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© 2022 by Pediatric Infectious Diseases and Immunization Society.Chronic granulomatous disease (CGD) is an a primary immunodeficiency characterized by recurrent severe bacterial and fungal infections due to defects in the nicotinamide adenine dinucleotide phosphate (NADPH) oxidase system. Both extracellular and intracellular pathogens such as mycobacterium tuberculosis also cause important infectious diseases in these patients. The diagnosis is usually made in early childhood. However, partial enzyme deficiencies may delay the diagnosis. We presented a patient who first had recurrent tuberculosis infectious disease and later developed pulmonary aspergillosis and was diagnosed with CGD. Primary immune deficiency should be considered in the differential diagnosis in cases of recurrent tuberculosis infectious disease. Patients with primary immunodeficiency, such as CGD, may be contracted by recurrent tuberculous infectious disease before developing invasive pulmonary aspergillosis. In this way, at least in some patients, the infectious disease can be controlled more effectively and the recurrence of the infectious disease can be prevented.

OBJECTIVE: Differential diagnosis of idiopathic pulmonary fibrosis (IPF) is important among fibrotic interstitial lung diseases (ILD). This study aimed to evaluate the rate of IPF in patients with fibrotic ILD and to determine the clinical-laboratory features of patients with and without IPF that would provide the differential diagnosis of IPF. MATERIAL AND METHODS: The study included the patients with the usual interstitial pneumonia (UIP) pattern or possible UIP pattern on thorax high-resolution computed tomography, and/or UIP pattern, probable UIP or possible UIP pattern at lung biopsy according to the 2011 ATS/ERS/JRS/ALAT guidelines. Demographics and clinical and radiological data of the patients were recorded. All data recorded by researchers was evaluated by radiology and the clinical decision board. RESULTS: A total of 336 patients (253 men, 83 women, age 65.8±9.0 years) were evaluated. Of the patients with sufficient data for diagnosis (n=300), the diagnosis was IPF in 121 (40.3%), unclassified idiopathic interstitial pneumonia in 50 (16.7%), combined pulmonary fibrosis and emphysema (CPFE) in 40 (13.3%), and lung involvement of connective tissue disease (CTD) in 16 (5.3%). When 29 patients with definite IPF features were added to the patients with CPFE, the total number of IPF patients reached 150 (50%). Rate of male sex (p, Roche, Financial Disclosure: This research received unconditional financial support from the company of Roche.

Tam Metin / Full Text ESCI WOS:000695272700018 Bu çalışmada, pnömoni ve üst solunum yolu enfeksiyonu (ÜSYE) kliniği ile başvuran şüpheli COVID19 hastaları arasındaki PCR testi pozitifliğinin ilişkisinin araştırılması amaçlanmıştır. Gereç ve Yöntem: Ondokuz Mayıs Üniversitesi Hastanesi pandemi kliniğine COVID-19 şüphesiyle yatırılan 80 hastanın kayıtları retrospektif olarak incelendi. COVID-19 şüphesi ile yatırılan 80 hasta, Toraks BT (Bilgisayarlı Tomografi) sonucu ve semptomları değerlendirilerek ÜSYE ve pnömoni olarak iki gruba ayrıldı. Hastalara çekilen Toraks BT görüntüleri, deneyimli iki radyolog tarafından değerlendirildi. BT bulguları, tipik görünüm, belirsiz görünüm, atipik görünüm ve pnömoni için negatif olarak sınıflandırıldı. Hastaların, demografik özellikleri, ek hastalıkları, temas öyküsü, verilen tedavi, geliş semptomları ve laboratuvar değerleri kaydedildi. Bulgular: Çalışmada 80 hastanın verileri incelendi. Normal BT bulguları ve ÜSYE semptomları olan 29 hasta (%36.3) ve BT’de tipik COVID-19 pnömonisi bulguları olan 51 hasta (%63.7) olduğu gözlendiYapılan analiz sonucunda PCR pozitifliğine etki eden faktörler incelenmiş ve analiz sonucunda ÜSYE olanların pnömoni olanlara göre PCR test sonucunun pozitif çıkma riskinin 6,6 kat daha fazla olduğu tespit edilmiştir. Nefes darlığı olmayanların olanlara göre pozitif çıkma riski de 6,5 kat fazla bulunmuştur ). Sonuç: Üst solunum yolu semptomları ile başvuran hastalarda PCR testleri negatif olsa da COVID-19 pnömonisiyle uyumlu tipik Toraks BT bulguları varsa hastalara tekrar test yapılmalı ve bulaş riskini en aza indirmek için gerekli önlemler alınmalıdır. The aim of this study was to investigate the relationship of PCR test positivity between suspected COVID-19 patients presenting with pneumonia and upper respiratory tract infection (URTI). Materials and Methods: The records of 80 patients admitted to the Ondokuz Mayıs University Hospital pandemic clinic suspected COVID-19 were retrospectively analyzed. Eighty patients hospitalized with high suspicion of COVID-19 were divided into URTI and pneumonia by evaluating their thorax CT (computed tomography) results and symptoms. Two experienced radiologists evaluated thoracic CT images taken to the patients. CT findings were classified as negative for typical appearance, indeterminate appearance, atypical appearance, and pneumonia. Demographic characteristics, comorbidities, contact history, treatment, presenting symptoms and laboratory values of the patients were recorded. Results: Data of 80 patients were analyzed in the study. It was observed that there were 29 patients (36.3%) with normal CT findings and URTI symptoms and 51 patients (63.7%) with typical COVID-19 pneumonia findings on CT. The risk of PCR test results positive was 6,6 times higher in those with URTI than those with pneumonia. Those without shortness of breath were found to have a positive risk of 6,5 times higher than those with shortness of breath. Conclusion: Although PCR tests are negative in patients presenting with upper respiratory tract symptoms, if there are typical thoracic CT findings consistent with COVID19 pneumonia, patients should be retested, and necessary measures should be taken to minimize the risk of transmission.

WOS: 000377055500006, PubMed ID: 27149176, The present study aims at describing the psychological complaints reported, as a part of the criminal investigation process, by the victims of sexual abuse as a part of the criminal investigation process, without attempting at reaching a medical diagnosis; and it discusses the relation of these reports with variables such as victim's gender, age and relation to the offender, type and duration of abuse, and parental marital status of the victim. Data is obtained from the statements of childhood sexual abuse (CSA) victims under the age of 15, as taken by Istanbul Juvenile Justice Department between the years 2009 and 2012. The sample consists of 175 cases with a total of 202 victim statements. Through the use of content analysis, the main and sub-categories of themes of the statements were determined. By means of the evaluation of the psychological condition of victims, we evaluated them in two categories: psychological complaints including self-harm and risk taking behaviors and psychological complaints with no self-harm and risk taking behaviors. The statistical analyses yield significant relations between the psychological complaints and children's parental marital status. Analysis of initial statements of sexual abuse victims is important as it may greatly contribute to professionals diagnosing and treating psychological complaints of these victims. It is essential that victims of sexual abuse should receive immediate psychological support starting with the criminal investigation process. (C) 2016 Elsevier Ltd. All rights reserved.

Amac: Yapilan calismada, psikiyatrik tani almis kisiler ve eslerinin bas etme stratejileri ile evlilik uyumunun; bunun yaninda kontrol odaklarinin psikolojik durum ile iliskisinin incelenmesi amaclanmaktadir. Materyal ve Yontem: Arastirmanin orneklemini psikiyatrik tani almis 51 cift (en az birisi psikiyatrik tani almis) olusturmaktadir. Calismada Kisa Semptom Envanteri, Evlilik Uyum Olcegi, Kontrol Odagi Olcegi ve Bas Etme Yollari Olcegi kullanilmistir. Bulgular: Ciftlerin evlilik uyumlari, esin kaderci bas etme stratejisi ile evlilik uyumu, tani almis kisinin genel semptom ortalamasi ile evlilik uyumu ve esinin problem odakli bas etme stratejileri ile kontrol odagi iliskili bulunmustur. Sonuc : Psikiyatrik tani alan bireylerin evlilik uyumu icin psikolojik durum, esin evlilik uyumu icin kaderci bas etmenin iliskili oldugu gorulmustur.

Objective: The purpose of this research is to analyse the relation between marital adjustment and ways of coping; and locus of control and psychological state in a sample of couples of whom at least one with a psychiatric diagnosis. Materials and Method: Sample consists of 51 couples (at least partner with a psychiatric diagnosis). Brief Symptom Inventory, Marital Adjustment Scale, Locus of Control Scale and Ways of Coping Questionnaire are used as tools of data collection in the research. Results: Couples marital adjustment, spouses’ fatalistic coping style and marital adjustment, patients’ general symptom level and marital adjustment, and spouses problem focused coping and locus of control are found to be significantly correlated. Conclusion: It is seen psychological state and marital adjustment for individuals with psychiatric diagnosis, spouses' fatalistic coping and marital adjustment are related., Amaç: Yapılan çalışmada, psikiyatrik tanı almış kişiler ve eşlerinin baş etme stratejileri ile evlilik uyumunun; bunun yanında kontrol odaklarının psikolojik durum ile ilişkisinin incelenmesi amaçlanmaktadır. Materyal ve Yöntem: Araştırmanın örneklemini psikiyatrik tanı almış 51 çift (en az birisi psikiyatrik tanı almış) oluşturmaktadır. Çalışmada Kısa Semptom Envanteri, Evlilik Uyum Ölçeği, Kontrol Odağı Ölçeği ve Baş Etme Yolları Ölçeği kullanılmıştır. Bulgular: Çiftlerin evlilik uyumları, eşin kaderci baş etme stratejisi ile evlilik uyumu, tanı almış kişinin genel semptom ortalaması ile evlilik uyumu ve eşinin problem odaklı baş etme stratejileri ile kontrol odağı ilişkili bulunmuştur. Sonuç: Psikiyatrik tanı alan bireylerin evlilik uyumu için psikolojik durum, eşin evlilik uyumu için kaderci baş etmenin ilişkili olduğu görülmüştür.

Tracheobronchial amyloidosis is a rare presentation and accounts for about 1% of benign tumors in this area. The diagnosis of disease is delayed due to nonspecific pulmonary symptoms. Therapeutic approaches are required to control progressive pulmonary symptoms for most of the patients. Herein, we report a case of a 68-year-old man admitted with progressive dyspnea to our institution for further evaluation and management. He was initially diagnosed with and underwent management for bronchial asthma for two years but had persistent symptoms despite optimal medical therapy. Pulmonary computed tomography scan revealed severe endotracheal stenosis. Bronchoscopy was performed and showed endotracheal mass obstructing 70% of the distal trachea and mimicking a neoplastic lesion. The mass was successfully resected by mechanical resection, argon plasma coagulation (APC), and Nd-YAG laser during rigid bronchoscopy. Biopsy materials showed deposits of amorphous material by hematoxylin and eosin staining and these deposits were selectively stained with Congo Red. Although this is a rare clinical condition, this case indicated that carrying out a bronchoscopy in any patient complaining of atypical bronchial symptoms or with uncontrolled asthma is very important.

Objective: As Turkish Respiratory Society Diffuse Parenchymal Lung Diseases-Pulmonary Vascular Diseases Study Group (TRS DPLD-PVD SG), we aimed to demonstrate the approaches of physicians with a questionnaire toward the patients with IPF in our country.Methods: An invitation letter including a questionnaire with 24 questions to assess the approaches they prefer in the patients with IPF and the capabilities of the departments they work at and a link for the questionnaire was directed to the mail groups of chest diseases and thoracic surgery specialists. Responses of the physicians who participated in the questionnaire were reviewed.Results: Thirty percent of the participants saw less than 5 patients with IPF in a year and 16.8% of them saw more than 21. 66.3% of partici-pants stated that anamnesis, symptoms and clinical findings along with typical radiologic findings would be sufficient for the diagnosis, while 27.7% suggested that pathological findings should indicate IPF along with clinic and radiologic ones.When the methods used for tissue samp-ling were viewed; application rates of bronchoscopic transbronchial biopsy, thoracoscopic biopsy and open lung biopsy were found very close to one another.In the patients with the suspected disease of IPF, the fields in which the hesitation was the most problematic were respectively pathological examination of biopsies (73.2%) and interpretation of radiologic findings (49.5%). 37.6% of the patients with diagnosis of IPF were directed to experienced centers; medical treatment and drugless follow-up rates were respectively 33.6% and 14.8%. Among the participants, 29.7% suggested lung transplantation for all cases while 48.5% only preferred this operation in particular ones, Objective: As Turkish Respiratory Society Diffuse Parenchymal Lung Diseases-Pulmonary Vascular Diseases Study Group (TRS DPLD-PVD SG), we aimed to demonstrate the approaches of physicians with a questionnaire toward the patients with IPF in our country.Methods: An invitation letter including a questionnaire with 24 questions to assess the approaches they prefer in the patients with IPF and the capabilities of the departments they work at and a link for the questionnaire was directed to the mail groups of chest diseases and thoracic surgery specialists. Responses of the physicians who participated in the questionnaire were reviewed.Results: Thirty percent of the participants saw less than 5 patients with IPF in a year and 16.8% of them saw more than 21. 66.3% of participants stated that anamnesis, symptoms and clinical findings along with typical radiologic findings would be sufficient for the diagnosis, while 27.7% suggested that pathological findings should indicate IPF along with clinic and radiologic ones.When the methods used for tissue sampling were viewed; application rates of bronchoscopic transbronchial biopsy, thoracoscopic biopsy and open lung biopsy were found very close to one another.In the patients with the suspected disease of IPF, the fields in which the hesitation was the most problematic were respectively pathological examination of biopsies (73.2%) and interpretation of radiologic findings (49.5%). 37.6% of the patients with diagnosis of IPF were directed to experienced centers; medical treatment and drugless follow-up rates were respectively 33.6% and 14.8%. Among the participants, 29.7% suggested lung transplantation for all cases while 48.5% only preferred this operation in particular ones.Conclusion: Some of the results of our study is compatible with the guidelines of IPF, is to show that the quality of debate and confusion still continued in this regard

Background and objective: Extrapulmonary sarcoidosis is common, and is almost always associated with concomitant thoracic involvement. Extrapulmonary manifestations vary on the basis of gender, age at presentation and ethnicity. The aim of this study was to investigate extrapulmonary involvement in patients with sarcoidosis in Turkey. Methods: This study was conducted by Turkish Thoracic Society Clinical Problems Study Group. New cases of sarcoidosis between 1 June 2004 and 31 May 2006 were recorded on electronic case record forms sent to all potential investigators and information about extrapulmonary involvement was collected. Results: One hundred and nineteen of 293 patients (83 female, 36 male, mean age = 45 +/- 12 years) had extrapulmonary involvement in this study (40.6%). The median time to diagnosis was 6 months and this was longer than patients with just thoracic sarcoidosis (P = 0.001). Extrapulmonary symptoms were present in 181 (61.8%) patients, and skin lesions, arthralgia and back pain were the commonest (33.4%, 20.8% and 16.4%, respectively). Incidence of organ involvement was independent of age with the exception of ocular involvement, which was higher in those under the age of 40 years (P = 0.007). Conclusions: Skin and peripheral lymph node involvement were the most common sites of extrapulmonary involvement and ocular involvement was more common in those under the age of 40 years in patients with sarcoidosis in a Turkish population.

Amaç: Bu çalışmanın amacı, Ankilozan Spondilit (AS)'li hastalarda akciğer fonksiyonlarını tespit edip, klinik parametrelerle arasındaki ilişkiyi araştırmaktır. Yöntem ve Gereçler: Bu çalışmaya AS tanısı almış 30 hasta ve 20 sağlam kontrol alındı. AS tanısı alanlar (Grup 1) ve sağlam kontroller (Grup 2) idi. Her iki gruptaki hastaların ağrısı istirahat VAS değerleriyle, fonksiyonel kapasiteleri göğüs ekspansiyonu, BASFI ölçümleriyle ve 6 dakika yürüme testiyle, hastalık aktivitesi BASDAI ölçümüyle, akciğer fonksiyonları ise; zorlu vital kapasite (FVC), birinci dakikada zorlu ekspiratuar volüm (FEV1) ve vital kapasite (VC) ölçümleriyle değerlendirildi. Bulgular: Gruplar arasında yaş ve beden kitle indeksi ölçümleri açısından fark yoktu (p0.05). Her iki grup arasında klinik parametreler (istirahat VAS, göğüs ekspansiyonu, BASFİ, BASDAİ, 6 dakika yürüme testi, hastalık süresi) ve akciğer fonksiyonları (FVC, FEV1, VC) açısından anlamlı fark belirlendi. Tüm akciğer ölçüm paremetreleriyle klinik ve fonksiyonel ölçümler arasında çok anlamlı ilişki tespit edildi. Sonuç: Bu çalışmanın sonucunda, hastaların klinik yakınmaları, fonksiyonel performansları ve akciğer kapasiteleri arasında ilişki tespit ettik Objective: The aim of this study was to determine pulmonary function in ankylosing spondylitis (AS) patients and to assess the relationship with clinical parameters.Material and Methods: A total of 30 patients with definite AS (Group 1) and 20 age-matched healthy controls (Group 2) were recruited for the study. Patients and healthy controls were assessed according to visual analog scale (VAS) pain, 6 minute walk test (6MWT), chest expansion, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and the Bath Ankylosing Spondylitis Functional Index (BASFI). Pulmonary function was assessed by forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and vital capacity (VC).Results: There was no statistically significant difference in age or body mass index between groups (p>0.05). There were significant differences in VAS pain, chest expansion, BASDAI and BASFI scores and pulmonary function parameters FVC, FEV1, VC and 6MWT between groups (p

Sarkomatoid karsinomlar akciğerin malign tümörlerinin %0.3-1.3'ünü oluşturan nadir görülen bir tümör grubudur. Küçük hücreli dışı akciğer karsinomlarının sarkom veya sarkom benzeri bileşen içeren ayrı bir tipidir. Bu yazıda, akciğerde sarkomatoid karsinom tanısı konulan üç olgu tanımlanmakta ve bu nadir tümörün histopatolojik ve klinik özelliklerini tartışılmaktadır. Sarcomatoid carcinoma is a rare tumor group accounting for 0.3-1.3% of all malignant lung neoplasms. It is a heterogeneous group of nonsmall cell lung carcinomas containing a sarcoma or sarcoma-like component. In this paper, we describe three cases of sarcomatoid carcinoma of the lung and the histopathologic and clinical features of this rare tumor are discussed.

Bu çalışmanın amacı, kliniğimizde 1 Temmuz 1998-31 Aralık 2003 tarihleri arasında sağ arkus aorta tanısı alan hastaların klinik ve radyolojik özelliklerini değerlendirmekti. Kliniğimizde görülen 13524 hastanın dosya ve kayıtları, demografik özellikler, öyküler, fizik muayene bulguları, radyolojik bulgular, spirometrik çalışmalar ve bronkoskopiler yönünden retrospektif olarak gözden geçirildi. Sekiz hasta (%0.06) sağ arkus aorta tanısı almıştı ve bu hastalar çalışma grubunu oluşturdular. Çalışma grubunda yaş ortalaması 45 ve yaşları 25 ile 70 arasında olan 6 erkek ve 2 kadın hasta vardı. Dört hasta semptomatikti. Bunlardan ikisi efor dispnesi, biri kuru öksürük nedeniyle bronşiyal astım tanısı almıştı ve buna yönelik tedavi görmekteydi. Bu üç hastanın klinik belirtilerine, sağ arkus aorta ve bileşenlerinin trakea ve sağ ana bronşa basısının neden olduğu radyolojik, spirometrik ve bronkoskopik olarak ortaya konuldu. Bir semptomatik hastanın semptomları sağ arkus aortaya bağlı olmayıp, küçük hücreli akciğer kanseri nedeniyleydi. Toraks bilgisayarlı tomografide (BT), sağ arkus aorta alttipinin yedi hastada (%87.5) anormal sol subklavyan arter ve sağ arkus aorta (ASSA/SAA), bir hastada ise ayna hayali sağ arkus aorta tipinde olduğu görüldü. Çalışmamızda, kliniğimizde bakılan hastaların %0.06’sında sağ arkus aorta tanısı konulmuş olup, bu değer literatürdeki çalışmalarda daha düşüktü. Hastalarımızdaki hâkim sağ arkus aorta alttipi ASSA/SAA idi. Kaynaklarda sağ arkus aortanın erişkin popülasyonda çok nadiren semptomlara neden olduğu bildirilse de, bizim sekiz hastamızın üçünde (%37.5) semptomlara yol açtığı görüldü. Bu nedenle, efor dispnesi ve kuru öksürükle gelen hastaların ayırıcı tanısında, sağ arkus aortanın da hatırlanması gerektiğini düşünüyoruz. The aim of this study was to evaluate the clinical and radiological features of the patients with right aortic arch who were diagnosed in our clinic between July 1st, 1998 and December 31st, 2003. The files and records of 13524 patients seen in our clinic were retrospectively reviewed to identify the patients and all the data including demographic characteristics, history, physical examination findings, radiological findings, results of spirometric studies and bronchoscopies. Eight patients (0.06%) were diagnosed as having right aortic arch and comprised the study group. The study group included 6 male and 2 female patients aged 25 to 70 years with a mean age of 45. Four patients were symptomatic. Among them, two patients presenting with effort dyspnea and one patient suffering from dry cough had been diagnosed as bronchial asthma and had been receiving relevant treatment. At the end of radiographic, spirometric and bronchoscopic studies it was understood that their clinical pictures were due to compression of trachea and right main bronchial system by right aortic arch and its components. Symptoms of one symptomatic patient were due to small cell lung cancer. On thoracic computed tomography, the subtype of right aortic arch was identified as right aortic arch with anomalous left subclavian artery in seven patients (87.5%) and right aortic arch with mirror image branching in one patient. In our study, right aortic arch was diagnosed in 0.06% of the patients seen in our clinic, a ratio that is lower than reported in the literature. Right aortic arch with anomalous left subclavian artery was the predominant type of right aortic arch. Although it was reported in the literature that right aortic arch rarely causes symptoms in adult population, it caused symptoms in three of the eight patients (37.5%). Therefore, we suggest that differential diganosis of the patients presenting with effort dyspnea and dry cough must include right aortic arch.

Bu çalışmada, kliniğimizde küçük hücreli dışı akciğer kanseri (KHDAK) tanısı alan hastaların klinik özelliklerini değerlendirmeyi amaçladık. Ocak 1988-Ocak 1999 tarihleri arasında kliniğimizde KHDAK tanısı alan hastalar çalışma grubunu oluşturdu. Çalışma grubunun dosya ve kayıtları; hastaların demografik özellikleri, öyküleri, fizik muayene bulguları, laboratuvar değerleri, tanısal işlemler, radyolojik bulgular ve evreleme çalışmaları gibi bilgiler yönünden retrospektif olarak gözden geçirildi. Çalışma grubu 564 (506'sı erkek, 58'i kadın) hastadan oluşmaktaydı. Ortalama yaşları 60 yıl (28-97) idi. Hastalarımızın %87'si halen sigara içmekte veya geçmişte içmiş olanlardı. Başvuru esnasındaki en sık semptomlar öksürük, balgam ve dispne idi. En yaygın radyolojik bulgu çapı 4 cm'den büyük düzensiz sınırlı, santral bir kitle görünümü idi. Tanı değişik yöntemlerle alınan biyopsi örneklerinin histopatolojik olarak incelenmesi ile konuldu. Bronkoskopi hastaların %83'ünde tek tanı aracı idi. Biyopsi örneklerinin histopatolojik incelemesi sonucunda %85.8 skuamöz hücreli karsinom, %10.3 adenokarsinom, %1.4 büyük hücreli karsinom, %0.45 adenoskuamöz karsinom ve %2.7 tıpı net olarak ayırt edilemeyen KHDAK tanılan konuldu. Tüm hastalarda yapılan evreleme çalışmaları, hastaların %85'inin IIIB ve IV evrelerinde tanı aldıklarını gösterdi. Metastazların en sık kemiklere daha sonra da sırası ile beyin ve karaciğere olduğu görüldü. Çalışmamızda hastalarımızda skuamöz hücreli karsinom uluslararası kaynaklarda bildirilenden çok daha yüksek bir yüzde ile en yaygın histopatolojik tip idi. Evre IIIB ve evre IV'teki hastaların yüzdeleri kaynaklardaki diğer çalışmalardan daha yüksekti. The aim of this study was to evaluate the clinical features of non-small cell lung cancer (NSCLC) cases that were diagnosed in our clinic. The patients who were diagnosed as NSCLC in our clinic between January 1988 and January 1999 were comprised the study group. The files and records of the study group were retrospectively reviewed to identify patients and all the data including demographic characteristics, history, physical examination findings, laboratory values, diagnostic procedures, radiologic findings and staging procedures. The study group included 564 patients (506 male, 58 female). The mean age was 60 years (28-97). 87% of the patients ıvere current smokers or ex-smokers. The most frequent symptoms on admission were cough, sputum, and dyspnea. The most common radiologic finding was a central mass with a diameter of more than 4 cm with an irregular border. The diagnosis was established by histopathologic examination of biopsy specimens obtained by various means, in which bronchoscopy was the sole means of diagnosis in 83% of the patients. Histopathologic examination of the biopsy specimens resulted as follows: 85.8% squamous cell carcinoma, 10.3% adenocarcinoma, 1.4% large cell carcinoma, 0.45% adenosquamous carcinoma, and 2.1% undifferentiated NSCLC. Staging procedures that were done in all patients reuealed that 85% of the patients were diagnosed at the stage IIIB and IV. Metastasis was most frequently to the bones followed by brain and liver. in ourstudy squamous cell carcinoma was the most common histopathologic type with a higher percentage than the preuious reports in the literature. The percentages of stage IIIB and IV were also higher in ourstudy than preuious papers in the literature

34- OZET Bu çalışmada, stabil KOAH'lı hastalarda inhale bronkodilatör ilaçlardan salbutamol ve ipratropium'un tek başlarına ve kombine uygulamasının etkilerini araştırılmıştır. Öyküsünde en az 20 paket/yıl sigara içme öyküsü bulunan 22 hastaya 1. gün 200 ug salbutamol, 2. gün 40 ug ipratropium ve 3. gün her iki ilacı kombine olarak verildi. Her gün ilaçlar verilmeden önce ve verildikten sonra 6 saat boyunca hastaların nabız, tansiyon ve solunum fonksiyon testi ile FEV1 ve FVC değerlerine bakıldı. Her üç ilaç gününde de bazal değerlere göre so lunum fonksiyonlarında anlamlı bir artış sağlandı, ipratropium ile oluşan bron- kodilatasyon 1. saatten sonra salbutamolden daha fazlaydı ve 6 saat boyunca devam ediyordu. İpratropium'a salbutamol ilave edilmesi solunum fonksiyon pa rametrelerinde ilave bir artış sağlandı. Elde ettiğimiz sonuçlara göre KOAH tedavisinde ipratropium bromid'in bir beta-2-agonist olan salbutamol'e göre daha iyi bronkodilatasyon yaptığını, bu etkisinin daha uzun sürdüğünü ve hastalığın tedavisinde öncelikle tercih edil mesi gerektiği fikrini söyleyebiliriz. Ayrıca iki ilacın birlikte kullanılmasıyla aditif bir etki görülmemiştir. 401