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Dirençli Granülomatöz Polianjiitis Olgusu
(Selçuk Üniversitesi, 2019 Mart) Limon, Muhammet; Gülcemal, Semral; Kanat, Fikret; Yılmaz, Sema
Vaskülitler, kan damarlarının inflamatuvardestrüksiyonu ile karakterize heterojen bir grup hastalıktır. Vaskülitler tutulan damar özelliğine göre klinik bulgu verebilir. Primer vaskülitler damar tutulum özelliklerine göre büyük, orta ve küçük damar vasküliti olarak ayrılır. Granülomatöz polianjiitis(GPA) ANCA ilişkili küçük damar vaskülitidir. GPA sınırlı ve sistemik tutulumla seyredebilir. Bu olgu, akciğer tutulumu olan sistemik ve sınırlı GPA olgularında tedavive yan etkileri paylaşmak için sunulmuştur.
The relationship between the findings of vestibular evoked myogenic potentials and severity of obstructive sleep apnea syndrome
(SPRINGER, 2020) Ulusoy, Bülent.; Gül, Osman.; Elsürer, Çagdaş.; Bozkurt, Mete Kaan.; Tülek, Baykal.; Körez, Muslu Kazım.; Ekmekçi, Hakan.; Çolpan, Bahar.
Purpose Our study aimed to evaluate the effects of chronic hypoxic state in Obstructive Sleep Apnea Syndrome (OSAS) on brainstem pathways using Vestibular Evoked Myogenic Potential (VEMP) test and to investigate the presence of new markers likely to be correlated with the severity of the disease. Methods The study was planned as prospective and double blind. A total of 60 patients (120 ears) diagnosed with mild, moderate and severe OSAS were included in the study and the patients are grouped as 20 patients in each group. Twenty volunteer healthy individuals (40 ears) shown to be without OSAS were included in the study. VEMP measurements were made in 60 study group patients (120 ears) and in 20 healthy controls (40 ears). The groups were compared in terms of variables such as the acquisition rate of oVEMP and cVEMP waves, interval between the waves, latency and amplitude of the waves. p < 0.05 values were considered as significant. Results The results of cVEMP test showed that the rate of wave acquisition in the moderate and severe OSAS groups was significantly lower than the control group and mild OSAS groups (p = 0.008). There was no difference between the control group and the mild OSAS group in terms of the rate of obtaining the wave (p > 0.05). In the moderate and severe OSAS groups, P1N1 amplitude and N1P2 amplitude values were found to be significantly lower than the mild OSAS group (p = 0.007 and p = 0.017, respectively). In the oVEMP test, there was no significant difference between the mild OSAS group and the control group in terms of the wave yield (p > 0.05); however, it was found that the rate of wave acquisition in the moderate and severe OSAS groups was significantly lower than the mild OSAS group (p = 0.041). There was inverse correlation between the N1P2 interval and P1N1 amplitude value and AHI in simple regression analysis and multiple regression analysis (p = 0.012 and p = 0.021; p = 0.009 and p = 0.040, respectively). Conclusion The negative effects of chronic intermittent hypoxia related with OSAS on the brainstem and vestibular system can be demonstrated by VEMP tests. Especially, the inability to obtain the wave is the most important finding showing this situation. Also, we think that N1P2 interval and P1N1 amplitude markers can be used to detect the subclinical negative effect of chronic hypoxia on vestibular nuclei in the brainstem.
Demographic, clinical and management characteristics of newly diagnosed COPD patients in Turkey: A real-life study
(DOVE MEDICAL PRESS LTD, 2020) Süerdem, Mecit; Günen, Hakan; Akyıldız, Levent; Çilli, Aykut; Özlü, Tevfik; Uzaslan, Esra; Abadoğlu, Öznur; Bayram, Hasan; Çımrın, Arif Hikmet; Gemicioğlu, Bilun; Mısırlıgil, Zeynep
Purpose: In order to determine the clinical and sociodemographic characteristics of newly diagnosed treatment-naive asthma and COPD patients in Turkey, a multicenter study in 2012 was initiated. We aimed to investigate the characteristics and therapies of COPD patients in the original study in more detail. Patients and Methods: This nation-wide, multicentric, non-interventional, prospective, real-life observational cohort study was conducted in 122 centers. The newly diagnosed patients were not receiving any treatment before the recruitment. Their general characteristics, the combined GOLD 2011 COPD categories and exacerbation histories were noted. The patients were followed up with 3 voluntary visits for 1 year. Their adherence to the inhaled treatment according to GOLD 2011 was evaluated during follow-up visits. Results: The study included 776 COPD patients. Their mean age was 59.4 +/- 9.1 years, and 11.9% of the patients were female. 35.1% of the patientswere in the GOLD 2011 C and D category. 12.6% are frequent exacerbators, and 52.8% had at least one comorbid condition. 71.8% overtreatment rate was detected. Their attendance rates for three follow-up visits became 55.9%, 32.9% and 18.7%, respectively. The adherence rate to the treatment was measured as 81.9%. Conclusion: Although these patients were diagnosed for the first time, the GOLD C and D categories and frequent exacerbator phenotype were found at a high rate. They were usually prescribed an overtreatment regimen. We think that newly diagnosed COPD patients should be evaluated carefully, and best effort should be made to treat these patients in accordance with the recommendations of the major COPD guidelines.
Bone mineral density in emphysema and chronic bronchitis phenotypes in hospitalized male chronic obstructive pulmonary disease patients
(WILEY, 2020) Yormaz, Burcu; Cebeci, Hakan; Yılmaz, Farise; Süerdem, Mecit
Introduction Risk of osteoporosis known to increase in chronic obstructive pulmonary disease (COPD), but is usually overlooked, especially in male patients. Objectives The present study compares the bone mineral density (BMD) measurements of male COPD patients with emphysema and the chronic bronchitis phenotype, and evaluates the association between density of emphysema and osteoporosis. Methods Ninety-four patients with COPD, and with emphysema and the chronic bronchitis phenotype, were included in the prospective study. A high-resolution computed tomography (HRCT) was used for the diagnosis of emphysema, and a dual X-ray absorptiometry was used to measure the BMD of the lumbar vertebrae and neck of the femur. Results Emphysema phenotype 45.75% and chronic bronchitis phenotype 54.25%, based on their clinical findings and a quantitative volumetric analysis by HRCT. Osteoporosis was found 60.47% and 17.65% of patients with emphysema and bronchitis, while osteopenia was detected 27.91% and 41.18% of patients with emphysema and bronchitis, respectively. A negative correlation was found between HRCT emphysema density and the bone densitometer t-score in patients with osteoporosis. Among the patients with osteoporosis, a positive correlation was found between Body Mass Index (BMI) and the bone densitometer t-score. Only BMI and emphysema score were found to be independent risk factors for a low BMD. One unit drop in BMI increased the risk of osteoporosis by 28% (OR = 1.28, 95% CI 1.14-1.45) (P < 0.001). One unit increase in emphysema score increased the risk of osteoporosis by 6% (OR = 1.06, 95% CI 1.03-1.09) (P < 0.001). Conclusion Especially male patients with emphysema, high dyspnea score, low BMI and frequent exacerbations should be evaluated for osteoporosis.
Effect of low-intensity pulmonary rehabilitation program on quality of life and pulmonary functions in patients with stable chronic obstructive pulmonary disease
(WOLTERS KLUWER MEDKNOW PUBLICATIONS, 2019) Çilekar, Sule.; Tülek, Baykal.; Kanat, Fikret.; Süerdem, Mecit.; Levendoglu, Funda.; Taşpınar, Ibrahim Tugrul.
OBJECTIVES: The effectiveness of low-intensity pulmonary rehabilitation program applied patients with chronic obstructive pulmonary disease (COPD) in terms of exercise capacity, dyspnea scale, life quality and respiratory muscle strength. METHODS: The study included 30 patients with COPD. The program was 3 days in a week, for a 6 weeks period between December 1st 2012 and August 31st 2013. Arterial blood gas (ABG), 6 minute walking test (SMWT), respiratory function tests and respiratory muscle strength were evaluated before and after treatment. St George's breathing questionnaire (SGRQ) was used to assess quality of life. The dyspnea scores were assessed by the Modified Medical Research Council (mMRC) and the COPD Assessment Test (CAT). Patient approvals were obtained for the study. For analysis of results kolmogorov smirnov test, shapiro - wilk test, wilcoxon test and sample ttest were used. RESULTS: Of 30 patients participated in our study, 26 completed the treatment program. There were increases in SMWT distance (P = 0.049), forced expiratory volume in one second, and forced expiratory flow (FEF 25-75) value (P < 0.05); and decreases in mMRC dyspnea scale score (P = 0.001), CAT score (p = 0.003) and SGRQ score (P <= 0.001). Maximum inspiratory pressure and maximum expiratory pressure values and ABG parameters did not show significant change. CONCLUSION: Low intensity pulmonary rehabilitation therapy has positive effects on exercise capacity, dyspnea scale, walking distance, and quality of life. Patient compliance was high in this treatment modality so according to our study results, low intensity pulmonary rehabilitation treatment can be prefer to high intensity pulmonary rehabilitation treatment in COPD.
Differences of viral panel positive versus negative by real-time PCR in COPD exacerbated patients
(TURKISH ASSOC TUBERCULOSIS & THORAX, 2019) Yormaz, Burcu.; Fındık, Duygu.; Süerdem, Mecit.
Introduction: Exacerbations of chronic obstructive pulmonary disease (COPD) are often caused by respiratory tract infections. The aim of this study was to investigate the clinical, laboratory and computed tomography features of patients with hospitalized COPD exacerbations in which respiratory viruses were detected using a real-time polymerase chain reaction (PCR) technique. Materials and Methods: This retrospectively planned study included patients hospitalized in the chest diseases clinic due to exacerbation of COPD between November 2018-February 2019. The study included patients who had virus-specific real-time PCR, and computed tomography scans of the chest. Results: A total of 110 patients were included in the study. Respiratory viruses were identified in the nasopharyngeal swabs of 50 patients (45.5%) using the real-time PCR method, with rhinovirus (25%), influenza A (13.1%) and coronavirus (11.8%) being the most commonly isolated agents. The mean age of the patients was 68.28 +/- 9.59 years in the virus-positive group and 68.20 +/- 8.27 years in the virus-negative group (p= 0.963). Gender distribution, rate of smokers, exposure to biofuels, blood leukocyte count, neutrophil percentage, C-reactive protein (CRP) level, FEV1/FVC ratio did not significantly differ between the two groups (p> 0.05). Procalcitonin (PCT) and TEV1 values were significantly lower (p= 0.001 and p= 0.028, respectively) and the number of exacerbations was significantly higher in the virus-positive group (p= 0.001). The length of hospital stay was longer in the virus-positive group than in the virus-negative group (p= 0.012). Among the findings of computed tomography (CT) of the chest, bronchial wall thickening, cystic bronchiectasis, and emphysema did not differ significantly (p> 0.05). The rate of infiltrative lesions (tree-in-bud opacity, ground-glass opacity, atypical pneumonia) was significantly higher in the virus-positive group (p= 0.020). Conclusion: Viral respiratory tract infections should be considered in hospitalized patients with an exacerbation of COPD who have a history of frequent exacerbations, normal PCT value, and the absence of consolidation in CT scan of the chest. The use of broad-spectrum antibiotic therapy should be avoided in patients with these features.
Psychiatric morbidity and quality of life in children and adolescents with cystic fibrosis
(Turkish Journal of Pediatrics, 2018) Şenses-Dinç, Gülser.; Özçelik, Uğur; Çak, Tuna.; Doğru-Ersöz, Deniz.; Çöp, Esra.; Yalçın, Ebru.; Çengel-Kültür, Ebru.; Pekcan, Sevgi.; Kiper, Nural.; Ünal, Fatih.
The aim of this study was to investigate psychiatric disorders, depression and anxiety levels, and quality of life in children and adolescents with cystic fibrosis (CF), and to compare them with those of children with non-cystic fibrosis (non-CF) bronchiectasis and healthy controls. A total of 103 children and adolescents aged 7-16 years (35 CF, 28 non-CF bronchiectasis, 40 healthy) were evaluated using The Schedule for Affective Disorders and Schizophrenia for School Aged Children (K-SADS), The Child Depression Inventory (CDI), The State-Trait Anxiety Inventories for Children (STAI-C) and the Pediatric Quality of Life Inventory (PedsQL)-C. The three groups were not statistically different with respect to age, sex, and familial sociodemographic variables. 80% of the children and adolescents in the CF group were diagnosed with a psychiatric disorder, which was significantly more compared to those of the two other groups. The CF group had significantly greater rates of depressive and oppositional defiant disorder and the non-bronchiectasis group had a significantly greater rate of anxiety disorder than the control group. The depression and anxiety symptom levels were significantly greater and the quality of life levels significantly lower in both the CF and non-CF bronchiectasis groups than the healthy controls. In the CF group, the presence of any associated psychiatric disorder led to significantly lower total and psychosocial quality of life scores. In conclusion, CF is associated with poorer QOL in childhood. In order to improve quality of life in CF, the psychiatric conditions of children and adolescents should also be evaluated and their follow-up and treatment should involve a multidisciplinary team approach. © 2018, Turkish Journal of Pediatrics. All rights reserved.
The Reliability and Validity of Turkish Version of Childhood Asthma Control Test
(SPRINGER, 2012) Şekerel, B. E.; Soyer, O. U.; Keskin, O.; Uzuner, N.; Yazıcıoğlu, M.; Kılıç, M.; Artaç, H.; Özmen, S.; Can, D.; Zeyrek, D.; Çokuğraş, H.; Canıtez, Y.; Aydoğan, M.; Kuyucu, S.; İnal, A.; Gürkan, F.; Orhan, F.; Yılmaz, O.; Boz, A. B.; Tahan, F.; Cevit, O.
Introduction The reliability and validity of Turkish version of Childhood Asthma Control Test (C-ACT). Purpose The management of asthma is an important as well as difficult issue of physician's daily practice particularly in busy clinical settings. C-ACT was created to identify asthma control levels in children aged 4-11 years. Our aim was to evaluate the reliability, validity and responsiveness of C-ACT in a Turkish sample of children with asthma. Method In this multicenter study, 368 children were enrolled. C-ACT was completed every month by parents and patients who were evaluated in 3 visits within 2 month intervals. At each visit, physicians interpret the control level and decided for the treatment step as established in GINA guidelines. Results The internal consistency reliability of the Turkish version of C-ACT (C-ACT1 to C-ACT5) was found to be 0.82, 0.83, 0.82, 0.82 and 0.80, respectively (reliability statistics, Cronbach's alpha). Test-retest reliability was 0.71. There was significant correlation between C-ACT and physician's assessment of asthma control at visit 1 (r = 0.65, P < 0.001). Conclusions Turkish version of C-ACT is an accurate and reliable tool to evaluate asthma control in children aged 4-11 years. Its widespread use may facilitate appropriate assessment of asthma control and may lead to decrease the number of uncontrolled patients.
Weaning failure from mechanical ventilation
(AVES, 2010) Uzun K.
Mechanical ventilation (MV) is a life-supporting modality that is used in a signifi cant proportion of patients in ICUs. The discontinuation or withdrawal process from MV is an important clinical issue. It has been estimated that as much as 42% of the time that a medical patient spends on a mechanical ventilator is during the discontinuation process. About 70% to 80% of patients who require MV for respiratory failure will be extubated after a trial of spontaneous breathing once the precipitating process has been corrected. It was found that approximately 15% of patients failed an initial attempt of weaning from mechanical ventilation. Prolonged MV is associated with a host of complications (eg, infection, gastrointestinal bleeding, and deep venous thrombosis). Under these circumstances, the clinical focus should include a search for all of the possible reasons that may explain the ventilator dependency.
Efficiency of silver coated urinary catheter in catheter-associated urinary tract infection in critical care unit
(AVES, 2010) Teke T.; Yavuz Z.; Atalay H.; Maden E.; Solak Y.; Uzun K.
Aim: Urinary tract infection (UTI) is the most prevalent cause of nosocomial infections, with an incidence of 40%. The incidence of urosepsis occurs in approximately 16% of the ICU patient populations. The purpose of this study was to determine the efficacy of a silver coated urinary catheter in prevention of catheter-associated UTI. Material and Methods: We investigated 21 patients (mean age with 71.4±9.0 year and 14 M, 7 F) foley silicon urinary catheter and 20 patients (mean age with 67.6±8.7 year and 15 M, 5 F) with silver coated urinary catheter. In all patients, foley urinary catheters were changed with silver coated catheter in critical care unit. Results: The most common cause of infection was Klebsiella (33%). The susceptibility of gram negative microorganisms against antimicrobial agents were amicacin, piperacillin-tazobactam and carbapenem. The cost of antibiotic was higher in foley catheter group than silver coated group (p<0.001). Conclusion: Silver coated urinary catheter is expensive, it is cost effect according to urinary infection and antibiotic cost.
Pneumothorax as an İnitial Manifestation of Obstructive Sleep Apnea Syndrome
(Springer Heidelberg, 2010) Tülek, Baykal; Kanat, Fikret; Yosunkaya, Şebnem; Ceran, Sami; Suerdem, Mecit
Case report A sixty-five-year-old man with bullous lung disease was admitted to emergency service with chest pain and dyspnea that developed during sleep. Pneumothorax was diagnosed both clinically and radiologically. After the chest drainage, the patient presented with a prolonged air leak that required thoracotomy. Further history and occurrence of pneumothorax during sleep suggested that obstructive sleep apnea might play a role in the development of pneumothorax. Nocturnal polysomnography later confirmed the diagnosis of severe obstructive sleep apnea syndrome. Discussion We hypothesized that obstructive sleep apnea may be a risk factor for pneumothorax especially in patients with bullous lung disease, and pneumothorax may be listed in the complications of obstructive sleep apnea syndrome.
Freeman-Sheldon (Whistling Face) Syndrome With Hyperpyrexia in the Newborn: Case Report
(Medecine Et Hygiene, 2010) Altunhan, Hüseyin; Annagür, A.; Ertuğrul, S.; Pekcan, Sevgi; Örs, R.
Freeman-Sheldon (whistling face) syndrome with hyperpyrexia in the newborn: case report: Freeman-Sheldon syndrome (FSS) is a rare, multiple congenital contracture syndrome that is relatively well-known, since affected children have a striking appearance. This entity was historically referred to as the "whistling-face syndrome". Malignant hyperthermia and hyperpyrexia have been documented in FSS after general anesthesia related to the neuropathy. We report a male neonate with FSS and hyperpyrexia without anesthesia. To our knowledge, our patient is the first in the literature with hyperpyrexia in the newborn period without anesthesia.
Ankylosing Spondylitis With Mycetoma Case Treated With Oral Itraconazole
(Springer Heidelberg, 2010) Bekçi, Taha; Kelsi, Recep; Maden, Emin; Özbek, Orhan
Pleuropulmonary involvement is an uncommon event in the course of ankylosing spondylitis (AS). Apical fibrosis, interstitial infiltrates, and pleural thickening were considered to be the main patterns. However, the presence of cavity is very rare in AS. Here, we report an AS case with aspergilloma, which has been successfully treated with itraconazole.
Obstrüktif Uyku Apne Sendromlu (OUAS) Hastalarda Kardiyovasküler Hastalıklar İçin Risk Faktörü Olan C-Reaktif Protein ve Homosistein Düzeyleri
(2010) Yosunkaya, Şebnem; Özer, Faruk; Yüzbaşıoğlu, Demet
Amaç: C-reaktif protein (CRP) ve homosistein aterosklerozis ve koroner arter hastalıkları için önemli risk faktörleridir. Bu çalışmada, OUAS'lı hastalar ile vücut kitle indeksi, yaş ve cinsiyet olarak eşleştirilmiş kontrol grubu arasında, ek hastalık, ilaç kullanma ve sigara içme durumlarının etkisini de dışlayarak, CRP ve homosistein seviyelerini ve bunların ilişkili olduğu parametreleri araştırmayı amaçladık. Gereç ve yöntem: Bu çalışma Ocak 2006-Ocak 2009 tarihleri arasında, bir vaka-kontrol çalışması olarak yürütüldü. OUAS şüphesi olan, 987 erkek hastaya gece boyu polisomnografi yapıldı. Dışlama kriterleri uygulandıktan sonra 230 kişi CRP ve homosistein ölçümleri için uygun bulundu. Vakalar apne-hipopne indeksine (AHİ) göre sınıflandırıldı: 36 kontrol (AHİ5), 84 hafif-orta OUAS (30AHİ5) ve 110 ağır OUAS (AHİ30). Gruplar arasında vücut kitle indeksi açısından farklılığı ortadan kaldırmak için ağır OUAS'lı grupta 10 aşırı kilolu vaka çalışmadan çıkarıldı. Sabah 07.00-08.00 arasında venöz kan örnekleri alındı. Bulgular: Plazma CRP seviyesi her iki OUAS grubunda, kontrol grubundan anlamlı olarak daha yüksek tespit edilmiştir (p0.001). Ancak homosistein seviyeleri açısından gruplar arasında fark bulunmamıştır (p0.163). Aşamalı (step-wise) regres-yon analizi ile, serum CRP seviyelerinde artışı esas açıklayan değişkenler bel çevresi (p0.220 p0.002) ve gece 90 ile üzeri satürasyonda geçen süre (p-0.145, p0.039) olarak, serum homosistein seviyesi ise Epworth uykululuk skalası (EUS) değerleri (p0.160 p0.015) ile ilişkili bulunmuştur. Sonuç: Bu çalışmada OUAS?lı hastalarda CRP yüksekliği ile belirlenen düşük düzey bir enflamasyonun olduğu ve bunun gece 90 ile üzeri satürasyonda geçen süre ve bel çevresi ile ilişkili olduğu belirlendi. Ayrıca, OUAS homosistein artışı yaparak bir kardiyovasküler risk yaratmıyor gibi görünmektedir.
Hafif Hiperhomosisteinemi ve Heterozigot Metilentetrahidrofolat Redüktaz Mutasyonu İle İlişkili Pulmoner Tromboemboli
(2010) Tülek, Baykal; Süerdem, Mecit
Hiperhomosisteineminin arteryel tıkayıcı damar hastalıkları ve venöz tromboz için önemli bir risk faktörü olduğu bilinmektedir. Bu yazıda, metilentetrahidrofolat redüktaz (MTHFR) enziminde heterozigot 677C-T mutasyonu bulunan pulmoner tromboembolili iki hasta sunmaktayız. Hastalarda ayrıca hafif hiperhomosisteinemi de gözlendi ve serum B12, B6 ve folik asit düzeyleri normal bulundu. Hastalar sistemik antikoagülasyonla başarılı bir şekilde tedavi edildi. Tromboembolik hastalıklarda herhangi bir edinsel ve kalıtsal risk faktörünün saptanamadığı durumlarda MTHFR 677C-T mutasyonunun araştırılmasını önermekteyiz.
The Distribution of FV Leiden Gene Mutation in Patients With Obstructive Sleep Apnea
(2010) Bekçi, Taha T.; Koçak, Nadir; Özen, Filiz; Teke, Turgut
Aim. We aimed to investigate whether this polymorphism has any effects on the development of the differences in the progression of the OSAS patients. Methods. The patient group was selected from patients admitted to the our Sleep Laboratory. Total 122 subjects, 44 OSAS patients (only), 32 OSAS patients with cardio vascular diseases (CVD) and 46 controls, were enrolled in the study. The control group consisted of healthy volunteers who had no symptoms of OSAS and scored 0 on the Epworth sleepiness scale. In order to determine gene mutations, DNA isolation was performed from peripheral blood samples. Results. While mean weight and BMI were significantly different, no significant differences were found between patient and control groups in terms of FV Leiden allele distributions. Conclusion. FV Leiden mutation does not affect progression in patients with OSAS.
The Effect of Telithromycin on Inflammatory Markers in Chronic Obstructive Pulmonary Diseases
(2009) Bekçi, Taha; Kurtipek, Ercan; Kesli, Recep; Maden, Emin; Teke, Turgut
Aim: To evaluate the anti-inflammatory effect of telithromycin on sputum interleukin-8 (IL-8), tumor necrosis factor-? (TNF-?), myeloperoxidase (MPO) levels in patient with chronic obstructive pulmonary diseases (COPD). Methods: Thirty four patients with mild to moderate COPD were enrolled in this prospective, single center, double-blind, placebo controlled study. Subjects received either telithromycin or placebo for 10 days. Before and after treatment period spirometric tests, arterial blood gas analyses were performed, sputum samples were taken for measurement of sputum inflammatory markers, and sputum was induced. Results: There was no statistical difference in baseline clinical or laboratory parameters between groups. After the treatment, the induced sputum IL-8, TNF-?, MPO levels is similar compared with pretreatment levels. Conclusion: In this study, anti-inflammatory effects of telithromycin in stable COPD patients were not demonstrated. Further studies are needed to determine the clinical significance of these findings.
Pyoderma Gangrenosum Presenting with Pulmonary Cavitary Lesions
(2009) Yosunkaya, Şebnem; Toy, Hatice; Genç, Emine; Akın, Bengi; Maden, Emin; Özer, Faruk
Neutrophilic dermatoses like pyoderma gangrenosum (PG) are characterized by sterile, neutrophilic, cutaneous infiltrates. Extracutenous neutrophilic infiltrations may also be seen, but pulmonary involvement is very rare and usually characterized by patchy infiltrates or interstitial pneumonitis. In this case, a PG case who had cutenous lesions and large cavitary lung nodules, is reported. He was a 49 years old male patient whose thorax computed tomography revealed multiple pulmonary nodules with central necrosis. In his transbronchial and bronchial biopsies, nonspecific inflammatory aseptic nodules were detected corresponded to the pathologic findings of skin lesion biopsies. A dramatic response was occured after applying corticosteroid and immunesupressive treatment. In conclusion, cavitary pulmonary nodules of our case were thought to be due to pulmonary involvement of PG.
Pulmonary MR Angiography in Swyer-James Syndrome
(2009) İlerisoy Yakut, Zeynep; Sakarya, Mehmet Emin; Paksoy, Yahya; Koç, Osman; Özbek, Orhan; Süerdem, Mecit; Uzun, Kürşat; Kıvrak, Ali Sami; Ödev, Kemal
Aim: The aim of this study was to investigate the pulmonary magnetic resonance angiography (MRA) imaging findings in Swyer - James syndrome (SJS) as a alternative imaging modalities. Methods: Thirteen patients had posteroanterior inspiratory/expiratory chest X-ray films and pulmonary MRA with SJS (6 males, 7 females) were retrospectively studied. Gradient-echo pulmonary MRA was performed in all patients with a 1.5 T MR unit. MRA imaging was performed in a single breath-hold during the injection of contrast media. Image analysis of the patients was performed. The results of pulmonary artery diameters and pulmonary peripheral vasculature were compared between normal sides versus the affected sides. Statistical analysis was performed with the Student t test. Results: The smaller pulmonary artery on the affected side with poor peripheral vasculature was observed with gadolinium-enhanced gradient-echo MRA in all patients. There was a significant difference between the diameters of the pulmonary arteries of the normal versus the disease sides (p< 0.0005). Conclusion: MRA successfully depicted the small pulmonary artery with diminished peripheral vasculature in patients with SJS. This study showed the pulmonary MRA imaging could be used as a alternative imaging modalities in the evaluation of patient with SJS.
Congenital Tuberculosis in Premature Twins After in Vitro Fertilisation
(BMJ Publishing Group, 2009) Altunhan, Hüseyin; Keser, Melike; Pekcan, Sevgi; Ural, Onur; Örs, Rahmi
Genital tuberculosis is a major cause of infertility in countries where tuberculosis is endemic. With recent advances in assisted reproductive technology, women with tuberculous endometritis may become pregnant and ultimately have children with congenital tuberculosis. In vitro fertilisation represents a useful treatment for infertility. Congenital tuberculosis is a rare and severe, rapidly progressive, disease. Making an early diagnosis of congenital tuberculosis is difficult, because it can mimic many neonatal illnesses. To the best of our knowledge, we report the first cases of premature twins with congenital tuberculosis following in vitro fertilisation. After the diagnosis of genital tuberculosis in the mother, the twins were screened and diagnosed for tuberculosis. The twins dramatically improved after anti-tuberculosis therapy. We also wish to draw attention to the importance of searching for genital tuberculosis as the possible cause of congenital infection, even if the mother is asymptomatic.

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