Background: We aimed to evaluate that defaulting from tuberculosis (TB) treatment rates and patient characteristics in our dispensary in 10 years period. Methods: The files of patients with treatment after default between 1997 and 2006 were retrospectively analysed. Statistical analyses were made using SPSS package programme. Results: Between 1997 and 2006 a total of 3142 patients undergoing treatment, 67 (2.13%) had defaulting from treatment. Treatment after default rates with respect to years were 3.2% in 1997, 2.8% in 1998, 3.0% in 1999, 3.0% in 2000, 2.9% in 2001, 3.4% in 2002, 1.4% in 2003, 1.0% in 2004, 0.5% in 2005 and 1.3% in 2006. The mean period for treatment after default was 2.4±1.6 months. When patients were grouped into two with respect to treatment periods (1997-2001 and 2002-2006); age, gender, marrital status, education status, the number of household contacts, the mean treatment after default months, the type of the disease, demonstrated no statistically significant difference. Conclusion: It was found out that treatment after default rates in our dispensary in 10 years period is less than 5% which is targetted by World Health Organization (WHO). No differences about social and clinical characteristics of cases were detected.

DOI: 10.4328/JCAM.698 Received: 17.05.2011 Accepted: 17.07.2011 Printed: 01.09.2013 J Clin Anal Med 2013;4(5): 418-9 Corresponding Author: Huseyin Melek, Uludag Universitesi Tip Fakultesi Gogus Cerrahi Klinigi AD, Gorukle, Bursa, Turkiye. T.: +905052581772 E-Mail: hmelek@hotmail.com Ozet Lipomlar en sik gorulen mezenkimal tumorlerdir. Genelde asemptomatik olup, nadiren dev boyutlara ulasirlar ve bircok benign ve malign tumoral hastalik ile karisabilirler. Tedavide total cerrahi eksizyon yeterlidir [1-3]. Sag torakotomi insizyonunda yaklasik 15 cm boyutlarinda, agrili, son bir yilda giderek buyuyen oncelikle malign tumoru dusunduren, eksizyon sonucu patolojik incelemede lipom tanisi konulan hastayi, lipomun nadiren dev boyutlara ulasmasi nedeniyle fotograflari ve literatur esliginde sunmak istedik.

Objective: To determine the possible factors affecting the sputum conversion time in patients with sputum smear-positive tuberculosis. Material and Methods: Files of 163 smear positive lung tuberculosis patients who had been treated at the Umraniye Tuberculosis Dispensary in 2006 were retrospectively examined. A p value of <0.05 was considered significant for the statistical analyses. Pearson Chi-Square test was applied for the cathegorical variables and the frequency analyses. The Mann Whitney-U Test was used for variables without a normal distribution. Results: The age of patients ranged between 16 and 70 years (mean: 33.6±13.3 years); 124 (76.1%) of the patients were male and 39 (23.9%) of were female. The conversion time was 2 months or shorter in 127 (77.9%) patients (mean conversion time: 1.96±1.04 months). We found no relationship between the conversion time and gender, smoking status, hospitalization, comorbidity and extent of radiological findings. The conversion time was 3 months or longer in 28 (31.8%) of 88 patients who displayed a cavity on chest X-ray and in 8 (10.8%) of 74 patients who displayed no cavity. This was statistically significant (p=0.001). The median value of the body mass index was determined as 21.4 kg/m2 (interquartile range:19.2-22.9) in patients in whom the conversion time was 2 months or shorter, and 19.6 kg/m2 (interquartile range:18.1-20.9) in patients in whom the conversion time was 3 months or longer. This result was statistically significant (p=0.015). Conclusion: The presence of a cavity on chest X-ray and low body mass index are factors that increasing time of sputum smear conversion.

Aim: Bullae and blebs are frequently associated with emphysema, but sometimes occur in absence of another associated disease. We aimed to find out the location, size of the bullae and/or blebs detected on computed tomography, accompanying radiological findings and relationship with pulmonary functions. Material and Method: Patients undergoing CT for various reasons between April 2008-May 2009 were retrospectively evaluated and 171 cases having bullae and/or blebs were included in the study. Result: Study population consisted of 125 male and 46 female patients, with a mean age of 63.88(28-90). Bullae were detected in 145(84.8%) and blebs in 112(65.5%). They were multiple in 135(78.9%) and solitary in 36(21.1%). In 27 cases all lung lobes were effected. Accompanying radiological findings were fibrosis, emphysema, peribronchial thickening, pleural thickening, parenchymal nodule, ground glass opacity and bronchiectasis Lung function tests(LFT) were noted. When bulla positive and negative groups were compared there was no significant difference in FVC% ve FEV1%, whereas FEF 25-75% and FEV1/FVC were significantly lower in bulla positive group. Bleb positive and negative groups had similar LFT values. When cases with single and multiple bullae and blebs were compared the difference was insignificant in all parameters but FEV1/FVC. Discussion: As a result presence of bullae, especially when multiple, can effect lung functions, therefore functional evaluation is crucial in cases with radiographic findings.

Accurate diagnosis of enlarged hilar/mediastinal lymph nodes is mandatory for adequate management of patients with known primary malignancy. We aimed to determine the sensitivity,specificity,accuracy of EBUS-TBNA for clarification of the nature of enlarged hilar/mediastinal lymph nodes in patients with known extrathoracic malignancy. Patients with extrathoracic malignancy who had undergone EBUS-TBNA for assessment of enlarged hilar/mediastinal lymph nodes in December 2008-September 2011 were reviewed. 48 patients who underwent EBUS-TBNA were included. Mean age of 12 male,36 female patients was 57.38 ±11.60. Malignancy was detected in 18(37.5 %),tuberculosis in 6(12.5%),sarcoidosis in 4(8.3%),anthracosis in 2(4.2%),reactive adenitis in 18(37.5%). EBUS-TBNA was also found to offer an effective accurate and minimally invasive strategy for evaluating nonmalignant lesions of pathological hilar and mediastinal lymph nodes such as tuberculosis and sarcoidosis. The sensitivity and specificity of EBUS-TBNA for malignancy in patients with reference pathology was 83% and 100%,respectively. Negative predictive value for malignancy was 90%. Procedure-related complications were minor bleeding in 2,slight reversible desaturation in 1. When both benign and malignant diagnoses are considered sensitivity, specificity and negative predictive value were 88%, 100% and 88%, respectively. We conclude that EBUS is a safe,minimally invasive,inexpensive and accurate procedure for diagnosing mediastinal/hilar lymphadenopathy in patients with extrathoracic malignancy. Nevertheless,due to the possibility of underdiagnosis,an invasive technique is indicated when results are negative.

Aim: To establish the diagnostic value of flexibl bronchoscopy (FB) in sarcoidosis.Material and Methods: Patients considered as sarcoidosis according to the clinical and radiological findings between 20042007 were included in this prospective study. Flexibl bronchoscopy (FB) was performed to all patients after clinical, radiological and laboratory evaluation. Multiple mucosal biopsies were taken, transbronchial lung biopsy (TBB) and conventional transbronchial needle aspiration (TBNA) of mediastinal lymp nodes according to Wang's mapping system were performed to all patients during FB. For the final diagnosis mediastinoscopy was performed if the bronchoscopic biopsies were non-diagnostic. The diagnostic value of bronchoscopy and bronchoscopic biopsy techniques were evaluated seperately.Results: Of the 49 patients included in the study with the pre-diagnosis of sarcoidosis, 2 were diagnosed as tuberculosis finally, therefore these 2 patients were excluded from the study. Of the 47 patients diagnosed as sarcoidosis, 17 (36,2%) were male, 30 (63,8%) were female and mean age was 40,55 +/- 13,65 years. Of all patients, 37 were diagnosed as sarcoidosis by FB (78,7%). TBB findings were positive in 20 (54%), TBNA were positive in 16 (43,2%) and mucosal biopsies were positive in 6 (16,2%) patients. In 5 (13,5%) patients sarcoidosis were diagnosed by more than one bronchoscopic techniques. Of the 20 patients diagnosed by TBB, 9 (45%) were at the stage 0 and I with no paranchimal involvement. The FB techniques were nondiagnostic in 10 patients and sarcoidosis were diagnosed by mediastinoscopy in these patients.Conclusion: The diagnosis of sarcoidosis can be established mostly by conventional bronchoscopic techniques. The diagnostic efficiency of TBB is high also in stage 0 and I pateints. Therefore in sarcoidosis suspected patients, pulmonologists should consider performing all of the conventional techniques during FB before the invasive diagnostic methods.

Aim: To investigate the effect of age on severity of obstructive sleep apnea syndrome (OSAS) severity was the aim of this study. Material and Method: The files of 874 OSAS patients diagnosed in our sleep laboratory between January 2005 – January 2010 were retrospectively analysed. Polysomnography was performed with Sleep Screen - Viasys device and scorring was done according to the criteria of Rech-Schaffen Kales. Chi-square and student's t-test was used in statistical analysis. Results: There were of 874 OSAS cases in the study. The mean age was 49.1±10.7 and of the cases, 602 (68.9%) were male, 272 (31.1%) were female. The severity of OSAS was mild in 235 (26.9%), moderate in 224 (25.6%) and severe in 415 (47.5%). A great majority of OSAS cases were belonging (65.2%) 40-59 years age group. Younger cases were 18.2% and older cases were%16.7 of OSAS patients. Mean AHI was 33.9 in younger (age<40), 36.8 in middle age (age=40-59) and 42.4 in older (age≥60) group. Age was <50 in 60.4% of mild OSAS cases whereas was the same in 50% of moderate OSAS and in 42.1% of severe OSAS cases. The severity of OSAS was statistically significantly increasing as age was advancing (p<0.05). As the cases were grouped as older and younger than 50 years of age, AHI, AI and ODI were statistically significantly higher and minimum saturation was significantly lower in older age group (p<0.05). Conclusion: OSAS is getting worser as the age is getting advanced.

Aim: To investigate the effect of concomitant chronic obstructive pulmonary disease (COPD) on obstructive sleep apnea syndrome (OSAS) severity and sleep structure Material and Method: The files of 874 OSAS patients diagnosed in our sleep laboratory between January 2005 – January 2010 were retrospectively analysed. Polysomnography was performed with Sleep Screen - Viasys device and scorring was done according to the criteria of Rech-Schaffen Kales. Chi-square and student's t-test was used in statistical analysis. Results: Of 874 OSAS cases, mean age was 49.1±10.7 and 602 (68.9%) were male, 272 (31.1%) were female. The severity of OSAS was mild in 235 (26.9%), moderate in 224 (25.6%) and severe in 415 (47.5%). In 91 (10.4%) patients there was Overlap Syndrome (OSAS+COPD). Overlap Syndrome (OS) was seen 12.5% of male patients while OS was in only 4.4% of female patients (p<0.001). There was no statistically significant relation between OS and severity of OSAS (p=0.199). Again, OS and pure OSAS patients showed no statistically significant difference regarding BMI, AHI, AI, ODI, sleep stages, sleep efficiency an minimum saturation (p>0.05). Mean age of OS patients was significantly higher when compared to pure OSAS patients (53.6 vs. 48.7; p<0.001). Conclusion: COPD has no effect on OSAS severity and sleep structure. COPD is more frequent in male and older OSAS patients as if in community.

Hickirik, hemen herkesin omru boyunca en az bir kere basina gelen, rahatsiz edici bir durumdur ve bilinen fizyolojik bir fonksiyonu yoktur. Cogunlukla kisa surelidir ve kendiliginden ya da bir takim soluk tutma manevralari ile kaybolur. Genellikle 48 saatten kisa surede gecmesi beklenir. Bu sure 48 saat-1 ay arasinda olursa persistan, 1 aydan uzun surerse direncli olarak tanimlanir.[1-3] Uzun sureli oldugunda altta yatan bir merkezi sinir sistemi, torasik, karin ici ya da metabolik bozukluga isaret edebileceginden onemlidir.[3] Pulmoner Embolide Farkli Bir Basvuru Sikayeti: Hickirik An Unusual Presenting Symptom in Pulmonary Embolism: Hiccup

Hemangiomas, which are among the least common benign chest wall masses, consist of dilated, tortuous, thin-walled vessels. They are typically cutaneous in location, intramuscular (IMH) location is uncommon, with a reported frequency of 0.8% among all benign vascular lesions. Hemangiomas of the latissimus dorsi muscle are very rare. Relatively rarely do they occur in young adults and are more frequent in females. A 25 year-old female patient applied to our clinic with a progressively growing painful mass lesion on her back which existed for 1 month. Physical examination revealed a firm, tender and mobile mass lesion in the inferior part of right scapula. Thoracic MRI demonstrated a well-enhanced mass lesion with 3 cm diameter. The lesion was totally excised and histopathologically diagnosed as cavernous hemangioma in latissimus dorsi muscle. Hemangiomas are extremely rare in adults and in latissimus dorsi muscle. We report this rare chest wall disorder presenting its unusual location and effective surgical treatment. The radiological, pathological and surgical images of the case are reviewed with accompanied literature.

Aim: To report results of procedures performed in the newly (September, 2007) established Bingol State Hospital Thoracic Surgery Clinic.Material and methods: Patients treated in our thoracic surgery clinic between September 2007 and March 2009 were retrospectively evaluated. During this period, 189 patients were treated. Procedures performed were as follows: 27 thoracotomies, three mediastinoscopies, three videothoracoscopies, 45 tube thoracostomies, seven bronchoscopies, five chest wall resection due to benign chest wall tumor, two thracheostomies and eight others. Trans-thoracic needle aspiration biopsy (TTNAB) with guidance of computerized tomography was obtained in five patients.Results: Among thoracotomy performed patients, anatomic lung resection was made in four patients (due to bronchiectasis in one, gun injury in one and due to non-small cell lung cancer, with lymph node dissection in two). Cystotomy-capitonnage to treat hydatid lung disease in two and decortication to treat empyema and pleural thickening secondary to tuberculosis in two were performed through a thoracotomy. Causes of thoracotomy were pneumothorax in six, foreign body aspiration in one, diaphragmatic eventration in two and other causes in eight patients. Diagnostic thoracotomy was performed in three patients. Among 45 tube thoracostomy performed patients, causes were as follows; spontaneous pneumothorax in 24, traumatic pneumothorax in 18 and other causes in three patients. In TTNAB performed four patients diagnosis was lung cancer. Complication was discovered in three patients (prolonged air leak in one, pneumothorax in one and hemorrhage in one). No mortality was seen.Conclusion: In this newly established thoracic surgery clinic, various diseases including lung cancer could be diagnosed and treated. Performing diagnostic and therapeutic procedures in peripheral thoracic surgery clinics, makes healthcare more available for patients besides decreasing patient load of hospitals located in bigger cities.

To evaluate the efficacy of iodopovidone as an agent for pleurodesis in malignant pleural effusion (MPE) and to compare the efficacy of small-bore catheter (Pleuracan, Braun, Melsungen, Germany) and conventional large-bore chest tube in pleural fluid drainage and sclerotherapy.

In order to find out prognostic factors and treatment results in small cell lung cancer (SCLC), 40 patients diagnosed in one year period were prospectively analysed. Following history and physical examination, patients were grouped according to ECOG performance scale and underwent Chest X-ray and thoracic computerized tomography (CT). Complete blood count, biochemical analyses, tumor markers were taken. Abdominal USG or CT, bone scintigraphy, cranial CT or MRI and bone marrow biopsy were made for detection of metastases. Limited stage patients received chemotherapy and thoracic RT, whereas cases with extensive disease received chemotherapy. Nineteen cases had limited and 21 had extensive disease. When laboratory findings between 2 stages were compared, LDH, SGOT and GGT were significantly higher in extensive stage (p= 0.005, 0.015, 0.001, respectively). Overall median survival was 6 +/- 1 months, cumulative survival in 6 and 12 months were 39% and 20.72%, respectively. Median survival was 10 +/- 2 months in limited stage and 3 +/- 1 months in extensive stage, with a statististically significant difference. Univariate analyses showed that incresed LDH, CA15-3, GGT and SGOT levels, hipoproteinemia and poor performance scale were poor prognostic signs (p= 0.024, 0.032, 0.047, 0.013, 0.021 ve 0.013, respectively), however multivariate analyses revealed no significant difference. Other blood tests, pleural effusion, age, mediastinal lymph node metastases and weight loss had no prognostic effect. Stage was found to be progniostic factor with both univariate and multivariate analyses (p= 0.045).

OBJECTIVE:To evaluate the relationship between aortic arch calcification and clinical and radiographical parameters on chest radiography. MATERIALS AND METHODS:We retrospectively evaluated 242 consecutive patients that were admitted to our intensive care unit for dyspnea. Chest radiography was performed for all patients with the posteroanterior view. Cardiothoracic ratio (CTR), mediastinal ratio (MR), aortic width (AW) parameters and the grade of aortic calcification were recorded. Patients with grade 1, 2 or 3 were defined as the calcification-positive (+) group and patients having no calcification (grade 0) were defined as the calcification-negative (-) group. Statistical analyses were performed on both groups. RESULTS:The study population consisted of 124 (51.2%) female and 118 (48.8%) male patients. The mean age was 67 ± 12 (range: 25-101) years. There was no significant relationship between aortic arch calcification and gender, presence of hypertension, diabetes mellitus, lipid levels, AW and MR, but age was correlated positively with aortic arch calcification with high statistical significance (p<0.0001). In patients with coronary artery disease (CAD), the prevalence of aortic arch calcification tended to be higher but was not statistically significant (p=0.07). The grade of calcification was not found to be correlated with gender, comorbidity, lipid levels, MR or CTR. However, as the grade of calcification increased, the mean age of patients in consecutive calcification grade groups tended to increase significantly. CTR, MR and AW increased with age. However, on regression analysis, only age was found to be an independent factor for aortic knob calcification (β=0.397, t=6.375, p<0.0001). CONCLUSION:Simple, useful radiographical parameters such as AW, CTR, MR and calcification grade can help to predict the etiology of dyspnea and cardiovascular disease.

Aim: We compared etiological factors and fluid properties in massive and nonmassive pleural effusions.Material and methods: Study population consisted of 159 cases having pleural effusion in chest -X-ray diagnosed between 2004-2006.Results: Thirty two (20.1 %) cases had massive pleural effusion(fluid in more than 2/3 of a hemithorax) whereas 127(79.9%) had nonmassive effusion(fluid in 1/3 or 2/3 of a hemithorax). Massive effusions were found to have exudate dominancy, however amount of effusion was not significantly correlated with fluid characteristics (p>0.05). Amount of effusion was not correlated with cell type (p>0.05). In massive effusions pH and glucose levels were lower and LDH levels were higher with statistical significance (p<0.05). 44.4% of massive and 17.6% of nonmassive effusions were hemorrhagic (p=0.004). The predominant diagnosis was malignancy in massive effusions (%46.9). TB effusions were nonhemorrhagic with statistically significant difference (p=0.004). Thirty per cent of malignant cases and 14.4% of benign cases were massive (p=0.025). None of the effusions due to systemic disease were massive.Conclusion: First diagnosis to be considered in massive effusions are malignancy. The probability of malignancy significantly increases when fluid is hemorrhagic.