Çalýþmamýzda üniversiteye yeni baþlayan gençlerde mevcut sigara içme durumunun belirlenmesi, sigara içmeye yöneltici nedenlerin ve gençlerin sigaraya bakýþ açýsýnýn saptanmasý amaçlanmýþtýr. 3533 (%49.3 erkek, %50.7 kýz) öðrenciye üniversitemize kayýt sýrasýnda 20 sorudan oluþan bir anket uygulanmýþtýr. Öðrencilerin 985'inin (%27.9) sigara içtiði, %56'sýnda babasýnýn, %30'unda annesinin sigara içme öyküsünün bulunduðu saptanmýþtýr. Aile bireylerinin sigara içmesi ile öðrencilerin sigara içme alýþkanlýðý arasýnda anlamlý iliþki vardýr (p<0.01). En sýk sigaraya baþlama nedenleri, arkadaþtan etkilenme (%83.7) ve merak (%38.3) olup, sigara içenlerin baþlama yaþýnýn 15-17 yaþ arasýnda yoðunlaþtýðý bulunmuþtur. Sigara içen bireylerin %62.1'nin yabancý marka kullandýðý, yabancý marka tercihi ile þehirde yaþama arasýnda anlamlý iliþki olduðu saptanmýþtýr (p<0.01). Ýçenlerin %84'ünün býrakmayý istediði, %68'inin býrakmayý denediði, deneyenlerin %82'sinin ilk 1 yýl içinde tekrar baþladýklarý belirlenmiþtir. Sigara baðýmlýlýðýnýn lise çaðýnda yoðunlaþmasý, bu öðrencilerin sigarayý býrakmaya istekli ancak "eylemsiz" olmalarý; bilgilendirici ve motive edici çalýþmalarýn bu yaþ grubunda artýrýlmasý ve sigaraya baþlamayý engelleme mücadelesinin baþlatýlmasý gerektiðini düþündürmüþtür.

The aim of our study was to determine the smoking habit among the youngsters, who are newly registered university students and also the possible causes directing them to smoke and the viewpoint of these students to cigarette smoking. During the registration period of our university we conducted a 20-item questionnaire to 3533 students (49.3% male and 50.7% female). The number of smoking students was 985 (27.9%) and the smoking rates among their fathers and mothers were 56% and 30% respectively. There was a significant relationship between the parents’ and the students’ smoking habit (p<0.01). The reasons for starting smoking were the influence of their friends (83.7%) and curiosity (38.3%). The age of starting smoking was mostly between 15 to 17 years. Among smokers, 62.1% were consuming foreign brand cigarettes and there was a significant relationship between consumption of foreign brand cigarette and living in the city (p<0.01). The rates of the intention to quit smoking was 84%, trying to quit was 68% and restarting smoking in the following year was 82%. Smoking addiction affecting a higher number of teenage students, and those students being willing to quit but remaining passive; it is necessary to increase the number of informative and motivating activities for this age group and to initiate "prevention of starting to smoke campaigns", targeting especially the parents.

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Hemoptizi nedeniyle göðüs cerrahisi kliniklerinde tedavi edilen hastalarýn bir kýsmýnýn etyolojisinde aspergillus suþlarý saptanýr. Aspergillus sporlarý, tüberküloz baþta olmak üzere, akciðerlerin çeþitli kavitelerinin iç yüzeylerinde ve nekroz kalýntýlarýnýn içinde filizlenenerek koloniler oluþturabilen, fýrsatçý bir enfeksiyon etkenidir. Bu enfeksiyon pulmoner aspergilloma olarak bilinir ve cerrahi tedavisi bazý özellikler taþýr. Bu çalýþmada, merkezimizde cerrahi tedavi uygulanmýþ aspergilloma olgularýnýn genel olarak deðerlendirilmesi amaçlandý. Merkezimizde Ocak 1988 ile Haziran 2001 tarihleri arasýnda aspergilloma nedeniyle 31 olguya cerrahi tedavi uygulandý. Tüm veriler hasta dosyalarýndan elde edildi. Olgularýn demografik ve klinik özellikleri, taný ve tedavi yöntemleri, postoperatif komplikasyonlarý ve ölüm oranlarý ile uzun dönem izlem sonuçlarý geriye dönük deðerlendirildi. Olgularýn 5' i kadýn 26'sý erkek olup, ortalama yaþ 42.2 ± 10.5 (17 - 60) idi. Altta yatan hastalýk araþtýrýldýðýnda, olgularýn 26' sýnda tüberküloz (%83.8) 2' sinde (%6.5) büllöz akciðer hastalýðý, 2' sinde (%6.5) kist hidatik ve birinde (%3.2) akciðer karsinomu saptandý. Taný yöntemi, preoperatif taný konulan 25 (%81) olgudan 9' unda balgam mikroskopisi, 4'ünde fiberoptik bronkoskopi, 12' sinde ise transtorasik iðne aspirasyonu (TTÝA) idi. Olgularýn 22' sine (%71) lobektomi , 4' üne (%13) pnömonektomi ve 5' ine (%16) "wedge" rezeksiyon uygulandý. Postoperatif dönemde, 3 ekspansiyon kusuru ile birlikte uzamýþ hava kaçaðý, 2 bronkoplevral fistül ile birlikte ampiyem ve bir retorakotomi gerektiren kanama olmak üzere toplam 6 (%19.3) olgumuzda komplikasyon geliþti. Sað pnömonektomi uygulanan bir olgumuz (%3.2) ise solunum yetmezliði ile kaybedildi. Uzun süreli izlemde, yalnýzca bir olgumuza tekrarlayan hemoptizi nedeniyle 10 ay sonra tamamlayýcý pnömonektomi uygulandý. Pulmoner aspergilloma, yaþamý tehdit edici komplikasyonlarý nedeniyle, semptomsuz bile olsa cerrahi olarak tedavi edilmelidir. Cerrahi tedavi tekrarlayan hemoptizileri önlemede oldukça etkilidir. Pnömonektomili olgular yüksek morbidite ve mortaliteye sahiptir.

Aspergillus species are found to be the etiologic factor in some of the patients with hemoptysis who are surgically treated in thoracic surgery clinics. Aspergillus spores make up an opportunistic source of infection with the potential of seeding within necrotic remnants and forming colonies in the inner surfaces of many cavitary lesions of the lungs, especially in tuberculosis. This infection is known as pulmonary aspergilloma and its surgical treatment has some unique features. In this study, pulmonary aspergillomas which were treated surgically in our center were evaluated. Between January 1988 and June 2001, 31 cases of aspergilloma were operated in our clinic. Data were retrieved from the patients’ files. They were retrospectively reviewed according to their demographic and clinical features, diagnostic and treatment modalities, postoperative complications, mortality rates and results of long-term follow-up. Five female and 26 male patients with a mean age of 42.2 ±10.5 years (range: 17-60 years) were enrolled for the study. Underlying lung disease was tuberculosis in 26 (83.8%), bullous lung disease in 2 (6.5%), hydatid cyst in 2 (6.5%) and lung cancer in one (3.2%) of the patients. Aspergillus hyphea were isolated by direct microscopy of the sputum in 9, in the material obtained by fiberoptic bronchoscopy in 4, by transthoracic fine needle aspiration in 12 and by thoracotomy in 6 cases. Operative procedures were lobectomy in 22 (71%), pneumonectomy in 4 (13%), and wedge resection in 5 (16%) patients. Postoperative complications occurred in 6 (19.3%) patients. These were prolonged air leak and air space in 3, empyema and bronchopleural fistula in 2, and postoperative hemorrhage requiring re-thoracotomy in one patient. One patient (3.2%) died of respiratory failure following a right pneumonectomy. Another patient underwent completion pneumonectomy for recurrent episodes of hemoptysis 10 months after his first operation. Because of its serious and often life-threatening complications, pulmonary aspergilloma should be treated surgically, even in asymptomatic patients. Surgical treatment is very effective in preventing recurrent hemoptysis. In our series, the modality with the highest mortality and morbidity was pneumonectomy.

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Bu çalýþmada, akciðer reseptörlerinin normokapnik ve hiperkapnik koþullarda solunum tipi üzerine etkileri kedilere kýsmi vagal blokaj uygulanarak araþtýrýldý. Deneylerde sodyum pentobarbital (30 mg/kg iv) ile anesteziye edilen aortik kemodenerve 10 kedi kullanýldý. Deney hayvanlarýnda, vaguslar intakt iken, soðuk uygulamasý ile miyelinli vagal liþer bloke edildikten sonra vagotomi yapýlarak miyelinsiz liþer kesildikten sonra hava ve hiperkapnik gaz karýþýmlarý solunmasý sýrasýnda, soluk hacmi (VT), soluk frekansý (f/dak) ve frenik ENG kaydedildi. Bu parametrelerden solunum dakika hacmi (VE), inspirasyon (TI) ve ekspirasyon (TE) süreleri hesaplandý. Ayrýca ortalama inspiratuar (VT/TI) ve ortalama ekspiratuar akým (VT/TE) hýzlarý saptandý. Bulgularýmýz, glomus karotikum intakt iken normokapnik koþullarda, yavaþ adapte olan (SAR) ve çabuk adapte olan (RAR) akciðer gerim reseptörlerinin inspirasyon süresinin belirlenmesinde etkili olduklarýný, buna karþýn C-lif reseptörlerinin normokapnide soluk hacminin düzenlenmesinde, hiperkapnide ise ekspirasyon süresinin kontrolünde etkili olduklarýný göstermektedir.

The purpose of this study was to investigate the effects of pulmonary receptors on respiratory pattern by differential vagal blockade during normocapnic and hypercapnic conditions. The experiments were carried out in ten aortic chemodenervated cats. Action potentials from the phrenic nerve, tidal volume (VT), respiratory frequency (f/min) were recorded in the experimental animals with intact vagi during cold blockade of myelinated vagal fibers and after vagatomy, while the animals were breathing air and hypercapnic gas mixture. From the recorded parameters, respiratory minute volume (VE), inspiration time (TI), expiration time (TE), the mean inspiratory (VT/TI) and the mean expiratory (VT/TE) flow rates were calculated. Although the slowly-adapting pulmonary receptors (SAR) and rapidly adapting pulmonary receptors (RAR) take part in controlling the timing of inspiration in normocapnic conditions, C-fibre receptors are involved in controlling both TE in hypercapnia and VT in normocapnia.

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Myasthenia gravis, nöromüsküler kavþaðýn, postsinaptik membranlarýndaki nikotinik asetil kolin reseptörlerin, otoimmün hastalýðýdýr. Hastalar sýklýkla asimetrik pitoz ve/veya diplopi, çiðneme, konuþma ve yutma güçlüðü ve genel halsizlik ile baþvurabilirler. Hastalýk enfeksiyonlar, gebelik, puerperal dönem veya çeþitli ilaçlar nedeniyle kötüleþebilir. Miyastenik kriz sýrasýnda, solunum kaslarý tutulmuþsa veya havayolunu temizleyen reþeksler azalmýþsa, mekanik ventilasyon desteði gerekebilir. Endotrakeal entübasyon ve invazif mekanik ventilasyonun çok sayýda komplikasyonu vardýr ve mortalitesi yüksektir. Noninvazif mekanik ventilasyon ise birçok pulmoner ve nöromüsküler hastalýkta baþarýyla kullanýlmaktadýr. Bununla birlikte myastenik krizde noninvazif mekanik ventilasyon kullanýmý hakkýnda az sayýda yayýn vardýr. Burada, noninvazif mekanik ventilasyon ile tedavi edilen bir miyastenik kriz olgusu sunulmuþtur.

Myasthenia gravis is an autoimmune disease of the nicotinic acetylcholin receptors at the postsynaptic membrane of the neuromuscular junction. Patients usually present with asymmetrical ptosis and/or diplopia, bulbar symptoms such as difficulties in chewing, speaking and swallowing and generalized fatigue. Infections, pregnancy, postpartum period and some medications may worsen the disease. If the respiratory muscles are involved or the airway-protective reflexes are lost, supportive mechanical ventilation may be necessary during acute myasthenic crisis. Endotracheal intubation and invasive mechanical ventilation have a number of complications and a high mortality. On the other hand, noninvasive mechanical ventilation is being successfully used in many pulmonary and neuromuscular diseases. There are few reports about the use of noninvasive mechanical ventilation in myasthenic crisis. We present a case with myasthenic crisis who was treated with noninvasive mechanical ventilation.

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45 yaþýnda erkek hasta dispne ve sol yan aðrýsý nedeniyle pek çok kez doktora baþvurmuþ. 3 yýl önce hastanemizde üst mediastende kitle saptanmýþ. Bronkoskopi normal, bronþ aspirasyon sitolojisi benign ve asidorezistan basil negatif bulunmuþ. Torakotomiyi kabul etmeyerek taburcu olmuþ. 3 ay sonra baþka bir hastanede yapýlan torakotomide ana vasküler yapýlara ve toraks duvarýna invaze kitle saptanmýþ ve anrezektabl olarak deðerlendirilmiþ. Biyopside akciðer dokusunda tümör izlenmemiþ; bir alanda granulasyon dokusu saptanmasý nedeniyle tüberküloz tanýsý konarak 6 ay tüberküloz tedavisi verilmiþ. Yakýnmalarýnýn devam etmesi ve 15 gün önce hemoptizi baþlamasý üzerine kliniðimize baþvurdu. Fizik baký ve laboratuvar incelemeleri normal bulundu. Akciðer grafisinde nonhomojen sol hiler dansite, toraks bilgisayarlý tomografisinde sol üst lob bronþunun baþlangýç kesimini saran kitle izlendi. Bronkoskopide sol üst lob içinde serbest, beyaz, iplik görünümünde uzantýlar ve apikoposterior segmenti tama yakýn týkayan vegetan kitle görüldü. Biyopside hiperkeratöz gösteren, skuamöz epitel ile çevrili polipoid yapý ve epitelde keratohyalin granülleri saptandý. Ýplik görünümündeki materyal saç kýlý olarak deðerlendirildi. Teratom düþünülerek torakotomi yapýldý. Ön mediyasten ve sol üst lobdaki kitlenin alt lob, perikard, pulmoner arter ve toraks duvarýný invaze ettiði gözlendi. Kitle içinde nekrotik, kötü kokulu materyal ve bol kýl mevcuttu. Kitle rezeke edilemedi ve biyopsi "matür kistik teratom" olarak deðerlendirildi.

A 45-years-old male patient had ongoing complaints of dyspnea and left-sided chest pain. A density in his left hilar region on chest X-ray and a mass on upper mediastinum on thorax computed tomography (CT) were detected in our hospital three years ago. Bronchoscopic evaluation was normal. Cytologic examination of the bronchial aspiration material was in benign character and negative for acid-fast bacilli (AFB). He was offered thoracotomy, but he did not accept it and was discharged. After 3 months he underwent thoracotomy in another hospital and a mass invading main vascular structures and also the chest wall was discovered. The mass was evaluated as unresectable. On biopsy, no tumor was seen in the lung tissue and as granulation tissue was seen in one area, the case was diagnosed as tuberculosis and received treatment for 6 months. He was admitted to our clinic because of ongoing complaints and hemopthysis which started 15 days ago. Physical examination and laboratory investigations were in normal limits. His chest X-ray revealed a nonhomogeneous density in the left hilar region. Thorax CT showed a mass in the left upper lobe and mediastinum. Bronchoscopic evaluation revealed fiber-like, white material in the left upper lobe and a mass subtotally occluding the apicoposterior segment. Biopsy showed polypoid structure with hyperkeratosis covered by squamous epithelium and keratohyaline granules in the epithelium. The fiber-like material was evaluated as hair. The patient underwent thoracotomy with a presumptive diagnosis of teratoma.The mass in the anterior mediastinum and left upper lobe was invading the lower lobe, pericardium, pulmonary artery and the chest wall. The mass contained necrotic, putrid material and a big amount of hair. The tumor could not be completely resected. The pathologic diagnosis was mature cystic teratoma.

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Kronik Obstrüktif Akciðer Hastalýðýnda (KOAH), astýmdakinin aksine, tedavi seçenekleri oldukça sýnýrlýdýr. Oysa KOAH, tüm dünyada önemli bir morbidite ve mortalite nedeni olup, hastalýðýn progresyonunu engelleyen yeni tedavi stratejilerine acilen ihtiyaç duyulmaktadýr. KOAH'da astýmdan farklý olarak, nötrofillerin orkestra þeþiðini yaptýðý bir inflamasyon, dolayýsýyla da nötrofilik inflamasyonda rol oynayan sitokinlerin hakimiyeti vardýr. KOAH'daki inflamasyonda rol oynayan sitokin ve enzimlerin baþýnda yer alan Interlökin 8 ve diðer kemokinler, Lökotrien B4 (LT B4), tümör nekroz faktör alfa (TNF a), fosfodiesteraz 4, nötrofil elastaz (NE) ve matriks metalloproteinazlar (MMP) gelecekteki KOAH tedavisinde kullanýlacak olan ajanlarýn baþlýca hedef molekülleridir. Bu derlemede, KOAH gelecek tedavisinde adý geçen bu ajanlar ve etki mekanizmalarý özetlenmiþtir.

There have been few therapeutic advances in the drug therapy of Chronic Obstructive Pulmonary Disease (COPD), in contrary to enormous advances made in asthma management. COPD is an important leading cause of morbidity and mortality all over the world. Therefore there is an urgent need to develop new strategies to prevent the progression of the disease. As opposed to asthma, neutrophilic inflammation and its cytokines play the chief role in the inflammation in COPD. As a consequence of this, interleukine (IL) 8, other chemokines, leukotriene B4, tumor necrosis factor alpha (TNFµ), phosphodiesterase 4, neutrophil elastase, matrix metalloproteinases have become potential targets to develop new therapeutic options. This review aims to summarize all future therapeutic options with their mechanisms.

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