Download A spicular pulmonary mass mimicking a secondary metastatic lesion

P001[Lung Pathology]
A spicular pulmonary mass mimicking a secondary metastatic lesion
Arjana Hamdi Sina, Dafina Pali Todri, Hasan Sulejman Hafizi
University Hospital of Tirana 'Shefqet Ndroqi'
A 52-year-old man with a 30 pack-year smoking history was admitted to our hospital with a 3
weeks history of cough with haemoptysis, chest pain, hematuria, weight loss and fever. At
admission, the patient was in moderate clinical condition and systemic review was unremarkable.
He has no significant past medical history and is on no medication. Laboratory data showed an
erythrocyte
sedimentation
rate
of
45mm/hr,
the
other
data
were
normal.
CT revealed a large spiculated mass 4.5cm x 4 cm with a central destructive cavity, in the 1st and
2nd segments of the left lung. Mediastinal lymph nodes up to 1 cm. In the right kidney was
revealed a heterogenic mass, which got contrast and seemed to infiltrate iliopsoas muscle.
Abdominal ultrasound-revealed a cortical mass, 4x4 cm in diameter, in the right kidney.
A fiberoptic bronchoscopy with bronchoalveolar lavage and transbronchial biopsies was performed.
Culmen and its 3 segments presented with edematous and hyperemic mucosa which cause a mild
obstruction. Bronchial lavage: cytology resulted – necrotic material, predominantly neutrophils; BK
culture
negative
Tran
thoracic
needle
biopsy
–
resulted
inflammatory
lesion.
The patient was discharged from hospital in 06/19/2013 with dg: Susp lung cancer and right
kidney
tumor.
Renal
mass
biopsyresulted
clear
cell
renal
carcinoma
He underwent the kidney resection and came after one month for evaluation of the pulmonary
lesion
which
was
almost
healed
with
subsequent
scarring.
The definitive diagnosis: Inflammatory pulmonary lesion and Clear cell right renal carcinoma
Keywords: Secondary pulmonary metastatic lesion, renal carcinoma, spicular lesion
Figure 1
CT at hospital addmission revealed a large spiculated mass 4.5cm x 4 cm with a central destructive cavity
Figure Nr. 2
Good resorption one month after antibiotic treatment
P002[Lung Pathology]
rectus hematoma is occured by cough
Harun Karamanlı, Bilal Arık
medical faculty of mevlana university
Abdominal rectus hematoma occur uncommon even though it can be created a state which shows
fatal course.rectus hematoma is seen more frequently in elderly women.
Patients were evaluated increasingly severe non-productive cough in last two week. Patients had
suffered increased pain in the lower right abdominal quadrant at last week. Rectus hematoma was
reported with abdominal CT lesion.
İn the patient's medical history and risk factors that make the story of the rectus hematoma
subacute nonproductive cough and use of aspirin was presented.
Numerous triggering factors which cause rectus sheath hematoma. Most of them cause
spontaneous bleeding after to use anticoagulant therapy.
In our case, the patient's risk factors were not detected accept cough and use of aspirin.
In case of prolonged and persistent cough may be developed rectus sheath hematoma as a risk
factors
Keywords: cough,rectus hematoma
rectus hematoma
P003[Lung Pathology]
Castleman's Disease, Case Report
Deniz Doğan, Nesrin Öcal, Alev Taşkın, Ergün Uçar, Hayati Bilgiç
Department of chest diseases, gulhane military medical academy, ankara, turkey
Castleman's disease, is a rare lymphoproliferative disease, usually detected by routine screening in
asymptomatic patients. It is also named as giant lymph node hyperplasia, angiofollicular lymph
node hyperplasia. It often occurs as a solitary benign mass in mediastinal field miscible with
thymoma. Histopathologically disease has two types; hyaline vascular type and plasma cell type.
Here we wanted to share a case, presented different from classical giant lymph node hyperplasia.
21 years old male, with no complaint, referred to our clinic because of a lesion seen in his chest
graphy in routine screening. Thoracic CT scan was obtained. Thorax CT revealed
peribronchovascular densities around bilateral lower lobe bronchus and collapse in middle lobe of
right lung and inferior of the lingula in left lung. The patient underwent diagnostic bronchoscopy.
The biopsy results were not diagnostic. Surgical lymph node dissection as Diagnostic surgical
procedure for the patient's existing lesions in the thoracic surgery clinic was performed. Pathology
of the specimens taken was reported as Castleman disease, hyaline vascular type.
This is an atypical presentation of Castleman's disease, and differs from other cases with
radiological findings. We shared this phenomen to be an example for cases whose preliminary
diagnosis does not include Castleman's disease.
Keywords: Castleman's disease, histopathology, lymph node
figür1
fıgure 1
bilateral alt lob bronşu etrafında peribronkovaskuler dansiteler a. mediasten kesiti b. parankim kesiti
peribronchovascular densities around bilateral lower lobe bronchus a. mediastinal section b. parenchymal
section
P004[Lung Pathology]
Primary Glomangioma of the lung: a case report and the review of the
literature
Muhammet Reha Çelik, Hakkı Ulutaş, Akın Kuzucu
University of Inonu Faculty of Medicine Turgut Ozal Medical Center Department of Thoracic Surgery
Glomangiomas are benign soft tissue tumors derived from the glomus bodies surrounding on
arteriovenous anastomosis. Glomus tumors are recorded to acount for 1.6% of all soft tissue
tumors and usually appear in extremities. We report a case 40-year-old female patient applied the
hospital due to chest pain with glomangioma in the lower lobe of her right lung.
A computed tomography of the chest revealed a solitary lesion of 4.0 cm in diameter. Preoperative
fiberoptic bronchoscopy was performed and no endobronchial pathology was seen. Video-assisted
thoracoscopic removal of the lesion with wedge resection of the adjacent normal lung parenchyma
was performed. The histopathological findings presented a glomangioma with uniformly arrenged
small round cells, including clear cytoplasms and small nuclei, without mytotic activity.
Since glomus bodies are rare or absent in the lung parenchyma, pulmonary glomangiomas are
extremely rare lesions. It can easily be misdiagnosed as more common primary and metastatic
lesions of the lungs, due to its rarety. Complete resection is the treatment of choice with a low
potential of recurrence. The tumor had a low potential of recurrence. Surgical approach and
complete resection is the best management for definitive diagnosis and curative treatment.
Keywords: Glomangioma, VATS, Complete Resection
P005[Lung Pathology]
A Rare Cause of Mediastinal Mass: The Idiopathic Fibrosing Mediastinitis
Tekin Yıldız1, Hüseyin Dülger2, Turgut Aydın3
1
MedicalPark Bursa Hospital, Chest Disease Clinic
2
Çekirge State Hospital, Chest Disease Clinic
3
Patomer Patology Laboratory
Idiopathic mediastinal fibrosis (IMF) is a rare pathological entity characterized with a dense fibrous
tissue proliferation and storage in the visseral compartment of the mediastinum. Its etiology is
undetermined in most of the cases. In many patients the etiology is unclear.
Sixty-three year old male patient admitted to our hospital with complaints of cough, chest
tightness, weakness, and fatigue. There was no significant risk factor except forty-pack / years
smoking. There was no known systemic or genetic disease. Physical examination revealed no
pathological findings except coarsening breathing sounds. The Chest X-Ray revealed that right
paratracheal and mediastinal expansion. Compute Tomography of the Chest showed that right
upper paratracheal region mediastinal mass that reaches up to 83x66 mm size?
Lymphadenomegaly? was detected. The patient underwent diagnostic mediastinoscopy.
Histopathology of tissue was reported as the fibrosing mediastenit. An important etiologic reason
was not detected during the investigation. Idiopathic mediastinal fibrosis was diagnosed. Still with
symptomatic treatment is followed.
When examining mediastinal mass, rarely, the IMF should be remembered.
Keywords: Idiopathic mediastinal fibrosis
P006[Lung Pathology]
Primary Tracheobronshial AL Amyloidosis
Nur Seda İbili1, Arif Hikmet Çımrın2, Atila Akkoçlu2, Duygu Gürel3
1
Dokuz Eylul University Faculty of Medicine, Internal medicine
2
Dokuz Eylul University Faculty of Medicine, Pulmonary medicine
3
Dokuz Eylul University Faculty of Medicine, Pathology
Amyloidosis is a collection of diseases in which different proteins are deposited
as insoluble -pleated sheets, disrupting organ function. Each precursor protein induces a
separate spectrum of organ involvement, and different disease manifestations within the
lung. Rreviews focuses on amyloid
derived from immunoglobulin light-chain protein (AL disease), which most frequently
involves the lung in both systemic and localized forms of the disease.
Keywords: Pulmonary amyloidosis, tracheobronchial Amyloidosis,primary AL
P007[Lung Pathology]
Low-grade mucoepidermoid carcinoma of the lung diagnosed by
transbronchial needle aspiration and bronchoscopic biopsy
İrem Hicran Özbudak1, Havva Serap Toru1, Tülay Özdemir2, Ömer Özbudak2, Gülay Özbilim1
1
Akdeniz University, School of Medicine, Department of Pathology, Antalya
2
Akdeniz University, School of Medicine, Department of Pulmonary Medicine, Antalya
INTRODUCTION:
Mucoepidermoid carcinoma (MEC) is a rare primary lung tumor, comprising less than 1% of all lung
tumors. They arise from bronchial glands in the central airways. Clinical symptoms are related to
the polypoid endobronchial growth of this tumor and tracheal and large airway irritation.
Transbronchial needle aspiration (TBNA) has also been touted as a safe and effective bronchoscopic
technique for diagnosing MEC.
CASE:
We report a case of a 34-year-old man who presented with wheezing on lie down position. Imaging
studies revealed a mass involving the right upper lobe bronchus. Bronchoscopy and TBNA were
performed. Pathological examination of biopsy specimen revealed a low-grade MEC characterized
by the presence of squamoid cells, mucin-secreting cells and cells of intermediate type. In
TBNA,intermediate type cells with bland nucleus and musinous background were noted.
DISCUSSION:
MEC is histologically identical to the salivary gland tumor of the same name. On the basis of
morphological and cytological features, tumors are divided into low and high-grade types. Lowgrade MEC have a much better prognosis than high grade tumors, the latter being similar to nonsmall cell carcinomas. This case emphasizes the importance of obtaining adequate biopsy to
establish the correct diagnosis. In addition, it highlights that MEC of the lung usually presents in
the low-grade form, carrying a favorable prognosis.
Keywords: Low-grade MEC, TBNA
P008[Pulmonary and Pleural Malignancies]
Endobronchial metastasis of gastric adenocarcinoma: a case report
Levent Özdemir1, Burcu Özdemir2, Suat Durkaya3, Sema Nur Çalışkan2, Ali Ersoy4, Gökhan
Büyükbayram1, Zulal Özbolat1, Caner Kır5
1
Dörtyol State Hospital Chest Disease, Hatay
2
İskenderun State Hospital Chest Disease, Hatay
3
İskenderun State Hospital Torasic Surgery
4
Antakya State Hospital Chest Disease, Hatay
5
Dörtyol State Hospital Patologia, Hatay
Lung metastases of extrapulmonary solid malignant tumors, although widely seen but
endobronchial invasion is observed as very rare. Most commonly tumors with endobronchial
metastases are breast, colon, kidney adenocarcinomas.
41 year old male patient with complaint of cough, shortness of breath, wheezing, was admitted. He
had a previous history of surgery for gastric adenocarcinoma 2 years ago and chemo-radiotherapy
treatment. In the bronchoscopy hyperemia and disorder was observed in the superior entry of the
left lower lobe mucosa. Gastric adenocarcinoma metastas was shown in the mocosa biopsies
Keywords: Mide karsinomu, endobronşiyal metastaz
resim 1
resim 1
Toraks bt
resim2
Patoloji
P009[Pulmonary and Pleural Malignancies]
Lung Tumor with β-HCG Positivity: Primary Pulmonary Germ Cell Tumor?
Primary Lung Cancer Secreting β-HCG?
Burcu Cirit Koçer1, Yurdanur Erdoğan1, Berna Akıncı Özyürek1, Funda Demirağ2, Meriç Ünver1
1
Department of Chest Diseases, Atatürk Chest Diseases and Chest Surgery Training and Research
Hospital, ANKARA
2
Department of Pathology, Atatürk Chest Diseases and Chest Surgery Training and Research
Hospital, ANKARA
Germ cell tumors (GCT) that originate outside the gonads are defined as extragonadal GCT. While
the most common extragonadal site is anterior mediastinum and followed by retroperitoneum,
pineal gland and sacral area in adults, primary pulmonary GCT is very rare. Also, paraneoplastic
secretion of β-HCG in nonsmall cell lung cancer (NSCLC) has been rarely reported.
A 43-years old male patient was admitted with dyspnea and chest pain. Thorax computed
tomography revealed multipl nodules, masses and pleural effusion. The serum β-HCG level was
elevated. A bronchoscopy was performed and endobronchial lesion was observed. Since a
differentiation of GCT from NSCLC could not be made by pathologic examination of biopsy
specimen, bronchoscopy was repeated and a sample was taken by cryobiopsy. The pathologic
examination could not distinguished malignant epithelial tumor and GCT again. Positron emission
tomography and ultrasonography showed no gonadal involvement. The case was evalutaed by
Medical Oncology and accepted as extragonadal GCT due to clinical, radiological findings and
elevated serum β-HCG level and chemotherapy was started.
The case was presented because of rarity of primary pulmonary GHT with endobronchial
involvement and β-HCG secreting NSCLC and also difficulties in pathologic differentiation.
Keywords: germ cell tumor, lung, B HCG
P010[Pulmonary and Pleural Malignancies]
Sılıcosıs and Lung Adenocarcınoma Case Presentatıon
Adil Can Güngen, Yusuf Aydemir, Hasan Düzenli, Hikmet Çoban, Canatan Taşdemir
Sakarya University Education And Research Hospital, Chest Diseases Department, Sakarya
An increase is seen in silicosis cases in our country due to environmental and occupational
exposure especially for people working in denim sandblasting. Silicosis is an interstitial lung disease
developing due to inhalation of inorganic silica particles. In this study patients with diagnosis of
silicosis and lung adenocarcinoma who worked in denim sandblasting are presented. Our case had
worked for 18 months in denim sandblasting. The case is diagnosed of silicosis by history, clinical
and imaging. Clinically worsening patient's transbronchial lung biopsy results that is done by
bronchoscopy were consistent with adenocarcinoma. According to this study it is believed that
patients with a diagnosis of silicosis may develop lung cancer in the following period or silicosis
image findings may be confused with lung cancer, therefore biopsies should be performed in these
patients to support the diagnosis.
Keywords: Silicosis, Denim Sandblasting, Lung Cancer
Akciğer grafi
chest X-ray
CT
P011[Pulmonary and Pleural Malignancies]
A patient with stage 3A Squamous cell lung cancer alive for nine years with
no surgery
Bulent Karagöz1, Ömer Ayten2, Ersin Demirer2, Tolga Tuncel1, Dilaver Tas2, Tayfun Çalışkan1
1
Department of Oncology GATA Haydarpasa Training Hospital İstanbul Turkey
2
Department of Pulmonology GATA Haydarpasa Training Hospital İstanbul Turkey
Lung cancer is still most common cause of cancer mortality throughout the world. 5 year survival in
advanced stage lung cancer patient who is not suitabe for surgery are expected to be 10-13
percent.
A 85 -year-old male patient was admitted to a our clinic with cough and hemoptysis in November
2005. 6x5x4 cm mass at anterior segment of left lung upper lobe and left hilar lymph node with a
diamater of 2 cm were observed at Chest CT. Endobronchial lesion that totally obstructing orifice of
left lung apical segment was seen on bronchoscopy. Biopsy was obtained from endobronchial
lesion. Result of the biopsy was squamous cell lung cancer. Chest MRI taken to determine aorta
invasion. 5x3 cm diameter mass at upper lobe of left lung that partially contact with aorta observed
at chest MRI (Figure1). FEV1 2.08 lt, FVC 2.48 lt FEV1/FVC %77 measured at PFT. According the
previous staging,the patient was adopted stage 3B (T4,N1,M0, according to current staging, stage
3A) and referred to chemoradiotherapy. Patient treated with carboplatin + docetaxel (6 sessions)
and received 200 cGy / day (5 days per week for six weeks) and 5000 cGy in 25 fractions
radiotherapy. Cancer progression was observed in February 2007 and June 2009. Gemcitabine and
vinorelbine, was administered to the patient respectively. The patient remained stable until the end
of November 2013. On this date 3 cm pleural effusion observed in control chest ct and paclitaxel
treatment was started. The patient still using paclitaxel treatment.
Keywords: squamous cell lung cancer, long survival time
Figure 1
Tedavi öncesi Toraks MR görüntüsü
Toracic MR image before treatment
Figure 2
Guncel Toraks BT görüntüsü
Current thoracic CT image
P012[Pulmonary and Pleural Malignancies]
Coexistence Of Lung Adenocarcinoma And Tracheal Hamartoma
Umut Sabri Kasapoğlu1, Pınar Atagün Güney1, Begüm Arıtan1, Sibel Arınç1, Hakan Yılmaz2, Murat
Kavas1, Ayşem Aşkım Güven1, Ayşe Ersev3
1
Sureyyapasa Chest Disease And Thoracic Surgery Training And Research Hospital, Department Of
Chest Disease, Istanbul
2
Sureyyapasa Chest Disease And Thoracic Surgery Training And Research Hospital, Department Of
Thoracic Surgery, Istanbul
3
Sureyyapasa Chest Disease And Thoracic Surgery Training And Research Hospital, Department Of
Pathology, Istanbul
Pulmonary hamartoma is the most freguent benign neoplasm of the lung. Although they are
benign, malignant transformation may rarely seen. We present a rare case of a synchronous
primary lung adenocarcinoma and tracheal hamartoma. A 74-years old man was admitted with
complaints of left chest pain. He had a history of traffic accident 15 days ago. Patient was admitted
hospital after the accident. A thorax CT on admission showed left pleural effusion and tracheal
mass. Histopathological examination of tracheal mass and pleural effusion confirmed hamartoma
and lung adenocarcinoma. It should be keep in mind, it is found coexistence of lung cancer and
hamartoma.
Keywords: Hamartoma, lung adenocarcinoma, lung.
Resim 1: Toraks BT, trakeal lezyon ve sol plevral efüzyon.
Figure 1: Thorax CT, tracheal mass and left pleural effusion.
Figure 2: Fiberoptic bronchoscopy
P013[Pulmonary and Pleural Malignancies]
Primary Endobronchial Leiomyoma
Birsen Cirit Ekiz1, Meftun Ünsal1, Burçin Çelik2, Yurdanur Süllü3, Muzaffer Aydın4, Gamze Koçak1
1
1Ondokuz Mayıs University, Department of Chest Diseases, Samsun
2
Ondokuz Mayıs University, Department of Thoracic Surgery, Samsun
3
Ondokuz Mayıs University, Department of Pathology, Samsun
4
3Ondokuz Mayıs University, Department of Radiological, Samsun
Leiomyoma makes up less than 2% of benign lung tumors. Although they are generally
endobronchial formations, they can rarely be seen as parenchymal lesions.
Our case was a 57 year-old male farmer. He came to Chest Diseases Polyclinic with complaints of
cough that started two months ago, hemoptysis, and white mucus. High resolution tomography
showed a nodular appearance with a diameter of 5 mm on the left lung inferior lingular bronchial
level into the lumen. Bronchoscopy showed a white pedunculated lesion with a smooth surface that
moved by touch and totally occluded the left lingular opening. Resection of the lingular segment of
the left lung was performed with surgical treatment. The case was reported to have leiomyoma as
a result of the pathological assessment. The patient whose symptoms totally recovered after
surgery is being followed up by our clinic.
Keywords: leiomyoma, endobronchial mass, asthma
P014[Pulmonary and Pleural Malignancies]
Small Cell Lung Cancer in Tracheobronchopathia osteochondroplastica and
Coexistence
Hikmet Çoban1, Canatan Taşdemir1, Hasan Düzenli1, Ahmet Nasır2
1
Sakarya Education and Research Hospital, Sakarya University, Clinic of Chest Disease,Sakarya,
Turkey
2
Clinic of Thoracic Surgery, Sakarya Education and Reseach Hospital, Sakarya, Turkey
Tracheobronchopathia osteochondroplastica is a rare benign disease, characterized by multiple
submucosal osseous and cartilaginous nodules in the tracheabronchus. Chest CT scan may
demonstrate that the special finding of multiple submucosal calcified nodules involving the anterior
and lateral wall of tracheobronchus, sparing of the posterior wall. The hallmark of fiberoptic
bronchoscopy (FOB) finding is the sessile submucosal nodules protruding into the lumen of trachea
and main bronchi, keeping the posterior wall intact. A patient who presented with dyspnea and
cough we thought TO preliminary diagnosis based on chest CT image. bronchoscopic image was
compatible with TO but pathological diagnosis have been reported small cell lung carcinoma. we
wanted to present this rare case because of TO and diffuse extension of small cell lung cancer to
the trachea and bronchi are uncommon pathologies.
CASE: The 65-year-old male patient presented with ongoing cough for three months. Lung had
decreased breath sounds bilaterally. In computed tomography of the thorax the mass surrounds
and collapse bronchus intermedius, middle and lower lobe bronchus. In the anterior and lateral
walls of the lower 2/3 trachea showing calcification and extending nodular appearance to
lumen(Figure 1). Fiberoptic bronchoscopy was performed and yellowish white multiple nodular
lesions were seen in anterior and lateral tracheal wall extends into the lumen(Figure 2).
Bronchoscopic biopsy of the middle lob bronchus was consistent with small cell lung cancer. In PETCT widespread bone metastases and right cranial parieotooksipital lobe metastases were detected.
Keywords: Tracheobronchopathia osteochondroplastica, small cell lung cancer
Figure 1
Toraks BT'de trakeal kalsifikasyon ve nodüller
Thorax CT showed tracheal calsification and nodules.
Figure 2
Bronkoskopide trakeada nodüller
Tracheal nodules on bronchoscopy
P015[Pulmonary and Pleural Malignancies]
Immunocytochemistry in differential diagnostics of tumoral pleurisy
Vasiliy N. Klimenko, Viktor I. Novik, Oleg Ivanov
Research Institute of Oncology after N.N.Petrov, Saint-Petersburg, Russia.
Aim of the study: Evaluation of an immunocytochemistry efficiency in differential diagnostics of
tumoral
pleurisy.
Materials: 45 patients are included in research aged from 30 till 75 years, among them 26 women
and 19 men who were in Research Institute of Oncology after N.N.Petrov on inspection concerning
tumoral
pleurisy
of
unspecified
primary
localization.
METHOD: In out-patient
immunocytochemistry
conditions it
research
was
made
of
thoracocentesis with the
a
pleural
subsequent
exudate.
RESULTS: On the basis of the checked immunocytochemistry research of a pleural exudate at 48
of 45 investigated it was succeeded to establish a pleurisy nosology. In 3 patients tumoral cages in
pleural exudate were present at insufficient quantity and they needed a diagnostic
videothoracoskopic method. Diagnostic efficiency of immunocytochemistry research in differential
diagnostics
of
tumoral
pleurisy
made
93%.
CONCLUSION: Immunocytochemistry research is highly effective method of diagnostics of
tumoral pleurisy in out-patient conditions.
Keywords: tumoral pleurisy, immunocytochemistry, pleural exudate
P016[Pulmonary and Pleural Malignancies]
Endobronchial spread of malignant melanoma to lungs
Nesrin Öcal1, Canturk Taşçı1, Gürhan Taşkın2, Deniz Doğan1, Levent Yamanel2
1
Department of chest diseases, gulhane military medical academy, ankara, turkey
2
Department of intensive care medicine, gulhane military medical academy, ankara, turkey
Malignant melanoma result of malignant transformation of melanocytes, metastasis mainly to
regional lymph nodes, skeletal, and nervous systems. However, malignant melanoma can also
metastasis to lung either. These metastases usually reach the lungs by tumor emboli to pulmonary
arteries. Endobronchial spread of malignant melanoma to lungs diagnosed by bronchoscopy cases
have limited number in literature. Here we share a malignant melanoma case spread
endobronchially.
62 years old male patient known to have malignant melanoma, was accepted to intensive care unit
with respiratory distress and was intubated. In first evalution of his HRCT, consolidation and pleural
effusion, constitute with large part of left lung’s atelectasis and less pleural effusion and partial
atelectasis of neighbor parenchyma in right lung were seen. For both possible endobronchial
metastasis causing airway obstruction and tumoral infiltration of parenchyma, bronchoscopy was
performed through the endotracheal tube. Airway visualization revealed edema of the left main
bronchus, concentrically significantly narrowed upper lobe, but segments were visible. Left lower
lobe input was narrowed and segments were not visible. In entrance of left upper lobe there was
an endobronchial lesion in brown- black color and slightly bulging form the mucosa like nevus.
Transbronchial biopsy was taken from this nevus like formed lesion and left lung upper lobe
apicoposterior. Both samples were reported as malignant melanoma by pathologist. We shared this
case as an example of rare appearance of malignant melanoma.
Keywords: endobronchial, malignant melanoma, metastasis
figür 2
fıgure 2
parankim kesitinde sol akciğeredeki tümör invazyonu ve atalektazinin görünümü
tumor invasion and atelectasis of the left lung, parenchymal sectional view
figür1
fıgure 1
mediasten kesitinde sol akciğeredeki tümör invazyonu ve atalektazinin görünümü
tumor invasion and atelectasis of the left lung, mediastinal sectional view
P017[Pulmonary and Pleural Malignancies]
A case of squamous cell cancer of the lung with synchronous renal cell
carcinoma
İhsan Ateş1, Hale Ateş2, Nirgül Kılıçaslan3, Ozan Yazıcı1, Doğan Yazılıtaş1, Ayse Naz Özcan4, Yetkin
Ağaçkıran5
1
Ankara Numune Education and Research Hospital, Department of Medical Oncology, Ankara
2
Turgut Ozal University, Department of Chest Diseases, Ankara
3
Ankara Numune Education and Research Hospital, Department of Infectious Diseases, Ankara
4
Atatürk Chest Diseases and Thoracic Surgery Education and Research Hospital, Department of
Chest Diseases, Ankara
5
Atatürk Chest Diseases and Thoracic Surgery Education and Research Hospital, Department of
Pathology, Ankara
Cansers developing in more than one focus are calling multiple primary canser ( MPC). Incidence of
MPC is %0.73-11.7 in recent publications. Although combination of multiple primary cancers in the
literature is mentioned greatly we have a small number of publication about lung squamous cell
cancer along with kidney cancer.MPC can be examined in two ways as synchronous and
metachronous In this case report we will talk about the presentation of lung squamous cell cancer
with primary kidney cancer based on the same session in a male patient. Our case is a 55-year-old
male patient,in left lung about 6 × 7 cm lesion was detected in chest radiograph which was taken
with complaints of shortness of breath and hemoptysis.In thorax CT left hilar 6.5 × 8 cm irregular
cavitary lesion and approximately 9 cm lesion in the right kidney was detected.In lung biopsy nonsmall cell carcinoma (in the foreground it is compatible with squamous cell carcinoma) and in
kidney biopsy renal cell carcinoma are detected. In PET-CT pulmonary artery invasion identified
and patient is accepted the end stage lung cancer. Gemcitabine-cisplatin combination in
conjunction with treatment of interferon and radiotherapy for massive hemoptysis was planned.
Although the combination of primary lung cancer and primary kidney cancer takes little space in
MPCs, each other metastases are too much. In any of the common lesion is likely to be considered
the primary cancer becouse of differing metastasis and primary cancer treatments
Keywords: multiple primary cancer, synchronous tumor, lung cancer, kidney cancer
RESİM1
FİGURE1
FİGURE2
P018[Pulmonary and Pleural Malignancies]
A Case Of Squamous Cell Lung Carcinoma Causing An Expansive Mass Lesion
On Chest Wall
Ümran Toru
Dumlupınar University Medical Faculty, Department of Chest Diseases, Kütahya, Turkey
INTRODUCTION:
Cough, hemoptysis, dyspnea and chest pain due to pleura or chest wall invasion can be seen in
lung carcinomas. Invasion of the chest wall by lung cancer is not common and represents only
about 3-5% of all patients. Here we reported a case of squamous cell lung carcinoma presenting
with chest wall invasion.
CASE:
34-years old male patient was admitted to emergency service with complaints of right-sided chest
pain, cough and hemoptysis. In physical examination; an expansive mass lesion on sternum was
observed (Figure 1), decreased breath sounds and dullness was detected in the right lung. PA
Chest Radiography showed opacity consistent with massive pleural effusion in the right lung. 5x6
cm sized lytic appearance mass lesion in the lower part of sternum, mediastinal lymphadenopaties,
right-sided massive pleural effusion and parenchymal cavitary lesion was observed in Thorax CT
(Figure 2). Sputum ARB and Mycobacterium Cultures were negative. Microbiological and sitological
analysis were performed by USG-guided fine needle aspiration from sternal mass lesion. Fiberoptic
Bronchoscopy revealed white-coloured, necrotic appearance endobronchial lesion at the entry of
right upper lobe and several biopsies were taken. Pathological diagnosis was consistent with
squamous cell carcinoma. The patient didn’t accept advanced treatment and we have learned that
the he died on the fifteenth day of discharge.
CONCLUSION:
Survival is not unfavourably influenced in lung cancers presenting with chest wall involvement
alone and no lymph node invasion whereas prognosis of patients with tumours both invading the
chest wall and mediastinal lymph node is worse.
Keywords: Lung cancer, chest wall
Figure 1
Sternumda ekspanse kitle lezyon.
Expansive mass lesion on sternum.
Figure 2
5x6 cm sized lytic appearance mass lesion on sternum and right-sided massive pleural effusion in Thorax CT
P019[Pulmonary and Pleural Malignancies]
Individualized treatment for lung cancer; How far sholud surgery go?
Tevfik Kaplan1, İlhan İnci2, Walter Weder2
1
Department of Thoracic Surgery, Ufuk University School of Medicine Ankara/Turkey
2
Department of Thoracic Surgery, Zurich University Hospital Zurich/Switzerland
Patients treated surgically for bronchogenic carcinoma can devolope a metachronus cancer. Limited
pulmonary resection for bronchogenic carcinoma after pneumonectomy is a feasible procedure
associated with acceptable morbidity and mortality rates. A 59 years old woman, who had
undergone a left pneumonectomy for large cell bronchogenic carcinoma, was found to have a
squamous cell carcinoma in the contralateral lung during follow up after 11 years. A mass of 4x3,5
cm located in the right upper lobe was resected by sleeve right upper lobectomy and also hilar
nodal dissection was performed under extracorporeal membrane oxygenating. The patient was
discharged on the 17th postoperative day. She has been followed-up for 78 months and no relapse
or metastasis is detected since then. The role of extended resection in a case for a metachronus
cancer on a single lung was discussed in the view of the literature.
Keywords: Lung cancer, metachoronous, pneumonectomy, sleeve resection
Figure 1A-1B
Figure 1A: Thorax CT of the right upper pulmonary mass Figure 1B: PET/CT revelead 3,2x4,4 cm mass in the
right upper lobe with a SUV max of 16,2
Figure 2
Figure 2: Thorax CT at 6,5 years follow-up with no evidence of disease.
P020[Pulmonary and Pleural Malignancies]
A Lung Cancer Mimicking Hematologic Malignancy With Diffuse
Involvements In PET-CT
Zahide Alaçam1, Neşe Dursunoğlu1, Gamze Gököz Doğu2, Suna Kıraç3, Bahar Baltalarlı4
1
Department of Chest Disease, Pamukkale Unıversity, Denizli, Turkey
2
Department of Medical Oncology, Pamukkale Unıversity, Denizli, Turkey
3
Department of Nuclear Medicine, Pamukkale Unıversity, Denizli, Turkey
4
Department of Radiation Oncology, Pamukkale Unıversity, Denizli, Turkey
Introduction
Non-small cell lung cancer(NCCLC) is the most frequent cancer leading to death wordlwide. ¾ of
those patients with NSCLC are in metastatic or locally progressive stage at the time of diagnosis.
Bone marrow is an organ having metastasis frequently via blood circulation and its metastasis is
important as it will change staging of malignancy. PET-CT has made faster the detection organ
metastasis in NSCLC.
Case
A mass in the apical segment of lower lobe of left lung and diffuse mediastinel lymphadenopathies
were found in a 56 years old male patient who admitted with sharp back pain. Squamous cell
carcinoma was diagnosed by fiberopticbronchoscopy and PET-CT was used for staging.
Involvement of skeletal system, bone marrow and muscles were found as well as pulmonary and
mediastinel involvements via PET-CT. Bone marrow aspiration and biopsy were applied to the
patient who also had deep anemia, thrombocytopenia, high sedimentation and LDH in his
laboratory as a disseminated hematologic malignancy could be. Malign epithelial tumor metastasis
was found but he died in a short time after chemoradiotherapy was planned.
Discussion
As the Treatment protocole would be completely different in the lung cancer patients with bone
marrow metastasis and in whom with concomitant hematologic malignancies, bone marrow
aspiration and biopsy are so important when bone marrow involvement was seen in PET-CT.
Keywords: Bone marrow metastasis, Non-small cell lung cancer, PET-CT
P021[Pulmonary and Pleural Malignancies]
Synchronous primary lung cancer; a case report
Aslıhan Gürün Kaya1, Aydın Çiledağ1, Murat Özkan2, Gökhan Çelik1, İlker Ökten2, Akın Kaya1
1
Department of Chest Diseases, Ankara University, Ankara, Turkey
2
Department of Thoracic Surgery, Ankara University, Ankara, Turkey
A 52 years old male patient was admitted with cough and sputum complaints. He had a 28 packyear smoking history. There was no abnormal findings on physical examination. Chest radiograph
showed an opacity with irregular margins at the right upper zone and right hilar enlargement
(Figure 1). Thoracic computed tomography showed a mass with 6x4 cm size in the superior
segment of right lower lobe and a mass with 3x2,5 cm size at the right upper lobe posterior
segment (Figure 2). Fiberoptic bronchoscopy was performed and no endobronchial lesion was
observed. A PET–CT scan revealed increased FDG uptake in the right upper lobe lung and right
lower lobe masses (SUVmax 23,3 and 38,5, respectively). The patient was evaluated by thoracic
surgery and right pneumonectomy was performed. The lesion located at the lower lobe was
diagnosed as large cell neuroendocrine carcinoma and the lesion at the upper lobe as was
diagnosed as adenocarcinoma with pathological examination.
The patient was presented because of rare occurence of synchronous primary lung cancer
Keywords: Lung cancer, multiple primary lung cancer, synchronous tumor
Figure 1
An opacity with irregular margins at the right upper zone and right hilar enlargement on chest radiograph
Figure 2
Computed tomography of the thorax revealed a mass at the right upper lobe posterior segment (A), a mass in
the superior segment of right lower lobe(B)
P022[Pulmonary and Pleural Malignancies]
A Lung Cancer Case with Wrong Diagnosis of Tuberculosis
İclal Hocanlı, Hadice Selimoğlu Şen, Abdurrahman Şenyiğit, Özlem Abakay, Halide Kaya, Melike
Demir
Department of Pulmonology, Dicle University School of Medicine, Diyarbakir, Turkey
Introduction
Lung cancer (LC) is a cancer with a growing number of patients in worldwide. Lung cancer and
tuberculosis sometimes be confused radiologically. However, diagnosis of pulmonary tuberculosis
should be based on the microbiological evaulation. A case of LC,who was suspected as tuberculosis
and received antituberculosis therapy (ATT), presented to draw attention to the differential
diagnosis.
Case
Sixty years old male patient were admitted to a medical center with complaints of weight loss and
cough. Positron emission tomography (PET) computed tomography (CT) was performed due to
detection of mass lesion on Thorax CT.
The SUV max value was measured as 15.5 on a pleural-based mass that localized on right upper
lobe, 6.8x6.2x5.5 cm in size, with irregular contours and containing an area of necrosis.
Bronchoscopic fine-needle aspiration biopsy and bronchoalveolar lavage results were reported as
benign histopathologically. Acid fast bacilli (AFB ) was negative in sputum. Antituberculosis
treatment was started based on QuantiFERON TB Gold test positivity. He was admitted to our
polyclinic with the same complaints in the first month of treatment. Sputum smears were negative
for AFB. The check thorax CT was reported as; 6 x 5.8 cm size mass in the right lung and multiple
millimetric subpleural nodules. There wasn’t any endobronchial lesion in bronchoscopy.
Transthoracic biopsy specimen was reported as nonsmall cell LC.
Conclusion
Tuberculosis can mimic many other diseases radiologically. The pathological and microbiological
evidence should be conclusive to avoid possible misdiagnosis.
Keywords: lung cancer, tuberculosis, differential diagnosis
P023[Pulmonary and Pleural Malignancies]
A Benign Lesion That Can Be Confused With Malignancy; Mucoid Impaction
Funda Uluorman1, Sibel Öktem Ayık1, Ayşe Dallı1, Melda Apaydın2
1
Department of Pulmonary Disease, İzmir Katip Çelebi University Atatürk Education and Research
Hospital, İzmir, Turkey
2
Department of Radiology, İzmir Katip Çelebi University Atatürk Education and Research Hospital,
İzmir, Turkey
Fifty five year old male patient reffered to the emergency room with fever, chest pain, and sputum.
He has COPD and HT of known disease. In his physical examination, his fever was 38,7°C; he has
rale in right middle and upper zone of the lung. In laboratory, there was leukocytosis and high CRP.
In thorax CT; in the lower lobe of the left lung and the upper lobe of the right lung, there was seen
sequelae changes and bronchiectasis and there is another nodule of 13 mm width properly
reported in the form of a round soft-contoure in lower lobe of the left lung.
He has 50 pocket/year smoking history because of this preliminary diagnosis of malignancy so we
took his PET-CT. There was a nodule that is approximately 28x10 mm size with relatively smooth
contoured nodular density in the lower lobe of the left lung, has increase metabolism (increased
radiopharmaceutical involvement), since benign pathologies. It has been learned that there is
another thorax-CT taken two months ago. But there is no image about the nodule.
When we took the output duration (two mounths of appearance is a short time for malignancy),
radiological view of the nodule,PET-CT findings into consideration and those were compatible with
infection of clinic signs; the mucoid impaction should take into consideration.
According to this case we want to take attention to mucoid impaction that is rare benign formation
and especillay we can become confused with malignancy.
Keywords: Mucoid impaction, nodule, malignancy
Thorax-CT
Thorax-CT there is a lesion in left lower lung
Thorax-CT-old( two mounths before)
Thorax-CT-old there is not a lesion in left lower lung
P024[Pulmonary and Pleural Malignancies]
The retrospective evaluation of our pleural effusion cases
Baran Gündoğuş, Özlem Saniye İçmeli, Hatice Türker, Merve Çiftçi
Süreyyapaşa Training and Research Hospital for Chest Diseases and Thoracic Surgery, İstanbul,
Turkey
We made a retrospective evaluation of clinical,radiological and laboratory characteristics of patients
with the diagnosis pleurisy who were hospitalized in our clinic in 2012.
580 patients had hospitalized in our clinic in 2012 and 106 cases (18,2 %) had pleural effusion.
The patients had pleural effusion included 74 men 32 women, with a mean age of 62 years.
82(77%) were exudative pleural effusion and 24(23%) were transudative pleural effusion with
Light’s criteria. X-ray revealed “unilateral pleural effusion” 55% in transudative pleural effusion and
82% in exudative pleural effusion. The most frequent causes of pleural effusions were determined
as neoplasia (29%) followed by congestive heart failure (23%), and tuberculosis (23%). In the
neoplastic effusion group, the most frequent locations of the primary tumor were lung
adenocarcinoma(47%), breast (17%), and mesothelioma (13%). Transudative pleural effusions
due to congestive heart failure were determined at high rate in Chest Disease Clinics.
Keywords: pleural effusion, transudative, exudative
P025[Pulmonary and Pleural Malignancies]
Lymphoma with lung involvement
Hayriye Bektaş, Savaş Özsu, Tevfik Özlü, Yılmaz Bülbül, Funda Öztuna, Yasin Abul
Department of Chest Diseases, Karadeniz Technical University, Trabzon, Turkey
66 year old male patient admitted with shortness of breath. He had a history of smoking about 150
pack year, farming and coffee business. Infiltrations detected in mid-lower zone of right lung and
lower zone of left lung at chest x-ray. High sedimentation (73) and peripheral eosinophilia (%9,9)
were determined in routine tests. Bilateral multiple round consolidations and multiple mediastinal
lymph nodes observed in thoracic computed tomography.
Bronchoscopy was performed with preliminary diagnosis of lung cancer, organizing pneumonia,
eosinophilic pneumonia, tuberculosis and lymphoma. Endobronchial lesion was not observed. Antituberculosis treatment was started upon cytology and ARB of the bronchoalveolar lavage were
benign, tuberculosis culture and PCR were positive. The patient admitted upon cough, increased in
shortness of breath and weight loss of 6 kg in 1 month despite the treatment. There were detected
common consolidations in the bilateral lung parenchyma and pleural effusion in the thorax-CT.
Steroid treatment was started as 1 mg/kg due to suspicion of organizing pneumonia. There were
reduced ratio of albümin/protein, increased of Ig-M, lambda and beta-2 microglobulin in advanced
tests. Bone marrow biopsy was performed because of suspicion of hematologic malignancy. Biopsy
was reported as low grade B-cell lymphoma. The patient accepted as lymphoma with lung
involvement and given one course of chemotherapy was detected pneumothorax and died because
of respiratory failure after 1,5 month of the diagnosis.
Lymphoma should be considered in the differential diagnosis of the patients outgoing with
consolidation and resolution can not be provided.
Keywords: consolidation, lymphoma, tuberculosis
Figure-1
Results
Figure-2
P026[Pulmonary and Pleural Malignancies]
Pleural malignant solitary fibrous tumor
Hülya Günbatar1, Fuat Sayır2, Selami Ekin1, Bünyamin Sertoğullarından1, Selvi Aşker1, Remzi Erten3
1
Yuzuncu Yil University Dursun Odabas Medical Center, Respiratory Medicine, Van
2
Yuzuncu Yil University Dursun Odabas Medical Center, Respiratory Surgery, Van
3
Yuzuncu Yil University Dursun Odabas Medical Center, Pathology Department, Van
Solitary fibrous tumor of the pleura is a rare, slow-growing tumor, often originate from the visceral
pleura. Not induced mesothelial cells, they are caused from mesenchymal connective tissue.
Although many features usually benign, can be seen as malignant tumors form. Men and women
are equal frequency and seen most frequently between the ages of 50-80. Thoracotomy and total
excision of the mass is usually required for definitive diagnosis. Surgical resection is generally
curative, although there is a slight possibility of local recurrence. The presented case is evaluated
as pleural solitary fibrous tumor with malignant potential. 60 year old male patient was admitted to
our hospital with the complaint of cough, phlegm and shortness of breath. Chest tomography was
identified 8.7 x 7.3 x 6.5 cm right lower lobe mass and operation proposed to the patient. The
patient refused surgery and after 9 months because of the increased complaints he was admitted
again. 9 months later, the patient's chest tomography was observed 8.7 x 11.5 x 9 cm mass in the
posterolateral right lower lobe extending from the pleura and inferior to the diaphragm. He was
operated. The macroscopic examination 13x10x7 cm in size with a weight of 490 g encapsulated in
appearance, firm mass in viscous beige was observed. Microscopic examination were considered as
malignant solitary fibrous tumor. On the immunohistochemical analysis, diffuse CD34 and focal
BCL2 viewed as positive. After the operation, patient was followed for recurrence.
Keywords: surgery, solitary fibrous tumor, pleura
P027[Pulmonary and Pleural Malignancies]
Multiple Lung Metastases From Parotid Adenoid Cystic Carsinoma Resected
After Five Years With Respiratory Failure
1
1
1
2
Hülya Günbatar , Selami Ekin , Bünyamin Sertoğullarından , Alpaslan Yavuz , Gülay Bulut
1
2
3
3
Department of Pulmonary Medicine, YYU University, Van, Turkey
Department of Radiology, YYU University, Van, Turkey
Department of Pathology, YYU University, Van, Turkey
Adenoid cystic carcinoma (ACC) is one of the most common malig¬nancy that arises in secretory
glands, particularly the major and minor salivary glands. It accounts for about 15% -25% of all
malignant salivary gland carcinomas. Typically, ACC is slow growing tumors with five-year survival
rate, but it spreads into adjacent tissues and develops distant metastasis via haematogenous
frequently to the lungs, bone, and soft tissues. We report a case of a 52-year-old man who
presented with respiratory failure and multiple metastases with a diagnosed adenoid cystic
carcinoma resected parotid gland five years before. A 52-year-old male, underwent a radical
cranio-facial resection for a right parotid gland adenoid cystic carcinoma, followed by postoperative
radiotherapy. He was followed-up with annual head CT scans for 5 years with no signs of locoregional recurrence. Physical examination respiratory system was normal. Blood gases analyses
showed moderate hypoxemia. pH; 7,49 pCO2; 31,8 Po2; 38,9 HCO3; 24,1 sat O2; 79,1. CT of the
thorax showed multiple lesions ranging in size from 5 mm to 4 cm distributed diffusely in both
lungs. CT-guided fine-needle aspiration of the lung lesion was performed. Pathological analysis
showed multiple cystic structures with cribriform pattern on different sizes intervening hyaline
stroma of the biopsy specimens reported adenoid cystic carcinoma. ACC of the parotid gland may
be indicate a life-long threat to some patients also may cause respiratory failure and requires
constant vigilance by medical practitioners.
Keywords: adenoid cystic carsinoma, metastase, respiratory failure
P028[Pulmonary and Pleural Malignancies]
A case of endobronchial Hodgkin lymphoma with extensive extra-nodal
involvement
Serap Argun Barış1, Tuba Çiftçi1, Elif Birtaş Ateşoğlu2, Pınar Tarkun2, Cengiz Erçin3, İlknur Başyiğit1
1
Department of Pulmonary Diseases, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
2
Department of Hematology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
3
Department of Pathology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
INTRODUCTION: The pulmonary involvement can be seen during the course of Hodgkin
lymphoma however initial presentation of the disease with respiratory symptoms is quite
rare. CASE: Twenty nine years old men admitted to our clinic with cough, dyspnea and difficulty in
walking within five days. Medical history of the patient was unremarkable. The patient was unable
to walk without support and he had a phocomelia on his right hand. There were multiple
lymphadenopathies in cervical and supraclavicular region on palpation while the biggest one was
3x2 cm in size. Physical examination of the respiratory system was normal. Chest x ray revealed
non-homogeneous at left lower zone and enlargement of right hilum. There were bilateral hilar and
mediastinal lymphadenopaties, bilaterally nodules in pulmonary parenchyma, consolidation in left
lower lob and bilateral pleural thickness in thorax CT. Fiberoptic bronchoscopy showed that surface
of left lower lobe posterior segment mucosa was covered with white plagues, right secondary
carina was edematous and anterior segment of the right upper lobe was obstructed. Multiple
mucosa biopsies and fine needle aspiration were taken. The pathologic evaluation of the biopsies
showed CD3 positive mature lymphocytes. The findings of PET-CT were consistent with the
involvement of spleen, bone, bone marrow, muscle, lung and pleura. Patient was diagnosed as
nodular sclerosing Hodgkin lymphoma with the evaluation of cervical lymph node biopsy.
CONCLUSION: Lymphomas should be considered in the differential diagnosis of mediastinal
lymphadenopathies and bronchoscopic evaluation should be performed in these cases.
Keywords: bronchoscopy, endobronchial, extranodal involvement, Hodgkin lymphoma, lung
Figure-1: Chest x-ray
P029[Pulmonary and Pleural Malignancies]
A Case of Basal Cell Carcinoma with Multiple Metastases in the Lung
Özge Şafak1, Neslihan Mutluay1, Dilek Saka1, Mehmet Bahadır Berktaş1, Yetkin Ağaçkıran2
1
Atatürk Chest Diseases and Chest Surgery Education and Research Hospital, Chest Disease,
Ankara, Turkey
2
Atatürk Education and Research Hospital, Pathology, Ankara, Turkey
A 63 year old female patient presented with the complaint of dry cough for 3 to 4 months. 6 years
ago, biopsy was taken from a bleeding lesion on head skin and diagnosed as basal cell carsinoma.
Respiratory system was normal in physical examination but 5x5 cm sized bleeding ulcerative lesion
was detected on the patient's head skin. On Computerised Toracal Tomography multipl metastatic
nodules in both lungs were present. On Positron Emission Tomoraphy- Toracal Tomography,
increased FDG uptake was detected on multipl nodules.Transthoracic fine needle biyopsy was
performed and biopsy was reported as 'basal cell carcinoma,lung metastasis'. Basal cell carcinoma
is a frequently seen skin tumor but it rarely makes metastasis so this case was presented.
Keywords: Lung metastasis, Basal cell carcinoma, Multiple nodules
The computerised toracal tomography view of the case with lung metastasis of basal cell
carcinoma
The computerised toracal tomography view of the case with lung metastasis of basal cell
carcinoma
P030[Pulmonary and Pleural Malignancies]
Pleural Effusion Due to Tyrosine Kinase Inhibitor Treatment
Aylin Özge Alpaydın1, Kemal Can Tertemiz1, Atila Akkoçlu1, İnci Alacacıoğlu2, Şerife Medeni Solmaz2
1
Dokuz Eylul University School of Medicine, Pulmonary Medicine
2
Dokuz Eylul University School of Medicine, Haematology
Tyrosine kinase inhibitors have been increasingly used in malignant patients. As the drugs started
to be used extensively new adverse events are recognized. Dasatinib is used in leukemia patients
refractory to especially imatinib and nilatinib.
We evaluated 3 chronic myeloid leukemia and 1 acute lymphocytic leukemia patients who were
been treated by dasatinib in our hospital’s hematology department and have developed pleural
effusion. Any pathological finding related with pleural effusion was not found with diagnostic
procedures (echocardiography and laboratory tests). Exudative pleural effusion was determined in
two patients, in one patient granulomatous reaction compatible with drug effect was observed.
Dasatinib treatment was terminated in all patients and in the follow –up regression was seen in
patients with control chest radiographs.
Pleural effusion is a rare complication which may develop during certain drug treatment regimens.
We presented 4 patients with pleural effusion that developed after dasitinib treatment which we
thought to be drug adverse effect. Patients under treatment with tyrosine kinase inhibitors
(especially dasatinib) should be followed-up closely for pleural effusion and respiratory involvement
and drugs should be terminated when necessary.
Keywords: Dasatinib, drug side effect, pleural effusion
P031[Pulmonary and Pleural Malignancies]
An Old Patient with Malignant Pleural Mesothelioma and Negative Positron
Emission Tomography
Berna Taşkın Doğan1, Zeki Çelen2, Ahmet Feridun Işık3, Öner Dikensoy1
1
Department of Pulmonary Diseases., Gaziantep University, Gaziantep, Turkey
2
Department of Nucleer Medicine., Gaziantep University, Gaziantep, Turkey
3
Department of Thoracic Surgery., Gaziantep University, Gaziantep, Turkey
Introduction
Malignant pleural mesothelioma (MPM) should be included in the differential diagnosis of pleural
effusions in subjects with a history of environmental asbestosis exposure in our country.
Sometimes, it should be difficult to differentiate from benign asbestosis plaques. Here, an elderly
case of MPM with a history of asbestosis exposure and pleural effusion accompanied with pleural
plaques, and with a positron emission tomography (PET-CT) with low SUV uptake, is presented.
Case
A 69 years old male patient presented with dyspnea and chest pain. He had a history of being a
resident in a soil house for 30 years. Chest CT showed left sided pleural effusion and significant
pleural thickening. Cytology and cell block of tapped pleural effusion that was exudate and in
hemorrhagic appearance showed no evidence of malignancy. Blinded pleural biopsy yielded chronic
inflammation. The patient was referred to thoracic surgery department due to fact that the patient
was an old subject with the history of asbestosis exposure and had exudative pleural effusion
associated with pleural plaques although his PET-CT (SUV:2.8) did not supported malignancy.
Pleural biopsy performed during video assisted thoracic surgery yielded biphasic MPM.
Conclusion
Malignancy should always be kept in mind and should be excluded in elderly subjects with
exudative pleural effusion and a history of asbestosis exposure although PET-CT does not support
malignancy.
Keywords: Mesothelioma, Pleura, Positron emission tomography
P032[Pulmonary and Pleural Malignancies]
The evaluation of treatment on quality of life in patients with lung cancer
İlknur Yaşar, Salih Serdar Erturan, Şermin Börekçi, Ersan Atahan, Ergi Hysi
Department of Pulmonary Diseases, Cerrahpaşa Faculty of Medicine, İstanbul University, Turkey
OBJECTIVE: We aimed to evaluate performance status,side effects of therapy,treatment
response,survival time,anxiety-depression levels and quality of life in lung cancer patients receiving
chemotherapy or chemoradiotherapy.In addition,to determine the effects of treatment on quality of
life in lung cancer patients.
MATERIALSMETHODS: 56 lung cancer patients receiving chemotherapy or chemoradiotherapy were enrolled
into the study between March 2011-November 2013.In total 43 patients were evaluated in the
study because 13 of them who had been exitus before the treatment was completed were
excluded.Side effects of chemotherapy,treatment response and survival time were observed.ECOG
performance scale was used to evaluate the performance status of patients.To evaluate quality of
life and anxiety-depression levels of patients we used EORTC QLQ-C30 and QLQ-LC13
questionnaires and Hospital Anxiety-Depression Scale before and after therapy.
RESULTS: The average age of fourty-three patients was 60,70±10,71 years;39(%90,7) were men
and 4(%9,3) were women.16(%37,2)of patients had small cell lung cancer(SCLC),whereas
27(%62,8) had non-small cell lung cancer(NSCLC).The average duration of survival of patients was
20,11±2,39 months.Alopecia,fatigue,nausea-vomiting and constipation were the most common
side-effects of chemotherapy.As ECOG performance status had worsened the side effects of
chemotherapy were experienced more intensely and quality of life was getting worse.We
determined that patients who had better treatment response had lower ECOG scores.We detected a
strong correlation between anxiety-depression and poor quality of life.
CONCLUSION: In conclusion, it was determined that the quality of life of patients with SCLC was
affected more positively and had better treatment response.We detected a strong correlation
between ECOG performance scale and EORTC QLQ-C30 questionnaire.
Keywords: Lung cancer, ECOG performance scale, quality of life, anxiety and depression
P033[Pulmonary and Pleural Malignancies]
Presentation of malignant pleural mesothelioma with distant metastasis:
report of three cases
Sema Canbakan, Seher Satar, Ayperi Öztürk, Arzu Ertürk, Nevin Taci Hoca, Nermin Çapan, Esra
Özaydın
Atatürk Chest Disease and Chest Surgery, Training and Research Hospital, Ankara
Malignant mesothelioma is known as locally aggressive tumor that rarely metastasizes to distant
sites. Reported cases of metastases are rare and the vast majorities are postmortem findings. We
present a case series of three malignant mesothelioma patients who had distant metastasis at the
time of the diagnosis. In all three patients, pleural tissue samples were collected to confirm the
histopathological diagnosis of mesothelioma. Additionally one patient had mesotelioma findings in
peritoneal tissue. One of these patients had a liver, another had adrenal gland and the third one
had adrenal gland and cranial metastasis at the diagnosis. This patient had peritoneal
mesothelioma additionally. The last patient who had multiple metastasis refused chemotherapy,
initiated palliative cranial radiotherapy. Unfortunately she died 3 months after diagnosis. Other two
patients administered first line chemotherapy and showed stable disease in regular follow-up. Nine
months later the patient with liver metastasis suffered from worsening of dyspnea and CT revealed
progression of pleural disease. At this time patient suffered from bone pain especially on hip and
leg. Multiple bone metastases were detected. Second line of chemotherapy and palliative
radiotherapy was administered for bone metastases. As a result, the patient survived for 18
months. The patient with surrenal metastasis was applied third line chemotherapy because of local
progression. This patient also developed bone metastasis before last line chemotherapy. In
addition, this patient was also given palliative radiotherapy for bone metastases. He died 36
months after the diagnosis of mesothelioma.
Keywords: Malignant mesothelioma, multiple metastases, prognosis
P034[Pulmonary and Pleural Malignancies]
235 Retrospective Lung Cancer Case Analyses at Konya Education &
Research Hospital
Ercan Kurtipek1, Nuri Düzgün2, Yaşar Ünlü3, Hıdır Esme2, Cengiz Burnik1, Süleyman Baktık4, Yüksel
Terzi5, Taha Tahir Bekçi1
1
Konya Training and Research Hospital, Department of Chest Diseases
2
Konya Training and Research Hospital, Department of Thorasic Surgery
3
Konya Training and Research Hospital, Department of Pathology
4
Konya Training and Research Hospital, Department of Radiology
5
Ondokuz May University Medicine Faculty, Department of Biostatistics
235 lung cancer cases; squamous cell carcinoma(SCCA), adenocarcinoma (adenoCA), large cell
cancer(LCCA), and small-cell cancer(SCCA) type, were analyzed retrospectively. Out of these, 193
(82.1%) were male and 42 (17.9%) female. SCCA was the most common type present (81 cases,
34.4%), SCCA (78, 40.4%) was the most common one followed by adenocarcinoma (61, 31.6%),
large-cell cancer (17, 8.8%) and small-cell carcinoma (13, 6.7%). Among women, the most
common cancer type was adenocarcinoma (19, 79.1%), followed with squamous cell carcinoma
(3,12,5%), and small-cell cancer (2, 8.3%). Large cell cancer type was not evident in females.
Most common lung cancer site was upper right lobe in 57 patients (28.6%), followed by left upper
lobe in 48 patients (24.1%), right lower lobe in 46 patients (23.1%), left lower lobe in 30 patients
(15.1%), and right medial lobe in 18 patients (9%). Whereas squamous cell carcinoma was the
most common lung cancer type located in the right upper and medial lobe and left upper lobe,
adenocarcinoma was mostly located in the left lower lobe and right lower lobe. Tumor type and
tumor size comparison showed that tumor size was statistically significantly higher in squamous
cell carcinoma and adenocarcinoma (p=0,002). Likewise, SUV-max value was higher in squamous
cell carcinoma and adenocarcinoma than other cancers (p<0.05).
In conclusion, tumor size is higher in squamous cell carcinoma and adenocarcinoma compared to
other types of cancers, a fact to be considered, particularly in patients with high SUV-max value.
Keywords: retrospective, lung cancer, analysis
P035[Pulmonary and Pleural Malignancies]
A Rare Case of Lung Adenocarcinoma and Langerhans Cell Histiocytosis
Coexistence
Eliz Oyman, Ebru Çakır Edis
Department of Chest Diseases, Trakya University, Edirne, Turkey
The female, 49 year old patient applied to polyclinic with a complaint of hemoptysis, which started
10 days ago. The patient, who had a history of 38 packets/years of smoking, was subjected to
thoracic computerized tomography; upon identifying an irregular-walled soft tissue mass of 4x2
centimeters on the upper lobe of the left lung, the patient was subjected to positron emission
tomography (PET/BT). PET/BT scans exhibited increased FDG uptake, of which the suvmax was
10.3, in the mediastinally located pulmonary parenchyma with spiculated contour of 20X27
millimeters on the apical section of the left lung. No uptake was identified in other regions. Since
no diagnosis could be obtained when the patient, of whom the bronchoscopy did not demonstrate
any endobronchial lesions, was subjected to pathological transthoracic fine needle aspiration
biopsy, the patient’s condition was consulted with the department of thoracic surgery. Non-small
cell adenocarcinoma (poorly differentiated adenocarcinoma) was identified through frozen section
procedure in the patient on whom upper left lobectomy was performed. The patient was subjected
to right axillary lymph node biopsy when right axillary lymph nodes were identified during the postoperative period. After the biopsy, the patient’s lymph node was reported to be a lymph node that
exhibits Langerhans cell proliferation (Langerhans cell histiocytosis). We found it appropriate to
submit this case in order to emphasize the fact that coexistence of lung adenocarcinoma and
Langerhans cell histiocytosis is seen very rarely and that the lymphadenomegaly identified on
every adenocarcinoma patient may not be connected to malignancy.
Keywords: lung, adenocancer, Langerhans Cell Histiocytosis
Picture 1
The picture of PET/CT; mass is in the mediastinally located, on the apical section of the left lung.
Picture 2
No uptake was identified in other regions.
P036[Pulmonary and Pleural Malignancies]
Primary signet ring cell carcinoma of the lung: a case report
Erdal İn1, Mehmet Mustafa Akın2, Müge Otlu3, Gökhan Varlı2, Figen Deveci1, Mehmet Hamdi Muz1
1
Firat University Faculty of Medicine, Department of Pulmonary Disease, Elazig, Turkey
2
Firat University Faculty of Medicine, Department of Pathology, Elazig, Turkey
3
Malatya State Hospital, Malatya, Turkey
İntroduction: Signet ring cell carcinoma (SRCC) is a subtype of adenocarcinoma. It can arise in
different organs including stomach, colon, bladder, prostate and breast. The vast majority of SRCC
found in the pulmonary system is metastatic. Primary disease to the lungs is rare. The main
feature of this type of malignancy is mucin-producing cells. We aimed to point out the importance
of differential diagnosis of primary and metastatic tumors, since they require different clinical
approaches.
CASE: 51-year-old non-smoking male patient with two-month-long cough, bloody sputum, weight
loss, fatigue complaints was admitted to our clinic. Physical examination was normal except
decreased breath sounds and dullness in the lower area of left hemithorax. Increased
nonhomogenous density with irregular margins on the left hilar area and moderate left sided
pleural effusion was found in the chest x-ray. An irregular limited soft tissue density sitting in the
mediastinal pleura and obliterating segment of the left upper lobe bronchus and branches was
observed on computed tomography scan of chest. The mucosa fluffy endobronchial lesions
obstructing the left upper lobe bronchus and lying through lower lobe bronchus were observed on
bronchoscopy. This area was biopsied. Pleural effusion samples were taken from the left
hemithorax. Bronchoscopic bronchial biopsy histopathological findings were evaluated consistent
with SRCC. Pleural fluid cytology was consistent with metastasis of SRCC. High FDG uptake was
detected in the mass of left lung in PET/CT (SUVmax: 9.2). There were no primary focus other than
lung. Patient was evaluated as primary lung SRCC with these findings.
Keywords: Signet ring cell carcinoma, lung, adenocarcinoma
P037[Pulmonary and Pleural Malignancies]
A case with malignant mesothelioma presenting recurrent pneumothorax
was undergone pleuropneumonectomy 7 years ago
Ümit Aydoğmuş, Tolga Semerkant, Gökhan Yuncu
Department of Thoracic Surgery,Pamukkale Univercity
Malignant mesothelioma is an extremely aggressive tumor arising from the pleura with median
survival of approximately 9–12 months. It can rarely present as a spontaneous pneumothorax. We
herein report a case with presenting as a recurrent left pneumothorax who had underwent right
pleuro-pneumonectomy (PPO) seven years ago.
The patient with epitheliel type MPM who had had undergone right pleurectomy ten years ago
(from the first episode of pneumothorax 7 years ago) is 65 years old female. She had underwent
PPO after one years from pleuroctomy because of local recurrent. After 5 years from PPO, she had
established mucinous overian carcinoma. Six mounths later, it had been showed left-sided pleural
effusion. We performed plerural byopsy and talc pleurodesis by thoracoscopy. Left pleural byopsies
had reported epitheliel type MPM. She recieved chemotherapy nine times. After 7 years from PPO,
she had recurrent left-sided spontoneous pneumothorax 4 times that was treated each other with
tube thoracostomy. We didn’t perofrmed surgical treatment because of low perofromans status of
the patient.
The pneumothorax is considered to may be depend on malignancy had occured in remaining lungsided after pneumonectomy. When occured the pneumothorax depend on malignancy it is a
therapeutic challenge.
Keywords: recurrent pneumothorax, presenting pneumothorax after pleuropneumonectomy,
malignant mesothelioma
X ray
Pneumothorax
P038[Pulmonary and Pleural Malignancies]
Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH): a
case report
Canan Gündüz1, Nesrin Moğulkoç1, Pervin Korkmaz1, Ali Veral2
1
Department of Pulmonary Diseases, Ege University, İzmir, Turkey
2
Department of Pathology, Ege University, İzmir, Turkey
Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia, is a rare disease which may mimick
lung malignancy. A 31 year-old male patient with no history of smoking or comorbidity was
diagnosed with pulmonary nodules on a routine chest x-ray in January 2009. Multiple pulmonary
nodules of variable size were revealed on contrast-enhanced thorax CT. The patient was referred to
our department for further investigation. Physical examination and pulmonary function tests were
normal whereas arterial blood gas analysis revealed mild hypoxemia. Routine blood tests were
normal and sputum was negative for acid fast bacilli. On PET/CT examination in February 2009,
1.7x1.3 cm nodule (SUV max: 4.1) in right lung lower lobe superior segment and bilateral
millimetre sized nodules (SUV max: 0.9-1.7) were detected. In March 2009, wedge resection by
VATS was performed and nodules with diameters of 0.4 cm and 0.5 cm were removed from right
lower lobe superior and posterior segments. Pathology was reported as showing multiple minute
neuroendocrine cell proliferations, tumorlets, and typical carcinoid tumors without mitotic activity,
necrosis or atypica. In addition, there was a sclerosing haemangioma (pneumocytoma). On the
octreotide scintigraphy performed to exclude metastatic carcinoid tumor, no pathological activity
was detected. At the last follow-up in June 2013, thorax CT revealed stable nodules. DIPNECH is a
rare pulmonary syndrome comprising a range neuroendocrine proliferations from preinvasive
hyperplasias and tumorlets to invasive carcinoid tumors. It usually requires surgically diagnosis.
Disease progression is usually indolent although deaths may occur.
Keywords: Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia, video assisted thoracic
surgery
P039[Pulmonary and Pleural Malignancies]
A rare tumor of the lung: Inflammatory myofibroblastic tumor
Özlem Saniye İçmeli1, Abidin Levent Alpay1, Baran Gündoğuş1, Dilek Yavuz1, Hatice Türker1, Merve
Çiftci1, Ayçim Şen1, Büge Öz2, Thomas V Colby3
1
Süreyyapaşa Chest Diseases and Thoracic Surgery Education and Research Hospital
2
Department of Pathology, Cerrahpaşa Faculty of Medicine, İstanbul University
3
Mayo Clinic
Inflammatory myofibroblastic tumor (IMT) is a rare lesion, representing 0.04-1.2% of all lung
tumors. It was first described by Brunn in 1939, but its etiology remains uncertain.
A 16-year old female patient was admitted to our hospital for further examination following
abnormal radiological findings. The physicial examination showed no abnormality, and routine
hematological and biochemical parameters were within normal range. Chest radiograph revealed
homogenous opacity of the right upper lobe with regular margins. Thoracic CT showed a nodular
lesion, 30x26 mm in dimensions, with lobular contours in the right hilar. Bronchoscopic
examination showed a vascular endobronchial lesion in the anterior right upper lobe, with bleeding
when palpated. She underwent right thoracotomy for diagnostic and therapeutic purposes since
bronchoscopic biopsy failed because of bleeding. With a pathological diagnosis of IMT, the present
report discusses her case accompanied by relevant literature as it is a very rare type of lung tumor.
IMT is rare benign tumor. The diagnosis is difficult to make before surgery since its clinical and
radiological features are variable and nonspecific. Although it is a benign lesion, it should be
completely resected and patients should be closely monitored following the resection in order to
avoid local invasion and recurrence.
Keywords: Lung,inflammatory tumor,myofibroblastic tumor
P040[Pulmonary and Pleural Malignancies]
The Mucoepidermoid Carcinoma Mimicking Asthma
Fulya Ciyiltepe, Tülay Özdemir
Department of Chest Disease, Akdeniz University, Antalya, Turkey
35 years old man has wheeze especially during night and when he is lying on left side.There is no
other symptoms, he has no disease and he never smoked.Phisicial examination, sft and plain chest
radiography are normal.He has been treated with different medications for asthma at different
centers but no changes has been occured.At thorax CT a lesion at the right middle lobe bronch
which was not obstructed lumen totally was found.Fiberoptic bronchoscopy was done an
endobronchial lesion at the right middle lobe bronch which let air passage was seen.Biopsy was
taken.Pathological result was 'mucoepidermoid carsinoma '.Pet-CT was taken for staging and no
pathological FDG uptake was found except the lesion.The patient was taken to the surgery.
The case shows that at those patients who have no response after medications for nonspesific
symtoms for asthma, other pathologies will be remembered.
Keywords: Asthma,Wheeze,Mucoepidermoid Carcinoma
bronchoscopy image
PET-CT image
PET-CT image
P041[Pulmonary and Pleural Malignancies]
Long Term Survival of Small Cell Lung Cancer ( Case report)
Günseli Balcı, Aydan Mertoğlu, Zühre Taymaz, Emel Tellioğlu
Dr. Suat Seren Chest Disease and Thorasic Surgery Training and Research Hospital,Chest
Departmant,Izmir
Small cell lung cancer (SCLC) is a disease that gives a good response to treatment but its mortality
is high. Few patients attain long-term survival, those with extensive disease having even shorter.
Most of the patients are lost due to relapses, second primary tumors and noncancer reasons. We
presented 2 SCLC patients as long term survivors. The first CASE: A seventy-nine year-old male,
diagnosed as SCLC in the right lung and treated with chemotherapy and radiotherapy 11 years
ago, was detected a right pulmonary mass with thoracic CT scan. The patient did not accept further
examination and treatment. Second case: Ten years before, the 60-year-old male patient received
chemotherapy and radiotherapy due to limited-stage small cell cancer in the right lung. In the 10th
year of the follow-up, left pulmonary mass was detected with thoracic CT scan. Transthoracic fine
needle aspiration biopsy was done; pathological examination revealed neuro-endocrine carcinoma
and chemotherapy was started. The cases presented which were complete cure in the first tumor
and a very long disease-free period.
Keywords: small cell lung cancer, long term survival
P042[Pulmonary and Pleural Malignancies]
A Rare Cause of Chronic Cough: Primary Signet Ring Cell Carcinoma of Lung
Emire Pınar Seyfettin1, Özlem Düvenci Birben1, Ayşe Elif Küpeli1, Dalokay Kılıç2, Handan Özdemir3,
Gaye Ulubay1
1
Baskent University, Department of Pulmonary Diseases, Ankara
2
Baskent University, Department of Cardiovascular Surgery, Ankara
3
Baskent University, Department of Pathology, Ankara
78 y/o female patient was admitted with cough for a month. She was coming from a province of
mining and intensive air pollution area, but was a nonsmoker. Physical examination revealed
dullness and diminished breath sounds on the left base under scapula. A homogenous increased
density was detected on the left lower zone of the lung on chest X-ray. Thorax computed
tomography showed a mass which obliterates the left lower lobe bronchus with atelectasis of the
same lobe, pleural effusion and a possible mass which compresses the distal part of esophagus.
Flexible bronchoscopy revealed no endobronchial lesion. No lesion was observed in esophagus in
upper gastric endoscopy. After the pleural tap, the fluid was exudative and lymphocytic. Patient
underwent video assisted thoracoscopic surgery (VATS) for pleural biopsy. Biopsy showed signet
cell pattern of adenocarcinoma. Signet cell is a rarely seen pattern of adenocarcinoma (1.5%). It is
commonly seen as a metastasis of gastrointestinal or urinary tract tumors. Smoking is the primary
risk factor in lung cancer. Environmental or genetic factors may have played a role in the present
case. We want to point out that this pattern can be rarely seen, may grow aggressively and may be
miscible with esophagus distal part tumors.
Keywords: adenocarcinoma, mediastinal mass
P043[Pulmonary and Pleural Malignancies]
Non-Hodgkin's lymphoma with endobronchial involvment: a rare case
Tuğba Çiçek, Mine Önal, Ayşenaz Özcan, Yetkin Ağaçkıran, Şükran Atikcan
Department of Pulmonary Diseases, Atatürk Pulmonary Diseases and Thoracic Surgery Education
and Research Hospital, Ankara, Turkey
Approximately 75% of all lymphomas are Non-Hodgkin's lymphoma, although endobronchial
involvement is very rare.
67 year old female asthmatic patient was admitted to our clinic with a complaint of shortness of
breath for one month. The patient was non-smoker. Bilateral expiratory rhonchi were heard on
auscultation. The chest radiograph revealed right hilar enlargement. Thorax computed tomography
revealed both axillary lymphadenopathy (LAP), multiple mediastinal LAPs and mass lesion
surrounding the right main bronchus. Fiberoptic bronchoscopy showed mucosal infiltration of the
right main bronchus, narrowing of middle and upper lobe orifices by endobronchial lesion. Multiple
biopsies were taken from these lesion. Histopathological and immunohistochemical examination of
the biopsy specimen revealed B-cell non-Hodgkin's lymphoma infiltration. Cyclophosphamide,
adriamycin, vincristine, and prednisone (CHOP) chemotherapy was started.
We reported this case because non-Hodgkin’s lymphoma mimicing lung cancer is very rare.
Keywords: endobronchial involvement, non-Hodgkin’s lymphoma, endobronchial mass
P044[Pulmonary and Pleural Malignancies]
Synchronous tumors of the lung, small cell lung carcinoma and primary lung
adenocarcinoma coexistence
Nesrin Öcal1, Deniz Doğan1, Ömer Deniz1, Ali Fuat Çiçek2, Hayati Bilgiç1
1
Department of chest diseases, gulhane military medical academy, ankara, turkey
2
Department of pathology, gulhane military medical academy, ankara, turkey
A 69 year-old male patient was admitted to our clinic with complaints of coughand left-sided chest
pain. Thoracic CT was performed to the patient as a result ofthe high density lesions seen in the
chest x-ray graphy. Thoracic CT revealed apleural-based mass in the right lower lobe and an other
mass on the left lungwhich is associated with the hilum and caused atelectasis in the distal
airways..Diagnostic bronchoscopy was performed to the patient who had 90 pack / yearhistory of
active smoking and chronic alcohol consumption. Separate biopsieswere taken from the both
lesions. While transbronchial biopsy was taken from theright lower lobe mass, endobronchial lesion
was seen on the left upper lobe andendobronchial biopsy was taken. Histopathologic examination
of the left upperlobe and right lower lobe revealed small cell lung carcinoma andadenocarcinoma,
respectively. Thereupon oncologic PET examination wasperformed for screening and evaluating if
there is another primary tumor site forright lobe adenocarcinoma. In PET examination, FDG
uptakes of extrapulmonarytissues were considered to be normal. Thus both lesions in the lung
thought to beprimary tumors of the lung. Our case is a good example of simultaneouslydetected
primary tumors of the lung and we reported this case in order toemphasize the possibility of
another primary tumor in the cases which are initiallythought to be metastatic lesions and for sure
the need of biopsies.
Keywords: lung cancer, synchronous tumors
fıgure 2
histopathological appearance of synchronous tumors a. infiltrative tumor consists of abortive glandular
structures and single cell infiltrations (x100 H&E) b. infiltrative tumor islands consist of atypical squamous
epithelial cells (x40 H&E)
fıgure 1
a. squamous cell carcinoma in left lung b. adenocarcinoma in right lung
P045[Pulmonary and Pleural Malignancies]
Quick Radiological Course of Lung Cancer Mimicking Pulmonary
Tuberculosis
Nesrin Öcal, Deniz Doğan, Cantürk Taşçı, Hayati Bilgiç
Department of chest diseases, gulhane military medical academy, ankara, turkey
Cavitary lung lesions are primarily due to pulmonary tuberculosis but they also can be associated
with other etiologies such as lung malignancies, fungal infections. To exclude tuberculosis with ARB
tests when these kind of lesions detected, is a generally accepted clinical approach. Rapid
radiological progression in cavitary lesions are usually interpreted as tuberculosis while a slower
progression is expected in malignancies. We presented this rare case because of a rapid
radiological progression in a patient with lung cancer.
Sixty-six year old male was admitted to our clinic with cough, weight loss, fever and fatigue. ARB
test was planned and nonspecific antibiotherapy was started because of the cavitary lesions in left
upper lobe on CT which was performed in another centre one week before admission to our clinic.
ARB test was negative and control CT was planned. CT revealed prominent progression of the
lesions. Although tuberculosis was the initial diagnosis because of this rapid progression diagnostic
bronchoscopy was performed. Endobronchial lesion in the left upper lobe was detected and
pathological examination revealed squamous cell lung cancer. We presented the case because of its
unusual and rapid radiological progressive nature.
Keywords: cavity, lung cancer, tuberculosis
fıgure 1
cavitary lesion in the left lung
P046[Pulmonary and Pleural Malignancies]
Ten Years After Hysterectomy, A Case Of Leiomyosarcom With Lung
Metastasis
Talat Kılıç1, Ömer Kaya2, Nusret Akpolat3
1
Department Of Chest Diseases, Inonu University, Malatya, Turkey
2
Clinic Of Chest Diseases, Yeşilyurt Hasan Çalık State Hospital, Malatya, Turkey
3
Department Of Pathology, Inonu University, Malatya, Turkey
Leiomyosarcomas are a relatively rare malignant tumors of smooth muscle orgin can arise from
gastrointestinal wall, uterine wall, soft tissue and, retroperitoneal tissue. Lung metastasis of uterine
leiomyosarcom is rare and usually occurs years after hysterectomy. In the literature, there are
metastases occurring simultaneously with uterine neoplasm and 20 years after hysterectomy
patients who had metastases have been reported.
Fifty-seven year old female patient admitted with exercise dyspnea, cough and sputum complaints.
In his history, 10 years ago there was hysterectomy surgery due to abnormal uterine bleeding and
had a history of diabetes.
On physical examination, blood pressure: 110/70 mmHg, heart rate: 78/minute, respiratory rate
20/minute, fire: 36.6 ° C. Respiratory sounds were diminished.
Computerized tomography revealed consolidations with air trapping at the level of superior
segment of the right lower lobe. Multiple pathological dimension lymphadenopathy were observed
in perihilar and subcarinal region.
Diagnostic bronchoscopy was performed. Endobronchial biopsy taken from the lesion was reported
as leiomyosarcom. It was learned a diagnosis of leiomyosarcom, when the records of patient
examined 10 years ago. The present findings in the lung were assessed metastatic lesions. The
patient was referred to oncology clinic.
Metastatic pulmonary leiomyosarcom cases are generally asymptomatic but non specific symptoms
such as cough, sputum, hemoptysis may also have. Previous operations and history of malignancy
should be questioned carefully especially in patients with pulmonary lesions. Also, as it was in our
case, leiomyosarcoms can metastases after many years. We think that these patients should be
followed up for a long-term.
Keywords: Lung metastasis, leiomyosarcom
P047[Pulmonary and Pleural Malignancies]
Lung adenocarcinoma and Hodgkin's lymphoma diagnosed simultaneously
in a patient: A case report
Abdulsamet Sandal, Lütfi Çöplü, Özge Öztürk
Hacettepe University Faculty of Medicine, Department of Chest Diseases, Ankara, Turkey
Pulmonary metastasis is seen in 20-54% of extrathoracic malignancies. Lungs are the second most
frequent site of metastases from extrathoracic malignancies. We report herein a case of lung
adenocarcinoma and Hodgkin's lymphoma diagnosed simultaneously during investigation for
radiologic view suggesting pulmonary metastases. A 75-year-old female subject with dyspnea and
weight loss of 10 kg during last 6 months applied to our hospital. On physical examination left
supraclavicular lymph node enlargement has detected. Thorax computerized tomography revealed
irregularly bordered multiple nodules reaching 1.5 cm in diameter and these lesions were evaluated
primarily as metastases. Pathology of excisional lymph node biopsy specimen was nodular
sclerosing type of Hodgkin's lymphoma and glandular structures suggesting metastasis. Screening
for malignancies of gastrointestinal system and breast was negative. Fiberoptic bronchoscopy
couldn’t be performed due to patient's inconvinience. Tru-cut biopsy of lesion located peripherally
at lower lobe of right lung has been performed and pathology revealed primary mucinous
adenocarcinoma of the lung. Patient’s Eastern Cooperatıve Oncology Group Performans Status
(ECOG-PS) was 4 and no systemical treatment for cancer couldn’t be done. Radiological findings of
advanced stage lung carcinoma could be similar with those of pulmonary metastases. Differential
diagnosis could help planning treatment if systemical treatment is possible.
Keywords: adenocarcinoma,adenocancer,cancer,Hodgkin's,lymphoma,metastatic,metastasis
Thorax computerized tomography image of the case
Thorax computerized tomography revealed irregularly bordered multiple nodules reaching 1.5 cm in diameter
and these lesions were evaluated as metastases.
P048[Pulmonary and Pleural Malignancies]
A case of lung cancer that is cured with the appropriate clinical approach to
the milimetric nodule
Evrim Eylem Akpınar1, Tevfik Kaplan2, Nalan Ogan1, Sümeyye Alparslan Bekir1, Meral Gülhan1
1
Ufuk University, Department of Chest Diseases, Ankara, Turkey
2
Ufuk University, Department of Chest Surgery, Ankara, Turkey
INTRODUCTION: Milimetric lung nodules are detected frequently by multi-detector computed
tomography. The studies provided increase in knowledge about etiologies, behaviors and approach
of the nodules. Sensitivity of PET-CT and success rate of biopsies are low. Frequent follow-up by CT
increases risk of radiation and cost. This report aims to emphasize the importance of approach to
milimetric nodules by means of presentation of a case who had incidental nodule.
CASE: 51 years-old male patient applied with the complaints of dyspnea, cough and sputum. He
had history of smoking (15 pack-years) and family history of lung cancer and incidentally detected
milimetric nodule (6 mm) on thorax CT after treatment of pneumonia on 2009. Milimetric increases
in dimension of the nodule was detected during follow-up by annual CT. Physical examination was
normal, laboratory examination showed increase in ESR and CRP, 99 mm/h and 22 mg/dl
respectively. Thorax CT on 3 October 2013 after antibiotic treatment revealed increase in diameter
(10.6 mm) and density of the nodule. Pathological activity was not detected on PET-CT. The patient
was operated after the decision of multidiciplinary council. Frozen section of the nodule on right
lower lobe reported as malignant epithelial tumor and the operation was completed by lobectomy
and lymph node dissection. Postoperative pathology reported as invasive mucinous
adenocarsinoma and the stage IA (T1a,N0,M0). Patient is following-up without adjuvant treatment.
CONCLUSION: The appropriate clinical approach to the milimetric lung nodules provides early
detection and treatment of lung cancer.
Keywords: milimetric nodule, lung cancer, follow-up
Picture 1
Thorax CT on 2009, showing 6 mm nodule on right lower lobe, density: -394 HU
Picture 2
Thorax CT on 2013, showing increase both in density and diameter of the nodule on the right lower lobe (10.6
mm, +22 HU)
P049[Pulmonary and Pleural Malignancies]
Primary lung cancer with bilateral multiple cavitary lesions
Ebru Ünsal1, Filiz Çimen2, Fatma Canbay2, Müjgan Güler2
1
Yıldırım Beyazıt University
2
Atatürk Chest Diseases and Chest Surgery Education and Research Hospital
Sixty six years old male patient. He was a farmer. He had operation for inguinal hernia 40 years
ago and had cataract surgery two years ago. He had smoking history as 100 package years. Also
his brother died from lung cancer. When he admitted to hospital, he had dispnea and hemoptysis
for 2,5 months. On physical examination, there was swelling of the veins in the upper extremity
and neck. Respiratory sounds were decreased. Oxygen saturation was 90%. Respiratory rate was
14/minute. On routine tests, hemoglobine: 15.6, WBC: 6800 Ne:4100, hct 47.4% PLT: 303000
INR: 1.11 Sedimantation:34/hr. The chest radiography showed enlargement of mediastinum and
bilateral nodular density of cavitation. Thoracic CT was performed and mass in the right
paratracheal area including both mediastinal and hilar lymphadenopathy and left upper lobe the
lesion contoured approximately 5 cm in diameter, 4cm sized cavities in both lungs and multiple
metastatic nodules were demonstrated. The patient was referred to the radiation oncology in terms
of SVCS. Without a tissue diagnosis, the patient had 10 days palliative radiotherapy for superior
vena cava syndrome (SVCS). Fiberoptic bronchoscopy (FOB) was performed. Apicoposterior
segment of the left upper lobe was closed with EBL. Apical segment of right upper lobe was
infiltrated with fragile mucosal lesion. FOB biopsies from both systems were reported as squamouscell pulmonary carcinoma. FOB lavage was reported as negative for ARB. The case was presented
to the oncology council and chemotherapy with the diagnosis of stage 4 non small cell lung cancer
was reported.
Keywords: cavity, lung cancer, metastasis
P050[Pulmonary and Pleural Malignancies]
Bronchial Adenoid Cystic Carcinoma:Case Report
Ergi Hysi, İlknur Yaşar, Günay Aydın
Department of Pulmonary Diseases, Cerrahpaşa Faculty of Medicine, İstanbul University, Turkey
İntroduction:Adenoid cystic carcinoma of lung (ACC) is a rare,low –grade malignancy that origins
from bronchus’s submucosal glands. Subsequent local recurrences are frequently seen.Lymph node
metastasis are reported but early distant metastasis are uncommon. We report a case of
aggressive distant metastatic bronchial adenoid cystic carcinoma in a patient presented with cough,
hemoptysis and back pain.
CASE: 48- years -old male patient, non-smoker. He presented to our clinic with a 1month history
of shortness of cough, hemoptysis and bach pain.Chest X-ray showed only a left hilar enlargement
while computed tomography of the chest revealed 2.3cm mass that obstructs left main bronchus.
Bronchoscopic examination of the left main bronchus showed half moon-shaped prominent mucosal
lesion causing bronchial stenosis. The examined secion of endobronchial lung biopsy was
compatible with adenoid cystic carcinoma.The patient was accepted inoperable after the PET-CT
screening shows high FDG uptake on bilateral adrenal and multiple bone areas.The primery mass
responded well to radiotherapy but metastatic lesions showed progress after chemotherapy.
DISCUSSION: Bronchial adenoid cystic carcinoma is regarded as a locally infiltrative and slowly
growing tumor but despite this may shows malignant features. Perineural invasion is a common
characteristic of the tumor in which early metastases are rarely seen. The primary treatment for
this tumor is surgery. For patient with postoperative positive surgical margins or N2 involvement
adjuvant radiotherapy is recommended. The role chemotherapy in treatment is limited. İn our
case, similar with published literatures radiotherapy has good results but in advanced disease
chemotherapy is evidently ineffective.
Keywords: adenoid cystic carcinoma,bronchus,early metastasis,
P051[Pulmonary and Pleural Malignancies]
Aggressive surgical staging for a patient with malignant melanoma should
be done when reqired: a case report
Alper Gözübüyük1, Kuthan Kavaklı1, Hakan Işık1, Okan Karataş1, Sezai Çubuk1, Gökhan Ayberik1,
Orhan Yücel1, Hasan Çaylak2, Sedat Gürkök1
1
Department of Thoracic Surgery, Gulhane Military Medical Academy, ANKARA
2
Diyarbakır Military Hospital, Diyarbakır
INTRODUCTION: Malignant melanoma is a neoplastic disease with increasing incidence and the
treatment is challenging when metastatic disease is present. The treatment option is determined
according to stage of the disease.
CASE: A 23-year-old man admitted with the resection of malign melanoma from preauricular area
and staging results of primer lesion with PET-CT after resection. There were two pathologic FDGuptake in seperate body location; left axillary area and superior-anterior mediastinum.
The PET-CT findings should be confirmed with histopathologically. Dynamic-CT-anjiography
revealed a 4.5 cm diameter lesion with heterogen dansity and smooth margine that had no
invasion to the wall of main pulmonary artery and assending aorta (Figure1).
He underwent exicion of left axillary lymph node and thymic lesion. The exicion of thymic lesion
started via VATS and the thymus was removed. The thymic area was explored with thoracoscope
after exicion and we determined that the pericardium was intact and the lesion was under the
pericardium and it was not orginating from thymic tissue (Figure2). The lesion was not biopsied or
resected at this time. It was completely resected after ten days from his first operation by a
cardiovascular surgeon.
The histopathologic examination of the resected specimens revealed that non-malignant left
axillary lymph node and thymus tissue and paraganglioma for intrapericardial lesion (Figure3). The
patient was staged as an early disease and no adjuvant therapy was planned.
CONCLUSION: The patient with very different SUV-Max value in the PET-CT should be confimed
with histopathologically even if it is requiered aggressive surgical approach.
Keywords: Malignant melanoma, paraganglioma, thoracic surgery, staging
P052[Pulmonary and Pleural Malignancies]
A Rare Case: Pleomorphic Carsinoma of Lung
Ayşe Dallı1, Sibel Öktem Ayık1, Demet Arıkan Etit2
1
Department of Chest Diseases, Katip Çelebi University,Izmir
2
Pathology Unit, Atatürk Training and Research Hospital, Izmir
Introduction and AIM: Pleomorphic carsinoma of lung is a less differential non-small cell lung ca. It
is a sub-type of Sacomatoid carsinoma. We accepted to present this case because it is seen rarely.
CASE: A 47 years old male referred to emergency service with complaints of cough and dispnea.
He was tachypnea and tachycardia. In blood gas there were hypoxy and hypocapnea. In Thoracic
CT there were pericardial effusion, paratracheal hilar subcranial lymphadenopathies, obstruction in
left lower lob bronchus and consolidation on its distal. He was hospitalized with pre-diagnosis of
lung cancer and pnomonia. Cardiology consultation was required beacuse of pericardial tamponade
on doppler ecocardiography. He was followed up after perikcardiosynthesis. Cytological analysis of
liquid was benign. Palpable lymph glands were determined on the neck. Neck USG showed a lot of
grown up lymph glands which biggest of them was 3x2cm on bilateral servical chain. Lymph gland
fine needle aspiration biopsy was carried out. Pathology result was pleomorphic malign tumor
metastasis. For histopathological diagnosis lymph gland excitional biopsy was carried out. biopsy
was reported as pleomorphic ca of lung. Bronchoscopy was arranged for the patient that still need
oxygene. In spite of high oxygene support he had hypoxia and was intubated, then the patient was
connected to mechanical ventilator. Then was sent to center that has intensive care unit.
CONCLUSION: Pleomorphic ca is a rarely seen lung tumor that has a bad prognosis. In cases
investigated with lung ca pre-diagnosis pleomorphic ca should be remembered.
Keywords: Pleomorphic carsinoma, Lung
P053[Pulmonary and Pleural Malignancies]
A Lung Adeno CA Case with Pancreatic Metastasis
Ayşe Dallı1, Sibel Öktem Ayık1, Mehmet Ali Uyaroğlu2, Hüseyin Sinan Akay3
1
Department of Chest Diseases, Katip Çelebi University,Izmir
2
Pathology Unit, Atatürk Training and Research Hospital, Izmir
3
Gastroenterology, Atatürk Training and Research Hospital, Izmir
Introduction and AIM: Encounter of pancreatic metastasis at a patient with known malignency is a
very rare situation. In this case report we accepted to present a case with adeno ca that have a
rare metatasis diagnosed by biopsy taken mass from pancreas but initially diagnosed as non-small
cell lung ca without determination of its sub-type.
CASE: A 59 years old male referred referred to emergency service at with an increasing dispnea
which 15 days before. In physical examination there was no respiration sound on left hemitoracs.
In radiography a massive effusion that produce mediastinal shift was determined on the left. In
thoracic CT a mass that occluded left main bronch and have no clear margins was seen in hilus.
Therapeutic thoracentesis was applied three times. Cytological analysis of pleural liquids were
reported as benign. In bronchoscopy that was carried out all segment halls were nearly completely
stagnant. There was a mucosal infiltration view. Pathology result of biopsy taken by bronchoscopy
was non small cell lung ca. In CT taken for examination a 5x6 cm large mass was determined at
the tail of the pancreas. A biopsy was taken from the mass in pancreas by endoscopic
ultrasonography. Patology result was reported as adeno ca.
CONCLUSION: Pancreatic metastasis of lung cancers are rare situations. During systemic
examinations pancreas should be evaluated and in detected mass probability of metastasis should
be remembered.
Keywords: Lung cancer, Pancreatic metastasis.
P054[Pulmonary and Pleural Malignancies]
Pulmonary cavitary metastasis due to Pancreas adenocarcinoma: a case
report
Hatice Kılıç1, Funda Karaduman Yalçın2, Ayşegül Karalezli1, Hatice Canan Hasanoğlu3
1
Ankara Research and Training Hospital, Department of Pulmonary Medicine, Ankara, Turkey
2
Sinop Boyabat 75th State Hospital, Department of Pulmonary Medicine, Sinop, Turkey
3
Yildirim Beyazit University Medical School, Department of Pulmonary Medicine, Ankara, Turkey
INTRODUCTION: Pulmonary metastatic cavitary lesions are most commonly associated with
metastatic squamous cell or mucinous carcinoma. Pulmonary metastases originating from head and
neck, esophageal, colon and urinary bladder cancer showing cavitation were seen as a case report.
We presented this case due to it is a rare entity.
Case presentation: We report the case of a 60-year-old man hospitalised with the complaint of a
rapidly weight loss and back pain 7 months ago. Endobronchial lesion was not observed by
bronchoscopy. Histopathologic examination of the transabdominal needle aspiration biopsy guided
by CT (computed tomography) showed metastasis of poorly differentiated pancreas
adenocarcinoma. A total-body CT scan revealed a tumor of the truncus of pancreas and multiple
cavitary lesions that are located in the lower lob predominant (Figure 1). No other metastases were
found. We don’t expect this cavity pattern as the metastatic pancreas cancer. Transthoracic tru-cut
biopsy was performed on the guided by CT from the lung. Cytopathological and
immunocytochemical results confirmed the diagnosis of metastatic pancreas cancer. So we planned
a multi-modal therapeutic approach. The tumor was highly aggressive. The patient has been died
due to massive pulmonary thromboembolism and respiratory failure while he had been diagnosing
for nine months (Figure 2). Multipl cavitary lesions had monitored throughout the entire lung on
the thorax CT.
CONCLUSION: The presentation of cavitary pancreas metastasis to lung is exceptional. We report
a case with multiple cavitary lesions by cancer had metastased from pancreas to lung due to ıt is a
rare pattern of involvement.
Keywords: Pancreas, lung, metastasis, cavity.
Figure 1
multiple cavitary lesions in thorax CT, more predominant in the lower lobes
Figure 2
Massive pulmonary thromboembolism appearance in thorax CT
P055[Pulmonary and Pleural Malignancies]
Synchronous lung and colon adenocarcinoma: a case report
Tuğba Çiçek1, Ayşenaz Özcan1, Yetkin Ağaçkıran2, Şükran Atikcan1
1
Department of Pulmonary Diseases, Atatürk Pulmonary Diseases and Thoracic Surgery Education
and Research Hospital, Ankara, Turkey
2
Department of Pathology, Atatürk Pulmonary Diseases and Thoracic Surgery Education and
Research Hospital, Ankara, Turkey
Synchronous tumors are defined as those occurring two or more primary cancer within 6 months of
the first primary cancer diagnosed. The incidence of multiple primary neoplasms is reported about
0.73–11.7%. In the literature that synchronous adenocarcinoma of lung and colon is a rare
condition.
A 75-year old male was admitted to our clinic whom suffering from cough with bloody sputum
during for 2 months. Computed tomography of the thorax revealed a right suprahilar mass lesion.
The patient underwent diagnostic fiberoptic bronchoscopy but biopsies were nondiagnostic.
Transthoracic biopsy was performed. Histopathological and immunohistochemical examination of
samples of TTF-1 and napsin-A were positive for lung adenocarcinoma. By 18F-FDG positronemission tomography a mass in the sigmoid colon was founded (SUVmax:24). Histopathological
and immunuhistochemical examination of samples revealed TTF-1 and napsin-A negative
adenocarcinoma. After colon resection, chemotherapy regimen was planned.
Detection of extrapulmonary masses in the follow up period of pulmonary malignancies are usually
considered as a metastatic lesion. However, it could also be another second primary malignancy.
Determining the etiology of the each lesion is important for therapeutic management. Synchronous
lung and colon cancer is a rare condition and can usually be detected during scanning for
metastases.
Keywords: multiple primary tumor, synchronous tumor, lung cancer, colon cancer,
adenocarcinoma
P056[Pulmonary and Pleural Malignancies]
Endobronchial Carcinoid Tumor Presenting Recurrent Pneumonia: Case
Report
Elif Yelda Özgün Niksarlıoğlu, Muzaffer Metin, Gülcihan Özkan, Nur Dilek Bakan, Güngör Çamsarı
yedikule Chest Disease and Thoracic Surgery Education and Training Hospital,Istanbul
Bronchopulmonary carcinoid tumors are uncommon pulmonary neoplasm that is derived
neuroendocrine cells. The most common symptoms are cough, hemoptysis and wheezing. A case of
33-year-old nonsmoker man was admitted to hospital with cough, fever and sputum that chest-X
ray showed infiltration on the right lower zone and he treated with moxifloxasin. He also had a
history of 3 times pneumonia last 3 years. So, a computed tomography (CT) scan of thorax
revealed. CT scan demonstrated a mass in the right lower lobe. On subsequent fiberoptic
bronchoscopy, an endobronchial polypoid mass was detected in the right lower lob mediobazal
segment. A forceps biopsy taken from the mass revealed chronic granulation tissue. Then, rigid
bronchoscopy was performed; endobronchial lesion was taken out that histopathological study
concluded in typical carcinoid tumor. Right lower lobectomy was performed. In the control FOB,
there was no endobronchial lesion during follow-up 6 months. Endobronchial carcinoid can present
with recurrent pneumonia. It’s important that endobronchial tumor must be considered in patients
with recurrent pneumonia and require CT scan and FOB.
Keywords: Carsinoid tumor, recurren pneumonia
P057[Pulmonary and Pleural Malignancies]
Lung Cancer Diagnosed During Preoperative Evaluation
Deniz Doğan1, Deniz Arık2, Mehmet Aydoğan3, Ömer Alan4, Alper Gündoğan1, Nesrin Öcal1, Cantürk
Taşçı1
1
Gulhane Military Medicine Academy, Ankara
2
Ağrı Military Hospital, Ağrı
3
Isparta Military Hospital, Isparta
4
Ankara Military Hospital, Ankara
87 year old male, with no pulmonary symptom was consulted to the chest diseases department
due to suspicious appearance in radiography performed prior to inguinal herniorhaphy operation.
The case had good overall condition and no complaints. There were no peculiarities in his
background except for 55-60 packs/year of smoking. In respiratory function test, FVC:2.82
(%104.4), FEV1:1.93 (%99.4), FEV1/FVC:68.4.
In PA lung radiography, peripheral located 24X26mm well-circumscribed nodular lesion was
observed in right middle zone and irregular-circumscribed mass lesion was observed in right
paracardiac region (Picture 1). Initially, contrast-enhanced thorax CT was performed on the case.
In thorax CT, two solid mass lesions were observed in right lung lower lobe sized 46x23 mm and
45x20 mm (Picture 2).
In fiber optic bronchoscopy, it was observed that the right lower lobe was narrowed by exterior
compression of mediobasal and posterobasal segment orifices and biopsies were conducted on
these regions. In FDG-PET examination, the case with SUVmax values of the lesions observed in
Thorax CT were measured as 7.5 and 8.1 respectively, and the histopathologic diagnosis was
reported as compatible with adenocarcinoma.
The male case at advance age with no pulmonary symptom has lung cancer detected
coincidentally. The case was diagnosed upon the suspicious appearance in the lung radiography
performed due to his advanced age during preoperative evaluation. As it is known, lung cancer
may become evident at advanced age in many cases without indicating any symptoms. We wanted
to emphasize the importance of radiologic examination in preoperative pulmonary evaluation once
again.
Keywords: lung cancer, preoperative evaluation, radiologic evaluation
Picture 1
In PA lung radiography, peripheral located 24X26mm well-circumscribed nodular lesion was observed in right
middle zone and irregular-circumscribed mass lesion was observed in right paracardiac region
Picture 2
In thorax CT, two solid mass lesions were observed in right lung lower lobe sized 46x23 mm and 45x20 mm
P058[Pulmonary and Pleural Malignancies]
Pleural biopsy for the diagnosis and staging of lung cancer; case report
Alper Gündoğan, Tuncer Özkısa, Deniz Doğan, Ergun Uçar, Seyfettin Gümüş, Cantürk Taşçı, Hayati
Bilgiç
Gulhane Military Medical Academy,Department of Pulmonary Medicine, Ankara
Diagnostic methods used in the diagnosis of lung cancer shaped by cancer type, size, location and
the presence of metastases. This spectrum starting from sputum cytology extends to open surgical
biopsy. Ideal diagnostic method is minimally invasive methods for final diagnosis can be reached.
We present a case that could not be diagnosed with recurrent thoracentesis and pleural cytology
but diagnosed with pleural biopsy as squamous cell carcinoma. Fifty-four-year-old female patient
was admitted with complaints of cough and chest pain. Unilateral pleural effusion on chest
radiographs were observed (Figure 1). Repeated thoracentesis with pleural fluid cytology and
sputum cytology was not diagnostic. Computed tomography revealed pleural effusion and total
atelectasis of right lung (Figure 2). Pleural biopsy revealed squamos cell lung cancer. Bronchoscopy
revealed endobronchial lesion, biopsy revealed squamous cell lung carcinoma. With the invazion of
pleura cancer was staged as stage 4. Pleural fluid cytology have a sensitivity of 40-90% for
malignant effusions. Cytology has a high diagnostic value in adenocarcinomas but it has lower
value in squamous cell carcinomas. Although pleural biopsy is less sensitive in malignant effusion,
when the pleural cytology is inadequate for diagnosis pleural biopsy is simple, easily accessible and
a minimally complicated method. Our case is important for emphasising importance of closed
pleural biopsy in the diagnosis and staging of lung cancer.
Keywords: Lung cancer, Pleural biopsy
Picture 1
Picture 2
P059[Asthma and Allergy]
Endobronchial tumours presenting as asthma
Ahmet Arisoy1, Selami Ekin2, Bunyamin Sertogullarindan2, Hulya Gunbatar2, Hanifi Yildiz3, Hilmi
Demirkiran1
1
Department of Pulmonary Medicine, Private Istanbul Hospital, Van, Turkey
2
Department of Pulmonary Medicine, Yuzuncu Yil University, Van, Turkey
3
Department of Pulmonary Medicine, Private Lokman Hekim Hospital, Van, Turkey
Primary tracheobronchial tumours are quite rare neoplasms. They frequently develop in the
trachea, carina, and endobronchial regions. Because they are rare, and because of the variation in
their histogenesis, their chest X-ray findings and clinical and operational outcomes have not been
well elucidated. Endobronchial tumours may be benign or show low- or high-grade malignancy.
Affected patients generally present with symptoms of either asthma or infection that has developed
as a result of obstruction. However, these symptoms are nonspecific. We herein report four such
affected patients in our clinic and discuss their symptoms, pathological findings, and treatments.
Keywords: Asthma, Endobronchial, Carcinoid tumuors, Adenoid Cystic Carcinoma
Figure 1
Mass lesion almost entirely blocking the right main bronchus
Figure 2
Bronchoscopic finding of pedunculated mass lesion almost entirely blocking the right main bronchus
P060[Asthma and Allergy]
Mast cells mediators FGF and TGFβ impaired β2–adenoreceptor function via
increased receptor phosphorylation
1
2
1
Latifa Chachi , Omar Tliba , Christopher Brightling , Yassine Amrani
1
2
1
Infection, Immunity and Inflammtion University of Leicester UK
Department of Pharmaceutical Sciences, Thomas Jefferson University USA
β2–adenoreceptor agonists evoke rapid bronchodilatation and are the mainstay of the treatment of
asthma symptoms worldwide. These drugs are used in long-acting form as add-on therapy to
inhaled corticosteroids, where they improve symptoms and lung function, and reduce the rate of
severe asthma exacerbation. ASM plays a role in the pathophysiology of asthma by increasing
bronchial hyper-responsiveness, airway remodeling and enhancing inflammation. we assessed
whether activation of receptor tyrosine kinases (RTK) modulate β2-adenoreceptor phosphorylation
and function ASM cells from healthy control, non-severe asthmatic and severe asthmatic were
incubated with mast cells mediators FGF (10ng/ml) or TGFβ (10ng/ml) for various time points (0,
2`, 10`, 30`) then β2–adenoreceptor phosphorylation (TYR141) and (TYR350) was assessed by
flow cytometry. We assessed the effects of FGF or TGFβ albuterol (10 µM) on albuterol induced
phosphorylation
of
β2-adenoreceptor
of
VASP
(ser157).
RESULTS: FGF and TGFβ causes a time dependent increase in phosphorylation of β2–
adenoreceptor (TYR141) and (TYR350) which was significant at 10 min. FGF and TGFβ also caused
an impaired β2-adenoreceptor function as evidenced by the loss of activation of VASP
phosphorylation (ser157) in response to albuterol. The potentially beneficial effects of β2adrenoceptor agonists in asthmatic airways may be blunted as a result of the loss of β2–
adenoreceptor function and that might be due to high concentrations of mast cells mediators like
FGF and TGFβ.
Keywords: ASM, RTK, Mast cells
P061[Asthma and Allergy]
D-dimer levels decreased in severe allergic asthma and chronic urticaria
patients with the omalizumab treatment
1
2
3
Arzu Didem Yalcin , Betul Celik , Saadet Gumuslu
1
Internal Medicine, Allergy and Clinical Immunology, Prof.Dr. Tse Wen Changs Lab. 5th floor,
Genomics Research Center, Academia Sinica,11529, Taipei, Taiwan.
2
3
Department of Laboratory Medicine and Pathology, Mayo Clinic in Jacksonville, FL, USA
Department of Medical Biochemistry, Faculty of Medicine, Akdeniz University, 07070, Antalya,
Turkey.
D-dimer (DD), a fibrin degradation product formed during the lysis of a thrombus is also detected
in high levels in patients with active chronic urticaria (CU). Severe persistent allergic asthma (SPA)
is associated with a procoagulant state in the bronchoalveolar space, further aggravated by
impaired local activities of the anticoagulant pC/S, AIII system and fibrinolysis, as demonstrated by
massive fibrin depositions in the alveoli of a SPA who died from a SPA attack who did not respond
to treatment. For the reason that we think of the effect of omalizumab both in bronchial and
systemic vascular area, we evaluated SPA (group I) and CU (group II) patients before and after
therapy period. Blood samples were taken on before treatment, 4th month, 8th month and 12th
month post treatment. We compared DD levels between groups: The significant DD difference was
observed between group-IA and group-IC (P=0.031); between group-IA and group-ID (P=0.003);
between group-IB and group-ID (P=0.049); The significant DD difference was observed between
Group IIA-1 and Group-IID (P=0.015). In the IIA-1 group there was a significant positive
correlation
between
DD
and
age
(p=0.008,r=0.848).
We
observed
that
FENO
concentrations(mean±SD) level decreased in follow-up period (Group-IA:65.55±7.90,Group-IB:
53.45±5.7, Group-ID:39.70±35). Total IgE level measurements were (mean±SD). Group-IA:
987.6 ± 386.5, group-ID:288.9±196.6).Total IgE level measurements were (mean±SD):Group
IIA-1: 757.9±156.7.9, GroupIIB:457.3±63.2, Group IID:238.9±96. Group IIA-2 consisted of
patients whose lesions were passive stage. In conclusion, mediators and cells classically involved in
procoagulant and anticoagulant pathways altogether play a role in SPA and CU pathophysiology
and omalizumab effect.
Keywords: Severe Persistent allergic asthma; chronic urticaria; d-dimer; Anti-IgE; omalizumab;
antithrombin III; protein C; factor V leiden and prothrombin G20210A mutation
1
Figure 1: (Group I:SPA, n:20) D-Dimer levels (mean±SD). Group IA: 467.63±106.39. Group IB: 430.00 ±
92.90. Group IC: 401.21 ± 72.19. Group ID: 377.37 ± 62.33.
2
Figure 2: (Group II: CU, n:8) D-Dimer levels (mean±SD). Group IIA-1: 506.25 ± 133.93. Group IIA-2: 437.75
± 54.83. Group IIB: 408.00 ± 125.39. Group IIC: 377.38 ± 104.50. Group IID: 350.87 ± 70.60.
P062[Asthma and Allergy]
Evaluation of Homocysteine, ECP, 25(OH)Vitamin D, Pro-inflammatory IL-1β
and Immune Modulator OX-2 Levels in Moderate Allergic Asthma Patients:
Association with Biological Treatment (Omalizumab) & Disease Activity
1
2
3
3
Arzu Didem Yalcin , Atil Bisgin , Gizem Esra Genc , Saadet Gumuslu
1
Internal Medicine, Allergy and Clinical Immunology, Prof.Dr. Tse Wen Changs Lab. Genomics
Research Center, Academia Sinica,Taipei,11529, Taiwan.
2
Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping
University, Linköping, Sweden.
3
Department of Medical Biochemistry, Faculty of Medicine, Akdeniz University, Antalya, Turkey.
Context: The mechanism of biological treatment molecule omalizumab in the use of asthma
treatment
is
believed
to
be
multifactorial.
There are many studies focused on this new treatment modality. However, the mechanism still
remains significant unknowns. In order to explore the relation between expressions of immune
system related biomarkers and disease characteristics, activity, this study was undertaken in
moderate
asthma
patients
underwent
omalizumab
treatment.
METHODS: Consecutive patients with moderate asthma disease (n=15,Group IA and IB) above
the age of 18 years that have no any other autoimmune and/or chronic disorders. Blood samples
from both groups were taken during their first visit (Group IA and II) then after 12 months of
treatment in asthmatic patients (Control IB). Serum levels of homocysteine (Hcy), eosinophil
cationic peptide(ECP), 25-hydroxyvitaminD(25(OH)D), IL-1β, soluble OX2(sCD200) and clinical
follow-up tests including fractional exhaled nitric oxide(FeNO), pulmonary function tests and
asthma
control
test(ACT)
were
evaluated.
RESULTS: Pulmonary function tests including FEV1 and FVC together with 25(OH)D levels were
significantly increased after the treatment. More than that, total IgE, Hcy, ECP,FeNO and sCD200
levels were significantly decreased. Regression analysis showed positive correlations between ACT
and FEV1, FVC; between FeNO and age, ECP for Group IA patients. Negative correlations were
detected between ACT and IgE; between age and FEV1; between FeNO and FEV1 and FVC for
Group
IA
patients.
CONCLUSIONS: Our data suggesting the potential use of serum biomolecules in concordance to
the clinical status of the asthmatic patients and might be a follow-up tool for the omalizumab
therapy.
Keywords: Biological treatment; allergic asthma; homocysteine; eosinophil cationic peptid; 25hydroxyvitamin D; IL-1β; OX2; biomarker discovery, CD200; omalizumab; Anti-IgE
1
OX2(sCD200) levels. Group IA mean±SD: 61.80 ± 3.15. Group IB mean±SD: 33.25 ± 6.30. Group II
mean±SD: 21.57 ± 5.55.OX2 is a novel immune-effective molecule, both cell membrane-bound and also
existing in a soluble form in serum, which has a dual effect as a pro-inflammatory through its receptor and an
immune modulatory.In our previous clinical study, OX2 levels were changing due to the clinical status of
patients that might be because of playing a role the pathogenesis of autoimmune/inflammatory diseases. Our
observations on the patients seem to be supporting the OX2 as a pro-inflammatory molecule.Thus the
increased levels seen in our study with active disease (Group 1A) presumably represents a manifestation of a
homeostatic response directed at control of inflammation, with the diminished levels then seen in postomalizumab group, thus reflecting, in turn, the successful suppression of the inflammatory response.
2
Vitamin D (25(OH)D) levels. Group IA mean±SD: 13.33 ± 2.85. Group IB mean±SD: 18.04 ± 2.02. Group II
mean±SD: 16.98 ± 2.15. 25(OH)D is also a steroid hormone that is acknowledged to have immune-modulatory
effects in vitro as well as in vivo. Data from previous studies, suggest that 25(OH)D plays a beneficial role in
pulmonary inflammation and a predictive marker for pulmonary function.However, it is still unknown that
whether this effect is on innate or adaptive immune system or related to cytokines and also its association with
asthma severity in relation to different treatment modalities. Thus by our study, we investigated the 25(OH)D
serum levels in asthma patients together with other inflammatory molecules in relation to omalizumab
treatment. 25(OH)D studies were increased in the last decade and many studies reported that its deficiency is
contrariwise correlated with body mass index (BMI), hypertension and diabetes mellitus and also it is associated
with an increase in the prevalence of various cardiovascular risk factors and cardiac diseases including coronary
artery disease, heart failure, atrial fibrillation, peripheral arterial disease, stroke and myocardial infarction.23 26 In our study, there is no difference in BMIs between the patients’ groups and healthy volunteers. More
interestingly two reported cases from our group: one with severe persistent asthma patient underwent the
omalizumab treatment with a stroke history without any intracranial embolism and the other with a dessicant
aort aneurism without any enlargement had an increased 25(OH)D levels after the long term treatment by
omalizumab. And we concluded that this increase in 25(OH)D might be due to an decreased use of systemic
steroids with successful biological treatment modality.The other possible explanation is as previously reported,
the seasonal factors in relation to vitamin D levels was the decrease between summer and winter. In our study,
we also had the samples from the patients during the highest pollination time in our region on May within the
average temperature of 25 °C with high humidity per cent as in mid-summer season in many other countries.
This data also suggest a new target to study; air pollination and seasonal effects. Asthma is a disease
associated with increased levels of eosinophils in tissues, body fluids, and bone marrow. Elevated levels of ECP
have been noted in asthma patients. There is also a correlation between increased levels of ECP and asthma
exacerbation as a biomarker.We observed a correlation between ECP and FeNO; and between FeNO and age in
the pre-treatment group (Group IA) in our study. The role of IL-1β in asthma pathology was previously defined
and associated with inflammation.30 Interestingly, there was a positive correlation between IL-1β levels and
SOA in Group IA, while a negative correlation was between IL-1β levels and FEV1 in Group IB. However, there
was no change in IL-1β levels between the groups and omalizumab has no effect on IL-1β levels.
Contraversially to our previous study a decrease on IL-1β levels in severe asthma patients, no change in the
concentration might be due to the patients’ had a moderate asthma and treatment period was shorter.
P063[Asthma and Allergy]
Bronchial thermoplasty in patients with poorly controlled asthma: three
cases
Turhan Ece, Züleyha Bingöl, Zeynep Yegin
Istanbul University,Pulmonary Department, Istanbul, Turkey
INTRODUCTION: Bronchial thermoplasty (BT) is a new technique for uncontrolled asthma. It
delivers thermal energy to the large airways and decrease the amount of smooth muscle. BT has
been shown to reduce asthma exacerbations, and improve asthma control and quality of life.
Metods: Stable adult asthmatics requiring optimal inhaler treatment (beclomethasone >=2000μg,
salmeterol >=100μg), post-bronchodilator FEV1 50-80% predicted; and, non- smoker for 1yr or
former smoker <10pack-year were included. Three seance BT were done.
Case I: A 45year-old male with uncontrolled asthma for 20 years, underwent BT. He had been
receiving optimal medical therapy with p.o prednisolone 8mg/daily. Symptoms did not persist after
BT. FEV1 prior to BT was 65% (1830ml), ACQ: 4, ACT:11. During 12 week follow-up, FEV1:44%
(1480ml), ACQ:1 and ACT:23.
Case II: A 45year-old female with uncontrolled asthma for 14 years underwent BT. She were
receiving optimal medical therapy with p.o prednisolone 16mg/daily and omalizumab. FEV1 prior to
BT was 82% (3610ml), ACQ: 5,5, ACT: 5. During 12 weeks follow-up, FEV1: 89% (3940ml), ACQ:
0,2 and ACT:25.
Case III: A 40-year-old male with uncontrolled asthma for 20 years, underwent BT. He had been
receiving optimal medical therapy with p.o prednisolone 16mg/daily. Heamoptysis (10cc) occured a
week after third seance. Symptoms improved after BT. FEV1 prior to BT was 66 % (2370ml),
ACQ:2.7, ACT:5. During 12 week follow-up, FEV1:65% (2340ml), ACQ:0.8 and ACT:25.
CONCLUSION: Response to BT varies from one patient to another. Further studies with different
asthma phenotypes are required to define the better responders from BT.
Keywords: Asthma, bronchial thermoplasty, uncontrolled asthma
P064[Asthma and Allergy]
The clinical impact of vitamine D on asthma
Seda Beyhan Sağmen, Özgür Baykan, Berrin Ceyhan
Marmara University
AIM: In this study, we aimed to examine the effects of vitamine D on asthmatic patients’ clinical
parameters and to compare those with healthy subjects.
METHODS: 106 patients with asthma and 84 healtyl subjects who have matched age and sex have
been enrolled into the study. Pulmonary function tests(PFT), smoking, number of attacks, drug
intake, peripheral eosinophila, total IgE value and skin allergy tests were evaluated. Plasma
vitamin D levels were measured by liquid chromotograpy coupled with tandem mass spectrometry.
Body Mass Index and Asthma Control Test were recorded. Clinical parameters were compared
between asthma and control group.
RESULT: 106 patients with asthma have mean age 36±9 years(78% female, 22% male). In
asthma group, 53 patients were ucontrolled, 39 patients partly-controlled and 14 patients
controlled. In the asthma and control group 8 % were vitamin D insufficient (20–29 ng/ml) and
92% were vitamin D deficient(0–19 ng/ml). There was no significant difference between vitamin D
concentrations of asthmatic and controls {7,89(CI %95:7,11-8,78)ng/ml;7,93(CI %95: 6,899,14)ng/ml, respectively}. Vitamin D levels were significantly associated with FEV1 (L/sn) and
MMEF(L/sn)(p<0.005,r=0,272;p<0,019,r=0,227). In asthmatcs, vitamin D levels increased
significantly in controlled asthmatics when compared uncontrolled group (p<0,049). Vitamin D
levels were inversely correlated with BMI inasthmatics (p<0,024; r=- 0,220).
CONCLUSION: In this study, we found low vitamin D levels in asthmatics and healthy subjects.
There was a correlation between vitamin D levels and asthma control level and PFT parametres,
these findings suggested that vitamin D replacement may be helpfull in treatment of asthma.
Keywords: Vitamine D, asthma, FEV1, ACT
P067[Asthma and Allergy]
The relationship of asthma with upper respiratory tract infections in young
adults and adolescents
Gulchekhra Tashmetova, Khurshidbek Tashmetov
Ministry of Public Health, Tashkent Institute of Postgraduate Medical Education, Tashkent,
Uzbekistan
Aim. To study the association of asthma with upper respiratory tract (URT) diseases in young
adults
and
adolescents.
Methods. We surveyed 2000 young adults (14-21 years) with standard questionnaire («Burney»,
1995), which was supplemented by questions for the preliminary identification of changes in the
URT.
Also
we
conducted
surveys
of
the lung function (pneumotachography, bodypletismography, provocative and dilated tests).
Results. 170 (8.5%) of 2000 adolescents and young adults showed signs of bronchial obstruction.
Comprehensive survey of these individuals confirmed obstruction in only 148 (7.4%) patients.
Among
those
patients
asthmatic
patients prevailed - 141 (95.2%), bronchoectasis was defined in 5 individuals and viscidosis - in 2.
We identified pathology of URT in 114 (80.8%) patients with BA. These conditions were alone or in
combination: seasonal allergic rhinitis - in 34 (29.8%), year-round allergic rhinitis - in 25 (21.9%),
neurovegetative form of vasomotor rhinitis – in 12 (10.2%), deviated septum with disorder of
nasal breathing - in 20 (17.5%), deviated septum without disorder of nasal breathing - in 15
(13.6%), chronic polyposis sinusitis - in 25 (21.9%), chronic tonsillitis - in 15 patients (13.6%).
Conclusion. The results of the study in young adults has shown existing of URT pathologies in
asthma. This situation indicates the common pathological mechanisms in the genesis and
development of asthma and requires correction therapy in time.
Keywords: Asthma, respiratory disorders, young adults, adolescents
P068[Asthma and Allergy]
The calcium-regulatory system condition at bronchial asthma patients
Inina Liverko, Nataliy Gafner, Vazira Abdullaeva
Republican specialized scientific and practical medical center of phthisiology and pulmonology.
Tashkent.Uzbekistan
Target: To learn the calcium-regulating system condition at bronchial asthma patients (BA).
MATERIALSMETHODS: At 45 BA patients and 15 healthy volunteers a research of total calcium in blood serum
using standard Biolatest «LACHEMA» sets was performed. The calcium-regulating system’s
functional condition with a load of calcium (intravenous 10% CaCl2 solution of 0.1 ml per kg of
body weight studing) test results was evaluated at all points of which (at baseline and after 2
hours)
a
parallel
total
calcium
study
was
conducted.
Results. It was noted, that the common calcareous content in the healthy blood serum varied
within 2.25-2.75 mmol/l. At BA patients with adrenal glands depressed functional reaction
hypercalcemia status was noticed in 36.7%, which among BA patients with adrenal glands’ normal
functional
potentials
was
not
noticed.
Resume: Thus, on the basis of calcium tolerance researches we may conclude, that on early
corticodependence stages the regulation system malfunctions reveal, manifestating in calcium
blocking unit oppression, which is probably for the second time and was caused by glucocorticoid
therapy.
Keywords: bronchial asthma, calcium-regulating system, corticodependence
P069[Asthma and Allergy]
Tracheobronchopathia osteochondroplastica case confused with asthma
Pınar Çimen, Mehmet Ünlü, Yelda Varol, Aysu Ayrancı, Nuran Katgı, Salih Zeki Güçlü
Dr.Suat Seren Chest Diseases and Surgery Education and Training Hospital
Tracheobronchopathia osteochondroplastica (TO) is a rare benign disease with unknown etiology
characterised by multiple osseos and cartilaginous nodules projecting into the lumen of the trachea
and bronchi. 58 year old female patient being treated for asthma for 15 years, she admitted to the
hospital with progressive shortness of breath and cough. Bronchoscopy was performed because of
the ırregularities in the wall of the trachea in the thorax computed tomography. Bronchoscopy
revealed multiple white nodules from vocal cords to the main bronchi and the biopsy was
consistent with TO. TO that makes tracheal irregularities should be considered in the differential
diagnosis of treatment resistant of asthma.
Keywords: Tracheobronchopathia osteochondroplastica, Asthma
P070[Asthma and Allergy]
The prevalence of allergic diseases in patients hyposensitized with
aluminum-containing allergen extracts
1
Tashpulatova Lobar Khalmurzayevna , Saodat Abdullayevna Rustamova
1
2
2
Department of Public Health School, Tashkent Medical Academy, Tashkent, Uzbekistan
Department of Phthisiology, Tashkent Medical Academy, Tashkent, Uzbekistan
MATERIALMETHODS: The development of persistent nodules that cause pain and itching at a vaccination or
hyposensitization injection site is a rare event. Patch tests with standard antigens and aluminum
compounds and histopathologic and ultrastructural studies were performed on 10 patients with
persistent subcutaneous nodules on the upper part of their arms after injection of aluminumadsorbed
dust
and
pollen
extracts.
RESULTS: The nodules appeared 1 month to 6.5 years after injections. The results of patch tests
with 2% aluminum chloride were positive in five patients. Histopathologic examination revealed
two different patterns: some biopsy specimens (from lesions of less than 9 months' duration)
showed a pure foreign body histiocytic reaction characterized by extracellular amorphous dermal
basophilic deposits with a histiocytic-macrophagic reaction; others showed a delayed
hypersensitivity granulomatous reaction in association with an histiocytic foreign body response.
The lesions were characterized by a unifocal or multifocal unencapsulated granulomatous reaction
in the deep dermis and/or subcutaneous tissue. Eosinophilic necrotic areas surrounded by dense
fibrous bands and a massive inflammatory infiltrate were observed. A granular basophilic material
in extracellular spaces and within the cytoplasm of some histiocytes was also noted.
CONCLUSIONS: Persistent subcutaneous nodules that develop after the administration of
aluminum-containing preparations may show two characteristic histopathologic patterns. A pure
histiocytic foreign body reaction was observed in early lesions, and a delayed hypersensitivity
granulomatous reaction was seen in older lesions. No relationship between histopathologic pattern
and patch test results was observed. Aluminum-free preparations should be used in patients in
whom these nodules develop.
Keywords: aluminum, allergen, prevalence
P071[Asthma and Allergy]
Two cases of ABPA diagnosed after long years period
Sibel Boğa, Nagihan Durmuş Koçak, Sinem Güngör, Pakize Sucu, Feyyaz Kabadayı
Süreyyapaşa Chest Diseases And Chest Surgery Training Hospital
Allergic Bronchopulmonary Aspergillosis(ABPA)is a clinical situation which is developed because of
bronchial and paranchimal destructions due to the hypersensitivity reactions against aspergillus
species -colonized in bronchial mucoid plugges.The disease consists of 5 stages and paranchimal
infiltrations in early stages may cause misdiagnosis,also bronchiectasis,fibrosis and depressed TIgE
production due to using high doses of inhaler corticosteroids can obscure the diagnosis in late
stages.That is why we present two cases of ABPA diagnosed after long years.
case 1:64 years old woman had been treated as smear negative lung tuberculosis in 1985.She has
been suffering caugh and dyspnea for years.She had operated because of bronchiectasis in 2000
and than began to use inhaler corticosteroid for asthma.She had been given oral corticosteroids for
rheumatoid artritis in 2009 and was consulted for persistant asthma in 2013.In physical
examination there were rhoncuses bilaterally,reversibility in spirometry and tubular bronchiectasis
in thoracal CT. Prick test and spesific IgE against aspergillus fumigatus were found to be
positive.TIgE level was 195 initially,than began to rise after discontiunation of oral steroids.
According to these criterias the diagnosis was considered as ABPA.
case 2:55 years old woman had been treated as smear negative pulmonary tuberculosis 35 years
before and had hemoptysis in 2008,consulted for persistant asthma in 2013.There were bilaterally
tubulary bronchiectasis in thoracal CT,reversibility in spirometry,high TIgE levels(2760)in plasma,
positive prick test and spesific IgE against aspergillus fumigatus.
Conclusively we propose that ABPA might keep in mind in differential diagnosis of smear negative
tuberculosis and in persistant asthma plus bronchiectatic patients.
Keywords: Allergic bronchopulmonary aspergillosis(ABPA),asthma,bronchiectasis
Figure 1
Thorax computed tomography sections of case 1
Figure 2
Computed tomography section of case 2
P072[Asthma and Allergy]
Phenotypes and features of asthma in our region
Barış Çil, Ayşe Füsun topçu, Abdurrahman Şenyiğit, Cengizhan Sezgi, Emine Önder
Department of Chest Diseases, Dicle University, Diyarbakır, Türkiye
Phenotype of an organism is a feature which results in with interaction of genetical infrastructure
and environmental factors. 169 In/Out patients were admitted in this study with these criteria:
Patients mustn't be under 18 years old. At least one month should pass after the asthma attack. In
our study, the cases were groupped as atopic asthma, non-atopic asthma, cigarette smoker
asthmatic patients, non-smoker asthmatic patients, patients who have normal weight and who are
slim, patients who are overweight and obese. 127 of 169 patients were females, 42 of 169 were
males. The mean age was 39,82. 102 patients (%60,4) were never smoked before and 67 patients
were smoker or ex-smoker (%39,6). 115 (%68,1) patients' body-mass index were >=25 and 54
patients' body-mass index were <25. 28 (16,8%) patients had atopic asthma and 139 patients
(%83,2) had non-atopic asthma. 68 patients (40,23%) were misusing the medication and using
method of medication of 101 patients (59,77%) was correct.
Patients who took the medication irregularly and misuse had lover PFT parameters and their
asthmas were not under control. In the obese asthma patients, rate of female gender was found
higher.
It was observed that the atopic phenotyped patients were younger and had more psychiatric
disorders. For detection of atopia in this phenotype, total IgE levels, positiveness of reversibility
and peripheric eosinophilia may be used as criteria. Most often detected allergen agent was polens
in our region. Besides, history of uptake of psychiatric medications should be investigated in atopic
patients.
Keywords: asthma, phenotype, obese
P073[Asthma and Allergy]
The Difference of FENO Levels According to Gender in Healty Subjects Who
Never Smoked
Mehmet Bayram, Muhammed Emin Akkoyunlu, Hatice Özçelik, Fatmanur Karaköse, Fatih Yakar,
Murat Sezer, Didem Özkan, Levent Kart
Dept. of Chest Diseases, Bezmialem Vakif University, Istanbul, Turkey
INTRODUCTION: Nitric oxide uprgulation occursat central and peripherial airways due to
inflammatory cytokine mediators. Fractioned exhaled nitric oxide increases in asthmatics especially
in eosinophilic inflammation. FENO is affected by height, age, atopi status in healthy subjects. Very
little known with the differences of FENO according to genders And the published data is
controversial. We aimed to investigate whether the FENO levels fifer according to gender in non
atopic, non smoker healthy subjects.
MATERIALMETHOD: Sixty five male and 65 female subjects within 18-65 years old who have never smoked
and have chronc air way disease history or have no atopy or asthma in their family history are
prospective included to the study. FENO test was performed Single Breathe method with 50ml/sec
exhalation flow. Antropometric parameters were measured. Bodypletsymography ve spirometry
were performed.
RESULTS: The distribution of FENO levels and other parameters according to gender is shown
Table-1. FENO, BMI, Body surface area, weight, height, FVC, FEV1, TLC, PEF were significantly
higher in males. Age Gender, body surface were associated with FENO in univariate lineer
regression analysis. In models with multiple linear regression analysis; age, gender and body
surface area were associated with FENO.
CONCLUSION: The difference between males and females should be kept in mind when evaluating
the fractioned exhaled nitric oxide levels.
Keywords: asthma, atopy, nitric oxide
The distribution of age antropometric, spirometric parameters and FENO levels according
to gender
Male
n=65
Female
n=65
p
Age
30(27-38)
31(25-35)
0.042
Heigh,t cm
176(171-179)
162(158-167)
<0.001
Weight, kg
83(70-89)
64(54-69)
<0.001
BMI
26(23-27)
23(20-27)
0.009
Body Surface Area m2 2,01(1,81-2,10) 1.68(1,55-179) <0.001
FVC lt measured
5,4(5-5.8)
3,76(3,2-4,11) <0.001
FVC predicted %
105(97-118)
106(96,5-121)
0.55
FEV1 lt measured
4,4(4,1-48)
3,1(2,8-3,3)
<0.001
FEV1 predicted %
106(100-110)
107(93-115)
0.819
FEV1/FVC
84(78-86)
82(80-87)
0.042
PEF measured
8,9(8,1-10,5)
6,2(5,2-7,2)
<0.001
PEF predicted %’si
90(83-109)
94(81-102)
0.509
TLC measured
6,3(5,6-6,7)
4,5(4,3-4,8)
<0.001
TLC predicted %
89(82-95)
91(87-104)
0.20
VC measured
5,4(5,1-5,9)
3,76(3,2-4,1)
<0.001
VC predicted %’si
101(95-113)
112(99-126)
0.03
feNO ppb
21(14-28)
14(10-21)
0.001
Table-2 Linear regression analysis for possibly associated with FENO
Log(FENO)
Parameter
Coefficient Standart Error p value
Univariate analysis
Age
0.014
0.006
.03
Gender
0.274
0.09
.00
Body surface area
0.479
0.209
.024
Total lung capacity 0.083
0.062
.185
FEV1 measured
0.075
0.067
0.27
-2,24
1,21
0.067
Body surface area
0.175
0.251
0.487
Age
0.009
0.007
0.216
-2,44
0,091
0.008
0.01
0,06
0.92
-2,29
0.121
0.062
0,216
0,249
0,387
0.009
0.007
0.129
0.43
0,212
0,046
Multivariate linear regression
Gender
Model-1
Multivariate linear regression
Gender
Model-2
Age
Multivariate linear regression
Gender
Model-3
Body surface area
Multivariate linear regression
Age
Model-4
Body surface area
P074[Asthma and Allergy]
Retrospective Analysis of Omalizumab in Patients with Severe Allergic
Asthma
Fatma Merve Tepetam1, Nezihe Çiftaslan Gökşenoğlu2, Özlem Oruç2
1
Clinic of Allergy Diseases, Sureyyapasa Chest Diseases and Chest Surgery Training and Research
Hospital, Istanbul, Turkey
2
Clinic of Chest and Allergy Diseases, Sureyyapasa Chest Diseases and Chest Surgery Training and
Research Hospital, Istanbul, Turkey
BACKGROUND:
Omalizumab is a monoclonal antibody that binds and inhibits free serum immunoglobulin E (IgE). It
is called an 'anti-IgE' drug. Omalizumab is indicated for patients with moderate-to-severe allergic
asthma with inadequately controlled symptoms.
OBJECTIVE:
We evaluated the efficacy and safety profile of omalizumab treatment.
METHODS:
Asthmatic patients treated with omalizumab, were evaluated retrospectively. Age, sex, weight, IgE
level, concomitant asthma medications, change in FEV1, emergency department visits,
hospitalizations, asthma exacerbations and corticosteroids bursts were recorded before and after
omalizumab initiation.
RESULTS:
A total of 17 patients, female:11(%64), male:6 (%36),mean age: 47,58 years formed the study
population. Mean IgE was 359,23 UI/ml. No adverse events were observed but tretment were
stopped in only one patient becaue of no response to Omalizumab treatment.
CONCLUSİON:
Omalizumab was effective in reducing asthma exacerbations and hospitalisations as an adjunctive
therapy to inhaled steroids
Keywords: Omalizumab, severe asthma, treatment
P075[Asthma and Allergy]
Therapeutic Strategies with Anti-IgE (Omalizumab)
1
2
3
Arzu Didem Yalcin , Betul Celik , Ayse Akman Karakas
1
Genomics Research Center,Internal Medicine, Allergy and Clinical Immunology, Academia Sinica,
11529, Taipei, Taiwan.
2
3
Department of Laboratory Medicine and Pathology, Mayo Clinic in Jacksonville, FL, USA.
Department of Dermatology and Venerology, Akdeniz Universiy, Faculty of Medicine, Antalya,
Turkey.
Omalizumab, a humanized mAb that binds to the CH3 domain, near the binding site for the highaffinity type-I IgE Fc receptors of human IgE, can neutralize free IgE and inhibit the IgE allergic
pathway
without
sensitizing
mast
cell
and
basophils.
We reported that Omalizumab in patients with severe persistent asthma(SPA) was an effective
therapy for asthma and co-morbid conditions (chronic urticaria(CU), bee venom allergy,latex
allergy,bullous pemphigoid, atopic dermatitis, food allergy, Samters syndrome, diabetes mellitus,
cardiovascular conditions).Our knowledge concerning the use of Omalizumab in treatment of
asthma and other allergic diseases has improved our understanding that treatment acts on many
levels, including regulating levels of inflammatory proteins including cytokines(MDA, NO, H2O2,
CXCL8, IL-10, TGF-β, GCSF, IL-17, IL-1β), PT, PTT, INR, MPV, platelet count, Hs-CRP, eosinophil
cationic peptide, vitamin-D(25(OH)D), homocystein(Hcy), OX-2, d- dimer, albumin and sApo-2L.
The decrease in Hcy concentrations and increase in 25(OH)D also support the possible vascular
endothelial
protection
mechanism.
Mediators and cells classically involved in pro-coagulant and anticoagulant pathways altogether
play
a
role
in
SPA
and
CU
pathophysiology
and
Omalizumab
effect
Since Omalizumab therapy lowers the serum levels of soluble TRAIL, and soluble TRAIL was found
to be correlated with survival in Stage 4 colon cancers, we don’t propose Omalizumab therapy for
the asthmatic patients with advanced colon cancer. The mechanism of action of Omalizumab in the
treatment of asthma is believed to be multifactorial, and includes effects mediated through altered
production of redox metabolites, TRAIL-related miRNA, and regulation of production of known
inflammatory proteins.
Keywords: Asthma, Anti-IgE, Omalizumab, chronic urticaria, inflammatory proteins.
P076[Asthma and Allergy]
The phenotype of the bronchial obstructive diseases in children
Svetlana Sciuca, Rodica Selevestru, Ianos Adam, Liuba Neamtu
State Medical and Pharmaceutical University
Aim.
Study
the
phenotype
of
the
bronchial
obstructive
diseases
in
children.
Materials and methods. The study foresees a retrospective research on 1294 children with the
bronchial obstructive diseases: 592 children with bronchial obstructive syndromes (45,8%:95%CI
43,0-48,5)
and
701
children
without
wheezing
(54,2%:95%CI
51,5-57).
RESULTS: The wheezing in infants is mainly induced by the viral and atypical infection and onethird of cases had a personal history of confirmed asthma. In 3-5-year-old children the wheezing is
confirmed 3 times less often than in infants, possibly at this age the frequency of the transient
wheezing regresses. The phenotype of wheezing in the young schoolchildren is maintained by the
personal, family history frequently encountered, by the mechanisms with high IgE. Teenagers
manifest the phenotype most frequently associated with atopic reactions. The obstructive
syndrome is the most frequently confirmed in infants and 3-5-year-old children in 65,4% and
21,5% cases, respectively. The study found increased serum levels of IgE in children with bronchial
disease (90.6±23.5IU/ml) compared with control group (12.9±77.6IU/ml,p<0.01). The range of
values the IgE in children with wheezing ranged from 0.1IU/ml to 534.8IU/ml. In the group of
children without wheezing IgE is of 0.1IU/ml to 88.3IU/ml. Hyper-IgE confirms the role of this
marker
in
atopic
status
in
children
with
bronchial
obstruction
diseases.
CONCLUSION: The phenotype of the transient whezing is the most often encountered in young
age (newborn, infants, preschool child, young schoolchild), but the allergic mechanisms (by the
allergic family history, confirmed bronchial asthma, mediated IgE mechanisms) were assessed in
schoolchildren and teenagers.
Keywords: bronchial obstructive diseases, wheezing, asthma, phenotype, children
P077[Asthma and Allergy]
Characteristics of Patients With Asthma Attack Followed in the Intensive
Care Unit
Selen Uslu1, Gül Karakaya2, Ali Fuat Kalyoncu2, Ahmet Uğur Demir2, Serpil Öcal3, Ebru Ortac
Ersoy3, Arzu Topeli3
1
Ordu University Ministry of Health Education and Research Hospital, Department of Chest
Diseases, Ordu
2
Department of Chest Diseases and Allergy, Hacettepe University Faculty of Medicine, Ankara,
Turkey
3
Medical Intensive Care Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
Asthma attack is a serious reason for morbidity and mortality when it is not treated effectively at
the right time. The data about efficiency of noninvasive mechanical ventilation in respiratory
insufficiency due to asthma attack are scant. In this study we investigated if there is a relation
between age, sex, comorbidities, asthma duration, asthma treatment, compliance to this
treatment, NIV/IMV treatment efficiency if performed and its relation with severity of asthma
attack, length of hospital stay and mortality. In this study we investigated the characteristics of
patients with severe asthma who were treated in Hacettepe University Medical Intensive Care
Unit(ICU) between January 2002 and December 2012 by reviewing the patients’records
retrospectively. A total of 22 patients were included in this study. Besides medical treatment,
noninvasive positive pressure ventilation (NPPV) was provided to 8 (36.6%), invasive mechanical
ventilation was to 5 (22.7%) and both were provided to 5 (22.7%) patients. Four (18.1%) patients
died in the ICU. In conclusion, we did not observe any relation between these parametres and
length of hospital stay and mortality. Only the first and the difference of PaCO2, pH and HCO3¯
changes were significant which shows the correct and effective use of NIV/IMV. There was no
relation between these and mortality which revealed that the reasons of death of the patients were
not respiratory, but rather infection or comorbidity.
Keywords: asthma, severe asthma, intensive care unit
Table 1: Characteristics of Alive and Dead Patients
Alive (n=18)
Dead (n=4)
Median
25-75 Percentile Median
25-75 Percentile
Age (year)
83.5
(62.7- 78.2)
83.5
(62.0- 88.2)
Hospital Stay (day)
13
(8.2- 27.2)
17
(11.0- 21.5)
APACHE II score (n=20) 14.5
(7.25- 18.75)
14
(10.5- 17.5)
pH (n=20)
7.35
(7.27- 7.40)
7.37
(7.28- 7.38)
pO2 (mmHg) (n=20)
62.5
(54.5- 84.2)
62.5
(55.2- 102.0)
pCO2 (mmHg) (n=20)
48.5
(36.7- 71.2)
60.5
(32.2- 82.7)
HCO3 (mmol/L) (n=20) 25.5
(22.0-31.0)
29.0
(14.5-33.0)
SaO2 (%) (n=20)
(80.5-95.7)
94.0
(91.2- 96.7)
90.5
P078[Asthma and Allergy]
Cost of asthma patients hospitalized in a state hospital
Jülide Çeldir Emre1, Özer Özdemir2, Ayşegül Baysak3, Ümit Aksoy1, Pelin Özdemir4, Adnan Tolga
Öz3, Nigar Dirican5
1
Turgutlu State Hospital, Department of Chest Diseases, Manisa
2
Egepol Hospital, Department of Chest Diseases, İzmir
3
Medical Park University, Department of Chest Diseases, İzmir
4
Su Hospital, Department of Chest Diseases, İzmir
5
Süleyman Demirel University Faculty of Medicine, Department of Chest Diseases, Isparta
PURPOSE: It was aimed to evaluate direct cost of patients with asthma hospitalized in a state
hospital, according to presence of comorbidities, age groups and severity pd asthma attack.
METHODS-MATERIALS: Patients that are hospitalized due to asthma attack in 2013 was included in
the study. Patient records and cost data was analysed retrospectively.
RESULTS: 144 patients were included in the study. %86,8 (n=125) of patients were female.
Average age was 60,9 (16 -101) and %45,8 of patients were over 65 years. Patient characteristics
are seen in Table 1.
Mean length of hospital stay was 8,5 ± 4,6 days, and total cost was 923,8 ± 562,2 TL on average.
Total cost tend to increase with increasing age, but it was not statistically significant (p=0,054).
Total cost and length of hospital stay was not different between two sexes. (p=0,94 and p=0,74).
Presence of comorbidities did not cause any differences of total cost and length of hospital stay
(p=0,44 and p=0,15); but total laboratory costs and antibiotic costs was higher in patients with at
least one comorbidity (p=0.025 and p=0,03). Length of hospital stay and total cost increased with
more severe asthma attacks (p< 0,001).
CONCLUSION: The cost of hospitalizations due to asthma attack is about ten times higher than
cost of ICS-LABA monthly treatment. Total cost was independent of sex, age and presence of
comorbidities, but directly proportionate to severity of asthma attack.
Keywords: asthma, cost, length of hospital stay
Patient characteristics
Sex, %
Female
86,8 (n=125)
Male
13,2 (n=19)
Age, mean
60,9 ± 17,1
Patients over 65, %
45,8 (n= 66)
Smoking history, %
Never smoked
81,3 (n=117)
Smoker
11,8 (n=17)
Quit smoking
6,9 (n=10)
Comorbidities, %
None
34,7 (n=50)
1
42,4 (n=61)
2
21,5 (n=31)
>2
1,4 (n=2)
Severity of asthma attack
1
35,4 (n=51)
2
37,5 (n=54)
3
27,1 (n=39)
P079[Asthma and Allergy]
The Number of expective asthma and COPD patients according to the cities
Sedat Altın1, Arzu Yorgancıoğlu2, Lütfiye Erkan1
1
Yedikule Chest Diseases and Chest Surgery Education and Research Hospital
2
Celal Bayar University Medical Faculty Pulmonology Department
AIM: To estimate the number of asthma and COPD patients in our country, benefiting from chronic
respiratory system diseases study of GARD
Material &
METHOD: In 2012, throughout Turkey using prevalance study in 3815 patients and TUİK data
calculations were made. Additionally, comparison was made with SGK records in 2011.
FINDINGS: According to the calculations in 2011, we concluded that 1.692.277 COPD and
2.655.158 asthma patients in our country. 789.604 of COPD and 1.652.124 of asthma patients
were regularly on medication. Totally, 4.347.434 patients had asthma and COPD diagnosed and
2.441.728 had compliance to medicine.
CONCLUSION: It was found significantly high asthma prevalance in East Blacksea region and
COPD prevalance in West Blacksea region. On the other side, asthma patients in Mediterranean
region, COPD patients in Central Anatolia had used inhaler therapy more than the other regions.
Keywords: prevalance, asthma, COPD
P080[Asthma and Allergy]
Cukurova University Hospital Chest Diseases Clinic Balcalı asthmatic
patients Tagged Determination of Levels of Anxiety and Depression
Hayriye Turgut1, Yasemin Akıl2, Refiye Özgen2, Soner Çakmak3, Zeynep Albayrak2, Müjgan İpek
Bozkurt1
1
Universty of Cukurova Balcalı Hospital, The Department of Chest Diseas
2
Universty of Cukurova Balcalı Hospital, The Bourd of Nursing Research
3
Universty of Cukurova Balcalı Hospital, The Department of Psychiatry
PURPOSE: The purpose of this study, pulmonary diseases and asthma admitted to the clinic on
patients with depression and anxiety was conducted to determine the frequency of cases.
MaterialMETHOD: It is a prospective study. Chest Diseases clinic or outpatient clinic for patients with
asthma, with demographic questionnaire consisting of questions,'' Trait Anxiety Inventory, Beck
Depression Inventory'' applied. Scale data and the results were compared statistically with SPSS 16
program.
Finding: Research participants were, mean age 49.9 ± 14.6 years of gender, 97.1% males.
Average of 20.2 ± 10.6 Beck depression scale. Average of 49.6 ± 11.7 STAI trait anxiety scale.
Advanced age and literacy beck depression in patients without (p = 0.003) and trait anxiety scale
(p = 0.006) scores are increasing. Was statistically significant. Between trait anxiety scale, Beck
depression with a very strong correlation was detected in the positive direction (r=0,608,
p=0,0001).
CONCLUSION: Advanced age and literacy beck depression in patients without and trait anxiety
scale scores are increasing. The longer the depression is increasing in trait anxiety scores.
Keywords: asthma, Depresion, Anxiety
P081[Asthma and Allergy]
University of Cukurova Balcalı Hospital Chest Diseases Polyclinic Follow in
the retrospective evaluation of patients with asthma
Hayriye Turgut1, Yasemin Akıl2, Refiye Özgen2, Zeynep Albayrak2
1
Universty of Cukurova Balcalı Hastanesi The Department of Chest Diseas, Adana
2
Universty of Cukurova Balcalı Hastanesi The Bourd of Nursing Resarch
PURPOSE: Cukurova University Balcalı Hospital Chest Diseases Polyclinic in asthmatic patients who
were followed up for 5 years of follow-up was to evaluate retrospectively.
MaterialMETHOD: January 2007 - December 2012 year of asthmatic patients hospitalized between data
files examined were age, sex, marital status, occupation, education level, place of residence,
smoking history, and comorbidities were statistically compared.
Finding: The average age of the participants of the patients 49.9 ± 14.6 years, 97.1% were
female.76.5% no smoking, 76.5% had a history of allergies, 52.9 'Deliver dust, smoke, odor, and
has been found to be allergic to pollen.
CONCLUSION: The average age of our patients was higher in women, housewives and those living
in cities has been found that the incidence is high.
Keywords: Asthma, Simoking, Allergy
P082[Occupational and Enviromental Diseases]
Loffler syndrome: Case report
Selami Ekin1, Hülya Günbatar1, Ahmet Arısoy2, Hanifi Yıldız3, Bünyamin Sertoğullarından1
1
Department of Pulmonary Medicine, Yuzuncu Yil University, Van, Turkey
2
Department of Pulmonary Medicine, Private Istanbul Hospital, Van, Turkey
3
Department of Pulmonary Medicine, Private Lokman Hekim Hospital, Van, Turkey
Löffler's syndrome is an acute pneumonia exact cause unknown. Interference in the etiology of
Löffler's syndrome parasitic, fungal, bacterial infections and drug effects to participate in the onequarter of patients with idiopathic. 17 year old male patient. The effort for a week shortness of
breath, chest pain, cough, abdominal pain and was admitted with fever. On physical examination,
body temperature 37.8 ℃, the arterial blood pressure was 128/83 mmHg, pulse rate 94/dk, and
room air oxygen saturation was 92%. Ronchi expiratuvar had bilateral auscultation. 4 pack / year
history of smoking and had quit smoking for 1 year. Alcohol and substance abuse and other drug
did not. The patient was a shepherd profession. Laboratory slightly elevated C-reactive protein,
21.5% eosinophilia and elevated total IgE (263 mg / dl) were detected. To be more common on
the right chest roentgenogram demonstrated bilateral patchy consolidation of more centrally
located and upper zones. Thoracic computed tomography contrast is taken to be significantly
scattered bilateral pulmonary upper lobe tumors, irregular areas of ground glass, and millimeter
focal opacities sentrinodüler limited subpleural nodules were found. Echocardiography was normal.
Oxygen saturation was 90% on room air. Bronchoscopy with bronchoalveolar lavage cell count less
than the patients with acute inflammatory cells, which 90% of eosinophil leukocytes and 10% were
reported as neutrophil leukocytes. In addition to symptomatic treatment initiated albendazole (400
mg / day, single dose) in the treatment of clinical dramatically improved.
Keywords: Loffler syndrome, eosinophilia
P083[Occupational and Enviromental Diseases]
The Factors Affecting the Treatment of Hydrocarbon Pneumonia with a Case
Hanifi Yıldız1, Selami Ekin2, Selvi Aşker2, Ahmet Arısoy3, Bünyamin Sertoğullarından2
1
Department of Chest Disease,Private Lokman Hekim Hospital, Van, Türkey
2
Department of Chest Disease, YYÜ Universitiy, Van, Türkey
3
Department of Chest Disease, Private İstanbul Hospital, Van, Turkey
AİM: Hydrocarbon pneumonia is rare aspiration pneumonia caused by accidentally aspiration of
hydrocarbon products such as diesel and gasoline and can develop serious complications. In this
case, we emphasized that early steroid and antibiotic treatment can prevent serious complications
of hydrocarbon pneumonia.
CASE: A 17-year-old male patient who accidentally aspired a small amount of diesel, admitted to
our emergency department with fever, cough, sputum, chest-pain and dispnea. The chest-X-ray
demonstrated ground-glass opacity at the middle and lower zones (Figure 1A). Oxygen, antibiotics
and steroid was given patient who had elevated CRP and leucocytes levels. On second day
symptoms and third day infiltrates reduced patient was discharged with maintenance therapy.
Seventeenth day, the reduction was observed in the opacity on chest-X-ray (Figure 1B).
Additionally, computed tomography showed ground-glass infiltrates in middle lobes (Figure 2A). In
Addition, an increase was observed in CRP and leucocytes levels and the antibiotic treatment was
given for two weeks. In second month, computed tomography evaluated as normal (Figure 2B).
CONCLUSION: In conclusions, the early treatment with steroid and antibiotic can prevent serious
complication of hydrocarbon pneumonia.
Keywords: Aspiration, hydrocarbons, pneumonia
Figure-1
Radiography:The reductions were observed in the ground-glass infiltrates detected on the middle and lower
zones. A: the first day, B: 17.Day
Figure-2
Toraks tomography: A ground-glass infiltrates observed in the middle and lower lobe on the seventeenth day.
B: İnfiltrates improved on the second month.
P084[Occupational and Enviromental Diseases]
Evaluation of Pulmonary Function Tests in Working Firemen
Sema Demir1, Derya Öztuna2
1
Ankara Numune Training and Research Hospital, Department of Pulmonary Diseases, Ankara,
Turkey
2
Ankara University Faculty of Medicine, Department of Biostatistics, Ankara, Turkey
BACKGROUND: Firemen are exposed to fire smoke. Fire smoke contains air pollutants. Smoke
exposure may increase the risk of pulmonary and cardiovascular diseases. The aim of this study
was to evaluate the effect of long term occupational smoke inhalation on respiratory functions and
related risk factors in working firemen.
METHODS: Between February 2012 and March 2012, 523 working firemen were retrospectively
evaluated within the scope of a screening program at our center. The study included 250 firemen
actively participating in a fire, and a control group of 273 firemen working in office. Detailed
evaluation of the firemen including age, gender, height, weight, spirometric measurements,
smoking status and duration, duration of work and comorbidities.
RESULTS: According to the results obtained from the study, FEV1 values were significantly
decreased in firemen actively pariticipating in firefight compared to the control group. The duration
of the study did not significantly affect pulmonary functions.
CONCLUSIONS: Development of diseases related to exposure to smoke may be prevented by the
development of more effective apparatus protecting from smoke, working in cycles in different fire
types, quiting of smoking and regular annual screenings.
Keywords: Firemen, pulmonary functions
P085[Occupational and Enviromental Diseases]
A recently defined occupation in silicosis: case report
Arif Hikmet Çımrın, Kemal Can Tertemiz, Aylin Özgen Alpaydın
Dokuz Eylul University School of Medicine, Pulmonary Medicine
Silicosis is a pneumoconiosis which develops with inhalation of silica particles (0,5-5 µm diameter).
Main occupational areas related with silicosis are smeltery, glassblowing, ceramic handwork, quartz
mills, and sandblasting. Sandblasting might be performed in different sectors. We present a case
who does sandblasting in a factory manufacturing guns.
A thirty-three year old male patient admitted to our occupational disease outpatient clinic with new
onset (2 months) dyspnea and chronic chough. He defined nothing in his medical history. Physical
examination was normal. Thorax CT revealed conglomerated milimetric opacities in upper and
middle zones of lungs, interstitial thickening, pleural retractions, parenchymal bands and
peribronchial thickenings His spirometric evaluation was as follows: FEV1 4.03 L (91% pred), FVC
4.03 L(90% pred), PEF 12.23 (123 % pred bek.), DLco /VA 5.06 (105 % pred), VO2 max. 41.01
ml/min/kg.
As a result, the case was diagnosed as pneumoconiosis (silicosis) due to sandblasting in a weapon
manufacturing factory. Although he defined dsypnea on exercise, there was no serious pulmonary
functional impairment. He was recommended to stop silica exposure and he is being followed up.
Keywords: Silicosis, sandblasting, cough
P086[Occupational and Enviromental Diseases]
Epidemiology of sarcoidosis in Republic of Belarus
Halina Baradzina
Belorussian State Medical University, Minsk, Belarus
This study objectives were analysis of sarcoidosis epidemiological indexes in 1977-2012 and
prognosis of the future epidemiological situation. Our results showed the incidence rate of
sarcoidosis increased 6.15 times from 1977 to 2012 and stabilized on 8.0 per 100000 (p<0.001).
The incidence rate growth occurred in 80-90s mostly due to diagnostic improvement. According to
prognosis, which has been calculated based on the equalization linear trend (у=0.3352х-666.15,
R2- 0.9466), incidence rate of sarcoidosis will be 9.6 per 100000 in 2017. Pulmonary sarcoidosis
composes
the
main
part
all
the
cases
(91.03%).
In 80-90s sarcoidosis was affecting mostly male (53%) and population around 25 years old (83.6
% patients were before 40 years), but now the situation has been changed. Males traditionally
prevail among newly detected patients in the age group below 34 (64.3±4.7%), females dominate
in total (59.8%) and in the age group above 35 (75.±4.2%). The maximum incidence rate among
males is observed in 25-34 years group (40.7±3.1% patients), though the incidence maximum by
women has moved to the range 35-44 years (30.3±2.4% patients). Percentage of the women
above 44 years affected by sarcoidosis has increased by 26.8±1.6% and the average age of
patients is slowly increasing especially by women. In 80-90s the patients above 44 were almost
never diagnosed. Prevalence rate of sarcoidosis in Belarus reached 49.1 per 100000 compare to
28.7
per
100000
in
1997
(p<0.001).
The results of analysis testify the increase of incidence rate of sarcoidosis and its transition to the
older age groups especially by women.
Keywords: sarcoidosis, epidemiology, prognosis, incidence rate.
P087[Occupational and Enviromental Diseases]
Do Meterological Alterations Cause Pneumothorax?
Atalay Şahin1, Menduh Oruç1, Fatih Meteroğlu1, Ahmet Erbey1, Bülent Öztürk2
1
Department of Thoracic Surgery, Dicle University, Diyarbakir, Turkey
2
Diyarbakır Educational and Teaching Hospital,Thoracic Surgery, Diyarbakır
The impacts of climatic changes on the occurrence of some diseases remains controversial. The
role of this relationship takes more attention for respiratory disorders.
Between January 2009 and Decembre 2013, we retrospectively evaluated the patients with primary
and secondary spontaneous pneumothorax those treated in thoracic surgery clinics in our province.
Characteristics of the patients and meteorological changes within this duration were studied.
Atmospheric pressure, temperature, humidity,rainfall and wind speed were provided from General
Directorate of Meteorology. Days with spontaneous pneumothorax and days without it were
evaluated regarding climatic alterations. Secondary pneumothorax was excluded in the study.
Clinical features of the patients and the role of meteorological changes in the occurence of
spontaneous pneumothorax were defined.
The mean age of 552 patients was 23.96 years, 92% of them were male. Primary spontaneous
pneumothorax was seen 89% of patients and secondary spontaneous pneumothorax was seen in
the remaining patients. Pneumothorax clusters were in 71.7% of cases. Significant difference was
not observed in the seasonal and annual distrubition of the disease. Age and gender made
difference. Differentiation was seen between days with pneumothorax and days without it in
atmospheric pressure, temperature, wind speed and humidity(p<0.05). Rainfall and difference in
minimum and maximum pressures did not made significance in days with pneumothorax
(p>=0.05).
Meteorological alterations change physical properties of the air and affect the occurence of
spontaneous pneumothorax.
Keywords: climate, spontaneous, pneumothorax
P088[Occupational and Enviromental Diseases]
Respiratory Effects of Tear Gas in Smokers
Eda Uslu1, Gülcihan Özkan1, Çağla Filiz Uyanusta Küçük2, Hilal Onaran1, Çağla Pınar Taştan
Uzunmehmetoğlu1, Aslıhan Ilgaz2, Gamze Ayar1, Makbule Özlem Akbay1, Hikmet Fırat2, Tansu
Ulukavak Çiftçi2, Serdar Akpınar2, Bülent Çiftçi2, Selma Fırat Güven2, Selen Bilekli2, Arif
Müezzinoğlu2, Fatih Torlak4, Peri Arbak3, Elif Dağlı1
1
Turkish Thoracic Society İstanbul Branch
2
Turkish Thoracic Society Ankara Branch
3
Turkish Thoracic Society West Black Sea Branch
4
Marmara University Medical School Epidemiology Department
The respiratory effects of tear gas on smokers has not been reported
despite its wide use for crowd control.
The aim of this study is to investigate the tear gas on respiratory system among smokers.
A questionnaire survey and lung function measurements were
performed among 460 individuals from Istanbul and 86 individuals from
Ankara during June 2013 demonstrations in Turkey.
62.6 % of the study population were smokers, 7.9% ex-smokers
and 28.6% nonsmokers. The frequency of chest tightness and
breathlessness were similar among smokers and non-smokers. (73.3% vs
70.7%) (p=0.786). The symptoms of cough and sputum production was less
frequent in non-smokers (75.0 % vs 30.9 %) (p=0.019 ), as well as
chest pain (49.8% vs 39.0% ) (p=0.095). Smokers had lower FEV1 than
smokers and ex-smokers. (96.8% vs 102.9% and 101.2 % respectively
p=0.301). All groups had similar FEV1/FVC (102.2%, 102.4 % and 104.1
% p=0.516). Non-smokers had shorter lag-time for breathlessness after
exposure than smokers and ex-smokers (2.9h vs 6.0h and 7.5h, p=0.193) as
well as chest pain (12.9h vs 13.9h and 29.6h, p=0.123).
Non-smokers had a very abrupt respiratory reaction to tear gas.
However smokers showed more frequent respiratory morbidity
Keywords: Smoking, Tear gas, respiratory findings
P089[Occupational and Enviromental Diseases]
Gender Differences İn Respiratory Findings Of İndividuals Exposed To Tear
Gas
Eda Uslu1, Gülcihan Özkan1, Çağla Filiz Uyanusta Küçük2, Hilal Onaran1, Çağla Pınar Taştan
Uzunmehmetoğlu1, Aslıhan Ilgaz2, Gamze Ayar1, Makbule Özlem Akbay1, Hikmet Fırat2, Tansu
Ulukavak Çiftçi2, Serdar Akpınar2, Bülent Çiftçi2, Selma Fırat Güven2, Selen Bilekli2, Arif
Müezzinoğlu2, Peri Arbak3, Elif Dağlı1
1
Turkish Thoracic Society İstanbul Branch
2
Turkish Thoracic Society Ankara Branch
3
Turkish Thoracic Society West Black Sea Branch
Information on the effects of tear gas on different genders is not adequate.
This study was carried out to investigate the respiratory complaints and lung functions in women
and men exposed to tear gas.
During the June 2013 public demonstrations questionnaire survey was performed and lung function
measuremenst were done in 460 demonstrators from Istanbul and 86 from Ankara.
283 males (age:31.2±11.1) and 262 females (aged:31.2±9.9) participated in the study. Smoking
rates were found to be 62.3% in females, and 64.1% among males. Females exposed to gas
indoors were significantly higher than males 31.5% vs 20.4% p=0.015). Among females,
compared to males chest tightness (79.4% vs 66.3%, p=0.001), cough (87.3% vs 77.8%,
p=0.003), chest pain (51.7% vs 41.8%), nasal discharge (78.8% vs 70.3%, p=0.016) and skin
irritation (54.2% vs 40.8%, p=0.002) were significantly more frequent. Duration of symptoms in
males compared to females such as chest tightness (4.9 hrs vs 5.6 hrs), cough (6.0 hrs vs 7.0
hrs), sputum production (18.2 hrs vs 23.7 hrs) were significantly shorter (p değerleri >0.05). Lung
function measurements showed % of FVC 99.0% in females and 98.5% males (p>0.05); FEV1
96.0% in females and 101.5% in males (p>0.05). FEV1/FVC were similar in both genders (102.4%
vs 102.3%). However MMFR values in females were significantly lower than males (89.8% vs
97.4% p=0.005).
Higher rates of respiratory symptoms and lower small airway funcitons in females may be due to
exposure indoors. Neverthless the possibility of gender response variability must be researched.
Keywords: gender, tear gas, respiratory findings
P090[Occupational and Enviromental Diseases]
Respiratory Effects Of Tear Gas Exposure On Innocent By-Standers
Eda Uslu1, Gülcihan Özkan1, Fatih Torlak3, Peri Arbak2, Elif Dağlı1
1
Turkish Thoracic Society İstanbul Branch
2
Turkish Thoracic Society West Black Sea Branch
3
Marmara Medikal School Epidemiology Department
Tear gas is used as crowd control agent as direct exposure causes immediate reaction on targeted
person. There is little information about the health effects of environmental exposure of the
residents at the site.
The study aims to investigate the effect of tear gas on the residents neighboring the demonstration
site who have been involuntarily exposed.
The respiratory symptoms and lung functions of 105 volunteers, who lived close to Taksim Gezi
Park where protests took place in June 2013, were investigated.
The average age of the subjects was 36 years and 51 % was female, 70% smokers, 28 % had a
chronic disease and 31% complained breathlessness after the gas exposure. 30% was exposed to
gas outdoors in a distance less than 1m, 38% indoors. Breathlessness were reported by 76%,
cough 89%, sputum 44%, chest pain 41%, bloody sputum 4%, nasal discharge 76%, eye redness
84%, skin irritation 46%. Cough symptom was significantly higher in the ones who were exposed
to the gas indoors. (95%vs 74% p=0,007). Sputum production was a more common complaint
with indoor exposure compared with outdoor distant exposure ( 50%vs18% P=0,002).
MMFR were found less than 65% predicted in 19% of the subjects showing isolated small airway
obstruction.
The results of the study has shown that tear gas has environmental health effects on innocent bystanders. Repeated use of tear gas during a protest with a long duration may harm respiratory
health of the residents and should be banned like tobacco smoke.
Keywords: tear gas, crowd control, respiratory symptom durations
P091[Occupational and Enviromental Diseases]
Pulmonary embolism and effects of atmospheric events
Tuğba Göktalay1, Ayşın Şakar Coşkun1, Yavuz Havlucu1, Ayşe Nur Tuncal2, Pınar Çelik1, Arzu
Yorgancıoğlu1
1
Celal Bayar University Medical Faculty, Department of Pulmonology, Manisa, Turkey
2
Directorate of Public Health, Chronic Disease Unit, Manisa
AIM: In this study, it was aimed to investigate to relationship between pulmonary embolism and
atmospheric events.
MATERIALMETHODS: Data of the 168 cases that were diagnosed as pulmonary embolism between 20072012 in our clinic were evaluated. Demographic features and risk factors were determined.
Hospital admissions day, average pressure (hPa), the average humidity (%), average temperature
(○ C) were recorded. Analyses were performed according to daily, monthly and seasonal admission.
RESULTS: Ninety three of 168 patients were male. Mean age was 59,58 ±16,4. DVT was the most
commonly identified risk factor (n = 38, 22.6%). 72 (42.9%) patients had a history of smoking.
132 cases (78.6%) had been diagnosed with thoracic CT Angio. Most patients were from the center
of Manisa and nearest settlement. Pulmonary embolism were most commonly occurred in the
winter and summer season (both 50 cases). In 161 patients (86.6%) monthly average atmospheric
pressure more than atmospheric pressure of the hospital admission was higher. There were no
case correlations with days, months, season and pressure, temperature, or humidity (p>0.05).
RESULTS: The data were showed no atmospheric influences in the development of pulmonary
embolism. In this regard we believe that there is a need for further evaluation.
Keywords: Pulmonary embolism, atmospheric effects
P092[Occupational and Enviromental Diseases]
A chlorine gas explosion (industrial accident) - Disability
Gülseren Sağcan, Kaan Gündüz, Hızır Aslıyüksek
The Council of Forensic Medicine, Istanbul
Chlorine is a highly reactive gas which is commonly found in industrial, environmental and
domestic environments. It causes inflammation in upper and lower respiratory tract because of its
moderate solubility in water. In acute exposure; cough, dyspnea, conjunctivitis, dermal irritation
and wheezing are common symptoms.
A male patient who had an history of industrial accident five years earlier, applied to the Council of
Forensic Medicine (CFM) to be evaluated for disability. A chlorine gas explosion which occurred
while chlorine tablets were being prepared for pool cleaning and caused burns in his neck and face,
dyspnea and conjuctivital irritations. Physical examination has shown that his general condition was
moderate, RR:26/min with accessory inspiration muscles aiding respiration, bilateral wheezing.
Chest x-ray showed ground glass opacities in the left middle zone. In his follow-ups, there were no
pathological signs in chest CT, Sp02: 99%, RR:24/min. When the obstruction improved, steroid
treatment was stopped.
Physical examination at CFM showed a history of childhood pulmonary infection and
cigarette:10p/years. He didn’t have any respiratory symptoms, oscultation were normal, Sp02:
99%, RR:24/min, and his spirometry findings were normal. Regarding the physical examination
and medical history, we decided he didn’t have a permanent disability because of this accident and
has recovered totally.
Exposure to toxic inhalation substances are mainly caused by chlorine and mixed compounds which
are mainly used domestically. Restrictive and obstructive pulmonary damage caused by long term
exposures commonly recover in months/years and permanent damage is considered to be effected
by individual factors.
Keywords: Chlorine, industrial accident, occupational disease, disability
P093[Occupational and Enviromental Diseases]
Lung Health Status Of Protesters Facing Tear Gas In Ankara, Turkey
(Analysis Of 86 Cases)
Çağla Filiz Uyanusta Küçük1, Aslıhan Ilgaz1, Hikmet Fırat1, Tansu Ulukavak Çiftçi1, Serdar Akpınar1,
Bülent Çiftçi1, Selma Fırat Güven1, Selen Bilekli1, Arif Müezzinoğlu1, Eda Uslu3, Peri Arbak2, Elif
Dağlı3
1
Turkish Thoracic Society Ankara Branch
2
Turkish Thoracic Society West Black Sea Branch
3
Turkish Thoracic Society İstanbul Branch
Tear gas is a crowd control agent used in protests. There is not adequate information about the
respiratory health effects of human exposure indoor and outdoors.
The aim of this study is to evaluate the impact of tear gas
exposure on the lung health, depending on the ways of its use during
public demonstrations.
A face-to-face questionnaire survey and lung function tests were carried out among 86 individuals
who had been exposed to tear gas during public protests in June 2013 in Ankara. The
characteristics of participants; 52 male,34 female, mean age;29.5, majorly university students.
52.3% of them were smokers.48.2 % of the participants'
exposure to tear gas was within 3 days or less prior to the time of
the questionnaire. 41.5 % of the participants' outdoor tear gas
exposure distance was less than 1 meter. 28 % had indoor tear gas exposure. The most significant
symptoms were redness of eyes,rhinorrhea,cough,shortness of breath and sputum.Non-smokers
had higher MMFR values than smokers. Women's FVC%,FEV1% and MMFR values were lower than
men's. Participants with a FVC lower than 80% made 9.3% of the whole group, 5 out of which had
also FEV1 lower than 80%.Participants with a FEV1 lower than 80% made 11.6% of the whole
group,3 out of which had also FVC lower than 80%. The participants whose MMFR values under
65% were 12.7% of the whole group.
Indoor tear gas exposure and smoking decrease pulmonary
functions. Restrictive changes in pulmonary functions and isolated
obstruction of small airways occurs predominantly.
Keywords: tear gas, pulmonary functions, crowd control
P094[Occupational and Enviromental Diseases]
Serum paraoxonase, arylesterase and lipid hydroperoxide levels of bird
breeders compared to healthy controls
Funda Yalçın1, Zafer Hasan Ali Sak1, Ayşegül Öney Kurnaz1, Faruk Günak1, Ferhat Namlı1, Mehmet
Gencer1, Hatice Sezen2, Nurten Aksoy2
1
Department of Chest Disease, Harran University, Şanlıurfa, Turkey
2
Department of Clinical Biochemistry, Harran University, Şanlıurfa, Turkey
Aim
In this study we aimed to evaluate the serum paraoxonase, arylesterase and lipid hydroperoxide
levels of bird breeders compared to healthy controls.
Material method
Forty bird breeders and 40 healthy controls were enrolled to the study. Serum samples were
collected and serum paraoxonase, arylesterase and lipid hydroperoxide levels were studied.
Results
Serum paraoxonase levels were statistically decreased in bird breeders group compared to control
group (113.82±23.82 U/l vs 130.49±41.32 U/l, p<0.001), and serum arylesterase levels were also
statistically decreased in bird breeders group compared to control group (88.82±27.16 U/l
vs.128.04±37.06 U/l, p=0.03). Besides, serum lipid hydroperoxide levels were statistically
increased in bird breeders group compared to control group (11.07±3.39 μmol/l vs. 9.71±1.76
μmol/l, p=0.02).
Conclusion
According to these results oxidative stress is increased and antioxidants are decreased in bird
breeders compared to healthy controls. These mechanisms might play role in susceptibility to
illnesses such as hypersensivity pneumonia that widely seen in bird feeders.
Keywords: Bird breeders, oxidative stress
P095[Occupational and Enviromental Diseases]
A case of silicosis
Arif Hikmet Çımrın, Aylin Özgen Alpaydın, Kemal Can Tertemiz
Dokuz Eylul University School of Medicine, Pulmonary Medicine
Silicosis, is one of the most important occupational diseases resulting from high-level exposure to
silica or silica-containing dusts. The most frustrating job that causes silicosis is sandblasting. Most
cases defined in the literature are the staff in the sandblasting area. However, there are silica
particles on the sandblasted textile products these products and purified by a group of workers in
the name of quality control. We presented a female case with silicosis who does not sandblasting,
but works as a quality control staff in a denim processing workplace.
A 41 year-old asymptomatic woman admitted with unexplained findings on her chest x-ray. She
was a never smoker. She was diagnosed as asthma a year ago and she was on medication. She
defined working in a denim processing company as quality control staff 6 years ago. She had to
retire after two years because of new onset cough and dyspnea. Her physical examination and
routine laboratory tests were normal. Spirometry was compatible with restrictive pathology. Thorax
CT revealed irregular patchy nodular densities predominantly in lower and middle lobes.
Bronchoscopy was normal. Histopathological analysis of open lung biopsy taken from the left lower
lobe showed granulomatous lesion with multinuclear giant cells containing brefringence crytalline
substances. The specimen was subjected to X-Ray and which determined the only observable
mineral as quartz. This case is interesting to show that silicosis may develop in workers in all staff
sandblasting places in addition to workers who personally does the job.
Keywords: dispnea, sandblasting,silicosis
P096[Occupational and Enviromental Diseases]
Airway Obstruction and Patchy Bilateral Pulmonary Infiltrations Related To
Tear Gas Exposure During Gezi Protests
Nilüfer Aykaç Kongar1, Özlem Soğukpınar1, Metin Barlan2, Haluk Celalettin Çalışır3
1
Bilim University, Medical Faculty, Department of Chest Diseases, Istanbul
2
Department of Radiology, Gayrettepe Florence Nightingale Hospital
3
Special Acıbadem Hospital
Mostly used crowd control agents –tear gasses- are known to be Oleoresincapsicum (OS) and
chlorobenzylidenemalononitrile (CS). OS and CS are toxic gases affecting whole metabolism
including particularly the skin and respiratory system. In Turkey during Gezi Protests, CS was used
mostly.
CASE: A 50 year old female with respitory complaints including phlegm and effort related dyspnea
admitted to hospital. The patient, with no prior respirotary complaints describes intense tear gas
exposure three times, 14, 13 and 11 days ago. Just after the exposures, the patient describes
dyspnea and wheezing. There was obstructive type respiratory dysfunction via pulmonary function
test and bilateral patched infiltrations existed in CT. The absence of lesions in earlier radiographs,
improvement in pulmonary function tests and almost full recession of paranchimal lesions 1 month
after the cessasiton of exposure were linked to CS gas exposure.
This case is presented to emphasize the importance of detailed and questioning anamnesis,
negative health effects of environmental and social life and the gases used are not as innocent as
reflected. Sub-acute and chronic health effects due to tear gas exposure need to be evaluated in
further studies.
Keywords: Tear gas, istanbul gezi park, pepper spray, bilateral patchy lung infiltrations, toxic gas
inhalation
P097[Occupational and Enviromental Diseases]
Hygienic problems in the etiology of chronic respiratory diseases in children
Angela Cazacu Stratu, Grigore Friptuleac, Rodica Selevestru, Svetlana Sciuca
State Medical and Pharmaceutical University, Chisinau, Moldova
AIM: The highlighting and detection of cases of chronic respiratory diseases in children from rural
areas
and
the
study
of
their
education
and
habitual
conditions.
Material and methods. The study included interviews with 1783 pupils from rural areas to detect
chronic respiratory diseases, the characteristic of instruction and residential conditions (the
concentration of CO2, CO, humidity, temperature, allergic factors triggers disease), the
characteristic
of
construction,
sanitary
condition
of
penthouses.
Results. By interviewing procedures and clinical examination was ascertained that every 17th child
suffers from a chronic respiratory disease (asthma, chronic bronchitis). In studied schools, the level
of morbidity caused by chronic respiratory disease varies between 58,8±6,51 and 6,9±0,32‰.
The studing conditions of pupils in the school are characterized by low temperatures, which does
not correspond to hygienic norms, great content of CO2 which exceeds with 3 times the hygienic
norm. Residential conditions are more unfavorable to children suffering from chronic respiratory
disease, characterized by low temperatures, increased humidity and increased CO2 concentration,
than to healthy subjects. The contamination of rooms with fungus (Penicillium, Mucor) and relative
humidity increased represents the determinant factors in the appearance of chronic respiratory
diseases.
Conclusion. Residential and occupational hygienic risks favor the development of lung disease with
chronic character during the first years of schooling of children.
Keywords: Hygienic problems, chronic respiratory diseases, children
P098[Experimental Research]
The Role of Bronchial Epithelial Cell Apoptosis in the Pathogenesis of COPD
Bülent Gögebakan1, Recep Bayraktar2, Mustafa Ulaşlı2, Serdar Öztuzcu2, Hasan Bayram3
1
Mustafa Kemal University, Faculty of Medicine, Department of Medical Biology, Hatay, Turkey
2
Gaziantep University, Faculty of Medicine, Department of Medical Biology, Gaziantep, Turkey
3
Gaziantep University, Faculty of Medicine, Department of Chest Diseases, Gaziantep, Turkey
There is an increased airway inflammation in the pathogenesis of COPD. Furthermore, animal
studies suggest that there may also be problem in the apoptosis and renewal of cells. However,
there are limited studies in human cells. We cultured primary bronchial epithelial cells (PBEC) from
bronchial explants of smokers (n=6) without COPD and smokers with COPD (n=8). Apoptosis was
studied by fluorescence activated cell sorting (FACS). qRT-PCR was used to assess the expression
of mRNA for apoptosis regulating proteins such p21CIP1/WAF1, p53, caspase-8 and caspase-9.
Although there was no difference in the ratio of viable cells between cells from smokers and
COPDs, the level of early apoptotic cells was significantly increased in COPD cells [mean ±
Standard Error of Mean (SEM)= 4.86±3.2%, p=0.015) as compared to smokers (mean ± SEM=
2.71±1.62%). In contrast, the percentage of necrotic cells was significantly increased in smokers
(mean ± SEM=15.21±5.08%, p=0.003) comparing to COPD cells (mean±SEM= 9.82±5.71%). The
expression of mRNA for p21CIP1/WAF1 and caspase-9 was similar in both groups, whereas p53
and caspase-8 mRNA expression was significantly greater in COPD cells than PBEC from smokers.
These findings suggest that BEC apoptosis is increased in COPD, and that this involves p53 and
caspase-8 pathways.
This study is funded by The Research Fund of Gaziantep University with the Grant no: TF.11.32.
Keywords: Apoptosis, Caspase, COPD, p21, p53
P099[Experimental Research]
Comparison of reducing effect on lung injury of dexamethasone and
bosentan in acute lung injury: An experimental study
Ömer Araz1, Elif Demirci2, Elif Yılmazel Uçar1, Muhammet Çalık2, Didem Pulur3, Adem Karaman4,
Muhammet Yayla5, Eren Altun2, Zekai Halıcı5, Metin Akgün1
1
Department of Pulmonary Diseases, Ataturk University, Erzurum, Turkey
2
Department of Pathology, Ataturk University, Erzurum, Turkey
3
Department of Pulmonary Diseases, Zonguldak Government Hospital, Zonguldak, Turkey
4
Department of Radiology, Ataturk University, Erzurum, Turkey
5
Department of Pharmacology, Ataturk University, Erzurum, Turkey
BACKGROUND: Different medical therapies are employed in acute lung injury (ALI) but there is
still a debate about the efficacy of these drugs. Among these therapies steroids are clinically
applied and bosentan is experimentally studied. The aim of this study was to evaluate the efficacy
of these two drugs to treat inflammation in ALI by histopathological comparison.
METHODS: The five experimental groups (n=5 per group) were: saline control; lipopolysaccharide
(LPS)+saline; LPS+dexamethasone; LPS+50 mg/kg bosentan; and LPS+ 100 mg/kg bosentan.
Bosentan was administered orally one hour before and 12 hours after LPS treatment.
Dexamethasone was administered intraperitoneally in three doses of 1 mg/kg; one dose was coadministered with LPS and the other two doses were given respectively 30 minutes before and
after LPS treatment. Vasodilation-congestion, hemorrhage, polymorphonuclear leukocyte (PMN)
infiltration, mononuclear leukocyte (MNL) infiltration, alveolar wall thickening, alveolar
destruction/emphysematous appearance, and focal organization were the parameters used as
criteria for evaluating inflammation and efficacy of treatment.
RESULTS: Compared to the LPS-only group (Figure1), dexamethasone treatment resulted in
significant improvements in vasodilation-congestion, hemorrhage, PMN and MNL infiltration,
alveolar wall thickening and emphysematous areas. Treatment with 50mg/kg dose of bosentan also
resulted in significant improvements in hemorrhage, PMN and MNL infiltration, alveolar wall
thickening and alveolar destruction. Reducing lung injury and reparative effects of 100mg/kg
bosentan were significant in all parameters (Figure2).
CONCLUSIONS: Bosentan is as effective as dexamethasone for treating lung injury in ALI.
Bosentan at 100mg/kg can be recommended as a first treatment choice based on its significant
reducing lung injury and reparative effects.
Keywords: Acute lung injury, Bosentan, Dexamethasone
Figure 1
H&E stained sections from LPS-only group. (A) arrowhead: hemorrhage, arrow: terminal bronchiole (H&E,
x100); (B) arrowhead: thickening of the interalveolar septum, alveolar filling defects (H&E, x100), (C)
arrowhead: PNL infiltration, arrow: MNL infiltration (H&E, x200), (D) arrowhead: vasodilation-congestion,
arrow: terminal bronchiole (H&E, x100).
Figure 2
H&E stained sections from Group V (100 mg/kg bosentan). (A) ias: interalveolar septum, Tb: terminal
bronchiole (x100), (B) (x200)
P100[Experimental Research]
The effect of sildenafil on findings of pulmonary inflammation associated
with smoke exposure in rats
Serap Argun Barış1, Çiğdem Vural2, Büşra Yaprak2, İlknur Başyiğit1, Haşim Boyacı1, Dilek Tuncel1,
Sedat Vatansever3, Tonguç İşken2, Füsun Yıldız1
1
Department of Pulmonary Diseases, Kocaeli University Faculty of Medicine, Kocaeli
2
Department of Pathology, Kocaeli University Faculty of Medicine, Kocaeli
3
Department of Plastic Surgery, Kocaeli University Faculty of Medicine, Kocaeli
AIM: The aim of the study was to evaluate the effects of sildenafil on pulmonary inflammation in
rats that exposed to smoke. MaterialMETHOD: Twenty-nine Wistar-Albino rats were enrolled into 3 groups. The healthy control was
exposed to fresh air while smoker and sildenafil groups were exposed to cigarette smoke for 8
weeks for 2 hours per day. Sildenafil 10 mg/ kg/day- 8 doses were administered using nasogastric
lavage. At the end of this period Light microscope was used for histopathological examination of
the lung tissues of sacrificed rats. The edema, hyperemia, hemorrhage, mononuclear cell
infiltration, thickness of inter-alveolar septum and distortion of the alveoli were evaluated and
degree of the inflammation was scored for each group.
RESULTS: The inflammation score was 7.25±0.93 in control group (n:6), 8.18±1.21 in smoker
group (n:11) and 7.08±1.66 in sildenafil group (n:12). There was a statistically non-significant
decrease in total inflammation score in sildenafil group compared to control and smoker groups.
While there was no significant difference in edema, hyperemia, hemorrhage and mononuclear cell
infiltration scores between the groups, it was found that the thickness of inter-alveolar septum and
alveolar distortion was decreased in sildenafil group. However this decrease was not significant.
CONCLUSION: This study suggested that sildenafil might decrease findings of pulmonary
inflammation such as thickness of inter-alveolar septum and alveolar distortion in rats that exposed
to smoke. Further long-term studies with large study population are needed in order to evaluate
clinical significance of these findings.
Keywords: inflammation, lung, rat, sildenafil, smoker
P101[Experimental Research]
The efficacy of H89 on Aquaporin 5 levels in asthmatic rat model
Yücel Kurt1, Mustafa Saygın2, Önder Öztürk3, Hasan Yasan4, Halil Aşçı5, İbrahim Aydın Candan6,
Dilek Bayram6
1
Isparta state Hospital, Clinics of ENT
2
Suleyman Demirel University, Medical Faculty, Departmen of Physiology
3
Suleyman Demirel University, Medical Faculty, Departmen of Chest Diseases
4
Suleyman Demirel University, Medical Faculty, Departmen of ENT
5
uleyman Demirel University, Faculty of Medicine, Department of Pharmacology
6
Suleyman Demirel University, Faculty of Medicine, Department of Histology ve Embriology
AIM: The effect of spesific protein kinase A inhibitor H89 on Aquaporin 5 levels that has a role in
inflammation of asthma pathogenesis were investigated in this study.
METHOD: In this study, 32 Wistar albino adult male rats which the weights ranging 250-350
grams were used. Animals divided into 4 groups that each group contains 8 animals.1. Control
group,2. Shame group (administration of 1 ml intraperitonal (ip) (Ovalbumine (OVA)
(25μgr/ml)+200 ml aluminum hydroxide (5mg/ml)) solution on 1, 2, 3, 7 and 10. days; 0.1 ml
intranasally (in) % 10 solution (20 ml SF+0,02 gr OVA dissolved in Dimethyl sulfoxide) on 8, 9, 10
ve 14. days x2). 3. Asthma group; ip+in OVA administration, 4. H89 group (ip+in OVA) + 0.1 ml in
H89 (30 µM 15 ml solution) x2). After the experiment lungs of rats were evaluated
histopathologically and immunohistochemically.
RESULTS: The histopathological evaluation of tissue; alveolar degeneration, mononuclear cell
infiltration and vascular congestion, haemorrhage and AQ5 levels were not found significant
difference in the sham and asthma group (p>0.05). Compared to the control group, asthma group
has significant increase in all parameters (p <0.001). Compared to asthma group, alveolar
degeneration and vascular congestion significantly decreased in H89 group (p<0.05).The reduction
of AQ5 levels were detected in the H89 group but it was not statistically significant.
CONCLUSION: Aquaporin5 levels and histopathological changes were increased in asthmatic
patients and a decrease was detected with treatment of H89.H89 can act on inflammation in the
pathogenesis of asthma so it can be used in asthma treatment.
Keywords: Asthma, Aquaporin 5, H89, Protein kinase A, Ovalbumin.
Figure 1
Asthma group of lung tissue image. AQP-5 positive staining (brown appear in the cell membranes of the alveoli
are white arrows) (immunohistochemical staining) (40X)
Figure 2
Asthma + H89 group of lung tissue image. AQP-5 levels has been decreased. (Immunohistchemical staining)
(40X)
P102[Experimental Research]
Targeting Ras Pathway via Ezrin Inhibitor in Non-small Cell Lung Cancer
Cells
Yasemin Saygideger Kont1, Haydar Çelik1, Tsion Minas1, Christina Kraus1, Neşe Atabey2, Aykut
Üren1
1
Georetown University, Lombardi Cancer Center, Department of Molecular Oncology, Washington
DC, USA
2
Dokuz Eylul University School of Medicine, Department of Medical Biology and Genetics, Izmir,
Turkey
INTRODUCTION: Non-small cell lung cancer (NSCLC) is the leading cause of cancer deaths in the
world. Advances in molecular biology and development of targeted therapies benefitted many other
types of cancers but unfortunately they have not significantly reduced mortality in NSCLC. One of
the most important signaling cascades for lung cancer is the Ras pathway, which is active in almost
all NSCLC patients. Ezrin is a cytoplasmic protein that belongs to the ERM (Ezrin, Radixin, Moesin)
family. Its expression strongly correlates with poor prognosis in NSCLC. Independent laboratories
published evidence suggesting that ezrin is required for growth factor mediated activation of Ras in
NSCLC. Since ezrin mediates growth factor signaling from receptor tyrosine kinases to Ras,
inhibition of ezrin may provide an alternative way of Ras inhibition in NSCLC cells with wild type
protein. Recently two small molecule inhibitors of ezrin have been described, NSC305787 and
NSC668394. We hypothesize that inhibition of ezrin will prevent Ras activity in NSCLC cells and
induce growth arrest.
METHODSRESULTS: A549 and H596 cell lines are maintained in RPMI medium and cell-mediated cytotoxicity
of the both compounds were measured using electrical impedance based systems. Cells treated
with appropriate amounts of both compounds and cell lysates were collected. Phospho-ERK and
Phospho-MEK levels were evaluated with western blot after compound treatment and found
significantly reduced in both cell lines compared to untreated cells. Gene silencing and proliferation
experiments are still in process.
Keywords: Non small cell lung cancer, Ras, Ezrin Inhibitors, in-vitro
P103[Experimental Research]
A novel TDP2 Inhibitor shows synergy with Etoposide in Non-Small Cell
Lung Cancer Cells
Yasemin Saygideger Kont1, Sanjay Adakhari1, Christina Kraus1, Tsion Minas1, Neşe Atabey2, Aykut
Üren1
1
Georetown University, Lombardi Cancer Center, Department of Molecular Oncology, Washington
DC, USA
2
Dokuz Eylul University School of Medicine, Department of Medical Biology and Genetics, Izmir,
Turkey
INTRODUCTION: Etoposide, a Topoisomerase-2 (Top2) inhibitor, has been used as a first line
therapy in most of the cancers, but not very effective in Non-small Cell Lung Cancer (NSCLC). Top2
inhibitors kill cancer cells by inducing Top2-DNA adducts and by preventing replication. Recently, a
protein, TDP2 (tyrosin phosphodiesterase) has been identified for the excision of Top2-DNA
adducts, suggesting a potential mechanism for drug resistance. TDP2 is frequently overexpressed
in lung cancer and thus, the hypothesis of this research is a small molecule inhibitor of TDP2 can
show synergy with Etoposide and can be a potential drug for the treatment of NSCLC and for other
cancers with Etoposide resistance.
METHODSRESULTS: A high throughput-screening assay based on 5'-tyrosine phosphodiesterase activity of
TDP2 was developed and a small molecule library of compounds was screened. NSC111041 was
found to be the leading compound that inhibited TDP2 activity in vitro. Expression levels of TDP2 in
NSCLC cell lines A549, H358, H596, H1395 and H1944 was detected with western blot and was
found to be expressed in all of the cell lines. Cytotoxicity was tested for Etoposide and NSC111041
with MTT test and synergy experiments were done using the same method and synergy was seen
between these two drugs. Next, TDP2 shRNA was transfected to A549 cells and synergy
experiments were repeated. NSC111041 showed synergy with etoposide only in cells expressing
TDP2 but not in cells without TDP2. Etoposide sensitivity was increased in TDP2 knock-downed
cells.
Keywords: Non small cell lung cancer, Etoposide, TDP2, small molecule inhibitor, synergy
P104[Thoracic Surgery]
Treatment of Sympathectomy and Long Term Results of Hyperhidrosis
Celal Buğra Sezen, Süleyman Anıl Akboğa, Ali Çelik, Anar Süleymanov, İsmail Cüneyt Kurul
Department of Thoracic Surgery,Gazi University, Ankara, Turkey
INTRODUCTION:
Hyperhidrosis is one of the most important social life limiting illness. Cause of excessive secretion
of the ecrine sweat glands. The aim of the present study was to investigate to 40 patients
retrospetively after medical and surgical affects of postopertive quality of life.
METHOD:
From 2007 to 2013, 40 consecutive patients who have palmar, axillar and fascial hyperhidrosis
underwent video-assisted thoracic sympathectomy and medical treatment. Before 2012, we only
performed symphatectomy T2-3-4 levels for region of hyperhidrosis. however, after 2012, we were
using oxybutinine treatment for hyperhidrosis. We performed medical and surgical treatment to 12
patients. Moreover, we also used medical treatment to 11 patients. On the other hand, after 2012,
rather then using T2-T4 level in sympatectomy, we used T3-T5 symphatectomy levels.
CONCLUSION:
When we compared only medical and surgical treatment groups’ quality of life scores, surgical
treatment group has better quality of life ( p = 0.030 ). Comparing to symphatectomy levels, there
is no any significant difference between these groups (p =0.107).
As a RESULT:
In recent years, alpha-blockers have been used mostly in the treatment of hyperhidrosis. But
medical treatment and symphatectomy treatment were effective for treating hyperhidrosis. On the
other hand, we still need to do more randomise analysis about this topic.
Keywords: Hyperhidrosis, Sympathectomy, Oxybutinin
Table 1
Sweating Regions of the patients who admitted for hyperhidrosis
Table 2
Comparison of Quality of Life Scores
P105[Thoracic Surgery]
A Rare Case: Acute Desending Necrotizing Mediastinitis
Abidin Şehitoğulları1, Muzaffer Yılmaz1, Mehmet Güven2, Ahmet Nasır1, Ali Kahraman3, Hazel Can4,
Yusuf Aydemir5
1
Sakarya Education and Research Hospital, Sakarya University,Department of Thoracic
Surgery,Sakarya, Turkey
2
Sakarya Education and Research Hospital, Sakarya University,Department of
Otolaryngology,Sakarya, Turkey
3
Bursa state Hospital,Department of Thoracic Surgery,Bursa, Turkey
4
Sakarya Education and Research Hospital, Sakarya University,Department of Anesthesiology and
Reanimation,Sakarya, Turkey
5
Sakarya Education and Research Hospital, Sakarya University,Department of
pulmunology,Sakarya, Turkey
Acute desending necrotizing mediastinitis(DNM) is a fulminant process that occurs as a
complication of cervical necrotizing faciitis that spreads along the fascial planes without
involvement of primary skin and muscle with high mortality rates. It is a clinical condition
characterized by high mortality despite intense treatment.
We present a case of DNM in 30-year-old girl suffering from a dental abscess.
Key words:, mediastinitis,
CASE:
A-30-year-old woman admitted with fever, exhaustion neck distendion for a week. He had a tooth
abscess one week ago.female patient who admitted to our department with the diagnosis of DNM
underwent Neck insision, and the abscess in her neck was drained with transcervical initiative.
Necrotic tissue in the area was debrided. Since thorax computerized tomography revealed
formation of empyema pouches and emission of pus content from the retropharyngeal area into the
mediastinum, decortication and empyemectomy were performed. The mediastinal pleura was
resected and the mediastinum was cleaned. The patient was discharged with full recovery.
Descending mediastinitis secondary to a deep neck infection is a rare occurrence. This study aims
to share this successfully treated case in the light of the literature.
Keywords: Dental abscess, mediastinitis; deep neck infection
The view of case in thorax CT
P106[Thoracic Surgery]
Two Cases Perıcardıal Dıvertıculum Resected With Thoracoscopyal
Bayram Metin1, Sevinç Şahin2, Selda Seçkin2, Eylem Yıldırım3, Yavuz Selim İntepe3, Hasan Doğru1
1
Bozok University, School of Medicine,Thoracic Surgery Department.Yozgat
2
Bozok University, School of Medicine,Pathology Department.Yozgat
3
Bozok University, School of Medicine,Chest Dissease Department.Yozgat
Pericardial cyst and diverticula compose %7 of all mediastinal masses.Pericardial cyst ant
diverticula are generally present at right cardiophrenic sinüs also other area.We aimed to present
that Two different cases With a preliminary diagnosis of mediastinal cysts were operated as
thoracoscopic.
Case 1:44 year old male patient, There are cough and wheezing complaints.Cystic lesion was seen
in the upper mediastinum in thoracic CT.
Cystic lesion was seen In Thoracic MRI that T1 hypointense, T2 hyperintense.Pericardial
diverticulum was removed by thoracoscopy.Patients were discharged from the hospital at 3 day.
Case 2. Female patients diagnosed with CML Two years ago. Cystic lesion was observed ın right
anterior cardiophrenic sınus at thoracic CT.Pericardial diverticulum was removed by
thoracoscopy.Patients were discharged from the hospital at 3 day.
Keywords: Mediastynal cysts, Pericardial divertucula, Thoracoscopycal resection.
Case 1. Toraks BT and MR
Case 1. Toraks BT and MR
Case 2. Toraks CT and cyst
Case 2. Toraks CT and cyst imaging
P107[Thoracic Surgery]
A Rarely Seen Pleural Leiomyoma Case
Ahmet Erbey, Menduh Oruç, Atalay Şahin, Fatih Meteroğlu, Ahmet Sızlanan, Serdar Monis
Department of Thoracic Surgery, Dicle University, Diyarbakir, Turkey
Fifty six year old female patient presented with history of chest pain and shortness of breath for
three years. X-ray and computed tomography of the thorax revealed a mass of 16X13X12 cm in
the right middle and lower lung areas. A right thoracotomy was performed. The mass originated
from the mediastinal pleura. The tumor was removed in parts. The macroscopic feature of the
tumor was a hard and irregularly surfaced white-yellow mass. Histopathologically, the tumor
consisted of packets and bundles of smooth muscle fibers without significant celluler necrosis and
mitotic activity.
Keywords: intrathoracic, benign, leiomyoma
Figur 1.
Tomographic view of the patient's mass
P108[Thoracic Surgery]
A Case of Agressive Fibromatosis in Chest Wall
Menduh Oruç, Ahmet Erbey, Fatih Meteroğlu, Atalay Şahin, Serdar Monis, Ahmet Sızlanan
Department of Thoracic Surgery, Dicle University, Diyarbakir, Turkey
Fibromatosis is also known as desmoid tumor and a rarely seen soft tissue tumor. Some reports
take them low grade fibrosarcoma since they are histologically classified among benign soft tissue
tumors. They are known to not metastasise but invade into the neighboring tissues. Therefore, it is
essential to remove them. Its etiology includes trauma, surgery,hormonal disturbance and it is
common in women. The diagnosis was made via mini thoracotomy in a 18 year old woman with
shortness of breath, dullness in the right chest and trauma in her past. We removed the mass upon
the the result yielded fibromatosis.
Keywords: fibromatosis, tumor, chest wall
Figure 1.
Tomographic view of fibromatosis
Figure 2.
The mass removed
P109[Thoracic Surgery]
Spontaneous Hemopneumothorax: Analysis of Six Cases
Meduh Oruç, Fatih Meteroğlu, Atalay Şahin, Ahmet Erbey, Serdar Monis, Ahmet Sızlanan, Serdar
Onat, Refik Ülkü
Dicle University, Medical School, Department of Thoracic Surgery, Diyarbakir, Turkey
PURPOSE: Spontaneous hemopneumothorax is a rare disease seen after ruptures of small vessels
due to adhesions found in visceral and parietal pleurae after lung collapse. It becomes life
threatening if it is not timely diagnosed and treated. We aimed to evaluate characteristics and
management of six cases.
Patients and
METHOD: Between July 2010 and Novembre 2013, 132 patients with spontaneous pneumothorax
were admitted to our clinic. Of them, six had hemopneumothorax. Patients were retrospectively
evaluated in age, gender, side, amount of drainage, clinical features and treatment modalities.
FINDINGS: Patients were examined at Emergency Department. They all were evaluated in chest
x-ray, computerized tomography of thorax, routine laboratory and coagulation tests. They
underwent tube thoracostomy with 28 F catheter and six of them were operated following
drainage. We made video assisted thoracoscopic surgery in two patients and axillary thoracotomy
in the remaining patients. Post operative complication was not seen.
RESULTS: Patients were examined in emergency department in chest x-ray, torax computerized
tomography and laboratory investigations. Chiest tube insertion was carried out in all patients. Six
patients were operated on: video assisted thoracoscopic surgery in two and axillary thoracotomy in
four patients.
Coclusion: Air fluid levels associated with pneumothorax in chest x-rays of patients with sudden
chest pain and dyspnoea but not trauma should remind spontaneous hemothorax. Close
observation prevents life threatening haemorrhage
Keywords: Hemothorax, spontaneous, pneumothorax
Tablo 1
n Age Sex Symptom
Hemithoraks surgery
1 24
M
Chest pain, Crick L
VATS
2 19
M
Dispnoe, crick
VATS
3 48
M
Chest pain, crick R
thoracotomy
4 25
M
Chest pain, crick R
thoracotomy
5 18
M
Crick
L
thoracotomy
6 21
M
Dispnoe, crick
R
thoracotomy
L
P110[Thoracic Surgery]
Intrathoracic Desmoid Tumor Misdiagnosed Radiological Cyst Hydatid: A
Case Report
Bayram Metin1, Sevinç Şahin2, Selda Seçkin2, Yavuz Selim İntepe3, Eylem Yıldırım3, Hasan Doğru1
1
Bozok University, School of Medicine,Thoracic Surgery Department.Yozgat
2
Bozok University,School of Medicine,Patology Department,Yozgat
3
Bozok University, School of Medicine,Chest Dissease Department.Yozgat
Desmoid tumors, develops as a result proliferation of fibroblastic and myofibroblastic cells,slowgrowing,not metastasis, seem The local invasion, high risk of recurrence (60%).These tumors
frequently observed in abdominal area, can also be seen on the chest wall In ratio of10-30%.Show
intrathoracic placement is very rare.We present a case that who operated, Radiologically with a
preliminary diagnosis of hydatid cyst but intraoperative encountered with solid masses.
81 year old female patient was admitted with progressively increasing shortness of breath. At the
Thoracic CT, homogeneous density 100x120x130mm cystic lesion in the right size and multiple
simple cysts 30 mm diameter in the liver were observed, and as hydatid cysts were evaluated.Total
mass with Two ribs in the chest wall to receive along with partial resection of the thoracic wall was
removed.mass was diagnosed "desmoid tumor".
Keywords: İntrathoracic placement,desmoid tumors,Hydatid cyst
İmaging of operation
İmaging of operation
Toraks CT
İmagine of Thoracic CT
P111[Thoracic Surgery]
Primary Benign Fibrous Histiocytoma of the Lung with FDG Involvement
Mithat Fazlıoğlu1, Tevfik İlker Akçam2, Umut Özdamarlar3, Nevin Fazlıoğlu4
1
Department Of Thoracic Surgery, Kayseri Research and Training Hospital, Kayseri, Turkey
2
Department Of Thoracic Surgery, Nevsehir State Hospital, Nevsehir, Turkey
3
Department Of Radiology, Kayseri Research and Training Hospital, Kayseri, Turkey
4
Department Of Pulmonology, Kayseri Acıbadem Hospital, Kayseri, Turkey
INTRODUCTION:
Fibrous histiocytoma is a benign tumoral lesion consisting of fibroblastic and histiocytic cells,
accompanied by varying numbers of inflammatory cells, foamy histiocytes and siderophages, and
has sheet- or short fascicle-type histomorphology. These tumors are generally localized in the
dermis or the superficial subcutaneous tissue. Fibrous histiocytoma of the lung is an extremely rare
tumor.
CASE:
A 30-year-old female patient was admitted with a coughing complaint persisting for 15 days. X-ray
revealed a lobulated contour radioopacity with a diameter of approximately 3 cm in the middle
zone of the right lung. CT showed a uniformly bound lesion mass with a size of 30x24 mm, which
had lobulated contour and soft tissue density in the posterior segment of the upper lobe of the
right lung. PET-CT showed intense FDG involvement (SUV max: 19.3) in the lobulated, spaceoccupying formation zone with a size of 30x24 mm in the posterior segment of the upper lobe of
the right lung. Due to the inability to differentiate between benignity and malignancy during the
operation, right upper lobectomy was performed, considering PET findings, as well.
Immunohistochemical staining was performed too. The patient was diagnosed with primary benign
fibrous histiocytoma of the lung (cellular type).
CONCLUSION:
The actual incidence of these tumors with lung localization is not known. In addition, despite being
a benign lesion, we showed that it could involve activity in the PET-CT. Due to the malignancy
potential and local recurrence in this type of pseudotumor case, definitive treatment is complete
surgical resection, if possible.
Keywords: benign fibrous histiocytoma, lung, operation
P112[Thoracic Surgery]
Giant Osteochondrome Case In Chest Wall
Menduh Oruç, Fatih Meteroğlu, Atalay Şahin, Ahmet Erbey, Serdar Monis, Ahmet Sızlanan
Dicle University, Medical School, Department of Thoracici Turgery, Diyarbakir, Turkey
A sixty five year old man who had coronary artery bypass surgery two years before, complained of
an aching and enlarging mass in his chest fort he last three months. A lump of 12X10 cm was
discovered on examination. After getting his thorax computerized tomography, an excisional biopsy
was performed. The histopathological resultant was osteochondrome. His left 7-10th ribs were
removed due to advanced age, age, getting enlarged and malignant potential. The resultant chest
wall defect of 12X12 cm was repaired with a methyl metacrylate mesh. Giant osteochondromes are
treated in surgical and esthetic way.
Keywords: chest wall, osteochondrome, mesh
Figure 1
Figure 2
P114[Thoracic Surgery]
The result of surgical stabilization of multiple rib fractures: a case
Suat Durkaya1, Levent Özdemir2, Burcu Özdemir3, Sema Nur Çalışkan3, Ali Ersoy4
1
İskenderun State Hospital Torasic Surgery
2
Dortyol State Hospital Chest Disease
3
İskenderun State Hospital Chest Disease
4
Antakya State Hospital Chest Disease, Hatay
Surgical stabilization can performed to multiple rib fractures for flail chest chronic pain and
permanent deformity of the chest wall.
47 years old male patient with non-vehicle traffic accident were evaluated in the emergency
department. Six rib fracture, flail chest and hemopneumothorax on the left was detected on
examination and thoracotomy was performed and follow-up were intubated in the intensive care
unit. On the 10th day of treatment in the absence of lung expansion and the reason that patients
with flail chest surgery with plaque stabilization operation was performed. The patient was
discharged without complications after the operation
Keywords: rib fractures, surgical stabilization
resim 1
resim2
P127[Thoracic Surgery]
Clarinet Musician’s Pneumothorax
Ahmet Nasır1, Abidin Şehitoğulları1, Ömer Tan2, Muzaffer Yılmaz1
1
Clinic of Thoracic Surgery, Sakarya Education and Reseach Hospital, Sakarya, Turkey.
2
Clinic of Thoracic Surgery, Uşak State Hospital, Uşak, Turkey.
Primary spontaneous pneumothorax (PSP) occurs in patients with no underlying pulmonary
disease. This disase is a significant global health problem. The pathogenesis of PSP is not known to
a great extent. PSP is belived to be caused by rupture of sub-pleural blebs or emphysema like
changes at the apex of the lung. The physical activity and playing wind musical instruments are a
potential risk for developing PSP with resulting in valsalva maneuver.We present a case of PSP in
otherwise healthy patients who developed pneumothorax during physical activity resulting in
significantly high mouth pressures.
CASE: A 30-years-old man presented to our emergency department with a sudden onset of severe
left sided chest pain while playing musical instrument (clarinet). The pain was sharp and pleuritic in
nature and there was shortness of breath. This activity results is generation of very high mouth
pressures and possibly increased intra-thoracic pressure.He was a smoker with 11-pack-year
history of smoking. He had no other significant past medical history and was not on any regular
medications. On examination, he had oxygen saturations of 95% while breathing room air and was
haemodynamically stable. Respiratory system examination revealed decreased air entry on the left
side.His chest CT showed left pneumothorax (Figure 1). He was treated with inter-costal chest
drain and admitted to the respiratory ward (Figure 2).
Respiratory physicians should be aware of this potential association between PSP and the playing of
musical instruments.
Keywords: primary spontaneous pneumothorax, musical instruments
Figure 1
Chest CT showed left pneumothorax
Figure 2
Chest radiograph after tube thoracostomy
P128[Thoracic Surgery]
A Late Diagnosed Case With Left Main Bronchus Rupture
Cansel Öztürk1, Mustafa Vayvada1, Mahmut Talha Doğruyol1, Şükrü Tamer Alban2, İrfan
Yalçınkaya1
1
Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital, Department of
Thoracic Surgery, Istanbul
2
Tekirdag State Hospital, Department of Thoracic Surgery, Tekirdag
22 year old male patient. Before fifty days admitted our hospital, he had a traffic accident. The
patient, followed with performed closed chest drainage and tracheostomy opening in intensive care
for diagnosed as bilateral hemopneumothorax, was sent to our hospital for further evaluation and
treatment. The patient's chest CT were examined and rupture of the left main bronchus was
considered. It was confirmed with rigid bronchoscopy. Isolated sleeve resection was performed to
left main bronchus by left thoracotomy. End to end anastomosis was performed by telescopic
method. There were no complications in the postoperative period and tracheotomy was ended. The
rehabilitation of the patient was begun accompanied with physiotherapists and psychiatrists. The
patient was discharged in seventeenth postoperative day and it was not detected any problem
except mild mental and neurological problems in control of the end of the second month.
Tracheobronchial injuries are rare, elusive cases after chest trauma, can be diagnosed in the late
period. They are clinical entities that good results can be achieved even if surgery is performed in
the late period.
Keywords: trauma, bronchial rupture, diagnosis, surgery
P129[Thoracic Surgery]
Thorascopic Approaching For Two Different Cyst in Two Lungs of a Patient
İrfan Yalçınkaya1, İlhan Ocakçıoğlu2, Elçin Ersöz1, Aysun Mısırlıoğlu1
1
Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital, Department of
Thoracic Surgery, Istanbul
2
Van Region Training and Research Hospital, Department of Thoracic Surgery, Van
42-year-old female patient. Four months ago, it was determined cyst in both lungs and liver of the
patient in chest radiological investigations. İt was approached by VATS (Video Assisted
Thoracoscopic Surgery) for the cyst in left lung lower lobe and hydatid cyst was determined and
performed cystotomy + capitonnage. In our clinic, it was approched by VATS for patient’s right
hemithorax. The lesion was seen as a pericardial cyst and total excision was performed. She was
referred to a general surgery clinic for the cyst in the liver. In the literature, it was not found that a
patient performed VATS for both hydatid cyst of lung and pericardial cyst.
Keywords: lung, cyst, hydatid, pericardial, thoracoscopy
P130[Thoracic Surgery]
Due to the use of Oral Anticoagulant Spontaneous Cases of Hemothorax
Taner Ege1, Tonguç Saba2, Cevahir Haberal2, Dalokay Kılıç1, Ahmet Hatipoğlu1
1
Departments of Thoracic Surgery,Medicine Faculty of Başkent University
2
Departments of Cardiovasculer Surgery, Medicine Faculty of Başkent University
INTRODUCTION:
Warfarin is effective on primary and second venous thromboembolism prophylaxis, in reducing the
risk of recurrent myocardial infractus and prevention of systemic embolism after myocardial
infarctus, prosthetic heart valves or prevent atrial fibrilas. Although the most important
complication is bleeding, hemothorax is quite rare. In this study, patients who entered the
emergency department and with complains about severe chest pain and spontaneous hemothorax
due to the use of warfarin has been observed.
FINDINGS:
67 year old male patient was admitted to the emergency department with sever pain on the right
of the chest without causing trauma. 3 years ago LAD stenting and use of warfarin due to acute MI
is known. Thoracic CT scan was taken, in the right hemothorax significantly pleural effusion was
observed. The laboratory results of the patient were INR: 5.8 Hb: 8.5 g / dL and HTC:25.7%. Drain
was applied on patient with diagnosis of spontaneous hemothorax.
RESULT:
Patients who has an oral anticoagulant therapy, to ensure effective anticoagulation therapy and be
monitored for side effects and pleural effusion on these patients hemothorax case, they need to be
kept in the differential diagnosis.
Keywords: Spontaneous hemothorax, hemothorax,warfarin
P131[Thoracic Surgery]
Hyperhidrosis is a rare complication of brachial plexus injury
Semih Koçyiğit
elazığ eğitim araştırma hastanesi
22 years old male
chief complaint was hiperhidrozis
no benefit was obtained in botox and iontoforez treatments
the patient was prepared for operation
complate blood cout was normal
chest x ray was normal
normal intubation tube
Endoscopic thoracic sympathectomy was applied to the patient
two hours of operating time
surgeon in 15 cases
after the operation the patient was transferred to the floor
In the period after the operation the patient could not squeezing our hands and could not lift his
arm.his arm was flaccid.
on examination, the supraspinatus, biceps, coracobrachialis and brachioradialis muscle paralysis
was seen
The shoulder portion of the adductor and internal rotators paralysis was observed.
neurosurgery and orthopedic consultation results were normal.
physical therapy consultation was done.
EMG was taken.
EMG was normal
Physical therapy has been applied for one month.
post-treatment portion in physical movement arm and shoulder movements occurred
physical therapy has been raised to three months.
after six months, the arm and shoulder movements were normal.
surgical treatment is the only permanent and definitive solution for the treatment of hyperhidrosis.
when the patient's daily life, professional activity, social relationships and personality is affected
method of operation should be considered in cases.
Besides the common complications,very rarely brachial plexus injuries may be seen after the
operation.On conclusion;
The materials 's used,
patient's position,
experience and the harmony of the anesthesia team,
the surgeon's skills and the experience are important and may be associated with complications
Keywords: brachial plexus injury
P132[Thoracic Surgery]
A Case of Extrathoracic Desmoid Tumour
Taner Ege1, Hampar Akkaya2, Dalokay Kılıç1, Ahmet Hatipoğlu1
1
Departments of Thoracic Surgery,Medicine Faculty of Başkent University
2
Departments of Pathology, Medicine Faculty of Başkent University
INTRODUCTION:
Extra-abdominalfibromatozis (desmoid tumor), local invasion and recurrence is frequent rare,
benign soft tissue lesion. Although chest wall involvement is rare, bone, nerves, and vascular
structures can invade.
FINDINGS:
43-year-old female patient with pain and swelling under the right armpit and taken to be noticed
by the right half of the chest wall on CT 85X41 mm mass in the superior segment detected patients
who underwent excision.
RESULT:
Desmoid tumors are a rare chest wall tumor and may suggest a RT implementation to block the
reccurence of the excision of the tumor by surgery.
Keywords: Desmoid Tumour, Extra-abdominal Fibromatozis, Chest wall Tumour
P133[Thoracic Surgery]
Castleman’s Dısease in The Mediastinum
Esra Yamansavci Şirzai, Tarık Yağcı, Ozan Usluer, Ahmet Üçvet, Soner Gürsoy
Dr Suat Seren Chest Diseases and Thoracic Surgery Training Hospital, Department of Thoracic
Surgery, İzmir
Castleman disease, most often seen in the region of mediastinal lymph nodes, is a benign
lymphoepithelial disease. There are two histological types, types hyaline vascular and plasma cell.
Various infectious agents (EBV, human herpes virus-8), inflammatory reactions (IL-6, vascular
endothelial growth factor) and hamartamöz proces are thought to be involved in the role of
etiology. According to the clinical findings localized and systemic (multicentric) forms are available.
Radiological tests used in the diagnosis of the disease is nonspecific. Localized type is usually
asymptomatic and treatment of this is surgical excision of the mass.
49 years old female patient was admitted with complaints of pain in the front wall of her chest.
Thorax CT, in the left hilum anterior mediastinal fat tissue, non homogeneous, irregular contours,
amorphous calcific densities found in soft tissue mass was detected 51x50 mm size (Figure 1).
Perilesional atypical vascular structures were determinate. Thoracic magnetic resonance imaging
showed close proximity to the surrounding vascular tissue but no evidence was noted about
invasion. high value of anterior mediastinal mass involvement of the SUV (SUVmax=5,7) were
found in PET CT. Large nucleoli in eosinophils, leukocytes, and plasma cells were determined in
trucut biopsy for diagnostic purpose, therefore tumor-derived lymph nodes were focused on.
Definite pathology report 'Hyaline vascular type of Castleman's disease' was reported. Mass was
excised with left thoracotomy. Patient, who follow-up ın 4 months, was presented because of its
rarity.
Keywords: Castleman’s disease, Lymph node, Surgery
Figure 1
P134[Thoracic Surgery]
Is Mediastinoscopy Really Necessary in the Diagnosis of Sarcoidosis?
Mustafa Küpeli, İsmail Kürşat Gürlek
Department of Thoracic Surgery, Gaziosmanpaşa University, Tokat, Turkey
Mediastinoscopy was defined by Carlens for the first time in 1959 for the histological diagnosis of
the mediastinal mass, is an invasive procedure. There are a few kind of mediastinoscopy that are
Extended Mediastinocopy, Videomediastinoscopy, VAMLA (Video-assisted mediastinoscopic
lymphadenectomy). When mediastinoscopy is mentioned,firs t it comes to mind standard cervical
mediastinoscopy. In 2012-2013 in our clinic, we performed standard cervical mediastinoscopy at
twelve patients whose age range was 29-75. with a preoperative diagnosis of sarcoidosis. The
histopathologic examinations of eight of twelve patients were reported as non- caseating
granulomatous reaction. Although mediastinoscopy seems as a minimally invasive surgical
procedure and has 95-100% as high as the rates of diagnosis of sarcoidosis, it has the risk of
hemorrhage, hoarseness due to damage of recurrent laryngeal nerve, major vascular structures,
even esophagus and trachea damage that could result in mortality, ranging of 0.001% and
0.15,and it should be performed by
experienced surgeons.
As a result, we think that in the diagnosis of benign pathologic diseases like Sarcoidosis, the
methods like Endoscopic ultrasound (EUS)-guided fine needle aspiration and Endobronchial
Ultrasound (EBUS)-guided transbronchial needle aspiration should be preferred instead of relatively
risky mediastinoscopy and even follow up should be performed by patient clinical symptoms.
We think that if mediastinoscopy is performed, the 4R lymph node, is easily accessible and has less
risk of complications, should be preferred and dissection of tissue should be performed as little as
possible and tissue should be verified by frozen section.
Keywords: EUS, EBUS, Mediastinoscopy, Sarcoidosis (EBUS)-guided transbronchial needle
aspiration should be preferred instead of relatively risky mediastinoscopy and even follow up
should be performed by patient clinical symptoms.
PICTURE 1
Radiological Images of the Cases
P135[Thoracic Surgery]
Case Report: Importance of Preoperative History
Mustafa Küpeli, İsmail Kürşat Gürlek
Department of Thoracic Surgery, Gaziosmanpaşa University, Tokat, Turkey
Hydatid cyst, caused by Echinococcus, is a parasitic infection of the lungs. For the first time in
1928, Rudolphi used the term “hydatid cyst” for Echinococcus infections in humans. It is observed
in liver (60-80%) and lung (10-30%). Pulmonary hydatid disease most commonly occurs in the
right hemithorax and in the lower lobe. Our case was a 29 years old male patient who lives by
farming. Before ten days admitting to our hospital, he has a history falling from a height of about
two meter. In the thorax CT taken 20 days after the trauma in the right major fissure 4.5 x2 cm in
size, lobular structure, hypodense, no contrast enhancement after iv. injection of contrast material,
properly contoured lesion was seen. Adjacent to the lesion in the posterior segment of the right
upper lobe the large one was approximately 1 cm in
diameter adjacent to each other, two nodular lesions properly contoured was observed and
reported hydatid cyst ?. Patient was referred to our clinic by the department of Chest Diseases with
a preliminary diagnosis of hydatid cyst. When CT images of patients were examined, the diagnosis
of hydatid cyst was
found suspicious and follow-up was recommended. Three months later, in the control CT of the
patient, complete resolution was observed in the lesions and previously detected cystic lesions
were considered as secondary to trauma.
Before surgical decision, a detailed history and radiological interpretation in the light of this history
can prevent unnecessary surgery that can be done.
Keywords: History, Hydatid Cyst, Radiology
PICTURE 1
Thorax CT image of patient wgo referred to our clinic for preliminary diagnosis of hydatid cyst.
PICTURE 2
Control Thorax CT image of the patient after 3 months
P136[Thoracic Surgery]
Evaluation Of Corrosive Esophagitis And Importance Of Preventive Medicine
Ayşenur Alper Gürz1, Füsun Ayşin Artıran İğde1, Yasemin Bilgin Büyükkarabacak2, Ayşen Taslak
Şengül2, Selçuk Gürz2, Ahmet Başoğlu2
1
Department of Family Medicine, Ondokuz Mayis University, Samsun, Turkey
2
Department of Thoracic Surgery, Ondokuz Mayis University, Samsun, Turkey
OBJECTIVE: Accidents are one of the main factors that shorten healthy life. All over the world,
corrosive esofagitis is a serious problem that threatens life. These accidents increase by accessing
generic cleaning supplies easily and taking preventive medicine measures inadequately. The aim of
this study was to determine the demographic characteristics of people who had corrosive
esophagitis and ensure the public awareness about these accidents.
MaterialMETHOD: We reviewed patients’ files who hospitalized about corosive eusofagitis between January
2002 and December 2013, in Ondokuz Mayis University, Department of Thoracic Surgery. 33 of
264 patients were excluded from the study because of taking corrosive for suicide.
RESULTS: 120 of the patients were women and 111 were men. Their age varied between 17 and
88 and the mean age was 40.2 years. 3% of them had a history of mental retardation and 33.6%
of them smoked. The highest amount of accidents occurred in summer (38.5%). The ingested
materials were bleaches (38.5%), nitric acid (21.6%), muriatic acid (8.2%). Only 3.9% of these
products were branded. Patients were subjected wrong practices such as feeding with yogurt
(14.8%) and drinking water(4.4%). Patients were hospitalized for 1 to 33 days. Also, average of
9.9 days in this period, they had prohibited oral intake.
CONCLUSIONS: It can be concluded that the subject of ‘Securing The Living Space’ which is
included in Primary Preventive Medicine is one the main practice of family physicians. The role of
the family physicians is very crucial since they are the first step of the health system.
Keywords: Corrosive Esophagitis, Family Physician, Preventive Medicine
P137[Thoracic Surgery]
Chest Wall Amyloidoma: A Case Report and Review of the Literature
Ali Kılıçgün1, Fahri Yılmaz2, Hüsna Bayrakdar2, Kamil Gürel3
1
Abant Izzet Baysal University, Department of Thoracic Surgery, Bolu
2
Abant Izzet Baysal University, Department of Pathology, Bolu
3
Abant Izzet Baysal University, Department of Radiology, Bolu
Amyloidoma is the least common presentation of tissue amyloid deposition, reported in many
anatomic sites including the genitourinary, respiratory, central nervous system, gastrointestinal
tracts, breast, skin and soft tissue. Amyloid is defined as an extracellular deposition of insoluble
protein complex in various tissues. Deposition of amyloid is generally systemic but sometimes it is
limited to a single organ. Amyloidoma of chest wall is extremely rare and it is previously reported
in a few cases in literature. Seventy-years-old woman with pain and swelling in her right breast
applied to our clinic. There was no known systemic disease in the story. In the radiological
examination of the patient, approximately 7x6 cm size tumor was observed at fifth rib in right
chest wall. In the light of those findings, with tomography-guided, tru-cut biopsy was performed to
the patient. Because of the fact that eosinophilic material gained from pathological results, patient
was scheduled for surgery. The tumors were removed after chest wall resection and reconstruction.
In the pathological examination of tumor, it was reported as amiloido. Due to the fact that the
placement of tumors to the chest wall is very rare, we presented this interesting case.
Keywords: Amyloid, Chest Wall, Thoracic Surgery,
P138[Thoracic Surgery]
Mediastinal germ cell tumor which has lung and sternal metastasis: a case
report
Merve Şengül1, Leyla Nesrin Acar1, Selim Şakir Erkmen Gülhan1, Pınar Bıçakçıoğlu1, Funda
Demirağ2
1
Department of Thoracic Surgery, Atatürk Chest Disease and Thoracic Surgery Education and
Research Hospital, Ankara, Turkey
2
Department of Pathology, Atatürk Chest Disease and Thoracic Surgery Education and Research
Hospital, Ankara, Turkey
%10-40 of germ cell tumors (GCT) have mixed histology. %7 of them be formed in the
mediasten.We present a mediastinal GCT case that metastases to lungs and sternum.
Case
A 15-year-old male patient presented with a one month history of cough.Chest X-ray showed
mediastinal enlargement. Chest CT scan revealed an approximately 19× 10×11cm mass in the
right hemithorax. We have performed biopsy by mediastinotomy. Due to frozen has resulted as
matur cystic teratoma we've decided to perform mediastinal excisional biopsy with right
toracotomy. Post operative pathology has reported as a mixed GCT that include both immatur and
matur teratom components(yolk sac tumor+choriocarsinoma+seminoma).Patient was undergo
chemotherapy programme in department of pediatric oncology.8 months after the surgery scans
have revealed an 1,2cm metastatic nodul in the middle lobe. Due to we've performed
metastasectomy with right retorakotomy.İt was verified by pathology report that it was a yolk sac
tumor metastasis.One year later,the patient presented with an approximately 20×10cm mass
above the sternum. PET-CT scan revealed an area of intense hypermetabolic activity within middle
and distal portion of the corpus sterni, extended to subcutaneous tissue exophyticly and including
bilaterally medial part of pectoralis major muscles(SUVmax:10.66).We have performed sternal
resection and reconstruction.Pathological report showed us it was a Malign Mixed GCT
metastasis(yolk sac+embriyonel karsinoma)and tumor gave invasion to sternal bone tissue but
found no tumor at the edge of the costal cartilage.
Result
Surgery followed by chemotherapy has been suggested at Mediastinal Malign GCTs. İt has bad
prognosis and survival rate is %57-88.
Keywords: germ cell tumor, mediastinum,surgery
P139[Thoracic Surgery]
A bronchopleurocutaneous fistula caused by an unusual foreign body
aspiration: Hordeum Murinum
Serda Kanbur, Talha Doğruyol, Serdar Evman, Elçin Ersöz, Mustafa Vayvada, Levent Alpay, Volkan
Baysungur, Çağatay Tezel
Süreyyapaşa Göğüs Hastalıkları ve Göğüs Cerrahisi Eğitim ve Araştırma Hastanesi
OBJECTIVE:
We report a case with Hordeum Murinum (HM) aspiration who was followed without diagnosis for
four months and presented with self extraction by fistulisation to the chest wall.
CASE:
Thirteen year-old male patient presenting with chest pain was referred to our clinic. Infiltration in
the right lower zone was seen on chest x-ray. Thorax computed tomography showed a lesion in the
posterobasal segment of the right lower lobe (Figure 1). Antibiotheraphy was started as patient
was negative for tuberculosis tests. During follow up physical examination showed pus coming from
the posterior axillary line of the 10. costa. Biopsy was taken and bronchoscopy was carried out.
Bronchoscopy was normal and biopsy result was reported as nonspesific inflammation. Abscess was
drained and cultures were negative. After four months of the first symptom, patient checked into
our outpatient clinic with a foreign body (FB) coming out from the area where abscess was drained
(Figure 2). FB was excised with the tissue surrounding and control bronchoscopy was performed.
Bronchial system was normal. In time skin lesion was closed, clinical and radiological recovery was
seen.
CONCLUSIONS:
FB aspirations can be seen in all age groups and is the most common cause of death due to home
accidents in infancy. HM is a stringy herb with a powerful tissue penetration that is very rarely seen
among FB aspirations. Cough, hemoptysis, dyspnea, pneumothorax, empyema and bronchiectasis
may be seen. Bronchoscopy and chest x-ray may be inconclusive for diagnosis.
Keywords: Hordeum
Figure
Murinum,
Foreign
Body
Aspiration,
Bronchopleuracutaneous
Fistula
1
Figure
2
P140[Thoracic Surgery]
A rare primary lung malignancy: Pulmonary Blastoma
Serda Kanbur, Talha Doğruyol, Serdar Evman, Elçin Ersöz, Mustafa Vayvada, Levent Alpay, Volkan
Baysungur, Çağatay Tezel
Süreyyapaşa Göğüs Hastalıkları ve Göğüs Cerrahisi Eğitim ve Araştırma Hastanesi
OBJECTIVE:
Pulmonary blastoma is a rarerly encountered lung tumor, usually seen in adults, consisting of
immature mesenchymal and/or epithelial structures. The most effective way for treatment is
surgical resection. Due to the rarity of this tumor in the literature we would like to present our
case.
CASE:
Fifty three year-old male patient presenting with cough and hemoptysis was referred to our clinic.
He had a 50 pack/year smoking history. Thorax computed tomography showed a 31x45mm mass
in the superior segment of the right lower lobe. Fiberoptic broncoscopic biopsy was reported as
non-small cell lung cancer (Figure 1). The maximum standardised uptake value in positron
emission tomography was 13.1 (Figure 2). Right lower lobectomy with mediastinal lymph node
dissection was carried out with right thoracotomy. The tumor was reported as biphasic pulmonary
blastoma and the inferior interlobar lymph node was reported as malignant. Patient was discharged
on the fourth postoperative day. He was given cisplatin-based adjuvant chemotheraphy and is in
the
fourth
month
of
follow-up.
CONCLUSIONS:
Pulmonary blastomas are developed from pulmonary mesenchymal tissue and seen in 0.25% to
0.50% of all lung tumors. They tend to appear peripherally and the prognosis is poor. The tumor is
classified in two groups as biphasic and monophasic types. The most common symptoms are
cough, hemoptysis and chest pain, however 25% to 40% cases are asymptomatic. Smoking history
is present in 82% of the cases. Surgical resection is the most effective treatment option, also
adjuvant chemoradiotheraphy is suggested.
Keywords: Pulmonary Blastoma, Lung Tumor, Thoracotomy
Figure 1
Figure 2
P141[Thoracic Surgery]
Maligniteyi taklit eden extra-abdominal fibromatozis; OLGU SUNUMU
Murat Kuru, Sami Ceran, Burhan Apilioğulları
Department of Thoracic Surgery,Meram Faculty of Medicine, Necmettin Erbakan University,Konya
Extra-abdominal fibromatozis(desmoid tümör), iyi differansiye kollajenöz fibroblastların yalancı bir
kapsül ile infiltratif büyümesi olarak tanımlanabilir. Fibrositler, fasya ve muskuloaponörotik
yapılardan gelişebilirler. Sıklıkla karın duvarı bölgesinde(%50) yerleşirler, bunu sırt göğüs duvarı
baş ve boyun ile alt ekstremiteler izler. Bu tümörlerin benign karakterli olmalarına karşın agresif
davranışları,lokal nüks oranı yüksekliği(yaklaşık %40) nedeniyle malign tümörler gibi tedavi
edilmeleri gerekliliği önemlidir. Tedavi geniş lokal eksizyon şeklinde olmalıdır. Etyolojileri iyi
tanımlanmamış olmakla birlikte travma,hormonal bozukluklar ve genetik etkenler en çok suçlanan
faktörlerdir. Biz, fizik muayene ve radyolojik bulgular nedeniyle malignite düşünülen, yapılan
operasyon sonucunda patolojisi extra-abdominal fibromatozis olarak rapor edilen olgumuzu
sunuyoruz.
Daha öncesinde bilinen bir rahatsızlığı olmayan 70 yaşında erkek hasta sol koltuk altında şişlik ve
ele gelen kitle nedeniyle başvurduğunda son 2 aydır sol kolunda,özellikle kolunu kullandığı
zamanlarda kramp tarzında geçici ağrıları olduğu öğrenildi.. Fizik muayenede sol aksillar bölgede
fikse ve solid karakterde yaklaşık 7x7 cm lik kitle lezyonu mevcuttu.Toraks BT ve MR incelemesinde
sol aksillada scapulayı saran ve destrükte eden, İVKM sonrası yoğun kontrast tutulumu gözlenen
heterojen karakterde lezyon rapor edildi. Hastaya sağ yan yatar pozisyonda sol torakotomi
pozisyonu verildikten sonra J kesisi ile sol orta aksillar hat hizasında yerleşmiş yaklaşık 7x7 cm lik
sert lastik kıvamında kas içerisinde fikse tümöral lezyona ulaşıldı. Kitleye ulaşmak için parsiyal M.
Latissimus dorsi insizyonu uygulanarak m. Teres major ve minöre uzanan kitleye geniş cerrahi sınır
uygulanarak rezeksiyon yapıldı.Patoloji sonucu extra-abdominal fibromatozis gelen hastanın ek
tedavisiz takibe alınmasına karar verildi. Postoperatif tümör lokalizasyonunda seroma ouşan hasta
tedavisi tamamlandıktan sonra postoperatif 8.günde taburcu edildi.
Keywords: extra-abdominal fibromatosis, desmoid,chest wall
thoracic MRI
thoracic MRI
P142[Thoracic Surgery]
Myastenia Gravis tedavisi verilen perikardiyal divertikül; OLGU SUNUMU
Burhan Apilioğulları, Sami Ceran, Murat Kuru
Department of Thoracic Surgery,Meram Faculty of Medicine, Necmettin Erbakan University,Konya
Myastenia Gravis anormal nöromuskuler iletimin neden olduğu otoimmün bir hastalıktır.
Postsinaptik membranda asetilkolin reseptörlerine karşı oluşmuş antikorlar yada kas spesifik tirozin
kinaz antikorlarınca meydana gelen otoimmun bir patolojidir. Özellikle beyin sapı motor nükleusları
tarafından innerve edilen istemli kaslar etkilenmektedir. Oftalmopleji,pitozis ve tekrarlayan
hareketlerle ortaya çıkan kas güçsüzlüğü ile karakterizedir. Myastenia gravisli hastaların %1015inde timoma, %70'inde ise lenfoid foliküler hiperplazi görülmektedir.Tedavisinde medikal
tedavinin yanı sıra kas güçsüzlüğü yaygın olan hastalarda timektomiye öncelik verilmelidir.Biz,
yaklaşık 1,5 yıldır myastenia gravis nedeniyle piridostigmin tedavisi alan ve yapılan cerrahi sonucu
perikardiyal kist tespit edilip postop 1.gün piridostigmin tedavisi kesilen olgumuzu sunuyoruz.
73 yaşında kadın hasta 1,5 yıldır myastenia gravis nedeniyle pridostigmin 4x1 tedavisi
almaktaymış. Son 15 gündür çabuk yorulma,yutma güçlüğü,aşırı terleme ve ara ara nefes darlığı
şikayeti mevcutmuş. Nöroloji kliniğinde yapılan toraks BT görüntülemesinde mediastende
prevasküler bölgede yaklaşık 5x3x2.5 cm ebadında düzgün sınırlı yumuşak doku dansitesinde
lezyon (timoma?) tespit edilmesi üzerine kliniğimize yönlendirilmiş.Fizik muayenesinde ek özellik
saptanmayan, asetilkolin reseptör antikor düzeyi negatif gelen, rutin kan tetkikleri normal olarak
raporlanan hastaya operasyon planlandı.Median sternotomi ile timus, çevre yağlı dokular ile geniş
rezeksiyon yapıldıktan sonra gözlenen perikardiyal divertikül çevresindeki lenf nodu ile birlikte
eksize edildi. Postoperatif birinci gün nöroloji kliniği tarafından mestinon tedavisi kesilen, patoloji
sonucu timus dokusu ve perikardiyal divertikül olarak rapor edilen hasta postoperatif 6.günde
sorunsuz şekilde taburcu edildi.
Keywords: myasthenia gravis, thymoma,pericardial diverticulum
thoracic CT
P143[Thoracic Surgery]
Blood patch pleurodesis in the treatment of persistant air leakage in
langerhans cell histiocytosis; a case report
Ayşe Baççıoğlu1, Nesimi Günal2, Ayşe Füsun Kalpaklıoğlu1, Koray Dural2, Berkant Özpolat2
1
Kirikkale University Faculty of Medicine, Department of Pulmonary Diseases, Division of
Immunology and Allergy Diseases
2
Kirikkale University Faculty of Medicine, Department of Thoracic Surgery
Pulmonary langerhans cell histiocytosis is a rare reactive disorder with unclear pathogenesis. 16year-old male patient complained about shortness of breath induced with exercise, non-productive
cough, and intermittent chest pain for one year. Pulmonary function tests were in restrictive
nature. There were multiple air cysts in lung parenchyma smaller than one cm and minimal
pneumothorax on the left hemithorax in high resolution computed tomography of thorax. There
was no hypoxemia in arterial blood gas analysis, and no pulmonary hypertension in
echocardiography. Pulmonary langerhans cell histiocytosis was diagnosed with clinical features and
typical radiographic appearance. Existence of multisystem langerhans cell histiocytosis was
excluded thorough a detailed history, comprehensive physical examination, and baseline
radiographic, blood and urine tests. He was recommended to quit smoking and close follow-up was
planned. A tube thoracostomy was performed for left sided total pneumothorax one month later,
and “blood patch” pleurodesis was done due to persistent air leakage with a successful outcome. As
far as we know this is the first case report of pulmonary langerhans cell histiocytosis who was
treated with autologous blood pleurodesis in the literature.
Keywords: Blood patch pleurodesis, histiocytosis, pneumothorax
P144[Thoracic Surgery]
In mediastinal lymphadenopathies with high FDG uptake in PET-CT
granulomatous diseases should be considered
Burçin Çelik1, Muhammed Ali Yılmaz1, Mehmet Gökhan Pirzirenli1, Murathan Şahin2
1
Department of Thoracic Surgery, Ondokuz Mayıs University Medical School, Samsun, Turkey
2
Department of Nuclear Medicine, Ondokuz Mayıs University Medical School, Samsun, Turkey
INTRODUCTION: Granulomatous diseases are quite common in our country. Tuberculosis and
sarcoidosis are the most common ones of these diseases. We would like to present cases of
granulomatous lymphadenitis which mimicked mediastinal tumors in PET-CT scanning and had high
FDG uptake.
CASE: Three patients whose PET-CT scannings revealed pathological FDG uptake due to
mediastinal LAP were admitted to our clinic. Two of them had cough and dyspnea and one had
operated breast ca+uterus ca. The patient with the diagnosis of breast ca+uterus ca was operated
in 2001 and 2009, and her follow-up PET-CT revealed pathological FDG uptake (SUV max: 20.3) in
the right paratracheal lymph nodes (LNs). In the patient who was examined for cough, PET-CT
revealed pathological FDG uptake (SUV max: 18.81) in the subcarinal and paraesophageal LNs.
Mediastinoscopic LN biopsies of these patients were reported as caseating granulomatous
inflammations. The other patient's PET-CT revealed pathological FDG uptake in subcarinal LNs
(SUV max: 21) and in the left interlobar LNs (SUV max: 28). The mediastinoscopic LN biopsy of
this patient was reported as non-caseating granulomatous inflammation.
CONCLUSION: Granulomatous diseases such as tuberculosis and sarcoidosis are the most
common causes of false-positive FDG PET-CT in our country. When the publications in the literature
are examined, it can be seen that FDG levels which have been reported are not as high as the ones
detected in our cases. In cases with high FDG uptake like our cases, we believe that tissue biopsy
is needed to eliminate the malignancy.
Keywords: mediastinum, lymphadenopathy, PET-CT, granulomatous disease
P145[Thoracic Surgery]
An Interesting Bronchial Anastomosis Causes Hemoptysis
Muhammet Ali Beyoğlu1, Leyla Nesrin Acar1, Selim Erkmen Gülhan1, Pınar Bıçakçıoğlu1, Ensar
Özdemir2
1
Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara,Turkey
2
Yuksek Ihtisas research and Training Hospital, Ankara, Turkey
Usually hemoptysis occurs from bronchial arterial circulation(%90-95).The blood supply of
bronchial arteria is systemic circulation therefore the bleeding preassure of bronchial arteria is
higher than pulmoner arteria. Bronchial arteria normally branches from descending aorta at the
level of T5-6 vertebrae. The abnormalities of bronchial arteria noticified %8-35. Acute control of
hemoptysis can be provided with bronchial arteria embolisation at 73- 98 percent. We present an
abnormal vasculer branching which causes hemoptysis. Left bronchial arter connected to right
internal mammarian arteria.CASE 42 year old male patient who had left thorocotomy lower
lobectomy operation three year ago because of bronchiectasis admitted to our clinic with
hemoptysis symptom. He has signified 400 ml of hemoptysis at the last 48 hours. At the physical
examination respiratory sounds was reduced at the left lower zone and determined ral at the
bilateral lower zones. In posteroanterior chest x-ray bilateral parenchymal infiltration and reduction
of left chest volume viewed. In thorax CT bilateral bronchiectasis and alveolar hemorrhage at the
left upper lobe and right lower lobe and left pleural thickness viewed. We did not determine active
hemorrhage at the fiberoptic bronchoscopy. Bilateral bronchial system cleaned from coagulum.
During the observation in intensive care unit,the patient had 150 ml of hemoptysis. We have
planned bronchial arteria embolisation. We have determined a pathologic left broncial arteria which
is connected with right internal mammarian arteria. The Bronchial arteria was obliterated. And the
patient discharged after 48 hour observation without hemoptysis.RESULT Hemoptysis is a common
symptom and requires urgent intervention.
Keywords: Hemoptysis, Bronchial arteria embolization, Bronchial arter abnormality
P146[Thoracic Surgery]
Permanent Lung Cavity Formation After Firearm Injury
Leyla Nesrin Acar, Muhammet Ali Beyoğlu, Selim Erkmen Gülhan, Pınar Bıçakçıoğlu
Ankara Ataturk Chest Disease and thorax surgery research and training hospital
Firearm injuries are 5 percentage of all thorax trauma. Firearm injuries have high preassure and
cause grave parenchymal damage at the surroundings tissue. The amount of tissue damage is
related with the amount of energy change between body and the penetrating object.
Released energy amount of the penetrating bullet is the difference amount of the inlet and outlet
moment. The energy alteration creates a permanent space in tissue. This space caused by the
tissue crush while the bullet in passing.If the densities of the damaged tissue is high it will absorbe
more energy amount. In this case we reported a permanent cavity formation after firearm injury.
CASE
21 year old male patient was considered with acut chest pain after firearm injury. In the physical
examination repiratory sounds were reduced at right hemithorax. In posteroanterior chest x-ray
hemopneumothorax and metalic object at the level of right scapula inferior border viewed. Right
hemithorax tube thoracostomy applied. In control chest x-ray bilateral lungs viewed expanse and
heterogen soft tissue densities at the right upper zone. In thorax CT, cavity formation viewed in
the right upper lobe. The bullet was placed under the skin, excised with local anesthesia. The
patient discharged after 10 day observation.
RESULT
Firearm thorax injuries are not very common in thorax trauma but requires urgent intervention and
clinical observation.
Keywords: Firearm thorax trauma, Penetrating thorax trauma, Hemopneumothorax
P147[Thoracic Surgery]
Postoperative satisfaction report of patients with pectus excavatum
corrected with minimally invasive technique
Akın Yıldızhan, Fatih Hikmet Candaş, Ömer Yavuz, Rauf Görür, Turgut Işıtmangil
GATA HAYDARPAŞA TRAINING HOSPITAL CHEST SURGERY SERVICE, İSTANBUL
BACKGROUND: In this study, postoperative period satisfaction levels of young patients who have
undergone minimally invasive correction of pectus excavatum, is researched.
METHOD AND MATERIALS: 23 males patients (mean age 21.7 years; range 21 to 27 years) who
had undergone minimally invasive intervention for the repair of pectus excavatum in our clinic
between March 2010 and December 2010 were restrospectively evaluated. Single step
questionnaires developed by Krasopoulos et al. have been administered to the patients in the
postoperative period.
RESULTS: In the preoperative period, all of the patients expressed that they social activity of their
naked chest sight. After surgery, 66.6 patients expressed that they social activity improved or
much improved, Self-respect average in the preoperative period was 5.16 (1-10); however, this
average increased to 7.38 (3-10) after operation.
In the postoperative period, 83.3% of our patients claimed that their health status was better,
44.4% of them told that their exercise capacity was better, 77.7 % of our patients expressed that,
they have no pain in postoperative period. 88.8% of them expressed that they were too much
pleased of their appearance and overall satisfaction with the final result.
CONCLUSİON: We observed that the correction of Nuss procedure straightens both the physical
and psychosocial well-being, having a positive effect on cosmetic pleasure of young adults,
postoperative period.
Keywords: Funnel chest; quality of life.
postoperative appearance
preoperative appearance
P148[Thoracic Surgery]
Nuss surgical technique results on pectus excavatum deformity
Ali Naycı1, Hakan Taşkınlar1, Cankat Erdoğan1, İsa Kıllı1, Semanur Kuyucu2, Olgu Hallıoğlu3, Dinçer
Avlan1
1
Department of Pediatric Surgery, Mersin University, Mersin, Turkey
2
Department of Pediatrics, Division of Allergy/Immunology, Mersin University, Mersin, Turkey
3
Department of Pediatrics, Division of Cardiology, Mersin University, Mersin, Turkey
AIM: Pectus excavatum is one of the anterior chest wall deformities where the sternum is like a
soup bowl. This deformity causes functional and physico-social disorders in children. Nuss
procedure is a minimal invasive technique for correcting this deformity. We evaluated our results
with this technique.
MATERIALMETHOD: 8 patients with the diagnosis of pectus excavatum who were treated with Nuss
procedure between 2009 and 2013 were included in this study. In this procedure; the depression of
chest was corrected by a substernal bar with the help of video-thoracoscopy. The results of this
technique, related factors associated with the success and the pleasure of patients were
retrospectively evaluated.
RESULTS: Preoperative data of patients were shown in the table. The mean follow-up period was
30,25±17,7 months. Nor recurrence neither early/late complication was seen. The symptoms or
complaints of patients were not decreased except for cosmetic appearing.
CONCLUSION: Nuss procedure is a minimal invasive, safe and successful technique for correcting
pectus excavatum deformity. Timing for operation, preparation and fixation of the steel bar and the
duration of the bar is closely related with the success of this technique. Cosmesis should be
emphasized while answering the expectations of these patients.
Keywords: Children, Nuss procesudure, pectus excavatum
Clinical features and preoperative findings
n=8
Sex
Mean
age
(years)
Sternal
Effort
Depressi Dyspn
on
ea
5M:3 10,25±3 8
F
,2
(%100)
Palpitati Heller
on
index
FEV1
6
1
3,74±1 93,66±1
(%75) (%12,5) ,6
3,3
FVC
FEV1/F
VC
91,83±8
86±7,5
,6
Echocardiogra
phy
MVP/MI
3 (%37,5)
P149[Thoracic Surgery]
Hemothorax that need to Thorachotomy due to central venous
catheterization
Yasemin Bilgin Büyükkarabacak, Ayşen Taslak Şengül, Burçin Çelik, Selçuk Gürz, Tuba Apaydın,
Ahmet Başoğlu
Department of Thoracic Surgery, Ondokuz Mayis University, Samsun, Turkey
AIM: In this study, we aimed to evaluate our patients who have hemothorax due to central venous
catheterization with literature.
PATIENTS: Four patients who were followed and treated because of chronic renal failure were
referred our clinic with breatness, chest pain and the disorder of general state. Right pleural
effusion was identified in all patients. Closed tube drainage was performed due to hemothorax that
was diagnosed with torasentesis. Drainage of hemothorax and decortication via thorachotomy were
performed to all of patients, because total expansion was not observed at control chest
radiography after closed tube drainage. Defect of V.Cava Superior was detected in two patients ant
defect of V.Subclavia was detected in two patients. But, none of them had active bleeding. The
pathological findings were reported as ' fibrinous pleuritis' in all of patients. There was no morbidity
and mortality.
CONCLUSION: If patients on hemodialysis have respiratory disorder after central catheterization,
iatrogenic hemothorax should be considered.Hemothorax that occurs due to central venous
catheterization can cause life threatening clinical results.
Keywords: catheterization, hemothorax, thorachotomy
P150[Thoracic Surgery]
Early surgical rib stabilization of flail chest
Yasemin Bilgin Büyükkarabacak, Ayşen Taslak Şengül, Zeynep Pelin Sürücü, Selçuk Gürz, Mehmet
Gökhan Pirzirenli, Ahmet Başoğlu
Department of Thoracic Surgery, Ondokuz Mayis University, Samsun, Turkey
İntroduction: Standart treatment method of flail chest is mechanic ventilation and internal
pnumotic stabilization.Recently, The aim is to decrese mortality and morbidity due to mechanical
ventilation with surgical stabilization is performed to patients who have flail chest.
In this study,patients who treated and followed due to flail chest are offered with literature.
MaterialMETHOD: Between 2009-2013, 20 patients who were treated and followed due to flail chest were
included in this study. 10 patients were treated with conservative treatment, 10 patient were
treated with surgical stabilization.Patients were evaluated for age,type of trauma, concomitant
trauma,time spent in hospital, mechanical ventilation time, mortality and morbidity.
RESULTS: In surgical stabilization group, average ventilator days was 6.8, and average ICU days
was 5.1 days, average time spent in hospital was15.9.In conservative treated patients group,
These times were 26.5,20.5 and 32.5 days respectively. Pnemonia was determined in 8 patients in
conservative treated group and 4 patienets in stabilization group. Mortality was 1 in surgical
stabilization group and 3 in conservative treated patient group.
CONCLUSION: Surgical stabilization of flail chest is a safe method to reduce mortality and
morbidity.
Keywords: flail chest, stabilization, surgery
P151[Thoracic Surgery]
Haemorrhage Into The Giant Bullae
Fuat Sayır1, Ufuk Çobanoğlu1, Hülya Günbatar2, Selami Ekin2, Aysel Sünnetçioğlu2, Selvi Aşker2,
Bünyamin Sertoğullarından2
1
Departmant of Thoracıc Surgery, Yuzuncu Yil University
2
Departmant of Thoracıc Medicine, Yuzuncu Yil University
Destruction of air spaces distal to the terminal bronchioles, caused by dilatation and come
together, the structure containing air on the lungs called bullae. Bullae can be seen also as a
complication of obstructive pulmonary disease may be part of as fibrotic lung disease. Bullae in the
presence of liquid-air level is often suggestive of infection. Massive hemoptysis, which may
depends on rarely bullae rupture of vascular structures in the wall. Spontaneous pneumothorax or
acute complications such as massive bleeding, even a tiny cysts require surgical intervention.
Infection and respiratory failure are mainly complications, as a result of mortality is 1.5%.
We presented a case, a rare complication of bleeding into bullae were operated in our clinic,59
years old male patient with shortness of breath and chest pain were admitted. He had 40 py
history of smoking and was monitored with COPD. On the computed tomography in the lower lobe
of the right lung 13x10 cm in size, containing air-fluid leveled and septation cystic lesion was
detected. The patient was taken to surgery, complicated bullae in the right lower lobe was excised
linear stated steppes, intense hemorrhage was removed. During the episode of surgery he had a
sudden cardiac attach and managed with medical treatment, was followed in the intensive care
unit. Patients followed with respiratory failure for 13 days in intensive care unit, died of cardiac
arrest.
Keywords: Bulla, lung, hemoptisis
Giant bullae, in inferior of right lung
P152[Thoracic Surgery]
Multidiciplinary approach for flail chest; a case
Özgür Karakurt1, Mehmet Ali Eryazğan1, Bülent Koçer1, Deniz Erdem2, Belgin Akan2
1
Departmant of Thoracic Surgery, Ankara Numune Teaching and Research Hospital, Ankara Turkey
2
Departmant of Anesthesiology and Reanimation, Ankara Numune Teaching and Research Hospital,
Ankara Turkey
Rib fractures are seen in 35- 40% of chest traumas, 10- 15% ofthese fractures may present with
flail chest. Flail chest has a mortality rate ranging 10- 40%. Mortality rate is usualy correlated with
coexisting severe multiple system injury.
A 45 year old male patient victim of a traffic accedent had epidural subdural hematoma, multiple
rib fractures in the left hemithorax, bilateral pulmonary contusion and flail chest. He had a
emergent craniotomy and 7 days after surgery he was unable to wean from ventilator. He
underwent a chest wall stabilasation and weaned from ventilator two days after stabilasation. He
was hospitalized for a month in order to eradicate wound infection. He has completed 1 year in the
follow-up and doing well.
Stabilasition of the anterolateral chest wall flail cehest is feasible in the absence of major
pulmonary contusion.
Keywords: Flail chest, Internal stabilasation, Multiple rib fractures, Trauma
Figure1
3 D reconstruction thorax CT images
Figure 2
Chest x-ray 3 months after surgery
P153[Thoracic Surgery]
Surgical treatment of lung's echinococcus cyst rupture into pleural cavity
Sunnatilla Abulkasimov, Shavkat Sabirov
Department of Thoracic surgery, National Center of TB, Tashkent, Uzbekistan
The rupture of echinococcus cyst into pleural cavity is a severe complication and frequent cause of
diagnostic mistakes. we observed 23 patients with the rupture of echinococcus cyst into pleural
cavity.
15 patients were treated during 1 month and 8 patients - during 3 months on account of TB,
pleurisy, spontaneous pneumothorax and empyema of pleura. Before operation in clinic according
to clinical-rontgenological data it was deternimed that only 6 patients. The remaining 17 patients
had lung collapse with presence of serous or purulent exudation in pleural cavity. It was also
observed that 7 patients had complete lung collapse of pleura and 16 patients had partial collapse.
18 patients had empyema of pleura developed and 5 had pleurisy. 15 patients had lung-pleural
process located on the right side, 8 patients - on the left side, 14 patients - mainly in lower
sections
of
the
lung.
Thoracotomy, ablation of shrunken chitinous shell from the pleural cavity and lung decortication
was carried out for 11 patients, lung echinococectomy was carried out 4 patients, lobectomy with
pleurectomy - for 3 patients, pulmon- and pleuropulmonectomy - for 5 patients. Good clinical effect
was
reached
for
all
operated
patients.
CONCLUSION: the rupture of echinococcus cyst into pleural cavity presents severe complication
and is subject to surgical treatment. The effectiveness of surgical treatment in case of this
pathology is high. The range of surgical operations is wide: from pleurectomy and decortication of
lung to pulmonectomy and depends on the condition of collapsed lung and pleural cavity.
Keywords: echinococcus cyst, complication, surgical treatment
P154[Thoracic Surgery]
Postpartum spontaneous pneumomediastinum
Ş. Mustafa Demiröz1, Mahmut Tokur1, Hilal Berber Kireçci2
1
Sutcu Imam University Medical School, Department of Thoracic Surgery, Kahramanmaras, Turkey
2
Private Caka Vatan Hospital, Department of Obstetrics, Kahramanmaras, Turkey
Postpartum pneumomediastinum (Hamman’s syndrome), typically occurs in young, healthy,
primiparous women.Incidence is estimated at 1 in 100000 deliveries.Treatment is supportive.Most
cases have a benign, self-limiting course, and recurrence is uncommon.It usually occurs in the
second stage of labour due to increased intrathoracic pressure.Upto our knowledge there are only a
few reports about post caseraen pneumomediastinum in English literature.
An 18 years old primagravida suddenly developed chest and neck pain with dyspnea just after the
elective cesarean section labour under epidural anesthesia.Both cardiac and respiratory sounds
were normal and there was no subcutanous amphysema.Vital signs and labortory findings were
within normal ranges.X-ray and CT revealed massive pneumomediastinum and also
pneumopericardium.No pneumothorax was present (Figure 1).ECG and arterial blood gas
examination were within normal ranges.Echocardiography was normal.Patient was taken to
intensive care unit for follow up and supportive treatment.
Pain and dyspnea were regressed by the 3th day.There was total resolution of pneumomediastinum
on CT in the 5th day of treatment (Figure 2) and the patient was discharged.
Pneumomediastinum is an unusual but potentially serious complication of labour.In Hamman's
Syndrome rupture of marginal alveoli with air entering into the mediastinum is the most likely
mechanism.Typical symptoms include chest pain, dyspnoea, dysphagia and neck pain.The
differential diagnosis includes PTE, AMI, aortic dissection, mediastinitis, pneumothorax and cardiac
tamponade.There are sometimes crunching sounds over the heart synchronous with the heartbeat,
called Hamman’s sign.Although most cases have a benign, self-limiting course, close monitoring is
required as theoretically cardiac tamponade can occur secondary to tension pneumomediastinum.
Keywords: Spontaneous Pneumomediastinum, Hamman's Syndrome, Postpartum, Caesarean
Section
Figure 1
Spontan pneumomediastinum and pneumopericardium developed after a cesarean section delivery.
Figure 2
Complete resolution of pneumomediastinum and pneumopericardium after five days of conservative therapy.
P155[Thoracic Surgery]
ROLE OF SURGERY IN TREATING OF FIRSTLY-FOUND DESTRUCTIVE
PULMONARY TUBERCULOSIS
Sunnatilla Abulkasimov, Shavkat Sabirov, Akram Irgashev
Department of Thoracic surgery, National Center of TB, Tashkent, Uzbekistan
Due to the ineffectiveness of the DOTS-chemotherapy, surgical treatment was performed in 72
patients with firstly-found fibrous-cavernous pulmonary tuberculosis (males – 43, females - 29) in
age of 18-53. Right before operations, 31 patients took treatment under the 1st DOTS category, 41
– under the 1st and 2nd categories successively during 1-1.5 years. Mycobacteria of tuberculosis in
sputum were found in 62 patients (86.1%), of them in 28 (38.8%) – with multi-drug resistance to
chemo-preparations
(izoniazid,
streptomycin,
etambutol,
rifampicin).
After pre-operative chemotherapy using basic and reserve preparations (etambutol, pirazinamid,
kanamicin, protionamid, lewofloksacin), segmental lung resection was performed in 15 patients,
lobectomy – in 21, pulmonectomy – in 28, thoracoplasty – in 8. Good clinical effect was reached in
66 patients (91.6%), unsatisfactory results – in 3 (4.2%). A total of 3 patients (4.2%) died from
the progress of post-operative pleural empyema and re-activation of tuberculosis.
Conclusion. Surgical treatment of firstly found fibrous-cavernous pulmonary tuberculosis after
ineffective therapy is important and significant for healing of the patients. It prevents transition of
the tubercular process in chronic forms
Keywords: PULMONARY TUBERCULOSIS, FIRSTLY-FOUND, surgery treatment
P156[Thoracic Surgery]
Extrapleural thoracoplasty MDR TB in lung
Shavkat Sabirov, Sunnatilla Abulkasimov
Department of Thoracic surgery, National Center of TB, Tashkent, Uzbekistan
Extrapleural thoracoplasty was performed in 88 patients. Patients were suffering from tuberculosis
from 2 to 5 years or more. Unilateral tuberculosis was diagnosed in 77.3 % of patients, bilateral in 22.7 %. Progressive course was observed in 70.5%, pulmonary hemorrhage - at 34.1%.
Drug resistance to chemo- 2 was found in 10.2%, to 3 drugs - 21.6 %, to 4 drugs - 37.5 %, to 5
drugs - at 30.7 %. After preoperative sputum conversion was achieved in 73.9 % of patients. 4- rib
thoracoplasty was performed in 2 patients (2.3% ), 5- rib - in 19 ( 21.6% ), 6- rib - in 61 ( 69.3
%), 7 - 8 rib - 6 ( 6 8% ) of them right - in 38 ( 43.2% ), left - in 50 patients (56.8 %).
Good results were achieved in the next 89.8% patients, unsatisfactory - in 7.9 %, with mortality in
2.3%.
Long-term results extrapleural thoracoplasty studied in 76 patients. 2-10 years ascertained clinical
cure in 93.4% patients, reactivation of tuberculosis - in 3.9%, mortality - in 2.6%.
Conclusion. With widespread and drug-resistant tuberculosis in the lungs and pulmonary resection
pneumonectomy are very dangerous because of the development of pleural pulmonary
complications and high mortality. This heavy contingent of patients extrapleural thoracoplasty is
the operation of choice with the nearest effective in 89.8 % and clinical cure in the remote terms 93.4 %
Keywords: MDR TB,lung, thoracoplasty
P157[Thoracic Surgery]
Malignant mesenchymal tumor of the chest wall; case report
Özgür Karakurt1, Mehmet Ali Eryazğan1, Mehmet Hakan Bulam2, Necip Cihan Hasçiçek2, Murat
İğde2, Bülent Koçer1
1
Departmant of Thoracic Surgery, Ankara Numune Teaching and Research Hospital, Ankara Turkey
2
Departmant of Plastic and Reconstructive Surgery, Ankara Numune Teaching and Research
Hospital, Ankara Turkey
Most of malignant mesenchymal tumors are located on lower extremities. Less frequently can be
found on thoracic and abdominal wall (%10-15).
Our patient is a 42-year-old male. 6 months before his admission to our clinic, he had a painless
mass on his left chest wall which was excised in another clinic. He had never gone to the other
clinic for pathological report. When he admitted to our clinic, he had a firm, painless, fixed mass on
his incision area. The pathological report was malignant mesenchymal tumor. At Thoracic CT an
MRI the mass was invading left 6th rib. The mass has been excised with lrft 6th and 7th ribs
including surrounding skin and subcutaneous tissue. The thoracic wall was stabilised with titanium
plates and mesh and skin and subcutaneous tissue defect was reconstructed with latissimus dorsi
musculocutaneous flap. He has no postoperative complications in our clinical follow-up.
It is crucial to have a preoperative pathological diagnosis to plan the definitive operation in chest
wall tumors. Massive chest wall resection and reconstructions can be performed in malignant chest
wall tumors with low morbidity and mortality.
Keywords: Chest wall, malignant mesenchymal tumor, reconstruction
Figure 1
Resection material
Figure 2
Intraoperative view of latisimus dorsi musclecutaneous flap and chest wall defect
P158[Thoracic Surgery]
Plication of the Diaphragm from Mini Incision (Case Report)
Sezai Çubuk, Gökhan Ayberik, Orhan Yücel, Alper Gözübüyük
Department of Thoracic surgery, Gata Medical Faculty, Ankara
Plication of the diaphragm is a surgery done for the fixation and pulling downward of the paralized
diaphragm to prevent the paradoxal movement of the diaphragm during respiration. We want to
express our results of thoracoscopic diaphragm plication in an obese female patient.
A sixty nine year old female admitted to our department with a complaint of dyspnea. Physical
examination of the patient revealed decreased breath sounds in the left lower hemithorax. Left
hemidiaphragmatic eventration was found on the chest X-ray of the patient (Figure 1). Respiratory
function test revealed restrictive respiratory failure. When we examined the patient’s history, we
have found that the patient had undergone a by pass operation one year ago. We suggested
diaphragmatic plication to the patient after the flouroscopy that showed paralysis of the left
hemidiaphragm. Procedures of the surgery was declared to the patient and minimally invasive
approach was planned for the patient because of obesity and advanced age. Plication of the
diaphragm was performed with a 4 cm. utility access in the 7 th intercostal space and a camera
port in the 4 th intercostal space. Pain complaint was minimal in postoperative period and dyspnea
was disappeared. The FVC value was improved from %57 to %96.
Recent advanced minimally invasive interventions are used in nearly every part of the thoracic
surgery practice. In this patient by using a 3 cm. incision, we minimalized the negative effect of the
thoracotomy on respiratory functions. Diaphragmatic plication via VATS is a safe procedure with
acceptable results.
Keywords: Diaphragma, Plication, VATS
Figure 1
Elevated left hemidiaphragm
P159[Thoracic Surgery]
Inflammatory Myofibroblastic Tumor With A Malign Appereance (Case
Report)
Sezai Çubuk, Gökhan Ayberik, Orhan Yücel, Alper Gözübüyük
Department of Thoracic Surgery, Gata Medical Faculty, Ankara
Inflammatory myofibroblastic tumor, known also as inflammatory pseudotumor, is a rare benign
tumor formed with the abnormal proliferation of the inflammatory cells. Lesions are generally found
in the lungs. Lesions are asymptomatic and there are no specific findings. The lesions are
diagnosed with histopathological examination eventually. We want to present our case prediagnosed malignancy but diagnosed as benign characterised inflanmmatory myofibroblastic tumor
after histopathological examination.
Fifty seven years old man admitted to our department with mediastinal lymphadenopaties and
bilateral lesions in the lungs (Figure 1). Thoracotomy was performed to the patient after the nondiagnostic bronchoscopy and fine needle aspiration biopsy. Because of multiple lesions and the
procedure was a performed for diagnosis, wedge resection was performed for the lesion in the
superior segment of the lower lobe of the right lung. The pathology of the lesion was reported as
inflammatory myofibroblastic tumor. The patient was taken to the conrol protocol. These lesions
can regress because of their inflammatory nature. But no change and invasion of the lesion can be
seen. Our case was regressed during the follow up period.
Distinction of the lesions from malignant tumors in inflammatory myofibroblastic tumors is difficult
as in our case. The treatment of the inflammatory myofibroblastic tumor is complet resection.
Relaps after the complet resection is rare. Chemotherapy, radiation therapy, steroid treatment can
be chosen for the cases that complet resection was not performed.
Keywords: Inflammatory Myofibroblastic Tumor, Malignancy, Regression
Figure 1
Bilateral lesions in the lungs
P160[Thoracic Surgery]
Gossypiboma Causing Ventricular Wall Laceration (Case Report)
Sezai Çubuk, Gökhan Ayberik, Orhan Yücel, Alper Gözübüyük
Department of Thoracic Surgery, Gata Medical Faculty, Ankara
Gossypiboma is a general name given to the mass forming textile materials which are left in the
surgical field inadvertently. We here want to present a paracardiac localized gossypiboma case
diagnosed incidentally who was operated for the reflux disease before.
50 years old female patient admitted to our department for a paracardiac lesion found in the
routine examination of the type 2 atrial septal defect surgery that is performed in childhood. She
was undergone a laparoscopic Nissen fundoplication 3 years ago. A mass lesion of 5x3 cm adjacent
to the ventricle was detected in the thorax tomography of the patient (Figure 1). Left thoracotomy
was performed to the patient and dens adhesions to the pericard was noticed. The lesion was freed
from the pericardium and lungs with blunt and sharp dissections. While dissecting the pericardium,
we found that the lesion had adhesions to the myocardium. After resection of the lesion, bleeding
control was performed. During the bleeding control, the ventricle was lacerated from the weakest
point. Bleeding was controlled with pledgeded sutures. No trombus was found in the
echocardiography of the patient performed after the operation. The patient was discharged and she
is under now under control for two years.
Gossypibomas are surrounded by a fibrous material that can adhere to the adjecent tissues.
Unwanted complications can be seen by these adhesions during dissection. The possibility of
cardiac and great vessel lacerations should be kept in mind while dissecting the foreign bodies
adjacent to these structures.
Keywords: Gossypiboma, Laceration, Ventricle
Figure 1
Lesion near the ventricle
P161[Thoracic Surgery]
Endobronchial Valve in Prolonged Air Leakage (Case Report)
Sezai Çubuk1, Orhan Yücel1, Ergun Tozkoparan2, Alper Gündoğan2
1
Department of Thoracic Surgery, Gata Medical Faculty, Ankara
2
Department of Chest Disease, Gata Medical Faculty, Ankara
Endobronchial valve is a bronchocopically applied procedure, generally performed for volume
reduction in emphysema. We used endobronchial valve for prolonged air leakage in a patient that
has von-willebrand disease. In this case report we want to indicate that the endobronchial valve
procedure can also be performed succesfully for prolonged air leakage.
21 years old man admitted to our department with effort dyspnea. Cavity in the right hemithorax
and trombocytopenia was deteched in the examination tests (Figure 1). The patient was operated
for the cavitary lesion with a hemotology consultation that was expressed as operable. The patient
was taken to the operation room in the postoperative early period for the increased hemoragic
drainage. No major focus for the bleeding was found intraoperatively. Drainage was controlled with
administration of eritrocyte suspention and fresh frozen plasma. The patient was consulted to the
hematology department again and von-willebrand disease was diagnosed after further evaluation.
Prolonged air leakage was found in the patient postoperatively. Because of hematologic disorder of
the patient, endobronchial valve was applied to the patient. After application of three valves to the
right upper lobe the patient was discharged. The valves were taken out after three months and no
air leakage was found.
Endobronchial valve is a safely applied bronchoscopic procedure that requires no surgical
intervention. The advantages of the procedure are safeness and easy appliablity, disadvantage is
expensive. Much more clinical trials are needed, for the exact effect of the endobronchial valve
procedure in the prolonged air leakage.
Keywords: Air leakage, Endobronchial, Valve
Figure 1
Cavitary lesion in the left hemithorax
P162[Thoracic Surgery]
A case with unusual localized thymoma was resected completely by
uniportal video assisted thoracic surgery
Ümit Aydoğmuş, Gökhan Öztürk, Gökhan Yuncu
Department of thoracic surgery, Pamukkale Univercity
Thymoma is a rare tumor usually localized anterior mediastinum. We herein reported a case with
thymoma localized paracardiac area that was resected completely by uniportal video assisted
thoracic surgery (VATS).
In thorax tomography of the patient referring chest pain, limited well lesion was localized at right
paracardiac region which pushed the lung parenchyma. The size of lesion that was in the anterior
mediastinum adjacent to the right atrium was approximately 50x33 mm and its average density
was 52 HU. We performed VATS. The lesion was removed en bloc using by single port disection.
The radiological differential diagnosis of the lesion was considered bronchogenic cysts and
pericardial cysts, and was reported as type AB thymoma by patologists.
Thymomas are commonly observed anterior mediastinum. The diagnosis of atypical localization of
thymomas is usually difficult. Hence increasing use of VATS provides minimally invasive diagnosis
and treatment of mediastinal mass.
Keywords: Thyoma, Unusual localized thymoma, uniportal videoasisted surgery
Visualization of mass in VATS
Visualization of mass in VATS 2
P163[Thoracic Surgery]
A Rare Complication Of Pika; Stone Aspiration and Caused To Lobectomy
Asuman Akın Türker, Leyla Nesrin Acar, Selim Şakir Erkmen Gülhan, Barış Hekimoğlu, Pınar
Bıçakcıoğlu
Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital
Pica is a condition with an unknown etiology and related to iron deficiency anemi a most of the
time. Intestinal obstruction and lead toxicity are the common complications of pica, where as stone
aspirati on has not been reported before as a complication.
CASE REPORT
A 38-year-old female patient presented with history of pica and had admitted to our clinic with
respiratory distress symptoms. Respiratory distress occurred after she took a stony sand in her
mouth. The physical examination revealed decreased respiratory sounds in the right hemithorax.
There was no patology detected on the chest X-ray (Figure 1). We have performed rigid
bronchoscopy and found foreign body (stone fragment) in the enterence of right lower basal
segment. We couldn’t remove the stone fragment because it was stuck into the segment. Under
general anesthesia the foreign body has palpated at out of the bronchus of basal segment, we have
tried to remove it with broncotomy but lower lobectomy have performed due to it had stuck into
the segment by right posterolateral thoracotomy (Figure 2). In the postoperative period the patient
was discharged on 6.days.
At the first visit after the operation,she has neglected the treatment and had has no treatment for
anemia, it is worrying that she says still desires to eat sand from time to time.
RESULT
Pika is a state of intestion of non-food ingredients. Stone aspiration is rare complication of pica.
Keywords: Pica; respiratuar aspiration;lobectomy
Preoperative X-ray
Appearance of resected lower lobe and stone
P164[Thoracic Surgery]
Spontaneous pneumomediastinum, chest pain
Aslı Balaban1, Rukiye Metineren1, Mehmet Suat Patlakoğlu2
1
University of Dumlupınar,Evliya Çelebi Goverment Hospital, Pulmonary Diseases Department
2
University of Dumlupınar,Evliya Çelebi Goverment Hospital, Pulmonary Surgery department
Pneumomediastinum can be described as air trapped in the mediastenium. The reason in most of
the cases is trauma. Usually no symptoms are seen and diagnosed spontaneously. Spontaneous
pneumomediastinum is mostly seen in young man and recovers spontaneously. Clinical signs are
varabile and the most common symptom is substernal pain. İn this case, the patient refered to our
clinic with chest pain and dyspnea. The aım of this case report is to emphasise that we must
consider spontaneus pneumomediastinum in differantial diagnosis of chest pain.
Keywords: spontaneous, pneumomediastinum
picture1
picture2
P165[Thoracic Surgery]
Togetherness of Thymolipoma and Thyroid Papillary Microcarcinoma
Ali Özdil1, Huriye Gülistan Bozdağ1, Alpaslan Çakan1, Ufuk Çağırıcı1, Özer Makay2, Mine Hekimgil3
1
Department of Thoracic Surgery, Ege University School of Medicine, İzmir, Turkey
2
Department of General Surgery, Ege University School of Medicine, İzmir, Turkey
3
Department of Pathology, Ege University School of Medicine, İzmir, Turkey
Thymolipoma is a rare tumor of anterior mediastinum that grows slowly. These tumors correspond
to 2% to 9% of all thymic neoplasms. Disorders such as myasthenia gravis, thymoma, aplastic
anemia and Hodgkin disease can also accompany thymolipoma rarely.
CASE: A 30-year-old woman, who had been examined with the complaint of shortness of breath,
was referred to our clinic because of detection of anterior mediastinal mass. Mediastinal
enlargement was seen in chest x-ray and thorax CT scan revealed commonly increased amorphous
densities in the mediastinal fatty tissue with demarcated margins those continued from the logy of
thymus to the cardiac level; hyperthyrophic right lobe of thyroid gland, intraglanduler nodule,
mediastinal elongation of inferior edge of thyroid gland (Figure 1). After the evaluation by general
surgery clinic, thyroidectomy was suggested for patient because of the retrosternal elongation of
thyroid gland. The patient was discharged in the fourth day postoperatively after an uneventful
follow-up. The result of histopathological examination was reported as “thymolipoma and papillary
microcarcinoma of thyroid gland”. The patient had radioactive iodine therapy for thyroid carcinoma
and was scheduled for follow-up for thymolipoma.
RESULT: Total extirpation of the mass is supposed for the treatment of thymolipoma. In the
literature several cases were reported those included togetherness of thymolipoma with thymoma,
thymic carcinoma, thymic carcinoid, lymphoma and neuroendocrine tumors, but the togetherness
of thymolipoma and thyroid papillary microcarcinoma was not reported.
Keywords: mediastinal surgery, thymolipoma, thyroid carcinoma
Figure 1
CT findings of retrosternal thyroid tissue and thymic pathology
Figure 2
Peroperative photos of thymolipoma
P166[Thoracic Surgery]
A Rare Mass On Male breast: Pilomatricoma
Bayram Metin1, Sevinç Şahin2, Selda Seçkin2, Yavuz Selim İntepe3, Eylem Yıldırım3, Hasan Doğru1
1
Bozok University, School of Medicine,Thoracic Surgery Department.Yozgat
2
Bozok University,School of Medicine,Patology Department,Yozgat
3
Bozok University, School of Medicine,Chest Dissease Department.Yozgat
Only few breast pilomatrixomas have been reported, with well defined nodules with
microcalcifications. İn this paper we report the of a case of pilomatrixoma
of the male breast, a rare benign neoplasm.
CASE: 25 years old male patient come with complaints mass on the right breast and under the
skın. Her laboratory test was normal. A mass lessıon was palpated about 3 cm upper of right breast
at the physicial examination.Often ıt has in the head and neck region. It is more common in women
and female-male ratio is 3:2. Patient's mass was removed by enucleated total incision of about 1
cm with local anesthesia. Pathology results was be came to pilomatrixoma of patients has been
followed.
RESULT: Previously known as calcifying epithelioma of Malherbe the pilomatricoma, is a benign
tumor.emerging from the matrix cells of hair roots located deep dermal or subcutaneous.It ıs most
common the chıldren and adults and ıts %60 ıs occured at first two decades.treatment is local
excision.
Keywords: pilomatricoma, breast, surgical treatment.
P167[Thoracic Surgery]
Recurrent spontaneous rib fracturs at patient with takayasu arteritis
Bayram Metin1, Aylin Okur2, Yurdanur Akyüz2, Halil İbrahim Serin2, Hasan Doğru1
1
Bozok University, School of medicine,Thoracic Surgery Department,Yozgat
2
Bozok University, School of medicine,Radıology Department,Yozgat
Entry: Takayasu's arteritis is a chronic large vessel vasculitis, developed in more young people,
influenced primarily at the aorta and branchs, watching with granulomatous inflammation in the
vessel wal. Corticosteroids and methotrexate, azathioprine like a traditional immunosuppressive
drugs are often used at the Takayasu treatments. Significant side effects may occur during the use
of steroids. One of this side effects are development of osteoporosis and spontaneous rib fracturs
releated this. We present a case of fracture of rib due to a long time the use of steroid for
Takayasu arteritis.
CASE: 34 year old male patient has been having severe pain on the right side of the chest For the
past week, have taken steroids and methotrexate therapy due Takayasu's arteritis over the past 10
years. He has continued to use steroids without going to control for last 2 years. Her PA Lung
graphy was normal. Fractur of Right 9. Rib and Callus of right 10. Rib seem at the thoracic CT.
Bone mineral density was decreased (osteopenia) and fracture risk was high In bone
densitometry.After the patient's control pain, patient were referred to follow-up the clinic for
reorganization of the direction for the Takayasu treatment.
RESULT: Treatment of rib fracture is closely related to the underlying etiology.Patients receiving
long-term steroid must be evaluated for osteoporosis. Which patients is to be given steroids to
More than six months should be performed a bone densitometry.
Keywords: Takayasu arterits,Spontaneous rib fractures, steroıd therapy.
P168[Thoracic Surgery]
Myofibroblastic tumors; Case report of Noduler Fasciitis
Mehmet Özgel, Sevinç Yağcı, Duran Yıldız
Malatya State Hospital, Departman of Thoracic Surgery Clinic, Malatya, Turkey
Nodular fasciitis (NF) is a benign, reactive proliferation of fibroblasts in the subcutaneous tissues
and commonly associated with the deep fascia. It is also known as subcutaneous
pseudosarcomatous fibromatosis, or proliferative fasciitis. NF is one such benign fibroblastic
proliferation whose rapid growth and rich cellularity frequently cause the lesion to be misdiagnosed
as sarcoma.
NF is most commonly seen between 3. and 4. decades and men and women appear equally
affected. Although it may be seen in any part of the body to the upper extremities, especially the
forearms are the most commonly affected regions. Trunk is the second most commonly affected.
Nodul is most commonly seen single, solid and palpable. It's size is approximately 2 cm.
Ultrasound-guided needle biopsy can be diagnosed with. If it does not pain, it can be followed or
therapeutic excision can be performed both diagnostic and treatment. Recurrence rate is around
1%. If it is would relapse, the diagnosis should be revised.
Keywords: Solitary nodul, chest wall
Figure 1
A mass in sternum and first costal junction in a section of Coronal T1-weighted MRI of the chest wall.
Figure 2
A round mass under pectoralis major in section of axial T1-2 weighted MRI.
P169[Thoracic Surgery]
Removal of an intraparenchymal foreign body by video-assisted
thoracoscopic surgery (VATS); A rare indication (Case Report)
Gürhan Öz1, Sibel Günay2, Ersin Günay3, Adem Gencer1, Okan Solak1
1
Department of Thoracic Surgery, Afyon Kocatepe University School of Medicine, Afyonkarahisar,
Turkey
2
Pulmonary Diseases Clinic, Afyon State Hospital, Afyonkarahisar, Turkey
3
Department of Pulmonary Diseases, Afyon Kocatepe University School of Medicine,
Afyonkarahisar, Turkey
Headscarf needle (or turban pin) swallowing and aspiration is a common event, especially in
countries where the Muslim population is more. Aspirated foreign bodies can be removed usually by
bronchoscopy procedures (flexible or rigid) or thoracotomy when bronchoscopy was failured.
Here, we reported the case of a 21-year-old woman who accidentally aspirated a turban pin.
Firstly, she applied to a gastroenterology clinic of a different hospital. Because of the localization of
turban-pin under diaphragm on chest-X ray, she underwent repeated unsuccessful gastroscopy
procedures (3 times). After taking her history in detail and combining with the upper sections of
abdominal tomography, we localized foreign body in her left lower lobe parenchyma. Video
bronchoscopy with a flexible fiberoptic bronchoscope was applied to this patient but turban pin
could not be visualized because of its localization at the periphery of the lung. The needle was
finally removed by video-assisted thoracoscopic surgery (VATS).
To our knowledge, this is the first intervention for removal of turban pin in our country and 2nd in
the English literature. So, we wanted to present this successful VATS operation for this rare
indication with the guidance of literature.
Keywords: Aspiration, foreign body, thoracoscopy, turban pin
P170[Thoracic Surgery]
VATS Thymothymectomy: Micronodular Thymoma with lymphoid stroma
Murat Kapdağlı, Salih Duman, Berk Çimenoğlu, Berker Özkan, Adalet Demir, Alper Toker
Departmant Of Thoracic Surgery, İstanbul Medical Faculty, İstanbul, Turkey
Thymomas are the kind of lesions which are located at anterior mediastinum and frequently
accompany paraneoplastic and autoimmune diseases. Lymphoid stomal micronoduler thymoma is a
rare subgroup of thymomas. These type of thymomas are limited neoplastic lesions which do not
cause recurrance, metastasis or malignancy related mortality, and have a benign course. In this
case report we will discuss a 61 year old female patient who had a 3.5 cm lesion located at anterior
mediastinum with concomitant oculopharyngeal muscular distophy, who underwent VATS
thymothymectomy The lesion was diagnosed as a lymphoid stromal micronoduler thymoma after
long term histopatologic study Close follow up was recommended post operatively. As a conclusion,
thymomas accompany autoimmune and paraneoplastic sendromes, and rare histopatologic
subgroups of thymomas have no exception.
Keywords: Thymoma, Anterior mediastinum, Micronodular thymoma, thoracoscopic
thymothymectomy
THORAX CT
Anterior mediastinum 3,5cm mass
P171[Thoracic Surgery]
Catamenial hemoptysis
Mehmet Bilgin, Duygu Kırıcı
Erciyes Universty Faculty of Medicine Departmant Thoracic Surgery
Catamenial hemoptysis is a rare condition that is associated with the presence of intrapulmonary or
endobronchial endometrial tissue. We describe a case of endobronchial endometriosis with
catamenial hemoptysis.
The patient was an 18 years old girl presented with recurrent hemoptysis episodes for the last
seven months. She had admitted to emergency department a couple of times with massive
hemoptysis. Bronchoscopic examination was performed, but no hemorrhagic focus was observed.
Hemoptysis were decreasing the second day and there was no hemoptysia in the third day. In
addition to bronscopy, the patient’s eosophagus, stomach and duodenum endoscopy was
performed. Follow-up bronchoscopic examination at the end of the menstrual cycle revealed that
the previous tracheobronchial lesions had disappeared.The patient was treated with GonadotropinReleasing Hormone (GnRH) analogues and hormones including estrogen and progesterone
therapy.
No hemoptysia after treatment made us think catamenial hemoptysis as possible diagnosis.
Keywords: Catamenial hemoptysis, endobronchial endometriosis, massive hemoptysis
P172[Thoracic Surgery]
Endobronchial Lipoma: A Rare Case
Barış Hekimoğlu1, Leyla N. Acar1, Erkmen S.ş. Gülhan1, Pınar Bıçakçıoğlu1, Yetkin Ağaçkıran2, Ali
Beyoğlu1
1
Department of Thoracic Surgery, Atatürk Training and Research Hospital for Chest Disease and
Chest Surgery, Ankara
2
Department of Pathology, Atatürk Training and Research Hospital, Ankara
Introduction
Endobronchial lipoma(EL) is extremely rare benign tumor, the incidence of bronchial lipoma among
all pulmonary tumours is 0.1-0.5% and 13% of benign tumors of lung. EL's are usually caused
when bronchial occlusion with nonspecific symptoms may be diagnosed incidentally. The failed to
respond to treatment of asthma, lung presenting with destructed, with a preliminary diagnosis of
malignancy in patients who were examined preoperative/postoperative EL diagnosed cases in
literature are included. Here was investigated due to pleural effusion and incidental presented rare
case of EL.
Case Report
Fifty-seven year old female patient was admitted to clinic with complaints of shortness of
breath.On physical examination, decreased breath sounds in right hemithorax was detected. Chest
radiograph findings consistent with right pleural effusion was detected and therefore, computed
tomography results pleural effusion on right side, in middle and lower lobes of right lung collapseconsolidation with air bronchograms were seen. Thoracentesis and closed pleural biopsy was
performed from right hemithorax. Fiberoptic bronchoscopy was performed to examinate the
bronchial tree. In right system problems were encountered. At left upper lobe apicoposteriorsegment entrance yellow-vascularized endobronchial lesion was determined, performed biopsies.
Pathologic examination detected mature adipose cells and identified EL. Patient refused further
evaluation, treatment and follow-up left.
Discussion
EL's are benign lessions but they can cause destroyed lung because of obstruction of bronchial
system. For this reason they should be removed endoscopically. Examining patients presenting
with pleural effusions, underlying pathologies must be kept in mind, if possible, endobronchial
system should be examined by endoscopic methods.
Keywords: Endobronchial lipoma, bronchoscopy, benign lung tumors
P173[Thoracic Surgery]
Giant Solitary Fibrous Tumor Causing Hypotension
Mehmet Furkan Şahin, Koray Aydoğdu, Funda İncekara, Göktürk Fındık, Sadi Kaya
Ankara Atatürk Chest Diseases and Chest Surgery Education and Research Hospital, Department of
Thoracic Surgery
Solitary fibrous tumors of the pleura is a rare disorder and usually arise from the visceral pleura.
They are usually benign, but %12-37 of cases might have a malignant course. These lesions are
usually asymptomatic. Non-specific findings can be seen, depending on the size and localization of
the mass. These slow-growing tumors can reach the size of filling the hemithorax. İn the diagnosis
imaging modalities are utilized. Preoperative diagnosis of these lesions are quite difficult, for the
definitive diagnosis, histopathological examination of total excised mass is required. Although
surgical removal of the tumor is enough for the treatment,there is risk of recurrence after surgery.
For this reason, in the postoperative period especially for malignant ones, close follow-up is
recommended.
In our study,we presented the case, although lesion is reached giant sized, proceeds
asymptomatically, preoperatively diagnosed by invasive approaches, intraoperatively from the
moment of patient appointed to the left decubitus position, rapidly hypotension clinic is developed,
caused by the malignant solitary fibrous tumor.
Keywords: hypotension, malign solitary fibrous tumor
CT imaging of solitary fibrous tumor
CT imaging of the solitary fibrous tumor -2
P174[Thoracic Surgery]
Coexistence of The Air İn Spinal Canal and Pneumomediastinum: A Case
Report
Kubilay İnan, Funda İncekara, Koray Aydoğdu, Göktürk Fındık, Sadi Kaya
Ankara Atatürk Chest Diseases and Chest Surgery Education And Research Diseases, Department
of Thoracic Surgery
Spontaneous pneumomediastinum is a rare clinical condition. Pneumomediastinum incidence were
reported as 1/7000 – 1/32000. Clinical presentation with sudden onset of chest pain, difficulty
breathing, cyanosis, dysphagia, dysphonia, subcutaneous emphysema and possible neck and back
pain. İn the diagnosis of these cases, chest radiography and CT is sufficient. BT is the most
sensitive method for the diagnosis of pneumomediastinum. Air bubbles seen with mediastinal
enlargement will confirm the diagnosis. In treatment, patients not considered surgical intervention
should not take food orally on follow up. İn this process patients are followed by. making daily
physical examination and chest radiographs. Follow-up of patients with symptoms regressed
rapidly and characterized clinically stable can be discharged.
8 year old male patient with chest pain, shortness of breath admitted to our clinic under
emergency conditions. İn radiography mediastinal emphysema has been showed. During one-week
clinical follow-up of patients receiving antibiotic treatment were also followed radiologically. In
addition mediastinal emphysema seen in CT, air in the spinal canal has been determined. Brain
surgery department recommended the antibiotic treatment and follow-up for the patient.In one
week follow up clinical complications have not developed. After clinical improvement in patients
discharging has been planned.
İn this study we wanted to emphasize that the cases with pneumomediastinum, air can also be
found in the spinal canal.
Keywords: Pneumomediastinum, Air İn Spinal Canal
Air in Spinal Canal
P175[Thoracic Surgery]
Primary Lung Adenoid Cystic Carcinoma
Cemal Özçelik1, Alper Avcı1, Derya Gümürdülü2, Muharrem Özkaya3
1
Thoracic Surgery Department, Cukurova University, Adana, Turkey
2
Pathology department, Cukurova University, Adana, Turkey
3
Thoracic Surgery Department, Numune Hospital, Adana, Turkey
INTRODUCTION:
Adenoid Cystic Carcinoma (cylindroma)(ACC), usually originated saliavry gald malignancy and
rarely seen pulmonary truck. Most of pulmonary ACC are originated trachea and major bronchies.
peripheral pulomary ACC is only 10% of all pulmonary ACC. primary peripheral pulmonary ACC is
so rarely, most of them are metasthasis. we are reporting a acse report of a patient who was
presented multıpl pulmonary masses in the right lung and treated by right intrapericardial
pneumonectomy.
CASE:
A-59 years old man who had right lower lobectomy before( carcinoid tumor) before was admitted
to thoracic surgery clinic because of the chemo threapy resisstant multıpl right lung masses. Chest
CT showed multıpl masses which is 5 cm maximal diametered. byopsy diagnosed ACC. Right
intrapericardial pneumonectomy was applied for surgical treatment and patient was referred for
radiotheraphy. 12 th month's follow up showed no recurrence.
DISCUSSION:
ACC, is a malignancy peaked 4-5 th decataes and no sex dominance.because the mass is covered
by mucasa, sputum study has no role in diagnosis. chosen curative treatment is surgical resection.
because of the submucosal spreat and local postoperative recurrences pneumonectomy is chosen
surgical tecnique. Most of patients are unresectabl and radiotheraphy is alternative tecnique for
these. Slow grown of the malignancy, every treated patient has high survi for 5 years.we think that
in suitable patients, surgical pulmunary resection is curative treatment for ACC.
Keywords: Adenois Cystic Carcinoma, Lung, Surgery
P176[Thoracic Surgery]
Giant Pulmonary Inlammatory Myofibroblastic Tumor In a Child
Alper Avcı1, Cemal Özçelik1, Derya Gümürdülü2
1
Thoracic Surgery Department, Cukurova University, Adana, Turkey
2
Pathology department, Cukurova University, Adana, Turkey
INTRODUCTION:
Pulmonary inflammatory myofibroblastic tumor (plasma cell granuloma)(IMT) is commonly seen
lower than 40 age. It is rare but important pulmonary tumor in childhood. It is 0.7% of all lung
tumors. No differences between sex and citizen origins. It is accepted a benign tumor, but some
suugest it as low grade malignancy because of the local invasion cases. Pathogenesis is unknown,
authoimmunity and inflammatory response could be the reason. Most of them are seen pulmonary
nodules, and there are no case over 7 cm diametered. We here present our case of IMT which is
giant(15x8x5 cm) diameters.
CASE:
a-9 yeras old boy was refered our clinic with chronic cough and right lung mass. Chest CT showed
15x8x5 cm lung mass. Diagnosis of IMT was obtained by transthoracic byopsy. Right
intrapericardial pneumonectomy and lymph node disection were applied via right thoracotomy. IMT
diagnosis was corrected. There was no recurrence at the 6th month’s follow up.
DISCUSSION:
The chosen treatment of IMT is compler surgical resection. Uncomplet resected cases have high
risc of recurrences. Corticosteroid treatment is recommented in childhood not even adult with
unrecectabl tumor cases. 5 year survilance is over than 90% in surgical group. Patients should be
closed follewed up after surgery because of the recurrence risk even it is accepted benign. We
suggest extensive surgery in resectabl IMT cases.
Keywords: Inflammatory Myofibroblastic Tumor, Child, Surgery
P177[Thoracic Surgery]
Anterior Mediastinal Fibromatosis
Cemal Özçelik1, Alper Avcı1, İsmail Can Karacaoğlu1, Derya Gümürdülü2
1
Thoracic Surgery Department, Cukurova University, Adana, Turkey
2
Pathology department, Cukurova University, Adana, Turkey
INTRODUCTION:
Mesenchymal tumors, either benign or malignant, are rare in the mediastinum, constituting less
than 2% of all mediastinal tumors and tumor-like lesions. Fibromatosis (desmoid tumor) is
commonly seen intraabdominal and head-neck region. Mediastinal fibromatosis is rare and only a
few cases are reported in the litherature. We are reporting a mediastinal fibromatosis case.
CASE:
A-45 Years old femalr admitted to our clinic with chest pain. Chest CT showed well circumcated,
16x7x7 cm diametered solid mass in the anterior mediastinum. Mediastinal mass excision was
applied via median sternotomy. Excisied mass was diagnosed fibromatosis histopathologically.
There was no recurrence at the 18 th month’s follow-up.
DISCUSSION:
Fibromatosis is a histologically benign tumor composed of fibroblasts and abundant collagen.
Although fibromatosis does not metastasize, it invades locally in an aggressive manner, infiltrating
into soft tissues and destroying the adjacent bones. Chosen treatment is surgical excision. Local
recurrences are frequent and radiothreapy is the chosen tecnique such these cases. Survival rate of
5 year is over than 95% surgical patients with tumor nagtive margins. We suggested that
fibromatosis sholud be keep in mind in the mediastinal masses diffrential diagnosis and must be
widely resected because of the local invasion risks.
Keywords: Fibromatosis, Mediastinum, Surgery
P178[Thoracic Surgery]
Spontaneous pneumothorax and Marfan sydrome
Deniz Doğan1, Ömer Alan2, Mehmet Aydoğan3, Alper Gündoğan1, Nesrin Çandır1, Cantürk Taşçı1
1
Department of Pulmonary Medicine, Gulhane Military Medical Faculty, Ankara, Turkey
2
Department of Pulmonary Medicine, Ankara Mevki Military Hospital, Ankara
3
Department of Pulmonary Medicine, Isparta Military Hospital, Isparta
CASE: 24 year-old-male patient was admitted with complaints of dispnea. His medical history
revealed pervious tube thoracostomy operation with the diagnosis of right spontaneous
pneumothorax. Clinical examination showed tube thoracotomy scar in the right hemithorax and
normal breath sounds in both hemithoraxs. Also, a slightly high arched palate was evident with
arachnoidactyly. Etiologic investigations was planned because of spontaneous pneumothorax
history. Waters graphy revealed high arched palate (Picture 1). There was no significant pathology
on PA chest radiography. Then, thorax HRCT (high resolution computed tomography) was
performed due to previous spontaneous pneumothorax but there was no pathological findings on
thorax HRCT scans (Picture 2). Also, his pulmonary function test was normal (FEV1: %82 (4.83l),
FVC:%86 (5.78l), FEV1/FVC:79.4, FEF25-75: %73 (3.85l)). The patient was diagnosed with Marfan
syndrome as a result of the genetic analysis.
CONCLUSION: Marfan syndrome is a hereditary disease affecting major skeletal system,
cardiovascular system and the eyes. As seen in the literature, approximately 4-15% of patients
with Marfan syndrome may develop bulla-bleb formation. Despite the story of pneumothorax in our
case, there were no pathological findings in advanced radiological evaluation. The diagnosis of
Marfan syndrome can be revealed with inspection findings and then with the advanced diagnostic
tests. In our case the situation leading to the diagnosis is previous spontaneous pneumothorax. In
this case report, we try to present the association between spontaneous pneumothorax and Marfan
syndrome.
Keywords: Spontaneous pneumothorax, Marfan syndrome, Tube thoracostomy
P179[Thoracic Surgery]
Konservatif Tedavi Edilen Trakeal Rüptür; Olgu Sunumu
Murat Kuru, Sami Ceran, Burhan Apilioğulları
Department of Thoracic Surgery,Meram Faculty of Medicine, Necmettin Erbakan University,Konya
Trakeobronşial rüptürler oldukça nadir görülmekle birlikte hayatı tehdit eden durumlardır.
Trakeobronşial yaralanmaların oluşum mekanizmalarında künt travmalar,penetran ve iyatrojenik
yaralanmalar rol oynamaktadır.Trakea rüptürlerinde seçilmiş olgularda konservatif tedavi
yapılabilmekle birlikte genel kabul gören yaklaşım cerrahi tedavidir. 2 cm’ye kadar olan yırtıklarda
konservatif tedavi, 4 cm’yi aşan yırtıklarda ise cerrahi onarım önerilmektedir. Laserasyonun
derinliği de önemlidir. Yüzeyel yırtıklar konservatif tedavi ile iyileştirilebilirken tüm duvarı tutan
yırtıklar ancak cerrahi onarımla iyileştirilebilir. Biz, künt travma sonrası trakea posterior duvarda
yaklaşık 5 cm’lik laserasyon gelişen, genel durumu iyi olması nedeniyle konservatif tedavi edilen
olgumuzu sunuyoruz.
19 yaşında erkek hasta ağaç nakliyatı sırasında iki ağaç kütüğü arasına sıkışması üzerine
başvurduğu dış merkezde yapılan fiberoptik bronkoskopi sonucunda trakea orta bölümünden
başlayan ve sağ ana bronş ayrımına kadar devam eden posterior yüzde 5 cm’lik laserasyon tespit
edilmesi üzerine kliniğimize yönlendirilmiş. Fizik muayenesinde genel durumu orta-iyi,şuuru açık ve
koopere olmakla birlikte palpasyonla minimal servikal ciltaltı amfizem olup oskültasyonda bilateral
akciğerler doğaldı. WBC:13,2 olan hastanın diğer kan tetkikleri normaldi. Oral alımı kesilen
hastanın ürografinli özofagografisinde kaçak saptanmadı, moksifloksasin ve metronidazol ile
mediastinit profilaksisi başlanıldı. Parenteral beslenme devam eden hastanın 5.gün oral alımı
başlanıldı. Takiplerinde ciltaltı amfizeminde azalma olan, ateş vb. komplikasyonlar gelişmeyen
hasta 10.gün sorunsuz şekilde taburcu edildi. Hastanın 1 ay sonra yapılan kontrol bronkoskopisinde
trakeada stenoz oluşturmayan vertikal granülasyon dokusu izlendi. Travma sonrası 6 aylık
takibinde semptomsuz izlenmekte olan hastayı cerrahi gerektirebilecek bir vaka olmasına rağmen
konservatif tedavi edilmesi nedeniyle sunuyoruz.
Keywords: tracheobronchial rupture, trauma, conservative
P180[Thoracic Surgery]
Tracheal Extramedullary Plasmositoma
Alper Avcı1, Cemal Özçelik1, Derya Gümürdülü2
1
Thoracic Surgery Department, Cukurova University, Adana, Turkey
2
Pathology department, Cukurova University, Adana, Turkey
INTRODUCTION:
Extramedullary plasmacytoma (EMP) is a rare plasma cell malignancy described outside of the bone
marrow. Plasmacytoma is relatively uniform proliferation plasma cells. EMPs arise in soft tissues
and form 8% of all plasma cell neoplasms. Most of EMP are localicated upper digestive-respiratory
systems. Tracheal tumors are uncommon and represent around to 2% of all respiratory tract
tumors.EMP is counted 3% of tracheal tumors. We report of a tracheal EMP case.
CASE:
A-51 years old female admitted to our clinic with dyspnea and cough. Chest CT showed a right
sided tracheal 3x3 cm mass in trachea. There was a anterolaterally tracheal obstruction. Tracheal
parcial excision, tracheoplasty was applied via median sternotomy after bronchoscopic
examination. Histopathological diagnosis was EMP. The patient was referred for radiotheraphy. No
recurrence at 6 th month’s follow-up.
DISCUSSION:
Tracheal tumors are rare and most of them are squamous ceel carcinoma and adenoid cystic
carcinoma types. Tracheal EMP is so rare. Usually ıt appears in 50-60 years old men with airway
obstruction symptyoms. Chest CT is one of the most important tecnique for the lesion’s
measurements, localications and for deciding treatment alternatives. Because of ıt is rarely seen,
there is no certain treatment tecnique forn EMP. Surgery and radiotheraphy are used for unique or
combined. Local recurrence ans metastasis are reported in limited reports approximately 30%. We
suggested that EMP should be keep in mind in additional diagnosis in tracheal tumor cases. And
also think that radiotherapy sholud be a alternative or primary treatment of EMP.
Keywords: Extramedullary plasmositoma, Trachea, Surgery
Tracheal lesion
The mass is obstructing trachea anterolaterally: CT
P181[Thoracic Surgery]
A Rare Endobronchial Foreign Body: A Tooth
Mustafa Gültekin, Atilla Can, Tamer Altınok
Necmettin Erbakan University Meram School of Medicine Department of Thoracic Surgery Konya
Turkey
Tracheobronchial foreign body aspiration,occurring in childhood (most often 1-3 years) and 7% of
fatal accidents were reported to be.If left untreated, can result in morbidity and even mortality.In
order to prevent serious complications,early diagnosis and treatment are very important.Promote
family history is the most important,suspected foreign body aspiration is an indication of a rigid
bronchoscopy.Often,sunflower,hazelnut,pistachio,toy parts are aspirated,while dental aspiration as
a foreign body aspiration is rare.
CASE: An eight-year-old girl,whose mother was about to exit her milk teeth during the operation
because of the removing from her hands she aspirated that.On chest X-ray calcified foreign body in
the right main bronchus was seen and on CT scan hyperdense foreign body was found in right
intermediate bronchus approximately 10 mm in size.She was referred to our clinic.Rigid
bronchoscopy was performed the same day and the tooth,nearly completely obstructing the right
main bronchus was removed.The next day she was discharged without complications.
Clinically recurrent pneumonia,lung abscess,acute respiratory distress,chronic lung injury and
irrevesibl even complete obstruction of the airway can cause death as a result of foreign body
aspiration.Especially in infants and small children because of the narrower diameter of the airways
the risk increases.Treatment is rigid bronchoscopy.
Keywords: foreign body aspiration, rigid bronchoscopy, tooth
P182[Thoracic Surgery]
Coexistence of Morgagni and Hiatus Hernias
Atalay Şahin, Abdullah Böyük, Ahmet Erbey, Menduh Oruç, Ahmet Sızlanan
Department of Thoracic Surgery, Dicle University, Diyarbakir, Turkey
Morgagni hernia is an uncommon pathology and a very rare condition in advanced age. Morgagni
hernia acts asymptomatic in adulthood but can turn on symptomatic situation in the later.
Morgagni hernia and associated hiatal hernia were diagnosed in a 75 year old woman who admitted
with severe dyspnoe, dysphagia and dyspepsia. Whole Omentum was seen to pass into the thorax
in the patient WHO was treated via laparotomy.
We present this condition that is rare but morbid when untreated.
Keywords: Morgagni, hiatal, hernia
Figure 1. Preoperative thorax tomograpy scan
P183[Thoracic Surgery]
Giant Simple Cyst of the Diaphragm In an Infant: A Case Report
Mustafa Gültekin, Atilla Can, Tamer Altınok
Necmettin Erbakan University Meram School of Medicine Department of Thoracic Surgery Konya
Turkey
The diaphragm means "intervening fence" in Greek.Two dome-shaped muscle that separates the
abdomen and thorax and aponeurosis consists of an anatomical structure. The most important
muscle in the human body after the heart and it is the body's functional striated the second most
powerful muscle.
CASE: One year old male infant,with the complaint of cough, sputum production and shortness of
breath and on chest radiograph in the left hemithorax properly limited consolidated area was
detected and he referred to our clinic. In thorax CT, contrast enhancement observed in the capsule
around the cystic lesion 9x8 cm in size, extending to the the spleen.Thoracic MRI on the left lung
approximately 9x8, 5x8 cm in size capsule with a hyperintense on T1-and T2-weighted sequences
containing proteinaceous cystic lesion was thought to be viewed.In the left lateral
thoracotomy,lung or chest wall is not associated with the cystic lesion thin wall thickness was
observed. When we opened the cyst a serous fluid was aspirated caused by the diaphragm and no
association was found with abdomen. Cyst was excised totally to diaphragmatic plication was
performed.Pathology was reported as, simple cysts (lined by mesothelial cells).
Cystic lesions may be acquired or congenital.In congenital cysts, showing similar histological
features,bronchogenic cysts, and teratoid cysts include sequestration.We offer our case,because of
the rarity of enormous proportions in infants.
Keywords: diaphragm, infant, giant cyst
P184[Thoracic Surgery]
Primary pleural hydatid cyst: A case report
Mustafa Gültekin, Atilla Can, Tamer Altınok
Necmettin Erbakan University Meram School of Medicine Department of Thoracic Surgery Konya
Turkey
Hydatid disease is a world health problem,especially in the Mediterranean countries including
Turkey and some other countries.The most common primary inoculation areas are liver and
lung.Intrathoracic but extraparenchimal placement is uncommon.Mostly as a result of parenchymal
rupture of hydatid cysts of the mediastinum, pericardium, pleura and chest wall become
inoculated.Although a wide variety of symptoms,30% of patients are asymptomatic.Primary
hydatid cyst of the pleura that we offer due to its rarity.
CASE: A 43 year old female,presented with back pain,in thorax CT the middle and lower zones of
dense calcified pleural-based periphery of the biggest 5x3, 5 cm sized nodular lesions were
observed.She was operated upon the detection of thoracic MRI of the left lung lower lobe laterally
localized pleural two separate focal calcification containing the mass,as well as lower lobe chest at
the level of lateral fill the walls and parenchyma towards the growth lobulated wall calcification
located cystic lesion.Hydatid cysts in the left thoracotomy with visceral pleural lesions located
between the parietal and visceral pleura,which is tightly bound to the visceral pleura,no connection
to the parenchyma was detected.Pathology results were reported as hydatid disease.She was
discharged on the fourth postoperative day without any complication.
Pleural hydatid disease can be classified as primary or secondary.The majority of reports of pleural
hydatid cysts in the pleural space and trans-diaphragmatic perforation caused by a transition
cysts.Primary pleural hydatid cysts are rarer than the secondaries.
Keywords: hydatid cyst, pleura, thoracic surgery
P185[Thoracic Surgery]
Thoracic trauma caused thoracotomy incision: Report of two cases
Mustafa Gültekin, Atilla Can, Tamer Altınok
Necmettin Erbakan University Meram School of Medicine Department of Thoracic Surgery Konya
Turkey
Penetrating thoracic traumas are life-threatening and require immediate intervention among
emergency chest surgery.Thoracic injuries can vary from simple skin incision can get into the
lungs.Depending on the size of the injury treatment can result in tube thoracostomy or emergency
thoracotomy.Most of penetrating chest trauma occur as a result of gunshot or stab wounds.We
offer one cattle attack case and the other one as a result of stab presenting to the emergency
department,the thoracotomy incision to create adventitious injuries and were treated without
requiring additional incisions.
Case1:Six-year-old male,with cattle attack with its horn in the left hemithorax penetrating thoracic
8th intercostal space about six-centimeter incision that creates (thoracotomy) showed and patient
was operated urgently.Placing the retractor through the incision provide exploration.About two cm
from the anterior diaphragm,lung parenchyma, primary repair of lacerations were the two cm.He
was discharged on the fifth postoperative day without any complication.
Case2: 24 years old male, depending on stab wounds were evaluated in the emergency
department. Left thoracotomy incision according to five cm thoracic penetrating injury to seventh
intercostal space.He was operated urgently.The cut was enough for exploration and no other
incision needed.Two cm parenchyma laceration was repaired primarly.He was discharged on the
third postoperative day without any complication.
Mortality in penetrating thoracic trauma,is lower than blunt chest trauma.Tube thoracostomy in the
treatment of stab wounds is usually sufficient,but 20 to 30% of cases in the emergency
thoracotomy is required.
Keywords: thoracic trauma, thoracotomy, thoracic surgery
P186[Thoracic Surgery]
Ogilvie Syndrome occurring after thoracic trauma
Mustafa Gültekin1, Atilla Can1, Tamer Altınok1, Murat Çakır2
1
Necmettin Erbakan University Meram School of Medicine Department of Thoracic Surgery Konya
Turkey
2
Necmettin Erbakan University Meram School of Medicine Department of General Surgery Konya
Turkey
Ogilvie's syndrome or acute colonic pseudo-obstruction, is a kind of syndrome also known as
excessive dilatation of the colon without organic obstruction findings.It is described in 1948 by
Ogilvie.This syndrome is rare and has a history of major trauma or surgery.Specific treatment of
the disease is a conservative approach and colonoscopic decompression.As a result of thoracic
trauma have presented our case because of its rarity.
CASE: A 45 year old male patient after a traffic accident with multple rib fractures and a right
hemopneumothorax treatment was started after emergency tube thoracostomy.In the early period
he was mobilized. On the third day gas, stool output stopped and oral intake interrupted and
abdominal CT scans were made.Excessive dilatation was present in the colon.In general surgery,
the patient underwent colonoscopic decompression and Ogilvie syndrome was diagnosed.Motility
regulators added to the treatment.No complications occurred during follow-up the patient was
discharged on the fifteenth day.
Ogilvie's syndrome, together with difficulties in diagnosis and treatment is a cause of significant
morbidity and mortality.Colonic ischemia and perforation are the most serious complications seen
in Ogilvie Syndrome.Spontaneous perforation has been reported in 3-15% of patients.Complaints
has decreased in most patients with colonoscopic decompression.Surgical intervention is an other
treatment method with signs of peritoneal irritation and in patients who do not benefit from colonic
decompression.
Keywords: thoracic trauma, pseudo-obstruction of the colon, Ogilvie Syndrome
P187[Thoracic Surgery]
Bilateral Pnömotoraksın Eşlik Ettiği Travmatik Pnömomediastinum: Olgu
Sunumu
Burhan Apilioğulları, Murat Kuru, Sami Ceran
Department of Thoracic Surgery,Meram Faculty of Medicine, Necmettin Erbakan University,Konya
Mediastende hava bulunması ''Pnömomediastinum'' olarak tanımlanmaktadır. Pnömomediastinum
görülme sıklığı 1/32000 ila 1/7000 arasındadır.Bu tablo kendiliğinden oluşabileceği gibi, travmatik
olarak da oluşabilmektedir. Kendiliğinden oluşan ve spontan pnömomediastinum olarak da ifade
edilir ve nadir görülür. Genellikle genç erkeklerde görülürken, travmatik pnömomediastinum;
toraks travmaları ve servikal travmalar sonucunda herkesde gelişebilir.Göğüs ağrısı, yutma
güçlüğü, pnömotoraksın eşlik ettiği vakalarda solunum sıkıntısı görülebilir.
Biz,travma neticesinde bilateral pnömotoraks, yaygın ciltaltı amfizemi nedeniyle kliniğimize
yönlendirilen,sonrasında pnömmediastinum tespit edilen hastayı sunuyoruz.
49 yaşında erkek,yaygın ciltaltı amfizemi,solunum sıkıntısıyla kliniğimize yönlendirildi.Hastada
bilateral pnömotoraks tespit edilmesi üzerine bilateral göğüs tüpü uygulandı.Toraks BT'de
pnömomediastinum saptanan hastanın Romatoid Artriti mevcuttu. Sağ 6-7 kotlarda fraktürü olan
hastanın yaygın akciğer spazmı vardı. Göğüs tüpünden,bronkodilatatör tedaviden fayda gören
hasta, klinik ve radyolojik olarak düzelmesi üzerine drenleri alınarak taburcu edildi.
Pnömomediastinumda PA-AC grafisinde solda kalp ile mediastinal plevra arasında hava sütunu hattı
tipiktir.BT ile kesin tanı konur.Olgumuzda yaygın ciltaltı amfizemi PA-AC grafisinin
değerlendirmesini zorlaştırmıştır.Bu yüzden tanı BT ile konmuştur.
Biz hastamızda toraks travması neticesinde alveoler rüptür ve pnömotoraks geliştiğini,
pnömotoraksın da mediastinal plevrayı bilateral etkilemesiyle pnömomediastinuma ve karşı
akciğerde pnömotoraksa neden olduğunu düşünüyoruz.
Pnömomediastinumun tedavisinin temeli altta yatan nedene dayanmaktadır. Eğer ana bronşial
sistem, akiğer parankimden major hava kaçağı, özofagus rüptürü gibi bir problem tespit
edilmemişse,tedavide çoğunlukla koruyucu ve destek amaçlı tedavi yeterlidir. Ciddi
komplikasyonlar için mediastinal iğne aspirasyonu,servikal mediastinotomi gibi cerrahi yöntemler
kullanılabilir.
Sonuçta pnömomediastinum, spontan veya travma sonucu oluşabilir. Kliniği oldukça değişkenlilk
gösterir. Komplikasyon gelişirse morbidite ve mortalitesi yüksek bir klinik durum olabilir.
Pnömotoraksın pnömomediastinuma eşlik edebileceği ve bilateral pnömotoraks durumunda
hastanın hayatının riske girebileceği unutulmamalıdır.
Keywords: Pneumothorax,Pneumomediastinum,trauma
chest x-ray
chest CT scan
P188[Thoracic Surgery]
Spontaneous Expectoration of a Bullet Following Gunshot, Presentation of a
Rare Case
H Volkan Kara1, N Onur Ermerak1, Çagatay Çimşit2, Pelin Çorman Dinçer3, Çağatay Çetinkaya1,
Bedrettin Yıldızeli1
1
Marmara University Faculty of Medicine Department of Thoracic Surgery Ístanbul
2
Marmara University Faculty of Medicine Department of Radiology Ístanbul
3
Marmara University Faculty of Medicine Department of Anesthesiology and Reanimation Ístanbul
Íntroduction:
Foreign bodies penetrating the thoracic cavity may have unpredictable course of behaving.
We present a penetrating gunshot case with an unexpected course with demonstrative radiological
images.
CASE:
39 year old woman had a gunshot. She had a penetrating wound on her right chest as the entrance
but no exit could be detected. After she was shooted she mentions a cough followed by a foreign
metallic body she exhaled. She had a computer assisted tomography revealing right
hemopneumothorax but no visual metallic foreign body. We inserted a chest tube and was a
massive air leakage right lung was nonexpanded
We did fiberoptic bronchoscopy and could not detect any prominent endobronchial pathology so did
a right thoracotomy. There was a small laceration on the mediastinal pleura and going through the
junction of cartilageous and membranous portion of the trachea which explains spontaneous
expectoration. We fixed the lacerated area. Her post operative period was un eventful and
discharge from the hospital on the 5th day of surgery.
This patient and her story reached to the national media by the family and discussed about the
possibility and mechanism of expectoration.
Discussion
This case seems to be the first documented patient that spontaneous expectoration had happened
at the time the injury. The lack of exit wound would be alarming the surgeon for existing
foreignbody within the body or even rarely spontaneous evacuation.
Keywords: Spontaneous Expectoration,Bullet, Gunshot
P189[Thoracic Surgery]
Non-penetrating thoracic work accident: A case report
Mustafa Gültekin, Atilla Can, Tamer Altınok
Necmettin Erbakan University Meram School of Medicine Department of Thoracic Surgery Konya
Turkey
According to blunt thoracic trauma penetrating trauma is less common.The most common causes
of stab wounds include,gunshot wounds,less frequently traffic accidents, falls and animal
bites.Penetrating thoracic trauma injuries, 37% of all firearm injuries accounted creating accounted
for 5%.We offer our patient who is exposed to a fall without penetrating stab wounds to the
thorax.
CASE: A 28 year old male patient at a construction site fell on the ground from a height of about
four feet, about 1.5 meters rebar in hand and it stucked to his right hemithorax.He was brought to
the emergency room without hte removal of that rebar.On the eighth intercostal space, anterior
axillary line on right hemithorax directed towards the interior of the thorax and palpation under the
tip of the scapula, which is manupil body (rebar) was present.Pneumothorax and hemothorax were
not seen on chest X-ray.Stab in the muscle layers of the body wall of the thorax showed that
watch.The patient could not get into body tomography because the rebar is large.Urgent
operational requirements set and foreign body was taken under sedation.Chest CT taken on the
absence of active bleeding.Rib fractures, hemothorax and pneumothorax were not observed.There
were hematoma and emphysema in the layers of muscles.A drain placed into the area of the injury
anda after the completion of treatment he was discharged on the sixth day without any
complications.
Penetrating thoracic trauma is a life-threatening emergency after blunt chest trauma.Treatment
options are,as in our case,conservative treatment,tube thoracostomy or which may require
emergency thoracotomy.
Keywords: non-penetrating thoracic injuries, work accidents, thoracic surgery
Picture 1
Rebar stuck patient to the right hemithorax
P190[Thoracic Surgery]
A Rare Case of Chylopericardium Presenting as Cardiac Tamponade
Secondary to Absence of Vena Cava Superior
Hakkı Ulutaş, Muhammet Reha Çelik, Akın Kuzucu
University of Inonu Faculty of Medicine Turgut Ozal Medical Center Department of Thoracic Surgery
Accumulation of the chylous fluid in the thorax and pericardium is called chylothorax and
chylopericardium, respectively.Herein, an extremely rare case of absence of vena cava superior
(VCS) and concomitant chylothorax / chylopericardium was presented.
Chest computed tomography of a 20-year-old male patient with the complaints of chest pain,
palpitations and shortness of breath revealed bilateral pleural and massive pericardial effusion
causing pericardial tamponade. Trigyseride and cholesterol levels of the fluid were 403 mg/dl and
51 mg/dl, respectively. Total parenteral nutrition was administered, however chest tube drainage
remained more than 500 cc daily. Video assisted thoracoscopy was performed and a pericardial
window was created with biopsies obtained from both pleura and pericardium. Somatostatin analog
was administered intravenously (5 µg/kg/h), since the chylous drainage continued at postoperative
day seven. Ligation of the thoracic duct was performed after a 3 weeks course of combined
treatment. Histopathological examination of the biopsies was reported chronic pleuritic and fibrotic
changes in both pleura and pericardium. Although chylous drainage from both hemithoraces has
terminated, serous drainage remained about 1000 cc/day on the left side. Computed tomography
angiography of the chest showed the absence of VSC and the patient was referred to military
hospital according to wishes of the patient and his relatives.
Absence of VSC as a cause of chylopericardium and / or chlothorax with no other obvious cause is
a very rare condition in the literature. This case emphasises that absence of VCS has to be
considered in the differential diagnosis within the context of chlopericardium.
Keywords: Chylopericardium, Absence of VSC, Cardiac Tamponade
P191[Thoracic Surgery]
Accidental Diagnosis Of Intrathoracic Needle
Ahmet Sızlanan, Serdar Onat, Serdar Monis, Ali Bırak, Refik Ülkü
Dicle University Faculty of Medicine Department of Thoracic Surgery, Diyarbakir,Turkey
CASE:
A 55 years woman was admitted with complaints of dyspnea to an other hospital. She had asthma.
A needle was seen on P-A chest graphy. She was admitted to our hospital because suspect of
bronchial foreign body. She did not have any history of foreign body. Lateral chest graphy revealed
multiple pieces of opaque needle. One part of the needle was intrapleural and the other parts were
in the muscles.
With the aid of scopy and thoracoscopy foreign bodies were removed.
Keywords: foreign body,videothoracoscopy, chest X-ray
P192[Thoracic Surgery]
A Case of Traumatic Diaphragmatic Rupture and Herniation of the Stomach
Sedat Koçal1, Kerem Karaarslan1, Tülin Durgun Yetim1, Ibrahim Yetim2
1
Department of Thoracic Surgery, Mustafa Kemal University, Hatay, Turkey
2
Department of General Surgery, Mustafa Kemal University, Hatay, Turkey
Diaphragmatic injuries in blunt and penetrating thoracoabdominal trauma, are less common
injuries and encountered serious difficulties in diagnosis. It can be diagnosed early or late. At the
end, herniation of abdominal organs to thorax is seen. The goal of surgery is attracting the organs
into its anatomical position and repairing diaphragm with primary suture or with a graft.
In our case, 31 year old male patient whom injured with gunshot 3 months ago in Syrian War and
had undergone emergency loparotomy was admitted to our hospital with dispnea and patient had
no gastrointestinal complaints. Tomography shown left diaphragmatic rupture and a large portion
of the stomach and intestines were herniated. Left thorocotomy was done. About 10x8 cm in the
left anteromedial diaphragmatic defect observed and here herniated stomach and the pericardium
was found to be adherent to the lung parenchyma. Adhesions were cleaned, abdominal organs
were taken to the anatomic position and the defect was repaired with a dual-mesh. Patient was
discharged after removing draine in post-op day 3.
Diaphragmatic injuries are often diagnosed late because of difficulties in radiological examinations
and both together along with the more serious due to other trauma. All kinds of thoracoabdominal
trauma may be injured at the diaphragm.
Keywords: diaphragm trauma, rupture
thorax ct
stomach which is herniated to thorax
P193[Thoracic Surgery]
A rare cause of multiple hydatid cyst: Blunt Trauma
Sezai Çubuk, Gökhan Ayberik, Okan Karataş, Orhan Yücel
Department of Thoracic Surgery, Gata Medical Faculty, Ankara
Multiple hydatid cyst as a result of rupture of the hydatid cyst after a blunt trauma is a rare entity.
We here want to present our multiple hydatid cyst case occured after a blunt trauma.
A 21 year old man was admitted to our department with a complaint of chest pain. The Chest Ct of
the patient revealed multiple cystic lesions and a cavitary lesion in the right hemithorax (Figure 1).
The cystic lesions were in the lung parencyma and in the chest wall. In the physical examination of
the patient we saw a thoracotomy scar. When we examined the patient history, we found a fall
history from a tree. He was then taken to a hospital where right pneumothorax was diagnosed.
Tube thoracostomy was applied to the patient and afterwards he had been operated. After the
operation he was said to have hydatid cyst. As we have seen multiple cystic lesion and a cavitary
lesion after the patients history, we thought that cavitary lesion is secondary to surgery and the
cystic lesions are the dissemination of the hydatid cyst. We have prescreibed antihelmintic drugs.
Patient will be evaluated for surgery after the medical treatment.
After the surgery of a ruptured hydatid cyst, medical treatment must be prescribed to prevent
dissemination. Medical treatment should be prescreibed for cases that are disseminated before
performing surgery. Pneumothorax and dissemination of the cyst are rare complications of hydatid
cyst. Physicians should be aware of these rare complications when managing this disease.
Keywords: hydatid cyst, multiple, trauma
Figure 1
Thorax ct sections demonstrating the cavitary lesion and multiple cysts.
P194[Thoracic Surgery]
A case of sarcoidosis with 13 times recurrent pneumothorax
Hüseyin Yıldıran, Murat Öncel, Güven Sadi Sunam, Kübra Altıntaş
Department of Thoracic Surgery, Selcuk University, Konya, Turkey
INTRODUCTION: Secondary pneumothorax can be seen in chronic imflammatory lung diseases
such as sarcoidosis.
CASE: U.A., 35-year-old male patient was admitted to the emergency room with sudden shortness
of breath and left chest pain. Due to the chest X-ray and thorax tomography, the partial
pneumothorax was determined in the left lung, so the patient was hospitalized. In physical
examination, patient’s general condition appeared normal, respiratory sounds were equal
bilaterally, minimal ronchi was auscultated. According to patient’s history, about 5 years ago he
had been operated due to the left lung pneumothorax. After that, biopsies was obtained with
thoracotomy and pleura was decorticated and so in the same year the patient was diagnosed with
sarcoidosis in another hospital. While in the hospital, autologous blood pleurodesis procedure had
done. 1 year after, right lung pneumothorax was determined, tube thoracostomy and talc
pleurodesis were done for the right lung. Within 5 years, he had 3 right, 9 left pneumothorax and
tube thoracostomy procedures were done for recurrent pneumothorax. During this period the
patient was prescribed steroid, bronchodilators, portable oxygen concentrator. We evaluated the
patient for left partial pneumothorax, his 13th one. We didn’t plan surgical treatment due to the
clinical stability of patient. Bronchodilator therapy was performed with nebulisator and teofillin. He
was evaluated with chest X-ray daily and followed up for 4 days and then discharged.
RESULTS: The case is interesting as having his 13th recurrent pneumothorax.
Keywords: chronic lung disease, pneumothorax, sarcoidosis
Figure 1
Pneumothorax, image of computed tomography
Figure 2
Posteroanterior chest X-ray
P195[Thoracic Surgery]
A Metacronous Double Primary Lung Cancer: Two Operation, Two Phisiology
Levent Cansever, Merve Hatipoğlu, Ali Cevat Kutluk, Celalettin İbrahim Kocatürk, Mehmet Ali
Bedirhan
Yedikule chest disease hospital, department of thoracic surgery
A 63 year old male had operated for NSCLC three years before. The tumor was located at left
upper lobe as big as 4.5 x 3 x 3 cm in diameter. Mediastinoscopy following by left upper lobectomy
had accomplished with success (T2aN0M0-R0). Histopathologic examination revealed that it was
adenocarcinoma (acinary pattern 60% and bronchioalveolary pattern 40%). A new tumor was
detected at the right lower lobe three years after left sided surgery. The SPN was as big as 1
cm.(SUV=2). Diagnostic and theurapotic VATS was necessary because of positive positron emission
tomography. Lobectomy and lymph node dissection was made via three port by VATS following
diagnostic wedge resection which revealed it was NSCLC. Further pathologic examination showed it
was adenocarcinoma with predominant lepidic pattern (T1aNoMo-R0). Two differnt surgical
technique and their physiologic aspect in the same patient was discussed.
Keywords: bilaterally metacronous tumor, vats lobectomy
P196[Thoracic Surgery]
adenocarcinoma of unknown primary of which are operated
Levent Cansever1, Murat Kıyık2, Merve Hatipoğlu1, Füsun Şahin2, Naciye Arda3, Ali Cevat Kutluk1,
Celalettin İbrahim Kocatürk1, Mehmet Ali Bedirhan1
1
yedikule chest disease hospital, department of thoracic surgery
2
yedikule chest disease hospital, department of chest disease
3
yedikule chest disease hospital, department of pathology
65 year old male. He had non productive cough. Computed tomography of the chest revealed a
mass which was 6 cm in diameter has been spotted in right paratracheal region. PET scan was
positive and SUV max was 11. There were no distant metastases in either cranial MR or Pet scan.
When there was no result obtained in transbronchial needle aspiration, thoracotomy was the only
way for diagnosis and treatment. 6 cm mass has been resected totally. It was round shaped with
regular margins. Pathologic examination resulted adenocarcinoma and TTF 1 (-), CK 7 (+), PSA (-),
CK 20 (-). As adjuvant treatment, four cycles of cisplatin and docetakcel have been given. It has
been 8 months after the operation and still the patient has no tumor spots. The presented case is a
rare condition even in the literature that operated successfully for mediastinal tumor with unknown
primary origin.
Keywords: unknown etiology, adenocarcinoma
P197[Thoracic Surgery]
Lung Reseciton for primary pulmonary tumor in sarcoidosis case which has
pulmonary and mediastenal placement:
Ali Cevat Kutluk1, Tevfik Fikret Çermik2, Levent Cansever1, Yunus Seyrek1, Celalettin Kocatürk1,
Mehmet Ali Bedirhan1
1
Yedikule Hospital for Chest Disease and Thoracic Surgery
2
Istanbul Samatya Education and Research Hospital department of nucleer medıcıne
58 year old male patient has been sent to our clinic with hipoksia. In
physical examination, respiratory sounds has been spotted declined in left basal region. In Thorax
CT, a 2.5 cm diametered nodule has been seen in left lung upper lobe anterion segment peripher.
In both hemithoraxes, there was plevral liquid. Left and right bronchial airways have been spotted
normal in broncoscopy. In TTİA, tumor was observed as non small cell lung cancer. In PET Scan,
there was a 2.6x2.4 cm nodule in left lung upper lobe apicoposterior segment ( SUV max 19.8).
there are some other several nodules: around subcarina 2.2 cm (SUV max 20.7), in
aortopulmoner region 2 cm (SUVmax 24.9), prevasculer (SUVmax 18), paratracheal
(SUV max 22.1), bilateral hiler (SUVmax:15), paraaortic(SUVmax:29,9). Nuclear
Medicine Specialist has emphasized that this patient might have sarcoidosis so
we discussed this case in our own meetings. At the end it has ben decided that
mediastinoscopi, thoracotomy and videomediastinoscopi should be done. 2L,4L
and 4R lymph nodes were examined. In pathology report chronic nonnecrotic
granulomatous infection of lymph node was the result for all stations. After this
report, with thoracotomy, left upper lobectomi and 3-4 cot resection hves been done.
P(T3N0M0R0). Surgery borderline has been observed as negative. The tm turned out
to be adenocancer. When The patient’s post-op vitals were stable, he was discharged.
There has been no recurrences for the past 2 years.
We should keep in mind that there can surprises in Lung Cancer Surgery.
Keywords: sarcoidosis lung cancer
P198[Thoracic Surgery]
Patients Treated For Mediastinal Cysts
Ahmet Sızlanan, Serdar Onat, Serdar Monis, Ali Bırak, Refik Ülkü
Dicle University Faculty of Medicine Department of Thoracic Surgery Diyarbakir, Turkey
OBJECTIVE: The aim of our study is to present our patients who treated for mediastinal cysts.
MATERİAL AND
METHODS: The patients treated for mediastinal cysts between January 2000 and 2014 were
analyzed retrospectively.
RESULTS: Thirty three patients treated during this period. Between 2000 and 2011, 25 patients
with primary mediastinal cysts were treated in our clinic. There were 19 female and 14 male
patients whose ages ranged from 1 month to 76 years. The symptoms of the patients, diagnostic
work-up and surgical approaches were evaluated. The most common symptoms were dyspnea and
chest pain. In 27 patients, thoracotomy was performed. VATS was used for four patients. Two
patients were underwent median sternotomy. The most common mediastinal cysts were
bronchogenic cysts (n.12) and pericardial cysts (n:7). There was no operative mortality.
CONCLUSION: Mediastinal cysts are benign lesions. Preoperatif evaluation must be performed and
appropriate treatment method is essential.
Keywords: Surgery, Cysts, Mediastinal,
P199[Thoracic Surgery]
complications of tuberculosis, lymph node connected to a bronchovascular
sleeve lobectomy in patients
Mehmet Ali Bedirhan1, Levent Cansever1, Ali Cevat Kutluk1, Süleyman Ceyhan1, Naciye Arda2,
Celalettin İbrahim Kocatürk1
1
yedikule chest disease hospital, department of thoracic surgery
2
yedikule chest disease hospital, department of pathology
A 75 year old woman admitted to our hospital with the complaints of cough and hemoptysis as
much as 50 ml once a week, since three years. Fiberoptic bronchoscopy revealed obstructing mass
at the orifice of left upper lobe but no pathologic diagnosis could be achived despite performed
twice. Positron emission tomography ofeither mass or atelectatic lobe were positive. Left
thoracotomy was performed following servical mediastinoscopy which resulted as tumor free. The
upper lobe artery and bronchus were surrounded and invaded. Bronchovascular sleeve resection of
the upper lobe was necessary because of technical difficulties of bronchovascular bundle.
Pathologic examination showed us invaded artery by lymph node and transbronchial invasion of
bronchial lumen mimicking obstructing mass, also by lymph node. No tumor was detected during
examinations. Paranchyma was containig obstructive pneumonia and necrotising granulomatous
imflammation. We share this interesting case because a major surgery was necessary due to of an
unusual complication of a lymph node caused by tuberculosis.
Keywords: tuberculosis, sleeve lobectomy
P200[Thoracic Surgery]
Analysis of Pediatric Patients Operated for Pleural Empyema
Serdar Monis, Ahmet Sızlanan, Refik Ülkü, Serdar Onat, Ali Bırak
Dicle University Faculty of Medicine Department of Thoracic Surgery Diyarbakir,Turkey
AIM: Despite continued improvement in medical therapy, empyema remains a common healty
problem. The aim of this study is to present our patient who treated for pleural empyema.
MATERIALMETHODS: The medical records of pediatric patients treated for pleural empyema in our clinic
were analyzed retrospectively.
RESULT: Sixty-six patients were treated from January 2006 to January 2014. Fourty-one patients
were male and 25 patients were female and mean age was 7.6 ( 1- 18). Empyema localized left
hemithorax for 42 patients, 22 patienst in left hemithorax and 2 patients in bilateral hemithorax.
Eight patients underwent thoracoscopy. The open decortication was performed for 47 patients.
Keywords: : Empyema, Decortication, Pediatric
P201[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
Traumatic fat embolism syndrome: 2 cases
Levent Özdemir1, Burcu Özdemir2, Gökhan Büyükbayram1, Suat Durkaya3, Sema Nur Çalışkan2,
Zulal Özbolat1
1
Dörtyol State Hospital Chest Disease, Hatay
2
İskenderun State Hospital Chest Disease, Hatay
3
İskenderun State Hospital Torasic Surgery, Hatay
Fat embolism syndrome is a rare disorder which can been seen usually with complication of long
bone trauma. It becomes apparent 24-72 hours after injury, with respiratory, neurological, urinary,
eyes and cutaneuous symptoms and sings.
19 and 23 years old 2 male patients with femur fracture, due to a traffic accident were evaluated
for dyspnea, confusion, fever, petechial skin rash on the anterior thorax and anterior axillary folds.
Chest X-ray and cranial CT scans of the patients were normal The patients had hypoxemia and
hypocapnia in arterial blood gases measurement. There was no more findings to explain
consciousness. Two patients who had clinical diagnostic criteria, were given steroid prophylactic
heparin oxygen and fluid therapy. Oxygenation and state of consciousness was improved after
treatment and cases were performed operation by orthopedics
Keywords: trauma, fat embolism
resim 2
resim1
P202[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
A rare fatal complication of thrombolytic therapy: cranial hemorrhage
Levent Özdemir1, Burcu Özdemir2, Sema Nur Çalışkan2
1
Dörtyol State Hospital Chest Disease, Hatay
2
İskenderun State Hospital Chest Disease, Hatay
Hemorrhage is the most feared complication of thrombolytic therapy. Closer follow-up of patients
must be careful, especially in terms of intracranial hemorrhage. Hemorrhages in the form of a very
minor hemorrhage, especially seen in the vein puncture and stopped by the buffer Major
hemorrhage was reported in 6.3%, intracranial hemorrhage 1.8%, and deaths associated with
intracranial hemorrhage is 0.6%.57 year old female patient with sudden onset of shortness of
breath and pain in the right side were evaluated in the emergency department. There was the
implementation of splints because of her history of left foot sprain 20 days ago.
In bad condition of the patient with blood pressure 100/50, pulse: 165, respiratory rate was 36 and
92 saturation under 8 liter-minute with oxygen fingertip Hypoxia, hypocapnia was observed in
arterial blood gas Echocardiography findings were pulmonary arterial pressure was 60 mmHg and
expansion of right cavities and paradox movement. Thrombus in the right main pulmonary artery
and its branches was detected on computed thorax.tomography. Thrombolysis (Reteplase)
therapy.was applied to the patient with the diagnosis of massive pulmonary embolism Cranial
tomography was taken due to headache, disturbance of consciousness and epileptic seizures after
8 hours of the treatment Emergency operation was performed. due to detection of hemorrhage in
cranial tomography.Patient died during the postoperative mechanical ventilation.
Keywords: massive pulmonary embolism, thrombolytic, cranial hemorrhage
Resim 1
Resim 2
P203[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
A rare cause of posterior mediastinal masses: extramedullary hematopoiesis
(2cases)
Levent Özdemir1, Burcu Özdemir2, Suat Durkaya3, Cansu Topal4, Gökhan Büyükbayram1, Zulal
Özbolat1, Ali Ersoy5
1
Dörtyol State Hospital Chest Disease
2
İskenderun State Hospital Chest Disease, Hatay
3
İskenderun State Hospital Torasic Surgery
4
Dörtyol State Hospital internal Medicine, Hatay
5
Antakya State Hospital Chest Disease, Hatay
Extramedullary hematopoiesis, is production of blood cells except for bone marrow and a
compensatory mechanism for a variety of hematologic disorders such as thalassemia, sickle cell
anemia, myelofibrosis, and hereditary sferositozis. Focus for EH, is usually microscopy, but in some
cases, whether in the form of the mass-like lesions, often the liver, spleen, lymph nodes, rarely
adrenal glands renal, breast, peripheral nerves, retroperitoneum and epididymis. Thorax, is a rare
region.
Case 1. 24 year old male patient without complaint, were examined by reason of the homogeneous
opacities which not delete heart contour in the chest radiograph.while application for job. He had a
history of transfusion for the thalassemia intermedia.Physical examination were unremarkable
except for sclera jaundice and hepatomegaly.On computed tomography bilateral paravertebral
homogenous soft tissue density areas. noticeably better on right position ın the posterior
mediastinum were detected. In the laboratory Hb: 8.2, wbc: 20400, Plt: 937 000, LDH: 444, Tbil:
7.2, Ferritin: 642 no abnormality other than
Case 2. 34 year old male patient with complaints of cough were evaluated. He had a history of
thalassemia intermedia.Physical examination were unremarkable except for sclera jaundice and
hepatomegaly.On computed tomography bilateral paravertebral homogenous soft tissue density
areas. ın the posterior mediastinum were detected.In the laboratory Hb: 8.1,wbc: 71900, Plt:
660,000, respectively.
The reason that patients with thalassemia intermedia associated lesions were considered as
extramedullary hematopoiesis masses. For diagnosis no additional attempts provided to the
cases.Symmetrical posterior mediastinal masses should be considered in the differential diagnosis
of extramedullary hematopoiesis and hematologic diseases
Keywords: posterior mediastinal mass, extramedullary hematopoiesis, thalassemia intermedia
resim 1
resim2
P204[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
Azygos lobe Frequency In Thoracic computed tomography
Levent Özdemir1, Burcu Özdemir2, Suat Durkaya3, Ali Ersoy4, Sema Nur Çalışkan2, Gökhan
Büyükbayram1, Zulal Özbolat1
1
Dörtyol State Hospital Chest Disease, Hatay
2
İskenderun State Hospital Chest Disease, Hatay
3
İskenderun State Hospital Torasic Surgery
4
Antakya State Hospital Chest Disease, Hatay
INTRODUCTION:
Azygos lobe of the lung is one of the rare congenital venous malformation. Diagnosis is usually
made by chest X-ray.Computed tomography can also be used in selected cases for advanced
examination and differential diagnosis. 1.2% is observed in high-resolution computed tomography.
We have explored our frequency of azygos lobe on computed tomography detected in our hospital
MATERIALSMETHODS:
Computed tomography withdrawn by any reason were evaluated retrospectively on PACS ( Picture
Archiving and Communication Systems) systems between September 2012 - November 2013 at
the Dortyol State Hospital
RESULTS:
In this period, about 2775 pieces drawn tomography ( female: 1,077 male: 1,698 ) were
evaluated. Thoracic computed tomography azygos lobe, the incidence was 1.54 %. Azygos lobe
1.39 % incidence in women (n = 15 ), while the rate of 1.64% in men (n = 28 ) were detected.
As a result,the frequency of azygos lobe detected on computed tomography l was higher than the
rate reported in the literature
Keywords: toraks tomografi, azigos lob
resim
P205[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
Is serum cystatin C a predictor of acute pulmonary thromboembolism in
patients with normal renal function?
Nuri Tutar1, Nur Aleyna Kemik1, İnsu Yılmaz1, Hakan Büyükoğlan1, Asiye Kanbay2, Ali Doğan3,
Fatma Sema Oymak1, İnci Gülmez1, Ramazan Demir1
1
Department of Pulmonary Medicine, School of Medicine, Erciyes University, Kayseri, Turkey
2
Department of Pulmonary Medicine, School of Medicine, Medeniyet University, İstanbul, Turkey
3
Department of Cardiology, School of Medicine, Erciyes University, Kayseri, Turkey
Early diagnosis is the key point in the management of acute pulmonary thromboembolism (PTE).
There are no reports in the literature comparing the serum cystatin C levels in patients with acute
PTE and normal volunteers. Therefore, in this study, we analyzed 50 acute PTE patients and 45
healthy volunteers with normal renal function. The serum cystatin C level was significantly higher
in the PTE group than in the non-PTE group [1.08 mg/dL (IQR 0.79-1.56) and 0.85 mg/dL (IQR
0.77-1.03), respectively, p=0.017]. When determining the presence of PTE, the highest value of
sensitivity and specificity was set at a cut-off value of 1.15 mg/dL with 93.3% specificity, 46.0%
sensitivity, 88.5% PPV and 60.9% NPV. In the multivariate model cystatin C was significantly
associated with the presence of PTE (OR: 12.34, 95% CI 2.64-57.75). In conclusion, cystatin C
may be an indicator of acute PTE in patients with normal renal function.
Keywords: diagnosis, pulmonary embolism, cystatin C,
P207[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
Swyer-James Macleod Syndrome with lower lob abnormality
Dilaver Taş, Sedat Demirsoy, Ersin Demirer, Ömer Ayten, Zafer Kartaloğlu
GATA Haydarpasa Training Hospital, Pulmonary Diseases Department, Istanbul, Turkey
INTRODUCTION: Swyer-James/MacLeod syndrome is a rare disease, characterized by unilateral
hyperlucent lung due to hypoplasia of the pulmonary artery and bronchiectasis.
CASE: A twenty-one years old male patient admitted with cough, sputum production and dyspnea.
He had a history of asthma. Bilateral ronchi was auscultated at physical examination. Whole blood
count and biochemistry results were within normal limits. Hyperlucency was observed in right lung
lower zone at chest X-ray (Figure 1). Volume loss at right lung middle and lower lobe with
bronchiectasis and right pulmonary hypoplasia at the same level were observed at Chest CT (Figure
2). Right middle lobe orifice was narrowed and two segments other than superior segment were
observed at fiberoptic bronchoscopy.
CONCLUSION: Swyer-James MacLeod syndrome should be considered in the diagnosis of patients
with unilateral hyperlucent lung.
Keywords: Swyer-James Macleod Syndrome, bronchiectasis
Figure 1
Figure 2
P208[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
The Case of Double Ethilogical Pleural Effusion
Hasan Düzenli1, Ahmet Nasır2, Hikmet Çoban1, Adilcan Güngen1, Canatan Taşdemir1, Yusuf
Aydemir1
1
Sakarya Education and Research Hospital, Sakarya University, Clinic of Chest Disease,Sakarya,
Turkey
2
Clinic of Thoracic Surgery, Sakarya Education and Reseach Hospital, Sakarya, Turkey
Chylothorax is the accumulation of lymphatic fluid in the pleural cavity.. The most common cause
of chylothorax is traumatic injury of the thoracic ductus. Transudative chylothorax secondary to
valvular heart disease and heart failure is a rare pathology and a few cases have been reported.
We wanted to present a case which concurrent transudative chylothorax and transudate pleurisy
secondary to heart failure and cardiac valve disease.
CASE: The 79-year-old male patient presented with sudden-onset shortness of breath. there was
bilateral pleural effusions which was more right than left and cardiomegaly on chest radiograph. A
diagnostic thoracentesis was performed bilaterally. Both sides were transudative. Symptomatic
catheter was inserted for the right hemithorax and significant improvement in symptoms. Three
days after catheter pneumothorax was observed in the right hemitorax. There was change in the
appearance of the liquid and after examination It was understood that developed chylothorax on
the right side. Pleural effusion secondary to heart failure and chylothorax was diagnosis and
treatment for two different etiologic factors were together. Oral intake when cut pleural fluid was
being transudate After oral intake was starting pleural effusion was return to chylothorax. After
persistent treatment of heart failure and chylothorax, pleural drainage was discontinued in the
twenty-fifth day of treatment
Keywords: chilothorax, heart failure, transuda pleurisy
Figure 1
Chest radiograph showed bilateral pleurral effüsion
Figure 2
Chest radiograph after cateter thoracostomy
P209[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
Anomalous pulmonary venous return and bronchiectasis togetherness in
same patient
Mustafa İlker İnan1, Ferhat Cüce2
1
Department of Pulmonary Medicine, Van Military Hospital, Van
2
Department of Radiology, Van Military Hospital, Van
INTRODUCTION: Anomalous pulmonary venous return (APVR) is an extracardiac left to right
shunt type as a result of the drainage of one or more pulmonary veins into the right side of heart
or systemic venous structures. A rare togetherness; we are presenting an asymptomatic partial
APVR (PAPVR) case which ‘s effect is compansated with the accompanying bronchiectasis in same
lobe.
CASE: A 24 year old male patient presented with the symptoms of cough and effort dyspnea since
childhood. There were crackles at the left base of chest on auscultation. His chest X-ray revealed
heterogeneous opacities at the inferior zone of left hemithorax and left paracardiac irregularity.
There were cystic bronchiectasis at the left upper lobe and a vascular structure that was lying from
the left hilar region to the upper mediastinum in thorax HRCT (picture 1). Multidedector CT
angiography was performed and it was seen that this vascular structure was the left superior
pulmonary vein which was draining into the left brachiocephalic vein (picture 2). In parenchymal
sections, there were cystic bronchiectasis at the upper lobe of left lung and around the
bronchiectasis there were mosaic attenuation areas.
CONCLUSION: It can be thought from this study that; airway obstruction and air trapping due to
accompanying bronchiectasis at same lobe results in decreased ventilation. As a result of
decreased ventilation, regional hypoxic pulmonary vasoconstruction occurs and the pulmonary
venous blood return decreases from this lobe, and so this can prevent patient from the negative
shunt effect of the small PAPVR.
Keywords: Bronchiectasis, Anomalous pulmonary venous return, Thorax Tomography
Picture 1
Cystic bronchiectasis and extra vascular structure in thorax HRCT
Picture 2
The left superior pulmonary vein which was draining into the left brachiocephalic vein and its 3D image in
thorax CT angiography
P210[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
The relationship between meteorological parameters and severity in
pulmonary embolism patients
Özlem Erçen Diken, Aydın Çiledağ, Uğur Gönüllü
Department of Chest Disease, Ankara University, Ankara, Turkey
There are few data about the seasonal distribution of pulmonary embolism (PE). The purpose of the
study was to analyze the relation of meteorological factors and the severity of acute pulmonary
embolism in patients with or without risk factor for PTE.
81 patients with PE were retrospectively evaluated. 47 (58%) patients were female and the mean
age was 65±15 years. 46 (56.8%) patients had any risk factor. 22 (27.2%) of 81 patients were
diagnosed in spring while 25 (30.9%) patients in summer. Patients were prominently diagnosed in
summer (p=0.339). PE was diagnosed more frequent in May (p=0.656).
PE was found positively in association with the increase in the temperature level (p=0.479) and
negatively with the humidity level (p=0.001). The frequency of PE was higher in moderate
atmospheric pressure levels (p=0.001). The relationship between PE frequency and temperature,
humidity and atmospheric pressure levels were given in Table 1.
A significant relationship was not found between the severity of PE and temperature, atmospheric
pressure and humidity level in patients with or without risk factor for PTE. Massive and submassive
PE was more frequently detected in spring and summer seasons (p=0.076) (figure1).
As a conclusion, the incidence of PE was higher in summer season and in May (between months).
The results confirm an association between decreased atmospheric pressure, humidity, increased
temperature and incidence of PE. Both the frequency and the severity of PE was increased in
summer and spring seasons. The seasonal relationship should be taken into consideration in
patients without risk factors.
Keywords: meteorological parameters, pulmonary embolism, seasonal distribution
figure1
The ratio of the patients with massive and submassive PE are higher in spring and summer seasons.
Table1
Temperature (°C) n
n
%
-5 - 7 interval
23 28,4
7,1- 19 interval
27 33,3
19,1- 31 interval
31 38,3
Atmospheric pressure (mbars)
900-910
14 17,3
911-920
60 74,1
921-930
7
8,6
Humidity (%)
25-50
28 34,6
50-75
40 49.4
75-100
13 18,5
The relationship between PE frequency and temperature, humidity and atmospheric pressure levels.
P211[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
Primary Antiphospholipid Syndrome In A Young 16 Years Old Man: Case
Report
Süreyya Yılmaz1, Füsun Topçu1, Hadice Selimoğlu Şen1, Yaşar Yıldırım2, Orhan Ayyıldız2, Cihan
Akgül Özmen3
1
Departments of Chest Diseases And Tuberculosis Dicle University Faculty of Medicine, Diyarbakır,
Turkey
2
Departments of Internal Medicine Dicle University Faculty of Medicine, Diyarbakır, Turkey
3
Departments of Radiology Dicle University Faculty of Medicine, Diyarbakır, Turkey
INTRODUCTION: Antiphospholipid syndrome(APS) is an autoimmune disease, characterised by
arterial and/or venous thrombosis and/or recurrent pregnancy loss in the presence of antiphospholipid autoantibodies. If occurs without any accompanying disorder primary APS is
considered.
CASE: 16 years old male patient was admitted to our service with complaints of chest pain, fever,
cough and shortness of breath. There were decreased respiratory sounds and minimal crackles at
bilateral lower lung fields on auscultation. Other examination findings were normal.
Consolidation areas in the lower lobe of right lung, upper-lower lobe of left lung and lingula were
observed in first drawn contrast enhanced computed tomography(CT), there was no embolism.
Patient was considered as Pneumonia(Figure 1), and antibiotic and general support therapy was
initiated.
Due to the patient's cough, chest pain complaints didn’t exceed and lack of radiological
improvement, CT pulmonary angiography(CTPA) was performed 25 days after the start of
treatment. Pulmonary thromboembolism(PTE) was detected on the right main pulmonary artery
and left pulmonary artery branches in CTPA. Consolidation areas in both lung lower lobe were
assessed in favor of necrosis, while areas of ground glass in the upper and lower lobes were
assessed in favor of infiltration(Figure 2).
Collagen tissue panel were negative(Table-1). Thrombophilia panel were studied(Table 2). Deep
vein thrombosis was not detected in bilateral lower extremity venous doppler ultrasonography.
Echocardiographic examination was normal.
CONCLUSION: Primary APS is a rare disease in children and adolescents compared to secondary
APS. We present a 16 years old case diagnosed PTE in order to contribute to literature.
Keywords: Antiphospholipid syndrome, Pneumonia, Pulmonary thromboembolism
Figure 1
Consolidation areas in the lower lobe of right lung, upper-lower lobe of left lung and lingula were observed in
first drawn contrast enhanced computed tomography
Figure 2
PTE was detected on the right main pulmonary artery and left pulmonary artery branches and consolidation
areas in bilateral lower lobe, areas of ground glass in the upper and lower lobes in CTPA
Table 1
ANA
Negative
P-ANCA
Negative
C-ANCA
Negative
Anti-JO1
Negative
Anti-Ds DNA
Negative
PO
Negative
Anti-SM
Negative
Anti-SSA
Negative
Anti-SM/RNP
Negative
Anti-SCL
Negative
Anti-Nucleosomes Negative
Anti -Histones
Negative
Anti-Cenp B
Negative
Collagen tissue panel of patient
Tablo 2
Initial
13th week
Lac Confirm
66.2 sec
58.1 sec
Lac Screen
125 sec
102 sec
Lac S/Lac C
1.89 ↑
1.76 ↑
AT 3 Activity
89 %
-
F VIII
36.8
-
Anti Cardiolipin IgM
22,6 U/ml ↑
17,2 U/ml ↑
Anti Cardiolipin IgG
72,6 U/ml ↑
60,3 U/ml ↑
APTT
38 sec ↑
48,6 sec ↑
INR
1,1
2,1 ↑
PAI-1 (4G/5G)
Heterozygous
-
MTHFR (C677T)
Heterozygous
-
MTHFR (A1298C)
Homozygous Normal -
F XIII
Homozygous Normal -
F II(G20210A)
Heterozygous
F V Leiden
Homozygous Normal -
Protein C
Normal
-
Protein S
Normal
-
Platelet Count
108 X 109 /L ↓
255 X 109 /L
CRP
40.7 mg/dl ↑
-
White blood cell count 19.4 K/L ↑
Thrombophilia panel of patient.
-
-
P212[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
Treatment of CTEPH with Inhaled Ilioprost In Two Cases
Mine Atun Dikici, Neşe Dursunoğlu, Zahide Alaçam
Department of Pulmonology, Pamukkale Unıversıty medical faculty, Denizli, Turkey
INTRODUCTION
Chronic thromboembolic pulmonary hyperension (CTEPH), is a cinical condition with high mortality
that occured with obliteration of the pulmonary tree after recurren pulmonary emboli. Although
pulmonary endarterectomy is the most effective method, drugs that used in the treatment of IPAH
could be efective as "vascular remodeling" seen in histopathology. But there is no drug approved in
the treatment of CTEPH. We aimed two CTEPH cases who treated with inhaled iloprost.
CASE 1
A 50 years old, female patient followed with CTEPH since 25 months. While mean pulmonary
arterial pressure was 100mmHg, capacity was NYHA-IV and 6MWD was 125 m at time of diagnosis,
they all improved (80 mmHg,135 m,NYHA-III) with inhaled iloprost after 3 monhts.
CASE 2
A 44 years old, female patient followed with CTEPH since 12 months. While mean pulmonary
arterial pressure was 72mmHg, capacity was NYHA-III and 6MWD was 130 m at time of diagnosis,
they all improved (40mmHg,335 m,NYHA-II) with endarterectomy and inhaled iloprost after 3
monhts.
DISCUSSION
Iloprost is a prostocycline analoque that is used via inhalation. A significant decrease was seen in
pulmonary vascular resistance and mean pulmonary arterial pressure but it is noticed that partial
oxygen was decreased as it increased arteriovenous shunts. Such side effects were not seen in our
patients in long term usage and clinical improvement was achieved.
Keywords: CTEPH, ilioprost, pulmonary hypertension
P213[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
Prognostic Value of Neutrophil to Lymphocyte Ratio and Platelet to
Lymphocyte Ratio in Patients with Acute Pulmonary Embolism
Burcu Baran, Nuri Tutar, Hakan Büyükoğlan, İnsu Yılmaz, Fatma Sema Oymak, İnci Gülmez,
Ramazan Demir
Department of Pulmonary Medicine, Erciyes University, Kayseri, Turkey
BACKGROUND: Acute pulmonary embolism (PE) is a serious clinical condition characterised by a
high mortality rate. Previous studies showed that leukocytosis was associated with recurrences of
venous thromboemboli, major bleeding and increased mortality. The aim of the present study was
to investigate the prognostic value of neutrophil to lymphocyte ratio (NLR) and platelet lymphocyte
ratio (PLR) in patients with acute PE during short term follow-up.
METHOD: A total of 60 patients with acute PE were included the study. Admission blood counts
and clinical data were obtained from medical charts.
RESULTS: The mean age was 63.8±17.8 years and thirty two patients (%53.3) were male. The
most frequnet risk factor was surgery in the last one month (n=16, %26.7). Thirty five (58.3%)
patients had right ventricular dysfunction on echocardiography. Three patients (5.0%) were
administered with thrombolytics with a diagnosis of high risk PE. Four (%6.7) of 60 patients were
died during 30 days follow-up. The median number of NLR in non survivers and survivers were
17.4 (min 7.1, max 83.3) and 5.9 (min 0.9, max 38.8). The median number of PLR in survivers
and non survivers were 573.5 (min 150.3,max 610.9) and 157.1 (min 67.5, max 863.6). The
differences were statistically significant both NLR and PLR (p<0.05).
CONCLUSION: NLR and PLR on hospital admission may be a predictor of 30-day mortality in acute
PE.
Keywords: pulmoner embolism, mortality, neutrophil lymphocyte ratio
P214[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
Pulmonary embolism after coronary angiography: Because of three cases
Elif Yılmazel Uçar, Omer Araz, Mehmet Meral, Metin Akgün, Hasan Kaynar, Leyla Sağlam
Department of Pulmonary Disease, Ataturk University, Erzurum, Turkey
BACKGROUND: We aimed to present three massive pulmonary embolism cases that we detected
coroner angiography as a risk factor in the last one year and we hoped it could be useful in clinical
practice.
Cases:
The first case, a 49 years-old female, admitted to our clinic with the complaints of dyspnea and
chest pain. She was underwent coroner angiography fifteen days ago. Occlusions were detected in
her five coronary arteries and she had normal echocardiography (ECHO) findings. We determined
thrombus in the main pulmonary arteries at her admission ECHO. Thorax CT angiography showed
thrombus bilateral main pulmonary arteries. The patient had hypotension and shock findings and
she took thrombolytic therapy.
The second case, a 59 years-old female, had coronary angiography twenty days ago. Third case, a
73 years –old female, had coronary angiography on day ago. They admitted to our clinic with the
complaints of sudden dyspnea, chest pain and syncope. There was thrombus in main pulmonary
arteries at their thorax CT angiography and acute right ventricular failure at their ECHO.
Thrombolytic treatment was applied to the patients.
All patients had acute/sub-acute deep vein thrombosis in their left femoral and popliteal veins. The
clinical findings were stabile after thrombolytic treatment, their follow-up is going on.
CONCLUSIONS: Coronary angiography might be a risk factor for pulmonary embolism. After
coronary angiography, the patients are evaluated carefully in terms of deep vein thrombosis.
Keywords: Coronary angiography, pulmonary embolism, risk
P215[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
The Fat Embolism That Occured After Leg Bone Fracture
Turan Aktaş1, Nurşen Yaşayancan2, Fatma Aktaş3, Zafer Özmen3
1
Department of Pulmonary Medicine, Gazi Osman Paşa University, Tokat, Turkey
2
Department of Pulmonary Medicine, Tokat State Hospital, Tokat, Turkey
3
Department of Radiology, Gazi Osman Paşa University, Tokat, Turkey
INTRODUCTION: Fat Embolism Syndrome (FES) is a clinical situation progressed through
inspiratory, hematological, neurological, dermatological findings as a result of penetration of the fat
particles into the circulatory system.
CASE: While the 28 years old male patient was being followed by the orthopedia department due
to the segmental fracture at right lower extremity after the traffic accident he had 3 days ago, a
consultation was demanded from us because of the sudden clouding of consciousness and
respiratory distress. The patient was in dyspneic and tachypneic situation when he was examined
in intensive care. Point petechial lesions were remarked on chest front wall and conjunctiva.
Significant descent in thrombocyte count was detected in laboratory examination
(thrombocyte:80000/dl). Ground-glass areas and bilateral extensive alveolar and interstitial
density increase are seen in P-A chest radiography and Thorax CT. Consistent appearance with
extensive micro thrombus was detected in cranial MR. Prednisolone treatment was began regarding
that the patient had fat embolism syndrome in consequence of present clinical and other findings.
The patient provided with respiration support at mechanical ventilator due to the increase in his
respiratory distress during his follow-ups was taken to the service by leaving the respiration
support following the recovery in his clinic after the follow-up at mechanical ventilator for 5 days.
The patient whose follow-ups in service were stabile was discharged from the hospital with
suggestions.
RESULT: FES is a clinical case which can create life threatening consequences via micro
thrombuses caused by fat particles.
Keywords: Fat Embolism, Bone Fracture, Thorax CT
P216[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
Study On Distribution Of Thrombophilic Gene Mutations in Patients With
Pulmonary Thromboembolism
Ercan Kurtipek1, Salih Çiçek2, Nadir Koçak3, Cengiz Burnik1, Yavuz Sultan Selim Aksooy4, Kenan
Koşan4, Korhan Kollu4, Mihrican Yeşildağ1, Taha Tahir Bekçi1
1
Konya Training and Research Hospital, Department of Chest Diseases
2
Konya Training and Research Hospital, Department of Genetic
3
Selçuk University, Selcuklu Medicine Faculty, Department of Genetic
4
Konya Training and Research Hospital, Department of Internal Medicine
INTRODUCTION: Recently, studies on venous thromboembolism(VTE) have remarkably
increased. Our objective was to determine the incidence of results for Factor V, Factor II
Prothrombin, MTHFR(C677T) and MTHFR(A1298C) in gene mutation analysis in patients who were
diagnosed with VTE.
METHODS: The study included a total of 103 patients, including 57 female (67.07±14.22 years of
age) and 46 male (61.22±16.90 years of age) who were diagnosed with PTE. The mean age of
patients was 64.46±15.68 years, with a range of 25 to 93 years. DNA was isolated from peripheral
blood of patients, and a mutation analysis was performed using Real-time PCR method.
RESULTS: The genotypical distribution patients are shown in Table 1 while frequency of allele
distribution is shown in Table 2. The genotype distributions were as follows: 72 (69.9%)
homozygous normal type; 28 (27.18%) heterozygous mutant; and 3 (2.92%) homozygous mutant
or Factor V Leiden; 96 (%93.20) homozygous normal; 6 (5.82%) heterozygous mutant.
CONCLUSION: The importance of Factor V mutation is that after treating patients with VTE and
the mutation, the probability of developing pulmonary embolism again is more likely compared to
other mutation analyses. Based on this, it would be better to recommend that presence of a Factor
V mutation should be controlled and demonstrated before making any decision to discontinue
treatment in patients with a diagnosis of embolism in order to reduce probability of a recurrent
pulmonary embolism, and accordingly duration of the treatment should be either extended or
continued for a lifetime.
Keywords: embolus, genetic, mutation
Table-1. Genotypic Distribution for Patient
FV Leiden
WILD
HETEROZYGOTE HOMOZYGOTE
72 (69.9 %)
28 (27.18 %)
3 (2.92 %)
F II Protrombin 96 (93.20 %) 6 (5.82 %)
1 (0.98 %)
MTHFR C677T
7 (6.81 %)
40 (38.83 %) 56 (54.36 %)
MTHFR A1298C 37 (35.92 %) 52 (50.48 %)
14 (13.60 %
Table-2. The Frequencies and Allelic Distributions of the Groups
WILD
HETEREZYGOTE HOMOZYGOTE TOTAL
FV Leiden
G allele
144
28
(69.90 %) (13.59 %)
0
(0 %)
172
(83.49 %)
FV Leiden
A allele
0 (0 %)
6
(2.91 %)
34
(16.50 %)
FII Protrombin G allele
192
6
(93.20 %) (2.91 %)
0
(0 %)
198
(96.11 %)
FII Protrombin A allele
0
(0 %)
2
(0.97 %)
8
(3.88 %)
28
(13.59 %)
6
(2.91 %)
MTHFR 677 C allele
80
56
(38.83 %) (27.18 %)
0
(0 %)
136
(66.01 %)
MTHFR 677 T allele
0
(0 %)
14
(6.79 %)
70
(33.97 %)
MTHFR 1298
A allele
74
52
(35.92 %) (25.42 %)
0
(0 %)
126
(61.16 %)
MTHFR 1298
C allele
0
(0 %)
28
(13.59 %)
80
(38.83 %)
56
(27.18 %)
52
(25.42 %)
P217[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
A case followed with the diagnosis of asthma and diagnosed as unilateral
lobar agenesis
Alper Gündoğan, Alev Taşkın, Seyfettin Gümüş, Ergün Uçar, Ergun Tozkoparan, Hayati Bilgiç
Gulhane Military Medical Academy,Department of Pulmonary Medicine, Ankara
Isolated pulmonary agenesis is a rare anomaly that may be seen alone or with other congenital
defects. In contrast to the pulmonary hypoplasia, relevant section of the lung is totally or partially
absent due to intrauterine growth defect. We present a case followed by the diagnosis of asthma
for several years and diagnosed as unilateral lobar agenesis.
Twenty-one year old male patient was admitted with shortness of breath. With a diagnosis of
asthma he was treated with bronchodilators. Slightly sunken appearance was noted on left
hemithorax and decreased breath sounds of the left apical heard. Left-shift of tracheal air column
and significant volume loss of left hemithorax was observed on chest radiograph(Figure 1a). The
mid-line formations displaced to the left and left upper lobe was’t observed at high-resolution
computed tomography(Figure 1b-c ). Fiberoptic bronchoscopy revealed that upper lobe bronchus
and segments was absent, sol bronchus continued to left lower lobe without any branching. (Figure
2).
The incidence of pulmonary agenesis is 9.7 to 3.4 per thousand. It is seen more often on the left
and is associated with other congenital anomalies. In the presence of opaque hemithorax with
mediastinal shift, it should be considered in the differential diagnosis. For early diagnosis it should
be suspected and further diagnostic management is needed. Many times it can not be diagnosed
until advanced ages. The diagnosis of pulmonary agenesishould be considered in patients who are
considered asthma with complaint of dispne in the differential diagnosis.
Keywords: pulmonary agenesis, congenital lung anomaly
Picture 1 a-b-c
Picture 2
P218[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
Maligniteyi taklit eden Wegener Granulomatozisi; OLGU SUNUMU
Sami Ceran1, Murat Kuru1, Burhan Apilioğulları1, Emin Maden2
1
Department of Thoracic Surgery,Meram Faculty of Medicine, Necmettin Erbakan University,Konya
2
Department of Chest Diseases,Meram Faculty of Medicine, Necmettin Erbakan University,Konya
Wegener granülomatozisi (WG) özellikle üst ve alt solunum yollarını ve böbrekleri etkileyen
sistemik nekrotizan bir vaskülittir. Kadınlarda daha sık rastlanan formunda üst solunum
yolları,akciğerler tutulurken; yaygın formunda böbrekler de tutulmuştur ve erkeklerde daha sık
gözlenir. Akciğer tutulumunda genellikle bilateral, kaviteleşebilen, düzgün sınırlı soliter nodül/kitle
görülür.Nekrotizan özelliği nedeniyle kaviter lezyonların gelişmesi başta maligniteler ve tüberküloz
olmak üzere pek çok hastalıkla ayırıcı tanı gerektirmektedir. Biz, radyolojik ve klinik bulguları
nedeni ile başlangıçta metastatik akciğer kanseri olduğu düşünülen,operasyonla histopatolojik tanı
alan 38 yaşında bir WG olgusu sunuyoruz.
Bilinen hastalığı olmayan 38 yaşında kadın hasta son 1 aydır artan öksürük,kanlı balgam ve
zayıflama şikayetiyle başvurdu. Akciğer grafisinde kavitasyon gösteren kitle izlenen hastaya toraks
BT çekildi. Sol üst lobda 68x83mm, kalın düzensiz duvarlı lümende hava sıvı seviyelenmesi
gösteren kaviter lezyon, bilateral akciğerlerde multipl kistik karakterde nodüler opasiteler
görüldü.Toraks MR'da sol üst lobda 5x6cm kaviter kitle ve akciğer parankiminde metastatik odaklar
görüldü.Kist hidatik İHA ve balgam ARB’leri negatifti. Girişimsel radyolojiyle konsulte edilen
hastanın lezyonlarının kist hidatikle uyumlu olduğu,transtorakal biyopsi yapılamayacağı öğrenilmesi
üzerine hastaya histopatolojik tanı amaçlı operasyon kararı alındı. Sağ 5. İnterkostal aralıktan kas
koruyucu torakotomiyle sağ orta lobda yerleşmiş fissür komşuluğundaki kaviter lezyondan multipl
biyopsiler ve sağ üst lobdaki nodüler lezyona wedge rezeksiyon yapıldı.Postop lökositoz ve
transaminaz yüksekliği olan hastaya sulbaktam+sefoperazon verildi.Klinik/radyolojik düzelen hasta
postoperatif 11. gün sorunsuz taburcu edildi. Patoloji sonucu dev hücre yapıları ve granülomu
anımsatan yapılar nedeniyle granülomatöz bir iltihap olarak değerlendirilen,immun değerlendirme
sonucu ANA, ANTİ MPO+PR3, C-ANCA,PR3 ANCA pozitif olarak gelen hasta wegener
granülomatozisi nedeniyle Göğüs Hastalıkları Kliniği tarafından tedaviye alınmıştır.
Keywords: wegener granulomatosis, vasculitis, lung cancer
thoracic CT scan
thoracic CT scan
P219[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
High mortality in emergency room; massive pulmonary thromboembolism
Nesrin Öcal1, Deniz Doğan1, Ergün Uçar1, İbrahim Arzıman2
1
department of chest diseases, gulhane millitary medicine academy, ankara, turkey
2
department of emergency medicine, gulhane millitary medicine academy, ankara, turkey
Massive pulmonary thromboembolism (PTE) is an important clinical picture, because if not
diagnosed timely may cause severe outcomes and death. Yet, the diagnosis of PTE is not always an
easy matter. The most significant landmark on this struggle is making the diagnostic tests rapidly,
when PTE suspicion arose, and starting the treatment early. But, similarity of the PTE symptoms
with cardiac pathologies cause time waste. In this respect, we wanted to share a massive PTE case,
which we thought remarkable.
47 year old male patient with severe chest pain behind the sternum, dizziness, cold sweats and
shortness of breath was admitted to the emergency room. On examination revealed his arterial
blood pressure 90 / 50 mmHg, pulse 110 / min., temperature 36°, and SpO2 89%. On ECG there
were sinus tachycardia, ST segment elevation and right axis deviation. There was a slight increase
in cardiac enzyme levels. These results primarily were suggestive of cardiac disease such as
myocardial infarction. However, measuring PaCO2 as 25 mmHg and PaO2 as 58 mmHg in arterial
blood gases suggested a possible PTE. After that D-dimer test result was 3500 µg/Land then
computed tomography (CT) angiography for pulmonary arterial system were taken. CT
angiography revealed filling defects consistent with thrombus in both main pulmonary artery and
anticoagulant treatment began. After follow up in intensive care, patient were stabilized.
We shared this case to emphasize that, in cases with symptoms such as chest pain suggesting
primarily cardiac pathologies, keeping PTE in mind can be life saving.
Keywords: massive, thromboembolism
fıgure 1
bilateral thrombus in pulmonary arteries
P220[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
A Takayasu's Arteritis Case Presented With Pulmonary Artery İnvolvement
Sebahat Genç1, Ertan Tuncel1, Mesut Demirköse1, Cenk Babayiğit1, Ersin Şükrü Erden1, Ramazan
Davran2, Burak Akçay3
1
Department of Chest Diseases, Faculty of Medicine, Mustafa Kemal University, Hatay
2
Department of Radiology, Faculty of Medicine, Mustafa Kemal University, Hatay
3
Department of Cardiology, Faculty of Medicine, Mustafa Kemal University, Hatay
Takayasu's arteritis (TA), is a large vessel vasculitis that the main branches of the aorta and the
pulmonary artery affected and is more common in young women. The etiology is not yet fully
elucidated, it is common in Asian races. Signs and symptoms occure as vascular ischemia of the
organs that fed by affected vessel. Pulmonary involvement is not rare, but is not symptomatic in
most cases. Our case, 52 year old female patient, the birthplace is Uzbekistan, was admitted to our
clinic with complaint of chest pain. On physical examination there were systolic murmur below left
clavicula, cracles at left lung basis, and peripheral pulses were absent in both lower extremities.
Oxygen saturation was 80% on room air. Chest X-Ray showed increased cardiothoracic ratio. On
echocardiography; sPAP was found to be 126 mmHg. Thoracic CT was reported as hypoplasia in the
left pulmonary artery, decrease in diameter and calcifications of thoracic and abdominal aorta. With
clinical and physical examination findings, the patient diagnosed with Takayasu arteritis.
Prednisone 1 mg / kg / day was given. Nebulized iloprost treatment 6x10 mcg / mL was started.
sPAP decreased to 75 mmHg in control ecocardiography.
In conclusion, because of Takayasu arteritis is a rare disease and pulmonary involvement is rarely
symptomatic we aimed to report this case
Keywords: Takayasu's arteritis, pulmonary hypertension, hypoxia
Figure 1
Narrowing and calcification of the abdominal aorta
Figure 2
Narrowing and calcification of the thoracic aorta
P221[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
Giant right atrium
Levent Özdemir1, Burcu Özdemir2
1
Dörtyol State Hospital Chest Disease
2
İskenderun State Hospital Chest Disease, Hatay
55-year-old female patient who had a history of coronary bypass surgery due to ischemic heart
disease three years ago were evaluated by causing shortness of breath. The patient's chest X-ray
showed a homogeneous opacity limited to minor fissure. in the right middle lower zone. The cause
of opacity was found to be a giant right atrium on echocardiography and computed tomography
Keywords: Giant right atrium
resim 1
resim2
P222[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
Unilateral hyperlucent lung: Hypoplasia of pulmonary artery
Levent Cem Mutlu, Gizem Kaplan
Namık Kemal University, Department of Respiratory Medicine
A 20-year-old women admitted to hosptal with complaints of cough, dypnea, chest pain and
wheezing. She has no significant past medical or surgical illness. Clinical examination of chest was
normal. Chest X-ray showed hyperlucent left lung. Computed tomography of thorax showed
hyperlucency especially at the basal segments of left lung, and decrease of the left pulmonary
artery. Spirometry showed no abnormality with forced vital capacity (FVC) 87% of predicted and
forced expiratory volume in 1 s (FEV1) 73% of predicted, while carbonmonoxide diffusion capacity
was low (DLCO %72). Ventilation-perfusion scan showed peripheral perfusion defects in the
hyperlucent lung. This radiologic appearance may be due to technical impropriety, chest wall
abnormalities and increased air volume and decreased pulmonary vascularisation on that side.
Pulmonary artery hypoplasia is the rare cause of unilateral hyperlucent lung.
Keywords: hyperlucency, pulmonary artery hypoplasia
P223[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
microscopic polyangiitis
Şeyma As, Ayşin Durmaz, Hatice Çiner Çağlayan, Işıl Gökdemir, Naciye Mutlu, Hüseyin Cem Tigin,
Murat Kıyık, Saadettin Çıkrıkçıoğlu
YEDİKULE,İSTANBUL,TURKEY
INTRODUCTION
Microscopic polyangiitisi(MPA),is the necrotizing inflamation of arterioles,venules and capilleries.
CASE REPORT
19 years old women patient who desciribes small amount of hemoptysis with sputum about one
week long came to us with 100 cc hemoptysis.We found out comman patchy infiltration in both
lungs in thorax BT.In chest radiogram we detected diffuse infiltration bilaterally.With these results
considering alveolar haemorrhagy, pulmonary edema and pneumonia we start to treat the patient
with 1 gr pulse steroid treatment for 3 days and moxifloxacin 1*400mg. ın laboratory tests positive
drop urine hematuria, anti GBM (-), c-ANCA (-), ANA (-), antids DNA (-), p ANCA borderline
positivity has been detected. At the 9. day of treatment because the recurrence of haemoptysis of
the patient we took a new chest radiograph. Cyclophosphamide treatment of 1 gr has been started
because of the progression of infiltrations in new chest radiography. we consulted parient with
rhomatology and nephrology and renal biopsy has been made. The patology of renal biopsy is
reported as crescentic glomerulonephritis vasculitis. Plasmapheresis is done because of the
persistent haemoptysis. after renal biopsy creatinin value increased fron 1.2 to 1.7. After detecting
renal trombosis in abdominal bt anjiography, enoxaparin sodium 0.6 mcg 2*1 is added to
treatment. After 7 seances of plasmapheresis the decrease in creatinin value to 1.2 is established.
MPA is the one of the most common causes of pulmonary-renal syndromes. Relapses are
commonly seen in first 2 years in 25% of patients. 5 year survival rate is 65%.
Keywords: haemoptisis,hematuria,microscopic polyangiitis, p-anca positivity
P224[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
Necrotizing pneumonia, suggesting a case of pulmonary embolism
Sakine Yılmaz Öztürk, Merve Nizam, Sinem İliaz, Emel Çağlar, Belma akbaba bağcı
young eğitimve the chest and Thoracic Surgery Research Hospital, istanbul
INTRODUCTION: the road to clinical diagnosis of pulmonary tromboembolizmde begins with the
doubt.This is in addition to the initial symptoms and findings for the presence of risk factors should
be taken into consideration.In this study, side pain, hemoptysis refers patients with complaints of
differential diagnosis has been the subject.
CASE: a 50-year-old male patient presented with complaints of side pain, hemoptysis. Fever,
shortness of breath symptoms. Complaints 10 days ago, influenza-like infections. No additional
disease or patient's smoking history on a resume. Medication history for Sarcoidosis. The patient's
general condition, the appearance of pale. Turgor tone normal, edema, ikter, cyanosis. Room air
oxygen saturation of 99%, pressure: 80/50mmHg, pulse rate: 64/min, respiratory rate: 20 l/min.
To listen lung crackles in the lower-right zone was fine. There was no other system consultations
property. Laboratory of leukocytes: 11000/mm3, CRP: 111mg/l, AST: 58U/l, ESR: 65 mm/st.
Room air arterial blood gas obtained from ph: 7.35, pco: 26.9, 49, sat: 82.10 days earlier on the
right aperture on the right aperture high chest radiograph, the base of the triangle-style
heterogeneous density increase and right hilar exhibit fullness. A chest radiograph prior to the new
movie gerilemeyen and complaints of the triangle is the expansion of the field under the patient
antibiotic infiltration progrese credited service. Sulbactam ampicillin iv + clarithromycin tb began as
the patient. Sputum gram stains and the rest of the patient's pulmonary embolism is suspected
negative direct exposure is the ARBS with the desired D-Dimer: 860 (< 200).
Keywords: angiography of pneumonia, pulmonary embolism
P225[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
The importance of D dimer levels in the diagnosis and prognosis of Chronic
thromboembolic pulmonary hypertension
Bahri Akdeniz1, Kemal Can Tertemiz2, Ebru Özpelit1, Melih Birlik3, Serap Acar4, Nezihi Barış1, Can
Sevinç2
1
Department of Cardiology Dokuz Eylul University School of Medicine Izmir, Turkey
2
Department of Chest Medicine, Dokuz Eylul University School of Medicine Izmir, Turkey
3
Department of Rheumatology, Dokuz Eylul University School of Medicine Izmir, Turkey
4
Dokuz Eylul University Physical therapy and Rehabilitation high school Izmir, Turkey
Chronic thromboembolic pulmonary hypertension (CTEPH) is rare, disease, however it may be
curable if early diagnosis is established. D-dimer, a degradation product of fibrin, has been used as
a screening marker for acute pulmonary embolism. In this study we aimed to asses of importance
of d dimer in the diagnosis and prognosis of CTEPH
METHOD: Retrospective chart review of 90 pulmonary hypertension patients was reviewed at our
PH outpatient clinic from 2007 and 2013. Demographic and clinical properties of these patients
were investigated; D dimer level was compared at CTEPH and other PAH group D dimer level was
correlated to echocardiographic hemodynamic and biochemical prognostic markers
RESULTS: A total 90 PH patients (18 in CTEPH and 72 in other PAH group) was included to this
study. D dimer level was slightly higher in CTEPH group compared to other PAH group; but not
significant (p=0.08). D dimer level was moderately correlated to age (p= 0.01) and functional class
in all patients. However there were no correlation about d dimer level and age (p=0.29), functional
class (p=0.35),6 minute walking distance (p=0.65), BNP level (p=0,16) pulmonary artery pressure
(p=0.20) and cardiac index (p=0.42) in CTEPH patients. D dimer level was also not correlated to
the presence of deep venous thrombosis (p=0.42) and localization of thrombus in lung (p=0.33).
CONCLUSION: Although D dimer level is slightly elevated in CTEPH, it is not beneficial to
differentiate it from other PAH groups. It is also not associated to other prognostic surrogate
markers.
Keywords: Chronic thromboembolic pulmonary hypertension, D dimer, diagnosis, prognosis
Table 1
Characteristics
CTEPH
Age
61,3±10,6 51.8±19.9
0.007
Sex (female %)
80,6
0,12
D dimel level(mg/L)
1.73±1,65 1.32±1.82
The proportion patients with increased d dimer level (%) 77,8
The comparison of patients with CTEPH and other PAH groups
Other PAH group p value
61,8
61
0.08
0.2
P226[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
A case with pulmorenal syndrome: Microscopic polyangiitis
Mihrican Yeşildağ1, Lütfullah Altıntepe2, Taha Tahir Bekçi1
1
Konya Education and Research Hospital, Pulmonary Department, Konya, Turkey
2
Konya Education and Research Hospital, Nephrology Department, Konya,Turkey
65 year-old female patient admitted to the hospital with symptoms of weight loss, nause, anorexia,
fatigue, cough and haemoptysis. In physical examination, Breath sounds were decreased in the
lower lobe of right hemitorax. Chest radiography revealed right perihilar cavitary mass. Thorax CT
demonstrated cavitary mass in the superior segment of the right lower lobe and consolidation
around it. Laboratory examination revealed hematuria, proteinuria, high level urea (111mg/dL) and
creatinine (4.52mg/dl). Haematocrit and haemoglobine values were low. Serological tests were
positive for p-ANCA and negative for Anti-GBM, anti ds DNA, C3, C4, and ANA. Sputum ARB was
negative. Broncoscopy was normal. Renal biopsy was reported as chronic interstitial nephritis,
global sclerosis. Granuloma was not seen. Immunofluorescent (IF) analysis was negative. The
findings was compatible with pulmorenal syndrome due to vasculitis. Diagnosis was considered as
microscopic polyangiitis with involvement of lung, p-ANCA positivity, compatible clinical and
serological findings, chronic interstitial nephritis in the biopsy though without granuloma and IF
negativity.The patient was treated with steroid and immunosupresif agents as well as with
plasmaferesis. Renal functions recovered, clinical findings were regressed, there was no need to
dialysis. In this report, we aim to emphasize the importance of early diagnosis by clinical and
serological findings in pulmorenal syndrome and indicate possitive effect in the prognosis of
patient.
Keywords: : Lung, renal involvement, microscopic polyangiitis, pulmorenal syndrome.: Lung,
renal involvement, microscopic polyangiitis, pulmorenal syndrome. Lung, renal involvement,
microscopic polyangiitis, pulmorenal syndrome.
Figure 1
Chest X ray. Right perihilar mass
Figure 2
Thorax CT shows a mass with cavitation in superior segment of right lower lobe
P227[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
Prognostic Effect of Serum Sodium, Glucose, Creatinine in Patients with
Acute Pulmonary Thromboembolism
Aliye Gamze Çalış1, Aliye Candan Öğüş2
1
Department of Chest Disease, Patnos Hospital, Agri, Turkey
2
Department of Chest Disease, Akdeniz University, Antalya, Turkey
PTE is a disease with high morbidity and mortality. Predicting prognosis in acute PTE RVD, troponin
and PESI are used. Serum sodium, creatinine, glucose levels studied prognostic values and
correlation between currently used markers.
112 patients were evaluated retrospectively who has been hospitalized in Chest Disease Clinic,
Akdeniz University between January 2010 - December 2012,ventilation/perfusion scintigraphy with
a high probability of PTE or acute PTE in chest CT angiography without CRF,DM.
Of the total 112 PTE cases, 86(76.8%) were staying stable (group1),26(23.2%) died within the
first 30days (group2).
On the first admission sodium level under the 135mmol/l approximately 48-fold increase in the risk
of death is determined.
Patients who died within 30 days of average eGFR 45.5mL/dk, the 100.3mL/dk the patients who
were stable.eGFR<60milliliter/min and >=60milliliter/min compared to the prognosis of the two
group, eGFR<60milliliter/min with 41.67-fold increase in mortality compared to the other group
(p<0.001).
The average values of the patients at admission serum glucose 129.1 mg/dl fatal group average
value was 140 mg/dL, and significantly higher than stable patient group (p<0.001).
Troponin-positive,RVD identified,PESI class V patients have high mortality rate,in these patients
presence of low serum sodium levels and eGFR, high levels of glucose, that supports these three
markers have high prognostic values.
Diagnostic performance the highest marker of the presence of low serum sodium level. If there is a
combination of three parameter, mortality risk 100%. Serum sodium, glucose and creatinine levels
can be used separately or together, suggest that the prediction of prognosis in acute PTE.
Keywords: Acute pulmonary thromboembolism, creatinine clearance, hyperglycemia,
hyponatremia.
Serum sodium, creatinine and glucose levels prognostic values
Variable
Sensitivity Specificity Positive Predictive Value Negative Predictive Value
Sodium
84.6%
89.5%
71%
95.1%
eGFR
80.8%
90.7%
72.4%
94%
Glucose
73.1%
84.9%
59.4%
91.3%
100%
100%
85.1%
Three Value 42.3%
P228[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
Treatment of massive pulmonary embolism due to heparin induced
thrombocytopenia with dabigatran: A case report
Ahmet Bircan1, Güçhan Alanoğlu2
1
Department of Chest Disease, Suleyman Demirel University School of Medicine, Isparta, Turkey
2
Department of Hematology, Suleyman Demirel University School of Medicine, Isparta, Turkey
Heparin induced thrombocytopenia (HIT) is a rare, potentially fatal, immun-mediated complication
of heparin therapy, associated with thrombosis and thrombocytopenia. A 57 years-old female
patient was referred to our clinic with diagnosis of massive pulmonary embolism (mPE). She had
shortness of breath, chest tightness and syncope. She was obese, hypertensive and received
LMWH prophylaxis due to total knee replacement for 10 days. Echocardiographic examination was
consistent with pulmonary hypertension and revealed a freely moving echogenic image
(thrombus?) in the right atrium. At admission, physical examination showed TA: 90/60mmHg,
pulse: 102/min., respiratory rate: 44/min., O2Sat:88% and, 2/6 systolic murmur at tricuspid
valve. Her all laboratory test results were in normal limits before surgery (plt:313x103/µL). At
admission, WBC: 13.2x103/µL, Htc: 35.5%, Plt:54x103/µL. Serum liver function tests (LFTs)
suggested for toxic/ischemic liver abnormality. Pulmonary CT angiography showed bilateral
widespread thrombi at all lobar, segmental pulmonary artery branches (Figure 1). Doppler
ultrasonography showed an acute thrombus at right popliteal vein. Based on these findings the
diagnosis of HIT was made. But HIT antibodies could not be analyzed. LMWH and warfarin were
discontinued and dabigatran was started (2x150mg). Her platelets count and LFFTs gradually
reverted to normal ranges (Figure 2). After platelets count increased over 150x103/μL, warfarin
was started again and dabigatran was discontinued. She is under control of outpatient clinic. Since
heparin and LMWH are widely used in medicine this life threatening complication of heparin should
be kept in mind, thrombocyte count should be monitored; in case of HIT an alternative
anticoagulant should be used.
Keywords: pulmoner embolism, thrombocyte, dabigatran, oral thrombin inhibitors, heparin
induced thrombocytopenia
Figure 1: Thorax CT slice
Thrombi at bilateral lower lobe pulmonary arteries
Figure 2: Thrombocyte count/dates
P229[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
Pulmonary Arterial Hypertension Associated With Primary Myelodysplastic
Syndrome
Zeynep Pınar Önen, Yasemin Karabacakoğlu, Öznur Yıldız, Banu Eriş Gülbay
Ankara University, School of Medicine, Department of Chest Diseases
The frequency of pulmonary complications of myelodysplastic syndromes is very high and most of
them are attributed to infectious causes. However, non-infectious complications are rare with very
few reported cases in literature. One of the most infrequent manifestations is pulmonary arterial
hypertension (PAH). At this point we would like to present 30 year old woman with confirmed
diagnosis of primary myelodysplastic syndrome with PAH.
She was admitted to pulmonary department for fatigue and exercise dyspnea. Anemia and
thrombocytopenia were the most prominent pathologies. She was referred to hematology
department. The analysis of bone marrow aspirate confirmed the diagnosis of myelodysplastic
syndrome. The echocardiogram determined right ventricular hypertrophy with preserved systolic
function. Systolic pulmonary arterial pressure was 75 mmHg. We conducted a comprehensive
etiological study for PAH. There was no other possible etiology for PAH. Patient was treated for
myelodysplastic syndrome with azacitidine. Despite this chemotherapy no significant changes in
pulmonary pressure was observed. Sildenafil treatment was started with 20 mg 3 times a day and
up titrated to 80 mg 3 times a day. Despite these treatments deterioration was eminent conclusion
for patient. According to the results of this case, specific pulmonary vasodilator treatment has to be
assessed in PAH associated with myelodysplastic syndrome treatment.
Keywords: Myelodysplastic syndrome, Pulmonary arterial hypertension
Picture 1
P230[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
Thyroid Function Test Results in Pateints with Pulmonary Hypertension
İsmail Hanta1, Çağlar Emre Çağlıyan2, Sezen
1
University of Çukurova, Faculty of Medicine,
2
University of Çukurova, Faculty of Medicine,
3
University of Çukurova, Faculty of Medicine,
XXX
Keywords: XXX
Sabancı Küçükaltun1, Mesut Demir2, Murat Sert3
Department of Chest Diseases, Balcali, Adana
Department of Cardiology, Balcali, Adana
Department of Endocrinology, Balcali, Adana
P231[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
Severe Primary Influenza A Pneumonia in Geriatric Patient
Miraç Öz, Zeynep Pınar Önen, Öznur Yıldız
Department of Chest Disease, Ankara University, Ankara, Turkey
Primary influenza pneumonia has a high mortality rate during pandemics, not only in
immunocompromised individuals and patients with underlying comorbid conditions, but also in
young healthy adults. Clinicians should maintain a high index of suspicion for this diagnosis in
patients presenting with influenza-like symptoms that progress quickly (2 to 5days) to respiratory
distress and extensive pulmonary involvement. For these reasons we would like to present our
severe primary influenza A pneumonia patient.
70-year-old lady admitted to our hospital with nonproductive cough and high-grade fever for two
days. C-reactive protein was increased at the admission. Patient presented with gradually
increasing dyspnea and severe hypoxemia after an antecedent of 2 days of typical influenza
symptoms. Chest x-ray and computed tomography scans revealed cystic dilatation with high
impact solids in the left side of bronchial system. Influenza A was reported from the pharyngeal
specimens. Neuraminidase inhibitor “Oseltamivir” added to the treatment protocol for 14 days.
Fever decreased with the increase of oxygen however radiological changes will be re-evaluated
after 6 months from the treatment. After the influenza A diagnosis ensuring an appropriate
oxygenation and ventilation strategy, as well as prompt initiation of antiviral therapy, is essential in
management.
Keywords: Influenza A, oseltamivir, pneumonia
Chest x-ray
cystic dilatation with high impact solids in the left side of bronchial system
P232[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
Pulmonary embolism in drug addiction: 2 cases
Sinem İliaz, Belma Akbaba Bağcı, Mediha Gonenç Ortaköylü, Ayşe Bahadır, Sakine Yılmaz Öztürk,
Merve Nizam, Emel Çağlar
Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Pulmonary
Medicine Department, Istanbul, Turkey
Drug addiction is a risk factor for deep venous thrombosis and pulmonary embolism. Irritant effect
of drugs to the veins supports the development of thrombosis. Right-sided endocarditis and septic
emboli development is seen more frequently in intravenous drug addicts than the normal
population. Cavitary nodules seen in septic emboli can cause pneumothorax. In this case, antibiotic
treatment and closed tube drainage is the treatment of choice. Pulmonary embolism is rarely seen
in people with drug addiction. Therfore, two cases are intended to be presented here. The first of
the cases was a 29 year-old male patient with deep venous thrombosis and pulmonary embolism.
The second patient was a 25 year-old male patient. He had septic emboli and deep venous
thrombosis. In follow-up of this patient, pneumothorax has developed. Difficulties in treating these
patients occur due to the withdrawal symptoms.
Keywords: drug addiction, pulmonary embolism, septic embolism, deep venous thrombosis
P233[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
Pulmonary infarction in the differential diagnosis of pneumonia: A case
report
Hadice Selimoğlu Şen, Özlem Abakay, Cengizhan Sezgi, Abdurrahman Abakay, Abdullah Çetin
Tanrıkulu, Ömer Faruk Önder
Department of Pulmonology, Dicle University School of Medicine, Diyarbakir, Turkey
INTRODUCTION: Pulmonary infarction is most commonly caused by pulmonary embolism (PE) in
combination with chronic left heart failure and malignancy. It occurs in the 10-15% of patients with
PE (2). A case who admitted with the diagnosis of pneumonia, but then confirmed as pulmonary
infarct is presented to draw attention to the differential diagnosis.
CASE: Fifty-two years old male patient was admitted to our clinic with a one week history of
cough, expectoration of yellow colored sputum, fever, exhaustion and dyspnea. The patient
suffered from congestive heart failure (CHF) for about 10 years. The initial laboratory blood test
revealed elevated inflammatory parameters such as white blood cells and C- reactive protein. The
widespread consolidation in the right middle and lower zones were detected on chest x-ray.
Thoracic ultrasound-guided thoracentesis was performed and pleural effusion was in exude
characteristic. The patient was placed on antibiotic therapy for a presumptive diagnosis of
pneumonia and parapneumonic effusion. However 72 hours later there were no clinical and
laboratory recovery with antibiotics treatment and hemoptysis and hypotension occurred.
Computed tomography pulmonary angiography was performed with the presumptive diagnosis of
PE. The multiple hypodense filling defects in right main pulmonary artery and lobar branches and
large focal areas of consolidation,that conforming to the pulmonary artery tracings in the right
middle lobe and lower lobe were observed.
CONCLUSION: Pulmonary infarct is a rare but frequently misdiagnosed entity. It should be
considered in the cases with clinical and radiological suspicion to pneumonia but unresponsive to
antibiotherapy.
Keywords: pulmonary embolism, pulmonary infarction, pneumonia
P234[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
Netrin 1 in Pulmonary Embolism
Ercan Kurtipek1, Zafer Büyükterzi2, Meral Büyükterzi3, Mustafa Sertaç Alpaydın2, Taha Tahir Bekçi1,
Fatma Eroğlu1, Said Sami Erdem4, Kenan Koşan5
1
Konya Training and Research Hospital, Department of Chest Diseases
2
Konya Training and Research Hospital, Department of Cardiology
3
Konya Training and Research Hospital, Department of Radiology
4
Konya Training and Research Hospital, Department of Biochemistry
5
Konya Training and Research Hospital, Department of Internal Medicine
Netrin-1 has been initially described as a laminin-related molecule, which is central in the nervous
system. Afterwards, it was identified not only in the nervous system, but also in non-neural organs
such as pancreas, breast and lung. Recent studies also have implicatedit in the activation of
endothelial cells. The present study aimed to demonstrate the relationship between serum netrin-1
levels and pulmonary embolism (PE) in patients who were diagnosed with PE as compared to
healthy control subjects. The study included 42 patients with PEand 40healthy controls.The mean
age was 64.83±15.82 years, and 64.68±8.79 years for patients with PE and healthy subjects,
respectively.
The netrin-1 levels were higher in the embolism group than in the control group. However, the
difference was not statistically significant (110.5±110.95, and 104.5±100.03,respectively p=0.89).
There is no study that examined the serum Netrin-1 levels in patients with pulmonary embolism.
The present study suggest that netrin-1 is not an efficient landmark for evaluating potential
endothelial dysfunction in patients diagnosed with pulmonary embolism, but it should be further
studiedin largergroups of patients and healthy subjects.
Keywords: Embolism, Netrin-1, endothelial dysfunction
P235[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
Retrospective evaluation of hospitalized cases with pulmonary emboli in
two years period
Nagihan Durmuş Koçak, Sibel Boğa, Sibel Arınç, Sinem Güngör
Sureyyapasa Chest Diseases and Thorax Surgery Training Hospital
AIM: To determine that demographical, clinical characteristics, diagnosing methods and prognosis
of cases with pulmonary emboli.
Methods and Material:A total of 46 hospitalized patient’s files between January 1st2012 and
December 31st 2013 with pulmonary emboli were examined retrospectively.
RESULTS: The mean age of patients were 59.6±16.9,30 (65.2%) of them were male,16 (34.8%)
of them were female.The severity of embolism was nonmassive in 31 cases and it was submassive
in 10 cases.The most frequent symptom was dyspnea (76.1%).Immobilization (26.1%) and having
previous venous thromboemboli (13%) were most frequent risk factors.According to Wells
classification, 5 patients had low, 26 patients had moderate and 14 patients had high
probability.Elevated serum D-dimer was in 38, pro-BNP was in 9 and troponin was in 4
patients.While lower extremity thrombosis was in 25 cases, 11 of them in proximal vens.For the
diagnosis, computed tomography angiography (CTA) was used in 30 cases and scintigraphy was
used in 3 cases.In 13 cases, diagnosis was made of clinically.The signs of right ventricle
dysfunction were seen in 9 patients.In treatment, LMWH was given in half of the patients and
combination of LMWH and varfarine was given another half of them.While minor haemorraghe was
in 2 patients because of treatment, exitus was not detected.The mean duration of hospitalization
was found to be 10.9±4.3 days.
CONCLUSION: In our clinic, pulmonary CTA was used mostly for diagnosis of PE.In approximately
one-third of them, high clinical probability and elevated D-dimer were used together for the
diagnosis.The massive emboli was not observed in study period.
Keywords: pulmonary emboli, deep venous thrombosis, Wells score, d-dimer
P236[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
Endothelial Dysfunction in Pulmonary Embolus Patients; Neutrophil
Lymphocyte & Platelet Lymphocyte Ratio
Ercan Kurtipek1, Zafer Büyükterzi2, Meral Büyükterzi3, Mustafa Sertaç Alpaydın2, Said Sami Erdem4
1
Konya Training and Research Hospital, Department of Chest Diseases
2
Konya Training and Research Hospital, Department of Cardiology
3
Konya Training and Research Hospital, Department of Radiology
4
Konya Training and Research Hospital, Department of Biochemistry
Pulmonary Embolus (PE) is a frequent urgent cardiovascular situation. Recent studies have shown
activated leucocytes form oxygen radicals leading to endothelial destruction and thus to increased
inflammation risk and thrombogenesis 1-3. The aim of the present study is to show possible
endothelial dysfunction and subclinical atherosclerosis in PE patients.
71 acute PE patients, diagnosed at the emergency and chest department at Konya Education and
Research Hospital, with a mean age of 64.94±15.27 and 83 healthy individuals with a mean age of
63.53±9.15 were included in the present study. Flow-Mediated-Dilatation (FMD) and Carotid Intima
Media Thickness (CIMT) as well as Neutrophil Lymphocyte Ratio (NLR) and Platelet Lymphocyte
Ratio (PLR) were measured. According to the data obtained, there were significant increases in the
NLR and PLR levels in the PE group (p<0.05) (Table 1). Furthermore, the FMD and CIMT levels
increased significantly in the PE group (p<0.05) (Table-2).
The findings of the present study suggest that endothelial dysfunction and subclinical
atherosclerosis in PE patients may have a role in mortality.
Keywords: Embolous, dysfunction, neutrophil lymphocyte ratio
Table-1. NLR and PLR results of all groups
NLR
PLR
Pulmonary Embolism
7.14±9.50 188.83±138.03
(n=66)
Healthy Control
(n=61)
2.19±1.09 15.14±49.38
P Value
p=0.001
p=0.04
Table-2.CIMT and FMD levels of all groups
CIMT
FMD
FMD %
Pulmonary Embolizm (n=71) 0.87±0.23 4.46±0.65 8.92±5.2
Healthy Control
(n=56)
0.80±0.07 3.43±0.24 10.56±3.56
P=0.04
P=0.001
P=0.03
P237[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
Pulmonary Trombus In The Activation Of Behcet’s Disease: A Case Study
Melike Demir1, Halide Kaya1, Hadice Selimoğlu Şen1, Özlem Abakay1, Cengizhan Sezgi1, Mahşuk
Taylan1, Abdullah Çetin Tanrıkulu1, Yeşim Cengiz Balyen2
1
Department of Pulmonary Disease, Dicle university, Diyarbakir, Turkey
2
Department of Family Praticer, Dicle university, Diyarbakir, Turkey
INTRODUCTION:
Behcet’s disease (BD) is a form of multi-systemic, chronic and inflammatory vasculitis. In this
paper, a patient with deep vein thrombosis and pulmonary thrombus is presented to draw attention
to the radiological similarities between pulmonary embolism, which is rare in BD, and pulmonary
vascular involvement.
CASE
Twenty-seven year old male patient was admitted to the polyclinic due to hemoptysis in the last 1
week. He was diagnosed with Behcet’s disease approximately a decade ago. The respiratory
system was normal in physical examination. No pathologies were found in the laboratory results
except the increased CRP (serum reactive protein). Hypodense filling defect was visualized in the
posterior segment of the right pulmonary upper lobe and the subsegmental branches of the left
pulmonary lower lobe, which represented PE, on the computed tomography pulmonary
angiography (CTPA) applied due to suspected pulmonary embolism (PE). Subacute- acute deep
vein thrombosis (DVT) was visualized within the cranial segments of the superficial femoral;
popliteal and deep crural veins on the right side on the lower limb venous Doppler
ultrasonography.
Anticoagulant therapy was initiated and rheumatology department was consulted. Rheumatology
department interpreted the existing radiological lesions as the activation of BD and added
cyclophosphamide and steroid to the treatment. CONCLUSION
Pulmonary vascular filling defects visualized on CTPA and the concomitant DVT should not only be
considered as pulmonary thromboembolism in Behcet’s disease; furthermore, activation of other
diseases that are visualized similarly on radiographs should also be suspected.
Keywords: Behcet’s disease, pulmonary thrombus
P238[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
A rare complication related with oral anticoagulant (warfarin) use: Diffuse
alveolar hemorrhage (4 case reports)
Serap Duru, Bahar Kurt, Merve Yumrukuz, Esra Erdemir
Dıskapı Yıldırım Beyazıt Education and Research Hospital, Department of Chest Disease, Ankara,
Turkey
Diffuse alveolar hemorrhage (DAH) caused by immune and non-immune etiological factors,
characterized by diffuse alveolar consolidation often presents with the clinical triad of dyspnea,
hemoptysis, anemia, as a result of the distruption of the alveolocapillary membrane of the lung. We
aimed to present 4 cases followed in our clinic, admitted to our emergency room with diffuse
alveolar hemorrhage as a rare complication of uncontrolled use of anticoagulant (Warfarin)
therapy.
Four cases (female:2, all over 60 years old) admitted to the emergency room with the complaints
of dyspnea, cough, hemoptysis, were learned that they had uncontrolled Warfarin use due to heart
valve replacement surgery in three of the cases, atrial fibrillation and past-history of coronary bypass operation in one of the cases. On physical examination, one patient with hipoxemic
respiratory failure had widespread, the others had infrascapular inspiratory rales. Hemoglobin
levels of all four patients were low (<10 g/dl), INR levels were over 3. PA chest X-rays of the
patients showed bilateral diffuse alveolar opacities more distinct in lower zones and computerized
tomography of the chest showed patchy ground glass infiltrates with the nodular asinary opacities.
After Warfarin treatment was withdrawn, clinical and radiological signs recovered rapidly and the
existent situation was thought to be DAH related with Warfarin use after excluding other reasons.
As a conclusion, DAH must be kept in mind in the patients using Warfarin, the patients must be
followed carefully since, DAH is rarely seen but has high mortality if early diagnosis, treatment can
not be done.
Keywords: lung, warfarin, Diffuse alveolar hemorrhage
P239[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
What Is The Role Of The Aır Pollutıon On The Development Of Pulmonary
Embolısm?
Sinem Berik Safçi, Ege Güleç Balbay, Peri Meram Arbak
Department of Chest Diseases, Faculty of Medicine, Duzce University, Duzce, Turkey
It is well known that air pollution causes thrombosis via increasing endothelial injury,thrombocyte
aggregation.Aim to evaluate the relation between the air pollution parameters and the clinical
features of pulmonary embolism patients.The mean age of the patients(11 males,18 females)was
63.6±19.3 years.Risk factors were immobilization in 11,heart failure in 5,malignancy in 3,previous
surgical procedure in 3 patients and thrombophilia ina patient.Deep venous thrombosis was found
in 9 cases(31%).11 patients admitted to the hospital in summer(mean PM=54.2 μgr/m3, mean
SO2= 2.5 μgr/m3),8 of the patients admitted in winter(mean PM= 116.5 μgr/m3, mean SO2=15.0
μgr/m3 ),8 patients and 2 patients admitted in spring (mean PM=88.1 μgr/m3, mean SO2= 4.0
μgr/m3 )and fall (mean PM= 69.0μgr/m3,mean SO2= 3.5 μgr/m3),respectively.The mean monthly
PM and SO2 results during the hospitalization of 9 patients with massive embolism (100.7 μgr/m3
and 13.1 μgr/m3) were significantly higher than those of 16 nonmassive (75.5 μgr/m3 and 3.6
μgr/m3,p=0.030 and p=0.024)and 4 submassive subjects(64.2 μgr/m3 and 2.7 μgr/m3, p=0.030
and p=0.082).The mean monthly PM and SO2 results of 6 patients who died(101.6 μgr/m3 and
10.3 μgr/m3, p=0.130 and p=0.701)were significantly higher than those of the patients alive(76.6
μgr/m3 and 5.4 μgr/m3) but the difference between the results was not significant.The mean
monthly PM and SO2 results of 9 patients with deep venous thrombosis (92.3 μgr/m3 and 12.7
μgr/m3,p=0.130 and p= 0.042)were significantly higher than those of the patients without deep
venous thrombosis(77.1 μgr/m3 and 3.6 μgr/m3).Increases in PM and SO2 resulted for developing
the risk of massive embolism and deep venous thrombosis.
Keywords: PM, SO2, pulmonary embolism
P240[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
Pulmonary thromboemboli in monozygotic twins with MTHFR, VKORC1 gene
mutations (Case report)
Serap Duru, Bahar Kurt, Merve Yumrukuz, Esra Erdemir
Dıskapı Yıldırım Beyazıt Education and Research Hospital, Department of Chest Disease, Ankara,
Turkey
Pulmonary thromboemboli (PTE) is a serious, life-threatening cardiopulmonary disease interaction
between the risk factors of the patient and related to conditions. Methylenetetrahydrofolate
reductase (MTHFR) gene mutation is very rare, is one of the underlying conditions in these
patients. We aimed to present the monozygotic twins that were diagnosed as PTE and are carrying
MTHFR C677T/A1298C and vitamin K epoxide reductase subunit 1 (VKORC1 G1639 A, VKORC1
C1173T) mutations that the resistans of oral anticoagulants (Warfarin).
A 48-year old female patient whose monozygotic twin diagnosed as PTE, deep vein thrombosis
(DVT) 6 months ago in our clinic, admitted to our emergency room with the complaints of bloody
sputum and sudden onset of shortness of breath. Computerized tomography pulmonary
angiography of the patient showed hypodense filling defects compatable with thromboemboli in the
middle, lower lobe segmental branches of the right pulmonary artery. Lower extremity venous
doppler ultrasonography revealed DVT in the patient. After low moleculer weight heparin (LMWH)
and Warfarin treatment started, liver enzymes elevated three times than the normal range and
plasma homocysteine level increased. After excluding the other etiologic reasons, heterozygotic
MTHFR C677T/A1298C, VKORC1 G1639A, VKORC1 C1173T gene mutations, have seen in the
monozygotic twins. After the warfarin treatment stopped the liver enzyme levels came to the
normal range immediately, contiuned with LMWH. As a conclusion, the patients diagnosed as PTE
have high mortality if early diagnosis, management can done.When Warfarin dose adjustment can't
be done in this patients properly, some rarely seen genetic mutations must not be missing out.
Keywords: Lung, Pulmonary thromboemboli, Gene mutation
P241[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
A case of ANCA negative Wegener 's Granulomatosis with diagnosed of
Nephrotic Syndrome
Saltuk Buğra Kaya1, Aşkı Vural2, Süleyman Savaş Hacıevliyagil1, Zeynep Ayfer Aytemur1
1
Inonu University Faculty of Medicine, Department of Chest Diseases, Malatya, TURKEY
2
Inonu University Faculty of Medicine,Department of Internal Medicine, Malatya, TURKEY
33 year old male patient was admitted to the hospital because of hemoptysis. In admission, there
is leukocytosis, elevated CRP levels are available. The patient was started with amoxicillinclavulanic. Thorax CT scans in multiple bilateral thick-walled cavitary lesions with irregular margins
and frosted glass image available around the lesion (Figure 1). Steroids and cyclosporine have
been started 5gr/g in patients with proteinuria due to nephrotic syndrome renal biopsy performed
six months ago in the other centers. Immunologic markers of vasculitis was as negative. The
bronchoscopy had diagnosis of patients with Wegener's granulomatosis, there were not
endobronchial lesion. The biopsy results in capillary walls lavage cytology in patients with
neutrophil infiltration was detected benign findings. The negative smears and cultures were
determined. The renal biopsy samples were examined us again; The conclusions was determined
areas of segmental sclerosis and thickening of the membrane. Patients with ENT was consulted. As
a result of the patient's upper airway biopsy evidence of vasculitis were found out. Control chest
radiography and chest CT cavitary lesions decreased markedly. Patients performed in all biopsies 6
months of immunosuppression is carried out under a clear diagnosis, although the clinical,
radiological examinations and immunosuppressive treatment severely receive a response due to
the patient at the forefront of Wegener 's granulomatosis including vasculitis was considered.
Steroid therapy was prescribed to fall 4 mg every 2 weeks. ANCA -negative patients with Wegener
's granulomatosis is a rare detected was asked by us to be shared.
Keywords: Hemoptysis, Wegener's Granulomatosis, Nephrotic Syndrome, ANCA (-)
Figure 1
Thorax CT scans in multiple bilateral thick-walled cavitary lesions.
P242[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
Recurrent Thromboembolism In A Patient with Antiphospholipid Syndrome
Müge Erbay, Esra Aydın Özgür, Hayriye Bektaş, Savaş Özsu, Tevfik Özlü
Department of Chest Diseases, Karadeniz Technical University, Trabzon,TURKEY
A 35 year-old woman, presenting with acute dyspnea, chest pain and pain in the right leg was
admitted to the hospital. She had a history of two times recurrent deep venous thrombosis (DVT),
pulmonary embolism. There was embolism in the lower-middle-right pulmonary artery and left
pulmonary segmental artery in the spiral CT scan. Hemoglobin 8.3, platelet 53.000, INR 1.4 were
determined in routine tests. Low molecular weight heparin (LMWH) treatment was started. Bone
marrow biopsy was performed because of thrombocytopenia and biopsy was reported as
hypersellularity. Genetic tests were studied, anticardiolipin antibody IgG was positive in serum and
ANA was detected weak positive. The patient was diagnosed with primary antiphospholipid
syndrome.
At an early age in patients with recurrent pulmonary embolism, detailed research should be made
to etiology. Researching about the cause of embolism is important to prevent new emboli. Target
INR value to be kept at higher levels in pulmonary embolism associated with AFS like in our case.
Keywords: antiphospholipid syndrome, recurrent deep venous thrombosis, pulmonary
thromboembolism
P243[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
VATS lobectomy for pulmonary arteriovenous malformation: a case report
Kuthan Kavaklı1, Hakan Işık1, Okan Karataş1, Deniz Doğan2, Alper Gözübüyük1
1
Department of Thoracic Surgery, Gulhane Military Medical Academy, ANKARA, TURKIYE
2
Department of Thoracic Surgery, Gulhane Military Medical Academy, ANKARA
INTRODUCTION: Pulmonary arteriovenous malformations (PAVM) are rare pulmonary vascular
anomalies that caused by abnormal communications between arteries and veins. Due to evidence
of progressive enlargement over a period of time and high morbidity rate, treatment should be
done to prevent severe complications.
CASE: A 37-year-old woman presented with cyanosis and dyspnea for last decade. The chest X-ray
revealed the spesific findings compatible with PAVM(figure1). In her blood gas analysis, SAT
O2:82.9%,pH:7.472,PaO2:43.1mmHg,PCO2:27mmHg.
Her brain CT was normal and there was no lesions compatible with Hereditary Haemorrhagic
Telangiectasia. There was a massive AVM in the right lower lobe(figure2a). It has two large feding
arterial vessels orginating from pulmonary artery(figure2b). She underwent embolisation(figure3).
The embolisation procedure was achieved uneventfully. However she does not relief probably due
to two large size of the proximal feeding artery and her SAT O2 was 90% after one month. Her
cyanosis was not resolved. We discussed about any surgical intervention including lobectomy.
There was no target area that will be curative when we performed wedge resection. Therefore, we
performed VATS lobectomy without any difficulty.
Chest tube was removed on 4th postoperative day and the patient was discharged
uneventfully(figure4). Her blood gas analysis was normal. The oxygen saturation was
98.8%,pH:7.456,pO2:98.1mmHg,pCO2:29.7mmHg four months after surgery.
CONCLUSION: The benign diseases of the lung should be treated curatively with minimally
invasive manner and less morbidity rate. VATS lobectomy can be accepted as a safe and minimally
invazive procedure for patients with PAVM especially when it was performed after transcatheter
embolisation.
Keywords: Embolisation, lobectomy, pulmonary arteriovenous malformation, thoracic surgery.
P244[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
Clinical effect of the precence of cancer in patient with pulmonary
thromboembolism
Mehmet Ali Habeşoğlu1, Sibel Kara1, Zuhal Ekici Ünsal1, Hatice Eylül Bozkurt Yılmaz1, Füsun Öner
Eyüboğlu2
1
Department of Chest Medicine, Başkent Universty, Adana, Turkey
2
Department of Chest Medicine, Başkent Universty, Ankara, Turkey
PURPOSE: The occurrence of malignancy increases the risk of pulmonary embolism (PE). In this
study, the clinical and radiological features of PE patients with and without cancer were compared.
METHOD: The data of patients diagnosed with PE between November 2011, and December 2013
by thorax CT were evaluated retrospectively.
FINDINGS: There was cancer in 50 (%29,2) of total 171 patient. The average number of risk
factors (2,6±1,1 vs 1,6±1,0; p<0,001) was higher in patient with cancer. Central venous
catheterization was significantly higher (p<0.05) as a risk factor in PE patient with cancer. The
oxygen saturation was lower (%88,2±6,8 vs %92,4±6,2; p<0,001), deep vein thrombosis more
often (%75vs %34,5; p<0,01) and, pulmonary artery pressure higher (49,1±11,9’vs 42,3±16,7
mm Hg; p<0,05) in patient with cancer. The cancer patients have mostly centrally located PE (%56
vs %42,1) on thorax CT but the difference statistically insignificant (p=0,069). The PE was
developed within 90 days after being diagnosed malignancy in 22(%44) of patients. The PE was
diagnosed incidentally in 13(%26) of cancer patient, in 44 (%88) after and, in 6(%12) before or
concurrently with cancer. One year mortality was %22 in patient with cancer while %7,4 patient
without cancer (p<0,05).
CONCLUSION: The clinical presentation of PE in patients with cancer is more severe. PE may be a
herald of malignancy and It can be determined incidentally. The careful follow up of patient for PE
within the first 90 days after the diagnosis of malignancy and considering prophylactic
anticoagulant therapy will be increase survive of patient.
Keywords: Cancer, Clinic, Pulmonary Thromboembolism
P245[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
Thrombolytic Treatment Due to Acute Massive and Submassive Embolism
and Results in İntensive Care Unit
Kezban Özmen Süner, Serpil Öcal, Atilla Kara, Mehmet Nezir Güllü, Kazım Rollas, Ebru Ortaç Ersoy,
Arzu Topeli İskit
Hacettepe University,Faculty of Medicine, Department of Medical İntensive Care
Patients with Pulmonary Thromboembolism(PTE),cardiopulmonary arrest, hypotension, right heart
failure increases mortality.So if there is not a contraindication, thrombolytic treatment is
recommended this patients.If there is not given thrombolytic treatment, especially in patients with
submassive PTE,there is seen40%persistant dyspnea,functional disability and right heart
dysfunction in their long-term follows.In this study,we aimed to assess the features of patients with
PTE and results of thrombolytic treatment in our Intensive Care Unit(ICU).
MaterialMETHOD: In our ICU,files of patients were analyzed retrospectively which received thrombolytic
treatment for thromboembolism at last5years.Demographic,
clinical,radiological,echocardiographic,labaratory features of these patients were analyzed from
files.Thrombolytic treatment and results have been reviewed.
FINDINGS: 19patients that radiologically diagnosed as massive PTE with dynamic computer
tomography were followed.The mean age of patients63,5 years and56% of them are female.There
was2patients with massivePTE and17 patients with submassive PTE.17patients were evaluated with
echocardiography which radiologically diagnosed as massive PTE but not had hypotension.There
was seen pulmonary hypertension and right heart failure16 of patients and 1of patients had
radiologically massive PTE and severe hypoxemia.Because of respiratory failure, invasive
mechanical ventilation was applied to 1patient,non invasive mechanical ventilation was applied to3
patients.Only oxygen support with mask was given to 15 patients.There was seen lower extremity
deep vein thrombosis in63% of patients,and PTE risk factors in 68%of patients.Only in3 patients
there was seen minimal bleeding as a complication.There was not seen any mortality in these
patients in the hospitalization period.
RESULT: The results support the literatüre knowledge,that oxygen demand and pulmonary
hypertension rapidly increased in massive and submassive PTE with thrombolytic therapy.
Keywords: Thrombolytic Treatment, Acute Massive and Submassive Embolism
Findings
Values
Before thrombolytic treatment After thrombolytic treatment
Pulmonary artery pressure (mmHg) 70±17,3
32±14,9
pH
7.47±0,15
7,45±0,048
pO2(mmHg)
54±11,4
71±15,1
pO2/FiO2
200±67,8
324±63,0
D-Dimer (mg/L)
8±15,9
-
Troponin (ng/mL)
0,065±0,23
-
CK-MB (ng/mL)
2,73±6,1
-
Values are presented mean±standart deviation.
P246[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
In Hyperhomocysteinemia Ground Developing With Recurrent Pulmonary
Embolism, Deep Vein Thrombosis and Sinüs Vein Thrombosis: Case Report
Fidan Sever1, Nazan Bağdagül Pekcan2, Aşkın Gülşen1, Hatice Yılmaz3, Şenol Kobak4, Mehmet Yaşar
Özkul2
1
Department of Chest Disease, Şifa University, Izmir,Turkey
2
Department of Neurology, Şifa University, Izmir,Turkey
3
Department of Internal Medicine, Şifa University, Izmir,Turkey
4
Department of Rheumatology, Şifa University, Izmir,Turkey
Cerebral venous thrombosis, clinical signs and symptoms is a disease of the variety of interesting
and challenging. Emergency service is 5 days with severe headache, drowsiness, recession, nausea
and vomiting, 39-year-old male was admitted with complaints. In patients with cranial magnetic
resonance angiography and venography common in all sinus thrombosis and chest computed
tomography angiography performed in the presence of pulmonary embolism was detected.
Curriculum Vitae 3 times there was an attack of pulmonary embolism. Sinus vein thrombosis,
recurrent deep vein thrombosis and pulmonary embolism in patients with hyperhomocysteinemia
on the ground to determine the cause of the phenomenon is presented in the literature.
Keywords: Hyperhomocysteinemi,Pulmonary Embolism, Sinüs Vein Trombosis
P247[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
An Asthma Diagnosted Case, Co-Existence With Right Atrial Myxoma And
Pulmonary Embolism
Hatice Sözgen1, Fatmanur Karaköse1, Abdurrahman Tasal2, Fatih Yakar1, Hatice Kutbay Özçelik1,
Muhammed Emin Akkoyunlu1, Mehmet Bayram1, Murat Sezer1
1
Bezmialem Vakif University, Department of Chest Disease, İstanbul, Turkey
2
Bezmialem Vakif University, Department of Cardiology, İstanbul, Turkey
INTRODUCTION: Myxoma is a benign tumor develops from cardiac origin and usually located in
left atrium. Myxomas can originate in right atrium in 25% of cases; and approximately 10% of this
patients may develop pulmonary embolism. This rare condition can cause difficulties in diagnosis
and the absence of clinical suspicion can cause delay in diagnosis.
CASE: 31 year old male patient was admitted with increasing shortness of breath and chest
tightness. Breath sounds and system inspection were normal in physical examination. The patient
was followed up with asthma diagnosis for 7 years and there was a history of tuberculosis in the
medical history. Pulmonary function tests showed findings consistent with the restriction. There
were bilateral segmental pulmonary artery filling defects in pulmonary CT angiography. The patient
consulted with cardiology and there was 3x3cm size a moving mass that adhered to interatrial
septum in the right atrium in echocardiographic examination. Operation was recommended for
patient. It was seen that, there was a notable regression in the patient’s complaints after
cardiovascular surgery.
DISCUSSION: Although myxomas are benign tumors, it's necessary to diagonse this condition
early because of obstruction findings, thromboembolic complications, prevent false diagnosis ( like
valve pathology) and to treat this pathology with surgery as soon as possible. These tumors carry a
risk of myxomatous emboli and require concurrent pulmonary embolectomy in operation. This
condition often undiagnosed for a long time and recurrent pulmonary embolism can occur when
investigating. It's important to be careful in embolic pathologies for intracardiac tumor possibility.
Keywords: myxoma,pulmonary embolism,surgical treatment
P248[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
Incidence Of Upper Extremity Thrombosis İn Pulmonary Thromboembolism
Hatice Kılıç1, Ayşegül Şentürk1, Hatice Canan Hasanoğlu3, Funda Karaduman Yalçın2, Tuba Öğüt1,
Ayşegül Karalezli1
1
Ankara Research and Training Hospital, Department of Pulmonary Medicine, Ankara, Turkey
2
Sinop Boyabat 75th State Hospital, Department of Pulmonary Medicine, Sinop, Turkey
3
Yildirim Beyazit University Medical School, Department of Pulmonary Medicine, Ankara, Turkey
INTRODUCTION: Venous thromboembolism is a clinical condition that often occurs from deep
vein thrombosis of lower extremity. The incidence of DVT in the etiology of pulmonary
thromboembolism is shown that at rates up to 90%. Doppler USG of lower extremities is
recommended generally to determinate the etiology of PTE. The aim of this study is to present the
importance of upper extremity thrombosis in PTE.
MaterialsMETHODS: Between 2010- 2012, 236 patients have been followed with the diagnosis of PTE were
included. Lower, upper extremity Doppler USG examination was performed to all patients to
determinate the cause of PTE.
RESULTS: The mean age of patients is 64,7± 16,9 (22- 95) and 56,8% (134) were female, 43,2%
(102) were men. According to the classification of PTE, 37 (15,7%) patients had massive, 103
(43,6%) patients had submassive, 96 (40,7%) patients had nonmassive PTE. Lower extremity DVT
was detected in 109 (46,2%) patients, both lower and upper extremities DVT was detected in 10
(4,2%) patients, only upper extremity DVT was detected in 10 (4,2%) patients. Eventually, DVT
was detected in 119 (50,4%) patients. Thrombosis of the upper extremity was detected in 20
(16,8%) patients.
CONCLUSION: Results from this study, upper extremity thrombosis has been found as important
as lower extremity thrombosis in the etiology of VTE. Therefore, upper extremity thrombosis does
not accompany patients with malignancy or fitted with central venous catheter inserted. It should
be kept in mind that, in hospitalized patients with peripheral vascular vein catheter, the upper
extremity thrombosis may occur.
Keywords: Pulmonary thromboembolism, thrombosis, upper extremity
P249[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
A Case of Heparin Induced Thrombocytopenia Treated with Fondaparinux
Halil Tosun1, Erdal İn1, Müge Otlu Karadağ2, Ramazan Ünver1, Mutlu Kuluöztürk1
1
Firat University Faculty of Medicine, Department of Pulmonary Disease, Elazig, Turkey
2
Malatya State Hospital, Malatya, Turkey
INTRODUCTION: Heparin-induced thrombocytopenia (HIT) usually occurs following the use of
heparin in the days of 5-14.Heparin therapy should be discontinued when HIT occured and direct
thrombin inhibitors should be initiated.
CASE: 82-year-old female patient was admitted to our clinic with the complaints of severe
abdominal pain, shortness of breath, palpitations and general condition of disorder starting one
day.She was hospitalized to our clinic after the determination of bilateral main pulmonary artery
thrombus in CTPA.She had a medical history of taking heparin about 3 months ago due to
operation of right arm.She had tachypne, damaged general condition and confused
consciousnes.The patient was treated with heparin. Pre-treatment platelet counts in the patient
was 84,000/mm3 but after the heparin treatment on the second day the platelet count was
57,000/mm3,and the third day 35,000/mm3,respectively.Patient was accepted type 2 HIT with a
history of using heparin within 3 months and falling of the platelet count over 50% compared to
the initial value. On the fourth day platelet count was: 28,000/mm3, the patient doppler was taken
to the patient and the thrombus was detected in the right crural vein. Fondaparinux with the dose
of 7.5mg/day was started. Warfarin was started after increasing in the platelet count on the eighth
day and showing the value of 112,000/mm3.Fondaparinux was stopped after five day with INR
levels of 2-3. Patient was discarded with arranging warfarin therapy after the clinical findings
improved, oxygen saturation increased and platelet count increased to 337,000/mm3 with the
treatment.
Keywords: Pulmonary embolism, heparin, thrombocytopenia, fondaparinux
P250[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
Pulmonary Arterial Hypertension in Patient with Neurofibromatosis Type I
Nevin Taci Hoca1, Arzu Ertürk1, Nermin Çapan1, Cengiz Burak2, Omaç Tüfekçioğlu2
1
Atatürk Chest Diseases and Chest Surgery Education and Research Hospital, Pulmonology
Department
2
Türkiye Yüksek İhtisas Hospital, Cardiology Department, Ankara
Pulmonary arterial hypertension (PAH) is a very rare complication of neurofibromatosis type 1
(NF1).
A 45-year –old woman was admitted to our hospital because of dyspnea, and cough. She had a
history of total thyroidectomy, and pericardiocentesis six years ago, and antituberculosis treatment
history because of tuberculous empyema.
Physical examination showed many cutaneous neurofibromas, multiple cafe au lait spots, and
axillaries freckling. Lisch nodules in iris were found. There were inspiratory crackles at the left lung
and dullness at the basal region of the right lung. She had pretibial edema.
Laboratory investigations revealed high ESR (84 mm/h) and CRP (8.08). Blood count, liver and
renal functions, urine analysis, coagulation tests, and collagen tissue markers were normal. Chest
X-ray showed bilateral pleural effusion, right pleural thickening, and consolidation at the right lower
lobe. Three sputum examinations for AFB were negative. Arterial blood gas tensions were as
follows: PH: 7.44, PO2: 45.2mmHg, PCO2:44.5mmHg. Echocardiography (ECO) revealed enlarged
right atrium, grade II-III tricuspid insufficiency, and systolic pulmonary artery pressure (sPAP)
90mmHg. Thrombus was not detected on CT angiography. Cardiac catheterization demonstrated
that PAP 88/37/54mmHg, PVR 5.6 wood units. Vasoreactivity test was negative. 6 min-walking
distance(6MWD) was 300 meters. Nasal oxygen,diuretic and bosentan treatment was started. After
18 months of the therapy 6MWD was 360 meters. Arterial blood gas status showed a PO2 of
67.2mmHg, PCO2 of 38.9mmHg. Control ECO demonstrated sPAP of 62mmHg.
If patients with NF1 have dyspnea, investigation for PAH should be performed immediately because
early diagnosis is important for survival.
Keywords: Neurofibromatosis, Pulmonary arterial hypertension
P251[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
Unilateral Pulmonary Artery Agenesis Case
Alper Gündoğan, Alev Taşkın, Seyfettin Gümüş, Ergun Uçar, Ömer Deniz, Ergun Tozkoparan, Hayati
Bilgiç
Gulhane Military Medical Academy,Department of Pulmonary Medicine, Ankara
Unilateral pulmonary artery agenesis is a rare congenital anomaly. It is a congenital anomaly due
to malformation of aortic arch during embriyogenesis. The final diagnosis is set usually at young
adults but asymptomatic patients can be at further ages. We present a case whose compliant has
been dsypnea for many years during exercises and diagnosed as unilateral pulmonary artery
agenesis.
21 years old patient admitted to the clinic with dyspnea during exercises. Chest radiogram revealed
volüme loss on left hemithorax and left shift of mediastenium. (Picture1) Toraks CT revealed left
lung volüme loss and absence of left pulmonary artery and its branches. (Picture 2) Broncoscophy
showed no abnormality. Pulmonary function test revealed slightly mixed restrictive and obstructive
pattern. No accompanying cardiac anomaly was detected.
The estimated prevelance of unilateral pulmonary artery agenesis is 1/200.000. Estimated age of
diagnosis is near 14 but diagnosis can be set later at asemptomatic patients. One third of patients
have left pulmonary agenesis. Perfusion is supplied by bronchial arteries or by collateral arteries.
Treatment choices includes surgery or embolisation. However surgical procedures is a choice when
there is recurrent hemoptiysis, recurrent infecitons or pulmonary arterial hypertension. İt should be
bear in mind that final diagnosis couldn’t be set until adult ages in asymptomatic patients and
suitable imagining tecniques should be used for differantial diagnosis.
Keywords: unilateral pulmonary artery agenesis
Picture 1
Picture 2
Thorax CT revealed absence of left pulmonary artery and its branches.
P252[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
Bronchiolitis Obliterans-organizing Pneumonia (BOOP)-like Variant of
Wegener's Granulomatosis: A Clinico-radiologic Study of 19 Cases
Fatma Sema Oymak1, Süleyman Balkanlı2, Afra
1
Erciyes University Medical School, Department
2
Erciyes University Medical School, Department
3
Erciyes University Medical School, Department
4
Erciyes University Medical School, Department
Kayseri/Turkey
5
Erciyes University Medical School, Department
Kayseri/Turkey
Yıldırım3, Soner Şener4, Oktay Oymak5
of Chest Diseases, Kayseri/Turkey
of Pathology, Kayseri/Turkey
of Radiology, Kayseri/Turkey
of Internal Diseases,Rheumatology Unit,
of Internal Diseases, Nefrology Unit,
Granulomatosis with polyangiitis [Wegener Granulomatosis (WG)] is a rare vasculitis. The
histopathological features of WG include necrotizing granulomatous vascular inflammation, but an
bronchiolitis obliterans-organizing pneumonia (BOOP) like variant has also been reported. This
study was undertaken to elucidate the histopathologic features of this form of WG. Clinical
information, radiographic findings, and follow-up data on the patients with WG were obtained from
hospital records and a review computer–generated lists of pathology department. Patients in
Erciyes University Medical School Center with WG were selected according to American College of
Rheumatology classification (ACRC) criteria between 2004 and 2014.The 19 patients with BOOP
ranged in age 27 from to 72 years (mean, 46 years) and included 6 men and 13 women were
obtained. Cough, fever, hemoptysis, and dyspnea were the most common presenting complaints.
The WG was limited form to the lung and upper airways in 14 patients (73%). Renal involvement
was present in 5 patients (27%). Antineutrophil cytoplasmic antibodies (ANCA) test was negative
in 14 patients (73%). Chest radiographs and/or tomography showed nodules in 15 (%78), 5 (27%)
of which were associated with cavitation. Two patients (15%) had alveolar hemorrhage. When
confronted by nodules and/or mass lesions with/without cavitation together with clinical signs of
inflammation, the clinician must also consider the possibility of immunological disorders, such as
WG, where BOOP is a rather common feature associated with vasculitis on lung biopsies. A careful
examination for extrapulmonary signs of vasculitis, and the presence of ANCA is, therefore,
necessary in such cases.
Keywords: Granulomatosis with polyangiitis, Wegener's Granulomatosis, Bronchiolitis obliteransorganizing pneumonia (BOOP), antineutrophil cytoplasmic antibodies (ANCA), vasculitis
P253[Klinik Sorunlar - Pulmoner Vasküler Hastalıklar]
Would RDW be a prognostic factor in pulmonary arterial hypertension?
Kemal Can Tertemiz1, Bahri Akdeniz2, Aylin
Sevinç1
1
Dokuz Eylul University School of Medicine,
2
Dokuz Eylul University School of Medicine,
3
Dokuz Eylul University School of Medicine,
Özgen Alpaydın1, Ahmet Melih Birlik3, Nezihi Barış2, Can
Pulmonary Medicine
Cardiology
Rheumatology
Aim and
METHODS:
Erythrocyte morphology is influenced by hematological pathologies, systemic inflammation,
infective erythropoiesis and nutritional deficiencies. Erythrocyte morphology might be evaluated by
“red blood cell (RBC) distribution width (RDW)”. We aimed to study the relationship of RDW with Nterminal pro-brain natriuretic peptide (NT-proBNP), 6 minute walk test (6MWT), pulmonary arterial
pressure (PAP), arterial blood gases analysis in patients with pulmonary arterial hypertension
(PAH) patients of our hospital
Results
Fifty-four female and 72 male patients whose mean age was 52 were included in the study. Mean
follow-up duration was 20 months. According to PAH etiologies, 20 patients were diagnosed as
iPAH, 14 as CTEPH, 24 were due to chronic cardiac disease, 10 were due to collagen vascular
disease and 4 were due to other diseases. There were significant correlations between
pretreatment RDW and functional capacity (FC), NT-proBNP, RV fractional area change, right
ventricle Tei index, arterial oxygen saturation and CRP (p<0.05). However 6MWT, TAPSE and mean
PAP were found not to be correlated with pretreatment RDW. Pretreatment and 3 month follow up
values of FC, PAB and TAPSE were significantly decreased, while there was no significant change in
RDW, 6MWT and NT-proBNP. Mortality was observed to be increased in patients with higher levels
of RDW.
CONCLUSION:
There are limited data upon the association between erythrocyte morphology and PAH parameters
and mortality. In our center we observed a close relationship between RDW and routine follow-up
and prognostic parameters of PAH as well as mortality.
Keywords: pulmonary arterial hypertension, RDW, mortality, NT-proBNP
P254[COPD]
Two adult patients with tracheomalasia
Ahmet Arısoy1, Mehmet Hakan Bilgin2
1
Private Istanbul Hospital, Pulmonary Medicine, Van, Turkey
2
Pulmonary Medicine, Van Bolge Hospital, Van, Turkey
Severe adult tracheomalacia is a dangerous disease that is difficult to manage, particularly at the
time of airway infection, and has a high mortality rate. Softening may occur in part or all of the
tracheal cartilage and may even extend beyond the trachea (tracheobronchomalacia).
Two male patients whom age are 83 and 66, were admitted to our clinic with noisy cough for many
years. 83 year old male patient was using COPD drugs for ten years. He was often infected and
expectorated purulent sputum. There were inability to sleep and drowning complaints last 6
months. He was taken intensive care unit and sedatized 3 mg midazolam. He had obstructive
apnea after sedation. We started high pressure BPAP with ventilator. His apneas continued after
BPAP. Trakeal stent was implanted to him at Yedikule chest diseases and thoracic surgery training
and research hospital. His sleep problems improved after stent. Bronchoscopy was performed to 66
yer old male patient due to suspected chest CT. Front and back wall of the trachea were adhered to
each other in bronchoscopy. He was taken to follow up.
Keywords: COPD, Tracheomalacia, Bronchoscopy
Figure 1
Flattened trachea in torax CT
Figure 2
Front and rear walls of the trachea were adhered in bronchoscopy.
P255[COPD]
Relationship Between Coronary Artery Disease and Pulmonary Arterial
Pressure in Patients with Chronic Obstructive Pulmonary Disease
Müntecep Aşker1, Selvi Aşker2, Uğur Küçük3, Hilal Olgun Küçük4
1
Department of Cardiology, Van Yuksek Ihtisas Training and Research Hospital, Van,
2
Department of Chest Diseases, Van Yuzuncu Yil University Dursun Odabas Medical Center
3
Department of Cardiology, Van Military Hospital, Van; Turkey
4
Department of Cardiology, Van Regional Training and Research Hospital, Van,
Chronic obstructive pulmonary disease (COPD) is characterized by chronic and progressive airway
destruction leading to irreversible airflow obstruction. Its cardiac manifestations are numerous
including coronary artery disease, right ventricular dysfunction, pulmonary hypertension and
arrythmias.
Pulmonary hypertension (PHT) shares common pathophysiological basis with CAD such as systemic
inflammation and endothelial dysfunction. In this study we sought to determine whether there is a
relationship between pulmonary hypertension and CAD and whether pulmonary hypertension is an
additional risk factor for the presence and extent of CAD in COPD patients.From May 2009 to
September 2012 patients with a diagnosis of COPD and pulmonary artery hypertension
(echocardiographic maximum systolic pulmonary artery pressure > 40 mmhg) who had undergone
diagnostic coronary angiography for evaluation of suspected coronary artery disease were
evaluated. Presence of >20% stenosis in coronary circulation was defined as coronary artery
disease and its severity was evaluated via Gensini score.A total of 95 patients (52 male; 43
female; mean age 63±8 years) with COPD and pulmonary hypertension were recruited in the
study.Mean mPAB was 35.9±8.53 mmhg. 68% of the participants had CAD. Median Gensini Score
was 14. Presence of CAD was significantly correlated to age, hypertension, FEV1% predicted and
biomass exposure.There was no statistically significant association between the presence of CAD
and pulmonary artery pressure.
In conclusion we found a high prevelance of CAD in patients with PHT secondary to COPD. But
despite similar operating pathophysiological mechanisms and resultant inflammatory cascade no
correlation between the presence and severity of CAD and PHT was detected.
Keywords: coronary artery disease •Hypertension, Pulmonary •Pulmonary Disease, Chronic
Obstructive
P256[COPD]
ß2 agonist ultra prolonged action versus ß2 agonist prolonged action in the
treatment of COPD patients in our hospital
1
2
Silvana Abdi Bala , Arian Cezar Mezini , Loreta Shaqir Agolli
1
2
2
University of medicine science, Tirana, Albania
University hospital of lung disease, Tirana, Albania
INTRODUCTION: COPD is a disorders characterized by the progressive development obstruction
of airway, which manifest as an accelerated decline in lung function, with symptoms such as
breathlessness on physical exertion, deteriorating health status, and exacerbations.
OBJECTIVE: To compare efficacy of indacaterol (ß2 agonist ultra prolonged) to that of fixed-dose
150mcg versus ß2 agonist prolonged action for the treatment of COPD disease.
Method
and
RESULTS: Under study were 90 patients with COPD in stage II-III, with an average age of 62.3 +
/
8.37
(range
43-79)
By sex were 55 males and 35 females. History for tobacco had 89 patients, 40 were smokers and
49 were ex-smokers. Respiratory examination you charge patients on the day of entry and 5
minute after application of indacaterol/ salbutamol. Another Spirometri was done after 12 hours We
obtained by use of indacaterol, an increase of FEV1 over 70ml after 5 minute and this effect
bronchodilatator is present even after 12 hours of application, compare with salbutamol and
salmeterol
respectively.
CONCLUSION: Indacaterol provides an ultra prolonged bronchodilator action versus Salmeterol
and onset of action of indacaterol in patients with COPD compare with salbutamol is immediate.
Keywords: Indacaterol, COPD, Salmeterol, Bronchodilatator effect
P257[COPD]
Frequency of exacerbation and hospitalization in patients with COPD who
continue to smoke
Serap Argun Barış, Tuğba Aşlı Önyılmaz, İlknur Başyiğit, Haşim Boyacı, Füsun Yıldız
Department of Pulmonary Disease, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
AIM: The aim of this study was to evaluate the frequency of exacerbation and hospitalization in
patients with COPD who continue to smoke.
MaterialMETHOD: The medical records of the COPD patients were evaluated retrospectively between the
years of 2007-2013. Demographic characteristics, smoking history, Charlson comorbidity index,
initial FEV1 value, stage of the disease, duration of follow-up, history of exacerbation and
hospitalization were recorded.
RESULTS: There were 11 female (9.2%), 109 male (90.8%) totally 120 patients were included
whose mean duration of follow-up was 3.2±1.7 years. Sixteen (13.3%) of the patients were
current smoker, 99 of them (82.5%) were ex-smoker and 5 of them (4.2%) were non-smoker. The
mean age was 69.7±7.9 years in ex-smokers while it was 62.94±6.8 years in current smokers.
There were no statistically significant difference on smoking history, FEV1 value, frequency of
exacerbation and hospitalization per year, duration of follow-up between the current and exsmokers (p>0.05). Stage 4 COPD were noted in 7.1% of ex-smokers while there was no patient
evaluated as stage 4 in current smokers. There was a statistical significant correlation between the
initial stage of the disease and the frequency of the exacerbations (p=0.003). The Charlson
comorbidity score was higher in ex-smokers compared to current smokers (p=0.02).
CONCLUSION: It was found that the current smoking rates were high in patients with COPD. It is
suggested that older age and presence of comorbidities in ex-smoker group might explain the
similar rates of exacerbation and hospitalization between current and former smokers.
Keywords: COPD, exacerbation, hospitalization, smoking
P258[COPD]
Changes in Functional Parameters in Chronic Obstructive Pulmonary Disease
and Blood Cotinine Level
Hatice Kozluca1, Gülseren Karabıyıkoğlu1, Emrah Dural2, Tülin Söylemezoğlu2
1
Ankara University School of Medicine Department of Chest Diseases, Ankara, Turkey
2
Ankara University, Institute of Forensic Sciences, Ankara, Turkey
Chronic obstructive pulmonary disease (COPD) is a disease that characterized by airflow limitation.
FVC%, FEV1%, FEV1/FVC ratio and FEF25-75% are the key functional parameters in COPD that
determined by spirometry. Most important known risk factor is smoking. Main metabolite of
nicotine, cotinine, reflecting the best marker of tobacco exposure.
We aim to investigate relationship between cotinine, smoking history and functional parameters in
COPD patients and healthy volunteers.102 COPD patients and 106 healthy volunteers were enrolled
in the study. In both groups, mean spirometric values were determined according to smoking
history.Gas chromatography-mass spectrometry method was used for determination of cotinine.
Cut-off for cotinine level(41.12ng/ml) determined by ROC analysis, was 97.2% sensitive and 100%
specific for randomization of smokers and non-smokers. According to smoking history there was
significant difference in cotinine (never-smokers:6.1ng/ml,current smokers:467ng/ml,exsmokers:8.8ng/ml). There was no difference in cotinine according to gender and age. Positive
corelation was observed between cotinine and number cigarettes smoked per day.
In both groups, cotinine and FVC%, FEV1% and FEV1/FVC ratio were not correlated. There was no
relationship between FEF25-75% and cotinine in study group. However negative correlation was
found between smokers in control group. According to smoking history FVC%, FEV1% and FEF2575% in ex-smokers of study group and FEF25-75% in current smokers of control group were lower.
Our study prove that cotinine is a reliable indicator of tobacco exposure and smoking effects COPD
in many ways. Negative correlation between FEF25-75% and cotinine in current smokers of control
group indicates early effects of smoking in peripheral airways.
Keywords: COPD, functional parameters, cotinine, cigarette
ROC analysis of cotinine
The distribution of cotinine (ng/ml) according to smoking history
Groups according to smoking history and spirometric values of cotinine
smoking history N
Age
Pack-year cotinine ng/ml FVC%
FEV1% FEV1/FVC FEF25-75%
patient
never-smoker
current smoker
ex-smoker
102
14
26
62
62.10
61.23
57.23
64.35
38.74
41.53
46,32
139.61
6,23
521,89
9.43
67.21
71.42
70.69
59.53*
48.72
58.14
53.84
44.45*
59.65
63.84
60.57
58.32
29.27
34.78
32.65
26.61*
control
never-smoker
current smoker
ex-smoker
69
24
30
15
40.96
44.33
35.24
47.05
10.41
19.76#
17.20#
178.89
6.06
412.23**
8.27
101.51
99.33
102.73
102.46
101.82
101.79
101.80
101.93
83.98
85.66
83.46
82.33
83.17
98.00
70.68^**#
83.60#
Group of cotinine distribution according to smoking history
SMOKING HISTORY
COTİNİN (ng/ml)
Average
Median Minumum-maximum
(±standard deviation)
Patient
6.23 (±3.71)*
never-smoker (n:14)
521.89 (±628.59)*
current smoker (n:26)
9.43 (±6.31)*
ex-smoker (62)
5.29
1.83 – 13.23
356.05 87.76 - 3313
8.88
1.33 – 38.43
Control
6.06 (±4.42)*
never-smoker (n:42)
412.23 (±383.73)*
current smoker (n:45)
8.27 (±5.97)*
ex-smoker (19)
5.11
0.41 – 19.48
258.82 11.44 – 1924.50
7.61
2.38 – 29.64
* p<0,05 (current smoker>ex-smoker>never-smoker)
P259[COPD]
Correlation of Clinical, Laboratory and Functional Parameters in Stable
Chronic Obstructive Pulmonary Disease
Mehmet Ünlü, Pınar Çimen, Sami Cenk Kıraklı, Nuran Katgı, İsmail Kayaalp, Aysu Ayrancı, Salih
Zeki Güçlü
Dr. Suat Seren Chest Diseases and Surgery Training Hospital-IZMIR
Dyspnea is most important symptom affecting the daily lives of COPD patients.It is not possible to
determine the degree of dyspnea and quality of life only by spirometry.Additional markers are
needed to assess the perception of dyspnea and the quality of life.In addition anxiety and
depression are the most common comorbidities affecting the lives of patients with COPD.In this
study we evaluated perception and degree of dyspnea in stable COPD patients with different
measurement methods and investigate the correlation between the clinical,laboratory and
functional parameters with dyspnea scales;and also aimed to determine relationship between level
of COPD and psychological influence of the COPD patients.101 COPD patients that were admitted to
Dr.Suat Seren Chest Diseases Training Hospital were included to the study between June 2012December 2012.OCD and BDI dyspnea scales that were used to assess patients, showed a strong
positive correlation with FEV1(p<0.05).Also VAS,MBS and mMRC had a significant positive
correlation with FEV1(p<0.001).SGRQ’s subunits,respiratory questionnaire assessing quality of
life,SGRQsymptom,SGRQactivity had a strong negative correlation with FEV1 (p<0.001),and FEV1
had a very strong negative correlation with SGRQtotal(p<0,05).Also HAD questionnaire had strong
negative relationship with OTD and BDI dyspnea scales (p<0.001),and showed a positive
relationship with mMRC and MBS scores (p<0.001).Both anxiety and depression had a strong
positive correlation with SGRQ scores (p<0.001).In conclusion,FEV1 is not enough for evaluation of
COPD.Dyspnea and the quality of life scales are needed.Also clinicians should be alert in terms of
anxiety and depression in COPD.
Keywords: Anxiety,depression,dyspnea scales,COPD,life quality
P260[COPD]
Pulmonary hypertension and intima media thickness in chronic obstructive
pulmonary disease patients
Selvi Aşker1, Müntecep Aşker2, Özgür Gürsu3, Şahin İşcan3, Aydın Rodi Tosu2
1
Department of Chest Diseases, Van Yuzuncu Yil University Dursun Odabas Medical Center, Van,
Turkey
2
Department of Cardiology, Van Yuksek Ihtisas Training and Research Hospital, Van,
3
Department of Department of Cardiovascular Science, Van Regional Training and Research
Hospital, Van, Turkey
To investigate and compare the carotid and brachial intima media thicknesses in chronic
obstructive pulmonary disease (COPD) patients with and without pulmonary hypertension (PHT).
A total of patients separated in three groups were involved in the study.Group 1 consisted of 47
COPD patients with PHT, Group 2 was composed of 71 COPD patients without PHT, and Group 3
was made up of 37 healthy controls. Demographic features, biochemical markers, and carotid and
brachial arterial intima media thicknesses (IMT) were comparatively assessed in these 3 groups.
The mean ages for Groups 1, 2 and 3 were 59.7±9.0, 55.0±10.2 and 47.6±9.7, respectively
(p=0.40). Three groups displayed significant difference in terms of gender distribution (p<0.001)
and smoking habit (p<0.001). In contrary, prevalences of diabetes mellitus (p=0.06) and
hypertension (p=0.11) were similar between groups. Carotid IMT, brachial IMT, hemoglobin,
hematocrit, serum levels of triglycerides, cholesterol, LDL, ejection fraction, oxygen saturation,
CRP, and HDL exhibited statistically significant difference between controls and COPD patients.
When Groups 1 and 2 are compared; only the right carotid arterial IMT was found to be thicker in
Group 1 (p=0.006). The other parameters studied were found to be similar between COPD patients
with and without PHT.
Our results have shown that COPD and PHT may result in significant changes in IMTs of carotid and
brachial arteries. However, no specific sonographic changes regarding IMT could be detected for
PHT in COPD cases. Further prospective, randomized, double-blinded trials are required to unveil
the actual potential of IMT in the diagnosis and follow-up.
Keywords: brachial artery,Carotid artery,chronic obstructive pulmonary disease, intima media
thickness,pulmonary hypertension
P262[COPD]
Clinical and functional characteristics of elderly COPD patients
Eylem Sercan Özgür, Sibel Atış Naycı, Cengiz Özge, Esin Taştekin, Ahmet İlvan
Department of Chest Diseases, Mersin University, Mersin, Turkey
AIM: COPD is a chronic inflammatory lung disease that usually becomes clinically apparent later in
life. The prevalence of COPD in the elderly are high. The clinical presentation of COPD in the elderly
may be complicated due to aging. For these reason management of COPD in the elderly population
may be challenged. We aimed to compare the clinical and functional characteristics of COPD in
young and elderly patients.
METHOD: We recruited 240 stable COPD patients. They were divided into two groups, <65 years
(n=154,young group) and >=65 years(n=86,elderly group). The clinical and functional
characteristics (cigarette, duration of disease, BMI, Charlson score, FEV1, mMRC, 6MWTD, number
of exacerbations and hospitalizations in the previous year, old and new of GOLD stage) of the
patients with COPD according to age were evaluated retrospectively.
RESULTS: The mean age was 61.55±8.2 years, FEV1 50.78±18.3%, and Charlson score
1.52±0.9. Elderly patients had longer disease duration, lower BMI and lower 6MWTD than young
patients (p=0.13,p=0.001 and p=0.002,respectively). There were no significant differences
between two groups in respect of Charlson score, FEV1, mMRC, number of exacerbations and
hospitalizations in the previous year, old and new of GOLD stage.
CONCLUSION: This study showed that lower exercise capacity and body mass index in elderly
COPD patients, however, there were not a significant relation between other cinical characteristics
of patients and aging. It was thought that clinicians need to evaluate age of patients in addition to
other clinical and functional parameters when COPD management and this issue needs further
study.
Keywords: COPD, comorbidity, elderly, GOLD stage
P263[COPD]
The Evaluation of nutritional status of stable COPD patients and to
investigate the effect of nutritional status on perception of dyspnea,
exercise capacity, body composition, hospitalisation and life quality
Gamze Ayar Karakoç, Dilek Ernam, Selahattin Öztaş, Ülkü Aka Aktürk, Erhan Oğur
Süreyyapaşa Chest Disease and Thoracic Surgery Education and Research Hospital
AIM: Malnutrition is a comorbidity oftenly seen in COPD patients who have progressive chronic
inflammation and severity.In this prospective study,we aimed to determine the nutritional status of
stable COPD patients and to investigate the impact of nutritional status on perception of
dyspnea,exercise capacity,body composition,hospitalisation and life quality
MaterialMETHOD: COPD patients were assessed using previous smoking story, physical examination and
irreversible airway obstruction.Fifty COPD patients and 30 control subjects were included into the
study. Exclusion criteria were also the co-existance of malignancies, malabsorbtion, DM,
neurological diseases,renal failure and unstable cardiac diseases known to influence the nutritional
state.Nutritional status was classified by the MNA questionnaire,perception of dyspnea was
assessed by the MMRC scale,exercise capacity was assessed by the 6MWT,life quality was assessed
by the CAT scale. Body composition parameters FM,FFM and FMI were analyzed and
hospitalisations during 6 months after discharge were recorded.
RESULTS: The COPD patients were divided into three groups as without malnutrition(%50),under
risk of malnutrition(%38) and malnourished (%12).The COPD severity,MMRC dyspnea score,CAT
score and hospitalisations during 6 months following were higher among the malnourished
patients. On the other hand, body mass index,6MWT results,FM and FFM were lower in
malnourished patients.A positive correlation between FFM and 6MWT and a negative correlation
between FFM and hospitalisation were observed.
MNA is a well-developed questionnaire which evaluates malnutrition in COPD patients.We
determined that malnourished COPD patients have higher airway obstruction degree, perception of
dyspnoea,CAT score and lower exercise capacity and FFM.FFM is an independent predictor of
exercise capacity and rehospitalisation during 6 months.
Keywords: COPD, malnutrition, free fat mass, 6 minute walking test(6MWT), exercise capacity
P264[COPD]
Sirtuin 1 gene polymorphisms are associated with COPD patients in Mugla
Serdar Kalemci1, Murat Kara2, Tuba Gökdoğan Edgünlü3, Ümmühani Özel Türkçü3, Esin Sakallı
Çetin4, Arife Zeybek5
1
Department of Chest Diseases, Mugla University, Faculty of Medicine, Istanbul
2
Department of Genetics, Mugla University, Faculty of Medicine, Mugla
3
Mugla University, School of Health, Mugla
4
Department of Medical Biology, Mugla University, Faculty of Medicine, Mugla
5
Department of Thoracic Surgery, Mugla University, Faculty of Medicine, Istanbul
BACKGROUND:
Chronic obstructive pulmonary disease (COPD) is characterized by progressive and largely
irreversible airflow limitation. Sirtuin (SIRT1) is a metabolic NAD1-dependent protein/histone
deacetylase that regulates proinflammatory mediators by deacetylating histone and nonhistone
proteins. COPD is associated with an abnormal inflammatory response in the lung. This study
aimed to investigate the associations of SIRT1 gene single nucleotide polymorphisms (SNPs),
rs7895833, rs7069102, and rs2273773 with COPD patients.
METHODS:
The subjects included 100 COPD and 100 controls. Genomic DNA was extracted from peripheral
blood leukocytes using DNA isolation Kit. The SIRT1 genotypes were determined by polymerase
chain reaction (PCR) with confronting two-pair primers (CTPP) using published PCR primers.
RESULTS: In this study, the SIRT1 gene polymorphisms were genetically analyzed in COPD
patients and controls. Results show that there was no significant difference in the allele frequencies
of rs7069102 (P = 0.953), but rs7895833 (P = 0.032) and rs2273773 (P =0.010 ) were significant
difference in between COPD patients and controls.
No significant difference was observed in the allele frequencies of the rs7069102 and rs7895833
polymorphisms between the patients and controls. However rs2273773 SNP was significantly
different between the two populations (p=0.007).
CONCLUSIONS:
We sought to investigate the role of Sirt1 in the pathogenesis of COPD. In this study, significant
difference was found in the distribution of rs7895833 and rs2273773 polymorphisms between
COPD patients and controls, suggesting that SIRT1 gene polymorphisms may be a significant
contributor to COPD susceptibility.
Keywords: COPD, SIRT1 gene, Polymorphism
P265[COPD]
Potential Risk Factors for Development of Anxiety-Depression in Chronic
Obstructive Pulmonary Disease
Ercan Kurtipek, Cengiz Burnik, Bengü Özkan Baktık, Bengi Akın, Fatma Eroğlu, Taha Tahir Bekçi
Konya Training and Research Hospital, Department of Chest Diseases, Meram, Konya
Chronic ObstructivePulmonary Disease (COPD) is currently considered a systemic disease with
pulmonary and non-pulmonary effects. The systemic effects are mediated mainly by increased
oxidative stress associated with systemic inflammation, elevatedcirculatory levels of inflammatory
cytokines, and acute phase proteins.The systemic inflammation is also accompanied by many
comorbidities, which affect prognosis of the disease. While cardiovascular diseases are common,
anxiety and depression are among othersignificant comorbidities. In the present study, we aimed
to evaluate the factors involved in development of anxiety and depression in COPD patients with
stable and exacerbation phases.The COPD patients were divided into two groups as those with a
stablephase (n=53, 62.43+9.8), and exacerbation phase (n=53, 66.13+10.34). We used HAD
Scalefor evaluating anxiety and depression. Dyspneawas assessed using the Modified Medical
Research Council (mMRC)Scale. Respiratory FunctionTest (RFT) and Arterial Blood Gas (ABG)
analysis were performed for all patients. COPD patients with exacerbations had significantly higher
scores of anxiety and depression compared to those with a stable phase (p<0.001). A Multiple
Regression Analysis showed that there was a significant correlation between anxietyandhigher level
of exacerbation (p<0.001 ve p<0.02,respectively)in mMRC, andbetween depression and higher
rate of annual hospitalization in mMRC (p<0.001 and p<0.02, respectively). Anxiety and
depression are among common comorbidities following cardiovascular diseases in COPD patients.
Although having exacerbations is particularly important for development of anxiety and depression
in COPD patients, annual hospitalization rate, severity of exacerbations, and high dyspnea scores
are also substantial contributors.
Keywords: COPD, anxiety, depression
P266[COPD]
Determination of The Ability in Using Inhaler Medicine and The Devices at
Home for COPD Patients Who Often Attend to Emergency Service
Merve Tarhan1, Özcan Hançer1, Levent Dalar2
1
Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul, Turkey
2
Department of Pulmonary Medicine, School of Medicine, Istanbul Bilim University, Istanbul, Turkey
Introduction and Objective
The factors such as not using the devices properly or making mistakes while using the medicine
cause problems in treatment for COPD patients. The aim of this study is to find out the ability of
COPD patients to use their medicine and devices. The patients are the ones who attend to the
chest emergency services regularly.
Material and Methods
This study included 217 COPD patients who attended to the chest emergency service at least 3
times within 30 day period between January- April 2013. Questionnaires were used to collect the
data about patients’ demeographics and illness. Their ability to use the inhaler was found out by
tests prepared by basing on Thoracic National Asthma Diagnosis and Treatment Guidelines.
Results
38,2 % of patients used the inhaler medicine correctly. 68.1% of 204 patients who were using a
nebulizer at home nebulised 4 or 6 times a day. 67.1% of the 146 patients with home oxygen
therapy was using oxygen under 12 hours a day. 68,3 % of the 60 patients who use noninvasive
mechanical ventilation in the house were using under 8 hours a day.
Discussion and Conclusion
With this study it has been found out that there needs to be sections in the hospitals where the
patients can ask their questions and where they can find the educational documents, films. Health
workers should give the trainings regularly.
Keywords: COPD, emergency, inhaler, nebulizers, oxygen concentrators.
P267[COPD]
Are Mean Platelet Volume and Platelet Count Relationship with
Exacerbations and Stable Period In COPD?
Yasemin Yurt, Semra Bilaçeroğlu, Aydan Mertoğlu, Emel Tellioğlu, Zühre Taymaz, Günseli Balcı
Dr.Suat Seren Chest Diseases and Surgery Education and Training Hospital,Pulmonology
Department,Izmir Dr.Suat Seren Chest Diseases and Surgery Education and Training
Hospital,Pulmonology Department,Izmir
PURPOSE: To search MPV levels and platelet count and to determine if there might be an acute
phase reactant at exacerbations and stable phase or different stages of the disease in patients with
COPD.
METHODS: 111 patients were analyzed at COPD acute exacerbation and stable periods and
identified with the control group. They were matched with control group of 31 persons.
Prospectively, patients who hospitalized with exacerbation of COPD in our hospital were evaluated.
The patients who were discharged from the hospital were evaluated at their control applications
after two months. Peripheral blood cells count, arterial blood gases, pulmonary function tests (PFT)
were analyzed during COPD exacerbation and stable period. Also, results of these measurements
were compared with the results of control group.
RESULTS: 86 male and 25 famale COPD patients were included in the study. There were 15 males
and 16 females in the control group. There were no significant differences in platalet count and
mean platalet volume(MPV) between COPD exacerbation and stable group compared with the
control group.When the patients with stable COPD were separated 4 groups according to the values
of FEV1, found no significant difference between the platelet counts and levels of MPV of these
groups.
CONCLUSIONS: We had no significant difference at the platelet counts and levels of MPV in
patients with COPD exacerbation and stable period compared with the control group. Platelets that
were affected by systemic inflammations, hypoxia, many factors such as smoking in COPD have
been known obviously.
Keywords: COPD, platelet counts, mean platalet volume
P268[COPD]
Determination of The Frequency of Vaccionation in COPD Patients Who
Often Attend to The Emergency Service
Özcan Hançer1, Merve Tarhan1, Levent Dalar2
1
Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul, Turkey
2
Department of Pulmonary Medicine, School of Medicine, Istanbul Bilim University, Istanbul, Turkey
Introduction and Aim
COPD patients attend to the emergency services between 1-4 times in a year due to high fever.
Bacterial and viral infections are amongst the most common reasons for the high fever. That is why
it is obvious that influenza and pneumococcus vaccinations will decrease the number of COPD
patients attendance to the emergency services. With this study it is aimed to find the frequency of
vaccination in these patients.
Material and Methods
This study is based on 217 COPD patients who attended to the chest diseases emergency service at
least 3 times in 30 day period between January- April 2013. In face to face interviews they were
asked to fill in the questionnaires which included questions about their vaccination period.
Results
53.9 % of them were admitted to the hospital when they attended the emergency service. 55,8 %
of the patients had never vaccinated and 72,4% of them were not vaccinated last year. The
percentage of the patients who stated that they did not find vaccination helpful was 64,5%. 47,5%
of the patients had never been advised to influenza or pneumococcal vaccination by the health
workers. Factors such as age, gender, education, smoking and regular outpatient controls did not
have a statistical impact on vaccination; however statisfical signifance was observed for long term
patients (p<0,01).
Discussion and Conclusion
Since immunization reduce the high fever in COPD patients, health care staff should be more
sensitive in recommending the vaccination to these patients.
Keywords: COPD, emergency, influenza, pneumococ, vaccination
P269[COPD]
Are CRP, fibrinogen and leukocyte count Relationship with Exacerbations
and Stable Period In COPD?
Yasemin Yurt, Aydan Mertoğlu, Semra Bilaçeroğlu, Emel Tellioğlu, Günseli Balcı, Zühre Taymaz
Izmir Dr.Suat Seren Chest Diseases and Surgery Education and Training Hospital,Pulmonology
Department,Izmir
PURPOSE: To investigate the levels of CRP and fibrinogen, leukocyte count in patients with COPD
acute exacerbation and stable periods.
METHODS: 111 patients were analyzed at COPD acute exacerbation and stable periods and
identified with the control group. They were matched with control group of 31 persons.
Prospectively, patients who hospitalized with exacerbation of COPD in our hospital were evaluated.
The patients who were discharged from the hospital were evaluated at their control applications
after two months. Peripheral blood cells count, arterial blood gases,CRP and fibrinogen were
analyzed during COPD exacerbation and stable period. Also, results of these measurements were
compared with the results of control group.
RESULTS: 86 male and 25 famale COPD patients were included in the study. There were 15 males
and 16 females in the control group. WBC, CRP and fibrinogen levels were increased significantly in
patients with COPD exacerbation and during stable period compared with the control group. PO2
values (mmHg), oxygen saturation (satO2 %) were decreased and PCO2 values (mmHg) were
increased significantly in arterial blood gas results of acute exacerbations and stable COPD
patients.
CONCLUSIONS: In our study, we had higher CRP, fibrinogen, and leukocyte counts in patients
with COPD exacerbation and stable period when compared with the controls.CRP, leukocyte count
and fibrinogen levels may be acute faz reactant in COPD with exacerbations in patients.
Keywords: COPD, CRP, Fibrinogen,Leukocyte Count
P270[COPD]
Seasonal characteristics of the functional activity of red blood cells in rats
with experimental model of COPD
Yulduzkhon Kayumova
Ministry of Public Health, Tashkent Institute of Postgraduate Medical Education, Tashkent,
Uzbekistan
Haemoctatic disorders have an important role in the forming of COPD. And seasonal byorithms of
the
haemostasis
can't
be
ignored
in
the
planning
of
an
experiment.
AIM: To study the aggregation of erythrocytes in rats with experimental COPD in different seasons.
METHODS: An experimental model of COPD was reproduced in white rats under the influence of
tobacco smoke in a special chamber, where they were placed daily for 30-40 minutes for 60 days.
2 series of expperiments were conducted at 1 year, thereby we formed 2 groups of experimental
COPD (16 in each group): 1st - spring, 2nd - autumn. Control - healthy rats - 10 in each group:
3rd - spring, 4th - autumn. Spontaneous aggregation of erythrocytes was quantitatively evaluated
by a special system of criteria for micrographs (made by a camera connected to a microscope) of
aggregates
of
red
blood
cells.
RESULTS: Seasonal differences were found in healthy rats: spring aggregation was 15.2% higher
than the autumn rate (p<0.05). Indexes of rats with COPD were significantly higher than in healthy
rats (p<0.001): a greater exceeding compared with the control was in autumn - by 37.2%, and in
the spring it was by 20.7%. When we were comparing 1st and 2nd groups statistically significant
difference
was
not
found.
CONCLUSION: In intact laboratory rats, there is a seasonal variability of aggregation activity of
erythrocytes. But in the experimental COPD imbalance of erythrocytes aggregation has not sesonal
differences.
Keywords: Experimental COPD, seasonal byorithms, erythrocytes aggregation
P271[COPD]
Lack of association between increased mitochondrial DNA 4977 deletion and
ATP levels of sputum cells from chronic obstructive pulmonary disease
patients versus healthy smokers
Ayla Karimova1, Duran Üstek3, Murat Kara4, Bülent Tutluoğlu2, Hülya Azaklı3, İlhan Onaran1
1
Department of Medical Biology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul,
Turkey
2
Department of Pneumology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
3
Department of Genetics, Institute for Experimental Medicine, Istanbul University, Istanbul, Turkey
4
Department of Genetics, School of Medicine, Firat University, Elazig
INTRODUCTION
Levels of the mtDNA mutation including the 'common' 4977 bp mtDNA deletion is elevated in lung
tissue of smokers relative to non-smokers. Although, somatic DNA alterations have been previously
detected in sputum cells of chronic pulmonary disease (COPD) patients, the incidence of 4977 bp
deletion in smokers with COPD is uncertain.
MATERİAL&METHODS
In this study we looked at smokers with and without COPD in order to evaluate the incidence of
mtDNA4977 and mtDNA copy number in sputum cells and in peripheral blood leukocytes (PBLs) in
relation to cellular ATP and oxidative stress status. Twenty-five COPD patients who were current
smokers, 22 smokers and 23 healthy nonsmokers participated in this study.
RESULTS
The frequency of occurrence of this 4977 bp mutation was significantly higher proportion in the
sputum cells of patients with COPD compared to smokers without COPD (p<0.0001). This
difference was not observed in PBLs. Levels of cellular oxidative stress measured by using 2,7dichlorofluorescin diacetate assay were significantly higher in sputum cells of subjects with COPD
than in the smoker group. However, mtDNA copy number, and cellular ATP levels in PBLs and
sputum cells were not significantly different between the studied groups.
DISCUSSION
We suggest that the accumulation of mitochondrial DNA 4977 bp deletion mutations may lead to
respiratory chain dysfunction by inhibiting oxidative phosphorylation. Therephore, accumulation of
mtDNA 4997 in sputum cells of smokers with COPD does not seem to have an important impact on
mitochondrial dysfunction in terms of ATP production when compared to those of healthy
Keywords: COPD, DNA 4977 deletion, oxidative stress
The relative amount of mtDNA4977 in sputum cells from COPD patients and healthy
smokers
PBLs from COPD patients, smokers and non–smokers controls
Characteristics of Subjects.
COPD
Smoker/nonsmokers 25/0
Non-COPD Smokers Control
22/0
0/23
FEV1, %predicted
43.7 ±11.2 a 80.5±12.9
97.3± 14.8
FEV1/FVC, ±12,7
42.6 ±10.7a
77.4±13.6
82.6 ±12.7
Female/ Male
5/20
5/17
6/17
Age
57.8 ± 5.2
50.7±4.6
51.4 ±4.0
Smoking,pack-years 49.2 ±14.6
44.5±16.2
Values are mean ± SD values. a p < 0.05
P272[COPD]
Correlation between red cell distribution width and disease severity and
mortality in COPD patients
Kemal Can Tertemiz1, Aylin Özgen Alpaydın1, Can Sevinç1, Hülya Ellidokuz2, Çağdaş Acara3, Arif
Hikmet Çımrın1
1
Dokuz Eylul University School of Medicine, Pulmonary Medicine
2
Dokuz Eylul University School of Medicine, Public Health
3
Dokuz Eylul University School of Medicine, Emergency Medicine
AIM: Erythrocyte morphology changes not only by primary hematological malignancies but also by
systemic inflammation, ineffective eritropoesis, and nutritional deficiencies. This influence can be
evaluated by “red blood cell (RBC) distribution width (RDW)”. We aimed to investigate the
relationship of RDW with disease stage, BODE index and survival in COPD patients.
METHOD: Medical records of 385 COPD patients who were being followed–up from 2005 were
studied retrospectively. Demographic features and BODE indices of patients that were classified
according to GOLD 2009 were recorded. Survival analysis of all patients by 2014 was performed.
Measured RDW values were evaluated.
RESULTS: Mean age of the patients was 65.6±9.6. COPD stage of the patients were stage 1; 16%,
stage 2; 52%, stage 3; 26%, stage 4; 56%. Median of BODE index was (0-3). As the BODE index
increased RDW also increased (r=0.383 p=0.000). RDW was found significantly different between
stages, the highest RDW was in the very severe stage (p=0.000). When the patients were grouped
according to the laboratory upper limit of RDW, survival rate was 31% in the RDW>14.3 group and
%75 in the RDW<14.3 group.
CONCLUSION: Erythrocyte morphology deteriorates as the severity of the diseases progresses.
Therefore, RDW; a simple and noninvasive test might be used as preliminary biomarker in the
evaluation of diseases severity. At the same time, the close correlation between survival and RDW
can be meaningful for the prognosis prediction.
Keywords: COPD, mortality, RDW
P273[COPD]
Risk factors of COPD in the population of the city
Gulchekhra Tashmetova, Abdulla Ubaydullaev
Ministry of Public Health, Tashkent Institute of Postgraduate Medical Education, Tashkent,
Uzbekistan
Aim. To study the risk factors of COPD in the population of Tashkent city, Uzbekistan.
Methods. We examined 3000 people (1600 men and 1400 women) in organized population working
in various enterprises in Tashkent. We performed screening conducted by questionnaire
(Ch.Bungetaim, D.Maza, 1978) designed to identify patients with COPD, and we studied the
functional
state
of
the
respiratory
system.
Results. Among examined people COPD detected in 8,7% (263 persons, that is 173 males and 90
females). The largest group was men with smoking (87% of male patients with COPD). Airways
colds were observed in 75,1%, occupational hazard - 46.2%. Other factors like family history,
sinusitis, allergic background did not influenced on the development of COPD. Study of risk factors
in the group of women showed the most significant part of the common cold, which amounted in
81.1% of all female patients. Less important were family history - 31.1%, allergic diseases - 21.1%
and sinusitis - 18.8%. Factors such as smoking, occupational hazards and polyposis are not the
determining factors in women. Many patients have a combination of factors, which also increases
the
risk
of
COPD.
Conclusion. So, in the formation of COPD in the population of Tashkent main role belongs to
smoking and occupational exposures in male patients and repeated episodes of respiratory
infections in females.
Keywords: COPD, epidemiology, smoking, common cold
P274[COPD]
Syndrome of the system inflammatory answer at COPD patients
1
1
2
1
Inina Liverko , Mirza Tillyashaykhov , Kamola Ubaydullaeva , Shakhboz Akhmedov , Natalya
1
1
Gafner , Ibragim Akhatov , Vazira Abdullaeva
1
2
1
Republican center of phthisiology and pulmonology. Tashkent, Uzbekistan
Tashkent Institute of postgraduated education of doctors Tashkent, Uzbekistan
Purpose. To study the frequency and degree of intensity of a syndrome of the system inflammatory
answer
at
COPD
patients.
Material. At 85 COPD patients with different severity (GOLD,2010) the state, defined as the
syndrome of the system inflammatory answer (SSIA) according to criteria of a severy infection was
studied.
Results. Studying of manifestations of the syndrome of system inflammatory answer (SSIA) at
COPD patients showed, that 12,5% of patients had different criteria of this syndrome. Dependence
of frequency of SSIA on severity of disease is defined: from 2% at moderate COPD to 48% at high
severity
of
the
disease.
High
specific
weight
of
SSIA
at
COPD
patients
with body mass deficiency (39,5%) is detected. It is established that SSIA is associated with high
rates of a system inflammation (SRB and fibrinogen). At COPD patients with body mass deficiency,
the inverse correlation between proteins – reaktant of a sharp phase and visceral proteins is
established.
Thus, SSIA is associated with obstruction degree, index of a system inflammation and
extrapulmonary dicturbances as a pulmogen exhaustion.
Keywords: COPD, syndrome of system inflammatory answer
P275[COPD]
Assessment of the state of patients with COPD
1
2
1
1
1
Inina Liverko , Kamola Ubaydullaeva , Shahboz Akhmedov , Nataliy Gafner , Ibragim Akhatov ,
Vazira Abdullaeva
1
1
Republican specialized scientific and practical medical center of phthisiology and pulmonology,
Tashkent.
2
Tashkent Institute of postgraduated education of doctors Tashkent, Uzbekistan
Purpose. To assesse a state of patient with COPD and degree of cardiorespiratory disturbances.
Material. At 96 COPD II-III-IV patients functional parameters of cardiorespiratory system were
studied: FEV1, 6-minute step test (6-MST), systolic pressure of a pulmonary artery (SPPA), SodiPolyaris's index and P-pulmonale, oxygen saturation (SaO2). The assessment of quality of life at
COPD
patients
was
studied
with
COPD
Assessment
Test
questionnaire
(CAT).
Results. Studying of state of COPD patients and its influence on life of patient, estimated on CAT
scale, showed that in 5,1% of cases - insignificant influence (0-10 points), in 26,8% - moderated
(11-20), in 41,2% - strong (21-30) and in 26,8% - extremely strong (31-40) influence of COPD on
life of patient. Clear correlation between influence of COPD on life of patient and severity of disease
and phenotypical features were defined. Severity of COPD depends on strong influence of disease
from 14,3% to 41,3%. Extremely strong influence of COPD on life of patient was noted at 41,7%
with emphysematous and at 20,8% with bronchitic type of disease. Among COPD patients with the
greatest total point of SAT significant functional disturbances, severy hypoxemia, decreasing of
physical capacity, manifestations of cor-pulmonary, defining unfavorable outcome of disease met
more often: SaO2<88% - at 41,6% of patients, 6-MST<150 m - at 40,6%, P-pulmonale > 2 mm –
at
60%,
SPPA
>
25mm.hg.с.
–
at
48,5%
of
patients.
Thus, the questionnaire of SAT is the simple and available tool of an assessment of a clinical
condition of patients.
Keywords: COPD, cardiorespiratory disturbances, COPD Assessment Test questionnaire (CAT).
P276[COPD]
Clinico-functional features of chronic obstructive pulmonary disease at
persons with body mass deficiency
1
2
1
1
1
Inina Liverko , Kamola Ubaydullaeva , Nataliy Gafner , Shakhboz Akhmedov , Ibragim Akhatov ,
Vazira Abdullaeva
1
1
Republican specialized scientific and practical medical center of phthisiology and pulmonology,
Tashkent, Uzbekistan
2
Tashkent Institute of postgraduated education of doctors Tashkent, Uzbekistan
The purpose of the study was estimation of clinic-functional correlation of COPD at persons with
body
mass
deficiency
(BMD).
Materials. We studied functional parameters of cardiorespiratory system: FEV1; result of the 6minute step test (6-MST); oxygen saturation (SaO2); systolic pressure of a pulmonary artery
(SPPA); index of Sodi-Polyaris and P-pulmonale at 96 COPD patients with index MB from 20 to 25
(56
patients)
and
less
than
17
(40
patients).
Results. The analysis of frequency of phenotypical features of COPD depending on severity of
disease showed that increasing of obstruction correlates with specific weight of the patients with
index MB less than 17, from 20,8% (FEV1 -50%), 43,3% (FEV1-30%) to 54,3% (FEV1<30%). It is
established that COPD patients with index MB less than 17 have significant expressed functional
disturbances, defining severy hypoxemia, decreasing of physical capacity, manifestation of corpulmonale and signs of diaphragm fatigue syndrome, that defines of unfavorable prognosis.
SaO2<88% was detected at 34,6% patients, having BMD, and patients with index MB from 20 to
25 had normal saturation. The result of 6-MST<150m in 1,4 times more often at patients with BMD
(38,6% against 27,4%), also is more often at this patients P-pulmonale > 2мм (30% and 21,4%),
Sodi-Polyaris index (30% and 19,6%), SPPA> 25mm.hg.с. (31,6% and 20,4%) and the lowest
level of a discriminant indicator of diaphragm fatigue syndrome (7,2±1,2 and 21,9±1,3).
Thus, the COPD patients, having body mass deficiency, are the contingent of high risk of
unfavorable prognosis and need in development of new approaches of metabolic therapy.
Keywords: COPD, body mass deficiency (BMD), functional parameters of cardiorespiratory system
P277[COPD]
Effect of different bronchodilators on changes of lung functional parameters
determing patients’ subjective feeling of dyspnea
Inina Liverko, Nataliy Gafner
Republican specialized scientific and practical medical center of phthisiology and pulmonology.
Tashkent.
PURPOSE: To assess effect of therapeutic agent on feeling of dyspnea in COPD patients.
METHODS: Pharmacological and functional monitoring in 70 COPD patients with analysis of the
following
indicators
of
breath:
FEV1,
RV,
TLC,VO2,
SaO2.
RESULTS: There was observed weak correlation between FEV1 changes and reduction of dyspnea
intensity after use of broncho-dilators in COPD patients. It was noted that change of tolerability to
physical exercises was related to changes of FEV1. It was found that decrease in dyspnea occurred
with increase in inspiration volume and reduction ratio RV/TLC. During receiving of salmeterol (S)
there was noted significant increase in ventilation and arterio-alveolar difference of oxygen partial
pressure, and FEV1 rising had negative correlation with falling paO2. While receiving ipratropium
(IB) there was no observed such effect, it was found decrease in intake of oxygen volume (VO2).
Comparison of effects of prolonged (90 days) use of S and IB in COPD patients showed practically
equal increase in FEV1 (36% and 33%, respectively). Clinical improvement was more in patients
receiving ipratropium bromide. After 4-week-therapy with theophilline in COPD patients there was
observed rising of FEV1 by 10%, tolerance test did not change while dyspnea intensity decrease.
CONCLUSION: There was noted that COPD patients were less sensitive to bronchodilatation and
their feeling of dyspnea did not reflect magnitude of expiration function disturbance.
Keywords: COPD, dyspnea, ipratropium bromide, theophilline, salmeterol
P278[COPD]
Is notification level of medication adherence effective in control of COPD
disease? MARS vs CAT
Ayşe Füsun Kalpaklıoğlu1, Ayşe Baççıoğlu1, Selma Demir2, Figen Ergür2, İlker Özsaraç2, Ömür
Güngör3
1
Kirikkale University Faculty of Medicine, Department of Pulmonary Diseases, Division of
Immunology and Allergy Diseases
2
Kirikkale Yuksek Ihtisas Hospital, Department of Pulmonary Diseases
3
Kirikkale University Faculty of Medicine, Department of Pulmonary Diseases
INTRODUCTION: One of the most important obstacles in treatment of chronic obstructive
pulmonary disease (COPD) is patients' lack of adherence to treatment. In this study, we aimed to
assess impact of adherence to drug therapy in COPD, as well as to identify the contributing factors.
METHODS: COPD patients who attended to meeting of "World COPD Day" in Kirikkale were
enrolled. Sociodemographic characteristics and COPD disease variables were recorded. Patients
self-filled COPD-assessment-test (CAT) and medication-adherence-report-scale (MARS) to assess
treatment adherence.
RESULTS: Seventy-two patients with a mean age of 67.03±9.57yrs (44-84), 73.6% male,
smoking consumption of 31.73±8.44pack/yrs, and disease duration of 27.77±8.66yrs attended the
meeting. Average MARS score (MARS-s) of the group was 22±3.02, while as 75% of patients had
high medication adherence (MARS-s>20). There were no difference by means of age, sex, marital
status, number of children, education level, smoking consumption, duration of disease and bodymass-index (BMI) between the groups with high and low (MARS-s<=20) medication adherence.
Mean CAT score (CAT-s) was 27.9±9.78, and patients with high CAT-s had long disease duration
(r=0.342, p=0.01). Correlation of MARS-s with CAT-s was insignificant (r=0.133, p=0.29), as well
as with sociodemographic characteristics, BMI, duration of COPD, and smoking consumption.
CONCLUSION: Adherence to drug treatment in patients with COPD was higher than expected, and
this could be due to fact that patients who attended the meeting might have relatively high
treatment expectations. However, high MARS-s was associated neither with sociodemographic and
COPD disease variables, nor with the control of the disease.
Keywords: CAT, COPD, MARS
P279[COPD]
Awareness of Asthma and Chronic Obstructive Pulmonary Disease in Kocaeli
Serap Argun Barış1, Aslı Zembat2, İlknur Başyiğit1, Haşim Boyacı1, Tuğba Aşlı Önyılmaz1, Füsun
Yıldız1
1
Department of Pulmonary Diseases, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
2
Department of Pulmonary Diseases, Evliya Çelebi Training and Research Hospital, Kütahya, Tukey
AIM: The aim of this study was to evaluate the awareness of COPD and asthma in Kocaeli.
METHOD: A questionnaire for assessment the knowledge of COPD and asthma were fulfilled and
pulmonary function test were performed in volunteers who admitted to the spirometry tent on
World COPD Day.
RESULTS: There were 193 (27.2%) female, 517 (72.8%) male, totally 710 participants were
enrolled and mean age was 46.15±14.5 years. Nearly half of the participants (58%) were smokers.
The importance of smoking in the progression of COPD (65.8%), place of smoking cessation in
treatment of disease (73.5%) and the role spirometry in diagnosis (69.1%) were relatively wellknown. However, only 52% of participants stated that COPD is a lung disease, furthermore the
knowledge level about the definition of emphysema and chronic bronchitis, role of prophylactic
influenza vaccination and requirement of long-term oxygen therapy were quite low. It is wellknown that asthma affects people of all ages (91.4%) and inhalation is preferred way of treatment
(%95.4). Totally 72.8% of the participants stated that asthma is not an infectious disease and
66.7% of them said that asthma does not affect daily life activities. Only 38% of the population
stated that asthma medications haven’t got risk of addiction.
CONCLUSION: This study suggested that knowledge of asthma is higher than COPD in general
population and future awareness programs are needed in order to increase the knowledge level
about COPD, the importance of prevention strategies such as influenza vaccination and decrease
the misunderstanding about addictive effects of inhalers.
Keywords: asthma, awareness, COPD
P280[COPD]
Prevalence of pulmonary embolism in patients with COPD attack
Erkan Ceylan, Canan Gedik, Asiye Kanbay
Medeniyet University Göztepe Training and Research Hospital
INTRODUCTION: Risk of pulmonary embolism (PE) is increased in patients with COPD. Diagnosis
of PE is difficult and prevalence is not clear yet in these patients. Aim was to determine prevalence
of PE in patients with COPD attack.
METHOD: Clinical probability for PE was defined in patients who were hospitalized due to COPD
attack. D- Dimer levels were measured. The patients who had high levels of d-dimer were
evaluated with CT angiography without considering clinical probability. Known attack causes were
recorded.
RESULTS: Mean age of the patients were 63.05±13.87 years and 64.3% (n=18) of them were
males. Nineteen (67,8%) patients had any known cause of attack. D-dimer levels were found high
in 57,1% of patients. Thrombus was detected in 8 of these patients. Three had high and rest of
them had moderate clinical probability. PE was detected in 31,6 %(n=6) of patients who had any
known cause of attack. Two of the 9 patients whose reason of attack were unknown had PE.
DISCUSSION: Prevalence of PE was found 28,6%. Prevalence of PE in COPD attack was found
9%-25% in different studies. In our study, 3 patient who were established as PE had high clinical
probability. The ratio of PE was 21.4% in patients who had been any known cause of attack.
CONCLUSION: Patients who were hospitalized due to COPD attack should be evaluated for PE,
even they have any known attack cause and don’t have high probability for PE.
Keywords: COPD attack,pulmonary embolism
P281[COPD]
Serum adiponectin, visfatin levels in patients presenting with acute
exacerbation of copd and it's relationship with inflammatory biomarkers
Mehmet Kalkan1, Erdal İn2, Teyfik Turgut3, Mehmet Hamdi Muz4
1
Uzm.Dr.Mehmet Kalkan Nusaybin devlet hastanesi,mardin
2
Yrd.Doç.Dr.Erdal İn fırat university,department of chest clinical,Elazığ
3
Doç.Dr.Teyfik Turgut fırat university,department of chest clinical,Elazığ
4
Prof.Dr.Mehmet Hamdi Muz fırat university,department of chest clinical,Elazığ
In this study, it is aimed to investigate adiponectin and visfatin levels in patients with COPD and
that can be used as an inflammatory marker and thus it is aimed to gain more comprehensive
information on the nature of systemic inflammation in these diseases.
39 COPD patients with acute exacerbation and 24 healthy control subjects were enrolled to study.
Venous blood samples were taken at 1. and 15. day of exacerbation from COPD patients, once
from healthy control subjects. Adiponectin, visfatin, hsCRP, TNF-α levels were measured at these
serum.
At the end of the study, it was observed that there was a statistically significant difference between
the serum TNF-α, hsCRP, adiponectin and visfatin levels in patients with COPD at the beginning of
the attack compared with the 15th day of patients with COPD and control group. It was determined
that there was statistically significant difference in comparison between the serum TNFα, hsCRP,
adiponectin, visfatin levels of the group of patients with COPD at the 15th day with the control
group. It was also determined that there was a negative correlation between the measured hsCRP
levels and respiratory function parameters at the beginning of the attack.
As a result, both of adipokines can be used as a marker of inflammatory, due to increasing of
adiponectin, visfatin levels during attack period of COPD, monitoring of positive correlation with
TNF-α and hsCRP of inflammatory markers but also it is thought to be need more studies in this
regard.
Keywords: COPD, TNF-α, hsCRP, adiponectin, visfatin
study of patients with COPD 1. and 15. on the day of pulmonary function test parameters
and serum TNF-α, hsCRP, adiponectin, visfatin levels
FEV1 (%ped)
30,66±11.08
36.43±13.22
<0.001
FVC (%pred)
46.68±13.33
54.10±16.70
<0.001
FEV1\FVC
47.82±9.83
48.69±10.06
>0.050
TNF-α (pg/ml)
36.04±11.28
20.63±7.00
<0.001
HsCRP (µg/ml)
248.01±43.57 142.71±71.71 <0.001
Adiponectin (µg/ml) 139.09±98.07 82.78±59.09
<0.001
Visfatin (ng/ml)
<0.001
20.66±9.69
15.58±7.97
P282[COPD]
Can red blood cell morphology be an indicator for COPD exacerbations?
Kemal Can Tertemiz, Aylin Özgen Alpaydın, Seda Salman, Arif Hikmet Çımrın
Dokuz Eylul University School of Medicine, Pulmonary Medicine
INTRODUCTION: RDW is a laboratory parameter showing red blood cell distribution width. RDW
can be effected by systemic inflammation. Recent papers showed that RDW could have a
relationship between prognosis and mortality in cardiac diseases. We investigated the usability of
RDW as an indicator for COPD exacerbations.
METHOD: We have analysed 100 in patients diagnosed as COPD according to GOLD guideline and
COPD exacerbation according to Antonissen criteria. Annual exacerbations, CRP, RDW and blood
gase analyses were evaluated in all patients.
RESULTS: Mean age was 70 years, median hospitalisation duration was 12(3-76)days and median
annual exacerbation rate was zero(0-7). We have seen that discharging CRP, pCO2, PaO2 and
oxygen saturations were improved significantly with respect to interning values (p<0.001).
Discharging RDW levels were found higher than interning values (p=0,004). The relationship
between RDW and Antonissen criterias, annual exacerbation rates, criticaly care requirement,
mortality, CRP, pCO2, PaO2 and oxygen saturations were not statisticaly significant. RDW levels
were significantly higher in exacerbations compared with stable period (p<0,05).
CONCLUSION: We have seen that RDW levels were significantly higher in COPD exacerbations
compared with stable period and were elevated during the hospitalisation. This increase shows that
RDW is effected like other inflamamtory markers in COPD exacerbations. Unfortunately RDW is
inadequate to show criticaly care requirement and mortality prediction.
Keywords: Inflammation, COPD exacerbation, RDW
P283[COPD]
Investigation of the relationship between the frequency of hospitalization
and comorbidity, and excessive dynamic airway collapse in COPD patients
with frequently hospitalized
Tülay Yarkın1, Meltem Ağca1, Göksan Acar2, Gökhan Göl1, Fatma Tokgöz1, Reha Baran3
1
Sureyyapasa Chest Diseases and Thoracic Surgery Teaching and Research Hospital
2
Van Lokman Hekim Hospital, Department of Chest Diseases
3
Acıbadem Fulya Hospital, Department of Chest Diseases
Frequent hospitalizations in COPD patiens is defined as 2 or more hospitalizations per year.
However, in our clinical pratique we see repeated hospitalizations with 2-3 months intervals in
some of the COPD patients. In this study, we investigated the factors suspected to be related more
frequent hospitalizations in a selected patient population.
Thirty-four COPD patients (F/M: 6/28) hospitalized at least 2 times per year were included to the
study. Patients’ demographics, laboratory findings, physical activity, comorbidity were recorded;
echocardiography and fiberoptic bronchoscopy(FOB) were performed. Patients were categorized
into two groups according to hospitalizations in a year: Group 1 (2 times), Group 2 (>2 times).
The mean age was 65±8(46-82), mean hospitalization number was 3.35±1,32. Twelve patients
were in Group 1, 22 in Group 2. Older age, lower physical activity, advanced stage, longer duration
of the disease, using nebulizator and home-oxygen were significantly higher rate in Group 2.
FEV1(pred%) was significantly lower in Group 2 (47%) than Group 1 (56%). Pulmonary
hypertension (n=11) and heart failure (n=10) were detected only in Group 2. FOB revealed
excessive dynamic airway collapse (EDAC) in 17 (50%) patients (Figure 1-2); and 16 of them
(94%) were in Group 2. Existence of EDAC and lowerness of FEV1 were found to be independent
factors for more frequent hospitalizations.
In this study, we detected that there were lots of differencies in the patients with hospitalized more
than 2 per year amoung COPD patients frequently hospitalized. Existence of EDAC and FEV1
lowerness could be responsible for more frequent hospitalizations.
Keywords: COPD, co-morbidity, excessive dynamic airway collapse
Saber sheath trachea
Tracheomalacia
P284[COPD]
Acute exacerbation of COPD in patients with stable COPD and assess the
leves of Hs-CRP
Hanife Caner, Güngör Çamsarı, Gülcihan Zehra Özkan, Nur Dilek Bakan, Ayşe Yeter, Elif Yelda
Niksarlıoğlu, Deniz Bilici, Serpil Başgüden
Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital,İstanbul
chronic inflammatory diseases in recent years,highly sensitive markers for determining the risk and
their gıidance is examined.markers of systemic inflammation as a highly sensitivitiy c reactivating
proteins(Hs-CRP) of the acute and stable COPD patients to determine the levels and these
parameters in acute the frequency of hospitalization,incidence,mortality and concomitant disease
relationship aimed to determine.
Keywords: Hs-CRP,COPD
P285[COPD]
Phosphorus supplementation can be a complimentary treatment in patients
with COPD
Şakir Özgür Keşkek1, Orhan Altınöz2
1
Department of InTernal Medicine, Numune Training and Research Hospital, Adana
2
Defne Hospital, Department of Pulmonology, Antakya
AIM: Malnutrition and electrolyte imbalance are common in patients with COPD. Previous studies
have reported an association between malnutrition and COPD. Moreover, it has been reported that
malnutrition leads to poor prognosis. Phosphorus is a major intracellular constutient that forms
several organophosphate compounds (structural proteins, enzymes, nucleic acids and high energy
stores). In this study we aimed to investigate the association between phosphorus deficiency and
COPD.
MATERIALMETHODS: A total of 84 participants, 40 patients with COPD as a study group and 44 healthy
individuals as a control group were enrolled. Respiratory function test was performed and serum
phosphorus level was measured. Patients were evaluated in terms of COPD according to the GOLD
2011. Medcalc 12.7 (Belgium) statistical software was used for statistical analysis
Resuts: The groups were matched in terms of age and sex (p=0.056, 0.537). Not surprisingly
FEV1/FVC was low in the study group (p<0.001). Serum phosphorus level was 2.7±0.8 in the
study group while it was 3.4±0.7 in the control group. The difference was statistically significant
(p=0.001) (Table 1). Phosphorus level correlated with FEV1/FVC (r=0.394, p= 0.011) (Table 2).
CONCLUSION: In this study we have found low levels of phosphorus in patients with COPD.
Phosphorus deficiency may be a findings of malnutrition and this condition is assciated with poor
prognosis. Mithocondrial energy production is impaired in case of phosphorus deficiency. Therefore,
respiratory muscles are affected negatively and the clinical status deteriorates. Consequently,
phosphorus supplementation can be a complimentary treatment for these patients.
Keywords: COPD, FEV1/FVC, Phosphorus
Table 1
Study group Control group
p
(N=40)
(N=44)
Age
57.0±12
51.4±14.1
0.056
Female N (%)
20 (50%)
18 (40.9%)
0.537
FEV1/FVC
59.5±6.3
81.9±3.9
<0.001
Phosphorus (mg/dl) 2.7±0.8
3.4±0.7
0.001
Calcium (mg/dl)
9.25±0.41
0.539
9.20±0.42
Characteristics and measurements of the groups
Table 2
Phosphorus
FEV1/FVC
r=0.394
p=0.011
The correlation analyses between phosphorus and FEV1/FVC
P286[COPD]
Reliability of the symptom based questionnaire for diagnosis of COPD
İlknur Başyiğit1, Serap Argun Barış1, Aslı Balaban2, Haşim Boyacı1, Esra Kuşlu Uçar1, Füsun Yıldız1
1
Department of Pulmonary Diseases, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
2
Department of Pulmonary Diseases, Evliya Çelebi Training and Research Hospital, Kütahya, Turkey
INTRODUCTION: It is suggested that making the diagnosis of COPD based on symptom
evaluation without performing spiromety would provide early detection of COPD in a high-risk
population. The aim of this study was to evaluate the reliability of the symptom based
questionnaire for the diagnosis of COPD. MaterialMETHOD: A questionnaire was performed evaluating the COPD symptoms and the smoking history
of participants who admitted to the spirometry tent constructed on World COPD Day.
RESULTS: There were 250 men (35.3%), 459 women (64.7), totally 709 participants completed
the questionnaire. While 187 of the participants (26.4%) stated that they had chronic bronchitis,
emphysema and/or COPD diagnosed by a doctor, only 95 of them (50%) said that they were using
inhalers for these diagnoses. It was found that the smoking prevalence of the doctor diagnosed
COPD cases was 41% (n:77). Half of the cases had symptoms of cough and sputum in the last
three months; however the number of the cases who had these symptoms for at least 2 years was
96 (13.5%). When we evaluate the smoking history of these chronic bronchitis cases, we found
that only 41 of them (42.7%) had smoking history. The number of the participants with dyspnea
was 540 (76.2%) and 24% of these participants noted that they had no difficulty in walking the
straight path.
CONCLUSION: This study suggested that using symptom based questionnaires for the diagnosis
of COPD could cause over-diagnosis and spirometric evaluation is needed in order to confirm the
diagnosis of COPD.
Keywords: COPD, diagnosis, questionnaire, spirometry, symptom
P287[COPD]
A sectional approach with undiagnosed COPD frequency in population
Seyhan Us Dülger, Özlem Şengören Dikiş
Sevket Yilmaz Training and Research Hospital, Pulmonary Diseases Clinic
INTRODUCTION: Preventable and treatable disease, COPD, is leading cause morbidity and
mortality today all over the world. To draw attention to this situation, we've worked in a shopping
mall at world of COPD day.
MATERIALMETHODS: Volunteers in a shopping center were included in our study. Volunteers were asked to
the smoking habit, the stories were related to the respiratory system, the Medical Research Council
(MRC ) made staging, Fagerstrom Test, Exhaled Carbon Monoxide Testing, Pulmonary Function
Tests were carried out.
RESULTS: 79 volunteers were included in our study.43(54.4%)smokers;36(45.6%) nonsmokers.
21 (48.8% ) were female and 22(51.2%) were male, average age 37.34 ± 11.2, mean body mass
index 26.06 ± 5.02; Fagerstrom the average values of 4.48 ±2.05 found addiction.19(44.2%)
people no complaints or symptoms, spirometry values were normal.24(55.8%) persons were under
the FEV1 of 80%.Shortness of breath, cough, sputum production such complaints were present. Of
these only 6 knew disease (25%).24(66.7%) were female and 12(33.3%)were men in nonsmoker
group. Mean age 47.86 ± 15.26, mean body mass index was 26.67 ± 4.39.In this group of 9
people (25%) were diagnosed with COPD present.
CONCLUSION: The prevalence of smoking with increasing COPD is a global health problem. The
ability to intervene in terms of disease progression at an early stage diagnosis is important. COPD
and smoking habits in dealing with community-based studies, we think it would be useful to do.
Keywords: COPD, smoking habbits, spirometry
P288[COPD]
Cardiac Comorbidıties In Exacerbation and Stable Period With COPD and
Evaluation Of The Effects Of Quality Of Life
Ömer Kaya1, Gazi Gülbaş2, Jülide Yağmur3, Saim Yoloğlu4, Yılmaz Ömür Otlu3, Zeynep Ayfer
Aytemur2
1
Clinic Of Chest Diseases, Yesilyurt Hasan Calık State Hospital, Malatya, Turkey
2
Department Of Chest Diseases, Inonu University, Malatya, Turkey
3
Department Of Cardiology, Inonu University, Malatya, Turkey
4
Department Of Biostatistics, Inonu University, Malatya, Turkey
OBJECTIVE: The evaluation of the quality of life and cardiac arrhythmia with 24 hours holter
monitoring in COPD patients who admitted to our center with a diagnosis of COPD exacerbation
and later, they were reexamined in stable period.
MATERIALMETHODS: 41 patients were admitted with COPD exacerbations. Routine laboratory tests, arterial
blood gases, pulmonary function tests and echocardiography were evaluated. 24-hour Holter
monitoring was performed first day of admission to hospital and stable period. SGRQ, CAT and
mMRC were evaluated. The data obtained were compared with stable period.
FINDINGS: Ventricular arrhythmias %68.2, supraventricular arrhythmias 85.3%, SV-run % 31.7
has been detected in 41 exacarbation patients. Evaluation was not done in seven patients in the
stable period because of they are ex. Ventricular arrhythmias %61.8, supraventricular arrhythmias
70.5%, SV-run %8.8 has been detected in 34 stable patients. PFT parameters were better with
ventricular arrhythmias. Ph, PaCO2, PFT parameter and SGRQ scores were found to be associated
with atrial premature beats. Ventricular arrhythmia was found to prolong the duration of
hospitalization in patients with COPD. Atrial premature beats were more frequent in patients with
severe COPD and APC were negatively affects the quality of life.
RESULTS: Arrhythmias are common in patients with COPD. Arrhythmias overlooked because of
focusing disease. Arrhythmias due to an adverse effect on course of disease and quality of life,
should be examined carefully and If you need advanced diagnostic methods should be used, such
as 24-hour Holter monitoring. Early identification and treatment are important.
Keywords: Cardiac arrhythmia, COPD, quality of life
P289[COPD]
Low Cognitive Ability in Patients with Bronchiectasis
1
1
2
1
1
Emel Bulcun , Pınar Yıldız Gülhan , Mustafa Gülhan , Dilay Çimen , Aydanur Ekici , Mehmet Ekici
1
2
1
Departments of Pulmonary Diseases, Kirikkale University Faculty of Medicine
Departments of Infection Diseases, Kirikkale University Faculty of Medicine
BACKGROUND: Patients with bronchiectasis may be associated with low cognitive ability. The goal
of this study was to determine the frequency and determinants of low cognitive ability in patients
with
with
stable
bronchiectasis.
METHODS: Thirty patients with stable bronchiectasis and 25 healthy control subjects
underwent a cognitive ability assessment using Wechsler Adult Intelligence Scale.
Age, BMI, the Hospital Anxiety and Depression scale and pulmonary function were assessed.
RESULTS: Mean scores on the verbal, performance, and full scale IQ scores were significantly
lower in the patients with bronchiectasis than in the healthy volunteers (87.5±16.3 versus
106.1±18.8;
p=0.0001).
Low cognitive ability in the patients with bronchiectasis was associated with higher depression
scores, lower oxygen saturation and poor lung function after adjusting for potential confounders in
multivariate
analysis.
Borg score after exercise in bronchiectasis patients with low cognitive ability was higher than that
of bronchiectasis patients with high cognitive ability, despite the PaO2 and FEV1 in both groups
was
similar
(6.2±1.8
vs.
4.6±1.5,
p=
0.01).
CONCLUSION: Low cognitive ability in patients with bronchiectasis may be associated with
reduced lung functions, more serious hypoxemia and higher depressive symptoms. Bronchiectasis
patients with low cognitive ability feel more intense dyspnea than high cognitive ability ones.
Keywords: Cognitive ability; Bronchiectasis; Hypoxemia; Lung functions
Subtest scores and composite scores of the control group and patients with
bronchiectasis
Bronchiectasis
n:30
Control group
n:25
P value
Full Scale IQ
87.5±16.3
106.1±18.8
0.0001
Verbal IQ
89.1±18.4
105.3±18.4
0.002
Performance IQ
87.1±13.8
105.2±18.0
0.0001
Similarities
7.4 ± 2.5
9.6 ± 2.2
0.004
Information
6.3 ± 2.6
9.5 ± 1.9
0.0001
Digit Span
7.3 ± 2.6
9.1 ± 2.9
0.03
Arithmetic
6.1 ± 2.4
9.8 ± 2.4
0.0001
Digit symbol
6.4 ± 2.3
8.9 ± 2.2
0.001
Picture completion
6.6 ± 2.6
9.4 ± 1.9
0.0001
Picture arrangement 5.5 ± 2.9
9.6 ± 3.1
0.0001
Block design
4.9 ± 2.3
7.3 ± 1.9
0.001
Object assembly
8.01 ± 2.2
10.2 ± 1.7
0.001
Comprehension
7.2 ± 2.6
9.4 ± 2.1
0.002
Ten subtests scores: each with M=10, SD=3 Three composite scores: verbal, performance,full scale, each with
M=100, SD=15
Predictors of cognitive ability measured by WAIS-Ras
Full Scale IQ score
Full Scale IQ score
β value p value
β value p value
Age
-0.12 0.3
Age
-0.06 0.6
Gender(male)
-0.02 0.8
Gender(male)
-0.10 0.4
Education
0.51 0.001
Education
0.48 0.002
BMI
-0.13 0.3
BMI
-0.09 0.5
Depressive symptoms -0.38 0.009
Depressive symptoms -0.27 0.05
FEV1%
0.25 0.04
Sat O2
0.27 0.03
Smoking
-0.17 0.1
Smoking
-0.11 0.3
*β is the standardized regression coefficient.
P290[COPD]
Relationship Between Diaphragm Thickness and Symptoms in COPD Patients
Melahat Bekir, Canan Cimşit, Hüseyin Arıkan, Derya Kocakaya, Şehnaz Olgun, Semiha Emel
Eryüksel, Sait Karakurt
Department of Pulmonology, Marmara University, Istanbul,Turkey
AIM: Diaphragm is affected in COPD as it’s thickness decrease and range of motion is limited. In
this study, we aimed to investigate the relationship between diaphragm thickness measured by
USG and symptoms and functional parameters in COPD patients of different stages.
METHOD: 48 stable COPD patients were included in the study. We determined the disease stage
by spirometry and diaphragm thickness was measured by a USG. Additionally; present symptoms,
exacerbation and hospitalization history, BMI, comorbid diseases and ongoing mediactions are
recorded and relationship between them and ultrasonography results are investigated.
RESULTS: Mean age of patients included in the study was 59 ±9 yrs. Cigarette smoking history
were 47 ± 25 pack years. Mean CAT scores of patients were 12±8, mMRC scores were 2±1 and
BMI were 29±5.
Number of patients in GOLD stages I, II, III and IV were 19, 19, 6 and 4 respectively. Mean
diaphragm thickness measured by ultrasonography was found as 1.8 ± 0.45mm. Mean diaphragm
thickness in GOLD stages I, II, III and IV were 1.96 ± 0.45, 1.61 ± 0.5, 1.73 ± 0.59 and 2.07 ±
0.86mm respectively.
There were no significant relationship between study groups staged as GOLD I, II, III and IV COPD
patients and diaphragm thicknesses. No statistically signifiant correlation between symptom scores
(CAT and mMRC ), BMI and diaphragm thicknesses were identified either.
CONCLUSION: In this study, no relationship was shown between diaphragm thickness measured
by ultrasonography and disease severity, symptom scores and BMI of COPD patients.
Keywords: COPD,Diaphragm Thickness
P291[COPD]
The Relationship Between Local and Systemic Inflammation with
Osteoporosis in COPD
Ömür Güngör, Ayşe Füsun Kalpaklıoğlu, Ayşe Baççıoğlu
Kirikkale University Faculty of Medicine, Department of Chest Diseases
The purpose of this study,COPD is one of comorbidity in patients diagnosed with osteoporosis is to
reveal the relationship with local and systemic inflammation.For this purpose,50 patients with
stable COPD and 25 healthy adults were examined Already acute phase reactants in patients with
acute exacerbations will give high results were excluded from the study.My mood ekspiriy as a
marker of local inflammation measurement of nitric oxide(FeNO)is made.HsCRP as a marker of
systemic inflammation,WBC and fibrinogen were studied.FeNO in patients with
COPD(21.20±10.29ppb,5.65ppb±15.12,p=0.003)and hsCRP of systemic inflammatory
markers(13,933±1011,9565±3583,p=0.000)and WBC(8234±3052,6624±1473,p=0.015)were
higher than the control group statistically,fibrinogen levels(p=0.626)were similar.With only a
correlation between FeNO hsCRP(r=0.256,p=0.027)had.PFT values as well as those with low hsCRP
and FeNO was higher(P<0.05).HsCRP with local inflammation in the airways,while the lower
respiratory function and hsCRP were both found to be associated with FeNO.In the majority of
patients with COPD(58%)had osteopenia,osteoporosis was detected in 26%,and this increased
comorbidity index as a femurT femurZ found statistically significantly lower scores.Osteoporosis in
patients with COPD with any relationship between FeNO values were
observed(r=0.042,p=0.719).Consequently PFT values of both local and systemic inflammation in
lower were found to be more.BMD have an impact on local inflammation in the airways,although
not closely related to hsCRP on osteoporosis,systemic inflammation observed in COPD suggests
that to be effective.Osteoporosis in advance with regular bone mineral density measurements can
be diagnosed and treated.Thus,measures will be taken of osteoporotic bone fractures.Inflammation
under control already high morbidity and delayed recovery of bone fractures due to hypoxemia in
COPD will be extremely important
Keywords: COPD, İnflammation, osteoporosis
P292[COPD]
Factors Affecting to Reduction of Bone Mineral Density in COPD
Ömür Güngör, Ayşe Füsun Kalpaklıoğlu, Ayşe Baççıoğlu
Kirikkale University Faculty of Medicine, Department of Chest Diseases
Purpose of this study,COPD diagnosis in patients with comorbidity,one of the osteoporosis PaO2,
BMI,respiratory failure type and respiratory function in testing(PFT)with the decline relationship is
to reveal.For this purpose,50 patients with stable COPD and 25 healthy adults were examined.In all
groups,FEV1,FEV1/FVC ratio and femurT(p=0.007,p=0.003)and femurZ(p=0.050,p=0.005)were
significant relationship between scores.PFT values lower than those with low Bone Mineral
Density(BMD)scores was observed.BMI of patients with COPD was found to be significantly lower
than the control group (26.29±4.77and29.22±6.05,p=0.025).BMI and while there is no significant
relationship between femurT score(p=0.169)lower in patients with low BMI femurZ score was
observed(r=0.161,p=0.035).Significantly associated with PaO2 between femurT score
(r=0.356,p=0.016),with a score of femurZ relationship was not statistically significant.Lumbalt and
lumbalZ scores and found no association between other parameters.Patients with Type 1 and Type
2 respiratory failure compared femurT,femurZ,lumbalT,lumbalZ scores assessed by the difference
in BMD was observed.As a result of osteoporosis different mechanisms occurring in COPD, although
low RDA and hypoxemia BMD increases downward.Retasyon addition of carbondioxide in COPD is
thought to be unrelated to the decline in BMD.On the other hand, with a low FEV1 and FEV1/FVC
ratio lower femurT COPD patients and was found to have femurZ scores. COPD is a disease
incidence increasing with each passing day, although both mortality and morbidity is high. For this
reason, examination of the mechanisms that make the morbidity and premature, especially for
measures to increase the comfort of living and at the same time will lead to a reduction of
mortality
Keywords: COPD, İflamattion, PFT, BMI,
P293[COPD]
Serum Paraoxanase, Arylesterase, Lipid hydroperoxide and Sulfhydryl levels
in Chronic Obstructive Pulmonary Disease
Funda Yalçın1, Zafer Hasan Ali Sak1, Ayşegül Öney Kurnaz1, Faruk Günak1, Seyhan Taşkın2,
Mehmet Gencer1, Nurten Aksoy2
1
Department of Chest Disease, Harran University, Şanlıurfa, Turkey
2
Department of Clinical Biochemistry, Harran University, Şanlıurfa, Turkey
Aim
In this study it is aimed to determine the levels of serum paraoxanase, arylesterase, lipid
hydroperoxide and sulfhydryl levels in healthy volunteers and in COPD patients.
Methods
Fifty COPD patient and 50 healthy volunteer were enrolled to the study. Serum paraoxanase,
arylesterase, lipid hydroperoxide and sulfhydryl levels were calculated.
Results
Serum paraoxonase levels were statistically decreased in COPD patients group compared to control
group (93.29±25.15 U/l vs 117.45±36.30 U/l, p<0.001), and serum arylesterase levels were also
statistically decreased in COPD patients compared to control group (154.64±30.43 U/l
vs.125.79±32.24 U/l, p<0.001). Sulphydryl levels were also statistically decreased in COPD
patients compared to control group (0.42±0.9 vs. 0.54±0.6 U/l) Besides, serum lipid
hydroperoxide levels were statistically increased in COPD patients compared to control group
(6.52±1.86 μmol/l vs. 3.78±0.98 μmol/l, p<0.001).
CONCLUSION:
Oxidative stress was statistically increased and antioxidants were decreased in COPD that might be
taken in consideration in pathophysiology of COPD.
Keywords: Chronic obstructive pulmonary disease, oxidative stress
P295[COPD]
Levels of Mean Platelet Volume (MPV) in patients with COPD
Hatice Kılıç1, Ayşegül Şentürk1, Funda Karaduman Yalçın2, Cantürk Kaya4, Tuba Öğüt1, Habibe
Hezer1, Emine Argüder3, Ayşegül Karalezli1, Hatice Canan Hasanoğlu3
1
Ankara Research and Training Hospital, Department of Pulmonary Medicine, Ankara, Turkey
2
Sinop Boyabat 75th State Hospital, Department of Pulmonary Medicine, Sinop, Turkey
3
Yildirim Beyazit University Medical School, Department of Pulmonary Medicine, Ankara, Turkey
4
Ankara Research and Training Hospital, Family Medicine Clinic, Ankara, Turkey
INTRODUCTION: Mean platelet volume (MPV) is an index of platelet activation. It has been shown
that activated platelets have a significant role in the pathogenesis of inflammation,
atherothrombosis. Cardiovascular diseases are located at the beginning of comorbidities in COPD.
In this study, we aimed to evaluate the relationship between MPV and smoking or COPD in patients
who present to chest department.
MaterialMETHODS: Smokers 535 (71,8%), non-smokers, healty 210 (28,2%) outpatients were enrolled in
this study. Smokers and non-smokers were compared MPV, other parameters. Pulmonary function
tests were performed to the smokers. Accordingly, patients with and without COPD were compared
in terms MPV and other parameters.
RESULTS: The levels of white blood cells (wbc), hemoglobin (Hgb) and hematocrit (Htc) in
smokers were statistically higher than non-smokers (The levels of wbc, Hgb and Htc in smokers,
non-smokers were, respectively[8000 (4000-19600), 6700 (3600-19500); 15 (7,3-18,3), 13,5
(9,1-17,8) ve 44,3 (31,7-58,8), 40,2 (30,6-50,8); p<0.00]). The level of MPV in smokers was
statistically higher than non-smokers [the levels of MPV were, respectively 10,1 (8-14,2), 9,6 (6,411,8) p<0.00]. There were 106 cases of COPD in smokers. The levels of platelets, MPV in with
COPD were higher than without COPD, however this elevation was not statistically significant [8,9
(6,7-12,1), 8,9 (6,1- 13,9) p=0.92].
CONCLUSION: In this study, it has been showed higher MPV values in smokers than non- smokers
and higher platelets, MPV values in with COPD than without COPD patients. However, according to
the stage of COPD, there is no difference in MPV levels were observed.
Keywords: COPD, Mean platelet volume
P296[COPD]
The effect of Vitamin D deficiency in current smoker COPD patients
Ezgi Özyılmaz1, Müjde Ocak1, Gülşah Seydaoglu2, Ali Kocabas1
1
Cukurova University Faculty of Medicine Department of Pulmonary Disease
2
Cukurova University Faculty of Medicine Department of Biostatistics
INTRODUCTION: Persistent smoking results more rapid loss in lung functions in COPD.High
prevalence of Vitamin-D deficiency is frequently reported for recent years. However, the effect of
Vitamin-D deficiency on lung function in COPD is still scarce. Our aim was to evaluate the potential
effect of Vitamin-D deficiency in lung functions among current/ex-smoker patients with COPD.
METHODS: 86-stable COPD patients who admitted to our Department were recruited. After
obtaining clinical and demographical data, comorbidity status,MMRC-dyspnea score,BODE-index
were recorded and respiratory function tests(RFT) and 6-minute walking tests were performed.
High pressure liquid chromatography was used for the measurement of serum Vitamin-D levels at
our Central Laboratory. Serum 25(OH)D3<=20ng/ml was accepted as Vitamin-D deficiency.
RESULTS: 51 patients were ex-smoker(59.3%) while 35 were current smoker(40.7%). Vitamin-D
deficiency was determined in 48.5% of the smokers and 33.3% in ex-smokers. When the current
smoker patients compared according to the presence of Vitamin-D deficiency, age, gender, GOLDstage, MMRC-dyspnea score and BODE-index was comparable among two groups while in VitaminD deficient current smokers, smoking intensity were higher(56 ± 29 vs. 36±18 pck/years) and prebronchodilator FEV1(%)(44±17 vs. 56±17) and FVC(%)(60±13 vs. 76±21) were significantly
lower(p<0.05). Among ex-smoker COPD patients, MMRC dyspnea score was higher(1.5±0.5 vs.
1.2±0.4), and pre-bronchodilator FEV1(L)(1.2±0.5 vs. 1.6± 0.6) and FVC(L)(2.2±0.8 vs. 2.8±0.9)
were lower in Vitamin-D deficient group.
CONCLUSION: This study showed that Vitamin-D deficiency may augment the rapid decline effect
of smoking in patients with COPD. However, this result should be confirmed with further studies
performed in larger cohorts with long term follow-up.
Keywords: The effect of Vitamin D deficiency in current smoker COPD patients
P297[COPD]
Risk factors in the development of frequent COPD exacerbations
Sedat Kuleci, Ezgi Özyılmaz, Yasemin Soydaş, Gülsüm Tezçağırır, Müjde Çiğerli Ocak, Ali Kocabaş
Department of Chest Diseases School of Medicine Cukurova Univertsity, Adana
Rationale: Patients with chronic obstructive pulmonary disease (COPD) can be categorized as
having frequent (FE) or infrequent (IE) exacerbations depending on whether they respectively
experience two or more, or one or zero exacerbations within the previous year. Knowing the risk
factors affecting the frequency of COPD exacerbartions may help the clinicians to prevent and/or
treat these frequent exacerbations more appropriately. In this study, we evaluated the risk factors
affecting the frequency of COPD exacerbations.
METHOD: In this study, two hundred forty eight stable COPD patients were recruited who admitted
to Department of Chest Diseases, School of Medicine, Cukurova University, Adana, TURKEY
between Februrary 2010 – October 2011. The COPD patients were categorized into two groups as
having frequent (FE) or infrequent (IE) exacerbations depending on whether they respectively
experience two or more, or one or zero exacerbations within the previous year. The
sociodemographic, clinical, functional and laboratory characteristics of frequently and infrequently
exacerbated COPD patients were collected and statistically evaluated.
RESULTS: Of 248 patients, while 39 (15.7%) patients had frequent (FE) exacerbations, 209
(84.3%) patients had infrequent (IE) exacerbations. 209 FE patients had higher mMRC
(38.5%vs.12.0%,p<0.001) and BODE (46.2%vs.12.9%,p<0.001) scores, and lower walk distance
(278,11±112,46m.vs.376,37±117,44m.,p<0.001). FE patients had lower spirometric values
(postFEV1%:46,82±21,84vs.61,03±18,19,p<0.01; postFVC%,68,10±22,11vs.80,59±18,12,
p<0.01).
CONCLUSION: In this study, we determined some possible risk factors for defining and predicting
the COPD patients, who were frequently exacerbated, and we suppose that properly defined risk
factors may offer an opportunity for preventing and cost-affected management of COPD
exacerbations in the future.
Keywords: COPD, risk factors, exacerbation
P298[COPD]
Does Quality of Life Really Important in Patients with COPD?
Yavuz Havlucu, Arzu Yorgancıoğlu, Ayşın Şakar Coşkun, Pınar Çelik
Celal Bayar University Faculty of Medicine Department of Chest Disease, Manisa, Turkey
In this study,we aimed to investigate the in which group quality of life is important to predict the
mortality in patients with COPD followed 10 years.
306 COPD patients assessed for eligibilityc at February 2003.35 patients were excluded due to not
meeting inclusion criteria and declining to participate to stdy and 20 patients were also excluded
after that because they could not complete the questionnaire.251 patients were assessed at the
beginning.St. George Respiratory Questionnaire(SGRQ) and pulmonary function test assessment
was done beginning and first year.Mortality will be obtained from hospital records and direct family
interviews.Patients were followed 10 years.Patients were firstly classified according to GOLD stage
and after each GOLD stage were classified according to SGRQ scores into 3 groups.
In this prospective study,218 patients(86.85%)were male and mean age was 65,55(43-82
years).When the begining parameters of dead patients and survived patients were compared,there
was a difference according to body mass index,smoking,PFT,and SGRQ scores(p<0.05).There were
100 patients in stage 2,131 patient in stage 3,and 20 patients in stage 4.Moratlity rates in stage
2,stage 3,and stage 4 were 9%,42.7%,and 55% respectively.Quality of life did not have advantage
when compared to the pulmonary function test to detect the mortality in stage 2 and stage 4
patients(p=0.247 and p=0.45).In stage 3,quality of life was more effective than pulmonary
function test to predict the mortality(p=0.00).
Quality of life is important parameter to predict the mortality but it does not have superiority to
pulmonary function tests in mild and very severe group of COPD patients.
Keywords: COPD, quality of life, mortality
P299[COPD]
Does serum uric acid levels predict in-hospital mortality in severe COPD
exacerbations?
Recai Ergün, Begüm Ergan
Dışkapı Yıldırım Beyazıt Education and Research Hospital
INTRODUCTION: Recent data showed high levels of serum uric acid is related with long-term
mortality in COPD patients. In this study we wanted to evaluate whether high levels of uric acid is
related with in-hospital mortality in severe COPD exacerbations which required intensive care unit
admission.
METHODS: COPD patients who developed acute respiratory failure due to an exacerbation were
included into the study. Patients’ demographic and clinical characteristics and follow-up data were
prospectively recorded.
RESULTS: A total of 70 patients (53 male; 75.7%) were included. The median age was 71,5 and
median APACHE 2 score was 25.5. Median blood gas values were 7.26 for pH, 71.5mmHg for PCO2
and 53.0mmHg for PO2. Fiftynine patients were followed with noninvasive ventilatory support
(84.3%) whereas others (n=11; 15.7%) followed with invasive mechanical ventilation. Length of
hospital stay was 16days, with a mortality of 41.4%. Serum uric acid levels were higher in nonsurvivors than in survivors (9.6 vs 6.1mg/dl; p<0.01)
CONCLUSION: In this study we found that higher serum uric acid levels were related with inhospital mortality. Therefore high serum uric acid levels are predictive for not only long term
mortality but also for short term mortality.
Keywords: COPD, uric acid, mortality
P300[Pediatric Pulmonology]
Adverse Effects of Antituberculous Treatment In Childhood
Tuğba Şişmanlar, Ayşe Tana Aslan
DEPARTMENT OF PEDIATRIC PULMONOLOGY, GAZİ UNIVERSITY, ANKARA, TURKEY
Tuberculosis is a disease requiring multi-drug treatment for a prolonged time. Simultaneous use of
multiple drugs increases the risk for side effects. Seventy five patients with a prediagnosis of
tuberculosis were followed between 2007 and 2012. Among these 61 were diagnosed with
tuberculosis infection and 14 with tuberculosis disease. Six of the patients in the tuberculosis
disease group were diagnosed with pulmonary tuberculosis, two with urinary and two with
tuberculosis lymphadenitis. The remainders were diagnosed with tuberculosis arthritis, pericarditis,
endobronchial and miliary tuberculosis.
Patients diagnosed with tuberculosis infection received isoniazid for 6 months (5-10 mg/kg/day).
Except for a patient with elevated liver function tests, no adverse events were documented.
Patients diagnosed with tuberculosis disease were initially started on a 3 or 4-drug regimen for two
months (isoniazid 10-15 mg/kg/day, rifampin 10-15 mg/kg/day, pyrazinamide 30-40 mg/kg/day,
ethambutol 15-25 mg/kg/day) followed by a 2-drug regimen for 4 to 16 months (isoniazid 10-15
mg/kg/day, rifampin 10-15 mg/kg/day). Treatment was delayed in two patients with elevated liver
function test results. Seven patients had elevated serum uric acid levels and they were encouraged
to drink water and were prescribed allopurinol. Hyperuricemia is the most common side effect of
the patients who were treated with pyrazinamide and these patients may require oral hydration
therapy and allopurinol during the course of antituberculous regimen treatment.
Keywords: adverse effect, child, treatment, tuberculosis
P301[Pediatric Pulmonology]
Importance of Flexible Broncoscopy in Immunocompromised Children with
Pulmonary Infections
Nesibe Gevher Eroğlu Ertuğrul1, Ebru Yalçın2, Nagehan Emiralioğlu2, Berna Oğuz3, Aydın Erden4,
Barış Kuşkonmaz5, Deniz Doğru2, Uğur Özçelik2, İlhan Tezcan6, Nural Kiper2
1
Department of Pediatrics, Hacettepe University, Ankara, Turkey
2
Department of Pediatric Pulmonology, Hacettepe University, Ankara, Turkey
3
Department of Radiology, Hacettepe University, Ankara, Turkey
4
Department of Anesthesiology and Reanimation, Hacettepe University, Ankara, Turkey
5
Department of Peadiatric Hematology, Hacettepe University, Ankara, Turkey
6
Department of Peadiatric Immunology, Hacettepe University, Ankara, Turkey
INTRODUCTION
Pulmonary infections are frequently seen in immunocomprimised children.
AIMS
1. To determine the importance of FB and BAL analysis in showing the agent of pulmonary infected
immunocompromised children.
2. To investigate the differences of agents and radiological findings between the pulmonary
infections arised after BMT and other immunocompromised cases.
3. To evaluate the reliability of radiological findings in showing the agent.
METARIALS AND METHODS
FB and BAL analysis for 79 immunocompromised and pulmonary infected children are
retrospectively studied and divided into two groups. Children in group-I (n=61) are the primary or
secondary immunosupressed patients applied FB and BAL because of pulmonary infections.
Children in group-II (n=18) are the patients applied FB and BAL because of pulmonary infections
after BMT.
RESULTS
In BAL sample analysis, the microorganism was shown in 37 (60,6%) patients of group I and 7
(38,8%) patients of group II. When the microbiological agents compared, the bacterial growth in
BAL samples was higher in group I (p=0,017). For other agents there was no significant difference.
No relation between HRCT findings and the agents shown in BAL could be found.
After the analysis of all diagnostic tools related with FB, it was determined that 62/79 of all
patients could be diagnosed. In 32/79 of all patients the agent was exactly shown and therapy
changed.
CONCLUSION
Although FB is applied under empirical anti-microbiological therapy, the importance of BAL analysis
in showing the agent of pulmonary infection in immunocompromised children and its contribution
to diagnosis is found to be high.
Keywords: Bronchoalveolar lavage, Flexible bronchoscopy, Immunosupression, Pulmonary
infections
P302[Pediatric Pulmonology]
Tuberculosis Concealed behind Immunodeficiency
Hikmet Tekin Nacaroğlu1, Semiha Bahçeci1, Nesrin Gülez1, Cansu Çetin1, Canan Şule Karkıner1,
İlker Devrim2, Ferah Genel1, Demet Can1
1
Department of Pediatric Allergy and Clinical Immunology, Dr Behcet Uz Children's Hospital, Izmir,
Turkey
2
Department of Pediatric Infectious Diseases, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
Introduction
Chronic granulomatous disease (CGD) manifests itself with recurrent pneumonia in lung, hilar
lymphadenopathy, empyema, abscess, reticulonodular images and granulomas. 2 patients with
CGD that we had a difficulty in their tuberculosis diagnosis were presented below.
First case
A 5.5 year old male patient hospitalised due to prolonged pneumonia had no characteristic other
than having had axillary lymphadenitis and cousin marriage in his family history. Parenchymal
nodular density in the right and hilar lympodenopathy were determined in his thorax CT. No
reproduction was established in the culture of patient without history of contact and his other
findings were as follows: PPD: 0 mm, quantiferon: (-), ARB (-), PCR (-) in AMS and BAL. His
phagoburst activity was determined as low, therefore he was diagnosed with CGD. Antituberculasis
treatment was initiated when caseous granulomatous inflammation was identified in the biopsy
performed with VATS. Second case;
In the family history of a 1.5 year old male patient hospitalised owing to ongoing fever for two
months, thrombocytopenia, frequent infection history was detected. Prevalent nodular/cavitary
lesions and hilar lymphadenopathy were determined in thorax CT. The patient whose oxidative
burst activity was neutrophile and no monocyte was established was diagnosed with CGD. No
reproduction was determined in the culture of the patient who had no contact history and PPD:
15x20 mm, ARB(-), PCR(-).
Consequence: Other than infecitous and noninfectious causes, CGD should also be taken into
consideration in the patients applied with nodular lesion in the lungs and secret tuberculosis
association should be investigated.
Keywords: Chronic granulomatous disease (CGD), tuberculosis,
Picture 1
Thorax CT views of the first case
Picture 2
Thorax CT imaging of second case
P303[Pediatric Pulmonology]
A Combination of Carinal Trifurcation and Tracheabronchomalacia in a
Patient Applied to Exertional Dyspnea
Semiha Bahçeci Erdem1, Yılmaz Yozgat1, Aytaç Karkıner1, Mehmet Küçük1, Canan Şule Karkıner1,
Hikmet Tekin Nacaroğlu1, Hüdaver Alper2, Demet Can1
1
Dr Behcet Uz Children's Hospital, Izmir, Turkey
2
Ege University Medical School Department of Radiology, Izmir, Turkey
Introduction
Carinal trifurcation can be defined as a close opening of upper right lobe or accessory lobe into
tracheal bronchus and carina. A combination of tracheabronchomalacia and carinal trifurcation was
only reported in one study. Tracheal anomaly was suspected in Thorax CT performed when there
was a right overload in the patient applied to cardiology department with exertional dyspnea.
Therefore, flexible bronchoscopy was carried out and a combination of tracheomalacia and carinal
trifurcation was established.
Case Report
A 7 year-old girl without a lower respiratory tract complaint previously applied to our Cardiology
Polyclinic with complaints such as exhaustion quickly and shortness of breath. There was no
feature available in her personal background and family history. In her echocardiography, right
cardiac cavities were identified as dilated and interatrial ceptum was observed as intact in
transesophageal echocardiography. In her thorax CT demanded for underlying pulmonary
pathology; tracheal anomaly (particularly tracheal bronchus) was suspected (Picture 1). It was
followed that there was a third bronchial entry (cranial trifurcation) next to carina and it progressed
with accessory bronchus. It was observed that right and left bronch openings lost their contour and
they were shaped as fishmouthing (tracheabronchomalacia) (Picture 2). Angiography was planned
to be performed in terms of cardiovascular anomaly accompanied with the patient.
Conclusion
It was aimed to emphasize the importance of flexible bronchoscopy and pointed out that there may
be pulmonary anomalies in the etiology of cardiac complaints as well as a very rare combination of
carinal trifurcation and bronchomalacia.
Keywords: Carinal Trifurcation, Tracheabronchomalacia
Picture 1
The thorax CT view of accessory bronchi stemming from the right side of
trachea.
Picture 2
Malacic segment in the accessory bronchial distal
P304[Pediatric Pulmonology]
Hypersensitivity Pneumonia in Schoolchild Admitted to Hospital with
Asthma Clinic
Semiha Bahçeci Erdem1, Hikmet Tekin Nacaroğlu1, Canan Şule Karkıner1, Güner Özçelik1, Nesrin
Moğulkoç2, Hüdaver Alper3, Sait Karaman1, Demet Can1
1
Department of Pediatric Allergy and Clinical Immunology, Dr Behcet Uz Children's Hospital, Izmir,
Turkey
2
Department of Pulmonary Medicine, Ege University Medical School, Izmir, Turkey
3
Department of Radiology, Ege University Medical School, Izmir, Turkey
INTRODUCTION:
Hypersensitivity pneumonia is a hypersensitivity reaction developed as a result of inhalation of
various chemical substances or organic dust particles, it’s also known as extrinsic allergic alveolitis.
The case of patient at school age who admitted to us with asthma clinic but diagnosed as PBD is
presented below.
CASE:
A 9 years old boy child who had cough, dyspnea on exertion and chest pain complaints for four
months was evaluated as asthma since he had partially benefited from inhaled steroid and pollen
susceptibility was determined in his skin test. In his examination, his lips were cyanosed and SaO2
was 86 % at room temperature. Crepitant rales and bilateral sibilant rhonchi were heard in two
lungs. Patchy nodular Infiltration was determined in patient’s chest radyograph. In his thoracic
computerized tomography, ground-glass areas were present in both lungs. Pulmonary hypertension
was not revealed in echocardiography. Inhaled steroid treatment was initiated and his hypoxia
recovered partly beginning from 7th day of the treatment. In his detail medical history, it was
found out that he lived above the office in which birds and bird manure were merchandised and
further examination was demanded to determine precipitant antibodies. Precipitant antibody levels
for pigeon and budgerigar were found to be high (Pigeon IgG >200 (0-38) ve Budgerigar IgG >200
(0-8)).
In conclusion, environmental exposure should be examined and hypersensitivity pneumonitis
should be kept in mind when the applicant children with asthma profile also have serious hypoxia
and in the presence of radiological findings.
Keywords: Asthma, hypersensitivity pneumonitis
P305[Pediatric Pulmonology]
Septic Pulmonary Embolism Secondary to Osteomyelitis in a Seven-year-old
Child
Adnan Deniz1, Zeynep Seda Uyan2, Yonca Anık3, Nazan Sarper4, Metin Aydoğan5, Emin Sami
Arısoy6
1
Department of Pediatrics, Kocaeli University, Kocaeli, Turkey
2
Department of Pediatric Pulmonology, Kocaeli University, Kocaeli, Turkey
3
Department of Radiology, Kocaeli University, Kocaeli, Turkey
4
Department of Pediatric Hematology, Kocaeli University, Kocaeli, Turkey
5
Department of Pediatric Allergy and Immunology, Kocaeli University, Kocaeli, Turkey
6
Department of Pediatric Infectious Diseases, Kocaeli University, Kocaeli, Turkey
INTRODUCTION: Septic pulmonary embolism (SPE) which is an emergency is rarely seen in
children. A seven year old boy with SPE secondary to osteomyelitis is presented.
CASE: Patient with respiratory distress was followed with diagnosis of pneumonia and pleural
effusion by using intravenous antibiotics and oxygen for twelve days. He was sent to our center
because consolidated areas in lungs gained nodular chracteristics, new cavitary lesions appeared
and his clinical status didn't improve. At presentation, he was tachypneic and hypoxic. Physical
examination revealed bilateral wide-spread rales and diminished breath sounds at the bases. On
follow-up, he developed left hip and leg pain. An increase was noticed in the diameter of left thigh
and leg. Pelvic CT was compatible with osteomyelitis, left lower extremity venous doppler
ultrasound was compatible with acute deep vein thrombosis (DVT). On thorax CT, ''feeding vessel
sign'' was detected in walls of multiple cavities. No pathology was detected in thrombotic and
immunologic workup. With radiological and clinical findings, patient was diagnosed as SPE and DVT
secondary to osteomyelitis. He was treated with meropenem and teicoplanin for six weeks. Lowmolecular-weight heparin was administered for DVT. Patient's respiratory distress and CT findings
regressed. Repeated doppler USG showed recanalization of thrombus.
RESULT: SPE, although rarely, can be seen in childhood. Typical features on CT are peripherally
located multiple round or wedge shaped nodules or cavities varying in size from 0.5-3.5 cm. Main
therapeutic approach is the treatment of primary infection.
Keywords: pulmonary embolism, osteomyelitis, child
P306[Pediatric Pulmonology]
Investigation of bacterial, viral and multiple etiology by multiplex PCR
methods in children with community-acquired pneumonia
Yusuf Aydemir1, Özlem Aydemir2, Sevgi Pekcan3
1
Sakarya University, Medical Faculty, Department of Chest Disease
2
Sakarya University, Training and Research Hospital, Clinics of Microbiology
3
Necmettin Erbakan University, Meram Medical Faculty, Pediatric Pulmonology
INTRADUCTION: Community-acquired pneumonia (CAP) remains a major cause of morbidity and
mortality in childrens. The etiologic agents are quite varied, including a number of viruses and
bacteria. However establishing a microbial diagnosis for patients with CAP is still challenging and is
often achieved in only half of cases by conventional methods. The aim of our study was to identify
with PCR which is a reliable, sensitive and rapid molecular method, for the bacterial, viral and
multiple pathogens that are the most common causes of CAP and to use these results as a guide
for the selection of ampiric antibiotic regimen.
METHODS: 41 patients diagnosed with CAP were included in the study. Both culture and PCR (for
bacteria), and only PCR (for viruses) methods, was performed from nasopharyngeal swabs and
sputum samples.
RESULTS: While at least one etiological agent was determined in 71% of all patients. In 19
patients (46%) at least one virus, 18 patients (44%) at least one bacteria were detected. 8
patients (20%) was found with multiple pathogen. In our study, most commonly respiratory
syncytial virus and S. pneumoniae were detected.
CONCLUSIONS: As a result, in our region, in the CAP etiology of viral and bacterial agents were
shown to play a role in approximately halved. In the discrimination of bacterial and viral infection,
the use of clinical features and markers of infection have shown no benefit. Use of PCR, providing
immediate and appropriate antimicrobial therapy and will result in a better response to treatment.
Keywords: Community-acquired pneumonia,etiology, PCR
Figure 1: Distribition of isolated pathogens
Figure 2: Distrubition of viral and bacterial patogens
P307[Pediatric Pulmonology]
A rare strıdor cause: Congenıtal subglottık stenosıs
Cem Murat Bal1, Figen Gülen1, Remziye Tanaç1, Hüdaver Alper2, Esen Demir1
1
Ege University Children's Hospital, Department of Pediatric Chest Disease
2
Ege University Children's Hospital, Pediatric Radiology
Congenital subglottik stenosis(CSS), an anomally defined as lateral contraction of larynx due to
abnormal development of the cricoid cartilage.Our patients diagnosed with CGS is presented in
literature data.
Case-1: 4 months male patient, admitted with complaints of increased wheezing for two
months.The tests performed (flexible laryngoscopy, EKO, MR angiography) on patient with
preliminary diagnosis of laryngomalacia and vascular ring in external center were found normal.
Physical examination results;weight:50p, height:97p, head circumference:75p, pulse:96/min,
respiratory rate:42/min. Suprasternal retractions, inspiratory and expiratory stridor and bilateral
slim crackles detected. During CT the narrowest point with 1,7mm diameter and the length of
11.7mm stenosis was spotted in the subglottic region. During the 9-month follow-up of patients,
treated with acute bronchiolitis no episodes were observed.
Case-2: 6 months male patient, with complaints of wheezing, accompanied by 10 sec sleep apnea
whose severity increases after crying and feeding began at 2 months, was admitted. It was
learned, the patient was hospitalized with severe croup attack three times at intervals of a month.
On physical examination; weight 25p, length 25p, head circumference 10p, respiratory
rate:42/min, heart rate:105/min. Also patient had, inspiratory stridors and suprasternal
retractions. On CT the narrowest stenosis in 1.5mm to 11mm in length detected in Subglottic
region.After treatment of croup episodes by ENT, during the examination of flexible laryngoscopic
supraglottic and glottic structures were found normal.Follow-up recommended for CSS.After birth,
in cases with early onset, persistent or frequently recurrent croup, flexible laryngoscopy in neck CT
for the diagnosis of CSS should be kept in mind.
Keywords: Congenital subglottik stenosis
P308[Pediatric Pulmonology]
Status of lipid peroxidation in children with bronchopulmonary dysplasia
1
2
Ilgar Almas Mustafayev , Lala Ismayil Allahverdiyeva , Alevtina Victor Bogdanova
1
2
3
3
Research institute of lung diseases, Baku, Azerbayjan
State Medical University, Baku, Azerbaijan
Research institute of pulmonology, Sankt-Petersburg, Russia
OBJECTIVE: To study
bronchopulmonary
the
condition
of
the
peroxidation
processes
in
children with
dysplasia
MATERIALSMETHODS: The study involved 103 patients with bronchopulmonary dysplasia at the age of first
days of life to 14 years. Analyzed such indicators of peroxidation as malondialdehyde (MD) and
conjugated dienes (CD). Endotoxemia condition was studied in the concentration of molecules
medium (MM) in the blood serum. Studies conducted in the acute and remission period of disease.
RESULTS: The status of all children in the acute period was extremely severe. All patients
underwent mechanical ventilation with high doses of oxygen. RDS occurred in 98% of patients. In
the acute phase of disease processes peroxidation and endotoxemia were moderatelyincreased.
The consentration of CD was 3,19 ± 1,2, MD-7,13 ± 3,9, MM-2, 32 ± 1,06. In remission showed
complete normalization of these indicators: CD-1, 37 ± 0,5, MD-3, 05 ± 1,2, MM-0, 78 ± 0,05.
CONCLUSION: Respiratory failure, hypoxia in BPD contribute to disruption of peroxidation
processes in favor of strengthening them, which manifests a moderate increase in peroxidation
products DC,MD and the index of endotoxemia MM. Adequate therapy helps normalize lipid
peroxidation in remission.
Keywords: bronchopulmonary dysplasia,lipid peroxidation,malondialdehyde,conjugated
dienes,molecules medium
P309[Pediatric Pulmonology]
Evaluation of Sleep Related Breathing Disorders in Pycnodysostosis Patients
Nilay Baş İkizoğlu1, Yasemin Gökdemir1, Zeynep Atay2, Belma Haliloğlu2, Serap Turan2, Saygın
Abalı2, Bülent Karadağ1, Fazilet Karakoç1, Refika Ersu1
1
Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey
2
Division of Pediatric Endocrinology, Marmara University, Istanbul, Turkey
BACKGROUND: Pycnodysostosis is an autosomal recessive disease characterized by short stature,
osteosclerosis, increased bone fragility. Pharyngeal narrowing can lead to obstructive sleep apnea
syndrome (OSAS) in these patients. In our study evaluation of the incidence of sleep related
breathing disorders in pycnodysostosis patients was aimed.
METHODS: Demographic data, pediatric sleep questionnaire (PSQ) scores, polysomnography
results and treatments of pycnodysostosis patients who were followed by Pediatric Endocrinology
Department in Marmara University were evaluated.
RESULTS: The mean age of the eight patients (7 girls, one boy) in the study was 12.2 ± 4.2, the
mean age at diagnosis was 6.5 ± 4 years. Habituel snoring was reported in 7 (87%) and apnea
during sleep was reported in 3(37.5%) patients. Two patients had adenoidectomy and one had
tonsillectomy. 4 patients (50%) received growth hormone. Mean PSQ score was 0.41 ± 0.19.
Polysomnography revealed OSAS in six patients (75%). Two (25%) had severe and four(50%) had
mild OSAS. OSAS was detected in 5 of 6 patients with PSQ score greater than 0.33. One of the two
patiets with PSQ score less than 0.33 had mild OSAS. OAHI ranged between 0-15.1 (median 2.9),
central apnea index ranged between 0-2.1 (median 0.4). Mean SpO2 value was 94.5± 1.6% and
lowest SpO2 value was 90.5 ± 3.5%. BIPAP was started in three patients. Control PSG was
planned for other patients during follow-up.
CONCLUSION: Sleep related breathing disorders are frequent in pycnodysostosis, so
polysomnography should be offered to all patients.
Keywords: children, obstructive sleep apnea syndrome, polysomnography, pycnodysostosis
Demographic data and polysomnography results of pycnodysostosis patients
Age
Gender
Habitual
snoring
Apnea
PSQ
score
PSG
result
CAI
OAHI
Lowest
SpO2
Treatment
13y
8m
M
+
-
0.54
Severe
OSAS
0
11.20 93
88
Bipap
15y
4m
F
+
+
0.41
Mild
OSAS
0.35 3.16
94
92
Bipap
10y
7m
F
+
-
0.15
Normal
0
97
96
-
15y
2m
F
+
+
0.38
Severe
OSAS
1.16 15.05 94
90
Bipap
9y
7m
F
+
-
0.36
Mild
OSAS
2.10 2.66
94
89
-
3y
3m
F
-
-
0.17
Mild
OSAS
1.15 2.12
93
86
-
15y
2m
F
+
+
0.59
Mild
OSAS
0.40 3.70
94
88
-
14y
8m
F
+
-
0,68
Normal
0
97
95
-
0
0.40
Mean
SpO2
PSQ: Pediatric sleep questionnaire, PSG: Polysomnography, OSAS: Obstructive sleep apnea syndrome, CAI:
Central apnea index, OAHI: Obstructive apnea index
P310[Pediatric Pulmonology]
A rare cause of respiratory distress: Surfactant protein C deficiency
Tuğba Şişmanlar1, Ayşe Tana Aslan1, Öznur Boyunağa2, Aylar Poyraz3
1
Department of Pediatric Pulmonology,Gazi University, Ankara
2
Department of Radiology, Gazi University, Ankara
3
Department of Pathology, Gazi University, Ankara
Interstitial pulmonary diseases are seen rarely in childhood, and their presentation shows
differences from that in adults. An 18-month-old girl presented with the complaints of recurring
pneumonia and failure to gain weight. She had diffuse crepitant rales in the right lung, subcostalintercostal retractions, pectus excavatum, and hepatomegaly. Oxygen saturation was 84%. In the
radiological examination, parenchyma of both lungs had widespread “frosted- glass” appearance
and a large number of subpleural millimetric cysts. No cystic fibrosis, tuberculosis, reflux, or
immune deficiency was determined in the patient. The echocardiography revealed pulmonary
hypertension, and oral sildenafil treatment was started. Widespread pneumatoceles developed in
the right lung, and the patient’s oxygen requirement increased. No infection was determined in the
microbiological examinations. Open lung biopsy was performed, and the pathological report
indicated chronic pneumonitis. In the genetic tests, a 173T mutation was seen, and a diagnosis of
surfactant protein C deficiency was made.
Methylprednisolone, hydroxychloroquine and azithromycin treatment was started. The
pneumatoceles showed resorption, and her need for oxygen decreased. The patient’s general
condition improved, and clinical and radiological improvement was also observed.
For patients with breathing complaints in the early period of life, frequently recurring lower
respiratory tract infections and growth retardation, interstitial pulmonary diseases must be
suspected. Early diagnosis and treatment are important.
Keywords: child, deficiency, interstitial, surfactant protein c
P311[Pediatric Pulmonology]
Pulmonary Function Tests in Children with Celiac Disease: A Preliminary
Pilot Study
Şebnem Özdoğan, Nafiye Urgancı, Merve Usta, Nuray Uslu Kızılkan
Şişli Hamidiye Etfal Research and Training Hospital
Objectives & Study: Celiac disease (CD) is a an immune-mediated condition, characterized by
destruction of small bowel mucosa after gluten ingestion in genetically susceptible persons.
Respiratory disease and subclinical pulmonary abnormalities are recognised complications of CD
but the pathogenesis of the lung disease remains uncertain. The aim of the study is to investigate
pulmonary
function tests in children with celiac disease.
METHODS: A cross sectional study involving 25 children between 8-18 years old with a diagnosis
of CD who were on gluten-free diet for at least 12 months and had negative endomisial antibodies
were involved. Each patient underwent pulmonary function testing.
RESULTS: 25 subjects (16 female, and 9 male) were enrolled. The mean age was 13.6±3.5 years
at the time of the study. The mean age of diagnosis was 7.5±4.2 years (1-16 years). The mean
duration of follow-up time was 76.1±45.1 months (12-156 months). Of 25 subjects, seven
(21.9%) patients had respiratory symptoms. Family history of asthma and/or allergic rhinitis/
eczema was present in 25% of subjects. A pulmonary function test abnormality was observed in 8
(32%) patients. Seven patients (28%) were noted to have mild obstructive changes, 1 (4%) with
bronchial hyperresponsiveness and 1 (4%) patient with restrictive changes.
CONCLUSION: Subclinical pulmonary abnormalities are present in CD. There may be an
association between CD and airway obstruction which needs further evaluation.
Keywords: Celiac disease, Pulmonary function test, children
P312[Pediatric Pulmonology]
The relationship between psychological symptoms, lung function, and
quality of life in children and adolescents with non-cystic fibrosis
bronchiectasis
Kayhan Bahalı1, Ahmet Hakan Gedik2, Ayhan Bilgiç3, Erkan Çakır2, Feyza Ustabaş Kahraman4,
Nurcan Keskin Osmanoğlu4, Selçuk Uzuner4, Ali Güven Kılıçoğlu1
1
Department of Child and Adolescent Psychiatry, Bakirkoy Research and Training Hospital for
Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
2
Department of Pediatric Pulmonology, Medical Faculty, Bezmialem Vakif University, Istanbul,
Turkey
3
Department of Child and Adolescent Psychiatry, Medical Faculty of Meram, Necmettin Erbakan
University, Konya, Turkey
4
Department of Pediatrics, Medical Faculty, Bezmialem Vakif University, Istanbul, Turkey
OBJECTIVES: The aim of this study was to evaluate the relationship between psychological
symptoms and health related quality of life (HRQOL) and clinical variables in children and
adolescents with non cystic fibrosis bronchiectasis.
METHODS: Seventy six patients participated in this study. Questionnaires were used to evaluate
the psychological status and HRQOL of the patients and healthy controls.
RESULTS: No significant difference was found between patient and control groups for mean
depression and trait anxiety scores. Only the child-rated physical health HRQOL scores were
significantly lower for patients than the controls. Regarding determinants of HRQOL, age of children
and FEV1/FVC percent predicted, had positive effects, while dyspnea severity and trait anxiety had
negative effects.
CONCLUSIONS: Non-CF bronchiectasis is associated with poorer HRQOL in childhood. The impact
of the disease on HRQOL occurs through both clinical and psychological variables.
Keywords: Anxiety, bronchiectasis, child, depression, quality of life.
P313[Pediatric Pulmonology]
Three milliary tuberculosis patients with different courses
Güzin Cinel1, Aslınur Özkaya Parlakay2, Saliha Kanık Yüksek2, Hasan Tezer2
1
Pediatric Pulmonology Department, Ankara Child Health and Diseases, Hematology Oncology
Training and Research Hospital, Ankara, Turkey
2
Pediatric İnfectious Diseases Department, Ankara Child Health and Diseases, Hematology
Oncology Training and Research Hospital, Ankara, Turkey
The clinical picture of milliary tuberculosis can differ depending on the number of bacilli in the blood
stream and immune response of the host.Here we present 3 patients with milliary tuberculosis;but
all had different courses.
Case 1:A 16,5year-old girl admitted to hospital with fever, cough, weakness and weight
loss.Milliary pattern was determined on her thoraxCT.Her tuberculin skin test(TST) was 0 mm.ARB
was pozitive in the gastric lavage, M. tuberculosis grew on the culture.She’s still under antituberculosis therapy for 7months, clinical and radiological findings improved.
Case 2:A 14,5year-old girl admitted with cough and fever.Milliary pattern was determined on her
chest x-ray.She didn’t have a BCG vaccine.Her TST was positive.ARB was positive on sputum and
M. tuberculosis grew on the culture.On the40th day of anti-tuberculosis therapy, she complained
with shortness of breath and stridor.There was a lymph node narrowing the trachea and left main
bronchus on her radiological investigations.Her respiratory distress improved with systemic-steroid
therapy.She's under anti-tuberculosis therapy for 3months.
Case 3:A 16year-old girl admitted with cough, sputum and fever and she had given antibiotic
therapy;but didn’t get well and referred to us.We learned that her 2 sisters died because of
probably tuberculosis.She'd milliary pattern on her radiological investigations.Tuberculin skin test
and sputum ARB were negative.Immunological investigations revealed she has chronic
granulomatous disease.We treat her with anti-tuberculosis therapy and imukin.
Milliary tuberculosis may show different clinical courses.Clinical picture's the worst in our patient
without BCG vaccine;and she'd complications during the therapy.These patients with milliary
tuberculosis should also be investigated to have imunodeficiencies.
Keywords: BCG, immunodeficiency, milliary tuberculosis
P314[Pediatric Pulmonology]
Children with chronic non-specific isolated cough
Özlem Yılmaz, Arzu Bakırtaş, Hacer İlbilge Ertoy Karagöl, Erdem Topal, İpek Türktaş
Department of Pediatric Allergy and Asthma, Gazi University, Ankara,Turkey
Background This study observed children with chronic non-specific isolated cough (chronic-NIC) to
investigate clinical differences between children whose symptoms resolved spontaneously and
those who turned out to have asthma, and then explored the differences among the children who
turned out to have asthma in terms of their time of response to a trial of inhaled corticosteroid
(ICS).
Methods Children with chronic-NIC were managed either with a wait-and-review approach or with a
two-week trial with 400µg/d of inhaled budesonide according to the preference of their parents.
Responses were monitored with a validated cough score. Treatment was prolonged to 8 weeks in
the case of partial responders. All children were followed up at 3-month intervals for at least a
year.
Results A total of 109 children were followed for 21(±5) months. Cough did not recur in 71%
(spontaneous resolution) but relapsed in 28% of the children who later responded to ICS treatment
again (asthma)(Table 1). Aeroallergen sensitization and previous history of chronic cough increased
the risk of asthma. Cough duration at admission, the cough score, the family history of asthma,
serum eosinophilia were not discriminative for the final diagnosis. There were no differences among
children who turned out to have asthma and responded to either to 2 week or 8 week trial with ICS
in terms of the study parameters above (Table 2).
Conclusions Initial response to the ICS trial may be misleading but the trial may be preferred for
children who have atopic sensitization and/or a previous history of chronic cough.
Keywords: asthma, children, chronic cough
Table 1. Comparison of children with chronic-NIC* considering the final diagnosis
(n=108)**
Spontaneous remission Asthma
(n=77)
(n=31)
Duration of cough, wk, median (25p-75p) 10 (8-12)
12 (6-16)
Cough score, wk, median (25p-75p)
4 (4-5)
4 (3-6)
Previous hx of chronic cough n, (%)
23 (30)
17 (55)***
Family hx of asthma n, (%)
26 (34)
13 (42)
Serum eosinophilia n, (%)
7 (9)
6 (19)
Atopic sensitization (%)
20 (26)
16 (52)***
*Chronic-NIC: Chronic non-spesifik isolated cough * *One patient who had a diagnosis of gastroesophageal
reflux disease was excluded. ***p< 0.05 compared to children with spontaneous remission.
Table 2. Comparison of children with chronic-NIC who turn out to have asthma
considering the initial response to ICS (n=30)
2-wk treatment 8-wk treatment
p
(n=8)
(n=22)
Time to relapse, wk, mean ± SD
14.1 ± 12.3
10.5 ± 9.6
0.39
Duration of cough, wk, median (25p-75p) 12 (8.5-23)
12 (6-16)
0.47
Cough score mean ± SD
3.8 ± 1.3
4.9 ± 1.9
0.20
Previous hx of chronic cough, n (%)
6 (75)
11 (50)
0.40
Family hx of asthma, n (%)
4 (50)
8 (36)
0.67
Serum eosinophilia, n (%)
2 (25)
4 (18)
0.64
Atopic sensitization, n (%)
6 (75)
9 (41)
0.21
P315[Pediatric Pulmonology]
A ten years girl with unexplained bleeding symptoms
Sare Betül Kaygusuz1, Selçuk Uzuner1, Kayhan Bahalı2, Sema Kurban3, Ufuk Erenberk1, Erkan
Çakır4
1
Department of Pediatrics, Bezmialem Vakif University, Medical Faculty, Istanbul, Turkey
2
Department of Child and Adolescent Psychiatry, Bakirkoy Research and Training Hospital for
Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
3
epartment of Child and Adolescent Psychiatry, Bezmialem Vakif University, Istanbul, Turkey
4
Department of Pediatric Pulmonology, Bezmialem Vakif University, Medical Faculty, Istanbul,
Turkey
PURPOSE:
Factitious bleeding (FD) is a rare disorder in pediatric population,we present a pediatric case of
factitious disorder with both hemoptysis and hematuria to draw attention that FD must be
considered at the absence of a definite diagnosis despite recurrent hospitalizations.
CASE:
A 10-year-old girl was admitted with complaints of hemoptysis and hematuria started 20 days ago.
She had no other symptoms that accompanied bleeding. Family history revealed nephrolithiasis in
mother and uncle. Physical examination was normal except for ulcerated lesions in the oral cavity.
The results of complete blood count, bleeding parameters, biochemistry and immunological
analysis were normal. Urine culture, p-anca and c-anca were negative. Remarkable difference was
determined in the erythrocyte counts of different urine analyses obtained in the same day, no
hematuria in the urine samples obtained under the supervision of a nurse. Findings of thorax CT,
abdominal ultrasonography, bronchoscopy and upper endoscopy were normal. Bronchoalveolar
fluid was clear, and no hemosiderin-containing macrophage was determined. Based on the clinical
examinations and analyses bleeding etiology due to a medical condition was ruled out. The patient
was referred to the Pediatric Psychiatry Department (PPD) with the prediagnosis of FD. PPD
revealed marital discord,discomfort she felt because of older sister’s leaving and that the mother
has had depressive symptoms and sometimes conversion. The case was discharged with the
recommendation that she be followed up by the PPD. On follow-up visits bleeding symptoms have
improved.
CONCLUSION:
FD must be considered in patients with inconsistency between complaints and examination
findings.
Keywords: hemoptysis,hematuria,factitious bleeding
P316[Pediatric Pulmonology]
The influence of airway supporting maneuvers on glottis view in paediatric
patients undergoing diagnostic flexible fiberoptic bronchoscopy
Tarık Umutoğlu1, Ahmet Hakan Gedik2, Mefkür Bakan1, Ufuk Topuz1, Hayrettin Daşkaya1, Erdoğan
Öztürk1, Erkan Çakır2, Ziya Salihoğlu1
1
Department of Anesthesia and Reanimation, Bezmialem Vakif University, Istanbul, Turkey
2
Bezmialem Vakıf University, Division of Pediatric Pulmonology, Istanbul, Turkey
Introduction and AIM: The aim of this study is to investigate the influence of the airway supporting
maneuvers on glottis view during pediatric flexible fiberoptic bronchoscopy(FOB).
MATERIALMETHOD: In this randomised, controlled, crossover study; patients aged between 0-15 years who
underwent FOB procedure having ASA I-II risk score were included. Patients having risk of difficult
intubation, intubated or patients with tracheostomy, and patients with reduced neck mobility or
having cautions for neck mobility were excluded from this study. After obtaining best glottic view at
the neutral position, patients were positioned Jaw trust with open mouth (A), Jaw trust with teeth
prottution (B) head tilt chin lift (C) and triple airway (D) manoeuvres and best glottic scores were
recorded.
RESULTS: 57 girl total 121 pediatric patients were included in this study. Both A and B maneuvers
improved the glottis view compared with neutral position (p<0,001), but we didn’t found any
difference between A and B maneuvers (p>0.05). C and D maneuvers improved glottis view when
compared both A and B maneuvers and neutral position (p<0,001), however we found no
differences between C and D maneuvers (p>0.05).
CONCLUSION: All airway supporting maneuvers improved glottic view during pediatric FOB,
however head tilt chin lift and triple airway maneuvers were found to be the most effective
maneuvers.
Keywords: Airway Supporting Maneuvres, Bronchoscopy, Flexible, Fiberoptic, Glottis, Pediatric
P317[Pediatric Pulmonology]
Chronic inflammatory disease presenting with lower airways granulation
Erkan Çakır1, Nagehan Emiralioğlu2, Deniz Doğru Ersöz2, Demet Demirkol3, Sedat Ziyade4, Ahmet
Hakan Gedik1, Fatih Aygün3, Özgür Kasapçapur5
1
Department of Pediatric Pulmonology, Bezmialem Vakif University Medical Faculty, Istanbul,
Turkey
2
Department of Pediatric Pulmonology, Hacettepe Universty, Medical Faculty, Ankara, Turkey
3
Department of Pediatric Intensive Care Unit, Bezmialem Vakif University Medical Faculty, Istanbul,
Turkey
4
Depertment of Chest Surgery, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
5
Depertment of Pediatric Rheumotology, Istanbul University,MedicalFaculty, Istanbul, Turkey
INTRODUCTION: A 3 year old girl with lower airway obstruction is presented. CASE: She was
admitted with anemia, diarrhea, vomiting, difficulty walking in age of 16 months and diagnosed
anemia, gastritis and Guillain-Barre syndrome. She had hemangioma under the right eye and
abdominal ultrasound, cranial CT, and echocardiography were detected as normal. Six months
before epistaxis, difficulty breathing and inspiratory and expiratory stridor started. Tracheal
mucosa was fragile in laryngoscopy and hemangioma was not found. Laringial CT was normal.
Bronchoscopy showed narrowing both main bronchus and the BAL fluid were not detected evidence
of pulmonary hemosiderosis. Bilateral segmental stenosis and occlusion were detected in thorax
CT. Hereditary hemorrhagic telangiectasia, Wegener and other examinations were normal in terms
of vasculitic diseases. because of the persistent respiratory problems, bronchoscopy reperformed
and both main bronchi of the granulation tissue and 80% is shrinking, shortness when switching
sub- air segment of the mouth most complete occlusion was observed. Granulation tissue
decomposed via rigid bronchoscopy. Chronic active inflammation and advanced fibrosis were found
in the biopsy. Relapsing polycondrit was considered and methotrexate added to steroid treatment.
Control bronchoscopy revealed significant improvement.
CONCLUSION: Patients was presented because rare presentation of relapsing polycondrit
Keywords: Child, stridor, relapsing polycondritis
P318[Pediatric Pulmonology]
Contributing of the early and repeated nasopharyngeal aspirate cultures to
the microbiological diagnosis of pediatric cystic fibrosis patients
Erkan Çakır1, Ahmet Hakan Gedik1, Mine Yüksel2, Meryem Iraz3
1
Department of Pediatric Pulmonology, Bezmialem Vakif University Medical Faculty, Istanbul,
Turkey
2
Department of Pediatrics, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
3
Department of Microbiology, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
INTRODUCTION: Early diagnosis of P. Auriginosa (PA ) is important Cystic fibrosis (CF) patients.
Nasopharyngeal aspirates (NFA) used in the sampling if the child couldnt sputum production.
Objective –
METHOD: in our clinic for early detection of PA, NFA were taken in all patients repeated every
month.
RESULTS: Sixty-four patients were enrolled to the study. Fifty-eight percent of the patients were
male and the median age was 42.5 months. Age groups of patients; 32 % between 0-24 months,
25-60 months 24% 21% 61 to 120 months, 121 months was 22% higher. Growth in 84 % of
patients had a total of [ PA (44%) MSS (20% ), MRSA (6%), S. Pneumonia (16%), H Influenza
(13%), Klebsiella (13%), Moraxella (9% ) and other (11%). 0-24 month most common
reproductions are PA (37%), S. Aureus (27%), S. Pneumonia (25%), Klebsiella (16%), 25-60
months PA (28%), S. Aureus (24%), H Influenza (12%), Moraxella (12%), Klebsiella (12%), 61 to
120 months PA (50%), S. Aureus (20%), H Influenza (20%), above the 121 months PA (39%), S.
Aureus (36% ), respectively.
CONCLUSION: In our patient group, PA, including 0-24 months in total, as well as in all age
groups has been the most commonly isolated bacteria. Early and often repeated NFA culture is
thought to be ultimately effective detecting the PA.
Keywords: Child, Cystic fibrosis, pseudomonas aerigunosa
P319[Pediatric Pulmonology]
Pulmonary arteriovenous malformation: Dıfferent treatment optıons
Cem Murat Bal1, Esen Demir1, Figen Gülen1, Nurşen Ciğerci1, Remziye Tanaç1, Hüdaver Alper2, Ali
Kınık3, Zafer Dökümcü4, Ata Erdener4, Mustafa Parıldar5
1
Ege University Faculty of Medicine, Department of Pediatric Chest Disease
2
Ege University Faculty of Medicine, Pediatric Radiology
3
Dr Behçet Uz Children's Hospital
4
Ege University Faculty of Medicine, Pediatric Surgery, İzmir, Turkey
5
Ege University Faculty of Medicine, Interventional Radiology, İzmir
Pulmonary arteriovenous malformation (AVM), are abnormal communication between pulmonary
artery (PA) and pulmonary veins (PV) without the capillary passage.Three cases with different
treatment modalities is presented.
Case-1:56/12,Male
Patient with 3years exertional dyspnea, born as twin in 35th weeks, observed in incubator for 24
days.Weight,height <3percentile,SaO280%,acral cyanosis,systolic murmur at chest and clubbing
were detected.Polycythemia,mass on right upper lobe on chest radiography and multiple PAVMs on
right lung upper lobe feeding on right superior pulmonary artery, draining the right superior PV
detected on CT angiography.Amplatzer device placed around neck by transfemoral catheterization
RSPA.At 9 months control,exercise capacity, height,weight increased.
Case-2:3/12,Male
Patient hospitalized twice with complaints of tachypnea,since two months.He was born as twin in
35th weeks and observed in incubator for 26 days.Weight,height 10th percentile,tachypnea,systolic
murmur on chest detected.The patient had SaO288%, and alveolar-arterial O2 gradient of 110.His
hypoxia didn’t improve despite 100% O2 inhalation.Vascular mass in7 mm diameter detected on
right lower lobe in MR angiography.The patient was monitored due to small lesions.Tachypnea in
follow-up continues.
Case-3:16/12,Male
Patient admitted with bruising on lips and three times hospitalization for pneumonia since 4
months.Born as twin in 35th weeks and observed in incubator for 35 days.Weight<3rd
percentile,SaO281%, tachypnea,sistolodiastolik murmur on chest,central cyanosis and clubbing
detected.Polycythemia,chest X-ray revealed mass in right upper lobe.In HRCT, numerous tubular
vascular structures on upper lobe of right lung were draining into SPV. Due to large lesion of the
right upper lobectomy was performed.The patient developed postoperative bronchopleural fistula,
diaphragmatic paralysis, empyema and followed without complications for 7 months.
Keywords: Pulmonary arteriovenous malformation
P320[Pediatric Pulmonology]
Comparison of nasopharyngeal specimens and bronchoalveolar lavage fluid
in children with tuberculosis
Erkan Çakır1, Ahmet Hakan Gedik1, Tarık Umutoğlu2, Özdinç Acarlı3, Mine Yüksel3, Hayrettin
Daşkaya2
1
Department of Pediatric Pulmonology, Bezmialem Vakif University Medical Faculty, Istanbul,
Turkey
2
Department of Anestesiology, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
3
Department of Pediatrics, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
Introduction PURPOSE: Childhood tuberculosis (TB) microbiological positivity is significantly lower than in
adults. Fasting gastric specimens and bronchoalveolar lavage fluid (BAL) gave similar results and
when used together have been shown to increase the microbiological positivity. In general
microbiological positivity ranged from 20-40 % in children A few studies have been conducted
concerning the effectiveness of nasopharyngeal aspirates in children (NFA). In our study, we aimed
to compare of BAL fluid with NFA.
METHOD: NFA was given before the bronchoscopy precedure.
RESULTS: The study included 40 patients with a mean age of 9.2 ± 4.7. In 9 patients (22.5%)
Mycobacterium tuberculosis was detected in BAL fluid (n=9, 22.5%) and in NFA (n=5, 12.5%) (p =
0.006).In a total of 10 patients (25%) positivity was obtained.
CONCLUSION: Compared with BAL samples, NFA significant decrease was seen in the detection of
bacilli and NFA samples were thought to be inadequate in detecting bacilli.
Keywords: child, bronchoalveolar lavage, nasopharyngeal specimens, tuberculosis
P321[Pediatric Pulmonology]
The evaluation of pulmonary function of children with bronchiolitis
obliterans by spirometry and impulse oscillometry methods
Zeynep Seda Uyan1, Erkan Çakır2, Yasemin Gökdemir3, Levent Midyat4, Ersin Öztürk1, Velat Şen3,
Ahmet Hakan Gedik2, Ela Erdem3, Refika Ersu3, Fazilet Karakoç3, Bülent Karadağ3
1
Division of Pediatric Pulmonology, Kocaeli University, Kocaeli, Turkey
2
Division of Pediatric Pulmonology, Bezmi Alem Vakif University, İstanbul, Turkey
3
Division of Pediatric Pulmonology, Marmara University, İstanbul, Turkey
4
Division of Pediatric Pulmonology, Sureyyapasa Chest Diseases and Thoracic Surgery Training and
Investigation Hospital, İstanbul, Turkey
Bronchiolitis obliterans (BO) is characterized by persistent symptoms of obstructive lung disease
following acute bronchial injury. Our aim was to evaluate the pulmonary function of children with
BO by spirometry and impulse oscillometry (IOS) methods. Forty-one postinfectious BO patients
(71% male) with a mean age of 106±60 months, followed for a median period of 29 (IQR: 7.5105.5) months in three different centres were enrolled. Mean age at diagnosis was 41±32 months.
Their median z-score of weight was -0,49 (IQR:-2.39-0.67) while median z-score of height was 0,82 (IQR: -1.80-0.35). Mean FEV1 value was 48.8±14.2%, FVC was 56.8±11.9% in 26 patients
who could perform spirometry. When the IOS results of BO patients were compared with their
spirometry results, percent of resistance values at 5,10,15 and 20 hz (R5, R10, R15 and R20)
(p=0.00, 0.00, 0.00 ve 0.01, respectively), reactance values at 5,10,15 and 20 hz (X5, X10, X15
and X20) (p=0.00, 0.01, 0.01, 0.00, respectively) and resonance frequency (p=0.00) were all
correlated with FEV1 results. In conclusion; pulmonary function of children with BO who cannot
perform spirometry can be evaluated by IOS method in which only minimal cooperation is needed.
Keywords: Bronchiolitis obliterans, child, spirometry, impulse oscillometry
P322[Pediatric Pulmonology]
A persistant asthmatic patient after lovebird contact: case report
Ahmet Hakan Gedik1, Selcuk Uzuner2, Burak Akovalı2, Erkan Cakır1
1
Division of Pediatric Pulmonology, Bezmialem Vakif University, Istanbul, Turkey
2
Department of Pediatrics, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkey
Introduction and AIM: Asthma is chronic respiratory disease characterized with recurrent episodes
where environmental factors are important. An asthmatic patient whose clinical and radiological
findings persisted after lovebird contact was presented. CASE: A nine-years-old allergic asthmatic
patient was admitted due to persistant cough and wheezing for 1 months. Her complaints increased
after living with a lovebird at home. Her father, aunt, and cousins had asthma, tuberculosis (TB)
contact wasn’t mentioned. Bilateral roncus and prolonged expiration were found in examination.
Inflammation in chest X-ray and mite-allergy in prick test (eosinophil 3.9%, ImmunglobulinE 92
mg/dl) were determined. Asthma and allergic rhinitis were treated with inhaled steroid, long-acting
beta-2 agonist, leucotrien antagonist, nasal steroid. Macrolid was given for atypical Mycobacteria.
Symptoms persisted after two weeks of these therapies. Computarized tomography revealed
atelectasis, infiltrations and frosted-glass appearance. Extrinsic allergic alveolitis due to lovebird
was thought. Bird feather specific IgE, Aspergillus antigen, Chlamydia and Mycoplasma serology,
and sputum cultures were negative, Quantiferon test was positive. Fiberoptic bronchoscopy was
normal, ARB in BAL and gastric aspirates were negative. Anti-TB therapy was begun due to
resistant clinical and radiological symptoms and positive Quantiferon test. During the follow-up,
Mycobacterium complex was obtained from BAL culture. Family screening was negative, after a
while her adolescent neighbour had TB was told by the family. Clinical and radiological complete
improvement was seen after therapy.
CONCLUSION: The diagnosis of TB disease should be excluded in the patients where clinical and
radiological symptoms and findings are resistant to therapy.
Keywords: Child, asthma, lovebird contact, tuberculosis
P323[Pediatric Pulmonology]
Total oxidative stress, total antioxidant status and paraoxanase activity in
pediatric patients with bronchiolitis obliterans
Ahmet Hakan Gedik1, Erkan Cakır1, Yasemin Gokdemir2, Seda Zeynep Uyan3, Elif Kılıc4, Emel
Torun5, Refika Ersu2, Bulent Karadag2, Fazilet Karakoc2
1
Division of Pediatric Pulmonology, Bezmialem Vakif University, Istanbul, Turkey
2
Division of Pediatric Pulmonology, Marmara University, Istanbul,
3
Division of Pediatric Pulmonology, Kocaeli University, Istanbul, Turkey
4
Department of Biochemistry, Bezmialem Vakif Univeristy, Istanbul, Turkey
5
Departmet of Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
Introduction and AIM: Oxidants are normal part of cell metabolism and important in cell
hemostasis. Airway mucosa developed antioxidant system to protect itself from harmful oxidants.
Imbalance between these systems may caused cell damage. Paraoxonase (PON), is an
antioxidizing enzyme, increased with diseases characterized by high oxidative stress. Oxidative
stress is supposedly down-regulates serum PON1 expression. We aim to determine total oxidative
stress (TOS), total antioxidant status (TAS) and PON levels and compare with control group in
pediatric Bronchiolitis Obliterans (BO) patients.
METHOD: The patients between 0-16 years-old was admitted between 2012-2013 september and
age and gender matched healthy controls were enrolled in the multi-center study. Serum TOS,
TAS, and PON levels were determined with ELISA method and compared with control group.
FINDINGS: Sixty-three BO patients, sixty-seven percent of them were male, enrolled in the study.
Median age was 74±58 months. Thirty-five children included to the study as control group and age
and gender distribution were not statistically different between the two groups (p>0,05). TAS
levels were significantly lower in BO group compared with healthy controls (p<0.001). No
statistically significant difference between two groups were found according to TOS and PON levels
(p>0.05). Preliminary results were reported because control group studies have been going on.
CONCLUSION: This is the first study about TAS, TOS, and PON levels in pediatric post-infectious
BO patients. According to preliminary report, TAS levels were significantly lower in BO patients.
Oxidant and antioxidant system may have important role in immune pathogenesis of BO patients.
Keywords: Child, bronchiolitis obliterans, total oxidative stress, total antioxidant status,
paraoxanase level
P324[Pediatric Pulmonology]
Three cases of familial pulmonary alveolar microlithiasis: the first year
results of disodium etidronate treatment
Erkan Çakır1, Ahmet Hakan Gedik1, Nur Buyukpinarbaşili2, Mehmet Bilgin3, Ufuk Topuz4
1
Division of Pediatric Pulmonology, Bezmialem Vakif University, Istanbul, Turkey
2
Department of Pathology, Bezmialem Vakif University, Istanbul, TURKEY
3
Department of, Radiology, Bezmialem Vakif University, Istanbul, TURKEY
4
Department of Anesthesiology, Bezmialem Vakif University, Istanbul, TURKEY
INTRODUCTION: Pulmonary alveolar microlithiasis (PAM) is a rare disease of unknown etiology
and is characterized by the deposition of calcium phosphate microliths within the alveolar
airspaces. PAM can be seen in a family and more frequently in siblings. No standard treatment
were used, but disodium etidronate can be administered. Data in the literature about treatment are
contraversial. This report presented the first year result of disodium etidronate treatment of 3
siblings (2 were twins). Cases: Disodium etidronate treatment first year results of 12-years-old boy
and 6-years-old twins were presented in this report. All patients did not have any symptoms,
oxigen saturations were normal, pulmonary function tests of big-brother was similiar when
compared before and after treatmant. Control chest computarized tomographies in one year have
revealed that treatment stop the progression of the disease of big brother, supplied significant
improvement in one twins, and worsened the other one. In the family screening one cousin was
also diagnosed with PAM and the number of cases increased to 4.
CONCLUSION: Disodium etidronate treatment results were different in three cases. Further
evaulations, big case series, and long period of follow-up are needed.
Keywords: Alveolar microlithiasis, disodium etidronate, child
P325[Pediatric Pulmonology]
Serum paraoxonase activity and oxidative status in pediatric patients with
pulmonary tuberculosis
Emel Torun1, Ahmet Hakan Gedik2, Erkan Cakır2, Tarık Umutoğlu3, Ozlem Gok4, Ulkan Kilic4
1
Department of Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
2
Division of Pediatric Pulmonology, Bezmialem Vakif University, Istanbul, Turkey
3
Department of Anestesiology, Bezmialem Vakif University, Istanbul, Turkey
4
Department of Medical Biology, Bezmialem Vakif University, Istanbul, Turkey
BACKGROUND: The aim of the study was to determine the oxidative status and paraoxonase
levels of children with pulmonary tuberculosis compared with healthy controls and to examine the
association of demographical and biochemical parameters with oxidative status. MaterialMETHODS: Forty children diagnosed with pulmonary tuberculosis (TB) and 40 -age and gender
matched- healthy controls were enrolled in the study. Serum total antioxidant status (TAS), total
oxidant status (TOS) and paraoxonase levels were measured. Oxidative stress index (OSI) was
calculated to indicate the degree of oxidative stress.
RESULTS: Age and gender distribution were not statistically different between the two groups
(p=0.387 and 0.5, respectively). The TAS levels were lower and TOS levels were higher
significantly in TB group compared with control group (p<0.001). The OSI was significantly higher
in TB group (p=0.006). Serum paraoxonase levels were significantly lower in TB group compared
with healthy controls (p<0.001). The lower paraoxonease levels were correlated with TAS and OSI
levels but not correlated with andropometric and biochemical parametres (r = 0,264, p = 0.018
and r = -0.255, p = 0.023, respectively).
CONCLUSION: Oxidative stress was significantly increased with a decrease in paraoxonase levels
in pediatric pulmonary TB patients.
Keywords: Paraoxonase activity, oxidative status, tuberculosis, child
P326[Pediatric Pulmonology]
Persistant High Immunglobulin E levels and Tuberculosis: A case report
Sare Betül Kaygusuz1, Ahmet Hakan Gedik2, Erkan Cakır2
1
Department of Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
2
Division of Pediatric Pulmonology, Bezmialem Vakif University, Istanbul, Turkey
INTRODUCTION: Thelper1 (Th1) lymphocytes have important role in immune response against
Tuberculosis(TB). Relationship between TB and high immunoglobulin E(Ig E) levels with Th1 related
mechanism was told in recent studies and reduction in high Ig E levels was noted with TB
therapy. AIM: To discuss relationship between high and persistant Ig E levels and
TB. CASE: Twelve-years-old female patient who have had chronic productive cough, frequent otitis
and sinusitis since 6 months-old and was followed-up with asthma, resistant atelectasis of right
middle lobe, bilateral bronchiectasis was admitted. Previous tests were normal except high IgE
(494 mg/dl), TB history of her uncle 5 years ago. After admission, atelectasis was found in
computarized tomography (CT) and bronchoscopy revealed dense purulent mucus. Aspergillus
fumigatus and Hemophilus influenzae were observed in BAL culture. Symptoms persisted and total
IgE increased (1750 mg/dl) despite appropriate therapy. Aspergillus fumigatus in prick test,
Aspergillus spesific IgE, control sputum culture, and immune deficiency tests were negative. PPD,
Quantiferon test, and ARB in gastric aspiratation were 20mm, positive and negative, respectively.
Control CT revealed multiple intrathoracic conglomerated lymph-nodes (30x25 mm).
Mediastinoscopic biopsy for Lyphoma resulted reactive hyperplasia. Anti-TB therapy was given to
patient who had TB disease contact, PPD and quantiferon positivity, infiltration and conglomerated
lymph-nodes resistant to therapy. Clinical and radiological improvement and reduction of IgE (289
mg/dl) were seen in second months of therapy.
CONCLUSION: This case was presented due to rare presentation TB with high Ig E levels with
almost complete improvement.
Keywords: Child, tuberculosis, immunglobulin E
P327[Pediatric Pulmonology]
A case of systemic involvement: The only reason Tuberculosis?
Mine Yüksel1, Ahmet Hakan Gedik2, Erkan Cakır2
1
Department of Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
2
Division of Pediatric Pulmonology, Bezmialem Vakif University, Istanbul, Turkey
INTRODUCTION: Childhood tuberculosis (TB) may be seen in a variety of forms. A TB case who
had systemic manifestations and with no underlying disease presented. CASE: 12-year-old female
patient was admitted to our clinic with leucopenia, high eryrocyte sedimentation rate, 15 mm PPD.
Before admission, anti-TB treatment had been given due to cough, infiltration on chest X-ray,
mediastinal lympadenopathy on chest CT resistant to therapy (with no TB contact, PPD:0mm,
microbiology: negative) and also all examinations had resulted normal due to leucopenia. Lesions
had regressed after 4 months, but family had stopped treatment After one year, the lesion on
chest X-ray had progressed to old size. After admission, bronchoscopy revealed narrowing of right
upper lobe apical segment orifis, mucozal deterioration, and tracheal bronchus. TB organizing
pnemonia was thought, anti-TB and steroid therapy was given to the patient whose transthoracicbiopsy was resulted alveolar fibrosis and chronic inflammation. Examination of pediatric oncology
and rhomatology resulted normal again. The lesions were entirely regressed, but leucopenia was
seen occasionally and convulsions occurred. Neuroimaging was normal, but anti-epileptic treatment
was given due to abnormal electroencephalography. After 3 years without complaints, lesions were
recurred in the same area on the chest X-ray made due to cough. Chest CT revealed a mass
completely obstructed the orifis of tracheal bronchus. Mycobacterium tuberculosis complex was
obtained from the biopsy taken with bronchoscopy and anti-TB treatment was given again. On the
second months of therapy lesion completely regressed again.
CONCLUSION: Cases were presented due to a rare cause of presentation.
Keywords: Child, tuberculosis, leucopenia, systemic involvement
P328[Pediatric Pulmonology]
A mass resistant to treatment in the course of tuberculosis: Organizing
pneumonia? Endobronchial tuberculosis?
Mine Yüksel1, Ahmet Hakan Gedik2, Gulsum Guzel1, Erkan Cakır2
1
Department of Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
2
Division of Pediatric Pulmonology, Bezmialem Vakif University, Istanbul, Turkey
INTRODUCTION: Pulmonary tuberculosis rarely comes out with heterogeneous mass. A case with
a mass detected when was examined due to clubbing and was referred to our clinic was
presented. CASE:Heterogeneous mass that filled the left upper-back mediastinum have been seen
in chest CT of the patient who have been examined due to clubbing and cough in September 2012.
Her history were unremarkable and had no TB contact. Her brother had a history of hytatid cyst
disease. Clubbing and a few micro-lymphadenopathy in the left-back servical area was detected in
physical examination. Blood counts and tests, neuron-specific enolase and vanilmandelic acid levels
in urine have been detected normal accept high sedimentation. Echinococcus anti-body, further
tests for TB have resulted negative. Abdominal CT and whole body SPECT have revealed normal
except a lesion in the upper-left lung. Transthoracic fine-needle aspiration biopsy of the patient
who was referred to our clinic revealed no pathologic finding. Mediastinoscopic sampling was
resulted necrotizing granulomatous lymph nodes and anti-TB therapy was started and administered
3 months with 4 drugs and 6 months with 2 drugs. Mycobacterium tuberculosis complex was also
reproduced from BAL cultures. Clubbing and cough were totally cured but no improvement was
detected in the size of the lesion and lymphadenopathy. Flexible bronchoscopy revealed
endobronchial lesion near-completely obstructed the upper lobe upper segment orifis of the left
lung. Steroid therapy was given with the diagnosis of TB organizing pneumonia.
CONCLUSION: The case was presented due to rare presentation of thorax mass lesion.
Keywords: Child, tuberculosis, organizing pneumonia, thoracic mass
P329[Pediatric Pulmonology]
Clinical association of Ig G1 subclass deficiency and Chronic eosinophilic
pneumonia: One case
Sevgi Pekcan, Nevzat Başkaya, İsmail Reisli
Necmettin Erbakan Üniversity, Meram School of Medicine, Pediatric Department
Ig G is major immunoglobulin and classified subgroups as IgG1, IgG2, IgG3 and IgG4. IgG1 and
IgG3 subclasses are rich in antibodies aganist proteins. Ig G1 subclass deficiency is very
rare.Chronic eosinophilic pneumonia is one of the eosinophilic lung disease. In the presence of
peripheral eosinophilia and radiological pulmonary infiltrates diseases suspected. When increase
eosinophils number in BAL and/or presence of eosinophils in lung tissue diagnosis is confirmed. We
present the patient who has IgG1 deficiency, chronic eosinophlia and %42 eosinophlia in
bronchoalveolar lavage fluid. The patient improved with inhaled steroids after long oral steroid.
This was presented in terms of clinical association. A 12 years old female patient who were followe
due to asthma in the other center for two years, altought usage of combination inhaled fluticasone
and salmeterol was admitted with cough and sputum production. In torax CT right lower
bronchiectasis, pneumonic consolidation in the right lower lob and ground glass opacities were
present IgG: 924 mg/dl, IgA: 157 mg/dl, IgM: 180 mg/dl, IgE: 108. 6 mg/dl and was. IgG1: 4896
mg/dl. Bronchoscopy was performed in the patient who has eosinophilia in complete blood count
(EO: 717/mm3 EO:%17) and symptoms persist. The patient was diagnosed chronic eosinophilic
pneumonia and Ig G1 subgroup deficiency 1 mg/kg oral steroid and IVIG therapy was began. As
can be seen immunodeficiency alone, sometimes may be associated with interstitial lung disease in
this respect, for immunological analysis bronchoscopy, bronchoalveolar lavage, lung may be added
if necessary.
Keywords: Ig G1 subclass deficiency, Chronic eosinophilic pneumonia, child, bronchoalveolar
lavage
P330[Pediatric Pulmonology]
Primary Ciliary Dyskinesia: Marmara University Experience
Yasemin Gökdemir, Ela Erdem, Nilay Baş İkizoğlu, Fazilet Karakoç, Refika Ersu, Bülent Karadağ
Marmara University Medical Faculty Pediatric Pulmonology
BACKGROUND: Primary ciliary dyskinesia (PCD) is an inherited disorder characterized by
impairment of mucociliary clearance.
OBJECTIVE: To report the clinical characteristics of patients with PCD
METHOD: 43 patients who are followed up in Marmara University Hospital, Pediatric Pulmonology
Department with the diagnosis of PCD were included in the study. Demographic and clinical
findings of patients were evaluated retrospectively.
RESULTS: 25 patients (58%) were female and the mean age was 11.1 ± 4.9 (1-18.5). Even
though the symptoms started in the newborn period in 62% of patients, the average age at
diagnosis was 5.8 ± 3.4 years. Parental consanguinity was present in in 78% of patients. Situs
inversus totalis was present in 93% of cases. All patients had history of rhinitis, 88% had
pneumonia, 61% had otitis and 39% had history of sinusitis. Sputum culture was positive in 71%
of patients. Clubbing was observed in 15% and chest deformity was observed in 22.5% of patients.
23% of patients had history of adenoidectomy and tympanostomy tube insertion, 13% had a
history of tonsillectomy operation. Bronchiectasis was detected in 83% of patients. One patient
(2%) underwent left lower lobectomy. Even though 72% of patients used the inhaler therapy
regularly, only 34% of patients performed chest physiotherapy 2 times a day on a regular basis. In
patients who were diagnosed and started treatment early, bronchiectasis developed similar to
those who were diagnosed late (p=0.09).
CONCLUSION: PCD is a progressive disease with significant morbidity that presents with recurrent
upper and lower respiratory tract infections.
Keywords: Primary ciliary dyskinesia, bronchiectasis, child
P331[Pediatric Pulmonology]
Vitamin D Status and Lung Function in Children with Asthma
Şebnem Özdoğan, Gizem Sarı, İbrahim Hakkı Aktan, Belma Aydın, Canan Irmak
Sisli Hamidiye Etfai Research and Training Hospital
OBJECTIVE: Although Turkey is a sunny country, vitamin D deficiency is quite prevelant. In the
last few years, there have been few studies showing the association between serum vitamin D
levels and asthma severity in children. In this study we aimed to examine the association between
serum 25-hydroxy vitamin D3 levels and asthma control and lung function as measured by
pulmonary function tests.
METHOD: We conducted a cross-sectional study involving children with asthma and healthy
controls aged 7-17 years old. Vitamin D status was assessed by measuring serum 25-hydroxy
vitamin D3 in both groups. The relationship between serum vitamin D levels and asthma control
and pulmonary function tests were also examined in asthmatic patients.
RESULTS: 71 asthmatic children and 71 healthy controls were recruited. Mean age in asthmatic
group was 11,9 ± 1,93 years old. 25-hydroxy vitamin D3 levels were low in both asthmatics and
control group (12,9±6,27 and 12,3± 6,4 ng/ml respectively). The asthma control assessment was
significantly worse in men. Vitamin D levels were significantly low in women especially who
completely covering the skin except face and hands. There was no correlation between vitamin D
levels and asthma control, and lung function. (p>0,05).
CONCLUSION: Contrary to the most previous studies, vitamin D levels do not correlate with
neither asthma control nor lung function.
Keywords: Vitamin D, asthma, children, pulmonary function test
P332[Pediatric Pulmonology]
Evaluation Of The Clinical, Laboratory And Radiological Findings In
Hospitalised Patients Diagnosed With Lower Respiratory Tract Infections
Nihal Aktaş1, Sevgi Pekcan2, Vesile Meltem Energin1
1
Department of Pediatrics, Necmettin Erbakan University, Konya, Turkey
2
Division of Pediatric Pulmonology, Department of Pediatrics, Necmettin Erbakan University, Konya,
Turkey
Viral agents is the major cause of acute lower respiratory tract infections (LRTI) in children.
PURPOSE: The evaluation of the clinical, laboratory and radiological findings of the hospitalisedtreated patients diagnosed with LRTI's, identifying viral agents and investigating seasonal
distribution of agents.
METHOD: This study was a retrospective chart review of 785 patients who were diagnosed with
acute lower respiratory tract infection between December 2010-June 2013 in Department of
Pediatrics, Necmettin Erbakan University Meram Faculty. Demographic, clinical, laboratory and
radiological findings were recorded. Nasopharyngeal aspirates of patients were studied by
polymerase chain reaction (PCR) method.
RESULT: One or more viral agents were detected in 329 (41,9%) patients included in the study.
Respiratory syncytial virus B (RSV B) (41%), rhinovirus (15,5%) and with RSV A (12,8%) were
most frequently isolated. In addition, multiple viral agents were detected in 28 patients (8,5%).
Levels of leukocytes, neutrophils and hospitalization period were significantly lower in patients with
detected a viral agent than not detected a viral agent (p<0,05). However, no significant difference
was found for CRP levels between the two groups (p = 0,906). Chest radiographs were normal in a
large part of patients identified viral agents (68%).
CONCLUSION: RSV, rhinovirus and influenza A are crucial for childhood pneumonias in Turkish
society. Mixed infections are not associated with disease severity.More studies are needed for
relability of CRP and radiological findings in diagnosis lower respiratory tract infections causing viral
agents.
Keywords: Bronchiolitis, children, pneumonia, respiratory syncytial virus, respiratory tract, viral
agents.
P333[Pediatric Pulmonology]
The case of hydatid cyst followed by hemoptysis
Nesrin Ceylan1, Hülya Günbatar2, Selvi Asker2, Nihat Demir1
1
Department of Child Health and Diseases, Yuzuncu Yıl University, Van
2
Department of Chest Disease, Yuzuncu Yıl University, Van
INTRODUCTION: Hydatidosis can be counted among the most important zoonotic diseases in the
world. Echinococcosis is an endemic disease especially in Turkey; however, hydatid disease of the
lung is rare and usually results from Echinococcus granulosus.
CASE PRESENTATION: In this report, we tried to present the case of a 12-year-old male patient
who had hemoptysis resulting from hydatid disease of the lung.
CONCLUSION: In spite of being one of the less common causes of hemoptysis, hydatid disease of
the lung requires greater attention in countries such as Turkey, where hydatid cyst disease can be
seen so common.
Keywords: Hemoptysis, hydatid cyst, lung
The Lung Bronkoskopy
At the anterior segment mouth, lesion in white membranous character which obstructs the lumen and is
protruded with coughing was observed.
Thorax CT
Focal bronchiectasis consolidated atelectasis lung tissue in the right upper anteroinferior of the right lung, and
cavity-looking area with about 10 mm diameter in the same area is being monitored.
P334[Pediatric Pulmonology]
Food Allergen Sensitivity as a Prognostic Factor for Wheezing in Children
Özge Yılmaz1, Fatma Taneli2, Esra Toprak Kanık1, Ahmet Türkeli1, Ceyhun Gözükara2, Hasan
Yüksel1
1
Department of pediatric Allergy and Pulmonology, Celal Bayar University Medical Faculty, Manisa
2
Department of Biochemistry, Celal Bayar University Medical Faculty, Manisa
AIM: We investigated the difference of clinical severity and lung inflammation and epithelial
permeability in wheezy children with and without food allergen sensitivity.
METHODS: We enrolled 1-3 years old children with multiple-trigger wheezing to this prospective
cohort study. The population was grouped as Fx5(+) and Fx5(-) (Levels >= 0.35 kU/L was
classified as sensitized). Number of self-reported wheezing episodes, emergency visits, days of
hospitalization, systemic steroid and bronchodilator usewere assessed very three months for one
year. Surfactant protein-D (SP-D) levels and CC16 protein levels were assessed at baseline. We
report preliminary results of the first 6 months of follow up.
RESULTS: Total of 290 children was enrolled. 42 of them were lost to follow up. Mean SP-D and
CC-16 levels were not significantly different among the Fx5(-) and Fx5(+) groups (161.7, 161.4,
p= 0.68 and 5.4, 5.2, p=0.99 respectively). Number of exacerbations, days of systemic steroid,
inhaled bronchodilator use, emergency visits during the previous three months period were not
significantly different groups at the beginning or at third month of follow up. However, number of
exacerbations during the previous three months period were significantly higher Fx5(+) group
compared to the Fx5(-) group at sixth month follow up (0.4 ±0.6, 0.1±0.4 respectively, p=0.004).
Similarly, days of systemic steroid and inhaled bronchodilator use, emergency visits were
significantly higher in the Fx5 (+) group (p=0.01, p=0.004, p=0.007 respectively)
CONCLUSION: These results indicate that lung inflammation and epithelial permeability are not
significantly different among wheezing children with or without food sensitivity.
Keywords: Wheezing, food sensitivity, surfactant protein D, Clara cell protein 16, epithelial
permeability, inflammation
P335[Pediatric Pulmonology]
Pulmonary Manifestations of Proteus Syndrome in a 5-year-old child
Fatma Demirbaş1, Özlem Kayabey2, Hülya Maraş3, Murat Deveci2, Bülent Kara3, Zeynep Seda Uyan4
1
Depatment of Pediatrics Kocaeli University, Kocaeli, Turkey
2
Department of Pediatric Cardiology, Kocaeli University,Turkey
3
Department of Pediatric Neurology,Kocaeli University, Kocaeli, Turkey
4
Department of Pediatric Cardiology, Kocaeli University, Kocaeli, Turkey
INTRODUCTION: Proteus syndrome (PS) is a rare sporadic condition which is characterized by
asymmetric and dispropotionate growth of multiple organs. Anomalies associated with PS are long
face, prominent forehead, hyperpigmented and hemangiomatous skin lesions and eye anomalies.
Pulmonary involvement which is a component of clinical diagnostic criteria, is uncommon. We
report a 5-year-old boy with PS who has pulmonary manifestations in early childhood.
CASE: The patient has been followed-up with the diagnosis of PS since 1 year of age. His height
and weight were below 3th percentiles. He had a long face, a prominent forehead, hypertrophy of
both feet and right middle finger of hand, hyperpigmented lesions and varicose veins on the skin.
Cranial MRI revealed cavernous hemangiomas. Reticulo-streaky densities with prominent vascular
markings and pneumonic infiltration were seen in right paracardiac region in chest radiography of
the patient, although he had no respiratory symptoms. His computed tomography of thorax
revealed hyperaeration of the right lung, multiple cystic lesions in the right lung and dilated right
pulmonary and azygos veins. Echocardiographic examination revealed asymmetric septal
hypertrophy and dilated ascending aorta, while contrast echocardiography was found to be normal.
The patient is still being followed-up due to his pulmonary manifestations in our clinic.
CONCLUSION: Although pulmonary manifestations in PS are uncommon, recognition of pulmonary
vein dilatation and bullous lesions in the lung at an earlier age are important for accurate
diagnosis, treatment and follow-up of the disease. Computed tomography has an important role in
the diagnosis and follow-up of these manifestations.
Keywords: Child, Proteus syndrome, Pulmonary manifestations
P336[Pediatric Pulmonology]
An Alternative Treatment to Tracheostomy in Pierre Robin Syndrome:
Mandibular Distraction Osteogenesis
Tuba Koçkar1, Serdar Al2, Sedat Öktem1
1
Division of Pediatric Pulmonology, Medipol University, Istanbul, Turkey
2
Department of Pediatrics, Medipol University, Istanbul, Turkey
A two month-old boy who was admitted to the hospital with the complaints of cyanosis and feeding
difficulty and he was diagnosed as Pierre Robin sequence. The patient who had frequent respiratory
distress and established respiratory failure had to undergo intermittent nasal CPAP or assisted
ventilation. Flexible bronchoscopy was performed for evaluation of the respiratory tract in the
patient who had difficulty in weaning from mechanical ventilation. Nasopharyngeal airway was
performed to ensure airway safety in the patient who had severe laryngomalacia. Because of the
respiratory distress did not resolve, we decided to perform mandibular distraction osteogenesis and
tracheostomy. Difficulty of feeding was improved after 11th day of mandibular distraction
osteogenesis. Computerized tomography (Figure 1) revealed an adequate airway; therefore
tracheostomy was closed at 18th day. The distractors were removed two months after ossification
of callus formation. We did not observe any complications during the surgery or post-operative
follow-up visits. Mandibular distraction osteogenesis can be used as an alternative treatment in
Pierre Robin syndrome patients who underwent tracheostomy.
Keywords: Pierre Robin, Mandibular Distraction Osteogenesis
Nasopharynx CT
P337[Pediatric Pulmonology]
The role of personal allergy history in bronchial asthma evolution in
schoolchildren from different habitual conditions
Svetlana Sciuca, Grigore Friptuleac, Rodica Selevestru, Angela Cazacu Stratu
State Medical and Pharmaceutical University
Aim. To assess the impact of risk factors on bronchial asthma (BA) in schoolchildren from different
habitual
conditions
Materials and methods. The study included 87 schoolchildren with BA from habitual unfavorable
conditions and 35 unexposed children. Habitual conditions were evaluated by determining the
values of relative humidity (RH%), temperature (t°C), and the concentration of carbon dioxide
(CO2). Quantitative and qualitative measurements were made with Air Quality Monitor 5000 device
(USA).
Results. Schoolchildren with BA had high frequency of comorbidity with chronic diseases: atopic
dermatitis (AD) in 71.3%:95%CI, 54.4-86.6, allergic rhinitis (AR) 56.6%:95%CI, 48.3-66.1,
adenoids
in
19.7%:95%CI,
13-27.8
cases.
Habitual unfavorable conditions caused an increase in chronic diseases in 81.6%: 95%CI, 77.585.7 cases, compared with 68.6%:95%CI, 60.7-76.5 children form favorable residential conditions.
AR was diagnosed in 60.9% schoolchildren from unfavorable conditions, compared with 45.7%
children from favorable habitual conditions. AD was 2 times more frequently found in children with
BA living in residential unfavorable conditions (25.6%:95%CI, 20.8-30.4 vs 11.4%: 95%CI, 5.916.9). Association of AR and AD in children with BA was observed more frequently in patients from
compromised residential conditions (10.3%: 95%CI, 7-13.6 vs 8.6%:95%CI, 3.8-13.4). Adenoids
were estimated in 23% children from unfavorable habitual conditions and only in 11.4% not
exposed
children.
Conclusions. Personal allergic history in interaction with habitual risk factors leads to the
progression of symptoms and persistence of bronchial obstruction in children with BA.
Keywords: asthma, schoolchildren, risk factors
P338[Pediatric Pulmonology]
The characteristics of our patients with cystic fibrosis
Sevgi Pekcan, Aslıhan Adabalı, Meltem Energin
Necmettin Erbakan Üniversity, Meram School of Medicine, Pediatric Department
Cystic Fibrosis referred to as autosomal recessive, more common in Caucasians, is a multisystem
disease involving multiple systems. 1/2000-2500 rate is seen all over the world. In our country,
the frequency is around 1/3,000. Recurrent respiratory tract infections, growth retardation,
diarrhea polyps and sinusitis are the most common causes of infertility.
Working with our faculty we have followed 64 children with a diagnosis of cystic fibrosis patients
were studied. Defining characteristics for these children, gender, frequency distributions, were
analyzed separately. 50% of the children in the patient group(32) consisted of boys, however,
50%(32) is composed of girls. 37.9% of our patients' s in consanguinity. The patients were
followed in 21% o (12) had a history of similar siblings.. The earliest age at diagnosis of our
patients, 7 days, later age at diagnosis was 20 years. the average age at diagnosis was found to be
25 months. The most common presenting complaints of the patients, 28% weight gain (16),
followed by 26.3%(15) for the cough. 21% of frequent infections, vomiting, diarrhea 15.7%,
malaise, anorexia 12.2%, respectively. Our patients first arrival of the findings meconium ileus
8.7%(5), sibling history were 21%(12), psödobartter is 45.4%, pulmonary findings of 40%(23),
growth retardation was 44.8%(13) ratio was determined. A minimum of 4 months of age at first
reproduction pseudomonas, has a maximum age of 17. 47 patients in 15(31.9%) were detected
bronchiectasis. our patients, 86% regular follow-up.
This shows that our patients receive early diagnosis.
Keywords: cystic fibrozis, child, follow-up
P339[Pediatric Pulmonology]
The Importance Of Bronchoscopy In Patients With Respiratory Problems
During Neonatal Period
Tuba Koçkar, Sedat Öktem
Division of Pediatric Pulmonology, Medipol university, Istanbul, Turkey
AIM: The aim of the study was importance of bronchoscopic evaluation in patients with respiratory
distress in the neonatal period.
MATERIALMETHODS: Bronchoscopy was performed in 18 patients who were followed neonatal intensive care
unit between December 2012 - January 2014. The data obtained from these patients were
evaluated retrospectively.
RESULTS: Ten out 0f the patients are males and 8 females, median weight 3000 g (1150-3740),
median gestational weeks 38 (29-40 weeks). Thirteen (72.2%) patient were operated for
congenital heart disease. Bronchoscopy was performed for due to the inability to be extubated,
persistent atelectasis and pneumonia, sitridor, 9 (52.8%), 5 (27.7%), 4 (22.2%) respectively.
Pulsatile airway pressure were seen in 5 out of operated patients. Laryngomalacia and
tracheomalasia, laryngomalacia and bronchomalacia, tracheomalacia and bronchomalacia,
laryngomalacia+tracheomalacia+bronchomalacia, only bronchomalacia, only laryngomalacia and
only tracheomalasia was determined in flexible bronchoscopy, 3, 3, 2, 1, 3, 3 and 2 respectively.
Tracheostomy were performed in 8 cases (44.4%). Six of these patients were removed from the
ventilator after 1, 16, 18, 34, 52 and 113 days. One out of patients were intubated and one were
referred to other centers.
Thirteen of which (72.2%) were discharged on room air, 1 discharged tracheostomy with
respiratory support, 1 discharged tracheostomy with supplemental oxygen, 1 cases tracheostomy
with ventilator support in our NICU. 1 patient referred other center on tracheostomy with ventilator
support, one patient was die.
CONCLUSION: Fleksibl bronchoscopy is an important diagnostic method in patients with
respiratory distress in the neonatal period.
Keywords: neonatal period, respiratory problems, bronchoscopy
P340[Pediatric Pulmonology]
Two cases: Foreign bodies that have not diagnosed early
Ahmet Sızlanan, Serdar Monis, Ali Bırak, Serdar Onat, Refik Ülkü
Dicle University, Faculty of Medicine, Department Of Thoracic Surgery, Diyarbakir
Aİm: Our aim is to present two cases. These cases were underwent lung resection
due to complications because of not have diagnosed early.
Case 1: A 18 years old man was admitted for hemoptysis. Thorax CT revealed bronchiectasis in left
lower lobe. Left lower lobectomy was performed. Wheat ear was seen in parenchyma.
Case2: A19 years old woman was admitted for bronchiectasis.Right lower lobectomy was
performed and bone pieces were detected in lower lobe bronchus.
CONCLUSION: Bronchoscopy must be performed in case of suspicion of aspiration of foreign body.
Keywords: foreign body, bronchoscopy, lung resection
P341[Pediatric Pulmonology]
Evaluation of Pediatric Bronchoscopy Results
Selim Asaroğlu1, Sedat Öktem2, Saniye Girit1, Yasemin Akın1
1
Dr Lütfi Kırdar Kartal Training and Research Hospital,Division of Pediatric Pulmonology
2
Faculty of Medicine, Division of Pediatric Pulmonology,Istanbul Medipol University
OBJECTIVE: Pediatric flexible fiberoptic bronchoscopy (FOB) the use of the nose, pharynx, larynx
and tracheobronchial tree is a diagnostic tool that allows examining.
Aim, applied to our clinic by a 2-year study retrospectively 116 cases of pediatric FOB; domestic
and overseas comparing with other published series aimed to concentrate attention on FOB.
METHODS: 1 February 2011 - 31 May 2012 between Pediatric Clinic of 116 patients with
bronchoscopy Pediatric Pulmonology Outpatient Clinic files and bronchoscopy reports were
examined.
RESULTS: Distribution of the patients, 77 (66.40 %) male and 39 (33.60 %) were females. Mean
age 33.41 ± 39.62 months in male, female patients, mean age of 48.89 ± 47.62 months, mean
age 38.62 ± 42.90 for the entire group is months.
In our study, the indications for bronchoscopy in patients stridor in order of frequency (33%),
persistent infiltration (18%), suspected foreign bodies (11%) has created.
116 patients included in the study evaluated the bronchoscopic. The most frequently reason
laryngomalacia (28%) were found to be. Other diagnoses in order of frequency in airway stenosis
or edema, bronchial purulent secretions, congenital anomalies, foreign body aspiration,
laringotrakeomalazi, the mucus plug, endobronchial tuberculosis, airline extrinsic compression,
mucosal inflammation were found. While 17 % of patients with normal bronchoscopic findings were
observed.
CONCLUSION: FOB pediatric patients with respiratory findings made with many indications is a
valuable diagnostic and treatment methods. Preparation before the procedure, anesthesia
monitoring during this procedure done in the environment and a team of trained reliability is quite
high.
Keywords: fiberoptic bronchoscopy, Child
P342[Pediatric Pulmonology]
A patient's lung mass with Epidermolysis bullosa: Ewing's sarcoma
Saniye Girit1, Ömür Akınel1, Yasemin Akın1, Gülnur Tokuç2
1
Dr Lütfi Kırdar Kartal Training and Research Hospital,Division of Pediatric Pulmonology
2
Marmara University Faculty of Medicine, Dept. of Pediatric Oncology
INTRODUCTION: Ewing's sarcoma is the most common malignant bone tumor of childhood.
Cases with Ewing's sarcoma may present with intermittent fever and localized pain. Epidermolysis
Bullosa (EB) is being monitored 9 years old boy.
CASE: Nine-year-old patient with EB admitted with intermittent fever a week and with chest pain.
Body temperature: 36,8 Co., pulse 146/minute, breath count 30/minute, including widespread in
the body bullosa - crusted lesions.
The left hemithorax breath sounds on the right decreased compared, bilateral coarse breath sounds
were evaluated. Laboratory tend to perceive the Hb, 8.3 g / dl, WBC 15000/mm3, ESR: 61mm / h,
CRP 184 mg / L, chest X-ray of the left lung, covering all increased consolidation was seen. The
patient with pneumonia treatment followed by acute phase reactants returned to normal. Chest xray checks covering the left lung and parenchymal consolidation is reduced and normally leave the
place was observed. However, in the left middle mediastinum border zone appears regularly on the
determination of the mass image taken with the patient in CT of solid heterogeneous character,
round, was seen. Fine-needle aspiration biopsy was reported as pathologically Ewing's Sarcoma.
RESULT: In patients with EB has increased risks Squamous cell cancer and malignant melanoma
but have not been reported association of Ewing's sarcoma. With clinical symptoms of pneumonia
on chest radiographs of patients treated persevering, especially smooth-edged lesions should be
investigated and the possibility of rare tumors should be considered.
Keywords: Ewing's sarcoma, pneumonia, Epidermolysis Bullosa
P343[Pediatric Pulmonology]
Congenital tuberculosis; a case report
Velat Şen1, Fesih Aktar2, Ünal Uluca2, Müsemma Karabel1, Mehmet Fuat Gürkan1
1
Department of pediatric pulmonology, Dicle University, Diyarbakir
2
Department of pediatrics, Dicle University, Diyarbakir
Congenital tuberculosis (CT) is a rare disease and the mortality is very high. The diagnosis of
disease is often difficult as clinical signs are nonspecific. CT is considered to result from vertical
transmission of infection from placenta to fetus aspiration of amniotic fluid or maternal blood by
the fetus during delivery leading to tuberculosis.
A 31-year-old, gravida 4, woman delivered a male infant. A two-month-old male baby born at full
term, weighing 2600 g, presented with symptoms including weight loss, fever, cough, hemoptysis
and respiratory distress was referred to our hospital. On physical examination; fever: 38.6 ° C,
pulse: 164/min, respiration rate was 62/min. The patient's had significant tachypnea, dyspnea,
subcostal and intercostal retractions. On auscultation bilateral diffuse crackles and rhonchi were
heard. The complete blood count showed a total white cell count of 23.1 109 per l, hemoglobin of
7.9 g per 100 ml and a platelet count of 601 109 per l. The CRP was 7.7 mg/dl and ESR was 41
mm/h. The chest X-ray (CXR) showed a consolidation with a cavitary lesion in the left upper/mid
zones. Contrast-enhanced computed tomography(CECT) showed consolidation with air
bronchograms and cavitation in the left upper lobe. The tuberculin test was negative while the
broncho alveolar lavage for AFB was positive. The patient was diagnosed with congenital
tuberculosis. Thereafter, antituberculosis therapy was added to nonspecific therapy.
We should to emphasize that infants who present with pneumonia not responding to antibiotics,
the possibility of congenital tuberculosis should be kept in mind.
Keywords: tuberculosis, congenital
P344[Pediatric Pulmonology]
Relationship between chronic pulmonary disease and depression in children
Mahmut Altuntaş1, Velat Şen2, Sevi Kelekçi2, Ünal Uluca1, Müsemma Karabel2, Fesih Aktar1,
Mehmet Fuat Gürkan2
1
Department of pediatrics, Dicle University, Diyarbakir
2
Department of pediatric pulmonology, Dicle University, Diyarbakir
INTRODUCTION: Along with the developments in medicine, life quality and lifelength of patients
with childhood chronic diseases have increased. In this study, frequency of depressive findings
accompanied by chronic lung disease of childhood and adolescence is examined.
METHODS: Study has been carried out in Dicle University, between June 2013 and November
2013 among 83 patients (25 asthma, 25 bronchiectasis, 25 tuberculosis and 8 cystic fibrosis).
Children’s Depression Scale (CDS) defined by Kovacs was performed to identify depression
condition.
RESULTS: 113 cases (83 patients, 30 control) have been included to our study. There is no
difference between study and control group in terms of gender and age. When CDS point average
of patient and control cases are compared, it is seen that CDS point average of patients is 6.72
+5.638, CDS point average of control group is 3.37+3.518. When CDS point average of patients
and control groups are compared, it has been found out that there is a statistically significant
relationship (p<0.001). It is found out that there is a significant relation between CDS point
average of patients and success in school, social adaptation and adherence to treatment
(p<0.001).
CONCLUSION: It is seen that in our study group, depression risk is higher in children with
asthma, cystic fibrosis and bronchiectasis but this increase is not discovered in children with
tuberculosis. Children with chronic lung disease whose depression risk is high should be assesed
and followed psychiatrically before their success in school, social adaptation and adherence to
tratment have been effected.
Keywords: Chronic, lung, child, depression, scale,
P345[Pediatric Pulmonology]
Surgical management of pulmonary hydatid cysts in children
Serdar Onat, Refik Ülkü, Ahmet Sızlanan, Serdar Monis, Ali Bırak
Dicle University Faculty of Medicine Department of Thoracic Surgery Diyarbakir,Istanbul
OBJECTIVE: Hydatid disease is a parasitic infestation caused by Echinococcus. It is endemic in our
country. This disease occurs in all age groups..
METHOD: The medical records of pediatric patients treated for pulmonary hydatid cysts in our
clinic were analyzed retrospectively.
RESULTS: Between 2000 and 2013,129 pediatric patients with pulmonary hydatid cysts were
operated. There were 80 boys and 49 girls (ages, 3-17, mean age 12.2 years). The symptoms,
localizations, radiologic findings, operative procedures, and complications, were analyzed. The most
frequent complaints were dyspnea (53%), cough (46%), and chest pain (38%). In 61patients cysts
were located in right lung and 51 in left lung. 17 patients had bilaterally lesions. Cystotomy and
capitonnage was the most common method.
CONCLUSION: Our conclusion is that hydatid cysts of the lung must be managed surgically in
children.
Keywords: lung,hydatid cyst, pediatric
P346[Pediatric Pulmonology]
Surgical approach to Jeune Syndrome
Ebru Türkoğlu1, Uğur Temel2, Sedat Ziyade3, Aslan Babayiğit1, Mesut Dursun1, Umut Zubarioğlu1,
Sinan Uslu1, Ali Bülbül1
1
Şişli Etfal Training and Research Hospital, Neonatology, İstanbul
2
Şişli Etfal Training and Research Hospital, Thoracic Surgery, İstanbul
3
Bezmialem Vakıf University, Faculty of Medicine Thoracic Surgery Departmant, İstanbul
INTRODUCTION: Jeune Syndrome is a rare skeletal dysplasia with a narrow and bell-shaped
thorax and pelvic bone deformities. Respiratory distress and recurrent infections are the main
reasons of mortality. We report a 12 days-old age case diagnosed as Jeune Syndrome and
operated using a rare method with external fixators for sternoplasty.
CASE: A 4kg male neonate was interned and intubated because of a serious respiratory distress. A
narrow and bell-shaped thorax, short and linear-shaped ribs with enlargement at their edges,
shortening of major bones, metaphysis enlargement and acetabular dysplasia were detected at his
radiogram. Jeune Syndrome was thought with clinical and radiological findings. Because of the
small thoracic cavity alveolary ventilation was seriously decreased and due to the limited thorax
expansion capacity respiratory distress was significant. Sternoplasty with external fixator
distraction was performed and fixators were enlarged as 1mm each day for increasing thoracic
expansion capacity. A totally sternal distraction of 3cm was carried finally and mechanical
ventilation rates were progressively decrased. External fixators were taken out at 10th week and
the patient is still in his postnatally 6th month follow up.
DISCUSSION: Jeune Syndrome is usually related with mortality at neonates. Sternoplasty, rib
distraction and laterally thorax enlargement to obtain enough lung expansion are rarely reported
surgical methods and can be life-saving for neonates born with this kind of congenital pathologies.
Keywords: Jeune Syndrome, sternoplasty
Figure 2
After extraction of the fixator at postnatal 134th day
Figure 1
External fixation at postnatal 34th day
P347[Pediatric Pulmonology]
Appendix localized gastrointestinal tuberculosis;a case report
Velat Şen1, Ünal Uluca2, Müsemma Karabel1, Fesih Aktar2, Selda Erdinç2, Mehmet Fuat Gürkan1
1
Department of pediatric pulmonology, Dicle University, Diyarbakir
2
Department of pediatrics, Dicle University, Diyarbakir
Tuberculosis is a major health problem in undeveloped and developing countries. Gastrointestinal
tuberculosis is rare in children. It develops with swallow of smear positive sputum or activation of
bacilli spreading from the first infection. It is most frequently occurs in the ileocecal region.
CASE: A five-years old girl was operated with diagnosis of acute appendicitis after abdominal pain,
fever, vomiting complaints. The patient was followed upon caseating granulomatous appendicitis
reported as a pathology report and to be seen of histochemical staining positive bacilli to EZN. It
was learned that her grandmother has tuberculosis and patient has history of contact with her
grandmother about three month. On physical examination the pulse 120 beats /min, fever: 38.5C,
in right submandibular areas and under the right armpit mobile lymphadenopathy 2 cm in size
were observed. Acording to laboratory tests the number of white blood cells were 31600/mm3,
hemoglobin 8.1 g / dl, platelet count 587000/mm3, the value of C-reactive protein was 19.7 mg /
dL. Chest radiographic findings were nor mal. Fasting gastric juice was received from the patient
during three days. M. Tuberculosis Complex produced in 32th day in samples that was received.
Isoniazid, rifampicin, pyrazinamide and streptomycin quadruple therapy was started due to EZNpositive bacilli in the patient's pathology report, caseating granulomatous appendicitis, history of
contact and the clinical relevance. We presented this case to emphasize that without other system
involvement tuberculosis can lead to acute appendicitis picture in children.
Keywords: Tuberculosis, childhood, acute appendicitis
P348[Pediatric Pulmonology]
Particularity bronchial foreign body aspiration in children from Republic of
Moldova
1
2
1
2
1
2
Liliana Toma , Victor Rascov , Svetlana Sciuca , Ina Garbi , Alina Starostin , Valentina Rascov ,
1
2
Valentina Mitu , Mariana Guzgan
1
2
State Medical and Pharmaceutical University, Chisinau, Moldova
Institute of Mother and Child, Chisinau, Moldova
AIM: To evaluate the frequency of foreign bodies aspirations in children from Moldova and
endoscopic
characteristics
of
local
changes
in
the
bronchial
tree.
MATERIALMETHODS: We have analyzed 151 cases of foreign body aspiration in the bronchial tree in children
with variations in age from 6 months to 7 years, during the years 2008-2013. Bronchoscopy
examination was performed with rigid bronchoscope in the endoscopic department in children with
a suggestive history of aspiration. Most children with foreign body aspiration had been hospitalized
in
the
department
of
therapeutic
profile
71.3%
cases.
RESULTS: Cases of foreign body aspiration is frequently found in children and during the last 6
years are increases with 30-35%: in 2008 and 2009 were registered 20 cases, in 2010-23 cases, in
2011 and 2012 by 30 cases, in 2013-28 cases. Maximal incidence was in the age group 1-3 years
(67.8%). Endoscopic examination in these children found signs of catarrhal endobronchitis 39.1%;
endobronchitis catarrhal-purulent and/or fibrinous 46.5%, purulent endobronchitis 11,7%.
Endoscopic changes associated with foreign bodies were identified in the 1/3cases: decubitus
lesions in 4.6% patients, formation of granular masses 17.7%, contact bleeding after extraction
16.3%. The etiological structure is represented in 82% of cases of foreign bodies of organic origin,
because Republic Moldova is an agricultural country where working with seeds.
CONCLUSION: In Moldova during the last years there has been a steady increase in the frequency
of foreign body aspiration into the airways in children, and in the causal structure predominates
foreign bodies of organic origin.
Keywords: bronchial foreign body, bronchoscopy, children
P349[Pediatric Pulmonology]
Primary ciliary dyskinesia: Retrospective Evaluation of Patients
Erkan Akkuş, Sevgi Pekcan
Department of Pediatrics, Necmettin Erbakan University, Konya, Turkey
Primary ciliary dyskinesia (Immotıle cilia syndrome, PCD) is an autosomal recessive, leading to
abnormalities in ciliary structure and function and is a rare disease in each 20,000 live births. The
most common ultrastructural electron microscopic examination of epithelial disorders is the
absence of dynein arms in cilia. In case of a part, ineffective ciliary function was observed. Result
in respiratory ciliary dysmotility, mucociliary clearance is impaired, epithelial secretions deposited
on the surface leads to bacterial infections. Due to chronic or recurrent infections bronchiectasis
occurs early.
METHOD: We presented 31 case that followed as PSD and that consisting demographic
characteristics, clinical findings and follow-up problems. Our aim in this study, the importance of
the disease, the frequency of follow-up needs to be done and in the process used to help promote
wanted to draw attention to the variability of the test.
RESULTS: Our study included 31 patients female: male 10:21, mean age was 8.2 years. 25
patients with Kartagener's syndrome (situs inversus) was diagnosed. In 20 patients had
bronchiectasis. Mean follow-up was 25.6 months. The most common clinical findings rhonchi, was
abundant mucus and postnasal drip complaints.
CONCLUSION: Primary ciliary dyskinesia diagnosed patients often have to come up with recurrent
pulmonary findings and patients with different diagnoses often are followed. In particular, thanks
to early diagnosis, chronic complications that may occur can be prevented. After receiving the
diagnosis of patients during follow-up, adequate follow-up can be lowered incidence of morbidity
and is associated with making the necessary tests suggest.
Keywords: Primer ciliary dyskinesia, Kartagener's syndrome, child
P350[Pulmonary Rehabilitation and Chronic Care]
Postoperative pulmonary complications
Azime Açar1, Şirin Akdeniz2, Hatice Kaçmaz2, Nazmiye Erbil2, Özgür Cengiz3, Abdullah Erdoğan2
1
Pediatric İntensive Care, Akdeniz University Hospital, Antalya,Turkey
2
Thoracic Surgery Department, Akdeniz University Hospital,Antalya, Turkey
3
Thoracic Surgery Department,Antalya Atatürk State Hospital,Antalya,Turkey
OBJECTIVE:
The purpose of this study was to determine the complications that occured in patients who
underwent thoracotomy and to monitor them more closely.
MATERIALSMETHODS: 100 who underwent thoracotomy were included in the study. Patients were observed
from the day of their admittance till the day of their discharge. The demographic parameters, their
diagnoses, treatments were recorded. Afterwards they were examined for pleural effusion,
atelectasie, pneumothorax, chylothorax, emphysema, air leak, pneumonia, residual pleural space,
bleeding and hemorrage in the manner of inspecation, oscultation, and drainage monitorization?.
RESULTS: 40 patients of the 100 experienced complications, 60 didn’t experience any
comptlications. 31 patients undervent wedge resection via thoracotomy,23 pateints underwent
lobectomy, 4 patients underwent pneumoectomy, 9 patients experienced decortication, 3 patients
underwent bulla resection, 3 patients underwent diaphracmatic operation. The other 21 patients
recieved different operations, via thoracotomy. Of the patients who underwent thoracotomy, 22
experienced air leaks, 5 had pneumonia, 7 had atelectasia, 2 had empyeme, 1 had broncho pleural
fistule, 1 patient had incision rupture, 1patient suffered from residual pleural space. 2 had
bleeding, 5 experienced dispnea, 2 had wound infections, 1 patiend suffered from shilothorax, 1
patient experienced emphysema.
CONCLUSION: It has been observed that in the early duration of the post operative stage
pulmanry and extra pulmonary complications occured. For these reasons patients who undergo
throacotomy for what ever reason should be followed up more closely for better health and life
quality.
Keywords: thoracotomy, thoracotomy complications
P351[Pulmonary Rehabilitation and Chronic Care]
Effect of Upper Extremity Training on Respiratory Muscle Strength and
Activities of Daily Living in Patients with Chronic Obstructive Pulmonary
Disease
Ebru Çalık Kütükcü1, Hülya Arıkan1, Çiğdem Öksüz2, Naciye Vardar Yağlı1, Melda Sağlam1, Deniz
İnal İnce1, Tülin Düger1, Sema Savcı3, Ayşenur Karaman1, Lütfi Çöplü4
1
Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and
Rehabilitation,Ankara.
2
Hacettepe University, Faculty of Health Sciences, Department of Ergotherapy, Ankara.
3
Dokuz Eylül University, School of Physiotherapy and Rehabilitation, Izmir.
4
Hacettepe University, Faculty of Medicine, Department of Chest Medicine, Ankara.
Introduction and AIM: Because of the use of accessory respiratory muscles during arm exercises, it
reduces these muscles’ contribution to the ventilation and increases the workload of the diaphragm
in patients with COPD. The aim of this study was to investigate the effect of upper extremity
strength training on respiratory muscle strength and activities of daily living (ADL) in patients with
COPD.
MATERIALSMETHODS: Seventeen COPD patients (13 men, 4 women, mean FEV1 = 45.9 ± 14.6%) were
included in the study. Respiratory muscle strength and ADL (ADL simulation test) were evaluated.
Respiratory frequency, heart rate and oxygen saturation, dyspnea perception were assessed before
and after ADL test. and the number of cycles (erasing board, washing dishes, removing weights,
inserting and removing lights) completed in 10 min during GYA test were recorded. Upper
extremity muscle strength training was given to patients at 40 to 50% of 1RM in 8-12 repetitions
for a total of 23 sessions (8 weeks).
RESULTS: MIP values and number of cycles in ADL simulation test of patients were significantly
increased with upper extremity training (p=0.045, p=0.001 respectively). Dyspnea perception
levels during ADL test were significantly reduced after training (p = 0.021).
CONCLUSION: Upper extremity muscle training increases inspiratory muscle strength and
positively affects performance during ADL in patients with COPD. Potentially positive effects of
upper extremity training should be considered especially in pulmonary rehabilitation programs of
patients who have difficulty because of dyspnea during ADL using upper extremities and should be
included in the program.
Keywords: COPD, strength training, activities of daily living, dyspnea, respiratory muscle strength
P352[Pulmonary Rehabilitation and Chronic Care]
The effects of inspiratory muscle training on pulmonary artery pressure,
respiratory and peripheral muscle strength in pulmonary hypertension
Melda Sağlam1, Hülya Arıkan1, Naciye Vardar Yağlı1, Ebru Çalık Kütükcü1, Deniz İnal İnce1, Sema
Savcı2, Ali Akdoğan3, Mehmet Yokuşoğlu4, Lale Tokgözoğlu5
1
Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and
Rehabilitation,Ankara.
2
Dokuz Eylul University, School of Physiotherapy and Rehabilitation, Izmir
3
Hacettepe University, Faculty of Medicine, Department of Internal Medicine, Unit of Rheumatology,
Ankara
4
Gülhane Military Medicine Academy, Department of Cardiology, Ankara
5
Hacettepe University, Faculty of Medicine, Department of Cardiology, Ankara
BACKGROUND-AIM: No information is known about the effect of inspiratory muscle training (IMT)
in patients with pulmonary hypertension (PHT). The purpose of this study was to investigate the
effects of IMT on pulmonary artery pressure, respiratory and peripheral muscle strength in patients
with PHT.
METHODS: Twenty-nine clinically stable PHT patients (mean age: 49.7±12.4 years, mean
pulmonary artery pressure: 85.2±27 mmHg) were included in this study. These patients were
randomly assigned to training (14 patients) or to control (15 patients) groups. IMT was performed
using threshold loaded device at 30% of maximal inspiratory pressure (MIP), 30 min/day for 6
weeks. At baseline and the end of six weeks, pulmonary artery pressures of all patients were
measured with by echocardiography. Respiratory muscle strength (MIP, maximal expiratory
pressure-MEP) and peripheral muscle strength (knee extensors, shoulder abductors and hand grip
strength) were assessed.
RESULTS: There were significant improvement in MIP, MEP, knee extensors, shoulder abductors
and hand grip strength after 6 weeks IMT training (p<0.05). At the end of IMT training, although
there is no change in pulmonary artery pressure in the training group, there was significant
increase in control group when difference values were compared (p<0.05).
CONCLUSION: The IMT increases respiratory and peripheral muscle strength in patients with PHT.
IMT may prevent from worsening in pulmonary artery pressure. IMT can safely use in PHT and take
place in the treatment of PHT due to positive effects.
Keywords: Inspiratory muscle training, pulmonary hypertension, respiratory muscle strength
P353[Pulmonary Rehabilitation and Chronic Care]
Effect of Core Stabilization Training on Functional Capacity, Peripheral
Muscle Strength and Endurance in Children with Bronchiectasis
Naciye Vardar Yağlı1, Melda Sağlam1, Ebru Çalık Kütükcü1, Deniz İnal İnce1, Hülya Arıkan1, Nural
Kiper2
1
Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and
Rehabilitation,Ankara.
2
Hacettepe University, Faculty of Medicine, Department of Pediatry, Unit of Pediatric Chest
Diseases, Ankara.
Introduction and AIM: Core stability training includes the exercise associated with the prior
activation of the local trunk muscles and should be advanced to include more intricate static,
dynamic, and functional exercises that involve the coordinated contraction of spinal muscles.The
aim of this study was to investigate the effect of core stabilization training on functional capacity,
respiratory and peripheral muscle strength in patients with bronchiectasis.
MATERIALSMETHODS: 10 patients with bronchiectasis (mean age:14.6±3.72 years) were included in the
study. Core stabilization training was applied for 3 days a week during 4 weeks for 1 hour which
included mat, swissball and theraband exercises. Functional capacity was evaluated with 6 minute
walk test (6MWT). Peripheral muscle strength (shoulder abductos, hand grip, knee extansors) was
assessed with digital dynamometer. Peripheral muscle endurance was evaluated with sit-ups and
squats tests.
RESULTS: 6 MWT distance were significantly increased after stabilization training (p< 0.01).
Dyspnea and leg fatigue perception were significantly reduced after training (p< 0.01). There was
found significant increases in patients’ peripheral muscle strength (p< 0.01). In addition, the
repetition numbers of sit-ups and squats were significantly increased (p< 0.01).
CONCLUSION: As a result of short term stabilization exercises improves functional exercise
capacity, peripheral muscle strength and endurance in children with bronchiectasis. Stabilization
exercises’ location on pulmonary rehabilitation should be investigated with planning researchs
which are done with a sufficient number of patients, compares the control group with other
exercise modalities and examines long-term effects.
Keywords: Bronchiectasis, stabilization training, peripheral muscle strength
P354[Pulmonary Rehabilitation and Chronic Care]
Comparison of Respiratory Muscle Strength, Dyspnea and Depression in
Patients with Interstitial Lung Disease with and without Severe Fatigue
Burcu Camcıoğlu1, Meral Boşnak Güçlü1, Müşerrefe Nur Karadallı1, Zeynep Arıbaş1, Gülşah Barğı1,
Nurdan Köktürk2, Haluk Türktaş2
1
Gazi University Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation,
Ankara
2
Gazi University Faculty of Medicine, Department of Chest Medicine, Ankara, Turkey.
BACKGROUND and AIM: Complaint of generalized fatigue is highly reported in patients with
interstitial lung disease (ILD) and constitutes the most frequent symptom. Comparison of
respiratory muscle strength, dyspnea and depression in patients with ILD with/without severe
fatigue has not been investigated so far. We aimed to compare pulmonary functions, respiratory
muscle strength, dyspnea and depression in patients with ILD with/without severe fatigue.
METHODS: Forty one patients with ILD were included. Severe fatigue was classified according to
Fatigue Severity Scale (FSS>=36 point). Twenty-eight patients (8M/20F, 47.85±10.44 years,
DLCO: 80.37±18.28%) with and 13 patients (6M/7F, 45.38±9.09 years, DLCO: 80.45±16.59%)
without severe fatigue were evaluated. Pulmonary functions were evaluated using spirometry,
respiratory muscle strength (MIP, MEP) using a mouth pressure device, dyspnea using Modified
Medical Research Council (MMRC) dyspnea scale and depression using Montgomery–Åsberg
Depression Rating Scale (MADRS).
RESULTS: Baseline demographic characteristics, pulmonary functions and DLCO were similar in
groups (p>0.05). Severe fatigue were prevalent in 68.29% of the patients and MIP (p=0.05) were
significantly lower, MMRC (p=0.01) and MADRS scores (p=0.009) were significantly higher in
patients with severe fatigue compared with others.
CONCLUSION: Patients with interstitial lung disease with severe fatigue have worse inspiratory
muscle strength and increased dyspnea perception and depression compared to patients without
fatigue with similar pulmonary functions. Pulmonary rehabilitation programs should include routine
fatigue evaluation and alleviation approaches in terms of inspiratory muscle and exercise training.
Keywords: fatigue, interstitial lung disease, respiratory muscle strength
P355[Pulmonary Rehabilitation and Chronic Care]
Respiratory and Peripheral Muscle Strength, Fatigue, Quality of Life and
Physical Activity Levels in Patients with Early Stage of Sarcoidosis with
Resting Dyspnea
Müşerrefe Nur Karadallı1, Meral Boşnak Güçlü1, Burcu Camcıoğlu1, Zeynep Arıbaş1, Gülşah Barğı1,
Nurdan Köktürk2, Haluk Türktaş2
1
Gazi University Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation,
Ankara
2
Gazi University Faculty of Medicine, Department of Chest Medicine, Ankara, Turkey.
BACKGROUND and AIM: Systemic and metabolic factors contribute abnormal respiratory functions,
respiratory and peripheral muscle weakness and dyspnea in sarcoidosis. However, pulmonary
functions, respiratory and peripheral muscle strength, fatigue, quality of life and physical activity
levels in patient with sarcoidosis with/without resting dyspnea have not been compared so far. We
aimed to compare the pulmonary functions, respiratory and peripheral muscle strength, fatigue,
quality of life and physical activity levels in patient with sarcoidosis with/without resting dyspnea.
METHODS: Fourteen patients with (46.50±12.03 years, 11F/3M) and 17 patients without resting
dyspnea (45.88±9.72 years, 10F/7M) were evaluated. Patient demographics were recorded.
Pulmonary functions and pulmonary diffusing capacity (DLCO) were measured. Respiratory muscle
strength (MIP, MEP) was performed using a mouth pressure device, hand grip muscle strength
using a dynamometer, fatigue using Fatigue Severity Scale (FSS), quality of life using Saint
George’s Respiratory Questionnaire (SGRQ) and physical activity levels using International Physical
Activity Questionnaire (IPAQ-SF).
RESULTS: Demographic characteristics, respiratory muscle strength, pulmonary functions,
predicted DLCO and physical activity total scores were similar in groups (p>0.05). Patients’
%45.16 had dyspnea at rest. Hand grip muscle strength were lower (p=0.019), FSS (p=0.02) and
SGRQ (p=0.039) scores were significantly higher in patient with resting dyspnea.
CONCLUSION: Patients with early stage of sarcoidosis with resting dyspnea have lower peripheral
muscle strength, higher fatigue perception and worse quality of life compared to patients without
resting dyspnea with similar pulmonary functions, respiratory muscle strength and physical activity
levels. Effects of pulmonary rehabilitation should be investigated in patients with sarcoidosis.
Keywords: dyspnea, quality of Life, sarcoidosis
P356[Pulmonary Rehabilitation and Chronic Care]
Effects of Inspiratory Muscle Training on Maximal Exercise Capacity, Muscle
Strength, Fatigue, Depression and Quality of Life in Patients with
Sarcoidosis
Müşerrefe Nur Karadallı1, Meral Boşnak Güçlü1, Burcu Camcıoğlu1, Zeynep Arıbaş1, Gülşah Barğı1,
Nurdan Köktürk2, Haluk Türktaş2
1
Gazi University Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation,
Ankara, Turkey
2
Gazi University Faculty of Medicine, Department of Chest Medicine, Ankara, Turkey.
BACKGROUND and AIM: Reduced respiratory muscle strength and exercise capacity were reported
in patients with sarcoidosis. However, the effects of inspiratory muscle training (IMT) on maximal
exercise capacity, respiratory and peripheral muscle strength, fatigue, depression and quality of life
have not been investigated so far.We aimed to investigate the effects of IMT on maximal exercise
capacity, respiratory and peripheral muscle strength, fatigue, depression and quality of life in
patients with sarcoidosis.
METHODS: A prospective, randomized controlled, double–blinded study. Fifteen patients
(45.06±8.06 years) received IMT (40% of MIP), and 15 patients (47.46±12.89 years) received
sham (5% of MIP) for 6 weeks. Maximal exercise capacity was evaluated using Modified
Incremental Shuttle Walk Test (ISWT), respiratory muscle strength (MIP, MEP) using mouth
pressure device, peripheral muscle strength using dynamometer, fatigue using Fatigue Severity
Scale, depression using Montgomery Asberg Depression Rating Scale (MADRS) and Quality of life
using Saint George’s Respiratory Questionnaire (SGRQ).
RESULTS: Baseline characteristics were similar in groups (p>0.05). Modified ISWT distance, MIP,
MEP, severe fatigue perception were significantly improved in the IMT group compared with sham
group. Modified ISWT distance and quadriceps femoris muscle strength improved within IMT group
(p<0.05). MIP, MEP, MADRS and SGRQ total scores were significantly improved within groups
(p<0.05).
CONCLUSION: Inspiratory muscle training improves maximal exercise capacity, respiratory
muscle strength and fatigue perception in patient with sarcoidosis. A six week IMT may not be
enough to improve depression, quality of life and peripheral muscle strength. IMT is safe and
should be included effectively in pulmonary rehabilitation programs.
Keywords: inspiratory muscle training, maximal exercise capacity, sarcoidosis
P357[Pulmonary Rehabilitation and Chronic Care]
The Relationship Between The Peripheral And Respiratory Muscle Strength
With Functional Capacity In Patients With Pulmonary Arterial Hypertension
Sema Savcı1, Serap Acar1, Buse Özcan1, Didem Karadibak1, Bahri Akdeniz2, Ebru Özpelit2, Can
Sevinç3
1
Dokuz Eylul University, School of Physical Therapy and Rehabilitaiton, İzmir
2
Dokuz Eylul University, Medicine Faculty, Department of Cardiology, İzmir
3
Dokuz Eylul University, Medicine Faculty, Department of Chest Disease, İzmir
OBJECTIVE: The aim of this study was to investigate the relationship between the peripheral and
respiratory muscle strength with functional capacity in patients with pulmonary arterial
hypertension.
METHODS-MATERIALS: Demographic variables, peripheral muscle strength, respiratory muscle
strength and exercise capacity were measured. Handgrip for grip strength and hand-held
dynomometer for lower extremity was used for the assessments. Respiratory muscle strength was
assessed by inspiratory muscle testing device. Exercise capacity was measured by cycle ergometry
test. Respiratory functions were measured during cycle ergospirometry test. The realtionship
between peripheral and respiratory muscle strength and functional capacity was evaluated with
Pearson Correlation Test.
RESULTS: According to the Pearson Correlation analysis Quadriceps Femoris muscle strength (p =
0.03, r= 0.675 R, p = 0.03, r= 0.671 L), handgrip strength (p = 0.02, r = 0.696 R, p = 0.011, r =
0.597 L) and maximal expiratory pressure (p = 0.01, r = 0.696) were positively correlated with
functional capacity.
CONCLUSION: Peripheral and expiratory muscle strength affects functional capacity in patients
with pulmonary arterial hypertension. As a result of this, it is adviced containing peripheral and
respiratory muscle strengthening programme in rehabilitation programmes for improving functional
capacity in PAH patients.
Keywords: Pulmoner arterial hypertension, muscle strength, functional capacity
P358[Pulmonary Rehabilitation and Chronic Care]
The Relationship Between Field And Laboratory Exercise Tests In Patients
With Pulmonary Arterial Hypertension
Serap Acar1,
Sevinç3
1
Dokuz Eylul
2
Dokuz Eylul
3
Dokuz Eylul
Sema Savcı1, Didem Karadibak1, Buse Özcan1, Bahri Akdeniz2, Ebru Özpelit2, Can
University, School of Physical Therapy and Rehabilitaiton,İzmir
University, Medicine Faculty, Department of Cardiology, İzmir
University, Medicine Faculty, Department of Chest Disease, İzmir
OBJECTIVE: The aim of this study was to investigate the relationship between the field and
laboratory exercise testing in patients with pulmonary arterial hypertesion.
METHODS-MATERIALS: Exercise capacity was tested by 6 Minute Walk Test and cycle ergometry
test. The relationship between the estimated oxygen consumption and measured oxygen
consumption was test with Pearson Correlation Test.
RESULTS: Walking distance and estimated VO2peak was correlated with measured oxygen
consumption (p =0.00 r = 0.881), maximal work load during cycle ergospirometry test (p =0.00,
r= 0.836) and maximal heart rate during cycle ergospirometry test (p = 0.05, r =0.684).
CONCLUSION: 6 minute walk test may be used equally in order to indicate the exercise capacity
as well as cycle ergometry exercise tests in patients with pulmonary arterial hypertension.
Keywords: Pulmonary arterial hypertension, 6 minute walk test, exercise testing
P359[Pulmonary Rehabilitation and Chronic Care]
Evaluation of Balance and Investigation of its Influences in Patients with
Chronic Obstructive Pulmonary Disease (COPD)
Serap Acar1, İsmail Özsoy1, Buse Özcan1, Sema Savcı1, Atilla Akkoçlu2, Sevgi Özalevli1
1
Dokuz Eylul University, School of Physical Therapy and Rehabilitation, İzmir
2
Dokuz Eylul University, Medicine Faculty, Department of Chest Disease, İzmir
Introduction and
OBJECTIVE: It has been reported in recent studies that balance disorders and fall risks increases
in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to
determine the risk of falling, balance exposure and related factors in patients with COPD.
MATERIALSMETHODS: Fourteen patients with COPD (mean age: 66.64 ± 9.22 years) and sixteen healthy
individuals (mean age: 69.43 ± 4.88 years) were studied. Pulmonary function test was performed.
Exercise capacity was assessed with 6 Minute Walk Test (6MWT) and history of falls was
questioned. Balance was evaluated with Berg Balance Test and Neurocom Balance Master System.
Quadriceps muscle strength was measured by hand-held dynomometer.
RESULTS: Pulmonary function test values and walking distances of COPD patients were
statistically significantly lower than the healthy subjects (p < 0.05). Diastolic blood pressure and
peripheral oxygen saturation changes during 6MWT was higher to the detriment of COPD patients
compared to helathy individuals (p < 0.05). Fall incidance for the past year was statistically
significantly higher in the COPD group (p < 0.05). The balance test results of the both groups and
reaction time values which was obtained from the limits of stability test, were statistically
significantly different (p <0.05).
CONCLUSION: Because of impaired respiratory and cardiac function, inactivity and poor muscle
strength it is thought that the result of longer reaction time in patients with COPD compared to
helathy individuals affects the balance and improves the fall risk.
Keywords: Chronic obstructive pulmonary disease, fall, balance
P360[Pulmonary Rehabilitation and Chronic Care]
Assessment Of The Relationship Between Stage of Disease And Physical
Function On COPD Patients
Orçin Telli Atalay1, Uğur Yanbal2, Atiye Kaş2, Harun Taşkın1, Berna Öztürk3, Ali İhsan Yıldız4
1
Department of General Physical Therapy And Rehabilitation, School Of Physical Therapy And
Rehabilitation, Pamukkale University,Denizli,Turkey
2
Department of Physical Therapy And Rehabilitation,Instutue Of Health Sciences,Pamukkale
University,Denizli, Turkey
3
Department of Pulmonary Diseases,Denizli State Hospital,Denizli,Turkey
4
Department of Pulmonary Diseases,Servergazi State Hospital,Denizli,Turkey
OBJECTIVE: COPD leads to many systemic diseases beside respiratory difficulty and repeated
infections. Progressive airway obstruction, chronic hypoxia and other related conditions may cause
disability as a result of progressive muscle weakness and decrease in physical functions. The aim of
this study was to assess the relationship between stage of disease and physical functions on COPD
patients.
METHODS: Eighty-two COPD patients being treated at state hospitals in Denizli were included into
this study. Demographic and disease related data were recorded. The stage of COPD was defined
by pulmonologists. The physical functions were assessed by using Simple Physical Function Scale
and Modified Medical Research Council (MMRC) scale was used for assessing dyspnea.
RESULTS: Thirty-nine ratio of the cases included in this study was stage B COPD patients. The
physical function of 34% of cases with average 6,12± 1,24 COPD years was defined as bedridden
because of severe lung disease and needed someone’s help for self-care activities (Class 4). The
average MMRC score was 3 in 29% of cases. There was a significant positive correlation between
physical function and COPD level (p<0,05) and also between physical function and MMRC score
(p<0,05).
CONCLUSION: The loss in physical function increase as stage of COPD proceeds. Dyspnea can be
one of the most important factors that influence the loss in physical function. We think that
increasing exercise capacity via participation into pulmonary rehabilitation programs at early stages
is important for preventing the loss in physical function and disability in COPD patients.
Keywords: COPD, Dyspnea, Physical Function
P361[Pulmonary Rehabilitation and Chronic Care]
Case Report: Preoperative Pulmonary Rehabilitation Programme Results of
Planned Lung Transplantation Surgery
Arif Balcı, Esra Pehlivan, Lütfiye Kılıç
Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, Istanbul,Turkey
CASE: 46 years old female patient, with a diagnosis of bronchiectasis and COPD, dependent type 2
respiratory failure was planned to Lung Transplantation Surgery (to Tx) in the preparations process
was referred to our unit. Despite maximal medical treatment, the patient’s exercise dyspnea was
not improve and patient was performed supervised Pulmonary Rehabilitation (PR) programme
between 01 March to 06 November 2013. For the time spent at home was also given a home
program. Supervised exercise program which consists of endurance training such as walking,
bicycle, arm ergometer and supper and lower extremity strength training and also breathing
exercises were performed to patients two days in a week.
At the end of the program although there is not improvement in the patient’s respiratory function
tests, there was an increase with the 6 minute walking test (6MWT) distance, treadmill walking
distances, cycling and arm ergometers distance. Although CAT and MMRC scores were not
changed, Beck Depression İnventory scores were increased (table1).
RESULTS: Tx planned with a diagnosis of bronchiectasis and COPD, dependent type 2 respiratory
failure in this case, although there was an increase in exercise capacity, psychological regression
has been attributed to lack of improvement in respiratory function. Consequently, analogously to
the literature, given the increased exercise capacity, lung transplantation is scheduled program
should be applied to all patients in which PR is concluded.
Keywords: pulmonary rehabilitation, lung transplantation, physiotherapy
Preoperative Pulmonary Rehabilitation beginning and ending values
Before PR After PR
%
01.03.13 06.11.13
6MWT(m)
300
419
+39,6
Treadmill walking distance(m) 330
860
+160
Cycling distance(km)
1,87
4,16
+122
Arm ergometer distance(km)
1,61
3,00
+86
%FVC
39
29
-25
%FEV1
29
29
0
FEV1/FVC
63
87
+38
BECK
21
34
+61
CAT
33
33
0
MMRC
3
3
0
P362[Pulmonary Rehabilitation and Chronic Care]
Case Report: Preoperative Pulmonary Rehabilitation Programme Results of
Planned Lung Volume Reduction Surgery
Esra Pehlivan, Arif Balcı, Lütfiye Kılıç
Yedikule Chest Diseases and Chest Surgery Training and Research Hospital,Istanbul,Turkey
CASE: 60 years old male patient, with a diagnosis of COPD (Bullous amphysema) was planned to
volume reduction surgery (to LVRS) in the preparations process was referred to our unit. There
was no remarkable characteristic except suffering 45p/year on his history had been complaining of
dyspnea on exertion. The patient who had maximum medical therapy and quited smoking, was
performed supervised Pulmonary Rehabilitation (PR) programme during ten days hospital stays
which were planed between 13 May to 24 December 2013. For the time spent at home was also
given a home program. Supervised exercise program which consists of walking, bicycle, arm
ergometer, upper and lower extremity strength training were performed to patients each days for a
week in each hospitalizations. At the end of the program although there is improvement in the
patient’s respiratory function tests, there was an increase with the 6 minute walking test (6MWT)
distance, treadmill walking distances, cycling and arm ergometers distances and a decline in Beck
Depression İnventory and CAT scores were determined (table1).
RESUTS: LVRS planned with bullous emphysema in this case, although there was an increase in
exercise capacity and psychological situation after PR, there was no recovery in the lung functions
in a similar way with the literature. LVRS planned in all cases it was concluded that the
implementation of PR programs.
Keywords: Pulmonary rehabilitation, Lung volume reduction surgeryi physiotherapy
Preoperative Pulmonary Rehabilitation Beginning And Ending Values
Before PR After PR
%
13.05.13 24.12.13
6MWT(m)
402
489
+21,6
Treadmill walking distance (m) 350
690
+97,1
Cycling distance (km)
3,5
4,31
+23,1
Arm ergometer distance (km)
2,58
3,31
+28,2
%FVC
60,0
50,3
-17,1
%FEV1
37,9
26,7
-29,5
FEV1/FVC
65,4
46,8
-28,4
BECK
25
12
-52
CAT
30
26
-13,3
P363[Pulmonary Rehabilitation and Chronic Care]
Sedentary Time Experiences of University Students Evaluation of Factors
Affecting the Respiratory Type and Frequency
Özden Canbay1, Esra Doğru1, Sibel Doğru2, Nilüfer Çetişli Korkmaz1, Sebahat Genç2, Ersin Şükrü
Erden2
1
Mustafa Kemal University, School of Physical Therapy and Rehabilitation
2
Mustafa Kemal University, Department of Chest Diseases, Hatay
OBJECTIVE: The study of sedentary life -long respiratory pattern among university students and
was designed to evaluate the factors affecting the frequency.
METHODS: The study university 2 Class of students not engaged in any sport; 19observational;
shortness of breath type and frequency of muscle shortening was assessed by tetsu. Statistically,
the Jonckheere - Terps, the Mann-Whitney and Chi - square test was applied.
RESULTS: Respiratory rate was significantly correlated with the Beck Depression Inventory (p =
0.046). Neck extension muscle strength Lovett Manual Muscle Test ' which is worth 5 according to
what type of breathing while breathing from the chest, neck, extensor muscle strength types mix
of weaker breathing (abdominal breathing, chest ) was found to.
Scoliosis is not correlated with the respiratory pattern and ferkans. 50 individuals 13 patients were
found to be functional scoliosis.
With the type and frequency of respiratory weight, gender, M. pectoralis major-minor, M.latisimus
dorsi was no significant relationship between brevity.
CONCLUSION: Despite Sedentary life for individuals included in the study because it is healthy
ferekans with respiratory pattern and posture, muscle shortness smoking status, body mass index
was not correlated. On the other hand, the type of respiratory muscle strength, mood was
significantly correlated with the respiratory frequency.
Keywords: Posture analysis, Respiratory rate, Respiratory type
P364[Pulmonary Rehabilitation and Chronic Care]
A Comparison of Health Related Quality of Life Instruments Of Coronary
Artery Bypass Surgery Patients Who Had Taken Postoperative
Cardiopulmonary Physiotherapy Programme
Tuba Ergene1, M. Gülden Polat2
1
Memorial Hospital Atasehir, Istanbul, Turkey
2
Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Marmara University,
Istanbul, Turkey
Cardiopulmonary physiotherapy is the preferred approach to prevent postoperative pulmonary
complications of cardiac surgery. Although the positive effects of preoperative pulmonary
physiotherapy education is well known, it is sometimes neglected due to circumstances concerning
the patient or the environmental limitations.The study investigates the effect of cardiopulmonary
physiotherapy which was performed from the early postoperative period to discharge, on the
functionality and quality of life of coronary artery bypass greft patients who have and have not
received respiratory physiotherapy education at the preoperative period. 130 male and female
patients, between the ages of 35 to 75, were included in the study: Group I consisted of 77
patients who have received both preoperative respiratory physiotherapy education and
postoperative rutine cardiopulmonary physiotherapy while Group II consisted of 53 patients who
did not receive preoperative respiratory physiotherapy education due to their clinical conditions and
therefore had to be operated sooner then scheduled but received the postoperative rutine
cardiopulmonary physiotherapy. The health related quality of life of patients was evaluated by
MacNew Heart Disease Specific Quality of Life Survey, Ferrans and Powers Quality of Life Index
Cardiac Version-IV, SF-36 Health Survey and Nottingham Health Profile; at the pre and
postoperative six weeks period. The study indicates that the preoperative respiratory education
promoted all aspects of quality of life parameters by increasing patient orientation and participation
to physiotherapy, mobilization and home-based cardiopulmonary programme postoperatively, and
although all scales technically executed similar measurements, the scales used in this study were
non-equivalent.
Keywords: Cardiopulmonary physiotherapy, coronary artery bypass, patient education, quality of
life, scales
Descriptive Data of The Groups
The Comparison of Pre and Post-operative Scale Scores of Groups
P365[Pulmonary Rehabilitation and Chronic Care]
Evaulation of walking capacity, spirometric findings, and the relationship
between them before and after coronary artery bypass surgery
Rengin Demir1, Hülya Nilgün Gürses2
1
Istanbul University, Institute of Cardiology, Department of Cardiopulmonary Rehabilitation,
Istanbul
2
Bezmialem Vakif University, Faculty of Health Sciences, Department of Physiotherapy and
Rehabilitation, Istanbul
AIM: To evaluate walking capacity and spirometric findings and to determine whether there is a
relationship between six-minute walking test (6MWT) distance and spirometric findings before and
after coronary artery bypass graft surgery (CABG).
METHODS: Eighteen male patients (mean age: 61.2±7.5) were studied before and after CABG.
6MWT distance, FVC, FVC%, FEV1, FEV1%, and FEV1/FVC were measured preoperatively and at
discharge from hospital. For statistical analysis; Wilcoxon test, paired t-test and linear regression
analyses were used.
RESULTS: Evaluation of walking capacity and spirometric findings are shown in Table 1.
There was no significant relation between 6MWT distance and spirometric findings before surgery,
but there was significant relations among 6MWT distance with FVC (r=0,61; p=0.007), FVC%
(r=0,61; p=0.007), and FEV1%(r=0,48; p=0.04) after the surgery.
CONCLUSION: From this study, it is concluded that after surgery, there is a significant worsening
of the spirometric findings and walking capacity at discharge from hospital and walking capacity
was significantly correlated with spirometric parameters; FVC, FVC% and FEV1 %.
Keywords: six minute walking test, coronary artery bypass surgery, pulmonary function test
Table 1: Evaluation of walking capacity and spirometric findings
Before
CABG
After
CABG
Difference % p value
6MWT distance (m) 351.9 ± 82.1 300.1 ± 50.1 -7.8 ± 37.4
0.008
FVC (l)
3.7 ± 0.6
2.3 ± 0.5
-36.1 ± 8.4
<0.0001
FVC%
96.7 ± 12.5
61.4 ± 10.6
-36.2 ± 8.6
<0.0001
FEV1 (l)
2.88 ± 0.5
1.9 ± 0.5
-33.2 ± 14.8 <0.0001
FEV1%
96.2 ± 17.2
61.9 ± 14.3
-35.7 ± 8.8
<0.0001
FEV1/FVC (%)
78.2 ± 8.7
78.6 ± 9.2
0.6 ± 5.8
NS
P366[Pulmonary Rehabilitation and Chronic Care]
Home Care of Patients with Mechanical Ventilator
Recai Ergün, Begüm Ergan Arsava, Gülten Ütebey, Sebahat Üstündağ, Esra Engin, Ayfer Uz
Dışkapı Yıldırım Beyazıt Education and Research Hospital
29 patients who were discharged from the intensive care unit were followed.
Keywords: Home Care, Mechanical Ventilator, Intensive Care, 29 Patient
Diagnosis of Patients, Number(%)
Diagnosis
Number %
Chronic Obstructive pulmonary disease 15
53.5
Cerebrovascular Diseases
5
17.8
Hypoxic encephalopathy
3
10.7
Cervical spinal trauma
3
10.7
Amyotrophic Lateral Sclerosis
1
3.5
Multiple Sclerosis
1
3.5
P367[Politics of Health]
Pulmonary service in Uzbekistan
Abdulla Ubaydullaev
Ministry of Public Health, Tashkent Institute of Postgraduate Medical Education, Tashkent,
Uzbekistan
The first step in the development of pulmonology in Uzbekistan was organization in 1978 of the
Department of Clinical Pulmonology at Tashkent Institute of Postgraduate Medical Education. The
department became the first in the former Soviet Union and played a leading role in training for
pulmonologists of Uzbekistan and other soviet republics. In 1988, at the Research Institute of
Tuberculosis and Pulmonology Republican pulmonology center was organized, it began work to
create pulmonology service in the country. This work aimed to optimize the detection, diagnosis
and
treatment
of
respiratory
diseases.
The second step was in 90s of the 20th century, it can be called the heyday of pulmonology science
and practice in Uzbekistan. During this period, the Order of the Ministry of Health of Uzbekistan №
569 ( November 14, 1993) was launched and it concerned the improvement of pulmonology
service.
The main objective was to create an effective system for helping our population and the formation
of functional structure of pulmonology service, which could be coordinated by Republican
pulmonology center. Freelance regional pulmonologists organized and led pulmonology
departments at provincial general hospitals. In clinics pulmonology rooms began functioning.
Specialists designed the Concept to reduce morbidity and mortality of nonspecific pulmonary
diseases in Uzbekistan. Its goal is to reduce morbidity and improve the results of treatment of
respiratory
diseases
in
the
country.
Pulmonary Service of Uzbekistan is the singular effective system to help the population in the area
of respiratory diseases in the territory of Central Asia.
Keywords: Pulmonary service, population, country
P368[Politics of Health]
Heybeliada Sanatorium (1924-2005)
Hakan Kıral
Süreyapaşa Chest Disease and Chest Surgery Training and Research Hospital, Thoracic Surgery
Department, Istanbul
The first sanatorium was established in 1858 in Germany by Dr.Brehmer. Dr.Dettweiler, opened a
new sanatorium in Falkenstein in 1875 and then sanatoriums were spread all over the world.
As soon as Republic is established in our country, the government has addressed the sanatorium
business. The hospital was opened on 1st November, 1924 as a 16-bed hospital.
Dr.Gökçe, the medical chief at the sanatorium, was sent to Europe to make investigations. The
medical chief of staff used his acquired knowledge and experience for the development of
Heybeliada Sanatorium. Hospital, opened with 16 beds in 1924, has increased the number of beds
to 630 in 1954, to 700 in 1977. In addition, a nursing school was opened to meet the needs of
nurse and a rehabilitation center was opened in 1954.
It has become any kind of surgery was done by established Thoracic Surgery Department and an
operating room since 1936. The modern laboratories and radiology units have been established.
This successful process has continued until the 1990s.
The August 1999 earthquake was the beginning of the end for Heybeliada sanatorium. It was
decided to shut down for the reasons of partially damaged buildings of the hospital, lack of staff,
transportation and deterioration in the balance of income and expenses. This valuable institution
was closed on 30thSeptember, 2005.
Heybeliada Sanatorium has been a pioneer and a starring role in the fight against tuberculosis and
other lung diseases in 81-year period in our country.
Keywords: Heybeliada Sanatorium, Sanatorium, Tuberculosis
P369[Politics of Health]
The analysis of workload in institutions related to pulmonology in 2012
Sedat Altın
University of Erzincan, Medical Faculty, Erzincan
AIM: To determine the workload of the pulmonologists working in the hospitals related to Ministery
of Health, university hospitals and private hospitals in which patients treated with chest diseases in
2012.
Material &
METHOD: Analyses of workload were made using Information System of Ministry of Health,
Directorate of Management Services and TSIM.
FINDINGS: In our country by the year 2012, 1768 pulmonologists, working in 703 institutions in
which patients with chest diseases treated, admitted 423.985 patients to the hospitals, followed up
them an treated these patients.
The rate of bed occupancy was 83% in hospitals related to Ministery of Health, 77% in university
and 58% in private hospitals.The number of beds per doctor was calculated as respectively 7, 4
and 2 beds. While the daily number of policlinics done by per doctor was 22.6 in Ministery of
Health, 8.9 in university and 12.8 in private hospitals, the number of the patients admitted to
hospitals, and followed up by pulmonologists per month was respectively 20.5, 15.3 and 12.5.
CONCLUSION: Although 68% of all pulmonologists are being employed in hospitals related to
Ministery of Health, 80% of workload has been provided by these institutions.
Keywords: workload, pulmonology, specialist
P370[Politics of Health]
Affect of Marrital Status on Mortality
Sedat Altın1, Edhem Ünver1, Gülşah Günlüoğlu2
1
Erzincan University Medical Faculty, Erzincan
2
Yedikule Chest Diseases and Chest Surgery Education and Training Hospital
AIM: This study is intended to investigate whether the marrital status iseffective on mortality both
in men and women or not in our country.
Material&
METHOD:
Calculations were made using marrital status, age, and sex numbers from TUIK death and
demographic statistics in 2012. Statistically comparison was performed using X2 test. P<0.05 was
accepted as significant.
FINDINGS:
In 2012 it was reported that 36.184.225 of population above 15 years of age were married,
15.492.867 single,3.071.832 widow, and 1.772.881 divorced. In spite of this, 191.129 of deaths
above 15 years of age were married, 124.177 widow, 20.524 single, and 13.450 divorced.
Crude rates due to marrital status were found as in single ones per mille 1,32, married 5,28,
divorced 7,59, and widow 40,42. In single women, crude rate was higher than single men
(p<0.0001).Conversely, crude rate in married men was attended almost half of women’s rate (Per
mille 0,68 despite 0,46).
In divorced population crude rate of women were twice than men’s (Per mille 88,2 despite 44,6)
In population above 65 years of age, the crude rate in women who were single, married and
divorced were higher than men at the same age (p<0.0001 all). Contrarily in men’s widows crude
rate was higher than women.
CONCLUSION: In the linear regression analysis, both age and gender and also the marrital status
were found effective on marrital status (for each p<0.0001). Crude mortality rate was found
significantly higher in men above 65 years age, whose wife is dead, than the other groups.
Keywords: Marrital Status, mortality rate, sex
P371[Politics of Health]
Is there any increase in the number of patient's with chest diseases?
Sedat Altın1, Gülşah Günlüoğlu2, Edhem Ünver1
1
Erzincan University Medical Faculty, Erzincan
2
Yedikule Chest Diseases and Chest Surgery Education and Training Hospital
AIM: To investigate whether the number of inpatients and chest diseases clinic increased or not
according to 2009 by the year 2012.
Material &
METHOD: Analyses were made using Information System of Ministry of Health, Directorate of
Management Services and TSİM and compared with the patient load.
FINDINGS: 6,998,000 polyclinic were done in our country in 2009 and it reached 8,402,000 in
2012 with an increase of 6.7% each year. In spite of this it had seen that the number of inpatients
were increased from 370.000 to 424.000 with the rate of 4.9% yearly in 2009.
In the same period the number of pulmonologists increased from 1588 to 1856 (5.6% yearly ).
This increase showed itself as 6.7% in the hospitals relevant to Ministry of Health, 4.2% in the
university hospitals and 3.2% in the private hospitals.
While Diyarbakır(218%), Kars (85%), Erzincan (83%), Kırklareli (63%), Çorum and Nevşehir(59%)
were the first five cities which there was an increase in the number of policlinics, Erzincan(177%),
Kırklareli (162%), Muş (133%), Yalova (108%) and Bayburt (105%) were the first five cities that
an increase in the number of inpatients.There had been 14 cities that policlinics showed a decrease
and Bingöl(39%), Hakkari (33%), Çanakkale (31%), Kırıkklae (24%) and Çankırı (20%) are the
cities that the most decrease had been.
In 21 cities we obtained a decrease in terms of inpatients. The most decrease was ocuured in
Hakkari with 44%, than respectively Bingöl with 33%, Karabük and Rize 31%, Siirt 30%
CONCLUSION: There is an increase in the number of pulmonologists parallel to policlinics and
inpatients in 48 cities. Anyhow in 3 cities both the number of pulmonologists and policlinics, also
the number of inpatients decreased.
:
Keywords: The number of patient, chest diseases, increase
P372[Politics of Health]
Is The Respiratory System Drugs Used Rationally?
Edhem Ünver1, Sedat Altın1, Cengiz Özdemir2, Sinem Sökücü2
1
Erzincan University Medical Faculty, Erzincan
2
Yedikule Chest Diseases and Chest Surgery Education and Training Hospital
AIM: Comparasion of the increase in the inhaler market which has the most increase among
respiratory system field, to the increase in the patient number in the last 5 years.
MaterialMETHOD: IMS numbers and TSIM numbers from Ministry of Health were used for analyses.
RESULTS: Depending on the IMS data, 24,796,119 boxes of inhaler drug were sold in the year
2009 and this had reached to 38,205,341 boxes in the year 2013 with an increase of 54.1%. In the
subgroup analyses, particular increase was observed in corticosteroid preperations with 91,6%
followed by 71.5% in combination preperations, 51,4% in anticholinergics, and 37,5% in beta2
agonists. Comparing with the year 2009, in 2012, pulmonology polyclinic admission number
increased by 55.6% (from 6,994,000 to 8,402,000 ). Mean hospital admission per person in 2009
was 4.5 and this was increased to 5.1 in 2012. This means that patient number increased from
1,550,000 to 1,650,000. Sixteen boxes of drug which was prescribed in 2009 per patient was
increased to 23 boxes in 2013.
CONCLUSION: Prescribed number of drug boxes had an excessive increase compared to the
increase in patient admissions in the last 5 years. It was concluded that inhaler use is over then
expected especially for corticosteroids and combination drug preperations. For an explanation for
this could be that asthma and COPD drug reports were easily given in the last 5 years and the
inhaler drugs were perscribed by the family physicians all through the year based on these reports.
Keywords: Rational drug use, respiratory system, inhaler marketing
P373[Politics of Health]
Are the mortality rates in Erzincan declining steadily?
Edhem Ünver1, Sedat Altın1, Zehra Hekimoğlu2, Hasan Ölmez2, İsmayil Yılmaz1
1
Erzincan University Medical Faculty, Erzincan
2
Erzincan Mengücek Gazi Education and Training Hospital
AIM: In our study, we aimed to compare the crude rate related to respiratory system diseases in
Erzincan and İstanbul with the average of Turkey between 2010-2012.
Material &
METHOD: Using data of TUİK, population, range of age, sex, number of deaths and rate of
Erzincan and İstanbul in 2010, 2011, 2012 compared with the average of Turkey. The factors that
have an effect on mortality were analyzed.
FINDINGS: Between the years 2009 and 2012, whereas crude rate in our country was progressing
per mille 5, it was per mille 6 in Erzincan, approximately per mille 4 in İstanbul.
When analysed exchange rate of mortalities in 2010-2012, it has seen that this value is 2.5% for
Turkey, 3.38% for İstanbul and 6.85 for Erzincan. In this exchange rate if you examine sex, in
Erzincan mortalities in men is higher than the average of Turkey with 15.67% though in İstanbul
this rate is closer to the average. But the rate in women is regressed as -3% in Erzincan while in
İstanbul it is two times higher (3.09%) than the average(1.45%). In addition the population above
60 years of age is 11.04% in Turkey, 8.82 % in İstanbul and 14.7% in Erzincan. Also the rate of
mortalities above 60 years of age (per mille 35.07) is higher than the average of Turkey (per mille
33.27)
Mortalities related to respiratory system are ever increasing in Turkey (from per mille 8.3 to 9.7).
While in İstanbul this rate is a little bit under the average of Turkey with per mille 9, it is per mille
11 in Erzincan, over the average of Turkey. Between 2010-2012, exchange ratio is around 16.9%
in Turkey (annual 5.6%), whereas is higher in İstanbul (26.8%, yearly exchange ratio 8.9%
increase). In spite of this trend of increase in Erzincan was broken and in 2012 it had been
decreased(8-9%)
CONCLUSION: Mortalities related to respiratory system, as a difference 2012-2010, while an
increase of 16% in Turkey,15.7% in İstanbul had seen, İn Erzincan there was a decrease of 18.3%.
Keywords: mortality rate, respiratory system, rate of change
P374[Politics of Health]
The Position of Emergency of Chest Diseases
Sedat Altın, Fikri Kıral, Sibel Yurt, Gulcihan Özkan, Levent Karasulu
Yedikule Chest Diseases and Chest Surgery Education and Research Hospital
AIM: While the number of emergency outpatients of chest diseases, we aimed to investigate
whether the applicants are really emergency or not
Material &
METHOD: The data of last 5 years of Yedikule Chest Diseases and Chest Surgery Training and
Research Hospital were analysed and according to ICD-10 codes and rate of triages in 2013 an
assesment was made.
FINDINGS: While in 2013 the number of outpatient of chest diseases were 364.346, 85.826
emergency outpatient came to our hospital. In last five years whereas the number of outpatients
increased 61 %, emergency referred patients showed an increase of 59%.
It was found that the rate of inpatients from emergency was 11%, and the death rate in
emergency service per mille 1.1.
Time allocated to patients in emergency clinic was average 11 minutes (8-36 minutes).
Approximately 81 patients were treated in weekday per Pulmonologs working in emergency clinic
including asistant, weekend 72 patients.
While top 5 according to the diagnosis of the patients lined up as J45 asthma (22.9%), J44
COPD(21.2%), J20 acute bronchitis (16%), C34 bronchus cancer (9.7%) and J10-18 pneumonia
(8.1%), 21% of patients referred to the emergency applied again in 24 hours after first application.
CONCLUSION: Because of the outpatients referred to the emergency service, time allocated to
real patients are becoming shorter. Emergency applications especially took place in day time, this
shows us that this is related about the patient’s behaviour who doesn’t want to deal with
formalities like waiting in outpatient clinic and taking appointment.
Keywords: Emergency, chest disease, problems
P375[Pulmonary Infection]
Kartagener’s Syndrome: Case report
Mesut Demirköse, Ertan Tuncel, Cenk Babayiğit, Ersin Şükrü Erden, Sibel Doğru, Sebahat Genç
Department of Chest Diseases, Faculty of Medicine, Mustafa Kemal University, Hatay
Kartagener’s Syndrome is characterized by the association of sinusitis, bronchiectasis and situs
inversus. It is a rare autosomal recessive disease and seen in 20,000 live births. A large number of
cases is detected in childhood. The basis of clinical findings are abnormalities of cilia structure and
function. Chronic bronchitis and bronchiectasis as a result of recurrent pneumonias, sinusitis and
chronic otitis media are frequent clinical findings.22 years old female presented with shortness of
breath began five years ago, cough and yellow sputum. She had been operated on for chronic
sinusitis. On physical examination; there were crackles and rhonchi on lung basis Pseudomonas
aeruginosa was isolatedfrom sputum culture. Thoracic CT scan showed situs inversus totalis and
bronchiectasis on the left upper lobe. The patient was diagnosed as Kartagener’s Syndrome.
Keywords: Kartagener's syndrome, sinusitis, bronchiectasis
Figure 1
Bronchiectasis in the left lung
Figure 2
Situs inversus
P376[Pulmonary Infection]
Comparison of health care associated pneumonia and community acquired
pneumonia in Turkish Thoracic Society pneumonia database
Canan Gündüz1, Sezai Taşbakan1, Abdullah Sayıner1, Ayşın Şakar Coşkun2, Feride Durmaz2, Aykut
Çilli3, Burcu Çelenk3, Oğuz Kılınç4, Seda Salman4, Armağan Hazar5, Fatma Tokgöz5, Nurdan
Köktürk6, Sakine Nazik6, Ayten Filiz7
1
Department of Pulmonary Diseases, Ege University, İzmir, Turkey
2
Department of Pulmonary Diseases, Celal Bayar University, Manisa, Turkey
3
Department of Pulmonary Diseases, Akdeniz University, Antalya, Turkey
4
Department of Pulmonary Diseases, Dokuz Eylül University, İzmir, Turkey
5
Süreyyapaşa Thoracic Diseases and Thoracic Surgery Training and Research Hospital, İstanbul,
Turkey
6
Department of Pulmonary Diseases, Gazi University, Ankara, Turkey
7
Department of Pulmonary Diseases, Gaziantep University, Gaziantep, Turkey
OBJECTIVE: Pneumonia in cases with history of hospitalisation, hemodialysis, accomodation in
nursing homes, receving ambulatory intravenous therapies and having decubitus ulcers is defined
as health care associated pneumonia (HCAP).
MATERIALMETHOD: The comparison of demographic data, isolated causative agents and prognosis of
patients with community acquired pneumonia (CAP) and HCAP is aimed. The patients with HCAP
and CAP registered by seven centers in the Turkish Thoracic Society Respiratory Infections Study
Group pneumonia database were retrospectively evaluated.
RESULTS: 785 cases (530 male, average age 65.3±16.4) were evaluated, 207 (26.4%) were
diagnosed with HCAP and 578 (73.6%) with CAP. Among HCAP cases, 140 (17.8%) had recent
hospitalisation in last 90 days, 28 (3.6%) went under hemodialysis in previous 30 days and 22
(2.8%) stayed in nursing homes. Pneumonia severity index (PSI), was 103.9±37.2 in HCAP and
94.6±35.4 in CAP (p=0.002). The most frequently isolated causitive microorganisms were;
P.Aeruginosa, A.Baumannii and S.pneumoniae in HCAP and S.pneumoniae and P.aeruginosa in
CAP. Although length of stay in hospital was higher in HCAP than CAP (8.6±5.5 vs 7.5±6.1 days,
p=0.03), the differences in ratios of length of stay in critical care unit were not statistically
significant (%9.7 vs %9.3) (p>0.005). Mortality ratio in HCAP was higher than CAP (8.7% vs
5.7%), however the difference was not statistically significant (p=0.14).
CONCLUSION: HCAP cases require special approach in the means of different reference data,
range of isolated agents and prognosis other than CAP. Therapies involving gram negative
microorganisms resistant to empirical antibiotherapies should be considered.
Keywords: health care associated pneumonia, community acquired pneumonia, hemodialysis,
nursing home
P377[Pulmonary Infection]
Different straints of Pseudomonas aeruginosa with a variety of antibiotic
susceptibility patterns in the same sputum
Aslıhan Gürün Kaya, Aydın Çiledağ, Akın Kaya, Özlem Özdemir Kumbasar
Department of Chest Diseases, Ankara University, Ankara, Turkey
A 60 year old female patient was admitted with cough, purulent sputum and hemoptysis. The
patient had been followed with a diagnosis of bronchiectasis since childhood. In recent years she
had a history of increased frequent exacerbations and hospitalization. The patient was treated with
inhaled tobramycin 2 years ago because of colonisation with Pseudomonas aeruginosa, but had not
diminished the frequency of exacerbations. She admitted to our clinic due to progression of
symptoms.
On physical examination fever and bilateral inspiratory crackles was detected and laboratory
analysis showed leukocytosis with elevations of sedimentation and CRP levels. Sputum culture
revelaed Pseudomonas aeruginosa and ceftazidime was initiated according to susceptibility test.
Due to absence of improvement in fever and complaints despite ceftazidime treatment, new
sputum sample was sent for culture. Three different straints of Pseudomonas aeruginosa were
isolated, that each one had different susceptibility pattern. First one was susceptible to cefepime,
ceftazidime and piperacillin-tazobactam; resistance to levofloxacin, the other one was susceptible
to levofloxacin and resistance to ceftazidime, piperacillin-tazobactam, imipenem and the last one
was sensitive to all of the tested antibiotics. The treatment was changed as cefepime +
levofloxacin. A clinical, radiolgical and laboratory improvement was observed with this treatment
and the patient was discharged.
In patients with colonised with Pseudomonas aeruginosa, in case of failure of antibiotic treatment,
it should be considered that the organism may have a variety of susceptibility pattern.
Keywords: Pseudomonas aeruginosa, bronchiectasis, antibiotic susceptibility testing
P378[Pulmonary Infection]
Agressive Hydatid Cysts
Gürhan Öz1, Mehmet Eroğlu2, Ersin Günay3, Ahmet Bal4, Emre Kaçar5, Olcay Eser6, Okan Solak1
1
Department of Thoracic Surgery, Afyon Kocatepe University School of Medicine, Afyonkarahisar,
Turkey
2
Department of Orthopedics and Traumatology, Afyon Kocatepe University School of Medicine,
Afyonkarahisar, Turkey
3
Department of Pulmonary Diseases, Afyon Kocatepe University School of Medicine,
Afyonkarahisar, Turkey
4
Department of General Surgery, Afyon Kocatepe University School of Medicine, Afyonkarahisar,
Turkey
5
Department of Radiology, Afyon Kocatepe University School of Medicine, Afyonkarahisar, Turkey
6
Department of Neurosurgery, Balikesir University School of Medicine, Balikesir, Turkey
Hydatid cyst is a zoonotic disease formed by E. granulosus larvae.
In this study, we evaluated 6 patients showing aggressive invasive behavior among 40 patients
who were operated between 2010-2013. In these patients, we observed invasion to vertabrate,
chest wall, diaphragm, mediastinal organs and lung and additionaly lung destruction. Chest
radiography and computed tomography were used for the diagnosis. Besides the routine
hematological and biochemical laboratory tests, hydatid cysts markers were also examined. Age,
gender, hospital admission, symptoms, radiological findings, surgical procedures, postoperative
complications and length of hospital stay were recorded.
Four of the six patients were male and the mean age was 47 year (12-81 years). Treatment were
conjunction with cystectomy via thoracotomy, respectively, corpectomy, chest wall resection,
excision of the cyst and lobectomy. In one patient bronchopleural fistula and atelectasis, in another
opareated patient prolonged drainage of bile were developed. The mean duration of hospital stay
was 9 days. One of them died due to the empyema at the end of 1st month of following
thoracotomy.
As a conclusion, in some patients, hydatid disease acting as a tumor can invade surrounding
tissues and organs also bone structures. Aggressive hydatid cysts can perform different clinical
complaints and ekstended surgery may be required besides cystectomy.
Keywords: cyst hydatid, invasion, destruction
P379[Pulmonary Infection]
Diagnosis of Patient with Bronchiectasis Pulmonary Nocardiozis
Renginar Mutlucan Eraslan, Erhan Tabakoğlu, Gökhan Söğüt
Department of Chest Diseases, Trakya University, Edirne, Turkey
66 year old female patient, the last 1 year of intermittent hemoptysis, has cough and sputum.She
has been admitted to various health organizations and treated with different antibiotics in many
times.Patients not responding to clinical was drawn thorax BT.In thorax BT bilateral from place to
place cystic bronchiectasis areas, common reticulonodular appearance and budding tree in findings
consistent with monitoring patients on tuberculosis and interstitial lung disease with the diagnosis
further analysis and treatment purposes have been transferred by our clinic.In investigation,
negative sputum ARB was detected and harvest cell did not produce. Except bronchiectasis,
immunosuppression and chronic disease was not detected in this patient. In recurrent two sputum
cultures,reproductive nocardia in patients with trimethoprim-sulfamethoxazole antibiotic treatment
was started.About 5 months in patients continuing treatment are observed clinical and radiological
response to treatment is still continuing.Nocardia is a more uncommon disorder and resulting in
decreased cellular immunity in patients with bronchiectasis and bronchial hygiene to be poor should
be kept in mind.
Keywords: bronchiectasis, hemoptysis, nocardia, tuberculosis
before treatment
after treatment
P380[Pulmonary Infection]
Two Cases of Antibiotics İnduced Manic Episode: Antibiomania
Ayşe Coşkun Beyan1, Evrim Göde Öğüten2
1
Department of Chest Diseases, Tatvan State Hospital, Bitlis
2
Department of Psychiatry, Tatvan State Hospital, Bitlis
Antibiotics are among the most prescribed drugs, recently. There are many rare and often adverse
effects of these drugs. Neuropsychiatric symptoms; which are rare but important adverse effects
have been reported more frequently. İn the lıterature there are case reports presenting manic
episodes developed afetr the use of especially macrolids, quinolones and peniciline grups
antibiotics. İn this case report we have presented two manic cases after using claritromycine and
cephalosporins. we wanted to take attention to necessity of the adverse effects of antibiotic drug
the prescrbing and the treatment.
Keywords: antibiomania, macrolids, manic episode
P381[Pulmonary Infection]
Endobronchial actinomycosis mimicking the lung cancer
İsmail Hanta1, Mustafa Faysal Baysal2, Sezen Sabancı Küçükaltun1, Efraim Güzel1, Derya
Gümürdülü3
1
University of Çukurova, Faculty of Medicine, Department of Chest Diseases, Balcali, Adana
2
Special Adana Hospital, Adana
3
University of Çukurova, Faculty of Medicine, Department of Pathology, Balcali, Adana
XXXXX
Keywords: Actinomycosis, pulmonary involvement, endobronchial lesion
P382[Pulmonary Infection]
Pneumocystis Carinii Pneumonia Complicated by Pulmonary
Thromboembolism and Pneumomediastinum
Cemile Selimova1, Kezban Özmen Süner2, Mehmet Nezir Güllü2, Sarvan Ağamuradov1, Ebru Ortaç
Ersoy2, Arzu Topeli İskit2
1
Hacettepe University,Faculty of Medicine, Department of Internal Medicine
2
Hacettepe University,Faculty of Medicine, Department of Medical Intensive Care
Pneumocystis carinii, is an opportunistic infection source in patients undergoing solid organ
transplantation,it has important relationship between mortality and morbidity.İn pneumocystis
carinii pneumonia(PCP) radiologically, in%90 of cases, there is a diffuse bilateral infiltrates
extending from the perihilar region at chest radiography.Otherwise; atypical radiological findings
can be detected as, cavitation, microcalcifications, pneumotosel, pneumothorax.Our case which we
follow due to PCP that has a history of renal transplantation, is complicated by pulmonary
thromboembolism and pneumomediastinum; so we decided to offer this case.
42years old male patient, has a history of renal transplantation about1 year ago, because of Focal
Segmental Glomerulosclerosis, hospitalizated in Intensive Care Unit with fever and type1
respiratory failure.Drugs that he used because of renal transplantation are Methylprednisolone,
Mycophenolate mofetil and Tacrolimus.In Thoracic CT there seen consolidation and ground glass
opacities which are compatible with PCP.Trimethoprim-sulfamethoxazole and methylprednisolone
started to patient. In follow up of patient with%50 venturi mask,whose general condition is stable
and has no fever, he described increase in shortness of breath and penetrative style chest pain
with breathing at right side.Patient was hemodynmically stable and monitoring of
electrocardiogram and cardiac enzymes were regular.Thoracic CT angiography wanted for
pulmonary thromboembolism (PTE).Results have been reported that in upper and lower lobes of
the right lung filling defects compatible with PTE, pneumomediastinum and subcutaneous
emphysema.Appropriate low-molecular-weight heparin dose was given to patient due to function of
kidney. With decreasing chest pain, dsypnea and oxygen demand patient was transferred to
service.
Keywords: Pneumocystis Carinii Pneumonia, Pulmonary Thromboembolism Pneumomediastinum
P383[Pulmonary Infection]
Endobronchial Mass Creator Yeast Infection
Merve Nizam, Mediha Gönenç Ortaköylü, Sakine Yılmaz, Sinem İliaz, Ayşe Bahadır, Belma Bağcı,
Emel Çağlar
Department of Chest Medicine, Yedikule Teaching Hospital for Chest Diseases and Thoracic
Surgery,Istanbul,Turkey
68 years old female patient, ongoing for 4 months cough, phlegm, shortness of breath. the
immunosuppression history and additional diseases of women without the patient's PA chest X-ray
in the right lower lobe consolidation was observed and thoracic CT right lower lobe parenchyma
extension showing the massive formation was observed. The patient underwent fiberoptic
bronchoscopy from the right bronchus intermedius mucosal infiltration. Here wang bronchial
biopsies and pathology of UTI Evaluation of spreading fungal hyphae and intense inflammatory
inflammation was detected. Patients with infectious diseases were consulted and caspofungin 50mg
1 * 1 was hospitalized for 10 days. The patient's cough and shortness of breath decreased slightly
higher in the first week of white blood cells and liver enzymes returned to normal were observed.
Well-being of the patient's response to treatment with oral fluconazole for 10 days on treatment
was continued. Check drawn on CT after 1 month decreased infiltration was observed. Patients who
also yeast infection endobronchial mass appearance was considered.
Keywords: immunity, not suppressed, endobronchial infection, fungal
P384[Pulmonary Infection]
Effect of Smoking on Prognosis and Mortality in Patients Hospitalized due to
Community Acquired Pneumonia
Feride Durmaz1, Ayşın Şakar Coşkun1, Yavuz Havlucu1, Aykut Çilli2, Burcu Karaboğa2, Oğuz Kılınç3,
Seda Salman3, Sezai Taşbakan4, Abdullah Sayıner4
1
Celal Bayar University Faculty of Medicine Department of Chest Disease, Manisa, Turkey
2
Akdeniz University Faculty of Medicine Department of Chest Disease, Antalya, Turkey
3
Dokuz Eylül University Faculty of Medicine Department of Chest Disease, İzmir, Turkey
4
Ege University Faculty of Medicine Department of Chest Disease, İzmir, Turkey
In this study,we investigated the effect of smoking on prgnosis and mortality in patients with CAP
by using the "Pneumonia Data Base".
702 patients hospitalized due to CAP and registered to “Pneumonia Data Base” in Pulmonary
Department of Celal Bayar University,Akdeniz University,Dokuz Eylul University,and Ege University
between November 2009 and May 2013 were included to the study.“Pneumonia Data Base” that
prepared by Turkish Thoracic Society Respiratory Infections Scientific Assembly included the datas
about findings of patients at first day hospitalization,controls at hospitalization and discharged
date,treatment results at first month and total treatment cost.
There were 465 male(66,2%)and mean age was 65 years.The percentage of never smoker,current
smoker,and ex-smoker were 37,2%,11%,and 51,7% respectively.There was no relation with chest
radiography and smoking status.In current smokers,ALT andAST levels were found significantly
higher and oxygen saturation were found lower.There were no relation between smoking status
and CRP and PCT.PSI was found significantly higher in ex-smokers whereas there was no relation
between CURB-65 and smoking status.No relation was found between smoking status and
hospitalization duration and treatment cost.According to treatment results,in 3-5 days,percentage
of totally cured patients were high in active smokers and the percentage of partially cured patients
were high in never smokers and ex-smokers.Mortality rate was found as 8,5%.Older age,presence
of comorbidity,presence of smoking history were found related with mortality.
As a result,we found that smoking affect many factors realted with CAP development and prognosis
negatively and it increases the mortality in CAP with other factors like presence of comorbidity and
older age.
Keywords: community acquired pneumonia, smoking, mortality, treatment result
P385[Pulmonary Infection]
Pneumocystis Carinii Pneumonia In Patient With Ulcerative Colitis
Oğuz Uzun, Ayşenur Gök
Ondokuz Mayıs University,Department of Respiratory Medicine,Samsun,Turkey
Pneumocystis carinii pneumonia which should be considered in immunosuppressed patients is a
cause of atypical pneumonia. We,therefore, present a case of Pneumocystis carinii pneumonia
which identified in a patient who is treated with immunosuppressant therapy due to ulcerative
colitis.
A 50 years old patient who was followed with a diagnosis of ulcerative colitis for 3 years admitted
with sudden onset and increasing of shortness of breath within last two months. Hypoxemia was
detected in the blood gas while radiologically diffuse bilateral ground-glass opacities were detected
in the lungs.Patient who is received azathioprine, mesalazine, metilpredinozolon, infliximab
therapies due to ulcerative colitis is considered as PCP with the current findings and then it was
performed bronchoalveolar lavage to the patient.In bronchoalveolar lavage fluid, immune
fluorescent antibody test of PCP was positive. Trimethoprim-sulfamethoxazole was initiated for the
patient.It was achieved a complete response clinically and radiologically after treatment.
As a result; Pneumocystis Carini Pneumonia should be considered in immunosuppressed patients
who presented with shortness of breath.
Keywords: pneumocystis carinii pneumonia, ulcerative colitis, immunsuppressed patient
P386[Pulmonary Infection]
Nocardia Infection On The Basis Of Extrinsic Allergic Alveolitis
Hatice Sözgen, Fatmanur Karaköse, Hatice Kutbay Özçelik, Fatih Yakar, Esat Hayat, Mehmet
Bayram, Muhammed Emin Akkoyunlu, Murat Sezer
Bezmialem Vakif University, Department of Chest Disease, İstanbul, Turkey
NOCARDIA INFECTION ON THE BASIS OF EXTRINSIC ALLERGIC ALVEOLITIS
INTRODUCTION: Extrinsic allergic alveolitis (EAA) is an IgE mediated hypersensitivity reaction
that caused from repeated inhalation of organic powders or chemicals. Nocardia infection is more
known as an opportunistic infection in patients who are immunocompromised, although this has
been reported in the literature that, this infection can develop %15 of patients without underlying
disease.
CASE: 32 year old male patient was admitted with complaints fatigue, shortness of breath and
cough. There was peribronchial interlobular septal thickening and diffuse areas of ground glass in
both lungs in an external center chest tomography 7 months ago. The patient was hospitalized.
Transbronchial biopsy and bronchoalveolar lavage could not be performed due to incompatibility in
patients who underwent bronchoscopy. Serologic tests were normal too. Open lung biopsy
performed ana the patholgy of biopsy resulted as EAA. There was a finding EZN+, gram+, PAS+
compatible with nocardia in microbiological examination. There was no predisposing factors that
may cause to nocardia infection. The patient who discharged after treatment, admitted to intensive
care unit because of bilateral pneumonia and respiratory failure a month later. The patient died
after development of sepsis and disseminated intravascular coagulation.
DISCUSSION: It is known that nocardia infection can be together with immunocompromised
patients or some pulmonary disease such as pulmonary alveolar proteinosis, bronchiectasis,
chronic obstructive pulmonary disease, whereas association with EAA is unusual and that’s why we
want to present this case.
Keywords: Nocardia,extrinsic allergic alveolitis,pulmonary infection
P387[Pulmonary Infection]
A Rare Involvement in Hydatid Cyst Disease: Rib Destruction caused by
chest wall involvement
Esra Akkütük Öngel1, Murat Yalçınsoy1, Sinem Güngör1, Selahattin Öztaş1, Gökhan
Hacıibrahimoğlu2, Ayşe Alp Ersev3, İrfan Yalçınkaya4
1
Süreyyapaşa Chest Disease and Surgery Trainig and Educational Hospital
2
Florence Nightingale Hospital, Chest Surgery, İstanbul
3
Süreyyapaşa Chest Disease and Surgery Trainig and Educational Hospital, pathology departmnet
4
Süreyyapaşa Chest Disease and Surgery Trainig and Educational Hospital, chest surgery
Hydatid Cyst Disease(HCD) is often settles in liver and lungs. Intrathoracic extrapulmonary
localizations are mediastinum, pleura, pericardium, myocardium, diaphragma, chest wall. The chest
wall localization are quite rare. Center may be soft tissue, sternum or rib in chestwall involvement.
Bone involvement of HCD is observed 0.9%-2%. In our clinic we presented a HCD with ribs
destruction which mixed chest wall tumors.
36 old female. The complaints are numbness in arm and dorsal pain. Chest radiograph revealed
multilobuled 7*6 cm mass lesion destruct 6th and 7th rib in the left parahilar region.
Fine needle biopsy reported as myxoid appearance not-cell material. Thoracic MRI showed 7*6*
5cm multilobuled mass lesion with mulitple cystic compartments destruct left posterior chest wall
and limited with lung parenchyma on anterior,vertebral body on medial extending to neural
foramen. Initial diagnosis were aneurysmal bone cyst, HCD, metastasis because it contains cystic
component and septation. Surgery was performed and paravertebral semisolid lesion invading 6th7th ribs and extend to vertebral column was seen. 6th and 7th ribs was partial resected from the
posterior vertebral junction. Cystic mass in extrapleural ektratorasik chest wall was removed.
Andazol treatment was started. Patients treatment completed 9 months. Four years later, patients
presented with hemoptysis were unremarkable. The patient is still our control with no complaint.
As a result, for our country, which is a major health problem in HSC, liver and lungs in the
differential diagnosis of cystic lesions outside, HSC atypical areas should be considered in the
differential diagnosis of patients believe that.
Keywords: Hydatid Cyst, chest wall involvement, Rib Destruction
P388[Pulmonary Infection]
Concurrent CMV and candida albicans pneumonia in an
immunocompromised patient receiving chemotherapy
Nesrin Öcal, Tuncer Özkısa, Ömer Deniz, Hayati Bilgiç
Department of chest diseases, gulhane military medical academy, ankara, turkey
One of the most important factors for mortality and morbidity in patients with cancer are
infections. Infectious agents, especially in patients undergoing chemotherapy for malignancy, show
a broad spectrum from conventional microorganisms to opportunistic pathogens. Among these
agents fungi, virus such as CMV, and P. Jirovecii are most common ones. We present an exemplary
case for this issue.
49 years old male patient, receiving chemotheraphy for oral cancer, referred to our clinic for
shotness of breath and fever. Chest CT scan was obtained in order tı display lesions in chest X ray
more detailed. Bilateral but more pronounced in right lung, multifocal, thick-walled cavitation and
micronodular infiltration were seen and diagnostic bronchoscopy was performed.
Protected brush and lavage materials taken from the patient was sent to pathology and
microbiology laboratories. Considering the immunosuppression status received materials cultured
for CMV, p. Jirovecii, ARB and for non-specific agents. Pathological examination of brush
preparations showed fungal spores, and microbiological assessment of a patient's protected brush
materials were positive for CMV and Candida albicans. Antifungal treatment and gansiclovir were
added to patient's current wide-spectrum antibiotic and on day 15, significant clinical and
radiological improvement was observed.
We shared this case as an example of concurrent opportunistic infections C. albicans and CMV, and
remind that carefully sampled bronchoscopic examinations can direct to succesful treatment.
Keywords: Candida, CMV, cavity, immunosuppression
fıgure 2
a. before fluconazole and gansilov treatment b. day 15 with fluconazole treatment and gansilov treatment
fıgure 1
widespread, multifocal cavities and micronodular infiltrates
P389[Pulmonary Infection]
Septic Pulmonary Embolism, a Case Report
Nesrin Öcal, Tuncer Özkısa, Ömer Deniz, Hayati Bilgiç
Department of chest diseases, gulhane military medical academy, ankara, turkey
Septic pulmonary emboli, is a phenomenon characterized with hematogenous spread of coagulated
blood containing microorganisms from right heart to the lungs an and infarct and abscess
formations in lungs. It is associated with some precipitating situations such as congenital heart
disease, IV drug use, long-term catheter use. Septic pulmonary emboli has high morbidity and
mortality. Early diagnosis and broad-spectrum antibiotics are the main factors determining the
prognosis. From this point, here we offer a septic pulmonary emboli case.
Keywords: catheter, embolism, nodule, septic
fıgure 2
radiological improvement in day 20 of treatment
fıgure 1
multifocal nodular opacities before treatment
P390[Pulmonary Infection]
Socialdemographic and Clinical Findings in Adult Patients with Community
Acquired Pneumonia
Ayşın Şakar Coşkun1, Yavuz Havlucu1, Cemile Çetinkaya2, Aykut Çilli3, Burcu Karaboğa3, Oğuz
Kılınç4, Öznur Kılıç4, Sezai Taşbakan5, Canan Gündüz5, Armağan Hazar6, Fatma Gündüz6, Nurdan
Köktürk7, Esra Uzaslan8, Ayten Filiz9, Öner Dikensoy9, Mehmet Polatlı10, Abdullah Sayıner5
1
Celal Bayar University Faculty of Medicine Department of Chest Disease, Manisa, Turkey
2
Malatya State Hospital, Chest Disease Clinic, Malatya,Turkey
3
Akdeniz University Faculty of Medicine Department of Chest Disease, Antalya, Turkey
4
Dokuz Eylul University Faculty of Medicine Department of Chest Disease, İzmir, Turkey
5
Ege University Faculty of Medicine Department of Chest Disease, İzmir, Turkey
6
Süreyyapaşa Chest Disease and Chest Surgery Teaching Hospital, İstanbul,Turkey
7
Gazi University Faculty of Medicine Department of Chest Disease, Ankara, Turkey
8
Uludag University Faculty of Medicine Department of Chest Disease, Bursa, Turkey
9
Gaziantep University Faculty of Medicine Department of Chest Disease, Gaziantep, Turkey
10
Adnan Menderes University Faculty of Medicine Department of Chest Disease, Aydın, Turkey
In this study, we aimed to investigate the socialdemographic and clinical findings in adult patients
with community acquired patients (CAP).
1085 patients registered to “Pneumonia Data Base” that prepared by Turkish Thoracic Society
Respiratory Infections Scientific Assembly between January 2009 and January 2013 were included
to the study.Socialdemographic findings, symptoms, comorbidities, habits, history, physical
examination findings, laboratory and radiological findings, pneumonia severity groups, treatment
result, duration of hospitalization, and cost of disease treatment of patients were obtained from
“Pneumonia Data Base”..According to patients status, control of patients were done different
duration and symptoms,physical examination findings, laboratory and radiological findings,and
treatment results were recorded.
There were 67.7% male and mean age was 64.9±17.4 years.The most seen symptoms were cough
(87%), sputum(80.5%), fever(58.1%). Comorbidities were seen in 81.8% of patients and 59.5%
of patients had smoking history.Percentage of immunization with influenza vaccine was 14.6% and
8.2% with PPV. Sputum cultur positivity was 15.8% an blood culture positivity was 2.9%. In chest
radiography, percentage of consolidation, interstitial/patch involvement, cavitation, abscess, and
pleural effusion were 76.4%, 31.3%, 2.2%, 1.3%, and 22.1% respectively.43.6% of patients were
totally cured, 43.4% were partially cured, 5.9% were treatment failure and mortality rate was
7.1%.Mean value of PSI and CURB-65 scores were 12.25±24.6 ve 2.40±0.55.
Although comorbidities were commonly seen in adult patients with CAP, immunization rate was
found low. Microbiologic culture positivity was also found low.
Keywords: community acquired pneumonia, clinical findings, socialdemographic findings
P391[Pulmonary Infection]
A Rare Cause of granulomatous lung infection: Cat-Scratch Disease
Levent Özdemir1, Burcu Özdemir2, Suat Durkaya3, Ayşegül Kaynar4, Sema Nur Çalışkan2, Ali Ersoy5
1
Dörtyol State Hospital Chest Disease, Hatay
2
İskenderun State Hospital Chest Disease, Hatay
3
İskenderun State Hospital Torasic Surgery, Hatay
4
İskenderun State Hospital Patologia, Hatay
5
Antakya State Hospital Chest Disease, Hatay
Cat scratch disease (CSD), is an infection with chronic inflammation of the entry point of lymph
nodes draining in subjects with the normal immune system. Encephalitis, neuroretinitis,
granulomatous conjunctivitis, hepatosplenic involvement, pneumonia and thrombocytopenic
purpura, may also occur in the form of clinical presentations in patients with suppressed immune
systems.
50 year old female patient was evaluated with cough, fever, joint pain. In her history operation due
to hydatid cyst of the liver 4 years ago the and usage of the deltakortil for one year due to
rheumatoid arthritis was established. Nodule was found on the right lower lobe superior and upper
lobe on thoracic computed tomography. Laboratory examination was unremarkable except
leukocytosis. Sputum aerobic culture and AFB were negative. The patient underwent diagnostic
VATS. Pathology result has been reported as polymorphonuclear leukocytes in granulomas,
granulomatous disease except sarcoidosis and tuberculosis in the foreground as cat scratch disease
Keywords: granulomatous lung, Cat-Scratch
resim 1
resim2
P392[Pulmonary Infection]
Pulmonary Hydatıd Cysts Beıng Ruptured in the Course of Enterıc Fever; An
Unreported Case
Hanifi Yıldız1, Selami Ekin2, Hatice Beyazal Polat1, Fatma Beyazal Çeliker1, Ahmet Arısoy3
1
Department of Pulmonary Diseases, Private Lokman Hekim Hospital, Van, Turkey
2
Department of Pulmonary Diseases Yüzüncü Yıl University Medical Faculty, Van,Turkey
3
Department of Pulmonary Diseases, Private İstanbul Hospital, Van,Turkey
AIM: Hydatid Cyst (HC) and Typhoid Fever (TF) are endemic in our country. HC is parasitic, cystic
disease. Lung cysts are rarely ruptured. Here, we introduce ruptured HC case in TF course for the
first time.
CASE: 32-year-old female applied to emergency-service with fever, cough, nausea, vomiting, and
abdominal pain. Left-suprahiler area opacification wasn’t detected in radiography (Figure-1).
Infection and reflux treatments were implemented. Patient worsened on 3rd day and was referred
to our clinic. Reflux was detected on gastro-duodenal radiography. H-antigen and O were found as
1/400 and 1/100 in Widal test. Leukocyte CRP and HGB levels were measured as 4300mm3,
10.7g/dL and 207mg/dl. TF and reflux diagnosis was made. Ground-glass infiltration and cavitary
lesion in upper-left zone were detected via radiography (Figure-1).
The patient considered having tuberculosis and malignity was taken over by our clinic. Through
parental administration, 40mg/day methylprednisolone, 3g/day ampicillin-sulbactam, 400mg/day
ciprofloxacin and H2 receptor-blockers were implemented.
Temperature, pressure, pulse and respiratory rate were measured as 90/60mmHg, 38°C, 130/min,
25/min, respectively. Breath-sound decrease and crackles were detected in the left-hemithorax. CT
presented a ruptured upper-lobe cyst, germinal membranes, ground-glass infiltrates and pleuraleffusion (Figure-2). Andazol treatment was started. Indirect hemagglutination was positive (1/640
dilution). Abdominal ultrasound was normal. At 5th day, opacity reductions were detected and CRP
was 5 mg/dl. The patient refusing surgical treatment was discharged with oral-therapy. CT in 2ndmonth was normal except ancient ruptured-cyst (Figure-2).
CONCLUSION: Finally, it shouldn’t be ignored that pulmonary hydatid cyst can rupture during the
course of TF.
Keywords: Hydatid cysts, rupture, typhoid fever
Figure-1
Figure-1: In radiography scanned in emergency, the undetected left suprahilar opacity is observed (1A).
Cavitary lesion, ground-glass infiltrates and blurred left sinus are observed in the radiography scanned after 3
days (1B).
Figure-2
Figure-2: In CT scanned on 2nd day, ruptured left-suprahilar cyst, germinal membranes, ground-glass
infiltrates and pleural effusion are observed (A1 and A2). In CT scanned in 2nd month, only the ancient
ruptured hydatid cyst is observed (B1 and B2).
P393[Pulmonary Infection]
Bilateral intra-arterial hydatid cysts in an 60 year old man
Sibel Atış Naycı1, Eylem Sercan Özgür1, Meltem Nass Duce2, Cengiz Özge1, Esin Taştekin1, Ahmet
İlvan1
1
Department of Chest Diseases, Mersin University, Mersin, Turkey
2
Department of Radiology, Mersin University, Mersin, Turkey
Hydatid cysts are serious health problem. They usually involve the liver and lungs. Although
embolization of hydatid cyst to the pulmonary arteries is very rare, early diagnosis and treatment
is essential. This case report present a patient with bilateral intra-arterial hydatid cysts.
A 60 years old male presented with hemoptysis, cough, chest pain and night sweats for one year.
He had no known medical problems. Respiratory system examination revealed fine bilateral basal
crackles. Serum laboratory test results were as follows: sedimantation, 40(0-10 mm/h);CRP,
19.9(<5 mg/L); WBC, 7.04x109/L with 9.2% eosinophils(4.5-11x109/L).
Chest x-ray showing right hilar enlargement and consolidation adjacent to the diaphragm left lower
zone(fig.1). He was started on antimicrobial treatment. Sputum smear examination for acid-fast
bacilli was negative. Chest CT revealed multipl fluid attenuation filling defects in the bilateral lower
lobe pulmonary artery extending into, a cavitary lesion containing air and infiltration in the
posterolateral segment of left lower lobe and infiltration in the apical segment of right lower lobe
(fig.2). Abdominal ultrasonography was normal. Serological test for hydatid cyst was found
positive. Echocardiography was normal. Surgical treatment didn’t perform due to widespread
lesions. Albendazole was started. He remained well during third month of his treatment.
Hydatid cyst embolization to the pulmonary arteries is very rare and life threatening disease. The
diagnosis of this diseases may present some difficult, even in the endemic areas. Hydatid cysts
within the pulmonary arteries have a characteristic appearance on CT.
Recognition of clinical and radiologycal finding is crucial for early diagnosis and treatment.
Keywords: hydatid cysts, intra-arterial, pulmonary arteries
Figure 1
Figure 2
P394[Pulmonary Infection]
Syndrome of Inapropiate ADH secretion with pneumonia
Ersin Demirer, Yasin Uyar, Ömer Ayten, Tansel Kendirli, Faruk Çiftçi
GATA Haydarpasa Training Hospital İstanbul Turkey
INTRODUCTION: Malignancies, diseases of central nervous system, infections like tuberculosis,
pneumonia, empyema and lung abcess can cause to Syndrome of Inappropriate ADH secretion.
CASE: Twenty years old female patient admitted with a cough and sputum production for two
weeks. She was hospitalized with a prediagnosis of pneumonia after a consolidation was observed
at chest X-ray. She had a history of medulloblastoma operation and chemotherapy six months ago.
WBC: 2800, Hb: 10.7 and Hct: 37.5. Neutropil count was 70% at peripheral blood smear
evaluation. Sedimentation rate was 106 mm/h and CRP was 249 mg/L. Na was 122 mEq/L and K
was 4 mEq/L at blood chemistry. Anorexia, nausea and vomiting were observed. ABG results were
as follows; pH: 7.25, pCO2: 55. She had epileptic seizures. Serum osmolarity was 240 mOsm/kg
while urine osmolarity was 530 mOsm/kg. Piperacillin/tazobactam and levofloxacin were
administered. A mass lesion with a diameter of 4x2.5 with undefined borders at right lung
anteromediobasal segment and nodular areas with patchy ground glass dansities at other basal
segments were observed at Chest CT. NaCl solution of 3% was used in the treatment of
hyponatremia. Pneumonia was treated and symptoms of hyponatremia disappeared.
CONCLUSION: Severe hyponatremia may be observed in patients with malignancy. Syndrome of
Inappropriate ADH secretion can also be observed in infectious diseases.
Keywords: pneumonia, syndrome of inappropriate ADH secretion
P395[Pulmonary Infection]
Multivariate analysis of some inflammatory and immune survival predictors
in patients with severe CAP
Kseniia Bielosludtseva, Tetyana Pertseva, Tetyana Kireeva
Department of faculty therapy, Dnipropetrovsk Medical academy
OBJECTIVES: to determine the significance of markers CD4, CD8, procalcitonin (PCT) and Creactive protein (CRP) as a predictor of survival in patients with severe CAP.
METHODS: 51 patients with verified severe CAP without HIV (age – 57,50±4,31 years, men – 37
(72,5%), women – 14 (27,5%)). General analysis, determination of serum PCT and CRP; CD4, CD8
prior
ABT
(visit
1),
on
8–10
day
of
ABT
(visit
3),
cluster
analysis.
RESULTS: in 6 (11,7%) patients with severe CAP, despite adequate ABT, lethal end of disease was
determined. All patients were separated on 3 classes: 1) whose PCT at visit 3 decreased by more
than 95,6% and CD4 increased significantly (by more than 335,7%) we can predict recovery with a
maximal probability; 2)patients whose PCT at visit 3 decreased by more than 95,3% and CD4
increased by more than 4,7%, have a chance to recover, although the risk of death and pulmonary
complications is high; 3)patients whose PCT decreased very slightly (by 1%) or significantly
increased (by more than 11,460%) and CD4 decreased by more than 50% have a maximum risk of
death.
CONCLUSIONS: with a substantial reduction of PCT and increase of CD4 during the adequate ABT
a favorable outcome of severe CAP can expect, whereas at the increasing of PCT and decreasing of
CD4 the survival is unfavorable.
Keywords: severe CAP, prognosis, predictors
P396[Pulmonary Infection]
Role of inflammatory markers as survival predictors in patients with severe
CAP
Kseniia Bielosludtseva, Tetyana Pertseva, Tetyana Kireeva
Department of faculty therapy, Dnipropetrovsk Medical academy
OBJECTIVES: to determine the significance of markers procalcitonin (PCT) and C-reactive protein
(CRP)
as
a
predictor
of
survival
in
patients
with
severe
CAP.
METHODS: 51 patients with verified severe CAP without HIV (age – 57,50±4,31 years, men – 37
(72,5%),women – 14 (27,5%)). General analysis, determination of serum PCT and CRP prior ABT
(visit
1),
on
8–10
day
of
ABT
(visit
2),
statistic.
RESULTS: in 6 (11,7%) patients with severe CAP, despite adequate ABT, lethal end of disease was
determined. Comparative evaluation of initial and final clinical and laboratory dataof survivors and
deceased patients with sCAP, found that at baseline all patients were characterized by pronounced
inflammatory response, regardless of the outcome of treatment.While the final data obtained that
levels of PCT and CRP were significantly different among the dead and the survivors patients. In
this case, there was a clear pattern: the patients who survived, there was a decreasein the level of
inflammatory markers, and those who died – on the contrary, the dynamic increase in PCT and CRP
determined
(table
1).
CONCLUSIONS: initial level of PCT cannot be a survival predictor of severe CAP, therefore the
dynamic decrease of PCT (more then by 78%) is a favorable survival predictor.
Keywords: severe CAP, prognosis, predictors, markers
Dynamics of general inflammatory parameters in patients with severe CAP depending on
the outcome of the disease
Initial data
(visit 1)
Initial data
(visit 1)
Final data
(visit 3)
Final data
(visit 3)
survivors (n=45)
died
(n=6)
survivors (n=45)
died
(n=6)
PCТ, ng/ml 17,9±3,9^
23,7±8,4
0,08±0,01*^
36,5±11,6*
СRP, mg/l
309,3±38,9 39,9±4,7*^
parameter
262,8±18,2^
579,1±74,3*^
N o t e s: 1. * – рs-d˂0,05 by the Mann-Whitney; 2. ^ – pv1-v3˂0,05 by Wilcoxon;
P397[Pulmonary Infection]
Different clinical, immunological and inflammatory predictors for survival at
patients with severe CAP from the position of multifactor analysis
Kseniia Bielosludtseva, Tetyana Pertseva, Tetyana Kireeva
Department of faculty therapy, Dnipropetrovsk Medical academy
OBJECTIVES: to determine
inflammatory markers as
the significance of clinical parameters, immunological and
a predictors of survival in patients with severe CAP.
METHODS: 51 patients with verified severe CAP without HIV (age – 57,50±4,31 years, men – 37
(72,5%), women – 14 (27,5%)). General analysis, SMRT-CO count, determination of serum
procalcitonin (PCT) and C-reactive protein (CRP); CD4, CD8 prior ABT (visit 1), on 8–10 day of ABT
(visit
2),
multufactor
analysis.
RESULTS: in 6 (11,7%) patients with severe CAP, despite adequate ABT, lethal end of disease was
determined. It was found that the most influential clinical criteria were the values of temperature
and respiratory rate, which factor loadings were 0,99 and 0,91 respectively. While the factor
loadings of scale SMRT-CO was minimal and amounted 0,59, which was less than the factor
loadings
of
heart
rate
and
SaO2
separately.
In evaluating of the factor load among laboratory parameters the most significant were CD4 (0,7),
CD8 (0,8), ΔCD4 (0,77), ΔPCT (0,7) and the value of band neutrophils (0,71). The immunological
markers were more influential than general inflammatory, factor loadings of ΔCD4, ΔCD8, ΔPCT
were higher than the initial data of them. Minimal impact on the system (about 0,5) had the results
of CRP and white blood cells, which resulted in the exclusion of these parameters from the further
statistical
analysis.
CONCLUSIONS: 1) SMRT-CO cannot be survival predictor at patients with CAP; 2)the most
significant laboratory predictors of outcome in patients with severe CAP is dynamics of CD4 and
PCT.
Keywords: severe CAP, progmosis, predictors
P398[Pulmonary Infection]
Role of procalcitonin (PCT) in diagnosis, treatment and prognosis of severe
CAP
Kseniia Bielosludtseva, Tetyana Pertseva, Tetyana Kireeva
Department of faculty therapy, Dnipropetrovsk Medical academy
OBJECTIVES: to determine the significance of marker PCT as a diferential diagnostic parameter,
parameter of efficiency and sufficiency of ABT, survival predictor in patients with severe CAP.
METHODS: 72 patients with probable severe CAP. General analysis, determination of serum PCT
prior ABT (visit 1), on 3-4 day of ABT (visit 2), on 8–10 day of ABT (visit 3), statistic.
RESULTS: At all patient with verified severe CAP (n=62) serum PCT was more then 0,5 ng/ml
(18,7±3,62 ng/ml) (norm - up to 0,05 ng/ml), at other - less then 0,1. At visit 1 all patient with
verified severe CAP had different serum PCT depending on ethiology: maximal - at Grammnegative respiratory agents (52,5±12,63 ng/ml); medium - at Gramm-positive ones (12,8±3,56
ng/ml); minimum - at pneumocystis pneumonia at HIV-infected patients with pneumonia
(2,81±2,42 ng/ml). At visit 2 at 8 from 51 patient without HIV with negative effect of ABT had
increase dinamic of PCT, which was the couse of ABT change. At visit 3 in 6 (11,7%) patients with
severe CAP, despite adequate ABT, lethal end of disease was determined. At the patients who
survived there was a decrease in the level of PCT (from 17,9±3,9 ng/ml at visit 1 to 0,08±0,01 at
visit 3), and those who died – on the contrary, the dynamic increase in PCT (from 23,7±8,4 ng/ml
to
36,5±11,6
ng/ml)
determined.
CONCLUSIONS: PCT and its dynamic is effective diagnostic and prognostic parameter, ethiological
marker of severe CAP and marker of efficiency and sufficiency of ABT
Keywords: severe CAP, procalcitonin, marker
P399[Pulmonary Infection]
Community Acquired Methicillin Resistant Staphylococcus aureus
Pneumonıa: A Case Report
Hale Ateş, Duygu Özol, Bülent Bozkurt
Turgut Ozal University, Department of Chest Diseases, Ankara
Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections are
becoming increasingly prevalent and causing increasingly fatal problems in healthy individuals.
The most common manifestations of CA-MRSA infections are skin and soft tissue infections and
pneumonia. We met CA-MRSA pneumonia cases rarely in our literature scan. We presented in this
case report the case which has hospitalized with diagnosis of community acquired pneumonia and
thougt the cause of MRSA.CA-MRSA pneumonia may be hemorrhagic or necrotizing, is commonly
associated with multilobar infiltrates or cavitation, and may be complicated by hemoptysis, pleural
effusion or empyema. Infections due to CA-MRSA have symptom onset before or within 48 h of
admission to hospital and patients have no significant previous healthcare contact. CAP, which is
due to CA-MRSA, individual with rapidly progressive, severe respiratory disease. In our case there
were clinical symptoms that has started ten days ago and exacerbated the last three days,
progressed to respiratory failure within a day. Despite we started ceftriakson, meropenem and
clarithromycin treatment respectively, our patient’s high fever continued and clinical improvement
wasn’t observed. Although there is no reproduction in culture we thought the cause of MRSA and
began to linezolide our case. After the linezolide treatment patient’s fever fell, dyspnea and
tachypnea healed, the opacity in chest X-ray regressed, CRP levels dropped and we concluded that
the patient sees the benefit from the treatment.
Keywords: Community associated pneumonia, MRSA
FİGURE3
FİGURE4
P400[Pulmonary Infection]
Diagnosis and treatment of a fungal lung abscess confused with tumor in a
renal transplant patient
Mustafa Ilgaz Doğrul1, Emire Pınar Seyfettin1, Müşerref Şule Akçay1, Gaye Ulubay1, Merih
Tepeoğlu2, Füsun Öner Eyüboğlu1
1
Department of Pulmonary Medicine, Baskent University, Ankara, Turkey
2
Department of Pathology, Baskent University, Ankara, Turkey
Male, 47 year old renal transplant recipient admitted to our clinic with right shoulder and back pain
for 3 weeks. His CRP was 256.3 mg / L, and leukocyte was 21x103/ mL. His smoking history was
15 pack-year. His chest x-ray was consistent with radiopacity at the right upper zone. Thoracic CT
(with no contrast) and thoracic MR was performed. A soft tissue mass (55x33mm) was detected in
the retrosternal space at the apex of the right lung extending from the posterior of the pectoral
muscle to anterior mediastinum. As endobronchial lesion was negative at fiberoptic bronchoscopy,
transthoracic biopsy was performed under CT. Pathologic findings were consistent with abscess,
abscess wall and suspicious fungal spores which stained with PAS. Second transthoracic biopsy was
repeated and pathologic finding was similar. Tissue biopsy cultures were negative. Serum
galactomannan, procalcitonin, tumor markers and CMV PCR were negative. There are no focus for
infection in dental examination. Empiric piperacillin-tazobactam was started but our patient's fever,
CRP and WBC levels were remained high. Iv voriconazol was added to his antibiotherapy because
of fungal spores detected in biopsy and his chest symptom relieved and his CRP, leukocytes levels
were regressed. The patient was discharged with oral voriconazole. In the eighth week of his
antifungal treatment; his clinical, laboratory and radiological findings were improved thus, it was
decided that the patient continued voriconazole treatment until radiological and biochemical total
regression. Insisting long-term antifungal treatment may cure huge fungal abscesses mimicking
severe tumoral lesion without surgical intervention.
Keywords: abscess, fungal, lung, renal, transplant
P401[Pulmonary Infection]
Hospital acquired low repiratory tract infection caused by A. baumannii
Sibel Doruk1, Handan İnönü Köseoğlu1, Gülgün Yenişehirli2, İlker Etikan3, Dursun Ali Sağlam4, Ayşe
Yılmaz1, Süheyla Kaya5, Özgür Günal6
1
Gaziosmanpasa University Department of Pulmonary Medicine
2
Gaziosmanpasa University Department of Microbiology
3
Gaziosmanpasa University Department of Bioistatistics
4
Ankara Training and Research Hospital department of anesthesy and reanimation
5
Gaziosmanpasa University Department of Internal Medicine
6
Gaziosmanpasa University Department of Infectious Diseases
OBJECTIVE: A.baumannii is a major cause of nosocomial infections. The treatment of infection is
difficult especially in critically ill patients. We aimed to evaluate general properties of cases with
low repiratory tract infection (LRTI) caused by A.baumannii. We also aimed to determine the
mortality.
METHODS: We investigated clinical data of cases with LRTI caused by A.baumannii treated in adult
intensive care unit in 2009-2013.
RESULT: We evaluated 87 patients (male/female: 56/31). All of the A. baumannii isolates were
resistant to gentamisin, III-IV. generation sephalosporines and quinolones. The resistance rates to
carbapenems in 2009 and 2010 were 28.6% and 33.3%, respectively. In the last 3 years the
carbapenem resistance rate was 100%. The overall mortality rate was 64.4%. We did not find any
effect of hypoalbuminemia, hypo/hyper natremia, uremia and any invasive procedurs performed in
ICU like parenteral/enteral feeding, oro/naso gastric feeding tube, cardiopulmonary resuscitation,
santral venous catheterization and intubation on mortality. However traceostomy increased
mortality four times and the mortality was higher in cases older than 65 /years.
CONCLUSIONS: Carbapenem resistance increases over the years. Invasive procedurs performed
in ICU do not affect the mortality except traceostomy. Mortality rate is higher in cases older than
65 /years and traceostomy increases the mortality four times.
Keywords: A.baumannii, multidrug resistant A.baumannii, broad spectrum antibiotics,
carbapenems, intensive care unit, mortality
P402[Pulmonary Infection]
Candida glabrata pneumonia: A case report
Meltem Çoban Ağca1, Tülay Yarkın1, Ebru Sulu1, Candan Elmalı2, Ahmet Balıkçı3, Begüm Arıtan1,
Mürşide Demirhan Uzun1
1
Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital, Department of
Chest Disease, Istanbul, Turkey
2
Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital, Department of
Pathology, Istanbul, Turkey
3
Süreyyapaşa Göğüs Hastalıkları ve Göğüs Cerrahisi Eğitim ve Araştırma
Hastanesi,MikrobSüreyyapaşa Göğüs Hastalıkları ve Göğüs Cerrahisi Eğitim ve Araştırma Hastanesi,
Department of Microbiology, İstanbul, Turkey
Although Candida glabrata is a saprophytic agent of the normal flora in healthy individuals, it may
lead serious pneumonia in immunosupressive patients. As a rare cause of pneumonia, it accounts
for up to 20% of pulmonary Candidiasis. Treatment is difficult, because of the frequent resistance
to antifungal agents.
An 80-year-old man previously diagnosed COPD was admitted to our center because of
breathlessness. He was dyspneic, tachypneic, and tachycardic. SpO2 was 82% at the room air; the
laboratuary findings were as follows: WBC 31.000/mm3, urea 53mg/dl, creatinin 2.83mg/dl, Creactive protein(CRP) 300mg/dl. Radiography showed consolidation in the middle and lower zones
of the right lung. Moxifloxacin (400mg/d,IV)was administered, and CRP decreased to 140mg/dl on
the third day of therapy while radiological progression was noticed. Besides the clinical situation
was unchanged, and we added piperacillin-tazobactam. Partial improvement was provided with this
therapy, and SpO2 arised over 90%. However there was no radiological change. Malignity was
suspected. Citological examination of sputum was revealed intensive fungal hyphae and spores.
Fiberoptic bronchoscopy was applied, there was whitish plaques on the nasopharynx mucosa, and
intensive thick secretion hardly aspirated all over the tracheo-bronchial tree. Candida glabrata was
growth in the bronchial lavage. Fluconazole was administered, and the clinical status improved
dramatically. Now, he is very well on the third month of the treatment, and radiology is gradually
improving.
CONCLUSION: Fungal infection should be suspected in case of severe pneumonia which is showed
no improvement with the broad-spectrum antibiyotics
Keywords: Candida glabrata, fluconazole, pneumonia
Pıcture 1
First day of hospitalizasyon
Pıcture 2
Citological examination of sputum;intensive fungal hyphae and spores
P403[Pulmonary Infection]
Outcomes of Middle Lobectomy Operation for Middle Lobe Syndrome
Hakan Kıral, Hakan Yılmaz, Serdar Evman, Levent Alpay, Cansel Atinkaya, Çağatay Tezel, Volkan
Baysungur, İrfan Yalçınkaya
Sureyyapasa Chest Disease and Chest Surgery Education and Research Hospital, Istanbul, TURKEY
AIM: Middle lobe syndrome is a rarely encountered condition. Surgery still is the definitive
treatment of choice for cases resistant to conservative medication. The clinical indications,
feasibility, effectiveness, and safety of surgical resection in treatment of middle lobe syndrome are
evaluated.
Patients and
METHOD: Clinical files of eight patients undergoing middle lobectomy for middle lobe syndrome in
our clinic between 2008 and 2013 are examined retrospectively. Patient demographics,
preoperative treatment duration, surgical techniques used and outcomes are analyzed respectively.
RESULTS: There were 6 female and 2 male patients, with an age average of 37.9(22 to 59).
Symptoms on admission were cough in 62.5%, shortness of breath in 37.5%, hemoptysis in
12.5%, and chest pain in 12.5%. Mean duration of these symptoms before the operation was
8.1(1-20) years. Middle lobectomy was performed via posterolateral thoracotomy in 5 and via
video-assisted thoracoscopic surgery(VATS) in 3. Mean chest drain duration was 2.6 days in
thoracotomy and 2.0 days in VATS group. Mean hospital length of stay of the patients was 3.9(2-5)
days; 3.8 for thoracotomy and 4.0 days for VATS groups, respectively. Re-thoracotomy was
necessitated in one patient for postoperative hemorrhage. No other complication was seen, with
overall postoperative morbidity calculated as 12.5%. No mortality was observed. The diagnosis of
all patients was confirmed by definitive pathological examination as bronchiectasis.
CONCLUSION: Middle lobectomy is an effective choice of treatment for middle lobe syndrome,
with low morbidity rate and short hospital length-of-stay. Either thoracotomy or VATS can be
applied safely.
Keywords: Bronchiectasis, Middle Lobectomy, Middle Lobe Syndrome
P404[Pulmonary Infection]
A rare pulmonary pathogen mimicking metastasic cancer: Streptomyces
Burcu Yalçın1, Serhat Erol1, Ayriz Tuba Gündüz2, Yasemin Özdoğan1, Serpil Tekgül1, Barış Yılmaz1,
Mehmet Ufuk Yılmaz1, Enver Yalnız1
1
Izmir, Dr. Suat Seren Chest Disease and Surgery Training and Research Hospital, Izmir Dept. of
respiratory disease.
2
Izmir, Dr. Suat Seren Chest Disease and Surgery Training and Research Hospital, Izmir. Dept. of
Clinical Microbiology
56- year- old male patient was referred to our hospital for cough and sputum production and
bilateral upper zone nodules at chest x-ray. His medical history was remarkable for nephrotic
syndrome and he had been receiving corticosteroid therapy for last two months. Laboratory test:
CRP: 10.2 mg/dL, ESR: 104 mm, WBC: 10400. Computed tomography of chest revealed pleura
based nodules in the right and left lower lobes. At admission patient was ordered intravenous
ceftriaxone. Bronchoscopy performed and there wasn’t any endobronchial lesion. Bronchial washing
staining and cultures were negative for tuberculosis and fungal infections. nonspesific bronchial
washing cultures grew Streptomyces. But it was at a concentration of 10³ CFU/mL 18 Ffluorodeoxyglucose positron emission tomography performed. Both left lower lobe and right lower
lobe nodules showed high FDG uptake. Transthoracic fine needle aspiration performed. Cytologic
findings were negative for malignancy. Staining was negative for tuberculosis or fungal infections.
Cultures were negative for Streptomyces.. One month after first admission second ct scan
performed. Regression of both nodules confirmed. Also high WBC,CRP and ESR were became
nearly normal. Nodules were caused by Streptomyces and with ceftriaxone therapy they were
disappeared. Pulmonary streptomyces infection is a rare disease especially diagnosed at
immunocopromised patients. Pleural effusion, infiltration and nodules can be seen at chest x-ray or
thorax ct. But as our case showed, shorter duration of therapy can be enough for selected patients.
We believe that, length of the therapy must be decided according to the severity and chronicity of
the underlying disease.
Keywords: metastatic Cancer, PET-CT involvement, Streptomyces Infection
P405[Pulmonary Infection]
Case Of Recurrent Pulmonary Aspergilloma
Ayşem Aşkım Öztin Güven, Sibel Arınç, Umut Sabri Kasapoğlu, Murat Kavas, Begüm Arıtan
Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital
Pulmonary aspergilloma commonly develops as a result of aspergillus colonization in tuberculosis,
sarcoidosis and bullous emphysema cavities. We present rarely seen a case with recurrent
pulmonary aspergilloma. 57 years old male patient admitted our clinic with hemoptysis. Two years
ago, right upper lobectomy was underwent due to pulmonary aspergilloma. After operation, patient
not received any treatment. CT scan of the patient; showing cavity disease on the right upper lobe.
Fiberoptic bronchoscopy was performed and a yellow-white plagues were observed in right lower
lobe. Blood and bronchoscopic lavage Aspergillus galactomannan antigen was negative. The patient
was started on oral voriconazole treatment and hemoptysis stopped. Side effects were not
observed. Bronchoscopy was done again after 6 months of this therapy. Plaque lessions in the right
lower lobe were regressed. Oral voriconazole treatment is useful for endobronchial aspergilloma.
Keywords: Aspergilloma; pulmonary; voriconazole.
Pretreatment bronchoscopy findings
Post treatment bronchoscopy findings
P406[Pulmonary Infection]
Assessment of long term prognosis of hospitalized patients with community
acquired pneumonia
Burcu Karaboğa1, Aykut Çilli1, Deniz Özel2
1
Department of Chest Diseases, Akdeniz University, Antalya, Turkey
2
Department of biostatistics, Akdeniz University, Antalya, Turkey
Community acquired pneumonia(CAP ) is a fatal infectious disease. The aim of this study, patients
admitted to the hospital after discharge early(1 month) and late mortality(3 months, 12 months)
determine rate and associated factors. For this purpose, age, sex, comorbidity, clinical and
laboratory findings, radiological features, cigarette use in the last 3 months of hospitalization,
antibiotic use, duration of hospitalization, used group of antibiotics, antibiotic changes, systemic
steroids, use of immunosuppressive, treatment success, PSI and CURB -65 severity scores were
recorded. In study between October 2009 and May 2013 who were hospitalized a total of 225
patients with CAP records were retrospectively. 145 of the patients(65.8%) were male and the
mean age was 62.8 years. Mean follow-up 3.2 years. 86% of patients had one comorbidity, and the
most common co-morbidities of DM,CAD, COPD. Early mortality rate was 9% (20 patients), 90 day
mortality was 12% (28 patients) and one year later mortality was 10% (23 patients). PSI and
CURB-65 score early and long term increased risk of mortality(p=0.001) and 3 days level decrease
is not enugh of CRP mortality was significantly greater(p=0.001). In our group of patients with comorbidities a significant relationship between early and late mortality were detected. Changed
treatment because of treatment failure in patients was significantly higher mortality in all
groups(p=0.001). Three mortality group comparison were similar findings and were not
significantly different. Consequently, high in long - term mortality in existence severity of disease,
and more is associated with treatment failure.
Keywords: pneumonia, 30 days mortality, long term mortality
P407[Pulmonary Infection]
Pneumonia Caused By Fuel Oil Aspiration
İbrahim Koç, Ayşen Dökme
Viranşehir State Hospital
21 yeras old miliraty personel was admitted to the emergency clinic with complaints of shortness of
breath, chest pain and fever. He had no previos medical history. His physical examination was
fever 38 C°, heart rate of 95 beats per minute, blood presure of 120/70mmHG, respiratory rate of
24 breaths per minute, oxygen saturation at room air was 90%. On oscultation of the lungs
revealed ronchi on all lung fields. On enquiry, he revealed to have siphoned the diesel tank an hour
ago. During the siphonhoning suddenly suffered from cough and tightness of breath. Chest X-ray
revealed consolidative area on the right mid-lover zone. Computed tomography of the lungs
revealed consolidative area with airbroncograms in the right middle lobe. The patient was
desaturated, tachipneic and dyspneic thus was taken to the intensive care unit. The patient was
treated with antibiotherapy and non-invasive mechanic ventilation when was tachipneic.
Pneumonia due to diesel fuel aspiration is a rare form of acute pneumonitis, develops after
aspiration of petrolium products. Children, animators those who make performance with fire-eating
or people who deal with petroleum products are under the risk of this type of pneumonitis as a
result of aspiration of these chemicals. Clinical features, duration of diseases and outcome of
diseases differs among patients. It is characterized by symptoms such as dyspnea, cough, chest
pain, fever and lung consolidations. Treatmant includes antibiotherapy, supportive care and in
cases of lipoid pneumonia steroids which is controversial.
Keywords: Aspiration, fuel oil,, pneumonia
P408[Respiratory Failure and Intensive Care ]
Causes of mortality of 38 patients who died in intensive care
Ahmet Arısoy1, Hilmi Demirkıran2, Hülya Günbatar3, Selami Ekin3, Bünyamin Sertoğullarından3
1
Pulmonary Medicine, Private Istanbul Hospital, Van, Turkey
2
Anesthesiology and Reanimation, Private Istanbul Hospital, Van, Turkey
3
Pulmonary Medicine, YYU Medikal Faculty, Van, Turkey
OBJECTIVE: Infections of intensive care units are the most important cause of mortality in
intensive care. In our study; we investigated causes of mortality in intensive care patients who
died between January and June 2013. Materialand
METHODS: We reviewed the records of intensive care patients retrospectively between 1 January
2013 and 30 June2013. Age, gender, reasons of the first accept the intensive care unit, staying
days in intensive care, mortality reasons, the bacteries isolated from who died of ventilator
associated pnömonia(VAP), and chest X-rays evaluated.
RESULTS: We investigated 38 patients who died in intensive care unit between January 2013June 2013. Of these patients, 14 patients (37%)ventilator-associated pneumonia, 9 patients (24%)
cerebro vascular accident, 6 patients (16%)heart failure, 2 patients (5%) massive pulmonary
embolism, 2 patients (5%)malignancy, 1 patients (2.5%) gastric cancer and pneumonia, 1 patient
(2.5%) died due to hepatic encephalopathy. 2 patients (5%)the exact cause of mortality could not
be determined. One patient(2.5%) have been gaven to organ transplantation due to diagnosis of
brain death. All of the patients who died due to VAP hospitalized more than 7 days. (Mean 16.5
days) The number of hospitalized patients more than 7 days were 24. Mortality rate was 58% in
these patients by VAP. Patients numbers were 16 who stayed more than 10 days. Mortality rate by
VAP was %75 whp sated more than 10 days.
CONCLUSION: Nowadays, infections of intensive care units, the most important cause of mortality
in intensive care. To prevent infections in intensive care, is far more important than cure.
Keywords: Intensive Care; Mortality; Pneumonia, Ventilator-Associated
Table 1
Age
Reason of acceptance intensive
care unit
Stayed number of days in
intensive care unit
Produced
microorganisms
59
COPD
13
ProteusMirabilis
58
SVO
8
Large number of
colonies
9
Serebral Palsy
7
NFGNB
72
SVO
13
Large number of
colonies
66
SVO
15
Large number of
colonies
22
Suicid
35
NFGNB
73
SVO
12
NFGNB
16
SSPE
18
Klebsiella
62
ISH
24
Enterobakter+NFGNB
90
Heart Failure
18
Large number of
colonies
78
SVO
10
NFGNB
75
COPD
17
P. aeroginosa
77
SVO
18
ProteusMirabilis
77
SVO
23
Klebsiella
Characteristics of patients who died of ventilator-associated pneumonia
P409[Respiratory Failure and Intensive Care ]
ARDS after bee sting
Ahmet Arisoy1, Hilmi Demirkıran2, Hüseyin Akdeniz3
1
Pulmonary Medicine, Private Istanbul Hospital, Van, Turkey
2
Anesthesiology and Reanimation, Private Istanbul Hospital, Van, Turkey
3
Radyology, Private Istanbul Hospital, Van, Turkey
33 year old female patient was admitted to our emergency department because of dyspnea that
was developed after bee sting. There weren’t any complaints excluding dyspnea. She didn’t have
swelling of the face or throat, pruritis, rash. Her respiratory rate was 30/min, arterial blood
pressure was normal, saturation was %74 by pulse oksimetry in emergency department. She was
taken to intensive care unit. Chest x-ray was taken. She had bilateral infiltrates on chest
radiograph. pH was 7.3, pO2 was 35 mmhg, pCO2 was 30 mmhg and her saturation was %75 in
her blood gases that was taken without oxygen. Her pO2/fiO2 ratio was 1.66. Complete blood
count and blood chemistry values were normal. İn chest CT, she had bilateral ground glass patcy
areas and plural effusion. Echocardiography was completely natural that was performed cardiology.
Dexamethasone, antihistamines, adrenaline and NIMV were began to her because of anaphylactic
reactions and respiratory failure. She was followed for three days in intensive care, after her
saturation was above %90 and her respiratory rate was 30/min than she was taken to pulmonary
clinic.
Keywords: Respiratory Distress Syndrome, Adult; Insect Bites and Stings; Anaphylaxis
Figure 1
Bilateral infiltrates
Figure 2
Two-sided pleural effusion and ground glass opasities
P410[Respiratory Failure and Intensive Care ]
Disseminated Tuberculosis In An Immunocompetent Host: Diagnosed by
Liver Fine Needle Aspiration Biopsy
Sibel Atış Naycı1, Eylem Sercan Özgür1, Orhan Sezgin2, Tuba Kara3, Cengiz Özge1, Gamze
Çavuşoğlu1, Ahmet İlvan1
1
Department of Chest Diseases, Mersin University, Mersin, Turkey
2
Department of Gastroenterology, Mersin University, Mersin, Turkey
3
Department of Pathology, Mersin University, Mersin, Turkey
Disseminated tuberculosis results from hematogenous dissemination of mycobacterium
tuberculosis. Extrapulmonary sites of infection commonly include lymph nodes, pleura, and
osteoarticular areas, involvement of the liver is rare. We report a patient with disseminated
tuberculosis with involvement of the lung and liver, and diagnosed with liver fine needle aspiration
biopsy.
48 year old female presented with a non-productive cough, dyspnea and fever for one month. The
physical examination: body temperature 39°C, pulse rate 95/min, blood pressure 140/90 mmHg
and respiratory rate 27/min and fine bilateral basal crackles. Chest radiograph revealed bilateral
reticulonoduler infiltrates(Fig.1). Laboratory findings showed that AST:167, ALT:177, LDH:582,
WBC:7310, CRP:121. Arterial blood gas analysis was consistent with a severe hypoxemic
respiratory failure. Chest CT showed diffuse bilateral ground glass opacities. Sputum smears for
acid-fast bacilli were all negative. Bronchoscopy wasn’t performed due to the poor condition of the
patient. Abdominal ultrasonographic revealed periportal fibrosis. Pathology of the liver biopsy
showed that chronic granulomatous inflammation with caseous necrosis. Systemic anti-tuberculous
drugs were started although elevated liver enzymes. Clinically and radiological findings were
improved and liver enzyme was rapidly decreases on 10 days of treatment. She remained well
during third month of her treatment.
The tuberculosis infections may cause a wide variety of different clinical diseases even if an
immuncompetent patient. Disseminated tuberculosis can be primary progressive with an acute
onset and rapid clinical course. So rapidly diagnosed and initiation of therapy is crucial. We think
that different non routine diagnostic methods needs to be considered in patients with rapid
progression.
Keywords: disseminated tuberculosis, fine needle aspiration biopsy, immunocompetent
Figure 1
Chest radiography on admission
P411[Respiratory Failure and Intensive Care ]
Effect Of Tracheostomy On Weaning And Prognosis İn The Respiratory
Failure Cases
Hanifi Yıldız1, Bülent Özbay2, Bünyamin Sertoğullarından3, Selami Ekin3, Hülya Günbatar3, Aysel
Sünnetçioğlu3, Ahmet Arısoy4
1
Region Education and Research Hospital, Department of Chest Disease, Van, Turkey
2
Department of Chest Diseases, Sıtkı Koçman University, Faculty of Medicine, Muğla, Turkey
3
Department of Chest Diseases, Yuzuncu Yil University, Faculty of Medicine, Van, Turkey
4
Department of Chest Disease, Private İstanbul Hospital, Van, Turkey
AIM: Comparison of weaning and prognosis in tracheostomy applied and non-applied patients who
undergone mechanical ventilation in intensive care.
METHODS: We studied 50 patients prospectively who had invasive mechanical ventilation because
of respiratory failure in between 2007-2009 years. Surgical tracheostomy was applied in elective
conditions to prolonged hospital staying. Patients were divided into two groups as tracheostomy
applied (Group-I) and non applied (Group-II). The groups were compared according to APACHE II
score, intensive care unit and mechanical ventilation time, weaning and mortality.
RESULTS: The study composed of 50 patients that 31 men and 19 women (24 with tracheostomy,
26 without tracheostomy). Mean age of group-I was 50±18, Group-II 61±18(P=0,041).
Distribution of groups according to diagnosis, age and gender is seen Table-I. Pneumonia and
cerebrovascular disease were higher in group-I (p<0,05). APACHE II score, mean age and the
number of patients with acute renal failure were higher in group-I. There were non statistical
reduction in the number of weaning in the group-II (Figure-I). Group-I had prolonged intensive
care unit staying and mechanical ventilation, lower mean age and APACHE II score (p<0,05). There
weren't significant increase in mortality in groups-II compared to group-I (Figure-II). In the groupI, while transient tracheal stenosis in one patient, the pneumothorax developed in another patient
who was weaned. In logistic regression analysis, Over 23,5 APACHE II score was correlated with
mortality (Sensitivity 71% and specificity 68%).
CONCLUSION:
Consequently, in prolonged respiratory failure, tracheostomy hasn't related statistically beneficial
effect on weaning and prognosis.
Keywords: prognosis, respiratory insufficiency, tracheostomy
Figure-I
Rate of weaning in patients with and without tracheostomy
Figure-II
Mortality rate of patients with and without tracheostomy.
Table-I
MAIN DIAGNOSES
Group-I
Group-II
(Number) (Number)
P-Values
KOAH
9
0,4
7
Pneumonia
12
5
0,021
Cerebrovascular disease
20
11
0,004
Acute Renal Failure
1
9
0,011
Those diagnosed with Multiple 9
12
0,578
Men / Women
14/10
17/9
0,772
Age (years)
(50 ± 18) (61 ± 18,) 0,041
Distribution of groups according to diagnosis, age and gender
P412[Respiratory Failure and Intensive Care ]
Two patients with ARDS
Ayşe Yılmaz, Dursun Ali Sağlam, Savaş Gegin, Semih Arıcı, Şener Barut, Fazilet Duygu, Handan
İnönü Köseoğlu, Serhat Çelikel
Gaziosmanpasa University Faculty of Medicine
INTRODUCTION: ARDS is a clinic manifestation caused the profound hypoxemia and sudden
bilateral pulmonary infiltrates; PaO2/FiO2<=200 mmHg and left heart failure does not depend on.
Case 1:63 year old male patient with multiple myeloma. Emergency was admitted due to high
fever for 4 days. The first chest radiograph was normal, he had crackles at left baseline and satO2
was 92%. He was taking prophylactic bactrim; he began quinolone and added tamiflu. Rapidly
progressive bilateral infiltrates on chest radiographs were developed, oxygenation deteriorated and
noninvasive mechanical ventilation was started. Created the antimicrobial treatment in consultation
with infectious diseases. There was no growth on culture. H1N1 RNA(PCR) was positive. Bilateral
widespread consolidations with air bronchograms revealed in thoracic CT and invasive mechanical
ventilation was initiated (Figure 1).
Case 2:Male and 42 years.He was admitted to the emergency room due to fracture of the right
femur depending on traffic accidents. The patient developed shortness of breath two days later;
low saturation was detected. Pulmonary embolism were not identified in thoracic CT angiography;
had multiple consolidations. Bilateral infiltrates on chest radiographs appeared and got worse
oxygenation. He showed improvement in clinical and chest X-ray with noninvasive mechanical
ventilation support in his control at follow-up (Figure 2).
CONCLUSION: Mortality rate is approximately 40% in ARDS. The patient with multiple myeloma
who have the potential pneumonia caused by swine flu virus died. The second patient who was
developed ARDS dependent femur fracture was performed a noninvasive mechanical ventilation
and showed clinical and radiological improvement at follow-up.
Keywords: ARDS, respiratory insufficiency, pneumonia, femur facture, H1N1 virus
Chest X-ray of the patients with ARDS connected to femur fracture
Figure 2.
Chest X-ray of the patient with ARDS connected to viral pneumonia
Şekil 1.
Figure 1.
P413[Respiratory Failure and Intensive Care ]
The effect of inflammatory markers on mortality in patients were monitored
in the intensive care unit and comparison with APACHE score
Ayşe Yılmaz, Süheyla Kaya, Yunus Emre Kuyucu, Şemsettin Şahin
Gaziosmanpasa University Faculty of Medicine
INTRODUCTION: Sepsis complicated by severe infections and systemic inflammation and
widespread organ dysfunction is characterized by a complex clinical picture. Sepsis and sepsisrelated complications are the main causes of mortality in critically ill patients. Rapid treatment of
patients with sepsis is vital for life.
OBJECTIVE: The effect of inflammatory markers on mortality in patients were monitored in the
intensive care unit and comparison with APACHE score. The relationship between inflammatory
markers and CRP, procalcitonin levels and inflammatory markers was aimed to compare.
MATERIALSMETHODS: CRP, procalcitonin, vitamin D, cortisol levels, LTE 4, NO, 8- isoprostane and H2O2,
levels were determined in 15 patients who were followed up in the intensive care unit. APACHE
scores of patients were calculated (expected mortality rates were recorded). Patients were followed
up for mortality and mortality rates and in mortality days were recorded.
RESULTS: The correlation between the 8-isoprostane from inflammatory markers and the apache
scores revealed a moderate positive and a significant correlation (r=0.58, p=0.02). The positive
moderate and a significant association which are detected the other comparative parameters: 1.
CRP and expected mortality rate (r=0.63, p=0.01). 2. Procalsitonin and mortality rates (r=0.59,
p=0.02). 3. CRP and the first 7 days of mortality rates (r=0.58, p=0.02). 4. Procalsitonin and
mortality rates between the first 7 and 30 days (respectively, r=0.59, p=0.02, r=0.67, p=0.005).
CONCLUSION: CRP and procalcitonin levels can predict mortality.
Keywords: APACHE score, inflammatory markers (LTE4,nitrit/nitrat,nitrit,8-isoprostane,H2O2),
intensive care unit, sepsis, mortality
P414[Respiratory Failure and Intensive Care ]
Effect of long term noninvasive mechanical ventilation on right heart
function in patients with Obesity hipoventilation syndrome
Feyza Kargın1, Can Yücel Karabay1, Huriye Berk Takır1, Cüneyt Saltürk1, Merih Balcı1, Selahattin
Öztaş1, Murat Yalçınsoy1, İpek Özmen1, Özlem Moçin Yazıcıoğlu1, Gökay Güngör1, Nalan Adıgüzel1,
Ramazan Kargın2, Zuhal Karakurt1
1
Süreyyapaşa Chest Diseases and Thoracic Surgery Teaching and Research Hospital,Respiratory
İntensive Care Unit
2
Kartal Koşuyolu Yüksek İhtisas Education and Research Hospital
AİM: We aimed to investigate effect of long term noninvasive mechanical ventilation(NMV) after
dicharge on right heart function and hemodynamic results in hospitalized patients in intensive care
unit(ICU) with respiratory failure due to obesity hypoventilation syndrome(OHS)
METHOD: Level of brain natriuretic peptide(BNP) at admission and after 9th month of
discharge,hemodynamic and echocardiographic parameters of patients were recorded prospectively
in level III ICU. Data were compared.
RESULTS: 36 OHS patients (23 female) with mean body mass index 45±11,age 61±13 were
enrolled in the study.During 9 month among echocardiographic parameters related with right heart
function significant change were found in systolic pulmonary arterial pressure,TAPSE and serum
BNP levels(43±8 vs 38±8 mmhg,p‹0.002; 2.1±0.3 cm vs 2.4±0.4 cm,p‹0.002; 1049±624 vs
358±255 pg/ml, p=0.029 respectively).However there was no significant difference in left ventricle
ejection fraction and left atrial function(63 ±7 vs 64 ±7 %, p>0.11;3.7± 0.7 vs 3.6± 0.6 p>0.55
respectively)
CONCLUSION: Long term NIV treatment in patients with respiratory failure due to OHS provides
significant improvement in right heart failure and BNP level.
Keywords: Obesity hipoventilation syndrome, noninvasive mechanical ventilation, right heart
function,brain natriuretic peptide
P415[Respiratory Failure and Intensive Care ]
Risk factors for Candidemia in medical Intensive Care Units (ICU)
1
2
Najada Gjylameti , Dhimter Kraja , Elida Mjekaj
1
2
3
3
Departament of Laboratory, University Hospital Center "Mother Teresa" Tirana, Albania
Departament of Infections Disease, University Hospital Center "Mother Teresa" Tirana, Albania
Service of Intensive Care Units, University Hospital Center "Mother Teresa" Tirana, Albania
Candidemia is one of the most serious hospital infections with a high rate of mortality in the ICU.
In
this
infection,
affect
a
number
of
risk
factors.
OBJECTIVE: The aim of this study was to determine the risk factors for candidemia and to
evaluate
the
role
of
colonisation
to
development
of
the
candidemia.
MATERIALMETHODS: Hospitalized patients were selected in ICU with over 19 years old and with more than 7
days stay. The following risk factors were be selected: the use of antibiotics, total parenteral
nutrition, presence of central venous catheter, urinary catheter, and endotracheal aspirates. The
collected samples were blood, urine and endotracheal secretions. All specimens were inoculated on
Sabouraud dextrose agar. Identification of the isolates were be done by standart method. Binary
logistic regression and chi square test were be used to analyse these risk factors.
RESULTS: From the 195 patients examined, 9 (4.6 % ) resulted with Candida sp. 55.5 % of them,
were C albicans, 33.3 % C glabrata and 11.1 % C.parapsilosis. Species isolated from respiratory
and
urinary
tract
were
the
same
as
in
candidemia.
CONCLUSION: The study showed that colonization of the respiratory tract, candiduria, the use of
antibiotics, total parenteral nutrition and central venous line are risk factors for candidemia.
Keywords: Candida glabrata, parapsilosis, parenteral nutrition, candidemia.
P416[Respiratory Failure and Intensive Care ]
Intensive care for the cases with thoracic and extrathoracic malignancies:
Indications and survival
Aybüke Kekeçoğlu1, Levent Dalar2, Derya Özden Omaygenç1, Ecder Özenç3, Filiz Koşar1
1
Yedikule Teaching Hospital for Pulmonary Medicine and Thoracic Surgery
2
Istanbul Bilim University, School of Medicine, Dept. of Pulmonary Medicine
3
Haseki Teaching Hospital, Clinic of Anesthesiology and Critical Care
BACKGROUND: Admission of the patients with lung cancer and other thoracic and non-thoracic
malignancies to the ICU has been criticized. It has been evaluated the survival and associated
factors identified.
METHODS: A retrospective study was conducted in consecutive patients with thoracic and extrathoracic solid organ malignancies admitted to two intensive care units between 2010- 2013. All
cases were inoperable and admissions to ICU after surgery have excluded.
RESULTS: A total 87 cases included. The mean age was 64,07±11,90 years (31-88) and 85,1%
(n=74) were man. The mean ICU stay was 12,95±16,48 days.
Total intubation time was 11,73±17,49 days (0-105). The mean APACHE II scores were
24,35±7,48 (11-49). The cases of thoracic malignancies were 59,8% (n=52) and 40,2% (n=35)
extra-thoracic. SCLC cases were 16,2% (n=11) and the NSCLC cases were 83,8% (n=57).
Respiratory insufficiency was the main indication 40,2% (n=35). A 42,5% (n=37) cases had
another indication in addition to respiratory insufficiency. A 17,2% (n=15) had oher indications. A
57,5% (n=50) cases were lost and 35,6 (n=31) have discharged from the ICU.
A 59,8% of the cases (n=52) had IMV support, 29,9% (n=26) had IMV and NIMV and finally
10,3% of them (n=9) had only NIMV. The cases lost in ICU have significantly longer stay
(p=0,014). A total 37 cases were survivors (%42.5). Mean survival time was 21.73±3.83 days.
CONCLUSION:
The cases that have solid organ cancer and have respiratory insufficiency intensive care support
make a significant contribution to survive. However the criteria to admission to ICU should be
stated clearly.
Keywords: intensive care, lung cancer, survival
P417[Respiratory Failure and Intensive Care ]
The analyzes of intensive care unit mortality in patients with chronic
obstructive lung diseases: What are the effect of comorbidities?
Esra Akkütük Öngel1, Zuhal Karakurt2, Cüneyt Saltürk2, Huriye Berk Takır2, Bünyamin
Burunsuzoğlu1, Feyza Kargın2, Gülbanu Horzum1, Özlem Moçin2, Gökay Güngör2, Nalan Adıgüzel2,
Adnan Yılmaz1
1
Süreyyapasa Chest Diseases And Thoracic Surgery Training And Investigation Hospital,Chest
Clinics,Istanbul,Turkey
2
Süreyyapasa Chest Diseases And Thoracic Surgery Training And Investigation Hospital,Inetnsive
Care Unit,Istanbul,Turkey
AIM: Chronic obstructive pulmonary disease (COPD) patients with acute respiratory failure (ARF)
frequently need intensive care unit (ICU) for application of mechanical ventilation (MV). We aimed
to determine whether comorbidities and clinical variables are predictive of ICU mortality.
METHODS: Retrospective, observational cohort study was done in a teaching hospitals’ respiratory
ICU during 2008-2012. Previously COPD diagnosed patients who admitted to the ICU with ARF
were included. Patients’ demographics, comorbidities (arrhythmia, hypertension, coronary artery
diseases [CAD]), body mass index (BMI), ICU admission data, application of noninvasive and
invasive MV, cause of ARF, length of ICU and hospital stay and mortality were recorded from the
patients file. Patients were grouped according to mortality (survival versus non-survival) and
groups were compared by all recorded data.
RESULTS: In study 1013 COPD patients (749 male) with mean age 70±10 year were included.
Comorbidities of nonsurvival (female/male, 40/131) group were significantly higher than survival
(female/male, 224/618) group as follows: arrhythmia (24% vs 11%), hypertension (42% vs 34%),
CAD (28% vs 11%), and depression (7% vs 3%) (p<.001, p<.035, p<.001, p<.007 respectively).
Logistic regression of mortality risk factors revealed as need of IMV, BMI<20kg/m2, pneumonia,
CAD, arrhythmia, hypertension, chronic hypoxia, and higher APACHE II (odds ratio, [confidence
interval], p values respectively, 27.7[15.7-49.0],p<.001; 6.6[3.5-412.7],p<.001; 5.1[2.98.8],p<.001; 2.9[1.5-5.6],p<.001; 2.7[1.4-5.2],p<.003; 2.6[1.5-4.4],p<.001; 2.2[1.23.9],p<.008; 1.1[1.03-1.11],p<.001).
CONCLUSIONS: ICU mortality predictors are arrhythmia, hypertension and CAD in patients with
COPD who admitted to ICU due to ARF. Especially it is known that increased ICU mortality in
pneumonia patients with COPD having cardiac comorbidities utilized IMV.
Keywords: Chronic obstructive pulmoner disease, intensive care unit, mortality, comoribidity
P418[Respiratory Failure and Intensive Care ]
Approach of Pulmonologists to Noninvasive Mechanical Ventilation Use at
Home for Chronic Respiratory Failure in Turkey
Aylin Özsancak Uğurlu1, Huriye Berk Takır2, Begüm Ergan3, Erdal İn4, Özlem Ertan Edipoğlu5, Ezgi
Özyılmaz6, Eylem Tunçay1, Ege Güleç Balbay7, Aslı Görek Dilektaşlı8, Pervin Korkmaz Ekren9,
Sevinç Sarınç Ulaşlı10, Mustafa Ilgaz Doğrul11, Tülay Kıvanç12, Elif Yılmazel Uçar13, Şehnaz Olgun14,
Özkan Devran15, Recai Ergün3, Zuhal Karakurt2
1
Department of Pulmonary Medicine, Baskent University, Istanbul, Turkey
2
Department of Pulmonary Medicine, Süreyyapaşa Göğüs Hastalıkları Hastanesi, İstanbul, Turkey
3
Department of Pulmonary Medicine, S.B. Dışkapı Yıldırım Beyazıt Eğitim ve Araştırma Hastanesi,
Ankara, Turkey
4
Department of Pulmonary Medicine, Fırat University, Elazig, Turkey
5
Department of Pulmonary Medicine, İzmir Dr. Suat Seren Göğüs Hastalıkları ve Göğüs Cerrahisi
Eğitim ve Araştırma Hastanesi, İzmir, Turkey
6
Department of Pulmonary Medicine, Cukurova University, Adana, Turkey
7
Department of Pulmonary Medicine, Duzce University, Duzce, Turkey
8
Department of Pulmonary Medicine, Uludag University, Bursa, Turkey
9
Department of Pulmonary Medicine, Ege UNiversity, İzmir, Turkey
10
Department of Pulmonary Medicine, Kocatepe University, Afyon, Turkey
11
Department of Pulmonary Medicine, Baskent University, Ankara, Turkey
12
Department of Pulmonary Medicine, Baskent University,Konya, Turkey
13
Department of Pulmonary Medicine, Erzurum Aziziye Araştırma Hastanesi, Erzurum, Turkey
14
Department of Pulmonary Medicine, Marmara University, Istanbul, Turkey
15
Department of Pulmonary Medicine, Trabzon Ahi Evren Göğüs Kalp Damar Cerrahisi Hastanesi,
Trabzon, Turkey
AIM: To define approach of pulmonologists in Turkey to noninvasive mechanical ventilation (NIV)
use, the most currently applied technique for home mechanical ventilation.
METHODS: A 38-question survey, developed and tested by the authors, was distributed
throughout Turkey to pulmonologists by e-mail.
RESULTS: NIV was reported to be prescribed for home use by 57% of all responders (536) and
81% of pulmonologists practicing NIV at clinical practice (365). NIV prescription was detected to be
associated with physician’s title, type of hospital, duration of medical licence, total number of NIV
patients treated during residency and current number of NIV patients per week (Table 1, p<0.05).
Main indications were listed as chronic obstructive pulmonary disease (median, 25 and 75
percentile: 75%, 60, 85), obesity hypoventilation syndrome (10%, 4, 20), overlap syndrome
(10%, 0, 20) and restrictive lung disease (8%, 3, 10). For utilization of NIV at home, Bipap-S
(40%, 0, 80) and oronasal mask (90%, 50, 100) were most frequently recommended. Pressure
settings were most often titrated based on arterial blood gas findings (72%). Humidifier was not
prescribed by approximately half of the physicians recommending domicilliary NIV and main reason
for this (60%) was being unrefundable by social security foundation.
DISCUSSION: There is wide variation in Turkey for utilization of NIV, which improves clinical
course of patients with chronic respiratory failure. Further studies are required to determine exactly
these differences, frequency of use and outcomes in appropriate patients.
Keywords: noninvasive mechanical ventilation, chronic respiratory failure, survey
Factors Related to NIV Prescription for Home Use of Physicians Utilizing NIV in Clinic
Practice
Domiciliary NIV Prescribers
(n=305)
Domiciliary NIV NonPrescribers (n=70)
Title: Academics
Specialist
Resident
97 (%31,8)
113 (%37)
95 (31,1)
21 (%30)
38 (%54,3)
11 (%15,7)
Hospital type (most frequent)
University
135 (%44,3)
48 (%15,7)
19 (%12,3)
22 (%31,4)
State Hospital
Duration of Medical License, yr
(Median, 25 and 75%)
10 (4, 16)
12 (7,19)
Total Number of NIV Patients during
Residency
100 (0,300)
40 (0,150)
Number of NIV patients per week
4 (2,7)
2 (2,5)
p<0.05 for all variables
P419[Respiratory Failure and Intensive Care ]
Relationship between Mortality and Proadrenomedullin and Other
Prognostic Factors in Patients with Sepsis/Septic Shock and Adrenal
Insufficiency
Baran Balcan, Şehnaz Olgun, Türkay Akbaş, Emel Eryüksel, Sait Karakurt
Marmara University Medical School Pulmonary and Critical Care Medicine
BACKGROUND
We investigate relationship mortality and proadrenomedullin and other diagnostic factors in
patients with sepsis/septic shock and adrenal insufficiency.
METHOD
We prospectively include 48 patients into the study between June 2012 and June in Medical ICU.
We divided the patients with sepsis/septic shock into 2 groups: patients with adrenal insufficiency
and without adrenal insufficiency. We investigate releationships among proadrenomedullin and
other prognostic factors and mortality in the patients in medical ICU setting.
RESULTS
We compared the patient with adrenal insuficiency and no adrenal insufficiency regarding
proadrenomedullin (2006 (1232-4361) vs 2947(1712-5019)), proBNP (4494pg/mL (1013-12254)
vs 8511pg/mL(1335-17328))) thrombocyte count (198000/mL(98000-224000) vs
138000/mL(88000-204000)), APACHE II (26(22-34 vs 24(20-36)) and did not found statistically
significance different (p>0.05). We found significant difference in CRP level (102(70-173) vs
217(121-326),in the patient with adrenal insuficiency and no adrenal insufficiency (p=0.008).
We choosed 2500 as a cutoff value for adrenomedullin level. The twelve patients out of 17 (%71)
died if adrenomedullin>2500, 10 patients out of 14 (%71) died if adrenomedullin<2500 in adrenal
insufficiency group (p>0.05). The five patients out of 7 (%71) died if adrenomedullin>2500, 5
patients out of 10%50) died if adrenomedullin<2500 in patients with no adrenal insufficiency
(p>0.05). There was no significant correlation between cortisol level after ACTH stimulation and
proadrenomedullin.
CONCLUSION
Proadrenomedullin, proBNP, CRP, APACHE II,thrombocyte count not useful to predict mortality in
patients with sepsis/septic shock and adrenal insufficiency in medical ICU.
Keywords: proadrenomedullin, sepsis, prognosis
P420[Respiratory Failure and Intensive Care ]
Assesment Of The Factors Associated With Mortality In Ventilator
Associated Pneumonia Of Multidrug Resistance Acinetobacter Baumannii
Aysun Şengül1, Erkan Şengül2, Serap Argun Barış3, Nüket Hayırlıoğlu4
1
Kocaeli Derince Education and Research Hospital, Department of Pulmonology, Kocaeli
2
Kocaeli Derince Education and Research Hospital, Department of Internal Medicine, Kocaeli
3
Kocaeli University Medical Faculty, Department of Pulmonology, Kocaeli
4
Kocaeli Darica State Hospital, Department of Microbyology, Kocaeli
OBJECTIVE: Acinetobacter baumannii is an opportunistic
patogen leading to serious infections and deaths. Ventilator
associated pneumonia (VAP) of A. baumannii have
increased the risk of mortality. We aimed to assess the
mortality in VAP of A. baumannii and factors affecting
mortality.
METHODS: The records of 54 patients followed due to
A.baumannii associated VAP were assessed retrospectively.
The patients were divided two groups according to whether
ocurring mortality within 30 days after isolation of bacteria.
The groups were compared according to following factors:
age, gender, comorbidity, APACHE-II score, day of
hospitalization, central venous catheter, nutrition
(parenteral-enteral), surgery, leucocyte count, thrombocyte
count, mean platelet volume, C-reactive protein and drug
resistance.
RESULTS: Mortality was developed in thirthy-eight patients
(%70). Mortality rate was higher in males than in females
(P=0.04). Renal failure was present in thirteen patients in
the died group and one in the survived group (P=0.01).
APACHE II scores was 21.14±4.26 in the died group and
14.20±4.89 in the survived group (P< 0.01). The count of
platelet was less in the died group than in the survived
group.
CONCLUSION: Male gender, high APACHE II score, renal
failure and low platelet count was related to mortality in
patients with VAP of A.baumannii.
Keywords: A.baumannii, APACHE II, mortality, pneumonia
Patients' demographics features
Variables
Mortality(+) Mortality(-) p
Age
65.84
55.75
0.14
Gender(M/F)
20/13
18/3
0.04*
Diabetes Mellitus
10
1
0.06
Heart Failure
13
3
0.24
Renal Failure
13
1
0.01*
Chronic Obstructive Lung Disease 9
4
0.91
Status Epilepticus
1
3
0.05
Hepatic Failure
0
1
0.11
Trauma
6
3
0.79
Surgery
4
1
0.08
Malignity
3
0
0.14
Cerebrovascular Disease
13
4
0.50
More than one Comorbidity
17
4
0.16
Total Parenteral nutrition
19
5
0.20
Enteral Nutrition
19
11
0.20
Central Catheter
26
12
0.62
APACHE II skoru
21.14
14.20
0.00*
P421[Respiratory Failure and Intensive Care ]
A local prilocaine induced methemoglobinemia case in an asthmatic patient
who admitted to emergency department with shortness of breath
Nesrin Öcal, Alev Taşkın, Deniz Doğan, Ergün Uçar
Department of chest diseases, gulhane military medical academy, ankara, turkey
Methemoglobinemia, presenting with shortness of breath, cyanosis, hypoxemia, is a rare pathology
that can have grave consequences. It may occur in acquired and congenital forms. In some
patients it can be misdiagnosis with pulmonary disease presenting with similar symptoms.
Especially in young patients it can be mixed with asthma. Here, we present an undiagnosed
methemoglobinemia case who was misdiagnosed as asthma attack in emergency department.
22 year-old male patient admitted to emergency department with dyspnea and bruising in fingers.
The patient told that he was using bronchodilator therapy because of asthma but these new
complaints started in the last two days. On physical examination, vital signs and respiratory system
examination findings were normal. Patient had cyanosis of the lips and fingertips. In the arterial
blood gas test PaO2 was 79.8 mm Hg pressure, SpO2 was 89.6%. No rhonchi was heard on
auscultation. The patient's current statements not evaluated in favor of asthma attacks and
methemoglobin level was measured as 32.6%. With detailed history it was learned that injection of
prilocaine was applied to the patient for tooth extraction 3 days ago. Patient was considered to be a
prilocaine induced methemoglobinemia and treated with ascorbic acid and supplemental oxygen by
hematology clinic. At 4. day, methemoglobinemia level was 2.1% and a significant improvement in
patients' symptoms was observed.
We presented this phenomenon in terms of reminding methemoglobinemia in the differential
diagnosis of cyanosis and shortness of breath.
Keywords: asthma, cyanosis, methemoglobinemia, prilocaine
fıgure 1
patient's blood gas
P422[Respiratory Failure and Intensive Care ]
Coexistence of methemoglobinemia and thalassemia minor, a case with
respiratory failure
Ramazan Öcal1, Nesrin Öcal2, Deniz Doğan2
1
Department of hematology, Gazi University Medical Faculty, Ankara, Turkey
2
Department of chest diseases, Gulhane military medical academy, ankara, turkey
Methemoglobinis a form of the oxygen-carrying metalloprotein hemoglobin, in which the iron in the
heme group is oxidized. Methemoglobinemia is a form of hemoglobinopathy and it can be
congenital or acquired. Thalassemia minor is also a congenital hemoglobinopathy. The coincidence
of Methemoglobinemia and Thalassemia minor in the literature is limited. In these small series it is
thought that this coincidence is due to the decreased ascorbic acid levels secondary to thalassemia
minor. In this study we reported this unique coincidence.
21-year-old male patient admitted to chest diseases clinic with dyspnea and cyanosis in his hands.
His complaints had a long history with some occasionally seen exacerbations. Physical examination
of his respiratory system was normal. SpO2 was 70% with pulse oximeter in room air so arterial
blood gas analysis was performed. Arterial blood gas analysis revealed as pH: 7.43, PCO2: 36.1,
PO2: 40.8, HCO3: 23.5, SaO2: 70.5%, methemoglobine %12. Blood analysis revealed WBC:
7.500, Hgb:12.4, Plt:248.000, Htc:37. By the way other biochemical analysis were normal. HGB
levels were low than expected for a patient who suffered from chronic hypoxemia, thus we
consulted the patient with our haematology department. Peripheral smear showed up coincidence
of Thalassemia minor. Per oral ascorbic acid treatment was started to the patient because he had
also decreased ascorbic acid levels. At the first week of the treatment, methemoglabin levels were
decreased to 2.4%and SpO2 levels were increased to %90.
We reported this case in order to re-emphasize this unique cooccurrence of methemoglobinemia
and thalassemia minor.
Keywords: hypoxemia, methemoglobinemia, thalassemia minor
P423[Respiratory Failure and Intensive Care ]
Respiratory failure developed in the early postoperative period
Deniz Doğan1, Mehmet Aydoğan2, Tuncer Özkısa1, Nesrin Çandır2, Deniz Arık3, Alper Gündoğan1,
Cantürk Taşçı1
1
Department of Pulmonary Medicine, Gulhane Military Medical Faculty, Ankara, Turkey
2
Department of Pulmonary Medicine, Isparta Military Hospital, Isparta
3
Department of Pulmonary Medicine, Ağrı Military Hospital, Ağrı
CASE: 28 years-old-male patient admitted to the outpatient clinic of General Surgery with sudden
abdominal pain. After clinical examination and diagnositc tests, surgery was performed with the
diagnosis of acute abdomen (apendicitis). In the postoperative period, pulmonary consultation was
requested because of the respiratory failure after extubation. On physical examination of the
patient with poor general condition and hypoxemia, fine crackles were auscultated bilaterally at the
base. The patients was treated with noninvasive mechanical ventilation(NIMV) because of
hypoxemia after extubation. Chest X-ray showed irregular opacities in the upper and middle zones
being more pronounced in the right lung. After that, HRCT(high-resolution-computed-tomography)
imaging was performed, and revealed patchy ground-glass-opacities in the peribronchovascular
areas of both upper lung lobes. 4-6 hours after application of NIMV, significant regression of clinical
signs were observed. After 16 hours later, chest-X-ray performed and it was completely normal.
CONCLUSION: Acute pulmonary edema which can be presented with different clinical and
radiological findings based on different etiologies, is a frequent cause of respiratory failure. In this
case report, in a young patient, acute pulmonary edema after extubation in the early postoperative
period is presented. Especially in the early postoperative period, inappropriate fluid therapy during
surgery and transfusion-related over-hydration, acute cardiogenic edema due to cardiac
pathologies and pulmonary edema with negative pressure based on laryngospasm after extubation
should be considered as a differential diagnosis in postoperative pulmonary edema. Especially in
young patients without any cardiac disease, over-hydration and pulmonary edema with negative
pressure should be considered in the foreground.
Keywords: Extubation, Pulmonary edema, Postoperative period
P424[Respiratory Failure and Intensive Care ]
Pulmonary edema secondary to rupture of mitral chordaea tendinae seems
pneumonia
Didem Özkan, Fatmanur Karaköse, Hatice Özçelik, Kübra Aşık, Esat Hayat, Murat Sezer
Department of Pulmonology, Bezmialem Vakif University, Istanbul,Turkey
CASE: 27-year-old female patient. She admitted with complaints of weakness, dyspnea for a week
and fever, cough for two days. She has been investigated for anemia for two mounths. She had a
flu a week ago. There is no property in her medical history. Bilateral rale and pansystolic murmur
was heared on auscultation. Bilateral diffuse reticular density was seen at chest x-ray. CRP:8.4,
WBC:7.7, Hgb: 5.5. Bacterial or viral pneumonia was thought.and she was hospitalized.
Ceftriaxone, clarithromycin and oseltamivir was administered. Arterial blood gas (ABG) analysis:
pH:7.49 Pco2:27 Po2:50 sO2:90. Oxygen therapy was administered.
The patients had plenty of pink frothy phlegm three hours later of hospitalization, Under oxygen
therapy, sO2: 80. T/A:,90/50 mmHg, pulse:140/min. Sinus tachycardia was present at ECG.
Pulmonary congestion was seen at thorax CT. ABG: pH:7.44 Pco2:34 Po2:55 sO2:90 (Under 8
l/min of oxygen therapy). The patient was consulted with cardiology and echocardiyography was
done. Severe mitral regurgitation and anterior mitral leaflet prolapse into the left atrium was seen
in systole. Chordae tendinae rupture was diagnosed. She was transferred to Coronory ICU. T/A:
50/30 pulse:155/min. Inotropic treatment and NIMV was adminestered. The patients couldn’t
tolerate mitral regurgitation and taken to surgery to do left atriotomy with annuloplasty. She was
followed in Cardiovasculary ICU after surgery.
CONCLUSION: Pulmonary congestion can be confused with infection. When congestion deteced,
emergency and fatal cardiac reasons must be considered especially rupture of chordae tendinea.
Keywords: pulmonary edema, rupture of chordae
Figure 1
Figure 2
P425[Respiratory Failure and Intensive Care ]
ICU and twelve-month mortality of patients with acute respiratory failure
admitted to the ICU: What is the role of comorbidities?
Huriye Berk Takır, Zuhal Karakurt, Cüneyt Saltürk, Feyza Kargın, Merih Balcı, Bünyamin
Burunsuzoğlu, Esra Akkütük, Özlem Moçin, Nalan Adıgüzel, Gökay Güngör
Süreyyapasa Chest Diseases and Thorasic Surgery Training and Research Hospital, Istanbul,
Turkey
INTRODUCTION: There is limited data about the role of comorbidities for intensive care unit
(ICU) and 12-month mortality of patients with acute respiratory failure (ARF) admitted to the ICU.
The effect of comorbidities and long term mortality predictors of acute problems were
investigated.
METHODS: This is a retrospective observational cohort study performed in a 22-bed, tertiary ICU
in a teaching and research hospital in 2012. All patients who were admitted to the ICU during oneyear period were included. Demographics, comorbidities, ICU data at the time of admission and the
last control were recorded. ICU mortality and at least 12-month mortality after ICU discharge were
analysed by Cox regression and Kaplan Meier survival analysis.
RESULTS: During the study period 1022 cases (362 female) were admitted to the ICU. ICU
mortality was 20.8% (n=213). Older age, noninvasive failure, longer invasive mechanical
ventilation (IMV) days, tachycardia, APACHE II score at the time of admission, low albumin and
PaO2/FiO2 were determined to increase mortality but presence of COPD was found to decrease
mortality(Table 1). The mortality of 809 patients was %51.9 (n=420). Fifty percent of the mortality
occurred in first 2 months. Malignancy, low albumin high APACHE II score at the time of discharge
were determined as mortality risk factors (Table 2).
CONCLUSION: The first year mortality after ICU discharge of patients with ARF admitted to the
ICU is higher than ICU mortality. In this group of patients, presence of COPD decreases mortality
while malignancy increases.
Keywords: Acute respiratory failure, mortality, intensive care unit
Table 1. The Logistic regression analysis for ICU mortality in acute respiratory failure
Odds ratio %95 confidence interval p value
Noninvasive failure
3.22
1.07-9.71
0.038
Invasive mechanical ventilation day
1.09
1.04-1.15
0.001
APACHE II score, at the time of ICU admission 1.11
1.07-1.15
0.001
Heart rate/minute
1.02
1.01-1.03
0.001
Age
1.03
1.01-1.05
0.009
COPD
0.55
0.34-0.89
0.015
Serum albumin, mg/L
0.56
0.39-0.80
0.001
PaO2/FiO2
0.99
0.99-0.99
0.002
Table 2. The Cox regression analysis of risk factors of mortality after ICU
Odds ratio %95 confidence interval p value
Presence of malignancy
1.64
1.12-2.41
0.011
APACHE II score at the time of ICU discharge
1.05
1.01-1.09
0.015
Serum albumin, mg/L at the time of discharge 0.62
0.49-0.79
0.001
P426[Respiratory Failure and Intensive Care ]
Relations Of Follow-Up C-Reactive Protein And Procalcitonin Levels To
Clinical Outcome Of Infection, Microbiological Growth And Mortality İn
Intensive Care Unit
Pınar Güven, Aslıhan Yalçın, Şehnaz Olgun, Emel Eryüksel, Sait Karakurt
Department of Pulmonary and Intensive Care
OBJECTIVES: CRP and procalcitonin are known as inflamation biomarkers. We aimed to determine
relationship between serial measured CRP and procalcitonin levels and clinical outcome of infection,
microbilogical growth and mortality in patients.
METHODS: Serial measured CRP and Procalcitonin levels in 30 patients that were hospitalized in
the intensive care unit of internal medicine of our hospital between 1 nowember - 31 december
2013 were prospectively observed. The patients were categorized in to four groups according to
relationship between levels of CRP and procalcitonin;
Group1: increase levels of CRP and procalcitonin
Group 2: decrease levels of CRP and procalcitonin
Group 3: increase levels of CRP and decrease levels of procalcitonin
Group 4:decrease levels of CRP and increase levels of procalcitonin
These 4 groups were discussed with clinic outcome of Infection, Microbiological growth and
mortality in Intensive Care unit
RESULTS: table 1
CONCLUSIONS: In the case of incerase or decrease levels of CRP and procalcitonin together are
more correlated with presence or absence outcome of infection and presence or absence of
subsequent microbiological growth situation whereas in the case of tat CRP and procalcitonin not
act together clinical evaluatıon is important to assess.
Keywords: CRP,procalcitonin,infection
Relations Of CRP And Procalcitonin Levels To Clinical Outcome Of Infection,
Microbiological Growth And Mortality
Total
Number(n
)
Microbiologica Microbiologica Mortality(+
l Growth (+)
l Growth (-)
)
Mortality(
-)
Clinical
Clinical
Outcome
Outcome Of
Of
Infection(+
Infection(
)
-)
Grou
p1
8
7(%87,5)
1(%12,5)
4(%50)
4(%50)
8(%100)
0
Grou
p2
13
2(%16)
11(%84)
2(%16)
11(%84)
3(%23)
10(%77)
Grou
p3
5
2(%40)
3(%60)
2(%40)
3(%60)
4(%80)
1(%20)
Grou
p4
4
1(%25)
3(%75)
2(%50)
2(%50)
4(%100)
0
P427[Respiratory Failure and Intensive Care ]
A case of diffuse alveolar hemorrhage because of uncontrolled warfarin
therapy
Taner Tarladaçalışır1, İlkay Albayrak1, Müge Kunduracılar2
1
Department of Thoracic Surgery, Edirne State Hospital, Edirne, Turkey
2
Department of Intensive Care, Edirne State Hospital, Edirne, Turkey
Diffuse alveolar hemorrhage (DAH), depending on the alveolar capillary damage caused by
bleeding into the alveolar spaces is characterized. Many drugs can be seen depending on the DAH.
Even though it has various causes bleeding complications, warfarin therapy is a rare cause of DAH.
In this study, patients who developed DAH depending on the uncontrolled use of warfarin is
presented.
Eighty-year-old male patient was admitted to the emergency department because of the ongoing
hemoptysis for three days. Why case with atrial fibrillation were using warfarin. In the initial
evaluation, patient was general condition middle, conscious and cooperated. Blood pressure 170/90
mmHg, pulse 106/dk, respiratory rate was 40/min. Arterial blood gases, pH 7.4, pO2 54, pCO2: 31
and saturation 88% was measured. Hemoglobin 12.3 g/dL, hematocrit 38.9%, INR: 6.3 was
measured. In a chest radiography, was detected diffuse bilateral infiltrates (Figure 1). After clinical
and radiological evaluation with the diagnosis of DAH was intubated and taken to intensive care.
Clinical and radiological healing with medical treatment was provided. The patient was extubated
and was discharged from intensive care.
One of the most serious complications of oral anticoagulants is DAH and is rare. Therefore, patients
should emphasize the importance of regular use of the drug, should be informed about possible
side effects. When the diagnosis of DAH, with effective and aggressive treatment can be
significantly reduced mortality rates should not be forgotten.
Keywords: diffuse alveolar hemorrhage, hemoptysis, warfarin therapy
Figure 1
The image of the patient on admission chest radiography was detected diffuse bilateral infiltrates.
P428[Respiratory Failure and Intensive Care ]
Epileptic Seizure and Oxcarbazepine Related To A Diffuse Alveolar
Hemorrahgia (DAH) Case
Recep Akgedik1, Berna Botan Yıldırım2, Şükran Akgedik3, Ali Bekir Kurt4
1
Department of Pulmonology, Ordu University, Ordu, Turkey
2
Deparment of Pulmonology, Ordu Education and Research Hospital, Ordu, Turkey
3
Department of Pathology, Ordu State Hospital, Ordu, Turkey
4
Department of Radiology, Ordu University, Ordu, Turkey
Diffuse alveolar hemorrhage (DAH) is a rare seen condition characterized by bleeding into the
alveoli, that has high mortality rate and requires immediate intervention. Patients with dyspnea,
hemoptysis, anemia, and bilateral alveolar infiltrates should be considered to have DAH.
Bronchoscopy performed in early stages and finding hemosiderin-laden macrophages in
bronchoalveolar lavage fluid is important in diagnosis. Most cases of DAH orijinated from
autoimmune vasculitis with kapillerit or connective tissue disease.
53 year old male patient with generalized tonic-clonic seizure brought to the emergency who had
hemoptysis began after the seizure and had bilateral alveolar infiltrates on chest radiograph was
hospitalized. Patient’s emergency visit and the 3rd day of hospitalization laboratuary results
compared and there was a 3 gr/dl decrease in Hb and %8,7 decrease in Htc. FOB was performed.
Hemosiderin-laden macrophages detected in bronchoalveolar lavage (BAL) that had taken from the
patient and diagnosed with DAH. Patient were treated with corticosteroids and Traneksemic acid.
Infiltrates rapidly improved. After a 12-day follow-up at service, patient were discharged healthy.
Patient has been followed for more than one year without symptoms or recurrence.
Depending on our literature scan, we found only one case of DAH which is related with epileptic
attack. However, carbamazepine is known to damage diffuse alveolar, but its relationship with DAH
has never been reported. This aspect of our case when using oxcarbamezepine, a DAH case that is
started after the seizure is quite interesting and rare, thus we found it appropriate to offer.
Keywords: Diffuse Alveolar Hemorrahgia (DAH), Epileptic Seizure, Oxcarbazepine
Figur 1
Bilateral alveoler akciğer infiltrasyonları
Bilaterally alveolar infiltrates in lung
Figur 2
widespread alveolar infiltrates in lung without subpleural area.
P429[Respiratory Failure and Intensive Care ]
Noninvasive mechanical ventilation: An 12-month experience
Sevda Şener Cömert, Benan Çağlayan, Banu Salepci, Gamze Çelik, Coşkun Doğan, Nesrin Kıral
Dr.Lütfi Kırdar Kartal Training and Research Hospital, Department of Pulmonary Diseases, Istanbul,
Turkey
AIM: To evaluate the effectiveness of NIMV in hospitalized patients with the diagnosis of
respiratory failure and reveal the factors associated with treatment failure.
METHODS: The patients hospitalized in our clinic with the diagnosis of respiratory failure and had
an indication for NIMV were included in this study prospectively.These patients were divided into
two groups.The patients that were completed the tratment and discharged from the hospital were
named as Group 1(treatment success),Group 2(treatment failure)included the patients who had the
indication of intensive care unit or died after the initiation of NIMV.Demographic findings,additinal
diseses,hospitalization history of last year,symptoms,GCS,pulse rate,repiratory rate,chest x ray
findings,begining and first hour arterial blood gas values, duration of hospitalization were recorded.
The success rate of NIMV was calculated.Data of patients in 2groups compared to investigate
factors effective on NIMV treatment failure.
RESULTS: Forteen(29.8%)female,33(70.2%)male, totally47patients diagnosed as respiratory
failure with a mean age of66.7±11.6were included.Whereas37(78.7%)cases had diagnosis
ofCOPD,rest of them had congestive heart failure,interstitial lung
disease,pneumonia,OSAS,restrictive diseas alone or together with COPD.Three out of47cases were
in treatment failure group while the rest of patients were discharged.The rate ofNIMV treatment
success was93.6%.The data for the patients in the 2groups and statistical comparisons are given in
Table 1.There is significant relationship between the treatment failure of NIMV in patients with
respiratory failure and GCS,increased number of comorbidities,pH value at the beginning and first
hour of NIMV(p=0.001,p=0.005,p=0.011,p=0.05).
CONCLUSION: Low GCS,increased comorbidities,low beginning and first hour pH value are
associated with failure of NPPV.In these cases,close follow-up and decision of invasive mechanical
ventilation at the right time,may be lifesaving.
Keywords: noninvasive mechanical ventilation, respiratory failure, treatment success
The clinical and laboratory findings of cases and the comparison of two groups
All cases (ort±SS)
Group 1
(ort±SS)
Heart rate
89.4±12.7
89.2±13.0 92.5±9.2
>0.05
Respiratory rate
20.9±3.8
20.8±3.7
21.7±4.9
>0.05
Glasgow coma scale
14.9±0.3
14.9±0.2
14.3±1.2
0.001
number of comorbidities
1.61±1.32
1.45±1.17 3.67±1.52
0.005
hospitalization history of last year
0.34±0.79
0.36±0.81 0
>0.05
hospitalization history in ICU last year 0.34±0.60
0.36±0.61 0
>0.05
pH
7.96±0.06
7.36±0.55 7.41±0.10
0.011
pCO2
66.5±8.8
66.2±8.1
0.07
pO2
61.3±22.7
58.9±19.9 95.6±38.5
>0.05
pH at 1. hour
7.38±0.06
7.38±0.05 7.40±0.15
0.05
pCO2 at 1. hour
63.7±11.3
63.2±10.1 70.8±25.3
>0.05
pO2 at 1. hour
60.2±12.2
60.3±12.3 58.7±12.7
>0.05
CRP
52.9±70.1
52.5±71.0 60.4±70.1
>0.05
Group 2 (ort±SS) p value
70.9±18.1
P430[Respiratory Failure and Intensive Care ]
Comparison of ASV with PSV-SIMV on acute respiratory failure
Aslıhan Yalçın, Pınar Güven, Şehnaz Olgun, Emel Eryüksel, Sait Karakurt
University of Marmara, Faculty of Medicine, Department of Pulmonary and Critical Care Medicine
INTRODUCTION: Adaptive Support Ventilation(ASV) is suggested to be more effective than
conventional mechanical ventilation(MV) modes in a shorter time period. Mainly post-surgery
patients were included in studies on ASV. Data on different groups of patients and benchmarks
with conventional modes are still lack of evidence.
AIM: To investigate that ASV could reduce duration of hospitalisation, MV, weaning and survival
status in intensive care unit(ICU) compared with a conventional mode; PSV+SIMV.
METHOD: A total of 32 mechanically ventilated patients were enrolled between September 2013January 2014 (TableI). Of 16 were followed on ASV and 16 on P-SIMV. Duration of hospitalisation,
MV, weaning and survival status were recorded.
RESULTS: 13 women, 19 men at the mean age of 61(±19,9), were included in the study. Although
difference was not statistically significant ASV reduced duration of hospitalisation, mechanical
ventilation(MV), weaning and survival status in intensive care unit(ICU) compared with P-SIMV,
survival rates were similar(TableII).
CONCLUSION: This study suggests that ASV may be an effective ventilation mode in a shorter
period of time.
Keywords: ASV, PSV+SIMV, acute respiratory failure
Table I
MV mode N
Median %75 CI P(<0.05)
Duration of MV (day)
ASV
P-SIMV
17
15
6.5
4
5-7
3-5.9
0,712
Duration of stay in ICU (day)
ASV
P-SIMV
17
15
9
7
8-16
5-9.8
0,638
Duration of extubation (day)
ASV
P-SIMV
8
7
2
1
1.5-2
1-2
0,667
Survive
ASV
P-SIMV
7/17 2
6/15 2
2-2
2-2
0,839
Table II
ASV PSV-SIMV
Hypoxemic respiratory failure
9
4
5
Hypercapnic respiratory failure 15 7
8
Shock, hypoperfusion
8
4
4
Postoperative, atelectasis
-
-
-
P431[Respiratory Failure and Intensive Care ]
A Rare Cause of Bronchospasm: Hypocalcemia
Fatma Yıldırım1, Hamit Küçük2, Okan Ermiş3, İsmail Katı3, Lale Karabıyık3
1
Gazi University Faculty of Medicine, Department of Pulmonary Medicine, Ankara
2
Gazi University Faculty of Medicine, Department of İnternal Medicine, Ankara, Turkey
3
Gazi University Faculty of Medicine, Anesthesiology Intensive Care Unite, Ankara,
Although the cases with laryngospasm after parathyroid surgery as hungry-bone syndrome have
been known; the bronchospasm cases haven’t been reported. In this case, the bronchospasm
treated with calcium supplementation in a patient with hypocalcemia was presented.
Forty-seven years old female patient had undergone parathyroid adenectomy and thymectomy
operation 10 days ago. Her postoperative extubation was failed due to bronchospasm, for this
reason she was admitted to anesthesiology intensive care unite. In her medical history she had a
spine operation because of kyphoscoliosis and restrictive lung disease. She was receiving methylprednisolone 40 mg iv, short-acting ß2 agonist and anticholinergic due to severe bronchospasm.
She was empirically receiving piperazyl-tazobactam 4x4, 5 g iv treatment due to lack of growth in
ETA culture. For her bronchospasm theophylline infusion was started with a loading dose. The
plasma level of theophylline was detected in the therapeutic ranges. but her bronchospasm
continued and her plateau pressures continued to remain high. Sedation and neuromuscular
blockade with Rocuronium were performed. The ionized calcium (iCa) level of patient was detected
too low, she was evaluated by endocrinology section and iv calcium replacement was made, antiphosphate treatment was started. As the iCa level of patient was elevated, the improvements in
the bronchospasm and the hypercapnia were observed. The severe bronchospasm in this patient
was thought to be occured due to hypocalcemia. The conclusion was that the patients with
respiratory distress due to severe bronchospasm in the intensive care unite, the calcium level
assessment of patients would be useful.
Keywords: hypocalcemia, severe bronchospasm
P432[Respiratory Failure and Intensive Care ]
Risk factors for mortality in pneumonia patients followed in ICU
Recai Ergün, Begüm Ergan
Dışkapı Yıldırım Beyazıt Education and Research Hospital
INTRODUCTION: In this study we wanted to evaluate the clinical characteristics and mortality risk
factors in patients with pneumonia.
METHODS: Patients with the diagnosis of pneumonia were included into the study between June
2013 and January 2014. Patients demographic, clinical and laboratory data were recorded
prospectively and mortality related factors were analysed.
RESULTS: A total of 51 pneumonia patients were included (median age 74, 24 males). Of them,
21 were community acquired pneumonia, 18 were healthcare associated pneumonia and 12 were
nosocomial pneumonia. There was no difference between the pneumonia groups for clinical and
laboratory characteristics. The mortality rate was 51.8% with a median APACHE 2 score of 24.5. It
was found that the presence of severe sepsis, development of acute renal failure and ICU-acquired
infection were related with higher mortality in bivariate analysis (p values are 0.01; <0.01 ve
<0.01 respectively). There was no difference in mortality among pneumonia groups.
CONCLUSION: Mortality related to pneumonia is high in ICUs; it’s even increasing in the presence
of severe sepsis,development of acute renal failure and ICU-acquired infection.
Keywords: pneumonia, intensive care, mortality
P433[Respiratory Failure and Intensive Care ]
Survival of patients with pulmonary thromboembolism in the ICU
Begüm Ergan, Recai Ergün
Dışkapı Yıldırım Beyazıt Education and Research Hospital
INTRODUCTION: Acute pulmonary embolism is a common and often fatal disease. Mortality can
be reduced by prompt diagnosis and therapy. In this study we wanted to evaluate the clinical
charateristics and mortality rates in acute pulmonary embolism patients followed in the intensive
care unit (ICU).
METHODS: Patients(n=17) who were diagnosed as acute pulmonary embolism and required ICU
admission between February 2012-2014 were included into the study and analysed.
RESULTS: Nine female and 8 male patients, with a median (interquartile range) age of 69.0 (62.074.0) years, were included. The median APACHE 2 score was 18.0(16.5-21.5), risk factor for
thromboembolism was present in 13 patients (76.5%). The most common symptoms were dyspnea
(94.1%) and pleuritic chest pain (76.5%). Median pH, PCO2 and PO2 values in the arterial blood
gas analysis were 7.47; 30.7mmHg ve 48.8mmHg respectively. Thirteen patients followed with
supplemental oxygen, whereas 4 needed mechanical ventilation support. Out of 10 who had
massive pulmonary embolism 9 treated with thrombolytic therapy; and one had minor bleeding
complication. Four patients (%23.5) were died.
CONCLUSION: Pulmonary thromboembolism can be a fatal disease; thrombolytic therapy may be
the choice of therapy in massive pulmonary embolism cases without any major complications
Keywords: pulmonary embolism, mortality, thrombolytic treatment
P434[Respiratory Failure and Intensive Care ]
Diaphragmatic Pacing and Ventilator Weaning Strategies in Amyotrophic
Lateral Sclerosis
Abdul Mukhtadir Khan, Stephen Kantrow
Louisiana State University Health Sciences Center
Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative disease that leads to
muscle weakness, muscle atrophy and eventual respiratory failure. We report a complication of
diaphragmatic pacemaker implantation and use of a multimodality approach to ventilator weaning
in
ALS.
66 year old woman with ALS and worsening respiratory function and dysphagia underwent
placement of diaphragmatic pacemaker and percutaneous endoscopic gastrostomy (PEG) tube. She
initially tolerated the procedure well, however on hospital day one oxygen requirements increased.
On hospital day two, the patient developed hypercapnic respiratory failure without obvious
respiratory distress and required intubation. Bronchoscopy was performed with removal of thick
secretions, and recruitment maneuvers were performed to re-expand atelectatic lung.
Glycopyrrolate to reduce oral secretions, aggressive oropharyngeal and nasotracheal suctioning,
and an insufflator-exsufflator machine were used. After achieving an FIO2 0.21, she was extubated
to noninvasive ventilation. Respiratory failure recurred, and was managed by repeat bronchoscopy
and the secretion management protocol. She was discharged home on noninvasive mechanical
ventilation
on
hospital
day
fifteen.
DISCUSSION: This case illustrates a complication of diaphragmatic pacemaker placement in ALS
patients with neuromuscular weakness and worsening respiratory status. Implementing a strategy
to prevent and remove airway secretions may improve liberation of ALS patients from mechanical
ventilation.
Keywords: Diaphragmatic Pacing, Amyotrophic Lateral Sclerosis
P435[Diagnostic Methods]
Value of Pulmonary Function Test in Patients with hyperthyroidism
Sibel Doğru1, Füsun Aydoğan2, Sebahat Genç1, Ersin Şükrü Erden1, Cenk Babayiğit1, Mesut
Demirköse1
1
Department of Chest Diseases, Mustafa Kemal University, Hatay, Turkey
2
Department of Nuclear Medicine, Mustafa Kemal University, Hatay, Turkey
This study nuclear medicine attending a clinic for hyperthyroidism in 8 patients ( mean age 53) and
a control group of 10 healthy individuals without any respiratory complaints (mean age 53) were
included. Thyroid scintigraphy, radioactive iodine uptake test and pulmonary function tests for
patients with hyperthyroidism were performed. Hyperthyroid patients and normal individuals
pulmonary function test forced expiratory volume in 1 second ( FEV1 ), forced vital capacity (FVC),
FEV1/FVC, forced expiratory maneuver in the middle of the flow rate ( FEF 25-75% ), peak
expiratory flow (PEF) values were recorded. Hyperthyroid patients, only 2 of them were found in
the restrictive respiratory disorder. Mean FEV1 in patients with hyperthyroidism, 97.6%, FVC 100.7
%, FEV1/FVC 85.3, PEF 80.5, FEF 25-75%, 70.8. In normal individuals, the average 105.9 % of
FVC, FEV1 100.2 %, FEV1/FVC, 81.98, PEF 98.5%, FEF 25-75% 76.2. In our study of pulmonary
function parameters in patients with hyperthyroidism FVC, FEV1, FEV1/FVC, FEF 25-75% values is
not affected whereas PEF, although not statistically significantly lower than in normal individuals
have determines that.
Keywords: Hyperthyroidism, Pulmonary function test
P436[Diagnostic Methods]
Thorasic findings of Behçet disease and left pulmonary artery agenesis: case
report
Nesrin Atçi1, Murat Çelik1, Hanifi Bayaroğulları1, Sibel Doğru2
1
Department of Radiology, Mustafa Kemal University, Hatay, Turkey
2
Department of Chest diseases, Mustafa Kemal University, Hatay, Turkey
Behcet's disease, firstly defined by Hulusi Behçet in 1937, which keeps the system a lot of
unknown etiology, repetitive attacks, indicating a chronic inflammatory disease. In the
Mediterranean region, the middle and far east as common and most often 80 to 370 per 100000
patient is monitored in Turkey. The most frequently seen in decades and male-female ratio is
equal. The classic triad is oral and genital ulcers and eye disease. Cardiovascular system,
gastrointestinal system, pulmonary system and skin diseases among the affected system. The
main pathological events are vasculitis and perivascular inflammation. Involvement of venous
structures, to the involvement of arterial structure is significantly more than the 20 to 40% of
patients in the vascular system involvement is seen. Respiratory system involvement in 1-10 % of
patients, compared to other system involvement is seen less often. Respiratory system
involvement is the most common cause of death is more common in men than in women. Thoracic,
vascular, parenchymal and involvement of surrounding structures on the early and accurately be
detected by MDCT and MDCT.
In our case, common pulmonary parenchymal involvement in the varicose expansion of the right
pulmonary artery and the presence of thrombus in the lumen of the left pulmonary artery agenesis,
pulmonary ischemia secondary to the presence of numerous systemic collateral arteries were
monitored. Our case is very rare and typically because of MDCT and MDCT findings aimed to
present.
Keywords: Behçet disease, pulmonar artery agenesis, thorasic manifastations, multidedector
computed tomography
P437[Diagnostic Methods]
Sudden left lung atelectasis in a case of acute myeloid leukemia underwent
allogeneic hematopoietic stem cell transplantation
Levent Dalar1, Serkan Güvenç2, Emine Tülay Özçelik2, Mutlu Arat2
1
Istanbul Bilim University, School of Medicine, Dept. of Pulmonary Medicine
2
Istanbul Bilim University, School of Medicine, Dept. of Hematology
Allogeneic hematopoietic stem cell transplantation is an established and effective therapy option in
acute myeloid leukemia. Its late complications can occur in many different ways of graft versus
host disease (GVHD), however early complications depend on almost totally infectious causes.
It developed a sudden total left lung atelectasis in a case of acute myeloid leukemia who is 56
years old female underwent allogeneic hematopoietic stem cell transplantation. The bronchoscopy
revealed a concentric obstruction in left main bronchus. The main bronchus dilated under
intravenous general anesthesia using resector balloon. It has been obtained effective lumen size
both main bronchus and lobar bronchi. The pathologic examination of the biopsies revealed no
specific cause. It can not be obtained Aspergillus spp, CMV or any specific agent in microbiological
examination.
The bronchial stenosis has been reported depending only infectious causes in early period of stem
cell transplantation. Theoretically stenosis can appear as a result of GVHD, however it can not be
found such a case in medical literature. In current case, the bronchial stenosis was idiopathic and
has been obtained cure by interventional bronchoscopic approach.
Keywords: balloon dilatation, bronchoscopy, leukemia, stem cell transplantation
P438[Diagnostic Methods]
Diagnostic Role of Video Assisted Thoracoscopic Surgery in Exudative
Pleural Effusion
Funda Seçik1, Ali Cevat Kutluk2, Sadettin Kamat1, Süleyman Ceylan2, Didem Görgün1, Levent
Cansever2, Celalettin Kocatürk2, Pınar Yıldız1, Mehmet Ali Bedirhan2
1
Yedikule Chest Disease and Surgery Training and Research Hospital, Pulmonology
2
Yedikule Chest Disease and Surgery Training and Research Hospital, Thoracic Surgery
Almost one third of the cases with pleural effusion remain unknown etiology although biochemical,
cytological and bacteriologic analysis. Video assisted thoracoscopic surgery(VATS) would be next
step in the diagnostic algorithm in the exudative effusion with unknown etiology. The impact of
VATS in patients with undiagnosed pleural effusions was examined.
METHODS: A total of 187 patients with pleural effusion were evaluated by video-assisted
thoracoscopy between 2008 and 2012. There were 70 female (37.4%) and 117 men (62.6%) in
the age range of 17 to 81 years. Clinical, radiological and histopathological data were collected
retrospectively.
RESULTS: Thoracoscopy was diagnostic as a malignant or tuberculosis in 84 patients (84/187;
44.9 %). The pathological results were mesothelioma (19 cases; 10.1 %), metastatic effusion with
the primary lung cancer (24 cases; 12.8 %), metastatic effusion adjacent to the extrapulmonary
cancer (10 cases; 5.3 %), lymphoma (7 cases; 3.7 %) and tuberculosis (24 cases; 12.9 %).
Nonspecific pleuretic changes was observed in the remaining 103 cases, (103/187; 55.1 %).
Follow-up of these cases revealed that the false negative results (3/103) 2,91 % for malignant
pleural diseases. We obtained 84 true positive, 3 false-negative, 100 true negative, no falsepositive results with a specificity of 100%, sensitivity of 96% and diagnostic accuracy of 98%. Use
of VATS allows for assessment of patients with undiagnosed pleural effusion who could not be
diagnosed with other methods.
Keywords: Pleural Effusion, Video Yardımlı Torakoskopik Cerrahi
P439[Diagnostic Methods]
Evaluation of Transbronchial Lung Biopsy at Ondokuzmayıs University
Medical Faculty Department of Pulmonary Medicine
Nurşen Yaşayancan
Tokat State Hospital Pulmonary Medicine Clinic, Tokat
AIM:
Transbronchial lung biopsy (TBLB) is a method of providing to sample lung parenchyma with
fiberoptic bronchoscopy. Diffuse parenchymal lung disease, lung cancer without endobronchial
involvement, metastatic lung cancer, infectious and non-infectious diseases can be diagnosed with
this method which has low mortality and morbidity. The aim is to obtain adequate samples for
diagnosis.
METHOD:
This study included patients that have been made TBLB without fluoroscopy in January 2008- May
2010 at 19 Mayıs University Medical Faculty Hospital of Pulmoner Medicine Clinic. Patients;
localized or diffuse parenchymal lung disease is thought as a result of history, physical
examination, laboratory and radiological examinations and applied transbronchial lung biopsy for
the diagnosis were evaluated retrospectively.
RESULT:
The procedure of TBLB were performed once to 227 cases and two times to 11 cases, totally 238
times. Eighty six cases (37.9%) women, 141 (62.1%) were male. The average age is 56.8
(17-86), the median age is 57.0.
Those had localized involvement in direct chest X-ray of 27.1% cases and diffuse involvement of
42.5 % cases had definitive diagnosis with TBLB. Those had localized involvement in thorax CT of
30.4% cases and diffuse involvement of 54.3% cases had definitive diagnosis.
The diagnosis rate of TBLB was found 54% in tuberculosis, 87% in sarcoidosis, 27% in idiopathic
pulmonary fibrosis, 73% in cryptogenic organizing pneumonia, 54% in epidermoid carcinoma, 40%
in non- small cell lung cancer, 31% in adeno carcinoma, 75% small cell carcinoma, 47% in lung
cancer in general and 14% in hypersensitivity pneumonia.
Keywords: Fiberoptic bronchoscopy, Transbronchial Lung Biopsy
Diagnosis and Percentages with Transbronchial Lung Biopsy
The number of patients diagnosed and
percentage of diagnose with TBLB (%)
Number of TBLB
operation
Diagnosis
n
1)Cancer
59 26 (41)
60
a)Lung ca
50 24 (47)
51
Nonsmall cell CA
10 4 (40)
10
Small cell CA
4
4
Epidermoid CA
23 13 (54)
24
Adeno CA
13 4 (31)
13
b)Malignant
mesothelioma
1
0 (0)
1
c)Metastasis infiltration
8
2 (25)
8
2) İnterstitial Lung
Disease
64 39 (56)
70
Idiopathic pulmonary
fibrosis
15 4 (27)
15
Cryptogenic organizing
pneumonia
12 11 (73)
15
Hypersensitivity
pneumonia
7
7
3 (75)
1 (14)
Sarkoidosis
23 21 (84)
25
Wegener's granulomatosis 3
1 (25)
4
RA lung involvement
2
0 (0)
2
Scleroderma lung
involvement
1
0 (0)
1
Silikosis
1
1 (100)
1
3) Infections
42 28 (62)
45
Tuberculosis
23 14 (54)
26
Pneumonia
19 14 (74)
19
4) Other Disease
8
2 (25)
8
Hydatid cyst
1
0 (0)
1
Amyloid lung involvement 2
2 (100)
2
Middle lobe syndrome
1
0 (0)
1
Panbronchiolitis
3
0 (0)
3
Eosinophilic pneumonia
1
0 (0)
1
Preliminary Diagnoses Before Transbronchial Lung Biopsy
Preliminary Diagnoses
n
Percentage (%)
1)CANCER
122
Lung Ca
115 40
Metastasis infiltration
7
2)INTERSTITIAL LUNG DİSEASE
70
Sarkoidosis
27
12
Idiopathic pulmonary fibrosis
25
11
Hypersensitivity pneumonia
9
4
Cryptogenic organizing pneumonia
4
2
Vasculitis
4
2
Silicosis
1
0.4
3) INFECTIONS
57
Tuberculosis*
55
13
Pneumonia
2
1
4)MEDİASTİNAL LYMPHADENOPATHY 3
1
3
*In 25 patients preliminary diagnose was tuberculosis and lung cancer
P440[Diagnostic Methods]
Older Humanbeing Foreign Body Aspiration
Dilek Eraslan
Department of Chest Diseases, Faculty of Medicine, Ege University, Izmir
70 year old male patient had a history of 60 pack-years smoking. Lying in the urology clinic for an
operation due to prostate carcinoma, metastasis nodules on thorax CT was viewed.Shortness of
breath, chronic cough and sputum of patients with metastases was directed to our clinic for
evaluation terms.. Laboratory findings were considered with pneumonia primarily.Regression after
antibiotic therapy was not observed in the control of CT scans. Bronchoscopy of the left lower lobe
bronchus was completely stuffed with a white tumor formation.The biopsy samples were resulted
as benign.Malignancy in mind in primarily in terms of detection of metastases were performed bone
scintigraphy. Left intertrochanteric regional activity showed an increased.Radiographs showed no
evidence of bone metastasis. Abdominal ultrasound was not showed metastasis.It was discussed in
Thoracic oncology council.Repeat bronchoscopy was proposed.Left lower lobe bronchus at
bronchoscopy viewed as stuffed with white material. Foreign body aspiration biopsy taken and
resulted as the bronchial mucosa showing inflammatory changes.At the advanced age of foreign
body aspiration was rare, but should be kept in mind as a diagnosis.
Keywords: Foreign Body, Aspiration, metastases
P441[Diagnostic Methods]
Lymphoma case who admitted with pleural effusion
Nesrin Öcal1, Seval İnceçayır Ozan2, Deniz Doğan1, Alev Taşkın1, Hayati Bilgiç1
1
Department of chest diseases, Gulhane military medical academy, Ankara, Turkey
2
Department of chest diseases, Marshal Fevzi Cakmak Military Hospital, Erzurum
Lymphomas often elicit symptoms, can be noticed earlier, like peripheral lymphadenomegalies but
in some cases are detected incidentally by radiological evaluation. In respiratory system radiology,
lymphoma takes the first place in differential diagnosis of mediastinal masses. The most common
radiological findings are mediastinal widening. Although pleural effusion less commonly may be the
first sign of hematologic malignancies, may be the result of disease progression (pleural
dissemination, chylothorax). In this view, malignant pleural effusion in these patients has both in
terms of diagnostic and prognostic significance. Here we present a lymphoma case diagnosed with
thoracentesis fluid cytology.
22 years old male patient, admitted with fever and right chest pain. Chest X ray revealed right
pleural effusion, and then thoracentesis was performed. Chemical analysis of the sample fluid was
exudative and chylothorax was not seen. While waiting for planned EBUS, pleural effusion on the
right was relieved and new effusion on the left appeared. Second thoracentesis was performed for
left side. Cytology of this pleural fluid was reported as Non-Hodgkin lymphoma and patient was
referred to hematology clinic. Having been diagnosed with thoracentesis, not only eliminated the
need for invasive procedures like bronchoscopy and EBUS, but also determinated the spread.
We shared his case to remind the diagnostic value of repeated thoracentesis in patient who thought
to have malignant pleural effusion.
Keywords: cytology, lymphoma, pleural effusion
fıgure 2
left pleural effusion after 1 week
fıgure 1
hastanın başvuru esnasında çekilen toraks BT'sinde mediastinal lenfadenomegaliler ve sağda plevral efüzyon
thorax CT of the patient at admission shows right pleural effusion and mediastinal lymphadenomegalies
P442[Diagnostic Methods]
The choice of reference values for interpretation of spirometry
1
2
2
2
Artem Tishkov , Marina Kameneva , Alina Gromova , Vasily Trofimov
1
2
Saint Petersburg Institute for Informatics and Automation of the RAS
First Pavlov State Medical University of St.Petersburg
The aim of the research is to stude correspondence for three spirometru evaluation systems:
russian Klement’s et al., european ECCS and american Nhanes III in determining the types of
ventilation
abnormalities
by
predicted
and
LLN
values.
The study enrolled 7 779 Caucasian people who were examined in pulmonary clinics of Pavlov’s
State Medical University in St.-Petersburg: 3 584 males (47,40 SD14,97 years, mean height
175,44 SD10,78) and 4 195 females (mean age 49,66 SD12,95 years, mean height 162,29
SD6,48). Spirometry was conducted in 2005 to 2011 years in accordance with ATS/ERS
recommended guidelines with all participants performing at least three acceptable maneuvers. We
studied the agreement in estimation of ventilation abnormalities applied to predicted and LLN in
different spirometric reference values: Klement’s et al. system for North-West Russia population,
ECCS and Nhanes III. In addition to obstructive and restrictive disorders, a mixed group (not met
the using criteria of the normal, restriction and obstruction) was identified. Statistical analysis was
performed using StatXact®8 software. Agreement was measured by Cohen’s kappa. The value 0.7
was considered as the minimum acceptable. Results are presented in the table.
Keywords: pulmonary function, ventilation disorder, LLN
P443[Diagnostic Methods]
Clinical Utility of Pleural Fluid NT-pro Brain NatriureticPeptide (NT-proBNP)
in Patients with Pleural Effusions
Ceyda Anar, Tuba İnal, Fatmanur Çelik, İpek Ünsal, Filiz Güldaval, Ayşe Özsöz, Hüseyin Halilçolar
İzmir dr. Suat Seren Göğüs hastalıkları ve cerrahisi eğitim araştırma hastanesi
Bacground: Definite diagnosis of transudative or exudative pleural fluids often presents a
diagnostic dilemma. The aim of this study was to evaluate whether amino-terminal brain natriuretic
peptide (NT-proBNP) levels in pleural fluid has a diagnostic value for discriminating heart-failure
related
pleural
effusions
from
non-heart-failure
effusions.
METHODS: One hundred twentty six subjects with pleural effusions were included. Samples of
pleural fluid and serum were obtained simultaneously from each subject. Biochemical analysis,
bacterial and fungal culture, acid-fast bacilli smear and culture, and cytology were performed on
the
pleural
fluid.
RESULTS: Subjects with heart-failure-related pleural effusion had significantly higher pleural NTproBNP levels than other subjects (P < 0.000). Pleural and serum NT-proBNP measures were
closely correlated. An NT-proBNP cutoff value of > 5133 pg/mL in pleural fluid had a sensitivity of
51.8%, a specificity of 98.9%, respectively (P=0.000, diagnostic accuracy 84.1%) for
discriminating
transudates
caused
by
heart
failure
from
exudates.
CONCLUSIONS: Pleural fluid NT-proBNP measurement in the routine diagnostic panel may be
useful in differentiation of heart-failure-related pleural effusions and exudative pleural fluids with
reasonable accuracy, especially in heart-failure patients treated with diuretics.
Keywords: pleural fluid, pro-BNP, heart failure
P444[Diagnostic Methods]
Modified External Fixation Technique In Prevention of Stent Migration In
The Treatment of Benign Tracheal Stenosis
Ahmet Levent Karasulu1, Levent Dalar2, Cengiz Özdemir1, Sinem Sökücü1, Sedat Altın1
1
1Yedikule Chest Disease and Thoracic Surgery Education and Research Hospital, Istanbul
2
2Department of Pulmonary Medicine, School of Medicine, Istanbul Bilim University, Istanbul
Aim
Benign tracheal stenosis (BTS) close to the vocal cords and cricoid cartilage is one of the reasons
for silicon stent placement and mostly complicated with migration. Our team applied modified
version of external fixation method definied by Dr Henri Colt in these patient population which were
candidates for endoluminal treatment due to difficulties of the surgical techniques or comorbid
conditions.
Case
26 years old male patient was referred to us after detection of a postentubation subglottik stenosis.
Stenosis starting 1 cm after vocal cords and narrowing the lumen up to 5 mm was detected
bronchoscopically. 16-14-16 mm Vergnon silicon stent was placed after tracheal dilatation. In the
follow up stent was migrated three times and stent was externally sutured to the subglottik area
with a method modified by our team.
Method
Narrowed subglottic area was dilated with rigid tubes and a 16x60 silicon stent was placed.
Angiocath which was proximally 16G and distally 18G was advanced forward transcutaneusly inside
the stent with the control of the rigid boncoscope. Loop that was made using 2/0 prolen passed
proximally, 0/0 prolen was moved distally and passed through the loop that was made form 2/0
prolen by the help of a collet and then taken out through 16 G angiocath canal. Two ends were tied
up as appropriate.
CONCLUSION:
In upper BTS cases that can not be operated due to comorbid diseases or problems of the surgical
technique, external fixation method defined by our team can be safely used
Keywords: Tracheal stenosis, stent, migration
P445[Diagnostic Methods]
Effective Management of Hemoptysis via Endobronchial Application of
Ankaferd Hemostat
Oğuz Uzun1, Levent Erkan1, İbrahim Haznedaroğlu2
1
Ondokuz Mayıs University, Department of Pulmonary Medicine, Samsun
2
Hacettepe University, Faculty of Medicine, Deparment of Hematology, Ankara
Background and
OBJECTIVE: Hemoptysis is symptomatic of potentially serious and life-threatening thoracic
disease and requires urgent evaluation and treatment. The aim of the present study was to
evaluate the hemostatic efficacy of endobronchial application of Ankaferd Blood Stopper® (ABS)
solution in patients with hemoptysis.
Patients and
METHODS: This retrospective study was comprised of 20 patients (18 males and 2 females) with
hemoptysis in whom endobronchial ABS was applied by 25 bronchoscopic procedures. The etiology
of hemoptysis was lung cancer in 11 patients, and non-malignant condition in 9 cases. In seven
cases, the bleeding started after the endobronchial or transbronchial biopsy procedure, and in the
remaining 13 cases there were a systemic or local endobronchial bleeding. ABS was applied to the
bleeding site through the bronchoscopic probe or through a catheter.
RESULTS: The mean age of the patients was 58 years (range, 25-81 years). Endobronchial
application of ABS was successful for 23 of the 25 bronchoscopic procedures. The etiology of
hemoptysis was due to pulmonary radiotherapy for lung cancer in the two ineffective cases. ABS
application was repeated due to recurrent bleeding in 3 patients.
CONCLUSION: This is the first case series demonstrating the use of endobronchial application of
ABS, a novel hemostatic agent, which is an effective method in the management of bleeding,
especially in local endobronchial malignant lesions. We think that bronchoscopic ABS application
may be an alternative and supportive therapeutic method in uncontrolled hemoptysis cases.
Keywords: Hemoptysis, Endobronchial application, Liquid hemostatic agent, Ankaferd hemostat
P446[Diagnostic Methods]
Use of a Silicon Self Expandable Stent In The Treatment of Tracheal Stenosis
Accompanying Posttravmatic Tracheal Fracture
Cengiz Özdemir1, Ahmet Levent Karasulu1, Levent Dalar2, Sinem Sökücü1, Nihal Geniş1, Sedat
Altın1
1
Yedikule Chest Disease and Thoracic Surgery Education and Research Hospital, Istanbul
2
2Department of Pulmonary Medicine, School of Medicine, Istanbul Bilim University, Istanbul.
Introduction and Aim
For most of the patients referred to our hospital for benign tracheal steosis (BTS), interventions
were done using Dumon stent. Silicon Dumon stents were generally preferred because of their
useful characteristics. On the other hand, increase of the migration and folding risk in the
angulated luminal lesions are the weakness of these stents. The aim of our poster is to discuss the
place of silicon self-expandable stents (SES) in the management of endoluminal treatment with a
case referred to our clinic with posttraumatic tracheal fracture and stenosis.
Case
M.S.S was a 59 years old male patient. He had a traffic accident in 2004 and operated for vertebral
fracture, left diafragma and aorta rupture. After staying 7 months in an intensive care unit, patient
was referred to our hospital for post entubation tracheal stenosis. In his broncoscopy, complex
stenosis starting 2.5 cm after vocal cords with a segment of 1 cm of a 70% of obstruction in the
tracheal lumen due to tracheal fracture and tracheal angulation. After surgical consultation,
stenotic area was dilated and Vergnon silikon stenotic stent was placed. After the procedure stent
migration was observed at one month intervals four times. So the patient was revaluated. 18x70
mm sized SES (Polyflex®) was placed instead. No complication was observed in our patient except
mucostasis in the 6 month follow up.
Conclusion
In BTS cases, in which angulation accompany tracheal fracture, silicon self-expendable stents are a
better option compared with Dumon silikon stents.
Keywords: post traumatic tracheal stenosis, stent, migration
P447[Diagnostic Methods]
Use of medical thoracoscopy in the diagnosis of pleural effusions: Case
reports
Erdal İn1, Figen Deveci1, Teyfik Turgut1, Gamze Kırkıl1, Mehmet Mustafa Akın2, Mehmet Hamdi Muz1
1
Firat University Faculty of Medicine, Department of Pulmonary Disease, Elazig, Turkey
2
Firat University Faculty of Medicine, Department of Pathology, Elazig, Turkey
İntroduction:Medical thoracoscopy is a procedure which allows the direct visualization of both
visceral and parietal pleura and allows biopsy by passing the chest wall. It can be carried out with
local anesthesia and concious sedation, which is a great advantage compared to video-assisted
thoracoscopic surgery.
Case-1:28 years old female patient was admitted with left massive pleural effusion. Atypical cells
were observed in the cytologically analysis of the pleural effusion. During pleuroscopy, common
pleural inflammation in the costal pleural areas, and large nodular lesions on these inflamed areas
were observed. Biopsy was taken from these areas. Pathology was evaluated as consistent with
metastatic adenocarcinoma.
Case-2:75 years old male patient with moderate right pleural effusion of which etiology is unknown
was admitted. During pleuroscopy diffuse nodular lesions in the right lateral costal pleura and
diaphragma were observed.Nodular areas were biopsied. Biopsy results were evaluated as
consistent with diffuse B-cell lymphoma.
Case-3:50 years old male patient with moderate left pleural effusion was admitted. There were not
atypical cells in the fluid cytology. Diagnostic pleuroscopy was performed. Large nodular lesions in
the lateral costal pleural surfaces were observed. These areas were biopsied. Pathology was
evaluated as consistent with malignant mesenchymal tumor.
Case-4:84 years old male patient was admitted with right massive pleural effusion. The cytological
examination was not diagnostic. Pleuroscopy was planned with these findings. Parietal pleural
thickening and diffuse infiltration on the right side were detected during pleuroscopy. Biopsy was
taken from the appropriate fields. Pathology results were reported as malignant epithelial
mesothelioma.
Keywords: medical thoracoscopy, pleuroscopy, pleural effusion
P448[Diagnostic Methods]
Suspicion of metastasis or granulomatous disease in an adult women: care
report
Deniz Doğan1, Kuthan Kavaklı2, Nesrin Öcal1, Okan Karataş2, Bülent Kurt3, Ergün Uçar1, Alper
Gözübüyük2
1
Gulhane Military Medical Academy, Department of Chest Disease, Ankara, TURKEY
2
Gulhane Military Medical Academy, Thoracic Surgery, Ankara, TURKEY
3
Gulhane Military Medical Academy, Pathology, Ankara, TURKEY
INTRODUCTION: The surveillance of cancer patients is an important issue to discover any
metastatic disease at an early satge and to treat the patients properly.
CASE: A 42-year-old woman admitted with right-sided multiple small noduler lesions on her Chest
CT. These noduler lesions were discovered on her ovarian cancer follow-up after two years of
surgical treatment. The patient underwent CT surveillance for three months interval. We
recommended her a one more CT six months later which revealed multiple small noduler lesions
with different locations from previous lesions and mediastinal lymph node enlargement. We
performed PET-CT again, before planning any invasive procedures to help us. The FDG uptake of
right parenchymal lesions, left lingular lesion and superior and inferior right paratracheal lymph
nodes were pathologic. These findings of PET-CT was helpful as a guide when deciding invasive
diagnostic approach. Then we discussed mediastinoscopy with the patient for her mediastinal
paratracheal lymph nodes and if it was not diagnostic to perform a wedge resection of one of right
parenchymal noduler lesion at the same time. She received this surgical diagnostic approach.She
underwent mediastinoscopy and superior and inferior paratrachial lymph nodes and subcarinal
lymph node were biopsied. The frozen section revealed a granulomatous lymphadenitis which was
enough for her diagnosis avoid the wedge resection of paranchymal nodule. Her final
histopathologic result was the same with frozen section result.
CONCLUSION: PET-CT can be helpful in a patient who has cancer history and with mediastinal or
parenchymal disease when planning invasive diagnostic methods despite its false positivity.
Keywords: Metastasis, granulomatous lymphadenitis, mediastinoscopy
P449[Diagnostic Methods]
Diagnostic role of endobronchial ultrasonography in recurrences of operated
lung cancer
Benan Çağlayan1, Sevda Şener Cömert1, Banu Salepçi1, Nesrin Kıral1, Ali Fidan1, Ferhan Karataş1,
Dilek Ece2
1
Dr.Lütfi Kırdar Kartal Training and Research Hospital, Department of Pulmonary Diseases,
Istanbul, Turkey
2
Dr.Lütfi Kırdar Kartal Training and Research Hospital, Department of Pathology, Istanbul, Turkey
AIM: To determine role of EBUS-TBNA in diagnosis of recurrences at operated non-small cell lung
cancer(NSCLC) cases in presence of new advanced hilar/mediastinal lymph nodes(LN).
METHODS: Files of patients operated with diagnosis of NSCLC previously whose current PET-CT
study revealed increased metabolic activity at hilar/mediastinal LN,convex-probe EBUS-TBNA was
performed between January 2011-June 2013 were retrospectively analyzed.Age and gender of
patient,diagnosis of primary tumor,operation performed previously,LN present at current PET-CT
and FDG uptake value were recorded.Station and size of LNs sampled by EBUS-TBNA and
cytopathological results were obtained from files.Malignant results were regarded as true positive
whereas to confirm diagnosis of benign results patients followed up radiologically for at least
6months or invasive procedures were performed.Sensitivity,specificity,NPV,PPV,diagnostic accuracy
of EBUS-TBNA in determining recurrences of operated lung cancer were calculated from obatined
results.
RESULTS: Twenty-four patients;10male,4female with a mean age of59.3±7.8were included.Mean
duration for occurrance of post-operative enlarged LN was 24.5±18.7months.Operation was
sublobar resection in one of cases,lobectomy or pneumonectomy in others.42LN stations were
sampled with EBUS-TBNA in 24cases.Cytopathological results of them were cancer recurrence in
9cases,second primary small cell lung cancer in one case,reactive or anthracotic lymphadenitis in
13cases,sarcoid reaction in 1case.Low-grade lymphoma and atypical carcinoid tumor recurrence
were diagnosed with invasive procedures in 2cases which malignancy was not the result of EBUSTBNA.Sensitivity,specificity,NPV and PPV of EBUS-TBNA in determining recurrences of operated
lung cancer were 90%,100%,93.4% and 100%,respectively.Sensitivity of EBUS-TBNA in
determining malignancy was 83.4% and accuracy for all diagnosis was 91.7%.
CONCLUSION: EBUS-TBNA is a safe and sensitive method to detect reccurrence in lung cancer
patients underwent surgery.
Keywords: diagnosis, endobronchial ultrasound, lung cancer, operated, recurrence
P450[Diagnostic Methods]
Retrieval of aspirated unusual foreign bodies aspirated by flexible
bronchoscopy in adults with non-depressed mental status
Ayşegül Şentürk1, Emine Argüder1, Ayşe Nur Soytürk1, Hatice Kılıç1, Hatice Canan Hasanoğlu2
1
Atatürk Training and Research Hospital, Clinic of Chest Diseases, Ankara,Turkey
2
Department of Chest Diseases, Yıldırım Beyazit University, Ankara, Turkey
Foreign body aspiration (FBA) is uncommon in adults have non-depressed mental status and no
risk factors for aspiration. Rigid bronchoscopy under general anesthesia is the gold standard of
diagnosis and management of foreign body aspiration. However, frequently flexible bronchoscopy
has become the preferred way to remove aspirated foreign bodies in adults for the last years. In
this report, we present three cases of foreign body aspiration removed by flexible bronchoscopy.
There was no complication after the procedure. Hence, we removed of voice prosthesis, hazelnut
and stalk of lemon under flexible bronchoscopy. These cases have non-depressed mental status
and no risk factor for aspiration. We presented these cases because these unusual foreign body
aspirations removed by flexible bronchoscopy were rare in adults with non-depressed mental
status.
Keywords: Flexible bronchoscopy, hazelnut, stalk of lemon, voice prosthesis
P451[Diagnostic Methods]
Can the qualification of material be estimated by macroscopic appearance of
the EBUS-TBNA smear?
Ayşe Güven1, Şafak Nur Kader1, Sevda Şener Cömert1, Benan Çağlayan1, Coşkun Doğan1, Dilek
Ece2
1
Dr.Lütfi Kırdar Kartal Training and Research Hospital, Department of Pulmonary Diseases,
Istanbul, Turkey
2
Dr.Lütfi Kırdar Kartal Training and Research Hospital, Department of Pathology, Istanbul, Turkey
AIM: Without on-side pathology it is difficult to decide about the adequacy of the EBUS-TBNA
material. But often assistan staff makes a comment about the qualification of material. The aim of
the study is to investigate the predictability of qualification of material from the macroscopic
appearence of smear material obtained by EBUS-TBNA.
METHOD: Smear preperations of EBUS-TBNA materials were given points according to the
macroscopic appearances from 0 to 5 by the same assitant staff in December 2013. 0 to 2 was
accepted as inadequate material whereas 3 to5 was adequate material. All smears for every
aspiration was sent to pathology department with different numbers. The same cytopathologist was
eximined the smears without knowledge of macroscopic scores. Macroscopic evaluation of smears
was compared with cytopathological results. The data obtained was eximined with SPSS 17.0
program and chi-square test.
RESULTS: 110 smears obtained by different aspirations by EBUS included in study. 23(20.9%) of
them were accepted macroscopically as inadequate, 87(79.1%)were adequate.There was a
statistically signifficance between microscopic evaluation and lymph node reflection of the smear
cytopathologically(p=0.01).
CONCLUSION: With experience and good training, from the macroscopic appearence of smears
obtained from EBUS-TBNA it can be estimated if the lymph node is sampled adequately.
Nevertheless more studies whith larger series are necessary in this issue.
Keywords: endobronchial ultrasound, smear, macroscopic appearance, sufficient material
P452[Diagnostic Methods]
The diagnostic value of bronchoscopy for evaluation of foreign body
aspiration in children
1
1
1
1
2
2
Svetlana Sciuca , Alina Starostin , Liliana Toma , Valentina Mitu , Victor Rascov , Ina Garbi ,
2
Mariana Guzun , Valentina Rascov
1
2
2
State Medical and Pharmaceutical University, Chisinau, Moldova
Institute of Mother and Child, Chisinau, Moldova
AIM: The purpose of our study was to determine whether bronchoscopy provides additional
information for children with a suspected foreign body in the airway and its treatment
MATERIALMETHOD: It presents of 38 cases of bronchial foreign body aspiration in children aged 3,26±0,2
years. The diagnosis was confirmed by endoscopic investigations performed with rigid
bronchoscope
in
children
with
a
suggestive
history
of
aspiration.
RESULTS: The results of the study found that the foreign body aspiration is an important medical
problem that occurs more frequently in children from rural areas (65.8%). Most cases of foreign
body aspiration occur in summer-autumn(73,7%). In 76.3% of cases of foreign body aspiration
debut was produced by bouts of dry cough, accompanied by dyspnoea(44.7%), wheezing(18.4%).
Foreign bodies localization: in the right bronchus (53%), in the left bronchus (37%), in 10% cases
fragments were detected in bronchial aspirates of both lungs. In 71% of cases, the endobronchitis
was catarrhal-purulent, in 26,3% of children were detected granulations in the fixation zone of the
foreign body, bleeding in 13,2% cases. The bronchoscopy confirmed the predominance of foreign
bodies of organic origin: sunflower seeds (71%), pumpkin seeds (5,7%), fish bone (5,7%),
walnuts, fruit stalks, watermelon seeds, egg peel by 2,6%, 7,2% other food extracts.
CONCLUSION: Bronchoscopy is invariably indicated on the basis of reliable history alone even
when symptoms are minimal, and imaging studies are negative. The long duration of the
procedure, presence of dense granulation tissue and type of foreign body are important predictors
of complications.
Keywords: Bronchoscopy, foreign body, children.
P453[Diagnostic Methods]
Complimentary Pulmonary Function Test Practice Results
Levent Özdemir1, Burcu Özdemir2
1
Dörtyol State Hospital Chest Disease
2
İskenderun State Hospital Chest Disease
To determine the smoking habituation,and to make up awareness about chronic airway diseases
such as COPD and asthma,on the publicity.with free pulmonary function test and applying cigarette
questionnaire.
Free pulmonary function tests were performed to the public for 166 male and 68 female 234
citizens.by the department of chest diseases on May.17-18,2012 in Dortyol State hospital yard with
previously made announcements to the public Pulmonary function tests were performed before the
cigarette questionnaire.Demographic characteristics,whether they previously performed pulmonary
function tests,smoking status,reasons for starting smoking,reasons for quitting smoking and
difficulties for quit attempts questioned to the citizens At the end of the test,citizens were given
information leaflets aboutCOPD,asthma,smoking cessation
The mean age of patients was 40±15.4.187(79.9%) said that they had not done before,pulmonary
function tests.It was found that 46.1% of the patients were current smokers(42.7% daily smoker
and 3.4% occasional smoker) 20.1% was exsmoker,3.4% has experienced and 29.5% was never
smoker.It was found that smoking rate was higher among males(51.8%) than females(32.3%) Age
of trying and starting smoking was found lower in males.The reasons for beginning smoking were
affectation(70.4%),interest(68.1%) and stres,sadness(34.6%).The reasons for quitting smoking
were fear to fall illness in the future(72.2%),because of damaging their
surroundings(46.3%).Difficulties of quitting smoking were found as nervousness(76.9%),wanting
smoking again(56.9%).At the end of the test 8 patients were found suffering from who received no
drug treatment before.4 patients diagnosed with asthma and 4 patients diagnosed as COPD and
given drug therapy.We thought we could create awareness with simple methods pulmonary
function tests and cigarette questionnaire.
Keywords: Sigara, Solunum fonksiyon testi
resim 2
resim1
P454[Diagnostic Methods]
Using propofol in flexible bronchoscopy for sedation
Ahmet Arısoy1, Selami Ekin2, Hilmi Demirkıran3, Hülya Günbatar2, Selvi Timuçin2
1
Pulmonary Medicine, Private Istanbul Hospital, Van, Turkey
2
Pulmonary Medicine, YYU University, Van, Turkey
3
Anesthesiology and Reanimation, Private Istanbul Hospital, Van, Turkey
AİM: Propofol is a fast acting and fast ending sedative – hypnotic drug. There weren’t enough
study about using propofol during bronchoscopy. İn our study, we investigated our patients that
were used propofol for sedation and we tried to look in terms of comfort for patients and
physicians.
METHOD: We prospectively investigated our patients that were applied bronchoscopy in 2012 and
2013. Patint’s demographic characteristics, indications for bronchoscopy, bronchoscopic
procedures, processing times, minor and major adverse events, hemodynamic parameters were
recorded. Patients were observed until discharged from bronshoscopy unit.
FINDINGS: 97 patients were studied. Average age was 65, 60 (%61) of the patients were male
and 37 (%39) were women. Major indication was central and periphreral masses that’s
presumptive diagnosis was lung cancer. Other causes were mediastinal-hilar lymph nodes
hemoptysis, tuberculosis, atelectasis, chronic cough, tracheomalasia. Average dose of propofol was
90 mg in patients who underwent biopsy and 70 mg who weren’t done biopsy. Average processing
time was 14 min who were done biopsy and 10 min who weren’t done biopsy. Nose bleeding was
developed in one patient after topical lidocaine and requiring ambu mask respiratory arrest was
developed two patints. Oxygen desaturation was developed in 35 patints that was improved
increasing oxygen.
CONCLUSION: Propofol was a sedative–hypnotic agent that was applicable and comfortable for
physicians and patients.
Keywords: Propofol, Bronchoscopy, Sedation
P455[Diagnostic Methods]
Transbronchial Biopsy and Bronchoalveolar Lavage as a Diagnostic Method:
Our 3-year experience
Tülin Sevim, Emine Aksoy, Fatma Tokgöz, Nilüfer Kongar, Oğuz Aktaş, Meltem Ağca, Nezihe
Gökşenoğlu, Yasemin Bodur
Sureyyapasa Chest Diseases and Thoracic Surgery Teaching and Research Hospital
Transbronchial biopsy (TBB) and/or bronchoalveolar lavage (BAL) procedures performed in our
clinic via the fiberoptic bronchoscopy between May 2010 and 2013, 283 patients were
retrospectively evaluated.
Of all 283 patients, 185 (65.4%) were female and 98 (34.6%) were male and the mean age was
53±14 (17-85). Both TBB and BAL were performed in 199 (70.3%), only TBB in 43 (15.2%) and
only BAL in 41 (14.5%) patients.
Initial diagnoses were recorded as sarcoidosis in 141 (49.8%), interstitial lung disease (ILD) in 109
(38.5%), malignancy in 25 (8.8%) and tuberculosis in 8 (2.8%) patients.
The final diagnoses obtained with all the other diagnostic methods and clinical assessments were
most commonly sarcoidosis [n =102 (36%)], usual interstitial pneumonitis [n =21(7.4%)],
tuberculosis [n=16 (5.7%)], malignancy [n=15 (5.3%)], and hypersensitivity pneumonitis [n=12
(4.2%)] respectively (Table-1).
The mean results of BAL are shown in Table-2. Excluding the nonspecifically diagnosed patients, a
final specific diagnosis was achieved in 210. The most common diagnostic methods were; TBB
[n=75 (35.7%)], BAL with clinical findings [n=34 (16.1%)], mediastinoscopy [n=29 (13.8%)],
radiological and clinical findings [n=26 (12.4%)], and video-assisted thoracic surgery [n=19
(9%)].
All FOB complications (5.3%) were: pneumothorax [n=11 (3.9%)], serious hemorrhage [n=2
(0.7%)], respiratory failure (n=1) and hypertension (n=1). One of the pneumothoraces resolved
with conservative treatment whereas chest tube insertion was required in others.
As a result, in 3 years, 283 BAL and/or TBB procedures were performed and 109 (51.9%) of them
were diagnostic. Overall complications were 5.3% (n=15) and no mortality was seen.
Keywords: bronchoalveolar lavage, fiberoptic bronchoscopy, interstitial lung disease,
transbronchial biopsy
Final diagnoses and diagnostic methods
n (%)
F/M
Sarcoidosis
Tuberculosis
102
(36%)
71/31
16
(5,7%)
TBB/mediastinos
copy/
VATS
37/22/1
BAL
with
clinica
l
findin
gs
25
Clinical
and
Tissue/ly
radiologi mph
cal
biopsy
findings
Other
diagnostic
methods
7
4
5
(previously
diagnosed)
1 (EBUS)
1
5
(microbiolo
gy)
1 (EBUS)
6/3/0
9/7
UIP
21
(7,4%)
1/0/10
10
11/10
Eosinophilic lung diseases
7
(2,5%)
2/0/0
2
3
5/2
CTD-related ILD
5
5
(1,8%)
4/1
9
(3,2%)
Lung cancer
1/0/2
4
2
4/5
6
Metastatic cancer/lymphoma/ (2,1%)
0/1/1
neuroendocrine tm
5/1
10
(3,5%)
COP
9/0/0
3
1
1
7/5
9
(3,2%)
NSIP/DIP/bronchiolitis
4/0/5
6/3
Hypersensitivity pneumonitis
12
(4,2%)
6/0/0
6
11/1
6
(2,1%)
Pneumoconiosis
5/0/0
1
0/6
7
(2,5%)
Anthracosis
4/3/0
4/3
9
(3,2%)
Unclassified ILD
7/2
26
Asthma/pneumonia/immunod (9,2%)
eficiency
14/12
refused further procedures/
lost to follow-up/exitus
38
(13,4
%)
28/10
F:female, M:male, TBB:transbronchial biopsy, VATS:video-assisted thoracic surgery, BAL:bronchoalveolar
lavage, UIP:usual interstitial pneumonia, CTD:connective tissue disease, ILD:interstitial lung disease,
COP:cryptogenic organising pneumonia, NSIP:nonspecific interstitial pneumonia, DIP:desquamative interstitial
pneumonia
Bronchoalveolar lavage findings
Cell
count/
viability
%
Macrophage
%
(min-max)
Neutrophil Lymphocyte
%
%
(min-max) (min-max)
Eosinophil CD4/CD8
%
(min(min-max) max)
Sarcoidosis
(n=91)
368 /
71
39 (15-75)
16 (5-41)
41 (10-70)
4 (1-12)
4,8 (0,219)
Tuberculosis
(n=11)
410 /
72
46 (27-62)
20 (9-35)
30 (5-60)
4 (2-12)
9,9 (0,479)
UIP
(n=19)
327 /
68
49 (15-83)
24 (5-63)
22 (6-50)
5 (2-10)
2,2 (0,49,8)
Eosinophilic lung
808 /
39 (16-61)
13 (6-20)
15 (5-30)
33 (3-70)
1,8 (0,2-
disease
(n=5)
74
3,9)
CTD-related ILD
(n=4)
1220 /
88
29 (10-60)
47 (18-82) 19 (6-45)
5 (2-9)
1 (0,32,5)
COP
(n=10)
498 /
81
37 (14-66)
22 (8-61)
6 (3-10)
1,3 (0,43,4)
NSIP/DIP/bronchiolitis
(n=9)
487 /
51
56 (37-75)
23 (10-41) 17 (8-33)
4 (2-8)
0,9 (0,11,8)
Hypersensitivity
pneumonitis
(n=12)
661 /
83
36 (15-68)
16 (8-24)
3 (2-5)
1,2 (0,17,1)
Pneumoconiosis
(n=4)
560 /
82
38 (19-57)
33 (22-50) 23 (15-39)
6 (3-8)
1,1 (0,22,0)
Anthracosis (n=4)
171 /
33
56 (45-65)
20 (10-27) 20 (6-30)
4 (3-5)
1,0 (0,31,9)
Unclassified ILD
(n=8)
336 /
69
56 (45-68)
18 (9-29)
22 (15-30)
4 (2-5)
1,8 (0,53,2)
Malignancy
(n=4)
251/ 61
56 (48-66)
21 (12-28) 20 (12-30)
3 (2-4)
1,7 (0,93,3)
Pneumonia
(n=16)
299/ 58
55 (25-78)
18 (8-40)
3 (1-10)
2 (0,110,2)
35 (12-70)
45 (8-70)
24 (10-40)
UIP:usual interstitial pneumonia, CTD:connective tissue disease, ILD:interstitial lung disease, COP:cryptogenic
organising pneumonia, NSIP:nonspecific interstitial pneumonia, DIP:desquamative interstitial pneumonia
P456[Diagnostic Methods]
The Comparison of Midazolam and Midazolam-Phentanyl as Premedication
in Bronchoscopic Procedures
Serap Diktaş Tahtasakal, Banu Salepçi, Benan Çağlayan, Sevda Cömert, Şafak Nur Kader, Ayşe
Güven
Dr. Lütfi Kırdar Kartal Education and Research Hospital, Department of Pulmonary Diseases,
Istanbul, Turkey
AIM: Besides ensuring correct diagnosis and reliability;patient tolerance,patient cooperation and
patient/bronchoscopist satisfaction are also increasingly gained importance at bronchoscopic
procedures so premadication is come to the fore.We aimed to compare the impacts of midazolam
and midazolam+phentanyl combination used at bronchoscopic procedures on oxygen
saturation(SpO2) and transcutaneous partial pressure of carbon dioxide(PtCO2),amnesia,tolerance
and patient/bronchoscopist satisfaction.
MATERIALMETHODS: Sixty-five patients with bronchoscopy indication were included in this prospective
study.Patients were grouped as midazolam(group M:32) and midazolam+phentanyl(group
FM:33),randomely.Just before the bronchoscopy Group M was given 2mg midazolam,Group FM was
given 20micrograms phentanyl+2mg midazolam,intravenously.In both
groups,phentanyl/midazolam dosage was increased as needed to make Ramsay Sedation Scale
3.During bronchoscopy,SpO2,PtcCO2and pulse rate were followed.Before,during and after the
bronchoscopy,systolic and diastolic blood pressures(SBP,DBP) were recorded.At the end of the
bronchoscopy patients were assessed by bronchoscopist in terms of amnesia,tolerance,repeatability
of bronchoscopy and patient/bronchoscopist satisfaction.
RESULTS: Mean age of 65 patients enrolled was 57.2±13.3 years;65% male and 35% female.The
increase in heart rate and PtcCO2 after procedure were statistically significant in both
groups(p<0.05).There was a decrease in both groups in terms of SBP,DBP,SpO2 after procedure in
both groups but decrease of DBP and SpO2 levels in Group FM was statistically
significant(p=0.028,p=0.006).Patients' sensation scores of pain,cough,dyspnea,amnesia
levels,patient/physician satisfaction and repeatability of bronchoscopy were not statistically
significant between two groups.
CONCLUSION: No difference was observed in terms of PtcCO2,SpO2 and comfort between
midazolam and midazolam+phentanyl combination used for sedation during bronchoscopy.It was
concluded that no further benefit was achieved with addition of an opioid to midazolam especially
during the short term bronchoscopic procedures.
Keywords: bronchoscopy, midazolam, phentanyl, premedication, transcutaneous PCO2
P457[Diagnostic Methods]
An Interesting Cause Of Atelectasis: Drug Aspiration
Ümran Toru
Dumlupınar University Medical Faculty, Department of Chest Diseases, Kütahya, Turkey
INTRODUCTION:
Aspiration of a foreign body (FB) is usually combined with acute clinical symptoms requiring
immediate medical intervention hovewer in approximately one third of patients, symptoms of
aspiration are less prominent. A high incidence of FB-related symptoms or complications occurs as
a result of the long delay between aspiration and diagnosis. FBs can mimic bronchial tumours in
some cases which require endoscopic intervention. Here we reported our case in which atelectasis
secondary to drug aspiration was detected.and endobronchial mass like lesion (EBL) was observed
in fiberoptic bronchoscopy (FOB).
CASE:
78-years old female patient was admitted to emergency room with dyspnea and cough complaints.
In physical examination decreased breath sounds and dullness was detected in the left lung.
Radiologic findings consistent with left lung atelectasis were observed in PA graphy and Thorax CT
(Figure 1). FOB was performed in order to elucidate the etiology of atelectasis and white-coloured,
bright surfaced EBL was detected at entry of the left main bronchus. Decomposition of the lesion
and opening of the airway was observed while forceps was pushed forward during biopsy.
Regression of the atelectasis was seen in control graphy and CT. Patients detailed anamnesis
revealed that she has aspirated her drug a few months ago.
CONCLUSION:
It should be noted that FBAs are the major causes of atelectasis and a detailed history should be
taken in such a patient. In cases with a prediagnosis of atelectasis due to FBA, the removal of FBs
under FOB is recommended because of high success rate.
Keywords: Atelectasis, foreign body, aspiration.
Figure 1
Lefft lung atelectasis in Thorax CT
Figure 2
White-coloured, bright surfaced endobronchial lesion at entry of the left main bronchus
P458[Diagnostic Methods]
Accuracy of the Indirect Hemagglutination Test in the differential diagnosis
of lung cancer and complicated hydatid cyst
Bayram Altuntaş, Yener Aydın, Atilla Eroğlu
Department of Thoracic Surgery, Ataturk University, Medical Faculty,Erzurum, Turkey
OBJECTIVE: When the cyst ruptures and become complicated, clinical and radiological distinction
from lung cancer is not possible. In this study, the differential diagnosis of complicated hydatid cyst
and lung cancer was investigated with the indirect hemogglutination test.
METHODS: In our clinic between January 2010 and December 2013, we studied the indirect test
hemogglutination in 28 cases whose clinical and radiological distinction could not be diagnosed as
hydatid disease or lung cancer and in 28 cases whose lung cancer was diagnosed as
histopathological in a prospective study.
RESULTS: The indirect hemagglutination test was positive in 25 of 28 cases (90%) and was
negative in 3 of 28 cases (10%) whose histopathological and differential diagnosis could not be
made. In all of these cases, histopathological diagnosis of hydatid cyst was diagnosed with the
operation. In two of 28 lung cancer patients in the control group, the indirect hemogglutination test
was found to be positive (7%), while it was negative in 26 (93%).
CONCLUSIONS: Our findings revealed that indirect hemagglutination contributes to differential
diagnosis of complicated hydatid cyst confused with primary lung cancer.
Keywords: lung cancer; hydatid cyst, indirect hemagglutination test
P459[Diagnostic Methods]
A rare cause of chronic cough and haemoptysis: tracheobronchopathia
osteochondroplastica
Meltem Çoban Ağca1, Tülay Yarkın1, Ebru Sulu1, Ayçim Şen2
1
Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital,Department of
Chest Disease Istanbul, Turkey
2
Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital, Department of
Pathology, Istanbul, Turkey
INTRODUCTION: Tracheobronchopathia osteochondroplastica (TPO) is an uncommon benign
disease characterized by multiple cartilaginous and/or bony nodules protruding into the airway
lumen of the trachea and main bronchi. The nodules originate from the cartilage,so typically spare
the posterior membranous wall of theairways. Although the aetiologyis not known, chronic
infections, chemical gas inhalation, degenerative disorders and kongenital factors are thought to
play a role. The most frequent symptoms are dry cough and haemoptysis. The patients are usually
older than fifty. Fiberopticbronchoscopy (FOB) and computerized tomography (CT) are useful for
diagnosis. Treatment is conservative, but rarely surgery is required.
CASE: A 50-year old female patient admitted to our polyclinic suffering from chronic dry cough
since about two months and haemoptysis since several days. She was non-smoker and healthy in
the past. In the detailed history, she was exposed to clorinegas while using a domestic detergant
two years ago. Physical examination and chest X-ray were normal. CT revealed milimetric nodules
on the tracheal wall and irregularity in the main bronchi She underwent FOB where we found in the
beginning of the trachea up to the lobar bronchi multiple nodules. Various biopsies were taken and
histological examination revealed chronic inflammation, submucosal metaplasia and bronchial
cartilage and lamellar bone, a clear evidence for TPO.The patient discharged with symptomatic
treatment.
CONCLUSION: TPO may cause chronic refractory cough, and haemoptysis. The bronchoscopic
appearence together with bronchial cartilage of the histologic examination leads to the correct
diagnosis.
Keywords: bronchoscopy, chronic cough, tracheobronchopathia osteochondroplastica
Picture 1
bronchoscopic appearence
Pıcture 2
histological examination,chronic inflammation, submucosal metaplasia and bronchial cartilage and lamellar bone
P460[Diagnostic Methods]
After opaque material aspiration pulmonary imaging
Orhan Yücel, Ufuk Turhan, Deniz Doğan, Cantürk Taşcı
GULHANE MILITARY MEDICAL ACADEMY
74 YEAR OLD MALE PATIENT.DUE TO COUGH APPLIED TO EAR-NOSE-THROAT CLINIC PATIENT
WAS REFERED TO OUR CLINIC. IN HIS STORY ESOPHAGOGRAPHY WAS DRAWN BECAUSE OF
DYSPHAGIA IN THE DEPARTMENT OF GASTROENTEROLOGY.AFTER DENSITY INCREASE ON CHEST
RADIOGRAPHY,PULMONARY COMPUTARIZED TOMOGRAPHY WAS BEEN ATTRACTED. THORAX CT
CONSIDERED DANSITIES REPORTING IN COMPLIANCE WITH OPAQUE MATERIAL. PATIENTS WERE
FOLLOWED SYMPTOMATIC FOR COUGH.
Keywords: ASPIRATION, THORAX CT, OPAQUE MATERIAL
P461[Diagnostic Methods]
Case of foreign body removed by fiberoptic bronchoscopy
Özlem Saniye İçmeli, Baran Gündoğuş, Hatice Türker, Meliha Demirci, Zehra Çoban
Süreyyapaşa Training and Research Hospital for Chest Diseases and Thoracic Surgery, İstanbul,
Turkey
Tracheobronchial foreign body aspiration in adults is rare when compared to children. 52-year-old
male patient who is sent to our clinic with the diagnosis of pneumonia, fiberoptic bronchoscopy
(FOB) and foreign body (triple dental prosthesis) removed. Delayed healing pneumonia.should be
considered in the differential diagnosis of foreign body aspiration. In this way, the removal of
foreign bodies from distal airways, FOB is a method that can be applied safely.
Keywords: Pulmonary, foreign body, fiberoptic bronchoscopy
Triple dental prothesis
P462[Diagnostic Methods]
Intercostal Lung Herniation
Ezel Yaltırık Bilgin1, Koray Kılıç1, Murat Türk2, İpek Kıvılcım Oğuzülgen2, Gonca Erbaş1
1
Department of Radiology, Faculty of Medicine, Gazi University, Ankara, Turkey
2
Department of Pulmoner Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
BACKGROUND:
We present clinical and radiological findings of an asymptomatic patient with an incidental lateral
intercostal lung herniation who had a history of mini-thoracotomy and cardiopulmoner
resuscitation.
CASE:
A 76 year old male patient, with history of surgery for renal cell carcinoma, had a thorax computed
tomography (CT). Thorax CT revealed an anterior mediastinel mass. Left sided mini-thoracotomy
and mass excision was performed and type- 1B thymoma with no capsule invasion was reported.
Initial post-surgery period, the patient had a cardiac arrest and recovered with cardiac
resuscitation. A follow-up thorax CT was performed after 1 year. CT showed herniation of lingular
segment through left hemithorax lateral wall defect.
DISCUSSION:
Lung herniation is a rare clinical entity; defined as protrusion of pulmoner tissue beyond the normal
confines of thoracic cage. Classification of lung herniation based on etiology, congenital or acquired
and by location, apical, diaphragmatic or intercostal. Most lung hernias are acquired. Acquired
hernias may be traumatic, spontaneus or pathologic. Most common type is traumatic, which can be
seen after blunt and penetrating trauma, tube removal, surgery. Most of cases are asymptomatic.
Patients also may present with swelling in the chest wall, palpable mass, pain, respiratuary
problems and infection. Surgical repair may be necessary if symptoms exist.
CONCLUSION:
Lung herniation is a rare condition which exists in differantial diagnosis of chest wall masses,
develop after trauma and thoracotomy. CT allows a detailed study of underlying anatomy and is
helpful in planning further management.
Keywords: Intercostal lung herniation, CT
P463[Diagnostic Methods]
Radiologic Findings of Patients with Acute Renal Failure
Ege Güleç Balbay1, Emine Banu Çakıroğlu1, Sinem Safçı2, Tansu Sav2, Şengül Cangür3
1
Department of Chest Diseases, Duzce University, Duzce,Turkey
2
Department of Internal Medicine Diseases,Department of Nephrology, Duzce University,
Duzce,Turkey
3
Department of Biostatistics, Duzce University, Duzce, Turkey
AIM: To investigate Radiologic Findings of Patients with Acute Renal Failure (ARF)
METHOD: Posterior-anterior chest film of Patients with ARF applied to nephrology department from
1 January 2012 to 30 April 2013 was evaluated.
FINDINGS: The mean age of 80 patients was 66.48±18.2 and 47 of them was male. The types of
ARF with prerenal, renal, postrenal and ARF on chronic renal failure (ARFCRF) were 57 (%71.3), 21
(%26.3), 2 (%2.5) and 20 (%25), respectively. There was abnormal radiogical findings in 52
(65%) of patients. Abnormal radiogical findings were 27 cardiomegaly (%34.2), 18 consolidation
(%22.8) and 17 pleural effusion (%21.5), respectively. Pleural effusion was mostly unilateral 14
(%77.8), left-sided 8 (%57.1) and massive effusion only in one patient (%5.9). Consolidation was
bilateral in 4 (%22.2. Lung mass was present in 2 (%2.5) patients. Thorax CT was evaluated in 7
patients (%8.9). 16 (%20) were dead. %23.1 and %14.3 of patient with abnormal and normal
radiological findings were dead respectively. %70 and %63.3 of patients with ARF and ARFCRF had
abnormal radiological findings respectively. The exitus rates of patient with and without pleural
effusion was %29.4 and %16.1, respectively. But the difference was insignificant.
CONCLUSION: Since abnormal radiogical finding is high in ARF patients, It is thought that chest
disease consultation may play a role in the managment of ARF patients.
Keywords: acute renal failure, chest X-ray
P464[Diagnostic Methods]
A case of tracheal amyloidosis admitted with rectus abdominis muscle
hematoma
Serap Argun Barış1, Nesrin Turhan1, Kürşat Yıldız2, İlknur Başyiğit1, Haşim Boyacı1, Sevtap
Gümüştaş3
1
Department of Pulmonary Diseases, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
2
Department of Pathology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
3
Department of Radiology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
Tracheobronchial amyloidosis is an uncommon disease which is generally misdiagnosed as airway
diseases because it presents with chronic cough and dyspnea. Here, we present a case with
tracheal amyloidosis who admitted to emergency room with the hematoma of rectus muscle due to
chronic cough. CASE: Fifty-three years old male patient admitted to emergency department with
severe cough, abdominal pain and swelling on the abdominal wall. He had cough for five years for
which he sought for medical assistance, misdiagnosed as asthma and was using inhalers. He is a
current-smoker with a 55 pack-years of smoking history. He had history of hypertension and
benign prostate hypertrophy. His respiratory system examination was normal while there was a
swelling about 15 cm on right lower part of the abdominal wall. Thorax and abdomen CT were
performed in the emergency department; there was a hematoma in the right rectus muscle and
there were bilateral miliary nodules, hilar and mediastinal calcified lymph nodes and localized
thickness on middle part of the right side of tracheal wall. Fiberoptic bronchoscopy revealed a
polypoid lesion in the middle part of the right lateral wall of trachea. The histopathological
examination of the biopsy specimens stained positive with PAS and Congo red. There was a
positive reaction for the AA protein in the immunohistochemical evaluation. The patient diagnosed
as secondary amyloidosis.
CONCLUSION: Tracheal pathologies should be considered in differential diagnosis of chronic cough
and bronchoscopic evaluation should be planned in uncontrolled asthmatic patients with an atypical
clinical presentation.
Keywords: amyloidosis, cough, trachea, hematoma
Figure-1: Thickness of right lateral wall of the trachea in thoracic CT
Figure-2:Hematoma in the muscle of right rectus abdominis in abdomen CT
P465[Diagnostic Methods]
Syringopleural Shunt Causing Pleural Effusion: Case Report
Fatma Tokgöz, Yasemin Bodur, Nezihe Gökşenoğlu, Tülin Sevim
Sureyyapasa Chest Diseases and Thoracic Surgery Teaching and Research Hospital
A 55 year-old woman presented to our clinic with breathlessness for 2 months. Her vital signs were
normal, in respiratory system examination breath sounds were diminished in the left lower area,
other system examinations were unremarkable.
Ten years ago she had had neck pain and numbness spreading to the upper extremities and had
been diagnosed as Arnold Chiari Type I malformation and syringomyelia with cavitation due to
cranial MRI. She had underwent sububoccipital decompression and syringopleural shunt procedure.
Since that time, she had no complaints and had no additional diseases.
The CXR (Picture 1) showed minimal pleural effusion on left hemithorax and thoracic ultrasound
(US) measured the fluid 11 mm in thickness. The fluid wasn’t considered to be connected to the
shunt by neurosurgeons. We sampled the fluid and determined transudate due to Light's criteria.
Still suspecting the shunt could cause the fluid, beta-2 transferrin was investigated found to be
positive in the fluid.
Beta -2 transferrin is a protein of the central nervous system occured with neuraminidase activity
and normally is found only in cerebrospinal fluid (CSF), aqueous humor, and perilymph. So the
pleural effusion was proved to be CSF contamination. Neurosurgeons decided an operation would
be risky and followed her with conservative treatment. Three months later, the patient’s complaints
similiar to the ones 10 years ago had restarted and the fluid was ongoing.
In our patient, pleural effusion emerged as the first clinical manifestation of syringopleural shunt’s
dysfunction, and beta-2 transferrin analysis provided a fast and true diagnosis.
Keywords: beta 2 transferrin, pleural effusion, pleural shunt
Picture 1
CXR at presentation
P466[Diagnostic Methods]
A pulmonary sequestration case: MDCT findings
Selçuk Parlak1, Ebru Şeref Parlak2, Aysun Erdoğan Okay1, Uğur Toprak1, Levent Altın1
1
Department of Radiology, Numune Education and Research Hospital, Ankara, Turkey
2
Department of Pulmonology, Ataturk Education and Research Hospital, Ankara, Turkey
Pulmonary sequestration (PS) is a rare congenital disease characterized by non-functioning lung
tissue. Arterial blood supply is derived from an aberrant artery originated from systemic circulation.
Although angiography is gold standard diagnostic technique, abnormal vascularization can also be
demonstrated by noninvasive methods such as CT angiography, MR angiography and Doppler. In a
single breath hold, whole thorax can be scanned by multi-detector CT (MDCT). Aberrant artery,
drainage veins and also the parenchymal findings can be evaluated by MDCT. Homogeneous or
non-homogeneous consolidation area or a cystic mass which is accompanied by air-fluid levels may
be seen on CT. It usually affects left lung and posterobasal segment of the lower lobes.
Sequestrations are typically divided into intralobar (ILS) and extralobar (ELS) forms. ILS accounts
for 75% of all sequestrations. ILS is surrounded by visceral pleura and normal lung tissue. ELS has
its own visceral pleura. Venous drainage of ILS is usually to pulmonary veins whereas ELS usually
drains to systemic circulation by azygous or hemiazygous veins. Most cases are symptomatic in
early ages. Productive cough, fever, recurrent pneumonia, dyspnea, hemoptysis are typical
symptoms.
A 41-year-old male patient who suffered from recurrent pneumonia episodes, was admitted to
thoracic surgery department. MDCT revealed a multilocular cystic lesion of 99x42 mm size,
accompanied by air-fluid levels in medial lobe of right lung (Figure 1,2). CT also showed a feeding
aberrant artery originated from abdominal aorta. In the lights of these findings the case is
diagnosed as ILS in which diagnosis was confirmed after surgery.
Keywords: Congenital, Multidetector CT, Pulmonary sequestration
Figure 1
Figure 2
P467[Diagnostic Methods]
Endobronchial lipoma
Ahmet Arisoy1, Oğuzhan Özdemir2
1
Pulmonary Medicine, Private Istanbul Hospital, Van, Turkey
2
Radyology, Private Istanbul Hospital, Van, Turkey
55 year old female patient who had shortness of breath for 2 years came our clinic. She had cough
and occasional sputum. She never smoke. On physical examination breath sounds decreased on
the right. Her chest X-ray was normal. She was underwent to thorax CT because of decreasing
breath sounds on right. Than, bronchoscopy was taken to her because she had right intermedier
mass in her CT. The smooth surface, bleeding mass was obstructing the right intermedier bronchus
on bronchoscopy and biopsy was taken. Biopsy result was benign. The mass density was fat
density that referring again to the thorax CT and the mass was considered to be a lipoma.
Keywords: Benign, Endobronchial, Lipoma
Figure 1
In Thorax CT; fat density lesion in the right intermedier bronchus.
Figure 2
On bronchoscopy; full obstructed bronchus intermedius, smooth surface, bleeding lesion
P468[Diagnostic Methods]
42-year-old case of Mac Leod
Oral Menteş, Belgin Samurkaşoğlu, Feza Uğurman, Sevim Düzgün
Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Chest
Diseases, Ankara, Turkey
Mac Leod syndrome or Swyer James syndrome is an uncommon disease characterized by
roentgenographic hyperlucency of ünilateral lung. This syndrome seems to be a disease after that
viral bronchiolits and pneumonitis. Postinfectious Obliterative bronchiolit can be asymptomatic. We
describe here a 42 year old Mac Leod Syndrome which is semptomatic and new diagnosed.
Keywords: Hyperlucency of unilateral lung, Mac Leod's syndrome, Swyer James syndrome
P469[Diagnostic Methods]
A Case Of Endobronchial Lipoma Presenting With Localised Persistent
Rhonchus
Recep Akgedik1, Necla Hare Kurt2, Şükran Akgedik3, İlknur Aytekin4, Ali Bekir Kurt5
1
Department of Pulmonology, Ordu University, Ordu, Turkey
2
Department of Pulmonology, Ordu State Hospital
3
Department of Pathology, Ordu State Hospital
4
Department of Thoracic Surgery, Ordu State Hospital
5
Department of Radiology, Ordu University, Ordu, Turkey
Endobronchial Lipoma (EBL) is an extremely rare tumor of the trachea-bronchial tree. Although it is
histologically benign in character, it can cause irreversible severe distal lung destruction due to
obstructive pneumonia. Therefore, early diagnosis and radical treatment is essential. We present a
case of endobronchial lipoma with interesting oscultation and radiologic findings which was
diagnosed and treated by fiber-optic bronchoscopy.
A 67-year-old man who complained of 6 months history of cough and dyspnea on exertion was
referred. The physical examination was unremarkable except the presence of persistent inspiratory
rhonchus heard over the left lung. CT revealed an irregular obstruction of the proximal portion of
the left upper lobe bronchus by a soft-tissue endobronchial mass. On fiberoptic bronchoscopy, a
total obstruction of the left upper lobe by a pale yellow mass with a smooth shining surface was
observed (figure 1). The lesion and its stalk was totally removed by the flexible bronchoscopy.
Histopathological examination of the lesion revealed EL(figure 2). The patient had been folowed
symptom free for one year.
To our knowledge, this is the first reported case of an endobronchial lipoma with localised
persistent inspiratory rhonchus and without fat density on CT scan.
Finally, we recommend patients with localised persistent inspiratory rhonchus should undergo
broncoscopy even they have normal chest radiogram and CT scanning in order to avoid
misdiagnosis of endobronchial tumor lesions.
Keywords: Endobronchial Lipoma (EBL), localised persistent inspiratory rhonchus, fiberoptic
broncoscopy
P470[Diagnostic Methods]
Impact of multimedia information on bronchoscopy procedure
Ersin Günay1, Sevinç Sarınç Ulaşlı1, Serdar Kokulu2, Gürhan Öz3, Olcay Akar1, Erman Bağcıoğlu4,
Elif Doğan Baki2, Mehmet Ünlü1
1
Department of Pulmonary Diseases, Afyon Kocatepe University School of Medicine,
Afyonkarahisar, Turkey
2
Department of Anesthesiology and Reanimation, Afyon Kocatepe University School of Medicine,
Afyonkarahisar, Turkey
3
Department of Thoracic Surgery, Afyon Kocatepe University School of Medicine, Afyonkarahisar,
Turkey
4
Department of Psychiatry, Afyon Kocatepe University School of Medicine, Afyonkarahisar, Turkey
AIM: During medical procedures, anxiety is a common problem that may lead to decrease in
tolerance and increase in stress of patients. It was known that there is an association between
information of patients about the intervention and decreased level of anxiety. In this study, we
aimed to investigate the effect of written informed consent and comprehensive multimedia
information on the anxiety level of patients, consumption of sedatives, difficulties during
bronchoscopy, complications and duration of procedure.
METHODS: 150 patients undergoing bronchoscopy was included to this study. They were
randomized in to two groups (Multimedia information group (MIG) (N=75) and written-informed
consent group (WICG) (N=75)). Signed written informed consent was obtained from all patients.
Comprehensive multimedia presentation was watched only to MIG. State anxiety scores were
evaluated with State&Trait anxiety inventory (STAI-S).
RESULTS: STAI-S score of MIG group (40.31±8.08) was lower than WICG (44.29±9.62)
(P=0.007). Satisfaction level was higher in MIG (P=0.001). Higher difficulties during “passage
through vocal cords” and “interventions during bronchoscopy” were present in WICG group
(P=0.013 and P=0.043, respectively). Midazolam consumption during bronchoscopy, and duration
of bronchoscopy was statistically lower in MIG group (P<0.001 and P=0.045, respectively).
Difficulties during “waiting period”, “passage through nasal/oral route”, “applications of local
anesthesia” and “complication frequency” were similar in both groups.
CONCLUSION: Besides reducing the state anxiety in patients undergoing bronchoscopy,
multimedia information can reduce the amount of sedation used, shorten the processing duration
and reduce the difficulties during bronchoscopy.
Keywords: Anxiety, bronchoscopy, multimedia information, state anxiety, written informed
consent, sedasyon
P471[Diagnostic Methods]
Oral codeine for flexible bronchoscopy: a randomized, double-blind,
placebo-controlled trial
Nezihe Çiftaslan Gökşenoğlu1, Emine Aksoy1, Nilüfer Kongar2, Oğuz Aktaş1, Yasemin Bodur1, Tülin
Sevim1
1
Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital, Istanbul, Turkey
2
Clinic of Chest Diseases, İstanbul Science Unıversity
Fibre optic bronchoscopy (FB) is a procedure which is commonly used in respiratuary medicine.
Benzodiazepine is widely used as a sedative agents in patients undergoing FB. Midazolam is the
most freguently used benzodiazepine. The effect of midazolam as an antitussive agent s limitted.
Codeine is a poor opiod, used as an antitussive agent. We examined the cough, secretion and
comfort level. 96 patients, who had undergone diagnostic bronchoscopy between January 2013 and
May 2013 in our clinic, were recruited to the study. This is a double-blind, prospective, plasebo
controlled clinical trial. Study population was 21 (%21,9) of them female and 75 (%78,1) of them
male. Avarage age was 56,9 ±1,4 years.
The study design was a randomized comparision between codeine phosphate and a placebo in
patients undergoing local anesthesia and midazolam sedation. This included 96 patients,
randomised in two groups. Group 1 (n:48) patients who received codeine before the FB and group
2 (n:48) patients who received placebo. Patients were allocated to receive codeine phosphate 20
mg or placebo one day before they were sedated with midazolam.
Bronchoscopist and patients charted their perception of cough, secretion and comfort level during
the procedure, on a 100 mm visual analogue scale(VAS).Blood pressure, heart rate, and oxygen
saturation monitored during bronchoscopy.
Codeine phosphate was effective to repress induced cough during the procedure. The evaluation of
the bronchoscopy by doctors is showed; higher comfort and less secretion.
This results indicates that the antitussive effect of codeine phosphate was effective during FB.
Keywords: Fibre optic bronchoscopy,codein,cough
P472[Tuberculosis]
To evaulate results scar and BCG vaccination of cases at application
tuberculosis preventive treatment
Beyhan Çakar
7th Tuberculosis Dispensary, Ankara
AİM: To evaulate BCG scar and tuberculin skin test (TST) results in aspects of demographic data
and indications of cases who received tuberculosis preventive treatment (TB-PT) between 20082012 years
METHOD: TB-PT chart of the cases between 2008-2012 in our dispensary were retrospectively
evaluated. “Prevention with Drugs” registry in the dispensary was used.
RESULTS: Total 616 cases received TB-PT. Indications were: TB case contacts 287 (46%),
tuberculin skin test positive children <15years old 127(21%), and immune depression 202 (33%).
Indication of TST conversion and sequela lesion was not present among cases. Male/female
percentages were 50/50 in TB contacts, 54/46 in TST positives and 59/41 in immunity supressions;
mean and standard deviation of ages were 10,55±7,09 (1-44), 10,14±6,66 (1-15), and
39,42±14,07 (1-80) respectively. BCG scar were not present in seven percent of TB case contacts,
7%, tuberculin skin test positive children <15years old (7%), and immune depression (12% ).
Thirty six % of TB case contacts and 47 % of immune depression were TST 15 mm+ and up.
Fourty four % of received TB-PT cases were between 5-14 years old. Rate percentages of received
tuberculosis preventive treatment TST positive children <15 years old decreased and immune
supressed group increased in these 5 years.
CONCLUSİON: There were not BCG scar in 8 of all cases.Hence BCG vaccination percentange rate
high. Immune supressed cases received tuberculosis preventive treatment increased due to TNF-a
inhibitors usage.The most of received tuberculosis preventive treatment were male cases. TST
positive percentages rate of all cases were 53%.
Keywords: Tuberculosis, tuberculin skin test, BCG scar, preventive treatment
P473[Tuberculosis]
Mean Platelet Volume as an Inflammation Marker in Active Pulmonary
Tuberculosis
Gülşah Günlüoğlu1, Esra Yazar1, Nurdan Şimşek Veske1, Ekrem Cengiz Seyhan2, Sedat Altın1
1
Yedikule Teaching Hospital for Chest Diseases and Thoracic Surgery, Istanbul, Turkey
2
Medipol University, Chest Diseases,Istanbul, Turkey
INTRODUCTION: Mean Platelet Volume (MPV) reflects the size of platelets. It has been shown to
be inversely correlated with inflammation in some chronic inflammatory diseases.
OBJECTIVE: This prospective study aimed at showing the usability of MPV as an inflammation
marker in patients with active pulmonary tuberculosis (PTB) by comparing them to healthy
controls. Additionally, its relationship with other inflammatory markers such as C-reactive protein
(CRP) and Erythrocyte Sedimentation Rate (ESR) as well as with radiological extent of disease was
examined.
PATIENTS AND
METHOD: The study included 82 patients with active PTB and 95 healthy subjects (the control
group). A whole blood count was done; CRP and ESR levels were compared; and in the PTB group,
the relationship of radiological extent of disease with MPV and other inflammation markers was
investigated.
RESULTS: MPV was 7.74±1.33 /μL in the PTB group and 8.2±1.13 /μL in the healthy group
(p=0.005). The blood platelet count, and the CRP and ESR values were significantly higher in the
active PTB group than in the control group (p<0.0001). While radiologic disease extent and MPV
had no correlation (p=0.80), the CRP (r=0.26, p=0.003) and ESR levels (r=0.39, p=0.003) were
significantly correlated with radiologic disease extent.
CONCLUSION: MPV was found lower in PTB patients than in healthy controls. MPV does not reflect
the severity of the disease. Using MPV as an inflammation marker in PTB and assessing it as a
negative acute phase reactant do not seem very reliable.
Keywords: İnflammation markers, Mean platelet volume, Pulmonary tuberculosis
P474[Tuberculosis]
The risk of originating and progressing of destructive pulmonary
tuberculosis in the patients with different genetic background
Fatima &1057;udratovna Tashpulatova
TASHKENT MEDICAL INSTITUTE OF PEDIATRICS
OBJECTIVE: Find out the relation between the genetic markers and the risk of originating and
progressing
of
destructive
pulmonary
tuberculosis
(DPT).
MATERIALSMETHODS: 337 patients with DPT were examined. We determined the combination types of
genetic markers: phenotype of haptoglobin, inactivation types of GINK, activity of glucose-6phosphate degirogenasis. 4 main combinations of genetic markers were chosen: negative (NCGM)
and positive combination of genetic markers (PCGM. Interim variants singled out both relatively
negative and relatively positive combination of genetic markers (RNCGM and RPCGM). As the
control
were
examined
212
healthy
people.
RESULTS: among the examined patients 33 (9,8±1,6 %) – had NCGM; 26 (7,7±1,4%)- PCGM.
190 patients were the carriers of RNCGM - 56,4±2,7%. Patients with RPCGM were 88
(26,1±2,4%). Among 212 healthy people the frequency of NCGM comprised - 5,2%; RNCGM 30,2%; RPCGM - 39,6%; PCGM - 25,0%. It was determined that the risk rate of DPT (Woolf B), RR
for the patients with NCGM comprises 2,0, for RNCGM - 2,9, RPCGM -0,52, PCGM - 0,25.
Progressing course of DPT was defined in carriers of NCGM (54,5±8,6%) and RNCGM –
(30±3,3%); involutive - in carriers of PCGM (100%) and RPCGM (95,5±2,2%).
CONCLUSION: persons having the combination of NCGM and RNCGM are predisposed to
originating and progressing of DPT.
Keywords: destructive pulmonary tuberculosis, progressing, genetic markers
P475[Tuberculosis]
Сlinical-biochemical data’s of drug using complications from chemo therapy
at patients with multidrug resistant tuberculosis of lungs
Fatima &1057;udratovna Tashpulatova
TASHKENT MEDICAL INSTITUTE OF PEDIATRICS
The AIM: study the clinical-biochemical data’s of drug using complications from chemo therapy at
patients
with
multidrug
resistant
tuberculosis
of
lungs.
Мethods: was established 120 patients with multi drug resistant tuberculosis of lungs. Among
clinical forms was prevail patients with fibro-cavernous forms of tuberculosis of lungs.
RESULTS: at the results of chemotherapy at 71 ( 59,1+4.5%) patients was drug complications
from chemotherapy. Clinically it was shown like skin- allergy reactions, dyspepsia, liver ache,
artralgia, allergy, cardio ache, headache, depression, paraestesi, poor sight. Biochemical changes
was characterized raised of activity of ALT, AST, changes of coefficient of De Ritis and bilirubin,
raised of urine ferments, changes of Reberg test. The main often biochemical changes was before
clinical.
CONCLUSION: was found clinical-biochemical changes of drug complications at patients with multi
drug resistant tuberculosis of lung
Keywords: Drug, chemo therapy, multi drug resistant tuberculosis
P476[Tuberculosis]
Parasternal tuberculosis and incidental abdominal mass in an HIVseronegative patient
Deniz Kızılırmak1, Zühal Müjgan Güler2, Ebru Ünsal2, Filiz Çimen2, Nermin Çapan2
1
Turgut Özal University Medicine Faculty,Pulmonary Diseases Department, Ankara
2
Atatürk Chest Diseases and CSER Hospital, Ankara
Extrapulmonary tuberculosis is an infectious disease of which diagnosis is still difficult because of
patients symptoms, course of illness and clinical findings. Soft tissue tuberculosis is a rare form of
extrapulmonary tuberculosis. Soft tissue tuberculosis can be clinically confused with malignancy
especially in cases without accompaniment of primary pulmonary tuberculosis. Majority of patients
are diagnosed with pathological issue.
A 39 years old, female, HIV seronegative patient is presented in this case. Patient had complaint of
a palpable swelling complaint in front of sternum. Surgical resection of the mass had been
performed and its pathology had been interpreted as granulomatous inflammation. The patient
were hospitalized with new case extrapulmonary tuberculosis diagnosis and anti-TB treatment
started. She had tenderness in the right lower quadrant on physical examination. USG and CT
scans showed a mass in the right lower quadrant with 6x5cm size. Gastroenterology Department
examined the patient with colonoscopy and reported a mass on ascending colon in which purulent
discharge came after biopsy. Its pathology report was interpreted as granulomatous necrosis.
We diagnosed the patient as soft tissue tuberculosis with concomitant gastrointestinal tuberculosis
and prolonged her treatment to 9 months. System queries and physical examination findings could
be signs of other lesions.
Keywords: soft tissue, gastrointestinal, tuberculosis
PHOTO 1
PHOTO 2
P477[Tuberculosis]
Changes in pulmonary function in patients with local forms of lung
tuberculosis
1
2
2
1
3
Larisa D. Kiryukhina , Pavel V. Gavrilov , Igor B. Savin , Olga S. Volodich , Maria V. Pavlova ,
3
3
Liudmila I. Archakova , Elmira K. Zilber , Piotr K. Yablonskiy
4
1
Department of Functional Investigation, Research Institute of Phthisiopulmonology, SaintPetersburg, Russia
2
3
Department of Radiology, Research Institute of Phthisiopulmonology, Saint-Petersburg, Russia
Department of Phthisiopulmonology, Research Institute of Phthisiopulmonology, Saint-Petersburg,
Russia
4
Department of Thoracic Surgery, Research Institute of Phthisiopulmonology, Saint-Petersburg,
Russia
Often the patients with local forms of lung tuberculosis do not have any complaints and only
spirometry is carried out for lung function examination. But spirometry parameters do not reflect
completely changes of lung volumes and lung gas exchange. So the aim of the study was
evaluation of pulmonary function changes in patients with local forms of lung tuberculosis.
Materials and Methods. 93 patients with lung tuberculosis with prevalence of defeat no more than 3
segments. All patients were performed Spirometry, Bodyplethysmography, measurement of
Diffusion lung capacity (DLCO), Computed tomography (CT) and 31 patients from them were
performed Perfusion scintigraphy (PS). We used descriptive statistics and Spearman correlation
analysis.
Results. Only 20 patients (22%) had airflow limitation (18 - mild disorders, 2 -moderate). 25
patients (27%) had lung hyperinflation with RV from 140 to 199% pred. Most of patients (87%)
had different disorders of DLCO: 69 patients (74%) had moderate decreasing from 78 to 61%
pred. and 6 patients had significant decreasing of DLCO (from 59 to 50% pred.). 6 patients with
normal
DLCO
had
decreasing
of
transfer-coefficient.
DLCO also had significant dependence with quantities of focuses (ρ=-0,41, p=0,04) by CT and the
same dependence was with defeat of lung capillary blood by PS (ρ=-0,41, p<0,05). PS has shown
decrease
of
lung
capillary
blood
flow
in
zones
exceeding
tuberculosis
focus.
Conclusion. Most of patients with local forms of lung tuberculosis even without airways disorders
had decreasing DLCO. It may be connected with defeat of lung capillary blood flow.
Keywords: lung function, diffusion capacity, lung tuberculosis
P478[Tuberculosis]
Matrix metalloproteinases and their inhibitors in patients with lung
tuberculosis without cavities
Dilyara S. Esmedlyeva, Olga T. Titarenko, Marina E. Dyakova, Larisa D. Kiryukhina
Research Institute of Phthisiopulmonology, Saint-Petersburg, Russia
Activity of matrix metalloproteinases (MMPs) in lung tissue destruction is discussed. Association of
MMPs with pathogenesis of different forms of lung tuberculosis (LT) is not clear.
AIM: to evaluate of MMPs and their inhibitors activity in patients with LT without cavities.
MATERIALSMETHODS: Serum of 54 patients with LT (there were only infiltrates without cavities) were
investigated. We studied pro-MMP-1, MMP-3,8,9 and tissue inhibitor of MMPs (TIMP-1) by ELISA
(R&D Systems, Invitrigen, eBioscience ); activity of elastase (NE), α1 – protease inhibitor (PI) and
α
2
–
macroglobulin
(MG)
by
synthetic
peptide
spectrophotometry.
RESULTS: Examined patients had significant increase of MMP-9 (832.49±88.08 ng/ml; X±m) and
NE (196.40±6.44 ME) with equal to referent levels of pro-MMP-1, MMP-3 and MMP- 8.
Concentrations of the inhibitors were not similar while TIMP-1 levels were normal
(745.78±55.67ng/ml) and those of PI and MG increased (2.10±0.05nmol/ml) and decreased
(1.92±0.06 nmol/ml) correspondingly (p<0.05 for both). Significant correlation of NE activity was
revealed with pro-MMP-1, MMP- 8 and MMP- 9 (r=-0.29; r=0.46; r=0.35 correspondingly). Activity
of inhibitors differently associated with the examined proteinases: MG with pro-MMP-1 (r=0.33), PI
with MMP-8 (r=-0.54), TIMP-1 with MMP-9 (r=-0.34). MMP-9 activity significantly correlated with
the types inflammatory tissue reactions (exudative, productive and caseous- necrotic: r=0.54) and
activity
of
TIMP-1
–
with
distribution
of
the
TBC
process
(r=0.310).
CONCLUSION: Patients with LT without cavities are characterized by increased level of MMP-9 and
not similar shifts in the inhibitors activity. This fact can reflect development of lung tissue
destruction and demands further studying.
Keywords: matrix metalloproteinases, lung tuberculosis, inflammation
P479[Tuberculosis]
The Moving Fungus Ball: Aspergilloma
Turan Aktaş1, Can Çolakoğlu1, Fatma Aktaş2, Zafer Özmen2
1
Department of Pulmonary Medicine, Gazi Osman Paşa University, Tokat, Turkey
2
Department of Radiology, Gazi Osman Paşa University, Tokat, Turkey
INTRODUCTION: Pulmonary aspergilloma is the most frequent seen form of aspergilus infections
which is colonized in saprophytic form to parenchymal cavity. It can occur during the chronical
infectious period along with cavitary lung diseases and especially the tuberculosis which causes
cavity in lung most often with %60 rate.
CASE: 52 years old female patient consulted with the complaint of hemoptysis holding for 2-3
days, beginning as a mixture with sputum, and afterwards continuing as active bleeding. A
tuberculosis story from 20 years ago was available. In P-A chest radiography, bilateral extensive
destruction and straight bordered radiopacity which is adjacent to destruction in right upper zone
drew attention. In thorax CT, apart from the bilateral extensive sequel changes, hyperdensity
formation in 16*12 size, which located inside 3*2.5 sized cavity mural in right chest upper lobe
apical segment, was detected. Following that, the patient had an thorax CT in prone position. In its
result, it was seen that the present taking up lesion moved. Another finding except extensive
destruction in bronchus was not seen in patient who had bronchoscopy.
RESULT: The most frequent consulting reason in aspergilloma is hemoptysis (%50-80), and about
1/3 of them are life-thretaning massive hemoptysis. The diagnosis is usually made through the
movement of fungus ball in thorax CT taken as supine and prone. Upper lobectomy is the primary
preference among the treatment choices, and also application of antifungal agents like intracavitary
amphotericin B, itraconazole and selective bronchial artery embolisation are the other treatment
alternatives.
Keywords: Aspergilloma, Fungus Ball, Tuberculosis, Hemoptysis, Thorax CT
P480[Tuberculosis]
An epidemiological evaluation of risk factors for tuberculosis in Albania
1
2
2
2
Vera Nuredin Kurti , Hasan Sulejman Hafizi , Anila Kristaq Aliko , Arian Çesar Mezini , Jolanda
Luan Nikolla
1
2
2
Lung Diseases Dispancery of Tirana
University Hospital of Tirana 'Shefqet Ndroqi'
BACGROUND
Albania is a transitional post-communist country characterized by a sharp economic –social
polarization. Furthermore, there are not data on risk factors associated with tuberculosis (TB) in
Albania.
OBJECTIVES: To explore pulmonary tuberculosis (PTB) risks in relation to potential determinants
in
Albania
and
to
determine
the
relationship
between
the
risk
of
TB
and
socio-economic
level
for
2012.
METHOD: Matched case-control. Cases were all new diagnoses of PTB (n 290) in University Lung
Disease Hospital and Tirana’s dispensary from January 2012 to June 2013. Age- and sex-matched
controls, one for each case (n 294), were recruited among patients attending dispensary for acute
lung
diseases.
RESULTS: Significant risk factors were unemployment (OR 3.2; 95% CI 1.24-8.22), low education
level (OR 0.30; 95%CI 0.10–0.80), poor living condition (OR 2.44; 95% CI 1.17–5.09), cooking
with biomass (OR 3.36; 95%CI 1.27–8.16), family contact with TB (OR 0.34; 95% CI 0.14–0.83)
History of smoking, alcohol consumption and chronic diseases were not significant on multivariate
analysis.
CONCLUSIONS: In our study, TB was associated with unemployment, low education level, poor
living condition, kitchen type and family contact with TB, reflecting the complex interaction
between non-communicable disease, urbanisation and a changing economic status. The
relationships between TB and gender differentials deserve further exploration.
Keywords: epidemiology, risk factor, tuberculosis, Albania, socio economic level.
P481[Tuberculosis]
Tuberculosis endemia evolution in Romania’s counties 2008-2012
Constantin Marica, Mihaela Tanasescu, Beatrice Mahler, Daniel Eparu
National Institute of Pneumology “Marius Nasta” Bucharest, Romania
Romania still has the greatest number of tuberculosis cases from the EU countries. During 20022012, the incidence of tuberculosis in Romania decreased by 44% from 142.2 per 100,000 patients
to
79
patients
per
100,000
inhabitants.
The number of new cases registered in 2012 was 13997 while the recurrence of 2911, compared to
14607
cases,
respectively,
of
3142
of
relapses
in
2011.
Even under these conditions, we retain the position of EU leaders in the number of TB cases. TB
mortality has also decreased in this period. Although, in the last years it’s ascertained a decreasing
mainstream of incidence, tuberculosis still remains an important challenge for health system so by
the total number of cases and particularly by the MDR TB and XDR TB cases.
Tuberculosis frequency is lower in urban areas, where there is 71.9 %000, compared to rural
areas,
where
96.2
%000.
Incidence
by
tuberculosis
isn’t
uniformly
distributed
in
Romania
territories.
The detection rates of new cases positive smear was over 70% -the target proposed by the WHOsince 1995 and a therapeutic success rate of new cases of pulmonary TB positive microscopy by
over 80% since 2003. It is known that TB epidemiometrical indicators correlate well with the
economic situation in a country. The dynamics is correlated with average income per capita.
These differences in territory bear out economics and social difficulties, unemployment and
deficiency at counties levels in apply of health programs, sanitary education, responsibilities of
sanitary workers.
Keywords: tuberculosis, social difficulties
P482[Tuberculosis]
Tuberculous pleurisy with coexisting parapneumonic pleurisy: Concurrent or
coincidence?
Yusuf Aydemir1, Adil Can Güngen2
1
Sakarya University, Medical Faculty, Department of Chest Disease
2
Sakarya University, Training and Research Hospital, Clinics of Chest Disease
May be difficult to determine the etiology of pleural effusions, and reason can not be found in some
of the patients. Some procedures -ranging from minimal intervention to surgery- is performed for
diagnosis. Parapneumonic and tuberculous pleurisy is easier to diagnose. However, the final
diagnosis may not be always the first diagnosis. 30 year old male patient, for 1 week, with fever,
cough, chills, weakness and chest pain was admitted. The patient's pleural effusion cloudy yellow
color, glucose: 40.5, Protein: 5.0, LDH: 1396, ADA: 10.50, complete blood count were normal,
sedimentation 80mm/h, bacterial culture and ARB were negative. Patient was diagnosed with
parapneumonic effusions. The patient was treated ampicillin-sulbactam. However, with long-term
antibiotic treatment did not decline in the fluid. Then history has deepened. It was learned that has
undergone a period of psychological depression and complaints that last 1.5 months, mild fatigue,
loss of appetite, sometimes rigth chest pain. Not improve with antibiotic treatment in patients with
pleural biopsies were performed. Showed granulomatous inflammation consistent with tuberculosis.
Antituberculosis treatment was started and clinical and radiological abnormalities completely
disappeared outside the left pleural thickening. It was concluded that before tuberculous pleurisy
and consecutively parapneumonic pleural effusion occurred.
As a result, it is important that follow-up with pleurisy patients and should be remembered in
patients without clinical improvement that there may be other reasons accompanying.
Keywords: parapneumonic pleurisy, pleural effusion, tuberculous pleurisy
PA Chest x-ray
Thoracic CT
P483[Tuberculosis]
Diagnostic value of a method based on interferon-γ release assay for
determining latent tuberculosis infection in different risk groups and its
comparison to tuberculin skin test
Nebihe İsaoğulları1, Cenk Babayiğit1, Burçin Özer2, Nizam Duran2, Cahit Özer3, Tacettin İnandı4
1
Department of Respiratory Diseases, Mustafa Kemal University, Hatay, Turkey
2
Department of Microbiology, Mustafa Kemal University, Hatay, Turkey
3
Department of Family Medicine, Mustafa Kemal University, Hatay, Turkey
4
Department of Public Health, Mustafa Kemal University, Hatay, Turkey
INTRODUCTION: It may be difficult to interpret result of tuberculin skin test (TST) because of
false positivity in BCG vaccinated people and in case of non-tuberculous mycobacterial infections.
In recent years, some in-vitro tests have been developed based on measurement of IFN-γ release
in order to overcome this difficulty. We aimed to investigate latent tuberculosis infection (LTBI) in
some risk groups by Quantiferon TB Gold in Tube test (QFT-GIT) which is an IFN-γ release assay
and to compare the results to TST.
MATERIALSMETHODS: 98 volunteer cases of diabetes (group 1), non-diabetic hemodialysis (group 2) and
diabetic hemodialysis (group 3) were enrolled. All cases were subjected to TST and QFT-GIT. Test
results were compared among three groups and evaluated in terms of different variables.
RESULTS: 9 patients with “inderminate” QFT-GIT results were excluded from the study. There was
no significant relation between BCG scar number and TST diameter. There was no significant
relation in terms of QFT-GIT positivity among three groups, either. Positive correlation was found
between TST diameter and QFT-GIT level in all three groups. Prevalence of LTBI in the study
population was 38.2% according to TST and 33,7% according to QFT-GIT test. When all patients
were considered, there was a moderate concordance between QFT-GIT and TST. (Ƙ value =0,708).
CONCLUSION: QFT-GIT can be used as an alternative to TST for detection of LTBI especially in
risk groups of a population with relatively high incidence of TB and with routine BCG vaccination
program.
Keywords: Latent tuberculous infection, risk groups, tuberculin skin test, interferon-gamma
release assay
P484[Tuberculosis]
A Tuberculosis Case Mimicking Mesothelioma
Buket Çalışkaner Öztürk1, Şermin Börekçi1, Nurlan Alizade2, Şebnem Batur3, Ahmet Demirkaya2,
Büge Öz3, Duygu Fidan1, Sema Umut1
1
Istanbul University Cerrahpasa Medical Faculty Pulmonology Department, Istanbul, Turkey
2
Istanbul University Cerrahpasa Medical Faculty ThorasicSurgery Department, Istanbul, Turkey
3
3Istanbul University Cerrahpasa Medical Faculty Pathology Department,Istanbul, Turkey
AIM: Tuberculosis and malignancy are two disease that can show similar clinical sympoms and
radiological findings and encountered in the differential diagnosis.We present a-case-report that
the patient has clinic symptoms as a tuberculosis or malignancy case but radiological findings as a
mesothelioma.
RESULTS: A-56-year-old man patient presented with effort dyspnea,high fever,night
sweats,weight loss for 20 days.He has no chronic disease except hypertension.Also, he has a
history of anti-TB therapy for 9 months 30 years ago.He had asbestos exposure along 15 years. On
the physical examination,there was no respiratory sound on middle and low area of the right
lung.Massive pleural effusion was seen on the chest X-ray.Fever was
38.5C°,ESR:78mm/h,CRP:32.The nonspesific antibiotherapy was started.1000cc clear and serous
pleural fluid was drained.It was exüdate, pH:7.38,ADA:151,EZN(-).The tuberculosis cultures of
sputum and pleural fluid was negative. Pleural fluid cytology had metaplasic cells and
lymphocytes.There were a 26x29x29mm lesion with irregular contour lesion(malignite?) on the
right upper lobe and a 28mm nodul and aground-glass opacity area with suspicious for malignancy
on the left lower lobe superior.High FDG ( SUDmax:14.7) on the thickness increase areas around
all of right pleural faces included mediastinum was seen on PET-CT. We considered mesothelioma
because of asbestos exposure and than for histopatological diagnosis pleural biopsy was taken with
VATS.Necrotizing granulomatous inflammation was seen and anti-TB therapy was started
diagnosed with tuberculosis.
CONCLUSION: To distinguish of tuberculosis frommalignite according to clinic and radiologic
findings can be difficult sometimes, in this conditions biopsy and histopathological diagnosis is
helpful.
Keywords: tuberculosis, asbestos, mesothelioma
PET-CT image
PET-CT image2
P485[Tuberculosis]
Screening for latent tuberculosis infection in BCG vaccinated Turkish health
care workers: Comparison of the Quantiferon-TB Gold in Tube test with the
tuberculin skin test
Cenk Babayiğit1, Burçin Özer2, Tacettin İnandı3, Cahit Özer4, Nizam Duran2, Orhan Göçmen5
1
Department of Respiratory Diseases, Mustafa Kemal University, Hatay, Turkey
2
Department of Microbiology, Mustafa Kemal University, Hatay, Turkey
3
Department of Public Health, Mustafa Kemal University, Hatay, Turkey
4
Department of Family Medicine, Mustafa Kemal University, Hatay, Turkey
5
Tuberculosis Control Dispensary, Hatay, Turkey
BACKGROUND: The risk for Mycobacterium tuberculosis infection among Health Care Workers
(HCWs) was reported to be 3.2 times higher than normal population. Tuberculin skin test (TST)
suffers from a number of well-documented performance and logistic problems. Quantiferon-TB Gold
In Tube test (QFT-GIT) has been reported to have better sensitivity and specifity than TST. We
aimed to investigate LTBI and to determine concordance between QFT and TST for detecting LTBI
in Turkish HCWs.
METHODS: Hundred healthy volunteer health care workers were enrolled. All were subjected to
TST and QFT-GIT. Results were compared among HCWs groups in terms of several variables.
RESULTS: Number of cases with QFT-GIT positivity is increased in accordance with the TST
induration diameter range. QFT-GIT result was negative in 17 (53.1%) of 32 TST positive
(>=15mm) cases. It was negative in all cases with TST diameters between 0-5mm. HCWs with
positive QFT-GIT results were significantly older than the ones with negative results. Furthermore
duration of work was significantly longer in QFT-GIT positive than in negative HCWs. Prevalence of
LTBI in the study population was 19.8% according to QFT-GIT test and 33.3% according to TST.
BCG vaccination rate was %100.
CONCLUSION: There was a moderate concordance between QFT-GIT and TST, when TST result
was defined as positive with a >=15mm diameter of induration. We suggest that QFT-GIT can be
used as an alternative to TST for detection of LTBI, especially in groups with high risk of LTBI and
in population with routine BCG vaccination program.
Keywords: Latent tuberculosis infection, health care workers, Quantiferon, tuberculin skin test
P486[Tuberculosis]
Pulmonary Tuberculosis and Pulmonary Embolism Association: Evaluation
Of Two Cases
Hadice Selimoğlu Şen, Özlem Abakay, Cengizhan Sezgi, Süreyya Yılmaz, Abdurrahman Abakay,
Abdullah Çetin Tanrıkulu
Department of Pulmonology, Dicle University School of Medicine, Diyarbakir, Turkey
INTRODUCTION:
Pulmonary embolism (PE), is an important clinical problem with high mortality. The acute infectious
diseases has been reported to induce the formation of PE. Tuberculosis (TB) is one of the most
prevalent infectious diseases in our country. The elevated plasma fibrinogen, impaired fibrinolysis,
decreased levels of antithrombin III and reactive thrombocytosis is associated with pulmonary TB
[1]. Rifampicin may also contribute to the hypercoagulation state by decreasing production and
increasing clearance of anticoagulant hepatic proteins. [2]. Two cases of TB accompanied by PE,
were presented for drawing attention to this relationship.
Cases:
The first case; 61 year old male patient was admitted to the emergency department with complaint
of shortness of breath in the 4th month of antituberculosis treatment. Lung ventilation-perfusion
scintigraphy revealed a high probability of PE. Pulmonary artery pressure was 85 mmHg on
echocardiography. Thrombolytic therapy was applied due to persistent hypotension.
The second case; 54 year old male patient was admitted to the emergency department with
complaint of sudden onset of dyspnea. There was a pulmonary TB history about 10 years ago. The
pulmonary artery embolism and tree-in bud view were detected on computed tomography
pulmonary angiography. Pulmonary artery pressure was 95 mmHg on echocardiography.
Thrombolytic therapy was applied to patient who continued hypotension. The patient with + + for
acid fast bacilli in sputum examination was evaulated as nux pulmonary TB.
Conclusion
Pulmonary embolism in patients with TB, as will be second to long hospitalization and rifampicin
treatment, may also occur related to the disease.
Keywords: pulmonary embolism, tuberculosis, hypercoagulation
P487[Tuberculosis]
A rare case of sternal and genitourinary tuberculosis
Akın Eraslan Balcı1, Mehmet Oğuzhan Özyurtkan1, Mustafa Akın2, Siyami Aydın1, Derya Özdemir
Tüten1, Murat Kılıç1, Suna Polatoğlu1
1
Fırat University Medical Faculty, Department of Thoracic Surgery, Elazığ, Turkey
2
Fırat University Medical Faculty, Department of Pathology, Elazığ, Turkey
Pulmonary TB is the most common presentation while extra-pulmonary tuberculosis constitutes 1520% of case load. Sternum is resistant to infections and thus involvement due to TB is rare even in
endemic countries. Here a case with both urinary and sternal TB has been discussed. A 68 yearsold diabetic patient presented with difficulty in urination to urology clinic, and was planned to
undergo TUR. Meanwhile he had sternal chest pain, fistulization and a palpable mass lesion. Chest
BT revealed a 3x2cm lesion in the xyfoid. The patient underwent both TUR and partial sternal
resection and reconstruction. The pathological examination revealed TB in both bladder and
sternum. AntiTb treatment was given to the patient. After 5 months, he developed re-fistulization
and the culture revealed enterococcus for which he was given appropriate antibiotics. After one
month, he developed klebsiella pneumonia and was treated again. Thereafter the fistulisation
disappeared and he has no more infection for the last 3 monts, and continues antiTb treatment.
Sternal Tb mostlt develops in middle aged people. Secondary skin infections and fistulization are
among commonest complication. Majority of authors are of the opinion that standard antitubercular chemotherapy is sufficient whereas some believe that surgical debridement with primary
closure should be combined with extended chemotherapy up to 24 months to prevent recurrence.
Keywords: Tuberculosis, Sternum, Fistulization
P488[Tuberculosis]
13 Yearly Adventure of Erzincan Tuberculosis Control Dispensary
Ertan Murat1, Edhem Ünver2, Sedat Altın2
1
Erzincan Tuberculosis Control Dispensary
2
Erzincan University Medical Faculty, Erzincan
AIM: To compare the features of patients that has taken tuberculosis therapy and monitorized by
Erzincan Tuberculosis Control Dispensary between 2001-2013
Material &
METHOD: Restrospective researches have been made by scanning 380 patients' Tuberculosis
Control Dispensary files whose records were kept properly in 13 years time period. Treatment
results and factors that effect the results were evaluated between the years. We had analyzed if
there was any statistically significance.
FINDINGS: The average age was 42,18 + 9,23, 157 of women, 223 of men (58.7 %). 324 of
them(85.3%) were new case, 26 relapse, 24 incoming transplantation, 2 of them MDR and 4
outgoing transplantation, 224 (58.9%) lung tuberculosis, 153 extrapulmonary tuberculosis and 3 of
them were treated together.
62 of extrapulmonary tuberculosis cases were lenf node tuberculosis, 31 tuberculosis pleurisy, 12
skin tuberculosis, 4 breast tuberculosis, 8 tuberculosis pericarditis, 9 of them bone tuberculosis, 8
meninx tuberculosis, 6 peritoneum, 8 kidney, 2 of them epididiymis, 1 adrenal, 1 endometrium, 1
bowel, 1 bladder, 1 liver, 1 larynx tuberculosis.
105 patients were from countryside, 273 were from city.
33 patients were tradesman, 31 of them were housewives, 16 farmer, 24 student, 15 workers, 11
unemployed, 8 soldier, 5 of them were prisoners. Regular treatment period was calculated as
8.74+3.12 months.
11 patients were exitus, in case 6 patients couldn't complete their treatment because they were
resistant cases and transplantation.
310 patients were diagnosed by pulmonologists, 17 by infectious diseases specialists, 53 by
Tuberculosis Control Dispensary and their treatment had been started.
Coclusion: Especially the number of extrapulmonary tuberculosis cases are increasing in last years.
İt is remarkable that the average age is higher in women than men. Complementation of treatment
is 83%, with 23 cases kür elde edilen,??? treatment success is 89.6%.
Keywords: Erzincan, Tuberculosis Control Dispensary, tuberculosis
P489[Tuberculosis]
Medicosocial description and features of clinical course of new case patients
with pulmonary tuberculosis
Saodat Abdullayevna Rustamova, Muhabbat Husanovna Djurabayeva
Department of phthisiology, Tashkent Medical Academy, Tashkent, Uzbekistan
MATERIALSMETHODS: We examined 50 patients with new-onset pulmonary tuberculosis. They were tested by
clinical,
microscopic
and
bacteriological
methods.
RESULTS: Sex and age: to 20 years old 2 patients, from 20 to 40 years old 28 patients, from 41
to 60 years old - 13, over 61 years old 7 patients, males - 36, women - 14.
Among the clinical forms dominated infiltrative tuberculosis in 35 cases, focal tuberculosis in 11
cases, tuberculoma in 2 cases and one case of disseminated and cavernous pulmonary
tuberculosis. In past history 11 patients had contact with TB patients, among them at 6 patients
there was a family contact, 2 patients in the past were in prisons. A third of patients had bad
habits: alcohol abuse at 12 patients and smoking – 23, drugs - 3. Patients without fixed place of
work were 31, poor material conditions established in 18 patients. General symptoms of
intoxication and cough with sputum were noted at all patients. Half the patients had
bacterioexcretion.
Drug
resistance
detected
at
4
patients.
CONCLUSION: Medicosocial description of new-onset patients is as follows: often tuberculosis
occurs in patients at working age with an active lifestyle. Basically, they were presented as social
unadapted individuals who did not have a permanent job and had poor material and social
conditions. Bad habits, mainly in the form of a combination of alcohol abuse and smoking,
concomitant diseases, criminal record present as risk factors. It’s typical of this category extensive
destructive forms of tuberculosis occurring with complications.
Keywords: new-onset, pulmonary tuberculosis, medicosocial
Concomitant diseases
24 (48%) patients had concomitant diseases. Among them dominated diabetes mellitus type I and II at 7
(29.2%) patients, chronic hepatitis at 4 (16.7%) patients and anemia of mixed origin at 3 (12.5%) patients,
non-specific bronchopulmonary diseases - 3 (12.5%), HIV infection - 2 (8.3%), diseases of the gastrointestinal
tract - in 2 (8.3%) cases.
Radiographic manifestations
Sides
Amount of patients %
one-side
36
72
double-side
14
28
the collapse of the lung 42
84
Radiographic manifestations of a specific process were as follows: at the majority of patients (72%) the
tubercular process was one-sided, in 14 (28%) cases process was double-sided, the collapse of the lung was
detected at 42 (84%) patients.
P490[Tuberculosis]
The results of treatment for latent tuberculosis infection(LTBI) in our
dispensary between 2010-2012
Filiz Öztürk1, Dilek Polat1, Özlen Tümer2, Haluk Çalışır3
1
Umraniye Tuberculosis Dispensary
2
Ümraniye Tuberculosis Association
3
Atakent Acibadem Hospital
OBJECTIVE: Discussing the results of the treatment for LTBI in Ümraniye TB Dispensary between
2010-2011
METHODS: Patient files and preventive therapy cards were examined retrospectively
RESULTS:
Between 2010-2012 a total of 650 persons with a mean age of 19.5 ± 16.4 years were included in
preventive therapy protocol according to national guideline. Out of 650 people 72.6% (473) were
close contacts of smear positive TB patients, 23.5% (153) were immune compromised, 3.5% (23)
were TST positive, 0.02% (1)had fibrotic lesions.
Among 1123 close contacts of 273 smear-positive patients treated during this time we were able to
examine 1086 (96.7%) at least once.
Among 473 close contacts with a mean age of 12.5 ± 16.4 who were decided to get preventive
therapy treatment was completed successsfully in 69% (326), 28.5% (135) defaulted, 0.2% (1)
got active tuberculosis, 1%(5) were transferred out, in 1.3%(6) therapy was stopped due to
hepatotoxicity.
Out of 153 people with a mean age of 42.1 ± 13.3 years who got preventive therapy because of
immune deficiency 68% (104) completed treatment, 11% (17) defaulted, 0.7% (1) were
transferred out, % 0.7 (1) got active tuberculosis, 2.6% (4) died. In 17% (26) treatment was
stopped for several reasons by the specialist.
CONCLUSION: We aimed to share and discuss the results of preventive therapy in our dispensary
region. In conclusion we observed similar treatment results in our two different groups.
Keywords: ltreatment for latent tubercolosis, contact, umraniye tuberculosis dispensary
P491[Tuberculosis]
A case of pulmonary and hepatic tuberculosis presented with jaundice
Canan Gedik1, Asiye Kanbay1, Erkan Ceylan1, İlyas Tuncer2, Tülay Zenginkinet3
1
İstanbul Medeniyet Unıversity Göztepe Research and Training Hospital,Department of Chest
Disease
2
İstanbul Medeniyet University, Göztepe Research and Training Hospital,Department of
Gastroenterology
3
İstanbul Medeniyet University, Göztepe Research and Training Hospital,Department of Pathology
Tuberculosis (TB), being a frequent, infection disease in our country, could affect all systems.
Extrapulmonary TB makes up 15-20% of all cases. Hepatic TB occurs after lenfohematogenous
spread of the bacilli. The most common form of hepatic tuberculosis is the widespread hepatic
involvement which accompanies pulmonary or miliary involvement. Despite the widespread
infiltration in the liver, it rarely reveals symptoms. What makes our case with pulmonary and
hepatic TB interesting is the emergence of the disease with symptoms and findings of
gastrointestinal system, rather than respiratory system symptoms.
A 64-year-old man.He had fever, chill, shivering, inflation and pain at the abdomen, jaundice in the
eyes and at the skin for 3 days. In his medical history, he had chronic obstructive pulmonary
disease(COPD). He ceased alcohol consumption 15 years ago. Vital status was as following: Blod
pressure:140/70 mmHg, Pulse Rate: 79/min., Respiratory Rate:14/min. Temperature: 38 C. On
inspection sclera and skin were icteric. Distension and collateral formation were observed at the
abdominal inspection. Hepatosplenomegaly was detected. During the examination of the
respiratory system, both hemithoraxes participated equally at respiration and bilateral rhonchuses
and rales were heard. The patient was hospitalized with the prediagnosis of liver cirhosis and
COPD.
Biochemical and haematological results were following.Urea:77mg/dl Creatinin:57mg/dl,
ALT:188U/L,AST:206U/L,T.Bilirubin:10.29mg/dl,CRP:31.7mg/dl,WBC:5.5,HGB:10.7,HCT:31.8,PLT:
92000T.Protein:3.6gr/dl,Albumin:2.06gr/dl,LDH:729U/L, AlkalenFosfataz 756U.
Other laboratory findings were normal. Hepatosplenomegaly was detected with ultrasonography.
Repetitive sputum examinations revealed acid resistant bacteria positivity. Liver biopsy was done.
Caseating granulomatous reaction was detected at the liver biopsy. AntiTB treatment was
begun.Despite the treatment, condition of the patient deteriorated.
Keywords: tuberculosis,hepatic involvement,jaundice
P492[Tuberculosis]
Tuberculosis among elder patients
Filiz Duyar Ağca1, 5no.lu Vsd Personeli2
1
3rd TB Dispensary Altındağ-ANKARA TURKEY
2
5th TB Dispensary HCWs/2005-2012 Yenimahalle-ANKARA TURKEY
AIM
Evaluation of tuberculosis(TB) patients who were 65 years and older
METHOD
Elder TB patients, who registered Yenimahalle TB Dispensary between January 2005-December
2012, were evaluated retrospectively.
FINDINGS
There were 1028 registered TB patients between 2005-2012; 181(17,6%) of them were 65 years
and older. The oldest one was 92. 88(48,6%) patients were female and 93(51,4%) were male. 179
were born in Turkey.
167(92,2%) were new; 13(7,2%) were relapse cases; 10 of them were pulmonary TB(PTB)
patients and female:male ratio was 3:10.
87(48,1%) cases had PTB; 79(43,6%) had extrapulmonary TB(EPTB) and 15(9,4%) had PTB+EPTB
diagnosis. Among EPTB cases, patients mostly had extrathoracic lymph node involvement(n=31);
frequent site was cervical region.
Among females, ratio of EPTB(54,5%); among males, ratio of PTB(60,2%) were higher.
32(17,7%) patients had a history of TB contact, no one got IPT.
133(73,5%) patients had concommitant disorders; those were cardiovascular(40,4%) and
pulmonary(19,1%) comorbidities. 55(33,4%) cases had multiple concurrent disease, 48(26,5%)
had none.
91,2%(n=165) had at least one symptom during first visit; most frequent symptoms were
cough(49,2%) and night sweats(37%). 16(8,8%) patients were diagnosed during routine controls.
Bacteriological examination were done to all PTB cases. 56,8%(58/102) of them were AFB sputum
smear(+), 13,7%(14/102) were culture(+).
180 patients were treated with 1st-line TB drugs. Treatment results were:
86,7%(n=157) treatment success, 12,2%(n=22) death respectively.
RESULTS
In recent years, no.of elder TB patients is increasing in dispensary region. Because of concurrent
diseases, elder patients have many general symptoms which are also seen at TB. Death is more
frequent compared with other age groups.
Keywords: Elder patients, tuberculosis
Organ involvement and bacteriological status of patients
PATIENT
NEW RELAPSE TREAT.AFTER DEFAULT TOTAL
S(+)C(+)PTB 40
3
0
43
S(+)C(-)PTB
10
3
0
13
S(-)C(+)PTB
11
1
1
13
S(-)C(-)PTB
24
3
0
27
S(-)C(?)PTB
6
0
0
6
EPTB
76
3
0
79
TOTAL
167
13
1
181
General features of our foreign tuberculosis patients
Mehmet Sinan Bodur1, Ayşe Emel Güngör1, Feyyaz Kabadayı1, Sibel Arınç1, Dilek Ernam1, Fatma
Armağan Hazar1, Sibel Boğa1, Mevhibe Esen Akkaya1, Tülin Sevim1, Kaya Köksalan2
1
Sureyyapasa Chest Diseases Training and Research Hospital
2
Istanbul University Institute of Experimental Medicine
In the last year, totaly 14 tuberculosis patients foreign-born applied to our clinic; whose are 6 from
Turkmenistan, three Azerbaijan, 2 Moldova and,1 of each from Uzbekistan, Syria and Indonesia.
Among these patients, 6 were female and eight male gender. Mean age 29.3 year were in women,
27.5 years in men. Totally, 5 patients MDR TB whose were 2 of them genotype mycobacterium
beijing. 5 patients were registered as paid sick, one of them in refugee status and 8 opened the
records with a medical tourism insurance. Foreign-born tuberculosis patients is extremely
important; for whose are of poor tuberculosis control, coming from countries with high incidence
and drug resistance rates. These patients are deported due to lack of residence permits and this
increases rate of defoulted.
Keywords: Tuberculosis, Foreign patient, General features
General features of our foreign patients
P494[Tuberculosis]
Vascular lesions suggestive of pulmonary tuberculosis
Orhan Yücel, Ferhat Onur Ural, Deniz Doğan, Cantürk Taşcı
Gülhane Military Medical Academy, Department of Chest Diseases, Ankara, Turkey
TUBERCULOSIS, MYCOBACTERIUM TUBERCULOSIS USUALLY CAUSED AND A CHRONIC BACTERIAL
AND GRANULOMATOUS CHARACTER IS A CONTAGIOUS INFECTION. WHILE THERE MAY BE
TUBERCULOSIS INFECTION OF A MULTIPLE ORGAN, THİS DİSEASE ESPECIALLY INTO THE LUNGS
AND MEDIASTINAL LYMPH NODES ARE FREQUENTLY OBSERVED.. BASIL IS SCATTERED WITH
COUGH, SNEEZE, OR OTHER WAYS TO AIR IN SALIVA FROM AN ACTIVE TUBERCULOSIS PATIENT,
THE INFECTION SPREADS TAKING WITH SUSPENDED PARTICLES ON THE AIR. OUR PATIENT IS 24
YEAR OLD MALE.HE ADMITTED İN LEFT FLANK PAIN WHİCH İS 2-3 WEEKS. BY LISTENING TO
BREATH SOUNDS WERE DECREASED AT THE LOWER SIDE OF THE THORAX.ON CHEST
RADIOGRAPHY LEFT SINÜS COSTODIAFRAGMATIKUS WAS CLOSED AND MILIMETRIC NODULAR
DENSITY INCREASE WAS IN LEFT UPPER LOBE. ULTRASOUND GUIDED THORACENTESIS IN
PATIENT WAS PERFORMED FROM LEFT HEMITHORAX. PLEURAL BIOPSY COULD NOT RETRIEVID
BUT 15 CC SEROFIBRINOZ PLEURAL FLUID WAS DRAINED. PLEURAL FLUID ADA WAS 113 U/L AND
BEGAN ANTI-TUBERCULOSIS TREATMENT(RIF+INH+EMB+PZA) WITH TBC PLEURISY DIAGNOSIS.
MILIMETRIC NODULAR DENSITY INCREASE WAS IN LEFT UPPER LOBE ON CHEST RADIOGRAPHY
WAS SUGGESTED PULMONARY TUBERCULOSIS FIRST BUT IN THE DETAILED PHYSICAL
EXAMINATION ON THE PATIENT'S LEFT CLAVICLE WAS PALPABLE NODULES ON PALPATION. IN
INSPECTION, THESE NODULES WERE NOT CERTAIN, BUT MORE RESEMBLED A VASCULAR
STRUCTURE. PATIENT WAS SHOT IN THE LEFT SHOULDER BY MAGNETIC RESONANCE IMAGING
AND THESE LESIONS FLEBOLIT / HEMANGIOMA WAS REPORTED AS. AFTER 6 MONTHS OF ANTITUBERCULOSIS TREATMENT LEFT PLEURAL EFFUSION RESOLVED COMPLETELY IN PATIENT AND,
CARDIO-VASCULAR SURGERY WAS PLANNED FOR VASCULAR LESIONS ON THE PATIENT'S LEFT
CLAVICLE.
Keywords: PULMONARY TUBERCULOSIS, TUBERCULOUS PLEURISY, VASCULAR LESION
P495[Tuberculosis]
Reasons of relapses of tuberculosis after treatment under DOTS strategy
1
1
1
Kazim Mukhamedov Sabitovich , Lubov Hegai Nikolayevna , Mavluda Khodjayeva Inogamovna ,
2
1
Ludmila Yugai Makarovna , Mukhabat Djurabayeva Khusanovna , Vyacheslav Kostromtsov
1
Vitalyevich , Saodat Rustamova Abdullayevna
1
2
1
Department of phthisiology, Tashkent Medical Academy, Tashkent, Uzbekistan
Department of Culture Laboratory of Tashkent TB Hospital N1.Tashkent, Uzbekistan
Reasons of tuberculosis relapse after the treatment under DOTS strategy was studied.
Materials. We analyses of 104 patients with relapses of TB, carried out treatment on DOTS ІІ
categories in TB hospital №1. Male was 63 (60,6 %), female - 41 (39,4 %).
Results. 65,8% were infiltrative forms of TB, 29,9% - fibro-cavernous TB, 4,3% disseminated TB.
M.tuberculosis have been found out in 66 (63,5 %) cases. The drug sensibility test has shown
resistance to isoniasid (H) in 35 (53,0 %) cases, rifampicin (R) - in 28 (42,4 %), ethambutol (E) in 5 (7,6 %), to pyrazinamid (Z) - in 7 (10,6 %) cases. Mono-resistance is noted in 18 (27,3 %)
cases, poly-resistance - in 25 (37,8 %) and multi-resistance - in 23 (34,8 %).
From 104 patients 71 (68,3 %) suffered of accompanying diseases: diabetes mellitus in 17 (23,9
%) cases, stomach ulcer - 7 (9,8 %), COPD - 12 (16,9 %), cardiovascular diseases - 11 (15,5 %),
alcoholism - 5 (7 %) and drug abuse - 8 (11,2 %). Complications of TB process are noted at 28
(26,9 %) patients. From them haemoptysis at 3 (10,7 %), respiratory insufficiency at 12 (42,8 %),
cardio-pulmonary
insufficiency
at
3
(10,7
%)
patients.
Conclusion. The frequent reasons of relapses are presence of accompanying diseases (62,6 %),
insufficient duration of treatment in a continuation phase, indiscipline of patients. Correct and
enough long treatment on DOTS strategy at continuation phase is the major link of preventive
maintenance of relapses of TB.
Keywords: tuberculosis, treatment, relapse of TB
P496[Tuberculosis]
The Evaluatıon of ekstrapulmoner tuberculosıs (TB) cases according to
years and sex
Beyhan Çakar
7th Tuberculosis Dispensary, Ankara
AİM:
To analyze ekstrapulmoner tuberculosıs (TB) according to years and sex cases treated between
2006-2012 in our dıspensary
METHOD: Dispensary records were analyzed retrospectively
RESULT: İn 7 years, 590 TB patients were treated in our dispensary. Pulmonary TB (PTB) were
296(50%), extrapulmonary TB(EPTB) were 255(43%), pulmonary TB + extrapulmonary TB were
39 (7%). All EPTB cases were 255 (43%). Rate percentage of EPTB cases according to years
(2006-2012) were 31, 37, 38, 42, 49, 53, 56 The rates percentage of EPTB patıents was increased
within years. Mean and standard deviation was 50,30 19,33 (1-87) in females, 44,55±22,82 (1-81)
in males. Rate percentages of new cases were in males 97 %,in females 95%. First three disease
of extrapulmonary involment in females were ekstrathoracic TB lymphadenitis, TB pleuritis,
genitourinary system TB(rates percentage 31, 13 and 12respectively).İn male population TB
pleuritis, ekstrathoracic TB lymphadenitis and TB, skeletal system TB were seen (rates percentage
32,16 and 13 respectively). Diagnosis was established by histopathology,mycrobiology and also
according to clinic and radiology features. These rates percentage of diagnosis were 76, 5,19 in
females, 67, 6, 7 in males respectively Rate percentages of all bacteriological examination Acid fast
bacill (AFB) were positive in smear 9% and cultured in 5%. First treatment commencement place
was mostly at dıspensary (%45).
CONCLUSİON: The rates percentage of EPTB patients was increased within years. EPTB and mean
age were high in female cases.The highest rates of EPTB involment was ekstrathoracic TB
lymphadenitis in females and TB pleuritis in males.
Keywords: Extrapulmonary TB, sex,localizations, diagnostic characteristics, treatment results
P497[Tuberculosis]
Ways of improvement of prevention of relapses of pulmonary tuberculosis
1
1
Mavluda Khodjayeva Inogamovna , Mukhabat Djurabayeva Khusanovna , Tohirbek Yakubbekov
2
3
1
Yunusovich , Gulnora Murmusayeva Kuchkarovna , Vyacheslav Kostromtsov Vitalyevich , Kazim
Mukhamedov Sabitovich
1
2
3
1
Department of Phthisiology, Tashkent Medical Academy, Tashkent, Uzbekistan
Therapeutics Department of TB Hospital N1, Tashkent, Uzbekistan
National Reference Laboratory, TB Institute, Tashkent, Uzbekistan
Introduction of the standard combined chemotherapy (SCT) on DOTS strategy notes improvement
of an epidemiological situation on tuberculosis in Uzbekistan. At the same time number of patients
with risk of relapse of tuberculosis (RT) increases. Now rate of RT average 30-40 %. For last 8
years this figure has not changed. However patients with resistant forms of M. tuberculosis
increase. Under our supervision there were 128 patients with RT after completion SCT. The analysis
of case records of these patients has given the chance to judge efficiency of treatment. We
establish following major factors of risk of RT: 1) Insufficient facility of adequacy controllable
course therapy at 82 (64,1 %) first time revealed patients; 2) 29 (22,7 %) patients who had major
residual changes in lungs after completion of treatment. Insufficient organization of supervision
over a condition of this patients group has affected on not timely revealing and treatment of
relapse; 3. Insufficient investigation of sputum on drug sensitivity test (DST) in 17 (13,3 %) cases.
Hereupon to certain number of patients the standard combined therapy appointed empirically. In
above mentioned groups particular importance has presence of several accompanying diseases and
harmful
habits
of
patients.
Conclusion. For improvement of prevention of relapses of pulmonary tuberculosis follows: 1.
guaranteeing of adequacy, enough long controllable course of chemotherapy, in intensive and
continuation phases on DOT taking into account DST; 2. to improve efficiency of organization of
revealing of TB at general medical networks; 3. the organization of full-fledged monitoring of
treatment.
Keywords: tuberculosis, relapse, prevention
P498[Tuberculosis]
Other counry of birth tuberculosis patients in Istanbul, 2005-2011
Zuhal Uğur1, Soydan Sinem Koymen1, Savaş Başar Kartal2
1
Istanbul Directorate of Public Health, tuberculosis branch
2
Istanbul Directorate of Public Health
AIM
Aim of this was evaluation of demographic, resistance patterns and treatment outcomes of
tuberculosis patients who were other country of birth.
METHOD
545 (%1.3) of 41.300 tuberculosis patients in registered based national tuberculosis data were
included in this study. Missing data was completed from medical files. Demographic feature,
resistant pattern, treatment outcome of patients was analysed.
RESULTS
293 (%53.7) of cases were male, %78.5 of cases was pulmonary tuberculosis, average age of
cases was 31.5. %79 of pulmonary cases were tested with sputum smear, %70 of these cases
were found AFB (+). %71.7 of cases were culture positive and %81.3 of these cases were tested
drug susceptibility test. Other country birth patients was found %0.49 in 2005, %2.2 in 2011. In
total cases, %59.2 in Asia, %27.5 in Europe, %13 in Africa. The most rates was found Azerbaijan
(%22.4), Turkmenistan (%11). In tested drug susceptibility cases, any resistance was found
%26.5, MDR was found %13.1. Treatment success (%77.2), treatment default (%2.2), treatment
failure (%2.2), death (%1.3) was found in treatment outcomes.
CONCLUSION
Other country of birth patients is increasing by year. They are coming from high resistance
country. Treatment default rate of other country of birth was found 5 times in all Istanbul’s cases.
Management and follow up of other country birth patients are difficult problem by years.
Keywords: other counry of birth, tuberculosis
P499[Tuberculosis]
Rhizobium radiobacter bacteremia in miliary tuberculosis
Ufuk Turhan, Alper Gündoğan, Tuncer Özkısa, Seyfettin Gümüş
Department of Pulmonology, Gülhane Military Medical Academy, Ankara, Turkey
Rhizobium species, known as Agrobacterium in the past but then classified by 16S rDNA analysis
commonly found in soil aerobic, motile, free of spores, catalase, oxidase, urease-positive and
gram-negative rods. In these group, especially plant pathogenic (R. radiobacter, R.rhizogenes,
R.rubi R.vitis) Rhizobium radiobacter can cause infection in humans. Until the 1980s, it was not
accepted as a cause of an infection in humans despite being isolated from clinical samples. For the
first time in 1980 it was isolated from a patient with prosthetic valve endocarditis as a cause of an
infection. These bacterias are usually cause infection in immunsupressed patients and / or in
patients whom foreign bodies like catheter-dentures are used. Infection may be seen as
bacteremia, peritoneal dialysis assosiated peritonitis, cellulitis, urinary tract infection and
endophthalmitis or pneumonia rarely. We present a miliary tuberculosis case who has Rhizobium
radiobacter bacteremia with. In the current literature, Rhizobium radiobacter bacteremia with
tuberculosis has not been reported before. Especially in miliary tuberculosis patients who have
persistant fever due to treatment, Rhizobium radiobacter bacteremia also should be keep in mind.
Keywords: miliary tuberculosis, Rhizobium Radiobacter
P500[Tuberculosis]
A Case of Lung Tuberculosis and Venous Thromboembolism
Alper Koç1, Ege Güleç Balbay2, Sinem Safçı1, Hafize Titiz2, Özgür Metin2
1
Department of Internal Medicine, Duzce University, Duzce, Turkey
2
Department of Chest Diseases, Duzce University, Duzce, Turkey
In developing countries, Tuberculosis continues to be a common and serious public health problem.
Pulmonary embolism (PE) is a disease with a high morbidity and mortality. We presented a case
with lung tuberculosis accompanying PE.
A 54 year old male patient who was yacht painter applied to polyclinic with complaints of loss of
appetite, weakness, weight loss, cough and sputum for two months. The posterioranterior chest Xray showed heterogeneous opacity on right upper and middle zone. The acid-fast bacilli sputum
microscopy was positive for two times. We started a treatment consisted of izoniazid, rifampicin,
pyrazinamide, ethambutol. On the 20.day of treatment, the patient complained pain and edema of
the left leg. In the left popliteal and saphena parva vein thrombus was detected through the
bilateral lower extremity venous doppler ultrasonography. Because of dyspnea, which was also
complained by the patient, computerized thorax tomography was ordered. This showed filling
defects consistent with thrombus in right lower lobe and left lower lobe segmental pulmonary
artery branches. Anticoagulant therapy was started.
Compared to healthy individuals, patients who are observed under the diagnosis of pulmonary
tuberculosis, especially in the first month of treatment with rifampicin, there was an increased risk
of venous thromboemboli (VTE). We think that, pulmonary tuberculosis patients under treatment
with appropriate clinical and laboratory features, if there is no another risk factor, the risk of VTE
should not be forgotten.
Keywords: pulmonary tuberculosis, pulmonary Embolism, rifampicin
P501[Tuberculosis]
The evaluation of RDW levels in patients with pulmonary tuberculosis
Özlem Abakay, Hadice Selimoğlu Şen, Ali İhsan Çarkanat, Süreyya Yılmaz, Abdullah Çetin
Tanrıkulu, Halide Kaya, Abdurrahman Abakay
Department of Chest Diseases, Dicle University, Diyarbakir, Turkey
Red Blood Cell Distribution Width (RDW) kırmızı kan hücrelerinin şekil ve büyüklüklerindeki
değişimlerini gösteren basit bir laboratuar testtir. Pnömoni gibi enfeksiyöz akciğer hastalıklarında
artmış olduğu bildirilmiştir. Bu çalışmada kültür pozitif akciğer tüberkülozlu hastaların RDW
düzeyindeki değişimlerin araştırılması amaçlandı.
Çalışmaya 56 kültür pozitif akciğer tüberkülozlu hasta ve 50 sağlıklı kişiden oluşan kontrol grubu
alındı.
Hastaların yaş ortalaması 49,0 ± 23,3 yıldı. Hastaların %66’si erkek, %34’i kadındı. Hasta ve
kontrol gruplarının yaş ortalaması ve cinsiyet dağılımı benzerdi (p >0,05). Hasta grubunda
ortalama RDW düzeyi 16.6±2.4 iken kontrol grubunda ortalama RDW düzeyi 12.5±1.4 olarak
saptandı. Hasta grubunun RDW düzeyi kontrol grubundan daha yüksekti (p<0.001).
Çalışmamız akciğer tüberkülozlu hastalarda RDW düzeylerinin sağlıklı kişilere göre yüksek olduğunu
ve bu yükselmenin hastalardaki inflamatuar sürece bağlı olabileceğini düşündürmüştür.
Keywords: Lung, RDW, tuberculosis
P502[Tuberculosis]
The evaluation of NLR ratio in patients with culture-positive pulmonary
tuberculosis
Özlem Abakay, Hadice Selimoğlu Şen, Cengizhan Sezgi, Mahşuk Taylan, Abdullah Çetin Tanrıkulu,
Abdurrahman Abakay
Department of Chest Diseases, Dicle University, Diyarbakir, Turkey
Theneutrophillymphocyteratio (NLR) is a cheapmarker thatindicatingsystemicinflammation. Ithas
beenreportedto be increased in infectiouspulmonarydiseasesuch as pneumonia.
Thisstudywasaimedtoinvestigatethechanges in thelevel of NLRin patientswithculturepositivepulmonarytuberculosis.
Thestudyconsisted of 49 patientswithpulmonarytuberculosisand 43 healthycontrolsubjects.
Themeanage of thepatientswas 49.6 ± 22.9 years. Sixty-nine percent of patientsweremale,
and31% werefemale. Themeanageandsexdistribution of thepatientandcontrolgroupsweresimilar (p>
0.05). Themean NLRvaluewas 2.26 ± 0.3 in patientgroupand0.3 ± 0.04 in
thecontrolgrouprespectively. TheaverageNLR valueof thepatientgroupwashigherthanthecontrolgroup
(p <0.001).
This studysuggestedthatNLR levels in
patientswithpulmonarytuberculosisincreasedcomparedtohealthysubjects,
andthisincreasemaydependstheinflammatoryprocess of patients.
Keywords: Lung, tuberculosis. NLR
P503[Tuberculosis]
Tuberculosis and Diyabetes intercourse
Sevim Brina
State Hospital,Department of Chest Diseases,Prizren
In this retrospective study of prevalence of diabetes mellitus in patients with pulmonary
tuberculosis and pulmonary tuberculosis with diabetes,we aimed to determine the relationship
between them.Because in spite of the progress in medicine diabetes and tuberculosis continue to
be an important health problem.Retrospectively in our study between 2011-2013 made in regional
hospital of Prizren,department of chest diseases recorded in total 1307 inpatient,patient with
tuberculosos,it was performed by 408.The data of this research done by researcher is gathered
from the questions involving socio-demografic,clinical characteristics of the patients.The data has
been collected from the files of the patients in the archive of the hospital and has been obtained
upon examination of the researcher.
As a result of research the average age of patients is 44+-years,and 82,6% of them are male
patients.48,5% of the mature had tuberculosis treatment between 0-2 month and 70,3% of them
lay at hospital for the first time due to tuberculosis.In this research 34,3% of the mature(140)had
additional chronic disease,16,4%(67)diabetes and 10,3%(42)hipertansio.It was found that 35,8%
of the mature with diabetes were diabet patients fot more than 5 years.In our study
53,7%(36)patients with diabetes are treated with Insulin and 38,8%(26)are treated with oral
Antidiabetic.
In patients with pulmonary tuberculosis,diabetes was higher compared to other diseases.Reunion
of diebetes and tuberculosis makes difficult to control the disease brings restrictions in fulfilling the
individual's daily activities.Therefore helath professionals at patients diagnosed with active
pulmonary tuberculosis,should pay attention to history in terms of diabetes blod glucose should be
provided and monitored in
Keywords: Diabetes,pulmonary tuberculosis, the frequency seen,disease correlation
P504[Tuberculosis]
The medico-social characteristic of patients with tubercular pleurisy
Akram Irgashev, Khayrulla Rajabov, Rustam Abdullaev
Department diagnostics of pathology of lungs and of pleura. National Center of TB, Tashkent,
Uzbekistan
The medico-social status was studied at 161 patients with the TB pleurisy. Men was 88, women 73.
Aged till 20 years were 6, 21-50 years–152, 51 and are more–3, thus women of reproductive age
were–66. On social composition among patients students were 8, workers and employees
budgetary-30, pensioners and invalids-42, the unemployed-46, housewives–30, businessmen–5.
152 patients the beginning of the illness connected with overcooling. The period from an onset of
illness to appeal to specialized medical institution were at 19 patients 1-2 weeks, at 57–3-4 weeks,
at 79–5-6 weeks, at 6- 6 and more weeks. The delay in the address for specialized medical care at
31 patients was connected by self-treatment, at 29–load work and fear to lose works, at 87–
underestimation of condition of health, at 14–untimely diagnostics in primary unit of health care. It
should be noted that at 34 patients (21,1%) pleurisy was complication of focal TB of lungs, at 15-is
revealed
HIV.
MTB
in
a
pleural
exudate
founded
in
23.
At all patients will reach good result from the carried-out antitubercular treatment against
pathogenetic therapy and punktsionny aspiration of an exudate from a pleural cavity.
Conclusion. Thus, the medico-social status of patients with tubercular pleurisy is characterized by a
prevalence among them the most young and able-bodied faces, and also vulnerable segments of
the population, untimely and late diagnostics of this pathology. Despite this, correct and adequate
treatment in the conditions of specialized medical institution allows to reach at all patients good
results from therapeutic treatment.
Keywords: tubercular pleurisy, medico-social status,
P505[Tuberculosis]
Concurrent Extensive Pulmonary Tuberculosis And Pott's Disease Mimicking
a Metastatic Lung Cancer and Multiple Myeloma
Buket Başa Akdoğan, Ömer Faruk Önder, Gülhan Boğatekin
Department of Chest Diseases, Teaching and Research Hospital, Diyarbakır, Turkey
One of the major health problems of our country, tuberculosis, can lead to severe disability when
settled in the skeletal system.These patients are capable of delay in diagnosis and should be
evaluated for respiratory system.We present a rare case of concurrent pott disease and extensive
pulmonary tuberculosis mimicking lung cancer with bone metastasis and multiple myeloma.A 79
year old male patient presented to hematology department with lumbago and fatigue.Hospitalized
with preliminary diagnosis of multiple myeloma due to anemia, increased sedimentation and
lumbago.Follow-up high fever patient's chest radiograph was taken and consulted to pulmanory
department considering lung cancer and pneumonia.On physical examination, the patient's general
condition was poor, middle.Evident cyanosis was present. Saturation on room air was 80.The
sibilant rhonchi on auscultation was bilateral and in places crackles were present.Bilateral patchy
infiltrates were detected at PA radiograph.Hemoglobin 11,6 g/dl, Sedimentation 65mm/sa, CRP
32mg/L and tm markers were negative.Brucella was found 2 times negative.Patient was transfered
to tuberculosis department.While sputum ARB was 2 times negative in later detected
+++/++.Computed tomography revealed mediastinal, paratracheal, precarinal, 14*18 mm
lymphadenopathies, alveolar and acinar nodules leading consolidation at left upper-lower lobe and
right lung.Thoracolumbar MR revealed; compatible appearance with the spondylodiscitis at Th12L1, fluid collection that may be compatible with pus or abscess were observed at posterior in the
epidural space, approximately 1.5 cm in diameter.Neurosurgery department agreed patient
compatible with pott.After 3 weeks of anti tuberculosis treatment patient transfered to
neurosurgery department for abscess drainage.Should be considered in the differential diagnosis.
Keywords: Pott's disease, vertebral tuberculosis, fever of unknown origin
chest radiograph
bilaterally patchaed infiltrates.
P506[Tuberculosis]
The Five-Years Analysis Of Preventive Treatment In Ankara Centre
Tuberculosis Dispensary
Tülay Sağıroğlu1, Suha Özkan2
1
Çankaya Central TB Dispensary, Ankara, Turkey
2
Yenimahalle Çamlıca Family Health Center, Ankara, Turkey
AIM: We want to evaluate the situation and the compliance of preventive treatment in our
dispensary, which is important in tuberculosis control.
METHOD: 5 years preventive treatment records between the years 2008-2012 in our dispensary,
were reviewed retrospectively. The characteristics of patients, the reasons for treatment and
outcomes were analyzed.
RESULTS: 44(2008), 74(2009), 129(2010), 100(2011), 199 in 2012, a total of 546 people were
taken to preventive treatment. The mean age was 28.1 ± 18.4 and their 52.6% are male. The
number of preventive treatment for close contact of tuberculosis patient by year, 27(61.4%),
35(47.3%), 59(45.7%), 27(27%), 108(54.3%) of 256 in total (% 46.9), while the tuberculin skin
test positivity 97(17.8%) in total. Immune suppression due to the preventive given to a total of
186(34.1%). 3 people had begun with sequelae lesions, 4 people with other reasons. Isoniaside
used almost all of prophylaxis, rifampicin is given in only 6 people. Immune suppression usually 9
months, others have been found to be 6 months of treatment. 78.8% percent completed, 16.7%
were defaulted. 2 people began to tuberculosis treatment, 16 people discontinued therapy due to
side effects, 2 people died. No statistically significant difference was found in treatment
completion-default rates, according to age groups, sex, the reasons for treatment
CONCLUSION: The number of people with preventive treatment is increasing in recent years in
our dispensary. The main reasons are greater prevention of close contacts, and the widespread use
of TNF-alpha inhibitors. We have to give priority for compliance.
Keywords: compliance, dispensary, prophylaxis, tuberculosis
P507[Tuberculosis]
Acute Tuberculosis in Intensive Care Unit
Kazım Rollas, Atilla Kara, Ebru Ortaç Ersoy, Kezban Özmen Süner, Mehmet Nezir Güllü, Serpil Öcal,
Arzu Topeli
Depatment of Medical İntensive Care Unit, Hacettepe Univercity, Anlara, Turkey
Tuberculosis(TB) is known as a chronic infectious disease, however TB might present acutely
mimicking other infectious or non-infectious processes. The most common acute forms of TB are
pulmonary, miliary and meningeal. The frequency of intensive care unit(ICU) admission in patients
with TB ranges 1-3% and mortality rate ranges 17.5-81%. The aim of this study was to determine
mortality rates and evaluate clinical features of active TB patients requiring ICU admission.
The medical records of TB patients requiring ICU admission were reviewed over a 5 year period
retrospectively.
Between January 2009 and 2014, 16 patients with active TB admitted to ICU were included in the
study. The mean age of the patients was 44.6 ±14.9. The mean APACHE II score was 21.0±7.8
and SOFA score was 6.3±3.0. Of the 16 patients 3 had pulmonary, 5 had extrapulmonary, 3 had
both pulmonary and extrapulmonary, and 5 had miliary TB. Ten patients recieved mechanical
ventilation(MV). Seven(43.8%) patients died in the ICU. The predicted death rate was 39.4%. The
cause of mortality was septic shock in 5 patients, respiratory failure in 2 patients. APACHE II and
SOFA scores were higher in patients who died(p=0.012, 0.048,respectively). Six of the 8
immunsuppressed patients, 1 of the 8 non-immunsuppressed patients died(p=0.041). The mean
MV duration was 17.7±14.6 days in patients who died and 7.1±14.4 days in patients who
survived.
In conclusion, active TB patients admitted to ICU have higher mortality rates, especially patients
with immunsuppression, co-infection, high APACHE II and SOFA scores and mechanical ventilation.
Keywords: tuberculosis, intensive care, acute
P508[Tuberculosis]
Mass-view Cases of Tuberculosis
Çetin Yaşar, Abdullah Çetin Tanrıkulu, Abdurrahman Abakay, Özlem Abakay, Cengizhan Sezgi,
Hadice Selimoğlu Şen
Dicle University. Department of Chest Disease, Diyarbakir
İntroductıon:Pulmonary tuberculosis is a disease with different radiological appearance.Pulmonary
TB can lead to diagnostic difficulties as radiological that giving similar results tümoral,systemic,and
inflammatory disease.In particular, diabetes,silicosis,aging and human immunodeficiency virus
(HIV) positive patients of cases are atypical radiographic appearance while sometimes may be
observed atypical features in patients without underlying disease.Tüberculosis sometimes nodules
and views with mass lesions may also come.
CASE: Twenty-five year old male patient has got of night sweats,cough,chest pain, loss of
appetite, weight loss, fever were present about 2 months.Physical examination was normally.There
is on the chest radiograph nodular lesions in the upper lobe of the left lung patients when
computed tomography was taken.There is 24x12 mm size with irregular contours showing band
formation and spicules elongation to pleura lobule contoured soft tissue density nodular lesion at
the apex of the left lung on the tomography.SUVmax values specified in pet ct: 3.8 was
measured.The patient thought it might be in the early stages of malignancy in patients with left
upper lobe wedge resection was performed.Pathology and histochemical examination; caseating
granulomatous inflammation and acid fast bacilli positive with EZN was detected and case was
evaluated of tuberculosis. The patient was started on treatment for tuberculosis.There was no any
complications and externa were with suggestions.
CONCLUSION: As a result, the incidence of pulmonary tuberculosis is increasing living in areas of
public life such as nursing homes, prisons. Tuberculosis in people living in such places because of
the different radiographic appearance of tuberculosis must be kept in mind.
Keywords: Tüberculosis, PET CT, Mass
P509[Tuberculosis]
History of Sanatoriums in Turkey and in the World
Emel Kibaroğlu1, Öztuğ Önal2, Cavidan Füsun Gökyar2, Gül Ulubayram2
1
National Federation of Anti-Tuberculosis Associations/Turkey
2
Ankara 4th Tuberculosis Dispensary
PURPOSE: Evaluation and documantation of establishment, functioning and social effects of
Sanatoriums.
MaterialMETHOD: Printed and photografic sources have been used.
RESULTS: Sanatorium movement has been started by Dr. Brehmer in Silesia. First Sanatorium in
USA has been funded by a tuberculosis patient, Dr Trudeau near Lake Saranac. In USA, spasific
sanatoriums for afro-americans, jews and artists have been builded. Marginal ideas like “Cave
Sanatoriums” came true in USA. Swiss Sanatoriums were always popular.
First sanatorium in Turkey has been established in 1904 in Hamidiye Etfal Hospital. The first
sanatorium of Turkish Republic was Heybeliada Sanatorium. Dr. Musa Kazım was the owner of first
private sanatorium in Turkey. Tuberculosis patients had to wait for years to be accepted in
sanatorium. Meanwhile lots of them died. During pre-antibiotic era, treatment was based on fresh
air, riched diet, sun bathing and absolute resting. Sanatorium life, created lots of novels like
“Letters of Yakacık” and Magic Mountain.
CONCLUSION: Sanatoriums supported tuberculosis control programmes by isolating the patients
and by surgical operations. As time passed, sanatoriums transformed into hotels (ie: Switzerland)
and other hospitals. Employees struggled with tuberculosis under poor conditions should be
mentioned with respect.
Keywords: history, tuberculosis, sanatorium
P510[Tuberculosis]
Outcomes of bronchial artery embolization for life-threatening recurrent
hemoptysis due to post-tuberculosis sequelae
Nihat Karadağ, Didem Görgün, Sadettin Kamat, Esra Yazar, Veysel Yılmaz, Pınar Yıldız
Yedikule Chest Disease and Surgery Training and Research Hospital, İstanbul
Recurrent hemoptysis due to pulmonary tuberculosis (TB) frequently develops in Turkey due to
intermediate prevalence of disease. Bronchial artery embolization (BAE) is an established
procedure to achieve treatment of recurrent hemoptysis. We aimed to study the effect of BAE on
the control of recurrent or massive hemoptysis in patients with post-TB sequelae. A total of 29
patients (26 males, 3 females) were identified as having undergone BAE from 2011 to 2013.
Among these patients, 11 (38%) patients presented with acute massive hemoptysis and 18 (62%)
patients with chronic hemoptysis. Seven (24%) patients experienced single episodes. Two (7%)
patients had active tuberculosis at presentation. In the outcome analysis, immediate control of
hemoptysis was achieved in 27 (93%) patients underwent BAE. Seven (24%) patients underwent
repeat BAE due to recurrent hemoptysis. Procedure related complication was seen in 1 patient.
More than three-quarters of the patients were followed up for at least 2 years. BAE can be used to
control hemoptysis due to tuberculosis.
Keywords: Bronchial artery embolization
P511[Tuberculosis]
An analysis of cases with rare extrapulmonary tuberculosis
Murat Yalçınsoy1, Sinem Güngör1, Bilgen Begüm Afşar Dönmez2, Olga Akkan3, Esra Akkütük1, Esra
Usta Bülbül1, Esen Akkaya1
1
Süreyyapaşa Chest Disease and Surgery Training and Educational Hospital
2
Adana Numune Training and Educational Hospital
3
Kartal Yavuz Sultan Selim Goverment Hospital
Tuberculosis(TB) is an infection can involve all organs and tissues. Although pulmonary TB is more
common, the form of extrapulmonary tuberculosis (EP-TB) is still a major clinical problem. AD-TB
incidence is 35.1%. According to 2012 Department of Tuberculosis case reports EPT is increased in
our country.
In our study, we investigated clinical and laboratory features of EP-TB cases retrospectively. Rare
EP-TB cases diagnosed and/or followed up in our clinic were included. Pleural and lymph node TB
cases common form of EP-TB were excluded. EP-TB diagnosis was made with clinical features,
response to treatment, microbiological and/or histological and/or radiological findings. 51 patients
(mean age: 34.6±15.8 F/M: 36/16) enrolled and most common involved was peritoneum (n:19,
37.2%). Other involvements were bone, skin, liver, breast, thyroid, tongue, pericardium,
genitourinary tract, larynx, lip, epiglottis, parotid gland, miliary, intestinal tract, chest wall and
spleen. Multiple organ involvement was detected in 19 (37.2%) cases. Additional pulmonary TB
was found in 27.5% (n:14) of cases. There was comorbidity in 10 (20%) of cases. 4 cases had TB
history and 16 cases had a history of contact with tuberculosis. All of the cases are negative for
HIV, HBsAg was positive in 1 case. The most common presenting symptoms were cough, weight
loss, abdominal pain. Chest radiography was normal in 23 cases, the mean treatment duration was
9 months.
As a result, the early diagnosis and treatment of rare extrapulmonary involvement is important to
avoid from serious complications of TB is a serious public health problem although treatable
disease.
Keywords: pulomnary tuberculosis, extrapulmonary tuberculosis, treatment
P512[Tuberculosis]
Pediatric Tuberculosis Cases in Denizli TB Control Dispensery
Hatice Betül Abdüloğlu1, Zeynep Dedeoğlu1, Seref Özkara2
1
Denizli TB Control Dispensary, Turkey
2
Atatürk Chest Diseases and Chest SurgeryEducation and Research Hospital Ankara,
AIM: To analyze characteristics of pediatric TB cases in Denizli TB Control Dispensary (TCD)
METHODS: Dispensary registries of 2008-2013 were examined retrospectively. Data about
pediatric TB cases (<18 years); age, gender, reason of application, contact history, TST, BCG scar,
organs involved, microbiological-histopathological diagnosis, treatment regimen and duration were
analyzed.
FINDINGS: There were 740 cases, 34 were children in the last 6 years in Denizli TCD. Five
pediatric cases (14.7%) were diagnosed by contact investigation. There were 7 (2 were
pulmonary) and 27 (13 were pulmonary) TB cases in 0-5 and 6-17 age groups, respectively.
Twenty cases diagnosed in university hospital, 2 in TCD and 12 in different hospitals. Distribution
of cases according to diagnostic methods are presented in Table 1. Treatment duration was 6
months in 47%, 9 months in 38.2%. Treatment outcome was successful in all cases.
DISCUSSION: Diagnosis of pediatric tuberculosis depends on being a TB contact, TST positivity,
appropriate clinical and radiological findings. Nonresponsive lower respiratory tract infection to
non-TB antibiotics should make us think about TB. To give importance to contact investigations and
to ask about contacts in detail is crucial. As in adult TB, in pediatric TB, cooperation with TCD is
required.
RESULT: Rate of cases diagnosed with only clinical and radiological findings is low. Patients were
treated successfully. Low number of pediatric TB cases points a successful program.
Keywords: Denizli, VSD, TST, BCG, Children's Tuberculosis
Table 1. Diagnostic methods in pediatric TB cases in Denizli TCD between 2008-2013
Bacteriologica
l diagnosis
ClinicalRadiologica
l diagnosis
Histopathologica
l diagnosis
Total
Number
Percen
Number
t
Percen
t
Number
Percen
t
Numbe
r
Pulmonary
8
72,7
0
0
3
27,3
11
Extra-pulmonary
3
15,6
13
68,4
3
15,8
19
Pulmonary+extra
-pulmonary
1
25
3
75,0
0
0
5
Total
12
35,3
16
47,1
6
17,6
34
P513[Tuberculosis]
Lung Transplantation or Anti Tuberculosis Therapy
Mehmet Bayram1, Kübra Aşık1, Didem Özkan1, Fatmanur Karaköse1, Yasemin Akkoyunlu2, Hatice
Özçelik1, Murat Sezer1
1
Department of Pulmonology, Bezmialem Vakif University, Istanbul,Turkey
2
Department of Clinical Microbiology and Infectious Diseases, Bezmialem Vakif University, Istanbul,
Turkey
CASE: 21-year-old female patient. She admitted to the external clinic with complaint of dyspnea
nine months ago. She has been investigated for anemi (Hgb:5,6 g/dl). Kollagen tissue markers
were negative. Bilateral reticular density and bronchiectasis were seen at thorax CT; interstitial
lung disease was thought. ARB was negative. Antibiotics were administered for four months due to
intermittent fever and steroid was adminestered for three months. Finally; doctors has planned
lung transplantation for the patient.
Patient admitted to us with dyspnea, cough and fever. On physical examination there was bilateral
ral. CRP:21, WBC: 23x103µ/l, Neutrophils: %87;3. Bilateral reticular density and bronchiectasis
were stil progress at thorax CT. Meropenem, Ciprofloxacin, fluconazole and vancomycin
antibiotherapy were administered, but fever couldn't be controlled. Infection parameters increased
progressively. Blood and urine cultures were negative. She couldn’t expectorate so ARB could not
be evaluated. PPD was anergic. Quantiferon test was suspicious, because of using steroid. IgG,
IgA, IgM, IgD, IgE, complements were normal. The sweat test was suspicios. Cortisol, ACTH values
were normal. Bronchial lavage and TBB with fiber optic bronchoscopy (FOB) were performed. ARB
was positive in the bronchial lavage. Histopathology of TBB revealed necrotic granulomatous
inflammation. Anti tuberculosis treatment was administered. Fever didn’t recur again and
infiltrations decreased at chest x-ray 2 weeks after the treatment.
CONCLUSION: In young patients who has bilateral infiltraition, tuberculosis should always be kept
in mind.
Keywords: interstitial lung, transplantation, tuberculosis,
Figure1
Figure1
P514[Tuberculosis]
Difference Of Symptom And Clinical Characteristics Of New Pulmonary TB
Cases In Males And Females
Aslı Şule Tıpırdamaz Yurteri1, Asiye İnan Süer1, Esra Tekinarslan1, Belgin Barbaros Kuranel1, Filiz
Duyar Ağca1, Kerime Reteroğlu Altunay1, Cemile Sağlam1, Sevkan Caner1, Tülay Sağıroğlu1, Nadiye
Alkan1, Feride Neval Solakoğlu1, Özden Turunç1, Yavuz Tanrıkulu1, Beyhan Çakar1, Nur Kafalı1,
Şeref Özkara2
1
Ankara TB Control Dispensary
2
Atatürk Chest Diseases and Chest Surgery Education and Research Hospital, Ankara
AIM: To examine symptoms and clinical characteristics of new pulmonary TB cases while
comparing male and female gender.
METHOD: New pulmonary TB cases’ characteristics in Ankara were collected with a form
prospectively. Data were seperately evaluated and compared for males and females.
FINDINGS: Some of new pulmonary TB cases registered in Ankara TB dyspensaries (January 1st,
2012- July 31st 2013). Total 154 cases: 102 males, 52 females; mean ages were 43.9±18.0 and
44.1±23.0, respectively. In males and females, nonsmoking rates were 25.5% and 73.1%; alcohol
drinking habit were 24.5% and 7.7I; family TB history were 34.3% and 42.3%; chest x-ray
revealed cavity 18.6% and 5.8%; bilateral involvement in 31.4% and 21.2%, (all these differences
were statistically significant; p<0,05). Smear positivity were 56.9% in males and 44.2% in
females. Most frequent symptoms were cough 74.5%, sputum 62.7%, fatique 59.8%, weight loss
58.8%, sweating 44.1% in males; fatique 63.5%, cough 55.8%, sputum 44.2%, sweating 42.3%,
weight loss 40.4% in females. Hemoptysis was present in 20.6% and 26.9% in males and females
respectively.
Discussion and RESULT: Weak side of this study is that, this is not a cohort. Pulmonary TB have
different characteristics in males and females in Ankara, where TB incidence is low. One third of
cases of both gender have TB history in the family. Smoking and drinking habits are more frequent
in males. Cough, sputum, fatique, weight loss in males and fatique, cough symptoms in females
are most frequent. Hemoptysis were seen in 20-25% of both genders.
Keywords: symptom, alcohol, smoking
P515[Tuberculosis]
Evaluatıon Of Contact Tracing In Kayseri Tuberculosis Control Dispensary
Şakir Hakan Aksu1, Arzu Sarıyıldız1, Türkan Yıldız1, Şeref Özkara2
1
Kayseri Tuberculosis Control Dispansery
2
Ankara Atatürk Chest Diseases and Chest Surgery Education and Research Hospital, Turkey
AIM: One of the services done by TB control dyspensaries is contact tracing. We aimed to study
contact tracing efforts and their results in Kayseri TB Dyspensary.
METHODS: All registered TB cases in 2011 and 2012 were included. Dispensary registries (VSD-11
and contact tracing forms) were examined. In this study, age, gender, case definitions,
bacteriological status, and number, time, and results of contact tracing were collected, analyzed.
FINDINGS: Total 351 cases, 169 pulmonary, 169 extrapulmonary and 13
pulmonary+extrapulmonary were present. Male/female numbers were 192/159, mean ages were
44.9±20.5. Smear and culture positivity were 96/182 (52.7%) and 88/182 (48.4%) in pulmonary
cases, respectively. Contact tracing were done in 237/351 (67.5%) and 138/182 (75.8%) of all
and pulmonary cases respectively. Mean duration between treatment initiation and first contact
tracing was 37.9±51.2 days. Number of examined contacts for each pulmonary case were 2.7±2,9.
Contact examinations after first visit were not done generally. Preventive therapy were given to
138 contacts of 55 cases. There were no TB cases detected in these contacts.
Discussion and RESULT: Limitation of this study is the inherent problems in registry. Main findings
are, late, incomplete contact examinations and not continuing periodical examinations. Contribution
of contact tracing to preventive therapy is important. There were no cases detected by contact
tracing. As a result, contact tracing in Kayseri TB Dyspensary should be improved.
Keywords: Kayseri, Dispensary, Contact tracing
P516[Tuberculosis]
Tuberculous Lymphadenitis after Tuberculous Pleurisy, Paradoxal Response
to Treatment? Case report
Alper Gündoğan, Ufuk Turhan, Cantürk Taşçı, Ergun Uçar, Seyfettin Gümüş, Ergun Tozkoparan,
Hayati Bilgiç
Gulhane Military Medical Academy,Department of Pulmonary Medicine, Ankara
In tuberculosis patients after the initiation of tuberculosis therapy, clinical or radiological worsening
of existing lesions or appearance of new lesions is called the paradoxical response to treatment.
Despite appropriate treatment cause of clinical or radiological deterioration is still unclear.
Progression of existing lesions or the emergence of new lesions in tuberculosis patient on follow up
brings to mind the suspicion of accuracy of diagnosis, drug reactions, drug resistance, treatment
adherence or another second disease. However, sometimes without monitoring any of these
conditions paradox progression with tuberculosis treatment can occur. We present a case that
paradoxical response monitored at sixth month of tuberculous pleurisy treatment. 21 years old
male patient was diagnosed with tuberculous pleurisy with pleural biopsy. (Picture 1) On his follow
up on sixth month of treatment he has swelling of the neck. CT revealed consolidation on right
lower lobe and necrotic right supraclavicular lymph node. Lymph node biopsy revealed tuberculous
lymphadenitis. (Picture 2) It is interesting that paradoxical progression present as tuberculous
lymphadenitis in our tuberculous pleurisy patient and it should be kept in mind in follow-up of
tuberculosis patients.
Keywords: Paradoxal response, Tuberculosis, Lenfadenitis, Pleurisy
Picture 1
Picture 2
P517[Tuberculosis]
Co-infection of Cytomegalovirus and Miliary Tuberculosis in an Elderly
Patient
Aslı Görek Dilektaşlı1, Ezgi Demirdöğen Çetinoğlu1, Özge Aydın Güçlü1, Esra Kazak2, Ahmet
Ursavaş1, Ercüment Ege1
1
Uludağ University Faculty of Medicine Pulmonary Diseases, Bursa
2
Uludağ University Faculty of Medicine İnfectious Diseases, Bursa
INTRODUCTION: Although miliary tuberculosis (TB) is well-known, co-infection with
Cytomegalovirus (CMV) is unusual. CMV cause a wide range of clinical scenarios depending on the
immune status of the patient. We present a disseminated miliary TB case and probable reactivation
of the CMV infection due to the severe wasting TB course.
Case-presentation: A 62-year old woman presented with a 3-month history of worsening
cough,dyspnea,malaise,night sweats, weight loss and functional ability. Physical examination
revealed fever, apathia, 3x3 cm mass on the arasternal side of the anterior chest wall, and bilateral
inguinal lymphadenopathies. Chest X-ray revealed diffuse,bilateral small lung nodules. Broadspectrum antibiotics with cefepim,oseltamivir and trimethoprim-sulphamethoxazole were started
emprically. Thoracic CT-scan showed innumerable tiny, well-defined, miliary nodules throughout
the lungs. Real time PCR for CMV was positive. As she was unable to expectorate sputum,
bronchoscopy was performed. The acid-fast smear of the bronchoalveolar lavage fluid was positive.
The patient was administered rifampin,isoniazid,ethambutol,pyrazinamide and adjunctive
corticosteroids. Gancyclovir was also started for the CMV reactivation. A marked improvemet in
clinical symptoms,radiologic findings was noted under this treatment.
CONCLUSION: Miliary TB is mostly manifest in the population with impaired cellular immunity.
None of the predisposing conditions for miliary TB were found in our patient except impaired
cellular immunity due to senility. CMV establish latent infection after acute infection recovery.
Reactivation of CMV may ocur at any time during the life, and reactivation occurs commonly in
critically ill patients. Clinicians should keep in mind that reactivation of CMV infection can be caused
by severe disseminated wasting TB course.
Keywords: miliary tuberculosis, cytomegolovirus
P518[Tuberculosis]
3 case is interesting because of a family history of tuberculosis
Hatice Betül Abdüloğlu, Adevviye Pelin Uz, Yasemin Erdoğan
Denizli TB Control Dispensary, Turkey
OBJECTIVE: Infectious pulmonary tuberculosis ( especially smear +) cases contact is to
emphasize the importance of control and protection treatment
METHODS:: A retrospective analyzed.Their patient files and contact information for the control and
protection status were examined.
RESULTS: Mus-born ca. 1994 Denizli on 10.03.2011 with VSD application to clinical, radiological,
bacteriological smear positive pulmonary TB control as a result of the GHH Find diagnosed and
made admissions.0.05.2011 on whether to continue treatment in the hospital 28/11/2011 VSD
output 'as a cure treatment is completed.
Control, not born in 1998 when his sister M.A. 22.11 2013, on the hospital of cervical of the lymph
nodes report this person 2011 in the treatment C.A.ile the same information that is in Tcd
understood from the records,in 2011, their birth certificate to remain in Mus in his brother's birth
certificate and therefore he uses the date M.a.nin contact couldn't control protection or treatment
and also the control of remaining as Tuberculosis existing record, the patient is suggested for all
the family is scanned again,born in 1996 in other brother of smear positive pulmonary tuberculosis,
and 2 basis. The main case is times the state to the emergency department of the hospital, and
went into the stomach the treatment with the diagnosis of phenomenon in 2011 contact does not
control and protection treatment, and are not identified.
CONCLUSION: in the control of Tuberculosis tuberculosis dispensary registration system in
pulmonary tuberculosis and contact preflight inspections and protection of their treatment is of
great importance.
Keywords: Denizli, VSD, Tuberculosis, protection
P519[Tuberculosis]
Miliary Tuberculosis Case due to Intravesical BCG Therapy
Alper Gündoğan1, Ömer Deniz1, Ufuk Turhan1, Tuncer Özkısa1, Cem Irkılata2, Hayati Bilgiç1
1
Gulhane Military Medical Academy,Department of Pulmonary Medicine, Ankara
2
Gulhane Military Medical Academy, Department of Urology, Ankara
Intravesical BCG therapy is a well-known and frequently used therapy for bladder carcinomas..
Tuberculosis disease due to BCG bovis can be detected after intravesical BCG therapy rarely.
Generally it is local but rarely can be a disseminated tuberculosis. We present a genitourinary,
miliary and possible intracranial tuberculosis case due to intravesical BCG therapy. 65 years old
patient had been used 6 sessions BCG therapy for uroepithelial carcinoma of bladder. He had
increasing fever and weight loss lasted about two months after BCG therapy. He had used empirical
antibiotics but symptoms continued. He applied to hospital for left vision loss. Eye examination had
been detected orbital mass in the left eye. Metastasis of bladder cancer was thought brain MRI and
Thorax CT were planned. Thorax CT revealed nodular lesions (metastasis, miliary
tuberculosis?)(Picture 1). Broncoscophy revealed no abnormality, transbronchial biopsies were
taken. Penil mass lesions had been detected on urological examination and excisional biopsy was
made. Bronchial lavaj fluid for alkali-resistant staining was negative, sputum staining for
mycobacterium was negative at other hospital. Transbronchial biopsy and penil biopsy revealed
granulomatous inflammation. Previous Brain MRI was examined again by radiology and brain
lesions were assessed compatible with tuberculomas. With the diagnosis of miliary tuberculosis
antituberculous therapy initiated and next control was planned. Miliary tuberculosis approximately
6-7 months after intravesical BCG therapy is evaluated as an attractive feature of the case. It
should be kept in mind that as a rare complication of intravesical BCG therapy may be a miliary
tuberculosis.
Keywords: Intravesical BCG, Miliary tuberculosis
Picture 1
Thorax CT reveals extensive micronodules
P520[Tobacco Control]
Comparasion the efficacy of smoking cessation therapies after earthquake
Selami Ekin1, Hülya Günbatar1, Bünyamin Sertoğullarından1, Ahmet Arısoy2, Hanifi Yıldız3, Ali
Eman4, Haci Yusuf Güneş4
1
Department of Pulmonary Medicine, Yuzuncu Yil University, Van, Turkey
2
Department of Pulmonary Medicine, Private Istanbul Hospital, Van, Turkey
3
Department of Pulmonary Medicine, Private Lokman Hekim Hospital, Van, Turkey
4
Department of Anesthesiology, Van Goverment Hospital, Van, Turkey
AIM: The most important cause of preventable morbidity and mortality is smoking. Seventeen
milion person smoke in Turkey and every year one hundred thousand people die due to smoking
releated disease.
MATERIALSMETHODS: Who admitted to smoking cessation, varenicline or bupropion, patients who started
treatment, smoking cessation success were retrospectively evaluated. Ongoing drug therapy 3
months and can be contacted by phone controls or patients included in the study were from. 274
patients were included in the study. 70.4% of patients (n = 193) were male and 29.6% (n = 81)
were female. The group of 151 people varenicline, bupropion was the 123 people. Varenicline and
bupropion for smoking cessation in patients with a significant difference was found between.
RESULT: In cases of natural disaster such as an earthquake, is less than the normal population,
and disasters in drug activities, active and effective smoking cessation clinics concluded functions
should continue.
Keywords: Smoking, earthquake, varenicline, bupropion
P522[Tobacco Control]
The impact of tobacco smoke on bronchial asthma in adolescents and young
adults
Naima Ubaydullaeva
Ministry of Public Health, Tashkent Institute of Postgraduate Medical Education, Tashkent,
Uzbekistan
Aim. To study the impact of tobacco smoke on bronchial asthma at a young age.
Methods. We examined 106 patients with asthma aged 14-21 years with a history of active tobacco
smoking. The control group consisted of 92 non-smoking young patients with asthma. We
conducted
a
survey
and
study
of
respiratory
function.
Results. Clinical manifestations of asthma were typical at 88.7% of patients with active smoking,
they had attacks of expiratory dyspnea and cough with difficult expectoration of viscous sputum.
Asthma occurred mostly at night and only in 18.9% - during the day. In the case of atypical course
of asthma 11.3% of patients had no cough with sputum, shortness of breath on exertion with
classic asthma attacks. And all of these indicators were not significant differences with the control
group. But signs of reversible airway obstruction were identified in 60.4% of active smokers, and
this indicator was 10,2% higher than in the control group. All examined patients in both groups
showed signs of bronchial hyperreactivity. "Smoker's cough” was in 83.0 of active smokers with
asthma, despite their young age. Specific anti-inflammatory drugs were used by only 24.5% of
young
smokers,
and
57.6%
by
non-smoking
patients
with
asthma.
Conclusion. Smoking worsens asthma and young smokers with asthma have more severe disorders
of respiratory function and symptoms compared with nonsmokers.
Keywords: Tobacco smoking, asthma, adolescents, young adults
P523[Tobacco Control]
Smokıng habits, levels of nicotine dependence, thoughts about smoking and
cessation in workers
Gülay YILMAZEL1, Fevziye Çetinkaya2, Melis Naçar2
1
Hitit University Health School,Corum
2
Erciyes University Faculty of Medicine, Public Health Department, Kayseri
Introduction and AIM: Smoking not only effects on health but also it is a hazard for occupational
safety. This study was to done to aim for determination smoking habits, levels of nicotin
dependence, thougths about smoking and cessation in workers.
MaterialMETHODS: This descriptive study was performed in the province of Corum between the dates
October-November 2013. The population of study was consisted by 110 workers working in the
cement factory. Study was completed with 83 volunteer men worker. Achievement rate was
75.5%. The data were collected a 40 items questionaire form. We used Fagerstrm Test of Nicotine
Dependence to determine levels of nicotin dependence.
RESULTS: It was found that 48.2% of workers were currently smoking.65.0% of workers had low
levels dependency. The means of Fagerstrom Test scores were found at high levels (2.88±2.86).
The means of age to starting to smoking was 21. We determined that levels of nicotine dependency
were rising with their marital status (unmarried, widowed/divorced), starting smoking early ages
and 15 years old, consuming usual kinds of cigarette, smoking continuously,consuming cigarette
daily at least 11 and over (p<0.05). Also it was found a statistical significant relation between the
thoughts about smoking and cessation with nicotin dependence in workers (p<0.05).
CONCLUSIONS: In this study we determined that smoking rates and the means of FTND scores
were high in workers. A major part of workers said that tried to cessation but had’nt successful.
Results indicate smoke cessation programs should be implement in factories urgently for
occupational health and security.
Keywords: occupational hazard, nicotin dependence, smoking habits, smoking cessation.
P524[Tobacco Control]
Smokers and non-smokers in men with long-term comparison of vital signs
after exercise
Sema Gül Türk1, Ertuğrul Deniz Köse2
1
19 mayis university, the department of cardio-pulmonary physiotherapy, samsun
2
gazi osman paşa oniversity, the department of anatomy, tokat
OBJECT: Smoker and non-smoker young men astroturf football activity aimed to pre-post
comparison of vital signs.
INTRODUCTION: Smoker and non-smoker astroturf football activity for young men to determine
their vital signs pre-post blood pressure(BP), heart rate(HR), respiratory rate(RR) measurements
were made and we have obtained data were analyzed by SPSS.
MATERIALSMETHODS: In our study, November 2013 - January 2014 between Mega Sports Facilities' from
what the average age 25.65 smokers with a mean age of 25.95 that non-smokers demographic
information (age, gender, height, weight, medical history, medical histories, smoking history) were
included.When they first enter the astroturf and match departure BP, HR, RR was recorded by
measuring.
FINDINGS: Our study involved 40 patients with a mean age of 20.85. 20 smokers and 20 nonsmokers were defined. Systolic BP and SS significant difference was observed in the comparison
values. In other measurements, no significant difference was observed.
RESULTS: Engaged in prolonged exercise, smoking in individuals with a history of PD and SS value
was determined that nonsmoking vary with the individual.
Keywords: smoking and exercise
P525[Tobacco Control]
Smoking Rates Among High School Students in Sındırgı district in Balıkesir
Ümit Tutar1, Fatma Esra Tutar2, Nejat Altıntaş3
1
Balıkesir Chest Diseases Hospital
2
Balıkesir Provincial Directorate of Public Health
3
Namık Kemal University, Department of Chest Disease, Tekirdag,Turkey
OBJECTIVE: We aimed to assess the rate of tobacco usage and the degree of cigarette
dependence in high school students in Sındırgı district in Balikesir.
MaterialsMETHODS:
From all high schools students in the district center who want to participate in the study were
asked to complete a survey.By subtracting 57 surveys from a total of 712 surveys,the remaining
655 surveys were included in the study.
RESULTS: A total of 655 students(374 male and 281 female)with an age range of 13to25 years
participated in the study.Of the participants,499(76.18%) had never smoked,24(3.66%) had quit
smoking,132(20.15%)were still smoking.Of the smokers,117 were male and 15 were female.Of
those surveyed,437(66.71%) had at least one smoker in their home.In437 families,while fathers
were smoker in335(51.14 %)of them,mothers were smoker in only58(8.85%). Largest families
were consisted of14 individuals.The percentage of people who smoke in a house according to the
total number of people living at home,ranged from 10%to50%.The number of families in which
single person smoked inside the house was 275(41.98%).Of these 275 families,only father in
192(29.31%)family,only child in 39(5.95 %)family, and only mother in 9(1.37% )family were
smokers (Table 1).In our study, the household of 125 participants(19.08%)was not a smoker at
all.
DISCUSSION: Tobacco product usage is around 21.7% in aged 15-24 years in Turkey according
to recent data.Of this age group,male and female compose 34.9% and 9.1% respectively(1).In our
study,smoking prevalence was 20.15%(132/655) in age group of 15-25years.While smoking rates
were 31.28%(117/374)in male student group,3.91%(15/281)in female student group.In this study
relatively lower rates found compared to Turkey’s average.
Keywords: high school, smoking addiction
Comparison of The Number of People who Smoke in a House with Type of Smoker Person
Number of
Household who
smoke
Number of
smoking families
The smoking rate
of fathers
The smoking rate The smoking rate
of mothers
of children
One person
275 (%41.98)
192(%29.31)
9 (% 1.37)
39 ( % 5.95)
Two person
121(%18.47)
106(%16.18)
29(%4.42)
69(%10.53)
Three person
36 ( % 5.49)
32 (% 4.88)
16 (%2.44)
21 ( % 3.20)
Four and over
5 (% 0.76)
5 (% 0.76)
4 (% 0.61)
3 (% 0.45)
Sigara İçenler ve Bağımlılık Dereceleri
Bağımlılık Derecesi* Erkek Kız Toplam
Düşük( FS**:0-2)
54
4
58
Orta (FS:3-7)
59
10 69
Ağır (FS:8-10)
4
1
5
*: T.C. Sağlık Bakanlığı Tütün Bağımlılığı ile Mücadele El Kitabına (2010) göre **: Fagerström Bağımlılık Ölçeği
Skoru
Smokers and Addiction Degrees
Degree of dependence* Male Female Total
Low( FS**:0-2)
54
4
58
Medium (FS:3-7)
59
10
69
High (FS:8-10)
4
1
5
*: By Turkish Republic, Ministry of Health Manual to Combat Tobacco Addiction (2010) **: Fagerström
Addiction Scale Score
P526[Tobacco Control]
Psychometric properties of the Turkish version of the Fagerström test for
nicotine dependence
Mehmet Atilla Uysal1, Derya Öztuna2, Ayşe Bahadır3, Çağatay Karşıdağ4, Aynur Horoz5
1
Yedikule Hospital for Chest Diseases and Thoracic Surgery Training and Research Hospital
Istanbul, Turkey
2
Ankara University, Faculty of Medicine, Department of Biostatistics, Ankara, Turkey
3
Uludag University, Faculty of Medicine, Department of Chest Diseases, Bursa, Turkey
4
Bakirkoy Education and Training Hospital for Mental and Neurological Diseases Istanbul, Turkey
5
Okmeydani Education and Research Hospital Istanbul, Turkey
BACKGROUND: Despite the fact that the reliability from the Turkish version FTND remains proven
formerly, the dimensionality of the FTND (one-dimensional or multidimensional) continues to be
not defined.
AIMS: This study aimed to assess the psychometric properties of the Turkish version of the
Fagerström Test for Nicotine Dependence (FTND).
Study Design: In this retrospective cross sectional study, the data analyzed in this study were
collected from two big smoking cessation clinics in Istanbul, Turkey.
METHODS: Confirmatory factor analysis was used to test the factor structure of the Turkish
version of the questionnaire using a large adolescent sample from two smoking cessation clinics.
Analyses confirmed that the Turkish version of the FTND has a two-factor structure with moderate
reliability.
RESULTS: This study found that using a total score as an estimate of nicotine dependence may
limit the assessment of specific smoking dependency and tailoring intervention approaches.
CONCLUSION: We suggest that a two-factor FTND in clinical practice would more accurately
determine the nicotine dependence of patients.
Keywords: Nicotine, Tobacco Use Disorder, Analysis, Factor
P527[Tobacco Control]
A Carbon Monoxide Intoxication Case Caused by Narghile (Water-pipe)
Smoking
Ramazan Öcal1, Nesrin Öcal2, Mehmet Sertaç Yıldırım1
1
Department of Internal Diseases, Bayındır Hospital, Ankara, Turkey
2
Department Of Chest Diseases, Gulhane Military Medicine Academy, Ankara, Turkey
Water-pipe tobacco (narghile) smoking is recently a common public health threat. Main reason for
this popularty is the misconception that water-pipes have less risk than cigarettes. Contrary to this
wrong belief, there are important datas demonstrating that water-pipe smoking causes lung cancer
at least as much as cigarette smoking. A water-pipe involves heating flavored tobacco with
charcoal and inhaling the resulting smoke after it has passed through a water reservoir. Because of
this contrivance, beside chronic risk of lung cancer and COPD, exposure to tobacco and charcoal
smoke brings out mortal risks such as carbon monoxide intoxication. Here, we present a case of
carbon monoxide ıntoxication case caused by narghile smoking.
28 year-old woman admitted to emergency department with dizzines, headche and dyspnea.
According to her friends, she was previously healthy. After smoking narghile for approximately 5
hours, she suddenly complained of dizziness, headache and dyspnea. The laboratory tests included
complete blood count, ruitin biochemistry were in normal levels. In blood gas analysis, pH was
7.43, PCO2: 46 mmHg, PO2: 73 mmHg, SaO2: 93%, bicarbonate 22.4 mmol/L, CO-Hb of 21%.
CO-Hb was aproximatly 20 times higher than normal levels. Considering all symptoms of the
patient and seriously high levels of CO-Hb, a decision was made to treat the patient with
hyperbaric oxygen. After hyperbaric oxygen treatment for 2 hours, symptoms of the patient
improved and CO-Hb levels fell to normal levels.
We shared this phenomenon to remind carbon monoxide intoxication due to water-pipe smoking.
Keywords: carbon monoxide, intoxication, narghile, water-pipe
P528[Tobacco Control]
One year smoking cessation ratios that refer to our outpatient clinics for
smoking cessation
Hatice Kılıç1, Ayşegül Karalezli1, Emine Argüder1, Habibe Gezer1, Mükremin Er1, Ayşegül Şentürk1,
Elif Babaoğlu1, Cantürk Kaya3, Pervin Demir4, H. Canan Hasanoğlı2
1
Ankara Atatürk Training and Research hospital pulmonary diseases clinic, Ankara
2
Department of pulmonary diseases, Yıldırım Beyazıt Üniversity, Ankara
3
Ankara Atatürk Training and Research hospital family medicine clinic, Ankara
4
Department of bioistatistic and medical informating, Yıldırım Beyazıt Üniversity, Ankara
BACKGROUND
In guidelines basic treatments that have been shown useful for smoking cessation are nicotine
replacement treatment, buprapion and varenicline treatment.
OBJECTİVE
The aim of the current work is to compare basic farmacoterapotic agents in terms of side effects
and smoking cessation ratios.
METHOD
550 cases, which refer to our smoking cessation outpatients clinic, are included.115 patients were
excluded because of incomplete data. The data of 435 patients who underwent medical treatment
was evaluated statistically. Cessation or continuation is learned from the records and telephone
visits at the end of both third month and the first year.Recommended treatments and using periods
are recorded.Patients are seperated into 3 groups according to their sort of treatment:Group
1:behavioral education (BE) and varenicline usage Group 2:behavioral education (BE) and
bupropion usage.Group 3:behavioral education (BE) and nicotine replacement treatment (nicotine
gum or nicotine strip.) These groups are compared in terms of smoking cessation ratios.
RESULTS
Smoking cessation ratios at the first month, third month and first year, group 1 group 2 and group
3 are 39,4%, 52,9%, and 32,9%. Smoking cessation ratios at the first month according to group
by range [84(44.0%),57(40.4%),28(28.9%), p=0,01 ] Smoking cessation ratios at the third month
according to group by range [109 (56.8%),81(56.6%),39(39.8%),p=0.01] Smoking cessation
ratios at the first year according to group by range [74(38.5%),45(31,2%),24(24,2%),p=0,01]
CONCLUSION
As a result, smoking cessation according to the fırst year varenicline and bupropion were
significantly superior than NRT. Varenicline users had a higher rate of smoking cessation but this is
not significantly statistical.
Keywords: farmacoterapy, smocing cessation, vareniklin.
P529[Tobacco Control]
The Tobacco Use and the Factors Influencing It in Two Faculties of Dentistry
Students in Turkey
Gülser Kılınç1, Mustafa Oral2, Behiye Sezgin Bolgül3, Gökhan Aksoy4, Türkan Günay5
1
Dokuz Eylul University Hospital Faculty of Medicine Children Dental Clinic, İzmir
2
Member of the Board of Directors of the Turkish Dental Association Ankara
3
Dicle University Dental Faculty Department of Pediatric Dentistry Diyarbakır
4
Ege University Faculty of Dentistry Department of Prosthodontics İzmir
5
Dokuz Eylül University Department of Public Health İzmir
OBJECTIVE: This study aims to determine the dentistry students' attitudes towards tobacco,
tobacco products and smoking habits.
MATERIALSMETHODS: The study was performed in Aegean and Dicle University Faculty of Dentistry in AprilMay 2013. A survey is conducted to 298 students out of 321 which are attending to the both of the
Faculty of Dentistry(92.8%) by applying a cross-sectional study. A questionnaire consisting from
26 questions were applied to determine the smoking habits of the students and to identify the
factors that can affect this habit.
RESULTS: 46% of the students participated in the study were female, 54% were male. Students
smoking rates are, 17.5%in the first grade, 40.5% in fifth grade and 27.1% in average
respectively. Smoking habits of 5th grades were significantly higher(p = 0.000). 11.1% of the
students reported that they smoked for the first time at the age of 15. It is observed that in first
grade 41% smokes domestic cigarettes and 24% smokes foreign cigarettes; in fifth grade 24%
smokes domestic cigarettes and 49% smokes foreign cigarettes. 5-10 units’ smoker smoking rates
among students with the highest(68.5%) were found. Family’s on a regular or occasional smoking
rate was found tobe 48.5%. 73% of the smokers stated that they want to quit smoking, while
64.5% of the students stated that they have tried quitting smoking once or more times already.
CONCLUSION: Students should be educated starting from the period they have attended tothe
school about the adverse health effects of smoking cigarettes and how to fight against cigarettes.
Keywords: Dentistry, Student, Tobacco,
P530[Tobacco Control]
The Perception of Dyspnea and Fatigue in Smokers
Betül Taşpınar, Ferruh Taşpınar, Cihan Caner Aksoy, Canan Gül, Emrah Afşar
Department of Physiotherapy and Rehabilitation School of Health Science Dumlupinar University
OBJECTIVE: The aim of the study was to compare the perception of dyspnea and fatigue in
smoker and non-smoker subjects who at the same age group.
MATERIALMETHOD: Seventy-two smokers (mean age 33.71±11.09 years), ninety-nine non-smoker subjects
(mean age 30.70±12.43 years) and totally 171 subjects were included in the study. Gender, age,
weight, height and body mass index of subjects were choosen as similarly because these
demographical characters may affect dyspnea and fatigue of subjects. The severity of dyspnea and
fatigue were evaluated via Visual Analogue Scale (VAS). Dyspnea severity was examined in four
different situations as night, day, rest and activity. Mann-Whitney U test was used for statistical
analysis.
RESULTS: Smoking duration in smoker group was determined as 14.1 pack years. Dyspnea
severity in non-smoker group during night, day, rest and activity was 0.38, 0.44, 0.38 and 1.19
respectively. Perceived fatigue was found as 2.53. It was observed that in smoker group these
values were 1.60, 1.23, 1.21 ve 2.94 respectively. Perceived fatigue was found as 3.47. When
compare the groups it was determined to be statistically significant (p<0.05).
CONCLUSION: Smoking causes to dyspnea and fatigue in young and adult individuals. However,
such symptoms may not be noticeable level in this age group. Therefore, individuals should be
informed about this topic and should be directed to activities such as sports or social activities and
starting to smoke must be prevented.
Keywords: Dyspnea, Fatigue, Smoking
P531[Tobacco Control]
Gastrointestinal system hemorrhage associated with varenicline
İlknur Başyiğit1, Pınar Tarkun2, Altay Çelebi3, Serap Argun Barış1, Gonca Doğru1, Füsun Yıldız1
1
Department of Chest Disease, Kocaeli University Faculty of Medicine, Kocaeli Turkey
2
Department of Hematology, Kocaeli University Faculty of Medicine, Kocaeli Turkey
3
Department of Gastroenterology, Kocaeli University Faculty of Medicine, Kocaeli Turkey
INTRODUCTION: The mostly reported gastrointestinal system side effects associated with the
varenicline are nausea and vomiting however gastrointestinal system hemorrhage was reported
although it is quite rare. CASE: Thirty-eight years old woman admitted with the symptoms of
abdominal distension and hematochezia that was started on 14th day of varenicline (Champix®
2x1 mg/day, Pfizer, NY, USA) treatment. Her medical history was unremarkable except 10 packyears of smoking history. Physical examination and laboratory tests were within normal limits. She
stated that the abdominal pain and distension were started two days after she started to use
varenicline 1 mg twice daily which was on 8th day of the treatment and she noticed hematochezia
last three-four days. Colonoscopy was performed and reported as normal findings except rectal
edema. The hemorrhage was thought to be associated with varenicline so the treatment was
ceased. Her symptoms were recovered within three days therefore this case was accepted as
gastrointestinal hemorrhage associated with varenicline.
CONCLUSION: Hemorrhagic adverse events especially epistaxis was reported associated with
varenicline thus in case of hemorrhagic events it should be considered whether it is associated with
the treatment and varenicline should be ceased.
Keywords: Varenicline, hemorrhage, side effect
P532[Tobacco Control]
The frequency of psychatric medication need among smokers who applied to
BAU smoking cessation outpatient clinic and had anxiety/depression
symptoms
Pınar Pazarlı Bostan1, Hatice Kutbay Özçelik2, Çiğdem Kınık3, Emel Koçer3, Fatmanur Karaköse2,
Levent Kart2
1
Sakarya University, Health School
2
Bezmialem University Medical Faculty, Pulmonary Diseases
3
Bezmialem University Medical Faculty,Psychiatric Diseases
AIM: Some psychiatric disorders, especially depression and anxiety disorders, are associated with
nicotine dependence.In this study,it is aimed to see frequency of psychatric medication need
among smokers who applied to BAU smoking cessation outpatient clinic(SCOC) and had
anxiety/depression symptoms.
METHOD: All smokers applying to BAU SCOC were evaluated with hospital anxiety and
depression(HAD) questionnaire and psychiatric examination results.The ones who had
anxiety/depression symptoms with HAD questionnaire were examined with psychiatrist and ones
prescripted psychiatric medication were recorded.
RESULTS: Among 414 subjects applying to SCOC in October 2011-March 2012, totally 269 (65%)
subjects who fully answered the questionnaire were evaluated.There was no difference among two
groups (the included and excluded) according to age,sex and smoking properties. 52%(n=140)
were male,the mean age was 42,7±10,7(19-79).The mean of smoking history was 27,5±16,6(175) pack-years; mean of Fagerstrom scores was 6.3±2.1(1-11).20% of the ones who had anxiety
symptoms were having antidepressant medication and 17.3% of them were prescripted an
antidepressant after psychiatric examination.14% of the ones who had depression symptoms were
having medication and 16.3% of them were newly prescripted.Totally 37 cases were having
antidepressant medication and 34 cases were prescripted antidepressant after psychiatric
examination.Antidepressant treatment and anxiete symptoms were more among
women(respectively p=0,01 and p=0,02).Female sex was an independent factor for prescripting an
antidepressant medication after psychiatric examination (p=0,02; %95GA=0,1-0,8).
CONCLUSION: It seems that 1/3 of the appliers(esp women smokers) to SCOC had psychiatric comorbidities.As the right diagnosis and treatment is directly associated with smoking cessation
management; we believe that SCOC should have enough equipment to detect psychiatric
comorbidities.
Keywords: smoking cessation, depression, anxiety
P533[Sleep Disorders]
Association of intermittent and continuous hypoxemia with carotid and
brachial arterial intima-media thicknesses
Selvi Aşker1, Müntecep Aşker2, Mesut Özgökçe3, Hilal Olgun Küçük4, Uğur Küçük5
1
Department of Chest Diseases, Van Yuzuncu Yil University Dursun Odabas Medical Center, Van,
Turkey
2
Department of Cardiology, Van Yuksek Ihtisas Training and Research Hospital, Van,
3
Department of Radiology, Van Regional Training and Research Hospital, Van,
4
Department of Cardiology, Van Regional Training and Research Hospital, Van,
5
Department of Cardiology, Van Military Hospital, Van; Turkey
OBJECTIVES: To assess the carotid and brachial arteries’ intima-media thicknesses (IMT) in
patients with intermittent (obstructive sleep apnea syndrome) (OSAS) and continuous (chronic
obstructive pulmonary disease) (COPD) hypoxemia together with other confounding demographic
and biochemical factors.
BACKGROUND: IMTs of carotid and brachial arteries in OSAS and COPD patients have not been
investigated before.
METHODS: Group 1 consisted of 80 patients with severe OSAS, Group 2 was composed of 80
severe COPD patients and Group 3 was made up of 37 healthy controls.
RESULTS: Carotid and brachial arterial IMTs were significantly higher in patient groups than the
control group. Else than the right carotid IMT, which was increased significantly in OSAS patients,
IMT measurements were similar in OSAS and COPD groups.
CONCLUSION: Both intermittent and continuous hypoxia result in significant changes in carotid
IMT and brachial IMT.
Keywords: Intima-media thickness; obstructive sleep apnea syndrome; chronic obstructive
pulmonary disease; carotid; brachial.
P534[Sleep Disorders]
An Overlooked Cause of Resıstant Hypertasion; Upper Aırway Resıstance
Syndrome
Müntecep Aşker1, Selvi Aşker2, Hilal Olgun Küçük3, Uğur Küçük4
1
Department of Cardiology, Van Yuksek Ihtisas Training and Research Hospital, Van,
2
Department of Chest Diseases, Van Yuzuncu Yil University Dursun Odabas Medical Center
3
Department of Cardiology, Van Regional Training and Research Hospital, Van,
4
Department of Cardiology, Van Military Hospital, Van; Turkey
Upper airway resistance syndrome (UARS) is a sleep disordered breathing syndrome
characterized by repetetive arousals resulting in sympathetic overactivity. We aimed to determine
whether UARS is related to resistant hypertension (RHT). 40 patients with RHT were enrolled in the
study. All patients underwent polysomnographic examination. UARS were determined in 14
subjects (35%). Arousal index was positively correlated with systolic blood pressure level. Eight
patients were treated with positive airway pressure treatment and blood pressure control was
achieved in all whereas no pressure reduction was observed in 4 untreated patients. We concluded
that UARS is a possible secondary cause of RHT.
Keywords: resistant hypertension, upper airway, arousal, upper airway resistance syndrome,
sleep disordered
P535[Sleep Disorders]
The Correlation Between Red Blood Cell Distribution Width Levels With The
Severity Of OSAS, Intima Media Thickness and Pulmonary Hypertension
1
1
1
2
Hülya Günbatar , Bünyamin Sertoğullarından , Selami Ekin , Serkan Akdağ , Ahmet Arisoy
1
2
3
3
Department of Pulmonary Medicine, Yuzuncu Yil University, Van, Turkey
Department of Cardiology Medicine, Yuzuncu Yil University, Van, Turkey
Department of Pulmonary Medicine, Private Istanbul Hospital, Van, Turkey
Introduction; Obstructive sleep apnea syndrome (OSAS) is characterized by repetetive collapse of
the upper airway during sleep. RDW, increased platelet activation have been reported as an
independent predictor of adverse outcomes in the general population and is believed to be
associated
with
cardiovascular
morbidity
and
mortality.
Objectives; We evaluated RDW, Mean Platelet Volume (MPV) and Platelet Distribution Width (PDW)
as a severity index in OSAS and the relationship of carotid intima media thickness and pulmonary
hipertension.
Methods; The study population consisted of 99 patients who were admitted to the sleep laboratory.
Based on the AHI, patients were grouped into three OSAS severity categories. Morning blood
samples were withdrawn from pa¬tients after a 12 hour fasting period. MPV, PDW, RDW was
measured in a blood sample collected and determined. Bilateral common carotid arteries of the
patients
were
scanned.
Results; ninety nine patients, 73 with OSAS and 26 simple snoring control cases were included.
Mean values of MPV, PDW and RDW were similar in patients com¬pared to simple snoring persons
in control group (p>0,05). RDW showed an inverse correlation with mean desaturation and lowest
desaturation ( p<0.05). Body mass index, AHİ, pulmonary artery pressure, desaturation time
under %90 were positively correlated with RDW (p<0.05). MPV, PDW, CIM had no correlation with
any
other
parameters.
Conclusion; The study showed a positive relationship between RDW and the AHI and systolic
pulmonary hypertension in pa¬tients with OSAS. Patients with prominent low saturation should be
considered further investigation for pulmonary hypertension.
Keywords: Carotis Intima Media Thickness, Pulmonary Arterial Pressure, Red Cell Distribution
Width
P536[Sleep Disorders]
Frequency of Obstructive Sleep Apnea Syndrome in Female Patients with
Atrial Fibrillation
Aslıhan Banu Er1, Okan Er2, Özgül Malçok3, Duygu Özol1
1
Turgut Özal University School of Medicine, Department of Pulmonology, Ankara, Turkey
2
Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey
3
Turgut Özal University School of Medicine, Department of Cardiyology, Ankara, Turkey
Arrythmia disorders are pretty seen in patients with OSA. It is consider that nocturnal hypoxemia,
adrenergic activation and alteration at intratorasic pressure are predisposed to AF. In this study,
we aim to assess the prevelance of OSA in female patients with AF admitted to our cardiology clinic
by making Berlin Sleep and STOP-BANG Questionnaire, also determine to the effect on AF.
We enrolled 112 consequent female patients with AF. All patient’s characteristics were recorded.
Electrocardiograms, Berlin Sleep and STOP-BANG questionnaires were applied. Mean ages were
67.8 ± 12.1. 23 of all cases have DM. 88 (78.6%) of patients have chronic AF and 24 (21.4%) of
whom paroxysmal AF. There were 100 (89.3%) patients in ryhthm control group and 9 (8%)
patients in rate control group.
Only 2 (1.8%) patients had performed electrical cardioversion. According to STOP-BANG
questionnaire, 67 (59.8%) of 112 patients had high risk for OSA. The average age and BMI are
consequently (69.8 ±11.1 year, 31.9±5.3) and (65±12.9 year, 25.8±4.6) of modarate and high
risky patients between AF and OSA.
Performing ryhthm or rate control of AF with antiarrythmic drugs was almost done in the female
patients, it was not found relationship between severity of AF and frequency of OSA. In according
to STOP-BANG questionnaire, the probability of OSA was very high in female patients following and
treating with AF. It should be considered that new studies will need in the future.
Keywords: Atrial Fibrillation, OSAS, Stop-Bang.
STOP-BANG Questionnaire
S-Snore
Are you snoring loudly?
T-Tired
Are you tired and sleepless in the morning?
O-Observed Did anybody tell you having apnea when you are sleeping?
P-Pressure
Did you ever take any medicine for high blood pressure?
B-BKİ
Body Mass Index >35 kg/m2
A-Age
Age>50
N-Neck
Neck diameter > 40 cm
G-Gender
Male
He or she is high risky patient whose at least 3 answers are “Yes” in STOP-BANG Questionnaire.
P537[Sleep Disorders]
Role of monitoring nocturnal oxygen saturation before polysomnographic
examination in patients suspected sleep apnea syndrome
Haldun Şevketbeyoğlu1, Dilaver Taş2
1
Konya Military Hospital, Department of Chest Disease, Konya, Turkey
2
GMMA Haydarpasa Training Hospital, Department of Chest Disease, İstanbu, Turkey
INTRODUCTION: Sleep apnea is considered by complaint, history, questionnaire and clinical
examination, and the presence or absence of sleep apnea is determined by polisomnographt (PSG).
The indication of PSG examination is still based on subjective data. In practice, PSG indication can
be more objective way by the measurement of nocturnal oxygen saturation in the patients home.
In this way, the identification of desaturation during sleep is evaluated as powerful predictor of
sleep apnea. With more practical test, an objective identification and prioritization of patients
undergoing PSG would be helpful. Here, characteristics of eight patients recorded saturation by
pulse-oxymeter during sleep was presented.
MATERIALMETHOD: Seven patients were male and one female, mean age 60,87 ± 10,26, mean body mass
index 36,46 ± 7,06 kg/m2. Clinically, SpO2 levels of patients prediagnosed sleep apnea were
recorded during the sleep by the pulse oxymeter device (CMS 50A, Oxymeter software programme
analysis).
RESULTS: SpO2 graphical summary of all patients are shown in table 1. As seen in table 1,
desaturation were observed in all patients and PSG requirement was decided, presuming sleep
apnea. In PSG, apnea-hypopnea index results are shown in table 1.
CONCLUSION: In patients’ home, saturation levels are evaluated by SpO2 measurement with
pulse-oxymeter. Due to ease of application of this method, preliminary analysis for PSG indication
may be performed. Thus we think this method might be an objective test for PSG indication.
However, in order to evaluate the validity of this method, large scale researches are evidently
needed.
Keywords: Sleep apnea, pulse oxymeter device, nocturnal oxygen saturation
Table 1:The pulse-oxymeter measurements and polysomnography results of patients
during sleep.
P538[Sleep Disorders]
RELATIONSHIP OF SYSTEMIC INFLAMMATION and AORTIC STIFFNESS WITH
SEVERITY OF OBSTRUCTIVE SLEEP APNEA SYNDROME
Emine Nilgün Ordu1, Gülgün Çetintaş Afşar1, Tülin Kuyucu1, Can Yücel Karabay2, Özlem Oruç1
1
Sureyyapasa Chest Diseases and Thoracic Surgery Education and Research Hospital, Pulmonary
Medicine
2
Sureyyapasa Chest Diseases and Thoracic Surgery Education and Research Hospital, Cardiology
AIM: Obstructive sleep apnea syndrome (OSAS) is considered as an independent risk factor for
cardiovascular disease. Our objective in this study is to investigate the relationship of serum CRP
and aortic stiffness parameters with severity of OSAS.
METHOD: 65 patients (10 women, 55 men) who were diagnosed as OSAS with polisomnography
were included to the study. Patients were divided into 2 groups as mild- moderate OSAS and
severe OSAS according to apnea hypopnea index (AHI). All patients’ body mass index (BMI) was
average 31.92 ± 5.15 and hypertension, diabetes mellitus,coronary artery disease and
hyperlipidemia were evaluated as additional diseases. Two groups were compared in terms of
serum CRP, aortic strain (AS) and aortic distensibility (AD).
RESULTS: AHI was 16.86 ± 6.96 in Mild-Moderate OSAS (n=28), and 59.65 ± 21.47 in Severe
OSAS group. Oxygen desaturation index (ODI) (p< 0.001), BMI and additional disease presence
was significantly higher in severe OSAS group. In all patients, 50 had additional disease; and there
was no significant relationship between AS, AD and additional disease presence. But CRP level was
significantly higher in patients with additional disease (p= 0.01). There was no statistical difference
between mild-moderate OSAS and severe OSAS in terms of AS (p=0,137) and AD (p=0,09) (Table
1). CRP level was significantly higher in severe OSAS group (p=0.024).
CONCLUSION: Altough CRP level was significantly higher in severe OSAS group, we found no
relation between disease severity and aortic stiffness as another cardiovascular risk marker.
Further prospective studies are needed on this subject.
Keywords: Obstructive sleep apnea sydrome, aortic stiffness, C- reactive protein
Table 1: Comparison of Mild-moderate and Severe OSAS in terms of Aortic Strain and
Aortic distensibility
*Ki kare testi
*Chi square test
P539[Sleep Disorders]
The Distribution of FV-Leiden, Prothrombin and Plasminogen Activator
Inhibitor Gene Mutations in Patients with Obstructive Sleep Apnea
Ege Güleç Balbay1, Ebru Uyrum2, Öner Balbay1, Ali Nihat Annakkaya1, Fatma Silan3, Merve Meliha
Hız3
1
Department of Chest Diseases, Duzce University, Duzce, Turkey
2
Akhisar State Hospital, Department of Chest Diseases, Manisa,Turkey
3
Canakkale Onsekiz March University, Department of Medical Genetics, Canakkale, Turkey
AIM: To investigate Factor V Leiden (FVL), Plasminogen Activator Inhibitor (PAI) or Prothrombin
(F2L) gene polymorphisms among OSAS patients.
METHODS: 62 patients (35 male) with the suspected diagnosis of OSAS were included. All patients
filled out a questionnaire regarding sleep disturbance and underwent polysomnographic (PSG)
examination. Genotypes were determined by a polymerase chain reaction and reverse
hybridization.
RESULTS: The mean age was 51 ± 12. 20 of the patients were not OSAS while 42 was OSAS. The
distribution of FVL genotypes for 1691 GG, GA and AA is found 95 %, 5% and 0% in non-OSAS
group and 88.1%, 11.9% and 0% in patient groups (p:0.654) respectively. The mutant genotype
was not observed for both FVL and F2L G20210A. The distribution of F2L 2021 GG, GA, AA was
found 95%, 5% and 0% in control group while 97.6%, 2.4% and 0% in patient group (p:0.545)
respectively. The genotype frequencies of the OSAS patients for PAI were 45.5% for wild, 45% for
heterozygote, and 10% for homozygote mutant genotype in control group and 31% for wild,
47.6% for heterozygote, and 21.4% for homozygote mutant genotype in patient group (p:0.413).
No significant associations with these three polymorphism were observed for OSAS and the data
was shown as odds value for FVL, F2L respectively; ORFVL=2.5 (95% CI: 0.280-23.573), ORF2L
=0.463 (95% CI: 0.027-7.811).
CONCLUSION: Although FVL mutation was insignificantly high in OSAS patients, it may be an
important risk factor in known hypercoagulability of OSAS patients.
Keywords: Obstructive Sleep Apnea, Factor V Leiden, Prothrombin, Plasminogen
P540[Sleep Disorders]
Sleep study in patients with Samter's syndrome
Gülgün Çetintaş Afşar1, Fatma Merve Tepetam2, Sema Saraç1, Ayşem Aşkım Öztin Güven1, Sibel
Arınç1, Özlem Oruç1
1
Sureyyapasa Chest Hospital, department of chest disease; İstanbul
2
Sureyyapasa Chest Hospital, department of allergy and immunology; İstanbul
Hypersensitivity to NSAIDs is often associated nasal polyps and asthma, together known as
Samter's triad. Sleep apnea syndrome(OSAS)is defined recurrent episodes of complete/partial
upper airway obstruction and often characterized by a decrease in blood oxygen
saturation.AIM: The target organs,in both Samter and OSAS,are lower and upper airways. In this
study,we compared Samter's cases that diagnosed in our Allergy department with patients that
admitted to our sleep labratoury and perform PSG but the diagnose is not sleep apnea
group.MaterialMETHODS: The study was carried out on 8(2men,6women) patients that diagnosed with Samter in
our allergy deparment and 9 patients(2 men,7women)that
admitted to our sleep labratoury and perform PSG but the diagnose is not sleep apnea group.Both
groups Epworth sleepiness test(ESS)and allnight polysomnography was performed.
RESULTS: The mean age and the mean body mass index of both groups did not different.3
patients operation of deviation, six patients polypectomy at least one up to 29 times, whereas the
current bilateral polyposis was present in 4 patients.In the control group were evaluated nasal
passages open.In Samter group ESS at least 3 points and no more than 15(averaged: 7.5), at least
2 and no more than 12 points in the control group (mean: 6.3) taken. In samter's group, we
diagnosed 2 patient positional, 1 increased with position, 1 REM dependent OSA.
CONCLUSION: Half of our patients were diagnosed with OSAS by PSG proven.Assessments of
these cases can be appropriate in terms of sleep.The number of cases is low, a greater number of
studies on this issue are needed.
Keywords: polysomnograhy, Samter syndrome, sleep apnea syndrome
Properties of cases
SAMTER'S SYNDROME
CONTROL GROUP
GENDER
2 cases men, 6 cases female
2 cases men, 7 cases female
AVARAGE AGE
FEMALE/MALE
46.2
46.1/46.5
44.2
43.5/46.5
AVARAGE BMI
FEMALE/MALE
26.28
27/24.09
27.08
27.3/26.25
SMOKING
2 cases quit, 6 cases nonsmoker
1 case quit, 8 cases nonsmoker
EPWORTH SLEEPINESS
SCALE
At least 3 point, no more 15
point(avg.7.5)
At least 2 point, no more 12
point(avg.6.3)
FREQUENCY OF
AWAKENESS
At least 10 times,no more 35
(avg.20)
At least 7 times,no more 28
(avg.18.6)
Polysomnographic findings of Samter patients
CASES
SLEEP
EFF.
FREQUENCY
AWAKENESS
ODI
MIN
O2
AHI
SUPIN
AHI
NONSUPIN
AHI
1
87%
13
1.5
92%
1.5
2.6
0.6
2
82.9%
12
0.5
95%
0
0.2
0
3
82%
29
0.8
91.5%
0.9
1
1
4
90%
10
2.9
92%
2.6
3.3
1.6
5
87.5%
17
9.2
87%
5.4
7
2.3
REM
AHI
6
86%
35
9.6
75.8%
10.3 12.6
4.9
7
87.9%
23
32.8 76.5%
35.8 50.5
14.5
8
64%
21
13.6 81%
9
6.7
11.3
23.4
P541[Sleep Disorders]
Obstructive Sleep Apnea Syndrome and Gastroesophageal Reflux Disease:
The Importance of Obesity and Gender
Özen K. Başoğlu1, Rukiye Vardar2, Mehmet Sezai Taşbakan1, Zeynep Zeren Uçar3, Sibel Ayık4,
Timur Köse5, Serhat Bor2
1
Department of Chest Diseases, Ege University Faculty of Medicine, Izmir
2
Section of Gastroenterology, Ege University Faculty of Medicine, Ege Reflux Study Group, Izmir
3
Department of Sleep Disorders, Dr. Suat Seren Chest Diseases and Surgery Training and Research
Hospital, Yenisehir, Izmir
4
Department of Chest Diseases, Katip Celebi University Faculty of Medicine, Izmir
5
Department of Biostatistics, Ege University Faculty of Medicine, Izmir
BACKGROUND: It is claimed that gastroesophageal reflux disease (GERD) increases in patients
with obstructive sleep apnea syndrome (OSAS). However, prospective and comparative studies are
limited and contradictory. We aimed to evaluate the prevalence of reflux symptoms in OSAS
patients and identify OSAS-related risk factors associated with GERD.
METHODS: In this prospective, multicenter study, we recruited 1104 patients scheduled to
polysomnography: 147 patients were in non-OSAS and 957 patients were in OSAS group. All
patients were filled out validated GERD questionnaire, and demographic, anthropometric
characteristics and medical history were recorded.
RESULTS: Out of 957 OSAS patients, 372 (38.9%) had GERD, whereas 47 patients (32.0%) had
GERD in non-OSAS group (p=0.497). There was no difference in terms of major GER symptoms
between non-OSAS and mild, moderate and severe OSAS groups.
The prevalence of GERD was increased in female OSAS patients (46.6%) compared to males
(35.7%) (p=0.002). In OSAS patients with GERD, body mass index (34.0±7.0 vs. 33.1±6.8,
p=0.049) was greater, waist (115.5±13.9 vs. 113.1±13.4, p=0.007) and hip (117.9±13.7 vs.
114.2±12.8, <0.0001) circumferences were larger when compared to OSAS patients without
GERD. Besides, Epworth sleepiness scores of OSAS patients with GERD were higher than the others
(10.3±6.0 vs. 8.8±5.6, p<0.0001).
CONCLUSION: In this large cohort study, the prevalence of GERD was significantly increased in
OSAS patients compared to general population (23%) but not to primary snoring patients. The
present results support that obesity and female gender were related with the prevalence of GERD,
but severity of OSAS did not influence GERD prevalence.
Keywords: OSAS, Reflux, Obesity, Gender
P542[Sleep Disorders]
Correlation between serum bicarbonate levels and obesity hypoventilation
syndrome in morbidly obese persons
Züleyha Bingöl1, Aylin Pıhtılı2, Penbe Çağatay3, Gülfer Okumuş1, Esen Kıyan1
1
Istanbul University, Istanbul Faculty of Medicine, Deparment of Pulmonary Medicine, Istanbul,
Turkey
2
Private Keçiören Hospital, Department of Pulmonary Medicine, Ankara, Turkey
3
Istanbul University, Istanbul Faculty of Medicine, Department of Biostatistics, Istanbul, Turkey
INTRODUCTION: Arterial blood gasses (ABG) are not routine in sleep laboratories due to its
invasive nature. Therefore, obesity hypoventilation syndrome (OHS) diagnosis is underestimated.
AIM: Evaluating place of serum HCO3 in OHS diagnosis in morbidly obese (BMI>=35) persons and
comparing serum HCO3 with ABGs and polysomnographic parameters.
Material–
METHODS: The demographics, polysomnographic parameters, Epworth Sleepiness Scores (ESS),
ABGs, spirometric measurements and serum HCO3 levels were recorded. (Ethical committee
approval no: 2013/381)
RESULTS: Of 165 patients (89 female, 76 male with average age of 50.29±10.45years and BMI:
40.25±5.65kg/m2, the mean serum HCO3 level was 25.81±2.6mmol/L. HCO3 levels in daytime
and morning ABG was 24.6±1.68mmol/L and 24.9±1.72mmol/L respectfully. Obstructive sleep
apnea (OSA) was found in 90.9% (52.7% severe, 24.7% moderate, 22.7% mild) and OHS in 40%
(n=66.) Correlation was found between serum HCO3 and age (r=0.227, p=0.003), BMI (r=0.196,
p=0.012), daytime ABG HCO3 (r=0.481, p=0.000) and PaCO2 levels (r=0.451, p=0.000), morning
ABG HCO3 (r=0.433, p=0.000) and PaCO2 levels (r=0.521, p=0.000), ODI (r=0.232, p=0.003),
mean SpO2 (r=-0.183, p=0.018), minimum SpO2 (r=-0.301, p=0.000) and time SpO2<%90
(r=0.271, p=0.000.) No correlation was found between AHI and serum HCO3. No difference was
observed in HCO3 of different OSA stages. HCO3 levels were higher in OHS patients when
compared to OSA patients (27.3±2.52, 25.46±1.78 p=0.000). When a cutoff of 26 taken for serum
HCO3, its sensitivity and specificity for the diagnosis of OHS was 70% and 70% respectfully.
CONCLUSION: Serum HCO3 levels can be helpful in the determination of OHS patients.
Keywords: morbidly obesity, obesity hypoventilation syndrome, serum bicarbonate
P543[Sleep Disorders]
Frequency and Predictive Factors of Obesity Hypoventilation Syndrome in
Morbidly Obese Persons
Aylin Pıhtılı1, Züleyha Bingöl2, Penbe Çağatay3, Gülfer Okumuş2, Esen Kıyan2
1
Private Keçiören Hospital Department of Pulmonary Medicine, Ankara, Turkey
2
Istanbul University, Istanbul Faculty of Medicine, Department of Pulmonary Medicine, Istanbul,
Turkey
3
Istanbul University, Istanbul Faculty of Medicine, Department of Biostatistics, Istanbul, Turkey
INTRODUCTION: Obstructive sleep apnea (OSA) is common (50-77%) in patients with a Body
Mass Index (BMI) >=35. The frequency of obesity hypoventilation syndrome (OHS) is not known in
these persons because arterial blood gasses (ABG) and capnography are not routine.
AIM: Evaluating frequency of OHS and determining predictive indicators of polysomnographic,
spirometric and ABG values.
Material –
METHOD: Polysomnography results of patients with BMI>=35 were evaluated. Persons with
obstructive and restrictive pulmonary diseases were excluded. Demographics, ESS scores,
polysomnography findings, ABG and spirometric measurements were evaluated.
RESULTS: Of 550 patients (336 female, 214 male with mean age of 51.6±11.1 years) BMI was
43.3±6.5kg/m2, ESS score 8.6±6.3, FEV1 92.9%±18.8% and FVC 94.6%±18.1%. OSA frequency
was 90.4% (AHI:41.05±28.5/hour, ODI:47.36±31.6/hour, time with SpO2<%90:23.5%±28.5%).
Of patients with daytime or morning ABG (n=437), 42% (n=184) had OHS diagnosis (56.5%
female, age: 53.3±10.5yrs, BMI: 44.39±6.8kg/m2, ESS: 9.38±6.14). Of OHS patients, 57.6%
(n=106) had severe OSA and 90.8% had ODI>10. Time with SpO2<%90 was 32.3%1±31.6%.
AHİ (p=0.002), ODI (p=0.000) and SpO2<%90 (p=0.000) were higher in OHS group.
ODI (p=0.034) and time SpO2<%90 (p=0.008) were independent risk factors for OHS. The
sensitivity and specificity of the following parameters for OHS diagnosis were 75% and 65% for
ODI>26/hour, 70% and 68% for>%10 of time SpO2<%90 respectfully.
CONCLUSION: OHS is frequent in morbidly obese persons. ODI and time with SpO2<%90 >%10
are independent risk factors.
Keywords: morbid obesity, obesity hypoventilation, obstructive sleep apnea
P544[Sleep Disorders]
Prevalence of Obstructive Sleep Apnea Syndrome in Patients With
Acromegaly
Mehmet Sezai Taşbakan1, Özen K. Başoğlu1, Ilgın Şimşir2, Füsun Saygılı2
1
Department of Chest Diseases,Ege University, School of Medicine, Izmir
2
Department of Endocrinology and Metabolism Disease, Ege University, School of Medicine, Izmir
OBJECTIVE:
Acromegaly is often associated with obstructive sleep apnea syndrome (OSAS) with a prevalence of
between 40 and 80 %. The aim of the present study was to evaluate the prevalence of OSAS and
identify clinical and sleep characteristics in patients with acromegaly.
METHODS:
A total of 22 acromegaly patients were included in this study prospective, cross-sectional study.
Demographic data, anthropometric measurements and medical history were evaluated. Spirometry,
chest x-ray, arterial blood gas analysis and full-night in-laboratory polysomnography were
performed.
RESULTS:
Of the 22 patients (14 men, mean age 47.5±10.2), mean body mass index was 32.5±4.3 kg/m2,
neck circumference was 41.7±4.3 cm and waist circumference was 107.4±10.4 cm. Sixteen
patients (72.7%) had comorbidities. Hypertension (50.0%), diabetes mellitus (45.5%),
hypothyroidism (31.8%) and dyslipidemia (18.2%) were most frequent diseases. All patients
reported snoring, whereas 16 (72.7%) had witnessed apnea and 13 (59.1%) had excessive
daytime sleepiness. Epworth sleepiness score was 11.4±6.1 and 54.5% had a score >10.
20 patients (90.9%) were diagnosed as OSAS (RDI>=5/h). Polysomnography results showed that
mean RDI was 40.7±30.5/h, nadir SpO2 (%) was 79.8±8.9 and mean SpO2 (%) was 92.1±4.4. A
total of 17 patients were deemed to be candidates for positive airway pressure (PAP) treatment
and 16 of them accepted (13 CPAP, 2 BPAP, 1 APAP).
CONCLUSIONS:
Our results confirm a high prevalence of OSAS (90.9%) in patients with acromegaly and provide
evidence that the majority of patients are candidates for treatment with PAP. Therefore, newly
diagnosed all acromegaly patients should be investigated in terms of OSAS.
Keywords: Acromegaly, apnea, sleep
P545[Sleep Disorders]
The Frequency of Periodontitis in Obstructive Sleep Apnea Patients
Hikmet Gamsız Işık1, Züleyha Bingöl2, Ülkü Başer1, Funda Yalçın1, Esen Kıyan2
1
Department of Periodontology, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
2
Department of Chest Diseases, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
INTRODUCTION: Periodontitis is a chronic inflammatory disease with a prevalance of 10-60% in
population. The relation between systemic inflammatory events such as diabetes, cardiovascular
diseases, metabolic syndrome and periodontitis have been demonstrated.
OBJECTIVE: The aim of this study was to evaluate the prevalance of periodontitis in obstructive
sleep apnea (OSA) causing systemic inflammation.
METHODS: Periodontal health status of the patients diagnosed with OSA (AHI >= 5/hour) was
evaluated. Periodontitis was defined as the presence of one or more sites exhibiting probing pocket
depth >= 4mm and clinical attachment level >=4mm. (Ethic No: 2013/1070)
RESULTS: In total, 90 OSA patients (54 males, 36 females, age:47.4±8.4years) were examined.
The mean BMI was 31.58±3.57kg/m2 and AHI was 36.41±23.28/h. The severity of OSA was; 50%
(n=45) severe, 32% (n=29) moderate and %17.8 (n=16) mild. Periodontitis was found in 94.4%
of the cases (mild: 35.2% and severe: 64.7%). Severe periodontitis frequency in males were
higher than females (70% vs 47% p=0.046). Severe periodontitis frequency was 66.6% in severe
OSA, 58.6% in moderate OSA and 50% in mild OSA patients. Periodontitis frequency was not
statistically different between OSA severity. Periodontitis frequency was higher (77%) in morbidly
obese patients when compared to the patients with BMI<35 (59%). But the difference was not
statistically significant. There was not any correlation between severity of periodontitis and BMI.
CONCLUSION: In this study, we concluded that the prevalence of periodontitis was higher in OSA
patients.
Keywords: Apnea hypopnea index, obstructive sleep apnea, periodontitis
P546[Sleep Disorders]
The accuracy of auto BPAP determined apnea-hypopnea index
Hatice Uluçoban Dede1, Selen Bozkurt2, Aykut Çilli1
1
Mediterranean University, Department of Pulmunology, Antalya
2
Mediterranean University, Department of Biostatistics, Antalya
Purpose
Auto Bi-level positive airway pressure (BPAP) devices not only titrate BPAP pressures but also
measure residual respiratory event.
The aim of this study is to determine the accuracy of BPAP derived residual apnea-hypopnea index
(AHI).
Methods
We studied 55 obstructive sleep apnea patients who underwent in laboratory overnight PSG
(polysomnography) using BPAP. Exclusion criteria are patients with central sleep apnea and
complex central apnea syndrome. The Wilcoxon Signed Rank test was applied for testing the
statistical significant difference between residual AHI obtained from BPAP (BPAP AHI) and AHI from
an overnight PSG on BPAP (PSG AHI). In addition, the Bland-Altman analysis was used to assess
agreement within the BPAP AHI and PSG AHI and the Spearman correlation coefficient was applied
for testing correlation.
Results
The median value of PSG AHI was 3.5(0.7-12.5) and BPAP AHI was 5.3(0.2-29.3). BPAP markedly
suppressed the respiratory event during the titration and a significant difference was obtained
between PSG AHI and BPAP AHI (p<0.001). The Spearman Correlation was applied on the
measured AHI and for both BPAP and PSG methods, measurements were positively correlated
(p=0.001, r=0.641). The Bland-Altman plots revealed substantial bias (AHI mean differance of
3.14) between AHI measurements with clinically unacceptable 95% limits of agreement (1.9-4.3).
Conclusion
Auto BPAP may overestimate residual AHI in OSA patients.
Keywords: BIPAP, PSG AHI, Residual AHI
P547[Sleep Disorders]
The Effect of Time Distribution on Sleep Quality
Abdullah Kansu1, Levent Kart2, Hatice Kutbay Özçelik1, Muhammed Emin Akkoyunlu1, Mehmet
Bayram1, Murat Sezer1
1
Bezmialem Vakif University
2
Fatih University
We aimed to determine the relation between sleep quality and time distribution in subjects having
no pathologic sleep structure.Medical and PSG records of subjects 20-70years old whom were
performed PSG at Bezmialem Vakif University from 1.10.2012 to 01.10.2013 were assessed for
eligilibity for the study. Inclusion criteria were as following:RDI<5 in PSG, no having upper way
resistance syndrome, having more than 60% sleep efficiency.We evaluated the clinic, demographic
parameters and compared the PSG parameters and time distribution.We took the circadian rythm
term in a different view comparing according to the time distribution.Fifty male and 51 female
enrolled to the study.Median agees of males and females were41,5(33-50),43 (35-51)
respectively.BMI of males and females were28(25-30) and(28-37)respectively.Waist circumference
of M and F were 98 cm (92-105) and 99 cm (93-115) respectively.Epworth of males and females
8(4-16) 8(5-10) respectively.Duration of sleep of males and females were06:02h (05:1706:34)and 06:05h respectively.Sleep parameters can alter in different timeframes. RDI levels were
significantly altered in different time frames.RDI level in3rd phase of sleep(03:00-04:30)was
significantly higher than 1stphase(00:00-01:30).We found significant alteration in sleep
efficiency.The factors effecting sleep hygiene and changing the circadian rhytm lead to disruption of
sleep and consequently lead to sleep disorders.In order to improve the sleep quality its essential to
fix the personel and environmental conditions. In diagnosis,follow up and management of patients
having sleep disorders the parameters associated with RDI such as high body mass index,neck
cirumference Epworth and the personel and environmental conditions should be taken account
together
Keywords: circadian rythm, rdı, sleep quality, time distribution
Shape 1
Uyku evrelerinin zaman dağılımına göre değişimi
Sleep stages and time distribution
Shape 2
Uyku-uyanıklık döngüsünün gün ışığı ile olan ilişkisi
Sleep time and daylight
P548[Sleep Disorders]
Metabolic Changes and Inflammation in Obstructive Sleep Apnea
1
2
3
1
1
Emel Bulcun , Ersel Dag , Murat Tulmac , Dilay Ahad Ahad Cimen , Aydanur Ekici , Mehmet Ekici
1
2
3
1
Department of Pulmonary Diseases, Kirikkale University Faculty of Medicine
Department of Neurology, Kirikkale University Faculty of Medicine
Department of Cardiology, Kirikkale University Faculty of Medicine
OBJECTIVE: There are different results on low grade inflammation and metabolic syndrome in
patients with obstructive sleep apnea (OSA). We investigated the relation between low grade
inflammation
and
metabolic
syndrome
in
patients
with
OSA.
METHOD: The study include 78 treatment-naive OSA patients(AHI >=5) and 28 control group
(AHI <5). Clinical information, body mass index, SF-36, Epworth Sleepiness Scale, Sleep Disorders
Questionnaire, and serum CRP were collected. Overnight polysomnography and blood sampling was
taken for glucose, insulin, high-density lipoprotein (HDL), low-density lipoprotein (LDL),
cholesterol, triglycerides. Metabolic syndrome was defined according to National Cholesterol
Education Program criteria. Each patient was assigned a metabolic score according to the number
of
discrete
components
of
metabolic
syndrome.
RESULTS: The components number (2.1±0.9 vs 1.2±0.8,p= 0.0001, respectively) and percentage
(33.3% vs 7.4%,p=0.009, respectively) of the metabolic syndrome and CRP levels (4.3±4.1 vs
2.6±2.9,p=0.01,respectively) were significantly higher in the patients with OSA than control group.
In bivariate analyses, the component number of metabolic syndrome was correlated with the CRP,
AHI and desaturatıon index. The component number of metabolic syndrome increased with an
increase in AHI and desaturatıon index in multivariate analysis independently obesity.
CONCLUSION: OSA is associated with metabolic syndrome and low grade inflammation. The
severity of the metabolic syndrome increased with an increase in OSA severity. Therapeutic
approaches to OSA may decrease cardiovascular risk by decreasing frequency of metabolic
syndrome in patients with OSA.
Keywords: Metabolic syndrome, Inflammation, Obstructive sleep apnea
Characteristics of Study Sample (N= 106)
Control group Patients with obstructive sleep apnea
p value
n:28
n:78
Age,years
43.4±13.8
48.6±9.1
0.06
Gender male/female
18/10
63/15
0.07
Epworth Sleepiness Score 6.4±11.7
10.6±6.0
0.02
Smoking p/y
6.7±12.2
13.9±15.9
0.01
BMI kg/m2
26.3±4.2
29.8±4.8
0.001
Total metabolic score
1.2±0.8
2.1±0.9
0.0001
Metabolic Syndrome (%)
7.4
33.3
0.009
CRP levels mg/L
2.6±2.9
4.3±4.1
0.01
Statistical significance p<0.05 SD: Standart deviasyon BMI: Body mass index CRP: C reactive protein
The predictors of total metabolic score in multivariate model
Total metabolic score
Total metabolic score
Total metabolic score
beta p
beta p
beta p
AHI 0.29 0.001
Desaturation index 0.21 0.02
CRP 0.20 0.02
Sex 0.10 0.2
Sex
0.15 0.1
Sex -0.009 0.9
Age 0.13 0.1
Age
0.15 0.08
Age 0.17 0.06
BMI 0.33 0.0001
BMI
0.42 0.0001
AHI 0.40 0.0001
Statistical significance p<0.05 AHI: Apnea hypopnea index BMI: Body mass index CRP: C reactive protein
P549[Sleep Disorders]
Dermatological findings in patients having Obstructive Sleep Apnea
Syndrome
İlkin Zindancı1, Hacer Kuzu Okur2, Mukaddes Kavala1
1
Medeniyet Üniversity, Goztepe Training and Research Hospital, Dermatology Department, İstanbul
2
Fatih Sultan Mehmet Training and Research Hospital, Chest Diseases Department, İstanbul
AIM: Obstructive Sleep Apnea Syndrome (OSAS) is charactherized by upper respiratory tract
obstruction episodes, either full (apnea) or partial (hypopnea) repeating during sleep. Decrease in
blood oxygen saturation level and oxidative stress during this period are the main reasons of
morbidity and mortality in OSAS. In our study, assesment of dermatological findings in patients
having diagnosis of OSAS are aimed.
MATERIALMETHOD: We assesed 475 patients who had diagnosis of OSAS by polysomnographic (PSG)
assesement. Of these only 63 who are in 18-55 years-old, male and not having diabetes mellitus or
obesity were included. Patients’ demographic charactheristics, PSG findings and lipid profiles were
recorded. Skin type analysis was done for all patients. Whole skin examination inluding oral cavity
and hairy skin were also done.
RESULTS: In the 63 male patients included, mean age: 42.7±7.5, AHI:29.4 ±19.3, BMI:
27.9±2.5, minimum okxygen saturationu:79.4±8.9, mean oxygen saturation:93.1±2.7, oxygen
desaturation index: 28.9±21.4. In dermatological examination, in 25 patients (39,1%) significant
findings were observed; seborreic dermatitis in 16 (25,3%), contact dermatitis in 9 (14,2%), tinea
infection in 8 (12,6%) were the most common dermatoses observed. Relation between
dermatological findings and OSAS was found significant.
CONCLUSION: Recently it is claimed that oxidative stress may play a role in etiopathogenesis of
inflammatory dermatosis. High rate occurance of dermatosis, mainly the seborreic dermatitis in in
our series seems to support this theory.
Keywords: dermatological findings,Obstructive Sleep Apnea Syndrome,oxidative stress
P550[Sleep Disorders]
Respiratory problems in Charcot-Marie Tooth disease
Hicran Orucova1, Züleyha Bingöl1, Hacer Durmuş2, Yeşim Parman2, Esen Kıyan1
1
Istanbul University, Istanbul Medical Faculty, Pulmonary Department, Istanbul, Turkey
2
Istanbul University, Istanbul Medical Faculty, Neurology Department, Istanbul, Turkey
INTRODUCTION: Charcot-Marie-Tooth (CMT) disease is the most common disease in hereditary
neuropathies. It’s progression is slow. In the literature respiratory problems are rarely reported in
patients with CMT. Vokal cord and diafragm dysfunction are the most common pathologies.
Respiratory assessment of our CMT patients who were sent to our polyclinic is shown in the Table.
RESULT: In most of our CMT patients sleep related breathing problems were frequent with vocal
cord and diaphragm dysfunction.
Keywords: Charcot-Marie-Tooth disease, diafragm dysfunction, hereditary neuropathies, vokal
cord dysfunction
Table
Patient Age /
VCD FVC (%)
No
Gender
1
2
3
4
36/F
34/F
19/F
15/F
+
+
-
-
Tracheostomy
49
58
93
5
43/M
-
81
6
39/M
-
21
7
8
20/M
28/M
+
+
Sittingsupine
FVC
difference
(%)
78
62
-%27
-%18
-%11
-%1
-%29
-%26
Diaphragm PaCO2
PSG
dysfunction (mmHg)
BIPAP
+
+
55
33
AHI<5,
ODI:0
Recommended
Morning
PaCO2:38
41
AHI<5,
ODI:23
Recommended
Morning
PaCO2:41
39
AHI<5,
ODI:6
+
Morning
PaCO2:39
41
AHI:2.2,
ODI:0.3
Morning
PaCO2:
44
-
+
AHI:26,
ODI:23
Recommended
+
49
AHI:6,
ODI:1
Recommended
Morning
PaCO2:49
44
AHI:21,
ODI:3
+
Morning
PaCO2:44
+
+
+
-
+
PSG: polysomnography, AHI: apnea hyponea index, ODI: oxygen desaturation index, VCD: vocal cord
dysfunction
P551[Sleep Disorders]
Does CPAP Treatment Lead to Gastroesophageal Reflux in Moderate and
Severe OSA Cases?
Hatice Kutbay Özçelik1, Ahmet Danalıoğlu2, Mehmet Bayram1, Muhammed Emin Akkoyunlu1, Fatih
Yakar1, Fatmanur Karaköse1, Murat Sezer1
1
Bezmialem Vakif University Medical Faculty Department of Pulmonology
2
Bezmialem Vakif University Medical Faculty Department of Gastroenterology and Hepatology
PURPOSE: To evaluate the CPAP treatment's effect on formation of gastroesophageal reflux (GER)
in the moderate an severe OSA cases by objective parameters.
MATERIALMETHODS: Thirty nine patients diagnosed OSA (moderate and severe) in our sleep laboratory and
no history of antiGER medication between 2012-2014 enrolled to study. Twentysix of them were
given esophageal manometer and pH meter for 24 hours, and 13 patients were excluded since
intolerance for manometer. We repated esophageal manometer and pHmeter after one-month
CPAP treatment to remained 13 patients.
RESULTS: 5 of the patients were female and 21 were male. Median age was 48,46 (44-54).
Median Epworth score was 11 (0,75-16,25), body mass index was 32 (29,50-35), RDI was 40,50
(23,2-69), sleep efficiency was 93(87,75-96,25), apnea was 136,5(59,75-300,5).Esophageal
manometer before CPAP treatment showed that median lower esophageal sphincter pressure was
20 (14,75-25), lower esofageal sphincter relaxation was %67 (51-78), and after a 24-hour
pHmeter DeMeester score was 18 (3-23). Pre-treatment sphincter relaxation insufficiency and age
were correlated. After the CPAP treatment avarage sphincter pressure was 21 (18-24,5), sphincter
relaxation was 51 (45-66), and DeMeester score was measured 10,4 (5-24,5). Before and after the
CPAP treatment, no significant difference was observed among DeMeester score (p=0.77),
sphincter pressure (p=0,73), and sphincter relaxation rates (p=0,52). However when evaluated
individually, 7 patients show some rise with their DeMeester score (Figure 1).
CONCLUSION: Eventhough our study supports that the CPAP treatment may cause GER, there is
necessity to do more research with more patients.
Keywords: OSA, gastroesophageal reflux, CPAP treatment
Figure 1
DeMeester scores before and after CPAP treatment
P552[Sleep Disorders]
The efficacy of oral appliance in patients with severe obstructive sleep
apnea
Önder Öztürk1, Süleyman Hakan Tuna2, Ulubey Hayri3, Oğuz Çelik1, Ahmet Akkaya1
1
Department of Chest Diseases, Medical Faculty of Suleyman Demirel University, Isparta
2
Department of Prosthodontics, Faculty of Dendistry, Suleyman Demirel University, Isparta
3
Tekirdağ State Hospital, Tekirdağ
AIM: It has been known that the oral appliansces are effective especially in the treatment of mıld
to modorate obstructive sleep apnea syndrome. The aim of this study was to evaluate the
effectiveness of an oral appliance (OA) “mandibular advancement devices (MADs)” for treatment of
severe obstructive sleep apnea syndrome (OSAS) in patients who refused continuous positive
airway pressure treatment.
MATERIALMETHODS: The patients with the symptoms of snoring, witnessed sleep apnea and excessive
daytime sleep, were evaluated by polysomnography and diagnosed as OSAS. The patients with
severe OSA who refused continuous positive airway pressure (PAP) treatment were recruited. An
oral appliance “mandibular advancement devices (MADs)” were prepared by the dentist.
Polysomnograms with OA were repeated at the fisrt month and 6 months. The following variables
were assessed: AHI, ODI, oxygen saturation at sleep, percentage of REM sleep.
RESULTS: Eleven patients (nine men and two woman) with mean age 53,73±2,90 years old were
selected to the study. AHI and ODI were measured as 50,66± 4,46 and 54,97±2,71 respectively at
baseline. OA reduced AHI significantly from 50,66 to 23,97, (p<0.05) at the first month and to
13,45 at sixth month. There was an improvement in AHI, Stage 3 (p<0.05), REM (p>0.05) and
SatO2 % at sleep (p>0.05).
CONCLUSION: Treatment with oral appliances, i.e., MADs, can be an effective in patients with
severe OSAS, who refuse to use or can not tolerate PAP therapy. We think that OA can be choosen
as an alternative therapy for severe OSA.
Keywords: Severe OSAS, mandibular advancement devices, polysomnography
P553[Lung Transplantation]
A Case of Acute Fibrinous and Organizing Pneumonia During Early
Postoperative Period After Lung Transplantation
İbrahim Onur Alıcı1, Erdal Yekeler1, Alkın Yazıcıoğlu1, Sema Turan2, Yasemin Tezer Tekçe3, Funda
Demirağ4, Nurettin Karaoğlanoğlu1
1
Turkiye Yuksek Ihtısas Education and Research Hospital, Thoracic Surgery and Lung
Transplantation Center, Ankara, TURKEY
2
Turkiye Yuksek Ihtısas Education and Research Hospital, Anesthesiology and Intensive Care,
Ankara, TURKEY
3
Turkiye Yuksek Ihtısas Education and Research Hospital, Department of IDCM, Ankara, TURKEY
4
Ataturk Chest Diseases and Thoracic Surgery Education and Research Hospital, Department of
Pathology, Ankara, Turkey
Acute fibrinous and organizing pneumonia (AFOP) is a distinct histological pattern related to diffuse
alveolar damage and orga