Search

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.

Ulusal Akciğer Sağlığı Kongresi’nde poster bildiri olarak sunulmuştur (14-18 Mart 2018, Antalya). Çalışmamızda benign mediastinal/hiler lenfadenopati saptanan hastalar takip edilerek lenfadenopatiye neden olan hastalıkların dağılımı incelenmiştir. Çalışmamız, Mayıs 2015 ile Haziran 2016 tarihleri arasında prospektif olarak yürütüldü. Çalışmaya mediastinal/hiler lenfadenopati nedeni ile EBUS/ Mediastinoskopi/ Torakoskopi yapılan olgular alındı ve başlangıçta biyopside malignite saptanan hastalar çalışmadan çıkarıldı. Çalışmaya dahil edilen benign mediastinal/hiler LAP saptanan 93 hastanın %59.1 (55)’i kadın, %40.9 (38)’u erkek, yaş ortalaması 55.1 (±12.6) idi. Seksen üç hastaya Endobronşiyal Ultrason Eşliğinde Transbronşiyal İğne Aspirasyonu (EBUS TBİA), 7 hastaya mediastinoskopi, 2 hastaya Video-asiste torakoskopik cerrahi (VATS) ve 1 hastaya torakotomi yapıldı. Hastaların %53.8 (50)’inde sarkoidoz, %12.9 (12)’unda antrakoz, %5.1 (5)’inde tüberküloz, %4.3 (4)’ünde silikozis, %1.1 (1)’inde churg strauss sendromu, %1.1 (1)’inde hipersensitivite pnömonisi, %1.1 (1)’inde enfeksiyon, %1.1 (1)’inde kanser, %19.4 (18)’ünde nedeni bilinmeyen lenfadenopati bulundu. Çalışmamızdaki esas bulgu benign mediastinal/hiler lenfadenopatinin en yaygın nedeninin sarkoidoz olarak bulunmasıdır. Enfeksiyöz nedenlerden tüberküloz ise 3. sıklıkta LAP nedeni olarak bulunmuştur. Ayrıca granülomatöz lenfadenitin benign mediastinal/hiler lenfadenopatilerin yarısından fazlasını oluşturduğu görülmüştür. Mediastinel/hiler LAP’lerin büyük oranda EBUS TBİA yöntemiyle örneklenebildiği saptanmıştır. Ayırıcı tanının yapılamadığı olgularda takip ile tanıya gidilebileceği de anlaşılmaktadır. Our study was conducted as prospectively between May 2015 and June 2016. Cases that underwent EBUS/ Mediastinoscopy / Thoracoscopy with the diagnosis of mediastinal/hilar lymphadenopathy were included in the study and patients who were diagnosed to have malignancy in the initial biopsy were excluded from the study. The included 93 cases consisted of 40.9% men (38) and 59.1% women (55) with a median age of 55.1 (±12.6) years. Patients underwent Endobronchial Ultrasound Guided Transbronchial Needle Aspiration (EBUS TBNA) (83 patients), mediastinoscopy (7 patients), video-assisted thoracic surgery (2 patients) and thoracotomy (1 patient). The final diagnosis of the patients was accepted to be sarcoidosis in 50 (53.8%), anthracosis in 12 (12.9%), tuberculosis in 5 (5.1%), silicosis in 4 (4.3%), churg strauss syndrome in 1 (1.1%), hypersensitivity pneumonia in 1 (1.1%), infectious in 1 (1.1%), malignancy in 1 (1.1%) and uncertain in 18 (19.4%). The main findings of this study revealed that sarcoidosis was the most common cause for benign mediastinal/hilar lymphadenopathy. Tuberculosis was the third most common cause of benign mediastinal/hilar LAP. Furthermore, granulomatous lymphadenitis comprised more than half of benign mediastinal / hilar lymphadenopathy. It has been found that mediastinal/hilar LAP can be sampled by EBUS TBNA method to a large extent. In cases with impossible differential diagnosis, follow-up of patients may direct one to diagnosis in time.

Pulmoner aktinomikozis, aktinomiçes türlerinin neden olduğu akciğerde kitle saptanan nadir durumlardan biridir. Nonspesifik klinik ve radyolojik bulguları olması nedeni ile tanı konulmasında güçlük yaşanmakta birçok olgu malignite ön tanısı ile gereksiz cerrahiye gitmektedir. 38 yaş kadın hasta son 1 aydır devam eden öksürük, öksürükle birlikte pembe renkte balgam ve sırt ağrısı şikâyeti ile başvurdu. hastaya bronkoskopi ve EBUS yapıldı. Sonuç alınamadığından hasta operasyona verildi. Sağ üst lobektomi sonrası pulmoner aktinomikoz tanısı konuldu., Pulmonary actinomycosis is one of the rare cases in which a mass in the lung is detected and the case is caused by kinds of actinomycetes. The diagnosis is difficult because of the presence of nonspecific clinical and radiological findings, and many cases result in unnecessary surgery with malignancy pre-diagnosis. A 38-year-old woman applied doctor for continuous coughing, coughing with pink mucous and back pain complications for the last month. Bronchoscopy and EBUS were performed on the patient. Since no results were obtained, the patient was operated on. Pulmonary actinomycosis was diagnosed after an upper right lobectomy.

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

Kronik Obstrüktif Akciğer Hastalığı (KOAH) önemli bir halk sağlığı sorunudur. KOAH atakları mortalite ve morbiditenin en önemli nedenidir. Atakların önlenmesinde etkin tedaviler henüz yeterli değildir. KOAH ataklarını sıklıkla bakteriyel veya viral infeksiyonlar tetiklemektedir. Bu yüzden, KOAH tanısı olan hastalara grip ve pnömokok aşısı önerilmektedir. Yapılan çalışmalar, aşılamanın mortalite ve morbiditeyi azalttığını göstermektedir. Biz bu çalışmada, çeşitli soruları içeren anket formu ile KOAH tanılı olgularla yüz yüze görüşerek, grip ve pnömokok aşısı uygulanma sıklığını sorguladık. Çalışmaya, Kasım 2009 ile Mart 2010 tarihleri arasında polikliniğimize başvuran 129 hasta alındı. Hastaların demografik verileri ve aşı uygulanma öyküleri anket formuna kaydedildi. Hastaların ortalama yaşı 67 (41–85) idi ve %95’i erkekti. Hastaların %8’inde hafif, %47’sinde orta, %45’inde ağır ve çok ağır KOAH tanısı vardı. Çalışmamızda, KOAH’ta grip için aşılanma sıklığının %37, pnömokok aşılanma sıklığının ise %15 olduğu görüldü. KOAH ağırlığıyla aşılanma sıklığı arasında ilişki bulunmadı. Çalışmamız KOAH olgularında aşılanma sıklığının az olduğunu göstermektedir. Bu nedenle aşılanmanın önemini daha fazla vurgulamalıyız., Chronic obstructive pulmonary disease (COPD) is an important public health issue. COPD exacerbations are the common cause of mortality and morbidity. Efficient treatment strategies for prevention of exacerbations are still inadequate. Most acute exacerbations are triggered by viral or bacterial infections. Therefore, vaccinations against influenza and pneumococcus are currently recommended for all persons with COPD. Several studies showed that vaccination reduces the mortality and morbidity related to COPD. The aim of present study was to investigate the influenza/ pneumococcal vaccination rate and predictors of influenza and pneumococcal vaccination among them. Questionnaire forms including questions about demographic data of patients and also influenza/pneumococcal vaccination were filled by face to face interview method. The study was carried out between November 2009 and March 2010 and this study included 129 patients. The mean age of the patients was 67 (41–85) years; and 95% were males. COPD severity was graded as mild in 8% of patients, moderate in 47 %, severe and very severe in 45 % respectively. The rate of patients having been vaccinated in the previous year was 37%, and the rate of pneumococcal vaccination at least once was 15%. In the present study it was found that there was no correlation between vaccination frequency and severity of COPD. This study showed that influenza and pneumococcal vaccination rates among COPD patients are quite low. Therefore, importance of vaccination should be emphasized by clinicians.

Amaç: Çalışmanın amacı kardiyak troponin ve sPESI'nin akut pulmoner tromboembolide (PTE) tedaviyi yönlendirmedeki rolünü değerlendirmektir. Bu çalışmadan beklentimiz; kardiyak troponin seviyesi normal olan ve sPESI'ye göre düşük risk grubunda olan hastaların ayaktan tedavi edilebilirliğini değerlendirmektir. sPESI ve kardiyak enzimlerin birlikte kullanıldığı çalışmalar mevcuttur. Ancak ayaktan tedavi değerlendirmesinde sPESI ve kardiyak enzimler birlikte kullanılmamıştır. Metod: Çalışmamız Nisan 2012 ve Mayıs 2014 tarihleri arasında Karadeniz Teknik Üniversitesi Tıp Fakültesi Hastanesi Göğüs Hastalıkları Kliniği'nde yürütüldü. Çalışmaya göğüs hastalıkları servisi, polikliniği ve üniversitemiz acil servisine başvuran akut PTE tanısı konulan, ayaktan ve yatarak takip edilen 206 hasta alındı. Hastalar tanı anından sonra 90 güne kadar prospektif olarak takip edildi. Primer sonlanım ilk 90 gün içinde tüm nedenlere bağlı ölümler, sekonder sonlanım ise nonfatal kanama veya rekürren VTE (venöz tromboemboli) olarak tanımlandı. Ayrıca ilk 30 günlük ölümler de kaydedildi. Kanser varlığı düşük riskli sPESI skorlamasında göz ardı edildi. Troponin-I cut-off değeri 0.04 ng/mL ve troponin-T cut-off değeri 0.014 ng/mL olarak kabul edildi. Hastalar troponin ve sPESI faktörlerine göre dört gruba ayrıldı. Grup-1: troponin negatif ve sPESI düşük; grup-2: troponin negatif ve sPESI yüksek; grup-3: troponin pozitif ve sPESI düşük; grup-4: troponin pozitif ve sPESI yüksek riskli hastalardan oluşmaktaydı. Grup-1'deki hastaların ayaktan tedavi edilmesi planlandı. Bulgular: Grup-1'de 52 hasta (%25.2), grup-2'de 44 hasta (%21.4), grup-3'te 7 hasta (%3.4) ve grup-4'te 103 hasta (%50) yer aldı. Grup-1'de 30 günlük mortalite %1.9 iken 90 günlük mortalite %5.7 oranında saptandı (p