Nekrotizan Histiositik Lenfadenit olarak da bilinen Kikuchi Fujimoto Hastalýðý (KFH) özellikle 30 yaþýndan genç kadýnlarda görülen, multipl servikal lenfadenopati ve yüksek ateþ ile seyreden, kendini sýnýrlayan ve 1-4 ayda gerileyen bir klinik tablodur. Sistemik lupus eritamatozis (SLE) ile birlikteliði sýk olarak bildirilir. Bu makalede yüksek ateþ ve öksürük þikayetleri ile tarafýmýza baþvuran ve posteroanterior akciðer grafisinde infiltrasyonlar saptanmasý üzerine pnömoni ön tanýsý ile kliniðimizde takip edilen, fizik muayenede saptanan servikal lenfadenopati biyopsisinde Kikuchi Lenfadeniti saptanan ve romatoloji kliniðince Sjögren Sendromu tanýsý konan 51 yaþýnda kadýn hasta sunulmuþtur. Hastalýðýn daha ileri yaþta saptanmasý, SLE yerine Sjögren Sendromu ve Sjögren Sendromu akciðer tutulumu ile birlikte olmasý gibi özellikli bulgular nedeniyle bu olgu sunulmaya deðer bulunmuþtur.

Kikuchi Fujimoto Disease (KFD), also known as Necrotizing Histiocytic Lymphadenitis (LAPs), is a clinical entity, which is particularly seen in young women younger than 30 years of age. The disease has a self-limited course that characterized with high fever and multiple lymphadenitis, which resolve within 1 to 4 months. The disease is reported as it is mostly seen in Systemic Lupus Erythematosus (SLE) patients. This study presented a 51-year-old female patient admitted to our clinic with symptoms of fever and cough. The physical examination revealed multiple cervical LAPs and the chest x-ray revealed multilobar infiltration. An excised biopsy of a cervical lymph node revealed the diagnosis of Kikuchi Lymphadenitis. The patient was then diagnosed with Sjögren’s Syndrome and its lung involvement with the appropriate serological markers and clinical picture. Herein, this report was presented to demonstrate that KFD may occur in older ages with Sjögren’s Syndrome and its interstitial lung instead of SLE.

Deskuamatif interstisyel pnömoni (DÝP), nadir idiyopatik interstisyel pnömonilerden biridir. DÝP, interstisyel inflamasyon ve/veya fibrozis ile iliþkili, alveolar boþluklar içinde büyük miktarlarda makrofaj birikim ile karakterizedir. DÝP, esas olarak sigara içme hikayesi olan üçüncü veya beþinci dekattaki erkekleri etkiler. DÝP, genellikle kronik ilerleyici nefes darlýðý ve öksürük ile kendini göstermektedir. Çomak parmak DÝP’de zaman zaman görülür. Kortikosteroidler tedavinin temelini oluþturur. Biz, çomak parmak þikayeti ile ileri tetkik amaçlý hastaneye baþvuran 38 yaþýnda bir erkek olguyu sunduk. Torakoskopik akciðer biyopsisi ile DÝP ile uyumlu bulgular saptandý. Sistemik kortikosteroidler ile tedavi ve sigara býraktýrýlmasý hastalýðýn iyileþmesini saðladý.

Desquamative interstitial pneumonia (DIP) is one of the rarest of the idiopathic interstitial pneumonias. It is characterized by the accumulation of macrophages in large numbers in the alveolar spaces associated with interstitial inflammation and/or fibrosis. It mainly affects men in their third or fifth decade of life who have a history of smoking. DIP usually presents with chronic, progressive dyspnea and cough. Clubbing is occasionally present in DIP. Corticosteroids are the mainstay of therapy. The current study reports the case of a 38-year-old man admitted to the hospital for further diagnosis of clubbing. The thoracoscopic lung biopsy specimens showed findings compatible with DIP. Treatment with systemic corticosteroids and smoking cessation resulted in disease improvement.

Sarkoidozda gastrointestinal sistem (GÝS) tutulumu nadirdir. GÝS’de en sýk tutulum yeri mide olup antrum tutulumu daha sýktýr. GÝS sarkoidozu pulmoner sarkoidozun bir parçasý olabileceði gibi tek baþýna da olabilir. En sýk semptomlar epigastrik aðrý ve bulantýdýr. Taný mide endoskopisi sýrasýnda alýnan mukozal biyopsilerde nonkazeifiye granülomlarýn görülmesiyle konur. Kliniðimizde daha önce sarkoidoz tanýsý konulan, ilaçsýz takip edilen ve dispeptik yakýnmalarý nedeniyle yapýlan GÝS endoskopisi sonucu taný alan, steroid tedavisine iyi yanýt veren mide sarkoidozu hastasý sunuldu.

Sarcoidosis of the gastrointestinal system (GIS) is rare. The stomach, frequently the antrum, is the primary affected organ in GIS. Gastric sarcoidosis may occur as a feature of pulmonary sarcoidosis or as an isolated case. The most common symptoms are epigastric pain and nausea. The diagnosis is dependent on the demonstration of noncaseating granulomas by endoscopic mucosal biopsies. The current study presents a patient who was followed by pulmonary sarcoidosis without therapy and was diagnosed with gastric sarcoidosis by GIS endoscopy.

Pulmoner langerhans hücreli histiositozis (PLHH) X langerhans hücreli histiositozisin alt grubu olup akciðerlerde langerhans hücre infiltrasyonunun görüldüðü nedeni bilinmeyen bir interstisiyel akciðer hastalýðýdýr. Klinik spektrumu non-prodüktif öksürük, nefes darlýðýndan spontan pnömotoraksa kadar çok geniþ olup olgularýn % 90'ýndan fazlasý sigara içicisidir. Yüksek çözünürlüklü bilgisayar tomografide (YÇBT) üst ve orta zonlarda retikülonodüler ve kistik görünümlerin olmasý karakteristiktir. PLHH nadir görülen bir hastalýktýr, genç, sigara içen ve spontan pnömotoraks nedeniyle baþvuran hastalarda akla gelmelidir. Nadir görülen bir hastalýk olmasý nedeniyle takip ettiðimiz 4 olguyu literatüre katmak amacýyla sunduk.

Pulmonary Langerhans Cell Histiocytosis (PLCH) X, which is a subgroup of Langerhans Cell Histioycytosis, is an idiopathic interstitial lung disease in which Langerhans cell infiltration is seen in the lung. PLCH X has a wide spectrum of symptoms from nonproductive cough and dyspnea to spontaneous pneumothorax, and more than 90 % patients who have these diseases are smokers. Reticular and cystic patterns were observed on the upper and middle lung lobes at high resolution computed tomography. PLCH X is a rare disease, and should be considered in patients who are younger, smokers, and patients who apply to the hospital by presenting with spontaneous pneumothorax. To contribute to the literature, four cases, which were followed, are presented, as it is a rare disease.

Burada yüksek çözünürlüklü bilgisayarlý tomografi incelemede tam ya da tama yakýn bir halkasal konsolidasyon alaný ile çevrelenmiþ buzlu cam alaný odaklarý yani ters halo iþareti þeklinde kendini gösteren ve histolojik olarak hipersensitivite pnömonisi almýþ bir olguyu sunduk. Hipersensitivite pnömonisi ve yüksek çözünürlüklü bilgisayarlý tomografide ters halo iþareti arasýndaki iliþki literaturde bu güne kadar tanýmlanmamýþtýr.

Herein is a case of histologically proven hypersensitivity pneumonia in a patient who presented initially with a focal, rounded area of ground glass opacity surrounded by a complete or nearly complete ring of consolidation known as reversed halo sign on high resolution computed tomography. To the best of our knowledge, this association has not been previously described.

Plevrapulmoner amebiyazis, amebiyazisin ender rastlanan bir komplikasyonudur. Plevrapulmoner komplikasyonlar genellikle karaciðerde amip apsesi olan hastalarda ortaya çýkar. Sað yan aðrýsý ve yüksek ateþ yakýnmasý ile baþvuran; plevral sývý etyolojisini araþtýrdýðýmýz olguda, tüp torakostomi uygulandý ve koyu kahverenginde yaklaþýk 1500 cc sývý boþaltýldý. Aspirasyon örneðinde amip trofozoidlerinin görülmesi üzerine çok nadir görülen bu olguyu literatür eþliðinde sunmayý amaçladýk.

Pleuropulmonary amebiasis is not a common complication of amebiasis. Pleuropulmonary complications usually occur in patients with amebic abscess of the liver. Tube thoracostomy was carried out and 1500 cc dark brown fluid was discharged in a patient presenting with lateral pleuritic chest pain and high fever, in which we investigated the etiology of pleural fluid accumulation. The current study presents a case in which amoebic trophozoites were seen.

Bochdalek hernisi diyaframdaki posterolateral defektten abdominal organlarýn toraks boþluðuna girmesi sonucu geliþen doðumsal bir hastalýktýr. Gebeliðin 8. haftasýnda plöroperitoneal membranýn septum transversum ile füzyonundaki bozukluk sonucu oluþtuðu düþünülmektedir. Defekt %70-90 sol taraftadýr. Olgularýn çoðunluðu doðduktan sonra solunum sýkýntýsý ile klinik bulgu verir ve eriþkin yaþa kadar semptomsuz seyir göstermesi oldukça nadir bir durumdur. Bu yazýda, yirmi yaþýnda nefes darlýðý ve göðüs aðrýsý þikâyetleriyle kliniðimize gelen ve yapýlan tetkiklerinde Bochdalek hernisi tanýsý alan hastanýn cerrahisi ve sonrasý takibinin anlatýldýðý bir olgu sunulmaktadýr.

A Bochdalek hernia is a congenital malformation characterized by a defect in the posterolateral diaphragm, in which the abdominal viscera migrate into the chest. It is thought to be the result of a fusion defect between the pleuroperitoneal fold and the septum transversum in the eighth week of gestation. Left-sided lesions account for 70-90% of the cases. The majority of these patients that present with respiratory distress after delivery, and progress asymptomatically until adulthood are extremely rare clinical entities. The current study reports a case of a 20-year-old male with a Bochdalek hernia, who presented with complaints of respiratory distress and left chest pain, and provides information about the surgical procedure and post-operative follow-up of the patient.

Akciðer kanseri dünyadaki en önemli ölüm nedenleri arasýnda yer almakta olup tedavi seçenekleri ve taný tekniklerindeki geliþmelere raðmen mortalite oranlarý halen yüksektir.
Burada,akciðer adenokarsinomu tanýsý olan 80 yaþýndaki bir erkek hastayý sunuyoruz. Hastaya sol alt lobektomi ve kemoterapi uygulandý. Tedaviden 12 ay sonra, primer akciðer adenokarsinomundan kaynaklanan, sol semitendinöz ve semimembranöz kaslarda izole bir çizgili kas metastazý saptandý. Hastaya metastazektomi ve kemoradyoterapiden oluþan tedavi kombinasyonu uygulandýktan 18 ay sonra, herhangi yeni bir metastaz bulgusu olmaksýzýn yaþamaktadýr.

Lung cancer is one of the leading causes of cancer deaths worldwide and despite advances in treatment and diagnostic techniques, the mortality rates remain high. We report here an 80-year-old male patient with lung adenocarcinoma. The patient underwent a lower left lobectomy and chemotherapy. After 12 months, an isolated skeletal muscle metastasis from a primary lung adenocarcinoma in the left semitendinosus and semimembranosus muscles was detected. The patient is alive without any signs of new metastases after 18 months from the completion of combination therapy consisting of metastasectomy and chemoradiotherapy.

Küçük hücreli dýþý akciðer kanseri (KHDAK) tüm akciðer kanserli olgularýn % 85’inden fazlasýný oluþturur. Bu olgularýn yaklaþýk üçte biri lokal ileri evre olgulardýr. Bu evredeki olgular çok heterojen bir gruptur ve bu nedenle tedavi planlamasý daha zor ve özelliklidir. Bu olgularda genel tedavi yaklaþýmý kemoradyoterapi olmakla beraber, tedavi kararý olgu bazýnda dikkatle ele alýnmalýdýr. Pemetreksed, timidilat sentazýn ve diðer folat baðýmlý enzimlerin potent inhibitörü olan sitotoksik bir ajandýr. Nonskuamoz KHDAK’de, faz III çalýþmalarla, önce ikinci daha sonra birinci basamak ve son olarak da idame tedavide etkinliði gösterilmiþtir. Bu makalede, adenokarsinom hücre tipine sahip, klinik evresi IIIA3 olarak belirlenen, multipl komorbiditeleri olan, bu nedenle tedavi planlamasý baþlangýçta ve progresyonda güçlükler taþýyan, buna karþýn taný konduktan sonra 4 yýl geçmesine raðmen halen metabolik tam yanýtta olan bir KHDAK olgusu sunulmuþtur. Tedavisi standart olmayan lokal ileri evre olgularda tedavi yaklaþýmý gözden geçirilmiþ ve ikinci basamakda pemetreksed tedavisine uzun süreli metabolik tam yanýt vurgulanmýþtýr.

Non-small cell lung cancer (NSCLC) constitutes 85% of lung cancer. One-third of these cases are locally advanced. The patients who in this stage are heterogeneous, and thus their plan of treatment is unique. Although standard treatment is combined chemoradiotherapy in these patients, the decision of treatment should be evaluated carefully for each patient. Pemetrexed is a cytotoxic agent, potent inhibitor of thymidylate synthetase and other folate-dependent enzymes. Phase III studies showed its effectiveness in the first and second line treatment of non-squamous NSCLC. In this report, a case of NSCLC with adenocarcinoma subtype who staged clinically as stage IIIA3 and had multiple co-morbidities was presented. For this reason, his initial treatment plan and treatment in progression resulted in difficulties. Nevertheless, the patient has maintained complete metabolic response after four years. The treatment approach to this group of patients was overviewed and long-term and complete response to pemetrexed in second-line treatment was emphasized.

Akciðer berrak hücreli tümörü nadir bir benign tümördür. Akciðer grafisinde pulmoner nodül saptanan 60 yaþýnda erkek hastayý burada sunduk. Akciðer bilgisayarlý tomografisi (BT)’nde sol akciðer üst lob anterior segmentte lokalize 2x2x1,5 cm çapýnda soliter nodül saptandý. Hastaya lobektomi uygulandý. Patoloji incelemesinde berrak sitoplazmalý poligonal hücreler izlendi ve tümör hücreleri HMB-45 ve NSE pozitif boyandý. Tüm vücut PET/CT incelemesinde renal hastalýða rastlanýlmadý. Bu olgu clear cell carcinoma olarak soliter pulmoner nodülün çok nadir örneðini göstermektedir. Hasta operasyondan 3 yýl sonra rekürens ya da metastaz göstermemiþtir.

Clear cell tumor of the lung is a rare benign tumor. The current study presents the case of a 60-year-old man who had an abnormal pulmonary nodule at chest x-ray. A computed tomography (CT) scan of the patient’s lung showed a 2x2x1.5 cm solitary nodule in the anterior segment of the left upper lobe. The patient underwent a lobectomy for the tumor. The pathologic examination revealed sheets of large round or polygonal cells with clear cytoplasm and immunoreactive positivity for HMB-45 and NSE. Investigation with PET/CT scan showed no evidence of renal disease. This case provides a very rare example of a solitary pulmonary nodule as clear cell carcinoma. The patient showed no evidence of recurrence or metastasis after three years postoperatively.

H1N1 enfeksiyonlarý, tüm dünyada önemli oranda mortalite ve morbiditeye neden olmaktadýr. Olgumuz 36 yaþýndaki bayan hasta taþikardi ve dispne nedeniyle acile servise baþvurmuþtur. Bilateral viral pnömoni nedeniyle serviste takip edilmiþ ve çok kýsa sürede durumu aðýrlaþtýðý için yoðun bakýma alýnmýþtýr. Boðaz sürüntüsü H1N1 ile uyumlu gelmiþtir. Yoðun antiviral ve antibiyotik tedavisine raðmen düzelmeyen hastaya yapýlan bronkoskopide yaygýn hiperemi sað alt lobdan hemoraji olduðu saptanmýþtýr. Hastaya 60 mg/gün prednizolon tedavisi baþlanmýþ, tedavinin 3. gününde ekstübe olmuþ ve genel durumu düzelmiþtir. Steroid tedavisinin alveolar hemoraji ile birliktelik gösteren viral pnömonilerde kýsa sürede düzelme saðladýðýnýn gösterilmesi amacýyla bu olgu sunulmuþtur.

H1N1 infections have high mortality and morbidity around the world. Our case is 36 years old woman, was admitted to emergency service with tachycardia and dyspnea. Then she was transferred to the chest disease clinic with bilateral pneumonia. But in a few hours she was taken to intensive care unit for close follow-up and intubation. Her nasopharyngeal swabs were found positive for H1N1. She didn’t improve despite anti-viral and antibiotics. Fiberoptic bronchoscopy was applied, diffuse hyperemia and hemorrhage from right lower lobe was seen. 60 mg/day prednisolone was started and at the third day of treatment she was extubated and her vital signs became better. This case shows that steroid therapy makes rapid improvement at H1N1 pneumonia patients with alveolar hemorrhage.

Plevral effüzyon sýk görülen önemli bir problem olarak karþýmýza çýkmaktadýr. Eksuda ayrýmý klinisyenler için sorun oluþturmakta ve bazý hastalarda ileri incelemelere raðmen %5-25 oranýnda taný konulamamaktadýr. Ailesel Akdeniz ateþi (AAA) tekrarlayan ateþ ve sistemik bulgularla karakterize, genellikle etnik gruplarda görülen otozomal resesif geçiþ gösteren otoinflamatuar genetik orjinli gösteren bir hastalýktýr. Pulmoner hemoraji, infarkt ve infiltrasyon FMF’in önemli pulmoner komplikasyonlardadýr. Ýlk AAA ataðýnýn tek baþýna plörezi olarak ortaya çýkma oraný < %10'dur. Bu yazýda tekrarlayan plevral effüzyonla baþvuran ve izole pulmoner tutulumu olan 70 yaþýnda FMF tanýsý konulan bir olgu sunulmuþtur.

Pleural effusion is a common condition and considered as an important clinical problem. The exudates remain a challenge for clinicians and 5-25% of the patients remain undiagnosed despite thorough investigations. Familial Mediterranean Fever (FMF) is an auto-inflammatory disorder with genetic origin showing an autosomal recessive inheritance pattern generally seen in certain ethnic groups characterized by recurrent fever and systemic findings. Exudative pleuritis has been reported as the solitary manifestation of the first FMF attack, in < 10% of patients. This case study describes a 70-year-old man with recurrent episodes of exudative pleuritis associated with pleuritic pain. After treatment with colchicine, 1.5 mg/d eliminated FMF attacks.

Otuziki yaþýnda erkek hasta 15 gündür devam eden sol plöretik aðrý ve terleme yakýnmalarý ile kliniðimize baþvurdu. Göðüs grafisi solda plörezi saptandý. Plevral sývý eksuda özelliðindeydi. Videotorakoskopik incelemede sol kostodiafragmatik sulkusta 4x1.5 cm boyutunda sarýmsý renkte lezyon saptandý. Kitle plevradan total olarak çýkartýldý. Patolojik taný plevrada hidatik kist idi.

A 32-year-old man was admitted to our clinic with complaints of left pleuritic pain and sweating persisting for 15 days. The chest x-ray revealed left pleural effusion. Pleural fluid was exudate. During videothoracoscopic exploration, a pleural, yellowish 4 x 1.5 cm mass lesion was observed around the left costodiaphragmatic sulcus. The mass was totally removed from the pleura. Pathologic diagnosis of the lesion was a hydatid cyst in the pleura.

Prolifere trikilemmal tümör saç folikülünün dýþ tabakasýndan kaynaklanan, %90’ý saçlý deride, çoðunlukla ileri yaþtaki kadýnlarda olan nadir bir cilt lezyonudur. Bu lezyonlar benign olmasýna raðmen malign karakterde olabildiði gibi nadiren lokal rekürrensleri ve metastazlarý olabilir. Üç yýl önce frontal bölgeden komplet malign trikilemmal tümör eksizyonu yapýlan 62 yaþýnda bayan hastadaki plevra metastazý olgusu nadir olduðundan dolayý literatür bilgileri eþliðinde sunuldu.

Proliferating trichilemmal tumor arises from the outer layer of the hair follicle and 90% of lesions originate from scalp. They are usually rare skin lesions in elderly women. Although these lesions are benign, local recurrences and metastases are rare, as malignancy may be possible. Three years ago, the complete excision of malignant trichilemmal tumors from the frontal region tumor with malignant pleural metastasis was reported in the case of 62-year-old female patient that presented with a review of the literature due to its rarity.

Obstrüktif uyku apne sendromu uyku sýrasýnda tekrarlayan üst solunum yolu obstrüksiyonu epizotlarý ile karekterize bir sendromdur. Uykuda üst solunum yolu açýklýðý inspiryum esnasýnda faringeal lümen içinde oluþan negatif basýncýn kollabe edici etkisi ile üst solunum yolunu açýk tutmaya çalýþan güçlerin dengesine baðlýdýr. Obstrüktif uyku apne sendromunun öksürük semptomu ile birlikte görülmesi nadir rastlanan bir durumdur. Bu iki tablonun bir arada bulunmasý ise hem uykuda, hem uyanýklýkta solunum sýkýntýsýnýn daha fazla hissedilmesine neden olmaktadýr. Tedavi edilemeyen kronik öksürük vakalarýnda obstruktif uyku apne sendromu düþünülmelidir. Bu çalýþmada uygun tedaviye raðmen klinik düzelme saðlanamayan ve polisomnografide rem iliþkili obstrüktif uyku apnesi saptanan bir kronik öksürük olgusu sunulmaktadýr.

Obstructive Sleep Apnea Syndrome is characterized by recurrent upper respiratory tract obstruction episodes during sleep. The aperture of the upper respiratory tract during sleep depends on the equilibrium between the collapsing effect of the negative pressure that occurs within the pharyngeal lumen during inspiration, and the powers that maintain the aperture of the upper respiratory tract. Obstructive sleep apnea syndrome with chronic cough is a rare situation. These two symptoms together make the patient feel more dyspneic both in sleep and awake states. In cases of incurable cough, obstructive sleep apnea syndrome should be considered. The current study presents a case of chronic cough, which was not cured despite appropriate treatment and displayed REM-induced sleep apnea in polysomnography.

ÖZET YOK (Editöre Mektup olduðu için)

No Abstract.