AMAÇ: Neopterin (Np) hücresel immünite ile iliþkili bir belirteçdir. Baþlýca IFN-γ tarafýndan uyarýlan monosit ve makrofajlardan üretilir ve vücut sývýlarýna salýnýr. Çalýþmamýzda, yayma pozitif akciðer tüberküloz olgularý, sekel akciðer tüberküloz olgularý ve saðlýklý eriþkinlerde serum ve idrar Np düzeylerinin ölçümünün, tüberküloz tanýsýnda ve reaktivasyon tayininde kullanýlabilirliðini ve yararýný araþtýrdýk. GEREÇ-YÖNTEM: Çalýþmamýza klinik, radyolojik ve bakteriyolojik olarak aktif akciðer tüberkülozu tanýsý alan 19 olgu, radyolojik olarak sekel tüberküloz ile uyumlu lezyonlarý olan ve 3 kez bakýlan balgam ARB direkt (-), teksif (-), kültür (-) olan 15 sekel akciðer tüberkülozlu ve 10 saðlýklý olgu dahil edildi. Olgularýn serum ve idrar Np düzeyleri ELISA yöntemi ile ölçüldü. BULGULAR: Çalýþmamýzda, aktif tüberküloz olgularýnýn hepsinin serum Np düzeylerinin standart cut-off deðerinin (10nmol/L) üzerinde olup, aktif akciðer tüberkülozlu olgularýn serum ve idrar Np düzeyleri sýrasýyla (ort: 15,07±2,83 nmol/L) (ort: 442,75±85,57µmol/ mol kreatinin) olarak saptandý. Bu deðerler hem saðlýklý kontrol grubuna (serum Np ort: 5,22±1,48 nmol/L, idrar Np ort: 146,53±13,27 µmol/mol kreatinin) göre hem de sekel akciðer tüberkülozlu gruba (serum Np ort: 10,67±1,46 nmol/L, idrar Np ort: 231,41 ±42,38 µmol/mol kreatinin) göre istatistiksel olarak anlamlý yükseklik gösterdi. Sekel akciðer tüberkülozlu olgularýmýzýn serum Np düzeyleri (ort: 10,67±1,46 nmol/L) de saðlýklý kontrol grubundan (ort: 5,22±1,48 nmol/L) anlamlý olarak yüksekti. SONUÇ: Sonuç olarak; serum ve idrar Np düzeyleri hastalýk tanýsýnda, aktivite tayininde radyolojik ve bakteriyolojik verilere yardýmcý noninvaziv bir parametre olarak kullanýlabilir ve ayný zamanda klinik takipte yardýmcý bir parametre olabilir.

OBJECTIVE: Neopterin is a marker associated with cell-mediated immunity. It is produced in monocytes/macrophages primarily upon stimulation with interferon-γ and release into body fluids. In the present study, serum and urinary neopterin (Np) concentrations were measured in patients with active pulmonary tuberculosis (TB) cases, with inactive pulmonary TB and healthy controls, in order to investigate its’role in the diagnosis and disease activity. MATERIAL-METHOD: Serum and urinary Np levels were evaluated in 19 patients with active pulmonary TB (clinical, radiological and bacteriological), 15 patients with inactive pulmonary TB (confirmed as one year radiologically stabile lesions and at least 3 negative sputum smears and cultures) and 10 healty individuals. Np levels were measured by ELISA. RESULTS: Serum and urinary Np levels in active TB patients (Serum Np mean: 15,07±2,83 nmol/L and urinary Np mean: 442,75±85,57µmol/ creatinin respectively) were significantly higher than the levels of the patients with inactive pulmonary TB (serum Np mean: 10,67±1,46 nmol/L and urinary Np mean: 231,41 ±42,38 µmol/creatinin respectively) and healthy controls (serum Np mean: 5,22±1,48 nmol/L and urinary Np mean: 146,53±13,27 µmol/creatinin respectively). Additionaly serum Np levels were above the standard cut-off levels (10 nmol/L). Serum Np levels in inactive pulmonary TB cases were also significantly higher than healthy controls (p<0,005). CONCLUSION: Serum and urinary Np levels may be used in the diagnosis of TB and may reflect the degree of disease activity in pulmonary TB patients. It may be used as an additional, noninvasive parameter to radiological and bacteriological tools.

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AMAÇ: Kliniðimizde taný konulan küçük hücreli dýþý akciðer kanseri (KHDAK) olgularýnýn klinik, histolojik ve epidemiyolojik özelliklerini tanýmlamak. GEREÇ-YÖNTEM: Kliniðimize Ocak-Aralýk 2005 tarihleri arasýnda yatarak KHDAK tanýsý almýþ olgularýn demografik özellikleri, radyolojik ve bronkoskopik bulgularý, taný yöntemleri deðerlendirildi. BULGULAR: Bir yýllýk süreçte 109 hastaya KHDAK tanýsý konuldu. Olgularýn yaþ ortalamasý 64.10±9.76 yýl(38-83) olup 82’si erkek, 27’si kadýndý. Olgularýn 95’inde (%87.15) 39.17±17.33 (5-90) paket-yýl sigara hikayesi vardý. Sigara içme oraný erkeklerde %91.46, kadýnlarda %74.07 idi. Hücre tiplerinin daðýlýmý yassý hücreli akciðer karsinomu (YHAK) %51.4, adenokanser %36.7, kombine tip %10.1, hücre tipi tanýmlanamayan ise %1.8 olarak saptandý. Erkeklerde en sýk YHAK (%54.87) görülürken kadýnlarda ise adenokanser (%55.55) ön plana çýkmaktaydý. Sigara içenlerde de YHAK ilk sýradaydý. Pasif sigara içimi hikayesi olan 8 olgunun 2’sinde YHAK, 6’sýnda adenokanser saptandý. YHAK %82.14’ü, adenokanserin ise %62.50 radyolojik olarak santral yerleþimliydi. Balgam sitolojisinde %19.26 oranýnda malign hücre gözlendi. Bronkoskopik incelemede olgularýn %61.50’sinde endobronþiyal kitle gözlendi. Bronþ lavaj ve biyopsi ile olgularýn %71.55’inde malign hücre saptandý. TTÝAB yapýlan 33 olgunun 30’unda (%90.90) tanýsal materyal elde edildi. TNM sýnýflamasýna göre deðerlendirdiðimizde olgularýn %68.80’i Evre III B ve IV idi. Malign plevra sývýsý adenokanser olgularýnýn %27.50’inde saptandý. SONUÇ: YHAK, akciðer kanserleri içerisinde en sýk görüleni olma özelliðini korurken genel olarak KHDAK, muhtemelen sigara içiminin artmasýna baðlý olarak kadýnlarda artmaya devam etmektedir.

OBJECTIVE: To describe the clinical, histological, and epidemiological characteristics of patients with nonsmall cell lung cancer in our hospital in last year. MATERIAL-METHOD: Patients that were diagnosed as nonsmall cell lung cancer (NSCLC) in our clinic between January 2005 and December 2005 were evaluated according to their demographic properties, radiological and bronchoscopic findings, diagnostic procedures and pathological grades. RESULTS: During this one year period 109 patients were diagnosed as NSCLC. There were 82 men (75.2%) and 27 women (24.8%). Mean age was 64.10±9.76 (38-83). 95 patients (87.15%) had history of 39.17±17.33 (5-90) pack-year smoking. Smoking rate were 91.46% in men, 74.07% in women. Pathological diagnoses of the cases included squamous cell carcinoma (51.4%), adenocarcinoma (36.7%), mixed type (10.1%) and undefined (1.8%). Squamous cell carcinoma was the most common type of lung cancer in men (54.87%). Among women, adenocarcinoma was the most common tumors of lung (55.55%). Among smoking patients squamous cell carcinoma was the leading type. Two of 8 patients who had passive smoking history were diagnosed with squamous cell carcinoma, other 6 patients were adenocancer. Radiological evaluation prompted that 82.14% of the squamous cell carcinoma, 62.50% of the adenocancer, lesions were centrally located. 19.26% of all sputum cytology showed malign cells. Endobronchial lesions were found in 61.50% (squamous cell carcinoma 66.07%, adenocancer 52.50%), and 71.55% were diagnosed after broncoscopic biopsy and lavage. Diagnostic materials were taken in 30 of 33 cases (90.90%) who underwent to TTNAB. 75 of the 109 patients (68,80%) were found stage III B and IV. Malign pleural effusion was found mostly with adenocarcinomas (27.50%).
CONCLUSION: Squamous cell carcinoma is still the most common type of lung cancer, and NSCLC are generally increasing among women as the smoking rates are increasing in this population.

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AMAÇ: Bu çalýþmada kliniðimizde platin bazlý kemoterapi sonrasý dosetaksel uygulanan ileri evre küçük hücreli dýþý akciðer kanserli (KHDAK) olgularýn yanýt, toksisite, sað kalým ve sað kalýmý etkileyen faktörler yönünden araþtýrýlmasý amaçlandý. GEREÇ-YÖNTEM: KHDAK tanýsý ile platin bazlý kemoterapi almýþ, progresyon geliþmesi nedeni ile ikinci basamak tedavi amaçlý en az iki kür dosetaksel uygulanan 33 hasta (3 kadýn, 30 erkek, ortalama yaþ: 55±9.16) çalýþmaya alýndý. Tüm hastalara dosetaksel 75mg/m2, 21 günlük sikluslarla uygulanmýþtý. Yirmibeþ (%75) olgunun performansý ECOG 0-1, 8 (%25) olgunun performansý ECOG 2 idi. Yedi olgu (%21.2) evre IIIB, 26 (%78.8) olgu evre IV olup ortalama 4 (2-12) kür tedavi uygulanmýþtý. BULGULAR: Objektif yanýt oraný %12.1 (4 olgu), progresyona kadar geçen süre 7.14±6.22 ay ve ortalama sað kalým 10.34±1.56 ay olarak bulundu. Birinci basamak tedavi bitiminden progresyona kadar geçen sürenin 3 aydan uzun olmasý (p=0.035) ve performansýn 0-1 olmasý (p=0.016) sað kalýmý olumlu etkileyen faktörler olarak saptandý. Birinci basamak tedavide paklitaksel almýþ olmanýn ve 65 yaþýndan büyük olmanýn sað kalýma etkisi tesbit edilmedi (sýrasý ile p= 0.88, p=0.84). Grade 3-4 nötropeni %18.8 (6 olgu), febril nötropeni %3 (1 olgu), grade 3-4 anemi %6 (2 olgu), enfeksiyon %9 (3 olgu) oranýnda idi. Bir olgu (%3) 3. kürden sonra enfeksiyon nedeni ile kaybedilmiþti. SONUÇ: Ýkinci basamak tedavide tek ajan dosetakselin iyi tolere edildiði, yanýt oraný düþük olmakla birlikte sað kalým sonuçlarýnýn iyi olduðu görüldü. Yüksek sað kalým rakamlarý kliniðimizde seçilmiþ hastalara ikinci basamak kemoterapi uygulanmasýna baðlandý.

OBJECTIVE: In this study we aimed to investigate the cases with advanced non small lung cancer (NSCLC) who received docetaxel after platin based chemotherapy for response, toxicity, survival time and the factors effecting survival. MATERIAL-METHOD: The study comprised 33 patients (3 females and 30 males; mean age 55±9.16 years) who received at least 2 cures of secondline docetaxel (75mg/m2, 21 days). ECOG performance status was 0-1 in 25 (75%) cases whereas 8 (25%) cases had performance status ECOG 2. Seven (21.2%) cases were stage IIIB, 26 (78.8%) cases were stage IV and the mean cure was 4 (2-12). RESULTS: The objective response rate was 12.1% (4 cases), the mean time to progression was 7.14±6.22 months and the mean survival time was 10.34±1.56 months. After firstline chemoterapy time to progression longer than 3 months (p=0.035) and the performance status 0-1 (p=0.016) were determined as favorable factors for survival. Receiving paclitaxel in the first line treatment and age more than 65 years were not found effective on survival (p=0.88, p=0.84, respectively). Grade 3-4 neutropenia was found 18.8% (6 cases), febril neutropenia was 3% (1 case). Grade 3-4 anemia was 6% (2 cases), infection was 9% (3 cases). One case has died after the 3rd cure because of infection. CONCLUSION: Docetaxel was observed as a well tolerated single agent in the secondline chemotherapy and the survival results were found good despite of low response rate. High survival rates might be due to giving secondline chemotherapy to the choosen patients in our clinic.

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AMAÇ: Cam fabrikasý iþçilerinde silika kristaline maruz kalma ile oluþan solunumsal semptomlarýn ve mesleki kronik bronþit geliþiminin prevalansýný ve solunum fonksiyonlarýndaki deðiþiklikleri incelemeyi amaçladýk. GEREÇ-YÖNTEM: Cam fabrikasýnda çalýþan 37 bayan (%23.4), 121 erkek (%76.6) toplam 158 iþçi (ortalama yaþ SD: 27.65±8.64 yýl) çalýþmaya alýndý. Ýþçiler solunum sistemi semptomlarý açýsýndan bir anket formu doldurdular. Tüm olgularýn solunum fonksiyon testleri (SFT) taþýnabilir spirometri ile yapýldý. Solunumsal þikayetler ve olgularýn solunum fonksiyon testleri benzer yaþ, cins ve sigara öyküsü olan kontrol grubu ile kýyaslandý. BULGULAR: Ýþçilerin ortalama çalýþma süresi 60.32±86.64 ay idi. Fabrikada çalýþan iþçilerde %19 öksürük, %23 balgam, %25 hýrýltý ve %16 dispne tespit ettik. Bu semptomlardan üçü kontrol grubu ile kýyaslandýðýnda istatistiksel olarak anlamlý derecede yüksek idi (sýrasýyla p=0.052, p=0.002, p=0.0001, p=0.013). Kontrol grubu ile kýyaslandýðýnda fabrikada çalýþan iþçilerde FEV1%, FVC%, PEF% ve FEF25-75% deðerleri anlamlý düzeyde düþük saptandý (sýrasýyla p=0.001, p=0.0001, p=0.0001, p=0.007). Fabrikanýn farklý bölümlerinde çalýþan iþçiler arasýnda solunumsal semptomlarýn prevalansý ve SFT parametreleri anlamlý farklýlýk göstermedi. Ýþçilerde çalýþma süreleri ile FEV1% deðerleri arasýnda negatif bir korelasyon izlendi (r=-0.214, p=0.007). SONUÇ: Cam fabrikasýnda çalýþan iþçiler artmýþ solunumsal semptomlara ve düþük SFT deðerlerine sahiptirler. Bu sektörde çalýþan iþçiler mesleki kronik bronþit riski altýndadýrlar. Bu iþ kolunda iþçi saðlýðýný korumak amacýyla gerekli önlemlerin alýnmasý, çalýþanlara mesleki hastalýklar konusunda eðitim verilmesi ve düzenli saðlýk kontrollerinin yapýlmasý uygun olur kanaatindeyiz.

OBJECTIVE: To determine the prevalence of respiratory symptoms, lung function abnormalities and the prevalence of chronic bronchitis among glass factory workers who were exposed to silica-cyrstal. MATERIAL-METHOD: 37 female (23.4%) and 121 male (76.6%) total 158 workers (mean age SD: 27.65±8.64 years) employed in glass factory were studied. All of the workers filled a questionnaire for their respiratory symptoms. Their pulmonary function tests (PFT) were determined by a portable spirometry. Their respiratory symptoms and PFT results were compared with a control group who has similar age, sex, and smoking habit. RESULTS: The mean duration of employment of workers was 60.32±86.64 months. The workers had high prevalence of cough (19%), phlegm (23%), wheezing (25%) and dyspnea (16%) when compared to control group (p=0.052, p=0.002, p=0.0001, p=0.013, respectively). The workers had lower FEV1%, FVC%, PEF% ve FEF25-75% results compared to the control group (p=0.001, p=0.0001, p=0.0001, p=0.007, respectively). The prevalence of respiratory symptoms and PFT results were not significantly different between departments of the factory. A negative correlation was found between FEV1% and duration of employment (r=-0.214, p=0.007).
CONCLUSION: Increased respiratory symptoms and reduced PFT results were found amongst glass-factory workers. This population is under increased risk of occupational chronic bronchitis. Taking precautions for workers’ health, training workers against occupational diseases, and regular check ups will provide those workers’ well-being.

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AMAÇ: Bronþektazili hastalarýn % 50’sinde etyoloji bilinmemektedir. Son yýllarda baðýþýklýk sisteminin bronþektazi geliþmesindeki rolü üzerinde durulmaktadýr. Çalýþmamýzda etyolojisi bilinmeyen kistik bronþektazili hastalarda monosit ve granülositlerin fagositoz fonksiyonlarý ve oksidatif patlama fonksiyonlarý araþtýrýldý. GEREÇ-YÖNTEM: Yüksek rezolüsyonlu bilgisayarlý tomografi (YRBT) ile bronþektazi tanýsý alan 15 olguda akut alevlenme olmayan dönemde monosit ve granülositlerin fagositoz fonksiyonlarý ve oksidatif patlama fonksiyonlarý; IgG, IgA, IgM, IgE düzeyleri çalýþýldý. Fagositoz için monositlerde %65-95, granülositlerde %95-99; oksidatif patlama için monositlerde %70-100, granülositlerde %95-100 aralýðý normal olarak deðerlendirildi. BULGULAR: Olgularýn hepsinde IgG, IgM, IgA düzeyleri normal, 2 olguda IgE düzeyi yüksek izlendi. Onbir olguda T hücre subgrublarý çalýþýldý, yalnýzca 4 olguda normal deðerlerde izlendi. Monosit fagositozu 6, granülosit fagositozu 8; monosit oksidatif patlama 5 ve granülosit oksidatif patlama fonksiyonlarý 5 hastada düþük olarak saptandý. Bir hastada 4 fonksiyonda, 2 hastada 3 fonksiyonda, 5 hastada 2 fonksiyonda birden bozukluk vardý. Oniki hastanýn (%80) en az bir fonksiyonu bozuktu. En az iki fonksiyonu bozuk olan 8 olgu (%53,3) vardý.
SONUÇ: Sýnýrlý sayýdaki bronþektazili olgumuzda fago-patlama panel de %80 oranýnda bozukluk saptandý. Eriþkin bronþektazilerde etiyolojide baðýþýklýk sisteminin incelenmesinin önemli olabileceði görüþündeyiz.

OBJECTIVES: The aetiology of bronchiectasis is unknown in 50% of patients with bronchiectasis. In recent years the role of immune system on the pathogenesis of bronchiectasis is emphasized. In our study we investigated the phagocytosis and oxidative burst functions of monocytes and granulocytes in the cystic bronchiectasis patients with unknown aetiology MATERIAL-METHOD: The levels of Ig G, Ig A, Ig M, Ig E and the phagocytosis and oxidative burst functions of monocytes and granulocytes were studied in 15 patients with bronchiectasis who were diagnosed with high resolution computed tomography (HRCT). Phagocytosis was assessed normal as 65-95% for monocytes, 95-99% for granulocytes; oxidative burst function was assessed normal as 70-100% for monocytes and 95-100% for granulocytes. RESULTS: In all patients levels of Ig G, Ig M, Ig A were normal, whereas in 2 cases Ig E was elevated. In 11 cases subgroups of T cells were studied and only 4 cases was determined as normal. In 6 patients monocyte phagocytosis, in 8 patients granulocyte phagocytosis, in 5 patients monocyte oxidative burst function, in 5 patients granulocyte oxidative burst function were determined as low. In 1 patient 4 functions, in 2 patients 3 functions, in 5 patients 2 functions were impaired. At least one function was impaired in 12 (80%) patients. Also there were 8 (53.3%) cases with at least two impaired functions. CONCLUSION: We determined impairment in phago-burst function in 80% of our limited number of patients with bronchiectasis. Immune sysytem might be important in the etiology of adult bronchiectasis.

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AMAÇ: Tüberküloz (TB) prevalansý yüksek olan bölgelerde, 35 yaþ altý hastalarda, soliter pulmoner nodüllerin (SPN) etyolojisinin önemli bir bölümünden TB’nin sorumlu olduðu ileri sürülmektedir. Bu çalýþmanýn amacý hastanemize baþvuran ve SPN ön tanýsýyla araþtýrýlan 35 yaþ altý hastalarda farklý taný oranlarýný belirlemekti. GEREÇ-YÖNTEM: Bu amaçla, retrospektif olarak, 2001-2006 yýllarý arasýnda, SPN ön tanýsý olan hastalarýn dosyalarý/kayýtlarý incelendi. Toraks BT’lerine göre lezyonlarýn boyutlarý, kalsifikasyon dereceleri, þekilleri tespit edildi. Hastalarýn son tanýlarý hasta dosyalarý ve/veya hastane bilgisayar sistemi kullanýlarak belirlendi. BULGULAR: SPN’li toplam 42 hasta saptadýk. Hastalarýn hepsi erkek, yaþ ortalamasý 23,3±3,7’di. SPN’lerin ortalama çapý 2,0±0,7 cm idi. 9 hastada TB, 5 hastada sekel TB, 4 hastada kist hidatik, 2 hastada metastatik kanser, 2 hastada arteriyo-venöz malformasyon, 2 hastada hamartoma, bir hastada fibrohistiyositik tümör, bir hastada pulmoner sekestrasyon, bir hastada schwannoma, bir hastada osteokondrom, bir hastada sferik pnomoni, bir hastada postoperatif sekel, bir hastada ise mukosel tanýsý konduðu ortaya çýkarýldý. 11 hastanýn takip edildiði, bu hastalarýn 6’sýnýn takiplerde benign olduðuna karar verildiði saptandý. SONUÇ: Hastanemizde, SPN ön tanýsý olan hastalarda, SPN nedenleri olarak birinci sýrada TB, ikinci sýrada da kist hidatik olduðu sonucuna vardýk. Çalýþmamýz, ayrýca, bu yaþ grubu hastalarda primer ve metastatik kanserleri de SPN ayýrýcý tanýsýnda akýlda bulundurmak gerektiðini düþündürmektedir.

OBJECTIVE: It was suggested that tuberculosis (TB) was responsible for an important part of the etiology of solitary pulmonary nodules (SPN) in patients under 35 years old in areas where prevalence of TB was high. The purpose of this study was to determine the rates of different diagnoses in patients, under 35 years old, applying to our hospital and who were investigated for the differential diagnosis of SPN. MATERIAL-METHOD: The files/records of the patients with a prediagnosis of SPN were investigated retrospectively between the years 2001 and 2006. The dimensions of the lesions, the degree and the form of the calcifications were determined using thorax CT. The final diagnoses of the patients were determined using patient files and/or hospital computer system. RESULTS: We detected 42 patients with SPN. The mean diameter of the SPNs was 2,0±0,7 cm. All the patients were male and the mean age was 23,3±3,7 years. In nine patients, TB, in 5 patients, sequel of tuberculosis, in 4 patients, hydatid cyst, in 2 patients, metastatic cancer, in 2 patients, arterio-venous malformation, in 2 patients, hamartoma, in one patient, fibrohistiocytic tumor, in one patient, pulmonary sequestration, in one patient, schwannoma, in one patient osteochondroma, in one patient pneumonia, in one patient post operative sequel, and in one patient mucocele were detected. Among II patients who were followed up, 6 were considered as benign. CONCLUSION: We concluded that TB was in first place and hydatid cyst was in second place as the causes of SPN in patients prediagnosed with SPN in our hospital. Our study also suggests that metastatic cancer should be bear in mind in the differential diagnosis of SPN in this age group patients.

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Nadir görülmesi ve tedavisiz tamamen düzelme özelliði ile pulmoner langerhans hücreli histiyositoz olgumuzu sunduk. Kýrkbir yaþýnda kadýn hasta kuru öksürük ve halsizlik yakýnmalarý ile hastanemize kabul edildi. Yirmi yýldýr günde bir paket sigara içmekteydi. Akciðer röntgenogramýnda üst ve orta loblarda daha belirgin olmak üzere difüz nodüler infiltratlar mevcuttu. Yüksek rezolüsyonlu akciðer tomografisinde multipl küçük nodüler lezyonlar görüldü. Pulmoner Langerhans hücreli histiyositoz tanýsý açýk akciðer biyopsisi ile konuldu. Hastalýk akciðerlerle sýnýrlý idi, herhangi baþka bir lokalizasyonda saptanmadý. Semptomlar ve radyolojik bulgular tedavisiz ve sigara býraktýrarak 3 ay sonra belirgin düzeldi. YRBT’de pulmoner lezyonlar kayboldu.

We presented a case of pulmonary langerhans cell histiocytosis with spontaneous remission. A 41-year old woman was admitted to our hospital with dry cough and fatigue. She had been smoking 20 cigarettes a day for 20 years. Chest X-ray film revealed diffuse nodular infiltrates in the predominantly middle and upper lung fields. HRCT showed multiple small noduler lesions. Pulmonary Langerhans’ cell histiocytosis was diagnosed with open lung biopsy. The disease was limited to the lung, since further investigations did not show any other localization. The symptoms and radiographic findings improved markedly within 3 months after the onset of symptoms without treatment and upon cessation of smoking. The HRCT scan follow-up showed resolution of pulmonary lesions.

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Hematojen yayýlým sonucu geliþen candida pnömonisinde, predispozan faktörlerin rolü önemlidir. Bunlar arasýnda aþaðýda sunacaðýmýz hastamýzda da olduðu gibi kanser, gastrointestinal cerrahi iþlemler ve geniþ spektrumlu antibiyotik kullanýmý ön sýralarda gelir. Fungal infeksiyonlar açýsýndan riskli hastalar, taný koymadaki zorluklar ve tedavi gecikmesini önlemek amacýyla dikkatli takip edilmelidir. Bu yazýmýzda, rektum adenokarsinoma nedeniyle total mezorektal eksizyon operasyonu uygulanan bir hastada postoperatif geliþen ve hematojen yayýlým sonucu akciðerde bilateral infiltrasyonla seyreden candida pnömonisi olgusu sunulmuþtur.

Predisposing factors are very important in candida pneumonia which results from hematogenous spread. As seen in our patient presented below, malignancy, surgery in the gastrointestinal system and usage of antibiotics of wide spectrum take place firstly. The patients who have risks for fungal infections, should be examined carefully to avoid treatment delay and diagnostic difficulties. In our article, we present a case who had candida pneumonia with bilateral infiltrations, which developed after low anterior resection for rectum adenocarcinoma and resulted from hematogenous spread.

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Acil Servis’ de ciddi yaralanmasý olan bir hastada pnömotoraks varlýðý saptandýðýnda tedavisi planlanýrken etyolojisi önemli olmamaktadýr. Burada bir baþka merkezde deðerlendirilerek spontan pnömotoraks tanýsý ile kliniðimize gönderilen 28 yaþýndaki erkek hastada ekspansiyon kusuru nedeniyle uygulanan cerrahi iþlem sýrasýnda fark edilen, preoperatif radyolojik olarak saptanamamýþ kist hidatikten yola çýkarak radyolojik deðerlendirmenin cerrahi iþlemler için öneminden bahsedilmektedir.

Pneumothorax may not always come to attention during the initial assessment of critically injured patients in emergency room. We present a 28 year old man who referred to our clinic as spontaneous pneumothorax. We performed surgical procedure because of expansion problem and realized intraoperatively that patient had hydatid cyst. We concluded that careful radiologic examination is an important issue in preoperative approaches.

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Akciðer tüberkülozunun progresif seyir göstererek göðüs duvarýna doðru ilerlemesiyle soðuk abse oluþturmasý ve bu tür olgularýn nadir görülmesi nedeniyle olgumuzun özelliklerini sunduk. Kronik böbrek yetmezliði (KBY) nedeni ile dört yýldýr diyalize girmekte olan 58 yaþýnda olgu sýrtýn sol tarafýnda aðrýsýz þiþlik, akýntý ve öksürük þikayetleri ile baþvurdu. Sol hemitoraksta infraskapuler bölgede yumuþak kývamlý fiks kitle ve yaklaþýk 2 cm altta lateral insizyon ve bu insizyondan seröz akýntý mevcuttu. Hastaya üc hafta önce bu bölgeden cilt biopsisi yapýldýðý ve patolojik incelemesinin granülomatöz dermatit olarak rapor edildiði öðrenildi. Balgam ARB bakýsýnda tüberküloz basili müspet bulundu. Radyolojik görüntülemelerde sol akciðerde fibroprodiktif lezyon ile ayný seviyeden baþlayan göðüs duvarýnda inflamatuar yumuþak doku deðiþiklikleri ve içerisinde multipl küçük abse formasyonlarý saptanmasý lezyonun interkostal geçiþini düþündürdü.

We presented a case of pulmonary tuberculosis invaded chest wall and caused cold abscess. A 58-year-old male patient was admitted to our hospital with a swelling on the left side of his back, discharge, and cough. He had been receiving dialysis therapy due to chronic renal failure for four years. On physical examination, a fixed smooth mass on the infrascapular region of the left hemithorax and 2cm below, a lateral incision with serous discharge were noted. Excisional biopsy had been performed on this region three weeks ago and the result had been reported as granulomatous dermatitis. The sputum smear was positive for AFB. On radiological examination inflammatory soft tissue changes, including multiple small abscess formations, were detected on chest wall and the parenchymal fibroproductive lesions were seen on the left lung's apical zone. Both lesions were found to begin from the same level, suggesting that the parenchymal lesion passed through the intercostal space and invaded chest wall. As a rare phenomenon, lung tuberculosis may follow a progressive course characterized by the development of a cold abscess on the chest wall, thus, this case was considered for presentation.

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Soliter pulmoner nodül ile baþvuran, cerrahi giriþim sonrasý yapýlan patolojik incelemelerde pulmoner kolesterol granülomu tanýsý alan, daha önce bildirilen etiyolojik faktörler araþtýrýldýðýnda buna ait herhangi bir bulgu saptanmayan kýrk altý yaþýndaki kadýn olguyu sunduk.

In this report, we presented a forty-six years old female patient with a solitary pulmonary nodule who had been diagnosed as cholesterol granuloma of the lung after surgical intervention. Previously reported aetiologic factors of cholesterol granuloma were investigated but no risk factor was detected.

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Kronik obstrüktif akciðer hastalýðý (KOAH), baþlýca sigara olmak üzere zararlý partiküllere ve gazlara karþý akciðerlerde geliþen inflamatuar yanýtla iliþkili hava akýmý sýnýrlanmasý ile karakterize önemli bir saðlýk sorunudur. Son zamanlarda inflamasyonun moleküler temelinin anlaþýlmasý konusundaki ilerlemeler, steroidlerin inflamatuar hastalýklarda etkinliðinin ve KOAH da mevcut inflamasyonun steroidlere olasý direnç nedenlerinin daha iyi anlaþýlmasýný saðlamýþtýr. Buna göre inflamasyon, kor histonlarýnýn asetilasyonu ile düzenlenen inflamatuar genlerin artmýþ ekspresyonu ile gerçekleþmekte, histonlarýn deasetilasyonu ile de baskýlanmaktadýr. Bu derlemede, KOAH’da steroid direncinde rolü olduðu ileri sürülen histon asetilasyonu / deasetilasyonu mekanizmasýndaki bozukluk ve buna yönelik tedavi yaklaþýmlarý sunulmuþtur.

Chronic obstructive pulmonary disease (COPD) is an increasing global health problem that is characterized by airflow limitation associated with an abnormal inflammatory response of the lungs to noxious particles or gases, primarily caused by cigarette smoking. Recently new sights into molecular basis of inflammation have shed light on the effectiveness of steroids on inflammatory disease and probable steroid resistance of inflammation. This inflammation is mediated by the increased expression of multiple inflammatory genes which is regulated by acetylation of core histones and this expression is supressed by deacetylation of these histones. In this review, the role of histone acetylation/deacetylation mechanisms projected in steroid resistance in COPD and therapeutic implications were reported

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