Ulusal Konsensus Toplantýsý adý altýnda iki yýl önce yapýlan bir dizi toplantý, 2004 yýlýnda Antalya Konsensusu 2003 baþlýðý ile bir kitapçýk olarak yayýnlandý. Ancak, okuyucu açýsýndan önemli bir referans niteliðindeki bu kitapçýðýn Akciðer Kanserinin Cerrahi Tedavisi bölümünde, eleþtiriye açýk ve yanlýþ yönlendirici bazý noktalar bulunmaktadýr. Bunlar kýsaca; temel yaklaþým bütünlüðünün oluþturulamamýþ olmasý, kavramsal ve terminolojik karmaþa, bazý konsensus maddelerinin birbiriyle çeliþmesi ve kaynak seçimindeki öncelikler olarak özetlenebilir. Bu sorunlarýn kýsa zamanda giderilmesi ile bu kitapçýðýn 3 yýl sonraki toplantýya temel olacak görüþleri oluþturmada önemli bir rehber olacaðýný düþünüyoruz.

Following a series of meetings that were held in Antalya with the name of “National Consensus Meeting” two years ago, a booklet called “Antalya Consensus 2003” has been published in 2004. Although it has a great importance to the readers as a reference book, it contains a number of controversial and misleading points in the chapter of “Surgical Treatment of Lung Cancer”. These are-in brief- lack of universality for the main approaches, its conceptual and terminological complexity, contradictory clauses among some statements of the consensus and inappropriate selection of the attributed references. We strongly believe in that this booklet will act as an important guide for the formation of new conceptions, which would in turn, constitute the fundamentals of the forthcoming meeting to be held within 3 years time, contingent on these issues are immediately eliminated.

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Bu çalýþmada 1999- 2002 tarihleri arasýnda SSK Süreyyapaþa Göðüs Kalp ve Damar Hastalýklarý Eðitim Hastanesi' nde tedavi edilen 419 akciðer tüberkülozlu olgunun verileri geriye dönük olarak incelenmiþtir. Diyabet saptanan 67 (%16) olgunun klinik ve radyolojik bulgularý, diyabetli olmayan 352 (%84) olgu ile karþýlaþtýrýlmýþtýr. Diyabetli grupta ortalama yaþ (50.4±11.3) diyabetli olmayan gruba (36.1 ±14.5) göre ileridir (p<0.001). Diyabetli olgular arasýnda erkek olgu oraný ( %97), diyabetli olmayan gruba (%83.8) göre yüksektir (p=0.004). Her iki grup arasýnda semptomlar ve semptom süresi açýsýndan anlamlý fark yoktur. Diyabetli olgularda yayma pozitiþiði (%85.1) oraný diyabetli olmayan gruba (%68.2) göre yüksektir (p=0.005). Diyabetli olgularda alt akciðer alanlarýnda tutulum(%25.4), diyabetli olmayan gruba (%8.3) göre anlamlý þekilde fazladýr ( p< 0.001). Diyabetli grupta olgularýn %47.8' inde, diyabetli olmayan grupta %31.5' inde konsolidasyon saptanmýþtýr (p=0.01). Diyabetli olgularýn 63 (%94)' ünde tedavi baþarýlýdýr. Diyabetli olmayan grupta 317 (%90.1) olguda tedavi baþarýsý elde edilmiþtir. Tedavi baþarýsý gruplar arasýnda anlamlý farklýlýk göstermemiþtir (p>0.05). Sonuç olarak özellikle ileri yaþ gruplarýnda tüberküloz ile diyabetin birlikteliði ve bu olgularda alýþýlmýþýn dýþýnda radyolojik görünümler olabileceði ayýrýcý tanýda göz önünde bulundurulmalýdýr. Bununla birlikte hastalýðýn tedaviye yanýt ve kür oranlarý diyabetli olgularda farklý deðildir.

In this study we retrospectively evaluated 419 patients with tuberculosis treated in SSK Süreyyapaþa Center of Chest Diseases and Thoracic Surgery between 1999-2002. We compared the clinical and chest radiographic findings of 67 patients (16%) with pulmonary tuberculosis and diabetes with those of 352 patients (84%) with pulmonary tuberculosis alone. The mean age of the diabetic group (50.4±11.3 years) was higher than that of the non-diabetic group (36.1±14.5 years). The percentage of male patients in the diabetic group (97%) was higher than that in the non-diabetic group (83.8%) (p=0.004). There was no significant difference regarding symptoms or the duration of symptoms between the two groups. The percentage of smear (+) patients were higher among diabetics (85.1%) than non-diabetics (68.2%) (p=0.005). Lower lung involvement in diabetics (25.4%) was significantly higher (8.3%) than non-diabetic group (p<0.001). More patients with pulmonary tuberculosis and diabetes developed consolidations (47.8%) than did patients with tuberculosis alone (31.5%) (p=0.01). Treatment success was achieved in 63 cases (94%) in the diabetic group and in 317 cases (90.1%) in the non-diabetic group. There was no significant difference in treatment success between the two groups (p>0.05). As a result, in older patients, the coexistence of tuberculosis and diabetes mellitus and the presence of In this study we retrospectively evaluated 419 patients with tuberculosis treated in SSK Süreyyapaþa Center of Chest Diseases and Thoracic Surgery between 1999-2002. We compared the clinical and chest radiographic findings of 67 patients (16%) with pulmonary tuberculosis and diabetes with those of 352 patients (84%) with pulmonary tuberculosis alone. The mean age of the diabetic group (50.4±11.3 years) was higher than that of the non-diabetic group (36.1±14.5 years). The percentage of male patients in the diabetic group (97%) was higher than that in the non-diabetic group (83.8%) (p=0.004). There was no significant difference regarding symptoms or the duration of symptoms between the two groups. The percentage of smear (+) patients were higher among diabetics (85.1%) than non-diabetics (68.2%) (p=0.005). Lower lung involvement in diabetics (25.4%) was significantly higher (8.3%) than non-diabetic group (p<0.001). More patients with pulmonary tuberculosis and diabetes developed consolidations (47.8%) than did patients with tuberculosis alone (31.5%) (p=0.01). Treatment success was achieved in 63 cases (94%) in the diabetic group and in 317 cases (90.1%) in the non-diabetic group. There was no significant difference in treatment success between the two groups (p>0.05). As a result, in older patients, the coexistence of tuberculosis and diabetes mellitus and the presence of unusual radiological findings should be taken into consideration in the differential diagnosis. Besides that, the treatment success rate was not different in diabetic group.

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Bu çalýþmada tedavi altýndaki hafif ve orta aðýrlýkta bronþ astýmý olan ve astýmsýz olgular arasýnda, gastroskopinin ve oluþturulan bilinçli sedasyonun FVC, FEV1 , FEV1/FVC, FEF25-75, PEF deðerleri ile SpO2 ve nabýz üzerine olan etkisi araþtýrýldý. 80 hasta bronþ astýmý olmayan (ÝV sedasyon uygulanan ve uygulanmayan); bronþ astýmý olan (ÝV sedasyon uygulanan ve uygulanmayan) olmak üzere 4 gruba ayrýldý. Ýþlem öncesinde ve sonrasýnda FVC, FEV1, FEV1/FVC, FEF25-75 ve PEF deðerleri, nabýz ve SpO2 deðerleri ölçüldü. Ýþlem süresince nabýz ve SpO2 deðerleri kaydedildi. ÝV sedasyon amacýyla Midazolam, bilinçli sedasyonu sonlandýrmak amacýyla ÝV Flumazenil uygulandý. Gastroskopi iþleminin ve uygulanan ÝV sedasyonun bronþ astýmý olan ve olmayan olgularda FVC, FEV1, FEV1/FVC, FEF25-75 ve PEF deðerleri üzerine herhangi bir etkisi olmadýðý gözlendi (p>0.05). Özefagus, mide ve duedonumdaki SpO2 deðerleri ortalamalarý tüm gruplarýn iþlem öncesi SpO2 deðerleri ortalamalarýna göre istatistiksel olarak anlamlý derecede düþük (p<0.01); nabýz ortalamalarý ise anlamlý derecede yüksekti (p<0.01). SpO2 hipoksi sýnýrý olan % 92' nin altýna inmedi. Tedavi gerektirecek düzeyde taþikardi gözlenmedi. Normal ve bronþ astýmlý olgularda gastroskopinin ve bilinçli sedasyon için uygulanan Midazolam'ýn güvenle kullanýlabileceði görüldü.

In this study we evaluated the effects of gastroscopy and anesthesia to induce a conscious sedation on FVC, FEV1, FEV1/FVC, FEF 25-75%, PEF values, SpO2 and pulse rates in asthmatics and non asthmatics. 80 patients were divided into 4 groups as bronchial asthmatics (sedated and non-sedated) and non-asthmatics (sedated and non-sedated). FVC,FEV1, FEV1/FVC, FEF25- 75%, PEF values, SpO2 and pulse rates were recorded before and after gastroscopy. SpO2 and pulse rates were also recorded during gastroscopy. IV Midazolam was used to induce sedation and IV Flumazenil to terminate sedation. We did not observe any effect of gastroscopy and IV sedation on FVC, FEV1, FEV1/FVC, FEF25-75%, PEF values in asthmatics and non-asthmatics (p>0.05). SpO2 values during the procedure (passing through esophagus, stomach and duodenum) were significantly lower than pregastroscopic results. But they did not fall below 92% which indicates hypoxia. Pulse rates increased significantly during gastroscopy (p<0.01). But treaetment was not needed. In asthmatics and non-asthmatics gastroscopy and induction of conscious sedation with IV Midazolam is safe.

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Pulmonary thromboemboli remains a leading cause of morbidity and mortality. Embolic obstruction of pulmonary vasculature may result in pulmonary hemorrhage but usually does not cause pulmonary infarction. Pulmonary infarction may occur during only in 10% of pulmonary emboli, but the rupture of pulmonary infarction is a very rare condition in the chest disease clinics. In the literature only a few case reports have been published. We report spontaneous hemothorax in a patient with pulmonary thromboembolism anticoagulated with enoxiparin (1 mg/kg, bid, SC) which was thought to develop due to ruptured pulmonary infarction. The patient was successfully managed with discontinuation of anticoagulation, blood and plasma transfusions, chest tube drainage for evacuation of blood from the pleural space.

Pulmonary thromboembolism remains a leading cause of morbidity and mortality. Embolic obstruction of pulmonary vasculature may result in pulmonary hemorrhage but usually does not cause pulmonary infarction. Pulmonary infarction may occur only 10 % of pulmonary emboli but, the rupture of pulmonary infarction is a very rare condition in the chest diseases clinics. In the literature only a few case reports have been published. We report here spontaneous hemothorax that thought to be occurred due to ruptured pulmonary infarction in a case of pulmonary thromboembolism anticoagulated with enoxaparin (1mg/kg, bid, SC). The patient was successfully managed with discontinuation of anticoagulation, blood and plasma transfusions, chest tube drainage for evacuation of blood from the pleural space.

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Konjenital lober amfizem (KLA) genellikle yenidoðan döneminde dispne, taþipne, öksürük, wheezing ve siyanoz gibi semtomlarla ortaya çýkan þiddetli solunum yetersizliði sendromuna yol açabilen nadir hastalýklardan birisidir. KLA etkilenen lobda aþýrý geniþleme, hava hapsi ve karþý akciðere herniasyon, komþu parankimde kompresyon ve mediastende yer deðiþtirme ile karakterizedir. Hastalarýn hemen hepsine yaþamýn ilk altý ayýnda taný konulur. Eriþkin dönemde taný konan nadir olgular literatürde bildirilmiþtir. Eriþkin dönemde taný koyduðumuz bir olgu nedeniyle KLA'i literatür ýþýðýnda gözden geçirdik.

Congenital lobar emphysema (CLE) usually presenting with symptoms like dyspnea, tachypnea, cough, wheezing and cyanosis during neonatal period is a rare disease which may cause severe respiratory distress. CLE is characterized by overdistention, air trapping in the affected lobe, herniation to the other lung, compression in adjacent parenchyma and mediastinal shift.Nearly all of the patients are diagnosed in first 6 months of life. Rare cases diagnosed during adulthood are published in literature. We present an adult case with CLE in view of literature.

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