deðerlendirilmesinde Epworth subjektif uykululuk deðerlendirme skalasý yararlý olabilir. Özellikle uyuklama nedeni ile trafik kazasý atlatmýþ ve noktürisi olan olgularýn OSAS yönünden deðerlendirilmesi önemlidir.

The aim of this study was to assess the cardiorespiratory variables (CRV) of suspected obstructive sleep apnea (OSA) patients using a polygraph. Patients who attended our clinic with sleep-related respiratory disorders were randomly selected. Detailed history, physical examination, spirometry, plain chest radiograph, biochemical parameters, electrocardiogram and Epworth Sleepiness Scale (ESS) were ordered and taken in every patient. CRV were studied using 8-channel POLY-MESAM (PM) (MAP; Martinsried, Germany) unit classified by the American Sleep Disorders Association (ASDA) as a level III sleep study. 20 patients were included in the study with the following characteristics: mean age 46±14 years (range 17-69 years), average smoking history 12±18 pack-years. Snoring, excessive daytime sleepiness, witnessed apnea, nocturia and traffic accident due to sleepiness were observed in 95 % (n=19), 75% (n=15), 75% (n=15), 60% (n=12) and 25% (n=5) of patients, respectively. ESS and Apnea-hypopnea index (AHI) of patients were significantly correlated (p<0.001, r=0.783). In patients with a history of traffic accident (5/20) and nocturia (12/20), a diagnosis of obstructive slep apnea syndrome (OSAS) based on a AHI>5 was significantly more common (p=0.03 and p=0.006, respectively). Epworth Sleepiness Scale can be helpful in clinical evaluation of suspected OSAS. Especially patients with a history of traffic accident and nocturia should be carefully evaluated for OSAS.

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Eriþkinlerde trakeobronþiyal yabancý cisim (YC) çýkarýlmasý ile ilgili deneyimlerimizi gözden geçirdik. 1988-2002 yýllarý arasýnda YC aspirasyonu nedeniyle 65 eriþkin hastanýn bronkoskopi kayýtlarý retrospektif olarak incelendi. Hastalarýn 43'ü (%66.2) bayan ve 22'si (%33.8) erkekti. Yaþ ortalamasý 31.2 (16-72) yýl idi. YC 48 olguda rijid bronkoskopi (RB), 12 olguda fiberoptik bronkoskopi (FOB), 2 olguda direkt laringoskopi ile çýkarýlýrken, 3 olguda torakotomi gerekli oldu. YC 36 (%55.4) olguda sað, 17 (26.2%) olguda sol bronþiyal aðaçta, 10 (%15.4) olguda trakea ve 2 (%3) olguda larinkste bulundu. En sýk görülen klinik semptom öksürüktü ve hastalarýn 45'inde (%69.2) mevcuttu. En sýk aspire edilen cisim 26 olgu (%40) ile türban iðnesi idi. Röntgenogramda, 33 (%50.7) olguda YC izlenebilirken, 19 olguda (%29.2) normal ve 13 (20%) olguda da indirekt radyolojik bulgular mevcuttu. Bronkoskopi sonrasý en sýk görülen komplikasyon hafif hemoptizi idi ve olgularýn 10'unda (%15.4) meydana geldi. Mortalite görülmedi. Eriþkinlerde trakeobronþiyal aðaçta YC nadirdir. YC'in tanýsý için kuvvetlice þüphelenmek gerekir. Erken taný ve tedavi esastýr, çünkü solunum yollarýnda uzun süre kalan YC geriye dönüþümsüz zararlara yol açabilir. YC'lerin çoðu rijid veya FOB altýnda baþarý ile çýkarýlabilir.

We reviewed our experience in removal of tracheobronchial foreign bodies in adults. Bronchoscopy records of 65 adult patients with foreign body aspiration between 1998 and 2002 were retrospectively examined. 43 patients (66.2%) were female and 22 patients (33.8%) were male. Median age was 31.2 years (range: 16-72 years). Foreign bodies (FBs) were extracted using rigid bronchoscope (RB) in 48 patients. In 12 patients flexible bronchoscope (FOB) , in 2 patients direct laryngoscope were used. Only 3 patients required thoracotomy. FB was found in the right bronchial tree in 36 (55.4%), in the left bronchial tree in 17 (26.2%), in the trachea in 10 (15.4%) and in the larynx in 2 (3%) of the patients. The most common clinical presentation was coughing, which occurred in 45 (69.2%) patients. The most common aspirated object was türban pin (26 patients; 40%). Foreign bodies were detectable in plain radiograph in 33 patients (50.7%). Plain radiographs were nondiagnostic in 19 patients (29.2%) and 13 patients (20%) had indirect findings. The most common complication after bronchoscopy was mild hemoptysis, which occurred in 10 patients (15.4%). Death did not occur. Foreign bodies in the tracheobronchial tree are rarely seen in adults. A high index of suspicion is necessary for the diagnosis. Early diagnosis and management are essential, as long-standing foreign bodies in the airway may cause irreversible and serious damage. In the majority of patients foreign bodies can be successfully removed using rigid or flexible bronchoscope.

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Celal Bayar Üniversitesi Týp Fakültesinde eðitim görmekte olan 178 öðrenciye anket verilerek sigaraya karþý tutumlarý, sigara ile iliþkili hastalýklar ve sigara içiminin kontrolü konusundaki düþünceleri ile ilgili görüþleri alýndý. 80'i (%44.9) erkek olan öðrencilerin yaþ ortalamasý 20.38±1.72 yýl idi. Öðrencilerin 32'si (%18) hergün, 17'si (%9.6) bazen sigara içiyordu. Sigara içme yaygýnlýðý erkek öðrencilerde kýz öðrencilerden belirgin olarak yüksek saptandý (erkek: %35, kýz: %21.4) (p=0.04). Sigaraya baþlama yaþ ortalamasý 15.37±1.61 yýl idi. Sigara içmeye baþlamadaki en önemli etmenler merak ve özenti idi. Sýnýþar arasýnda sigara içme alýþkanlýðý açýsýndan anlamlý farklýlýk saptanmadý (p=0.2). Sigarayla iliþkili hastalýklar olarak akciðer kanseri (%99.4), larenks kanseri (%98.8), kalp-damar hastalýklarý (%97.2), oral kavite kanserleri (%93.2) sigaranýn neden olduðu en sýk patolojiler olarak belirtilirken yeni doðan bebek ölümleri (%85) ve mesane kanseri (%65.1) oluþturma etkisinin daha az bilindiði saptandý. Sigarayla iliþkili hastalýklara ait bilgi düzeyleri klinik öncesi sýnýþara (1,2,3) göre klinik sýnýþarda (4,5,6) daha yüksek olup mesane, oral kavite kanserleri ve kronik bronþit gibi hastalýklarda bu yükselme anlamlý düzeydeydi. Sigara ile ilgili yasa ve yasal önlemler konusunda sigara içen ve içmeyen öðrenciler karþýlaþtýrýldýðýnda bazý önlemler konusunda anlamlý düzeylere ulaþan görüþ farklýlýklarý olduðu gözlendi. Sonuç olarak sigara içme oranýnýn yüksek olduðu týp fakültesi öðrencilerinin sigara konusunda daha fazla bilinçlendirilmesi gerektiði söylenebilir.

178 students of the Medical Faculy of Celal Bayar University filled in a questionnaire investigating their attitudes towards smoking, smoking-related diseases and tobacco control programs. The mean age of 80 male (44.9%) and 98 female (55.1%) students was 20.38±1.72 years. 32 of them (18%) were smoking regularly while 17 of them (9.6%) were occasional-smokers. The smoking prevalence was higher in males (male: 35%; female 21.4%; p=0.04). The age they began smoking was 15.37±1.61 years. The difference among classes was not significant (p=0.2). Among smoking-related diseases, lung cancer (99.4%), laryngeal carcinoma (98.8%), cardiovascular diseases (97.2), oral cavity carcinoma (93.2%) were the ones which the students were mostly aware of. Sudden infant death syndrome (85%) and bladder carcinoma (65.1%) were less known to be related to smoking. This awareness of disease-causing effect of smoking was better in the forth, fifth and sixth classes than in the first three classes. The opinions of the smokers and nonsmokers about legal precaution were significantly different in some aspects. It is concluded that medical students with high smoking prevelance should be educated more intensively about tobacco.

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24 yaþýndaki kadýn hasta, sezaryen ile doðum yaptýktan 2 gün sonra baþlayan nefes darlýðý, öksürük ve yüzünde þiþme þikayetleri ile baþvurdu. Postero-anterior göðüs röntgenogramýnda sað alt parakardiyak alanda homojen opasite, toraks bilgisayarlý tomografisinde sað parakardiyak alandan üst mediastene doðru uzanan infiltratif kitle saptandý. Mediyastinoskopi ile non-Hodgkin lenfoma tanýsý konuldu. Gebelikle baðlantýlý olmasý ve seyrek görülmesi nedeniyle olgu, literatür eþliðinde sunuldu.

A 24-years old woman attended to our clinic with complaints of cough, shortness of breath and swelling of her face two days after delivering a healthy baby through sectio operation. Her posteroanteior chest radiograph showed a homogeneous opacity in the right lower paracardiac zone.The computed tomography scan of the chest showed an infiltrating mass beginning from the right paracardiac zone and extending to the upper mediastinum. Mediastinoscopy lead us to the diagnosis of non-Hodgkin lymphoma. The case is discussed in the light of accompanying literature, because of its rarity and its relationship with pregnancy.

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Yüksek irtifalarda (>2500 metre) ortaya çýkan pulmoner rahatsýzlýklarýn baþlýca nedeni hipobarik hipoksidir. Yüksek irtifalarda akut olarak ortaya çýkan ve hayati tehdit oluþturabilen baþlýca akciðer rahatsýzlýklarý; akut dað hastalýðý ve yüksek irtifa akciðer ödemidir. Bu hastalýklar tespit edilir edilmez, eðer acil tedavi uygulanmaz ise sýklýkla saatler içerisinde ölümcül olurlar. Yüksek irtifada bulunmak, ayrýca mevcut pulmoner, kardiyak ve nörolojik bozukluklarý þiddetlendirebilmektedir. Bu derlemede yüksek irtifalarda ortaya çýkan acil akciðer sorunlarý olan akut dað hastalýðý ve yüksek irtifa akciðer ödemi gözden geçirildi.

Pulmonary disorders that occur at high altitude (>2500meters) are caused by hypobaric hypoxia. The major life-threatening pulmonary disorders that occur at high altitude are acute mountain sickness and high altitude pulmonary edema. These disorders can lead to death in hours if not treated immediately. Additionally, high altitude can aggravate preexisting pulmonary, cardiac and neurologic disorders. Acute mountain sickness and high altitude pulmonary edema that are pulmonary emergencies occurring at high altitude are reviewed in this article.

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Kliniðimizde histopatolojik olarak akciðer kanseri tanýsý alarak kemoterapi uygulanan olgularýmýzda geliþen hematolojik komplikasyonlarý araþtýrmayý amaçladýk. Bu amaçla kliniðimizde histolojik olarak primer akciðer kanseri tanýsý alarak kemoterapi baþlanan ve tedavi sonrasýndaki takiplerinde hematolojik komplikasyon geliþen olgular çalýþmaya alýndý. 1999-2002 yýllarý arasýnda kliniðimizde 1132 olgu histolojik olarak primer akciðer kanseri tanýsý aldý. Bu olgulardan 237'sine (%20.9) kemoterapi uygulandý. Kemoterapi uygulanan olgulardan 48'inde (%20.2) hematolojik komplikasyon geliþtiði saptandý. Bu olgularýn 45'i erkek(%93,7), 3'ü kadýn (%6.2) olup yaþ ortalamasý 61.3±9.2 yýl olarak bulundu. Komplikasyon geliþen ve geliþmeyen olgularýn yaþ ortalamalarý arasýnda istatistiksel anlamlý fark saptanmadý(p=0.113). Anemi 37 olguda (%77), lökopeni 30 olguda (%62.5), trombositopeni 13 olguda (%27 ) saptandý. Grade 3-4 anemi 6 olguda (%12.5), lökopeni 8 olguda (%16.6), trombositopeni 4 olguda (%8.3) saptandý. Febril nötropeni 2 (%4.2) olguda görüldü. 4 olgumuz alterne radyoterapi almaktaydý (Biri küratif diðerleri palyatif dozda). Ortalama komplikasyon geliþme süresi; anemi için 10.6±5.8 gün, lökopeni için 9.3±4.8 gün, trombositopeni için 7.3±3.9 gündü. Ortalama düzelme süresi sýrasýyla 7.4 ± 4.5, 5.8±4.1, 9.1±6 gündü. 8 olguda(%16.6) anemi, 2 olguda (%4.2) lökopeni düzelmeden olgular kendi istekleri ile hastaneden ayrýldýlar. Kullanýlan kemoterapi rejimlerinin anemi, lökopeni ve trombositopeni geliþtirme potansiyelleri ayrý ayrý deðerlendirildiðinde aralarýnda anlamlý fark saptanmadý (p>0.05). Kemoterapi rejimleri konvensiyonel ve yeni ajanlar olarak gruplandýrýldýðýnda yeni ajanlarýn kullanýldýðý rejimlerde daha fazla komplikasyon geliþtiði görüldü (p=0.019). Yeni ajanlar kendi aralarýnda kýyaslandýðýnda komplikasyon geliþimi açýsýndan fark anlamlý bulunmadý (p=0.611). Komplikasyon geliþimi ile siklus sayýsý arasýnda lineer iliþki saptanmadý. Komplikasyonun aðýrlýk derecesi ile yaþ, kullanýlan rejim, siklus sayýsý arasýnda iliþki saptanmadý(p<0.05). Geliþen komplikasyonlar nedeniyle 2 olguda (%4.2) kemoterapi sonlandýrýldý. 5 olguda (%10.4) ilaç dozlarý azaltýldý. 6 (%12.5)olguda 2. kez komplikasyon geliþti. Komplikasyona baðlý ölüm görülmedi. Biz bu çalýþma ile kemoterapi alan olgularýn her kür öncesi ve sonrasý kemoterapi yanýtlarý kadar komplikasyonlar açýsýndan da özenle takip edilmesinin önemini vurgulamak istedik.

We aimed to evaluate the hematologic complications which occur after chemotherapy (CT) in cases with lung cancer. The cases diagnosed as primary lung cancer and who developed hematologic complications following CT were included in the study. In our clinic between 1999 and 2002, 1132 cases were diagnosed histopathologically as lung cancer. CT was administered to 237 (20.9%) of them. Hematologic complications were seen in 48 (20.2%) of those who received CT. 45 (93.7%) of them were men and 3 (6.2%) of them were women, the average age was 61.3± 9.2 years. There was no significant difference between the ages of the complicated and non-complicated group (p=0.113). Hematologic complication was anemia in 37 (77%), leucopenia in 30 (62.5%) and thrombocytopenia in 4 (8.3%) cases. Febrile neutropenia was seen in two (4.2%) cases. Four cases were receiving – one curative, others palliative- alternate radiotherapy. Average period until complication occurrence was 10.6 ± 5.8 days in anemia, 9.3 ± 4.8 days in leukopenia and 7.3 ± 3.9 days in thrombocytopenia. Average period of improvement was 7.4± 4.5, 5.8 ± 4.1, and 9.1 ± 6 days, respectively. 8 (16.6%) cases with anemia and two (4.2%) cases with leukopenia left hospital with their free will before improvement. CT regimens were compared with respect of their potential of causing hematologic complications. No difference was discovered (p>0.05). It was seen that regimens combining new agents more often caused hematologic complications than the conventional agents (p=0.019). The comparison of the new agents did not reveal any difference for the frequency of complication (p=0.611). There was no linear relation between complication occurrence and number of CT cycles. The complication grade was not related to age, regimen and number of cycles (p>0.05). Chemotherapy was ended in two (4.2%) cases and the dosage was decreased in five (10.4%) because of complications. In six (12.5%) cases, hematologic complications repeated in the following cycles. We wish to underline that cases receiveing chemotherapy should be followed carefully before and after chemotherapy, not only for the response but also for hematologic complications.

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