Objective: Lethargy, apathy, daytime sleepiness are common features of Obstructive sleep apnea syndrome (OSAS). These features are already seen in hypothyroidism. OSAS is more frequent in obese patients and overt hypothyroidism may substantially add to this risk. We aimed to evaluate the incidence of hypothyroidism in cases applying with OSAS symptoms who have no known clinical thyroid disease to evaluate the necessity of thyroid hormone screening in OSAS.Materials and Methods: The study population consisted of patients with no known history of thyroid disease. All patients were screened in the sleep laboratory for one night and polysomnography. Serum thyroidstimulating hormone (TSH) levels were measured by chemiluminescence method in patients referred to our sleep center for an overnight sleep study.Results: Of 1473 subjects, 1406 (95.5%) were diagnosed as OSA (Apnea-hypopnea index (AHI)>5). Elevated TSH levels were detected in 3 cases in the nonapneic group (4.47%) and 54 cases in the OSAS group (3.90%). In mild-moderate OSAS group, the mean TSH value was 2.02 mu U /ml and in patients with severe OSAS this value was 2.44 mu U/ml, though the difference was not statistically significant (p=0.08). AHI was found to be weakly correlated with TSH values, though the correlation was statistically significant (r=0.05, p=0.04). Mean TSH values were not correlated with oxygen desaturation index (ODI) or lowest oxygen saturation values (r=0.02 and r=-0.02, respectively).Conclusion: The measurement of TSH levels in suspected OSAS cases may help both differential diagnosis between OSAS and hypothyroidism, but subclinical hypothyroidism was not found more common in patients with OSAS.

OBJECTIVES:We monitored increases in CO 2 levels during sleep by measuring transcutaneous pCO 2 (PtcCO 2 ) to determine its relationship with polysomnographic data in normocapnic patients with obstructive sleep apnea syndrome (OSAS). MATERIAL AND METHODS:Between October 2011 and December 2012, 139 patients underwent PtcCO 2 monitoring with polysomnography.All patients were evaluated with arterial blood gas (ABG) measurements and pulmonary function tests (PFTs).We excluded 13 patients with COPD and/or daytime hypercapnia and 29 patients whose PtcCO 2 records could not be evaluated. RESULTS:The patients' mean age was 46.8±10.3years.Fifty-nine patients (60.8%) were male, and 38 (39.2%) patients were female.The mean overnight PtcCO 2 was ≤45 mm Hg in 84 (86.6%) patients and >45 mm Hg in 13 (13.4%)patients.In the group with PtcCO 2 >45 mm Hg, 10 patients had an apnea-hypopnea index (AHI) >15, and 3 patients had an AHI<15, without a statistically significant difference (p=0.078).The mean apnea and apnea/interapnea periods were similar.The mean PtcCO 2 values correlated with time spent when the SpO 2 was <90% (r=0.220,p<0.031).When we grouped the patients by AHI, 60 (61.8%) patients had an AHI>15 (moderate to severe OSAS), and 37 (37.2%) had an AHI<15 (mild OSAS).Of the former group, 16.7% had a mean PtcCO 2 >45 mm Hg, whereas this ratio was 8.1% in the latter group.The difference was not statistically significant (p=0.359).In the group with an AHI>15, the highest PtcCO 2 levels were significantly higher (p<0.05). CONCLUSION:We conclude that seemingly eucapnic OSAS patients may experience hypercapnia when sleeping, and PtcCO 2 monitoring may be useful in the early diagnosis of hypercapnia.

Objective: The aim of this study was to analyse those pneumonia patients at the age of 70 years and above, who were hospitalised in our clinic and to determine the factors affecting treatment success.Methods: The recordings of the patients who were hospitalised in our clinic due to the diagnosis of pneumonia between January 2012 and January 2013 were retrospectively evaluated. Patients aged 70-years and older were involved in the study. Those patients who died or transferred to the intensive care unit were considered treatment failure. The data obtained for the patients with treatment failure and for the patients discharged from hospital in good health were compared.Results: Of the cases, 55 were found to be 70 years old and above. The mean age of the patients was 79.7 +/- 6.3 years (70-97). Twenty seven patients (49.1%) were male and 28 patients (50.9%) were female. The group with treatment failure included 7 patients (12.7%) and the group with treatment success included 48 patients (87.3%). In the group with treatment failure, the mean age was 83.8 +/- 6.8 (75-97) years, the most common symptom was cough (57.1%), and the most common concurrent diseases were diabetes mellitus (42.9%) and cerebrovascular disease (42.9%). In the group with treatment success, the mean age was 79.1 +/- 6.0 years (70-94), the most common symptom was cough (66.7%), the most common concurrent diseases were hypertension and congestive heart failure (50%) and chronic obstructive pulmonary disease (33.3%). Treatment failure was found to be significantly higher in women (p= 0.04), in individuals living in nursing homes (p= 0.04), in patients with multilobar involvement (p= 0.009), in the presence of pleural fluid (p= 0.03) and in patients in the pneumonia Group 3 class according to the pneumonia classification system of the Turkish Thoracic Society (p= 0.04). In the group with treatment success, the concentrations of serum sodium were significantly lower.Conclusion: In advanced age pneumonia cases, living in a nursing home, being female, having a radiological presence of multilobar involvement and pleural fluid, and being in the pneumonia Group 3 class were more likely to be associated with treatment failure.

Objective: To determine the effect of comorbidity as well as other demographic, pulmonary function test and smoking- related parameters on smoking cessetion. Methods : Between May-2013 – December-2013, smokers followed at least for one month were included. The demographic data, comorbid diseases, PFTs, smoking history and medication were recorded. The effect of comorbid disease as well as demographics, PFTs, smoking-related parameters on smoking cessetion were analyzed. Chi-square and Mann Whitney –U tests were used in statistical analysis. Results: For 206 smokers, median follow up was 3 months and 121(58.7%) were male, 85(41.3%) were female. Mean age was 41.3±12.2 (16-79). Smoking history was 27.6 pack-years while mean Fagerstrom Dependence Score was 6.3. Comorbid disease was existing in 124(60.2%) cases. Physchiatric diseases 43(20.9%) were the leading comorbid disease followed by heart failure and hypertension (6.7% and 8.3% respectively). Of the cases, 74.8% has been discontinued even in the first month of follow-up and 1 month quitting rate (out of 206 patients) was 21.4% while it was 10.2% for 3 months (out of 128 patients). Comorbid diseases showed no statistically significant effect on quitting rates. Considering for 3-months-period, quitters were older (mean age:51.8 vs. 40.4; p=0.003), more heavy smokers ( 40.5 vs. 27.1 pack-years; p=0.006) and with lower FEV1/FVC ratio (71.9 vs. 77.9; p=0.049) Conclusion: Many of the smokers who attempted to quit has failed in following smoking cessetion program. Comorbidity was not found to be effecting quitting rates. Older and more heavy smokers as well as smokers with relatively lower FEV1/FVC ratio were found to be more succesive in quitting smoking.

BACKGROUND: Continuous positive airway pressure (CPAP) and bi-level positive airway pressure (BPAP) are the gold standard treatments for obstructive sleep apnea syndrome (OSAS), but CPAP/BPAP is not well tolerated and requires long-term follow-up. OBJECTIVE: We prospectively assessed subjective and objective adherence and factors that affect adherence in OSAS patients. METHODS: Subjects using CPAP/BPAP were questioned about adverse effects of CPAP/BPAP and were assessed with the Epworth Sleepiness Scale (ESS) at the first, third, sixth, and twelfth month, and once every 6 months after the first year. CPAP/BPAP use and objective and subjective adherence were assessed. Subjects who used CPAP/BPAP for at least 4 hours per night for at least 70% of the days monitored were regarded as adherent, and those who did not were considered non-adherent. The relationships between adherence and demographic data, polysomnography findings, ESS scores, and adverse effects were statistically analyzed. RESULTS: Six-hundred forty-eight subjects who were diagnosed with OSAS by polysomnography and accepted to use CPAP/BPAP in our sleep center between January 2005 and June 2011 were included. Four-hundred fifty-one subjects (69.6%) were men, and 197 (30.4%) were women. Two-hundred forty-eight (38.3%) subjects attended follow-ups, 246 (37.9%) were called by telephone, and 154 (23.8%) could not be reached. Of the whole population, 63.9% had obtained their CPAP/BPAP machine. In the 248 subjects who attended follow-ups, subjective adherence was 85.1% and objective adherence was 64.5%. Improvement in ESS score (P < .001) and satisfactory sleep (P < .001) were found to be significantly higher in the adherent group. Chest discomfort, difficulty falling asleep, and sleep disturbances were significantly higher in the non-adherent group (all P < .01). CONCLUSIONS: Of the whole population, just 38.3% attended follow-ups. The objective adherence was lower than the subjective adherence in subjects who attended follow-ups. Younger subjects were more adherent, and the most important factors that correlated with adherence were substantial improvement of daytime sleepiness and effect of CPAP/BPAP on satisfactory sleep. CONCLUSIONS: CPAP/BPAP adherence should be followed with objective monitoring.

Objective: In smoking patients, the early diagnosis of COPD is important in order to stop the progression of the disease. In our study, we aimed to determine the frequency of COPD and small airways disease (SAD) and the relation between the smoking habit and pulmonary function tests in patients who were admitted to our smoking quitting outpatient clinic.Methods: A questionnaire to determine the smoking habits and Fagerstrm Nicotine Dependence Test were administered to all patients admitted to the smoking quitting outpatient clinic between April 2002-April 2009. Physical examinations were made and respiratory symptoms were questioned. Patients were diagnosed as COPD and SAD according to the GOLD criteria. In statistical analyses, chi-square test, T-test and and Pearson correlation test were used.Results: Of the 372 patients included in the study, 200 (53.8%) were women and 172 (46.2%) were men with the mean age of 43.9 +/- 11.2 years. The mean history of smoking was 31.9 +/- 18.5 packs. year, mean score for Fagerstrm Nicotine Dependence Test was 5.5 +/- 2.5. One hundred and thirty nine (53%) patients had effort dyspnea, 120 (45.7%) had cough and 68 (26.1%) had sputum as complaints. Sixty (16%) patients were diagnosed as COPD and 122 (32.7%) were diagnosed as SAD. Of patients who were newly diagnosed as COPD; 20 (40.9%) were mild, 27 (55.1%) were modarate, 2 (4%) were severe. COPD and SAD were statistically higher in patients over 40 years of age, with a smoking history of over 30 packs. year and in males (p<0.001). A correlation between smoking history (packs. year) and FEV 1 / FVC ratio (r=0.42, p<0.001) and FEF 25-75 (r=0.34, p<0.001) was found. No correlation was found with the nicotine dependence test.Conclusion: Early stage COPD and SAD were diagnosed in high ratio of patients admitted to smoking quitting outpatient clinic, who were male, over 40 years of age and had a smoking history of over 30 packs. year. It was concluded that smoking quitting outpatient clinics are important, not for only eliminating an important risk factor for COPD, but also for early diagnosis.

Introduction: PAP(Positive Airway Pressure) is the gold standard treatment for OSAS(Obstructive Sleep Apnea Syndrome).But it is not well tolerated and requires long term follow-up. Objectives: We aimed to assess prospectively subjective and objective adherences and factors that effect adherence in OSAS patients who were in the course of PAP treatment. Methods: Patients using PAP were questioned for adverse effects of treatment and were assessed with ESS (Epworth Sleepiness Scale) at 1st, 3rd, 6th, 12th months and once in every six months after first year. PAP usage, objective and subjective adherence were assessed. Patients who used PAP for at least 4 hours per night for at least 70% of the days monitored were regarded as adherent and who didn’t meet this criteria were considered as non-adherent. The relationship between adherence and demographic data, PSG (polysomnography) findings, ESS(Epworth Sleepiness Scale) scores and adverse effects were statistically analyzed.For statistical analysis; Chi-square test,Kolmogorov-Smirnov test,T-test,Mann Whitney-U test and Logistic Regression analysis were used with SPSS package program. Results: Six hundred and forty eight patients who were diagnosed with OSAS by PSG and accepted to use PAP in our sleep center between January 2005-June 2011 were included. Four hundred and fifty one patients(69.6%) were men and 197(30.4%) were women.Two hundred and forty eight(38.3%) of cases attended follow-ups, 246(37.9%) were called by phone and 154(23.8%) couldn’t be reached. Of the whole population 63.9% had obtained their PAP machine. In 248 cases who attended to follow-ups subjective adherence was 85.1% and objective adherence was 64.5%.Improvement in ESS score and satisfactory sleep were found to be significantly higher in adherent group(p<0.05).Chest discomfort, difficulty falling asleep and sleep disturbances were significantly higher in the nonadherent group(p<0.05). Conclusions: Of the whole population, just 38.3% has attended follow-ups. The objective adherence is lower than subjective adherence in patients who attended to follow-ups. Additionally, younger patients were found to be more adherent and the most important factors that correlate with adherence were observed to be significant improvement of day time sleepiness and effect of treatment on satisfactory sleep. It was concluded that PAP recommended patients should necessarily be followed up and during follow-ups; machine times on counters should be controlled. recommended PAP titration. 5 After patients’ informed consents were taken; CPAP titration was performed automatically with the AutoSet auto-titrating device (ResMed, Australia) with full night polysomnography, according to suggestions by AASM guidelines. 20,21 BIPAP titration was performed by ResMed VPAP IV device in patients who couldn’t tolerate high pressures during CPAP titration; patients who have overlap syndrome and nocturnal hypoventilation. The PAP pressure for each patient was set at the minimum pressure needed to abolish snoring, obstructive respiratory events, arousal frequency and improve oxygenation. During the procedures nasal and masks were used. reports and prescriptions according to the pressure levels observed at titration night. Patients were trained on PAP usage by technicians. All the patients who accepted to use PAP were set up appointments for follow-up at 1st, 3rd, 6th, 12th months and once in six months after first year. During follow-up visits; their ESS scores, concomitant diseases (hypertension obesity hypoventilation, COPD, cardiovascular diseases, hypothyroidism, diabetes mellitus, depression) and previous ENT operations (tonsillectomy, nasal septoplasty, uvulupalatopharyngoplasty, nasal polypectomy, radiofrequency ablation) were assessed and they were questioned about quality of sleep (difficulty in falling asleep, sleep disturbances, snoring, noise of the machine , chest discomfort), morning symptoms (dry mouth or nose, headache, waking up tired) and mask related symptoms (skin abrasions and ulcerations, persistent air leakage). Mask type (nasal or oro-nasal) and presence of built-in heated humidifier were noted. Machine time on counter (objective adherence) was compared with patients’ self-reports (subjective adherence) of PAP usage in terms of hours per night and nights per week of usage. PAP usage was calculated as total hours of PAP used / number of days passed since the beginning of PAP treatment. For adherence; the definition of “The percentage of patients who used CPAP equal to or greater than 4 hours per night for at least 70% of the days monitored” 11 was used. A telephone call were made with patients who didn’t attend follow-ups and were asked whether they have obtained their machines; if they have, whether they have been using it.

Yaygin degisken immun yetmezlik (Common variable immunodeficiency CVID), her yasta ortaya cikabilen, tekrarlayici bakteriyel enfeksiyonlar ve hipogammaglobulinemi ile karakterize primer immun yetmezlik sendromudur. Ilk olgu 27 yasinda kadin hasta: Psoriasis mevcut olan hasta bir haftadir devam eden ates, diare oksuruk, balgam, nefes darligi sikayetleri ile basvurdu. Muayenesinde hipotansiyon ve splenomegali bulundu. Akciger grafisinde ve yuksek cozunurluklu BT’de iki tarafli alveoler konsolidasyon ve plevral efuzyon tespit edildi. Torasentez ile ampiyem tespit edilerek toraks tup drenaji uygulandi. Immunglobulin (IgG, IgM, IgA) duzeyleri ileri derecede dusuk bulunan hastaya CVID tanisi konarak intravenoz Ig (IVIG) tedavisi uygulandi. Ikinci olgu 57 yasinda erkek hasta: Ilk kez 2010 yilinda sol plevral efuzyon nedeniyle yapilan plevral biyopsi sonucu nonnekrotizan granulomatoz hastalik gelmesi sonucu 9 ay antituberkulo tedavi aldi. Daha sonra tekrarlayan hemoptiziler nedeniyle iki kez klinigimizde yatan hastaya malignite dusunulerek cekilen PET-BT’de sol akciger alt lobda enflamasyon ile uyumlu tutulum tespit edildi. Yapilan bronkoskopik ve laboratuvar incelemelerinde malignite, vaskulit ve tuberkuloz tespit edilmedi. 2012 yedinci ayda sagda plevral efuzyon nedeniyle tekrar yatirilan hastanin torasentezle alinan plevral mayi ampiyem ile uyumlu geldi, batin ultrasonunda hepatosplenomegali tespit edildi. IgA, IgG ve IgM belirgin azalmis bulundu. Hastaya CVID tanisi konarak torakoskopi sonrasi IVIG uygulandi. Antibiyotik tedavisine cevap vermeyen, psoriazis, splenomegali gibi otoimmun hastaliklarin ve sarkoid benzeri granulomatoz hastaliklarin eslik ettigi tekrarlayici, komplike toplum kokenli pnomonilerde CVID akla getirilmelidir.

Background: This study aims to determine clinical approaches of chest physicians' (CP) and thoracic surgeons' (TS) in various divisions in Turkey on chemical pleurodesis.Methods: An invitation letter for a web-based questionnaire including 18 questions on chemical pleurodesis was delivered to CPs and TSs via electronic mail groups of Turkish Respiratory Society, Turkish Thoracic Society and Thoracic surgeons. A total of 126 physicians including 69 CPs and 56 TSs answered the questionnaire. One physician did not report his/her speciality.Results: Total number of pleurodesis in respondents in a year was 3441 (mean: 30.5 +/- 44.4), and most commonly used agents were talc in powder form, bleomycin, tetracycline and talc solution (78.5%, 30%, 24.8%, 24%, respectively). The mean number of pleurodesis in TSs and CPs in a year were 45.9 +/- 51.8 and 13.1 +/- 23.1 (p<0.001). Forty percent of TSs and 12.7% of CPs reported that they performed pleurodesis at first attack (p<0.001). Nine point two percent of CPs and 60.7% of TSs marked thoracoscopic pleurodesis as a method (p<0.001). In case of failed pleurodesis, there was a significant difference in favor of TSs for the repetition of the process with same agent (p<0.001). The question of "Who should perform pleurodesis?" was answered by 93.5% of respondents as TSs, and by 63.4% of respondents as CPs. When the same question was evaluated according to the speciality, answers of TSs and CPs were 100%, 29.1% and 87.7%, 92.3%, respectively.Conclusion: Our study results showed that there were different trends of TSs and CPs on pleurodesis in Turkey and these results were consistent with the literature in general.

Background In the diagnosis of malignant lymph nodes (LNs) and staging of lung cancer, sampling of mediastinal and hilar LNs is essential. Mediastinoscopy is known as the gold standard. Convex probe (CP) endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) is a noninvasive and highly sensitive diagnostic method in mediastinal and hilar LN sampling. Objectives Evaluating the role of CP-EBUS-guided TBNA in the diagnosis of mediastinal and hilar LNs suspicious of malignancy. Patients and Methods One hundred twenty patients with a known lung malignancy or hilar/mediastinal LNs detected by thoracic computed tomography (CT) and/or positron emission tomography (PET)-CT suspicious for malignancy were included in this prospective study. The procedure was performed by Olympus 7.5 MHz CP endoscope and EU C2000 processor by the oral route under topical anesthesia and conscious sedation. After visualization of LNs, their dimensions were recorded. Aspiration was considered as “insufficient” if there were inadequate lymphocytes on the smears. Diagnosis of “malignancy” on cytologic examination was considered as the “final diagnosis”. If diagnosis was negative for malignancy, more invasive procedures were performed to confirm the diagnosis. Results Twenty four females and 96 male patients (mean age, 57.8 ± 9.1) were included. A total of 177 LN stations were aspirated in 120 patients. In 82 patients, the diagnosis was malignant by EBUS-guided TBNA and in the remaining 38; the diagnosis was established by further invasive procedures. Of the 38 EBUS-guided TBNA negative patients, 28 were diagnosed as non-malignant and 10 were malignant. The sensitivity, diagnostic accuracy and negative predictive value of CP EBUS-guided TBNA were 89.1%, 91.6% and 73.6%, respectively. No major complications were seen. Conclusion As an alternative method to mediastinoscopy, EBUS-guided TBNA is a safe and noninvasive procedure with high sensitivity in the diagnosis of malignant mediastinal LNs.

Gereç ve Yöntem: Ocak 2008-Aralık 2008 arasında stabil KOAH’lı hastalar çalışmaya alındı. Dünya Sağlık Örgütü (DSÖ) kriterlerine göre anemi (erkeklerde Htc<%39, kadınlarda Htc<%36) ve polisitemi (Htc>%55) belirlendi. Spesifik etyolojisi belirlenemeyenler KOAH’a bağlı anemi olarak kabul edildi. Çalışmaya dahil edilen hastaların yaş, cinsiyet, ek hastalık, VKİ, sigara alışkanlıkları, hemogram değerleri kaydedildi, akciğer grafisi incelendi, solunum fonksiyon testleri, MRC dispne skorlaması yapıldı. İstatistiksel analizlerde ki-kare ve Mann-Whitney U testleri uygulandı.

Aim: Obstructive Sleep Apnea Syndrome (OSAS) may be found concomitantly with Chronic Obstructive Pulmonary Disease (COPD) or with Asthma. In our study we aimed at retrospectively determining the frequency of COPD and asthma in patients with OSAS and their respective effects on the quality of sleep and severity of OSAS.Material and Method: Files of patients who were evaluated in the sleep laboratory between dates January 2005 and January 2010 were analysed. All cases were examined for COPD, asthma and daytime sleepiness according to Epworth Sleepiness Scale (ESS). Pulmonary function test and polysomnograpy had been performed with all patients. For the diagnosis of COPD, GOLD criteria; for EEG scoring, Rechtschaffen-Kales criteria and for respiratory scoring, AASM 1999 criteria were used. For statistical analyses, SPSS, Chi-square, Kolmogorov-Smimov, T test, Mann-Whitney-U tests were used.Results: Out of 998 cases 98.2% were diagnosed with OSAS of whom 11.3% of patients had COPD. Age, frequency of male sex and ESS were significantly (p< 0.05) higher in patients with OSAS and COPD than patients with OSAS without COPD, but no significant differences in terms of BMI and sleep parameters were found. In patients with OSAS and asthma (6.7%); BMI, frequency of female sex, ESS, stage 3 rate were found to be significantly (p< 0.05) higher, sleep efficiency and apnea index were found to be significantly lower (p< 0.05) than in patients with OSAS without asthma, but no statistical differences were found in terms of other sleep parameters.Conclusion: In older male patients with OSAS; COPD is more frequent. Asthma is more frequently seen in female obese patients with OSAS than general population. In patients with asthma sleep efficiency is lower and ESS is higher. No relation between severity of OSAS and the presence of COPD or asthma was determined. In patients with OSAS, symptoms of COPD and asthma must be questioned, pulmonary function tests must be carried out

OBJECTIVE: Newly arising enlarged or hypermetabolic mediastinal/hilar lymph nodes (LNs) in patients with previously diagnosed extrathoracic malignancies raise suspicion of metastasis. Relatively high proportion of these LNs is due to a benign condition. We aimed to determine frequency of malignant LNs and role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for clarification of the origin of suspicious LNs in these patients. METHODS: Consecutive patients with a known extrathoracic malignancy and suspected hilar/mediastinal LN were included in this prospective study. Computed tomography (CT) of thorax and positron emission tomography-CT of all patients were taken. LNs with short axis >1 cm at CT of thorax and SUV ≥ 2.5 were accepted suspicious for malignancy. All patients underwent EBUS-TBNA for pathological verification of LNs. Patients with benign diagnosis either underwent invasive procedures or were followed up. The results were evaluated for frequency of malignant hilar/mediastinal LNs and sensitivity, specificity, and diagnostic values of EBUS-TBNA. RESULTS: A total of 48 cases with a mean age of 57.4±11.6 were included. All cases had the diagnosis of an extrathoracic malignancy. 78 LNs were aspirated with EBUS-TBNA in 48 cases (1.62 LNs/patient). The mean short axis of aspirated LNs was 1.51±0.63. Results of EBUS-TBNA revealed malignancy in 15 cases (31.2%), tuberculosis in six cases (12.5%), sarcoidosis in four cases (8.3%), and reactive adenitis in 23 cases (48%). The sensitivity, specificity, and negative predictive value of EBUS-TBNA for malignancy were 83.3%, 100%, and 90.9%, respectively. When both benign and malignant diseases were considered, sensitivity, specificity, negative predictive value, and diagnostic accuracy of EBUS-TBNA were 89.2%, 100%, 86.9%, and 93.7%, respectively. CONCLUSIONS: The ratio of benign LNs in patients with extrathoracic malignancies is relatively high. EBUS-TBNA is a safe, minimally invasive, and effective method for clarification of intrathoracic LNs.

Gold treatment for obstructive sleep apnea syndrome(OSAS) is continuous positive airway pressure(CPAP).We aimed to assess prospectively prescription,subjective and objective compliances in OSAS patients recommended PAP treatment,factors effecting compliance.648 patients (69.6% men,30.4%women)recommended to use PAP in January 2005-June 2011,were included.Patients using PAP were questioned for adverse effects and assessed with ESS(Epworth Sleepiness Scale)at follow-ups.Prescription,objective and subjective compliances were assessed.Relationship between compliance and demographic data,PSG(polysomnography) findings,ESS scores,adverse effects were analyzed.The mean age was 51.29±9.97 and mean BMI(body mass index) was 33.52±6.56.In the first night PSG;mean AHI(apnea-hypopnea index) was 54.16±26.41 and AI(apnea index)was 31.46±26.95.248(38.3%)cases attended follow-ups,246 (37.9%) were followed by phone visits and 154(23.8%)couldn't be reached.Patients usingPAP for at least 4 hours per night for at least 70% of the days monitored were regarded as compliant and who didn't meet this criteria were considered as noncompliant.In whole population 63.9%obtained PAP machine(prescription).In 248 cases attending follow-ups,subjective compliance was 85.1%;objective compliance was 64.5%.Higher ODI(oxygen desaturation index) and lower SpO2(oxygen saturation) observed in first night PSG were found to positively affect prescription (p<0.05).Improvement in ESS score and satisfactory sleep were significantly correlated with objective compliance(p<0.05).Chest discomfort,difficulty falling asleep and sleep disturbances were significantly higher in noncompliant group (p<0.05).