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OBJECTIVE: This study aimed to compare the success rate of 3 different drug prescription policies: Free drugs with online system prescription, free drugs with doctor’s prescription, and drugs paid for by patients with doctor’s prescription. MATERIAL AND METHODS: The effect of 2 different Ministry of Health (MoH) projects with free-of-charge and self-payment pharmacotherapies for smoking cessation were compared. Patients who completed 6 months of pharmacotherapy and follow-up were evaluated. The first period was free-of-charge medication, which was determined by an online system, the following period was the self-payment period, and the third period was free medication, which was prescribed by a doctor. In all the groups, smoking habits in pack years and comorbidities of the patients were recorded, and pulmonary function tests (PFTs) and expiratory carbon dioxide (CO2) measurements were performed. Patients who had an expiratory CO2 level >5 ppm at the control visits were accepted as quitters. RESULTS: A total of 829 patients with 438 patients in the first free-of-charge period (group 1), 111 in the self-payment period (group 2), and 280 in the second free-of-charge period (group 3) were enrolled in the study. Smoking cessation rates were significantly higher in the self-payment medication group (25%) according to the MoH’s free-of-charge project groups. There was no difference in smoking cessation rates between the 2 free-of-charge medication project groups (15% in group 1 and 11% of group 3). Among all the patients, we compared 124 patients who quit smoking with 705 patients who did not. The quitters were older, mostly male, and heavier smokers. In addition, the number of patients with chronic obstructive pulmonary disease and obstructive PFT rates were higher among the quitters. Their dependency score, PFTs, and the use of free medication was lower, and treatment duration was longer. Independent factors that increased smoking cessation success were longer treatment duration, lower dependency score, and self-payment of medication. CONCLUSION: Free medications provided via 2 different modalities did not increase the smoking cessation success. Paying for the medication, lower dependency score, and longer treatment duration increased smoking cessation success independently.

Numerous studies determined that the neutrophil/lymphocyte (NLR) and platelet/lymphocyte ratios (PLR) had prognostic value in several cancer types. This study aimed to evaluate the relationship between NLR and PLR values with the survival time of lung cancer patients. Patients diagnosed with lung cancer between January 2014 and December 2016, were retrospectively evaluated. Demographic characteristics, disease stages, laboratory parameters recorded, and the relationship of NLR and PLR values with the survival time and the disease stage evaluated. NLR and PLR were categorized into two groups. SPSS 17.0 software package was used for the statistical analysis. ROC analysis, Student T-test, Chi-square, and Mann-Whitney U test were used. Mean age of 62±8 years were included in the study. In the NSCLC group, the average NLR and PLR values were 4±3.35 and 194.6±144.4 respectively. Regarding the NSCLC group, the overall survival time was shorter in the subgroup with an NLR >3.43 (13.1 months) compared to the subgroup with an NLR ≤3.43 (24.3 months). The mean survival time was shorter in the group with a PLR > 136.9 compared to the group with a PLR ≤136.9 (15.9 and 24.6 months respectively). Subgroups consisting of survivors and non-survivors in the NSCLC group showed a statistically significant difference considering neutrophil and lymphocyte count, CRP, NLR, and PLR values (p

Asin many tumors, the relationship betweenKi-67 proliferation index and treatment response in lung cancer is emphasized. In this study, we aimed to investigate the relationship between Ki-67proliferation index (Ki-67PI) and the therapeutic effects of radiotherapy in small cell lung cancer and its effect onsurvival. Materials and Methods: The files of patients with limited stage small cell lung cancer in our hospital were retrospectively reviewedAge, sex, stage, additional disease, response to treatment according to The Response Evaluation Criteria in Solid Tumors (RECIST) and survival time were recorded. Bronchoscopic or transthoracic lung biopsy specimens were taken at the time of diagnosis were stained with Ki-67 immunohistochemical stain. Response to treatment and survival of patients were compared statistically with Ki-67 values. Results: The mean age of the patients was 65.13 ± 9.92 years, the mean survival time was 343.83 ± 273.23 days and the meanKi-67 PIwas 68.70 ± 9.49.17 patients with partial response and 13 patients with complete response were evaluated. The Ki-67 PI (62,29 ± 7,52) was lower in patients with partial response than in patients with complete response (77,08 ± 2,84) (p Conclusion: Patients with high Ki-67 had a better survival effect than those with low Ki-67, and patients with complete responses had a higher Ki-67 value.

Aim: Bleomycin is an antitumor antibiotic used successfully to treat a variety of malignancies, predominantly germ cell tumors and Hodgkin’s lymphoma (HL). The major limitation of bleomycin therapy is the potential for life-threatening interstitial pulmonary fibrosis. Early identification of asymptomatic patients who may develop toxicity is important. We aimed to evaluate fluorodeoxyglucose positron-emission tomography (FDG-PET/CT) findings to predict bleomycin toxicity (BT) early after chemotherapy with doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD) chemotherapy before clinical symptoms and radiological changes occur. Materials and Methods: HL patients who were treated with ABVD were evaluated. SUVmax values of lung parenchyma were analyzed in FDG-PET/CT at diagnosis and after 4 cycles of chemotherapy in all patients. At the end of the chemotherapy cycles, lung parenchymal SUVmax values of patients with BT and without BT were compared statistically. Results: Twenty (66.7%) male and 10 (33.3%) female patients with HL were included. Five (16.7%) HL patients developed BT. In 3 HL patients, BT was determined after 5 cycles and in 2 patients, BT was seen after 6 cycles. In all 5 of these patients with BT, FDG uptake in PET-CT was increased after 4 cycles of chemotherapy and BT was predicted before clinical and radiological findings by FDG-PET/CT. After 4 cycles of chemotherapy, lung parenchymal SUVmax of patients with BT (3.24 ± 0.76) was significantly higher than in patients without toxicity (1.84 ± 0.52) (p < 0.001). In patients with BT, a significant increase was established in lung parenchymal SUVmax after 4 cycles of chemotherapy when compared to the time of diagnosis (p = 0.043). Conclusion: BT can be fatal. Early detection of BT is essential in clinical practice. FDG-PET/CT can predict BT before clinical and radiological findings occur.

To evaluate the role of ultrasonography (USG) in the diagnosis of bleomycin-induced pulmonary toxicity (BT).The study included patients with suspected BT during treatment with bleomycin due to various oncologic diseases between June 2015 and May 2017. The patients initially underwent clinical and high-resolution computed tomography (HRCT) examinations and pulmonary function tests (PFT)-diffusing capacity of the lung for carbon monoxide (DLCO), followed by registration of USG findings-number of comet tail artifact (CTA) images by a different pulmonologist. We compared the findings from USG, HRCT, and PFT-DLCO tests between BT and non-BT groups. With the diagnosis based on clinical-radiologic and PFT-DLCO assessments taken as the gold standard, we determined the sensitivity and specificity of the USG outcomes for diagnosis of BT.The study included a total of 30 patients. Nine patients were diagnosed as having BT according to their clinical and radiologic findings and PFT-DLCO measurements. The mean number of CTA images was 68.7±22 in patients with BT vs 28.2±9.3 in those without BT (P.001). The difference in CTA images between the patients with and without ground glass density was statistically significant (28.3±9.5 and 64.6±24.5, respectively, P.001). In patients with BT, there was a negative correlation between the number of CTAs and DLCO% and FVC% values (P=.004; P=.016). USG had a sensitivity of 100%, and a specificity of 95% diagnosing BT in selected patients.In bleomycin-induced toxicity, USG findings are correlated with HRCT and PFT-DLCO findings, with a remarkably increased number of CTAs in BT. Thoracic USG examination is a diagnostic tool with a high sensitivity and specificity for diagnosing BT.

AIM: To investigate the diagnostic value of ultrasound (US) guided transthoracic fine needle aspiration biopsy (TTFNA) and US guided transthoracic tru-cut biopsy (TTTCB) in malignant thorax lesions. MATERIALS AND METHODS: Patients who underwent US guided transthoracic biopsies between April 2014 and May 2017 were retrospectively evaluated. Patients who were diagnosed as thoracic malignancy and both TTTCB and TTFNA performed for the same lesion were included in the study. The diagnostic accuracy of TTTCB, TTFNA and their combination were analyzed. The diagnostic accurracy of methods were statistically compared by McNemar Test. RESULTS: Thirty two patients were included in the study. Ultrasound guided TTFNA and/or TTTCB were diagnostic in 30 (93.8%) of them. TTFNA was diagnostic in 23 (%71.8), TTTCB were diagnostic in 26 (%81.2) of these pateints. Seven (77.7%) of 9 patients in which TTFNA was not diagnostic, TTTCB was diagnostic. The diagnostic accuracy was 71.8% and 81.2% for TTFNA and TTTCB, respectively. When TTTCB and TTFNA were performed consecutively in the same procedure, the overall diagnostic accuracy was 93.7%. There was no difference between the diagnostic accuracy of US-guided TTFNA and TTTCB (P=0.508). The diagnostic accuracy of combination of TTFNA and TTTCB was significantly higher than that of TTFNA alone (P=0.016). During the procedures, pneumothorax which did not require chest tube insertion was detected as complication in 1 case (3.1%). CONCLUSION: Diagnostic accuracy of US-guided TTFNA and TTTCB is high and has no superiority to each other. Combining both procedures under the quidence of US increases the diagnostic accuracy statistically significantly.

Purpose: The changes due to interstitial lung diseases (ILDs) in the lung parenchyma reveal comet tail artifact (CTA) that is defined on ultrasonography (USG), and is a type of reverberation artifact. We planned to investigate the significance of thoracic USG in the evaluation of the effect of ILD on pulmonary tissues in the present study. Materials and methods: The present cross-sectional study included patients diagnosed with ILD, and the control group between January 2016 and December 2017, high resolution computed tomography (HRCT) findings (the severity and extension scores for HRCT), pulmonary function tests, and pulmonary function tests and carbon monoxide diffusion test (PFT-DLCO) findings of all patients were recorded. Then, the number of CTAs detected on thoracic USG was recorded by a different pulmonologist. The data of the two groups were compared with each other. Results: Thirty-six (50.7%) patients and 35 (49.3%) healthy controls were included in the study. The mean number of CTA in the control group was 25 +/- 6.4 while the number of CTA in the ILD group was 68.3 +/- 16.2 (P < 0.001). Negative correlations were found between the total CTA and DLCO, DLCO%, forced vital capacity (FVC), and FVC% values (P < 0.001). Positive correlation was found between the total number of CTA and the total HRCT score (P: 0.01). The sensitivity of B-lines on USG was 94.4%, and specifitiy was 97.1% with a cutoff value of 39.5 to diagnose intersititial involvement. Conclusion: Thoracic USG may be a good diagnostic tool for diseases that commonly involve the lung interstitium such as ILD., NA

During an apnea, hemodynamic complications such as hypoxemia, a rise in systemic and pulmonary arterial pressure, and changes in heart rate occur in patients with obstructive sleep apnea (OSA). Potential mechanisms of OSA-associated renal dysfunction include renal hypoxia, hypertension, endothelial dysfunction. Hypertension is common in patients with OSA. This study aims to assess OSA patients' renal functions and investigate the creatinine clearance (CC) values across OSA patients with and without hypertension. The study included 530 individuals with OSA and 60 individuals with an apnea-hypopnea index (AHI) of 0.05). A statistically significant difference was detected in urea and creatinine levels between the OSA and control groups (p=0.005; p=0.012). Creatinine clearance decreases in patients with OSA in the presence of HT. Patients with OSA often experience cardiovascular disorders, and glomerular endothelial dysfunction occurs in OSA patients.

Objective: To evaluate the clinical, laboratory, radiological, and demographic data of H3N2 pneumonia cases hospitalized to the Pulmonology Department during H3N2 pandemics and compare them with non-H3N2 community-acquired pneumonia (CAP) cases. Methods: The study population consisted of all CAP cases hospitalized to our Pulmonology Department between December 2013 and February 2014 during the influenza outbreak. The patient files were evaluated for physical findings, laboratory data, radiological findings, and treatment and outcome of cases. H3N2 was diagnosed using polymerase chain reaction (PCR) analysis of throat swabs. The clinical, radiological, and laboratory findings of H3N2 pneumonia cases were compared with those of non-H3N2 pneumonia cases. Mann–Whitney U test, Chi-square test, Fisher’s exact test, and logistic regression analysis by the forward step wise method were used for statistical analyses. P value0.05). The rates of treatment failure and/or transport to the intensive care unit with the need of invasive mechanical ventilation and mortality rates were also similar in both groups (p>0.05). Conclusion: H3N2 pneumonia/viral pneumonia is a member of CAP. Although the number of H3N2 cases are extremely small to draw a conclusion, the results of this study highlight that the clinical, radiological, and laboratory findings of H3N2 pneumonia cases are not different from those of non-H3N2 CAP cases.

Background: the aim of this study is to evaluate the efficacy of positron emission tomography-computed tomography (PET-CT) in the diagnosis of, NA

Background: this study aimed to investigate the diagnostic value of fine-needle aspiration biopsy (FNAB) performed under the guidance of thoracic ultrasonography (USG) for the diagnosis of thoracic lesions such as peripheral lung lesions, pleural lesions, mediastinal lesions, and chest wall or supraclavicular metastases of lung lesions. Material and methods: cases with thoracic lesions that were found eligible for biopsy by thoracic USG and underwent FNAB between January 2008 and December 2016 were included in the study. Demographical characteristics and radiological findings of the cases, lesion size as detected by USG, sonographic patterns, number of FNABs per lesion, diagnosis based on FNAB, final diagnosis of inconclusive cases and the methods used to establish the final diagnosis, and developed complications were recorded. Results: FNAB was performed for peripheral lung lesion in 188 (72.6%), mediastinal mass in 23 (8.9%), chest wall metastasis of lung tumor in 23 (8.9%), supraclavicular lymph node metastasis of lung tumor in 18 (6.9%), and pleural lesion in 7 (2.7%) cases. The corresponding diagnostic accuracy was 78.7%, 78.2%, 95.6%, 94.4% and 85.7%, respectively. A diagnosis could be made in 211 (81.4%) of 259 cases (195 [92.4%] malignant and 16 [7.6%] benign). The overall diagnostic success of the procedure was 81.4%, and the success rate to diagnose malignant and benign lesions was 81.9% and 76.1%, respectively. Pneumothorax which needs pleural tube in placement was seen in five patients, with peripheral lesion as the major complication. Conclusion: USG-guided FNAB performed for thoracic lesions is associated with a high rate of diagnostic success (81.4%) and a low rate of major complications (1.9%)., NA

Introduction: To examine the clinical, radiological and radiometabolic (PET-CT) features of parenchymal nodules detected simultaneously during primary lung cancer diagnosis. Methods: Patients with primary lung cancer diagnosed between January 2014 and December 2016 were retrospectively reviewed. The cases were separated as parenchymal nodules detected and not detected during diagnosis. Patients with calcific nodules and with shorter follow-up ( Results: The study included 195 cases (34 female, 161 male, mean age 60.7 ± 9.5). At the time of diagnosis, nodules were present in 73 (37.4%) cases. The number of benign lesions was 33 (45.2%), while the number of malignant lesions was 40 (54.8%). Characteristics of cases with and without nodules as well as malignant or benign cases are discussed. Discussion and Conclusion: The rate of synchronous nodule in diagnosis was 37.4%. Of these, 20.5% (40 cases) was malignant. There was no statistically significant difference between cases with and without nodules regarding histopathology, stage, treatment, smoking history, age, sex. There was no statistically significant difference between benign and malign nodules (histopathology, stage, smoking history, age, sex) except for nodule size and treatment characteristics. There was no difference between malignant and benign nodules based on radiological findings (border features, internal structure etc), whereas radiometabolic features were statistically significantly different.

Objective: End-expiratory CO level, which is used to test smoking cessation is known to be effected by many factors. We aimed to evaluate effect of small airway obstruction (SAO) on end-expiratory CO levels. Methods: The study population consisted of cases who applied to smoking cessation clinic between April-December 2014. The duration of smoking (pack-years), pulmonary function tests (PFT) and end-expiratory carbonmonoxide (CO) were noted at first visit. The cases were questioned for last time of smoking and amount of cigarettes they smoked within past 12 hours. Pearson correlation test was used to determine factors effecting CO levels. Results: Mean age of 167 cases -112 male (67.1%), 55 female (32.9%) was 38.7±12.7 years. Mean duration of smoking was 23.3±16.4 pack-years, mean CO level was 14.1±6.9 ppm, mean FEF25-75% was 77.2±28.2. Mean period elapsed after last cigarette was 1.5±1.8 hours, mean number of cigarettes smoked within past 12 hours was 7.2±5.0. SAO was found in 50 cases (34.1%). Correlation analyses revealed that CO levels were correlated positively to duration of smoking and amount of cigarettes they smoked within past 12 hours (p=0.03, r=0.228; p=0.000, r=0.511, respectively) and negatively to the last time of smoking (p=0.023, r=0.176). SAO and in PFT was not correlated to CO level (p>0.05). Conclusion: End-expiratory CO level is closely related to duration of smoking, number of cigarettes smoked within past 12 hours and period elapsed after last cigarette. Presence of SAO does not seem to effect CO levels.

Background: Recently the association between vitamin D level and obstructive sleep apnea syndrome(OSAS)has been investigated in a few studies.We aimed to find out if obstructive sleep apnea syndrome is associated with vitamin D deficiency. Methods: Patients who were referred for polysomnography were included in the study.Full night polysomnography was performed and blood vitamin D levels were measured.It is a cross sectional study.We compared vitamin D levels of OSAS and non-OSAS patients,as well as mild-moderate OSAS patients and severe OSAS patients.We evaluated the correlation between vitamin D levels and apnea-hypopnea index(AHI)and body mass index(BMI). Results: The mean age of 181 patients was 49±12,60% were male,mean body mass index(BMI) was 31±6.Mean vitamin D level was 15.5±11.6 ng/ml,and 134(74%) patients had vitamin D deficiency.One hundred sixty one patients(89.5%) were diagnosed as OSAS;52(32%)mild,38(23.5%)moderate,72(44.5%)severe,19 subjects did not have OSAS.Mean age,mean BMI was higher in OSAS than the patients without OSAS(50 vs 38 yrs and 32 vs 26;p 0.05).Vitamin D levels were similar in different OSAS groups(p=0.68).There were no correlation between vitamin D levels and AHI and BMI. Conclusion: Vitamin D levels were similar in the patients with or without OSAS.A substantial number of patients referred to sleep laboratory had vitamin D deficiency and lower vitamin D levels than general Turkish population.We concluded that patients referred for polysomnography should be screened for Vitamin D deficiency and treated as indicated to prevent other comorbidities.

In OSAS,female/male ratio is about ½ and 10% of male population is effected by the disease.Lower incidence in female subjects seem to be attributed to hormones,body fat distribution,upper airway anatomy and functions,neurological respiratory control mechanisms.We investigated the effects of gender on sleep architecture,incidence and severity of OSAS. A total of 1387 subjects admitted for polysomnography between January2011-December2015 were retrospectively analysed. The study population consisted of 892(64.3%)male,495(35.7%)female subjects;1263(91%)were diagnosed as OSAS;363(29%)had mild disease,342(27%)had moderate disease and 558(44%)had severe disease.OSAS was diagnosed in 93%of males(n=831)and 87% of females(n=432).Body mass index(BMI) was similar in men and women.Men had higher sleep efficiency and lower sleep and REM latency(p Considering female population,122(24.6%)were in premenapausal and 373(75.4%)were postmenapausal;68% of former and 93.6% of latter group had OSAS.In premenapausal group majority of the subjects had mild OSAS(57.8%),whereas severe disease had higher incidence in postmenapausal group(37.8%) In this study,evaluating PSG data due to gender in a large group of patients,we found that menhad higher incidence of OSAS,more severe disease and were at younger ages.Most women wih OSAS were postmenapausal.Women had lower sleep efficiency,higher latency to sleep onset and latency to REM.As a conclusion,gender is one of the major factors influencing PSG data and should be taken into consideration in evaluating OSAS cases.

Introduction: Miliary Tuberculosis (TB) is a rare and lethal form of TB and needs urgent detection and treatment. Miliary TB due to drug-resistant strains of Mycobacterium tuberculosis is even more difficult to manage. We present clinical and bacteriologic findings of a rare case of miliary multi-drug resistant tuberculosis (MDR-TB). Case Presentation: Our case was a young female patient with in vitro fertilization (IVF) pregnancy, who had radiological diagnosis of miliary TB and had not responded to antituberculous therapy with four drugs. Second line antituberculous drugs were started empirically and definite diagnosis of MDR-TB was obtained by culture and drug susceptibility test of biopsy specimens. Conclusions: Although very rare, MDR miliary TB can be seen in immunocompetent subjects. We, thereby, emphasize that early recognition and initiation of treatment are associated with a significant improvement in outcomes. Tuberculosis remains a serious worldwide health problem associated with high morbidity and mortality.

Study objectivesA recent study reported an association between obstructive sleep apnea (OSA) and low vitamin D levels. In this study, we measured vitamin D levels in patients referred for evaluation of suspected OSA and sought to identify associated risk factors for vitamin D deficiency. Our objective was to determine whether evaluations of patients with suspected OSA should include routine screening for vitamin D deficiency.MethodsUsing a cross-sectional study design, we measured vitamin D levels in consecutively enrolled patients referred for an OSA evaluation to Dr. Lutfi Kirdar Kartal Training and Research Hospital in Istanbul, Turkey. We conducted full-night polysomnography and compared vitamin D levels both between patients with OSA and patients without OSA and across the various severity levels of OSA. We evaluated the association between vitamin D levels and various clinical and demographic characteristics, including the apnea-hypopnea index and body mass index.ResultsFrom April 2014 to June 2015, 195 patients were referred for OSA evaluation. Of these, 181 patients (93%) consented to participate and underwent full polysomnography and measurement of vitamin D levels. The mean ± standard deviation age was 49 ± 12 years and body mass index of 31 ± 6 kg/m2. Polysomnography led to the diagnosis of OSA in 162 of the patients (89.5%): 52 (32%) were categorized as having mild OSA, 38 (23.5%) as having moderate OSA, and 72 (44.5%) as having severe OSA. Vitamin D level was 15.5 ± 11.6 ng/mL (95% confidence interval; 13-17 ng/mL) and 134 patients (74%) met the criterion for vitamin D deficiency (< 20 ng/mL). Sex, vitamin D levels, and percentage of patients with vitamin D deficiency were similar in patients with and without OSA (P > .05). Vitamin D levels were similar across OSA severity categories (P = .68). We found no association between vitamin D levels and the apnea-hypopnea index or body mass index.ConclusionA large proportion of patients referred for OSA evaluation had vitamin D deficiency. Vitamin D levels did not differ by OSA diagnosis status or severity. Patients referred for polysomnography should undergo routine screening for vitamin D deficiency as well as clinically indicated treatment to prevent associated comorbidities.

In several studies, low spirometric levels have been shown to increase the success rates of smoking cessation, whereas other studies have indicated that pulmonary function has no effects on quitting smoking. Given the fact that there are contradictory results on this subject, we aimed to investigate the effect of identifying airway obstruction via spirometry and its explanation to subjects on the success rate of smoking cessation in the short term.Subjects who were admitted to the smoking cessation out-patient clinic, underwent pulmonary function tests (PFTs) and completed at least 3 months of the cessation program following their admittance were included in the study. At the first interview, all subjects were asked about their comorbid diseases and smoking habits. PFTs were performed. Subjects who had an obstruction on PFT were informed that their condition was smoking-related, and that further deterioration could be prevented following smoking cessation. Then the smoking cessation date was determined together with the subject, and one of the smoking cessation medicines was prescribed. All subjects were given control appointments twice for the first month and once per month for the following 2-month follow-up period. Subjects who had CO levels between 0 and 5 parts per million were considered as non-smokers.The mean age of the 563 subjects was 41.9 ± 12.1 y 340 subjects (60.4%) were male. A total of 162 subjects (28.8%) came to the follow-up visits following the first interview. The success of smoking cessation for 3 months was 11.3% for all subjects and 39.5% for subjects who came to follow-up visits. Of the subjects with obstruction on PFT; 22.8% stopped smoking, whereas 8.4% of the subjects without obstruction did so (P.001). The percentage of subjects with obstruction on PFT was significantly higher (P.001) and the FEV1 % (P = .005), FEV1/FVC (P.001), and forced expiratory flow 25-75% (P = .008) levels were significantly lower in the quitters compared with the non-quitters. Logistic regression analysis showed that age (P = .001) and the presence of obstruction on PFT (P = .029) were independent variables.Advanced age and the presence of obstruction on PFT increase the success of smoking cessation. Pulmonary function tests should be performed on all patients who apply to smoking cessation out-patient clinics, and patients should be informed about their condition.

Herediter multipl ekzostoz (HME) cok sayida osteokondromlarin varligi ile karakterize, otozomal dominant gecisli, farkli fenotipik bulgularla karsimiza cikabilen bir hastaliktir. Insidansi 1/50.000’dir. Ekzositoz (osteokondrom) en sik rastlanan benign kemik tumorudur. Temel defekt bozulmus enkondral kemik olusumu ve enkondral kemiklesmenin oldugu jukstaepifizyal bolgelerde cok sayida benign kemik asiri buyumesinin (ekzositoz veya osteokondrom) olusumudur. Osteokondromlar kafa kemikleri haric hemen hemen her kemikte bulunabilir. En sik yerlesim yerleri dizler, humerus, kalca, skapula, kostalar, el bilegi, ayak bilegi, dirsek, eller, ayaklar ve pelvistir. Toraks tutulumu diger uzun kemiklere gore nadir gorulmekle beraber agri, toraks deformiteleri, enfeksiyonlar, bronsiektazi ve nadir de olsa hematoraks gibi ciddi komplikasyonlara yol acabilmektedir. Bu yazida, gogus agrisi yakinmasiyla basvuran ve akciger grafisinde soliter pulmoner nodul tespit edilen HME tanisi olan hasta sunuldu. Soliter Pulmoner Nodul ile Seyreden Herediter Multipl Ekzostoz Olgusu A Case of Hereditary Multiple Exostosis Presenting as a Solitary Pulmonary Nodule

OZET Amac: Pulmoner emboli (PE), hastanede yatan hastalarda sik gorulen, morbidite ve mortalitesi yuksek bir hastaliktir. PE’lerin onemli bir kismi alt ekstremite derin venoz sisteminden kaynaklanir ve bu derin ven trombozlari (DVT) cogunlukla asemptomatiktir. DVT ve PE proflaksisi tum dunyada kabul goren, rutin kullanima girmis yontemler olmasina karsilik risk grubundaki hastalara proflaksi uygulamalari ihmal edilebilmektedir. Calismamizi, hastanemizde yatan ve risk faktoru tasiyan hastalarda DVT proflaksisinin hangi siklikta uygulandigini arastirmak icin planladik. Gerec ve Yontem: Hastanemizin cerrahi, ortopedi, yogun bakim, dahiliye, onkoloji, plastik cerrahi, kadin dogum, gogus hastaliklari, noroloji, norosirurji ve uroloji kliniklerinde yatan hastalar, ayni gun icinde ziyaret edilerek, hem kendileri hem de dosyalari goruldu. DVT ve PE icin risk faktorleri saptandi. Proflaksi almasi gerekip gerekmedigi, 2001 ACCP kriterlerine gore belirlendi. Proflaksi alip almadigi, proflaksiye kontrendike bir durumu olup olmadigi kaydedildi. Bulgular: Hastanemizde yatan 275 hasta ziyaret edildi ve dosyasi incelendi. Hastalarin 134’u (%48,7) kadin, 141’i (%51,3) erkekti ve yas ortalamalari 53,09±19 idi. Hastanede ortalama yatis surelerinin 8,1±10,1 gun oldugu saptandi. En sik saptanan risk faktorleri ileri yas (%52,0), immobilite (%38,9), operasyon oykusu (%36,4), malignite (%28,7) ve obezite (%21,1) idi. Proflaksi almasi gereken 170 hasta vardi ve bunlarin 56’sina (%32,9) profilaksi uygulaniyordu. Klinikler ayri ayri incelendiginde, risk gruplarina profilaksi uygulanma oraninin en yuksek ortopedi (%84,6) ve noroloji (%60,0) kliniklerinde bulundugu, onlari %37,5 ile yogun bakim unitesinin izledigi goruldu. Kadin hastaliklari ve dogum, onkoloji, plastik cerrahi ile uroloji kliniginde profilaksi uygulanan hasta saptanmadi. ABST­RACT Objective: Pulmonary embolism (PE) is frequent among hospitalized patients, with a high morbidity and mortality rate. Although prophylaxis for PE and deep venous thrombosis (DVT) is accepted worldwide and the procedures are routinely applied, prophylaxis may sometimes be ignored in risk groups. The aim of our study was to evaluate the rates of DVT prophylaxis in risk groups among patients hospitalized in our hospital.

Except from the longer hospital stay times for the male patients (p 0.05). The characteristics studied in patients with complications did not differ from the patients without complication (p>0.05) and the allocation according to the present disease, as malignant or benign, also did not create a signifi cant difference between groups (p>0.05), except that the malignancy was more frequent in the elderly (p

Aim: Examnation of pleura and pleural effusions with three dimensional ultrasonography (3D USG) device which has the facility of real time and very realistic images. Methods: Twenty five consecutive patients assessed for pleural effusion between January 2012 and December 2012 were included in the study. All patients were exmined with 3D USG. Parietal pleural thickness was measured and pleural surface appearance recorded as regular appearance / irregular appearance with 3D USG. Demographic findings, symptoms, physical examination findings, postero-anterior chest x-ray findings of patients were also recorded. Pleural effusions of patients were also classified as exudative and transudative by using Light9s criteria and 3D USG data of two groups were compared with each other. Results: Of the cases 17 (68%) were male, 8 (32%) were female. The pleural effusion of 13(52%) cases was transudate and 12(48%) cases was exudate. The average thickness of the parietal pleura of patients with exudative pleural effusion was measured as 4.3 ± 1.6 mm, pleura of 8 (66.6%) patients was irregular and of 4 (33.4%) patients was regular. The average thickness of the parietal pleura of patients with transudative pleural effusion was measured as 1.9 ± 0.7 mm, pleura of 3 (23.1%) patients wasl irregular, of 10 (76.9%) patients was regular. The thickness of the pleura in patients with exudative pleural effusion was found to be statistically different (p=0.01).The appearance of pleura in terms of being regular or irregular was not statistically significant between two groups (p = 0.57). Conclusion: Three-dimensional ultrasonography devices can be used as a diagnostic tool in pulmonary diseases.

Aim: To evaluate clinical, laboratory, radiological and demographic data of H3N2 pneumonia cases admitted to Pulmonology department during H3N2 pandemic season and compare with non-H3N2 community acquired pneumonia (CAP) cases. Methods: The study population consisted of all CAP cases admitted to our Pulmonology department between December 2013 – February 2014 influenza season. The patient files were evaluated for physical findings, laboratory data, radiological findings, treatment and outcome of cases. H3N2 was diagnosed by polymerase chain reaction (PCR) of throat swabs. The clinical, radiological and laboratory findings of H3N2 pneumonia cases were compared with non-H3N2 pneumonia cases. Mann Whitney U, Ki-square, Fisher9s exact, logistic regression analysis by forward stepwise method were used for statistical analyses. P value Results: During H3N2 pandemic season, 69 cases were diagnosed as CAP; 62 (89,8%) were non-H3N2 CAP, 7(10,2%) were H3N2 pneumonia. The demographic data, CURB-65, PSI scores, clinical, radiological and laboratory findings of two gorups were similar (p>0,05). The rates of treatment failure and/or transport to intensive care unit with need of invasive mechanical ventilation were significantly higher in H3N2 group (71,4% vs. 25,8%, p=0,024; OR: 7,18; 95%CI: 1,26 – 40,77). Mortality rates were similar in both groups ((p>0.05). Conclusion: The need of MV and intensive care treatment is more frequent in H3N2 pneumonia cases. Correct diagnosis, close follow-up and intensive care support is of vital importance in patients admitted due to CAP during influenza season and suspected to have viral pneumonia.

Aim: The aim of this study was to investigate the factors influencing to obtain material that does not reflect the lymph node(inadequate material). Methods: Files of EBUS-TBNA performed patients between July 2013-November 2014 in our clinic were examined retrospectively.Demographic data of patients,the stations,short axis and morphological characteristics of EBUS-TBNA performed LNs,number of punctures from each LN and needle type used in EBUS-TBNA were recorded.The absence or limited number of lymphocytes in the smear (with 40xmagnification, Results: 331 patients included in the study.A total of 1655 punctures(2.56±0.74/LN) were performed from 644 LNs in 331 patients.The average short axis of LNs was 1.75±1.05 cm.There was no statistically significant relationship between age and gender of the patients,short diameter,echogenicity and edge features of the LNs with obtaining inadequate material.The number of LN puncteres were 307 and 337 with M(Medi-GlobeGmbH) type and O(Olympus) type needles respectively and the ratio of obtaining inadequate material with them were were 15.3% and 13.1% respectively(p> 0.05).However a highly significant inverse relation between obtaining inadequate material with puncture number for each LN was revealed(p Conclusion: Three or more puncture from each LN should be performed in order to increase the diagnostic value of EBUS-TBNA.