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Giriş ve Amaç: Yapılan birçok çalışmada Obstrüktif Uyku Apne Sendromu'nun (OSAS) kardiyovasküler hastalıklar için bağımsız bir risk faktörü olduğu gösterilmiştir. Ancak OSAS ile venöz tromboemboli (VTE) arasındaki ilişkiyi ortaya koyan çalışmalar yetersizdir. Bu çalışmada Pulmoner Emboli (PE) tanısı alan hastalarda OSAS sıklığını polisomnografik olarak ortaya koyup OSAS varlığının pulmoner emboli için bir risk faktörü olabileceğini klinisyenlerin dikkatine sunmak amaçlanmıştır.Yöntem: Düzce Üniversitesi Tıp Fakültesi Göğüs Hastalıkları Servisinde PE tanısı alan ardışık 50 hasta prospektif olarak OSAS sıklığı yönünden değerlendirildi. Çalışmaya katılmayı kabul eden klinik durumu uygun gönüllü 30 olguya Polisomnografik inceleme yapıldı. Apne-Hipopne İndeksi 5'in üzerinde olan hastalar OSAS olarak kabul edildi. PE'de OSAS sıklığı tespit edildi ve PTE olguları majör risk faktörü olup olmamasına göre iki gruba ayrılarak karşılaştırıldı.Bulgular: 28-85 yaşları arasında (61±15,ortalama±SD), 14 kadın, 16 erkek toplam 30 olgu çalışmaya dahil oldu. Nonmasif PE 24 olgu (%80), submasif PE 3 olgu (%10), kronik pulmoner tromboemboli 2 olgu (%6,7) ve masif pulmoner emboli 1 olgu (%3,3) mevcuttu. Olguların %56,7'sinde (17/30) OSAS tespit edildi. Orta ve ağır OSAS (AHİ > 15) olanların oranı ise %26,7 (8/30) idi. Bilinen majör VTE riski olmayan pulmoner tromboembolisi olan hastalarda (n=20), VTE risk faktörü olan hastalara göre (n=10) anlamlı olarak daha yüksek oranda OSAS tespit edildi (sırasıyla %70; 14/20 ve %30; 3/10, p=0.045). Majör PTE risk faktörü olan grubun yaş ortalaması daha düşük, (66 ve 52, p=0.015) kilosu ise daha yüksek (81 ve 88 p=0.025) bulundu. Majör risk faktörü olmayan grupta BUN düzeyleri anlamlı olarak daha yüksekti. PTE majör risk faktörü olan ve olmayan grupta vücut kitle indeksi, hematokrit düzeyi, AHİ ve diğer polisomnografik bulgular yönünden anlamlı fark saptanmadı. Yapılan multivaryant lojistik regresyon analizinde görünür majör risk faktörü olmayan grupta PTE için tek bağımsız risk faktörünün OSAS olduğu tespit edildi (p=0.049).Sonuç: PTE'si olan olgularda OSAS oranları toplumdan çok daha yüksek oranda bulundu. Çalışmanın sonuçları OSAS'nın PTE için bağımsız bir risk faktörü olabileceğini düşündürmektedir. Bu konuda daha kapsamlı çalışmalara gereksinim vardır. Background and Objectives: It is evaluated that obstructive sleep apnea syndrome (OSAS) is an independent risk factor for cardiovascular diseases. However, there is no further study demonstrating the relationship between OSAS and venous thromboemboli (VTE). In this study, the aim is to evaluate OSAS via polysomnography in patients with pulmonary embolism and drawing the attention of clinicians to the presence of OSAS may be a risk factor for pulmonary embolism.Method: In the Department of Chest Diseases of Düzce University School of Medicine, 50 patients with pulmonary embolism were evaluated for the frequency of OSAS, prospectively.Polysomnographic evaluation was performed to clinically stable 30 patients agreed to participate in the study. Patient with apnea-hypopnea index more than 5 was defined as OSAS.The frequency of OSAS in the patients with pulmonary embolism was detected and the properties of those patients compared with other cases.Results: Between the ages of 25-85 (61-15,mean ?SD), 30 patients (14 women,16 men) were included in study.There were 24 patients with non-massive pulmonary embolism (%80), 3 patients with submassive pulmonary embolism(%10 ),2 patients chronic pulmonary embolism (%6,7)and 1 patient with massive pulmonary embolism (%3,3), respectively.%56,7 of the patients (17/30)OSAS were detected. The percent of patients with moderate and severe OSAS (AHI >15) was %26,7 (8/30).The patients with no known major risk factors for pulmonary embolism had significantly high rates OSAS compared to,those with having major risk factors (respectively %70; 14/20, %30 3/10 and ;p:0,045 )The mean age of the group with major risk factor for VTE was found low.(66-13 and 52 -15, p:0,015)There was no significantly difference for gender, weight and body mass index between the groups, who have major risk factors for VTE and who have no major risk factor for VTE.Conclusions: The rate of OSAS in patients with PE was much higher than that of community. Moreover, the clinical significance of moderate and severe OSAS patients in the community for at least 5 times higher. The group with idiopathic thromboembolism without a risk factor has OSAS in higher rates when compared with the group with risk factors. More comprehensive search is needed on this subject.Keys: pulmonary embolism, obstructive sleep apnea syndrome, sleep apnea, venous thromboembolism 48

WOS: 000266684100017, PubMed ID: 19181507, Epidemiological characteristics of sarcoidosis differ according to geographical distribution. The aim of our study was to disclose epidemiological characteristics in our country. The data was collected from investigators, who sent information on newly-diagnosed patients via internet. In 2 years 198 female and 95 mate patients were enrolled to the study (f/m:2.08). Mean age of patients was 44 +/- 13 years (17-90). Mean age of mate patients was 38 12 while mean age of female patients was 48 13 (p < 0.001). 73.4% of patients were nonsmokers (85.4% of females; 48.4% of mates; (p < 0.001)). About 50% of our 293 patients were housewives. Familial sarcoidosis was found in 3 patients' first degree relatives. Estimated annual incidence of sarcoidosis for Turkey was calculated as 4 per 100,000 person. According to our study, 2/3 of sarcoidosis patients were women; mean age of patients was 45 and the disease began 10 years later in female patients. 80% of patients were nonsmokers; negative relation between sarcoidosis and smoking was evident especially in women. Familial sarcoidosis frequency was lower compared to other studies in the literature. There was no occupational exposure history in our patients. Our incidence rate, is similar with the results of other European studies. (C) 2008 Elsevier Ltd. All rights reserved.

Giriş ve amaç: Sigara kullanımıyla ciddi ve ölümcül hastalıklar arasında ilişkilerin ortaya konmasından sonra sigara kontrolü için çalışmalar başlatılmıştır. Sigaraya hiç başlamamak en etkili ve yararlı yöntem olmakla beraber, sigara içmekte olanların bu davranışlarından vazgeçmelerini sağlamak üzere de çaba gösterilmesi önemlidir. Tarama yöntemleri sigara bırakma motivasyonu artırarak sigara bırakmada etkili olabilmektedir. Bu çalışmada Düzce ilinde 30 yaş ve üzeri sigara içenlerde akciğer kanseri semptom taramasının sigara bırakmadaki rolünü araştırmak amaçlandı.Yöntem: Düzce ilinde, deprem sonrası yapılan kalıcı konutlarda randomize 700 hane seçilerek 30 yaş üzeri sigara anamnezi olan 500 olgu çalışmaya alındı. Olguların demografik özellikleri, sigara alışkanlıkları ve akciğer kanseri semptomları (hemoptizi, kronik öksürük, göğüs ağrısı, kilo kaybı, ses kısıklığı ve çomak parmak) bir anket formuyla yüz yüze görüşmeyle sorgulandı. Sigaranın akciğer kanseri için önemli bir risk faktörü olduğu vurgulandı ve bu semptomlardan en az bir tanesi olanlara Göğüs Hastalıkları poliklinik kontrolü önerildi. 500 olgunun 25 tanesi geçmişte sigarayı çeşitli yıllarda bırakmış olgulardan oluşmaktaydı. Bu olgular çalışma grubunun kendiliğinden bırakma oranlarını hesaplamada kullanıldı. Halen aktif sigara içen 475 olgunun 353'üne 6 ay sonra telefonla ulaşılarak sigara alışkanlıkları yeniden sorgulandı.Bulgular: Toplam 353 sigara içen olgunun 32 (%9,1) kadın, 321 (%90,9) erkekti. Yaş ortalaması 46±9, ortalama 36±24 paket/yıl sigara anamnezi olan olgulardan oluşuyordu. 130'u (%36,8) sigarayı bırakmayı düşünüyordu ve 65'i (%18,4) sigarayı bırakmayı denemişti. 6 ay sonraki kontrolde 17 olgu (%4,8) sigarayı bırakmış, 59 olgu (%16) sigarayı azaltmış, 2 olgu (%0,6) ise artırmıştı. Sigarayı bırakanların hiçbiri ilk görüşmede bırakmayı düşündüğünü söyleyenler veya daha önce bırakmayı deneyenlerden değildi. Sigarayı bırakanların yaş ortalaması daha yüksekti (p=0.044) ve daha uzun süredir sigara içme öyküleri vardı (p=0.001). Hemoptizi ve çomak parmak semptomlarının varlığı sigara bırakma oranlarını anlamlı olarak artırmaktaydı (sırasıyla p=0.048, p=0.013). Başlangıçta sorgulanan 500 sigara anamnezli olgunun 25'i ortalama 5 yılda sigarayı bırakmıştı (yılda ortalama 5 olgu). Çalışma grubunun yıllık kendiliğinden bırakma oranı %1 (5/500) idi. Bu çalışmada akciğer kanseri semptom sorgulamasından 6 ay sonraki bırakma oranı (%4,8), kendiliğinden sigarayı bırakma oranından (%1) anlamlı olarak yüksekti (p=0,001).Sonuç: Akciğer kanseri semptom taramasıyla sigara bırakma oranları artırılabilir. Bu çalışmada doktorların poliklinik hastalarına yaptıkları telkinle benzer düzeyde sigara bırakma oranlarına ulaşılmıştır. Sigara bırakma poliklinikleri yanında bu tip çalışmalar da sigara mücadelesine katkıda bulunabilir.Anahtar Kelimeler: sigara bırakma; akciğer kanseri tarama; hemoptizi; çomak parmak Introduction: After the relationships were proved between smoking and serious, mortal diseases some studies conducted to control smoking. Although no beginning smoking is the most effective and useful way, it is important to strive for smoking cessation. In this study it is purposed to research whether the symptoms of the lung cancer among 30 years old and older cases in Düzce has a role on smoking cessation.Materials and Methods: In Duzce randomized 700 household were chosen from the permanent houses built after the earthquake and 500 cases who have smoking history were included in this study. Demographic features, smoking habits and symptoms of lung cancer (hemoptysis , chronic cough, chest pain, lose of weight, hoarseness and clubbing ) were evaluated by a questionnaire with a face to face manner. Smoking had been a very important risk factor was emphasized. And everyone who had at least a symptom of lung cancer was advised to have a policlinic control. 25 of 500 cases were the ones who had given up smoking in the past years. These cases were used to evaluate the self cessation ratios.353 out of the 475 active smoker were interrogated after 6 months for their smoking habits by phone.Results: Among these 353 cases, there were 32(%9.1) women and 321 (%90.9) men, mean age was 46±9 years, mean duration of history of smoking was 36±24 pocket /year. 130 cases (%36.8) were intended to smoking cessation and 65 had tried smoking cessation. At the control after 6 months 17(%4.8) of them had given up smoking, 59 (%16) of them had decreased, and 2(%0,6) of them had increased. Cases who had given up smoking were not the ones who had an intention to smoking cessation and had tried cessating at the first meeting. Cases who had given up smoking had an older mean age (p=0.044) and they had smoking histories for a long time (p=0.001). Having symptoms like hemoptysis and clubbing were increased smoking cessation ratios expressively (p=0.048,p=0.013). Cases (25) who were interrogated at first visit had cessated smoking averagely in 5 years. Spontaneous smoking cessation of the study group was %1 (%0.001).Conclusions: Smoking cessation ratios can be increased by researching symptoms of lung cancer. In this study, similar smoking cessation ratios were reached compared to the suggestions of physicians during policlinic controls. As well as the smoking cessation policlinics, also these kinds of studies can have contributions among struggling with smoking.Key WordsSmoking cessation, lung cancer screening, hemoptysis, clubbing 49

Aims and backgroundTo evaluate the relationship between delayed diagnosis and the degree of invasion and survival in lung cancer.MethodsOne hundred and three patients (96 men) with lung cancer were included. Stages in the diagnosis of lung cancer were classified as follows: symptom-to-doctor interval, i.e., the interval from the first symptoms related to the presence of lung cancer to the first consultation with a medical professional; doctor-to-diagnosis interval, i.e., the interval between the first medical visit and confirmation of the diagnosis; and diagnosis-to-treatment interval, i.e., the interval between diagnosis and complete TNM staging and treatment. The symptom-to-treatment interval (STI) was the sum of the 3 intervals. The degree of invasion was determined by the TNM classification.ResultsThe patients were followed up for a mean period (± SD) of 7.4 ± 8.7 months. Seventy-six (74%) patients were diagnosed with non-small cell lung cancer (NSCLC) and 27 patients (26%) with small cell lung cancer (SCLC). The mean length of STI was 120 ± 101 days (median, 90). The mean length of the symptom-to-doctor interval was 63 ± 62 days (median, 45), while the doctor-to-diagnosis and diagnosis-to-treatment intervals were 41 ± 82 days (median, 10) and 16 ± 12 days (median, 12), respectively. When the STIs of the patients were correlated with tumor stage, tumor invasion, lymph node involvement and metastasis, no significant differences were found. Patients with an STI longer than 60 days had a significantly longer survival. Regarding the type of lung cancer and STI, the median survival was shorter in patients with an STI of less than 60 days both in NSCLC and SCLC, although this was not statistically significant in SCLC.ConclusionsThe shorter the diagnostic interval, the shorter was the median survival in our study. The reason for the apparent discrepancy between poor prognosis of lung cancer patients in spite of early diagnosis might be much faster progression of the disease itself.

Amaç: Bu çalışmada astımlı olgularda OSAS sıklığını ve OSAS'ın astım şiddeti ve kontrol düzeyi üzerine etkilerini araştırmayı amaçladık.Giriş: Obezite sık rastlanan her iki hastalık içinde ortak risk faktörüdür. Yine üst solunum yollarında anatomik ve fonksiyonel anomaliler ve reflü ortak birlikteliktir. Astım semptomlarının gece arttığı bilinen bir gerçektir. Üstelik OSAS'da fizyopatolojisinin odak noktası olan üst solunum yollarının astımda da etkilenen önemli bir bölge olması bu iki hastalığın birbirleri üzerine nedensel olabilecek etkileşimini araştırmaya sevk etmektedir.Yöntem: Göğüs Hastalıkları Polikliniğine başvuran ardışık 50 erişkin astımlı hasta (35 kadın/ 15 erkek) çalışmaya alınarak polisomnografi uygulandı.Bulgular: Astımlı hastalarda OSAS oranı %40 (orta ve ağır OSAS %16) olarak bulundu. Astım şiddetine göre OSAS oranları açısından anlamlı fark saptanmadı. Astımda daha iyi kontrol düzeyi sağlandıkça OSAS görülme sıklığı artmakta idi ancak farklar istatistiksel olarak anlamlı değildi. OSAS bulunan astımlı olguların hepsinde horlama mevcuttu. Habitüel horlaması, tanıklı apne ve gündüz aşırı uyku hali semptomları olan astımlılarda olmayanlara göre OSAS görülme sıklığı anlamlı olarak yüksekti. Majör semptomların birlikteliği arttıkça OSAS görülme sıklığı da anlamlı olarak artıyordu. Astımlı olguların boyun çevresi ve vücut kitle indeksleri arttıkça Apne-Hipopne İndeksi ve OSAS şiddeti anlamlı olarak artmakta idi. Triseps yağ kalınlığı ile astım şiddeti arasında anlamlı pozitif korelasyon tespit edildi.Sonuç: Erişkin astım hastalarında normal topluma göre çok yüksek oranda OSAS bulundu. Özellikle obez ve boyun çevresi kalın astımlı hastalar OSAS semptomları yönünden mutlaka sorgulanmalıdır. Astımlılarda majör OSAS semptomu varlığında polisomnografik inceleme mutlaka yapılmalıdır. Horlamanın olmaması astımda OSAS'nu dışlamada önemli olabilir.Her iki hastalığın birlikteliğini, etkileşimini ve uzun dönem sonuçlarını ortaya koymak için daha ileri çalışmalara ihtiyaç vardır.Anahtar Kelimeler: astım, uyku apne, obezite, horlama AbstractObjective and Introduction: Obesity is a common risk factor for two prevalent disorders, namely asthma and obstructive sleep apnea syndrome (OSAS). Similarly, anatomical and functional abnormalities of the upper airways and reflux are other associated factors. It is known that symptoms associated with asthma are generally more severe at nights. Moreover, upper airways as the essential area in the pathophysiology of OSAS also constitute the mainly affected region in asthma. Therefore these two different disorders can cause each other as having a mutual pathway in etiology. The objective of this study was to investigate the prevalence of OSAS in patients with asthma and its effect on the severity and the management of asthma.Material and Methods: The consecutive 50 asthma patients (35 female and 15 male) attending the outpatient clinic of the department of Chest Diseases were included in this study. All of these patients were undergone to Polysomnographic examination.Results: The overall prevalence of OSAS was 40% in asthma patients. This ratio was 16% regarding the moderate and severe OSAS. However, the prevalence of OSAS according to the severity of asthma were not significantly related. Although the prevalence of OSAS was increased in well controlled asthmatic patients, this relation was not statistically significant. Snoring was observed in all asthma cases with OSAS. Particularly, the prevalence of OSAS was significantly more common in asthma patients having the symptoms of habitual snoring, witnessed apnea, daytime sleepiness than those of not. The incidence of major symptoms was positively correlated with the incidence of OSAS. Similarly, as the diameter of the neck and body mass index in asthma patients were increased, the Apnea-Hypopnea index and severity of OSAS were also significantly elevated. Lastly, the adipose tissue thickness in triceps was positively correlated with the severity of asthma.Conclusions: The prevalence of OSAS was significantly higher in asthma patients than that of normal adult population. According to our results, obese asthmatic patients or asthma patients with large neck diameter should be investigated for the presence of OSAS symptoms. Consequently, polysomnographic examination must be performed in asthma patients with major OSAS symptoms. On the other hand, the absence of snoring may be criteria to exclude OSAS in asthmatic patients. Further studies are required to explore the long term results of coincidence, relation and cross interaction of these two common disorders.Key words: asthma, sleep apnea, obesity, snoring 44

Annakkaya, Ali Nihat N/0000-0002-7661-8830; BILGIN, CAHIT/0000-0003-2213-5881 WOS: 000222523400003 PubMed: 15236493 This study was designed to evaluate the effects of furniture production, mainly including fir tree (aberia mulleriana), on respiratory health of young workers and to compare the results with those obtained from previous Studies. Sixty-four furniture-decoration students (57 males and 7 females) and 62 controls (54 male, 8 female) from different departments in the same school were included into the Study. All participants were assessed with a questionnaire (concerning history of occupational exposure, work-related respiratory and other symptoms, smoking history, previous asthma history), full physical examination, spirometric evaluation and chest radiograph. Participants then performed serial monitoring of peak expiratory flow rates (PEER) at work and away from work within a month. Mean age of students was 20.9 +/- 3.7 years, 20.5 +/- 2.6 years in controls. There was no difference between study and control groups with regard to age, gender, smoking status and previous asthma history. Reported cough (23.4% vs. 8.1%) and shortness of breath (18.8% vs. 6.5%) were significantly higher in furniture-decoration students than in controls (p = 0.016 and p = 0.034, respectively). Furniture-decoration students had higher conjunctivitis (34.4% vs. 9.7%, p = 0.001) and rhinitis (34.4% vs. 19.4%, p = 0.044) history when compared with controls. Both students and controls were normal in terms of respiratory examination. PEF recordings were performed for approximately one month. Diurnal variability greater than 20% was seen in 12/64 (18.7%) of students at work, whereas it was detected in 4/62 (6.4%) of controls (p = 0,034). When comparing for the presence of diurnal variability greater than 20% in weekends, no difference was found between groups (p = 0.457). In conclusion, early detection of work-related respiratory changes by serial monitoring of peak expiratory flows should save the workers from hazardous respiratory effects of the furniture production, especially in young population.